Eyes Fixed And Dilated

A site devoted to my interest into the resuscitation of mature BBW cardiac arrest roll playing patients. Mature BBW who smoke and have interests into medical roll play. Where big unhealthy ladies go to die but only after they been shocked, chest compressed, and manually ventilated.

[iamthebastard2017]

Eyesfixedandialated

[eyesfixedanddilated]

Dana S. was a striking woman in the campaign ad—thirty-eight years old with shoulder-length blonde hair streaked with natural highlights, parted slightly off-center and falling softly around her face. She had warm hazel eyes that crinkled at the corners when she smiled, full lips parted to show straight white teeth, and the kind of healthy, girl-next-door glow that made the anti-smoking message hit harder. In the photo she looked vibrant and approachable, the kind of mother and daughter who seemed invincible.

Dana S. smiled brightly in that campaign ad that went viral across North Carolina billboards and social feeds. At thirty-eight, the blonde mother from a small town outside Raleigh shared how she’d picked up her first cigarette at thirteen while helping care for her chain-smoking grandmother through emphysema and endless hospital stays. The ad ended with a stark warning about the lifelong grip of nicotine. But just weeks after the campaign ad was released, Dana started smoking again, lighting up in the parking lot after her shift at the warehouse, telling herself one pack wouldn’t undo the message she’d helped sell.

Six months later she was on the OR table for a total hysterectomy—fibroids the size of grapefruits, the surgeon had said, nothing to do with the cigarettes. The procedure went fine. She woke up in recovery groggy but stable, joking with the nurse about finally being done with the monthly hell. Back on the floor, though, her vitals refused to settle. All night her monitors painted an ugly picture: blood pressure swinging wildly between 88/52 and 142/78, heart rate flickering from sinus tach at 118 down to bradycardic dips of 52, SpO2 hovering in the low 90s despite nasal cannula, and occasional PVCs marching across the screen. The night nurse kept titrating fluids, pushing low-dose pressors, and calling the resident every hour as Dana drifted in and out, pale and diaphoretic, complaining of chest tightness she blamed on “just gas from the surgery.”

At 2:17 a.m. the alarms escalated into a full scream.

“Code blue, room 412!”

The night team exploded into the dimly lit room. Dana’s eyes were already rolling back, lips blue, skin the color of old paper. “She’s arresting—PEA on the monitor!” the resident shouted. A tech sprinted down the hall and rammed the heavy Metroline crash cart through the doorway, its wheels squealing on the tile. The charge nurse yanked the front plastic cover off the cart in one practiced motion, flipped it over, and slid the rigid CPR board beneath Dana’s limp body, lifting her torso just enough to position it under her spine for better compressions.

A burly ER tech climbed onto the board and began chest compressions, two hundred pounds driving straight down through her sternum. The first crack of ribs sounded like green wood splitting. Blood-tinged froth bubbled from the corner of her mouth. “Pulse check—nothing. BP unobtainable. SpO2 seventy-eight and tanking,” the nurse called out. “Get the airway.”

The anesthesiologist slid the laryngoscope in. Thick, coffee-ground vomit sloshed onto the sheets as the tube went past the cords. “Tube’s in. Capnography connected.” The little digital waveform flickered to life on the Zoll M Series defibrillator—flat, weak humps. “EtCO2 eight millimeters of mercury. We’re not circulating shit.”

“Push epi, one milligram IV now,” the attending barked. The charge nurse slammed the syringe into the central line port, flushed it hard. “Continue CPR—rotate every two minutes.” The tech’s arms glistened with sweat; every thirty compressions he’d call out “switch” and another set of hands would take over, palms landing on the same bruised, crepitant sternum. The capnograph numbers climbed grudgingly to twelve, then fourteen—decent CPR—before sliding back down.

“Rhythm check—now coarse VF!” someone yelled. “Zoll charged to two hundred joules.” Pads already slick with gel. “Clear!” Shock. Dana’s body arched violently. “Still VF. Epi two, push amiodarone three hundred milligrams IV.” Another syringe slammed home, the nurse’s gloves streaked red from the line. CPR resumed, ribs popping louder now under fresh hands.

“EtCO2 jumping—forty-two!” the RT shouted. “ROSC—carotid pulse present!” For thirty chaotic seconds her heart stuttered back: HR 118, BP 82/44, SpO2 84 percent, EtCO2 holding at thirty-eight. Then Dana’s eyes flew open in terror and a massive seizure ripped through her. Her whole body convulsed in grand-mal fury—back arching off the CPR board, arms thrashing, legs kicking so hard the IV poles rattled, teeth clamping down on the ET tube with a wet crunch. Frothy pink sputum sprayed across the Zoll screen. “She’s seizing—hold compressions, give midazolam five milligrams IV, push more epi!” The attending yelled over the chaos as the waveform flatlined again. “Back into VF—recharge two hundred!”

They shocked her twice more in quick succession on the Zoll, each jolt lifting her torso like a broken puppet. “Push another epi, one milligram. Lidocaine one hundred milligrams IV now.” The drugs went in rapid-fire—syringes clicked, ports flushed, the code nurse barking dosages like a drill sergeant. “Rhythm check—PEA again. Bicarb fifty mEq IV, calcium chloride one gram IV—get it in!” The vials cracked open; milky calcium and fizzy bicarb flooded her veins while the team hammered away at her caved-in chest.

“EtCO2 fourteen… now up to thirty-five—brief ROSC!” Second time around, her pulse flickered for maybe forty-five seconds: HR 132, BP 68/36, SpO2 hovering at 79 percent. No seizure this time, just agonal gasps around the tube before the Zoll screamed VF once more. “Defib three hundred joules—clear!” Shock. Her body jerked hard enough to split another rib with an audible wet snap. “Still VF. Amiodarone second dose one hundred and fifty milligrams IV. Rotate compressors—let’s go!”

They ran the full ACLS script for forty-three brutal minutes. More epinephrine—six doses total. Another round of bicarb when the ABG came back showing profound acidosis. Calcium again when PEA refused to budge. The capnography waveform grew shallower with every cycle, the green line barely wiggling above zero during the worst stretches, then spiking briefly with each fleeting ROSC before crashing back to single digits. Skin mottled purple from the groin down. The smell of burnt flesh from repeated shocks mixed with the metallic tang of blood, sour gastric contents, and the sharp chemical bite of the drugs.

While the code raged, the unit clerk called Dana’s husband. “Mr. S., your wife has taken a turn. You need to come to the hospital right away—room 412.” He arrived twenty minutes later, still in work boots and flannel, face drained of color as he was ushered into the chaotic room just as the team was winding down.

At 3:00 a.m. the attending stepped back, gloves dripping. “Last rhythm—asystole. EtCO2 zero. We’ve been down too long.” The room went still except for the soft hiss of the ventilator still trying to breathe for a dead woman. Someone reached over and silenced the Zoll alarms. Dana S. lay on the ruined bed and CPR board, chest caved and purple, mouth gaping around the tube, the campaign smile long gone.

The attending pulled the husband aside, voice low. “I’m sorry. We did everything we could. She didn’t make it.” The man staggered forward, sank into the chair beside the bed, and took his wife’s cold, mottled hand in both of his. Tears cut tracks through the sweat and grime on his face as he leaned close, whispering goodbyes—promises to raise the kids right, apologies for every fight, and soft I-love-yous pressed against her forehead—before the nurse gently guided him out so they could begin the grim work of cleaning up what was left of Dana S.

Two nurses stayed behind to prepare the body for the morgue. They worked with quiet efficiency under the harsh fluorescent lights. First the defibrillator pads were peeled off her pale, burned skin with a sticky rip, leaving angry red rectangles on her chest and side. The ET tube was deflated and gently withdrawn from her slack mouth, a final trickle of pink fluid following it. EKG electrodes were plucked away one by one, the adhesive pulling at her clammy flesh. They stripped away the soiled gown and began bathing her with warm soapy water and soft cloths, wiping down her arms, neck, and face with careful strokes. When they reached her lower body they rolled her slightly; a large postmortem bowel movement had leaked across the sheet and between her buttocks. They cleaned it methodically—lifting her legs, washing the feces from her skin and the creases with fresh cloths and solution until the area was clean and dry—then tucked a fresh pad beneath her before covering her with a clean sheet and body bag. Dana’s once-vibrant form, now still and emptied, was zipped away and wheeled down the quiet hallway toward the morgue.

[eyesfixedanddilated]

Cynthia Sikes' character, Sande Swanson, dies in the Flamingo Road episode titled "The Bad and the Beautiful" (Season 2, Episode 19), which originally aired on April 13, 1982. In this episode, Sande escapes a sanitarium to stop her brother, but her car plunges over a cliff, resulting in her death.

The rain hammered the Florida coast like a voodoo drum as Michael Tyrone stood in the candlelit back room of the old Tyrone mansion, eyes closed, lips moving in a low, guttural chant. The high priestess Julia had warned him the spirits demanded precision. One wrong syllable and the curse could rebound. But Michael never doubted. He had spent weeks preparing the doll—blonde hair clipped from Sandy’s own brush, a sliver of her silk blouse pinned to its chest, a drop of her blood dried on its tiny lips.

He raised the long silver needle. “Sande Swanson,” he whispered, voice thick with old hatred and older grief. “You betrayed your blood. Now the blood betrays you.”

The needle drove straight into the doll’s heart.

Twenty miles away, on the narrow cliff road above the Gulf, Sandy’s silver 1979 Cadillac Eldorado convertible fishtailed through the downpour. She had the top down despite the storm, wind whipping her blonde hair across her face. One hand gripped the wheel; the other fumbled desperately in the console for her pack of Virginia Slims. The manila envelope full of damning evidence against Michael lay on the passenger seat. She needed a cigarette—badly. The lighter clicked, sparked, but the wind kept snuffing the flame.

“Damn it,” she muttered, eyes flicking down for a split second as she tried again.

That was all it took.

The steering went dead in her hand. The engine coughed once, then died completely. Sandy’s scream tore through the thunder as the Eldorado left the road. It hung for one impossible second against the black sky, headlights carving useless arcs through the rain, before gravity claimed it. Metal screamed against rock all the way down the sheer face of the cliff, tumbling end over end until it slammed into the jagged boulders below with a sickening crunch of steel and bone.

Field Carlyle was first on the scene—radioed by a passing trucker who had seen the lights disappear. He skidded to a stop, jumped the guardrail, and half-slid, half-fell down the rain-slicked slope. Sheriff Titus Semple and Claude Weldon arrived minutes later, lights flashing blue and red against the storm.

They found Sandy pinned behind the crumpled dashboard, blood streaking her face, one leg bent at a sickening angle, the unlit cigarette still clutched between her fingers. Her eyes fluttered open when Field touched her cheek.

“Michael…” she rasped. “It was Michael. The ritual… the doll… he killed me with a needle.”

Titus leaned in, rain dripping from his hat brim. “Slow down, darlin’. What’d you find?”

She coughed; blood flecked her lips. “Envelope… in the glove box. Everything. The New Orleans woman… the bodies… he’s not even my brother, Titus. He’s—”

Her voice fractured. Her eyes rolled back.

“Stay with me!” Field shouted, pressing his coat to the worst of the bleeding.

Paramedics fought the cliff with ropes and stretchers. They stabilized her just enough to load her into the ambulance. Sirens wailed through Truro as the rain kept falling, relentless.

At Truro Memorial Hospital, the trauma bay exploded into controlled chaos under the harsh fluorescent lights. Dr. Harlan Bennett, the grizzled chief of surgery, took one look at the monitors and barked orders like gunfire. “Get the crash cart in here! Physio-Control LIFEPAK 5—now!”

Nurses sliced away Sandy’s blood-soaked clothes. One team slammed two large-bore IV lines into her arms while another began bag-valve-mask ventilations. Her blood pressure read 60 over 30 and dropping fast.

“Sinus bradycardia—heart rate falling… 40… 30!” a nurse shouted.

“Continue CPR—five compressions to one ventilation!” Bennett ordered. “Epinephrine, one milligram IV push! Atropine, one milligram IV! Somebody prep the tube!”

The burly respiratory therapist slid the laryngoscope in and passed the endotracheal tube. “Tube in—confirmed!”

They connected her to the LIFEPAK 5 monitor/defibrillator, its distinctive green trace glowing ominously. Conductive gel was slapped onto the paddles. The machine’s capacitors began their high-pitched whine.

“Charging to 200 joules!” the nurse called.

“Everybody clear!”

The team stepped back. The first monophasic shock jolted Sandy’s body violently off the table. The monitor flickered—brief narrow complexes—then flatlined into asystole.

“Resume CPR! Five and one!” Bennett snapped. “Push another milligram of epinephrine. One amp of sodium bicarbonate—suspected acidosis from the trauma and downtime!”

Sweat already beaded on every forehead. The room filled with the rhythmic thump of chest compressions, the hiss of the ventilator, and the steady beep of the LIFEPAK 5 counting down the seconds. Ribs cracked audibly under the force.

They shocked her again at 300 joules, then 360. Each jolt arched her broken body like a marionette. More drugs flowed. More compressions. More bicarbonate and lidocaine when fleeting ventricular fibrillation appeared.

