The Chickasaw Plum

 

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Chapter 4 of a work in progress by John R. Guthrie

Chickasaw: The Good Times and Hard Life of Doctor Christopher Jacques

 

 

Chapter 4: The Gethsemane of Chastity Lee Howard

 

March swooped in, warm and blustery. The willows and poplars in the yard were garbed in the pale and tender yellow-green of early spring. Within the double-wide trailer, Chastity lay on her bed. Her mother, in the next room, prepared to go to church. Chastity, lying on her back, staring at the ceiling, was pensive. But maybe, maybe, it could be that I’m not even a little bit pregnant. That it’s just like a bad dream, like last night when I dreamed that I was supposed to be home by myself but I new there was  something, something really bad in the front room, something worse  than a witch, worse than a devil, worse than Raw Head or Bloody Bones in the scary stories for kids. I wanted to scream but couldn’t make a sound. I wanted to run but I couldn't move a muscle. Maybe I’m dreaming now, and when I wake up, I’ll have to run to the bathroom for a Kotex. ‘cause my period will be started. Everything will be just the same as before.

But her reverie dissolved when she remembered how at school after she first found out she was pregnant, she had to raise her hand in class to go pee so often that the girls whispered, the boys snickered and her face blazed as she left her classroom, unable to lift her yes from the floor before her and moving quickly to the door. But why am I so tired? I’m so worn out I can’t get outta bed to go to school lotsa days, and I can’t get my shoes on hardly. I don’t do nothing but lay around on my bed until that candlewick counterpane leaves dents in my skin. Still I don’t ever sleep good, and I get sick to my stomach nearly every day and just lie there and listen to my music. I don’t think I could live without my music. There has to be a better way. Things can’t be this bad forever. Maybe Randy will come back. You never know. He’d pull in the driveway in that black Honda with the spoiler on the back. I’d hear the car, look out the window and see him getting out. I’d go running to meet him. He’d give me a big hug, and I’d hug him back. Then he’d step back, his hands on my shoulders. “Chas,” he’ll say, just look at  you. Prettier than ever.”

I’ll start tearing up. “But where you been, Randy?”

“Like I said, Honey, I just needed time to think things over, to take it all to the Lord in prayer. And I’m back now, I’ve come for you. We’re gonna go away now, the three of us. Sometimes she though she wasn’t really pregnant, that it was all a mistake, that her period was just late. 

Rubbing her tummy, transistor radio in hand, she arose and stepped into the tiny living room of the trailer. TV church was playing on the screen across from the couch. She turned the volume down then sat again, then lay back to listen to her favorite station WCRS, 98 Rock, on the transistor radio she had pressed to her ear. She picked up a left-over Double Stuff Oreo from the side table and took a bite.  

Her mother, purse in hand, peered in through the living room door, scowling at the recumbent Chastity and speaking to her as she entered. Chastity, absorbed in her music, made no reply. Narrow-eyed, Mama stepped over and grabbed the radio from Chastity's hand, flinging it to the floor. The battery tumbled out as Chastity shrank back, then rose to a sitting position. “Young’n, you better pay attention when I speak to you."

Chastity hung her head, staring at the floor.

Her mother continued. "You better look at me, Miss Lady! All you do is lie around and eat. I sure worked when I was pregnant with you (burden that you were, implicit in her tone). Somebody’s got to pay for all this. You’re showing already. Soon you’ll be big as the side of a barn. I sure don’t have the money for new clothes for this.” She nodded at Chastity’s mid-section as she spoke, then concluded, “You need to get a job.”

“Mama, I will soon, I just can’t right now. I just don’t have any energy. I’m throwing up every morning.” Chastity's eyes blinked and her jaw twitched. “Mama,” She ventured, “please, Mama, I heard that up in Charlotte there’s a Doctor that can help girls in trouble.”

Her Mama looked at her with that particular loathing with which unfortunates confront the reflected image of themselves. “Child,” she hissed, extending her neck toward Chastity,  "I know that because the preacher told us everything about that place when he preached against it. Even if that murder farm, that abortuary weren’t the devil’s work, you don’t have the $400. I don’t either. Not to mention that that car of mine being near older than you. It ain’t going to no Charlotte, and you’re not either. Especially not to kill an innocent baby, you ain’t. I'd rather see you dead and in your grave than you a-murdering a grandchild of mine. You made your bed, Miss Jezebel, now you lay in it!” She stepped up and turned the volume on TV church back up, turned and left the room.

