The Splendor of Ordinary Days

by Jeff High

  Precious seconds were flying by. Still bouncing up and down, I snapped out instructions. “Camilla, hold the mask tightly over his mouth and nose and start bagging him.”

  She complied with a vengeance, squeezing vigorously on the oxygen bag, pumping him full of air.

  “Camilla, we’re not trying to inflate him like a flat tire. Just give him one slow squeeze every eight seconds.” She was wide eyed and scared to death, but nodded obediently with quick bobs of her head.

  Finally, the defibrillator was ready to analyze Hoot’s heart rhythm. But when I stopped compressions to allow for the test, I noticed the valve of the oxygen tank sitting on zero. Camilla had been pumping him full of room air.

  “Camilla, you need to cut the O2 tank on, wide open.” I was still calm but the aggravation was beginning to show. With quick, birdlike movements she looked back and forth between the tank and me, her face in a blank panic. I looked over to Nancy, speaking quickly.

  “Nancy, turn the valve counterclockwise as far as it will go.” She nodded and turned it so hard I thought she might twist it off.

  Mary Jo hit the analyze button. Above the din of the small crowd the mechanical voice of the defibrillator announced, “Shock advised.”

  “Set it at two hundred fifty joules. Everybody step back!” I nodded to Mary Jo.

  The shock caused Hoot’s body to jolt, almost lifting off the floor. Finally, his quivering heart was getting smacked back into rhythm. All eyes were on the defibrillator, waiting, watching. Magically, after a few sputtering waves, it began to show a sinus rhythm, a normal heart wave. Once again Ol’ Sparky had done his job. I exhaled a deep breath. Crisis over.

  That is, until five beats later, when the rhythm went flatline. No quivering, no V-fib, nothing.

  This was bad ­news—­really bad news. The small voice of panic began whispering in the back of my head. For a moment I stood there, frozen in disbelief. All eyes were on me. The only solution for ­jump-­starting a flatliner is drugs, delivered quickly and methodically in a timed sequence, and then shocking him. The voice was now screaming: Get moving, Luke—Code Blue! Code Blue!

  “Camilla, keep bagging him.” I searched the room and pointed to a lanky fellow in his late thirties. “­You— Did you see the way I was doing those compressions?”

  He nodded.

  “I want you to start doing them just like I was. Press ­hard—­he’s a big fellow. Try to do a hundred a minute.”

  I turned to Mary Jo. “We need to get him to the exam room and run a full code. Where’s our lift stretcher?”

  “We don’t have one.”

  “We don’t have one?” I responded incredulously. We had to get him off the floor and onto the gurney, which, I now noticed, wasn’t there.

  “Where’s the gurney?” I looked down the main hallway of the clinic. Nancy was waddling toward me, her short legs moving as quickly as they could. I met her halfway.

  “Cindy’s getting it. It was back in the storage room covered with the Christmas decorations. She’s cleaning it up.”

  I pressed my lips sternly together, squelching back a fuming desire to scream, loudly and with gusto. “Nancy, I don’t care if it’s clean or not. Bring it now and bring an extra bedsheet.”

  I returned to the waiting room and recruited three men and two of the heftier farm women to help lift Hoot. We got the extra bedsheet under him just as Cindy arrived with the gurney. The air was thick with confusion and tension. Hoot’s life was slipping away.

  With three of us on each side, we yanked him up so hard he almost went airborne. Stepping quickly, we dished him onto the gurney in a smooth, sweeping motion that was perfectly ­executed—­except for the small detail that no one had thought to lock the gurney’s wheels. Upon landing, Hoot scooted across the floor like a roller skate, his massive limbs dangling from all sides. I dove and caught him. We moved swiftly.

  Including the staff, about ten of us crowded into the small exam room. I stood at the head, calling out orders, timing the intervals, running the protocol. The passing minutes became a surreal blur as events moved with an unbelievable rapidity.

  Everything imaginable went wrong.

  Camilla, who normally had a ­rock-­steady hand, was so shaken she took forever to get an IV started. This forced me to give the first two doses of epinephrine by direct injection into his jugular, creating no small mess of blood. No one could find a blood pressure cuff big enough to fit Hoot’s arm. We pulled his boot off and put one at his ankle. I couldn’t intubate him because the battery in the laryngoscope was dead. The only atropine available was a month out of date. I used it anyway. With no way to get quick lab results, I was left desperately short of critical metabolic information. It wasn’t that the clinic’s resources were primitive; they were nonexistent.

