Saving Dr. Tremaine

by Jessica Matthews

  “The same.”

  Annie poked the tips of her stethoscope in her ears and listened to his chest. Lung sounds were faint. Immediately she decided to run another test strip and saw that his heart was throwing more PVCs.

  His eyes suddenly rolled back in his head and he went limp.

  Annie muttered an unladylike curse as she checked his carotid pulse. Nothing.

  Storage compartment doors and supply box lids flew open as she grabbed a variety of necessary medical equipment. Establishing an airway was paramount, so she ripped open an oropharyngeal mask from its package while she yelled above Mic’s soft-rock music station.

  “We have a code blue.”

  CHAPTER TWO

  “DO YOU want to stop?” Mic called over his shoulder.

  Annie could use the extra pair of hands, but pulling over would only delay their arrival at Hope.

  “What’s our ETA?” She ripped off Turlow’s non-rebreather mask, tipped his head back and inserted the airway over his tongue and into his throat.

  “Traffic’s light. Less than two minutes. Give or take.”

  In a split second she weighed Turlow’s need for more than she could provide with Mic’s ability to shave his estimated time of arrival in half. “Go.”

  The ambulance lurched forward as Mic stepped on the gas pedal. Knowing he would notify the ER of their upgraded status, Annie concentrated on their patient.

  The familiar adrenaline rush swept over her, heightening her senses as she fell into the routine for which she’d trained. She attached a bag-valve-mask to the airway, commonly called an ambu-bag, and double-checked the oxygen rate. Fifteen liters.

  With the airway and breathing part of the ABCs taken care of, she had to address the circulation problem. Moving to the side of the gurney, she began chest compressions, at the same time wrapping her foot around the nearest wheel that was locked to the floor in order to anchor herself to her patient. From the way Mic careened around street corners, she could wind up at the other end of the ambulance if she didn’t. It wouldn’t do Turlow any good if she was bouncing around the back of the vehicle instead of taking care of him.

  The EKG strip showed a regular rhythm of wide and bizarre loops, indicating Turlow had gone into ventricular tachycardia. With smooth motions born of training and experience, she affixed the disposable defibrillator electrodes to Turlow’s chest and set the machine to charge. As soon as it had reached the required voltage, she pressed the button that send two hundred joules of electricity into his heart.

  The rapid heart rate and rhythm remained unchanged.

  She increased the power to 300 joules and repeated the process without effect. This wasn’t what she wanted to see. Time was becoming her—and Turlow’s—enemy.

  “How’re you doing back there?” Mic asked.

  “Not so good. What’s our ETA now?”

  “About thirty seconds. The hospital’s dead, er, straight ahead.”

  “Come on, buddy,” she told her patient as she squeezed the bag, forcing oxygen into his lungs. “You can’t check out on my watch. Not today. Not when we’re this close to Hope.”

  She moved the setting to the max at 360 and shocked his heart again.

  The strip showed the rhythm had changed to an irregular pattern that oscillated on the baseline. The ventricular sites were firing so fast that Turlow’s heart muscle could only quiver instead of fall back into a regular rhythm. Ventricular fibrillation. It was a more welcome sight than a flat line, but still not the one she wanted.

  “I hope you’re hurrying, Mic,” she called, grabbing a prefilled syringe of epinephrine out of her drug box.

  “We’ll be there before you can say, ‘Honey, I’m home.’”

  She injected the drug into Turlow’s IV port just as the doors swung wide and Fern Pyle, a seasoned fifty-year-old nurse, squeezed past to take charge of the ambu-bag so Annie could concentrate on other tasks.

  “Talk to me, Annie.” Jared’s familiar voice came as a relief and she completely forgot her earlier unkind thoughts about him. Right now, he was a most welcome colleague.

  She continued chest compressions, working up a sweat as she relayed everything she’d done from the moment Turlow had lost consciousness, including the drugs and dosages she’d given. Meanwhile, Mic dashed into the back to unlock the gurney. A few seconds later, he began sliding it out of the ambulance.

