Lars being killed, then resurrected and turned into the same magical being that lion is has been hinted at since the very first episode of Steven Universe. It’s been in front of our eyes this whole time.
Lets first look at the Lyrics for cookie cat and analyze it:
Lars attitude completely changed once he was on the ship, and on homeworld. From admitting his cowardly ways, to standing up for himself, protecting his friends, and showing his appreciation for everything he didn’t appreciate before. “Frozen treat with an all new taste” symbolizing his cold attitude before, with who he is now.
“He left his family behind”, yes both Steven and Lars did leave their families behind. But Lars didn’t willingly leave his family behind like Steven did. Steven left his family behind to protect them. Steven probably feels a great satisfaction knowing that he’s not the cause for his family’s danger anymore. Lars probably feels more torn, and upset by leaving his family behind. A family he didn’t appreciate before. Also Lars seems to feel guilt for leaving Sadie behind when he could have protected her. So I feel this applies more to Lars then steven.
Now lets look at the first ever scene in the series:
the scene starts off with Steven yelling no! And his dramatic reaction to the loss of his beloved Cookie Cat ice cream.
then proceeds to Steven being in denial claiming that it “has to be a dream”. So why so dramatic over ice cream? Because it’s not about ice cream. The scene symbolizes lars’s death in the recent episode off colors.
Steven calls out for Lars.
holds him, and continues to mourn for the loss of his Cookie Cat. So why hold Lars? Someone who obviously is busy stocking, and clearly rejects his affections. It’s because Steven holding him tightly hints at the recent events that just unfolded in the previous released episode.
Then the next frame Lars addresses that cookie cats have been replaced with Lion lickers. I believe this hints at Lars (Cookie Cat) changing into the same magical being that lion is (being represented as Lion Lickers)
I’d like to point out in the next frame that Lars describes cookie cats as “wimpy” which is particularly odd that he chose that adjective to describe cookie cats. He could have said stupid, lame, gross, etc. any typical insult. He chose “wimpy” how does Lars see himself? Lars does not view himself in very positive ways. He does see himself as a coward, scared, everything that a wimp is.
Lars continues to say “why don’t you make some with your “magic belly button”. Which I also find odd to some extent. Being that we needed to address Steven, and his gem origin at some point in the episode, but why would Lars address it in that way? Why is Lars the first to address Steven’s gem, and gem abilities? Not someone else? Someone with better understanding of gems? I might be reading a little bit into this, but I think this is foreshadowing Steven healing Lars much like Lars is claiming that Steven heals Cookie Cat, and bring cookie cat back with his “magic belly button”. Much like Steven does with Lars. Reviving Lars after he died with his magical healing powers.
Next Steven describes cookie cat as having a crunchy exterior, which sounds like who? Lars pretends to be tough, and have a rough exterior to impress people like the cool kids. Which also goes into his style. His tough-looking graphic tees, his edgy haircut, even his gauges. I believe he does all of this to make him look tough. So that he can “fit in” and look cool to the cool kids.
Then Steven describes cookie cat have a creamy inside. Much like Lars who plays it off like he’s this cool tough guy, but inside he’s this soft, pampered kid with a loving family, who loves to bake. Who has genuine feelings that he tries to hide for people. Who cares, and has more bottled up emotions than anyone could have figured.
Then Steven brings it back to mourning of his cookie cat. Claiming that cookie cat was “too good for this world”. Why so much emphasis on the loss of cookie cat? Why so dramatic? Why make it seem so literal for the death of cookie cat? It’s because cookie cat is really just Lars.
Also id like to point out cookie cats mixed colored eyes. Something about that reminds me of Lars’s scar over his eye.
Sketch of Cath and Levi from Fangirl by rainbowrowell, aka my heart book. Also one of my ALL TIME OTPs. Plus when fall comes around, I feel so very Cath-like. All I want to do is get tarred and sweatered, drink hot coffee, and write/read/draw.
“Well, Mr. Jest, I’ve sometimes come to believe as many as six impossible things before breakfast.”
His feet stalled all at once, his face turning to her, bewildered.
Her grin fell. “What is it?”
Jest’s eyes narrowed, studying her.
Catherine cowered beneath the inspection. “What?”
“Are you sure you aren’t the one the King is in love with?”
