Fragile Blood

By Agnes Fischer

Others thought she had everything a woman could want, an adoring husband, two wonderful children and a life many would be envious of, other than Agnes. This is a novel, based on a true story, about an American nurse who leaves her native Oregon and starts up a new life in Freiburg with her German husband. Early on in her marriage she realizes that her relationship with the young physicist-teacher is deteriorating. She doesn't love him anymore, yet is reluctant to admit it. What is she to do? The dilemma is a common one. The emancipated, loving and direct manner in which she finally approaches separation and continues on with her life is all but common. Her pursuit? She wants to find her soul mate, and what a surprise it is when she does. Her life is turned upside down, and in more ways than one.

This is a book for any responsible bumbler or stumbler, male or female, who is equipped with a loving heart and an open soul and, who has decided to live life according to intuition, even though it can be scary sometimes.

• Language: English
• Publisher: AuthorHouse UK
• Release date: Feb 24, 2011
• ISBN: 9781456774097

Agnes Fischer

Agnes Fischer (pen name) was born in 1963 in Portland, Oregon. She studied and received her Bachelor of Science degree at the University of Oregon. Choosing to work in a heart center as a technician before continuing on with graduate school at University of Wisconsin La Crosse, she discovered her interest in nursing and opted for the local nursing program instead, where she received her Associate Degree. Between 1991 and 2003 she worked in the United States and in Germany as a registered nurse. Since 2008, Agnes Fischer has been working as an English teacher. She lives with her husband and three children in Germany.

Book preview

Chapter 1

1998

She extinguished the dreadful sound coming from her right with a swift left hook. Silence. Her eyes closed again. Agnes hugged the edge of the bed, slowly becoming aware of her breathing as she listened to the rain beating relentlessly against the windowpanes. It was 5:00 Sunday morning, a time when most people sleep, unless they work in a bakery or, as in her case, as a critical care nurse on an intensive care unit. Simon rolled over sleepily, reaching out his arm to embrace her. She slid out from under its decent and tiptoed over to admire Max, their eighteen-month-old son, who was sleeping in a basket hanging from the ceiling. Simon had made it for him. Max loved the contraption even though his hands and feet now pressed against its borders. Agnes stroked Max’s delicate fingers and then, with a gentle push, sent him swaying back and forth before closing the door behind her. All she had on her mind was a potent cup of coffee as she maneuvered her way through an obstacle course full of building blocks that lead to the cupboard-sized niche she and her husband called the kitchen. Agnes reached over the counter and pressed the coffee machine switch, then paused a moment, palms and elbows supporting her body weight at the chin and shivered at the thought of venturing into this piss-cold January weather. The machine gurgled into life as she made her way to the bathroom.

Agnes pulled her hair back into a ponytail and slipped on a hair band to hold it in place. She inspected herself in the mirror, turning her head to the right, to the left and then face on, staring at her inquisitive blue-green, actually green-blue, eyes. Her fingers instinctively ran across her cheeks, feeling the strong outline of her bones. She pushed her nose, that drifted slightly to the right, back to the middle and tried to imagine it a little smaller. And why, she wondered, did her parents name her Agnes? It didn’t fit, nothing quite fit. She grimaced at the thick, dark eyebrows that every hairdresser itched to pluck. She was small and slender, but never in her life would she have described herself as sexy. No hips, no bust. Perhaps one day she would change her name. She would have preferred straight coal-black hair and olive skin instead of her chestnut curls and countless freckles that exploded in the sun to give a fraudulent impression of a deep tan. Not that she had to worry about multiplying pigment cells on this rain-sodden day. She glanced at her watch, put her daydream on hold and got ready for work.

Agnes rested against the kitchen counter, cupping her coffee in her hands while relishing her last few moments in this warm oasis. Between sips, she blew across the surface in vain, scolding herself for always misjudging the time, then grudgingly, she tipped her unfinished coffee in the sink and pulled on her Gore-Tex jacket and rain pants. The rain splattered against her clothing as she ran to the garage to fetch her bike. Her faithful, battered old city bike had more scratches and rust than original silver paint. A red, yellow and green sticker on the frame identified it from hundreds of other similar bikes in Freiburg. The bell worked, it had a basket for shopping and good tires. It had a decent lock, but no self-respecting thief would steal the bike, the lock maybe. Standing next to their nine-year-old, forest green Passat hatchback, Agnes balanced her bike with one hand while supporting the garage door with the other, hoping the rain would ease up. Agnes never considered driving in Freiburg. She had no sense of direction. The roads were too narrow. There were too many one-way streets. Every overtaking streetcar threatened to crush her against the lines of parked cars. Reluctantly Agnes had accepted that she was petrified of city driving. Cycling was more dangerous, but less threatening.

