Time of Death

by Lucy Kerr

  “Breathe. Slowly,” I said. “Is Matt there? Put him on.”

  People often commented on how much Charlie and I looked alike—short, with our mom’s red hair and brown eyes and our father’s round cheeks and freckles. But the similarities ended at the five-foot mark. Where I was low-key, rolling with the punches, and often acting on impulse, Charlie was devoted to routines, checklists, advance planning, and anything else that could suck the fun out of a situation. While my sister might be tightly wound, however, she was also levelheaded. This kind of hysteria—and the fact she’d resorted to calling me—meant things were truly bad.

  “Hey, Frankie.”

  “Hey, Matt.” I pictured Charlie’s husband, a big, shambling Viking of a man, an English professor at the local community college. His gentle smile and easygoing nature complemented Charlie perfectly, but I could now hear the strain in his voice as well. “What’s going on?”

  “Preeclampsia,” he said. “She was complaining about headaches and not being able to read inventory reports at the store, and when she came in to the hospital, her blood pressure was sky-high.”

  “When did they admit her?”

  “Yesterday.”

  “Good,” I said. “Preeclampsia’s nothing to mess around with.”

  That was putting it mildly. Unpredictable and fast-moving, preeclampsia could—and did—kill mothers and babies. I’d seen it with my own eyes.

  “She’s doing great,” he said, trying to sound upbeat and failing miserably. “Just gotta get that blood pressure down. We’ll be home in no time.”

  “What was her last BP? Do you remember?”

  “One fifty-two over one hundred.”

  I frowned. With those numbers, Charlie wouldn’t be going home tonight. Or at all, most likely, until the baby was born. “What are they giving her?”

  “I wrote it down.” A pause. “Hydralazine. Magnesium sulfate? And a shot. Betamethasone.”

  “Tell her it hurts,” Charlie said in the background.

  “Tell her that’s normal,” I retorted, though the spunk in her tone was a good sign. “The magnesium in the IV is going to burn a little, but it should prevent seizures. The shot is a steroid, to help the baby’s lungs develop faster.”

  “That sounds good,” he said. “Isn’t it?”

  “Healthy lungs are always good.” I didn’t add that if the doctor was giving Charlie betamethasone, she’d be delivering in days, not weeks. “How’s she holding up?”

  “Oh, she’s a trooper, your sister. Doesn’t like bed rest.”

  “I have a business to run,” Charlie called. “And an eight-year-old. I can’t stay in bed for the next six weeks!”

  If Charlie carried this kid for the next six weeks, it would be a miracle on par with the Cubs winning the World Series.

  “Then rest, and let me talk to Frankie,” Matt told her affectionately. Charlie’s arguing grew faint, and he said, “Okay. I’m in the hallway.”

  “How bad is it? Be straight with me.”

  The cheerful note dropped away. “Not good. She’s so worried about the baby she’s in a full-on panic. She’s fighting everything the doctor tries to do. She doesn’t trust the nurses. And the stress isn’t helping her blood pressure.” He sighed. “I love your sister, but she is a terrible patient.”

  “I know.” Charlie saw hospitals the same way she had when she was six: the place where our father had gone to get better—and instead, he’d died. Even now, more than twenty-five years later, she didn’t trust doctors. Or nurses, come to think of it.

  I knew better. During my father’s final heart attack, I’d been huddled in a corner of the room, hidden behind a chair, watching as the nurses worked frantically to save him. I’d seen how much they cared, and I’d seen how quickly a life could change—or end. That moment had set me on the path toward nursing—and away from both Stillwater and a life in the family business.

  I liked to believe my dad would have understood my decision, even if the rest of my family didn’t.

  “Where’s Riley?” I asked, thinking back to my eight-year-old self and wondering how my niece was handling matters.

  “Your mom’s watching her. Which probably isn’t helping anyone’s blood pressure.”

  I paced from kitchen to bedroom and back again. “Charlie needs to calm down. The more her blood pressure spikes, the more dangerous it is for her and the baby. She could start having seizures.”

  He dragged in a breath. “Can you tell her that? She might listen if it came from you.”

