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shock-doc-cpr · 6 days ago

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Marissa’s Emergency

Thirty-year-old Marissa Klein had almost rescheduled her annual gynecology exam. Work deadlines and weekend plans pressed on her calendar, but a reminder ping convinced her to keep the appointment.

It began as every year did — routine questions, a nurse’s chatter, the rustle of the paper gown. She slid her feet into the stirrups, ready to endure the brief awkwardness and then go about her day.

But midway through the exam, her chest gave a violent flutter. Her breath caught.

“Something’s wrong,” she whispered, eyes wide.

Dr. Patel froze. “What do you feel?”

“My heart — it’s racing. I can’t breathe.”

The nurse clipped a pulse oximeter to her finger, pressed electrodes against her skin. The monitor confirmed it: a dangerous tachyarrhythmia, her heart hammering at nearly 200 beats per minute.

Dr. Patel crouched to meet her gaze. “Marissa, your heart’s in an unsafe rhythm. We’re going to reset it with controlled shocks. You’ll be sedated, and you may feel your body move. But you’re not alone.”

---

Defibrillation

Adhesive pads were pressed to her chest and side, wires coiling to the defibrillator. The sedative chilled her veins, softening her panic into haze.

“Sync mode engaged. Charging to 100 joules. Clear.”

The first shock cracked through her.

Her torso jerked sharply, chest muscles seizing, legs snapping taut in the stirrups. Her breasts jolted with the contraction, a muffled grunt escaping her throat. The monitor fluttered — then returned to chaos.

“No conversion.”

“Charging to 150 joules. Clear.”

The second shock snapped her body higher, shoulders lifting, arms twitching, calves straining against the stirrups. Her chest arched, breasts shifting with each violent contraction. The monitor still screamed arrhythmia.

“She’s still in it.”

Dr. Patel’s voice never faltered. “Third attempt. 200 joules. Clear.”

The machine whined, then discharged. Marissa’s entire torso lifted cleanly off the table, legs snapping straight, chest seizing in one final contraction before dropping limp.

The monitor paused… then fell into steady, even beeps.

“Normal sinus rhythm restored,” the nurse breathed.

Dr. Patel pressed a hand to Marissa’s shoulder. “You’re safe now. We’ll transfer you to the hospital.”

---

Aftermath

The room quieted, adrenaline fading. Marissa stirred, chest aching as if a heavy weight had slammed into her sternum. Her legs trembled, still sore from the spasms.

The nurse peeled away the electrode pads, leaving red, square outlines on her skin. “The soreness is normal. Your muscles contracted hard with each shock.”

Marissa’s voice was thin. “I felt… everything. Like I wasn’t in control of my body.”

Dr. Patel gave a tired smile. “That’s exactly how it works. It’s frightening — but it saved you.”

---

Hospital Arrival

By the time she reached the emergency department, her heart, though steady, was slowing dangerously.

“Heart rate in the 30s,” the nurse called.

Dr. Chen, the cardiologist, leaned over her. “Marissa, the shocks reset your rhythm, but now your heart’s too slow. We’ll use the pads again, not to shock, but to pace your heartbeat. You’ll feel every impulse — it may be uncomfortable. But it will keep you alive.”

Her lips trembled. “Do it.”

---

Transcutaneous Pacing

The pads were pressed firmly back onto her chest and side. The machine clicked into pacing mode.

“Set rate: 70. Output: starting at 50 milliamps.”

The first pulse hit. Marissa gasped as her chest twitched sharply in time with the pacing. Her pectorals contracted with each impulse, causing her breasts to lift and twitch visibly with every beat.

Her shoulders gave small shrugs, her abdomen tightening rhythmically.

“It’s… every second… like my chest is being kicked,” she gasped.

The nurse increased the current until the monitor aligned each pulse with a heartbeat.

“Capture achieved at 80 milliamps. Consistent pacing.”

Now the jolts came relentlessly — thump, thump, thump — her upper body jerking rhythmically, breasts twitching with each contraction. Unlike defibrillation, this was not once-and-done. It was constant.

