Lie Still (2 page)

“Launch” is probably the better verb. It’s a rocket with a very short fuse. You strike the match and make sure you can get the hell out of the way because a million things are about to happen, and the process, unless you and someone from Hospital Security physically block the door, will run its course. “Get help” is all I said. That’s all it takes. I closed my eyes for half a second and when I opened them Robin was gone. I heard her shout just outside the door, then someone running, then another voice shouting.

I felt Henry’s breastbone and walked my fingers down to its end. I backtracked an inch and squared the heel of my left hand in the center of his chest. I put my right hand on top of my left, locked the fingers together, then rose up on the balls of my feet, directly over him. The gurney was too high for me to lock my elbows, but I could still bear my weight into his chest, feeling for what I guessed was just enough “give”

to squeeze the heart between the spine and the ribcage and pump blood downstream.

6

D AVID FARRIS

I wondered what a small-town code team would look like.

I don’t often pray but I remember thinking of God, and for a couple of milliseconds I might have asked for mercy for Henry, and just as much for me.

Even alone and scared I was thankful to be doing something physical. Just like everyone else doing CPR for the first time, I didn’t know if I was doing it right. I imagined his heart being squeezed under my palms, then passively refilling. Once as a med student I watched an intern do chest compressions on a pulmonary cripple who had a line in the artery in his wrist. We could see on the monitor the blood pressure waves she was generating, and she adjusted her stroke to the best wave. In him at least, the best flow came with a sharp and frighteningly deep squeeze. His ribs cracked. The intern winced. The resident said, “It’s better than staying dead.” He did that also.

I bore down on Henry’s chest, trying to do the same kind of stroke. I counted to fifteen, because that’s what I’d learned in CPR class. I gave him two more breaths, then started over. The eternity of pumping and breathing alone probably measured less than ninety seconds by the clock.

He was an awful color. I stopped once and again laid my fingers on his throat. Some patients bounce right back. If my desire counted, his carotid would have been booming. I tried to invoke all my years of study and training and a fiercely wrought want and strength of will. As if it might help.

The exam room door jumped open, shattering our silent supplication. It hit the wall behind it and shook with a deep bass vibrato. Patty Kucera, RN, one of the ER regulars and a sizeable woman of around six feet and 280 pounds, was first of the motley cavalry of backwater medicine to charge in. On her heels were two other women, a tall man in hospital scrubs, and Robin.

I had run codes as an intern, but when you’re the intern giving orders to an experienced code team, it’s like being a little kid telling Mom what goes next in the cookie dough.

She’ll do what you say as long as you say the right thing. If LIE STILL

7

you say the wrong thing, Mom will do the right thing and smile at you. You’ll learn. I knew the approved protocols for a standard code, but sometimes that’s not enough.

The best spot at a code is the one standing over the patient’s heart, bobbing up and down. The job is at once the most mindless and the most critical. You can look around, talk to people, smile sometimes. It is like sex: You can do it with empathy and passion or you can do it with your head in the next county—if your mechanics are adequate the immediate outcome likely will be identical. It is not, however, the place for the person who’s supposed to be making decisions, so I tagged Patty to take over the chest compressions.

It’s a sea change to go from the physical simplicity of one-rescuer CPR to the role of the Guy-in-Charge-of-the-Code. I stood there for a second knowing I was forgetting something. I mouthed to myself, “ABC. Airway, breathing, circulation.” I asked, “Where’s Respiratory?”

“Right here, Doc.” It was the lone male in the crew, a respiratory therapist—RT—named Roger. He had somehow materialized a breathing bag and mask and was jamming the mask onto the boy’s face, squeezing in oxygen. He gave me a little sideways grin. He was straining to hold the mask tight to Henry’s face with one hand. The mask was too big and half the oxygen was being expelled over the eye sockets with a farting noise. Even so, the chest was definitely moving.

Vickie Rhoades, the evening shift charge nurse out on the wards, slit Henry’s sleeves and pant legs with long gliding scissors strokes. In seconds he was naked but for stained briefs. She threw flimsy wires around his neck and connected pasties to his chest for the EKG. She tucked the free parts of the wires under his shoulders so they wouldn’t flop around and get pulled off, which they always do anyway.

