21. CHAPTER 21
CHAPTER 21
T hey spent the morning going over the scenes set in the operating theatre until Mr Atrosky was satisfied. He finally allowed them a lunch break at one o’clock, and this time, Clara got to eat at Craft Services. The food was probably delicious, but it tasted like ash in her mouth as she spent her whole time trying not to glance at Taylor and the table for two that he occupied with Devon.
As the afternoon wore on, Clara could see the actors getting increasingly tired, and the lines around Taylor’s eyes deepened.
Clara glanced across at Mr Atrosky and frowned. He was sweating heavily despite doing nothing to exert himself.
She stopped paying attention to the actors, who were at a particularly tense part of the scene and started observing the director. He didn’t look well, and as she watched, the colour in his face gradually changed from a healthy pink to a pallid grey.
When he took something out of his pocket and took a puff on it, then began to rub his left arm, Clara walked to his side.
“Mr Atrosky,” she said quietly.
Initially, he ignored her, either caught up in the scene or his own pain.
“Mr Atrosky,” she said louder.
The director’s dark gaze swung towards her. “Yes? Was there something wrong with this run-through?” His voice was strident, even as he struggled for breath.
“No. There’s something wrong with you.” Clara tried to keep her voice low, but the actors had stopped and were all staring at her, waiting for her to correct them as she had done many times throughout the day.
Even as Mr Atrosky shook his head, he rubbed his shoulder again. “Nothing’s wrong with me. I’m fine.”
“No, you’re not. We need to call an ambulance,” Clara told him, stepping into his personal space and ignoring the gasps around her as she leaned forward and grabbed his wrist, feeling for his pulse.
“I do not need an ambulance. I do not like to be touched. Please let go of me.” Mr Atrosky tried to pull out of her grip, but she held firmly onto his wrist.
“Your pulse is racing. Do you have heart problems?” Clara ignored his objections and continued to question him.
“Yes, how—“ he panted, his free hand reaching up to mop at his sweating brow.
“Lacey, call an ambulance, now. He’s having a heart attack. We need to get him to a hospital.”
“Doctor, you’re overreacting. It’s just a little bit of chest pain. It will pass,” the director wheezed at her.
“When you get angina, it usually passes by now, doesn’t it?” Clara demanded.
“Yes, but—“ He mopped his brow again.
She didn’t let him talk before interrupting him, “And your GTN usually works, doesn’t it?”
“Yes, but—“
“You’re having a heart attack,” Clara stated bluntly. “Lacey, have you called that ambulance yet?” She glanced over at the young woman.
Lacey stood close by, shuffling from foot to foot, worry clouding her face, but no phone in her hand. “No, I—Mr Atrosky? Should I call an ambulance?”
“No, I’m fine. Stop overreacting; this isn’t a heart attack,” the director wheezed.
“Oh really?” Clara said sarcastically. “What’s happening then?”
“It’s just an angina attack.” He took his GTN inhaler out of his pocket again and took another puff of it. “It will settle soon. Please stop fussing. Everyone, back to positions, and we’ll run this scene from the start.” He wrenched his arm out of Clara’s grip so hard that she stumbled backwards.
Clara glanced up and saw Taylor take a step towards them, his jaw tight with anger, but she shook her head to stop him. There were a lot of people in the room, and it would look strange if he stepped in to defend her when he was supposed to barely know her.
“With all due respect, Mr Atrosky. Time is muscle. So you will listen to me. Your heart is currently struggling to get enough oxygen. You’re sweating. You feel a little bit faint. You’re struggling to catch your breath because you have a tight band around your chest and pain in your arm. You’re telling yourself this is just like your normal angina pain, and soon enough, it’ll stop. But it isn’t like your normal pain; it’s worse, far worse. Feel free to stop me when I’m wrong.” Clara stood her ground and faced down the director as total silence fell across the room, with every pair of eyes staring at her.
