Heart Trouble

by Jae

  There it was. The bead was lodged just anterior to the middle turbinate in his right nostril.

  “Are you ready?”

  With wide eyes, Jonah nodded.

  Using one hand to immobilize his head, she slid the catheter into his nostril.

  Jonah whimpered and tried to move his head to the side.

  “It’s okay. I’ll be done in a second.” She touched the suction tip to the bead and slowly withdrew the catheter.

  A red bead, covered in mucus, appeared.

  Hope dropped it into the plastic basin Scott held out and wiped the snot from Jonah’s upper lip. She shone the light into his nose again, checking for other foreign objects and making sure there was no bleeding. Good. No damage to the nasal mucosa. She nodded and rolled back her stool. “Great job, Jonah. We’re done.”

  Tears still rolled down his cheeks, but now he was beaming. “Can I get the sticker now?”

  Hope had to grin. “Of course.”

  “Thank you so much, Doctor.” Jonah’s mother held out her hand and then seemed to realize that Hope wore mucus-covered gloves. She withdrew her hand and smiled. After a quick, less friendly glance in Scott’s direction, she picked up her son and carried him out of the exam room.

  “Jeez,” Scott muttered. “Thank God I didn’t go into pediatrics.”

  Yeah, thank God—for the poor kids! “It wasn’t that bad. He was actually very cooperative for a boy of his age.”

  Scott made a face.

  Hope shook her head at him. “Go check if Mr. Hegland’s labs are back.” She stripped off her gloves and threw them into the medical waste container by the door before following Scott.

  One glance at the electronic patient board stopped her in her tracks. Jonah’s name had been removed, but in its place, five new names had shown up on the board. As Hope watched, another appeared at the bottom.

  The triage nurse walked over and dropped an armful of intake sheet clipboards into the rack marked patients to be seen.

  At the nurses’ station, the EMS radio crackled to life. “We’re coming in with a twenty-eight-year-old male who crashed his car into a tree. He’s alert and oriented, but he’s got a large forehead laceration.”

  He probably hadn’t worn a seat belt. Hope had seen it countless times. He would need a CT scan to check for brain injuries as soon as he arrived.

  Janet Wang, her third-year resident, stepped out of exam room two, looked at the patient board, and blinked. “What happened?”

  “Someone who shall remain nameless mentioned the Q word,” Paula said.

  An ambulance siren grew louder and then stopped mid-wail as the rig reversed into the ambulance bay. Red lights bounced off the automatic doors.

  Ignoring her superstitious co-workers, Hope grabbed a surgical gown and rushed toward the ambulance bay.

  * * *

  Laleh’s rapid heartbeat still hadn’t normalized by the time her mother stopped the Volvo in the hospital’s parking lot. Her heart felt as if it were going to burst out of her chest. Was it just her imagination, or was her chest starting to ache?

  Fear gripped her, accelerating her pulse even more.

  The ground seemed to sway beneath her as she staggered across the parking lot toward the large, blood-red emergency sign above the entrance.

  Her mother gripped Laleh’s elbow, steadying her. “Are you all right? Can you walk? Do you want me to get a doctor?”

  Laleh weakly shook her head. If she made it a few more steps, they’d be in the emergency room anyway.

  The sliding glass doors swished open in front of them. They walked past a security guard, who gave them a concerned look.

  A line had formed in the admissions area. In a tiny room with a Plexiglas door, a man was having his blood pressure taken, and the clerk behind the reception desk was busy getting insurance information from a patient who didn’t seem to speak much English. The person he had brought to translate wasn’t much more competent. This could take a while.

  Oh no. Laleh needed to sit down. Now. The few steps from the parking lot had left her breathless and dizzy. She pressed her palm to her chest. Even though she wasn’t a religious person, she prayed for her heart to slow down. Stop it. Please, please.

