LITMIR.BIZ

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took his first steps into the water. Three. That’s what he’d allow himself this morning. Three waves, then he had patients to see.

      Her surfer had left the beach an hour ago, same surfboard tucked under his right arm, same bold strides across the sand she’d watched for three days. And now she was impatient to leave, too. Impatient, like her father, which was exactly why she didn’t get up and walk away. She was on holiday now. The one she’d fought for. She’d walked out the door, gone straight to the airport and come to Hawaii, since this was the site of their next meeting anyway. Yet, as much as she hated to admit it, the impatience with so much leisure time was beginning to trickle in. “Read a book, take a nap,” she said aloud, as a reminder. “Watch the surfers.” Even though not one of them held the same appeal as the surfer Adonis she watched every morning. He was perfection, and the rest were…unremarkable.

      A group of five young boys running toward the water, all with surfboards tucked under their arms, did catch Susan’s attention for a moment, though. They were having so much fun. Young, probably college-aged, all of them taking a break, doing some surfing, looking at the pretty girls, probably drinking too much, sleeping too little. The follies of youth, she supposed, picking up her book and hunting for the page where she’d left off.

      The follies of anything, that’s what she missed. That had been part of her confusion lately, and the whole reason why she’d come on holiday. There were things to think about, life decisions to make. Turning her attention to the book, Susan was staring at the page more than reading it, when, suddenly, something in the distance caught her attention. A number of people on the beach were running toward…well, she couldn’t make it out, but she could hear the far-off shouts, could see more and more people moving in that direction. Then people were huddling about something, and screaming.

      The warning hairs on the back of her neck suddenly prickling, Susan jumped up, dropping her paperback into the sand, and started off toward the gathering group, which was growing larger by the moment. A few moderate steps, followed by a few faster ones, then she broke into a full run, her bare feet burned by the hot sand as she fought through the growing group, shoving herself to the front of it, where she nearly stumbled over a young man, probably not more than twenty years old, sprawled on his back. Mullet haircut, cartoon-character tattoos on his chest, he wasn’t moving.

      Without a thought about it, her true nature took over. “Stand back,” she shouted, dropping to her knees next to the boy. “I’m a doctor.” Magic words. Everybody stepped back and the noisy crowd hushed, except for another young man who appeared to be the same age as the one in distress. Normal brown hair, no tattoos.

      “Do something!” he cried. “You gotta do something.”

      Susan did. She began an assessment of the boy in the sand. First discovery—no pulse.

      “Board came back up and hit him,” the other young man said. “He couldn’t have seen it coming.”

      Second discovery—no respirations.

      “He went under, but he didn’t come back up right away. I went under looking for him.”

      Third discovery—blue lips, ashen pallor, pupils unresponsive.

      Time to perform CPR. “How long?” she asked her patient’s buddy.

      “Huh?”

      “How long was he under? How long ago did he stop breathing?”

      “He’s not breathing?” the buddy sputtered.

      “How long?” Susan shouted, trying to get through to him. “Tell me how long?”

      “I don’t know. Maybe four or five minutes.”

      He was right on the cusp of either living or dying and could so easily tip one way or another, she thought as she did a quick exam of his neck. Surfboard injury could mean head trauma or even a broken neck. She couldn’t move him if his neck was broken. “No more than that?”

      “Uh, I don’t know. Could have been. I wasn’t really paying attention.”

      She nodded, not satisfied with the answer. But wasting more time asking was futile.

      Gently, she probed one side of the young man’s neck, then the other. Nothing visible, nothing to feel. No air moving in or out. No pain response to her sternal rub either.

      Susan felt the boy tipping toward death, and she dragged in a shaky breath to steady herself. “We need to roll him over,” she said, bracing her hands to splint his neck. She needed the water to drain from his mouth so she could begin resuscitation. Yet she had to pay attention to positioning his body, in case there was a serious spinal injury. A wrong move could make him a paraplegic or a quadriplegic.

      “Don’t over-think,” she whispered. No time to think. No time to weigh the options.

      She gestured to three men standing in the crowd, watching. “You, you and you…I need you to help me get him over on his side. Slowly.” She pointed to the positioning she wanted from the men, then continued, “On the count of three, roll him gently onto his left side. No sudden movements, and don’t jerk him.” Brave words for what she was beginning to think the outcome might be, given all the options. But he was dead already as it was, and without moving him she couldn’t perform CPR.

      That was always the dilemma—to risk further, possibly permanent injury to save a life. Something, in all her years of being a doctor, she’d never had to deal with. Something she’d never had to put to the test until this very moment, as she braced the boy’s neck with her hands, desperately wishing she’d had more experience in direct patient care. “One, two, three…”

      In unison, the men moved the boy to his side and a substantial trickle of water drained from his mouth. But he didn’t begin to breathe on his own, sputter a bit of it out and gasp for a replacement of air, as she’d hoped he might. That did happen. Drain the water and spontaneous respirations began. But they hadn’t, and a huge thorn of dread jabbed her spine. “Okay, roll him back over, same way,” she instructed. “One, two, three…”

      As the youth went back into the supine position, it was becoming obvious to the crowd watching on that they were losing ground. Time was almost gone.

      Not to be daunted, however, Susan felt for a pulse in the boy’s neck…still nothing. Then the pulse in his groin artery. Nothing again. Absolutely nothing.

      The full knowledge was assaulting her now. It was too long. He was probably already past the point of return, too long without oxygen, but, still, it could happen, couldn’t it? She’d read medical accounts of these situations, where better results were recorded. It might not be too late. It just couldn’t be…

      Susan started chest compressions and prepared to do mouth-to-mouth breathing, too, when a stranger emerged from the crowd and took over that duty. For the next several minutes, the two of them performed CPR quietly and skillfully. It was a frantic scene in which the crowd had stepped even farther back and a few people who didn’t want to watch the final outcome had skittered away. No one standing around Susan and the stranger spoke either, no one moved. Susan almost wished they would make some noise, something to cover up the stark sound of silent death settling in, because with every chest compression that failed to produce a heartbeat, and with every breath the man across from her put into the boy that failed to draw out one of his own, her optimism diminished.

      After five minutes of this, her arms were aching and burning, on the way to going numb. And nothing was happening.

      But he was so young…too young to die. Somebody loved this boy…his mother, his father. A girlfriend waiting at home for him, making dreamy plans for their future. For the people who loved him, she wouldn’t quit.

      But she knew the rules. Ten to fifteen minutes without any response whatsoever meant it was hopeless. In her heart she did know this young man wasn’t going to be resuscitated—her first patient in so many years she couldn’t even remember, and she could not save him.

      Yet she still couldn’t quit. She looked plaintively

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