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and sees the flashing red lights on the screen. “Everything OK, Marie?” She is used to the minor problems that happen during many surgeries and waits to hear the alarm go silent, to know all is under control.
    “It will be. Could you mix up some epinephrine for me?”
    The reassuringly high pitch of her oxygen monitor is starting to drop, and there is more resistance against the breathing bag. I squeeze it with both hands. I trace the tubing—it’s clear; the blockage must be inside Jolene’s airway passages. I put my stethoscope over her back on the right, on the left, and can hear only faint breath sounds, a high-pitched wheeze when she exhales.
    “Mindy, get a suction catheter out of the bottom drawer and hook it up to the vacuum.”
    My voice is steady and calm, but I know she hears a new urgency. I slip the catheter down Jolene’s breathing tube to check for plugs. The tube is open.
    The numbers on the oxygen monitor begin to spiral down. Any reserve is going fast. Jolene is in bronchospasm. Her smaller airways are swelling and tightening, strangling her from the inside. It must be anaphylaxis—a profound allergic reaction, or undiagnosed asthma. But her heart rate should have increased, at least initially.
    My mind separates itself from my body. I enter some hyperfunctioning realm where I race forward in emergency protocols, calling for backup help, telling Stevenson we have to stop the surgery, turn her over.
    He stares at me as if I’ve lost my mind. “She has an open wound on her back. We can’t turn her over.” I hear someone command him to put sterile towels over her back and turn her over now. Now! It is my voice.
    Her heart rate keeps falling, the pitch on the oxygen saturation monitor is in a steep decline. Nurses and technicians pour into the room, but no other anesthesiologists are available. I rip sterile drapes from the operating field, shove my hands under her shoulders and head, tell Stevenson to grab her feet, Mindy to push the epinephrine, give her albuterol, atropine, antihistamine. We logroll her onto the gurney as her monitors plunge in pitch, plunge in heart rate.
    Her skin is white, her lips are dusky. I call out emergency drug doses, order another IV, a defibrillator and arterial line. I place my hands over her sternum for chest compressions—her heart is failing and can’t circulate the drugs that might save her life. I tell Stevenson to squeeze the breathing bag. The pressure monitor bounces off the scale with each breath like a bicycle pump on a tire with a blocked valve. Jolene’s chest compresses easily beneath the heels of my hands, her pulse shows I’m circulating blood. But blood without oxygen is worthless. Her face is gray now, her lips dark blue.
    She is dying. My God, this child is dying. I can feel blood rush into my face, the team watches me, waits for me to pull off a miracle, all of us teeter on the brink of realizing that Jolene has already been starved of oxygen for so long nothing of her former self will survive. A sound buzzes inside my head, and the garish operating lights make my hands glow as they pump up and down on Jolene’s sternum. I don’t know how much time has passed. Ten minutes? An hour? The noise level has dropped from a cacophony of commands to a heavy, weighted silence.
    I feel Stevenson’s hand on my shoulder, a gentle, focused pressure. “Call it, Marie. Call the code off. It’s over.”

4
    There is a roaring in the background, maybe inside my head, as if some cavernous space has cracked open. Everyone in the room—Mindy, Alicia, Bethany, Don—stares in never-intersecting lines of sight. If we look at one another, or speak, or break open the tight circle we stand in, this disaster will become real. It will become irreversible.
    Someone squeezes my hand. Don has grasped it, urging me back into the role I must play, the professional face I need to apply. I look up and clear my throat, try to make my eyes focus. “Thank you. Everyone. I