  I had my doubts—giant, Everest-sized doubts—but all I said was, “Put her on.”

  “Why did Matt talk to you outside?” Charlie asked when she was back on the line. “Is it the baby? Did they find something? It’s worse than they’re telling me, isn’t it?”

  “It’s exactly what they’re telling you,” I said in the same brisk-yet-reassuring tone I used with my patients. “You have preeclampsia, and it’s serious, but treatable. Everything they’re doing is to help you and the baby.”

  “It’s a girl,” she said.

  “It’s a Stapleton girl,” I corrected. “Which means she’s a fighter. But you have to help her, Charlie. Calm down. Stop fighting the doctors. Rest and let the meds do their thing.”

  For a time, the only noise was the beeps and whirrs of the monitors.

  “I’m scared,” she finally whispered. I closed my eyes at the pleading note in her voice. The same one she’d used when we were kids, a pitiful little wheedle that wound itself around my heart. “Tell me she’s going to be okay.”

  I don’t lie to my patients. I never promise what I can’t deliver, because I’ve seen what that does to patients and their families. What it had done to mine. I swallowed and tried to figure out the kindest truth I could give my sister.

  Because she was my sister, she understood the meaning behind my silence.

  “Come home, Frankie.” She drew a great, shuddery breath. “Please.”

  “I’m not sure what good I can do.” I glanced down at my laptop, the screen filled with palm trees and beaches and bargain airfare. I’d wanted a break, the chance to clear my head and get some answers about myself. Going home would only churn up more questions. But I knew how hard it must have been for Charlie to ask, and my resolve softened.

  “You can be here. With your family.” She didn’t add “for once,” but I heard it all the same.

  I had a few days off duty. I could stick around long enough to make sure Charlie and the baby were out of the woods. Spend some time with my niece, Riley. I could—perhaps—put to rest some of the ghosts I’d left behind in Stillwater. By the time I returned to Chicago, the gossip about my failed engagement would have died down.

  I wanted to shake things up, and this definitely qualified.

  I closed the laptop, bidding farewell to my dreams of San Diego and surfing. “I’m on my way.”

  TWO

  Nestled in a bend of the Illinois River, halfway between the state capital and the state line bordering Missouri, Stillwater was the biggest town in the county—which wasn’t saying much. It boasted a high school and a junior college, a historic downtown my mother assured me was thriving, and Stillwater General Hospital. I pulled into the hospital close to ten, parking at the far edge of the emergency lot out of habit.

  I stood and stretched in the sharp night air, glad for the down vest I’d thrown on at the last minute. Stillwater Gen had transformed since I’d moved away twelve years ago. The modest rural hospital had become a full-fledged medical center—helipad on the roof, office buildings along the perimeter, two new wings towering over the old three-story brick building. Would my father have lived if this new facility had been around twenty-some years ago?

  Some questions have no good answers.

  Thanks to traffic, I’d spent almost seven hours in my ancient Subaru with nothing but coffee, staticky radio, and raging self-doubt to keep me company. I was no closer to understanding my serial-engagement ways than when I
’d set out from Chicago. I’d anticipated plenty of time to think while I was home—Stillwater wasn’t typically a hotbed of excitement—but one look at the emergency entrance proved tonight was anything but typical.

  Ambulances from neighboring towns lined the ER driveway, lights flashing in a silent, disjointed rhythm. The sound of radio chatter and indistinct shouting carried across the parking lot, and I could hear the rhythmic thumping of a medical helicopter approaching overhead. Stillwater Gen had been hit with a large-scale trauma, and the department was in triage mode. I wondered how many patients they could take. Stillwater was the biggest trauma center around, but the number of rigs parked outside suggested the ER would be stretched to breaking.

  The realization was like a shot of adrenaline. My fingers itched to get inside and help out, to run IVs and apply the right kind of pressure, to do something, rather than simply watch. Sitting idly by wasn’t in my nature, and I instinctively picked up speed.

  Then, with an effort, I slowed my pace. This wasn’t my hospital. I wasn’t authorized to help—I couldn’t even take someone’s temperature. I jammed my icy hands into my vest pockets. My job was to help Charlie. Nobody else.

