The Black Dagger Brotherhood Novels 5-8

by J. R. Ward

  “When were you going to tell me, Whitcomb? Or did you think Columbia was on a different planet and I wasn’t going to find out?”

  Jane crossed her arms over her chest. She was a tall woman, but Manello topped her by a couple of inches, and he was built like the professional athletes he operated on: big shoulders, big chest, big hands. At forty-five, he was in prime physical condition and one of the best orthopedic surgeons in the country.

  As well as a scary SOB when he got mad.

  Good thing she was comfortable in tense situations. “I know you have contacts there, but I thought they’d be discreet enough to wait until I decided whether I wanted the job—”

  “Of course you want it or you wouldn’t waste time going down there. Is it money?”

  “Okay, first, you don’t interrupt me. And second, you’re going to lower your voice.” As Manello dragged a hand through his thick dark hair and took a deep breath, she felt bad. “Look, I should have told you. It must have been embarrassing to get blindsided like that.”

  He shook his head. “Not my favorite thing, getting a call from Manhattan that one of my best surgeons is interviewing at another hospital with my mentor.”

  “Was it Falcheck who told you?”

  “No, one of his underlings.”

  “I’m sorry, Manny. I just don’t know how it’s going to go, and I didn’t want to jump the gun.”

  “Why are you thinking about leaving the department?”

  “You know I want more than what I can have here. You’re going to be chief until you’re sixty-five, unless you decide to leave. Down at Columbia, Falcheck is fifty-eight. I’ve got a better chance of becoming head of the department there.”

  “I already made you chief of the Trauma Division.”

  “And I deserve it.”

  His lips cracked a smile. “Be humble, why don’t you.”

  “Why bother? We both know it’s the truth. And as for Columbia? Would you want to be under someone for the next two decades of your life?”

  His lids lowered over his mahogany-colored eyes. For the briefest second, she thought she saw something flare in that stare of his, but then he put his hands on his hips, his white coat straining as his shoulders widened. “I don’t want to lose you, Whitcomb. You’re the best trauma knife I’ve got.”

  “And I have to look to the future.” She went over to her locker. “I want to run my own shop, Manello. It’s the way I am.”

  “When’s the damn interview?”

  “First thing tomorrow afternoon. Then I’m off through the weekend and not on call, so I’m going to stay in the city.”

  “Shit.”

  There was a knock on the door.

  “Come in,” they both called out.

  A nurse ducked her head inside. “Trauma case, ETA two minutes. Male in his thirties. Gunshot with probable perforated ventricle. Crashed twice so far on transport. Will you accept the patient, Dr. Whitcomb, or do you want me to call Goldberg?”

  “Nope, I’ll take him. Set up bay four in the chute and tell Ellen and Jim I’m coming right down.”

  “Will do, Dr. Whitcomb.”

  “Thanks, Nan.”

  The door eased shut, and she looked at Manello. “Back to Columbia. You’d do the exact same thing if you were in my shoes. So you can’t tell me you’re surprised.”

  There was a stretch of silence, then he leaned forward a little. “And I won’t let you go without a fight. Which shouldn’t surprise you, either.”

  He left the room, taking most of the oxygen in the place with him.

  Jane leaned back against her locker and looked across to the kitchen area to the mirror hanging on the wall. Her reflection was crystal-clear in the glass, from her white doctor’s coat to her green scrubs to her blunt-cut blond hair.

  “He took that okay,” she said to herself. “All things considered.”

  The door to the lounge opened, and Dubois poked his head in. “Coast clear?”

  “Yup. And I’m heading down to the chute.”

  Dubois pushed the door wide and strode in, his crocs making no sound on the linoleum. “I don’t know how you do it. You’re the only one who doesn’t need smelling salts after dealing with him.”

  “He’s no problem, really.”

  Dubois made a chuffing noise. “Don’t get me wrong. I respect the shit out of him, I truly do. But I don’t want him pissed.”

  She put her hand on her colleague’s shoulder. “Pressure wears on people. You lost it last week, remember?”

