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Doubtful. Almost impossible. Besides, I don't think there's any distension at all.'
    'But look,' Thea said. 'His blood pressure's dropped and his venous pressure has gone up and he's having those extra beats. It could be tamponade.'
    'Or too much calcium or too little potassium or a drug reaction or an internal hemorrhage, or just an old man's old heart giving up. Thea, be reasonable.'
    At that instant, with no increased warning whatsoever, one of the errant premature beats fired off precisely on the ascending portion of the following T-wave, and Petros Sperelakis's heart stopped.

CHAPTER 6

    Thea felt herself go cold.
    Her father's heart was in ventricular fibrillation. The powerful cardiac muscle was quivering impotently within his lion's chest like so many strands of spaghetti, unable to generate a heartbeat in any organized fashion. The colored monitor readings overhead were recording the disaster.
    Pulse 0… Mean arterial pressure 0…
    Selene had run off to page Scott Hartnett. The ICU intensivist was heading across campus from the cafeteria.
    The biological clock of brain death had begun ticking the instant Petros's heart had stopped.
    Thea's own heart felt like an expanding balloon, her stomach a pit of molten acid.
    Calcium… potassium… Perhaps it was an abnormality of one or the other of those, she thought desperately. Or maybe some drug toxicity. Or maybe tamponade.
    'Tracy,' she heard her voice say with no great authority, 'please call a Code Blue.'
    To one side of the cubicle, Niko stood, his arms folded, his face stone.
    'Code Blue Medical ICU… Code Blue Medical ICU…' the overhead page operator's voice droned from speakers outside the unit. 'Code Blue Medical ICU.'
    Tracy raced in with the crash cart and immediately reached up and hit the button that started the red sweep-second hand on the code clock set high on the wall over the door. The time started at zero, but Thea knew fifteen seconds or more had already elapsed. Every one of those seconds diminished the likelihood of a successful resuscitation and increased the evolving brain damage. The point of no return in any cardiac arrest was felt to be four minutes. No blood pressure beyond four minutes, unless deep body cooling had occurred from exposure or drowning, and brain damage would be irreversible. The only way to extend the four minutes was through effective CPR.
    Seconds later, the hospital CEO and nursing supervisor were there, along with one of the other ICU nurses. Amy Musgrave took up the Code Blue clipboard that was hanging by the door and began recording the event.
    'I've got this, Susie,' she said to the nurse. 'You help Tracy. Where's the intensivist?'
    'On his way from the caf.'
    The first technician arrived pushing her EKG, and began hooking Petros to the leads of his machine. Inhalation was next, then the evening nursing supervisor, who saw Musgrave handling what would have been her role had the chief not been there, and backed out of the rapidly filling cubicle.
    Thea glanced at the door, her mind unwilling to grasp that this was her show. The code clock was nearing thirty seconds. She was off to a terrible start.
    Do something! her mind screamed. This is jour father. Do something!
    She had taken, and of course passed with top marks, any number of advanced cardiac life support courses. She had instant total recall of the step-by-step problem-solving algorithms related to cardiac arrest.
    Rhythm: ventricular tachycardia … Institute basic life support including chest thump… Give amiodarone 300 mg IV and prepare to defibrillate at 200 joules…
    All she needed to do was compensate for the wave of anxiety that seemed to be smothering her. Over her years of training, she had participated in a number of codes, but almost always, she had deferred control to one of the other docs. In Africa, more than a few of her patients had died, but a cardiac resuscitation was seldom successful when nothing could be done about the underlying