No immunity, not in the end. He had resisted as long as he could. But now, he no longer had any control over his body. He could do nothing but lie helpless, paralyzed and at the mercy of the creature endlessly circling. Tapping that eerie cadence around and around, stopping only to prod at him, squeeze and pinch and crush. His ankle. His hand. His ribs.
Killian could not even scream anymore. Sometimes he felt on the verge of knowing why. The tentacle snaking down his throat did not truly hurt, though on occasion it inspired such panic that he would rather be dead than endure its presence any longer. Then the moment would pass, he would lose concentration and forget the invader, and try to beg an instant’s peace, and wonder why even the smallest hint of his pathetic pleas would not come forth.
YOU CAN NEVER BE FREE OF ME. I SHALL HAVE YOU FOR ALL ETERNITY.
Yes, Master.
Had there truly been a time when that commanding voice held no sway? The mantra scripted, the despair half-pretend?
NO MATTER. SAY IT FOR ME AGAIN. FEED ME YOUR MISERY.
No hope.
IT IS REAL THIS TIME.
No hope.
THE BATTLE IS LOST.
No hope.
NO HOPE. NO HOPE, TRIPOD. NO HOPE FOR ANY OF YOU. KILLIAN.
Killian?
*****
Emma burst into the waiting lounge, cursing, her heart pounding as if she’d just sprinted up to the top of the clock tower. Of course they would page her as soon as she ran down to the cafeteria for five minutes; she should never have let her dad talk her into taking a snack break.
“Whale?” she called urgently even as she spotted the physician’s distinctive shock of bleached hair across the room. He had his feet up on a coffee table and looked even more haggard than before; apparently, the past 30 hours had been rough on him, as well. He did not get up when he heard his name, opting to merely wait until Emma had perched nervously on a chair nearby. Dr. Whale gave her a reserved smile before speaking.
“He’s out of surgery.”
For an instant, Emma thought she might black out from the relief. Whale rubbed at bloodshot eyes, continuing,
“We did everything we could for him, for now. His lung has been repaired, his shoulder reduced, and temporary closures provided for his other injuries; they’ll have to be addressed at a later date, when he’s stronger. He’s had probably a dozen units of blood and may require more over the coming days.”
Emma felt a hand on her shoulder and realized that her father must have cleared up quickly downstairs in order to be able to be with her, and then snuck in while her attention had been riveted on the physician’s words.
Whale sighed and stretched his neck.
“I’m not going to lie, Emma; he’s not out of the woods yet. He’ll need constant supervision in the Intensive Care Unit until we’re sure he won’t crash on us at any second. The biggest complication that we’re dealing with right now is the neurological condition which, I can’t even remember if I told you, has gotten exponentially worse since Wednesday.”
“The brain shriveling?” clarified David, and Whale nodded.
“The best thing for thatwould have been to keep him sedated while we work on a therapy, like we did for the others, but for some unknown reason, every sedative we’ve tried has only made everything worse. His blood pressure will fall, or he’ll develop an arrhythmia or respiratory depression or something else equally as dangerous. It’s totally bizarre, and none of the other slaves have reacted this way. Bottom line is, I don’t think it’s safe to keep throwing different sedatives at him and hoping one will stick. We’ll allow him to wake up and just try to keep him comfortable with painkillers.”
Around a lump in her throat, Emma managed to ask,
“But didn’t you say the brain condition is slowed down when they’re sedated?”
“I did,” shrugged Whale. “But faster brain deterioration will kill him slower than a clot caused by low BP would.”
Emma nodded slowly, the long list of threats to her husband’s life squeezing at her heart until she could not speak. Behind her, David quietly asked,
“What about something like total anesthesia? Would that slow the condition?”
“That would be even more risky than sedation,” explained Whale. “With general anesthesia, you always want to use the smallest dose for the shortest amount of time, otherwise all sorts of bad things can happen, from respiratory arrest to brain damage.”
A moment of heavy silence filled the room, uninterrupted by the background noises of the busy hospital. Then Emma squared her shoulders.
“So when can I see him?”
With great reluctance, Whale stood up, unfolding slowly like a man many years his senior.
“Let’s go,” he groaned. “He’s going to be disoriented at first; hopefully you can help with that.” He glanced at David, then back at Emma as he added,
“Only you, though. For the time being, at least.”
David caught Emma’s hand in a quick squeeze. “Give him our best.”
*****
His Master had its clawed hand around his arm, squeezing without involving any of its nails. It hurt the stake driven through his wrist. But that was, after all, its privilege.
Harder, Master. Take what you will. I am yours.
“Killian.”
Bloody hell. Swan was in the church. He could hear her. He could almost see her, if he tried hard enough to open his eyes and focus. Impossible!
I SHALL HAVE HER TOO.
No!
A piercing pinch. A whimper without sound.
Yes… Master…
*****
It could only be an extension of his Master’s recording experiment, but how it was supposed to succeed was utterly mystifying. Any little sound stalled before it even started, not just the screams he wanted to unleash. So how would his Master glean any sort of energy from him this way?
THAT IS NOT YOUR CONCERN.
Killian’s elbow twitched and he felt an immediate jolt of stiff pain in his shoulder. He could not say when he’d been torn loose from his imprisonment, what almost certainly should have been the structure against which he’d breathed his last and surrendered his soul. The figment Emma was back, or perhaps had never left, though their Master had yet to make good on its threats against her. It must wish to drain the last remaining drops of scream energy from him first, wringing him out like a filthy, useless rag, scraping him down to the rind and then beyond.
She called to him. He could not acknowledge.
I AM HERE, insisted his Master. He felt it. Its marks of possession carved into his flesh. Unyielding limbs pinning him, holding him still.
Which of its appendages was slender enough to slip inside a nostril? Killian had no recollection of that particular trick.
“Hold still–”
DO NOT MOVE, TRIPOD.
