John Godey - The Snake

The patient was dead weight as they tried to sit him up. His head lolled forward against Papaleo's chest. Kelly held him steady and Papaleo leaned over him, placed his ear against the smooth brown skin and tapped.

Sounded all right, but what could he really tell with the patient unable to breathe deeply?

"Let's get him back down, nurse, shall we?"

"Doctor, I think we-"

He cut her off with a frown. Got to keep them in their place, especially the old-timers, mustn't let them get ahead of you.

He picked up the patient's arms and studied them. No needle tracks. Well, the normal pupils had told him that. Overdose of some kind of pill? A possibility. Do a gastric lavage? He realized that he was sweating profusely. He wiped the sweat from his face with his forearm. Kelly watched, her lips pursed.

He said, "Who brought him in?"

"The police. I think they're still around."

"I'll step outside for a second and talk to them." Should have thought of that earlier, dammit. He started away from the table, then returned.

"Maybe some kind of overdose, though the signs are absent. Still… get some Narcan, will you, please? Yes, and set up an I.V. with five percent dextrose and saline."

Nurse Kelly nodded her head and her lips softened. Good, Papaleo thought, I'm on the beam, Kelly approves.

"Oh yes, let's protect against an insulin overdose. Add fifty percent glucose."

He found the cops in the anteroom, drinking coffee and chatting with the security guard. They told him what they knew. No help.

"What about his movements. Was he jerking? You know-you've seen epileptics."

The cops agreed that although he had been staggering he hadn't appeared to be convulsed.

"It looks like overdose to me," one of the cops said. "A lot of Hispanics overdose these days."

Kelly maybe, but a dumb cop no. Papaleo returned through the reception room to Room D. Kelly had already hooked up the I.V. and she was back working with the suction apparatus, picking away at the mucus in the patient's mouth.

"Not alcohol," she said. "No odor."

"I'm well aware of that. I have a nose, too."

Kelly's lips tightened up again. Papalco looked down at the patient blankly. What else was there, chrisesakes? Take a blood sample, check for sugar? But it would take at least a half hour. Some kind of GI haemorrhage?

"Could be in apparent bleeding," he said aloud.

"Doctor," Kelly said, "I think we're in trouble."

He thought so himself, but the declaration would have to come from him, not from a nurse. What the devil could it be? He ticked off items in his mind. Alcohol, no. Overdose, none of the signs. Trauma, no. Stroke — who knows? He decided to listen to the heart again. There was some change, and it was for the worse-beat more rapid now, and weaker. The patient's chest barely seemed to be moving. Paralysis, some kind of paralysis?

Kelly said, "Doctor, I think we want a Code Blue."

Code Blue was the emergency call that mobilized a surgeon, an anaesthetist, the Chief Resident, extra nurses. It was clearly indicated, Papaleo thought, but suppose they all piled in and made a sure, quick, easy diagnosis? Christ! Better hold the Code Blue for another minute or two.

"Presently," he said to Nurse Kelly, and studied the patient hopelessly.

Why should he resist just because they might think he was a dunce? That's what everybody thought of first-year interns anyway. They would come in, fire questions at him with the same sort of hauteur he had used with the two cops outside… "Well, doctor?" Keily looked grim. "I think we're about to lose him!

Sweat was pouring down the sides of Papaleo's face. "Very well. Let's do a Code Blue."

Dr. Shapiro, the Chief Resident, was down in less than a minute. He ran his hands over the patient's chest, almost abstractedly, while Papaleo, earnest, sweating, filled him in. Shapiro's face was a mask. Before Papaleo was quite finished, Shapiro interrupted.

"Let's tube him," Shapiro said. "He needs air. Nurse, get hold of a respirator." Nurse Kelly, looking righteous, moved away from the table.

"He can't breathe because his muscles aren't functioning properly. We want a mechanical aid to help the chest muscles do their work."

Should have thought of it, Papaleo told himself, when I noticed that he didn't seem to be lighting for breath. Mechanical respirator: endo tracheal tube pushed into the windpipe, attached to a cock on wall that pumped oxygen directly into lungs.

Shapiro removed the nasal catheter when Kelly arrived with the respirator. He had some initial trouble incubating the patient, and Papaleo thought, Christ, if he has trouble, what would have happened to me? Other members of the Code Blue team had arrived, but there was nothing for them to do, as yet.

With the tube emplaced in the patient's trachea, Shapiro stepped back a pace and shook his head. "I don't know." He looked worried. Then, frowning, he stepped forward to the table again. "What's this, on his thigh?"

The light summer trousers were stained with a scuffing of grime, sweat, and a little blood. Papaleo hadn't noticed it before.

"He must have scraped it when he fell. The policemen who brought him in said he collapsed in the street."

"Hand me a scissors. We'll cut them off."

But, abruptly, Shapiro bent over the patient with his stethoscope.

"I swear," Papaleo said, "I can't figure out what's wrong with him," and then shut up because Shapiro was still auscultating.

Shapiro straightened up. "I can't raise a heartbeat. Let's get going."

The entire Code Blue team pitched in. Everyone worked with great intensity, injecting, kneading, pounding-Papaleo, with a shudder, felt a rib break under his fist-but to no avail. The patient's heart refused to start up again.

"You can all go," Shapiro said. "We've lost this one."

Before he left, Shapiro reminded Nurse Kelly to phone the Medical Examiner's office and ask them to send the death wagon around to pick up the body for autopsy. In death from an undiagnosed cause, Papaleo, recalled, no permission from next of kin was required.

"Death from cardio-respiratory failure due to unknown causes," Shapiro said to Papaleo. "Don't forget, the M.E. gets a duplicate of your report."

"I should have thought of the mechanical respirator earlier," Papaleo said.

"I'm sorry."

"Well, you'll think of it next time." Shapiro took a last look at the corpse on the table, said "Good night," and left the room.

The surgical resident, wearing white ducks and a dirty sweatshirt, shuffled into Room D. His yawn turned to a scowl when he was told that the patient had died and that the Code Blue had been canceled. He charged Papaleo and Nurse Kelly with wantonly disturbing his sleep.

"I'm doing a very difficult abdomino-peritoneal resection at seven o'clock and if I'm not at my best during the operation… Christ!"

Nurse Kelly flushed and said defensively, "Well, I'm sorry doctor. The patient's condition indicated a Code Blue, and we didn't know he was going to die."

"Well, somebody should know those things," the surgical resident said, giving Papaleo a dirty look. He turned abruptly and shuffied out. He was barefooted.

"Five minutes late for a Code Blue, and he's mad," Kelly said. "Surgeons, they're born that way."

Papaleo had once heard someone say that surgery residents begin getting difficult in their third year so that they could open their own practice with their arrogance at full bloom. But he had seen plenty of arrogant first-year interns who were preparing for surgery, so Kelly was probably right, they were born that way.

"It's a fact of life," Kelly said, "the way heart specialists are dangerously overweight and plastic surgeons are handsome, and orthopods are built like football players."

And radiologists are shy of people, Papaleo thought. While Nurse Kelly picked up the pieces-phoned the M.E.'s office for the death wagon, and got an orderly to wheel the body to the hospital morgue near the truck exit-Papaleo went to another room, where he put a butterfly suture under the eye of a man who had been kicked decisively in a brawl.