Chapter 3 - The Theater of WarScrubbing in was a ritual Althia had performed thousands of times, but tonight felt different. The water running over her hands felt like liquid ice. In the reflection of the stainless steel mirror, her eyes were hard, unblinking, and entirely devoid of mercy.
She walked into Operating Room 4, the designated flagship suite of Sterling Memorial.
The room was a cathedral of high-tech machinery, glowing monitors, and sterile white light. Sarah Lin was already at the table, checking the instrument trays. Dr. Marcus Keller stood ready as the secondary observer.
"Patient is prepped, draped, and under general anesthesia," the circulating nurse announced. "Arterial line and central venous catheter are secured. Bispectral index is at 45."
Althia stepped up to the table, her gloved hands held high. Sarah helped her into her sterile gown, and Marcus tied the back. She walked to the operating table and looked down at Richard Sterling.
The old man looked frail, tubes taped across his face, his chest rising and falling to the rhythmic hiss of the mechanical ventilator. Richard had always treated Althia like a daughter—perhaps better than a daughter. He had funded her fellowship, praised her breakthroughs, and openly spoken of the day she would legally join the Sterling dynasty.
And your son destroyed it all five days ago, a voice whispered in her head.
"Let's begin," Althia said, her voice echoing clearly through the room's intercom. "Median sternotomy. Scalpel."
Sarah slapped the heavy steel handle into Althia’s palm.
With a single, fluid motion, Althia pressed the blade to Richard’s chest and drew it downward. The skin parted cleanly, exposing the sternum.
"Saw," she commanded.
The electric whine of the sternal saw filled the room, sending a fine spray of bone dust into the air as Althia split the breastplate. She cracked the ribcage open with the retractor, exposing the pericardial sac.
"We're entering the pericardium," Althia noted, her eyes locked on the swollen, purple-tinged mass of the ascending aorta. It pulsed with a sickening, erratic rhythm, ballooning outward like an overinflated tire about to blow.
"Look at that arch," Sarah muttered under her breath. "It's dissecting toward the innominate artery."
"I see it," Althia said coolly. "Establish cardiopulmonary bypass. Cannulate the right axillary artery and the right atrium."
"Bypass initiated," the perfusionist called out a few minutes later. The gentle hum of the heart-lung machine filled the background, taking over the work of Richard’s failing heart and lungs.
"Cross-clamp applied," Althia said, her hands moving with terrifying precision. "Now, let's cool him down. We're dropping core temperature to 18 degrees Celsius for deep hypothermic circulatory arrest."
For the next thirty minutes, the operating room grew quiet except for the digital chirps of the monitoring equipment. They were walking a tightrope over an abyss. At 18 degrees, cellular metabolism slowed to a crawl, buying Althia precious minutes to surgically reconstruct the shattered aorta without a tidal wave of blood blinding her field of view.
"Temperature reached 18 degrees," the perfusionist reported. "Circulatory arrest initiated. Pumps off."
The steady hum of the bypass machine died away. The room fell into an eerie, suspended silence. Richard’s brain and body were now devoid of blood flow. Althia had a strict window of forty-five minutes before irreversible neurological damage set in.
"Suction," Althia ordered.
She sliced open the diseased ascending aorta. A dark pool of stagnant blood cleared away, revealing the catastrophic internal damage. The inner layer of the vessel wall had shredded like wet paper, creating a false lumen that was choking off blood supply to the rest of the body.
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"Hand me the Dacron graft," Althia said.
As she began the meticulous, microscopic stitching required to anastomose the artificial graft to the fragile, bleeding remnants of the aortic root, the heavy double doors of the OR suite suddenly banged open.
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