Compromised, page 12
part #1 of MetroGen Forbidden Love Duets Series
Angela reversed course in a dead sprint.
Chapter 19
Michael had reached the front doors of MetroGen. It was such a weird post call day. He’d kissed Angela twice, been semi kidnapped by a lady firefighter, and was now wearing a stolen firefighter uniform.
His crap with Angela would have to wait. Tiffany was supposed to deliver tomorrow, and he couldn’t bring himself to return home knowing she had less than twenty-four hours left. The staff could turn a blind eye again if he slept on the couch in her room for the second day in a row.
Each and every thought disappeared from his mind when he saw Angela run past him. Her blue eyes were panicked.
He dropped the bag with his clothes in it and started running after her before he processed the events. There was only one reason she’d be back tonight.
Tiffany was crashing.
They didn’t need to speak, their destination was the same. They found the nearest staff stairwell and took the steps two at a time. Angela used her badge to get them into OB.
Barely through the door, the code blue alarm went off. Unerringly, they galloped toward Tiffany’s room, her nurse waving frantically at them from the hallway.
“Did you call the code?” Angela asked.
“No, the code is in the OR,” the nurse said.
They entered and found Tiffany laying silent and unmoving in her bed. The heart monitor above her beat wildly with a wide complex tachycardia.
“She’s in SVT. Roll her to the left and start vagal maneuvers while I get the adenosine,” Angela commanded and hit the code button by the bed. Her next order was to the nurse. “Get me more bodies in here.”
Moving quickly, Michael dropped the head of the bed and forced a pillow under Tiffany’s left shoulder. He glanced at the fetal monitor. The baby’s heart rate had dropped below 90. “The baby!”
“I know. I’m giving her the adenosine now.” Angela had ripped open the med cart and had the syringe in her hand.
Michael massaged Tiffany’s neck, remembering their abortive practice attempt. “Angela, adenosine will kill her. You said—”
“SVT will kill her if we don’t stop it now, and we’ll lose the baby. We have to,” Angela said and pushed the med.
Tiffany’s head jerked back, and she gasped for a second. Then the heart rhythm rate went flat.
“This should last less than ten seconds,” Angela told him.
Those ten seconds were an eternity.
Tiffany surged upward for a second, gasping, color returning. She flopped back down and murmured, “Brett. Joshua.”
“She’s back!” Michael exclaimed, his own heart slowing down in relief. She was blinking, confused at what had occurred. “You went into SVT, and Dr. Perkins brought you back.”
Angela place an oxygen mask over Tiffany’s face and said. “We have to delivery you right now. The baby is struggling.”
Tiffany managed to nod and croaked. “Baby. Envelope.”
Taking her hand, Michael confirmed, “Yes. I know. The baby’s name is in the sealed envelope.”
She squeezed his fingers, repeating. “Brett. Josh.”
“Go out and physically find me some bodies right now. Steal them from the other code,” Angela said to the bedside nurse, who immediately ran into the hallway.
Tiffany’s grip on his hand went slack, and the heart monitor alarmed. Its screen read a new insane zigzag rhythm without any formed complexes.
He felt her wrist for a pulse.
Nothing.
Same as at her neck.
“Goddamn it, she’s in V-fib. Compressions now. I’m starting the code clock.” Angela turned on the defibrillator, and the timer someone had taped to it.
The nurse reentered, “The mother in the OR isn’t doing well. Charge nurse is gonna try to send us some help. She’s calling peds too.”
“You’re recording now. We have four minutes to get her back. I’m pulling the epi. Harper, start the CPR.” Angela tossed the code clipboard to the nurse and rifled through the code cart.
Michael positioned himself over Tiffany’s chest and started to pump. It would take 100 beats a minute to keep her blood circulating.
Nora burst through the door, followed by the Chief of Anesthesia, Dr. Jules Marin and Dr. Clarissa Morgan from peds. Nora was wearing a disposable delivery gown from the OR. Morgan and Anesthesia guy were in wrinkled scrubs, their hair pointing in crazy directions. He went to the head of the bed, and Morgan went to the baby warmer in the back of the room.
