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The elevator down the corridor opened, and Dr. Ana Agüero came onto the floor. The three at the station noticed her before she reached them.

Dr. Ana crossed the unit at an even pace. At 5’5” she was slim, her straight brown hair swept up and neat, gray coming in plainly at her temples and roots— she didn’t hide it, and it suited her over a face that ran younger than the gray suggested. No scrubs; she wore a tailored outfit with a white coat over the top, a slim gold watch, and clear-rimmed glasses over deep brown eyes. Neutral nails, simple slip-on leather mules, nothing super flashy or showy anywhere. She looked expensive without working at it, and senior in a way the white coat had little to do with.

Ana reached the station and set a slim leather bag on the counter. The other three drew in around her. She pushed her glasses up with one knuckle, looked once down the row of glass doors, and turned back to the three faces already waiting on hers. “Good evening, everyone,” she began, her Argentine accent noticeable. “What do we have?”

Nurse Bri went first, glancing down at her clipboard more out of habit than need. "Room 1, Elise Arnell: 53 year old female. Post-MI. She coded in the ED earlier today, defib times 2, epi times 1, downtime of 4 minutes before ROSC. They took her up to the cath lab after and the procedure went well. She's sedated and intubated now, neuro intact when we lightened her earlier. Systolic's a little soft— she's on a touch of norepi, 4 mics, holding her mean arterial pressure in the mid 60s. Otherwise she's doing well. Cardiology's back at 9 tomorrow to reassess."

Ana nodded slowly, her eyes going to the glass of room 1, where the monitor traced its steady green line. "Wean the norepi as she tolerates. I don't want to be chasing a pressure all night if she doesn't need it." She looked back to Bri. "Good."

Dr. Sloane picked it up from there, uncrossing her arms, "Bed 2 HAD Aaliyah Vaughn, 30 year old female." The past tense landed before the rest of it did. "Dr. Sarah sent her up from the trauma bay around 3:00 this afternoon. Didn't ask— just dumped her on us. High-speed MVC, blunt trauma to the head, chest, and abdomen. She came up unconscious, intubated, and her numbers were ugly from the jump. We kept her going as long as we could, but she ended up coding. We shocked her 11 times, four rounds of epi, worked her 35 minutes. She stayed in refractory V-fib, pupils fixed and dilated. I called time of death at 6:27." Sloane paused. "She's toe tagged and covered. We're just waiting on transport to take her over."

For a moment nobody said anything. Dr. Ana's gaze moved to the closed door of bed 2, the drawn blinds, the room gone dim behind them. Thirty years old. She let it sit there, brief and real, before her jaw tightened a fraction.

"Three o'clock," Ana repeated. "So Sarah knew what she had, and she moved this woman upstairs before she could die in the trauma bay." It wasn't a question. Her voice stayed level, cool, more contemptuous for how quiet it was. "She sends me the ones she's already lost so the death goes on our board instead of hers." She shook her head once. "We'll talk about it another day. You made the right call stopping when you did— 35 minutes on those numbers was generous."

"That's what I figured," Sloane agreed, and moved on. "Bed 3, Valeria Alvarez, 31 year old female. Opioid overdose, brought into the ED earlier today. She seized in the trauma bay— about 20 minutes, per Dr. Lindsay— before they broke it and got her sedated and intubated. She hasn't coded, but her vitals have been all over the place since she came up, and I don't love how she looks." Sloane's mouth flattened. "Honestly, I've got a bad feeling about this one. I'd keep a close eye on her tonight. And there were some neuro deficits noted after the seizure, so neurology's going to come by in the morning to work that up."

"What's she doing hemodynamically right now?" Ana asked.

"Borderline. Soft pressures, tachy to the 110s, and her sats have dipped a couple of times on the vent even after we adjusted her settings." Answered Dr. Sloane.

Dr. Ana studied the room a moment. "Then trust the feeling. Low threshold to call me on her— I'd rather hear about it early than get walked in on it."

Sloane nodded, not saying anything else.

That left Nurse Megan, who'd been quiet at the edge of the group. She straightened slightly when Ana's attention shifted to her. "Bed 4, Michelle Nguyen, 46 year old female. Post-op day 4 from an open appendectomy. She's got a fever, she's tachycardic, and her pressure's on the softer side. She's awake and oriented, but she says she feels worse today than she did yesterday." Megan glanced at her notes. "We've got broad-spectrum antibiotics running, she's getting fluids, and fresh cultures went off to the lab a little while ago."

"What was her lactate?" Dr. Ana asked.

Megan hesitated half a second, clearly a little nervous. "I'd have to check the most recent one..."

"Check it. If it's up, or if it's climbing off the last draw, that changes how worried we are." Ana said it without any edge— a correction offered more than delivered. "A day-4 belly that feels worse instead of better is telling you something. Cultures are right, fluids are right. Just don't let the number get away from you."

"I'll pull it and get back to you," Megan answered.

Dr. Ana straightened and swept the row of rooms one more time, filing it all where she kept it. "All right. Good handoff." She picked her bag up off the counter. "Let's get to work."

The huddle loosened and broke, each member of the team peeling off toward their own end of the ICU.

Over the next little while, the unit settled into the evening. The bright urgency of the day shift completely gone, and what replaced it was quieter and slower— the particular rhythm of our ICU at night, when the work turned to watching, charting, and the small maintenance of people too critical to be anywhere else.

Dr. Sloane took a seat at one of the workstations, logging her notes on Aaliyah and Valeria, her face lit pale by the monitor. Dr. Ana was in and out of the rooms, unhurried, reading her way into each patient the way she liked to at the start of a shift— checking a vent setting here, scrolling a trend line there, and building the picture she'd carry until morning. Nurse Bri moved between beds, practically with muscle memory at this point.

Nurse Megan pulled up Michelle's labs at the far workstation. She found the lactate she'd been sent for and felt something in her shoulders ease: 1.8, down slightly from the draw before it. Not the number of a patient falling off a cliff. Michelle was souring, but slowly, and the antibiotics had time to work. When Dr. Ana passed behind her a minute later, Megan caught her. "Michelle's lactate came back," she reported. "1.8. Trending down, not up."

"Good." Dr. Ana didn't slow much, but she gave a small nod that landed like approval. "Keep watching it. That's the right thing to be tracking." And Ana moved on toward room 1.

Nurse Megan turned back to her charting. She was most of the way into it when Bri drifted over and set a fresh stack of flowsheets on the counter beside her, close but not crowding.

"You did good work on that code earlier," Bri complimented. She said it lightly, her eyes on the flowsheets and not on Megan, giving her room. "35 minutes is a long time. Not everybody keeps their head in the game that long."

Nurse Megan's hands paused on the keyboard. "Didn't matter, though."

"Sure, it didn't change the outcome," Bri agreed, easy about it. "But that’s a different thing than not mattering." She squared the papers, still not making Megan look at her. "Some of them you don't get back even when you did everything right. Doesn't mean you did anything you weren’t supposed to." After a pause, "You holding up okay?"

"Yeah." It came a little too quick, and Megan knew it, and softened it. "Yeah. I'm good…"

Nurse Bri let that stand. She didn't push, didn't make her sit in it— just gave a small nod, like the answer was fine whether or not it was true, and let the subject close on its own. "Holler if bed 3 does anything weird. Sloane's twitchy about that one." Nurse Bri was already moving off as she said it, and the ordinary business of the floor closed back over the moment.

For a while, it was quiet. The monitors kept their steady lines. Somewhere a pump beeped and was silenced. Megan finished her note.

Then the tone changed.

It came from room 1: a sharp, insistent alarm cutting across the calm, the pitch that every one of them knew in their spine before they even looked up. On the central monitor, Elise Arnell's rhythm came apart, the clean line torn into something fast and chaotic.

Dr. Ana was three steps from room 1 when the alarm went off, and she was through the door before anyone else fully processed what was going on.

The monitor told her most of it in a glance: the clean line she looked at ten minutes ago tore into a fast, coarse pattern, the signature sawtooth scrawl of ventricular fibrillation. Dr. Ana pressed two fingers to Elise's carotid and got nothing back. No pulse. The heart on the screen wasn't beating; it was quivering, and quivering didn’t move any blood.

"She's in V-fib, no pulse," Ana shouted. "I need everybody in here, NOW."

Dr. Ana dropped the head of the bed flat, laced her hands over Elise's sternum, and started chest compressions herself.

Elise Arnell didn't look like someone whose heart just stopped. That was the strange, awful part of it— she looked great. 53 and holding it beautifully, a tan she hadn't earned in our building, straight blonde hair still neat against the bed’s padded surface despite the day she had. She had a bright white manicure not too long ago, and it survived the ED code, the cath lab, all of it; her nails reflected the light as her hand rocked with each compression Ana drove into her bare chest. She was fuller-chested, and her body moved with the force going into it, but the face stayed slack, sedated, and unbothered, as though the whole catastrophe were happening to someone else. Dr. Ana continued pumping away at Elise’s chest, her large tits bouncing and jiggling around, her belly rippling out.

The rest of the team was already coming. Nurse Bri reached the doorway first, took in the room in a single stride— Ana on the chest, the rhythm on the screen— and went straight for the code cart, pulling it in behind her with a rattle of wheels.

Nurse Megan was a half-step behind her. For one moment the alarm went through her like a cold wire, the old lurch, her stomach knotting on itself the way it always did in the first second of these. Then she moved through it, the way she was learning to, and her hands found the cart.

"Bri, take the chest," Ana ordered. "I'll run it."

They traded without losing a compression— Ana lifting away in the same instant Bri's hands came down, Bri settling her weight into the rhythm, clean and unbroken. Ana stepped back to the foot of the bed, where she could hold all of it in view at once: the monitor, the patient, her three people.

"Pads," Ana barked.

Megan pulled the defibrillator pads from the cart, peeled them, and set them— one under the right collarbone, one below the left breast— pressing each down firmly, the leads clicking home into the machine. The rhythm redrew itself across the screen in that lead, and it was the same as before: coarse V-fib, the tall, ragged, disorganized waveform of a heart doing everything except what it was supposed to do.

At the head of the bed, Dr. Sloane slipped in without being asked. She took hold of the endotracheal tube already seated in Elise's throat, checked it at the lip, reconnected the ambu bag, and began to breathe for her— controlled squeezes of oxygen worked around the compressions. "Airway's secure," Sloane reported. "I've got the head."

Nurse Megan drew the first milligram of epinephrine and capped the needle, holding it where Ana could see it. Ready, not given.

Dr. Ana's eyes stayed on the monitor a moment longer, reading the coarse waveform. Coarse was better than fine. Coarse still had something to work with. "Alright, charging to 200." Ana called out.

She reached for the defibrillator and thumbed the charge. The machine answered with its signature high-pitched, rising whine, winding up toward the shock. Bri still delivered deep, strong chest compressions, Sloane still bagging, Megan holding the epi, all of them waiting on the tone to peak.

"Clear," Ana’s voice surged once the defibs were charged and good to go.

The team came off the patient all at once— Bri lifting her gloved hands from Elise’s bare chest, Sloane leaning back off the airway, everyone's weight pulling away from the bed in the same instant. For a half second Elise lay untouched, alone in the center of the room with the charge waiting.

Ana pressed the shock button.

The current went through the 53 year old hottie, and her body answered instantly. Her legs tensed hard, feet flexing at the ankles, her toes curling tight and involuntarily, showing off the deep, thick, soft wrinkles throughout the soles of her size 8 feet as the jolt raced down through her. Elise’s shoulders jerked against the bed’s padded surface, then let go, and she dropped back into the bed, motionless again, everything that seized in her going loose all at once.

Every eye went to the monitor. The line scrawled its noise for a second or so as the machine caught back. It settled, and it was the same as before. Coarse V-fib. Tall, ragged, and disorganized. The shock did absolutely nothing.

"Still V-fib," Ana stated. No heat in it, just the read. "Resume compressions."

Bri's hands came back down without hesitation, and the rhythm picked up where it left off, her weight driving into each one. Sloane resumed bagging at the head, oxygen moving again in time with the chest.

"Epi, one milligram." Ana ordered.

Nurse Megan had it ready. She pushed the milligram she was holding into the line and flushed it after, the drug on its way now, and said, "Epi's in."

"Good." Ana's eyes stayed on the monitor a moment longer, then went back to the patient. Two minutes of compressions ahead before the next rhythm check, the code settling into its cycle around Elise's still, composed face.

