The following short story is excerpted from nurse-author Joyce Renwick's anthology In Praise of What Persists. You can order a copy from Amazon.
The paramedic raised his booming voice. "Picture this. Spanky and I are barreling down the Interstate doing eighty and on the radio, old Tennessee Ernie Ford's singing 'Nearer my God to Thee-'"
"Who? Come on Bill." Amy squinted up at the red-faced man in the blue uniform as he held forth under the influence of three cups of middle-of-the-night coffee. "Don't ambulances have to obey the speed laws too?"
"Nah." Bill took another swallow from his Styrofoam cup. He glanced over at Officer Bancroft who was sitting in the corner by the coffeepot.
The Emergency Room's examination bays were empty. The spillover from Evenings had accounted for the usual off-and-running first few hours of the shift, but by three a.m. the scrapes brought in after the bars closed had had their stitches and gone home, and the intern had shuffled back to his quarters to sleep.
"Yeah," Bill picked up his story, "me and Spanky were going hunting in West Virginia."
Spanky and Bill, two of the paramedic ambulance drivers whose area included the hospital, and Officer Bancroft, a local patrolman, had stopped into the Emergency Room to join Amy and Carolyn as they waited out the middle of the night.
"Sure, Bill," Amy said. She went to the coffeepot and came back with a steaming cup of black coffee. Each night they sat together like three-year-olds in a sandbox, she thought, in staring parallel play. Each night caught together in the waking dreamtime their bodies couldn't let go.
"Hunting in the ambulance?" Carolyn asked. The young blond nurse was in her usual chair, turned into the corner to avoid the glaring overhead lights.
Bill grinned at her. "Why sure," he said. He stood in front of her, both hulking and boy-like, while his partner Spanky-short and square with wire-rimmed glasses on a freckled face-sat on the plastic couch wearing an old man's intensity like a badge.
"Bill just wanted to tramp around in the woods," Spanky said. "Don't let him fool you, Aim."
"Oh, I'm not easily fooled."
Amy, now brown-haired and pale at twenty-eight, knew she was rarely fooled, and never noticed. In fact, no one had noticed her on the street, or anywhere else in the last couple of years. After the baby, her hair had darkened and so had everything else in her life. She worked nights because eleven to seven paid better than the other shifts and her husband Ronnie's work as a carpenter was seasonal, sporadic. She never got enough sleep during the day, and she often worried that her three-year-old son might be home alone at night while Ronnie stepped out for a beer.
"Hunting." She raised an eyebrow to Bill, then eased down onto the green Naugahyde beside Spanky, careful not to spill her coffee.
She stared down at her scuffed white shoes. Even though Carolyn, an ex-Navy nurse, sometimes changed her uniform twice a shift to withhold a pristine standard, Amy's shoes were her small rebellion. Polishing her shoes, she thought, would be denying the reality of her job, the time on her feet, the effluvia she walked through. She would keep them scuffed.
She took a sip of the bitter coffee. "Come on Bill," she said quietly, "carnage every night and you still go hunting?"
"Has nothing to do with it." Bill rode his chair like a horse. He peered down at his large hands spread open in front of him. "It's fate, Aim." He laughed. "Look, I was born in those hills. A gun in hand is just natural."
"Sure." The walkie-talkie on Officer Bancroft's belt rattled and died. The tiny patrolman was sitting on a molded plastic chair. At five foot five he had just made the town police department's height requirement. "Firearms aren't a problem when you know what you're doing." He winked at Bill and patted his service revolver.
"I've seen too much of it," Amy snapped. "Take that gunshot wound last week."
The patrolman checked his watch. "Old guy caught him breaking and entering?"
Amy nodded. "And carrying away his TV."
"Yeah," Bill said, "we remember it, don't we, Spanky? Brought him in babbling. Silent as stone once he got here."
Amy stared down into her coffee. "Is a TV worth that? Guns, Bill. And we get the leftovers."
"Amy, honey, you've got the wrong perspective."
"What perspective should I have?"
Bill lifted his hand, finger extended, and fired a shot into the light fixture overhead.
