Free from 9/27 to 10/2
by Ketan Desai
Publisher BookSurge Publishing
Published in Literature & Fiction/Action & Adventure, Mystery & Thrillers/Thrillers & Suspense, Mystery & Thrillers/Mystery, Literature & Fiction/Contemporary, Mystery & Thrillers, Literature & Fiction
Free from 9/27 to 10/2
What if Al Queda or ISIS had biological weapons? Find out in Germs of War, a novel of international intrigue, Islamic fundamentalism, and rogue CIA agents.
Dr. Neil Kavesh was dying to yank the tube out of his mouth and take a natural, deep breath.
At 3.45 am on Monday morning, he began to drown. The bacteria, forced into his lungs by the ventilator, had quickly got to work. Five liters of fluid had rapidly entered the doctor’s lungs. None of the sophisticated equipment attached to him diagnosed the internal flooding, reporting only that his oxygenation status was deteriorating.
Dr. Kavesh awoke choking and fighting for his life. The ventilator could not assist him in breathing any more. Identical alarms sounded inside both cubicle four and at the centrally located nurses’ station. Nurses Gibson and Davidson quickly absorbed the information from the silently screaming monitors: a pulse over 100; blood oxygenation of less than 90 per cent and falling rapidly. Oblivious to Nurse Davidson’s sudden appearance by his side, Kavesh began to panic. His eyes snapped open. Sweat began to drench his brow as he tried to suck in more air than the ventilator would allow.
Immediately, Nurse Davidson realized that an emergency situation existed, one that had to be handled by the doctor on call. With equal measures of trepidation and urgency, she lifted the telephone by the patient’s bedside and made a call to the on-call doctor. A sense of frustration rose inside her as several rings passed before she heard the irritated voice of Dr. Calixto Romero.
“Dr. Romero here,” he finally answered.
“This is Sarah. Dr. Kavesh in number four is having trouble breathing. His pulse is 110 and his pulse oxygenation is down to 85 per cent. The ventilator alarm is going crazy!”
Romero gave a long, melodramatic sigh. He cursed this nurse’s gross incompetence. Obviously the patient’s asthma was reactivating.
“What’s his inspired oxygen?” he drawled.
“Sixty per cent,” she replied.
“Increase it to 100 per cent. Also, give him 80 milligrams of Solumedrol.” Nothing that steroids cannot fix, he thought with satisfaction. Good thing they were discovered at Mayo Clinic.
“Will you come and take a look?”
Romero really hated this attitude that some nurses had. It was as if they had to see the doctor stand by the bedside and wave a magic wand over the patient to ward off whatever evil spirits brought them down in the first place. It did not seem to matter if the situation could be handled over the telephone.
“No. If he doesn’t improve, call me back.”
Nurse Davidson slammed the telephone down and rushed off to carry out his instructions.
For a short time, the increased oxygen arrested the speed of Kavesh’s demise. The doctor even managed to fall asleep for a few moments, as more oxygen was able to penetrate the dense mass of fluid occupying his lungs. His respite was short-lived.
Within ten minutes of the ventilator changes, the ventilator’s assorted alarms began sounding again as Dr. Kavesh began to succumb to the suffocation of his lungs. Viewing the monitors with increasing alarm, Head Nurse Gibson rushed to call Dr. Romero, waking him again.
“Dr. Kavesh cannot breathe and all of the alarms are going off. Get here right away!” She hung up before the startled doctor could reply.
Romero leapt to his feet and stormed into the MICU proper. How dare that insolent cow order him around! He swept aside the curtains of cubicle four.
“What the... ”
Kavesh’s dying eyes convinced the resentful doctor of the situation’s legitimacy. Dr. Romero glanced at the ventilator to verify the settings. He saw appropriate rates for inspired oxygen, pressure, and volume. He pulled on his stethoscope and listened to Kavesh’s chest, expecting to hear loud wheezes of asthma exacerbation. Instead, Romero heard nothing, nothing at all. He listened harder - bubbling! The sound of fluid bubbling in Kavesh’s chest.
Impossible! Asthma exacerbation does not produce fluid. Moreover, Kavesh had no history of heart failure.