“I need an OB!” Angela pushed the meds. “1 mg of epi on board now.”
“Dr. Carlisle’s coming soon. They’re almost in control of the bleeding.” Nora tossed her gown on the ground and rolled the emergency C-section cart to the foot of the bed. She uncovered it, putting on new gloves and delivery gown.
“You can’t do this, Nora,” Michael said, letting Tiffany’s chest recoil.
“Right now, she’s the only one in the room who can,” Angela snapped.
“There has to be someone else with an MD!” Michael growled back.
“I haven’t assisted in a C-section in fifteen years.” Anesthesia adjusted Tiffany’s head and switched out the oxygen mask for the bag mask equipment. “How many minutes?”
“Two,” the nurse said. “Why couldn’t she have waited till tomorrow when we had full staff?”
Angela snapped open Tiffany’s gown to place the defib pads on her chest, working around Michael’s CPR. “We’ll shock her, and you’ll intubate, Dr. Marin. I’m starting at the max 360 joules.”
“Hold compressions. Everyone clear.” Dr. Marin and Michael both stepped back.
Usually during a code, they’d start at 200 Joules of electricity, but desperate times called for desperate measures.
The defibrillator whined as it reached full charge, and there was a brief thunk when it delivered the shock.
All eyes went back to the cardiac monitor. The wild rhythm of v-fib trailed off into a single flat line.
Asystole.
No electrical activity. Her heart was no longer even trying to beat on its own.
“Compressions!” Angela poked Michael in the shoulder. “Keep going until Dr. Marin intubates.”
Michael was dimly aware of the two senior doctors passing intubation supplies back and forth. His world narrowed down to making sure Tiffany’s chest went down and up deep enough. He was squeezing her heart from the outside, forcing blood through her body.
“Why isn’t OB here yet?” Angela said.
“They’ll be here any second. They were coding the mom in OR,” Nora said, masked, scalpel in hand.
“We’re coding one here,” Angela responded hotly.
Marin said, “I’m ready. Hold compressions.”
He intubated her quickly, and Angela checked her chest while he used the bag to provide breaths. “You’re in.”
“Good.” The anesthesiologist taped the tube in place. “Resume compressions.”
Michael went back at it. “How long?”
“Three minutes and thirty seconds,” the nurse said. “1 mg of epi, one shock at 360J, and now we have a secure airway.”
“One last chance,” Angela said. “Pushing 1 mg of epi, second dose now.”
Michael pushed harder. He needed the epi to circulate and reach the heart. He was the only heartbeat Tiffany had.
“Stop,” Angela commanded him.
He couldn’t stop. “No, we have to—”
“Stop now!” She grabbed his shirt and physically propelled him away from Tiffany. “If she’s not back now, we have to cut.”
Everyone turned to the monitor. Michael willed the epi to do something. Even a single beat.
Still in asystole.
“Take the baby,” Angela told Nora.
Nora hesitated. “But—”
“I order you to take the baby NOW. The only chance we have to get Tiffany back is to get the baby out. The baby is dying each second you wait!” Angela stabbed a finger at the fetal monitor which had slowed down under 70, a decel, signaling a lack of blood flow to the baby.
“Yes, Dr. Perkins.” Nora cut downward for the first incision.
Remembering their practice scenario, Michael gloved up in time for Dr. Carlisle to run through the doors.
Nora kept cutting. “I’m sorry. It was four minutes.”
“Don’t care. Keep cutting,” Carlisles’ own gown was covered in blood from the OR. She shredded it and threw on a pair of gloves. “Med student, firefighter, or whatever the fuck you are today, grab the other side.”
She and Michael grabbed both sides of the vertical incision in Tiffany’s abdomen, and Nora sawed downward. “I’m at the uterus.”
“Don’t stop. Breach the uterine wall,” Carlisle commanded.
