The Sunflower: A Novel (3 page)

He smiled. “Tempting.”

“It would make my mother’s Christmas. She’s always wanted me to bring home a doctor. And a handsome one at that.”

Paul smiled. “Thank you.”

Just then Kelly stepped into the room. “Doctor, paramedics are in transit. We have a child with respiratory distress.”

He continued suturing. “Where’s Doctor Garrity?”

“We had a code blue on the floor. A woman went into arrest while delivering a baby.”

“What’s the ETA?”

“About two minutes.”

“Is the child still conscious?”

“Yes.”

“What’s his oxygen saturation?”

“It’s dropping. It was eighty-eight percent at the house, now it’s down to eighty-two.”

Paul frowned. “What happened?”

“Possible aspiration of an unknown object. The parents and the paramedics tried the Heimlich, but it didn’t help.”

“Tell the paramedics to get an IV going but don’t delay transport.”

“I’ll call.”

Paul looked up at Lily. “I’ll have to leave when the child arrives. I don’t think I’m going to finish this in time. Will you be okay?”

“Yeah.” She was quiet for a moment. “When I was a teenager, I was babysitting a neighbor kid when she choked on a cinnamon bear. She finally coughed it out, but it scared me to death.”

Paul tied off another suture. “Choking always scares me.”

Just then Ken entered the room. “Dr. Cook, we’ve got a cardiac arrest in transit.”

Paul groaned. “When it rains, it pours. What’s the ETA?”

“Five minutes.”

“Status?”

“Paramedics are performing CPR. A forty-two-year-old male who was out shoveling snow when he collapsed.”

Kelly stepped in behind Ken. “Doctor, the ambulance with the child is here.”

He set down the needle, lifted the scissors and snipped the tourniquet. He looked up at Lily. “I’ll be back.”

“Good luck.”

He said to Kelly, “Wrap her with some gauze, then come help me.” He walked out into the hall as the paramedics brought in the child. He was a small boy of three or four. His face was bluish and his eyes were open and wild and a large paramedic struggled to hold him as he flailed wildly, the end of the IV tube whipping with his motion.

“What’s our oxygen saturation?” Paul asked.

“Seventy-nine.”

“Give him to me.” Paul put his arms around the boy and began the Heimlich. Nothing.

“Get him on the table. Get him monitored.”

Just then a woman burst through triage into the E.R. screaming “Where’s my boy?”

The triage nurse had unsuccessfully tried to grab her arm as she passed and she was now following her. “Ma’am, we need you to stay out in the lobby.”

“Where’s my boy? I’m not leaving my boy.”

Kelly arrived. “Dr. Cook, the boy’s mother…”

“Let her back.”

Kelly shouted down the hall, “This way, ma’am.”

The woman ran to where they had gathered around her son. She grew even more panicked at the sight of him. “Do something…please!”

Paul asked, “Do you know what he swallowed?”

“No. He was just playing under the tree.”

“Were there small ornaments?”

“I don’t know. Just take it out! Take it out! He can’t breathe!”

Paul turned to Kelly. “We’ve got to sedate him. Give me one milligram of Versed.”

She injected it into the IV but the boy continued to fight against the men holding him.

“Saturation dropping,” Kelly said.

“The Versed’s not enough. What’s his saturation?”

“Seventy-five.”

“Great,” he said caustically, “I’ve got to find out what he swallowed.” He turned to the mother. “How much does he weigh?”

“Uh, uh, thirty pounds.”

Paul did the math in his head.
One milligram per kilogram.
“Kelly, get me fifteen milligrams Succs.”

Just then the sliding doors opened and a frigid gust of wind flooded the hall. Two paramedics in thick boots tramped inside pushing a stretcher with a man strapped to it. Marci walked up, her antlers gone. “Doctor, paramedics are here with the cardiac arrest.”

“Where’s Garrity?”

“Still on the floor.”

“You’re going to have to help me, Marci. What room’s open?”

“D. Delta.”

