by Chuck Logan
"Are you treating for pain?"
"Nancy gave him twenty-five milligrams of Demerol. I'm going to get him something cool for his throat."
Amy breezed past and Broker watched her model the possibilities of baggy blue trousers as she walked down the hall. "She's pleased with herself," he said.
"Yes, nice, ah, glutes. Nordic skiing, diagonal stride, would be my guess," Allen yawned. He blinked and continued in a more serious voice, "She was extra careful extubating him and bringing him out of anesthesia. He has a tricky throat to work in. She's as good as or better than anyone I've worked with in Level One, so she's earned some strutting rights." As an afterthought, he said, "She's wasted on this place."
Then he patted Broker on the shoulder and drifted back down the hall and sat heavily on a folding chair. At the other end of the corridor Amy Skoda stopped to chat with Iker. They both looked up at Broker at the same time, and Amy batted her eyelashes, then lowered her gaze, walked away from Iker, and turned out of sight down the hall.
Then Broker nodded out on his feet and came back when he started to lose his balance. Dead-tired, he saw some movement. Iker and Shari started toward the dispatch room across from the ER cubbyhole and the yells started.
"Heads up, gang! We got another one!"
"What now?"
"No problem, relax, a broken arm, lacerations," called Brecht. "A drunk tried to drive a snowmobile through a birch tree. Thing is, that Tahoe they're using as an ambulance got stuck on the street, so we're going to have to manhandle the stretcher in."
Broker went to the garage, slipped back into his wet boots, and
went to the street in front of the hospital, where deputy Sam had mired the Tahoe in a drift. Amid much yelling, they hauled another man lashed to a Stokes stretcher into the garage. Lumps of frozen blood the size of jelly beans stuck to the new patient's face and he smelled of alcohol and gasoline. A bloody pressure bandage was wrapped on his head.
Tracking snow, they stomped in through the garage and transferred the guy to a treatment table in the vacant emergency cubbyhole. Milt had been moved deeper into the building.
"This one's mine," Brecht said and he commenced the call for tests and service. Amy appeared at Broker's side, handed him a Dixie cup full of chipped ice, and said, "Hold this a sec." Up close, in addition to the gray eyes, she had long lashes. And she smelled good. Neither medicinal nor cosmetic.
But clean. And just so . . . there.
Broker kicked off his snowy boots and put his dry slippers back on as Amy joined the ER doc and bantered for a moment. Then she broke away and returned down the hall. "No big deal, a broken leg," she said, taking back her Dixie cup.
Whoa!
Broker came up sharp on the balls of his feet, his eyes darted. Heard something . . .
"You all right?" Amy asked.
Broker held up his hand. Stop. Listen. He stared at the skinny nurse with the black ponytail, who had been watching Sommer and had been out into the snow briefly to help with the new arrival. She was now hurrying up the hall toward the recovery room.
Broker, who could hear his daughter cough across a crowded auditorium, detected it through the medical chatter. Cued by his hard eyes, Amy and the other nurse caught it one beat later. Allen, sitting zombielike in the corridor, lurched up in his chair, raised his head, and turned.
The once rhythmic beep-beep-beep of Sommer's monitor was improvising in a minor key.
Booop . . . booop . . . booop . . .
"Oh fuck!" The color drained from Amy's face and the Dixie cup went flying and ice chips skittered over the waxed linoleum floor as she sprinted down the hall.
Chapter Ten
Booop . . . Booop . . . Booop. "Shit! Call a code. He's arrested in here!" Amy yelled as she ran
through the door into the recovery room. Broker was right behind
her and he saw Sommer lying rigid with his eyes shut, his lips and
cheeks turning the blue-gray color of the glacier water, and from
then on it only got worse. "Christ, he's in V fib! What the fuck happened?" Allen rushed
into the room and his dazed eyes swept the monitor and then fixed
on Sommer's face. "I don't know. He came out clean in the OR. He was fighting
the tube. Vitals were fine, train of four. Now . . . he bradied on me,"
Amy shouted back as she moved behind Sommer, clamped his face
in both her hands. "What the . . . ?" blurted Dr. Brecht, coming through the door. "He's in bradycardia. Bag him, start CPR," Allen said, crossing
his hands over Sommer's sternum. Immediately Brecht reached for
the defibrillator that sat on the cluttered crash cart.
With one eye on the monitor screen where a low, bumpy line
traced the failing heartbeat, Amy thrust Sommer's jaw up, opened
his mouth, and swept a finger in his throat. He hadn't swallowed his
tongue. "ABC's, ABC's," she chanted under her breath. "Oxygen."
She grabbed the oxygen mask as Brecht checked the defibrillator
cords and unwound the paddles. Amy yanked the mask over Som
mer's face and pumped the balloon bellows.
Allen pistoned down in a CPR rhythm and burned a question at
Amy. "How long?" he demanded.
"I don't know," Amy said between clenched teeth.
"More than four minutes?"
"I don't know, goddammit."
Brecht lowered the paddles and went to the cardiac monitor.
