“1—2—3—4—5”. Alice heard the noise again. “1—2—3—4”. A regular pounding beat which stops for an instant and the resumes. She could not help but count with the beat. “1—2—3—“. The noise is metallic, high pitched, sharp, and incessant. “1—2—3—4”. Then it stops again. Slowly she opens her eyes. She looks up. On the wall is an oscilloscope with a line running horizontally. “1—2—3—4”. When she hears the noise the oscilloscope line seems to vibrate an instant—just like the noise. It is not in her head. “1—2—3”. Then the noise stops again. It stops for what seems an eternity. She feels the color drain from her body. She is suddenly scared. Then the counting starts again and she relaxes and dozes off.
Two young male nurses are sitting at the monitor station, talking. One of them is the telemetry nurse; the other the charge nurse.
“Did you see the Spurs last night?”
“Man, they were great. That layup with three seconds to go…no one else could have done it!”
“They gonna do it again this year…another championship!”
“…who’s that new nurse in ICU North? Man, she got an ass on her that don’t stop moving?”
“That’s Jarline…. Before you think about getting in her pants—she got three kids—you better keep your ‘little Richard’ in check”.
“What are you two guys talking about?”
A young nurse joins them at the telemetry table.
“Hi, Jessie….just things.”
The telemetry nurse looks at the tracing. “Hey, that lady in 13, she’s got a lot of PVC’s.”
“Had she had any runs of V Tach?”
“No, No, just lots of PVC’s”
“That’s ventricular fibrillation—call a code—call a code—now—now.”
Jessie reaches for the phone. She dials 911 and the code for the room.
All three run into room 13
“What is going on? What are you doing to me?” Alice could think but she could not speak. Her eyes were focused straight ahead. She could not move her eyes even though she tried. Her vision would come and go. She could hear people speaking but she could not focus on the words. She could not understand what they were saying. It just seemed like a horrible noise. She tried again to speak, “Stop it. You’re hurting me. Leave me alone! Stop hitting me….you’re going to break one of my ribs.” Her mind would fade out for what seemed an instant then return. Sometimes she would feel like she was a bird, flying high over her bed. She could even see her face, her motionless face. That scared her and she wanted to close her eyes. Then she would return and hear the noises and feel the pounding on her chest. She just wanted to be left alone—“leave me alone, listen to me, leave me alone!”
But no one seemed to hear her or seemed to care. The pounding went on and on and on. They stopped—suddenly she felt a burning pain ripping through her whole chest. Then the pounding started again.
“Start compressions—start compressions”
“Thirty to one”.
Overhead they heard the words, “Code Blue, ICU, Code Blue, ICU”
They continued to work. After a minute they stopped. Jessie felt her neck and looked at the monitor. “Nothing”.
They started compressions again.
The code team arrived with the ER physician. He looked at the monitor and then the patient. He asked quickly if she was a full code.
“Yes, yes, she is only 48. She had an electrolyte imbalance after her gallbladder was removed. She has no known heart disease”.
The doctor murmured, “Female, fat and forty.”
“V fib” said the doctor, “Let’s shock her”. The compressions stopped.
The telemetry nurse applied the paddles to the chest—one to the center of the chest, one to the left side of the chest. Someone shouted “all clear”. There was an ominous whirling sound and then a sound like thunder. The body jolted. The whole bed shook.
The compressions were resumed again. After two minutes the compressions were stopped so the ER doctor could intubate the patient.
The burning spread through her chest. In addition, she became aware that her legs and arms were burning but that her toes and fingers were numb and the numbness was spreading.
A fear overwhelmed her; her heart had stopped. That was it; her heart had stopped. She was dying.
Suddenly she felt someone grab her throat and open her mouth. She could not see who it was, but someone was shoving a tube into her mouth and throat. She wanted to gag but couldn’t.
Again she felt she was floating upwards. She looked down on her limp body. She could see through the walls of her room into the waiting room where her husband and children were sitting, unaware of what was happening. But her children were not young adults anymore, they were children again, laughing and playing, as they had done twenty years before, their faces becoming more and more in focus while the surroundings began to grow darker and darker. “Help me. Please help me.” “Please help me.”
The nurse grabbed a tube in a plastic bag from the emergency cart. She cut the plastic and removed the tube. The doctor threaded a metal guide through the tube. Standing behind the patient, he leaned over her head and then tilted it backwards. He opened her mouth, lifted her tongue and chin with a laryngoscope, a metal blade with a light at its end enabling him to see her vocal cords. He then inserted the tube between her vocal cords and pulled out the guide wire. The tube was then connected to an Ambu bag and the patient was ventilated.
The compressions resumed.
The doctor said, “Still, V fib. Give 300 mg of Amiodarone stat”. The nurse broke open a vial with a needle at its end, and inserted the needle into the IV tubing and injected the medicine.
The Ventricular Fibrillation stopped but the tracing became flat—asystole.
Jessie shouted, “Dammit, dammit”. The doctor ordered more adrenaline, then vasopressin, then bicarbonate, then calcium, but nothing worked. After 20 minutes, he was sweating profusely. He shook his head then told the nurses to stop. “Nothing, nothing, nothing. Just stop.”
He finally looked at Alice. She was female, but she was not forty, she looked to be in her mid 30’s and even now, was exceptionally beautiful. How could this have happened?
He turned to Jessie. Jessie looked up to him. She could not smile; she could hardly speak. “She had had an elective cholecystectomy—but afterwards, she got real short of breath. It was strange. Dr Leitner, the surgeon, thought it was nerves and gave her a sedative. He did transfer her to the unit to be monitored.”
The doctor asked, “Had she a history of phlebitis or a clotting disorder.”
Jessie picked up the chart, “No, no, she had no prior medical problems…but…her mother had died with a pulmonary embolism after a minor surgery.”
The doctor asked, “Was she on blood thinners?”
“No, no, she was only going to be here a day.”
“Has anyone spoken to her family?”
“I told them she was having a problem.”
Just then Dr. Leitner entered the unit. The ER doctor told him what had occurred. Dr. Leitner became pale, his body limp. He leaned onto the wall. He then went to the waiting room to speak to the family.
The ER doctor told Jessie, “This is a great case for the bottom feeders.” He then went back to the ER.
After the ER doctor left the unit, Jessie went to the phone and called the law firm she worked for as a spotter. She knew this was “big bucks”.
She gave all the patient’s demographics to the secretary, knowing that in 4 or 5 days one of the lawyers would call the husband, offer his regrets, and, of course, his services “for this horrible tragedy which should never have occurred.
While Jessie was on the phone, a nurses’ aide entered room 13 to “clean up” so that family could visit. Looking down at the patient, she shook her head, lamenting the patient’s youth. She looked at Alice again, leaned forward wiping a tear from her eye.