Grave Prognosis
By Daniel Kalla

Chapter One

After stepping into the nightclub, it took a moment for Mike Todd’s eyes to adjust to the room’s dimness. But once they did, he felt as if he had walked onto the set of a fifties’ film noir. The scattered couches, drab walls adorned with a few black-and-white pictures, the bar and, perhaps most important, the cloud of smoke that hovered in the poorly vented room, invoked a sense of something sinister. Adding to this effect were the nearly two hundred mainly black-clad people crowded into the small club.

"Mike, over here!" called a woman’s voice.

Mike wove his way through the mismatched, and seemingly randomly scattered chairs, ottomans, and sofas until he reached the tattered, orange-gray couch that Nicole and David had claimed.

David Klein shook Mike’s hand, and Nicole Samus greeted him with a hug and a kiss on his cheek. "Welcome to the BeatRoom. Is it just like you imagined?" she asked expectantly.

"As a matter of fact, it is," Mike said. "Much like the karaoke club, the line dancing place, and the oxygen bar were. Can I go home now?"

"I think you misunderstand the purpose of tonight," David piped up. "These aspiring poets are going to stand up in front of a roomful of strangers, and pour their hearts out. That takes guts."

"And?"

"And we’re going to laugh at them. It’ll be fun."

Nicole punched David’s arm. "That’s awful. Nobody laughs at you up there."

"Because they don’t get me," explained David.

"David, no one gets you," said Mike, as he squeezed himself into a corner of the couch beside Nicole.

"What’s on your shoes?" David asked, pointing to the dark stains on Mike’s oxfords that could even be seen in the weak light.

"I forgot to bring a pair to change into. So I had to work in these."

"Fascinating. But what I asked is what’s on your shoes?"

Mike pointed to the tip of his left shoe. "That’s where the drunk puked on me."

"Emergency Medicine. All glitz and glamor," Nicole interjected.

"True enough, but this particular drunk was only four years old. He had confused a bottle of his dad’s ouzo for liquid licorice. And then my next patient, a drunken homeless guy, tried to wash the stains off. But I wasn’t all that keen to have him piss on my feet."

"What about the other stuff? Looks like blood," Nicole asked.

"It is." Mike sighed. "An older fellow came in with belly pain. Nice guy, too. And stoic like you wouldn’t believe. In fact, when I told him that his abdominal aortic aneurysm had dissected—"

"You’re losing me, Mike," Nicole said.

"Sorry. The main blood vessel in his belly was leaking, and about to burst. Like Saran wrap covering a crack in a dam," Mike explained. "When I gave him the news, he just smiled and asked me to call his brother-in-law, the life insurance salesman. Then he told me a story about how he stood on a landmine in Korea forty-five years ago and how terrified he had been. After he finished, he smiled again. And there was no mistaking it, he had that look in his eyes." Mike shook his head. "He said he wasn’t scared anymore. Told me he was ready to lift his foot. About a minute later the aneurysm burst right in front of my eyes."

"What did you do?" Nicole demanded.

"What could I do? I opened his abdomen and tried to clamp the aorta, but it was hopeless. Like trying to turn off a fountain from above. All I accomplished was to soak the floor of the ER and my shoes with the poor guy’s blood."

"Too bad." Then after a pause, David added, "They look like they used to be nice shoes."

Nicole punched his arm again.

Mike surveyed the bleak room. He could barely see the framed posters on the walls, let alone make out the faces. Even if the light were better, he wouldn’t have recognized the portraits of such Beat writers as William S. Burroughs, Allen Ginsberg, Lawrence Ferlinghetti, and Jack Kerouac.

Just then a spotlight hit the center of the room, and Mike’s attention was drawn to the empty stool and microphone that it illuminated. At the same moment a voice announced over a speaker, "Show time."

From Mike’s side of the room, a tall blond woman gracefully approached the stool. Only when she passed by his couch could Mike see her features in the weak light. She was stunning, but what struck him most was the way she moved. Wearing a formless gray dress and no makeup, she still conjured up a vision of a model gliding down a Paris runway.

