Legacies

3.

Powder from Alicia's latex gloves left white smudges on Hector's latest chest X ray as she held it up to the window. She didn't need a lightbox to show her how bad it was. His lung fields were almost entirely opaque. Only small dark pockets of uninfected lung remained, and those were becoming progressively smaller with each successive film. Soon even the ventilator would be unable to force oxygen to his blood cells.

She turned and faced the comatose child, who seemed to have shrunk since she'd last seen him yesterday morning. Naked, spread-eagle on the bed, Hector seemed to be made more of plastic tubing than flesh—two IV lines, one in an arm and one in a leg, the ventilator tube down his throat, a catheter running into his penis to his bladder, the CVP line running under his clavicle, the cardiac monitor leads glued to his corduroy chest. His skin had a mottled, bluish cast. Sorenson was wiping the crusts from his eyes.

Tuning out the ICU Muzak of beeps and hisses, Alicia picked up Hector's chart and read his latest numbers in dismay. His O2 saturation was dropping, his WBC count had been 900 this morning, and his blood pressure was in the basement.

He's slipping away, she thought. And there's not a damn thing—

A change in the beeps from Hector's cardiac monitor caught her attention. She checked the screen and saw the dreaded irregular sine-wave pattern of ventricular fibrillation.

Sorenson looked up, eyes wide above her surgical mask. "Oh, shit."

She reached a gloved hand toward the code button.

"Wait," Alicia said.

"But he's in V-fib."

"I know. But he's also in immunological collapse. He's got nothing left. We can't save him. The Candida's in his brain, in his marrow, clogging his capillaries. We can break a few more ribs pounding on his chest, submit him to a few more indignities, and for what? Just to prove we can delay the inevitable for a couple of hours? Let the poor boy go."

"You're sure?"

Was she sure? She'd tried everything she knew. All the subspecialists she'd called in had attacked Hector's infection with every weapon at their disposal. All to no effect.

I can't seem to be sure of anything else in my life, but of this one thing I am absolutely certain: No matter what we do, Hector will not survive the morning.

"Yes, Sorenson. I'm sure."

Stepping aside from all her emotions, Alicia watched the sine waves slow, then devolve into isolated agonal beats, then flat line.

Sorenson looked at her. When Alicia nodded, the nurse checked her watch and recorded the time of death of Hector Lopez, age four. As Sorenson began removing the tubes from Hector's lifeless body, Alicia ripped off her surgical mask and turned away.

Staggering under the crushing futility of it all, she leaned against the windowsill and looked down at the street. The cheery glare of the morning sun seemed an affront. She felt tears streaming down her cheeks. She could not remember feeling this low in all her life.

What good am I? she thought. Who am I kidding? I'm useless. I might as well call it quits now and end this charade.

When she caught herself eyeing the cars below and wondering how it would feel to plummet toward them, she pushed herself away from the window.

Not yet, she thought. Some other time, maybe, but not today.