“Take him there and keep the CPR going. What’s his rhythm?”

“V-tach.”

“Have the paramedics shocked him?”

“Two hundred, three hundred and three hundred sixty joules.”

“Give him a milligram of epinephrine, wait one minute and if he’s still in V-fib, shock again with three hundred and sixty joules. Kelly, where’s the Succs?”

“It’s ready.”

“Saturation’s fallen to seventy,” Ken said.

“Get me the intubation kit.”

“Right here.”

“Okay, guys, let’s do this. Give him the Succs, Kell.”

Kelly pushed the syringe. Within moments the boy went completely limp. The woman screamed, “You killed him! You killed my boy!”

“He’s not dead, ma’am. Medic, please take Mom to the family waiting room.”

“I brought him in alive! He was alive! I love you, Stevie.”

“He’s still alive, ma’am,” Paul said, “He’s going to be all right.”

The paramedic took the woman by the arm. “I need you to come with me, ma’am.”

“I love you, Stevie. Mommy loves you,” she sobbed as she was led away.

Paul inserted the laryngoscope into the boy’s mouth and lifted his jaw, exposing the vocal cords.

Marci walked back into the room, “Doctor, we need you, the patient just vomited and the paramedics can’t get him intubated.”

“I can’t leave, suck out the vomitus and bag him until I can get there. Kelly, get me the…” Kelly handed him the forceps before he could finish. He reached down the child’s throat. There was a spot of color among the vocal cords. “There it is.”

“Doctor,” Ken said, “Saturation’s at sixty-eight.” Just then the heart monitor started beeping. “He’s bradycardic,” Ken said.

“What’s the rate?”

“Thirty.”

“Ken, start CPR. Kelly, two-tenths milligram of atropine IV and get a six ET tube.” He clamped the forceps on the object and slowly worked it out of the vocal cords. It was a small toy soldier. He dropped the toy and forceps on the bed tray. “Ken, where are we?”

“Nothing.”

“Tube, Kelly.”

She handed him a narrow, plastic tube. He passed it between the boy’s vocal cords, then stopped to listen. “Breath sounds, end tidal CO2 are good. Kell, hyperventilate him.”

“Doctor,” Ken said, “he’s in V-fib!”

Paul felt for a pulse. “I’m going to shock him, Ken, the pads.”

Ken pulled the boy’s shirt up and stuck pads to his chest, clipping wires on with alligator clamps. “Ready.”

“Charge to twenty joules, all clear.” The tiny body jerked.

They all looked to the monitor. Nothing.

“Charge to forty joules, all clear.” Another jump.

“Saturation’s up to ninety, Doctor,” Kelly said.

“We’ve got oxygen, if we can just get this heart beating.”

“Still nothing,” Ken said.

“Ken, CPR. Kelly, epi two-tenths milligram IV.”

Ken began massaging the boy’s chest. Paul stared at the monitor, “Come on, come on.”

“Come on,” Kelly echoed.

Paul turned back, “Forty joules. Again. Clear.”

Marci was again standing at the door. “Doctor, what do you want to do with your patient in D? We can’t intubate him, we’ve shocked him six times, three doses of epinephrine and we’re up to a hundred and fifty milligrams of lidocaine.”

A bead of sweat rolled down Paul’s temple to his jaw. “Are there any other docs in the hospital who can help us?”

“We’ve paged overhead but no one’s responded. We’ve called Dr. Mabey at home, but he can’t get here for twenty minutes.”

“This will be over in twenty minutes. Ken, continue CPR. I’m going to D for thirty seconds.”

He ran the forty feet to D. Inside the room a slightly overweight man lay on his back, his shirt cut off of him. There were two paramedics; one of them was pumping on the man’s chest while the other watched. Camille, the respiratory therapist, was holding a mask over the man’s face and compressing a large bag to force oxygen into his lungs. Paul quickly scanned the cardiac arrest record trying to analyze what had been done and what still could be done. All looked to him, their eyes revealing their helplessness.

