Cardiac Care Unit . . .
Between the doctors racing around, the nurses taking orders like they were on the battlefield, and the spooks that had gathered in attendance to watch it all unfold, it was hard to see what the Code team was doing to revive Dr. Smith.
But when they all backed off and I saw the defibrillator pads being placed on his chest—one on his upper right pectoral, the other on his lower left ribs—I knew my caseworker was not long for this world.
Ricky’s telling me everything that’s going on, from the shots of adrenaline, to the joules (the energy released in one second by a current of one ampere through a resistance of one ohm) used on the defibrillator. He’s explaining what each of the people’s jobs are, and who does what, but I can’t really focus on any of what he’s saying.
“Ventricular fibrillation, most likely . . .”
Even though there is all of this excitement going on around Dr. Smith’s oxygen starved body, the rest of the CCU is business as usual. What I’m being explained is that Dr. Smith’s heart is misfiring. Normal electrical pathway for the heart is Sino atrial (SA)—Atrioventricle nodes (AV). But the signals are fibrillating—misfiring.
“If he makes it out of this—” Ricky starts to say.
“. . . Well, if he does, he’ll probably end up in hospice care. And those patients, they’re just waiting to die. All the hospice people do is keep the patients so drugged-up that they don’t have to suffer their end.”
We get as close as we can get without being in the way and I just listen.
A thin, black doctor directs the code, “Cardio-vert at two-hundred joules. Head clear, feet clear, all clear!” He touches a button and Dr. Smith’s body arches, lifting up off of the gurney, his back curved impossibly.
They all watch the black and green screen, looking at the erratic spikes that seem everywhere on the monitor.
“Still V-fib. Resume CPR.”
They move around quickly, purposefully.
“. . . Administer epinephrine.”
All eyes are on the screen. Small numbers to the right of the numerous green spikes tell the doctors they aren’t having success.
“. . . still V-fib . . . cardio-vert again, three-hundred joules,” and a high-pitched wine sounds as the electricity is building for the shock charge.
“Head clear, feet clear, all clear!”
Again, Dr. Smith’s body lifts and drops.
And everybody is silent, waiting, hoping.
More anxious now, “. . . still V-fib, continue CPR. And give me Lidocaine, IV bolus.”
And as sudden as the Lidocaine starts to enter his body, there is a change. You could hear a pin drop. All of our eyes, they’re all staring at the screen that now shows a pulse.
A cardiologist yells, “We’ve got V-tac!”
“We’ve got a pulse,” a nurse confirms.
“Ventricular Tachycardia,” Ricky whispers to me. This is like watching House, only . . . in the episode that is my life, the people really die.
Sure enough, the rhythmic spikes come, one after the next.
And then another.
Ricky slaps me on the shoulder, “See . . . have a bit of faith, Jack.” Somehow, at least Dr. Smith’s heart is still alive.
I notice a most curious thing, the spooks are acting funny. They are huddling together in little groups and hurrying away to dark areas where they can disappear into the shadows. But they’re not leaving . . . they’re just hiding. Getting out of the way.
And I have an uneasy feeling about what is probably coming next.
Ricky squeezes my shoulder, “That’s modern technology for you. We cheat death here, sir.”
I glance cautiously at him, and then back at my caseworker. The spooks are waiting for something to happen. And as far as I can tell, everybody else is all about pats on the back and high-fives. People are smiling, proud that they could save the life of one of their own. But the spooks and I, we know different.
“You’re too negative, Jack,” Ricky says. “Lighten-up, buddy.”
And as the word, buddy, leaves his mouth I see two of them lumber out of the darkness. I ask Ricky if he still wants to bet, and he looks at me like I’m insane.
“Why . . . what do you see?”
The Gatherers. They are thicker in the trunk than the spooks, with their long spider arms, their thin sharp fingers, and their double-bladed knives. They slowly amble over to the gurney, lurching from side to side, as if they’re worn-out from a long day of ripping chests open and sucking out life.