The code settled into its grim rhythm. Nurse Bri pumped away at Elise’s bare chest at a hard, even clip, her arms locked, her shoulders stacked over her hands, driving her weight straight down. The compressions came in a steady mechanical cadence— thudthudthud, each one sinking deep into Elise's chest and letting it spring back before the next fell. Two inches down, full recoil, over and over. Her chest caved under each stroke and rebounded, and with every downstroke her belly rippled outward, the force of the compression traveling through her. Elise’s big, perky tits jiggled around in perfect sync with Nurse Bri’s compressions. The bed shifted faintly with the tempo. It was violent, but unfortunately necessary.

"Good compressions, Bri," Ana complemented, watching the depth. "Stay right there."

Dr. Sloane breathed for her from the head of the bed, a squeeze of the bag every few seconds, her eyes moving between Elise's chest and the ET tube. Nurse Megan stood ready at the crash cart, the used epi syringe set aside, her jaw tight and her eyes fixed on Bri’s hands working Elise’s chest.

The clock on the monitor counted the cycle down. Dr. Ana let it run, giving the compressions and the epi their two minutes to do what they could, her attention split between the patient and the timer, reading the room the way she read everything.

"Coming up on two minutes," Ana called out as it wound down. "Charging again— 300 this time. Keep going till I call it, Bri."

She reached for the defibrillator and thumbed the charge. The machine took the command and began to climb, its high-pitched whine rising again through the room, going toward 300 joules while Bri stayed on the chest— thud, thud, thud— the charge building in the background as the code ensued.

"CLEAR," Ana called out once the defibs were ready to go.

The team came off her again— Bri's hands up off the chest, Sloane back from the airway, Megan staying back.

Ana delivered the shock once she ensured everyone was clear of Elise.

It discharged with an ugly, heavy KA-THUNK, and Elise's body was thrown with it. Her torso heaved up off the bed, her arms flung out and slapped back down, her whole frame tossed and jarred by the electric current tearing through her. The bed rocked under the force. Then the charge released her and she dropped, dead weight, back down onto the bed— arms askew, head lolled, everything gone slack in an instant.

Every eye shot to the monitor. The screen threw its noise for a split second, then cleared and drew the rhythm plain. Coarse V-fib, exactly what it showed before the shock. 200 joules didn’t touch it, and now 300 joules didn’t either.

"Still V-fib," Sloane shook her head, reading it off the screen.

"Coarse," Ana added, her eyes on the same waveform. She didn't reach to resume anything yet. For a moment she just looked at it— the rhythm that wouldn’t budge.

"Let's rotate," Ana directed. "Megan, take over."

Bri lifted her hands and Megan stepped in without a break in the rhythm, dropping her weight onto Elise's chest and picking the compressions right back up, her strong athletic hands pummeling Elise. Her jaw was set and her pretty brown eyes were a little wide, the tension sitting on her plainly, but her hands did the job and did it well. Elise’s chest caved and sprang under each downstroke, her belly rippling out with the force, tits bouncing around again.

Nurse Bri moved to the cart, free now, ready for whatever came next.

"Good," Ana nodded, watching the depth of the compressions for a moment. "Right there." Her eyes went back to the monitor, to the coarse waveform still scrawling its ugly line, then to the clock counting the cycle. "We're going again. Charging to 360." She reached for the defibrillator and thumbed it up. "And I want another epi. One milligram."

"Epi, one milligram," Bri called out, already drawing it up. She had it up in a moment, pushed it into the line, and flushed it after. "Epi's in."

"Good." Ana nodded, succinct and to the point.

The defibrillator climbed toward 360 joules, its usual whine rising through the room while Megan stayed on Elise’s bare chest, delivering deep, violent chest compressions.

The cycle ran itself out, the minutes blurring into one another, compressions holding to the end, and Dr. Ana called the clear.

Hands came off Elise, the room pulled back from the bed. Ana then delivered the shock.

This one moved through Elise differently. There was no heave, no toss— just a fast, fine shiver that ran the length of her body that came and went in an instant. And as it passed, Elise’s eyes drifted open. Not all the way, just half— the lids parting to show a sliver of blue underneath, fixed on nothing, staring up at the ceiling with no awareness behind them. It was the emptiest thing in the room, and for a second it stopped the breath in more than one throat.

No one reached to close them. Every eye was already on the monitor.

The screen resolved out of its noise, and there it was, unchanged: coarse V-fib. Three shocks now, three rounds of epinephrine, and the rhythm scrawled the same ragged, disorganized line it showed at the very start.

"Still V-fib," Sloane noted quietly.

Dr. Ana looked at it, and this time she didn't call for anything.

For a second nobody moved. Nurse Megan looked to Dr. Ana, already shifting her weight forward, ready to drop back onto the chest and resume CPR. It was the rhythm of it; you worked until someone told you to stop.

"Hold off," Ana spoke, quiet and even. Megan stilled.

Ana turned to Sloane. "How long has she been down?"

Sloane checked, though she already knew. "About 15 minutes. Refractory V-fib the whole way— three shocks, three rounds of epi, no change. Pupils are fixed and dilated."

Ana didn't answer right away. She looked at Elise— the half-open eyes, the blonde hair still neat, the bright white nails, the composed face that never once caught up to what was happening inside her— and she let Sloane's answer settle, taking the full measure of it before she moved.

Then she reached down and stripped off her gloves.

"That's it," Ana stated. "We've done everything we can for her tonight." Her voice stayed level and certain. "Time of death, 7:43 P.M."

The room let go around her— hands coming away from the bed, the code cart going quiet, the work simply over.

"Let transport know we have another. She goes down to the morgue with Aaliyah now." Ana told the team.

For a moment after the time of death call, the room stayed as it was, everyone still gathered around a patient who no longer needed them.

Then it began to come apart, quietly. Sloane reached up and silenced the heart monitor, and the jagged, chaotic line vanished from the screen, taking its noise with it. She leaned over the head of the bed and disconnected the bag valve mask from the endotracheal tube, setting it aside; the small hiss of forced oxygen stopped, and the room went even quieter.

Dr. Ana was already moving. She dropped her gloves in the bin and stepped out toward the workstation, the paperwork of a death waiting for her, her mind visibly turning ahead to the calls she owed— the family/next of kin, most notably. Sloane went with her a moment later, peeling off toward her own charting, and the room cleared until it was down to the two nurses and the recently deceased woman in the bed.

Nurse Megan didn’t move. She stood where she ended the last round of compressions, looking down at Elise— at her half-open blue eyes, the neat blonde hair, the almost peaceful face, even now, looked like it belonged to someone who should be fine. Megan looked a few seconds too long. Something behind her own eyes went flat and far away, the particular stunned stillness of a young nurse processing how quickly a living patient becomes a body.

Nurse Bri saw it. "Hey. Megan." Her voice was easy, low, pitched to reach her without filling the room. Megan's eyes came up. "Why don't you help me get these leads off of her."

It wasn't really a question, and it wasn't really about the leads. It was a rope thrown, dressed up as a task— something to do with her hands, a reason to look somewhere other than that face. Megan took it. She blinked, drew a breath, and came back into her body, moving around to the far side of the bed.

The two nurses worked together in the quiet. Bri peeled the electrodes away one at a time, and Megan followed her lead, easing the leads free and coiling the wires, the small tasks that come after— the ones nobody teaches you until you’re on the job. Bri kept close as they went, her movements unhurried, letting Megan match her pace.

"You kept your head the whole time she was down," Bri complimented, not looking up from her hands, laying it out like a fact rather than a comfort. "That's the job. That's all this job ever is." A moment passed, another electrode lifted away. "The rest of it, you feel later. On your own time. Not in here."

Nurse Megan didn't answer, but something in her shoulders let down a fraction, and she kept working, staying close to Bri's side as the two of them tended to what was left.

A couple of hours later, the unit found its way back to normal (or its own version of normal). The urgency of Elise Arnell’s code was well behind them now, folded into the night like everything else, and the floor returned to its slower work— the watching, the charting, the quiet maintenance of the living. Elise's room stood dark and empty at the end of the row, stripped and cleaned, and bed 2 sat empty beside the memory of Aaliyah. Two of them gone in a single evening. The ICU absorbed it the way it absorbed everything, and kept going.

The team drifted back to the main station between rounds, the way they did at the start of the shift, though the mood changed in the hours since. Nurse Bri worked through her charting with the same steadiness she brought to everything. Nurse Megan sat a seat down, quieter than she was at the start of her shift, but back in her body, doing her notes, steadier for having been kept busy. Dr. Sloane came and went, checking her patients, her eyes lingering a little longer on bed 3 each time she passed it. And Dr. Ana moved among all of it, in and out of the rooms, the calls to Elise's family behind her now, the night's losses filed where she kept such things.

The two who remained on the board that night would go on to write very different endings.

Michelle Nguyen, in bed 4, turned the corner she was circling. The fever that worried them broke over the days that followed; the antibiotics found their mark, her pressures firmed, and the day-4 belly that was trying to tell them something quieted down to nothing. She stayed in the unit a few more days for observation, then moved out of it entirely— off the ICU, onto a floor bed, and eventually out the front doors five days later with discharge papers instead of a toe tag, a full recovery from a post-operative sepsis that could just as easily have killed her. The careful, unglamorous management held.

Valeria Alvarez, the OD patient, didn’t get the same ending. The bad feeling Sloane carried about bed 3 proved true, as those feelings too often did. Overnight and into the next day she slipped further from them rather than closer: her vitals eroding, the ground she never quite gained giving way beneath her. The following afternoon the team fought to hold her together and ultimately couldn’t; she coded, and despite everything they tried, she was unable to be brought back. She was pronounced at 1:13 that afternoon, on a different shift, in front of the daytime ICU crew— but it was Sloane who saw it coming the night before, standing at this same station, saying she didn't love how the woman looked.

(reposted from original blog to new resus blog) Part 4 https://www.tumblr.com/defib-the-hidden/817424039823966208/weve-lost-her-part-4?source=share

John and Natalie stared intently at the EKG above Autumn's head which read a long flat endless green line.

Dr. John defeatedly pulled a pen light and flashed it at Autumn's hazel eyes. "Pupils are fixed, I'm sorry we've lost her," he admitted with a professional tone of defeat in his voice.

Natalie's eyes fell, dejected as she removed the bag from Autumn's parted lips.

"Time of death 1:05," Dr. John called out, probing Autumn's chest with his stethoscope. She barely felt it, her chest so numb from the repeated bashing.

Natalie's soft fingers lightly waved over Autumn's eyes, shutting them as Autumn surrendered to the darkness.

There was a loud click as the EKG was shut off and a soft rustling as the blankets were pulled over Autumn's face. The cool air ripped at her legs and ankles as the blanket pulled over her face exposing just her feet.

Natalie softly let her fingers linger against her right ankle as they stepped out.

For the first time Autumn felt alone, exposed despite being covered and somewhere between delirium and exhaustion unable to comprehend what came next.

The missing beeps and clicks that had enticed her before were absent, leaving her alone with her own emptiness in the face of death.

"Ok cut!" Dr. John called out.

Kelly McGee blinked beneath her blankets twice. Coming back to reality, she slowly peeled the blankets from her face and ripped at the tape that had held the tube in her mouth and sucked precious air, breathing using her own diaphragm for the first time in what felt like a year.

James Bachman walked out from behind the camera to help the young adult film actress as she pushed herself to her elbows, the blonde wig falling away from her brightly dyed pixie cut.

She sucked in deep breaths looking at him with a daggering look to remind him not to say a word until she had recovered.

He dutifully removed the "Dr. John" lab coat and handed it to 18-year-old Jordan White, who moved in to comfort her still recovering girlfriend.

Kelly forcefully grabbed a fistful of the scrubs that had been poorly fitted to her actress girlfriend and kissed her forcefully.

"Oh you liked that," Jordan whispered in her ear when she was finally able to break free of Kelly's kiss.

Wisps of cool morning air found their way under the blanket that covered her, tickling the bare skin of her legs, arms and stomach- the beige wool blanket covering here somehow simultaneously providing warmth and exposure. She dared not move even the slightest muscle, not even sure if she could if she wanted to at this point. The skin at the peak of her bust, and just at the edges of her ribs stretched slowly, rhythmically with each forced breath. The tube pushed between her lightly parted lips urging the only movements from her otherwise still body. A rhythmic click accompanied each puff of cool stale air forced down her throat, a pinging beep of the ekg machine above her head lulled her into a meditative trance as her eyes glazed over on the ceiling. Why she was there, she couldn't say, they hadn't told her. Now it was just her- autumn- lying alone with her existence.

