Takes place in the interim between the hallway and where we next see Sam in the infirmary. Always wondered how the heck they revived her after two zat blasts and decided to figure it out. Thanks for reading!
The sound of the first zat blast ran through me like ice as I raced down the hall. It shook me that Colonel O'Neill had actually taken the shot, but the entity had left him no choice. He had to keep it in the confines of the SGC. Had it gotten out, its power would have made even the most damaging of computer viruses seem like child's play.
I rounded the corner in time to see Colonel O'Neill fire the second shot and Sam hit the floor.
In retrospect, I had only two emotions running through me as I watched her drop. I was shocked, and I was angry that it had all come down to this. The shock came from the moment. The anger had been there from the second the entity had taken control of Sam. All of us stood there in stunned silence, if only for a few seconds until I found myself instinctively moving toward her amid the surreal circumstance.
Sam lay on her side, and I gently rolled her on to her back as my hand reached for a pulse. I found none. I checked again, pressing two fingers where her carotid artery had been pulsing with life just seconds ago. Still, there was nothing – no pulse, respiration.
I looked up at the rest of them as they stood there, waiting for me to report. I looked at Daniel.
"Call a code and get a medical team here now!"
Daniel complied, moving quickly to sound the alarm around the corner.
I turned my attention toward Sam, pulling her limp arm to the side. I have a habit of talking a code through in my mind. It keeps me focused when every second counts. There is no room for distraction.
Locate the vee of the sternum, two fingers up, heel of hand, one on top of the other, and begin compressions. I began counting as I pushed down on her heart muscle.
"One," I count quietly aloud. In the silence of my mind, I finish with, alligator.
It may seem childish and maybe even stupid, as I sit here and reflect on it all, but saying that word is my way of keeping calm and pacing my treatment plan.
"Two," I said, pressing down once more, elbows locked. Alligator.
I heard Daniel's voice over the base intercom system calling for the medical team, the people I have come to know and trust and who perform above expectation during a crisis. It gave me comfort to know they were on the way. Even unit commanders take respite in being part of a team and not just being the lead dog.
"Three." Alligator. Another push.
My mind raced ahead with treatment options, but my common sense was roaring in my ears – two zat blasts were fatal and final.
I continued the compressions until I reached eight. Then I moved to Sam's head to give two deep breaths. The penetrating smell of ozone stung deep in my sinuses. I have smelled it before, at one time reveling in its meaning that a storm was approaching. Now, it signified yet another kind of storm, one that had unleashed the power of lightning from a small Goa'uld weapon.
I breathed for her a second time and it was back to compressions. I went through the cycle three more times. I was ready to change positions when Teal'c knelt down, ambu-bag in hand. There was a small medical locker somewhere nearby, but hell if I could remember where it was. He placed the mask over her face and squeezed the bag, forcing air into Sam's lungs.
I was grateful for the help. I could hear my team responding, the clatter of their steps clanking off the walls of the base tunnels. I reduced the compressions to five now that Teal'c was assisting.
"Five. Breathe," I said, watching him squeeze the bag again. I'm not sure who taught him to do what he was doing. Maybe it was Sam, which would have made the whole ordeal ironic. She had trained a jaffa to help save her life instead of taking it. Perhaps he had come to learn the process from seeing it all too often in the SGC when the outside universe threatened and infiltrated.
The response team rounded the corner as I again began compressions. They put their kits down around us, opening the boxes to get at supplies.
"She's in full arrest. Start a glucose IV and push an amp of epi," I said, continuing to press down with my tiring hands.
I continued working with Teal'c until the intravenous line was established and the epinephrine had been administered. My pace was quickening, the alligator mantra dying off as the battle began to turn for the worse.
Charles Hanson, an EMT with my response unit, placed cardiac leads on Sam. He worked around me, skillfully cutting open enough of the hospital garb of his newly acquired patient to place the discs. Once the leads were in place, I held up on the compressions, looking to the monitor's readout with anticipation. The flat line on the readout confirmed my worst fears.
To use the defibrillator at that point would have been useless. In order for a heart to be restarted by an electrical shock, it has to be in a state of movement – "fibrillation", as we like to call it in the crisis biz. The zat gun, unfortunately, got the last word with the entity and Sam's physiology. It worked as advertised, effectively killing her with the second shot.
"No pulse," I said, as a matter of confirmation with Hanson. I saw Sylvia Wainwright, the head nurse from the day shift, across from me. She had been the one to start the IV.
"Get a gurney over here," I said to her, starting compressions again.
"Already here," she answered.
At my command, two EMTs brought it forward, pushing away the straps and removing the pillow from the headboard. They lowered it to floor level.
"Hanson, take over for Teal'c. Let's get her on the gurney."
It almost looked like a ballet the way my team moved. Teal'c relinquished control of the ambu-bag to Hanson, and the other EMTs took up position around Sam. At the count of three, they lifted her limp body and placed it on the gurney.
I took a position on the gurney, as well, in order to continue CPR without interruption on the way to the infirmary. I'd done this before, desperately trying to keep Samantha Carter alive as I felt the seconds tick by. There is no feeling like knowing time is running out to do the right thing in order to save a patient's life. It's even worse when you are trying to save a friend.