  With her mother still gripping her elbow, she got in line. Her pulse thudded in her neck. Her entire body seemed to pound in the wild rhythm of her heartbeat. She couldn’t breathe…couldn’t think…

  How much longer? She turned her head and glanced up at the giant clock on the wall, but its hands blurred before her eyes. A wave of nausea gripped her. The beige linoleum floor started a slow, twisting motion. She clutched her mother’s arm, trying to keep herself upright, but her knees buckled.

  A scream echoed in her ears.

  Suddenly, she was staring up at a dozen blurry shapes surrounding her. Then the bright fluorescent lights faded away, and the world went dark.

  CHAPTER 2

  After finishing up with the accident victim, who luckily hadn’t suffered any head injuries beyond the laceration, Hope walked over to the nurses’ station and took the next clipboard from the rack. A glance at the admission sheet revealed that the patient suffered from chronic abdominal pain.

  Great. He’d probably had this problem for months or even years, and now he would expect her to have the answer for his irritable bowel within an hour. She loved her work, but sometimes the unrealistic expectations of some patients were frustrating to no end.

  A commotion from the admissions area made her turn around.

  “Dr. Finlay! Quick! Someone collapsed out here.”

  Hope tossed the chart onto the counter and sprinted through another set of glass doors toward the admissions area.

  With a glance, she took in the scene in front of the reception desk. The triage nurse knelt over someone lying on the floor while a nurse’s aide held on to a crying older woman, who looked as if she was about to collapse herself. “Please, please, help my daughter!”

  Hope pushed through the gawking people surrounding the patient. Now she could see her. It was a young woman, probably a few years younger than Hope’s thirty-one. Her face had gone pale beneath her olive complexion, and she lay without moving. Was she even breathing?

  The triage nurse held her fingers to the young woman’s carotid artery. “No pulse. She’s coding.” She interlinked her fingers, put one hand on top of the other, and centered them on the young woman’s sternum.

  Adrenaline rushed through Hope. Her vision tunneled, her focus now only on the collapsed patient. “Someone get me a stretcher! Let’s get her to a trauma room.” She waved at the security guard. “Jake, get these people out of the way.”

  Gurney wheels screeched over the linoleum. Janet and Paula pulled a stretcher to a stop next to their patient.

  “On my count.” Hope looked at each member of her team to make sure they were ready. “One, two, three.”

  With practiced ease, they lifted the young woman onto the gurney.

  Janet climbed up and straddled her to continue compressions. A nurse placed the mask of an ambu bag on the patient’s face and started squeezing the bag to pump air into her lungs.

  “Do we have a history on her?” Hope asked while they rushed the patient down the hall.

  “No,” the triage nurse answered. “She hasn’t been through triage yet. Her mother says she’s had episodes of tachycardia for a few years, but never anything like this.”

  Two nurses jumped out of the way and flattened themselves against the wall to let the stretcher pass.

  “Put her in trauma two,” Paula shouted.

  They wheeled the stretcher into the trauma bay. As soon as they had her in the room, a flurry of activity broke out.

  Janet hopped off and immediately resumed compressions from a position next to the stretcher. The respiratory tech took over the ambu bag from one of the nurses.

  “Get the crash cart over here,” Hope said. “Let’s get her clothes off and hook her up to the monitor.”

  Paul
a grabbed a pair of trauma shears and cut off the patient’s clothes.

  As the blouse fell away, Hope noticed a large stain on the material. Had the patient been hit in the chest by something? A direct blow could disrupt the heart’s rhythm if it hit at the wrong moment. But there was no hematoma on the woman’s chest.

  One of the nurses attached electrocardiograph patches to the patient’s now-bare chest and hooked the leads up to the cardiac monitor and the defibrillator while another clipped a pulse oximeter to her finger.

  “Run normal saline,” Hope said from her position at the foot of the treatment table, where she had the best overview and could direct her team.

  Paula inserted a catheter into the patient’s arm, hung a bag of normal saline, and connected the IV line.

  Hope’s gaze zeroed in on the monitor. “Pause compressions for a rhythm check.”

  When Janet paused with her hands on the patient’s chest for a moment, the green line on the EKG showed a squiggly pattern.