Beep, beep, click, beep, beep, click... she had lost track of how long she had been there. Maybe it had only been a few minutes, maybe days of endless nothingness.

Beep, beep, click, and then another click, a different click this time nearly pulled her from her distant trance. A soft wave of cool air tickled her pale face as a door opened slowly. She could not immediately tell who had entered, a doctor, a nurse, a friend to visit? These thoughts faded quickly back into nothing, the trance of sounds pulling her back into the fog.

The wavy chestnut hair of her nurse Natalie greeted the fringes of her vision answering her questions. She looked intently, probably too intently, at a clipboard in her hands. Their juxtaposition was startling to Autumn in ways it hadn't been before. The two girls were of similar age yet found themselves in strangely different paths in this story.

Natalie's bright blue scrubs fitted her tightly in flattering ways but in the same way exposed nothing leaving Autumn feeling more exposed and emptier.

"Autumn O'Riley, 18, brought into the ER after collapsing at cheer practice, resuscitated and placed in a medically induced coma, no change in condition after 6 hours" she read methodically to no one.

Autumn felt her toes tense with each word, O'Riley felt like a horrid cliché, cheerleader even worse and out of touch with herself, nothing felt real, who she was hours ago and who she was now were not the same person and this girl, lying lifelessly on this bed felt so far from who she should be.

Natalie peeled back the blankets, exposing her naked form to the cool air. Autumn felt every hair on her body stick out into the fresh air, the sensation of her exposed nipples tightening in protest to the cold. It left her feeling an internal warmth, somewhere between horror, and arousal that only seemed to deepen her trance like stare into the void.

The icy face of a stethoscope touching her bare chest brought her attention to each sensation assaulting her body. The itchy tackiness of each ekg lead, the gentle thump of her heart that seemed to lightly shake the gentle fold of skin at the base of her left breast, rapidly out of time to the beeps that filled her ears.

She felt breath become more labored, if it was fear from her situation, or the icy hand of the cool air constricting her body she couldn't say. Even the pressure of Natalie's fingertips pressing into the stethoscope that radiated into her skin felt binding.

As if on cue the navy-blue cuff strapped tightly to autumn's left upper arm began contracting, even the pulsometer around her pointer finger felt like it was crushing around her fingernail. Autumn wanted to scream, to jump up, cry out, something!

But just as soon as the walls came crashing in, they jumped back out, Natalie pulled the blankets back over her patient and the room returned to its peaceful trance- beep, beep, click, beep.

Her eyes lulled again into a hazy daze as she lost herself in the ceiling once more. She felt each fiber in her face relax, deeper, deeper, like she was falling, melting into the soft sheets beneath her.

She was small— 5’0” (if that), slim and petite under the spread of leads and lines that ran across her skin. The young lady was an Asian-American female who was naturally tan— the kind that didn’t come from a tanning bed/salon. Her hair sat at collarbone length, near-black and softly wavy, blunt bangs cut clean across her forehead. The features beneath them were striking— particularly those sharp dark eyes that were highly expressive. There was a thin silver hoop pierced through her right nostril, two equally small hoops through her earlobes. She wore a black sports bra and matching black underwear and nothing else; the outline of nipple piercings shaped the front of the bra in two small points. A patchwork tattoo sleeve covered her right arm shoulder to wrist— a layered collage of black ink work, fine lines and shading running into each other in a way that read deliberately curated rather than impulsive. A small crescent moon was inked on the outside of her left ankle, just above three silver anklets that reflected the overhead light each time the gurney moved. Her nails, fingers and toes both, were painted a fresh glossy bright white. Two 18 gauge IVs ran from the antecubital folds of each arm. Five EKG electrodes stuck to her ribcage around the sports bra. A pulse oximeter was clipped to the index finger of her right hand. A blood pressure cuff was wrapped around her left bicep area.

“Clara Khai, 19 year old female,” began the medic at the foot of the gurney, her voice clean and unhurried. “Witnessed syncopal episode at home approximately 35 minutes ago. Partner made the 911 call— said the patient was midsentence, sitting on the couch, and just dropped. Out for about 60 seconds. Regained consciousness on her own before we got on scene. By time we walked in she was alert and oriented, sitting up. Two large bore IVs in, 18 gauge, normal saline. On the rig we got her set up on the portable heart monitor. Heart rate’s 132 sinus tach with frequent PVCs and a couple of short runs of non-sustained V-tach. Pressure 106/64, sats 96 on room air. Chief complaint is palpitations, lightheadedness, and nausea. Reports she’s felt off for two or three days, but couldn’t quite say how. No known cardiac history, no family history she’s aware of. Vapes nicotine and occasional THC use, no illicit drug use as far as we know. No prescription meds, no known allergies.”

The medic at Clara's head leaned in slightly, voice softening as she addressed her patient. “Alright, Clara, we’re going to slide you over to their table in just a second. You’re going to stay sitting up just the way you are now, nice and easy. On three.”

The medic at Clara's head finished her count, and the three of them slid Clara across in a single smooth motion, keeping her upright the whole way. The padded surface of the trauma room table received Clara without much complaint— the small rustle of the transfer barely registering on her face, though her hands tightened a little against her thighs as she settled.

“Alright, Clara, you’re doing great,” one of the medics reassured, already stepping back.

Nurse Nancy moved in from Clara’s left almost before the EMS crew finished clearing— clipping off the wires from the portable monitor and clipping in the hospital leads in their place. The EMS crew’s pulse oximeter came off Clara’s index finger and the ER’s was on a second later, this one tethered to the wall. The trauma bay monitor lit up almost immediately. Heart rate 136. BP 104 over 61. Sats 95 on room air. The rhythm strip running across the screen showed sinus tach interrupted every fourth or fifth beat by the wide, ugly downstroke of a PVC.

Dr. Lindsay was at the right side of the table now, just below Nurse Nancy, where Clara could see her without turning her head. She kept her voice low and steady.

“Clara, I’m Dr. Lindsay. I’m the attending physician who will be taking care of you this evening, okay? You’re in good hands.” Introduced Lindsay.

The EMS team was rolling the empty gurney back toward the doorway, handoff complete, the lead medic giving a small acknowledging nod to Lindsay on the way out. The case officially belonged to our team.

Clara watched Lindsay’s face for a moment, her chest still rising and falling a smidge too fast. When she spoke, her voice came out quiet and breathy.

“Okay, like… yeah. Hi. Hi, I’m… I’m Clara…” the young lady answered Lindsay. She blinked, swallowed, and kept her eyes on Lindsay, “Did somebody… is somebody calling my girlfriend? She rode separate. She was, like, right behind us, I think? I just want to know if she’s here yet. Or if somebody can tell her what’s up.” Continued Clara. There was a pause before Clara kept talking. “Sorry. I’m sorry. I’m just— I don’t feel right. Something’s, like… something’s really not right, ya know?”

Dr. Lindsay's eyes stayed on Clara's, her face settling into something close to a small, careful smile as she listened. "It's nice to meet you, Clara. I just wish it was under better circumstances."

Lindsay shifted her weight, hands resting lightly on the rail before continuing, "We'll follow up about your girlfriend in just a few minutes, okay? I promise. Right now I just want to focus on you. Is that alright?"

Clara nodded— a small, quick nod, eyes still locked on Lindsay's face.

Dr. Lindsay's voice stayed calm and even. "Good. So you just told me something doesn't feel right, correct? Tell me a little more about what you're feeling, Clara. Have you ever felt anything like this before? Any fainting episodes like this in the past?"

Clara opened her mouth, then quickly closed it again. Her tongue touched the inside of her bottom lip. Her chest still rose and fell too fast, "Um. No. No, like, never. Never anything like this." Her voice came out a little thinner, "Tonight was the first time I, like— the first time I passed out. I've never fainted before in my life. I didn't even know what was happening until I came back or whatever it’s called."

Clara drew a small breath, dropped her eyes to her own hands for a second, then brought them back up, "My heart's been doing weird stuff on and off for like, two days? Maybe three? I don't know. It feels like it skips or something. Or flutters. Like it's not beating right, and then it'll go really fast for a second and then slow down, and then it does it again. And I keep getting these waves of dizziness. Like the room's going sideways for a second, and then it stops." Clara tried to explain. The young patient paused briefly, then continued, "And I keep feeling sick to my stomach. Not throw-up sick but like, just... wrong. Like something is— I don't know. I just know something's wrong, and I, like, don't have the words for it. I'm sorry I can’t explain it better."

Clara’s eyes went back to Lindsay's. "I just thought I was tired. Or stressed. My girlfriend was the one that called 911— she really really wanted me to come in."

Dr. Lindsay’s expression softened a little, “Well, I’m glad she did. She made the right call. That’s somebody who cares about you.”

Lindsay let that sit a second before going on, “Two or three days you’ve been feeling off, right?”

Clara nodded.

“Okay. A couple more questions from me. Any history of heart problems you know of? Anything in the family? Any anxiety, diagnosed or otherwise? Any drug use? Any medications at all, prescription or over the counter?” Lindsay followed up.

Clara’s eyes flicked up to the ceiling for a split second, like she was checking herself for the answers, then came back to Lindsay. “No. My heart’s, like, fine, I think. I mean, nobody’s ever told me anything was wrong with it. And nobody in my family has, like, heart stuff that I can think of.”

Clara paused briefly, then went on, “I’m low-key kinda freaked out right now, ya know? But I don’t have, like, diagnosed anxiety or anything. I’ve never been on meds for anything like that. And, um… for drugs, I just vape and smoke a little weed sometimes. That’s it. I don’t, like, mess with any of the crazy stuff. And nah, no meds. None.”

Dr. Lindsay’s gloved hand came to rest gently on the edge of the table next to Clara’s, close but not touching, “It’s totally normal to feel freaked out right now. I know this is overwhelming, and nobody ever pictures their night ending up here.”

Clara nodded— small and a little uneven. Her eyes glassed for a second before she blinked it back. “Yeah. Yeah, no, I… thanks. I really appreciate that.” Clara’s voice was a little thinner than before. “I keep, like, trying to tell myself this is just, like, a really bad panic attack or something. Like that’s what this is. But it doesn’t feel like that. It feels different. I don’t, like… I don’t know how to explain it.”

Dr. Lindsay straightened a little, “Okay, Clara. Here’s what we’re going to do next. We’re going to start with some basics— I’m going to have my team draw some blood tests. Blood count, your electrolytes, kidney function, magnesium, a couple of cardiac markers, a thyroid check, a drug test, and a pregnancy test. That last one’s just routine for any female your age, we run it on everybody. We can pull all of it off the IVs already in your arm, so nobody has to poke you again. We’re also going to get a 12-lead EKG— that’s a full electrical picture of your heart. The leads you have on right now are just for monitoring.”

Lindsay paused, gauging Clara, “I know that’s a lot of words. The short version is— we’re trying to get a complete picture of what’s going on inside you so we can figure out what’s making your heart do what it's doing. Are you with me?”

Clara let out a little breath that was almost a laugh, except not really, “Yeah, no, I’m with you.” She took a beat. “Like, heads up though— that pregnancy test is gonna come back negative. Ya know, because I have a girlfriend…” A tiny attempted smile, gone almost as fast as it came. “But, like, run it anyway. I get it.”

Clara swallowed, then continued, “Whatever you guys need to do is cool or whatever. I just want to know what’s wrong with me.”

Behind her, Nurse Nancy was already pulling tubes from the drawer— purple top, green top, blue, gold, gray, red— the little plastic clatter of them stacking in her palm before she stepped to the IV in Clara’s right arm.

Nurse Nancy’s voice came in low and warm, “Just gonna pull these off the line in your right arm, baby. You won’t feel a thing. Hold still for me.”

Clara nodded.

Nancy worked smoothly— uncapping the IV port, threading the vacutainer adapter on with one hand, the other steadying Clara’s forearm with a soft, careful touch. The first tube clicked into place and filled fast, dark red rising up the inside of the container. She switched it out for the next, and the next, the empties going neatly into the tray by her hip. Her free hand kept a thumb resting on the back of Clara’s wrist the whole time, like an anchor of sorts.

“Doing great, sweetheart. Almost there. Two more.” Nancy offered a polite smile.

“Mhmm,” Clara breathed.

When the last tube was full, Nancy capped the port and tucked the rack of labeled blood onto the counter behind her, where Nurse Heather quietly gathered them to send over to the lab.

As Nancy stepped back, Dr. Jen the resident moved in from the head of the bed, stethoscope already off her neck. She came around to Clara’s right side and stopped at eye level with her.

