A Step Beyond by Christopher K Anderson Page B

uncertain. So he sniffed a little bit deeper. The odor was sweet and slightly pungent. As it slowly expanded into his lungs, he realized that it was intestinal gases. The gases had grown foul inside the wound. He began to gag.
    Endicott looked up to see Carter’s back hastily retreat through the portal. He then looked across the table at Nelson, who with a blood-soaked sponge in hand was about to go after him.
    “It’s not unusual. Some fresh air and he’ll be all right,” Endicott said. Tom Nelson looked uncertainly at the portal.
    “I need you here,” Endicott said. As their eyes met, they heard the sound of Carter vomiting in the next room.
    They quickly returned their attention to the body on the table. Towels were draped over the abdomen to form the boundaries of a rectangle outside the wound. The skin was pulled back, revealing a thin layer of red oblique muscles. The lower portion of the opening was filling with blood.
    “Sponge,” Endicott said.
    Nelson carefully pressed a sponge against the blood.
    “Hemostat,” Endicott said.
    Wiping the perspiration from his brow as he placed the sponge in the sink, Nelson hesitated at the sight of several clamps of various sizes. He chose a medium-sized one and handed it to Endicott.
    “Sponge.”
    Nelson wiped the blood clear.
    “Don’t wipe. Press,” Endicott instructed. “Wiping the sponge across the vessel may increase the hemorrhaging.”
    Endicott located the severed vessel and quickly clamped it shut.
    “Hold this,” Endicott said, presenting the end of the hemostat to Nelson. They heard Carter quietly enter the room to resume his vigilance at the life-support monitors.
    “Ligature.”
    “What?” Nelson asked, his voice strained.
    “The thread.”
    “Thread,” Nelson repeated as he placed it in Endicott’s hand.
    “We are going to tie off the vessel to stop the bleeding. Listen carefully; although the simulation made this look easy, it can be somewhat tricky the first time you try it. I want you to hold the hemostat straight up while I pass the ligature around behind it. You will then lower the handle and raise the tip so that I can tie a knot around the vessel. When I say ‘off,’ remove the hemostat. With the scissors cut the thread at the points I indicate. Take care not to cut or touch anything other than the thread. Are you ready?”
    “Ready,” Nelson replied, attempting to sound more confident than he actually felt.
    “OK, lift the hemostat.”
    Nelson obeyed and held the clamp perpendicular to the body, allowing Endicott to pass the thread behind it.
    “Pull up slightly so that I can get the thread around the vessel.”
    As Nelson pulled, the clamp slipped off the vessel and blood spurted from the severed tip.
    “Damn,” Nelson said.
    “Sponge,” Endicott ordered. “Quick.”
    Endicott took the sponge and dipped it into the wound. “Blood pressure.”
    “One-thirty over eighty,” responded Carter.
    “Good,” Endicott replied. “Let’s try it again. Hemostat.” Nelson handed the hemostat over and watched as Endicott clamped the vessel shut at a spot slightly farther back than he had the first time.
    “OK, hold this here,” Endicott said, offering the clamp. “Do not put too much tension on the blood vessel. Pull back gently. That’s good.”
    Endicott tightened the thread around the vessel. He looked up and smiled triumphantly. “Off.”
    Nelson released the clamp and, when he was sure the knot would hold, breathed a sigh of relief.
    “Cut the ends with the scissors.” Endicott held the two ends of the ligature apart. They formed a giant V. “Not so close.”
    “Where then?” Nelson asked.
    “A centimeter up from the knot. It may come undone if you cut too close, and the ends may get in the way of the scalpel if you cut too far.”
    Nelson, taking a deep breath, bent over the body and clipped the thread.
    “And now,” Endicott said, “the external obliques.”
    Without turning around, Carter spoke. “The