Why be a nurse, if not to nurture? Why be a caretaker, if not to care? Why work in a hospital, if not to heal? Why study medicine, if not to save?
I am a nurse. I am a caretaker. I worked in a hospital. I studied medicine.
I tried to nurture. I did care. But those people, those poor people, I could not heal.
The souls who succumbed on Reaper’s Sabbath, I could not save.
Saturday, April 14, 2012
7:00 a.m.
In Tampa, it was the phone that woke Jo. She snapped into consciousness and fumbled for the cell phone on her bedside table. Blinking the sleep from her eyes, she squinted down at the name flashing at her on the screen and frowned. Work? Did she have the day wrong? It was supposed to be her day off. She had specifically requested April fourteenth off. Why, oh why, did the hospital have to call her on this, of all mornings?
She got rid of a hearty groan before she flipped open her phone, instantly brightening her voice to its “pleasant bedside manner” tone in time to answer, “Hello?”
The voice on the other end wasn’t at all pleasant. It was panicked. “Jo? It’s Mike. Can you come in?”
Jo sighed. It wasn’t like the ER unit coordinator to be so abrupt, so she tried to turn him down gently. “Mike, I’m off today. Sounds like you’re slammed, but it’s Gabby’s birthday. She’s having a party later. Can you call someone else?”
“I’ve tried; there’s no one else. We need you here; we need all the help we can get. It’s bad, Jo… really bad. Everything’s falling apart; people are dropping like flies. I think… I think I’ve got it, too.”
Jo drew in a sharp breath as she sat up in bed. “What?? Got what? What’s going on?”
Mike’s voice was incredulous. “Didn’t you see the news yesterday? I mean, before it went off the air? It’s this virus… it started up in the Northeast yesterday, but it’s spread... This has got to be the same thing.”
An icy finger traced the length of Jo’s spine, leaving shivers in its wake. Quickly, she thought back to yesterday. She’d gotten off work at seven in the morning. She’d picked up Gabby from Makayla’s house, then gone to bed. She’d slept until afternoon. She had tried to turn on the NBC Nightly News while she cooked dinner, but she’d gotten only the rainbow color bars that signaled the station was off the air. The CBS Evening News was also having trouble; all she’d seen on that channel was the CBS logo, frozen on the screen. And ABC had been simply static. She’d flipped through the channels in confusion, noticing that some of the cable channels still worked, but many were simply dead air.
Passing through the kitchen, Gabby had commented that it was weird and, with her head half in the fridge, babbled something about planes flying over Washington, D.C. that morning. Distracted by her cooking, Jo hadn’t even caught it all, let alone connect it to what was happening with the TV. Must be a problem with the television signal, she’d thought, and wondered if she should call the cable company. She had shrugged off the notion, figuring her neighbors would have taken care of that by now. All she could do was wait. It didn’t bother her. She wasn’t a big television viewer, anyway, and Gabby could certainly live without TV for a night.
They’d put on a movie, instead, while they ate, letting the comedy on screen take the place of dinner conversation between them, or lack thereof. Even the stupidest of movies was better than awkward silence. When it was over, she and Gabby had each retreated to their separate rooms to read. Jo had nodded off, as she always did when she read in bed, and now it was morning. She had no idea what Mike was talking about, but she sensed she had missed something major.
She let out her breath in another sigh. “So you need me to come in,” she said, accepting her plight. Hopefully she could put in a few hours, until they got some back-up, then head home for Gabby’s birthday sleepover.
“Desperately.” Mike’s voice was pleading.
“Alright. Give me half an hour or so. I’ll be in.”
“Sure. Thanks, Jo, you’re a lifesaver. Oh, and hey – wear a mask. If you don’t have one at home, stop at Walgreens on the way and get one, alright? This thing is serious… I don’t want you gettin’ sick.”
“O-okay… I will,” Jo replied, feeling that shivery sensation sliding down her spine again. Every ounce of instinct protested as she pushed back the covers and forced her legs out of bed.
She ignored the bad feeling, dressing quickly and quietly in a pair of dark purple scrubs, in honor of Gabby’s birthday. Purple was her favorite color. She slipped on a pair of Crocs and tiptoed up the hall, into the kitchen. She was in the middle of scrawling a note for her daughter when she heard a small voice ask, “Where are you going?”
Jo looked up, her pen poised over the notepad. Gabby was standing on the threshold in her pajamas, dark hair in tangles, eyes sleepy, yet suspicious. “I thought you weren’t going to work today.” Her dark eyes flashed, wounded and accusatory. Her mouth puckered at the corners, scowling. “Or did you forget it’s my birthday?”
