Ch. 21 – Let It Rip

“Are we really going to try and pull a fast one on these gangsters?” Derrick asked.

Tony was already looking around for the sterilized cochlear implants. “Yeah. It’s either that or we wake the patient up, and ask him to make the decision. But if we did that, that bozo Alan would have a fit.”

“But, what if we just . . . did what he told us to? Just installed the cochlear implant receiver that he gave us, and kept our mouths shut? The White Leopards like to infight and play their games, why should we get in the way?”

“‘Do no harm’,” Tony said. “That’s what my uncle always told me, and it’s the doctors’ oath. We might only be mod-docs, but we’ve got to have rules, Derrick. Otherwise, we’re just a bunch of unlicensed crooks cutting people open for money.”

There it was again: Tony’s backbone and righteousness. If he wasn’t like that, Derrick would’ve never survived that night many years ago, when he was young and alone; burned, bleeding, and broken. But it was going to get him killed some day!

“But Tony, White Leopards don’t play by the rules! You know it as well as I do. And that Alan guy seems like he’s in charge. What if he finds out we gave him the wrong implant, and sends someone to get revenge?”

Tony chuckled. “Then we fight back. He never told us there was a torture device on his receiver, so we wouldn’t be the ones who messed up.”

“But there are only two of us—”

“—I don’t wanna die either. But this would be the best choice, even if I was fine with destroying a patient’s life. Think, Derrick. Think.” Tony put a hand on his hip, and exhaled through his nostrils. “We’ve got three choices: implant their torture device, implant our receiver, or don’t operate. Refusing to operate is a dead end, literally. Now the question is: are we more likely to get shot if we fuck with Ah Jun, or not?”

“Well, Alan seemed pretty ready to shoot us if we didn’t listen to him, and he said he was going to test the implant receiver after we finished.”

“Sure, maybe he would have shot us back then. But now that we know what he’s up to, we can turn the tables on him.”

“You mean shoot him?” Derrick whispered. “His buddies outside would hear it though; they’d blast us, as long as they could avoid the patient—wait, you don’t mean we should take Ah Jun hostage, do you?”

Tony scrunched up his face. “Not quite, my boy. But you’re kind of getting it.” He nodded towards the door to the shop. “The White Leopards: they care about Ah Jun. All those bozos seemed worried about the old man when they brought him in for surgery, so he must be important to them.”

“Not Alan though, right? If he wants to put a torture device in Ah Jun’s head.”

“Exactly. But here’s the thing, he’s only one guy. And he’s trying to keep this extra surgery a secret from the rest of them.”

Alan’s tense demeanor in the operating room seemed like it was because he was calling his boss . . . But if he was hiding something from the other White Leopards, he’d have been very tense as well. “Yeah,” Derrick said. “He also looked worried when I went out into the shop to get the signal capture device. Maybe he was scared that I would tell someone what we were doing.”

Tony grinned and nodded his head. “Spot on.”

“So you mean that if we listened to Alan, and implanted the torture device, the rest of the White Leopards would target us since we did the operation? Maybe they’d think we were working together with Alan?”

“Right. If their boss will only share his ‘special intel’ with Ah Jun, that means the old man outranks Alan, and the rest of the Leopards will listen to him once he recovers from the surgery. So implanting the torture device is another dead end.”

“Then we have to implant our own receiver . . .” Derrick said. A few minutes had already passed since they had started deliberating. He glanced at the monitor showing Ah Jun’s vitals, to make sure nothing had changed. Sure enough, his vitals looked normal, but they couldn’t afford to be distracted in case his condition suddenly deteriorated.

“Don’t worry, I’m keeping an eye on the monitor,” Tony said.

Derrick nodded. “The thing is, Alan’s going to test his receiver, right? What if he tries to test the micro-shaker chip, finds out it’s not working, and then kills us?”

“We make sure he’s not the only bozo in the room,” Tony said. “Instead of calling only him back in, we’ll have everyone come in to the operating room. If he tries to test the torture device, they’ll all know something’s wrong, and that’ll put him at risk, since we can expose him.”

“. . . But what if they don’t believe us anyway?”

Tony shrugged his shoulders. “That’s life in Chinatown, my boy. Gangsters will lie and act as if they were doing you a favor. But don’t worry, Derrick; I won’t let you die. You were once my patient too, after all.”

There didn't seem to be any changing Tony’s mind at this point. Derrick opened up the cabinets where he had stored the sterilized cochlear implants. “They’re right here, Tony.”

“Ah, good.” Tony looked around and paused. “Actually . . . I don’t even know if we have enough supplies for a cochlear implant surgery.”

Derrick glanced at the crash cart, and then opened up the supply cabinet. “We might have just enough, if we use them carefully.”

“Okay, you ready for round two, Derrick?”

“Kind of, but we also don’t have much of a choice here. We either do the surgery, or get shot by White Leopards.”

