A few people have asked for the earlier stories, so to spare folks having to scour back through my blog to find the story they are after, here is a full index, which I will pin and try to keep updated.
Tilly's arms began to ache from the labour of forcing her own weight through them into Zara's chest. She could feel the muscles in her back start to burn from pulling herself back up each time, even with the benefit of extra leverage from kneeling on the bed. But she kept going. Kept performing the chest compressions at a rate 105 per minute, driving pulses of blood around Zara's body with her efforts.
"Coming up on another minute, let's charge again, step it up to 360." Carl said, nodding to Trish who flicked the controls on the defib. "Tilly, switch off after this shock, Marie, take over."
Tilly glanced up at him, part of her thinking that she could keep going for another round. But she saw his small, sad, smile and gentle nod to the side. He knew what she was thinking, understood it, but also knew that exhausting oneself isn't worth it when there's enough fresh arms. Tilly kept up her rate and depth as the defib built up its charge, and when it bleeped in readiness she was already sliding off the bed before Carl could call "Clear." She stumbled a little, her foot missing the step she had stood on earlier, Marie there to steady her. The agency nurse gave her shoulder a comforting squeeze as she guided Tilly past her.
"Shocking." Trish announced, drawing Tilly's eyes back to Zara. The shock was unleashed, surging between the combo pads, through Zara's squirming heart. The muscles in her chest twitched, her heart stunned for the briefest of moments as Zara's limbs flicked outwards slightly. Then her heart began to shudder again, still trapped in the misfiring fibrillations.
"No change," Carl announced, "get another round of epi in her, and check her ABG's." He nodded at Marie, who got into position and began compressions, then spared another glance for the monitor. "Get some cool packs back on her too." Tilly caught a glimpse of the temperature reading on the monitor. 42.1. Even though she had lost circulation, the drug that had invaded Zara's cells continued turning energy directly into heat.
Tilly started to move, but Anna stepped up next to her. "Flex your arms and hands a bit." She told her softly. Tilly did so, bending her arms and rippling her fingers, feeling the tingling as her own blood returned to the muscles and digits that had been locked, as she walked to another cupboard and grabbed some more chemical cooling packs. The ones that had been scattered over Zara's body when she was brought lay in a damp heap, their contents melted to room temperature. Tilly cracked them and slapped them across Zara's abdomen, thighs and neck, slotting others into her arm pits and between her legs. She looked around at the others. Nobody made any adjustments to the cool packs. Either they were correctly placed, or the situation was already so futile that perfect cool packs would make little difference. The ice bath hadn't.
* * *
Anna nodded to herself as she watched Tilly place the ice packs, covering everything she would have done herself. Zara was once more being chilled from inside and out, cold saline being pushed into her veins through the central line and IV's in her arms. The only other thing they could try would be flushing Zara's insides with more cold saline, cutting holes in her for chest tubes and invading her body directly. They'd done something similar before, in reverse, for a hypothermic patient in a prolonged arrest. But the calculus was different here. The hypothermia itself gave them time to do the invasive procedures and see an effect. In this situation, time was already racing away from them, and the high temperature was being driven from within Zara's cells. Flushing her insides wouldn't make much difference to the important organs which were cooking from the inside, but could alter the temperature readings they were getting. It was marginally better to be able to see a more accurate measure of her temperature. If the drug stopped ramping up her temperature, it could give the team hope. Maybe even a pulse. There would still be one hell of a fight for Zara, one that she would likely lose given the widespread organ damage, but there would be a glimmer of hope.
As Anna thought through all this, she leaned around to look at the bag attached to the urinary catheter. The fluid in it was murky, traces of brown wisping through it. Tilly had come to stand beside her again, so Anna gave her a nudge and nodded towards the catheter bag. Tilly followed her gaze, and Anna saw the slight slump of the student nurses shoulders. "Kidney function is declining." She said.
Carl didn't even look. He just nodded. Anna saw his jaw work, the slight tensing as he thought and decided. "Jamie, can you check her pupils please." He said, his flat tone indicating he already knew what the result would be.
Anna continued watching while Jamie eased open Zara's eyes and flicked a penlight across them. She was glad she couldn't see the young woman's pupils, already feeling creeping dread for the fellow mother down the hall. Jamie looked up and shook his head. "Dilated and unresponsive."
Carl nodded again, then let out a small sigh. "Let's shock her again, and get an EEG in here. I don't want to keep beating on her if her brain is already...gone."
Cooked. Anna thought, sadly. She sensed Tilly move past her, heading out of the room to retrieve the requested machine. Anna stepped forward a little more, closer to Carl. He leaned heavily on the rail at the foot of the bed, his gaze wandering from Zara's body to the monitors, to the hemoperfusion, then to Anna. She wanted to give him a hug, and she could see the same desire to give comfort reflected, but they wouldn't push professionalism. They both knew, both understood the mutual sentiment, and settled with near imperceptible nods.
The defib finished it's charging sequence, everyone getting clear of Zara, before Trish pushed the shock button again. Zara jerked with the burst of electricity, the bed beneath her squelching slightly, dampened by residual water from the ice bath and the sweat that continued cascading from Zara's whole body. For a brief moment the monitor stopped alarming.
Then a monotone whine filled the room.
* * *
Tilly walked quickly to the store room, pulling the cart with the EEG from it's nook as she held the door open with her foot. As she was crossing back across the hall, she glanced towards the relatives room, seeing Jaya walking slowly towards the Resus room. Tilly held in any reaction, but hurried her pace. She dragged the cart into Resus 3, waiting for the door to swing closed before she spoke. "Her mother's coming." She said, noticing the main monitor screaming the tone of asystole.
Carl straightened, looking at Anna. "I'm sorry, could you..."
Anna nodded. "I'll go to her."
Carl mouthed a thanks, then waved Tilly around towards the head of the bed. He didn't need to ask if she had helped with one of these machines before. She'd been on a placement in the ICU when Anna had one attached after her incident. Jamie was already wiping the clinging sweat from Zara's brow as they parked the cart and Tilly started to unravel the leads and peel off the protective backing of the electrodes. She passed them individually to Carl, who placed them in the correct positions. Within a minute Zara's head, still shaking gently from the continuous compressions Marie delivered to her sternum, was crowned with the bizarre tiara of electrodes.
Tilly felt her hand trembling slightly as she flicked the power on the EEG monitor. The was a brief moment while the machine calibrated, and then Zara's brain activity began to trace across the screen.
Or more precisely, the lack of brain activity.
Every lead showed the same flatline as those of the heart monitor.
Tilly double checked the connections, the settings. Everything was correct. She shook her head, before letting her gaze drop to the floor.
Beside her Carl sighed. "Let's do a pulse and rhythm check after this cycle."
Tilly forced her head back up, forced herself to watch the last moments, as Marie did ten more compressions, the last few tailing off and the final one little more than a nudge as she stepped back. Hands went to Zara's carotid, femoral and radial, but Tilly wasn't in a position to reach any of them. She knew what they'd find away. Nobody even spoke, they just looked to Carl and shook their heads.
"Alright. It's only been nine minutes, but there's no cardiac or brain activity. Her temperature is still 42.2. There are no causes we can reverse and zero chance of meaningful recovery. I think it would be kinder to let her go now. Is everyone agreed?" The same heads gave Carl tiny nods. But before he continued, he looked at Tilly. She took a breath, then nodded too.
Carl turned to the clock. "Time of death, 12:13 pm. Thank you everyone." And with that he reached over and flicked off the main monitor. Tilly heard a cry from outside the doors that sent a shiver down her spine.
* * *
Half an hour later, Anna stood by the main desk in the ER, holding a sleeping Hope tightly, rocking gently from side to side. She still felt the sting of dealing with Jaya as the older mother broke down follow the realisation that her daughter was gone. As soon as Carl left Resus 3 and guided Jaya to the relatives room, Anna had gone straight to the creche. Tilly approached, still looking downcast, but she managed to flash a small smile at Anna and her baby.
"How are you doing?" Anna asked her, not needing to lower her voice much. She and Carl had been blessed with a child that slept like a rock until she wanted something.
Tilly shrugged. "It happened so fast." She said, wringing her hands.
Anna nodded, understanding exactly how the student nurse was feeling. "You never get used to it, or at least, you shouldn't. But it does get easier to deal with."
Tilly gave a twisting nod. "She was still warm. When we cleaned her up." She shivered slightly.
"You couldn't have done anything different. Just remember, it wasn't your fault, not one bit of it. We do our best, and sometimes we don't win. Here more than most places in the hospital."
"Thanks. I'll be alright. Just needed a moment." Tilly said.
Anna was about to suggest her old spot as a good place to take a breath, but a twinge of phantom pain in her abdomen stopped her. Images flashed through her mind. The knife. The blood. Her own breath caught for a second and she clamped her eyes shut as she drove the intrusive memories away.
"Are you okay?" Tilly asked, concern in her voice.
Anna swallowed then took a deep breath, recentring herself. She opened her eyes and nodded. "Yeah, sorry. I'll be alright." Hope gave a small content snore. "Especially with this one to keep my feet on the ground." Out the corner of her eye she saw Carl stepping out of the Resus Rooms corridor, trailed by Jaya and a police officer. "And her father."
Tilly glanced around and smiled, "I'd best get back to some work. But thanks, again."
Anna nodded as the student nurse walked away, the spring in her step returning. Carl walked over, Jaya and the police officer heading for the exit. There were no cuffs on her. Carl stopped beside Anna, bending slightly to gently kiss the top of their daughters head, then leaned against the desk.
"What's going to happen to her?" Anna asked.
Carl blew out a long breath through his nose. "I don't know. They're taking her into custody. But that might be as much for her own protection from herself. She's fully aware that she's responsible. They're more interested in the original supplier and she's co-operating. Whether they charge her..." He shrugged. "Unless she's a brilliant actor, she'll be punishing herself for the rest of her life whatever they do."
Anna nodded but also held Hope even closer to her.
"Do you want me to pick something up for dinner on the way home?" Carl asked.
Anna shook her head. "I'll make something. There's already some chicken ready." She said, determined to prove she could weather the emotional elements of the job and still function.
"Okay then. I'll see you in a few hours." Carl said, planting another little kiss on Hope's head. Anna lowered the still snoozing child into the pram, kissed Carl, and set off, turning back to wave at Carl and at Tilly as she left.
* * * * * * * * *
I hope everyone has enjoyed this story. Now for the bad news. Well, not neccesarily bad, more of an unknown. Right now, I don't know when I'll be back with the next story. I have an idea, and a rough plan, but little more than that. I also have a different project that I want to at least outline before I even make a start on the next story in the Anna Swift universe. And, I also don't want to leave big gaps between updates. My current plan is to have half the story complete before I even begin posting it, and hopefully use the feedback to keep my momentum going.
However, I will offer up one little tease : Mass Casualty Incident
Tilly ignored the water splashing across the front of her scrubs as she reached in deeper to get both hands under Zara's shoulders, using her forearms to support the beauty's head as her whole body convulsed wildly in the ice bath. Alarms began to chorus from the monitors in a cacophony of tones and chimes.
"Get her back on the bed!" Carl's voice cut through the commotion of alarms, as other nurses rushed to help. Tilly continued to support Zara's head as the sling whirred and lifted her out of the churning water. Her limbs twitched and shook, muscles driven by random and chaotic electrical signals cascading through her nervous system. The other nurses helped to protect the lines and contain the worst of the thrashing to keep her in the sling. Meanwhile Carl had dragged the crash cart right up next to the bed and was drawing some drugs into a syringe. He grabbed the IV even as Zara was being carefully swung over the bed, fingers slipping along its length to find the inline port. "Pushing diazepam, 10mg."
The sling lowered Zara's naked body onto the trauma bed. As soon as it went slack, the bands were unhooked and left to fall loose over the sides of the bed, ignored. With Zara's body twitching madly, trying to remove the sling from beneath her would be impractical.
Tilly remained at the head of the bed, following her training. Her hands cradled Zara's head gently. She didn't hold tightly, or try to fight Zara's convulsive movements. Her hands merely offered a cushion for Zara's head to bounce off, keeping it contained and protecting the ventilator hose. The integrated bite block of the tube holder also proved its worth, as even from this angle Tilly could see how tightly Zara's jaw was clenched.
She spared a glance at the monitor, but the chaos of the seizure produced enough artefacting that the ECG reading was a garbled mess matching the strident alarms. The diazepam began to take effect, the seizure slowing, becoming less intense. Then in a split second it stopped completely, Zara falling totally limp on the bed.
But the monitor continued its alarming. Tilly shifted her fingers to the carotid pulse point. After a few seconds she looked up at Carl and shook her head. He sighed. "Pulseless V-tach. Someone get on her chest and ready the defib."
* * *
As Anna walked back to the relatives room, she tried to quell the unease boiling inside her. This was going to be a difficult conversation. Not just because Jaya's daughter was in such a precarious condition, but also because Anna was about to accuse her of causing Zara's potentially lethal predicament. She stopped outside the door and took a deep breath, steeling herself, then opened the door.
Jaya was still sat on the couch staring at the floor, statuesque, her arms still wrapped protectively around the handbag. She didn't even look up as Anna entered the room.
"Mrs. Chamarthi." Anna said as she stepped over to the couch opposite Jaya, a squat coffee table separating the two. "Mrs. Chamarthi." Anna repeated, slightly sterner, finally forcing the older woman to look up at her. "Zara is in a very critical condition. We need to know if she has taken anything. Anything at all. I'm not talking about party drugs." Anna drew in another breath, studying Jaya intently. "Has she ever used anything she might have bought online? Something for weight loss?"
When Jaya's arms tensed around the handbag, Anna froze, feeling her stomach drop. She was right. She took a moment to settle herself, cutting off a flare of anger before it could build. It was clear that Jaya had seen the realisation on Anna's face when her eye's flicked back to the floor and stayed there.
"Mrs Chamarthi." Anna's voice softened. "If you know anything. You need to tell us. I'm sure you didn't mean for any of this to happen. The criminals who sell these drugs never mention the side effects. But you need to understand." She paused, picturing her own daughter, imagining the effects her next word would have on herself. "Zara is very ill. It is likely that even with the right treatments, she won't survive. The only chance she has is if we know what she took, and every second matters right now."
For the longest moment, Jaya remained stoney faced and silent, then she cracked. Her face crumpled and she let out a sob. "I'm so sorry. I didn't..." Her words chocked off, but her arms released the tight grip on the hand bag and her hand reached inside, pulling out a cardboard box, the same kind you'd have for any over the counter medicine. She dropped it on the table as she buried her face in her hands.
Anna pushed herself to her feet, picking up the box on the way and made for the door. As she headed towards Resus 3 she examined the box closer. It was obviously not a real product. The cardboard was flimsy, the artwork upon it clearly printed on an old domestic printer, complete with streaky lines and a strange colour shift where one of the colour cartridges had run out. It also lacked any of the information you'd find on a real pharmaceutical product. No ingredients list, no dosage, no side effects. She opened it up carefully, almost surprised to see that the pills were at least in a blister pack instead of completely loose. They were small and yellow, with no identifying markings, but they matched the description of dangerous black market 2,4-DNP pills that had been on the database. Her heart sank as she reached Resus 3 and looked through the doors to see Zara's body shaking rhythmically as her chest was brutally compressed.
* * *
Jamie took up the first round of compressions, his huge hands making Zara look small on the trauma bed. There was so much power in his frame that it looked to Tilly as if he was barely making any effort. Tilly herself had detached the ventilator and fixed the yellow ambu bag to Zara's ET tube, pumping the bag steadily every few seconds. Trish was managing the drugs, drawing the first round to be ready for Carl's order, while Kirstie had taken up the chart to record the details. Marie had set the defib to charge, before she grabbed a towel and did her best to dry off Zara's chest, careful to avoid dislodging any electrodes. She dropped the towel behind her without ceremony, quickly checking that the still attached Combo Pads had stayed firmly secured. She gave a Carl a nod as she retreated, his finger hovering over the shock button on the defibrillator.
A few moments later the machine let out the double bleep of a readied charge. "Everyone clear." Carl said, waiting a moment as Tilly plucked off the ambu bag and Jamie held up his hands, leaning back slightly on the step that stuck out from the trauma beds bottom rail. "Shocking." He said, finger twitching against the button. The machine delivered the shock, Zara's body giving a sharp spasm on the bed. Everyone's gaze turned to the monitor, watching the momentary chaos of the shock return to the sawtooth of V-tach. "No response, resume compressions and bagging, give her one of adrenaline and a round of atropine. We'll shock again in 1 minute."
The jumped back into action, Trish reaching for the IV with the already prepared drugs in hand. Jamie was already back in position, tilting his weight into Zara's chest before Tilly had even picked the up the bag again. She almost had to snatch the end of the tube as Jamie's compressions forced Zara's entire body to rock in rhythm on the bed. The bed itself rattled as the force translated into the frame. Tilly was aware of all the motion around her, perfectly alert to everything, including the slight squeak of the door as it opened, as Anna returned. Tilly looked over her shoulder, still squeezing the bag. The expression on Anna's face was a grim one, and in her hand was a small box.
Carl let out a sigh. "Trish." He said, nodding at the defib as she finished inserting the ALS drugs. He stepped out of the group around the bed, heading around to Anna. Anna flashed Tilly a sad smile before turning to her husband.
* * *
"It was these." She said, handing over the box. "The pills match the description." She sighed as Carl opened the box and tipped the blister of pills into his hand. "Just one. Just one pill did this to her." Anna voice was filled with her melancholy and second-hand regret. Carl looked them over, then put them back in the box. He took a couple of steps away, to place the box by the computer, making sure it was out of the way and wouldn't accidently get cleaned away. "Is there anything more we can do?"
Carl looked over at Zara and gave a half shrug. "A hemoperfusion machine is on its way down. We'll give it a try, but once things have progressed this far..." He blew out a breath. "It's already in her cells. There won't be much in her blood stream to filter out." Anna's head dropped and she leaned into him slightly. He gave her a short embrace. "We'll still give her every chance we can."
"I know you will." Anna whispered, before easing back from him, letting him get back to work. She crossed her arms, holding herself tightly as she leaned back against the desk watching the team do their best.
"Marie, can you get hemoperfusion access in one of her legs, just like lines for dialysis?" Carl asked over the sounds of the attempts to save Zara. She nodded and paused for just a moment as she counted off cupboards, then headed directly to the correct one. Anna was mildly impressed by that. A lot of agency nurses could struggle with the location of various items, especially those that were rarely used. Anna herself couldn't remember the last time she'd needed to be in that cupboard while a patient was in the room. Marie was coming back with the wrapped-up tray when the telltale bleeps of the defib rang out.
Trish ordered the team to pause once again, and Anna watched on as Zara's entire body twitched savagely as the shock jolted through her. A shiver ran down Anna's spine, one of her hands drifting down to the scars on her abdomen. This was the same room where the battle for her own life had almost been lost. She still had real no memory of that day. By the time she was in this room her heart had already stopped. But even before that, there was little more than flashes, and the almost certainly imagined formless void where she had fought against the encroaching darkness. She steeled herself. She was coming back to work here. She had to face it head on.
The mood in the room dropped a notch, as the ringing alarm of the monitor persisted, but the trace on the screen changed, the high peaked saw teeth giving way to the more randomly shivering chaos of ventricular fibrillation. Zara's heart was now shuddering within her chest, desperately trying to beat, but unable to do so.
* * *
"Ok, she's in VF. Tilly, can you take over compressions?" Carl asked as he held out a hand for the ambu bag.
"Yeah." She replied, moving around as Jamie stepped back. She climbed up, weaving her fingers together as she did, bringing them to rest on Zara's sternum. She could feel the heat of the young woman's skin. Even though she had lost circulation, the fire inside her was still burning, consuming the energy of her cells, turning it into the heat that was destroying her. She took a split second to adjust the position of her hands, unnoticeable to any of the others, lining them up perfectly the deliver the best chest compressions she could. This was only the second time she had done them on a real living person. Or real dying person, she considered, her hands plunging down two inches, forcing down Zara's ribs and crushing her heart against her spine to artificially pump blood through her body.
"Good." Carl encouraged her. "Kneel on the bed if you need more leverage." He advised. Tilly simply nodded, recognising the benefits of the suggestion, but not wanting to break the rhythm she had already found. It was such a repetitive motion, she was able to keep track of what was going around her. Marie had gotten the large double lumen catheter unpacked and had pulled Zara's leg to one side, taking a stance looking towards Zara's gently waving feet. She used one arm to restrain the leg and find the spot, as she deftly lined up the catheter itself for insertion.
Behind Tilly the door squeaked again, a technician entering with the hemoperfusion machine. It was similar to a dialysis machine, in form as well as function. The key difference was the precise form of filtration. Unlike the standard dialysis machine, the one for hemoperfusion used a cartridge containing either activated charcoal, or in this case, a special resin that would bind toxins without affecting the primary blood cells.
"Over there, get it ready please." Carl told the technician, who look somewhat incredulous at the scene before him. Hemoperfusion was occasionally brought down to the trauma rooms on an emergency basis, but not during active resuscitation measures. Tilly could almost see him thinking You're closing the stable door after the horse has bolted. But, he clearly wasn't paid enough to contradict one of the most notable doctors working at the hospital. He rolled the machine to the bottom of the bed, assisting Marie with getting it setup. They quickly primed the lines, flushing them of air and ensuring the connection to the filtering column was secure. The input and output lines from the machine were attached to the respective ports on the catheter and moments later Zara's blood was being pumped through the circuit, where the biochemical resin in the column leached out toxins.
"Right, that's almost 2 minutes since the last shock." Carl announced, foregoing the interim minute so that the hemoperfuser could be sorted. Trish set the defib to charge, while Tilly maintained her compressions. She was beginning to feel the strain in her back, and when the defib was ready and Carl ordered the team to clear Zara's body, she was grateful to lean back and stretch it out. The shock jolted Zara's body, her arm flicking out to the edge of the bed, her fingers falling just over the side, nails clinking against the lowered rail almost imperceptibly.
"No change." Trish told the team, even though they were all looking at the monitor.
"Let's keep it going." Carl said, "Give her another round of drugs. If we get a pulse back she might have a chance." His tone gave away his lack of confidence in even that first step. But Tilly caught the way his eyes glanced over at Anna. He'd seen what some would call a miracle before.
* * *
Anna looked into Carl's eyes during that short glance. He wasn't in too deep. There were times he would throw his entire sense of self into his work, fighting against the grimmest odds to the point of sacrificing a part of himself. She knew she was included in that data set, and was eternally thankful. But that wasn't what she saw when their eyes met. He was looking to her for direction. Submitting to her emotional involvement in this case. As a mother. Anna gave the tiniest smile, recognising his belief in her, but she shook her head ever so slightly as she dropped her gaze. She'd seen the database results about the chemical, she knew how bad this was. Her heart ached for the girl on the bed, and that girl's mother, who Anna desperately hoped had only the best intentions. But this wasn't a time to go all-in. Play it out, give it the best shot you had, but no one would argue with the outcome in this situation.
Anna watched as Tilly clambered onto the gurney, kneeling beside Zara to gain the better leverage as her hands landed on the young woman's chest, glistening as sweat continued to well out of every pore. Zara's chest collapsed inwards and sprung back with each compression, an artificial beating her of heart that showed on the monitor beneath the chaotic electrical activity. The room had gone quiet, settling into that grim routine when there was little else to do but persist with their current interventions. The bed clinked, wires and tubes rattling against the frame, while the hemoperfusion machine hummed. The ice bath, almost forgotten, gurgled as it's water circulated needlessly. The monitor's alarms continued to ring, but faded into the background for the team. They'd be aware of any change in the tones, but otherwise it was simply ignored.
A glance at the clock told Anna that it had been around five minutes since Zara's heart had lost it's rhythm. There was still time. Still a sliver of hope. But both were trickling away.
Been away for a while, life stuff I won't dump on here, other writing projects that I want to keep seperate, and a substantial amount of wasted time. I hadn't realised it had been almost two years though.
But I am alive, and a bit of good news, I have actually fully finished this whole story, there's two more chapters after this one which just need some editing, so I'll be dropping those over the next couple of days.
I just wanted to say a big thank you to all of the people who dropped DM's asking about progress and checking on me. I didn't reply at the time, mostly because I was only checking tumblr rarely so they were often a week or more old, and my head wasn't in the right space for some of that time. But anybody that hasn't been replied, just know I do appreciate the messages, and the drip of activity on my blog has kept it in my mind, even if I struggled to put things onto the page.
I hope you enjoy :)
Story Index
Pageant Fever: Chapter 1 | Chapter 2 | Chapter 3
* * *
Chapter 4
Lucy frowned at the young woman on the gurney. Sweat continued to roll off Zara's body, and her temperature was still rising, despite the large chemical cold packs that had been slapped around her body. Her muscles continued to twitch randomly, but Lucy wasn't sure if it was the sheer internal heat, an electrolyte imbalance from the sweating, an active infection attacking the nerves, or something Zara had ingested. Or even a combination. It wasn't just Zara's peripheral muscles that were affected. The monitor alarmed, showing her rapid chaotic heart rate, letting out an additional warning noise each time Zara's heart threw off a PVC. They were becoming more frequent. On top of that Zara's breathing was plainly ineffective. Every so often she would give a gasp or grunt, but she couldn't support her own oxygen levels, forcing Lucy to continue breathing for her with the ambu bag.
Lucy knew there was little more she and Dave could do in the ambulance. Without knowing what was happening inside Zara, the best they could do was fight to keep her alive, until they could get to the hospital, where Lucy hoped the team there would be able to figure out the cause of Zara's current state. She watched Dave as he finished inserting an assortment of drugs intended to reduce the fever. There had been no effect so far, Zara's rising temperature ticking up to 41C. If it got much higher, or lasted a long time, there was a risk for severe, permanent damage to Zara's organs and brain.
Dave knew it too. "Steve, what's our ETA?" He shouted to the front.
"3 minutes." Was the reply.
"Make it 2 if you can!"
* * *
Anna had trailed Carl as he continued preparing for his incoming patient, alerting facilities staff that they would need an ice bath in Resus 3, then gathering the team of nurses, Trish was there and Kirstie, along with two Anna hadn't worked with before, a short but powerfully built man called Jamie, and an older agency nurse whose name tag identified her as Marie. Lastly was Tilly. She stood back and watched as they donned their protective gear, green plastic gowns with long sleeves, sealed by gloves, along with close fitting masks and full face visors, their names quickly scrawled in marker along the head band.
They all assembled outside the ambulance entrance, Carl quickly going over a few points and procedures he wanted done as soon as possible. Anna stayed back just a little, she didn't want to distract him as he got his plans together. She watched Tilly instead. The student nurse was no longer practically vibrating with eagerness. She was almost totally still, but not in a tension clenched way. She was simply focused, alert and prepared. Ready to do whatever she was asked. As she had told Anna earlier, she was in the zone.
The sound of sirens started to cut through the background noise of the city, rapidly growing louder as the ambulance raced towards them along the road parallel to the river. It reached a near ear splitting volume as the ambulance came out of the shadow of a nearby building, its lights flashing brightly despite the dazzling midday sun. The ambulance shot past the front of the hospital, turning tightly into the access road and pulling around in front of them.
Anna lingered back as the team stepped forward and pulled open the rear doors of the ambulance. As the gurney was pulled out, she heard Carl's commanding voice take charge.
"What have we got?" He asked. They already had many of the details, but it was always wise to double check anything that might have been missed in the relay of radio calls. Out the corner of her eye, Anna noticed an older woman climb out of the front of the ambulance, evidently their patients mother.
"Zara Chamarthi, 21. Initial instance of syncope followed by a seizure. Post seizure she presented with an SVT rhythm, converted to sinus tach after 2 shocks. She's pyrexic with a temperature of 41.2 and still rising. Resps are diminished and being supported by BVM. Heart rate of 170 with multifocal PVC's. No reported history of seizures, no prior signs of illness or reports of drug use and no reported medications either." Lucy replied as the team started moving towards the entrance Standing back, Anna couldn't help but feel like that was very little to go on. It would make the team's job even harder, leaving them managing symptoms until they could discover the cause and treat the actual problem.
Clearly Carl thought so too. "Okay then let’s get her inside, prepare for an RSI before we put her in the ice bath. I want a central line in to monitor her core temperature and get some blood off to the labs, put a rush on the full blood count and basic tox screen. In the meantime, let's start her on..." As the team accelerated away from her Carl's voice dwindled as he rattled off a range of drugs. Anna had hung back, opting to make herself useful.
She stepped towards the older woman, who seemed to be shambling after her daughter with slow, stunned footsteps. Anna intercepted her with a gentle touch on her shoulder. "Are you her mother?" She asked quietly.
The older woman nodded, looking at Anna with widened eyes, but said nothing.
"Come with me." Anna told her softly. "I'll show you through."
