Red Doctor Valeris knew immediately that there would be no problem diagnosing this case. The Black Doctor slumped back in his seat, gasping for air, his face twisted in pain as he labored just to continue breathing. Christine and Bones burst into the room, and Valeris could tell that they knew instantly what had happened.579Please respect copyright.ＰＥＮＡＮＡPWpThiusFN
"Heart attack," Christine said grimly.
Valeris nodded. "Yeah, but I don't know how bad."
"Get the cardiograph in here. We'll soon see."
But they didn't need the electrocardiograph to diagnose the nature of the problem. All three doctors had seen the picture often enough—the sudden, massive blockage of circulation to the heart that was so common to beings, human and non-human, with central circulatory pumps, the kind of catastrophic accident which could cause irreversible crippling or sudden death in mere minutes.
Bones injected some brozine to ease the pain, and administered oxygen to help the labored breathing, but the old man's color didn't improve. He was too weak to talk; he just lay helplessly gasping for air as they lifted him up onto a bed. Then Bones took an electrocardiograph tracing and shook his head.
"We need to get word back to Hospital Earth, and fast," he said quietly. "He just waited a little too long for that cardiac transplant, that's all. It's a bad one, real bad. Tell them we need a surgeon just as fast as they can get one out here, or the Black Service is going to have a dead physician on its hands."
There was a sound across the room, and the Black Doctor motioned feebly to Bones. "The cardiogram," he gasped. "Give it to me."
"There's nothing for you to see," Bones said. "You mustn't do anything to excite yourself."
"I said give it to me!" Dr. Chang took the thin strip of paper and ran it quickly through his fingers. Then he dropped it on the bed and lay his head back hopelessly. "Damn," he said, so softly they could hardly hear him. "It's too late for help now."
Bones checked his blood pressure and listened to his heart. "It'll only take a few hours to get help," he said. "You rest and sleep now. There's plenty of time."
He joined Valeris and Christine in the corridor. "Looks like he's right, this time," he said. "The damage is severe. He's too weak to hold out for very long. Well, maybe long enough for a surgeon and surgical squad to get here, but I doubt it. Still, we'd better get the word out."
A few moments later he put the earphones aside. "It'll take six hours for the nearest ship to get here," he said. "Maybe five and a half if they really push it. But when they get a look at that cardiogram on the screen they're probably going to just throw up their hands. He needs a transplant, simple as that. But even if we can keep him alive until a surgical squad gets here the odds are a thousand to one against his surviving the operation."
"He asked for it, the stupid son of a bitch," Christine said. "They've been trying to get him into the hospital for a cardiac transplant for years. Everybody's known that one of those towering rages would get him sooner or later."
"Maybe he'll hold on better than we think," Valeris said. "Let's watch and wait."
But the Black Doctor was not doing well. Moment by moment he grew weaker, laboring harder for air as his blood pressure crept slowly down. Thirty minutes later, the pain came back; Bones took another tracing while Valeris checked his venous pressure and shock level.
As she finished, Valeris felt the Black Doctor's eyes on her. "It's going to be all right," she said. "There'll be time for help to come."
Feebly the Black Doctor shook his head. "No time," he said. "Can't wait that long." Valeris could see the fear in the old man's eyes. His lips began to move again as if there were something more he wanted to say; but then his face hardened, and he turned his head away helplessly.
Valeris walked around the bed and looked down at the tracing, comparing it with the first one that was taken. "Your opinion, Bones?"
"It's no good. He'll never make it for five more hours."
"What about right now?"
Bones shook his head. "It's a terrible surgical risk."
"But every minute of waiting makes it worse, right?"
"Well, yes."
"Then let's stop waiting," Valeris said. "We've got a synthetic heart in condition for use, don't we?"
"Yeah."
"Good. Prep it." It seemed as though someone else were talking. "Bones, you're first assistant. We'll get him onto the heart-lung machine, and if we don't have help available by then, we'll have to try to complete the transplant ourselves. Christine, you're on anesthesia, and it's going to be a tricky job. Use local blocks as much as you can, and have the heart-lung machine ready well in advance. We'll only have a few seconds to make the shift. Now let's get moving!"
Bones stared at her. "You sure you want to do this?"
"I never wanted anything less in my life," Valeris said fervently. "But do you think he can survive until a Hospital Ship arrives?"
"No."
"Then I have no choice. You two don't have to worry. It's a surgical problem now, and I'll assume full responsibility."
The Black Doctor was watching her, and Valeris knew she had heard the conversation. Now the old man lay helplessly as they went about getting the surgical room prepared. Christine readied the anaesthetics, checked and rechecked the complex heart-lung machine which could artificially support circulation and respiration at the time that the damaged heart would be separated from its great vessels. The transplant synthetic heart had been grown in the laboratories on Hospital Earth from embryonic tissue; Bones removed it from the frozen specimen locker and brought it to normal body temperature in the special warm saline bath designed especially for that purpose.
