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The fifteenth day dawned the same as the previous fourteen. “Rise and shine!” Dani’s voice rang out, rousing Brian from another round of restless slumber. Even though he had spent all day and night lying down in almost constant darkness, he found it surprisingly difficult to sleep in the ICU. Unable to roll over or reposition his body at all, he could never seem to get comfortable on the hard hospital bed, whose bleached sheets made his skin crawl, and the cacophony of noises from the equipment kept him from being able to relax. He would lie awake for hours, listening to the ventilator hissing, the monitors blipping, and the IVs dripping. Whenever he did manage to drift off, one of the nurses would inevitably come in to check his vitals and wake him up again.

He heard the sound of water sloshing around as Dani set down something heavy, then the rattle of her closing the curtain around his bed. A cloud of dread descended over him, for he knew what was coming next.

“It’s time for your bath, Brian,” Dani announced cheerfully, turning down his blankets. “I’m gonna get you all nice and clean.”

I can’t be that dirty after one day, he thought grudgingly. Can’t you just leave me like this? But of course, he had no way to tell her so, and she couldn’t read his mind. There was nothing he could do but lie there helplessly as she took off his hospital gown, exposing his naked body.

She dipped her washcloth into the warm water and wrung it out before she began wiping his face with it. She ran the washcloth over his forehead and into his hair, working the soapy water into a lather as she scrubbed his scalp. It felt good, but he wished she would use real shampoo. The soap dried out his skin and made his scalp itchy. It was torture to not be able to reach up and scratch it himself.

After rinsing with clean water, she continued bathing his upper body, washing his chest and arms before working her way down to his legs and feet. Brian could feel the lukewarm water on his skin, her gloved hands gripping his limbs as she lifted them up to get at the undersides, the tips of her fingers tickling the soles of his feet. He could feel everything, yet he couldn’t move anything.

“I’m just going to get some fresh water,” said Dani when she finished washing between his toes. “I’ll be right back.”

Brian wondered if she knew he could hear her, or if she spoke that way to all her patients, whether they were awake or not. As humiliating as this whole experience was, he appreciated being talked to like an actual person who could listen and comprehend what she was saying, rather than some inanimate crash test dummy. Still, he shivered as he waited for her to come back, his body lying unclothed and uncovered on the bed. He had never felt more vulnerable.

When Dani returned, she had her husband Rob with her. He held Brian’s head steady between his hands while Dani removed the cervical collar from his neck and carefully washed the folds of skin underneath it, working around his tracheostomy. The site where the tube had been inserted was still tender, but according to Rob, the hole in his throat was healing well. Brian wondered what it looked like, but thought he was better off not knowing. He couldn’t wait until he was able to breathe on his own again so they could take the tube out and let the hole close for good. He wanted them both gone. Brian enjoyed the brief break from wearing the bulky neck brace, but before he knew it, Dani was putting it back on, immobilizing his head once more.

Next, she and Rob worked together to roll Brian onto his right side. He was turned every few hours to prevent pressure sores from forming, a task which took two people in order to keep his spine properly aligned. Dani washed his back while Rob went to the other side the the room to check on Nick.

“How you doing this morning, man?” he heard Rob ask.

“Not too great,” Nick replied. Brian could tell by the tone of his voice that he wasn’t feeling well; he could practically picture Nick grimacing in pain. “I’ve got this fluttery feeling in my chest that won’t go away.”

“Yeah? How ‘bout I take a listen?” Rob responded. He kept his voice light and casual, but Brian was concerned. It wasn’t like Nick to complain about the way he was feeling; normally, he was the type who tried to tough it out until he couldn’t take it any longer. Something really had to be bothering him for him to admit to being in any discomfort.

“I don’t hear anything different,” said Rob after a long pause, “but I do see some pacing spikes on the monitor, which means the pacemaker part of your ICD must be firing off impulses to regulate your heart rate. That’s probably the fluttering you’re feeling. It’s a normal part of having a pacemaker - nothing to worry about for now.”

Brian tried to relax and enjoy the sensation of Dani scrubbing his back with the warm washcloth. He did not enjoy the feeling of her gloved fingers prying apart his buttocks to wipe between them, nor did he appreciate her washing what was in front. His penis seemed to, though, for he felt it stiffen as she rubbed it with the cloth. It wasn’t the first time this had happened, and in some ways, it was actually a relief: at least there was one part of him that didn’t seem to be paralyzed. But mostly it was just embarrassing. He knew Dani, as an ICU nurse, probably thought nothing of it, but that didn’t make it any easier for Brian to endure. The only woman who was supposed to give him an erection was his wife.