"Oh, drink your coffee and get out of here," Amy said. "You're not making the connections. Why do I have to put up with you every night?"
Carolyn, who had been staring at the wall, turned in her swivel chair and smiled. "Amy, you're just burned."
"Sure I'm burnt, and what about you?"
Carolyn shrugged, her large face flat with a studied calm.
Yes, she was getting burnt out already, Amy thought. She had seen it in the older nurses, their coldness. No, not coldness exactly. They're numb. Yes, that's it. Numb. As if they've felt too much, done too much that mattered, and they can't acknowledge them anymore, those feelings worn thin from overuse.
Amy glanced around the room. A smiling Santa Claus beamed at them from the red and green crepe paper twists that draped the receptionist's desk. Somebody had sprayed the lounge with pine scent.
"Just another crispy critter," said Spanky.
"Yeah, that reminds me." Bill cleared his throat. "There was this fire last week up on 28th Street. Remember Spanky?"
Spanky nodded. "Oh yeah."
"We got called up there to accompany the trucks, Aim. Got into this burnt-out house and saw this woman sitting there big as life at the kitchen table. She was black, her eyes big white marbles."
Amy yawned, quickly covering her mouth.
"Now I thought," Bill said, "this sure is strange, 'cause I knew it was an entirely white neighborhood. I just wasn't thinking." He shook his head. "'Cause when I got close, I saw she was burned to a crisp. She was just sitting there-all stacked up, I guess-because when I reached out to her, she fell into ashes at my feet."
"They really look like that?" Amy asked.
"Sure," said Spanky.
"You all are ruining my concentration!" Carolyn wailed. She swiveled around in her chair. "TM-I'm taking a class."
"Geez," Amy said. She stood and walked to the nurses' station, tossing her empty cup into a trash can on the way. Static crackled on the rescue monitor, then the phone rang out.
Amy picked up the receiver. "Here we go again." She listened a moment. "Okay, we'll be ready for you." She hung up. "Bleeder coming in," she called over to Carolyn who jumped up and headed across the hall.
"We'll need the larger room." Carolyn propped open the door to the minor surgery room and pulled back the curtains.
"Rescue Ten is bringing him in." Amy turned to Bill and Spanky. "Want to stick or split?"
"We'll hang around," Bill said, "maybe you'll need some muscle."
"Okay-just no more stories, right?"
"Swear to God," Spanky answered.
"See you folks," Officer Bancroft said. He pulled on his hat and was gone out the side door, the walkie-talkie on his belt screeching in the static-laden voice of the dispatcher.
The old fear she always felt when a case was coming in pawed at Amy's throat. It didn't matter that she'd worked in the Emergency Room for two years, or in nursing over eight. Each time the same metallic taste came to her tongue; the same stage fright pounced on her and made her breathless. She stomped the familiar back. Don't think. She hurried to the ambulance entrance and latched open the double doors. A December chill filled the hallway.
Carolyn had already set up the IV fluids, monitors, and suction and alerted the night supervisor, saying they might need her. She rejoined Amy in the cold hall. A light dusting of snow was falling outside.
"Have you called the doc?" Carolyn asked, glancing out the doors. She handed Amy two pairs of gloves.
"I'll wait a little," Amy said as she pulled on the vinyl gloves. "You know how pissed Joseph gets if we wake him too soon."
"Once the case is here, he's okay. We'll get this guy in the room first." Carolyn snapped on her gloves.
"You got it."
Rescue Ten backed into the entrance ramp, beeping and flashing. The paramedics rolled the stretcher out of the ambulance, up the ramp and through the doors into the tiled hallway where Amy and Carolyn were waiting. One of the paramedics pulled a bright blue blanket off the patient as they came in and threw it into a wheelchair sitting in the hall. On the stretcher a grey mound of a man-a worn forty-five or fifty-lay motionless, his grimy T-shirt rising and falling almost imperceptibly, above a mother-of-pearl belt buckle.
In the doorway to the minor surgery room, Carolyn gestured to the younger paramedic at the back of the stretcher.
"Was he conscious when you found him?"
"Nope," the small man said, flicking a shock of blond hair out of his eyes, "smells like he's been celebrating."