  “Yeah, you’re right.” Dubois smiled. “And at least he doesn’t throw things anymore.”

  Chapter Seven

  The T. Wibble Jones Emergency Department of the St. Francis Medical Center was state-of-the-art, thanks to a generous donation from its namesake. Open for just a year and a half now, the fifty-thousand-square-foot complex was built in two halves, each with sixteen treatment bays. Emergency patients were admitted alternately to the A or the B track, and they stayed with whatever team they were assigned until they were released, admitted, or sent to the morgue.

  Running down the center of the facility was what the medical staff called “the chute.” The chute was strictly for trauma admits, and there were two kinds of them: “rollers” who came by ambulance, or “roofers” who were flown into the landing pad eleven stories up. The roofers tended to be more hard-core and were helicoptered in from about a hundred-and-fifty mile radius around Caldwell. For those patients, there was a dedicated elevator that dumped out right into the chute, one big enough to fit two gurneys and ten medical personnel at one time.

  The trauma facility had six open patient bays, each with X-ray and ultrasound equipment, oxygen feeds, medical supplies, and plenty of space to move around. The operational hub, or control tower, was smack in the middle, a conclave of computers and personnel that was, tragically, always hopping. At any given hour there were at least one admitting physician, four residents, and six nurses staffing the area, with typically two to three patients in-house.

  Caldwell was not as big as Manhattan, not by a long shot, but it had a lot of gang violence, drug-related shootings, and car accidents. Plus, with nearly three million residents, you saw an endless variation of human miscalculation: nail gun goes off into someone’s stomach because a guy tried to fix the fly of his jeans with it; arrow gets shot through a cranium because somebody wanted to prove he had great aim, and was wrong; husband figures it would be a great idea to repair his stove and gets two-fortied because he didn’t unplug the thing first.

  Jane lived in the chute and owned it. As chief of the Trauma Division, she was administratively responsible for everything that went down in those six bays, but she was also trained as both an ED attending and a trauma surgeon, so she was hands-on. On a day-to-day basis, she made calls about who needed to go up one floor to the ORs, and a lot of times she scrubbed in to do the needle-and-thread stuff.

  While she waited for her incoming gunshot, she reviewed the charts of the two patients currently being treated and looked over the shoulders of the residents and nurses as they worked. Every member of the trauma team was handpicked by Jane, and when recruiting, she didn’t necessarily go for the Ivy Leaguer types, although she was Harvard-trained herself. What she looked for were the qualities of a good soldier, or, as she liked to call it, the No Shit, Sherlock mental set: smarts, stamina, and separation. Especially the separation. You had to be able to stay tight in a crisis if you were going to W-II the chute.

  But that didn’t mean that compassion wasn’t mission-critical in everything they did.

  Generally, most trauma patients didn’t need hand-holding or reassurance. They tended to be drugged up or shocked out because they were leaking blood like a sieve or had a body part in a freezer pack or had seventy-five percent of their dermis burned off. What the patients needed were crash carts with well-trained, levelheaded people on the business ends of the paddles.

  Their families and loved ones, however, needed kindness and sympat
hy always, and reassurance when that was possible. Lives were destroyed or resurrected every day in the chute, and it wasn’t just the folks on the gurneys who stopped breathing or started again. The waiting rooms were full of the others who were affected: husbands, wives, parents, children.

  Jane knew what it was like to lose someone who was a part of you, and as she went about her clinical work she was very aware of the human side of all the medicine and the technology. She made sure her people were on the same page she was: To work in the chute, you had to be able to do both sides of the job, you needed the battlefield mentality and the bedside manner. As she told her staff, there was always time to hold someone’s hand or listen to their worries or offer a shoulder to cry on, because in the blink of an eye you could be on the other side of that conversation. After all, tragedy didn’t discriminate, so everyone was subject to the same whims of fate. No matter what your skin color was or how much money you had, whether you were gay or straight, or an atheist or a true believer, from where she stood, everyone was equal. And loved by someone, somewhere.