Leighanne. What he wouldn’t give to hear her voice in his ear and feel her hands on his body instead. He missed her and Baylee so much, it hurt. When he had first woken up in the hospital, he’d wondered why they weren’t at his bedside, but by listening to Dani talking to Nick, Brian had learned that the Keys had all been evacuated and the airport closed not long after his accident. Even if they had flown down, they would have been forced to leave and wouldn’t be allowed to come back while Key West was underwater. He supposed that was why he hadn’t seen Howie there either. It made sense, but it didn’t make being without his family any easier. At least, for now, he still had Nick.

“I’ve been feeling so nauseous,” he heard Nick saying, as Dani dried him off and pulled the blanket back up over his body. “I barely have an appetite anymore, which is weird for me.”

“Yeah, but that’s pretty typical for a heart failure patient,” Rob assured him. “It can be caused by congestion from fluid building up around your liver and gut. You’ll feel a lot better once we get that under control. I see Dr. Elizabeth upped your dosage of diuretics. Did you notice yourself having to urinate more than usual during the night?”

Nick snorted. “Only, like, once an hour.”

Rob chuckled. “Sucks, huh? But hey, at least your kidneys are working. Your lungs sound less congested today, too.”

Listening to their conversation, Brian tried to keep his mind focused on the positives. The new medications Elizabeth had prescribed were working. Nick was doing better, even if he didn’t seem to feel any better.

When Rob came back to Brian’s side of the room, Brian hoped he would be able to see some signs of improvement in his own condition as well. But the exam started off as badly as it always did. “Hey Brian, can you open your eyes for me?” Rob asked, and of course, Brian could not. Bright light flooded his retinas, nearly blinding him, as Rob pried his eyelids apart anyway and shined his penlight straight into them. “Pupils are equal, round, and sluggish,” Brian heard him say, presumably to Dani.

Before he could lower Brian’s eyelids again, an alarm began to sound on the other side of the room. Brian’s heart leapt into his throat as he heard Nick let out a harsh cry of pain.

Dani reacted quickly, ripping the privacy curtain open as she left Brian’s bedside in a rush and raced across to Nick’s, Rob right behind her. “Nick, are you okay?” she called.

As his eyes adjusted to the light, Brian could see Nick lying on his back in bed, his mouth gaping open as he gasped for breath. His hands had curled into tight fists that clawed at his heaving chest. His eyes were half-open, but didn’t seem to be focused on anything.

“Talk to me, Nick,” said Dani as she leaned over him, pressing her fingers to the side of his neck. When Nick did not respond, she looked back at Rob. “I can’t feel a pulse.”

Rob’s eyes were fixed on the heart monitor, which was going haywire, a red light flashing while the alarm wailed. “He’s in V-fib,” he replied, lowering the head of Nick’s bed so that he was lying flat. “The ICD should shock him any second now.”

It seemed like the longest few seconds of Brian’s life, watching the doctor and nurse stand by and do nothing as they waited for the defibrillator inside his friend’s chest to fire. But sure enough, Nick’s body suddenly jerked, his fists flying up off his chest before falling limply to his sides.

Another second passed, as Rob studied the rhythm on the monitor. “No response,” he said after a moment’s pause, silencing the shrill alarm with the press of a button. “Starting CPR.”

No! Brian screamed without making a sound. He wanted to look away, but he couldn’t turn his head or close his eyes. He was forced to watch as Rob bent over Nick’s bed and began pushing vigorously on his chest. Please, no, Brian thought frantically, feeling his own heartbeat accelerate as Nick’s faltered. Not again. Not now.

“I’ll bag him,” said Dani, hurrying to the head of the bed. She hit a blue button on the wall to summon help before she grabbed an Ambu bag. Taking the oxygen tubes out of Nick’s nostrils, she tilted his head back and secured the mask tightly over his mouth and nose. She held it in place with one hand while she squeezed the attached bag with the other, giving breaths in between compressions.

C’mon, Nick, Brian begged, wishing he could say the words out loud. He remembered being on the receiving end of that resuscitation mask, relying on the nurses and doctors to hand-pump oxygen down his throat during the power outage. The only thing that had helped him stay calm was hearing Nick’s voice encouraging him to hang on, reassuring him that he would be all right. Brian wanted to return the favor, but the trach tube prevented him from being able to talk to Nick. He formed the words in his mind instead and hoped God would help get his message to Nick, one way or another. Keep fighting, Frack; your family needs you. We love you, bro. Come on back to us now.

After what seemed like an eternity, Dani asked, “Have you felt any more defibs from the ICD?”

“Now that you mention it… no,” replied Rob, breathing hard from the effort he was putting forth to keep blood flowing through Nick’s body. Beads of sweat had formed on the back of Rob’s neck, and his biceps bulged beneath the sleeves of his scrub top as his arms applied the pressure needed to force Nick’s heart to contract. “How long since the last shock?”

“About two minutes.”

