Radclyffe - Love On Call

“Right. Airway will be the thing.”

Glenn nodded. “If you need an assist, holler. I’ll be right across the hall.”

Bruce appeared around the corner. “The first bus is here.”

Abby strode confidently into the center of the waiting staff. “All right, everyone, you know what to do. Let’s go to work.”

Mari took a deep breath and hurried into her room, quickly scanning the instruments set out beside the exam table. She pulled on gloves just as a stream of first responders burst into the ER pushing stretchers toward the rooms where Bruce had directed them. Two EMTs angled a stretcher into Mari’s cubicle with a small form nearly dwarfed by oxygen tanks, an EKG monitor, and IV bags. All Mari could make out beneath the tape and O2 bag was a blue-tinged face and a shock of yellow hair.

A heavyset redhead at the front of the stretcher croaked hoarsely, “Juvenile, maybe ten years old, buried in three feet of dust—” He lost his voice for a second, then continued, voice steadier although agony misted his eyes. “The family had already dug him out, and the dad was doing mouth-to-mouth. We intubated in the field.”

“Pulse ox?”

“60.”

Mari’s stomach plummeted. 60 was barely compatible with life and not enough to sustain brain function. She quickly listened to the boy’s small chest and could hear no air moving in the lower two-thirds of his lungs. Thankfully she detected a rapid heartbeat, but that wouldn’t last long if they couldn’t ventilate him. “On a hundred percent O2?”

“That’s what’s running, but it doesn’t seem to be doing much good.”

Mari glanced at Beverly, a middle-aged brunette nurse who’d arrived to help. Her mouth set into a tight line, and Mari didn’t have to ask why. If they did nothing, this child was dead. But no matter what she did, it probably wouldn’t make a difference. Still, her job was to fight, as long as reasonable, and fight she would.

“All right,” Mari said, hoping she sounded confident, since she hadn’t actually heard of what she planned to do being used for anything like this. Although she hadn’t heard of this until ten minutes ago. “Let’s set up a saline lavage, get another pedi tube ready.” She looked up at the two EMTs. “What size do you have in there?”

“Six,” replied the second EMT, a thin young blonde with a silver hoop through the corner of her left eyebrow.

“Who intubated him?”

“I did,” the blonde said.

“Did you see debris in his trachea?”

“I didn’t see anything. It was a blind intubation.”

“All right then, let’s see what we can see.” She ought to clear this treatment with someone before she went much further. “Beverly, can you get Dr. Remy or Glenn for me?”

“Not for a few minutes,” Beverly said. “I saw them both at a resuscitation on my way in here.”

“We don’t have a few minutes,” Mari muttered.

“Let’s not waste any time, then,” Beverly said briskly, as if telling her to do what she needed to do. She stood by with suction and a small-bore catheter connected to a saline bag under pressure.

“Time me.” Mari took a deep breath and slid out the breathing tube, removing the only thing keeping the boy breathing—and alive. She didn’t have long, but then, neither did he. She slid in her laryngoscope and lifted his chin, giving herself a narrow tunnel down which to evaluate his airway. The thin light at the end of the instrument illuminated the back of his throat and the upper part of his trachea. Where she should have seen glistening pink mucosa she saw only thick clumps of dark debris. It looked as if someone had poured concrete into his windpipe. No wonder he couldn’t breathe.

“Let me have the lavage catheter.”

Beverly slid the thin tube into Mari’s hand and she threaded it down into the debris and hopefully into his trachea. “Go ahead, open up the bag and get the suction ready.” Fluid shot into his trachea, completely blocking what remained of his airway. If this didn’t work, he’d drown. The saline mixed with the dust from the grain silo, threatening to glue shut any possible avenues for airflow, and Mari frantically suctioned before the mixture turned into paste.

“Time?”

“Thirty seconds,” Beverly said.

“Another fifteen seconds,” Mari said, the muscles in her shoulders starting to ache.

