Once inside, Mitt pressed the button for ten, and then let himself lean his back and head against the elevator wall. Desperately, he tried to make sense of what he’d just witnessed. He had no idea if it was the same group of sad people that he’d seen in the OR and the surgical conference room, but they appeared similar. Regardless, in his mind they certainly represented the same pitiful constituency that Mitt imagined had been operated on at Bellevue Hospital in the distant past. How his mind was capable of mentally imagining such a crowd, he had absolutely no idea. Nor why, which seemed an important question, his hallucinations were coming more frequently and with increasingly realistic details. The vision of the young girl had been shocking enough, but these crowds of tortured souls were far worse. And what about the rats? A few years ago, when he’d read a book about the history of Bellevue Hospital, he’d learned that rats coming in through the sewers had been a major problem in the hospital over many, many years, partially due to its location along the East River. He’d been appalled that the vermin had been known to climb over bedridden patients at night, possibly gnawing people and even infants. As awful as that sounded, why was his creative mind adding those creatures to his hallucinations? It certainly hadn’t been something he’d spent a lot of time thinking about.
The elevator door opened on the tenth floor, and Mitt exited. He’d mostly recovered from the fright of his hallucination, even wondering anew what would have happened had he simply ignored what he’d seen and just boarded the elevator despite it appearing jammed full. Would they have physically blocked his way or just instantly disappeared? It was an interesting thought, but he doubted he’d have the courage to put it to the test.
When Mitt pushed into the ICU proper, he felt significantly better than he had on his previous visits. He imagined the resuscitation team was already present, so he was confident he wouldn’t be expected to do something beyond his abilities. He was also just becoming more acclimated purely by repetition.
As he approached Elena Aguilar’s ICU room, he again saw a clutch of people observing just outside the door, but it was a significantly smaller number than had been outside Latonya Walker’s room. When he got close enough to see within the bay, he could tell it was the same team that had responded to Walker’s arrest. He wasn’t surprised, as he imagined there was only one resuscitation team on during the night, but he didn’t know that for sure.
First he looked for Dr. Madison Baker either inside the room or in the hallway, even though he didn’t expect her to be there. He knew she’d been at Walker’s arrest by chance. Although he wished she was there for the support she offered, he didn’t want to call her if he didn’t have to.
“How is the resuscitation going?” Mitt asked one of the few ICU nurses observing the action from the hallway. She was a youthful Hispanic woman who was about Mitt’s age. He was impressed she was working in the ICU, where most of the other nurses appeared older and more seasoned.
“Not well,” the woman said. She briefly eyed Mitt, making him suspect she was thinking the same thoughts about his age. “I think they are about to call it quits.”
“So soon?” he questioned. He tried to see this youthful nurse’s name tag, but it was covered by the surgical gown she was wearing over her scrubs like Elena’s earlier nurse.
“I understand there’d been some disappointing new developments in the patient’s condition,” she added. “And that’s in addition to her reverting back into ventricular fib after every defib attempt.”
“Oh?” Mitt questioned. “Like what kind of new developments?” Elena Aguilar not breathing on her own for more than twelve hours was certainly serious enough. He couldn’t imagine what could have been more “disappointing” than that. He noticed some of the ICU staff who had been watching the proceedings were turning to leave.
“I heard she’s been exhibiting some decerebrate posturing,” the nurse said. “And that’s serious stuff, especially when it’s progressive as it’s been. It certainly goes a long way to explain why she hasn’t made any attempts to breathe on her own the whole time she’s been here.”
“I’m not familiar with decerebrate posturing,” Mitt admitted. “What is it exactly?” He tried to rally his tired brain, but it was difficult. He vaguely remembered the term from his medical school neurology rotation, but all that came to his mind was it being seriously bad news and generally incompatible with life.
“You don’t know what decerebrate posturing is?” The nurse eyed Mitt with surprise, but then her expression changed, ushering in a smile of sudden understanding. “Wait a second! Are you perchance a new resident? I mean, it is the beginning of July.”
Mitt raised his hands in mock surrender. “Third-day surgical resident,” he confessed. He was happy to admit it, particularly there in the ICU.
“Of course! Well, welcome to the team! To answer your question, decerebrate posturing is a hyperextension reflex. Usually, the arms are tensed with the palms rotated outward and wrists flexed, which you can see some of if you look in at this patient. What it probably means is that she’d had a major stroke that involved the brain stem.”
“Good grief,” Mitt said, wondering if Elena Aguilar had had a stroke during her surgery, which no one suspected, particularly Anesthesia.
“Are you following this patient, or are you here just being curious, like me?”
“I assisted with her vein stripping this morning.”
“Well, that’s nice to hear. At least she no longer has any varices.”
Mitt regarded her. He was mildly taken aback by what seemed like an insensitive comment, but he saw a slight rise to her eyebrow, suggesting she was indulging in a bit of “insider” black humor.
“Well, nice chatting,” the nurse said. “I have to get back to my patient who luckily is doing a lot better than this poor woman. Sorry about your patient, but good luck in your residency!”
“Thank you,” Mitt said. As the nurse walked away, he moved into the relatively crowded room and found a place to stand off to the side behind the medical resident, who was clearly the captain of the resuscitation team. Since the ventilator was respiring Elena Aguilar, no one needed to be manning an Ambu bag, and everyone was watching the monitor except the medical resident, who was kneeling on the bed and doing the chest compressions. By moving slightly side to side, Mitt was able to get a reasonable view of Elena’s body and confirm what the nurse he’d been talking to outside the room had told him, Elena’s arms were rigidly held along her sides with her wrists flexed and palms directed outward. Also, from his perspective, it appeared as if her back was slightly arched. Her legs, still covered with Ace bandages, were definitely straight out, with the toes extended and pointing medially. Mitt made a mental note that what he was looking at was an example of decerebrate rigidity, suggesting that Elena Aguilar had suffered a major stroke, or maybe even a series of major strokes that had been missed.
“All right, everyone, clear,” the captain of the resuscitation team called out. “Let’s try one last defibrillation attempt.” In either hand, she was holding up the charged paddles of the defibrillator. As soon as everyone backed away, she placed the paddles against Elena’s chest and discharged the defibrillator. Elena’s body reacted stiffly, very different from Latonya Walker’s when she’d been shocked.
At that point everyone in the room, now including Mitt, watched the overhead monitor to see the result. Within seconds the blip reappeared, tracing a wildly abnormal pattern as it moved across the screen.