I sat back, looked ten thousand miles through the front windshield, and took a deep breath. "Yes, Charlie, I hear her."
Charlie nodded and handed me the keys. "I hope so." He looked out the window and crossed his arms over his chest. "For your sake, for that little girl's sake, and for Emma's sake, I hope so."
Chapter 34
he sound of breaking glass jolted me off the pillow. "Emma?!" I looked toward the kitchen and the sound.
"Emma?!!"
I heard a rustling, and then a muted moan. Emma was lying faceup on the kitchen floor, her nightgown twisted around her. Her eyes were open, and she was gripping her chest. Her face was a picture of excruciation. I hit my knees, felt her carotid and distal pulse, and knew she had about three minutes before her heart stopped.
"Charlie!" I screamed out the back porch while digging through the drawer of kitchen utensils. "Charlie! Call 911! Charlie, call 911!"
If I was to give Emma any chance whatsoever, I had to alleviate the pressure on her heart. The only way to do this was to draw off the blood, and the only thing I had that would do it was the meat injection syringe in the kitchen utensil drawer. I found the sixinch needle, the width of a pencil lead, screwed it onto the syringe itself, and kept screaming for Charlie the whole time. Emma's eyes had closed, and her carotid pulse told me her systolic pressure was now less than 80. She was unconscious, from either the pain or the lack of blood flow, but that was good because I didn't want her to remember what I was about to do. I turned the Oz canister on Full and ran the tubes to her nose. Her neck veins were bulging, meaning pressure was backing up in the system.
At this point, the brain-damage clock started ticking. I spread her out flat on her back, stretched her limp arms above her head, angled the needle, and pressed it into my wife. The tip pierced the pericardium; I drew on the syringe, started the flow, and unscrewed it from the needle. The result allowed a free-flow stream of oxygen-depleted blood to spray across me and the opposite kitchen wall. Almost a liter of blood painted the kitchen walls and floor before the flow slowed and began to pump with the now-regular beat of Emma's heart.
As the pressure subsided and the flow continued up her throat, Emma's eyes opened. This did not mean she was necessarily conscious, but it did mean that oxygen was reaching her brain. If I could get to her heart, sew up the hole, and Life Flight got here in time, we could make it to the hospital, where I could place Emma on a machine that would keep her alive for twelve hours while we found a heart. It was all possible.
I never doubted. I had done it a hundred times. All I needed was enough fluid and to keep one lung expanded and her heart pumping. I looked her in the eyes and said, "Emma, I'm here. Stay with me."
She nodded, closed her eyes, and faded again.
Charlie rushed in with a cell phone held to his ear, and his eyes grew as wide as silver dollars. "What are you doing?!"
I cut him off. "She's okay, but we've got about two minutes."
As his eyes scanned the scene in the kitchen, he screamed wildly into the cell phone for Life Flight.
I put my finger over the end of the needle, stopping the flow, hoping to force some volume out into Emma's body, and said in as calm a voice as I could, "Charlie, IV fluids and toolbox in the trunk."
He looked at me, unsure whether I was helping or hurting. I said it again, calmly, "Now, Charlie."
Charlie flew out the front door, emptied the trunk, and came tearing back into the kitchen. As he did, his heels hit the wet, slippery blood on the linoleum and sent him airborne five feet. His feet flew toward the ceiling while his head aimed directly for the doorjamb. Rather than protect his head, Charlie consciously cradled the fluids in his arms and broke his fall with his head. He should have been out cold, but the adrenaline kept him going. He sat up, turned his head as if he were trying to see with one eye, and held out the IV fluids.
I rigged a drip, handed it to Charlie, and said, "Squeeze this as hard as you can."
I pulled an intubation tube from the emergency kit I kept at the house and ran it down Emma's throat, clearing the airway.
Charlie wrapped his strong hands around the IV bag and began force-feeding the fluid into Emma's heart. His gaze was lost somewhere above her face. As he pumped fluid into her arm and, hence, her heart, the fluid coming out the end of the needle turned pale, and at times, clear.
"Razor blade and wire cutters," I said to Charlie.
