“Clinic,” Woody Greenberg said. “You sent them.”
“Oh…yeah, I’m distracted.” David shot Jill a glance. “Okay, Gary? Help MacIntyre, he’s already with the first one. Jill, check the second one’s status in labor room three, and call George Mackey. He’s probably sleeping, and if he yells, ignore, stay sweet.” David flipped the second patient’s chart page, his brow creasing. “This is odd, re-check her urine for albumin.”
Jim Holloway, second year resident like Sam, came running up. “You called about an ectopic?”
“Ruptured,” Woody told him.
“I’ve only seen it done once,” Jim said.
“Learning time,” David said, looking at Woody and Holloway. “You two go scrub, fast. Phipps - change, you scrub for the ectopic too, Sam can manage the routine one, he’ll probably just need a catcher’s mitt.
David fast-glanced at Phipps, Holloway, and Greenberg. “Okay, crew, see you in OR 4.”
He touched Jill’s arm as the others moved off. “You okay?”
“No.”
He exhaled. “Listen,” he said low. “The second you get in there you’ll see a new life on its way and you’ll get right into it. It will take your mind off the other thing.”
She smiled weakly. “That ectopic sounds bad.”
“It’ll take longer. I’ll call you when we’re done.”
Minutes later David, his two residents and an intern, were all in the OR, scrubbed and gowned. The patient was already anesthetized, the anesthesiologist busy adjusting her intubation and the right amount of anesthetic. The others took seconds to peer at the ultrasound of her lower abdomen and pelvis in the view box.
“Refresh me on why ectopics happen?” Phipps asked.
“You sleep through that lecture?” Woody groused.
Holloway spoke fast. “Fertilization happens in one of the two fallopian tubes. If the tube is scarred from some infection, the fetus gets stuck there and grows…”
“Fetus is just a few weeks old, nonviable.” David eyed the bulge in the pencil-diameter fallopian tube. “This must have been incredibly painful.”
He turned back to the operating table.
“Hemoglobin and hematocrit taken?” he asked the charge nurse. She answered yes, read the results from a lab sheet, and said two units of blood were coming.
“Tell them to hurry, we may need to transfuse.”
Beeping suddenly speeded from the patient’s monitor, and then a high, thin alarm lasting ten seconds.
“BP down to 80 over 50, pulse up to 130,” Woody said, frowning at the monitor.
“Oh shit, internal hemorrhage.” David took a scalpel from the scrub nurse. Phipps finished placing sterile towels around the incision area, and Holloway finished painting it with antiseptic.
“BP 70 over 40, pulse 96!” Woody piped.
“Get the blood here,” David snapped.
“It’s coming, it’s coming,” from someone.
He barely heard. Made a quick incision in the left lower quadrant of the abdomen, and saw blood well up.
The clock on the wall read 1:55.
18
The second delivery came faster than expected, no complications. It was a boy. And a thrilled mother. And two surprised interns, Jill and Tricia, who had finished clinic early and come up to help. Suddenly the two had free time on their hands. George Mackey just wanted to go back to sleep.
“Bed, bed, bed,” Mackey groaned trudging into the scrub room, pulling off his cap and surgical gown, dumping them into the laundry bin.
Tricia, entering behind him said, “We heard about your night. A tough delivery, three hours of sleep, and then the breech?”
Jill behind Tricia was silent.
“Hell, yeah.” Mackey headed for the sinks. “A fat-kid breech who weighed nine and a half pounds. Phipps kept saying, ’Fat-ass kid! You ever see such a fat-ass kid?’ Don’t think the mother heard, she was moaning, but hell, you gotta do something about Phipps’s mouth!”
“Promise him candy and he’ll shut up. Damn, how does he stay so skinny?” Tricia dumped her surgical gown and cap into the bin.
Then Jill did too.
And looked in, and saw a snake slithering black across OR laundry and up the side of the bin.
She froze, blinked, and the snake disappeared. Her heart rocketed and she felt weak. Grabbed a linen shelf to steady herself.
“You okay?” Tricia frowned, washing at one of the sinks.
“Just had a bad moment.” Jill came to the sink next to her. Pedaled soap and water and started scrubbing out. Snakes, thank God, had disappeared during the excitement of the delivery. Now she was a mess again. The bad images were rushing back, storming her mind.