She retreated further into the garage. Rain had greeted New Year and, for the last four days it hadn’t stopped. The rain pelted down with renewed force, challenging her to postpone her journey. Agnes looked at her watch again. Resignedly, she took a deep breath and pushed off into the downpour. Cycling was a great way to shed her morning lethargy. Her legs woke up while pedaling through Gundelfingen and started burning as she worked her way up the hill that lead towards Zähringen. The bike refused to engage in any gear but third, and it only had three, since her accident a year ago. A gray-suited Mercedes driver had sent her flying over the handlebars after cutting her off at an intersection. He had continued, convinced of his right of way. Agnes’ bike had landed under the front of a stationary tram. She gasped as she stood on the pedals to overcome the gradient, refusing to grind to a halt. Gusts of rain stung her cheeks and her nose began to run. Water seeped through the seams of her rain gear. Agnes smirked. Like all native Oregonians raised west of the rainy Cascade Mountains she was born with a layer of protective moss, but she still hated cycling in the rain. Normally, she enjoyed the solitary ride to the clinic along the rural path. She knew every curve, greeted the ponies and the goats along the way, dreamed of owning one of the massive three story, prime reality houses. Today she didn’t notice anything; she just wanted to get to work.

The rain had eased by the time she reached the grounds of the Freiburg City Medical Center. Though it was still dark, it was possible to discern the outlines of the magnificent fountains through the gloom. In the spring and summer, sparkling water cascaded into the circular ponds while squabbling ducks competed for tidbits fed to them by recovering patients under the shade of the magnificent maples. Today, the moss-covered fountains were silent and the maples offered no refuge from the rain. Agnes dismounted, locked her bike amongst the others and scurried to the main entrance. The East Wing was modern, resembling a tiered cake of glass and concrete. The extension had been completed the year before, built on the landscaped grounds of an elegant hospital founded almost two hundred years before. The high-ceilinged, stately buildings had been demolished and replaced by this eight-floor, glistening, airtight edifice dedicated to neurology. Rooms were stacked on and beside each other with austere regularity. Rows of blinds hung outside sealed windows. Tramways of light ran along the ceilings of every room and corridor.

Agnes hustled through the deserted main entrance hall, past the vacant newspaper-coffee stand and up the winding stairway to what the Germans call the first floor. Just before reaching the large, windowless doors boldly marked in black, Neurological Unit 2, she turned left into the dressing room. She hung her dripping rain gear on hooks, her clothes in her locker and grabbed a pair of crisply ironed blue scrubs from one of the shelves. An inner change always occurred parallel to the physical change of clothes. The woman who slurped her coffee and always found tomato sauce on her shirt after eating spaghetti was now exact, efficient and a bit on edge. The job she was to carry out for the next eight and a half hours simultaneously challenged and burdened her. Agnes slipped on her Birkenstocks and glanced at her watch before putting it in her locker. She ignored her craving for a cigarette. It was 05:55. Time to go in. As she stood up from the bench, a wave of morning sickness overwhelmed her. She sat back down on the bench; wishing she could vomit and clear her system, but she knew this green throbbing feeling would last until late afternoon, until then work would serve as a distraction. She pulled herself together and stood up again, walked out of the changing room, and, taking one last deep breath, hit the hand push and strode through the swishing electronic doors into the wide corridor of the neurological intensive care unit.

The familiar chorus of short, high-pitched peep-peeps, indicating thirsty infusion systems along with various other multi-sound-length, multi-pitched reacting monitoring devices, welcomed Agnes as usual this morning. She dismissed the sudden flat-lining drone. A patient had probably dislodged his electrodes. There was no flurry of activity. The sound stopped as abruptly as it began. Agnes popped her head around the door of the medication room to her right where a young night-shift nurse was priming IV tubing with TPN, a yellowish mixture of nutrients and sugars. Morning Heike. Heike acknowledged her with the flash of a smile, but remained focused on her task. Quiet night? asked Agnes. Heike raised her eyebrows. That bad, huh? Heike nodded. Agnes withdrew her head from around the door and continued along the corridor passing the blank X-Ray viewing screens hanging on the wall and a crash cart with an overflowing ‘sharps’ container. Agnes paused by a temporarily parked bed to let Ralph swerve into the first of the two main patients’ rooms with a clear plastic bag of saline fluid. At the main station Agnes walked past multicolored, dancing graphics displayed on the central monitor and continued on to her mailbox. She put two envelopes into her backpack and entered into the adjacent meeting room where the day and night staffs were gathering for change of shift report. Most chattered around the table, a smaller group stood by the wall of kitchen cabinets and clustered around the coffee machine and microwave.