Tony chuckled. “You’ve gotta get used to it, Derrick. As doctors, there are lots of things we can’t control. Let’s focus, now. Go ahead and prep the patient, establish a sterile field, and then get scrubbed and gowned again. It’s time to rock and roll.”

Tony was back in surgery mode again, so there was no turning back at this point. Derrick nodded his head, and got to work.

#

Assisting with two surgeries in a row was exhausting, especially when the threat of death hung over your head. Derrick blinked his dry eyes, trying to lubricate them so his vision didn’t get blurry at a critical moment.

Doing surgery with just the two of them made it hard to keep the patient clean, and at a low risk for infection. Legitimate operating theaters usually had surgeons, assistants, and nurses who scrubbed themselves clean, and stayed sterile throughout the surgery. Non-sterile nurses were there to pass non-sterile supplies into the sterile areas, like by opening sterilizer packets, of which the insides were sterile, but outsides were non-sterile.

Sterile items came in packets or pouches, which maintained their sterility until the packet was opened. The outsides of those packets were exposed to the environment, and therefore were considered non-sterile. So when transferring items into the sterile field, Derrick had to open the packaging and then drop the item onto the mayo tray without letting the packaging touch anything in the field.

That was the problem. Derrick was Tony’s assistant, but he also had to be the non-sterile nurse who opened up all the supplies. So they had to do things a bit out of order.

“I’m all ready here, Derrick. Go ahead and open the implant,” Tony said. He was already gowned up and standing next to the patient, ready to begin the surgery and make the first incision.

Derrick had set up the mayo tray—a tray on a stand covered by sterile drapes to protect items placed on it from contaminants—and had already stocked it with all the key equipment and consumables they would need for most of the surgery.

All that was missing was the cochlear implant itself. Their plan was to open it last, and then cover it with sterile cloth until it was ready for insertion, in order to reduce the risk of contamination during the surgery. It wasn’t a perfect strategy, but this way Derrick wouldn’t have to break his sterility mid-operation.

“Okay. I’ll go grab the implant now.”

Derrick took the two cochlear implant receivers that Nathan had sterilized that morning out of their transport pod, and placed them on a bench in the non-sterile part of the operating room. He grabbed one at random and peered at it through the transparent plastic half of the bag.

“Huh, this one has a stain on the inside of the bag.” That morning when receiving the bags from Nathan, the stain must had blended in with the bag’s blue pattern, but under the harsh light of the operating room, it stood out like spilled ink.

“Hold it up so I can see,” Tony said. He shook his head after glancing at the pack that Derrick held up in the air. “It’s contaminated. They probably serviced their sterilizer right before the cycle that they put the bag in, so the cleaning agents got mixed in with the gas inflow. You sterilized one more this morning, right?”

Derrick placed the stained bag back into the storage pod—they would hopefully be able to use the implant inside, after sterilizing it again—and then picked up the other one. “Yeah. This one looks fine, I think.”

“Okay, careful with it. It’s the only one we’ve got left.”

Derrick walked the bag over to the sterile field. Moving slowly and deliberately, he pinched the edges of the packet containing the cochlear implant receiver, and peeled it, separating the plastic side from the paper side, and then tilted the whole package toward the sterile field. The paper crinkled as the cochlear implant receiver shifted a bit from it’s initial position, but it refused to budge any farther.

“What’s wrong now?” Tony asked.

“It’s, uh, not coming out of the sterilizer bag.”

Derrick gave the bag a few timid shakes, but moving it too roughly to try and dislodge the receiver would risk damaging the fragile electrodes if it fell onto the tray with enough force

“Try to pull it out, real gentle-like.”

They had a few more packs of sterile transfer forceps: small metal tongs that had been sterilized so they could be used to move around objects without contaminating them. Derrick would need both hands to open a bag holding the forceps, so he placed the half-opened packet containing the receiver down on a clean surface in the non-sterile area.

With the forceps grasped in his left hand, it was time to try and pull the receiver out. Widening the opening of the bag containing the receiver was tricky; he had to pull on the top flap of the packet while making sure his hand didn’t touch its inside and contaminate it. Derrick held his right hand in the awkward position, and then reached deep inside with the forceps, making sure not to put any pressure on the sensitive electrode array.

The receiver budged, but pulled the bag along with it. What was keeping it in there?! Looking in from the plastic side of the bag, there was nothing obviously caught on the receiver. Twisting the forceps, Derrick tried coaxing it out from another angle, until it finally popped out of the bag.

Tsst.

Uh oh. What was that?

Derrick placed the receiver onto the sterile field and backed away to avoid contaminating it, and then turned the bag over in his hands. There was a tiny rip in the paper half of the bag, back near where the receiver had been stuck.

“Shit.” Derrick swallowed dry. How long had the bag been exposed to the environment?