Tuesday, November 3, 2009

Perspectives, Volume I

The following events are not fictional, but they may have happened at different times, with different patients, at different places. Each one of the authors has had patients just like these, in situations just like those described. If you want to know what it’s like to live a day in the life of an ambulance driver, or a small town cop, or a small town ER nurse, join us for the story.

It’s the same story. On the same night. With the same people.

This is what we do, and working with paramedics and cops like these is part of the reason we do it. What follows is part 3 of the story. Start with Matt, the cop, for part 1. Then follow along with Ambulance Driver for part 2 as he picks it up and carries it before handing it – and the patients – off to me.

Then come back here for the conclusion. I’ll still be here.
The Saturday night shift in Small Town ER – a 3-bed ER in a rowdy little town – started with the usual fare of runny noses, sprained ankles, and anxiety attacks along with a few walkie-talkie “migraines” thrown in for good measure. Typical “clinic” stuff. Also as usual, I’ve been paired up with Moonlighting Paramedic working as an ER Tech (not as a nurse but I can sign off on what he does with some degree of confidence, at least) and Dr. Moonlighting Resident is in the call room waiting for his dinner while we work on getting beds cleared for the next wave waiting out in the lobby.Just the three of us on duty tonight, and I’m actually very lucky to have a competent hand with me (MP, not the Doc). Been known to work it by myself. It’s not uncommon.

It’s been busy but not crazy, and MP and I have just sent out for dinner ourselves in the vain hope that the simple act of doing so would not bring chaos to our door instead. Because, you know, God Forbid we actually get to eat.

I hear the tones go out on the radio. “Small Town EMS, Small Town Fire Rescue, Priority One call, westbound on County Road 234, rollover MVC with multiple patients. Life Flight has been notified.”


“Any word on dinner?” I ask MP as I grab the portable radio and stick it in my back scrub pocket so I can keep tabs on what’s going on as I go ahead and sign off on the discharge of the patients in the exam rooms – all two of ‘em – and MP begins to clear out the trauma bay. That one can wait for his x-rays from the lobby just as well.

“Nope, reckon it’ll get here when it gets here.”

“Medic One to Dispatch, we’re 23” (we’re on scene) comes out over the radio. I look at MP and I can see him itching to be out there with them. He’s real gung-ho like that.

Double-check the crash cart, clear the monitor entries and prep them for the inevitably incoming patients. Minutes/seconds used now are minutes/seconds saved when the patients arrive. MP brings in two more runny nose cases and puts them into the exam rooms. Time to light a fire under Dr. Resident’s ass. He picks up the phone. “Doc, Medic One’s out on a multi-victim MVC and I’ve got two back here you can clear out real quick if you’ll come on.”

He does, and we do, and I am relieved to hear over the radio that the chopper has been called down for one from the scene. Thank GOD for that. Not surprisingly, I also hear cussing and screaming in the background as Medic One talks to Dispatch. Saturday night in the ER usually smells like an old, stale brewery. Sounds like tonight will be no exception.

“Medic One to Dispatch, we’re 76 (en route) to Small Town ER.”

Here we go….

“Let me know when they get here.” Dr. Resident has refreshed his coffee and is walking back to his room.

My stomach growls. MP goes for a quick potty break, which is not a bad idea. Might not get another one for a few more hours.

The radio goes off: “Medic One to Small Town ER…”

We’re as ready as we’re ever gonna be. An unhappy Frequent Flyer Patient comes up to the desk demanding to know why he hasn’t been called back yet. I raise two fingers of one hand to tell him “just a minute” and grabbing my pen, flanked by MP, I answer: “This is Small Town ER, go ahead Medic One.”

Hey Babs, it’s AD on Medic One. We’ve got a 15 minute ETA on two victims from a rollover MVC. Victim #1 is a 17 year old male who was apparently ejected. Initially agonal respirations on scene, unable to maintain his own airway without positioning. He’s tubed, with bilateral breath sounds and initial etCO2 of 32, spO2 91% on high flow oxygen. GCS is 1, 1, 3. Left pupil is blown.” Vitals 86/40, HR 52, RR 20 (ventilated)….”

FFP decides to go somewhere else. Folks in the lobby, apparently onto what’s going on, have trickled out one-by-one deciding to go somewhere else or just wait and come back later.