“Clara? I’m Dr. Jen— one of the emergency medicine residents. I’m just going to listen to your heart and lungs for a minute, okay?” Jen introduced herself.

Clara turned her head a fraction to look at her. “Yeah. Yeah, that’s cool…”

Dr. Jen gave her a small, quick smile— the kind that came out without fully reaching the eyes, and slid the bell of the stethoscope under the bottom edge of Clara’s sports bra, against the patient’s sternum. The diaphragm pressed gently. Jen listened. Moved it— left lower sternal border. Listened. Then up to the second intercostal space on the right. Then the left. Each spot for a few heartbeats. The resident’s face stayed neutral but attentive.

“Take a deep breath in for me, Clara. Through your nose, out through your mouth.” Instructed Jen.

Clara complied, the breath catching a little at the top before she let it back out. Jen moved the stethoscope to her back— sliding under the band of the sports bra at the shoulder blade, then down a few inches, then over to the other side. Same pattern.

“And one more for me. Big breath in. Good girl.” Jen continued. She listened a second longer than she needed to, then straightened, the stethoscope coming back up to drape around her neck. She gave Clara another of those quick, neutral nods. “Thank you. You did great, Clara.”

Dr. Lindsay glanced toward Nurse Heather. “Let’s get a portable chest x-ray on her.”

Nurse Heather nodded and was already moving— out through the bay doors and back in under a minute, wheeling the portable unit ahead of her. The machine settled at the foot of the table, the boom arm extended, the head positioned to face Clara’s chest at the right distance and angle.

“Clara, hi.” Nurse Heather’s voice was a tad lower than Lindsay’s and flat in a way that wasn’t unkind. “I’m going to put a plate behind your back so we can get some pictures of your chest. I need you to lean forward for me just a couple inches so I can slide it in. Like you’re trying to sit straighter.”

Clara nodded, pressed her palms flatter to her thighs, and rolled her shoulders forward.

“Good. Hold right there.” Nodded Heather.

Nurse Heather slipped the plate in behind her in a quick, smooth motion, settled it against the padded surface of the table so it sat upright behind Clara’s back, and helped her ease against it. The edge of the plate sat just below the base of her skull and ran down past her ribs to about where her lower back started.

“Okay. Sit up nice and tall for me. Chin up just a bit. Arms relaxed at your sides— yep, just like that.” Heather instructed.

Heather crossed back to the portable X-ray unit, adjusted the head half an inch, then looked at the rest of the team.

“X-ray. Everybody clear, please.” Called out Nurse Heather.

The team stepped back, and Heather moved behind the machine with a lead apron on, finger near the trigger.

“Deep breath in for me, Clara. Hold it.” Nurse Heather instructed.

Clara drew the deepest breath she could manage, her eyes pinned on a spot on the ceiling.

“Hold… hold…” guided Heather.

There was a soft mechanical click, the brief electric hum of the exposure.

“Good girl. Breathe.” Nodded Heather.

Clara let the breath out in a rush.

Heather was already moving— retrieving the plate from behind Clara’s back with one hand, helping her sit comfortably again with the other, the plate going to the unit’s reader. After a few seconds, there was a soft beep from the machine, and the image was on its way to PACS.

“All done,” Heather spoke. “That was easy.”

Clara managed a small, shaky laugh. “Yeah. Like… that I can do. Just don’t, like, make me think too hard right now. I’m still a little freaked out, not gonna lie!”

Dr. Sarah pushed off the wall and crossed to the monitor in the corner of the trauma bay, glasses pushed up the bridge of her nose. The chest film came up on the screen— the gray scale of Clara’s torso resolved in seconds, lungs, heart, ribs, all readable in a glance.

Sarah’s icy blue eyes scanned it once, then scanned it again, but slower. Then a third pass for the details.

“Clean,” Sarah spoke without turning around. “Heart size is normal. Mediastinum’s fine. Lung fields are clear bilaterally— no fluid, no pneumothorax or hemothorax, no swelling. CP angles are sharp. No bony abnormalities. She’s structurally fine.”

Sarah finally turned, addressing Dr. Lindsay, “From a film standpoint, nothing here that explains why she’s throwing PVCs at us.”

Clara’s eyes shifted between Sarah and Lindsay, the way somebody listens to a language they don’t quite speak but is trying to pick out the words that matter.

“So that’s, like… good? Or?...” Clara asked, trying to clarify.

Dr. Sarah’s gaze flicked to Clara for a half second, the look not quite warm and not quite cold either, “That means your heart and lungs look structurally normal on the x-ray. No fluid or blood, no blockages, no enlargement. Which is what we like to see.”

Dr. Sarah turned back to Lindsay before Clara could quite catch her breath on it, “Whatever’s going on with her, it’s not coming from the plumbing, so to speak.”

It came without warning. It was a small, sharp pain in the center of Clara's chest— quick and deep with a hot edge to it. Clara’s shoulders pulled in toward it on reflex, her forehead creasing, the breath she was drawing in cutting off in her throat. One of her hands lifted off her thigh and pressed tightly to her sternum, just around the EKG electrodes, like she could push it back down. "OWW!" A noise escaped from the young lady’s throat.

The pain faded almost as fast as it appeared. Clara held very still for a few seconds after it passed, eyes wide, her hand still pressed firmly to her chest.

"Oh my god. Oh my god, that… what was that?!" Clara asked nervously. She looked at Lindsay first, then at Nancy, then back at Lindsay.

"Like, what was that?! I just felt— it was like a… like, sharp. Right here." Clara pressed her palm a little harder against her sternum. "Just for, like, a second. Did you guys see that? On the… on the screen, did it… was that something?!" Clara’s voice was raised now, and more breathy. Her chest was rising and falling faster than before. "Is it, like… please. Please don't tell me it's getting worse." Clara continued, shaking her head.

Dr. Lindsay’s eyes were already on the monitor before Clara finished asking. The rhythm displayed across the bottom of the screen showed it now— the trace surging into a fast, wide cluster of complexes, 7-9 beats stacking on top of each other before pulling itself back to its sinus baseline. The heart rate number rolled upward across the run and stayed elevated when it ended: 158.

“Looks like a run of V-tach,” Sarah stated flatly from her spot near the monitor. “Nine beats. Self-terminated. She’s back in sinus tach.”

“Got it.” Lindsay’s voice stayed level. Her hand came to the rail again, her body angling closer to Clara without crowding her. “Clara, hey. Look at me, cutie. Your heart slipped into a bad rhythm on the monitor, and we caught it. It stopped on its own. You’re okay right now. Breathe with me— in through your nose, out through your mouth.”

Nurse Nancy was already there from her side of the table, one warm hand settling lightly on top of Clara’s where it stayed pressed to her sternum. “Right here, baby. We’re right here with you.”

Clara’s breath came in uneven and fast. Her eyes were huge. Tears rose without quite spilling.

“That… that freaked me out. Like, whatever happened just now.” Clara turned her hand over under Nancy’s so her palm was pressed against Nancy’s instead. “That was so… like, I felt it. I felt it! Like, all the way through me. Oh god…”

Clara blinked fast a few times, looked at Lindsay, then back at Nancy, then back at Lindsay again. “Is… is my girlfriend, like, here yet? Is she almost here? Please. Like, please. I just want her here. I want her, like, right now.” Clara’s voice raised a bit, clearly nervous.

Dr. Lindsay’s eyes held Clara’s, her voice soft and even, “I know it’s scary, Clara. I know. But we’re still ahead of this. You’re doing great. Your girlfriend is on her way— she’ll be here as quickly as she can. Right now we just need you to focus on you, okay? On staying with us, on breathing. Can you do that for me?”

Clara nodded, small and quick, then nodded again, like she was trying to convince herself with the second one. Her tears finally tipped over the lower lids and rolled down one of her cheeks. She didn’t wipe them, “Yeah. Yeah, I… I can do that. I’m trying. I’m, like, trying.”

Clara squeezed Nancy’s hand tighter, her eyes stayed on Lindsay’s, “It’s just… like… I really, really don’t feel right. I know I keep saying that, but it’s just… it’s not the same now. It feels really really different than it did, like, twenty minutes ago. I don’t know how to say it though…”

Clara drew a shaky breath, then continued, “Like… okay, I’m not trying to be dramatic, like, I swear I’m not. But something’s, like… it’s wrong. It’s really wrong. Like, I just know. I don’t… I don’t think I’m okay. I really don’t think I’m okay.”

Clara’s voice dropped a bit after a quick pause, “I really need her to get here.”

Dr. Lindsay’s expression softened a fraction, but her voice stayed steady, “And she’ll get here, Clara. I promise. Just try to stay calm for us while we work, okay? That’s the best thing you can do for yourself right now.”

Clara shook her head. A small, fast, tight shake, her hand still gripping Nancy’s tightly, “No, like… you don’t get it. Something’s really, REALLY wrong. Like…” Her voice caught, and her eyes spilled fresh tears down her cheeks. “Like, I could die wrong. Like that kind of wrong…”

Clara said the word die like it cost her something to get it out.

A short, terrible silence settled across the trauma bay for the split second after. Nurse Nancy moved closer without letting go of Clara’s hand, lowering herself a little until her face was at Clara’s level, her voice dropping into the register she reserved for the worst nights of people’s lives. “Hey. Hey, look at me, sweetheart. Look at me.” Nancy waited until Clara did. “I hear you. We all hear you. We’re taking what you’re feeling very seriously, understand? Nobody in this room is brushing you off. We’ve got eyes on every single thing your heart’s doing right now, and I’m not leaving this side of you. Not for a second. You hear me?”

Nancy held Clara’s gaze, “You’re not alone in this, hun. We’re all right here.”

“Let’s get a bedside echo,” Lindsay chimed in, already turning toward the ultrasound machine in the corner of the room. “I want a look at the structure right now and see if the chest x-ray missed anything. And let’s get her on continuous 12-lead, not just monitor leads— I want to see what those runs actually look like across all of them.”

“On it,” Sarah nodded. She was already moving toward the medication drawer. “I’m pushing 2 grams of mag IV while you do the echo. We can revisit amiodarone if she throws another run.”

“Yeah. Mag first.” Agreed Lindsay.

Dr. Lindsay wheeled the ultrasound to the right side of the table, the screen waking up under her hand as she settled onto the rolling stool at the level of Clara’s hip. She squeezed a small puddle of conductive gel onto Clara’s chest just below the xiphoid process and her black sports bra, then dropped the probe into it.

“Just an ultrasound of your heart, Clara. Same kind of probe they use on pregnant bellies, just a different angle. This will take me a couple of minutes.” Lindsay kept Clara in the loop.

Clara nodded. Her eyes were fixed on the ceiling now, like that was the only place she could put them and still hold herself together. Nurse Nancy still held her hand. Dr. Sarah stood on her left now, two small ampoules of magnesium sulfate already drawn into the syringe.

“Clara, hi. I’m Dr. Sarah— one of the attendings tonight. I’m going to push a medication into your IV that’s going to help settle your heart down a little. It’s called magnesium. You might feel warm. You might feel kind of flushed in your face. Maybe a weird taste in your mouth, like metal. That’s normal. Don’t worry about it.”

“Okay… yeah…” Clara’s voice was smaller than before.

Dr. Sarah went to the port on the IV in Clara’s left arm, threaded the syringe in, and started pushing slow and steady, eyes on the monitor at the same time.

Dr. Lindsay’s eyes were on her ultrasound screen, the four chambers of Clara’s heart resolving in clean grayscale, the muscular organ squeezing inward in a tight, coordinated rhythm. She moved through the standard views: parasternal long, parasternal short, apical four-chamber— her free hand tilting the probe in tiny adjustments, her face neutral and focused. She watched the chambers move. Watched the valves open and close. Watched the pericardium. Looked at the superior vena cava. Came back to the apical four. After a long pass, Lindsay pulled the probe off, “Structurally clean. EF looks like 60ish, easy. No wall motion abnormalities. No effusion or tamponade. Chambers are normal. Valves are normal. There’s nothing wrong with the way her heart’s built.”

Lindsay set the probe down and gave Clara a small, steady nod, “That’s good news. It means the heart itself healthy. We’re chasing an electrical problem now.”

Clara’s eyes stayed on the ceiling, “That’s, like… that’s good, right?”

“It rules some things out.” Lindsay chose her words carefully.

A tear slid down Clara’s face. She heard Lindsay, but didn’t say anything.