"Third bleeder this week," Amy said, coming in behind them. "Merry Christmas. How's his blood pressure?" She rolled an IV up to the table.
"Barely there. Sixty over zip."
"Okay, get him on the table fast."
Amy ran to the wall phone, took a deep breath, and dialed the intern's quarters.
As she grabbed the end of the stretcher, Carolyn shouted over into the lounge, "Hey, Bill, two hundred fifty pounds of dead weight here."
Carolyn turned back to the men from Unit Ten. Both were splattered with the coffee-ground-like separated fiber and liquid of old blood.
"Have a hard time getting him out?" Carolyn asked. She re-wrapped the blood pressure cuff around the patient's arm as the paramedics pulled the stretcher beside the table.
"You don't know the half of it," the older, dark-haired paramedic said. "Walk-up. Room full of crap. Got the picture?"
Bill and Spanky hustled into the room, nodded to the men from Unit Ten, and helped them heave the unconscious man onto small operating table that stood in the center of the room.
"Heavy bastard," Bill said. "Good luck, guys. We just got called. Fire on 35th." He motioned to Spanky.
"Any family coming in?" Carolyn asked the blond paramedic who was stripping the soiled sheets off the stretcher.
"Don't think so." The paramedic threw the sheets in one of the hampers along the wall. "Guy lives alone. The Resident Manager heard him fall and called us. Manager's been through this with him before, and doesn't want to have anything to do with the guy. "
"Pulse is thready," Carolyn said, her fingers on the unconscious man's wrist. "Where's the doc?"
Carolyn pulled out her bandage scissors and split the man's T-shirt and trousers. She grimaced as she peeled away the clothing. The grey trousers were fouled, the man's legs plastered with dry blood.
"Aim," Carolyn called over to Amy at the phone. "This one needs blood right away-lots of it. Look at this." Carolyn held up the soiled clothing. "Check out his nail beds."
"Already called the lab." Amy picked a packet off the equipment cart and tore it open.
Amy glanced at the man's bluish fingernails as she stuck adhesive disks to his hairy white-skinned chest and attached the wire leads to the heart monitor. His chest rose and fell in shallow breaths above his bloated abdomen. She noted his closed eyes and ashen face.
Here we go again, Amy told herself, don't think. She had turned some kind of corner in her life she knew; her nerve had fallen away from her like some flimsy plastic film. Acting out of habit, she ran her hands over the man's taunt abdomen.
"Belly's like a drum," she said to Carolyn. "There's still a lot in there." She picked up a clipboard. "Got a name for the chart?"
"Wallet's there," Carolyn said, cocking her head toward the stool. She pumped up the blood pressure cuff.
Dr. Joseph strolled in wearing a rumpled green scrubsuit. The intern pulled the curtain across the doorway.
"What do we have here?" he asked. He glanced at the unconscious man. "Looks like a John Doe to me." He wrinkled his nose. "Smells like an alky bleeder."
"Name's Timothy Whalen," Amy said, the patient's black leather wallet open in her hand. A plasticised card fell to the floor. She dropped the wallet and a bunch of keys into a yellow plastic bag and shoved the bag toward the paramedic who was at the closet getting replacements for the supplies they had used.
"See if the supervisor's out there," Amy said to him, "and give her the wallet so she can call the family."
The young paramedic nodded. "Just for you, sweetheart." He took the bag.
Amy shot him a frown. "Cut it out," she said.
"Got a chart going?" Dr. Joseph asked.
Amy gave him the clipboard. He glanced at the chart and handed it back to her.
"Start another IV on him," the doctor said as he leaned over the man, a stethoscope dangling from his neck, "and get the lab in here, stat."
The lab technician came in as he was speaking. Dr. Joseph glanced at Amy. "You're anticipating again."
"Sure," Amy said, "I've done this before. Want me to start the bloodline?"
"Do it," the intern said. "And put that rate at 120 drops per minute." He gestured toward the IV Carolyn had started.
Dr. Joseph glanced again at the chart Amy had propped on the cart in front of her. "Any history?"
