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I don’t know how long I’ve been asleep, but I am awoken by the sound of people getting into my room. A machine is being turned on, someone says “Let´s take a look at her heart, maybe we can find what is making her sick.” I feel a gel filled wand placed at the center of my chest and then being slowly moved all around my left side. I feel it sliding slowly and gently over my breast from one side the other. I hear clicks every so often and eventually the sound of my heartbeat, the blood flowing through my veins sounding like flowing water, a whoosh, whoosh with each heartbeat. One person is giving the other instructions, there are things to be measured, places that have to be rechecked. I feel a lot of pressure at the very end of the test as if they need to do that to get a clearer image of something. All the while I am still connected to the ventilator with its regular puffs rising my chest, making me breathe. They are talking amongst themselves and I try to listen but can’t make out what they’re saying. Someone tells a nurse: “Please prepare her for the cath lab, we’ll see you there in around 20 minutes.” “yes doctor”. What is going on? Please tell me. But nobody says anything. Moments later, I am being unhooked from the various machines that surround me. I am being prepared for transport. My head was always elevated around a 30° angle, but now, it is lowered to a horizontal position and they unhook the last tube, my ventilator, and switch it to a manual bag. I feel my bed moving someplace. A door opens and closes. This time my eyes are taped shut, so I can’t see the overhead lights, but I know I am going somewhere. Another door opens and closes, “OK, let’s transfer her, one, two, three…” I know the drill by now, as I am being placed in a hard bed, gurney or whatever. I am completely naked as they take the sheet off my legs and open them up a bit. I am being given a bath in the groin and perineal area. The water is lukewarm and it contrasts with the cold air of the room which I can tell is brightly lit despite having tape over my eyes. After my groin and vulva are washed and dried, I feel someone is shaving my right groin area and then a cold liquid is splattered on it. I feel a series of pinches in quick succession, as if they were numbing the area. Then they place drapes over my legs and belly. “We are ready to begin doctor”. Someone approaches me. I can hear that he is wearing a facemask by the way his voice sounds and he touches my groin. Because of the numbing, I don’t feel any pain, but I can tell something is going on there. I first feel poking and then I get the strangest feeling, as if someone was touching me with his finger from inside my body, moving all the way from my groin to my chest. I feel pressure in the middle of my chest now. “The catheter is inside the heart, please prepare the contrast solution.” “Contrast is ready doctor”,” Contrast in please”, I get a warm tingly feeling all over me, in my head, my hands and my lower abdomen. The doctors are talking among themselves: “we can see the contrast is going right through…wait! She’s in v-fib. Begin chest compressions, prepare the crash cart”. I suddenly feel like my heart is being squeezed tight from the inside. I would scream, except I can’t. In a second, a pair of strong, big hands lay on my bare chest, and they begin compressing firmly and counting. “one, two, three, four…” “charging at two hundred” I hadn’t realized the gel pads were still on my chest until I heard “All clear, ready” then the beeping of the machine signaling it was charged and felt the jolt of electricity going through my body, my whole body tensing up, my fingers, my toes, my neck, all contracting in a single movement and then relaxing at the same time. “She’s biting the endotracheal tube, I can’t ventilate, give me a bite blocker”. The bite blocker is now in my mouth. As I feel two quick pumps of air go into my lungs, two hands are placed on my chest once more and the compressions start again, pounding, crushing me inside with each blow. I hear that meds are being administered, then I hear a cracking sound, I think something broke inside me. But that doesn’t stop the pressing or the counting. After what seems a while, I hear “Let’s check again for pulse”. I feel a stethoscope on my chest and fingers touching my neck, my wrist, my left groin and my ankle. “No pulse, resume compressions”. A different set of hands touches me this time and they begin pumping and counting again. This time I feel that, even though they are pumping air into my lungs every so often, I can’t breathe, I am gasping, or at least I would if I could. I can hear the sound of the bag being pressed to inflate my lungs, but I don’t feel enough air coming in. I can’t do this. “There is blood in the endotracheal tube, she must have a perforated lung. Check for breath sounds”. The compressions stop, a stethoscope is placed on various points of my chest. “She has a collapsed left lung, get the chest tube tray, suction please”. I feel liquid being squirted onto my left side, as the compressions resume and the ambu bag is taken off the tube in my mouth. Something spatters my face, I guess it must be blood shooting out of the tube as they keep doing compressions. A suction tube is threaded down the tube in my throat and into my lungs, I feel the need to cough but I can’t move, I am drowning in my own blood, choking. As this happens a sharp blade in pressed against my ribs on the left side. I feel a lot of pain. Someone in actually placing their finger inside my chest digging for something. Then, a tube is thrusted inside me penetrating inside until I feel something pop. “Ready, the tube is draining, continue ventilating”. All this happens while someone is pounding my chest continuously in spite of the chest tube being placed at the same time. I don’t know how much time has passed, but it feels like ages. “Ok, two-minute mark, let´s check again” compressions stop, “no heartbeat, shock again” I brace myself. “All clear”.  The beeping sound of the machine announces what is to come and once again, a flash of light crosses my eyes, my entire self-contracts and relaxes a second later. I feel drugs being pushed through my central line. And compressions resume, hard, fast, violent. I am no longer me but a doll, I feel pain in my whole self. The pounding is all I know, all I understand and feel.  I am shocked once more and again, my body contracts and then falls with a small thud on the narrow table. The movement is enough for my arm to fall of the place where it was positioned. How much of this can a body take? I want this to stop, I don’t care anymore. STOP! But they don’t stop, they keep counting twenty-eight, twenty-nine, thirty, I get two breaths and it starts all over again. I feel like they are preparing my right side now for a chest tube, I can’t believe it. They are going to do it again, and indeed, as my chest is being compressed over and over again, they cut a hole on my right side, dig into it and penetrate my chest with another thick, painful tube. After a while of this I hear: “We’ve got a shockable rhythm, get ready, all clear”. In a second I get another shock, my mangled muscles offer no resistance, my hands and feet curl, my neck contracts and moves my head, I feel my eyes rolling back in my head. I land back on the table. I feel fingers searching for a pulse all over my naked body once again. “We’ve got a pulse, quickly begin pacing before she becomes unstable again.” I begin feeling small but uncomfortable shocks every second. They come from the pads placed on my chest. Now, instead of having my chest pounded on, my heart is being paced with an external pacemaker that delivers a smaller shock about every second. My body quivers and contracts. And with each shock I can feel the air leave my lungs and they barely manage to get more air in before another shock comes. My breasts jiggle with every shock and every time they shake, the tubes placed on both sides of my chest move a painful bit. These people are torturing me. I want to escape. I want to die. They take the tape of my eyes and check my pupils by shining a bright light into each one of them. “Ok people, she needs surgery, call the OR and tell them to be ready for us, she won’t last long as she is, she’s got a severely leaky valve and an enlarged heart, she is very unstable, we have to get her on the heart lung machine fast. Don´t move her an inch until we get word that they’re ready.” And just like that, everything got quiet. I lay there, on the table, feeling a shock for every beat of my heart, unable to think, only feeling the present, the shocks, hearing machines beeping, and somebody doing small talk. Waiting. A phone rang “they are ready for us, tell the blood bank we will be needing more units soon, there is a lot of blood coming out of those drainage tubes”. They took the ambu bag off my tube for a moment, just long enough to suction the blood out of my lungs one more time and then reconect it, trying to pump enough air inside me between shocks. and then softly, but still connected to the external pacemaker, I was moved to a gurney and began moving again, this time towards the OR. I was at their mercy.

My body, engulfed in a cocoon of plastic, my heart, artificially kept beating, my body waiting for me to be awaken. I signed up for this experiment, not knowing what would happen with my body after being forced to fall asleep. All I remember is the gas, the sweet gas putting me to sleep, forcing my eyes to close, to numb the pain before an electrical shock sent my heart into overdrive. The people at the lab knew how to handle such a situation, making sure to my lungs were supplied with just enough oxygen to keep them going.

I laid peacefully on the bed, unaware of my surroundings, the monitor that captured my faint heart rate as the ventilator occasionally pumped fresh oxygen into my lungs. I wasn’t supposed to wake up for another couple of years, but the oxygen shortage inside my pod decided otherwise. Without knowing, my lungs started to demand more and more oxygen, something the system just couldn’t supply. All sorts of alarms started to go off, I was choking. I was dying. My heart started to speed up as my body started to spasm lightly on the table, fighting to stay alive. The ever so slightly moving monitor fell flat, that was it. My heart, my body failed to fight.

A team of doctors and nurses stormed into my little room, cursing and giving commands to one another before tearing open the cocoon my body was held in. A strong set of male hands started to compress my still chest as a nurse disconnected my breathing tube from the automatic ventilator before connected an ambubag to the open end. My chest caved in each time the man used his entire weight to crush my sternum, hoping to bring me back. The monitor occasionally captured the attempts, a small bump interrupting the flat line running across the screen. The doctor’s set of compressions came to an end, taking a break to fill my lungs with much needed oxygen as the nurse gave the ambubag two big squeezes.

The muscular man interlocked his hands once more, before lowering them back onto my nude chest. It felt like he didn’t care whether or not my ribs broke, the force he used was tremendous as he only cared about bringing his little experiment back to life.

“C’mon Lauren, damn it, fight!”, he sighed out, looking over at the monitor, then back to my body.

My body continued to rock side to side as his hands forced my sternum inwards, in turn forcing my stomach out. The monitor continued to blare it’s alarm as a nurse injected some epi into my arm. My peaceful body, once so still, now being worked on by an entire team continued to endure the torture it was forced though. The flat line running across the monitor in the corner of the room suddenly changed into a squiggly line.

“Prepare to shock her.”, the male commanded, out of breath as he wiped away the sweat forming on his forehead.

A nurse unpacked the defibrillator packs, placing the orange pads above my right breast, and one below my left breast before turning the knob on the machine present in the room. The chime echoed throughout the room as the male doctor compressed my heart a few more times before the machine gave it’s signature double bleep.

“Clear!”, one of the nurses commanded before firmly pressing the paddles onto the orange spots on my chest.

My chest jerked violently, moving one of the orange pads before crashing hard down again as the entire team looked at the monitor, hoping for a change.

“Nothing, go again!”, the male doctor commanded before firmly compressing my heart once more.

The defibrillator started to charge up again as the nurse responsible for my breathing gave the ambubag another big squeeze.

The defibrillator finished charging, right as the female finished filling my lungs with much needed air.

“Clear!”, the nurse once again commanded after correcting the orange pad, and releasing the current onto my still chest.

My chest once again violently jerked, before crashing hard down onto the bed below.

The strong male hands found their way back to my sternum, ready to compress my heart. The man used his entire weight, putting his knee onto the bed, ignoring the way he bended my ribs below him. My entire frame rocked from side to side, making my breasts jiggle in the process.

“Come back to us, you can do it.”, the man sighed as he finished another set of rough compressions.

Another huff of air was forced into my lungs, making my bruised chest rise before falling flat again.

The man once again interlocked his hands, lowering them onto the bruised spot between my breasts, before crushing my sternum between them and the bed.

His set nearly came to an end, before the monitor started to display a faint rhythm.

“Check her pulse points, confirm it’s steady.”, he commanded out of breath, once again wiping away the sweat from his forehead.

A group of nurses started to touch my body, looking around my pulse points. None of them said something, until the one at my femoral point confirmed it.

“I have a steady beat, nothing too spectacular, but it’s there.”, she announced with excitement.

The doctor gave her a nod, before ordering the nurse to connect my battered body back to the automatic ventilator.

“She’s ready for phase two.”, he said with a grin before filling in the file hanging from the end of my bed.

After they had removed the breathing tube, I was able to look around properly for the first time. I saw there were three drainage tubes coming out of my chest. Because I was unable to lift my head up due to the pain, I was not sure exactly what part of my body they came out of, but in fact, two of them were each about two centimeters (almost an inch)  on each side of the lower end of my mid-sternum incision. The third one was right below my left breast. They were all draining blood and fluid from my chest. They went down to three containers that were sitting on the floor to let gravity help the draining. My urinary catheter was hanging by the side of the bed so I couldn’t really see it, but every now and then a nurse would come in and I would hear the clicking sound of the urine collection bag being opened and then drained. I also had a thin wire coming straight out of my chest, it had no electrode, it just protruded from the inside, it turned out to be the internal pacemaker they had placed directly into my heart muscle after I was taken off the heart-lung machine and my heart was restarted. As I had been monitored many times before, I knew that each colored wire was placed on an electrode in a specific spot. The red one, the most important, was placed under the left breast to monitor the apex of the heart, on the upper right of my chest, the white wire was connected to its own round white electrode, the same way, the black wire was on the upper left side of my chest, the green one was placed on the lower left side, and the brown was around the middle of my chest, a little more towards my belly, because there was a big white patch covering my whole incision so it couldn’t be placed there.  

