Balance

Alex’s shift began at midnight in the ER. He was a paramedic, but the hospital he worked out of required him to spend two shifts a month working on-call in the ER, off the truck. To tell the truth, most nights it was pretty quiet, with a few major incidents here or there, but most people came and went quietly. The majority of the people who came through the ER doors were fine, really. Give them two baby aspirin and they went home without a glitch.

That being said, Alex didn’t expect much excitement from his shift at the hospital tonight. He arrived, and promptly went to the nurses’ station to get the scoop on how the day had gone so far.

“Ladies, how are we doing on this fine evening?”

The nurses all looked up with a smile, and Alena, the head nurse for the night shift, responded,

“ ’Lex! It’s good to see you tonight. We’re actually a little busier than normal, so we really could use your help tonight. We have an 86 year-old frequent flyer in 106, head trauma in 109, chest pain in 110, and we just got a call that Davis and Curry have a potential poisoning on the way.”

“Sounds like this will be interesting then. Where should I start?”

“Go with Jenny. She’s finishing her rounds, and she’ll be taking the incoming patient.”

“Alright then. Page me if you need me elsewhere.”

“Oh, don’t worry; I will.”

Alena winked at him as she picked up a chart and walked away from the station. Alex found Jenny as she was finishing up an IV on the patient in 106.

“Hey Jenn; what do we have here?”

Jenny looked up and replied, “Hi, Lex. This is Mrs. Watson. She comes to see us pretty often these days. Various reasons, but today she’s feeling lightheaded, and she’s having some difficulty breathing.”

Turning to Mrs. Watson, Jenny continued, “Lara, this is Alex. He’s a paramedic, and he’ll be helping us out tonight. If you need anything, feel free to get ahold of either him or I, and we’ll take care of what you need.”

Alex nodded, and Mrs. Watson smiled. “I’m in here two or three times a month. I know a lot of these nurses on a first name basis by now.” The woman chuckled. “I’m surprised I haven’t met you before. I’m sure we’ll get to know each other quite well in time. This place is almost a second home for me these days.”

Alex smiled in return and said “I’m looking forward to it…uh…I mean…”

Jenny laughed, as Mrs. Watson smirked, and ended the moment of awkwardness by cutting him off. “I know what you mean. I truly am looking forward to getting to know you. The staff here say you are quite the paramedic. Maybe you can give me a lift here sometime.”

Right then, the page came over the loudspeakers that the ambulance had arrived, and the patient was being admitted to room 107. Quickly stepping across the hall, Jenny and Alex prepped the room as Davis brought the patient into the room.

“Ok, Davis, what can you tell us?” Jenny said.

“Well, he’s 17, and his mom called 911 because her son had collapsed in the garage. When we arrived on scene, he was passed out on the floor, the hood was open, and there were two cups on the ground. One had some antifreeze in it, and it looks like he drank some of it. Not sure how much, but my best guess is he took a decent swig if it knocked him out.”

Jenny nodded and ran to get the on-duty doctor. Alex looked at Davis and asked “Where’s his mother?”

“Not sure she’s coming. She called it in, but when we arrived, she showed us where he was and walked away. Didn’t seem too upset.”

The doctor rushed in, and had Jenny take vitals while he attempted to diagnose the unconscious patient. During the commotion, the P.A. crackled to life again, stating that there was a car accident victim being rushed in at the moment, and she was to receive priority care.

Stepping out of the room, Alex walked over to the room where the new patient was being set up.

“Alena, what happened?”

“Hit and run vic. Pregnant. Low vitals, not sure about the baby yet. We need that doctor over here STAT.”

Alex ran over and informed the doctor that he was needed elsewhere, and took the doctor’s orders on how to treat the poison victim.

“Pump his stomach, give him the antidote, and hope for the best. Keep an eye on him for me tonight; feels like I’m going to be a little tied up for a while.”

“Sure thing, doc. I have it covered.”

Alex had one of the nurses handle the stomach pumping while he hunted down the antidote for antifreeze. On his way back, he stopped in Mrs. Watson’s room.

“Well, hello there, sailor. What’s all the excitement out there?”

“We just admitted a pregnant woman who was involved in a hit-and-run.”

Mrs. Watson nodded slowly and pursed her lips in thought.

“It’s sad, when a life hasn’t even begun, but it is already in jeopardy. I’d say they are both in the best of hands now, though. Nature will have its way, in the end.”

