His North Star

Satisfied that the breath sounds were the same in both lungs, Nathan straightened. "Ventilate him."

The nurse nodded. She attached the tube to the mechanical ventilator, pumping oxygen into him.

Nathan monitored the kid's vitals. When his blood pressure started to dip even lower, he had the nurse start fluid resuscitation while they waited for the electrolyte panel results.

Twenty minutes later, the first nurse rushed back in with the test results. "I've got it, Dr Bellamy."

Nathan took the chart from her. Although he knew what the results would be, he was disappointed at the numbers. The kid had severe hypernatremia and hyperchloremic acidosis—there were too many sodium and chloride ions in his blood.

Nathan set the chart away. "Give him sodium bicarb, 8.4% strength intravenous injection," he said to the nurses. "Then get naloxone hypochlorite going through his I.V. infusion. Start at 60% and keep an eye on his vitals. Page me the instant anything changes."

"Yes, Dr Bellamy."

As the nurses gave the medication, Nathan stepped out of the room. Leaning against the closed door, he took a deep breath of untainted air. It didn't help much—the reek of blood, shit, vomit and bleach was burned into his nostrils.

He glanced at his watch. 7:52pm. His 12-hour shift was nearly over. He could leave and sign the kid off to the incoming doctor, but he wouldn't. Not a chance in hell. This kid was his patient. He'd see this through himself. He'd keep the kid alive.

Straightening, Nathan went down an adjacent corridor to the breakroom. Another doctor was there, inhaling a sandwich. They greeted each other with weary friendliness. Going to the coffee machine, Nathan poured himself a cup. He downed it in one gulp.

Damn. Just, damn. An 18 year old kid had swallowed handfuls of industrial-strength bleach, knowing what would happen. He'd shown no fear as it happened...as his throat and his guts corroded...as he gasped for breath and vomited blood.

To think there were people who still spouted the worn-out spiel that suicide was a 'cowardly' act. Fucking fools. Were such people ignorant, or did it go deeper than that? Did they intentionally dismiss suicide as a cowardly act so they could absolve themselves of any responsibility to prevent it?

He didn't know. But one thing was for sure; the kid on that ventilator was not a coward. It must take guts for a human to override the inbuilt biological imperative to survive. It must take sheer fucking guts to pick such a painful way of ending it.

Nathan slumped into a chair and stretched his legs. He was seated for a mere fifteen minutes when the Code Blue came. There was a cardiac arrest in the kid's room.

Nathan's blood iced over. He shot to his feet and out of the breakroom.

The corridors were busy, but he didn't have far to go. The door was already ajar. He burst in. The Code Team—a nurse, an orderly and a respiratory therapist—was behind him, rushing in with the crash cart.

The original two nurses had flattened the kid's bed. One of them was doing chest compressions. The other was monitoring the kid. Her eyes were wide. Her voice was urgent. "We're not getting a pulse, Dr Bellamy! He seemed like he was stabilizing, then he suddenly started coding!"

What happened next, took thirty minutes.

The respiratory therapist took the kid off the ventilator and manually bagged him. Two nurses placed the pads underneath him as the third nurse continued the chest compressions.

"Give him 1mg epi," Nathan said to the nurse who wasn't performing the chest compressions. After she'd done that, he turned to the Code Team nurse. "Charge once he's in v-fib."

The nurse strode to the other side of the bed, to the display. Once the kid had a shockable rhythm, the nurse set the level to 200 Joules and jammed down on the charge button.

Nathan grabbed the defibrillator. "Clear!"

Everyone took their hands off the kid. Nathan put the defibrillator pads to his chest, pushed the buttons down and delivered the shock. His body jerked. They all checked the monitor—the heart rhythm was still in ventricular fibrillation. Normal cardiac function hadn't restarted.

His blood like ice, Nathan barked at the nurse, "Start compressions again."

The respiratory therapist bagged the kid and the nurse restarted the compressions, pumping hard for two minutes.

Meanwhile, Nathan told the Code Nurse at the machine, "Turn it up to the maximum."

She did. When he nodded at her, she hit the charge button.

Nathan held up the defibrillator. "Clear!" He put the defibrillator to the kid's chest and delivered the shock. He glanced at the ECG monitor again. The kid was still in v-fib. There was still no regular rhythm yet.

No! No, God, no! This wasn't the way his shift would end! This fucking kid was not going to die on him!

"Again!" Nathan barked to the nurse doing the chest compressions. After another round, he nodded to the Code Nurse and she charged the defibrillator again. "Clear!" He delivered the third shock.