Something twitched deep down inside his chest, sparking a powerful urge to retch. The Master’s device between his teeth confirmed itself as not-tentacle by its texture and flaccid presence, no roiling, pulsating muscle beneath its rubbery exterior, and yet it began moving again, this time sliding up his throat and exiting in one long, slippery slither, its tip scraping irritated muscle as it went.
Gagging hurt, but coughing was worse.
“Breathe,” urged many voices, Emma’s and at least one other. Z, if she weren’t dead and could speak. Or maybe it was only after death that she would.
FILL THOSE LUNGS WITH SCREAMS.
*****
When Dr. Whale had first led Emma inside, she would have sworn it was the wrong room. Her emaciated husband was simply unrecognizable, even compared to what she’d seen of him the day before. Discolored, withered, and limp, taped and wrapped, sickly pale skin free of dirt but painted with a sheen of sweat. After so many situations just like this, she probably should be at least somewhat accustomed to all of the gadgets necessary for life support, but they shocked her every time. Whale’s team had at least traded the I/O line for a more long-term central line, which she knew would cut down on the number of needle sticks necessary for blood sampling and the like.
Emma sighed. He was going to hate this. He always did, but now the parallels to his time as the Vocivore’s slave–not in control of much of anything, feeling trapped and helpless–would make it that much worse. Not to mention the damage to his hand that would take away all autonomy.
Well, she told herself, it was a miracle he was even around to hate it. And besides, it would be different this time. Magic would return soon; it had to. And then, even if she couldn’t heal everything completely, she might be able to shorten his length of stay in his least favorite place.
No, she realized. She now knew of several places that would rank lower than this.
“Killian?” she called again, tenderly stroking his bony arm. In the 15 minutes she had been with him, he had showed some brief flashes of near-awareness: slight limb movements, fluttering of his eyelids, minute grimaces eliciting pangs of sympathy within her. In response to her voice, his heart rate would pick up momentarily, though it was difficult to tell whether that was from glad recognition or startled anxiety. In between, however, he would settle back into a frightening stillness that only the monitors proved could not be death.
A few minutes ago, a couple of nurses had removed the endotracheal tube from his throat after Whale had declared him stable enough to breathe on his own. The bout of choking that followed was painful to watch, but Killian still seemed mostly out of it as they attached an oxygen mask to his battered face. His eyes fluttered briefly open but did not focus before slipping closed. Since then, it was back to nothing again.
Whale appeared beside her and leaned over Killian in order to have a listen to both lungs.
“He’ll come around in his own time,” he assured Emma. “This is not unusual after such extensive surgery.”
*****
Something had changed.
The paving stone had warmed, softening into something almost comfortable, a concept so unfamiliar as to be suspicious. The persistent cooing from up above mingled with an utter cacophony of bewildering sounds, none of which belonged to any reality within the horribly familiar confines of the sanctuary. And the light touch on his arm, the gentle stroking along intact flesh… for the first time, it was not altogether unpleasant. Which would only confirm what he no longer feared: total, unreserved surrender.
Does it please you, my Master?
The end of the deception and the fight.
IT IS GOOD.
He could feel it prodding at his chest with its cold, unyielding legs. He did not pull away. No horror stirred his heart, though he knew it wanted something of him.
WAKE UP.
More places were being petted, encircled, or invaded than his Master had limbs to account for; nothing made sense. And why was it insisting he wake up when he was already awake? Perhaps he could appease it with a groan.
Killian coughed. His whole throat felt raw as if acid slime had eroded all the tissue away.
I may no longer have any screams to give.
His ankle spasmed. Stabbing, burning cramps spread up his wrist from an oddly immobile hand. But his Master seemed unfazed by the revelation and continued its touching.
“Please–OPEN YOUR EYES–Killian. It’s time–YOU MUST WAKE–wake up now.”
The babbling had returned, voices on top of voices, all begging to be heard amidst the rolling of whitecaps pitching the floor into sudden, violent motion, squashing him down as though he weighed a thousand pounds, and in an instant, Killian was retching like the greenest of new recruits on their first day at sea.
If he’d thought coughing hurt, his stomach trying to eject what wasn’t there took that pain and magnified it a hundredfold.
“…Pretty common, too, after anesthesia…”
Shut the hell up, Whale, and let a man die in agonized peace.
HE WON’T ASPIRATE WITH THE NG TUBE CLEARING HIS STOMACH.
“Trust me.”
His Master’s suit had turned white.
The bucking slowed, gravity returning to normal from his feet upwards. Killian’s eyes were watering in lights far too bright and colorless, lacking any hint of refracted hue.
It wasn’t a white suit. A white coat.
“Killian?”
Tilting his neck even the slightest degree seemed to drive iron stakes all around its perimeter. Killian blinked away the tears into which his Master’s image had dissolved, leaving behind only smeared shapes and hazy colors as it bellowed a whisper,
I REMAIN.
His first in-focus sight had to be of bloody Whale, leaning over him in professional study. But the physician’s voice hadn’t been the only one to blend with the Vocivore’s menace.
“Swan?” he mumbled, almost noiseless, and promptly gagged. What he’d taken for a tentacle tightened on his arm in trembling reassurance.
“I’m here, Killian.” She moved into his field of vision and his weary eyes looked into her face, desperate for the calm that only she could provide. “You’re safe; you’re at the hospital. You made it.”
Though his vision remained blurred and unsteady, there was no mistaking the relief on her face, nor the steady stream of tears coursing down her cheeks as she tried to smile.
Sudden, paralyzing panic overtook him; he could not remember… his Master, it was there, always there, but beyond its looming presence… only fragments. A life. Such a precious life… and a corpse…
“Wh…” he tried, then, “H…”
“Don’t try to talk just yet,” interjected the bothersome physician. “You had a tube down your throat to help you breathe, and there still a smaller one going down into your stomach to help with nausea and for feeding later.”
The majority of Whale’s words got lost in the storm clouds of confusion and worry, and Killian chose to ignore the rest. But moving to keep Emma in view brought a wave of such intense pain that the room lights went out and a high-pitched, pressurized buzzing filled his ears.