After nearly twenty-five minutes of relentless ACLS protocol, the team was exhausted. The LIFEPAK 5 showed nothing but a flat, accusing line. Dr. Bennett made the call.

“Last ditch—intracardiac epinephrine. Get me the long needle.”

A nurse handed him the 6-inch cardiac needle attached to a syringe loaded with 1 milligram of epinephrine. Bennett positioned his gloved hand over Sandy’s exposed chest, feeling for the fourth intercostal space just left of the sternum. With a sharp, practiced thrust, he drove the long steel needle straight between her ribs, piercing skin, muscle, and finally the pericardium with a faint pop. He felt the subtle give as the tip entered the right ventricle.

He pulled back slightly on the plunger—dark venous blood flashed into the syringe, confirming placement—then slammed the plunger home, injecting the concentrated epinephrine directly into her dying heart muscle.

For a heartbeat, nothing happened. Then Sandy’s body convulsed violently. Her back arched off the table in a grotesque spasm, blood foaming at the corners of her mouth around the ET tube. The LIFEPAK 5 trace stuttered, producing a brief, frantic run of wide QRS complexes before collapsing back into flatline.

Bennett stepped back, gloves bloody, shoulders sagging. “Time of death… 11:47 p.m.”

The room fell silent except for the rain against the windows and the soft, steady tone of the LIFEPAK 5 now recording only absence.

In the hallway Field sank to his knees. Titus removed his hat and pressed it to his chest like a prayer. Claude Weldon’s face hardened into something cold and final.

Outside, miles away in the candlelit room, Michael Tyrone felt the doll grow suddenly heavy in his hands. The needle he had driven into its heart snapped clean in two. For the first time in years, the great Michael Tyrone smiled—then the smile died when the phone rang and Sheriff Titus Semple’s voice, low and lethal, told him the news.

Sandy Swanson was gone.

But the truth she had clawed from the edge of death was already loose in the world, and it had Michael’s name on it.

[eyesfixedanddilated]

Miami Vice Resuscitation Scene.

Sara Davis stepped out of Sonny Crockett’s black Daytona into the humid Miami night, the airport terminal lights still glowing faintly behind them like a distant memory. She was exhausted from the long haul—Miami to Bogotá to Paris and back—and her usual bright smile was strained, her flight attendant uniform rumpled under a light jacket. Crockett had surprised her at the gate with a bouquet of flowers, something simple and hopeful, the kind of gesture that reminded her why she kept seeing him despite the crazy schedules. “Tomorrow night,” she promised, kissing him lightly on the cheek. “I just need to crash.”

Crockett watched her disappear into the apartment building, then slid back behind the wheel. Halfway down the block he glanced over and saw the flowers still lying on the passenger seat. Damn. He killed the engine, grabbed the bouquet, and jogged back up the stairs, the familiar jangle of his keys in his pocket cutting through the quiet hallway.

He was raising his hand to knock when the first scream tore through the door.

It wasn’t a cry of surprise or pain—it was raw, animal, the sound of someone whose body had turned against them. Crockett’s cop instincts kicked in instantly. He rammed the door open with his shoulder (it wasn’t locked) and burst inside, calling her name. “Sara? Sara!”

The apartment was dim, just the glow of a single lamp. The scream came again, choked off into a guttural moan, from the bathroom. He shoved the door wide.

Sara was on the cold tile floor, back arched like a bowstring, limbs thrashing in violent convulsions. Her eyes were rolled back, whites showing, foam flecked with pink at the corners of her mouth. Sweat poured off her, soaking the front of her blouse. Her hands clawed at her stomach as if something alive were tearing its way out from inside. A thin trickle of blood ran from her nose. Her legs kicked spasmodically, heels drumming against the bathtub, and every few seconds her whole body would seize so hard her spine lifted clear off the floor.

Crockett dropped the flowers and fell to his knees beside her. “Sara! Jesus Christ, what’s happening?” He tried to cradle her head, but her neck whipped side to side with such force he nearly lost his grip. Her lips were turning blue. He could feel the heat radiating off her skin—cocaine toxicity already spiking her temperature. Another convulsion hit, harder, and vomit mixed with blood sprayed across the sink. The smell of it—sharp, chemical, wrong—filled the small room.

He didn’t waste time on questions. Scooping her up in his arms, her body still jerking against him like a live wire, Crockett ran. Down the stairs, out into the night, her head lolling against his shoulder. He laid her across the Daytona’s front seat as gently as he could, then floored it, siren screaming from the unmarked car’s dash as he weaved through traffic toward Jackson Memorial. Sara’s convulsions never stopped. Every few seconds her back would bow again, a wet, choking rattle coming from her throat. Crockett kept one hand on the wheel and the other pressed to her chest, feeling her heart hammering erratically beneath his palm—too fast, then stuttering, then too fast again.

By the time he screeched into the ER bay, Sara was barely breathing. Two orderlies and a nurse yanked the car door open and pulled her onto a gurney. Crockett followed at a run, badge flashing, voice raw: “She’s a flight attendant—collapsed in her bathroom—convulsions—get her inside!”

Sara Davis was already in full-blown cardiac arrest by the time the orderlies slammed the gurney through the double doors of Jackson Memorial’s Trauma One at 11:22 p.m. The fluorescent lights overhead buzzed like angry insects, casting a harsh, greenish glare that made every bead of sweat on her skin glisten like oil. Crockett skidded to a halt just outside the thin curtain, badge still clutched in his clammy hand, the crushed bouquet of flowers forgotten and trampled on the Daytona’s floor. He could only watch through the narrow gap as the green-scrubbed team swarmed her, their voices overlapping in a chaotic symphony of urgency.

“Unresponsive! No pulse—get the pads on!” the charge nurse shouted. She yanked off Sara’s lightweight coat first, the fabric still carrying the faint, stale ghost of cigarette smoke that clung to the collar and cuffs—Sara’s secret vice, a pack-a-day Benson & Hedges Lights 100’s habit she hid from everyone, even Crockett, lighting up in airport smoking lounges or on long layovers to steady her nerves after the endless flights and the crushing pressure of the side runs she’d gotten sucked into. The nurse’s hand brushed the pocket; a crumpled soft pack tumbled out onto the tray table with a soft rattle of cellophane. “Benson & Hedges Lights—smoker on board,” she muttered, tossing the half-empty pack aside next to the shears without a second glance. The sharp riiiip of trauma shears followed, slicing through Sara’s blouse, exposing her pale, sweat-slicked skin mottled with burst capillaries and petechiae, breasts bare under the merciless lights, nipples already dusky from hypoxia.

The heavy monophasic Physio-Control LIFEPAK 5 defibrillator—boxy, beige-and-blue, with its signature bulky handheld paddles and analog-style energy selector dial—sat ready on the crash cart. A nurse grabbed the reusable metal paddles, their stainless-steel surfaces cool and gleaming. She squeezed a thick ribbon of clear, saline-based conductive gel from the large squeeze tube onto the center of each paddle’s circular electrode face. The gel made a wet, viscous squelch as it landed. She rubbed the paddles firmly together in quick, circular motions, spreading the medium evenly, excess dripping onto the floor with soft plops. “Rhythm check—ventricular fibrillation! Charging to two hundred joules!”

The harried resident’s voice cracked as he glanced at the monitor’s jagged, chaotic waves. “Clear!” The paddles slapped onto Sara’s chest with a wet smack. THWACK. Ozone crackled sharp; Sara’s body arched violently, spine cracking audibly, the stench of singed skin blooming. “Two hundred again—CPR, now!”

They lifted the paddles, wiped them quickly with a towel, reapplied fresh gel—squelch, rub, schlick—and shocked again at 200. Still coarse VF. “Three hundred!” Another cycle of gel, rub, press, THWACK. The room pulsed with thud-thud-thud compressions cracking ribs, the compressor’s grunts, bag-valve hisses fogging with pink foam. “Airway—intubate her!” Suction roared, yanking bloody vomit. Tube in, they shocked at 300, then maxed at 360—each time the ritual repeated: lift, wipe charred residue, squeeze gel ribbons, rub together, slap back on hard, “Clear!”, THWACK. Burns blistered across her breasts.

11:28 – First full rotation of compressors. Arms already burning. “Still VF, refractory!” Lidocaine slammed in. Gel-rub-press-THWACK at 360. Monitor flickered to asystole for twelve seconds, flat tone slicing the air, then snapped back to coarse VF. “Another epi! Sodium bicarb—one amp—she’s acidotic from the coke!” Fresh gel applied, the tube growing lighter. Compressions never stopped; sweat poured, gloves slick. Bretylium dripped slow. Another cycle—epi every five minutes, repeated lidocaine.

11:35 – Twenty-minute mark. Paddles prepped yet again—gel squelch, rub, smack—360 joules. Brief pulseless electrical activity: narrow QRS marching uselessly before collapsing back into fine VF. “Keep going—rotate!” Fourth compressor stepped in, grunting louder, ribs crunching wetly. More epi, more bicarb when pH dropped to 6.92. Gel between every shock, paddles warmer, burns deepening to angry purple welts. The faint tobacco scent from the discarded Benson & Hedges pack mixed with the thickening haze of singed flesh and antiseptic.

11:42 – Another round: gel, rub, press, THWACK. Asystole for nearly twenty seconds, weak disorganized rhythm, then VF again. “Epi! Bretylium repeat!” Fifth compressor, arms visibly shaking. Second lidocaine bolus. The VF waveform shrank further.

11:48 – Thirty-plus minutes. Team breathing ragged. Paddles prepped with the nearly empty gel tube—squelch sounding weaker now. THWACK at 360 produced only faint twitches. Brief PEA again, then straight back to fine VF. “More bicarb—pH is tanking!” Sixth compressor rotation; one nurse’s voice cracked as she called the count. Sweat flew in arcs. The chemical rot of cocaine and the ghost of cigarette smoke hung heavy.

11:55 – Another full ACLS cycle: gel application slower from fatigue, rub, hard press, “Clear!”, deafening THWACK. Monitor flatlined longer—almost thirty seconds—before flickering back. Seventh compressor, his grunts turning to groans. Additional epi push, third amp of bicarb, repeat bretylium. VF whisper-fine now, like static dying on an old radio.

12:02 – Forty minutes in. Paddles wiped and gel-smeared once more, the schlick sluggish. THWACK. Sara’s body barely lifted. Asystole stretched to forty seconds. Weak agonal rhythm tried and failed. “Another epi—keep compressing!” Eighth rotation; the lead compressor’s shoulders slumped visibly between sets. The room reeked of exhaustion—sweat, burnt skin, vomit around the ET tube, and that persistent stale tobacco note from the coat pocket.

12:08 – Final desperate cycles. Gel tube squeezed dry; a nurse grabbed a backup. Rub, press, THWACK after THWACK. VF almost gone, converting momentarily to PEA then flatlining longer each time. More drugs pushed—epi, lidocaine top-off, bicarb drip started. Compressors rotated for the ninth and tenth time, voices hoarse, arms trembling uncontrollably. The monitor’s waveform was a dying whisper.

12:15 – Fifty-three minutes. Ninth full cycle: fresh gel ribbons squeezed with shaking hands, rubbed slower, pressed hard. THWACK. Brief organized rhythm flickered—sinus tachycardia for eight seconds—then collapsed into coarse VF again. “Epi! Lidocaine repeat!” Tenth compressor rotation; one resident’s arms gave out mid-set, forcing an immediate switch. The air was thick, almost unbreathable—ozone, cooked flesh, ammonia sweat, chemical rot, and the faint Benson & Hedges ghost clinging to the discarded coat.

12:22 – Another paddle prep, the gel now warm from repeated handling. Squelch, schlick, smack. 360 joules. Asystole for nearly a full minute, then a weak, wide-complex PEA that dissolved back to fine VF. Eleventh rotation; a nurse’s voice broke as she called “Fifteen and two!” More bicarb, another epi, bretylium top-up. The team’s scrubs were drenched, faces pale with exhaustion under the buzzing lights.

12:28 – Gel tube replaced a third time. Rub, press, “Clear!” THWACK. VF waveform almost flat now. Twelve-second asystole, then a single premature ventricular contraction that triggered coarse VF again. Twelfth compressor, his grunts turning into labored gasps. “We’re at an hour—keep going!” the resident rasped, sweat streaming into his eyes.

12:35 – Sixty-three brutal minutes in. Paddles prepped yet again—gel squelch now faint and sticky. THWACK. Sara’s body barely twitched. Monitor flatlined for over a minute, flickered into agonal PEA, then nothing. Thirteenth and fourteenth compressor rotations; one nurse stepped back, hands cramping, another took over with a visible tremor. Final epi push, last lidocaine bolus, bicarb nearly gone. The VF was gone entirely now—pure asystole stretching longer each time, the room silent except for the wet crunch of compressions and the ragged breathing of the team.

By 12:42, after seventy grueling minutes of relentless cycles—hundreds of paddle preps with viscous gel squelches and schlicks, rib-cracking compressions that had turned her chest into a bruised, sunken wreck, ozone-laced shocks that left her breasts a map of raw burns, and drug boluses that had exhausted the crash cart—the resident finally stepped back. His scrubs were soaked through and stained, face gleaming with sweat under the buzzing lights. The monitor showed absolute flat asystole—electrical silence that felt heavier than any scream. He pressed fingers to the femoral, then carotid—cool, clammy skin with no pulse whatsoever. The team stood panting, gloves dripping, the abandoned bag-valve hissing its lonely rhythm, the ghost of Benson & Hedges smoke still faint beneath the overwhelming stench of defeat.

