THE DUTY CREW

“Who’s the med-nurse and what have you given the patient so far?” Zettler had come a long way from her just-out-of-nursing school status of a year-and-a-half ago. Being a nurse in the military during wartime made you mature rapidly. Experiences with critically ill medical and surgical patients that would ordinarily take 5-years took only 6-months at Queens Naval Hospital. In addition, Minerva Zettler came from a loving Jewish family in which she was the oldest of three sisters and had achieved caretaker status in her relationship to them. Hers was a caring family that acknowledged God, goodness and respect. Respect for Zettler was simple as taught by her father and mother. “Treat others as you wish to be treated.” Moses Zettler gave this instruction to his daughters ad nauseum. “That’s what respect is all about.” Such a simple philosophic guideline had always worked to discipline Minerva Zettler’s feelings–except with Captain Moustaffa.

“Me, LT Zettler. LT Zoulas–I’m the med-nurse here.” The trim Lieutenant was 5-years older and one rank above Zettler. “I gave him 5 mg of Valium when he began fighting the ventilator and increased the oxygen flow rate. He was turning blue. I took him off the Byrd and hand bagged his breathing and he responded immediately. The Respiratory tech told me to keep him on the Byrd machine and he’d come by and check on him.”

“What about this Huxley?” Zettler demanded an explanation for his apparent cavalier attitude in dealing with respiratory obstruction. Without an airway, the patient couldn’t breathe. Huxley’s response to LT Zoulas should have been immediate.

“Yes ma’am, I was here just 15-minutes ago and changed the tracheostomy tube and rechecked the machine.” Huxley glared at Zettler. “He was okay.”

“Well he’s not okay now.” Norman was moving around the patient. “Nice call Zoulas, putting that hard neck collar on and strapping him to another bed board. You wouldn’t have been able to do chest compressions otherwise. Huxley, the Byrd is doing nothing and I can’t get any air into him with the Ambu bag.”

“Yes, sir. That’s why I brought a new machine after LT Zoulas called me.” He disconnected the ineffectual Byrd and affixed the new one to the trach-tube. A burley ICU Corpsman who had been doing chest compressions stopped while the new Byrd began to introduce air into Moustaffa’s lungs. The EKG still registered a straight line.

“We don’t have any rhythm to countershock. It’s just a flat line but let’s zap him anyway.” Norman had to try everything before declaring the arrest effort over. “Give me the paddles and set the machine at 200 joules.” Norman applied the insulated paddles and Zettler steered everyone clear of the forthcoming electrical jolt.

“Clear.” Zettler gave the signal to shock the patient. Everyone but Norman held their hands free in the air. If anyone touched Moustaffa or touched anything that was in contact with Moustaffa’s body, the electricity would also shock them. Norman pushed the button on the right paddle touching Moustaffa’s chest. With both paddles generously covered with electrolytic gel and against the chest wall, the energy delivered to the patient caused the whole body’s skeletal muscle system to contract even though Moustaffa was paralyzed.

Nothing happened to the EKG.

“Draw some blood gases. I want a stat report.” Norman initiated five more shock attempts and administered additional doses of adrenalin, xylocaine, calcium and bicarbonate. The EKG was still a flat line. The blood gas report came back and Norman read some of the numbers to the team. “Oxygen is 18, C02 is 90 and the pH is 6.10. No wonder we couldn’t bring him back.” Moustaffa had severe respiratory acidosis. Normal values were in the range of: Oxygen 100, C02 38 and pH 7.34.

Captain Moustaffa was dead.

“Huxley,” Norman yelled.

“Yes sir.” Huxley maintained an impassive attitude. He was the only respiratory tech on duty this Christmas. “What went wrong here? Moustaffa’s airway became patent right after you changed machines?” Norman would have to explain the death to the MOOD and the XO.

“I don’t know sir.” Huxley’s response was mechanical and uncaring. “Machines fail, sir.”

“I have to call the MOOD and he has to call the exec about this death.” Norman glared at Huxley. “I’m going to need a better answer than that, Huxley. Write something technically adept in the patient’s chart right now.” Norman picked up the phone to page Dr. Friendly.