"Cute, isn’t she?" Nicole whispered to Mike, elbowing him just below his ribs.

The performer didn’t introduce herself. Instead, she sat down on the stool and flashed a wistful, half smile. Her green eyes widened momentarily. Then the smile left her lips.

The name of her poem, she announced, was "Life, What’s the Point?" Although her poem alternated between verse and prose, she spoke it with a pleasant, lilting voice and a steady rhythm that made it sound musical. At first Mike had difficulty concentrating on her poem. He was distracted by the legs that emerged from her dress hem, somewhere near mid-thigh, and the way they unapologetically crossed and uncrossed as she recited.

At one point a drunken voice in the back of the room called out, "Hey, Leonard Cohen, when did you start looking so fucking good?"

"About three tequilas ago," she nonchalantly replied to scattered laughter.

Then she continued with her poem. "You listen to my rants because I please your eye. You want in my pants, so you lend a sympathetic ear. But make no mistake, the chill in my soul is as real as real can be."

She seemed to look straight at Mike, making him feel uncomfortable. But as he listened, he grew captivated by her poem. She spoke of personal emptiness, to which he could relate, then she concluded with the same bleak verse that began her poem:

"Did you ever long for the barrel of a gun scratching your temple?

Did you ever swallow a mixture of pills you prayed would prove ample?

Have you ever stood on a ledge and willed your feet to lead by example?

For I have known this loveless life. It’s a path I have trampled."

Finished, she replaced the microphone in its holder. "Thank you for listening," she said demurely, then rose and walked away from the stool.

Even as the announcer was saying, "Let’s hear it for the desolate sounds of Monica!" the audience was clapping enthusiastically.

Mike looked at David. "What do you think?"

"Not one of her best, but not bad. Comes here every Tuesday. She’s got quite the following, too. Then again, look at her. She could fill the place by reading the warning labels off cigarette packages."

"I thought that was your act," Nicole quipped.

David turned to Mike. "I live with this, Michael. Now that should put a chill in your soul as real as real can be." But he warmly stroked Nicole’s arm as he spoke.

"C’mon," Mike urged, "I know you’ve got more to say about her."

"Actually, she has real talent. I’m sure she’s trying to get this stuff published."

"Why’s that?" Mike asked.

"Look how drably she dresses. Trying to get noticed for her poetry and not her appearance."

"That would be your psychiatric opinion?"

"No. That would be a highly intelligent observation. Don’t get me started on my psychiatric opinion. Were you listening to her poem, for God’s sake?"

Before Monica had finished reciting, a man at the back of the room stood up and walked toward the exit. He had no intention of leaving; he just wanted a seat closer to the ladies’ room. And as he moved his large frame to a recently vacated chair, he reflected upon her poem. Maybe I’m doing her a favor, he thought.

For a man of his size, he slipped with surprising agility into the empty chair. Then he waited. And waited. To his mind, the performers that followed Monica weren’t of her caliber. The only bearable one was some guy named David who taunted the audience with a series of mildly humorous invectives.

Out of boredom, the man repeatedly dipped his hand into his jacket pocket and toyed with the small plastic plunger. It felt so deceptively innocuous.

Finally, he noticed his cue. He eased out of his seat as she passed. He expertly dodged the counter-flow traffic so that he was a mere five feet away as she rounded the corner, heading for the ladies’ room. By the time her hand reached the door, he was directly behind her. Without slowing a step, he discreetly stretched his draped right hand across to the back of her right thigh. In one fluid motion he stabbed her leg with the tiny needle and syringe held in his hand.

As soon as he had passed Monica, in a voice barely loud enough for her to hear, he said, "It’s time dear." Then, without turning around or altering his pace, he walked out of the BeatRoom.

Having finished his unusual poetry reading, David returned to his seat. "I thought that went quite well," he loudly remarked, seemingly indifferent to the cold stares of the people at the neighboring couches.

"Better than last time, angel." Nicole turned to Mike. "Last week David referred to the audience as pond scum. I don’t know why he has to provoke people like that."

"That’s David for you," Mike said with a shrug. "But it explains why you never run out of cake at his birthday parties."

