Wednesday, June 12, 2019

Critical care


Ben loved working as a newly minted critical care physician in the intensive care unit. This was his element. He was in total control.

He loved having among the most advanced medical technology available in the entire hospital at his fingertips. He loved the sights and sounds of his handheld ultrasound on color Doppler mode. He loved the steady flow of the mechanical ventilators. He loved the extracorporeal membrane oxygenation (ECMO) machine. And he loved how others had to ask him how to work these gizmos and gadgets.

The intellectual challenge of caring for the sickest of the sick, those with multiple organ failure, was utterly fascinating. Ben took pride in making the daily rounds checking the patient's vital signs, lines and tubes including Foley catheters, central lines, endotracheal tubes, surgical drains, fluids, labs and electrolytes, imaging, and medications such as antibiotics and pressors. He would be the one in charge of piecing together the entire puzzle and coming up with the assessment and plan for the patients while others waited on what he had to say. When he spoke to his staff, he would sometimes pause for effect, smiling wryly as the interns and residents rushed to jot down his every word, then dispense his nuggets of medical wisdom to them. Ben was whipsmart, and he knew it.

Most of all, Ben loved the thrill of bringing patients on the brink of death back to life again. It was an absolute adrenaline rush for him. God himself couldn't have done a better job.


As a child, Ben grew up dirt poor, but his home was a happy home. A praying home. A home where the Bible was read and talked about every day. A Christian home.

His parents weren't intellectuals, just simple folks trying to make ends meet each day. They always tried to give their kids the best they could, even if the best wasn't always up to snuff.

Ben's dad worked multiple minimum wage jobs, mostly maintenance and janitorial work, while his mom was a waitress.

Nevertheless, through scrimping and saving, they were able to send Ben off to the state college like he had always wanted. And through hard work, sheer smarts, and true grit Ben was able to get into medical school too.

That's when Ben lost his faith. Specifically it was in his gross anatomy class. After he had dissected his cadaver, Ben stepped back to take it all in. He expected an epiphany, but felt nothing. All that lay spread out on the table before him was mere flesh and bones. That's it. A meat machine.

Oxygenated blood circulated through the arteries, and returned deoxygenated via the veins, while supplying various organs along the way, but once the blood stopped flowing, the organs stopped operating. They would become necrotic and die. And that was it. No different than a car without oil unable to start up.


Ben was close to his parents, especially his mother. She wasn't a bright woman by any means, let alone an accomplished woman, but she loved, and she loved Ben, and Ben knew it.

Long ago, his mother gave Ben a little cross on a necklace and asked him to always wear it so he could remember what Jesus did for him. It was a special silver cross that she had purchased for Ben from an antique store that was going out of business. That's how she got a good deal on it, even though she still had to pull extra night shifts at the local diner just to buy Ben the cross.

Despite becoming an atheist, Ben simply couldn't bear to forego wearing the cross.


The CDC flew Ben out to consult for them on an outbreak of a new infectious disease.

No one knew what the disease was exactly. Let alone how to stop it. However, China was ground zero, and indeed many scientists suspected it was a hybridized superbug that the Chinese communist party had developed in order to weaponize but quickly lost control over. That was how the disease became known as the Xiao: it was named after the other-worldly necropolis of oblong tombs in the deserted Lop Nur region of China where it was believed the Chinese had specialized laboratories designed to produce bioweapons.

In any case, no one was willing or able to provide more information, not once the Xiao had proved fatal to so many so quickly. The Chinese said it was Western propaganda to discredit China and keep it from becoming a significant player on the world stage.

When the Xiao hit stateside, the CDC was prepared and able to quarantine affected pockets of populations. However, nothing could be done for those in quarantine except for supportive care. It was simply a matter of time before they would die. And who knew if the quarantines would hold.

The Xiao was beyond biosafety level 4.


Ben put on level C personal protective equipment - full-body, air-supplied positive pressurized hazmat suit, gloves, respirator, and more - in order to minimize exposure. Still, there was no guarantee. Other medical staff had become infected and died.

However, Ben knew he had to see the patients up close and personal in order to figure it out. Besides, who else could do what he could do?

As he stepped across the black and yellow biohazard tape and into the quarantined intensive care unit, his heart began pounding, not in fear or panic, but with a surge of adrenaline and excitement. This was what he lived for.


That is until he too became infected and lay dying alongside other infected patients.

Ben was angry about his wasted potential in life. He could have done so much more. He could have made astonishing medical discoveries. He could have cured this and other diseases. He could have won the Nobel. Instead, he would die. He couldn't understand how this could be.

What a cosmic joke all this was. There was no rhyme nor reason for it. Just pitiless indifference. Baldur the beautiful is dead! Ben fumed inside, even as his vent let out a pathetic sigh.

Ben's thoughts turned to his parents and his siblings. They couldn't visit him. How much he'd miss them. Especially his mother. His dear beloved mother. His death would wreck her.

Ben couldn't control himself any longer. He broke down and sobbed. Baleful, pitiful sobs that lasted till he fell fast asleep.


Ben awoke, still in the ICU. The hums, beeps, and buzzes of the ICU, normally safe and familiar, felt distant now, and eerie. Perhaps death had come for him at last.

His heavy head hung down, and he glanced the cross around his neck. The cross his mother had given him.

Ben mustered what strength remained, and sat up. He weakly clutched the cross in his hand, then kissed it, then stroked it, across his lips, across his face. How has mother had wanted him to wear this cross! Well, he did, and what good did it ever do him? Jesus Christ, he screamed inside because he could no longer scream out loud, if you died for me, then why am I dying?


Ben awoke to beams of sunlight. For a moment he thought he had died, but no, he was still in the ICU.

However, Ben felt better. Much better. That's when he noticed all the physicians, his colleagues, staring at him from the outside through the window. They were speaking rapidly and waving their hands in astonishment, pointing to his monitors and looking at his improved vitals.

What's happening? Ben thought. What happened? Am I better? Why am I better?

Ben's mind raced to find answers. Did I receive some new treatment? No. Did anyone come to see me yesterday? No. Did anything change at all? No.

Wait. Wait a second. Can it be? Is it possible? The ions. Potentiating toxicity. Yes, yes. Destabilizing proteins in the chains. Okay, yes, true. Mutagenic effects on the genome. Possible, no probable, of course! That must be it! Yes, that was it. Yes! The silver ions acted upon multiple targets to destroy the Xiao when he repeatedly kissed and stroked the cross across his face.


Ben's discovery led to his recovery as well as the recovery of the other patients.

As he walked out of the hospital, faint but alive, he saw his parents and siblings. They ran toward him. His mother hugged Ben so tightly he joked he needed a vent to breathe again.

Ben thanked his mother for the cross she gave him. If it wasn't for the cross, Ben would have died. And Ben remembered his prayer - more like a desperate cry - nights before. A cry that came from the depths of his soul. God had heard him.

When he arrived home, Ben picked up his Bible for the first time in a long time. He opened it and his eyes fell upon a psalm. "O Lord, you have searched me and known me!" it began.