Chapter 18 Down by the Water
Down by the Water
Theo
Theo tilted her tablet toward the intern, tapping at the screen where potassium levels contradicted everything else they were seeing. The kid crowded her space, nodding too vigorously, his questions tumbling out before she could finish a single explanation.
She’d worked seven days straight, her life narrowed to the clean boundaries of twelve-hour shifts.
It was a tad illegal. Technically discouraged.
But the department was short-staffed, and Dr. Morrison made a show of reminding her about rest while continuing to schedule her anyway.
Which was fine. It suited them both. It was better to keep moving than to stop.
Better to diagnose strangers than to sit in her empty apartment remembering Catherine’s lips against hers, or the feel of her smile in the crook of her neck, the quiet finality in her voice when she’d said, I wish things were different.
"But what about the sodium?" The intern's question pulled her back. Theo inhaled, ready to explain.
"Theo!" Natalie's voice cut across the department with an urgency that made everyone's head turn.
The sliding doors burst open. A gurney came through fast, pushed by two paramedics moving with synchronized speed, and Theo's heart stammered in her chest. For one terrible moment, she was certain it would be Catherine.
Pale hair spread across a pillow, blue eyes closed, body still and wrong in ways Theo wouldn't survive seeing again
But the figure on the gurney had sparse gray hair, dark skin, and a familiar duffel bag resting at his feet.
Harry. No, no, no.
Theo's training overrode everything else. She was moving before conscious thought caught up, crossing the floor in three quick strides, her hands reaching for gloves from the wall dispenser as she went.
Harry's skin carried a bluish tinge that made her stomach drop.
His chest heaved with each breath, muscles straining visibly beneath his worn shirt, the kind of respiratory distress that meant minutes mattered.
His lips were cyanotic, fingernails dark, and when Theo leaned close, she heard the wet rattle of fluid in his lungs.
"Resus one," she called out. "I need oxygen and IV access."
The gurney rolled into the bay. Staff materialized around them quickly. A nurse cut away Harry's shirt with trauma shears while another positioned the oxygen mask over his face.
Theo moved to Harry's side, her hands finding his wrist to check his pulse. Thready and fast, racing under her fingertips with arrhythmia that suggested his heart was failing along with his lungs.
"Sats are at seventy-eight," someone reported from the monitor.
Too low. Dangerously low. Theo's hands moved across Harry's chest, feeling for abnormalities, finding nothing but the rapid rise and fall of respiratory distress. His eyes remained closed, no response when she called his name, no reaction to the sternal rub.
“High-flow oxygen,” Theo said. “All the way up.”
A nurse moved in quickly, adjusting the mask. Theo watched the monitor, waiting for the numbers to climb. They didn’t.
“Still dropping,” Natalie said from Harry’s other side.
Theo hadn’t seen her arrive. She was just there, steady and close, tracking the same data, the same lack of response.
Theo nodded, moving to the next intervention. "We need to intubate. Get me a seven-five tube and prepare for RSI."
Equipment appeared on the tray beside her. Theo positioned herself at the head of the bed, tilting Harry's head back to open his airway.
The laryngoscope felt familiar in her hand, cold metal catching the bay's bright lighting as she inserted the blade and visualized his vocal cords.
The endotracheal tube followed, sliding through with resistance that suggested swelling, and Theo secured it with quick movements she'd performed countless times.
"Tube's in," she confirmed, stepping back to let respiratory therapy connect the ventilator.
The machine took over breathing for him, its rhythmic whoosh filling the bay with mechanical sound. But Harry's oxygen saturation continued dropping, the monitor's numbers descending in steady increments.
"Sats at seventy-two," the nurse monitoring vitals reported.
"Give me an ABG," Theo said.
A blood sample was drawn from Harry's arterial line. Theo watched the monitors while they waited for results, tracking the numbers that told Harry's story in clinical language. Heart rate climbing, blood pressure dropping, oxygen levels refusing to stabilize despite mechanical ventilation.
The blood gas results came back worse than expected. Severe acidosis, carbon dioxide retention, and oxygen levels indicated his lungs were failing to perform even basic gas exchange.
"He's in respiratory failure," Natalie said. Not a question, just acknowledgment of what the numbers showed.
Theo's jaw tightened. "Start him on vasopressors. Norepinephrine drip, titrate to maintain MAP above sixty-five."