  A nurse came up to her. “Dr. Goldberg just called in sick.”

  “That flu?”

  “Yes, but he got Dr. Harris to cover.”

  Bless Goldberg’s heart. “Our man need anything?”

  The nurse smiled. “He said his wife was thrilled to see him when she was actually awake. Sarah is cooking him chicken soup and in full fuss mode.”

  “Good. He needs some time off. Shame he won’t enjoy it.”

  “Yeah. He mentioned she was going to make him watch all the date movies they’ve missed in the last six months on DVD.”

  Jane laughed. “That’ll make him sicker. Oh, listen, I want to do grand rounds on the Robinson case. There was nothing else we could have done for him, but I think we need to go over the death anyway.”

  “I had a feeling you’d want to do that. I set it up for the day after you get home from your trip.”

  Jane gave the nurse’s hand a little squeeze. “You are a star.”

  “Nah, I just know our boss, is all.” The nurse smiled. “You never let them go without checking and rechecking in case something could have been done differently.”

  That was certainly right. Jane remembered every single patient who had died in the chute, whether she had been their admitting physician or not, and she had the deceased cataloged in her mind. At night, when she couldn’t sleep, the names and faces would run through her head like an old-fashioned microfiche until she thought she would go mad from the roll call.

  It was the ultimate motivator, her list of the dead, and she was damned if this incoming gunshot was going on it.

  Jane went over to a computer and called up the low-down on the patient. This was going to be a battle. They were looking at a stab wound as well as a bullet in his chest cavity, and given where he’d been found, she was willing to bet he was either a drug dealer doing business in the wrong territory or a big buyer who’d gotten the shaft. Either way, it was unlikely he had health insurance, not that it mattered. St. Francis accepted all patients, regardless of their ability to pay.

  Three minutes later, the double doors swung open and the crisis came in at slingshot speed: Mr. Michael Klosnick was strapped to a gurney, a giant Caucasian with a lot of tattoos, a set of leathers, and a goatee. The paramedic at his head was bagging him, while another one held the equipment down and pulled.

  “Bay four,” Jane told the EMTs. “Where are we?”

  The guy bagging said, “Two large-bore IVs in with lactated ringers. BP is sixty over forty and falling. Heart rate is in the one-forties. Respiration is forty. Orally intubated. V-fibbed on the way over. Shocked him at two hundred joules. Sinus tachycardia in the one-forties.”

  In bay four, the medics stopped the gurney and braked it while the chute’s staff coalesced. One nurse took a seat at a small table to record everything. Two others were on standby to bust out supplies at Jane’s direction, and a fourth got ready to cut off the patient’s leather pants. A pair of residents hovered to watch or help as needed.

  “I got the wallet,” the paramedic said, handing it over to the nurse with the scissors.

  “Michael Klosnick, age thirty-seven,” she read. “The picture on the ID is blurry, but…it could be him, assuming he dyed his hair black and grew the goatee after it was taken.”

  She handed the billfold over to the colleague who was taking notes and then started removing the leathers.

  “I’ll see if he’s in the system,” the other woman reported as she logged onto a computer. “Found him—wait, is this…Must be an error. No, address is right, year’s wrong, though.”

  Jane cursed under her breath. “May be problems with the new electronic records system, so I don’t want to rely on the information in there. Let’s get a blood type and a chest X-ray right away.”

  While blood was drawn, Jane did a quick preliminary examination. The gunshot wound was a tidy little hole right next to some kind of scarification on his pectoral. A rivulet of blood was all that showed externally, giving little hint of whatever mess was inside. The knife wound was much the same. Not much surface drama. She hoped his intestines hadn’t been nicked.

  She glanced down the rest of his body, seeing a number of tattoos—Whoa. That was one hell of an old groin injury. “Let me see the X-ray, and I want an ultrasound of his heart—”

  A scream ripped through the OR.

  Jane’s head snapped to the left. The nurse who’d been stripping the patient was down on the floor in full seizure with her arms and legs flapping against the tile. In her hand she had a black glove the patient had been wearing.