  “Time?” Jared asked.

  “About three minutes,” she huffed, as she moved with the patient until she stood with both feet on the ground.

  Mic and Annie raised the stretcher and the wheels snapped into place. Somehow the EKG strips for the past several minutes were in Jared’s hands. He stepped aside to study them, able to see what Annie had been fighting. V-tach had turned into V-fib.

  Mic and Annie rushed their human cargo onto the dock and through the double doors. He pushed while Annie stood on the lower rail and continued CPR with Fern’s help. Her arms ached from the strain and a trickle of sweat ran between her breasts, but she couldn’t give up.

  Turlow’s life was at stake.

  As soon as they’d entered the trauma room, several other nurses, including Ravi, transferred Turlow to a hospital bed on Annie’s count of three.

  Clearly, Billie Brooks, the ward clerk, had done her job in calling the switchboard as soon as Mic had upgraded their status. Protocol demanded that a code blue announcement would summon a variety of other hospital technicians from EKG, lab and the pharmacy, and now these extra people milled in the background, ready to follow Jared’s orders.

  Everyone had a job to do and Annie concentrated on counting her compressions. She knew without looking that Jared had fixed his attention on the monitor to see what effect the dose of epinephrine had caused.

  “V-fib,” Fern announced.

  “He’s going to make us earn our pay,” Jared said grimly, as he replaced the airway with an endotracheal tube before he nudged Annie out of the way.

  “Paddles,” he ordered, stripping off the disposable electrode patches Annie had attached earlier.

  Fern handed them over, then squirted the conduction gel on their smooth surface as he held one in each hand.

  “Clear,” he called.

  Like everyone else, Annie stepped away from the bed. She was grateful for the momentary respite—CPR was hard work.

  Turlow’s body jumped from the electrical pulse. No change.

  In spite of her outward calm, a sense of foreboding came upon her. “Come on, Gary,” she muttered. “Don’t give up.”

  “Go to 300,” Jared ordered. Fern increased the setting, and as soon as the beep sounded he raised his voice. “Clear.”

  Still no change. Turlow’s heart refused to settle into a normal sinus rhythm.

  “Go to 360.” He positioned the paddles again as Fern adjusted the setting on the defibrillator. “All clear.”

  Turlow’s body jerked as the third surge of electricity hit his heart.

  “Still in V-fib,” Fern reported, her gaze on the blip moving across the screen as she squeezed the air bag.

  “Lidocaine. How much does this guy weigh?”

  “About 230,” Annie replied, as she resumed her compressions, mentally willing his heart to life. “Give or take.”

  “A big guy.” Jared called out a dose and Ravi injected the proper amount in Turlow’s IV port.

  “Getting tired?” Jared asked her.

  “I can manage.” The day she couldn’t do her job was the day she’d resign.

  “Let Mic take over,” he ordered. “He’s fresh.”

  Although she wasn’t happy to be replaced, now wasn’t the time to argue. It was their department policy to provide CPR assistance in order to free the doctors and nurses to handle other things and Mic was, as Jared had said, fresh. She swapped places with her partner and watched the proceedings from a place near the door.

  “Still in V-fib, Doctor,” Fern said calmly.

  “Here we go,” Jared said, as he placed the pad
dles on Turlow’s chest. “Clear.”

  Annie knew the pattern. Administer the drug then, thirty to sixty seconds later, use shock. Drug, then shock. With each failure her hopes for a positive outcome slipped further down the slope of no return.

  Jared functioned calmly, never raising his voice in excitement as some physicians responded under similar circumstances. He acted as if he encountered this situation every day, which, during his training in Chicago, he probably had.

  In spite of his cool head and detached manner, Annie knew he wasn’t unaffected by his fight with the Grim Reaper. She saw the darkening patches of sweat on his cotton scrub shirt, the tiny beads collecting on his upper lip and his forehead. Every now and then, he bit on his lower lip.

  Billie counted off the elapsed minutes. Ten, twelve, fifteen.