Morning Agnes, mumbled Connie, raising his head carefully from his supporting hands. He was waiting for Harold to refill his coffee.

Morning, said Agnes with a mocking grin on her face. Another tough night at the Crash? The Crash was an ear-deafening, hardcore music establishment whose exclusive inner and outer appearance owed its thanks to spray paint.

An eighteen year old disco Queen danced him off his feet, laughed Harold sitting down beside him with a fresh pot of coffee. He can’t move for aching.

She was twenty-two, interjected Connie.

Yeah, yeah, yeah. She was probably sixteen.

Purple would suit you better, Connie, said Agnes.

What? said Connie, looking bemused.

Sorry, I thought you were wearing mascara, but it’s those rings under your eyes, commented Agnes dryly. Black doesn’t suit you.

Thanks for your concern, muttered Connie, lowering his head.

Any time, she said, giving Harold a wink as she walked over to Jude, the day manager. Agnes and Jude were drawn together, not so much because they were older, but because they had children. Jude raised her daughter alone and worked full-time. They didn’t have time to talk about discos and dating.

Good to see you, said Jude with a hug. Yesterday was crazy. Coffee? Agnes shook her head and leaned back on the cupboards, Short staffed again? Jude nodded, Worse than usual. As she poured her coffee she ran her eyes over Agnes.

Why doesn’t staffing hire more part-time extras so there would be more nurses to draw from? asked Agnes.

We’ve asked, said Jude touching Agnes’ arm. The answer’s always the same – ‘the budget won’t allow it’. Jude moved beside her and lowered her voice, You don’t look so good. Are you all right?

I’ll be fine, answered Agnes squeezing her lips. Stomach bug. Jude studied Agnes’ face, sipped her coffee and held her assessing gaze. She put her cup down and moved in front of Agnes so they were shielded from the other nurses. How many weeks? The question startled Agnes. She reddened. She couldn’t bluff Jude.

Six.

Does Simon know?

Agnes shook her head. You’re the first.

Jude slipped an arm around her and whispered Congratulations. Agnes managed a weary smile. Is there anything I can do? added Jude. Agnes thought for a moment, Yes. Get that lazy aid, Rainer, to empty the sharps containers. I jabbed myself last week and today the container on the crash cart in the corridor is overflowing.

Done, said Jude.

All right, all right! I’ll come, said Dr. Henning in his strong Bavarian accent as he rose from his seat, his hands surrendering into the air. "I’ll be there. Jazzhaus, tomorrow 21:00." The two young female nurses looked very pleased with their efforts to get him away from work for an evening. Mathias Henning was a neurologist in his late thirties. His experience and professional adeptness were responsible for his impressively early promotion to ICU assistant head of staff. The nurses appreciated his light touch under pressure. He understood the ins and outs of being an intensive care nurse because he had been one himself in his earlier days.

OK everyone, let’s get started, he said with a clap of his hands. It’s 6:04.

Catch you later, mouthed Jude to Agnes. The younger nurses faltered in their accounts of their Saturday night exploits. Dr. Henning clapped his hands again. The buzz of conversation subsided. OK Guys. Let’s go. Down to business. He looked around the gathering of day and night nurses. The door opened. Ralph slipped in, Heike’s just finishing up. Dr. Henning nodded, waiting for all eyes to be on him. Another full house. Thirteen patients. Another busy day. And, he paused, Ute’s ill. We’re one member of staff down again. A discontented murmur ran around the room.

I’m sorry. No substitutes are available. I’ve called the cardiac station and intensive care one, but they can’t spare anyone. We’ll just have to manage. Dr. Henning looked around the assembled group. No one spoke, but the staff was upset. Not at Ute, she like all the ICU nurses would crawl into work if she could. If she was sick, she was sick. Neither were they angry with Mathias. He had to cope like them. No, it was the politicians, the medical insurance companies, the administrators, the managers, the ones they never saw who put them under pressure with their new policies for improved health and efficiency. The nurses were rushed and then blamed for anything that went wrong.