Her chest muscles ached, her eyes welled. “It won’t stop…”

“I know,” Dr. Chen said softly. “This is temporary. We’ll place a wire inside soon, which won’t cause this twitching. Hang on.”

---

Relief

An hour later, Marissa was prepped for transfer to the cath lab. Her body was exhausted, sore from the endless pulsing. When the pacing pads were finally removed, the silence in her chest — no forced contractions, no external jolts — felt like release.

The internal pacing wire took over smoothly, guiding her heartbeat without the painful muscle spasms. For the first time since the clinic, her body was still.

Lying in the hospital bed, electrodes replaced with finer wires, she pressed her palm to her chest. It was tender, raw, but steady.

Her eyes blurred with tears as she whispered, “I’m still here.”

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shock-doc-cpr · 21 days ago

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A really good story, I’m not a Laura a time called kind of person but this is good!!

Kali’s Cardioversion

Her name was Kali Markos. Twenty-four, with olive skin and wavy dark brown hair. A colorful headband always pushed her hair back just enough to show off the eyebrow ring on her left side. The nasal septum piercing below it, just barely noticeable at a glance, gave her a faintly alternative look. Her eyes were a warm brown, but brightened with just enough eyeliner to draw them out. She wore makeup like she wore everything else- as an accessory, never an identity. Kali’s naturally striking features did the heavy lifting.

Both of her arms were covered in vivid, colorful tattoos that ran from her shoulders to her wrists- an assorted mural of flowers, serpents, eyeballs, mandalas, and inked memories she barely recalled getting. The young lady’s style leaned dark: black tank tops that clung to her slim frame, low-cut necklines, cut-off shorts, and scuffed skate shoes. An anklet dangled around one bare ankle like a charm from a life that never slowed down long enough to mean anything.

Kali lived in a cluttered apartment with a friend- someone equally adrift, where ashtrays overflowed and the fridge never quite closed right. The place always smelled faintly of incense, marijuana, and last night’s mistakes. She didn’t mind. Her world was small, immediate, and fueled by impulsivity. Parties, pills, flashes of laughter in dark rooms. The kind of nights that started with dancing, hanging out, in a blur, or not at all.

Her crowd was a mixture of burnouts, partiers, and trust fund kids with self-destructive streaks. She fit in by never asking questions, never planning ahead, and never letting herself care too much. Kali thought of herself as different, vibrant, and untamed. People around her- those who lingered longer than one night, tended to use other words like self-destructive or reckless. A drop dead gorgeous girl hell-bent on going nowhere fast.

A couple years back, she'd been in a pretty bad car accident. Some guy she barely knew, drunk off his ass, took a turn too fast and sent them into a guardrail. Kali was banged up, wound up in our trauma bay, spent a couple nights in the hospital, but walked away mostly fine. The guy didn’t. Jail, maybe prison now. She never followed up. She didn’t care. It wasn’t her mess to clean up.

Tonight wasn’t supposed to be different. Just another party. Just another night of fun. Just another pill.

The next thing she knew, her heart was racing. Not just a little faster than normal- it was pounding out of her chest. Her skin flushed, her breath shallow, her friends’ laughter warping into something distant and underwater. She felt… weird. And not in the usual way.

By the time the ambulance doors opened and the gurney wheels squealed onto the tile floor of our emergency department, Kali Markos was in trouble.

But she didn’t know the full extent of what was to come.

"What do we have?" Dr Lindsay asked as the paramedics rolled the gurney through the trauma bay doors. The room had already been prepped- curtains pulled, monitors ready, and the portable ultrasound cart parked beside the bed. Nurse Nancy stepped up alongside the stretcher, gloved and steady.

"Twenty-four year old female, found at a house party. Awake and alert on scene. Complaining of severe palpitations, shortness of breath, and just generally feeling 'off.' Vitals en route: BP 152 over 90, heart rate 164 and irregular- sinus tach with PVCs on the monitor. She's tachypneic but maintaining her O2 sats. She denied any drug use." The medic rattled off.