Alex left the room at that point, mulling over the few short words she had said.

Returning to his poison patient, Alex administered the antidote, and checked the patient’s vitals. In the middle of doing so, another alarm hit the P.A. Jenny could be heard from the hallway yelling something at him. Stepping through the curtain, the sight before him was almost too much to take in. Down the hall, nurses were running his direction pushing a crash cart. The doctor was on the hallway phone, speaking loudly and sternly to whoever was on the other line.

“I don’t care what you have to do, get her in surgery NOW! Get the on-call surgeon in here ASAP, tell him he doesn’t have a choice, and he needs to get in here AND DO HIS DAMN JOB!”

As the doctor slammed the phone back onto the cradle, Alex’s attention was drawn to Jenny, across the hall from him, staring at him expectantly.

“HELLO! Alex! Get in here; she’s coding…all hands on deck.”

Rushing across the hall, he followed the crash cart into Mrs. Watson’s room.

“What the hell happened?!”

“We don’t know. She’s never exhibited these symptoms before, but we thought she might be developing pleurisy or pneumonia. She was stable until a minute ago. Nothing about her symptoms made us worry, so we were just waiting on some of her tests to come back.”

Alex proceeded to charge the defibrillator as Jenny prepped Mrs. Watson for  the shock.

“CLEAR!” The 86 year-old woman’s body rose and fell. No heartbeat.

“Charging!” Alex looked intently at the vitals readout, waiting for the slightest flicker of a heartbeat.

“CLEAR!” Again, her body rose and fell with the charge, and again, no heartbeat.

“One more time…we’ll try it one more time.”

“CLEAR!” The moment after the third charge, both Jenny and Alex held their breath for what seemed like hours, awaiting the result of the final attempt to bring her back…

The vitals readout beeped back to life, as her heartbeat spiked, then settled, and she began to breathe again. Alex and Jenny sighed simultaneously.

“Alex…see if the doctor is available. We need him to authorize some more tests on Mrs. Watson.”

“Yeah…yeah, sure thing.”

“And Alex…nice work.”

“Uh, thanks. Just part of the job, you know?”

Alex left the room, searching for the doctor on the floor. He found him in the empty room where the expectant mother had been minutes before, sitting on the bed.

“Hey, doc, you busy?”

“What…? Oh, no. Just thinking. Praying, really. The patient who was in here, probably won’t make it. She’s in really bad shape right now, and she just went down to surgery. She’s 8 months pregnant, so they will probably have to C-section the baby tonight, and then try and save them both separately.  Just…you never get used to these types of things. I’ve been an ER doctor for 14 years, and I’ve seen hundreds, if not thousands, of people come through these doors. But these types of cases, where kids are involved…it never gets any easier to see. But I’m rambling. What did you need, Alex?”

“Mrs. Watson down the hall crashed a few minutes ago, and we got her stabilized, but we need to run some tests right away that Jenny needs your approval for.”

“Ahh…well, anything for my favorite frequent flyer. I’ll head over there now. Can you check on our antifreeze patient again, please?”

“Of course.”

Alex returned to the teenager’s room, and upon finding him still comatose, began to document his vitals.

“Shit…ALENA! Can you come in here real quick?”

From down the hall, he heard her respond, “On my way.”

When she walked in the door, she had a puzzled look upon her face.

“What’s up, Lex?”

“His temperature, first and foremost. He has a temp of 109. I administered the antidote almost 20 minutes ago. Shouldn’t he be starting to level out? We pumped his stomach almost an hour ago, the antidote has been in his system a while. Why is he still getting worse?”

“I don’t know, honey. Let’s wait a little while longer and give the treatment some more time to do its work. If he doesn’t start to get better, we may have to start him on dialysis.”

“But we can’t do that without parental consent, can we?”

“His driver’s license says he’s almost 18. If it comes down to it, we’ll act like he’s a legal adult in this situation. Our job is to try and save lives. If needs be, we’ll take the consequences of doing our jobs. I’m sure we’ll be fine.”

Still unsure, Alex nodded quickly, and crossed his arms.

“Why are we so busy tonight? We never have this many critical patients in such a short period of time.”

“That’s just the way it goes, Lex. Sometimes, a whole bunch of tickets get punched at the same time.”

“I guess. We might have to call more people in if we get more admitted.”

“Alex…why do you think they have you medics take shifts with us? This is all the staff we have. There is no one else to call. These lives rest on us.”

