Page 31 of Look on the Bright Side

Rather than an answer, she just gave a thumbs-up, then ran down the hall, her fatigue melting in the rush of adrenaline. The patient was being wheeled in, barely visible on the gurney, a paramedic straddling her, doing compressions, and a panicky-looking man following close behind.

Dr.Unger was running the scene, getting the history from Anton, the paramedic alongside the patient. “This is Mrs.Almeida, age ninety-four. She collapsed at her rehab center forty minutes ago,” Anton said. “History of dementia, atherosclerosis, stroke, breast cancer. Two milligrams of epi in the field with no response.”

Ah. The patient was gone, then, but Lark knew they’d keep working on her. You didn’t just pronounce someone without even trying, especially with a family member present. It was a commandment in Dr.Unger’s ER.

“Mom! Mom, don’t leave me!” said her son, who had to be close to seventy. “Please, Mom!”

“Dr.Smith,” said Dr.Unger, “take over compressions, and Danny, work the bag.”

“Bagging,” Danny said.

“Taking over compressions,” Lark said.

Shit. Compressions on a very old lady were akin to beating her with a baseball bat. It wasn’t a request, though. Lark went to Mrs.Almeida and started, the Bee Gees’ song “Stayin’ Alive” immediately playing in her head, keeping her compressions fast and hard. She heard a rib crack and winced.

On TV or in the movies, CPR looked like nothing more than a brisk massage. In real life, to make blood flow through a still heart, you had to push so hard the whole rib cage compressed and expanded, and ribs often cracked under the pressure. It was brutish and dreadful for the patient, with about a hundred compressions a minute. Only occasionally did someone come back fully after CPR, and most of those people weren’t ninety-four.

Lark herself had a DNR already in place. Most doctors and nurses she knew did.

“Give her another milligram of epi,” Dr.Unger said.

“One milligram of epi going in,” said Mara. It was habit, Lark had learned, for people to echo the order to avoid any mistakes.

A bead of sweat fell off Lark’s forehead and onto the patient’s chest. She could hear Dr.Unger giving the talk. “Your mom is very sick…we’re doing everything we can…do you think she’d want this level of intervention?”

“Give her everything!” the son yelled, an edge of hysteria in his voice. “Save her! I don’t care what it takes!”

“I understand, and we’re doing everything we can,” Dr.Unger said, his voice low and kind. “The problem is, I’m not sure we’re helping at this point.”

“Don’t give up, Mom! Please, Mom!”

Another rib cracked under Lark’s hands. I’m so sorry, Lark thought. The patient was so thin…if she had severe dementia, like Mrs.Fontaine, she might not have been eating much.

“Amiodarone, three hundred mil,” Dr.Unger said. “Charging to one twenty.”

“IV amiodarone, three hundred mil,” Luis said.

“Stop compressions and clear.”

Lark stood back, and for a second, silence fell over the room. Dr.Unger put the paddles on Mrs.Almeida’s naked chest, which was bony and thin, her small, shriveled breasts barely visible. The charge made her body jump, but no pulse showed on the monitor.

“Again,” said Dr.Unger. Another jolt. No response. “Continue compressions. Lalita, take over for Lark.”

“Taking over, Lark. Good job.” Lalita took her place, and Lark wiped her brow with her arm.

Dr.Unger looked at her. “Dr.Smith, would you mind speaking to the patient’s son?”

She nodded, still breathing hard, and went over to the man. His face was stained with tears, and his eyes were too wide. Oh, God. This shouldn’t be his last memory of his mother alive…not that she was. But research showed that it was better for a loved one to see that the staff was doing their best, to witness the process themselves, rather than be shoved into a room to wait.

“I’m so sorry about this, sir,” she began.

“You have to get her back,” he said. “Try everything. I’m not ready to lose her.”

“We’re trying, but her condition is grave,” Lark said, putting her hand on the man’s sleeve. “We’re doing everything we can.” She knew—everyone in the room knew, except the son—that the woman was not going to make it. The patient had been down for almost an hour now, and she had earned the right to die. But without advance directives, and with the son standing right there, CPR continued. “I’m afraid she’s not responding, even though we’re doing our best.”

“I don’t care about your best! I want her back! Mom, please!” There was a primal anguish in his voice, unguarded and raw.

Oh, it was wrenching, and on today of all days…Lark’s eyes filled with tears. “I’m so sorry,” she said, swallowing a sob. “There’s nothing more we can do.”

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