“.…Victim 2 may be the driver, apparently self-extricated at the scene. Apparent ETOH on board, uncooperative with history and exam. Numerous small lacerations and abrasions, the worst of which is a 4 cm forehead lac. We have him immobilized as best we can, PMS intact x 4, no neuro deficits. GCS 15. Eyes – PEARL. Vitals 136/74, HR 112, RR 14. See you in fifteen minutes.

“Fifteen minutes!! Hot damn, dinner just arrived and we have time to actually eat!!!!

But first we call in X-ray, CT, Lab, and Respiratory so they’ll either be here or be close by when the truck comes. Pop the crash cart open and have everything ready to roll. Make sure there are enough gloves for everybody. Place blank charts in the room and fill out the chief complaints since we already have those. After we wolf down dinner, I make a call to the doc to give him the report. Then MP and I mosey out to the ambulance dock for a quick smoke while we await their arrival.

The ambulance doors open to the sounds of Patient Two’s displeasure with his situation.


Oh, joy.

AD shakes his head as he preps Patient One and the stretcher to roll out. I smile. “Out stirring up trouble again, I see.”


“Well what can you expect with all these shit magnets on tonight?”

As Patient One is unloaded and Escorted into the Trauma bay I get the scoop: His name is Bobby and he is a casualty of typical teenage boy antics gone terribly wrong. Driving too fast, drinking, having a grand old time, and they took a bad curve with a little more bravado than their vehicle could handle. Parents are on their way.

“Last BP?”

“70/palp.” AD says.



“Hey MP,” I call out, “will you do a quick triage and stick a 14 in Jimmy Boy there? He needs a line and bloodwork. And a foley *wink*. Send a drug screen and call CT to clear his spine and look at his head while they’re at it.”

“I’m one step ahead of you.” Who says belligerent patients don’t get good care? They get top-notch care!

Doc shows up just as we are transferring Bobby over to the ER stretcher and getting him hooked up to the monitor, which is showing a heart rate now in the 40s. This kid’s going fast. As the doc makes a quick assessment I start gathering the appropriate meds from the crash cart.

“Doc, the other one is obvious ETOH and combative but it was a rollover. MP’s getting a line and blood work will be cooking, I sent him on to CT to clear head and c-spine.”

Oh, cool.”

MP has done his thing – minus the Foley, since he knew I was half- kidding about that, and he’s needed in here right now anyhow. This one needs a lot more but most importantly, he needs to not be here in the Bandaid Station.

MP takes over things with the doc and the crash cart. I grab the phone and dial.“Doc, I got Big City Hospital Trauma on the line. They’re getting Dr. Iamgod to the phone for ya.”

I hand him the cordless phone and then turn to the registration clerk who won’t leave until I sign the consents with her attesting to the fact that the patient is unable to sign for himself and that it is indeed a medical emergency necessitating immediate intervention without parental consent. I give her my quick scribble and move on. MP, Respiratory, and the doc are handling the patient for now and so I just keep things moving.

I turn to Dr. Resident and ask a question I already know the answer to: “Air or Ground?”


Out in the field the chopper can be called without all the hullabaloo involved in a COBRA transfer. But the second they hit the hospital premises, COBRA takes effect so it’s paperwork and procedure all the way, baby. All the way. Bureaucracy at its finest. Leave one thing out and the receiving hospital will complain and then the powers-that-be come down on this hospital and all the fallout will go to the ER Charge Nurse. Have to have an accepting facility and an accepting physician. There has to be a doctor to doctor report and a nurse to nurse report, transfer paperwork filled out and consent for transfer signed by SOMEBODY, everything documented, charting up to date and copies made to send, an inventory taken of all their worldly goods on their person, the whole freakin’ nine yards. Anything to interrupt care in the process of trying to get them appropriate care. One nurse, one tech, one green doc, two difficult patients. And somebody’s got to organize it all. That job falls on the charge nurse, never mind the fact that she’s the ONLY nurse in the department.

And so right now I’m really wanting to shoot AD for not calling another chopper out to the field. But Dr. Iamgod accepts the patient so I call Big City Hospital Chopper Line for transport while MP breaks out the Epi, Atropine, and the Dopamine. We now have a 25- minute ETA on the chopper.

I call dispatch to notify them so they can get the fire department out to the helipad. That’s in case the jet fuel catches fire. That’s just standard procedure here at Small Town Hospital.

See, I have to make those calls. We don’t have a unit clerk and by default I double as the House Supervisor. I’m lucky to have somebody in Registration tonight and she’s tied up doing her own job. Many nights we have to do that too. The fun part is when I have neither a tech nor a registration clerk after 11pm. Those nights really suck.

