Authors: Catherine Lanigan
Jack reached out his aching arm to Sophie and motioned her away. “Save her, Sophie. Save her.”
the nurse's station to the ER bay on the opposite side. Bart Greyson, an RN with a decade of ER experience, had just gone in there with a stainless steel defibrillator cart.
Bart ran the ER with an iron fist and more stamina than the entire staff combined. He could pull over forty-eight hours on duty with only a half dozen, ten-minute catnaps while sitting at his computer. Bart had brains, insight and skill...and a case of Red Bull in his locker. He was a legend at Indian Lake. No one second-guessed Bart or his orders.
“You're the first of the cardiac team here,” Bart said to Sophie as he shoved a medical chart into her hands.
“Dr. Barzonni is on call?” Sophie asked, never taking her eyes from her patient.
“I just got word he's upstairs with an emergency surgery. We've paged Dr. Caldwell. I left a message at the nurse's station, as well. I don't know who will show up,” Bart replied with a huff of exhaustion. He stuck his hands on his hips. “Figures. It's a full moon. It's always an asylum here during a full moon.”
Sophie gently lifted Aleah's eyelid and examined her. “I heard her scream but she's unconscious,” Sophie observed.
“She was unconscious on arrival and except for that one time, she's been unresponsive.”
Sophie turned to the defibrillator. “She's in arrest?”
“No. Arrhythmia. The Code Blue was for the other victim. Dr. Hill had to leave Aleah and see to the John Doe. He was the driver of the other car. The cops are working on getting an ID for us.”
Sophie had worked with Dr. Eric Hill nearly every weekend since she'd begun her ER duties six months ago.
Dr. Hill was five years past his internship and residency at Cook County Hospital in Chicago. He'd told Sophie that in those five years, he felt he'd seen everything emergency medicine could throw at a person. He'd come to Indian Lake for a change of pace. Well, he'd gotten it. Unless there was a major accident like this one, most weekends in the ER were run-of-the-mill household accidentsâfalls or injuries with toolsâand relatively minor illnesses where the patients or their parents didn't have medical insurance.
Sophie watched Dr. Hill and three nurses work on a tall, overweight man in the next bay. He appeared to be in his late thirties. “He's hardly got a scratch.”
“Drug overdose. Cops said he had heroin in the car with him and as the paramedics were tending to the three other victims, he shot up.”
“How are they bringing him down?”
“Paramedics gave him naloxone on site. Nasal spray was all they had. They didn't get to him right away because he didn't seem injured, just confused. It wasn't until he dropped to his knees and passed out that they noticed the dilated pupils and white patches on his mouth. Once they got him here, we gave him more naloxone by injection. What a mess.” Bart shook his head but continued to work.
Sophie scanned Aleah's reed-thin, very still body while two other members of the ER team hurried in to assist. Donna Jessup was one of Sophie's coworkers on Dr. Caldwell's team and worked one weekend a month in the ER. With her was Rob Seymore, a lab technician who quickly began drawing blood for the usual tests.
Aleah's brown hair was matted to her head with glass and blood, much like Jack's had been. She was still in her street clothes, though her blouse had been cut away and twelve electrodes had been placed on her chest.
“Donna, did you run an EKG yet?” Sophie asked.
“We had another cardiac patient just after these accident patients. It's been bedlam, but I'm on it. I'm on it.” Donna attached the leads and turned on the EKG machine. She held the printout. “Infarction and atrial fibrillation.”
“A-fib?” Sophie circled the gurney and studied the printout. “Did Dr. Hill order an echocardiogram?”
Rob continued, “Yes. He was in the middle of examining her when the other patient started convulsing. And his heart stopped.”
Sophie flipped the pages of Aleah's chart as Bart continued.
“Dr. Hill said Aleah's suffered a blunt chest trauma which is quite obvious from the bruising. He ordered the requisite round of tests.”
“Did he mention cardiac contusion?”
Bart and Donna shook their heads.
“No, but it's my guess...” Donna winced. “Sorry. It's not my place toâ”
“Don't apologize.” She held up her hand, though she didn't take her eyes off the chart. “If she's ruptured the cardiac chamber or if there's a disruption of the heart valve that could be the cause of her dysrhythmia.”