Charlie dug one hand through the tool bag and came out with a large pair of Channel Lock wire cutters and a box of regular razor blades.
I turned Emma on her right side, stretched her left arm over her head to pull apart her rib cage, and switched the Plasmalite bag for Charlie. Just before I cut her I looked at Charlie and said, "Turn your head."
He said, "Do what you got to do."
I handed him an eight-ounce bottle of Betadine from the kitchen counter, held out my hands, and said, "Cover me."
Charlie did as he was told and painted my hands and forearms brown. I smeared the over-pour across Emma's chest and ribs and then had Charlie douse the razor blade. Timing my touch with Emma's inhalation, I felt for the radial pulse. It disappeared completely when she breathed in, a symptom called pulsus paradoxus- meaning "paradoxical pulse."
I pulled the pouch from my pocket, threaded a needle, and laid it across Emma's bare chest. Then I cut an eight-inch incision horizontally between ribs four and five, snipped a six-inch section of the rib with the wire cutters, and placed a rolled kitchen towel at either side to both sop blood and hold the ribs apart. I sliced the pleura-the sac that holds the lung-deflating the lung, and pushed it out of the way. I reached in, saw the pericardium, touched it with the tip of the razor, and blood and water flowed.
Peeling away the tough sac exposed Emma's heart and showed me what I was looking for-a transmural rupture. I stuck my finger in the hole, stopping the flow. The heart had begun a ventricular fibrillation. In short it's called V-fib, meaning it had stopped beating and was now quivering. This was both bad and good. Bad in that it had stopped beating, but good in that it would be easier to sew and wouldn't need much help to get going again.
Charlie had emptied his second bag and figured out how to rig the third himself. He closed his eyes and squeezed his palms together, his neck straining under the pressure. He was in pain, the back of his head was bleeding a good bit, and he was both screaming and crying at once. I couldn't tell if his body hurt, his heart hurt, or both.
I placed my flashlight between my teeth, pointed it inside Emma's chest cavity, and stitched an eight hole purse string-a stitch that does exactly what it sounds like. When I pulled it closed, the tissue tore in three places, so I had to reach farther across the tissue of her heart and start over. I pulled again, and it held.
Something outside of me told me I was hearing a helicopter, but whatever it was lied to me. With the stitches holding, I reached in and palpitated Emma's heart with my hand, easy at first, then harder. That's when I realized she had quit breathing.
No problem, I told myself. Sometimes the body just needs reminding. With my hand still palpitating her heart, I breathed forcefully through the intubation tube and filled Emma's lung. The heart took its cue and began beating on its own. I pulled my hand out, Emma breathed by herself, and I checked the carotid pulse. Low but present. The clock was ticking. We were only seconds ahead of the Reaper, but we were ahead.
Charlie finished his third bag, and we were still a long way from getting to the hospital. I propped Emma's feet up, hoping to drain whatever fluid I could into her chest, and checked her pulse again. This time there was none. I turned her again, massaged her heart, and kept breathing into the tube coming out her mouth.
Charlie was covered in red, screaming at the top of his lungs, and looking toward the ceiling. Whatever he was looking for, he couldn't find. Inside myself, I knew we still had time.
As I was leaning over to breathe again, a young paramedic dressed in blue and wearing rubber gloves came flying throu
gh the front door. He looked at me, saw nearly five liters of blood and fluid splattered and puddled across the kitchen, and his jaw dropped.
I screamed, "I need two pads and charge to 200! Now!"
He shook his head as if dazed.
"Charge to 200! Now!"
The paramedic dropped his bag, pulled out two pads attached to long wires, and stuck them to Emma's chest and back. I massaged, breathed again, and he charged the machine. When the green light told him we were go, he said, "Clear!"
I pulled my hand, and he shocked Emma. Her body stiffened, relaxed, and I felt for a pulse. Nothing.
I reached in his bag, pulled out what I needed, and said, "Highdose epinephrine! Shock at 300!"