Then Mike turned his attention back to his search. He had been hoping to see Monica, the tragically beautiful or beautifully tragic poet, ever since her brief appearance. He had no plans to approach her; nor did he envision any across-the-room flirtation. He just wanted another look. But he scoured the room for her in vain.

After David, came the evening’s final performer—a slight, nervous man who had a sparse patch of hair under his lip that barely qualified as a goatee. He could hardly be heard above the clamor of the inattentive crowd, but Mike enjoyed his angry poem, "Meet My Parents, Channels 4 and 7."

Then, the announcer said, "That’s all folks," and the lights came up.

Mike’s attention was reflexly drawn to the noticeable bloodstains on his shoes. But he quickly looked away and said to Nicole, "I’m going to have to watch a lot of Disney movies before I can come back and sit through this despair again."

"I think she may be single," Nicole said, as she donned her jacket.

"Who’s that?"

"Monica. The only reason you’d even consider returning here."

"Look, Nicole, just because I said I might return—" But Mike didn’t get the chance to finish. He was interrupted by a loud, panicky voice coming from somewhere on the other side of the room.

"Is there a doctor here?" the voice bellowed.

Mike and David rushed toward the source of the voice, pushing their way through a circle of people. On the dirty floor near the bar a woman contorted wildly, contracting her arms and legs. Three people were kneeling around her; one man was feeling for a pulse while the others were trying to restrain her arms and legs.

"Excuse us, we’re doctors!" Mike said, gesturing for the three men to move as he squatted near the woman’s head.

"She’s having an epileptic fit," said one of the men. "I’ve seen my wife have a dozen of these, but this one’s been going on way longer."

Mike ignored the remark. "Has anyone called 911?" Someone signaled affirmatively. "Okay, I need help moving her onto her side."

It took four of them to roll the seizing woman onto her side. Then Mike placed a jacket under her jerking head.

After he completed a cursory physical exam, he checked her skin for the telltale track marks of intravenous drug abuse, but found none. Then he asked a bystander to check the stricken woman’s purse for medications, syringes, or anything relevant.

"Does anyone know this woman?" he asked of the room. But the blond hair and gray dress, now soiled with urine, had already identified her to Mike.

"She’s here every Tuesday," someone ventured.

"That bit of essential medical history aside," David intervened sarcastically, "He wants medical details. Does she have epilepsy? Does she use drugs? Is she a diabetic? Or is this just part of her act?"

"Her name’s Monica," the bartender volunteered. "She usually looks healthy. And I don’t think she’s into drugs, because she hardly ever drinks. But that’s as much as I know."

No one else had any useful input.

Mike turned to David. "She’s obviously been seizing for a while. Look at her color—gray as her dress. Where the hell are the paramedics?"

Two minutes later the first of the paramedics arrived. The growing crowd parted to allow them through. Mike recognized both men. Joe Murray was balding, fortyish, and fair-skinned. "You’ve got it all wrong, Dr. Todd. How it works is I bring you the patients," he joked.

His partner, Juan Rodriguez, acknowledged Mike with a nod, as he opened his pack and prepared the necessary equipment.

"Guys, we’ve got a long case of status epilepticus here," Mike said. "Let’s get her on ten liters of oxygen. Joe, we need an IV now. Juan, give her four milligrams of lorazepam IV ASAP."

Joe and Juan squatted on either side of Monica. Like an experienced wrestler, Joe pinned her flailing arms. Meanwhile Juan delicately threaded an intravenous catheter into her animated extremity. Then he applied a small syringe to the catheter and pressed the plunger. "Okay, the voodoo juice is onboard."

Soon after the initial intervention, the woman’s body relaxed. Her breathing eased and her color improved. Joe whistled approvingly and said to Mike, "Now I see why you were trying to save her."

Juan rolled his eyes at the politically suspect comment. "Do you know her, Doc?"

"No idea. She did a poetry reading earlier. Pretty heavy stuff. It makes me wonder if she deliberately OD’d on something. Anyway, we’d better get her over to St. Joseph’s."

