Critical Care (28 page)

Claire fought the image of Kevin's face, his suffering in that
trauma room, and the unbearable memory of how helpless she'd
been to save him. And now she was expected to ...

Calm down. Claire breathed through her nose, willing her own
pulse to slow and her shaky hands to steady, reminding herself
that Sarah's condition had improved. That in fact she had been
stabilizing. Logan would never leave her bedside if she were still
in danger. Wrong. Dead wrong. Claire's stomach sank. Logan left
because he had no choice, because he had another critical patient
coming in. So he chose to trust Claire. With Sarah's life. Trust this
pathetically weak link.

Claire's gaze darted toward where Erin, Logan, and Keeley were
working on the cardiac patient some twenty yards away. Even from
here, she could see the anxiety on the new nurse's face as she struggled to follow Logan's rapid-fire orders. It had to be a nightmare
situation for a nurse who'd been out of commission for months,
caring for a dying sister. Keeley was good, more than good, but she
was recovering from a tragedy. Claire knew that feeling only too
well. Even two years after Kevin's death, the Sacramento physician's overbearing criticism was branded into her memory. And
today was a nightmare day for everyone. Especially Sarah. A dedicated nurse on her way to work in this very ER, waylaid by a tragedy she could never have imagined.

Claire checked the overhead monitor again, quickly noting
Sarah's heart rhythm and oxygen saturation, and watched the drip
rate of the IV solutions before glancing back down. Though Sarah's
face had been cleaned, there was still dried blood in her nostrils
beneath the prongs of the translucent green oxygen cannula. Her
forehead and the bridge of her nose had swollen, and below the
thick gauze bandage wrapped around her head, her left brow was
already eggplant purple. She looked battered and fragile and achingly childlike. Claire's heart tugged, remembering the toughcookie impression she'd had of this hardworking young nurse that
first day they'd met at the CISM interviews. Sipping her Diet Coke
and shrugging. Then dismissing the incredible pain of her day by
saying, "I'm a nurse. I do what needs to be done. Then I come back
the next day and I do it all again."

Claire moved forward as Sarah opened her eyes and attempted
to speak.

Her weak voice was interrupted by shallow breaths. "Please ...
tell ... him . . ." Sarah's eyes, startlingly blue against her too-pale skin, drifted upward, then focused again. Her lashes fluttered and
she licked her lips, tongue touching the tidy sutures Logan placed
at the corner of her mouth. "I'm so ... sorry."

Claire leaned close. "Who? Tell who?"

"Logan." Tears welled in Sarah's eyes. "Tell him ... I . . .
tried ..."

Claire's brows drew together with confusion. "What?"

Sarah moaned. "Couldn't ... sleep. Bad nights." She gulped
a breath and her eyes opened wide. "I tried ... to get here. Can't
be ... late. Tried ... so hard. The pills ... shouldn't have . . ." Her
tears spilled over as a ragged sob left her lips. "I'm ... sorry. Tell
him that ... please. I let Logan down."

Let Logan down? Claire blinked with disbelief. She gently stroked
Sarah's pale cheek. "Don't worry. Oh, sweetie, don't worry about
anything like that. All that matters now is that you get well."

Claire drew back, acutely aware that Sarah's breathing had
become labored. Far more labored. Like a fish flopping on a riverbank. Gulping, struggling. And not only because of the emotion
and tears. Claire checked the pulse oximeter on Sarah's fingertip;
then her gaze darted to the digital display on the monitor overhead-92 percent. Her blood oxygen saturation had dropped significantly, and her heart rate was rising to ... 124. Oh no. Claire
punched the button to start the blood pressure reading and lifted
her stethoscope from around her neck. She squeezed Sarah's shoulder. "Sarah, talk to me. What's going on?"

"Pain ... too ... much ... pain. My ... chest." She stared at the
ceiling, her pupils dilating, pale skin dotting with perspiration.

Claire swept Sarah's gown aside and pressed the stethoscope
against her chest, noting with sickening dread the deepening
bruises over her rib cage and how one side of her chest seemed out of symmetry somehow. Something was desperately wrong. Claire
listened first to the right side of Sarah's chest: rapid air exchange,
normal; and to the left side ... nothing, no air moving. Claire
shifted the stethoscope and listened again, pressing the circular
plastic disc flat against Sarah's clammy skin. Her heart wedged into
her throat. No breath sounds. Lung collapse?

Claire dropped the gown, her eyes riveted to her patient's face.
Sarah's eyes were closed, nostrils flaring, respiratory rate rising,
neck veins becoming more and more prominent, lips chalky gray.
All symptoms, Claire suspected with mounting anxiety, of pressure
from trapped air in the chest cavity around the collapsed lung.
Pressure capable of pushing major vessels, even the heart, toward
the opposite side of the chest and causing circulatory collapse.
Tension pneumothorax?

Claire quickly replaced the oxygen cannula with a high-flow
mask, fitting it over Sarah's face, cranking the oxygen to full flow,
and watching the reservoir bag inflate and distend in response.
"I'm making it easier for you to breathe. Sarah?"

Sarah opened her eyes, but they drifted upward, showing too
much white as she fought to speak. "It's ... Emily's ... birthday,"
she whispered. "I'm ... sorry, Logan. Daddy, please ... help me."

