“Nick?” She called his name, but he was unconscious and could not respond. Pressing two fingertips to the carotid artery in his neck, she palpated for a pulse, but felt nothing. Without the telemetry monitor, there was no way to know what Nick’s heart was doing, but it didn’t seem to be pumping blood, and the ICD implanted inside his chest had failed to correct the problem. If she didn’t intervene, he was going to die. “No pulse,” she announced to the rest of the room, her own heart racing. “I’m starting compressions.”
“Be careful, babe,” she heard Rob warn her, as she took Nick’s arm out of its sling and shoved it aside. “If the defibrillator didn’t do the trick the first time, it’s gonna try again. You don’t wanna get shocked, too.”
“I don’t want him to die, either!” Dani shot back, pulling down Nick’s hospital gown and putting the heel of her hand over his sternum. “Besides,” she added matter-of-factly, as she placed her left hand on top of her right and laced her fingers together, “there’s never been a reported case of a rescuer being injured from an ICD shock during a resuscitation.” She locked her elbows and began pumping.
A second later, as if on cue, she felt a sudden vibration beneath her hands; Nick’s torso twitched as a strange tingling sensation spread through her fingertips. It was uncomfortable, but not unbearable. Feeling energized by the flow of electricity from his body into hers, she compressed his chest even more forcefully.
Elizabeth and Patrick appeared, parking the crash cart alongside Nick’s bed. They worked in tandem, interrupting Dani’s compressions just long enough to roll him onto his side; Patrick wedged a CPR board under Nick’s body while Elizabeth applied one of the external defibrillator pads to his back. She put the other pad on his chest, making sure it was several inches away from the ICD. While the portable defibrillator analyzed his heart rhythm, Dani’s hands pushed down repeatedly. She paused when another wave of electricity surged through them, but Nick still did not respond.
“He’s in V-fib,” said Elizabeth, looking at the defibrillator’s monitor. “How many shocks has he already received?”
“At least three so far,” Dani replied, resuming compressions. “I felt the last two.”
“The device is programmed to deliver up to six shocks per event. We can disable it with a magnet and try external defibrillation instead, but if you can stand it, we should probably let it complete its therapy first and see if it’s enough to restore a sinus rhythm. External defibrillation can damage an ICD,” Elizabeth explained.
Dani nodded. “Go for it. I’m fine.” She continued pumping Nick’s chest as Patrick placed the resuscitation mask over his face and began bagging him. “C’mon, Nick,” she panted, breathing hard from the physical effort of keeping his blood flowing. “Come on back to us.” She felt the ICD fire off a fourth shock, but there were still no signs of life from Nick.
In the background, she could hear Elizabeth rummaging around in the drawers of the crash cart. Out of the corner of her eye, she saw the cardiologist draw a dose of something into a syringe and inject it into Nick’s central line. Dani pumped harder, hoping she could help deliver the drug to his heart that much faster. Perhaps she pushed a bit too hard, because she heard a disconcerting crunching noise that suggested she had cracked part of his rib cage. She cringed, but continued the compressions. A broken rib was better than being dead.
“You doing okay, Dani?” Elizabeth asked. “Want me to take over?”
She shook her head, her hair falling into her sweaty face. “No, I’m fine for now,” she said, though her hands had gone numb. Nick’s body twitched beneath them as a fifth shock from the ICD passed through it, making the tips of Dani’s fingers tingle with the feeling of pins and needles.
Suddenly, she heard Patrick shout, “He’s vomiting!” She looked up to see Patrick pull the mask off Nick’s face as reddish fluid foamed from his open mouth.
“Roll him before he aspirates!” Dani barked, reaching for Nick’s right shoulder. As the other two helped her turn him onto his side, Nick started to cough, his stomach contents splattering onto the floor. “He needs suctioning,” she said to Patrick, but with the power off, the suction unit on the wall was worthless. “You’ll have to clear his airway with your finger.”
“What?” Patrick made a face. “Why me?”
Dani glared back at him. “Because you have gloves on and I don’t, asshole! Don’t argue; just do it!”
