Chapter 4
Chapter four
Helen
The patient is Teddy. The adrenaline that was missing before appears with a vengeance. Blood rushes in my ears, pounding. I swallow against a dry throat.
Unable to look away, my gaze wanders over his face, tracing every detail I once memorized in the dark.
Straight jaw, now slackened by unconsciousness.
Full lips that once dragged along my skin, currently tinged an alarming shade of cyanotic blue.
Brown hair, the color of wheat, still damp from the ocean.
It clings to his forehead, slick strands clustered together.
His eyes are closed, but I know what they look like.
Blue. Pale as the sky on a hot summer day when the sun bleaches away the most vibrant hues.
I’ve felt the weight of those eyes on me.
I’d watched them drink in the contours of my naked body.
The shock on my face must be evident because for the first time in weeks, Larry takes a step toward me, not away.
“You okay, doc?”
I force a swallow and lie, “I’m fine.”
Stunning. So gorgeous. Whispers a phantom voice in my mind, unbidden.
Stop! I need to get hold of myself. This isn’t the time or place to relive that long-ago night. I shake my hands out in front of me, the way you do when they’ve fallen asleep.
Lindsey’s back in the room. Together we pull off the sheet from the ambulance and place the thicker hospital blankets over Teddy. No! The patient. Think of him only as the patient. I keep my eyes on the floor as we work, deliberately not looking at his naked body until he’s covered.
Once that’s done, Lindsey attaches a cardiac monitor to the man’s chest. She reaches up to turn on the monitor attached high on the wall in the corner of the room.
Instantly, a steady beep-beep-beep emits from the screen.
A thin green line scrolls across with the expected dips and bumps of normal sinus rhythm.
At least his heart’s working.
“We need a blood glucose STAT, draw labs including lactic acid and coags. Start a drip with warmed saline. Order an EKG and a chest X-ray,” I tell Lindsey. Then I ask Larry, “How were his O2 stats on the way here?’
“Fine.” Larry looks up from where he’s making notes in the medical chart.
“That’s good.” The cold water, ironically, might save him. It has a protective effect on the brain and internal organs. Like chicken put in the freezer, the body can undergo trauma without long-term damage.
Please be okay.
Lindsey writes my instructions down so she can enter them into the computer that sits in the hallway. “I’ll start the IV, then put in the orders.”
“No,” I say, too forcibly. “I’ll do it.”
Both Lindsey and Larry snap their heads up at that. They turn to me, questioning, a totally reasonable response. It’s not usually the doctor who starts the IV, it’s a nurse, but something about Lindsey touching him, sticking a needle into Tedd—the patient’s—arm unsettles me.
“I’ve got it,” I tell them, as I brush past Lindsey to get the supplies out of a nearby drawer.
She shrugs lightly. “Suit yourself.”
I barely notice her leave the room.
An alcohol swab, tourniquet, gauze, 18-gauge IV, and bandage all go on the steel tray that I wheel over to the bedside.
When I tug the patient’s limp hand out from under the sheet, I notice how his skin is deathly pale, almost translucent.
The body pulls blood away from the extremities in the cold, trying to keep the heart and brain alive.
Come on, come on.
There are large, ropy veins in his lower forearm, perfect for what I need.
I wrap the tourniquet tight and rub at his skin, coaxing the vein to rise.
The sharp, stinging smell of rubbing alcohol hits the back of my nose as I swipe it over his skin.
I take a deep breath. Then, holding his arm steady, I insert the needle.
The return flash of blood should be reassuring, but it isn’t because the whole time I watch Teddy’s face to see if he’ll respond.
Nothing.
Not even a flinch at the prick of the needle.
Quickly I hook the tubing up to the bag of saline that hangs from a tall silver IV pole next to the bed. I’ll swap that saline out with the warm one when Lindsey brings it in.
I’m applying the clear bandage over the IV when his fingers give the slightest twitch. I whip my head up to find Teddy staring back, recognition sparking in his beautiful eyes.
My lungs forget how to work.
“Your hair’s longer,” he slurs softly, raising his hand like he wants to touch me, but he’s too weak. His hand falls back onto the bed with a dull thud. His lashes flicker, struggling, failing to stay open. He mumbles, “I…” A pause, a breath too shallow. “I like it.”
Something cracks open inside of me.
He goes still, utterly motionless.
“Teddy?”
