Not Well Visualized

 The time clock read 17:58. I patted myself and yanked my badge out of the back pocket of my scrubs, fumble-fucking it into the edge of the machine and swiping fast. Upside down. 17:59. I flipped and slid the badge again. The time clock recorded my arrival at 18:00. I turned in silent triumph to saunter into the break room for morning report and ran face-to-chest into Jenny, badge in hand. She reached over my shoulder to badge in as I bounced off her cleavage. 18:01. “Hey, better luck next time.” She shrugged. 

Ted was charge nurse again tonight, the last of his 6-night stretch. That wasn’t promising. His voice was flat as he rattled off the list of patients currently in the department, and the number of ambulances lining the halls waiting for beds. It wasn’t a surprise, we’d all weaved around the rigs to get into the parking lot. I sank into the busted leather couch against the window as I scanned the faces around me. It was the usual mix of cross-fitters and exhausted-looking young parents. The odd 30-year night shift veteran who seemed to exist outside of time, complete with ancient surgical scrubs and stethoscopes. James leaned over and raised his arm. I snuggled in against his side and inhaled his aftershave. 

“How’s Annie and the kids?” I whispered. He sighed softly into my hair.

“Doing ok. I had to pick Gabe up from school again, for being disruptive. He’s having a really hard time with the transition to mainstream classes. And Annie has a migraine.” 

“You’d think that if he’s doing so badly in the regular classes they’d want to put him back with his paraprofessional. I mean, has he even made it through a whole day yet?”

“Ha. Yeah, no. But, budget cuts. And mainstreaming is supposed to be better.” He sighed again and I could feel the muscles of his shoulder and chest tense. “We’ll get through it.” 

“I know, totally. It’s just the new thing, he’ll get used to it. I’m sorry about Annie’s migraine.”

“Yeah. How is Henry, still working on the book?” 

“It’s going really well! I mean, that’s what he tells me. He’s making lots of progress, he really thinks that it will be ready for an editor soon.”

“That’s great! He’s such a smart guy, I’m sure it’ll be amazing.”

“Oh, totally. Even though it’s taking longer that we expected, it’s going to definitely be worth it when he’s done.” I paused for a few seconds but couldn’t leave it alone. “I mean, it seems like she’s getting them more frequently lately, you know? The migraines?” He nodded but I could feel that he wasn’t looking at me.

Ted was ready with assignments. I was hoping for triage, I’d rather face the ED lobby than a line of medics out the door before I’d even finished my first cup of coffee, but you couldn’t ask for a specific assignment on Ted’s 6th of 6. 

“Janelle, pod 1, 10-14.” I made a face and a few people laughed. “Ok, so.” Ted rubbed his dry palms together. “Go team, or whatever. Let me know what’s going on, if you need help don’t wait to ask for it.” 

People stood up and started to gather their mini coolers and stanley cups. James waved at me on his way out the door, smiling. “I’m in pod 3! I’ll catch up with you later.” He was always happy to get going, to be helping people. Normally the “nursing is my passion” types made me want to poke my own eyes out with trauma shears, but for James I made an exception. He was my longest friend at Mercy General. We were always telling each other that we needed to hang out and get our families together, but the scheduling never seemed to work out.

I jogged over to pod 1 to snag my favorite computer in the far corner of the nurses’ station, as far away from my assigned stretch of rooms as possible. Jenny ambled over and stood next to me.

“I have 20-24, I think. Aren’t you in 10-14?”

“Oh, yeah, I am, but I prefer this desk.”

She just shook her head at me. With an angry groan I vacated the seat and flopped down at the empty computer across from my rooms while Jenny unpacked her rucksack. She pulled out a fan, a large tupperware container of jerky, a bottle of brackish liquid, and a gallon-sized pink water jug with encouraging comments written on each of the “hydration milestones.” Cracking her neck, she rippled her huge shoulders and leaned back into her chair, which squealed ominously.