It hit harder the next time. Clara’s breath hitched at the back of her throat— a sound somewhere between a gasp and a small, involuntary cry. Her free hand, the one not gripping Nancy’s, pressed flat against her sternum again, fingers splayed wide. The wince that crossed her face was deeper than the last one. Her eyes shut tight, then snapped open, and the tears just kept coming.

“OH! Nonono, it’s… oh my god, it’s doing it again…” Clara grimaced.

On the monitor, the rhythm strip went chaotic. A long stretch of PVCs ran across the screen, doubled into couplets, tripled, and then the trace pulled into the wide, ugly run of true V-tach— the QRSs marching across in fast, deformed succession. 12 beats. 13. Then 14. The heart rate number flashed up into the 170s and held there. The BP cuff cycled, and the number that came up wasn’t quite as friendly as the one before: 92 over 54.

“V-tach,” Sarah noticed, her voice sharper than her last call. “15 beats. 16. Self-terminating… for now.”

The rhythm pulled back toward sinus, but the rate didn’t come back down with it. It stayed at 178.

“Pressure didn’t bounce back,” Nurse Heather observed, eyes on the cuff readout. “Still 92 over 54.”

Lindsay’s jaw set, “Sarah, get amiodarone drawn— 150 milligrams. Heather, I want the pads on her now, just in case. Jen, get suction and airway set up at the head of the bed.”

“On it,” all three said in some overlapping order.

“Clara?” Lindsay was in tight again, voice the same calm, even one as before. “Clara, look at me. I know that hurt. I saw it on the monitor. We’re going to give you another medication that’s stronger than the first one, and it’s going to help calm your heart down. Nurse Heather is going to put some sticky pads on your chest— that’s just so we have a backup plan if we need it. You’re not in trouble yet. Stay with me, cutie.”

Clara was breathing much faster, shoulders rising and falling under the EKG wires, her hand still pressed hard to her sternum. “It was, like… it was, like… way worse that time. It felt… it felt huge. I felt it in my whole chest, I… like…” She lost the sentence partway through and just shook her head, eyes pinched shut for a second or two before going on, “I’m scared. I’m really really fucking scared. I’m telling you, something’s wrong here…”

The defib pads went on in seconds. Heather peeled the backing off the right anterolateral pad and pressed it against the upper right chest just below the collarbone. Heather then stuck the left lateral pad along the outside of Clara's left rib cage. The cables extended out to the defib unit Sarah pulled in closer to the table.

And then the next wave of symptoms hit again. It came different. It didn't slap her and go— it landed and stayed. Clara's whole body bent toward it, her chin tucking almost to her chest, a low sound forced out of her that wasn't a word— more of a drawn out moan.

"OHHH! Oh no, oh no, oh no, oh…" Clara groaned and moaned. Her legs shifted. Her hips rolled half to one side. Her free hand left her sternum and clawed at the edge of the table, then went back to her chest, then to the table again, like she couldn't decide where to put it and couldn't keep still long enough to figure it out. Her face was bright red and tight, and the breath came out of her in fast, shaking pulls.

"Sustained polymorphic v-tach," Dr. Sarah called out from the monitor. Her voice was in a different gear now. "She's in it. She may not come out."

The rhythm strip rolled past in jagged, ever-changing complexes, the QRSs twisting around the baseline in the unmistakable signature of polymorphic VT— wide one second, narrow the next, the axis shifting beat to beat. The heart rate number sat in the 190s now. The BP cuff cycled and dropped a worse number than before: 76 over 42.

"Pressure's 76 over 42," Heather shook her head.

"She still has a pulse— carotid feels thready but it's there." Nancy's fingers were light against the side of Clara's neck. Her other hand still held Clara's.

Clara's eyes opened wide, "I'm… I'm cold. Oh my god, I'm really, really cold. Like… I'm hella cold. Why am I— why am I… freezing?!"

A hard shudder went through Clara’s petite frame. The anklets on her ankle made a small noise against each other. Clara found Lindsay's face again, "My… my heart's gonna stop, isn't it?! Like… like, for real… is it gonna stop beating?! Is my heart gonna stop?!" Her voice cracked open on the last word. "Oh fuck, please, please don't let it stop, please…"

“Push amio fast— another 150 in,” Lindsay ordered. “Don’t run it over 10, slam it. Mag’s not holding her.”

“Pushing.” Sarah was already at the IV port in Clara’s left arm, the syringe of amiodarone in her hand, the plunger going down in a steady, controlled run. “150 in. Going in now.”

“Nance, draw up another 2 grams of mag— I want it ready,” Lindsay added. “And Heather, defib to 100 joules synchronized. Don’t charge yet, but be ready.”

“100 joules synced, confirmed.” Nodded Heather.

The amiodarone went in over maybe twenty seconds— fast and hard, the kind of push you do when the slow infusion isn’t really an option anymore. Dr. Sarah followed it with a saline flush and stepped back.

The monitor didn't care. The strip kept rolling— that same beautiful, terrible polymorphic display, the QRS’s writhing on the screen the way Clara was writhing on the table beneath them. The rate number ticked up another step instead of down. 198. 204. The cuff cycled, and the new number came back even uglier than the last: 70 over 38.

“BP 70 over 38,” Heather called from the cuff. “Peripheral pulse barely.”

“Carotid?” Lindsay asked.

“Still palpable,” Nancy answered, fingers still at Clara’s neck. “She’s perfusing.”

Clara was making sounds that weren’t quite words anymore— a low, drawn out groan that broke off and started again, then broke again, her body twisting against the padded surface of the table in small, helpless arcs. Her knees came up and dropped. Her hand fisted in the padded vinyl beside her thigh, white knuckled. The leads stretched and tugged at her chest as she moved. The anklets jangled with every shift.

“OH! Oh my god, oh my god, it’s… it’s worse, it’s so much worse, like— please— PLEASE make it stop, like… please, somebody just…” Clara trailed off, absolutely terrified. She turned her head sharply, eyes finding Nancy through the tears, “It hurts. IT HURTS. IT HURTS SO BAD, I… like, I can’t… I can’t, I CAN’T—” She lost the words, and the sentence collapsed into a thin, awful cry somewhere between a sob and a moan, her hips rolling, her free hand grabbing for the edge of the table and missing, “Please… please don’t let me die. Please, like, I’m… I’m not ready, I’m not ready, please, like, PLEASE!!!”

Lindsay’s eyes were already moving to Sarah, then to Heather at the defib. Lindsay made the call— she had to, “Sarah, charge to 100. Heather, Nancy— hands on her while we prep for the shock, both of you. Keep her present, keep her on the table. I’ll tell you when to back away.”

“Charging to 100.” Sarah called out. The defib unit gave a low rising hum as Sarah dialed the settings and pressed the charge.

Nurse Heather moved up onto Clara’s right side and laid a steady hand across her shoulder. Nancy did the same on the left, never letting go of Clara’s hand.

Dr. Lindsay leaned in close, until her face was directly in Clara’s line of sight. Her voice stayed low and steady, but there was a different weight in it now, “Clara, I need you to listen to me. Your heart is going into a really dangerous rhythm, and the medicines we just gave you aren’t working fast enough. So we’re going to have to shock your heart with those pads on your chest to try to break the rhythm and get it back to normal. I’m not going to lie to you, okay? It’s going to hurt. It’s going to hurt a lot. But it’s going to be quick, and I really need you to be brave for me. Can you do that for me, cutie?”

Clara’s face crumpled. The sobs came out of her hard— a single broken, full-bodied gasp that broke into a series of smaller, hitching ones behind it. Her eyes were huge, the dark of her irises swallowed up by how wide her pupils were. The tears poured. “S-shock my heart?! Like… like, while I’m— while I’m awake?! Oh my god, OH GOD, NO, LIKE— NO, PLEASE— PLEASE… LIKE—”

Clara shook her head fast, then again, then again, her whole body shaking with the sobbing now. Her free hand groped blindly against the table until her fingers tightened around Nancy’s, knuckles again, “Just… please just make it stop, please, like… make it stop, MAKE IT STOP!!!”

Clara’s voice cracked on the last words. Her eyes flew back to Lindsay’s, glassy and wet, absolutely begging, “Please don’t… please don’t do it… like— please, isn’t there something else?!?! Like, isn’t there…”

Dr. Lindsay didn't take her eyes off Clara's face, but didn’t know what to say to the terrified 19 year old.

"Away the patient," Sarah called from the defib.

Nurses Heather and Nancy both stepped back in the same motion, their hands coming off Clara, palms lifted clear of her body. Lindsay straightened and pulled back half a step. Jen took her hands off the suction and airway setup.

"Everybody clear. Shocking." Sarah announced, her eyes sweeping the room for a second.

The shock was delivered.

Clara's body locked in a single, fast clench, every muscle in her going tight at once. Her shoulders pulled inwards, her whole petite frame compressing in on itself for a split second like one massive, full-body shudder. Her hands snapped into tight fists at her sides.

The sound that came out of her was a ragged, rising yelp that escaped her throat and didn't quite stop where it sounded like it should’ve. Her left ankle flexed in the spasm as well.

And then her body let go. She slumped forward against herself, her chin still tucked, her hands going from fists to limp open in the same instant, the sob that came out of her after almost a continuation of the yelp.

Every set of eyes in the trauma bay went to the monitor. The rhythm rolled past unchanged— the same wide, twisting complexes as before. Clara’s heart rate number sat where it sat. Polymorphic VT, untouched.

“Crap,” Sarah grumbled. “Still in VT. No conversion.”

Dr. Lindsay’s jaw worked once. She turned back to Clara without a second of hesitation, then back to Dr. Sarah, “Sarah, charge to 150. Same configuration.”

“Charging to 150.” Confirmed Sarah, her fingers on the controls.

Clara was breathing in rapid, shallow, frantic heaves now, her chest rising and falling visibly, her face still red and tear streaked, her hands trembling against the table. Nancy’s hand was back around hers for the time being.

Dr. Lindsay leaned back in close, “Clara? Hey, beautiful. Look at me, sweetheart.”

Clara’s eyes dragged up to Lindsay’s. They were red, glassy, and beyond terrified.

“That shock didn’t break the rhythm. I’m sorry. We have to go again. We’re going to bump the settings up a little, but it’s the same thing— pads, quick shock, done.” Explained Dr. Lindsay.

Clara’s whole face changed, “What— WHAT?! Like… AGAIN?! No no no no, like, no— please, PLEASE, no—” Her head was shaking again. The sobbing came back through the breaths. “I… I just did it, I just did the thing, like, please, oh my god, please don’t…”

Clara gulped a breath, “Can’t you… can’t you, like, give me more meds or something?! Like, more of the heart stuff?! PLEASE, like, give me more, give me anything, just please, PLEASE, don’t shock me again!!!”

She turned her head toward Nancy, then back to Lindsay, eyes pleading on both sides, “Please. Like, please. I’ll be— I’ll be brave, I’ll, like, I’ll do whatever, just… not again, please not again…”

“Away the patient,” Sarah called out, not giving anyone a chance to answer the terrified young lady.

Nurses Heather and Nancy stepped back again, hands lifting clear, Lindsay pulling out of the close space at the same time. Jen’s hands came up.

“Everybody clear. Shocking.” Sarah announced.

KA-THUNK!!!

Clara’s mouth shut hard, teeth clacking together, jaw locking in the same instant her whole torso jerked. The sound that came out from between her clenched teeth wasn’t a yelp this time— it was lower, harder, a buzzing NNNN held against her teeth as the current ran through her and her whole upper body twitched once, twice, a third smaller time. Her eyes stayed open through it. Wide. Wild. Pinned to the lights above the table.

And then her body unclenched. Clara gasped— a huge open-mouthed gulping breath, like surfacing from underwater, and then another, smaller one, and another. Her teeth came apart. Her shoulders dropped. Her hand reached sideways and found Nancy’s again before her eyes did.

When her eyes did move, they went straight to Lindsay’s face, “Th— that’s… that’s it, right?!” Her voice came out broken and shaking. “Like… like, no more? No more shocks? Please…” A shuddering breath. “I… I was brave, right? Like, I was brave for you guys, right? Please, like, please just let that be it. Please. I, like… I can’t, like… I can’t do that again, please just let that be it!”

Every eye in the room snapped back to the monitor. The monitor displayed the same rhythm. The second shock did absolutely nothing.

“Same rhythm,” Dr. Sarah shook her head, her voice flat.