It took a moment, but when the laugh came, It was honest and unforced. The idea that the King might wish to marry her was one thing, but the thought of him being in love with her was an entirely different realm of absurdity.
“I assure you, he’s not,” she said, still smiling, though Jest looked unconvinced. “What does that have to do with impossible things?”
“It just sounds like a queenly sort of thing to say,” he said, offering his arm again. Cath took it, though with more hesitation. “And, well, impossible is my specialty.”
She peered up at his profile, his angled features, the mask of kohl. “That,” she said, “seems entirely believable.”
Steve ran into the hospital Catherine right on his heels. She
had called HPD and HPU’s security on the way to the campus. She had never seen
Steve so worried before when you had fell silent on the other end of the line.
It took a few moments but security came to her aid picking up
her phone redirecting them to the hospital.
“My name is Steve McGarrett, my daughter was brought here from
HPU…” Steve grabbed the nurses station tightly trying to remain calm.
The nurse nodded, “She’s in room 24, I’ll take you to her
“Is she okay?” Steve followed the nurse quickly.
“The EMTs that brought her in reported it as anaphylactic shock.
They gave her epinephrine, that is all I can tell you because that is all I
know.” She looked at him as they turned the corner, “The doctor will let you
She left him outside the door. Catherine stepped up to him
taking his hand, “Steve…”
He stared into the room seeing you attached to electrodes and
IVs. He felt his heart pounding against his chest before his vision blurred.
Hearing Catherine shout his name was the last thing he remember before blacking
He opened his eyes a while later cringing as he felt an ache on
the side of his head, “Easy there…”
He looked over to Catherine sitting to his
right, “Cath…what happened?”
“You had a panic attack Commander McGarrett.” He looked to his
left at a doctor writing on a chart, “In the process you blood pressure
dropped and you passed out hitting your head.”
“A panic attack?” Steve squinted in disbelief.
“I can only assume it was because you saw your daughter in a
frightening situation.” The doctor finally looked at him a small smile on his
“Y/N, is she alright?” Steve started to sit up but the doctor
put a hand on his shoulder.
“She’s fine.” He stepped to the side showing you asleep in the
bed next to him, “We’re giving her a steroid to help stabilize her
further, but she’ll be fine and up and running fully in a couple days.”
“Do we know what caused it?” Steve looked over to you asleep
taking in slow breaths.
“The university security went to the dorm room she was staying
in.” He looked to Catherine who stood up taking his hand, “Her dorm buddy
said that she was doing fine, but Y/N complained about being hot. They asked if
she ate or drank anything and apparently she drank a flavored water. It was
Steve shut his eyes taking in a deep breath before looking to
the doctor, “And she’s going to be alright?”
“As soon as she wakes up, you can take her home.” The doctor
told him, “I do advise seeing her PCP in the next couple of days for a
check-up. As for you…deep breaths and maybe some xanax.”
“Thanks Doc…” Steve mumbled before putting a hand to his face.
“Steve…” Catherine squeezed his hand, “she’s fine.”
“I know…I just…I’ve known her for four months and in that
time she’s been in the hospital twice…” Steve looked at her, “I don’t
“Steve…it’s been four months…” Catherine smiled at
him, “And you have never been happier. From what I understand the bottle
was a brand from China and she probably just saw water. It was an
accident…What’s important is that you let her try something new and…you
showed up when she was in trouble.”
Steve looked back to you feeling a tightness in his
chest, “A panic attack…you think this is going to be common?”
“More than likely.” Catherine leaned down kissing his cheek.
They ended up keeping you overnight despite you waking up a few
hours later. On the way home you kept feeling him glance at you, “What?”
Steve looked away when you looked at him, “I’m just
“I’m fine.” You sighed, “Tired…embarrassed…but fine…”
“Embarrassed?” He looked at you again as he stopped at a light.
“Yeah…” You looked down at your hands fidgeting, “I was
really looking forward to today…and now…I just…I should’ve looked at the
“Y/N, there’s no way you could’ve known.” He told you trying to
“I know that I’m allergic…I know that I live on a tropical
island now…I need…” You started to spout out.
“Hey, hey!” He raised his
voice getting you to stop, “It is done…it happened. You can’t go back
and change it.”
“…I know…” You teared up
looking at him, “I’m sorry I put you through this…”
He stared at you for a moment
before pulling off to the side of the road putting the truck in park. You
watched him get out of the truck, walk around to your door opening it. He stood
there and waited for you to get out.