“Of course I didn’t forget,” Jo assured her, laughing. “Mike called; the hospital’s jam-packed and short-staffed, and they need my help. Just for the morning, until they can bring some temps in. I’ll be home in a few hours, I promise. Plenty of time to get ready for the slumber party. You go back to bed and don’t worry.”
Gabby heaved a huge sigh. “I should have known you’d get called in, even on your day off. Even on my birthday.” She rolled her eyes and turned on her heel, flouncing dramatically back to her bedroom.
Jo shook her head after her daughter, now an official teenager. So this was what she had to look forward to for the next seven years. With a sigh of her own, she found her keys and her purse and slipped out of the house. The last words she shouted to Gabby before she closed and locked the door were, “I’ll be back later!”
***
Even through her surgical mask, Jo could detect the change in the air as she left the clear, bright Florida morning and entered the emergency room. The air inside the building was stagnant with the stench of vomit and death. Looking around in dismay, she could see why.
The halls were lined with patients on gurneys, overflow from the already-full rooms. Some were writhing in misery; others appeared lifelessly still. The curtained areas were packed with still more sick people, as were the waiting rooms. Jo tried to block out their frightened cries as she hurried past them.
An old woman with wide, half-crazed eyes reached out to her with a gnarled, sore-spotted hand, ranting, “And God said to Noah, ‘I have determined to make an end of all flesh, for the earth is filled with violence because of them! Now I am going to destroy them along with the earth! I am going to destroy from under heaven all flesh in which is the breath of life! Everything that is on the earth shall die!’”
“Not if I can help it!” Jo shouted over her shoulder as she jogged by, heading for the nurses station. For as jam-packed as the emergency ward was, she would have expected the central hub of the ER to be bustling with activity. She was surprised when she found the nurses station all but deserted. She set her purse down on the hexagonal counter and stepped around to the inside.
A weak groan drew her eyes to the floor. There, slumped against the counter, was the very man whom she’d spoken to on the phone less than an hour ago. Instantly, she dropped to her knees beside him. “Mike?” She gently shook his shoulder. The large man lifted his drooping head; his blonde curls were plastered to his scalp with sweat, and there were flecks of dried vomit caked in his stubble of beard.
He looked at her blearily, blinking a few times, as if trying to focus his vision. “Jo,” he croaked.
“Oh, Mike…” She shook her head, looking at him in pity. “I had no idea it was this bad. On the phone, you-”
“It’s worse than I thought. It comes on quick… kills even quicker. You shouldn’t have come,” he murmured, closing his eyes. “I know I called… but you shouldn’t have come here.”
“You need my help,” Jo asserted, struggling to keep her voice calm while her heart slammed against her ribs. “I can help. Let’s start by getting you into a bed. Can you stand?”
She reached out to help him, but Mike shook his head. “There are no beds.”
“Sure there are; we’ll find something. I’ll get some help. Where is everyone else?”
Again, he shook his head in defeat. “There is no one else. Not that I’ve seen. They’re all gone.”
“Gone? What do you mean, gone? They left??” She stared at him incredulously, unable to believe that her coworkers could have bailed and left the ER like this.
“No… dead. Or close to it.” He began to cough then, racking coughs that shook his heavy body. “’Fraid I’m not far behind them,” he whispered, as he looked up at her miserably, his blue eyes full of tears.
“Don’t say that,” Jo ordered briskly, giving him a little shake as his chin started to droop to his chest again. “Stay with me, Mike; I’m not going to let you die. Wait here while I find some help… I’ll be right back. Just hold on.”
As Jo stood up, a little voice in the back of her head told her not to leave him, but the logical side of her argued with it. Surely, there had to be someone left who knew what was going on, who could help. There had to be a doctor on call. This was the hospital; this was the Emergency Room. Even when it was understaffed due to illness or bad weather or whatever it may be, there were doctors on call.
She headed for the staff lounge first, expecting to find at least someone at the coffee pot, loading up on caffeine to get through the morning. But at first glance, the lounge, like the nurses station, appeared empty. The coffee pot was half full, but one whiff told her it was stale. It had likely been sitting there half the night. She turned, and that was when she noticed the lone figure slumped over the length of the couch, one arm dangling to the floor.
Jo approached cautiously and knelt down on the floor beside the couch. As she did, the smell of vomit overpowered the faint aroma of the coffee. She pushed aside a wastebasket, which had been dragged up alongside the sofa. Congealed vomit ran down its sides. The woman on the couch was lying on her belly, her dark hair in her face. It, too, was crusted with vomit. Gingerly, Jo brushed it out of the woman’s eyes. When she recognized her face, she drew in a low breath and released it shakily. “Dr. Tavarez?” she asked, rubbing the shoulder of the resident with whom she’d worked the occasional night shift. “Ana?”