“For the love of God, Hook,” Dr. Whale was saying, muffled at first but slowly clearer as Killian’s senses returned. “Hold still; there’s about 101 places you could tear open and we just finished putting you back together.”
Killian could only gulp unsatisfying breaths under the weight of the several cannonballs that seemed to be piled on his chest. In a much more patient tone, Emma pleaded,
“Try and relax, Killian; everything is fine. Hope is fine. The monster is dead. There’s nothing to worry about. I promise.”
Hope. It was Hope, the corpse. Hope kidnapped, Hope tortured, Hope dead. Emma was saying one thing, but he saw another. Hope dead. Maybe Emma didn’t know. So many terrifying scenes jumbled in his head. So much screaming and pain and despair. And Hope’s corpse, there among the flashes. The wounds were real. The Master was real. But Hope dead was not?
How would he ever be certain?
Emma’s touch; that felt real. Whale and his lackeys, as they performed their checks and asked questions he could not possibly comprehend… less so, but then again, their knowledge struck him as far beyond anything he could ever conjure.
Whence came the corpses?
I HAVE CONSUMED THEIR SCREAMS. THEY ARE DEPLETED.
His Master once again circled his bed. And Killian closed his eyes. Resigned to the torture.
*****
Emma watched her husband slip back into a troubled slumber and scrubbed at her face. The brief moment of clarity had been equally as encouraging as heartbreaking. He knew her; that was certain, and momentarily seemed to soothe at her touch, but the long periods of terrified delirium before and after had been difficult to stomach. Not to mention the apparent anguish that any small movement caused him.
Whale finished scribbling a progress note and pursed his lips. “Well, that went about as well as could have been expected. His neuro scores are encouraging, so we don’t have to be as concerned about hypoxic brain injury.”
Clearing her throat, Emma resumed resting her hand on Killian’s arm. Whether or not he consciously felt her presence, subconsciously she had to believe that she could provide a bit of a buffer between him and his nightmares. “Sure didn’t last long.”
“Combination of post-anesthesia and his pain meds. Really, sleep is the best thing for him, as long as it stays peaceful like this.” He checked a readout on the complicated IV pump and made a quick adjustment. “It’ll probably be like this the first few times. You may have to keep reminding him where he is and all that; he might not remember each time he wakes up. By tomorrow morning, I’d expect him to seem more alert and possibly stay awake for longer periods of time.”
The physician yawned and did not even seem sorry. “It’s going to be another long night, Emma. People in and out frequently. You’re welcome to stay, but no one would be surprised if you decided to go home for a couple hours’ sleep.”
Emma shook her head. “I need to be here for him.”
“Your choice.” He headed for the door. “Don’t hesitate to call someone if you have any questions or concerns.”
After he left, Emma watched Killian breathe, reassured by the small cloud of condensation that formed on the inside of his mask each time he exhaled. Then she composed a quick update to her father; she knew he would take care of spreading the word to everyone else waiting for news. That accomplished, she settled in for her lonely vigil.
Killian had endured a month’s worth of little to no rest, and low-quality sleep when he could get it. Compared to that, three or four nights of watching at his bedside was nothing.
***AAAAHHHH!!! THANK YOU MY WONDERFUL COCONUT FRIEND!!!!!!***
(what the heck happened to the horizontal line, tumblr??)
Present (Friday, continued)…
The first siren was the most beautiful sound Jones had heard in a very long time. His sense of time had been growing increasingly fuzzy, but his estimate would have leaned toward a wait of at least an hour. Likely a gross exaggeration, but with Killian in such dire straits, and the attention-seeking behavior of his own dizzying pain, every moment had stretched to an interminable age.
Thankfully, Emma had resumed the duty of applying pressure to her husband’s wounds, and Jones could take advantage of the respite to recline back against the bloodied altar. He didn’t know for sure, but he had a suspicion that fragments of the stun projectile remained in his throbbing shoulder. Emma had graciously wrapped a second bandage around the first, which seemed to be containing the bleeding for the most part, but didn’t do much for the agony. All adrenaline now long gone, Jones could feel each heartbeat through the wound, and an overwhelming exhaustion pressed down upon him. More than once, he had caught himself beginning to topple sideways, close to passing out. Dizziness bordered on nausea. He could only imagine how Killian must be feeling. As far as Jones could tell, his counterpart drifted in and out of consciousness, frequently coming back with sobs of terror as he relived tortures endured, and Emma could not always soothe him easily.
Now, as the first scream of a siren echoed up to the rafters, Jones forced himself alert and struggled closer to Killian’s side, knowing that Emma would want to direct the help where it was needed most. She met his gaze gratefully, squeezed Killian’s knee with a murmured word of encouragement, then rose. As she jogged toward the front door, Jones listened to the labored breathing beside him and prayed that the medics weren’t too late.
“In here,” called Emma, one foot still inside the church. Evidently she was reluctant to leave her husband for too long. “Hurry!”
Killian whimpered and Jones lay a gentle hand on his forearm.
“Still with us, mate?”
Uniformed paramedics trooped inside, following Emma’s urging, and Killian shivered, seemingly only half-aware of his surroundings. The detective managed one more reassuring squeeze before shuffling aside. He watched with hooded eyes the efficient dance of emergency medical assessment, waving off attention for his own injuries in favor of faster intervention for Killian.
The medics were quick to administer supplemental oxygen as they measured vitals and made a preliminary examination of his wounds. Emma managed level-headed answers to their questions, keeping out of their way but determined to stay by Killian’s side. He seemed confused and afraid, struggling against every touch despite Emma’s pleas for him to remain calm. The medic at his left side was already on her third cannula as she tried to hit a moving target. Pouches of blood and saline awaited only a reliable access to Killian’s compromised circulatory system.
Emma’s phone buzzed. After reading the message and typing a quick reply, she reported to no one in particular,
“Second ambulance is close. My dad’s following in his truck. He’s gonna direct them in here.”