* * *
Tilly kept a few paces ahead of the gurney as the team rushed towards the resus bays, pushing a set of doors open with another student nurse, then leapfrogging the rattling gurney to get the doors into Bay 3. As they entered she took note of the ice bath set up a short distance from the bed. A technician was there just finishing up laying out a set of straps on the bed, which could be connected to the integrated hoist on the ice bath. The bath itself was already full, a layer of ice cubes floating on the surface as the water churned slightly, a pump circulating the water through a refrigeration unit.
As the rest of the team moved the ambulances gurney to the trauma bed, Tilly circled around to the crash cart, extracting a laryngoscope and, with a quick glance back at the girl being lifted over, a 6.5mm ET tube. She then opened a different drawer, her hands moving straight to the drugs she had checked just a handful of minutes ago. She placed everything onto a tray and moved over to the head of the bed as the others finished arranging Zara on the bed.
Trish was already readying the central line, while Carl came around, glanced at the tray and gave Tilly a quick nod. He turned to Lucy. "Pre oxygenate her please. Tilly?" He asked, turning to the student nurse. She looked up attentively. "Have you assisted on an intubation before?"
"Only in a surgical setting practically. I know the theory on emergency RSI's though." She told him.
"Good, can you apply cricoid pressure when I ask you?"
Tilly nodded, flexing her fingers in preparation.
Carl flashed her a quick, comforting smile. "On my mark then." He turned to Lucy and gave her a quick nod.
The paramedic nodded in reply and backed off, bringing the ambu bag with her, holding it ready in case there were complications. Carl drifted around to the right angle and slid the laryngoscope into Zara's mouth, pushing the blade in and pulling back to open the young woman's airway and give him a view of her vocal cords.
"Cricoid on." He said, his eyes still focused on Zara's trachea.
Tilly placed her fingers on the hard ring of cartilage around Zara's trachea and pushed it down, blocking the oesophagus to prevent aspiration.
"Good." Carl muttered, as he eased the lubricated tube down until only a few inches stuck out of Zara's mouth. "Very good. Check the placement for me." He told her, as he held out a hand towards Lucy for the bag.
Tilly had the briefest moment of looking around, before realising she had a stethoscope around her neck. She pulled it off and plugged it into her ears, before grabbing the bell and lowering it Zara's naked chest.
Carl squeezed the bag steadily, his hand clenching firmly, but gradually.
"Left air entry." Tilly said, before moving the head of the scope to the right side of Zara's chest. Carl squeezed the bag again. "Right air entry. Placement seems good."
"Excellent. Let's get her on the vent and prepare her for the ice bath. Until we know what's going on, our first priority is bringing her temperature down."
* * *
Anna gently guided Jaya through the emergency entrance and towards the Resus room. They proceeded slowly, Jaya's steps shambling and slow, as if walking through treacle. Anna felt a keen wave of sympathy as she imagined what the woman must be feeling. It was one thing to understand it conceptually, but now that she was a mother herself, Anna felt it in a way she hadn't before.
They reached Resus 3 as Tilly was securing the ET tube with a blue holder and Carl was attaching the ventilator. At the same time Trish finished with the central line, the large double port catheter inserted just below the left side of Zara's collarbone. She attached a bag of chilled saline to one port and grabbed one of the small wires dangling from the ports, connecting it to a lead attached to the monitor, the young woman's core temperature appearing on the screen.
Another nurse, one of Tilly's fellow students judging by the fact that Anna didn't recognise the name written on the visor, was drawing a blood sample from the IV in Zara's arm. She quickly capped it and handed the sample to a tech who was waiting just inside the door. The young man hurried out, rushing towards the elevator and the labs.
Anna watched him go, then looked to the monitor. From this distance she couldn't make out much in the way of detail, but the flashing portions were more than enough to tell her that the young woman was in a critical condition. Temperature, heart rate, BP, o2 sat and pulse readings, all were flashing in alarm. The team was bustling around her body, pushing ordered drugs into the various IV's, inserting a foley catheter or readying the straps of the hoist.
With a minute they were ready, drawing the young woman up into the air. They proceeded carefully, making sure no lines, leads or hoses got disconnected as they swung her over the small distance to the tub. The nurses steadied her as the hoist lowered her down into the gently churning water, then they quickly arranged her, keeping her face above the surface but otherwise submerging as much of Zara's overheating body as they could. Not that there was much danger of her drowning in the tub, with the ventilator forcing air into her lungs regularly.
Despite all the efforts the team were making, Anna had a bad feeling. She turned to Jaya, who seemed to be clutching her handbag tight to her chest as she stared through the window. "Let me show you to the relatives room." She said, easing the older woman back from the glass and shepherding her down the corridor to a door with just a narrow window in it. Inside were a number of comfortable chairs and couches, arrayed around small coffee tables. Anna showed Jaya to a couch, noting how she never let up her grip on the handbag. It was common for relatives to hold onto their belongings in such circumstances, seeking comfort. But the way Jaya held the handbag seemed far more defensive, almost as if her overriding concern was protecting it.
Anna settled into an adjacent chair, waiting patiently, ready to answer any questions or to offer comfort, but Jaya remained in stony silence, staring at the floor. Between that and her strange behaviour with the bag, Anna started to feel unsettled. She couldn't be totally sure, people responded to these situations in a myriad of different ways, but this... It felt wrong to Anna.
"Would you like some coffee? Or tea or water?" Anna asked, breaking the subdued quiet.
Jaya remained silent, simply shaking her head once.
"Okay. I'll go and see if there is any news." Anna said, pushing herself up from the chair and heading to the door, unable to shake her unease.
* * *
After the frantic activity of those first minutes, Resus 3 had become almost still. They'd administered the ordered drugs and gotten Zara situated in the ice bath, now there was very little for the team to do but wait, for the results to come back from the blood test, or for Zara's condition to change in some way. Which so far hadn't happened. Even with the ice bath Zara's core temperature was 41.7, beyond a normal high-grade fever. She was well into the range of irreparable organ damage if her temperature didn't fall soon. The fact that the young beauties temperature hadn't changed despite the icy water circulating around her was a bad sign.
Tilly knelt beside the ice bath, one hand reaching into the water to cradle Zara's head. An inflated pillow kept her face above the surface, but it was always sensible to be extra careful. Even with an ET tube ostensibly occluding Zara's airway, there was no benefit in risking aspiration. It was uncomfortable for Tilly, the ice cold water turned her hand numb within a minute, forcing her to change hands every couple of minutes. She did her best to recover by clamping her free hand into her armpit, not even noticing the large damp patches forming on her scrubs under her arms as the fabric wicked away the water.
Around her, other nurses kept eye's on the monitors, pumps and ventilator, while Carl stood by the computer, fingers drumming on the desk as he scrolled through a database after inputting Zara's symptoms, while he waited on the results of the quick tox screen and full blood counts. There was an alerting chime as the results arrived in the inbox. Tilly glanced over to see Carl frowning as he looked through the results.
That was the moment the door clattered, drawing Tilly's attention. She watched Anna step into the room, the senior nurse quickly taking in the readings on the monitors, before she headed over to Carl. Tilly rearranged her hands again, keeping an ear out for the conversation.
"Any results yet?" Anna asked.
"They just came through," Carl shook his head, "no signs of infection, nothing on the quick tox panel, she's clean for every party drug and common pharmaceutical." He started pulling off the PPE. Despite the decent climate control in the trauma rooms, the extra gear was still stifling. The nurses followed suit, Marie quietly helping Tilly as she kept one hand in the water.
"What could it be then?" Anna asked.
Carl turned back to the computer, refining the database search. "If we eliminate street drugs, and viral or bacterial causes it narrows it down." There was still plenty of results, more than they could possibly test for. "At this point the two most likely causes are a brain tumour affecting the hypothalamus, though I doubt we can get her through CT in her current condition to confirm." He looked over at the beauty pageant contestant in the tub and sighed. "But I'm leaning towards this." He said, pointing at the second result on the screen.
Tilly watched Anna lean close as she read the entry. "2,4-dinitrophenol poisoning?"
"It's supposed to be an industrial chemical, but," Carl grimaced, "it's also sold on black markets as a weight loss drug. Exactly what a beauty pageant entrant wants to give them the perfect figure. In simplified terms, it burns away fat, quite literally." He said, indicating the temperature readout on the monitor. It was now wavering between 41.7 and 41.8, the cooling bath having no effect.
"Is there any treatment?" Anna asked him, looking sadly over at Zara.
"There's no antidote. It's not a common occurrence and there isn't much research on it. Even mild exposure can be fatal." Carl tapped away on the keyboard, inputting orders. "There's some treatments that we can try, but they carry risks that might make things worse if we're wrong."
Anna stood there, frowning. "Her mother..."
Carl glanced at her, raising an eyebrow questioningly.
"She seemed very protective of her handbag. I'm worried you're right, but worse, I'm scared it wasn't even her idea." Anna murmured, nodding at the young woman in the tub.
Carl stood up slowly, leaning closer to Anna, speaking in a low voice that Tilly could only just make out. "I can talk to her if you want, you aren't on the clock." There was something he didn't put into words but was clear between them.
Anna touched his arm appreciatively but gave a small shake of her head. "I'll do it. I'm a mother too, maybe I can get through to her. Get the treatments ready." She said her fingers lingering on his arm as she turned away and headed for the door. Carl returned to typing away furiously, while Tilly watched Anna go.
There was a small splash, Tilly jerking in surprise, worried she'd let her mind wander off, but it wasn't her doing. The splashing grew more vigorous as Zara's body began to convulse. "She's seizing!" Tilly shouted, reaching into the water with both arms to support the trembling figure in the bath.
Lucy grabbed the foil packet from the rear pouch on the monitor, unravelling the cable before ripping the packet open to access the pads. She looked down at Zara's chest, noticing just how much sweat covered it, to the point it was forming small beads that rolled off down her side or into the valley between her breasts. Before attaching the pads, she grabbed another bag and pulled out a small towel, using to try and dry off Zara's flesh so the aed pads would get a good connection.
As she did that, Janice had rotated around to Zara's head. She did a quick visual exam to look for a head injury but found nothing noteworthy. Janice tilted the young woman’s head back and thrust her jaw forward to open her airway. Lucy saw Janice frown out the corner of her eye, then the retired medic reached for the airway bag and pulled out a manual suction device. She worked the tube on the end of it into Zara's mouth, pushing it in deep, then pulled on the handle in the centre, expanding the bellows style bulb in the centre, sucking out the foamed spittle that had collected in Zara's airway during the seizure.
Lucy peeled the plastic backing off each of the large square Quick-Combo pads, placing one just above Zara's bra, towards her right shoulder, while the other went on her left flank, between the bottom of her rib cage and her left breast. Lucy pressed them both hard, smoothing out the pads and ensuring the adhesive had a good grip. She then turned to the monitor, twisting the dial around to point at the 100J mark and pressing the button to begin the charging sequence.
Meanwhile, Janice put the suction device to the side and selected a geudel airway, inserting it backwards then rotating it into position so that the green ringed tip rested against Zara's lips. "She's barely making any respiratory effort. I'm going to start bagging her." Janice told Lucy as she ripped the sterile packaging of a purple ambu bag open and readied it, attaching the mask and plugging a line from the small oxygen canister into the back of the bulb..
Lucy watched as Janice sealed the mask over Zara's mouth and nose, squeezing the bag and pumping oxygen into Zara's lungs, inflating her sweat slick chest. Beside her the monitor let out a double beep. "Ready for synchronised shock at 100 joules, bag away." Lucy said, noticing there was still a lot of people around them. "Everyone stay clear!" She said assertively, quickly checking she had her finger on the shock button before making sure nobody was too close to the limp form on the floor. "Shocking!"
* * *
Anna stood quietly next to Tilly as Carl spoke briefly on the phone. He finished, hanging the phone back on the wall and was halfway turned when Tilly spoke up.
"What have we got?" She asked, excited and clearly jumping at the chance for something juicy.
Carl took a moment to share a knowing smirk with Anna. It was almost exactly how she used to react to the red phone when she had started here. Hell, she had felt the question bubbling up to her own lips, even though she wasn't working. Tilly looked between them for a second, slightly confused by the interplay between them, but snapped her attention back to Carl when he started to speak.
"Just an early heads up. Young woman having a seizure at the convention centre. It's only a mile down river so they'll bring her in shortly. Ambulance isn't there yet, but the centre has volunteer paramedics, so they don't expect much of a delay. ETA is anywhere from 15-20 minutes."
"Oh, cool. Is there anything I can do?" Tilly asked, practically vibrating as if ready to take off at a moment’s notice.
Carl glanced at Anna and chuckled. "I need to give Neuro a heads up, and radiology too in case an MRI is needed. Details are pretty thin though, so we'd better play it safe. Go and get Resus 3 setup and ready just in case." He looked around the nurses station, but evidently couldn't see what he was looking for. "Apparently Trish is busy, do you want to go and observe her?" He asked Anna.
Tilly turned to her expectantly, looking hopeful and somehow even more excited. "If it won't cause any problems. I'm not sure where things would stand legally."
"So long as you aren't treating patients I don't think there'll be an issue, and I'll send Trish along when I see her for the official sign off." Carl replied.
"In that case, I'd love too." Anna said with a smile towards Tilly. She reached out to give Carl's hand a quick squeeze then followed the bubbly young nurse through the black marked doors to the Resus Suite.
It was amazing to see just how much Tilly had grown in the last two years. Not physically. She was about 5 foot high, with an almost quintessential cheerleader build and such a youthful face that if you only looked at that you'd place her closer to 17 than her actual 21. It was the confidence that had been the biggest change. Back during Anna's ICU stay, Tilly had been meek, quiet and nervous to the point of being positively twitchy. As they'd talked over a couple of weeks, the younger nurse had started to open up and more importantly begun to believe in herself.
Now, like Carl had said, the young nurse gave of a sense of having been born for the role. And her personality, her energy, shone through, even in the way she moved. To boot, it was infectious. Just following Tilly, Anna felt a little more pep in her own step and every single person Tilly passed seemed to get just a little brighter simply by her very presence.
Anna had wanted to come back to work. Simply being around Tilly made her excited for it.
* * *
Zara's whole body gave a single sharp twitch as the burst of electrical charge zapped across her chest in an instant. One of her thin strapped shoes was kicked off by the motion and her head limply rolled to one side. Lucy frowned as she watched the monitor that continued its urgent alarming.
"No response. Bag her, I'll charge again at 150." She ordered, setting the defibrillator to charge up. As it did so, she returned to the drug bag, taking out an IV kit. With the practiced efficiency of years of experience she cracked it open, swabbed the back of Zara's wrist with a sterilising wipe and was lining up the needle with the vein by the time the monitor let out it's notifying bleeps. She ignored it, pushing the needle into the vein with a smooth motion, then deftly peeled off the backing of the adhesive wings. "Going with a round of adenosine." She said, hurrying to draw the drug.
Deep in focus, she didn't notice the approaching commotion until it broke through the ring of onlookers. "...tell me what is going on? Why isn't anyone on the st..." The voice cut off with a strangled shriek. Lucy glanced up to see a woman with a shocked expression on her face. Although her frame was substantially different to Zara's, squat and heavy set compared to Zara's lithe, graceful appearance, judging by the features she could see, and the reaction, it was clearly Zara's mother. She still didn't expect the next words out of the dumpy woman's mouth. "Do you have any idea how much that dress cost!" She shouted.
A wave of revulsion swept across the onlookers like a physical force as they realised what she had just said. Lucy felt it too, though she'd been in the job long enough to know that sometimes, though rare, the shock of seeing a loved one in a medical emergency can make people blurt out things without even thinking. She hoped this was one of those instances. Luckily Janice intercepted Zara's mother's attention.
"Ma'am, your daughter is very ill right now, please stay back." She said, shuffling back on her knees as Lucy finished inserting the drug and returned to the monitor.
"Adenosine in, ready to shock at 150, everyone stay back." She repeated, doing another check down the length of Zara's body. "Shocking!" She announced as her finger pushed the button. Zara gave another jerk as her heart was struck by the jolt, her arms and legs flicking out slightly before falling still. The monitor continued its alarming for a few more seconds, then settled into a rapid bleeping. "Back in sinus tach. How's her breathing?"
"Still diminished, but she's making a bit more effort." Janice reported.
"Keep bagging her for now." Lucy said, blowing out a breath and taking a moment to reset herself.
Now that the current emergency was resolved, there was still the underlying issues to take care of. Lucy pulled over a bag and took out a unit of saline, spiking it with the line that she then plugged into the IV catheter. After that she rooted through a different piece of kit for an ear thermometer, passing it to Janice as she stood up.
"Katie." Lucy said to the girl who was still hovering around. "Just hold this up about here for me ok." She told her, waiting for Katie to take the bag and nod in understanding. Now to deal with the mother. Her comment about the dress had cleared some space around the woman, which was probably for the best when discussing potential medical information. "Ma'am? What's your name?"
"Jaya." The woman said, staring down at her daughter.
"Right Jaya. Has Zara ever had a seizure before?" Lucy asked her gently.
The woman finally pulled her gaze away from the limp young woman. She shook her head slowly. "No...No never."
"Okay." Lucy nodded, making the motion big to keep Jaya's attention on her. "Has she been ill recently? Headache? Nausea? Fever?"
"She hasn't mentioned anything. She was fine when I left her in the dressing room."
"Is she on any medication at all?"
A slight hesitation then another shake of the head. "Nothing."
"Right." Lucy braced herself before the next question, knowing it could lead to some sort of explosive reaction. "Has she ever used any drugs? Cocaine? Ecstasy?"
A frown cut across Jaya's face, and she seemed to tense up, gripping her handbag tightly, but her voice at least remained at an indoor level. "No she would never even dare!"
Lucy held up a placating hand. She waited a moment until Jaya subsided. "Has she been out in the last couple days? She might not have taken anything intentionally."
"No. She doesn't go out. Not to bars and not to parties! Why are you asking all these questions?"
"I'm sorry, I'm just trying to rule things out." Lucy told her, using her best sympathetic voice, despite Jaya's increasingly combative attitude.
Janice took that moment to interject. "She's at 39.5 C."
Lucy glanced around in shock. If Zara truly hadn't shown any signs of being ill just an hour ago, then whatever caused this fever was incredibly aggressive. A temperature that high is on the cusp of being a life threatening emergency in itself.
Which is why Lucy was very relieved when she heard a booming voice commanding the ring of onlookers to move back. She didn't need to even look around to know that it was her regular partner on the ambulance, Dave. More help was here.
* * *
Anna leaned against a counter just inside the doors of Resus 3, watching Tilly as she pulled open the drawers of the crash cart, checking everything on the list fixed inside the drawer was there. As she did, her head bobbed, as if she was listening to some music. She worked up from bottom to top, and after finishing that drawer, she closed with a bump of her hip.
"Everything's there." She said to Anna with a smile.
"You're sure, you've got everything?" Anna asked her.
Tilly cocked her head, looking around the room, her gaze falling on each cupboard, cabinet and piece of equipment. She turned back to Anna. "I'm pretty sure..." She said.
Anna nodded. "You did. But it's always best to double check yourself. Mistakes in here can literally be life or death."
"I know." Tilly said, stepping over to the counter and leaning against it next to Anna, looking towards the trauma bed with a thoughtful expression.
"Carl say's you're doing well." Anna told her. "And you seem to be enjoying yourself. I mean, I've never seen anyone practically dancing as they checked supplies."
Tilly glanced at her, a slight blush warming her cheeks. "It helps me focus. Like you said, there's a lot riding on us doing things right."
"That's one way to do it. Can you still focus when things get intense?" Anna asked, curious. Dancing around the resus room would be basically the opposite of professionalism.
"I have no problem there. When things are going crazy, I'm in the zone. It's why I love working down here. When it's quiet though..." Tilly shrugged. Anna got the sense that she'd explained things this way many times, and after a moment it finally twigged.
"You have ADHD." Anna made it a statement, rather than a question. Tilly nodded, while seeming to shrink in on herself slightly. "Do your supervisors know?" Anna asked.
"It's in my file. I don't know if they read it, I don't exactly broadcast it though. People sometimes get the wrong idea and don't trust me with anything important, which just makes things worse."
"Hmm." Anna, murmured as she thought for a moment. Tilly was looking at the floor, clenching her arms tighter. Anna turned and laid a hand on her shoulder. "Well. If you come back here after you graduate, I promise to always throw you at the biggest fire."
Tilly snapped her head up. "Really?" Anna smiled and nodded, prompting Tilly to grin, that bubbling energy returning in an instant.
Carl took that moment to come into Resus 3. He looked grave. "Paramedics are on site, but they're rushing the patient in. She's got a fever of 40.2 and climbing, and has already had a run of SVT." He looked to Tilly. "We're going to need as many cold packs as you can carry. Then get into high grade PPE, we may be dealing with an aggressive infection" He told her.
Tilly glanced at Anna, the corner of her mouth curling in a quick smile before she darted around Carl, heading for the store room.
* * *
The gurney rattled gently, it's wheels squeaking on the polished floor of the central corridor of the convention centre as the paramedics rushed it towards the entrance where the ambulance was parked. Lucy pushed with her elbows, her hands occupied with holding the ambubag to Zara's face, pumping the bulb every few seconds.
As soon as Dave and Steve had arrived to find their patient no longer simply seizing, but apparently gripped by a rapidly escalating fever of unknown source, they made the call to scoop and run. She needed cooling as soon as possible, and the few cool packs the ambulance carried had been left inside it. With Zara in such a precarious state but as stable as she was likely to get without intense intervention, the decision had been simple. They'd hurried to swap monitors, then load her onto a board then the gurney, throwing a thin sheet over her bared chest to preserve some modesty, and had placed the ambulances monitor between her legs.
Lucy kept an eye of the display, watching Zara's rapid heart rate flicker across the screen. Dave and Steve drove the gurney, guiding it through the gap being formed ahead of them by the centre's security. Janice trailed behind them, shepherding Jaya while carrying a bag in her hand in addition to the one strapped to her back.
The team of paramedics finally broke out into the sunshine outside, rolling the gurney down the access ramp and up to the ambulance, spinning it around so that Zara's head would go in first. Once the doors were open Lucy dropped the ambu bag onto the bed, climbing into the ambulance and helping to get the gurney inside. She resumed bagging as the others got themselves sorted, Dave joining her in the back while Steve went up front to drive. Janice showed Jaya to the front passenger seat, then popped her head in through the side door.
"Here's your drug kit Luce, I'll take the rest of our gear back." She said to Lucy, who nodded in thanks. Janice looked at Zara, still limp and sweating on the gurney, a grim expression on her face. "Let me know how it goes." She said, before pushing the door closed.
"Get them cool packs out." Lucy told Dave. Now that the ambulance doors were closed, she cast the sheet off of Zara, baring her chest once more.
Dave quickly pulled out all three chemical cool packs, cracking them to activate the reaction. They were bigger than those you could buy at a pharmacy, large enough that they covered the span between Zara's arm pits, fully covering her breasts. The second went over the beauty queens abdomen, while Dave did his best to shape the third around Zara's head and neck. With that done, Dave looked around to the front of the ambulance. "Get us going Steve, we don't have time to waste!"
The ambulance rumbled and started to move. Even though the journey would be short, there was still plenty for the two medics in the back to do. Dave was taking a pair of shear to the rest of Zara's dress, cutting from the side of the waist down to the top of the side slit. Without that small bit of fabric he could fully spread the dress to be clear of Zara's body. He also removed the slim set of underwear, leaving Zara totally naked on the gurney. Her whole body was slick with a layer of clammy sweat.
At her head Lucy was doing her best to keep breathing for Zara, while also trying to get a temperature sensor attached. It was tough, the sweat repelling the adhesive, but with a clean and quick movements she was eventually able to get the sensor to stick. It probably wouldn't hold for long, but it wouldn't need to. Once they got Zara into the emergency department they'd probably insert a probe into a central port. As it stood, the monitor began to show a reading, the number joining that of her heart rate and flashing an angry red.
"Surface temp is already 40.7C. She's burning up." Lucy said with a shake of her head, looking down at Zara. Her eyes had cracked open slightly, but there was no alertness behind them.
"Going with another bag of saline and some antipyretics." Dave said, shuffling about and manipulating the iv line.
They were halfway to the hospital when Zara twitched slightly, her arms and legs contracting for a brief moment. Lucy looked between the monitor and the body on the gurney. The monitor was still alarming at the extremely rapid heart rate, and Zara gave another small twitch.
"Muscle tremors." Dave said in a low voice. "This isn't looking good."
Chapter 2 for everyone, later than I’d wanted, but it was just so stupid hot weatherwise, that I’ve been spending more time hugging a cold tile floor than I have writing. Anyway, hope you enjoy this next installment. There’s a bit more catching up with characters, but we get close to the real action towads the end.
* * *
Story Index
Pageant Fever: Chapter 1
* * *
Awareness came back to Zara gradually, like wading through sludge in a thick fog. She could hear sounds, but to begin with, it was little more than a muddled mixture of pitches. Gradually it started to resolve into something more. She could tell it was voices, and eventually figured out they were filled with a concerned tone, but the words were still beyond her reach. Sensation started to come back to her body too. It was not pleasant, the detached floaty feeling of her arms and legs. And the tingling that came after, pins and needles that felt like being stabbed all over. Eventually it eased and things started to come into proper focus. She let out a groan and fought to open her eyes.
"I think she's coming around." A voice said. Zara blinked a few times as she tried to look towards the speaker. It was Katie. She was kneeling over her, holding a small battery powered fan that whirred with a high-pitched whine. "Hey Zara. Can you hear me?" She asked.
Zara let out another groan as she looked around. She was still back stage, but in a slightly more open area. Most of the other contestants were lingering around, there were a few other fans pointed towards her, but they were at least keeping their distance. There was someone she couldn't see.
Despite it clearly being long enough for the others to move her a distance, and for her to regain consciousness, her mother was nowhere in view.
"It's okay Zara, you fainted, but you're okay, don't try to move just yet."
Zara merely grunted, letting herself lie still for a while. The tingling eased off, but she didn't feel fine. She felt hot, like she was still under the bright burning lights. And it wasn't just her imagination. When Katie pressed her hand to Zara's forehead she let out a gasp.
"She's still burning up." She turned to one of the other girls. "See if you can find an ice pack or something and bring those fans closer."
The girl ran off, dodging around slightly as someone else approached wearing a sparkly gold suit jacket. "Ladies, ladies, talent round is starting in 2 minutes, what's the hold up!"
Katie turned towards him, the makeup that made her smile striking turning the frown that she wore into something twice as fierce. "Are you blind?" She hissed.
"Hey. Don't get snippy with me. We're on a tight schedule here, if she's ill, she's out. And if number 1 isn't on stage in 2 minutes, so is she. That goes for all of you. No show? No shot." He snarled at the girls. One or two pulled away and headed back to their dressing cubicles, but most of them stayed put, gathered around their friend. "Looks like the judges won't have much to choose from." He said, turning on his heels. He pulled up short when he heard a freakish gasping.
Throughout the host's tirade, the pins and needles had returned to Zara's body with redoubled ferocity. They were joined by hazy swashes of colour flickering across her vision as patches seemed to vibrate and distort. She could feel her arms and legs trembling amongst the miniature stabbing sensations. Then everything exploded for an instant before replaced by black in an instant.
Katie swung her gaze around to Zara, just in time to see her eyes roll up into her head. Her friend let out another strangled gasp as her back arched, arms and legs rapidly escalating from slight tremors through to shakes, into the erratic thrashing of a full-blown seizure.
"Oh god, Zara! Some-someone call an ambulance!"
* * *
Lucy was sat in an unobtrusive first aid room just off the main hall of the convention centre. It was one of her days off from her actual paramedic job, but like most people and especially those in the emergency services, money was getting a bit tight. So, she was here, earning almost double her normal daily wage. The organisers of big events, and the locations themselves, didn't want to risk any blow back from injuries or incidents, so they would pay good money to have a couple of fully trained paramedics on hand.
The first time she had done a shift here, she had been surprised at the first aid room. Considering the unobtrusive door, she had expected something more like a closet with a basic office style first aid kit. Instead, it was large enough for three beds, and a comprehensive selection of equipment. They could easily deal with cuts, sprains, and breaks, they even had proper splints and a full back board. There was a monitor/defib just like they had in the ambulance, and a reasonable selection of BLS gear. They only thing the room really lacked compared to an ambulance, was drugs. They had some naloxone and epi-pens but beyond that everything else in the cabinet was standard over the counter grade pain relief and topical gels.
Which was why they would happily pay good money for a qualified and currently licensed paramedic. An agreement was in place with the local trust, allowing medics to sign out a drug kit for these sorts of large events. Any usage had to tightly documented, and the most controlled drugs were excluded, to prevent them being a particularly juicy target, but at least it gave a reasonable number of options to deal with most situations until a proper ambulance arrived.
