by Melissa Yi
"They took him to UCH." University College Hospital, nicknamed UC or UCH. The anglophone trauma centre. For whatever reason, it’s not part of the "superhospital" yet. "Dr. Chia called them while Dave ran the code. We were trying to stabilize Patrick until the paramedics got in. He was an obvious trauma."
Yeah. Doesn't get more obvious than shot in the throat. Unbidden, my mind played the opening chords to Bon Jovi's "You Give Love a Bad Name," even though they'd sung about a heart shot, not throat. My drowsy brain enjoyed making jokes like a drunken 45-year-old. I forced more relevant words out of my mouth "So he had a heart beat?"
"We were doing CPR. Fluids. Dave intubated him. We didn't have time to give blood—Kris ran to the blood bank and barely grabbed the units in time to hand to the paramedics en route."
In other words, they secured his airway and breathing, reduced the bleeding, and gave him a heart beat through CPR. With any luck, the blood would maintain his circulation long enough to get him to the trauma team.
Still, asystole from a penetrating trauma. Poor prognosis, although not as bad as blunt trauma.
"I was pushing on his wound—" Her voice broke.
This time, I did place my hand on her arm, so softly that I barely touched the hairs, let alone the skin. Still, she closed her eyes and nodded in acknowledgement.
It was the first time I’d seen Andrea crack. ER nurses are tough.
Sure enough, she patted my hand and drew away to rearrange a syringe on top of the trauma cart, which gave me the space to say, "Where was the wound? Front, back, side?"
She pointed to the right side of her own throat. Not the midline, so the shot had likely missed the trachea, but would easily transect the carotid artery or jugular vein, and likely had, since his heart had stopped.
But Andrea had applied pressure to keep whatever blood he had circulating, and Dave had secured his airway, and someone had done CPR while Kris ran for blood and Dr. Chia assembled the trauma team.
I could have done more. I could have wrestled an ultrasound machine outside to check on the vessels, or inserted a central line, or gotten UCH on the horn to liberate Dr. Chia for more advanced work. Probably Dr. Dupuis would still have intubated, because he's God, but I would have helped, damn it, if they'd let me.
"Did you get ROSC?" Return of Spontaneous Circulation.
"We got electrical activity. Dr. Chia thought she felt a pulse at the end, after a bit of fluid, but we didn’t want to stop CPR."
Patrick was mostly dead, to quote The Princess Bride, but we had to cling to the fact that it meant he was also barely alive. One upside: temperature well below freezing. Hypothermia would slow down his circulation and therefore his blood loss. But he could have easily bled out, depending how long he lay there.
"Any idea when this happened?" I asked.
Andrea shook her head. The colour had returned to her plump cheeks, and she reset the IV pump. "The police are coming to talk to all of us. They'll probably question you, too. You talked to him in room 13, right?"
I closed my eyes. Yes, I talked to him before I asked him to leave the room. And he got shot. I couldn’t help feeling guilty, although chances were, even if I hadn’t given him the boot, he would have had to return to work. Security isn’t a no-risk job. "Has anyone talked to Alyssa, his girlfriend in room 13?"
She pressed her lips together and smoothed her patterned pink and blue scrubs over her midsection. "I don't know. You'd better ask around before you go in."
I couldn't rip open her curtain and start blaring away that Patrick had been shot in the throat. But I couldn't let her lie there Not Knowing, either. That was hell, too.
I should leave the decision to Dr. Dupuis and Dr. Chia, Patrick’s attending physicians. I’d never treated him. Lack of judgment and insight once again.
My neck twinged. Then I rubbed my eye before I caught myself. I tried not to touch my face when I worked, for fear of giving myself conjunctivitis, vomiting, and diarrhea from the crusty eyes and gastros I waded through every shift. That reminded me of Tucker, which made me tachycardic again. Still. "I will. Thanks for...working on him."
She looked away, steeling her emotions before she spoke again. "He was so nice, even in the middle of the night. And so handsome when he showed up in a suit the other day! I told him his mother would be proud, and he laughed and shook his head."
