Chapter 6 - Defiance and the Scalpel
Jo was out of her chair before Daniel could even hang up the receiver.
The weariness, the regret, the hesitation—all of it burned away instantly. When an alarm sounded, Johanna Merrick did not think; she moved.
They hit the stairs at a sprint, taking the concrete steps three at a time. By the time they burst through the double doors of the Pediatric Intensive Care Unit on the second floor, the hallway was already an orchestra of blaring alarms.
Inside Room 214, the blue crash cart was parked against the wall.
Dr. Chen was leaning over Owen, her hands covered in blood as she adjusted a pressure-infuser bag of saline. The collection canister at the foot of Owen’s bed—which had contained two hundred milliliters of old, dark fluid when they left the trauma bay—was now half-full of foaming, bright-scarlet arterial blood.
*Heart rate: 162. Blood pressure: 54/30. SpO2: 86%.*
Ethan was pressed into the far corner of the room, curling into a tight ball against the medical supply cabinet, his hands clamped over his ears in a instinctive, futile attempt to block out the flashing red light on the monitor.
“What happened?” Jo demanded, grabbing a yellow sterile gown from the wall dispenser and snapping it on.
“The chest tube decompression relieved the pleural pressure,” Chen said, her voice shaking slightly with adrenaline. “When the lung expanded, it dislodged an internal hematoma from a fractured third rib. The jagged bone edge sheared the internal mammary artery. He’s bleeding out directly into his chest cavity. He’s lost three hundred cc’s in five minutes!”
“Where is the on-call pediatric cardiothoracic surgeon?” Daniel roared.
“Dr. Roberts is forty-five minutes out!” Apprentice cried from the side of the bed, desperately trying to start a second large-bore IV line in Owen’s right arm. “He was at a conference in North Island! He’s stuck on the bridge!”
“He doesn't have forty-five minutes,” Jo said, her hands already flying over the vascular cut-down tray. “He has eight minutes before he goes into asystole from hypovolemic arrest.”
Just then, the door swung open again.
Captain Aldrich marched into the room, flanked by two senior administrative supervisors.
“I heard the code!” Aldrich snapped. “Chen, clamp that chest tube and prep him for immediate ground transport to Rady Children’s Hospital downtown!”
Chen looked at Aldrich like he had lost his mind. “Rady Children’s is twenty-five minutes through downtown traffic, Captain! He will bleed to death in the ambulance before we cross the bay!”
“We do not have a pediatric cardiothoracic surgeon on site!” Aldrich yelled back. “If this child dies on the table in an adult military facility during an uncredentialed open thoracotomy, the liability falls entirely on this hospital! I will not authorize an open-chest procedure without an attending surgeon scrubbed!”
“He is bleeding from the internal mammary!” Jo stepped between Aldrich and the bed. “All we need to do is an anterolateral thoracotomy, identify the bleeder, and throw a figure-eight suture around the vessel! Chen can do it, and I can assist!”
“No!” Aldrich snarled. “I am the Chief Medical Officer, and I forbid it! Put him in the transport unit!”
“You cowardly son of a bitch,” Daniel whispered.
Daniel didn't shout. He turned to the two men who had accompanied him earlier—his SEAL master chiefs who had waited in the PICU hallway.
“Master Chief Miller,” Daniel said.
“Sir,” the thick-shouldered operator responded, stepping into the doorway.
“Bar this door,” Daniel ordered. “Do not let Captain Aldrich, security, or anyone else into this room who is not carrying blood products. If anyone attempts to interfere with the medical team treating my son, consider it a direct hostile breach of a secure command element and neutralize them.”
Aldrich’s eyes bugged out. “Brandt! This is mutiny! You cannot use armed SEALs to seize an operating bay!”
“Watch me,” Daniel said.
Miller and the other operator stepped inside, grabbed Aldrich by his lab coat lapels, and smoothly, professionally dragged him backward into the corridor. The heavy wood-and-glass door clicked shut, and the distinct sound of a magnetic lock engaged.
Outside, Aldrich pounded on the glass, screaming silently, but Master Chief Miller simply stood in front of the window, his six-foot-two frame completely blocking the view.
Inside Room 214, the air was electric.
“Chen,” Jo said, her eyes burning like white phosphorus. “You took the pediatric fellowship at Johns Hopkins. You’ve cracked chests in trauma rotation.”
Chen swallowed. Her hands were shaking, but she looked down at Owen’s graying face. “Only on animal models and twice as second-assist on adults.”
“I’ve done sixteen on teenagers in the field,” Jo said, stepping beside her. “You hold the retractor and clear the field. I’ll guide your hand to the mammary artery. We clamp, we tie, we save him. Together.”
Chen looked at Jo. The resident doctor, Apprentice, stepped up behind them. “I’ll bag him,” Apprentice said, his voice finally finding steel. “I’ll keep his airway open. Do it.”
Chen drew a breath. “Scalpel. Ten blade. Rib spreader.”
“Right here,” Jo said, handing her the cold steel.
Daniel Brandt stepped back to the corner where Ethan was hiding.
He dropped to his knees in front of his surviving twin. Daniel didn't look away from his son’s face. He knew his signing was terrible. He knew his hands were clumsy. But he lifted them anyway.
Daniel signed:
**I am here.**
**Do not look at the blood.**
**Look at me.**
May you like
Ethan stared at his father’s trembling, scarred hands. Then, the little boy lunged forward, wrapping his arms around his father’s neck, burying his head into Daniel’s camouflage collar. Daniel held him with everything he had, his tears finally breaking free, falling onto the boy’s navy-blue hoodie, while behind them, the battle for Owen’s life began.
***
