Code Triage

by Candace Calvert

  “Can’t we wait until . . .” The woman’s eyes, red and tear-swollen, darted toward the door of Golden Gate Mercy ER’s code room. Sirens wailed in the distance. “My husband—is he here?”

  Leigh glanced at the young assistant chaplain on the other side of the gurney.

  Riley Hale shook her head, streaked blonde hair brushing the shoulders of her gabardine suit jacket. She cradled a hand under her dark arm sling and gazed down at the patient. “I’m so very sorry, Mrs. Baldwin,” she said, her Texas cadence stretching the words like pulled taffy. “I left messages, but unfortunately your husband hasn’t responded.”

  “And we can’t wait,” Leigh added firmly, checking the vital sign display on the monitor mounted above the gurney. “Acetaminophen is liver toxic. We don’t know how many were left in that bottle, and in combination with the other pills and the alcohol you ingested . . .”

  The woman clutched the sleeve of Leigh’s white coat, fingers sinking into her forearm. Her eyes searched Leigh’s face, chin shuddering. “Please, you have to understand. I’ve never done anything like this,” she insisted, her voice thickened by the drugs, breath pungent with alcohol. “I don’t drink. Ever. But I haven’t slept since my husband left me two weeks ago. I can’t eat. I can’t work. I can’t . . .” Her voice dissolved into a wrenching moan. Tears splashed down her face. “We said vows. He made promises before God. Twenty-three years. Two children. We’re a family. He can’t be with that woman.” She trembled, her eyes riveted to Leigh’s. “You have to understand.”

  I do. Leigh took a breath, pushing memories down, then extricated herself from the woman’s grasp. “Please cooperate. If you swallow the stomach tube willingly, the process will be easier.” Her heart tugged at the painful vulnerability in her patient’s expression. “But regardless, we’re doing this procedure now. Even if it means restraining your arms and holding you down. We have to.”

  Leigh watched her patient’s eyes for a moment and knew, with familiar and painful certainty, that this ugly, uncomfortable procedure was nothing compared to what this poor soul had already suffered. And would continue to endure over the sad months ahead. I’ve been there—I’ve been you. She squeezed the woman’s hand gently. “We want to help you. Help us do that.”

  She stepped away from the bed so that the nurse could raise the head of the gurney and explain the procedure. Then watched as she applied lubricant to the end of the tube, slid a bite block inside the patient’s lips, inserted the tube, and checked its placement. The nurse released the clamp on the attached tubing to start the flow of liquid from the distended bag hanging above the gurney. Into the stomach from the bag and back out into a collection container near the floor—one liter, two, or more, whatever it took to wash out the pill fragments, to save this woman’s life.

  Riley Hale moved close, took hold of the patient’s hand, and murmured words of encouragement. The woman was cooperating; that was good. That made it easier. But . . .

  Leigh saw her patient’s eyes move expectantly again to the exam room door. Hoping for a glimpse of her husband. Praying, perhaps, that the promises of love and fidelity made before God would be restored. Leigh knew how that felt. And she knew, too, that though this shattered woman had chosen to cooperate with having her stomach pumped, swallowing the truth was much, much harder. Even with vows . . . nothing lasts forever.

  She glanced at the large clock on the code room wall, designed to accurately time resuscitations, ticking second by second during a fight for life. She sighed, thinking of her own timetable, her own life. So much to do now that she was back in San Francisco full-time. Finish clearing out the house, turn it over to the leasing company, schedule job interviews, make sure her sister was settled in a new apartment . . . and following through with her counseling appointments. Then Leigh could move on with her life. Give up—quit once and for all—the painful struggle she’d endured for nearly a year. One more week—October 3, and we’re over, Nick. I need this to be over.