Her mother hesitated, still buttoning up the white blouse the gold angel pin on the collar and looked back toward her daughter. "Chastity?"

Her voice was the merest of whispers. "Yes Ma'am"

“Maybe you better just make plans to get the hell out.”

“But Mama…”

“Don’t but Mama me. It wasn’t me that told you to go out and screw everything with pants on, to be Whore of Babylon for Chickasaw County and run the preacher off in the process. So be getting ready to get out.”

Chastity stood and moved toward her bedroom. “No…”

Mama stepped over, drew back, and delivered a roundhouse slap to Chastity’s face, leaving a red blaze on her left cheek.

“You little strumpet. Don’t you ever dispute my word,

Chastity, sideways from the attempt to dodge the blow, clutched the wall with both hands and slid downward until she was sitting on the floor.

Her mother, hands on her hips, leaned over her and commanded, “Get out!”

She looked up at her mother, face glistening with tears, her retorted; a high pitched and anguished cry. “Mama, I don’t have no place to go. No-o-o pla-a-a-ce.”

Mama, her eyes narrow, said nothing. She turned, picked up her purse from the side table next to the couch. She kicked the transistor radio on the floor beneath the couch then walked out, slamming the door behind her. The dinner plates in the cabinet tinkled.  Chastity heard the engine of the 1985 Pontiac start with the bumper sticker that read, “I AM THE CHRISTIAN THE DEVIL AND THE LIBERAL MEDIA WARNED YOU ABOUT,” its valves tapping nervously as her mother drove out of the yard, the old car pitching and yawing like a boat in an uncertain sea as it crossed the potholes. On TV church, the choir was singing:

Tis midnight, and for others’ guilt,

the man of sorrows weeps in blood.

He that hath in anguish knelt,

 is not forsaken by his God.

Chastity, holding her cheek, snuffling, breathing hard, sat leaning up against the wall. She finally rolled over to her knees, balancing against the wall with one hand, the other pushing her up from the floor so that she slowly rose to her feet, her swollen belly bulging between her blouse and her unsnapped jeans. She couldn't think except to know that she was even more tired than before. If I could just sleep, just for a while. Rubbing her reddened jaw, she stepped into her mother’s bedroom and fumbled through the drawer of Mama’s bedside table. She found the amber vial marked Halcion and opened it, and dumped one of the blue tablets there into hand, then, two more, hesitated, then emptied the vial, quickly gulping all of them down and chasing them with water from the glass on the bedside table. Hugging herself, she stepped into her own bedroom and lay down, not bothering to remove her shoes. Almost immediately she felt like she was going to heave. She couldn’t remember what was good for feeling like you were going to throw up, but got up again, went into the bathroom and found a vial with some of Mama’s diet pills left in it. I don’t know. Maybe. I don’t care. She opened it and gulped down the contents. Only then did she spot the small partly filled bottle marked Milk of Bismuth and Paregoric, Mama’s favorite remedy when her stomach got upset. She opened it up and gulped the remaining contents. She went to her room, lay down on her bed and pulled the blue raincoat that lay on the bed over her shoulders. Her wish for a retreat from her fearful, small and uncertain world was soon granted and she slept.

She was trying to go to school, but the wind was blowing cold, whistling as it scooted the storm clouds twisting through the sky. Then she was in church and she knew she wasn’t supposed to be there; the deacons had told her so. Randy was in the pulpit again. “Are you washed, Chastity,” he said, “washed in the blood of the lamb?” In that moment, she knew in the middle of her being, deep within the filthy meat of her,  the meaning of dread, because though she thought she'd been saved, if she'd been truly saved, she wouldn't be in this kind of trouble. She arose from her pew and ran right through the door as hard as she could. But she couldn’t get away from whatever was after her. She was gasping; help me, Lord, please help me. Something bad’s after me and I don’t know what. But she knew no help would come. She glanced over her shoulder and finally saw it. It was a man—or something— on a horse chasing her. People were screaming somewhere. Fire and light came from him, but didn't burn him, just outlined him, his cape (or was it wings?) spreading as the horse reared, kicking with its front legs for balance. The flames that were the rider’s hair stood out around his head, blowing in the wind, not quite concealing the outlines of the four curving horns that grew from its forehead.

