Julie hesitated, then said, “I heard Dr. Marcus riding you. Not what he said but…just so you know, he can be hard to get along with sometimes.”
Krissie wasn’t quite sure how to respond. There were certain rules of professional etiquette, and while she’d seen them broken countless times when some doctor or nurse was a pain the rear, she didn’t think she should encourage it her first night on the job.
But she didn’t have to say a thing. Nancy chimed in. “I try to stay out of his way, because you never know when some little thing will annoy him. But mostly he’s okay. I don’t think he means to be edgy.”
“I don’t think so, either,” Julie agreed. “Because he can be really nice sometimes. But other times, there’s this look on his face, and you know he’s uptight about something. So I just duck.” She gave a little laugh. “If he’s mad about something I did, he has to find me.”
Krissie couldn’t contain her smile. “Sometimes that works.”
“Yeah, you can’t really hide, being the charge nurse. Anyway, you’ll find he’s here a lot. The other docs all have families, so Dr. Marcus is on call most of the time.” Julie scrunched her face a little. “Sometimes I think he doesn’t sleep.”
Or maybe, Krissie thought, he has trouble sleeping. She certainly did, even after all this time. Nightmares seemed ready to pounce, and were one of the reasons she preferred the night shift. When she had a nightmare while sleeping during the day, she only had to open her eyes to see sunlight, and she had learned it dispelled those images quickly. At least most of the time.
“Anyway,” Nancy said, “it’s probably the war.”
Her comment was laden with the knowledgeable tone of someone who thought they knew. Krissie didn’t think Nancy could imagine the half of it.
They did find a deck of cards, however, and after ten, when the patients had all been checked on, medicated and settled, Charlie joined them. He remained shy, but Julie seemed to have taken a shine to him, making him blush with alarming regularity.
Charlie left at midnight, his shift over, and Krissie sent Julie and Nancy to take a break. They announced they were going to the cafeteria to meet up with some friends from other wings and would be back in half an hour.
Krissie was amazed to discover how relieved she was to be left alone for a little while. The ward was quiet, the call board remained silent, Hester Alexander’s heart monitor continued its steady rhythms.
One by one, she checked on her patients, moving soundlessly as she opened doors and looked in. Mr. Hedley was going to need a new IV bag of antibiotics in about an hour. Other than that, everyone seemed to be resting comfortably and sleeping deeply. Mrs. Alexander opened her watery blue eyes just briefly, then returned to sleep. Krissie silenced the monitor in her room. It was enough that she could keep an eye on it from the nurses’ station; no need to disturb Mrs. Alexander’s sleep.
The next couple of hours passed smoothly enough, and finally Krissie decided to take her own break, a half hour in the break room with her bagged lunch and another cup of coffee from the coffeemaker on the counter.
She had eaten only half of her turkey sandwich when her pager sounded. Julie. Dropping her sandwich on the waxed paper, she took off for the ward at a fast walk, just as the PA system announced a code and a room number.
She arrived a few seconds later on the ward to see Nancy waving at her from the door to Mrs. Alexander’s room. From the nurses’ station she heard the unmistakable warning from the cardiac monitor. Ignoring it, she began to jog down the hall, even though you were never supposed to run in a hospital.
“Cardiac arrest,” Nancy said quietly. Inside the room, Julie was hovering over the patient looking helpless. Damn it, an LPN should know better.
“CPR, Julie. Did you call the doctor?”
Nancy nodded. “Yes. He answered the page.”
“Julie, I’ll take over. Where’s the crash cart?”
“Getting it.” Nancy fled.
Flatline. It was a sight a nurse saw too often, but never wanted to see. She joined Julie at the bed and motioned to her to take the breathing bag, while she herself climbed on the bed, straddled the patient and took over the chest compressions. Each compression registered on the monitor, but nothing else.
Dr. Marcus and the crash cart arrived together, along with a crash team assembled from all over the hospital. The high whine of the charging defibrillator filled the room along with business-like chatter as the team acted.
“Intubate.”
Krissie paused in the compressions to allow the doctor to insert an endotracheal tube in the esophagus. He worked swiftly, and moments later the breathing bag was attached to it, again worked by Julie.
“Two hundred,” the doctor said, then to Krissie, “Off the bed.” He was holding the paddles and Krissie quickly jumped down. “Clear!” he said, and applied the paddles.
Mrs. Alexander’s body jumped, but the flatline remained.
“Push 20 ccs of sodium bicarb.”
Another nurse stepped forward with a syringe. “Pushing.”
“Give me three hundred.”
A jolt of three hundred volts was applied, lifting the patient half off the bed. Still a flatline.
Krissie climbed back on the bed and continued compressions, 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.