  In the ambulance bay, paramedics were unloading a gurney. A fluffy ball of red and white—a pom-pom?—tumbled to the ground as they ran toward the entrance. A nurse met them halfway to the door, checking the IV they’d started and nodding as one of the men rattled off vital signs. I cocked my head, trying to figure out if it was the cadence of the words or the voice itself that sounded familiar. Before I could decide, they disappeared inside the building.

  An older man—barrel-chested, his shoulder-length gray hair visible beneath a beat-up black trucker hat, his mustache drooping like walrus tusks—sat hunched on a bench near the main ER entrance. A relative, I guessed, or a witness.

  “Busy night,” I said. “What happened?”

  He grunted, rubbing his arms against the cold.

  A warning prickled along my scalp. “Sir? Are you waiting for someone, or do you need help?”

  Slowly, he lifted his head to look at me, mouth working soundlessly.

  “Sir, are you in pain?”

  “Elephant,” he rasped after a moment. “On my chest.”

  Up close, his skin was gray. Rivulets of sweat poured down his face, soaking his faded Harley-Davidson T-shirt though the night was cool.

  “What’s your name?” I crouched next to him.

  “Clem,” he managed.

  His cap, I noticed, was emblazoned with “World’s Best Grandpa.”

  “Clem, my name’s Frankie. I’m a nurse, and I think you’re having a heart attack. Were you in the accident, or did you drive here yourself?”

  He gripped my arm with surprising force. “Not . . . accident.”

  The prickling sensation intensified. I could imagine it perfectly. He’d driven himself to the ER only to find it swamped; he’d been overlooked in the chaos.

  “I need help!” I shouted toward the silent ambulances. “I have a patient in possible cardiac arrest and we need transport, stat! Somebody help!”

  There was no response—the EMTs and paramedics were inside, and nobody in the waiting room could hear me through the dual sets of doors. In an instant, I made my choice. Off-duty or not, I wasn’t going to leave a man to die. Charlie and the baby would have to wait.

  “Let’s get you inside.” He shook his head, but I dropped my backpack and slipped an arm around his waist. “I’ll help you, okay? Up we go . . .”

  I hefted him to his feet, straining under his bulk. A muscle in my back twinged in warning, but I ignored it and tried to propel Clem forward. No good. He outweighed me by at least a hundred pounds, and he couldn’t support himself. Before we both toppled over, I eased him back to the bench. “I’m getting a wheelchair. Hang on, Clem.”

  I sprinted through the main entrance, doors sliding open to admit me—and stopped short. A solid mass of people, all clamoring for answers about their loved ones, blocked my way. I shoved my way through the crowd and saw countless teenagers in Stillwater High colors, sprawled in chairs and slumped on the floor. Most had the lacerations and glassy-eyed look associated with car accidents. But there were too many kids for a car accident, I realized. Someone mentioned a game, and it hit me—not a car crash. A bus crash. In football season. No wonder the ER was jammed.

  Unfortunately, Clem’s heart attack wasn’t going to wait for a more convenient time.

  “I need help!” I cried, but my voice was lost amid the clamor. “Someone get me a wheelchair!”

  I spotted a sturdy-looking teenager with mouse-brown hair, a panicked expression, and a deep-purple blazer embroidered with the word volunteer. I grabbed her arm. “You! Get me a wheelchair. Or a gurney. Outside. Now!”

  She stared at me, then whirled away and sprinted down the hall like a scared rabbit. I cursed under my breath and fought my way outside again to check on Clem, who was looking worse. “Clem, hang in there. We’re going to take care of you.”

  What we? Nobody else had shown up. The EMTs were still inside. The ambulances stood, lights whirling, doors hanging open, just as before.

  Doors open.

  I raced to the first rig and hoisted myself into the back. “Nitro, nitro, nitro,” I muttered, yanking on drawers and peering at the contents. “There you are.”

  Nitroglycerine spray won’t stop a heart attack, but it can relieve chest pain, at least temporarily. I was hoping it would get Clem on his feet long enough for us to make it inside.