She screamed, and kept on screaming though her throat ached. Shrinking back. She whimpered, “Please, please, oh, please, dear Jesus, help me.” The creature on the horse raised its hand. He had something, club? Sword? Gun? in his hand. Whatever it was, she knew he was going to kill her with it, to send her to Hell like she deserved; because she had sinned bad, offending God. Because she was a harlot, and that is the worst kind of whore. Because she deserved eternal torture. Save me, Jesus. But it was too late. She bowed her head and prepared to die. Our father, who art in heaven, give us the day our daily bread. Forgive us our trespasses…”

She squeezed her eyes shut, on her knees now, hugging herself, waiting for the blow that would strike her down.  

“Chastity?” It was a different voice. Her eyes blinked open. She felt cold down there. Looking toward her groin, she rubbed the wet spot, then lifted her fingers to her nose, looked  and sniffed. She had wet herself. The she saw Raggedy Ann, one eye missing, a favorite since infancy, smiling down at her from her special perch on the dresser. She was at home, and the voice came from the front room.

 Though she was sleepy, her heart was tripping as fast as the valves in Mama’s Pontiac. But it can’t be somebody calling me from the front room. Mama’s gone to church, and she never gets back before the middle of the afternoon. And anyway, the voice coming from the front room is too soft, too sweet, to be Mama.       

“Chastity!”

She rolled slowly to the side of the bed and sat up, paused to let the dizziness pass. She remembered her radio, looked around for it before she remembered that it wasn’t working any more because she had made Mama mad. Still holding her raincoat around her shoulders against the chill, she stepped into the front room. The picture of Jesus on the wall above the TV caught her eye. He was down on his knees in the Garden of Gethsemane, hands clasped in front of him. His eyes were open, but he was praying very hard because He knew that his Heavenly Father was going to have him crucified the next morning because of everybody on earth except him was so sinful. This seems awfully unfair, Him having to die because of her sins, and those of others like her. But suddenly he wasn’t looking up at heaven any more. He was looking across his shoulder, directly at her. As she watched, He grew larger, finally stood, and growing larger still, stepped out of the picture. His presence filled the room with light so bright it spilled right through the walls of the trailer and made dark shadows in the yard. 

When he saw her open mouthed astonishment, he smiled real sweet and said, “Yes, child, it’s definitely me.”

Chastity stood there, unable to respond as He spoke again. “Come unto me, all ye that labor and are heavy laden, and I will give you rest.”

Chastity swept her head back and forth, as if denying what she was seeing and trying to wake up at the same time.

“Yes, I mean you, Chastity!” He looked serious, but kind anyway.

Her voice was small indeed. “Yes, Jesus?”

Then he wasn’t smiling any more, and looking her right into her eyes, said, “Verily I say unto thee, Chastity, if thy right hand offends thee, cut it off.” She lifted her hand, looked at it.

He smiled as if amused at this. “No, not that, Chastity. You know what I mean.” He was looking -- at her tummy? She followed his gaze to the bulge of her abdomen. “Now you’re catching on, kid,” Jesus said softly. “Better get to work.” Then, like a candle burning out, his light slowly dimmed and extinguished. He returned to the picture frame and was on his knees peering up at the sky once more, silent and unmoving. 

His words echoed through her mind. “If thy right hand offends thee, cut it off.” She repeated this command to herself several times, trying to give form and substance and relevance to His very special personalized message just for her. But she was still mystified. And then, like the lightning’s flash that illumines the night, she understood as clearly as she’d understood anything in her life, and she was renewed by this instance of comprehension.

