Sophie's Path

Sophie flipped the pages of Aleah’s chart as Bart continued.

“Dr. Hill said Aleah’s suffered a blunt chest trauma which is quite obvious from the bruising. He ordered the requisite round of tests.”

“Did he mention cardiac contusion?”

Bart and Donna shook their heads.

“No, but it’s my guess...” Donna winced. “Sorry. It’s not my place to—”

“Don’t apologize.” She held up her hand, though she didn’t take her eyes off the chart. “If she’s ruptured the cardiac chamber or if there’s a disruption of the heart valve that could be the cause of her dysrhythmia.”

Sophie assessed more of Aleah’s condition. Her skin was growing more pale and gray by the second. The bruises on her chest were turning a deep purple. Sophie pressed lightly on Aleah’s ribs. “She’s broken nearly every rib on the right side.”

“Dr. Hill thinks her lung may be punctured,” Bart said. “He ordered thoracentesis.” He began inserting the catheter into Aleah’s chest while Sophie went around to the other side of the bed.

Sophie stuck the earpieces of her stethoscope into her ears and listened to Aleah’s chest. It rattled like a freight train and Aleah’s breathing was labored. She was bleeding internally, but until all the tests were run, they wouldn’t know the extent of the damage.

In the meantime, they had to get her stabilized. Aleah’s chest cavity was filling with blood and fluid, which would be putting pressure on her heart and lungs. Sophie didn’t want to guess how much time they had to prevent respiratory arrest or another—this time deadly—heart attack.

First, she needed do a thorough examination. In a trauma case like this, every nanosecond counted.

Sophie glanced at Bart as he continued to work. “She’s lost a lot of blood. Transfusion?”

“It just came down from upstairs.” He nodded to the stainless steel counter where the IV bag of blood sat. Donna was rushing with her EKG cart out of the bay. “Sophie, can you hook up the plasma for me?”

Immediately, Sophie attached the plasma bag to the IV and regulated the monitor. Then she felt for Aleah’s pulse. It was almost imperceptible it was so weak.

Bart finished with the catheter and Sophie turned to him. “Her chart says that she was born in this hospital. She had coronary artery abnormalities at birth.” She paused as Bart nodded gravely. “I’ll need Dr. Barzonni to confirm, but because of the trauma to the chest wall, blood flow to her heart could be severely diminished.”

As she spoke, she saw Nate Barzonni race into the ER. Dr. Hill quickly gave him the specifics about the addict’s condition. They both hung over the patient, assessing.

Sophie had worked with Nate for over a year now, and she knew his professional moves better than anyone. Though Nate always showed an implacable expression to his staff and the patient, when he raised his left eyebrow even a fraction, it meant he was concerned. If he dipped his chin to his chest, his brain was analyzing input like a computer. The longer his head remained bowed, the more difficult the case. The minute his head snapped up, Nate had made his diagnosis and decisions on how to proceed.

While Nate’s head was still lowered, the attending nurse said, “Blood pressure is ninety over fifty. Pulse is dropping, as well. Fifty. Forty-eight. Doctor, I have no pulse!”

The addict’s heart monitor flatlined. The alarms beeped. Sophie’s head shot up. Most people thought those sounds signaled pandemonium, but to her it meant action. All hands on deck. It was the moment when everyone’s skills, talents and expertise were paramount. They were like fine-tuned mechanics in a precision Swiss watch. Each cog, each spring was essential to the whole. Except they were not marking time as a clock would. They were racing against time. Trying to beat it to save a life.

“Defibrillator!” Nate shouted. He locked eyes with Sophie and nodded abruptly, with almost a jerk.

Sophie turned to Bart. “I’m going with Dr. Barzonni. You got this?”

“Go!” Bart said and continued his efforts to stabilize her.

As Sophie rushed between the beds, her gaze shot across the room. Jack Carter was sitting ramrod straight in the bed, staring at the action around him. His eyes bore into hers. For a fleeting second she thought she could read his mind.

What about Aleah?

Icy chills shot down her spine. She nearly turned and went back, but Nate needed her. The patient did, too. Once in the bay, she sprang into action. She pulled the paddles out of the defibrillator dock and spread them with lubricating gel. She handed the paddles to Nate. Holding her breath, she stood back as he placed one paddle on the left side of the man’s heart. The other he placed to the right over the sternum.

“Clear!” Nate said loudly as the attending nurse and Dr. Hill backed away.

Sophie hit the defibrillator’s button and watched the needle on the monitor jump as the electrical shock was discharged into the dying man.

The patient’s barrel chest heaved. His back arched as it rose off the gurney with the shock and then flopped back down. He remained still. Nate listened to his heart with the stethoscope. He checked the monitor.

Still flatlined.

Dr. Hill’s eyes were filled with defeat. He spun on his heel and rushed over to Aleah.

Sophie knew Dr. Hill was desperate to save all his patients. This loss was going to hit him hard.

“Again!” Nate said and presented the paddles to Sophie for more lubrication gel. He positioned the paddles.

“Clear!”

Sophie’s eyes were wide as she depressed the defibrillator’s button again. The monitor jumped.

This time the man’s body arched only slightly.

“Epinephrine!” Nate barked, holding out his hand for the vial that Sophie knew was the last hope.

Sophie reached over to the stainless steel tray where one of the nurses had already prepared the syringe. She grabbed it and properly placed it in Nate’s hand the way she did with all his surgical instruments. They worked well together. She knew it. And she knew he knew it, too.

Nate jammed the long needle straight into the patient’s heart and depressed the plunger. Sophie watched as the lifesaving serum left the syringe and hopefully did its job.

She checked the monitor.

Flatlined.

She hit the blood pressure machine hoping it would show even the tiniest indication of life.

Nothing.

Nate put his stethoscope to the man’s chest. Sophie knew what he was hoping to find—a blip. An echo. A whisper of life.

Nate straightened. He shook his head.

“I need you in the next bay, Doctor. She’s cardiac contusion I believe, with a history of dysfunctional coronary arteries from birth,” Sophie said to Nate.

“How old?”

“Twenty-one. Punctured lung. We’re doing thoracentesis now. She’s A-fib,” Sophie explained in soft but professional tones as they walked over to where Aleah clung to life.

Sophie struggled not to glance over at Jack, but noticed he was now sitting on the side of his gurney, legs over the side, hands clenched on the edge of the bed. He looked like a man ready to bolt.

His eyes were dark with anger, pain and confusion. She saw his mouth move. She realized that the word he kept saying was “Please.”

Bart handed the catheter over to Dr. Hill. They had now siphoned over a quart of fluid from Aleah’s chest cavity.