I don’t know how long I’ve been asleep, but I am awoken by the sound of people getting into my room. A machine is being turned on, someone says “Let´s take a look at her heart, maybe we can find what is making her sick.” I feel a gel filled wand placed at the center of my chest and then being slowly moved all around my left side. I feel it sliding slowly and gently over my breast from one side the other. I hear clicks every so often and eventually the sound of my heartbeat, the blood flowing through my veins sounding like flowing water, a whoosh, whoosh with each heartbeat. One person is giving the other instructions, there are things to be measured, places that have to be rechecked. I feel a lot of pressure at the very end of the test as if they need to do that to get a clearer image of something. All the while I am still connected to the ventilator with its regular puffs rising my chest, making me breathe. They are talking amongst themselves and I try to listen but can’t make out what they’re saying. Someone tells a nurse: “Please prepare her for the cath lab, we’ll see you there in around 20 minutes.” “yes doctor”. What is going on? Please tell me. But nobody says anything. Moments later, I am being unhooked from the various machines that surround me. I am being prepared for transport. My head was always elevated around a 30° angle, but now, it is lowered to a horizontal position and they unhook the last tube, my ventilator, and switch it to a manual bag. I feel my bed moving someplace. A door opens and closes. This time my eyes are taped shut, so I can’t see the overhead lights, but I know I am going somewhere. Another door opens and closes, “OK, let’s transfer her, one, two, three…” I know the drill by now, as I am being placed in a hard bed, gurney or whatever. I am completely naked as they take the sheet off my legs and open them up a bit. I am being given a bath in the groin and perineal area. The water is lukewarm and it contrasts with the cold air of the room which I can tell is brightly lit despite having tape over my eyes. After my groin and vulva are washed and dried, I feel someone is shaving my right groin area and then a cold liquid is splattered on it. I feel a series of pinches in quick succession, as if they were numbing the area. Then they place drapes over my legs and belly. “We are ready to begin doctor”. Someone approaches me. I can hear that he is wearing a facemask by the way his voice sounds and he touches my groin. Because of the numbing, I don’t feel any pain, but I can tell something is going on there. I first feel poking and then I get the strangest feeling, as if someone was touching me with his finger from inside my body, moving all the way from my groin to my chest. I feel pressure in the middle of my chest now. “The catheter is inside the heart, please prepare the contrast solution.” “Contrast is ready doctor”,” Contrast in please”, I get a warm tingly feeling all over me, in my head, my hands and my lower abdomen. The doctors are talking among themselves: “we can see the contrast is going right through…wait! She’s in v-fib. Begin chest compressions, prepare the crash cart”. I suddenly feel like my heart is being squeezed tight from the inside. I would scream, except I can’t. In a second, a pair of strong, big hands lay on my bare chest, and they begin compressing firmly and counting. “one, two, three, four…” “charging at two hundred” I hadn’t realized the gel pads were still on my chest until I heard “All clear, ready” then the beeping of the machine signaling it was charged and felt the jolt of electricity going through my body, my whole body tensing up, my fingers, my toes, my neck, all contracting in a single movement and then relaxing at the same time. “She’s biting the endotracheal tube, I can’t ventilate, give me a bite blocker”. The bite blocker is now in my mouth. As I feel two quick pumps of air go into my lungs, two hands are placed on my chest once more and the compressions start again, pounding, crushing me inside with each blow. I hear that meds are being administered, then I hear a cracking sound, I think something broke inside me. But that doesn’t stop the pressing or the counting. After what seems a while, I hear “Let’s check again for pulse”. I feel a stethoscope on my chest and fingers touching my neck, my wrist, my left groin and my ankle. “No pulse, resume compressions”. A different set of hands touches me this time and they begin pumping and counting again. This time I feel that, even though they are pumping air into my lungs every so often, I can’t breathe, I am gasping, or at least I would if I could. I can hear the sound of the bag being pressed to inflate my lungs, but I don’t feel enough air coming in. I can’t do this. “There is blood in the endotracheal tube, she must have a perforated lung. Check for breath sounds”. The compressions stop, a stethoscope is placed on various points of my chest. “She has a collapsed left lung, get the chest tube tray, suction please”. I feel liquid being squirted onto my left side, as the compressions resume and the ambu bag is taken off the tube in my mouth. Something spatters my face, I guess it must be blood shooting out of the tube as they keep doing compressions. A suction tube is threaded down the tube in my throat and into my lungs, I feel the need to cough but I can’t move, I am drowning in my own blood, choking. As this happens a sharp blade in pressed against my ribs on the left side. I feel a lot of pain. Someone in actually placing their finger inside my chest digging for something. Then, a tube is thrusted inside me penetrating inside until I feel something pop. “Ready, the tube is draining, continue ventilating”. All this happens while someone is pounding my chest continuously in spite of the chest tube being placed at the same time. I don’t know how much time has passed, but it feels like ages. “Ok, two-minute mark, let´s check again” compressions stop, “no heartbeat, shock again” I brace myself. “All clear”.  The beeping sound of the machine announces what is to come and once again, a flash of light crosses my eyes, my entire self-contracts and relaxes a second later. I feel drugs being pushed through my central line. And compressions resume, hard, fast, violent. I am no longer me but a doll, I feel pain in my whole self. The pounding is all I know, all I understand and feel.  I am shocked once more and again, my body contracts and then falls with a small thud on the narrow table. The movement is enough for my arm to fall of the place where it was positioned. How much of this can a body take? I want this to stop, I don’t care anymore. STOP! But they don’t stop, they keep counting twenty-eight, twenty-nine, thirty, I get two breaths and it starts all over again. I feel like they are preparing my right side now for a chest tube, I can’t believe it. They are going to do it again, and indeed, as my chest is being compressed over and over again, they cut a hole on my right side, dig into it and penetrate my chest with another thick, painful tube. After a while of this I hear: “We’ve got a shockable rhythm, get ready, all clear”. In a second I get another shock, my mangled muscles offer no resistance, my hands and feet curl, my neck contracts and moves my head, I feel my eyes rolling back in my head. I land back on the table. I feel fingers searching for a pulse all over my naked body once again. “We’ve got a pulse, quickly begin pacing before she becomes unstable again.” I begin feeling small but uncomfortable shocks every second. They come from the pads placed on my chest. Now, instead of having my chest pounded on, my heart is being paced with an external pacemaker that delivers a smaller shock about every second. My body quivers and contracts. And with each shock I can feel the air leave my lungs and they barely manage to get more air in before another shock comes. My breasts jiggle with every shock and every time they shake, the tubes placed on both sides of my chest move a painful bit. These people are torturing me. I want to escape. I want to die. They take the tape of my eyes and check my pupils by shining a bright light into each one of them. “Ok people, she needs surgery, call the OR and tell them to be ready for us, she won’t last long as she is, she’s got a severely leaky valve and an enlarged heart, she is very unstable, we have to get her on the heart lung machine fast. Don´t move her an inch until we get word that they’re ready.” And just like that, everything got quiet. I lay there, on the table, feeling a shock for every beat of my heart, unable to think, only feeling the present, the shocks, hearing machines beeping, and somebody doing small talk. Waiting. A phone rang “they are ready for us, tell the blood bank we will be needing more units soon, there is a lot of blood coming out of those drainage tubes”. They took the ambu bag off my tube for a moment, just long enough to suction the blood out of my lungs one more time and then reconect it, trying to pump enough air inside me between shocks. and then softly, but still connected to the external pacemaker, I was moved to a gurney and began moving again, this time towards the OR. I was at their mercy.

On ICU My Boss comes and tell me what my fatal is!At the moment my organs are not asked on the black or white market. My Boss ask me somethings from the station who hapoend last days ago. I don’t know fully black out. He told me I get a recovery but must stay on the normal ward.

He tells me I get a ECT Therapie that i forget the station. After I am back on the normal ward I resive the first ECT from that my Boss had talked before During the ECT they don’t gave me a Anesthesia I think they would only damage my brain. It was horrible and painfully for me. And befor every shock i hoped the Shock kills me. After I was unconscious and they wheeled my to my room.

And after I came to a nurse told me when the demand for my organs is there then I am the firt patient who is accompanied to death. She and my Boss get me time to find a soulution for my privat life but i have only a small Appartement that was from the hospital means I have nothing to lose I ask my boss why they don’t put me in a introduced coma. He laughed No we can’t Jessy has told you sure some informations they are going out. You was an employee from a wistleblower why we should be kind to you! Now my life is laying on a hospital bed restrained and diapered and waiting for my end that comes three days after I talked with my boss on ICU. They wheel me in the Anesthesia room they ask how I would recive ECT again. I tell them again asleep. Now they place the boufant cap on my head now I have to lift my head for a last time. The personal knows that I have to die they gave enough time to me to accept my fatal.

I am lie there and know its time for my last breath. From now on I don’t have to do something. I saw and Heard to much and i have told things who where top secret. Now they will shock me with ECT. The Treatment makes me brain death. Then my body is no longer able to survive the pain. I take now my last breath! Next three hours are very hard for me. When I am after two hours not brain death then they shock my awake why the Anesthesia is only planed for two hours. But i hope two hours are enough for my brain. Last they harvest my organs. I have to die but i die for the right thing! I have done the right thing to tell everybody what happened in this hospital! And now its fatal i die how the patient before me!

Poor Simon she lost brain aktivities after three hours. She was 40 Minutes awake during ECT. The Medical Staff ignored that she was awake the Staff continue the treatment why they hope Simon loses her Brainactivitis quicker! The Treatment Team stops the treatment 5 minutes later. And wheel Simon to OR where she gets again Anesthesia but it was to late to help Simon against the pain! She had a lot of pain first her body from ECT and second her brain who is tortured. They gave Her only the Anesthesia that Simon is not feeling how her brain stop working. 10 minutes later she was brain death.

Check out my newest story! Feel free to leave feedback, and I hope everyone likes it 🙂

There were a few typos in my initial draft, so bear with me a bit!

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The intensive care unit (ICU) is a department in most hospitals that focuses on patients who are critically injured or ill, and often on the verge of death. The ICU has advanced equipment that typically isn't found in other departments of the hospital, and ICU staff members receive extensive training and have in-depth expertise, giving their gravely ill or injured patients the best chance possible given the circumstances. Despite all of this, patients still succumb to their injuries and illness in the ICU.

Our latest ICU casualty was 27 year old Amy Russell. Amy was a petite, nerdy white woman standing at 5'4 with big blue eyes, brown hair with bangs, fair skin, and a small tattoo on her left ankle. Amy was a nice, quiet girl who kept to herself most of the time, and had a promising career in IT.

Amy ended up in our ICU after being involved in a bad car accident while driving home from work. Amy had an open fracture in her right femur, a ruptured spleen, lacerated splenic artery, lacerated splenic vein, and a lacerated left gastric vein. Due to the severity of her injuries, she was taken up to the operating room shortly after arrival at the emergency department to treat her injuries and stabilize her. Amy's surgery was touch and go for awhile, but she pulled through. The surgical team had to remove her spleen, ligate her splenic and left gastric veins, cauterize her splenic artery, and repair her open femur fracture via internal fixation and intermedullary nailing.

Since she was still in rough shape after surgery, it was decided that she would be sent to the ICU for observation and be left on sedation for pain management purposes. After surgery, Amy's vital signs were: BP 107/70, heart rate 104bpm, o2 saturation 100% on a high flow oxygen ventilator, and she had a GCS of 10. The ICU team also had Amy set up on an antibiotic cocktail to limit post-operative infection, and weaned her off of fluid resuscitation and blood products since her vascular injuries were repaired. Initially, it seemed like Amy was on a slow and steady path to recovery.

Amy laid in the ICU bed intubated, with the tube connected to a blue tube holder, and hooked up to a ventilator. There were EKG electrodes scattered all over her chest, which was covered by a blanket. There was a large bandage covering a majority of her abdomen from the intense surgery she just endured, and her right thigh was immobilized and covered with bandages. The ICU nurses checked on Amy every few minutes after surgery.

She remained stable for several hours, but the situation changed in the middle of the night. Just shy of 3am, Amy became hypotensive, displaying a BP of 85/47. A bedside FAST scan was ordered, a d-dimer was ordered, and a chest x ray was performed. The FAST scan and x-ray didn't show anything new, and the d-dimer was slightly elevated. The ICU team felt that Amy could've developed a post-op PE, but felt uneasy about administering anticoagulant drugs due to her freshly repaired vascular injuries. The ICU team elected to have a pulmonology consult before deciding on their next move.

