Mercy

by Rada Jones

  He turned left.

  He didn’t see the truck. The road was wet. The night was dark. He wasn’t thinking straight.

  He slammed the brakes and turned the wheel. The brakes screeched like a dying wild bird. The car swerved, then slid on the slick asphalt. A pole came toward him. He pulled the wheel right, swerved, and slid toward the culvert. He hit it, then flew over it. The car twisted in the air like an Olympic diver. Caught in the blinding headlights, a ghost-like white aspen rushed toward him, upside down. Up again. Upside down.

  His head exploded into darkness.

  66

  Taylor’s shift was almost over. She dropped the vials in the transport tube and sighed. She was glad to be done. Her feet hurt. Her back too. She was so hungry she could cry.

  Working in the ER wasn’t what she expected. She’d learned a lot. Some technical skills, like finger-sticks—sticking needles in people’s fingers to check their blood glucose—and measuring vital signs. She learned where to find weird things like the anoscope, for looking into people’s nether side, and the Magill forceps, for removing foreign bodies from tight places. She learned about the ER culture. ER people were not like the others. Something about working here made them into a team. Some were nice, some less so, but they were all intense, dedicated, and funny.

  Getting exposed to the never-ending human tragedy and the occasional comedy had helped shift her focus beyond herself. An only child, then a deserted child when her father left, she got too much attention. She figured out she was the center of the universe.

  Nope. She wasn’t sure the universe had a center, but if it did, she wasn’t it. Maybe her mother. People orbited around her mother like planets on a gravitational pull. Taylor’s feelings about her mother had changed after she started working in the ER. Her mother had a peculiar way of interacting with people. They were attracted to her like cats to a sun patch. It was like wherever she was, it was warmer.

  Taylor got her bag and headed out. The door opened and she walked into Dr. Crump. She apologized. He smiled.

  “Hi Taylor.”

  “Hello.”

  “Done for the day?”

  “Yes, thank God.”

  He laughed. “That’s what we all say.”

  They walked out the door. The sky had broken into sheets of rain. Taylor stopped under the awning to get her phone.

  “You need a ride?”

  “I…I was calling Eric, my boyfriend, to pick me up.”

  “I’ll take you. No bother, I live that way anyhow. You’re living with your mother, right?”

  “Yes.”

  “Let’s go. Even better, wait here. I’ll get the car.”

  Taylor felt uncomfortable. Why would he give her a ride? She was just a nursing assistant. He was a doctor. And married. Was it…No, he didn’t give off that sort of vibe. He was handsome and all, but she was over older men. She had Eric.

  His blue Audi arrived and she climbed in. Next to his beautiful dark suit, her scrubs looked out-of-place. She wished she’d waited another five minutes so she wouldn’t have to ride with him. She sat up straight, her bag on her knees, trying to cover her bulging belly.

  “How’s it going? How do you like the ER?”

  “It’s like no other place. It’s fascinating, scary, and exhilarating, all at the same time. Awful and disgusting, at times.”

  He laughed. “I couldn’t say it better myself. The fact that your mother works there must make it harder.”

  “I haven’t worked with her. Not yet.”

  “You probably won’t. She’ll try to avoid that.”

  Taylor nodded.

  “How are you feeling?” He took a quick glance at her belly.

  Taylor blushed. “I’m all right.”

  “Do you know if it’s a boy or a girl?”

  “No.”

  “You like surprises?”

  I hate surprises. I can’t remember ever having a good surprise. From Dad leaving home to this pregnancy, plus everything about Dick, every surprise I had was a blow across the head. I hate them with a passion. And I hope there won’t be any surprises about this kid, though it would be a surprise if there were no surprises.

  “Not so much.”

  He nodded as if he understood.

  “When is the baby due?”

  “September.”

  “That’s a good month. The weather is still nice, but the heat of the summer is over.”

  Not like I planned it this way.

  “Have you thought about what you’ll do?”

  Taylor bristled. That’s none of your business.

  “I know it’s none of my business.” He drove slowly, looking straight ahead. “But I’d like to tell you a story.”

  May as well. I hope we get home soon.

