The Unexpected Hero

by Rachel Lee

  “Exactly. Anyway, I guess I was harsher and more critical than I needed to be by far.”

  She pursed her lips. “You might say that.”

  He flashed another smile, quickly. “The thing is, like it or not, we become adrenaline junkies after a while. That can affect our judgment. So just watch out for it. I found when I first came here that I had a tendency to magnify every symptom. If you’re not careful, every cold can look like pneumonia or lung cancer or TB. I know that sounds like a stretch, but I’ve run that course. Sometimes still do. Where we’ve been, nothing was ever as simple as it looked at first glance. Now we’re in a place where it most often is that simple.”

  “I can see that.”

  “I’m sure you can. Just remember, you’ve been conditioned to see things otherwise. Don’t run on automatic. Ever.”

  With that, he picked up his charts and walked away, leaving her feeling as if, despite their friendlier conversation, she’d just been scolded again.

  He had the most unfortunate manner, she decided. And was probably hypercritical, to judge by the way Julie and Nancy were trying to avoid him.

  It was kind of funny, when she thought about it. Dr. David Marcus might have a bark, but at least he had the good grace to realize when he had crossed the line. And there were four other doctors in the joint practice that served the county and the hospital, so it wasn’t as if he was the only one she’d be dealing with.

  That was the point at which she realized that peace could have another downside. With only six patients on the ward, she actually had very little to do. There were only so many times she could disturb them by entering their rooms, only so many treatments and checks to be administered, and with a twelve-hour overnight shift yawning in front of her, she would need to make work to occupy herself.

  Quite a change. Quite a change indeed. One thing Dr. Marcus had been right about: she was used to being on adrenaline most of the time. The cases on this ward shouldn’t elevate her stress level by so much as a molecule.

  A doer by nature, she decided to check the linen closet and supply closet for the routine needs of any hospital ward. She expected to find everything well-stocked, though. She wasn’t the only night shift nurse to have time heavy on her hands.

  As she was approaching the linen closet, an orderly emerged from the nearby cleaning closet with a cart, pail and mop. He seemed startled at her approach, then took a wide stance, as if planting himself firmly. A young man with tousled blond hair, a too-thin body and a narrow chin, he watched her approach almost warily. He looked to be fresh out of high school, which would have put him well out of her milieu when growing up, and the kindest word anyone would apply to his appearance was “ordinary.” Poor guy probably had trouble getting dates.

  “Hi,” she said as she approached. “I’m Kristin Tate, the new night nurse.” Something about him looked familiar, but then darn near everyone in the county looked familiar, even after all her time away.

  “I recognize you,” he said. Then, as if making a decision he added, “Charlie Waters. You probably don’t remember me. We only talked a couple of times.”

  She smiled. “Sorry, I’m still getting to know everyone again. Nice to meet you. I was just wondering what I’m going to do all night. Any suggestions?”

  A shy smile lit his face. “I play cards.”

  “Now that’s an idea. Maybe the four of us can play.”

  “After I finish,” he agreed.

  “Do you have a deck of cards?”

  He looked down at his scrubs as if to say, “Where would I be hiding them?”

  “Good point,” she said in response to his gesture. “I’ll look through the drawers at the nurses’ station. We can’t be the only folks who have wondered how to get through a quiet night.”

  “Probably not,” he agreed. “But I have a lot of work to do. Bathrooms and floors before the patients go to sleep. After that?”

  “It’s a date.”

  Julie and Nancy joined Krissie in her tallying of the supply closets, then returned to the nurses’ station with her. No call lights, no monitor warnings. All the patients were happily watching TV or sleeping and, for the moment at least, experiencing no problems.

  “It’s awfully quiet tonight,” Julie remarked.

  Krissie perked at that. “You mean it’s not usually like this?”

  “Absolutely not,” Nancy said. “We usually have a few more patients than this. More injuries, for one thing. And in August it’s strange to have only one dehydration case.”