Dr. Lindsay’s eyes closed for a half second. Then they opened, and she came back down close to Clara’s face, “Clara? Sweetheart? Look at me. I’m so sorry— that dangerous rhythm is still there. I’m going to have to shock—”

Clara’s face broke before the word came all the way out, “No. NONONONO!!!” The sob ripped through her, almost a scream, full-bodied, her shoulders shaking. “No more. No more, please— NO MORE!!!” She begged.

Clara’s head whipped from side to side. The tears were coming so fast they ran into her hair, into the EKG leads, down her neck, “I’m so… I’m so scared, oh my god, I’m so scared— please, PLEASE, like… I don’t want to die. I don’t… I don’t want to die.. I DON’T WANT TO DIE!!!”

Her voice broke open on the last words, and a sound came out of her that wasn’t quite crying anymore— closer to wailing, raw and high. Clara’s free hand grabbed at the air for a second and then went back down on the table. “PLEASE… please don’t— please…”

Dr. Lindsay’s hand came to rest gently on the table beside Clara’s hip. She didn’t try to talk over her. She waited a second or two.

“Sarah.” Lindsay’s voice was quieter now. “Charge to 200.”

“Charging to 200.” Sarah confirmed.

The team peeled back from the table, gloved hands lifted, bodies pulled away, the space around Clara's body emptying.

"Everybody… CLEAR." Dr. Sarah called out after a quick look to ensure nobody was in direct contact with Clara.

THUMP!!!

The sound that came out of Clara was higher than the last. It was a quick, sharp “OHH!!!” forced up out of her chest at the instant the electric current met her body. Her whole body went rigid for the half second the shock ran through her, every muscle in her pulling tight at once. Her shoulders pulled high and locked. Her arms went straight at her sides. Her belly pulled tight. Down at the far end of the table, her bare feet flexed, toes scrunching down hard, the small tendons across the tops of her feet standing up under the skin, the soft, wavy, prominent wrinkles fanning out across the surface of her tiny size 5.5 soles.

Clara relaxed (or as much as she could). Her breath punched out of her in a single hard rush, a thin wet sound coming out behind it that was almost a whimper. Clara’s toes uncurled slowly. Her hands lay where they fell— one limp open, the other half-curled, fingers twitching a little from fear.

A small, shaky sob worked its way up out of her. Then another. Clara’s chest was rising and falling fast and uneven, her eyes pinned somewhere off to the side, on nothing.

"Oh god. Oh god, oh god, oh god…" Her voice was small and thin, barely there as she babbled. "Is… is that it?! Like— are we done?! Are we done with the shocks?!" The 19 year old hottie asked the team as a fresh tear rolled down her cheek. "Please. PLEASE tell me we're done." Clara continued .

Dr. Sarah's eyes were already on the monitor. Lindsay's went with hers. The display rolled past: same complexes, same axis-shifting polymorphic rhythm that three shocks did literally nothing to.

"No conversion. It’s still there" Sarah shook her head. Her voice came out tight now in a way it wasn't before.

Dr. Lindsay paused for a second and drew a breath, "Charge to 300. Same configuration."

"Charging to 300." Sarah confirmed, her gloved fingers working the controls on the defib.

The defib's whine started up— that familiar high-pitched, rising electrical hum that crested upward and upward as the charge built in its capacitors. Clara's eyes snapped wide the moment the sound began.

"No… no no no— no, no, NONONO!!!" The words came out as a single continuous string. Her head began shaking from side to side dramatically. The sobbing came up over her breaths again. "No more. No more, please, no— NO MORE, NO MORE!!!"

Clara was trying to push back from the sound with her shoulders, like she could put distance between herself and the pads still stuck to her chest if she tried hard enough. Her free hand found the edge of the table and gripped as hard as she possibly could.

"I'm so scared. OH GOD, I'm so scared, I'm so, like… I’M SO, SO SCARED!!!" Clara shouted, absolutely terrified. Her eyes flooded again. Her chest was hitching in a way that was nothing but pure panic, "I don't … I don't wanna die. Please. PLEASE don't let me die. Please, like— like, don't, don't, please… please don't let me die!"

“Clear the patient, shocking,” Dr. Sarah relayed to the team.

Everyone on our team peeled away from Clara again. Hands lifted, bodies stepped clear of the table.

The 300 joule shock discharged.

The scream came out of Clara short, high, and sharp— a single sound that started in her throat. Her face contorted in pain all at once: brows pulled in with her forehead creasing, mouth half open, every muscle around her eyes pinched tight. Her petite frame jerked hard against the table— a sharp, snapping twitch that ran through her shoulders and her arms and down her ribs and into her hips, not all from the current. Some of it was her body bracing for the current. Some of it came afterward, as the body realized what just hit it.

Immediately after the shock, a sound came up out of her that wasn’t a scream and wasn’t a sob— something drawn out and shapeless, a high, broken “AHHHHH!” that lost air halfway through and didn’t quite refill. Clara’s eyes flew open and went everywhere— to the monitor, to the lights, to the IV pole, to the ceiling, to Nancy, to the defib, to Lindsay, to the wall behind Lindsay, to nothing in particular and then back to the monitor again, darting and skipping and never landing for more than a fraction of a second. Her chest was heaving. Her mouth stayed open. The wet shine on her cheeks reflected the overhead lights.

Dr. Jen the resident’s eyes were the first ones to move back to the monitor. She was up at the head of the table— quiet, watchful, hands on the suction setup just in case, and she tracked it before anyone else that the strip on the screen still showed the same thing. The rhythm was the same. The rate was pretty much the same. The polymorphic arrhythmia was unchanged.

“Hey… I’m still seeing polymorphic v-tach,” Jen relayed discreetly to the team, her voice low and careful.

Dr. Lindsay’s eyes went to the monitor a half second behind her. Sarah’s, too. Confirmation passed between the two attendings in the briefest of looks.

“Let’s go ahead and charge to 360,” Lindsay decided.

“Charging to 360,” Sarah answered with a quick nod.

The defib whined back to life.

Clara’s whole body knew before her mind did. Her shoulders pulled back hard against the table. Her hands snapped up off the surface of the table and then dropped again, like she didn’t know what to do with them. Her eyes— still wet, still wide, still darting anxiously around the room, found the defib at the side of the table, found Sarah’s hand on it, and stuck there.

“No— nononono, NO NO NO!!!” Clara spiraled a bit. Her breathing came apart. It went from fast to shallow and gulping, a panicked pattern she couldn’t seem to slow. Clara’s chest rose and fell in tight, useless heaves. Her shoulders were shaking. Her teeth were chattering, “What— what’re you guys doing to me?! Like… what are you doing?! Please… PLEASE, what the fuck are you doing?!?!”

A sob ripped through Clara, “Just… I don’t know, just make it stop, like— JUST MAKE IT GO AWAY, PLEASE, somebody, like, please just make it stop, somebody…”

Her head jerked back and her eyes squeezed shut. Tears made their way out from under her eyelids and ran sideways down her temples into her hair, “I can’t— I can’t, I JUST CAN’T!!!”

Clara’s voice broke completely on the last one. The word came out shredded. She kept repeating it anyway, “I CAN’T, I CAN’T, I CAN’T, I CAN’T, like… please, PLEASE, PLEASE, I can’t, I can’t… you don’t get it, like…I JUST CAN’T!!!”

“Okay, everyone… CLEAR.” Lindsay called it out that time.

The rest of the team broke clear of Clara once again. Hands, bodies, fingers, all coming up and away.

KA-THUNK!!! The shock discharged.

A sound came up out of Clara that wasn’t a scream this time. It was tighter, smaller, and kinda blocked— a short, hard choking sound caught somewhere in the back of her throat, like the air she meant to push out got stuck somewhere on the way out. Her eyes flew open and wide for a single stunned second before they closed again. Clara’s right hand snapped up off the table and pressed flat against her chest, between the EKG leads and defib pads, fingers spread wide. Her torso pulled forward involuntarily, ribs curving in, head snapping back for a split second. Clara’s thighs clenched hard— quads and hamstrings tensing hard against the padded surface of the table, knees jumping with the smallest reflexive twitch.

After the shock, Clara collapsed backward in slow, exhausted stages. Her shoulders eased down. Her chest unclenched. Her right hand stayed pressed to her sternum but went slack against it, fingers slipping flat, the hand riding her chest as it rose and fell. Her thighs released. Her head tipped back against the padded surface of the table, and her eyes shut.

Clara didn’t say anything. The next wave of sobs came up out of her more quietly now— small, broken, and traumatized. Tears slid sideways out from under her shut eyelids and ran down into her dark, wavy hair. Her shoulders shook with each breath. Her mouth stayed slightly open. The wet sounds were the only ones she made.

Clara’s hard sobs slowed. Her breathing slowed with them— still uneven, still wet, but softer, lower in her chest, and a little less wrecked. A small moan slipped out of Clara with the next breath, then again with the one after— small, low sounds, more reflex than anything else.

She didn’t open her eyes, “My— my girlfriend,” Clara panted, voice scraped down to almost nothing. “Where’s my— like, is she… is she here yet?”

She swallowed, then continued, “And is someone, like— is someone gonna call my mom too? I want… I wanna see my mom before I die...”

Clara’s eyes opened, but not all the way. Just enough. “I wanna go home. I just— I just wanna go home. I wanna get outta here...”

Nurse Nancy bent low again. She never let go of Clara’s hand. With her other hand, she brushed a piece of Clara’s bangs back from where it covered one of her eyes, the touch slow, gentle, and careful.

“Hey, baby. Hey.” Nancy’s voice was the warmest thing in the bay. “Your girlfriend is here. She got here in the last few minutes— we got a notification on the tablet. We’ve got her set up in a private waiting room just down the hall— she’s safe, she’s close, and she knows you’re with us. The minute we can bring her back to you, I promise we will. And we’ll get on the phone with your mom shortly too, sweetheart. We just have to get you taken care of first. You’re before so brave for us.”

Nancy squeezed Clara’s hand, “You just keep breathing for me. Stay with us. You’re doing so good, hunny.”

Clara's eyes blinked slow. She didn't quite look at Nancy— her gaze was at some middle distance, like even looking was too much in that moment.

"God…" Clara’s voice was rough and thin. "Like… I thought all this was just anxiety or something. I thought I was, like, having a really bad week. I didn't think— I didn't think I'd have to go through, like, all this. Ya know, the shocks and stuff…" A small, shaky exhale escaped her lips, then she went on, "I'm just— I'm just so fucking scared. Like, I'm so scared. I didn't think I'd be here tonight. I just… I didn't, like, think I would die tonight…”

Nurse Nancy's thumb moved in slow, deliberate circles on the back of Clara's hand. The veteran ER nurse didn't rush her. She let the silence after Clara's words settle for a moment, like she was sitting in it with her.

"I know, baby. I know you didn't." Nancy’s voice came out low and steady. "Nobody ever does. Not once in the 23 years I've been doing this— not one single person walks in here thinking tonight's the night something crazy like this happens to them. That's not on you, sweetheart. There was no way for you to see this coming. The fact that you thought it might be anxiety? That's a smart, regular thing for a person to think. It doesn't mean you missed anything. It doesn't mean you did anything wrong."

Nancy paused for a second, then kept talking, "And being scared right now? You go ahead and be scared. You're allowed. You've been through something nobody should have to go through. You hear me? We've got you. I've got you. Right here. I'm not going anywhere, baby girl."

Nurse Heather’s eyes were the first ones on the monitor this time. She held them there a second, then another, like she was making sure before she said it, “Lindsay. Same rhythm. No conversion.”

Dr. Lindsay’s jaw set. She took a single slow breath through her nose, “Charge again. 360.”

“Charging to 360.” Dr. Sarah overheard and set the defibs.

The defibrillator whined back into its usual rising hum.

Clara’s body jerked at the sound, knowing another shock was about to come her way. Clara’s eyes flew open. Her chest heaved, tits shaking inside her black sports bra. The cracks in her breathing came apart all over again.

“No. No, no, no, no, no— oh my god — OH MY GOD, NO, PLEASE, NO,” Clara’s bare feet kicked out at the far end of the table— small, uneven kicks, both heels coming up off the surface and dropping again, showing off the soft, prominent wrinkles along the soles of her size 5.5 feet. Her knees came up. Her free hand grabbed at the air and didn’t find anything.

And then she came apart sideways. Her whole upper body leaned left and crumbled into Nancy— head dropping against Nancy’s chest, weight folding into her, the EKG and defib wires pulling at angles they weren’t made for. Nancy caught her without flinching. One arm came up around Clara’s back, the other cradled the back of her head, and Nancy held her. Nancy’s cheek came down against the top of Clara’s dark, wavy hair, “I’ve got you. I’ve got you, baby. I’ve got you.”