There was no response from the young doctor, not the slightest movement. Fearing the worst, Jo reached for her wrist. Picking up her arm, she saw that it was covered in open sores, the same kind she’d seen on the old woman in the hall. Mike, she recalled, had had some on his face. They looked like chickenpox, only larger, deeper. She wished she was wearing gloves, but there was little time. Touching only where necessary, she pressed her middle fingers against the radial artery in the doctor’s wrist to feel for a pulse. She felt nothing.
Noticing Dr. Tavarez’s own stethoscope lying on the floor next to her, Jo picked it up and slipped it into her ears. She slid its round end down the front of the doctor’s scrub top and listened, but there were no breath sounds and no heartbeat. At first, she kept moving the scope around, thinking surely she was missing something, surely she wasn’t listening in the right place. But soon, disbelief gave way to dejection, and she let the stethoscope fall.
Dr. Tavarez were dead. How many others would she find in the same state?
Trying to keep her mind focused on the task at hand, and not let it wander, Jo washed her hands at the sink, scrubbing until they were pink and raw. She covered them with latex gloves. Slinging her own stethoscope around her neck, she left the lounge. In the hall, she paused and looked around. With gurneys lining the halls and no other staff in sight, the ER suddenly seemed overwhelming. How was she going to get to everyone, all on her own?
She decided she would start by checking on Mike. Then she would make rounds, seeing every patient, starting with the ones in the rooms, then the ones in the hall, and finally, those in the waiting room. She would do what she could to treat them and make them comfortable, and while she worked, she would look for the rest of the staff. It seemed as good a plan as any, and so Jo jogged back to the nurses station.
Her composure quickly lapsed back into panic when she rounded the counter and found Mike in the throes of a grand mal seizure. His eyes were rolled back in his head, exposing only the whites, and flecks of foam bubbled at the corners of his gasping mouth, as his body convulsed violently on the floor. One arm kept knocking against a cabinet as it jerked, putting an audible rhythm to his spasms. Thwack. Thwack. Thwack.
Jo had witnessed plenty of seizures in the ER, but that didn’t stop them from being scary. Especially when it someone she knew twitching like that. But she couldn’t let her emotions get the best of her. She knew what to do. She could stop it. Dilantin, she thought. That was the drug of choice for treating a seizure. As an R.N., she wasn’t allowed to prescribe it herself, but in this case, she didn’t care about the rules. There wasn’t a doctor in sight, and if she didn’t medicate Mike and stop the seizure, he could hurt himself, even suffer brain damage.
Without a second thought, she went racing to the drug lock-up and tore open the cabinet where the Dilantin was kept. She knew this room like the back of her hand, had helped organize it, even. In trauma situations, she was usually the one sent scurrying to get whatever medication the doctor ordered, and so she knew just where the Dilantin would be. Or should be. But the shelves were hopelessly empty.
Breathing fast, she rummaged through the other shelves, other cabinets, checking labels on bottles and boxes before she shoved them aside. But there were no anti-seizure drugs to be found in the ER. And then Jo realized… They must have used their entire stock on the influx of patients with the virus.
Sighing in defeat, she left the drug lock-up and returned to check on Mike. Thankfully, his seizure had stopped. He lay motionless on the floor, unconscious, but still breathing. There was not much else she could do for him until she had a hospital bed with medical equipment for him. With that thought in mind, she set about her original plan, to scope out the rest of the ER.
The patient in the first room she checked was a man, about her age, and he was dead. The patient in the second room, a woman, was also dead. Her attention was drawn to the third room by the unmistakable noise of a heart monitor sounding an alarm, and she rushed in to find a young man, no older than twenty-five, unresponsive in his bed. His dusky skin was blemished with the same sores that plagued the other patients and Dr. Tavarez. Oxygen was still flowing through the mask that covered his mouth and nose, but the waves on his EKG did not rise and fall with any sort of regularity. The line on the monitor was chaotic, like a child’s scribble, a cardiac rhythm she recognized as ventricular fibrillation. The man’s heart wasn’t beating, only fluttering. It was not pumping any blood, and she knew that if she did not do something to restore it to its normal rhythm, it would stop altogether, and the man would die.
She looked around for a crash cart. If she could shock his heart, she might be able to save him. There was no defibrillator in the room, so she rushed out into the hall, searching wildly. She spotted one of the red carts that carried a defibrillator parked next to a teenage girl on a gurney. The girl was dead and topless, her shirt torn right off her chest so that she could be shocked back to life. Whoever had done it had been unsuccessful.