  I gave him the spray and counted to sixty. “Is that better?”

  He dipped his chin and groaned.

  “Clem, stay with me. Tell me about your grandkids. What are their names?”

  “Just CJ,” he wheezed as I took his pulse: fast and thready. “He’s eight.”

  “So is my niece,” I said. “I bet he’s a handful.”

  Clem’s smile was more like a grimace. “Wanted . . . to . . . help.”

  “Don’t they all?” I said, dosing him a second time. “Let’s try walking again.”

  He shook his head and tried to twist away. Despite his protests, I hoisted him to his feet, my muscles burning.

  We took a step. And another. And another, just as pain tore through my back, so fierce I nearly let go of Clem.

  An instant before I crumpled to the ground, bringing Clem with me, a soft voice said, “I found a wheelchair.”

  I looked up. The volunteer I’d yelled at earlier stood breathless and red-faced, her hands gripping the back of a wheelchair.

  “I stole it from admitting.”

  “Good girl,” I gasped as she maneuvered the chair behind Clem.

  Together we eased Clem into the seat, and I set off at a run for the ambulance bay, ignoring the burning along my spine, the girl at my heels. The automatic doors slid open, and we were in. I only hoped we weren’t too late.

  If the lobby had been chaos, the ER itself was a cyclone—noisy and fast-moving, but purposeful. The staff dashed from one room to another, barking information and commands. Sobs and moans filled the air, and the PA system called out a nonstop litany of doctors and departments.

  I’m too small to move patients as big as Clem by myself, as proven by the fiery pain in my back, but I’ve got a good set of lungs, and now I put them to use. “Hey! This guy’s gonna code! Somebody help!”

  Every hospital has its own lingo and procedures, a language you only learn through experience. But a code is universal—it’s like shouting fire in a theater, and it gets you immediate attention.

  Although . . . not always the attention you expect.

  A doctor, stocky and scowling, shot out of a nearby exam room, halting when he realized I wasn’t one of his staff. His ice-blue gaze flickered to the girl beside me, brow lowering, and he snapped, “You’re not supposed to be back here.”

  “This man—”

  “I’m in the middle of a multivictim trauma. Get in line.”

  “Excuse me?” Doctors
have egos, to be sure, but this wasn’t the time. “He’s a classic MI. Chest pain, shortness of—”

  “Take him to triage,” he said with a wave of his hand, and turned away.

  My vision hazed with anger. Clem had been waiting, alone and terrified, in the dark. More waiting wasn’t the answer. “Forget triage. I’ll take him to the cath lab myself.”

  When patients present with a myocardial infarction—a heart attack—the best thing to do is take them to the cardiac catheterization lab, so we can find the blocked artery and use a balloon to open it up. Ideally, you do it within sixty minutes—but I had no idea how long Clem had been sitting outside. We could be at the nineteenth minute, or the fifty-ninth. I turned to the volunteer, frozen in terror beside me. “Lead the way. And grab me some defibrillator pads, just in case.”

  The doctor spun around. I met his glare with my own, my words arrow-sharp. “Chest pain radiating to the left arm, shortness of breath. Pulse thready and 112 bpm. Administered two sprays of translingual nitro at three-minute intervals. You need to—”

  “Start a line!” he bellowed to the nurse standing three feet away. “Four milligrams morphine, oxygen, put him on a monitor. I want his troponin levels, stat.”

  “We’re out of rooms,” she warned.

  “Then do it in the hallway,” he snapped. “He won’t care about the view.”

  He was a jerk, but at least he was a competent jerk. In seconds, orderlies were whisking Clem down the hall, transferring him to a gurney while one of the nurses ran for a cardiac cart. The nameless doctor turned to me, his tone coldly polite. “You’re a family member?”

  “I’ve never seen him before. He was on the bench outside, and I recognized the symptoms, so I stepped in.”

  His veneer of politeness vanished. “And you happened to be carrying nitro spray with you?”

  I paused. “I pulled it off an ambulance.”

  “I see.” His lip curled as he took in my rumpled sweater and tattered jeans. “I take it you’re qualified to diagnose and treat cardiac cases.”