It had been a quiet day so far. Someone had tripped off the end of the escalator, earning a sprained wrist and a friction burned knee, and there'd been a couple of people who had been mildly dehydrated thanks to the warm summer weather outside. Other than that, Lucy had mostly sat at the table on her phone. On older woman, Janice, sat opposite her. Although she had retired from the ambulance service almost five years ago and was approaching seventy, she had a wealth of experience and could easily keep up with Lucy. Janice had in fact been the one to get Lucy involved with these side gigs, having worked with her when the younger medic was a trainee. She still popped by the station regularly to catch up with the crews and offer advice if needed. When she overhead Lucy complaining about the cost of car repairs, she jumped in with the offer of these side jobs.
"Keep that ice pack on it until it’s all melted. If it’s still painful tomorrow go to the doctors, alright." Janice was saying to the young man with the sprained wrist as she showed him out the door. She then returned to the small table, and her cup of strong black coffee. She settled into the seat and took a long sip, grimacing slightly at the taste. Lucy had asked her about it, even tried to show her other methods of coffee that actually tasted pleasant, but Janice was set in that respect. She glanced over at Lucy, looking at her hands. "That fool boy, whatshisname still hasn’t proposed yet?"
"Matt." Lucy reminded her. "And not yet."
"It's been what? Two years?"
"Yeah. It's not that long."
"You young people." Janice said with a humorous tone as she shook her head in an exaggerated manner. "My Kenneth, god rest him, put a ring on my finger after only four months."
Lucy rolled her eyes. "And you spent 48 years happily married." She recited, having heard the tale a dozen times over the last yeah.
Janice grinned and chuckled, then turned more serious. "Have you considered dropping a hint or two?"
"I might have thought about it. I don't want to push too hard though. He's dealing with a lot at the moment, with the promotion and the tensions at the moment." Lucy replied. Even though the local police department had never been involved in any noteworthy incidents, and in fact had one of the best records in the country, events far away had still prompted greater scrutiny. The commissioner’s response, while factually correct in relation to their record, had been distinctly tactless. Now, if he wanted to keep his job, he needed to fix the damage. Which meant creating a position to improve community relations, and who better than an officer who was still held in high regard by the press and public for his heroics during the sinking of the Beetle?
The first month had been tough on Jones, who preferred to be on the street actually doing something. Being trapped in endless meetings and conferences had grated on him, especially when he had to contend with the same head of HR that had landed him on the river patrol in the first place. The suits had wanted a poster boy, someone to distract the press until it blew over. They hadn't expected Jones to have ideas, or the will to fight for them. At least now that he had managed to push his plan through the various committees, and was out there trying to implement it, he seemed to be getting back to himself.
Janice was about to respond, when the radio sat between them on the table squawked.
* * *
Anna stood outside the window to the creche, hiding slightly behind the wall. She could see Hope through the window, her daughter laid out on a plush mat, seemingly happy enough. She was, as much as a 6-month-old could be, somewhat used to being without her mother for short periods of time. Between checkups and the latter stages of recovering from her ordeal, Anna had had to leave Hope with Carl or her grandparents a few times. It was often harder on Anna, leaving that little bundle of joy. While she had every confidence in the creche's staff, they were all degree level educated in early years care and education and knew she would only be a quick call and a few minutes away, it still tugged at her.
She shook her head and blew out a breath, taking one last look at her daughter, before she turned on her heels and headed for the main elevators. She emerged back by the nurses station, which was just as bustling as ever. Trish and Tilly had disappeared, but Carl was still at the desk, his back to her as he leaned over a chart, absently tapping the pen on the desk as he scanned through it. Anna walked over to him, glancing at the chart. On the front sheet was a toxicology report. She could see a couple of the lines were highlighted. She looked at him, seeing the frown on his face.
"Something wrong?" She asked him.
He looked at her, trying to smooth the frown without much success. He sighed then shrugged. "There's been another wave of spikings." He muttered, then waved at the chart. "19-year-old girl came in early this morning after having a bad reaction. She crashed out of nowhere, and we barely got her back."
"That's good though isn't it?" Anna asked, slightly confused.
Carl gave a noncommittal jerk of his head. "This new batch that’s out there. Something in it is causing direct damage to the cardiac muscle in some patients. Cardiology are giving her the wrong side of 60/40 odds, and they're already talking about fitting an LVAD."
Anna fell silent, deep in thought. An LVAD, or left ventricular assist device, was an extreme measure. As the name suggests, it assists the left ventricle by effectively taking over its job. It requires open heart surgery and permanent power and is generally used as a stop-gap measure until a transplant is found. If cardiology was already considering it, the patient must be in serious danger. Carl was still frowning down at the chart. "I understand how bad it is for her. Why are you upset though?" Anna asked. She knew Carl would often get invested in his patients, it was part of why she loved him and why he was a great doctor, but the anger she could sense in him was something new.
He looked down and had to consciously unclench his fist, letting out a long sigh. "I know we're quite a few years from it, but I'm already imagining Hope being out there, being a victim of something similar."
"Ah." Was all Anna said, as her own mind took up the same thoughts. She reached out to take his hand and the two of them pulled close to each other, leaning on one another for a few moments.
"How was Hope?" Carl asked eventually.
"She seemed happy. I kept on eye on her for five minutes and she didn't kick off. I think it'll work out fine."
"Good. It'll be nice to have you back." Carl replied, giving her hand a squeeze.
Anna nodded, looking out over the department, finding herself excited to be coming back. She spotted Tilly on the opposite side of the station, pushing an IV pump towards one of the store rooms. "How's Tilly been doing?" She asked with a slight nod in the nurse’s direction.
"Ha. Give her another year and you'll have some serious competition." Carl replied, then seeing Anna's arched eyebrow, he held up a hand. "Not in that way." He chuckled. "She's great. Passionate and dedicated with the talent to match. Hell, she volunteered right off the bat to pinch closed an artery, on her first day. Whatever you said to her, it certainly rubbed off."
Anna couldn't help but smile. It was good to hear the student nurse was excelling. She had also seen that Anna was back, and having deposited the IV pump, was making her way over. Anna opened her mouth to congratulate her on that glowing review, when the red phone rang.
* * *
Lucy and Janice were both hurrying across the convention centre, laden with their bags. A member of the convention centre's staff had radioed them, describing a young woman in the middle of a seizure. An ambulance was also reportedly on the way but had given an ETA of fourteen minutes.
The pair entered Hall G, scanning over the stalls and crowds until they saw a member of staff running in their direction. They followed, paying no attention to the colourful displays around them. They were guided towards the stage that had been set up, then down its side and through a gap in the black curtains into the back stage area. The staff member ushered them down the narrow curtain corridor and into the dressing area. A huddle of people was a clear indicator of where their patient lay.
"Let us through please." Lucy called as they rushed up to the group. Thankfully they parted easily, backing away to give them plenty of room, and the two medics finally laid eyes on Zara.
The young woman was still deep in the grasp of the seizure, her limbs twitching in a chaotic rhythm as her brain fired off random impulses. Her chest heaved as she took gargling breaths that hissed through her teeth producing a thin foaming spittle. Luckily for her and the two medics, it was clear one of the bystanders had at least some rudimentary first aid training. Probably the girl whose hands framed Zara's head but didn't try to hold it tight, keeping it on a cushion so that Zara didn't smash her head against the floor as she thrashed.
"What's your name?" Lucy asked the girl as she shrugged the bags off her shoulders onto the floor and knelt down beside the trembling form, reaching out to grab Zara's arm, trying to find a pulse as she shook.
"K...Katie."
"Ok, Katie. Is she your friend?"
The girl nodded. "Her name's Zara."
"Right. How long has she been like this?"
"I don't know, a few minutes maybe? She... she fainted first, but she woke up again. Then...Then..."
"It's alright Katie, you're doing great." Lucy tried to encourage her, even as she turned to Janice. "She's tachy, at least 160, can you get the monitor ready?" Janice nodded and got to work, so Lucy returned her attention to Katie. "Has she ever had a seizure before?" She asked as she pulled out the drug kit and started to open it.
"I... I don't know! We only see each other every few months. Her... her mom might know."
Lucy took out a needle and syringe, tearing open the sterile packaging. "Can you give her a call?" She asked the girl.
"I don't know the number. She's meant to be somewhere here. I'm sure I saw her."
"Ok, ok, Katie, that's alright. Can somebody try and find her please." Lucy asked the wider group of people.
"I could make an announcement." A voice said. Lucy glanced over to see the announcer, looking humbled and rather sheepish in his shiny suit. She simply nodded at him and turned back to the task at hand.
She grabbed a vial and pulled a dose of lorazepam, then folded Zara's skirt along the side slit, baring her thigh, before unceremoniously jamming the needle into the muscle and pushing down on the plunger.
Meanwhile Janice had the monitor already prepared and was taking her sheers to the sari portion of Zara's dress without any consideration for its beauty or expense. As tough as the high-quality fabric was, the shears made light work of it and within a few moments Zara's chest was exposed to the crowd. She wore a small bra, with thin straps that were almost invisible, and even though her breasts would not be large by anyone’s standard, they bounced and jiggled as her body continued to shake.
Lucy watched Janice dot the electrodes around Zara's chest, noticing the sheen of sweat even as her older partner commented, "She's really warm, like she's running a fever."
Lucy nodded, turning her attention to the monitor as it began to display the activity in Zara's chest, immediately alarming as soon as it had a signal. The lorazepam finally started to have an effect, the thrashing easing into twitches, the picture on the monitor becoming clearer as the seizure induced artefacts diminished. The alarming continued though.
"Looks like SVT, we need to cardiovert her." Lucy looked back at Zara as the seizure seemed to come to an end, leaving the young woman eerily still. "Check her airway! I'll get the pads on her!"
I’m back :) First up, a quick update, my other project stated off strong then got a bit snarled and frankly I spent far too long trying to brute force through it. I have put it to one side for the moment and will be back to focussing on med stories for a while. In a similar vein I did struggle for a while on figuring out what my come back story was going to be. I toyed with some ideas such as exploring Anna’s time in the ICU and recovering afterwards, but nothing seemed to have the combination of character development and resus material that would work.
So instead, we’ve jumped forwards about a year from the epilogue of Code Red, and I’ve gone back to basics for getting myself, Anna, and all you lovely readers back into the world of Anna Swift. I don’t know how quick I’ll be with updates, I need to get back into the swing, plus summer is sort of busy for me on top of the heat always dragging me down for the first few weeks. But anyway, onto the story. As is often the case with my stories, this first chapter is mosstly setup, but I hope it gets you interested and I hope you enjoy.
* * *
Story Index
* * *
Zara was sat in the passenger seat, staring out the window as the car turned into the convention centre's expansive car park. It was only half full, but that still meant over a thousand cars arrayed out on the tarmac and concrete. Her mother guided the car down the rows towards a fenced off area close to the building. A marshal with a bright orange jacket waved them to a stop and approached the window.
"Here for the pageant?" He asked, with the flat tone of a phrase he'd uttered dozens of times in the last hour.
"Yes we are. Here's our pass." Zara's mother smiled widely as she held out a lanyard and a sheet of paper.
The marshal barely even glanced at them. "There's still some places down at the end." He stepped back and waved them through, his attention already turned to the next car that approached behind them.
They followed his directions, pulling into a space further down the car park, but didn't get out immediately. Her mother reached around and dragged her handbag out of the back seat and began to rifle around in it. It took some time. The damned thing was colossal. Zara had seen tradesmen on the city trains with smaller toolboxes.
Zara avoided rolling her eyes, opting instead to look out past the convention centre, where the docks operated on the far side of the river. Once upon a time similar activity would be taking place right here, but as industries changed this side had fallen into disuse, then disrepair, eventually leading to the redevelopment that had built the convention centre, hotels, and a supposedly thriving nightlife. Not that Zara had seen any of that. Not with her mother practically barring her into the room last night.
"Here." Her mother got her attention. She was holding out a pill and a bottle of water.
"Do I have to?" Zara asked.
"You want to win the national competition don't you? You're 21, it's your last real chance."
"I haven't won the county yet!" Zara motioned to the imposing convention centre.
"You will." Her mother said, with an expression that was beyond certainty.
"Mum, tell me you didn't..."
"Consider it an investment in your future. Now go on take it, you need to be perfect for the final."
Zara eyed the pill with trepidation, but seeing the frown beginning on her mother’s face she finally relented and took the pill, taking a sip of water to wash it down.
Her mother was back to smiling widely. "Good girl. Now let’s go."
* * *
Anna sat on the sofa in their apartment. She was starting to feel almost fully back to herself. Recovering from her injuries had taken a considerable amount of time, especially the neurological damage. But with intensive physiotherapy and close guidance, she had ended up with little in the way of permanent damage. A few tingles in her left side, and a very marginal clumsiness, were all that was left. In fact, she'd been cleared to go back to work months ago. There was only one reason why she hadn't.
A blabbering gurgle dragged her gaze downwards to look into a set of eyes that matched her own. Hope Fiona Diane Teague. Her daughter. The 6-month-old baby cracked a smile as she let out some more incoherent, but clearly happy, noises. Anna smiled at the child in her arms. "Was that good?" She asked, prompting another babble. "Yeah." She rearranged her clothing, glad for the larger buttons as she manipulated them with one hand, then lifted Hope to her shoulder as she stood up. Gently bouncing her daughter to burp her, Anna began to gather various bits and pieces into a bag.
"We're going to go and see daddy, aren't we. And then we'll check out the creche, where there’s lots of really nice people, and new friends. Ooooh, and toys. Yeah, won't that be nice."
Hope responded with another noise, and then a soft blegh. Anna held Hope slightly out from her and glanced at the little bit of spit up on the towel she'd strategically placed over her shoulder. "It's your own fault for being so greedy." She said jokingly as the baby wiggled her limbs in excitement, smiling despite the trickle on her chin. Anna grinned as she wiped it away with the corner of the towel. "All better. Now let’s get you in here."
She gently placed Hope into the pram, buckling her in then tilting the basket up to give her a bit of a view. Anna quickly double checked the bag for various supplies, adding some milk, then placed it into the tray underneath the basket. She pushed the whole lot to the door, pausing to check herself in the mirror. She didn't want a repeat of the time she had gone out to the shops with category 5 bed hair.
"Right then little one, let's go."
* * *
Zara trailed her mother through the backstage area of the convention centre. The concept of privacy was clearly little more than a passing thought. Each 'cubicle' was basically three panels, a mirror and two sides that stuck out just far enough for a simple stool.
"26, 27, here we are, 28." Her mother announced as she hung the garment bag on a hook, then grabbed the large case from Zara's hand and placed it on the shelf in front of the mirror with a thump. "Get changed into the dress. I'm just going to... double check the arrangements." She left without even looking at Zara.
The young woman sat on the stool with a sigh, spinning idly for a couple of seconds as she tried to get in the mindset. Big smiles, graceful movement. It all felt like such a chore. For a brief moment she considered just running away. Or sabotage. But ultimately it would just lead to her mother’s anger.
She shrugged out of the hoody and kicked off her shoes, glancing around to make sure nobody was staring at her. She slipped off her t shirt and jeans and looked at herself in the mirror in just her underwear. She was slim and toned. Not rib-showing-ly skinny, simply fit and healthy. Apparently that wasn't good enough for her mother.
Just a few more months. She thought to herself. Get this and the national competition out of the way, then maybe I can finally live my own life.
She turned from the mirror and unzipped the long bag. Despite her frustrations with her mother, she had to admit that there were some things about this whole thing that she did enjoy. The dresses were one of them and this particular one was simply stunning. Much like herself, it was a blend of two cultures. Below the waist the long straight western skirt would hang down to her ankles, with a split down the side to allow for some 'leg action' and easy movement. Above the waist it was effectively a single long rectangle of fabric, a sari style that would wrap around her body and bust and up over and round her shoulders, while still providing glimpses of her midriff and cleavage, leaving her arms free. It was a soft gold colour that complemented her dark olive skin tone, accented with deep vibrant colours that created a pattern around the trim.
It was simple enough to put on, once you had the technique, and in under a minute she was checking it in the mirror, twirling this way and that, making slight adjustments to get the effect just right. She perched back on the stool and opened the case. It was split into three sections. Hair products, make up and jewellery. She left the first two, those were claimed by her mother. Instead, she took out the jewellery. She slid a pair of thick bangles onto her forearms, and then picked up the necklace. Though necklace was something of an understatement. A gold chain went around the back of her neck, while the front was a triangular expanse of links and stone settings surrounding a sizeable ruby. A family heirloom that had seen centuries turn, her mother had claimed it was fate that it fit her so perfectly. Zara was rather more confident that it was genetics, especially with it having been resized for her paternal grandmother.
Adorned with the jewellery, she had little other option to wait for her mother to return. So, she reached for her own bag and took out a chemistry textbook to study for her upcoming tests.
* * *
It was a bright and warm day, with just the slight hint of a breeze to keep things comfortable. Hope was blabbering to herself and reaching up to play with the colourful trinkets dangling from the handle of the detachable basket. As she stopped at a crossing, she found herself in the cliche situation of an older woman cooing over a baby. She didn't mind though, making polite conversation as they waited for the traffic lights.
A few minutes later she reached the hospital. As she pushed the pram towards the doors she saw Hope grimace and let out a little grunt. "Now that’s just rude. Dropping a stinker right before we see everyone?" Hope relaxed and grinned up at her letting out a squeaking giggle. Anna rolled her eyes and chuckled as they entered the doors to the emergency department.
It was still much the same as it had been, laid out with the hub in the middle and various areas spreading out behind coloured doors. Anna skirted around the edge of the spacious waiting area and past the main reception desk. One the receptionists must have seen her out of the corner of her eye, and had started turning towards her, presumably to direct her to the desk first, but then she recognised Anna and smoothly turned it into a smiling wave. Anna waved back, then reached into her purse for her badge and looped it over her head with one hand.
Through the doors beyond the reception desks was the main nurse’s station. It was a bustling hive of activity as charts were compiled and exchanged, discussions were held, and the near endless amount of paperwork was worked on. Despite the number of people, she saw Carl immediately. He was next to Trish, at one of the computers, double checking something. Anna rolled the pram over towards them, Hope's happy gurgling alerting them both. With full smiles the pair skirted out through a gap in the circular desks. Trish gave her a quick friendly embrace, stepping out of the way to let Carl grab her tighter and give her a peck on the cheek. He then turned to their daughter, leaning down almost into the basket.
"You might not want..." Anna started, before snorting in laughter as Carl recoiled slightly.
"How can something so beautiful and cute, create something so foul?" He said, keeping his eyes on the small child as he reached in and let her play with his hand. He glanced up at Anna. "How's she been this morning?"
"Good as gold. Even her tooth hasn't been a bother today."
"Good. We'd better get you changed while you’re still in a good mood then." He said to Hope, who replied with a squeak and a kick of her legs.
"I can take her if you want." Trish inserted, smiling down into the basket.
"If you're sure." Anna agreed readily enough.
"Of course." Trish said as Carl eased out of the way, letting the nurse take the handles of the pram. "Come with auntie Trish and we'll get you cleaned up in a jiffy." She said as he wandered away towards the bathrooms.
Carl settled in next to Anna leaning against the desk, their hands finding each other’s and linking almost unconsciously. "You haven't just handed over a poo-splosion have you?"
"God no. I couldn't do that to even my worst enemy." They both stood there, staring into the middle distance for a moment, having a joint flashback to the level 1 biohazard that had led to the sacrifice of a onesie and a couple of towels.
"Are you still feeling good about coming back?" He asked her for the dozenth time.
Anna looked around the department, feeling the smile on her face. "Yeah. Now that I'm here, yeah, I think it's the right decision."
Carl looked at her and nodded. "Good. The creche should be ready for her whenever."
"I'll take her up once Trish is back."
The stood in companionable silence for a few moments, until a nurse in the white uniform of a student nurse hurried over with a chart in her hand. "Dr Teague, I've finished the discharge form for Mr Daniels, if you could just sign off on it for me, sir." That last word was spoken not with a tone of outright deference and respect, much closer to something of a joke.
Anna looked at her for a second, then her name clicked. "Tilly?" It was one of the student nurses who had cared for her when she was still in the ICU.
"Oh, Anna! It's so good to see you! You look amazing!" The young nurse practically bubbled with excitement.
"It's good to see you too. What are you doing here though? I thought you would have graduated by now?" Anna replied.
"Nearly, just a few more weeks. This is my final placement. I opted to go for the more advanced trauma nursing course, like you said."
Anna remembered their conversations, when she was still in the ICU but off the ventilator. The student nurse had been filled with questions and the more they talked, the more excited, more inspired, Tilly had become. It had also been a great help to Anna, reconnecting some of those scattered memories, and distracting her from the lingering trauma of her early recovery.
"That's great news. We might even get to work together." As if on cue Trish returned from the bathroom, pushing the pram with one hand, holding Hope to her shoulder in the other. Anna reached out to take her daughter. "If this one settles in at the creche I might even be back next week. On which note, I'd better take her up, but I'll have an hour to burn, maybe we can catch up if you aren't busy."
"I'd like that." The student nurse said, stepping back enough to let Anna manoeuvre Hope into the pram and wheel it towards the elevators, with a parting wave at the three of them.
* * *
Zara stood on the second rank of the large well-lit stage, along with other 29 young women vying for the county title. The staging struck her as a little absurd. The front 15 stood in a wide arc, the rest of them perched on individual boxes spaced in the gaps between the front rank, each about 3 feet high, with a set of steps running down the back. She looked out at the cavernous room. There was a moderately large crowd assembled in front of the stage, just behind a long table where the judges sat. Beyond the crowd close to a hundred stands and booths were set out in long rows. Makeup brands with product samples, local and national shops hawking their wares at inflated prices, the rampant commercialisation of beauty.
It all made her a bit uneasy. Especially when half the contestants assembled around her looked practically identical to one another. That wasn't to say she hated them. There were a couple that played into the Mean Girls stereotype, but the vast majority were as lovely in personality as they were in visage. An array of spotlights was highlighting each contestant as their names were read out, giving them a moment to wave and make an impression.
Zara tried not to adjust her sari. She felt absurdly warm under the bright lights and was glad that the makeup her mother had smothered on her had antiperspirant qualities. She could feel the sweat running down her back and legs and didn't even want to imagine what such a quantity of sweat would have done to her face, especially in harsh lighting.
Suddenly it was her turn, the even brighter spotlight bathing her in a glow that almost burned. She didn't let the feeling show. Raising her arm and waving as the announcer spoke into a microphone. "Contest 29, Zara Chamarthi." The crowd gave a ripple of applause just like they had for each of the other contestants, which increased a little as she gave a quick twirl, the skirt portion of her dress swishing gracefully.
Thankfully, the spotlight cut off after a few more seconds. Not just because it reduced the heat afflicting her. That brief twirl had left her slightly dizzy, and she had to take small shuffling steps to even out her balance. That isn't normal. She thought, blinking her eyes hard for a moment. Her breathing felt quicker as well. Maybe I’m just thirsty.
The announcer introduced the last contestant, then walked out into the centre of the stage. "And those are our contestants for today. Shortly we'll bring them out individually to display their chosen talent and to tell us about themselves, but for now, let's give them all a big round of applause as they leave the stage!"
The crowd launched into a slightly more spirited ovation as the contestants all gave another wave and moved according to the choreography, the back rank stepping off their boxes and filing into the gaps of the front rank before the long line filtered off the stage behind the curtains.
Without the burning of the lights, Zara should have felt more comfortable, but even backstage was stifling, especially with all thirty of them crammed into a tight corridor before they could get to the more spacious dressing area. The others were all engaging in conversation. It was something of a niche circuit, and many of them had attended similar events in the area for years, to the point that each became a chance to catch up with each other.
Zara didn't feel much like chatting, she could feel herself getting hazier, wishing the rest of them would hurry up. She felt someone touch her arm and turned her head towards them. It felt like such a sluggish movement. It was one of the other girls, Katie, who she'd known for almost 6 years now. She was saying something, a concerned look on her face, but the words sounded vague and muffled. Zara tried to open her own mouth but was hit by a sudden wave of tingling all throughout her body and mind. Katie seemed to slide sideways.
Zara realised that it was actually herself, falling, a moment before she impacted the floor, and everything went black.
Short Story Summary and Content: 4,518 words, female victim, on-site drowning and resuscitation.
--
“I’m not sure I can jump that.” Ellie peered across the water, trying to judge the distance between boulders.
Mateo stepped up next to her, waving to his sister and brother-in-law on the opposite bank. “Paloma made it, and she’s a little shorter than you. Why don’t I go first, and then I’ll make sure you don’t slip off when you land?”
Ellie was quiet for a few seconds, so he turned to look at her. Her eyes were unfocused as they looked down at the water. She wasn’t an athlete, he’d grant her that, but she was able-bodied and slim, and he didn’t see any reason why she couldn’t make it. He did feel bad that it was making her anxious, however; he wanted her to have a good time, and she had been up until that point.
He definitely didn’t blame her for being anxious; there’d been a lot of rain recently, and the body of water was swollen and rapid.
He reached out and gripped her shoulder, rubbing his thumb across her collar bone. “It’s okay,” he said. “We can hike back to the parking lot and take that other trail. We’ve hardly started this leg. Paloma and Josh won’t mind.”
Ellie blinked and shook her head, a strand of hair slipping free from her pony tail. “No, I can do it. I’m just being silly.”
He stepped closer and kissed her temple, then reached up to smooth the curl behind her ear. At this distance he could make out the constellation of faint freckles scattered across her cheeks and the bridge of her nose. “You’re sure?”
She nodded and offered him a brave smile. “I’m sure. I’m going to back up some so I can run, though. And yeah, please go first. In case I trip or something. Or overshoot.” That last bit was said with a wink.
She’s so beautiful, he thought. And a very good sport.
“Want me to take your pack?” he asked, reaching for the small, golden yellow day pack she was carrying. She nodded, smiled, and rewarded him with a quick kiss.
“Alright,” he said, turning back to grin at her from her position on the riverbank. “Here I go!”
He jogged a few steps forward and then jumped across, making sure to land toward the middle of the boulder. The landing jarred his bones, and he turned, trying to keep the ruefulness out of his smile as he waved at Ellie. She didn’t need to know the landing made him feel closer to fifty-seven than thirty-seven. He took a step toward the edge of the rock and held out his hands.
Ellie nodded, tugged at the hem of her terra cotta-colored puffer vest, and then took off. She’d probably backed up farther than she needed; her boots splashed in the mud before she hit the rock. She ran across the top, moved to leap from one boulder to the next. Instead, her foot slipped off the edge, dumping her backward onto the rock, arms flying up. She landed hard, legs dangling off the edge, and he heard a sickening crack and a wheeze as the wind was driven out of her. Then she went limp and slid off the rock and into the water.
“ELLIE!” he shouted, shocked at how quickly this was happening. The current carried her unconscious body downstream before he could move. He finally reacted, dropping both packs onto the rock before throwing himself in after her, hands outstretched, trying to grasp her before she was carried too far.
He belly-flopped, graceless, splashing in nowhere near close enough to grab her. He thought he heard shouting, but he couldn’t spare anyone else a glance as they were both carried downstream. He tried to swim faster than the current was carrying them, his eyes never losing sight of that orange vest.
Ellie’s downstream progress was halted by the branches of a low-hanging tree. She got caught up in it, and he was able to reach her, one hand grabbing the biggest branch above his head to anchor himself, the other darting out to snag the back of her vest. He yanked her backward toward his chest, trying to pull her face out of the water with the same gesture. The smaller branches poked him in the face, scratching across his cheek. He ignored them, quickly releasing his grip on her vest so he could snake his arm around her chest, tipping her head back against his shoulder.
“Ellie!” he shouted, trying to get a look at her face. Her skin was already pale, her features slack. Her eyes were cracked open just a hair, but he didn’t think she was conscious. He shook her, but she didn’t respond. “ELLIE!”
He gripped the branch hard, using his strength to pull them both toward it, then released the branch, quickly lunging for a point closer to the shore. He caught it, barely. He took a deep breath and did it again. He was about to go for a third lunge when he heard Josh shouting from above him. His brother-in-law was laying on a nearby rock, hand outstretched. Then he spotted Paloma on her knees next to him, ready to help.
Mateo lunged once more, caught himself, and felt his feet brush the rocks and sand on the bottom. “I’m going to shove her toward you!” he shouted, and he saw Josh nod and stretch out both hands. He released the branch, planted his feet, and then grasped Ellie under the arms. He heaved her out of the water and toward the other man, thrashing as he staggered forward. Her head sagged backward and her wet, stretched out curls hit him in the face.
Josh and Paloma dragged her out of his hands and up the side of the rock.
In the minute or so it took Mateo to climb out, Josh had her flat on her back and was kneeling at her head, carefully thrusting her jaw up. He scooted around and leaned his ear close to her mouth, his fingers pressing into the pulse point in her neck. Mateo crawled over to them, just in time to see Josh lean down, pinch her nose closed, and breathe into her.
“I don’t have a signal!” he heard Paloma shout. She was standing back, cell phone in hand.
