manually pumping oxygen into the boy's lungs.
"OK," said Vivian. "Let's intubate."
The tech pulled the mask away. Within seconds, Vivian had the ET tube in place, the oxygen connected.
"Lidocaine's in," said a nurse.
The medical resident glanced up at the monitor. "Shit. Still in V. fib. Let's have the paddles again. 200 joules." A nurse handed him the defibrillator paddles. He slapped them onto the chest. The placement was already marked by conductive gel pads: one paddle near the sternum, the other outside the nipple. "Everyone back."
The burst of electricity shot through Joshua O"Day's body, jolting every muscle into a simultaneous spasm. He gave a grotesque jerk and then lay still.
Everyone's gaze shot to the monitor screen.
"Still in V. fib," someone said. "Bretylium, 2502 Hannah automatically resumed chest compressions. She was flushed, sweating, her expression numb with fear. "I can take over," Abby offered. Nodding, Hannah stepped aside.
Abby climbed onto the footstool and positioned her hands on Joshua's chest, her palm on the lower third of the sternum. His chest felt thin and brittle, as though it would crack under a few vigorous thrusts; she was almost afraid to lean against it.
She began to pump. It was a task that required no mental exertion. Just that repetitive motion of lean forward, release, lean forward, release. The alpha rhythm of CPR. She was a participant in the chaos yet she was apart from it, her mind pulling back, withdrawing. She could not bring herself to look at the boy's face, to watch as Vivian taped the ET tube in place. She could only focus on his chest, on that point of contact between his sternum and her clasped hands. Sternums were anonymous. This could be anyone's chest. An old man's. A stranger's. Lean, release. She concentrated. Lean, release.
"Everyone back again!" someone yelled.
Abby pulled away. Another jolt of the paddles, another grotesque spasm.
Ventricular fibrillation. The heart signalling that it cannot hold on.
Abby crossed her hands and placed them again on the boy's chest. Lean, release. Come back, Joshua, her hands were saying to him. Come back to us.
A new voice joined in the bedlam. "Let's try a bolus of calcium chloride. 100 milligrammes," said Aaron Levi. He was standing near the footboard, his gaze fixed on the monitor.
"But he's on digoxin," said the medical resident.
"At this point, we've got nothing to lose."
A nurse filled a syringe and handed it to the resident. '100 milligrammes calcium chloride."
The bolus was injected into the IV line. A penny toss into the chemical wishing well.
"OK, try the paddles again," said Aaron. '400 joules this time." "Everyone back!"
Abby pulled away. The boy's limbs jerked, fell still.
"Again," said Aaron.
Another jolt. The tracing on the monitor shot straight up. As it settled back to baseline, there was a single blip - the jagged peak of a QRS complex. At once it deteriorated back to V. fib.
"One more time!" said Aaron.
The paddles were slapped on the chest. The body thrashed under the shock of 400 joules. There was a sudden hush as everyone's gaze shot to the monitor.
A QRS blipped across. Then another. And another.
"We're in sinus," said Aaron.
"I'm getting a pulse!" said a nurse. "I feel a pulse!"
"BP seventy over forty... up to ninety over fifty..."
A collective sigh seemed to wash through the room. At the foot of the bed, Hannah Love was crying unashamedly. Welcome back, Josh, Abby thought, her gaze blurred with tears.
Gradually the other residents filed out, but Abby couldn't bring herself to leave; she felt too drained to move on. In silence she helped the nurses gather up the used syringes and vials, all the bits of glass and plastic that are the aftermath of every Code Blue. Working beside her, Hannah Love sniffled as she wiped away the electrode paste, her washcloth stroking lovingly across Josh's chest. It was Vivian who broke the silence.
"He could be getting that heart right now," she
"OK," said Vivian. "Let's intubate."
The tech pulled the mask away. Within seconds, Vivian had the ET tube in place, the oxygen connected.
"Lidocaine's in," said a nurse.
The medical resident glanced up at the monitor. "Shit. Still in V. fib. Let's have the paddles again. 200 joules." A nurse handed him the defibrillator paddles. He slapped them onto the chest. The placement was already marked by conductive gel pads: one paddle near the sternum, the other outside the nipple. "Everyone back."
The burst of electricity shot through Joshua O"Day's body, jolting every muscle into a simultaneous spasm. He gave a grotesque jerk and then lay still.
Everyone's gaze shot to the monitor screen.
"Still in V. fib," someone said. "Bretylium, 2502 Hannah automatically resumed chest compressions. She was flushed, sweating, her expression numb with fear. "I can take over," Abby offered. Nodding, Hannah stepped aside.
Abby climbed onto the footstool and positioned her hands on Joshua's chest, her palm on the lower third of the sternum. His chest felt thin and brittle, as though it would crack under a few vigorous thrusts; she was almost afraid to lean against it.
She began to pump. It was a task that required no mental exertion. Just that repetitive motion of lean forward, release, lean forward, release. The alpha rhythm of CPR. She was a participant in the chaos yet she was apart from it, her mind pulling back, withdrawing. She could not bring herself to look at the boy's face, to watch as Vivian taped the ET tube in place. She could only focus on his chest, on that point of contact between his sternum and her clasped hands. Sternums were anonymous. This could be anyone's chest. An old man's. A stranger's. Lean, release. She concentrated. Lean, release.
"Everyone back again!" someone yelled.
Abby pulled away. Another jolt of the paddles, another grotesque spasm.
Ventricular fibrillation. The heart signalling that it cannot hold on.
Abby crossed her hands and placed them again on the boy's chest. Lean, release. Come back, Joshua, her hands were saying to him. Come back to us.
A new voice joined in the bedlam. "Let's try a bolus of calcium chloride. 100 milligrammes," said Aaron Levi. He was standing near the footboard, his gaze fixed on the monitor.
"But he's on digoxin," said the medical resident.
"At this point, we've got nothing to lose."
A nurse filled a syringe and handed it to the resident. '100 milligrammes calcium chloride."
The bolus was injected into the IV line. A penny toss into the chemical wishing well.
"OK, try the paddles again," said Aaron. '400 joules this time." "Everyone back!"
Abby pulled away. The boy's limbs jerked, fell still.
"Again," said Aaron.
Another jolt. The tracing on the monitor shot straight up. As it settled back to baseline, there was a single blip - the jagged peak of a QRS complex. At once it deteriorated back to V. fib.
"One more time!" said Aaron.
The paddles were slapped on the chest. The body thrashed under the shock of 400 joules. There was a sudden hush as everyone's gaze shot to the monitor.
A QRS blipped across. Then another. And another.
"We're in sinus," said Aaron.
"I'm getting a pulse!" said a nurse. "I feel a pulse!"
"BP seventy over forty... up to ninety over fifty..."
A collective sigh seemed to wash through the room. At the foot of the bed, Hannah Love was crying unashamedly. Welcome back, Josh, Abby thought, her gaze blurred with tears.
Gradually the other residents filed out, but Abby couldn't bring herself to leave; she felt too drained to move on. In silence she helped the nurses gather up the used syringes and vials, all the bits of glass and plastic that are the aftermath of every Code Blue. Working beside her, Hannah Love sniffled as she wiped away the electrode paste, her washcloth stroking lovingly across Josh's chest. It was Vivian who broke the silence.
"He could be getting that heart right now," she
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