  “My wife, Sheila, and I, we’ve been married for twenty-three years. We hoped for children. Sheila did. For me, it wasn’t that important. We tried everything. No luck. We went to in vitro fertilization. Sheila became pregnant. Unfortunately, she lost the pregnancy. We tried again. She carried that one to twenty-two weeks, then lost it. She was devastated. She became depressed and withdrawn. We tried all sorts of treatments. Nothing worked. Our marriage… our marriage went through some rough patches. I almost lost her.” He choked.

  “I’m sorry,” Taylor mumbled.

  “She’s better now. We are better now. We’re talking adoption.”

  Taylor looked out the window. Five more minutes.

  “I saw you’re pregnant. You’re so young. You have your whole life ahead of you. I don’t know if giving up your child for adoption is something you’ve considered, but I’d love you to meet Sheila. She’s wonderful. She’ll be a great mother. We’d welcome your baby. We’d welcome you too. You could spend as much time with him as you wanted. We’d be happy to have you both.”

  “That’s… very generous of you.”

  “Not at all. It would be generous of you.”

  “I haven’t decided what to do. I’m still trying to find my bearings.”

  “I understand. I just wanted to put it out there. And I’d love it if you could meet Sheila either way. She’s a lovely person and an artist.”

  “What type of art?”

  “Pottery. She has a studio in the back yard.”

  “I’ve always had an interest in pottery,” Taylor said.

  “Why don’t you stop by, one of these days,” he said, pulling in Emma’s driveway.

  “I just might. Thank you.” She climbed out awkwardly, her thickened belly in the way. He gave it a longing look.

  “My pleasure. Good luck, Taylor. Stay in touch.”

  Taylor smiled and nodded.

  Behind the window, a shadow moved.

  Guinness was watching.

  67

  Back in the ER for another shift, Emma finished discharging Room 6. Her phone vibrated. A message from Boris. She smiled. Boris was fun to be with and had the best stories. But, more importantly, he made her feel good about herself. I can use that.

  “Trauma code, Emergency Department, Room 1.” The metallic voice cut through the ER noise, stirring a new urgency in everyone but the patients. The scrubs’ chaotic movement gathered into a stream flowing to Room 1. Emma grabbed her stethoscope, straightened her achy back, and followed.

  “Mine?” she asked Judy.

  “Yes.”

  “What is it?”

  “MVA. Male.”

  “Anything about his injuries?”

  “Head and torso. They’re still extricating.”

  “ETA?”

  “Fifteen minutes. Longer if they’re having trouble.”

  Time for the full trauma garb—gown, mask, hat, and booties. She suited in a hurry. Two minutes later, the room was crammed with masked blue people she could barely recognize. We look like a den of Martians! Thank God for the yellow labels. She attached the one labeled “ER Doctor” to her gown. She pulled on her gloves as the sirens started.

  She checked her equipment: video laryn
goscope, #8 endotracheal tube ready, with the hyper-curved metal stylet inside and the air-filled 10cc syringe attached, oxygen ports ready, suction, warm IV fluids, difficult airway cart.

  The sirens got louder. Their wails intertwined like those of lovesick cats. Emma went to the ambulance door to meet them and gain an extra minute to listen to the EMTs.

  She punched the silver plate door opener with the back of her fist. She stepped in the ambulance bay. The sirens died. The silence fell heavy on her ears, still buzzing with the ruckus.

  The ambulance door opened. Roy, the EMT, held a mask over the patient’s face, pumping air into his lungs with his blue AMBU bag. Brandon, his partner, performed CPR. The deep chest compressions squeezed blood out of the heart, pushing it to the essential organs. His strained face shone with sweat. He saw her, and his tension softened. His work was almost done. They’re off the hook. Now it’s us.

  “Hello, Dr. Steele. MVA. Thirty-five-year-old male. We have a 20 in the right AC. He was tachycardic and hypotensive when we got him. We just lost the pulse. We gave two rounds of epi. No return of spontaneous circulation. He’s been in PEA for the last five minutes.”

  PEA. Pulseless electric activity. It can be anything. Shock? Tension pneumothorax? Cardiac tamponade?