And police are swarming. Family members and friends are crowding the ER lobby. Some are crying. Some are angry. Some have decided, “Well, since I’m here anyway, maybe I can get them to look at this bump I’ve had on my elbow since the ninth grade…”

….and it’s then that I notice that Jimmy has been returned to his exam room. Sure is awful quiet for somebody who was raising all immortal hell earlier. The CT tech has sent the image for radiology reading 30 miles away and is awaiting a faxed report.


No response. I hit the lights and check the pupils. Mite bit sluggish but reactive. Vitals stable. Breath sounds clear. Belly soft.

Snoring. The stench of his breath permeates the room. The deputy sitting with him rolls his eyes.

Likely just sleeping it off, but I’d still like that CT report back. Just in case. That’s why I “requested” it in the first place. Belligerence could be from the alcohol, but we can’t just automatically assume that’s the case. Could be something else going on in there.

Call to the lab: “We got that ETOH in exam 2 yet?” I’m banking at least a 250.

“It’s coming off now,” she tells me. “354.”

I pull the bandage off the forehead lac to check it. Still bleeding but not so much. Nice hematoma coming up there. Dude probably got at least a good concussion out of that hit.

Back to the trauma bay to check on progress. I walk in just in time to see Bobby’s arms begin to bend and his hands begin to clench. “We need some O-Neg,” Doc says. “Squeeze it in.”

Only one person in the hospital can get that from the hospital blood bank and it has to be retrieved from there by that person, about 3 pages worth of paperwork filled out and double-signed to retrieve it, and it cannot be brought by the lab. That person is, by law, an RN and that person is, by default, me. I go and get it and bring it back, hanging it on a pressure infuser. We’re terribly short of actual hands.

As I hang it, I look at Bobby.

His lungs rise and fall from the rhythm of the Respiratory Therapist’s hands on the ambu bag. His blood pressure is only being maintained on a dopamine drip, and he’s posturing. This is what “life support” is. X-ray had done a side view of his neck on the stretcher and the film is hanging in the room. C1 and C2, the top two bones in his spine, aren’t broken but they’re a little farther apart than they should be and they’re a little bit out of line. We’re breathing for him but it’s getting harder to do – his belly has gotten firm indicating a belly bleed and now that blood is collecting and putting pressure on the diaphragm, giving resistance to the ventilatory effort. Before long it will be impossible to inflate his lungs and that will be the end of that. We’re giving him blood to replace what he’s losing – even if he is losing it internally, we’re giving medicine to keep his blood pressure up high enough to actually pump the oxygen into all those cells to keep his organs alive… everything his body should be doing on its own, we’re doing for it – and for what? If he survives he’ll live the rest of his life on a ventilator and likely in a vegetative state. The kid who took off riding and partying with his buddies tonight has died and he’s not coming back. All that’s left is this shell.

And there’s not really much more we can do here but maintain until the chopper comes. Doc is just standing back looking at him. For a split second, so am I and so is MP. We all have kids about that age. It’s hard to see.

“Doc, his mom and stepdad are here – you might want to go talk to them before the chopper lands. I’m sure they’re going to want to see him before he goes out. And the CT report on the other one is coming in over the fax now and you still need to go eyeball him. Chopper should be about 10 minutes out.”

Doc takes a deep breath and slowly walks out of the room, head down. He’s a new guy and this is a hard night for him too. He went to med school to make a difference and to save people. Medical School gave him all the ideals and the theory, and now here in residency – without his mentor but with MD behind his name and all the expectations that go with that – he is getting hit with a hard dose of reality. We can’t save them all.

I follow, to check on the CT report myself. It’s clear. Good. We can pump the guy full of fluids and a banana bag until his ETOH level comes down enough for the deputies, still hovering nearby, to cart him off to jail. But he can wait.

I go back to Bobby’s bedside. MP is monitoring him and RT is still struggling with bagging him. I hear a soft knock on the door.

The parents.

I step outside the room to talk with them. I know Doc already has, but before I bring them in they need to be prepared for what they’re going to see.

“C-c-can we see him?”

Mom is wiping her eyes and holding on to her husband, who’s just barely standing himself.

I place a hand on her shoulder. “Yes, I’ll bring you in to see him but I want you to understand that he’s not going to be able to talk to you, okay?”

