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“Twenty-eight. Twenty-nine. Thirty.”
He broke compression, tilted her head back, pinched her nose, and sealed his mouth over hers. Two breaths, full inflation, and her chest rose under his hands, fell, and rose again. He checked the monitor. The flat tone continued. The line was flat, with no electrical activity and no mechanical capture.
He went back to compressions.
“One. Two. Three. Four.”
Between the first and second round, he reached for the crash cart with his left arm without stopping compressions. His right hand stayed on her sternum. His left crossed his body and found the drawer, pulled it open, and closed around the adrenaline, one milligram per milliliter. He drew it up by feel, capped it, and set it on the floor beside her thigh. His right hand never stopped. Twenty-six. Twenty-seven. Twenty-eight.
“Twenty-nine. Thirty.”
He broke compression and checked the IV line. The site was in her left antecubital, placed twenty minutes earlier, and the catheter was still secure. He uncapped the adrenaline and pushed one milligram straight into the IV port, then recapped the syringe, set it aside, and went back to compressions.
“One. Two. Three. Four.”
The monitor spiked. The flat line jumped on a single wide, aberrant complex, then nothing. The flat tone resumed. Marcus kept counting. Fifteen. Sixteen. Seventeen. His shirt was damp. The clinic was cold, but sweat had broken across his back and under his arms. The overhead lights hummed. The flat tone filled the room. Delphine’s body moved under his hands with each compression. Her head turned slightly with each push. Her arm lay at an angle that would have hurt if she could feel it.
“Twenty-eight. Twenty-nine. Thirty.”
He broke compression and gave two more breaths. Her chest rose and fell. The monitor showed nothing. The flat tone held. Marcus reached for the second drug, amiodarone, three hundred milligrams, drew it up, and pushed it into the IV. The crash cart protocol was written on a card taped to the inside of the drawer, and he didn’t look at it. The dosages lived in his hands and had lived there for decades.
He went back to compressions.
“One. Two. Three. Four.”
His jaw was locked. The muscle at the hinge jumped visibly. His teeth were clenched. The count came through anyway, steady and unbroken. Fifteen. Sixteen. Seventeen. The flat tone continued. The line on the monitor stayed flat. Delphine’s lips were fully gray now. The color had left her face entirely. Her skin had gone waxy, with the stillness that came before fixed pupils, the kind doctors learned to recognize on sight.
“Twenty-eight. Twenty-nine. Thirty.”
He broke compression, gave two breaths, and checked the monitor. Nothing. The flat tone held. Marcus reached for the third drug, sodium bicarbonate, fifty milliliters, drew it, and pushed it. The IV line took the volume and the fluid ran clear. He recapped the syringe and set it down. His hands were steady, his breathing controlled, his compressions holding at a hundred and ten per minute. He had been doing this for three minutes, maybe four. Time compressed during arrests. It always did.
He went back to compressions.
“One. Two. Three. Four.”
On the seventeenth compression of the third round, the monitor caught.
The flat line jumped on a single wide, aberrant complex. Another followed a second and a half later, then a third. The rhythm established itself, irregular and bradycardic, forty beats per minute but present. The flat tone stopped. The monitor registered each complex with a soft beep. Forty. Forty-one. Forty-two.
Marcus sat back on his heels. Both hands hovered over Delphine’s chest. He didn’t touch her. He watched the monitor. The line resolved. The complexes widened. The rate climbed. Forty-five. Fifty. Fifty-five. The rhythm was sinus bradycardia with occasional PVCs. Not good, but not flat.
Delphine’s chest rose on its own, one shallow breath and then a deeper one. Her lips remained gray. Her skin was cold. Marcus put two fingers back to her carotid. He held them there. The pulse was weak and thready, forty beats against his fingertips. He counted. Forty-one. Forty-two. Forty-three.
He didn’t move. He stayed on his knees beside her body with his fingers on her neck and his breath coming in controlled pulls that didn’t match the hammering in his chest. The clinic held the quiet of machines that had stopped alarming. The overhead lights hummed. The oxygen mask hissed. Delphine’s chest rose and fell. Rose and fell. The monitor beeped at fifty-five. Then sixty. Then sixty-two.
Marcus reached for the blood pressure cuff. He wrapped it around her arm and pumped. The gauge climbed: one-twenty, one-forty, one-sixty. He released the valve and the needle dropped to seventy over forty, too low but not zero. He adjusted the IV drip, increasing the rate to one-fifty milliliters per hour of normal saline. She needed volume.
He checked her pupils with the penlight. They were equal and reactive, slow but present. The gray hadn’t left her lips. It would take time. If she had time.
The monitor held at sixty-two. The rhythm was irregular but sustaining. Marcus sat back on his heels and put his hand on Delphine’s forehead. Her skin was cold and damp. He left his hand there. He didn’t speak. The flat tone was gone. The room was quiet except for the monitor beeps and the hiss of oxygen and the sound of his own breathing, audible now that the counting had stopped.
Sixty-three. Sixty-four. Sixty-five.
He stayed where he was.
The flatline returned twenty minutes later.
Delphine was unconscious on the gurney Marcus had dragged alongside her. He had waited to move her, because moving arrest patients risked losing whatever fragile rhythm had established itself. When it held, he lifted her by the shoulders and hips and transferred her to the gurney in one smooth motion. Her weight was nothing. Eighty pounds, maybe less. Her arm had hung loose. Her head had rolled toward his chest. He laid her on the thin mattress and straightened her limbs and connected the monitor leads to the gurney’s built-in system. The readings held. Heart rate: sixty-eight. Blood pressure: seventy-two over forty-six. Oxygen: ninety-one and climbing.
