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anything he had everexperienced in similar emergencies. Movements became automatic, observations and orders instinctive. Dozens of facts and variables were processed instantly and simultaneously.
    Later, with the patient successfully resuscitated and stabilized, he would learn from the nurses that he had acted quickly, decisively, and calmly. It was only after hearing their account of his performance that he realized fully what he had done.
    The change
had been part of him ever since.
    “Mom, call an ambulance, please,” he said as he rolled Annie to one side to prevent her from aspirating her own stomach contents, should she vomit. His fingertips were already at the side of her neck, feeling for a carotid pulse.
    As
the change
intensified, all sense of the woman as a friend, a loved one, a patient, yielded to the objectivity of assessment. If it became necessary, in any way, to hurt in order to heal, then hurt he would.
    “Frank, my medical bag is in a large carton at the back of the van. Could you get it, please?”
Please. Thank you
. The use of these words during a crisis kept everybody calmer, including, he suspected, himself. Stroke; heart attack with arrhythmia; epilepsy; sudden internal hemorrhage causing shock; hypoglycemia; simple faint mimicking a grand mal seizure; the most likely diagnostic possibilities flowed through his mind, each accompanied by an algorithm of required observations and reactions.
    Annie’s color was beginning to mottle. Her back remained arched and her arms and legs continued to spasm. Her jaw was clenched far too tightly to slip any buffer between her teeth. Again and again, Zack’s fingertips probed up and down along the side of her windpipe, searching for a pulse. She had had chest pain at the table. Zack felt certain of that now. Heart attack with an irregular, ineffective beat or complete cardiac standstill moved ahead of all other possibilities in his mind.
    “Judge, are you okay to come down here and help? Good. I’m going to put her over on her back. If she starts to vomit, please flip her back on her side, regardless of what I’m doing. Lisette, check the time, please, and keep an eye on it.”
    Zack eased the woman onto her back. Her seizure was continuing, though her movements were becoming less violent. Again he checked for pulses, first at her neck, then in each groin. There were none. He delivered a sharp, two-fistedblow to the center of her chest and began rhythmic cardiac compressions as Frank arrived with his medical bag.
    “Judge, please fold something up and put it beneath her neck, then lay that chair over and put her feet up on it if you can. That’s it. Frank, there are some syringes with needles already attached in the bottom of the bag. I need two. Also, there’s a little leather pouch with vials of medicines in it. I’ll need Valium and adrenaline. That one may say ‘epinephrine’ on it. Mom, did you get the ambulance? Good. How long?”
    “Five minutes at the most.”
    “Frank, can you do CPR?”
    “I took the course twice.”
    “Good. Take over here, please, while I get some medicine into her to stop her seizing. Don’t bother trying mouth-to-mouth until she stops. Just pump. You’re doing fine. Everyone’s doing fine.” Zack placed his fingertips over the femoral artery. “A little harder, Frank, please,” he said. “Time, Lisette?”
    “Just over a minute.”
    Without bothering with a tourniquet, Zack injected Valium and adrenaline into a vein in the crook of Annie Doucettes arm. In seconds, her seizure stopped. Frank continued pumping as Zack hunched over the woman and administered half a dozen mouth-to-mouth breaths. Moments later, Annie took one on her own.
    “Hold it, Frank, please,” Zack said as he searched, once again, for a carotid artery pulse. This time he felt one—slow and faint, but definite. He checked in her groin. Both femoral artery pulses were palpable. Again, the woman took a breath, then another.
Come on, Annie
, his