Norman kept thinking about the CPR effort as he ran. Seconds counted and he looked at his watch. He increased his speed and Zettler kept pace. The brain can only last 5-to-7-seven minutes without oxygen. All the hospital staff were trained in CPR. The nurses, doctors, corpsmen and corpswaves were good at it. What was unusual right now was that CPR was needed on a Ramp ward. These were supposed to be minimal care patients in stable condition. Norman looked at the Ward sign they just passed–J. Five more to go. He looked to his other side. Zettler was jogging at his pace. Her hair was moving up and down held in place on top only by her cap. She caught him looking at her.
“What? What are you thinking?” She exhaled the questions as part of her aerobic breathing.
“I can’t imagine what we’re gong to find. The M through R Wards have orthopedic patients just idling around having casts changed and letting bones heal. No strong pain medications are allowed and the worst things we usually get called for are Malaria attacks.”
“You never know. Someone can throw a pulmonary embolus if they’re too sedentary and suddenly get into some real physical activity.” Zettler looked at the marker for the L wards. “Next ward on the left.”
They turned together and ran directly over to Corpsman Adams doing mouth-to-mouth and the card player patient doing chest compressions. The Anesthesiology Resident arrived at the same time pushing an equipment cart. Norman looked at him. The JMOOD was in charge of the CPR team, but the Anesthesiologist was a key player.
“Okay George establish the airway. I’ll take over the chest compressions.” Norman looked at the corpsman’s nametag. “Adams, take a breather and tell me what happened.”
“I haven’t a clue Dr. Norman. I came in to give the meds and this patient–Hobart Jones–was unresponsive.”
“I have the endotracheal tube in.” Dr. George Bloom connected the Ambu bag to the tube and began squeezing oxygenated air into Jones’s lungs. He moved the bed table to the side to give himself room.
Huxley came in huffing and puffing from his run down the ramp. Most of his breathing noises were exaggerated. He never hurried to cardiac arrests, especially one he was responsible for.
“Get his clothes off LT Zettler. And you, connect up the portable ECG machine from the Anesthesia crash cart.” Norman barked at the corpsman from L Ward who had just come over.
“I’ll have to cut his uniform off.” Zettler produced a large bandage scissors from her uniform pocket and started cutting the shirt. Adams undid the belt and the pants were removed.
“Start writing everything down, please–all procedures and drugs given.” Zettler gave the order to the operating room corpswave who had come down with the anesthesia resident. “Huxley what are you staring at?” Zettler followed his gaze to the bed table that was now pushed about 4-feet away from the CPR effort.
“Do you need an extra hand?” Dr. Buzby Brisbane looked at Norman and Zettler.
“Start the I.V. Buzz.” Norman then looked at Huxley. “Huxley connect up your Byrd machine to the endotracheal tube.” Dr. Bloom disconnected the Ambu bag and Huxley attached the machine.
“Synchronize it manually Huxley. One breathe to every three chest compressions.” Norman then gave the standard algorithm for cardiac arrest medications. Zettler yelled out the names of the medications as she injected them into the I.V. tubing injection ports.
“Oh damn–VF.” Brisbane gave the ECG diagnosis to Norman. Ventricular fibrillation was a lethal arrhythmia. “I’ll get the paddles to shock him.” He placed the clear electrode paste on Jones’s chest and attached the two small round paddles to deliver the counter shock. Okay stand clear here comes 250 joules.”
“Okay. I’m here. Someone brief me. What happened here?” Curly Norton was huffing from his long run. He was leaning on Jones’s right leg when Brisbane delivered the shock. All of Jones’s muscles contracted at the same time with arms flailing and both gigantic legs kicking straight out. Norton got kicked and sent tumbling to the floor rolling over twice and rendering his Santa Claus beard askew.
Pinino and Thornbush were now present. She looked at the fallen Santa Claus and then over to the now naked Jones. Her initial laugh at Santa covered by her right hand to her mouth was now turning to a gag as she saw CPR resuscitation in full swing. The Ward L Corpsman was putting a Foley catheter into the patient’s penis. Brisbane looked at the ECG monitor and now saw a straight line.
