On the Gulf Side

ON THE GULF SIDE

By T. C. Clark

© 2011 T. C. Clark

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Smashwords Edition

For my mother

CHAPTER ONE

Four o’clock. Time for a late lunch or an early dinner. The cafeteria was nearly empty, the frenzied fever of lunch-time conversations long gone. The smell of Friday’s fish special lingered though, along with that rigid scent all cafeterias seemed to tout; warm milk and fryer grease, embedded in the Formica table tops and stained carpet.

Katherine carried her tray past the lumbering ice machine and sat at a table by the tall north windows. For a long moment she looked out over the empty chairs and barren table tops, savoring the aloneness yet achingly aware of the loneliness.

Had things gone as planned, she would have met Marshall at noon and they would have shared a Cobb salad and insignificant conversation, because of late he didn’t seem to have a whole lot to say. Instead she was sitting alone, eating a tuna sandwich, ignoring the throbbing ache in her feet and the vague but haunting visions of the past few hours.

She hadn’t eaten since breakfast -- half of an over toasted English muffin smeared with orange marmalade -- and the shift started out hectic and hadn’t let up until mid-afternoon. By then, two people had died. One was sixty, the other six. Grandfather and grandson. She watched as wet snow slid down the window panes, leaving shimmering beads of water that would eventually undergo a metamorphosis and become shimmering dots of ice. Concentrating on the asymmetric patterns, she willed the visions of the elder man and the child from her thoughts but no matter how hard she tried, they wouldn’t go away. Even with her eyes closed so tight that her eyebrows hurt, she still saw them with perfect clarity; the old man’s broad nose and shocking white hair, each stained with blood, and the blonde haired boy with soft blue eyes and thin coral pink lips, glazed with lifelessness.

Watching someone die was the most difficult part of her job. Of course, she witnessed a few miracles, but death had a way of erasing those celebratory moments from memory, had a way of lingering through the day and into the night. Death could turn dreams into nightmares.

Eyes still closed, she silently recited Midnight on the River, a soothing ode that nearly always distracted her thoughts and relieved tension. She had learned the poem in second grade and had recited it hundreds of times since. It had become her semblance of prayer.

Just as she finished the first half of the tuna sandwich and the fourth line of the poem, another page came over the hospital-wide intercom.

Trauma alert, emergency department. Trauma alert, emergency department.

Katherine immediately directed her attention to the page. Hesitating only a moment, she dropped her sandwich to the plate and pushed herself away from the table. Even after seven years as an emergency room nurse, she still felt a chill on the back of her neck whenever an alert was called. Trauma alert meant someone had met up with one of life’s tragic events. It meant someone was close to dying, and that was something Katherine could never accept as ordinary. Destiny, maybe. Not ordinary.

Her hand automatically went up to feel for the stethoscope around her neck as she sprinted from the cafeteria toward the emergency room, and it was there, like an extra appendage. Her pocket was full of pens, a roll of tape and half dozen packets of alcohol. As she pushed through the emergency room doors, a pen jabbed at her hip and she put her hand in her pocket and rearranged the contents, ignoring the few alcohol swabs that fell out onto the floor.

She was nearly out of breath when she arrived in the trauma unit. In the instant she passed through the door she silently asked why she hadn’t chosen another profession -- something less physical and certainly less stressful. It was the question she often asked when responding to a trauma alert.

The stark silence and bright light were a momentary surprise, although she had been in the room countless times before. The bluntness always stabbed at her senses, taking her breath away for one short moment. The unit was a large room with four bays, each equipped with all the emergency equipment and monitors needed to attend to the broken, bleeding bodies wheeled through the doors. Less than an hour earlier, the room had been amassed with confusion as the trauma team struggled to save the old man and his young grandson, but no evidence of the strife remained.

A young nurse stood near the supply cart at the first bay, and the panic in her eyes broadcast her inexperience. It was Vickie Bledsoe’s first day working in the trauma unit, and Katherine was her mentor.

