Shivering, she felt her head swim again. "Sure hope so."

"And if these ER cowboys are finished spearing you," Janet continued, but much louder, "perhaps we could get the lady a blanket?"

She started to lose consciousness, and tightened her grip on Jimmy's hand, but he couldn't hold her out of the darkness.

Chapter 13

Janet dashed through the corridor, guiding the stretcher around corners, the race a deadly earnest repeat of what they'd done in jest through the streets of Buffalo two Saturdays ago.

Even Jimmy helped, setting intravenous bottles swaying in the turns as he muscled their precious cargo along.

Stewart Deloram adjusted IV rates on the run.

Janet continued to utter a steady stream of comforting words- reassuring J.S. that all would be well, that they'd beaten these odds many, many times before, that this would soon be little more than an unpleasant memory. But she couldn't be sure her patient even heard, and she estimated they had ten minutes to stop the flow of blood or J.S. would die.

They commandeered an elevator and seconds later were met by a team of nurses and an anesthetist who ushered them into an OR.

The bleeding continued.

Changing, scrubbing, then redonning sterile gowns, gloves, and masks cost more precious minutes.

"Pressure's down to sixty-two," called out one of the OB nurses.

Stewart rushed to open up the IVs as wide as they'd go.

Jimmy hustled back to J.S.'s side. No stranger to keeping out of the way, he hovered discreetly by her head, holding her hand and talking quietly to her, until a nod from the anesthetist indicated she'd finally been put under. He then stepped back into a corner, apparently determined to stay and observe, his dark eyes glistening.

Janet recognized in them what she'd never seen him show before: fear.

My God, he's in love with her, she thought.

"Ready for you, Doctor," said the anesthetist, his voice clipped and urgent. "Pressure's falling, sixty over zip." He had the requisite wisps of gray hair sticking out from under his cap to tell her she hadn't pulled a rookie.

The nurses secured J.S.'s legs in stirrups and positioned an OR stool adjusted for Janet's height between them. Taking her seat, Janet prepared to do the definitive treatment- scrape any pieces of afterbirth off the inner lining of the uterus. With nothing left in the way, the organ could clamp down tight on itself and tamponade the bleeding sites, like pressure on a cut.

The os of the cervix hung open, pouring blood, and tissue trailed out its orifice, debris caught in a stream.

"Suction," she ordered.

Catheters drained everything away with the sound a straw makes at the bottom of a milk shake, and the crimson flow receded.

Janet quickly inserted a dilator to widen the passage, then went into the vault with a curette to clean out any remaining material.

"Still sixty over zip, and pulse climbing to one sixty. You may not have much time." The anesthetist spoke the grim warning with glacial cool.

"Keep calling out the readings." She retrieved only small amounts of tissue, yet blood continued to pour over her hands, warm and fluid with not a clot in sight.

Definitely something wrong with her coagulation.

"Any repeat on the INR?" she asked.

"Still high, but the rest is okay," Stewart replied. In other words, low prothrombin remained the problem, not the more horrific DIC, at least so far.

He continued to work frantically with the IVs- replacing spent packets of red cells and plasma, binding the new ones in pneumatic cuffs that accelerated their flow, hanging up more liters of saline to pour in as much volume as possible- all to keep her circulation from collapsing completely. The dread in his eyes said, I'm losing!

"Fifty-five over zip."

Janet finished raking the curette over the inner uterine wall and pulled out the last segments of the afterbirth, none of it enough to explain such a copious hemorrhage. There should have been some improvement by now.

Unless…

"BP down to fifty, pulse is still high… one fifty-five… one sixty…"

She'd soon arrest.

A cold sweat crept up Janet's back.

Either the coagulation problem hadn't corrected at all, or in doing the curettage, she'd shoved the instrument right through the uterine wall and opened up a new bleed. Pliant enough to expand and accommodate the size of a baby, the tissue is delicate, and a curette could penetrate it without her ever feeling the pop of the metal tip punching all the way through. She'd never made the mistake before, but shit happens when you least want it.

She'd have to go in and check.

"A number eleven scalpel," she ordered, removing the curette. "Prepare for a laparotomy and a repair of a possible uterine puncture."

She heard the indrawn breaths as everyone's pupils pulsed wider, but nobody said a word. From now on she'd be the only one to speak.

The nurse at her side snapped a pointed blade onto a stainless-steel handle and laid it flat in her outstretched hand.

Her colleagues shoved the additional instrument trays they'd need into easy reach and whipped off the sterile covers. One of them quickly prepped the area she'd be cutting.

Stewart slid a nail-sized needle under J.S.'s collarbone and into her subclavian vein to start a sixth IV.

"Get ready to tamponade the incision with gauze, and give me suction, plenty of it."

In a single move Janet made a four-inch horizontal slice through the skin into a yellow layer of subcutaneous fat, following along the top of the pelvis, the so-called bikini cut. Immediately the trench filled with blood, but the nurses' fingers pulled the edges apart and pressed folded white gauze into the incision, soaking up the flow as fast as it appeared.

In a second pass she cut deeper, parting the yellow globules where she'd left off down to the glistening white fascia that lined the abdominal muscle. Across this layer she made a third sweep with just the tip of her blade, and the diaphanous sheet sprang open, permitting strands of maroon-bellied muscle to bulge out. Handing back the scalpel, she quickly separated them with her fingers, working around the catheters that noisily sucked out the blood, making her way down to the pearl-gray membrane that lined the pelvic cavity. Without needing to be asked, two nurses assumed the task of holding the tissue apart with small stainless-steel claws as she went.

Once she'd cleared enough space, a third nurse slapped a pair of pointed tweezers into Janet's left hand and surgical scissors into her right. Using the former to snag the membrane, she lifted it enough to make a tiny tent and snipped another four-inch opening.

Retracting the edges with her fingers, she brought the dark maroon surface of the pear-shaped uterus into view. Gleaming like new, it lay in a blood-free bed of ligaments and ocher-colored membranes.

Perhaps she hadn't perforated it after all. To be sure, she delicately explored the slippery contours with her fingertips, checking for any tiny holes.

None.

She watched it for leakage.

Crimson seepage from severed vessels in the skin flowed into the space, but nothing else. The exterior remained intact, giving the appearance of a womb as ready to receive and grow life as always.

But from its interior the unrelenting flow persisted, silently coursing out between J.S.'s legs to spatter noisily into the most recent steel basin the nurses had placed there.

After the rush of activity, Janet felt overwhelmed with helplessness. She'd reached the limit of what she could do.

More vitamin K wouldn't help. It took hours to work.

Removing the uterus would produce more hemorrhages.

The sole hope for survival rested with the fresh frozen plasma- if the clotting factors kicked in soon enough.