“Yes, blessed Savior.” She stood and though she was so wobbly she had to hold on to the wall, stepped in to the kitchen and rummaged through the drawers, leaving them hanging open as she went. Finally, in the drawer that held a jumble of hand tools, she found the skinny ten-inch screwdriver. Moving to the bathroom at the end of the hall, she first looked at herself in the mirror. Her face stared back at her, a face with lips and cheeks quite naturally carnation pink with the merest hints of lavender on a canvas of eggshell. Sloe eyes, luminous brown with specks of green and bronze so that they weren’t brown any more at all. Cinnamon hair that never would do right, now short, the color all wrong. I never liked it until Randy had called it my crowning glory, and said never to cut it. But after everything happened, she couldn’t bear to see it in the mirror, and couldn’t stand the memory of him stroking her hair, holding it to his nose to inhale the scent of it, smiling a goofy smile at her as he held a strand of it above his upper and made a mustache of it. She’d hacked it off with Mama’s sewing scissors, then evened it up the next day when Mama said it looked like somebody had been at it with a chain saw. 

She lifted the screwdriver very slowly, and stabbed it onto the center of her reflected face, the mirror cracking and splintering the glass which tinkled into the lavatory.

In the front room, the TV choir was holding forth again:

By the light of burning martyrs,

Jesus’ bleeding feet I track

Toiling up new Calvaries ever

With the cross that turns not back

As Chastity listened, she knew that choir was singing especially for her. Burning martyrs!  She looked down at the shards of glass and picked up one that was knife-shaped, wrapped a long length of toilet paper around one end for a handle, held it up, and saw one hazel eye looking back. Holding it in her fist and scribing it across the tender white skin of her left wrist, she watched, fascinated, as the thinnest of red tracings appeared.

She felt a sense of triumph, of joy. It was not that she especially wished or intended to kill herself, but that as the blood welled on her left wrist, she had a sense of control, of being in charge that she had never felt before. She smiled then, the smile of one who knows that deliverance is at hand.

Unzipping the jeans that were so tight she couldn’t button them, rolling them over the sensuous flare of her hips, down the fine taper of her thighs and the fullness of her calves, she kicked them off and brushed them aside with her foot. Her blouse was soon dropped on top of the jeans. Pulling her bra around, she unhooked it and let it drop to the floor. Her breasts, once erect cones with pink nipples, were heavier than before, sagging, veins swollen. Looking down, she traced a circle around the areola of her left nipple, surprised at how dark it had become. Would Randy like me now? Standing erect again, inserting the extended fingers of both hands into the waistband of her cotton panties, she lowered them beyond the tuft of hair down there, dropped around her ankles and stepped free. Grasping the lighted magnifying mirror off of the lavatory, she sat it on the floor. With the long and thin-tipped screwdriver in her right hand, she knelt so that the mirror was beneath her crotch, its light illuminating the triangle of hair at the junction of her thighs. She parted her labia and raised he screwdriver, peering for a moment in the mirror at the source of her shame, then aiming the screwdriver for the moist rosiness of the opening there.

***

It wasn’t Chastity whose distress brought Dr. Jacques to Austerity Regional Medical Center’s emergency department that Sunday afternoon, but a 50-year-old patient named Nick Turnipseed.

“His family says he has a cold,” the emergency room nurse said, her voice in the telephone receiver small and distant. Christopher’s voice was less than enthusiastic as he replied, “A cold?” Colds, even bad colds, were not Christopher Jacques idea of a good reason to call an overworked doctor to the emergency room on a Sunday afternoon, especially one such as this when he spring breezes warmed the Smoky Mountain foothills, but he had seen the family ever since he had returned to Austerity to practice. He felt a sense of obligation to be there for them.

“Well, if that’s what it is, it’s a bad one,” she replied. “He’s been coughing so bad he can’t get his breath.”

When Christopher Jacques arrived in the emergency room, Nick’s wife, Myrtle was sitting on the chair beside the gurney where her husband was coughing nonstop, leaning forward, holding to the edge of the gurney with one hand and trying to stifle the cough with the other. His shirt was unbuttoned but he hadn’t managed to get into the hospital gown that lay on the gurney beside him yet.

Myrtle was thin, her hair streaked with gray, wore thick glasses, and her usual look of perpetual worry was heightened by her husband’s plight. She rose as Christopher entered and grabbed his hand in both of hers. 

“Dr. Jacques, I’m so glad to see you. Nick’s been coughing all night. Seems like he can hardly stop. It got so bad he feels like he’s smothering, so Eleanor and I brought him in. Eleanor’s worried sick. That girl sure loves her daddy; you know that. She’s outside having a smoke right now.” Nick, his chest and abdomen heaving, cheeks puffing out as he tried to stifle a cough, just waved a hand in greeting.