At the moment Vickie looked like one of the mannequins at Wartman’s department store; posed and still and pale. Unlike a perfectly proportioned mannequin though, Vickie was short, thin hipped and her posture suffered to such a degree it seemed she was going to fall over. Despite the urgency of the moment, the only thought that came to Katherine just then was how Vickie could benefit from breast reduction surgery.

Goodness, where is everybody? Katherine asked sheepishly, embarrassed by her secret contemplations.

Vickie’s shoulders suddenly fell, as if she had been holding her breath, and her posture became even worse. I don’t know, she said, but they’re bringing in an MVA!

Katherine winced. Another motor vehicle accident. A vision of the blonde boy’s face surfaced again and she squeezed her eyes shut to force it away.

They’ll be here in about four minutes, Vickie said. I’m ready to panic, I swear!

Katherine offered a consoling smile as she opened the supply cart then walked to the control panel at the head of the bed and turned on the oxygen and suction valves. Vickie was right behind her, like a puppy on a leash.

Oh, I’m so nervous I could pee my pants! Vickie whined.

Katherine managed a laugh. Relax. Take a deep breath. Just remember everything you practiced in training and you’ll do just fine.

Vickie complied. Her chest rose and fell in an exaggerated effort as she took a deep breath.

Katherine looked around the room, ignoring her own sense of heart-pounding urgency. She was just as anxious as the younger nurse, but experience had taught her to hide the apprehension. Where is everyone? she asked again.

The other members of the trauma team arrived just after the words passed her lips. As doctors, nurses and technicians pulled on gloves, gowns, and masks, Katherine couldn’t help thinking that the semblance was that of a well choreographed ballet. All that was missing was the orchestra.

Everyone was in their place before the ambulance crew shoved the gurney into the room and began to recite a report. The man was 78, had rammed his car over an embankment along I-80 and had no outward signs of injury -- no bleeding, bruising, or bone breaks. The ambulance driver reported that the man had a stable heartbeat and blood pressure when they arrived on the scene and was breathing on his own, but that his condition had started to decline just as they pulled up to the emergency room entrance.

Katherine and other team members immediately lifted the patient from the gurney to the bed and began assessing his condition.

What should I do? Vickie whispered, her hands visibly shaking.

The young nurse stood so close that Katherine could feel the heat of her skin and the tremble of her body. Get him hooked up to the monitor, Katherine said.

Dr. Alfred Winston, a second year Resident just starting his emergency medicine rotation, moved up to the bed and placed his stethoscope on the patient’s chest. New nurse? he asked, his head bobbing in Vickie’s direction.

Katherine nodded.

I didn’t know we hired inexperienced nurses for the trauma unit, he said, his voice pinched with disgust.

She’s not inexperienced, Katherine answered in a practiced voice. She worked intensive care for two years before transferring down here.

Dr. Winston rolled his eyes.

Katherine watched as he moved his stethoscope over the patient’s chest, his brows furrowed in confusion. She immediately placed her hand on the patient’s neck to feel for a pulse. There was none.

No pulse! she instantly called out.

Her body began to react immediately, although her thoughts were hovering between exhilaration and trepidation. She put one knee up on the edge of the mattress and leaned over the unconscious man, positioning her hands on his chest just at the base of the sternum. As she began the compressions, his sternum cracked beneath her hand and she inwardly shivered. It reminded her of the first time she performed CPR as a student nurse and had felt the patient’s bones break beneath her hand. Afterwards she had stood in the hallway and cried. It just happens, a senior nurse had said while trying to comfort her.

It just happens.

Another trauma team member placed a mask over the patient’s face and began forcing oxygen into his lungs. His name was Larry, a technician from the respiratory department. Are we going to save this one, Katherine? he asked without looking up. The question was almost a pleading.

Katherine glanced knowingly at Larry. It was the team’s third trauma of the day. The first two patients died despite the team’s efforts and Katherine and Larry shared a sense this patient would die too. If they had discussed their thoughts at that moment, they would have confessed they also shared a feeling of stark, bone gripping helplessness.

