#defibs

She was stripped by EMS for access. Topless, the breathing tube taped and secured at the corner of her mouth, her chest a moving canvas of color, metal, and equipment all at once. Tattoos sleeved both of her arms in dense, intricate patchwork, more ink scattered across her chest and belly in pieces that didn’t quite connect to one another but still worked. Two small silver barbells glinted through her nipples. A nasal septum ring sat in her nose. Multiple piercings climbed the curve of each ear. Defibrillator pads were stuck to her bare, small-breasted chest in their standard placement, the wires trailing off the edge of the gurney. Five EKG leads dotted her torso between the tattoos and nipple piercings. A blood pressure cuff was wrapped around her left bicep. A pulse oximeter was clipped to her right index finger, its red light glowing faintly, giving a less than ideal readout. IV lines ran into the antecubital fossa of each arm, the tubing taped down and trailing toward bags of fluid connected to the gurney's pole.

Below the waist, her pants were cut away and discarded somewhere on the ride in, leaving her in nothing but a pair of plain black panties. Her legs, like her arms, were covered in patchwork tattoos from thigh to ankle. Her feet were bare— size 8 with soft, prominent, wavy wrinkles that fanned out across her soles. A fresh pedicure in matte black gel sat on her toes, the polish unchipped, almost obscenely perfect against everything else.

The trauma bay was waiting.

Dr. Lindsay stood at the edge of the open trauma room near the entryway, gowned and gloved, her expression set in the calm, neutral focus that her team came to recognize as her working face. Dr. Sarah stood just behind her left shoulder, arms crossed over her own gown, her perpetual low-grade irritation already in full swing. Dr. Jen the resident hovered a step or two further back, quiet and watchful, her hands folded in front of her. Nurse Nancy stood ready at the side of the trauma room table, the warmth in her face still somewhat present, her gloved hands resting lightly on the edge of the table. Nurse Heather was already moving, silent and efficient as always, double checking everything and ensuring that the crash cart was unlocked and within arm's reach.

The EMS gurney rolled into the trauma room and stopped alongside the table. The compressions didn’t stop with it.

"Alana Hawthorne, 24 year old female," the lead medic began, raising her voice just enough to make sure everyone in the room could hear. Her eyes found Lindsay's and stayed there. "Collapsed at a friend's apartment after complaining of chest pain and heart palpitations. Friends called 911, said she'd been using cocaine earlier in the evening. We arrived to find her unresponsive, agonal respirations, no palpable pulse. Initial rhythm was pulseless v-tach. Started CPR on scene, intubated successfully on the first attempt, established bilateral antecubital IV access. We've been bouncing between pulseless v-tach and coarse v-fib the entire ride over here. Currently in coarse v-fib."

Lindsay gave the smallest nod, listening.

"Down time fifteen minutes total— maybe longer," the medic continued, her cadence never breaking. "Two defibrillation attempts at two hundred joules biphasic, no conversion. Three milligrams of epinephrine on board, one milligram of atropine, and we gave her two doses of naloxone en route given the history. No response to any of it. GCS three. Pupils fixed and dilated."

The last sentence landed in the room with a quiet, unspoken intensity. The team knew right off the bat that things were looking particularly grim for the tatted up hottie EMS just wheeled in.

Nurse Nancy's mouth tightened almost imperceptibly. Sarah's arms shifted across her chest, the irritation behind her glasses ticking up a single, almost invisible notch. Jen's eyes didn’t move from the patient. Heather kept working, but her hands slowed for a fraction of a second before resuming. Lindsay's face didn’t change at all.

"Last shock?" Lindsay asked, her voice even.

"Roughly two minutes ago," the medic answered. "We're due for another rhythm check now."

Lindsay nodded once. "Thank you. Let's get her over."

The room moved as one.

"On my count," Lindsay directed. "Hold compressions for the transfer. Ready— one, two… THREE."

The medic doing compressions lifted her hands clear. Gloved arms slid beneath the patient— under her shoulders, under her hips, under her thighs and calves— and in one fluid motion, Alana Hawthorne was lifted from the gurney and laid down onto the trauma room table. Her blue hair fanned out again across the black padded surface beneath her head. Her bare feet came to rest at the far end of the table, the matte black polish on her toes shining from the harsh overhead light for just a moment before someone's body moved between the overhead light and her legs.

The EMS crew stepped back. One of them was already pulling the now-empty gurney clear of the bay, the other two lingering at the threshold in case anything else was needed.

