Lawd. No more, please no more. I had such a hard time with thinking up an idea for this chapter because I’m Sick was supposed to be a one shot. Even the second part was a stretch, but I had an idea of what I wanted for the story line. This was difficult and may not be my best but I hope it is enjoyable just the same. I did have fun writing the fluffier parts though! -Admin O
You opened an eye when Jin got up, the sheets shifting over you and his weight displacing your side of the bed. It was still dark when you glanced at the window. Jin had told you that he was going to leave early to get a fresh set of clothes for work, but you didn’t realize that entailed waking up at the crack of dawn. “What time is it?” You asked groggily, word barely coherent. A hand met your head and ruffled your hair. “Shh, go back to sleep. I’ll see you at the hospital.” Jin murmured, his voice also laden with sleep. You hummed in agreement, not really registering his words.
The alarm startled you. Your heart pounded as you blearily searched for the source of the racket. Slamming your hand down on the clock, you rattled the nightstand. It was excessive, but got the job done. After your little romp in the car, you and Jin had gone up to your apartment and washed up. Exhausted from the day and not exactly looking forward to another work day, you settled on ordering pizza for dinner. Autumn was coming and the nights were getting chiller, so you lent Jin a pair of oversized sweats. They were of course too short and exposed his ankles. He commented on how he needed to start leaving spare clothes at your place. Slipping into a thick nightie, you playfully asked why he would ever need to do that. He simply replied by hooking an arm around your waist and tossing you on the bed. There was a little more roughhousing before Jin swept you up for a goodnight kiss and spooned you. Within minutes both of you were knocked out cold.
The time read an ungodly 06:00. Sighing, you rolled over and stretched your stiff body out. All in all, you had gotten a decent amount of sleep though you hadn’t really been able to get back to sleep after Jin left. Sleep or no sleep, work was going to be an adventure. Deciding to keep things strictly professional at the hospital, you were going to have to resist the urge to sneak kisses in Jin’s – Dr. Kim’s – office. Sighing again, you finally hauled yourself out of bed.
Sipping on your thermos of coffee, you squeaked down the hallway in your sensible shoes. Dr. Kim was already in his office when you arrived, his white shirt crisply ironed and hair styled neatly. He didn’t bother looking up when you greeted him and you quietly sat at your desk. He was already hacking away at his keyboard. It was probably the sound of you slurping that got his attention. “Coffee?” He asked, suddenly interested in your presence. Nodding, you rifled through the stack of folders that had likely been delivered by the medical biller for review. Dr. Kim waved you over. You resisted the urge to roll your eyes and got up, thermos still in hand. As soon as you were within reach, he grabbed the coffee and didn’t hesitate to take a large swallow. “Hey!” You called a little too loudly.
He placed a finger over his lips and glared, a silent warning for you to hush. Taking another gulp, he returned to his screen and placed the cup down on his desk. Kissing your coffee goodbye, you returned to your seat. Booting up your computer, you began to filter through patients that needed something or another.
The day passed pleasantly with only mild cases coming your way. It was both a blessing and curse as if offered you time to sneak peeks at Jin and revel in how lucky you were. It was only when one of the medical assistants came knocking at the door was your peace disturbed. She directly addressed Dr. Kim, ignoring you. Apparently she had something that she needed to discuss with him in private. Taking the hint, you got up to leave. Usually you wouldn’t have thought twice about the encounter, but you noticed how she smoothly placed her hand on his forearm on your way out. The gesture lodged some unease in your belly. It didn’t help that she was petite and pretty. What was worse, she banged the door shut just as you were pulling it closed behind you.
You scoffed in disbelief as you stared at the door. Firstly, an M.A. touching a doctor so casually was definitely out of place. Secondly, what the hell? You were a doctor too and deserved some respect. It had been a while since you had felt so offended. Choosing to hold back and walk it off, you headed for the nurses’ station.
As you approached, you could hear the excited chatter. “…doesn’t mean she’s not going to try!” “He doesn’t have a girlfriend does he?” “No way, he’s too attractive to be single.” “Doesn’t matter, she wants him and you know how she has to get what she wants.” Snippets of the nurses’ conversation flitted through the air and sparked your curiosity. Parking yourself right in front of the main counter, you asked, “What’s going on?” Immediately, you were bombarded with details of the young M.A.’s plan to seduce Dr. Kim.
