“I’ll tell you what,” said Dani, smiling. “There’s a phone at the nurses station just down the hall. If you can make it there, you can use it. It’ll give you a good excuse to get up and move. Whaddya say?”
“I say let’s do it,” Nick replied without hesitation. After lying in bed for the last few days, he was eager to stretch his legs.
“Then let me help you this time,” Dani insisted. “Getting out of bed can be quite a process with all this equipment around you.”
“Tell me about it,” Nick agreed, thinking back to his failed escape attempt the previous day. He hadn’t been allowed out of bed since, not even to use the bathroom. As if pissing into a plastic urinal wasn’t bad enough, he was already dreading the humiliation of having to ask Dani to bring him a bedpan. If he could prove he was capable of walking down the hall, hopefully she would let him go to the bathroom by himself.
“Don’t worry - we’re going to get rid of some of these tethers so you don’t have to drag so many tubes around with you,” Dani assured him, as she went to the sink to wash her hands.
“Sounds good,” said Nick gratefully, eager to be free from at least some of the tubes and wires.
Dani dried her hands and snapped on a pair of sterile gloves. She disconnected the IV line from the catheter in his neck, then drew up a syringe of clear liquid. “This is just a solution to flush your central line, so it doesn’t get clogged,” she explained, as she slowly injected it into the catheter.
“When can that come out?” Nick wanted to know. It was uncomfortable having tubes hanging out the side of his neck, and the dressing that held them in place itched his skin.
“I’m not sure,” said Dani apologetically. “Right now it’s necessary so we can deliver medications directly to your heart and monitor your blood pressure more closely.”
Nick sighed, the anxiety building inside him again. He wanted to rip the thing right out of his vein and run screaming from the room. The realization that he wouldn’t get far with a failing heart - if he didn’t bleed to death first - only intensified the feeling that he was being held hostage in his hospital bed.
Dani gave him a sympathetic smile. “I know… it’s a real pain in the neck, right? Like, literally.” He groaned at her bad joke, and she winked, her brown eyes twinkling. “But hey, on the bright side, at least we don’t have to stick you every time we need to draw blood.”
“Yeah… I’m starting to think you people are a bunch of vampires,” he muttered back, shooting her a quick smirk. He didn’t much feel like laughing, but he appreciated her trying to lighten the mood.
“How do you know we’re not?” Dani replied, raising her brow. “Some of us do sleep during the day, stay up all night, and never see the sun. I mean, when you think about it, what better field would there be for a vampire to work in than healthcare?”
“Good point,” said Nick. He wished she would hurry up and help him out of bed. He couldn’t wait to get back on his feet. Even a brief walk in the hallway would feel like an excursion after lying down for so long.
Dani puttered around his bed, removing the blood pressure cuff from around his arm and the pulse oxygen sensor that had been clipped onto his finger. When she unplugged the cable that connected the electrodes on his chest to the monitor behind his bed, an alarm immediately sounded. “Ignore that,” she said, silencing it with the flick of a switch. “It’s just letting me know it’s not capturing any of your vitals.”
Nick nodded.
“I’m going to switch your supplemental oxygen supply over to a portable tank now, so you may feel short of breath for just a few seconds,” she explained, as she fiddled with a valve on the wall behind him. Nick noticed when the oxygen stopped flowing into his nostrils, but he was still able to breathe easily enough without it. “How you doing, Nick?” Dani asked, as she adjusted the settings on the tank.
He shrugged. “Fine.”
“There should be oxygen flowing through your cannula again,” she said when she was finished. “Can you feel it?”
Nick inhaled deeply through his nose and nodded again.
“Okay, good. I think we’re all set then. We have to leave the a-line in for now,” she added, gesturing to the thin tube in his wrist. “You can wheel the IV pole along with you, and I’ll take care of the oxygen tank.”
“Awesome,” Nick replied eagerly. “I can’t wait to get out of this bed.”
She smiled. “We’re going to take it slow,” she warned him. “You’d be surprised at how quickly your leg muscles can weaken when they’re not being used at all. You’ve basically been lying down for the last few days, so your body may need some time to adjust to being upright again. I’m just going to have you sit on the side of the bed for a minute first and see how that feels before you try to stand.”
