April Jeffers, RN, yawned as she looked up from the computer screen. Paperwork had definitely not been on her list of top ten reasons she wanted to be a Registered Nurse, but on this day she found herself wishing there was more, just to fill the tedium of a very slow workday. A faint smile creased her lips as she checked the last report for errors. Little Marcus Wade had been a great patient. She could still see the three-year-old as he sat bravely on the treatment table in ER Six, lips quivering as he watched with grim determination not to cry while she cleaned and bandaged his wound. Marcus had somehow managed to burn his hand and forearm on his mother’s iron in the short time she had left it unattended while taking care of other household business. It was an ugly second-degree burn, but Marcus would recover with no permanent injury and minimal scarring. Unlike Marcus, however, his mother had been an emotional basket case, brimming with guilt and an endless supply of tears during the whole of her son’s treatment. For the entire two and a half hours the injured boy was in the ER, the poor lady had nervously paced the halls, grabbing everyone she passed and explaining to them what a sorry excuse for a parent she was. April felt certain the boy would be laughing and playing the next day. She wasn’t so certain about the mother.
April hit the “Enter” button, sending the last of the reports up to the hospital mainframe, which she called the “Great Computer on the 7th Floor.” She stood and stretched, then walked around the counter of the nurse’s station into the sterile, white hospital hallway. Looking down the hall toward the ER entrance, she felt a twinge of guilt when she realized she was hoping to find something going on out there, something coming her way. As supervising nurse of the ER, anything coming her way generally meant tragedy for someone else in the form of a car wreck, shooting, heart attack, or worse. On this day, all was quiet. Even the cleaning crew working on the windows at a lethargic pace appeared to be caught up in the lassitude of the shift. She walked the twenty or so steps down the hall to the ER entrance and looked out the windows at the small but nicely manicured lawn and the busy D.C. street beyond. Deep in her own thoughts and entranced by the quiet, she started when Andrew, one of the window cleaners, spoke to her.
“Folks must be getting healthier,” he said. “Not bringing you much business today.”
April smiled at him. “Yeah. It’s tough on us, but it’s good news for all of them,” she said, motioning to the traffic outside. She turned and slowly began to walk back toward the nursing station.
Andrew watched her walk a few steps and finally waved, saying, “You have a nice day, ma’am.” He turned back to his window and listened as the nurse’s rubber soled shoes squeaked into the distance.
As she approached the nursing station, the phone began to ring and April quickened her pace. She picked up on the fourth ring, answering, “ER…April.”
The calm voice on the other end replied, “April, this is Jason. I’m two blocks away and inbound to you with a fifty-seven-year-old male. He is unresponsive. Blood pressure is stable at one-sixty over ninety. Our preliminary assessment is probable myocardial infarction. Traffic is light. ETA about three minutes.”
“I’ll have the team ready, Jason,” April said. As an afterthought, she added, “Thanks for the call. We were all about to fall asleep around here.”
Jason answered in a serious tone, “April, you might want to shake out the big guns up in cardiology. This patient is very important. Make sure everyone is ready.”
April frowned at her friend’s last remark. Jason was usually very lighthearted and calm as he went about his stressful business. Her pulse quickened slightly in response to his worried tone as she reflexively went through the necessary steps to prepare for the incoming patient. She reached under the counter and pressed the button to summon the emergency response team. Almost immediately a calm, but obviously mechanical, female voice began proclaiming, “ER Team…Code Six…ER Team…Code Six…” As if by magic, a myriad of people materialized in the hallway, moving equipment, preparing ER Treatment Room Five to receive the patient, and removing various expendable supplies from carts and drawers. April walked quickly back down the hallway to the ER entrance, noting that Andrew and his maintenance team had properly vanished when the emergency was announced. At the door she turned her head in response to the familiar sound of a powerful engine gunning its way up the slight incline from the street to the hospital emergency entrance. Rather than the familiar red and white ambulance she expected to see rushing her way, she was startled to see a black Chevrolet Suburban, its windows tinted so dark she could not see the occupants. Behind it, a second similar vehicle was keeping pace. In the distance she could hear the familiar siren of the ambulance, but it was not in sight.
Eight doors flew open almost simultaneously on both sides of the two Suburbans and the occupants exited quickly. Two men and two women, all dressed in black suits and carrying serious expressions, came from the lead car. Two similarly dressed men and two U.S. Marines in battle dress uniforms exited the second vehicle. April was shocked and frightened to see that the Marines carried M-16 rifles and immediately positioned themselves on either side of the door to the emergency room. One of the men from the lead car stood in front of April and said, “United States Secret Service, ma’am. We need to secure this location immediately, so you need to…”
April cut him off. “Wait!” she said in a commanding voice. “We have an emergency patient coming.” Motioning toward the sound of the siren, she continued in an authoritative tone, “An ambulance will be here in less than a minute. Your cars are parked squarely in the way. Every second we lose is dangerous for our patient, so I don’t care what you need to do or what you think I need to do. My only concern is the patient, so move those cars out of the way now!”