Okay.” She sniffles.

“He has a tube in his mouth that we’re breathing for him through. There’s a real big bandage on his head and he’s swollen so he won’t look quite the same right now. And he has wires and IV lines and all.”


“And we’re going to send him to Big City Hospital where they will do everything they can for him. In fact, we’re flying him out in just a few minutes and after you see him I just need for you to sign a paper saying we can send him where he needs to go, okay?”

She sniffles and wipes her nose. “Okay.”

I peek into the door. “I’m bringing his parents in.” MP nods as he turns the Dopamine up a little higher and prints another rhythm strip off the monitor to add to the documentation he’s been fervently trying to catch up in time to get copies made and handed over to the Flight team.

They shuffle in, huddled together. The second she lays eyes on her son she runs up to him, caressing his head. “I’m here, baby, Mama’s here,” she croaks through her tears as she rubs his hair back and kisses his forehead. Her husband is standing beside her with one hand on her shoulder and the other holding his son’s hand. He shudders and a tear falls.

I love you, boy.”

These are their goodbyes.

I have located a fresh box of Kleenex and offer it to Mom. “There’s the helicopter,” I tell her, gently indicating the sounds overhead. “It’s time to get him ready to go.” She nods, with her tissue up to her face, kisses her son one last time, and they come with me out of the room. Mom signs the transfer consent and I make sure they have directions to Big City Hospital so they can meet their son there. They determine that it’s best they go ahead and leave now since the drive takes so much longer than the flight. I secure a cell phone number from them…just in case.

Flight team takes one look at the boy and they all shake their heads in unison. Report is given and we begin to load him up onto their stretcher, taking extra care to keep the lines from being entangled. I hang the second unit of blood and squeeze it in as they move him, keeping one eye on that and one eye on the monitor as he is moved.

And then….

Uh. Guys? Can you stop moving him a minute? Looks like V-fib on the monitor.”

Everyone backs away and the rhythm doesn’t change. A quick check confirms it.

The flurry of activity starts. Chest compressions begin. There are shouts of “clear” as we send shocks through his heart. More drugs being pushed through an IV line. This is it, I think.

We all think that.

And we’re all wrong.

Just as suddenly, we get a rhythm back. A good one. His heart beats once more. He has a pulse. For a second, we all stare at the monitor in utter disbelief.

RT removes the ambu bag and Bobby is hooked up to their transport vent. Report is completed, the blood transfusion is done, and copies of his chart and x-rays are placed into an envelope to go along with him.

A crowd has gathered outside to watch the helipad. Family, friends, neighbors, and just nosy bystanders are lined up across the parking lot to witness the final flight of a young boy whose life is ending far too soon, a young man whose hands should be clutching a girl and a set of car keys instead of the final futile traces of life.

On the other side of the helipad, away from the crowd, stands a man conspicuously alone, watching, bewildered. He looks as if he’s about to jump out of his skin. But he waits until the stretcher is loaded, not daring to interrupt. I step back as the blades begin to churn loudly. Over the shrill engine and the sounds of the props picking up speed, I barely hear it: “Ma’am! Ma’am!! Nurse!!” I turn my head to locate the source and I see him running toward me through the din. His face is stark with fear. And confusion. And grief. And worry. I move away from the chopper toward him until he stops breathlessly in front of me. Over the sound of the wind and the engine and the rotors he shouts, “I was on the job when I got the call…” It almost seems like an apology. He takes a breath and his frown deepens. His eyes are pained. His voice shakes. “WHAT happened to MY BOY?!?”

The wind churns up dust and debris, forcing the crowd back as the rotors build up speed enough to take flight. I motion for Dad to come inside with me where we can explain things. It won’t go well. Inside the ER Jimmy continues to sleep off his drunk, oblivious to the fact that his future is now going to have to be in the hands of a public defender.

I don’t feel sorry for him.

As I escort Bobby’s father through the wave of people crowded in that tiny area, a very irate patient demands to know, “What about this bump on my elbow? Am I gonna have to wait all night? I thought this was an Emergency Room. What if I’d been dying? Then what? I’d just die here in this waiting room wouldn’t I?”




I called the flight team for an update before I left at the end of my shift. The flight nurse, a normally stoic and highly professional young man, called me back. “Our boy didnt’ make it, Babs,” he told me, his usually steady voice shaking with emotion.

I noticed something else right off the bat too: he’d used the phrase, “our boy”. That’s a first. Something about this kid really got to him.