With a disgusted groan, Patrick put his gloved finger into Nick’s mouth and scooped out the rest of the vomit. Nick seemed to be regaining consciousness; he continued to cough, trying to clear his own airway. Dani could hear him taking raspy breaths in between the retching noises, and she let out a sigh of relief.
“He’s back in sinus rhythm,” said Elizabeth, her eyes on the portable defibrillator screen. At the same time, her fingers palpated his carotid artery. “Pulse has been restored.”
Dani picked up Nick’s right hand and pressed her fingertips to the inside of his wrist. She felt a faint fluttering there as well. “He has a weak radial pulse, too.”
Elizabeth nodded. “Then we’ve achieved a return of spontaneous circulation. Good work, everyone,” she said, reaching for her stethoscope. “Let’s get a B.P. and monitor his breathing. Give him ten liters by mask and leave him in the recovery position until we know he can protect his own airway.” She slipped the stethoscope into her ears and leaned over Nick to listen to his chest, leaving the two nurses to carry out her instructions.
“Yo, Pat!” Rob called from across the room. “Come bag my patient, and I’ll take care of Carter.”
“Be my guest,” said Patrick, sounding relieved, as he stepped over the puddle of vomit next to Nick’s bed and took Rob’s place behind Brian’s.
“Is that blood?” Dani asked, looking down at the reddish-brown liquid on the floor. Her mind raced, as she wondered what could have caused Nick to throw up blood. Had she damaged more than his ribs during that last resuscitation? Was he bleeding internally?
Rob laughed. “That, my dear, is Red Dye 40. He just had a cherry popsicle, remember?”
“Oh… right.” Dani forced a laugh, too, feeling dumb. “Duh. I think I broke one of his ribs doing CPR... I was starting to worry it had punctured something.”
“Way to go, She-Hulk,” he joked as he brushed past her, giving her a playful smack on the butt. “You were so hot, babe.”
She raised an eyebrow. “What do you mean, were?” she asked, pretending to be offended, as she wrapped the blood pressure cuff around Nick’s right arm. “I hope I still am!”
“Always,” said Rob, smiling. “But especially when you’re saving someone’s life.”
“All right, you two, that’s enough pillow talk,” Elizabeth interrupted, giving them both a look as she replaced her stethoscope around her neck. “If you were paying as much attention to your patient as you are to each other, you might have noticed that he’s awake.”
Dani looked down in surprise. Sure enough, Nick’s eyes were open.
***
In his dream, Nick was drowning.
Submersed in deep, murky water, he struggled for the surface, but whenever he came close, a strong wave would crash over him, pushing his body back under. He bobbed up and down like a cork, unable to keep his head above water long enough to breathe. His lungs burned, desperate for fresh oxygen.
Something brushed the bottom of his foot. Looking down, he saw Brian floating on his back, a few feet below him. His best friend looked surprisingly relaxed. Brian smiled and waved up at Nick, beckoning him to come closer, but Nick shook his head. He knew he couldn’t allow himself to sink any further into the depths of the dark water, or he would drown for sure. He wondered how Brian had managed to stay so calm. How could he possibly breathe down there, without any diving equipment?
The answer to that appeared a second later, in the form of a small fish. As it swam toward Brian, the fish’s body suddenly inflated to four times its previous size, becoming as round as a beach ball. Pufferfish! Nick thought excitedly, temporarily forgetting about his breathing problem. He watched in astonishment as the pufferfish approached Brian, positioning itself in front of his face. Brian put his hands on either side of the fish’s body and pulled it right up to his mouth. No, Brian! Nick wanted to shout. He waved his arms wildly, trying to warn his friend that pufferfish were extremely poisonous. The deadly neurotoxin they carried could paralyze a person. But Brian didn’t seem to be worried. He gently squeezed the sides of the pufferfish, forcing air from its stomach straight into his mouth. Somehow, it worked. Brian’s chest expanded as his lungs filled with air, and the fish deflated back to its former shape. Nick shook his head in disbelief.
