'Jack? What are you doing -- '
'How's your patient?' Still in a state of shock, she focused her attention on Kenichi.
Even as she restarted the IV, attached EKG wires, she was wondering what Jack was doing in Mission Control. He had not sat at a flight surgeon's console in a year, now here he was on the comm loop, his voice calm, even casual, as he asked about Kenichi's status.
'Is he still seizing?'
'No. No, he's making purposeful movements now -- fighting … '
'Vital signs?'
'Pulse is rapid -- one twenty, one thirty. He's moving air.'
'Good. So he's breathing.'
'We're just getting the EKG hooked up now.' She glanced at the monitor, at the cardiac rhythm racing across the screen.
'Sinus tach, rate of one twenty-four. Occasional PVCS.'
'I see it on biotelemetry.'
'Taking BP now ... ' She whiffed up the cuff, listened to the brachial pulse as the pressure was slowly released. 'Ninety-five over sixty. Not significantly -- ' The blow caught her by surprise. She gave a sharp cry of pain as Kenichi's hand flailed out, striking her across the mouth. The impact spun her away, and she flew across the module, colliding with the opposite wall.
'Emma?' said Jack. 'Emma?' Dazed, she reached up to touch her throbbing lip.
'You're bleeding!' said Nicolai.
Over her headset, Jack's frantic voice demanded, 'What the hell is going on up there?'
'I'm okay,' she murmured. And repeated, irritably, 'I'm okay, Jack. Don't have a cow.' But her head was still buzzing from the blow. As Nicolai strapped Kenichi to the patient restraint board, she hung back, waiting for her dizziness to pass. At first she did not register Nicolai was saying.
Then she saw the look of disbelief in his eyes. 'Look at his stomach,' Nicolai whispered. 'Look!' Emma moved closer. 'What the hell is that?' she whispered.
'Talk to me, Emma,' said Jack. 'Tell me what's going on.' She stared at Kenichi's abdomen, where the skin seemed to ripple and boil. 'There's something moving -- under his skin -- '
'What do you mean, moving?'
'It looks like muscle fasciculations. But it's migrating across the belly ... '
'Not peristalsis?'
'No. No, it's moving upwards. It's not following the intestinal tract.' She paused. The squirming had suddenly stopped, and she was staring at the smooth, unworried surface of Kenichi's abdomen.
Fasciculations, she thought. The uncoordinated twitching of muscle fibers. It was the most likely explanation, except for one detail, Fasciculations do not migrate in waves.
Suddenly Kenichi's eyes shot open, and he stared at Emma.
The cardiac alarm squealed. Emma turned to see the EKG whipsawing up and down on the screen.
'V tach!' said Jack.
'I see it, I see it!' She flipped on the defibrillator charge button, then felt for a carotid pulse.
There it was. Faint, barely palpable.
His eyes had rolled up, and only the bloodred sclerae were visible. He was still breathing.
She slapped on defibrillator pads, positioned the paddles on the chest, and pressed the discharge buttons. An electric charge of hundred joules shot through Kenichi's body.
His muscles contracted in a violent and simultaneous spasm.
His legs thrashed against the board. Only the restraints kept him from flying across the module.
'Still in V tach!' said Emma.
Diana came flying into the module. 'What can I do?' she asked.
'Get the lidocaine ready!' snapped Emma. 'CDK drawer, right
'Found it.'
'He's not breathing!' said Nicolai.
Emma grabbed the ambu-bag and said, 'Nicolai, brace me!' He maneuvered into position, planting his feet on the opposite wall, his back pressed against Emma's to hold her in place as she applied the oxygen mask. On earth, performing cardiopulmonary resuscitation is demanding enough, in microgravity, it is a nightmare of complex acrobatics, with drifting equipment, tubes and tangling in midair, syringes filled with precious drugs away. The simple act of pressing your hands against a patient's can send you tumbling across the room. Although the crew had practiced this scenario, no rehearsal could reproduce the genuine chaos of bodies frantically maneuvering in a closed space, racing against the clock of a dying heart.
With the mask over Kenichi's mouth and nose, she squeezed the ambu-bag, forcing oxygen into his lungs. The EKG line continued to thrash across the screen.
'One amp lidocaine IV push now,' said Diana.
'Nicolai, shock him again!' said Emma.
After the briefest hesitation, he reached for the paddles, placed them on the chest, and pressed the discharge buttons. This time two hundred joules arced through Kenichi's heart.
Emma glanced at the monitor. 'He's gone into V fib! Nicolai, start cardiac compressions. I'm going to intubate!' Nicolai released the defib paddles, and they floated off, dangling at the ends of the wires.
Bracing his feet against the wall of the module, he was about to place his palms on Kenichi's sternum when he suddenly jerked his hands away.
Emma looked at him. 'What is it?'
'His chest. Look at his chest!' They stared.
The skin on Kenichi's chest was boiling, squirming. At the contact points where the defib paddles had delivered their electric jolts, two raised circles had formed and were now spreading, like ripples cast by a stone in water.
'Asystole!' came Jack's voice over her headset.
Nicolai was still frozen, staring at Kenichi's chest.
It was Emma who swung into position, bracing her back against Nicolai's.
Asystole. The heart has stopped. He will die without cardiac compressions.
She felt nothing moving, nothing unusual. Just skin stretched over the bony landmarks of his breastbone. Muscle fasciculations, she thought. It had to be. There's no other explanation. With body braced in position, she began chest compressions, her hands performing the work for Kenichi's heart, pumping blood to his organs.
'Diana, one amp IV epinephrine!' she ordered.
Diana injected the drug into the IV line.
They all looked at the monitor, hoping for, praying for, a blip the screen.
'There has to be an autopsy,' said Todd Cutler.
Gordon Obie, director of Flight Crew Operations, flashed him an irritated look. Some of the others in the conference room gave Cutler dismissive nods as well, because he had merely stated the obvious. Of course there would be an autopsy.
Over a dozen people had gathered together for this crisis meeting.
An autopsy was the least of their concerns. Right now, Obie was dealing with more urgent issues. Normally a man of few words, he'd suddenly found himself in the uncomfortable position of having reporters' microphones thrust at his face whenever he appeared in public. The excruciating process of assigning blame had begun.
Obie had to accept a portion of responsibility for this tragedy, because he had approved the choice of every member of the flight crew. If the crew screwed up, in essence, he had screwed up. his choice of Emma Watson was starting to look like a major error.
That, at least, was the message he was hearing in this room. As the only physician aboard ISS, Emma Watson should have realized Hirai was dying.
An immediate CRV evac might have saved him.
Now a shuttle had been launched, and a multimillion-dollar rescue mission had turned into nothing more than a morgue run. Washington was hungry for scapegoats, and the foreign press was asking a politically incendiary question, Would an American astronaut have been allowed to die?
