Nano

CHAPTER 12

It had not been the best morning for Pia. First she had to get up earlier than usual to take George down to the bus station to catch a bus to Denver Airport. She hated saying good-bye in general, especially with the potential for a scene since George had ended up wanting to drag it out, sitting in her car. She’d come to appreciate his visit, especially as it had allowed her to see Berman’s house and make sure he knew she had a boyfriend. But the previous night after they had gotten back from the dinner party and she had warmed up to him and wanted to have sex, he’d proved to be incapable with all the alcohol he had foolishly drunk. So she was glad he was leaving, but then couldn’t get him to get out of the car. She had been eager to get to work, looking forward to asking some of the programmers at Nano about the feasibility of her mechanical solution to the flagellum problem. When George finally did climb out of the VW, Pia had made sure to leave quickly, lest he return to ask her to promise yet again to be better about answering his communications and pressure her into making a commitment to come out to L.A.

As if saying good-bye to George wasn’t enough, Pia’s morning at work had been a disappointment. First she found out that none of the programmers associated with the microbivores project was available, at least until the following day and maybe not even for the rest of the week. Next, Mariel had the same chip on her shoulder that had epitomized her behavior on Monday. Pia had to work closely with her, and that was difficult when Mariel was in one of her passive-aggressive moods.

But the worst event of the morning was the sudden appearance of Berman in an uncharacteristically jovial and expansive mood. To Pia’s chagrin it seemed that the previous evening’s festivities had not dampened his interests in pursuing a social relationship. Pia had hoped to convey the proper message by showing up with a boyfriend, but it was apparently not to be. If anything, Berman had seemed emboldened, even in Mariel’s presence, making Pia wonder exactly what George had said to Whitney Jones during their conversations.

Berman had invited Pia to a festive dinner for the visiting Chinese delegation and maybe even a movie over the following weekend. On both accounts, Pia had begged off, saying she was going to be busy entertaining her houseguest, which, as it turned out, was not the right thing to say. Berman had responded with: “Didn’t he take an early flight to L.A. this morning?”

Pia had tried to cover her tracks as best she could. Berman had actually helped by finding enough humor in the situation to laugh. “You’ll have to come up with something better than that. And factor this into your thinking: I promise no repeat of my boorish behavior before my China trip. Scout’s honor.” He’d held up his three middle fingers in the form of a scout salute as convincing proof of his sincerity. “You don’t have to respond immediately,” he had added. “Think it over. I’d just like to show some appreciation for your contribution here at Nano. No strings attached.”

Pia had sheepishly agreed to think about the invitations but felt foolish not to have guessed that George couldn’t be trusted not to blab when he had too much to drink.

When noon had rolled around and Pia was able to clear her lab bench, she was relieved to leave and go out for a run. This was part of the new Pia, the Pia who had begun to embrace exercise and outdoor pursuits, as advocated by the company’s healthy-lifestyle policy. If employees exercised and didn’t smoke there was a significantly lower premium on health insurance.

As often as Pia was able, and weather permitting, she would change into her company running gear, most of it emblazoned with the Nano logo, and head out for an hour or so in the middle of the day. As a creature of habit, she always took the same unpaved public road up the mountain and away from the Nano complex.

Running helped Pia center herself. On this particular day she maintained a steady metronomic pace and focused on the physical acts of running and breathing. Her work, and the distinct and different social problems that Berman and George presented her, were forced to the back of her mind. Breathing in the crisp mountain air, she pushed herself to greater effort, reveling in the sensations coming from her quadriceps, hamstrings, and calves. The sun was out and felt strong against her face in the 5,000-foot-plus elevation.

The run was going particularly well, and Pia checked the running app on her iPhone, which was strapped to her upper right arm. The GPS was on, and the app marked her progress on the route, keeping logs of times and distances. As she passed a distinctive weathered pine tree, she saw that she was making great time. The activity calmed her. It was as if she didn’t have a care in the world.

