Hypothermia

The short tale of a raging snowstorm, old superstitions, and an eerily quiet hospital.
"Every pair of hands mattered in a medical emergency, each one shaving precious seconds off of the time it took to deliver life-saving care… The room should be alive with people, with information and instructions bouncing off of the tiled floors in a cacophony of controlled chaos.

Instead, she was met with silence.”

Notes:

Hi friends! I wrote and submitted this to the Freeze category of Rusty Fears 6. While it didn't win (congrats to the winners!!) it did earn me an Honorable Mention!
Also apologies to my Do No Harm readers for not updating in a while. The next chapter is in the works, it's just taking some research and also I'm gonna be a whole ass doctor in less than a month (?!?!?!) and shifts + graduation things are kind of a time suck.

Work Text:

The people here knew the cold as well as she did. Even better, in some ways, considering she had only moved to rural Maine twenty-odd years ago. Most of the families she treated had hunkered down against the ice and snow on the same plots of land for generations. The memory of winter’s cruelty was engraved into the very bricks of their homes and the chemistry of their blood - an immeasurable substance produced deep in the marrow of their bones that lived alongside the red cells, white cells, and platelets. It couldn’t be quantified by the samples she drew from her patients’ veins, nor could she hear it with her cold stethoscope pressed against warm skin, but it was there nonetheless. Tales of past hardships and home remedies for hypothermia were passed down from parent to child as easily as family recipes, ranging from utter pseudoscience and legends of frozen specters, to scientifically sound strategies that had kept their lineage alive for over a century.

The latter knowledge was necessary, even in this day and age. While modern medicine could bring someone back from the brink of death, such miracles required proximity, and hers was the only hospital for over an hour in every direction. Factor in the snow and ice that often left rockier roads impassable, and as a result her Emergency Department saw far fewer patients dying of exposure than a city-dweller might expect.

That wasn’t to say that they didn’t happen, of course. Though heart failure, cancer, and infections were by far the most common ailments that brought people to her hospital, just as they were in every other part of the country, she still saw three or four cases of hypothermia every winter. And so Dr. Grace Thatch was only mildly surprised when her pager - that ancient bit of plastic - alerted her to the arrival of one such patient at half past four in the morning. Usually, the device’s screen would be filled with additional details of the patient’s condition, spelled out in the abbreviated jargon that came naturally to her after decades of practicing medicine. Tonight, however, only one word appeared: hypothermia . She spared a glance out of the call room’s window as she hurriedly exchanged her pajamas for scrubs. Snow was coming down far faster than the weatherman had predicted, and through the white haze she could barely make out the dim glow of the streetlamp that illuminated the parking lot. It was a wonder that her mystery patient had managed to get here at all.

Her hospital’s crumbling brick walls created an interior barely large enough to house its twenty-five beds, the vast majority of which lay vacant on any given night. As a result, it took her less than thirty seconds to walk from the call room to the ED at a brisk pace. Though this journey was usually unremarkable, tonight there was a chill that grew more noticeable the farther she strayed from her warm bed. A quick detour as she made her way past the main entrance confirmed that it was closed, but the temperature continued to drop as she made her way to the ring of curtained off beds that formed the ED. Someone must have left the door to the ambulance bay cracked. Sandra, who was the nurse on duty and a temp from Georgia, likely hadn’t closed it properly after returning from her cigarette break. She would need to be reprimanded later, once their new patient had been assessed and stabilized.

The patient in question hadn’t been signed in yet; the dry erase board at the nurse’s station was the same unblemished white of the snow rapidly accumulating outside. A cold mug of coffee told her which computer Sandra had claimed, but there was no open chart or post-it note there to provide her with further information on their new admission. Usually, this would mean that the patient was too ill to be left alone. It was certainly plausible that they were unstable, given what little she knew of them; the more severe cases of hypothermia could present with low blood pressure and oxygen, fluid in the lungs, coma, brain damage, and heartbeats that were abnormal or even absent entirely.

But if their condition was that critical, the ED wouldn’t be so quiet . Every pair of hands mattered in a medical emergency, each one shaving precious seconds off of the time it took to deliver life-saving care. Sandra would have asked the nurses running the floor for assistance. The room should be alive with people, with information and instructions bouncing off of the tiled floors in a cacophony of controlled chaos.

Instead, she was met with silence.

“Sandra?” she called out. Though she spoke at a volume that should have echoed through a full room, much less an empty one, her words sounded uncharacteristically soft.

There was no response.

“Sandra?” she repeated, trying and failing to be louder than before. Her words were strangely muffled by the heavy, unnatural quiet of the room. It was a tense, breathless stillness that reminded her of the distortion that comes with steady snowfall. Grace shivered, though whether it was from this unnerving serenity or the air’s persistent chill she couldn’t be sure. A softer part of her thought fleetingly of taking the time to go close the ambulance bay door, but her conscience wouldn’t allow it. Nearly ninety seconds had elapsed since she’d received the page, and wasting further time on her own comfort would only prolong her patient’s suffering.

She turned to scan the rest of the ED quickly, eyes flitting from one empty cot to another until… there . The curtains around bed six had been pulled shut. Her steps were quick and precise as she crossed the room, and she deliberately ignored the way her sneakers seemed to crunch rather than squeak on the tiles beneath her. She had a job to do. The rest had to wait.

