He opened one of the alcohol preps and swabbed the area vigorously, making the vein stand out even more. He then pulled one of the 18-gauge IV catheters out of the holder and opened the packaging. “Here we go, Matt,” he said. “Big poke. Hold still.”
Matt held still. Jim got an immediate flash of blood in the catheter’s chamber, indicating he was in the vein. He slid the catheter downward, until the hub was flush against the skin, and pulled out the needle, leaving the catheter behind. Needles that safed themselves after use were still a few years in the future, so Jim dropped the sharp on the floor and put his foot over it to keep anyone—particularly himself—from getting accidentally poked with it before it could be secured in the sharps container. God only knew what kind of nasty bloodborne diseases Matt Tisdale might be carrying. He pushed forcefully down on Matt’s vein above the catheter to keep blood from oozing out and then, with the mechanical skill of one who has performed the maneuver hundreds, maybe thousands of times before, he picked up the saline flush and popped the cap off of it with one hand. He then plugged the end into the catheter and released the pressure on the vein. Carefully, he flushed a little bit of saline in, making sure the IV was patent. It was. He then disconnected the syringe part of the flush, leaving the flush tubing and the catheter in place. He dropped the syringe next to the foot covering the exposed needle—it would be placed in the sharps container as well—and then covered the catheter portion with the transparent dressing from the start kit. He then taped everything in place with the tape strips from his leg.
“All right,” he said. “Give me the end of that IV tubing.”
Corban reeled it in and handed it over. Jim removed the cap and screwed it into the hub on the saline lock he had just installed. He then reached over and opened the clamp on the tubing. He looked at the drip chamber and saw the fluid was infusing rapidly. Another confirmation that the IV was correctly placed in a vein. He then looked at Matt’s arm and felt the area just downstream of where the catheter was. There was no swelling or other signs that the IV fluid was extravasating. It was a good line.
“I’m in,” he said. He then looked over at the monitor. Matt was still in SVT at 210.
“Let’s do this thing, dude,” Matt told him. “Give me the shit.”
Jim reached in the football and got the shit. He pulled out a vial of Adenosine and a 10ml syringe. He put a needle on the end of the syringe and then popped the cap on the vial. He drew up two milliliters, which contained six milligrams of the drug. He then recapped the needle, removed it from the syringe, and set it aside in case he needed to use it again. He opened the second alcohol swab from the start kit and used it to sterilize the hub on the IV tubing, the one closest to the end that plugged into the catheter. He then screwed the syringe of Adenosine onto that hub.
“You ready, Matt?” he asked.
“Yeah,” Matt said softly, taking a deep breath. “I really hate this part.”
“Me too,” Jim said. He pinched the IV tubing just above the hub and then rapidly pushed the entire syringe full of Adenosine into the tubing. As soon as it was in, he un-pinched the tubing and glanced at the drip chamber to make sure it was flowing again. It was. He then turned his eyes to the monitor. The Adenosine usually worked in less than ten seconds.
Ten seconds came and went, and nothing happened. The tracing continued to blast along at 210 beats per minute.
“What’s happening?” Matt asked. “I don’t feel that funky shit in my chest like before.”
“It didn’t work,” Jim said.
“What the fuck do you mean, it didn’t work?” Matt barked.
“I mean it didn’t work,” Jim said. “It happens sometimes. Your heart doesn’t want to convert this time.”
“What the fuck do we do now?” Matt demanded.
“I’ll give you another dose,” Jim said. “Twelve milligrams this time.”
“Jesus fucking Christ,” Matt said, shaking his head. “You’re not earning your fuckin’ Christmas bonus here, dude!”
Jim screwed the needle back on the syringe and opened another vial of Adenosine. This time he drew up four milliliters of the drug. He swabbed the hub with the alcohol prep again and fastened the syringe.
“All right,” Jim said. “Let’s hope it works this time.” He pinched the tubing, injected the medication, and then un-pinched. A quick glance at the drip chamber and then his eyes went back to the monitor screen.
This time, something happened. Matt’s heartbeat stopped completely for the better part of five seconds. Jim glanced over at him and saw he was even more pale.
“Ohhhh, fuck, I hate this shit,” Matt groaned.
Jim understood. It undoubtedly felt terrible when your heart was no longer beating. But at least the medicine had worked this time. As long as Matt’s heart started back up, everything should be good.
Two wide-complex beats fired off on the monitor screen. There was another long pause and then two more fired. A shorter pause and then three narrow, inverted beats fired in rapid succession. After that, normal complexes began to fire at a reasonably regular rate of ninety-two per minute. Jim breathed a sigh of relief.
Matt’s sigh of relief was even bigger. “Fuck me,” he said. “My chest feels normal again and I can breathe. Did it work?”
“It seems like it did,” Jim said. “You’re back in a normal sinus rhythm.”
Matt nodded. “My man,” he said. “That’s why I keep you around.”
“He’s better now?” Diane, the flight attendant, asked carefully.
“It seems like it,” Jim said. “Let me just check his blood pressure again.”
Jim put the stethoscope back in his ears and pumped up the cuff once again. This time, Matt’s reading was 162/90, which Jim suspected was his normal pressure that he walked around with day in and day out.
“How are you feeling, Matt?” Jim asked him.
“Better,” Matt said. “Much better. Go ahead and get all this shit off of me now.”
“No way, Jose,” Jim said. “I’m keeping this monitor on you and that IV in your arm and this football open until we’re on the ground. And when we get there, I want you to go to the hospital immediately.”
“Fuck that shit,” Matt said. “I just want to finish my drink and then catch a little sleep.”
“I’m going to have to insist this time, Matt,” Jim said. “You’re having these episodes way too often now and they’re getting harder to break. You need a cardiology workup.”
“You don’t get to insist anything, dude,” Matt told him. “You’re here to do what you just did, and I thank you for it.”
“Listen, Matt,” Jim said. “This is some serious shit you’ve got going on here. Do you want to die? Because this might very well kill you one of these times.”
“We all gotta go sometime,” Matt said.
No one had noticed that Diane had disappeared. At least no one noticed until she came back with a middle-aged balding man in a white uniform in tow.
“Hello,” the man said, his voice stern and unamused. “I’m Michael Bordon, the captain of this aircraft.”