Kilburn needed to see the vocal cords to pass the endotracheal tube into the windpipe, but he couldn’t even spot the blade of the laryngoscope through the secretions. His own chest thumped harder. “Got to do this blind!” he said to himself as he dropped the suction catheter and the laryngoscope on the bed.

He slid a finger along the tongue until it ran into the soft nub of tissue it sought: the epiglottis. With his trembling right hand, he snaked the endotracheal tube along his finger and beyond the epiglottis. First pass, he felt nothing but smoothness as the tube slipped into the esophagus. Wrong passage. He pulled back and tried again, forcing the tube even further forward. This time, his fingers met the welcoming resistance of the tracheal rings. The tube bumped down the windpipe. A geyser of green sputum erupted from the other end, forcing him to duck again.

When the flow slowed to a trickle, the nurse passed Kilburn the ambubag. He attached it to the end of the tube and squeezed the balloon-like pump, meeting fierce resistance. Sweat poured off him as he fought to squeeze breath after breath of oxygen into the fluid-filled lungs.

Kilburn felt a hand on his shoulder. He looked up to see that two more members of the ICU team had reached the bedside. “Good work, Graham. We’ll take it from here,” Robin James, the ICU attending physician, said as he gently pulled the bag from Kilburn’s hands.

Kilburn nodded and backed away from the bed. There was nothing more for him to do.

Though it had seemed as if the nurse and he had been alone with the patient for hours, the intubation had taken less than two minutes. More gowned and masked members of the Code Blue team flooded into the room. Kilburn watched as they swarmed the patient. Nurses started new intravenous lines and piggybacked medications on top of existing ones. The respiratory technician hooked the endotracheal tube to the ventilator. Orders were voiced in even tones. Everyone moved with urgent, nearly choreographed, purpose. None of them showed a trace of panic, but their determination was palpable.

Despite the expert intervention, Mallek’s color never lightened. And the vital-sign readings on the monitor steadily deteriorated. His oxygen saturation level dipped into the fifties. His blood pressure fell below sixty. The monitor’s alarm screamed its unrelenting concern.

Then Mallek’s pulse began to slow.

“Damn it!” Kilburn muttered under his breath. He turned and headed for the door. He didn’t want to stay for the end.

9 - Philadelphia, Pennsylvania

9

Philadelphia, Pennsylvania