Heike slid in through the door, indicating to Dr. Henning that he was wanted on the phone. He asked Jude to continue the debriefing. She stepped up to the table and smiled. Morning. Here we go. Room 2, Frau Dr. Binder, forty-five year old female came in ten days ago with a subarachnoid hemorrhage, aneurysm successfully clipped, post-op day 8. Patient is stable, alert and appears to be fully oriented. Prophylactic vasospasm therapy with a Nimodipine infusion. She has complained of mild nausea. Keep a close eye on her and have Paspertin at hand. Medicate upon first signs or complaints. Fr. Dr. Binder is recovering well; let’s keep it that way. Questions? Jude waited a few moments before moving on to the next patient. Dr. Henning returned and waited by the door until Jude had completed her report and then he took up his position at the head of the table.

That was ICU 1. They’re transferring two patients. The first had an acute stroke yesterday morning and had to be reanimated last night. He’s unstable, but breathing on his own so we get him. I’ll give a detailed report as soon as I know more myself. He’ll take Herr Weiss’ bed in Room 3. Herr Weiss is being transferred to a medical, long term care facility. Dr. Henning looked to Jude, Please check transport arrangements for him, and then he re-addressed the whole group. We are also getting a twenty three year old male whose motorbike flipped at high speed. He’s still in the operating room and it is not yet known when he’ll be coming out. Dr. Henning paused to let the information sink in.

Maggie raised her hand. Dr. Henning invited her question by raising his eyebrows. Isn’t that early for him to come here? He shrugged, He’s young and he’s breathing on his own and there are more serious cases than him. The neurological ICU 1 was for patients requiring breathing support. Patients on respirators had priority, the rest, irrespective of their complications, were shipped elsewhere. The neurological ICU 2 was, as the nurses knew full well, the first dumping point. The staff exchanged glances. Harold leaned towards Connie and whispered in his ear. Connie nodded.

Is that something you wish to share with the rest of us? asked Dr. Henning. Harold looked embarrassed and shook his head. What can I say? said Dr. Henning turning his hands upwards. Given the pressure on beds, this is the best place for him. Connie, he’s assigned to you. Connie sat up and nodded, his fatigue now gone and replaced by a keen alertness. Connie had excelled on an emergency trauma team in Berlin. At the age of twenty-seven, he had seen his share of motor vehicle accident victims.

We need a spot for him by 11:00am to be on the safe side. Jude, see if you can find space for Frau Meyer on a general unit. Jude nodded. Oh, and one more thing, added Dr. Henning. "I noticed that Herr Spitz hasn’t had a bowel movement in the last three days. As he’s not allowed to strain, one of you lucky people must give him an Einlauf. Agnes understood almost everything, but she had been in Germany for less than two years and her comprehension was by no means perfect, especially when people rattled on at an explosive pace. Her brow furrowed. She lent over to Jude. Surely, Mathias can’t mean give him a casserole," she whispered.

"Einlauf, nicht Auflauf! clarified Jude, Enema, not casserole. The hushed words were audible in the lull following Dr. Henning’s request. Oh, of course, said Agnes, blushing among the chuckles and grins. Good job, said Jude, digging her lightly in the ribs with her elbow. We needed some light relief."

Agnes, said Dr. Henning, don’t invite me home for dinner. Everyone laughed. OK, it’s 6:25. Get through bedside report so the poor night shift team can get some sleep and, let’s have a good day!

They filed through the main station and into the corridor where they split into pairs of one day and one night nurse and headed towards their assigned patients. At the counter Dr. Henning began scribbling his signature on a pile of papers as he reviewed the arrangements for the day with Jude at the counter. Opposite and to the left and right of the main station were the two main rooms, 2 and 3, which held four patients each and were fronted by a sliding glass door. The two smaller corner rooms, 1and 5, at each end of the corridor, held two patients, while room 4, was reserved for individual patients requiring isolation or special attention. Despite the differences in size, there was uniformity about the rooms. They all had gray-framed, high-sided electronic beds and bedside tables with neatly arranged items such as mouth swabs and Bepanthen salve. Behind each bed head was a ganglion of cables for heart and blood pressure monitors and for suction and infusion machines that gurgled and pulsed. Clear bags and bottles hung from IV poles infusing medication, nutrients and electrolytes into the patients’ veins. Each room had a medical cart pushed out of the way against a wall. The drawers were filled with an assortment of medical supplies; ampoules of emergency intravenous medications, needles, tubing and sterile instrument sets to sterile gloves and masks. A bright red sharps container for disposed syringes and needles stood on top. The patients´ rooms overlooked the attractive medical center grounds, but the patients were rarely able to take advantage of the view.