One of Killian’s medics seemed to be getting ready to activate a power drill into his upper arm. Jones wondered if he might be starting to hallucinate, but in response to Emma’s look of confusion, the medic explained how the long bones can be just as effective at transporting drugs and fluids as peripheral veins are. “It’s not overly painful,” yeah right. Already woozy, Jones couldn’t watch, and even Emma had to look away as the battery-powered device buzzed a stylet through skin and muscle and into the humerus. Perhaps the woman was correct; Killian didn’t seem excessively bothered. He’d grown quiet and mostly still, focused on the effort of breathing. Under the mask, he almost looked like a fish out of water, gulping at air too thin to metabolize. The impression was only strengthened by the bluish-gray tinge to his skin.
This was evidently cause for concern. The activity around him doubled in calm intensity, and even Emma backpedaled to allow them more space to work. Jones was just gathering the fortitude to stretch out a comforting hand when the church door scraped open again. He had missed hearing the new ambulance come wailing up, but he could see a doubling of the whirling flashes outside.
David still had his arm in a sling, but that didn’t stop him from being the first one inside.
“Emma!”
Fixated on her husband’s struggles to breathe, Emma didn’t seem to even hear her father’s call. David urgently beckoned the new arrivals inside and started up the aisle himself. He did an impressive double take at the monstrous corpse on the floor, watching it warily as he skirted an unnecessary circle around it, then hurried to the foot of the stairs. He faced a moment of indecision when catching a glimpse of his son-in-law in the midst of the crowd of medical professionals, eventually deciding to creep up in between Emma and Jones in order to provide his daughter with moral support. Kneeling behind Emma and pulling her close against his chest, he cast a worried glance at Jones.
“Hey, partner. You okay?” he murmured, making sure to keep his voice at a level that would not disrupt critical communications elsewhere.
“Glad you could j-join us, mate,” Jones gritted out, shivering painfully. The sackcloth tunic he wore certainly did not provide much warmth. He was beginning to regret having insisted Emma lay all of the blankets she’d found over Killian, especially considering that most of them were now strewn carelessly in a heap after the medics had desired better access to their patient.
David read his thoughts and reached gingerly around Emma, grasping at one of the discarded blankets nearby. Absently, Emma helped him to drag it back out of the way. The prince tore his eyes away from the frantic scene in front of him, gave Emma a comforting squeeze, then pulled away. As he spread the blanket over his quaking partner, David hissed,
“What the hell happened? What were you two even doing here?”
“Saving the world, naturally,” grimaced Jones. The second band of EMTs had finally arrived, and they were trotting toward the altar, though to Jones it appeared as if they were moving in slow motion. David finished tucking the corner behind his good shoulder, leaving the fabric loose beneath the saturated bandage on the other side.
One uniformed man started to set up shop at Jones’ right just as Emma turned and reached for David, her strong façade crumbling. David was forced to adjust his position in order to accommodate his wounded shoulder blade. As the prince gathered his weeping daughter in his arms, Jones could hear him whispering words of hope. He’s going to be ok. They’ll get him home; Whale will fix him up. People could survive a collapsed lung. And they were talking about Killian, here.
Jones heard all of this despite the other portion of his attention devoted to responding to the questions being put to him by the two EMTs assessing him. Turning his face away from the blood pressure cuff that was currently magnifying the throb in his coat-hanger-pierced forearm, Jones caught sight of what had so deeply upset Emma. Not only were the medics inserting some sort of drain in Killian’s chest below the still-protruding dagger, but they were also preparing to intubate and take over his respirations with mechanical ventilation. It all looked serious and scary, but was obviously for the best, if his own efforts were ineffective.
True professionals, Jones’ medics kept their focus solely on him despite the commotion nearby. Their attempts to start an IV were barely distinguishable from the squeezing, pulsing anguish lower down his punctured forearm; Jones was just grateful they hadn’t yet pulled out their bone drill to use on him. As he looked past the gurney that was waiting at the bottom of the stairs, Jones spotted the massive corpse of the Master slumped where they’d left it. And surrounding it…
“Bloody hell,” muttered the detective. Still in the dark about the situation and extremely on edge, David’s head snapped up and he looked around wildly, fumbling for his gun.
“What is it? What’s the matter?”
“They’re over there.” Jones gave a stiff nod to indicate the direction in which he was looking.
The slaves were gathering around their Master. Forming a mournful and eerie circle tribute. Or maybe it was panicked directionlessness. Even those too weak, stunned, or injured to walk were compelled to slither along the ground, inch by agonizing inch, all to be closer to the commanding presence they could no longer feel or hear. If anything were to remind the detective of a zombie horror film, the sight before him now would have been a top contender. Even more were staggering their way into the bustling church, clogging up the doorway through which additional paramedics were attempting to enter.
“Wow,” grunted David, still slightly alarmed. “That’s disturbing.” He glanced warily back at Jones. “You’re not… feeling the urge to join them, are you?”
The detective’s attempt at a laugh came out more like a groan. “Not yet, mate; thank the gods. I’ll let you know if I do.”
“Well,” said David thoughtfully, “at least it will make it easier to round them all up.”
A sudden frenzy of activity distracted both men from the sight. Emma scrambled to her feet as Killian’s backboard was hauled up in preparation for transport to the ambulance. She shot the briefest of glances at her father, but was already making as if to follow even before he had a chance to say,
“You go. I’ll handle things here.”
Just as the front doors had ground to a close behind Killian’s gurney, one of Jones’ medics rose to her feet. She found a place on the altar’s façade on which to hang his bag of saline, saying,
“Okay, Mr. Jones. I know you’re probably anxious to get to the hospital where you’ll be more comfortable, but since you’re stable for now, we are obligated to triage the rest of the scene before deciding who gets priority.”
“Understood,” Jones assured her. “I can wait.”
As she collected her remaining equipment, her partner turned to David.
“Would you mind keeping an eye on him? I’ll tell you what to watch out for.”