Nick thought she was underestimating his strength, but he played along, allowing her to slip her arm behind his back and support him as he sat up. With her help, he slid his legs over the side of the bed, scooting forward until his feet were touching the floor.
“How do you feel?” Dani asked.
“Fine,” insisted Nick, who was dizzier than he wanted to admit.
“That’s good. Now, don’t hate me, but I have to put a couple of things on you before I can help you stand. Hospital policy,” she added apologetically. “First... proper footwear.” She produced a pair of slipper socks with nonskid soles. “The last thing we want is for you to slip and fall on the floor,” she said, as she knelt down and pulled the socks onto his feet.
Looking down at his legs, Nick snorted. With the white compression hose and fuzzy slippers, they looked more like an elderly woman’s than a not-quite-forty-year-old man’s. “Sexy,” he said sarcastically, and Dani laughed.
“I know, right? But wait… there’s more!” she exclaimed, whipping out a thick, white fabric belt. “This is a gait belt. It goes around your waist to help me lift you if needed and grab hold of you if you were to lose your balance.”
Nick shook his head. “You’re making me feel like I belong in a nursing home,” he griped, but he lifted his arms and let her wrap the belt around his waist anyway. “I did get out of bed all by myself yesterday, you know.”
“Yes, and you almost passed out, remember?” Dani replied without missing a beat, as she cinched the belt snugly around his middle. “Is that too tight?”
Nick smirked. “Nah, it’s all right. Can we do this already?”
She smiled back at him. “You bet. On the count of three, you’re going to push yourself up to a standing position, okay? One… two… three.”
Without the tangle of tubes and wires to worry about, Nick had no trouble standing up this time. Dani had been right about one thing, though: his legs were weak. He wobbled slightly before she helped him regain his balance, and even then, he still felt woozy.
“You feeling okay?” she asked, holding on to his arm with one hand while the other kept a firm grip on the gait belt behind his back.
He nodded.
“Any dizziness or shortness of breath?”
“No,” Nick lied, sure that the sensation would pass in a few seconds.
“Are you ready to try taking a step?”
He took a deep breath before nodding. “Yeah.”
“All right, awesome. Hold onto this,” said Dani, pushing the IV pole to his left side. She positioned herself on his right, her hand resting lightly on his back. “Now you let me know if you start to feel light-headed. You can stop and rest any time.”
“I’m all right,” he assured her, anxious to get going. He took a tentative step forward, followed by another, fighting the queasy feeling in his stomach.
“That’s it,” Dani said encouragingly, as she walked alongside him. “You’re doing great, Nick.”
He snorted. “You sound like Lauren when our son was first learning to walk.”
“Is that a bad thing?” asked Dani. “If so, I’m sorry - I swear, I’m not trying to treat you like a baby. It’s just good to see you back on your feet. In the ICU, we celebrate every success, no matter how small.”
“No, I understand,” Nick said. “It’s all good. Just thought it was funny.”
She smiled. “Still feeling okay?”
“Yeah… just tired.” His legs felt heavy, and his heart was already beating hard, like he’d been running uphill instead of shuffling slowly across a flat surface. He inhaled deeply, but the extra oxygen didn’t seem to help much.
“Take it easy,” said Dani. “Let me know if you need to sit down.”
“No… I’m okay.” Nick needed to get to that phone; he needed to call Lauren and beg for her forgiveness. But as he approached the doorway, the queasy feeling in his stomach intensified into full-blown nausea. He paused, pressing his hand to a spot at the base of his ribcage, as waves of pain began to radiate from his stomach to his chest.
“Are you sure?” Dani asked, putting her hand on his shoulder. “You’re looking pretty pale all of a sudden. Plus, you’re sweating.”
He forced a shaky laugh. “Guess I’m in worse shape than I thought.”
Dani didn’t reply at first. She reached for his hand and pressed her fingers firmly against the artery on the inside of his wrist. “Your pulse feels weak,” she said, frowning, after a few seconds had passed. “Your blood pressure may be dangerously low. We should get you back in bed.”
“No,” said Nick stubbornly, shaking his head. Despite how winded and woozy he was, he was determined to make it out the door and down the hall. “I wanna keep going. I have to talk to my wife.”