“Time of death… twelve forty-two,” he said hoarsely, voice raw and broken. He silenced the flatline tone with a sharp click that echoed unnaturally loud in the sudden, terrible quiet. One nurse gently closed Sara’s staring eyes with trembling fingers. Another pulled the ET tube free with a final wet suck, a trickle of bloody foam spilling across her chin, and drew the sheet up over her ravaged, burned body. The resident stripped off his bloody gloves, tossed them into the red biohazard bin with a dull thud. The faint scent of conductive gel still lingered, mixed with the ghost of Benson & Hedges smoke and the heavy stench of death and failure, as he walked out to where Crockett waited, rooted like a ghost in the hallway.

[eyesfixedanddilated]

The humid night air in southern Georgia pressed down like a damp, filthy blanket on the sagging double-wide trailer parked on a weedy dirt lot just outside Valdosta. It was late August 2025, the paper-mill stench from down in Cairo mixing with the thick reek of chain-smoked cigarettes that had soaked into every inch of Betty Jean Crawford’s home for the last fifty-three years. Seventy-one years old, widowed since Earl dropped dead from the same black-lung bullshit, Jean was a two-pack-a-day woman—Doral Full Flavor 100s, the cheap red-and-white packs she bought by the carton at the Dollar General because they hit hard and didn’t break the disability check. The trailer reeked of stale tar, nicotine, and the faint chemical bite of her nebulizer mist.

She sat slumped on the cracked black leather couch, topless, her paisley blouse wadded and shoved under one heavy armpit because the sweat ran in greasy rivers down the deep, pendulous crease between her massive, sagging breasts. Her short gray hair was matted flat with sweat and grease, reading glasses perched crooked on top like a dirty crown. Yellow nicotine stains streaked the first two fingers of her right hand; her teeth were the color of old ivory from decades of Dorals. The portable nebulizer compressor hummed on the coffee table beside an overflowing ashtray crammed with crushed Doral 100 butts—some still smoldering, filters crusted with dried pink lipstick and yellow phlegm. A half-empty pack of Dorals lay next to it, cellophane peeled back, lighter beside a jelly jar of Evan Williams bourbon sweating rings onto the wood.

The attack came like a boot to the chest.

Not the usual COPD wheeze she lived with. This was a crushing, wet vise that made her eyes bulge. Jean’s hand shot to her left tit, nails—chipped and tobacco-stained—digging bloody crescents into the soft, veined flesh as she tried to claw the failing heart out. A thick, rattling gurgle tore from her throat, part death rattle, part vomit. Frothy pink sputum bubbled at the corners of her blueing lips and dribbled down her chin onto the heavy roll of her belly. The jelly jar slipped from her trembling fingers and exploded across the linoleum in a spray of glass and cheap bourbon. Urine flooded the crotch of her beige elastic pants as her sphincter gave way with a wet hiss. Her body convulsed once, tits flopping heavily, then she folded sideways like a sack of wet cement, head cracking the armrest with a dull thunk. One breast spilled over the couch edge, nipple dark and flattened against the cracked leather. The nebulizer kept hissing faintly while the last Doral butt in the ashtray burned itself out.

Neighbor Leroy found her forty minutes later. He didn’t waste words. “Goddammit, Jean,” he muttered, already punching 911 on his flip phone, the smell of shit and bourbon and old smoke hitting him like a wall. The ambulance took twenty-eight minutes bouncing down the backroads.

Paramedics Travis and Big Mike kicked the screen door open into a choking fog of cigarette stench, sour bourbon, fresh feces, and the metallic tang of nebulizer mist. Jean lay exactly as she’d fallen—topless, one arm pinned awkwardly beneath her rolls of fat, the other dangling limp, skin already turning that waxy, grayish-yellow only heavy smokers get. Travis dropped to his knees in the puddle of piss, bourbon, and glass that sliced through his uniform pants.

“Full arrest. Move.”

They dragged her dead weight onto the filthy carpet between the couch and the TV tray. Big Mike grabbed the trauma shears and sliced her pants and piss-soaked panties off in one brutal motion, exposing the sagging folds of her belly, varicose veins crawling up her thighs like purple road maps, and the mess smeared between her legs. They slapped the AED pads on: one high on the right chest, the other low on the left flank where her heavy breast sagged over the edge. “Analyzing… shock advised.” Two hundred joules. Her entire body arched violently off the floor, breasts slapping together with a wet, meaty sound, gold necklace whipping across her sweaty face. No rhythm.

Travis stacked his hands and drove into compressions—deep, fast, brutal. On the fifth push they both heard the sickening wet crunch of ribs snapping like green twigs under his palms. He didn’t stop. Sweat poured off his forehead and dripped onto her cooling, nicotine-stained skin. Mike bagged her hard, her cheeks ballooning, a slurry of vomit, pink froth, and sputum spraying around the mask seal. They started an IV in the crook of her elbow—veins rolling and blowing twice, dark blood trickling down her arm from the failed sticks—then slammed the first round of epi. Another shock at 300. Her body jerked like a hooked catfish on a line, more urine and thin shit leaking onto the carpet. Three-sixty joules. Travis’s gloves tore open; his own blood mixed with the mess on her chest where the pad had burned a raw circle into her skin.

They intubated her right there on the trailer floor. Travis wrenched her head back, scraping her yellowed dentures aside with the laryngoscope blade. The tube slid in with a disgusting, sucking gurgle past the swollen tongue and thick secretions. Mike taped it down while the vent hissed. Travis kept hammering her broken chest—each compression now accompanied by a grinding, crackling sound of ribs shifting and grating under his hands like broken glass in a bag. Her left pupil was already fixed and blown, staring blankly at the water-stained ceiling. Twenty-seven minutes of this nightmare: drugs, shocks, sweat, blood, shit, vomit, and the sharp ozone smell of the defibrillator. The monitor stayed flatline except for a few useless agonal spikes that meant nothing.

Travis finally sat back on his heels, gloves slick with blood, shit, and fluids, breathing like he’d run a marathon. “23:47. Call it.”

They left her sprawled naked on the carpet—ribs caved in like a stomped cardboard box, ET tube still jutting from her slack, foam-crusted mouth, a thin trail of pink sputum leaking from one nostril. Her heavy breasts splayed obscenely to the sides, one nipple scraped raw from the AED pad. The gold necklace was smeared with sweat, blood, and a smear of her own shit. The nebulizer still hissed on the table next to the overflowing ashtray of Doral 100 butts and the scattered romance novels kicked across the floor.

Betty Jean Crawford—seventy-one, two-pack-a-day Doral 100s smoker—died ugly on her trailer floor in southern Georgia, tits out, ribs shattered, lungs full of fluid and tar, heart finally quit for good. The resuscitation was textbook brutal. It just wasn’t enough. The South Georgia heat and a lifetime of cheap cigarettes won anyway.

[eyesfixedanddilated]

Ginger Mckenna Rothstein of “Casino”

The fluorescent lights in the dingy hallway of the Sunset Strip motel flickered like dying fireflies, casting long shadows across the threadbare carpet that smelled of piss, cigarette smoke, and old vomit. Ginger McKenna Rothstein—once the sharp, high-rolling wife of a Vegas casino boss, now just another strung-out ghost in Los Angeles County—leaned hard against the cinderblock wall, her short, sweat-matted blonde hair sticking up in wild spikes. Her colorful silk blouse, a riot of pink, purple, and blue patterns, clung to her clammy skin, the fabric torn at one shoulder from where she’d clawed at herself earlier in a coke-fueled panic. Track marks dotted the inside of her left arm like purple-black railroad tracks. In her trembling right hand, she held a rigged-up syringe: a “hot load,” the dealer had called it—pure cocaine base cooked fast in a spoon over a lighter flame, dissolved sloppy in tap water, no filter, just enough to slam the veins hard and fast. She was chasing the dragon one last time, or maybe chasing oblivion. She didn’t care which.

She jammed the needle into a bulging vein, thumbed the plunger down in one greedy push. The rush hit like a freight train—euphoric fire exploding behind her eyes, heart slamming against her ribs like it wanted out. For ten seconds, she was invincible. Then the crash came sideways.

Her pupils blew wide as saucers. Chest pain knifed through her like a hot poker—cocaine’s vasoconstriction clamping down on her coronary arteries, starving the heart muscle even as her blood pressure skyrocketed. She gasped, clawing at the wall, her manicured nails scraping concrete. Sweat poured off her in sheets; her skin burned to the touch, core temp spiking toward 106 degrees from malignant hyperthermia. Nausea rolled up fast. She retched, vomiting a thin stream of bile and half-digested pills onto the carpet between her bare feet. Her legs buckled. She slid down the wall, knees splaying, the silk blouse riding up to expose the bruises on her thighs from days of benders.

Seizures came next—grand mal, full-body thrashing. Her arms flailed, fists drumming the floor, head cracking back against the cinderblock with a wet smack. Foam bubbled from her lips, pink-tinged from biting her tongue. Urine soaked the crotch of her pants and puddled beneath her. Her heart, racing at 180-plus beats per minute, stuttered into chaotic ventricular fibrillation—cocaine’s sodium channel blockade and catecholamine storm turning the ventricles into a quivering bag of worms. No pulse. She went limp, eyes half-open and glassy, chest still but for the occasional agonal gasp. The hallway fell silent except for the distant hum of traffic on the boulevard.

A hooker two doors down heard the thud and screams. She cracked her door, saw the mess, and dialed the front desk. “Send the ambulance—white bitch OD’d bad.” LA County Fire Department Engine 9 and Rescue 9 rolled hot from Station 9, sirens wailing through the pre-dawn streets. It was 1976; LA County’s paramedic program was still fresh off the Wedworth-Townsend Act, those early crews straight out of the Harbor General training pipeline. Paramedics Ramirez and Kowalski hit the hallway in under eight minutes, boots crunching broken glass and stepping over the vomit puddle.

“Jesus Christ,” Ramirez muttered, dropping his jump bag. Ginger was in full arrest—witnessed collapse into VF on the quick-look paddles. Kowalski delivered a sharp precordial thump with the side of his closed fist to the lower sternum—thud—a 1970s Hail Mary to try converting the fibrillation before defibrillation. It didn’t work. They started CPR: sternal compressions at 80 per minute, 15:2 ratio with bag-valve-mask ventilations—old-school BLS. Ribs cracked audibly under his palms on the third set, a gritty crunch like stepping on dry twigs. Ramirez slung an IV in her antecubital, blood flashback weak and dark. They intubated her right there on the filthy carpet—laryngoscope blade flashing, ET tube sliding past swollen vocal cords slick with secretions. Oxygen hissed in at 100%. Defib pads on: stacked shocks—200 joules monophasic, then 300, then 360. No change.

“Hot load coke, looks like,” Ramirez radioed base hospital at County General while they bagged her. “Seizing prior, now in arrest. Giving epi.” First round: 1 mg epinephrine 1:10,000 IV push, flushed with saline. They loaded her onto the gurney—limp as a rag doll, head lolling, the colorful blouse now streaked with bile and blood from her bitten tongue. Sodium bicarbonate 1 mEq/kg IV bolus followed—standard for the profound acidosis from seizures and poor perfusion, that lactic acid buildup turning her blood to battery acid. Another epi. Lidocaine 1 mg/kg for any ectopy. They worked her in the back of the ambulance the whole Code 3 run down the 101, sirens blaring, compressions never stopping, the monitor beeping flat and hopeless.

At Los Angeles County General Hospital—that sprawling concrete beast in Boyle Heights, the county’s dumping ground for every overdose, gunshot, and street casualty in ’76—the ER was already a war zone. Fluorescent lights buzzed over gurneys stacked two deep, the air thick with the copper stink of blood and the sharp bite of Betadine. Residents and nurses in sweat-stained scrubs swarmed the trauma bay as the paramedics wheeled her in.

“DOA coke OD, down maybe 15-20 minutes,” Kowalski panted, still pumping her chest. “Full ACLS in field—precordial thump, three epis, bicarb, lido, stacked shocks. Persistent asystole.”

The charge doc, a battle-hardened resident named Patel who’d seen a dozen just like her that shift, took over. They hooked her to the hospital monitor—flatline. More CPR. Another round of epi. More bicarb. Then a calcium chloride bolus (10 mL of 10% solution IV) on suspicion of hyperkalemia from rhabdomyolysis or to stabilize membranes in the toxic milieu. When peripheral access faltered and the rhythm stayed dead, Patel called for the last-ditch move: intracardiac epinephrine—a long needle plunged directly between the ribs into the heart chamber, 1 mg of 1:10,000 straight into the muscle. The team winced at the brutality of it, but this was 1970s County General—desperate times. They continued compressions, feeling the heart twitch under the needle.