The emotion she felt on the inside wasn’t in her voice, though. Instead, she spoke without hesitation. Let’s get him on the monitor, Vickie!

She continued the compressions as Vickie placed five small circular patches on the patient’s chest. The cardiac monitor was then switched on, just as Dr. Marshall Conrad pushed his way through the door.

What have we got? he asked, his voice so loud and firm that it echoed off the walls.

The Resident stood erect, squared his shoulders and swallowed hard. An MVA, sir.

MVA? Is that all I need to know, Dr. Winston? An MVA? Will someone here please give me the history on this patient?

Katherine looked up and nodded at Vickie.

The young nurse took a deep breath and quickly gave an accurate, detailed description of the patient’s history and his current condition, including the fact that the man was in cardiac arrest.

Thank you, Dr. Conrad said with exaggerated enthusiasm. His eyes fell hard on the Resident. Good thing the nurses know what’s going on, eh Doctor Winston?

The Resident reluctantly nodded and Katherine couldn’t help feel a little sorry for him. Like Vickie, he was new to the trauma setting. Given time, they both would learn to push the jitters aside and their reactions would become automatic. Meanwhile, the little mistakes and moments of humiliation would, hopefully, serve to deflate the young doctor’s bighead syndrome.

Dr. Conrad moved to the foot of the bed and Katherine could visualize his cool, instant assessment of the patient’s condition. She didn’t have to look back over her shoulder to know his ice blue eyes were taking rapid inventory of every person and every piece of equipment in the room.

Stop CPR, he said, as he looked at the monitor to assess the patient’s heart rhythm. Ah, v-fib, he mused. That ol’ heart is just quivering... He immediately pulled the paddles off the monitor. Let’s shock! he said. Let’s do it!

He switched on the defibrillator and positioned the paddles on the patient’s chest.

Three hundred joules. Everyone stand clear! Clear!

Katherine and Larry moved away from the gurney.

As the electrical shock was delivered, the patient’s body jerked slightly. For one very brief moment, the trauma team was silent, anticipating the miracle of medical resuscitation.

Now what have we got? Dr. Conrad asked as he again turned toward the cardiac monitor.

Katherine looked at the monitor, too. Asystole. Flat lined.

No heartbeat! Dr. Conrad called out. Resume chest compressions! Give him two amps of epinephrine!

While another nurse administered the epinephrine, Katherine leaned over the patient and resumed chest compressions. As she pushed down on his chest, brown-red blood began to spill from his mouth. With each compression the blood gushed past his lips and spilled onto the pillow.

We got a bleeder, someone said with a hint of disgust in their voice.

Dr. Juan Jamar pushed through the doors and immediately took position at the head of the bed. He, too, made a quick assessment of the patient’s condition, concentrating on the respiratory status. Katherine felt relieved to see him. Jamar was the best pulmonologist on staff and the patient, hovering at the edge of death, definitely needed a lung doctor’s expertise.

Well, nice of you to show up, Dr. Conrad teased.

Was in the can, Jamar answered as he pulled on latex gloves with a loud snap.

Dr. Conrad chuckled.

The respiratory technician inserted a suction tube between the patient’s lips to clear blood from the airway.

What have you got, Larry? Dr. Jamar asked.

A real mess, Larry said as he manipulated the suction tube.

Jamar leaned in close. Yep, by golly, he’s a bleeder. His voice was playful but his sense of urgency was prevalent. Let’s get him intubated.

He tipped the patient’s head back and looked down the throat with a lighted scope.

Ah, yes. Definitely a bleeder. Give me some more suction...move it to the side. More suction...more. Okay, hand me a number eight tube.

Katherine stopped chest compressions momentarily as Dr. Jamar slid the endotracheal tube down the patient’s throat.

Okay, breathing tube is in...resume CPR, he said calmly.

Katherine started compressions again as Larry pushed oxygen with a bag into the endotrachial tube. Each chest compression brought forth a little more sticky blood. The odor began to thicken and Katherine turned her head away.