"He's been out, but I can guess," Amy said. "Lonely alcoholic, holiday season. One binge, one office party too many. Why doesn't anybody ever tell drunks about bleedouts?"
"Not here, but the paramedics found him in a room-size mess."
"Yeah," Carolyn said, pointing to the clothing on the floor at her feet. "Black. Old blood mixed in. Lots of it."
The huge man stirred on the table. He groaned as the doctor slid the stethoscope over his chest and abdomen. "Mr. Whalen," the doctor said, "do you hear me?"
The man mumbled and began to choke. He raised his head and shoulders, vomited, then fell back onto the table with a thud. The dark brown coffee-ground-like material spread from his chin and neck onto the sheet behind his head, wetting his hair. An acrid smell of sour whiskey and old blood filled the room.
"Let's get him on his side," Dr. Joseph said, "pronto."
Amy and Carolyn rolled the heavy man onto his left side. As Carolyn steadied him, Amy pushed a kidney basin against his cheek. She quickly ran water onto some gauze squares at the small sink and wiped off his face.
"There you go, Tiny Tim," she said.
"You'll need this." Carolyn threw her a towel.
"Well," Dr. Joseph said as he stood back and watched nurses clean up the man. "We can be pretty sure those fragile vessels in the esophagus have been leaking for some time. Stomach bleeding too, by the looks of him. Abraded bowel. Booze just eats those tissues up."
Feeling something on her leg, Amy glanced down and noticed dark liquid was dripping off the table onto her shoe. The man vomited again. She jumped back too late. Her face and uniform were splattered, her eyes suddenly wet.
Amy remembered her arrival at the Intensive Care Unit after a rough flight to the Coast. Her husband Ronnie had decided not to accompany her. It had been after midnight when she arrived, and her brother was already unconscious on a ventilator.
"Hello, Paul," she had whispered, leaning over him. "Hello friend. It's Amy. Do you hear me?"
She glanced down at Timothy Whalen. He looked terrible. She turned to wipe off her face, hit the propped clipboard, and the chart clattered to the floor.
"Have the lab type and cross match three units of whole blood," Dr. Joseph said to Carolyn. Amy stooped to pick up the clipboard.
"Yes, sir," Carolyn said, shooting Amy a puzzled look. "Anything else?"
"Three more units of blood, standby."
Carolyn picked up the wall phone and dialed the lab.
Dr. Joseph avoided Amy, the scattered papers, the dark puddles on the floor, and walked over to study the cardiac monitor mounted on the wall.
"What's his pressure?" he asked.
There had been no response in her brother's face, Amy remembered. No movement of his body except for the steady rise and fall of his chest in response to the ventilator.
"70/45," Carolyn answered, her fingers palpating the artery inside Timothy Whalen's elbow.
The man coughed, followed by an explosive flow of projectile vomiting which shot across the room, splattered the x-ray light boxes, and the green tiled wall.
A diminutive Asian lab technician entered the room, glanced at the wall, then at the choking man lying on his side. She skirted around the table, and as soon as he quieted, from behind him drew a vial of blood from his right arm, which rested on the ridge of his hip.
"Those blood vessels holding up?" Dr. Joseph asked her.
"Yes, sir," the lab tech said in a small voice. "Okay for now." She left quickly, watching where she walked.
Amy put a clean towel and a suction tube at the patient's head and wiped off the man's pale lips. There was an explosive sound and a fetid smell rose in the air of the small room as a mahogany ooze appeared below the patient's hips.
"Oh!" Carolyn said, pulling a stack of incontinence pads out of the metal closet behind her, "here it comes." She yanked a pair of gloves from the box beside her and tossed them to Amy.
"Mr. Whalen." Carolyn shoved a few plastic pads and several towels under the patient's buttocks. "You're not going to do this to us, are you?"
The man moaned in reply.
Her brother had looked young to her, Amy thought, incredibly youthful, even handsome. His face was clear, unwrinkled, relaxed on the life support, as he no longer fought for breath. His wavy hair had been brushed back from his high forehead uncharacteristically. In contrast to the calm of his face, there was more grey in his brown hair than she remembered when she had last seen him only a few months before.
