He had started in mind-body treatment two years ago, after the stomach pains he had been having were diagnosed as a slowly bleeding ulcer. The abbreviated relaxation exercise, which his therapist had taught him, helped greatly in getting him through times like this in the E.R.
Because of the scheduling change he had made with Eric Najarian, it was his second straight brutally long shift. And of course the volume of patients had been far greater than average. Every room was full. In one of them, still unconscious and awaiting a CT scan, lay Norma Cullinet, the nursing supervisor. She had fallen down a flight of stairs, fracturing her arm and the base of her skull. Now, as if the fates had decreed that he hadn't yet been stressed to the breaking point, there was a Priority One on the way.
From his earliest days at Harvard, Reed had carefully cultivated his unflappable facade. Besides himself, his wife, his therapist, and perhaps Eric Najarian, no one knew how inaccurate that image truly was.
Ulcers, migraines, insomnia, periods of profound depression-if not for the mind-body therapy, he might well have come unglued long ago.
Now, though, with the selection of the new associate E.R. director due any day, and Carolyn so desperate for him to get the position, Reed knew he had to maintain. It was ironic that the biggest edge he held over Eric was his perceived coolness under fire.
More than once, though, following his 'cool' handling of a particularly harrowing case, Reed had gone off to one of the men's rooms and thrown up. In fact, after nearly freezing up with the woman who had ruptured her larynx, he had done just that.
'They're two minutes out, Reed.'
The nurse's voice and touch on his shoulder snapped Reed out of his reverie.
'Everything ready?' he asked.
'Ready and waiting.'
'Do we have a name?'
'Leone. Loretta Leone. All we have for an old record is an E.R. sheet from two days ago. The orthopedists put a cast on a minimally displaced wrist fracture.'
'And she's already intubated?'
'Uh-huh. The rescue squad can't give us a down time, but they think she'd been out for a while when they arrived. Apparently the policemen who found her didn't do much in the way of CPR while they were waiting around.'
'What's the latest rhythm?'
'Agonal, idioventricular beats at about eight a minute.'
'No response to the epi or Isuprel?'
'None.'
The nearby radio crackled to LIFE. 'This is Boston Rescue Seventy-Eight, off at White Memorial.'
'They're here,' the nurse said.
Reed pulled off his glasses and rubbed at the strain in his eyes.
'Is someone still in with Norma?'
'Dr. Teagarden came in about fifteen minutes ago and took over.
Apparently she and Norma have been friends for years. She's got the whole neurosurgical service standing by, waiting for the CT results.'
'Did she have any complaints about the way we handled the case?' Reed asked.
'None that I heard.'
'Okay, then,' Reed said, more relieved at that news than the nurse would ever know. 'Let's have a look at this Priority One.'
The electronic doors to the ambulance bay slid open, and the rescue squad, continuing cardiac compressions and mechanical ventilation, hurried back to the assigned major medical room. Reed met them at the gurney and assisted them in the transfer of Loretta Leone.
His initial assessment was not optimistic.
She was the dusky violet color of death. Her pupils were midposition and unresponsive to light.
'Get some E.K.G leads on her,' he said. 'We'll — un the strip off that.
Keep the monitor going as well. It doesn't look good. Not good at all.'
This was the moment when Reed had to make a decision as to whether they should proceed with attempts at resuscitation. The rescue team leader, Judy Kelly, was one he had worked with many times. She was perhaps the very best of a group of excellent paramedics.
'Any change?' Reed asked.
Judy shook her head. 'This is the rhythm we found her in.' She handed over an E.K.G strip. 'It looks the same as the one now.'
'Do you have a good IV?'
'Excellent.
Reed listened to the patient's chest to ensure that the endotracheal tube hadn't been pushed so far down the trachea that it was occluding one of the main bronchial tubes.
'She's full of fluid,' he said. 'Full to the brim.
Let's hang in there just a bit, everyone. Give her an amp of bicarb and another amp of epi. And send off a set of blood gases, just in case. I don't think we're going to be at this too long, though.'
He glanced up at the monitor screen. The woman's rhythm remained the same-slow, wide complexes at eight or so a minute.
'Call cology down here,' he said. 'We may want to put in a pacemaker… Pupils?'
'Fixed,' someone called out.
'Keep pumping. Someone check her femorals to be sure we're generating a decent pulse. Judy, give me your best guess at a time.'
'Twenty minutes minimum before effective CPR was started,' the paramedic said.
'What do you think?'
'Honestly?' She glanced over at Loretta Leone and the team that was working on her. 'I think it's not fair to this woman to continue.'
Reed rubbed at his chin and wondered for a moment how far backed up the waiting room was getting.
'Anybody know if she has any family?' he asked. next of kin,' the nurse said. 'It's right here on her last E.R. sheet.'
'She's like a bag lady, only with a one-room apartment,' Judy said. 'The place was full of empty bottles waiting to be returned, and junk in every corner.'
'Jesus,' Reed muttered. 'Give her one more amp of epi and call for those gas results. Oh, and you might as well try an amp of calcium as well. I want to keep going until the cardiologist gets here.'
The cardiology resident, an overweight, abrasive man named Jason Berger, entered the room with two medical students in tow. One was an attractive young woman.
'Fucking place looks like a war zone out there,' Berger said.
'what do you have?'
'Fifty-five-year-old woman found pulseless on the floor of her apartment,' Reed said. 'No medical history except a broken wrist fixed here two days ago. Twenty minutes minimum before CPR was started.
There's been no change in anything despite Isuprel, bicarb, and several amps of epinephrine.'
Berger looked up at the monitor. 'Did you give her calcium?' he asked.
'Yes.'
Berger pushed past the resuscitation team and listened briefly to Loretta Leone's heart and lungs.
Then he put his arm around the waist of the female medical student. Reed saw her stiffen as Berger led her over to the monitor.
'what do you see?' Berger asked.
The young woman looked flustered and uncomfortable.
'Slow rhythm,' she managed. 'Very broad complexes. I… um…
I don't know what else.'
'what you see,' Berger said theatrically, 'is a dead heart. X % call that an agonal rhythm-the rhythmic flow of sodium, potassium, and calcium in and out of cardiac cells, creating an electrical impulse.