Throughout the preparations the Black Doctor lay watching, still conscious enough to recognize what was going on, attempting from time to time to shake his head in protest but never quite succeeding. Finally Valeris came to the bedside. "Don't be scared," she said gently to the old man. "It's not safe to try to delay until the ship from Hospital Earth gets here. Every minute we wait is counting against you. I think I can manage the transplant if I start now. I know you don't like it, but I am the Red Doctor in authority on this ship. If I have to order you, I will."
The Black Doctor lay silent for a moment, staring at Valeris Then the fear seemed to fade from his face, and the anger disappeared. With a great effort he moved his head to nod. "Carry on," he said softly, "Red Doctor."
Valeris knew from the moment she made the decision to go ahead that the thing she was undertaking was all but hopeless.
There was little or no talk as the three doctors worked at the operating table. The overhead light in the spaceship's tiny operating room glowed brightly; the only sound in the room was the wheeze of the anaesthesia machine, the snap of clamps and the doctors' own quiet breathing as they raced feverishly time.
Valeris felt as if she were dreaming, working like an android, going through mechanical motions that seemed totally unrelated to the figure lying on the operating table. During her training she had assisted at hundreds of organ transplant operations; she himself had done dozens of heart transplants, with experienced surgeons assisting and guiding her until the steps of the procedure had become almost second nature. On Hospital Earth, with the unparalleled medical facilities available there, and with well-trained teams of doctors, anaesthetists and nurses the technique of replacing an old worn-out damaged heart with a new and healthy one had become commonplace, posing no more threat to a patient's life than a simple appendectomy had posed four centuries earlier.
But here in the patrol ship's operating room under crisis conditions there seemed little to no hope of success. Already the Black Doctor had suffered violent shocks from the damage that had taken place in his heart. Already he was clinging to life by a frail thread; the additional shock of the surgery, of the anaesthesia and the necessary conversion to the heart-lung machine while the fragile tissues of the new heart were fitted and sutured into place tiny blood vessel by tiny blood vessel was more than any patient could be expected to survive.
Yet Valeris had known when she saw the second cardiogram that there was simply no choice but to make the attempt. Now she worked swiftly, her lithe body engulfed in the voluminous surgical gown, her dainty fingers working carefully with the polished instruments. Speed and skill were the only things that could save the Black Doctor now, to offer him that one-in-a-million chance for survival.
But that speed and skill had to be Valeris's, and Valeris knew it. The knowledge felt like a lead balloon strapped to her shoulders. If Black Doctor Blasius Chang was struggling for his life now, Valeris knew that she herself was struggling for her life----the only kind of life that she wanted, the life of a physician.
Black Doctor Chang's antagonism to her as an alien, as an incompetent, as one who was not fit to wear the collar and cuff of a physician from Hospital Earth, was common knowledge. Thus Valeris realized with perfect clarity that if she failed now, her career as a physician would be over; no one, not even herself, would ever be entirely sure that she had not somehow, in some dark corner of her Vulcan mind, deliberately failed.
Yet if she had not made the attempt and the Black Doctor had died before help had arrived, there would always be those who would accuse her of purposefully delaying the surgery.
Her mouth was dry; she longed for a drink of water, even though she knew that no water could quench this kind of thirst. Her fingers grew numb as she worked, and moment by moment the sense of utter despair grew stronger in her mind. Bones worked stolidly across the table from her, inexpert help at best due of the sketchy surgical training he had had. Even his solid presence in support here did not lighten the load for Valeris. There was nothing that Bones could do or say that would help things or change things now. Even Blob, waiting all by himself on his perch in the control room, could not help her now. Nothing could help now but her own individual skill as a surgeon, and his bitter determination that he must not and would not fail.
But her fingers faltered as ten thousand questions percolated in her mind. Was she doing this right? This vessel here ... clamp and tie it? Or dissect it out and try to preserve it? This nerve plexus ... which one was it? How important? How were the blood pressure and respirations doing? Was the Black Doctor holding his own under the attack of the surgery?
The more Valeris tried to hurry the more she seemed to be wading through waist-deep mud, unable to make her fingers do what she wanted them to do. How could she save ten seconds, twenty seconds, thirty seconds? That thirty seconds might make the difference between success or failure, yet the seconds ticked by swiftly and the procedure was going slowly---too slowly.
She reached a point where she thought she could not go on. Her mind was searching desperately for help—any kind of help, something to lean on, something to brace her and give her support. And then quite suddenly she understood something clearly that had been nibbling at the corners of her mind for a long time. It was as if someone had snapped on a floodlight in a darkened room, and she saw something she had never seen before.
She saw that from the first day she had stepped down from the Vulcan transport that had brought her to Hospital Earth to start her medical training, she'd been leaning on crutches to support her.
