The Edge of Death

The Edge of Death

By John Benedict

 

 

 

CHAPTER 1

Tuesday, 5:00 p.m.

 

Consciousness crept slowly into Nick Chandler’s brain, fingers of awareness snaking into his mind like shafts of sunlight penetrating the morning haze. Here, in the meadow where he lay, there was no time—or pain. He was content to bask in the warm sun and drink in the mingled scent of freshly mown grass and the heady nectar of honeysuckle. Such peacefulness was beyond his experience.

Voices that seemed miles away hummed lightly about his ears. Or was it just the sound of insects flitting about in the hedgerow? The only other sensation he felt was the rhythmic whoosh of air being forced into his mangled chest.

Thoughts began to coalesce, disturbing ones. Questions queued up for attention, threatening to perforate the fuzzy cocoon of his mind. Where am I? What happened to me? Then a stranger thought, more insistent, jumped the line. Am I dead?

Chandler shooed these thoughts away—he didn’t want to deal with any questions right now. Answers usually brought pain and he preferred the tranquil limbo of his nonexistence. But one question buzzed back, like a pesky horsefly, refusing to be ignored: Was this what it felt like to be dead? He couldn’t be sure—and, he realized, he didn’t care. Deep down, though, he remembered that people were supposed to care about such things.

He sensed that something was different about him, changed somehow, though he couldn’t put his finger on it; the feeling was way too vague. But he knew he was right.

Chandler sighed. Too much work for now—he was bone-tired. Besides, the sunlit meadow beckoned. He let his mind submerge again, bobbing just beneath the surface of consciousness.

An unknowable amount of time passed as Chandler drifted in and out, until the buzzing returned and grew louder, finally nudging him awake. He sensed other people around him, picked up bits of conversation.

“ . . . congestive heart failure secondary to viral myocarditis . . .”

“ . . . overwhelming sepsis with full-blown ARDS . . .”

“ . . . multi-system organ failure with progressive renal and hepatic shutdown . . .”

Later an older male voice, deep and resonant with a professorial tone, commanded his attention. “Lauren, bring us up to speed on what happened yesterday.”

Chandler struggled to focus and stay awake to hear this part; the meadow would have to wait.

A young female voice, crisp and assertive, answered. “He coded around noontime and we consider it a miracle that we brought him back in the first place. An hour later, though, he arrested again and this time we couldn’t get him back. He was pronounced dead. He was then rushed to PML.”

“You mean Dr. Mueller’s lab?”

“Yes. The postmortem lab.”

“I assume you are all familiar with Dr. Mueller’s groundbreaking research into resuscitation science?” the professor said, garnering quiet murmurs of assent. “Go on, Lauren.”

“The patient was immediately placed on full cardiopulmonary bypass. His heart was stopped with a hyper-cool cardioplegic solution, ultra-low oxygen therapy was instituted, and a slew of cerebral protective drugs and antithrombin agents were administered. After twenty-four hours of this treatment, combined with sufficient resting of the myocardium, they attempted to restart his heart. Amazingly, after several countershocks, his heart resumed beating and he was soon transferred here to the ICU. The patient hasn’t regained consciousness, though.”

That certainly answers a lot of questions, thought Chandler. Carol Sue was right about the virus—should’ve listened to her. And now that they mentioned it, he did remember signing some weird form dealing with resuscitation. It was from the Buchanan Med Center Bioethics Committee and was so chock-full of legalese, he hadn’t been able to make heads nor tails of it at the time. But the gist of it was, if any of it came into play, you were basically fucked. And by signing it, you had just helped the hospital install an ironclad covering for their collective butts.

He had been so sick when he was admitted that this particular form and all the others he signed had been a complete blur to him. Except now, he could call to mind clearly the five-page experimental resuscitation protocol that dealt with the Mueller lab. He could page through the sheets in his mind, backward, forward, and zoom into any paragraph for a closer look. He had no idea how this was possible.

The professor spoke again. “So, what is his prognosis at this point?”

Prognosis? The word was delivered with such grave overtones. Again, Chandler fought off a wave of drowsiness.