The paramedic, now joined by the driver, had connected a fresh IV bag and was continuing to force-feed Emma. He did as he was told. I expunged the air bubbles, slammed the syringe into Emma's heart, shot in the entire dose, and pulled my hand away. The paramedic yelled, "Clear!" and I watched Emma's chest rise and fall.
Nothing.
"High-dose epinephrine and shock at 360! "
"Clear!"
Nothing.
Charlie began screaming, "Emma! Emma! Emma!"
I looked at the paramedic and screamed, "Shock at 360!"
He said, "But sir . . . "
"Shock at 360! Now! Do it now!"
He looked to his partner, who had quit squeezing on the bag and was just looking at me.
The driver said, "Sir, the patient is asystolic. By protocol, we're in the V-fib algorithm and-"
I grabbed him by the throat and squeezed as hard as my hand would allow. "The patient is my wife! Charge and shock at 360!"
I shoved him out of the way, charged the machine, shot in more epinephrine, and shocked Emma at 360. She convulsed one last time, her arms twitching almost as if she were hugging herself or trying to keep warm, and fell limp.
I was charging the machine and pounding on Emma's chest with both my hands when Charlie tackled me off her, slamming me to the floor and sliding us across the linoleum where he pinned me and held me down.
I fought to free myself from Charlie's grip, but no matter what I did, I could not get him off me. He buried his head against mine and screamed, "Stop it! Stop it! You hear me? She's gone! Reese, Emma's gone!"
The words reverberated in my head without meaning.
The paramedic walked out of the kitchen, talking into his shoulder radio. "We've got a situation here. I've never seen anything like it. The patient's thoracic cavity is cracked open ..." He lowered his voice. ". . . with hand tools, kitchen utensils ... via the rib cage. We've given high-dose epinephrine-intracardiac, shocked each time to 360, and ..." He paused and looked back into the kitchen. "She's not coming back."
For several minutes Charlie and I lay on the floor, Emma's head on my chest. I didn't know anything was wrong with Charlie until he pulled his face close to mine and said, "Tell me what this looks like. I want to know." That was the last image Charlie ever saw.
An ophthalmologist later confirmed that when Charlie had fallen, he detached his right retina and injured the left. If he had stopped there he'd still be able to see out of one eye, but as he squeezed and strained to push fluids into Emma's body, he saw the curtain come down over his left as the other retina came fully detached.
The paramedics gave a full report of my heroic attempt to save Emma's life. Several hospitals heard about it and sent doctors to interview and research. In a vain attempt to exonerate me, the professionals in my field coined what happened that day the Mitch Procedure. Three years ago I read in Chest that an unnamed doctor in Atlanta, Royer no doubt, had hired lawyers to remove a description and accompanying history of the Mitch Procedure from all future medical textbooks, citing inconclusive evidence.
He was unsuccessful.
Chapter 35
t was midnight when the rains came down in force. The winds blew in first, rattling the house; then the lightning lit the night sky like an angry woman shaking her fist. I stood on the porch, face hovering over a cup of tea, watching the wind tear at the trees and water. I looked across the lake and in the lightning flashes saw Charlie's dock. I strained my eyes against the nowsideways rain. What I saw did not surprise me.
Charlie stood on his dock, dressed in boxer shorts and skin, facing the rain. The waves were crashing against the corner dock post and soaking him from the waist down. The rain took care of everything else. He was dancing in place, waving at the rain, and his face was upturned, scanning the sky for lightning. Every time it cracked a tree and sent flames skyward, Charlie roared in delight, threw his arms in the air, and screamed at the top of his lungs.
"Hah! I saw that!"
The thunder rocked again.
"Hah, hah! I can see! I can see!"
Lightning cracked again, this time longer with five or six flashes. It hit another tree nearby, and the percussion sounded so loud it rolled through the house like an earthquake. Charlie stepped nearer the edge of his dock. The wind whipped through our cove and pulled at him; he wrapped himself in its arms and danced with the storm.
Lake Burton is known for its violent storms that pass as quickly as they come. The storm cracked another time, then blew northward and, like a jealous lover, left Charlie standing alone and mostly naked on his dock. Georgia came running out of the house, whining, licked his shins, and the two climbed up the walk to his house. Dance over.