Still nothing. After another round of CPR, it was game over. The kid had no cardiac activity at all.

Before Nathan could call for the chest compressions to start again, a nurse raised the kid's eyelid. "Pupils are fixed," she said. She reached in her scrubs for her flashlight, clicked it on and shone it in his eyes. "No constriction." Her own eyes wide, she lifted them to Nathan's. "Dr Bellamy, I think..." Her voice shaky, she trailed off.

Nathan swallowed the icy lump in his throat. He held the nurse's gaze for a beat, then looked down at the teenager. A kid with his lips, gums, throat, stomach and intestines corroded by the handfuls of bleach pills he'd swallowed like vitamins.

A kid who'd ultimately succeeded in his objective. He'd gotten what he wanted—death. But why? What possible reason would a teenager have to choose this fate for himself? What had sunk him to this depth of self-destruction?

"His etCO2 is 6," the respiratory therapist said. "The kid's gone, Dr Bellamy. We're not getting him back. I think we need to call the time of death."

That was true. He needed to call it. Nobody else in this room was authorized to do that. Turning away from the dead teenager, Nathan looked at his watch. With his throat burning as though he'd swallowed bleach himself, he said: "Time of death, 8:42pm." Right at the close of his shift. What a way to end it.

The Code Team quietly dispersed. The two nurses were quiet as they tidied the room.

The dead teenager lay silent.

Nathan left the room. He stood in the corridor, giving himself a minute to decompress before he went to the nurse's workstation.

"In 5 minutes," he said to the nurse at the desk, "Have Jason Holst's elder sister brought to Consulting Room 4. I need to talk with her about her brother."

"Sure thing, Dr Bellamy."

Nathan went into the empty Consulting Room 4. He turned on the lights and sat behind the desk. This was one of the things he hated most about his job. Every time he lost a patient, it killed a piece of his soul.

This time it was a teenager. Just a kid. Hell. For the first time, Nathan gave serious consideration to how long he could last as an ER doctor, until everything within him burned out.

It wasn't uncommon for doctors in residency to quit because of burnout and disillusionment. Of the seven other doctors who'd begun this ER residency at the same time as him, five now remained. One had switched her specialty to Dermatology, where the stress and mortality rate were a lot lower. The other had given up on medicine altogether. He now owned a hardware store in Brooklyn.

While it was true that Emergency Medicine had two big advantages over all the other specialties, there were also drawbacks. An ER doctor never knew who'd walk in, what their problem would be, and how severe. It wasn't that way in other specialties. There was some predictability there. A nephrologist treated the kidneys. A pulmonologist treated the lungs. A geriatrician treated the old. A pediatrician treated the young.

But in Emergency Medicine, you never knew. That minute-to-minute strain, and the pressure to stay efficient despite it, was something ER doctors alone faced.

Nathan felt the strain every minute. And when he lost a patient, he lost a piece of his soul.

The door opened and the dead kid's sister was ushered into the room. She was a young woman in her early twenties, with a sweet face. And he was about to tell her that her little brother was dead.

Nathan stood. "Miss Holst?"

The young woman nodded, dabbing her eyes with a tissue. "Yes."

"Please sit." He gestured to the chair across the table. "I'm Dr Bellamy. I gave your brother first-line treatment for his toxicity."

The young woman sat, squeezing the tissue. "Is he okay now? Is he stable? Can I come to his room and see him?"

Nathan paused a second, steeling himself. "Miss Holst, I'm sorry to have to tell you—"

This was as far as he got before her expression turned stricken. She blanched. All color drained from her face, she stared mutely at him.

Then her face turned pink again. Her eyes closed. She slumped down, slamming her head on the table as a half-broken sob escaped. "He's dead, isn't he? He's dead! That's what you're about to tell me, isn't it? Jason's dead! That's it, isn't it? Dead! Dead! He's dead!"

She slammed her head on the table again. Hard. "Dead! He's dead! Jason! Jason!" Like a lunatic, she continued slamming her head. Her skull made a sickening thud as it hit the wood. "Dead!" She hit her head. "Dead!" She hit her head. "Dead!"

When she was about to slam her head again, Nathan had enough. She'd fracture her skull long before the table would splinter, and he didn't want to have to admit her too.

Sitting forward, he slipped his hand between her head and the table. Her forehead landed into his cupped palm. His knuckles took the brunt of the hit against the wood.