“The patient is basically terminal and will be lucky to survive the night,” Lauren answered, delivering her clinical assessment with a tasteful touch of sorrow.

Talk about your good news-bad news. He wasn’t dead, but it didn’t sound like he had long to live. Except again, Chandler knew they were wrong, as they’d been about the consciousness part. He couldn’t say how he knew, or why, just that he felt certain. But what was it the perky med student, Lauren, said? She considers it a miracle that I’m still alive. A tiny smile curved his swollen, cracked lips and pulled painfully at the tape holding his endotracheal tube in place. Miracle might not be quite the right word for it, he thought, drifting back down into the narcotic haze of the soft meadow.

 

CHAPTER 2

Tuesday, 11:30 p.m.

 

Many hours later, Nick Chandler floated in that peculiar void between consciousness and dreaming, the drugs coursing through his veins only heightening the strangeness of the experience. His last intact memory played images through his mind. The fact that he recalled the exact details of that night, right down to the vibrant colors of Carol Sue’s tattoo, went unnoticed.

* * *

Halfway through his graveyard shift, on a night that seemed as ordinary as countless nights before, Nick pushed his cleaning cart out of the ICU room, being careful not to bump the doorframe with the various mops and brooms bristling from his cart. He shook his head. The room still stank of death, despite all the industrial-strength cleaners he had used. He was happy to leave.

Nick yanked off his mask and cap. Fresh air never tasted so good, he thought, peeling off the flimsy yellow gown and the latex gloves and chucking them all in the trash bin outside the room—the red plastic one with the biohazard label on it. The laundry bag hanging off the back of his cart was filled to the brim with dirty rags; better take care of those.

Nick made his way down to the hospital basement and navigated the twisty corridors to the laundry with ease, something he hadn’t done two years ago, when he had first started working at the med center—he used to get lost down here all the time. Now, he knew the layout well—past the MRI machines with all their funny magnet signs, and past the CAT scanners.

Nick hoped the laundry room would be empty, but his luck was not that good; several other members of the janitorial staff were taking a break, or trying to hide from their supervisors. Carol Sue was there. So was Nasty Mike Kuzmich. Both were seated on plastic crates tipped upside down on the dusty floor, puffing away on their beloved cigarettes.

“Hey Nick,” Nasty Mike said, sniggering. “What you got there? A full load? Three bags full?”

“No,” Nick said, “just one bag.”

Nasty Mike snorted loudly and started laughing.

“Don’t pay him no mind, Nick,” Carol Sue said before taking a long drag on her cigarette.

Nasty Mike continued as if she hadn’t spoken. “Fuckin’ moron!”

Carol Sue belted Nasty Mike across his upper arm. “Shut up,” she said, and made an ugly face at him.

Nasty Mike frowned and rubbed his arm for a moment. But he wasn’t done.

“What’s that smell?” Nasty Mike stood and scrunched his nose up something fierce. “What’s that god-awful smell?”

“Leave him be, shithead,” Carol Sue said. She got up and walked over to Nick. He watched the bright pinks and greens in her Tinker Bell tattoo slide in and out from under her sleeve as her arm moved. Carol Sue’s teeth were yellow and crooked, but he liked her and thought she was pretty, with her long black hair.

“Maybe you oughtta throw that stuff in a hazardous waste box,” she said, eyeing his laundry bag. “It does stink,” she added in a soft voice that only he could hear.

“Okay,” Nick said. He looked around the room, then pulled a large flattened cardboard box off a stack in the corner. He tried to fold the preformed cardboard piece into a three dimensional box, but all the confusing flaps and arrows quickly turned into a jumbled mess in his mind. Carol Sue reached out to help him.

“Let me be,” Nick snapped at her. “I’ll do it myself.”

Nasty Mike was staring at him. Nick felt his face heat.

“I seen it all now,” Nasty Mike bellowed, shaking his head. “Outsmarted by a fuckin’ box!” Nasty Mike bent over and mashed his cigarette in his Pepsi can. Then he looked straight at Carol Sue. “Just like I said, sweetcakes—a fuckin’ moron.”