Trying to feign ignorance, you held back a laugh and nodded for them to continue. Her bright idea was to use her feminine wilds to charm the doctor into a date. Resisting the urge to gag, all you could do was pity the poor fool. Dr. Kim wasn’t the most tolerant when he was tired and inadequately caffeinated. And you wore him out quite a bit last night. As if on cue, the M.A. came running down the hall, clearly upset. When she came closer, you could see that she was crying.
It was strangely a bittersweet moment. You were glad that Jin had rejected her but you felt bad for her as just yesterday you were in her shoes. Before anyone could question the girl, an overhead page rang throughout the hospital. “Code Blue in the ER. Code Blue in the ER.” You could feel your heart stutter in your chest as you froze for a second.
Dr. Kim’s nurse was up out of her seat instantly and you could hear Dr. Kim’s door smash open down the hallway. Not waiting for either of them, you shook off your shock and bolted, heading for the ER.
Darting past patients on gurneys and trying not to smack into staff, you sprinted through the maze of poorly sectioned off rooms that made up the ER. It was easy to tell where the coding patient was as a crowd of nurses and M.A.s were beginning to assemble. The sight irritated you as part of their training was to help or clear out and they were doing neither. Pushing past them, you made it into the room to find a middle aged woman of average build lying on the bed. Not your typical code blue patient, you couldn’t hide your surprise. Collecting yourself, you demanded an IV line be started and someone do an EKG with a rhythm strip. The more experienced nurses jumped at the order and got right to work.
A breath later, Dr. Kim was at your side, his nurse dragging a defibrillator behind him. You could tell that he too was a little taken aback by the demographics of the patient. You asked the M.A. next to you to draw blood to get a troponin level and order a stat chest and abdomen CT scan. Dr. Kim got the EKG leads ready as a nurse punched in the patient’s information into the machine. Rushing over, you helped the patient take off her shirt as you ran through the steps of diagnosing a myocardial infarction in your head.
After the blood was drawn, the EKG completed, and the woman rolled off to radiology, you sagged into an empty bed. The adrenaline was slowly evacuating your veins and tiredness seeped into your bones. Sighing, Dr. Kim sat beside you and handed over the EKG. Looking it over, the only thing you could find abnormal was the tachycardia. There was no evidence of ischemic change. In fact, it was one of the most beautiful EKGs you had seen in a while.
Dr. Kim’s nurse appeared before you and gave Dr. Kim a small slip of paper. Leaning closer, you read it over his shoulder. The woman’s troponin levels were normal, effectively ruling out insult to the heart. “Get the repeat.” He ordered. The nurse nodded and left. Dr. Kim glanced over at you. “What do you think, Newbie?” He asked. Tilting you head to the side, you considered your options. “She doesn’t have a history of GERD or hyperlipidemia and seems to be in perfect health from the records. Athletic and a healthy eater.” You though aloud.
He nodded, analyzing the situation with you. “Honestly, the chances of an MI are slim right now.” Dr. Kim stated. You scratched your head, frustrated by the lack of an explanation for the patient’s angina. Cases like this were the scariest.
The patient looked completely worn out when you returned to her room. “How are you doing?” You inquired with a kind tone. The woman didn’t respond and looked like she was about to cry. “The good news is that you didn’t have a heart attack.” Dr. Kim interjected. She turned her attention to him. “What you have is a case of Takotsubo cardiomyopathy, otherly known as broken heart syndrome.” He continued. Laptop in hand, he showed her the CT. “You see how your heart almost looks like a balloon? That’s not normal.” He pointed out. She exhaled sharply, taking in his explanation.
“The good news is that it’s fixable.” Dr. Kim added. “The left ventricle, the big pumping chamber, is enlarged. But in your case, this is only temporary and your heart can heal completely with proper medication.” He elaborated. “Now, let me ask you, have you recently had anything very stressful happen?” He questioned. The tears that threatened to fall earlier came pouring down the woman’s face. You reached over to the bedside table and grabbed her a tissue, which she took thankfully.
“My husband suddenly passed away last week.” She answered. Dr. Kim licked his lips, slightly unnerved by her response. “Our condolences,” you took over, “Let me explain your condition a bit more.” “See, after menopause, women stop making as much estrogen, a hormone that helps protect the heart. When post-menopausal women undergo extreme stress, like you have, it can take a toll on the heart. The extra work on the heart makes it expand like you see on your CT.” You informed her. “But in can be fixed.” Dr. Kim reiterated. “We’ll keep you overnight just to make sure everything is fine and start a beta blocker. Beta blockers are usually prescribed to treat high blood pressure, but in your case, it will help reduce the stress on your heart. You’ll only have to take it for a month if you can keep your stress under control.” The woman wiped her face and nodded in understanding.