"He looks so good," she had said aloud to the quiet nurse who stood behind her.
"Looks like internal bleeding for some time," Dr. Joseph said. "Some of this is black. Really old stuff, not bright red new blood."
Dr. Joseph glanced up at the wall clock. "Why me, Lord?" he asked the ceiling. "I've been on for forty-eight and this is my second bleeder." He turned to Carolyn. "Any frank bleeding? New stuff?"
"No," Amy said answering for Carolyn. "Christmas week, every year. I've been here long enough to see the patterns. Bleeders-holidays and springtime."
"Yeah," the intern said. "Scientific study." He percussed the man's hard abdomen. "Liver's like a rock," he said. "Those small belly vessels that take over get overtaxed and carumba!"
"Carumba!" said Carolyn. "Teddie, is that your considered medical opinion?"
"Dr. Joseph to you," he said.
A deep rumble came from the patient.
"Get that blood going," Dr. Joseph said. "Where is that nursing supervisor?"
She had sat at her brother's bedside, Amy remembered, and tried to orchestrate his care. She watched the dosages change on his IV medications, followed the monitors, asked numerous questions, made a pest of herself-
A square, wire-haired woman in a white lab coat rushed into the room carrying a rectangular plastic bag of packed blood cells.
"Here we go," the supervisor said. "Who will check the numbers with me?"
Amy ran over and read off the blood label. "HL 102450-
0 Positive," she called out. "Okay?"
"Sign here," the supervisor said, "and I'll go get the next unit. Should be ready by the time I get back to the lab." She rushed out.
If someone ever asked her to describe the smell of a bleedout, Amy thought, what would she say? Imagine an outhouse, and a slaughterhouse. On a hot day. Stop, she told herself.
"Line's ready," Carolyn said. She ran a saline flush through the tubing and hooked up the blood.
"Open it up," Dr. Joseph said, "he's lost a lot."
Bill popped his head around the curtain. "A shitload."
"Bill, you still here?" Amy said. "Get to the lab, find the supe, and be sure the guy's family has been called."
"Aye, aye, sir."
Amy glanced at the patient. A rapidly enlarging halo of bright red blood pooled at Timothy Whalen's head.
"New bleeding," Carolyn shouted.
"Blood pumps," Dr. Joseph barked to the nursing supervisor who burst into the room carrying another unit of blood.
The woman stood for a moment and stared down at her highly polished sticky-bottomed shoes before she turned to go.
"Frank bleeding," Dr. Joseph said, "and still oozing. Start another bloodline. We'll try a Blakemore to stop the throat hemorrhage."
"Okay, doctor," the supervisor said. She left running. Amy heard Bill's booming voice follow her down the hall.
Her brother had aged before her eyes, Amy thought. He never regained consciousness. Finally, the hard decisions were her's to make, and she made them.
"What's his blood pressure?" Amy asked.
Carolyn took the stethoscope out of her ears. "Fifty-four over zip."
"Not good," Dr. Joseph said. "Get that Blakemore tube going. Where's that other blood? We'll do a lavage-rinse him out with ice water. Increase the IV-150 drops."
"Okay," Carolyn said, a thermometer in her hand, "but his temp's up now, and he's chilling."
"Scrap that blood and put up another. Bad blood, or he's allergic."
When he died, Amy thought, Paul looked seventy. In three weeks she had seen the future become the present in her brother's face. Ronnie had not understood this when she told him. The last time she stood at her brother's bedside and touched his cooled skin, he had looked like their grandfather. Enough, she told herself, stop.
Amy moved in to take Timothy Whalen's blood pressure. "58/30," she called out. She went to the equipment cart and set up the Blakemore tube.
"Hell," Dr. Joseph said, "let me start that new line."
"Gladly." Carolyn handed him an IV start pack. "His veins are collapsing."
"Damn, I was afraid of that."
Dr. Joseph turned the patient onto his back to palpate the veins in the crook of his left arm. As he leaned over the man there was a new rumble, and Dr. Joseph jumped away as projectile vomiting hit the tiled ceiling and the light fixture overhead. The vomiting came in paroxysms, as the black ooze continued from between Timothy Whalen's legs.