  Suddenly, the pattern became asytole—ventricular standstill—a flat line. Annie had seen other physicians give up at this point, but not Jared. He tried once, then twice more. After a third unsuccessful attempt, he straightened.

  “How’s our clock?” he asked Billie, who was responsible for recording the transpired events.

  “Nineteen minutes.”

  He handed the paddles back to Fern. “That’s it. Time of death, eleven-sixteen.”

  For a split second no one moved, as if it took time for everyone’s brain to transition between fight and surrender. Annie’s high hopes fell to reluctant acceptance and she drew a bracing breath as her adrenaline surge faded.

  Jared walked away, his shoulders not quite as squared as usual. She slipped out after him, knowing without looking that the ER staff would begin disconnecting Turlow’s body from the monitors and IVs before they hauled him to the morgue and did their clean-up.

  Working a code required speed, not neatness, so a messy room and a messy ambulance were given facts. She and Mic would be out of service for at least thirty minutes just to restore and disinfect their equipment. Then would come the paperwork.

  Mic had stashed their gurney outside the trauma room, so Annie pushed it toward the ambulance entrance, noting that halfway there Mic had joined her.

  The back of the ambulance was as untidy as she’d expected. Plastic wrappers, alcohol pads, drug vials, and syringe cases littered the floor where she’d thrown them.

  She didn’t mind the task if the patient survived because it seemed a small price to pay for a man or a woman’s life. But when the patient didn’t, it became an unpleasant chore. Doubts circled like vultures as she mentally replayed the call from start to finish. Second-guessing came quite easily at this stage.

  In her head, she knew that she’d done everything possible. They’d given Turlow a better chance by heading at speed for the hospital rather than parking on the side of the road, but she couldn’t stop wondering if it might have made a difference.

  She waited on the driveway while Mic moved their vehicle to avoid blocking traffic in case of another emergency. As soon as he parked in a stall, she hopped into the back and began inventorying her drug box while Mic stowed equipment in the built-in storage compartments.

  Finally, he broke the uneasy silence. “You did the right thing, Annie.”

  It was as if he’d read her mind. “Did I?”

  “He needed to be here, Annie. Here. At the ER. Not stranded on the side of the road.”

  She nodded before she let out a long breath. “I know. I just hate to lose one.”

  “It happens,” he said pragmatically.

  “Yeah, it does.” Enough had been said. She had to put this situation behind her or she’d be useless on their next run.

  Forcing her attention to more mundane matters, she said, “We’d better get another O2 tank.”

  “OK.” He peered into the compartment. “Add airways to the list, too.”

  She jotted down the medications that would have to be replaced before they returned to the station. There would be hell to pay if they needed something on their next call and didn’t have it.

  After they’d restored their unit to order, Mic went in search of someone who could fill their supply requests. Meanwhile, Annie slipped into the ER’s small lounge to write her report. Because breakfast had been a long time ago and it was hard to say when she’d be able to eat lunch, she grabbed a stale donut to go with the can of orange soda she’d collected from the vending machine.

  Halfway through her treatment record, Jared strode in. Immediately, she tensed, wondering what might come next.

  Clearly oblivious to her wariness, he made a beeline toward the industrial-sized coffeemaker and filled a mug bearing a cruise line logo. “I didn’t realize you were still here,” he commented offhandedly.

  He sounded like his usual polite, professional self, but she wasn’t going to get too chummy just yet.

  “The job isn’t finished until the paperwork is done,” she reminded him.

  “Ah, yes. Paperwork. One of those never-ending tasks.”

  “Like laundry,” she said, thinking of the piles waiting for her at home. If she’d tackled them yesterday on her day off, instead of running errands and taking time out to enjoy the sun, her clothes would be hanging neatly in the closet instead of lying in wrinkled heaps on her bedroom floor.

  “Yeah.” He leaned back against the counter and stood in a relaxed pose with his mug to his mouth. He acted as if nothing untoward had happened between them that morning, but she wasn’t surprised by his attitude. After working with men in close proximity, she’d learned how they operated. When they got upset they vented, and after that they put the incident behind them. Forgot the episode, as it were.