David hesitated, looking torn. “I…” He turned stricken eyes upon Jones. “Killian, I didn’t want to give Emma one more thing to worry about, but in her message she said that Hope was… safe? I didn’t see her… and who’s taking care of her right now?”
The detective gave him the best impression of a reassuring grin that he could manage under the circumstances.
“She isn’t here, mate,” replied Jones with a definite slur to his words. He could feel some kind of narcotic beginning to take effect, blurring pain and mental acuity alike. “But she is safe and being looked after; I give you my word.”
David’s teary smile was laced with confusion. “She… but then where…?”
With a deep sigh, the detective closed his eyes and rested his head back against the hard surface behind him. “I don’t believe that’s my story to tell, David. Sorry.”
He heard the medic begin to relay quiet instructions to the prince and slitted one bleary eye open to interrupt.
“If you’d rather assist with the injured slaves, I should be okay here. This thing has an alarm, doesn’t it?” Jones indicated the portable EKG currently monitoring his heart rate. David winked at him, rubbed his eyes with one hand, and settled in next to Jones.
“Nonsense. What kind of friend would I be if I left you here all alone?” He shifted his weight a bit, trying to get comfortable. “Besides, I wouldn’t be much help anyway with one arm out of commission. Bossing the medics around, I guess, but I get the feeling they don’t need my input.”
Jones gave him the barest hint of a smile before closing heavy eyelids again. “Thank you.”
For the second time in three days, Detective Jones was reminded of that lonely Seattle night, when the poison in his heart had nearly killed him. He even had the aching soreness in his chest as an additional parallel.
How much nicer it was to have a caring friend by his side while he waited!
The time is 1859 and pagers throughout the ICU begin to chirp. It’s time: Tube O’clock. This simple and easy protocol was designed to ensure each patient is tubed NO SOONER than five minutes before death or one hour after end of Nursing shift. All pending intubations will now take place at 0700 & 1900: […]
Sorry for the delay, it’s been a rough couple of weeks but I’m starting to bounce back a little. This probably isn’t my best, but I hope you enjoy it all the same.
Carl couldn’t take his eyes off of Anna as they pushed the gurney around a corner. She looked… Amazing. The way she rocked back and forth, compressing their patient’s chest, making her ponytail bounce each time. Her face was a picture of focus, gaze locked on the young woman beneath her as she forced blood through Shona’s ice-cold body. Damn, she was so gorgeous. The way she put her entire soul through her interwoven fingers, into those chest compressions that bent in Shona’s ribs rhythmically. He could see she was doing what he had suggested. Putting her passion, their shared passion, into her efforts.
He took a moment, just one moment, to let a small thrill of pleasure shoot through him. Images flashed through his mind, memories of last night and ideas for when they got home. All the toys they could play with. He took a deep breath, first things first, get their patient back. He let out the breath as they crashed through the doors into Trauma 4.
They pulled the gurney across, lining it up next to the trauma bed. Carl let Anna maintain compressions, as the rest of the team unclipped the straps of the backboard. It was a small risk, but they couldn’t get Shona into the vest that was spread on the bed while she was still strapped down. The vest was capable of keeping her immobilised, the reinforced back and its own means of being secured doing a close enough job.
“Let’s get ready to move her, nice and easy now.” Carl commanded, watching as his other nurses and the paramedic got in position. The ambubag was disconnected and dropped on the gurney as Dave gets his hands underneath Shona’s shoulders, Kirstie gently supporting her head. Others held her arms and legs, kneeling on the bed so they could reach. “Ok, we’re all ready Anna, we’ll move on your call.”
She nodded, her lips moving, as she started to announce her compressions. “43…44…45…46…47…48…49…50!” She finished, pulling her hands away and rising on one knee, un-straddling Shona’s ghostly white body. Anna helped with the transfer, her hands beneath Shona’s waist and thighs. They moved her over as fast as they safely could placing her on the already warm vest. Everyone could feel the contrast, between the heat of the water filling the ribbed plastic, and the chill of the flesh of the young woman they were trying to save. They all knew it meant they had time, but there was still a primitive part of each of them that was scared by that cold.
As soon as they placed her down Anna stood on a step and placed her hands back on Shona’s chest, resuming her barrage, counting in her head once more, to allow Carl to give his orders. “Let’s ready the combo pads, A/P positions in case we need to pace her, then we’ll get her wrapped up.” Anna kept going with her compressions, in the rhythm enough to be able to look around and watch as Trish tore open some sterile packaging and removed a pair of large square electrodes. Trish peeled off the backing of the first pad, revealing the thick layer of electro-conductive gel. Without being asked Anna raised her hands from the ice-cold sternum beneath them and grabbed the other pad. Like a well-oiled machine, Trish placed the first pad, smoothing the edges to make sure the foam stuck well, a split second before the others log rolled the young woman, allowing Anna to slap the other pad onto Shona’s back, similarly fixing it well.
Shona was rolled flat, and Anna’s hands immediately settled back in their prior position, though the pad was now between her fingers and Shona’s flesh. It had little effect on Anna’s compressions. While flexible, the gel was thick and viscous enough that it held its shape enough to allow the force of Anna’s professional chest compressions to translate straight through to Shona’s sternum, forcing it down and simulating a pulse as her heart was squeezed against her spine. Around her hands Trish was folding in the various panels of the vest and clipping them together, tightening the straps to provide a little bit of immobilisation.
Carl continued to run the code. “Roger, grab me the central line, with the temperature catheter. Kirstie get the monitors changed over; did you get anything from upstairs?”
“No luck on the full ECMO, dialysis machine is on it’s way though.” Kirstie told him, as she pulled the thick lead from the portable monitor, connecting it to the large one that hung above the bed. It instantly began to whine the monotone cry of asystole and was quickly muted. Everyone knew the situation.
