Thursday / Friday
Eleven hours later Ginny pushed open the door to the ICU, pulled a pen from her pocket, grabbed a blank sheet of paper, slid into a chair in front of room Seven, and smiled at Gloria, who no longer looked as fresh as she had at dawn.
“Bad day?” she asked.
Gloria nodded. “It’s a good thing my other patient is stable.”
“I’m ready.”
“Armstrong got here just after you left and did the most thorough neurologic check I have ever seen. Ice water in the ear and everything. He came out frowning and ordered CTs, with and without contrast; MRI; EEG; skull series; drug screens; viral scans; tons of stuff. We repeated the lumbar puncture and this time it showed extremely high levels of protein. The EEG showed widespread structural damage and the Evoked Potentials showed brainstem involvement. So far, all the lab tests for the Epstein-Barr virus have come back negative. So it begins to look as if we can rule out Guillain-Barré. That raises the question of what else it could be.
“All the scans said the same thing. No excess pressure within the skull, no bleeding, and no swelling, so we didn’t do the craniotomy, but the techs said it didn’t look like normal brain tissue either. The EEG was the strangest of all. It showed almost no electrical activity. Not even what should have been there as a baseline, you know — the background noise of a comatose patient. So we took him off the ventilator to check for spontaneous respirations. There weren’t any, of course.
“None of us have ever seen anything like it. Armstrong has been a worse ass than usual. He’s been on the phone to people all over the U.S. about it. I gather he’s taking the whole thing personally. He’ll have to write it up, of course. Otherwise, someone might think he missed something. So I guess we’ll hear how it comes out in the end.”
“But what does it all mean?” Ginny asked.
Gloria shrugged. “It means, according to the tests, that man’s brain is dead. His heart’s still beating so we can’t turn off the ventilator.” She made a face. “Mustn’t let it be suggested we didn’t do everything in our power. In the meantime, we treat him just as if he were going to get well.”
“Transplant coordinator?”
Gloria shook her head. “It was discussed, but we haven’t been able to rule out an infection so they don’t want anything to do with him.”
“Is his family here?”
“Yes, a nephew and niece-in-law. They are distressed, of course, but seem to understand what’s been said to them. Any other questions?”
“No. I’ll take it from here, thanks.”
Ginny looked Professor Craig and the equipment over, jotted down a few notes, then hurried out to meet her other patient. Initial assessments complete, she turned her attention back to Craig, swinging past the monitors to pick up EKG strips.
“When did this start?”
Ann, the charge nurse for this shift, looked at the strips in Ginny’s hand. They showed intermittent irregular heartbeats. “Looks like four p.m.”
“Gloria didn’t say a thing about ectopy.”
“I guess she missed it.”
Ginny groaned at the thought of having to fill out an incident report. She studied the waveforms, comparing them to the strips in her hand.
“His heart is dying, sooner even than we could have expected.” She glanced at the clock. There was no way to squeeze what she knew was coming into her usual routine. She gritted her teeth and prepared for a bad night.
“We’d better call Respiratory and let them know what’s in the wind,” Ann said.
“Yes, and I’ve got to call both of his doctors. Can you get them on the phone for me?”
“What’s the code status?”
“Full code. Not that it will do any good, but we have to try.”
Fifteen minutes later, Professor Craig went into full cardiac arrest.
There was no hope. There had never been any hope. Whatever had destroyed Professor Craig’s brain was now destroying his heart. They worked in calm haste, trying everything, accomplishing nothing.
Dr. Littleton shook his head at last. “Call it.”
Ginny glanced at the clock, three minutes past eight p.m. She jotted down the time and watched as the rest of the crew backed away from the bed, reluctant to give up even now.
“That makes him an M.E. case,” she murmured to Ann. “It’s been less than twenty-four hours since admission.”
“And you get to do another incident report. Let me know when you’re ready for the family to come see him.” Ann followed the others out.
Ginny shut the door behind her, closing herself in with the dead man. There was very little for her to do to prepare the body. Nothing could be removed until after the Medical Examiner had finished with him. She turned off the machines and disconnected the apparatus, covering the bloody spots and wiping away some of the more unpleasant aspects of death, then tucked the sheet around him and stepped back.
She stood quite still, looking down at the shell of a man she had known. “In the midst of life, we are in death.” The phrase floated unbidden into her mind. Ginny knew, better than most, how fragile is the human condition, and how easily destroyed. “In nomine Patris…” Except, she reminded herself, frowning, that he shouldn’t be dead. “…et Filii…” I’ve taken care of lots of Guillain-Barré patients and so has Armstrong. “...et Spiritus Sancti…” and they don’t do this. They don’t die.
Instinctively, her hand went to the talisman at her neck. The Scots believe that the rowan is a portal tree, a guardian at thresholds such as the one between life and death. They carry small items made from its wood on journeys, to prevent losing their way.
This death had all the earmarks of a man who had taken a wrong turn and found himself in an unfamiliar land. Ginny asked the rowan to guide the soul of Donald Craig to his final destination, then turned her back on the body and went out to get the family.
* * *