Then, ahead of her in the road, she saw a male figure lying facedown, legs straight and arms stuck out to the side, as if he had been crucified and tipped off the cross and onto the ground. He didn’t seem to be moving, and Pia’s pulse, which had been holding steady at a moderate rate, suddenly picked up speed. Her intuition told her the man was in trouble, and her first thought was whether she was up to lending a hand. She’d been through medical school, but as far as emergency medicine was concerned, her training only made her aware of what she didn’t know. How to actually be a doctor was learned in residency training, which Pia had yet to do. She knew all too well that there was a reason a trainee could not get a license to practice medicine until after some level of graduate medical education had been achieved.

Controlling her anxieties as best she could, Pia ran up and knelt beside the stricken individual, who was dressed in the same running gear she was. He was Asian. Quickly determining the man was seemingly not breathing and had no apparent pulse at the wrist, Pia maneuvered him over onto his back. She shook him forcibly, trying to rouse him. Leaning over him, she put her ear close to his mouth. Now she was certain. The man was not breathing! His mouth was partially open, and along his lips she saw a bit of foam, making her wonder if he’d had a seizure.

Wasting no time, as she knew time was critical, she again felt for a pulse and found none. With the flat of her hand she pounded the man’s chest several times. She had remembered that maneuver from a lecture. What she couldn’t remember was why it was done, but she did it anyway. She then reached for her phone to dial 911 in hopes of summoning help. Thanks to the GPS device in her phone, she could give very precise details of where she was located, which she did rapidly after telling the operator she’d come upon an unresponsive man who wasn’t breathing and had no pulse. Her final comment was that she had no idea how long the man had been lying next to the road.

After being reassured that an EMT vehicle was being dispatched, Pia started administering CPR. Her first priority was thirty chest compressions, using the heels of her intertwined hands. At least she could remember the outlines of the procedure. While she was doing it, she made certain that she was getting at least two inches of chest compression. It was not difficult. The man was lanky, perhaps in his forties, and seemed in good shape and hence was supple. The rationale she knew was to propel blood through the one-way valves of his heart and out into his system to keep the man’s brain alive until his heart could be restarted with a defibrillator.

After thirty compressions, Pia stopped. Quickly she pinched the man’s nose closed, fought successfully against her reluctance to seal her mouth over the victim’s, and forced her breath into the man. She saw that his chest rose appropriately. After two good breaths she returned to the chest compressions. Following thirty more, she broke off again to repeat the breathing. Before doing so, she quickly tried for a pulse at the man’s wrist. Unsuccessful at feeling a pulse, she pushed up the man’s sweatshirt sleeve on his right arm to check for a pulse in his ante cubicle fossa — his elbow. What she saw surprised her: the man was tattooed on his forearm with a series of numbers, reminding Pia of concentration camp victims of the Nazis. She tabled the thought and moved on quickly.

To her surprise, at the elbow she thought she felt a pulse. Encouraged, she then felt for the man’s carotid artery. Here there was a definite pulse! It was rapid and faint but definite, a good sign, provided the circulation was adequate to get oxygen to the brain. With her hand on his neck she noticed something else: the man’s skin seemed hot, but there was no perspiration on his forehead. The thought went through her mind that he might have been suffering from heat stroke despite the cool outdoor temperature.

Pia was confused by the conflicting range of symptoms. In addition to his problematic cardiac status, she saw what looked like urticaria, or hives, on his forearm. It was also apparent that he had vomited, because there was some vomitus on the ground next to him. And there was that foaming at the mouth she’d noticed initially. Pia worried that despite the thready pulse, the man might be about to die of shock, possibly septic shock, with his elevated temperature.

Pia again leaned over to recommence the breathing part of the CPR and suddenly felt resistance when she tried to blow into the man’s lungs. To her astonishment, the man spontaneously started breathing. He even coughed. Pia checked the pulse at the wrist. It was stronger. Then the man quickly woke up.

As if waking from a slumber, he gazed up at Pia with obvious surprise and gripped her by the arm, shaking her as if shocked she was there, and wanted to make sure she was real. He spoke quickly and excitedly in what Pia took to be Chinese. The man then pulled on Pia’s arm in an attempt to sit up, but only managed halfway before falling back. Pia was transfixed, as if she were confronting a ghost. It had been such a sharp recovery: one minute the man was dead, as far as she was able to determine; the next he was very much alive. His eyes were darting around. He seemed terrified.