Clara was sobbing into the crook of Nancy’s neck now, full-bodied, shaking uncontrollably, “Please. Please, like— please, please don’t, please don’t shock me again, PLEASE, LIKE — PLEASE, I CAN’T, LIKE — I CAN’T DO IT ANYMORE!!!”

Clara’s fingers clenched a fistful of the fabric in Nancy’s scrub top, “Please, like… MAKE THEM STOP!!! TELL THEM NO MORE!!!”

“Clear the patient.” Sarah called out, her voice a bit firm.

Nancy peeled herself away from Clara, gently, but quickly, easing her back upright on the table, her hands lifting from Clara’s back and Clara’s hair. Clara’s head sagged forward a bit. Nancy stepped back. Heather stepped back. Lindsay pulled clear. Jen lifted her hands.

“Everybody clear. Shocking.” Sarah called out, her voice a little more firm that time.

The sound that came out of Clara this time was small. Just a quick “OOO”, soft and high-pitched. Her upper body twitched once— a single fast pull through her shoulders and her ribs, and then it stopped.

Clara’s head rolled. It rolled slow, slightly sideways, finding the angle gravity wanted it at, coming to rest with one cheek tilted toward her left shoulder. Her eyes were still wide open. Clara’s pupils were huge, the eyelids stayed up, and the eyes themselves were facing somewhere out past the bay, somewhere none of them could follow— there but not seeing.

Clara’s chest didn't rise. It didn’t rise again either. Her hands lay where the shock left them— one slack against the padded surface of the table, the other still half curled on the opposite side. The anklets on her left ankle lay still against each other. The wet shine on her tear streaked cheeks reflected a little bit in the overhead light.

One thing was unmistakable: Clara was limp on the table.

The team felt something was off before any of them spoke about it. The quality of the air in the bay changed in the space of two seconds. Nancy was the closest. She moved back in without anyone asking her to, the back of her hand brushing the side of Clara’s cheek as she stepped up, then her fingers wrapping around Clara’s slack hand and squeezing, “Sweetie? Are you with us?”

Clara didn’t say or do anything.

Nancy’s free hand moved to Clara’s sternum next. She made a tight, knuckled fist and rubbed her knuckles firmly against the bone of Clara’s chest, a deep press in a slow circle— the kind of stimulus that generally produces some sort of response from a patient. She did it again and pressed harder. She watched Clara’s face the whole time, but Clara’s face did nothing.

Clara’s eyes stayed open. The pupils stayed huge. Her mouth stayed slightly parted. The wet trails on her cheeks didn’t move because her face wasn’t moving. Clara’s head stayed tilted left where gravity left it.

“No response to painful stimuli.” Nancy’s voice was the steadiest thing in the room.

Dr. Jen the resident moved in from the head of the table. Her fingers settled along the side of Clara’s neck in the soft strip of skin over the carotid. She held them there. She waited a few seconds. She moved her fingers slightly. She waited again. Her eyes flicked up to the monitor and back to her fingers. The rhythm strip on the screen rolled past in that same wide, ragged polymorphic twist that six shocks did nothing to. Jen held the carotid for 10 full seconds.

When the young resident spoke, her voice came out quiet, “She’s pulseless. Still in polymorphic V-tach.”

The trauma bay shifted into a different mode in less than a second.

“She’s not perfusing. Lower the table flat. Move.” Lindsay’s voice changed— different now. It was more firm and intense— the same type of voice that’s run plenty of codes.

Nurse Heather hit the release at the side of the bed, and the back of the trauma table descended in a smooth mechanical drop, the upright bend flattening out, Clara’s body easing down into a supine position. Clara’s head settled. Her arms fell loose at her sides. Her eyes stayed wide open, glassy and somewhere else. The leads tugged a little as her body changed angles.

“Cutting her bra,” Sarah called out, already reaching for the trauma shears on an equipment tray nearby. She came back in fast, the shears in her hand, and slid the blade up under the band of the black sports bra and cut clean from the bottom to the neckline in a quick series of snips. The fabric fell open and back to the sides of Clara’s ribcage, leaving her bare from the waist up. The two small piercings through Clara’s nipples reflected some of the bright overhead light. The EKG leads stayed stuck where they were. The defib pads stayed where they were placed.

“Push 1 of epi now, IV,” Lindsay directed, eyes already on the monitor. “And another 150 of amio over the same line. Bolus the amio, don’t run it.”

“Drawing the amio,” Nancy confirmed, already at the medication drawer.

“Drawing the epi,” Sarah confirmed beside her.

“Heather, on her chest— start CPR. Jen, take over airway, bag-valve and get a good seal.”

“On it.” Nurse Heather was already positioning herself at the side of the table, gloved hands stacking heel-over-heel just over the center of Clara’s sternum, body squaring up over her, shoulders aligning.

Heather wasted no time getting started. The first compression came down hard— heel of her right hand stacked over the left, arms locked straight, shoulders aligned directly over Clara’s sternum. Clara’s small chest caved deep under the force and snapped back up against Heather’s palms before she came down again. The next compression went down just as deep. And the next. And the one after that. Clara’s belly bumped and rippled with each one, the rhythm of the resuscitation moving through her petite body. Clara’s small, perky tits bounced and jiggled around wildly as Heather pumped away at her bare, wired up chest.

At the head of the table, Jen pressed the bag valve mask down onto Clara’s face with her left hand, the soft plastic settling over her nose and mouth in a clean, tight seal. Jen’s left hand kept the mask sealed; her gloved fingers ran along the underside of Clara’s jaw and pulled it forward into the rubber, the airway opening. With her right hand, she squeezed the bag slowly in a controlled motion every six seconds or so, enough to lift the chest visibly under Heather’s hands between compressions. A soft, low whoosh of air came each time. Clara’s head bobbed in a tiny, rhythmic response to the compressions, hair stirring against the padded surface of the table, eyes still wide and open and not blinking, fixed on the row of ceiling tiles overhead.

“Epi’s in,” Sarah spoke, drawing back from the IV port on Clara’s left arm.

“Amio’s in,” Nancy added, withdrawing her own syringe from the port on the right.

Dr. Lindsay stood at the foot of the table. Her eyes ran the room— Heather’s count, Jen’s bagging, the monitor, the IV lines, the team, back to Clara’s face, back to the monitor before speaking, “Good. Let’s do a two minute cycle. I want us to start off strong on this one.”

The first two minute cycle of CPR went the way those cycles always seem to— too fast and too slow at the same time. Heather hammered out roughly 200 compressions across it. Jen got somewhere around 20 breaths in. Sarah and Nancy ran the meds and watched the line. Lindsay watched everything and everyone.

"Hold compressions," Lindsay instructed the team. "Pulse and rhythm check."

Nurse Heather lifted her gloved hands off of Clara’s sternum and stepped back half a step, breathing a little harder now. Jen paused the bag. Nancy's fingers slid to Clara's carotid one more time, "No pulse," Nancy shook her head, looking towards Lindsay.

The strip on the screen rolled past in the same ragged polymorphic twist that ran across it pretty much all night. "Still in VT," Sarah called out from the monitor.

Dr. Lindsay didn't pause, "Let’s hit her at 200. Unsynced."

"Charging to 200. Unsynchronized." Dr. Sarah nodded as she moved to the controls for the defibrillator.

In anticipation of the shock, Heather pulled clear, gloved hands lifted. Jen retracted the bag valve mask up off Clara's face and held it. Nancy took her fingers off Clara’s carotid and stepped away. Sarah stayed at the defib. Lindsay was already at the foot of the table.

THUMP!!!

A brief, limp twitch ran through Clara’s chest and shoulders. Her arms gave a small reflexive jump and settled. Her bare feet kicked a single short kick at the far end of the table— half a kick, no real force behind it, and went still again, the soles of her cute size 5.5 feet wrinkling again.

Clara’s head turned a smidge to the left. Her eyes stayed wide pen, staring straight up at the ceiling tiles, glassy and unmoving.

The monitor didn't bother changing— of course it didn’t.

Sarah shook her head, “No conversion.”

“Charge to 300. Same thing.” Lindsay ordered.

The rising, high-pitched sound built faster this time, the team already in their cleared positions.

“Okay. Everyone… CLEAR.” Lindsay’s voice surged as the next shock was delivered.

That one hit Clara differently. Clara’s chest shot up off the table, back arching hard, shoulders pulling back, small perky tits bouncing wildly, hips lifting clean off the padding in a single sharp upward bow, every muscle along the front of her body utilized at once. Clara held there, a stiff, locked arc for several seconds. The pads on her chest stayed stuck. The leads stretched a little bit. Her left foot pointed and held.

Then she dropped. Clara’s back came down against the padded surface in an ungraceful, weighted thump. Her arms slapped down at her sides. Her head rolled, finding its tilt to the left again. Her eyes were still wide open.

Dr. Sarah’s eyes flicked to the monitor, “Still polymorphic VT. No conversion.”

Lindsay didn’t break, “Resume CPR. Heather, back on her chest. Jen, back on the bag.”

“On it.” Heather was already in position, her hands stacking heel over heel onto Clara’s sternum, body squaring up over her. Her first compression came down hard. Her second came down just as hard. The rhythm picked back up where she left it prior to the shocks.

Dr. Jen the resident brought the bag valve mask back down onto Clara’s face, sealed it, and squeezed. The soft whoosh of air started up again.

The second cycle of CPR went by even faster than the first (or it at least felt that way). Nurse Heather pounded out another stretch of compressions, sweat starting to show along her hairline. Dr. Jen kept the bag going. Sarah and Nancy stood at the IV lines, ready for whatever came next. Lindsay called the time the next two minutes was up, “Hold compressions. Pulse and rhythm check."

Nurse Heather lifted. Jen paused the bag. Nancy went back to the carotid.

"No pulse, Linds,” Nancy shook her head. The strip showed exactly what it kept showing. Polymorphic VT, ragged and tireless.

"No change," Dr. Sarah confirmed from the monitor.

"Okay, this rhythm just won’t budge. Let’s go again at 360.” Lindsay responded.

The team wasted no time, delivering that next shock promptly.

Clara’s petite frame was tossed around effortlessly on the table, every muscle firing seemingly all at once. Her torso went into something that looked less like a single seize and more like a hard, drawn-out shiver— shoulders, ribs, belly all shaking under the current, her small perky tits almost vibrating as the current worked its way through her body.

At the far end of the table, Clara’s bare feet kicked hard— heels coming up off the padded surface and slamming back down again four or five times in succession, the soft, wavy, deep wrinkles fanning out across the surface of her small, size 5.5 soles.

Clara dropped back to stillness in a tumbled way, body settling unevenly— one shoulder lower than the other, one hand turned inward, her left foot still slightly rolled to the side. Her eyes stayed wide open. Her head stayed turned— that time to the right.

Dr. Sarah's eyes went back to the monitor, but zhe didn't speak right away. Then: "Rhythm change…”

Dr. Lindsay's head came up.

"V-fib," Sarah spoke. "She's in V-fib now..."

Dr. Lindsay's voice came faster now, "I need another 1 of epi. Another 150 of amio. And give me 1 of atropine while we're at it— I want everything in her. Push them through the right line."

"Pulling epi and amio," Nancy confirmed.

"Atropine drawing," Sarah added.

"Jen— I want her tubed. 7.0 ET. Get suction ready just in case. Heather, keep compressions going through it. We'll hold for the pass only." Lindsay continued.

"Okay." Jen was already moving.

The resident handed the bag valve mask off into Nancy's free hand and stepped fully up to the head of the table. She pulled the laryngoscope handle from the airway tray to her left and clicked the blade into place, the small light at the tip blinking on. Nurse Heather kept hammering compressions at her left— the table itself shifted a little under each one, Clara's head bobbing along in sync.

Dr. Jen tucked her right hand under the back of Clara's neck and tipped her head back, her slack mouth opening wider, lips parting, her loose tongue settling toward the back of the throat. With her left hand, Jen introduced the curved blade of the laryngoscope along the right side of Clara's tongue, then swept the tongue to the left as the blade slid into the midline of the mouth, the tip seating cleanly into the vallecula at the base of the tongue. Jen lifted up and away along the long axis of the handle— not levering, the way Lindsay hammered into her during sims a hundred times. The epiglottis came up next. Behind it: the small triangle of the glottic opening, the pale arch of the vocal cords on either side, the line of the airway beyond.

"I have cords." Jen called out.

