Richard Mabry - Code Blue

She could only imagine the anguish pursuing this option might cause her. But it looked as though Cathy's chances of staying in Dainger were slim to none. Frying pan or fire? Bad choices, either way.

Before she could lose her resolve, Cathy punched in a series of ten numbers. An electronic voice invited her to enter an extension number or hold for an operator. What was the extension? Once it had been as familiar as her name. Could it have flown from her memory in such a short time?

Think, Cathy. "Please hold for the operator." Was it 2732? Was that it? She punched in the numbers and waited as the call rang through.

"Family Practice."

When she heard the voice, the name of the secretary came to Cathy immediately. "Lisa?"

There was a brief pause. "Yes? Who's calling?"

"This is Cathy Sewell. Is Dr. Gross in?"

"Oh, Dr. Sewell. So good to hear from you. How are you doing?"

Just wonderful-someone wants to kill me, the bank is threatening to foreclose, and I'm sleeping in a guest room in the parsonage after my apartment burned. Couldn't be better.

"Fine," Cathy said. "Just fine. Now is Dr. Gross there?"

"Sure. Let me buzz her."

Cathy was relaxing to the strains of a classical piece when she heard the cheery voice of the department chair, the woman who'd been her mentor during her residency. "Cathy, good to hear from you. How can I help?" That was just like Amy. Right to the point.

"Amy, is that position at the school still available?"

The silence that followed gave Cathy her answer before Amy spoke. "We filled it right after you turned it down. Are there problems with your practice there in Dainger?"

Cathy assured Amy that everything was fine. Oh, there were a few glitches, but nothing unusual. She just wanted to explore her options. Maybe she'd come back for Grand Rounds next month and they could visit. Amy encouraged her to do that, perhaps stay over so they could have dinner together.

As she hung up the phone, Cathy felt her throat tighten, as though someone had just put a noose around her neck and kicked the horse out from under her. Pretty apt, she figured.

That door had slammed shut. There was no way out. No running away from Dainger.

The day seemed to stretch to infinity, but at last Cathy could head home. Well, not really home. Then again, where was home? Did she even have a home? Ugh, enough philosophy.

She had just buckled her seat belt when her cell phone rang. She fished it out of her purse and scanned the display: the hospital. Had there been an order she'd neglected to write? Was she behind on her dictation again? "Dr. Sewell."

"Doctor? This is Glenna in the ER. Isn't Ella Mae Mercer your patient?"

Bells clanged in Cathy's head. "Yes."

"The ambulance just brought her in-comatose. When Ella Mae didn't return from lunch, her secretary got worried and decided to check on her. She found Ella Mae on the couch in her living room, totally unresponsive. The secretary called 911. They brought her here."

Cathy threw the car into reverse and backed out of her parking space. "Is she breathing on her own?"

"Shallow. Blood pressure's down, pulse slow. Pupils a little constricted but equal. No signs of trauma."

"Get her on oxygen-mask for now, but we may have to tube her. Start an IV, draw blood for glucose, BUN and creatinine, liver panel, and a tox screen. Get some blood gases cooking. Alert radiology that we may need a head CT. Who's the ER doctor today?"

"Dr. Patel. He thinks she may have had a stroke."

Cathy accelerated, hoping she wouldn't encounter her nemesis, the black SUV. She squealed around the corner."Tell Dr. Patel not to do anything. I'll be there in two minutes."She took a deep breath. Be diplomatic, Cathy. "And thank him for me."

In a few moments, Cathy was at Ella Mae Mercer's bedside. Her examination was swift and focused. No cuts or swelling of the scalp. No stiffness of the neck. Pupils equal in size, maybe a bit constricted, but normal reaction to light. Tendon reflexes diminished generally. No evidence of head injury. A little young for a stroke. "Let's hold offon that brain CT for now."

"Radiology's on standby. I'll keep it that way until you're sure," Glenna said.

"See if one of the ambulance crew that brought her in is still around." Cathy heard the squeak of rubber-soled running shoes as Glenna hurried out of the room.

The lab work would help, but it would take a while. The physical exam suggested a few things. But if Cathy's suspicions were right, the EMTs should be able to confirm them.

"You wanted to ask me something, Doc?"

Cathy turned and saw a paramedic she didn't recognize standing in the doorway.

"Tell me what you found at Ella Mae's home."

"She was on the living room couch-lying there with her hands crossed over her chest- almost like she'd been… laid out."

"Any sign of drugs in the room?"

"Didn't I-?" He reached into the pocket of his jacket and pulled out a small amber vial. He held it out to her. "I picked this up offthe coffee table next to the couch. Thought I'd already given it to Glenna. Sorry. I'm coming offa double shift, and I guess I'm a step slow."

A glance at the label on the bottle confirmed what Cathy already suspected. Now she knew why Ella Mae was in a coma.

Cathy put the vial in her pocket. "Besides the pill bottle, did you see any liquor? Beer? Wine?"

"No." The EMT shook his head. "Nothing like that in the room. Just a half-full glass of water on the table next to the pills."

Ella Mae had said she didn't drink. Cathy hoped that was true. If so, it might make the difference between her living and dying. "Thank you. Now please send Glenna back in here."

Cathy turned back to Ella Mae, letting her eyes travel back and forth between the figure lying deathly still on the bed and the monitor displaying her vital functions. Respirations were shallow and slow, oxygen saturation dropping. Blood pressure down, although not at shock levels. Cathy needed to rid the woman's circulation of the tranquilizer as quickly and completely as possible. But before that, she had to make sure Ella Mae's breathing and circulation were adequate.

"So it's a drug overdose?" Glenna's voice came from behind Cathy, soft yet focused.

"I'm pretty sure it is, and I don't have time to wait half a day for the results of a tox screen. I'm ready to go with that diagnosis."

"What do you-?"

A sharp electronic screech made Cathy turn toward the monitor. The pulse oximeter showed a dangerous drop in oxygen saturation. When Cathy looked at Ella Mae's chest, she could hardly detect any motion there.

"She's quit breathing. We need to tube her." Cathy snatched up a laryngoscope from the equipment cart in the corner and moved quickly to the head of the gurney. She checked the light at the tip of the scope, then moved the plastic oxygen mask aside and opened Ella Mae's mouth. Cathy slipped the L-shaped instrument in, moving it carefully along the tongue, lifting the epiglottis. Pooled saliva obscured her view of the vocal cords.

"Suction," Cathy said.

The words were hardly out of Cathy's mouth before Glenna slid the tip of a suction tube into Ella Mae's throat and cleared the secretions.

"Endotracheal tube." Glenna slapped a large, curved plastic tube into Cathy's free hand.

Where did the vocal cords go? It had probably been a year since Cathy had done an intubation, but she hoped her instructors had been right when they said it was like riding a bicycle.

"Please, God." She didn't realize she'd spoken the words aloud until she heard Glenna whisper, "Yes, please Lord."

There! She saw the cords, the gateway to the airway she had to enter. Careful now, don't mess this up. Cathy eased the tip of the tube between the cords, and in a matter of seconds a mechanical ventilator pumped oxygen into Ella Mae's lungs at a regular fourteen breaths per minute.