Here After

by Sean Costello

  Now the nurse fitted an oxygen mask over the girl’s nose and mouth and instructed her to take some deep breaths. Peter picked up the syringes containing his induction agents and glanced at the monitor. His patient’s vital signs were stable, but her oxygen saturation—an indication of the adequacy of her respirations—was beginning to slip from its starting value of 100% into the middle 90’s. The girl was sedated now, and Peter quite reasonably assumed that her desaturation was due to respiratory depression, a common side effect of narcotics. With a view to ventilating her manually, he injected his induction cocktail, rendering her paralyzed and unconscious. He then took the mask from the nurse, reached for the black rubber bag that acted as a reservoir of fresh gas flow and found it collapsed. He adjusted the fit of the mask on the girl’s face, closed the pressure relief valve and increased the flow of oxygen, a series of maneuvers that predictably resulted in a fully inflated bag, the compression of which would then force oxygen into the patient’s lungs.

  But there was still no air in the bag; it hung there like a punctured beach ball. The girl’s saturations were in the high 80’s now and still falling.

  Tendrils of panic tightened around Peter’s heart. He said, “What the hell?” and turned to his machine.

  The surgeon was in the room now, looking concerned. He approached the bed, saying, “What’s going on?”

  Peter said, “I’ve got no pressure in the circuit,” and thumbed the oxygen flush button, opening a valve that purged the circuit with oxygen, a maneuver normally guaranteed to flood a closed circuit with fresh gas. The result was a loud whoosh of gas into the room through a huge leak Peter could not locate.

  The surgeon said, “Pete, her saturation’s seventy-nine.”

  Peter lifted the mask off the girl’s face. Her lips were blue. “Fuck,” he said, and punched the flush valve again, producing the same result.

  All eyes were on him now, the room dead silent, everyone waiting for him to remedy the situation. He could feel the panic coursing through him like white water down a rocky chute.

  The saturation monitor generated a musical note that registered the patient’s heart rate, a finger probe sensing the pulse in concert with the oxygen saturation. When the saturation was normal—between about 96 and 100% —that note was high and cheerful, providing an auditory cue that all was well. But as the oxygen level fell, the note reflected its decline with an increasingly ominous descent into the lower registers. That was all Peter could hear now—that low, deathly note, sinking deeper with each subsequent heartbeat—along with a growing shriek in the center of his skull, the sound of a high wind over a seething gray tide.

  The circulating nurse said, “Doctor Croft,” and Peter said, “Get me an Ambu bag.” The nurse dashed out of the room and now the surgeon came to the bedside. He said, “Shouldn’t you do mouth to mouth or something?” and Peter said, “Fuck,” unable to free himself from this deadly inertia. The nurse was taking forever and Peter said, “Get me something,” because his patient was dying and he couldn’t think of what else to do.

  Then the nurse was back with the Ambu bag, thrusting it at Peter, helping him tear it out of its plastic storage bag, and now Peter was pressing the mask to the girl’s dusky face, squeezing air into her starving lungs with the self-inflating bag, trying not to black out as the nurse attached the feed line to an oxygen source and the saturation monitor quickly resumed its comforting pitch.

  The surgeon said, “Jesus Christ,” and gave a nervous laugh. People went back to their duties and Peter intubated the patient’s trachea with shaky hands, feeling the hot flush of shame in his face, realizing he could have done this while he was waiting for the Ambu bag, could have stuck in the tube and forced air into it with his mouth. He attached the Ambu bag to the endotracheal tube and asked the circulating nurse to ventilate the patient while he turned his attention to the machine. He found the leak right away—the Biomed tech had removed the carbon dioxide absorber from its mount and forgotten to reattach it, leaving a gap in the circuit the diameter of a garden hose. Peter attached it now, then connected his patient to the mechanical ventilator. He dialed in an appropriate mix of gases and saw an Ambu bag hanging on the side of the machine, within easy reach. Every machine had one and he knew that.

  He felt like an incompetent fool.