She ignored them all and scowled at the older man, who she knew was having a heart attack and needed help as soon as possible.
“I—I—I’m fine. I—“ Mr Atrosky’s voice trailed off, and he stared straight ahead.
Clara immediately took a step forward. “Mr Atrosky?”
He didn’t reply.
She took hold of his wrist, feeling for his pulse. It was there, but it was thready. Slinging her other arm around his shoulder to support him as he slumped down in his seat, she called out, “Lacey, we need that ambulance. Phone them now.” Clara’s voice was so firm that the younger woman grabbed her phone out of her pocket without asking any more questions. “When you have them, put them on speakerphone so I can talk to them.”
The shocked silence was broken by Devon’s quiet voice, “He said he was fine.”
Clara didn’t take her eyes off the man in front of her but still managed a snarky remark for the actress. “Yeah well, he can’t answer you because he’s unconscious from the heart attack he’s having.”
She nearly felt bad for being mean; then her mind flashed to images of the other woman hanging off Taylor’s arm. But she reminded herself that she didn’t have time for jealousy; she needed to concentrate on the next problem.
“I need some of you guys to get him onto the operating table,” she ordered.
Some of the crew, who had been standing around and watching, stepped in and grabbed hold of Mr Atrosky to stop him sliding off his chair. Picking him up, they carried him across the room.
Clara kept hold of his pulse; it was still present, but it felt fainter.
“Taylor, shove that dummy on the floor. We need to lie him down,” Clara ordered, giving a small smile when he didn’t hesitate, pushing the mannequin they had been using to practise with out of the way.
The men laid the director down on the operating table.
“Lacey, do you have the ambulance people yet?” she demanded.
“They’re transferring me now to the ambulance service.” Lacey rushed over to Clara.
“Great, put it onto speaker phone.” Clara moved around Taylor and started hooking the director up to the anaesthetic machine monitors. As she did, she checked his breathing; it was present but shallow.
“Hello, ambulance service. What is your address?” A voice rang out from the phone.
Clara gestured to Lacey to speak as she concentrated on her monitoring; she had no idea what the address was. “Taylor, do you remember the stuff I need to cannulate?”
“Yeah, I think so.” He stood as close as he could to her without getting in her way.
“Great. Tourniquet, cannula, alcohol wipe, bung, dressing. You got it?” Clara glanced over at him and saw him nod. “Okay, Mr black shirt, standing over in the corner by the defibrillator.”
A crew member pointed to themselves.
Clara nodded. “Yup. Unplug that whole trolley from the wall and bring it over.”
Glancing over her shoulder, she saw Devon standing next to the boxes of gloves and asked, “Devon, can you bring me over those boxes of gloves.”
The actress was frozen to the spot, her eyes wide and unblinking. Clara waited, and when Devon didn’t move, she lunged over and snatched two boxes of gloves, small for her and extra-large for Taylor, as she had the feeling she was going to need his help very soon. She dumped them on top of the anaesthetic machine so they were in easy reach. Pulling a pair out, she slipped her hands into them.
She turned back to Mr Atrosky, grabbed some scissors off the anaesthetic machine, and used them to cut the front of his shirt open; snatching the pads of the defibrillator, she peeled the backing off and stuck them to the director’s chest.
“Oh no,” Lacey interrupted the dispatcher she was talking to, “that was Prada; he’s going to be very upset.”
Clara shrugged. “Oh well.”
She ignored the assistant’s protests about designer clothes while she waited for the blood pressure to finish cycling; her eyes didn’t leave the ECG on the screen, which showed this was a heart attack.
“What is your emergency?” The voice from the phone asked, and Clara indicated that Lacey should stand closer to her.
Raising her voice, she said, “Hi, my name’s Doctor Clara Upford. I’m a consultant anaesthetist. I have a sixty-nine-year-old man with a known cardiac history who is having a STEMI. His sats are ninety-two percent on room air. I still have a pulse. However, it’s weak, and he’s lost consciousness.”