Kali sat upright on the gurney, barefoot, stripped down to just her black bra and cut-off shorts. Her tattooed arms rested in her lap, the colorful ink standing out against her flushed, olive-toned skin. Her chest rose and fell rapidly with each strained breath. Her dark hair clung to her temples beneath her go-to colorful headband. Her septum ring and eyebrow piercing caught the bright, overhead trauma bay lights with tiny metallic flashes.

Dr Jen joined, stepping in beside her. “Kali, I’m Dr Jen- I’m one of the residents here. We’re going to take good care of you, okay?”

Kali nodded slowly, her movements tight. “I don’t know what’s happening. My heart won’t slow down. I feel… weird.” Her voice was hoarse, almost apologetic. “But I didn’t take anything. I swear!”

Nancy offered a soft but steadying touch as she checked the EKG leads on Kali’s chest. “You’re doing fine, sweetheart. Let’s get a closer look at what’s going on, alright?”

The monitor beside the bed lit up. Lindsay stepped forward, arms crossed, watching the waveform scroll across the screen: sinus tachycardia, frequent PVCs, and a rate still in the 160s.

“She’s a pretty girl” Nancy murmured under her breath to Jen, slipping the blood pressure cuff around Kali’s left arm. “Greek maybe?”

Jen gave a small shrug, eyes fixed on the screen. “Possibly. Let’s get a tox screen, BMP, CBC, and troponin started.” The resident changed the subject.

“And start her on fluids.” Lindsay added, her tone calm but attentive. “Order a twelve-lead. If she gets any more irritable, we may have to escalate quickly.”

IV fluids were already flowing as Nurse Nancy sent the blood samples off to the lab. The unspoken energy of the trauma bay filled the space, broken only by the occasional beeping of the heart monitor as it continued its relentless staccato. The rate remained in the 160s- still sinus, but with more frequent PVCs creeping in.

Dr Jen positioned the additional EKG leads, moving quickly but carefully over Kali’s tattooed skin. “Hold still for me, please.” she instructed gently. Kali didn’t answer, but she complied.

The twelve-lead EKG printed out with a low mechanical whine, and Jen took it straight to Lindsay. The attending glanced over it, scanning from lead to lead.

“Tachycardia at 172… multifocal PVCs… QTc looks slightly prolonged, but not dangerously so. No ST elevations, no ischemic changes. Nothing to scream ‘heart attack,’ but it’s an irritable rhythm.”

Jen nodded. “Should we keep the defib pads on standby?”

“Not quite yet” Lindsay replied, “She’s not crashing, but I don’t like how agitated that rhythm’s getting. And I want to get an ultrasound to rule out anything structural.”

Jen nodded, then got ahold of the bedside ultrasound probe and rolled the cart over. Nancy dimmed the lights slightly as she spread conductive gel on Kali’s chest.

“Sorry, the gel might feel a little cold” Jen warned.

She placed the probe below the sternum and navigated to the parasternal long axis. On the monitor, the team could see it clearly: Kali’s heart, racing in real time.

“Good contractility” Jen thought out loud, adjusting the probe, eyeing the display monitor. “No pericardial effusion. Chambers look normal. No signs of right heart strain. Valves are functioning.”

“So structurally, she’s fine” Lindsay nodded. “It’s all electrical. I bet we’re dealing with a tox case.”

As if on cue, the lab results pinged onto the nearby computer terminal. Nancy pulled them up.

“BMP shows mild hypokalemia-potassium’s 3.1. Everything else within normal limits. Troponin negative.”

“And tox screen?” Lindsay inquired.

Nancy hesitated a second. “Positive for THC… and MDMA.”

Kali’s head snapped toward them, overhearing the team. “That’s bullshit! I didn’t take anything!” Her voice was sharp and indignant now.

“No, it’s not. You tested positive for ecstasy and THC, Kali.” Dr Lindsay answered firmly. “We’re not here to judge or get you in trouble- we just need to know what’s in your system so we can treat you properly.”

“I literally didn’t take anything!” Kali denied, more forcefully. Her chest rose and fell in quicker bursts now, not just from the tachycardia but from rising frustration. “Your stupid test is wrong.”

Jen exchanged a nervous glance with Nancy.

