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Two Excerpts from Old Soldiers

On his arrival at the patient's room, this time he encountered someone in a white coat who looked even more junior than he did. That was hardly possible, since he was a first-year resident, but on closer inspection he realized that it was a medical student who had called the cardiac arrest. Now the young student was standing nervously at the bedside of a young woman, who was clutching her chest. Darren had beaten the nurses with the crash cart to this emergency, so he had time to ask a couple of questions before they came crashing into the room behind him. "So what's going on?"
     "I'm sorry," responded the young medical student. "This isn't a real cardiac arrest. Mrs Hamilton here has a history of PSVT and now her heart is racing."
     PSVT refers to a condition where the heart's electrical signals speed out of control and the heart beats very quickly. Mrs Hamilton seemed aware of what was going on.
     "This has happened before," she began, "but it always went away on its own before. The palpitations are getting very uncomfortable."
     Darren checked her pulse and confirmed that it was an incredible 200 beats per minute. A team of nurses arrived in the room behind him, and again he heard the familiar shout, "Anyone who doesn't need to be here…get out!"
     Darren winced as the enormous nurse manhandled people out of the way. This time he felt moderately more confident because he had arrived first and was pretty sure he knew what to do, but this time there was a more complicated choice of drugs to use. As the nurses attached leads and monitors to the patient and started an intravenous, he took a few deep breaths and prepared to order the medication. He wanted to sound like he knew what he was doing this time, so he went over all the algorithms he had memorized in his head until once again a nurse stood poised and ready to give a drug. This time the syringe was not preloaded. She was not sure what drug he would choose. The room seemed silent and motionless for a moment until he said, "Adenosine." The nurse poised by the intravenous line reached for a syringe.
     "Adenosine," repeated the huge nurse who now towered over Darren's shoulder. She did not sound disapproving, but did sound like she wanted him to be sure.
     "Adenosine. Six milligrams IV-Push." This time he said it with authority.
     Mrs Hamilton looked expectantly at Darren. What she did not realize was that he had just ordered a medication that would briefly stop her heart and allow it to reset its electrical rhythm. Darren was sure it was the right drug, but he had never seen it used before, and he was starting to wonder what its effects would look like.
     On the heart monitor, Mrs Hamilton's heart was still beating at a rate of 200 per minute. As the nurse with the syringe injected it into Mrs Hamilton's IV, Darren looked at the patient. "This may make you feel a little ... funny."
     "Okay," she answered. She was satisfied with his answer because he seemed to know what he was doing. Darren appreciated the sentiment, but deep down he was wondering exactly what she really would feel in the next moment. He focused his eyes on the monitor. The medication reached Mrs Hamilton's bloodstream and in an instant her heart tracing went from 200 beats per minute to a flat line. Darren continued watching the monitor intently. Mrs Hamilton heard the whine behind her that is so frequently used on television to indicate that someone has died, and she turned around. Seeing the flat line, she turned back to Darren with a questioning look in her eyes. Darren's face remained impassive, and he continued watching the monitor. Now, seeing that his eyes remained fixed on the monitor, Mrs Hamilton turned around again. Her heart monitor still showed a flat line. All this took only a couple of seconds. Once again, the room around Darren seemed silent and motionless. All except for Mrs Hamilton's eyes moving back and forth from him to the monitor that indicated her cardiac arrest, but her mind was not racing nearly as fast as Darren's.
     Oh my God, he thought. Any second now she's going to pass out and die. What if I've killed her? Mrs Hamilton looked back in his direction. Making a feeble attempt at a smile, he nodded. Despite his outwards show of confidence, he thought: When the hell is her heart going to start up again?
     "Beep." A heartbeat appeared on the monitor. "Beep, beep, beep…."
     Darren closed his eyes for a long second and took a deep breath. He opened his eyes as Mrs Hamilton said: "Thank goodness, my palpitations are finally better."
     The monitor showed a nice, normal rhythm at a rate of 65 beats per minute.
     "Good old adenosine," said Darren, as though he had seen it before many times and not just in a textbook.
     He took a moment to talk with the medical student, and suggested she talk to her attending physician about what had happened. She thanked him and he began to make his way out of the room past the inevitable crowd of people that accumulates at cardiac arrests.
     "Way to stay calm." The huge nurse slapped him on the back on his way out of the room and nearly knocked him over. "My name's Tina, by the way."
     Tina, thought Darren. That must be the equivalent of a gigantic Hell's Angel named 'Tiny'.
     "Thanks," he answered. "My name's Darren."
     "You're having a fun night already and it's still only seven o'clock," she added.
     "I know," he answered, and began to head back to the Emergency Department.
     Darren had only walked a few steps when he realized he had better stop to take a breath. Partially relieved that everything had gone well and partially triumphant he had saved a patient from a life-threatening condition, he stepped into the nearest staff washroom and splashed cold water on his face. When he looked back up in the mirror and assessed how he was feeling, he found he was almost as excited at the approval he had won from the nursing staff as he was about the medical care he had been executing.
     He had only just finished calming down and heading for the Emergency Department when the code pager rang and the familiar claxons sounded overhead once again. He ran.
     That long night became longer and longer. At his third cardiac arrest of the night, he had to put in a central line and an endotracheal tube. He finished some of his work in Emergency after that, but it was not long before he was running to a fourth cardiac arrest.
     At about four o'clock in the morning his work was done and he headed for his call room. He had been exhausted when he started his day some twenty-one hours earlier, and now he was so exhausted he probably could not sleep. He stared at the ceiling from his call room bed and noticed his shoes were still on his feet. He felt the only thing keeping him alive was adrenaline. He could not remember whether he had eaten dinner, but he did not care because he was nauseated anyway. His medical school days of reading crisp, detailed textbooks and studying for standardized exams seemed a thousand years distant. The only thing standardized about medical emergencies was the terror they produced, and the crucial detail in every case was always an exception to the rule. Multiple-choice examinations were feeble preparation for a world where the educational technique for invasive procedures was most often described as: "See one, do one, teach one."
     He had only been lying down for about fifteen minutes when the code bells sounded again. It was the fifth cardiac arrest of the night. Earlier in the night he had been afraid to go to the bathroom for fear the code pager might ring. No matter what he did he could feel its weight at his side as a constant reminder of a terrifying responsibility. This time, it was starting to seem routine. Not routine in the sense that he felt in control and knew what was going on, but routine in that his feet just carried him out of bed and raced him there without his consciously willing it. The halls sped by him as though in a dream. People's voices seemed far away as he ran down the hall. The next morning when asked how many cardiac arrests had been called, he had to think hard to remember if the fourth and fifth had been real or imagined.