“Thank you. Stay on the line; an ambulance is on its way,” the dispatcher replied.
Taylor was back by her side, offering her a tray with her cannulation equipment; she gave him a brief smile, took the tray, and moved down to Mr Atrosky’s hand to insert the drip.
“Taylor, do you remember how to give oxygen?” Clara pointed to the mask hanging from the side of the anaesthetic machine.
Taylor nodded and stepped forward to grab it.
“Great. I need you to put on some gloves and give him some oxygen, okay? Just like I showed you, lift his chin and get a good seal,” Clara confirmed. “I’m going to get this cannula in.”
“No problem.” Taylor didn’t hesitate, following her instructions exactly.
Clara moved to stand by Mr Atrosky’s arm. Quickly getting the drip in, she stuck the dressing on to secure it. The tone of the monitor suddenly changed, and her eyes flew to the screen; he was in cardiac arrest, and the monitor showed the frantically erratic rhythm of ventricular fibrillation, also known as VF.
Clara announced loudly to the room, “Everyone. We have a cardiac arrest. I am charging the defibrillator.”
She dashed over to the box and pressed a couple of buttons until the familiar noise of a defibrillator charging filled the room.
“Everyone stand clear.” Clara checked carefully to make sure no one was touching the bed before she said, “Shocking.” She then pressed the red button to discharge the energy into Mr Atrosky’s heart.
The director’s body jolted on the bed as the current flowed through him. There were audible gasps around the room, but Clara ignored them, concentrating on her patient.
“Charging again.” She waited for the defibrillator to charge and delivered the next shock, which again caused his body to jolt on the bed.
This time, there weren’t just gasps. There were stifled sobs.
“Charging again.” While the box gained its energy to deliver what she hoped would be a life-saving shock, Clara carried on talking. “I need every person in the room who knows CPR to put gloves on and get in a line. Once I’ve delivered this shock, we need to start chest compressions.”
No one moved; everyone seemed too stunned.
She raised her voice, “Grab some gloves and get in line.”
And suddenly, there was a flurry of activity as five people donned gloves and lined up.
Not ever drawing breath, she checked the defib screen, which still showed ventricular fibrillation. “Everyone stand clear, shocking.”
The director’s body jolted off the bed.
“Start CPR. We are going to do thirty chest compressions to two breaths.” She hit the timer button on the anaesthetic machine. “Lacey, come and stand right here. I need you to tell me when two minutes are up. Taylor, I’m right behind you. I’m going to intubate him, and I’m just grabbing a couple of things. I can’t remember where I put the tube ties, so once it’s in. Your job is to hang onto it, okay.”
She didn’t wait for Taylor to respond before she hip-checked him out of her way, a laryngoscope in one hand and tube in the other. She opened the director’s mouth and put the blade in.
“Stop compressions,” Clara requested.
The person pumping on the chest, desperately trying to keep the blood and oxygen flowing, paused, staring at her wide-eyed.
“I’m through the cords, inflating the cuff. Restart compressions,” she announced. She grabbed the mask Taylor was holding from his hand, removed it from the tubing, and attached the tubing to the top of the airway. “Taylor, take hold of this breathing tube and don’t let go. I’ll find a tie when I can.”
Clara stepped aside when she was confident that Taylor had hold of the tube and flicked the ventilator on, announcing, “Continue compressions; do not stop for breaths. Lacey, what’s my time?”
“One minute forty seconds.” The young woman’s shaking voice replied.
“Thanks.” Clara moved around to the defib again. “Continue chest compressions. I am charging the defib.” Once the noise rang out to indicate it was fully charged, she put her hand up, “Stop compressions.”
The man doing CPR immediately halted and stepped back.
“We have VF, and everyone clear. Taylor, disconnect the oxygen, leave the breathing tube hanging out of his mouth, and step back.” She paused, checking he was following her instructions, which he did without hesitation. She pressed the red button. “And shocking.”
