I hardly celebrate Valentine’s Day. It’s not that I’m against romantic love; I figure one of the ace cards in my life is that I met Matt in high school and didn’t waste a few decades finding the right person. (This is us, struggling to say goodbye before he flew off to Greece on a school trip. Our friend Zygo took a picture of us through the bus window.)
So I’m not going to bludgeon you with flowers. Instead, I’m going to give you anatomical hearts and
circulation pictures and the second chapter of Human Remains, because nothin’ says romance like trying to resuscitate a dead body in the snow. This book is almost ready to rock and roll! Let me know if you want to be part of my “street team,” reviewing an advance copy.
And if you want to read Stockholm Syndrome first, they’re down to their last two copies at Librairie Paragraphe Books! Go grab it in the next 24 hours, support an indie bookstore, and rebel against the norm by reading about a hostage-taking while everyone else.
The body wore a shiny, new, navy ski jacket. It lay crumpled on its left side, its black-jeaned legs slightly bent, and one arm rolled up underneath it, while the other arm hung forward, half-blocking the chest. Its skimpy black gloves and beat-up Converses didn’t look like much protection against the snow.
But of course, the most shocking thing was the black bag over its head.
Ryan stood frozen. His breath spun into the air, making white clouds in the night.
Roxy bent her head, tipping her floppy ears forward. Her nostrils flared and glistened under the dim light of the streetlamp.
“Let me check it while you call 911,” I said to Ryan. Even as I spoke, he pulled his phone out of his pocket. With the other hand, he reeled Roxy’s leash in tight to his body. He yanked off his left glove so he could work the buttons while watching the body.
If this was a crime scene, I shouldn’t touch anything, including the bag taped around its neck.
But I was a medical doctor.
Okay, a resident doctor. But still. My job was to make sure he was alive.
And if he wasn’t, my job was to bring him back.
There’s a saying in medicine, “They’re not dead until they’re warm and dead.”
Snow meant zero degrees Celsius or lower. This man was definitely not warm and dead.
I swallowed hard.
I had to do my job.
If only I could do my job with gloves and a face mask.
I crouched low. “Hello?” I raised my voice to be heard above the traffic, including the stuttering roar of a helicopter. Normally, I’d shake him, or do a sternal rub, but I didn’t want to touch the body.
More snowflakes landed on the jacket.
The bag didn’t flutter with the man’s breathing.
No airway. No breathing.
“Hope, he’s—” Ryan didn’t want to say it, but we both knew he was thinking the D word. Not Disability, but Death. “Don’t touch it, Hope.”
If only I had an ultrasound machine to do a sono pulse check, looking for a beating heart, instead of going skin to skin. “Just the radial artery,” I said. I reached for the closest arm, the right arm, sheathed in the painfully new ski jacket.
The wind carried Ryan’s words toward me as he spoke on the phone. “Ambulance. But maybe police. We found someone with a bag over his head. He’s not moving. He looks…gone.”
I touched the man’s sleeve first, through my mitten. His arm felt firm, even with that light touch, and it belatedly occurred to me that I didn’t have to check for a pulse if the man had rigor mortis.
The arm resisted me when I lifted it. It did move, but only a few centimetres before I’d have to apply greater pressure. The muscles had seized up. But it didn’t feel locked-in, like I imagined rigor mortis would.
On the other hand, it was literally freezing outside. Was I feeling rigor mortis, or one very cold person?
I didn’t trust my numb hands to undo the black tape around his neck, and surely there might be fingerprints or hair trapped in the tape that constituted police evidence, if this was a homicide.
I yanked off my mittens and used my nails to lift a bit of the right sleeve and expose the skin. In the dim light, I couldn’t detect bruising or obvious lacerations on his dark brown wrist.
Since I didn’t have any open cuts or sores either, it was probably safe to touch him bare-skinned.
Ryan was giving directions. “We’re near the corner of Lindsay and Bullock. Yes, just south of the hospital. My girlfriend is a resident doctor from Montreal. She’s checking for a pulse.”
I slid my hand just inside the radial styloid, pressing hard to compress the artery against the bone and maximize any pulse.
His skin felt slightly cooler than mine, but not icy. Faintly warm.
The radial pulse is the first to go. Unless you’ve got a blood pressure of at least 80 millimetres of mercury, the body shuts down circulation to the arms.
The blue lights of a police cruiser raced up Lindsay Lane toward us, its siren splitting the air.
“Ryan,” I hollered, above the din, “there’s no radial pulse.”
Roxy barked twice and jumped onto her back legs. I sucked my breath in. Nice dog, but she was still a Rottweiler who wanted to snack on a dead body, as far as I was concerned.
“No radial pulse. That’s right, no radial pulse,” Ryan yelled into his phone while winding Roxy back into place beside him.
“I’ll have to open that bag over his face!”
“What?” Ryan frowned at me, trying to triangulate between 911, Roxy’s antics, and my voice.
Ryan’s eyes were so wide, I could see the whites glowing under the street light. “What? No, Hope, he’s dead. I think they want you to leave it for the police!”
