retold the story, she recalled seeing everything as if from the wrong end of a telescope, feeling desperate for air despite wearing an oxygen mask, and being about to pass out. The chief resident kept yelling for intravenous digoxin while others stuck her with IV needles and shouted a flurry of other orders:
“Furosemide!”
“Nitro!”
“Morphine!”
Like happy hour at a bar, she’d thought, watching the darkness close in on her.
A nurse had brought the syringe of digoxin up to the rubber injection port on a small intravenous bag.
Then that lone clear voice. “No! This is dig toxicity.” And a dark-haired girl with a plain face had grabbed the needle away before it could be injected. “The rhythm strip shows atrial flutter with block,” she added, speaking firmly and loudly enough to cut through the melee without resorting to panicky shouting like everyone else.
The rest of the team had immediately turned to give her their attention. “Look,” she said, running the long strip of paper upon which the ECG had been printed through her fingers, handling it like a ticker tape and pointing out the salient features.
Yes, yes, yes, the doctor in Bessie McDonald had thought, her hearing intact enough to pick up sufficient snatches of the quick-fire explanation to know it was correct even as her vision narrowed to mere pinpoints of light.
Atrial flutter with block, a hallmark of digoxin toxicity, meant a far too rapid heartbeat where the upper chambers, the atria, pounded along at 300 a minute, and the lower chambers, the ventricles, contracted at exactly half that rate, 150 a minute. The trick? To recognize it from the other arrhythmias where the atria and ventricles raced ahead at the same speed and the drug of choice was more digoxin. Had the chief resident succeeded in giving an additional dose to Bessie, however, he would have entrenched the problem, rendering her myocardium twice as resistant to treatment, and she could have died. Pumping at that speed, the chambers weren’t emptying properly, and her lungs were filling up with fluid. While the other drugs they’d ordered would help empty it out, the definitive step to solve the problem – slowing down her heart – had to be done by a synchronized countershock of electricity.
Melanie had come through for her on that count as well. Bessie felt the paddles lathering up her chest with lubricant, then “Pow!” A huge white light ripped up the inside of her skull. Yes! Despite the sensation of being kicked by a horse, the jolt of direct current, she knew, would stun the atria, render their conduction pathways refractory to the fast impulses, and allow her own natural pacemaker time to reassert itself. Within minutes she began to feel better, opened her eyes, and saw Melanie smiling at her.
“Quite a feat for a fourth-year student,” Bessie said. “You know, up until that point, I got the impression nobody on staff appreciated your skills.”
Melanie chuckled. “Hey, that’s the job of teachers with medical students. Keep ‘em tired and feeling stupid. Makes it easier to stuff them with knowledge. But to what do I owe this trip down memory lane?”
Bessie reached for the paper with her good arm. “This got me going,” she said, tapping the article about Kelly McShane. “It all happened that same year. I remember her. She was so pretty and pleasant around patients. I thought then she’d make a great doctor. And if you recall, Chaz Braden had been my cardiologist. Come to think of it, he kept ignoring my complaints of being nauseated. That should have tipped him off my digoxin level was rising.”
“You’ve got a pretty good memory for something so long ago.”
“What do you expect? I nearly died. As for the time when Kelly McShane disappeared, I figure just about everyone remembers that, at least where they were.”
“How do you mean?”
“Thursday, August 8, 1974. That was the night Nixon resigned. He gave a TV speech at nine P.M,
“Furosemide!”
“Nitro!”
“Morphine!”
Like happy hour at a bar, she’d thought, watching the darkness close in on her.
A nurse had brought the syringe of digoxin up to the rubber injection port on a small intravenous bag.
Then that lone clear voice. “No! This is dig toxicity.” And a dark-haired girl with a plain face had grabbed the needle away before it could be injected. “The rhythm strip shows atrial flutter with block,” she added, speaking firmly and loudly enough to cut through the melee without resorting to panicky shouting like everyone else.
The rest of the team had immediately turned to give her their attention. “Look,” she said, running the long strip of paper upon which the ECG had been printed through her fingers, handling it like a ticker tape and pointing out the salient features.
Yes, yes, yes, the doctor in Bessie McDonald had thought, her hearing intact enough to pick up sufficient snatches of the quick-fire explanation to know it was correct even as her vision narrowed to mere pinpoints of light.
Atrial flutter with block, a hallmark of digoxin toxicity, meant a far too rapid heartbeat where the upper chambers, the atria, pounded along at 300 a minute, and the lower chambers, the ventricles, contracted at exactly half that rate, 150 a minute. The trick? To recognize it from the other arrhythmias where the atria and ventricles raced ahead at the same speed and the drug of choice was more digoxin. Had the chief resident succeeded in giving an additional dose to Bessie, however, he would have entrenched the problem, rendering her myocardium twice as resistant to treatment, and she could have died. Pumping at that speed, the chambers weren’t emptying properly, and her lungs were filling up with fluid. While the other drugs they’d ordered would help empty it out, the definitive step to solve the problem – slowing down her heart – had to be done by a synchronized countershock of electricity.
Melanie had come through for her on that count as well. Bessie felt the paddles lathering up her chest with lubricant, then “Pow!” A huge white light ripped up the inside of her skull. Yes! Despite the sensation of being kicked by a horse, the jolt of direct current, she knew, would stun the atria, render their conduction pathways refractory to the fast impulses, and allow her own natural pacemaker time to reassert itself. Within minutes she began to feel better, opened her eyes, and saw Melanie smiling at her.
“Quite a feat for a fourth-year student,” Bessie said. “You know, up until that point, I got the impression nobody on staff appreciated your skills.”
Melanie chuckled. “Hey, that’s the job of teachers with medical students. Keep ‘em tired and feeling stupid. Makes it easier to stuff them with knowledge. But to what do I owe this trip down memory lane?”
Bessie reached for the paper with her good arm. “This got me going,” she said, tapping the article about Kelly McShane. “It all happened that same year. I remember her. She was so pretty and pleasant around patients. I thought then she’d make a great doctor. And if you recall, Chaz Braden had been my cardiologist. Come to think of it, he kept ignoring my complaints of being nauseated. That should have tipped him off my digoxin level was rising.”
“You’ve got a pretty good memory for something so long ago.”
“What do you expect? I nearly died. As for the time when Kelly McShane disappeared, I figure just about everyone remembers that, at least where they were.”
“How do you mean?”
“Thursday, August 8, 1974. That was the night Nixon resigned. He gave a TV speech at nine P.M,
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