Then, out of the darkness, loomed another creature. It had the face of a rather unfortunate-looking fish, but its long, slender body was more snakelike. As it slithered toward Nick, he realized it was some type of eel, but by that time, it was too late to swim away. The eel struck without warning, lunging straight at him. Even before it touched his body, Nick felt a surge of electricity shoot through his chest, making his heart flutter. He let out a silent scream, his mouth filling with water, and the last of his air supply escaped his lungs as the liquid he’d inhaled flowed in.
Nick knew then that he was doomed, that he was going to die in the dark depths of the water he’d once loved. Yet he fought to live. Flailing his arms and kicking his legs as hard as he could, he propelled himself upward, away from the eel. As he approached the surface once again, the powerful waves battered his body, pushing him back down. Water filled his lungs, making them feel as bloated as the pufferfish’s body. His chest felt ready to burst from the burning pain and pressure of being unable to breathe.
Then someone threw him a lifeline.
He looked up and saw a life preserver bobbing above him. With his last ounce of energy, he managed to reach up and hook his arm around it. Then he felt himself being hauled out of the water. It took all of his strength to hang on as he was pulled through the choppy waves. A flash of lightning illuminated the black sky overhead, revealing the silhouette of a small fishing boat.
“C’mon, Nick!” he heard a voice call out to him from the boat. “Come on back to us!”
I’m trying, thought Nick, but he couldn’t speak, couldn’t breathe. A pair of strong arms reached down and pulled him out of the water. As he collapsed onto the boat deck, coughing uncontrollably, he felt more hands on his body, rolling him onto his side so he could expel the water from his lungs.
Only once he was out of danger did it occur to him that he had left Brian behind. But he didn’t want to go back into the water. He was too exhausted to keep fighting the waves… too afraid of what would happen if he lost the fight. Brian will be okay, he thought as he let his eyes close, eager to rest awhile.
When he opened them again, he was looking into a pair of beautiful, brown eyes.
“Hey there,” Dani said softly. “How are you doing?”
Slowly, the rest of the room materialized around her, and Nick realized he was lying not on a boat deck, but in his hospital bed. He’d had another nightmare… but the look on her face and the pain in his chest were enough for him to know that wasn’t all he had experienced. “I dunno… you tell me,” he muttered, his voice muffled by an oxygen mask. “What happened?”
“Well…” She gave him a grim smile. “Let’s just say your ICD did its job.”
“So I got shocked.” It wasn’t a question. As the details of his dream became muddled, the memory of the bomb detonating inside his chest manifested itself. He looked down, half-expecting to see a bloody hole where his heart should have been, but the only outward sign of damage was some mild bruising over his breastbone.
Dani nodded. “Several times, actually. It took a few tries before it was successful.”
With a sinking feeling, Nick realized he had been near death again, not only in his dream. “Did you have to do CPR on me?” he asked, already knowing the answer. What else could have caused those bruises on his chest? She confirmed his suspicion with another nod. “Thanks,” he added softly, “for saving me again.”
“No need to thank me,” she replied, shaking her head.
“I know, I know… just doing your job, right?”
“Well, yeah… that, and I may have cracked one of your ribs. I’m so sorry,” said Dani, biting down on her bottom lip.
Nick’s mouth dropped open underneath the oxygen mask. “Holy shit... are you serious?” He ran his hand down his torso, cautiously tracing the curves of his rib cage with his fingers, and winced when he encountered a tender spot on his right side. No wonder his chest was so sore.
“I wish I wasn’t, but it does happen sometimes,” Dani replied sheepishly, tucking a strand of blonde hair behind her ear. Nick stared at her, still trying to understand how someone so petite could possibly push hard enough to cause him that much pain.
“She doesn’t know her own strength,” said Dr. Rob with a crooked smile, as he came up behind Dani and rested his hands on her shoulders. “Sorry about that, man. It should heal in about six weeks if you take it easy.”
Nick was starting to wonder if he would even still be alive in six weeks, but he didn’t tell them that. Instead, he said with a sigh, “Not much else to do around here except take it easy.”
“I know.” Dani offered Nick a sympathetic smile. “I’m sorry.”
