Page 9 of Broken Dreams

She couldn't believe Nick was there, dressed in light gray sweats, and realized her mind hadn't been playing tricks on her after all. She forced herself to quickly review Mr. Goetz's medical history. “No, he doesn't. He's never had a seizure before that I'm aware of.”

“Good to know.” Nick's attention was focused on the patient. “Where's the code cart? I want the intubation equipment ready once the seizure has passed.”

“I have it right here.” Paul opened the bottom drawer of the yellow cart next to him and pulled out a smaller bin holding various airway equipment. He quickly positioned it beside Nick.

“Maybe we should intubate him now?” She placed a hand a Mr. Goetz’s arm, feeling each tremor down to the soles of her feet. “He's not breathing very well.”

“I can't intubate him until the seizure is over. His jaw muscles are locked tight.”

She sensed Nick’s frustration. As they both stared at Mr. Goetz, his face grew dusky. She found herself holding her own breath as she watched. Would his heart handle the strain?

“The medical response team should be here at any minute,” Paul informed them.

Amber knew the physical therapy gym was located on the opposite side of the building from where the intensive care units were located. And it was those staff members who took turns responding to medical emergencies.

The movement beneath her hands stopped. She glanced up at Nick. “The seizure is over.”

“I'm going to intubate him. He's already post-ictal.” Nick reached for the equipment he'd already set up. “Amber, hold him steady.”

Did Nick have medical practice privileges here? She wasn’t sure, but breaking policy was a minor concern compared to the threat of losing Mr. Goetz.

“What else can I do?” She didn't have critical care experience, but understood the basics. This was required training for all staff members in the VA hospital.

“Connect the heart monitor while I give him some breaths with the Ambu bag.” Nick had already hooked up the Ambu bag to the portable oxygen tank on the cart.

“All right.” Her fingers fumbled with the unfamiliar task, but soon had the electrodes placed and her elderly patient’s chest. The beeping of Mr. Goetz's heart on the monitor was reassuring.

Nick gave him one last breath then set the Ambu bag aside and reached for the laryngoscope. Amber held on to Mr. Goetz while Nick opened the elderly man's mouth and peered into the back of his throat to visualize the trachea. With a deft movement he slid the breathing tube into place.

The beeping and the heart monitor slowed down.

She gasped. “I think his heart rhythm is changing.”

At that moment, the rest of the medical emergency team arrived.

“Do you need help?” The resident physician spoke between panting breaths from his mad dash from the ICU.

“Yes, he needs an IV so we can give him a milligram of atropine.” Nick finished securing the endotracheal tube, then pulled the stylet out. “Amber, hand me the Easycap so we can check the tube placement.”

“Okay.” When placed on the end of the endotracheal tube, the Easycap device changed color if correctly placed in the patient's airway and not his esophagus, the tube leading to his stomach. She slid the device on the end of the tube. Relief washed over her when the yellow color confirmed the breathing tube was correctly placed.

“Placement is good.” She took the device off then connected the Ambu bag to the endotracheal tube. “Listen for breath sounds.”

“I need a stethoscope.”

The resident who'd run to their emergency handed his over.

Nick listened as she gave big breaths with the Ambu bag. She watched the monitor. Mr. Goetz's heartbeat improved with the delivery of oxygen. “I hear breath sounds on both sides. And his pulse is stable. Let's hold off on the atropine,” Nick said.

“He needs to be transferred to the ICU.” The resident took over the situation. “What happened?”

“A seizure, although he doesn't have a history of them.” A detail that continued to nag at her. What could possibly have caused Mr. Goetz to have a seizure? “He's in rehab because of a broken left hip. He was due to go to a nursing home in a few days, but he's on a waiting list. I can get the rest of his stuff out of his room and bring it up to the ICU.”

“Sounds good.” More staff members arrived with a gurney. Together, the team transferred Mr. Goetz from the gym mat up and onto the cart.

She stood back, allowing the medical emergency team to take her patient away. She glanced at Nick, who used a cane to help him stand. “I am surprised to see you here, but am very thankful that you were around to help.”

He shrugged. “I'm still getting therapy three times a week. I've been employed by the government for years, which gives me certain privileges to be treated at any VA hospital.”

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