  “She’s in v-fib.” The ventricles of their patient’s heart were quivering uselessly, not pumping blood to the body and the brain. If they didn’t interrupt the dysfunctional rhythm quickly, it could degenerate to asystole, with almost no hope of saving her life.

  “Charge the defibrillator to two hundred,” Hope said.

  The high-pitched whine of the defibrillator charging filled the trauma room.

  A nurse placed bright orange gel pads on the patient’s bare chest, one just below the right clavicle, the other more sideways beneath the left breast.

  Come on, come on. Hurry! How long had their patient been down at this point?

  As soon as Paula called “ready” from the defibrillator console, Hope grabbed the defibrillator paddles from the crash cart. There wasn’t much space between the table and the wall on the left, so she crossed over to the patient’s right side. “Hold compressions,” she called to Janet, who was still doing CPR. She had to bend over the patient and stretch so she could place the paddles on the gel pads without leaning her hip against the table. “Everybody clear?”

  The nurses, the resident, and the respiratory tech stepped away from the patient and the treatment table.

  “Clear,” someone shouted.

  Hope tightened her grip on the paddles and glanced over her shoulder to make sure no one was touching the patient or the stretcher. Then she pressed the discharge buttons.

  A jolt of electricity arched through the patient. Her arm flew up and hit Hope in the chest.

  Electricity tore through Hope. She stumbled back and crashed into the IV pole.

  She heard Paula’s “We’ve got a pulse” as if from very far away.

  “Dr. Finlay! Are you all right?” Janet clutched her shoulders.

  Dazed, Hope stared at the resident. Dammit. That was stupid. She must have placed the right paddle a little too far to the side. What a rookie mistake! You’re lucky all that happened was triggering the deltoid and getting a slap in your chest.

  Hope’s chest and arm, down to the tips of her fingers, were tingling. Her heart hammered against her ribs, but she knew it was just the adrenaline, not an arrhythmia caused by two hundred joules tearing through her.

  “I’m fine.” She took a steadying breath and stepped back to her patient’s side. Instead of the squiggly line indicating ventricular fibrillation, the monitor now showed the steady pattern of normal sinus rhythm.

  “BP?” Hope asked.

  Paula pressed a button to inflate the blood pressure cuff around their patient’s arm. “Ninety over sixty.”

  Hope gestured to the IV, which thankfully hadn’t been ripped from the patient’s arm when she had stumbled into the pole. “Turn the fluids up a little.”

  Paula took the blood pressure again, and they watched it rise.

  The respiratory tech removed the mask from the patient’s face.

  The young woman’s eyelids started to flutter, but she didn’t quite wake up yet.

  Hope watched her for a moment. “Welcome back.” She inserted the earbuds of her stethoscope, warmed the bell between her fingers for a moment, and listened to the patient’s heart and lungs. Both lungs sounded clear. No heart murmur either.

  With a satisfied nod, she removed the earpieces and slung the stethoscope around her neck to have her hands free. Gently, she pulled back the patient’s right eyelid, then the left and shone a penlight into her eyes, one at a time. Both pupils constricted equally.

  Finally, she ran her fingers over the back of the patient’s head, beneath the long, black hair, to make sure she hadn’t hurt herself when she’d collapsed. No blood, no swelling.

  She stepped back, stripped off her gloves, and resisted the urge to rub her chest and arm. Maybe it was just her imagination, but they were still tingling. She was shaking all over. Christ. Something like that hadn’t happened to her since her second day of residency, when an overeager first-year resident had shocked the patient without making sure his fellow doctors had stepped away. She took a moment to look around and get her bearings.

  As usual after a code blue, the trauma room looked like a disaster area. The patient’s cut-off clothes and empty wrappers of tubes, fluids, and gel pads littered the floor. The medical students who had crowded into the room to watch the resuscitation stared at her.

  “Back to work, people,” she called and was glad to hear that her voice sounded normal. “Paula, please call the CCU and tell them we have an admission. Move her to one of the treatment rooms for monitoring. And while we wait for a bed to become available upstairs, let’s get an EKG and draw blood for a standard blood panel, ABG, cardiac markers, and electrolytes. Get a cardiologist down here and call a tech for an echo.”