The pulmonologist arrived within the next few minutes. Their assessment of Amy concluded that she didn't have a pulmonary embolism even though she had certain diagnostic indicators. The pulmonologist thought Amy was suffering from something known as a fat embolism. This is a scenario where bone marrow (typically from a broken bone) ends up in blood supply, and becomes lodged elsewhere in the body. These incidents are particularly lethal when the stray bone marrow becomes lodged in the lungs or brain.

Since fat emboli are an uncommon occurrence, the pulmonologist wanted to order a CT angiogram. Since she wasn't stable enough for transport to radiology, it was decided that a bronchoscopy was ordered to look for pulmonary edema, a textbook symptom associated with fat emboli. Repeat labs were also drawn to check for changes in hematocrit, hemoglobin, co2, and platelet levels.

The bronchoscopy confirmed pulmonary edema, and the labs had abnormal results; hematocrit was 27.3%, hemoglobin was 9.1 g/dL, co2 was 37 mEq/L, and her platelet levels were down to 114,000 per microlitre. The ICU team administered vasopressors to increase BP, hung 2 units of platelets from the rapid infuser, started her on an IV drip of iron to help with hemoglobin and hematocrit, a bag of albumin was hung, and a central venous pressure (CVP) monitor was set up. Additional electrodes were stuck onto Amy's chest, and a separate display monitor was set up for the CVP.

All of the interventions did little to nothing to improve Amy's condition. Her BP remained low, she developed tachycardia, and developed petechial rashes on both her axillary areas. Since Amy's condition wasn't improving, the doses for all her medications were upped, her ventilator settings were altered, and a 3rd and 4th unit of platelets were started on the rapid infuser.

Her course of treatments continued for another hour or so, but things changed around 4am. At that time, Amy's ET tube became filled with blood and her blood pressure was taking a nosedive. A few nurses rushed into the room and began suctioning her ET tube out. The attending physician and a few respiratory techs were notified of the sudden change.

The nurses kept suctioning out blood, but Amy wasn't moving any air. The respiratory techs had to reintubate Amy, which proved to be a difficult task. Shortly after reintubation, Amy went into cardiac arrest.

Deep, rapid chest compressions were started by one of the nurses. The nurse could feel a few of Amy's ribs pop just beneath her gloved hand as she delivered strong, forceful compressions. Amy's skinny chest caved in rhythmically during the initial phase of the code. Just a few feet away, another nurse detached the ventilator and hooked an ambu bag onto Amy's ET tube. A 3rd nurse stuck defib pads onto Amy's bare chest, and another nurse was injecting the first doses of epinephrine, atropine, and sodium bicarbonate into the young woman's IV. The heart monitors showed pulseless electrical activity (PEA), so CPR, ambu bagging, and drugs were the only course of action that could be taken right away.

Amy just laid in the bed, eyes closed while her chest took an absolute beating. The nurses pumped away on her frail, skinny chest. Her head bobbed during each individual compression, and her feet swayed at the other end of the bed, showing off the delicate, silky wrinkles in the soles of her size 6 feet.

The first 3 minutes worth of resuscitation efforts failed to convert the young brunette out of PEA, so a 2nd round of drugs were injected intravenously. Amy continued to receive fast, hard chest compressions, but the first nurse got tired, so they swapped out with another nearby nurse. The monitors chirped loudly in the half second in which CPR was stopped during the switch, but began beeping rhythmically once compressions were restarted. About 2 minutes later, Amy's ET tube refilled with blood, so suction had to be applied for the 2nd time. The tube was cleared, only to refill just 30 seconds later. While the breathing tube was suctioned out, Amy also started developing a nosebleed, and was bleeding from her IV sites. Amy went into rapid onset DIC, so FFP and more platelets were hung from the rapid infuser.

At the 6 minute mark of the code, Amy remained in PEA. Since the DIC compromised her IV sites, an IO was drilled into her left thigh since a central line placement wasn't a practical option at that moment. After one of the resident physicians drilled the IO in place, the next round of drugs were injected intraosseously.

At the 7 and a half minute mark of the code, Amy finally converted to V-Fib. The defib pads were charged to 250j, and a shock was delivered after all personnel stood clear. Amy's back arched, and her chest was thrust into the air briefly, but the shock failed to convert her out of V-Fib. A cycle of hearty, vigorous chest compressions were performed before the next shock.

A 300j shock was delivered in the coming seconds. Amy's body jerked and her toes curled slightly, wrinkling the soles of her feet. Post shock, her toes released from the clenched position back into a relaxed state. Shock #2 failed to produce a pulse, so a 3rd shock was delivered shortly thereafter at 360j. Amy's lifeless body jolted violently on the bed as the dose of electricity coursed through her dying body. This shock sent Amy back into PEA, so CPR and ambu bagging was resumed, along with the next dose of drugs going into the IO.

The next few minutes came and went with no change, with Amy's downtime just passing 10 minutes. Blood leaked from her nose and rolled down by her mouth and her cheeks from DIC. Blood was dripping down both her arms from her former IV sites. Amy's complexion was a ghostly, sickly whitish grey, and she was cool to the touch.

Approximately 3 minutes later, Amy's ET tube had to be suctioned out for the 4th time in such a short period of time. The plastic suction tube made a slurping sound as it gulped up all the blood that clogged the breathing tube. Just a few inches away, one of the nurses was pounding away on Amy's chest. The nurse had a red, flushed look on their face due to the tiring nature of giving compressions. However, they knew their inner complaints were nothing compared to what Amy was going through, so they kept going.

Several more unproductive minutes passed, with Amy deteriorating to an agonal rhythm. Yet another cycle of drugs were given, but once again failed to work effectively. The entire ICU team was growing more and more tired from giving chest compressions, and the once loud, hectic room became eerily silent, knowing that the end appeared to be near for the young woman they've been working on.

The ICU team coded Amy for another 5 minutes, but she was maxed out on drugs, asystolic, and had blown pupils. At that point, the ICU team ceased their efforts, calling time of death at 4:34am after an 18 minute code. The ambu bag was detached and the flatlined monitors were switched off. The nurses quietly removed the EKG electrodes and defib pads from Amy's bruised, battered chest. Lastly, her body was covered and a toe tag was placed before she was sent off to the morgue.

Hit & Run

Kim was a 24 year old Asian woman who had shoulder-length brown hair, brown eyes, and a petite frame. She was a cute, shy girl who worked downtown in I.T. as an app developer. On a morning not too long ago, her typical commute to work took a tragic turn.

Since parking is limited downtown, Kim usually parked her car in a parking garage a few blocks away from her job and walked the rest of the way. While crossing the in a crosswalk, a car sped around the corner, blowing through the red light, and striking Kim. She had very little time to react, so she stood frozen in fear for the half second it took for the speeding vehicle to run into her. The car initially struck Kim in her right thigh. She fell forward, slamming her torso on the hood of the car. She tumbled violently across the hood of the car before coming to a hard landing on the pavement as the car sped off, completely disregarding what had just happened.

A handful of nearby onlookers called 911, completely shaken up by what just happened. Kim laid in the street, battered and moaning in pain. “Help me…” she muttered. Kim had strong, throbbing pain in her right thigh and felt a sharp pain in her chest when she inhaled. She knew she was seriously hurt, but didn’t know the full extent.

A small crowd of nosey onlookers began to form around the injured woman. “are you ok miss?!” one of them asked. One of the members of the crowd started taking a video on their phone. Kim groaned and begged for help from the spectators.

In just a few short minutes, emergency services arrived on scene. Police ordered the nosey crowd to back away from Kim and the fire department set up cones and barricades to temporarily block off the street so first responders and emergency vehicles can gain access to the scene. Traffic was then redirected so the ambulance can pull in.

When the medics arrived, they promptly started their assessment of Kim. The paramedics discovered a compound fracture of the right femur. The exposed bone had to be reset and immobilized as soon as possible to avoid complications such as infections, fat embolism, circulation disturbances to the lower leg, or improper healing. While the medics reset the exposed bone, Kim yelped and cried loudly. After the bone was reset, the laceration on the anterior thigh was bandaged, and a splint was placed on the thigh. Even though Kim had sensation and movement in her lower extremities, a cervical collar was placed to play it safe. Kim’s winter jacket and shirt were cut off, only sparing her purple bra. The medics noticed bruising and redness all over Kim’s chest, which raised a red flag. A portable heart monitor was set up in order to monitor vital signs. Initially, Kim’s vital signs were: BP 94/57, heart rate 118 bpm, and an o2 saturation of 93%. The EGK was abnormal, showing an alternating tall-short QRS complex sporadically. At that point, EMS decided to set up 2 large bore IVs. The first attempt at IV access was unsuccessful since Kim wasn’t an easy stick, but IV access was obtained on attempt #2. A bag of finger’s lactate was hung to initiate fluid resuscitation and 1 dose of morphine was injected intravenously for pain management. Kim was then placed onto a backboard and stretcher, and taken into an ambulance for transportation to the ER.

Kim remained hemodynamically unstable during transport. The ringer's lactate maintained her vital signs, but didn’t necessarily improve them; all they did was buy her much needed time. Her breathing didn’t improve, so the medic in the back of the ambulance examined Kim with a stethoscope. Diminished breath sounds on the right side were noted, as well as muffled heart sounds. The medic decided to set Kim up on a nasal cannula with high flow oxygen. For the remainder of the ambulance ride, Kim remained responsive, but her condition didn’t improve much. She laid on the stretcher, trying her best to fight back tears. “am I gonna die?” she asked the medic. “we’re taking good care of you miss, just hang in there for us!” the medic replied, attempting to be reassuring.

Minutes later, the ambulance came to a stop in the hospital’s ambulance bay. The back doors swung open while the trauma team waited just a few feet away. The paramedics wheeled Kim out of the ambulance and into the ER’s entrance while the trauma team followed. “take her to trauma 1” one of the doctors said. “what do we have?” another doctor asked. “24 year old female, auto vs pedestrian. Hypotensive, tachy, 93% o2. Open femur fracture was reduced and splinted, possible chest injury. Diminished breath sounds on the right. We gave her a bag of lactate and a round of morphine. Patient has movement and sensation in all extremities, pupils are equal and reactive, and patient is awake and alert.” The medic replied, trying to give a quick rundown. “thank you, we’ll take it from here.” One of the doctors replied.

Once Kim was in the trauma room, she was lifted onto the table. It was all overwhelming for her: all of the people barking orders at one another, the bright light above her, and the sense of urgency everyone had. Kim lost her composure and began sobbing hysterically and saying “please, I don’t wanna die!” the trauma nurses tried to calm Kim down so the doctors could work.

After Kim was calmed down, the rest of her clothes were removed, making her completely nude in a room full of absolute strangers. Kim continued crying while she was long rolled off of the backboard and examined for any back/spinal injuries. After returning her to her previous position, the trauma team ordered trauma labs, a chest x-ray, and a FAST scan. The chest x-ray showed a stable, non-displaced transverse fracture of the eternal manubrium, multiple stable rib fractures on both sides of the thorax, and tension pneumothorax on the right side. The FAST scan showed pericardial effusion and a myocardial contusion. The FAST scan came back negative for the abdomen and pelvis.

Based on initial findings, the trauma team began Kim on the massive transfusion protocol. 4 units of unmatched o-negative blood, 2 units of platelets, and 2 units of FFP were hung from the infuser. With transfusion started, the trauma team’s next step was to address the tension pneumothorax on the right side. Since Kim was hemodynamically unstable, the attending physicians didn’t feel comfortable with sedating Kim during the chest tube placement.

Kim was given lidocaine while a small area on her right chest was cleaned off with rubbing alcohol. A 1 inch incision was made in between her ribs. Kim felt the cold, sharp blade’s every move as it cut through her skin with both ease and precision. When an adequate opening was created, the chest tube was inserted. Kim screamed and cried loudly in excruciating pain. Both air and blood leaked from the tube, allowing the young woman’s lung to reinflate.

Once proper chest tube placemen was confirmed, the trauma team focused on the pericardial effusion. Trauma surgery and cardiothoracic surgery were consulted before making the next step. Both surgical departments suggested a pericardiocentesis to aspirate the excess blood and fluid trapped in the lining of Kim’s heart. The space between Kim’s 5th and 6th ribs just to the left of her sternum was sterilized. A catheter and small collection bag was attached to the back of the large, fine needle. The needle was stuck carefully into Kim’s chest and maneuvered towards her heart. Kim could feel both pressure and a sharp, localized pain in her chest. She remained relatively calm during the procedure.