He crashed as we were landing,” he continued. “We just couldn’t bag him anymore. There was just too much pressure against the diaphragm, we couldn’t inflate his lungs. We tried. We tried. They cracked his chest as soon as we got him in there, but…… ” He took a deep breath. “Blood just poured out everywhere .….” Another deep breath. “When the family got there….”

Another deep breath. And a long, deep sigh. “It–it wasn’t pretty

He sighed again. His voice began to trail off. “It wasn’t pretty. It wasn’t pretty. It just…it – it wasn’t pretty.”Nothing about tonight was pretty. And the worst part? Nothing about tonight had to happen in the first place. But for the irresponsibility and callous disregard of one person for all his “friends,” it wouldn’t have.

Senseless shit. I finally have the luxury of time to be angry. I finally have the luxury of time to feel. Anything.

But I needed to go home and wash the night off in the shower and try to get some sleep. Because I had it all to do again in just a few more hours.

I just had one thing that I needed to do first.


I drove the half hour to another town, to another house. On the way, I thought about Bobby. I thought about his mother. And I also thought about that image – the mother’s family huddled together on one side of the helipad while his father stood alone on the other. I could relate to him. I knew his place because it’s the same as mine. He worked long, irregular hours. He missed important moments in his son’s life while he tried to earn a living. And now he would never get to make it up. He didn’t even get to say goodbye.

I pulled into the driveway and parked. They’re usually up by now. It was a longshot, because we don’t get along. His wife hates the fact that I breathe air. But I had to ask.

He answered the door and looked down quizzically at this frazzled, pale, shift-weary woman standing on his doorstep in her scrubs.

It was a bad night. We lost a kid. I just…I just need to hug them.”

He studied me for a second and then nodded. And then he called the kids to the door.

Perspectives, Volume II: Miss Helen

The following events are not fictional, but they may have happened at different times, with different patients, at different places. Each one of the authors has had patients just like these, in situations just like those described. If you want to know what it’s like to live a day in the life of an ambulance driver, or a small town cop, or a small town ER nurse, join us for the story.

It’s the same story. On the same day. With the same people.

This is what we do, and working with paramedics and cops like these is part of the reason we do it. What follows is part 3 of the story. Start with Lawdog, the cop, for part 1. Then follow along with Ambulance Driver for part 2 as he picks it up and carries it before handing it – and the patient – off to me.

Then come back here for the conclusion. I’ll still be here.


Murphy’s Law Corollary Number Something-or-other: No Good Deed Goes Unpunished.

Right up under that is a little section of the code that’s very well-known throughout the entire working world: If You Come In On Your Day Off, All Hell Will Break Loose.

But there’s another old adage: Time Is Money. So here I am for some overtime. AD’s working anyhow, so I might as well make a little extra Christmas money. The way I look at it, the day will be done in 12 hours regardless but I’ll be glad I did it come payday.


Wolfing down the last crumb of my biscuit from Vern’s, I clock in for the 11a-11p shift, throw my backpack up under the desk, and stand up straight for a quick stretch before turning to the day nurse, who appears to be catching up her documentation on a chart.

“So what we got?”

“Shhh.” She winks at me.

I grin as I look around at the empty rooms. To my surprise, Moonlighting Paramedic walks out of an exam room that he has just cleaned from the last patient.

Whoa. Three people on? Sweet! But what did they call me in for?

MP tosses the bagged-up trash into the bin. “Ambulance is out, though. Hopefully it’s nothing.”

“Yeah, I know. They’ve gone out to Ms. Schenk’s house,” I tell them as I wash my hands and begin to double-check the crash cart and room supplies.

Day Nurse picks her head up from her chart. “Miss Helen? What’s wrong with her?”

That, I dunno.”

Picking up the phone, I call Medical Records to request Ms. Schenk’s old chart. A floor nurse and the unit clerk tag along as she brings down a very thin folder containing nothing more than some old bloodwork and a couple of x-ray reports.

What’s wrong with Miss Helen?” They’re all concerned, and rightfully so. As her old file attests, she’s not what we would call a frequent flyer. She’s notoriously stoic and stubbornly independent. If she’s had an ambulance called out to her, something is seriously wrong.

Bodie calls in on the radio. MP answers it, motioning for paper to write down the report as we gather around to listen. Shocky, paced, grey, morphine. Shit. 72 years old and from the sound of it, she’s had a massive heart attack. Shit. Not today. Not Miss Helen. Not on my shift. Damn.