The smell defied exact description -- rank, sour, fecal -- but it was as distinct as the scent of a lemon. Medical personnel could recognize the odor of gastric blood immediately and they also knew it as an omen. It was unwritten medical knowledge...when a patient begins to bleed from the digestive tract during CPR, it’s as good as over. Goodbye, patient. Hello, morgue. Perhaps the unwritten rule made the odor so unbearable. In Katherine’s mind, the odor symbolized impending death.

She glanced at the clock. They had been working on the patient for nearly twenty minutes and there was still no indication they were going to succeed in bringing the man back from death’s brink. She tried to concentrate on the rhythm of the chest compressions but her shoulders ached terribly and her hands had gone numb. She signaled for relief and Vickie stepped forward.

Dr. Conrad put out his arm, stopping Vickie’s steps. He looked to the Resident. I think Doctor Winston could use a little CPR practice, he said.

Without hesitation, the Resident moved in and took over the compressions.

As Katherine stepped back from the bed, Dr. Conrad leaned into her. He didn’t apologize, but he did offer a slight smile and a raised brow, then he reached toward the patient to feel for a femoral pulse. Let’s check our rhythm...stop CPR, he said.

All the activity in the room, except the delivery of oxygen, came to a momentary standstill as Dr. Conrad turned toward the cardiac monitor and assessed the patient’s heart rhythm. Ah... he said, bringing a finger to his lip as he looked at the machine. I don’t see anything viable. Continue CPR and let’s give another amp of Epi.

They would continue their efforts to revive the man, but Katherine thought it was obvious his soul had gone on to wherever it is souls go. His eyes were beyond blank, beyond emptiness. No textbook would define death as lifeless eyes, but Katherine knew. Dr. Conrad knew. They all knew. Lifeless eyes meant a soulless body.

From the corner of her eye, Katherine watched Dr. Conrad walk to the back of the room and lean his shoulder into Dr. Jamar’s back.

Hey, Jamar. Did you see Smythe’s new Beemer out in the parking lot? he asked.

Dr. Jamar nodded, his lips pressed together in mock disgust. The two physicians talked in loud whispers, and Katherine felt annoyed by their attempt to separate themselves from the moment’s anxiety. The patient was in cardiac arrest, bleeding from his mouth, nose and rectum, and the physicians were talking about cars.

Midnight blue, Dr. Conrad whispered.

I know, said Dr. Jamar, and midnight blue leather interior. Now, I ask, how many appendectomies did the good Doctor Smythe have to do to afford a fine automobile like that?

One, Dr. Conrad said.

Both men laughed, then in the next instant Dr. Conrad ordered the administration of more medications and assessed the cardiac monitor for a heart rhythm.

They tried epinephrine again, but the miracle medicine had no effect. They gave more electrical shocks. They administered bicarb and a host of other medications in hopes of stimulating the patient’s heart. They suctioned and they suctioned. They hung two units of O-negative blood. They did everything medical science allowed them to do, and maybe a little more; an injection of this, an injection of that. Finally, Dr. Conrad cleared his throat and lifted his hand into the air.

All right, people, good job. Let’s call it. Time of death 14:57.

And everyone stopped what they were doing.

The orchestration had ended, the finale had played. For a brief moment they just stood in their places, motionless and breathless. Most were exhausted by the ordeal, including Katherine. Her shoulders were slumping and her muscles ached. But a few others seemed undaunted, like Dr. Marshall Conrad. His clothes were without a wrinkle or stain of perspiration and his face was aglow with that often envied bronze tan. He reeked of confidence.

Katherine watched as he leaned against the wall near the door and peeled off his latex gloves, dropping them on the floor. As other members of the trauma team left the room to resume their duties elsewhere in the hospital, he nodded in acknowledgment. Obviously they appreciated his softly spoken thank you or see ya around and Katherine couldn’t decide if she felt irritated or intrigued. It wasn’t often that a doctor took the time to thank the team members. In fact, thanks was rarely part of a doctor’s vocabulary. All the same, she couldn’t help wondering about Marshall’s sincerity.

As if reading her mind, he stepped in front of her and placed his hands on her shoulders. Good job, Kay.