“Stand clear. We have to try another shock.” After 10- minutes of resuscitation effort, Dr. Bloom announced, “This man is dead. He had fixed and dilated pupils when I got here.” He looked at the Ward corpsman. “Adams what about when you saw him–how long ago?”
“About 30-minutes. His pupils were fixed and dilated then too, sir.”
“Dr. Norman. It’s your call” Bloom looked at the JMOOD.
“Bring him back Dr. Norman. I don’t want anymore soldiers dying on my Duty.” Norton was brushing off his Santa suit with his white-gloved hands.
Huxley looked over at the bed table again. Zettler caught the gaze and went over to the table.
“You seem so interested in this bed table Huxley. Why is that?” She opened the drawer.
“Oh, my God.” She lifted the drug paraphernalia set-up, holding the tourniquet and the syringe.
“It’s a heroin outfit.” Pinino gawked at the equipment. “He overdosed.”
“Look for needle marks.” Brisbane began looking closely at the interior of the arms and then the groin. “No ‘needle-popping’ here and no intravenous tracks.”
Huxley sidled away from the group but Zettler came up against him.
“How did you know it was there Huxley?” Her voice was low and accusatory. The rest of the team were working on Jones and ignored them.
“I don’t know what you’re talkin’ about, ma’am.” He glared at her with a lethal leer.
“Wait. Look here.” Brisbane massaged a small clotted puncture wound on Jones’s right thigh. “He injected himself in the quadriceps. Get a blood drug screen for opiates and take his temperature.” Brisbane wrote the order on the lab chit that was being sent down with the first blood specimens drawn from a femoral artery during chest compressions. The compressions produced a pulse and therefore a vessel could be identified. Likewise, the intravenous line was established once the circulation began moving–artificial or not. Fifty-percent of the time they had to “cut-down” on an ankle vein but they were lucky with Jones.
“Temperature 96.7.” Zettler reported aloud.
“Well we weren’t too far behind his arrest but 30-minutes of cardiac standstill kills the brain.” Norman said. His verbalization triggered a pause for re-assessment of the resuscitation effort.
“Stop CPR. I want to look at his eye grounds.” The anesthesia resident took out his ophthalmoscope and looked through the dilated pupil. “He’s got an hypoxic retinopathy–pretty advanced. You’re right, Dr. Norman. I think we got here 30-minutes too late. Nice try everyone.”
“Damn. If he ‘O D’d, I have a Security nightmare to write up here. LT Potska, you and two of the MPs seal off the ward and start searching every bed, locker and pillowcase for drugs.” Norton went over to Norman who officially called off the arrest and pronounced Hobart Jones dead.
“Send for the Morgue Watch Duty Crew.” Norman wrote the order on Jones’s chart.
“The what?” Thornbush immediately put her hand to her mouth. She just blew her cover.
All eyes turned to the redhead in the white staff coat and blue scrubs.
“Follow me. We have to seal off this area.” Pinino whisked her away before Norton could focus on her.
“Huxley, I’m not through with you. After we’re done here I want to talk with you and Security about this bag of goodies.” Zettler held up the planted heroin paraphernalia.
“I don’t know anything about it. I have to go. I have live patients to attend to.” Huxley left her staring after him amidst the rest of the staff getting their documentation of the CPR effort. He pushed his tripod-wheeled Byrd machine by Thornbush and Pinino.
“We have to meet somewhere private.” Thornbush whispered to Pinino’s right ear. She delivered the words with a breathy exhalation.
“Meet me in room F-113. It’s off the F-1 ward.” His walkie-talkie beeped and he pressed the receive button.
“LT Pinino? Do you read? Over”
“Pinino, here. Go ahead. Over.”
“The 1500 hour air-evac is going to be late because of the snowstorm. New ETA is 1515.Over.”
“Roger that. I’ll pass the word. Over and out.” Pinino re-clipped the radio to his belt and turned to Thornbush. “I’ll see you in 5-minutes at F-113. I have to go back and tell them about the air-evac delay.”
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