Nothing.
My hands clamp onto his shoulders, shaking lightly as my heart rate quickens. I don’t like how gray his skin has gotten. “Teddy?”
Larry stiffens beside me. “Do you know him?” he asks, but his voice is distant, lost in the fog of my rising panic.
“What?” I ask without looking away from Teddy.
“Do. You. Know. Him?” Larry repeats, enunciating each word in a clear loud voice. “You said his name?” He’s staring at me, suspicion narrowing his eyes, and that’s when I realize that out of all the information Larry’s given me, not once did he mention Teddy’s name.
My heart stumbles. “Umm,” I hedge, not sure how to answer.
I understand his concern. The hospital has a strict policy.
We aren’t allowed to take care of friends or family.
The administration believes doctors become a liability when we treat people we know.
That our judgment gets clouded by emotion, and didn’t I just prove that to be true?
By insisting that I be the one to put in his IV?
What Larry doesn’t understand is that here in the ER we closely monitor the outcomes of our patients, with special attention to anything negative. We record every single death and complication. We meet once a month as a department to go over those harrowing statistics.
I know with certainty that I’m a much better doctor than my partner, Dr. G.
I have the numbers to prove it. Which means that Teddy is statistically more likely to live if I treat him.
But if I tell the truth and admit I know him, his care will be taken away from me.
He’ll be at risk. I can’t have that. How could I live with myself if something horrible happens to him?
On the flip side, how can I gamble with the thing that’s most important to me, my career? If the hospital finds out I breached protocol and treated him, there will be consequences…bad ones. Every rule-following instinct, every risk-adverse tendency in me screams against it.
I’m silent, debating what to do.
The heart monitor goes crazy, flashing red. I turn to watch Teddy’s heart rate fall like a rock thrown off a cliff.
80, 70, 60 beats per minute.
Larry isn’t watching the monitor. He stares at me, waiting for my answer.
Panic overrides rational thought. My lips move before I can stop them and I say, “Never seen him before.” The lie burns, a bitter pill I choke down knowing how wrong it is, but in this moment, I only have one priority.
Save Teddy.
Larry steps closer, his voice tense. “Helen—”
30.
A sickening, gut-churning dread swallows me whole.
20.
“He’s going into bradycardia,” I yell, my stomach sinking along with his heart. Fear turns into terror when the rhythm suddenly shifts. Those slowing beeps transform into one long continuous wail of the monitor.
Larry hustles to the top of the bed. “He’s not breathing.” He places his fingers under Teddy’s chin, searching for the carotid artery. His expression turns grim. “No pulse.”
I stare at the monitor. Flatline. No more beats. No more blood pumping.
Dead.
Teddy’s dead.
I suck in the breath that he is no longer capable of.
He’s never going to laugh again, surf again, dance again…touch me again.
No!
I won’t accept that.
“Asystole! Get the crash cart. I need epinephrine now!” In one fluid motion, I throw back the blanket that covers his chest, drop the bedside railing, and use my foot to lower his bed.
I’m short so I need him beneath me for the chest compressions I’m about to administer to have any effect.
I lace my hands together and press them to his bare sternum, right over his heart.
Under my fingers, his skin is cold and waxy.
Keeping my arms extended, I push down, counting out loud starting at one. Teddy’s chest caves in under my weight.
My hair hangs down in front of me, a swaying, straight black curtain. Teddy was right—last Christmas my hair came to my shoulders, but I haven’t cut it since. Now it reaches the middle of my back.
Larry’s still in the room. I shout at him over the cacophony of the monitors. “Epi! I need Epi! Go.”
He runs to the door, almost crashing into Lindsey, who sprints in just as fast as he’s running out.
I’ve almost counted to twenty when suddenly the room erupts as the rest of the critical response crew rush in.
Nurses, respiratory techs, and other team members crowd the small room until it’s claustrophobic.
All of them look to me for instructions.
Neal, my most-experienced nurse, enters with the rest of them. Without a word, I step aside and let him take over compressions. It’s not something we discuss. We’ve worked together long enough that this is a dance we’ve perfected. He’s strong and can do this for hours without tiring.
I move to the head of the bed, the standard position for the person running a code. Lindsey stands close to me with a pen and a sheet of paper. She’ll be the recorder. Her job is to write down exactly what happens. She’ll note what medications were given at what time and who administered them.