Infection Runs Deep

CHAPTER TWENTY-SEVEN: TEXTBOOK THEORIES

The best defense was to pretend that everything was normal. Problems didn't exist, at least to Senator Siles's knowledge.

The new normal, I supposed. A mixture of my old job and this hellish new reality. When did running for my life and working at gunpoint shift from an impossibility to a daily occurrence?

A loud wailing sounded from one of the curtained off areas. Leo took off at a sprint, me hot on his heels.

"34 year-old male with severe cardiac and respiratory distress. No response to antibiotics," Leo said as he checked the patient's vitals. "Grab the paddles."

I yanked the paddles off the nearby cart. "Charging to 100. Should we intubate?"

He took the paddles from me. "Top drawer."

The top drawer slammed open with a rattling clatter, revealing a long row of endotracheal tubes, or ETTs. I grabbed a 8.0mm tube and a laryngoscope. The patient convulsed, his body jarring from the electric shock.

"No change," Leo called, glancing at the monitor. "Starting compressions." I set the paddles back on the cart and resumed prep for intubation.

The plastic ripped open with a sharp crunch, the tube sliding out easily. With the patient's head tilted slightly back, the laryngoscope fit it perfectly, the ETT sliding into place.

"Ambu bags?"

"Bottom drawer," Leo said in between pants. If done correctly, CPR was very physically exertive. Hard to maintain for more than a few minutes without reprieve. Keeping your elbows locked, you have to drive the patient's chest down hard enough to hit the heart. For an adult, that can be up to two inches deep. It often breaks the ribs, but it's supposed to. How else can you reach the heart?

"This organization sucks," I muttered as I retrieved the ambu bag and twisted it onto the end of the ETT. The bag compressed under the squeeze of my fingers. Nice and even, at a rate of about 20 breaths per minute.

"Holding compressions," came a breathless command. "Back in v-tach. Paddles. 200."

With my free hand, I jabbed the charge button, programming 200 joules. Leo took over respirations, maintaining my set rhythm.

"Charged. Clear." Leo stopped respirations and held his hands away from the body. The paddles were smooth in my hands, slick with defibrillation gel. It made a loud squish as I applied them to his chest, bracing my limbs as his body recoiled with a jerk.

I tossed the paddles back and took over CPR. After two rounds of 30 compressions, I stopped to get a read on his vitals.

"Asystole," I said. "BP completely bottomed out." I made a fist and brought it down hard on the patient's chest. Still no change. "Do we have epinephrine? Or atropine? Anything?"

The bag forced air into the patient's lungs with every squeeze of Leo's hand. With his remaining one, he slid open a drawer behind me, sending the metal colliding into my spine as I continued compressions.

I bit back my yelp, pausing CPR to rip open the syringe packing and jab it into the clear vial of epinephrine. The syringe slid into the IV port with ease, allowing me to twist on and administer the medication with a big push.

I did another round of compressions, my arms burning and chest heaving.

"He's still asystolic," Leo muttered as I continued. After a few more rounds, I paused for a vital check. "Goddamnit. He's flatlining." The compression of the ambu bag came to a halt. "Call it."

I stared sadly at the screaming monitor, then to my patient. A long sigh escaped my lips. Flipping over my wrist, I checked the time. "Time of death: 13:08."