The Edge of Death

By John Benedict

CHAPTER 1 Tuesday, 5:00 p.m.

Consciousness crept slowly into Nick Chandlers brain, fingers of awareness snaking into his mind like shafts of sunlight penetrating the morning haze. Here, in the meadow where he lay, there was no time or pain. He was content to bask in the warm sun and drink in the mingled scent of freshly mown grass and the heady nectar of honeysuckle. !uch peacefulness was beyond his e"perience. #oices that seemed miles away hummed lightly about his ears. $r was it %ust the sound of insects flitting about in the hedgerow& 'he only other sensation he felt was the rhythmic whoosh of air being forced into his mangled chest. 'houghts began to coalesce, disturbing ones. (uestions )ueued up for attention, threatening to perforate the fuzzy cocoon of his mind. Where am I? What happened to me? 'hen a stranger thought, more insistent, %umped the line. Am I dead? Chandler shooed these thoughts away he didnt want to deal with any )uestions right now. *nswers usually brought pain and he preferred the tran)uil limbo of his none"istence. But one )uestion buzzed back, like a pesky horsefly, refusing to be ignored+ ,as this what it felt like to be dead& He couldnt be sure and, he realized, he didnt care. -eep down, though, he remembered that people were supposed to care about such things.

He sensed that something was different about him, changed somehow, though he couldnt put his finger on it. the feeling was way too /ague. But he knew he was right. Chandler sighed. 'oo much work for now he was bone0tired. Besides, the sunlit

meadow beckoned. He let his mind submerge again, bobbing %ust beneath the surface of consciousness. *n unknowable amount of time passed as Chandler drifted in and out, until the buzzing returned and grew louder, finally nudging him awake. He sensed other people around him, picked up bits of con/ersation. 1 . . . congesti/e heart failure secondary to /iral myocarditis . . .2 1 . . . o/erwhelming sepsis with full0blown *3-! . . .2 1 . . . multi0system organ failure with progressi/e renal and hepatic shutdown . . .2 4ater an older male /oice, deep and resonant with a professorial tone, commanded his attention. 14auren, bring us up to speed on what happened yesterday.2 Chandler struggled to focus and stay awake to hear this part. the meadow would ha/e to wait. * young female /oice, crisp and asserti/e, answered. 1He coded around noontime and we consider it a miracle that we brought him back in the first place. *n hour later, though, he arrested again and this time we couldnt get him back. He was pronounced dead. He was then rushed to 564.2 17ou mean -r. 6uellers lab&2 17es. 'he postmortem lab.2 18 assume you are all familiar with -r. 6uellers groundbreaking research into resuscitation science&2 the professor said, garnering )uiet murmurs of assent. 19o on,

4auren.2 1'he patient was immediately placed on full cardiopulmonary bypass. His heart was stopped with a hyper0cool cardioplegic solution, ultra0low o"ygen therapy was instituted, and a slew of cerebral protecti/e drugs and antithrombin agents were administered. *fter twenty0four hours of this treatment, combined with sufficient resting of the myocardium, they attempted to restart his heart. *mazingly, after se/eral countershocks, his heart resumed beating and he was soon transferred here to the 8C:. 'he patient hasnt regained consciousness, though.2 That certainly answers a lot of questions, thought Chandler. Carol Sue was right about the virus should!ve listened to her" *nd now that they mentioned it, he did remember signing some weird form dealing with resuscitation. 8t was from the Buchanan 6ed Center Bioethics Committee and was so chock0full of legalese, he hadnt been able to make heads nor tails of it at the time. But the gist of it was, if any of it came into play, you were basically fucked. *nd by signing it, you had %ust helped the hospital install an ironclad co/ering for their collecti/e butts. He had been so sick when he was admitted that this particular form and all the others he signed had been a complete blur to him. ;"cept now, he could call to mind clearly the fi/e0page e"perimental resuscitation protocol that dealt with the 6ueller lab. He could page through the sheets in his mind, backward, forward, and zoom into any paragraph for a closer look. He had no idea how this was possible. 'he professor spoke again. 1!o, what is his prognosis at this point&2 #rognosis? 'he word was deli/ered with such gra/e o/ertones. *gain, Chandler fought off a wa/e of drowsiness.