“Yeah,” Jacques replied, his eyes fixed on his patient now. “We need to check Nick out.” He took his stethoscope out of his clinic coat pocket, put the ear pieces in his ears and said, “Nick, let’s listen.”

Still unable to speak, Nick nodded as the doc stepped over and listened in front first, then reached around and listened across the lung fields.

Finally getting his breath and speaking, Nick said, still gasping, barely able to hold his head up, “Whacha hear in there, Doc?”

Mmm, between coughs, sounds sort of like a symphony orchestra tuning up, Nick,” Doc replied, still listening. He left his stethoscope hanging around his neck and checked both sides of Nick’s throat with his fingers, noting the enlarged lymph nodes there. “We need to check this out thoroughly, Nick. I’d like to get a chest X-ray.”

Myrtle nodded in emphatic agreement and soon the X-ray tech was wheeling in the portable X-ray unit. The X-ray showed the upper lobe of the right lung to be whited out from the fluid within.

“You have pneumonia, Nick. We need to keep you here a while,” Dr. Jacques explained. “I’m going to order some antibiotics IV – through the needle – for you. As short of breath as you are, some oxygen will help you feel more comfortable.”

Breathless from his illness, he still protested, “Doc, I ain’t got no time for a hospital. I got to make a living. Can’t you just give me a shot or something and send me home?”

Eleanor, an attractive woman in her mid-twenties, her brown hair hanging long and straight, stepped forward. Her brow wrinkled above her blue eyes as she spoke. “Daddy, you listen to what Dr. Jacques says. We gotta get you better. Then you can worry about making a living.”

Nick’s wife Myrtle was nodding in emphatic agreement. Nick slumped down a bit more, too weary to argue further.

Eleanor, eyes intent, addressed Christopher, a bit of an edge in her voice. “You gotta get Daddy well.”

“I’ll do my best,” he replied.

 

***

Dr. Jacques wrote the orders and dictated Nick’s history and physical. He was prepared to leave, anticipating the rest of the day off, perhaps watching a movie, catching up on the paper work that followed him around, but already thinking already of the next week in the clinic and the mechanics of keeping it going. Full house scheduled for in the morning. Payroll on Thursday. Lab tech’s moving to Ohio, got to run a help wanted ad.  

He headed toward the automatic front doors of the emergency room. It was Lilith, on duty the front desk, who called to him as he was about to depart. “Not so fast, Chris. You have another one coming in by ambulance.”

Chris frowned as he turned to respond. “Who is it, Lil?”

Glancing around the waiting room at the several persons within earshot, she indicated them with a nod of her head and said, “Please step over here.”

He cocked his head to one side slightly, stepped closer, placed one hand on the desk and said, “What’s going on?”

Leaning closer, she spoke sotto voce for the sake of privacy as Christopher looked down at the floor. He shook his head slowly as he listened, then said, “Do they have an IV running?”

“They’re trying. Had trouble finding a vein, then the one they found blew.”

“OK, have Trauma 1 set up, a veinous cut down tray waiting. Four liters D5 and lactated Ringer’s hanging and ready to go. Six units type O blood stat, tech on stand by to type and cross match four units as soon as she gets here. Stat lab to include CBC and short biochemical profile. Cath urine for analysis.”

“I’ll get it started.”

Chris turned away, then hesitated and turned back. I’d feel better if Lil was there to help. She knows her stuff. Don’t want to give her the wrong idea, but…

Lil, please, can you come back and help? I need somebody who” he hesitated here, “…who’s really good.”

She colored slightly. There’s no one in the world I’d rather hear say that. Then she added for her own benefit; as long as it’s purely professional…“Sure. Soon as I can get somebody on the desk I’ll be there.”

“Great. And who’s coming with her, Lil? Anybody?”

“Her Mom’s following by car.”