“I’ll take you home.” Dr. Kim volunteered after you finished typing the prescription for 50mg of Atenolol into the patient’s chart. You had already referred her to a cardiologist for follow up and a therapist for grief counseling. You leaned back in your chair, your knees hitting the edge of your miniscule desk. “It this going to become a regular thing?” You teased. Dr. Kim eased his office door shut, making sure not to draw any attention. “I can’t take my cute girlfriend home after work?” He threw back, voice intentionally muted. He smirked, clearly expecting you to jump at the opportunity. “Mmm,” you pretended to consider, “Don’t you have cuter M.A.s to go on dates with?” His mischievous expression fell and he demanded, “How did you know that?”
You tapped your chin and mumbled, “I wonder…” He rounded on you and you sprung up from your seat giggling. Chasing you, Jin scurried around the furniture. Narrowly managing to avoid him, you grabbed your purse and blazer from the hook behind the door. Jin stood half-crouched, awaiting your next move. Not giving him the chance to lunge, you ripped open the door and scooted down the hallway. Slowing your pace the further you got away from Dr. Kim’s office, you glanced back over your shoulder. You were a little disappointed that he didn’t follow.
Just as you turned to face forward, Jin’s towering form above you had you skidding to a stop. You clutched your chest as your blood pressure spiked from the scare. When you opened your mouth to ask how he was able to cut you off, he interrupted, simply stating, “Shortcut.” You guessed seniority had its secrets. He turned on his heel and headed for the parking garage. Catching your speeding breath, you wondered if you had made Jin angry with poking around in his affairs. The jab was meant as a joke. Had you gone too far?
Jin stood with his car door open, engine already purring, when you got to his normal spot. “Get in.” He ordered. You obeyed wordlessly, not wanting to sour his mood further. He made sure that you were securely buckled in before pulling out. “How did you know that M.A. asked me out?” He asked again, focus trained on the road. “The nurses were talking about it.” You answered honestly. All at once, Jin seemed to deflate, tension leaving his body. “Why?” You questioned. “I rejected her saying that I had a girlfriend. I don’t want any weird rumors floating around. Especially ones about you.” He replied. The idea that he was already concerned about protecting you warmed you. You chuckled and said, “You had me scared.” Jin grinned, briefly flashing it at you before returning his eyes forward. “Scared that she was going to steal me away?” You smacked him lightly on the thigh. “No, scared that you were dumb enough to two time me.” You asserted. Jin snorted in mock offense.
“Already? It’s only been two days!” He defended himself. “One day actually.” You corrected him. He smiled and rolled his eyes. “Either way, we have to be more lovey-dovey before we’re allowed to fight.” He commented with a suggestive wink thrown your way. “I knew you hand an ulterior motive for wanting to take me home.” “Nah, I just wanted some dinner.” He joked and stuck out his tongue. Pouting, you pinched his cheek. Jin gave an exaggerated cry of pain and demanded a kiss to make up for it. All too willingly, you obliged, giving him a soft peck on the cheek where it was starting to turn red. You spent the rest of the ride with your fingers interwoven with his, watching the sunset turn the sky orange and purple.
Jin managed to find a spot right in front of your building. You hopped out and he trailed behind, locking his car with a distinct beep. Trotting into the lobby, Jin grabbed you by the shoulders and directed you towards the stairs. You huffed at his ridiculous fear of the elevator but gave in anyway.
Dinner had been lovely, with Jin whipping up some spaghetti and you handling dessert. The two of you chatted over wine and shared fun stories as you got to know each other better. The clock read 21:00 and you had work in the morning. You wanted Jin to stay but didn’t want it to be weird that he spent three nights in a row. So you said nothing, hoping that he would make the call himself.
In true cocky Jin fashion, he made a beeline for the bedroom as you did the dishes. The way he slackened his tie on the way had you raising a brow. “Hey,” you called, turning off the tap, “where do you think you’re going?” You hoped you sounded nonchalant. There was no response. You toweled off your hands and headed for the room. Jin was sprawled across your bed, lying with his arms folded under his head. His dress shirt and socks were neatly folded on your dresser.
