hospital speaker system: Code Blue, MICU. Code Blue, MICU.
Abby joined the other surgical residents in a dash for the stairway. By the time she'd jogged into the MICU, a crowd of medical personnel was already thronging the area. A glance told her there were more than enough people here to deal with a Code Blue. Most of the residents were starting to drift out of the room. Abby, too, would have left.
Had she not seen that the code was in Bed 4. Joshua O' Day's cubicle.
She pushed into the knot of white coats and scrub suits. At their centre lay Joshua O' Day, his frail body fully exposed to the glare of overhead lights. Hannah Love was administering chest compressions, her blonde hair whipping forward with every thrust. Another nurse was frantically rummaging through the crash cart drawers, pulling out drug vials and syringes and passing them to the medical residents. Abby glanced up at the cardiac monitor screen.
Ventricular fibrillation. The pattern of a dying heart.
'Seven and a half ET tube!' a voice yelled.
Only then did Abby notice Vivian Chao crouched behind Joshua's head. Vivian already had the laryngoscope ready.
The crash cart nurse ripped the plastic cover off an ET tube and passed it to Vivian.
'Keep bagging him!' Vivian ordered.
The respiratory tech, holding an anaesthesia mask to Josh's face, continued squeezing the balloon-like reservoir a few times, manually pumping oxygen into the boy's lungs.
'OK,' said Vivian. 'Let's intubate.'
The tech pulled the mask away. Within seconds, Vivian had the ET tube in place, the oxygen connected.
'Lidocaine's in,' said a nurse.
The medical resident glanced up at the monitor. 'Shit. Still in V. fib. Let's have the paddles again. 200 joules.' A nurse handed him the defibrillator paddles. He slapped them onto the chest. The placement was already marked by conductive gel pads: one paddle near the sternum, the other outside the nipple. 'Everyone back.'
The burst of electricity shot through Joshua O' Day's body, jolting every muscle into a simultaneous spasm. He gave a grotesque jerk and then lay still.
Everyone's gaze shot to the monitor screen.
'Still in V. fib,' someone said. 'Bretylium, 2502 Hannah automatically resumed chest compressions. She was flushed, sweating, her expression numb with fear. 'I can take over,' Abby offered. Nodding, Hannah stepped aside.
Abby climbed onto the footstool and positioned her hands on Joshua's chest, her palm on the lower third of the sternum. His chest felt thin and brittle, as though it would crack under a few vigorous thrusts; she was almost afraid to lean against it.
She began to pump. It was a task that required no mental exertion. Just that repetitive motion of lean forward, release, lean forward, release. The alpha rhythm of CPR. She was a participant in the chaos yet she was apart from it, her mind pulling back, withdrawing. She could not bring herself to look at the boy's face, to watch as Vivian taped the ET tube in place. She could only focus on his chest, on that point of contact between his sternum and her clasped hands. Sternums were anonymous. This could be anyone's chest. An old man's. A stranger's. Lean, release. She concentrated. Lean, release.
'Everyone back again!' someone yelled.
Abby pulled away. Another jolt of the paddles, another grotesque spasm.
Ventricular fibrillation. The heart signalling that it cannot hold on.
Abby crossed her hands and placed them again on the boy's chest. Lean, release. Come back, Joshua, her hands were saying to him. Come back to us.
A new voice joined in the bedlam. 'Let's try a bolus of calcium chloride. 100 milligrammes,' said Aaron Levi. He was standing near the footboard, his gaze fixed on the monitor.
'But he's on digoxin,' said the medical resident.
'At this point, we've got nothing to lose.'
A nurse filled a syringe and handed it to the resident. '100 milligrammes calcium chloride.'
The bolus was injected into the IV line. A penny toss into the chemical wishing well.
'OK, try the paddles again,' said Aaron. '400 joules this time.' 'Everyone back!'
Abby pulled away. The boy's limbs jerked, fell still.
'Again,' said Aaron.
Another jolt. The tracing on the monitor shot straight up. As it settled back to baseline, there was a single blip — the jagged peak of a QRS complex. At once it deteriorated back to V. fib.
'One more time!' said Aaron.
The paddles were slapped on the chest. The body thrashed under the shock of 400 joules. There was a sudden hush as everyone's gaze shot to the monitor.
A QRS blipped across. Then another. And another.
'We're in sinus,' said Aaron.
'I'm getting a pulse!' said a nurse. 'I feel a pulse!'
'BP seventy over forty… up to ninety over fifty…'
A collective sigh seemed to wash through the room. At the foot of the bed, Hannah Love was crying unashamedly. Welcome back, Josh, Abby thought, her gaze blurred with tears.
Gradually the other residents filed out, but Abby couldn't bring herself to leave; she felt too drained to move on. In silence she helped the nurses gather up the used syringes and vials, all the bits of glass and plastic that are the aftermath of every Code Blue. Working beside her, Hannah Love sniffled as she wiped away the electrode paste, her washcloth stroking lovingly across Josh's chest. It was Vivian who broke the silence.
'He could be getting that heart right now,' she said. Vivian was standing by the tray table of Joshua's trophies. She picked up the Cub Scout ribbon. Pinewood Derby, third grade. 'He could've gone to the OR this morning. Had the transplant by ten o'clock. If we lose him, it's your fault, Aaron.'Vivian looked at Aaron Levi, whose pen had frozen in the midst of signing the code sheet.
'Dr. Chao,' said Aaron quietly. 'Would you care to talk about this in private?'
'I don't care who's listening!The match is perfect.! wanted Josh on the table this morning. But you wouldn't give me a decision. You just delayed. And delayed. And fucking delayed.' She took a deep breath and looked down at the award ribbon she was holding. '! don't know what the hell you think you're doing. Any of you.'
'Until you calm down, I'm not going to discuss this with you,' said Aaron. He turned and walked out.
'You are.You are going to,' said Vivian, following him out of the cubicle.
Through the open doorway, Abby could hear Vivian's pursuit of Aaron across the MICU. Her angry questions. Her demands for an explanation.
Abby bent down and picked up the Pinewood Derby ribbon that Vivian had dropped on the floor. It was green — not a winner's ribbon, but merely an honourable mention for the hours spent labouring over a small block of wood, sanding it, painting it, greasing the axles, pounding in the lead fishing weights to make it tumble faster. All that effort must be rewarded. Little boys need their tender egos soothed.
Vivian came back into the cubicle. She was white-faced, silent. She stood at the foot of Josh's bed, staring down at the boy, watching his chest rise and fall with each whoosh of the ventilator.
'I'm transferring him,' she said.
'What?' Abby looked at her in disbelief. 'Where?'
'Massachusetts General. Transplant Service. Get Josh ready for the ambulance. I'm going to make the calls.'
The two nurses didn't move. They were staring at Vivian. Hannah protested, 'He's ha no condition to be moved.'
'If he stays here, we're going to lose him,' said Vivian. ' We are going to lose him. Are you willing to let that happen?'
Hannah looked down, at the frail chest rising and falling beneath her washcloth. 'No,' she said. 'No. I want him to live.'
'Ivan Tarasoft was my professor at Harvard Med,' said Vivian. 'He's head of their transplant team. If our