The curtain twitched back and Abby Remy looked in. “What’s the story?”

“Foreign material in the airway. Some kind of thick, particulate matter—dust, I guess,” Mari said without looking up. “He was tubed on arrival, but not oxygenating. We’re lavaging to clear the trachea and mainstem.”

Abby threaded her way between the EMTs, who hadn’t budged, to the head of the table and looked over Mari’s shoulder. “Lift the laryngoscope a little bit more so I can get a better view.”

Mari took a deep breath and lifted. Now her arm was beginning to shake. Keeping the jaw open and the airway exposed was strenuous, and she hadn’t intubated anyone in almost a year.

“How long on the lavage?” Abby asked.

“Forty-five seconds.”

“O2 sat?” Abby called out.

“58,” the male EMT reported.

Mari’s stomach plummeted. She was going to lose this boy.

“Keep going. You’ve almost got it,” Abby said quietly, her sure, certain tone injecting much-needed strength into Mari’s aching arm. “You want me to take over?”

“No,” Mari said just a bit breathlessly. “He’s almost clear.”

“There you go,” Abby said with a note of victory. “The suction fluid is coming back clear.”

Mari finally breathed. “Turn off the saline and let me have the new ET tube.”

“Here you go. A pedi six,” Beverly said and slipped the curved plastic endotracheal tube into Mari’s outstretched hand.

Never moving her gaze from the small dime-sized opening that led down into the boy’s trachea, Mari slid the tube between his vocal cords and toward his lungs. “Hook us up?”

The ventilator began to hiss, and Mari slid out the laryngoscope and stepped back.

Abby listened to his chest with her stethoscope, nodding as she quickly moved the diaphragm over his chest. “Breath sounds are good. Pulse ox?”

“65,” Beverly said.

“Increase the rate to twenty and decrease the volume. Let’s rapid pulse him.”

The pulmonary tech adjusted the ventilator, and the machine cycled quickly in short, sharp bursts as if it was panting.

“Suction him down the tube, Mari,” Abby murmured.

Quickly, Mari complied, barely able to take her eyes off the pulse oximeter, hardly breathing herself as the numbers began to edge up. 68, 72, 75, 80, 85, 90.

“Holy Jesus,” the big burly EMT muttered. “You got him back.”

“Let’s get a chest X-ray,” Mari said, tempering her elation. A million things could go wrong, and if he’d been without cerebral perfusion for too long, she might not have saved him after all. Now only time would tell if he would recover. She had to be sure he didn’t have other injuries that could complicate his recovery, and then they would wait.

Abby said, “Draw a full panel of bloods and get him up to the intensive care unit.” Abby squeezed Mari’s shoulder. “Very nice, Ms. Mateo.”

“Thank you.”

As quickly as it had begun, it was over. Beverly drew bloods from the IV line and the two EMTs, who appeared to have no intention of leaving their charge, pushed the stretcher out into the hall. Another stretcher materialized in her cubicle, this one with a young man whose right arm was misshapen and bloodied.

“Hi, I’m Mari Mateo, a PA,” she said, and got back to work.

*

Mari had no idea how much time had passed by the time the last patient left her cubicle for an observation room upstairs. It might’ve been ten minutes, it might’ve been ten hours. All she knew was she’d never felt so exhilarated in her life. She’d splinted fractured limbs, inserted a chest tube under local anesthesia, and treated an acute case of asthma with inhalation agents and intravenous medications, avoiding a dangerous intubation. She’d evaluated more complex cases in one day than she had in a month of training, and she’d managed mostly on her own. She’d been dimly aware of the seething activity around her as she’d worked—once she’d heard the high-pitched wail of someone’s heart breaking, and a moment later Glenn’s low-pitched, melodious cadence calling for a cutdown tray. Dr. Remy popped in and out of her room, checking patient status, reviewing a treatment plan, offering suggestions.