That was such a mom thing to say. A lump grew in my aching throat. I forced some words past it. "I bet. I wish I could've done something for him besides see patients with diarrhea."
The frown lines on her forehead cleared for a second as a tiny smile touched the corner of her mouth. "Oh, knowing you, you'll do something, all right." She brushed my arm to cheer me up as she maneuvered the IV pole past me. "'They also serve who only stand and wait,'" she tossed over her shoulder.
I grimaced. I knew it was a line of poetry, and why she was quoting it. She was telling me it was okay that I hadn't tended to Patrick at the end. Me running the ER as best I could while they resuscitated him was also a service to him, and to the rest of the team.
But my heart throbbed. My throat burned. My dry eyes smarted. And most of all, fury roiled in my chest and made me clench my jaw.
I stomped out of resus to confront Dr. Dupuis.
On my first day at St. Joe's, he'd called me in for a Code Blue that turned out to be a murder. We'd worked side by side then. What was so different now, that he’d forbid me from joining the code?
First I had to review the patients with him, so I collected my work station and pushed it toward him, which made me feel like an overburdened camel.
He and Dr. Chia murmured together at the ambulatory desk. Her eyes widened, but he stood up right away, blocking my view of her and swiping his hair away from his eyes. "Thanks for staying in, Hope."
"Why?" I said. One word, but he knew I was simmering with distrust. I was really saying, Why did you make me.
He held up his palms as if to ward off the WOW if I tried to kneecap him with it. "I know you're angry."
"Residency is supposed to be about learning. That's why McGill charges tuition and we get paid bupkes. But you blocked me from learning at a code, even though I want to be an emergency doctor. Why?"
Dr. Chia wrapped her white coat tighter around herself before she got up from the desk and walked around us, toward the acute zone, leaving us alone to fight.
"Because I wanted to protect you," he said.
"From what? Because I have PTSD? You were one of the people who gave me a reference letter to come back! Which was—thank you," I muttered. I’m Canadian, polite even in the midst of an argument. I’ve never shouted at a staff doctor before, let alone my absolute favourite one, and the one I counted on for a reference. My cheeks flared as I fought to reign it in.
"You're welcome," he replied evenly. "No, that's not it. I knew you'd handle it. Any code could traumatize you more, but I knew you wanted to learn and would go nuts if you sat at home for months." He pushed his glasses up and frowned at me, showing the wrinkles around his eyes. "It was for your safety. If the code had been inside, I would have brought you right in. But it was in the parking lot where two men had attacked you. It was a crime scene. What if you'd come out for the code and gotten attacked again? Then we'd have two victims instead of one."
My hands flew to the scalpel and needles I'd stuffed in my pockets. I forced myself to interlace my hands and place them at my navel. A counsellor had given me feedback about how to make my body language less "frantic" and after I’d gotten over feeling offended, I’d started applying her tips at work. "That's my decision. I get to decide my own risks."
Dr. Dupuis didn’t blink. "No. As your supervising physician, I make the call. I'll review the case with you, I'll teach you as much as I can, but I couldn't put you at risk for the third time tonight. Sorry."
I exhaled. He wouldn’t budge. Even if I continued to object, or brought it up with the residency director, he would stand by his decision. I respected that, even though
a tiny part of me still wanted to face punch him.
"It's a marathon, not a sprint, Hope." Dr. Dupuis’s nostrils flared. "You'll have tons of codes. With our call karma, we could have another ten tonight. Not worth going out there where we can't protect you."
"You weren't protected, either," I said.
"I was watching everyone."
That was an extra stress for him, literally trying to watch everyone's backs while running a trauma code. I paused to consider that. You think it's hard to pat your head and rub your belly at the same time? Try saving someone's life and watching for stray bullets at the same time.
I tried to reduce my heart rate by concentrating on the facts. "What time did you find him?"
"Val said it was 2:32 a.m."
"How long do you think he was out there? Did you ask his boss to narrow the window of how long he must’ve been lying on the ground?"
