Thirteen Days

By Wesley Harden III

Chet was a difficult man to like but he was an easy man to love. 

• Language: English
• Publisher: Wesley Harden III
• Release date: Dec 23, 2019
• ISBN: 9780988880634

Wesley Harden III

Wesley Harden III is a retired surgeon living in Northern Virginia with his wife, Debbie, and their two dogs, Milo and Odie.

Book preview

Chapter One    Day One: The Operation

Get in here if you want to rearrange the living room. This god-damned furniture isn’t going to move itself. It was his second beer and still only ten a.m. 

Mary was putting breakfast dishes away. I’ll be there in a minute. What’s your hurry? Chet returned to his easy chair and felt a sudden, fleeting pain in his chest.

Chet shrugged it off as he always did when confronted by an unpleasantry in his life. Muscles, he thought. It will pass. He tried to convince himself it was from all the leaf-raking the day before. So, he sipped his beer and lit another cigarette. At the end of the second drag, the pain became unendurable pushing through to his back, taking his breath away. It felt like something was ripping inside of him. 

He tried to stand, but his feet would not hold him. He fell to the carpet.

Mary, in the kitchen defiantly putting a K-cup in the machine, heard the thump but disregarded it as just Chet impulsively rearranging the furniture himself. 

After waiting patiently for her coffee to brew, she decided it might be prudent to see if Chet needed a hand with the bigger pieces. 

Chet was on the carpet, lying on his side, curled into the fetal position, his face contorted as if he was trying to speak. 

Chet! Dear God! She knelt beside him and touched his head as if to check for a fever. She rolled him onto his back and lifted his head. As she rolled him, his eyes moved to keep her in sight. He winced. Perhaps, she thought, he was more comfortable on his side and she rolled him back over. It didn’t seem to make a difference.

Chet! Chet!

He looked up at her blankly. He was trembling, growing increasingly pale. She reached into her pocket, retrieved her cell phone and dialed 911.

She tried to comfort her husband but there was little she could do. She knew how to console an injured child. A brush-burn on the knee, a boo-boo on the forehead. But nothing like this.

Anybody who looked this tortured by pain, she knew, was surely dying.

The paramedics worked quickly to stabilize the man on the floor. They checked his vital signs. They placed him on high flow oxygen. In hushed tones and in a code only they understood, they discussed intubating his airway, but his breathing was not labored, and he seemed aware. They knew that whatever was wrong with their patient was going to kill him soon. 

She read their concern. The tall one stood and ran to the front door to retrieve the gurney. When he returned, they placed him gently onto it and strapped him in, careful not to dislodge the green oxygen mask from his face or cause too much discomfort. 

Mary noticed the little plastic bag at the end of the mask made shallow, cyclic inflations and deflations. Then it appeared to stop.

C’mon, Chet, hang in there buddy, the tall one said.

Braintree Memorial, this is Medic Twelve. Picking up sixty-nine-year-old white male with chest pain. Blood pressure one hundred over eighty-eight on the right, less on the left. Pulse one hundred-ten and thready. Oxygen sat ninety on four liters rebreather.

Okay. Twelve. Move quickly. No TPA.

Roger.

Mary understood virtually none of it. 

The short one turned to her. Mrs. Pettigrew, we have to move quickly. Do you want to ride with us?

She thought quickly. No, I must bring my son. She turned toward the entrance to the hall. She saw Benny standing there with the same blank countenance he had for twenty years. I’ll be along directly. 

She followed them out. She took Chet’s hand and squeezed it tightly. They exchanged glances. As the paramedics closed the back door of the ambulance, she thought this would be the last time she would see her husband alive. 

Mary hastened back to the house to put on more presentable clothes and took Benny to his room and dressed him as well. She figured she was only about five minutes behind the ambulance.

When she arrived, there was a helicopter spooling up on the pad behind the emergency entrance. The high whine of the machine drew Benny’s attention. The electric doors opened with a hiss and she led Benny into the ER. She bypassed the receptionist and went right to the first nurse she could find.

My name is Mary Pettigrew; they just brought my husband in. Chet.

Oh, yes, Mrs. Pettigrew, the doctors are evaluating him now. They have determined he needs to be transferred to University Hospital for further evaluation.

What’s wrong with him?

I’ll let you speak with the doctor but he is quite ill, and the University Hospital is more equipped to handle this kind of emergency.

"What kind of emergency?"

Mrs. Pettigrew, I’ll let you speak with the doctor. She glanced at Benny. Perhaps you should have a seat in the waiting room and Dr. Quintana will be right out. She turned and left.

With a combination of fear, isolation and anger, she took Benny to the waiting room and sat down. She found the talking heads on CNN irritating as they sat behind their desk laughing about something trivial. She could not hear as the volume was turned down, but she didn’t care if she could. Her only thought was of Chet. She squeezed Benny’s limp hand and waited. She was convinced Chet was gone while they were probably lounging in the breakroom discussing a clever way to tell her that.

