“Epidurals tend to do better than subdurals.”
“I hope so, because I’m going to be very upset if she doesn’t wake up. She’s a hero. I want to get to know her.”
“Come on. Let’s check her and Lila and make a final decision about who goes.”
“Lila.”
The two friends made their way through the ICU, looking in on each of the glass-enclosed rooms as they passed. They were both seasoned veterans of their profession and were blessed with a sixth sense that often told them a patient was about to go sour, or even sometimes that the ICU was about to be inundated. Today, short a nurse, they were both a bit edgy but comfortable knowing there wasn’t a situation that could arise where they wouldn’t know how to react.
Patty Moriarity lay serenely still, breathing easily. Patches of gauze were taped over her eyes to protect them against dryness. The right side of her face was gentian with bruising, and in places, streaks of black and blue had made their way across the midline.
“Patty,” Donna said, bending over the bed rail and straightening the oxygen prongs. “Patty, it’s your nurses Donna and Anne. Squeeze my hand if you can hear me.”
“Anything?”
“Nope.”
“She doesn’t look as light as I thought she did.”
“My experience with epidurals is that the coma seesaws lighter and deeper, and then most of them just wake up.”
“Okay, that cinches it. Lila is history. She’ll do fine in the step-down unit or even on one of the floors. Listen, our resident hero here is due for a neuro check. You want to stay and do that, and I’ll get the paperwork started on Lila?”
“Sure.”
“But no reliving your you-know-what with you-know-who.”
“I’m all business.”
With pleasant thoughts of her husband hovering just below the surface, Donna removed Patty’s eye patches. Her pupils, which were initially quite dilated from having been covered, gradually became smaller and reacted to direct light by constricting even further. Good signs.
“Patty, it’s Donna. Squeeze my hand. Please squeeze my hand.”
Nothing.
Donna pressed her thumbnail into Patty’s forcefully enough to cause discomfort. Ever so slightly, Patty’s thumb twitched. At least Donna thought it did. She repeated the maneuver. Nothing. And again. Same result. Shrugging, she worked each of Patty’s limbs and digits through a full range of motion. No resistance. Finally, the nurse ran her thumbnail in an arc heel-to-toe along the bottom of each of Patty’s feet. Minutely, Patty’s great toes responded with the slightest downward movement, toward the irritant sensation. The Babinski sign, a reflex upward movement of the toe, often signifying a disconnection between the brain and the extremities, was absent. It was another positive finding-or at least not a negative one. Patty’s neurologic status was no worse than it had been, and if the slight movement to a painful stimulus was real, it might even be better. Carefully, Donna pulled down Patty’s lower lids and squirted in a small amount of lubricant. Then she took new patches and taped them in place.
Come on, baby. Time to wake up and smell the coffee.
At the thought, Donna reflexively inhaled deeply through her nose. Then again. She looked about, quickly going to red alert. Seeing nothing, she hurried to the doorway.
“Hey, Annie,” she called out.
Anne Hajjar poked her head out of Lila Terry’s room.
“Patty awake?”
“I wish. Come down here, will you? I smell smoke or something.”
Anne was halfway down the corridor when she smelled it-a faint, chemical odor, more acrid than simple smoke. She stopped short as Donna hurried past her to the nurses’ station and grabbed the fire extinguisher. They were moving together, trying to locate the source of the odor when, with two loud gunshotlike snaps, acrid black smoke began billowing from someplace beneath the beds in rooms 2 and 6.
“Call a Dr. Red, Annie!” Donna shouted as she dashed into the first of the rooms, extinguisher at the ready. “Jeannie, Lesley, get ready for an evac, respirator patients first as soon as we have Ambu Bags to ventilate them and a minimum of three people per patient. Each of the other patients needs at least two with them. Put signs on their beds. Send one through four to the ER, all the rest out to Two East.”
Donna hurried past her. Moments later, the hospital-wide page system broadcast the operator’s uncharacteristically urgent voice.
“Dr. Red, to ICU stat. . Dr. Red to ICU stat. . Dr. Red to ICU stat.”
Dense black smoke had now nearly filled the two patient cubicles and was drifting out into the corridor connecting all the rooms with the nurses’ station. Donna felt certain this was an electrical fire of some sort, probably within the wall. She was the charge nurse today, and until someone in authority arrived from security or the fire department, all decisions were hers.
The acrid fumes were making it unpleasant to breathe. There were two Ambu Bags in the ICU and three portable oxygen cylinders. According to the Dr. Red protocol, the respiratory therapist should be up with as many more breathing bags as she could quickly get her hands on, followed by someone from the ER with the ones they had, and finally, just in case, a nurse with the bags from the crash carts on each floor.
Donna pulled on a blue paper mask, handed them out to the other nurses, and then saw to it that those patients not on respirators had them in place.
“Okay, Annie,” she called out, “let’s get portable oxygen into two and six, and move them first!”
Before any patients could be moved, the ICU began to fill with people, and noise. Two medical students burst in along with a surgeon and several nurses. A huge uniformed security guard suddenly appeared on the scene, as well, barking out orders like General Patton at anyone who would listen and trying at the same time to convince people that he was in charge and they were to pay attention to him. The patient in cubicle 6 was removed from her ventilator by one of the nurses. A med student transferred her bags of IV fluids from poles onto her bed. Then they slowly guided her bed through the crowd and out of the unit while a tech from respiratory inflated her lungs from an Ambu Bag hooked up to one of the cylinders of oxygen. One gone.
The number of people milling about was increasing almost as rapidly as the density of the smoke. What seemed like dozens of voices were shouting and issuing orders at once.
“. . Oxygen. Hook a portable tank to the bag!. .”
“Where are the portable tanks?. .”
“. . There are none! Just go!. .”
“. . You can’t move him like that. He just had a hip replaced!. .”
“. . Everybody, just quiet down and listen to me!. .”
“. . The IV pole! It’s falling over. Watch it!. .”
The ICU continued filling up with far more nurses, physicians, technicians, and security people than were needed to move the remaining patients. Everyone was talking or shouting or coughing. Certain her voice was just adding to the commotion, Donna quickly gave up trying to coordinate anything and focused instead on getting the very unstable eighty-year-old post-op cardiac patient in cubicle 2 ready for transfer. Across the bed from her, partially enveloped in smoke, rubbing at her eyes with her sleeve, Anne Hajjar did her best to keep up.
“. . I’ve got this!” a man was bellowing. “Let go, for chrissakes.”
“No, you don’t. You don’t know what in the hell you’re doing!. .”
“. . You’ve got to turn off the oxygen, dammit! Turn it off or you’ll risk blowing us all up!. .”
More bodies, more noise, more turmoil, more smoke. Donna, Anne, and another nurse, all of them sputtering, were maneuvering the bed with their unconscious patient toward the doors as fast as they could manage while still adequately breathing for him.