You tensed for a moment when
he embraced you tightly. He held you for a long time before he spoke, “You
listen to me very carefully…the only time you ever have to be sorry with me is
if you break my heart. Nothing you do it going to make me run away.”
He smiled feeling you wrap
your arms around his waist burying your face in his chest. He felt you mutter
something against his chest, but he couldn’t make it out, “What was that?”
You pulled away enough to
look up at him, “Aloha wau iā ʻoe kekahi…Dad…”
You watched his
eyes light up and glisten. He smiled pulling you close again letting his cheek
rest against the top of your head, “Aloha wau iā ʻoe kekahi, Y/N.”
Hi! I’m Cath, I’m from Québec, Canada and my first language is French
but I fluently speak English. If you’re from Europe imu because I’d LOVE
to travel there. I love learning new things and discovering new
cultures! I like to watch Netflix, read books, music, learning new
languages and walking in the forest!
The One Who Noticed | Stiles Stilinski | Chapter One
Catherine was wondering around her room searching vigorously for her new black skinny jeans that she had just bought at the weekend before she had to start at her new school. She was going to Beacon Hills High, and boy was she nervous for it. She was looking in her wardrobe once again, but she just couldn’t see them anywhere. “Mom! Have you seen my new Black Skinny Jeans? I could have sworn I…” She drifted off, as she noticed they were at the back of her closet. “Oh,Never mind!”Stupid me. She thought. She decided to grab them quickly so she could pull them on.
She didn’t want to be late for school. She went and checked herself in the mirror to make sure she didn’t look like a clown. She didn’t look like a clown after all. In fact she thought her choice of clothing was pretty good today.
There was something lingering in the back of her mind, she just couldn’t stop thinking about. She had heard stories about this place. She had heard that there were kind of… Supernatural creatures in Beacon Hills. Whether or not that was true, she did know that there were a lot of murders in this town. She felt sorry for the Sheriff’s department in this town they must really have it rough. She looked around her room doing a mental check to make sure she had everything. She was pleased with herself that she did a quick tidy. Otherwise it would have stuck on her mind all day. And she didn’t need the stress of a messy room on her first day.
She grabbed her bag and her Ipod as well and headed downstairs to see if her Mom was ready. Her Mom had her first day at a new job too. They had typically moved from San Francisco but they wanted a change. She had to admit she missed home already. But she would try her very best to make new friends today.
She found her rushing around the hall and the kitchen in a panic. Typical Mom. She thought to herself with a slight smirk. “Um,Mom?Are you Okay? Have you got everything?” Alexandria jumped in place at her daughters voice. Turning around only to see her smirking at the staircase, she relaxed. “Cath, you scared me! And yes I think I have everything…” She looked at her daughter with an unsure expression. “Bag? Purse? Keys? Phone? Lunch and possibly some cash for dinner?” Catherine listed off everything her Mom should have. “Sweetie. I have everything now he he."Alexandria grabbed her phone and her keys, off the hall table and they both headed out to her car. "What would I do with out you Catherine."She smiled.
Alexandria was also starting her first day of work as a Nurse. She was going to be working at the main Hospital down town. Beacon Hills Memorial Hospital. She had a passion for helping people who really needed it. And she was very good at her job. Catherine was so proud of her.
When Catherine was strapped in she hit play on her play list. It was Thirty Seconds to Mars. This band saved Catherine’s life once.Whenever she felt basically shit, she would put this band on to listen to, and all of her worries went away. It was because of all of the deep lyrics in the songs that always told her she would be okay.This band was her life.
Some people back in San Fran thought it was kind of pathetic that music was her escape from reality. But she never cared. It was kept from being lonely. Catherine looked out her window looking around until her Mom spoke. "Now Catherine remember, if you don’t make any friends today there’s always tomorrow okay?” She took in a sharp breath starting to feel nervous already. Her heart beating so fast she wasn’t sure if she was ready. Making friends was not her strong suit. If she even attempted to talk to someone back home they would just ignore her and put their attention elsewhere. She never minded though. She just brushed off her shoulder. It meant she could have no problems with people hanging over her.