“Then I’ll get you a wheelchair,” Dani replied rationally. “I don’t want you to push yourself too hard. We can try walking further tomorrow.”
“I don’t need a wheelchair,” Nick protested, tired of feeling like an invalid. “I’m fine.” But as he tried to take another step forward, his knees suddenly buckled. He felt Dani grab the gait belt behind his back as he lost his balance, but all she did was slow his fall, helping him slump safely to the floor.
“See, now that’s exactly what I was trying to avoid,” she said, as she knelt next to him, her arm around his shoulders. “Are you okay?”
Nick shook his head again, finally forced to admit defeat. “No. I’m really dizzy… and nauseous…” This time, he could not deny the fact that he had almost passed out. He was covered in cold sweat, and his heart was hammering so hard, it felt like it was about to burst out of his chest.
“You need to lie down for a few minutes,” she said, helping lower his head to the floor. “Let me grab something to elevate your legs.” He lay helplessly while she went and pulled the pillow and blanket off his bed. She placed the pillow behind his head, then folded the blanket and used it to prop up his feet. “Better?” she asked.
“A little,” Nick lied, but he didn’t feel better at all. If anything, he was feeling worse by the second. Lying flat on his back like that, he could barely catch his breath, and the pain and pressure in his chest were building. His heart seemed to be skipping beats, which scared him so much, he was relieved when Dr. Elizabeth appeared in the doorway.
“What happened here?” she asked, hurrying into the room.
“I was helping him ambulate when I noticed he was diaphoretic,” Dani explained. Nick suspected she had hit the call button to summon help while she was getting the pillow and blanket. “He collapsed before I could get him to sit down.”
Dr. Elizabeth’s eyes swept over Nick’s body. “Why is he off the monitor?”
“Just trying to limit how much equipment we had to bring with us. His vitals were stable before he got up.”
Elizabeth raised her eyebrows. “And now?”
Dani bit down on her bottom lip. “Pulse is weak and thready. I was just about to get a B.P.”
“Let’s get him back into bed and on the monitor first,” said Dr. Elizabeth. “Bring a wheelchair.”
Dani rushed out of the room, returning with a wheelchair. She and Dr. Elizabeth used the gait belt to help get Nick up from the floor and into the chair. Even though the two women did most of the work, the effort of moving from the floor to the wheelchair and finally to the edge of his bed left Nick gasping for breath. He hunched over, his chest heaving as he inhaled the oxygen flowing through the tubes in his nose. His vision was blurry, as if he was about to pass out again. His head and his heart were pounding. Sick to his stomach, he suddenly began to vomit. The small amount of oatmeal he’d eaten for breakfast ended up on the front of his hospital gown, along with the rest of his stomach contents.
“S-sorry,” he stammered breathlessly, as Dani held a basin under his chin.
“It’s okay,” she said soothingly, rubbing his back as he threw up again. When he was finally finished, she and Elizabeth eased the soiled gown off of him and lifted his legs over the side of the bed so he could lie down. Nick felt so unwell, he wasn’t even embarrassed about being helped, half-naked, into bed by two beautiful women.
“How are you feeling now, Nick?” Elizabeth asked, slipping her stethoscope into her ears.
“Bad,” he admitted. “My chest hurts… It’s hard to breathe…”
“Let me take a listen.” She leaned over him, pressing the end of the stethoscope to his bare chest as Dani moved around his bed, hooking him back up to the various pieces of monitoring equipment. In the background, he heard an alarm go off on the heart monitor, which didn’t help his anxiety any.
“He’s bradycardic,” Dani said, as she wrapped a blood pressure cuff around his arm. “Pulse is thirty-eight.”
“Get the crash cart,” said Dr. Elizabeth.
When Nick saw Dani roll over the same red cart they had used to try to resuscitate his roommate that morning, his panic skyrocketed. His pulse pounded in his ears as he looked desperately up at Dr. Elizabeth, her face but a blur in his snowy field of vision. “Am I having a heart attack?” he asked, a new terror taking hold of him. “My dad died of a heart attack…” Tears welled in his eyes as he considered the possibility of passing away the same way his father had, without ever seeing his son again. “Please, don’t let me die.”
