The Unexpected Hero

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.

Chapter Two

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. Alexander’s room with his cart, trundling all the blood samples to the lab. Moments later the orderlies came out, carrying away trash, pushing the crash cart with them to restock it and prepare it for another code. Then came Julie and Nancy, both with hanging heads.

“We messed up,” Nancy said as they joined Julie behind the counter and sat. “We called the code and called you, but we should have started CPR.”

“Yes, you should have.” But Krissie took pity on them, too. “I was there in less than a minute. Compressions started soon enough anyway.”

They nodded. “We never had anyone die before,” Julie said softly. “Never.”

Krissie looked at them, not knowing quite what to say. “It never gets any easier,” she managed finally. “Now just make sure Mrs. Alexander is ready to be seen by her family. I’m going to check on the other patients. If any of them awoke, they’re probably disturbed by this. Tomorrow, we’ll talk about managing these events a little better.”

Rising, she touched their shoulders in turn. “We learn from our mistakes. I still do. But there was nothing you could have done that would have saved her.”

The two girls nodded, but neither looked particularly relieved.

To her dismay, she found the boy with the broken leg, Tom Mason, wide awake and looking frightened. He was only ten. “Am I going to die, too?”

“Of course not!” Krissie pulled a chair closer to his bed. “You’re young and healthy. The person who died was very old and sick. There’s a difference.”

He nodded and allowed her to pat his hand as she sat beside him.

“I know it’s scary for you,” she said calmly. “It’s scary for everyone. But you don’t even have a heart monitor, which should tell you something.”

“Okay.”

She waited, giving him space to talk, to say whatever he needed to, but he remained quiet, as if trying to sort through things in his own mind his own way.

“Look,” she said presently, “Some people are sick and come to hospitals to die. Others, like you, just managed to break their legs jumping out of a tree, and they come here to get better. Before you know it, you’re going to be hobbling around on crutches and asking your friends to sign your cast. Just tell them not to use dirty words.”

At that, a shy smile peeped out. “Mom would be furious.”

“You better believe it. She’ll probably go get a can of white paint to cover it up. And what if she just keeps painting the rest of you?”

A tired little laugh escaped him. “She’d paint my bottom, and it wouldn’t be with a paintbrush.”

Krissie forced a grin. “You think she’d spank you?”

He shook his head after a minute. “She never hits me. She doesn’t have to.”

“Oh,” Krissie said knowingly. “The mother voice.”

“Yeah. And Dad says her looks can kill.”

“Oh, I know all about that. My mother never spanked me, either, but one look and I’d practically burst into flames or something.”

“I go hide. I hate it when she’s mad at me.”

“Somehow I think she doesn’t get mad at you often.”

“No,” he said with confidence. “I’m pretty good most of the time.”

“I believe you.”

He looked at her from the corner of his eye. “But she was mad when I jumped out of that tree. Especially when she saw my leg.”

“Probably more worried than mad.”

“Yeah, that’s what she said later.”

“Do you want me to call your mom, ask her to come in?”

He hesitated, then shook his head. “I’m okay. You’re right. I’m not old and sick.”

“No, you’re not.” She headed for the door, but when she got there, his voice stopped her.

“Can you leave the door open?”

She smiled back at him. “Sure. And why don’t you turn on the light on your bed and read one of those comic books. But don’t turn the TV on, okay? Not with the door open.”

“Okay.” He reached for a comic book from one of the stacks on the table beside the bed and flipped on the fluorescent light at the head of the bed. “Thanks, Miss Tate.”

“Just call me Krissie, okay? Can I get you anything? A drink? Jell-O?”

“I’m okay. Thanks.”

“Use that call button if you want anything.”

“I will.” At that he grinned, then turned his attention to the comic book.

Am I going to die, too? Outside, Krissie had to stop and lean against the wall, closing her eyes and reaching for balance. How many times had she heard that question from boys only a few years older than this one? From men, women and children. And how many times had she had to lie about it?

Am I going to die, too? The question haunted her nightmares. Bloody hands gripping her arm. Shattered bodies, shattered faces, shattered lives. Death riding her shoulder as if he were her partner.

God!

After a minute, she regained her equilibrium and was able to continue her ward check. Everyone else still slept, apparently unaware the grim reaper had paid a visit.

Mrs. Alexander’s son—a rawboned man who looked as if he had worked hard outdoors his entire life—arrived and went into the room with David, then emerged ten minutes later by himself, walking away with a tight jaw and reddened eyes. David came out a minute later and approached the station.