The trauma room belonged to our team, and the fight for Alana’s life was on.

The moment the EMS gurney cleared the trauma room, Lindsay stepped forward into the space the medics just vacated.

"Don’t resume compressions just yet," she ordered calmly. "Rhythm check."

Jen, who was slated to take over chest compressions from the EMS medic, lifted her gloved hands clear of Alana's chest and stepped half a step back. Every set of eyes in the room turned to the heart monitor mounted above the head of the table.

The green line crawled across the screen in chaotic, jagged peaks and valleys— no organized complexes, no discernible rhythm— just electrical nonsense.

"Coarse v-fib," Sarah observed flatly from Lindsay's left, her arms already uncrossing as she moved towards the head of the bed. "Definitely shockable."

"Charge to two hundred," Lindsay agreed. "Heather, confirm the defib pads are placed properly. Nancy, get ready to push another round of epi. Jen, you’re on compressions if she doesn’t convert."

The trauma room came alive around her. Nurse Heather's hands were already on the defibrillator pads, fingers moving across them. "Charging," Lindsay called out. The unit began its rising, high-pitched whine. Nancy drew up the epinephrine from the crash cart, her face set in the gentle, focused neutrality she wore during every code she'd ever worked in her 23 years in our ER. Jen planted her feet at the side of the table, waiting for whatever came next.

"Charged," Heather told the team, taking a look at the defib controls after checking the pads. "Two hundred joules."

"Everyone CLEAR," Lindsay stated, her voice sharper now, cutting across the room.

Everyone lifted their hands. The bag valve mask was disconnected from Alana's breathing tube.

Alana's body reacted to the two hundred joules of electricity as if something invisible passed through her all at once. Her torso tensed hard against the table in a single convulsive wave, a motion that looked uncannily like a full-body shiver drawn out and suspended. Her shoulders pulled forward slightly off the surface of the table. Her hands, resting limp at her sides a half second earlier, curled into loose, incomplete fists. And her eyes— those bright, icy blue eyes, stared lifelessly above, remaining wide open. They didn’t look at anything. They stared past the overhead light above the table, wide and vacant, the pupils fixed and dilated exactly as the paramedic reported.

"No change. Start compressions," Lindsay ordered shortly after the shock, and Jen's hands came down onto Alana's sternum without hesitation, performing deep, violent chest compressions. Alana’s chest caved in deep, recoiling hard, her belly rippling and undulating. Her small, A-cup breasts barely moved with the force of the compressions.

Nancy's jaw tightened almost imperceptibly as she stepped in with the syringe of epinephrine, uncapped the port on the left antecubital IV, and pushed the drug through with a steady thumb. Nurse Heather's eyes flicked to Alana's face for a fraction of a second before she reset the defibrillator for the next cycle. Even Sarah, who’s seen more hotties being coded than she could count at this point, let her gaze linger on those open eyes for half a second longer than necessary before looking away.

"Epi's in, Linds," Nancy reported softly. "Flushing now."

"Tube check while we're cycling," Lindsay continued, her voice steady, moving the team forward through the ACLS algorithm. "Sarah, confirm placement."

Dr. Sarah was already moving. She pulled the stethoscope from around her neck, leaned over Alana's chest between Jen's compressions, and listened to both lung fields and the epigastrium with quick, efficient placements. "Bilateral breath sounds, nothing over the stomach. Tube's good."

"Noted." Lindsay's eyes moved to Heather. "Let's get a rainbow draw off the right IV— CBC, BMP, troponin, coags, lactate, blood gas, tox, and a d-dimer. And I want a bedside echo as soon as we get a chance— I want to see what the heart’s doing exactly. Nancy, help me with the neuro checks while Jen’s on compressions."

Nurse Nancy moved to the head of the bed and leaned down over Alana. She pulled a penlight from her scrub pocket and, with the gentleness of a woman who’s done this God knows how many times and still somehow made it feel like the first, she eased each of Alana's open eyelids fractionally wider than they already were and shined the light across them one at a time. The blue irises with blown pupils didn’t respond in the slightest.

"Pupils still fixed and dilated…" Nancy reported grimly. "No reaction."

Dr. Lindsay gave a small nod. She moved in and pressed her gloved knuckles firmly against the center of Alana's sternum for a deep, grinding sternal rub, just above where Jen's compressing hands were working. No grimace. No flinch. Nothing.