Alena walked back to the nurses’ station, and Alex stepped outside for a cigarette. Outside, he found Davis restocking the ambulance.

“Hey, buddy. Looks kinda rough in there. Lots of excitement going on.”

“Yeah. I’m not sure excitement is the word for it. You know, we deal with stuff like this all the time, but all we do is stabilize and transport. After we drop them off here, we don’t really think about the patients anymore. But inside these doors, the fight really begins. It’s hard to imagine doing this every day.”

“By doing the same thing you do. They do their jobs to the best of their ability, and then let the chips fall where they may. Their jobs are not to save lives. Their job is to try and save lives. Alex, what we do is not that different. We all simply put the patient in the best position we can to facilitate recovery. Sometimes they recover, sometimes…they move on. It’s part of the job, man. Shake it off, and don’t let it get to you. If you let the gravity of it all cloud your mind, you are doing both the patient and yourself a disservice. Listen, I gotta go. We’re bound to get another call here in a minute, and we need to be ready to go. I’ll see you on the truck tomorrow night.”

“See you later, Davis.”

Alex finished his smoke, and went back inside. He went to the nurses’ station and found Alena and Jenny there.

“Jenn, Alena, any news on our criticals?”

Jenny spoke up, “Nope. Waiting on test results for Mrs. Watson, the hit-and-run is still in surgery, and the kid’s temp is still holding at 109.”

“So…what do we do now? What do you want me to do?”

Alena sighed, and said slowly, “Nothing. There is nothing to do now but wait. Wait on results. Wait on news. Wait on change. At the moment, it is all out of our hands. Until something changes, we wait.”

“Mrs. Watson is awake now, though. She was asking about you when we got back from x-ray. You could go see her while you wait.”

Alex made his way over to Mrs. Watson’s room, and when he entered, she smiled radiantly at him.

“Here comes my hero. I understand you are the one responsible for me still breathing.”

“Eh, it was a group effort.”

“Modest as well, I see. Either way, I must thank you. I appreciate the work you and your colleagues do for me. You all are so nice, and very good at your jobs. You make being here much easier.”

“That’s what we aim for.”

“You do quite a good job at it…”

Mrs. Watson looked at Alex for a moment, and then spoke again, “There’s something bothering you, isn’t there? What’s on your mind, son? Maybe I can help.”

“I don’t want to get into it with a patient…I’m supposed to be here for your benefit, not dumping my problems on you.”

“Nonsense. I want to hear. It lets me see the person behind the hero, as it were. What’s bothering you?”

“Well, it’s actually about tonight. I normally work the ambulances, and when I have shifts here in the hospital, I never see this many real emergencies. I feel like there should be something I can do to help save these people. I hate the waiting. There should be something I can do.”

“You cannot control the outcome of every case that comes through the door, Alex. You can’t expect that of yourself. It’s not fair to you, or to the rest of us, quite frankly. I can’t have you worrying about what you could or should or might have done with someone else while you help me out. You’re going to wind up with a world of regret, and you’re more likely to make a mistake with your mind wandering like that.

“There is a concept remembered in older societies that is often forgotten by those in America. Our relatively young society has latched onto the concepts of liberty, logic, and due process. We seem to be under the impression that outcomes are always under our control, and that regardless of what happens, the machinations of man are always at work pulling the strings. Under this mindset, we seem to forget something many older cultures remember: a force referred to as “Nature.” Nature: the natural balance and order of life, uninhibited and mostly unaffected by the schemes and actions of mankind.

“Life and death, order and chaos, sound and silence, are all under the influence and guidance of Nature. Few places exhibit the influence of Nature as prominently as a hospital, in my experience. You medical people do what you can to fix these broken bodies, but in the end, some of us just don’t recover. Some of us just aren’t meant to survive what we come in here with. And there is nothing you can do about that. You just have to accept the fact that life lies beyond your realm of control, and all that is required of you is your best.

“Nature will balance the scales, and while you can help some of us recover from what ails us, eventually every one of us has to die at some point so that another can be born. Nature balances these things quite nicely without our meddlesome intervention. There is a time to be born, and a time to die. A time to be sick and a time to be well, a time to fight for change, and a time to accept the way things are. You can struggle your whole life, but the scales will constantly balance themselves. Sometimes, the best you can do for us people is doing what you have done for me: come and talk. Make us comfortable. Give us the best of your efforts, and treat us like people. And after all that, let us go when it is our time. Let the scales balance out.”

