by Bobby Akart
She shoved her way through some family members milling about in front of the intake desk. Sonny and Peter followed her through the crowd, perturbed that people wouldn’t get out of the way once their loved one had been assigned the appropriate tag.
“I’m Jessica Albright with the sheriff’s department WET team. I brought a drowning victim in named Jimmy Free. Can you tell me where he is?”
The nurse tucked her hair behind her ears and reached across the desk to take a clipboard from another nurse. She scanned the handwritten notes. “I have a John Doe. Male. Mid-twenties. Brought in by the AmboCart.”
“That’s him. He’s my nephew,” she lied in order to be treated as family. “His uncle and father are with me. Where is he?”
“Trauma eight. End of the hallway.” She pointed to her right.
The three of them forced their way through the crowd and past a security guard, who made a half-hearted attempt to stop them as they rushed through the double doors leading to the trauma wing. The guard had been preoccupied with a man who was inebriated or high on something.
Jessica led them to the nurses’ station in the trauma wing. “What can you tell me about the drowning victim in trauma eight?”
“Are you family?” the nurse asked.
“Yes. All of us are.”
The nurse read the notes on his chart. “He was unconscious on arrival. His breathing was light and labored. A team is in there working on him now. Their first steps were to improve his oxygenation and then to stabilize his circulation. We should know something shortly.”
“Can I see my son?” Sonny’s voice was pleading.
“Sir, he’s not conscious, and we really need to let the trauma team do their jobs. It would be best for you to wait in—” She began to point toward the waiting room before Jessica cut her off.
“We’ll stand at the end of the hallway by the window. I’m a paramedic with the sheriff’s department, and we’d like to be available to provide the doctor his medical history if asked.”
The nurse scowled. Before she could order them out, she was called away by a doctor who’d stuck his head out of another trauma room. The loud, steady blare of a patient coding could be heard as the doctor opened the door.
Jessica nodded her head toward the end of the hallway, and the guys immediately picked up on the subterfuge. They moved quietly and quickly away from the nurses’ station to the window overlooking the parking lot. Jimmy’s room was the closest to them.
Ten minutes later, the door opened, and the emergency room physician exited. She removed her face mask and gloves before wiping the sweat off her brow. The hospital’s HVAC system had been adjusted to run for just a few minutes every four hours to conserve fuel in their generators.
Sonny immediately charged toward her. “How’s my son?”
The doctor took a deep breath and raised her eyebrows to open her eyes wider. She looked like she hadn’t slept in days, or at least since the hurricane swept over the Keys.
“I’m Dr. Golic. And you are?”
“Sonny Free. That’s our son, Jimmy. My wife should be here soon.”
“Well, Mr. Free, your son is either part fish or has the nine lives of a cat. He’s not conscious, but from my examination, I can tell you he’s been through a lot.”
Peter offered an explanation. “We got caught on the water as the storm hit. He’s been missing ever since.”
Dr. Golic shook her head in disbelief. “Wow. That explains it. To say this young man is waterlogged is an understatement.”
“He’d just dropped below the surface when we found him,” said Jessica. “I performed CPR and intubated him to force air into his lungs. He regained consciousness for a brief moment before passing out.”
“You intubated him?” the doctor asked.
“Yes, my name is Jessica Albright. I’m a paramedic with the WET team.”
A look of recognition came over Dr. Golic’s face. “I thought I’d seen you around. You likely saved this young man’s life, Jessica.”
“Oh, thank God!” exclaimed Sonny as he broke down crying. He looked past the doctor toward the door. “May I go see him?”
“In a moment. The nurses are cleaning up and getting him into a gown. It’s a tedious job because he doesn’t need to be jostled unnecessarily. Plus, let me explain where we are in his treatment.”
Sonny’s chin dropped to his chest, but he nodded his understanding.
“Are there complications?” Jessica asked.