Coagulated blood was aspirated from the needle. Kim’s vital signs didn’t improve, so a repeat echocardiogram was performed. The echo still showed evidence of worsening pericardial effusion. The trauma team decided to perform a 2nd pericardiocentesis. The 2nd attempt at the procedure withdrew both fresh and coagulated blood, but didn’t ameliorate the situation. Kim’s vital signs continued to decrease rapidly, so she was started on vasopressors. The medication failed to stabilize her vital signs, and her level of consciousness decreased over the ensuing minutes, so the trauma team decided to intubate her. A 7.0 ET tube was navigated into her airway. Once the breathing tube was in the correct place, it was secured with a blue tube holder and an ambu bag was attached.

With Kim’s pericardial effusion remaining the same combined with her decreased vital signs, the trauma team called for a cardiothoracic surgery consult. The surgeon arrived minutes later and ordered another echocardiogram. This particular echo showed cardiac tamponade, meaning Kim’s situation was worse than before. The surgeon made a quick, but unconventional call. They suggested performing a pericardial window in the emergency department. The trauma team felt very uncomfortable with this idea since this is a procedure typically reserved for the operating room. A pericardial window is a procedure where a small cut is made into the chest so that a small portion of the pericardium can be removed so the excess blood can exit the sac around the heart. The trauma team didn’t feel that there was a better option in the moment, so they let the cardiothoracic surgeon lead the way.

The procedure began with a small, midline incision with an 11 blade scalpel beginning in the subxiphoid area, extending down past the diaphragm, and ending at the upper abdomen/epigastric area. Once the skin was separated, a 15 blade scalpel was used to cut through the fat and muscle so the xiphoid process could be exposed. Once the pointy, bony structure was exposed, it was snipped completely off with a tool known as a rongeur. A rongeur is a scissor like tool commonly used in orthopedic surgery to make cuts within bones. Since the xiphoid process is thinner than most bones, it’s an excellent tool to use in a pericardial window since it cuts through the bone quite easily. After the xiphoid process was excised, 2 nurses were each given Richardson retractors to keep the incision area opened wide enough. In order to reach the heart from this viewpoint, the surgeon had to get through a layer of fat that’s quite common in the thorax, known as the cardiophrenic fat. The overlaying area of fat was cut probed and shifted around, finally exposing the pericardium. With echocardiogram guidance, the surgeon made a 1 inch incision into the pericardium with a 15 blade scalpel. Before the portion of the pericardium could be taken out, Kim’s vital signs continued to drop. More fluids and vasopressors were given, but the surgeon had a sense of urgency; they knew they had to finish the procedure sooner rather than later. The portion of the pericardium was excised.

To everyone’s surprise, the line of sight became filled with blood since Kim started bleeding profusely from the incision site. Suction and surgical sponges were introduced to the area, but failed to fix the unexpected problem. The cardiothoracic surgeon put 2 and 2 together and realized Kim was bleeding profusely because of a cardiac chamber injury. The pericardial window created an area for this unwanted blood to flow into. Basically, they traded 1 problem for another: instead of Kim bleeding into her pericardium, she was bleeding into her chest and out of the incision area. The surgeon told the nurses to remove the retractors, sponges, and suction and quickly stapled up the incision area. The surgeon ordered the trauma team to place a left sided chest tube for additional drainage.

While the left chest tube was being placed, Kim became pulseless. The heart monitors displayed v-fib, so one of the nurses began chest compressions. Kim’s skinny chest caved in rhythmically, making her belly bounce outwards during each individual compression. After the 2nd chest tube was placed, blood shot out of the tube and onto the floor below. Epinephrine and atropine were pushed into the IV while the defibrillator paddles were being gelled and charged. The zoll m-series paddles were pressed up against the patient’s bare chest, and a 200j shock was delivered once everyone backed away. Kim’s pale, battered body jolted on the table, but no change on the monitor was seen. CPR was resumed as the paddles were gelled again and recharged to 300j. The 2nd shock was delivered once the cycle of compressions and ambu bagging was completed. Kim’s limp body flopped on the table, but no change was shown on the monitors. One of the nurses resumed deep, violent compressions on the dying 24 year old while the defibs were being readied just a few feet away. A short while later, shock #3 was delivered. Kim’s back arched from the increased intensity of the shock, before returning to her previous position a second or so later. Once again, Kim was in v-fib so the same cycle was repeated. The fourth shock caused Kim’s feet to leap into the air an inch or so above the table before slamming back down in an instant, wrinkling the soles of her size 6 feet. The 4th shock sent Kim into PEA, so harsh chest compressions were restarted.

A few cycles of compressions and another dose of cardiac stimulating drugs failed to restore a pulse, so the trauma team decided to perform a left anterolateral thoracotomy because of the dire situation. Betadine was splashed onto the left side of Kim’s chest. A 10 blade scalpel was used to make an incision in the 5th intercostal space starting at her sternum, extending across the chest below her left nipple, and ending in the mid axillary area just shy of her left armpit. The underlying fat and connective tissue was cut through to make room for the rob spreader, which was promptly placed moments later. With chest compressions still ongoing, the knob on the rib spreader was turned. A loud, repetitive popping sound was heard during the opening of Kim’s chest. There was a small rush of blood once the chest was cracked open, but the bleeding was rapidly quelled with suction. A vascular clamp was placed on the aorta to preferentially redirect bloodflow to the young woman's heart and brain.

External CPR was stopped and substituted with direct cardiac massage. One of the ER doctors wrapped their hands around Kim’s weakly fidgeting heart and squeezed it forcefully, desperately trying to get it to restart. The cardiothoracic surgeon made a larger incision into the pericardium, which was met with a large amount of both coagulated blood and fresh blood. The area was suctioned out so the line of sight could be restored. The surgeon didn’t have a perfect view of things, so they probed around in Kim’s chest attempting to find the precise location of the injury.

Within 30 to 45 seconds, the cardiothoracic surgeon felt something small and solid within the left ventricle. The surgeon pulled lightly with their index finger and thumb and were shocked at what they pulled out. A small bone fragment from one of the rib fractures broke off, sliced a hole in Kim’s left ventricle, and partially plugged up the laceration. The surgeon then called for a PGX surgical stapler to close the wound. 4 staples later, the ventricular laceration was closed. However, Kim remained in PEA despite the wound being fixed. Internal massage went on and the surgeon re-examined Kim’s chest cavity. “Right ventricle is empty and flaccid, but I can find a wound.” The surgeon said, shaking their head. The surgeon then inspected the posterior aspect of the heart for lacerations, but came up empty. “I don’t get it, she should be coming back by now.” The surgeon uttered in a frustrated tone.

The drugs converted Kim back to v-fib, so the trauma team put their search in hold in order to shock her. The zoll PD 1200 internal paddles were lowered into Kim’s chest cavity and around her fluttering heart. A 20j was delivered and accompanied by a full, wet thunk. V-fib was still present on the monitor so resuscitation efforts continued. A cycle of internal compressions were performed while the internal paddles were being recharged. Internal shock #2 was delivered in the coming moments. The 30j shock caused Kim’s torso to flop slightly, but once again didn’t restore a heartbeat. The same repetitive cycle was resumed for a moment before internal shock number 3 was delivered. Kim’s torso flopped and her heart twitched as the electricity coursed through her dying body. Fine v-fib was running across the monitors, so a 4th shock was administered. Again, her body jerks and her toes curl, showing off the prominent wrinkles in her soft soles. Post shock, her toes relax and spread from their previously clenched position. Kim remained in fine v-fib, so another internal shock was delivered.

Unfortunately, Kim became asystolic after this shock. One of the nurses checked Kim’s pupils, discovering that they were fixed and dilated. At that point, resuscitation efforts were stopped and time of death was called at 9:16am. The high pitched, flatlined monitors were switched off and the ambu bag was detached. The ekg electrodes were disconnected from Kim’s cold, battered chest. The finichietto rib spreader and clams were removed. After everything else was done, Kim’s body was covered up and ate tag was placed before being sent off to the morgue.

Later on, Kim’s autopsy revealed that the mystery injury was a partial detachment of the pulmonary artery from the right ventricle. The artery became semi detached and lodged in the posterior pericardium, explaining the massive bleeding and inability to restart her heart after the left ventricular laceration was repaired.

Patient 2 Sherri Gray was in bed 6 with an oxygen saturation of 70 on full ventilator support and a capnography of 20. Her vitals were a pulse of 130 and Bp 90/40 with her heart showing Atrial Fib with PVC’s on the monitor. The poor gas exchange was due to the the loss of respiratory cells in the alveoli and accumulation of fluid. The PVC’s were from the irritable cardiac muscle responding to the continued decease in oxygen and accumulation of carbon dioxide. Her feet were swollen as well as her hands. The skin color was pale gray with a shade of jaundice. Both the swelling and jaundice was from the kidneys and liver starting to fail.

A RT and nurse were going down the line of beds repeating their maintenance care of the patients. An RT were preparing to suction Sherri again. “Mrs. Gray we’re going to section you now. If can hear me this will help you breath”. They quietly discussed Sherri’s poor prognosis and continued deterioration. The RT had slid the soft suction catheter into the ET tube as brown and yellowish mucus filled the wall mounted suction canister. The nurse was checking the vitals for the chart.

Suddenly Sherri’s monitor alarm went off. It was her heart rhythm which now registered as ventricular tachycardia. The tall sharp and rapid spikes pushed across the monitor screen. The nurse pushed the code blue button on the wall. The RT disconnected the ventilator hose going to Sherri’s ET tube and released the CPR button on the hospital bed. That allowed Sherri to recycle flat on the bed and be prepared for resuscitation. Now flat in the bed the nurse and RT pulled the headboard out of the bed and slide it under Sherri as they lifted her torso. Once they had layed her back down the nurse quickly snapped off the front the Sherri’s hospital gown and began doing CPR. The RT attached a bag mask to the ET tube and ventilated Sherri after the nurse finished the first cycle of compressions. Sherri’s lungs full of fluid made artificial ventilation almost impossible. She had drowned in that fluid and the decreased oxygen had pushed her grossly weak heart into cardiac arrest.The other nurses in the unit came pushing the crash cart to assist. A hospitalist had been examining the patient in bed 10 walked over to help. The nurse doing the compressions briefed everybody “53 yoa age female full code status with an extensive cardiac history”. The hospitalist quickly looked over the grossly flabby obese patient as her body laying having her chest being pumped hard and fast. Sherri’s flabby breasts bounced around her chests with each pumped. He then looked up at the wall mounted monitor displaying VT. The doctor asked the nurse to hold CPR. He took his fist and raised high above Sherri’s freckled chest. With all his strength he thumped that fist in between Sherri’s big breasts. He looked up at the monitor watching the tracing trace off the screen. Then that line reappeared on the screen with the same pattern as before. “Ok charging the paddles to 100j so I can cardiovert her.” He slide the paddles off the unit and a nurse squeezed conductant gel on the paddles. He then pressed against Sherri’s clammy chest calling out “Clear”. After checking to see if everybody was clear he pushed the shock button. Sherri’s flabby arms twitched inward as her legs jerked. The RT reached up and silence the alarm so the code team could talk with their PPE on. The only change in the display after the shock was it shooting the tracing off the screen the same spiking pattern reappeared. The RT quickly squeezed the bag as the air was forced into her lungs. As he forced the air in the tube a wet growling noise could be heard. The doctor held the paddles on Sherri’s chest and called out he was charging to 200. After the brief period he again called “Clear”. Again Sherri’s flabby body jerked as her arms contracted. “Nurse administer Amiodarone at 150mg/3ml.” The nurse opened the medication box and popped the caps. After she assembled the med she then injected it into Sherri’s IV.

As Sherri’s code was progressing another heart monitor alarm could be heard. A nurse walked down the corridor to bed 9 and slide the curtain open to find the alarm sounding. It was Francis Black who’s heart rate had slowed to 40 bpm. The monitor was registering weak wide QRS complexes as her heart was failing. The nurse pushed the code blue button and checked for a carotid pulse. Not finding one she pushed the recycle for cpr button and start compressing Francis’s gray flabby chest. She then droppped the side rail and continued cpr without the board being in place. In seconds another nurse arrived along with an extra RT. They got the 68 year old on the headboard and continued CPR. This time when she pressed down she felt ribs pop as the 68 year old was getting compressed. Francis’s bones were bridle from osteoporosis. The doctor shouted from bed 6 “What do you all have”? The nurse responded “68 yoa female full code status with a history of N stage COPD in pulseless bradycardia”.