“Paloma!” Josh barked, his commanding tone nothing like his usual speaking voice. Mateo wondered if that was how he spoke when things went sideways during his work as a firefighter. Josh gave Ellie another breath and said: “Run back to the trailhead. Drive until you get a signal or get to the ranger’s station. Tell them one victim, drowned, with a head injury, in respiratory arrest. GO!”
Paloma blanched, staring down at Ellie, but she only hesitated for a few seconds before she turned, thrashing through the scrub toward the trail.
Meanwhile, Josh was breathing for Ellie. Her eyes were still cracked open, glinting through her eyelashes. But she was motionless aside from her chest rising and falling with each forced breath.
“What c-can I do?” Mateo asked, his heart pounding and an icy feeling settling in his stomach.
“Grab my pack,” Josh said between breaths. “Just behind you.”
Mateo complied, dragging it close.
“Small compartment. Plastic case.”
Mateo handed him the small plastic case and Josh popped it open, revealing a CPR pocket mask. He slipped the elastic over Ellie’s head and pressed the mask over her nose and mouth before leaning over and giving her a breath through the valve. He gave her several more breaths before he pulled the mask to the side and leaned close to her mouth again, his fingers pressed to her neck.
Several seconds passed, and he pressed the mask to her face and gave her another breath. Mateo watched Josh unzip her vest and lean close to her ear.
“Ellie! Take a breath!” He called, his voice loud. Then he pressed the knuckles of his fist between her breasts and dragged them up and down for what seemed like a long time before shaking his head and giving her another breath. With her vest open, Mateo could see her stomach was bloated.
Mateo reached out and picked her limp, cold hand off the rock and clasped it hard in his. “Ellie! Please, just breathe!”
She didn’t respond, accepting Josh’s regular breaths without resistance.
“There’s a shirt in my bag,” Josh said, before giving Ellie another breath. “She’s bleeding.”
Mateo put her hand down gently and found the shirt. He scrambled around to the top of her head, looking for blood. Sure enough, there was a bloodied section of wet hair just to the right of her pony tail. He didn’t wait for Josh to give him instructions; he carefully pressed the shirt against the blood, using his other hand to keep her head steady.
“Breathe, cariña,” he said, and heard the beg in his voice.
This went on for another minute before Josh pressed two fingers into her neck. Then he reached down and pressed two fingers to her wrist.
“What?” Mateo asked, seeing Josh shake his head.
Josh adjusted the tilt of her head before giving her another breath.
He didn’t respond to Mateo; instead, his brother-in-law let out a rush of air, shook his head again, and then took a deep breath so he could give it to Ellie. He was holding her jaw carefully, making sure he maintained the seal on the mask. Every so often, he checked her pulse.
Josh was in the middle of one of his cycles of breaths when Mateo realized Ellie’s skin was turning gray.
“Josh!” Mateo exclaimed. “Is she turning blue?”
Josh immediately pressed fingers to her neck and her wrist. He held them there for ten seconds before cursing.
“Dammit, Ellie!” Josh straightened up and clasped his hands together, pressing the heel of his hand down between her breasts. Then he started compressions, deep and fast. Despair sank down onto Mateo’s shoulders as he realized this meant her heart wasn’t beating.
Mateo had never seen CPR performed in real life. The procedure wasn’t anything like movies or even CPR classes led him to expect. Josh was caving in her chest, only for her ribs to spring back up each time he rose off her.
No, no, no, Mateo thought, staring down at his girlfriend as her shoulders shook and her feet rocked. She didn’t want to jump, and I talked her into—
“MATEO!” Josh was shouting at him, and he got the impression he’d been trying to get his attention. “Twenty-nine, thirty!”
Josh leaned over and gave her two breaths before starting again with compressions. He made it to the tenth before Mateo heard a crunch. He flinched, and when he looked up at Josh, his brother-in-law was grimacing. Despite this, he continued exactly as he’d been going, forcing her chest down and releasing it over and over again.
“Next time I hit thirty, I need you to take over breaths,” he said. Sweat had sprung out along his hairline. “Can you do that?”
“Y-yes!” Mateo removed his hand from the t-shirt and moved around to her other side. Her head and shoulders were rocking in time with Josh’s compressions, and he realized there was foam coming out of her nose and mouth underneath the mask. He looked up at Josh. “Is that normal? The foam?”
“Yes, it’s okay. Breathe!”
Mateo grasped her face, trying to make sure he kept her head tilted back, and wrapped his lips around the valve. When he breathed into the mask, there was a slight delay and then her chest rose. It fell when he broke the seal to inhale. He gave her another breath.
He looked down at her, listening to Josh count as he thrust his hands into Ellie’s sternum. Mateo ran his thumb across her cheek, sweeping away droplets of water that had run out from underneath the mask.
“-twenty-eight, twenty-nine-thirty! Breathe!”
As Mateo gave her breaths, Josh was pressing his fingers against her carotid. “After this cycle, we switch,” he said, moving his hands back to her sternum.
Mateo gave him a panicked look.
“—ten, eleven, twelve—I will make sure you do it correctly—sixteen, seventeen, eighteen—”
Sure enough, when Josh hit thirty, he shifted over and gave her two breaths. Mateo jerked himself forward and over her, clasping his hands together and settling the heel of his hand between the hardened dots of her nipples, visible through her shirt. Josh pushed Mateo’s shoulders over his hands and said: “Two inches!”
“One, two, three…” Mateo counted as he forced his girlfriend’s chest down over and over again. The movement felt horrible and violent, but he reminded himself that it had to be, if she had any chance at all. He heard his voice crack and told himself to stop thinking. “—twenty-nine, thirty!”
Josh’s breaths were over quickly, and Mateo was back to compressing Ellie’s chest.
By the time they reached the end of five cycles, Josh told him to switch off again. His arms burning, Mateo leaned over and gave her two breaths, watching her chest rise and fall. Josh continued the merciless assault on her sternum.
“One, two, three…”
Abruptly, Ellie made a gurgling sound and water surged up into the mask, carrying with it bits of trail mix and breakfast. He jerked the mask off her face, the elastic tangling in her hair, and Josh reached over and directed her face to the side. Mateo watched him sweep vomit from her mouth with his finger before he returned to chest compressions.
“What—”
“She’s not back,” Josh said, his voice gruff. “People can vomit when you’re resuscitating them. You have to keep giving her breaths.”
His hands shaking, Mateo pulled the mask free from her hair and pressed it back to her face, breathing into her when Josh said: “Thirty!”
“There’s more… resistance,” Mateo said, giving her another breath and finding it difficult.
Behind them, Mateo heard something large crashing through the scrub, accompanying by hard breathing. Paloma suddenly dropped down beside him, swinging a black duffel over Ellie and dropping it next to Josh.
Mateo couldn’t spare much attention for her, though he could hear her breathing hard and spitting.
“Switch with me,” Josh said. He glanced off to the side. “No, Paloma, I meant Mateo. You need a minute before you can help. Just sit and have some water.”
They switched, and Mateo was back to crushing Ellie’s chest. “One, two, three, four—”
“Not quite so fast,” Josh said, unzipping the duffel. “And come all the way up each time so her heart can refill with blood.”
Mateo adjusted his technique. She was so petite; he worried he was doing her permanent damage, assuming she survived. “Six, seven, eight, nine, ten…”
Josh had set the mask aside and come out with a case of a plastic pieces with flared ends. “This will help with her airway until the ambulance gets here,” he said, measuring one of the pieces against the side of her face. “Don’t stop compressions.”
“…eighteen, nineteen, twenty…”
Josh opened Ellie’s mouth, slid the plastic piece between her teeth and then twisted it. The flanged end rested against her teeth.
“…twenty-eight, twenty-nine, thirty…”
Josh grabbed something else out of the duffel and Mateo heard the rustling of plastic as he continued pressing her chest well past thirty. Then Josh had a bag-valve mask in his hands, which Mateo had seen on television. He pressed the mask to her face and Mateo stopped his desperate assault, watching as Josh squeezed the bag twice.
Then Mateo was back to performing chest compressions. “One, two, three, four, five, six…”
There was the unmistakable sound of a vehicle driving up the trail. This portion, up until the river, was wide enough for a vehicle, though the trailhead was blocked by bollards and a fence.
“Has to be the ranger,” Paloma gasped. “They would have the key for the post at the trailhead!”
“…nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty-four…” Mateo heard a car door slam. “…twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty!”
As Josh squeezed the bag, Mateo heard footsteps in the scrub. Then it was time for him to do chest compressions again. He glanced up briefly when a female ranger dropped to her knees across from him.
“…five, six, seven…”
“I brought an AED, EMS should be here in five minutes, give or take, they’re just up the road. What happened?” She unzipped the AED case and started setting up the device.
“…sixteen, seventeen, eighteen…”
“She slipped, hit her head and fell in. We pulled her out but she was already in respiratory arrest. Lost her pulse about seven minutes ago.” Josh responded.
“…twenty-seven, twenty-eight…”
“You an EMT?” The ranger asked, pulling out a pair of medical shears.
“Connect pads!” The AED commanded.
“Firefighter,” Josh said, squeezing the bag. “She’s my future sister-in-law. Ellie.”
The ranger nodded and leaned over Ellie, making short work of her wet shirt and bra. When she peeled back the layers, Mateo saw an angry red bruise over Ellie’s sternum. The ranger dried off Ellie’s chest with the dry side of Josh’s bloody t-shirt.
Then it was time for him to press his hands to that bruise and make it worse.
“One, two, three…”
“Connect pads, plug in the connector!” Chimed in the AED. The ranger worked around Mateo’s hands, applying one pad to Ellie’s upper right chest and another just below her left breast.
“…fifteen, sixteen, seventeen…”
“Analyzing rhythm. Do not touch patient.”
“Hold compressions,” Josh said, squeezing the bag. Mateo lifted his hands.
“Analyzing rhythm, do not touch patient.”
“Paloma, do you remember how to use this mask?” Josh asked, squeezing the bag again.
“Shock not advised. Resume CPR for one minute.”
Mateo followed directions. “One, two, three...”
To his left, Paloma and Josh switched places, Josh adjusting her grip on the mask and talking her through its use.
Paloma dutifully squeezed the bag. She’d been crying, but now her eyes were dry and focused.
“One, two, three…”
Ellie’s abdomen bulged grotesquely with each compression, and her ribcage and cartilage still occasionally popped and cracked. He’d noticed the compressions got easier as time passed, even though his arms ached.
“Analyzing rhythm, do not touch patient.”
Josh lifted his hands and looked at Paloma. “You can give her breaths while it’s analyzing.”
Paloma squeezed the bag.
“Analyzing rhythm. Do not touch patient.”
Another breath. Mateo realized Ellie’s nipples had gone purplish and stiff.
“No shock advised, resume CPR for one minute.”
“God DAMMIT, Ellie!” Josh’s outburst, accompanied by the resumption of his chest compressions, made Mateo flinch. “Where is that ambulance? She needs meds! Fuck!”
“Are you okay to continue?” The ranger asked. Her eyes were kind, belying the sternness of her tone.
“Yes.” Josh was still directly comparing Ellie’s chest. “Yes. Sorry. You and I will switch after the AED kicks in again. Fifteen, sixteen, seventeen, eighteen, nineteen, twenty…”
Mateo didn’t know when his tears had started, but they were running down his cheeks now. He reached out and squeezed Ellie’s hand hard before releasing it.
She isn’t going to make it, he realized. We weren’t close enough to the help she needed.
I shouldn’t have convinced her to jump.
He’d planned to propose that summer, had a ring he was paying off at a local jeweler. Ellie had previously told him she didn’t need a ring, but that if it was important to him, she did have some preferences. The ring actually was important to him, even if it was the last vestige of old traditions that he mostly didn’t adhere to.
She’d never even see it, and for what reason?
He covered his face in his hands and let out a sob.
When the AED next chimed in, he made himself pull his hands down far enough to look at her. He did feel a duty to remain present, to not check out. To stick with her to the bitter end.
“Shock not advised. Resume CPR for one minute.”
She still looked like herself, despite her gray skin and the bruises. Her hair was starting to dry and curl up around her face. He could see her chipped nail polish, and her purple boot laces.
“…ten, eleven, twelve…” Counted the ranger, her fresh arms producing effective, hard compressions.
Josh reached over and grabbed Mateo’s arm. “There’s still a chance, Mat. The paramedics can do things for her that we can’t.”
Mateo wasn’t sure if he meant it, and when he looked up, he saw Paloma staring hard at her husband, as though she was trying to decide the same. Then she nodded, noticed Mateo watching her, and nodded again.
A few seconds later, two paramedics rushed out of the scrub and to Ellie’s side. One of them immediately identified Mateo as the loved one and ushered him a few more feet away, as much space as the brush would allow.
“This is Ellie. Thirty-four, hit her head and drowned,” he heard Josh say. “Respiratory arrest followed by cardiac arrest approximately fourteen minutes ago. AED has not advised any shocks.”
Everything became a blur. He heard words like “monitor, intubate, and epi.” Paloma was relieved by Josh, and she hurried to Mateo’s side, grabbing his hands and murmuring a prayer under her breath. A high-pitched whine rose over everything.
Soon, Josh was sidelined while the medics removed the plastic airway and used some kind of metal device with a light in it to help them guide in a tube. Mateo didn’t know what any of it was called, but he recognized that they were intubating her. They inserted an IV and pushed medication. He heard the Velcro of a blood pressure cuff. The ranger was squeezing the bag now while one of the medics performed chest compressions.
Josh was suddenly beside him, speaking quietly. “They do chest compressions after injecting the medication because that will circulate it. The epinephrine will help her heart get to a rhythm that they can shock. They might give her other drugs.”
More time passed. One of the medics was cutting off the rest of Ellie’s clothing. He covered her lower half with a blanket, though Mateo had no idea where the blanket had come from.
A couple of minutes later, and they injected more medication into Ellie’s IV. Mateo watched as the medics switched off just like he and Josh had. One of them used a device with a canister and a tube to suction her lungs. They pushed more drugs and switched off again. This time, he noticed one of the medics pried open Ellie’s eyes and flashed a penlight across them.
“Sluggish,” the medic said.
Another round of drugs and they switched places. Mateo wondered how much her body could take. Or her brain.
One of the medics suddenly reached over and pointed at the monitor. “V-fib!” The medic exclaimed, sounding surprised.
Mateo watched as they placed two floppy, bright orange squares on Ellie’s chest.
“They’re going to use the defibrillator now,” Josh said.
Mateo’s ears were ringing and everyone sounded like they were speaking underwater. He watched as one medic performed furious chest compressions until the other approached with the paddles, and then both the first medic and the ranger raised their hands. The medic with the paddles pressed them to the orange squares. Ellie jerked, and then one medic pressed his fingers into her neck and the other pressed two fingers into her inner thigh.
The medic with the paddles shook his head, and the female medic leaned in, pressing down on Ellie’s chest for ten seconds until she leaned back again and the cycle was repeated.
This time, after the shock jerked Ellie’s chest and flicked her limbs, they administered more medication and returned to cycles of chest compressions and breaths.
“They’ll shock her again,” Josh said, sounding far away.
He was right. The medic performing chest compressions leaned back, the ranger disconnected the bag, and the medic with the paddles delivered a third shock. The medic’s defibrillator must be stronger than the bystander AED, he thought, watching her body jerk.
The medics pressed their fingers into her pulse points and stared at the monitor.
This time, they seemed excited by what they felt. Mateo blinked at the monitor, which was no longer screaming, and looked over at Josh.
Josh turned to him, grabbed him by the upper arms, and shook him.
His hearing roared back as Josh was saying: “They got a pulse, Mat! Mat, she has a pulse!”
The ranger was still squeezing the bag, but the medics had stopped compressions. He felt lightheaded. Mateo could see the purple marks between her breasts every time her chest rose. One of the medics took the place of the ranger, pausing his squeezing of the bag and looking down at Ellie’s chest for several long seconds before nodding and squeezing the bag again, this time seeming to take cues from whatever he saw when he looked down.
“She’s making some respiratory effort,” the medic said. “Ellie? If you can hear me, the tube down your throat is helping you breathe. You had an accident. We’re taking care of you and we’ll take you to the hospital soon. Your friends are here with you.”
The other medic looked up, stethoscope pressed to Ellie’s chest, and made eye contact with Mateo. “Boyfriend… you can come hold her hand for a few minutes until we are ready to move her.”
“We can take the back seat out of my SUV,” the ranger was saying.
Josh had to help Mateo crawl over to Ellie.
Ellie’s hand was still very cold when he took it between his hands. “Can she hear me?” He asked, his voice hoarse.
“She may hear you, but she won’t react much.” The medic squeezing the bag said. “You should say whatever you need to say. Do you understand?”
Mateo nodded.
Josh and the female medic were talking quietly, and he heard “fragile” and “could crash again.”
Mateo took a deep breath and squeezed Ellie’s hand.
“I love you.” His throat immediately spasmed, and he cleared it hard before he could speak again. “I love you. I want you to stay. I want to marry you. And… and, Ellie, I’m so sorry.”
Tears ran hot down his cheeks.
“I love you,” he choked out. “Forgive me.”
And then, in his hand, he felt the tiniest twitch of her fingers.
Always great to see new writers in the space and this is a great first story, I hope we get plenty more. Anyone waiting on my own next entry will have to wait a little longer. I've made good progress on my other project, but have been doing little bits here and there on Anna's story, that I'll try and bring together into something soon. In the meantime, check out the above.
Only a week late for Valentines, but here it is. I will actually be taking a break this time to work on other projects. My current plan is to get a good 20k-30k words written before I return to the Anna Swift universe. Hopefully won’t be too long if I get on a roll.
Anyway, I hope you enjoy this ‘little’ nugget, (3.8k words, I got carried away again), and that it will tide you over until I return.
It was early in the afternoon when a nurse opened the door tentatively. Carl immediately looked around. He'd spent the intervening time sat there, statuesque in his vigil, in a trance like state. He barely moved, but part of him was constantly alert for any alarm or change. Nurses came in often, but always with purpose. It had taken them only a few hours to get used to ignoring his presence. Most recently they had reduced the sedation again. It was the hesitancy with which the door was opened that drew his gaze.
She was young, her white tunic marking her as a student nurse. He raised an eyebrow at her as he tried to remember her name. "Err... Her parents are here. Um.. Sir."
Her flighty, nervous manner reminded him of who she was. "You.. You don't have to call me Sir, Tilly." He reminded her for the third time. He also realised how dry his throat was. "I'll be right there." He stood, closing the ring box and slipping it into his pocket as he did so. The door clicked as Tilly retreated, while Carl poured a cup of water from the pitcher on a rolling tray. Anna certainly wouldn't be needing it today. He swirled it around his mouth before swallowing, clearing his throat slightly. He leaned over Anna, laying a gentle kiss on her forehead just below the halo of small electrodes. "I'll be right back." He whispered. His hand brushed hers as he passed, heading out of the door.
Tilly was stood by the nurses’ station, offering hot drinks to the couple that stood with their arms linked as if to support each other. They weren't old old, early 60's but aging well. Anna's parents. Her father was a shade under 6 foot but had probably been taller in his youth. His broad shoulders told of a man accustomed to physical labour, though he was also hedging towards portly. A builder, who was starting to take things easier so that he could enjoy his retirement.
Anna's mother was of a height with her husband, with a willowy build. Her hair was a light blonde that made the few streaks of grey look like silver highlights. He knew from some of Anna's pictures that she would often wear it styled, but here it was bound in a simple, expedient tail.
Carl took a steadying breath as he came to a stop behind them. "Mr and Mrs Swift?" He asked. They turned towards him. "We spoke on the pho...oof" Anna's mother had gathered him into a crushing hug. She clung to him for a few seconds, then pulled away, keeping her hands on his shoulders.
"Are you okay?" She asked him, looking him in the eyes. It was clear that Anna had emulated her mother, who had also been a nurse for a considerable portion of her career. The way she not only checked on others first, without considering herself, but also looked for what they might not be saying, were identical to her adopted daughter.
Carl tried to say something, but his throat seemed to close, and he had to swallow roughly. Anna's father stepped in to help. "Dear, none of us are okay right now." He gently pried his wife’s grasp off Carl's shoulders, and reached out to give him a firm handshake.
"Sir." Carl found himself saying, pointedly ignoring the flat look Tilly gave him.
"Please, Carl, call me Colin."
Carl nodded, reaffirming the handshake.
"Diane." Anna's mother said, placing a hand on his shoulder again, barely restraining herself from giving him another hug.
They stood there for a few moments, until Tilly placed a pair of sleeved paper cups on the counter. Finally, Carl spoke again. "She's this way."
* * *
He'd seen her at her worst, when she was pulseless, bloodless, literally open, and utterly lifeless. Her parents hadn't. Where he was able to take comfort in how much she had improved in the last two and a half days, they were totally new to the situation.
Diane let out a strangled noise, between a sob, a gasp and a cry. "Oh, my baby!" She rushed forward, pushing Carl's chair out of the way with a quiet squeak. She leaned over the bed, reaching out and stroking Anna's hair. Colin was more hesitant. He approached from the opposite side of the bed, his gaze flickering to all the tubes and wires as he approached. He reached out, his hand hesitating until he looked at Carl.
Carl nodded. "It's okay, you can touch her." He said. "They've reduced the sedation. You should talk to her. She might be able to hear you."
Colin laid his hand on the crown of Anna's head, leaning close to whisper something, his thumb stroking gently. He looked at Carl "Is she....?"
"She'll live." Carl said, but he knew it was his responsibility to give them the full truth. "But... We don't know if she'll still be...." He looked down at his feet, his hands clenched on the bottom rail of the bed.
He broke.
It all hit him, Carl, the boyfriend. Dr Teague had processed it logically, and had contained the efforts of Roger and Trish. He suddenly understood why they had been so concerned, as his head dropped and he felt the tears overwhelm him, streaking down his cheeks to fall on to the floor at the foot of the bed.
He wasn't even aware of anything else until he felt hands pulling him away from the bed, pushing him down while still supporting him, until he landed in the chair and practically folded in upon himself.
"Carl...Carl." He finally managed to raise his head, greeted with Anna's mother. "I'm sorry. But you...you need to tell us everything. Everything that happened." Her eyes were hard. Filled with pain, made worse by the love she felt for Anna. But she had experience far beyond Anna or Carl. This was the best way, for all of them. To confront it, head on.
* * *
This time, Anna floated up towards that near consciousness. There was so much to take in. Quite literally a near lifetime of memories had returned to her. It would have felt great, if it weren't for the gaps. The best way she found to describe it was like a grand tapestry. Long, continuous, and detailed. Except some rogue arsonist had burned out parts of it.
She got flickers of context, but beyond that, the torched memories were gone. Pieces of herself that were nothing but ash. The biggest of these was right at the end, like a huge, obliterating scorch mark.
The last thing she remembered was a night, a lovely night, where her and Carl had shared an intense fantasy on the living room floor. After that, there was nothing but the sense of lost time. Her next memory was that feeling of utter wrongness.
She still didn't know what had happened. It must have been bad though. To have that significant a gap, and to still have that pain through her belly and chest. Wait... The pain across her chest came into focus as she suddenly realised what may have caused it. Oh shit... Did they have to resuscitate me? She started to piece more things together. The abdominal pain, it must have been some sort of trauma. A car crash maybe? She thought. It didn't fit though. Her limbs were basically fine, the paralytics stopped her from using them, but they weren't broken.
I didn't have a SCA. She thought. There wouldn't be much abdominal trauma there. She felt something though. Something significant, something that wasn't just beyond her grasp, but was intentionally being hidden.
WHAT HAPPENED! She wanted to scream. She could hear voices. Someone was there. Why couldn't she just ask them!
There was a small period of quiet. Not silence. Monitors and machines still beeped and bonged all around her. But she was alone. Please... Someone just talk to me.
She would have cried if she'd been capable. Instead, she was trapped within an unresponsive body, unable to communicate, left alone with nothing but her own thoughts. To some, hell is fire, brimstone and punishment. They have lived lives where true hardship is something that happened to others. They don't realise that the true hell is awareness, without a shred of agency. To know all consuming pain and fear, with absolutely no hope of doing anything about it.
She was wrapped up in impotent panic, surrounded by it, until something broke through. Three words, and a touch.
"I'm here Petal." A whisper. A hand on her forehead, rough and hard with callous. Yet so gentle, and so comforting.
Daddy?
Other voices. She recognised Carl's voice, but it was so broken. It hurt to hear him speak in such a tone. And then came her mother's voice.
"...Everything that happened."
Anna was caught. She hated to hear the pain in those voices. Yet she needed to know what had happened to her.
* * *
She was intrigued, but also apprehensive. It was a strange dichotomy. She'd wanted to know what happened, and now that she was going to get the answers, she was terrified of them.
"We had a patient. An OD. Anna recognised her. We...We couldn't save her. But her boyfriend...he...he followed Anna. She fought. God did she fight. But he stabbed her. Twice." Car's voice was thick, and she could hear him gasping as he tried to collect himself. Oh, how she wanted to reach out and hold him.
"We...We didn't even know. Somehow she tossed him over the railing. We thought he jumped. I'm so sorry. We didn't even think of her."
"You didn't have a reason to." Her mother said, so tender and loving.
"She... She might have saved herself." Carl let out a strangled groan. "We were about to leave the stairwell, and...and this hit one of the nurses."
Anna couldn't see, her eyes were still bound shut by the paralytics, but she felt a connection to whatever it was he was showing them. It felt ... more than significant.
"I gave it to her.” An image of the heart shaped necklace sprang to her mind. “Just a few days ago." His voice shattered, and her heart reached out to him as she heard his sobs. Slowly he seemed to regain control. "I found her. She'd lost so much blood. I thought she was gone, but she saw me."
More sobs. A distant whisper. "It's okay, keep going."
"Trish, the nurse, she went to get help. I held her, held her as she faded away. I'm so sorry. There was nothing I could do..."
It's not your fault. Anna thought towards him.
"It's not your fault." Diane said in a gentle tone.
It took him a few moments to collect himself, before continuing his recount of events. Anna simply listened. There wasn't much more she could do. Lying there, unable to show any kind of response to the information she was receiving, the details of the fight to resuscitate her. She felt his fear, and it fed her own fear, despite the fact her contained consciousness was evidence they had been successful in the end.
Then he got to the part that gave her all sorts of complicated feelings. "We...We couldn't stabilise her BP, there was too much bleeding, and the surgeon couldn't find it. We…had to open her chest." Carl's voice came close to breaking, thick with pain. "We needed to stop the blood flow by clamping her aorta. Once...Once I did that, I had to...I had to pump her heart myself."
Holy shit. She thought. He had my heart in his hands.
She didn't know what to feel. Terror, for one. She'd been so close to death that tearing her chest open was a good option. Yet. He had literally held her heart. Pumped it, manually. She had been more than willing give it to him emotionally. He had been forced to take it physically. How many times had she fantasized about that exact situation?
He was still talking. "They...We...were going to call it. It had been so long. And she wasn't responding." He paused. "Four seventeen. That was the time." Anna felt her father's hand tighten upon her own limp fingers. "I don't know if it was a delayed reaction to the drugs. Or if it was her. If she was giving us one last chance. But it worked. One last shock, and her heart started again."
* * *
She hadn't paid too much attention to the details of the following surgery. Carl's account had become dryer, as if he was reading a script, which made sense. He wouldn’t have been there for that part. At some point he had finished the story. She'd been too busy thinking about everything before that. All the steps he'd described as they battled for her life. Everything she'd ever dreamed of. Carl forcing air from his lungs into hers, chest compressions, defibs. Intubating her. Directly massaging her heart.
She was trying to reconcile that with the physical pain she still felt. The emotional pain she'd heard in Carl's voice. Fear of damage that might not be apparent yet. What kind of recovery she would have, and how long it would take. Thinking of the future made her nervous. What would her relationship with Carl be like? Would he still share their special interest, after everything he'd had to do to her? Would she still be into it?
Would it change the dynamic of their relationship? They'd had plenty of time before their revelations to be confident they were good together, but if either of them lost that element that had taken it to the next level, would they be able to get back to where they were? Or would they mourn that loss?
At least he isn't mourning YOU!
It was a fair point. It didn't totally stop her from dwelling on all those questions, as she drifted away. They occupied her so much she didn't even consider whether they'd pushed more sedative, or if she was slipping into a natural sleep.
* * *
It had been cathartic, reliving the events of that day. It had also been draining. Carl had planned to stay until well into the evening. He was broken out of a doze by Colin gently shaking his shoulder.
"Perhaps you should go home and get some rest." He said.
Carl looked at his watch, it was barely after 4:30 in the afternoon. The thought of his bed was compelling.
But Anna was here.
Colin could clearly tell what he was thinking. "It's okay, she's not going anywhere, and she'll have company."
Carl finally nodded, sitting up. He'd taken a more comfortable chair in the corner, letting Anna's parents take the bedside. "Do you have anywhere to stay?" He asked, knowing how something like that could slip through the cracks.