  Once the patient was transferred onto the fracture table and the procedure got underway, Peter sat behind the drapes, out of view of the staff, and fought to suppress the well of tears that rose to his eyes. He spent the next hour and a half in the grip of the gnawing fear that he had harmed this innocent girl, though experience told him he hadn’t. The entire event had lasted less than three minutes—he’d checked it on the monitor’s database—the period of critical desaturation no more than thirty seconds in duration. A young healthy patient could tolerate three times that degree of hypoxia and survive unharmed.

  Still, he worried.

  And when the case was done and the girl opened her eyes, responding appropriately to his commands, the relief he felt was indescribable.

  He dropped the patient off in the recovery room, then told the desk clerk he’d be in Wendell Smith’s office if they needed him.

  * * *

  When Peter came in, Wendell was sitting at his desk, peering over the tops of his bifocals at something on his computer screen. He gave Peter a quick double-take and hopped to his feet, as if afraid Peter might collapse.

  “Jesus, man,” Wendell said, “are you all right?”

  Peter said, “Do you have a minute?” and leaned with both hands on the back of the stout leather chair facing Wendell’s desk.

  “Of course, sit.”

  Peter came around the chair and lowered himself into it, free falling the last few inches. His hands were still shaking.

  Wendell removed his glasses, setting them on top of a stack of journals. He said, “What’s going on?”

  “I just came this close to killing a patient,” Peter said, showing the department head a slip of space between his forefinger and thumb. Then he described the mishap in detail, shame making it impossible for him to meet Wendell’s gaze.

  When he was done Wendell said, “The girl’s okay?”

  “Yes, thank God.”

  “And you checked your machine before the case.”

  “Always do, but—”

  “So it was Biomed’s fault, plain and simple. Those guys are the mechanics, Peter, they know those machines better than you or I ever will. He should’ve known better.” Wendell took out his pen and squared a small note pad on the desk in front of him. “Which tech was it?”

  “That’s not why I’m here,” Peter said. “I’m not here to lay blame. And besides, you know full well that in a court of law a defense like that would be squashed in an instant by any even halfway competent prosecutor. The bottom line is, I’m responsible. I should have checked the circuit again. I knew the machine had just been serviced and—if it even occurred to me—I just assumed everything was okay.” He waited for Wendell’s concurrence, evident in the gradual softening of his posture. Then he said, “And even that’s no big deal. It was how I handled it. That’s why I’m here. If I’d handled it properly, this would be a non-issue. But there was an Ambu bag right there on the machine, not two feet away, and I didn’t even think of it. I froze, Wen. Just...froze.”

  “The nurse should have known that, too. Why’d she go running out of the room?”

  “Please.”

  “Okay, okay,” Wendell said. “Just my instincts coming through. It’s my job to protect you guys, you know.” He leaned back in his chair and smiled. “You think you’re alone in this? Two weeks ago on call, I switched a ventilator off to suction a guy’s tube. I hooked him up to the circuit again but forgot to turn the ventilator back on. I didn’t have a resident that night, but I did have the trots. I took a quick run out—three minutes tops—and when I came back the guy’s sats were in his boots. I felt like an idiot, worried myself sick for the next four hours,
but he was fine, too.”

  “I don’t see your point.”

  “My point is, this is a dangerous, stressful job, and shit happens. We’re human, we make mistakes. What matters is the outcome, right? Your patient’s fine. And what better way to learn? If I live to be a hundred, I’ll never make that little blunder again. I’m sure you won’t either.”

  “I’m not talking about an isolated event here,” Peter said. “Some days it’s like I’ve never done the job before. I forget things. Critical steps. The other day, instead of reversing a patient, I paralyzed him again. Picked up the wrong syringe. The day before that I ran a Remifentanil infusion with no Remi in it, just saline. I drew the stuff up and forgot to put it in the syringe. If that patient doesn’t have recall, I don’t know who will.” He leaned forward in the chair, holding his shaking hands up for Wendell to see. “Look at me, Wen. What I’m telling you is, I’m unfit. I froze today and that kid almost paid the price. I want out. I can’t do this anymore.”

  Wendell began to fidget. “Peter, if you need more time—”

  “You’re not listening,” Peter said, getting to his feet. “I’m done, Wendell. Finished.”