They worked her for twenty-five more minutes. Sweat dripped off the docs’ foreheads onto her exposed chest. A nurse called out the time: “Call it.” Patel checked pupils—fixed and dilated—listened for heart sounds, felt for a femoral pulse. Nothing. “Time of death, 0417.” They peeled off the pads, the ET tube still in her throat like a plastic accusation, the intracardiac puncture site oozing a final trickle. The colorful blouse lay cut open and bloodied on the floor beside the gurney. Ginger McKenna Rothstein’s body, once the envy of Vegas showgirls, now just another statistic on the coroner’s log: acute cocaine intoxication, probable IV hot load, cardiac arrest secondary to ventricular arrhythmia, hyperthermia, and refractory acidosis. No next of kin notified that night. The morgue van would come at dawn.

In the hallway outside, a janitor mopped up the blood and piss tracked in from the ambulance bay. Another overdose in LA County. Another ghost in the machine.

[malecpr89production]

[malecpr89production]

[eyesfixedanddilated]

Fictionalized Account of “COPS” Season 2, Episode 8 (Portland, Oregon – Multnomah County Sheriff’s Office, originally aired November 1989; user-noted as 1988)

Grainy 16mm night-vision footage rolls. Rain hammers the cracked sidewalk outside a sagging single-story house in Southeast Portland, right off Powell Boulevard. Deputy John Blackman, Multnomah County Sheriff’s Office, kicks the door wider with his boot. The COPS crew follows tight—cameraman, producer, and sound guy lugging the Nagra reel-to-reel. Inside: shattered vodka bottle, blood on the kitchen linoleum, and the middle-aged woman—47, chronic alcoholic, face already purpled from the earlier beating—slumped against the couch. Her husband, reeking of booze and rage, stands over her screaming about the neighbor. On camera, Blackman yanks the man outside, slaps cuffs on him while the drunk keeps yelling.

What the episode never shows is what happened the second the husband was out the door.

Blackman turned back inside and saw her. She’d gone limp, eyes half-open, no chest rise. “She’s unresponsive!” he barked. The deputy—trained in basic first aid—dropped to his knees on the filthy floor, tilted her head back, and sealed his mouth over hers for mouth-to-mouth. Two quick breaths. Nothing. He tried again. That’s when the odd gurgle came—wet, rattling, like a clogged drain. Her loose upper dentures had shifted during the punch and now blocked the airway, bubbling with blood and saliva. Blackman gagged but kept going, pinching her nose harder, forcing air past the plastic plate while her chest barely moved.

The sound guy—a former EMT who’d left the ambulance for TV work—dropped his boom mic and jumped in without being asked. “I got compressions!” he yelled. He locked his hands over her sternum, right where the husband’s punch had landed. Late-’80s protocol: two-rescuer CPR, 5 compressions to 1 breath. “One… two… three… four… five!” he counted out loud, deep, hard thrusts that made her whole body jerk. The deputy delivered the breath on the “five,” fighting the gurgle every time. The sound guy’s count was steady, almost mechanical: “One-and-two-and-three-and-four-and-five—breathe!” Ribs cracked on the third set—audible pops under his palms—but he didn’t stop. Sweat dripped off his forehead onto her blouse. The cameraman kept rolling from the doorway, but the producer waved him back; this part would never air.

Sirens finally cut the rain. Portland Fire & Rescue paramedics burst in, took one look, and cut the deputy and sound guy loose. “V-fib—get her on the gurney!” They ripped her blouse open right there on the kitchen floor, slapped the old Lifepak 5 pads on. First shock—200 joules—her body arched like she’d been electrocuted. Still flat. They loaded her into the boxy orange ambulance while the sound guy, still gloved in someone else’s blood, helped cinch the straps.

Inside the rocking ambulance screaming down McLoughlin Boulevard, the code went full ACLS. Mouth-to-mouth had bought maybe ninety seconds; now the paramedics took over with bag-valve-mask, but the gurgling dentures kept fouling the seal until one medic yanked the plate out with a gloved finger and tossed it on the bench. Compressions never stopped—100 per minute now, the new single-rescuer rhythm kicking in. Epinephrine 1:10,000 straight into the antecubital IV. Lidocaine bolus. Second shock—300 joules. Her arms flopped wildly. Third shock—360. Nothing. The medic riding in back was drenched, counting out loud between breaths while the driver radioed ahead to Providence Medical Center.

The ER trauma bay was already set when they wheeled her in at 11:17 p.m. The code team—two docs, three nurses, a respiratory tech—took over without missing a beat. Full ACLS drill, 1989-style:

• Intubation: the resident slid the 7.5 ET tube past the bloody teeth while compressions continued uninterrupted. “Tube’s in—capnography zero, keep going.”

• More epi—every three minutes now—pushed hard through the line.

• Sodium bicarb for the suspected acidosis from her alcoholism and prolonged downtime.

• Another round of lidocaine.

• Stacked shocks: 360, 360, 360. Her chest jumped each time, skin reddening under the pads, the smell of singed flesh mixing with the metallic tang of blood.

They cracked the chest at minute eighteen—left thoracotomy right there under the harsh lights, ribs spread with a Finochietto retractor so they could massage the heart directly. Fingers inside her thorax, squeezing the flaccid muscle, trying to coax it back. More drugs: calcium chloride, another epi, bretylium when lidocaine failed. For twenty-six brutal minutes the room was nothing but the wet slap of compressions, the hiss of the ventilator, barked orders, and the flat-line scream of the monitor. Blood-tinged froth bubbled from the tube. Her dentures sat in a kidney basin on the crash cart like evidence.

At 11:43 p.m. the attending called it. “Asystole for two full minutes. We’re done.” The team stepped back, gloves bloody, scrubs soaked. The heart lay still inside the open chest. Pronounced dead—commotio cordis from a single punch to an already damaged alcoholic heart. No dramatic music, no voice-over. Just the quiet click of the monitor being silenced and the clatter of used ampules hitting the sharps container.

The husband was already in a holding cell downtown, still drunk and oblivious. The COPS episode cut the segment at the arrest, the usual “charges pending” graphic slapped over the patrol car. Viewers never saw Deputy Blackman’s mouth-to-mouth on the kitchen floor, never heard the gurgling dentures, never watched the sound guy counting out 5-and-1 compressions like it was still 1986. They never saw the thoracotomy or the final flat line under the ER lights. Just another Portland domestic call—ugly, ordinary, and off-camera lethal.

[eyesfixedanddilated]

Linda Sue Smith was fifty-five years old and had spent the last forty-one years turning her body into a slow-motion train wreck in the humid backwoods of Jonesboro, Arkansas. Born in a single-wide trailer off Highway 63, she started stealing cigarettes from her mother’s purse at fourteen, the same summer she dropped out of school to work the counter at the local Dairy Queen. By eighteen she was up to a pack a day. By thirty it was two packs of unfiltered Camels, and she never looked back. She liked the way the smoke filled her lungs like wet concrete, the way it made her feel grounded when everything else—two failed marriages, three kids she barely saw, a string of dead-end jobs—kept slipping away.

Her body had paid the price in full. At five-foot-four she carried two hundred and eighty-seven pounds, most of it hanging in heavy, pale folds that stretched and dimpled like bread dough left too long in the heat. Her breasts were massive, pendulous sacks that rested on the upper roll of her belly; each one bore a faded tattoo she’d gotten in a Memphis parlor in 1998—a cluster of purple grapes on the left, a snarling wolf’s head on the right that had blurred into a dark bruise over the decades. A third tattoo, a cheap blue rose, peeked from the inside of her left thigh just above the knee. Her skin was a roadmap of stretch marks, cigarette burns, and the yellowish tint of chronic poor circulation. Years of smoking had turned her lungs into stiff, crackling sacks; her heart was enlarged and lazy, arteries furred with plaque. She had type-2 diabetes she ignored, hypertension she treated with more salt, and a cough that rattled like gravel in a tin can every morning.

On the morning of July 17, 2025, the Arkansas heat was already pressing down like a wet wool blanket by nine o’clock. Linda stood barefoot in the living room of her small brick ranch house on Race Street, wearing nothing but a pair of cheap royal-blue panties that cut into the soft overhang of her lower belly. She had been packing for a weekend trip to Tunica—casino lights, free drinks, maybe a little slot-machine luck—and the black suitcase lay open on the faded floral rug like a gaping mouth. A cigarette burned between her yellowed fingers while she stared at her reflection in the cheap full-length mirror propped against the red-painted wall. She took a long drag, coughed once, twice, then a third time so hard her heavy breasts shook and a rope of thick phlegm landed on the rug between her feet.

“Goddamn lungs,” she muttered, voice hoarse and wet.

She reached for another cigarette out of habit, but the motion triggered something deeper. A sudden, crushing weight slammed into the center of her chest—like a fist made of hot iron. Pain exploded outward, racing down her left arm and up into her jaw. Her vision tunneled. She tried to call out, but only a strangled wheeze escaped. The cigarette dropped from her fingers and burned a black hole into the rug. Linda’s knees buckled. Two hundred and eighty-seven pounds of failing flesh hit the floor with a wet, meaty thud that shook the cheap framed pictures on the red walls. Her head bounced once on the carpet; her blue panties rode up between the massive cheeks of her ass as her body settled into an awkward sprawl, left arm flung out, right hand still clutching at the place where her heart was stuttering and dying.

Her neighbor, old Mr. Wilkins from two doors down, had come over to borrow a wrench and found the front door ajar. He stepped inside, saw the naked, motionless mountain of a woman on the rug, and screamed for help. 911 was called at 9:17 a.m.

Jonesboro Fire Department Engine 3 and Medic 1 arrived in under six minutes. The two paramedics—experienced hands named Ramirez and Cole—knew the second they crossed the threshold they were looking at a code blue. Linda lay supine, skin already taking on a dusky, bluish-gray cast across her lips and nail beds. Her massive chest was still. No pulse at the carotid. Ramirez dropped to his knees beside her, ripped open the cardiac monitor, and slapped the pads onto her bare skin while Cole cut away the blue panties with trauma shears, leaving her completely naked on the rug.

Defibrillator pad placement was textbook but immediately complicated by the sheer volume of tissue. Ramirez lifted the heavy left breast with one gloved hand—feeling the soft, cool weight of it flop heavily against her side—and placed the apex pad just below the breast tissue in the left mid-axillary line, pressing it firmly into the sweaty skin so the adhesive would stick. The sternal pad went below the right clavicle, but the upper roll of fat and breast tissue kept trying to slide it out of position; he had to tape it down with extra strips while her body jiggled from the compressions Cole had already begun. The monitor showed coarse ventricular fibrillation—ugly, chaotic squiggles across the screen.

“Charging to 200!” Ramirez yelled.

Cole was already doing CPR, palms stacked on the center of her chest, just above the wolf-head tattoo. Each compression sank deep into the soft fat; her enormous breasts and belly rolled and slapped with every thrust, the grape tattoo distorting grotesquely as the skin moved. Sweat poured off Cole’s forehead and mixed with the sheen already coating Linda’s pale torso. The room filled with the wet, rhythmic sounds of flesh being pounded—thump, thump, thump—while her belly fat rippled like waves on a pond.

Airway management was a nightmare. Cole had already tried bag-valve-mask ventilation, but Linda’s obesity made a seal almost impossible. Her heavy cheeks and thick tongue collapsed the mask no matter how he positioned her head. Ramirez took over airway while Cole continued compressions. He tried a jaw thrust; the fat under her chin resisted. He inserted an oropharyngeal airway, but it kept slipping out. “We’re gonna have to tube her,” he said. He grabbed the laryngoscope, but the view was terrible—grade four, nothing but tongue and epiglottis swollen from years of smoking and reflux. He suctioned thick, brown secretions that smelled of old cigarettes and infection. Two attempts failed. On the third he finally got the tube past the vocal cords, but when he squeezed the bag, the chest barely rose; her stiff lungs and massive chest wall fought every breath. End-tidal CO2 was low and dropping.

They shocked her at 200 joules. Her arms and legs jerked violently; her breasts flopped upward and slammed back down with a heavy smack. The monitor still showed VF. They resumed CPR, now with the tube in place, but ventilation remained difficult—every squeeze of the bag met resistance, and gastric contents began to reflux up around the tube, bubbling out the sides of her mouth in a frothy pink mix of mucus and blood-tinged fluid from ruptured capillaries in her lungs.

“Load and go!” Ramirez called after the second shock. They rolled a reinforced bariatric stretcher beside her, but even with four firefighters helping, it took grunting effort to log-roll her massive, lifeless body onto it. Her belly sagged heavily over the sides, breasts spreading outward, the defib pads threatening to peel off with every shift. They strapped her down as best they could and wheeled her out into the blinding Arkansas sun, the stretcher creaking under her weight.

In the ambulance, the fight continued. Cole took the head of the stretcher, bagging her through the ET tube while Ramirez drove and a third medic ran the monitor. They shocked her twice more en route, each jolt sending ripples through her pendulous flesh. IV access was finally secured in her left antecubital fossa after multiple attempts, the vein buried deep under layers of fat. Epinephrine pushed. Another round of amiodarone. Her skin grew colder, the tattoos standing out like dark islands on a sea of gray. The ambulance rocked as they hit potholes on Race Street, her body shifting and jiggling with every bump.

