To the Bone Read Free Page B

facts he was sure of against his deductions and intuitions, the known against the inferred, the risks of what he was considering against the near-certain consequences of playing it safe.
    He turned back and said, “Tell the lab to run blood cultures and a pregnancy test. Get me six platelet packs, two units of fresh frozen plasma, and ten bags of cryoprecipitate. We’re going to treat her for severe DIC. Get an IV in her arm. Jackie—”
    He could see that she was surprised, but ready.
    â€œGive her ten thousand units of heparin IV, and hang a drip at a thousand units per hour.”
    Mary, the recording nurse, lowered her clipboard and stared at him. “You’re going to give her a blood thinner? When she’s already bleeding?”
    â€œShe’s bleeding because she’s clotting ,” Monks said. “If we don’t break that cycle, she’s dead.”
    â€œAre you sure it’s DIC, Doctor?”
    Monks’s temper jumped another notch toward the snapping point. “I’m not sure of anything, except that we’ve got minutes. Everybody get moving, please .”
    Jackie, stable, competent, and obedient, was already taking out a vial of the clear heparin and drawing it up. But she looked worried, too.
    She had a right to be. It was a very long shot. If Monks was correct about the DIC, Eden Hale was probably going to die anyway.
    If he was wrong, the heparin might kill her.
    Â 
    Monks pushed down hard with the heels of his hands on Eden Hale’s sternum, five times, at one-second intervals. Then he leaned close to her face, his head turned to the side and his ear to her lips, listening for a sound of life. He straightened up and stared at the monitors, willing a miracle. He had been doing this for fifteen minutes. CPR was like running a race, a desperate physical effort to stay ahead of the enemy, death.
    Finally, he admitted that he had lost. He stepped back, shoulders sagging with fatigue.
    â€œAll right,” he said. “We’ll stop now.”
    In fact, it had been all over for at least the last five minutes. The nurses knew it, and were quietly tidying up. Their body language said it all.
    â€œWhat time are you pronouncing her, Doctor?” Mary Helfert said. She was stiff, all business, holding her clipboard like a shield. Her body language was unmistakable, too. She did not approve of his decision to use heparin.
    Monks looked at his watch. “Four forty-three A.M. ,” he said. “I can’t sign a death certificate. The DIC killed her, but I don’t know what caused that.”
    â€œWill this be a medical examiner’s case?”
    He nodded. The death fit several criteria that automatically put it in the city’s jurisdiction for autopsy. It was unexpected, and she was young and healthy.
    â€œKeep trying to find the family, and have them notified,” Monks said. This was usually done by contacting local police or sheriffs and having them send an officer to the house. It was considered more humane than a phone call from a hospital. “And call Dr. D’Anton’s clinic as soon as it opens.” Any history that D’Anton might have been able to give them was academic now, and probably would not have helped anyway. But he might know how to contact the family, and he should be informed.
    The recent surgery was one more criterion that made Eden Hale a city ME’s case. The possibility remained that the DIC had been caused by surgical infection.
    Monks walked out of the cubicle, washed, and went to the ER physicians’ room.
    They had come close to saving her. The heparin had started to dissolve the clotting, and her circulation had started flowing properly again—but by then it was just too late. Weakened by the long lack of blood and God knew what else, her heart had stopped. The coroner’s report would help them fill in the blanks.
    Monks hated to lose a patient, and hated like hell to lose one