I wrote the following excerpt about two years ago, when I decided I wanted to write a trashy, popular fiction novel. A lot of the rest of the book has changed, or morphed, mutated or whatever you want to call it, but this chapter has largely stayed the same. I think it sets the tone for the story I want to tell, even though the language is a little clunky and I think it veers a little bit towards the melodramatic. Melodramatic is OK for a story about a burned out Liam Neeson-type that wants to avenge the death of his daughter, though, isn’t it? It can’t very well be subtle. No one’s going to read this first chapter and assume the book is going to be a subtle, nuanced examination of our own mortality, nor should they. They hopefully go: “Cool. A dirty resuscitation. What comes next?” If they do, I have done what I have set out to do, clunky word choices be damned. If they don’t, maybe I need to add more fire.

I’ve also added the scene that came after, which was workshopped in class and where someone might have made a comment that inspired one of the FAQs in the other section. Look. I get that it wouldn’t happen like that because nurses are meticulous in recording how much fluid a patient gets. But unfortunately I don’t think anyone is going to want to read a book where two people argue over whether 250ml of fluid was given over an hour or over an hour and a half. And honestly, if they wanted that kind of action, they could just go to university, get a degree, apply for a job in any one of the many, many fine hospitals in this country, hang said bag of fluid, and then argue with their colleague over the rate in which it was given. For bonus points they could argue over whether potassium should have been added to the bag. It would save me the grief, and they would probably be paid for it, too.

-PC

One

The piston on the CPR machine emits a high pitched whir as it pulses up and down on the chest at a hundred beats per minute. Half of the torso is charred and blackened, making it crack and pop like a bag of potato chips with each compression.

This woman is dead. Deader than dead. He knows it. But they need to keep going.

Her eyebrows and eyelashes are completely burned off, but her chin and neck are spared. Her head was bent forward, possibly tucked to her chest as she was trying to get out of the house. They’re going to need to secure an airway before the swelling from this CPR closes her throat off completely.

‘Get me a tube.’

‘What size?’

‘Don’t care. Anything. Let’s go.’

Felix Sanderson takes his laryngoscope with his right hand, and tries to open the jaw with his left. The mouth barely opens, and what he can see down the mouth is already too swollen and too filled with soot. He’s not going to be fitting any sized tube down there.

Felix says, ‘I’m gonna need a scalpel.’

Felix says it loud, but no one’s listening because they can’t hear because there’s an alarm going off somewhere that’s drowning everything out that keeps getting louder for every second it’s not acknowledged. And no one hears him because there’s a piston making a high pitched whir on a chest that is cracking and popping like bag of chips, and there’s people running around everywhere barking orders at one another, and there are 15 people standing at the foot of the bed, a mix of medical students and nurses, whispering and talking and staring, and it’s chaos. But it’s always been chaos, chaos as long as he’s been doing this, so he just says it again a little bit louder, and hope someone hears him.

‘Guys. I need the front of neck access kit, and I need a scalpel.’

He can hear the order being relayed down the food chain like some game of Chinese Whispers. Chinese Yelling, he thinks? Hah. Doesn’t matter. He’s been heard. Thank God. The alarm blares again behind him because silencing it only silences it for thirty seconds and then it starts again. So much noise.

A scalpel comes over in a kidney dish. It’s the wrong kind, the one with the sharp pointy end but too narrow to make any decent sized cut. And he could say something, but then three people will go run off looking for the right scalpel, and there might not even be one down here, and there’s no time because the alarm is buzzing and the numbers are so low they’re not reading and she looks young and so he just needs to go for it and it will probably cut just fine.

Go. Just go.

It cuts through her neck, and then his pinky finger follows through the cut, and he hears a big gush of air as it goes through the tracheal ring.

‘Tube. I need the tube.’

The tube, a size 6 he thinks, follows the tract his finger made and slides into the trachea.

‘Get the cuff up. Get me the bag.’

He squeezes the bag, connected to the oxygen that’s connected to the tube that passes through the neck and into the lungs, hopefully breathing life into this lady. He can’t see the chest go up and down with the breaths he gives, because the big piston doing the CPR is still there, in the way, coaxing the heart to push the blood in a circle. But it feels right. He’s in.

‘You have a trace. You’re in,’ Amir says. Good.

He looks up to the side. Amir has just finished putting a chest tube in the left thorax, where they suspected one of the lungs was punctured. Pink cappuccino froth leaks from the end of it before he hooks it up to a drain. Nice work.

