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Peter Benton stands in the corner of the ICU room, arms crossed and face set as a pack of nurses gather around the inert body on the gurney.
“Three, two, one,” someone counts off, and John Carter is hoisted from the gurney and onto the waiting bed with professional ease. Peter feels his heart clench as the transfer takes place, his eyes glued to the portable cardiac monitor that displays the boy’s heartbeat.
Still there.
One nurse detaches the ambu-bag from Carter’s ET tube, then attaches the tube to the vent. His chest continues to rise and fall. Others arrange John’s limbs in a straight line, securing the pulse ox monitor to his index finger and heart monitor stickers to his chest under the papery hospital gown. IV lines and cannulas are adjusted. Blankets are pulled up a little past his waist.
Peter’s attention is fixed to the monitor. Beep. Beep. Beep. He can’t bring himself to look away. After the events of that afternoon, nothing is to be taken for granted. Every peak and wave on the monitor screen feels, in some way, like a gift.
Peter feels old, and tired. The muscles in his arms and shoulders and abdomen still ache.
After a few minutes, the transfer is complete, and the nurses file out. Peter moves forward. He stands at the edge of the bed, looking down. The boy is still far too pale. Skin waxy. But he’s got more color in his face now than he did just thirty minutes ago, when Peter was breaking his ribs with chest compressions down in Trauma 2.
Despite the steady beeping of the monitor, Peter seeks out physical proof. He takes Carter’s limp wrist in his hand, presses his thumb into the pulse point. His skin is cold and clammy under the heat of Peter’s grip. He closes his eyes and sighs as he feels the steady thrum of blood pumping through Carter’s radial artery.
They’ve got him on a propofol and fentanyl drip for now, for at least the next 24 hours. Amiodarone, too, to stave off another cardiac arrest.
Cardiac arrest. Jesus.
He falls into the chair at Carter’s bedside and buries his face in his hands.
Forty-five minutes ago
A normal day in the ER. At least, as normal as it gets. Carter is on top of things, sunny and talkative, as usual. And, as usual, Peter stays focused on his job, letting the constant stream of chatter flowing from his student’s mouth fade into the background. Comforting, like white noise. But also, to Peter, mostly uninteresting. Still, though. It was good to have Carter back on his team. It had been a rough few months, for both of them. Peter was trying, now, to be better.
An MVA comes in. A guy wrapped his car around a telephone pole. Altered mental status. Screaming and thrashing around in pain. Peter sweeps into Trauma 1, Carter trailing behind him, to find Malik, Carol, Haleh, Doyle and Kerry struggling to hold the agonized patient down long enough to administer a sedative.
Without needing to be told, Carter rushes to hold the guy’s arms down. The moment the needle sinks into the man’s thigh, though, the patient revolts. An almighty shout, and he bucks upwards, sending Carter sprawling to the ground with a shoulder to the chest.
It doesn’t alarm Peter at all, in the moment, when Carter doesn’t immediately get up. Peter is busy trying to get a chest tube set up. He’s not paying much attention. But then Malik’s baffled voice calls out from where he kneels on the floor next to Carter.
“Yo, guys, uh… I don’t… I can’t feel a pulse on Carter.”
“What?” Peter snaps. Malik’s words are ridiculous. He rolls his eyes, then strains his neck to peer around the crowd, catching a glimpse of Carter’s crumpled form. Long limbs tangled up in each other, trauma goggles askew. It’s not an entirely unfamiliar sight. He’s done this before. “Carter, you’re fine, get up,” Peter orders. He’s just dazed from the hit, that’s all. He’ll be okay. Peter picks up a scalpel, preparing to make an incision.
But then Malik speaks again, and this time his confused tone is replaced with urgency. “Benton! He’s not breathing either! I’m telling you, Carter ain’t got a pulse!”
Peter freezes, the scalpel slipping from his hands. Malik wouldn’t say something like that unless he was one hundred percent sure.
“Carter?” The question slips from his lips before he can stop it, his tone uncharacteristically soft.
The patient on the table is nearly abandoned as bodies converge around Carter. The kid’s friends, his colleagues, yelling and crying out. Panic.
“Move!” Peter orders, tube forgotten. Fingers to Carter’s neck. Nothing. He peels Carter’s eyelids back and shines a light. His pupils are dilated and nonreactive. A cold sweat breaks out across Peter’s back, then. His breaths feeling tight inside his lungs. Oh, Jesus. No pulse. Not breathing. Carter was…. dead? No. No, that didn’t make sense, because Carter had been talking and laughing just minutes ago. He was fine.
And yet. No pulse. No fucking pulse.
