Ch. 22 – Preset #5

“Shit.” The bag was fucking ripped. “Hey Tony!” Derrick called. “Come take a look at this.”

Tony looked over from the array of tools he was organizing on the mayo tray. “What happened?”

“The sterilizer bag, man.” Derrick held the bag out at arm’s length as Tony lumbered over. “See? It’s this tiny little rip, right here.”

Tony crouched down to get a better look, and squinted his eyes. “How long has it been there?”

“No idea. I don’t remember seeing a rip when I was handling the bag . . . but maybe I just missed it.”

“Let’s see the implant.” Tony put on a pair of gloves, and gripped the transfer forceps. He lifted the implant off the sterile field and turned it slowly, making sure not to let his hand fall over the sterile field to avoid contaminating it. “I can’t see a single defect on this thing. No debris from the bag, either, if it was ripped.”

“But I definitely felt some resistance when I was trying to pull it out,” Derrick said.

“So you think it tore just now?”

“Yeah, I think so.”

Tony set the implant back down on the sterile field and exhaled. “Okay. We’ll use it, then. It’s our only option, and I can’t spot anything wrong with it, so we’ll just have to assume it’s sterile. Cover it up, and let’s get started.”

“Okay.”

And so the second surgery of the night began.

#

Derrick counted up the last of the bloody, fat-stained gauze that they had used in the surgery. It was standard practice to ensure all the gauze was accounted for before suturing the surgical wound, else the team might’ve left one in the patient’s body by accident.

“Okay, gauze check is complete. You’re good to close the wound.”

“Finally,” Tony rasped. They had both been running on fumes the whole operation, and the urgent knocks on the operating room door from Alan didn’t help—he had kept reminding them that he was ‘running out of time, so hurry the fuck up.’

Tony sutured up the surgical wound. “How’s the monitor looking?”

“Everything looks . . . good. Seems like he’s in the clear for now.”

“Hmph. He’s a hardy old man. I guess he’s gotta be one if he’s lived this long as a White Leopard who’s still walking around Chinatown. But his buddies want to take him outta here right after we’re done.”

“You think he’s gonna die?” Derrick asked, his heart pounding in his chest.

“Yeah, he might. It was already a miracle that he survived through two surgeries. We did a great job minimizing the blood loss, but after more than four hours of surgery, he’s got a high risk of developing complications.”

“We pumped him full of intravenous antibiotics during the surgery, but who knows if the cheap stuff we’ve got is still effective,” Derrick said.

Tony snipped the last knot on the sutures, and passed the forceps and needle holder to Derrick. They were warm in his hands: still holding the heat of Tony’s exertion.

The patient’s face had a healthy tone, showing no signs that he was any worse for wear after the additional operation, although complications weren’t always apparent right after a surgery. The tape holding the plastic endotracheal tube to his lips was stained with blood, but the tube itself stayed in place: firmly inserted in his windpipe to ensure that there was an opening for oxygen and carbon dioxide to flow through.

“I’ll be damned if I let this man die of a surgical infection after we’ve already put in the work to save him,” Tony said.

“So what do we do, then?”

“We’ll keep his body strong, so it can squash potential infections on its own. You monitor his body temperature, and up the heating in the climate control; if we keep it too cold in here, it’ll weaken his immune system. I’ll take his endotracheal tube out before we get the man off anesthesia so he doesn’t start coughing and instigate bleeding around the cochlea due to the implant.”

“Alright, I’ll get on it.”

Tony nodded his head: a weary sort of nod. He would be drinking that night; it was almost guaranteed. “Anesthesia input!” he yelled. “Prepare Preset #5.”

The anesthesia machine chirped in response to the voice-activation. “Preparing to apply Preset #5: rapid wake-up with deep extubation. Accounting for patient’s age and body mass. Please confirm to begin patient pre-oxygenation.”