"We can sort a hotel." Colin replied.
Carl shook his head. "I have a spare room, you're more than welcome to it."
Colin and Diane looked at each other, having a wordless conversation, before eventually nodding simultaneously. "Thank you, that would be good." He walked over to his wife and placed a hand on her shoulder. She leaned her head against. "I'll see you later love." He told her.
Carl got his feet, flexing his knees slightly to get more life into them, and walked over to the bed. He pulled out the necklace, rubbing his thumb over the locket. He leaned close to Anna, lifting her head slightly to slip the chain under neck, clasping it and rearranging it so the heart shaped locket rested on her chest. He gave her another kiss on the forehead, then retreated with Anna's father.
* * *
The next few days fell into a routine, the three of them taking overlapping shifts by Anna's bedside, each of them getting some alone time for a few hours, but still having someone to talk to for a while. It turned out that Colin was a proficient cook, so even though all three were being emotionally eaten by worry, they had some good food to sustain them.
On the 6th day since they had nearly lost her, Thompson had given the go ahead to remove the sedation. He'd wanted to give her injuries time to heal, just in case she had an adverse reaction to waking up. Colin had stayed for an extra couple of hours, but she hadn't woken and he had been forced to relent and head back to Carl's for some sleep of his own.
That just left Carl with her. It was another agonising wait. Logically, he knew it could take half a day for the drugs to wear off and for her to come around. Seeing no response after three hours was perfectly normal. Every minute that passed still gnawed at him. He fell into that trance-like awareness again, near motionless, but acutely aware of every monitor, every machine.
He sensed the change on the ECG as soon as it happened. Her heart rate quickening.
* * *
Each time she had risen to that semi-consciousness, she had spent a while fighting it, trying to move or open her eyes. Her body had remained frustratingly still every time. Eventually she would settle into another period of listening to the people she loved. She was never alone. She could feel them holding her hand. But if it was quiet, she would try to sort through her memories.
There were still the torched gaps, but as she explored she found other small pieces, fragments, that were missing. Sometimes it was akin to a scratched disc. She'd be thinking of an event, playing through it in her mind, then it would suddenly skip. In other cases, it was like a newspaper that had something spilled across it. Words that had smudged and become unreadable, images that were mostly clear, but had a chunk that was distorted.
There was something else too. Something that seemed to be after the great scorched hole in the tapestry, but before her recollections of this half consciousness. While she was being resuscitated. An empty space. A void. But she was within it. Feeling everything they did to her. A greater more present darkness waiting for her. There was terror. And anger.
Had it really happened? She didn't 'remember' it until after she heard Carl explaining the details. Was it just a dream? Her subconscious taking the pieces she'd heard and trying to process it? Or had she actually crossed into some sort of Limbo? She didn't know. She never would. It stuck with her though.
She had no idea how long it had been. She 'came around' again, rising from unconsciousness to her half-awake state. She began the usual fight, as if it was part of her routine. It took a few moments to realise something had changed. Usually, she effectively flailed against nothingness. This time though, she met resistance. It was thick, like treacle without being sticky. She pushed against it, and though it impeded her, she felt progress. It made her fight harder, made her throw more effort into it.
"Anna? Can you hear me?"
It was Carl! He must have felt something or seen something.
"That's it. You can do it baby. Just open those beautiful eyes for me."
She wanted to scream with exertion as she pushed against that resistance. Going further. Getting closer to something.
With a mental chime, she felt something connect.
The darkness peeled away.
* * *
He was already stood over her when he felt the tiniest twitch of her fingers. The monitors, ECG and EEG, both showed a huge increase in activity. She was almost there.
"Anna? Can you hear me?" He called. He heard the nurse outside poke her head into the room, then rush off. He didn't look around, his attention locked onto her face. Her eyelids rippled.
"That's it. You can do it baby. Just open those beautiful eyes for me." He told her.
Her eyelids fluttered. So did his heart.
They slid open.
* * *
The light literally blinded her for a few moments. She couldn't see anything in the bright expanse. Then things began to take shape. Her eyes adjusted to the light gradually. Over the course of a few seconds, it faded from dazzling to normal, but everything was still blurred. She had to blink a few times, each time the shapes resolving that little bit more. One shape in particular.
Carl.
He was leaning over her, the concern clear on his face. He must be wondering if she even recognised him. She blinked once more, her vision fully clearing, and stared into his eyes. With a push of will, she nodded ever so slightly, not even enough to lift her head off the pillow.
He smiled.
"There you are."
She nodded again, more to one side. It caused him to look at her, confused.
She twitched her hand. The one that once again had the small box in it. Gave another nod, with a slight frown, frustrated by the tube in her mouth.
He glanced down at it then back at her, his eyes widening. She nodded again.
"You...you heard me?" He whispered.
Anna nodded again.
Her gaze trailed to the ring as he lifted it out the box. He picked up her hand and she gave it a squeeze.
* * *
He looked between the ring and her eyes. Those wonderful chestnut eyes, and the mind behind them. She was still there. Whatever things she might have lost, that look, those small expressions, told him all he needed to know. Anna was still there.
His mind whirled. She knew about the ring. She'd heard him. In the space of a second all his hidden fears surged to the surface. What if things would be different between them? If the experiences of the last week changed their relationship. Changed their intimate life? Maybe even everything beyond that? He'd meant what he said to Thompson. He would not walk away from her. But would she still want him, if there were longer term problems with health, both literally and euphemistically?
He looked into her eyes. She was looking into his. Communication flowed, just like it had between her parents. They'd both been thinking the same thing. And they were both in agreement. They loved each other. More than anything else in the world. They would deal with it, together.
They nodded to each other.
He took half a step back, and went down on one knee, holding onto her hand.
"Anna Swift, will you marry me?"
She squeezed his hand. Nodded her head. And blinked her eyes twice, the yes they always used with patients who couldn't speak.
He couldn't help but smile, and he saw her lips do the same, as much as they could around the blue tube holder. He hurried to his feet, leaning close to kiss her just above it, his lips practically on the side of her nose. He held her, until she finally tapped him with her hand. He pulled away to see her glance down pointedly.
He grinned as he held up her hand and slipped the ring onto her finger.
I know I said I was taking a break from Anna and Carl, but during the writing of Code Red this was always in my head. Between Valentines Day coming up, and the cathartic need to kinda vent some my own experiences, and the love so many of you showed for Anna’s story, I couldn’t resist. There’ll only be one more chapter on this one. My original plan was for it to be a one-shot, but as always, it got a bit out of hand and I doubt I’d have it ready for V day, so it’s going to be two chapters, one now, one soon, hopefully next week. As always, I hope you enjoy.
It wasn't even a feeling, let alone a thought. It was barely even a sensation.
It was the first thing she was aware of, before she was even aware of her own name, of even the very concept of her. It was like being a new-born. The was no point of reference, no experience to compare it to. It was just...
Wrong.
Slowly it faded away, as did existence.
* * *
Awareness crept up again. There was more to it this time. She had a sense of self at least, though who that self was... it was beyond her at the moment. It wasn't entirely a good thing either.
Cold.
That was the biggest sensation. Literally everything was cold. From the tips of her toes to the top of her head. Her whole body, as she realised she actually had a body, was enveloped in an icy chill. The recognition of her body led to something worse.
Pain.
As soon as she felt it, the cold became background noise. Her chest and abdomen burned with white hot flares of sheer agony. It was the most painful sensation she had ever felt. Which didn't mean much, when your apparent existence could only be measured in moments.
Am... Amne... Something meaning memory loss.
That was actually a proper thought. She had no idea where it came from. But it made sense. It explained why everything felt so utterly new and horrifying. It didn't explain what had happened to her memories, or why she was feeling these particular sensations.
It was like something was just beyond her reach, some sort of understanding. But before she could grasp it, her awareness started to dwindle away once more.
* * *
Still cold, still hurting.
Not the most pleasant of circumstances to wake up too. Not that she was actually awake. She was ... something.
Vegetative state. Some distant part of her mind supplied.
Caused by...? She questioned. Frustratingly, she didn't get a response. It was like a dodgy phone call, with the reception dropping out. Which in itself was maddening. Phone call? Reception? What were those? The words she apparently knew, but she just couldn't nail down specifics.
Yet the metaphor also made perfect sense to her.
Let's start over. She deliberately thought. What do I have to work with?
The cold and the pain gave her a sense of her body. She tried to use it. Open her eyes, move a hand, wiggle her toes. But she felt absolutely no response. She sent the message, but it wasn't received.
Paralytics. Again, that far off aspect interjected, cutting off before she could even ask it elaborate. She almost expected a crackling hiss.
How about something simple? Who am I?
As soon as she posed it, she realised what a phenomenally complex question that was. Impressions bounced off her consciousness. As limited as that was, all she got was snatches. It was better than nothing.
Well clearly I'm good at irony. First I can't remember the term for memory loss, then my simple starting question is one of unrivalled metaphysical complexity. And what the fuck does THAT even mean!?
Let's try this one more time. She thought again, after quelling the frustration. What is my name?
More impressions flickered through her mind, but slower. The one that struck her the most was a piece of paper. Widely spaced lines. Grey pencilled letters in a rough, child's scrawl.
AnnA SwiFT.
She felt a wave of emotions. Excitement and loving encouragement. Someone gathering her tiny form up in their arms and giving her a hug. "Yay, you did it! That's your name see, all written out in letters!"
The memory stunned her. Mummy? She thought after it as her focus broke, and it drifted away.
It took her ... some amount of time, she had no way to tell, to pull herself back together.
Okay, my name is Anna Swift. We have a starting poi... oh for god's sake!
That noise was joined by pain, searing through her ribs as she took a breath.
No. I didn't breathe. Something forced a breath into me. The correct word for it escaped her. What the hell happened?
She tried to reach for memories again, but they were fuzzy and indistinct. They were there though, even if she couldn't quite take a hold of them right now. The cold and pain were still present, they seemed, lesser, than before though. Whether they had actually grown weaker, or if she had just become used to them, she couldn't tell.
With a great deal of effort, she managed to tune out the various irritating noises. Beneath it all there was a humming, rising and falling, warbling...
Not humming. Voices.
As soon as the thought coalesced, so too did the voices.
"... Stelling actually called it. Then just after pronouncing her, she went back into Vfib! One more shock and they got ROSC."
"Do they think she'll still be....her?"
There was a quiet moment that lasted suspiciously as long as a shrug. "It's too early to tell. She was down for over 30 minutes. She isn't brain dead, but..." Another shrug. "We've all seen how little might be left."
No, no, no. I'm here. She wished she could speak. Tell them she could hear them. But her body was... effectively a prop. A lifeless hunk of meat that refused to listen to her. Is that what they meant?
The words locked in shot to her from that distant part of her mind. She couldn't grasp the full meaning, but it filled her with abject terror.
"It’s only been 50 hours and she's hopped up on all these drugs. Maybe we can have hope. She's chalked up one miracle already. She might have another in her."
"I hope so." There was a sigh. "We'd better let him in before he breaks down the door."
Him? Who is him?
She got more flashes, again too fast to process. She noticed they all had one emotion in common. Love.
* * *
Carl knew there was no chance of getting back to sleep. The last two days had been nothing but a haze. Most of his time had been spent in the ICU, right by her side, or here, getting snatches of rest. He sat up, noticing he was still fully clothed. It was the same set of clothes that Roger had handed to him on that morning, nearly two days before. As if on cue, the bedroom door cracked open.
Roger looked at him, cocking his head slightly. Neither spoke for a stretching moment, yet communication flowed. The nurse sighed. "Take a shower. I'll make some breakfast." He said, before closing the door.
It was a struggle, both to simply move on the one hand, and to not sprint back towards her bedside on the other. With an effort of will that astounded him, he managed to make his way into the ensuite, and into the shower. Standing under the water, it started to gnaw at him.
He should be there with her.
Sat next to her when she woke up.
When. Not if. He simply could not allow the concept of if to exist. He finally noticed the locket and chain wrapped in his hand. He ran it between his fingers, cleaning the blood off it, unsure if it was water or tears splashing on the gleaming metal.
He dried and dressed himself on autopilot. One moment he was under the shower, the next he was striding towards the apartment door. He was only brought up short when Roger stepped into his way.
"You need to eat something." The nurse said, his voice as hard granite. He stood there as Carl dragged his eye towards him. Roger didn't yield. "What will she think? If she wakes up to a shadow of the man she loves?" Roger waited until Carl finally nodded and clapped him on the shoulder. "Besides, my bacon and eggs... only a fool refuses them."
The first bite was mechanical, food on fork, fork into mouth, chew, chew, chew. Then flavour exploded, dragging Carl back into some semblance of reality, instead of the zombie he realised he'd been.
"Told ya." Was all Roger said, as the pair consumed the early breakfast.
The sun was only grazing the horizon as Roger drove them to the hospital. The streetlights were still blazing, lighting the front of the car in shifting waves. Even though Carl had properly awakened, they didn't talk. What could you say, on the way back to not only where she was, but where it had happened in the first place.
* * *
They stepped into the hospital, walking into the hub of A&E. Technically they should have used the more general entrance, as visitors. It was somewhat ironic, but despite working there, they didn't really know which way to go from the normal entrance. From A&E, the ICU was directly upstairs.
A few steps through the door, Carl stopped walking. He didn't know if it had been there yesterday. Yesterday there could have been a twelve-foot clown and an entire symphony orchestra, and he wouldn't have noticed. His head was clearer now, thanks to Roger's breakfast. A table had been set up against a wall. It was overflowing with colourful flowers and an expanse of cards. He took slow, tentative steps towards it. It could have been a memorial. It still might become one.
He picked a card at random. We're all rooting for you Anna. You can win this. Beneath was a score of names. It took him a moment before realising it was from the radiology department. Another card was from a patient they'd had a month ago. A third was from the local police station. There were dozens more. Individuals and organisations. The fire department. Ambulance station. And so many former patients.
Carl felt the tears stinging his eyes. She'd touched so many lives. Yet, none more than his.
He didn't notice her until Trish stepped up beside him and pulled him into a hug. He didn't know which one of them needed it more. Trish and Anna were so alike in personality, that he didn't need to wonder how she was still working. Anna would have done the same, had their positions been switched. He also knew Anna would have needed that hug too. Trish finally let him go, switching to Roger. Carl glanced back at Roger but the nurse, his actual genuine friend, he realised, simply nodded towards the elevator.
He leaned against the wall of the box as it carried him up towards the ICU. Trying to hold himself together. He needed to, for her. It was a long ride, despite only taking him up 4 floors. The elevators were designed to be gentle, when dealing with critical patients, you could never be too careful. It was still agonising.
Finally, the door opened and he stepped out, walking up to the doors of the ICU. He swiped his ID badge on the RFID sensor. ICU visiting hours were weird. Patients were often that critical that having set hours didn't make much sense. Usually though, you needed a nurse or patient advocate to accompany them. He went in alone. No one had stopped him yet.
He knew where she was and headed directly there, passing the rows of beds. There was only a few individual rooms in their ICU, for the most critical patients or for those where other circumstances were involved. Being a member of staff helped, but the key factor was that her attacker was still in the building. He wouldn't be walking for a long time, and there was a 24-hour police presence on his door. And she was among the most critical of patients in the ICU, he was reminded, when he saw her through the window.
Before he could go much further, someone stood up from a chair and stepped into his path. It was Dr. Matthew Thompson, one of the consultant neurologists.
"Carl, could we have a quick chat?" He said.
* * *
Carl looked at him, apprehensive. Surely he wasn’t about to tell him that she was too far gone, or that something had happened. Thompson held up a placating hand.
"Just relax, if anything, the signs are encouraging, but we still need to talk." Thompson guided him to the window but set himself between Carl and the door. "So, as you know we've been periodically easing back on the sedation to observe for any improvement in brain function. Up til now, there's been only minor changes. But we did it again just now." Thompson made sure Carl was following, and gave him the smallest of nods and the slightest of smiles. "The EEG readings ramped up, especially to audio triggers. It's a really good sign. We're confident that she'll wake, but..."
The smile faltered; the nodding stilled. "You need to be prepared for possible problems. She suffered a significant and widespread hypoxic injury. She will wake up. But she might not be the Anna you once knew." Thompson sighed at looked down at his feet. "Her personality might be altered. Amnesia is a strong possibility, especially short term, but potentially long term too. And... and so far we have no idea about the state of her motor function, or her speech capability."
"So what? I'll be there for her, every step of the way." Carl replied, hearing an edge in his voice.
Thompson chewed his lip and looked away. He'd seen so many people give the same reaction to such news. He would be surprised if even 30% of the people who told him that actually stuck to it. "I need to level with you Carl, professional to professional. And please listen to me. You need to be prepared for the possibility that when she wakes up... She might not be your Anna anymore, and she may require 24/7 care. I know you love her and as soon as I can tell you anything better, I promise I will, but you need to be aware of how serious this might be."
"I am well aware of how serious this might be." Carl reflected back, his voice on the very cusp of turning venomous. "I'll push her wheelchair if she needs it. I'll dress her, I'll learn any method she needs to communicate. I'll change diapers and feeding tubes if that's necessary. The only way I will ever" he let that word come out with a hiss, "leave her, is if she no longer wants me around."
Thompson stared at him for a long stretching moment. Then he finally nodded. "Alright. Alright." Carl started to move past him to the door, but Thompson sidestepped into his path. "At least give our nurses a minute, OK? As you have made abundantly clear, you know plenty from working here, that includes procedure."
Carl felt his jaw clench, but finally nodded, settling for gazing through the window as the nurses finished up their tasks of cleaning and repositioning Anna's limp body.
* * *
The ICU nurses finally left Anna's room, letting him in with sympathetic smiles. He knew by now that one of them would be waiting on a stool by the window. Constant observation meant just that, but they would at least give him audible privacy.
He slowly approached her bed, taking in the sight of her. She was still wrapped in the cooling vest, wires and tubes sprouting out beside her neck running to various monitors and pumps. She still looked a mess. But she had so much more colour than she did two days ago. Her lips, what he could see behind the ET tube holder, were a little pale, but only cooling vest pale. Not cooling vest and hypovolemic pale. She looked alive. Before he sat down he reached up and gently swept a few stray strands of hair off her forehead, behind her ear.
He sat down in the chair, not even needing to move it into place, the nurses had placed it back in the same spot it had occupied for most of the last two days. He slid his hand into the cuff of the vest, taking her hand in his.
"Your parents are on the way. They'll be here this afternoon. They really wanted to get here sooner but.. well, you probably know more about your mum's boss than I do." He smiled up at her head, despite her closed eyes and stillness. "They trusted me to take care of you. I...I haven't even properly met them, and they trusted me, because of you." He chuckled a little, then sighed.
I had become almost a ritual, the last few days. "I'm sorry. I lied to you." He pulled out the small box, easing her hand slightly out of the vest, settling the box half in his hand, half in hers. "My grandfather did leave me a trust. But it didn't need managed. He left me a trust to use for three things. Education, a home, and a ring." He looked up at her face just like he had the last two times. He spoke, with every ounce of truth and strength he had. "So please. Anna. Please wake up, so I can put it on your finger."
* * *
The tones of the voice that spoke to her next made her pay attention. They felt so close to ... something ... the impressions from the distant part of her mind were reaching out, but it just didn't quite match. Yet her mind supplied her with a memory of secondary school physics. Resonance. The right tone would make everything fall into a pattern, but if it was even just a little off it became chaos. Well, that is astonishingly unhelpful! She thought, before paying attention to the words.
"Your parents are on the way."
Mummy's coming? Ugh, so infantile, yet, right now, she had a life experience of less than 2 days, that she could access at least. Perhaps I should just go easy on myself, whoever myself really is. She resolved.
"You probably know more about your mum's boss than I do."
She got a few images of staring at a ceiling, holding a phone to her ear and making 'polite conversation noises'. Well, that gives me some idea of what a phone is. And that perhaps I should have paid more attention. I hope I haven't been a bad daughter. She spent too long thinking about that, considering she had no recollection of ... oh, just about all her life. Then she noticed the voice was talking again.
"I'm sorry. I lied to you."
That's a great start. Lying to someone? Rather rude.
She felt the equivalent of a rebuking mental slap from a hidden part of her.
"He left me a trust to use for three things."
Wait... The voice was so close. Patterns were trying to form, but it was just ever so slightly off, scattering them apart before they could set.
"Education, a home, and a ring."
Gold. Five stones, in a mirrored pattern. That image was clearer than anything she had ever seen since her apparent 'rebirth'.
"So please. Anna. Please wake up, so I can put it on your finger."
The voice had been off. Tainted by fear and grief. But that last line...
Carl.
It was his voice. The connection was made. It resonated. Like a tone that could shatter glass, it shattered the walls that were holding her memories back. It was so much, it quickly overwhelmed her before she had the chance to sort them out. For once she was glad she was fading out.
* * *
Carl's attention was drawn by the EEG monitor as the spikes seemed to stretch and become chaotic, but they settled down a few moments later to what, he assumed, was a steady, literally sedated, pace.
Had she heard him?
He slipped his free hand over hers, giving it a soft squeeze.
"It's ok. We have all the time in the world. Take it slow. I'll be here." He whispered, as he settled into the position he had held for much of the last two days, leaning onto the bed, laying his head on his elbow as he kept his hand touching hers, the ring nestled between them.
I got a bit carried away with this one. It’s a long chapter, and I did consider splitting it into two, but honeslty felt it wouldn’t work as well in two pieces, it all fits together as a single unit. I really hope it is worth the read, but can’t say much else without spoilers.
I’ll be taking a break from the series after this, I’ve got some non-resus stories I want to try and write while I’m still in the groove, and I need to emotionally recover from such a heavy story.
The sky was shrouded with a layer of grey cloud and rain pattered down, drumming lightly on the old slates. It wasn't too hard a shower, spring was more a time of drizzle and persistent light rain, rather than howling storms. Carl watched large drops splash on the ground beneath a crack in the aging cast iron gutter as he sat on the old wooden bench underneath the lean-to porch, situated next to a side door of the small, old church. Anna had often told him that she wasn't religious, but in this part of the world that didn't particularly mean much. In small villages with no other amenities beyond perhaps a pub or inn, the church was simply the place where community events took place. Festivals. Jubilee celebrations.
Weddings.
Funerals.
Carl shivered as the memory intruded upon him again. He still hadn't been able to shake free of the images, despite counselling. Anna, laid out on the trauma bed, lifeless. Her utterly unmoving heart held between his hands. The sound too. A screaming monitor just behind him. Sarah's sobs as the young nurse cracked.
A hand on his shoulder broke him free of the grim reverie with a jump. Carl looked up to see Roger stood beside him. The nurse gazed down at him with a look in his eyes. Not quite pity, more of understanding with a sad element of helplessness. Which was more than true. They'd talked about it at length on more than one occasion since that day. Roger's presence in Trauma 3 wouldn't have changed anything, and every idea the two of them had come up with to combat the recurrent memories had been a bust. The only thing left to try was deeper, more intensive therapy.
He just had to get through today. Maybe doing that would help all by itself. Carl gave Roger a nod and pushed himself to his feet, throwing off the past and coming fully back to the present. They both stepped up to lean against different thick oak pillars, gazing out through the haze of the rain at the church's graveyard. Anna's adopted family had been a fixture of the village for untold years. There were generations of Swifts buried here.
Roger blew out a breath. "Do you know what you're going to say?" He asked.
Carl nodded, slipping a hand into the inside pocket of his black suit, pulling out a folded piece of paper. "I don't know if I'll be able to though."
"You will." The nurse said, making it seem like a simple statement of fact. A moment later he stood straighter, looking out at the road leading down to the church. Carl followed Roger's gaze, quickly locking on the long black car as it passed behind the trees. Roger turned to him, his hand landing on Carl's shoulder again. "Here she comes. We should get inside."
* * *
THE DAY OF THE ATTACK
Stelling had relented to Carl's request for 5 more minutes with a small nod, easing back from the bed to leave him to it. He turned to look at Mark, or more particularly the rapid infuser.
"Go ahead with another full round of blood products."
"This'll be all we have." The nurse warned.
"Jones will be here." Carl told him. Not that it would matter if they didn't get Anna back by the time the red bags were empty.
Through the conversation Carl's hands had continued to squeeze Anna's heart, palms and fingers pumping the otherwise inactive muscle. He feel the blood in the chambers, a glance at the monitor telling him that Anna's blood pressure, above the aortic clamp at least, was almost at a normal level. They, He, just needed that heart in his grasp to beat on its own.
He glanced at the clock. 2 of those 5 minutes had slid by already. It was so hard to tell time when everyone was so quiet. And when there was so little else to do. It also meant it had been 4 since the last round of adrenaline.
"Get me another round of epi." He said to Trish. "Inject it directly into her heart."
It was a desperate measure. It was a more desperate time. This was already one round beyond the usual maximum. She'd probably bled a few rounds out before they stopped the worst bleeding. As a justification for breaking protocol, it wasn't the best. However, the protocol was based on evidence. Any epi beyond the maximum showed no clear difference to outcomes. But if, technically, that maximum amount hadn't truly made it into her system, maybe giving her one more would make a difference.
Carl kept up the compressions while Trish filled the syringe, and stepped up beside him. "Right in there." He indicated with his finger, while still compressing. He was pointing just below where the coronary arteries branched from the aorta, and did his best to keep Trish’s target still as he made sure blood still flowed. The sheer size of the aorta would mean some, maybe even most of the drug would be sent elsewhere, but it also meant the whole heart itself would receive a decent dose at the same time.
Carl desperately hoped it would be enough.
He watched Trish guide the point of the needle towards the indicated point. Her hands were tightly controlled, not even a single tremor. The needle pierced the aorta just above the ventricle, sliding in just a tiny distance. Trish held the barrel with one hand, keeping the tip of the needle where it needed to be, and eased the plunger in with the other. Carl's massage pushed the drug into her system, and her heart.
Trish extracted the needle, stepping clear of Anna's chest, limiting any potential to accidently introduce an infection, in the increasingly vain hope that Anna would survive long enough for that to be a concern. Carl had hoped for an immediate response to the adrenaline, but Anna's heart didn't react.
Come on baby. Come on. Come back to me. Come back to me baby.
He repeated variations on that refrain in his head as he stared at her face.
He never even noticed the moment he started saying it out loud.
"Carl....Carl!"
Everything looked hazy, until he blinked away his tears. As his vision cleared he became aware of everything.
Sarah was sobbing. She'd detached the ambubag and dropped it next to Anna's head. The monitor behind him continued to scream, Anna was still asystolic. Her heart refused to even twitch. It laid there in his hands, lifeless, just like the rest of her body.
The surgeons had stopped working. He raised his head, to see Jones stood inside the trauma room, a large bag slung over one arm. His other was wrapped around Lucy as she buried her face in his shoulder. Trish laid her hand on Carl's elbow. He couldn't look at her.
Instead, his gaze drifted towards Stelling. He didn't expect it, but she looked broken. Her eyes glistened with her own tears. "Carl, I'm sorry. I'm so sorry." She took a shuddering breath. "It's been 35 minutes. I...I have to call it." She looked at the clock, one hand gripping part of the sheets in a knot. "Time..." Her voice cracked. "Time of death, 04:17"
* * *
Anna was able to feel Carl's compressions. But not much else. Her abdomen no longer existed to her senses. She did not feel her lungs inflating. The pulses from those compressions had slipped beyond her. She only felt the physical squeezing of her heart by his hands. And even that was fading away from her.
Please don't stop.
Her mental voice had barely the strength of a whisper.
Don't let me go.
She felt so insignificant. She tried to cling to that feeling of her heart being massaged, but it too was beginning to fade. Even though she was in a lightless void, a greater darkness seemed to be drawing in around her.
The squeezing of her heart stopped. Not like her sense of it faded away. It simply stopped.
They had stopped.
No...
She whimpered as that final darkness started to rush in at her.
* * *
Carl's world was ending. Tears tracked down his face, soaking into his mask. He looked at her blank face, her empty eyes.
She can't be gone.
But she was. Her heart, cradled in his hands, lay totally still.
He heard others crying around him, in a far off, disconnected way. He couldn't move, his body frozen.
She's gone. Anna's gone.
* * *
I'm so sorry Carl
The rushing darkness was close to snuffing her out completely. Close to erasing everything she was. Her memories of the past. Her feelings in the present. Her hopes for the future.
No.
All those dreams of times with Carl. Of love. Family. Life.
Not like this.
She wasn't pleading.
She was pissed.
I won't leave him! You hear me! I will NOT go!
Anger had never really come easily to her. It had always seemed like a waste of energy.
Now, she raged, pulling on every memory, every emotion. Every dream.
You think I'm just going to let you take all of that from me?!
She roared at the eternal darkness.
FUCK YOU!
She drew all her rage into a single point and cast it out like a supernova, a brilliant flash in the darkness.