“Heyyy now. Alright alright alright! Looks like this kid here is yours!” The paramedic grinned at me as he wheeled a stretcher out of room 10. He slapped his clipboard down on the upper ledge and leaned over the top of my computer.

“Yeah, hi. What have you got?”

“Well aren’t you friendly!” I glared at him and he straightened up and started flipping through his paperwork. “11 year old male, history of autism, some kind of breathing issue. Coming from home. O2 sat is 96% when we can get him to keep the monitor on, heart rate 146, afebrile. We gave 2 breathing treatments on the way. Mom says she doesn’t have an inhaler.” 

“He has asthma? The inhaler ran out, or?” 

He shook his head. “No asthma, she says. Just ‘something really wong with his breathing.’ Apparently he has like, episodes, over the last couple months?” He leaned over the computer again and lowered his voice as I stared up at the stubble on his throat. “Mom’s kind of a freak. You’ll see.” 

“Great, awesome.” 

He smirked and wheeled the stretcher briskly toward the ambulance bay doors. 

Walking into room 10 I was immediately annoyed at the mother, who had turned off all the lights in the room and was frantically patting her son’s back and staring at the glow from the blank vital signs monitor on the wall behind his bed. She jumped when I started talking.

“Hey there, I’m Janelle, I’m going to be your son-”

“Austin!”

“-Austin’s nurse tonight.” I smiled, hoping to calm her down as I pulled the boy’s damp shirt off and started putting him on the cardiac monitor. Watching him as I moved through my tasks, I began to feel unsettled. He was sitting bolt upright in bed, leaning slightly forward with his hands on his knees, breathing extremely fast. His face was pale and I could see a sheen of sweat on his forehead and upper lip. Over the rushing sound of the oxygen and albuterol blowing through the nebulizer mask that the medic had left over his mouth, I could hear a faint whistling. His mother and I both paused as his oxygen level with it’s jagged waveform popped up underneath his heart tracing on the monitor. 

“His oxygen’s 99%” I mumbled, perplexed. “That’s great.”

She looked at me, searching my face, then turned back to the monitor.

“What does that mean?”

“It means that he’s getting enough oxygen. It’s a percentage of the oxygen in his blood, perfect is 100%, so 99% is really good. We’ll have to see how he’s doing without the nebulizer running, but maybe the medicine has really helped his asthma.” As I recited the explanation I’d given to more patients than I could count, the unsettled feeling grew into the distinctly uncomfortable awareness that something wasn’t right here. This kid looked terrible, if his breathing had been helped at all by the albuterol then the O2 sat was the only indicator.

“He doesn’t have asthma. I told them that he doesn’t have asthma.”

“Well…what is it that you think is happening? Has this happened before?”

“Hi Mom, I’m Dr. Kirkpatrick. And who do we have here?” She flinched and turned to the tall, lanky man in scrubs standing beside the bed, gesturing at her son without quite looking at him. He nodded at me, radiating impatience, and I started picking up clothes and tidying in the room. 

“This is Austin.”

He touched the boy lightly on the shoulder, and getting no response, started to listen to his breathing. As he moved his stethoscope around over the heaving chest he nodded and threw out the occasional “um-hm” at her story. It had started a few months ago, when they moved into a new house in the country. Austin was nonverbal, and it was just the two of them, she’d expected him to have a hard time with the transition to a new but it was much worse than she’d expected. He’d gotten lost on the property somehow the first night they’d arrived, all the confusion with the movers, and when he’d finally wandered back home it was like something had happened to him. He’d regressed, hitting and crying out, not sleeping, and then the breathing episodes started. 

Dr. Kirkpatrick mumbled “I see” and held the wrist to palpate a pulse. The boy jerked it away without looking at him. He raised an eyebrow and moved his stethoscope to the boy’s neck, to listen for stridor, the whistling sound made by patients with swelling in their airway. 

