The man in black laughs at me as I compress the baby's chest. His mother found him face down in his crib, unresponsive. I try to ignore the small cold body that I hold in my arms as we get back in the unit.
The man in black laughs at me as I play my flashlight around the body lying in the field. He has been thrown out of the back window of a car, and lies, motionless and broken, in tall grass near the interstate. A beetle crawls across his nose, which I brush off.
The man in black laughs at me as I watch a nursing home CNA do lazy, ineffective compressions on the chest of a resident, her hands splayed across the middle of his chest. She does not lean over the body or press down much. The man's eyes stare vacantly at the ceiling.
The man in black sits in an easy chair across from the patient I am now assessing. His heart is beating 30 times a minute and he is so pale that he looks like a black and white photo of himself.
"You're too late. He's going to die." The man in black is leaning over my shoulder as I fasten the velcro of the cuff around the man's arm.
I can't obtain a blood pressure.
"He's going to die," he says. Smiles. "He's going to die. You can't save him."
I quickly run a twelve lead. No STEMI. We load into the unit. Oxygen is applied. We get enroute to the hospital.
"You're going to miss the IV. He's gonna die. You can't save him."
I stick the IV in his arm. Pace or Drugs? Pace or Drugs?
The man in black sniffs at me with a grin on his face. "You're killing him. Every second you wait you're killing him. He's going to die."
I compromise by slapping the pads on the man and pulling up my atropine.
"A little medicine to help you, sir!" I cinch the line and push in the medicine. The man's heart rate rises to 35, 40,37...stays in between 35-40.
The man in black looks at me sourly. "It doesn't matter. He could be having the big one. He's going to die."
I try again for another pressure and get a systolic of 70. No bottom number.
"You should've gone with pacing!" The man in black is gleeful again. "You've killed him."
Shut up, I think to myself.
I push in another half milligram of atropine.
Slowly, the man's rate picks up. I look at him and see he's gotten some color back in his cheeks. Not today, buddy, I think to myself.
I leave the line wide open and patch the hospital. His rate is now in the 60's and I have a pressure of 100/50. We bring him into the cardiac room, and I walk out, sweaty, tired. But I won. I won it this time.
* * *
I slide the atropine boxes into the trash can and look at the man in black triumphantly.
He stares at me petulantly. "I win in the end!" He says. "I win! I always win in the end."
I give him the finger.
"Maybe so," I say, my voice strong and loud. "Maybe so, dipshit. But not today."