Annie

AUDIO: Listen to the author read Annie aloud.

{mp3 width="100" height="50"}Kathy{/mp3}

Editor's note: Kathy McCue is an emergency physician in Anchorage. Some shifts are tougher than others, such as this last night with one of her then-most frequent visitors.

"Annie, you gotta stop drinking, girl!" choruses rang out. "You might have really done it this time."

"How long's this gonna take? You wanna put a tube...down my nose?" The tube drains 700cc of red blood and clot from her stomach in less than five minutes. Twenty minutes later two liters of blood nearly overflow the suction canister.  The fire truck had to hose down the sidewalk where they found her.

Annie has esophageal varices, engorged veins caused by cirrhosis. They ruptured and bled. She retches around the tube and clots fill the bed next to her while I sew down the central venous line and start the forced infusion of packed red blood cells and warm saline. She retches again, and I tell her we need to secure her airway so she won't drown in her own blood.

"We love you, Annie. We are your family. We're going to do everything we can to help you. You're surrounded by all of us who love you."

"Are you ready?"

She nods yes and looks defeated.

I call for the etomidate and succs, and 20 seconds later she is intubated. It's a strange relief when finally the patient can no longer talk to you or move voluntarily. The emotional part is gone, and now the real life-saving can begin.

Dr. Richards tells me Annie was quite the head-turner in Barrow, where he was her family physician. All the boys wanted to take her out, all the girls wanted to be in her gang.  That's where they gave her the first drink. That's where they stole her confidence.  She came to Anchorage with a new son and few ideas.

Anchorage life has been a challenge to say the least. Thirty days in, thirty days out. Isaac's got a room and a bottle at the Mush Inn if you can get there before he passes out. The Dumpster's dry on nights like these. Fifty-six rape exams in eight years. Assault with a deadly weapon and six wintery months at Hiland, all for beating the shit out of that old man who shared his bottle and thought he could have her too.

I have seen her in the ER nearly every shift for the last five years.  When no one had seen Annie for a few days, we called around to the shelters, to police dispatch, to the other hospitals just to make sure she was still alive. We worried when she wasn't around.

Annie told us she was going to die every single day for the last six months. She didn't tell us she was going to die today.

The blood bank brings two more units of O negative. Six units of fresh frozen plasma are thawing on the counter. There must be twenty people helping. Textbook pages flash before my eyes. I can't just watch her die. Not Annie, she lived too hard to die like this.

Central supply has a Slengstaken-Blakemore Tube. Old-school. Like a case of measles, few in my generation have even seen one. An ICU nurse in his 60s arrives and schools the younger crowd. I slide the tube down her throat, and he inflates the balloon, putting pressure on the bleeders in the esophagus. The bleeding slows. Less than 200cc in the last 15 minutes.

The endoscopist is coming from home. Call for more blood. Get her up to the ICU.  Touch her, and she'll know we're here.