“She can go to the morgue now. They don’t want an autopsy.”

“But…”

“I told him we needed to do one anyway, to find out what happened. He said he doesn’t care what happened. It’s enough she’s gone, let her be.”

Krissie nodded slowly.

“We got the blood samples and we have the urine bag, right?”

“Yes, I saw the lab guys take it all.”

“Okay, then. We’ll have to rely on toxicology, a BUN test, the other tests I ordered. It’ll probably be enough.”

She understood, though. He wanted to know exactly what had gone wrong, and if the blood and urine tests didn’t show anything, questions would plague him for a long time.

He reached for the now-cold cup of coffee he’d left on the desk an hour ago and drank it down. Then he gave her a kind of cockeyed smile. “That was awful.”

“I can get you fresh.”

“Tell you what. Let me buy you breakfast at Maude’s. You get off at seven, right?”

“Right.” Part of her hesitated, saying no, this would be stupid, but another part didn’t want to go straight home, not after this night. “It’s a deal. I’ll meet you there as soon as I get out of here.”

“Deal. A little artery-hardening food is what I need right now.” Then, with a nod, he left.

The sun was already well up and growing hot when Krissie left the hospital shortly after seven. Dressed again in her street clothes, carrying her small backpack, she walked across the pavement to her car. Her eyes felt gritty, a sure sign she needed some sleep, but she’d toughed this out before countless times. Impatiently, she ran her fingers through her short, streaked hair.

As she started to pull out of the parking lot, a small wave of panic washed over her and she almost turned for home rather than downtown and Maude’s diner.

This was purely professional, she told herself. Two colleagues getting together to eat and unwind a bit before going home to bed. There was nothing to be afraid of.

But her recently defunct relationship had left its own set of scars, among them her fear and dislike of controlling men. That little outburst from David last night about his expectations of her as a nurse had been controlling. She still squirmed a little when she thought about it, but reminded herself that he hadn’t behaved that way during their encounters the rest of the night. Still, he had the potential to become a problem of the kind she had just shucked.

But only if she let him, she reminded herself. Keep it professional, keep it purely social and don’t let him get close. That was a recipe for avoiding trouble, one she intended to follow.

Feeling more comfortable about it, she found a parking space near Maude’s and walked the rest of the way to the diner. For some reason, Maude had added a Café sign to her window, even though the neon above announced City Diner. Not that it mattered, she supposed. Everyone still called it Maude’s, or Maude’s Diner.

Inside, wonderful aromas filled the air, and the clanking of flatware and the clatter of crockery joined the hum of early-morning conversation. Like many such places, the early-morning weekday crowd was composed mostly of older people, men, women and couples, who had no need to think about getting ready to go to work. Later in the day, the composition would change, first with the lunch crowd, then the dinner crowd.

David stood out: a man in his prime, maybe around forty, with dark hair that didn’t yet show a dash of gray. In his dark blue polo shirt and khaki slacks, he looked lithe and fit. He’d taken a table near the window and already had a cup of coffee in front of him. He started to get up as she approached, but she waved him back into his seat and then slid onto the vinyl-covered chair facing him.

Before she had a chance to say a word, a cup slammed onto the table in front of her and started to fill with coffee. She looked up and saw Maude’s daughter, Mabel; the younger woman was surely a clone of her mother.

“Good to see you back, Krissie,” Mable said as she topped off the mugs. “Menu? Or do you know what you want?”

Krissie knew better than to ask for anything unusual or healthful. This wasn’t a place for healthful eating. “Two-egg onion omelet and rye toast, please.”

Mabel nodded, then looked at David. “The usual?” “Please. With some extra hash browns.” “Got it.” Mabel sort of smiled and walked away, coffee carafe in hand.

Krissie smiled. “You’re going for broke.” “The hash browns, you mean? Yeah. I need every calorie I can get. I still have office hours, starting at nine.”

“You should be catching a nap then.”

“I couldn’t sleep right now.”

She looked down at her coffee, then across at him again. “I would have thought you’d have learned to sleep anytime, anywhere.”

“Because of being military?” He shrugged. “That used to be easier. You might not understand this yet, I don’t know. But the losses are harder now. Maybe because the patients aren’t usually in such a bad state.”

Krissie nodded slowly. “I guess I can see that.”

“Maybe you won’t feel that way. I hope not.”