"No response to painful stimulus," Lindsay reported. She reached down and took Alana's left hand in her own gloved one, the one with a cool silver spiral ring still wrapped around the index finger. "Alana, sweetheart? Squeeze my hand if you can hear me. Alana, can you squeeze my hand?"

Alana’s hand stayed limp and motionless in Lindsay’s grip.

At the foot of the bed, Sarah uncapped the end of a reflex hammer and drew its handle firmly up the sole of Alana's bare right foot, from heel to toe along the lateral edge, and through the soft, wavy wrinkles in the sole of that foot. The matte black polish on her toenails caught the overhead light as her foot remained motionless— no withdrawal, no plantar reflex, no Babinski, no nothing. Just a foot with a fresh pedicure that would not so much as twitch for any of them.

Dr. Sarah straightened slowly, her expression unchanged behind her thick-rimmed glasses. "Fifteen minutes down, fixed and dilated pupils, and nostrils full of cocaine," she began, her voice low and flat, almost to herself. "Not exactly a good Friday night in my book. At least she has pretty feet though."

Dr. Lindsay didn’t feel compelled to answer.

"Two minutes," Heather announced from the defibrillator.

"Hold compressions," Lindsay raised one hand, indicating that Jen should stop. "Next rhythm check."

Dr. Jen the resident lifted her gloved hands again and stepped back, her chest rising and falling more visibly now. Every eye went back to the monitor. The green, squiggly line continued its nonsensical movements.

"Still coarse v-fib," Sarah confirmed.

"Charge again. Two hundred." Lindsay wasted no time.

"Charging," Heather called out.

"Lindsay— she needs an amp of bicarb. NOW." Sarah's voice cut across the room without waiting to be invited. "She's probably going to the morgue anyway, but she needs this now if it's cocaine like the medics suspected."

Lindsay didn’t hesitate. "Do it. Nancy, push it as soon as the shock's clear. Heather, swap in on compressions if she doesn’t convert— Jen, you're tagging out."

"Got it," Nancy nodded, already reaching for the sodium bicarbonate ampule on the crash cart. Heather moved into position at the side of the table, relieving Jen without hesitation for when the next cycle of CPR would have to be performed. The resident stepped back, flexing her hands, and found a spot at the head of the bed where she could see the monitor and make herself useful with the bedside ultrasound when the next pause came.

"Shocking. Everyone CLEAR.” Lindsay called out, her fingers now on the defibrillator’s controls.

The next jolt went through the 24 year old, and this time the reaction was different. Where the first shock pulled at her upper body, this one rolled down into her legs. Her thighs twitched hard against the table beneath her. Her calves jerked once, then again. Her bare feet flexed sharply at the ankles, her soles arching, and her toes curled and scrunched in a tight, involuntary clench before going slack again a second later. The matte black polish flashed under the lamp, then stilled.

The monitor showed no change whatsoever. Coarse v-fib, unchanged, unbothered by the controlled dose of electricity that just passed through Alana.

"Resume compressions," Lindsay directed our team, and Heather's hands came down onto the patient’s sternum, and the battle for her life continued.

"Hold compressions," Lindsay ordered after another cycle or two of high-quality chest compressions from Heather. "Rhythm check. Jen, get the ultrasound probe on her chest while we're paused."

Nurse Heather lifted her gloved hands clear of Alana's sternum and stepped back, breathing steadily. Jen the resident was already moving, the bedside ultrasound rolled in close, the cardiac probe in her gloved hand and a squirt of clear conducive gel waiting on Alana's bare skin just below the sternum. She crouched slightly, angled the probe up beneath the ribs, and her eyes went to the screen. The team's eyes went with her.

What appeared on the small ultrasound display wasn’t a heart in the way that any of them wanted to see one. The ventricle walls fluttered and twitched in a fast, disorganized sort of way. There was no organized contraction. No coordinated squeeze. No pericardial effusion. No tamponade. Just a muscle maintaining electrical chaos and refusing to do the one thing it existed to do.

Jen's voice came out steady. "No effusion. No tamponade. Walls are twitching, no organized motion. Consistent with v-fib."

She kept the probe there for a half second longer than she needed to. Jen was 28 years old, and the young lady on the table was 24, and Jen was looking at a heart that shouldn’t have belonged to someone younger than her. She lifted the probe away and placed it on the cart without saying anything else, but the moment was one she’d be thinking about later on after her shift.

"Copy," Lindsay gave a slight nod. "What’s on the monitors? Can we confirm v-fib, please?"