Dr. Dupuis frowned. "Charles was calling for backup and trying to get the police on scene. He thought we might get shot next. He kept yelling, ‘Don’t shoot!’" He sighed and shook his head. "The guards are under a lot of stress."
It could have been a throwaway line, but something in his voice caught my attention. "You mean they’re stressed out about Patrick getting shot?"
"Yes, but...I mean before that." He swept his hand through his bangs. "They were already under a lot of pressure. That whole OR thing—"
"What, exactly, happened?" I'd obviously missed a lot in my month away.
He glanced at me. "You didn't hear? Someone went up to the OR’s and cleaned out all the drugs just before Christmas. Midazolam, Fentanyl, intubation equipment, you name it. They scooped everything up, probably had no idea what anything was, so they took it all. The hospital started an investigation, and heads are going to roll. Security's going to have to take the hit, even though, for the past two months, they've been filing reports about the OR surveillance cameras not working properly. Plus the OR staff should have locked it all up anyway. Doesn’t matter."
Shit rolls downhill, Tucker once pointed out to me. The guards were ranked lower than surgeons, operating room nurses, and probably even cleaning staff. Yep, the guards would take the hit. Just like residents work longer hours than staff, and younger doctors cover oversights by overconfident blowhards like Dr. Callendar, the guards would play scapegoat for the OR theft.
I sighed. "You think that's got anything to do with Patrick getting shot?"
"It would be a stretch," said Dr. Dupuis. "I know that he was working that night. So was I. I saw him patrolling the halls. For what it's worth, he acted normal. The police questioned all of us. I told them I was in the ER, but as far as I could tell, the guards were doing their jobs, same as usual."
I tucked that into the back of my exhausted cortex. I'd have to Google the OR theft. That hadn't hit my radar while I was working in Ottawa, but I ignore the news when I'm neck-deep in work. Which is always. Tucker had been in Los Angeles at Christmas, so my gossip hound had missed the action. And our friend Tori prides herself on data instead of dishing dirt, which makes her a saint, but slightly less relatable.
"Okay. I have some other questions about Patrick tonight. I heard his wound was on the right." I pointed an index at my own throat. "You think his carotid and his IJ were hit?"
Dr. Dupuis nodded. "Andrea described what sounded like an expanding hematoma. Nothing pulsatile, but he might not have had enough blood left by the time we came across him."
"How big was the wound?"
Dr. Dupuis held his fingers about a centimetre apart. I didn't know bullets well enough to figure out what kind that would be, but the police would.
"Could you tell the entrance or exit wound?" The exit wound is bigger, because the bullet kind of explodes out of there.
Dr. Dupuis glanced at me sideways, although he understood why I was asking. "We didn't roll him, but the front seemed like the entry site. I palpated a larger exit wound in the back." He held his fingers out about 3.5 centimetres this time.
"So whoever shot him was facing him."
"Looked that way."
Our eyes met straight on. I’d heard of execution-style killings where they shot you from behind. If you couldn’t see them, then even if you survived, you couldn't testify against them.
Also, it would take a lot of...detachment to shoot someone from the front.
But why shoot anyone in the neck? Wouldn't you aim for the brainstem if you wanted instant extinction?
To me, a throat shot implied something different. Either you had poor aim, because you’d missed the head entirely—or you had very good aim, and you deliberately zeroed in on the jugular. Or the trachea.
I had to think about this, and we didn't have time to think. We had an increasing tide of patients, and my brain kept firing out useless tidbits.
"Don't dwell on this," said Dr. Dupuis. "It's going to be a long night as it is."
I didn't answer. He should know that I couldn't turn off my brain. Repeatedly telling me no, for my own good, made me want to give him the finger immediately before I cartwheeled off a cliff.
I changed the subject. "Is someone going to tell his girlfriend, Alyssa Taylor, in room 13? She’s been trying to reach him for hours."
Dr. Dupuis paused. "We’ll have to see who's next of kin. It's probably his parents."
That made sense. You usually don't change your power of attorney until you get married. Still, tears stung my conjunctivae. If something happened to Ryan or Tucker, no one would tell me. I’d have to wait in line. I had to blink and breathe until my eyes dried up again.