But as the doctors and nurses work to stabilize Dr. Smith, the gatherers are using their long knife-wielding arms to climb up and position themselves on Dr. Smith’s body.
For a moment some of the spooks leave their small groups and edge towards the gurney, but one of the gatherers raises up—his arms spreading like an angry bird—and the spooks quickly scurry back to their shadows. Returning to their work, the gatherers seem to be measuring my caseworker’s body for something.
Their arms raise slowly upward, their hands high in the air, the knifepoints facing downwards. This is the part I want to see, and can’t bear to watch. I’m squinting, and Ricky doesn’t know . . . but he knows.
And me and the spooks, we’re on the edges of our proverbial seats. Ricky is not convinced until he hears the loud tone.
“. . . We lost his pulse!”
“We have pulseless V-tac!”
“Immediate cardio-vert at three-sixty joules!” the doctor instructs, calm but forcefully.
And at that very moment, when the smiles melt away, when the jubilant attitudes disappear, and the high-fives become nervous hands, again . . . the Gatherers strike.
Their arms and knives are so fast and so sharp that they must have cut through him in just three or four seconds. Doctors and nurses are scrambling again. And the Gatherers, they’re already reaching inside some invisible incision in Dr. Smith’s chest.
My chest stings just watching all of this.
Ricky, he’s quiet as a light switch, frozen. Searching for words. He’s watching me watching the doctors who are trying to revive my caseworker.
“. . . Head clear, feet clear, all clear!”
Up he goes, down he goes.
And the Gatherers, they don’t like this little carnival ride the humans are putting them through. Both of them spread their arms seeming to hiss at all of the doctors and nurses that are only prolonging their visit. I don’t think that they like this place.
Now it’s become a tug-of-war for Dr. Smith’s soul. The doctors in this world, using all the drugs and technology that evolution provides them, trying to keep him alive. The Gatherers, clawing and pulling at Dr. Smith’s soul, freeing it of its worldly moorings.
Frustrated, one of the doctors says, “. . . we’ve got a-systole,” and he shakes his head, sweat turning his light green scrubs a dark forest green. “. . . No activity.”
With each thing the Code team tries, the Gatherers efforts are frustrated, but only momentarily. And with every pause in the doctor’s fight, the Gatherers pull at the man’s soul, again.
Still no heartbeat.
The Gatherers are winning. They’re good at their job. And as I watch them, I realize that they were designed for this one purpose. They’re emotionally inert and impassive about their work. They might as well be honeybees or something equally as apathetic to their chores.
These well-intentioned human doctors . . . they never had a chance.
Searching for a miracle, the black doctor offers, “. . . we could try trans-cutaneous pacing?” He looks at the cardiologist.
“We’ve been working this for nearly forty-five minutes,” the cardiologist sighed, catching his breath, his arms crossing loosely in front of his chest. “He’s got a history of heart complications. Eats sausage like it’s going out of style . . .” He shakes his head.
“Fine . . .” the doctor says, rubbing his forehead. “Let’s call it.”
And that, I say sadly, is that.
The Gatherers pull Robert “Call me Bob” Smith out of his own body, right through the opening in his chest and he looks like a crash-test dummy. He’s a dimly glowing tan-grey outline of a person. A faceless form—a grey skin sack, with large scared eyes as wide as saucers.
The spooks all rush to the side of the gurney and the Gatherers toss the panicked form down at the very moment one of the doctors say, “. . . What’s the time?”
The spooks haul off their newly harvested soul. And the Gatherers, after a thorough inspection of the insides of Dr. Smith’s corpse, crawl back down and follow the spooks into the darkness.
Ricky turns around, all the color in his face flushed away. He’s as white as a bleached sheet, and he looks sick.
Sorry, I tell him, I didn’t want it to happen.
“But . . . you never had any doubts, either, did you?”
I shrugged as we walked down the hallway.