Mackey washing two sinks down was bitching about overweight. His own. “At least I was a thin kid! That breech was fat at birth! Well what do you expect? His ma weighed 260 unpregnant. We need wider tables. Okay done, now I’m gonna go raid the vending machines.”
He left griping about his pillow getting cold.
Jill and Tricia dried on sterile towels, then left through the scrub room door to the bustle of the main corridor.
“Bed sounds like a good idea,” Tricia said, eyeing an empty wheelchair. “Maybe I can grab a nap someplace.”
“The lounge,” Jill said absently, her mind flashing back to her laundry bin fright. Her body felt cold all over. She rubbed her hands; didn’t know what to do.
“Are you really okay?” Tricia peered up feelingly from behind her glasses. “You seem, uh…okay, you’re fretting, right? About Jesse, and the Jenna Walsh attack and the seven snakes in the chapel? Minor stuff like that?”
Jill blinked. She had planned on a quiet moment like this to bring Tricia up to date. What had she been thinking? The rest of the hospital knew. Peter even said it had been on cable, online. For her, the last few hours had been a blur.
Tricia seemed to read what she was thinking. “Two minutes after you and David took off, the hospital drumbeats went nuts. Snakes in the hospital chapel! Like the snake on Jenna Walsh!”
Jill exhaled, and hitched herself up onto an empty gurney. Tricia - “oof” - hitched herself up too. “There hasn’t been a moment to talk,” she huffed, trying to get comfortable, watching an orderly push a gurney past.
“Now there is.”
Speaking haltingly, Jill told the rest about their charge down to Security, Sivak’s cardboard box, then the run up to Pathology and the awaited snake autopsy.
“The assumption being,” Tricia said, “that if you can pinpoint where the snakes came from it will help knowing where the creep came from.”
“Yeah.”
“Pity garter snakes are everywhere. My grandmother in Brooklyn’s afraid to go into her back yard. Saw one snake last summer and won’t set foot out the door.”
Discouraging but true. They both fell silent.
What now?
Two nurses rushed past, and an orderly pushing a lab cart with rattling wheels, and a revoltingly cheery, pink-smocked volunteer saying “Hi!”
Jill didn’t see them. “Wonder how Jesse’s doing.” She’d pulled out her cell phone and started to watch him sleep. His little cheeks looked plumper, and his tiny rosebud lips twitched a little. She felt a bit better, watching him. Then switched to her photo of Jesse and David, both asleep, with that sweet little face on David’s shoulder.
This, she decided, was her therapy. It helped, anyway. She gazed at the photo.
Tricia meanwhile - “I’m Auntie” - had been on her phone with the NICU, asking how Jesse was doing.
“The nurse said he hoovered down four ounces of milk and just went back to sleep,” she said, hanging up. “They were calling him Slugger. Now they call him Chugger.”
Jill cracked a smile. “They’ve got me on speed dial. Ditto the NICU security guys.”
She inhaled deeply. A long moment passed.
“I feel so frozen,” she finally said faintly.
“Me too. Another maniac’s loo
ming and what can we do about it? I hate feeling helpless.”
Tricia nervously cleaned her glasses with her scrub top and pushed them back on. Pursed her lips, leaned to peer down the wide hall, and stopped another passing nurse.
“How’re they doing in OR 4?”
“The ectopic? Still at it. Just ordered another unit of blood.”
Jill sighed, watching the nurse move on. “David and I were going to go up to see Jenna,” she brooded. “I could go alone, but what would I do? The poor woman’s comatose, she’s going downhill neurologically, and that’s neurosurgery’s domain. What could I do?” she repeated in frustration.
“Sounds like you just want to see her.”
A slow nod. “It’s so pulling at me. This nagging feeling that I should be there. I don’t know why.”
“Then go. Or how ‘bout if I go with you? For company?”
Jill found herself climbing off the gurney. “Good idea, let’s go.”
It was as if Jenna hadn’t been moved, or turned, or massaged to avoid bedsores, which of course she had been. But she lay now as she’d lain last night, on her back on pillows with her eyes closed, her bed slanted up and her head swathed in bandages. The blue blanket up to her chin was so neat…as if she’d been laid out for a wake…
Jill pushed down the awful thought.
