Booop. . Booop. . Booop.
“Shit! Call a code. He’s arrested in here!” Amy yelled as she ran through the door into the recovery room. Broker was right behind her and he saw Sommer lying rigid with his eyes shut, his lips and cheeks turning the blue-gray color of the glacier water, and from then on it only got worse.
“Christ, he’s in V fib! What the fuck happened?” Allen rushed into the room and his dazed eyes swept the monitor and then fixed on Sommer’s face.
“I don’t know. He came out clean in the OR. He was fighting the tube. Vitals were fine, train of four. Now. . he bradied on me,” Amy shouted back as she moved behind Sommer, clamped his face in both her hands.
“What the. .?” blurted Dr. Brecht, coming through the door.
“He’s in bradycardia. Bag him, start CPR,” Allen said, crossing his hands over Sommer’s sternum. Immediately Brecht reached for the defibrillator that sat on the cluttered crash cart.
With one eye on the monitor screen where a low, bumpy line traced the failing heartbeat, Amy thrust Sommer’s jaw up, opened his mouth, and swept a finger in his throat. He hadn’t swallowed his tongue. “ABC’s, ABC’s,” she chanted under her breath. “Oxygen.” She grabbed the oxygen mask as Brecht checked the defibrillator cords and unwound the paddles. Amy yanked the mask over Sommer’s face and pumped the balloon bellows.
Allen pistoned down in a CPR rhythm and burned a question at Amy. “How long?” he demanded.
“I don’t know,” Amy said between clenched teeth.
“More than four minutes?”
“I don’t know, goddammit.”
Brecht lowered the paddles and went to the cardiac monitor. “Jesus,” he said.
“What?” Allen asked.
Brecht poked a button on the monitor. An alarm began to wail and the Ely doctor erupted. “The fucking alarm was turned off!”
“No. That’s not true. .” Nancy protested.
“Nancy, shut up,” Amy said. And Broker, standing back against the wall out of the way, winced at the reflex of damage-control in her voice.
“Christ, Amy,” Nancy stammered, “I just went out to help with the accident case, I looked in before I went outside,” she protested. “His vitals were normal, he was talking. The monitor was set and he was fine.”
“Well, he’s not fine,” Allen muttered as he pumped down. “He’s in arrest. I want to see your charting. I want to know how much sedation he had on board.”
“I brought him out clean,” Amy declared, the gray of her eyes tightening, going steely.
“What the hell?” Mike, the administrator, lurched in the doorway.
“Get him out of here,” Brecht shouted. Shari, the paramedic, stepped in and gently but firmly crowded the horrified administrator back into the corridor. Allen and Amy stared at each other, their faces inches apart as they worked. Brecht returned to the defibrillator and held a paddle electrode in each hand.
Amy shook her head. “He’s coming back.”
But the line on the monitor was still going a bumpy boop de boop and Brecht hovered, holding the paddles like cymbals. Allen kept up the compressions.
Boop beep boop beep beep beep. .
“Keep ventilating, he’s coming around,” Amy said as the white clay of Sommer’s chest moved. “I’m telling you, he’s breathing,” Amy insisted.
“She’s right,” Allen raised a hand in the first calm gesture since the incident started. “He’s back.”
Broker caught peeks of Sommer in the blue-clad scurry and could see the faint pink filter into his cheeks, his throat, and into his motionless, thickly muscled forearms.
Allen popped back one of Sommer’s eyelids and Nancy handed him a slim penlight. “Mid position, reactive to light. C’mon Hank, wake up, man,” Allen whispered.
Sommer lay like a grotesque doll with his smock pulled to the side and his swollen belly bulging in the harsh light. A long splash of Betadine bathed the incision and bled thick orange streaks down his hip and groin. The incision itself looked like a line of flies melted into his skin and, below the cut, his genitals were a heap of spoiled white fruit. Gently, Allen tidied the smock as the steady beep-beep-beep marked time in the silent room.
Allen swayed, regained his balance, and shot a withering stare at Amy. “I want to know all the meds he’s had in the last thirty minutes.”
“I did everything right.” Amy’s posture was firm, but her cocky, confident demeanor had deserted her, and her words came out with a dry rasp that grated into irritation. “Doctor, sit down, you’re asleep on your feet.”
“Answer the question. Any signs of recurarization?” Allen persisted.
“No, dammit,” Amy said.
Allen steadied, took a breath, exhaled, spoke in a more normal tone. “I’m sorry, he’s a friend of mine. .” He looked at Sommer, the monitor. He rocked again. Caught himself.