“It’s all right.” He let his eyes wander past Dani and Rob to Brian’s bed behind them. The other nurse, Patrick, was bagging Brian now. Nick watched his friend’s chest rise and fall a few times before he asked, “Is Brian doing okay?”
Rob nodded. “As far as we can tell. It’s hard to know for sure without most of our monitoring equipment.”
“I bet. Any idea when the power will be back on?”
“I dunno. Maybe I should go check on the guys I left in charge of looking at the generator, eh?” Rob grinned. “You guys got this?” he asked Dani, patting her on the shoulder.
“Yeah, we’re fine,” she replied, reaching for her stethoscope. “Go find out what’s going on with the generator.” Once Rob had grabbed a flashlight and left the room, she perched on the edge of Nick’s bed. “I just need to check your blood pressure,” she said, as she slipped the stethoscope into her ears. She pressed the other end to the inside of his elbow, just below the cuff that had been wrapped around his arm. Nick felt the cuff tighten as she inflated it. A furrow appeared in her brow as she frowned in concentration, listening carefully while the cuff gradually loosened again. “Ninety over sixty,” she announced when she was finished, taking off the cuff. “A little on the low side, but not bad - a lot better than it was a few minutes ago.”
Nick swallowed hard. “What do you think made my heart start freaking out this time? I wasn’t even doing anything.”
“It’s not your fault,” Dr. Elizabeth spoke up from somewhere behind him. She came around to the other side of Nick’s bed so he could see her face as she answered his question. “Arrhythmias are just another unfortunate symptom of worsening heart failure. They can’t be predicted or prevented, even by the ICD. All it can do is attempt to correct the problem, as yours did.”
“So you’re saying it’ll probably happen again,” he replied flatly. The prospect of facing another defibrillator shock filled him with dread. It was a hopeless, frightening feeling, knowing his heart could give out on him again at any time, without warning.
“I’m going to adjust your dosage of antiarrhythmic drugs to hopefully prevent another episode like this one,” said Dr. Elizabeth, “but until you get a new heart, it’ll always be a possibility. That’s why we put in the ICD.”
Nick touched the tender pocket of skin into which the device had been implanted. A part of him wanted to tell her to take it out and let him die, but he knew that was just the pain talking. “My chest is really sore,” he said, rubbing his side. “Can you give me anything for that?”
“Of course. Dani, let’s try Tylenol with codeine and see how he does with that.” She and Dani helped him roll onto his back and raised the head of his bed until he was sitting halfway up. Dr. Elizabeth took off the oxygen mask he’d been wearing and replaced it with a nasal cannula so he could drink. Dani brought him a bottle of water and two tablets, which he took.
As Nick was waiting for the painkillers to kick in, the lights suddenly came back on. All around the room, machines sprang back to life, emitting a loud array of alarms and beeps.
“We have power!” Dani exclaimed, slapping Elizabeth a high five across the bed.
“Everything will need to be reset,” the doctor replied, all business again. “I’ll start with the vent so poor Patrick can stop bagging. Will you take care of this half of the room?”
“You bet.” Dani bustled around Nick’s bed, checking and reprogramming every piece of equipment, as Elizabeth did the same on Brian’s side. In a manner of minutes, both heart monitors were blipping steadily, while the ventilator hissed softly in the background. The medley of medical noises, once so unnerving to Nick, now felt reassuringly familiar. Everything was back to normal - his new “normal,” anyway.
Rob returned a few minutes later and rambled something about a vapor lock preventing the generator from pulling fuel from its reserve tanks. “It’s fixed now,” he proclaimed, “so we should be good to go for another few days.”
The reason for the outage didn’t matter much to Nick. He was just glad the power had been restored, at least for the time being.
“Did you hear that, Brian? We made it, bro,” he called across the room, feeling relieved as he watched his friend’s chest rise and fall without anyone squeezing a bag over his face. Brian was still unable to breathe on his own, relying on the ventilator to force oxygen into his lungs, but Nick tried to look on the bright side. At least he and Brian were breathing, and both their hearts were beating. They were no longer in any immediate danger. “We’ll be okay now.”
***
