“But it’s been over fifteen minutes, and if he’s still in arrest—” one of the paramedics started, but the man cut him short.
“I started CPR almost immediately.”
“But still...”
“Did no one report he’d been electrocuted?”
That stopped the paramedic’s arguments. In electrocution, since the heart had no underlying disease causing the arrest, resuscitation should continue for far longer than for any other cause of arrest. There was always hope an electrocuted victim could revive after protracted resuscitation efforts.
She delivered one last breath before snatching the bag-valve mask from a female paramedic’s hands, sealing it over the boy’s face and beginning positive pressure ventilation with 100 per cent oxygen. The man stopped the cardiac compressions to attach the cardiac monitor’s electrodes to the boy’s chest.
Following through with her ventilatory assessment, Cassandra grabbed a stethoscope and listened to the chest. “Chest rising well, equal air entry over both lungs.”
The man nodded, finger on the boy’s carotid artery, eyes on the monitor. He added his own assessment. “Still pulseless, though—heart’s in ventricular fibrillation.” He turned to the paramedics.
“Charge the defibrillator.”
In seconds they’d handed him the paddles of the defibrillator.
“Everyone, clear!” he shouted.
The first shock produced no change in heart rhythm.
“Increase the charge,” he ordered.
A second then a third shock still produced no effect. And three shocks were the limit at a time.
“Back to CPR, then,” Cassandra said. “Time for venous access and intubation.”
“Yes.” He made way for the female paramedic to take over cardiac compressions. “Which do you want to handle?”
She didn’t relish the idea of coming near the boy’s mouth again. “I’ll take venous access.”
He held her eye for a second, jolting her yet again. He understood her reluctance—sympathized? With a nod, he turned to the other paramedic. “No. 2 Miller laryngoscope, straight blade, 4.5 endotracheal tube, uncuffed.”
Whoa! Not just a doctor. A specialist of some sort. An anesthetist maybe? Whatever, the man was just too impressive altogether...
Drool over him later. Get a line into that little boy.
He finished the intubation, slipped the ETT in place, tested its correct placement and decompressed the stomach to further aid ventilation. Everything done with staggering speed and precision. It didn’t make Cassandra feel any better about her struggle to locate a vein.
“No luck?”
She bristled at his question, brought the spurt of irritation under control and made one last attempt. No go.
“Let me do that.” He reached out to take the cannula out of her hands.
She turned on him. “You got a way to inflate his collapsed veins?” His eyebrows rose at her vehemence, his hands, too, in a conciliatory gesture. “You go ahead, then,” she muttered. “Administer epinephrine though the ETT. I’ll go for the intraosseous route.”
That hard, hot energy he emitted spiked, the explicit awareness in his eyes back in full force. Still, when he talked, he was the personification of professionalism. “0.2 mg/kg epinephrine, 1/1000 solution,” he ordered the paramedic.
Her heat rose. Her concern, too. “0.1 mg/kg is the maximum initial dose via ETT!”
“No.”
“Just no?”
“Yes.”
Overconfident, imperious. She hated that in men.
“I assume you do know what you’re doing?”
“I do.”
And she really believed he did. It was probably why overconfident imperiousness looked good on him.
She turned to the paramedic. “You have an intraosseous kit?”
“No, but we have spinal needles,” the paramedic said.
“Close enough. Get me an 18-gauge needle.” The efficient man handed it to her in two seconds flat. “Ready Ringer’s lactate solution, two bags, and giving sets while I do this.”
She located the point of insertion in the boy’s tibia, an inch above the medial malleolus in his foot, inserted the needle perpendicular to the bone with a screwing motion until it ‘gave’ when she entered the marrow cavity. A centimeter in, she stopped, removed the needle, leaving the catheter in. In seconds she had her line secure and fluids pumping into the inert boy.
“Good job. No extravasation?” her resuscitation partner asked, checking whether any fluids were leaking out of the bone. She shook her head and he said, “Better deliver the subsequent doses of epinephrine via this route, then.”
They did that and after a minute he sighed. “There’s a slight change in rhythm—no palpable pulse, though. We’ll have to shock him again.”
They went through the three-shock routine again. With the last shock, the cardiac monitor blipped the hoped-for change.
“He’s back.” The man’s expression didn’t reflect the relief in his voice. Her anxious eyes jerked to the cardiac monitor to make sure. “Sinus rhythm, 80 beats per minute. A bit slow, but we have him back.” He reached out a hand and squeezed her shoulder. “Good work.”
Relief and pleasure at his praise, at his touch, melted her tense face into a wobbly smile. One he didn’t return, the intensity back instead. His eyes went to her lips, rested there until they began to swell, open—then he turned to the crowd and said something in Spanish. Something about la madre. Telling them to allow the mother back? Cassandra had forgotten all about her. He hadn’t. Nice...
Then everything crashed back on her after the vacuum in which she’d been suspended, with only the man and the boy for company. Even the paramedics had been faceless tools of assistance. Now everything seemed to zoom into existence once again. Bystanders. The wailing mother. Then a second set of medical personnel materialized on the scene.
The man jumped to his feet, exchanged rapid conversation with one of them, and suddenly she was shoved to the side. The frantic mother hurled herself at her toddler, people again restrained her, the newcomers descended on the scene and implemented the protocols of moving a critically injured victim with total efficiency.
Then just as suddenly, the whole crisis receded, leaving her behind.
He was leaving her behind!
He was walking away with a man who probably was the pediatric intensivist who was taking over the case, deep in conversation. Not looking back.
In seconds all she could see of him was the back of his regal head receding out of sight as the sea of people between them thickened then obscured her vision.
As anticlimaxes went, this one was a whopper.
But what had she expected? What was there to expect? They were both waiting to catch planes that would probably take them to opposite ends of the earth. The best they could have had was an hour of—of what? And, anyway, what could possibly top what they’d just shared: dragging a life back from the brink of death? Anything from then on would have been an anticlimax. Never had she shared such an intense experience with anyone. At work she collaborated with others, saving lives, daily, but it had never been this immediate, this synergistic.
Now