 

***

“Code Red, Trauma 1. Code Red, Trauma 1.” The hospital switchboard operator’s voice over the public address system sounded as calm as announcer of flights at the airport as she announced the dying Chastity’s arrival. The lab tech, officially the phlebotomist, tall and sallow enough to merit his unofficial name, The Vampire stood by, as well as an IV nurse and two nursing assistants, alerted prior to the ambulance turning into the emergency room drive. They jumped to assist as the ambulance braked to a stop in a bevy of flashing blue, red, and amber lights, the headlights alternately flicking on and off in a dancing display of light and color worthy of any disco. Both rear doors of the ambulance swung wide smoothly. The first tech, her brunette pony tail swinging through the port in the back of her baseball cap that had EMS/CHICKASAW embroidered beneath the logo on the front, bent low as she emerged. She was closely followed by a bulky male tech, his skin the color of espresso. They put their backs into withdrawing the gurney. Ponytail turned and hit the latch at the base of the collapsible gurney. The catches that held the legs in position snapped audibly as they fell into place. Espresso sat the portable heart monitor, it beeping away, beside Chastity. Her normally peaches and cream complexion was now the color of chalk. Covered with a blanket to keep her warm and help forestall shock, the slowing of vital systems that were already gripped her in its deadly coils, she was unmoving as they bumped the gurney up the low concrete ramp and through the automatic doors that parted for them.

As she rolled into the open-fronted room with the plastic sign over the door that indicated TRAUMA 1, the code team, the assortment of nurses and techs from different parts of the hospital, chattering anxiously, pulling on the gurney, wired with the nervous energy of the effort they were entering into. Each pushed themselves into place around the silent and still girl on the stretcher and sat to work. The team trying to retrieve her from the shore of the dark and endless river to whose rocky shore she now clung.

“Doctor,” the E.R. nurse exclaimed, “she’s delivering. Head’s already out.”

Dr. Jacques caught a glimpse of the head and then the emerging shoulders of a small and malformed fetus between Chastity’s legs, blood streaked, head flattened and far smaller than normal. “Catch it and let’s see what we have,” he said to the nurse, a woman of middle years who peered intently at the emerging fetus through her wire-rimmed spectacles.

“Not good, Doc,” she replied. “Anencephalic. Way tiny.” Jacques looked quickly as the nurse picked up the malformed creature and syringed the nostrils syringed to clear them of fluid. The fetus, droll, wizened, tiny and troll-like, its brow flattened and wrinkled due to the absence of brain tissue, grimaced once, and making no attempt to breath, moved no more.

“Not a chance,” the nurse commented. Too small, too many anomalies.”

“No vitals?” Jacques queried.

Listening to the tiny unmoving chest, “Nothing,” the nurse replied.

Jacques grunted, shaking he head, then gave Chastity his full attention.        

Lil called the declining vital signs as the hematology tech on one side and one of the ER nurses on the other attempted to get an intravenous line going. “BP 60 over 40, pulse 100. BP 58 over 38. Pulse 101.” The tech got the scarlet flashback in her IV catheter that indicated that she had entered a vein. “Got it,” she cried.

“Wide open, then,” Dr. Jacques said in reference to the crystalline Ringer’s solution that now ran in a steady stream through the drip chamber near the bottle of IV fluid. Though his heart raced, his voice was measured, clear, determinedly deliberate. Then the flow of fluid stopped.

“Shit. It blew.” The tech announced, looking at the blue nodule from fluid beneath the skin from the fluid flowing through the needle she had inserted. She grabbed a butterfly setup—a smaller needle—swabbed and then looked for a vein on the back of Chastity’s hand, “Collapsed,” she said. “Can’t find anything.”

Jacques, hands in surgical gloves, held his hand palm up for the scalpel Lilith was already holding. He made a 4 inch cut above the dying girl’s collarbone. Her blood pressure was so low that little blood oozed forth. Without being asked, Lil picked up two retractors shaped like curved dinner forks and gaped the wound open as Jacques used the handle of his scalpel to tease the subclavicular vein free of its anchoring tissues, ran a suture under it, a blue vessel the diameter of a pencil and lifted it. Lilith slid the hollow canula into the vein and Dr Jacques tied it into place.

“Wide open,” Dr. Jacques said once more. A tech twisted the valve below the IV bag, letting the fluid course freely into Chastity’s circulation.

“It’s good,” Lilith said, and looked up at the wall mounted monitor that showed a climbing blood pressure in green fluorescent numerals in the lower right hand corner, and heart rate in the left. The EKG blip bounced its way across the screen, the machine beeping each time the blip bounced upward.