Sherri’s resuscitation continued with her now in course VF. The doctor prepared to shock her again with the paddles this time at 360J. When he had called clear and with paddles pressed into the flabby chest he pushed the shock button. Sherri’s arms and legs contracted as her head arched back. As her dying body lay lifeless now the code team checked for a pulse and the heart monitor. Her heart was still in course VF as the team continued CPR.

The doctor stepped away to look in on Francis finding her laying naked with the other staff doing CPR. He looked up at that monitor and watched the compression register. “Hold CPR please” he requested. As the nurse paused the monitor screen registered a flat line. “Ok she’s in asystole push a 5ml. of epinephrine and continue CPR.”

He stepped back to Sherri’s bed where her code was continuing. The doctor pulled the paddles off the cart then the nurse gelled them again. He charged them and pressed them against Sherri’s gray chest. When he shocked her, her body responded as before. He checked her femoral pulse as the nurse began pushing down on her chest. He called out to the nurse leading Francis’s code “If their no change go ahead and push another Epi. The doctor looking at Sherri’s charge nurse said”Start a Lidocaine drip at the max rate for her weight.”

At Bed 9 Francis was in complete respiratory failure along with heart failure. Her lungs were so bad that the RT couldn’t force air to move into her lungs. The ambu bag would blow off the ET tube which had filled with brown mucus. The doctor walked down and felt her femoral pulse as that team worked. As the nurse pushed down on Francis’s chest the doctor could feel the blood pressure increase. “Ok give her 5ml of atropine and continue CPR.” “Scribe call the pharmacy and tell them we need more ACLS drugs up here Stat!” It was hard to continue 2 codes out of the same crash cart.

About that time all could hear another monitor alarm sound. It was toward the other end. The doctor walked up and opened the curtain on Bed 3. It was Jessica Greene throw multi focal PVC’s and blood pressure was 40/0 BP. “I need a couple hands down here please.” A nurse from each of the other codes walked down to Bed 3. “Give her a dose Lidocaine at 1.5 mg/kg push and hang a drip. Watch her blood pressure we may need to start a dopamine drip.”

The doctor return to Sherri who was now in fine VF. He grabbed the paddles and prepared to counter shock her again at 360J. A nurse doing CPR stepped back, as Sherri was laying with her arms stretched out. Her morbidly obese body lay still and completely nude. The doctor placed the paddles as before now a bright red burn from the shocks. He pressed the shock button and Sherri’s reaction wasn’t as intense. After this shock her heart converted into asystole. “Give her a 2 amps of sodium bicarbonate and atropine at 0.5 mg”. Continue CPR. “How’s things going down in bed 9”? He asked. He was now standing where he could see all three patients.

“Doctor she’s still in a wide complex PEA with rate of 20.” As one of the two nurses did CPR on Francis and the second RT ventilated her. “Doctor she’s not moving air down here”. The doctor looked at Sherri who’s ventilations weren’t able to be made either. “Give Francis 2 amps of Sodium Bicarbonate and atropine at the max rate for her poor gas exchange and acidosis.”

The nurse treating Jessica called out “Doctor Bed 3 is now in VF we need to defib her.” Those two nurse disconnected the vent hoses hooked up to Jessica’s ET tube. They then got her on the headboard being used as a CPR board. Now the nurse snapped off the front of Jessica’s gown. As all three patients were now being administered CPR for the grave conditions. The doctor was faced with the life or death decision as he watched which patients were salvageable and who wasn’t. He watched all three codes progress another minute or two and saw only one decision. He walked over to bed 9 where Francis Black lay the monitor over her head tracing asystole. Every ventilation made a grunting noise like a pig, her skin was cyanotic. Her lungs damaged by the lifetime of smoking now failing from the ravages of the ARAD’s and pneumonia. “Ok guys she’s gone. Time of Death 3:40 am, just leave everything and go help with Bed 3.” The doctor pulled the curtain closed on Bed 9.

“She’s still in asystole so roll the crash cart to Bed 3.” Spoke the doctor As he looked at Sherri the nurse was pushing on her chest. He could see that her condition was only getting worse. “Go another epinephrine.” Sherri lay naked with her pubic hair showing and her legs lay with her feet pointing outward.

He continued on the Bed 3 where Jessica was in the mist of slipping into cardiac arrest. From her the septic shock caused by the pneumonia and had pushed her heart into fibrillation. It lay in her chest quivering and unable to push blood. The energy from the nurses chest compressions had taken over the pumping action. The doctor grabbed the paddles from the crash cart and pushed charge to 200J. He placed the paddles on Jessica’s chest and called Clear. As the shock shot through Jessica’s body reacted more violently than the older and bigger Sherri. The defibrillation failed to convert Jessica. He hit recharge and selected 300J and shocked her again with no change. He went ahead and repeated the third shock at 360J which only made Jessica body react more. The nurse felt for a carotid and shook her head no. “Ok start CPR again” said the doctor then asking loudly “what is Sherri’s condition now”? The charge nurse responded “No pulse and very small QRS PEA on the monitor rate about 10. Capnograph is worse and O2 sats are in the 30’s.”

At that moment the alarm went off from behind the curtain beside Bed 3. It was Kim in Bed 4 now slipping into her cardiac arrest. The doctor slid open the curtain between Bed 3 and 4.

“Go ahead and terminate Sherri’s resuscitation, we’ve got another one down here.” Orders the doctor to the code team working Sherri. Scribe show Mrs. Sherri Grays time of death at 3:52 am. The charge nurse was the last to leave Bed 6 and pulled the curtain shut.

Both Sherri and Francis were now legal dead and as their resuscitation over continued their journey in death. Both lay naked all life save interventions still in place. Their eyes relaxed and opened widely as did their mouths. The heads began turning purple and their bowels moved. Both had their nipples harden and they both perspired for the final time. The only difference was the paddle burns visible on Sherri’s chest. Both overhead heart monitors continued to run showing flatlines on all indicators.

The doctor took the paddles had the nurse gelled them and shocked Kim now in fine VF. Her pudgy body shook as the electricity activated her muscles. A nurse who had been working on Sherri now start CPR on Kim. The doctor turned around with the paddles in his hand pushed the select button. He then shocked Jessica at 360J afterwards her nurse continued CPR. “Give them both a Amiodarone at 150mg/3ml. and then 5ml of Epi.” “Doctor the pharmacy called and they’re out of all cardiac drugs.” Said the scribe. “Dam it so all we have left is what’s in our box. Nurse count what we have”. “Doctor theirs 2 sodium Bicarbonate’s and 2 Epi left.” Answered the nurse. He turned with the paddles to Kim and shocked her at 360J. He had never thought he would ever have to work so my patients at the same time. As he watched both the 31 year old and 54 year old had CPR being performed on them. Neither had any good readings on the monitor with their capnograph and Oxygen saturation; both not conducive to return of spontaneous circulation. As he took the paddles again he then shocked both at 360J. Both dying ladies arms twitched inward as well as their legs. That shock converted Kim to asystole but Jessica’s younger heart continued to show the wiggling line dancing across her monitor screen. “Give them both each the last amp of sodium bicarbonate. Give Jessica another Epi”. The doctor turned to the team working Kim and said “I’m calling her at 4:05am.” They stopped their efforts near exhaustion. “ The doctor took the paddles and prepared to shock Jessica again. This time Jessica got another 360 and her heart continued the random non life sustaining rhythm. As they team continued to work on Jessica, Kim’s body laying naked under the bright lights proceeded with death. Her eyes opened, her jaw dropped,her nipples hardened and her body sweated for the final time. The nurses, RT, and doctor continued to save Jessica a fellow nurse. Her firm young breasts bounced as the nurse pushed downward fast. The RT attempt to force even the smallest amount of air into her lungs. The doctor took the paddles and gave her another 360 which failed to convert Jessica again. He told the nurse to empty the last dose of Epi into Jessica’s IV. The nurse pushed the plunger emptying the last drop. It to failed to reverse Jessica pulseless condition.

Two other nurses went ahead and contacted the next of kin for the other three dead ladies. In each case they allowed the family to view the loved one via FaceTime. The nurses went ahead and cleaned up the interventions and filled out the appropriate documentation. Sherri, Francis, and Kim we’re covered with sheets after each having been wrapped with a sheet and tape. The nurses taped their arms at the wrists legs and ankles.

By now the doctor called the code on Jessica at 4:20am. The nurses repeat their care for her body. It was the best they could do given the situation and storages. All 4 bodies were placed in the waiting room which was being used as a temporary morgue. After several days the bodies were moved to a refrigerated truck for further storage. After a few weeks the were buried in a mass grave with other victims of the illness.

Candice was a 44 year old white woman, standing at 5'6 with a pleasantly plump build, shoulder-length brown hair, and brown eyes. Candice was always a history buff, so it’s no surprise that she worked as a history teacher at the local high school. Outside of work, she was married to her husband John for the past 12 years. The two of them never had kids, but Candice often joked that her students counted as her kids.

Candice didn’t have any significant medical history, but had been experiencing shortness of breath and heart palpitations on and off for approximately 3 weeks prior to the incident, and attributed her symptoms to the day to day stress of being a teacher.

Yesterday, Candice was brought to our emergency department after being found semi conscious and struggling to breathe in her classroom after school by the school’s janitor. The medics informed our emergency department that they set up 2 large bore IVs and hung a bag of normal saline, gave her nitro for her chest pain, and put her on an o2 mask with high flow oxygen. “Please… call John…” she said weakly to the medics while they prepped her for transport. The medics told her that the ER staff would get ahold of her husband, but that didn’t reassure her at all. “call him… I have to see him before I die!” she replied in a weak, wobbly voice. The medics told her she wasn’t going to die and that she was in good hands, but Candice had an impending sense of doom.

During the ride over to the hospital, Candice’s condition worsened. Her eyes were teary as she continued gasping for air. She began the cough up blood, which sprayed the inside of the o2 mask. She began coughing up larger amounts of blood, so the medics suctioned out her mouth while she continued to cough and hack away. Even though the medics cleared her airway of blood, she continued to frantically gasp for air. Her vital signs were also dropping rapidly despite the medics' attempts to stabilize her.

Suddenly, Candice’s cries and gasps stopped. She let out a calm exhale and her eyes opened wide, drifting off into unconsciousness. The heart monitors displayed pulseless electrical activity, so the medics had to start coding the 44 year old in the back of the ambulance. The medic in the back of the ambulance set up the Lucas thumper so they’d be able to multitask more easily.

Once the Lucas thumper was wet up, it began delivering perfect, mechanical chest compressions. Candice’s chest caved in, and her large, natural breasts jiggled in sync with the machine’s motions. The medic then injected doses of epinephrine and atropine into the teacher’s IV in an attempt to obtain a shockable rhythm. The next step was to intubate her. A 7.0 ET tube was carefully navigated into her airway during ongoing compressions. This was a bit of a moving target for the paramedic, but they were able to successfully place the breathing tube and secure it with a blue tube holder. Once the ambu bag was attached, the medic started bagging her while the Lucas thumper did its work.

The first handful of cycles proved ineffective since Candice remained in PEA, so the next round of drugs were pushed intravenously at the 3 minute mark of the code. After just one more cycle of ambu bagging and Lucas compressions, Candice converted to v-fib. The medic gelled the defibrillator paddles and began charging them. Once the paddles were ready, the Lucas was paused and the paddles were placed up against the patient’s bare chest, and a 250j shock was delivered. Candice’s body jolted violently in response to the shock, but failed to produce a change. The medic resumed the Lucas compressions while they gelled and recharged the defibs to 300j. Moments later he paddles were ready and the next shock was delivered. Candice’s back arched, thrusting her chest into the air while her eyes stared lifelessly above. Once again, this shock failed to convert her out of v-fib, so a 360j shock was delivered shortly after. This shock caused Candice’s feet to leap up above the gurney before slamming back down a second later, showing off the thick, soft wrinkles throughout the soles of her size 9 feet. The third shock sent the cute teacher back into PEA, so the medic resumed the Lucas thumper.

Candice arrived at the emergency department a few minutes later and was still in PEA despite Lucas thumper compressions and another dose of epinephrine and atropine, having a total down time of 6 minutes at that point.

After the medics informed the ER team of the situation, they removed the Lucas thumper and let the ER staff take over. A nurse began deep, harsh chest compressions on the patient, causing her head to loll and her belly to bounce outwards from the residual force of each individual compression.