The boy didn’t seem to be watching the stethoscope, but as the doctor’s long fingers advanced it toward his neck he reacted suddenly and violently, throwing his arms up and scooting backwards toward the edge of the bed. Dr. Kirkpatrick’s glasses flew past me and I bent quickly to pick them up so that he couldn’t see my face. James was going to love this, we’d all have traded places with this kid in a second if it meant getting to slap Kirkpatrick.

When I composed myself and stood up, I saw that he’d moved to the door and squared his shoulders, a gesture that I was familiar with: he was done with this case. The mother followed him, reaching out her arms, but fell back when he rapped out a list of demands.

“Call RT and get them to give him an hour-long nebulizer treatment. He’s not wheezing, but we’ll be sure. Orapred 15 mg, chest xray, mark him ready for recheck after the hour-long.” He strode from the room and I hurried out to call respiratory therapy and gather the meds.

Over the next hours the line of ambulances slowly disgorged their contents and faded away into the night. I got 2 chest pains, a meth-addled police dog bite victim who also eventually complained of chest pain, and a series of forgettable abdominal pains. Nothing exciting, but busy. I kept an eye on the boy’s vital signs on the bank of monitors in the nurses’ station and could see that nothing much had changed after the additional hour of inhaled steroids. His oxygen still looked good, his breathing and heart rate were way too fast. Typically, I got sucked into helping the new grad in the rooms next to mine restrain a combative patient and by the time I’d finished explaining all the legal documentation to her it was nearing midnight and I’d failed to mark the boy “ready for reevaluation.” When I sat back down at my computer to take stock and catch up on my own work I could see that he’d been back in the room, because the chart was now highlighted green, “ready for discharge.” I printed out the paperwork and darted into the room, eager to wrap this up and hopefully land a quiet post-op complication in the empty room that I could sit on until an inpatient bed freed up in the morning. 

As I walked in my mouth went dry. The mother was wringing her hands and talking to him in a low voice, and the boy was much, much worse. His face had taken on a greyish sheen and his lips were dusky. He was still sitting up tilted forward in that “tripod” position, mouth open, and every few breaths a strangled shriek escaped his lips. His mother turned away from him and stared at me. Not knowing what else to do, I started fiddling with the O2 sat monitor, moving it from one of his fingers to the other. 99%, with a perfect jagged wave form showing the correspondence between his breathing and his heart rate, stayed on the screen. I took it off his finger and unplugged it, found a spare one wrapped in the cords stored in the basket behind the monitor and plugged it in. 100%. I tried it on my own finger, biting my lip. 96%. I was reminded once again how incredibly fucking stupid it was that I was still secretly smoking. Avoiding eye contact with the mother, I stared at him, lost in thought. 

What was going on? His chest xray was normal. His oxygen levels were good, and he had no signs of carbon monoxide poisoning or any known source, mother reported that they had checked the carbon monoxide detectors in the home before moving in and she was always with him. No other weird toxic exposures. 

I didn’t realize at first that the mother was talking to me. “You see? I told the doctor when he was here, he’s so bad now, this is the worst one he’s had.” She spoke in a panicked whisper and I had to lean forward to hear her. “There’s something really wrong, it just keeps getting worse, you have to do something, you have to…” she trailed off. Trying to look confident, I nodded. “I’ll go get the doctor. We need to figure out what’s happening. Poor little guy is really struggling.” She didn’t answer me.

Pacing the halls looking for Kirkpatrick, I could see that it was later than I’d realized. Triage had settled down to a handful of lobby regulars provisioned for the long haul, chip bags strewn around their chairs and filthy fleece blankets with disney characters pulled up over their heads. I found Mary in the single booth still open, clacking away at her computer with a thick organic chemistry book open in front of her. She covered it with her hand when she heard my footsteps behind her.

“You’re not exactly hiding that.” 

“Honestly, dude, I could give a fuck. They can fire me. I hate this place.” I laughed as she slumped over the book and faceplanted into the pages.

“Don’t you need them to pay for medical school or whatever it is you’re doing?”

“Physician’s assistant. Dickhead. And please, our education benefit is like 5 dollars.” 