After all of the intrigue surrounding their arrival, finally laying eyes on her new patient felt almost anticlimactic. She was struck by how wholly unprepared they seemed for the storm that raged outside, dressed only in dark trousers and a thin white undershirt. It was no wonder that they’d ended up with hypothermia. Alarm began to prickle along her skin and at the nape of her neck, though it too was colder and more muted than she’d otherwise expect. Her hospital was hours away from Maine’s seaside tourist traps, but no one from her usual patient population was foolish enough to wear this in the middle of a Nor’easter.

The mystery figure’s face was deathly white with blue-tinged lips. Decades worth of instincts kicked in to push aside her unease. Dr. Thatch began to talk to the patient while pulling on a pair of nitrile gloves over fingers that had started to go stiff and numb with the cold. “Can you hear me? Can you tell me your name?” The words came out at a near whisper.

The figure on the bed remained motionless. No shivering; that was a bad sign, as was their unresponsiveness and coloring. Quickly, she pulled out scissors from the breast pocket of her scrubs and cut through their shirt, exposing a swath of pale, mottled skin. She removed her stethoscope from its habitual perch around her neck and pressed its diaphragm just to the right of the patient’s sternum. Their breath sounds were slow and shallow, heartbeat faint and irregular, but at least both were present for now. “You’re in the hospital, I need you to open your eyes. Can you hear me?” Her vocal cords strained in an effort to be heard over the oppressive silence.

No reply.

Christ, where was Sandra? Between their likely respiratory depression and her need to measure their core temperature, this patient had earned themselves an intubation. She needed more hands.

She moved the stethoscope to the left side of the patient’s chest. Both lungs were working, at least. She pressed the emergency call button mounted to the wall to summon one of the nurses.

The most pressing question was whether hypothermia or hypoxia had caused any brain damage. She reached out to perform a sternal rub, needing to gauge their responsiveness to pain -

- and flinched backward when her gloved knuckles made contact with the patient’s bare skin. It was so cold that it burned, like frozen metal, and it seemed to cling to her glove for a moment as she jerked her arm away on reflex. How was this person still alive ?

Bracing herself against the unpleasant sensation did little to quell the near-pain as she searched for a pulse on the patient’s wrist. Their arms were obviously frostbitten, as each limb nearly up to the shoulder was firm to the touch and had turned a telltale shade of blue-gray that would likely blister and blacken once they’d been re-warmed. The radial pulse was completely absent on the left, as she’d unfortunately expected. Starting thrombolysis and blood thinners as soon as possible was their best chance at minimizing amputation.

She began to form a prioritized to-do list, as she continued her hurried exam. Intubation, use that to measure core temperature in the esophagus, then an EKG and vitals. If their blood pressure was soft, start pressors. And then she should…what? Oh, right. Try external rewarming before resorting to more invasive methods. Start an IV, if their arm wasn’t too frozen for the needle. Give… What had she just said? Why couldn’t she remember? After a moment, it came to her: tPA and heparin. Right. After the heparin, they’d need… fluids? Christ, why couldn’t she remember anything? She’d seen upwards of fifty cases of hypothermia throughout her career, this wasn’t new to her. But her thoughts felt foggy, compared to the hot spike of adrenaline that such medical emergencies usually provided.

Dr. Thatch shook off her growing concern. Her own fatigue didn’t matter - this patient was hers to care for, and they were potentially dying in front of her while she dawdled.

As she turned to leave in search of an intubation kit, the still body behind her jerked to life. A frozen hand clutched at her wrist with surprising strength. She spun back around to find her mystery patient fully alert, sitting up, eyes open to reveal pupils blown wide with fear.

“Help me,” they begged, in a broken voice equally as affected by the room’s heavy air as her own.

“It’s okay,” she comforted. “I’m a doctor, you’re in the hospital, I’m here to help you. Can you tell me your name?”

“Help me,” they repeated, breath hitching into a sob. Their grip on her wrist tightened painfully. Every square inch of contact between their skin and hers seared with cold, nerves screaming in sharp agony, desperately warning her to escape from their grasp.

Dr. Thatch fought for her voice to remain calm. “Okay, it’s alright. Just breathe, okay? Let me go and I’ll get some supplies I need to help you.”

The figure released her just as quickly as they’d grabbed her. “I’m sorry, I’m sorry, I’m sorry,” they mumbled, rocking back and forth as they cradled their frostbitten hand to their chest.

She forced out professional reassurances through numb lips. “It’s okay, just stay there, I’ll be right back.”

Once again she turned away, and this time no one stopped her. She stumbled toward the nearest supply closet on sluggish legs. It was freezing in here. By now she was shivering uncontrollably, muscles beginning to ache from the strain. And where the hell was Sandra, or the other nurses who should have come running once she’d hit the call button? The alarm that she’d suppressed earlier returned, even more distant than before. Rather than fight, flight, or freeze instincts kicking her nervous system into high gear, Grace felt as if she was floating in a sea of white. A sense of unreality settled on her, heightened by the unnatural silence that now felt like a physical pressure on her eardrums. The only noise that broke the stillness were the muffled words of her patient from where they sat just a few beds down. “I’m sorry, I’m sorry, I’m sorry…” The low drone of their pleas quickly became background noise, reduced to the whispering quality of a bitter wind.

Grace wondered what they had to be sorry for.

Finally, she reached the closet. She tried and failed to shove aside the veil that was clouding her mind in a willful attempt to reorder her mental checklist. It… she didn’t have to intubate now, right? The patient shouldn’t be awake with a heartbeat that slow or skin that frigid, but they were , so there was no need to shove a tube down their throat. Right? As for the EKG…