She looked up, gazing at him as though she'd forgotten he was even there. Their eyes held, both silent. Hers filled with tears. She sank her head down once again, letting it rest in his palm.

And she wept.

She sobbed for an hour straight, her tears flowing unchecked into his palm.

It was 10:05pm. and although his shift was long over, he didn't hurry her or interrupt her weeping. He waited until she finally quietened and raised her hot head from his palm. Her face was a blotchy mess. Nathan withdrew, getting a paper towel to wipe her tears from his hand.

She dabbed at her face. "Sorry," she rasped.

"Don't apologize. Where are your parents? Why are you here alone?"

Her lip quivered. "There's nobody else. Our mother died when Jason was only a baby. Our father remarried a few years ago. She made him kick us out. I live...lived...with Jason. I work two jobs. We don't have insurance so I don't even know how I'm going to pay this hospital bill." Her voice broke again. "I've tried calling Dad a thousand times but it keeps going to voicemail. Mom would never have done this to us. She cared about us. He doesn't anymore. And now my...my brother is dead." She erupted into fresh sobs.

Again, Nathan waited until she regained some composure. "I'm sorry. We lost him because he went into cardiac arrest and couldn't be resuscitated."

"What's going to happen now?" Her breath hitched. "What'll I do?"

"Your brother will be handed over to the Toxicologist and the Pathologist for a post-mortem. In severe poisoning cases like these, a complete toxicology report takes several weeks. You'll be kept updated, and you'll be informed as soon as he can be released to a funeral home. In the meantime, if you need the services of a Chaplain or a Licensed Therapist, I can refer you."

She listened, half-sobbing. "Did you do everything for Jason? Did you try your best to save him?"

"We did what we could. We put him on oxygen and gave drugs to balance his electrolytes. For your sake, I regret that we didn't succeed."

"For my sake?" She made a harsh noise. "Why should anyone care about me? I was the one living with him. I knew he was having a hard time with his grades and bullies and the issues with Dad. But I was too busy to notice that he felt...hopeless."

As she said the word 'hopeless' her sobs began afresh. Her head fell into her hands. "It's my fault. If I'd paid more attention...if I'd noticed he was suicidal...but I didn't notice. I was too busy working, and...and now he's dead. My baby brother's dead. I killed him. This is my fault. I should die, too. Oh, Jesus help me. I want to die, too."

The broken weeping restarted.

Nathan sat with the grieving girl for another half hour. They left the room together, and he escorted her to the Hospital Chaplaincy. He left her in the pastor's capable hands and he returned to the ER.

It was still bustling. Patients were arriving, nurses were triaging them, and doctors were picking names from the whiteboard. The death of an 18-year-old kid hadn't ground the place to a halt. The place hadn't so much as broken stride.

While this was the ideal thing, it destroyed another piece of Nathan's soul.

He filled out Jason Holst's paperwork and had his corpse handed over to the Pathologist. After that, he found the doctor who'd begun the 8:30pm. shift and signed his remaining patient off. It was now this new doctor's responsibility to phone Animal Control about that dog who'd bitten a chunk out of his owner's arm.

At last, Nathan changed out of his scrubs and left the hospital.

He drove home with the radio off. The icily corrosive lump was in his throat. It didn't matter that he'd saved a toddler with severe meningitis, and a crash victim with a collapsed lung. All that mattered was this teenager's death.

By 11:45pm., Nathan unlocked his apartment door and went in.

His lone footsteps echoed as he went to the kitchen. He'd lived alone long enough to be a decent cook. He could throw a quick meal together, but he didn't. He wasn't hungry. Besides, the lump in his throat wouldn't permit food to pass.

He chugged a glass of water, went to his bedroom, stripped and got into his solitary bed.

He didn't drift off until 2:00am., but that was fine. His shift tomorrow didn't start until noon, so he could afford to sleep in. He set his alarm to 9:30am., and slept.

**

He was at Delta Lake Hospital by noon the next day.

As usual, he saw a steady stream of patients. The difference was that he couldn't fully concentrate. The dead kid haunted his thoughts. Aside from that, there was a prickle at the back of his neck.

The prickle began as soon as he started his shift. It was an icy sensation that he had no logical explanation for. As though an invisible creature hovered over his shoulder, shadowing him...drawing closer and closer. Coming...

It arrived by 10:42pm.

He'd finished up with a patient and was going for a 5-minute coffee break when the same Triage Nurse from last night strode to him.