Bill poked his head in the door. "Need a cork? Doc, there's some guy out here with a cold demanding to be seen. Says it's the middle of the night and from the look of the waiting room we obviously ain't busy."
"Look," Dr. Joseph yelled, "we've got a trainwreck in here. Tell him to go to an all night drugstore or wait." He paused. "Sure it's a cold?"
"Get out of here, Bill!" Amy shouted. "Get us towels. And a mop."
The supervisor came in with two blood pumps and another unit of whole blood. She handed Carolyn the pumps and checked the numbers on the blood with her.
"You okay?" the supervisor asked, coming up to Amy after Carolyn took the blood. She put a hand on her arm.
Amy nodded. "I'm fine."
"I know your brother just . . . I'll get the ice for the lavage," the supervisor said, turning to the doctor. "Want the next unit of blood?"
"Yes," Dr. Joseph bellowed. "Ice. And four more units."
"Don't think they have that much on hand."
"Then get on the horn to Red Cross, damn it."
Carolyn attached the pumps onto the units of blood going into the left and right arm sites while Amy helped Dr. Joseph put the Blakemore tube down the patient's nose to the junction of the esophagus and stomach where the blood vessels were the most likely to have ruptured.
Once assured of the tube's correct position, they injected the liquid mercury into the Blakemore tube's blind outer tube, so the heavy fluid would press against the bleeding varices in Timothy Whalen's throat. While they were doing this, Carolyn pumped in the blood.
Bill came in with two more units of packed cells that Carolyn hung as soon the first units were empty.
"Super says Red Cross will have more blood here by special messenger in ten minutes," Bill told them.
"Good," Dr. Joseph said, "we'll need it. Pressure?"
"Forty-five over zero," Amy's voice was almost inaudible.
"What did you say?" Dr. Joseph shouted. "Got a hemoglobin?"
"Four," the supervisor said, coming in.
Timothy Whalen vomited, wrenched by a projectile stream, which hit the overhead light above him. His splattered face was grey.
They rolled him onto his side so he wouldn't choke as the red blood and coffee ground material dripped down on them from the light fixture. A thick cloud of odor-of vomited whiskey, old blood and black waste-hung in the room.
"The tube still in place?" Dr. Joseph asked.
Amy adjusted the Blakemore tube. "It's okay now." She touched her hair and then glanced down at her stained uniform and shoes. She grabbed more towels from the metal closet and threw them on the floor. "How about more IV lines?" she asked.
"You've read my mind," the intern said. He pulled a clean patient gown out of the closet and threw it over his splattered scrubs. "Take one foot and I'll take the other. If you can't find a vein, try the ankle. You," he said pointing to Carolyn, "set up more tubing."
Carolyn rolled over two IV poles on which saline and blood tubing were already hanging. "What do you think I've been doing over here?" she asked.
"Okay, okay. The stink's got to me."
"You!" Carolyn glanced down at her stained uniform. She ripped off her gloves and put on new, double gloving. She pulled the towels away from under the patient's hips and stuffed them into a plastic trash bag, which she tossed into a corner. The black ooze continued as she pushed clean pads under the man's buttocks.
"It's a blessing this guy's not awake," she said. "Aim, did you get the last pressure?"
"Yes." Amy leaned over the patient's yellow feet. "The chart's up to date."
Amy ripped off her gloves so she could feel the cool surface of Timothy Whalen's skin, searching by touch for a vein that had not collapsed. She stuck the large number eighteen needle into a vein at the top of his left foot. "Best I can do," she said as she attached the blood tubing. She grabbed a sterile towel and pressed it against her face.
After a few tries, Dr. Joseph got a bloodline going into the inside of the man's right ankle.
"We need blood pumps on all four lines," Dr. Joseph said.
The supervisor came in with a basin of ice and more blood pumps. "Found the pumps," she caught her breath, "on Ward B. Knew you'd need them."
"Good. Get two more units of blood, pronto," Dr. Joseph said. "Stat."