1'he patient is basically terminal and will be lucky to sur/i/e the night,2 4auren answered, deli/ering her clinical assessment with a tasteful touch of sorrow. Tal$ about your good news%bad news" He wasnt dead, but it didnt sound like he had long to li/e. ;"cept again, Chandler $new they were wrong, as theyd been about the consciousness part. He couldnt say how he knew, or why, %ust that he felt certain. &ut what was it the per$y med student, 'auren, said? She considers it a miracle that I!m still alive" * tiny smile cur/ed his swollen, cracked lips and pulled painfully at the tape holding his endotracheal tube in place. (iracle might not be quite the right word for it, he thought, drifting back down into the narcotic haze of the soft meadow.

CHAPTER 2 Tuesday, 11:30 p.m.

6any hours later, Nick Chandler floated in that peculiar /oid between consciousness and dreaming, the drugs coursing through his /eins only heightening the strangeness of the e"perience. His last intact memory played images through his mind. 'he fact that he recalled the e"act details of that night, right down to the /ibrant colors of Carol !ues tattoo, went unnoticed. <<< Halfway through his gra/eyard shift, on a night that seemed as ordinary as countless nights before, Nick pushed his cleaning cart out of the 8C: room, being careful not to bump the doorframe with the /arious mops and brooms bristling from his cart. He shook his head. 'he room still stank of death, despite all the industrial0strength cleaners

he had used. He was happy to lea/e. Nick yanked off his mask and cap. )resh air never tasted so good, he thought, peeling off the flimsy yellow gown and the late" glo/es and chucking them all in the trash bin outside the room the red plastic one with the biohazard label on it. 'he laundry bag hanging off the back of his cart was filled to the brim with dirty rags. better take care of those. Nick made his way down to the hospital basement and na/igated the twisty corridors to the laundry with ease, something he hadnt done two years ago, when he had first started working at the med center he used to get lost down here all the time. Now,

he knew the layout well past the 638 machines with all their funny magnet signs, and past the C*' scanners. Nick hoped the laundry room would be empty, but his luck was not that good. se/eral other members of the %anitorial staff were taking a break, or trying to hide from their super/isors. Carol !ue was there. !o was Nasty 6ike =uzmich. Both were seated on plastic crates tipped upside down on the dusty floor, puffing away on their belo/ed cigarettes. 1Hey Nick,2 Nasty 6ike said, sniggering. 1,hat you got there& * full load& 'hree bags full&2 1No,2 Nick said, 1%ust one bag.2 Nasty 6ike snorted loudly and started laughing. 1-ont pay him no mind, Nick,2 Carol !ue said before taking a long drag on her cigarette. Nasty 6ike continued as if she hadnt spoken. 1>uckin moron?2

Carol !ue belted Nasty 6ike across his upper arm. 1!hut up,2 she said, and made an ugly face at him. Nasty 6ike frowned and rubbed his arm for a moment. But he wasnt done. 1,hats that smell&2 Nasty 6ike stood and scrunched his nose up something fierce. 1,hats that god0awful smell&2 14ea/e him be, shithead,2 Carol !ue said. !he got up and walked o/er to Nick. He watched the bright pinks and greens in her 'inker Bell tattoo slide in and out from under her slee/e as her arm mo/ed. Carol !ues teeth were yellow and crooked, but he liked her and thought she was pretty, with her long black hair. 16aybe you oughtta throw that stuff in a hazardous waste bo",2 she said, eyeing his laundry bag. 18t does stink,2 she added in a soft /oice that only he could hear. 1$kay,2 Nick said. He looked around the room, then pulled a large flattened cardboard bo" off a stack in the corner. He tried to fold the preformed cardboard piece into a three dimensional bo", but all the confusing flaps and arrows )uickly turned into a %umbled mess in his mind. Carol !ue reached out to help him. 14et me be,2 Nick snapped at her. 18ll do it myself.2 Nasty 6ike was staring at him. Nick felt his face heat. 18 seen it all now,2 Nasty 6ike bellowed, shaking his head. 1$utsmarted by a fuckin bo"?2 Nasty 6ike bent o/er and mashed his cigarette in his 5epsi can. 'hen he looked straight at Carol !ue. 1Just like 8 said, sweetcakes a fuckin moron.2