“Pressure’s falling again,” one of the nurses announced.

Jacques scowled. “Where’s the blood? We need the blood.”

At that moment the hematology tech entered, the bags of blood on a steel surgical tray she held before her, shingled, bloated like ticks and the color of mulberries. Lil had one hanging before the tech got a foot into the bay, replacing the needle that ran the Ringer’s solution with the one that evolved from the blood bag.

“Push one amp bicarb,” Jacques ordered. The emergency room nurse responded, uncapping the needle on the fat preloaded syringe that held the sterile baking soda solution and piggybacking it into the intravenous line, thus avoiding Chastity’s system becoming so acidic from the build up of waste products as to kill her. More hospital personnel were arriving, each intent on contributing to the effort that was unfolding in Trauma 1.

The gaping cut-down site began to bleed more vigorously as Chastity’s blood pressure increased, a rivulet leaking from her incision and tracing its way down her naked shoulder.  Lilith slapped on a stack of gauze squares, pressed once and turned her attention back to other things. The numbers indicating blood pressure on the monitor began to decline again.

“Dopamine,” Jacques said.

Lilith slapped the syringe into Jacques’ hand and he injected, blood pressure climbing again as the green blip bounced along. Then it straight lined, the beep of the machine changing to a steady squeal.

“Get on her chest,” Jacques said evenly, his voice calm though his own heart was beating a rapid tattoo. The espresso colored emergency tech fitted one hand over the other and began the chest compressions.  Each time he pushed down on Chastity's chest, the blip on the screen arced upward, a soft and smooth series of blips not unlike that of the Smoky Mountains that lay to the north of Austerity Regional, the gentle curve quite unlike the heart’s natural rhythm. Then Chastity quit breathing.

“We gotta breathe for her,” Lilith said. She placed one hand under Chastity’s neck, and lifted. Lil snagged her lower jaw and opened her mouth wide, and sighting through the lighted long-tongued intubation device, Chris slipped it onto her throat pulling her tongue forward with a gauze pad until he could see the two white ridges of her vocal cords through the built in scope. He slipped the clam-colored plastic tube between them and down her throat and into her trachea. Lil injected air from the dangling syringe of the trach tube, inflating the balloon at its far end to keep it in place, then unhooked the syringe and put it aside. Her hands moving quickly and with assurance, she joined clicked the bulging Ambu-bag and squeezing it rhythmically, began breathing for her, glancing down at the second hand of the wristwatch she wore to establish a steady 12 breaths per minute. The green blip on the monitor began to skip sharply again; little smooth hill, Mt. Everest, smooth hill, once, twice then a half dozen times. Then it quit.

One of the techs in the cubical was already handing Dr. Jacques the electric paddles smeared with conducting jelly. “400 watt seconds,” Jacques said. He placed the paddle on Chastity’s pale chest, one beside the sternum, the other beneath her sagging left breast, and called “CLEAR!”

ZZZZZ…. the current sizzled, and Chastity’s body bowed upward as her muscles seized in response to the jolt of current and then fell back again with a Whump! He lifted the paddles, two red burns, circles that mirrored the round paddles of the defibrillator, blazed against the pale flesh of her chest. The gummy conducting gel on the paddles was warm to his touch. 

The emergency tech resumed pumping on Chastity’s chest, one hand over the other.

“Good, we got something.” A normal heart rhythm appeared on the screen for perhaps fifteen seconds, then relapsed into an ineffective flutter. Dr. Jacques turned up the power to 750 Watt Seconds, enough to light up a string of electric bulbs, and applied the paddles again. “Clear!” Like a dance troupe in their routine, everyone on the code team simultaneously lifted their hands away from patient and gurney. 

ZZZZZ…. Her body arched once more, then collapsed onto the stretcher again. Whump. 

This time the rhythm held. A slow series of peaks and valleys like a craggy mountain range in the west, a slightly irregular ventricular rhythm that began immediately after the shock.

“Another bicarb.”

“Got it,” said the IV nurse, who injected it slowly into the IV line.

The monitor showed a straight line again as Chastity died once more.