"Jesus," he said.
"What?" Allen asked.
Brecht poked a button on the monitor. An alarm began to wail
and the Ely doctor erupted. "The fucking alarm was turned off!"
"No. That's not true . . ." Nancy protested.
"Nancy, shut up," Amy said. And Broker, standing back against
the wall out of the way, winced at the reflex of damage-control in
her voice.
"Christ, Amy," Nancy stammered, "I just went out to help with
the accident case, I looked in before I went outside," she protested.
"His vitals were normal, he was talking. The monitor was set and
he was fine."
"Well, he's not fine," Allen muttered as he pumped down. "He's
in arrest. I want to see your charting. I want to know how much
sedation he had on board."
"I brought him out clean," Amy declared, the gray of her eyes
tightening, going steely.
"What the hell?" Mike, the administrator, lurched in the door
way.
"Get him out of here," Brecht shouted. Shari, the paramedic,
stepped in and gently but firmly crowded the horrified administrator
back into the corridor. Allen and Amy stared at each other, their
faces inches apart as they worked. Brecht returned to the defibrilla
tor and held a paddle electrode in each hand.
Amy shook her head. "He's coming back."
But the line on the monitor was still going a bumpy boop de
boop and Brecht hovered, holding the paddles like cymbals. Allen
kept up the compressions.
Boop beep boop beep beep beep . . .
"Keep ventilating, he's coming around," Amy said as the white
clay of Sommer's chest moved. "I'm telling you, he's breathing,"
Amy insisted.
"She's right," Allen raised a hand in the first calm gesture since
the incident started. "He's back."
Broker caught peeks of Sommer in the blue-clad scurry and
could see the faint pink filter into his cheeks, his throat, and into his
motionless, thickly muscled forearms.
Allen popped back one of Sommer's eyelids and Nancy handed
him a slim penlight. "Mid position, reactive to light. C'mon Hank,
wake up, man," Allen whispered.
Sommer lay like a grotesque doll
with his smock pulled to the
side and his swollen belly bulging in the harsh light. A long splash of
Betadine bathed the incision and bled thick orange streaks down his
hip and groin. The incision itself looked like a line of flies melted
into his skin and, below the cut, his genitals were a heap of spoiled
white fruit. Gently, Allen tidied the smock as the steady beep-beep
beep marked time in the silent room.
Allen swayed, regained his balance, and shot a withering stare
at Amy. "I want to know all the meds he's had in the last thirty
minutes."
"I did everything right." Amy's posture was firm, but her cocky,
confident demeanor had deserted her, and her words came out with
a dry rasp that grated into irritation. "Doctor, sit down, you're
asleep on your feet."
"Answer the question. Any signs of recurarization?" Allen per
sisted.
"No, dammit," Amy said.
Allen steadied, took a breath, exhaled, spoke in a more normal
tone. "I'm sorry, he's a friend of mine . . ." He looked at Sommer,
the monitor. He rocked again. Caught himself.
Amy shook her head, disbelieving. The small room was full of
sympathy but she found herself at bay, and when she spoke she was
speaking to herself, not replying to Allen. "Could he have aspirated
when we went after the new patient?" She shook her head, bit her
lip. Thinking out loud, she muttered, "God, did I take the airway
out too soon?"
Beep-beep-beep.
The doctors and nurses stood in a circle over Sommer as the
room took on the acoustics of a brightly lit morgue. When Brecht
broke the silence and told Nancy to wheel the snowmobile accident to X-ray, she moved like she was walking underwater. Iker appeared in front of Broker and raised his hands, questioning. Broker shook his head, exhausted. He pushed past Iker and continued down the hall away from the institutional tile, the stainless steel fixtures, the barren whiteness of it.
He shoved through the emergency room door, and paused in the garage to pull on his parka and light a cigar. Then he stepped out into the stinging snow. It was more hospitable than where he'd been.
A moment later Shari joined him. Cupping her hands expertly against the wind, she lit a filtered cigarette with a Zippo. They stood for several minutes, smoking.
"Friend of yours?" Shari asked.
"I just met him three days ago," Broker said. "I don't get it." He couldn't make it fit coming after the storm, the long paddle, the plane ride, the blizzard, the successful operation.
Shari was direct. "The nurse-anesthetist fucked up. Which is a hard call because Amy is really good."
"How? Without the big words."
"Who knows. The guy's got that short, muscular neck, a receding chin, and the buckteeth. He's an anesthetist's nightmare. After surgery, when they take him off the gas, they remove the breathing tube and the carbon dioxide builds up in his bloodstream. That gets him breathing again. What they're saying is his airway collapsed in the recovery room. So maybe he was breathing but still had enough residual sedation in him to come back on him and he went hypoxic."
"Allen said . . . curare something?" Broker asked.
"Recurarization," Shari said, nodding. "It means like reparalysis. If Amy miscalculated the amount of sedation he had on board it could have taken effect again, and he takes a spill off the steep slope of the oxygen-hemoglobin-dissociation curve. That'd do it."
"Jesus."