Carol Sue glared at him. “You’re the moron. Now, get the hell outta here.” She pointed to the door.

“Don’t worry, I’m leaving.” Nasty Mike walked toward the door, bumping into Nick on his way. As he reached the door, he called back over his shoulder, “Bitch!”

Carol Sue turned to Nick. She had a nice smile on her face and touched his arm. “He’s such an asshole. Forget about the box, Nicky. Those buggers can be tricky.”

Nick felt ready to cry. He bit his lower lip.

She looked again at his cart and her smile faded. “Were you cleaning that room?” she asked. “The filthy ICU room with the patient who died? The one with the horrible smell?”

“Yeah, they told me to,” he said meekly.

“You washed your hands, right?”

Nick looked at the floor. “I was about to,” he mumbled. “I wore gloves.”

“Shit,” she said, shaking her head and looking plenty worried. “Go wash your hands. Now! And use the goddamn disinfectant.”

Nick went over to the sink. “There was some serious bad shit in that room,” Carol Sue continued, watching him wash his hands. “When you get home, take a good shower. Don’t forget, now.”

“I won’t,” he said, keeping his face turned away so she wouldn’t see the tears.

 

CHAPTER 3

Wednesday, 11:45 a.m.

 

Tequila. What a cool name. He liked saying it—almost as much as drinking it. Chip Allison poured another shot glass full of tequila—his third, or maybe it was his fourth. But who’s counting, anyway? No, this wasn’t your Don Julio Anejo tequila, the stuff his dad liked to drink, aged for two years in oaken barrels and poured from the neat bottle with the fancy wooden stopper. And no, this wasn’t even Jose Cuervo Especial tequila. Rather, this was the cheapest rotgut money could buy, complete with the chintzy metal screw cap.

Of course, let’s be honest here. Honesty is the best policy, right? He wasn’t really drinking it to savor the flavor. That much was clear. And who gives a flying fuck that it’s only twelve noon. There was a celebration going on here—his twenty-third birthday—so he had every reason to get hammered. And as long as we’re telling the truth, it’s not really a shot glass, either. It was one of those mega shot glasses. You know, the three or four ounce jobbies—the true volume of which, only God Almighty knew.

He spilled a little tequila on the dingy white Formica countertop. Shit. Can’t even do that right. But then, just as quickly, he came to his own defense: Wait, hold on—no worries. Just a smidge, no need to panic. His mom liked that word—smidge, that is, not panic. Short for smidgeon—whatever the hell that was. Although, truth be told, even dear old Mom wasn’t too happy with him nowadays.

Retrieving a soggy washcloth from the pile of dirty dishes overflowing the sink, he swabbed up the spilt tequila. There, clean as a whistle. He tossed the rag back toward the sink.

Movement caught his eye and he peered out the little window of his third floor apartment’s kitchenette, eyes following a sparrow fluttering down to join several others hopping around in the brown grass of his tiny backyard. Geez, when had the grass gotten that brown?

An unexpected wave of sadness came over him as he remembered when things had been different. Very different, in fact. Everything had been going well—really well—until that awful decision involving Michelle six months ago. How could he have been so stupid as to believe her? Was it really possible to fuck up your life so badly in such a short time? This line of questioning never failed to make his head hurt.

Out in the living room, Frodo was talking worriedly to Gandalf. Commercial break was over. Drink in hand, he sauntered back into the room and plopped down on his worn sofa, not five feet from the boob tube. The taco chips were there waiting for him. Salt always went well with tequila, right?

He checked his watch. He had to be at work in . . . let’s see . . . nine hours. Or was it eight? His subtraction skills were sub-optimal at the moment. Taking a siesta. Wasting away again in Margaritaville. Whatever. Plenty of time. He had experience in these matters. Besides, how alert did you have to be to watch the stupid cardiac monitors in the ICU? The newer computer-driven monitors had sophisticated dysrhythmia detection algorithms that rarely missed identifying a dangerous rhythm and then sounding the alarm.