Carl didn’t reply to Kirstie as she moved onto the other parts of the monitors. He took in the information, then focused on his next task. He moved around to Shona’s head, Dave shifting out of the way. Roger placed a sterile wrapped pack on the corner of the bed, then retreated to the side of the room, where a dozen IV bags were being kept warmed. Carl took the large wide needle from the tray, lining it up along Shona’s neck. He pressed it against the large jugular vein, barely visible thanks to the girl’s blue skin, then in a smooth motion he pushed it in, sliding the length of the needle neatly into the vein. He wasn’t finished though.
Also on the tray was a 20cm long tube, with a spiral that seemed to twist around the thin core, and a bunch of connectors at one end. Carl grabbed it, feeding it into the large opening on the central line, easing it forward, into Shona’s body, deep down the vein, towards her heart. Her heart that only moved because Anna was still pressing down, rapidly and rhythmically, squeezing the organ that refused to beat on its own.
* * *
Anna was starting to feel the effect of her compressions on her arms as she crossed the 3-minute mark. She reached 100 in her head, then started over again, going for a fourth round. She could feel the way Shona’s chest swelled against her hands as Dave squeezed the ambubag, forcing in air that was promptly forced back out by the actions of her own hands. The thick rubbery temperature vest surrounded the circle left for her hands, Trish having strapped it together, before working on the lower sections until Shona was wrapped up from her neck to her knees.
Anna watched Carl work, seeing his concentration as he slid the catheter into the central line, feeling the way it advanced, making sure it was going in correctly. Eventually the plug where it split into a half dozen connectors nestled into the port that stuck from Shona’s neck. Two of the connectors were attached to a small device that began to circulate warmed saline, the device in turn was linked to the monitoring system and, after a few seconds of calibration, Shona’s core temperature was displayed for the whole team to see.
“Core temperature of just 19…” Carl said, trailing off slightly with a frown on his face. Anna knew that signified he was thinking hard about a decision. It took a few seconds, then he gave a small nod to himself. Anna was pretty sure it was totally unconscious on his part. “Let’s go ahead with the thoracic lavage, Roger, get me 4 chest tubes.” Anna cringed internally, but she knew that it was probably Shona’s best chance. Carl continued. “Anna, switch off after this round, Kirstie, you take over, Trish go ahead with the NG tube and then place a urinary catheter.” It would be needed Anna thought, as warmed saline was being pushed into all of Shona’s IV’s, including the central line via one of the dangling connectors.
As her internal count approached 100, Anna began to count out loud again. “94…95…96” Kirstie stood up on a step on the opposite side of the bed and shared a nod with Anna as she wove her fingers together and straightened her arms. “…97…98…99…Switch” Anna finished, pulling her arms away. She stepped aside making sure she wasn’t in anyone’s way as she shook out her arms, trying to recover quickly. She then set about the task that Carl hadn’t spoken out loud.
In the corner of the room were two tall infusers. IV bags could be hung from the top, like a standard drip, but were instead fed into a console that managed the temperature, pressure and flow rate. Anna grabbed them both, one for each side. She placed them by the head of the bed, then headed for a different corner. There, she grabbed two chest drain units, carrying them to the bed, hooking one on each side roughly in the middle of the bed, just next to Kirstie’s legs as she leaned over Shona and delivered compressions.
In the meantime, Carl had almost gotten setup on Shona’s other side, the small surgical kit laid out on a small metal trolley. Anna stepped forward, unclipping the straps of the vest and opening one side, revealing Shona’s chest. Her skin was still ghostly white, the only visible colour being the soft blues and purples of the bruise forming in the valley between her breasts, caused by the compressions that continued to make her ribs flex inwards.
Roger had been waiting, an iodine-soaked swab on a stick in his hand. A moment after Anna revealed Shona’s chest, he smeared the brown disinfectant across it, from up towards her collar bone, down alongside the soft curve of her breast, and over her lower ribs.
“Kirstie, hold compressions.” Carl ordered, armed with a gleaming scalpel. As soon as Kirstie lifted her hands Carl lowered the scalpel towards the space between Shona’s 2nd and 3rd ribs. He made a few decisive cuts, cutting through the layers of tissue. “Tube.” He held out the scalpel, which Anna carefully took, while Roger slapped the chest tube into his other hand. Carl pushed the tube through the hole he had made, sliding it into Shona’s chest, between her ribs and the front of her lung. It had taken 10 seconds since compressions stopped to get the tube in.
12 seconds later another tube stuck out, this one lower down between Shona’s 5th and 6th ribs, basically on the opposite side of her lung. “Ok, Go.” Carl said, prompting Kirstie to resume her barrage. The ends of the two chest tubes swayed and bounced for a few moments but were soon taken in hand by Anna and Carl and connected into what was effectively a loop. From the infuser warmed saline was pumped through the upper tube into Shona’s chest cavity, washing over and around her lungs, providing warming throughout her chest, before draining out of the second tube into the sealed container. This container then fed back into the infuser, which would be able to keep the saline warm enough to be effective.
Carl monitored the loop until it was running through fully, ensuring the compressions were causing no problems. He nodded, satisfied. “Right, let’s get ready to do the other side, Trish, take over compressions as soon as Anna has arranged the vest.” Anna was already folding the vest back over, lining up the tubes to meet gaps and checking that nothing was kinked. As soon as she was done, she slipped around the bed and took position to repeat the entire process on Shona’s left-hand side.
* * *
Lucy had guided Jones through the triage area, gratefully handing the wheel chair off to a nurse who came to assist. Zainab also approached, having just finished an exam on one of the collared patients.
“Hey Lucy, who do you have for me?”
“Zee, this is Matt Jones. Spent 5 minutes in near freezing water. No signs of inhalation or injury, just moderate hypothermia. He’s been responsive throughout, but I’d recommend a full exam and observation.” Lucy said professionally, despite her weariness. They were guided into an empty cubicle and Jones was assisted onto the bed. Lucy leaned against a pillar relaxing a little as Zainab took a chart and started to note things down. “You might want to give psych a call.” Lucy’s voice carried a joking tone. “I’m pretty sure charging further into a sinking ship falls under crazy.”