  For a split second everyone froze.

  “She just touched his hand and went down,” someone said.

  “Back in the game!” Jane clipped. “Estevez, you see to her. I want to know how she is immediately. Rest of you get tight. Now!”

  Her commands snapped the staff into action. Everyone refocused as the nurse was carried over to the bay next door and Estevez, one of the residents, started to treat her.

  The chest X-ray came out relatively fine, but for some reason the ultrasound of the heart was of poor quality. Both, however, revealed exactly what Jane expected: pericardial tamponade from a right ventricular gunshot wound: Blood had leaked into the pericardial sack and was compressing the heart, compromising its function and causing it to pump poorly.

  “We need an ultrasound of his abdomen while I buy us some time with his heart.” With the more pressing injury ascertained, Jane wanted more information on that knife wound. “And as soon as that’s done, I want both machines checked. Some of these chest images have an echo.”

  As a resident went to work on the patient’s belly with the ultrasound wand, Jane took a twenty-one-gauge spinal needle and plugged it into a fifty-cc syringe. After a nurse Betadined the man’s chest, Jane pierced his skin and navigated the bone anatomy, breaching the pericardial sack and drawing out forty ccs of blood to ease the pericardial tamponade. Meanwhile, she gave out orders to prepare OR two upstairs and get the cardiac bypass team on the ready.

  She gave the syringe to a nurse for disposal. “Let’s see the abdominal.”

  The machine was definitely misbehaving, as the images were not as clear as she’d like. They did, however, show some good news, which was confirmed as she palpated the region. No major internal organs appeared to be affected.

  “Okay, abdomen appears sound. Let’s move him upstairs, stat.”

  On her way out of the chute, she put her head into the bay where Estevez was working on the nurse. “How’s she doing?”

  “Coming around.” Estevez shook his head. “Her heart stabilized after we hit her with the paddles.”

  “She was fibrillating? Christ.”

  “Just like the telephone guy we had in yesterday. Like she’d been hit with a load of electricity.”

  “Did you call Mike?”

  “Yeah, her husband’s coming in.”

  “Good. Take care of
our girl.”

  Estevez nodded and looked down at his colleague. “Always.”

  Jane caught up with the patient as the staff wheeled him down the chute and into the elevator that went to the surgical suite. One floor up she scrubbed in while the nurses got him onto her table. At her request, a cardiothoracic surgical kit and the heart/lung bypass machine had been set up, and the ultrasounds and X-rays taken downstairs were glowing on a computer screen.

  With both hands latexed and held away from herself, she reviewed the chest scans again. Truth be told, both of them were subpar, very grainy and with that echo, but there was enough to orient herself. The bullet was lodged in the muscles of his back, and she was going to leave it there: The risks inherent in removing it were greater than letting it rest in peace, and in fact, most gunshot victims left the chute with their lead trophy wherever it ended up.

  She frowned and leaned in closer to the screen. Interesting bullet. Round, not the typical oblong shape she was used to seeing inside her patients. Still, appeared to be made of garden-variety lead.

  Jane approached the table where the patient had been hooked up to the anesthesia machines. His chest had been prepped, the regions around it draped in surgical cloth. The orange wash of Betadine made him look like he had a bad fake tan. “No bypass. I don’t want to use up the time. Tell me we have blood for him on hand?”

  One of the nurses spoke up from the left. “We do, although his blood didn’t type.”

  Jane glanced across the patient. “It didn’t?”

  “The sample reading came back unidentifiable. But we have eight liters of O.”

  Jane frowned. “Okay, let’s do this.”

  Using a laser scalpel, she made an incision down the patient’s chest, then sawed through the sternum and used a rib spreader to pull open the heart’s iron bars, exposing—

  Jane lost her breath. “Holy…”

  “Shit,” someone finished.

  “Suction.” When there was a pause, she looked up at her assisting nurse. “Suction, Jacques. I don’t care what it looks like, I can fix it—provided I get a clear shot at the damn thing.”