Sophie assessed more of Aleah's condition. Her skin was growing more pale and gray by the second. The bruises on her chest were turning a deep purple. Sophie pressed lightly on Aleah's ribs. “She's broken nearly every rib on the right side.”
“Dr. Hill thinks her lung may be punctured,” Bart said. “He ordered thoracentesis.” He began inserting the catheter into Aleah's chest while Sophie went around to the other side of the bed.
Sophie stuck the earpieces of her stethoscope into her ears and listened to Aleah's chest. It rattled like a freight train and Aleah's breathing was labored. She was bleeding internally, but until all the tests were run, they wouldn't know the extent of the damage.
In the meantime, they had to get her stabilized. Aleah's chest cavity was filling with blood and fluid, which would be putting pressure on her heart and lungs. Sophie didn't want to guess how much time they had to prevent respiratory arrest or anotherâthis time deadlyâheart attack.
First, she needed do a thorough examination. In a trauma case like this, every nanosecond counted.
Sophie glanced at Bart as he continued to work. “She's lost a lot of blood. Transfusion?”
“It just came down from upstairs.” He nodded to the stainless steel counter where the IV bag of blood sat. Donna was rushing with her EKG cart out of the bay. “Sophie, can you hook up the plasma for me?”
Immediately, Sophie attached the plasma bag to the IV and regulated the monitor. Then she felt for Aleah's pulse. It was almost imperceptible it was so weak.
Bart finished with the catheter and Sophie turned to him. “Her chart says that she was born in this hospital. She had coronary artery abnormalities at birth.” She paused as Bart nodded gravely. “I'll need Dr. Barzonni to confirm, but because of the trauma to the chest wall, blood flow to her heart could be severely diminished.”
As she spoke, she saw Nate Barzonni race into the ER. Dr. Hill quickly gave him the specifics about the addict's condition. They both hung over the patient, assessing.
Sophie had worked with Nate for over a year now, and she knew his professional moves better than anyone. Though Nate always showed an implacable expression to his staff and the patient, when he raised his left eyebrow even a fraction, it meant he was concerned. If he dipped his chin to his chest, his brain was analyzing input like a computer. The longer his head remained bowed, the more difficult the case. The minute his head snapped up, Nate had made his diagnosis and decisions on how to proceed.
While Nate's head was still lowered, the attending nurse said, “Blood pressure is ninety over fifty. Pulse is dropping, as well. Fifty. Forty-eight. Doctor, I have no pulse!”
The addict's heart monitor flatlined. The alarms beeped. Sophie's head shot up. Most people thought those sounds signaled pandemonium, but to her it meant action. All hands on deck. It was the moment when everyone's skills, talents and expertise were paramount. They were like fine-tuned mechanics in a precision Swiss watch. Each cog, each spring was essential to the whole. Except they were not marking time as a clock would. They were racing against time. Trying to beat it to save a life.
“Defibrillator!” Nate shouted. He locked eyes with Sophie and nodded abruptly, with almost a jerk.
Sophie turned to Bart. “I'm going with Dr. Barzonni. You got this?”
“Go!” Bart said and continued his efforts to stabilize her.
As Sophie rushed between the beds, her gaze shot across the room. Jack Carter was sitting ramrod straight in the bed, staring at the action around him. His eyes bore into hers. For a fleeting second she thought she could read his mind.
What about Aleah?
Icy chills shot down her spine. She nearly turned and went back, but Nate needed her. The patient did, too. Once in the bay, she sprang into action. She pulled the paddles out of the defibrillator dock and spread them with lubricating gel. She handed the paddles to Nate. Holding her breath, she stood back as he placed one paddle on the left side of the man's heart. The other he placed to the right over the sternum.
“Clear!” Nate said loudly as the attending nurse and Dr. Hill backed away.
Sophie hit the defibrillator's button and watched the needle on the monitor jump as the electrical shock was discharged into the dying man.
The patient's barrel chest heaved. His back arched as it rose off the gurney with the shock and then flopped back down. He remained still. Nate listened to his heart with the stethoscope. He checked the monitor.