A few moments later, a mother and her kid sat down in the waiting room. The kid had the sniffles and kept snorting up tallow-green, liquid snot. The mother looked fine. On the other side of the ER her husband lay dying and this little kid had a cold. She wanted to tell her to take the little bastard home and deal; there were more serious things going on here.

Mrs. Pettigrew, I’m Doctor Quintana. I’ve been looking after your husband. He glanced over at the snotty kid and extended his hand to Mary. Perhaps we can discuss this someplace else. Please tell me. Is Chet still alive?

Yes. 

She followed him, her hand still clutching Benny’s, to a small conference room.

Mrs. Pettigrew, your husband has a very serious condition. We believe he has what’s called a dissecting aneurysm of his aorta. It’s the big artery coming out of the heart. It is a very critical condition and beyond our capacity to treat here at Braintree. He has been stabilized sufficiently to be transferred to University Hospital in Boston where they have experts who can handle this condition.

Is he going to make it?

I can’t answer that. But time is critical, and we are taking him to the helicopter for transfer. Can I see him?

Quintana was slightly surprised she did not say ‘we.’

I’m sorry, he’s been loaded onto the helicopter now and they are leaving. He’s dying. I should have had the chance to see him before you took him away.

Yes, I’m sorry. But, as I said, time is of the essence. The ward clerk will give you a detailed map and instructions on how to get to University Hospital. He stood. I wish you all the best.

He glanced at Benny again and left.

She studied the instructions. Understanding most people had some sort of driving software on their phone, she threw the anachronistic instructions onto the floor after buckling Benny into the passenger’s seat. It was Saturday morning. She figured it would take forty-five minutes to reach the hospital.

She knew in her heart he was already dead and all they would need from her were the funeral arrangements.

The team was pulled together quickly. Atticus Reynolds, the Director of the University Hospital’s cardiac surgery program, was just dressing after his second case when he got the stat page from the Cath Lab. His first inclination registered at some more primitive level of his brain told him to ignore it. He had completed a busy Saturday morning doing cases left over from Friday’s Cath schedule. He wanted to go to the office, finish some departmental paperwork, go home and leave whatever problem the catheter jockeys had gotten themselves into for the guy on call. Reynolds, he said

Atticus, this is Dawson.  I have a sixty-nine-year-old male with a Type A dissection on the table here.

Son of a bitch! 

I’ll alert the OR and be right down.

Good. I’ll get him ready. This guy’s got one shot. 

Reynolds changed into a fresh pair of baby-blue scrubs, pulled on his white coat and headed for the cardiothoracic recovery room. He paused at the end of his most recent post-op, looked at the monitor, felt the pulse in the man’s foot and walked on. 

Arnie Sedgewick, one of the cardiac anesthesiologists sitting at the Nurse’s Station, said he heard there was a dissection in the wings and he would get ready. Atticus merely nodded.

Reynolds went to the catheterization suite and found Hancock in the dark room viewing the digital images he had just taken of Chet’s heart and chest vessels.

Oh good, you’re here, Dawson Hancock, the interventional cardiologist, said. This guy’s in trouble. His coronaries are fine, but he dissected from just above the root all the way to the renals.

Atticus stared at the images as Hancock played the video back and forth showing the flailing interior part of the vessel. 

There’s perfusion into the carotids but he’s sheared off his spinal artery.

I’m not so sure about the carotids.

You’ll soon find out.

I guess we will won’t we. Thanks, Daws.

With the images set in his mind, Atticus formulated his approach. They had to move quickly if they there was any chance to save the man. Chet had been taken to the pre-op holding area, intubated and sedated by Sedgewick. Lines were being placed by the anesthesia resident and the cardiac surgery fellow sat at the computer entering data. He had very little to go on from the transferring hospital, as there were no relatives present from which to obtain a history. He was told the wife and son were on the way but there could be no delay. They could not wait for formal introductions and explanations. There simply was no time.

Ordinarily, the Cardiothorcic Fellow would make the long incision, open the chest, splitting the breastbone with a compressed-air-driven saw and have the patient on bypass before Atticus arrived. Not this time. One false move and the aorta would explode as if it contained a stick of dynamite.  Atticus opened the chest himself while the fellow dug out the artery in the groin for heart-lung bypass.

In a well-practiced ballet where few words were required, the nurse placed the scalpel onto Atticus’ outstretched hand.

Let’s see what he brought to the party, Atticus said as he made the cut.

With the breast-bone split, he opened the sac around the heart. Dark blood sloshed around inside the heart sac, a sign of impending doom had they not arrived in the nick of time. The tense, distended, reddish-purple aorta emerged dominantly from the heart, like a large tube of meat hanging in a butcher’s window. The outer layer was thin and fragile as wet tissue paper. Sometimes, the wizards of the Cath Lab could repair these with catheters, balloons and stents but this one was beyond their technical reach. The blood in the sac was a clear indication the aneurysm would blow open into the sac and instantly kill him. 

Atticus took a suture and placed it into the floppy right auricle, snipped quickly and directed the large