"The police and the doctors at UC will contact the next of kin, Hope. They're probably working on him right now."
"I know." I should let Patrick—and my preliminary investigation—fall to the wayside. My job was the patients in front of us, who were legion.
"Let's catch up on the patients you saw."
"Okay." I obediently scooped up the clipboards and tried to load the CHEST PAIN up on my WOW. A little hourglass spun, but nothing happened.
"Try on the desktop. Sometimes it's faster," said Dr. Dupuis, rolling his chair sideways to give me more room at the counter.
He was right. We whipped through the three cases and picked up our next charts.
I couldn't resist checking on Alyssa's blood test results, though. Her pregnancy test had come back negative, which made my face twist, even though her battered body and grieving mind didn’t need another stress. Her CT head and face were ordered but pending.
Meanwhile, I kept my fingers and toes crossed for Patrick.
I had to text Tucker.
Bullets in the parking lot. Be careful. Don't come until at least 0700. I love you.
He didn't answer. I left a phone message for him too, to be sure.
I texted my parents next, because I knew they'd worry, and I definitely didn't want my family descending on me to make sure I was okay, only to get blown away too.
And then I texted Ryan. Even though I knew it was hopeless. Even though he was blocking me, it broke the rules, and my very existence on this earth was offensive to him.
Thinking of you.
15
Back to work. Mo’ patients, mo’ problems.
Andrea beckoned me over to the black landline before I had a chance to enter some orders. I picked up the receiver, conscious of my own heart banging in my chest. Was it possible Ryan or Tucker would call me through the hospital—
"I’m sorry—" Roxanne’s high voice came through the phone.
My hand clutched the receiver. Roxanne. Nurse frenemy.
My brain kicked in. We didn’t have to stop being friends. In fact, she was apologizing. Maybe she was sorry for blocking me from Patrick's code? No, she was still talking.
"—but could I get some Ativan?"
Oh. Roxanne wanted an order. Ativan was a common benzodiazepine, or sedative. "For you?" I tried to joke.
She half-laughed. "I wish! It would knock me out for the rest of this shift."
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It probably would, because she was slender enough to make her Italian grandmother weep, and she probably didn’t take drugs on the regular. Unlike some. I glanced at room 14 in case Lori Goody had somehow bounced back.
"It's not for room 14," said Roxanne, reading my mind over the phone. "Room 13 was going nuts in the CT. They couldn't do her. She was rolling her head back and forth. I had to run up."
Alyssa Taylor thrashed so much that they couldn't scan her brain. Too much artifact. As with a regular photo, if the subject was moving too much, the CT scanner couldn't capture a good image, which meant..."Someone told her what happened to Patrick?"
"No. At least, I didn't. But she was trying to get up, trying to rip off her collar—"
I was already entering the order on SARKET, which processed it, for once. "Two milligrams IV okay? But start at one."
"Perfect."
Radiology hated if patients went bananas in CT. Then if we oversedated patients, they shook their heads while we gave an antidote or, if that failed, had to intubate them because they'd forgotten how to breathe.
I still wondered if Alyssa had overheard or had intuited how Patrick was doing. Although Andrea and I had spoken on the other side of the ER, in low voices, most staff wouldn’t be that circumspect.
First I had to enter my orders and deal with some VIRAL ILLNESS and COUGH, which was exactly as mesmerizing as one could expect.
Next, I tried to talk to Dr. Dupuis, but he was with a patient.
Meanwhile, I picked up a SEIZURE, which sounded like a fun change of pace, but turned out to be a 22-year-old with known epilepsy who hadn't taken his medication for a week, then indulged in a few beers. Nothing for me to do except recommend taking his anti-epileptics, not alcohol, and to draw blood levels for Valproic Acid et al.
When Dr. Dupuis and I convened again, on the ambulatory side, as distant from room 13 as we could get, I pounced on him to whisper about Patrick.
He shook his head. "He didn't make it."
I wanted to scream. I wanted to howl.
No. He was young and healthy.
No. God and Dr. Chia had worked on him.