In Room 3 Heike updated Harold on their two patients, while Maggie and Agnes stood beside Herr Weiss’s bed. Three weeks previously he had been helping his son slaughter cattle, but at the end of the day he had turned the bolt gun on himself. Miraculously or unluckily he survived. His wife, a woman of roughly 75 years, revealed to the doctors that he had suffered severe, chronic joint pain over the last several years and had often voiced doubt about whether life was worth living anymore. Herr Weiss might exist for many years, but he would never move again. He was being discharged to the Edelweiss medical care facility. There was little more to be said. Agnes agreed to liaise with Jude over his transfer. Frau Dr. Binder in the adjacent bed was making excellent progress. She was a pediatrician at a private children’s clinic. A full recovery was expected as long as no major complications occurred. The successful occlusion of a ruptured aneurysm with clips had left her with minimal residual deficits. She had been lucky, very lucky.

Frau Dr. Binder occasionally complains of nausea. Here, said Maggie, tapping an ampoule on the bedside table, is the Paspertin. She did not need to explain to Agnes that vomiting increased intracranial pressure and could cause a re-bleed in the brain or a even a stroke in such a patient. Vomiting was to be avoided at all costs. "I think that’s all, ¨ said Maggie, going to the door.

What’s it like having a doctor as a patient? inquired Agnes. Maggie rolled her eyes. Sleep well, said Agnes.

Have a good shift, said Maggie walking down the corridor to the exit.

Frau Binder continued sleeping while Agnes carried through her routine check–monitored vital signs were current and acceptable, bed rails up, call light in reach, no kinks in the tubing, infusions running at correct dosages, central line secured and system closed, no swelling or redness around insertion sites. The patient stirred and opened her eyes as Agnes straightened out the covers. Good morning Frau Dr. Binder, how was your night? inquired Agnes as she checked for chaffing around the ears and nostrils while casting a glance at the oxygen flow meter that was running at 2 liters per minute.

I slept wonderfully, she answered very deliberately in a governess-like manner of one who has spent many years managing children. She had a detectable slur, but Agnes had no difficulties understanding her. That’s just what you need, said Agnes while jotting down a few notes and recording the patient’s vitals. Everything’s looking good. You’re making excellent progress. Any nausea?

No, none. I’m so looking forward to going home.

It shouldn’t be too long.

I was hoping this week.

You’ll be with us for a little while, said Agnes replacing the clip chart, avoiding the subject of dismissal date. After leaving this unit, Frau Binder would probably be spending another week or so recuperating on a general neurological floor before going to a rehabilitation center.

I’ll start packing today.

Before you make any plans, speak to the head neurologist when he comes around. He’ll answer all of your questions.

I don’t want to cause you any more work. I can look after myself, you know. Agnes had to concentrate in order to understand her when she started getting emotional.

That’s very nice of you Frau Dr. Binder, said Agnes plumping her pillows and smoothing the bed cover, but your job is to rest and get better. Our job is to look after you. You’ll have plenty of work waiting for you when you get back to your clinic. Agnes disinfected her hands and went over to Herr Weiss.

Herr Weiss lay on his back, propped with pillows, his arms outside the covers and by his sides. Agnes moved into his field of vision and squeezed his hand. There was no reaction, but it was a gesture she needed to make. Good morning Herr Weiss. He focused on her. How are you today? His eyes drifted away and back. Your daughter’s visiting this morning. Do you remember that you are leaving us today? His heart monitor indicated a slight increase in rate. His breathing shortened. Your daughter’s going with you to make sure everything is just right. His eyes tracked Agnes. I’m going to start as we do each day, she said lowering the bed rails and giving him a running commentary on her routine. Agnes left the suctioning of his tracheostomy until last. She worked efficiently and with great care to minimize the discomfort that only showed in his eyes and in his breathing. Finally, she reapplied the oxygen back over his tracheostomy. She straightened out his covers, put the rails up, disinfected her hands and left as the X-ray technician came in.