  Paula strode toward the wall phone.

  Hope shoved open the sliding door and stepped out of the trauma room. Slowly, her trembling stopped, but the feeling of disbelief stayed. She knew she’d run through the entire code later, trying to find out where exactly things had gone wrong. But before she could do that, she had work to do. For one thing, she needed to talk to the patient’s mother and let her know that her daughter was stable for now.

  “Is the patient’s mother still here?” she asked the nurse’s aide she’d last seen with the crying woman.

  “Yes,” he said. “I put her in the private waiting room.”

  “Do we have a name?”

  He hesitated. “Samadi or something like that. It sounded Japanese.”

  “More likely Iranian or Syrian,” Hope said, even though she hadn’t paid all that much attention to how her patient looked. She had only a vague impression of black hair and high cheekbones, so their patient could be Asian American after all.

  When the nurse’s aide shrugged, she walked toward the small waiting room.

  Janet hurried after her. “Wait! Do you…do you want me to talk to the family while you go get checked out?”

  Hope appreciated the resident’s offer, but she shook her head. “I’m fine. It wasn’t really painful, more like a strong shock from a cattle fence. It surprised me. That’s all.”

  “All right,” Janet said with a hint of reluctance. “If you’re sure…”

  “I’m sure.” Hope gave her a pat on the shoulder and continued on to the waiting room. She paused for a moment, habitually making sure that her name tag was straight and there were no blood stains on her scrubs or lab coat before opening the door.

  The fawn-colored couch and easy chairs were empty. The only person in the room—a small, Middle Eastern woman of around fifty—was pacing.

  As Hope entered, the woman froze and looked at her as if caught between the impulse to storm toward her to find out information about her loved one and the urge to run away because she didn’t want to hear the bad news Hope might deliver.

  “Mrs. Samadi?” Hope asked.

  The woman nodded and swallowed audibly.

  “I’m Dr. Hope Finlay. I treated your daughter.”

  “Laleh. Her name is Laleh. Is she…?” Mrs. Samadi wrung
her hands, her eyes glassy with tears.

  “She’s stable at the moment,” Hope said quickly.

  Mrs. Samadi plopped down onto the couch as if her knees had buckled. “Oh thank God!”

  Hope sat next to her so they could talk eye to eye but kept a respectful distance.

  “What happened?” Mrs. Samadi finally asked. She had a faint Middle Eastern accent that made the w sound more like a v.

  “Your daughter…Laleh, she suffered from a type of abnormal heartbeat that stopped the blood flow to her brain. That’s why she passed out. Luckily, we were able to get her heart back to a normal rhythm very quickly. We’re still running tests to figure out what caused it. Does your daughter have a history of heart problems?”

  “No.” Mrs. Samadi vehemently shook her head. “Sometimes, her heart beats a little too fast, but the doctor said it’s only stress.”

  Hope doubted it, but she said nothing.

  “Can I see her?”

  “We’re setting up an EKG and running a few other tests, but once that is done, I’ll get a nurse to take you to her. Do you have any other questions?”

  Mrs. Samadi shook her head again. “I just want my daughter to be all right.”

  “We’re doing our best,” Hope said. In the last six years, first as a resident and now as an attending, she had learned not to make any promises beyond that. She said good-bye to Mrs. Samadi and strode back toward the treatment rooms to check on her patient and fill out the code sheet.

  * * *

  Bright fluorescent lights filtered through Laleh’s closed eyelids. Somewhere nearby, something metal clinked onto a tray. Low voices drifted into the room. For a moment, she thought she was in her aunt and uncle’s restaurant, but the smells were all wrong. Instead of the tantalizing aromas of basmati rice, saffron, and cardamom, the harsh smell of disinfectant and the sour odor of sweat assaulted her nose.

  What…? Where…? She opened her eyes and squinted against the overhead light.

  After a moment, a tiled, sterile room swam into focus around her. Medical equipment surrounded her.