Mrs. Shenk, or “Miss Helen” as everybody around the hospital knew her, was a beloved Pink Lady for years after her husband died until she got to be too frail to keep up the pace anymore. Most Pink Ladies were just bored, rich, “proper” blue-haired ladies doing the volunteer thing because it was expected. They avoided the ER, commonly known as the Bargain Basement, because it was too…dirty. Noisy. Hectic. There’s blood there, and people often aren’t bathed and are cussing up a storm. It’s not as “polite” as the little 15-bed inpatient floor and so it just wasn’t a place for “polite company” to be. They always smiled sweetly, but you could always pick up a smidgen of condescension in their smiles and the saccharine dripped from their voices.

But Miss Helen was different. Rich, definitely, and proper, I suppose, but if you got her riled…she could be, let’s just say, very opinionated and very vocal in her opinions, caring not what anyone thought about her language.


I like ‘em spunky, because I’m spunky myself. Every day, Miss Helen would come back to the ER just to say “hey” with a genuine smile and wish everyone a wonderful day, often sticking around to chat if patient census was low. If we needed something for a patient, she’d run to the floor or to the kitchen to get it and bring it back. If we needed dinner ourselves and were too busy to get it, she’d retrieve it from the kitchen or even make the dinner runs to town for us.

Being something of a saucy little lady herself, I think she liked the action and unpredictability of the ER and she definitely took a liking to the brusqueness of the ER staff. She got the chance to be irreverent, bringing out a side of herself here that she couldn’t show to most of the rest of the world. And she knew that what she said in the ER, stayed in the ER. Out there in the world, around the community and especially around the menfolk, she had to be proper and keep up appearances. In here she could let loose in the safety and confidentiality of the nurses’ lounge. A special relationship developed between her and the ER staff.

That relationship was cemented with the icing on her cinnamon rolls.

At least once a week she brought in these huge, moist, to-die-for homemade cinnamon rolls and danishes, still warm from the oven. Cream cheese, blueberry, raspberry, and “regular”. She took great pride in those rolls and we took great joy in them. I can probably attribute a good 10 lbs on my frame to those things. Licking the last bit of glaze from my fingers I’d tell her, “I don’t know why I bother eating these things. I should just apply them directly to my ass.”

She’d always laugh and wink at me.“Well, darlin’, they probably wouldn’t taste nearly as good to your ass as they do to your tongue. If you’re gonna tote ‘em, might as well enjoy ‘em.”

Got a point there. She knew she had a good thing going with her pastries. Should have marketed them – she’d have made a killing. Instead, I suspect she’d been using them as enticement to extend the company of those strapping young lads who came to her door at the whim of her – ah, Ghosts. Heh. She always did like excitement and she could play “Damsel in Distress” with the best of ‘em.


As if on cue, a family of four and a couple of other people arrive to triage and one appears to be vomiting. Day Nurse volunteers to start triaging while MP calls Country Doc to Come On Down! and I ready the room stretcher before running to the Little Girl’s Room while I have the chance. Day Nurse brings a couple of patients back to the other exam rooms, getting them situated.

I emerge just in time to hear “Code Blue, ER” being called out over the PA system.

Miss Helen.

Country Doc squeezes into the room with me behind the medics as the x-ray tech rolls down with the portable machine and RT follows right behind. Country Doc has been around awhile and has partaken of the legendary cinnamon buns, and he now stands beside the empty ER stretcher, awaiting her and looking on gently. Floor Nurse, the Medical Records clerk, and the floor Unit Clerk are looking on in horror, following the crowd as AD continues compressions with the stretcher on the move and he slams out an updated report as we quickly and in one motion move her over to the ER stretcher. RT and the registration clerk enter as I get the monitor leads switched over from the truck’s to ours and MP takes over compressions.

“We’ve got it from here, boys”, Country Doc drawled in the direction of the medics, and he said something else to them but I wasn’t listening. He closed the door and returned to Miss Helen’s side.

“Back off the compressions a second. Let’s see what we have.” MP stops, hands hovering just over Miss Helen’s chest. We look at the monitor: V-fib. Day Nurse starts writing on the Code Record as I deliver 360 joules, and Miss Helen’s body rises and falls in response to the electrical current. Ohhh, no, Miss Helen. You don’t get out of baking those rolls that easy, little lady. You owe us a batch now. A BIG one.