Time becomes funny, after that. Later, Peter will remember bits and pieces. Gurneys. Clearing the next room. He and Malik hauling Carter’s unmoving body onto the table in Trauma 2. More bodies flooding the room, exclamations of “oh my God” and “is that Carter?” and “what the hell happened?”.
What Peter remembers, afterwards, more than anything else, is the fear. A level of fear that is frankly shocking. Unlike anything he’d ever experienced. Not with his dad, all those years ago, unmoving on the porch swing. Not with his mother. Not with Gant. He can’t explain it. It’s a horror movie, watching Carter be moved from a stretcher onto the table, lifeless.
The second Carter is on the table, his focus sharpens. Everything cast in stark relief. Peter has a job to do. He has to fix this. He has to get Carter back. Questions of what happened would have to wait until later. Airway. Breathing. Circulation. His student wasn’t breathing. That was the first problem. Weaver, who seems to have materialized out of nowhere, is already on it, laryngoscope and ET tube in hand. Her expression is solemn and determined.
“Carol!” she barks out. “Start CPR!”
“I got it,” Peter says, voice tight, moving the charge nurse out of the way, not entirely gently. Carter was his. His.
Carter is stripped of his trauma gown and his scrub top. Monitors are attached to his chest. A deafening, horrifying chorus of beeeeeeeeeeeeeeeeeeeeep fills the room. The sound of flatline.
No. Nope. Unacceptable. Death is an unacceptable outcome. Peter will not allow this. He gets up beside the table and begins compressions. He blocks everything else out, his own heart racing while his student’s remains terrifyingly still. Peter will do these compressions, forcing Carter’s heart to beat, until the heart can do it on its own. That is the only acceptable outcome.
“Come on, man,” he growls as he pounds up and down. “Come on. Don’t do this. Come on, Carter.”
The beat of the chest compressions bangs in his head like a sledgehammer. Hands clenched together, arms aching, he pumps against Carter’s heart. Seconds tick by. How long has it been? He feels something give way, under his hands. On the next compression, a distinctive crack sounds through the room. Peter doesn’t let up. Broken ribs are nothing, now. An afterthought. He keeps going, staring fiercely at the heart monitor. Straight line. He keeps going. Carter’s chest inflates up and down with artificial breaths. He pumps against it. Again and again and again.
“Don’t be an asshole, Carter,” Peter snarls. Or pants. He can feel heavy beads of sweat gathering on his forehead. He pays them no mind. “Don’t you dare die.” Not now. Not after Gant. He can’t… Carter can’t die. That shouldn’t be possible. Peter needs Carter to be okay. He needs it. It’s important. Someone like Carter cannot be allowed to just… die. Out of nowhere. Carter is his student. Carter is going to be a surgeon.
Pump. Pump. Pump.
And then – a shaky, short little wave on the heart monitor.
“V-fib!” Kerry all but screams. “Charge to 200!”
“Charging!”
“Clear!”
Peter pulls his hands away as the paddles deliver 200 joules of electricity to Carter’s heart. The boy’s whole upper body violently jolts off the table. Collapses back down.
Beeeeeeeeeeeeep. Flatline.
Peter lurches forward and resumes compressions. Again. Again. Again. Come on, Carter. Come on! He feels nearly sick to his stomach, remembering a scene just like this, just a few months before, with Gant on the table. The look on Carter’s face, when they realized who it was… Peter will never forget it, as long as he lives.
And the look on Carter’s face, now, with a tube sticking out of his mouth. Totally blank.
Guilt churns in his stomach. He’d mishandled things. He knows that, now. He understands. Carter. Keaton. Gant. Carla. So many things. So many mistakes. They loom over him, over this whole scene, a specter.
Not Carter.
He continues pumping. He feels another one of Carter’s ribs break underneath his hands. Keeps going. Beat, he silently wills his student’s heart. Crunch goes another rib.
“We’ve got v-tach!” Carol calls out.
“Charge to 250! Clear!”
Peter yanks his hands back as Carter’s body convulses, then settles.
Nothing.
He restarts chest compressions. On and on and on and on. How long has it been? He doesn’t want to think about it. Was it a preexisting condition no one knew about? A sudden MI? A stroke? Or just bad luck? Carter is young. He’s healthy.
“V-tach! Charge to 300!”
The pads stick to the skin of Carter’s chest like magnets as he’s shocked. And then… beep. beep. beep.
“We’ve got a rhythm!”
“Sinus tach!”
Peter stumbles backwards, clutching his chest. He realizes, only now, that he’s gasping for breath, heart racing, drenched in sweat. There’s a buzzing in his ears. But there’s that other sound, coming from the heart monitor. Glorious. Beep. Beep. Beep.
A heart, beating on its own.
Peter lets out a hysterical laugh, shaking his head, leaning against the wall for support. His knees, he realizes distantly, are shaking. His hands too.