More medications entered Harry's system through the IV lines that now ran from both arms. Theo moved through interventions, adjusting ventilator settings, ordering a chest x-ray, and considering every possible cause and treatment for his rapid decline.
But Harry's body wasn't responding. His heart rate continued climbing, breaching one-forty, one-fifty, the monitor's alarm shrieking with each new threshold crossed. His blood pressure dropped despite the vasopressors, falling toward numbers that couldn't sustain life.
"V-fib," someone called out.
Theo's eyes snapped to the monitor. The regular rhythm had dissolved into chaotic waves, Harry's heart quivering uselessly instead of pumping.
She grabbed the defibrillator paddles, charging them while a nurse applied gel and lowered the bed.
"Clear," Theo said, pressing the paddles against Harry's chest.
His body jerked with the shock's force. The monitor showed continued fibrillation.
"Charge two hundred. Clear."
Another shock. Another failure to convert. Theo set the paddles aside and positioned her hands on Harry's sternum, lacing her fingers together and beginning chest compressions with force that made his ribs flex beneath her palms.
Thirty compressions later, her shoulders were burning with the effort.
Natalie took over breathing, squeezing the bag valve mask in coordination with Theo's compressions. Around them, staff moved, drawing up epinephrine, preparing additional shocks, documenting everything in real time.
"Epi's in," a nurse reported.
Theo continued compressions, counting under her breath, maintaining the rhythm that might restart Harry's heart. Two minutes passed. Another round of epinephrine. Another shock was delivered with no change in the chaotic rhythm on screen.
Sweat gathered at her temples beneath the overhead lights. Some distant part of her mind registered the damage she was likely doing to his ribs, but that was a problem for later, for the living. Right now, her only focus was on making Harry one of them.
"Theo," Natalie said.
Theo didn't stop. Another round of compressions, another squeeze of the bag, another injection of medication into a body that wasn't responding.
"Dr. Brennan," Natalie repeated, firmer this time.
"Not yet." Theo's voice came out harsh, breathless from exertion.
"He's gone, Theo."
The words hung in the air between compressions. Theo's hands stilled mid-push, hovering over Harry's sternum while her brain processed what Natalie had said.
She looked at the monitor, at the flat line that had replaced the chaotic rhythm, at the absence of electrical activity that meant there was nothing left to restart.
"Time of death, fourteen-thirty-two," Natalie said.
The bay fell silent except for the click of machines being turned off. The ventilator's whoosh ceased. The monitor's alarm was silenced. Staff stepped back from the bed, their roles complete.
But Theo froze. Her gloved hands remained above Harry's chest, fingers laced together, shoulders curved forward in the posture of resuscitation.
She could see his face now without equipment obscuring it, could see the recently shaved gray stubble on his jaw and the deep lines around his closed eyes and the stillness that meant he'd never open them again.
Her arms lowered slowly, her hands falling to her sides as she climbed off the bed. She looked at Harry’s body, at the sheet being drawn up over his chest, and felt nothing beyond the distant awareness that she should be feeling something.
Natalie’s hand settled at her elbow, both firm and gentle, guiding her away. Theo let herself be moved. She couldn’t think of a reason not to.
They walked past occupied bays where other patients existed in various states of crisis and recovery. The ER continued around them with indifferent momentum, unaffected by one death among many. Natalie stopped outside an empty consultation room and opened the door.
She waited until Theo stepped inside, then said softly, “I’m so sorry, Theo. Do you want me to stay with you for a bit?”
Theo swallowed. Her voice came out rough, barely there. “No. We can’t be two doctors down.”
Natalie held her gaze for a moment, then nodded. “Alright.” Her voice stayed calm, steady. “Take as long as you need. Come back if you’re able. If not, page me, and I’ll find you cover.”
Theo managed a wordless nod and watched Natalie leave. Then she sank into one of the chairs.
She stared at the poster directly ahead, showing the chain of survival for cardiac arrest, each link illustrated with clear graphics and concise text, and felt the information slide across her awareness without sticking.
Fifteen minutes passed. Maybe more. Time felt unreliable, measured only by the continued hum of lights and the distant sounds of the ER beyond the closed door.
Eventually, she stood, and before she quite knew how, she was back at the nurses’ station.