“It’s not wrong, Kali.” Lindsay stated, firm and unwavering. “And if your rhythm keeps worsening, we may need to intervene. Do you understand that?”

Kali didn’t respond. Her jaw clenched, her eyes darting toward the monitor, then away. The tension in her body made her tattoos seem to vibrate slightly with each uneven heartbeat.

Nancy gently reached for her hand. “We’re not here to judge you, hunny. We just want to help.”

But Kali wasn’t listening anymore. Her stare had fixed itself in the opposite direction of the team. She was silent, seething, and scared, though she’d never admit it.

The waveforms danced across the screen like the last flickers of a neon party still pulsing in her chest. But something in them had shifted, and Lindsay saw it too.

“Get the crash cart closer just in case” she spoke discreetly to Jen. “Let’s stay ahead of this.”

The steady rhythm on the monitor suddenly skipped, then changed seemingly out of nowhere.

Jen was the first to catch it. “She’s in stable V-tach” she called out, eyes fixed on the monitor as the waveform widened into jagged peaks. “Rate’s one-ninety. Still has a pulse.”

Dr Lindsay was already moving. “Push 300 of amiodarone. Let’s try to chemically convert her before we get the paddles involved.”

Kali shifted on the table, her breaths coming faster now, more shallow. She winced, pressing a hand to her chest. “What’s happening? My chest...” she gasped. “It’s worse. It hurts..."

Nancy leaned in beside her, her gloved hand curling around Kali’s. “I’ve got you, sweetie. You’re okay, just breathe through it, alright?”

But Kali wasn’t okay. Sweat started to appear across her face and chest, her dark hair damp against her temples. He girl’s entire body seemed tenser now, muscles drawn tight beneath tattooed skin. Her brown eyes nervously darted to the heart monitor- she knew something had changed. This was no longer just weird. This was wrong.

“Amio’s ready.” Jen reported, drawing up the syringe and handing it off.

Lindsay took it and pushed the med into the IV port without hesitation. “Let’s see if this does anything.”

They watched. One moment. Then another. The monitor didn’t change. The rhythm remained fast, wide, and dangerous.

“No response” Jen reported under her breath.

Lindsay didn’t look away from the screen. “Alright. Charge the defib pads, we need to cardiovert. We’re not going to wait for her to crash.”

Nancy gave Kali’s hand a small squeeze, her voice a low murmur. “We’re gonna take care of you, I promise. Just stay with us.”

Kali’s breaths were shallow now, her lips parted as though trying to form a question- or maybe a protest, but no words came. Her heart was still beating, just not the way it should.

Jen nodded to Lindsay’s instruction. “Charge the pads to 100 joules once you set them up, synchronized.”

Kali’s eyes flicked toward her- wild, glassy, pleading. “Wait… what are you doing? What is that?!”

Nancy didn’t let go of her hand. “They’re going to shock your heart to try to get it back into a normal rhythm, sweetie. I’m right here. Just keep looking at me.”

“No- no, wait!” Kali stammered. Her voice cracked as her breath quickened. “Please… don’t let them do this! I don’t want to die!”

“You’re not going to die, hunny!” Nancy reassured, though her voice trembled faintly now too. “We’ve got you.”

Scissors snipped at the thin straps of Kali’s black bra, and the garment fell away, revealing her pierced nipples and bare, olive-skinned chest. Jen quickly placed the defibrillator pads: one just below Kali’s right collarbone, the other along her left side beneath the breast. The sticky adhesives pressed into her skin, not budging at all.

Her heart rate continued to climb- still in V-tach, still unstable.

“Ok pads charged to 100. Everyone…CLEAR” Lindsay firmly called out.

Everyone stepped back. A mechanical beep, and then…

The shock hit. Kali’s shoulders shrugged forward, a quick shiver following. Her eyes squeezed shut, a guttural moan escaping her lips. Her toes curled sharply, involuntarily, showing off the black nail polish on her toes, and the soft, wavy wrinkles throughout the soles of her size 8 feet.

Still V-tach.

“no change” Jen confirmed. “Charging to 150.”