  The helping crew came to help take out the stretcher. The long, articulated metal legs dropped to the ground with a clunk. The stretcher rolled to Room 1, Roy and Brandon glued to it like limpets. Emma joined them. She looked at the patient, trying to assess his injuries. It wasn’t easy, since he was covered in blood. No beard. Thin moustache. No movement, other than the two-inch chest wall rise when Brandon lets it recoil. C-collar stabilizing the neck. The gash above his ear isn’t bleeding. Of course not. There’s no blood pressure. All bleeding stops. Eventually.

  Brenda stabilized his neck. On her count, they moved him to the ER stretcher. The respiratory therapist took over the airway. The mask made obscene farting noises with every squeeze. It’s leaking air. The bagging’s no good.

  “No breathing, no pulse,” Emma dictated. “Let’s expose him and hook him up to our monitors. Continue CPR.”

  Trauma shears came out of pockets. Bloody clothes vanished, exposing a bruised, fit body. Abrasions everywhere; a palm-sized bruise over his left chest. That chest is moving funny.

  Leaning over the head of the bed, Emma pried open the eyes. “Pupils 4 mm, equal and reactive to light. Ten-inch laceration to the left parietal region, oozing blood.” Something about him looks familiar. She wiped the blood off his face.

  Carlos.

  She took in a sharp breath. She opened her mouth to tell them. She closed it back. They don’t need that added stress. It won’t help.

  “Dr. Steele!”

  Kayla, the ER clerk, stood in the doorway, her face whiter than snow.

  “The police are here. We have an ID.”

  “Yes. Get me the allergies and medical history please.”

  “It’s…”

  “I know.” Emma tried to stop her.

  “Carlos!”

  The room gasped. They stepped forward to see him better.

  “Back, everybody! We have a patient to save.” Emma’s voice cracked like a whip over the room. They stepped back. All but Faith. Faith moved in.

  Her blue eyes swallowed her face. She sobbed. She screamed.

  “Carlos! What did you do? Why did you do this?” Hands shaking, she touched him, exploring him as if she couldn’t see. She bent over him close enough to kiss him.

  Emma caught Judy’s eye. She nodded to the door. Judy put her arm around Faith’s shoulders, guiding her out.

  “We need a surgeon,” Emma said.

  “I paged him. He didn’t call back,” Kayla answered.

  “Page him again. Hold the scanner.”

  She turned back to Brenda: “What do we have for IV access? Labs?”

  “Got a 20 from EMS. Working on a second,” Brenda said.

  “Good. Getting it would be even better. We need a second line and labs. I need a type and cross. He’ll need a transfusion.” If he makes it.

  “Amy, get me the IO drill. How’s he bagging?”

  “Poorly” the RT said, pulling the face into the mask to improve the seal.

  “Try an oral airway and reposition the jaw.” She turned to Chris. “Start transfusing.”

  Still no second line.

  “The IO?”

  Judy handed it to her.

  Emma glanced at Carlos. Almost six feet, maybe 70 kilos. She chose the two-inch yellow intraosseous needle and screwed it in the business end of the drill. She cleaned the skin below the knee joint and placed the needle tip at a right angle to the shin. She pushed her weight into the drill, then pulled the trigger.

  The drill bit into bone. The bone cracked as the needle broke through.

  Emma checked the placement. Solid. She took out the stylet, attached a syringe to the IO needle, and sucked in the murky red fluid. Bone marrow. I’m in. She flushed it and handed it to Chris.

  Amy stepped back. Gina took her place, continuing CPR.

  Still nothing. He’s as good as dead, but maybe… The chest injury—maybe a tension pneumo? Or cardiac tamponade? Either of those could stop his heart. Worth a try. He can’t get any deader. She splashed green phosphorescent gel on the ultrasound probe.

  “Stop CPR.”

  She placed the probe on the chest. Left of the sternum, between the second and the third ribs. She glanced at the screen. A thick black stripe between the probe and the quivering heart. Tamponade. That black stripe is blood around the heart, squeezing it shut. The only way to save him is to stick a needle in it and drain it. But the surgeon isn’t here and the only pericardiocentesis I ever did was on a pig, in the simulation lab. The pig didn’t make it. I guess I get to do a real one today. I hope it works out better.

