Chapter 10 - THE ETHICAL STAND
The electric sternal saw screamed to life with a high-pitched whine,
cutting swiftly through the dense bone of Richard’s chest.
Fine bone dust drifted upward,
instantly cleared away by the localized smoke evacuator.
As the sternum parted cleanly down the center,
the underlying anterior mediastinum came into view.
A tense murmur rippled through the surgical team as everyone caught their first glimpse of the pathological monster inside.
The ascending aorta was swollen to nearly triple its normal diameter,
mottled with dark purple bruising and ominous fluid blisters.
It looked less like a blood vessel and more like a ticking time bomb wrapped in translucent parchment.
I placed a surgical retractor into the sternal edges,
cranking it open slowly to expose the beating heart and aortic root.
The pericardial sac was bulging under immense internal pressure from leaking arterial blood pooling in the pericardial space.
If cardiac tamponade set in fully before we established bypass,
the heart would arrest instantly.
I signaled the perfusionist to prep the right femoral artery and vein for immediate cannulation.
Suddenly,
the intercom buzzer on the wall panel chimed shrilly,
breaking the intense concentration of the room.
An anxious voice from the scrub nurse station announced that Preston Sterling was demanding entry via the sub-corridor intercom.
I did not even look up from the operative field,
keeping my eyes locked on the swollen,
pulsing aorta.
I instructed the circulating nurse to cut the intercom connection immediately and lock all sub-corridor access doors permanently.
The nurse complied instantly,
silencing the frantic voice of the man who thought his bloodline gave him dominion over life and death.
I turned my full attention back to the delicate anatomy before me,
directing the surgical assistant to secure the aortic cannulation purse-string sutures.
Every movement of my fingers was calculated,
deliberate,
and executed with absolute emotional detachment.
I was no longer Althia Vance,
the betrayed fiancée nursing a broken heart in a Parisian hotel room.
I was the supreme commander of this operating theater,
wielding the ultimate authority over life and death.
The cannula was inserted into the femoral artery and advanced smoothly under transesophageal guidance.
I connected the arterial and venous lines,
giving the crisp command to initiate full cardiopulmonary bypass.
The heart-lung machine hummed to life,
taking over the sacred duty of oxygenating and circulating Richard’s blood.
Slowly,
the grossly distended aorta began to decompress as venous return was diverted into the massive machine.
The immediate threat of rupture subsided,
buying us the precious time needed to perform the complex reconstruction.
Sweat beaded on my forehead beneath my surgical cap,
instantly dabbed away by the attentive scrub nurse.
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We were safely on bypass,
but the hardest part of the operation was only just beginning.