“Jesus Christ,” he utters. No one is paying attention to him now. “Jesus Christ.” In the resolution of the immediate crisis, the doctors have stepped back. Nurses rush forward – Lily, Carol, Haleh – setting up IV lines, cutting off the remainder of Carter’s clothes.
“I want a 12 lead ECG,” Kerry orders hoarsely. “I want continuous cardiac monitoring, and I want an echocardiogram. Blood gas, CBC and a chem panel. The works. I want to know what the hell happened here. Haleh, page radiology, I want a head CT as soon as it becomes available. Page cardiology. I want Kayson down here. And someone call up to the ICU, make sure they’re getting a bed ready.” She rips of her gloves and chucks them in the trash. She gives Carter a last lingering look. “Jesus Christ.” Her voice cracks. She limps out of the room in a hurry, cane clacking as she goes.
The ICU at County General is not a place where Peter has spent much time. He’s a surgeon. He cuts. He fixes. What happens next has never been his job. It’s never interested him. Maybe that’s his problem? He feels out of place, here. Useless.
Carter’s heart stopped, in the middle of his shift. And they’re not sure why. They’re not sure if it will happen again. He’s going to in the ICU for at least 48 hours. Everything about… everything… is incredibly uncertain. Peter hates it. He likes facts, numbers. Answers. Precision.
None of these things are being provided to him, now. Just the low and slightly frantic beeping of Carter’s fragile, tachycardic heart. The constant whoosh and hiss of the ventilator. The drip drip drip of IV fluids into Carter’s veins. The squeaking sound of nurses’ shoes against linoleum as they move up and down the hallways. Distant murmurs. The dim blue light. There’s something incredibly eerie about this place, Peter notes. About its patients, and its staff. Everyone operates inside of strange hush, with a kind of solemn reverence. Like they’re all too aware that the balance between life and death is different, in this ward, than it is out there. It reminds Peter of being in a church when there’s no service going on.
People drift in and out. ICU nurses, mostly, monitoring vitals. Poking and prodding. A doctor, occasionally. And friends, from downstairs. They give Peter nervous glances as they speak soothing words to the boy in the bed. They smooth his hair back, they squeeze his limp hand, they fuss over his IVs. They blink back tears.
The ICU doctors are keeping Carter’s temperature down to protect his brain. 92 degrees. A cooling blanket covers him from the top of his shoulders, keeping his temperature down. Ice packs in his armpits, on his groin. A cooling pad draped across his neck. That, and all the tubes and wires… It all looks terribly uncomfortable. Peter is grateful for the propofol drip that protects Carter from this sensory nightmare.
He sits there quietly, saying nothing. He stares at the cardiac monitor. He studies it. Scrutinizes every beat, every peak. Fixated on it like it’s a Bull’s game. When he’s alone, he cradles John’s wrist in his hand, feeling his gently thumping pulse.
Kerry sits, for a while. She doesn’t try to talk to Peter, and Peter appreciates this. In her silence, Peter finally feels compelled to speak.
“He took a hit to the chest, right before,” Peter says hollowly. He’s been replaying the moment in his mind on repeat. “The patient. The guy caught Carter in the chest with his shoulder.”
Kerry peers at him through her glasses. “Yes. Yes, I was also thinking about that,” she says.
This is beyond Peter’s area of expertise. He’s not an ER doctor. He’s not a cardiologist. “It’s possible, then?” he asks her. “That he got hit in the chest and it stopped his heart?” It seems unbelievable. Preposterous.
But Kerry hums. She reaches forward and takes Carter’s hand, almost absentmindedly. Peter watches as her thumb massages circles into the flesh between John’s thumb and index finger. “All our tests are coming back clear. No evidence of preexisting conditions. Nothing that explains this. I talked to Kayson. Showed him the scans, the bloodwork. He agrees.”
“Agrees about what?”
Kerry sighs. “It’s rare, but it’s possible. I’ve seen it a couple of times. A blunt impact to the chest, at the wrong moment, can trigger cardiac arrest. Commotio cordis. An electrical disruption of the heart.”
Commotio cordis. The words are unfamiliar to Peter. He swallows. Tries to find the right words. Tries to process this. “He, uh… will he be okay?” He hates how vulnerable the words sound, and he resents the sympathetic smile Kerry gives him.
“I think so. If he’s stable for the next 24 hours, they’ll start warming him up. Then reduce the sedation. Extubate, if he can trigger the vent. A few more days in the ICU, for monitoring. A couple more days in a step-down unit.”
Peter absorbs all of this, then feels a flare of impatience. I think so isn’t good enough. “He’ll be fine, then?” Peter presses her. “No lasting effects?”