Romero silently begged an answer from Kavesh’s wide, terrorized eyes. The two men panicked simultaneously.
“Blood count, arterial blood gasses, and electrolytes! Stat! Twelve lead EKG now!”
Cubicle four became a hive of activity as every nurse jumped in to help. Blood was drawn, an EKG performed.
Kavesh’s oxygen saturation continued its rapid decline... eighty.... seventy-nine.... seventy-eight.
The EKG monitor showed an increasingly irregular heartbeat.
Beep... beep.... beepbeep.... beepbeep.
“Give him a double dose of nebulizer!”
Romero remained convinced that asthma exacerbation was at the root of the breathing problems. The fluid would be an enigma to solve later. The nebulizer would have helped if it had indeed been an asthma exacerbation. Five minutes went by. The nebulizer achieved nothing.
The oxygen level in Kavesh’ bloodstream accelerated its free-fall.... seventy.... sixty-nine.... sixty-eight.
Kavesh’s heart began to beat even more erratically!
Beep... beepbeepbeep... beepbeepbeepbeep.
Kavesh lost consciousness.
“Get a chest X-ray!” Gibson half suggested, half ordered.
A digital X-ray was quickly taken.
The results of the arterial blood gas test were the first to come back. Romero looked at them uncomprehendingly. Carbon dioxide normal, oxygen low; entirely inconsistent with a severe asthma attack. In desperation, Romero increased the volume and pressure of the inspired air, hoping that an increase in airflow would somehow remedy the situation. The breathing machine pushed a greater volume of air with a stronger force into the small, remaining lung tissue. It was like blowing air into an over-inflated balloon. The balloon burst.
Oxygen saturation fell into the forties and sank to thirty-nine... thirty-eight.
The heart began to go crazy. It did not like this overabundance of carbon dioxide and lack of oxygen. The rate shot up to two hundred twenty.
“He’s in V-tach! Call a code! Cardiovert him with 360 joules now!” Gibson shouted.
The cardiac arrest crash cart burst into cubicle four. Romero hurriedly activated the cardioverter to charge it. Once ready, he placed its two paddles on Kavesh’s chest.
“All clear!” he warned.
Everyone else stepped back from the doctor and patient. The charge lifted the increasingly lifeless Kavesh clear off the bed’s surface with his arms flailing, like a man drowning at sea. Romero looked optimistically at the monitors. The patient’s signs did not improve.
“Again,” ordered Romero. The procedure was repeated several times.
Romero called out in desperation, “Any other laboratory results back?”
“All electrolytes normal, blood counts normal,” was the quick, anonymous reply.
The answer so baffled Romero that he stood away from the patient’s chest to ponder the situation. Kavesh was not internally bleeding into his chest. Abnormal sodium or potassium levels were not causing his heart to beat irregularly. So, what was it?!
“Give him an ampoule of bicarbonate! Give him lidocaine!” In desperation, Romero threw everything in his armamentarium at the near-dead Kavesh, hoping something would work. Nothing did.
The heart had had enough. The entire staff looked up simultaneously at the EKG monitor as it registered a flatline.
“External pacemakers! Quick!”
Romero tried pacing the heart externally, hoping that it would respond. It did not. It was like flogging a dead horse.
The X-rays, developed from a scanned image and processed within the MICU, were thrust before Romero’s eyes. He refused to believe the evidence before him. Two-thirds of Kavesh’s chest cavity had filled with fluid. His lungs looked as though they were two sponges left exposed outdoors to soak up rainwater. The pathetically small nubs of unsubmerged lung on top could not supply the oxygen demanded by Kavesh’s body.
By failing to consider anything other than asthma exacerbation, by failing to get a chest X-ray sooner, and by failing to remove the fluid in Kavesh’s chest, Romero had sealed his professional ruin.
The ubiquitous, steady tone of the EKG machine doubled as Kavesh’s funeral march. Romero called off the code and officially pronounced Dr. Neil Kavesh dead.
It was 4.15 am.
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Ketan Desai is a physician, entrepreneur, and writer. He writes for Seekingalpha.com and talkmarkets.com