said. Vivian was standing by the tray table of Joshua's trophies. She picked up the Cub Scout ribbon. Pinewood Derby, third grade. "He could've gone to the OR this morning. Had the transplant by ten o'clock. If we lose him, it's your fault, Aaron."Vivian looked at Aaron Levi, whose pen had frozen in the midst of signing the code sheet.
"Dr. Chao," said Aaron quietly. "Would you care to talk about this in private?"
"I don't care who's listening!The match is perfect. ! wanted Josh on the table this morning. But you wouldn't give me a decision. You just delayed. And delayed. And fucking delayed." She took a deep breath and looked down at the award ribbon she was holding. '! don't know what the hell you think you're doing. Any of you."
"Until you calm down, I'm not going to discuss this with you," said Aaron. He turned and walked out.
"You are.You are going to," said Vivian, following him out of the cubicle.
Through the open doorway, Abby could hear Vivian's pursuit of Aaron across the MICU. Her angry questions. Her demands for an explanation.
Abby bent down and picked up the Pinewood Derby ribbon that Vivian had dropped on the floor. It was green - not a winner's ribbon, but merely an honourable mention for the hours spent labouring over a small block of wood, sanding it, painting it, greasing the axles, pounding in the lead fishing weights to make it tumble faster. All that effort must be rewarded. Little boys need their tender egos soothed.
Vivian came back into the cubicle. She was white-faced, silent. She stood at the foot of Josh's bed, staring down at the boy, watching his chest rise and fall with each whoosh of the ventilator.
"I'm transferring him," she said.
"What?" Abby looked at her in disbelief. "Where?"
"Massachusetts General. Transplant Service. Get Josh ready for the ambulance. I'm going to make the calls."
The two nurses didn't move. They were staring at Vivian. Hannah protested, "He's ha no condition to be moved."
"If he stays here, we're going to lose him," said Vivian. ' We are going to lose him. Are you willing to let that happen?"
Hannah looked down, at the frail chest rising and falling beneath her washcloth. "No," she said. "No. I want him to live."
"Ivan Tarasoft was my professor at Harvard Med," said Vivian. "He's head of their transplant team. If our team won't do it, then Tarasoffwill."
"Even if Josh survives the transfer," said Abby, 'he still needs a donor heart."
"Then we'll have to get him one." Vivian looked straight at Abby. "Karen Terrio's."
That's when Abby understood exactly what she had to do. She nodded. "I'll talk to Joe Terrio now."
"It has to be in writing. Make sure he signs it."
"What about the harvest? We can't use the Bayside team."
"Tarasoft likes to send his own man for the harvest. We'll assist. We'll even deliver to his doorstep. There can't be any delay. We have to do it fast, before anyone here can stop us."
"Wait a minute," said the other nurse. "You can't authorize a transfer to Mass Gen."
"Yes I can," saidVivian. "Josh O"Day is on teaching service. Which means the Chief Residents are in charge. I'll take full responsibility. Just follow my orders and get him ready for ambulance transfer."
"Absolutely, Dr. Chao," said Hannah. "In fact, I'll ride with him."
"You do that." Vivian looked at Abby. "OK, DiMatteo," she snapped. "Go get us a heart."
Ninety minutes later, Abby was scrubbing in. She completed her final rinse and, elbows bent, backed through the swinging door into OR 3.
The donor lay on the table, her pale body washed in fluorescent light. A nurse-anaesthetist was changing IV bottles. No need for anaesthesia on this patient; Karen Terrio could feel no pain.
Vivian, gowned and gloved, stood at one side of the table. Dr. Lima kidney surgeon, stood on the other. Abby had worked with Lim on previous cases. A man of few words, he was known for his swift, silent work.
"Signed and sealed?" asked Vivian.
"In triplicate. It's in the chart." She
"Dr. Chao," said Aaron quietly. "Would you care to talk about this in private?"
"I don't care who's listening!The match is perfect. ! wanted Josh on the table this morning. But you wouldn't give me a decision. You just delayed. And delayed. And fucking delayed." She took a deep breath and looked down at the award ribbon she was holding. '! don't know what the hell you think you're doing. Any of you."
"Until you calm down, I'm not going to discuss this with you," said Aaron. He turned and walked out.
"You are.You are going to," said Vivian, following him out of the cubicle.
Through the open doorway, Abby could hear Vivian's pursuit of Aaron across the MICU. Her angry questions. Her demands for an explanation.
Abby bent down and picked up the Pinewood Derby ribbon that Vivian had dropped on the floor. It was green - not a winner's ribbon, but merely an honourable mention for the hours spent labouring over a small block of wood, sanding it, painting it, greasing the axles, pounding in the lead fishing weights to make it tumble faster. All that effort must be rewarded. Little boys need their tender egos soothed.
Vivian came back into the cubicle. She was white-faced, silent. She stood at the foot of Josh's bed, staring down at the boy, watching his chest rise and fall with each whoosh of the ventilator.
"I'm transferring him," she said.
"What?" Abby looked at her in disbelief. "Where?"
"Massachusetts General. Transplant Service. Get Josh ready for the ambulance. I'm going to make the calls."
The two nurses didn't move. They were staring at Vivian. Hannah protested, "He's ha no condition to be moved."
"If he stays here, we're going to lose him," said Vivian. ' We are going to lose him. Are you willing to let that happen?"
Hannah looked down, at the frail chest rising and falling beneath her washcloth. "No," she said. "No. I want him to live."
"Ivan Tarasoft was my professor at Harvard Med," said Vivian. "He's head of their transplant team. If our team won't do it, then Tarasoffwill."
"Even if Josh survives the transfer," said Abby, 'he still needs a donor heart."
"Then we'll have to get him one." Vivian looked straight at Abby. "Karen Terrio's."
That's when Abby understood exactly what she had to do. She nodded. "I'll talk to Joe Terrio now."
"It has to be in writing. Make sure he signs it."
"What about the harvest? We can't use the Bayside team."
"Tarasoft likes to send his own man for the harvest. We'll assist. We'll even deliver to his doorstep. There can't be any delay. We have to do it fast, before anyone here can stop us."
"Wait a minute," said the other nurse. "You can't authorize a transfer to Mass Gen."
"Yes I can," saidVivian. "Josh O"Day is on teaching service. Which means the Chief Residents are in charge. I'll take full responsibility. Just follow my orders and get him ready for ambulance transfer."
"Absolutely, Dr. Chao," said Hannah. "In fact, I'll ride with him."
"You do that." Vivian looked at Abby. "OK, DiMatteo," she snapped. "Go get us a heart."
Ninety minutes later, Abby was scrubbing in. She completed her final rinse and, elbows bent, backed through the swinging door into OR 3.
The donor lay on the table, her pale body washed in fluorescent light. A nurse-anaesthetist was changing IV bottles. No need for anaesthesia on this patient; Karen Terrio could feel no pain.
Vivian, gowned and gloved, stood at one side of the table. Dr. Lima kidney surgeon, stood on the other. Abby had worked with Lim on previous cases. A man of few words, he was known for his swift, silent work.
"Signed and sealed?" asked Vivian.
"In triplicate. It's in the chart." She
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