Leaning against the doorjamb, you crossed your arms. This man was something else. “You should clear out a drawer for me.” Jin stated matter-of-factly. You scoffed. “You say that like sleeping over is going to be a regular thing.” You replied. He winked. You chuckled in disbelief. “Don’t you miss your bed?” You asked, taking a seat on the edge of the bed. “Not particularly.” Jin said as he rolled over onto his stomach to be closer to you. Smiling to yourself, you turned and began to lightly massage his shoulders.
“What? Thinking about moving in?” You teased. Peeking up at you, Jin bit his lip. A moment of silence passed. “I was kidding!” You exclaimed, removing your hands from him. Rolling onto his back again, he asked, “Would it be so bad?” Staring wide-eyed at him, you were at a loss for words. He couldn’t be serious. He said himself it had been only two days.
Realizing your hesitancy to answer, Jin reached over and pianoed up your ribs. You squeaked and jerked away from the ticklish sensation. Not letting you go, he slid nearer and dug his fingers into your underarms. You flailed, scooting back while simultaneously trying to push away his playful fingers. Jin retaliated by capturing your hands in his and swinging a leg over you. Falling into the pillows, you were thoroughly trapped. All you could do was thrash and screech. It only made the onslaught worse though. Laughing, he fought off your attempts at freedom and continued to unearth your sensitive areas.
It was only when your giggles turned into coughs did Jin let up. He pulled you to sit up and rubbed your back as you caught your breath. “You okay?” He asked, genuinely concerned. You nodded, not yet up to speaking. In apology, he placed a gentle kiss on your temple. “You think that’s going to be enough?” You demanded, feigning annoyance. Jin raised an eyebrow in confusion. You pointed to your lips.
Smiling in understanding, Jin pressed a sweet kiss to your lips. Before he could break away, you cupped his cheek and pushed back more firmly. He groaned quietly, liking where this was headed. Angling down towards you, he tugged at your lower lip, sucking it between his own. In response, you wrapped your arms around Jin’s neck and leaned back. He fell with you, landing on his hands to stop himself from crushing you. His bangs fell in his eyes and you brushed them back. Jin’s dark eyes studied your face. “Pretty eyes, pretty nose. How are you so extremely pretty?”
You couldn’t help but laugh at his cheesiness. “Prettier than that M.A.?” You asked as you pulled him closer. Twisting his lips into a cute frown, he rested his hips over yours. He held onto your face, his thumbs rubbing soothing circles just under the apples of your cheeks. “She could never compare to you.” He answered, his eyes steadily boring into yours. Any frisky banter that you had intended died in your throat. It was one of the rare moments where Jin was completely serious. You had no idea how to react.
Luckily, you didn’t have to reply. Jin gave you a series of short quick kisses before nosing along the column of your neck. He inhaled and said, “I don’t think I’ve had my fill of you yet.” Your heart skipped a beat before speeding. A sharp nip was delivered to the delicate skin below your jaw line. Your head lolled to the side to give him more room to explore. You moved your hands to rest on Jin’s waist as he teased down your jugular with his teeth. Where the innocent flirtations from earlier had gone you had no idea. All you knew was that Jin had this awful knack for getting you excited at the drop of a hat and it was infuriating.
Working his undershirt up his body, you busied his mouth with your own. Making sure to lightly drag your nails down his sides as you went, you resolved to incite him as he had done to you. You broke the kiss just long enough to pull the tank top over Jin’s head and chuck it as far as you could. He wasn’t going to get redressed anytime soon. His tongue tentatively dipped into your mouth. Taking the opportunity presented, you scraped your teeth along the flat of his tongue. The barely audible moan that Jin released in reaction served to spur you on.
Curling your tongue around his, you ran your hands up and down Jin’s bare back, fingers massaging the hard strength they found. As you released the pent up tension from his muscles, you could feel his body begin to relax. But you didn’t want him to get too comfortable. Just to mess with him, you spread your legs further, bringing his pelvis in line with your core. Jin looked like he had just gotten the wind knocked out of him when he felt your heat. Smirking up at him, you hurriedly pivoted and flipped your positions so that you straddled him. He groaned, hands smoothing over your thighs.