“You’re going to have ‘assistant’ in your title, all this work to be their bitch officially for life.” I poked my head into the corner behind her desk where the ER docs liked to hide to chart. No luck. 

“Who are you looking for?”

“Kirkpatrick.”

“Ugh, why?”

“Because I need him to come see this kid he’s trying to discharge to death.” I finished my sweep of triage and the fast track rooms.

“Good luck. I think he’s outside the trauma rooms in Pod 2.” 

“Thanks.” 

Pod 2 had almost entirely emptied out. He wasn’t sitting outside, but I could hear typing in the most recently used trauma room and pushed aside the curtain for find him standing up at the wall-mounted computer charting, as 2 women from environmental services mopped blood and picked up trash from the floor around him. He was oblivious to them. I tried clearing my throat, but he didn’t react. Something about the fact that he and I were almost the same age made tapping him on the shoulder seem even more degrading. I cleared my throat again, louder, and the EVS women started giggling. 

“Hey, hey doctor! Hey, I think she needs you!” The older of the 2 women waved him away from the computer and he took one earbud out. I could faintly hear some kind of computerized techno beat hissing from it and felt my face turning red. 

“Yes?”

“The kid in 10, he’s up for discharge?” 

“Yes.”

“Well…did you see him?” 

He didn’t bother to respond to this. 

“I’m just…would you please go back in there? The mother is asking to talk to you, she’s really worried that he doesn’t seem better.” I said, shifting the blame onto his mother like a coward. He rolled his eyes and marched toward the room as I trotted to keep up.

The boy was unchanged, if not a little sweatier. He listened to his lungs again and prodded him cursorily while the mother and I watched, silent.

“You can try racemic epi in another nebulizer. Although there doesn’t seem to be any swelling in his throat. Then he’s ready to go home. The discharge instructions are updated in the chart, you can give them a take-home pack of the steroids if we have any, or they can pick it up at the pharmacy tomorrow.” Then he walked back out.

I called RT for help with the racemic epi and stood with her in the medication room as she loaded the nebulizer. “It’s weird, right? I mean, he looks awful.” 

“I know, yeah. But his lungs are clear. And he’s not having an allergic reaction, so I have no fucking idea why we’re doing this.” She nodded at the med in her hands.

“But what could it be?” 

“I don’t know, it’s weird. But maybe it’s behavioral? You know, like, he’s autistic and he’s freaking out and hyperventilating?”

“Do you really think so?” I asked, doubtful. “He looks…he looks like he’s choking.”

She shrugged and handed me the med as her pager went off. “I’ll go back in there with you, if you want? I’ve just got to run up to ICU really fast, they’re intubating someone.” 

“No no, you go, I’ve totally got it.” I flashed her a thumbs up, feeling guilty for adding to her workload. I could have mixed the racemic epi myself but I wanted to talk about the kid and get some kind of reassurance. 

I walked back into the room alone and his mother helped me slide the mask onto his sweaty face. He glanced at me then, blue eyes opened incredibly wide, like a horse in a barn fire, then they slid past my face and stared over my shoulder at the wall. Not knowing what else to do, I stood by the bed and held the mask tubing up away from his body, so that the mask wouldn’t pull down. Tentatively, I reached out and patted his hand. His mother’s eyes darted back and forth between his heaving shoulders and my face. After a few minutes the nebulizer’s fog turned to wisps and I gently took the mask off his face. There was no change. 

His mother started to cry, quietly. “Oh god, oh god, oh god…”

I felt myself starting to sweat in the overheated closeness of the room. “I’ll be right back.” 

This time I didn’t have to look far for Kirkpatrick, he was standing so close to my desk that I almost ran into him coming out of the room. He launched into the attack immediately.

“Why is that patient still here?”

“Because…because he just finished the racemic epi. Don’t you want to reevaluate him?”

“For what?”

My voice was getting louder. “For his respiratory distress?”

Kirkpatrick shook his head. Out of the corner of my eye I could see Jenny getting up slowly from her chair. “He’s not in respiratory distress. His lungs are clear, his vitals are fine except for minor tachycardia from all the albuterol he’s had.”