The gurney was elevated. I felt and heard the struts lock into place. We began to move quickly through the halls toward the treatment area.
"Sylvia, when we get there, I want an intubation tray and another amp of epi."
"Right away," she acknowledged, pushing the cart through the corridor.
Like a bad dream that had come back to haunt me, we entered the trauma room at almost a full sprint. My hands felt bruised from my efforts to keep blood circulating through my patient's body. I found somewhat of a respite when I hopped down to the floor so Sam could be transferred to a treatment bed.
Hanson stepped in to take over compressions. We had all drilled enough as a team that they were more than capable of anticipating what I wanted and needed in an emergency. They worked as I had trained them, to do the job and stay the course no matter who was the object of their work. I was never so glad to have them around me, doing what they did best.
Sylvia ordered another nurse to get the intubation tray while pushing the next amp of epinephrine into the IV. I took the moment to pull on gloves. The tray was brought to my side, clanking slightly as it was brought to a stop.
I picked up the laryngoscope, watched as Sylvia brought Sam's head into position. I began inserting the scope when the tremble in my hands was suddenly on display for all there.
Sylvia looked at me, concerned.
"You okay?" she asked quietly, no trace of condescension in her tone. She realized that trauma cases involving members of the SGC were personal for me. Those involving SG1 border on a conflict of interest, they were so like family to me.
"I'm fine," I lied. "Get an EEG set up. I want ABGs, STAT."
The reading from the arterial blood gas test was essential. Zat blasts caused everything in the body to shut down, including oxygen exchange in the lungs. For all I knew, we had been spitting into the wind for the last seven minutes if Sam's lungs refused to work. There was no telling the extent of brain damage caused by the shots or by whatever it was that the entity had been trying to do in the hall. Her previous EEGs had shown an entirely different pattern, one that told us the entity had occupied her brain and had put her normal readings – Sam's very being – on the back burner. To that end, it was an assumption on my part as to what actually happened. I do know, though, that it was a better educated guess than any other emergency physician on the planet could have given.
I willed myself to get a grip on my emotions as I pushed on her jaw and slid the scope in place. The endotracheal tube was placed in my hand without my asking. I inserted it, visualizing the vocal chords and aiming it into the airway. I finished the procedure and attached the bag quickly, giving the job of ventilation to Sylvia.
I told Hanson to stop compressions so I could check the monitor. The ominous flat line sailed across the screen, surrounded by red critical warnings.
"Resume compressions," I said. "Give an amp of sodium bicarb."
Again, time seemed to step its passing up a notch. I fought against the panic that was beginning to bloom in me. My mind raced through the different drug therapies we could try if our first efforts failed.
I was handed the ABG report, and I found hope in that her oxygen level was at eighty-eight percent. It certainly was not an optimal level, but it meant that her body had not shut down completely. There was a chance that we might succeed in reviving her.
I reached for my pen light, the bane of Jack O'Neill's visits to the infirmary. I checked Sam's pupils, careful to avoid disturbing the ET tube. The pupils were fixed and dilated – lifeless and unresponsive.
I straightened. "Hold compressions," I said.
We all looked at the monitor expectantly. A flash of excitement flew through me as I saw the weak signs of a struggling cardiac muscle trying to start once more.
"She's in a-fib," I told them, trying to control my voice. "Let's shock her."
Hanson stopped compressions. Chad Ramos, another member of the team, took a pair of utility scissors and cut open the rest of Sam's hospital shirt, exposing her to the rest of the room. I realize that modesty goes out the window in a crisis, but I felt like she had been put on public display in front of a general, a colonel, and her team – her friends. Hell, there were probably SFs there, but I was not of a mind to take an inventory. Still, I found myself taking an intentional position to block their line of sight to her. If she survived, which I knew might be a long shot, I wanted her dignity intact. If she died, I did not want that view being how her friends remembered her.
Ramos laid down conductor pads on Sam's chest, in the anterior and lateral positions. The orange plastic contacts prevent the skin from burning as the defibrillator delivers its electrical charge to the body.
"Charge to two-hundred," I said.
The high-pitched whine of the defibrillator pierced my senses as Ramos charged the machine.
"Clear," I said with authority, feeling my anger rising because Death was trying to win again. Death will always win over the human body at some point, but doctors are trained to fight the inevitable outcome.
I pressed the trigger on the paddles. The flow of electricity shot into her body, causing it to tense sharply, pushing the paddles into my hands. My arms were steady in anticipation of the reaction. I looked to the monitor expectantly.
There was no conversion, just the faint ripple of her struggling heart shown on the readout. Sylvia pushed two more respirations.
"Let's go again at two-hundred," I said. Again, the machine whined its charge. "Clear."
I shocked her, bracing against the rebelling muscles in her body. The gurney groaned at the disturbance. Sam's arm lolled off the side of the bed, listless and dead.
I looked at Hanson, prepared to have him begin compressions again when I realized his face was shiny with sweat.
"I'll take over," I told him, handing off the paddles and taking position.