The morning routine rolled on. Blood samples had already been drawn, lab specimens sent and medication administered. As the last rounds of doctors, professors and medical students trailed away Agnes carried a basin of warm water to Frau Binder’s bed.

Freshen up time. Agnes reached across to wipe her face, but her forearm was firmly moved to one side.

Please! I can do this myself. I’m not a child. She indicated Herr Weiss’s bed. There is someone who needs your help.

I’ll see to him as soon as I have finished with you. Now, I have work to do. Agnes wrung out the face cloth, but she had second thoughts about wiping Frau Binder’s face. Instead she offered the face cloth to Frau Binder. She looked at Agnes and took the cloth. You’ve missed a bit there, said Agnes pointing to the secretions in the corner of her eye. Frau Binder didn’t protest. Agnes rinsed the cloth and washed the back of her neck while looking for symptoms of skin irritation. She then gestured towards the toothbrush and basin on the bedside table. Would you like to try it yourself?

Yes, thank you, said Frau Binder.

Let’s help you sit up first, said Agnes laying the washcloth over the side of the basin. Frau Binder shuffled upright with Agnes‘ help. Agnes rearranged pillows at her back, placed a towel around her patient‘s neck and handed her a toothbrush. Fr. Binder‘s fine motor control was far from 100%, but the practice did her good. After she had finished cleaning her teeth, Agnes finished what her patient couldn‘t do and applied a smear of salve to her lips.

That’s a good start, isn’t it, said Agnes pulling the ties on Frau Binder’s medical gown. Agnes washed her back, shoulders and armpits. She offered the rinsed cloth to Frau Binder, ¨Would you like to do your chest and abdomen?"

Thank you.

While Frau Binder washed herself, Agnes washed her patient’s legs and replaced her incontinence pad. When she had finished she washed and disinfected her hands and began with Herr Weiss. She glanced at the clock and figured that once she had finished she might have time for a coffee.

She found Jude in the break room blowing smoke out through an open window. She stubbed out her cigarette like child caught red handed.

Sorry. I didn’t have time to go outside.

Agnes laughed, poured herself a coffee and sat at the table. Connie put his head around the door, Transport’s here for Herr Weiss. Frau Meyer is gone. Any news on the motorbike admission? Jude indicated to Agnes to remain seated, I’ll go. Finish your coffee. She shepherd Connie out of the room, No news. I’ll let you know as soon as I hear anything.

Thanks, said Connie as they disappeared through main station."

Jude was completing paperwork for Herr Weiss’s transfer at the counter when his sister arrived.

Sorry to disturb you, Agnes, said Jude, poking her head around the door of the break room, Frau Schumacher is here. Would you like to speak to her?

Of course, said Agnes tipping her drink down the sink. I’ll come now. She made her way through the main station. Jude indicated to the seated women. Frau Schumacher stood as Agnes approached and they made their way to Herr Weiss’s bedside while discussing his progress and the day’s arrangements. Agnes left her to speak to her brother and moved to Frau Binder’s bed.

Everything OK?

Fine.

Any nausea? Frau Binder shook her head. If there is call me or press this, said Agnes moving the call light closer to hand.

I will dear. There’s no need to fuss. I can manage.

Harold pushed a gurney into the room and parked parallel to Herr Weiss’s bed. Agnes spoke to Herr Weiss and with his sister as she and Harold transferred Herr Weiss and all of his attachments onto the gurney. A last comfort check was made, and then Harold pushed him into the corridor. Agnes accompanied them to the electronic doors and said goodbye. As she returned she saw that Connie was settling up his new patient into Room 1. Agnes started stripping Herr Weiss’s bed. Everything was cleaned, prepared and disinfected by the time the next patient was wheeled in.

This is Herr Wald, 47, said Jude. She placed a sheaf of notes at the end of the bed, I’ll leave these for you to read. Admissions want us to take another patient. I’ve got to find another space.

He can have mine, interrupted Frau Binder, I feel fine.

You’re making excellent progress, but you’ll be here for a few more days, Frau Dr. Binder, answered Jude. She glanced subtly at Agnes. See you later.

By the time Herr Wald was settled Agnes wanted and needed a shower. It wasn’t the work that made her perspire. The dank odor of stress was caused by constant alertness to every eventuality and detail. She wondered often times if she was cut out for this work. Harold came into the room to check on his patients. She looked at her watch. Perhaps she had time to pour some hot water on a packet of soup. .