  “Peter, please. I heard you out, now do the same for me.”

  Peter sank back into the chair, feeling breathless, trapped. He just wanted out.

  Wendell said, “I can’t even begin to imagine what you’re going through, but you can’t just throw your life away over this. You’re a huge asset to this hospital, to this community. And you’re still a young man. If you walk away now, what’ll you do with yourself? How will you fill your time? Pay the bills? I know you like to keep your private life private, but what about counseling? Have you thought about that? I discussed it with the group while you were away, and if you needed more time for something like that, everyone’s willing to give it to you, all the time you need. Maybe it’d help you get some perspective on things.”

  “I understand what you’re saying, and I appreciate your concern,” Peter said, standing again. “But it’s over for me. If I hurt somebody here, through negligence or incompetence, I’d never forgive myself.”

  Wendell stood now, too, his expression grim. He stuck out his hand and Peter shook it. “Sounds like your mind’s made up.”

  “Thanks, Wendell. Thanks for everything.”

  “Can you finish out your day?”

  Peter shook his head. “I’m sorry.”

  “Don’t worry. Today’s an admin day for me. I’ll finish up for you.”

  “Thanks again.”

  At the office door, the department head said, “Can I call you in a couple of weeks? See how you’re making out?”

  Peter said, “Sure.”

  Behind them Wendell’s intercom buzzed, his secretary’s voice coming through. “Sorry to interrupt,” she said, “but there’s a call for Doctor Croft.”

  Wendell said, “If it’s the OR, tell them I’ll be taking over.”

  “It’s an outside call,” the secretary said. “The OR transferred it down here. Apparently it’s urgent.”

  Wendell said to Peter, “Want to take it?”

  “Yeah, all right.”

  “Put it in here,” Wendell said to his secretary. To Peter he said, “Go ahead, I’ll wait for you outside.” He pointed at the phone on his desk. “Just hit the flashing button.”

  Peter waited for the door to close behind Wendell before he picked up the receiver and said hello.

  “Peter?”

  At the sound of his name, its frantic tone spoken by this man, Peter felt panic tighten around his heart all over again. “Roger?”

  “Can you get to a television set? Right now?”

  Peter thought quickly. There was one in the patient waiting area upstairs. “Yes, but it’ll take a minute. Why?”

  “Just do it. CTV, NewsNet. I’m taping it in case you miss it. I’m at home, call me right back.”

  The line went dead. Peter hung up and ran out of the office, past Wendell Smith and his wide-eyed secretary, the woman uttering a startled cry as he flew past her desk. He broke into the main hall on the admin level and veered into a stairwell on the opposite side, almost bowling over an elderly volunteer lugging a stack of charts. Propelled by a mix of emotions he had no time to define, he took the risers in reckless threes, slammed through the door on the second floor and skidded toward a surprised porter who yanked open the door to the waiting area for him. Out of breath, he waded into the midst of gray-haired patients in wheelchairs waiting for joint replacements, patients on stretchers with brain tumors and obstructed bowels, and snatched the remote off an end table cluttered with magazines. Under the collective gaze of patients and staff, he aimed the remote at the wall-mounted television and found CTV.

  The program was already underway, and at first Peter couldn’t figure out what Roger wanted him to see. Then the anchor said, “Back now to Angela Ling for more breaking news from the town of Oakville, thirty minutes east of downtown Toronto.”

  The scene changed to an attractive Asian reporter standing outside a cordon of police tape stretched between tree trunks in a sunny public park, the reporter raising the microphone to her lips now, pointing with her free hand into a broad expanse of tree-studded grounds.

  “This peaceful urban setting was the scene not an hour ago of a brazen kidnapping attempt,” Ling said, “the highlights of which were captured on film by this man—” the camera panned back to reveal an elderly gentleman standing next to the reporter, a silver video camera slung around his neck “—Donald Perfetto, who had been videotaping his granddaughter’s seventh birthday party here in Warner Park.”