Did I say that out loud? Surely not. But maybe she heard me, because all at once she had little blips on the monitor. The pacer? Nooo…that was removed in the transition and with all the compressions going on.

I think I hear a little something amongst the hiss of the oxygen. RT frowns quizzically and raises the mask just a little.

Quit…beating… me,” she barely croaks out. “What… I…do to you?”

Surely AD and Bodie heard the whoops coming out of that room with that. The whole town could have heard that. Country Doc just smiles. “Let’s get another line, hang some Lidocaine and let’s get her TNKase’d.”

Day Nurse steps out to check on the other patients in the ER, leaving the door open. I see that AD and Bodie have left already, but in walks Old Family Doc, who has been looking after Miss Helen for close to 30 years.

“She’s too spunky to let this beat her,” Old Family Doc says as he looks her over and listens to her chest.

Old Perv…always…did…like…my…chest…” came from underneath the mask.

He pulled back and laughed. “She’ll be fine,” he said. “I’ll call Dr. GoodHeart and see if he can take her on over at Big City Hospital.”

God Bless Old Family Doc. They just don’t make ‘em like that anymore.

MP and Country Doc step out to check on the other patients for a minute while I pull up a stool and sit down by Miss Helen to start another line, still keeping a close eye on her and the monitor. She’s got a rhythm but it still ain’t pretty. Looks like some sort of heart block, maybe second degree. Still kinda grey there. Blood pressure’s up to 90/50, which ain’t too bad for a lady her size. I’d feel better if it were 120/80, though.

“Miss Helen, you gave us a pretty good scare there. I hate to do this, but I’m gonna have to put another needle in your arm so it’ll be a little horsefly bite but just for a second, okay?”

Do what you have to do, Honey.”

She didn’t flinch as I pushed the needle in and flushed it, hooking up the little port for IV access later. Odds are she’ll have a central line placed after she gets to the ICU, but this will work for now.

“Miss Helen, I’m going to put some medicine into your IV that will break up any clots that might be getting in the way of the blood flow to your heart, okay?”

She nods.

“You got any bleeding problems or had any surgery recently?”

No, hun. This is the good stuff, isn’t it?” She’s seen this before.

“Yes, Ma’am, this is the good stuff.”

MP and Country Doc are peeking in and out as I ready the TNK to give her. Country Doc rolls in to watch her and the monitor as I push the dose into her IV.

It was pretty,” she said.


Heaven. It was pretty. Blue sky, peaceful…”

I raised my brow at that and watched the monitor, hoping to see something different there. Hearts throw some funky rhythms, pretty scary ones, when they re-perfuse. Right now, I’d give anything for something a little prettier than what we have right now. It’s too slow.

Come on, Miss Helen. Perk on up, now. Anytime now would be fine.

MP peeks his head in. “We got in touch with her daughter, but it’ll be a couple of hours before she can make it here. Old Family Doc made the transfer arrangements to go to Big City Hospital. I just called dispatch for transport. Hand me her chart and I’ll get it copied for you.”

Country Doc moseys back in and peers at the monitor, frowning. “What’s her pressure?” he wants to know.


“Her hands are cold, too,” he muses. “Tell ya’ what – hold off on the Lidocaine. Let’s try a fluid bolus and start a dopamine drip before the ambulance gets here.”

I break open the crash cart for the pre-mixed dopamine and set it up. It seems odd somehow that we’ve coded Miss Helen and haven’t even had to break the seal on the crash cart, until now. I look at my watch.

Not even thirty minutes since LawDog, AD and Bodie brought her in here. It seems like hours.

I have to look up the dopamine drip rate, but I get it hung in short order. AD can figure the dose in his head, and he’s taught me the shortcut, but it never sticks. I’ve worked too many night shifts and overtime for the past twenty years. The hard drive is full, and new stuff keeps getting deleted. Even the shortcuts.

Well. That was interesting,” came from under the mask. I look up at the monitor and see a short run of v-tach march across the screen.
You cannot faze this woman.

“It’ll be over in a sec, Miss Helen,” I reassure her. “It’s a sign that the clot’s breaking up.”

At least, I hope it’s reperfusion arrhythmia.

Miss Helen reaches for her mask. RT, still standing behind her head, starts to pull her hand away but I shake my head at him and he pulls away. She raises up the mask and speaks, still weak but starting to gain some strength.


“Yes, Ma’am?”

