counting automatically until Dr. Marcus said, “Clear.”
She jumped down again and another shock was applied. Nothing.
“Epinephrine.”
A large syringe was slapped into his hand, and Krissie watched as he stabbed the needle directly into the old lady’s heart.
“Clear!”
Snap!
Nothing.
“Clear.”
Snap!
Still that awful straight line…
“Compressions,” Dr. Marcus said.
Krissie started to climb on the bed, but a male nurse beat her to it, giving her a break. Her arms were shaking. Her stomach turned upside down.
They called time of death at 3:31 a.m.
David Marcus evidently had no desire to leave medical matters until morning. He sat at the nurses’ station while orderlies worked in Mrs. Alexander’s room, cleaning up the inevitable detritus of the code. In those moments where every second counted, items such as syringes and swabs went flying, along with their packaging. Mrs. Alexander herself lay carefully arranged beneath a sheet, awaiting whichever came first: a visit from immediate family or the trip to the morgue.
From moments of intense activity to absolute stillness. Krissie sat on a chair, staring at nothing. It didn’t matter how many times she saw this, every time felt like a personal failure.
“There wasn’t any warning?” David asked.
“I was in the break room eating my lunch when I got the page. The code was called right after that. You’ll have to check the monitor.”
“Wasn’t anyone watching it?”
“Julie or Nancy, I thought. But you can check and see if there was any warning.”
His face tightened and he looked off into distant space. “She was getting better.”
“That’s how it looked.”
“I guess we’ll find out from the autopsy. But damn.”
She managed a nod. “Why’d you push the bicarb?”
“Because she was on a potassium-sparing diuretic. There was a possibility that her kidneys hadn’t cleared enough of it so it was one of the first things I thought of.”
“I can see that.”
“Except that tests didn’t show anything wrong with her kidneys.”
“Things change.” Krissie rubbed her eyes, trying to hold back a tidal wave of despair. Before long, the second-guessing would set in. It always did and seldom helped. A lot of medical people, herself included, belonged to a secret society of flagellants, beating themselves up when they lost a patient they felt they shouldn’t have. Given another half hour, she’d probably be telling herself it was all her fault for taking a break.
“Damn it, David, we both know how fast things can change. She’d evidently had a heart attack in the past. Hence the arrhythmia that caused the congestive heart failure.”
“I know that,” he snapped. “And I was treating all of that. The arrhythmia, the edema…”
“I know.” She almost snapped back.
“Maybe I shouldn’t have cut so much diuretic.”
Krissie shook her head. “That change shouldn’t have caused such a big effect so fast.”
“No, you’re right.”
Astonished that he had so quickly accepted her judgment after snapping at her, she blinked and stared at him.
He turned to the monitor and hit the buttons to play back the hour before the attack.
“Coffee?” Krissie asked finally. Every nerve in her body seemed to be firing. “I can’t just sit here.”
“Sure. Thanks. Black, please.”
Forcing herself to stand, she walked back toward the nurses’ break room. She didn’t want to wonder if things might have been different if she hadn’t gone on break, if Julie and Nancy hadn’t been so obviously overtaken by the enormity of what they were facing. Training. She’d need to give them more training. They were little more than kids, really.
And none of those thoughts helped. A woman had died, and no one in the medical profession would ever be comfortable with that outcome if there was the remotest possibility they might have prevented it.
She filled two cups, paused to look at her sandwich, then, realizing she wouldn’t be able to eat it, swept the remains into the trash.
Back at the ward, she found David peering intently at the monitor. “There it is,” he said, when she came up and put the coffee beside him.
“What?”
“See that? Major slowdown. Like it just wound down.”
“Arrhythmia?”
“For about fifteen seconds before the slowdown. Easy enough to miss. The monitor should have alarmed.”
“Maybe it did. It was screeching when I got here, and Julie and Nancy were in the patient’s room.”
He nodded slowly. “It was fast.”
She scanned the playback as he ran through it again. “Awfully fast.”
“Looks more like SCA, sudden cardiac arrest.”
Krissie nodded. “Not much time to do anything.”
“No.” He lowered his head for a moment. “I need to call her family.”
The worst task of all, Krissie thought. “I’ll talk to Julie and Nancy, see if I can learn anything additional. For the report.”
He nodded. “Thanks. God knows what I’m going to tell the family.” He pushed forward on the ECG readout, then said, “It’s clear compressions were started in about a minute.” The spikes showed that clearly. “You weren’t too late.”
It struck her then that he was trying to let her know she couldn’t have done any more. His generosity, when he was sitting there blaming himself, was all the more touching. And totally unexpected after the way they had started.
“David—”
He cut her off. “I need to call the family.” He rose and strode away, looking lonely as only a doctor at a time like this could.
The phlebotomist emerged from Mrs.
