Henry lets out a shaky breath, his eyes flickering from the monitors and then back to Elizabeth again, wishing he understood what any of the numbers meant. It doesn't go unnoticed by him that the main ceiling light has now been switched on, illuminating the room in a harsh glow. He watches as Ellie moves the chair on the opposite side of the bed, pushing it back towards the wall, the legs letting out a harsh whine as they scrape against the floor. She looks up apologetically. "Sorry, just making room for the x-ray machine to get in."
"Of course." He glances behind himself. "I'll move this one."
"Oh, you don't have to. I can get it."
He doesn't pay any attention to her, moving behind the chair to lift it out of the way, before going back to stand next to Elizabeth's bed. He rubs at the back of his neck, feeling worse than useless. All he can do is stand and watch. Panic and dread creep over him, and he feels like someone has wrapped him in a sheet of ice.
Ellie is busy, taking Elizabeth's blood, labelling the containers and handing them across to another staff member. Her movements are methodical, smooth, calm and yet they do nothing to ease Henry's frazzled nerves because he can see how her gaze returns consistently to Elizabeth's monitors every few minutes. He feels like he is in the calm before the storm.
Finally, when he can take the tension no longer, he asks, "How bad is it?"
Ellie looks up at him, her eyes sympathetic. "There's something not quite right," she admitted. "But as Dr Monaghan has said, we need more tests to know exactly what it is."
"What do you think it could be?"
"There's a couple of possibilities…" Her brow furrows, her pen twirling between her fingers and she clicks it, in and out, the sound reverberating around the room.
"I want to know what they are," Henry tells her firmly. "You're doing extra tests, what are you looking for?"
She considered her words for a few seconds. "The chest x-ray will show us if Elizabeth is beginning to show any signs of a chest infection, if there are any collections in the lungs-"
"What kind of collection?"
"Normally either blood or air."
Henry bits down on the inside of his bottom lip, barely feeling the pain that the move elicits. "That sounds bad."
"All of them are very treatable," she assures him. "But we need to know just what we're dealing with. These tests will give us a better idea."
"Ok." He looks back down at Elizabeth and he has to lock his knees to stop them from buckling underneath him. She looks so fragile and there is nothing that he can do to help her. His urge is to wrap his arms around her and pull her close to him, but the tubes and lines that are ironically designed to help keep her with him, prevent that. He thinks about telling her to fight this, but he knows that if she has any control in this situation then she's already doing that.
Elizabeth's blonde hair is fanned across her pillow and he remembers how it had looked that morning. She'd been on her side, facing him, one hand partially tucked under her cheek. There had been a ray of light seeping in from a gap in the curtains, and it had glinted off her hair, making it glow. Her cheeks had been tinged pink and her mouth had been set in the smallest of smiles. She had been so calm, so peaceful that he had resisted the urge to wake her, deciding that she needed her rest more than anything he'd had in mind. Part of him…all of him regretted that now and wished that he had woken her, soothed away her initial grumbles with a kiss, held her close and told her just how much he loved her. He knew that she knew he loved her, but how he wished those had been his parting words either in the afternoon, or in the morning. But they weren't. He can't even remember what his last words to her were; he just knows what they weren't.
Elizabeth's hair still shines under the harsh fluorescent lighting of the hospital room, but all that really does now is highlight the pale, sickly waxiness of her skin. How did it come to this? He wonders.
The pad of his thumb traces the edge of her cheekbone, her skin cool underneath his touch and he thinks about how she would have turned into his caress, the way she would have smiled at him, and how he would give every cent they had for her to do that now. She doesn't of course, she stays still and silent, and he feels like his heart is straining against his chest, his stomach churning. "I love you," he finally tells her, hoping that she can hear him. He has held the words back all night, for reasons he can't quite explain, but now they tumble easily from him.
His gaze stays on Elizabeth, afraid to look away from her; even for a second. He is distantly aware of Ellie's keen gaze, that she has returned to her table, and he can hear the scratch of her pen against paper. Henry falls silent again.