“You know the song,In the Garden?’

I smile. “Yes, Ma’am, I sure do.”


“Yes, Ma’am.”

She takes my hand with hers. “Will you sing it for me?”

A quick glance at the monitor, her color, and her eyes tells me that it’s fine to take a minute to sing this old hymn for her. I’ve got the dopamine going, fluids running wide open, and she’s had her TNK. All we’re waiting on is her ride and I’m not about to leave her side right now anyway. Choking back my own shyness about singing in front of anybody, I slowly and quietly begin:

I come to the garden alone…while the dew is still on the roses…”

Weakly, she begins to join in. A small town nurse and her patient who not even an hour ago was being kicked back from the Pearly Gates, singing:

And the voice I hear…falling on my ear…The Son… of God… disclo-o-ses….”

Miss Helen’s eyes are gleaming. I smile at her and continue with her:

Aaand..He…walks with me, and He talks with me….And He tells me I am his own…And the joy we share… as we tarry there…None other…has ever…known…”

RT looks up as her voice fades, and the monitor screeches its alarms. Her rhythm is unbroken v-tach now, and Miss Helen’s eyes are closed. She’s not breathing.

I turn around and see AD and Bodie standing there with their empty stretcher, ready to load Miss Helen up for transfer. They seem…pensive. Resigned.

“Call the Code again,” I tell Bodie sadly as AD starts compressions. “Get everyone back in here,” I called to his back as I charged the defibrillator paddles…


We worked her, Lord knows we did. We tried everything we could think of. Country Doc pulled out all the stops. AD threw in a suggestion or three. None of it brought her back. There comes a time when enough is enough, and you just have to let go. Miss Helen wasn’t there any more, and all we were doing was beating her up. Finally, Country Doc called it and we pulled a sheet over her chest before stepping away and taking in the sight of this once-spry spirit now lying there, lifeless.

I’ve seen a lot of different looks in the eyes and on the faces of the dead. Many held stark fear. Many were dark. And quite a few were like Miss Helen’s: they held peace. It was impossible to miss. I smiled tearfully at her and wished her well in her new life before taping her eyelids closed.

She was at peace.

Her daughter, Abigail, got there not twenty minutes later. Of course she was heartbroken. Providing some tissue and a shoulder, I pulled a chair to the bedside and brought Abigail in to say goodbye.

Meanwhile, I went on with my work. They don’t let you be a human being, not and still do everything a nurse has to do. The ER backed up while we were working the code, more patients signed in to triage, and I still had yet to call the funeral home, call Big City Memorial and cancel the transfer, and call the organ procurement folks. Work to be done now. Feeling comes later.

Miss Helen’s funeral was held the following Sunday afternoon. The entire Schenk clan had come home to Bugscuffle for the weekend and the whole county turned out for the service. The ER called in temp staff to help cover for the full time nurses who wanted to attend. Lawdog, all decked out with his bolo tie and church gun, served as one of the pallbearers. The procession was at least a mile long.

After the service, Abigail approached me and wanted to say “thank you” for that afternoon in the ER. I had let myself forget about it, but she hadn’t. She had planned to come visit that day, she said, but she had to postpone at the last minute and so was feeling the guilt for not having been there for her mother’s last moments. She needed to hear something – anything - about that day. So I shared the stuff that was uniquely Miss Helen. The way it all started with the ghost call and Lawdog’s having to convince her to come to the ER. The remark about having seen Heaven. The comment to her doctor. The hymn. The peace in her eyes. Abigail listened intently before breathing a long, deep sigh…and then she smiled her mother’s smile before hugging me tightly.

At home today, I heard a horn outside. I went outside to investigate, wondering if I had just maybe bumped the “panic” button on my car and then bumped it again, as it was a single horn blow.

As I stepped outside, she was approaching the back door with a foil-wrapped tray in her hands. Even through the screen door, I could smell the cinnamon.

“I am just so grateful that Mama didn’t die alone,” she smiled. “She was with people she knew. That was her favorite hymn, you know.”

At a loss for any words, I just smiled.

She looked down at the tray and fumbled for words. “I, I brought these for you, from Mama’s recipe..I never could match hers, though…but…” She looked up at me and sighed. ”I just wanted to bring you something to tell you how much I appreciate the fact that she didn’t die alone.”

Humbled by the gesture, I accepted them and her hug. It was then that I realized one very important thing:

This is why I call this place home.