* * *
Anna's heart twitched in his hands. For a long moment he thought he had imagined it. Then it quivered, wriggled, and began to squirm. Carl's head snapped around to the monitor, that persistent whine had gone, replaced by the two tone alarm, and a coarse v-fib was juddering along the screen.
"Charge to 50!" He called out, spinning around to grab the wand like paddles.
"Carl..." He heard Stelling saying something, but he blocked her out. Thankfully Trish had set and charged the defib.
Carl turned to back to Anna, plunging the paddles into her open chest, placing them around her shivering heart.
"Clear!" He shouted, even though no one was touching her. They'd all stood back after giving up.
He pressed the buttons.
Anna's heart spasmed once as the shock jolted through, the muscles throughout her chest giving a tiny jerk. Time almost stopped. Anna's heart fell still. For an agonising, endless moment, it stayed still.
Then it moved.
A co-ordinated contraction, first the atria, then the ventricles.
The monitor bleeped, once, twice, three times. It continued bleeping.
And Anna's heart continued beating.
* * *
She's alive.
Carl finally breathed again, his brain buzzing as thoughts ran into one another. But that was the most important one.
Anna's alive!
"Get the vest! We need to cool her down!" He shouted. Her body was alive, he needed to keep her brain that way too. He looked beside him to Edwards, wordlessly asking for an update.
"Renal artery is grafted, it'll hold for long enough." She said. "We can pack the rest and give her a few hours at least." She said, with a relieved sigh.
"Keep that infuser going, just like you have been." Carl told Mark. It wasn't much of an apology for his earlier forcefulness, but the nurse nodded, his expression offering forgiveness.
"Carl." It was Stelling again. "You need to leave her to us."
"Not yet."
"Now." She didn't shout, but her voice held the same unyielding command he often used. Unsurprising really. He'd learned it from her. "I can forgive your actions so far. But it's time to step aside." She held his gaze for a moment, then looked down at Anna. "We'll do everything we can. I promise."
A small part of his mind snarled at that. She had literally declared the love of his life dead. But he knew the senior doctor well. Where there was real hope, she would fight for her patients. Anna had that hope now.
Finally, Carl stepped back from the bed. His knee's trembled, and he had to place a hand on the crash cart to steady himself for a moment. The last hour had been a chaotic, terrifying, adrenaline rush. With Anna back, and nothing left for him to do, it finally started to hit him. He pulled off the glasses, mask, and gloves, letting them drop to the floor as the nurses followed their orders. He only had eyes for Anna.
Before the bed got too busy he slipped around to the top of the bed, next to Sarah. The nurse was still taking shaky breaths, but she had reattached the ambu-bag. She eased to one side for him, letting him close enough to lean down over Anna's head.
"I love you Anna Swift." He breathed, as he laid a quick gentle kiss on her forehead. "I love you."
He stood straighter, moving out of the way as the nurses arranged the cooling vest. The surgeons were working both sites, packing sterile gauze into her chest and abdomen and preparing to cover the sites temporarily before they took her to the operating theatre. They left the aortic clamp in place for now. He watched on as the whole team worked together to gently lift her up enough to slide the vest underneath her, extracting her shredded clothing at the same time.
He could feel himself trembling, the shock ramping up as he found himself unable to take his eyes off the blood soaked bundle that had been dumped on the floor. He jumped when Stelling put her hand on his arm. "Carl." She said quietly, the stony voice of his boss replaced by the compassion of a friend. "Go and get cleaned up. We'll let you know if anything changes." He struggled to nod, but the comforting squeeze Stelling gave his arm helped.
His legs felt like lead, and there was a constant ringing in his ears. He had to keep glancing at the monitor to confirm it wasn't an alarm as he backed out of the trauma room. Though the windows he watched as they got the vest wrapped around Anna's body and switched the ambu bag for a ventilator. It was one of the hardest things he'd ever had to do, but he finally dragged himself down the hall enough to take her from his view.
* * *
He shuffled down the corridor, pushing through the doors and heading for the staff room. He ignored all of the stares at his bloody clothes. All the questions from nurses and doctors. The words themselves didn't penetrate, but it was clear they knew now that it was Anna in trauma 3. His lack of response probably didn't help them, but he simply couldn't.
He finally made it to the staff room. He trudged to his locker, fingers refusing to cooperate as he manipulated the lock. Eventually he pulled it open. A change of clothes hung there, but he ignored them. Instead, his hands went to his jacket, finding a small box inside one of the pockets. His hand clamped around it, pulling it out.
It was all too much. He staggered back until he managed to brace his hand on one of the sofas, then he sank down until he sat on the floor. His mind was spinning beyond his, beyond anyone’s control. He'd come so close to losing her. He still might.
He wept.
He didn't know how many people came through. They said things to him. Gave comforting squeezes on his shoulders. An occasional one sided hug. Some sat by him for a time. It all just passed him by. He simply stared at the bank of lockers. At one in particular. Anna's. Daylight started shining through the lone window, casting a wedge of light across the lockers. To his perception it seemed to jump across lockers in small movements as the sun rose. The rest of the time all he saw was Anna laying on the landing covered in blood. Anna mouthing three words to him. Anna staring past him. Anna with a tube shoved down her throat. Anna receiving deep compressions. Anna with her chest open and her heart in his hands.
Finally, someone managed to break through to him. They had been sat beside him for a while. And he'd been vaguely aware of a conversation between the one next to him and someone else. He just wanted them to go away. To leave him alone. But they wouldn't. The person moved to kneel in front of him.
"Carl. Come on mate." He said, shaking Carl's shoulder, first gently then more aggressively. "Don't make me slap you."
Carl blinked, his eyes finally moving to look at Roger.
The nurse let out a breath. "Good. Listen. She's out of surgery. She's still with us. You hear me? She's still with us."
Carl tried to reply, but his mouth was dryer than the Sahara. He opted for a nod.
"That's it. They're gettin' her situated in the ICU, but you're going to have to change before they let you in, yeah?"
Carl glanced down at himself. The blood, Anna’s blood, on his clothing had dried, turning to a coppery colour. He gave another nod. Roger stood, and held out a hand, helping to haul Carl to his feet. Pain shot through his back and legs. The physical sensations helped to pull Carl back together more than the words. He must have winced or groaned.
"Yeah, 6 hours sat on the floor will do that to you." The nurse said, trying for a bit of levity.
It had been that long? Roger kept him steady as Carl found his feet. He finally parted his hands. The small box had left deep indentations in his palms, but he kept it from view. He started towards his still open locker.
"I'll get those. You get into the shower."
Carl's knees protested, but he took a step. He clapped a hand on Roger's shoulder and gave him a nod. He tried to say something but couldn't find the words. He just nodded again.
The nurse reached up and mirrored Carl's gesture. "It's ok mate. I know."
Carl slowly made his way to the shower, not letting the small box out of his grasp, as awkward as it made the process.
* * *
Carl sat beside the ICU bed. Machines whirred and whooshed and chirped around him. But he could only look at the figure on the bed. Anna looked a mess. But an alive mess. The ET tube was still held in her mouth by the tube holder, and she was wrapped up in the cooling vest. He could just see the bandages through the translucent material, taped over her chest and abdomen. But her skin had colour to it, her lips were pink.
The neurologist had been to examine her, but the findings were inconclusive. There was some damage. She'd been in cardiac arrest for more than half an hour. Nobody was getting through that unscathed. But at this point they had no way to tell just what had been affected, or how bad it was. The EEG monitor was encouraging though. A halo of electrodes ringed her hairline, the wires running to the screen that showed good steady spikes. Neurology wasn't his department, he couldn't interpret them to any significant degree, but he knew one thing. Spiky brain waves meant she wasn't brain dead.
A nurse was fluttering around the machines, checking readings, adjusting levels. Carl said nothing while she was there. He simply held Anna's hand. It chilled his fingers a little, with the vest covering her completely, but he could withstand that. Eventually the nurse wrote one last thing on the chart, and with a small smile, she slipped out of the room. Carl watched her go. Then his hand slipped into his pocket.
"I'm sorry." He said to Anna, almost pretending she wasn't unconscious. "I lied to you, earlier." He took a shuddering breath as he pulled out the small box. He shifted her hand, exposing her fingers, and cradled it as he placed the box half in his hand, half in hers. "About the accountants."
He sighed. He could feel the tears prickling his eyes again. "My grandfather. He did leave me a trust, but they didn't need managed. Not today. Or yesterday, I guess." He said with a chuckle that almost became a sob. "He left me a trust that I was only to use for three things. Education. A home. And..."
Carl looked up at Anna's face. Her beautiful face. His heart ached, desperate to see those eyes open.
"And a ring." He whispered, gently opening the small box.
Inside laid a gold band, wide, but not excessively so. With a series of small stones set into the band itself, forming a palindrome of ruby, sapphire, diamond, sapphire, ruby.
He'd seen her admiring it in the window of the jewellers. Seen her wide eyes and radiant smile. That reaction told him everything he needed to know. She wanted him just as much as he wanted her. And that ring was the perfect one for his perfect partner.
"So please. Anna, baby I'm begging you. Please wake up so I can put it on your finger."
* * *
13 MONTHS LATER
Gravel crunched beneath the wheels of the black car as it made its way down to the church. Flowers adorned the trees that lined the trail, bouquets of pink and white. It was a long trail, almost frustrating by the time it pulled up outside the main door. Anna struggled to contain her excitement as her dad stepped out and rounded the back, coming up to her door and helping her out of the vehicle. Anna hid the wince, the scars were still a little tight, but she could bare it, especially today.
"Are you ready Petal?" He asked, looking her in the eyes.
She nodded, struggling to find any appropriate words, before realising that words were mostly meaningless. She reached out and pulled him into a hug.
He chuckled. "I'm so proud of you." He said into her hair. His voice was thick, heavy with love, true pride, and tinged with the memory of how she was a year ago. " Let's go." He whispered, as they both heard the first few notes from the organ.
As they walked into the church Anna was comforted by the steadfast presence of her father. She might have been adopted, but he was her father. Her hand laid on his arm gently, but he held it firm, ready, just in case. It had been a long year, and she was still recovering. The tingles and numbness in her right side could still come unexpectedly.
They stopped just inside the outer door, beneath the stone vaulting. Literal centuries of brides had stood right there, waiting for the right moment in the music. Trish was there, along with Anna's niece and a young boy, barely even 4 years old, one of Carl's cousins. Trish was already crying, a huge smile on her face. She approached tentatively, but Anna accepted the hug without tottering. It was Trish's turn to be unable to speak. She pulled back, nodded, still with the big smile, and hugged Anna again.
"You're going to make me late..." Anna whispered to her.
Trish finally retreated with a shared grin, and the organ music launched into the main theme. Trish shepherded the children around the corner, leaving Anna and her father in the vestibule, waiting for the cue. Her dad laid his hand upon hers, giving it a reassuring squeeze.
"Let's go kiddo."
The music came around to 'the moment' and Anna stepped onto the aisle confidently. She looked around, greeted by the sight of so many familiar faces. Plenty of family, hers and Carl's. Colleagues and friends, the line there was pretty blurred. She didn't want to consider the bill for agency staff the hospital was taking. They hadn't complained though. Perhaps it was the trusts idea of a wedding gift. Even Dr Stelling was there.
It didn't matter how many times Anna told the trauma lead that she understood her actions, the senior doctor was endlessly apologetic. It was genuinely becoming annoying. Part of Anna wanted to grab her by the shoulders and shake her while screaming 'You don't need to apologise again! I would have done the same thing!' She was glad Stelling had allowed Carl to give her that last jolt, but...ugh, I'm over it, why aren't you, she thought.
The steady arm suddenly felt firmer, and Anna caught herself. She hoped nobody noticed. That was the biggest lingering issue. If she got distracted her mind could float off and leave her limbs behind. Totally normal, for someone who had been dead for half an hour, apparently. In time it would hopefully get better. It was still irritating.
But it did force her to focus, and what a sight it was. Carl stood before the altar, in a frankly ...mmmmfff... fitting suit. She was sure she hadn't forgotten a word, an embarrassingly common occurrence in the last year. For once she knew what she saw was beyond such petty things as words.
Many would say it was a pretty standard suit. But with Carl in it... How do you clothe the perfect man?
He'd been the first face she truly saw when she awoke. He'd held her as emotions pulled her apart and she dragged herself back together again, a beacon when communication was almost impossible. He'd held her arm as she took her first steps on wasted legs, steadied her as she relearned balance. He read her favourite books aloud to ease her off to sleep despite the beeps and bongs of various monitors. He had taken her home, to their home, and cradled her when the nightmares came. As she gradually returned to who she once was, he was there. Always waiting, ironically she reflected, patiently, until she was ready for the next step.
It had been a long year, and at times it was terribly hard. But it only served to deepen their love for each other. The ring was on her finger throughout. And, once her recovery permitted, they'd been able to have some moments of ... fun. Considering they were both employed in the medical profession, they ought to have seen it coming. They'd both been terrified when the doctor asked them to come and double check some results from a routine post-'event' exam.
Anna's hand drifted towards her belly, where the bump was only just starting to show, and Carl's joined it as she alighted the small set of steps up to the altar. His fingers lingered for only a moment though, they had ceremonial obligations to fulfil. Anna watched the embrace between Carl and her father, and realised just how bonded the two had become. If, in some bizarro universe she ever tried to divorce Carl, she had no idea who her father would choose.
Roger's presence behind Carl was also an element she would never have foreseen. They'd been colleagues, sure enough. But something around the 'event' had changed their relationship on a fundamental level. Men. They were weird.
And then Carl took her hands, and it was just the two of them. Nobody else mattered. The vicar was giving his spiel, and Anna was slyly glad she could blame the 'event' for her distraction when it came to the parts that actually needed her input. The truth was she didn't care for anything else but him. His eyes. His smile. Him, standing there before her. It took her a moment to realise what the vicar had said, until Carl unfolded a piece of paper. His voice barely wavered as he read out the handwritten vows, and Anna's heart became physically, metaphorically, and eternally, his.
THE END
* * *
There we go, didn’t want to say this upfront in case of spoiling it, but I hope I made some people reading cry as much I did when writing. It’s the ending I always had in mind but it was so intense to write. Hard but exhillirating. I was up to 2:30am doing the first draft because I was so into it. I sincerely hope everyone enjoyed this series, and I will be back with more stories from Anna and Carl eventually.
I just wanted to say a big thank you to everyone who has messaged me about this story, and I wanted to apologise if I haven’t yet replied to you. This week got kinda busy out of nowhere, so I had less free time than expected, and this chapter was tough to write. A few things I wanted to include that took a while to actually make work. Sorry if it’s not quite up to the quality of the rest, I hope you all enjoy it anyway :)
Anna felt the scalpel slicing through her skin, and the flesh beneath. The scissors brutally cutting the intercostal muscles. Then came the rib spreader. She could feel every pop, crack and shift of her ribs. It had to be Carl. Through all this she could feel other touches and pressure inside her abdomen. The surgeon was clearly occupied. Which left only him with the skills to do such a procedure.
It was such a clinical way to describe it. A procedure. He was tearing open her chest, ripping her wide open. She was only dimly aware of the clamp that pinched her aorta. The remnants of her mind were too focused on what was going to come next. She was a trauma nurse. She knew what an emergency thoracotomy entailed. What it led to.
Oh fuck.
The thought buzzed in her mind. She was mostly terrified. Going to such lengths. It rarely ended well. Maybe 1 in 20 patients actually lived once they got to the point that splitting their chest open was a good option.
The deeply buried kinky part of her was elated.
He's going to have our heart in his hands.
Will you give it a rest you horny bitch! The rest of her mind screamed.
Bizarrely, even trapped in a formless, lightless, soundless void, Anna got the distinct impression of a shrug.
We're basically fucked anyway. If it's going to be the last thing we feel, we may as well enjoy it.
The logic, macabre it may be, was hard to deny. If you had the opportunity to choose your final thoughts, sexual thrills were far better than terror and existential dread.
Then she felt his hands envelope her heart. If she'd been capable, she would have shivered as the full impact of it stuck her. Those strong, tender hands were cradling her little pump. His palm squeezed inwards, pushing upwards at the same time to force the blood from her ventricles.
Anna wasn't sure if it was thanks to the clamp on her aorta and the blood being pushed into her body by the rapid infuser, or if it was from those direct compressions. Either way, she felt the surges of blood through her upper body, joined by that feeling of becoming more present again.
That gave her pause. It had been so gradual she hadn't even noticed she'd been starting to fade again. The sudden increase in her perception brought it into stark clarity. Despite feeling all the sensations of the thoracotomy, she'd been unaware of the inflation of her lungs, great whooshing breaths driven into her by a rubbery bag. In her abdomen she could sense the surgeon moving discrete parts of her anatomy about, whereas before it had been little more than one singular sensation of something being done.
The increased lucidity had forced kinky Anna shrink back too. As much as you could try and choose sexual excitement, it couldn't stand up in the face of the overwhelming realisation that death was coming closer. She began to cling to that feeling of blood pulsing through her, of Carl's hands grasping her heart.
Oh, my love.
She'd been so caught up in her own mind, she hadn't considered what might be going through his. Breaking open the chest of the love of his life. Taking her heart in his hands, assuming direct responsibility for pumping it, trying to preserve the last vestiges of life that lingered within her.
How long has it been?
She cursed the timelessness of this limbo she was trapped in. It hadn't been too long. Not yet. She wouldn't be considering these things if it had been. But did they know that? How could they know that? Would they pick an arbitrary time limit? A specific sign?
If only I could tell them.
That made her wonder. Could she do something? She used every bit of focus that she had, pushing it towards her heart. Trying to mentally force it to react. It was her heart dammit, it should listen to her.
It did. At least partially. She felt it begin to quiver.
Holy shit.
She mentally gasped, elated that she managed to make something happen, to give herself a chance.
Holy shit....
A metaphysical dizziness washed over her. This time she felt herself rapidly fade, for a moment thinking she was going to go completely. The sensations in her abdomen slipped into formlessness again. The surging blood from Carl's internal compressions became, ironically, vague pulses. The only thing she could feel with any clarity was her heart itself. That quivering mass of muscle being crushed in Carl's palms.
A momentary pause.
Something else around her heart, pushing on it.
A blinding flash as the internal paddles shocked her heart.
Back to squirming, those weird spoon based compressions again.
Another flash, another shock coursing through her heart.
Her heart went back to shivering.
Carl's hands were back, compressing her fibrillating heart between them.
Come on.
Her mental voice sounded weaker.
Come on.
The paddles were back.
The flash cut through the empty blackness, blasting her heart.
Silence. Nothingness.
No. No. Please keep going.
Please.
* * *
It was Dr Stelling shouting his name. He did not have time for her. Anna's heart had become still after the third internal shock. Trish's hands were already waiting for the paddles when he turned to her with them, allowing him to quickly get his hands back into Anna's chest and around her heart, resuming the rolling motion of his hands to create an artificial pulse around her body. He glanced towards the doors, but Stelling was hidden behind the figures of Lucy and Zach on the opposite side of the bed.
She had clearly been expecting him to respond. "DR TEAGUE!" She shouted again. "Would you care to explain what the hell is going on!?" She stepped into the trauma room, the door flapping loudly behind her. "First you abandon your patient. Then you steal away my surgical consult, and my emergency theatre spot, for a patient that apparently sprung up out of nowhere. And now I've just been informed you were potentially abusive to a technician!" It was obvious she was so wrapped up in her anger she wasn't actually paying attention to what was happening on the bed. "You had better have a damned good explanation!" She finished.
Carl still didn't respond, but he caught Lucy glance at him, then around at Stelling. The paramedic, in her big high-vis coat, stepped away, revealing the trauma bed. Stelling, who had been advancing towards the bed, pulled up short. First she clocked the open chest, Carl's hands disappearing into the gaping hole. He could almost see her eyes flickering, as they took in the rest of the bed. The abdominal surgery, the expanse of blood, the few patches of cloth beneath the body that weren't stained black. Blue. The same blue worn by Trish, Jessica, Sarah and Mark. He saw the anger on her face transform into horror, as her head slowly turned towards the top of the bed.
"What..." She gasped, recognising Anna easily, despite the blue tube holder hugging her mouth. She seemed to take a second to regain mobility, her feet dragging as she came up to the side of the trauma bed. "What happened?" She asked, gradually coming to her senses, her eyes drifting to the monitor and the flatline that ran across it.
How could he respond? Part of him wanted to roar out that the animal in the room across the hall had stabbed her, had tried, maybe even succeeded, to murder her. And for what? Because Anna had recognised the girl that his self-serving bullshit decisions had killed? Dr Teague was being overridden by Carl. The doctor could understand the young man's pain, a need to escape from the occasionally crushing aspects of reality. The lover was more than tempted to storm across the hall, find the biggest, sharpest, object in reach and do what his hind brain begged him to do. In that moment, the only thing stopping him was the fact that his hands, still squeezing her heart, were her only chance at seeing tomorrow.
It was Trish who managed to answer her. Somehow she'd managed to totally quash her earlier panic. How much had it cost her? To see her best friend, clinically dead before her, and shut that out in its entirety? Compartmentalisation did work, but not that quickly. Not without destroying something else.
"Two stab wounds to the upper abdomen. Severed renal artery, significant trauma to the abdominal aorta. She lost at least 2 litres of blood before discovery."
Stelling listened, engaging the clinician. She'd been working the trauma rooms for long enough that her own husband could have been on the table, and she would have followed the textbook.
"When did she loose cardiac output?" She asked, peering closer at the wounds.
This time nobody was willing to answer her.
* * *
Carl could hold up under Stelling's piercing gaze. Even Trish could. The other nurses were too cowed by her title and seniority. It was Sarah, still squeezing the ambu bag every few seconds, that cracked first.
"25 minutes." She whispered, her head bowed as if she was staring down at Anna's half open eyes.
Stelling seemed to sag, resting her hands on the edge of the bed as she looked down at her feet.
"Carl..." She murmured.
"She's had steady, consistent cardiac massage since she arrested. We've replaced her volume, repaired the worst of the bleeders." Carl told her. "We get a pulse back and she'll be alright."
"After 25 minutes? Not counting the hypoxic effects of the preceding hypovolemia...."
"We had her on the rapid infuser within 4 minutes of her arrest. She is not gone." Carl said, his voice strained, as if desperately trying to convince himself.
Stelling looked down at Anna's face, and Carl couldn't help but follow her gaze.
Despite everything happening to her body, she was so beautiful. Her hair spilling out around her head, ringlets forming at the tips. She'd always disliked them, at least when she was working, straighteners were part of her daily arsenal. But Carl loved them. The straighteners couldn't completely eliminate the little kinks and waviness of her hair, after a short time they would start to return. It would cascade down over her shoulders, so she usually trapped it in a tail to keep it out of the way. But once she released it, the waves framed her face in such a way that it made every expression so much more vibrant. Every smile was radiant, every frown a critical indictment, even if most of those were born of sarcasm.
As she lay there on the trauma bed, totally and utterly still, her hair was a painful contrast to the rest of her. Deep colour vs deathly parlour. Thick lush volume compared to a limp and lifeless form.
He kept on squeezing her heart between his hands as he saw her half open eyes, staring blankly into an infinite distance. Lower on her face the tube holder covered most of her mouth, but he could still see the glimmer of her teeth in the gap. And her lips, slack and pale. But was there a hint of colour in them?
"Carl... maybe you should step outside." Stelling sighed. "You're too close to this. To her."
Carl tore his gaze from Anna's features to look his boss in the eyes. He could feel the fire within him, flickering and spitting at the very suggestion that he leave Anna. The way Stelling seemed to pull back from the table suggested to him that she saw it too.
The shocked look that crossed her face quickly resolved into a frown.
"Carl. You have to think about what she would want. Could she truly live a half-life? Unable to care for herself, let alone others?"
"We aren't there yet." He said, but the words didn't have much strength. In truth, they were there. A trauma induced cardiac arrest was a short code. After 20 minutes the chance of a favourable outcome dropped off rapidly, and Anna was starting to approach 30.
Stelling clenched her own fists as she leaned on them, knuckles pressing into the firm mattress of the trauma bed. "Please don't force my hand Carl. We all want her to get through this. But I can't let you torture her body when everything she is has gone."
Carl shook his head. He loved Anna. If he could snap his fingers and trade places with her, he would do so in an instant. But Stelling had a point. A little longer and they would have no hope of saving Anna. Her body, maybe, but not that smart, caring, wonderful woman that had claimed his heart.
He wished they had taken a chance to really talk about their wishes in such a circumstance. Would she accept permanent disability? Being reliant on round the clock care? He already knew he would step up and do it himself if needed. But is that what she would want? Or would he be 'saving' her to assuage his own guilt? He cursed himself for not knowing, and again as he came to one conclusion. He didn't have it in him to make that choice for her. It simply hurt too much.
"5 minutes." He said, his voice losing the hardened edge as the reality settled upon him. Beyond that time, he would almost certainly be losing her in some way. "Give me 5 more minutes."
Anna was still there, in that sightless, soundless void. She knew she'd been shocked twice, the all-encompassing flashes were impossible to ignore. But that was it. There hadn't been a flash in a while.
I'm asystolic. There's nothing to shock. My heart isn't even twitching.
She didn't know exactly how long it had been since then, she barely even had a sense of time. She knew it was passing though. She could still feel the persistent chest caving compressions. Knowing the team that was giving them to her, Anna was certain they were being delivered 100 times a minute. It didn't help her figure out the passage of time though. Every time she tried to count them the number slipped through her grasp.
Am I starting to fade away?
The thought scared her. Which was an odd feeling without it being joined by her heart speeding up in response. Before she let it grip her completely she felt something new. Her mouth was pulled open, a cold metallic object sliding into her throat.
Laryngoscope. I'm being intubated.
Less than a week ago the idea would have thrilled her. She had been desperate for it. She was desperate for it now, for entirely different reasons. As much as she'd always felt the burning desire to be laid out on a trauma bed with so many people fighting to resuscitate her, she didn't want to die.
Except that's what's happening. I'm dying.
No. Clinically I'm already dead. My mind just hasn't caught up yet.
She felt the tube push into her trachea, quickly followed by a lung swelling breath. It had an immediate effect. Coupled with the blood that must be flowing into her body, she felt... It was hard to put into words. How do you describe feeling like you're fading back in? Becoming more present perhaps? Ultimately it may not matter. With the boost in clarity, Anna understood that if they didn't get her heart beating soon the fading would return. Would progress. Until there was nothing left.
A poke in her neck, and a second in her wrist, drew her away from thoughts of her own demise. More lines. Her meagre senses gave her flushes of hot and cold pulsing throughout her body, drugs and fluids coursing through her system. Throughout it all, she felt the constant squeezing of her chest as someone beat upon her sternum.
Is it Carl? She wondered.
She knew it wasn't him the moment she felt a hand brush her hair. Tenderly. Lovingly. The soft kiss on her forehead confirmed it. And it terrified her. If he was openly kissing her while she laid there in full cardiac arrest...
Are they calling it? Am I dead?
Her panic doubled when she felt the splash of a tear on her face. It trebled when the rhythmic crushing sensation stopped.
No! No! I'm sorry Carl! I'm sorry I couldn't hold on long enough!
I'm so sorry my love.
An intensely sharp sensation smashed through her panic. It cut across her belly, from centre to side. The panic faded into hope. There must be a surgeon there, and they were not waiting around. As hands plunged inside her she felt it all. It wasn't painful, pain still didn't register to her. If it had done, she expected it would have been excruciating. Instead, it just felt a strange mix of weird, wrong. And fascinating.
Not the time!
The surgeon dug around inside her for a short while, then stopped. Even with Anna's ineffective sense of time, she could tell it wasn't long enough to fix her mutilated insides. But they weren't giving up. The compressions had restarted while she was distracted, and they were still going.
A new sensation appeared on her chest, next to the savage thrusts. It was wet and slimy, spreading across her ribs and rolling over her breast. The crushing sensations stopped.
Another scalpel began to cut into her.
* * *
Carl hadn't wanted to consider it. The desperation it embodied. The sheer traumatic brutality of what he was thinking to do. And yet. Anna was losing blood as fast as they could pump it into her. Even with four lines from a rapid infuser. It was quite literally a do or die moment. He either did it, or the love of his life certainly died. It was extreme. A last-ditch hail-mary. It was the only thing left to try. As soon as it became clear to him that this was the only option, he knew there was not a person on earth that could stop him from trying it.
"Trish." He said, his voice carrying across the trauma room easily, despite the whining monitor, the slurping suction and the clinking of the trauma bed as Lucy compressed Anna's chest. "Prepare for a left side thoracotomy. I'm going to cross clamp the descending aorta. It should limit the bleeding and give preferential perfusion to her heart and brain."