As they approached the school, her stomach knotted itself. She looked around at all the wild teenagers outside the school. It was a lot and Cath was beyond scared now. She could feel her stomach getting tight. She forgot to eat this morning. She hadn’t eaten today because she was too nervous. Just don’t be scared Cath, you can do this. She tried to calm herself down by looking out the window of the car again a little only to result in her feeling worse. She had a cold sweat coming on.
Alexandria picked up on her daughter’s hesitation to get out of the car, and she gently elbowed her. “Hey Cath, are you alright? We’re here…You can get out now.” She said with a smile. She sighed. She knew she was trying to make her feel better. She chuckled. “Thanks Mom. Don’t remind me.” She gave her Mom her best smile. “See you tonight Mom. Have a good first day at the Hospital.” Kissing her cheek she got out and then was left to wait for first bell.
Catherine heard a car coming her way. She twirled around, and saw a metallic blue Jeep coming straight for her. And it didn’t look it was going to stop.
Acting immediately she dived onto the grass, rolling over a few times before landing on her back. Her head shot up with wide eyes looking toward the Jeep that was just about to kill her. Finally the driver managed to stop the Jeep from rolling forward any more. Who was that ass hole? She thought to herself. She then saw a guy with brown hair shoot out from the front seat. She noticed a few people staring down the situation. Great.Now I have people staring me down. Perfect. This is awesome. Her stomach became a knot again. “Oh my god! Are you okay?!"The guy came over with genuine concern and worry on his face.
He was the most handsome guy she had ever seen. He had beautiful chocolate brown eyes, and a couple of small moles on his cheeks and his neck. He looked down at her with concern and surprise. Cath felt a throbbing at her ankle, and winced in pain. "Ow. My ankle. It really hurts… I must have gone over it with out realizing. What a klutz I am. ” She chuckled nervously. It was already swelling up. How did I even go over it? I practically dived onto the grass. This I will never know. She thought secretly.
His mouth and eyes widened. “This is in no way your fault-I lost control of it-it’s been kind of faulty lately and um…uh I should get it looked at.” He nervously put his hand to the back of his neck. “What’s your name?” He said raising an eyebrow. It was kind of adorable. “I-I’m-Catherine.” She said looking over to him. He smirked. “Stiles. And I think we had better get you to the hospital. Can you get up?” He asked softly kneeling down at my side. “I think I might need help…” She said glancing at him awkwardly.
He then stood up and stood in front of her, holding his hands out to her. “Come on. I’ll pull you up.” He half smiled. The girl hesitantly took his hands unsure of whether she should trust him or not. He almost effortlessly pulled her up from the grass, and pulled her against his side. Catherine put her arm around his neck hesitantly, whilst his was around her waist. Her stomach was going super crazy now. “Okay let’s get to my Jeep.” He said quickly. “Okay.”
“And by the way… What where you doing there anyway?” He spoke raising an eyebrow.
“I had just been dropped off.” She said. “By my Mom.” She spoke trying to be as nice as possible.
He helped Cath into his Jeep, and then he went to grab her bag. Which she hadn’t realized she’d thrown halfway across the grass. Wow.I really must have gone crazy to try and save myself. Stiles was smirking whilst he got back in and turned on the ignition.Catherine watched him amusingly as he almost stalled it. Trying to get it into first so he could pull away. Why are you nervous?Maybe he’s always jumpy? I would probably feel the same if I were him. She intently watched him as he finally started pulling away cursing at himself. It was really amusing to watch.
“Are you okay over there?” He asked out of the blue breaking the silence. He made Catherine jump a little. “Uh- um yeah."She smiled. Although Catherine had lied… She was so nervous around him.It wasn’t everyday that a handsome guy almost kills her with his Jeep. She was very unsociable around people. It wasn’t them though. It’s just Catherine. She had always been alone. She was never used to the idea of someone actually wanting to spend time with her.She wasn’t sure if she could fully trust Stiles just yet. But she would try her best.
Her ankle was in agony. He glanced over to her as she winced once more at the pain in her ankle. They were approaching the Hospital. Catherine unbuckled her seat belt when Stiles spoke. "I just wanna to say that I am so sorry that I did this to you. I should have been paying more attention. But don’t worry, I know one of the best Doctors in here that’ll help you get fixed right up.” He smiled. Hope in his voice. “You have a connection in here?” The brunette asked in confusion. “Yeah my best friend’s Mom. She’s the absolute best… Just don’t annoy her…” He awkwardly said. She nodded slowly in agreement. Wow what a nice smile. Catherine smiled back and he then got out and then came over to her side. He opened the door and helped her over to the entrance.
