To Brian’s great relief, within only a minute or so after the intraosseous injection, Emma’s agonizing full-body contractions slowed and then mercifully disappeared altogether. Quickly the medics took her vital signs. Alarmingly, Brian could see that Emma hadn’t regained consciousness despite the seizure having stopped.
“Pulse is steady and blood pressure is low,” Alice said, removing her stethoscope from her ears. “How about her oxygen level?”
“Not great,” George said. “Below ninety but she seems to be breathing okay.”
“Let’s hook up an ECG and get her into the stair chair,” Alice said. “Come on! Move it! We have to get this one to the ED now!”
Tom and Bill picked up the stair chair and brought it next to the hospital bed, which gave Brian an idea of the hierarchy with the medics. Alice and George were paramedics, manning the ALS ambulance, and Tom and Bill were EMTs probably manning a BLS ambulance, or basic life support. As Tom and Bill organized the safety straps in preparation for securing Emma in the carrier, Alice and George collapsed the hospital bed’s rails in unison. The moment they did, almost as if in response, Emma exploded into another full-blown seizure.
“Draw up another ten milligrams of Versed!” Alice barked while she and George made sure Emma didn’t convulse herself off the bed now that the side rails were lowered. A few seconds later Alice was handed the appropriately filled syringe, which she used to inject the drug into the cannula still positioned into Emma’s marrow cavity. Emma’s convulsions immediately began to slow and then stopped. Alice was pleased until she tried to take Emma’s blood pressure, at which point she realized that Emma had no blood pressure and no pulse, even though the ECG that George had attached was showing a slow but regular heartbeat. She wasn’t breathing, either.
“Good lord!” Alice exclaimed. “We’re looking at PEA. Start CPR stat!”
George climbed up onto the bed to start chest compressions. Alice took an ambu bag from Tom, attached the oxygen line to it, and then started respiring Emma.
Brian was horrified at this sudden turn of events, watching his thirty-four-year-old wife being given CPR and knowing she was at death’s door. It was as if he was caught in a nightmare and couldn’t wake up. Nor could he even move.
“How the hell could she have PEA?” George demanded between compressions.
“I don’t know for sure, but I suspect loss of vascular resistance,” Alice said. “Tom, draw up one milligram of epinephrine and give it stat.”
“Circulatory collapse from anoxia?” George asked. He paused momentarily to allow Tom to connect a syringe to the tibial cannula.
“Yes,” Alice said. “This is the kind of case where I wish to hell we had the capability for some kind of emergency electroencephalographic tracing to be one hundred percent, but that’s my guess. Well, more than my guess. It’s the only explanation.”
Despite feeling like he wanted to run away and hide, Brian couldn’t move. Knowing things had just gone from bad to worse, he was desperate to at least understand what was happening, so he managed to lean toward Bill, who for the moment was idle. “What’s PEA?”
Obviously distracted, Bill still turned to Brian. “Pulseless electrical activity,” he said. “The heart’s trying to beat, but it can’t. It usually means there’s little or no blood coming into the heart because it’s all pooled peripherally due to circulatory collapse.”
Before Bill could explain more, Alice called out to him to run down on the double and bring up the Lucas CPR, a battery-driven cardiac compression device. As Bill headed out the door, he had to dodge Hannah, who was on her way in. Fearing what she was about to see, Brian intercepted her, blocking her view of the spectacle taking place.
“What’s happening?” Hannah said, trying to peer around Brian’s body. “How is Emma doing? Has the seizure stopped?”
“It’s important for you and everyone else to stay out of the way,” Brian cried out, purposefully evading Hannah’s question. “Where is Aimée?”
“She’s in the kitchen with the others. I just want to be sure Emma is okay.”
“They are attending to her,” Brian said evasively. “Really, it’s better for you not to be here.” To back up what he was saying, Brian herded Hannah out the door into the hallway. At that moment Bill was rushing up the stairs carrying the Lucas device, and he squeezed past into the guest room. “They’ll be taking Emma to the hospital very shortly,” Brian added. “You join the others. I’ll go along with Emma if possible, and I’ll call you guys just as soon as I can.”
“All right,” Hannah said reluctantly, and backed up a few steps. She then fled down the stairs.
When Brian returned to the guest room, he could hear from Alice’s order that Tom was giving yet another dose of epinephrine, a major cardiovascular stimulant, meaning the first dose probably hadn’t had any effect. Stepping over to the foot of the bed, Brian spoke to Alice, who, with George, was rapidly setting up the Lucas. “I’ve had EMT training,” Brian said. “Can you tell me what’s happening here?”
“Sorry. We’ve got to get this patient out of here. I don’t have time to explain.”
Once they had the Lucas machine giving the chest compressions, they transferred Emma from the hospital bed to the stair chair. It was obvious to Brian that these people had prior experience working together since everyone knew their role without a lot of talk or direction. Then with Alice walking alongside and doing the breathing, Tom and Bill maneuvered the stair chair out of the guest room, down the stairs, and out the front door. George brought up the rear carrying the rest of the equipment. Brian followed, grabbing a face mask off of the foyer’s console table and putting it on. Outside, a few of the neighbors who’d come out of their homes in response to the sirens silently watched as Emma was rapidly loaded into the ALS ambulance. For Brian there was a sense of unreality about the whole scene, especially with everyone wearing face masks. It was as if he were participating in a science-fiction horror movie. Alice leaped in the back to ride with Emma. George started for the cab, but Brian grabbed his arm.
“She’s my wife,” he rasped. “Can I ride in the ambulance?”
“Of course,” George said. “Hop in!”
As Brian climbed into the front of the ambulance, he felt even more like he was caught in a nightmare that he couldn’t escape. The fact that his wife was in the back, fighting for her life, seemed so far-fetched that it couldn’t possibly be true.
Chapter 14
August 31
Riding in the ambulance with the siren wailing was a true déjà vu for Brian, reminding him of countless trips he’d made in one of the ESU heavy vehicles speeding out to handle some kind of disaster like an active shooter or a hostage incident. When you were a member of the NYPD ESU, most every call was a serious event, which required being prepared for the worst. The good and bad part of that was it was never boring like being a patrolman could be. As the ambulance drew closer to MMH Inwood, he found himself wishing he was back on the force and in an anonymous ESU transport, as it would mean Emma wasn’t in the back struggling for her life.
George and Alice had used the radio to let the MMH Inwood Emergency Department know what they were facing, namely a patient in extremis and receiving CPR. Brian heard the back-and-forth exchanges with growing alarm. What tormented him was Alice’s request for an emergency electroencephalogram with neurological consult. He knew that was out of the ordinary for someone with a run-of-the-mill cardiac arrest and receiving CPR.