Astride her patient like a jockey, Anika rode the gurney toward the waiting elevator, her upper body sawing with the beat of the CPR. An orderly had a ventilation bag over the patient’s face and forced air into his lungs in time with her movements. Once the elevator doors closed, she felt a sudden calm overcome her. It was always like this. For the first frantic moments she worked without thought, her training guiding her hands and her body. And now came the descent to the emergency room. She had forty seconds before the door opened again and until that time there was nothing she could do except maintain the CPR’s steady cadence. Her mind was freed.
It was the gift that kept her sane amid the carnage of negligence, stupidity, and increasingly, violence. Her eyes were on her hands, but her consciousness was focused on nothing at all. She was completely detached now, actually as calm as though she were in a trance. It was the same when she ran marathons. The last quarter of the distance was not run with the body but with the mind.
She became aware that her heartbeat was synchronized with her CPR.
The doors opened, and just as quickly the chaos returned. The orderlies wheeled the gurney down a bright hallway toward an open trauma bay. The life-flight helicopter had radioed information about the car crash victim during their inbound journey so nurses and another doctor were waiting. A portable defibrillator was standing by, and a nurse was poised with jelly and the electrodes for the heart monitor. Voices crashed above the sounds of electronics. Amid the pandemonium, Anika continued massaging the patient’s chest until everyone was ready to take over.
She shifted her weight so the heart monitor could be attached to his bare torso, its green line showing activity only when she compressed his body. When she stopped, he’d flatline once again. The gurney wheels were locked down, and an orderly stood to help Anika from the table, but she vaulted off like a longtime horsewoman, landing lightly on her rubber-soled shoes.
A nurse intubated him, running a direct oxygen hose into his mouth to keep his lungs working. The second doctor, Petr Heimann, had the defib’s paddles positioned in an instant. “Clear!”
The young man convulsed as electricity jolted his body. The heart monitor gave a matched spike but returned to a steady whine.
“Again,” Anika called.
The defibrillator charged and Heimann sent another blast through the dead man. This time a slow beat followed the spike.
Come on, come on, Anika silently prayed as she looked at his ruined legs, already thinking what would need to be done if they could get his heart beating normally. His pants had been cut away at the accident site, and even without X rays, she knew he’d lose both legs below the knees. One leg was held on by only a few ribbons of flesh. Tourniquets around his lower thighs were keeping back the blood and turning his skin a deathly gray. She imagined the gushes of blood that would pour from the ragged limbs when they’d release the thick rubber bands.
“He’s crashing again,” a nurse said.
Anika didn’t need to ask for epinephrine in a cardiac needle. Another nurse had it ready without being told.
The needle was long, an instrument better suited for a nightmare than a hospital, but Anika slid it between his ribs without pause, pressing it directly into the patient’s heart muscle.
Once she’d injected the drug, she removed the needle. “Shock him again.”
For the third time Heimann greased the paddles and applied them to the man’s naked chest, upping to 360 joules. At this stage, the dangerously high current couldn’t hurt him any longer.
“Clear,” he said with less anxiety. They all knew the outcome of this battle.
The jolt of electricity arched the patient’s back as though he was a bow being drawn taut. He fell back to the table, and somehow, miraculously, his heart began beating with an anemic rhythm. Anika and Petr began to work on the other injuries.
Checking his eyes, she discovered the pupils were pinpricks and did not respond to the penlight she flashed into them. He was in a deep coma. She ran her gloved hands through his hair and discovered a knot the size of an egg on the side of his skull. Closed head injury. They needed a CAT scan to determine the amount of brain damage. Judging by the other injuries, she believed it was safe to assume his head had taken a brutal pounding.
Anika crushed down her suspicions. Her job was to keep the patient alive long enough for the surgeons to take over. Once he left the ER, the future of the young joyrider was out of her hands.
“Tell radiology we need full trauma series X rays and a CT,” she told a nurse. “What do you think, Petr?”
“He’ll lose the legs even if he has enough mind left to control them.”
“The arm?”
Dr. Heimann glanced at the shattered limb. “Hamburger.”
The two doctors looked at each other, both silently thinking that maybe they should have called the patient when they had the chance. Was the Hippocratic oath meant to cover saving the life of a brain-dead triple amputee?
“Surgery is ready anytime we are,” a nurse announced.
“Okay, thanks.” Anika opened the tourniquets to allow blood to seep to the open wounds, returning natural color to the skin. Before the flow turned into a torrent she retightened the bands.
The patient’s heart rate was steady but shallow, and no matter how much saline they forced into him, his pressure remained low. He had internal injuries. Knowing the violence of the accident, Anika felt that some of his organs had likely detached, and that was where the bleeding was. A ruptured spleen was common with this type of crash. She sounded his abdomen and found it tight with the stress of blood filling the cavities.
She was about to confer with Heimann about a chest tube when the patient went into cardiac arrest for the third time. No matter how heroic the efforts, there was nothing they could do but watch him die. After a further ten minutes of frantic work Anika felt a touch on her shoulder. Petr’s stern eyes said enough.
“Call him.”
Angered, she looked at the wall clock, stunned to see they’d been working for a half hour. “5:18 P.M.” Her shift had ended eighteen minutes ago.
Anika stripped off her latex gloves and yanked the cloth cap from her head. More than anything she wanted to wash the sweat from her spiky black hair but there would be police outside the ER waiting to speak with her. The patient had been a criminal, after all.
As an emergency doctor, she knew the importance of distancing herself from her patients, yet losing even one pained her in a secret place she told no one about. She had to force herself to push back those feelings until she gained the perspective of time. Anika washed her hands in the scrub sink outside the trauma bay and changed into fresh scrubs in the doctors’ lounge, taking a moment to soothe her hair back against her head. In the mirror, her eyes were surprisingly clear considering what had just happened and that she’d just finished a twelve-hour Saturday-night shift. Heimann met her on her way out.
“Go start your vacation. I’ll handle the police and the paperwork.”
“Are you sure?” She was startled. Heimann wasn’t known for his bedside manner toward patients or coworkers.
“Ja.”
“Thank you, Petr. I owe you one.”
Anika decided to go to her apartment for her shower rather than do it at the hospital. She wanted to avoid Dr. Seecht, her boss, at all costs. She threw the laundry that had accumulated in her locker into a shoulder bag. Since her apartment was across the street from the huge medical center, she’d wear scrubs home.