While the paramedics were preparing the patient for the move, Mike said his good-byes to David and Nicole, explaining that he intended to stay with the patient until she reached the ER.

As Joe and Juan were loading Monica into the back of the ambulance, Mike noticed a change on the monitor. "It must be a loose lead." Even as he made the remark, he knew the patient didn’t look right. He put his fingers on her long neck, and searched purposefully. "She hasn’t got a pulse! Get her back on the sidewalk!"

The monitor showed an asystole, also known as a "flat line." Joe and Juan reacted instinctively. No sooner had the stretcher landed on the sidewalk with a loud thump, than the paramedics began CPR. Joe used a breathing mask to force oxygen in and out of her lungs, while Juan straddled the stretcher and used his interlocking hands to violently compress her chest in an attempt to passively circulate blood through her inactive heart.

"Give her epinephrine three milligrams and atropine one milligram now!" Mike barked. "And get two liters of normal saline into her stat!"

Mike removed some equipment from Juan’s kit, then took over Joe’s position at the head of the stretcher. Devoid of all intrinsic muscle tone, Monica’s doll-like head flopped obediently into the anesthetic or "sniffing" position on the stretcher. Mike clicked open a laryngoscope, which in profile resembled a small scythe. He leaned forward, steadied his left hand, and advanced the implement’s blade into Monica’s mouth. He gently pushed her tongue out of the way so he could use the laryngoscope’s light to visualize her vocal cords, then he inserted the endotracheal or breathing tube down her windpipe. Once the tube was secured, they had a more efficient way of getting oxygen to the lungs as well as protecting them from inhaling any vomit.

As he completed his physical exam, Mike considered the possibilities. "Can’t be a tension pneumothorax or pericardial effusion," he said, referring to either a massive air blister in the lungs or a buildup of blood between the heart and its sac. "Too young to be a heart attack, but I guess possible. We know it’s not the blood sugar. Basically it comes down to super high potassium, drugs, poisons, or a huge pulmonary embolus."

A large crowd had already formed on the sidewalk around Mike and the paramedics. The fascinated but bewildered audience watched the spectacle in silence. They heard a multitude of drug names and dosages such as "Narcan five milligrams," "magnesium sulfate two grams," "two ampoules of bicarbonate," and "more epinephrine" bandied about.

Juan stopped his piston like compressions, and brought a hand to Monica’s neck. "Doc, we got a pulse," he said in a quiet, almost disbelieving voice.

"We sure do!" Joe smiled as he inflated the blood pressure cuff on her left arm. "Pressure’s holding at 140. I can’t believe we got her back from asystole. That never happens."

Some of the people in the crowd began to clap.

Mike shook his head. "We’re not out of the woods yet. Let’s get her over to St. Joseph’s before God-knows-what happens next."

As they loaded Monica into the back of the ambulance, Joe said, "Shame to disappoint our fans by leaving so soon."

Mike frowned. "In this neighborhood they won’t have to wait long ’til someone else gets stabbed or shot."

Juan got into the driver’s seat as Mike and Joe hopped into the back. As soon as they were in, Juan switched on the sirens and started the ambulance.

As they neared St. Joseph’s ER, Joe said, "Considering she’s had two slow dances with the Grim Reaper in the past half hour, she’s remarkably stable. We could easily pull this tube out and she’d breathe fine."

"Don’t take any chances with this one," Mike cautioned. "She’ll die just as soon as look at you."

Joe sighed, and squeezed another breath of pure oxygen into her lungs. "She’s like all the other women I’ve met."

Mike pointed at Monica. "A seizure followed by cardiac arrest in a healthy twenty-something year old. It’s bizarre. But it reminds me of a lot of another case I heard about recently. A woman arrived—" Mike’s train of thought was interrupted by the red light emanating from St. Joseph’s huge neon "ER" sign as it flooded into the back of the ambulance.

To Be Continued . . .

Daniel Kalla practices emergency room medicine in Vancouver, Canada. He co-wrote the film script To Love and To Perish for Highwire Entertainment (now in pre-production). His forthcoming novel is entitled Lethal Assistance. He can be reached via e-mail at [email protected].