They arrived at NEA Baptist Memorial Hospital at 9:38 a.m. The ER team was waiting—two doctors, three nurses, and a respiratory therapist. They rushed her into trauma bay one, the stretcher groaning as they transferred her to the gurney. Her naked, sweat-slicked body slapped heavily onto the plastic sheet. The ER physician, Dr. Patel, took one look at the monitor and the tube already in place and nodded grimly.

“Continue CPR. Push another epi. Let’s get better access—18-gauge in the other arm if you can find it.”

The team took over compressions. A fresh set of hands—smaller and less fatigued—pressed deep into Linda’s chest, causing her massive breasts to wobble and her belly to quake with each downward thrust. The original defib pads were swapped for hospital ones; the tech had to lift and reposition her heavy left breast again, wiping away sweat and adhesive residue before pressing the new apex pad firmly into the fatty tissue below it. The sternal pad was re-taped. They delivered synchronized shocks at higher energies while the respiratory therapist struggled with the airway. Suction pulled more foul secretions; ventilation pressures stayed sky-high. “Lungs are like concrete,” the therapist muttered, adjusting the ventilator settings as pink froth continued to ooze around the tube.

They worked her for another eighteen minutes in the brightly lit ER. Chest compressions rotated every two minutes, each provider’s arms burning from the effort required to compress through so much adipose tissue. Her body convulsed with every shock, thighs spreading wider on the gurney, the blue rose tattoo on her leg twitching. Labs came back showing sky-high troponin, potassium derangements, and a blood gas that confirmed profound acidosis. They gave bicarbonate, more epi, calcium. Nothing worked.

At 9:56 a.m., after the latest rhythm check showed asystole—flat line across the monitor—Dr. Patel held up a hand. “We’ve been at this for forty minutes total. No signs of life, no reversible causes we haven’t addressed. Anyone have any objections?” The room was silent except for the hiss of the ventilator still trying to push air into dead lungs.

“Time of death, 9:56 a.m.,” Dr. Patel said quietly.

They left the ET tube protruding from her slack, secretion-crusted mouth, the defib pads still adhered to her chest, IV lines dangling. Linda Sue Smith lay naked under the harsh fluorescent lights of the ER trauma bay, her enormous frame finally still on the gurney. The wolf on her right breast stared blankly at the ceiling tiles, the grapes on her left forever unripe. Her ruined lungs—those tar-black sacks that had carried her through fifty-five years of bad choices—had finally given out for good.

Outside, the Arkansas cicadas kept screaming in the pine trees, indifferent as always. Inside the hospital, the only sound was the soft drip of fluid from the corner of Linda’s mouth onto the sheet, marking the end of a life that had been slowly killing itself for four decades, one cigarette at a time. her at

[eyesfixedanddilated]

Chelsea Thompson was 37 years old, thirty-four weeks pregnant with her second child, and already carrying the weight of two lifetimes. At 360 pounds, her body strained under the added burden of late-pregnancy edema, gestational hypertension that had climbed to 160/100 despite labetalol drips, and a twenty-year pack-a-day habit of Marlboro Light 100’s that she had finally traded for a high-nicotine vape she kept clipped to her hospital gown like a security blanket. The nicotine still hit her bloodstream in sharp, chemical jolts—vasoconstriction on top of the vascular scarring left by two decades of tar and carbon monoxide. Johnny, her husband of twelve years, sat beside the bed in Room 12 of the Labor and Delivery unit, rubbing her swollen ankles and trying to keep his voice light.

“You’re doing great, babe. Baby girl’s heart rate is steady at 145. They said another week and we’ll meet her.”

Chelsea tried to smile, but a sudden vise clamped around her chest. She gasped, hand flying to her sternum. “Johnny… something’s wrong.” Her face went gray. The fetal monitor strip, which had been tracing nice accelerations, flattened into a ominous baseline. Then she slumped sideways, eyes rolling back, no pulse at the carotid.

“Code blue, L&D 12! Code blue!” the nurse screamed into the hallway.

Within thirty seconds the room exploded with people. Johnny was gently but firmly escorted to the doorway, eyes wide, hands shaking. The code team—two hospitalists, three nurses, a respiratory therapist, anesthesia, and the on-call OB—swarmed the bed. The overhead lights blazed white. Someone yanked the bed away from the wall so they could work from both sides.

“Time of arrest, 14:37,” the code leader called. “She’s thirty-four weeks, fundal height at the xiphoid—pregnant arrest protocol. Get left uterine displacement now!”

Two nurses positioned themselves. One slid a rolled sheet under Chelsea’s right hip for a 30-degree tilt while the other pressed hard on the fundus, manually shoving the heavy gravid uterus leftward off the inferior vena cava. Chest compressions began immediately—deep, 2.5-inch plunges at 110 per minute, right over the lower half of the sternum because pregnancy shifts the heart upward. Chelsea’s massive breasts and abdominal pannus made the mechanics brutal; each compression produced a wet, fleshy thud and a faint crackle as the first rib gave way under the force. Her body jerked like a puppet with every push, the hospital gown riding up to expose pale, stretch-marked skin already mottling with dependent livor.

“Pads!” someone barked. The defibrillator pads slapped onto her chest—right sternal border and left mid-axillary line, avoiding the breasts as best they could. The monitor screeched: ventricular fibrillation, coarse and chaotic.

“Charging to 200 joules biphasic—clear!”

“Clear!” the team echoed.

The first shock ripped through her. Chelsea’s entire torso arched violently off the bed, arms flinging outward, legs stiffening in a brief decerebrate posture. A faint wisp of smoke rose where the pads met skin; the electrical burn left two angry red rectangles. CPR resumed instantly—two minutes of uninterrupted compressions, ventilations at 10 per minute via bag-valve-mask, 100% oxygen. The ET tube would come soon; pregnancy made aspiration a nightmare.

“Epinephrine 1 mg IV push,” the leader ordered. A nurse had finally secured a 18-gauge in the antecubital above the diaphragm—critical so the drug wouldn’t pool in the compressed pelvis. The first milligram of epi raced in. Chelsea’s skin flushed deeper crimson; her pupils, visible when someone pried an eyelid, were already fixed and dilated from hypoxia.

Rhythm check at two minutes: still VF.

“Second shock—200 again—clear!”

Another violent arch, another crack of cartilage. More CPR. The fetal monitor, still clipped to her belly between compressions, showed the baby’s heart rate plunging from 140 to 70, then 50—severe bradycardia, late decelerations, the strip looking like a saw blade of distress. The fetus was suffocating inside her.

“Epinephrine 1 mg—third dose,” the leader called at the four-minute mark. “Push amiodarone 300 mg if we stay shockable.”

Johnny watched from the doorway, tears streaming, whispering, “Come on, Chels… fight.”

At four minutes and ten seconds—no return of spontaneous circulation—the OB stepped forward. “Perimortem cesarean. Now. Scalpel.”

No time to move to the OR. They draped Chelsea’s abdomen with sterile blue towels right there on the bed. The OB made a vertical midline incision from pubis to umbilicus—fast, no anesthesia, no hesitation. Blood welled instantly, dark and thick. Retractors clicked open. Another swift slice through the fascia, then the uterus. Amniotic fluid gushed, warm and tinged pink. The OB reached in, felt for the baby’s head, and delivered a tiny, slippery girl in one smooth motion.

The infant—six pounds even, surprisingly robust despite the maternal arrest—was blue and limp for three terrifying seconds. Then the neonatology team rubbed her vigorously, suctioned, and gave a few puffs of positive-pressure ventilation. A thin, furious cry split the room. Pink flooded her skin. Apgars 7 at one minute, 9 at five. Healthy. They wrapped her in a blanket and held her up briefly so Johnny could see before whisking her to the warmer for full resuscitation and NICU evaluation. The placenta followed moments later with a wet slap onto the drapes.

The moment the uterus was emptied, maternal hemodynamics shifted dramatically. Venous return improved instantly. The next rhythm check—after the fifth epinephrine and 300 mg amiodarone—showed a brief organized rhythm, then pulseless electrical activity. Another round of high-quality CPR, now easier without the gravid uterus compressing the vessels. The team gave a sixth milligram of epinephrine. At six minutes and forty seconds post-arrest, the monitor chirped: sinus tachycardia at 138, palpable carotid pulse, blood pressure 82/48.

“ROSC!” the leader shouted. “Get her to the cath lab—likely STEMI from her nicotine and hypertension history. Start norepinephrine drip, cool her if we need targeted temperature management.”

Chelsea’s chest still heaved with the ventilator. Her broken ribs clicked with every mechanical breath. The defibrillator pads had blistered into second-degree burns. A thin line of blood trickled from the fresh C-section incision, now hastily packed and sutured at bedside. Her face remained swollen and gray, but the pulse was real.

Johnny was allowed back in, sobbing as he touched his daughter’s tiny hand on the warmer and then laid his forehead against Chelsea’s clammy temple. “You did it, babe. She’s here. Our girl’s here.”

The code team stepped back, sweat-soaked scrubs, gloves bloody. Outside the window the April sun over glinted off the Ohio River, indifferent to the miracle and the carnage that had just unfolded in Room 12. Chelsea would survive the night, intubated and sedated, her heart now stented for the acute occlusion the cath lab would confirm. The baby—named Lila Marie—would thrive in the NICU, lungs pink and strong, already demanding milk from a pump because her mother’s body, though battered, was still producing colostrum.

The Marlboro Lights and the vape were finished forever. The hypertension would be managed. The weight would be fought another day. But for now, in the fluorescent glow of L&D, a family of three had clawed its way back from the brink—one shock, one scalpel, one cry at a time.

[theicufloor]

Paddles placed. CHARGED CLEAR!!!!

[eyesfixedanddilated]

1991 – A Spring Afternoon in Suburban Ohio

The McDonald’s on Route 42 was the usual midday rush of grease, fry timers, and the faint smell of cigarette smoke drifting from the break room. It was April 1991, and twenty-two-year-old Tracey Harlan—now a shift manager six days a week—sat at the small corner table in the back office, her swollen belly pressed against the edge of the Formica. At eight-and-a-half months pregnant with their second child, she was enormous: five-foot-four and well over two hundred and eighty pounds, her once-youthful curves buried under the soft, heavy weight of morbid obesity made worse by gestational diabetes and sky-high blood pressure that no one could convince her to treat properly. Her red-and-white McDonald’s manager polo stretched tight across her chest and belly, the name tag reading “Tracey – Manager” slightly crooked. She refused to take maternity leave early. “We need the money,” she always said, even as her ankles swelled like balloons and her vision sometimes blurred.

Her pack of Marlboro Light 100s sat on the table beside the schedule clipboard and a half-empty Styrofoam cup of coffee. The white-and-gold soft pack showed the familiar red roof logo, with the elegant script “Fine Tobacco’s” printed prominently on the top flap. She shook one long white cigarette free, placed it between her lips, and lit it with her Bic lighter. Tracey took a long, deep drag, cheeks hollowing slightly, then exhaled a thick plume of smoke toward the ceiling vent. It was the same habit she’d started at sixteen—watching her Aunt Linda smoke on the back porch—and she had never quit, not through her first pregnancy, not now. The nicotine helped her focus while she penciled in shifts for the high-school kids.

She was halfway through rearranging the closing crew when it hit.

A crushing pressure slammed into the center of her chest, like someone had dropped a cinder block on her sternum. Tracey gasped, the cigarette tumbling from her fingers onto the table. “Oh God… Joe…” Her face went ashen. Sweat broke out across her forehead and upper lip. She clutched at her chest, eyes wide with raw terror, then slumped sideways in the chair and slid to the floor in a heavy heap, the schedule papers scattering around her.

One of the teenage cashiers screamed. “Call 911! It’s Tracey—she’s down!”

The call went out at 1:47 p.m. The only on-duty medic in the entire county was her husband, twenty-four-year-old Joe Harlan.

Joe had become a paramedic in 1987, driven by the memory of that terrifying night in 1985 when Tracey had collapsed in the high-school parking lot after the spring formal. That night had haunted him for years—the way her hand had clutched his arm in terror, the helplessness he felt doing bystander CPR while waiting for the ambulance, the long code in the ER where he could only watch. After they married and their daughter Emily was born in early 1986, Joe realized he never wanted to feel that powerless again. He enrolled in the local community college’s EMT program in the fall of 1985 while still working at the family greenhouse during the day. He studied late into the night after rocking Emily to sleep, determined to learn everything he could about cardiac emergencies, difficult airways, and obstetrics. He earned his paramedic certification in 1987 and joined the county fire department as the youngest full-time medic on the roster. Now, at twenty-four, he was the sole paramedic on the day shift, responsible for the entire rural district.

When the tones dropped for “unconscious pregnant female at McDonald’s,” his stomach dropped. He knew the address. He knew the patient.

He arrived in under four minutes, lights and sirens blazing, the old box-style ambulance skidding into the lot. Joe jumped out, jump bag and LIFEPAK 10 monitor-defibrillator in hand, black paddles clipped to the side, his dark blue uniform shirt already damp with sweat. Inside, employees pointed frantically toward the back. Tracey lay on the tile floor beside the table, her pregnant belly rising and falling in shallow, labored breaths, the Marlboro Light 100 still smoldering on the table above her.