Rob stopped and straightened up, sighing as he wiped the sweat from his brow. “Let’s see if it worked,” he said, looking up at the heart monitor overhead. Lying on his side, unable to lift his head, Brian couldn’t see the screen clearly, but he waited hopefully for a sign that Nick’s heart had started beating again. He felt a rush of relief when he heard Rob say, “Looks like he’s back in sinus rhythm.”

Dani reached down and pressed her fingers to the side of Nick’s neck again. “I’m still not feeling a pulse,” she said uncertainly.

Rob shook his head as he studied the monitor. “He’s not registering an arterial blood pressure either. Must be pulseless electrical activity. Resuming compressions.” Brian’s heart sank as he saw Rob bend over to continue CPR.

“Do you want any drugs?” Dani asked.

“Yeah, but then who’s gonna bag him?” Rob was practically panting now, his breath coming in short gasps as he kept pumping Nick’s chest. The hospital bed rattled underneath his weight with the impact of each compression. “We could use another pair of hands in here.”

“I hit the call button; Elizabeth should be here any minute. In the meantime… I can multitask.” Dani squeezed the Ambu bag to deliver one more big breath to Nick’s lungs, then darted around his bed and disappeared from Brian’s line of sight. She was back in a matter of seconds, rolling the red crash cart to the head of the bed. Grabbing the Ambu bag, she gave Nick another breath, then opened the top drawer of the cart and took out a syringe. “Epi?” she asked Rob.

“You know it,” he replied in between compressions.

Dani squeezed the Ambu bag again before she injected the drug into Nick’s IV. “Epi’s in. Need a break?”

Rob nodded. “Have at it, babe.” They traded roles without missing a beat. The second Rob removed his hands from Nick’s body and stepped back from the bed, Dani rushed forward to replace them with her own. She continued pumping Nick’s chest from the opposite side of the bed, as Rob took her place at the head to bag him.

Brian had a better view of Nick now that Rob was no longer in the way, and he could see clearly just how bad Nick looked. His skin was ashen, as if all the life left in him had faded away. His left arm hung limply off the side of the bed, twitching slightly each time Dani pushed down on his chest. Brian could see the skull and crossbones inked on the inside of Nick’s wrist. It gave him an ominous feeling. Old habits die hard, the inscription on his tattoo said. Nick was the type to die hard, too. C’mon, you stubborn son of a bitch, Brian silently begged, staring at his best friend’s blank, colorless face. Damn it, Nick, don’t you do this to me now! He desperately wished he could reach out and take hold of Nick’s hand, give it a squeeze, and tell him to hang on.

Out of the corner of his eye, Brian could see his own hand lying on the bed beside him, but no matter how hard he tried to flex and curl his fingers, he couldn’t move a muscle. His right hand remained useless and still, just like the rest of his body. It was agonizing to lie there and watch Rob and Dani work on his best friend, knowing there was nothing he could do to assist them. He had never felt more helpless. As the fear and frustration took hold of him, hot tears sprang into his stinging eyes. The room blurred as they clouded his vision, but he couldn’t even blink them away. The tears overflowed, trickling freely down the sides of his face.

“Pause for a pulse check,” said Rob after another minute or two had passed. He palpated the artery in Nick’s neck, as Dani stopped pumping.

“Anything?” she asked, sounding hopeful as her eyes darted up to the heart monitor.

If Brian had been in control of his breathing, he would have held his breath as he awaited Rob’s reply. C’mon, Nick, he kept praying, as his own heart pounded hard inside his chest. Please...

But Rob shook his head. “Nothing. Still PEA. Continue CPR.”

The rhythm of resuscitation resumed as Dani went back to her compressions, the bed rattling with each artificial beat of Nick’s heart. His chest rose and fell as Rob inflated his lungs with air from the Ambu bag and Dani’s hands deflated them again. Having fully taken over his body’s most basic functions, the two of them worked together in perfect sync to keep oxygenated blood flowing to Nick’s brain.

“Another amp of epi in,” said Rob as he injected more medication into the IV. “If we’re ever gonna get a pulse back, we need to think about what else could have put him in cardiac arrest, besides the obvious. Reversible causes… Hs and Ts… go!”

“Hypoxia,” replied Dani, raising her eyebrows as she glanced over at Rob.

Squeezing the Ambu bag, Rob shook his head. “He has good chest rise with ventilation, and he’s gotten less cyanotic since we started giving him high-quality compressions and one hundred percent 02. How about hypokalemia? I saw in your notes that he’s now on a higher dose of diuretic. He could be low in potassium.”

“If you’d read my notes a little closer, you’d know Elizabeth switched him to a potassium-sparing diuretic when she prescribed dig. If anything, he’s hyperkalemic, in which case more potassium will kill him!” Dani argued, pumping Nick’s chest harder. “He’s getting plenty already; I’ve been bringing him bananas for breakfast.”