He's unsure of how much time has passed, he knows it hasn't been long when there is a loud, sharp, repetitive beep from the monitor, accompanied by a wail from the ventilator. Henry's shoulders jerk at the noise and he takes an instinctive step back from the bed.
Ellie is there almost instantly, she pulls at a red button on the wall and this noise almost drowns out the rest of them, a loud, insistent siren.
Feet thud as staff flood into the room.
"Put out a peri-arrest call," Ellie instructs as she pulls the pillow out smoothly from under Elizabeth's head.
Henry feels a hand at his elbow, guiding him away from the bed with a gentle but firm guide, accompanied by an unknown voice, kind but resolute. "Dr McCord, you need to leave the room."
"Elizabeth…what…the alarms…I can't…" The blare of the alarm cuts through his brain and he can't focus. He's a man who has prided himself on his ability to make coherent and decisive arguments in difficult situations, but now his brain isn't linking up with his mouth and his protest, as nonsensical as it is, is falling on deaf ears.
The hand is now linking under his arm, pulling him back. "They need to get into the bed so they can help her. We need to give them space."
Through the people now crowded at Elizabeth's bed, Henry can just make out her face, the same impassive expression there as before, as though she's completely unaware of the chaos now surrounding her. His voice is firmer this time. "I don't want to leave her."
"You can't stay, come on now."
His argument is futile, and he knows it. He can see them peel away Elizabeth's gown and realises that although he doesn't want to leave, he also doesn't want to watch this. Doesn't want to have these images seared onto the back of his eyelids, so he finally acquiesces to the grip on his arm.
The stares of Elizabeth's DS agents are sympathetic and somehow that just makes it worse, they look at him and then bow their heads.
The ward door is propped open and he feels like he's in slow motion as hospital staff run in, past him and towards her room.
Henry tries again to form words to the woman who is walking with him, her hand patting his arm in what is meant to be a reassuring manner, although nothing could reassure him right now. "What's happening to Elizabeth?"
"She needs some extra help just now."
"They said peri- arrest, what does that mean?"
The woman blinks and he can see the discomfort that flickers across her face, the way she sucks in her bottom lip for a moment. "Why don't we get you into the relative's room." It's a statement of intent rather than a question,
He presses her again. "What's happening?"
"In here," She guides him into the relative's room. She flicks the light switch and the light comes on with a low buzzing noise, flickering once, twice before it settles. "Do you want me to make you hot drink?" She asks him.
Henry blinks incredulously. "No, I want to know what's happening to my wife."
"One of the doctor's will be along when they can, they'll explain-"
Frustration wells in his chest and he interrupts. "I want to know how bad this is! I want to know what is going on!" He snaps. His breath falls in harsh rasps and he can see her jerk back at the venom in his tone. He runs a hand through his hair, his chin dropping to his chest for a moment as he collects what is left of his patience. "I'm sorry," he mumbles after a moment.
"It's ok. You must be terribly upset." Her head tilts, her mouth twists sympathetically. "But I'm not the best person to explain any of this to you."
"You're the only one here," Henry points out. He takes another deep breath. "Is it bad?"
There is a moment of silence and he can see her thinking over her words. "She's very unwell just now," she finally tells him. "But the team will do everything they can."
He expects to feel the bottom fall out of his world, but it doesn't. In some ways that would be easier. Instead he just feels numb, and if anything it makes him feel worse. He needs to call Will and the kids and the thought makes him feel dizzy, nauseous.
She speaks again. "Would you like me to wait with you?"
He shakes his head. "No, it's ok."
"Would you like me to bring anything to you?" He gives another shake of his head. He feels her staring at him for a moment before she gives a small nod. "Alright then, well someone will be in when they can."
Henry gives a nod.
Her shoes are quiet on the floor when she turns to leave and the door falls closed behind her with a quiet click.
He waits a minute, breathing in and out, trying to collect his thoughts, the light is still buzzing in the background. A minute, maybe two and he finally reaches into his pocket for his phone.
Despite that feeling of uneasiness that had niggled at the back of Ellie's head over the last hour or so, she hadn't expected the sudden wail of the alarms. After all she had seen similar situations before and as all the right decisions had been made, she had assumed that it was just nightshift paranoia that had left her with that lingering discomfort.