“Tracey!” Joe dropped to his knees beside her. “Baby, I’m here.” He checked for a pulse—weak and thready—then her airway. She was unresponsive. “She’s in respiratory distress—possible cardiac event. Pregnant, third trimester, history of hypertension and gestational diabetes.” He radioed for backup (none was coming quickly) and began high-flow oxygen while cutting away the front of her manager polo and bra with trauma shears for access. Her heavy, bare breasts and massively distended pregnant abdomen were exposed to the cool air; the stretch marks and dark linea nigra from two pregnancies were stark under the fluorescent lights.

The LIFEPAK 10 showed coarse ventricular fibrillation.

“VF!” Joe’s voice cracked with fear but stayed professional. “Charging to 200 joules!” He delivered the first shock with the black paddles. Her obese body arched violently, breasts and belly jiggling from the current, a guttural rush of air forced from her lungs. Immediate CPR began—deep compressions on her chest, the weight of her obesity and the large uterus making each push harder. He manually displaced the uterus to the left to relieve aortocaval compression. The airway was difficult: her tongue fell back from obesity and pregnancy-related edema, and bag-valve-mask ventilations produced only minimal chest rise with audible gastric insufflation. Joe switched to a demand valve attached to the BVM for higher-flow positive-pressure breaths, but even then her chest barely moved against the resistance of her heavy breasts and gravid uterus.

Epinephrine 1 mg (1:10,000) IV was pushed as soon as he got access in her antecubital vein. Joe quickly checked a bedside glucose—42 mg/dL—and pushed 50 mL of D50W IV to address hypoglycemia related to her gestational diabetes. After two minutes the rhythm was still VF. Second shock at 300 joules—her torso convulsed again, arms flopping, a thin line of saliva and vomit trickling from the corner of her mouth. Third shock at 360 joules. Lidocaine 1.5 mg/kg IV bolus (approximately 190 mg for her estimated weight) was given for refractory VF, followed immediately by a lidocaine drip at 2 mg/min. Sodium bicarbonate 1 mEq/kg IV was administered for suspected acidosis from her diabetes.

In the ambulance en route to the hospital, the rhythms cycled relentlessly: VF to asystole to pulseless electrical activity and back to VF. Joe performed a second round of shocks with the black paddles of the LIFEPAK 10, more epinephrine, another lidocaine bolus, and atropine for the brady-asystolic phases. Airway management remained a nightmare—repeated attempts at intubation were hampered by her short, thick neck, swollen tongue, and the enormous pregnant belly pushing the diaphragm upward; each failed attempt produced more gastric contents that had to be suctioned. The demand valve continued delivering forced ventilations, but her chest rose unevenly, the left side lagging from possible rib fractures already developing under the relentless compressions. Her body reacted graphically to every intervention: her heavy breasts shifted and bounced with each mechanical thrust of CPR, her abdomen quivered, and dark purple mottling began spreading across her dependent skin as perfusion failed.

At the small community hospital, the ER team took over. They continued 1991 ACLS protocols for another twenty-five minutes—more shocks on the monophasic defibrillator, repeated epinephrine and lidocaine (with the drip continued), bicarbonate repeats, and calcium for possible hyperkalemia or electromechanical dissociation. There were three brief ROSC moments: one lasting almost ninety seconds with a weak pulse and faint respirations, another for forty-five seconds, and a final narrow-complex rhythm that lasted nearly two minutes before rearresting into VF again. Each time Joe stood at the head of the bed, holding her hand when he could, whispering encouragement through gritted teeth while continuing to manage the difficult airway with the demand valve.

But the underlying damage was too great. The acute myocardial infarction—triggered by plaque rupture in her coronary arteries from years of smoking, morbid obesity, uncontrolled gestational diabetes, and pregnancy-induced hypertension—had caused massive heart muscle death. After a total of forty-eight minutes of resuscitation, with no sustained ROSC and the fetus still viable, the physician made the call for emergency perimortem cesarean section.

In the trauma bay, under bright lights, the team performed a rapid C-section while CPR continued. Joe stood frozen at her side, gloved hands still on the bag-valve, as the surgeon made the incision through her lower abdomen. Within ninety seconds a healthy baby boy was delivered—pink, vigorous, and crying loudly—handed immediately to the waiting neonatal team. The infant was stable, Apgars 8 and 9, and whisked to the warmer as the code continued on Tracey for a few final minutes.

It was not enough. The mother’s heart never recovered.

“Time of death, 2:35 p.m.”

Joe stood beside the gurney, still in his paramedic uniform, staring at the woman he had loved since high school. Her body lay exposed from the resuscitation and surgical efforts, the remnants of her McDonald’s polo pushed aside, her pregnant belly now surgically opened and still. The Marlboro Light 100 pack was still in the ambulance, forgotten on the squad bench. He reached out and gently closed her eyes, tears cutting clean tracks down his grease-smudged cheeks.

Outside, the spring afternoon continued, indifferent, while inside the small ER, a young paramedic held the hand of his high-school sweetheart and the mother of his now-two children, the weight of everything they had built—and everything they would now have to face alone—crushing down on him like the chest pain that had taken her away.

[eyesfixedanddilated]

Karen Mitchell had always been a fighter. At fifty-nine, the Indianapolis native—born and raised on the south side near Garfield Park—had stared down more than her share of battles. She’d carried four hundred and ten pounds on her five-foot-four frame for decades, her knees screaming under the load. Cigarettes had been her quiet companion through two divorces and raising two kids alone, a pack-a-day habit for twenty years until she quit cold turkey in 2018. Hypertension had thickened the walls of her heart; mild congestive heart failure and an enlarged left ventricle kept her on a handful of pills she lined up every morning like soldiers. But last year she’d done the impossible: dropped a hundred and fifty pounds through sheer stubbornness, physical therapy, and a gastric sleeve she’d fought her insurance to approve. When the orthopedic surgeon at IU Health Methodist finally replaced her ruined right knee two days ago, Karen had squeezed the nurse’s hand and whispered, “This is the new me. No more excuses.”

Now, on postoperative day three, she sat propped up in her hospital bed on the sixth-floor ortho unit, the Indianapolis skyline hazy beyond the window. Her left leg—still her good one—was elevated. The right was wrapped in a bulky dressing, a continuous passive motion machine gently bending and straightening it with a soft mechanical hum. She weighed two hundred and sixty pounds these days, still heavy but lighter than she’d been in thirty years. The night-shift nurse had just finished her vitals: blood pressure 142 over 88, heart rate 92, oxygen saturation 94% on two liters of nasal cannula. “Looking good, Karen. Physical therapy at ten.”

Karen smiled, tired but proud. She’d walked twenty feet with the walker yesterday. Her kids were coming from Fishers and Carmel that afternoon with grandbabies. Life felt possible again.

It started as a tickle.

At 10:17 a.m., while the physical therapist was adjusting the CPM machine, Karen felt a sudden, deep flutter low in her right calf—like a tiny fish flipping inside the vein. A piece of clot, formed in the sluggish blood pooling behind her surgical site despite the heparin shots and compression boots, broke free. It was the size of a small grape, a red-and-white plug of fibrin, platelets, and trapped red cells. It rode the venous return up the femoral vein, into the inferior vena cava, through the right atrium, and straight into the right ventricle. The heart pumped it out into the main pulmonary artery, where it lodged like a cork in a bottle—saddle embolus, straddling the bifurcation and occluding both left and right pulmonary arteries almost completely.

Inside Karen’s lungs the catastrophe unfolded at the cellular level.

Millions of alveoli continued to inflate with each desperate breath, but the capillaries surrounding them now stood empty. Blood that should have streamed past the thin alveolar-capillary membrane—where oxygen diffuses into red cells and carbon dioxide slips out—never arrived. Ventilation-perfusion mismatch became total in the lower lobes. Deoxygenated blood poured back into the left atrium, then the left ventricle, and out to her starving body. Her arterial oxygen tension plummeted. Mitochondria in every cell—muscle, brain, heart—began to choke. Oxidative phosphorylation slowed; ATP production crashed. Cells switched to anaerobic glycolysis, flooding her bloodstream with lactic acid. Her pH began to drop.

Her right ventricle, already enlarged and thickened from years of hypertension and the back-pressure of mild CHF, suddenly faced a wall. Pulmonary vascular resistance tripled in seconds. The RV wall tension soared. Sarcomeres in the RV cardiomyocytes stretched beyond their optimal length; actin-myosin cross-bridges slipped apart. Calcium flooded the cytosol but couldn’t trigger proper contraction. Troponin leaked. The RV dilated like a balloon, bowing the interventricular septum leftward and crimping the left ventricle’s filling. Cardiac output began its fatal plunge.

Karen gasped. “Something’s… wrong.” Her chest felt as though an anvil had been dropped on it—not the crushing pain of a heart attack, but a terrifying fullness, like her heart was being strangled from the inside. She clutched the bed rail. Her heart rate monitor spiked from 92 to 138 in under thirty seconds—sinus tachycardia, the body’s frantic attempt to compensate for the falling stroke volume. The alarm chirped. Sweat beaded on her forehead, rolled down her temples. Her lips, once a healthy pink, turned a dusky blue-gray almost instantly as deoxygenated blood backed up in her capillaries. The skin of her face and neck paled to a waxy ash-gray.

The physical therapist froze. “Karen? Talk to me.”

She couldn’t. Her respiratory rate shot to forty, shallow and useless. Chemoreceptors in her carotid bodies screamed hypoxia; her brain stem drove her to hyperventilate, but the oxygen never reached the blood. At the cellular level, her neurons began firing erratically as ATP dwindled. Her vision tunneled. Within another minute, faint lacy purple mottling began to bloom across the skin of her forearms and the backs of her hands—irregular, net-like patches where blood flow stagnated in the dermal capillaries.

A nurse burst in at the sound of the alarm. “Oh God—PE protocol! Call rapid response!” She slapped the code button.

Karen’s monitor now showed the classic signs: sinus tachycardia at 152, new right-axis deviation, an S1Q3T3 pattern emerging on the tracing—the deep S in lead I, Q wave in III, inverted T in III—textbook for acute right-heart strain. Premature ventricular contractions began popping across the screen like static. Her blood pressure dropped to 78 over 42. The mottling spread rapidly, climbing up her arms to her shoulders and chest, the purple lacework deepening against the gray pallor of her skin.

She slumped sideways, eyes wide with terror. “Can’t… breathe…” The words were barely a whisper. The monitor alarm changed tone.

“PEA! She’s in PEA!” the nurse shouted.

The code team poured into the room. The charge nurse’s voice cut through the chaos as she stepped to the foot of the bed: “Karen Mitchell, fifty-nine, post-op day three right knee replacement, history of hypertension, CHF, and obesity. Full code!”

In the first frantic seconds they dropped the bed rails, flattened the head of the bed, and yanked the bulky hospital headboard off its tracks with a metallic clatter, sliding it free so the airway team could stand at the top. Two techs heaved a rigid blue backboard under Karen’s 260-pound body—“One, two, lift!”—her limp frame thudding onto it. Compressions started immediately: a resident locked his hands over her sternum and began pushing hard and fast, 110 per minute, the force rippling through her heavy chest wall. Her ribs cracked audibly on the third set of compressions, a sharp pop that cut through the shouts. The mottling deepened across her chest and abdomen, turning a vivid marbled purple as blood stagnated in the skin.

“Airway!” the anesthesiologist called, positioning himself at her head. He tried bag-mask ventilation first, but her large neck and chest made a seal nearly impossible. The mask slipped despite two hands and an oral airway; each squeeze bulged her cheeks more than it moved her chest. “Poor seal—minimal rise!” Gastric air inflated her stomach instead. After thirty seconds of ineffective bagging, her oxygen saturation readout crashed below 60%. He switched to video laryngoscope. “Intubating—grade 3 view.” The first attempt failed; swollen tissues and a large tongue blocked the path despite ramping blankets under her shoulders. Suction pulled a small rush of regurgitated gastric fluid. On the second try, the tube slid in with a hiss. Capnography waveform stayed nearly flat—almost no CO2 returning because pulmonary blood flow had all but stopped.

The team cycled roles every two minutes. Compressions continued without pause on the backboard, the resident’s arms burning as he drove two inches deep into Karen’s chest. Her skin grew cool and clammy; the purple-black mottling now covered her legs and feet, fixed and unmistakable. Epinephrine went in every three to five minutes—first dose, second, third—each push met with a brief, futile bump in the arterial line pressure that quickly faded. They bolused tPA through the central line in a last-ditch effort to lyse the saddle embolus, but the clot was massive and the circulation too poor to deliver it effectively.

Minute after minute ticked by. The room filled with the rhythmic thump of compressions, the hiss of the ventilator now attached, and the steady beeps of medications being called out. Karen’s body lay motionless on the backboard, her once-proud frame now a battlefield of failing systems—cyanotic lips and nail beds a deep slate-blue, mottled skin like cold marble. At the cellular level, her cardiomyocytes exhausted their last ATP stores; potassium gradients collapsed across membranes; brain cells in the hippocampus and cortex died in cascading waves.

They worked her for twenty-eight grueling minutes. The monitor never showed a shockable rhythm. It stayed PEA, then slowly flattened into asystole—a straight green line, the final silence.

At 10:47 a.m., the code leader called it. “Time of death, 10:47.”

