As Laurie's hyperkalemic treatment began to bring down the high potassium that Jack feared was coursing around in her blood, an anesthesiologist showed up. He proceeded to deftly intubate Laurie so she could be respired with more certainty. When he straightened up after finishing the procedure, Jack caught his name. It was José Cabreo, and Jack did a double take. He remembered the man's name from Roger's lists. Jack found himself watching José's every move and was relieved when the anesthesiologist quickly left.
The peritoneal dialysis was started percutaneously without a hitch, using a large bore trocar. Jack averted his eyes as the trocar was punched through Laurie's abdominal wall, but he was close enough to hear the popping sound it made as it went through the fascia, and he winced. A moment later, he watched as isotonic fluid free of potassium was then run into her abdomen. Jack secretly crossed his fingers and prayed that the procedure would help. He was aware that with the extensive surface area within the abdomen as a result of the loops of intestine combined with the rich plexus of blood vessels, peritoneal dialysis was the most efficient even if passive way to lower potassium or any other elevated electrolyte in the blood.
Unfortunately, after ten minutes of the aggressive therapy, there was disappointingly little change in Laurie's status. Caitlin ordered more calcium gluconate and injected it herself. Jack heard this from afar, as he'd begun pacing between Laurie's bed in front of the nurses' station and the elevator lobby. It wasn't the caffeine that was propelling him now, it was his mounting fear and guilt. His nagging concern was that this episode might be another instance of his being a jinx to those he loved. The thought haunted him mercilessly. In one night, he already had lost a potential child; now he was on the verge of losing the person he loved. To make matters worse, he knew he was at least partially to blame.
When the stat Woodwork came back, Caitlin brought it over to Jack. "Well, you were absolutely right," she said while pointing to the highlighted abnormally high potassium level. "That's about as high as I've ever seen it. After this is all over, I'd like to hear how you knew."
"I'll be happy to tell you," Jack said, "provided Miss Montgomery pulls through." If Laurie didn't make it, he didn't know if he'd be willing to talk to anybody.
"We're doing our best," Caitlin said. "At least her color is good and her pupils have definitely come down."
As the minutes inexorably passed, Jack kept his distance. As a bystander, it was progressively upsetting to him to see Laurie splayed out on the bed with a stranger pounding on her chest and another dispassionately squeezing the breathing bag. The ambulatory patients who had earlier come to their respective doors to watch the unfolding drama had gone back to their beds. Most of the floor nurses had also been called away by the needs of their own patients.
It was twenty minutes to six when the first truly optimistic sign occurred, and it was Caitlin who noticed it. "Hey! Gang!" she shouted. "We're getting some electrical activity in the heart!" The medical resident who was not currently doing either the closed chest massage or the breathing-bag compression rushed over to the EKG machine to look over Caitlin's shoulder. "Send off another stat potassium level," Caitlin yelled to the nurse who was assisting them.
"Wow! Those complexes are starting to look quite normal," the resident said to Caitlin, who nodded in agreement. "And they are getting better."
"Hold up on the compressions!" Caitlin called out to the resident, who was kneeling on the bed over Laurie. "See if she's got a pulse!"
The resident who had been breathing for Laurie also stopped long enough to feel along Laurie's neck for a pulse. "She's got a pulse! And, my gosh, she's breathing on her own!" He took the mask away from the end of the endotracheal tube. With his palm, he could feel the amount of air she was breathing in and out. "She's breathing pretty darn normally, and she's bucking the endotracheal tube."
"Deflate it and pull it out!" Caitlin ordered. "Her EKG now looks completely normal."
The resident quickly followed orders and slipped the tube out of Laurie's mouth but still held her chin back to make sure her airway stayed open. Laurie coughed several times.
Hearing these exchanges, Jack rushed back from where he was pacing in the darkened elevator lobby and went behind the nurses' station desk. Laurie had been connected to one of the monitors built in over the desk, but to see it, one had to be on the opposite side of the counter from where the action was. A half hour earlier when he'd looked at it, the blips for the blood pressure and pulse had been tracing straight lines across the screen. It was different now, and his heart leaped in his chest. Laurie had both a pulse and blood pressure!
"Hold up on the peritoneal dialysis!" Caitlin ordered. "And drain out the cation exchange resin. We don't want to overshoot and then have to worry about too low a potassium level."
Jack rounded the nurses' station counter. There was once again a flurry around Laurie as Caitlin's latest orders were carried out. Jack didn't want to get in the way, but as hopeful as these developments were, he wanted to be close to her.
"Hallelujah!" said the resident who had been most recently breathing for Laurie. "She's waking up!"
Unable to hold himself back, Jack crowded in at the head of Laurie's bed that had been backed up against the nurses' station countertop. He looked down and saw what he thought was a miracle. Laurie's eyes were open, and they were moving from one face poised over her to another and reflected not a little confusion and fear. Unexpectedly, Jack burst into tears such that it was hard for him to see. All he could do was shake his head when he tried to talk.
"Release her wrists," ordered Caitlin, who had pushed in across from Jack. The restraints had been left in place during the ordeal. Caitlin bent over Laurie and gave her shoulder a reassuring squeeze. "Everything is okay. Just relax. We've got things under control. You're going to be all right."
Laurie tried to speak, but her voice was barely audible. Caitlin had to bend down to put her ear next to Laurie's mouth. "You're in the Manhattan General Hospital," Caitlin said. "Do you know your name and what year it is?" Caitlin listened, and then straightened up. She looked across at Jack, who had calmed enough to control his crying and wipe away the tears. "This is looking very good indeed. She's oriented. I have to say your rapid diagnosis undoubtedly saved the day. With as high as her potassium was when we started, she surely wouldn't have been able to be resuscitated."
Jack nodded. He still couldn't talk. Instead, he bent down and put his forehead on Laurie's. Now that her hands were free, Laurie reached up and patted the side of his head and whispered in a scratchy voice: "Why are you so upset? What's going on?"
Laurie's questions unleashed another wave of tears. All he could do for the moment was squeeze Laurie's hand.
A nurse at the nurses' station desk stood up behind the counter. She'd just answered the phone. "Dr. Burroughs," she called. "The stat potassium on Montgomery is four milli-equivalents."
"My word," Caitlin exclaimed. "That's darn near perfect." She turned to her three resident underlings. "Okay, here's what we are going to do! While I call the attending physician and give her an update, you three get the patient down to the cardiac care unit and get her set up on the monitor. I'll want another potassium level as soon as you get there, and I'll be there as soon as I finish here so we can decide on her fluids."
As the preparations were quickly made to move Laurie, Jack found his voice. "I'm not upset," he whispered in Laurie's ear. "I'm happy you're okay. You gave us a scare."