“Like I said, your early intubation of the patient made all the difference. The mechanical ventilation was able to keep his arterial saturation at near ninety-two percent. Naturally, because of his time in the water, it was difficult to get accurate readings on the pulse oximeter due to vasoconstriction. However, using the oximeter on his earlobe gave me a reading I was comfortable with.
“His body temperature was a real issue. As we all know, the temperatures in the coastal waters are at least ten to twelve degrees cooler than normal. Even under ideal conditions, remaining in Florida Bay for that length of time in mid-November can bring on hypothermia. We’ve employed some thermal insulation protocols to bring his temp back to normal.”
The doctor paused, and Jessica sensed she was equivocating or perhaps stalling. Sonny was antsy to see his son, and he deserved to know the entire medical prognosis, so she repeated her question.
“Complications?”
The doctor grimaced and nodded. “He was near death when you rescued him. Not surprisingly, he was suffering from dysrhythmia, a medical term for an abnormal heart rhythm. Even advanced cardiac life-support interventions are often ineffective with patients who have low core body temperatures. We tried atropine and lidocaine, administered intravenously. However, I wasn’t satisfied with the results. We used defibrillation to steady his heart rate, but we have to continue to monitor it.
“Once he’s stable, I’ve ordered the team to undertake gastric decompression to deal with the amount of water he swallowed. We’ll also continue to push fluids to help him recover.
“Lastly, it takes up to six hours for lung injuries to present. We’ll continue to monitor him for wet lung sounds, productive cough, and, of course, his irregular heart rate.”
“My god, how can I tell his mother?” asked Sonny, who was overwhelmed by the doctor’s detailed explanation.
Dr. Golic was about to respond when the team of nurses exited the trauma room. “Doctor, the patient has stabilized as his body temperature increased.”
“Great news,” said Dr. Golic. She turned to Sonny. “Mr. Free, you’re going to be able to tell Jimmy’s mother that her son had an intense desire to live under the worst of circumstances. He needs your love and support now. Keep your thoughts positive and pray for him.”
Sonny nodded and looked toward the door. He didn’t have to ask permission, as Dr. Golic knew he was anxious to go inside. She stepped back and pushed the door open but issued a note of caution as she did.
“Please stay calm. He looks like he’s been through hell, and in a way, he has. However, your son is a fighter, and he needs his father to fight alongside him.”
Sonny couldn’t stop the tears from flowing, and he thanked the doctor before slipping inside. Peter thanked her as well and followed Sonny. Jessica hung back.
“Dr. Golic, have you withheld anything or sugarcoated it for Sonny’s benefit?” It was the type of question that some medical professionals would take offense to, but not Dr. Golic.
“That’s all of it,” she replied with a sigh. “There is, however, one matter that I need to raise that only you can probably answer.”
“What’s that?” asked Jessica in a concerned tone.
“How did you find him? By that, I mean was he underwater already or on the surface?”
“We were searching and spotted him from a distance, waving his arms over his head. From his body movement, he appeared to be standing in shallow water. Then, suddenly, he slipped below the surface. When I dove underwater t
o pull him out, he’d apparently lost his footing and fell into a trough created by the current.”
“For how long?” asked the doctor.
“Underwater? I can’t be certain.”
The doctor grimaced, glanced toward Jimmy’s room, and then reached for Jessica’s arm. She led her several feet away from the door so their conversation couldn’t be overheard.
“Increased duration underwater increases the risk of death but also the potential for severe neurologic impairment. If he was below the surface for less than five minutes, the chances are less than ten percent that he’ll suffer diminished neurologic function. Over five minutes? The percentages rise to fifty-fifty. More than ten? Then I can almost assure you of some type of neurological damage.”
Jessica’s eyes grew wide. All of her training had been focused on rescue and resuscitation. She’d never considered the impact on the brain for a drowning victim.
“Okay. By underwater, do you mean unconscious and not breathing?”
“Yes, if you know.”
“Again, I can’t say for certain, but I’d put it at more than five minutes and less than ten. How much of that time Jimmy was holding his breath, which he’s very good at, versus being in an unconscious state is anybody’s guess.”
