Amnesia (11 page)

Pleasantly surprised at the light traffic she was soon pulling into the doctor’s parking lot below the Emergency Room entrance at St. Luke’s. It wasn’t her normal place, but today she wanted to be different. She noticed a yellow corvette a few cars down from her parking place and knew immediately it was Darrion’s favorite car; showy and extravagant with lots of muscle under the hood. She had to admit that the car was indeed beautiful, the sleek form wonderfully pleasing to the eye, the sunroof adding the hint of freedom, the dark interior giving the feeling of class. She had never ridden in the car, but secretly she would love to see what it felt like, being pulled back into the seat as the car sprang into motion leaving all else behind. She sighed, reminding herself that it would never be worth having to take that ride with Darrion Stanton.

She skipped up the steps off to the left of the parking lot and took the path up the hill toward the main entrance. She decided instead to take the patient exit to the right, the one usually reserved, by practice not rule, for patients being released. Entering this way she came to the staff elevators first and decided to take them instead of the typical public transport around the corner. She stood patiently, waiting for the descending car to arrive, rocking gradually back and forth, still humming the song she had just heard on the radio.

At last the elevator doors in front of her began to open and she stepped up to them to get in, not realizing that there was someone on the other side attempting to disembark. The man came barreling out of the door, white smock clutched in his left hand, his right hand pulling car keys from his pocket. So intent on getting out he didn’t see her either, and the two collided heavily, both bodies crashing to the ground.

Lissa fell straight back, the weight of the large man adding to her frame, hitting the floor hard and knocking the wind out of her. As it worked out the man ended up right on top of her, groaning with pain, as if he had taken the brunt of the collision rather than her. For a moment they both laid there, her trying to catch her breath, he trying to work past the obvious pain, which actually seemed focused in his shoulder. Lissa opened her eyes trying to determine the identity of the stranger, knowing at once that she had never seen the face. She would have remembered the long scar trailing raggedly down his left cheek to his chin. She gasped for a moment, sensing the darkness behind the scar before he had even opened his eyes.

Then he did open his eyes, revealing pain and anger beyond any she had ever seen before, and instinctively she feared him knowing that he was dangerous. He blew his breath out slowly through clenched teeth and then finally seemed to realize he was on top of her. He started to move, then froze, the angry look switching to fear and recognition. He waited there motionless for a moment as he stared into her face, as if waiting for something to happen. When nothing did, he painfully rose and ran off, cradling his right arm.

Lissa lay there a moment longer staring after him, sensing that she had just met an enemy, but couldn’t for the life of her figure out what she had done. She gathered herself back together and rose, noticing that the smock the disfigured fellow had been carrying lying at her feet. She bent and retrieved it and looked at the hospital badge clipped to the right pocket. “John Smith” it said. Although she was certain the moniker was fake, the picture was of the same face that she had just been staring into. She noticed something oddly familiar about the tag itself that took her a moment to place, something peculiarly distinct, but somehow reminiscent. Then she recognized the dark ink stain that had crept under the edges of the clear plastic, blemishing the white card underneath. She knew that stain because she remembered using the card as a
straight
-edge on one of her charts a few months ago leaving the discoloration.

A sudden chill coursed up her spine raising the hair on the back of her neck at the discovery, the implications racing through her dazed mind. Her old card stolen from her destroyed car affixed with a different picture being worn by the frightening man that had just rammed into her, who had apparently known who she was. Her mind reeling with the implications
,
she searched the rest of the smock, finding only a spent syringe and nearly empty vial of potassium chloride. She went pale, feeling slightly dizzy, and looked desperately for a place to sit down before she passed out.

The public address system broke through her spell, blaring the cold announcement, “Code Blue, Long-Term Recovery—Code Blue, Long-Term Recovery.” Her first thoughts were of her recently awakened coma friend lying helpless and alone in that ward, adding deep concern for his safety to her already terrified state, sending her into a near panic.

Abandoning the slower elevators she left the alcove, turned the corner into the stairwell and raced up the seven flights of stairs. Adrenaline boosted her already athletic body pushing her past her usual limits. She arrived on the seventh floor moments later gasping for air. Her lungs burned deeply and she knew they would be painful for
a while
. Her legs ached as well, feeling weak, threatening to give out. She paused in the stairwell a moment before opening the entry door, trying to slow her racing heart. She fought to calm her awkward breathing and steady her trembling legs before pulling open the stairwell door, ready to use her skills to rescue another human being.

She stepped onto the floor, raced past the nurses’ station, and almost into room 7014 before she noticed the team rolling the crash cart the other direction. Turning, slightly confused, she stared at the medical personnel rushing into the room down the hall. She hesitated only a moment before she turned and followed the team, knowing that her training and authority were just as crucial to this patient as to the one for which she had felt such fear.

She entered the room and pushed past the members of the Code Blue Team, noting she was the only physician in attendance. She quickly took in the scene. One nurse was squeezing the football shaped Ambu bag, the triangular mask placed over the patient’s nose and mouth forcing air into the body keeping the oxygen moving through the system. Another was leaning over the body delivering heart compressions, in lieu of the heart’s normal rhythmic beating. A third was placing pads from the AED, Automated External Defibrillator, on the patient’s chest and side, preparing for the “shock of life” he would certainly need at some point. She glanced above their heads to the EKG monitor revealing a chaotic line of bumps and hills flowing across the screen, the clinical indication of fine ventricular fibrillation. Doctor Brandon glanced up at the clock on the wall and noted the time, 15:42, and quickly calculated the forty-minute window the body could stand being in this state. If she couldn’t bring back a normal sinus rhythm by 4:22 PM she would be forced to pronounce him dead,
the ultimate loss to any doctor.