  To top it all off, the EMTs had yet to arrive because they had been far out at a friend’s farm helping to deliver a calf. Only in Watervalley.

  Minutes passed. Numerous times the drug protocols sparked some sputtering waves. When that happened, we quickly shocked him, desperately trying to revive a normal rhythm. But nothing was working. Panic was seizing everyone, permeating the frantic voices of those around me. My frustration and anger mounted. Hoot Wilson was an otherwise robust, healthy man of ­forty-­three. To my thinking, it just wasn’t his time yet. But he was about to meet his maker because remote Watervalley lacked the fundamental equipment needed to keep him alive and all of my training couldn’t make up the difference.

  In my head I had been doing the math. It had been over thirty minutes since Nancy had first shaken him. By all the odds, he didn’t have a chance. I needed to think about calling it, but I just couldn’t. My irritation and fury surfaced. I took over doing the compressions and yelled audibly.

  “Come on, dammit. Get a rhythm going.” Sweat poured down my face. Everyone in the room was standing, staring with lost expressions. This ad hoc group had followed my instructions as best they could, but the drama had left them ­shell-­shocked and exhausted. Everyone knew the inevitable was coming. We had given multiple doses of epinephrine and atropine, we’d done continuous compressions, multiple shocks, and yet nothing. No sustained rhythm. I had lost him.

  Finally I stopped and stepped back, heaving deep gasps in and out, trying to catch my breath. I searched the long, somber faces of those in the room, particularly that of Mary Jo, the staff nurse. I was looking for confirmation. It was time to call it. That was when I noticed something that made me feel like an even grander failure.

  It was Wendy, Hoot’s daughter. All the while she had been sitting quietly in the corner of the exam room watching the terrible drama of her father’s last minutes. But something was remarkably odd. Instead of being in a state of panic and tears, she looked placid, curious. She sat and waited patiently for me to break the silence. I needed to call it, but her presence stopped me.

  Hoot was gone. At this point it made no sense to send her away, so I motioned for her to come closer. Her face expressionless, Wendy walked up to her father and with her pudgy hand she squeezed his large, bare foot and spoke in a soft and determined voice.

  “Don’t go yet, Daddy.”

  I exhaled deeply. It was the final straw, an epitaph to my failure.

  And then I heard the beep, a singular heartbeat on the cardiac monitor. The room held its collective breath. The beep was followed by another, then another, then another. We all stood in stunned, shocked silence.

  After ten more beats, Nancy Orman, a devout Baptist who for all of her ­fifty-­three years had lived, walked, and breathed a mile away from the nearest known sin, blurted out in a low, weak voice, “Holy shit!”

  Everyone else was speechless.

  Miraculously, the heartbeat continued.

  About this time the EMTs arrived. We loaded Hoot into the ambulance and I rode along for the ­forty-­five-­minute drive to the regional hos
pital in the next county. It was the closest facility available.

  Hoot’s heart rate remained constant. He even began to regain a drowsy consciousness on the ride over. A few days later he got a pacemaker and within a week he was back on the farm. It was a miraculous turnaround, one for the medical journals. But to the people of Watervalley, it seemed to be no big deal. To their thinking, it was just providential timing and grace.

  For me, it was more complex, a combination of critical elements. Yet still, I couldn’t completely account for it, just like so many other things about Watervalley that in time I would come to realize were simply not explainable.

  Being dead on the exam room table for that long normally impacts mental function. But with Hoot’s loud and happy personality, no one noticed a difference. He was just glad to be back among his cows and with the darling jewel of his life, his daughter, Wendy.

  From then on, every day after school, Wendy would go and sit in the corner of the milk parlor and calmly do her homework while Hoot went about his work. Engrossed in her lessons, she would quietly study, seemingly oblivious to the incredible noise and clamor of the milk machines and baying cows. But every so often she would look up from her book, and sweetly, proudly gaze over at her immense father and, with a face of pure love, smile.

  Hoot’s Code Blue happened on the Thursday of my first week as the new doctor at the Watervalley Clinic, my first job out of med school. I’d like to be able to say that the days leading up to it since my Saturday arrival had not been quite so eventful.

  Unfortunately, that just wouldn’t be true.

  Photo by Amanda Hagler

  After growing up on a farm in rural Tennessee, Jeff High attained degrees in literature and nursing. He is the ­three-­time winner, in fiction and poetry, of an annual writing contest held by Vanderbilt Medical Center. He lived in Nashville for many years, and throughout the country as a travel nurse, before returning to his original hometown, near where he now works as an operating room RN in general surgery.

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