The digital interface for the climate control wasn’t on a voice-activation system, but that also meant that it as simple and robust. Derrick touched the up arrow a few times. There was a muffled clunk, and then deep humming filled the room as the aging system started warming the room.

“Clearing secretions,” Tony said. The suction machine hummed as Tony turned it on and vacuumed saliva out of the patient’s throat. “Confirm. Apply Preset.”

The machine chirped a few more times, and then let out a deep beep. “ACTUATOR ERROR. CANNOT AUTOMATICALLY APPLY SELECTED PRESET.”

“AGH. Not this again.” Tony stomped over to the anesthesia machine and started punching new sedative composition numbers into the touchscreen, before pounding it in frustration as it displayed an error, and then giving up and using the manual knobs instead. “I knew something was wrong when it hadn’t given us any problems the whole day.”

“Everything okay, Tony?”

“Yeah, it’s fine. Here, can you help me reverse the neuromuscular blockade? I’ll pull the tube out.”

They took the patient’s endotracheal tube out and watched the monitor as Tony turned the anesthetics off.

Nothing alarming happened, but although the patient had no problems breathing unaided, he was still verbally unresponsive as time passed by. Derrick and Tony took turns holding the oxygen mask on the patient’s face, and performing a jaw thrust to keep the airway clear.

“Are you worried, Tony? It’s already been twenty minutes since we turned off the anesthetics.”

“Don’t forget, he’s an older patient, and we had him down under for more than four hours now. He’ll come around.”

“I hope so.”

After a few more minutes, the patient moved his arm towards his head, grasping weakly at the air.

“Finally,” Tony said. He held Ah Jun’s hand, and squeezed it, while lightly tapping the patient’s face with his other hand.

Ah Jun’s chest moved up and down, and his eyes opened slowly. They gazed up towards the ceiling, unmoving, before closing again.

“Alright, he’s coming around.”

Someone pounded on the door to the shop again. “IS HE READY YET?” Alan yelled.

“HOLD ON,” Tony yelled back at the door. “GIVE US A FEW MINUTES.”

Tony crouched down closer to Ah Jun, and spoke in an even, warm tone.

Ah Jun opened his mouth, but said nothing, shaking his head from side to side with his eyes half-closed.

Tony said, enunciating each word. Tony showed no emotion on his face, speaking as if he was reciting the terms contract.

Ah Jun said, gesturing with his arm. His voice was raspy: not surprising, given he’d had a tube down his throat for four hours.

“He’s babbling . . .” Derrick said. “I don’t think he understands what you’re saying.”

“This sort of confusion is normal given his age and the length of the operation. Yeah, he won’t remember a single thing I’m saying, but his buddies are about to take him away to god knows where. So I’ve gotta at least try to tell him what we did to his body. It’s his right to know.”

Tony continued on about the details of the surgeries, and his recommendations for rest and recovery post-operation, which Derrick jotted down summaries for, in English and Chinese. They would give the instructions to whoever claimed responsibility for Ah Jun’s care: probably Alan.

Then there was more pounding on the door. “HURRY UP. WE NEED TO GO.”

“Are you sure you wanna let the other White Leopards in now?” Derrick asked.

“They’re one minute from busting the door down, judging by the sound of it,” Tony grumbled. “Stay here, Derrick, I’ll let em in.”

Tony walked up to the locked door and yelled back. “OKAY, LISTEN UP.” He waited for the commotion in the shop to quiet down. “WE’RE GOING TO LET EVERYONE INTO THE OPERATING ROOM TO SEE AH JUN. HE SAID THAT HE WANTS ALL OF YOU TO SEE THAT HE’S FINE, SO MAKE SURE YOU COME THROUGH ONE AT A TIME.”

A cacophony of voices started talking all at once, making it impossible to understand any of them.

Tony put his hand on the doorknob and continued. “ARE YOU ALL READY? I’M GOING TO OPEN THE DOOR IN THREE, TWO ONE . . .”