Chapter 2 - The Blue Lips
I moved before the sound of her fall had even finished echoing off the vaulted glass ceiling.
Nine years of muscle memory took over. You don't think; you don't calculate hospital hierarchy; you don't look at badges. You move toward the sound of sudden collapse because in trauma medicine, the difference between a living human being and a brain-dead corpse is measured in fifty-second increments.
I covered the fifty feet across the marble lobby in four strides, sliding onto my knees beside the fallen woman just as the gold folder’s papers settled around us.
"Call a Code Blue!" I shouted over my shoulder, my voice cutting through the lobby’s background noise with the raspy, booming authority of an artillery command. "Lobby atrium! Get a crash cart and a rapid-response team down here now!"
"Audrey!" Langston rushed forward, his polished leather dress shoes slipping slightly on the slick marble before he caught himself on the edge of a planter. He dropped down on the opposite side of her body. "Audrey! Can you hear me?"
The woman—Audrey Langston—was violently gasping for air, but no oxygen was reaching her lungs. Her eyes were wide, bloodshot, and filled with a terrifying, primal panic. Her mouth opened and closed like a fish pulled from water, a dry, faint whistle issuing from her windpipe with every desperate effort to inhale.
"She... she was coming to bring me my forgotten grant files," Langston stammered, his hands hovering over her chest, trembling visibly. "Audrey! Jesus Christ, Audrey, look at me!"
"Move your hands, Victor," I said, my tone flat, hard, and stripped of all deference.
I grabbed her coat, unbuttoning it with three sharp tugs, and tore open the silk blouse beneath to expose her chest and throat.
Her trachea was pushed distinctly to the left side of her neck, the large anatomical landmark displaced like a bent pipe beneath her skin. The right side of her chest was completely immobile, fixed in a state of hyper-expansion, while her left chest struggled through shallow, erratic rises. The jugular veins on the right side of her neck were distended, bulging thick and dark green against her skin, pulse waves hammering against the tight tissue.
I pressed my left ear directly to the right side of her ribcage, placing my fingers over her radial artery.
No breath sounds. Absolute, dead silence in the right lung field.
Her radial pulse was paper-thin, fluttering at over one hundred and sixty beats per minute, fading rapidly as her heart fought against a crushing wall of internal pressure.
"Tension pneumothorax," I said, looking up directly into Langston’s eyes. "Right side. Her lung has collapsed, air is leaking into her pleural cavity, and the trapped pressure is shifting her mediastinum. It’s compressing her vena cava. Her heart can't fill."
Langston’s face went pale, but his mind instantly fought the diagnosis. "No. No, that’s impossible. She doesn't have trauma! She didn't fall from a height! She has asthma—she’s had severe exercise-induced asthma for ten years. It’s a severe laryngospasm or a status asthmaticus event. She needs epinephrine and an inhaler!"
"Look at her trachea, Victor!" I growled, pointing a finger at her throat. "Look at the deviation! Look at her neck veins! An asthma attack doesn't displace a windpipe two inches to the left! She’s suffered a spontaneous rupture of a subpleural bleb. Air is pumping into her chest with every gasping swallow, and it has nowhere to go!"
"She needs a bronchodilator!" Langston insisted, his voice rising into a high, cracking register that shocked the surrounding residents, who had gathered in a terrified, helpless circle around us. "Where is the code team? Where is the emergency cart?"
Denise Carter dropped to her knees beside me, carrying a portable suction unit and a basic bag-valve mask she had grabbed from the security desk.
"Code team was called," Denise said, her eyes fixed on Audrey’s bluing lips. "They’re coming from the third floor. Elevator two is currently held for service."
"Elevator held?" I snapped. "How long?"
"Two to three minutes," Denise said.
Audrey’s hands suddenly dropped from her neck. Her eyes rolled backward, showing only the whites, and her entire body went limp against the cold marble. The violent whistling in her throat stopped entirely.
She was no longer breathing.
"Audrey!" Langston screamed, grabbing her shoulders and shaking her. "Audrey! Stay with me! Respirations stopped! Start mouth-to-mouth! Get her on a stretcher!"
"Don't you dare blow air into her mouth!" I roared, grabbing Langston by the lapels of his white coat and shoving him back with enough force to send him onto his hips. "If you bag her or give her mouth-to-mouth right now, you will force more air into her thoracic cavity and kill her in thirty seconds!"
"She’s in cardiac arrest!" Langston yelled, scrambling back toward her. "We need to perform CPR! We need to move her to the Emergency Department!"
"If you do chest compressions on a tension pneumothorax, you are squeezing a heart that has zero blood returning to it!" I stood up, looking around the lobby. "Where is the wall-mounted emergency kit?"
Denise pointed toward a recessed alcove forty feet away beneath a glowing red emergency sign. "There! Wall cabinet B-4!"
"Get it!" I ordered.
Denise jumped to her feet, sprinted across the polished floor, her rubber-soled shoes screeching against the marble. She reached the glass-fronted cabinet, reached for the chrome latch, broke the plastic security seal, and threw the door open.
She froze.
May you like
Her shoulders drooped. She stood staring into the interior of the box for two long, terrifying seconds before turning back to us, her face completely drained of color.
"It’s empty," Denise called out, her voice trembling. "There’s no kit inside."
