The resus bay door swung open, medics rushing in with the stretcher in tow.

“56 year old male, chest pain, diaphoretic. Vomited times two on the way in. BP 90/62, pulse 103.” the taller of the two paramedics calls out as he directs the stretcher to resus 2. His partner, a young woman, follows along, but is clearly taken back from what is happening. She’s obviously new, and obviously terrified.

Jessica Hannam is the first nurse to respond, as she steps away from the nursing station to come up to bed 2. “Page the doctor please” she calls to the nurses behind her.

“Doctor to resus stat.” calls through the emergency department overhead.

Within minutes, nurses, clerks and attendants fill the resuscitation room.

“Move him onto the stretcher” Jess instructs the medics as she steps up beside the younger of the two. A nursing attendant takes his place beside the male medic, all grasping the blanket beneath the distressed patient. “On three. One. Two. Three.” The man his lifted effortlessly onto the stretcher next to him, the medics moving their gurney away quickly.

It is like a mob scene. Jess attaches caridac monitor leads to the patients chest as he gasps, clutching a basin in front of him. Heaving, his body tenses as his stomach surges. Another nurse brings up the crash cart, while another applies oxygen, and a third begins to start an IV line. This is all happening simultaneously, and within minutes.

“Any medical history?” Jess calls to the medics, not looking up from her task.

“Nothing.” states the male medic. “Not so much as a broken finger”

Beep. Beep. Beep. The monitor springs to live, echoing the irregular rhythm of the mans heart beats into the room. Rhythm strips begin to spill from the machine at the head of the bed, as Jess looks at the monitor screen above her.

“Shit” she mutters under her breath.

Just then, Dr Kate Foster steps up to the bedside.

“Story?” she asks, immediately taking charge of the situation. Looking at the monitor, she frowns. “Jess, two large bore IVs, and page medicine, please.” Pulling her stethoscope from her neck, she places it to the mans chest.

The male medic speaks up, repeating his previous story for Kate. “Hector Valdez, 54, woke up from a nap with chest tightness. Called EMS. By the time we got there, he was sweating, with dry heaves. Vomited on route. Vitals are shit.”

Glancing distastefully at the medics choice of language in front of the patient, Kate turned to the obviously terrified man.

“Mr Valdez, I am Dr Foster.” Turning to the crash cart behind her, Kate draws up the first required medication. “You are in good hands.”

Reaching for the newly inserted IV line, Kate inserts the needle into the closest port. “Atropine point six going in,” she calls.

“Want RT?” Jess calls out, returning to the bedside, hanging a second saline bag beside the already full one. Doesn’t hurt to be ready, she figures.

Suddenly, the patient becomes limp. His hands fall to his sides, his basin falling to the floor.

“He’s crashing!” Kate calls, turning back to the crash cart. “Atropine point six going in, again.”

“Attention please,” the overhead page calls through the hospital. “Code blue, emergency, resus. Code blue, emergency, resus”

“He’s in v-fib, charge the paddles.”

Kate reaches back to the paddles that are suddenly at her side. Reaching over the still form of the man, she can hear the sound of the charge reaching its peak.

“Clear?” she calls out. Taking a quick glace around, she places the paddles appropriately and releases the climaxed charge.

The mans body surges, rising off the stretcher in a violent jerk.

Kate frowns, looking at the monitor above the bed. “Charge again. Clear?”

Another surge. The monitor shows that the patients heart has stopped, no rhythm showing on the screen.

“Start CPR.”

Immediately, the attendant is at the bedside again, experienced hands work over the chest at the base of the sternum, compressing with a force that pushes the stomach to jut out with each movement.

“Amio three hundred” Kate calls out.

It is as if everything is compressed into one movement. No one is in one place long enough for anyone to register that they were there to begin with. Everything is so quick. Rushing, discarded items falling on the floor, nurses calling to each other. An overhead page calls out “RT, 23, to emerg resus”

"Okay, stop for a minute" Kate calls, checking the monitor agian. A rhythm has returned, but not one that helps the situation.

Kate reaches for the paddles again. “Charge” Looking around her, she nods everyone back. “Clear?” Another quick check, followed by the surge of electricity rushing through the mans body.

Kates mind is racing. But not as ones mind would usual race. It is as if her mind is on autopilot, sending out orders to the staff around her, its almost like she doesn’t even have to think about what to ask for next. She is calm. A helpful trait in times like this. Nothing is worse in a code when the doctor is hyper. Doesn’t set a good tone for those working with them. Like is any charge situation, you need to appear calm. Even if you aren’t, and all you want to do is cry, hide or scream, you need to stay calm. And Kate did just that. She always did.

They loose a heart rhythm, starting CPR again.

Five minutes passed.

“Give me another shot of Amio. Three hundred, please.” she asks the nurse at her side. Kate doesn’t recognize her. With a quick glance, she can tell this nurse is new. Her terrified eyes are wide at the sight, but she is keeping it together. She will probably break down later.