Maybe the couple on the other side of the bed had prompted the feeling. They’d been sitting like chins-down, arms-folded dummies when Jill and Tricia entered. Not crying, or touching each other or Jenna, or trying to speak to her. Relatives of brain-injured patients were encouraged to do that - speak, hold or even read to the patient. But this pair…nothing.
Until both of them looked up, blank-faced, and the woman said, “The doctor was just here,” as if she resented the intrusion.
Her tone was flat. Unemotional. She had a low, raspy voice.
Jill introduced herself and Tricia, who muttered hello and stooped to examine the nurses’ chart at the foot of the bed. “Vital signs good,” she said. “Pulse, temp, respiration and blood pressure.”
“Yeah,” said the man. His arms were tight around his brown wool jacket in his lap, as if he were impatient to leave. “Too bad someone bashed her brain in. They can stay in a coma like that for years.”
They?
The woman had short dyed-blond hair, dark roots, and thin lips. “We’re Dara and Brian Walsh, Jenna’s brother and sister-in-law,” she said in the same flat tone. Her eyes narrowed. “You said you’re from obstetrics?”
“Yes.” Out of habit Jill lifted Jenna’s wrist and felt for the radial pulse. It was normal. Jenna’s eyes were closed in her pretty face, but there was no movement behind her lids.
“Your sister-in-law sustained serious injuries,” Jill said. “Needed OB surgery to repair her uterus and…remove the deceased child.”
Dara glanced at Jenna’s flat belly, then looked back.
“Were you aware that child wasn’t hers?”
“Yes. Jenna was a surrogate mom.”
Brian Walsh seemed to wince. Gripped his jacket tighter and said nothing. The couple had been facing the IV pole a few feet in front of them. They never looked at Jenna’s face.
Dara raised her chin. “We’re Catholics,” she told the IV pole. “The Church considers surrogacy a sin.”
Tricia frowned, switching her gaze from the beeping monitor to Dara. “I was raised Catholic,” she said stonily. “Liberal priests say surrogacy for an infertile loving mom and dad is okay, and don’t like the Vatican trying to control them.”
Dara stiffened in indignation. “If a couple is infertile, it’s God’s will,” she rasped. Her husband, reacting at last, gave her a chilled look: Don’t talk to the heretics.
Jill’s heart lurched and she felt suddenly furious. Jenna had suffered and been terrorized. Her life as she’d known it had been destroyed. It was a horrible tragedy that brought tears to Jill’s eyes…and these so-called next-of-kin sat here like stones of judgment?
“So you must consider your sister a sinner,” she said sharply across the bed, her fists clenching the bed rails. “And she’s been unable to regain consciousness to repent, so she must be headed straight to burning hellfire, is that how it goes?”
Both expressions glared at her.
Jill leaned over Jenna, her voice rising. “Did you hear the details of her attack? A three-foot-long snake pinned alive to her cross? Do you feel no sorrow for her suffering?”
Brian Walsh jumped from his chair and ran out to the hall. “Get that woman out of there!” he yelled. “Get her out!”
An orderly and a neuro resident came running, tried to calm him in the hall. “She!” he bellowed, pointing, and something else indecipherable. “…insulting our religion! Get her out!”
“Nice,” Tricia told glaring Dara. “In a hall of surgical post-ops trying to recuperate. Very considerate.”
The orderly started dealing with Walsh, and the neurosurgical resident came in. Will Keenan, who Jill and Tricia knew. Ignoring Dara, he put one hand on each of their arms, pulling them close.
“Spare yourselves, we’ve been fighting with them,” he whispered, beckoning them back out to the hall. Further up the orderly, a big guy, looked ready to deck Walsh, who was still shouting.
Keenan started trying to tell Jill and Tricia more when they heard a sharp, “Okay, break it up,” from yet a new voice …and turned to see Keri Blasco there, with Alex Brand coming up behind her.
“Your wife here?” Brand asked Walsh as he passed him, and Keri Blasco stepped to look into Jenna’s room.
“Yep, she’s here.”
She told Dara Walsh, “Stay, please, we’d like to question you in a minute.” Brand ordered Brian Walsh back into Jenna’s room, then turned to Jill, who was looking at both of them with surprise.