“Marci, give him another milligram of epi, wait a minute and then, if there’s no change in rhythm, shock him again with three hundred sixty joules. Set me up for an intubation. I’ll be right back.”

Paul ran back to the other room. The boy’s face was an ugly blue. “Where are we?”

“Still in V-fib,” Ken said.

“Shock him with another three hundred joules.”

Kelly looked at him. “Three hundred?”

“I mean forty.” They exchanged glances. “Forty. Clear.”

The body jumped.

The monitor stopped beeping. “We’ve got rhythm,” Ken said.

Paul grabbed the boy’s wrist. “We’ve got a pulse. Kell, call Primary Children’s, we’re going to need a pediatric ICU, let’s see if they can get a helicopter through this storm.”

“Saturation up to ninety-five percent,” Kelly said.

The color was slowly returning to the boy’s face. Paul exhaled in relief. “Good job, guys, good job. Stay with him, I’m going back to D.”

Paul ran back to the other room. The team was still working on the man but visibly distressed. Marci looked up: “We can’t get his heart beating, and we still can’t get him intubated.”

Paul took the tube and successfully maneuvered it into place.

“Good job, Doctor,” Marci said.

“That’s why you make the big bucks,” one of the paramedics said.

“Let’s shock him,” Paul said. He grabbed the paddles. “Marci, three hundred and sixty joules. Clear.”

The body heaved.

“Anything?”

The paramedic shook his head.

“Atropine?”

“We’ve maxed out.”

“CPR, now. Marci, more epinephrine, two-tenths milligram.”

She injected the steroid into the IV.

“He’s not responding,” Paul said. “I’m shocking again. Three hundred sixty joules. Clear.”

The body heaved again but as quickly settled.

It’s like trying to jump start a sofa,
Paul thought. “He’s not responding to anything.”

The monitor flatlined.

“He’s asystole!” Marci said.

“I’m shocking again. Three hundred sixty joules. Clear!”

Nothing. Paul looked around the room. “Have you seen any pulse at all?” he asked.

“Nothing,” replied a paramedic.

“No, Doctor,” said Marci.

“How long has he been arrested?” Paul asked.

“We picked him up forty-three minutes ago,” the paramedic said. “The call came in fifty-six minutes ago.”

Just then the sound of a helicopter landing shook the windows. Paul looked at the man. He was dead and had been for half an hour. Paul exhaled in frustration. “Let’s call code.”

Marci glanced at her watch. “Time of death sixteen twenty-seven.”

The Life Flight crew passed outside the room. Just then Kelly stepped in. “Doctor, the boy’s heart rate is down to forty, we need you.”

Paul turned to Marci. “I’ll see the family when I’m done.” He hurried back to the boy. Halfway down the hall the red-faced man from room G stepped in front of him. “Hey, we’ve waited long enough. What about my wife’s X-rays?”

Paul’s temper flared as he walked around him. “Get back in that room. I’m trying to save a life.”

The man timidly walked back to his wife. The helicopter crew stood outside the boy’s room, waiting. “Trip’s delayed, boys,” Paul said. He glanced up at the monitor as he entered. The boy’s heart rate had dropped four more points. He called out, “Atropine, two-tenths milligram IV.”

V-fib again appeared on the monitor. “What’s going on here?” he mumbled to himself. “Kell, charge to twenty joules. Clear.” The body jumped.

“We’ve got a beat,” Ken said.

“For a moment,” Paul answered as the rate began sliding. “We’re keeping him alive with epinephrine. How’s saturation?”

“He’s fine, doctor. Ninety-five percent.”

Dr. Garrity looked in. “I’m back, do you need help?”

“I can’t hold a heart beat. We’re maxed out on atropine and we’re up to three milligrams of epinephrine. Any ideas?”

He shook his head. “You’re doing all you can. We’ve got a car accident coming in, with level-two multiple injuries.”

The heart monitor started beeping again.