“Nick, I promise, you are not going to die today,” the doctor replied, studying the rhythm on the monitor as she listened through her stethoscope. “And I don’t think you’re having a heart attack. You’re having an arrhythmia - an irregular heartbeat. We’re going to give you some medication to try to revert it back to a healthy rhythm. Dani, administer one milligram of atropine, IV push, please.”
“You got it. Hang in there, Nick,” said Dani, squeezing his shoulder reassuringly as she injected something into his IV.
Nick felt the effects of the medication almost immediately. There was a swooping sensation in his chest as his heart reacted and began to race, followed by a hot flash that made his face flush with sudden warmth. This did nothing to help his nausea or dizziness; in fact, it only made his symptoms worse. “I really don’t feel good,” he said, shaking his head. “God… I’m gonna die, aren’t I?”
Dr. Elizabeth gave him a grim smile and shook her head. “Not if we can help it,” she said. “Dani, let’s hook him up to a twelve-lead ECG.” To Nick, she explained, “This will give us a more detailed reading of your heart’s electrical activity.”
“You know what we call Dr. Elizabeth around here?” asked Dani conversationally, as she attached more electrodes to Nick’s chest and limbs. “We call her the Queen of Hearts. That’s because she’s the best cardiologist in the Keys. You couldn’t be in better hands.”
“Good to know,” said Nick faintly. He could feel his heart slowing down again, but it still seemed to be beating abnormally, making his chest ache as it thumped heavily against his ribs. The blip of the heart monitor in the background was uneven, like a piece of music being played by a percussionist with no sense of rhythm. Suddenly, the alarm went off again.
“He’s bradying down again,” said Dani, looking from the monitor to Dr. Elizabeth.
The latter was studying a strip of paper that had been printed from the ECG machine next to Nick’s bed. “He’s in complete heart block,” she said. “We need to begin transcutaneous pacing.”
“Wait… what now?” Nick was frightened by the unfamiliar medical words they were using. They might as well have been speaking a foreign language. He didn’t understand most of it, but he knew it must be bad because he was feeling worse by the minute instead of better. As much as he wanted to believe them when they said he wasn’t dying, he was filled with a sense of impending doom.
“There’s good news and bad news, Nick,” said Dr. Elizabeth. “The ECG is showing no signs of a heart attack - that’s the good news. What it does show is a problem with the conduction system of your heart, probably caused by the cardiomyopathy. Your heartbeat is usually controlled by an electrical signal that passes from the upper chambers of the heart to the lower chambers, but in this case, that signal has been blocked. Your atria and ventricles aren’t communicating, so they’re contracting independently of each other, completely out of sync,” she explained. “Because of that, your heart is beating too slowly to effectively pump blood to the rest of your body - that’s the bad news. If we don’t correct the problem soon, you could be at risk for another cardiac arrest.”
Nick closed his eyes as he tried to absorb all of this information. When he opened them again, he asked, “So what can you do to correct it?”
“We’ll have to put you on an external pacemaker in order to help your heart beat normally again,” answered Dr. Elizabeth. “It’ll only be temporary, until you’re stable, but eventually you will probably need a permanent pacemaker implanted to prevent this type of arrhythmia from recurring.”
“Great,” said Nick sarcastically, feeling again like he’d aged five decades in a single day. Pacemakers were for old people, not guys in the prime of their lives. But he was in no position to argue about whether he needed one or not.
“We’re going to put a pair of pacer pads on your chest and back,” Dr. Elizabeth explained, as Dani pulled the extra electrodes off his chest and wiped his skin clean. “They’ll send small pulses of electricity to your heart, stimulating it to contract.”
“That sounds painful,” Nick said warily, while Dani peeled the clear back off a large, sticky pad and applied it to the left side of his chest.
“It can be uncomfortable,” Dr. Elizabeth admitted, as she and Dani rolled him onto his right side to place the other pad on his back, below his left shoulder blade. “Once we get started, we can give you some pain medication and a mild sedative if it gets to be too much.”
“Don’t worry, Nick,” added Dani. “I know this is scary, but we’re going to get you through it, okay?”
Nick nodded, swallowing hard. He had no choice but to trust her. With his life hanging in the balance, he lay back and let the so-called “Queen of Hearts” take control of his.