With CPR ongoing, the attending physician ordered a battery of blood tests: a CBC, BMP, tox screen, cardiac enzyme test, and a d-dimer. After all the blood was drawn and sent off to the lab for stat testing, a chest x ray was performed. The x ray showed a 2.8cm right atrial dilation, but no other noteworthy findings. Because of the right atrial dilation, the ER attending ordered an echocardiogram. The echo further confirmed the right atrial dilation, but didn’t show evidence of any other conditions on the short list of diagnoses such as: major STEMI, thoracic aorta or SVC aneurysm, or structural heart defects. The attending thought this was either a PE or a bleed in the lungs from undiagnosed pulmonary artery hypertension. The treatments for these 2 conditions are very different from one another and the wrong treatment could exacerbate things, so the ER team’s goal was to obtain ROSC and send her off to radiology for a chest CT angiogram.

Around the 10 minute mark of the code, Candice converted back to v-fib. The orange defib pads were stuck onto her bare chest and the electric whirring of the defibs being charged could be heard amongst the organized chaos in the room. When the paddles were ready to go, they were pressed up against Candice’s chest and a 300j shock was delivered. Her body flopped quickly on the table as the jolt of electricity coursed through her lifeless body. V-fib remained on the monitors, so a cycle of chest compressions were delivered while the paddles were readied for the next shock.

A short while later, the paddles were recharged and a 360j shock was promptly delivered. Candice’s arms and legs bounced around in response to the shock. This shock sent the 44 year old history teacher back into PEA, so CPR was resumed.

The nurses pumped away at Candice’s chest cover the coming minutes to no avail. Her ET tube began to fill up with blood, so the ambu bag was detached and the tube was suctioned out in order to obtain a clear airway. The suction tube made a slurping sound while it withdrew both fresh blood and clotted blood from the patient’s airway. After a few quick rounds of suction, the airway was restored and the ambu bag was reattached and the code continued.

Candice continued to receive deep, violent chest compressions. Her flabby torso jiggled around, and her left arm hung off the side of the table, bouncing slightly, in sync with the CPR that was being performed. The next dose of meds were injected into her IV, but the ER team began to grow less and less optimistic as more time went on.

It took another 5 and a half minutes, but Candice converted back to v-fib at the 17 minute mark of the code. Once again, the paddles were charged and pressed up against the history teacher’s bare chest. Once everyone backed away, 300 joules of electricity were sent back into Candice’s dying body. The shock forced the 44 year old’s limp body to twitch abruptly in response to the jolt of electricity. Once again, Candice wasn’t able to be shocked out of v-fib, so the team recharged the paddles and hit her again at 360. Her toes scrunched, wrinkling the soles of her feet; post shock, her toes relaxed from their clenched position. Another unsuccessful shock was delivered before Candice once again converted back to PEA.

One of the nurses resumed CPR on Candice. They could feel her cold, clammy skin through their gloved hands as they pumped the cute history teacher’s chest repeatedly. Candice’s chest was red and bruised from several broken ribs and the constant, forceful pressing of her sternum. Her eyes remained wide open, with a blank, lifeless stare up above while her head bobbed around slightly from the compressions.

Candice was given another dose of meds at the 19 minute mark of the code, and converted to v-fib 2 minutes later. The ER team shocked Candice 3 more times, and coded her for another 5 minutes to no avail. Despite the ER staff’s best efforts, time of death was called on Candice at 15:53 while she was still in v-fib after a 26 minute code.

The ambu bag was detached and the chirping heart monitors were turned off. The nurses shut Candice’s eyes for the final time and began plucking the EKG electrodes off her bare, battered chest. The orange defib pads were peeled off and her body was covered up with a sheet, only leaving her feet exposed. A toe tag was placed on the big toe of her left foot before she was sent up to the hospital morgue.

*here's my latest story! There may be some typos here and there, but I hope you guys like it!*

Every year, thousands of Americans have cholecystectomies performed on them in order to treat symptomatic gallstones, gallbladder infections, and other associated conditions. The surgery is performed laparoscopically- a minimally invasive procedure where a few small incisions are made in the abdomen so cameras and other pieces of equipment can be used to perform surgery without having to open the patient’s entire abdomen. This form of gallbladder removal reduces the patient’s risk of infection and speeds up recovery time, with some patients even being released from the hospital the same day of the surgery.

Laparoscopic cholecystectomies are proven to be quite successful and are relatively easy procedures for most general surgeons, but they of course present potential complications. Infections, surgical error, abscesses within the abdomen, blood clots, and adverse anesthesia reactions have all been documented as potential complications. Cholecystectomy complications very rarely result in death, with mortality rates as low as 0.15%. Despite these low mortality rates, deaths still occur- one of which occurred at our hospital recently.

The patient was Bailey Moore- a previously healthy 23 year old who was of average height and slim build, and a fair-skinned, natural readhead with greenish eyes. Bailey had complained of upper right quadrant cramping, nausea, and a dull pain in the upper right quadrant after meals. Her symptoms persisted over the coming days, so she sought treatment at our ER. The emergency department performed an abdominal ultrasound and discovered a 2.1cm gallstone, along with several smaller gallstones around 0.4cm in size. With a diagnosis rendered by emergency physicians, Bailey was referred to our surgical department for further consultation and treatment.

The surgical team confirmed the ER's diagnosis of gallstones, and felt that a laparoscopic cholecystectomy was the best course of treatment. In preparation for the surgery, a few blood tests were ordered (CBC, BMP, Tox screen), an abdominal CT scan was performed, and she was given pain medications to temporarily alleviate her symptoms.

The following morning, Bailey was prepped for surgery and sent up to the OR. After being anesthetized, the surgical team intubated the young redhead with a 7.0 ET tube, securing the tube with a blue tube holder, and attaching the tube to a ventilator. The surgery began with 4 small incisions being made in her abdomen- 1 by the belly button, 1 in the right lower flank, 1 in the epigastric area, and 1 in the upper right quadrant above the gallbladder's actual position. The cut by the belly button and the incision in the epigastric area are camera insertion sites, while the incision in the right flank is for drainage (blood, pus, bile, etc). Lastly, the incision in the RUQ above the gallbladder is intended for the equipment used to remove it. After the incisions were made, the equipment and cameras were inserted into their correct locations. Once everything was in place, the procedure continued.

First, the gallbladder was located after the cameras were adjusted slightly. With the gallbladder located, the next step is to clip the celiac artery. The reason for this is to limit blood loss upon removal of the gallbladder. Since the gallbladder doesn’t have 1 major vein responsible for drainage, this is the only vessel clipped during the procedure. Following the celiac artery being clipped, the cystic duct was located and subsequently clipped. The reason for this is to prevent bile leakage into the abdomen upon removal of the gallbladder. Bile leakage into the abdominal cavity can cause complications such as infections (particularly peritonitis), or abscesses within the URQ. After the celiac artery and cystic duct were clipped, the next step was to ligate both structures. The ligature took several minutes each to ensure that there wasn’t blood or bile leakage. Following that step, a bag was placed over the gallbladder through the tool in the incision site in her URQ. Once the bag was placed over the gallbladder, the device pulled slightly on the small, green organ, removing it successfully.

After the gallbladder was removed, the surgical team kept the cameras in place for a moment to check for any signs of bleeding or bile leakage. Once the OR team realized there weren’t any overt issues, they removed all their equipment and closed the 4 small incision sites with derma bond, and sent Bailey up to a recovery room. Over the following few hours, Bailey regained consciousness and was extubated. Following a few post operative tests, Bailey was released from our hospital and told to refrain from strenuous activity for the following few weeks so the incision sites heal properly. At the time, it appeared the surgery was a success and Bailey was well on her way to recovery.

Approximately 2 weeks Post-OP, Bailey woke up that morning feeling a bit off. She had a dry, unproductive cough, felt short of breath, and also a bit fatigued. Her symptoms were tolerable at the time, so she decided to carry on with her day. But as the day went on, her symptoms grew increasingly worse, and she eventually fainted, prompting a 911 call from one of her friends.

On scene, EMS reported that Bailey had regained consciousness, but was having difficulty breathing. She was breathing heavily, practically gasping for air while the medics gave her an oxygen mask. Even with the oxygen mask, Bailey could barely say more than a few words at a time. Her eyes became teary at that point, because of the pain and discomfort. “I’m gonna be ok. They’re gonna get to the bottom of this.” She thought, trying to reassure herself, completely unaware that she’d be toe tagged and under a sheet just a little while later. The medics continued their assessment and asked her a few basic questions pertaining to her symptoms: “do you have a history of asthma?” “did you take any drugs?” “did you swallow anything that may have gotten stuck?” “did you have any recent surgeries?” Bailey shook her head “no" to the first 3 questions, then nodded “yes” to the final question. Bailey couldn’t get the words out herself, so she pointed to her belly and showed the medics her gallbladder surgery scars.

The medics next course of action was to set up a portable heart monitor and 5 lead EKG. The heart monitor showed sinus tachycardia with a heart rate of 132bpm, hypotension with a BP of 70/38, and an o2 saturation down to 94% even though she was wearing a mask. The 5 lead EKG showed t wave inversion in leads 1 through 4 with incomplete right bundle branch block. EMS realized the severity of the situation and immediately prepped her for transport and notified our emergency department that they were en route.

During transport, the medics were able to obtain IV access and begin fluid resuscitation. Even though fluid resuscitation commenced, Bailey’s condition continued to remain serious. She clenched her chest in pain, feeling as if there were a thousand tiny glass shards inside her lungs during every breath. At that point, every breath was a major undertaking for her. The medics decided to push pain meds to help the young woman feel more comfortable, but it only did so much for her. She continued breathing heavily, almost gasping for air. Eventually, Bailey started coughing. It was the same dry, unproductive hacking that she experienced on and off throughout the day. But moments later, she began coughing up blood. The blood stained the inside of the o2 mask she was given, and there were a few blood droplets on her face. “Oh my god…” she muttered weakly, with a terrified look on her face. For the remainder of the ambulance ride, her vital signs remained unstable, and she continued to cough up blood.

Upon arrival at the ER, Bailey was still experiencing hemoptysis with the same symptoms described earlier. The ER team immediately took the young woman into an open trauma room and began running tests. They first ordered blood tests: a CBC, a BMP, a toxicology screen, and a d-dimer. A chest x-ray was ordered, but showed non-specific abnormalities within the thorax. An echocardiogram was ordered, showing right ventricular dilation, as well as a right ventricular thrombus. A thrombus in the right ventricle is an uncommon, and often fatal finding that’s indicative of a massive blood clot that’s in transit to the lungs from elsewhere in the body. With this serious finding in mind, the ER team promptly started the 23 year old on anticoagulants in an attempt to break up what was likely a massive pulmonary embolism. However, these meds take a little while to work. Since time didn’t appear to be on Bailey’s side, the ER team decided to get in touch with interventional radiology and pulmonology in order to perform catheter directed thrombolysis (CTE).

CTE is a non-surgical procedure where an IV line is set up into a vein in your groin area and a catheter is then inserted. This catheter is then navigated into the location of a blood clot with x-ray guidance, and the blood clots are either dissolved or physically removed by the catheter.

However, Bailey’s condition worsened just as she was about to be sent over to interventional radiology. She coughed up copious amounts of blood over the span of a few seconds, and then became unconscious. A nurse did a sternal rub, saying “Bailey? Stay with us hun", to which she received no response. At that point, Bailey’s eyes were wide open, staring lifelessly above. The ER team knew Bailey was about to code, so a crash cart was wheeled into the trauma room, while the attending ordered her to be intubated. A 7.0 ET tube was navigated into Bailey’s airway over the following few seconds. A blue tube holder was used to secure the ET tube, and an ambu bag was attached.

While tube placement was being confirmed, the heart monitors showed that Bailey was in PEA, so ACLS protocol was initiated. Deep, violent chest compressions were started by one of the nurses. Bailey’s skinny chest caved in and her belly rippled in sync with the ongoing efforts. Epinephrine and atropine were pushed into her IV line in order to get a shockable rhythm. The first round of drugs and first handful of CPR cycles failed to convert the young redhead to a shockable rhythm, so a 2nd dose of epi and atropine were injected intravenously at the 3 minute mark of the code.

The drugs were able to produce a shockable rhythm after approximately 45 seconds, so the ER team stuck the orange defib pads onto Bailey’s bare chest and charged the paddles to 250. Everyone backed away over the next couple of seconds, and shock #1 was delivered. Bailey’s body jolted on the table for a moment before going limp again. The heart monitors showed v-fib, so a cycle of CPR was performed while the paddles were recharged to 300. When the paddles were charged, everyone stood clear while the paddles were pressed up against Bailey’s bare chest for shock #2. This 2nd shock caused bailey’s B cup breasts to jiggle around in response to the increased strength of the shock, but once again failed to achieve ROSC. V-fib still displayed on the monitors, so the paddles were recharged to 360 and Bailey was shocked for a third time. Bailey’s feet leapt an inch or so above the table before slamming back down, showing off the silky, prominent wrinkles throughout the soles of her size 8 feet. This 3rd shock sent Bailey back into PEA, so chest compressions were resumed.