Karen Mitchell, who had fought her weight, her cigarettes, her failing heart, and had won every battle until this one, never made it to physical therapy that morning. She never saw her grandchildren. In the quiet that followed, the only sounds were the abandoned ventilator still cycling on a dead woman, the backboard still under her mottled, gray-purple body, and the distant traffic on 16th Street carrying Indianapolis through another ordinary spring day.

Outside, the city kept moving. Inside room 6214, the woman who had once weighed four hundred and ten pounds and had come back from the brink now lay still, the final, massive pulmonary embolism having done what obesity, smoking, and heart disease never could: it had stopped her heart at the cellular level, one suffocated mitochondrion at a time.

[eyesfixedanddilated]

Jamie’s Hidden Career

Jamie sat behind the wheel of her silver minivan in the Walmart parking lot, engine off, kids safely dropped at school an hour earlier. Thirty-six, still tight-bodied enough that her husband called her “the hot mom,” but bored senseless by the long firefighter shifts that left her house empty most days. The OnlyFans money had become addictive—thousands a month from videos of her vacuuming in a thong, fingering herself on the kitchen island, or riding her thick suction-cup dildo while the dryer ran. This morning’s live stream was meant to be quick and nasty: “Morning Marlboro & Me 💦 100s only, boys.” Camera on the dash, top yanked down, lacy black bra barely containing her tits as she lit the first cigarette.

She took a long, slow drag, exhaled toward the lens, then reached for the second Marlboro 100. That was when the heart attack hit like a freight train.

White-hot crushing pain detonated behind her sternum and shot down her left arm. The cigarette tumbled from her lips into her lap, burning through her thin yoga pants. Her face twisted in agony, eyes bulging. She tried to gasp but only managed a strangled, wet gurgle. Her body seized, back arching hard against the seatbelt as her heart lurched into coarse ventricular fibrillation. The live feed kept rolling for 1,347 viewers as she slumped sideways, lips turning dusky blue, a thin line of drool sliding from the corner of her mouth.

A shopper two rows away saw the unnatural twitching and sprinted over. By the time she yanked the door open, Jamie was in full cardiac arrest—no pulse, no breathing, eyes half-lidded and vacant.

The retired EMT bystander started CPR immediately while someone else called 911. Engine 14 and Medic 7—her husband’s own company—were dispatched for an “unconscious female, not breathing.”

When the crew arrived, they recognized the minivan instantly. “That’s Jamie—fuck!”

They dragged her limp body out onto the cold asphalt, scissors flashing as they sliced her shirt and bra completely off, exposing her full, pale breasts to the morning air and the growing crowd. AED pads slapped on, one over the right upper chest, the other below her left breast, wires trailing across her naked torso.

Shock advised.

“Clear!”

First shock—200 joules biphasic. The defibrillator discharged with a loud, sharp crack! Her entire body convulsed violently upward, back arching like a bow, every muscle seizing in tetanic contraction. Her full breasts jerked upward and slammed back down hard, flopping wildly side to side from the massive electrical surge. Her arms shot straight out then snapped inward, fists clenching, legs kicking once against the pavement. Coarse VF still marched across the monitor.

CPR resumed instantly—deep, brutal compressions that cracked ribs within the first minute, her sternum visibly sinking with each thrust. They attempted an i-gel supraglottic airway, but chest rise remained poor from the ongoing arrest.

Second shock—300 joules. The machine charged with a rising whine, then CRACK!—a louder, more brutal discharge. Jamie’s torso exploded upward again, spine hyperextending, breasts slamming together then bouncing apart with obscene force, nipples hardening involuntarily from the current. Legs scissored once, heels scraping asphalt. The monitor showed finer VF now, slower and more chaotic.

Epi 1 mg pushed. Amiodarone 300 mg. They finally secured an ET tube after multiple attempts amid swollen cords and frothy secretions, with ETCO2 reading critically low at 7 mmHg.

Rhythm check: brief ROSC—sinus tach at 138 for maybe eight seconds—then pulseless electrical activity. They loaded her onto the stretcher, LUCAS mechanical CPR device strapped on, hammering her already caving chest, and rushed her into the back of Medic 7.

During the eight-minute transport to Saint Elizabeth’s Hospital, the crew continued the fight. The ambulance sirens wailed as they blasted through traffic. Inside the bouncing rig, the LUCAS kept pounding while the monitor showed her slipping back into polymorphic VF.

Third shock—360 joules. CRACK-BANG! Jamie’s body nearly lifted off the stretcher, every muscle firing at once in a full-body tetany. Her breasts whipped upward so violently one pad nearly peeled off, then slapped back down with a wet smack against her bruised ribcage. Fingers clawed the air, toes curling hard.

Magnesium 2 g pushed. More epi. They bagged her through the tube, but lung compliance was dropping fast from pulmonary edema.

Fourth shock—360J. CRACK! Her torso jackknifed again, breasts bouncing in heavy, uncontrolled arcs, the left one jiggling longer from the pad placement.

Fifth shock followed immediately—another 360J. This one produced a weaker convulsion: her body bucked, breasts quivering rather than flopping.

They rolled through the ambulance bay doors at Saint Elizabeth’s ER at 9:05 a.m. A full code team was waiting—residents, attending, nurses, respiratory therapists. They transferred her straight into Trauma Bay 2, LUCAS still running, ET tube in place, pads still attached.

The ER resuscitation stretched on for another twenty-eight brutal minutes. They continued cycling shocks as the monitor flipped between fine VF, PEA, and brief, unstable organized rhythms that never held.

Sixth shock—360J. Her body arched hard on the gurney, breasts flopping wildly under the harsh overhead lights.

Seventh—360J. Another violent full-body contraction, spine curving sharply, breasts bouncing in heavy arcs as the current ripped through her.

Eighth—360J. Weaker now, her torso twitching rather than lifting, breasts quivering with residual electricity.

They pushed more epi, amiodarone, bicarb when the blood gas came back pH 6.7. The respiratory tech suctioned the ET tube repeatedly as pink-tinged fluid bubbled up from her failing lungs. Ribs were fully shattered. Her once-perfect chest was deep purple from the mechanical compressions and repeated shocks, smeared with sweat and IV fluids.

At twenty-five minutes in the ER—total downtime now approaching forty minutes—the monitor flattened to asystole. Pupils fixed and dilated. ETCO2 zero. They ran two more rounds anyway, one final shock (CRACK!—a pathetic, limp twitch this time, breasts barely moving), but nothing returned.

Jamie’s husband, standing at the foot of the bed in his turnout gear, voice breaking, called it at 9:33 a.m.

“Time of death… 9:33.”

They covered her ruined body with a sheet right there in the trauma bay, ET tube still protruding from her slack mouth, yoga pants sliced open from the initial scene work.

What no one in the family knew—what only Jamie had kept secret—was the digital frenzy erupting around her OnlyFans account. She had meticulously hidden it: a dedicated burner phone kept in her glove compartment or buried in her lingerie drawer, a separate ProtonMail address never linked to her real identity, and all payouts routed through a privacy-focused payment processor into a solo checking account she opened under a slight variation of her maiden name with a PO Box address. Her husband had never seen the app, never glimpsed the earnings notifications, and had no idea she even had a second phone.

The platform’s automated moderation quickly muted the live stream and flagged it for graphic violence and real medical trauma, removing public access within minutes. But screenshots, short clips of the initial collapse, the first violent shocks on the pavement, and her body convulsing under the defibrillator had already been screen-recorded by dozens of viewers. These fragments exploded across Reddit’s r/NSFL, r/Death, and r/OnlyFansLeaks subreddits, then spread to X (Twitter), Telegram gore channels, and niche fetish forums that traded “real accident” content.

By late afternoon, the story of the “hot OnlyFans mom who had a heart attack mid-smoke tease and got shocked to death live” was trending in dark corners of the internet. New subscribers surged—curious onlookers, shock-seekers, and longtime fans rushing to unlock her full archived library before anything else disappeared. Tips poured in as morbid “tributes,” and pay-per-view unlocks for the muted original live (plus her earlier explicit videos) skyrocketed. Within the first 48 hours, the account generated over $14,000 in fresh revenue. Over the next two weeks, as edited compilations circulated wider and true-crime/clickbait YouTube channels covered “the tragic OnlyFans death caught on cam,” the total swelled past $47,000—driven by renewed subscriptions, mass tips labeled “RIP Jamie,” and opportunistic creators reposting stills with links back to her page.

Even after her death, the account remained active in a strange half-life. OnlyFans continued processing payments and auto-depositing earnings into the hidden account because no next-of-kin claim or verified death notification had been filed with the platform (Jamie had never added any recovery contacts or family trustees). The money—nearly fifty thousand dollars by month’s end, climbing slowly as occasional new views and tips trickled in—sat completely untouched in the privacy-focused bank account. Her grieving husband, now a single father navigating funeral arrangements and two devastated kids, remained utterly unaware of its existence. No shared passwords, no joint emails, no paper trail in their home. The funds simply lingered in digital limbo, quietly accumulating a few extra dollars here and there from lingering morbid curiosity, a final, macabre fortune born from the very performance that ended her life—forever inaccessible to the family she left behind.

Jamie never came back. Thirty-six. Mother of two. OnlyFans creator for a few lucrative months. Dead after a prolonged, heroic resuscitation that stretched from a Walmart parking lot through ambulance transport to a hospital trauma bay, while strangers around the world turned her final moments into viral tragedy porn.

[eyesfixedanddilated]

It was a humid Wednesday morning in September 1990 in downtown St. Louis, the kind of late-summer day where the Mississippi River haze clung to the high-rises and the air conditioning in the midtown insurance office building struggled to keep up. The open-plan floor on the eighth level of the old brick-and-glass tower smelled of fresh Xerox toner, burnt coffee from the break-room Mr. Coffee, and the faint, sweet tobacco haze of Virginia Slims menthols—still perfectly legal to light up at your desk back then. Typewriters clacked alongside the occasional IBM Selectric hum, and a few early PCs with green phosphor screens blinked under fluorescent lights. Gwen Thompson, forty years old and a sharp account representative who’d clawed her way up from claims processor after her divorce, sat at her cubicle in a bold leopard-print blouse with oversized red and teal polka dots, her signature gold chain necklace glinting against her collarbone and long silver earrings swaying as she typed. Her voluminous blonde hair—teased high in that classic 1980s-to-’90s style—was slightly frizzed from the humidity, framing a face that still turned heads but carried the faint lines of stress and two decades of smoking.

Gwen had been a Virginia Slims girl since her early twenties—“You’ve come a long way, baby,” the ads had promised, and she’d believed it, keeping a pack in her top drawer next to her lipstick and the photos of her two kids, eight-year-old Tyler and six-year-old Madison, whom she raised alone after their deadbeat father skipped town. Her hypertension was managed (barely) with a daily pill she sometimes forgot, and the polycystic ovarian disease that had made her periods hell and her weight fluctuate was just another thing she powered through with black coffee and determination. She’d lit her third Slim of the morning at 9:45, taken a deep drag while reviewing a client file on workers’ comp claims, and then—mid-sentence on the phone with a policyholder—her voice cut off. Her eyes widened, she clutched her chest with one manicured hand, and she crumpled sideways out of her swivel chair, hitting the thin carpet with a dull thud that echoed between the fabric partitions.

“Gwen? Gwen!” Her coworker Denise screamed first, knocking over her own coffee mug. Heads popped up across the sea of cubicles. Someone yelled for help. Frank from accounting, who’d taken a CPR class at the YMCA last year, dropped to his knees beside her. “She’s not breathing—call 911!” The office erupted: phones dialed frantically on rotary and push-button lines, the receptionist shouting the address into the receiver while the rest of the floor froze in that 1990s mix of panic and protocol. Frank tilted Gwen’s head back—her big hair splaying across the floor like a halo—and started chest compressions, counting aloud in the old 15:2 rhythm he remembered. Her lips were already blue-tinged. No one had an AED; those were still rare outside hospitals and airports. The Virginia Slim still smoldered in the ashtray on her desk, forgotten.

St. Louis City paramedics rolled up eight minutes later, sirens wailing down Olive Street. The ambulance was a boxy 1980s Ford E-350, red-and-white with the old “EMS” lettering, stocked with the standard 1990 gear: LifePak 5 monitor-defibrillator (monophasic, of course), oxygen tanks, intubation kit, and a drug box heavy on epinephrine and bretylium. Two paramedics and a basic EMT burst in—uniforms starched, mustaches thick, radios crackling with dispatch chatter. “Adult female, mid-forties, sudden collapse, unresponsiveness,” the lead medic radioed as they cut open Gwen’s blouse with trauma shears, exposing her chest. They slapped on the paddles. “V-fib—clear!” The first shock hit at 200 joules; her body arched once. CPR resumed immediately—15 compressions to 2 ventilations via bag-valve mask. No ROSC. Second shock at 300 joules. Still coarse V-fib on the green screen. They intubated her right there on the office carpet—laryngoscope blade flashing under the fluorescents—while an IV line went into her antecubital vein and the first 1 mg of epinephrine pushed. Third shock: 360 joules. The monitor kept screaming that chaotic, wavy VF line. “Refractory—load her up, we’re going hot to Barnes-Jewish,” the medic barked. They strapped Gwen to the gurney, continued CPR in the tight elevator down to the street, and rolled her into the ambulance as the office staff stood clustered on the sidewalk, some crying, whispering about her kids.