Dr. Golic made several notes on Jimmy’s chart and then looked down the hallway toward the nurses’ desk, where another patient was being assigned a room.
“I’ll have a neurologist look in on him once he regains consciousness. He’ll assess the young man’s mental condition. I just need to emphasize to you that full neurological recovery rarely happens after ten minutes of normothermic submersion. This doesn’t need to be shared with his parents yet. Let’s keep him alive first.”
With those ominous words, Dr. Golic left Jessica standing in the hallway alone. For the first time, she broke down in tears.
Chapter Eight
Sunday, November 10
Mariner’s Hospital
Tavernier, Florida
Jessica checked her watch again. It had been forty-five minutes since she’d left her boat parked at Mangrove Marina in Hurricane Harbor. The deputy had been kind enough to offer her time to watch over it, but she couldn’t count on her staying much longer. She needed to relieve the deputy, and besides, Jimmy had not regained consciousness although his vitals had stabilized.
“Guys,” she began, “I’ve gotta get back to the boat. Plus, I’m sure Hank will arrive with Phoebe, and they’re only gonna allow so many of us in the room with Jimmy.”
“How many?” asked Peter.
Jessica shrugged. “Three, maybe four, but I doubt it. They don’t want him to feel overwhelmed when he comes to.”
“Maybe I should—?” Before Peter could finish his question, there was a gentle knocking at the door before it slowly opened. Phoebe’s worried face appeared.
Sonny immediately rushed to her and pulled her the rest of the way inside. Peter held the door while the parents consoled one another. The tears began to flow again as Sonny relayed to Phoebe what they knew about Jimmy’s condition.
Hank and Mike filled the doorway, craning their necks over the distraught parents to catch a glimpse of Jimmy. Mike had spent plenty of time in a hospital bed of his own lately, so he knew what to look for on the monitors near Jimmy’s bed. He frowned when he studied the cardiac monitors. Jimmy’s body was fighting to live, but his heart appeared to be struggling.
Jessica whispered to the guys, “Let’s step outside and give them some time with Jimmy. We don’t want the nurses to run us off.”
The Albright men exited the room and moseyed over by the window. It was getting dark, and the minimal visibility was getting closer to zero with no ambient light coming from the surrounding buildings.
“How is he?” asked Hank once Jessica arrived by their side.
She went through the list of considerations Dr. Golic had been most concerned with as it pertained to any drowning victim, including one in Jimmy’s condition. She avoided any discussion related to neurological matters since it would only lead to speculation and undue worry. She even debated within herself whether she’d tell Mike. She rarely withheld anything from him for his protection. She simply thought there was plenty to worry about regarding Jimmy’s recovery without adding possibilities of a less-than-full neurological recovery.
After providing them the update, she explained her concern for the boat. Mike agreed to give Jessica and Peter a ride to the marina while Hank took a few minutes to visit with Jimmy.
He entered trauma eight with trepidation. Hank still felt guilty for offering Jimmy to Lindsey to perform the role of border guard at the two bridges leading onto the Keys. He never suspected that his second son might get caught up in her dubious plan to destroy the bridges.
The three of them stood over Jimmy’s bed, watching every part of the young man’s body for signs of movement. Sonny told them the doctor deemed Jimmy to be unconscious rather than in a coma. In a comatose person, the brain was so heavily damaged that neither the sensory nor internal networks were functioning correctly. The body rarely moved or reacted to any external stimuli in that state.
Dr. Golic had described Jimmy’s condition as unconscious with a hint of exhaustion. His body and mind had been through a traumatic experience. Quite simply, it needed to rest. The doctor doubted it was prepared to expend one iota of energy more than it needed to.
Mike returned from dropping off Jessica and Peter at the boat. They thanked the deputy for taking the time to watch over the vessel and promised her a favor of some kind if she needed one.
“Any change?” Mike asked as he entered the room.
“No, not really,” replied Hank. “I’ve been trying to understand the monitors. They’re like the ones you were hooked up to, but I have to admit I was too messed up to learn what they were for.”