Kali groaned again, one hand weakly gripping Nancy’s wrist. “Please… please stop. I can’t… I can’t do this again…”

Nancy gently brushed some loose strands of Kali’s hair, tucking some behind one ear. “I know it’s scary. I know. Just stay strong, okay sweetie?”

“CLEAR” Lindsay’s voice surged once more.

KA-THUNK! Kali tensed up on the table, legs twitching. Her cry was shorter this time- more of a high pitched yelp.

“Still in V-tach…” Jen observed, pinching her lips, eyeing the monitor. “Let’s try again at 200.”

Kali’s eyes were wide, her lips trembled. “No more! No more! I don’t wanna die!!!” Kali begged and pleaded with the team. Nancy felt terrible and didn’t let go until the absolute last second.

“CLEAR.”

The third shock surged through her.

Kali gasped, her body jolting sharply in response. Then she went still, as if someone flipped a switch.

Her head lolled to one side. Her eyes fluttered, then rolled back, half lidded and glazed over.

“Kali? You with us?” Nancy gently nudged the young lady. The veteran ED nurse placed two fingers on Kali’s neck, feeling for a carotid pulse. Nothing!

The monitor transitioned into a furious alarm.

“She’s coding!” Jen shouted. And just like that, Kali Markos slipped into full cardiac arrest.

The monitor blared a shrill, high-pitched beep. A furious display of jagged peaks, then disorganization. Ventricular tachycardia degraded into coarse ventricular fibrillation within seconds.

“She’s in v-fib!" Jen's eyes widened, looking at the monitor.

“Start compressions!” Lindsay snapped, taking charge.

Dr Jen immediately moved to the side of the table, lowering the bed, and began CPR, her arms straight and locked as she delivered hard, fast compressions to Kali’s bare chest. The piercings in her nipples shifted subtly with each brutal, downward thrust. Her tattoos danced with the rhythmic thrusts, especially the colorful serpent one wrapping her right bicep. Her head bobbed loosely to the side, dark hair falling over her half-lidded, rolled back eyes.

“Getting the crash cart set up for the next shock- Nancy, bag her for me. I want her oxygenated.” Lindsay commanded.

Nancy positioned herself at Kali’s head, securing the mask portion of the ambu bag over her mouth and nose. With each squeeze, her chest rose and fell beneath the defib pads. She whispered softly, barely audible over the commotion. “Come back to us, Kali… keep fighting, sweetheart. You have your whole life ahead of you.”

Lindsay was already prepping for intubation. “Jen, rotate out in fifteen. I'll get the airway first.”

As Jen continued CPR, Lindsay grabbed the laryngoscope and size 7.0 ET tube.

“Draw up 20 of etomidate and 100 of succinylcholine” she instructed. Nancy passed the syringes without missing a beat.

With Kali’s jaw gently pried open, Lindsay inserted the laryngoscope blade, sweeping the tongue aside. “Vocal cords in view… tube going in.”

The endotracheal tube slid between the cords with practiced precision. Lindsay inflated the cuff, secured the tube with a blue tube holder, then connected the ambu bag again. Nurse Nancy bagged while watching for chest rise.

“Good placement. Equal chest rise, tube fogging, capnography confirming.”

“Get back on her chest. Go ahead and swap out, Jen. Good job on those compressions.” Lindsay ordered, giving her resident protégé a compliment. Nancy switched in, Jen taking over ambu bagging.

Each compression sent a shudder through Kali’s body. The twenty-four year old’s chest caved in, recoiling hard, her belly rippling out. Her ribs strained beneath the pressure, skin now pale and cool. Her arms flopped slightly at her sides with the movement, the lines of her tattoos distorted with every downward drive.

“Push one milligram of epinephrine IV, now” Lindsay looked over to Jen.

Jen handed over the syringe. “Epi's going in.”

“Still v-fib.” Lindsay observed, eyes locked on the monitor.

“Charge to 200. Let’s get ready to shock her.”

Jen pressed the button, the rising, high pitched electrical whir of the defibs charging filled the room.

“Everyone CLEAR.”

