To his astonishment, her eyes fluttered open, she moaned, and said, “Some dinner party, eh, Doc?”
“What happened, Nell?”
“The back of my cabin blew… where propane tank is.”
He reached for her hand, feeling the need to hold it, not just to comfort her, but to keep his own from trembling.
“Was in the tub taking my bath,” she continued. “That’s what saved me.”
Her voice kept fracturing into different pitches, all of them high, as if forced through a strainer. The soft tissues near her vocal cords were swelling closed. She’d need a tube to keep breathing, and fast.
Like a drowning man clinging to a single plank, he focused solely on what he knew best: checking her pulse – weak; assessing her breathing – labored and noisy; fine-tuning her IV – running fine. The routine momentarily kept his larger questions at bay, and all their ramifications. “We’ll soon be at the hospital,” he said, reassuring her and hitting the numbers for ER on his phone.
She began to moan again, and mutter incoherently.
“This is Dr. Mark Roper, and I’m bringing in an eighty-year-old woman who’s been in an explosion and has first- and second-degree burns to the head and trunk, but with more severe airway involvement…”
His own voice sounded far away as he continued to brief the triage nurse, kneeling over Nell and watching Lucy at the wheel as they sped along the deserted road. Riddles and ghosts continued to circle, threatening to come in from the darkness.
He continually had to reposition Nell’s head to prevent her tongue from falling backward where it might obstruct her breathing; only then did he realize she’d finally worn her damn plate.
“Roper’s special,” the triage nurse called into her intercom the minute she saw Mark jump out of the Jeep in the ambulance bay.
Lucy frowned.
Instantly orderlies, nurses, and two doctors arrived to help.
“I thought only doctors who didn’t want your patients called them Roper’s specials,” she said to him as they transferred Nell to a stretcher and raced her down the hall.
One of the physicians, a tall ebony-skinned woman with a long gray braid down to her waist gave her an incredulous look. “Where are you from, gal? In ER it means when Mark sends us someone he can’t handle alone, we better be on our toes.”
“Dr. Lucy O’Connor, meet Dr. Carla Moore, one of the few in this establishment who don’t always consider me and my patients to be a pain in the ass.” He tried to sound calm, yet he still quaked inside, trying to keep memory from intruding on what had to be done now.
Nell’s respirations were already down to a squeak. “Seems like we need to intubate this one,” Carla said, as they skidded into a resuscitation room the size of a shoe box lined with racks of equipment, everything – lines, monitors, IVs – within easy reach.
Carla shoved an anesthetic tray at him. On it were different-sized endotracheal tubes spread out in a semicircle around a laryngoscope. “Will you do the honors? I could use your help.”
He nodded, slipped on a pair of sterile gloves, then positioned Nell’s head and neck as if she were leaning forward to sniff a flower, maximally opening her airway. He reached for a silver suction probe to clear away her saliva, his fingers fumbling the instrument as he worked.
Stepping to his side, Lucy quickly grabbed a ventilation bag and mask. “Let me help you,” she said, handing them to him. For a second, he felt her hands linger on his and give them a squeeze. The orchestrated chaos and noise of a resuscitation swirled about them – people shouting orders, running to draw bloods, sticking in needles, snapping on electrodes.
Her touch steadied him.
He placed the mask on Nell’s face and squeezed a few trial puffs of oxygen into the woman’s lungs. There was a lot of resistance, the effect of her airway closing off. He scissored her mouth open with his fingers, removing the partial plate. But his thoughts finally slipped his control and streaked unchecked toward reckless conclusions he never would have even considered twenty-four hours ago.
The explosion must have been deliberate, to prevent her from telling him anything, just as someone had silenced Victor Feldt and Bessie McDonald. What’s more, he and Lucy would also have been in the blast had they arrived on time. That couldn’t be an accident either.
Lucy handed him the laryngoscope, snapping it open and illuminating the blade.
Taking it with his free hand and keeping Nell’s mouth pried wide apart with his fingers, he slid the instrument along the side of her cracked and swollen tongue. This was going be a difficult intubation. As calculating as a computer, his brain flashed to the alternative, a tracheotomy, or cutting a hole directly into her windpipe.
Nell’s eyes snapped open, her pupils wide with fear, and she grabbed at his hand. Her lips moved around the blade of the scope as if she were trying to say something.
He took it out.
Her attempts to form words continued.
He bent down to hear, once more fighting back his nausea at the terrible smell.
In a high-pitched whisper no louder than a breath, he heard her say, “What’s my chances?”
He involuntarily glanced along a length of her blackened skin where it had split open and glistened in its own juices. The rest remained intact. She might survive the burn, the tub having protected her, but not the ordeal on the respirator that lay ahead, pneumonia being the most likely cause of death. Beyond that, if the burns were truly just second-degree, she’d avoid painful skin grafts and a protracted recovery. Comfort her with a lie, or give her the truth? Or a bit of both. He usually had more time to make such calls.
She seemed to sense his hesitation, widening her eyes and imploring him with her gaze to answer.
Before he hooked her lungs up to a machine, before he submitted her to the indignities of ventilators, catheters, and mind-numbing drugs, before he stole her voice by sticking an tube through it, she’d a right to say “Yes” or “No.”
“The skin doesn’t appear to be too bad, Nell. Your airway, though, needs help.”
“Odds?” she whispered back.
“Four to one against, for most eighty-year-olds. But you’re way better than most. And once the swelling goes down in your throat, they get way better.”
He wasn’t sure she’d heard him as a darkness seemed to gather behind her eyes again. But then she shook her head. “No lingering… on a chest pump… and don’t let me… choke to death.”
The sounds in the resuscitation room seemed to grow very distant.
“You understand what that means-”
Her stare silenced him.
What she wanted was clear as a shout. To be put out of her misery, pure and simple. He imagined Charles Braden leering over his shoulder. “Nell, I can’t do that,” he whispered.
She retreated into the black recesses where such final decisions are made, but not before he saw an unmistakable flash of contempt in her gaze.
“What’s the delay, Mark?” Carla asked.
“She refuses a respirator, but asks us to keep her from choking to death.”
“Wants to go to heaven, but doesn’t want to die,” muttered a young nurse behind him.
He ignored her and, agonizing over the ordeal he was sentencing Nell to, made his decision. “That means I sedate her with midazolam, we intubate to protect her airway, and you keep her topped off with morphine to combat her pain. Remember, she gets the same compassion you would give your own grandmother…”
As he spoke, looks of distaste spread over the faces of Carla and her staff. It was a gray call. No one in ER was ever comfortable with half measures that violated their pull-’em-back-from-the-brink-no-matter-what mentality. Little wonder. They didn’t see what some of their successes had to go through once they got upstairs. At the same time Nell would feel betrayed by his sticking a tube down her throat. Yet he wouldn’t give in to what she asked. He could no more commit active euthanasia than will his heart to a standstill. So he’d do what he could live with, no matter how anybody else in the business might second-guess him, or his patient despise him on her deathbed. And Charles Braden could go to hell.