Carol !ue glared at him. 17oure the moron. Now, get the hell outta here.2 !he pointed to the door. 1-ont worry, 8m lea/ing.2 Nasty 6ike walked toward the door, bumping into

Nick on his way. *s he reached the door, he called back o/er his shoulder, 1Bitch?2 Carol !ue turned to Nick. !he had a nice smile on her face and touched his arm. 1Hes such an asshole. >orget about the bo", Nicky. 'hose buggers can be tricky.2 Nick felt ready to cry. He bit his lower lip. !he looked again at his cart and her smile faded. 1,ere you cleaning that room&2 she asked. 1'he filthy 8C: room with the patient who died& 'he one with the horrible smell&2 17eah, they told me to,2 he said meekly. 17ou washed your hands, right&2 Nick looked at the floor. 18 was about to,2 he mumbled. 18 wore glo/es.2 1!hit,2 she said, shaking her head and looking plenty worried. 19o wash your hands. Now? *nd use the goddamn disinfectant.2 Nick went o/er to the sink. 1'here was some serious bad shit in that room,2 Carol !ue continued, watching him wash his hands. 1,hen you get home, take a good shower. -ont forget, now.2 18 wont,2 he said, keeping his face turned away so she wouldnt see the tears.

CHAPTER 3 Wed esday, 11:!5 a.m.

Tequila. What a cool name" He liked saying it almost as much as drinking it. Chip *llison poured another shot glass full of tequila his third, or maybe it was his

fourth. &ut who!s counting, anyway? No, this wasnt your -on Julio *ne%o te)uila, the

stuff his dad liked to drink, aged for two years in oaken barrels and poured from the neat bottle with the fancy wooden stopper. *nd no, this wasnt e/en Jose Cuer/o ;special te)uila. 3ather, this was the cheapest rotgut money could buy, complete with the chintzy metal screw cap. *f course, let!s be honest here" +onesty is the best policy, right? He wasnt really drinking it to sa/or the fla/or. 'hat much was clear. And who gives a flying fuc$ that it!s only twelve noon" 'here was a celebration going on here his twenty0third birthday so he had e/ery reason to get hammered. And as long as we!re telling the truth, it!s not really a shot glass, either" 8t was one of those mega shot glasses. 7ou know, the three or four ounce %obbies the true /olume of which, only 9od *lmighty knew.

He spilled a little te)uila on the dingy white >ormica countertop. Shit. Can!t even do that right" But then, %ust as )uickly, he came to his own defense+ Wait, hold on no worries" ,ust a smidge, no need to panic" His mom liked that word panic. !hort for smidgeon smidge, that is, not

whate/er the hell that was. *lthough, truth be told, e/en dear

old 6om wasnt too happy with him nowadays. 3etrie/ing a soggy washcloth from the pile of dirty dishes o/erflowing the sink, he swabbed up the spilt te)uila. There, clean as a whistle" He tossed the rag back toward the sink. 6o/ement caught his eye and he peered out the little window of his third floor apartments kitchenette, eyes following a sparrow fluttering down to %oin se/eral others hopping around in the brown grass of his tiny backyard. 9eez, when had the grass gotten that brown& *n une"pected wa/e of sadness came o/er him as he remembered when things

had been different. #ery different, in fact. ;/erything had been going well really well until that awful decision in/ol/ing 6ichelle si" months ago. How could he ha/e been so stupid as to belie/e her& ,as it really possible to fuck up your life so badly in such a short time& 'his line of )uestioning ne/er failed to make his head hurt. $ut in the li/ing room, >rodo was talking worriedly to 9andalf. Commercial break was o/er. -rink in hand, he sauntered back into the room and plopped down on his worn sofa, not fi/e feet from the boob tube. 'he taco chips were there waiting for him. !alt always went well with te)uila, right& He checked his watch. He had to be at work in . . . lets see . . . nine hours. $r was it eight& His subtraction skills were sub0optimal at the moment. Ta$ing a siesta" Wasting away again in (argaritaville" Whatever" #lenty of time" He had e"perience in these matters. Besides, how alert did you ha/e to be to watch the stupid cardiac monitors in the 8C:& 'he newer computer0dri/en monitors had sophisticated dysrhythmia detection algorithms that rarely missed identifying a dangerous rhythm and then sounding the alarm. Chip plucked his i5hone out of his pocket and set the alarm. Couldnt afford to be late for work. hed ne/er get back into med school that way. So responsible " " " -ad should he say the great and fearless Colonel *llison would be proud. He was always or