Kali’s limp body was tossed around effortlessly as electricity coursed through her again. Her bare chest shot up, back arching, before plopping back down on the table.

“Still v-fib, Linds” Nancy reported, shaking her head.

“Resume CPR. Let’s get a femoral line in- she’s gonna need more meds.”

Kali’s shorts and underwear were quickly snipped off with trauma shears. Lindsay grabbed the sterile kit. Draping Kali’s groin area, she located the femoral vein with practiced fingers. “Betadine. 18-gauge needle in. Wire going in… advancing dilator…” Dr Lindsay thought out loud during the placement of the femoral line.

Each step was precise. The catheter slid into place, taped and flushed.

“Central access confirmed. Give another milligram of epi. 150 of amiodarone after that.”

“Epi in… Amio going in next.” Jen called out, reading each label aloud.

Nancy never stopped compressions, pumping her chest hard, fast, and repeatedly. Kali’s chest recoiled under the brute force of each push.

“Two minutes up” Jen looked to Lindsay, “Still looks like v-fib.”

“Let's shock again at 300” Lindsay stated. Her voice remained calm, clipped, and professional despite the hectic scene unfolding.

The defib pads whined again.

“CLEAR!”

Another shock made its way through Kali’s motionless body. Her arms jumped. Her chest twitched sharply.

Still v-fib.

“Resume CPR, still no pulse” Lindsay ordered, her voice firm.

The room didn’t slow. No one hesitated, and Kali’s heart still refused to come back despite the team's work up to that point.

“Another two minutes. Still v-fib.” Jen calls out to the team.

“Ok, let’s re-charge to 300 this time." Lindsay replied. Her voice remained sharp, controlled, but her eyes flicked briefly to Kali’s lifeless form- her bare chest rising with each ambu bagged breath, the bruising around her sternum beginning to show.

“Charging to 300… defibs ready.” Jen confirmed.

“CLEAR!”

The jolt of electricity raced through Kali’s body, causing her chest to jump violently and her legs to spasm. The monitor stuttered, then returned to chaos.

“No change, still VF” the resident eyed the monitors, then glancing at Lindsay.

“Resume compressions.”

Nancy climbed back up onto the stool and drove her palms into Kali’s sternum again. Her chest gave under each forceful compression- ribs creaking, tattoos warping with every thrust. Jen squeezed the ambu bag, but a smear of pink-tinged foam appeared at the edge of the ET tube.

“Lindsay... there’s some blood in the tube.”

“She’s probably aspirated or has some pulmonary edema. Keep bagging. We’ll push through it.”

Another round of epinephrine went in. Then lidocaine. Then magnesium.

After the cycle of compressions were finished, a 360 joule shock was administered.

“CLEAR!”

Kali's bare feet leapt up an inch or so above the table, her heels crashing back down with an ungraceful thud, showing off the wrinkles in the soles of her feet once more. However, the rhythm was unchanged even after the shock. Coarse v-fib appeared to be the winner of the battle up to that point.

Lindsay folded her arms. “Give bicarb.” she said quietly. “And another round of epi. 1mg IV push."

Dr Jen nodded and delivered both. Nancy hadn’t said a word in minutes- just kept pumping Kali’s chest hard and fast, her own breaths trembling between counts.

Lindsay watched the clock. Nearly twenty minutes down.

“Let’s try again. Charge to 360.”

Jen readied the defibrillator again. Her hand hovered over the controls.

“CLEAR.”

Kali’s body tensed violently, and this time, didn’t settle back as naturally. One of her arms slid slightly off the edge of the table. Her head lolled to the side. Her eyes stared upward, half-lidded

The monitor alarmed, still v-fib.

“Rhythm check” Lindsay ordered. “Hold compressions. How are her pupils?”

The room fell silent except for the monitor’s erratic waveform.

Jen leaned in, shining a pen light into Kali’s pupils.

“Pupils fixed and dilated..." The young doctor shook her head.

Lindsay stared at the monitor one last time. The waveform didn’t even flicker now. Just the same stubborn, jagged mess. Refractory ventricular fibrillation.

She let the silence hang for a moment. Her shoulders sagged.

