“Another four of lorazepam. And hang a Dilantin drip. Run in a gram over fifteen minutes,” I said, calling for the heavy artillery of anti-seizure drugs. Pulling the stethoscope off my shoulders, I leaned over Lara’s jerking form and raced through a head-to-toe physical exam. Filled with fluid, her lungs were all gurgles and wheezes. A bluish tinge enveloped her fingers and lips. I glanced at the monitor. Her oxygen saturation had dipped into the seventies—respiratory failure territory—and her blood pressure had risen even higher. “We have to stop this seizure. Now!” That meant medically paralyzing the young girl. I recited the drugs and sequence I wanted them given.

“Dr. Dafoe, you better look at this …” Jan waved an ECG printout at me like it was a flag.

I studied the twelve squiggly lines, stunned by their implication. “A heart attack? At fourteen? She must have cocaine on board, too.” I looked to the respiratory technician. “Everything ready?”

She nodded and pointed shakily to the tray beside me.

“Okay, Anne, give her 100 of sux.”

Anne stuck a syringe into one of the four IV lines leading into Lara’s arms. She pushed on the plunger. Within seconds of administering the succinylcholine—a fast-acting drug that paralyzes muscles and renders patients into rag dolls—the twitching began to subside. Soon Lara lay still on the bed. As expected, she stopped breathing. What I didn’t foresee (but should have) was the fountain of foam spewing from her mouth, as her lungs passively expelled their fluid contents.

I grabbed for the scythe-shaped laryngoscope. The knuckles of my left hand ached, and I glanced down at the source: the healing jagged gash from my bike chain that ran across my knuckles like a jailhouse tattoo. Ignoring the pain, I clicked open the laryngoscope’s blade and eased it into Lara’s mouth pushing her tongue out of the way. To pass the endotracheal tube into her windpipe, I needed to see her vocal cords, but I couldn’t visualize anything through the froth. I stuck a suction catheter in her mouth but it was as hopeless as trying to vacuum up water from a burst and still-spewing pipe. The monitor’s alarm screamed, warning me what I already knew: Lara’s oxygen level was dangerously low.

“Bag her!” I said to the respiratory technician who fumbled to cover Lara’s mouth with the clear facemask and pump oxygen in with a balloon-shaped Ambu-bag.

I turned to Anne. “I have to do this retrograde.”

Anne’s eyes betrayed her skepticism as she reached for the retrograde intubation kit. Her doubt was well founded, too. It was a technically challenging procedure at the best of times, I was firmly perched on the ‘wing and a prayer’ side of the statistical success curve.