“But can’t you see that there’s something going on with him?”

He narrowed his eyes at me. “Do you feel that we haven’t adequately worked him up?”

“YES.”

“So, what?” He ran a hand through his thick dark hair and suddenly looked not just mad but exhausted. “It is your professional opinion that we should do more tests?” 

Not trusting myself to speak, I nodded.

His eyes glinted. “ALRIGHT. I will order a full set of labs and blood cultures. You can start an IV and I will order IV fluids. I’ll consult pediatrics and see if there is any additional imaging they recommend.” 

As he walked away I heard the boy’s mother gasp behind me and my heart sank. My hands were shaking, and without looking at her I walked slowly to the stock room to collect supplies, trying to calm myself. Puttering around in the supply bins for longer than I needed to, I tried to shake the sense that I was on the wrong side of something, somehow. Who would know more about this than respiratory therapy, she had assessed him herself, and she thought it was behavioral. He was just…working himself up. And his mother was hysterical! And here I was, getting drawn into this crazy workup, spending hours in this dark room, fighting with Kirkpatrick, over a nonverbal kid having a panic attack?

But underneath the embarrassment and the logistical worries about the tests and the difficulty of starting an IV on a combative, slippery kid, I felt a crawling unease. A strange thought floated into my head, that I just had to get him through until the morning, somehow. This wasn’t a panic attack, something was wrong. 

When I returned to my desk with an armful of supplies, Jenny was standing outside room 10 watching the closed door with a keen look, waiting for me. 

“What’s up?”

“Just discharged my dialysis guy, figured you might need some help in there so I went in to look at the kid’s arms for the IV. Mom’s a little intense.” 

“AGREED.”

“There’s no fucking way we’re going to be able to hold that kid still for an IV, even with both of us. We’ll need to sedate him.”

“Jesus, I know. You think we an get Kirkpatrick to give him a little Ativan?” I fretted. 

“Maybe it’ll help his breathing.” She shrugged.

I looked at her, suddenly overcome with uncertainty. “Listen, Jenny, you’ve been doing this for a long time…”

She chuckled “20 years?”

“Yeah, and I mean…have you ever seen anything like this? Am I overreacting?” 

She crossed and uncrossed her muscular arms as she paused to consider her words. “Hmm…not exactly.” She said in her even, gravely voice. “Go ask Kirkpatrick for the ativan and we’ll get this shit done. You’ll feel better knowing that you turned over all the rocks, right?”

I sighed, relieved. “Yep. Thanks.”

“You want to give him ativan?” Kirkpatrick whispered at me furiously. He was nearly inaudible on a good day, but his voice got even quieter when he was angry. “I thought you were insisting that he can’t breathe. You want to make him sleepy?” 

“No, I just…we can’t get the IV without it. It’ll take a whole team of people to hold him down.”

“No ativan.”

When I returned to Pod 1 I just shook my head at Jenny and stormed back into room 10. This was getting ridiculous. I was ready to vent my frustration at his mother, who couldn’t handle her kid, so that we could just get this the fuck done and get him out of here, but when I saw the boy my fury evaporated and I felt very scared. 

He was making the shrieking noise with every breath now, and he looked unbelievably exhausted, his eyes were drifting closed even as his head bobbed up and down with the effort of his breathing. 

“Oh jesus” I exhaled. His oxygen read 99%. I pulled the monitor clip off his finger and flung it off the bed, then I walked over and flicked on the lights. His mother was holding his shoulders and staring hard at his face and chest, she didn’t turn around. 

“YOU HAVE TO HELP HIM, WHAT ARE YOU PEOPLE DOING!?” She snapped at me.

“I don’t know what’s wrong with him. There’s nothing wrong with him!” I snapped back, my voice rising in panic.

Then she turned and looked directly at me, blinking in the bright fluorescent lights. “I tried to tell him, this is the worst one he’s had and it’s going to kill him if you don’t do something. It’s wrapped around his throat. Can’t you see it?”

