It is natural law that all complex systems move from a state of order to disorder. Stars decay, mountains erode, ice melts. People get off no easier. We get old or injured and inevitably slide right back into the elements we were first made from. The organized masterpiece of conception, birth, and maturation is really only two steps forward before three steps back, at least in the physical world. Sometimes when Charlotte lost a patient she thought about that and found it comfortinga reminder that she hadn't failed in what was ultimately an unwinnable game. But if she thought about it too long, she had to wonder if her entire medical career was an interminable battle against the will of the universe.
She resisted sinking into such rhetoric the night Jane Doe was whisked across Puget Sound in a medevac helicopter to Beacon Hospital's intensive care unit, to Charlotte. It seemed they always came in the middle of the night, the ones from the more remote hospitals on the Olympic PeninsulaWest Harbor and Forks and Port Townsend. Charlotte could picture some overwhelmed doctor reaching his breaking point too many hours before the next sunrise, dreading a night of slumping blood pressure and low oxygen levels and erratic heart rhythms, finally picking up the phone to plead the case for a flight to Seattle. Not that anyone had to plead; they were never turned down.
Charlotte had her own survival plan for these long nights on call: get the critical facts over the phone, tend to the crises of her eleven current patients before the new one arrived, grab a Diet Coke and some Oreos from the vending machines, a blanket out of the warmer at the nursing station, then tuck into a ball on the love seat in the ICU's waiting room and listen. Listen for the chop of the helicopter blades, the rising pitch of the engine as it settled onto the roof with its cargo of impending death. Listen for the buzz of an elevator being held open, the swish of the automatic doors into the ICU wing. Sometimes the next sound was a "code four" alarmsomeone who'd clung to breath all the way over the peninsula, the islands, the bay, giving up just when the medical mecca was reached, as if a glimpse of heaven in flight had convinced them to move on. Most often the next sound was her pager, confirming the patient had arrived. And then Charlotte was up, the blanket dumped in the hamper and her white coat buttoned.
She made her first assessment before she was even through the patient's doorway: weight, age, the color of the skin, the shade of the bruises, the number of tubes snaking from the body, sucking fluid away, pumping fluid in. By the time she was at the bedside she was ticking off which invasive lines would have to be removed, replaced, inserted.
Jane arrived just after 3:00 a.m. with no fewer than five tubes: one down her throat, another in her neck, two in her left arm, and one looping from her bladder. Jane's arrival was heralded by pages and alarms and a scrambling of personnel that stopped just shy of a code four. She came with a four-inch stack of medical records, a splint on her right arm, a scaffold of hardware stabilizing her right lower leg, and so much edema that her skin was pocked with the medic's handprints. But she did not come with a name. Not her own name, at least.
The medics rolled the orange transport gurney next to the bed and, smooth as a dance, coiled up all the lines and logrolled Jane onto her side to slip a plastic board underneath her. Charlotte stood at Jane's head and Anne, the nurse, held Jane's feet. On the count of three all the lines and tubes and wires and the sodden, bruised flesh of Jane Doe slid onto the clean white sheets of the bed that would become her next home. The medics talked while they moved, disconnecting the portable monitors, locking down the empty gurney. "Pressure dipped to seventy after takeoff so we upped the dopamine. Had her on a hundred percent O2 halfway across to keep her saturation above ninety." The taller of the two handed Charlotte a clipboard to sign, looking more relaxed now that Jane Doe was hooked up to the hospital's equipment and off his hands. They had met before, on some other transfer, though his name tag was half-covered by the bell of his stethoscope and Charlotte couldn't recall it. He tapped the stack of chart notes he'd brought. "I wasn't sure she was even going to make it across.".
Excerpted from Gemini by Carol Cassella. Copyright © 2014 by Carol Cassella. Excerpted by permission of Simon & Schuster. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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