"Okay," the supervisor said, "I know what pronto means. Red Cross should be in by now. Is this going to work? Want some Vitamin K? I can get it."
"Why not? And some cimethedine. And get the lab tech here for another hematocrit."
"The fool has blown every blood vessel in his entire gut," Carolyn moaned, looking down at Timothy Whalen, "he's losing it."
The lab tech came in with two units of blood. As she took another blood sample, Carolyn hung the units on the new lines going into Timothy Whalen's feet.
Amy looked at the ashen man on the table. Four units of blood were hanging like red clouds above him, spilling bloody rain into his veins as quickly as they were able to pump it in. No matter how hard they tried, they weren't replacing his blood loss fast enough.
Carolyn put on fresh gloves and injected ice water into the inner chamber of the Blakemore tube that projected like a rubber snake from Timothy Whalen's nose.
A burned out nurse isn't callous, Amy thought. She glanced over at Carolyn who still seemed to believe she could stop the tide. A burnt out nurse knows too much and too little at once. She isn't unfeeling. Amy thought of the hardened nurses of old movies. Damn, she thought, the opposite is true. As time goes by she doesn't feel less, she feels more. Each case is a new assault on her emotions, more painful to bear. Each time more courage is needed to stand fast. Each patient is again, her brother.
"Timothy Whalen never planned on this," Amy said to the air. "How long do you think he's been bleeding?"
"A week, ten days maybe," Dr. Joseph said. "Denying he had a problem the whole time, I'd guess. Give the K and the cimethedine as soon as it arrives."
Carolyn stopped running the ice water through the nasal tube briefly to pump up the blood pressure cuff. "Oh no," she said.
Dr. Joseph glanced quickly at the cardiac monitor.
"Forty," Carolyn called out, "and I'm just palpating."
''Let me see." Dr. Joseph moved in front of Carolyn, pumped up the BP cuff and listened. "Get the dopler," he said.
The supervisor came in with the medications. "Ready for the
next units?" she asked.
"Lab girl brought them in," Dr. Joseph said. "Get the dopler. We'll amplify the sound of his pressure."
"What's it now?" He looked over at Carolyn. "Let me do that lavage."
"Look," Carolyn said, "five pints of blood in so far and there's no sign of this bleeding stopping." She pulled down an empty unit of blood and hung another. "The human body only carries what? Ten to twelve pints?"
"We'll give twenty if we have to," Dr. Joseph said. "Thirty. What's his heart rate?"
Amy looked at the monitor. "Fifty-two," she called out. "PVC's, lots of irregularities."
"Good thing we don't have other patients down here," the supervisor said, pulling back the curtain. "That's it. That's all the blood there is. We called all over. Red Cross. Other hospitals. Nothing more available in less than an hour." She looked over at the man on the table. His lips were white, colorless. "I'll try again," she said.
Amy glanced at the splattered green walls, the stained ceiling. The floor of the minor surgery room was three layers of sticky towels.
Well, she thought, Christmas week riddle: What's a little eggnog among friends? Answer: soiled death. Sick, she told herself. Stop.
The supervisor turned at the door. "Want me to get the Intensive Care bed ready?" She looked at the patient, then at Dr. Joseph. "He's not going to make it, is he?"
"Found any family? They coming in?" Dr. Joseph asked.
"I called every number I could get from his wallet."
The supervisor shook her head.
Amy looked up at the mahogany-colored stain on the overhead light.
"Why do we do this?" she hissed to Carolyn who stood by her, changing gloves. "Why aren't we all dressed up and selling cosmetics at Saks? Or home with our families? My son would love to see me home one Christmas of his life. Why, Carolyn?''
Looking at the ashen man, Carolyn rewrapped the blood pressure cuff around his arm. "He's like one of the hairs on my own head," she said quietly.
The man on the table stopped breathing as the thirteenth unit of blood was being pumped into the one remaining open vein on the top of his bruised right ankle. In the air of the fetid room hung a familiar silence.
"I gave him all the coagulants known to man, Blakemore, ice lavage, thirteen pints of blood, for Christssake, then a code." Dr. Joseph sat down in the nurses' station. "Let me do the papers."