Would you keep an eye on mine too? asked Agnes. I need a break. Harold nodded. Agnes cast a last glance at Frau Binder, then stripped off her gloves as she left the room and dumped them in the nearest garbage can. Another new patient was being wheeled into Room 2, during which Herr Spitz lay parked in the corridor waiting to be pushed to a general unit. Jude stood at the counter of the main station filling out forms. She looked up as Agnes approached, One in, one almost out. Dr. Henning has been called to ICU 1. They’ve got more emergencies than they can handle.

It’s crazy.

It’s normal.

I need ten minutes, said Agnes sliding past Jude into the break room and putting on the water. She sat at the table sipping her cup of soup while making additions to her morning report.

Ten minutes later as Agnes exited the main station, she heard Connie shouting for help, Agnes! Come here! Now! She ran to Room 1 and pushed through the door. Connie was bent over the motorcycle accident patient. He was palpating his carotid pulse with one hand while trying to discern a heart rhythm with his stethoscope with the other. The heart monitor was dancing in preventricular contractions followed by couplets of normal conduction. Before she could ask why no alarm had gone off the heart rhythm collapsed to ventricular tachycardia and triggered a blaring, two-toned bell-like sound throughout the unit. Jude was the first of the staff to come running, What do you need, she said poking her head around the door.

Cardiac arrest! Get a doctor, Mathias if you can. Bring the crash cart and come back with Harold! Jude was off and running.

Agnes checked for a pulse. She never fully trusted machines. She looked at the monitor again. Ventricular tachycardia. No palpable pulse. No breathing. Connie had already removed the backboard from the wall next to the door. Carefully, but quickly they slipped it under the patient’s back.

I’ll ventilate, said Agnes, knowing that Connie had more strength for compressions than she would ever have. She grabbed a facemask, ripped open the package and placed it over the patient’s mouth. Connie had already started with compressions. Agnes ventilated according to protocol. Connie’s eyes moved from the patient, to the monitors, to Agnes and back to his hands. After a minute of CPR Agnes abruptly said, Stop CPR, while casting a look at the heart monitor. The rhythm had deteriorated from ventricular tachycardia to ventricular fibrillation. The crash cart bumped through the door. Jude pushed it to the bedside.

One more minute CPR before we defibrillate, said Agnes. And where the hell is the doctor?

Jude turned on the defibrillator, You want doctors? In a hospital? She yanked off the old heart monitor electrodes and replaced them with two large pre-lubricated paddle electrodes and placed them onto the patient’s chest, implementing the standard anteriolateral electrode placement. Agnes and Connie continued compressions and ventilation.

Do we wait for a doctor? asked Connie half gasping for air.

The longer we wait, the worse his chances, answered Agnes between breaths. They looked to Jude.

You two decide. I’ll back you all the way, answered Jude.

Let’s do it! Now! said Connie. Before we lose him.

Jude, take my spot, Agnes said. Harold entered the room as they switched places. Harold, get a doctor. I don’t care who, but get one! Now! Harold left running. Agnes selected the energy level and charged the capacitors while Connie and Jude continued CPR.

Clear, 200J! Jude and Connie stepped back. Agnes placed the paddles and administered a first shock. No heart beat. No rhythm. Nothing. She recharged the capacitors. It seemed like forever.

Clear 200J! She administered a second jolt. The portable monitor remained dead. Come on guy, here comes the big one, she said, urging herself on. Agnes turned the voltage up to 360J. Jude and Connie stepped back. Harold reappeared at the doorway.

Clear, 360J. The torso jumped off the backboard. A rhythm flickered for an instant and died. The heart didn’t pump, ventricular fibrillation again.

Continue CPR, instructed Agnes, I’ll intubate. Harold, administer 1mg Epinephrine.

Seconds ticked away as Agnes’ fingers quickly assembled the laryngoscope. She extended the patient’s head and flexed his neck. Jude placed a rolled towel to place under his occiput.

Stop CPR. Jude and Connie rested. Connie was breathing deeply. Agnes opened the patient’s mouth. She inserted the blade of the laryngoscope into the right side of the mouth, displacing the tongue to the left and advancing the blade until she had exposed the glottic opening.