“What…what are you talking about?” My voice was shaking. I found myself peering at his throat, while fighting the urge to run out of the room.

“Look! Look right here.” She reached toward him and pointed a shaking finger at his neck, under his chin. “It’s faint but you can just see the outline of it. It’s strangling him.” I moved closer to the bed and leaned very close, so close that I could feel his panting breaths rifling my hair as I bent down. Just below his chin, the skin did look…different. Poreless, smoother somehow. I couldn’t tell if it was the shadows, but there was a very light bluish outline across the front of his neck going under his chin and pulling slightly up under his ears before disappearing into his hairline. 

“What the hell…”

“After he got lost, when he came back that night, and that was the first time I saw it.” She was talking very fast now, words suddenly tumbling out of her in a rush. “Everything was wrong after he came back, he wasn’t himself and he, he started…talking sometimes. The first time in his life, ever, he was talking and you’d think I would be so happy, I should be so happy, but it’s not…it’s not his voice. It doesn’t sound like his voice and it only happens at night, I’ll hear him talking in his bedroom and then he’ll start crying and I’ll come in and he’s like this. Now every time it happens it’s worse and I can tell it’s killing him. It’s going to KILL HIM if I don’t DO SOMETHING and I came here because it’s a goddamn hospital and you people are supposed to know what to do–” 

“But there’s nothing…there’s nothing wrong with his throat.” I whispered. 

She glared at me. Suddenly her arm shot out and she grabbed my wrist and pulled me towards him. I nearly fell into the bed, as I tried to right myself and jerk my hand back she dragged it to his throat and pressed my fingers against his skin.

I gasped and threw myself backward but she wouldn’t let go. “You feel it? It’s right there.”

As I struggled to pull away and she fought me, I felt something round and dry rasping against my palm, so cold it was painful to touch, and on either side of it I could feel the warm damp skin of his neck and chin. “LET GO! LET GO!” I was yelling at the top of my lungs and scrambling backwards when Jenny flung open the door and stomped in. 

“What the FUCK is going on in here?” 

His mother released my hand and I fell backwards, almost on top of Jenny, and backed out of the room. I was terrified to look away from him. He was turned toward me, staring at my face, and he looked like he was choking to death, the skin on his lips was darkening as I watched. His mother flung herself across the bed and started sobbing loudly. Jenny took a last long look at the room, said a few gruff words that I didn’t hear, and closed the door.

I wiped my face with my hands and realized that I was crying.

Jenny watched me scrub my face. “So, the IV is a no-go.” We were alone in our half of Pod 1, separated from the rest of the ER by the empty triage booths and a series of long hallways. I had no idea what time it was, it felt like we were outside of time somehow. I had the sensation that I was struggling to wake up from a dream.

“I, I don’t know, what–” 

“Did she hurt you?”

“No, she grabbed me but I”m–” I tried to slow my breathing “I’m fine. I’m fine. I just have no idea what to do now. The kid…” 

“Looks rough, yeah, I agree. But you’ve tested everything. Except for some infection, which nobody thinks he has, right?” 

“Right.” 

“So there’s nothing else to work up. And his vital signs are fine. And if he’s having a panic attack, and Kirkpatrick won’t let us give him ativan, then he’ll be better off at home where things are familiar and he can calm down. Right?’

My breathing was normalizing, slowly. “Right. No, you’re totally right. I just…I just feel like there’s something else going on.” 

Jenny gave me a steely look. “What did RT say when they looked at him?”

I shook my head.

“Janelle. No offense, but you’re pretty new, and you’re making this harder than it needs to be. The kid is ok. The tests didn’t find anything, his vitals are normal, maybe something weird is going on but probably not. Probably he’s just a weird kid and it’s 3am he has a weird mom and they just need to go home and go to bed. They can follow up with the pediatrician tomorrow. Ok?”

“Ok” I sighed. There was a lump in my throat.