Dani plugged the pacer pad wires into the defibrillator on top of the red crash cart - apparently, it doubled as a pacemaker. When she first began pushing buttons and fiddling with the dials on the machine, Nick didn’t feel any different. This isn’t so bad, he thought, letting out the breath he’d been holding. But that was before he felt the first shock surge through him, followed by another - and another - and another. Every second, his upper body jerked with a jolt of electricity. Each one was like a jab to the chest with a white-hot poker. “Holy shit,” he exhaled sharply, as the air was forced from his lungs.
“Hang in there,” Dani said, squeezing his hand. “I know it hurts.”
“No kidding. How ‘bout those painkillers?” he asked, his voice shaking.
Dani looked at Dr. Elizabeth, who nodded. “Give him eight of fentanyl and five of diazepam.”
“Relief is on its way,” said Dani, as she added the new drugs to Nick’s IV. When he didn’t reply, she remarked, “Isn’t it crazy what a little electricity can do? I mean, who ever came up with the idea of shocking a person to control their heartbeat? It’s like something out of Frankenstein.”
“Actually, it was a man named John Alexander MacWilliam who first experimented with applying electrical impulses to the heart in the late eighteen hundreds,” Dr. Elizabeth answered matter-of-factly.
Dani raised her eyebrows. “Queen of Hearts and heart-related trivia right here,” she told Nick, with a reverent nod toward Elizabeth. “So anyway, what’s your favorite horror movie?”
“Huh?” said Nick, confused by the seemingly random question.
“Frankenstein is one of mine; that’s what made me think of it. What’s yours?” Dani asked again, as she fiddled with his IV.
“I dunno,” Nick muttered. It was too hard to think clearly with his whole torso twitching every time his heart contracted. He could only focus on his own discomfort.
“Oh, come on, Carter, I’m trying to distract you here!” Dani said, sounding exasperated. “The least you can do is play along.”
Despite his pain, Nick managed to smile. “Okay, okay… um… Aliens. Not the first one - the sequel.” It was an honest answer, but he wished he would have thought of a different series when the chestburster scene from the first film started replaying in his mind. He rested his hand on his own quivering chest and imagined his heart exploding through it with a quick spatter of blood.
“Nope, not a horror movie,” Dani said dismissively, shaking her head. “Aliens may be scary, but it’s more of a sci-fi film. I’m talking true horror movies.”
Nick rolled his eyes. “Okay, fine. Nightmare on Elm Street, then.”
“The original or the remake? Or one of the five hundred sequels?”
“Original, of course. But some of the sequels weren’t so bad. I’m a big Freddy Krueger fan.”
“Solid choice,” said Dani, smiling, as she sat down on the edge of his bed and picked up his hand again to check the pulse in his wrist. “Personally, I prefer the more realistic stuff, like Psycho or Silence of the Lambs.”
“You like serial killers, huh?”
“I love serial killers.” She grinned as she looked up from her watch. “God, that sounds so twisted, doesn’t it?”
“Nah, I get it,” said Nick, smiling back. Either her attempt to make conversation and take his mind off the treatment was working, or the medication must have been kicking in, because the pacing was becoming more bearable. He was starting to feel better.
“What’s his pulse?” Dr. Elizabeth interrupted.
“Seventy and strong,” said Dani, giving Nick’s hand a reassuring squeeze.
“Good. Let’s pause the pacing and see what his underlying rhythm looks like.” With the push of a button, the pacemaker stopped firing, and Nick felt an overwhelming sense of relief. Dr. Elizabeth placed her stethoscope on his chest, listening as she looked at the monitor. “Back in normal sinus,” she said at last.
Dani smiled down at Nick. “See? I told you we’d get you through this.”
He nodded. Now that he was finally able to relax, he could feel the effects of the sedative she’d given him. He was still light-headed, but his eyelids were growing heavy, as exhaustion set in.
“Dani, draw some blood to send to the lab. I want a CBC, lytes, and cardiac enzymes,” said Dr. Elizabeth, all business as usual. “We’ll need to run more tests to assess whether you need a permanent pacemaker implanted,” she told Nick, “but until we have the results, I’m putting you on strict bed rest. I don’t want you walking around while you’re at risk for another arrhythmia.”
It wasn’t what Nick wanted to hear, but he was too exhausted to argue. Talking to his wife would have to wait for another time.
***