Black Doctor Shah had been a crutch upon whom she could lean. Bones, for all his clumsy good-heartedness and for all the help and protection he'd offered, had been a crutch. Blob, who'd been by her side since the day she was born, was still another kind of crutch to fall back on, a way out, a port in the storm, as it were. They were crutches, every one of them, and she had leaned on them heavily.
But now there was no crutch to lean on. She had a quick mind with good training. She had two nimble hands that knew their job, and two legs that were capable of supporting her weight. She knew now that she had to stand on them squarely, for the first time in her life.579Please respect copyright.ＰＥＮＡＮＡmBykUumq6m
And suddenly she realized that this was as it should be. It seemed so clear, so obvious, so unmistakable that she wondered how she could have failed to recognize it for so long. If she could not depend on herself, then Black Doctor Hugo Chang would have been right all along. If she could not do this job that was before her on her own strength, standing on her own two legs with no crutches to lean on, how could she claim to be a competent physician? What right did she have to the goal she sought if she had to earn it on the strength of others? It was she who wanted to be a Star Surgeon—not Blob, not Bones, not anyone else.579Please respect copyright.ＰＥＮＡＮＡGBk0k2OiwN
She felt her heart thundering in her chest, and she saw the operation before her as if she were standing in an amphitheater peering down over some other surgeon's shoulder. Suddenly everything else disappeared from her mind but the immediate task at hand. Her fingers began to move more swiftly, with a confidence she had never before felt. The decisions to be made arose, and she made them without hesitation, and knew as she made them that they were right.579Please respect copyright.ＰＥＮＡＮＡvBnYSaZ1bZ
And for the first time the procedure began to move. She murmured instructions to Christine from time to time, and placed Bones's clumsy hands in the places she wanted them for retraction. "Not there, back a little," she said. "Right, you got it. Now hold this clamp and release it slowly while I tie, then reclamp it. Slowly now ... that's it! Christine, check that pressure again."579Please respect copyright.ＰＥＮＡＮＡYl62L5Id2W
It seemed as if someone else were performing the surgery, directing her hands step by step in the critical work that had to be done. Valeris placed the connections to the heart-lung machine perfectly, and moved with new swiftness and confidence as the great blood vessels were clamped off and the damaged heart removed. A quick check of vital signs, chemistries, oxygenation, a sharp order to Christine, a caution to Bones, and the new synthetic heart was in place. She worked now with painstaking care, manipulating the micro-sutures that would secure the new vessels to the old so firmly that they were almost indistinguishable from a healed wound, and she knew that it was going right now, that whether the patient ultimately survived or did not, she had made the right decisions and had carried them through with all the skill at her command.579Please respect copyright.ＰＥＮＡＮＡeua0WG2xmP
And then the heart-lung machine fell silent again, and the carefully applied cardiostimulator flicked on and off, and slowly, at first hesitantly, then firmly and vigorously, the new heart began its endless pumping chore. The Black Doctor's blood pressure moved up to a healthy level and stabilized; the gray flesh of his face slowly became suffused with the healthy yellowish-pink of an Asian face. It was over, and Valeris was walking out of the surgery, her hands trembling so violently that she just barely got her gown off. She wanted to laugh and cry at the same time, and she could see the silent pride in the others' faces as they joined her in the dressing room to change clothes.579Please respect copyright.ＰＥＮＡＮＡig2TkGqyxZ
She knew then that no matter what happened she had vindicated herself. Thirty minutes later, back in the sickbay, the Black Doctor was awake, breathing slowly and easily without need of supplemental oxygen. Only the fine sweat standing out on his forehead gave indication of the ordeal he had been through.579Please respect copyright.ＰＥＮＡＮＡK7UdmWamho
Swiftly and clinically Valeris checked the vital signs as the old man watched her. She was about to turn the pressure cuff over to Christine and leave when the Black Doctor said, "Wait..."579Please respect copyright.ＰＥＮＡＮＡ8RUfni7FUx
Valeris turned to him. "Yes, sir?"579Please respect copyright.ＰＥＮＡＮＡifaUHaSa2j
"You did it?" the Black Doctor said softly.579Please respect copyright.ＰＥＮＡＮＡYHfMCjMF52
"I did, sir."579Please respect copyright.ＰＥＮＡＮＡCfVzVDLoka
"The transplant is done? I'm going to live?"579Please respect copyright.ＰＥＮＡＮＡ7qVBaJHQBJ
"Yes to both questions," Valeris said. "It went well, and you can rest now. You've been a good patient."579Please respect copyright.ＰＥＮＡＮＡqzcfkz4ol1
For the first time Valeris saw a smile cross the old man's face. "A foolish patient, maybe," he said, so softly that no one but Valeris could hear, "but not so foolish now. Dammit, girl! You're a doctor, not a Vulcan!"579Please respect copyright.ＰＥＮＡＮＡMt9alIOJNa
And with a smile he closed his eyes and went to sleep.579Please respect copyright.ＰＥＮＡＮＡQsZy5cOoEl