Chip plucked his iPhone out of his pocket and set the alarm. Couldn’t afford to be late for work; he’d never get back into med school that way. So responsible . . . Dad—or should he say the great and fearless Colonel Allison—would be proud. He was always big on responsibility. And integrity. Which explained why he was so disappointed when he found out about his delinquent son.

Chip tried hard to get his dad’s face and stinging words out of his mind. Luckily, just then, the black riders rode across the screen, snorting and wailing, gnashing their teeth, blood dripping from their foaming mouths as they galloped down the road toward the Shire. Chip sat there mesmerized, crunching absently on some chips. Usually, he really liked this part of the movie. Today, however, Chip shuddered a little as he imagined the riders were somehow coming for him. He drained the tequila.

CHAPTER 4

Wednesday, 11:45 a.m.

 

The late-morning sun eventually cleared the nearby building and light poured in through the venetian blinds, bathing the ICU room in a garish, almost phosphorescent light, rousing him awake. Chandler squinted hard and cursed at the painfully bright horizontal stripes. But he quickly retracted his curse. The light was a wonderful thing, after all; it meant he had survived the night, something his good doctors had thought unlikely. Somewhere between his last conscious period and now, he’d discovered a will to live.

Chandler took inventory of his body. His heart had been ravaged by an especially virulent infection that had started it all. What had they called it—a viral myocarditis? They’d said his heart was ruined. Except he detected internal evidence that his immune system was rallying, locking onto the viral protein coat and taking out the virus. He could tell his heart was on the mend.

Similarly, his lungs were repairing themselves, the damaged capillaries starting to shore up their leaks and the oxygen exchange steadily improving across the delicate alveolar membranes. As the extracellular fluid diminished, the compliance of the pulmonary tissue improved, thereby decreasing the need for high pressures to ventilate him. Soon, he knew, the ventilator would not be necessary. His kidneys and liver were also responding to the improved cardiac output and no longer spiraled toward total shutdown.

He could see all these changes in his body as he had never seen before. How was that possible? He certainly wasn’t a doctor. Besides, even a doctor couldn’t see the inner workings of his own body. But it was more than that. He sensed that his brain was somehow directing these wonderful changes, manipulating his autonomic nervous system to improve blood flow here, tweak perfusion there, in a kind of intelligent design approach to healing by following the innate blueprints of his body, right down to the cellular level. Again, he sensed this was all a manifestation of the transformation he had somehow undergone.

The urge to sleep came over him again, but he resisted. He knew their goal was to keep him sedated, and to that end, he was on round-the-clock narcotics and a propofol drip. He’d have to deal with that before long.

He heard people entering his room and was careful not to open his eyes; no need for them to know he was conscious just yet. He was beginning to connect names with the voices. The attending doc, cardiologist Dr. Leffler, was speaking.

“Gorman, why don’t you examine the patient and tell us all where the endotracheal tube is, instead of cutting corners and just saying it’s in good position. Good for what? Medicine is not a field for sloppiness, young man.”

One of the med students, presumably Gorman, leaned in close to him. Chandler felt a slight touch on his lips, then his tube was jostled a bit. He struggled to remain still and fought back an overwhelming urge to gag.

“Tube’s at twenty-two centimeters at the lips,” Gorman said, adding with a hint of irritation, “Still in good position.” But the next part was not spoken aloud. Chandler saw the words form clearly in Gorman’s mind, then heard them just as plainly in his own: Doesn’t really matter where the goddamn tube is, now, does it, Leffler, you frickin’ asshole! This guy’s toast! This surprised Chandler so much that his eyes almost flew open.

When Gorman stepped back to join the group, the connection was broken.

 

 

Dr. John Benedict, husband and father of three sons, graduated cum laude from Rensselaer Polytechnic Institute and entered post-graduate training at Penn State University College of Medicine. There, he completed medical school, internship, anesthesia residency and a cardiac anesthesia fellowship. He currently works as an anesthesiologist in a busy private practice in Harrisburg, Pennsylvania.

To learn more, please visit the author's website at www.johnbenedictmd.com

 

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Tag der Veröffentlichung: 09.03.2014

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