"Coarse v-fib," Sarah confirmed from the head of the bed.

"Charge again to two hundred. Jen, you're back on compressions if we don’t get her back. Nancy, another round of epi as soon as we resume. Heather, three hundred of amio after the epi." Lindsay directed her team.

"Three hundred amio, got it," Heather acknowledged, already turning toward the crash cart.

"Charging," Heather added a second later, the defibrillator's whine rising again.

A moment later, the shock discharged and went through Alana, her torso responding with a sharp, tight twitch— a single hard tense across the muscles of her abdomen and chest, her ribcage drawing inward against itself for half a second before going completely limp. As her body slackened, her head rolled gently to the side, the blue hair that’d been splayed around her now shifting against the table so that one half of it pooled across her shoulder and the other half stayed where it had been. Her open eyes didn’t move with the motion. They went on staring up at the overhead light from the new angle, just as fixed and vacant as before.

"Okay… no change on the monitors. Resume compressions," Lindsay observed the monitors post shock.

Dr. Jen's hands came down on Alana's sternum and she began CPR again, her face set in tight concentration.

"Pushing epi, 1 milligram," Nancy relayed to the team, uncapping the IV port and pressing the syringe through. As she withdrew the empty syringe and reached for the saline flush, her eyes dropped to Alana's face— to the still-open eyes, to the matte black gel polish she could see at the foot of the table, to the silver spiral ring wrapped around Alana's slack index finger. With her free hand, Nancy reached up and gently brushed a stray lock of vivid blue hair away from Alana's cheek and tucked it behind her ear. The gesture took less than a second. No one but Nancy knew did it.

"Epi's in," she said softly.

"Amio's up," Heather added, stepping in with the syringe of amiodarone. "300 milligrams." She pushed it through the right antecubital line and flushed it without breaking pace, then turned immediately back to the defibrillator to reset for the next cycle. Her movements were a fraction faster than they were five minutes ago. She didn’t look at Alana's face. She didn’t look at the monitor for any longer than she had to. There was a job in front of her, and she was going to do it, and she wasn’t going to think about anything else while she did.

The phone on the wall by the trauma room door rang.

"Labs are back," Heather made her way over and answered it, picking it up on the second ring. She listened, her face neutral, scribbling on the clipboard at the desk with one hand. "Copy. Thank you." She hung up and turned, reading off the numbers as she walked the page back to the table.

"pH 6.84. Lactate 17. Bicarb 8. Potassium 6.1. Troponin elevated, 8.3. Tox screen positive for cocaine and THC." Reported Nurse Heather, her tone even.

The numbers landed in the trauma room one after another, and no one said anything about them at first. Lindsay's expression never changed. Nancy's hands kept moving on the IV line. Jen kept her compressions going at the steady, brutal pace she set. But the silence between the callouts became a different kind of silence than it was just a few minutes ago. It was a silence with a whole lot of weight in it.

Dr. Sarah straightened from where she was leaning against the side of the table and stepped half a pace closer to Lindsay. Behind her thick-rimmed glasses, her blue eyes were sharper than they’d been all night, and the perpetual irritation in her face condensed into something heavier and more deliberate.

"Lindsay," Sarah started, and her voice was low but absolutely clear. "Come on. pH of 6.84, lactate of 17, fixed and dilated pupils, fifteen minutes of downtime before she even got here— maybe longer. She's dead. You and I both know it."

Lindsay didn’t look up from the patient. She watched Jen's compressions for one full cycle, her face giving nothing away. Then she said, very calmly: "Let's keep going."

Dr. Sarah held her position for a moment longer. Then she gave a single, tight nod and stepped back to the head of the table without another word. Whatever she felt about the decision stayed inside her chest where it belonged, where every difficult thing in Dr. Sarah Grayson's life always lived. Lindsay made her call. Sarah respected the call enough not to fight her on it twice.

"Two minutes," Heather reported from the crash cart.

"Hold compressions. Rhythm check." Lindsay ordered.

Jen lifted her hands.

"Coarse v-fib." Sarah eyed the heart monitor.

"Charge to two hundred, let’s shock her again." Lindsay ordered.

Heather confirmed, "Charging to two hundred."

"Clear the patient. Shocking." Lindsay’s bluish gray eyes scanned the room to ensure everyone was a safe distance from Alana in anticipation of the shock.