“Epinephrine, I cc, cardiac needle.” The emergency room nurse broke the seal on the formidable looking six-inch cardiac needle, and dumped it on the tray. She picked up a syringe and swiveled them together, then drew up the clear 1-10,000 epinephrine solution and handed it to Jacques. He reversed it, and holding it like an ice pick, steadying the tissues of Chastity’s chest with his left hand, he inserted it in the space between her fifth and sixth ribs near the breastbone. Pressing it through the chest wall and into the heart, he felt a loss of resistance as it penetrated her heart’s hollow left ventricle. He pressed the plunger down, injecting the epinephrine directly into the heart.  He looked up at the monitor. A brief fizzle of activity like the careless scratching of a child’s pencil, showed on the screen, then it flattened again. Then after a flurry of scribbles, a normal heart rhythm ensued, held, and progressed across the screen of the cardiac monitor’s screen.

Dr. Jacques realized he had been holding his breath. He exhaled with an audible who-o-o and the rapid beating of his own heart slowed. He and the others watched the monitor as the rhythm continued, blood pressure rising. Jacques took a deep breath. “Youth,” he said to no one in particular.

“Youth?” a tech said.

“Yeah,” Jacques responded as the monitor beeped along at a steady 58 beats per minute “that’s the best time to die and still get to come back. We don’t often get them back when they’re that far gone.”

 “She’s breathing on her own,” Lil said, placing the Ambu-bag on the table, leaving the trach tube in place, it hanging from her mouth like the proboscis of a nectar drinker.

The EMS tech that had driven the ambulance in, the bulky African American, the one who had pumped Chastity’s chest with the palms of his hands, turned his hands and stared at their light palms for a moment. He looked over at Jacques and said, “I heard it. I really heard the wings flapping. Did you, Doc?”

 “Yeah,” Jacques said, “they sounded leathery and cold sure enough, this time, didn’t they? But we got her back.”

The lab tech gathered up the tray that had brought the blood bags, and the others began to talk, to neaten up, to go on their way, their mood lighter, for they had defeated, for the moment, the Dark Angel, the demon Death whose wings the Emergency Tech had seen and heard as he pumped Chastity’s chest.

 Chastity had color in her face, and her bare chest moved up and down as she breathed. Lil looked down at the patient that had been a corpse just minutes before. Jacques followed Lil’s gaze. Chastity was still lying now quite naked on the gurney as the nurse swabbed off the blood with an alcohol sponge. Chris’s thought’s meandered. Finely sculpted, though a bit bloody here and there.

Lilith entertained her own mantra, one that bubbled to the surface of consciousness unbidden from some distant undergraduate classroom; Death be not proud, death be not proud, death be not proud… Jesus, I didn’t even know I remembered that… John Donne maybe? …Death be not proud though some have called thee mighty and dreadful, for though art not so….  She looked up, her reverie broken as Jacques spoke. 

“Good work, guys. It doesn’t get much better, in fact,” Jacques said as by ones and twos, the helpers completed their tasks and wandered away until only one ER nurse, Lilith and Doctor Jacques remained to continue tidying up and dealing with details. Jacques turned back to his patient. He took up a needle driver, inserted a curved needle and, using the most meticulous of intracuticular stitches, ran the suture back and forth between the cut skin margins of the incision above Chastity’s collar bone. He then pulled the incision together, achieving a fine cosmetic closure.

“Nice work,” Lilith said, looking at the meticulous suturing that left only a short and thin length of knotted blue suture showing at each end. He’s good. He’s very, very good. The plastic surgeon couldn’t do better.  

“Thanks.” Jacques smiled, inordinately pleased at these two words of praise, for it was not the words, it was their source.  

A waiting room nurse stuck her head in the cubicle at that moment and said, “Dr. Jacques, the mother is in Grief II.”

“I…excuse me,” he said, looking closely at Lilith. Saying nothing further, he looked at dead fetus now wrapped in a sterile towel on the stainless steel cart at the side of the cubicle, its face exposed to show its gaping mouth and flattened features. He took a deep breath.

Lilith spoke. “It’s better this way, you know, better than the baby lingering on a day or two. You did what you could. You got the Mama back.”

“”Yes, I guess. And we did get the Mama back,” Jacques replied, then turned away, and stepped out of the cubicle.

 

 

 

The Chickasaw Plum  -  Volume III - Number 2 - February 2006

 

 

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