"Dr Bellamy, we've got a high-priority. I haven't had time to put her name on the board. It's another suicide attempt." She sighed as she said it, handing Nathan a chart. "Near-drowning. She loaded her pockets with rocks and walked into the lake. A guy camping saw her, fished her out and called an ambulance. He puts her submersion time at around 10 minutes. EMTs started resuscitation on the spot. Her spontaneous gasp after rescue was under 20 minutes. She's conscious and talking now. Says she's got a headache."

The prognosis sounded good, but with near-drowning, there was always a risk of bacterial pneumonia or delayed drowning. It'd be good to know if she'd had any lung problems in the past.

"Do we have her medical records?" Nathan asked.

"Not right now. Sorry." The Triage Nurse shrugged. "She's a Canadian tourist, so there's no point trying the EMR. Her primary care doctor's in Québec and we can't get him on the phone until tomorrow morning."

"Where've you put her?"

"Room 11."

The icy prickle walking up his spine, Nathan walked down the corridor. He scanned the chart. The woman's name was Stéphanie Chopin. 43 years old. Her temperature was 96.6. It was low, but she wasn't hypothermic. Her oxygen saturation wasn't dangerously low either. She'd probably live.

But then, as he'd been reminded last night, things could always change for the worse.

Inside Room 11, was Stéphanie Chopin. She was sitting propped up and connected to an ECG machine. Her head was in her hands. Wavy dark hair tumbled down her slim shoulders.

As he shut the door behind him, Nathan noticed that her hands were trembling. "Mrs. Chopin?"

She looked up, clasping her hands in her lap. "It's Miss Chopin," she snapped. The harshness of her tone was softened by her Québécois accent. "I'm recently divorced." She paused, a flinty look entering her eyes. "In case you're wondering, that's not why I walked into the lake. I wouldn't kill myself over that cold-hearted cheating bastard. Or over any man, come to it. All the males on this planet put together aren't worth my life."

Although taken aback by this response, Nathan didn't let it show. "I'll just call you Miss Chopin," he replied. "I'm Dr Bellamy. I hear you're having a headache?"

She nodded.

"I'll examine you so we know how you're doing. Would you prefer to have a nurse present?"

"You mean as a chaperone? There's no need for that. You don't look like a molester." Stéphanie Chopin's lips twisted into a sneer. "But then, one never knows with men."

Nathan didn't say a word to that.

For the next few minutes, he examined her in silence. He checked her ECG heart rhythm and took her pulse, using the opportunity to test her hand's temperature. Her hand was too cool for his liking, and it hadn't stopped trembling.

Saying nothing about it yet, he confirmed her pulse rate with the number on the cardiac monitor. She was slightly bradycardic, but had no ectopic beats. He listened to her chest. There were fine crackles in her lungs, like ancient paper being crumpled.

"There's fluid in your lungs," Nathan told her, speaking again for the first time. "After we finish your examination, I'll send you for a chest X-ray to see how severe the edema is. I doubt you'll need to be ventilated. I'll give you a diuretic to flush out the excess fluid and you'll be kept overnight in the ICU's Observation Ward."

"But I'm having a headache!" Stéphanie Chopin clasped her hands tighter. "Aren't you going to do anything about that? My head hurts! I already said so!"

Nathan sighed. "I was getting to that, Miss Chopin. I hadn't forgotten. One thing at a time. I have some questions to ask you, so we can figure out why you're having the headache."

"Alright. Fine."

"Good. Now, did you hit the water at speed or from a height?"

"No. I didn't dive. I just put heavy rocks in my pockets and waded in."

"I see." Nathan paused, noticing that her hands still hadn't stopped shaking. She was clasping them together, but it wasn't helping much. He kept silent about it for now. Instead, he reached for her, gently probing her skull and neck with his fingers. He was searching for tender spots. As he probed, he watched her face for wincing. "Any stiffness?"

"A little."

"Do you remember hitting your head at any time?" he asked.

"I don't think so."

"Can you tell me today's date?"

"April 6th, 1982."

"Good. Do you remember what you had for dinner last night?"

"Mushroom ravioli."

Nathan nodded. She didn't have memory loss, which was always a good sign. He took the flashlight from his pocket. "Keep your eyes open for me." He shone the pinpoint light into her eyes, checking her pupil responses. All fine.

Which begged the question of why she had a headache. There were no physical signs of trauma, no memory loss, no speech difficulties, and her oculomotor nerves were fine.

Nathan switched off his flashlight. "How long have you had these spasms in your hands?"