  “I’m not complaining,” Julie remarked. “When the ward is full, we hardly get a breather.”

  “True that,” Nancy agreed in the slang of the young.

  Julie hesitated, then said, “I heard Dr. Marcus riding you. Not what he said but…just so you know, he can be hard to get along with sometimes.”

  Krissie wasn’t quite sure how to respond. There were certain rules of professional etiquette, and while she’d seen them broken countless times when some doctor or nurse was a pain the rear, she didn’t think she should encourage it her first night on the job.

  But she didn’t have to say a thing. Nancy chimed in. “I try to stay out of his way, because you never know when some little thing will annoy him. But mostly he’s okay. I don’t think he means to be edgy.”

  “I don’t think so, either,” Julie agreed. “Because he can be really nice sometimes. But other times, there’s this look on his face, and you know he’s uptight about something. So I just duck.” She gave a little laugh. “If he’s mad about something I did, he has to find me.”

  Krissie couldn’t contain her smile. “Sometimes that works.”

  “Yeah, you can’t really hide, being the charge nurse. Anyway, you’ll find he’s here a lot. The other docs all have families, so Dr. Marcus is on call most of the time.” Julie scrunched her face a little. “Sometimes I think he doesn’t sleep.”

  Or maybe, Krissie thought, he has trouble sleeping. She certainly did, even after all this time. Nightmares seemed ready to pounce, and were one of the reasons she preferred the night shift. When she had a nightmare while sleeping during the day, she only had to open her eyes to see sunlight, and she had learned it dispelled those images quickly. At least most of the time.

  “Anyway,” Nancy said, “it’s probably the war.”

  Her comment was laden with the knowledgeable tone of someone who thought they knew. Krissie didn’t think Nancy could imagine the half of it.

  They did find a deck of cards, however, and after ten, when the patients had all been checked on, medicated and settled, Charlie joined them. He remained shy, but Julie seemed to have taken a shine to him, making him blush with alarming regularity.

  Charlie left at midnight, his shift over, and Krissie sent Julie and Nancy to take a break. They announced they were going to the cafeteria to meet up with some friends from other wings and would be back in half an hour.

  Krissie was amazed to discover how relieved she was to be left alone for a little while. The ward was quiet, the call board remained silent, Hester Alexander’s heart monitor continued its steady rhythms.

  One by one, she checked on her patients, moving soundlessly as she opened doors and looked in. Mr. Hedley was going to need a new IV bag of antibiotics in about an hour. Other than that, everyone seemed to be resting comfortably and sleeping deeply. Mrs. Alexander opened her watery blue eyes just briefly, then returned to sleep. Krissie silenced the monitor in her room. It was enough that she could keep an eye on it from the nurses’ station; no need to disturb Mrs. Alexander’s sleep.

  The next couple of hours passed smoothly enough, and finally Krissie decided to take her own break, a half hour in the break room with her bagged lunch and another cup of coffee from the coffeemaker on the counter.

  She had eaten only half of her turkey sandwich when her pager sounded. Julie. Dropping her sandwich on the waxed paper, she took off for the ward at a fast walk, just as the PA system announced a code and a room number.
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  She arrived a few seconds later on the ward to see Nancy waving at her from the door to Mrs. Alexander’s room. From the nurses’ station she heard the unmistakable warning from the cardiac monitor. Ignoring it, she began to jog down the hall, even though you were never supposed to run in a hospital.

  “Cardiac arrest,” Nancy said quietly. Inside the room, Julie was hovering over the patient looking helpless. Damn it, an LPN should know better.

  “CPR, Julie. Did you call the doctor?”

  Nancy nodded. “Yes. He answered the page.”

  “Julie, I’ll take over. Where’s the crash cart?”

  “Getting it.” Nancy fled.

  Flatline. It was a sight a nurse saw too often, but never wanted to see. She joined Julie at the bed and motioned to her to take the breathing bag, while she herself climbed on the bed, straddled the patient and took over the chest compressions. Each compression registered on the monitor, but nothing else.