Swallowing with difficulty, Jo grabbed the crash cart and dragged it into the room with the young man. She got the defibrillator ready, charging the paddles and slapping pads onto the man’s chest and side to take the shock. When she defibrillated him, his whole body jerked up from the bed with the surge of electricity, but the rhythm on the heart monitor didn’t change. She shocked him a second time, and then a third, when the monitor suddenly flatlined.
“No…” Jo moaned, throwing the paddles aside. She began chest compressions, trying in vain to keep blood flowing through the man’s virus-ravaged body. She could feel the fever on his skin, and the pustules popping beneath her palms as she pumped his bare chest. She knew she was over her head, with no one around to assist her, no one to monitor his oxygen or inject his IV with drugs that might stimulate his heart. After some time, she knew it was over. The man was dead. She was not going to bring him back.
She took a shaky breath as she stripped off her gloves and wiped the perspiration from her forehead with the back of her wrist. Her eyes shifted to the clock, as they always did when a death was called, but as a nurse, it wasn’t her right to pronounce a death. Only a doctor could do that. Even so, she found the man’s chart by the foot of his bed and noted the time on it. 8:34.
Shoulders slumped in defeat, she made her way into the next room, and the next. There was nothing in either to encourage her. In one of the trauma rooms, she found one of the attending physicians and two of her fellow nurses, people she had known and worked with for years, slumped lifelessly on the floor around the gurney that held their patient.
Every last one of them was dead.
The situation in the hallway wasn’t much better. Most of the patients who had been brought in too late to get a real bed had passed away in the hall. Even the raving old woman who had shouted Bible verses at Jo as she’d come in was now silent and still on her gurney, her sore-covered arm hanging limply through the metal rail. There wasn’t even a clean sheet nearby with which to cover her.
She returned to the nurses station to check on Mike. She wouldn’t have thought there was much more that could shock her on that morning, but she got a terribly familiar jolt when she knelt down to check his breathing and pulse and found both vital signs absent. In the time it had taken her to circle the ER and fail to save the only other living person she’d encountered, he, too, had slipped away, another countless victim to the virus that had taken over the hospital.
Letting his wrist droop to his chest, she felt the prickle of tears behind her eyes, as her former panic descended into despair. She sank all the way to the floor, letting the coolness of the tile seep through the seat of her scrubs. She was already shivering, but it had little to do with the cold. There was nothing else she could do, and as a nurse, there was nothing she hated more than feeling helpless.
Uninvited, thoughts of Luis entered her mind, the memory of sitting on the cold, tiled floor of her kitchen while her husband died in her arms. Even though she’d witnessed the same thing happen to far too many patients in the ER trauma room, even with a team of doctors and nurses working on them, she had always blamed herself for not being able to save him, or least keep him alive until the ambulance got there.
And now she wondered, was there no saving anyone this virus struck? Were they all doomed to die of it, every last person exposed? How long would it take for the symptoms to claim her, too?
Swiping her eyes with the back of her hand, she took a deep breath and forced herself to get up. She left the nurses station, where Mike lay, dead, but still warm, and wandered back down the hall. She came across the dead girl she’d found the crash cart near, still lying half-naked on the gurney, her small breasts pointing towards the open air. She looked only a few years older than Gabby, and Jo’s heart twisted with agony as she looked at her. The girl was far past feeling, but Jo felt for her, remembering how self-conscious teenage girls were about their bodies. Dead or not, it wasn’t right to leave this girl exposed in the hallway.
There was no one else around to see her, no one living, at least, but still, it made Jo uncomfortable to leave her there, and so she wheeled the gurney towards the elevator. If she could not save her, the least she could do was take her down the morgue, where she could find something with which to cover her.
The elevator came unusually quickly, for there was no one else trying to ride it, and indeed, when it opened, it was empty. There was no elevator music playing, only eerie silence, as Jo pushed the gurney in. She pressed the button for the ground level and stared at the closed doors for the short ride down. She could not look at the dead girl next to her.
When the doors slid open again, she pushed the gurney into the hall. It was chilly down on this level; they kept the air conditioning cranked up high for the sake of the bodies. The air only got cooler as Jo entered the morgue. Her mouth fell open as she looked around in dismay. Every autopsy table, every drawer that was open, held a body. They were nearly identical in death: ashen skin, pocked with festering, purple-red lesions. All victims of the virus.
Several of the corpses had already been dissected for autopsy; their chest cavities were open wide, flaps of skin drawn back. But where was the medical examiner? Jo looked around and noticed a closed door on one side of the room. She hadn’t spent much time down here, but guessed it led to an office. She strode across the room, taking care to avoid looking at any of the corpses, and knocked twice on the door. No answer. She knocked once more and waited a few seconds before tentatively turning the knob.