Amy and Carolyn nodded. They went back to minor surgery and first restocked the CPR cart. Another one could come in any moment, unannounced.
They removed the Blakemore tube from Timothy Whalen's nose, the IV and the bloodlines from his extremities, pulled the dirty sheets out from under him, washed him, and diapered him with five layers of pads. They covered him to the chin with a clean sheet, laying him out just in case someone decided to come in.
Carolyn knelt to pick up a plasticised card from the floor. "From his wallet, I guess," she said to Amy. She held up the card. "'God grant me the serenity-'" Carolyn read. She studied the card a minute. "At least he was trying." She tossed the card into the wastebasket.
After an hour, Amy and Carolyn wrapped Timothy Whalen and moved him down to the morgue. They came back to mop the minor surgery room. Amy glanced at the stains on the ceiling and the upper tiled walls. She tried to ignore the fetid smell. During the day the housekeepers would have to reach the stains. She and Carolyn had cleaned up the worst, but Amy knew the housekeepers would still complain, not knowing what the worst was. Nobody knew about the black shit and old blood of a bleedout. Nobody wanted to know. Amy didn't blame them. She bombed the room with disinfectant spray and closed the door.
About six a.m. Amy and Carolyn moved into the nurse's lounge with their Styrofoam cups of coffee. Bill and Spanky sat in the lounge grinning, their bulky blue jackets across their knees.
"Morning time!" Bill said as Amy and Carolyn eased themselves onto the Naugahyde couch. "We just got back. That guy make it?"
"Nope," Amy answered.
"Didn't think he had a chance," said Spanky. "You know the odds."
They heard the door close as Officer Bancroft came in with a draft of cold air. There was snow on his shoulders and cap. He went directly to the coffeepot, filled a cup and started out the door again with a wave.
"Have a busy night?" Bill called after him.
"Nothing much. A robbery and an assault. Some guy with a tire iron." The patrolman raised his coffee cup and headed out the door. "Got to go. A load of paperwork to do."
"Got a story for you!" Bill said turning to Amy.
"No, I don't want to hear one of your stories," Amy said shaking her head.
"Oh, you'll like this one," Bill said, "it's about a little dog."
"No," Amy said. She took a sip of coffee and glanced at Carolyn who was smiling. "Well, all right," she said, "but be quick about it. Day shift will be in soon."
"Well," Bill said. He paused a moment and glanced at Spanky, who got up to get a cup of coffee. "There's this seafood restaurant down by the docks, and this couple-friends of mine-went down there for dinner. And they saw this little friendly white dog without a collar in the parking lot outside the restaurant. They said to themselves, 'If this little dog is still here after we eat, we'll take him home.'"
"And darned if he wasn't there," Spanky said, coming back to sit down.
"Yeah," said Bill, "so they took him home. My friends already had a cat, but that wouldn't be a problem with such a little dog. So they went to bed thinking they'd take the little fellow to the Vet the next day for his shots and all. In the middle of the night they heard some noise, but they thought that the little dog was strange and he'd be okay once he got used to them."
"Okay, Bill," Amy said, "will you speed this up?"
"Well," Bill said.
"Come on," said Carolyn, grinning. She lit a cigarette.
"Well, in the morning the couple found the little dog frisky as ever. They couldn't find their cat, but they thought he'd just gotten lost out of jealousy. Then they saw there was a great mess of things under the dining room table-small bones and fur-and they got concerned."
"Yeah," said Spanky, "animals get jealous."
"They took the little dog to the Vet and the Vet asked them, 'Where did you get him?' They told the Vet about the seafood restaurant and all. Then they told him about the bones. The Vet looked at them funny. 'This isn't a little dog,' the Vet said, looking at the little white long-haired fellow, 'it's a long-haired Siberian rat.'"
"Must have been a pet of the sailors," Spanky said.
"Get out of here, Bill!" Amy shouted. She leaped to her feet. "Get out of here! Take you, and your stories, and get out of here." She pointed to the door.
"Okay, Aim. See you tonight." Bill laughed as he grabbed his coat. "Come on, Spanky, sun's up."
H O M E