Chapter 42 Summary
Prayer does not help. With two months left in Marion’s year of internship, Our Lady’s residency program is put on probation. There will be a final appeal, so until they are shut down the staff can only keep working.
One Friday night an ambulance drives up and the crew rushes in with a rolling stretcher. Marion hears the story as he walks with them. This young Black boy, about twenty, ran a red light because he was in a gang-related gunfight. Someone got shot in the head and is on his way here as well. This boy on the stretcher is the shooter. He was broadsided by a van, flew out of his vehicle (he was not wearing a seat belt), and got hit again by his own car as it spun around in the crash.
Although he is unconscious, the boy’s skull is intact. His pulse is thready and racing under Marion’s fingers. His blood pressure is dropping and his belly is swelling. Marion takes him immediately to the operating room and the surgical team prepares for an effulgence of blood once the incision is made. Even knowing what is coming, they are unprepared for the amount of blood that escapes the cut and pours over everything. Deepak enters the room and Marion steps aside, but the Chief Resident tells him to stay where he is.
As they work, Marion senses the source of the bleeding is somewhere behind the liver, and he is correct. However, the boy has lost too much blood, what blood he does have is no longer clotting, and his temperature is dropping. They do what they can to close the boy up and send him to the Intensive Care Unit in the hopes that he will be more stable in a few hours so they can finish the surgery. In the meantime, transplant teams are on their way to harvest organs and body parts from the man he shot.
His name is Shane Johnson, Jr., and his family is gathered in the waiting room. In the Intensive Care Unit two hours after they began surgery, Shane is alive—barely. In surgery, Marion and Deepak determine the boy’s vena cava is torn, and the placement of the liver makes it impossible for them to repair it. After several moments of silence, Deepak cuts open the boy’s chest with an electric saw. Marion does not ask what his superior is doing, and Deepak does not explain. In the larger operating room next door, a crowd of White faces is gathered around the operating table.
Deepak modifies a chest tube to use as a stent that will also serve as a “crude bypass” so blood can continue flowing to the heart as they work on the torn vena cava. Now that the blood has been redirected, there is not as much blood where they are working and the surgeons can actually see and reach the tear. As the operation is nearing completion, a voice from behind Marion asks Deepak if he is using a Shrock shunt. It is a male who is polite and conscious that this is a “delicate moment to intrude” but speaks with the authority of entitlement. Deepak looks up quickly and then returns to his work. The voice says he is impressed with Deepak’s work and assumes Deepak is the attending physician. The Chief Resident tells the truth, and the voice asks if they ever see the lazy attending physician. No one answers. The voice learns Deepak has done six Shrock shunts: one died on the table, one died a week later (probably from...
(This entire section contains 1069 words.)
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something else), and three others were alive and well six months after their operations. Shane Junior is the sixth.
The voice says he has only done four such operations, two of which were not on trauma patients, and all four died. He suggests Deepak write his experiences; Deepak says he has tried but no one will publish a report from this hospital. The voice tells him to write the paper, adding this patient, and he will look at it; if it is good, he will see that it gets published in the American Journal of Surgery. He says he will check on this patient’s progress and then starts to give his name. Deepak interrupts him and says he knows who he is and thanks him.
As the visitor is leaving the room, Deepak starts to ask a question but stops. The man is now in a rush because he has a cadaver organ that he should be taking back to his hospital. Deepak tells him that if he would teach them how to harvest kidneys they could start the procedures and save him and the others time. The man says he does not trust anyone else to do it, for none of his residents get the volume of patients they need to become proficient. Deepak tells him the residents at Our Lady do get the volume, but they are being shut down. The man is concerned and asks if the rumors about Popsy are true; Deepak simply nods.
The man learns that Deepak is a doctor of great experience, an FRCS-certified surgeon, and he asks Deepak to come to Boston and perhaps become the resident who can harvest for him. His fare will be paid. After he leaves, the two surgeons finish in silence. Deepak is moved by the fact that the man heard his name just once and is able to repeat it; in all of his time here, none of the “other” doctors ever cared to see Our Lady residents as people. Deepak is convinced that hard work and doing the right thing do pay off in the end.
Marion has to ask twice before Deepak tells him who the visitor is. First he neatly sidesteps the question by asking a nurse if that man’s team was here to harvest the heart or the liver. When she tells him the man took the liver, Deepak smiles and finally answers Marion’s question. He says he is not completely certain because of the mask, and if he had seen his fingers he could have been one hundred percent sure, but he thinks they have just met one of the most prominent liver surgeons in the world—a pioneer in liver transplants. The man’s name is Thomas Stone.