  She cleaned the area below the probe with disinfectant. She donned sterile gloves and took the catheter from Judy. It was a 14, as big as a knitting needle, only meaner. Just looking at it made her sick. Her hands shook. She took a slow, deep breath to steady them. She rested the back of her right hand on his chest. Her left pressed the probe into the skin. The needle went in. Its tip, a bright dot of light, appeared on the screen above the dark stripe. She advanced the needle, watching the white tip progress toward the dark stripe. One more centimeter. She got in.

  Like the only star in a dark night sky.

  Dark blood flashed in the needle. Emma dropped the probe. She held the catheter in with one hand and pulled out the monster needle with the other.

  His blood, dark red and warm, splattered her, covering her glasses. She grabbed the large syringe with her bloody gloved hand. It was so slippery she almost dropped it. She struggled to attach it without displacing the catheter. Blood spurted everywhere, blinding her. By feel alone, she got the syringe attached. It instantly filled.

  That’s the pressure keeping the heart hostage. They say 25 cc is enough to…

  The monitor beeped, dancing with joy. The heart was back.

  The room gasped. Emma felt faint.

  “We have a pulse. Blood pressure?”

  “Checking it.”

  “Labs?”

  “I have them. Sending them now.”

  “IV access?”

  “18 in the left AC, and a 20 in the right AC.”

  “Surgeon?”

  “On his way.”

  It’s a darn long trip. Emma wiped the sweat off her forehead with a bloody sleeve.

  “Blood pressure 106/93. Oxygen sat 90%.”

  “Let’s start another unit of blood. Recheck vitals in 3. Sal, let’s give TXA.”

  “He’s breathing on his own,” the RT said.

  Should I intubate? If I do, I get control of the airway but I may drop his blood pressure. I may even give him a tension pneumothorax.

  “Blood pressure 110/90.”

  It’s holding.

  “Quick chest X-ray, please. And pelvis. A finger-stick. Let’s get ready
to intubate.”

  “What do you want for intubation?” Sal asked.

  “Ketamine and Sux, please. Fentanyl first. He’s going to need a drip to keep him down when the RSI wears off.

  “Propofol?”

  “No. That’ll drop his blood pressure. Let’s do ketamine while we’re figuring things out. Then we can switch.”

  “OK.”

  She slid the ultrasound probe along his right abdomen, looking for blood. Big-time black stripe between the liver and the right kidney. He’s got blood in his belly.

  “Blood pressure dropping. 85/62.”

  Damn it. I can’t send him to the scanner, and I can’t intubate. I don’t even know if it’s his tamponade reaccumulating or he’s bleeding in his belly. Probably both.

  “Where’s that damn surgeon?”

  “The damn surgeon’s right here,” a tall white coat said, stepping gingerly to avoid the blood pooled on the floor.

  “I’m Dr. Roth.”

  “Hi, Dr. Roth. I’m Emma Steele, and I’ve never been happier to see a surgeon.”

  68

  Carlos went to the OR. Emma stole a moment to get herself together. She went to the bathroom to clean up. She washed her hands. She rinsed her face with cold water. She breathed. What a roller coaster. First the trauma code. Then finding out it was Carlos. Dead. Bringing him back, just to see him fall apart again.

  She looked in the mirror. A pale, tired woman looked back. She put on lipstick to improve her morale. It didn’t help. She went back to her desk. Judy was waiting.

  “Will you speak to Faith? She’s the closest thing he’s got to family.”

  Emma wished she could say no. It was too personal. She was close to them both. Besides that, George’s suspicion made her weary. She knew Carlos hadn’t killed all those people. Somebody else had. Faith? It can’t be. But then who?

  “Sure.”

  Faith sat alone in the grim family room. Her hands in her lap, tears streaming from her clear blue eyes, she looked like Botticelli’s Madonna. Her golden hair warmed the dingy room heavy with people’s misery.