Catherine was on a hospital bed with her ankle all bandaged up. It wasn’t broken thank god. But it was twisted. She can still walk around she thought, but she needed to use crutches. Well at least I won’t be missing any school.Mom would have hated that. Here education was so important to her. Especially if she want to help people in the field. She could hear Stiles and whom he called ‘Melissa’ talking in the next area.
She leaned in to listen in on what they were saying. “Stiles!? What the hell did you do to that poor girl?” She asked seriously. There was silence until Stiles’ voice was heard. “Ah. I lost control of the Jeep, and the next thing I know, that girl Catherine came out of nowhere. And then she jumped out of the way to try and save herself but she accidentally went over her ankle. And now it’s all my fault and I feel terrible!” He sighed annoyed at himself.
He said her name. He actually said it. He didn’t just say it. He remembered it. He felt bad? It’s not his fault his Jeep was out of control, right? Catherine wouldn’t hold a grudge because he was genuinely sorry. But…Nobody ever remembered her name. Ever.She smirked to her myself and listened in some more.“Well your lucky her ankle isn’t broken. Maybe you should go talk to her? And perhaps when you guys go back to School, you can help her get around!It’s the least you can do for the poor girl."She said to him."Okay! Okay! Yeah your right. I’ll go talk to her now.”
She then saw Stiles come toward her bed looking slightly sheepish.“Hey.How do you feel?” He spoke softly with a warm and friendly smile. It was enough to give Catherine butterflies. “It feels better than it did earlier.” She said giving him a half smile.I cannot stay annoyed at this guy. He’s too sweet. She placed her hands on her lap. “Are you ready to go back to school?I’ll help you.” He said to her looking guilty. “Yeah…But first I should probably tell my Mom what happened. I think it’s bet she knows about this.” He nodded toward me.
“I’ll take this for you.” He said grabbing her bag before Catherine could. She giggled quietly at his attempt to be helpful. His phone then beeped in his pocket as they made our way to the reception. She approached the lady at the desk and told her to give a message to her Mom saying she had hurt herself, but she was okay. Not exactly telling her myself but it’s okay… I don’t want to ruin her day with this.
Catherine thought to herself for a moment before walking down the hall to catch with the boy who was carrying her bag. She had made a friend. She smiled at him. His back facing her.
And his name was Stiles.
“So…Which year are you in?” He asked Catherine curiously.
“Sophomore."She smiled at him.
"Oh,cool,so… how old are you?"His eyebrows raised in curiosity.
She sent him a confused glance. That’s slightly over the top. She then smiled and giggled at him.
”…And that was probably the creepiest question I’ve ever asked…“ He put his hand on the back of his neck rubbing it like he did earlier.He was totally nervous. Catherine could tell. She could also tell he wanted to know everything about her. She was just good at reading people. This was very new to Catherine. And she liked it. Unfortunately she wasn’t one of those people who was liked all that much.
"It’s okay! I’m 17.” She smiled at him. He gave her a half smile looking to the ground. It was a look that could kill. Her stomach became feathers. He grabbed her arm lightly and pulled her over to a bench nearby. Break time? “Can I tell you something? He asked. The brunette with slight waves in her hair just nodded,smiling because she would listen to anything this guy has to say at this point.
"There’s been some… Murders going on in Beacon Hills recently… And as my dad is the Sheriff of this town, he’s gotta investigate. But he’s not really been getting anywhere.”
“Murders?"She echoed. She felt her stomach drop slightly. "Yes…I also sort of like to help him figure it out sometimes… But he’s struggling.The other problem is I really can’t figure out what’s going on either… There was a body found this morning at 5 am,whilst somebody was out jogging. And they say nothing animal or human committed the murder. It’s bizarre.” He wiped his forehead.
“Where was it found?” He was looking off into he distance. Catherine honestly didn’t know what to think. Shouldn’t someone his age be focusing on studying for school and not solving murders? She bit her lip as she looked at him. He is beautiful.
“In the preserve."He spoke looking into the distance. Cath followed his gaze and saw some other students coming toward their table. A guy and three girls. Were they his friends? She thought.