His fingers gently manipulated her taunt neck muscles and she wanted very much to melt under his touch. Instead, she stood firm. Thank you, she said.

They spoke in voices barely above a whisper. Medical people always whispered in the presence of the dead. It wasn’t a skill that had been taught them, or even ever mentioned. They just did it.

His eyes scanned her face and she thought she would drown in the brilliance of his gaze.

I mean it. You did a super job.

Thanks, Marshall.

He leaned closer to her. I missed you at lunch, he said, and she could feel his tepid breath against her ear.

She managed a smile. Busy day. I was just eating lunch when this trauma was called.

There’s always dinner. We can go to the club, by the river, pick out a nice quiet table near the fireplace?

She sighed. I would love to go to the club, Marshall, but...

But?

But I can’t. My friends...the party. I have to go.

He frowned.

Remember, Marshall? I told you about it.

Ah, yes. The party.

She backed away and his hands fell from her shoulders. He smiled with only the left corner of his mouth, as he so often did. Then the smile dropped away and he studied her face again.

Are you okay? he asked.

She nodded.

You look tired.

I am, she said. This is the third patient we’ve lost today. All three of them from accidents on I-80.

Lady Luck isn’t hanging around in the halls?

Katherine tried to laugh at the cliché, but the noise that escaped her throat sounded more like a wounded animal. No, and she sure wasn’t on the interstate either.

Too bad. He glanced over at the bed. I missed the first two. Meetings. Sometimes I think I attend more meetings than I see patients. He shook his head and took a deep breath. How did my Resident do?

He did very good during our first trauma call. It was an older man and his grandson. We worked on them at the same time and it was utter chaos. Doctor Jamar had Doctor Winston put a chest tube in the little boy.

Marshall shook his head. Winston wasn’t ready for that.

Katherine held his eyes for a moment then looked away. It didn’t matter. The kid’s heart was crushed; the sternum was pushed into the spinal column. Chest tube or not, he didn’t have a chance.

Marshall winced.

Katherine hated the vision that replayed in her mind. She hated the fact that the Resident had practiced a useless procedure on the child’s body. He was already dead, but the thought of doing something unnecessary to a body, especially that of a child’s, seemed heartless.

She looked toward the man lying lifeless on the bed. I’m curious, why did we work on him for so long?

Marshall raised an eyebrow.

She sighed. It’s just, well, after twenty minutes it became obvious we weren’t going to bring him back. Still, we went for nearly an hour.

A dullness rose in his eyes, something that hinted of compassion or perhaps subtle disgust. I hate defeat, he said flatly. He wiped his forehead on the back of his arm then added, My Resident also needed the experience.

Katherine winced slightly. What about compassion?

A semblance of a laugh puffed through his lips then he placed his hand along side her face, his fingers gently tracing her cheekbone. Compassion doesn’t belong in the trauma unit, Kay. You know that.

She understood that his words weren’t meant to be callous. He was right -- in life and death situations, compassion is best left outside the trauma room. A patient’s life depended on skill and critical decisions. All the same, it haunted her that a body would be subjected to futile treatment for the sake of an ego or even Resident’s need to learn and practice.

That’s what I like most about you, Marshall said, patting her cheek ever so softly before putting his hand in his pocket, you’re a fragile soul.

Fragile soul?

That’s what my grandmother called special people. Angels of flesh...fragile souls.

Katherine pushed the hair from her forehead. I don’t know, maybe I don’t belong in the emergency room. Days like these haunt me. People dying. I won’t get any sleep tonight.

Well, he said with a hint of a smile, I have the perfect remedy for that. Have dinner with me.

Katherine shook her head. The party. I really have to go.

I know, you have to go. But maybe you could slip out a little early, meet me at the club later?

She closed her eyes and tried to think of nice words to turn him down.

I’m pushing it, aren’t I? he asked.

Just a little. Why don’t you come, Marshall? After work, at the Rogue.

Not one of my favorite places, he teased. Great bourbon but lousy food.

"It’ll be just a small