  Dr. Marcus and the crash cart arrived together, along with a crash team assembled from all over the hospital. The high whine of the charging defibrillator filled the room along with business-like chatter as the team acted.

  “Intubate.”

  Krissie paused in the compressions to allow the doctor to insert an endotracheal tube in the esophagus. He worked swiftly, and moments later the breathing bag was attached to it, again worked by Julie.

  “Two hundred,” the doctor said, then to Krissie, “Off the bed.” He was holding the paddles and Krissie quickly jumped down. “Clear!” he said, and applied the paddles.

  Mrs. Alexander’s body jumped, but the flatline remained.

  “Push 20 ccs of sodium bicarb.”

  Another nurse stepped forward with a syringe. “Pushing.”

  “Give me three hundred.”

  A jolt of three hundred volts was applied, lifting the patient half off the bed. Still a flatline.

  Krissie climbed back on the bed and continued compressions, counting automatically until Dr. Marcus said, “Clear.”

  She jumped down again and another shock was applied. Nothing.

  “Epinephrine.”

  A large syringe was slapped into his hand, and Krissie watched as he stabbed the needle directly into the old lady’s heart.

  “Clear!”

  Snap!

  Nothing.

  “Clear.”

  Snap!

  Still that awful straight line…

  “Compressions,” Dr. Marcus said.

  Krissie started to climb on the bed, but a male nurse beat her to it, giving her a break. Her arms were shaking. Her stomach turned upside down.

  They called time of death at 3:31 a.m.

  Chapter 2

  David Marcus evidently had no desire to leave medical matters until morning. He sat at the nurses’ station while orderlies worked in Mrs. Alexander’s room, cleaning up the inevitable detritus of the code. In those moments where every second counted, items such as syringes and swabs went flying, along with their packaging. Mrs. Alexander herself lay carefully arranged beneath a sheet, awaiting whichever came first: a visit from immediate family or the trip to the morgue.

  From moments of intense activity to absolute stillness. Krissie sat on a chair, staring at nothing. It didn’t matter how many times she saw this, every time felt like a personal failure.

  “There wasn’t any warning?” David asked.

  “I was in the break room eating my lunch when I got the page. The code was called right after that. You’ll have to check the monitor.”

  “Wasn’t anyone watching it?”

  “Julie or Nancy, I thought. But you can check and see if there was any warning.”

  His face tightened and he looked off into distant space. “She was getting better.”

  “That’s how it looked.”

  “I guess we’ll find out from the autopsy. But damn.”

  She managed a nod. “Why’d you push the bicarb?”

  “Because she was on a potassium-sparing diuretic. There was a possibility that her kidneys hadn’t cleared enough of it so it was one of the first things I thought of.”

  “I can see that.”

  “Except that tests didn’t show anything wrong with her kidneys.”

  “Things change.” Krissie rubbed her eyes, trying to hold back a tidal wave of despair. Before long, the second-guessing would set in. It always did and seldom helped. A lot of medical people, herself included, belonged to a secret society of flagellants, beating themselves up when they lost a patient they felt they shouldn’t have. Given another half hour, she’d probably be telling herself it was all her fault for taking a break.

  “Damn it, David, we both know how fast things can change. She’d evidently had a heart attack in the past. Hence the arrhythmia that caused the congestive heart failure.”

  “I know that,” he snapped. “And I was treating all of that. The arrhythmia, the edema…”

  “I know.” She almost snapped back.

  “Maybe I shouldn’t have cut so much diuretic.”

  Krissie shook her head. “That change shouldn’t have caused such a big effect so fast.”

  “No, you’re right.”

  Astonished that he had so quickly accepted her judgment after snapping at her, she blinked and stared at him.

  He turned to the monitor and hit the buttons to play back the hour before the attack.

  “Coffee?” Krissie asked finally. Every nerve in her body seemed to be firing. “I can’t just sit here.”