"Okay, good. Pause compressions," Lindsay nodded.

Nurse Heather lifted off Clara's chest, awaiting further instruction.

Dr. Jen reached for the 7.0 endotracheal tube on the tray— straight, clear, the stylet already curved through it, and threaded it down through the right side of Clara's mouth past the laryngoscope blade, then through the cords. She watched the cuff disappear past the white arch and then a centimeter or so beyond.

"Cuff through. Holding at 22 at the lip." Jen called out to Lindsay. Jen held the tube with her right hand to keep it from migrating and pulled the stylet free with her left, then unclipped the inflating syringe and pushed air into the pilot balloon at the proximal end of the tube. 5 cc’s. The cuff inflated. She popped the bag valve free of the mask and clicked it directly onto the end of the ET tube.

"Bagging through the tube now," Jen spoke, the bag squeezing in her right hand, the soft whoosh that came back this time a little different— cleaner and deeper, Clara’s chest rising in a more even, fuller bow. Nancy moved up with the stethoscope and listened over the right chest, then the left, then the epigastrium, "Equal bilateral. No gastric. Tube’s in.”

"Good. Push the meds," Lindsay ordered.

Sarah and Nancy turned to the IVs at the same time. The syringes went into the ports across the next several seconds— epinephrine, amiodarone, atropine, each pushed and flushed clean behind it.

The next five minutes folded into themselves. Three more defibrillator shocks were sent through Clara's body— all at 360 joules. More epi went in. Another bolus of amio. Another atropine somewhere in the mix. Sodium bicarbonate at some point. Nurse Heather pounded through another full cycle, then a partial, before Sarah quietly tagged in and took over compressions for the next two minutes so Heather could catch her breath, shake her arms out, and hop back in. Jen kept bagging through the tube. Nancy ran from the medication cart to the monitor and back like she was holding both ends of a thread.

The clock on the wall moved in a way that didn't seem to match what they were doing. Time seemed to be dragging on and speeding up simultaneously.

And on the screen, the line just kept being the line. Coarse V-fib. Disorganized, fast, ragged, and unmistakable to anyone who knew what they were looking at. The QRSs never reassembled themselves. The amplitude rose and fell, fine in one stretch, coarser in the next, but the rhythm never resolved into anything that looked like it was trying to come back.

The trauma bay was a bit quieter now. Not silent— Sarah’s count was still going under everything, the rhythmic thudthudthud of CPR heard, Lindsay still called orders in the same calm, even voice. Nobody made small comments. Nobody asked unnecessary questions. The team moved with the muscle memory of people who all knew exactly what they were doing.

"Charge to 360, we need to shock her again.” Lindsay told the team.

The team quickly prepped for the next shock and peeled clear.

This shock caused Clara's body to twitch sharply in a single tight pull through her shoulders and her chest, her small perky tits with pierced nipples bouncing around a bit. Her arms snapped close to her ribs for a split second. Down at the far end of the table, her toes curled— quick, tight, and involuntary, the bright white nail polish on her toes visible.

Dr. Sarah's eyes went to the monitor before the shock was fully done, "No change. Still V-fib."

"Again at 360. Charge the pads." Lindsay shook her head.

The next shock moved Clara less in the body and more in the head. Clara's shoulders barely lifted off the table— a little jerk, almost gentle, like a thing trying to wake up and failing. But her head turned rolled with the shock, slow and sideways, coming to rest with her cheek tipped toward her right shoulder. Clara’s eyes stayed open through the whole motion wide and glassy. They didn't blink. They didn't change.

Sarah looked, "No change. She’s still V-fib."

Following that shock, the next ten minutes of the code went by without much change. Five more defibrillations. More epi. More amio until they reached the ceiling on it. More chest compressions, traded off again, Heather and Sarah swapping every two minutes or so, Lindsay stepping in once herself when Sarah needed thirty seconds to breathe. Jen kept bagging through the tube. Coarse V-fib remained the rhythm despite everything.

Clara's body was beginning to show signs associated with prolonged cardiac arrest. The flush from the panic earlier was gone, her face now ghastly pale. Her lips, when Jen looked at them up close, were taking on a faint purplish color, cyanosis creeping in.

Between ambu bag squeezes, Dr. Jen reached for the penlight clipped to her scrub pocket and clicked it on. She brought it up close to Clara's right eye first. The light fell across the wide dark of the pupil. It stayed wide— no reaction. Jen repeated the same thing in the left eye, but that pupil was also fixed and dilated. Jen brought the light back to the right and held it there for a longer second, watching, willing it. Clara’s pupil didn't budge, remaining totally blown. Dr. Jen clicked the penlight off and slid the pen light back into her scrub pocket. "Dr. Lindsay… her pupils are fixed and dilated bilaterally,” she told Lindsay who was at the far end of the table.

Dr. Lindsay caught Jen's words and gave her a single small nod— the kind that meant heard, understood, keep going. She didn't acknowledge it past that. "Resume compressions. Another epi, 1 milligram . And another half amp of bicarb behind it." Lindsay told the team.

Dr. Sarah was already drawing it before Lindsay finished the order.

Nurse Heather came back down onto Clara's chest, gloved hands stacking in the same spot they kept finding for the better part of twenty minutes now, and started the grim rhythm again. The downstrokes came as deep as they did at the beginning, which was something— Heather kept her arms from shortening the way arms tended to shorten in long codes, but the skin under her palms wasn't quite the same skin from the beginning. A bruise was forming in the center of Clara's chest, a dark mottled flowering of purples and reds spreading outward from the sternum, the kind of bruise that forms after roughly 20 minutes of pumping away at a bare chest. The defib pads at the edges of the discoloration sat relatively undisturbed. Clara’s nipple piercings caught the light again, her nipples fading a bit in color from lack of proper circulation.

Clara's eyes still weren't closed despite all the resuscitation efforts she’s endured up to that point. They stayed wide open and glazed over, unmoving except for the small involuntary movement her whole head made with every downstroke Heather gave her— bobbing a fraction of an inch with each compression, hair stirring against the pad of the table, a tiny rhythmic dip and rise like a thing being rocked.

Nurse Nancy pushed the epi. Dr. Sarah followed it with the bicarb.

Dr. Lindsay's eyes were on the monitor. Her jaw clenched a little, then unset. She didn't say what she was thinking. None of them did. But in reality, the whole team knew how Clara’s code was going to go and in all likelihood.

Several more minutes flew by without any change. Three more shocks went into Clara— three more controlled jolts of electricity passed between the pads. The last meds drifted out into circulation that the compressions kept moving for her, since her own heart wasn't moving anything. CPR kept turning over in two minute cycles. The rhythmic thudthudthud of Nurse Heather's gloved hands against Clara's bare chest sounded almost like a bleak metronome of sorts.

Around it, the noise that wasn't compressions thinned to almost nothing. The occasional monitor alarm chirped— a low electronic screech when the pulse ox lost its read for a few seconds, a different tone when the BP cuff cycled and couldn't find a number. Nobody startled at those anymore. Nobody talked over them. The team spoke more economically: a confirmation when a med went in, a "still V-fib" when Sarah glanced at the screen, a quiet "swap" when somebody else stepped beside Heather to take compressions for a cycle. That was pretty much it. The trauma bay was almost too quiet, given what was happening in it.

Dr. Lindsay stood at the foot of the table. Her bluish-gray eyes were on the monitor and stayed there. Her hand rested on the end of the table, not far from one of Clara’s feet. Her face was the same— composed, professional, and unhurried, but something behind it was settled in a way it wasn't a several minutes earlier.

When the current CPR cycle ran its course, Lindsay didn't let the next one begin. She raised her hand a little, just enough for Nurse Heather to catch the motion. "Hold compressions, please," Dr. Lindsay ordered Heather, and by extension, the rest of the team.

Nurse Heather's hands lifted off Clara's chest in the same instant Lindsay finished speaking. She took a half step back from the table, shoulders rolling once as she was able to take a little break after all that CPR.

Up at the head of the table, Jen reached down to the connector where the bag valve met the end of the endotracheal tube. She twisted it free with a small, careful motion of her fingers with a quiet plastic click as the fitting came apart, then a small hiss of air leaving the bag as it disengaged. She set the bag down on the table beside Clara's head.

Every set of eyes in the room moved to Lindsay. The pause that followed was the kind of pause that carried a heavier weight to it— not so much waiting as bracing. Dr. Sarah looked at her over the rim of her glasses. Nancy looked up from where she still stood on Clara's left side. Heather looked straight at her. Jen was already looking at her too.

Dr. Lindsay let her own eyes pass slowly across each of them. Then she came back to the table and brought them down on Clara— on her open eyes, on her parted mouth around the ET tube, on the dark nasty bruising at the center of her chest, and on the small, still feet at the far end of the table where some anklets remained around one ankle.

Lindsay drew a small, steady breath, then began speaking, "Alright, everyone. We've been working on Clara for nearly half an hour now, and we haven't been able to convert her from V-fib at any point during our efforts. I don't believe we have the ability to produce a meaningful recovery for her anymore. So I'm going to go ahead and call it."

Dr. Lindsay glanced at the clock on the wall, "Time of death, 22:31. Thank you all for your efforts tonight."

The team seamlessly transitioned into post-code care.

Dr. Jen reached up behind the head of the table and clicked off the heart monitor. The bay went quieter again, but now it was more of an eerie quiet.

Nurse Heather stepped to the right side of the table and started working the EKG wires loose. One at a time, she unsnapped each lead from the small circular electrode it was clipped to— pop, pop, pop, the soft plastic clicks running across the torso and then back across the lower chest— leaving the round white stickers themselves stuck to Clara's skin where they were. The dangling ends of the leads she gathered back toward the monitor, draping them across the head of the table in a small, neat tangle.

Nurse Nancy worked the IVs. She peeled back the clear tegaderm at the right antecubital fold first, gentle even though there was no longer any reason to be gentle, then drew the 18 gauge catheter out cleanly. A tiny bubble of dark blood welled up at the puncture site and stayed there, no pressure behind it to push it any further. She pressed a small square of gauze over it anyway, the way a nurse does. She moved to the left arm and did the same.

Dr. Sarah unwound the BP cuff from Clara's left bicep, the long stretch of velcro coming apart with the soft, low riiip the velcro of those cuffs always made, and rolled the cuff back up into itself and set it onto the counter on the side of the room.

Dr. Lindsay stepped in from the foot of the table and came around to Clara's right side. She reached down and slid the pulse oximeter free of Clara's right index finger with a small careful pinch of its sides, the spring releasing soundlessly, and laid the small device aside on the table. Clara's hand, freed of it, stayed exactly where it was. Lindsay's fingers brushed the back of Clara's hand for a half second.

Nurse Heather stepped back over to Clara's chest. She slid two fingers under the edge of the right defib pad and lifted slowly, peeling it back the way you peel something that wasn’t really made to be ripped, the adhesive giving up in a slow, smooth release, leaving a faint pink rectangle in its outline where the pad sat for the better part of the last little while. The cable on the back end of the pad followed it up and out of the way. She did the same with the left pad. Two pink remnants of the pads sat on Clara’s bare chest, framing the bruise over her sternum in a way nobody wanted to look at for too long.

Nurse Nancy moved up to Clara's face. Her hand was unhurried as she gently shut Clara’s eyes for the final time. Nancy stood there for a moment longer than the gesture required, her thumb resting against Clara's temple, before she let her hand fall.

Dr. Lindsay pulled a toe tag and a black pen from the wall-mounted dispenser on her way back over. She filled out the small cardstock tag against the back of the patient's chart at the foot of the table— name, date of birth, medical record number, the time and date of death— her handwriting clean and unhurried, the way it always was. She finished. She tied the string of the tag to the big toe of Clara's left foot with two careful loops. The card hung against the side of Clara's left foot, and the size of the card and the size of the foot were nearly the same. The toe tag brushed up against the hot, wrinkled sole of Clara’s left foot as Lindsay finished up.

Dr. Jen reached for the folded white sheet on the back counter and brought it to the head of the table. Dr. Sarah came around to the foot. They opened it together— a single shake-out, the fabric flaring above Clara in a brief soft cloud, and let it settle. They smoothed it down as it dropped. The sheet covered her feet first, then her legs, then her hips and her bruised chest and her shoulders, then lastly her face. Dr. Jen pulled the top edge just over the crown of her head; Sarah pulled the bottom edge straight across the tops of her feet. The two of them tucked the sides under the curve of her body at the same moment, the way they have done many times before, and will likely again at some point.