Vickie wrapped a wide floppy yellow rubber tube around the boy’s left biceps area and slip-knotted it. She snapped her finger on the big vein over the elbow, wiped it furiously with alcohol, and slid in an IV. She finessed the catheter off the needle and up the vein, pressed hard on the vein with the 8

D AVID FARRIS

other thumb to plug it off, snap-released the tourniquet, connected the line, and opened the roller valve, all without spilling a drop of blood. The whole thing took maybe thirty seconds.

“Got an IV,” she said. “D-Five. Runs like a racehorse.

TKO for now. Atropine and epi going in. An amp of D-Fifty, Doc?”

I was blank. There was no reason to give sugar. I mumbled, “No. Hypoglycemia this isn’t.”

“It’s protocol,” she said.

“Well, okay, I guess it won’t hurt. We’ll try everything.”

“Narcan?” Vickie asked.

Again a blank. Narcotic reversal? “He a user?” I asked.

“No. Protocol.”

I said, “Sure. Wouldn’t want to buck protocol.” She smiled and nodded.

Patty was breaking a sweat over Henry’s chest. “You need a break?” I asked her.

“Naw, I’m fine.”

Two more women had come in, but there was nothing immediate for them to do. They stood waiting for a job, adding their worry. One said, “Oh my God, it’s Henry.”

Half the hospital’s evening personnel were in the room.

“Who’s tending shop?” I asked.

“Beulah,” Patty answered with a grunt.

“Who’s she?”

“Ward secretary. She’ll call us if somebody needs something important.” In a thirty-bed hospital even the secretary will know who’s in trouble.

Robin was bent over the EKG, staring, running out foot after foot of printout and bunching it up in one hand like toilet paper. With a small mastodon bouncing on the kid’s chest the print needle was all over the strip and none of it meant a thing. You could have seen that from Flagstaff. “What’s the rhythm?” I asked, making conversation. She looked up with the pained expression of someone awaiting her executioner.

“Lots of artifact but there’s nothing underneath it,” she said.

“Hold your compressions a sec,” I said. Nurse Kucera LIE STILL

9

wiped her brow. Robin stopped bunching up the EKG printout and slowly stretched out her left arm as the strip got longer and longer. The needle lazily drifted back and forth like it was dreaming about something pleasant, then spiked an irregular plateau wave. Maybe somebody was popping popcorn in a microwave in the next building. “Looks pretty flat,” she said.

“Resume compressions,” I said. “Let’s draw up another round of epinephrine and atropine and get an intubation tray ready. Can somebody get a blood gas?” I felt better giving real orders, even if they were obvious. “I’d say he’s about forty kilos. Give another half milligram of epi and o-point-five of the atropine.”

Once the drugs are emptied into the IV port and chased into the vein with a flush of IV fluid, you stand there hoping somehow something will change. It’s a lull in the action.

“What happened to Henry?” Vickie asked Robin.

Robin jerked more upright like a puppet coming to life.

She was pretty, slim, stylish, and in her mid-twenties, all of which set her apart in Glory’s hospital. She jerked her head a bit, swinging brown hair over her mouth. “How well do you all know him?” she said.

“We all know Henry,” Patty said. “Frequent flyer. Asthma.

Seizures. Well, real seizures maybe—fake seizures for sure.

Big-time loser.”

We stared at Robin. “I wish I knew what happened,” she said. “He told us his asthma was bad. Pollen or something.

Wanted his epi shot.” She shrugged. “We gave it to him,” she said, nodding toward me.

They looked at me. There was a moment of silence, either sympathetic or accusatory, I wasn’t sure. “He didn’t bounce around on the stretcher for you?” Patty asked, screwing up one side of her face and jerking her arms like fishhooks.

“No,” I said.

“Did he insist on showing you his crooked penis?”

“Well, yeah, that did come up.”

“Did you feel honored?”

“I had a feeling I wasn’t the first.”

10

DAVID FARRIS

“His asthma must have been way worse than we thought,”

Robin said.

“Maybe,” Vickie said. “Maybe he was so tight he couldn’t even wheeze. I’ve heard that happens.”

“He’s never been even close to that bad before,” Patty said.

“Did Daniel come in with him?” Vickie asked.

“Daniel? His dad? Is Daniel his dad?” Robin asked.

“Yeah. Pompous little greaseball. Dark goatee,” Patty said. “Bigger loser.”