When the first beeps sounded from the monitor, she had frowned to see that both heart rate and BP were flashing at her. The ventilator followed them, binging its unhappiness at her.
Heart rate was up, one twenty and climbing in every flash, BP had suddenly plummeted and her oxygen saturations were copying that downward trend.
Ellie was on her feet in seconds. The pattern on the arterial line was something she had only ever seen in textbooks or slides. She pulled the emergency buzzer. There was too much happening too quickly, and she knew that this was heading in one direction.
She sees the first of her colleagues run in. "Put out a peri-arrest," she tells them as she pulls the pillow out from under Elizabeth's head. She reaches behind for the ambu-bag, turning the oxygen pipe it was attached to as high as it would go.
Out of the corner of her eye, Ellie can see Henry McCord being pulled away, can see the look of pained horror that is etching into his features. She looks away, not the time, her attention is needed here. "Can we get the pads on her?" she asks. Her fingers fumble ever so slightly as she tries to disconnect the ventilator from the ET tube. Attaching the bag instead.
She sees Niamh nod at her request, can hear the trundle of the crash cart as it's rolled into the room. The emergency alarm has been turned off now, but the monitor continues it steady, urgent beeping. Niamh peels back the hospital gown, folding it at Elizabeth's waist, placing the de-fib pads on. Ellie hopes they won't be needed.
Lewis runs into the room, past the auxiliary who is leading the husband from the room. He twists sideways to get past them at the door.
"What do we have?"
"Heart rate is climbing, we're now at one-sixty," Ellie told him. "BP is crashing." She pauses briefly, "The arterial line looks like it's showing pulsus pardadoxus. I'm bagging on 100% oxygen but there's resistance on bagging and her sats are barely at 85%."
"Right." He looks at the flashing numbers. Glances around the room and realises that until the crash team arrives, he's in charge. Sweat prickles at his forehead and the nape of his neck. "I'm going to listen to her chest." He swings the stethoscope from around his neck, glad that his hands aren't trembling. "Can we silence the monitors for a moment, please." He sucks his lower lip in between his teeth when he realises that there are now no lung sounds on her left-hand side. Swallowing back against the lump in his throat, he realises just what he's dealing with and now he's up close, he can see that the veins in her neck are beginning to distend. "I think we have a tension pneumothorax," he announces.
"Heart-rate's up to two-hundred."
He can't wait for the rest of the team. They're probably only minutes away at most, but he's very aware that at this point in time Elizabeth McCord doesn't have those minutes to spare. "Ok, can I get a sixteen-gauge needle and an alcohol swab please." He takes in a large breath as someone hands them to him. He feels from her clavicle, fingers palpating down, finding the second inter-costal space. Another breath and he wipes the area with the swab. "Pause bagging," he instructs. He visualises a line on her chest. Another breath and he stabs downward at ninety degrees, piercing the skin, a hiss of air greeting him. "Bag," he tells Ellie.
The monitors continue to flash, but the relief he expects to feel doesn't come. Her heart rate is still climbing, her oxygen falling. "There's still resistance," Ellie informs him, shaking her head, her lips pulled so thin that the edges of them are turning white.
His palms are sweating underneath his gloves. "Ok, I…I…need a thoracostomy set. Can we prep that please?"
The words are no sooner out his mouth then the monitor lets out a low whine. He sees Maggie frown, leaning across to press her fingertips to the pulse point in Elizabeth's neck. "We've lost output, we're in PEA. Starting chest compressions.
Her fingers fold over each other on top of Elizabeth's chest, pressing down in a series of rapid compressions and he can hear her counting underneath her breath.
He's saved from making another decision by the arrival of the crash team. The head anaesthetist pulling on his gloves at the door as he barks out. "What have we got?"
"Gunshot to the chest approximately 15 hours ago, surgery to repair damage to left lung, drain the pericardium and repair damage to left and right ventricles. Initially recovery uneventful. About half an hour ago, we noticed mild tanchycardia and dullness to the left side along with increasing oxygen requirement. While waiting for the chest x-ray we had a sudden onset tachycardia, hypotension and a drop in sats. Pulsus paradoxus seen on the monitor and resistance when bagging. No lung sounds on the left and neck veins are distended. Air present on needle decompression but it's failed. She's in PEA and we've just started chest compressions. I've asked for a thoracostomy set."