I began pushing down again with a steady rhythm, my determination to start Sam's heart becoming strong. I glanced at the clock. Twelve minutes had passed since the ordeal began. What we were doing simply was not bringing Sam over the barrier into a steady response.
"Come on, Sam," I said quietly. "Don't give up."
I looked at Ramos. "Push another epi and charge to three-hundred."
He did as I asked, administering yet another dose of epinephrine. The defibrillator whined again as he charged it. When it was ready, I reached for the paddles, placing them. I was aware that I was bordering on bringing back someone who would be damaged beyond repair if I succeeded, but my instincts told me to try.
I shocked again, and waited. We looked at the monitor. Finally, we were rewarded with a steady sinus rhythm, where the heart beat normally and strong. I stood there for a moment, feeling shaky, waiting for the dips and spikes on the readout to fail, but they remained. I handed off the paddles and checked Sam's pupils again. There was no reaction.
"Get me that EEG," I said to no one in particular, the despair creeping into my voice. I pulled a sheet up to cover Sam now that she seemed stable.
For the first time, I looked behind me, knowing that SG1 and General Hammond would be watching. Jack O'Neill was the first face I focused on. As soon as I did, I wished I hadn't. He was pale and in shock, and he had every right to be. He had caused this. He had no choice. He stepped forward for me to report. Unfortunately, I had nothing to say. Until the EEG was done, I would have no answer except to say that she was alive.
"Give it a minute, Colonel. Let me see what's going on," I said, warding off his unspoken questions.
I turned toward the gurney again to find the EEG being set up with its multiple leads. The second the readings began to appear, my heart dropped. There were none. Sylvia gave a furtive glance my way, but I did not acknowledge it. I didn't want to acknowledge what we all knew – Sam had crossed over to brain death.
I could feel Colonel O'Neill approach from behind.
"Doc?" he said tentatively.
I faced him. "We're doing everything we can, Colonel."
"Doc?" he insisted, not going for my dodge.
I hesitated but told the truth. "We're running tests, but it's not looking good."
Thankfully, General Hammond put a hand on O'Neill's shoulder.
"Colonel, let them work. I need statements from you, Doctor Jackson and Teal'c."
Jack protested. "Permission to stay, sir?"
The general was sympathetic but firm. "Jack, let them do their work. Doctor Fraiser will report when she has answers."
When a general subtly commands a room to clear, the order is heeded. Somehow, I think he knew then what the prognosis was. I like to think he was giving me time to get my bearings, which were blown to hell at that point.
Later, after we had settled Sam back in the isolation room for security reasons, I made my way to Hammond's office to give my official report. He closed the door as I took a seat. My feet ached when I sat. I realized then how long I had been standing.
"Report, Doctor," he said, taking his seat at the desk.
I had no idea how to say it or where to begin. Saying that someone was simply dead was not kind, though it was the truth.
"We've done everything we can, sir."
"What are her chances of recovery?"
He wasn't catching my drift, and that made it all the harder.
"There are no chances, General. The EEG was negative for activity," I said, hardly believing I was uttering the words.
Hammond looked stunned. He sat back in his chair and ran a hand over his face. "No hope at all?"
"No, sir," I said, bringing on with brute force my professional physician's control. I had vowed I would talk to them, the members of the SGC who asked, like a disassociated participant. That way, I could stay focused on the task at hand, whatever remained of it.
"Have you told Jack yet?"
"No, sir. I need to take care of some things before I talk to him. He's with her now."
Hammond issued a heavy sigh, his bewildered yet resigned persona in command. "Do what you have to, Doctor."
I rose from the chair and headed straight for my office. There was only one more thing I really had to do, one more answer I needed. I already knew what the answer was, but I made it a formality to confirm it. Truthfully, it was a chance to steel myself for what was to come.
It has been almost four hours since we worked on Sam. Her medical file sits in front of me. I carefully read the living will that has been placed in the folder. It reads "no extraordinary means". I know in my heart that I did the right thing in trying to bring her back, but now we are defying her last wishes that she not be kept alive on life support.
Jack O'Neill, I know, sits at her bedside right now. If there is anyone I need to confront about this last step of Sam's life journey, it is he. Rightfully, he will be the first to know and the last to say goodbye, if I know his ways. I dare not think about what the future holds, because I honestly cannot imagine it right now.
I close the folder, concealing the will from my sight. I have to go tell Jack that Sam is gone, that there is truly nothing more to be done to bring her back to us. I am so tired, but I have now reached the last leg of the journey as her doctor and friend. I will find time to grieve, just not now. I don't have the luxury of grief when I lose the battle. Detachment is my only defense against the sometimes-overwhelming sorrow that I know will come later. I know what awaits me in the small hours of the morning, when the darkness outside matches the blackness of my emotions. The stillness of the night air will become my companion when I cannot sleep for the memories and second-guessing that I will do when I replay these events in my mind.
I leave my office and take the elevator down a floor. My weariness suddenly overcomes me, and I lean against the car wall. In my career, no medical review board green light has ever salved my sense of loss when a patient dies. It certainly will not comfort me when my sleep is restless and disturbed by memories. Most of all, it will not convince me that I did everything in my power to save the life of my patient – my friend.