You are trained for this in school. They have mock codes, teach compressions, tell you what to do. But nothing prepares you for the real thing. Nothing they can teach in a class room can prepare you for the sight of a man dying in front of you. No ‘dummy’ can compare to the feeling of a mans ribs breaking under the pressure of your hands with each compression you administer in an attempt to save his life.

Nothing they teach in school truly prepares you for this kind of work.

Ten minutes have passed. Then fifteen.

“Okay, stop. Everyone stop.” Kate calls, looking up to the monitor.

A steady hum fills the room as the monitor shows a flat line across its screen.

Everyone looks at each other, adrenaline rushing through their bodies, waiting for the next order.

Sighing, Kate shakes her head. Looking down at the man, she frowns. His skin is white, slightly yellow tinged, mouth falling open slightly. His eyes are open, but completely lifeless. Its a strange sight, if you've never seen it before. Unfortunately, Kate had seen it many times.

He’s gone.

“Okay, everyone. We did our best.” Turning, pulling her gloves off and tossing them to the floor, Kate looks up at the clock on the wall above the mans head. “Call it. 18:14.”

No one moves for a moment, as if they are waiting for Kate to change her mind. They know its over, but you cant help but wait just that one more second. As if that one second will change everything, and the patient will sit up and say “Syke! Just kidding.”

The second passed. Slowly, everyone dispersed. Jess joins another nurse at the foot of the bed, reading over the code report she was still writing. That had to be one of the worse jobs in a code. The poor nurse who has to stand there, listening to every single order, word, movement and action in a crisis situation, and write it all down accurately. Then have to track everyone down after the fact to make sure she has their names right. It seems so insignificant given the gravity of the situation. And a big pain in the ass.

Within minutes, the area was cleaned up, the code report completed, and the curtain pulled around the patient. Two float nurses remained, preparing the body for family to come and say their goodbyes.

Sitting down behind the nurses station, Jessica sighed. “It had been such a good day, too” she said, turning to look at Kate who was now filling out her portion of the required documentation.

Kate didn’t look up. “Yeah, well, yesterday was slow too. And the day before. You know we cant have more than two good days. It’s the rule.”

Jess grinned. Although Kate’s face remained sober, Jess new it was her shot at humor.

It was true, though. Like an unspoken rule in an ER. Two slow shifts, equaled one crazy one. That just seemed to be the way it went. Leaning back in her chair, Jess stretched her arms over her head. She remembered a time when they had made it through four straight nights without so much as an angry drunk coming in saying he was going to stab them with their IV needles. But that just made everyone one edge…..they knew it was coming.

And it did. The next night, they were greeted with three codes, two MVCs and six cops in the department bringing in the citys ‘elite’. Jess grinned, remembering she had that night off, but heard the stories. Triage was a mess, with a 11 hour wait and at least sixty seven people waiting for the various areas of the emerg, it had to be one of the worse nights Orlando Generals ER had seen.

Leaning forward again, Jess reached over and pulled out a blank nursing note. Setting it in front of her, she grunted. She really didn’t feel like documenting the incident she just took part in. Looking up and over the nursing station, she saw the medics still looming around. The male medic appeared to be hitting on Sarah, the newest RN in the department. Sarah, however, wasn’t having it. In her polite way, she nodded to his stories, smiled at his obvious come ons, but carried on with her work of closing up the crash cart. Lucky for her, the pager on his hip went off, calling them to another call.

Obviously disgruntled with this, the man gave Sarah one last appreciative smile, before turning to leave. His young partner following behind, rolling her eyes at him while shooting a smile at Sarah.

Turning back to look at Kate, Jess rolled her chair closer to her.

“So how is your day going, hun?” she asked, reaching over Kates paper work to grab her now warm Coke.

Sitting up to stretch her back, Kate looked to Jess “Other than the fact I just let a man die, not bad.”

Jess scowled at her friend “Don’t even start that shit” She scolded. “You cant save everyone, and you know that.”

Kate didn’t respond. A simple shrug is all she gave.

Silence fell on the two friends, each returning to the mountain of paperwork that now greeted them.

Jess had to appreciate Kates determination. She always thought she could save everyone. Deep down, she knew that wasn’t possible. There are some things you just don’t have control over. And especially in an ER, you learn that fast.

The two had met a year earlier than Kate had signed on to the newest MD position at Orlando General Hospitals emergency room. Just like every other ER in the country, they were sorely short staffed, both in nurses and doctors. Every new addition helped, for the most part. There was always those few doctors who seems to slow things down rather than speed up the process. Sometimes Jess just couldn’t figure out what it was that they did all day? How could they go through an 8 hour shift and only see 6 people? Then there were the good ones. The ones everyone loved working with. The ones that when the nursing staff saw their names on the list as the ‘overnight’, they sighed with relief.

Nights tended to be a double edged sword. It was nice because management wasn’t around, so there was more freedom. Coffee runs were done nightly by the clerks, and the volume of patients tended to be a little slower. But it was also hard, because it came down to just one doctor from 2 am until 7 am. One MD for the entire department, which consisted of resuscitation, main, triage and minor treatment. That put a great deal of strain on that one doctor, but also on the nursing staff who had to face the constant questioning from angry patients, wondering when their turn would come. They didn’t seem to understand or care that it was one person for the whole 60 bed ER. They were there for their problem, and their problem alone. And seemingly, that should be enough.

