Peter Clement: The Inquisitor

The causes of refractory V-fib. automatically flashed through Earl's mind. "How's his potassium, sugar-"

"No metabolic problems," Michael cut in, "other than a slightly high glucose after the bolus you gave him-"

"An overdose, maybe?" Stewart Deloram interrupted, inserting himself as part of the huddle. "Tricyclics, aminophylline, speed…" He rattled off the drugs that might precipitate this kind of arrest.

Thomas Biggs stood a little off to one side. He watched the proceedings but offered no suggestions.

Earl found his own attention drawn to Artie's eyes as they blinked more furiously than ever. Leaning directly over his face, he said, "Close your eyes once if you can hear me, Mr. Baxter."

The fluttering stopped. The lids closed and opened.

"Do you see me?"

They closed and opened again. Then he stared at Earl, his pupils wide with fright, seeming to want an explanation.

Earl shivered. This happened every now and then, the patient's heart not beating, the lungs not breathing, but the brain kept alive and conscious with CPR. Only he'd never seen someone in such a state remain so alert before. "Let's be careful what we say, guys," he cautioned.

Stewart continued to expound his list in a much lower voice.

"Tox screen isn't back yet," Michael interrupted, "but I emptied a vial of bicarb into him in case he'd OD'd on tricyclics. Combined with the rest of what we tried, he's had every antidote there is." Again, right to the point. Whatever sapped his spirits these days, his skill stayed as sharp as ever.

But Artie's eyes, so pained and aware, drew Earl's attention away from the discussion.

Jimmy stepped up and spoke into the man's ear. "I'm the hospital chaplain, Mr. Baxter. Is it all right if I say a prayer with you?"

Artie showed no response.

Still locked into the man's stare, Earl felt it pull him in, like a tether. Perhaps he hadn't heard Jimmy's question. "Are you Catholic, Mr. Baxter?" he asked.

Two blinks.

"Is that a no?"

One blink.

"Do you have any pain?"

No response.

The resus team kept pumping and ventilating him.

Stewart discussed options with Michael.

"… float a pacemaker wire into his heart, hook the myocardium, and try to recapture a normal rhythm."

"Go for it," Michael said, pivoting on his heel and rushing toward the door. "I'll get the pacemaker."

Earl remained barely aware of them, transfixed instead by the black, bottomless pools at the center of Artie's eyes that beckoned him closer. What did he want? "Dr. Biggs, if you'll help me get a line through the right subclavian," Earl said, turning away, "Stewart can go in with the pacemaker from there." In order to function he must distance himself. A lifetime in ER had taught him how. But he knew that Artie was still looking at him. He could sense the patient's stare burrowing into the back of his skull.

Thomas must have felt it too. He hesitated, and the surface of his mask rippled as he clenched his teeth. Then he snapped on a sterile pair of gloves over his regular ones and got to work.

In seconds Thomas and Earl had inserted a needle the size of a three-inch nail through the skin below Artie's right clavicle and into a vein the caliber of a small hose.

Michael returned with the pacemaker equipment, and the three ER physicians stood back to let Stewart perform his magic.

Already double-gloved and -gowned, he delicately threaded a sterile pacemaker wire through the needle sticking out from beneath Artie's clavicle. Throughout the entire procedure, he eyed the monitor for evidence that he'd passed the wire through the vein, maneuvered it into the heart, and hooked its tip into the wall of the first chamber. He asked J.S. to stop pumping, and the sounds of her exertions ceased. The hiss of the ventilating bag as the technician squeezed a volley of air into Artie's lungs and the lilting beauty of Jimmy's voice while he murmured the Twenty-third Psalm became the only noises in the tiled chamber.

Earl watched the priest stroke Artie's head and thought, A special kind of man. He could laugh and joke, yet remained fearless when it came time to comfort the sick, the suffering, and the dying, and he pulled it off day after day. That took a rare brand of courage. Even people of faith could get too close to the ones they tried to help. Earl had seen the fear and suffering in ER overwhelm men and women of God as often as it broke many fine physicians. Yet Jimmy never appeared to flinch from it.

Stewart continued to manipulate the pacemaker wire, but the monitor showed no change, and the pattern remained ragged as a saw's edge.

He nodded to J.S., and she resumed pumping.

A familiar icy tightness gripped Earl in the pit of his stomach as the sense they weren't going to make it crept through him.

But Artie's eyes remained open. Imploring. Beseeching.

Stewart laid down the wire, glanced over to Earl, and silently shook his head.

J.S. continued to pump, her expression questioning him whether to stop for good.

Artie began to blink wildly again.

He knows he's going to die, Earl thought. Time to sedate him. Otherwise the instant they called off CPR, he'd suffocate, awake and aware. It would be like strangling the man.

"Get me ten milligrams of IV midazolam," he told Susanne.

Her eyes widened, but she went to the medication bin and proceeded to draw up the syringe.

"For the record," he said quietly, scanning the aghast eyes of those watching him,

"I'm going to make him comfortable, then withhold any further treatment, including CPR, on the grounds it's futile." Without saying it outright, he'd declared they were not about to commit active euthanasia. To the lay person it might sound like word games, but because he was invoking a physician's right not to inflict useless interventions on a patient, Artie's resulting death would be considered natural under the scrutiny of law.

The frowns on everyone told him they felt otherwise. "Anybody have a better idea?" he asked.

Michael, Stewart, and Thomas grimly shook their heads.

Susanne, J.S., and the respiratory technician did the same.

"Mr. Baxter objects," Jimmy said.

Earl bristled. "For the love of God, Jimmy, you know the rules as well as anyone."

"At least have the decency to look at the man while you decide his fate."

Nobody else said a word.

Earl forced himself to meet that dark, fluttering stare.

Artie repeatedly blinked his eyes in couplets. No! No! No! they screamed, brimming with agony.

Earl's heart gave a wrench. "But we can't help him," he whispered to Jimmy. "At least I can make sure he doesn't surfer."

"Tell your patient, Earl."

Artie stopped blinking and glared at him.

Oh, God, thought Earl. "Mr. Baxter, you know we tried everything?"

He blinked yes.

"I'll make you comfortable-"

Two quick blinks cut him off.

"But-"

"I think he wants something," Jimmy said.

A single blink. Yes.

"You want what?" Earl asked. He couldn't think of anything else to say.

Artie responded with a scowl of disgust.

"Something medical?"

No.

"What then?"

The desperation in Artie's stare grew.

Then Earl knew.

"Your wife?"

Tears welled out of Artie's eyes. Yes, he blinked. Yes! Yes! Yes!

"Is she here?" Earl asked.

"In the waiting room," Susanne replied. Her voice sounded as if her windpipe had tightened to the size of a straw.

"You want to see her, Artie?"

The hideously slack face of the dying man had already acquired the consistency of cold mud. Yet it shifted ever so slightly, and Earl swore he glimpsed relief in those amorphous features. Yes! he blinked.

"Then we'll get her for you," Earl said.

Susanne hurriedly retrieved a chair from the corridor and placed it by the stretcher in case Artie's wife couldn't stand.