The next shock went through her, and this time Alana's back arched faintly off the table, her chest pushing up against the air above her in a slow, shallow rise before falling back down. The skin of her forehead crinkled briefly, eyebrows lifting in an expression that was almost a flicker of surprise, the kind of micro movement her face might’ve made in life when something unexpected was said in a conversation. Then it was gone, and her features went smooth and slack again.

"No change, resume compressions." Lindsay shook her head, folding her arms.

Dr. Jen's hands came back down. The cycle started over.

In the corner where she had a half step of extra room, Lindsay watched her team work and felt the quiet pressure of the decision she was going to have to make settling more firmly across her shoulders with each passing minute. She knew what the numbers said. She knew what the echo showed. She knew what prolonged downtime, fixed and dilated pupils, and a bloodstream full of cocaine added up to. But she also knew that the moment she said the words “let's call it”, this beautiful young woman with blue hair and a matte black pedicure was going to stop being a patient and start being a body, and Lindsay was the one who was going to have to be the person who made that happen. So for now, she gave them one more round. And then another.

"Two minutes," Heather called out again. "Hold compressions. Rhythm check."

"Coarse v-fib… again…" Dr. Sarah observed on the monitor readout, her tone a little crabby.

"Let’s shock her again. Charge to two hundred." Lindsay ordered the team.

The next shock coursed through Alana Hawthorne's body, and her bare feet lifted clear off the surface of the trauma room table— not high, just enough that the heels rose an inch or two above the table before plopping back down with a soft, ungraceful thud that seemed louder in the trauma room than it had any right to be. Her toes, with their unchipped matte black polish, gave a small involuntary curl on the way down and then went slack, the wrinkles in the soles of her feet jutting out noticeably.

The monitor still didn’t change.

"Resume compressions," Lindsay stated more evenly.

Dr. Jen's hands came back down on Alana's sternum, and the code kept going…

The trauma room moved through another cycle of compressions, but that cycle felt so much longer than the ones before it, even though it was exactly the same amount of time.

Jen's gloved hands stayed planted on Alana's sternum, pushing down at the same brutal, rhythmic pace she’d been keeping up. Heather took back over on the bag valve, squeezing much needed oxygen into Alana's lungs through the endotracheal tube in time with the cadence above. Nancy stood at the left side of the bed, her gloved hand resting lightly on Alana's tattooed forearm, just above the IV. Dr. Sarah remained near the head of the table, her arms crossed again, her eyes flicking between the monitor and Alana's face and back. Lindsay stood at the foot of the bed, watching our team work, her own hands clasped in front of her gown.

Those two minutes felt like twenty.

"Time," Heather called out discreetly from the side.

"Hold compressions," Lindsay ordered, her voice softer now. "Let’s do a rhythm check."

Jen the resident lifted her hands and stepped back a couple feet, her chest rising and falling hard. Every set of eyes went to the monitor.

The green line was still scrawling its same chaotic, jagged nonsense across the screen. Coarse v-fib. Stubborn, electrically alive (sort of!), and refusing to convert to anything else despite everything our team threw at it.

Nobody said the words this time. They didn't need to.

Dr. Lindsay drew in a slow breath through her nose and let it back out. "Let's do a full set of checks. Sarah, pulses. Jen, repeat the echo. Nancy, plantar reflex and toes. Heather, watch her chest for any spontaneous respirations after you detach the ambu bag. I'll do pupils and stimulus."

The team moved as a collective unit, no one questioning anything, no one needing to be told twice.

Dr. Sarah pulled her stethoscope from around her neck and pressed the end of her stethoscope first to the side of Alana's neck, just beneath the angle of her jaw, holding the position with the patient, methodical thoroughness that defined her. She held it for ten full seconds. "No carotid pulse." She moved to Alana's right wrist, fingers finding the radial groove. "No radial." She moved to the crease of Alana's right hip, pressing through to the femoral triangle. "No femoral pulse." She walked the length of the table to Alana's bare right foot and pressed two fingers gently into the top of it, just below the ankle, on the dorsum. The matte black gel polish on the toes didn’t so much as quiver. "No dorsalis pedis."

She brought her stethoscope up next, slipping the bell beneath the tangle of EKG leads to listen at four points across Alana's chest, then over the precordium, taking her time. The room held its silence so she could hear. After almost a full thirty seconds, she straightened and pulled the buds from her ears. "No breath sounds. No heart sounds. Nothing."