Claire's breath stuck in her throat. Please, God, don't let Sarah
die. She swallowed hard, her heart thudding inside her ears. I can
do this, Lord. I can do it ... if you help me. She jabbed her finger
against the bedside alarm, then shouted through the doorway, "I
need help in here. Hurry!"

She lifted the head of the bed to aid Sarah's breathing, all the
while continuing to pray. Help me, Father. Help me to help her. Claire's
heart pounded and she held her breath, and a comfort-almost like
floating on still water-washed over her, steadying her hands and replacing the crippling anxiety with ... peace. Unparalleled and
amazing peace. Along with a feeling of being guided, almost like
a parent's hand helps a child to write. Suddenly Claire knew that
everything-every single thing-was going to turn out all right.
No matter how ugly the numbers were on the monitors and how
terrifying the sound of Sarah's lungs, Claire could do what needed
to be done. All the help she needed to make this incredible miracle
happen was right here with her. As close as her own heartbeat.

Claire leaned forward and looked into Sarah's eyes, nodding
with calm assurance. "We've got you covered-hold on to that."

Logan jogged through the door and saw in an instant why Claire
had called him. Sarah's condition had deteriorated dramatically.
She was barely conscious, eyes swimming and lips dusky. He met
Claire's gaze as he lifted his stethoscope from around his neck.
"Vital signs?"

"Pressure 92 over 40, heart rate 128-sinus tach-respirations
40, pulse ox-" Claire glanced at the display-"89 percent on the
nonbreather mask." Her lips pressed together for an instant. "I
can't hear any breath sounds on the left, Logan. And her neck
veins-"

"Full," he agreed, lifting the stethoscope to his ears. "I'll take
a listen, but I think it's tension pneumo. Let's be ready. Get me an
18-gauge needle; I'll need to decompress this before her heart's
compromised. And go ahead and set up for a chest tube to follow." He looked at Sarah's face, deathly pale behind the translucent
green mask. His gut wrenched. I'll fix it, Sarah.

Logan listened carefully to both lungs as Claire gathered the
necessary equipment. Sarah moaned as he turned her to listen at the back of her chest ... grating from the rib fractures, no air moving. "Sarah," he said after nodding at Claire, "I'm going to needle
your chest to help you breathe. No time for anesthetic. I'm sorry.
But hang tough for me, okay?"

She nodded almost imperceptibly.

In seconds he'd pulled on a pair of surgical gloves and, holding the needle in one hand, used his other fingertips to locate the
intended puncture site on Sarah's hastily prepped chest. He counted
ribs and felt the spaces between, easier than most patients because
she was thin. Harder than any patient before ... because she's Sarah.
Logan pushed the emotion aside, found the site-second intercostal
space at the midclavicular line-and without hesitation plunged
the needle through her skin. He guided it over the second rib to
avoid the vessels beneath, advanced it carefully deeper and toward
the pleural space, holding his breath, until ... there was a sudden
hiss of escaping air accompanied by a fine spray of blood. Yes!

Sarah groaned, Logan breathed, and on the other side of the
gurney Claire whispered over her efficiently organized chest tube
tray, "Thank you, Lord."

Erin closed her eyes, weak with gratitude. By the time she'd been
able to leave Keeley and the cardiac patient, Logan had inserted a
needle into Sarah's upper chest to relieve the dangerous pressure,
then followed it with a sutured-in chest tube. A portable X-ray
taken afterward confirmed her lung was re-expanding. And now,
twenty-five minutes after the crisis, Sarah dozed with her heart rate
and oxygen level markedly improved.

Erin looked down at Sarah, her mind still tumbling with a
frightening list of what-ifs. What if the lung collapse had proceeded further? What if Sarah had stopped breathing and her heart rhythm
deteriorated? What if ... ? "Thank goodness you were in here,"
she said, turning to Claire. "You caught the tension pneumo just
in time. I don't know what I'd have done if you . . ." She choked
against a rush of tears.

"You know how hard I was praying. But-" Claire's expression grew troubled as she looked down to where Sarah dozed"Sarah kept apologizing. She said something about having bad
nights ... not being able to sleep and that she couldn't be late and
couldn't disappoint Logan. And something about ... oh no." She
pressed her hand to her chest, her eyes wide. "Where are Sarah's
belongings?"

"Over there." Erin pointed toward a plastic bag in the corner
of the room. "What's wrong?"

"Something else she said," Claire explained, grabbing the bag
and dumping its contents onto a chair. "I just remembered." She
poked through Sarah's purse, then began checking the pockets of
the scrub top, snipped away by the paramedics and speckled with
dried blood. "Sarah mentioned something about pills and ... oh,
boy."

"What?" Erin asked, stepping close to see what Claire found.
"What is that?"

"A prescription bottle," Claire said, her voice dropping to a whisper as she glanced toward Sarah. "She's been taking sleeping pills."

Logan rubbed his neck, then leaned back in his office chair with
a long sigh, grateful there was a break in the day's chaos. He'd
even had time to change into clean scrubs. Things were finally settling down. He checked the clock on the wall. Three thirty in the afternoon? No wonder he felt wiped out. But at least he had things
under control. The cardiac patient went to the CCU with an external pacemaker, and the vehicle accident cleared hours ago, though
the TV news kept running that footage of Sarah's car dangling from
the freeway guardrail.