Endorphins

While Linda was giving the bicarb, Ray stood at Joan's side, watching the monitor. The lidocaine he had given her earlier had helped for awhile. Now her rhythm was becoming even more irregular, and as he watched, Joan's heart beat slipped into chaos.

'God, she's in V. fib. Get the defibrillator.' Ray placed his fingers along Joan's sternum, breastbone, feeling for the landmarks to tell him where to place his hands. He then placed his left hand over the lower third of her sternum, placed his right hand on top of the left, and began to push her sternum down, pushing blood from her heart into the arteries carrying the blood and oxygen to her brain. 'Give her an amp of epinephrine, now. Charge the defibrillator to 200 joules. Hand me the paddles.'

As the defibrillator was charging, the paddles were handed to Ray. He placed the paddle in his right hand just below and lateral to her left breast, and the other paddle over the center of her chest.

'OK, everyone clear?'

'Clear.'

'Clear.'

'Here goes.' As he pushed the red button on both paddles simultaneously, a surge of electrical current penetrated Joan's chest, flowed through her heart, and back into the paddles. The monitor still showed ventricular fibrillation. 'Charge it to 300 joules.' The defibrillator whined as the paddles where charging.

'It's at 300, Doc.'

'OK, everyone clear?'

'Clear.'

'Clear.'

Again Ray pushed the two red buttons simultaneously. Joan's body jerked as the larger current pulsed through her body. The monitor showed a momentary pause, and then a very fine, chaotic pattern.

'Give her 3 amps of Epi now. Charge the paddles to 360 joules.'

Linda pulled three amps of epinephrine from the crash cart, and as quickly as she could, injected each of them into Joan's IV. 'It's all in, Doc.'

'Keep pushing her chest for another minute. Are the paddles charged?'

'To 360 joules. Ready.'

As a code team member took over compressing Joan's chest, Ray found himself saying a little prayer. He knew that Joan's death would be hard for Sandra. But it also would be hard for him. He didn't like patients dying on him when he didn't even know why. Somehow he would find out why.

'OK, everyone clear?'

'Clear.'

'Clear.'

'Here goes.' Joan's body again jerked as the current pulsed through her body. But the monitor was now showing a straight line. 'Someone got a flash light?'

Linda reached into her pocket. 'Here, Dr. Dehey.'

Ray stepped to the head of the bed, and gently lifted Joan's eyelids. Her pupils were dilated. He turned on the flashlight, and brought the light across her pupils. There was no response. Joan's brain was dead. It no longer responded to light, it could no longer maintain a heart beat, and it's breathing centers were destroyed. Joan was gone.

The code had been going on for nearly 40 minutes. The monitor still showed a straight line, the respirator was still breathing for Joan, and her chest was still being compressed by another human being. But Joan Denning was gone. Even if her heart could be made to beat again, even if her brain could be resurrected enough to give her spontaneous respirations, Joan Denning would never be Joan Denning again.