Jones smirked a little, leaning back on the bed. “I’d say the crazy one is the one who followed me after being told to get off the boat.” He still sounded tired but was definitely recovering.
Lucy shrugged. “Someone had to save your ass. You’d be at the bottom of the river if I hadn’t.”
“True…True…” Jones smiled faded, his tone becoming a little more subdued. “I just hope it was worth it.”
Lucy nodded, looking at the floor. “They’ll do their best. Just like you did. You gave her a chance if nothing else.”
Jones bit his lip, nodding, but his gaze had drifted away from her, staring at nothing. Lucy knew what he was seeing. A mental image of Shona, pale and lifeless. She felt the same way.
Zainab broke them both out of their solemn contemplation. “We should really get you out of those wet clothes Mr Jones, they won’t be helping you to warm up.”
Jones nodded, groaning as he leaned forward and started to fumble with his uniform. A nurse moved in to assist him. Lucy glanced at him. “I’ll be back.” She told him, before nodding to Zainab and the nurse. Lucy left the cubicle, initially planning to get a coffee, but with her mind she drifting she was a little surprised to find herself standing outside Trauma 4. Her eyes were drawn to the table. Tracy was performing chest compressions on the young woman on the table. The vest covered most of her chest, but Lucy could see the tubes running out through slits to the containers.
She could see the doctor tidying away the surgical kit and giving more orders. She could see Dave, still rhythmically squeezing the ambu-bag connected to the breathing tube, stood at the head of the bed. And she could see the monitor, that constant, unbroken line that proclaimed Shona’s heart was still completely inactive.
As soon as the camera angle changed, presumably someone in the news control room had realised they were showing a possibly dead woman under intensive CPR and had cut away, Anna and Carl started to get prepared. Carl called out for his team to join him in Trauma 4, the other rooms already claimed by those doctors who were scheduled for today. There was fewer of them than normal, a few of the nurses already occupied with minor injuries or the other trauma rooms. Zainab was also occupied by the cubicles, sheer practicality making her more useful with the minor injuries that don’t need a fully qualified emergency doctor to double-check.
Anna and Carl were joined by Kirstie, Roger, and Trish. It would be enough for now; they could also call for additional help if they needed it when their patient arrived. Carl looked at them, figuring out a plan.
“We all saw what we’re dealing with. Cold water drowning, clearly no pulse. Don’t expect it to be any different when they arrive here. Our priorities are maintaining artificial circulation and oxygenation while we warm her up. We need to go fast, but careful. The last thing we need is to trigger rewarming collapse. Kirstie, I want you get in touch with Cardio-thoracics and with Nephrology, I want an ECMO or a dialysis machine, both can heat her blood directly, so either will do. We’ll also need warmed saline, a lot of it Roger, I want to get a warmed gastric lavage going as soon as we can and depending on her temperature, we may need to consider a thoracic lavage too.”
Anna cringed slightly at that. A thoracic lavage would involve sticking tube through their patient’s chest wall. It was brutal, but effective. Carl was continuing.
“Anna, Trish, get the temperature vest set up too, warm her from inside and out. Remember everyone, we have time. We do not give up until she is warm, understood?” The team all nods. “Ok, let’s get ready people.” Carl finished, the others all going about their tasks. Trish went to get the temperature vest from Trauma 1, giving Anna a few moments alone with Carl.
“You sound confident.” Anna told him as they stepped out of the way of the others.
He shrugged. “We have every reason to be. We have the equipment, the skills, and the circumstances favour us. Cold water drowning discovered almost instantly? It’s not a guarantee, but in our line of work? It’s the best damn odds we could ask for.” He looked at her seeing her far off gaze. “Are you doing ok?” He asked.
She nodded slowly, then looked back at him, with a sharper nod. “Yeah. Just doing what you said.” Her voice went quieter, just between the two of them. “Accepting it. Using it.”
Carl nodded slowly. “Ok. Let me know if it gets too much. You can take a step back if you need to.” He told her, keeping his own voice quiet.
Anna slipped her hand into his and they gave a mutual squeeze. Then, Trish came into the room with the bulky vest and Anna went to help her. They laid it on the trauma bed, spread open, ready and waiting for them. To Anna it looked inviting, and she couldn’t help but wonder what it would be like to be wrapped up in it. At this point she would normally feel ashamed and try to bury the thought. This time, she didn’t try to eradicate it. Instead, she filed it away. Something to think about later, maybe…even do later. She thought back to her unit on psychology during nursing school. Using rewards to encourage behaviour. If they succeeded, she would ask Carl if he could ‘tinker’ with one over the rest of the weekend, they were his experiment after all, maybe they could be her reward.
She shook her head, dispelling the fantasy and disguising the small smile on her face, as if she were trying to shake a stray lock of hair out of her eyes while she was setting the control panel on the pump unit, which they had hooked to the end of the bed. The had just finished arranging the hoses so they wouldn’t be an obstruction when a receptionist stuck her head into the trauma room.
“We just got a 2-minute warning on the casualty.” She announced.
“Thanks” Carl dismissed her, looking to the rest of his team. Kirstie was still on the phone in the corner, and she shrugged at Carl’s questioning look. “Keep trying, everyone else, let’s get out front.”
* * *
Lucy kept on rocking her body weight forward and backward, keeping her shoulders and elbows locked, hands planted between Shona’s pale breasts. Each time she leant forward, her hands pressed down the drowned young woman’s sternum 2 inches, squeezing Shona’s stopped heart, pushing blood out of it and around her body. When Lucy rocked backwards, Shona’s ribs sprang back also, releasing the pressure on her heart and allowing it to refill with blood.
Lucy did this over and over and over again, keeping the blood flowing. Keeping hope alive.