******************

Kurt was in a pleasant marching rhythm. As the green soldiers passed his section on the left, he chose not to notice them. But there were so many. He felt as though he had walked for days with this column of men passing in the opposite direction when the sound of voices from behind forced him to pay greater attention.
     "Look at all the heroes off to fight the British!" Kurt recognized Schuler's voice as the source of the taunt. He turned to look and saw that Schuler was laughing and pointing at the clean uniforms of the new recruits. Now that his attention was focused on the young infantrymen marching past, Kurt briefly recalled his own life at their age. Many of them looked only seventeen or eighteen years old. At eighteen he had been an aspiring architect hard at his studies, and his only thoughts of war had been stories of the war of 1914 told by his uncle, but his uncle was notoriously quiet on the subject. Once again Kurt felt like an old man among children, even though he was only in his late twenties. Now, for a fleeting moment, he wondered what his life would have been like had it been touched so early by war. His eyes caught those of one of the infantry, and he saw them filled with fear. The young soldiers seemed awed by the veteran paratroopers walking away from the front. Their eyes were searching, questioning. They seemed to ask, "What is the future going to bring?" The young fools had no idea what to expect and now they looked at the sweat, dirt and blood on the uniforms of the paratroopers to give them the answer. Kurt was caught by the irony that in fact he and his men were not returning from combat. They were just continuing the stepwise job of creating nuisances for the enemy during a less than organized retreat. Kurt turned to continue marching but Schuler's taunts continued.
     "Are those medals on your uniform? I did not realize that the Iron Cross was being given for keeping your room tidy."
         Kurt turned an angry glance to Oberjager Schultz, who stepped out of line and moved purposefully towards Schuler. Schuler had all but stopped marching, and two infantry soldiers were standing near him receiving his taunts, so stunned that they did not even defend themselves. As Schultz forcefully pushed them out of his way and grabbed Schuler by the collar, Schuler's look of self-satisfaction dissolved. Kurt could taste the irony that the least experienced of the paratroopers was the first to brag to these recruits. Of course Schuler had taken quick advantage of the fact that the paratroopers were filthy and seemed to be returning from a battle, because the awe that fact inspired in the green infantry made them easy targets for his taunts. For just a moment Kurt sympathized with them, but the moment was fleeting. As Schultz manhandled Schuler towards him, Kurt remembered that the inexperience of conscript soldiers could mean death to those who fought alongside them.
     "Perhaps you think that marching with your section is not a high enough priority?" Hans Schultz yelled as he hauled Schuler up before Kurt. Schuler was silent and pale. He had clearly hoped to win approval from the more experienced paratroopers by bullying the young recruits. Now that his efforts were only winning him discipline, his boisterous exterior shrunk quickly back to size. Kurt meted out his sentence.
     "Herr Oberjager Schultz, I think that Jäger Hans Schuler would like to inspect the route for five kilometres up ahead. He should do so double-time and then return with a report on the condition of the road." Having received his orders, Schultz had only to glance in Schuler's direction to send him running ahead. Schuler's heavy pack bounced on his back and he braced himself for a workout. He had shown himself to be a loudmouth when placed in the presence of his juniors, but Kurt retained some sympathy, since Schuler had never been an unreliable soldier.
     Kurt pointed down the road and gestured in Schultz' direction. Schultz assembled the section, most of which had slowed to a halt when the disruption began, then the Corporal shouted instructions and they resumed their march. Kurt had noticed that his men were considerably outnumbered here by soldiers of the army. With animosity boiling under the surface between the Heer and the Luftwaffe, he felt compelled to do all he could to ensure that Schuler's immaturity did not result in an eruption of hostilities. He walked towards the Lieutenant who was in charge of the infantry.
     "I apologize for my soldier's outburst, Herr Oberleutnant. It will not happen again."
     "Fine, Unterfeldwebel." The Lieutenant was a younger man than Kurt. He looked sharp and professional, but as they exchanged salutes Kurt saw something in his eyes. It was the same combination of fear and awe worn by the troops the young Lieutenant commanded.
     As Kurt turned and returned to his section, he chided himself for the bit of sympathy he had felt for the young infantry. Now he felt glad only that they were marching in the opposite direction. If they were nearby, their inexperience could kill him as surely as it was about to kill all of them.
     He hated them.
     He silently thanked Wehrmacht protocol that he could address the Lieutenant only by his rank. He did not want to know that man's name. That young, ignorant lieutenant was only a piece of meat that was about to be ripped to pieces by the wrath of British bombers and tanks. Looking at Kurt, the eyes of those infantrymen had been probing his face, his clothes, and his rifle. They had been searching for any clues as to what to expect in battle, what to expect from a vastly superior enemy, what to expect from themselves. Most of them would never learn the answers.

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