Who Desires Us Ill

On this particular elevator ride, suspended between the hours of night and morning, and carrying persons caught between hope and fear, development and decline, and, now, between floors, there was waged a struggle between life and death and, most abruptly, between the instincts of conscience and self-preservation.

God, he thought who would have thought that on this night, in this elevator, and with this patient, Hunter would be left to address a dilemma of such complex dimensions, and with such unfettered freedom of choice?

As he compressed Lyle's chest, his eyes scanned the resuscitation kit upon which the defibrillator sat, looking for an oxygen mask and ambu bag with which he could deliver artificial respirations.

His jaw slackened when he realized that they weren't there! After fifteen quick chest compressions, he frantically rummaged through the equipment. How could these items have been absent from the kit? He knew what he must now do: Perform mouth-to-mouth respirations.

Ordinarily, he would have begun the respirations with absolutely no hesitation. However, this situation was certainly not ordinary and, in the interval of a few seconds, the doctor's mind was flooded with extraordinary considerations and arguments.

He reminded himself of how the official position of the United States Centers for Disease Control was that there was very little, if any risk of contracting Human Immunodeficiency Virus from oral secretions, but he knew that most medical professionals placed little trust in that credo. How could he place his lips upon this patient's mouth, and take that risk? Besides, if Fortuny died here and now as a result of this cardiac arrest, Hunter could subsequently state that he had given him vigorous CPR, including mouth-to-mouth respirations, and nobody would ever know that he had not actually performed the respirations. In that brief moment, Hunter's survival instincts produced in his gut several justifications for not delivering the breaths.

These rationalizations ranged from the thought that he wasn't only protecting himself, but also his young family who depended upon him and his health, to the excuse that, by not resuscitating Lyle, he would be sparing this patient from the suffering inherent in a slow and agonizing death from AIDS-related infections. He could create the pretense in his own mind that he was actually doing Lyle a favor by allowing him to die quickly and avoid future suffering.

However, Hunter's conscience firmly asserted to him that this was not his choice to make. Lyle had clearly told him that he did not want to die yet. "But," his ego argued, "nobody else would know."

"Oh, yes!" his conscience screamed back, "I will know, your God will know, and the souls of all those who have gone before will know!"

The arguments were overwhelming, and the need to act quickly if adequate brain oxygenation was to be maintained was pressing. Instincts battled instincts within fractions of seconds in that small, lonely, immobilized elevator.

And inevitably the strongest instincts prevailed. The next conscious thought in the doctor's mind was his displeasure with the repugnant taste of the opportunistic yeast which was abundant in the mouth of Lyle Fortuny as he breathed air into, and sustained the life of his patient.

Hunter's actions at this point were more the result of instinct than thought and reason. Prolonged CPR, the administration of multiple rounds of intravenous epinephrine and bicarbonate, and repeated attempts at defibrillation over a period of nearly thirty minutes.

After the eleventh shock, cardioversion was successful, and Lyle's rhythm normalized and his blood pressure stabilized. He remained so lethargic that he was not yet breathing adequately on his own, so Hunter continued intermittent mouth-to-mouth respirations.

Finally, the elevator began to hum and whine and with a jerk began to ascend to the eighth floor.