“Okay… so maybe he needs calcium,” said Rob with a shrug, as he squeezed the Ambu bag again. Brian didn’t know how he could stay so calm and casual while Nick lay dying on the bed before his eyes. Of course, he was probably used to treating critically ill patients, but it bothered Brian that the doctor didn’t seem more concerned by his best friend’s lack of a heartbeat.

“You give him calcium now, and you’ll never get him back.”

Rob and Dani both looked up in surprise as Dr. Elizabeth entered the room. Brian’s heart skipped a beat, but he felt the slightest bit of relief. If anyone could bring Nick back, it was this woman, the “Queen of Hearts,” as he’d heard her called.

“Calcium is contraindicated in patients taking digoxin, as it can cause an irreversible condition known as ‘Stone Heart,’ which prevents the heart from contracting,” the cardiologist explained, opening another drawer of the crash cart and rummaging through its contents. “What was his last rhythm?”

“PEA, almost two minutes ago.”

Elizabeth emerged with a syringe and a small vial. “I’m going to administer two grams of magnesium sulfate,” she announced, as she drew up a dose of the medication and added it to Nick’s IV. When she was done, she turned to Dani. “Hold compressions so we can check for a pulse.”

“Who’s running this code, you or me?” asked Rob, scowling at her.

“I am,” answered Elizabeth coolly, slipping her stethoscope into her ears. “He’s my patient.” When Dani stopped pumping, the doctor put the end of the stethoscope where her hands had been and listened for a few seconds, frowning.

Meanwhile, Rob was feeling the side of Nick’s neck. “Still no sign of a pulse.”

Elizabeth nodded, looking at the monitor. “No electrical activity either. He’s in asystole,” she said matter-of-factly, as Brian’s stomach clenched. He didn’t have to be a doctor to know what this meant: Nick had flatlined. His heart was not even fibrillating any longer; it had come to a complete and perhaps permanent halt. Yet Dr. Elizabeth didn’t seem ready to pronounce his death. “Switch places and continue CPR,” she commanded, glancing up at the clock.

Rob moved to the side of the bed and began compressing Nick’s chest again, as Dani went back to bagging. “How long are we gonna keep going like this?” he asked grudgingly.

Dani glared at her husband. “We’re not giving up on him yet! He hasn’t even been down that long!”

To Brian, it felt like an eternity, but he was grateful for Dani’s determination.

“What is his down time?” Dr. Elizabeth asked.

Dani looked at the clock. “Almost eight minutes.”

“And when was his last epi?”

“About three minutes ago.”

“I’ll give him another amp,” said the cardiologist, taking a second syringe out of the top drawer of the red cart. “To answer your question, Rob,” she added, as she injected it into Nick’s IV, “we’ll keep going long enough to give the meds a chance to work.”

Thank you, thought Brian, feeling a faint glimmer of hope. All he could do was watch as they continued to work on Nick, pumping him full of oxygen and drugs in a desperate effort to restart his heart. Every couple of minutes, they would pause to check for a pulse, and when the waveform on the monitor remained a flatline, they would rotate roles and resume the process of trying to resuscitate him.

This went on for several more rounds, until Dani suddenly gasped, jerking her hands off of Nick’s body as if she had just been burned. “Did you see him twitch?” she asked, her voice shrill. “The ICD tried to defib him; I felt it!”

“High-quality compressions can mimic a shockable rhythm,” said Dr. Elizabeth, looking up at the heart monitor. “Hold compressions. Let’s see what happens.”

The room fell silent as the three of them froze, their eyes fixed on the monitor. Brian’s eyes burned, unable to blink, as he watched and waited for one of them to speak again. Each second seemed to take an eternity.

Finally, Dani drew in another sharp breath, causing Brian’s heart to skip a beat. “There!” she exclaimed. “That’s a sinus rhythm!” She reached up and pushed a button on the monitor to turn the volume back up, and a series of slow, steady blips rang out through the room. Beep… beep… beep… Brian had never heard a more beautiful sound; it was like music to his ears.

“But is it a perfusing one?” Elizabeth asked.

Rob pressed his fingertips to Nick’s neck once more. “I can feel a weak carotid pulse,” he confirmed.

Listening to Nick’s chest with her stethoscope, Elizabeth smiled and nodded. “Nice save, everyone.”

Fresh tears flooded Brian’s eyes as he watched Nick’s chest rise and fall. Thank you, he thought with relief. In that moment, it didn’t matter that he couldn’t move, couldn’t speak, couldn’t blink or even breathe. As long as Nick’s heart was beating, hope was still alive. It was all Brian had to hold on to, like a buoy bobbing in the waves of a stormy sea, a beacon of light burning through the darkness. He couldn’t let go.

***