In the quiet that followed, the slow, mournful melodies of Charlie's harmonica filtered through the leaves and cried a lonely tune. Charlie was the eternal optimist. Life was always sunny, always half-full, but at times his soul cried. And when it did, it did so through that instrument. If you wanted to know what he was really feeling, what his heart might say, you needed to listen to him breathe through that harmonica.
I walked down to the dock, stepping over fallen limbs and more leaves than any backpack blower could handle. Across the lake, the shoreline was spotted with an irregular pattern of house lights, suggesting that the power was out up and down the lake. The water had returned to its dormant, black-glass state. The clouds had blown through, ten billion stars shone down from above and, east over my shoulder, a lazy half-moon appeared. It looked like it had kicked back and was watching a ball game.
I sat down in my favorite chair, an Adirondack, propped my feet up on a makeshift ottoman-a planter holding no plant-and leaned my head back. The storm had cooled the night air, but it was not cool. Sort of a warm summer blanket that you didn't mind wearing.
I thought of Royer, his kindness, and how much I missed him. Of working alongside him in the OR, discussing cases, sharing successes. Together, we were good.
I thought of Annie, her cough, the purple beret that was too big, her yellow dress and Mary Jane shoes, the water jug that was almost full, and her gentle, trusting eyes.
I thought of Cindy, the weight on her shoulders and her outer frail facade that was so close to cracking. I didn't know how much longer she could keep it up.
Then I thought of Emma and how much of her I saw in Annie.
"Son of David," I whispered, "I want to see."
Chapter 36
ike the scalpel I was so accustomed to working with, Emma's death severed me. I watched my heart roll through the dirt like a discarded piece of rotten fruit, beating outside myself.
My whole life, everything about my existence, had led to one singular moment, but that moment had come and gone and left me alone. All my preparation had been in vain.
I wanted nothing to do with medicine, with surgery, with my past, or with sick and hurting people ever again. I tried to forget all I had learned, all I had become, all the faces and hearts I had helped heal, to push Delete and blank the tape that had become my mind and walk away.
After the funeral I packed one bag, listed our Atlanta penthouse with a Realtor, called the Vietnam Veterans to pick up anything they wanted, and drove north. Somewhere around the 1-285, I threw my pager out the window. Another few miles and I to
ssed out the second. Once on State Road 400, I pitched the first of the cell phones into oncoming traffic, where a semi-tractor flattened it. Soon I followed it with Emma's cell phone, which hit the asphalt and shattered into pieces. When I got to the lake, I walked to the end of the rickety old dock and threw my second, and last, into the water.
Hours later, I walked into the house and unplugged the ringing phone. I looked around, locked the door, and drove out the driveway.
Eight months later I returned. I can't really tell you where I went. It's not that I'm ashamed, but rather, I just don't remember. On more than one occasion, I had to look at the cover of the phone book just to tell myself what city I was in. At one point in the first couple of weeks I remember looking down at the odometer, and five thousand miles had clicked by. Three months later, the trip set had turned over, and I calculated the mileage at around fifteen thousand.
A couple of things stand out. I remember seeing the Atlantic, I remember seeing the Canadian Rockies, I remember seeing the Pacific, and I remember being encouraged to turn back at the Mexican border. Other than that, I can't tell you much. I guess my credit card and ATM receipts would tell the real story.
When I finally showed up at the lake, Charlie was just returning from a "school" where they teach blind adults how to live after losing their sight-most by violent accidents. We walked around each other for a couple of days like the same ends of two magnets turned to repel rather than attract. It's not that we didn't want to talk, we just didn't know how or where to start. I mean, how do you talk to the brother of the wife you couldn't save?
Finally he just walked over, put his hand on my shoulder, and said, "Reese, you're the greatest doctor I've ever known."
Maybe that hurt most of all. I hugged him, we cried some, never really said more, and then just started picking up the pieces, which by that time had scattered all over the place. Every now and then we'd find one. Still do. Sometimes together, sometimes alone. Building the house, the boathouse, and then boats just became our own group therapy. We've been regular attendees ever since.