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again," said Val. "Eighty�"
    "Doc, she's in V-tach!" one of the EMT's cut in.
    Toby's gaze shot to the monitor. The rhythm had deteriorated to the jagged pattern of ventricular tachycardia. The heart was using only two of its four chambers now, beating too fast to be efficient.
    "Defibrillator pads!" snapped Toby. "We'll go with three hundred joules."
    Maudeen hit the charge button on the defibrillator. The needle climbed to three hundred watt-seconds.
    Toby slapped two pads on the patient's chest. Coated with gel, the pads ensured electrical contact with the skin. She positioned the paddles.
    "Back!" she said, and squeezed the discharge button.
    The patient thrashed, all her muscles jerking simultaneously as the current shot through her body.
    Toby glanced at the monitor. "Okay, we're back in sinus�"
    "No pulse. I've got no pulse," said Val.
    "Resume CPR!" said Toby. "Hand me another syringe."
    Even as she opened the packet and twisted on the pericardiocentesis needle, Toby knew they were losing the fight. She could suction out liters of blood, but more would accumulate, compressing the heart. Just keep her alive until the surgeon gets here, thought Toby, and the words became her mantra. Keep her alive. Keep her alive . . .
    "Back in V-Tach!" said Val.
    "Charge to three hundred. Get a lidocaine bolus in�" The wall phone rang. Maudeen answered it. A moment later she called out, "Morty's having trouble crossmatching that blood I sent up!
    The patient's B negative!"
    Shit. What else can go wrong? Toby slapped the paddles on the chest.
    "Everyone back!"
    Again the woman's body jerked. Again the rhythm settled back into rapid sinus.
    "Getting a pulse," said Val.
    "Push that lidocaine now. Where's our fresh frozen plasma?"
    "Morty's working on it," said Maudeen.
    Toby glanced at the clock. They'd been coding the patient for nearly twenty minutes. It seemed like hours. Surrounded by chaos, with the phone ringing and everyone talking at once, she felt a sudden flash of disorientation. Inside the gloves, her hands were sweating, and the rubber was clammy against her skin. The crisis was spiralling out of her control....
    Control was the word Toby lived by. She strove to keep her life in order, her ERin order. Now this code was falling apart under her command, and there was nothing she could do to salvage it. She wasn't trained to crack a chest, to sew up a ruptured ventricle.
    She looked at the woman's face. It was mottled, the flabby jowls deepening to purple. Even as she watched, she knew the brain cells were starving. Dying.
    The ambulance driver, exhausted from chest compressions, switched places with his fellow EMT. A fresh pair of hands began pumping.
    On the monitor, the heart tracing deteriorated to a jaggedly chaotic line. Ventricular fibrillation. A fatal rhythm.
    The team responded with the usual strategies. More boluses of antiarrhythmics. Lidocaine. Bretylium. Higher and higher jolts from the paddlles. In desperation Toby withdrew another fifty cc's of blood from the pericardium.
    The heart tracing flattened out to a meandering line.
    Toby glanced around at the other faces. They all knew it was over.
    "All right." Toby released a deep breath, and her voice sounded chillingly calm. "Let's call it. What time?"
    "Six-eleven," said Maudeen.
    We kept her going forty-five minutes, thought Toby. That's the best we could do. The best anyone could do.
    The EMT stepped back. So did everyone else. It was almost a reflex, that physical retreat, those few seconds of respectful silence.
    The door banged open and Dr. Carey, the thoracic surgeon, made his usual dramatic entrance. "Where's the tamponade?" he snapped.
    "She just expired," said Toby.
    "What? Didn't you stabilize her?"
    "We tried. We couldn't keep her going."
    "Well, how long did you code her?"
    "Believe me," said Toby. "It was long enough." She pushed past him and walked out of the room.
    At the nurses' desk she sat down to gather her thoughts for a moment before