“Alright, she's not responding to our efforts and has no neurological response. I'm going to go ahead and pronounce her. Time of death, 1:11am.” Lindsay's tone was neutral.

Jen stopped ambu bagging. Slowly, gently, she reached out and placed her hand on Kali’s forehead, brushing aside a strand of Kali's hair poking out from her headband.

“I’m so sorry, sweetie...” Nancy whispered, giving Kali's hand a quick squeeze.

No one moved for a moment. Kali's body on the table was still- tattoos faded against ghastly pale skin, the endotracheal tube secured but now useless, the bruises spreading across her chest. The code was over.

The trauma bay was quieter now- eerily so.

The monitor still beeped rhythmically, its screen showing nothing but cold, unrelenting ventricular fibrillation. Jen finally stepped forward and pressed the power button, the monitor going dark.

Lindsay exhaled softly. “Let’s get her cleaned up.”

One by one, they moved with solemn precision. Jen carefully peeled away the EKG leads from Kali’s bruised, battered chest. Each adhesive pulled back from her skin leaving red, circular marks on her skin. Nancy detached the IV tubing from Kali’s arms and removed the tape. Then the femoral line- gently pulled and held with gauze.

Jen reached up and unclipped the ambu bag from the endotracheal tube. The detached breathing tube hung there now- silent and purposeless. The endotracheal tube remained in place, but no air moved through it anymore.

Nancy turned her attention to the defib pads and slowly peeled them from Kali’s chest and side. The skin beneath was reddened, slightly irritated. The evidence of each jolt they’d tried to deliver.

Kali lay still on the table- bare and lifeless, marked with deep bruises along her sternum from the violent compressions she received. The piercings in her nipples remained in place, glinting faintly in the overhead light.

From the supply cart, Nurse Nancy retrieved the toe tag, filling it out quickly and efficiently. She then crouched at the foot of the table, paused for a moment, then gently lifted Kali’s left foot. Her sole was soft and slightly wrinkled, toes relaxed. She stared for just a second longer than necessary- an unexpected lump catching the veteran nurse in the throat, then looped the band around Kali’s left big toe and secured the tag, the label hanging downward, brushing against the soft soles of the young lady's feet.

Nancy then moved to the head of the bed, smoothing back Kali’s dark hair again and adjusting her headband slightly. Her fingers hovered over Kali’s forehead.

“You didn’t deserve this...” the ER nurse murmured.

She waited another beat, gently resting her palm over Kali’s cooling hand. Then, carefully, she closed Kali’s eyes for the final time.

A fresh sheet was drawn up over Kali’s body- first over her chest, then her shoulders, then finally her face.

The overhead light dimmed slightly as Lindsay pulled the curtain closed behind them.

Kali Markos had always lived fast. She chased highs without thought, danced until the sun rose, and surrounded herself with questionable people who mistook recklessness for freedom. At twenty-four, she was still full of life and fire- olive skin inked with vivid color, piercings flashing defiantly, her smile wide and bright when she let it show. There was a beauty in her chaos, a magnetism to the way she navigated the world.

But chaos doesn’t negotiate. It doesn’t pause to reflect. It doesn’t make room for second chances. And in the end, it left her here: toe tagged and under a sheet in our emergency department.

She’d entered the trauma bay with her heart racing and her head spinning, scared but not yet broken. She’d argued. Denied. Dared. But her body, betrayed by substances and strain, buckled, then failed. Despite the team’s efforts, despite every jolt, every drug, every compression, Kali never came back.

Now, the room was silent. The only movement came from the sheet that rested gently over her frame, pulled smooth by the last pair of gloved hands that would ever touch her. Only her feet remained visible, pale against the sterile linens, her toes relaxed. From her left foot dangled the toe tag- white cardstock swinging slightly, brushing against the arch of her sole. It read:

MARKOS, KALI.

AGE: 24

GENDER: FEMALE

TIME OF DEATH: 1:11AM

There was no music here. No laughter. No fire. Just the hush of the trauma bay and the echo of what had been- a beautiful young woman once brimming with life and defiance, now quiet, still, and marked only by a toe tag.

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