Dr. Hill's eyes were filled with defeat. He spun on his heel and rushed over to Aleah.
Sophie knew Dr. Hill was desperate to save all his patients. This loss was going to hit him hard.
“Again!” Nate said and presented the paddles to Sophie for more lubrication gel. He positioned the paddles.
Sophie's eyes were wide as she depressed the defibrillator's button again. The monitor jumped.
This time the man's body arched only slightly.
“Epinephrine!” Nate barked, holding out his hand for the vial that Sophie knew was the last hope.
Sophie reached over to the stainless steel tray where one of the nurses had already prepared the syringe. She grabbed it and properly placed it in Nate's hand the way she did with all his surgical instruments. They worked well together. She knew it. And she knew he knew it, too.
Nate jammed the long needle straight into the patient's heart and depressed the plunger. Sophie watched as the lifesaving serum left the syringe and hopefully did its job.
She checked the monitor.
She hit the blood pressure machine hoping it would show even the tiniest indication of life.
Nate put his stethoscope to the man's chest. Sophie knew what he was hoping to findâa blip. An echo. A whisper of life.
Nate straightened. He shook his head.
“I need you in the next bay, Doctor. She's cardiac contusion I believe, with a history of dysfunctional coronary arteries from birth,” Sophie said to Nate.
“Twenty-one. Punctured lung. We're doing thoracentesis now. She's A-fib,” Sophie explained in soft but professional tones as they walked over to where Aleah clung to life.
Sophie struggled not to glance over at Jack, but noticed he was now sitting on the side of his gurney, legs over the side, hands clenched on the edge of the bed. He looked like a man ready to bolt.
His eyes were dark with anger, pain and confusion. She saw his mouth move. She realized that the word he kept saying was “Please.”
Bart handed the catheter over to Dr. Hill. They had now siphoned over a quart of fluid from Aleah's chest cavity.
“Sophie,” Dr. Hill said. “Take over for me. Bart, get Donna back here.”
Bart bolted from the bay.
Sophie went to work while Dr. Hill and Nate conferred. Nate listened to Aleah's heart.
Sophie depressed the button on Aleah's blood pressure machine, which squeezed the cuff on her upper arm. “Ninety-five over sixty.” She looked up at Nate. “She should be improving with the tube in her chest. Not getting worse.”
Sophie needed Nate's brilliance to take the lead in Aleah's case. The girl's lips were turning blue. Sophie took her pulse and then her blood pressure once again to be certain. “She's dropping.”
Suddenly, the heart monitor flatlined.
“Get me those paddles!” Nate motioned to the defibrillator at the head of the gurney.
Sophie grabbed the paddles, lubricated them and handed them to Nate, who placed them on Aleah's chest.
Just as she'd done only minutes ago, she pressed the button to send the electrical current into Aleah's body.
Sophie felt as if she were falling over a rushing waterfall. The sounds in the room, the alarm of the heart monitor, Dr. Hill's voice and Nate's commands swam together and created an undecipherable cacophony. Her motions were rote.
Sophie could almost feel Aleah's soul leaving her body. She glanced above Aleah's head to see if there were any odd lights in the room. Her grandmother had told her that souls exited the body through the top of the head. Probably an old wives' tale from Italy. But something was happening here. Sophie could feel it.
Nate shocked Aleah's body a second time, but to no avail. Again, he called for the injection of epinephrine and Sophie watched as he rammed it into Aleah's small chest.
Aleah was completely lifeless, but Nate didn't give up. He placed the paddles again and commanded Sophie to hit the button.
The heart monitor was still flatlined.
They'd lost. Death had won. The monitor's long, droning alarm was telling her she hadn't performed her duties correctly.
Dark thoughts filled her mind, putting an acrid taste in her mouth. She couldn't find the strength to beat them back to their cave.
She felt utterly inadequate. She wished she'd continued with school. She should have become a doctor. Maybe with more knowledge she would have known how to save this young woman. Though she was certain that Aleah's chances had been worse than the man in the next bay, and he hadn't made it, either.
Sophie blinked slowly. Time trudged forward as though she was moving through a thick gelatin. She felt weightless and leaden simultaneously. She would have liked to sit right down on the floor and go to sleep.