Kate was one of those good ones. One of the ones everyone was glad to see on the work list. Jess had grown close to her when Kate had ended up doing two nights in a row, something that wasn’t usually customary, but being the new kid in town, she wanted to impress and agreed to a shift switch with another doctor. Jess had been on her stretch of nights, and the two enjoyed one slow, and one very busy night respectively.

Between patients, they had talked about their families, friends. Jess was an Orlando girl, born and bred. Kate had gone to UC Berkley, being from the LA area, then taken her PhD at Stanford University. Upon completing her residency, she said she had needed a change, so came to Orlando. She wasn’t overly revealing when asked about her experiences in her residency, but Jess never thought anything of it, sharing her stories of nursing school and the horrible things she had to go through. No one chooses this profession for the glamour, she pointed. There was nothing glamorous about catheters and explosive diarrhea.

Since then, the two had become best friends, spending at least one of their days off together on their stretches off. Their schedules worked differently, but they made time to hang out whenever possible. Kate picked up extra shifts often, making it hard to have any kind of social life, but lucky for her Jess understood, being in the same field and seeing the job first hand.

Jess knew Kate would always be one of the ‘great’ doctors. One of the ones that the patients always requested and remembered. Those were the ones that stuck.

Finishing up her paperwork, Jess collected her forms, notes and charts and piled them to the side. Looking at the clock, she smiled. “Thank god, only 20 minutes left. Time flies when your having fun, eh?”

Kate laughed. “Tell that to Heather,” she stated, referring to one of the nurses currently working in main emerg. “The lady in room 10 is obstructed tighter than Roseanne Barr in a spandex suit, and I just ordered the works. Fleet, colace, everything.” Turning to smile at Jess, she tilted her head. “I think shes mad at me now.”

Jess burst out laughing. “I would be too. I would frigging kill you. But hey, hopefully she doesn’t go until after shift change, then its just a nice little ‘Good Morning’ for the next group.”

The two girls laughed, both knowing it wasn’t really funny to anyone but them. Finishing up with the chart in front of her, Kate stood from the desk.

“This your last shift?” She asked, placing her stethoscope in the pocket of her lab coat. Stretching her arms over her head, Kate yawned.

Her scrubs were wrinkled, her hair a mess, but no one could argue that she was beautiful. She was one of the girls everyone in school figured would be the trophy wife or socialite. When she told them she wanted to be a doctor, they always seemed shocked. Not that she wasn’t smart. Quite the opposite. But coming from the land of the rich and famous, having a father who was one of the top film producers at the time, and a mother who was best known for her spread in a 1970’s Playboy issue, it seemed to everyone else easier for her to just take advantage of what was presented to her.

But Kate knew better. She knew she was attractive. Long brown hair and piercing blue eyes made her stand out easily in a crowd. But she knew looks fade, and she had bigger plans for her life than using aesthetics. She had her goals early on, and worked her ass off to achieve them.

Although her family had money, Kate insisted on paying for medical school on her own. She took out the student loans, worked part time and over the summer. She still had one hell of a debt to pay off, but she didn’t regret anything. She did things her own way, and on her own merit. And she always knew she would be better for it.

Grabbing her pile of papers, she scanned the patients she still had to reassess. “Six people to reassess.” She said, not really directing the statement to anyone in particular. Turning to Jess, she continued. “You think I can just sign them over and go home now?”

Jess laughed. “I don’t think Jim would like that very much” she responded, referring to the doctor schedule to come on following Kate.

Sticking her lip out in a pout, Kate huffed. “Fine.” She said, shoving the papers in her pocket. “No ones a keeper anyways.”

Jess stood, circling around the desk as Kate stepped out the other side and towards to door. “You on tonight?” she asked, glancing at the monitor above bed one that had now began to chime. Looking at the patient, she surveyed quickly. She was fine. A young woman who had taken too many Tylenol. Apparently, three didn’t work fast enough for her, so she thought ten would do it. Must have been one hell of a headache.

She turned back to Kate as she answered.

“Yeah, I took Marianne’s night shift. But then I’m off for three.” Opening the door to resus, Kate glanced back at Jess. “You?”

“Nope,” Jess replied with a happy grin. “Im off for five now.”

“Bitch.” Kate responded, not even trying to keep her voice quiet. “Well, have a good night. Think of me tomorrow night while your being young and reckless.”

“Oh I will. Remember, Im going to the NSync concert tomorrow! So excited, I might pee myself." Jess said with a smile as she gathered up her paperwork. "I still wish you could have come with me. Now I have to go with my fucking cousin who keeps telling me of her plan to tie Lance to a chair and fulfill her wildest fantasies" Jess cringed with the thought of her cousins attacks on Lance. "Think of me while your sewing up some drunk who got in a fight with a neighbours fence”

Laughing, Kate headed down the hall towards the minor treatment area. Calling behind her, she waved over her shoulder. “Oh, Im sure I will have a very interesting night.”

If only she knew just how interesting it would be…..