Mike glanced at the devices and jutted out his chin. “They’re slightly better than twenty minutes ago. It might take a while before he wakes up.”
“Not really.”
The four of them looked at each other. Hank thought he was hearing voices, but when he saw everyone else’s reaction, it became clear. Jimmy had awakened.
“Hey, over here,” he said in a barely audible whisper. “I’m awake.”
Phoebe and Sonny leaned over the railings and gently held their son’s hands as they took turns kissing his cheeks. Their tears streamed off their cheeks and noses onto their son. Rather than cry with them, he smiled. He was alive.
“I’ll get the nurse,” said Mike, who was through the door before anyone could acknowledge him.
Hank was also emotional. “Save your strength, Jimmy. I’m sure the nurses will need to talk to you.”
Loud footsteps could be heard in the hallway, coming toward the door. The soles of their sneakers squeaked on the floor as the two nurses pivoted to come inside. All of Jimmy’s loved ones immediately stepped back to allow them to check on their patient.
Hank made eye contact with Sonny and motioned for him to come around the bed to join Phoebe. For his part, he stepped out of the way to allow plenty of room for the medical team to work.
Shortly thereafter, Dr. Golic arrived with her stethoscope slung over her neck and shoulders. She nodded to Hank but focused her attention on Jimmy. She pulled out her penlight and studied Jimmy’s eyes, speaking to him in soft tones as she explained the purpose of each examination technique she employed.
Afterwards, she issued orders to the two trauma nurses regarding Jimmy’s medications and intravenous feeding. She also set new goals for cardiac and respiratory functions. Now that he was awake, it was hoped his recovery would hasten.
“Jimmy, welcome back. You are a remarkable young man. Part fish is the way your family has described you.”
Jimmy smiled and rolled his eyes. “I’ll never go in the water again.”
Dr. Golic laughed as she picked up his wrist and felt his pulse while studying the rate shown on the cardiac monitor.
�
�Somehow, I doubt that. You are a survivor. Survivors are known to take calculated risks when necessary. You shouldn’t fear the water, especially since you’ve lived through this.”
Jimmy smiled and nodded. He turned his gaze upon his parents, who looked like they were staring at a newborn baby, their son. He’d been given a second chance in life and planned on making the most of it.
“When can I go home?” asked Jimmy.
Mike laughed. “Sounds like something I’d say.”
Dr. Golic wasn’t sure what he meant by that, so she responded to Jimmy. “You’ve still got some work to do, young man. We need to assess your lungs for the next twenty-four hours or more. Also, there are other specialists on staff who will look in on you as part of our normal protocols.”
She avoided getting into the discussion of the neurological consequences of his near-drowning experience. Not to mention the hospital’s psychologist would poke her head into Jimmy’s room at some point to assess him for post-traumatic stress disorder.
Jimmy frowned at her response.
“Jimmy, you stay right here,” said Sonny. “Your mom and I will stay close. That’s okay, right?”
“Absolutely,” Dr. Golic replied. She turned to address Hank and Mike. “No more than two. I’m sorry.”
Hank nodded. He reached out and squeezed Jimmy’s foot. “You rest up, buddy. Lacey and Tucker are home, as is Peter. We’ll fix you up a double helping of conch stew. Right, Mom?”
Hank reached out to squeeze Phoebe’s hand. The group laughed. Phoebe’s home remedy for pretty much anything was a hefty portion of conch in some recipe or another.
The group said their goodbyes as Hank and Mike eased out of the room. A joyous, emotional reunion took place in Jimmy’s room moments later.
Chapter Nine
Sunday, November 10
Overseas Highway
Florida Keys
The Keys were engulfed in darkness as Mike drove across the Snake Creek drawbridge connecting Islamorada with Windley Key. Finished in 1981, it had been the third bridge to span the two islands since the Overseas Railroad was built in the early twentieth century. It was the only remaining operating drawbridge in the Keys. Or, at least, it was.