Tess Gerritsen - Harvest

"Parr wants our statistics to look good. And all the research shows that outpatients are more likely to survive a transplant."

"Without a transplant, Josh O" Day's not going to survive at all."

"I know it's a tragedy. But that's life."

She lay very still, stunned by his matter-of-fact tone.

He reached out to touch her hand. She pulled away.

"You could change their minds," she said. "You could talk them into--'

"It's too late. The team's decided."

"What/s this team, anyway? God?"

There was a long silence. Quietly, Mark said: "Be careful what you say, Abby."

"You mean about the holy team?"

"The other night, at Archer's, we all meant what we said. In fact, Archer told me later that you're the best fellowship material he's seen in three years. But Archer's careful about which people he recruits, and I don't blame him. We need people who'll work with us. Not against us."

"Even if I don't agree with the rest of you?"

"It's part of being on a team, Abby. We all have our points of view. But we make the decisions together. And we stick by them." He reached out again to touch her hand. This time she didn't pull away. Neither did she return his squeeze. "Come on, Abby," he said softly. "There are residents out there who'd kill for a transplant fellowship at Bayside. Here you're practically handed one on a platter. It is what you want, isn't it?"

"Of course it's what I want. It scares me how much I want it. The crazy thing is, I never knew I did, not until Archer raised the possibility…" She took a deep breath, released it in a long sigh. "I hate the way I keep wanting more. Always wanting more. There's something that keeps pulling me and pulling me. First it was getting into college, then med school. Then a surgery residency. And now, it's this fellowship. It's moved so far from where I started. When I just wanted to be a doctor…"

"It's not enough any more. Is it?"

"No. I wish it was. But it isn't."

"Then don't blow it, Abby. Please. For both our sakes."

"You make it sound as if you're the one with everything to lose."

"I'm the one who suggested your name. I told them you're the best choice they could make." He looked at her. "I still think so."

For a moment they lay without talking, only their hands in contact. Then he reached over and caressed her hip. Not a real embrace, but an attempt at one.

It was enough. She let him take her into his arms.

The simultaneous squeal of half a dozen pocket pagers was followed by the curt announcement over the hospital speaker system: Code Blue, MICU. Code Blue, MICU.

Abby joined the other surgical residents in a dash for the stairway. By the time she'd jogged into the MICU, a crowd of medical personnel was already thronging the area. A glance told her there were more than enough people here to deal with a Code Blue. Most of the residents were starting to drift out of the room. Abby, too, would have left.

Had she not seen that the code was in Bed 4. Joshua O" Day's cubicle.

She pushed into the knot of white coats and scrub suits. At their centre lay Joshua O" Day, his frail body fully exposed to the glare of overhead lights. Hannah Love was administering chest compressions, her blonde hair whipping forward with every thrust. Another nurse was frantically rummaging through the crash cart drawers, pulling out drug vials and syringes and passing them to the medical residents. Abby glanced up at the cardiac monitor screen.

Ventricular fibrillation. The pattern of a dying heart.

"Seven and a half ET tube!" a voice yelled.

Only then did Abby notice Vivian Chao crouched behind Joshua's head. Vivian already had the laryngoscope ready.

The crash cart nurse ripped the plastic cover off an ET tube and passed it to Vivian.

"Keep bagging him!" Vivian ordered.

The respiratory tech, holding an anaesthesia mask to Josh's face, continued squeezing the balloon-like reservoir a few times, manually pumping oxygen into the boy's lungs.

"OK," said Vivian. "Let's intubate."

The tech pulled the mask away. Within seconds, Vivian had the ET tube in place, the oxygen connected.

"Lidocaine's in," said a nurse.

The medical resident glanced up at the monitor. "Shit. Still in V. fib. Let's have the paddles again. 200 joules." A nurse handed him the defibrillator paddles. He slapped them onto the chest. The placement was already marked by conductive gel pads: one paddle near the sternum, the other outside the nipple. "Everyone back."

The burst of electricity shot through Joshua O" Day's body, jolting every muscle into a simultaneous spasm. He gave a grotesque jerk and then lay still.

Everyone's gaze shot to the monitor screen.

"Still in V. fib," someone said. "Bretylium, 2502 Hannah automatically resumed chest compressions. She was flushed, sweating, her expression numb with fear. "I can take over," Abby offered. Nodding, Hannah stepped aside.

Abby climbed onto the footstool and positioned her hands on Joshua's chest, her palm on the lower third of the sternum. His chest felt thin and brittle, as though it would crack under a few vigorous thrusts; she was almost afraid to lean against it.

She began to pump. It was a task that required no mental exertion. Just that repetitive motion of lean forward, release, lean forward, release. The alpha rhythm of CPR. She was a participant in the chaos yet she was apart from it, her mind pulling back, withdrawing. She could not bring herself to look at the boy's face, to watch as Vivian taped the ET tube in place. She could only focus on his chest, on that point of contact between his sternum and her clasped hands. Sternums were anonymous. This could be anyone's chest. An old man's. A stranger's. Lean, release. She concentrated. Lean, release.

"Everyone back again!" someone yelled.

Abby pulled away. Another jolt of the paddles, another grotesque spasm.

Ventricular fibrillation. The heart signalling that it cannot hold on.

Abby crossed her hands and placed them again on the boy's chest. Lean, release. Come back, Joshua, her hands were saying to him. Come back to us.

A new voice joined in the bedlam. "Let's try a bolus of calcium chloride. 100 milligrammes," said Aaron Levi. He was standing near the footboard, his gaze fixed on the monitor.

"But he's on digoxin," said the medical resident.

"At this point, we've got nothing to lose."

A nurse filled a syringe and handed it to the resident. '100 milligrammes calcium chloride."

The bolus was injected into the IV line. A penny toss into the chemical wishing well.

"OK, try the paddles again," said Aaron. '400 joules this time." "Everyone back!"

Abby pulled away. The boy's limbs jerked, fell still.

"Again," said Aaron.

Another jolt. The tracing on the monitor shot straight up. As it settled back to baseline, there was a single blip — the jagged peak of a QRS complex. At once it deteriorated back to V. fib.

"One more time!" said Aaron.

The paddles were slapped on the chest. The body thrashed under the shock of 400 joules. There was a sudden hush as everyone's gaze shot to the monitor.

A QRS blipped across. Then another. And another.

"We're in sinus," said Aaron.

"I'm getting a pulse!" said a nurse. "I feel a pulse!"

"BP seventy over forty… up to ninety over fifty…"

A collective sigh seemed to wash through the room. At the foot of the bed, Hannah Love was crying unashamedly. Welcome back, Josh, Abby thought, her gaze blurred with tears.

Gradually the other residents filed out, but Abby couldn't bring herself to leave; she felt too drained to move on. In silence she helped the nurses gather up the used syringes and vials, all the bits of glass and plastic that are the aftermath of every Code Blue. Working beside her, Hannah Love sniffled as she wiped away the electrode paste, her washcloth stroking lovingly across Josh's chest. It was Vivian who broke the silence.