  Now the scene changed again, to Mr. Perfetto’s amateur footage: a few seconds of kids swarming around a picnic table, lining up for slices of cake doled out by an old woman who could only be Mrs. Perfetto. In the midst of all the excited chatter came a distressed, “Grampa, look,” and the video fell away from the scene, swaying above the old man’s Hush Puppies for a beat as he lowered the camera to see what his granddaughter was upset about. Then Perfetto’s voice, “Oh, Madonne,” and the video flashed up and to the right, wavering into focus on a jittery scene, recorded from a long distance at first, then pulled in as tight as the camera’s zoom lens would allow: grainy footage of a hunched figure wearing a black ski mask and dark, heavy clothing running toward the trees behind the play area, a span over flat ground of about three hundred feet. For the first few seconds only the figure was visible, then Peter saw a pair of small tan legs dangling from the figure’s off-camera side—and now a glimpse of blond hair, lit up by the sun as the kidnapper broke from the shadow of an enormous maple. Three shirtless young men who’d been playing Frisbee were converging on the kidnapper now, attempting to block his access to the dense stand of trees bordering the rear of the park; but the kidnapper kept running, straight-arming the first young man who got in his way, slashing at the second with what could only be a knife, its dull glint there and then gone. The third man, tall and heavily muscled, ran straight at the kidnapper as he passed a chain link fence enclosing what looked like a large power box. In the instant before impact the kidnapper side-stepped the young man, grabbed him by the hair and drove him head first into a fence post. With about a hundred feet left to the tree line now, two men on motorcycles roared into the space between the kidnapper and the trees and dismounted, dropping their bikes with the engines still running. The action vanished behind some bushes for a moment, then the kidnapper blurred into view again—without the ski mask this time—and made for the tree line unopposed, showing only his back to the camera. The kidnapper skidded to a stop at this point, the arm holding the child swinging wildly out in front of him, then the kid was on the ground and the bikers came into view, one of them limping, the kidnapper’s mask in his hand, the other joining a trio of park workers rushing in on foot to join the action. Though seriously outnumbered, the kidnapper seemed ready to reach for the kid again. Then one of the park workers made a grab for him, the kidnapper spun d
efensively...and the footage broke up and ended.

  Now the film reversed at high speed, the characters in this blurry drama backpedaling comically through space—then a freeze-frame of the kidnapper, a hunched behemoth in a long coat flared open like a cape, bald head bowed, powerful shoulders a streak of violent motion.

  Then, with calculated deliberateness, the kidnapper’s image clicked closer to the viewer, now closer again, each new frame centering on that gleaming head until it filled the screen in a kind of pixilated collage that was pure media art, a digital, impressionist’s portrait of the dragon rampant, at once unforgettable and pointless, the details of the face obliterated by distance and shadow.

  Now the spotlight returned to Angela Ling, Angela saying, “Exciting stuff. But despite the heroic efforts of almost a dozen people, this would-be kidnapper got away, fleeing the area in an escape vehicle police believe was waiting for him on a dirt service road behind the park. Numerous observers have reported seeing a white van peeling off recklessly down Shay Street, which intersects the service road, but apparently no one thought to record the license number.

  “Two men were injured in the encounter, one of them seriously.” A quick replay of the Frisbee player slamming into the fence post. “Twenty-one-year old Samuel Basco was rushed by ambulance from the park. The other man—” a flash of the biker limping out from behind the trees “—thirty-two-year old Clarence Hawes, is being treated at an Oakville clinic for a stab injury to his thigh, which apparently missed a major artery by less than an inch.”

  Angela Ling appeared again, closing in on a growing knot of reporters now, doing her best to clear a path for her cameraman. “Here they are now,” she said, “six-year-old Graham Cade, the victim in this foiled abduction attempt, and his fifteen-year-old sister, Risa, who had been supervising Graham while he played in the park.”

  The girl, Risa, held her baby brother in her arms, the boy’s back to the bobbing cameras, his thin chest heaving under a bright red T-shirt. The kid was clutching his sister for dear life, sturdy arms locked around her neck, bare legs clenching her hips. Risa was clearly distraught, her eyes streaming tears, her voice breaking as she described what had taken place.