Alex tilted his head to one side, pondering her words.

“Where did you learn all that stuff, Mrs. Watson? How do you know what it’s like here, and how to deal with it all?”

She smirked and replied, “Mr. Watson was a nurse when we were young. He had to learn to deal with many of the same things as you kids do in these walls. And since he had to learn how to live with the balance, so did I.”

She winked, and then laid her head back and closed her eyes.

“I need to rest a little while. We should continue our conversation in a little while. We old ladies require our daily naps.”

She opened one eye and stuck out her tongue to one side. Alex grinned and replied, “Alright then. I’ll be back later and we’ll pick this back up.”

Alex returned to the nurses’ station and continued to wait for the results on the patients. He spent the next couple of hours talking with the nurses, checking charts and vitals repeatedly, and thinking all the while about his conversation with Mrs. Watson.

After a while, the results for the teenage poison patient came back. Alena looked them over, and then quietly set them down on the desk. Everyone was waiting expectantly for her to reveal what they said, but she simply sat down and tiredly rubbed her eyes.

“So, are you going to tell us what was in those results, or are you just going to sit there?” Jenny asked.

Alena looked over at the group, and just shook her head.

“What? No…it can’t be that bad…” Alex said as he reached over and picked up the sheet of paper.

“…complete kidney failure? So let’s get him on dialysis. Let’s get moving…at least now we know how to treat him, right?”

Alena sorrowfully stood up and walked around the nurses’ station to where Alex stood.

“Lex, we can put him on dialysis, but this means his kidneys won’t heal. He’s going to be put on the transplant list, and who knows how long it will take for him to get a matching donor, or even how high up the list he will be placed. This poor kid probably won’t make it through the night.”

Silently, they all stood there, contemplating the life that was being cruelly cut short. The boy was almost 18, and he was in the fight for his life. All Alex could think about were the words of Mrs. Watson, who lay sleeping directly across the hall from this boy. A boy whose name he suddenly realized he did not know.

Clearing his throat and composing himself for a moment, he gathered his thoughts.

“Alena, what’s his name?”

“Thomas. Why?”

“It just hit me that I have been trying to save this kid’s life all night long, and I don’t even know his name.”

More time went by, with the team quietly doing their work. About an hour before the end of the shift, both Thomas and Mrs. Watson passed away, suddenly and without warning. A life that had just begun, and a life that had been fully lived both passed through the ER that night, and both were tragic in very different ways.

With the deaths of Mrs. Watson and Thomas, everyone was awaiting news of the mother and child that had been sent to surgery hours before, with every head bowing in desperate prayer at one point or another. Near the end of the shift, news trickled down that the surgery had been successful, but both mother and child were in intensive care.

Over the next few days, Alex would check in on the two and waited to see signs of improvement. After almost a week, Alex received a call from the ER.

“Alex? Hey, It’s Jenny. I just thought you would want to know that the mother from that hit-and-run last week is out of the ICU. They’re letting us see her, and I was hoping you would go with me…”

“Yeah, absolutely. How’s the baby though?”

“I’m not sure. I haven’t heard whether the baby is still in NICU or not, but I will try and find out. Meet me in the ER in an hour, and we’ll go up and see her.”

Alex was so anxious to see something good come out of that night in the ER that he rushed right over to the hospital as soon as he got off the phone. When he arrived, he and Jenny went up to the room where the mother was being kept. Just before walking in, Jenny grabbed his arm.

“Lex…look…”

Looking through the hall window into the room, Alex saw an image that nearly made his knees buckle. Inside, he saw the mother, sitting in the embrace of her husband, smiling immensely, holding in her arms a beautiful, healthy little girl.

Alex smiled and watched for a minute or two. Then he grabbed Jenny’s hand and said,

“Come on. Let’s go celebrate. Dinner’s on me.”

The entire time as they walked out of the hospital, Alex couldn’t stop replaying Mrs. Watson’s words in his mind. Life balances the scales. There is a time to live, and a time to die. He realized that while there had been two devastating losses that night, there had been two wonderful recoveries. The scales had indeed balanced themselves, and instead of carrying the weight of the sadness of the loss, he had found a way to see the beauty in both the tragedy and the recovery.

There are thousands of stories like this one that old hospital could tell. Stories of life and death, of sickness and healing, and of those who learn to live every day locked between the extremes, but in the end, they are all simply stories of the balance.

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