Give me the tube and the stylet Harold. Agnes advanced the tube through the right corner of the mouth, then through the vocal cords, the stylet inside the tube serving to aid in placemen. Just 2 cm more, she mumbled to herself. Good, she said straightening, Harold, inflate the cuff. This was done to secure the tube in its position. Agnes withdrew the stylet, then auscultated the epigastrium with her stethoscope to make sure she hadn’t intubated the patient’s esophagus while Jude ventilated once with the ventilation bag. This was a ridiculous error to make, but it was very easy to do. No gurgling, continue ventilation, reported Agnes. Chest wall is rising appropriately. Lung sounds in left and right lung fields present. The endotracheal tube was correctly placed. Agnes grabbed the paddles. She stood like a boxer going into the final grueling round.

Step back. Clear, 360J.

The body heaved off of the backboard and slumped back on it. All eyes were fixed on the heart monitor. There was a rhythm, ugly, uneven, but it pumped blood. There was a chance of life. Connie bit his lip. The door opened and Dr. Henning entered.

Take a break, Agnes, said Jude. We’ll manage the rest.

Agnes rested against the corridor wall breathing deeply. She felt herself cramping in the abdomen. She would have gone straight to the washroom but for the sound of something having fallen to the ground in Room 3. She ran along the corridor to room 3 and pushed the sliding doors open. She scanned the room for a split second. Frau Binder was holding a syringe in one wavering hand, the other fumbling near her neck with the infusion system. The ampoule of Paspertin lay on the floor along with a spilt cup of tee.

Stop! yelled Agnes, practically leaping to the bedside.

I used the call button. No one came. I know what to do.

You stupid cow! continued Agnes taking charge of the still full syringe. What did you say? slurred Frau Binder disbelievingly.

Syringe now, repeated Agnes without batting an eyelid while double-checking that the infusion system had remained closed. She quickly prepared a new syringe and injected a dosage. If you ever try a stunt like that again I’ll… Agnes didn’t dare say what she thought. And, Frau Binder had used the call button. Theoretically, someone should have come right away. Agnes was in no mood, however, to apologize right now, she couldn’t.

Frau Binder looked sheepish and nodded slowly. No one came, she said lamely. Agnes ignored her blustering, Are you still nauseous? Frau Binder shook her head, It’s gone now.

Agnes squirted the old syringe’s contents into the nearby sink before throwing it away, then put the new one in her pocket. The afternoon nurse will check in on you soon, she said flatly, then left the room while pulling the med cart behind her out into the corridor.

Agnes sat on the toilet. It was quiet. She bowed forwards, elbows on her thighs and supported her throbbing head in her hands, waiting for her abdomen to stop cramping. When it finally stopped she left the cubicle, splashed cold water on her reddened eyes and left the bathroom knowing that Dr. Henning would want to speak to her. He was waiting for her in the break room. She poured herself a glass of mineral water and faced him.

You handled things well. Thank you.

And the patient?

He’s back into a Sinus Rhythm now. He should make it. He’s young, he’s breathing, he’s…

Wait, said Dr. Henning, holding up his hand. I’ve also insisted that the ICU 1 take him back.

That’s good.

Jude said you ran everything better than most doctors. He hesitated, You saved him. It was a courageous thing to do. There’ll be an inquiry, you know. Agnes nodded. We support you, continued Dr. Henning, but sometimes that doesn’t count for very much. If they stick by the rules and say a full-blown resuscitation is only to be run by doctors… It’s not America. His words trailed away.

I know, said Agnes. It seemed the right thing to do at the time.

You saved his life. It was the right thing to do. He placed his hands on her shoulders, Do your bedside report and go home. His pager bleeped. He looked down. Sorry. Got to go. Agnes swallowed a gulp of water in the empty room.

Connie found her in the changing area. She was sitting in her blue scrubs with her elbows on her knees and with her head in her hands. That’s where you are, he said, crouching and placing an arm around her. I didn’t want you to leave without saying thank you. I knew we could revive him. He lent over and placed an arm around her shoulder. Are you going to be all right?

I’m OK, but I’m tired, really tired.

Get some rest, he said softly, placing his hand on her shoulder. I’ve got to be getting back. Connie retreated, waggling his fingers.

See you, said Agnes. She shucked herself out of her blue scrubs and began to tremble and shake. Even when she put on her clothes from the locker she felt as naked and vulnerable as a snail without its shell. She looked through the window. It was overcast, but not raining. She slipped on her shoes, bundled her rain gear under her arm and smiled weakly at the realization that her morning sickness was gone.

Agnes walked down the winding staircase, through the bustling entrance