big on responsibility. *nd integrity. ,hich e"plained why he was so disappointed when he found out about his delin)uent son. Chip tried hard to get his dads face and stinging words out of his mind. 4uckily, %ust then, the black riders rode across the screen, snorting and wailing, gnashing their teeth, blood dripping from their foaming mouths as they galloped down the road toward

the !hire. Chip sat there mesmerized, crunching absently on some chips. :sually, he really liked this part of the mo/ie. 'oday, howe/er, Chip shuddered a little as he imagined the riders were somehow coming for him. He drained the te)uila. CHAPTER ! Wed esday, 11:!5 a.m.

'he late0morning sun e/entually cleared the nearby building and light poured in through the /enetian blinds, bathing the 8C: room in a garish, almost phosphorescent light, rousing him awake. Chandler s)uinted hard and cursed at the painfully bright horizontal stripes. But he )uickly retracted his curse. 'he light was a wonderful thing, after all. it meant he had sur/i/ed the night, something his good doctors had thought unlikely. !omewhere between his last conscious period and now, hed disco/ered a will to li/e. Chandler took in/entory of his body. His heart had been ra/aged by an especially /irulent infection that had started it all. ,hat had they called it a /iral myocarditis& 'heyd said his heart was ruined. ;"cept he detected internal e/idence that his immune system was rallying, locking onto the /iral protein coat and taking out the /irus. He could tell his heart was on the mend. !imilarly, his lungs were repairing themsel/es, the damaged capillaries starting to shore up their leaks and the o"ygen e"change steadily impro/ing across the delicate al/eolar membranes. *s the e"tracellular fluid diminished, the compliance of the pulmonary tissue impro/ed, thereby decreasing the need for high pressures to /entilate him. !oon, he knew, the /entilator would not be necessary. His kidneys and li/er were

also responding to the impro/ed cardiac output and no longer spiraled toward total shutdown. He could see all these changes in his body as he had ne/er seen before. How was that possible& He certainly wasnt a doctor. Besides, e/en a doctor couldnt see the inner workings of his own body. But it was more than that. He sensed that his brain was somehow directing these wonderful changes, manipulating his autonomic ner/ous system to impro/e blood flow here, tweak perfusion there, in a kind of intelligent design approach to healing by following the innate blueprints of his body, right down to the cellular le/el. *gain, he sensed this was all a manifestation of the transformation he had somehow undergone. 'he urge to sleep came o/er him again, but he resisted. He knew their goal was to keep him sedated, and to that end, he was on round0the0clock narcotics and a propofol drip. Hed ha/e to deal with that before long. He heard people entering his room and was careful not to open his eyes. no need for them to know he was conscious %ust yet. He was beginning to connect names with the /oices. 'he attending doc, cardiologist -r. 4effler, was speaking. 19orman, why dont you e"amine the patient and tell us all where the endotracheal tube is, instead of cutting corners and %ust saying its in good position. 9ood for what& 6edicine is not a field for sloppiness, young man.2 $ne of the med students, presumably 9orman, leaned in close to him. Chandler felt a slight touch on his lips, then his tube was %ostled a bit. He struggled to remain still and fought back an o/erwhelming urge to gag. 1'ubes at twenty0two centimeters at the lips,2 9orman said, adding with a hint of

irritation, 1Still in good position.2 But the ne"t part was not spoken aloud. Chandler saw the words form clearly in 9ormans mind, then heard them %ust as plainly in his own+ -oesn!t really matter where the goddamn tube is, now, does it, 'effler, you fric$in! asshole. This guy!s toast. 'his surprised Chandler so much that his eyes almost flew open. ,hen 9orman stepped back to %oin the group, the connection was broken.

D". #oh $e ed%&t, husband and father of three sons, graduated cum laude from 3ensselaer 5olytechnic 8nstitute and entered post0graduate training at 5enn !tate :ni/ersity College of 6edicine. 'here, he completed medical school, internship, anesthesia residency and a cardiac anesthesia fellowship. He currently works as an anesthesiologist in a busy pri/ate practice in Harrisburg, 5ennsyl/ania. 'o learn more, please /isit the author@s website at www.%ohnbenedictmd.com