She stepped up to the side of the bed, her mind relinquishing control to years of training and practice. She ordered the defibrillator capacitor charged to 200 joules. This was the minimum setting to try to jolt the heart back into symmetrical pumping. Of all the tutelage the student doctor received, perhaps the most rehearsed was how to handle cardiac arrest. It was drilled with such specifics that there was no question at any point on what t
o do. That was as it should be—
there was never a more critical point in a patient’s care as when their heart had stopped working as designed. The idea was simple enough, use electric shock and specific medications to bring ordered cadence to chaotic twitching.

The nurse putting the pads on the patient’s chest a heartbeat earlier repeated the order aloud as he punched the buttons on the AED to the appropriate setting.  A low whine started as the machine announced it was filling the batteries. Then the two-beep signal sounded notifying the user that it was ready. The doctor quickly checked the pads, on the top of the chest just right of center, the other on the patient’s side, for placement and a good attachment. Nodding her approval she called for clear, signaling everyone to back, and nodded to the nurse to push the button. Two hundred joules of electricity leapt out of one pad, traveled through the man’s body, raced across the heart, and into the other pad, causing him to literally jump into the air above the bed.

“No conversion,” someone called out urgently. Lissa checked the EKG monitor herself, finding the grim news that there was no change to the erratic heartbeat.

The doctor wasted no time ordering the AED charged to 300 joules and stood back to allow the CPR to continue, waiting for the machine to recharge. At the appropriate sound, she again stepped in, called for clear, and shocked the man’s system, bringing the torso completely off the bed. Again there was no conversion and the compressions began again as the defibrillator was once again charged, this time to 360 joules—the maximum setting.

Disappointment filled the room as the third shock produced the same results. Despite the coldness with which most medical personnel are perceived, they more than any other know how precious life is. They fight valiantly to stave off cruel fate, determined that death is not an option, but a final loss. Those present would not give up so easily, incited instead to greater conviction, resolved to be defeated only after embittered battle.

Lissa quickly intubated by sticking a long breathing tube down his throat while calling out, “Give me one milligram of Epinephrine, and keep it coming every five minutes!”

One of the members of the team plunged the needle of an already prepared syringe into the IV already placed in the patients arm then answered back, “One mg of Epi in, repeating every five.”

Lissa then took over heart compressions from the fatigued nurse opposite her, who gratefully fell back to the rear of the crowded room. The drug worked sluggishly, but eventually turned the nearly flat line into higher waves as the heart transitioned from fine to coarse v-fib. A good sign at last, though it left the doctor a little bewildered. Although she couldn’t quite place it, something nagged at her, like she was overlooking an important piece to the puzzle. Unfortunately, she didn’t have the time to sort it out now. Her patient needed her.

With the Epinephrine on board and the v-fib altered, it was time to try the AED once again. Building up to 360 joules, the nurse again called out the AED was charged, and then hit the button to discharge the current into the man’s chest. Then came the first blip, the promise that the heart would come back to them, but quickly changed back to the erratic waves that could be so fatal. Lissa looked back up at the clock. 4:06. Time was not on their side and she needed a better answer. And she needed it fast.

She ordered a bolus of a hundred fifty milligrams of Lidocaine added to his IV. After waiting three more minutes while still pumping his chest, they administered another shot. The more potent drug was still not having the desired affect and she was starting to get worried. There wasn’t much more she could do and she only had thirteen minutes left.

Her mind scrambled in vain through the procedure, trying to find some missed step, knowing that she hadn’t missed anything, but unable to determine why the patient was still in distress. She looked down at his face, voicelessly asking what it was that she was missing, and realized that she recognized the man as the one she had treated nearly a week ago for a bad fall. It was odd, she thought, that he should be in this ward, rather with the others in orthopedics. His real problem after all was simply broken bones, not a long-term affliction. She noticed a long gash on his check that she hadn’t seen before. Undoubtedly it was sustained in the fall, but it looked almost like the long scar she had….

“Dolores!” she yelled, never averting her attention from the man beneath her. “Get me a phlebotomy tray! And someone give me a bolus of 100 milligrams of Sodium Bicarbonate, and hang a bag of it at 150 drops per minute!”

The nurse reappeared a moment later with a toolbox full of tape, vials, and short tubes with attached needles, all arranged for easy accessibility to take a sample of blood.

“Get a sample down to the first floor lab STAT! Have them check his potassium levels!”

The nurse bustled over and unceremoniously retrieved blood from the IV. As soon as the vial was filled the nurse disappeared at a run. Doctor Brandon raced through her pharmacology background, readying herself for a severe case of hyperkalemia, an overdose of potassium. Part of her prayed she was wrong, not wanting to connect the malicious man downstairs with the dying man she was working on. But she knew it was imperative to know the cause of the arrest if she were to save his life.

She yelled out orders to have a thousand milligrams of calcium chloride standing by, ready to pump into his IV if her suspicions were correct. She also had the nurses prepare fifteen units of insulin as a chaser, along with the sodium bicarbonate already on board. When all was prepared the room waited anxiously for the sound of the ringing telephone. The clock ticked mercilessly, the minute hand sliding agonizingly toward the number four. Lissa pounded out the CPR tempo on the man’s bruised ribs, not pausing for the respirator to replenish his lungs with oxygen. At her side nurses scurried unnoticed to administer continual doses of the Bicarb and Epi as ordered.

“Come on, come on, come on,” Lissa chanted under her breath between her own panting from the exertion of the CPR compressions. “Please, please, please,” she pleaded with whatever powers that be to hurry the lab along, knowing even as she did that her conclusions were correct. She felt somehow responsible for all of this. More than just her position as the physician in charge of the code team, although that weighed heavily on her too. No, it was like just knowing about the man with the scar on his face downstairs made her somehow culpable.