The ambulance ride was a blur of controlled chaos along the short route to the medical campus. Sirens blared; the medic in back kept the 15:2 compressions going while the driver weaved through traffic near Forest Park. “Push another epi—1 mg,” the lead called. “Still V-fib.” They gave lidocaine 1.5 mg/kg IV for the refractory rhythm, followed by a 360-joule shock. Her body jerked under the straps each time. Bretylium 5 mg/kg went in next when the lidocaine failed to convert it—standard 1990 protocol for persistent VF after the initial stacked shocks and pressor. The monitor never settled. Blood pressure cuff readings were flatline. The EMT hyperventilated her gently with 100% O2, watching the ET tube fog with each bag squeeze. Gwen’s earrings clinked faintly against the metal rails with every compression. “ETA three minutes—tell ER we’ve got a code in progress, refractory VF, downtime about twenty minutes now.”

Barnes-Jewish Hospital’s emergency department in 1990—still operating under the pre-merger Barnes Hospital wing but referred to by the growing combined campus name in local parlance—was a bustling hive of white coats, beeping monitors, and the smell of Betadine and stale cigarette smoke from the staff break room. The trauma bay doors flew open as the medics wheeled Gwen in at 10:18 a.m. “Forty-year-old female, office collapse, witnessed V-fib arrest, refractory after three shocks, epi x2, lido, bretylium on board—still in it!” The ER attending, a harried resident, and a full code team—nurses, respiratory techs, another resident—swarmed her. They hooked her to the bigger ER defibrillator, confirmed the tube placement, and continued the 1990 ACLS algorithm without missing a beat.

“Resume CPR—15:2,” the attending ordered. Paddles on. “Clear—360 joules!” Her body convulsed again. Epinephrine 1 mg IV push every five minutes, clocked precisely on the code sheet. Another round of lidocaine, then a second dose of bretylium when VF persisted. Sodium bicarbonate 1 mEq/kg went in around the twenty-five-minute mark for suspected acidosis from prolonged downtime—common in the era’s protocols. They ran a quick arterial blood gas, adjusted ventilation, and shocked her seven more times total in the bay, each 360-joule delivery accompanied by the metallic smell of ozone and the rhythmic thump of compressions. IV fluids wide open. A central line went in under sterile drapes while the team rotated compressors to avoid fatigue. The monitor never left coarse ventricular fibrillation—the squiggly, unorganized line that refused to organize no matter what they threw at it. Her hypertension history and long smoking pack-a-day habit had likely scarred her coronaries; the PCOS and possible undiagnosed metabolic issues didn’t help. No reversible causes popped on the quick H’s and T’s checklist they mentally ran through.

Thirty-eight minutes into the code—total downtime now over an hour—the attending glanced at the clock, then at the exhausted team. “We’ve done everything per protocol. Any objections?” Silence, except for the ongoing whoosh of the bag and the relentless V-fib on the screen. “Call it. Time of death: 10:56 a.m.”

They stopped compressions. The monitor was turned off. Gwen lay still under the harsh lights, her big hair matted with sweat, leopard-print blouse cut away and discarded, gold necklace removed for the code. The ER nurse noted the time on the chart, her single-mom status already radioed ahead so social work could start on the kids. Outside the bay, a chaplain waited to speak with whoever claimed her. In the office back in midtown, the phone was already ringing with the news that would shatter two young lives and leave a desk empty, a Virginia Slims pack untouched in the drawer. Gwen Thompson had powered through a lot in her forty years, but refractory ventricular fibrillation didn’t negotiate—not even in 1990.

[eyesfixedanddilated]

The Last Easter

The Easter ham glistened on the table, its sweet pineapple glaze still warm, when Linda Brooks suffered a sudden, catastrophic acute anterior ST-elevation myocardial infarction—most likely caused by complete thrombotic occlusion of the proximal left anterior descending (LAD) coronary artery. Her four-decade smoking habit—two packs a day since her early twenties—had silently ravaged her coronary arteries for forty years, accelerating atherosclerosis, promoting plaque rupture, and triggering the massive anteroseptal myocardial necrosis, acute left ventricular failure with cardiogenic pulmonary edema, and immediate electrical instability culminating in ventricular fibrillation.

Linda, 61, sat beaming at the head of the long oak table in her daughter’s backyard in Pigeon Forge, Tennessee, the Great Smoky Mountains rising softly behind her. She was a big, soft woman—five-foot-four and two-hundred-thirty pounds—with warm, comforting curves her family had always hugged without hesitation. Her bleached-blonde hair framed a round, joyful face, and her pale hazel eyes sparkled with pure happiness at having every child and grandchild together on Easter Sunday. She wore a flowing green-and-white floral dress that hugged her generous belly and breasts.

She reached for another deviled egg, smiling so wide her slightly yellowed teeth—stained by forty years of heavy smoking and daily coffee—showed, when the crushing vise of ischemic pain exploded across her central chest, radiating like fire into her jaw and left arm. Profuse diaphoresis beaded instantly across her forehead and upper lip. Her face drained of color. Her hazel eyes flew wide in raw terror as her mouth opened in a desperate, silent gasp. Only a wet, gurgling agonal sound escaped as ventricular fibrillation erupted from the ischemic myocardium. The deviled egg dropped from her fingers. She lurched sideways, knocking over the sweet tea pitcher in a shattering crash, then collapsed face-first into the potato salad, her heavy body knocking plates aside. Her generous belly and breasts hit the table hard.

“Mommy! No—Mom!” her daughter screamed, voice shattering with panic.

The backyard erupted in horror. Grandchildren wailed and scattered. Her middle son, Travis, dropped to his knees beside her, tears streaming. “Mom, stay with me! Please, God, don’t do this!” He rolled her limp, heavy form onto her back on the grass. Her once-bright hazel eyes stared blankly upward, pupils already dilating wide and dark as cerebral perfusion failed. Travis laced his hands and began high-quality CPR—pushing hard (at least 2 inches / 5 cm deep) and fast (100-120 compressions per minute) into the center of her soft, heavy chest, allowing full recoil between compressions, minimizing interruptions, and changing compressors every two minutes or sooner if fatigued. Each thrust made her large breasts and belly jiggle heavily with the force. “One and two and three—come on, Mom! Breathe for us!”

The 911 dispatcher guided him while the family sobbed prayers around them. No carotid pulse, no breathing—classic sudden cardiac arrest secondary to the massive anterior MI.

Eight agonizing minutes later, the Sevier County ambulance roared up the gravel drive.

Paramedics found Linda mottled gray-pink, unresponsive, pulseless, and apneic. They cut open her pretty floral dress with trauma shears, exposing her vast pale belly and heavy breasts in a simple white bra (left in place where feasible). Monitor/defibrillator pads were applied. “She’s in ventricular fibrillation—shockable rhythm!” the lead paramedic shouted.

They charged the biphasic defibrillator to 150 joules (per manufacturer recommendation for initial biphasic shock) and called “Clear!” Everyone stepped back. Linda’s heavy 230-pound body arched violently upward off the grass, arms flailing outward, then slammed back down with a sickening thud as the current coursed through her chest. Her wide, glassy hazel eyes remained open and unfocused. “Still VFib. Resume high-quality CPR immediately—push hard, fast, full recoil, minimize interruptions!” They continued uninterrupted compressions for two minutes, her anterior chest wall already developing early bruises from the required depth. Epinephrine 1 mg IV/IO was pushed after the initial defibrillation attempt failed.

Rhythm check: “Still VFib—charging to 200 joules… Clear!” The second shock made her torso convulse again, breasts and belly rippling with the force; she slammed back down. A third shock at 200 joules followed the next two-minute cycle, her skin beginning to show faint red burns where the pads had delivered the energy. Her slightly yellowed teeth (stained by four decades of smoking) were clenched; a medic inserted an oral airway adjunct/bite block and used the laryngoscope. The blade clicked against those molars as he visualized her swollen, dusky-purple tongue and vocal cords. He advanced the endotracheal tube on the second attempt, immediately attached quantitative waveform capnography to confirm tracheal placement (sustained waveform) and monitor CPR quality, taped the tube securely between her lips, and delivered ventilations at 10 breaths per minute (one every 6 seconds) with continuous chest compressions. The bag hissed with each squeeze, her heavy chest rising and falling; persistently low or decreasing ETCO₂ prompted immediate reassessment of compression depth, rate, recoil, and team performance.

They loaded her massive, lifeless body onto the stretcher—belly sagging heavily over the straps—and raced toward the small local hospital in Pigeon Forge, continuing high-quality CPR en route with minimal interruptions.

In the ambulance, racing down the winding mountain road, the monitor displayed relentless rhythm changes typical of extensive myocardial damage from a proximal LAD occlusion: persistent refractory VFib, degeneration into pulseless electrical activity (PEA)—organized electrical activity without effective cardiac output—and periods of asystole (flatline). They delivered four additional shocks during the short transport whenever the rhythm was shockable, resuming CPR immediately after each. “Still VFib—charging to 200 joules… Clear!” The fourth shock jerked her body so hard her head lolled sideways, the heavy frame quivering on impact with the stretcher. “PEA now—continue CPR.” Epinephrine 1 mg IV/IO continued every 3-5 minutes. Amiodarone 300 mg IV/IO bolus was pushed for refractory VFib/pulseless VT. Pink, frothy fluid (cardiogenic pulmonary edema from acute left ventricular failure and elevated pulmonary capillary pressure, worsened by decades of smoking-related lung damage) began appearing in the ventilation bag. Her hazel eyes, now dull and fixed, reflected the flashing red lights. Persistently low ETCO₂ values reinforced the need to optimize CPR quality and switch rescuers frequently.

They burst through the ER doors at the Pigeon Forge hospital still performing CPR, handing off seamlessly to the code team.

Under harsh fluorescent lights, Linda’s heavy body lay exposed on the trauma gurney—dress in tatters, belly spilling slightly to the sides, breasts marked with angry red burns from repeated defibrillator pads that were already beginning to blister at the edges. Her blonde hair was matted with sweat and grass. Those same gentle hazel eyes that had read bedtime stories and celebrated every family milestone stared wide open, pupils fully dilated and unreactive.

The team followed the current Adult Cardiac Arrest Algorithm precisely: cycles of 2 minutes of high-quality CPR (monitoring depth, rate, recoil, and ETCO₂), brief rhythm checks (<10 seconds), defibrillation for shockable rhythms, and epinephrine 1 mg every 3-5 minutes. They delivered eight more shocks in the bay whenever VFib/pulseless VT recurred, using equivalent or higher energy as permitted. “VFib again—clear… charging to 200 joules!” Her body arched violently with each discharge, the heavy breasts and belly quivering on impact with the gurney. “Still VFib—next shock at 200 joules… Clear!” Another full-body convulsion, then a heavy thud. “Persistent VFib—escalating to 300 joules… Clear!” The defibrillator whine rose; her 230-pound frame jerked upward sharply before slamming down again. Amiodarone 150 mg (second dose) was administered for ongoing refractory VF/pVT. They systematically addressed reversible causes (the Hs and Ts)—hypoxia (aggressively managed with ventilation and 100% oxygen), coronary thrombosis (the primary culprit from the massive anterior MI, accelerated by her forty-year smoking history), hydrogen ion (acidosis from prolonged low-flow state), and others—while establishing central venous access. Waveform capnography guided efforts: an abrupt sustained rise to ~35-40 mmHg would indicate ROSC; persistently low values (<10 mmHg) after optimized CPR signaled poor prognosis. No atropine was administered, consistent with current guidelines that no longer recommend it routinely in cardiac arrest. Vector change or double sequential defibrillation was not attempted, as their usefulness for refractory VF/pVT has not been established.

The team worked desperately for a total of forty-three minutes from collapse, cycling repeatedly through VFib → PEA → asystole with no sustained return of spontaneous circulation despite optimal high-quality CPR, multiple defibrillations (totaling fifteen shocks across the scene, ambulance, and ER with energies ranging from 150 J initial to 300 J in later attempts), vasopressors, antiarrhythmic therapy, advanced airway management with waveform capnography, and treatment of reversible causes.

The doctor finally stepped back, voice thick with sorrow and exhaustion. “We’ve done everything possible according to protocol. Time of death… 3:47 p.m.”

The steady, final tone of the flatline filled the room.

Linda Brooks lay still—her generous, loving body now cooling and empty. The endotracheal tube still protruded from between her slightly parted lips, her slightly yellowed teeth just visible around the plastic. Her wide, lifeless hazel eyes stared blankly at the ceiling, as if still searching for her family’s faces.

In the waiting room, her daughter collapsed into her husband’s arms, wailing, “She was supposed to watch the grandbabies grow… She was the heart of us all… Those damn cigarettes finally took her.”

Outside, the Easter sun shone warmly on the Smoky Mountains, indifferent to the loss. The massive anterior myocardial infarction—fueled by four decades of smoking—had unleashed profound cardiogenic shock, pulmonary edema, and refractory arrhythmias that no amount of guideline-directed resuscitation could overcome. Linda Brooks, the warm center of her family, was gone—leaving an empty chair, unfinished deviled eggs, and hearts forever broken on what should have been a day of celebration.