he had heroin in the car with him and as the paramedics were tending to the three other victims, he shot up.”
“How are they bringing him down?”
“Paramedics gave him naloxone on site. Nasal spray was all they had. They didn’t get to him right away because he didn’t seem injured, just confused. It wasn’t until he dropped to his knees and passed out that they noticed the dilated pupils and white patches on his mouth. Once they got him here, we gave him more naloxone by injection. What a mess.” Bart shook his head but continued to work.
Sophie scanned Aleah’s reed-thin, very still body while two other members of the ER team hurried in to assist. Donna Jessup was one of Sophie’s coworkers on Dr. Caldwell’s team and worked one weekend a month in the ER. With her was Rob Seymore, a lab technician who quickly began drawing blood for the usual tests.
Aleah’s brown hair was matted to her head with glass and blood, much like Jack’s had been. She was still in her street clothes, though her blouse had been cut away and twelve electrodes had been placed on her chest.
“Donna, did you run an EKG yet?” Sophie asked.
“We had another cardiac patient just after these accident patients. It’s been bedlam, but I’m on it. I’m on it.” Donna attached the leads and turned on the EKG machine. She held the printout. “Infarction and atrial fibrillation.”
“A-fib?” Sophie circled the gurney and studied the printout. “Did Dr. Hill order an echocardiogram?”
Rob continued, “Yes. He was in the middle of examining her when the other patient started convulsing. And his heart stopped.”
Sophie flipped the pages of Aleah’s chart as Bart continued.
“Dr. Hill said Aleah’s suffered a blunt chest trauma which is quite obvious from the bruising. He ordered the requisite round of tests.”
“Did he mention cardiac contusion?”
Bart and Donna shook their heads.
“No, but it’s my guess...” Donna winced. “Sorry. It’s not my place to—”
“Don’t apologize.” She held up her hand, though she didn’t take her eyes off the chart. “If she’s ruptured the cardiac chamber or if there’s a disruption of the heart valve that could be the cause of her dysrhythmia.”
Sophie assessed more of Aleah’s condition. Her skin was growing more pale and gray by the second. The bruises on her chest were turning a deep purple. Sophie pressed lightly on Aleah’s ribs. “She’s broken nearly every rib on the right side.”
“Dr. Hill thinks her lung may be punctured,” Bart said. “He ordered thoracentesis.” He began inserting the catheter into Aleah’s chest while Sophie went around to the other side of the bed.
Sophie stuck the earpieces of her stethoscope into her ears and listened to Aleah’s chest. It rattled like a freight train and Aleah’s breathing was labored. She was bleeding internally, but until all the tests were run, they wouldn’t know the extent of the damage.
In the meantime, they had to get her stabilized. Aleah’s chest cavity was filling with blood and fluid, which would be putting pressure on her heart and lungs. Sophie didn’t want to guess how much time they had to prevent respiratory arrest or another—this time deadly—heart attack.
First, she needed do a thorough examination. In a trauma case like this, every nanosecond counted.
Sophie glanced at Bart as he continued to work. “She’s lost a lot of blood. Transfusion?”
“It just came down from upstairs.” He nodded to the stainless steel counter where the IV bag of blood sat. Donna was rushing with her EKG cart out of the bay. “Sophie, can you hook up the plasma for me?”
Immediately, Sophie attached the plasma bag to the IV and regulated the monitor. Then she felt for Aleah’s pulse. It was almost imperceptible it was so weak.
Bart finished with the catheter and Sophie turned to him. “Her chart says that she was born in this hospital. She had coronary artery abnormalities at birth.” She paused as Bart nodded gravely. “I’ll need Dr. Barzonni to confirm, but because of the trauma to the chest wall, blood flow to her heart could be severely diminished.”
As she spoke, she saw Nate Barzonni race into the ER. Dr. Hill quickly gave him the specifics about the addict’s condition. They both hung over the patient, assessing.
Sophie had worked with Nate for over a year now, and she knew his professional moves better than anyone. Though Nate always showed an implacable expression to his staff and the patient, when he raised his left eyebrow even a fraction, it meant he was concerned. If he dipped his chin to his chest, his brain was analyzing input like a computer. The longer his head remained bowed, the more difficult the case. The minute his head snapped up, Nate had made his diagnosis and decisions on how to proceed.
While Nate’s head was still lowered, the attending nurse said, “Blood pressure is ninety over fifty. Pulse is dropping, as well. Fifty. Forty-eight. Doctor, I have no pulse!”
The addict’s heart monitor flatlined. The alarms beeped. Sophie’s head shot up. Most people thought those sounds signaled pandemonium, but to her it meant action. All hands on deck. It was the moment when everyone’s skills, talents and expertise were paramount. They were like fine-tuned mechanics in a precision Swiss watch. Each cog, each spring was essential to the whole. Except they were not marking time as a clock would. They were racing against time. Trying to beat it to save a life.
“Defibrillator!” Nate shouted. He locked eyes with Sophie and nodded abruptly, with almost a jerk.
Sophie turned to Bart. “I’m going with Dr. Barzonni. You got this?”
“Go!” Bart said and continued his efforts to stabilize her.
As Sophie rushed between the beds, her gaze shot across the room. Jack Carter was sitting ramrod straight in the bed, staring at the action around him. His eyes bore into hers. For a fleeting second she thought she could read his mind.
What about Aleah?
Icy chills shot down her spine. She nearly turned and went back, but Nate needed her. The patient did, too. Once in the bay, she sprang into action. She pulled the paddles out of the defibrillator dock and spread them with lubricating gel. She handed the paddles to Nate. Holding her breath, she stood back as he placed one paddle on the left side of the man’s heart. The other he placed to the right over the sternum.
“Clear!” Nate said loudly as the attending nurse and Dr. Hill backed away.
Sophie hit the defibrillator’s button and watched the needle on the monitor jump as the electrical shock was discharged into the dying man.
The patient’s barrel chest heaved. His back arched as it rose off the gurney with the shock and then flopped back down. He remained still. Nate listened to his heart with the stethoscope. He checked the monitor.
Still flatlined.
Dr. Hill’s eyes were filled with defeat. He spun on his heel and rushed over to Aleah.
Sophie knew Dr. Hill was desperate to save all his patients.