The Secret Service agent was stunned, not accustomed to being spoken to in such a way. He turned to the driver of the lead Suburban, who, in turn, had to turn his face away to stifle a grin. In response to a stiff nod from the senior agent, he climbed into the still running vehicle and quickly moved it to a nearby parking space that was out of the way of the entrance. The driver of the second Suburban gunned his powerful engine as he followed closely behind. After re-parking the SUVs, the drivers, still out of hearing range, exchanged a few words followed by a long laugh, irritating the senior agent. He turned back to April, who was still piercing him with daggers from her eyes. Glancing briefly at the cars, she said curtly, “Thank you,” and turned to the hold the door open for other ER personnel who were coming out to attend to the patient.
“Ma’am,” the senior agent said to April, “we still need to secure…”
“Don’t bother me now,” April snapped at him. “I have a patient!” She walked to the ambulance, leaving the agent standing alone.
After taking a brief moment to gather himself, the senior agent pointed to the two agents from the second Suburban. “You two! Take the perimeter!” Motioning to the remaining agents, he said, “You come inside with me.” As they entered the building, he removed a small radio from his pocket and, pressing a button on the side, said, “Control, Eagle has arrived. Hospital personnel are attending to him now. The building is not secure…I repeat…not secure.” He glanced at April with a frown. “My team is addressing that as we speak.” There was no response and he put the radio back into his jacket pocket.
The once quiet hospital hallway was quickly awash with dozens of people rushing about, some working, others just gawking, as word had spread quickly throughout the building that the President of the United States was being rushed to the Emergency Room. An orderly in hospital whites reached over the counter at the nursing station and switched on a radio. Several people crowded around to listen as the announcer said, “The atmosphere at the ballroom is still very tense. President Tyler was taken by paramedics to an undisclosed hospital. Unconfirmed reports indicate the President collapsed during his speech to the American Broadcasters Association this evening. At this time details are sketchy…as additional information becomes available we will interrupt our regularly scheduled broadcast…”
Heads turned from the radio as several attendants and EMTs rushed past pushing a gurney on which lay the President of the United States. The crowd of people murmured in response to brief glimpses of his ashen face as he passed.
“That’s not the President,” said one elderly lady in a hospital robe and pink slippers. “He’s much too young. Poor dear…”
“They have stand-ins, you know,” a Hispanic orderly explained with a knowing look to a young LPN. “The President is probably over in Pakistan or Russia doing secret stuff and they hired this guy to fake a heart attack so the spies wouldn’t know he was gone.” The nurse stared at him with wide eyes.
Many tried to move closer for a better look, but were blocked by the group of Secret Service agents encircling the gurney so closely they made it difficult for the attending nurses and physicians to reach their patient. Were it not for the gravity of the situation, an onlooker would have found a great deal of comedy within the quiet battle between the emergency room personnel and the Secret Service agents as they bumped and shoved to maintain close proximity to the President. The gurney was finally wheeled into a treatment room and parked next to a hospital bed. Doctors and nurses quickly and efficiently began the process of moving the President onto the bed and hooking him to various diagnostic instruments and IV medications. All eyes turned to the heart monitor as it began a weak but regular beat. After only a few tense moments the tracing on the monitor changed from a recognizable rhythm to an irregular wavy line and began to emit a constant tone.
A voice in the crowd said, “Dear God, we’re losing him.”
One of the attending physicians shouted, “Defibrillator, now! This is Robert Tyler, for God’s sake. Follow the protocol to the letter! This takes precedence over everything. Does everyone understand? Now paddles!”
The doctor quickly positioned the paddles onto the President’s bared chest and shouted, “Clear!” as he pressed the button to initiate the electrical impulse. When the paddles expended their charge, the President’s body arched as the muscles responded to the electrical current, then slowly relaxed back onto the bed. Everyone looked in unison to the monitor, which remained flat lined. The doctor waited a few seconds, then shouted once more, “Again! Clear!” The body arched once more. This time, after a three to four second pause during which everyone in the room held their breath, a sinus rhythm began to sound and show on the screen of the heart monitor. The crowd collectively exhaled and relaxed, but the doctor continued to bark orders. “Start an Integrelin drip, stat! Get cardiac enzymes every thirty minutes! Tell the cath lab to be ready! You know the drill.” He clapped his hands. “Good job, people. Now keep it up!”
April and two other nurses rushed out of the treatment room in response to the doctor’s commands, pushing their way through the crowd gathered at the door trying to get a peek at the situation. As they passed the group of Secret Service agents, all with black suits and earpieces, guarding the door to the treatment room, the senior agent recognized the bossy nurse and nodded his head, smiling slightly.
Even though she was in a rush, April managed a frown as she passed two old men standing near the waiting room entrance and overhead a part of their conversation. “…ran this country into the ground,” she heard one of them say. “I don’t care what it is. I hope it kills the bastard.”
April passed the men without comment, but as she gathered up supplies to take back to the treatment room she wondered to herself how people could become twisted enough to think of things like that.
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