At the head of the bed, Lindsay leaned in close. She lifted Alana's right eyelid a fraction wider with the gentle pad of her gloved thumb and shined her penlight across the bright blue iris. The pupil— already dilated to nearly the edge of the iris, didn’t react. She moved to the left eye and did the same. Nothing.

"Pupils still fixed and dilated bilaterally." Reported Lindsay, which surprised nobody at this point.

She set the penlight down. With the same hand, she reached down and took Alana's hand in her own, the silver spiral ring still wrapped around the slack index finger, and she leaned slightly forward over the bed.

"Alana?" Lindsay's voice was soft, almost conversational, the trauma room voice she used with patients she was trying to bring back to themselves. "Alana? Hey, beautiful, are you with us? Can you squeeze my hand for me? Anything at all?"

The hand in hers stayed loose, cool to the touch, and totally still.

Dr. Lindsay set it back down on the table with a care that bordered on tenderness. She made a fist of her own gloved knuckles and pressed them firmly into the center of Alana's sternum, grinding down hard into the bone in the way that had jolted countless half-conscious patients into reaction over the years. Alana's body didn’t respond. Her face didn’t grimace. Her breathing (or lack thereof) never changed.

"No response to painful stimulus." Lindsay reported.

At the foot of the bed, Nancy rolled the bedside cart aside and stepped in close to Alana's bare feet. She lifted the right foot gently in her gloved hand, cradling the heel in her palm gently, the wrinkles fanning out across the sole of Alana’s foot. With her other hand, she took the handle of the reflex hammer and drew it slowly and firmly up the edge of Alana's sole, from heel toward the ball of the foot, passing through every wrinkle and crease, just as Sarah did earlier in the code. The matte black polish caught the overhead light. Her toes didn’t move. Her arch didn’t flex. There was no withdrawal, no Babinski, no plantar reflex of any kind.

Nurse Nancy kept her hand wrapped around Alana's heel for a moment longer than the test required, looking up at the young woman's face from the foot of the bed.

"Alana, honey?" she began, her voice low and warm and entirely free of any clinical edge. "Sweetheart, can you wiggle your toes for me? Anything you can give us, baby. Just a little wiggle."

Alana's toes didn’t move. The matte black polish stayed exactly where it was, unchipped and obscenely intact, a small bright detail at the foot of a body that had stopped being able to do anything at all.

Nancy lowered the foot gently back to the table and rested her hand on Alana's shin for a moment before letting go. She didn’t say anything else.

A few feet away, Jen had the cardiac probe back on Alana's chest, her eyes locked on the small screen of the bedside ultrasound. The image she saw was the same image she observed earlier. Twitching ventricle walls. No organized contraction. No effusion. No tamponade. A muscle still electrically alive but mechanically gone.

"Same as before," Jen shook her head. "Just the v-fib twitch. No organized cardiac activity."

The resident lifted the probe away.

At the side of the bed, Heather eased the bag valve back from the breathing tube, holding it suspended in the air a few inches above Alana's face. Her eyes dropped to Alana's bare chest, watching the spot just below the sternum where any spontaneous respiratory effort would show itself as a rise. She watched for fifteen long seconds. The ribs, tattoos, and the small barbells through her nipples didn’t move at all.

"No spontaneous respirations," Heather stated.

She didn’t bring the bag valve back to the tube. There was no point now.

Dr. Lindsay looked around the room at her team, taking in each of them in turn— Sarah at the side of the table with her stethoscope still hanging in her gloved hand, Jen with the ultrasound probe lowered to her hip, Nancy at the foot of the table with one hand resting against Alana's shin, Heather standing motionless beside the head of the bed with the bag valve held quietly at her side.

She drew in another slow breath.

"Alright, everyone." Her voice was calm, steady, and level, but there was something underneath it now that wasn’t there earlier, something soft and weighted that the people in the room who knew her best could hear. "Her pupils are fixed and dilated, no response to painful stimuli, plantar reflex is absent, no pulses anywhere, no spontaneous respirations, no breath sounds or heart sounds on auscultation, v-fib confirmed by bedside echo and the heart monitors. We've shocked her five times, and EMS shocked her twice. We've performed various cycles of high-quality chest compressions and given her multiple doses of meds. She was down at least fifteen minutes prior to arrival, and we worked her an extra twenty-two minutes, which means she's had a total downtime of about thirty-seven minutes. At this point, I don't believe a meaningful recovery is possible."

She paused. Her eyes moved around the team one more time. "Does anyone have any objections to me calling this code?"