She’d heard the driver call out the minute warning. She was aware of Dave hooking things to the gurney and moving around her. She was also aware of the burning in her arms, the lead weight feeling of lactic acid build up. It was a long, excruciating minute. But Lucy never faltered. Shona’s ribs bent inwards 100 times in that minute. Each perfect compression forced her abdomen to roll and her shoulders to pop. Her feet swayed and her head bobbed as the force of the compressions translated through her body. It was brutal, what her body was enduring. But that brutality was the only chance she had.
Lucy felt the entire ambulance tilt as it swung into the hospital grounds, felt the inertia tugging her as the brakes squealed and brought the ambulance to a stop. She ignored it all, maintaining her compressions until she saw the blur out the corner of her eye as Anna mounted the gurney, straddling Shona’s unresponsive body. Just like they had done two days ago, and so many times before, Anna gave a short countdown before Lucy drew back her hands, Anna planted her own, and Shona’s chest continued to be compressed.
The gurney was pulled from the back of the ambulance, Dave squeezing the Ambu-bag regularly, and was rushed towards the emergency entrance. Lucy let them go. She dropped onto the bench, flexing her aching fingers and breathing deeply to pay off the oxygen debt. She shook her arms out, then looked at the man beside her. Jones was still wrapped tightly in the blanket and was staring out after the gurney that had already disappeared around a corner and vanished from sight.
“Come on Jones, you need to get to checked over.” She told him, dragging herself to her feet. She helped him from the back of the ambulance, despite the exhaustion she was feeling, and led him toward the entrance. An observer would have struggled to tell which was helping the other, and Lucy was grateful to the porter who ran over with a wheelchair, easing Jones into it before she pushed him into the busy triage area, leaning heavily on the handles herself.
* * *
The wind had eased to a stiff breeze, though it still cut straight through you, in the hour since Shona had fatefully boarded the now sunk Beetle. Yet, none of the team that had assembled outside the sliding door was shivering. Their collective adrenaline rush banished the cold. There was a tension, but it was that invigorating kind of tension, rather than a panic fuelled one. They knew they were up to the task. Their determination was written all over their faces. So, they stood, filled with an anticipation that grew in intensity as the sirens of the ambulance grew louder. Like the legendary warrior, calmly waiting to enter an arena, their own kind of battle was about to begin, and they radiated the same serenity. The same clarity of purpose. The same capacity to spring into action at a moment’s notice.
The siren reached a crescendo, with an accompaniment of squealing tires, as the ambulance pulled into the emergency bay. Anna waited a beat, then stepped forward, giving Roger and Trish just enough time to pull open the rear doors of the ambulance, before she planted her foot on the step, lined herself up, and vaulted onto the gurney. Her knees made the metallic blanket crinkle as she landed softly and shuffled her knees forward. She gave the countdown, and as soon as Lucy’s hands left the patients sternum, Anna snapped hers into position.
Even through her blue gloves, Anna could feel just how cold the young woman was. Her ghostly pale skin seemed to pull the warmth out of Anna’s hands in an instant. It did not deter the nurse. She began her initial round of compressions. The first press was firm and harsh, to gauge the resistance of her patient’s chest, then those that followed were perfectly judged, pushing in the ideal two inches and drawing back fully in under a second. The gurney moving beneath her had no effect on Anna. She was in her zone. This, this was what she was born to do, and nothing, internal or external, could disturb her rhythm as she put all her effort into delivering the best chest compressions she could to the young woman who lay pulseless between her legs.
As she settled into her task, she became more aware of what was going on around her. She heard the whistling of the flatlined monitor, and she heard Carl say something loudly. He was clearly asking for details, as Anna began to hear the response from the paramedic who was pushing the gurney with one hand, while he squeezed the Ambu-bag that was connected to a breathing tube with the other.
“This is Shona. Trapped and immersed in near freezing water. Immersion resulted in asphyxiation via drowning. Due to the water temperature she’s profoundly hypothermic, skin temperature of just 23C. She’s been in respiratory and cardiac arrest for between 18 and 25 minutes, confirmed asystole for 5 of those, but likely much longer. Resuscitation attempts started 14 minutes ago, with no response. She also has a closed fracture to her left tibia. We cleared her lungs and intubated 8 minutes ago, applied chemical heat packs and warmed saline as much as we could. Throughout she’s had a palpable pulse with compressions, so major internal bleeding is unlikely.”
Carl nodded through the report, and Anna knew he was taking in everything, filing it away in his mind, able to recall every detail at a moment’s notice, to the point that the chart Roger was making notes on would be for later doctors, not for the ER team. At the edges of her vision Anna saw black tarmac turn into the marble effect veneered flooring that ran through the ER and almost every other hospital, school and government building in the western world. During those moments Carl was processing what he had been told, and then he began to give orders.
“Right, let’s carry on as planned. Get her into Trauma 4 and get her in the TMV. I want a central line in addition to those bilateral IVs, and I want wide bore access in one of her legs, ready for extracorporeal warming. Let’s get an NG tube inserted too, bi-directional for the gastric lavage. Let’s get a core temp before we consider surgical intervention though.” Carl briefly held his fingers against Shona’s femoral pulse point, his wrist resting against Anna’s calf. “Good pulse with compressions Anna, keep it up, but let’s also get a Lucas ready, this could be a long one people!” He said, a tone to his voice that instilled confidence and re-doubled their determination.
They were going to get their patient back. Shona, Anna reminded herself, looking at the girl beneath her, forcing her name into the front of her mind. She had a cute face, even with pale skin and blue lips, that much was clear. The tape holding the ET tube also pulled at the corner of her mouth, forming a grimace, as though she could feel each brutal compression that Anna delivered. Not that Anna was deterred. She was going to do everything she could to get Shona back. To see those lips pink instead of blue. Smiling instead of a forced grimace. She wasn’t alone in those thoughts. The whole team was feeling the same way as they guided the gurney into the Trauma Wing and crashed through the doors into Trauma 4.
A few people have asked for the earlier stories, so to spare folks having to scour back through my blog to find the story they are after, here is a full index, which I will pin and try to keep updated.