"Alright, any epinephrine given?"
"None yet."
"Ok." The anaesthetist folds his arms across himself as he takes his place at the bottom of the bed, surveying the proceedings and taking immediate charge. He points to one person at a time, reeling off what he wants them to do. "Give one milligram epinephrine. Get blood gases. Prep for finger thoracostomy." He meets Lewis' gaze. "You done one of these before?"
"Yeah, but not during an arrest," he admits.
"You happy to do it now?"
Lewis wants to shake his head, to say no, but he knows he can't, knows he needs to step up. "Of course."
"Good." He waves his hand, sending Lewis to the nurse who is setting up the trolley with enviable speed.
He positions himself at the side of Elizabeth, her skin is dyed orange from the layer of iodine that has been liberally applied in preparation. One of the arrest team positions herself at his right-hand side.
Suddenly there is a loud cracking and he sees Maggie falter in her compressions, a wince crossing her face. "I think I broke a rib."
"Keep going," the anaesthetist tells her. "If we don't get her back then it's the least of her worries. Ease back slightly though, I'd prefer not have a flail chest to deal with."
The compressions restart and Lewis grimaces at the sound of the broken rib scraping and crunching at each one. "I'm ready to start," He announces.
"Ok, pause compressions and bagging."
The nurse next to him, simultaneously lifts Elizabeth's arm above her head, giving him the access he needs. He counts down to the fifth intercostal space. He pauses for a brief second, steadying his hand before he makes the incision with his scalpel. His finger presses into the wound until he can feel the fourth and fifth rib. "Kelly clamp." They're placed into his hand and he widens the cut slightly, before advancing them forward, in between the ribs.
"Bit more pressure," the anaesthetist tells him.
Lewis nods. Cold sweat is breaking out across his back, but he presses firmly with the clamp, wriggling it until he feels the pleural wall puncture. He pulls the kellys back and presses his finger back in, checking he is where he should be. "I'm in," he tells them. He can hear the rush of air and a small gush of blood trickles over his hand and onto the white sheet.
"Good. Now retreat. Recommence bagging and check for output."
"Still no pulse and still in PEA," someone called out.
"Ok, recommence compressions and give another one of epinephrine." He leaned slightly towards Lewis, who's shoulders have deflated. "You did a good job, but it's not always enough on its own to restore spontaneous circulation."
Lewis nodded. He can see the sheen of sweat on Maggie's forehead as she presses quickly down on the chest.
A cycle passes quickly. "Off the chest for a rhythm check." He sees Maggie's arms shaking as she leans up and off Elizabeth's chest. "Can someone else take over chest compression if needed please."
The mechanical voice sounds from the defibrillator, Ventricular Fibrillation, charge 180, charging…press shock."
"Everyone stand clear." He nods to the nurse at defibrillator and she nods back, holding down the large orange button. The machine sounds again. Stand clear, shocking… Elizabeth gives a small twitch on the bed. Shock delivered, recommence CPR.
"Check output please."
"Still nothing," someone calls out.
"Go for another cycle, someone draw up more epinephrine. And someone else run another set of gases."
The room is becoming overly warm, but the team moves seamlessly, or at least that's how it appears to Lewis. He wipes his forehead with the back of his arm before stepping forward to take the set of blood gasses out of the arterial line. His fingers fumble on the catch and he swears under his breath as blood oozes up and over the line, soaking into the sheet in a bright red splotch. He looks up to give Ellie an apologetic glance, but she's too busy bagging to pay any attention, and when he sees the rest of the bedding, he realises she's not going to care about the mark his carelessness has left.
He's at the door to the room, ready to sprint to the analyser, when he hears the low monotone of the defibrillator once again. Ventricular Fibrillation, charge 200…press shock. Stand clear, shocking…
There's the dull thud as it delivers another pulse of electricity and the last thing Lewis hears as he races down the ward is, Shock delivered…