The ER team kept up the fight to save their young patient. Bailey’s chest caved in from the deep, forceful compressions she continued to receive. One of her arms hung off the side of the table and bounced around in time with each individual compression. Bailey’s feet swung around ever so slightly on the opposite side of the table as her chest was being pumped repeatedly. While this was ongoing, her ET tube began to fill up with blood. The suction made a slurping sound while it removed the blood from the ET tube. But just as the blood was removed, it refilled. A second round of suction had to be applied in order to restore the young lady’s airway.

It took another 5 minutes to convert Bailey back to v-fib, with her total down time being just under 11 minutes. The paddles were charged to 360 joules and pressed up against her bare chest, and a shock was delivered. Bailey’s chest shot up, with her back arching. Her eyes were wide open, staring lifelessly above as her body plopped back down on the table after the shock. She remained in v-fib, so another 360j shock was delivered a short while later. Her torso twitched slightly during this quick dose of electricity, but she converted back to PEA.

Epi, atropine, and bicarb were all injected intravenously while the code raged on. Bailey’s ET tube kept refilling with blood, so multiple suction attempts were made in order to maintain the young patient’s airway. Aggressive CPR was also being performed, and was starting to take its toll on the young woman’s body. Her chest was starting to become bruised, and a few ribs had become broken since the start of the code. But all of that seemed minor in the grand scheme of things.

The meds and compressions failed to produce a shockable rhythm, so bailey was given yet another dose of meds at the 17 minute mark of the code, and again at the 20 minute mark. The medication and compressions produced v-fib, so the paddles were once again charged to 360 and pressed up against Bailey’s bare chest, and she was shocked yet again. Her dying body twitched on the table in response to the shock, but remained in v-fib. After a cycle of compressions, another shock was delivered. Bailey’s toes scrunched up, wrinkling the soles of her feet once again. The ER team was still unable to restart Bailey’s heart, so resuscitation efforts went on.

The ER team shocked Bailey 3 more times, pushed another round of drugs, discovered fixed and dilated pupils, and coded her for another 6 and a half minutes, but were ultimately unable to bring her back. Unfortunately, Bailey’s time of death was called at 13:56 while she was still in v-fib.

The ambu bag was detached from the ET tube and the monitors were switched off. The EKG electrodes and orange defib pads were pulled off of Bailey’s bare chest. Her eyes were then shut for the final time before a toe tag was placed and covered with a sheet.

The private emergency department waiting room was full of family and a few friends. All gather from calls for their friend, mother, and wife; who had collapsed at the soccer field earlier. The grim prognosis that “they were doing CPR and shocking her” was only made more apparent with the 90 minutes of no information now at the hospital. Her husband had arrived last from his public works job. Now a low hum of quiet talking and dead silence only allowed more anguish.

Suddenly the waiting room door opened and in stepped young doctor in scrubs and an apparent nurse. Both with grim and unanimated looks on the faces. Stephiane’s burley husband stood up knowing the news wasn’t good. The doctor grabbed the husbands hand firmly looking him in the eye asking “are you Stephiane’s husband”? The husband nodded. “I’m afraid your wife has passed, she’s suffered a fatal cardiac event, we tried everything we could but she was unable to survive.” The doctor spoke, as the grief and devastation filled the room of Stephiane’s circle. “She was in cardiac arrest when she arrived and we attempted to resuscitate her for 60 minutes. The damage to her heart was so severe, our efforts failed to get her stabilized” he added. “Sir had she been feeling ill?” He further spoke “as in cases like these we have notified the coroner’s office. They will as expected do an autopsy to help you and your family find the closure that you need” As the husband stood speechless as the nurse stepped up “sir here’s your wife’s jewelry” opening her hand and placing several rings, earrings, and multiple piercings of Stephiane’s in his hand. It was that moment the tragedy of of Stephiane’s sudden and untimely death really hit home.

Down a short corridor from their trough double doors and around a corner was Treatment Room 1. In it lay the body of Stephiane a 42 year old soccer mom have been pronounced dead after a 2 hour resuscitation. Her 5’ pudgy 290 pound naked corpse lay on the treatment bed. The Lucas devise still attached over her and now silent. A couple of nurse was completing the post pronouncing charting and cleaning their victim up. Vicky the charge nurse pushed the print button on the overhead cardiac monitor as a strip of paper began streams out of the unit. The machine was making a lowed humming noise as the strip printed out with the dark black flat lines on it,which matched the flatlines tracing across the screen itself. Each confirming for the patients chart, she was indeed deceased. The pudgy black haired, with her arms had been unattached from the sides of the Lucas device and now we’re stretched straight out. Her pudgy hands had nicely manicured finger nails. Sue the other nurse was taking the Lucas device off now. She released the two side catches which detached it from the back plate and pulled the top portion off. In the center of Stephiane’s chest was a bright pink circular impressions left by the Lucas device’s 10,000 strokes compressing the alabaster white chest. Her D cup size breasts were still firm and the nipples were as large as the impression left by the Lucas. Those nipples were firm, wrinkled, and rock hard as the priapism was in fullness. That supple chest was dotted with the defib pads, 4 and 12 lead electrodes. Stephiane’s body was sweaty as all the minuscule sweat glands were dilating for last time. Her blue eyes were open widely with the glassy gaze of death as was her mouth opened and now deathly relaxed. The Igel airway was still in place and secured with the strap which ran tightly around the back of her head through her beautiful wavy soft coal black hair. The yellow ambu bag was still attached to the ET tube slide in the Igel. The bag had been squeezed 1000 times during Stephiane’s resuscitation providing life giving oxygen for her body. The nurses pulled from underneath Stephiane, her shirt orange with #1 Soccer Mom Stephiane printed on the front which had been cut down the middle. The shirt had also had the sleeves cut all the way to the collar. Her black loose shorts and lacy panties were pulled down around her ankles. A little over Ninety minutes ago this story had started with Stephiane at one of her kids soccer games. The whole day spent at the soccer field was a regular for her and today she had start at 8:30am. 4 games later and now this was the last one of the early evening. Like usual she was setting in her folding canvas chair, in one arm rest pocket was her pack of Marlboro Light 100’s and a lighter. The other pocket was her 30oz. turbie cup which had been refilled several times. Without thinking and as she’d done all day long she reached for a cigarette. She was holding it in one hand between the index and middle finger with her lighter in the other. Suddenly her child’s team scored a goal causing the crowd to stand and cheer. She stood up cheered turned to her friend saying ”I’m so dizzy and I can’t catch my bre....”. The lighter and cigarette dropped from her hands as they relaxed. In the next second her knees buckled and Stephiane collapsed on the ground.

Another parent was a nurse ran to her as the crowd began to gather around. The nurse rolled the lifeless 5’ mother on her back, Stephiane only made a gurgling exhalation of air. The nurse immediately checked the ABC’s, called for somebody to call 911. The nurse didn’t feel a pulse or respiration’s as Stephiane’s facial color was already turning gray. The nurse worked in ICU at the local hospital and knew what to do next. She placed her hands in the center of Stephiane’s chest and started pushing down as hard and fast as possible. As she pushed down an audible pop noise was heard and the nurse felt ribs being dislocated. Another parent was an EMT and had ran to get his med bag out of his car. He came over and got out a bag mask from his kit and started artificial respiration’s. The 290 lbs 42 year lay their on the sidelines being tended to as best as could be expected. Stephiane’s belly had became dissented from the lack of airway and her obesity. It had been about 15 minutes when I’m the distance a siren could be heard. The noise got close and shut off and a rescue squad arrived.

The truck and crew were BLS trained and brought over their gear. The standard BLS resuscitation gear which was an AED, suction kit, and airways. The nurse let the firefighter/EMT take over as the EMT continued bagging the patient. The first thing they did was cut open Stephiane’s Number 1 Soccer Mom shirt as well as cut the bra strap. Her big floppy breasts pushed open the garments as the other firefighter began pumping Stephiane’s chest hard and fast. The other firefighter hurriedly took the AED and open it cover. He stretched out the chest pads and peeled the back off the right upper chest pad. He stuck it in the prescribed area of the chest. He repeated with the left chest pad, having to push Stephiane’s breast up to apply. Now with the pads in place the AED announced “Analysis heart rhythm stand clear”, as the firefighter EMT’s stood clear. Stephiane laid on the bright green grass half naked stirring up her face with a expression of confusion. She was unconscious laying their but still had enough responsiveness to still have a facial expression. After several seconds the AED announced in its female computer generated voice “Charging place stand clear”. The auditable tone grew louder as the unit charged itself. Then the machine announced “Stand Clear And push the shock button now”. As the firefighter did so sending the wave of energy into the 42 year old’s chest. The energy caused Stephiane’s body to reflexively move her face still had the confused expression. The Firefighter went back to do CPR as before and at the direction of the AED. They repeated the AED cycle two more times with in each case Stephiane getting a shock of more energy with no change. In between CPR cycles and AED cycles, the EMT bagging her had retrieved a I-gel airway from the proper bag. He had gelled it with the lube and slide it in Stephiane’s mouth. As he pushed into her throat he noticed she had been salivating heavily. He pushed it as far as he could noticing the bulge in her throat. Once he had it in place he secured it with the strap connected the bag mask. He watched her chest rise as he squeezed it and listened for breath sounds to confirm placement. As another siren approached the AED charged itself another time. Stephiane’s reaction to this shock was as before. The EMT in charge looked around the crowd and asked “Anybody know what happened”? The nurse who was a friend quietly spoke up “ Her names Stephiane, she’s 42, she told me that she had Hypertension and Type Diabetes”.

A county EMS unit pull in the parking lot. The crew jumped out and got their gear out of the side compartment. They grabbed the normal take in bags, a monitor defib, and Lucas Device. They got to the patient and assessed the situation. With the cardiac resuscitation in the field the Lucas was were their treatment started. The medics and EMT’s wrestled Stephiane’s dead weight on to the back plate. Then they snapped in the top of the Lucas and pushed it on. The piston extended some the medic pushed it down to the chest wall and pushed the start button. In an instant the computer in the device measured the thickness of Stephiane’s chest and calculated how far to push. As that was finished it began pumping away. Each stroke caused Stephiane’s blotted belly to ripple some. They quickly lifted her on to the ambulance cot while the Lucas pumped, as it was programmed. Once on the cot they pushed Stephiane over to the Med Unit and then pushed her on the cot inside. A rescue squad EMT climbed in with the medics. As the Lucas pumped away each medic took on a task. One medic took Stephiane’s arm stretching it out place a tourniquet. He took a 16 gauge jelco IV cath and inserted it in a vein at the wrist. He pulled back with a syringe drawing blood into it. The EMT had spiked an IV bag and handed that medic the IV tubing.

The other paramedic placed the electrodes around Stephiane’s obese torso and snapped then into the lead cable from the heart monitor. They showed Stephiane’s heart was in fine VF the medic plugged the defib pads from the AED to the manual unit. He then set the energy setting “ How many shocks she got in her”? He asked. The EMT said “4”. The medic dialed the manual unit to 125 in biphasic mode and hit charge. He called “CLEAR!” Pushed the button. Stephiane’s arms and legs retracted then relaxed as her eyes wide open stirred glassy into space the Lucas continued pumping away on her chest. The monitor showed the heart had converted to asystole after pausing the Lucas . The medic looked around at the crowd of folks watching and said “guys let’s get her to the truck”. By now one of the other EMT’s had retrieved the ambulance cot from the truck. Each crew member took an arm or leg and the medic lifted Stephiane’s torso by Stephiane’s cut shirt as they carried to the cot. The Lucas continued pumping away without missing a beat. They laid her down and then raised the cot rolling it to the ambulance. Once they locked the cot in the medic turn off the Lucas to look at the monitor which was a flat blue line on the screen. He quickly turned the Lucas back in and it continued the chest pressing. Each push caused Stephiane’s tummy to bulge upward. Once in the back the medic pulled out the IO kit. He connected a obese tip to the drill as the EMT spiked and hung an IV. As he flushed the tubing the medic drilled the IO in Stephiane’s humerus. The medic grabbed the line and attached it to the IO port and opened the valve as IV fluid began flowing. The medic then assembled an Epi syringe set, flushed it, then injected it into the tubing. The crew working in the cramped space didn’t have to talk much for they all knew what each needed to do. One of the original responders would squeeze the bag attached to Stephiane’s I-gel airway. Each squeeze made that gurgling noise cardiac arrest victims often made. He looked at Stephiane’s eyes open wide with the pupils large round and empty. The medic looked at the EMT saying “Atropine” as he prepped it for administration. The EMT asked “Bicarb”? Looking at the medic. “Yes 2 amps please” as they were being assembled the medic looked at the capnograph on the monitor as the pulse line made wide even waves from the Lucas. The medic looked at the EMT bagging their patient and told him to squeeze deeper. This was to get the capnograph higher hoping to increase the low O2 saturation. The medic then pushed the large sodium bicarbonate syringes in series. He looked at the forth responder watching them work saying”Ok you go ahead and drive”. The EMT got out of the back and in the drivers side.