“Yes. But he kind of disappeared,” Robin said. “I thought it was weird.”

“He’s like that,” Patty said.

Roger, the RT, interrupted. “Doc, I don’t think I’m ventilating him too good. What do you think about maybe intubating him?”

“Stop compressions. Check for a rhythm,” I said.

Patty stepped straight back and slowly raised her locked hands and elbows over her head. The room was silent.

Vickie poked in the neck for a pulse. The EKG was still flat.

I mumbled, “Resume compressions,” and looked at Roger. I said, “Sure, Roger.” We both knew he probably had done a hundred more intubations than I had.

I ripped open the plastic wrap around the intubation tray and unfolded the sterile wraps to check the equipment. The blade fit the handle and the light worked. I slid the fat soft aluminum wire stylet inside the tube and bent it into a banana curve, just as the anesthesiologists always did.

I stepped under the IV line, over the EKG cable, under the oxygen tubing and slithered up to the head end of the gurney. I would need leverage. I leaned into the gurney. It began to roll away. “Lock the fucking gurney, please,” I said. Patty stepped back from the CPR. She kicked down the wheel-lock lever then leaned back into Henry’s chest.

I said quietly to Roger, “Okay.” He looked at me. I repeated it, making a small waving motion with the laryngoscope in my left hand, staring at the boy’s mouth. Roger moved the mask aside and stepped back.

Henry’s mouth was full of regurgitated food. “Oh shit.

LIE STILL

11

We got chunks. Suction.” I was nearly yelling now, which of course adds nothing of use. Vickie handed me the suction tubing. Attached was a tip the size and stiffness of wet spaghetti. I wrenched it off and flung it backward against the wall behind me, cutting the back of my hand on a metal bracket. “Fuck. Who put this sucker on here?” I asked—

shouted. I tried to scour out Henry’s mouth with the open end of the main tubing. “Those are for getting secretions out of bronchi, not for getting peas and carrots out of the trachea.”

“I’m sorry, Doctor,” Robin blurted. Though she had spoken to me she was staring straight ahead, apparently focused on Henry’s spirit leaving the room. I was surprised anybody had answered my rhetorical question. It reminded me, though, whose ER it was. The staff was not here to be sub-versive. They were here to help sick people and I was a guest on a reluctant invitation. I’d best not bite at them.

The stream of what had been stomach contents looked like vegetable beef soup. Once I got the mouth cleared I said to Roger, “Let’s give him some of the good air.” After eight or ten breaths of oxygen I again said only, “Okay,” cueing Roger to step back. I guided the tip of the laryngoscope blade down the boy’s tongue and lifted.

I prayed for the anatomy to be clear, just this once. It wasn’t. All I could see was a muddle of mucus secretions and pink, puffy soft tissues shaking in jerky synchrony with the chest compressions. The only thing I recognized with certainty was a single pea stuck to a tonsil. “It never looks like the goddamn pictures,” I said. “Stop compressions a second.”

I used the suction tip to clear the secretions and then as a probe to gently part the tissues. Suddenly the cavity seemed to pop open and there lay the target, the inside of Henry’s voice box. Then, just as suddenly, the tongue flopped around the blade and all I could see was a fat gray wad of blubber covered with taste buds. “Fuck,” I mumbled. I pulled out and motioned Roger to give Henry some breaths.

While the oxygen went in I sighed and looked around at the nurses. Robin spelled Patty at the chest compressions, 12

DAVID FARRIS

diving into Henry’s chest like she was pushing the Devil himself back to hell. After a dozen breaths Roger stepped away again. I put the blade down Henry’s throat again, concentrating on keeping the tongue to the left where it belonged. The view opened up again. The target was clear. I passed the endotracheal tube to what I was certain was the trachea.

“In,” I said.

A flurry of concerted activity began, like a string quartet, all moving in different ways but creating a single result: I inflated the cuff at the tip of the tube, Roger connected the breathing bag, Patty laid her stethoscope into the boy’s right armpit, and Robin resumed bouncing on Henry’s sternum.

Roger squeezed the bag. The stomach rose. A gurgle came from the mouth. I groaned. Patty listened to both sides of the chest, then the stomach, as Roger repeatedly squeezed the bag. She told me, practically shouting because her ears were full of stethoscope, what I already knew: “It’s in the esophagus.”