He didn't wait for an acknowledgement, he simply spun on his heels and went to the cupboards at the side of the room, pulling out the sterile sealed thoracotomy tray, dumping it on a trolley before taking out a gelatinous block. He tore off his gloves, barely noticing the open fingertips where his nails had sliced through the latex from clenching his hands so hard. He ripped the plastic wrapping from a gelatinous puck, mashing the antiseptic substance between his hands, forcing it into every crevice and joint, spreading it up his arms to the elbow. A messy but acceptable replacement for properly scrubbing in, when time was of the utmost essence. And right then, it was. Anna had been in cardiac arrest for 16 minutes. At this point, single seconds mattered.
He double layered his gloves, put on a mask and plastic glasses, then made his way back to the bed. Anna's arm had been pulled out to a right angle, dangling limply from the side of the bed. Trish had cast away the shiny orange defib pad and coated the left side of Anna's chest with iodine, spreading it from her collar bone, all the way down across her breast and ribs, down to the previously sterilised area from the abdominal incision. She pulled apart the packaging of the tray then stood out of the way.
Carl didn't say anything. Neither did anyone else. His body language, even with his face hidden by the PPE, was all too clear. He picked up the scalpel, using his other hand to landmark each rib as he counted up the ribs to the fourth intercostal space. He didn't need to take a deep breath for this. His decision was made, his determination stronger than diamond. Lucy stopped her compressions and Carl lowered the blade.
The scalpel cut through her skin and flesh easily in a long line from her sternum to her side. He followed it with a couple more careful and deeper cuts, then dropped the scalpel back on the tray, picking up the surgical scissors. His fingers pushed into the pleural cavity with a tactile pop, pushing her lung gently out of the way as he inserted the scissors, cutting through flesh and muscle to create the opening.
A few moments later the scissors joined the scalpel and Carl took up the rib spreaders. As he cranked the handle he heard the slight pooping as the cartilage connecting Anna's ribs to her sternum, already weakened by the extended bout of savage compressions, gave way.
He wrenched the spreader further and further, creating a gaping hole that allowed him to ease her left lung out of the way, revealing it. His target. The most important thing to him. Not just in this moment, but for the past few weeks, physically and emotionally.
Anna's heart.
* * *
It lay there, unmoving. He'd listened to its thumping beats often ever since they’d discovered their shared interest. Watched its electrical rhythm on a screen. That wonderful little organ had pumped away for 26 years, day in and day out.
Until 17 minutes ago.
With such a low blood volume the chambers of Anna's heart looked pale and sunken. Without more blood it couldn't beat on its own. That was Carl's first task.
He took a cross clamp from the tray in his left hand, while his right slid underneath her heart and gently lifted it. Other than a few traces from the incision, there was very little free blood in Anna's chest. It made the aorta easy to identify and he carefully worked the clamp around the thick blood vessel. The clamp pinched the aorta, but he didn't put too much pressure on it. While they needed to reduce the blood loss, completely blocking the artery would make it difficult for Edwards to actually find the bleeders. You can't see what’s bleeding without any blood flowing. Besides, it could be tightened if needed.
With the clamp in place, it was time. He needed to provide that blood flow, for the surgeons and for Anna's brain. With her heart still resting in his right palm, he brought his left hand over to envelope it. Anna's heart was literally in his hands. He squeezed his hands together, palms first, pushing inwards and upwards from the apex of her heart. Squeezing blood from the muscles chambers, into her circulatory system. With the clamp limiting the flow to Anna's abdomen most of the blood was pushed towards her arms, brain, lungs and through the coronary arteries to her heart itself.
The rapid infuser was still pushing blood into her veins at an incredible rate. Between the new products and the artificially limited circulation, Carl could actively feel the chambers between his hands filling. The monitor chimed, drawing his gaze. He could compress Anna's heart by feel alone. The trace of the A-line that had previously shown only small bumps with the external compressions was now showing big powerful spikes. The numerical display also showed an improvement, with two numbers present now. It was only 70 over 20; but having a palpable blood pressure was infinitely better than the state Anna had been in just minutes before.
"That's it Anna." He said, looking towards her face. Her head was leaning to one side, dragged by the ambu bag and the tube it was connected too, the blue holder pulling at the corner of her mouth as it kept the tube secure. Sara was shining a light across Anna's eyes. She stifled a sob.
"F...fixed and dilated." She whined.
Carl shook his head, staring down at Anna's half lidded eyes, seeing the chestnut ring around the wide dark pools. "No. No, that's just the epi." He said. It was true that epinephrine caused the pupils to dilate. And she'd had several rounds already.
She'd also been in cardiac arrest for nearly 20 minutes.
"I need you to get your heart beating now baby." He didn't care that he was saying it aloud. Everyone knew of their relationship. Everyone had their own friendships with her. They were all invested, all desperate for her to live. "You hear me. Just beat your heart."
He wasn't religious. But he prayed to the universe that she would hear him. In the meantime, his hands continued their rolling motion, compressing her heart between his palms.
* * *
Edwards poked about inside Anna's belly as Carl went to work on her chest, but still couldn't find the source of the major bleeding. As Carl worked, with compressions stopped, Edwards watched the blood clear away thanks to the suction. She examined organs and blood vessels, trying to find the source, but with no blood pumping it was difficult. She found some damage to upper edge of the small intestine, but there wasn't enough to cause that much bleeding. She investigated deeper, pushing the intestines out of the way.
Carl got the clamp on and started the direct internal compressions. Blood began to spill out, but much more limited. Edwards directed the suction to the right spot, clearing it as she explored deeper. She was totally focused on her task, ignoring the events at the head of the bed. Finally she found the source of the bleeding.
"There's a big nick in the aorta!" She groaned. "It's going to be tough but I think I can repair it." She said, finally looking up at the others. The nurse at the head of the bed had tears in her eyes and Carl was frowning.
He looked at her. "Do it. Quickly." He commanded, squeezing Anna's heart with determination.
"Put a bit more pressure on the clamp." Edwards told Zach, Jessica's single suction tube could manage for a moment, and Carl was busy giving the compressions that were sending much needed blood to Anna's brain. The bleeding from the crucial blood vessel eased further, until it was little enough to allow her to work. "Good, now hand me 3-0 prolene." She kept a finger in the spot, feeling the small dribble of blood from the sliced vessel. The knife had cut through almost a third of the artery. The repair would have to be strong.
No one spoke as Edwards took a synthetic graft and began suturing it around the damaged section. She worked quickly, fingers steady and dextrous as they manipulated the hooked needle.
* * *
Carl kept up his compressions, squeezing Anna's heart between his hands. He could feel the chambers filling with blood, which his palms pushed out as they worked the muscle. It was encouraging. Without the active bleeding her pressure was coming back up. Blood was perfusing through the parts of her body that weren't clamped off. They were making progress, Anna's heart just needed to start beating.
"Push another epi into that central line." Carl ordered, Trish moving around to comply as Mark exchanged the blood bags again. Over a dozen empty bags now sat dumped on a counter. Carl had barely noticed when the sheepish blood tech came back with the second order.
"Ok, that should hold the aorta. Zach, ease that clamp off." Edwards called out. Carl watched as the trainee surgeon worked the clamp, glancing over at Edwards. She nodded along as if counting to herself, while her fingers carefully squeezed Anna's aorta just beneath the repair. "Yeah, we've got some perfusion and the repair is holding. I can see some other bleeding but no major haemorrhaging. We can keep the clamp at that and fix the rest later. I'm going to try and reconnect the renal artery now."
More good news.
It still didn't outweigh the fact that Anna's heart remained unmoving between his hands.
"Come on baby. You've got everything you need. It's time to come back to me." He whispered, staring down at her face, so slack and lifeless, eyes still half open, her grey tinged lips hidden behind the tube holder. Was there a little more colour to them?
He continued squeezing her heart, willing it to beat with each pump of his hands. Then he felt it.
He didn't need the sudden change of the monitors alarm to tell him what was happening in his hands. The persistent whine had switched to the familiar two tone as Anna's heart quivered and trembled in his grasp.
"She's fibrillating! Get them internal paddles charged to 30 joules!" He shouted, continuing to compress the shivering organ.
It was Trish again who leapt into motion, quickly taking the internal paddles from a drawer and connecting them to the defibrillator. She turned the dial and initiated the charging sequence. As she did, Carl looked at the clock. 4:06. Anna had been down for 23 minutes. There was still hope.
"They're charged." Trish said, holding the paddle out beside Carl, trying not to look at her friend’s heart as it squirmed between Carl's crushing hands. He pressed on the ventricles twice more before dropping Anna's heart, quickly grabbing the paddles. He placed the spoon shaped ends on either side, pushing them together to give some extra compressions as he lined them up in the correct position and waited for the surgeons to clear. Then he pressed them in hard, pining the shuddering mass between them. He pushed the buttons.
* * *
Anna's heart jumped as the shock blasted directly through it. She seemed to pull inwards ever so slightly as other muscles were also triggered. Her heart stopped dead for the briefest of moments, then returned to the uncoordinated quivering.
"No change, go again at 30!" Carl ordered, using the paddles again to squeeze Anna's heart. It wasn't as effective as his hands, but it was better than nothing for the few seconds needed to charge the small shock. "This time Anna. Come on now."
"Charged." Trish called again.
The second shock caused the same reaction. Anna chest twitched slightly. Her jumped and stilled. Then it resumed squirming.
"Damn it." Carl hissed, pulling out the paddles and handing them back to Trish. "Another epi, push it up to 40 for the next shock in one minute!"
His hands dove back into Anna's chest resuming the internal compressions. On one hand they were gentler than external compressions. Her sternum wasn't being crushed in, shaking her whole body and forcing the whole trauma bed to clink in rhythm. On the other hand, they were far more brutal. He was practically crushing her heart between his palms each time he pushed blood up and out and through her body.
He kept it up for a minute, ensuring oxygen was delivered around Anna's system, then he grabbed the paddles again. He scooped her heart between them and delivered the shock.
Anna twitched.
.
Her heart jumped.
.
It fell still.
.
It stayed still.
.
The monitor began to whine once more.
"Dr Teague!" An angry voice shouted from the doors to Trauma 3 as they burst open.
The flu has pretty much gone, I didn’t get this done sooner thanks to a busy weekend. I’m glad so many of you are enjoying this and are invested in Anna’s story. Will she live or will the team lose her? I’d love to see your thoughts.
Carl's arms were starting to burn. He'd only been delivering the forceful compressions for 2 minutes. He was out of practice. He usually ran a code, giving the orders and performing procedures. He always had Anna on hand to give compressions. She was incredible, she could do compressions at a perfect depth and rate for over 5 minutes with ease. But she couldn't give those chest compressions to herself. Not when she was lying underneath his hands in full cardiac arrest.
Carl looked around the trauma room, taking stock of what needed done. They needed to start a central line to get the plasma and TXA into Anna's body alongside the cross matched blood that should all be arriving soon. With the rapid infuser and a surgeon on site they would hopefully get Anna's blood pressure back up, they'd need to constantly monitor that with an arterial line. There hadn't been any point up to now, messing around with a cuff would have wasted time just to tell them that Anna's BP was practically non-existent. Anna's abdomen would need sterilised too.
Next he checked who he had to work with. In the trauma room with him were four nurses, a paramedic, a surgeon and a cop. He liked Officer Jones, but at this point he wouldn't be of any use. Jessica still looked worn out. Mark was an option to take over, but Carl knew the nurse had been shaken by his own attitude. The situation was too important, Anna was too important, to put in someone he wasn't absolutely confident in. He struggled for a moment, his gaze drifting down to her face. Her eyes were closed, her skin ghostly pale. He could only see a small portion of her lips in the gaps of the tube holder, but what he could see was a bloodless grey. He shook his head. He couldn't dwell on it. Right now, she needed Dr Teague the professional. Not Carl, the man who loved her.
"Sarah." He said to the nurse closest to him, her hand squeezing the ambu bag every few seconds. "Take over after this cycle. Lucy, swap onto the bag." He told the paramedic, who swiftly skirted around to the head of the bed and took the rubbery blue bulb from Sarah. The nurse shifted into position opposite him, mounting the step attached to the gurney. "No pulse check, straight in." He told her. They all knew they would feel nothing. "3...2...1!" He pulled away, Sarah instantly taking over, her hands thrusting Anna's sternum down to the perfect depth.
Carl took just a moment to catch his breath, then launched into orders. "Trish, get an arterial line in her wrist, I want a constant BP on the monitor. Jessica, prep her abdomen. Mark, handle the blood order when it gets here, full units in the infuser, I'll set a central line for the others."
As he was grabbing the central IV kit he glanced over to the phone, where Dr Edwards was requesting equipment from upstairs.
"Just bring a variety of grafts down, I have no idea what I'm going to find, but I need to get in there now." She was saying. Her gaze lingered on Anna's belly as it popped and rolled from Sarah's efforts, as she listened to whoever was on the other end of the phone. "Now dammit! It... It's one of our own."
* * *
Carl had to locate the jugular vein mostly by touch, Anna's blood volume so low that the vessel was almost hidden. At least it gave something to concentrate on, instead of how deathly cold her skin felt, even through his latex gloves. He managed to find it, framing it between his fingers before he took the wide bore cannula and slid it through her skin, into the vein. As soon as it was in he took the included bandage and laid it over the needle and around the port, securing it. He finished the line with a 3 port connector, ready for the TXA, FFP and leaving a spare for quick drug insertion.
He was still leaning over when he looked up, checking the progress of the others. Instead, he got a full view of her breasts, wobbling and shaking each time her chest was forced down then recoiled. His tore his eyes away, clenching a fist. He closed his eyes tight, gritting his teeth as he tried to banish the images from the weekend before, when he'd made those breasts jiggle in far more pleasurable circumstances.
He failed, and in doing so all the other walls broke down. It wasn't the sexual element that shattered him. It was who it had become attached too. Thinking of that evening drew out the feelings he'd felt then. The depth of his love for the woman he'd spent it with. The woman whose heart had become so tied to his own. A heart that, were it not for the pounding compressions, would be laying unmoving in her chest.
From the moment he had seen her lying on the landing, drenched in her own blood, he had been forcing the fear away, attempting to contain it. To bury it. To focus on being the doctor. It was nowhere near enough. He had never loved anyone as much as he loved her. And now he was losing her. The grief was smothering him, punctuated by the persistent whine of the monitor.
He couldn't do this. He opened his eyes, looking down at her face. Her hair was spread out around her head like a dark halo, framing her pale and lifeless features. He didn't have the strength to fight his hand as it reached out and stroked her head, his fingers gliding across the silky smooth locks of deep auburn. He felt the tears stinging the corners of his eyes as he leaned down and kissed her forehead.
She needs you.
I can't watch her die.
Then don't. Save her! Take that fear and use it!
It was similar to what he had told her, when she was struggling with the interest they shared. When it was distracting her from the work at hand. Don't fight it. Don't bury it. Utilise it. Let it become an enhancement to your efforts.
His eyes snapped open, letting a tear splash down onto Anna's cheek. He took a deep breath as he pulled himself back together. He was Carl, the man who loved her. And Dr Teague, the professional. Both of them together, ready to do anything to save her.
* * *
Trish managed to establish the art-line in just a handful of seconds. As diminished as Anna's blood vessels were, the radial artery was easy to find. It was the one they palpated for a pulse, they all knew it by heart. They could find it, even if there was no heart beating.
Trish inserted the needle and hooked the line up to the monitor within just a single minute. She looked up to Carl for further orders. That was when she saw the clear conflict within him. She felt like an absolute fool. She'd come so close to losing her head, so close to falling apart completely. She was Anna's best friend.
Carl was so much more than that. The kiss he gave her was so tender, his tears so painful to see. Then she saw the shift in his manner. He stilled, the shuddering fear disappearing in an instant. He straightened up, looking straight at her, his eyes ablaze with something new. It took her a moment to realise that fire within him was determination. As frantic and desperate as the situation was, Trish felt a core of steel settle within herself.
By then Carl had already looked at the cannula in Anna's wrist, then the trace it reported to the monitor, a gentle bump each time Sarah's hands caved in Anna's ribs, squeezing her heart and pushing blood through her body. The flashing reading beside it was grim. 37 on top, a pair of dashes below. And that was with nearly four full units pushed in by the rapid infuser.
Trish followed his gaze as he then looked at Anna's bloody abdomen. Jessica had taken a bottle of iodine and had liberally splashed it over Anna's belly, an orange brown flood washing over the lingering scarlet swirls and becoming a deep dirty brown as it mixed with the fresh blood that trickled from the wounds each time Sarah sent an artificial pulse through Anna's body. The nurse used a small swab on a stick to spread the disinfectant, creating a wide area of yellow tinged skin for the surgeon. No one bothered with drapes, there wasn't time. What was necessary had been done, that was all that mattered.
Dr Edwards rolled over a trolley loaded with surgical instruments, not a full complement, but what they kept in the cupboards of the trauma room. For situations that were at least similar to this. Not even those bureaucratic types who managed and planned the trauma rooms would ever have expected the tools would be used to try and save the life of a nurse who had been stabbed in the very hospital she worked in.
It was a moot point now. One of their nurses, their best even, their colleague and their friend, was lying on that trauma bed, her heart stilled in her chest because she had lost so much blood. They couldn't allow it to stand. They had to do everything in their power to stop the bleeding, to get that small heart in that petite chest to beat once more.
Edwards had scrubbed up and donned a pair of cream latex gloves that reached almost to her elbow. In her hand was a gleaming scalpel. "Have that suction ready," she said, looking at the steady rivulet of blood being forced out by the compressions. "Two units at least." She told Jessica, who had just finished adjusting the large articulated lights over the trauma bed. The nurse quickly pulled a different trolley over then rushed through a pair of connecting doors to fetch a matching unit from Trauma 1.
Trish watched as Edwards stepped up to the side of the bed, taking a deep breath. It was clear that she could feel the tension in the room. "Hold compressions while I make the first incision." She said aloud. As soon as the rhythmic distending stopped she lowered the scalpel to Anna's belly, the insanely sharp blade seeming to meet no resistance as it cut through skin and flesh, drawing a thin red line across Anna's yellow stained abdomen.
* * *
Carl motioned to Lucy and Sarah to switch places, then watched as the surgeon cut through flesh and muscle, the thin red line rapidly thickening as she got through the final layer, the free blood in Anna's abdominal cavity rushing out. "Resume compressions!" Edwards commanded, then glanced to Jessica. "Hand me the retractors." Anna's belly began to bulge again as Lucy started to thrust down on her sternum, each compression forcing a gout of blood from the incision. The scarlet flow doubled when Edwards inserted the retractors, cranking them open to create a gaping hole into Anna's abdomen. Blood cascaded down her side, the existing stain on the white sheet beneath her shorn scrubs expanding in seconds, saturating the fabric to the point that Anna's blood began to drip off the side onto the floor.
"Get that suction in there!" Edwards shouted at Jessica, who had been momentarily stunned by the sheer scale of the flow. She started, grabbing the suction tube in one hand, flicking on the machine with the other, before plunging the end of the suction in to the turbulent crimson pool. The machine hummed, quickly drowned out by the slurping sound coming from the tube itself. Carl knew that much blood had to mean a completely severed artery. He felt his fear rising again but took it and pushed it towards action. He was moving towards the second suction unit when the door opened, drawing his focus.
It was the blood order. He diverted away from the suction, meeting the tech halfway, snatching the bag out of his hands. He took it to the counter, grateful to see Mark already moving over. He pulled open the bag, taking out 4 red bags and handing them off to Mark, who went to swap the near empty bags. There was another 6 units of blood still in there, along with 2 trios of different bags. He took one of each of those, spiking them with an IV line. While walking back to the bed he looked over at the tech. "Is there another batch ready to go?"
The tech nodded, but also shrugged, drawing an arch look from Carl. "We've got another full batch, but that's it."
"What? How?" Carl had to fight to contain the flare of anger. This was a major trauma centre, they should be carrying much more than 20 units of a single type.
"This is the third trauma patient in 2 hours with that type, plus a dozen surgeries through the day." He shrugged again, speaking with a blasé tone. "It's just bad luck."
Carl let his anger come through. He spun the tech to look at the bed. "That is one of the best nurses you'll ever see. One of the best people you'll ever see." The tech paled as he realised who was on the bed and saw the state she was in.
"We...we've already called the regional bank, a resupply is coming in an hour or so." The tech told him, dragging his gaze away from the intensive resuscitation efforts.
"Not good enough." Carl said. The regional blood bank was only 10 minutes away at a normal driving speed. "Call them again, tell them to have matched blood ready to go. Jones!" He called to the police officer who had until now been keeping out of the way of the medical professionals. "You know where the blood bank is?"
He nodded. "Donated there myself just last month." He said, already moving for the door, giving Lucy a quick glance before disappearing. The paramedic was too focused on compressions to acknowledge him. The tech was still stood there.
"Go!" Carl's voice wasn't loud but carried enough command to send the tech scurrying to comply, almost crashing into a green scrubbed young man pushing a cart through the doors.
* * *
Edwards stayed out of the discussion about blood, silently wondering if Carl's overstepping was going to cause trouble in the future. Not that she disagreed with anything he had done. The damage inside Anna's belly was severe. She was going to need a considerable amount of surgery to fix everything that had been caught by the knife and it would require a substantial amount of blood products. That was a secondary concern right now. Edwards didn't need to fix everything. She just needed to repair the worst of it and reduce the bleeding enough to get the nurse's heart beating again.
If only it was that easy.
The single suction unit was barely keeping up with the blood being forced out by each compression, it didn't have a chance of clearing the field. Edwards was able to make some headway with large gauze swabs, plunging them in and removing them seconds later, having already reached their limit. She was finally getting a half decent view when there was a commotion at the door.
"Steady on!" A voice she recognised exclaimed. She raised her head to see one of the surgical department's trainees dodging around the tech, finally arriving with the requested equipment.
"Zach! Get that tray over here then scrub in to assist!" She called, before turning back to the mess of Anna's insides. She hadn't cleared all the blood, but she had enough visibility to identify one of the major bleeds. Carl had come over and hung the additional bags running into the central line and was now looking to her. "Renal artery has been completely severed." She told him, before looking at Jessica. "Hand me a vascular clamp." The nurse kept the suction in place with one hand, reaching for a clamp with the other. "Next one along." Edwards told her, prompting the nurse to hand her the more suitable metal device. Delving deep with her fingers into the pulsating sea of blood, she followed the spilling vessel back enough to give her plenty to work with, then guided the clamp along the back of her digits and secured it on the artery, reducing that flow to a trickle.
Zach stepped up to the table opposite her, immediately operating the second suction unit, poking the end of the tube deep into the surgical opening. Edwards waited for a few moments. With two suction units removing blood, and the major artery no longer spilling it, the field should be clearing. The level of blood reduced somewhat. But not enough. Fresh blood was still pumping into Anna's abdominal cavity. Clamping the renal artery had only served to redirect it.
Edwards looked up at Carl, shaking her head. "There's another major bleeder, maybe more than one. It's just too much. I can't stop what I can't see."
Carl didn't say anything, couldn't say anything. The monitor continued to scream, the ecg showing an unbroken asystole. The blood pressure reading had barely changed, the line showing only small bumps. He looked at the clock. 3:57. Anna's heart had stopped 15 minutes ago. She was running out of time, and he was running out of options to do anything about it.
Getting back in the groove now, hopefully going back to work won’t completely wipe me out and I’ll still have energy to make progress. We’ll see. In the meantime, enjoy.
Story Index
Chapter 1 | Chapter 2 | Chapter 3 | Chapter 4
* * *
Anna could see nothing. Hear nothing. She felt no pain.
But she did feel something. Pressure. Deep, repetitive pressure in the centre of her chest. Enough to bend her ribs inwards easily. Chest compressions. Someone was manually pumping blood from her heart.
She was in cardiac arrest.
Is this real?
She couldn't tell. Maybe she was dreaming. She'd spent many nights dreaming of being under intensive resuscitation. CPR, defibs, artificial respiration. A whole team doing everything they could to keep her alive, to get her heart beating again.
Those dreams had never been so... terrifying. Flashes of memory, recent memory, came to mind. The gut-wrenching pain of a knife in her belly. A flood of red all around her. Carl's face, staring down at her with a fearful, heartbroken expression.
This is real.
She'd been stabbed. She'd bled out. And her heart had stopped.
More sensations. The pressure on her chest halted, then her whole body was lifted slightly, dropped a moment later. The compressions resumed, repetitive, almost hypnotic with so little else for her to sense.
A sudden spike of much more intense pressure broke through to her, on her leg. The same feeling, mirrored onto her other leg.
IO cannulas?
She must be in the trauma room now. They were arranging the rapid infuser, to give her more blood. Would it be enough? Or was it all too late? The compressions paused for a brief moment, only to resume. Something chill landed on her chest, joined by a twin a second later.
The compressions stopped again. Something landed upon the two spots, pressing hard. Paddles. The two chill squares must be gel pads. She was about to be...
A flash of white exploded in the darkness. Every muscle in her chest twitched in unison then fell still as her heart was jolted by electricity.
Defibrillated.
* * *
Carl pressed the buttons, the charge shooting between the two paddles, right through her heart. He watched her whole body spasm, as if the muscles in her chest had been plucked up then released. A short, sharp movement that spread her arms and legs wider.
He lifted the large black paddles off of the glistening orange squares, turning to look at the monitor. The ecg trace showed a large spike as the shock was displayed. It fell back to the centre line, which flattened for a second, before it returned to the chaotic squiggling that showed before the shock.
"She's still in V-fib. Push that epi and resume compressions for one minute." Carl said, prompting the team back into action. He turned to Mark. "Is someone from surgery on the way?" He asked.
The male nurse looked at him, taking an unconscious step backwards. Was he letting his emotions control him? Letting aggression into his voice?
"You called the code red, that includes a surgical consult doesn't it?" He asked again, reigning in his tone. Mark nodded. "Good, could you please find out where they are?" He said, pointing at the phone. "She doesn't have time." He whispered to himself as the nurse passed him.
Carl turned back to the trauma bed. Under the barrage of Jessica's compressions Anna's body shifted and flexed, her shoulders popping, head rocking gently beneath the mask of the ambu bag. Each time Sarah squeezed the blue bulb, Anna's chest swelled with the oxygen rich air, only for it to be pumped out by the compressions, forcing a soft huh, huh, huh, noise to emanate from her mouth.
He glanced over at the clock. 4 minutes. She's been down for 4 minutes. He grimaced, shaking his head as he reached out and grabbed her cold hand, giving her fingers a squeeze. Come on baby, come back to me.
"Charge to 300." He said to Trish, placing Anna's hand down gently on the bed before turning to grab the paddles again.
He held the paddles up as the whine behind him built, until finally it let out a double bleep.
"Everyone clear!" He announced, but the team was already raising their hands again. He planted the paddles on her chest and unleashed the second shock.
Anna twitched again as the shock coursed through her chest. Her arm flicked out to dangle from the edge of the bed. The alarm of Vfib cut out, silence reigning for a few endless seconds. Then the stretching whine began.
"Asystole." Trish muttered with a saddened moan.
Carl slammed the paddles roughly on top of the defib. "Sarah, take over compressions. I need to get her intubated."
* * *
Carl pulled open the airway drawer of the crash cart, grabbing the laryngoscope and a blade, clicking them together. He selected a 6.5 ET tube ripping the packing half open, then took a dark blue Thomas tube holder as well. He stepped around the bed, laying the tube and holder next to Anna's head. Trish had taken over compressions from Jessica, leaving Sarah still working the ambu bag. Carl opened the scope and flicked on its light, then tapped Sarah with his elbow. She gave one last hit of air then stepped to the side, dropping the bag on to the bed.
Carl slid into position, using one hand to tilt Anna head back and open her airway. He slid the blade between her gleaming teeth, mentally fighting to ignore her pale blue-grey lips. He advanced the blade, cranking back on the handle to open Anna's airway even further. Just like he had the previous weekend during their play. Again, he could see the vocal cords clearly, this time they were slack and lifeless.
"Cricoid on." He said, Sarah reaching over to press on the ring of cartilage around Anna's trachea, occluding the oesophagus behind. The last thing Anna needed right now was to aspirate. Sarah's other fingers helped to steady Anna's head as the compressions continued unabated.
Carl held the scope steady as he pulled the tube out of its packaging, shifting it in his fingers to line it up properly. He took a deep steadying breath, then plunged the tube into Anna's mouth, sliding it along the blade and pushing the tip between her vocal cords and into her trachea. She made no reaction. He eased it further into her airway, until the line marking 20cm was level with her teeth.
"I'm in, get that bag on!" He pulled the scope out, casting it to the side as he grabbed his stethoscope. Sarah removed the mask, connecting the bag to the tube and pumping it smoothly. Carl pressed his steth to Anna pale flesh, avoiding the electrodes, gel pads, and Trish's interlaced fingers as he moved the bell around after each breath. He clearly heard the steady whoosh of each breath entering and inflating Anna's lungs. It was the only sound he heard. Her heart lay silent and unmoving within her chest. "Good position."