As the ambulance pulled away in the back Stephiane’s condition remained unchanged. The mechanical sound of the Lucas pumping up and down on her chest 100 times a minute and the siren filled the air. The medic looked at the EMT saying “get me another Epi and D50, she might be have severe diabetic hypoglycemia”. He was looking at her obese body trying to figure out the cause of her arrest. Treating the H’s and T’s was the current protocol for cardiac arrest. After he emptied both syringes into the IV running in Stephiane’s arm he pushed pause on the Lucas. The monitor showed the patients heart with wide QRS complex’s at a rate of 10. He could here a heart beat with his stethoscope meaning she had Pulseless Electrical Activity. He knew no matter the cause this was one of the worst outcome heart emergencies. The medic asked for 300 mg Amiodarone for IV bolus push and once he had it administered it. The EMT providing the ventilations looked at the medic and asked about vasopressin next for Stephiane. He nodded and the other EMT pulled the box from the drug bag. After which he assembled it and handed to the medic. The Medic was trying to figure with H’s and T’s might be the cause as he stopped the Lucas and watched Stephiane’s heart still in PEA how be it faster. The QRS complex’s were dancing across the screen at a rate of 50 now. The medic felt for any pulse at the carotid artery. He then asked the EMT for a amp of calcium so he could push it in the event Stephiane was hypokalemic. The EMT then handed him another Epi since it was time for another dose. The medic asked for Narcan next thinking that Stephiane might have overdosed even if she hadn’t presented with the overt signs of drug use. He then had the EMT ready another Amiodarone at 150mg and even hung a dopamine drip. The EMT bagging Stephiane watched the capnograph wave form to see if the ventilations were effective. He had noticed the bag was harder to squeeze and the wave form was flattened. The EMT also observed some reddish frothy sputum pumping up in the ET tube. He then took his stethoscope and listened to her lung sounds. He told the medic that they were diminished on the right side. The medic radioed the ED “Medic 2 ETA 5 with a 42 YOA female cardiac arrest with PEA on the monitor. ACLS being administered at this time”. The crew continued treating their clinically dead patient as per protocol all the way to the Medical Center.

It was after a year and a half good news. Donna and I was at her oncologist getting the report on her cancer. Eighteen months ago we had started this medical drama with a mass discovered in Donna’s right lung. Shortly after a biopsy diagnosed her with having non small cell carcinoma. The follow up PET scan showed that the cancer had spread to her liver, pancreas, and breast. The oncologist was frank then giving her 6-10 months to live. The first course of chemotherapy had no effect of the tumors and new cancers were observed in her brain. Other than weight and some hair lose she’d not been really sick. The oncologist suggested a clinical study with a new immune therapy to control her cancer. It had came with a lot of warnings but we felt that it might give her a positive outcome. After the course of therapy the first report was no growth and shrinking of tumors. Now 9 months later the doctor told us the news we’d never thought we would never hear “Complete Remission”.

We were about half way home about Piketon when she said her chest was hurting. She felt like an elephant was setting on her chest. Donna seemed so restless all of a sudden and her color wasn’t right. She said “Honey I think I’m having a heart attack” as she sweated profusely. I didn’t know what to say. I noticed her breathing was growing more erratic with every second.

Donna’s heart was in an crisis, ischemic damage from years of smoking combined with myocardial weakening from the immune therapy. The clinical study hadn’t isolated cardiac myopia as a side effect of the therapy. Both combined with her bodies reaction of being so excited was all it took to induce a myocardial infarction. Her heart was struggling to act as a pump, cells were either already dead or dying. Not in one area of the muscle but systemic to the whole heart.

As I was trying to make sense of all this I noticed on the right was an urgent care center. I pulled up in the lot and drove to the ambulance entrance. A staff member standing outside noticed Donna leaning over on me and went in to summon help. 2 guys ran out and I got out and opened the passenger door. A couple of more nurses ran out pushing a gurney. The more muscular built guy pulled Donna over as the other guy grabbed her under arm. Both held her under her arms now and supporting the back as the lifted her limp body I grabbed her legs to help. I saw that Donna had wet her trousers as we laid her flat. The muscular guy felt for a pulse in Donna’s neck “No pulse she’s in cardiac arrest”. They rolled her through the doors and down the corridor as a clerk walked up to me. “Now sir what’s her name?” “Donna White” mam. “What’s her age sir”? “57 she’s my girlfriend” I responded. As we walked inside I could hear the staff working on Donna down the corridor. “Has she been sick recently”? The clerk asked. “Ahh yes she’s had cancer and ahh”. “Ok sir what about chest pains or heart trouble”? “No not really just for a few minutes ago”. While she continued to ask me the information Donna was down the hall being resuscitated.

Donna lay lifeless on the gurney as staff worked to stabilize her life threatening condition. “Ok guys cut her cloths off” the doctor in charge ordered. As the nurses took their shears cutting the blouse and trousers off as the tall EMT pushed hard on Donna’s chest. “Hook her up to the monitor and get a reading” the doctor spoke. He stood at her feet watching the aggressive activity. A nurse hooked EKG pads to the cable ends hooked to the overhead monitor. Another nurse turned the unit on as the other EMT placed an ambu bag over Donna’s mouth and nose to provide artificial ventilations. The nurse stuck the small white foam pads on Donna’s gray freckled chest. “Hold CPR” as the monitor picked up Donna’s heart tracing. The screen was filled with spiked lines across it. “Ok she’s in VF, nurse hand me the paddles” he took them for the nurse. He held them up and the nurse applied gel to the metal side. The doctor rubbed them together and placed one on the right upper chest and the other below the left breast. He pressed the charge button and set the dial to 200 joules. He called “Clear” and instantly Donna’s 200 lb. body jumped from the gurney. Her heart rhythm continued the spike across the screen and the doctor charged again with an increase to 250j. This shock caused the same reaction as it shot through the 57 year olds body. Again the tracing showed no change on the screen, her heart fibrillation continued unabated. The doctor repeated the counter shock this time at 300j and Donna only reacted with more back arch and arm contraction. The doctor stepped back looking around the gurney giving instructions to the staff. “Start CPR” to the tall EMT and looked at the nurse saying “IV with D5 normal saline”. He looked at the other nurse and asked for a curved blade, laryngoscope, and a 7.0 ET tube. He then told the clerk acting as the scribe to call EMS for a emergency transfer to the Portsmouth the closest hospital. The nurse spike the the D5NS and then slide the angiocath IV catheter into the patients arm. As she completed hooking the set up the EMT pushed down hard causing Donna’s flabby breasts the bounce across her chest. The Doctor slide the blade into Donna’s mouth visualizing the vocal cords. He advanced the ET tube along the blade into the trachea and inflated the cuff with the 50 cc syringe. The air filled the cuff in Donna’s mouth cause it to open some. The doctor checked for breath sounds watching Donna’s chest rise with each deflation of the bag mask. He could hear the air rattling into her lungs scared by a life of smoking. The EMT began compressions again as Donna lay eyes glassy and without any responsiveness. He looked up at the monitor the screen still filled with erratic spikes. “Nurse administer 5 ml. of epinephrine and an amp of bicarbonate.” The other nurse had placed large round defib pads on the chest. “Ok let’s shock at 250j again”nurse charge the unit and call Clear when it’s ready”. The ladies voice shouted clear as all the staff stood away from Donna. Suddenly the stillness of death was interrupted with Donna’s body contorting as the electric shock triggered contraction. This shock caused her heart’s fibrillation to cease and asystole now traced across the monitor screen.

As that was going on the clerk that took Donna’s info escorted me out the ambulance entrance. I heard the nurse call clear and saw Donna’s contract to that shock down at the end of the hallway. The nurse told me that they would be transferring Donna to the hospital in Portsmouth which was about 20 miles away and that I would be best to wait on the parking lot. I could follow the ambulance on it’s way with her to the hospital.

The clerk walked down the corridor with the medical history. “Donna White 57 year of age female with a history of terminal non small cell carcinoma in remission. No cardiac history other than hypertension. She’s had a previous bariatric surgery 10 years ago.”

The clinicians continued care for their cardiac arrest patient. The nurse gave the epinephrine and the bicarb. The other nurse switched doing CPR with the EMT as the other EMT provided artificial ventilations with the bag mask. In the distance the responding EMS unit could be heard getting closer. As they arrived Donna’s cardiac arrest continued with her in asystole and the second round of cardiac drugs on board.

As I set in my car the EMS unit pulled up and the medics unloaded their gear onto the ambulance cot and rolled it inside. As I waited in the car I called Donna’s daughters to tell them about their mom. They were both shocked and fearfully the outcome. All I told them that she was having what I thought was a heart attack making no reference to see her lifeless naked body being shocked. I told them to meet us at the hospital in Portsmouth and hung up. It seemed to be forever that I waited for the EMS crew to bring Donna out.

The sliding doors opened and the medics pushed what looked to be Donna laying on the cot. Over top her was a Lucas device pushing up and down on her chest. I could see her color was grayish pink and they rolled the cot in the ambulance. Then the ambulance sped away.

In the back of the ambulance the medic continued to give Donna ACLS care. He injected another Epi into the IV tubing. He then checked her pupils which were not blown and fixed. Thinking to himself Donna was another attempted resuscitation that would end in a sudden cardiac death. Every 5 seconds the portable ventilator would give Donna another breath of oxygen rich air. The Lucas pumping up and down every second on her chest pushed, on her ischemic dead heart which pushed blood through her circulatory system. Donna’s brain continued to function as the blood rich oxygen remained consistent. Donna’s mind was still fuzzy as she laid their in dying confusion. She didn’t know what was happening to her. The pain of the Lucas stroking her chest the ribs dislocated from the CPR. Her dying thoughts were wanting to tell her daughters, grand kids, and boyfriend she loved them. Her eyes were open as she gazed up at the Lucas and medic working over top her. She heard a voice (the driver) “How’s she doing?” The medic treating her respond “No change she in asystole I don’t why they urgent care can’t pronounce these. She a goner for sure”. She felt like she was smothering as the years of smoking added the her demise. The tar stained lungs fluid when fluid choking the gas exchange. Her O2 sats drifted down as her capnograph readings began to rise. The CO2 in the cells rose and brain cells start to die. Donna slipped from the fuzzy consciousness to unresponsiveness as the medic noticed Donna’s pupils dilated and fixed. The medic continued treatment by hanging a dopamine drip to increase vasoconstriction and pushed an ampulla of sodium bicarbonate to try to reverse the capnograph reading. He then picked the Radio mic as contacted SOMC with the report. “In route with a 5 minute ETA, 57 yoa female cardiac arrest, asystole on monitor, poor O2 sats and capnograph, ACLS in progress, witnessed arrest at Urgent care, history of cancer and hypertension.” ER responded “Waiting on your arrival”.

I arrived at the hospital the ambulance was empty, medics had already took Donna back. I was taken to the private waiting room.

In the back Donna’s resuscitation continued the doctor looked over her quickly barking out orders like a general. He told the staff to draw blood gases and push another Epi. He also told a nurse to start pacing Donna. Her heart only registered a weak complex QRS wave ever few paces. None of which triggered a detachable pulse which meant she was having pulseless electrical activity. Shortly the gases came back as bad as the non invasive O2 sats and capnograph. The doctor examined Donna for any signs of life and found none. He asked the charge nurse to print a monitor strip and pronounce Donna dead. As the staff finished their efforts radiology arrived and took a portable chest X-ray. It’s was an odd site X-rays machines cross hairs aiming on the center of her chest discolored from the chest compressions. That chest still now as the radiology tech called out the warning the machine buzzing taking the picture. It showed the doctor his 57 yoa cardiac arrest victim chest was full of fluid from pulmonary edema and an enlarged heart. The anterior ribs were creaked and dislocated from the chest compressions. As the doctor read Donna’s medical history, her body continued in its full transition into death. The skin mottled and blood pooled some.