Keri looked surprised too. “Bonus finding you here,” she said. “Got a minute?”
19
They conferred near the nurses’ station. Jenna’s clothes, which David had carefully preserved, were a boon, both cops said. Fibers had been found on them. Forensics was overwhelmed with rapes and homicides, but…
Keri and Alex stopped awkwardly, looking frustrated.
“I know.” Jill said. “Rapes and homicides go to the front of the line.”
“The long, never ending line,” Alex groused. “Forensics is overwhelmed.”
“What color are the fibers?”
“Brown, a wool and poly mix,” Keri Blasco answered. She wore a navy blazer and her blond hair was pulled into a ponytail. “But damn, unless it’s a major felony and they go looking for a match…”
Tricia looked from one cop to the other, taking it all in.
And Jill thought, brown wool?
“Sounds like Brian Walsh’s jacket,” she said, tipping her head down the hall. “He’s got it there with him.”
Tricia and both detectives cast narrowed gazes back to Jenna’s room. A uniformed cop stood outside.
Then Keri shook her head, frustrated again. “Problem is, what if the fibers do match? These people are relatives. They could say they’d seen and visited each other on other occasions.”
Jill shook her head. “But Jenna hadn’t seen her brother since last summer. “Who wears wool jackets in summer? We met the surrogate couple last night. They said Jenna hadn’t seen her brother since June, maybe. They were estranged, after that just fought a couple of times over the phone.”
Alex was frowning deeply, his lips pressed tight. “That could be argued as hearsay. The law...our hands are tied at every turn.”
That had dawned on Jill a second after she’d said it. Her mother, the prosecutor…
Then Brand’s face cleared a little. “Unless,” he said, brightening, “new matching evidence from the alley where Jenna was attacked can be found on Walsh’s jacket. Anything. Dust, debris…”
“That just could work,” Keri said. “If we could get a court order for the jacket-”
Jill touched Tricia’s arm,
her adrenalin surging. “How ‘bout we just go take the jackets? We’re not cops!”
“Yeah!” Tricia said vehemently. “We’ll say Jenna’s allergic to wool or something.”
The cops looked at the two interns.
“There are a lot of brown jackets,” Keri said, trading a reluctant glance with Brand. “Even if something were found, we wouldn’t have probable cause to use them…”
“But it would narrow your search,” Jill insisted. “Then you can find something that will stick.” She didn’t wait for no. “C’mon, Trish.”
Open-mouthed, both detectives watched the two go to Jenna’s room, which emitted sudden sounds of a ruckus.
They followed quickly.
Inside, Will Keenan was threatening to call Security if the Walshes didn’t get off his back. They were yelling “It’s God’s will!” as he worriedly watched the monitor’s beeping slow, felt for Jenna’s pulse with one hand, and tried to speak into his phone with the other.
“Pulse is dropping,” he practically hollered. “It’s at 50 beats a minute. Yeah, get down here.”
“And you get back,” he told Dara and Brian Walsh, trying to control himself. “It’s still possible to reverse this. The dropping pulse means increasing intracranial pressure. The brain’s continuing to swell. The membranes around it are continuing to produce fluid which we can-”
“You are fighting God’s will!” Walsh shoved Keenan.
“Jesus, that’s assault!” Will cried.
“Do not take our Lord’s name in vain!”
“Listen, I’m Catholic too and you’re bat shit crazy!”
“Cavalry’s here! Oh, crap!” Another resident raced in past slack-jawed Jill, and then a nurse and an intern. Tricia let them pass and brought up the rear just as the monitor’s alarm went off - a non-stop, ten-second squeal punctuating the frantic air.
“Dear God,” Jill whispered under her breath. She stood frozen, staring at Jenna’s pretty, loveable face; felt her heart drop.
“Cardiac arrest! Code red!” Keenan suddenly yelled as the alarm changed to an intermittent beep beep beep beep. It kept going. The sound was so heart-rending. Jill and Tricia stepped back as someone pushed in a rolling crash cart. The room was suddenly crowded with activity, loud and frantic, even after someone turned the alarm off. The Walshes moved stiffly toward the rear as the team surrounding the bed put electrodes on Jenna’s chest, and checked the crash cart’s oscilloscope.
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