"Yeah. And nobody was there. He couldn't get air. He started sliding into arrest and no one caught it. Somebody—probably Nancy, who's working a second shift and is covering three jobs today—neglected to calibrate the monitor alarm." She shrugged. "Cut the O's to the brain for four minutes and the guy's a carrot. It happens."
Broker turned away and wandered back into the hospital where
people continued to teeter on stilts of shock. Amy stood vigil in the
recovery room at the head of Sommer's bed. Brecht, Judy, and
Nancy huddled a polite distance from her. It was like a wake in
there, so Broker went back in the hall and saw Allen pacing, bent
forward, as if he were walking uphill. Allen blinked, focused, and
recognized Broker, then walked over and patted him on the shoul
der. The fatigue he'd kept at bay to perform the operation now poi
soned his face into a haggard nicotine-yellow, and Broker read it all
in the surgeon's hollow stare. Save the guy and then . . .
Allen attempted to smile. "I have to tell Milt. You know, he's
been asleep through all this." "What happens now?" Broker asked.
Allen slowly shook his head. "It depends on how long he didn't
get oxygen. He's comatose. He could wake up in a few hours or in a
few days, or it could be weeks. Or . . ." Allen pursed his lips. "Once
he opens his eyes he can be evaluated by a neurologist. Until then,
we're only speculating but . . ." Allen faltered, his voice caught. "Jesus, look at him. He's suffered some damage." "Some damage?" Broker repeated. "Brain damage." "You mean?" "I mean, she shouldn't have pulled that tube so soon in the OR." "He was talking. They were talking. They were teasing back
and forth," protested Broker.
Allen made a weak, erasing gesture with his right hand. "I don't
know. It's like . . ." he swatted the air, ". . . stop signs. Nobody
obeys them anymore, they can't be bothered to take the time." A
sound between a cough and a laugh rattled in his throat. "She was
in a hurry, I guess."
Then Allen continued down the hall to the nurses' station and
Broker watched him pick up the phone slowly as if the receiver were
an anvil. Slowly, Allen pressed in the numbers and waited and then,
as he began to talk, his facial expression collapsed inward like a
piece of crumpled paper.
Standing ten feet away Broker could hear the stunned, vaguely
familiar female voice protest over the phone, "No, what a minute,
how could that happen? He was in the hospital, goddammit."
Chapter Eleven
It was still snowing. But softer now, almost out of respect. "Stop signs, huh," mulled Dave Iker. "He's got a point. World
War Three will probably start some hot afternoon down in Min
neapolis at a four-way stop."
They were both pretty beat up.
Iker's service belt reeked of wet leather, piled on his desk in the
sheriff's office in the Ely courthouse. They were still wearing the
mismatched sweat suits from the hospital, and Iker's purple and red
sweatshirt bore the crude drawing of a bearded man holding a big
grasshopper. The type underneath spelled: ST. ERHO FESTIVAL, MENAHAGA, MINNESOTA
St. Erho was the patron saint who rid Finland of grasshoppers.
Uncle Billie maintained that St. Erho's Day, like St. Patrick's Day,
was an excuse to get drunk, because there never were grasshoppers
in Finland.
Broker stared out the window at the moderating storm and it all
went into a distracted glide, and he mused how lots of Finns had set
tled around Ely. Maybe because the lakes and forest and six months
of winter reminded them of home. Or maybe their national ethic of
fatalism attracted them to farm fields full of granite rocks.
Broker caught himself drifting, shook his head, and asked, "That nurse-anesthetist, Amy, she local?"
Iker nodded. "Ummm. Amy Skoda is one of the few who fig
ured how to come back and earn a living." He slowly raised his eyebrows. "She
was asking about you, before it all went bad."
"Skoda? She a Finlander?" Broker asked.
"Half Finnish, half Slovene; the cream of the local gene pool." He threw an arm toward the wall where a procession of retired peace officers stared down from framed portraits. "Second picture up there. Stan Skoda's kid." Skoda filled the picture frame like an amiable fireplug and Broker vaguely remembered the man from hunting parties when Broker was in high school.
"Take a hike. I gotta make a call," Iker said. The format glowing on his computer screen gave his face a lime tint as he hunched back to his chair and stared at the number jotted in his spiral notebook.
Broker nodded, got up, and went looking for the gents, as Iker reached for the phone. He had to make the duty call to Hank Sommer's wife and explain the circumstances of the tragedy.
When Broker returned, Iker was predictably more gloomy.
"How'd it go?" Broker asked.
"She said '—but he was in the hospital' three times." Iker shook his head. "Could have been worse. That doctor, Falken, had already called and prepared her. She's got this nice voice," Iker said. "You know, like way down at the bottom of an air conditioner."
Broker nodded. He knew how it worked; the phone rings and a strange cop from faraway invites a wife to take a sudden plunge to where she keeps her personal ideas about mortality.
Iker, who lived thirty miles of impassable highway to the west in Tower, then called his wife, made sure that she and the kids were all right, and explained the day's events and how he was stranded with Phil Broker.