Amy shook her head, disbelieving. The small room was full of sympathy but she found herself at bay, and when she spoke she was speaking to herself, not replying to Allen. “Could he have aspirated when we went after the new patient?” She shook her head, bit her lip. Thinking out loud, she muttered, “God, did I take the airway out too soon?”
Beep-beep-beep.
The doctors and nurses stood in a circle over Sommer as the room took on the acoustics of a brightly lit morgue. When Brecht broke the silence and told Nancy to wheel the snowmobile accident to X-ray, she moved like she was walking underwater. Iker appeared in front of Broker and raised his hands, questioning. Broker shook his head, exhausted. He pushed past Iker and continued down the hall away from the institutional tile, the stainless steel fixtures, the barren whiteness of it.
He shoved through the emergency room door, and paused in the garage to pull on his parka and light a cigar. Then he stepped out into the stinging snow. It was more hospitable than where he’d been.
A moment later Shari joined him. Cupping her hands expertly against the wind, she lit a filtered cigarette with a Zippo. They stood for several minutes, smoking.
“Friend of yours?” Shari asked.
“I just met him three days ago,” Broker said. “I don’t get it.” He couldn’t make it fit coming after the storm, the long paddle, the plane ride, the blizzard, the successful operation.
Shari was direct. “The nurse-anesthetist fucked up. Which is a hard call because Amy is really good.”
“How? Without the big words.”
“Who knows. The guy’s got that short, muscular neck, a receding chin, and the buckteeth. He’s an anesthetist’s nightmare. After surgery, when they take him off the gas, they remove the breathing tube and the carbon dioxide builds up in his bloodstream. That gets him breathing again. What they’re saying is his airway collapsed in the recovery room. So maybe he was breathing but still had enough residual sedation in him to come back on him and he went hypoxic.”
“Allen said. . curare something?” Broker asked.
“Recurarization,” Shari said, nodding. “It means like reparalysis. If Amy miscalculated the amount of sedation he had on board it could have taken effect again, and he takes a spill off the steep slope of the oxygen-hemoglobin-dissociation curve. That’d do it.”
“Jesus.”
“Yeah. And nobody was there. He couldn’t get air. He started sliding into arrest and no one caught it. Somebody-probably Nancy, who’s working a second shift and is covering three jobs today-neglected to calibrate the monitor alarm.” She shrugged. “Cut the O’s to the brain for four minutes and the guy’s a carrot. It happens.”
Broker turned away and wandered back into the hospital where people continued to teeter on stilts of shock. Amy stood vigil in the recovery room at the head of Sommer’s bed. Brecht, Judy, and Nancy huddled a polite distance from her. It was like a wake in there, so Broker went back in the hall and saw Allen pacing, bent forward, as if he were walking uphill. Allen blinked, focused, and recognized Broker, then walked over and patted him on the shoulder. The fatigue he’d kept at bay to perform the operation now poisoned his face into a haggard nicotine-yellow, and Broker read it all in the surgeon’s hollow stare. Save the guy and then. .
Allen attempted to smile. “I have to tell Milt. You know, he’s been asleep through all this.”
“What happens now?” Broker asked.
Allen slowly shook his head. “It depends on how long he didn’t get oxygen. He’s comatose. He could wake up in a few hours or in a few days, or it could be weeks. Or. .” Allen pursed his lips. “Once he opens his eyes he can be evaluated by a neurologist. Until then, we’re only speculating but. .” Allen faltered, his voice caught. “Jesus, look at him. He’s suffered some damage.”
“Some damage?” Broker repeated.
“Brain damage.”
“You mean?”
“I mean, she shouldn’t have pulled that tube so soon in the OR.”
“He was talking. They were talking. They were teasing back and forth,” protested Broker.
Allen made a weak, erasing gesture with his right hand. “I don’t know. It’s like. .” he swatted the air, “. . stop signs. Nobody obeys them anymore, they can’t be bothered to take the time.” A sound between a cough and a laugh rattled in his throat. “She was in a hurry, I guess.”
Then Allen continued down the hall to the nurses’ station and Broker watched him pick up the phone slowly as if the receiver were an anvil. Slowly, Allen pressed in the numbers and waited and then, as he began to talk, his facial expression collapsed inward like a piece of crumpled paper.
Standing ten feet away Broker could hear the stunned, vaguely familiar female voice protest over the phone, “No, what a minute, how could that happen? He was in the hospital, goddammit.”