  “Sure. Thanks. Black, please.”

  Forcing herself to stand, she walked back toward the nurses’ break room. She didn’t want to wonder if things might have been different if she hadn’t gone on break, if Julie and Nancy hadn’t been so obviously overtaken by the enormity of what they were facing. Training. She’d need to give them more training. They were little more than kids, really.

  And none of those thoughts helped. A woman had died, and no one in the medical profession would ever be comfortable with that outcome if there was the remotest possibility they might have prevented it.

  She filled two cups, paused to look at her sandwich, then, realizing she wouldn’t be able to eat it, swept the remains into the trash.

  Back at the ward, she found David peering intently at the monitor. “There it is,” he said, when she came up and put the coffee beside him.

  “What?”

  “See that? Major slowdown. Like it just wound down.”

  “Arrhythmia?”

  “For about fifteen seconds before the slowdown. Easy enough to miss. The monitor should have alarmed.”

  “Maybe it did. It was screeching when I got here, and Julie and Nancy were in the patient’s room.”

  He nodded slowly. “It was fast.”

  She scanned the playback as he ran through it again. “Awfully fast.”

  “Looks more like SCA, sudden cardiac arrest.”

  Krissie nodded. “Not much time to do anything.”

  “No.” He lowered his head for a moment. “I need to call her family.”

  The worst task of all, Krissie thought. “I’ll talk to Julie and Nancy, see if I can learn anything additional. For the report.”

  He nodded. “Thanks. God knows what I’m going to tell the family.” He pushed forward on the ECG readout, then said, “It’s clear compressions were started in about a minute.” The spikes showed that clearly. “You weren’t too late.”

  It struck her then that he was trying to let her know she couldn’t have done any more. His generosity, when he was sitting there blaming himself, was all the more touching. And totally unexpected after the way they had started.

  “David—”

  He cut her off. “I need to call the family.” He rose and strode away, looking lonely as only a doctor at a time like this could.

  The phlebotomist emerged from Mrs. Alexander’s room with his cart, trundling all the blood samples to the lab. Moments later the orderlies came out, carrying away trash, pushing the c
rash cart with them to restock it and prepare it for another code. Then came Julie and Nancy, both with hanging heads.

  “We messed up,” Nancy said as they joined Julie behind the counter and sat. “We called the code and called you, but we should have started CPR.”

  “Yes, you should have.” But Krissie took pity on them, too. “I was there in less than a minute. Compressions started soon enough anyway.”

  They nodded. “We never had anyone die before,” Julie said softly. “Never.”

  Krissie looked at them, not knowing quite what to say. “It never gets any easier,” she managed finally. “Now just make sure Mrs. Alexander is ready to be seen by her family. I’m going to check on the other patients. If any of them awoke, they’re probably disturbed by this. Tomorrow, we’ll talk about managing these events a little better.”

  Rising, she touched their shoulders in turn. “We learn from our mistakes. I still do. But there was nothing you could have done that would have saved her.”

  The two girls nodded, but neither looked particularly relieved.

  To her dismay, she found the boy with the broken leg, Tom Mason, wide awake and looking frightened. He was only ten. “Am I going to die, too?”

  “Of course not!” Krissie pulled a chair closer to his bed. “You’re young and healthy. The person who died was very old and sick. There’s a difference.”

  He nodded and allowed her to pat his hand as she sat beside him.

  “I know it’s scary for you,” she said calmly. “It’s scary for everyone. But you don’t even have a heart monitor, which should tell you something.”

  “Okay.”

  She waited, giving him space to talk, to say whatever he needed to, but he remained quiet, as if trying to sort through things in his own mind his own way.

  “Look,” she said presently, “Some people are sick and come to hospitals to die. Others, like you, just managed to break their legs jumping out of a tree, and they come here to get better. Before you know it, you’re going to be hobbling around on crutches and asking your friends to sign your cast. Just tell them not to use dirty words.”