Suddenly in a mischievous mood, you rid yourself of your shirt. “You’re going to give me a heart attack.”Jin whined. The line was amusing considering today’s events at the hospital. Pretending to give him CPR, you gave yourself an excuse to feel his toned chest and trace the pads of your fingers over his nipples. He shivered at the sensation. You leaned forward, allowing him an ample view of your bosom as you gave his neck the same treatment he had given yours. The rate of Jin’s breathing sharply picked up. You licked a bold stripe down his midsection, loving the way the ridges of his abdominal muscles flexed under you. Testing the waters, you rolled your hips down and felt his hardening bump. Pleased, you worked a bruise into his prominent collarbones. His fingers gripped your thighs so hard it bordered on painful.
The temperature in your room rose as you unbuckled Jin’s belt and unfastened his pants. Turning the tables, he flipped you back over. At this point, you had rolled over so many times that you were dangerously close to falling off of the bed. Finding the position optimal, Jin extracted himself from between your legs to free himself from the confines of his pants and boxers. Returning his attention back to you, you couldn’t help noting the visible lust etched in the way his eyes roamed your disheveled appearance. He stood bare as he unzipped your trousers and pulled them down your legs. The way his arms bulged with the motion captivated you. He quickly extracted a foil square from the wallet in the pocket of his discarded pants. Ripping the package with his teeth flashily, he rolled the protection on. You lay as nude as Jin when he climbed back into bed.
Plastered on Jin’s face was a devious grin as he rested on all fours above you. It seemed as though he was also in a teasing mood. It astounded you that the man that commanded respect at the hospital could also be a huge goofball with insufferable smugness. What was more surprising was that you loved all of it.
Ignoring Jin’s hunger, you reached up and carded your fingers through his hair tenderly. He was yours. That meant so much to you. His eyes fluttered shut at your gentle touch. When he reopened them, his gaze was even darker than before.
You gasped as Jin pinned your wrists above your head and bit down on the side of your breast. Back arching at the sudden pleasure-tinted pain, you bit your lip to stifle the moan caught in your chest. Not satisfied with that, Jin slammed his hips into your folds, making sure you felt his need directly. You couldn’t hold back the whine then.
Haughtily, he rolled into you, paying you back for the gesture earlier. The move had your toes curling. Jin nuzzled into your shoulder as he moved against you, his breath warm on your skin. You had properly learned your lesson. When Jin was riled up it was either raw lust or playfully flirty. Tonight he wanted nothing more than to bury himself hilt-deep inside of you and have you screaming his name.
Jin’s tall nose ran down between your breasts to your belly, only stopping so he could flick the tip of his tongue into your belly button before he went lower. He released your hands to pry apart your thighs and resettled himself between them. Pressing a timid kiss to your hip, he rested his cheek against the bone. The mix of cute and down-right sexy had you squirming, wishing he would get on with whatever he had planned because you were desperate.
Shifting to get some relief where you needed it, Jin stopped you by pressing down hard on your pelvis. Locked in place, you could only look at him sinking further as you ached. He stroked the back of your calf absently before throwing it over his shoulder, opening you up to him. He wore a sinister smirk that bared his teeth after smelling you. Embarrassed, you broke eye contact. But Jin wasn’t having it. He smacked as much of your ass as he could reach with you lying down, demanding that you watch the little show he was putting on.
Just to drive you insane, he blew on your wet center, sending a shudder up your spine. Jin’s eyelids were heavy with passion as he took in your reaction. Not really wanting to be spanked again, you kept your eyes trained on him as he tentatively licked a line between your folds. The sensation had you digging your heel into Jin’s back. Like a horse hearing a gunshot, he was off, sucking hard on your clit and drawing circles along your slit. You keened and whimpered, the desire fogging over your mind and immersing your body in pure bliss.
Thinking that nothing could top this feeling, Jin slipped a finger inside of you as he rolled your bundle of nerves between his lips and proved you wrong. Your nails cut into your palms even through the fabric of the sheet you held onto for dear life. Breaths already harsh, Jin pumped in and out of you, making breathing even more difficult. Adding his pointer and drawing more moisture, he drank you up.
Right as the swell of your impending end washed over you, Jin pulled his digits from you and wiped his mouth on the inside of your thigh. Whining in frustration, he sucked each finger clean. Pointedly staring you down, he tasted the tips and ran them over your core once more. Sensitive from his attack, you couldn’t help your tremble. Jin chuckled wickedly, enjoying the hold he had over you.