  She repeated her orders to the nurse, gave Riley an appreciative smile, and strode across the ER’s main room toward the doctors’ desk. She glanced at the large assignment board, then around at the circular arrangement of patient rooms, frowning. Half of the patients were “campers,” waiting endlessly for admission to rooms upstairs. All too common these days, but nonetheless frustrating. A large part of the reason she’d gone into emergency medicine was the fast patient turnover. Many of her friends were internists, family practice specialists, or pediatricians with office walls full of fading patient photos. They loved it that way, wanted the long-term relationships—and accepted the turmoil and grief that often came with that—but that’s not what Leigh signed on for.

  She liked it fast, furious, fully caffeinated, and adrenaline-pounding. And as uncomplicated as possible. “Treat them and street them.” The old ER mantra. Not that she didn’t care—of course she did, and she wanted to help, use her skills to save lives. But she needed to walk away when her shift was over and leave it all there. That’s what felt best; that’s what worked for her. She needed that cushion to keep the job, the people, from getting too close. For anything more, there were chaplains like Riley. And when Leigh wanted companionship, uncomplicated, pain-free, no strings, she went to the stables and flung her arms around the neck of her horse.

  “Dr. Stathos?”

  Leigh glanced toward a nurse at the door of an empty patient exam room. “Yes?”

  “Looks like we’ve got a heads-up on patients coming our way.” She beckoned, pulling the red stethoscope from around her neck. “Come take a look at the news.”

  Leigh walked into the room, and the nurse turned up the volume on the small patient TV mounted on the wall. “I’m pretty sure they said they’d be coming to Golden Gate. Possible carbon monoxide poisoning.”

  Leigh watched as the reporter, a familiar woman from a local channel, spoke into the camera. “. . . initially relayed to 911 operators in a heart-wrenching call from a four-year-old girl. Thought to be a case of child abandonment, but officers discovered—oh, wait, folks.” Her face disappeared for an instant, then returned. She nodded eagerly. “In fact, I’ve just located the officer who first discovered this medical emergency. SFPD patrol officer Nick Stathos.”

  Leigh’s breath caught. The camera panned over a group of uniformed officers, a woman in a steel gray blazer with spiky blonde hair, and focused in on . . . Nick. His face filled the TV screen. Black hair mussed, shadow of beard growth, and the oh-so-familiar dark-lashed eyes.

  “Is it true,” the reporter asked, extending her microphone, “that you were the one who started CPR on the baby?”

  “I did some mouth-to-mouth, that’s all. Until the medics got there.”

  “And,” the reporter continued, “you were off duty, but you responded to the call anyway? Put yourself on the line for this family, even when you weren’t required—”

  “This is my patrol area,” Nick interjected, dark brows drawing together as if he couldn’t quite fathom her question. “It’s like my own neighborhood. I know these people. Of course I’d help them. It’s what I do.”

  And who you are, Nick. Always. Leigh swallowed against a raw lump that should have healed months ago. She couldn’t watch this. If the ambulance brought the family here, fine, she’d deal with it. Nick was off duty, so he’d likely not accompany them. He’d promised to give her space, and he’d kept that promise so far. She hadn’t seen more than a passing glimpse of him since she and her sister moved back into the house the first part of August. Leigh turned to leave the room just as the reporter asked another question.

  “Officer Stathos, is it true that the SWAT team was on its way here because the mother refused to allow officers and paramedics in? that there may have been weapons in that apartment? and you volunteered to go in despite that danger?”

  Leigh left the room—she didn’t need to hear Nick’s answer. She’d heard versions of it over and over during the three years they’d been married. Of cou
rse he’d taken the risk. He always did. Because . . . “It’s what I do.” And it was one of the reasons—a pair of soul-killing reasons—she had to end their marriage.

  +++

  Sam glanced at Nick’s older-model black BMW, parked next to a trio of Vespa scooters. “Okay if I ride with you to Golden Gate Mercy? That way, Carla can have the city car.” Her eyes—icy blue-violet in the morning light—met his, and he knew she was forcing the casual expression.

  He’d made it clear long ago that their brief affair last November had been a mistake, and they’d managed to settle into a casual, if awkward, friendship. She was his best friend’s sister and they still shared grief over his death, but there could be nothing more. These past two months he’d done his best to avoid her altogether. He knew it hurt her, but with Leigh back at the house, he wouldn’t let anything jeopardize the chance that they could save their marriage.

