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.
Chapter 1 | Chapter 2 | Chapter 3 | Chapter 4 | Chapter 5 | Chapter 6 | Chapter 7 | Chapter 8
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.
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."
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.
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.
Her mental voice had barely the strength of a whisper.
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.
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.
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.
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.
All those dreams of times with Carl. Of love. Family. Life.
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.
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.
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.
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.
Carl finally breathed again, his brain buzzing as thoughts ran into one another. But that was the most important one.
"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."
"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 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."
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.
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.
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.