“I’m heading home. You’ve got this. Go and tell Ted in Pod 2 that you need someone to stand by when you discharge them, in case the mom tries any more bullshit.” She shouldered her knapsack full of protein powders and waved goodbye. I felt my eyes watering again as I watched her disappear through the ambulance bay doors into the dark. 

I stood in the nurses’ station alone, shifting my weight from foot to foot. It was officially the middle-of-nowhere o’clock, everything felt empty and liminal. My palm burned where I had touched…his neck, I shuddered, willing the memory away. I touched his neck. I stared at the closed door, feeling the same rising terror I’d felt as a kid sprinting up the stairs out of the basement. Then I grabbed the stack of discharge paperwork and ran to Pod 2.

Ted was standing with the remaining night crew, listening to the EMS radio crackling. “I was wondering if–”

“Hey” he replied briskly. “There’s a roll-over MVA coming in, one casualty on scene and 3 patients coming in. Sounds like at least one trauma code, maybe 2. Did you clean up your pod yet so that you can come lend a hand?”

“Um, not yet, I actually was hoping–”

“Are you serious?” He said, deeply pissed off. A few nurses drifted closer to listen, and I saw James poke his head out of the trauma room he was prepping.

“Yeah, I’m sorry, I have just been having a lot of trouble getting the kid ready for discharge.” This was true.

“That kid has been up for discharge for 6 fucking hours!”

“Hey, Ted.” James said, walking toward us.

“Listen” Ted whirled on him. “This is not your fucking problem? Right? You have a fucking job to do?”

James stopped in his tracks and stood there, silently.

Ted turned back to me. “You need to get that kid out of there and get over here and help with these patients. Now.” 

I felt James’ hand on my shoulder as I rounded the corner back into Pod 2. “Hey, Janelle. Wait.” When I turned he caught me in a quick hug. “If you’re really having trouble, maybe call security? They can probably spare someone, even with the trauma coming in–”

“No, they won’t, it’s only Mitch and Cassandra on tonight.” I tried not to sound panicked. 

He frowned. “Well, um…shit. What about the chaplain? They’re a calming presence.” I made a face and he laughed. “I know how you feel about that stuff, but I can tell you, I’ve seen them help a lot of people. It’s an emotional safety thing.”

“You’d better go.”

“Just call the operator, they’ll connect you!” He called over his shoulder, already jogging back. 

The chaplain, a tall man named Steve with a gentle demeanor, arrived startlingly fast. It made sense that they stayed near the ER at night, since their main role was comforting the families after patients’ died. As awkward as I felt asking for his help, it was an enormous relief to have another person with me in the corner full of darkened rooms. The door to room 10 remained closed and although I strained, I couldn’t hear anything inside. I told a much of the backstory as I could, but found myself stuck trying to explain what had happened when his mother had grabbed my hand. Swallowing hard, I shook my head. “Just, um, the kid’s mom is a little reactive so be aware of that.” 

He nodded. “It’s probably been very hard for her, feeling like no one believes her or can help her son. I’ll go talk to them, and I’ll call you in when we’re ready for the discharge papers.” 

Sitting in my chair, I watched the charts for the trauma patients and felt guilty for being so useless. CPR was only in progress on one of the patients when they arrived, but none of the survivors of the wreck were doing particularly well. I didn’t want to deal with Ted again but I absolutely couldn’t not show my face when everyone was stretched thin like this. Just as I was considering tapping on the door and letting Steve know that I was going to run over to Pod 2 while he chatted with the mother, he opened the door and beckoned me urgently inside.

Steve’s face was pale and the atmosphere inside the room felt charged. The boy’s breathing was worse, he was losing energy, and I wondered what would happen when he finally fell asleep. Would the panic attack be over, or would he stop breathing completely? I banished thought. This was a panic attack, or a behavioral something-or-other. He needed sleep and he’d be fine. His mother fixed me with a piercing stare as I walked in but said nothing. She was kneeling beside the bed now. Steve walked behind me and flicked off the overhead lights. The room was plunged into darkness, illuminated only by the red light of the cardiac monitor on the wall. 