Nobody spoke. Sarah's mouth tightened behind her glasses but she gave a small shake of her head. Jen looked down at the floor for half a second and then back up at Lindsay, her expression open and ready. Nancy met Lindsay's eyes and gave the smallest, most patient nod. Heather didn’t move at all, but her silence said the same thing the others said.

Lindsay nodded once.

"Okay. I'm going to go ahead and call Alana Hawthorne's time of death at 1:37 AM. Thank you for your efforts tonight, everyone. You performed exceptionally well despite the poor patient outcome."

For a long moment, nobody moved.

Then Sarah let out a slow, almost inaudible breath through her nose and reached up to remove her stethoscope away from her neck with a little more force than the gesture really needed, draping it over her shoulder. Behind her glasses, the perpetual irritation in her face hardened into something quieter and heavier, and she never said a word.

Dr. Jen lowered the ultrasound probe the rest of the way to the cart. She was 28 years old. The woman on the table who just died was 24. Jen kept her face very still, but inside her chest something shifted into a place she would think about later, in private, when she was alone.

Nurse Heather set the bag valve down on the side of the table without a sound and began, almost on instinct, to start tidying the equipment within her immediate reach. Her head stayed down. Her hands stayed busy. She didn’t let herself stop— she never did.

And Nancy was already moving toward the head of the bed, her hands already gentling, her face already softening into the expression she wore for God knows how many patients in moments identical to this one.

The trauma room felt different after the call.

The energy was gone. The urgency was gone. What was left in its place was an almost eerie quiet that had weight to it — the kind of quiet that always settled into a room in the minutes after a death, when the team's hands had nothing left to do for the patient and the patient had nothing left to give back. Above the bed, the cardiac monitor was still tracing its same useless, jagged scrawl across the screen, the coarse v-fib refusing to know it had been pronounced dead. Heather reached up without a word and switched it off. The green line vanished into a flat black screen, and the soft electrical hum the monitor had been making for the better part of an hour stopped along with it.

The only sound in the room now was the soft squeak of Nancy's footsteps as she rolled the equipment cart closer to the head of the bed.

"Alright, sweetheart," Nancy started softly, almost to herself, as she stepped into position at Alana's side. "Let's get you taken care of."

She started with the defibrillator pads. The adhesive on them was strong by design, made to stay secured through chest compressions, shocks, and the organized chaos of a working code, and they didn’t want to come off easily. Nancy worked her gloved fingers under the edge of the first pad and peeled it back slowly and carefully, the skin beneath it pulling up slightly with plenty of resistance before letting go. She had to tug a little harder than she would’ve liked.

"I'm sorry, baby girl," Nancy murmured as she worked. "You're doing great."

The pad came free. She set it aside on the cart and started on the second one.

A few feet away, Jen quietly stepped in to help without being asked. She was working on the EKG leads, peeling each round electrode off Alana's bare chest one at a time and coiling the wires neatly back onto the monitor cart. Her hands were steady. Her face was very still. She was going to think about this case for a long time, and she knew she was going to think about it, but right now she was just going to do the work in front of her until it was done.

Across the room, Heather moved on from the monitor and was tidying the trauma bay with her usual quiet efficiency— gathering used syringes into the sharps container, balling up wrappers and dropping it in the trash, wiping down surfaces. Her head stayed down. Her hands stayed busy. When the trauma room was reset, she would go grab fresh linens and equipment for the next patient who would inevitably come through this bay tonight, because that was the job and the job didn’t stop just because the code did.

Dr. Sarah peeled her gloves off with a snap and dropped them into the bin by the door. She didn’t look back at the table. She didn’t say anything to anyone. She pushed the door open and stepped out into the corridor, and the door quietly closed behind her. She would process this in her own way, in her own space, and nobody on the team needed to ask where she was going.

Dr. Lindsay moved to the small desk built into the trauma room wall and was filling out the official paperwork in her neat, precise handwriting— the time, the rhythm, the interventions, the pronouncement, the chain of custody language for the medical examiner's office. She worked through it without rushing. When she was done, she set the pen down, looked back at the table for a long moment, and then stepped quietly out of the room to make her phone calls.

Nurse Nancy was alone with Alana now, except for Jen finishing up the last of the leads on the far side of the table.

"Quick pinch, sweetheart," Nancy warned gently, sliding the catheter of the right antecubital IV out from the soft skin in the crease of Alana's elbow. The line came free smoothly. Nancy pressed a small square of gauze over the puncture site for a few seconds, more out of habit than necessity. "There you go, good girl."