Now she was very scared. She breathed in and looked down to the table as they all approached Stiles. "Hey, you get my text? The guy said."I was just about to read it but I was talking to Catherine here.” He gestured toward the girl who was now wearing a crème sweater. “Catherine is new everybody so be nice okay?” He glared over at the annoyed looking girl. Now she looked even more pissed off. What’s her deal?
It was then that Catherine thought she heard something. A voice? She looked around trying to figure out what it was. But she wasn’t sure where it came from. “Are you okay sweetie? Has Stiles been molesting you?” The redhead said sarcastically. Cath looked her way and smirked. “Nope…” She said a bit red faced. “But he did almost kill me this morning with his Jeep…” She said glancing over at him. Her eyes widened. “Stiles? How on earth could you have possibly almost killed her?” He looked annoyed at her. “It was an accident okay? She jumped out of the way anyway an-” He was cut off by the tanned guy. “Dude was it your Jeep again? You really need to get thing that looked at buddy."He said looking at Stiles then Catherine. "I’m Scott by the way."He offered her with a smile.
"Nice to meet you.” She chuckled at his remark toward Stiles.“Yeah,yeah look there’s nothing wrong with duct tape okay?"He annoyingly to 'Scott.’
"Whatever man.” He continued to chuckle. Then glanced at me, and smiled.
“I’m Lydia.” The redhead spoke. Catherine finally learning her name.
She gave her her hand to shake. Catherine once again hesitantly took it.“Good to meet you Lydia.” And she looked at the other two quiet girls who were looking down at some kind of ancient book.They were having some kind of a hushed conversation. Lydia then pushed the book closed and cleared her throat. Catherine’s eyes widened. This is way too much.I don’t want to cause any trouble here.
“Um hello, there’s a new girl at our table and you haven’t introduced yourselves yet.” They both looked up at Catherine guiltily.“Oh!I’m so Sorry! I’m Kira.” The Asian said smiling. The other girl looked toward Catherine with a small smile. “Malia."And then she opened the book again. What is that book? Cath thought. It looked really old.
"Awesome!It’s great to meet you guys.” She smiled being friendly. Just don’t be weird. Don’t be weird. And then Catherine could hear that voice again. She looked up confusingly with her eyes wide hoping to find who it was. Except there was no-one else nearby. Strange…
Suddenly Catherine was standing inside the school. She had never been in there before she thought. How could I be in there now? The lights were out. How did I get here? Did I pass out? It this maybe a dream? It was freezing cold. It felt like it was after school hours.
Realizing Catherine had no idea what was going on she started to hyperventilate in fear. Her heart beat picking up so fast she might explode into pieces. It was so cold here. What am I doing here?Where’s the rest of the group?Where’s Stiles? She noticed she never had her crutches any more and her ankle was perfectly fine now.That is so weird… What the hell is this?
Catherine started walking toward what looked like the entrance of the school. And she saw someone standing outside. It was a tall man wearing all black. He had his back facing her. So she didn’t know what he looked like. She could hear that voice again. “Get to me first before he does!” The man then moved to reveal a dead body in front of him. Catherine screamed. She couldn’t do anything but scream. She just stood there. Unable to move. She screamed so loud her ears might have fallen off. She couldn’t believe what she was seeing. She was then suddenly swallowed up by a dark cloud of nothing.
It’s been an exceptionally long time since I’ve shared one of my “vignettes” from the emergency department. Over the summer, I have had many exciting moments in the ED, but this is by far the most memorable.
One particularly busy night, we get a call from EMS that they’re bringing us a pt in his mid 50s with a probable inferior STEMI. His vitals were normal with the possible exception of borderline hypertension. ASA was given, but no NTG was given due to possible posterior involvement.
We start getting ready for the incoming patient, expecting a quick turnover to cath lab. I don’t think anyone anticipated what happened over the next several hours.
As soon as the pt rolls into the ED, I could tell something wasn’t right. He was pale, extremely diaphoretic, and less responsive than EMS made him sound. This wasn’t any fault of their own, apparently he had just started this as the ambulance pulled up to the hospital. His vitals somehow were still normal, but he still looked sick as can be. Our EKG also confirmed an inferior MI, with significant ST depression in V1/V2, which is suspicious for posterior involvement, and he also had some possible signs of RV involvement. So, we get the ball rolling. The cath lab was activated, the cardiologist was called, and paperwork was getting its due diligence. From what we could get from the patient he had a hx of well controlled HTN, but otherwise no significant medical hx except for a remote appendectomy. He did smoke, however.
