Bitter Aftertaste

Kevin stood in front of the coffee station, hands resting on the counter, a faint ribbon of steam rising from the chipped coffee mug in his hand. The morning was cold. The kind of cold that settled in bones and reminded a man why he hated winter in the first place, but he barely noticed it. He was used to it. Everyone at the hospital was used to the climate at this point. Hell, the climate was one of the main reasons why the hospital was so damn busy all the time. But again, Kevin didn't mind it, not anymore. He has seen a lot. Almost everyone of his co-workers have. Whether it was traumatic brain injuries from slipping on ice, severe frostbite, cardiac events, car accidents, or even carbon monoxide poisoning, Kevin didn't mind anymore.

Kevin Langdon has been working as an ER nurse at St. Mary Hospital for approximately three years. He had graduated nursing school at twenty-four, and immediately started his career at St. Mary Hospital. Of course, it took him a while to get promoted from resident to a CEN (Certified Emergency Nurse). He still remembers very well all of the mistakes he made as a resident. From misplacing instruments to misplacing patients, Kevin is surprised he even finished his residency.

Kevin sips his coffee, now gone from boiling hot to warm. To be fairly honest, he hates coffee. He has hated coffee his entire life. But he seriously needed it to survive a shift. A grimace appears on Kevin's face, the coffee leaving a bitter aftertaste in his mouth. He's still not used to the taste, he doesn't think he ever will be. But what choice does he have? He has tried energy drinks before. That may seem ironic, especially him being a nurse and being well-informed in the consequences of drinking too many energy drinks. But it didn't help him regardless, so he quit drinking those.

The pager clipped on his scrub pocket suddenly starts beeping, the tiny screen shining a vibrant green color. Kevin glances down at his pager, chugging down the remaining coffee in his cup before throwing it in the trash can and exiting the break room. Emergency at the E.R. It's probably another homeless person with frostbite, he thought. The hospital gets piles of homeless people with frostbite, especially since they just started giving them free resources like blankets and warm clothes due to an increase in budget.

"Kevin, we need you in Trauma Bay five, stat. Patient is alert, anxious, and complaining of severe abdominal pain. Penetrating GSW to RUQ with no exit wound visible. Abdomen rigid, distended, and tender to palpation," My co-worker, (nurse) Jaylen informs me rapidly as we both enter the trauma bay after we put on our personal protective equipment.

"Large, irregular wound with abrasion rim. Tachycardia (130s), hypotensive (90/50 mmHg). Diminished bowel sounds," states my other co-worker in the room, (nurse) Adeline.

I spare her a glance, replying sternly. "Did you apply dressing already?" She responds with a yes, "dressing applied with moderate, dark red blood soakage."

"Good, but she's bleeding a lot. How old is she?"

"Her name's Jade Maddison, thirteen year old girl. No past medical history, first time in the E.R as far as we know."

Kevin inhales sharply, looking down at the girl on the gurney with a thoughtful expression. Okay, breathe, think. First we have to have the hemorrhage under control. We've already done that, what's next? Kevin looks around the room, documenting the staff with him. There's an anesthesiologist, nursing staff, support staff. The anesthesiologist has already secured the airway and provided oxygen. We've already assessed the injuries, now we need to prepare for imaging to locate the bullet and any other internal damage. Kevin looks at Jaylen, his mind working a mile a minute.

"Administer 100% oxygen and assist with intubation or chest tube placement for pneumothorax if needed." Kevin says, immediately looking at Adeline after. "Adeline, please establish two large-bore IVs, initiate fluid resuscitation and monitor vitals every 5 minutes." They both nod and get to work.

Kevin then addresses the radiology technician in the room, Larry. "Please take an x-ray, as well as an CT. We need to see if there's bleeding in her brain, and locate the bullet."

Another nurse, Thomas, continues applying pressure and more dressing to the girl's wound. Kevin assists him, grabbing more gauze as they wait for the x-rays. A few moments later, they come back. Both Thomas and Kevin examine the x-rays provided. The bullet appears as a bright white object against darker soft tissues. "CODE BLUE!" Announces Jaelyn as she pushes the button next to her, "We need a crash cart. now!"

A CCN barges in the room, the crash cart in front of her as she rushes to Kevin's side of the patient. She can't breathe, the oxygen isn't reaching her brain or organs. "Start CPR," Kevin orders Thomas, who hurries to do so. Kevin places a backboard under the patient to ensure the compressions are effective.

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After 26 whole minutes, the staff stops the resuscitation process. Brain cells begin to die within 5 minutes without blood flow and oxygen. Even if the heart was restarted after this window, the damage is catastrophic and permanent. She's gone, Kevin thinks. "Time of death; 20:58." he announces. "You tried your best," Kevin says to Thomas, who's shaking looking down at the little girl laying on the gurney, "we all tried our best. Her wounds were just too severe."

"How could someone do this to a child?" Thomas whispers with a shaky voice, his hands equally trembling with adrenaline.

Nobody responds. Nobody has the heart to. The air smells of metallic blood and antiseptic. The room is physically cluttered with torn packaging, saline bags, and discarded gloves. The silence is jarring. The only sound is the hiss of the oxygen flowmeter being turned off. (nurse) Adeline immediately beings the cleanup. To everyone in this hospital, cleaning the patient's face and straightening the sheets isn't just a task, it's a final act of restoring dignity before the family arrives.

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Half an hour later, after he has helped finish the cleanup process and has informed the family, Kevin finds himself back in the break room, pouring himself another cup of coffee. The fluorescent lights buzz with a harshness that feels personal. His scrubs are damp with sweat. He finally takes a sip of his coffee after staring at the cup for a minute or two. The heat hits his tongue first, followed by that sharp, scorched bitterness. Usually it's the fuel that keeps him going, but tonight, the flavor is different. It's thin and acidic, mirroring the hollow ache in his chest. Every swallow feels heavy, as if he's trying to wash down he silence of the room.

Kevin's mind loops back to the moment he called the time of death. I could have done more, he thinks. He thinks back to the weight of that little girl's hand when he checked for any more wounds, and how his own hands are now doing a subtle yet uncontrollable dance against the cup. The bitterness of the coffee lingers, as it always does. But the moral bitterness of the situation is what truly chokes him. He knows he has to finish the cup, throw on a fresh pair of gloves, and walk back out on the chaos of the E.R. But for these two minutes, the bitterness is the only thing he allows himself to feel.