And yet, Felix thinks, this woman is dead. And he knew it before she was wheeled through the door. But she’s young and this is some sort of accident and so you try your best. But she’s still dead. Although now she’s dead with a tube hanging out of her neck and another one coming out of the chest, and there’s pink cappuccino froth all over the floor.

Someone grabs a light, peels back the burned eyelids, looks at the eyes.

‘Felix, both of these pupils are fixed and dilated.’

She’s gone.

‘Do we have a blood gas?’ he says.

‘pH is 6.8. Lactate so high it’s unrecordable. The potassium… 8. She needed insulin.’

‘We’re gonna stop. Objections?’ he asks.

No one says anything.

They stop. The running stops, the talking stops. Everything stops. Catch your breath, go get a cup of coffee, fill out the paperwork, then call the coroner.

One by one, people leave the bedspace. Show’s over.

Felix takes a deep breath. Everything is now quiet, except for the high pitched whir of the automatic CPR machine, still compressing away on this woman’s chest at a hundred beats per minute.

‘Someone shut that thing off,’ Felix says to no one in particular.

#

The curtains are drawn in a three meter square around the resuscitation bay, with the body lying in the geometric middle. Felix Sanderson reaches behind his neck and undoes the tie to the gown before throwing it into the linen skip. The gown is one of the new ones the hospital got during the COVID pandemic, and is now covered in a slurry of blood and soot.

In theory, everything they do in Resus is as sterile as an operating room. The reality, however - of a chaotic space half the size of an operating theatre, of arms and legs being thrown about, of dozens of people involved and another half dozen just wanting to rubberneck, of going from not knowing what you need next to needing it right away - the reality is very different. This was decidedly not surgery.

Not to mention, Felix thinks as he takes off his bloodstained gloves and flips them into the yellow biohazard bin before walking over to the sink. Not to mention, the patients getting surgery are completely different. Resus patients are coming off the street and aren’t washed or prepped. They aren’t showered and fasted, scheduled 4 weeks in advance. They haven’t told all their friends that they are going in for surgery, coming in with shaved legs and their best underwear. These patients are coming in after falling from a roof onto a fence post, or having a heart attack while mowing the lawn, or getting stabbed at the bar over a spilled drink.

Or after being lit on fire. How the hell did this woman get lit on fire?

‘Was that fucked? That felt fucked.’ Amir sidles next to Felix, doffing his own gown.

‘I need an ice cream.’ Felix tells his most senior registrar. He has known Amir since he was a medical student, intellectually curious even back then. He ascended the ranks quickly from student to Intern to registrar to senior registrar: putting in the hours, ticking off assessments and milestones, navigating the personalities, to essentially become Felix’s second-in-command.

Amir says, ‘You need a shower.’

‘These fancy new gowns,’ Felix says, ‘get bought on the COVID credit card, Mister Prime Minister showing the world he’s got our backs. Splash proof, virus proof, bomb proof, sweat proof. Now there’s no more COVID and we got a storeroom full of these sauna suits they want us to use, and probably won’t expire till the next pandemic hits.’

‘Can’t blame that stink on those gowns, boss.’

He looks over to Amir. ‘It was 8/10 fucked, making me extra glad to see you on today.’

‘You know that way I threw in the chest tube?’ Amir says. ‘Using just your two fingers to slide it between the ribs? You taught me that like 10 years ago. On that massive lady that hosed into her chest. It was my first week. To this day, I don’t do them any other way.’

From the sink Felix looks over at the aftermath of the resuscitation. The monitors at the side of the bed are still on, straight lines displayed in place of the blips of vital signs. Empty packaging and saline bags litter the floor next to long streaks of red where a blood spill was hastily wiped down with a towel to prevent a slip during the chaos. Metal trolleys stacked with used sterile fields and pots and trays, antiseptic-soaked squares of gauze, and overflowing sharps bins filled with needles and wires litter the sidelines.

‘Is it weird being back?’ Amir asks.

One of the cleaners has come between the curtains now, dragging a mop and yellow bucket on wheels behind him. He barely looks up to the burned body under the sheet in front and to the left of him. He dunks the mop into the bucket in silence before methodically running it across the bloody smears. Textured streaks of currant jelly slowly become diluted puddles of pink, before disappearing from the textured white linoleum completely.

Felix says, ‘Like I never left.’