He hung the stethoscope around his neck then picked up the tube holder, unravelling the strap and unwinding the plastic screw. He slipped it over tube, easing the integrated bite block between Anna's teeth and settling the foam rim over her mouth. "Where's that surgeon!" He shouted over his shoulder as he fed the plastic guide on the strap underneath Anna's neck, pulling it through and poking it through the clip. He secured the strap, then started to spin the screw to fully secure the breathing tube. "Well?" He finally looked over at Mark.
"They're saying she's already down here." The nurse said, looking fearful.
Carl shook his head, biting his lip. It wasn't Mark's fault. He had to remember that. He looked towards the trauma room doors. He knew where the surgeon would be. He felt his anger rising as he thought about who the surgeon would be looking at. "Trish." He said, his voice going cold, hard as steel. "I'll take over. Go to trauma 2. Bring that surgeon. Drag her here if you have to. On my authority." Other than the asystolic nurse on the table, Trish had the highest seniority. With his orders it would hopefully be enough. He straightened up, bringing his hands together. Trish waited for him to nod and pulled away.
Carl's hands landed on Anna's sternum. So cold. He drove the thought away, along with his fear, pushing them both into his hands, using them, to cave her chest inwards and squeeze her heart.
* * *
Trish was barely hanging on. She'd just given the most intense compressions she ever had. Her best friend’s life literally in her hands. And now she had to go and potentially argue with the clinical lead of the emergency department. She staggered back from the trauma bed, watching Anna's body shudder under Carl's, under her boyfriend’s, brutal chest compressions. She couldn't give anything less. A steel she never realised she possessed ran through her veins. Her trembling hands stilled. The tears prickling her eyes cut off as if a tap had been closed. She spun on her heels, storming through the doors of the trauma 3, and God himself help whoever got in her way.
She crossed the corridor in three strides, channelling an action hero as she kicked open one half of the paired doors. Her eyes took in the entire room in a quick scan, locking on the lone green scrubbed individual. The others were busy, but not "our patient is actively dying" busy. The green scrubbed doctor was talking with Dr Stelling, standing by the lightboxes where a series of x-rays were displayed. Stelling could be fearsome. Yet right now, something far worse was happening a dozen paces directly behind Trish. Stelling could rage and rant, and Trish knew she would stand fast. It would have been intoxicating, if it wasn't so necessary.
Trish walked over, dodging around Kristie, who only just caught the look on her face and pulled up short, but too late to intercept the determined nurse. Trish drew level with the pair of doctors and didn't wait on propriety. She sidestepped in front of Stelling, facing the surgeon with a quick glance down at the name tag.
"Dr Edwards. You are needed in Trauma 3. Now." Trish said in a clear voice.
The nurse knew it was coming. "Excuse me Nurse Fielding!" Dr stelling exclaimed. "Dr Edwards is presently occup..."
Trish spun blazing with justified insubordination. "Your patient is stable. Yes?" She said, her voice low, yet also carrying right the way across the trauma room. "Dr Teague's patient is not." She turned her back on Stelling once more. "You are needed Doctor." Each word was stressed and sent a shiver down the spine of every medical professional present. It wasn't something anyone could specifically identify. But it was clear all the same. Something terrible was happening.
The surgeon stared at her for just a moment, then nodded. They both moved, Trish and Dr Edwards, at the same time, leaving Stelling behind.
"What patient?!" Stelling shouted after them.
Trish didn't answer. There was nothing she could say that wouldn't cause the entire team to rush to Trauma 3. She wouldn't blame them. The hate she felt for the barely conscious figure on the bed of trauma 2 was new to her. But it was still a barely unsurmountable obstacle. Technically nurses didn't take an oath to do no harm. But it was implied, and there were certain codes of conduct. Right that moment, Trish would have happily walked over and personally throttled the scum who had attempted to murder her friend. He may yet have succeeded.
* * *
Carl couldn't look down. If he looked down he would see her. Anna. Lifeless, intubated, her heart forced to beat by his own hands. They'd both wanted this, Anna especially. But not like this. They'd wanted a clean fantasy. No danger. No risk. This was nothing like that.
This was real.
Her heart had come to a complete standstill.
If he failed to keep forcing her sternum down, squashing her heart against her spine, sending blood through her body, she would die.
His eyes looked around the trauma room, trying to find anything else to focus on. The big screen of the monitor showed a flatline above the slight pulses his compressions caused. The clock showed him that she had been without a pulse for 7 minutes already.
His gaze locked on the doors. He needed a surgeon. Without someone to stem the bleeding, he couldn't save her. He knew some procedures. He was already tempted to use them. But they wouldn't make any difference if she was still haemorrhaging from her abdomen. He knew the theory, where everything should be. But he didn't have the practice, and there were definitely blood vessels spilling out where they shouldn't. Maybe he'd seal the right vessel, eventually, after wading through the freely flowing blood. But by then though, Anna would be ... gone.
He concentrated on giving her the best compressions he could. Deep. Fast. Steady. His stethoscope flicked and bounced as it hung around his neck, distracting and irritating. He transitioned to one handed compressions for just long enough to pull away the steth and cast it onto the bed beside Anna’s gently rocking head.
Finally, he saw a flicker of movement in the corridor. Trish's blue scrubs, closely followed by surgical green. The surgeon came through the doors backwards, peeling off her gloves as she did, heading for the bin without even looking over.
"This had better be good Carl. Pissing off Stelling rarely ends well." Edwards commented as she dumped her gloves and took a new pair from the box on the wall. She turned to look at the bed and stopped, eyes widening as she saw the sky blue of the cut scrubs beneath the naked body on the bed.
"It's Anna." Carl told her, almost choking on the words.
Edwards looked at him, and the nurses, seeing their expressions. She advanced on the bed, shaking off the shock and becoming clinical. "What happened?"
"Two stab wounds to the lower right abdomen. She lost at least 2 litres of blood. Hypovolemic shock leading to cardiac arrest. She's been down for 8 minutes." Carl managed to say as he kept thrusting his hands down between Anna's breasts. "You need to stop the bleeding so we can restore her volume."
Put like that, it sounded simple. Except none of them had any idea of precisely what the damage was. If it could even be fixed, let alone if it could be fixed in time to save her.
Edwards didn't say anything, she skirted around the bed, waving Lucy out of the way. The large gauze pad had soaked through with Anna's blood, overwhelmed to the point that it had run down her side, forming a crimson circle on the white sheet beside her. Edwards peeled away the gauze, letting out a grimacing moan.
"Cross match on the way?" She asked, probing the wounds.
"Yes, FFP and TXA too." Carl told her. Edwards nodded.
"Good. There's at least one arterial bleed. I'll need to open it up wider to see just how bad it is."
I’d planned to have this chapter ready for New Years Day. Then i got the flu. Pretty badly. Close to hospital stay badly. It certainly put paid all my plans for New Years at any rate. Instead of a 5 course meal and a few drinks, I had some dry toast and a shot of Night Nurse. It’s still lingering a bit, like a hangover, but the worst is past and I can function again, so here I am with chapter 4. Hope you enjoy.
Story Index
Chapter 1 | Chapter 2 | Chapter 3
* * *
Trish's mind was still a blur from the last few minutes. Recognising the locket that had struck her back. Falling behind Carl as they both dashed up the stairs. Seeing him cradling her best friend, then realising Anna was covered in blood. She'd followed Carl's orders more out of trained instinct than any conscious decision, rushing back down the stairs, only just avoiding tripping at one point. She'd burst out of the stairwell into the trauma wing, shouting for help, but those nearby were too pre-occupied with their chaotic work in Trauma 2. They'd also taken the drop kit that hung on the wall.
She had crashed through the double doors into the main foyer of the trauma centre, barking at the nurse’s station to call the code red and alert the blood bank. She was still running to the front entrance, for the grab bag that was positioned there. Sarah intercepted her. "Trish, Dr Stelling already put a blood order in?" The younger nurse said, the question in her voice.
Trish stumbled to a halt. "It's not for..." She couldn't bring herself to say his name, "him. He...He stabbed Anna!" She cried aloud.
Everyone paused for an eternal moment, staff gasping in shock, patients confused and concerned. Trish took a shuddering breath, on the edge of breaking down completely, when a steady, authoritative voice joined a hand on her shoulder.
"Where?" Jones' single calm word grounded her.
"The top of the stairwell, by the helipad." Trish said. Jones looked to Sarah, who nodded, knowing where she meant.
"Lucy!" He shouted in the direction of the front door. Trish looked over seeing the paramedic already grabbing the kit from its alcove.
"Jessica, get a gurney!" Sarah shouted in another direction. "Mark, call that Code Red to Trauma 3 then get there yourself!" He was senior to her, but he didn't argue, reaching for the phone.
Trish was barely following their actions, trying to process everything. Jones pushed her through into the trauma wing, to the elevators, hammering the call button. "Focus." His solid tone got through to her. "She needs you." Trish blinked a few times, then nodded. The others had caught up just as the elevator arrived and they piled in, Trish claiming the grab bag from Lucy.
The elevator took an agonising eternity to lift them to the top floor. As the door opened and they stepped out, Trish could tell it was as bad as she had seen from the stairs. Worse even. But the limited time she'd had to process the situation was enough for her to act while the others froze behind her. She stepped forward and threw the bag down to cause a loud thump. It had its desired effect.
Hearing Carl describe Anna's situation and seeing her friend's pale blood-stained chest shook her, but she clung onto Jones' words as best she could, even when she pressed the gauze against Anna's abdomen and got no response to what would have been agonising pain.
While the others got ready to lift Anna onto the waiting gurney, Trish kept her hands pressed tightly to the wounds. On Carl's order they lifted their colleague, her sheared scrubs still hooked around her arms, onto the gurney, raising it up a moment later. They gathered the equipment and began to move towards the elevator. Trish glanced back.
She wished she hadn't. The pool of blood was big. Mortally big.
* * *
As they pushed the gurney towards the elevator Carl was keeping one eye on the monitor, and one hand on hers, but his gaze shot to Anna's face when he heard a tiny whimper. For a moment he thought he had imagined it, but then he saw the mildest flutter of her eyelids.
"It's ok Anna, I'm just helping you breath." Sarah told her, leaning close over her head as she closely followed the gurney, squeezing the ambu bag smoothly.
Carl felt a flutter of relief. She was still responsive. Once they got the rapid infuser connected they could stabilise her and get the surgeons to fix the damage. It was wishful thinking. As the elevator doors closed, the monitor let out a warning tone, that switched to a full-on alarm before Carl could even read the screen. The ecg was still flickering away with a rapid rhythm, but the pulse reading had flattened.
"Pulse check!" He shouted, as he grabbed her hand, reseating the finger sensor in the vain hope that he had accidently dislodged it. The screen didn't change. He looked at the others, the pained expressions on their faces telling him before they could even shake their heads. Anna's heart was no longer pumping blood.
"PEA arrest! Get on her chest!" He commanded Jessica, trying not to scream as he reached for the shears in the bag.
Lucy steadied the tall nurse as she climbed up to kneel beside Anna, weaving her hands together, waiting just a moment for Carl to snip the centre of Anna's bra the bottom edge lined with wet red. The cups popped apart, clearing her sternum, replaced an instant later by Jessica's hands, which immediately thrusted down, bending Anna's ribs inwards and compressing her heart.
Carl was again reminded of their play session the prior weekend. His half compressions making Anna's belly pop in a counter rhythm. These compressions were real. Each 2-inch pump forced Anna's entire slim abdomen to bulge. They came at such a rapid rate that it produced an effect akin to rolling waves across her ghostly flesh, with enough force to pop Trish's hands as they held the bandage tight to Anna's wounds. Carl tore his gaze away from his love's distending stomach, looking instead to the monitor.
The ecg waveforms were becoming unstable, the lack of a true pulse and the savagery of Jessica's compressions turning the electrical rhythm into a chaotic storm of spikes. The reading from the pulse ox was marginally more encouraging, the compressions producing waves on the line. They were small, but at least they were there.
"Tell me the rapid infuser is waiting for her." Carl said, looking at Trish.
Before she could respond, Sarah spoke from Anna's head. "Mark is on it, Trauma 3. It'll be fully loaded with O-neg." She said. The detached medical professional inside Carl was impressed by her confidence. The emotional part merely prayed that she was right, concerned only for the beautiful woman that was in cardiac arrest before them all. He lowered his head, gripping the rail of the gurney, the alarming noise of the monitor that filled the compartment cutting through his soul. He took a breath, unintentionally synchronising with the woosh of the ambu bag as Sarah squeezed it firmly, grasping for the professional side that Anna needed right now.
"As soon as the door opens we move. Jessica get a more stable position." He said as he looked at the display above the elevators control panel. Jessica finished 30 compressions, using the brief interruption of another bagged breath to loop a knee over Anna's hips, straddling the dying nurse.
The display ticked over. The elevator rumbled to a stop, letting out a ding as the doors started to slide open.
* * *
Geoff, a member of the facilities team at Riverside hospital, kept himself to himself. He was good at cleaning. Meticulous even. He should take pride in it, others would say. It seemed a strange response to him. Everything had a proper state. He just got things back to how they should be. He had just finished cleaning up Trauma 1 and was moving down the corridor. Apparently there was an incident in the stairwell that needed cleaning. It didn't bother him. Better to be doing something than sitting around. A lot of the others, especially his boss, complained when the medics called for something. Geoff didn't. It gave Geoff a good reason to not sit around with the complainers. He was playing a tune in his head, his fingers tapping the handle of his cart, he didn't know what it was called, he'd only caught a snippet on the radio in the office, but it was catchy. He turned, about to push the stairwell door open with his hip, dragging the cart behind him, when there was a ding from the elevator just a few yards away.
"Move! Move! Move!" Geoff heard the shouting first. Then the screeching alarm. It was a lot of noise. He didn't like noise but working here he was used to it. He did what he was always did. Get out of the way, and let the noise move away from him. He pulled the cleaning cart parallel to the wall, giving them as much space as possible. A gurney was pulled out of the elevator, making an impressively quick turn to head down the hall. Someone was riding on top of it.
That was odd. Not unknown, but odd. It made Geoff pay extra attention. The gurney was big, hard to accelerate. Geoff rarely paid attention to patients, their problems were their own, not his. But that gurney spent so long in his view, that he couldn't help but see the person on it. He would have just let it slide beyond him, gazing past it, except he saw a particular shade of blue. A very familiar shade of blue. He was surrounded by it every day, nurses coming and going. Asking him to do x, y or z. They were usually beside a gurney though. Not on it.
It piqued his attention even more, in that brief time. He noticed the blue giving way to black. Again, that black was common enough, as spots and splashes. That much though. That wasn't normal. Especially next to bright vibrant red. Something was very wrong. The gurney built up speed as it passed him, and he got a momentary look at the face of the person on it. Even with the rubbery mask over her mouth and nose, he knew those eyebrows. That hairline. It was one of the nurses. One he liked. One of the kind ones. She didn't treat him as something less. She never shouted or snapped her fingers, but she also didn't assume he was stupid. He was different. He knew that. But she treated him like he was at least close to normal. She told him what she wanted him to do, clearly, but without being condescending. He enjoyed doing those jobs for her. It would be nice if she was his boss instead.
And yet now she was on a gurney, with another nurse on top of her, hands pressing on her chest. The annoying alarm coming from a machine that had a group of wires connected to her. It was a bad sound. He knew that much. Something bad had happened. To her. Geoff hesitated. He wasn't sure what to do. He froze, watching the gurney as it rushed down the corridor toward the other trauma rooms.
Geoff didn't know what to do. Obviously he couldn't go and help. He'd just be in the way. He should be doing as asked but couldn't seem to open the door. Someone stepped up close to him, dressed in a lot of black. Or was it dark blue? He said something, a stony expression on his face, like a gargoyle, but everything had happened so quickly, Geoff was still confused. The man in black looked at him for a moment, then his face became human.
"Can you stop anyone from using the stairs, until I get some tape?" The man in black asked him.
"I was meant to clean something." Geoff stated. That was what he'd been asked to do.
"I know." The man in black nodded. "Can you stop anyone going in until I tell you though? It's important."
Geoff considered it for just a moment. The man in black seemed distracted. Geoff felt distracted too. He wondered if they were distracted by the same thing. "I can do that." Geoff told him, nodding in reply to the nod of the man in black. It seemed weird to him, bobbing your head to say yes, but he'd learnt what it meant, and it seemed to help when talking to other people.
"Is er...Is she going to be ok?" Geoff was surprised at himself. He didn't usually ask questions, but she was nice. He liked her. She should be ok, right? Being nice was a good thing and more good things happened if you were good. Right?
"I don't know. I really don't know." Officer Stone replied, his voice strained and weary, watching the gurney pivot and crash through the doors into trauma 3.
* * *
The double doors clattered open as the gurney slammed against them, swinging back easily as hands reached out to push them further. The team lined the gurney up next to the trauma bed, dropping the rail.
"Get ready to move her over." Carl ordered, watching the team take up position around the beds. Sarah dropped the bag, uncovering Anna's slack, pale lips. Trish maintained pressure on the bandage and Jessica continued compressions from on top of Anna's lifeless body. Everyone else reached under her, supporting her shoulders, waist and legs. "Ready Jess." Carl said, the young nurse nodding.
"27...28...29...30!" Jessica counted out, before un-straddling Anna, getting out of the way of the others.
The team half lifted, half slid Anna across to the wider trauma bed, her blood-stained clothes dragging along with her. Trish was leaning across the gurney, keeping her hands on Anna's belly until Lucy, stood on the other side, reached over and replaced her. Jessica shuffled across to kneel beside Anna, resuming compressions just a few seconds after she had stopped. Carl disconnected the monitor, grabbing the wires and leads to plug them into the bigger monitor that hung over the trauma bed as Jones removed the unneeded gurney.
"Cut the rest of her clothes off!" Carl commanded. "I want full peripheral IV's, both arms, both legs. Is that infuser ready?" He asked, looking at Mark. The nurse shut the last container and nodded. 4 bags of O-negative blood ready to be forced into Anna's body, to replenish what she had lost. "Rush a sample for cross matching." Carl told him.
Trish ran some shears down Anna's black pants, reducing them to ribbons. Her shoes were pulled off along with her socks, baring Anna's feet. A couple of snips took care of her underwear. Carl fought his own shears through the looped fabric over Anna's shoulders. Within a minute of giving the order, Carl was looking down at Anna, the love of his life, lying totally naked before the team. She'd always been pale, long hours and night shifts precluding any sort of decent tan, especially at the tail end of the winter months. Now she was beyond pale, her body effectively drained of colour. Because it was drained of blood the bright crimson trails on her skin the only thing that wasn't a ghostly grey.
"Use the IO gun." Carl told Trish, as he grabbed Anna's limp arm and an IV kit, poking the needle in quickly. He grabbed the lines from the infuser, hooking up the first two, looking down at Anna's legs as the IO gun punched a wide bore access into her thigh bone. Trish reloaded the device as Mark secured the cannula taking another line from Carl to connect it. The second IO port was done in 30 seconds, the rapid infuser switched on to pump blood down all four lines into Anna's body.
"Pulse check after this cycle." Carl said, as he stepped back to grab a pair of purple gloves, sliding his hands into them.
Jessica beat down her hands, crushing Anna's sternum five more times before pulling back slightly. Hand pressed into pulse points at Anna's neck, wrist and inner leg, as every head looked up at the large monitor. The waves of the compressions disappeared from the pulse line, the chaos of the ecg trace also reducing. It still squiggled randomly.
"V-fib on the monitor. Charge to 200 and hand me the gel pads! Continue compressions and get a round of epi ready!" Carl said, taking a slim packet from Trish as she turned a dial on the defibrillator that sat upon the crash cart. Carl ripped the sterile packaging, peeling a shiny orange gel pad from the backing, placing it next to the electrode on Anna's right shoulder. The other he nestled on her side, just beneath her left breast. Pads in place, he turned and grabbed the large black paddles from the machine that was letting out a rising tone as its capacitors charged.
"Charged at 200!" Trish announced as the defib let out a double beep.
"Everyone clear!" Carl looked across Anna's body. Jessica had slid off the bed, Sarah held the ambu bag in the air, and Lucy raised her hands.
Between food comas, hangovers and family visits I managed to find some time for writing. Enjoy :)
Story Index
Chapter 1 | Chapter 2
* * *
Anna could feel the tears trickling down her cheeks. Carl was here. He came. But it was too late. She could feel herself slipping away. Darkness was tickling the edges of her vision, like some terrifying reversed halo. The sudden spike of pain when he pressed their joined hands over her wounds had brought a sharp clarity for a moment, that rapidly dwindled. Carl was looking towards the stairs, his mouth moving. He was shouting, but she couldn't decipher his words, her mind too foggy. He looked back down at her. He was talking again, to her. She forced herself to focus again. It was getting harder each time.
"...on its way. You hear me baby, more help is coming. You just need to stay awake." He begged her, hand cupping her cheek, fingers cradling her jaw while his thumb gently stroked the tears from one eye.
Anna tried to shake her head, but she was too weak. "Tired." She whined, surprised at how weak her voice sounded. Not tired. Dying. Part of her mind whispered. Who knew your own thoughts could sound distant?
"I know. I know baby, but you have to stay awake. Can you do that for me?" Carl had leaned closer; his face was the only thing her enclosing vision could see now. She gave a tiny nod. Without a hand on her cheek, he wouldn't have been able to tell. He smiled at her, trying to be reassuring. Even in her current state, Anna could see the fear behind it. "That's it." He told her, giving her hand a soft squeeze that she could barely feel. Her heart was becoming an insignificant accompaniment in her ears. Taptaptaptaptap. With the occasional failed beat, a random skip. Taptap...tapap...taptap...ap...taptap....tapa...pap....taptaptap.
"C...old." She sighed out.
"I know. I know." Carl repeated, glancing down her body and beyond. He was looking at all the blood that she'd lost. He grimaced, his own eyes sparkling with tears. He shook his head, looking back her. "We're going to make you feel warm really soon Anna. I promise."
Anna sobbed, or at least tried to. It was like a hitch in her breathing. She was going to die in his arms. Better than alone. One part of her mind said. But it'll hurt him so much. Another replied, before both faded away into silence. She looked at him, taking in his face, doing everything she could to focus on every little detail as the shrinking darkness threatened to swallow her whole.
"S...Sorry." She gasped out.
She felt her body attempt to replace the air in her lungs.
It failed.
* * *
Carl had seen her eyes twitching and shifting while still gazing up at him. He knew she was taking what might be her last look at him.
"S...Sorry." She said, her voice so quiet and hollow.
Carl swallowed a sob, gently shaking her head. "Don't be sorry. Please don't be sorry." He pleaded with her. Her eyes were losing focus and he realised her chest was still. "No. No. No. Stay with me Anna!" He shouted at her. His fingers bent around, pressing against her neck, looking for her carotid pulse.
It was there. But it was so weak. A tremulous fluttering. Pease keep going. He had to do something. If she was too weak to breath, he would have to take over.
He shifted to a better angle. He couldn't take his hand off her wounds. He would have to improvise. He used his other hand, the one cradling her head, to tilt her head back and open her airway wide. He leaned over, bending in half as her head still rested on his leg. He couldn't pinch her nose, so instead he opened his mouth wide, sealing over her blueing lips off centre, to block her nose as much as possible. Her lips were cold enough to leech the heat from his own.
He blew the breath into her.
They'd done this before, plenty of times while indulging in their shared fantasies. This wasn't a fantasy though. He'd become so used to the slight moment of resistance before she accepted the breath, that when he forced his breath into her and her lungs expanded readily, without a reflexive rejection, that he was surprised. And terrified. She really was slipping away from him.
"Come on!" He shouted upwards in frustration. He needed, she needed, more help to arrive.
Anna let out a whimper as the breath eased out of her lungs, her eyes seeming to brighten.
"It's ok. It's ok baby." He told her, before taking a deep breath and repeating the life-giving kiss, making her lungs swell with his air again. He could feel her lips twitching beneath his own.
He broke the seal, lifting his head, looking down at her. She was clearly fighting to focus her eyes on him. Her mouth was moving, too weak to make sounds.
But it was words.
Three words.
The same three words over and over.
I love you.
Something splashed on her cheek and Carl realised his own tears were flowing freely now.
"I love you too Anna." His voice cracked. "I love you."
Her eyes were fading again. Carl took a deep breath, shaking his head softly.
"No." His voice steadied. "I'm not letting you go!"
He leaned in, forcing another breath into her, giving her his air to keep her with him.
A mechanical rattling began to emanate from the elevator shaft.
* * *
What was left of Anna consciousness was trapped in her own mind, on the cusp of unravelling entirely. She was dimly aware of Carl giving her more breaths, her body feeling almost disconnected now. She suspected it wouldn't be long before she felt nothing at all. Those first breaths had let her tell him though. Her last words would be a declaration of love. She took some measure of solace from that.
Carl kept on breathing for her, willing the elevator to move faster, to get the others here. He reached with his fingers again, relieved that he could still feel that faint pulse in her neck. He took another glance at her face as he raised his head to inhale. Her eyes were half-lidded, staring at the ceiling without focus. He was forcing another breath into her lungs, feeling her chest rise as it brought her belly with it, when the rumbling of the elevator stopped. A few moments later, the elevator dinged, and the doors slid open.
Trish led the newcomers out of the elevator, the drop kit slung over her shoulder. Following her and guiding the gurney were Jessica and Sarah, along with, surprisingly, the paramedic Lucy and Officer Jones. Trish already knew what they would find, but the others seemed to stumble in unison as they saw the scene on the landing. Anna laid there utterly lifeless, her scrubs consumed by a black stain, connected to the expanse of crimson on the floor beside her. Another pool closer to the stairs, connected by the streak she'd left as she'd tried to drag herself towards the elevator the team had just left. The thump as Trish dropped the drop kit dragged them back to the moment.
"Two penetrating wounds to the abdomen, four-inch blade." Carl's voice, through considerable effort, was steady. He looked directly at Jones and nodded back to the stairs where he had seen the knife. "She's lost at least two litres of blood. Pulse is rapid and thready. She lost consciousness and stopped making respiratory effort 90 seconds ago." He told them as the nurses and paramedic spread around Anna's body, Trish unzipping the drop kit. "Sarah, I need you to bag her. Trish, get a gauze pad and be ready to put pressure on these wounds. Jessica we need a line in ASAP. Lucy, can you lower the gurney, we need to move her downstairs and get the rapid infuser going immediately. Hand me some shears."
Trish passed out the ambu bag, IV kit and tore open a gauze packet. Jessica handed over a set of safety shears from her front pocket. Sarah knelt by Anna's head, taking the ambu bag and ripping it out of its sterile packaging. She connected the mask and pressed it over Anna's mouth and nose, squeezing the bulb. She gave two breaths before pulling the drop kit closer, reaching in to take out a small oxygen cylinder.
Carl, one hand still pressed over Anna's belly, cut awkwardly down the centre of Anna's scrubs and the once white undershirt beneath. He cast open the half his hand wasn't over, waiting for Trish to be ready with the gauze. Her hands were trembling. Carl bit back on his frustration. He was barely holding it together himself, seeing the skin of Anna's chest and abdomen, terrifyingly pale under the red stains. When Trish finally gave him a nod he pulled away, taking his coat off the wound and spreading the other half of Anna's clothing in a single motion. He unlinked his fingers from Anna's limp digits, giving her hand a squeeze as he dropped the coat that dripped with her blood.
Trish pressed the gauze to Anna's belly with both hands, while Carl shuffled behind her and grabbed the basic monitor from the drop kit. He unravelled the leads, quickly dotting them around Anna's chest, then took the pulse oximeter and clipped it onto her finger. He watched the screen as the readings came in, his head dropping when he saw the disparity between the ecg and the pulse ox. Anna's heart was trying to beat nearly three times a second. It was only sending a pulse through her body every other attempt.
He looked up, seeing that Jessica had managed to get IV access in one of Anna's arms. "Get that blood in, she's barely perfusing." He commanded.
They'd done all this in a short time. Jones was only just coming back up the stairs, Kevin's knife sealed in an evidence bag. Carl looked around the team, they had done everything they could up here. He waved Lucy to move the gurney closer. "Let's get ready to move her."
* * *
Anna knew help must have arrived. She couldn't place any sensation specifically, but there were enough of them that there must have been at least two more people other than Carl. Slowly she felt herself coming back together. Between the consistent oxygenation and the trickle of blood into her body she regained some awareness.
She felt hands all over her, lifting her into the air before dropping her roughly onto something. A gurney. She thought.
She began to see something. It wasn't clear, just light and shadow, but it was better than the darkness. Her eyes must have fluttered because sounds too were coming back.
"It's ok Anna, I'm just helping you breath." Whoever was above her said. The words didn't actually make sense to Anna, but she was able to recognise they were words.
The lights shifted, changing in colour tone. It seemed more enclosed too. The elevator.
For a moment she wondered if perhaps she was going to make it after all.
Then she became aware of her heart beating in her ears.