“I’m there,” Nora said. Carlisle plucked the scalpel away from Nora, who reached down into the abdomen and came back with a small bloody bundle.
Carlisle wasted no time clamping and cutting the cord. They handed the baby to Dr. Morgan’s waiting hands.
“Now, the ring clamp,” Carlisle passed Nora the metal surgical clamp. Nora used it to hold the uterus closed before they stepped away from Tiffany, their job done for now.
“Resume compressions,” Angela ordered.
Michael moved toward the head of the bed, and she stopped him. “Not you. Borenstein, trade places with him. Harper, go to the baby.”
“Let me stay. I’m stronger than she is,” Michael argued, unable to tear his gaze away from Tiffany’s blank, slack intubated face. A nurse was breathing for her now, forcing air into lungs that no longer breathed.
“No, strength doesn’t matter. You’ve already done a cycle of CPR, so your arms are shot, and I have more people coming. Get the baby to the NICU.”
“Apgars 7 at one minute. Heart rate’s over 100, and she’s pinking up. I need more hands,” Morgan called out without turning away from the baby. “Harper, get me the transport isolette from the hallway.”
He went out to the hallways and flattened against the wall because an army of nursing staff racing into the room almost trampled him. Angela would finally have the bodies she needed.
When he rolled the isolette in, Morgan efficiently transferred the baby inside. She reattached the neo-puff to the portable oxygen.
She’d cleaned up the baby somewhat. The baby girl had dark wavy hair and blinking gray eyes, facing light for the first time in her life. Her little fists waved in the air, fighting against the seal of the mask. Every breath made her a pinker.
Michael almost smiled. They’d saved her.
Then he heard Angela give orders for more cardiac meds and request blood.
The door closed behind him, and he was out of the fight.
Chapter 20
It was almost an hour before Michael could return to L and D. He’d cleaned off the blood crusting him to the elbows and put on scrubs. No one would want what was left of his borrowed firefighter uniform. He’d have to find his badge downstairs somewhere later.
A pall hung over the L and D hallway. Sounds were muted, no one wanting to speak.
The quiet spoke volumes.
He knew what lay down the hallway. Yet he had to see it for himself.
A clump of nurses huddled outside what had been Tiffany’s room. They were holding onto each other, tears streaming down their faces.
The charge nurse imposed her body in front of the door when he tried to enter.
“You don’t want to go in there.”
“I’m going in.”
“It’s better you don’t. You don’t want to remember her this way.” The nurse was over fifty, undoubtedly a veteran of many battles for patients, won and lost. “You’ll never forget what you’ll see.”
“Then I’ll see it.” Michael walked through the door.
The room was dark and quiet. The only light was two bright portable surgical lights pointed at the bed.
The darkness partially hid what he assumed to be a titanic struggle. The room had been neat and ordered before. Now it was ransacked. The code cart was propped at an odd angle, two of its drawers on the floor. Gloves, gowns, and masks had been haphazardly discarded on the edges of the room, and he counted at least three empty transfusion bags. Blood was smeared on the floor in drag lines, as if someone had raced in total abandon of sterile technique.
He forced his attention on the center of the room where three figures in scrubs were gathered around Tiffany’s body. One figure got up, leaving the other two at the chest and abdomen.
It was Chief Feldsher. “I’m sorry.”
“What happened here?”
“Tiffany Wickwire died at 2137. We did everything possible. Dr. Perkins did everything possible. She’s the one who threw the drawers.” Feldsher indicated the mess by the code cart.
He tried to pass her; she moved to block him.
“You too? What don’t you want me to see?”
Feldsher’s shadowed face remained impassive. “We’re sewing her back up. Dr. Perkins tried everything. Internal cardiac massage through the C-section… and then they cracked her chest.”
“Cardiothoracic surgery came down and cracked her chest?”
“No. Dr. Marin and Dr. Perkins did it together. He worked shock trauma for the military. They tried. They really did.”
