Free A Brain by Robin Cook

needle holder from its original position on the shank of the needle, he used the instrument to grab the needle tip, bringing the suture out into the wound. With essentially the same technique, he put the silk through the other side of the wound, trailing the suture off into Dr. Lowry’s waiting hand so he could tie the stitch. They repeated this procedure until the wound was closed with black sutures, giving the impression of a large zipper on the side of Lisa’s head.
    During this part of the procedure, Dr. Ranade was still ventilating Lisa by compressing a breath bag. As soon as the last stitch was to be placed, he planned to give Lisa one hundred percent oxygen and reverse the remaining muscle paralyzer her body hadn’t metabolized. On schedule his hand again compressed the breathing bag, but this time his experienced fingers detected a subtle change from the previous compression. Over the last few minutes Lisa had begun to make initial efforts to breathe on her own. Thoseefforts had provided a certain resistance to ventilating her. That resistance had been gone on the last compression. Watching the breathing bag and listening with his esophageal stethoscope, Ranade determined that Lisa had suddenly stopped trying to breathe. He checked the peripheral nerve stimulator. It told him the muscle paralyzer was wearing off on schedule. But why wasn’t she breathing? Ranade’s pulse increased. For him anesthesia was like standing on a secure but narrow ledge on the side of a precipice.
    Quickly, Ranade determined Lisa’s blood pressure. It had risen to 150 over 90. During the operation it had been stable at 105 over 60. Something was wrong!
    â€œHold up,” he said to Dr. Newman, his eyes darting to the cardiac monitor. The beats were regular but slowing with longer pauses between the spikes.
    â€œWhat’s wrong?” asked Dr. Newman, sensing the anxiety in Dr. Ranade’s voice.
    â€œI don’t know.” Dr. Ranade checked Lisa’s venous pressure while preparing to inject a drug called nitroprusside to bring down her blood pressure. Up to this point Dr. Ranade believed the variation in Lisa’s vital signs was a reflection of her brain responding to the insult of surgery. But now he began to fear hemorrhage! Lisa could be bleeding and the pressure in her head could be going up. That would explain the sequence of signs. He took the blood pressure again. It had risen to 170 over 100. Immediately he injected the nitroprusside. As he did so, he felt that unpleasant sinking feeling in his abdomen associated with terror.
    â€œShe might be hemorrhaging,” he said, bending down to lift Lisa’s eyelids. What he saw was what he’d feared. The pupils were dilating. “I’m sure she’s hemorrhaging,” he yelled.
    The two residents stared at each other over the patient. Their thoughts were the same. “Mannerheim’s going to be furious,” said Dr. Newman. “We better call him. Go ahead,” he said to Nancy Donovan. “Tell him it’s an emergency.”
    Nancy Donovan dashed over to the intercom and called out to the front desk.
    â€œShould we open her back up?” asked Dr. Lowry.
    â€œI don’t know,” said Newman nervously. “If she’s hemorrhaging inside her brain it would be better to get an emergency CAT scan. If she’s bleeding into the operative site, then we have to open her up.”
    â€œBlood pressure still rising,” said Dr. Ranade with disbelief as he watched his gauge. He prepared to give her more medication to bring the blood pressure down.
    The two residents remained motionless.
    â€œBlood pressure still rising,” shouted Dr. Ranade. “Do something, for Christ sake!”
    â€œScissors,” barked Dr. Newman. They were slapped into his hand and he cut the sutures he’d just finished placing. The wound spontaneously gaped open as he got to the end of the incision. As he pulled