Scent of Evil

11

Harry had explained to me that Dr. Franklin called an available operating room “a miracle” because they were usually heavily booked and, at three, grand total, in short supply. Number two was open because electricians had been replacing the fluorescent tubes in the ceiling, a mundane fact that explained the dramatic scene that greeted me as I walked through the room’s swinging door.

Operating rooms routinely share three attributes: they are clean, they are more or less filled with exotic and arcane machinery, depending on the budget of the hospital, and they are as bright as the Sahara at noon. The one I entered had the equipment, but that was it.

Milly had been shifted from the rolling bed to the operating table in the center of the room. He was naked, huge, pale, and blood-streaked, his dirty white body glowing with the reflected brilliance of a trio of tripod-mounted flood lamps. But where the rest of the room would have been lit normally by overhead fluorescents, this one was dark, its distant corners almost indistinguishable to my eyes, as yet unaccustomed to the gloom. On first impression, it seemed Milly, dazzlingly suspended, was floating in dark space, asleep and utterly passive, attended to by a flurry of some eight green-clad satellites, all laying out instruments, hooking up equipment, and generally preparing for the doctor’s arrival. He looked so out of place, his soft, spongy flesh overflowing the narrow table, one arm dangling off to one side, punctured by an IV line attached to a blood bag hooked to a nearby stand. His head was extended back, his torn mouth open and filled with a thick tube hooked to the oxygen equipment and an ambu bag, still being rhythmically squeezed by a technician. I noticed how shockingly yellow his gnarled toenails looked in contrast to his almost bloodless skin.

A far door banged open with a brief flash of light and Franklin stormed in, mask already in place, trailed by a smaller, thinner man, also in scrub greens. Franklin went straight to the tray on which the surgical tools were being laid out, and without waiting for sterility-insuring assistance, ripped open a package of latex gloves and snapped them onto his still-damp hands, muttering to the smaller man, “Don’t wait for a nurse. They’re busy and there’s no time.” His former jaunty tone had been cooled by concentration.

He grabbed a scalpel from the tray and positioned himself to Milly’s left side, the nurses and technicians still moving about, some of them with their gowns still untied in the back, one of them beginning to drape the body with large, dark-green squares of cloth.

Franklin waved her away. “Later. I want to go in now. Vitals?” he asked the woman at the head of the patient.

She nodded. “Systolic seventy, pulse fifty. Things are slowing down again.”

“Okay, Mr. Crawford, time to see if we can help you out a little.” Franklin placed the point of the blade on Milly’s sternum, just above his nipple line, and in one smooth, almost theatrical movement, sliced a deep incision from the front of the chest, across the left rib cage, and all the way to where the back met the table top, about eighteen inches long.

“Finochetto,” he barked.

A glistening steel apparatus with a crank on one end appeared from the surrounding gloom. Franklin’s surgical assistant fit the device between two of Milly’s ribs and began to turn the crank. There was a sound of wet tearing, a few sharp snaps, and finally several loud cracks as the ribs, one by one, were pried apart.

I had moved through the shadows to where I was now standing behind the two surgeons, and as the ribs yielded to the spreader, I saw a sudden frothing of pink bubbles from the lung beneath the ribs, followed by a brief, explosive cascade of blood that poured from the wound and splashed off the table, soaking both men’s pants and covering the floor. A nurse threw down a thick green sheet that both men trampled beneath their feet, absorbing some of the blood and reducing the risk of slipping.

Milly’s left lung, suddenly unrestrained, expanded a good six inches from the huge hole in his chest. It was streaked with blood, somewhat pink, but heavily marked with dull gray stripes and clusters of black spots. “Look at that-heavy smoker. As if your diet wasn’t enough to kill you,” Franklin muttered. “Give me a lap pad. Vitals?”

“Systolic fifty, pulse thirty. Almost off the charts.”

“Come on, fella, don’t crap out on me now. Keep that suction coming.” Franklin squeezed the lung, now held in the lap pad, and followed it as it deflated up into the chest cavity, his entire hand and half his forearm disappearing from view as he bent over and shoved the lung up and out of the way for a clear view of the heart’s left side, snipping away at thin connecting tissue with his other hand as he went.

“Move the light so I can see inside.” Franklin paused and spoke to his assistant over his shoulder: “Walt, I want you to move to my other side and hold this lung out of the way.”

Walt quickly accommodated this request, allowing me a brief unimpeded view of the wound and what it revealed. Milly’s chest was now totally empty, easily hollow enough to fit two footballs. Its bottom was like a water-filled grotto, the water being thick, dark-red blood, and was constantly being drained by two large-bore suction catheters hooked to a sizable transparent jug, now about half full. At the back of the grotto, high up against its far wall, a fat, bulging swelling-a sack of red flesh-was straining against its contents, some of which was dribbling down the wall to the pool below.

“Systolic forty, Doctor. He’s almost gone.”

“Not yet, he’s not. Walt, push it further up, but watch out for the major vessels.” Franklin took up his scalpel again, reached in, and sliced the bulging sack on the far wall.

“Suction here.”

More dark blood poured out as from a burst water balloon, along with several small clots. The suction tube made a sound like some obnoxious child overworking his straw at the end of a satisfying ice-cream soda.

“Blood pressure rising.”

“All right, nice goin’, Mr. Crawford,” Franklin muttered to himself. “Get some more light in here.”