I was already reaching for the bag, bracing for myself for whatever sick smell that would balloon out at me as I tore it. “Just ask them. He’s still warm.”
“Uh…my girlfriend, the doctor…she’s worried about the bag over the head. Do you want her to take it off?” He shook his head. “Yeah, he looks dead, and he has no pulse, but he’s still warm…yes, I’ll hold.” He glared at me. “Hang on a second.”
I nodded. In the ER, the staff and I could make the decision, but in the field, at what could be a crime scene, with the police car screeching to a halt on the other side of the street.
I stood up, and my vision started to blacken at the edges. I hadn’t eaten much today. Too busy packing and driving from Montreal through the snow. I blinked, waiting for my vision to come back. I’d never fainted in my life. I had no intention of doing so over a corpse.
“Hope, they said not to touch the bag. Hope? Are you okay?”
“Fine,” I said, too loudly. My vision was starting to clear. “I’ll do CPR.”
I donned my mittens to nudge the body onto his back. He wanted to stay curled up. Ryan had to hold down the shoulder while I twisted the hips flat on the ground.
I dropped to my knees, interlaced my fingers, and extended my arms to begin CPR. The new Advanced Cardiac Life Support algorithm is all about CPR. Get that blood pumping. Even if he’s hypoxic with a bag over his head.
His ribs cracked under my first compression.
I’ve never broken anyone’s ribs during CPR. It’s one of the risks of CPR, but it’s never happened to me.
I could be puncturing his lungs with his own ribs, with each compression.
“Over here!” Ryan’s cry pierced the night air. Roxy barked ferociously as a police officer bolted across the road toward us.
Another siren whooped.
The first police officer yelled on his radio while I continued compressions, gritting my teeth.
Roxy barked and leaped in response. Ryan had to beat a retreat, holding her back.
A second officer sprinted to my side and took over CPR while I checked for a pulse in the wrist. It was strong, thanks to his efforts.
Sweat trickled down the side of the CPR officer’s face as he pounded the man’s chest. He shook his head and glanced at the officer on his radio, possibly for a second opinion, before turning back to his compressions.
Two more officers crunched through the snow toward us, already calling on their radios for more back up, but I was most relieved when an ambulance jerked to a halt on Lindsay Lane.
Paramedics hustled to the scene with a stretcher, a kit, and a monitor. One of them sliced open the head bag with scissors, reminding me that it’s better to ask for forgiveness than permission.
The sour smell of vomit hit the air as chunks fell out of the bag hole. I held my breath while the other paramedic cut open the jacket to apply electrodes to the man’s chest. Yes, it did look like a man. No breasts.
The CPR officer was gasping, so I said, “Do you want to switch off?” He nodded, and I signalled another officer, who ran in, dropped to his knees, and started compressions so enthusiastic that the man’s slim, dark brown-skinned chest indented with each one.
We paused for a second to check the rhythm: an occasional narrow complex at 30 beats per minute. No pulse.
Hypothermia is one of the causes of pulseless electrical activity. So is hypoxia.
“Restart CPR! And I can get an airway in!” I called, moving to the head, but the airway guy was already on his stomach, shoving what I assumed was a laryngeal mask airway or a Combitube into the man’s mouth. It was hard to see what was going on, in the dark, with everyone shouting on their radios, and Roxy still barking up a frenzy.
“Got it!” called the airway guy.
“Great. Let’s get him warm and oxygenated. Can you get a sat?” I turned to stare at the yellow tracing on the monitor, which was just showing the jagged movement of compressions right now.
“It’s not picking up, but the CO2 detector is yellow.”
“Good job! Give him an amp of Epi!” I said. We had airway and we were providing primitive breathing and circulation. Epi is controversial in hypothermia, but you can give one dose.
“Let’s load him up and protect his C-spine,” said the second paramedic. I helped lift the legs on to the stretcher while they managed to get a cervical spine collar on him and some pads on either side of his head. A third officer took over CPR.
“I can take over compressions,” I told the CPR police officer, even though I’ve never done them while jogging along beside a stretcher, but he shook his head.
The patient’s belly looked distended. I opened my mouth to mention a nasogastric tube, when they had the chance, but a female police officer took my arm and said, “We have some questions for you. Could you come to the station with us?”
While you’re waiting for more Human Remains (deeeeelicious, I tell you), check out two mega-giveaways: science fiction and fantasy (I’m giving away Fairy Tales Are for White People!) and mystery/thriller (I’m giving away Code Blues, the first Hope Sze novel, in hopes that sane people will leave a good review).
Just to show you that I’m not a complete V-Day Grinch, I’ll end with another story. Remember Zygo, who took the picture of me and Matt in high school? When Anastasia was a baby, we attended Zygo’s own wedding with his lovely wife Jenny and a Tardis wedding cake. (Gosh, I miss that sweet little baby. However, I have to admit that Matt carried her around the entire time.)
Ah, love. I heard it makes the world go ’round. Of course, I’ve also heard that the earth’s spin is due to “gravitational collapse of accreting material,” but details, details.