Trailing wet kisses back up your abdomen, he slid your leg off of his shoulder. You let it fall ungracefully back to the bed, trying to slow your pounding heart. He squeezed your breasts as he nipped over a hickey he had left at the base of your neck earlier. Lips now fully dry, he gave you a peck. Hand gliding down your body, he wedged it beneath you and flipped you over as if you weighed no more than a kitten. Taken back by the action, you brushed your tousled hair out of your face.
Wrapping an arm around your waist, Jin pulled you up to rest on your knees and elbows. Butt fully in the air, you felt exposed. But then his hips were flush against your ass and all shame flew out the window. You pushed back on him, a silent plea to hurry up. Not giving in, he decided to take his time with you and traced his fingers across your thighs as he held your waist steady.
Glancing back, you caught Jin admiring the curve of your derriere. Flaunting your assets, you wiggled your rump a bit. Eyes flickering back to yours, he looked ready to devour you. You swallowed hard as he ran the head of his length down your folds. Your slick made it easy for Jin to rub into you harder and harder until you were groaning when the tip grazed your clit.
Suddenly his fingers were digging into your ribs as his grip tightened. Then all you could register was his dick spreading you open, filling you to the brim with his girth. Finally your ache was appeased. You shrieked as he bottomed out. Jin waited a second, the feeling of being completely inside of you calling for a momentary time out before he lost it. It only allowed you to revel in the overwhelmingly snug fit. How he still managed to stretch you was beyond you. But you doubted you would ever get enough.
Patience wearing thin, you rolled you hips, demanding Jin to move. And then he was. Slowly drawing back, he slid home in a gentle thrust. Sighing in satisfaction, you pressed back more against him, needing to be even closer. Without warning, he slammed into you, jerking you forward. He wrapped his other hand around your waist so he could hold his forearms together and molded his chest to your back. The position allowed him to hold you still as he delivered another rough stroke that had you crying out.
It had your fingers curling into the bed as you tried to anchor yourself. Another smooth deliberate pump had you sure that Jin would be the death of you. He alternated between powerful thrusts and unhurried glides and it was a maddening decent into carnal satisfaction.
Your arms shook as you struggled to stay upright when Jin shifted his pace to just pounding into you. The sound of skin slapping skin filled the air along with Jin’s soft groans and your mewls. You could feel his heart hammering away against your back and you were sure yours was beating just as hard. Sweat slicked your skin and Jin’s bangs dripped onto your shoulder as he swept your hair to one side and left kisses at the top your spine.
You met him thrust for sharp thrust and there was no build up to warn you of your orgasm. It hit you out of the blue with hips snapping forward as your back arched and neck strained with the intensity of it. Emitting a low growl near Jin’s ear as you came, you incited him to move faster, prolonging your orgasm as long as he could. Your walls fluttered and clamped down hard on his member.
Jin suddenly grabbed your shoulder and rammed his cock hard into you. He came with a deep groan even before your muscles released him. Jin let go of both your shoulder and waist simultaneously and there was nothing holding you up any more. You collapsed with Jin on top of you as you tried to come down from cloud nine. Jin’s weight made it considerably more difficult to catch your breath but it wasn’t unpleasant. The skinship was comforting, especially as he nuzzled into the juncture of your neck and shoulder.
“I’m serious about the drawer.” He whispered. You reached around and weakly slapped his naked ass.
I met you on Sunday, the first day of my work week. It was early afternoon, my preceptor and I were all caught up with tasks and charting when they called the code overhead. “Code Blue ER ETA 5 minutes.” The charge nurse started to head down to help (they are required to go to all codes in the hospital to help).
“Why don’t you go down with her?” My preceptor suggested. “We’re not doing anything.”
I’m always down for a field trip to break up the day. When we got to the ER the charge nurse assigned everyone a job for the code, she had no job for me and decided that I would be in the way. So I was relegated to the hallway until I was needed.
I was standing across from the ambulance bay doors when you were rolled in on the EMS stretcher. Someone was doing chest compressions as you were rolled into the ER. The brief glimpse I got of you was not promising, you didn’t look good. I found out later that you’d been out with friends and started complaining of some heartburn. You got out of the car to get some air and you went down. 911 was called, but you were down over 5 minutes before they got there.
You had no pulse when the paramedics got to you. You were found to be in PEA, they began CPR and you got a couple doses of Epi. Four members of your family came in through the ambulance doors a few minutes after you and they were lead away by the house supervisor to a private room.