So, everything seems to be progressing as expected. The cardiologist is on their way, the patient’s vitals are stable, and he was looking slightly improved. We didn’t have labs back, but at that point his CXR was normal as well. The physician needed to go check on another patient on the other side of the ER, so I stayed in the room with the nurses just to keep an eye on the patient.
Well…for all of you new followers out there, I have the privilege of being the owner of my very own black cloud which always chooses the most inopportune moments to make its appearance. About two minutes after the physician left the room, the patient suddenly becomes obtunded, slumps over in his bed, and then of course the monitor shows him going into a pretty impressive v-fib.
All hell breaks loose. We’re already busy and short staffed, and it always makes these situations harder to control. A code was called, compressions were started, and the doctor comes running in the room. The patient gets shocked with no ROSC and proceeds to get intubated. He get’s epi, get’s another shock, and then has a pulse just as the cardiologist walks into the room. We all take one giant sigh of relief, and start trying to stabilize him for transport to the cath lab. His BP dropped significantly, so he was placed on levophed as well. Right after the levophed starts to hang, he arrests again. At that point, a vicious cycle beings where we get a pulse and then lose it a minute later. He gets an amiodarone bolus/drip, dopamine, and a whole lot of epi. Nothing seems to be working, and 30 minutes into this the cardiologist and ER doc begin discussing calling it. Just as it’s about to be called, we get a pulse-stronger than any of the other times. We wait a minute or so to get everything settled, and then he is whisked off to the cath lab.
Unfortunately, following the general theme of the night, the fun didn’t end there.
About 20-30 minutes later, we get an update from the cardiologist. His cath came back surprisingly not as severe as expected, with diffuse moderate vessel disease but no obvious blockage that would cause his MI. He was going to be scheduled for a CABG in the AM, but his case was still perplexing. It was suggested that maybe the clot dissolved with all the CPR he received, but the cardiologist also thought maybe a pulmonary embolism might be the cause so he sent the pt to get a CTA of his chest.
About 5 minutes later, the scout image (basically just a CXR) of his CT is available on the computer to view, so I open it just so I won’t forget to take a look at it later. I jumped out my seat as soon as I opened it BECAUSE OF THE MASSIVE TENSION PNEUMOTHORAX HE HAD. I immediately show the ER doc, and we start running to radiology (which isn’t that far away at all), nearly crashing into the cath lab nurse who was running to the ER to grab the doctor. We get into the CT suite and, in a style reminiscent of a Grey’s Anatomy episode, the ER doctor performs a needle decompression (However, unlike Grey’s anatomy he still manages to find the time to wipe down the area with an alcohol prep). After that, instead of dragging him all the way to the ICU, he got transported to the ER for a quick chest tube and then was sent on his way to the ICU. His tension pneumo was the result of several rib fractures secondary to how much CPR he went through.
Amazingly, and against all odds, several weeks later the patient walked out the hospital-alive. He was extremely lucky. Not many people survive cardiac arrests, even in the hospital, and especially with all of the other complicating factors. Not only that, but he walked out without a single neurological deficit.
In Emergency Medicine, we don’t get to celebrate many victories. Even though we provide the best care possible many of our most critical patients are too sick or too injured. Even for those we save, many suffer from complications and debilitating issues for the rest of their lives. To have that one patient, maybe one of the sickest I have seen in a long time, walk out of the hospital as if nothing happened is a victory that I’ll remember probably for the rest of my life. It’s the victories, no matter how small, that remind each of us how rewarding our profession is.
Jest ducked his head closer to Cath so she could hear him when he whispered, ‘I cannot tell you how I look forward to a lifetime at your side, and all the impossible things I’ll have you believing in.’
Cath’s heart was beginning to patter when a disgruntled sound came from Jest’s other side, startling her. She’d forgotten Raven was there.
‘Such happiness I hope you’ll make, but these flirtations I cannot take. I wish for you all the joy this darkened world can employ, but you’re still giving me a stomachache.’ With a squawk, Raven tossed himself into the air and went to join Hatta instead.