No Man Left Behind

It started out like any other day. An older man was brought to the hospital following multiple fainting episodes and falls. He was found to be in complete heart block, and a temporary cardiac pacemaker was placed. In a short period of time, he became dependent on the temporary pacemaker to keep him alive. But the device started failing to reliably maintain his heart rate, so he was quickly brought up to the operating area for a permanent pacemaker insertion. We proceeded rapidly as the failing temporary pacemaker was allowing his heart to stop for increasingly long periods of time. However, such things are not uncommon and while there was a sense of urgency, the surgery proceeded in a relatively routine fashion. After making an incision in the upper chest, I opened a blood vessel and (using x-ray fluoroscopy) guided permanent pacemaker leads into the heart. Satisfied with the positions, I sutured down the leads and focused on enlarging the area where the pacemaker itself would lie. It was a routine case, just like the numerous ones I had done before. Then it happened. The sound of an explosion suddenly erupted through the operating area and the very floor below us shook. Then everything went black. Operating areas usually have no windows and are dependent on artificial light. Backup power sources are supposed to kick in when the flow of electricity to the hospital is interrupted, but nothing happened. There was absolute blackness. After what seemed to be an eternity (but was likely only a few moments), very dim lights appeared around the edges of the room, emitting just enough light to see dark shadowy outlines of people and equipment. An alarm began to sound just as the acrid smell of burning plastic began to fill the room. The nursing supervisor poked his barely visible head in through the door and yelled, “There is a fire in the basement below us. The hospital has almost no power; everybody must evacuate now!” To take the patient out of the operating area now with an open wound, the temporary pacemaker failing, and the permanent pacemaker not yet in place, would almost certainly have led to his death. “No,” I said calmly. “I need to finish.” “Everyone out now!” the supervisor yelled again. “Anyone who wants to leave can,” I said. There was a scramble of shadowy figures as people left.