  She tried to do the same, to not take a confrontation personally, but it wasn’t always easy to ignore the past when it still stung.

  Like now. He seemed rather approachable, but sticking to professional topics seemed a safe conversational bet.

  “How did Turlow’s daughter take the news?” she asked.

  “Not very well.”

  She’d expected as much. “I got the impression they were very close.”

  “I did, too. She suspected he was having a heart attack, but with all the measures we have now she didn’t imagine he could die from it. For him to go that quickly, he most likely suffered a massive infarct. We did what we could.”

  She toyed with her pen as her thoughts returned to the same track they’d followed earlier. “But it wasn’t enough.”

  “We gave it our best shot.”

  “I guess.”

  He hiked up one eyebrow. “Are you saying that you didn’t?”

  She was irritated that he thought otherwise. “Nothing of the sort. I did everything I was trained to do. I went by the book, though I can’t help but wonder if those two minutes made a difference.”

  “I doubt it. I would have treated him the same way if he’d been in my ER. Look at it this way, you gave him more of a chance than if he’d suffered his fatal MI at home by himself. And if the autopsy confirms my opinion, it wouldn’t have mattered if a cardiac surgeon had been present.”

  She hadn’t thought of it in those terms. “You’re right.”

  “Of course I am.” Jared raised the cup to his mouth and swallowed.

  Annie felt better after his reassurances, but was somewhat surprised that he was taking time to visit with her. The temptation to ask why he was being so nice to her after that morning grew stronger, but she hated to break the amiable spell. Mentioning his electrical problems, and the fact that she hadn’t found time to call the power company and straighten out the situation, was bound to turn this pleasant man into his less-tolerant, if not downright angry counterpart. If he continued to show such compassion and understanding, she might actually find her surly neighbor quite likable.

  She motioned to his mug and steered the subject in a safer direction. “Neat mug. Where did you go on your cruise?”

  “Alaska,” he replied. “The inside passage from Vancouver to Seward.”

  “Had you gone before?”

  His mouth curled into a gent
le grin and his eyes took on the appearance of someone who was reliving an event. “Never. It was quite an experience. I took my sister for her twenty-first birthday. It was a combination of family tradition and a bribe.”

  Somehow, she didn’t see Jared as a man who held family traditions in as high esteem as she did. “A bribe?”

  “She wanted to drop out of college and I had to do something.”

  “Did it work?”

  “She finally finished with her master’s degree in elementary education, so I’d say so.”

  She wanted to ask why his sister’s decision mattered to him, but the question seemed too personal. For now, it seemed better to stick to general topics.

  “Would you go again?” she asked.

  “Without hesitation. What about you?”

  “I’ve never been on a ship or been to Alaska. Someday, though, I will.”

  “You should.” The pager on his waist went off and he glanced at the display. “I wonder if there’s anyone left in Hope who hasn’t come through this department in the last four hours.”

  “You know what they say. ‘No rest for the wicked.’”

  This time he laughed and the full smile on his handsome face made him extraordinarily handsome.

  Handsome enough to make her stop breathing.

  Handsome enough to make it difficult to swallow.

  “It’s been quite a day so far, hasn’t it?” he asked ruefully.

  She didn’t know if he was referring to the code blue, a heavier-than-usual flood of walk-in emergencies, the scene that had started this day on its obvious wrong note, or the combination thereof.

  “Yes, it has,” she agreed, meeting his gaze. He didn’t look or sound as if he intended to yell at her about anything, but one never knew. And if he was going to complain, she wouldn’t cower like a whipped puppy.

  “About this morning,” he began.

  Here it comes, she thought as she stiffened. “Yes?”

  “I shouldn’t have complained about your bagpipes. It isn’t any of my business what instrument you’re trying to um, er, play.”

  She couldn’t have been more surprised if he’d told her that she’d won a free trip to her ancestral homeland. “Really? Do you mean that?”