"Nellie's treadmill stress test was positive," Dr. Carolyn Jessup explained, "and a subsequent cath showed fairly severe coronary artery disease. She was a perfect candidate for randomization into the Vasclear study. Right, Nellie?"
Nellie Hennessey, eyes closed, was breathing deeply and regularly.
"Jennifer," Jessup went on, "maybe we should be giving her a tad less pre-op medication. If I have to stay awake for this, everyone does." She glanced over at the nurse, her eyes smiling. "Seriously, nice job. She's perfect.... Anyhow, Brian, Nellie's symptoms disappeared almost immediately and haven't returned. This is her third and last follow-up cath. Then she becomes an alumna."
"What Vasclear group is she in?" Brian Holbrook asked, already knowing the answer.
"Beta. Okay, Doc, you're on. Let's switch sides. You do the right heart and afterward I'll switch back and do the coronary-artery shots. Nellie's asleep so you're not being graded on this. Just relax and have fun."
Surprised and pleased at being asked to do anything other than observe, Brian moved behind Carolyn to take her place at the table.
"Everything on the Ward-Dunlop works pretty much like the one you're used to," she said, "except the controls are much more responsive, and the connections on the ports just click and lock."
"Impressive," Brian said, proceeding with the pressure studies and dye injections.
The nurse, Jennifer, was working beside him now, keeping a careful watch on Nellie, checking her blood pressure and IV.
"Everything okay?" Brian asked her.
"All systems are go," she replied.
Brian took some pressure measurements through the catheter, then injected some dye to check the tricuspid and pulmonic valves. The moment he had thought might never come was here. He was back in the cath lab, regaining control, piece by piece, of his own destiny.
"You seem pretty comfortable there, pardner," Jessup said, returning to her position to do the left heart and coronary-artery exam.
"Just like riding a bike. She's got a pretty healthy-looking heart."
"Wait till you see her coronary arteries. These pictures we're about to shoot are going to be the eighteen-month-afters. The befores are in the cine-library through the door just past the women's changing room. Did security give you a code for the keypad?"
"Great. Sometime soon, go and take a look at Nellie's pre-Vasclear films. We've got two Vangard viewers in there. One for backup."
"I'm impressed," Brian said. The viewers, from what he remembered, cost around twenty thousand dollars apiece.
"You'll be even more impressed when you review her films," Carolyn said. "Now, let's take a look at her left heart and coronaries."
The experimental Ward-Dunlop catheter was exceptionally easy to manipulate, and certainly showed up well on X ray.
"Left anterior oblique cranial...right anterior oblique caudal..."
Jessup called out each angle, waited for Andrew to position the X-ray camera, then injected some dye and activated the camera with her foot pedal. Overhead, one screen showed the bright white of the X-ray-opaque dye as it briefly filled Nellie's coronary arteries before being washed away, and another traced her heartbeat, oxygenation, and other vital signs. In the glassed-in control room to their right, the other nurse, Lauren, monitored duplicate screens, and kept watch over the machine that was recording the injections on videotape. Later, the tape would be reviewed by Jessup, and a report dictated. The width of every significant artery and every blockage would be carefully measured by computer and recorded.
"...Right anterior oblique cranial," Carolyn said, completing the last of the five left coronary-artery views. "Okay, everyone, if there is anyone with reasons why this woman and this catheter should remain in holy matrimony, let him speak now or forever hold his peace.... There being no objections to removal of this line, I hereby do so."
Carolyn withdrew the catheter with the same smoothness, the same confidence, as she had displayed throughout the procedure. But quite suddenly, a brief flurry of extra heartbeats appeared on the screen. Then another burst.
A few moments later, Nellie Hennessey moaned.
Then she opened her eyes.
Then she began screaming.
From the Paperback edition.