“What are you doing” I whispered fiercely. He shook his head at me, slightly, and turned to bed, bible open in his hands.

“Bow your heads and we will pray.” Not knowing what else to do, I tipped my head and stared at the floor. The sound of the boy’s breathing filled the room and I shuddered as I  felt the frozen rasping again across my palm.

“Lord, listen to my prayer: turn your ear to my appeal. You are faithful, you are just; give answer. Do not call your servant to judgment for no one is just in your sight.” Steve was speaking firmly and quickly. “The enemy pursues my soul; he has crushed my life to the ground; he has made me dwell in darkness like the dead, long forgotten. Therefore my spirit fails; my heart is numb within me. I remember the days that are past: I ponder all your works. I muse on what your hand has wrought and to you I stretch out my hands. Like a parched land my soul thirsts for you.” He paused and took a long breath.

A wave of nausea broke over me as I recognized that the silence in the room was because the boy had stopped breathing. I leapt toward the bed and began rubbing his back, I could feel him moving but I could barely see him in the dim light, just the shining of his eyes. “C’mon, hey! Hey, Austin! AUSTIN C’MON BUDDY.” I scrambled toward the back of the bed for oxygen tubing, a bag-valve mask, the code button to call for help, but I was disoriented in the dark and bounced off the monitor column and head of the bed, knocking equipment onto the floor blindly. Steve continued talking, faster, louder, as I fumbled for the boy’s hands in the dark, trying to feel a pulse. I was afraid to touch his neck.

“Lord, make haste and answer; for my spirit fails within me. Do not hide your face lest I become like those in the grave. In the morning let me know your love for I put my trust in you. Make me know the way I should walk: to you I lift up my soul.”

Holding onto the boy's wrist, suddenly I had the sensation that I was pulling him down towards me, my hands slipping on his sweaty skin. I couldn’t feel his breathing or his pulse anymore, it was like his body had frozen. The glinting light from the monitor reflecting off his eyes drifted up towards the ceiling, my neck craned back to and I felt dizzy, like I was in a boat that had capsized.

“Rescue me, Lord, from my enemies; I have fled to you for refuge. Teach me to do your will for you, O Lord, are my God. Let your good spirit guide me in ways that are level and smooth. For your name’s sake, Lord, save my life; in your justice save my soul from distress. Glory to the Father, and to the Son, and to the Holy Spirit:— as it was in the beginning, is now, and will be for ever. Amen.” Steve’s voice echoed in the room and I pulled hard, my head swimming, and felt resistance as I hung my whole weight on the boy’s arms. His mother was shouting “STOP, STOP” and I felt her grab me from behind. I lost my grip and we tumbled together into the corner of the room, away from the bed.

We struggled to get free of each other and she stood up, partly blocking my view of Steve. I watched as he reached up toward the boy and grabbed him around the waist, lifting him, and then seemed to unhook him, somehow, to raise him up and forward, and then bring him gently down from the ceiling onto the bed. There was still no sound in the room but our breathing and I pressed my back against the wall, counting.

The boy gasped. 

His mother fell on the bed with him, patting his face. I stood up on shaking legs and inched along the wall until I found the light switch. Fluorescent light flooded the room. The boy was lying on the bed, looking dazed. The skin on his face and neck were flushed, and he was leaning into her arms, breathing a little fast but normally. Steve stood beside the bed, his bible on the floor nearby. He bent down slowly and picked it up, then turned and walked out of the room. I couldn’t move, just stood there watching, as the boy’s breathing slowed and he fell asleep. His mother curled against him, watching me silently, then closed her eyes. 

I walked out of the room, straight past the commotion and drama in Pod 2, out into the ambulance bay. Steve was nowhere to be seen. The air was cold and grey light was filtering over the parking lot. Almost sunrise. Dayshift trudged from their cars, clutching dutch brothers cups, as I watched, and lit a cigarette.