Both Franklin and Walt now had their hands in the chest, and yet there was still enough room for me to see the heart itself, visible through the opened pericardial sac, rhythmically squirming like a fist in a pink mitten, closing and opening, closing and opening. With each contraction, a small spurt of blood arched out into the grotto.

Franklin was speaking to Walt, both of them with their heads almost inside the chest. “All right, can you see it? A hole in the ventricular wall… right there. It just missed the L.A.D. coronary artery. See? It’s a little hard with all this fat. Just follow the spurts.”

He stuck a red hand out at the nurse next to him. “Four-oh cardiovascular and a big needle, single-ended.”

Equipped with his sewing kit, he reached back into the cavity, made a couple of quick sutures, and stopped the bleeding. “Okay, the hole’s been placated; how’s he doin’?”

The technician at the head answered. “Systolic ninety-five, pulse sixty. Nice job, Doctor.”

Franklin withdrew both his hands and straightened. “Nice job, Mr. Crawford. With any luck, maybe you can go back home and die of a heart attack, like you deserve.”

One of the nurses laughed. The tension eased measurably. I could sense not victory-the chest was still wide open, after all-but certainly a growing optimism. If death had not yet blinked, it was beginning to yield.

“All right, let’s heat up some saline and clean up a little here. You people have really let things go to the dogs.”

This drew a couple of more timid laughs, and the team shifted into gear. The grotto, now deprived of its primary liquid source, was suctioned almost dry, more blood bags were hung and fed into the IV tubing, crimson-soaked pads were removed from the cavity and hung out for later counting and collection, and Franklin’s requested hot saline, warmed to just above body temperature in a nearby microwave oven, was applied to swab Milly’s interior.

Walt was still in place, bent over holding the lung out of the way. My back hurt just looking at him. “Dr. Franklin, where’s the bullet then?”

There was a skipped beat in the room. No one had forgotten the bullet, but with the flush of success, it had slipped to second billing. That changed with Walt’s question.

Franklin looked over to one of the nurses. “Let’s do a portable film.”

She left the room, returning soon with another technician in tow, both of them lugging a large X-ray machine on wheels, whose odd, birdlike shape was made even more alarming by its appearing from the peripheral gloom. Everyone pitched in to gingerly hoist Milly up high enough so a film plate could be slid underneath him; the exposure was made, and the technician and his machine exited.

The results were delivered a few minutes later, and Franklin held the film up to one of the floodlights so Walt could see it from his stooped position.

“There it is, lodged against the spine. That’ll probably take care of his walking days.”

“What did it go through to get there?” Walt asked in a soft voice.

Franklin used his scalpel as a pointer, trying to trace the course of the bullet, muttering anatomical landmarks as he went. He finally paused, let a few seconds of silence pass, and then muttered, “damn.”

“What?” The nurse’s voice was nervous, not wanting to hear that victory might still elude them.

“It looks like the bullet passed through the back wall of the left atrium.”

Dead silence greeted this piece of news.

“Vitals are improving,” the woman with the ambu bag said hopefully.

“That’s because we’re still feeding him blood. There’s a hole there, I’m afraid. Let’s just cross our fingers it’s a simple in-and-out. We might pull this off yet, people. Come on, hope springs eternal.”

The tension I’d noticed easing earlier returned with force. The room was so still the quietest mutterings between both surgeons were easily overheard.

Franklin was back with both his hands inside the chest. “Okay, it’s going to be tight back here. We got pulmonary veins, the artery, and the bronchus to contend with, all jammed in together. Maybe the bullet whacked the bunch of them, and their being so tight together has stopped a major bleed, or maybe the exit is just beyond by a hair and we’re sitting pretty. Here, hold this clear while I rotate the heart. Little more… Ah, there we go. We’ve got some arterial blood here. Little more… Hold it there… Oh, shit.”

There was a sudden whooshing sound, followed by a cascading of liquid. Bright-scarlet blood, as if poured from a garden hose, abruptly filled the chest to overflowing and splashed noisily onto the already soaking floor.

“Lap pad, now.” Franklin shoved the pad deep into the chest and looked without speaking at the oxygen therapist.

“BP falling, pulse falling.”

Franklin was now talking to himself. “Looked like the whole back of the atrial wall gave away. Crawford, you bastard, if you’d taken better care of yourself, you might have had a stronger heart. What the fuck do you expect me to do, goddamn it?” He kept looking into the chest. “Keep up the suction and hang more blood.”

“Twenty beats per minute,” the woman’s voice intoned, in the quiet, gloomy room to her motionless audience. Her gradual countdown took five minutes, during which not another voice was heard. “Ten… Two… There’s been one in the last two minutes.” And finally: “No cardiac activity.”

In the stillness greeting this statement, Franklin straightened for the last time. He peeled off his gloves and dropped them on Milly’s stomach, pulled off his hat and mask, and, walking away into the dark, let them both fall to the floor as he vanished stoop-shouldered through the door.

There were a few half mutterings as people followed his example, some to go back to tend to the living, others to get the necessary equipment to clean up the mess.

In less than a minute, I was alone with Milly Crawford, as I had been when I’d first found him in his apartment. His eyes were half open, staring unblinking into the hot, bright lamps. The fat tube protruded from his mouth, silent and without purpose. His body, where it wasn’t covered by the stained green sheets, was as white as marble and would soon be as cold.

“You know who did it?” Harry stepped out from the surrounding darkness, his eyes sad and his voice gentle.

“I was hoping to ask him.”

“I’m sorry.”

I shifted my gaze back to Milly. “So am I.”