She moved to the left arm and did the same. "Quick pinch." The second line came out as easily as the first. "Good girl."

The blood pressure cuff came next, unwrapped from around Alana's left bicep with practiced movements. Then the pulse oximeter, gently unclipped from her right index finger. As Nancy pulled it free, her eyes rested for a moment on the silver spiral ring still wrapped around that same finger— a ring Alana clearly loved, a ring she probably put on this morning without any idea that a stranger in a trauma bay would be the last person to ever see her wear it. Nancy left the ring exactly where it was.

She wet a fresh cloth from the basin on the cart and turned her attention to Alana's chest, where the ultrasound gel pooled and dried in the spaces between the tattoos. She wiped it away in slow, gentle passes, working around the small barbells through Alana's nipples, working around the ink, treating each square inch of skin with the same unhurried care she would have given a living patient.

It was on the third pass with the cloth that she saw it.

Across the center of Alana's sternum, just where the heels of Jen's and Heather's hands had been driving down for the better part of an hour, a deep purplish bruise had bloomed beneath the skin. Nancy knew exactly what she was looking at. CPR did this. CPR always did this when it was being done correctly, with enough force to actually move blood through a stopped heart, and Nancy has seen this exact bruise on countless patients across her 23 years of trauma nursing, and would very likely see it again.

She paused with the cloth in her hand and looked up at Alana's face— at the wide open blue eyes, at the smooth slack features, at the vivid royal hair fanned around her head against the surface of the table.

"Poor baby," Nancy spoke quietly. "You've been through a lot tonight, haven't you?"

She finished wiping the gel away and set the cloth aside.

Across the table, Jen finished with the leads. She lingered for a moment, her hands resting on the edge of the cart, looking down at Alana's face once before lifting her eyes to meet Nancy's. She didn’t have the right words for what she wanted to say. Nancy gave her a small, knowing nod— the kind of nod a veteran nurse gave a young resident who was working a hard case, and Jen gave a tiny nod back, and then she turned and stepped quietly out of the trauma room.

Nurse Nancy was alone with Alana now. She moved to the head of the bed and gently combed her gloved fingers through the vivid blue hair, smoothing the tangles that the ambulance ride and the resus left behind, working it back into something like the way it probably looked when Alana styled it earlier in the evening. The short bangs across the forehead got the same gentle attention. Nancy worked slowly, taking her time, the way she would have if Alana could feel it.

"There you go, sweetheart," she murmured. "Let's get you looking like yourself again."

When her hair was settled, Nancy reached up with the soft pad of her thumb and forefinger and, very gently, eased Alana's right eyelid closed. The bright blue iris and the wide black pupil disappeared beneath the lid. Nancy did the same for the left eye. The blue was gone now. Just the dark of closed lids, and the long lashes against fair skin, and the smooth stillness of a face that finally looked like it might be sleeping.

"Time to rest now, honey," Nancy told her softly.

She stood with her hand resting lightly on Alana's temple for a moment longer than she needed to.

Then she stepped down to the foot of the bed. From the cart, she took a small white toe tag and a black pen, and she began to fill it out in her neat, careful handwriting— name, date of birth, time of death, medical record number. When the tag was filled out, she lifted Alana's left foot gently in her gloved palm, cradling the heel the same way she cradled it for the plantar reflex check earlier.

"Alana?" Nancy began, her voice soft. "Sweetheart? I'm just going to place a tag around the big toe on your left foot. It's just so we can take good care of you from here, understand?"

She looped the small string of the tag around Alana's big toe— the matte black gel polish on the nail still as unchipped and as perfect as it’d been when she first rolled into the trauma bay, and tied it gently in place. Then she lowered Alana’s foot back to the table with the same care she lifted it with.

She crossed back to the cart and lifted a clean white sheet from the stack. She unfolded it as she walked back to the table, and then, starting at Alana's bare ankles, she drew the sheet slowly upward— over her legs, over her hips, over her bwlly and tattooed arms and bruised chest, over her shoulders, and finally up over her face. The vivid blue hair disappeared beneath the white. Nancy rested her gloved hand on the sheet over Alana's shoulder for a long moment.

Then she turned, gathered the last of the discarded wrappers and used supplies into her arms, and walked quietly to the door of the trauma room. At the threshold, she paused and looked back one more time— at the still form on the table, at the white sheet, at the quiet of the room— and then she stepped out and let the door close behind her.