“It depends, Peter. We’ll know for sure when he wakes up. But… I’m optimistic. He was lucky, all things considered. That this happened in the ER. We got him back pretty quickly. He wasn’t deprived of oxygen for more than a minute or two. I can’t make any promises. But…” she smiles tenderly, looking down at the intern, patting his arm. “But I think he’ll be okay.”
Peter nods tightly, trying to rein in his emotions. The relief that courses through his veins threatens to send tears spilling from his eyes. “Good,” he bites out, working desperately to keep his voice steady. “That’s good.”
He sends up a silent prayer of gratitude. Kerry’s words are cautious, but he believes them. He believes her. Carter will be fine. He’ll make sure of it.
He stands up abruptly. Kerry glances up in surprise. “You good to stay with him for a few minutes?”
She blinks. “I’m due back in the ER in fifteen minutes,” she tells him, regret in her voice.
“That’s fine,” he says gruffly. “I won’t be long.”
He makes a beeline to the elevator, punching in for the eighth floor. The library. He’s got some books to check out. He’s going to learn everything there is to know about fucking commotio cordis.
Two days later
“Doctor Benton?”
Peter awakens with a jolt, his back screaming in protest. For a moment, he’s completely disoriented. He is not in his bed at home. He’s… he’s in a rickety plastic chair in the ICU. And big brown eyes at staring up at him.
Peter lets out a shaky breath. Right. Right. “Hey, man,” he says, as gently as he knows how. The boy blinks up at him, looking distraught.
“What’s… what’s going on?”
Carter’s been in and out for the last ten hours or so, ever since they started reducing sedation. Peter is exhausted. He hasn’t been home in days. But Carter’s family is nowhere to be found. And so he stayed. Through all the tests and exams and procedures, Peter stayed.
“You’re in the ICU, remember?”
Carter’s eyes fill with tears. He nods his head. “Hurts.”
“You’ve got some broken ribs. Do you want more morphine?”
A tear leaks down the boy’s face. “Yes please,” he whispers hoarsely. His lower lip trembles. He looks terribly frightened. Confused.
“Okay,” Peter says, adjusting the dial. “Okay. You’re alright, man. It’s alright.”
He rests what he hopes is a comforting hand atop the crown of his student’s head. “Just relax. Rest. It’s alright.”
At the physical contact, though, a sob breaks loose.
“Hey,” Peter says desperately, reaching for Carter’s hand with his free one. “Hey. Shhh. Shhh.” It’s just the drugs, Peter tells himself. He’s just confused. Overwhelmed. He can’t control his emotions. “Don’t cry, man. You’re alright.”
Peter’s explained to him, a couple times now, in various states of awareness, that he had an accident. That his heart stopped. That they had to do CPR. But, Peter’s emphasized every time, he was going to be fine.
Every time, though, Carter just looks terrified and bewildered.
Now, as the rush of morphine hits his veins, his sobs turn to tiny gasps and hiccups. Tears continue to flow freely from his glazed-over eyes, as if he’s not even aware of them. Beep beep beep goes the heart monitor as it slows down and evens out.
Peter caresses the side of Carter’s face, and the boy whimpers, shuddering and leaning into Peter’s touch “See? You’re alright. Just breathe. Just relax.”
John stares up at him. “I died,” he whispers, voice cracking.
Peter’s heart hurts. He did. He did die. Carter died. He was dead. For a few unconscionable minutes, two days before, Carter had been dead. It was terrifying and it was awful and it was shocking and it was so wrong. It still doesn’t feel entirely real.
“You’re okay now,” Peter tries to reassure him. That’s what all the tests were saying. “You’re gonna be okay. Just… just sleep. Rest.”
Carter’s eyelids are drooping. He looks at Peter with an expression of trust and devotion that feels wholly undeserved. His fingers curl around Peter’s hand. “Stay?” he asks, his syllables starting to slur together. “Will… will you stay for a little while?”
Peter’s skin prickles. Some old instinct, deep within him, urges him to flee. But he nods anyway. A year ago, a moment like this would have been unthinkable. Peter had never been the kind of person to stay, to linger inside challenging, emotional moments. Even a few months ago, he probably would have left this boy to the care of the nurses.
Now, though…
This year, Peter had narrowly avoided an HIV diagnosis. He was rejected from pediatric surgery. Dennis Gant was dead. Peter had his damn appendix removed. Carla was pregnant. And Carter had very nearly died.
That was more than enough to humble a man like Peter Benton.
So he leans forward and presses a kiss to his student’s forehead. “I’m not going anywhere,” he promises, allowing himself to feel a wave of affection for the boy. A surge of protectiveness. He would not leave. He would not screw this up.
John’s eyes flutter closed.
Peter settles in for the night.