“It’s all right,” Pia said, trying to calm him. She checked her watch, wondering just how long the man had been without breathing and heart action. She also worried when the EMTs would arrive, hoping they were close by.

The runner again tried to get up. When he again faltered, he spoke quickly — what was he trying to say? The two of them had no language in common, but Pia could tell by the man’s face that his terror was mounting, not lessening.

“It’s okay,” Pia repeated. “It’s okay. An ambulance is coming. Just try to lie still.” She knew it was common for people who’d just suffered a medical crisis to be anxious, but this was different. The man was trying to get up and leave. Who was he afraid would find him?

Pia’s fear was that the man would lapse back into cardiopulmonary arrest, as nothing had been done to alleviate what had caused his heart and breathing to stop in the first place. Yet the man seemed to become more alert as the few minutes passed. When the man heard the wail of the approaching ambulance’s sirens he looked even more scared, and started shaking his head. “No, no,” he said to Pia. They were his first English words. “Please.” He sat up, and this time didn’t fall back.

“It’s okay,” Pia repeated calmly while keeping her hand on the man’s shoulder. “It’s okay. It’s okay. You’ll be safe.”

The ambulance and a Boulder Police car came to a screeching halt, and two EMTs and a police officer hurried to the downed runner’s side. It was clear they were surprised to see the victim sitting up with his eyes darting about.

“I’m a doctor,” Pia announced hastily. “Maybe not a practicing doctor, but a doctor, nonetheless. I was running and I found him collapsed on the road, not breathing, and he had no pulse. I did CPR and got a thready pulse. Then he suddenly woke up. I thought he’d be in shock, but he suddenly seems pretty normal.”

The runner was clearly more agitated with the arrival of the policeman and the EMTs. He was talking loudly, gesticulating madly, and struggling to get to his feet. Pia kept her hand on his shoulder to keep him in a sitting position.

“Hey, sir, take it easy. What’s your problem?” said one of the EMTs.

“He doesn’t seem to speak much English, if any,” said Pia. “He’s very agitated.”

“I can see that,” said the EMT. “We can’t take him to the hospital if he doesn’t want to go. I mean, he looks normal.”

“He has to go. He wasn’t breathing for I don’t know how long. We have to check his brain function and try to figure out why his heart stopped. I’m telling you, when I first got here the man was dead as far as I could tell.”

“Bill’s right,” said the police officer, indicating the EMT. “If he refuses treatment…”

“I think he works at the same company as I do, Nano. You’ve heard of Nano, no doubt.”

“Obviously,” the policeman said.

“He’s wearing the same jogging clothes as I am, as you can see. We’re all given this equipment as employees of Nano.”

The EMT named Bill stepped forward with a blood-pressure cuff, but the runner yelled at him and tried to pull away from Pia’s grasp.

“We’re trying to help,” Pia said to the man. “We have to take you to the hospital.”

Pia had been kneeling by the man’s side and now stood up. With Pia’s restraining hand gone, the runner tried to stand, but his knees gave way. Some of the fight went out of him.

“I’ll come with you,” said Pia to the man, indicating herself and pointing to the ambulance and making driving motions. She pointed to the Nano logo on her sweatshirt and then to the one on his. It was the best she could do. The man nodded, as if comprehending. The EMTs then tried to get him onto the collapsed gurney, but the man refused. Instead they helped him first to his feet, something he insisted on, and then into the back of the ambulance. Inside the ambulance they secured him to the gurney. At that point he was no longer resisting, but Pia could see that the fear remained in his eyes. When one of the EMTs jumped out to get in the driver’s seat, Pia climbed in the back.

As the ambulance started and headed back down the mountain, Pia could see that the patient, although calmer than earlier, was still agitated. She wondered what he was so afraid of. She also wondered, if he worked at Nano, which wasn’t a given, what department he worked for. He didn’t look much like a scientist, but what did she know? Since he apparently could only speak a couple of words of English, he seemed like a stranger in a strange land. To try to calm him, she grasped his hand. He seemed grateful. He squeezed hers in return.