Michael lashed out, “Where was everyone? Where was cardiothoracic? Where was OB when the chips were down?”
“A triage decision was made. We were in the OR because a mom abrupted, and OB was the only ones who could save her—which we did. Tiffany’s best and only chance lay with Dr. Perkins,” Feldsher said, crossing her arms over her chest.
Michael stepped around her anyway and realized the person sewing up the chest was Nora. The paper drape did little to conceal the brutality of what had occurred.
Tiffany was open in one jagged line from pelvis to clavicle. Nothing was untouched between her hips and her head. The mess by her neck showed placement of crash lines for fluids, pressors, and blood.
Nora rotated her stool in his direction, tears on her cheeks. “Baruch dayan ha-emet.”
Her whispered words of ‘blessed is God, the true judge,’ the traditional Hebrew she’d taught them for bad news, made his world kaleidoscope.
Michael was at the airport, watching the military unload the flag covered casket containing what was left of Josh. He was in the bank, holding the dying woman who cried for the baby that died with her.
He’d thought he could do better.
He could be better if he’d known more.
Five years had passed, yet here he was, still powerless.
So he ran from this dead room, going nowhere, because no matter where he was, he’d still fail.
Chapter 21
Angela saw Michael go by from the L and D, where she’d been preparing Tiffany’s death certificate and readying to page pathology.
The baby’s paperwork was over in peds. The infant bracelets were waiting for the adoptive parents. Their identity was guarded with an ironclad locked chart protocol the secret service would envy. Feldsher and Michael were the only ones who knew their identity.
In the hour since she’d seen him, he’d aged a decade. The pain was stretching him till he broke.
“Medical student Harper, follow me,” she said and led him down the hall to the transitional space between L and D and Peds. She ushered him into one of the area’s family consult rooms.
It was a risk of discovery, but who couldn’t see she was trying to help a shattered medical student?
He hadn’t been ready.
She closed the door behind them and shoved a chair in front of it.
“I am sorry.”
“Why?” he whispered, an unbearable amount of pain behind one syllable.
He wasn’t asking why she was sorry. Instead, he was asking the universal question of why did this happen?
“Because it was inevitable,” she told him, her heart breaking for him because it was one of the hardest lessons every medical student must learn. Good, deserving people will die unfairly.
He shook his head. “No. No, no, no. If OB could have called you sooner… if cardiothoracic… if I’d… If you’d…”
“No.” She placed a hand on his arm. “Michael, this was going to happen. We bought her time, which is what she wanted. We bought the baby time.”
“We could have saved them both,” he almost begged, asking her to tell him his wish was true.
Unbidden, she used her two hands to make him face her by placing her hands on his chest. “We couldn’t.”
“Why not? Why do they always die? No matter what I do, they always die.”
The line fully crossed, she lay her head on his chest. She understood what was happening to him. This wasn’t about Tiffany, or not her alone. Michael wasn’t here; he was reliving the traumas of the past—his brother, the shooting he’d witnessed.
He tightened his arms around her, trembling, and she wanted… she wanted nothing more than to give comfort to the man she loved.
“Michael. Michael. It’s going to be okay.” She got up on her tiptoes and gave him a gentle kiss on the lips.
He froze, every muscle of his tensing. His dark eyes searched hers, overwhelmed with emotion. She knew better. He knew better. Too much. Too soon. They were on the precipice, and the abyss was below them.
They stared at each other for a second or an eternity.
And something broke free…
Michael’s hands shot out, and he dragged her to him. His mouth came down on hers, brutally plundering her mouth.
She didn’t ask for any quarter. When he lifted her up, placing her legs around his waist, their tongues battled for dominance and control. Her hands played wildly in his hair, and he was equally rough with his caress on her shoulders.
“More,” she demanded, riding him through their clothes, unable to stop this train wreck.
“More,” he agreed, pressing her against the wall opposite the door. He stripped off her shirt and bra. It was unlikely he got more than a glimpse because she tore his shirt over his head, her hands briefly on his washboard abs.