Within a minute of getting into our ER room a pulse was detected and we started the hypothermia protocol. This is when I got involved. I was sent for the pads for our temperature management system. This protocol is started in an attempt to preserve brain function in patients that do not regain consciousness after coding. I entered the room and I saw you laying there, tubes had been inserted into your throat, bladder, and veins. You didn’t move at all when we touched you. The ER doc prepared to insert a central line into your neck while we applied the pads and started the cooling process. I looked up and noted out loud that you’d gone into a junctional rhythm. Your heart rate was in the 40s and your blood pressure was dropping too. I helped hang a bolus and get the pressor ready to go.
At that point my charge nurse motioned for me to follow her. Our work with you at this point was done. You’d be coming up to the ICU shortly and would be another nurse’s responsibility.
The rest of the day passed, I took care of my patient and helped reintubate our other patient.
When I came back a day later, we were assigned your room. The news wasn’t good. Your CT yesterday showed a severe anoxic brain injury. The EEG over night showed no seizures, but it also didn’t show any other activity. The doctors ordered an MRI to confirm what the CT showed… which it did.
Your neuro assessment was unchanged since you’d arrived even after you’d been rewarmed. GCS of 3-6. Pupils unequal and sometimes reacting to light. Cough and gag reflexes come and go. No reaction to pain or spontaneous movement. You’re not breathing on your own, the ventilator is doing all the work for you.
Your daughter and one of your siblings arrive later that morning. Your daughter asked me lots of questions and I answered honestly. She apologized for all her questions and I assured her it was ok. The crit care doctor came in and was bluntly honest with her. The chances of you getting better are extremely slim. Your daughter is realistic and understands that this is it. You have a large family and she wants everyone that wants to to have a chance to visit, so the plan is made to withdraw care tomorrow afternoon.
Your family spends the next hour in your room on the phone and crying. I bring them tissues and continue to care for you. As your family looks like they’re getting ready to leave, I approach your daughter and ask her if anything were to happen over night if she would want us to try to bring you back (it seems silly to ask, but I had to just in case). She says no and you are made DNR. We also minimize treatment, discontinuing antibiotics and your insulin gtt. No longer are we in life-saving mode, we are just giving your family a bit more time to say goodbye.
The next morning there’s a blizzard… your favorite kind of weather, I’m told later. We care for you all morning while waiting for your family to arrive. It is late morning before your daughter finally makes it in. She’s pregnant with your second grandchild. You were so excited for your first grandson, she tells me. I give your family some time alone to say goodbye after they confirm with the doctor that we are withdrawing care.
Your family leaves, they’ve decided that they don’t want to be here for the end. It’s ok, I’ll be here. After coordinating with the RT, we begin. I give you large boluses of Fentanyl and Versed, per the doctor’s instruction, and the RT extubates you. Nothing happens. Within a minute your SATs begin to drop. You don’t appear to be breathing at all. I hold your hand and watch the monitor, pausing alarms whenever they go off. It takes several minutes, but your heart rate finally begins to slow. Your SATs are in the 20s and soon so is your heart rate. The SAT no longer registers, so I turn it off so it won’t alarm. Your lips and fingers are grey. I listen. There is no heartbeat, despite the ugly QRSs that continue to blip across the screen. You’re in PEA. My preceptor listens too and confirms. We call time of death.
I’m sorry we had to meet like this. Though, truthfully, I’m not sure I ever met you. I think you were probably gone before you were even rolled into the ER. I’m sorry you’ll never get to meet your grandson and that your family is going to be without you. It’s an awful situation. I am grateful you have such a loving family that did not make us torture your body with modern medicine for way longer than necessary hoping for a miracle.
This was my first patient death in the ICU, but it will not be the last. It is the nature of the ICU beast.
**Patient experiences VTach arrest, gets a few minutes of CPR and a few shocks, and is brought back to sinus rhythm**
Patient on Christmas Eve: Can I go home today?
Doc: I’m afraid we can’t send you home today. We have to move you out of the ICU and be sure you can get up and move around without chest pain. You just had a very bad day, so we need to make sure you’re really stable before you can go home.
Patient: Ok, what about tomorrow?
Doc: Maybe. We’ll have to take it one day at a time and see how you do.
Patient: But it’s Christmas tomorrow! I don’t want to be in the hospital on Christmas!
Doc: I understand, but ma'am, you DIED yesterday. It can take a few days to get better after you DIE.