The director’s body jolted.
“Continue CPR. Lacey, I need you to tell me when we’re another two minutes in,” Clara called as she ripped the top drawer of the arrest trolley open and silently thanked herself for putting some pre-filled mini jets of adrenaline in, as she thought they would look good on film.
Snatching one, she injected the drug into the drip. “First adrenaline going in.”
Clara looked around herself. The room was full of people, some queuing up to take a turn at CPR, and the rest were just standing staring, with horror in their eyes. A lot of people were going to need a lot of debriefing after this.
“Is someone meeting the ambulance?” Clara glanced around the room, and only blank faces stared back. “Lacey, can you radio down and get security to wait for the ambulance and bring them up.”
She was aware of Lacey doing what she had been asked, but her mind had already moved on to her next task. Her eyes darted around until they fell on the tape she usually used to tie the breathing tube in, and she snatched it up, striding to the head of the bed.
She stood so close to Taylor that her body was pressed up against his. “I need you to keep holding the tube while I tie it in. Don’t let go, okay.” Clara felt the rumble of his affirmative answer rattle through her, and despite the dire situation, she shivered involuntarily.
When she had finished tying the tube in place, she checked her knot once more before she announced, “Tube is secure. Taylor, just stay here and make sure it doesn’t go anywhere. Lacey, what’s my time check.”
“Just coming up to two minutes,” Lacey said.
“Thanks. Continue CPR.” Clara stepped back to the defib.
The man who was currently taking a turn doing chest compressions nodded at her and put his head back down to continue what he was doing.
“Charging defibrillator,” Clara called out. The wail of a fully charged defib rang through the room. “Stop compressions.”
Clara stared at the monitor. “We have a non-shockable rhythm, dumping charge.” Leaning forward, she felt for a pulse in Mr Atrosky’s neck, and she sighed in relief when she felt a beat under her fingers. “We have sinus rhythm.”
“Is he going to be alright?” Devon’s trembling voice called out from the corner.
“He needs to get to a hospital. He could still deteriorate,” Clara said briskly. She wasn’t going to lie and say everything would be alright.
“Taylor. I feel faint,” Devon called out.
Taylor glanced up, and his eyes didn’t seek Devon’s out; they sought Clara’s, waiting to see how she would react.
Clara swallowed once, trying to dislodge the lump in her throat, but she immediately stepped forward and nudged Taylor away, taking over the job of supporting the tube. She grabbed some tape that had been stuck to the anaesthetic machine and firmly attached the tubing to the bed so it couldn’t accidentally be pulled out.
She tried not to look at Devon collapsing against Taylor the second he was within reach and tried to ignore the stab of jealousy that rolled over her when she saw the actor sweep Devon up into his arms and carry her out of the room as she wept on his shoulder.
Clara wrenched her mind away from Taylor and back to her patient. She could still see on his ECG that his heart was in trouble and hoped the ambulance would arrive soon. They needed to get Mr Atrosky to a cath lab so they could open up the blocked blood vessel in his heart.
Now that she had a bit of time, she got some fluids going and started medication to raise his blood pressure, as it was currently lower than she would have liked. Again, she was glad she had fully stocked the movie set with actual medical equipment.
Two paramedics came rushing into the room, carrying everything they would need to deal with a cardiac arrest. They both ground to a halt when they saw Mr Atrosky lying on the operating table, hooked up to far more advanced equipment than they carried.
Clara stepped forward and spoke clearly, “My name is Doctor Clara Upford. I’m a consultant anaesthetist. The patient is Damien Atrosky, a sixty-nine-year-old man.” She gave them a full handover, explaining everything that had happened and what she had done to save him.
When the paramedics loaded him onto their gurney and wheeled him out the door, she didn’t even ask them; she just followed them out, climbing into the ambulance with them.