“Too early to tell. So what’s your background?”

He sipped his coffee as if buying time to consider what he should say.

“Oh, come on,” she prodded. “You read my jacket. Fair’s fair.”

At that, he smiled. “Okay. I enlisted at eighteen, became a medic in time for Desert Storm. Bad enough, but I was still on fire with the desire to be able to do more to help, so eventually I went to college, got admitted to medical school. The army picked up the tab on my medical training in return for a six-year commitment. It was mostly okay. Until Iraq.”

“Yeah.”

“Same for you?”

She shook her head, biting her upper lip. “Not quite. I went to nursing school on scholarship and enlisted after I got my B.S. in nursing. The navy trained me to be a nurse practitioner, and the next thing I knew, I was in Asia on the USS Hope after the tsunami.”

“My God, that must have been awful.”

“Not my favorite memory. But after that, I was attached to the Marine Corps and served in Iraq.”

“In the field,” he said as if it weren’t a question.

“In the field,” she agreed. “Well, at bases with field hospitals.”

“Yeah, the ones they pretend aren’t at the front line.”

She lifted her gaze and saw understanding there. A wealth of understanding. “There is no front line.”

He nodded. “Exactly.”

Mabel returned and slapped their plates down in front of them. Krissie stared at hers, certain there had to be more than two eggs in that omelet. Plus there were hash browns she hadn’t asked for and four slices of rye toast.

David must have read her expression. He laughed. “I think Maude thinks you’re too thin.”

“Maude thinks everyone is too thin.”

Krissie glanced toward the window and caught sight of her reflection. She was a little under her fighting weight, and worse, she suddenly realized that the blond streaks in her light brown hair were growing out to the point that they no longer looked good. She experienced a moment of self-consciousness, then quickly dismissed it. She’d only applied those streaks because Alvin had insisted on it. He’d wanted her to go completely blond, but at least she’d managed to draw that line. Of course, with Al, it was his way or the highway. It had taken a while, but she’d finally chosen the highway.

Whatever had possessed her to stay for so long?

“Penny for your thoughts?”

David’s voice drew her back, and she looked at him. “Nothing,” she said. “Just a memory.”

“And thoughts are worth a lot more than a penny these days.”

David could be charming, she realized. That concerned her as much as their initial encounter. Control and charm had gone hand-in-hand with Alvin. Just like that, she went on high alert.

“What’s wrong?” David asked.

Perceptive, too. “Nothing,” she said firmly and turned her attention to her overburdened plate. Just the sight of all that food made her feel full, but she hadn’t eaten a bite. And since she hadn’t eaten her lunch during her break, she knew she was going to have to tuck in or get sick later.

She picked up a slice of toast, already buttered by the prodigious purveyor of fatty food herself, Maude, and took a bite. At least her stomach didn’t revolt. In fact, once the toast reached bottom, she began to feel hungry. A sip of coffee took care of the last of her revulsion.

David tucked in, too, and for a while, they ate in silence.

The tragic mood of the night began to give way to life. One of the hardest and fastest lessons medical people had to learn was that life went on even when someone died. That they weren’t God, and sometimes had to just let go. Clinging to their losses only made them less capable of caring for the next patient.

But neither could they afford to grow hard. No, they just had to quick-time their way through the sense of failure and loss to be ready for the next case.

David spoke. “So you worked in the VA hospital in Denver, right?”

She tensed immediately. “Yes. I did.”

He looked at her. “Bad topic?”

She half shrugged. “Well, it was emotionally tough. Easier in some ways than Iraq, harder in others.”

“I would think so. At one end, you’re focused on saving a life. At the other, you’re looking at the destruction left in the wake of it.”

“You can never do enough. And the vast majority of the patients I had were amazingly positive, considering what they faced. Oh, they got angry at times, and depressed, but by and large, they handled it better than I did.”

“How so?”

She hesitated. “Well…sometimes I found myself furious. Because we saved them for this? A life without limbs, a life with brain damage, a life of paralysis? And every time it started to overwhelm me, some patient would say he was glad he’d made it.” She shook her head and closed her eyes for a minute. “Sorry.”

“No, I’m sorry. I shouldn’t have brought it up. The whole point of dragging you here for breakfast was to get some calories into the two of us and shuck what happened so we can get on with what comes next.” He looked rueful. “So, idiot that I am, I stick my foot right in it.”

She had to smile, and made a major effort to shake off the memories. “I guess we all get our scars.”