Opening the door, she found herself looking in on the medical examiner’s office. It was typical of any doctor’s office – well-stocked bookshelves, filing cabinets, a large desk with a computer, and a leather office chair… in which a man was slumped, facedown over his keyboard, as if he’d simply collapsed in the middle of typing a memo.
Jo rushed to him, knowing, from previous experience, that she was already too late. Indeed, the coroner was without a pulse, the heat already leaving his body. She sighed behind her mask, feeling even more desperate than before. But before she turned away, she noticed the cursor flashing on his computer monitor, where he had, indeed, been typing a memo of some sort. His findings on the effects of the virus, it seemed. Jo paused to read it, her eyes skimming over the text. Disturbing phrases popped out at her. “… virus of unknown origin… effects primarily nervous and digestive systems, leading to cardiac and respiratory failure secondary to brain deterioration… causes high fever, skin lesions, vomiting, headache, seizures, leading to death…”
On a sticky note placed on the desktop to the side of his keyboard, where his cold hand now rested, he’d jotted a few extra notes. These were the most jarring of all.
strain: unidentified
cause: unknown
incubation period: short! under 10 hrs
transmission: airborne
mortality rate: ~100%
Trembling all over, Jo stumbled back, afraid, for a moment, that she would faint. She didn’t faint, though. She regained her composure enough to scramble out of office. Leaving the girl she’d brought down with the other bodies, she ran for the elevator, and when its doors did not open instantly, she took the stairs. She welcomed the noise of her pounding feet echoing in the stairwell as she jogged up, and she didn’t stop after one flight. She continued up a second flight, and then a third, bypassing both the ER and the surgical floor. Finally, panting, she stopped on the third story landing and hunched over, hands on her knees, to catch her breath. Then she pushed through the heavy door.
She was in the Neuro wing now, where patients with head trauma were admitted. As she entered the quiet corridor, Jo thought for sure she would find staff here who could help. No one with the virus should have been brought to this floor. But as she started down the hall, she quickly discovered she was wrong.
At first, she thought the lumps of hospital blue and sterile white were piles of discarded scrubs, tossed aside like soiled bed linen. But as she came closer, she recognized hair and shoes and realized they were people, doctors and nurses and custodians, slumped on the floor where they had collapsed and died. After checking for pulses on the first two she came to, she knew she did not need to check the others.
Fighting tears, she continued down the hall, checking patient rooms, on the off-chance she might find someone alive. But the sights and sounds were the same in every room: a patient or two, lifeless in bed, with EKG alarms wailing out the solitary tone that signaled cardiac arrest. Every heart monitor that was on showed a flatline, the numbers representing heart rate, blood pressure, breaths, and oxygen saturation reading zero.
There were no signs of life on this floor.
That was, until she reached the very last room. Thumping sounds attracted Jo’s attention outside the room, and she ran to the doorway. But any last ounce of hope she’d held onto drained away when she looked in and discovered the source of the sounds: they were the product of the rhythmic convulsions of a blonde man in the midst of a seizure. She got close enough to his shaking bed to realize that she recognized him: he was the same man she had treated for a concussion and scalp laceration during her last night shift in the ER. Surely, he’d never expected to enter the hospital with a bump on the head and succumb there to a virus that offered virtually no chance of survival.
Watching him convulse, his spittle foaming up in the corners of his mouth, she remembered Mike, and she couldn’t stand it any longer. She turned and ran, ran almost blindly, until she slammed against the door through which she had come. She yanked it open and practically threw herself back into the stairwell, but once there, she stopped, clutching at her chest for breath. She could feel herself starting to hyperventilate. Shrinking back into the wall, she slid to the floor, bending her legs at the knees. There, she clutched her knees to her chest, hugging herself in a ball. And she rocked.
The motion evened out her hysterical breaths, and she released the emotion that had been building in her chest since she’d first set foot in the ER. The dam which had been holding back her tears broke, and out they poured, as she began to sob.
Eventually, the tears gave way to sniffles, and finally, nothing but her regular breathing to break the stifling silence of the stairwell. She sat there, on the landing, for much longer than needed, but what else was there to do? Where else was there to go? She dreaded the thought of checking another floor, and finding more bodies of people like her, hospital staff she recognized, but she could not go home. She feared the virus was on her now, in her, no matter the precautions she’d taken to protect herself. If she carried it home, she’d risk exposing others... most importantly, Gabby.
She would stay at the hospital, and if she fell ill, like the others, then she would die there, too.