  “Riding with me isn’t a good idea,” he said, after glancing toward the paramedic crew loading Kristi and Abby—both already on oxygen—into their rig. Lights flashing, the ambulance with the baby pulled away from the curb, its siren giving a warm-up yelp.

  “But you’re going to the ER, right?” Sam dragged her fingers through her new short hairdo, and for a moment her expression reminded him so much of her brother, Toby, his best friend, that his heart stalled. “You promised that mother . . . um . . .”

  “Kristi Johnson,” he said, supplying the name and trying not to think that Sam’s report to Child Crisis would be a deciding factor in the family’s future. “Yeah, she trusts me.”

  “Of course.” Sam’s expression lost all casualness. For an instant she looked vulnerable, soft. Hopeful, maybe. “You’re that kind of guy.” She shifted the clipboard in her arms, and the tough-girl look returned. “So, catch a ride?”

  Nick met her gaze fully. “Leigh’s working.”

  Sam hesitated, letting the receding siren fill the quiet between them. Then she sighed. “I’ll have Carla drop me off.”

  “Good—thanks.” He started walking back to his car, then heard her speak again.

  “Nick?”

  He turned his head. “Yeah?”

  “I’m going there. That’s my job. And this was bound to happen sooner or later. Your work, mine, hers—they all intersect, you know?”

  “I know,” he said or tried to. His heart had climbed into his throat, and his breath came in short puffs . . . almost the same way as when he’d been trying to save Kristi Johnson’s baby. Because despite a sheaf of legal papers, he refused to believe there would be a divorce. That Leigh would really end it. He’d barely had a glimpse of her in the past six months—she’d commuted back and forth from her sister’s treatment center in Sausalito, working just enough shifts to stay on staff at the hospital. And now, when there was so little time to change his wife’s mind, he finally had a chance to see her beautiful face again. The same morning she’d finally meet Samantha Gordon—the reason she’d given up on their marriage.

  +++

  Leigh set down her coffee cup and punched the button on the base station radio. “Golden Gate Mercy, Dr. Stathos, go ahead.”

  “Ten-four, Dr. Stathos. This is Medic Seven, paramedic Kenny Walsh. Coming in Code 3 to your location with an eleven-month male in respiratory distress. Possible carbon monoxide poisoning. Monitor shows sinus tach. Respirations assisted via bag valve mask with 100 percent oxygen at 20 breaths per minute. Pulse ox: 99 percent. Skin very pink. Baby lethargic. Weak cry. We’re attempting an IV line.”

  Leigh nodded. “Copy that, Medic Seven. What’s your ETA?”

  “Three minutes. Be aware: there are two more victims coming your way.”

  More victims . . . It was going to be a busy morning, but she’d get through it. If there was one thing Leigh had learned in her life, it was that nothing—good or bad—lasted forever.

  Chapter Two

  “No sweeter sound,” Leigh said, raising her voice over the infant’s vigorous cries as the EMTs wheeled the gurney into the ER exam room. The pair of respiratory therapists standing beside the intubation setup were thinking the same thing, no doubt: Keep screaming, babe, and we don’t slide a nasty tube down your throat. She turned to the medic. “I like this better than your report en route.”

  The paramedic, a redhead with a square jaw and sunburned nose, nodded. “This little man doesn’t like needles, for sure. I tried a brachial vein—it blew. Sorry. But I think the high-flow oxygen assist was bringing him around anyway. I hear some wheezes on the right. There was emesis on his nightclothes, so I’m wondering if he aspirated. The sister was vomiting too.”

  Leigh lifted her stethoscope from around her neck as she checked the medics’ portable monitor: sinus rhythm at 128, pulse ox 100 percent. She looked down at the baby. Eyes tracking normally, strong cry, vigorous movement of extremities. Skin—face, chest, limbs—cherry red. “So why are we thinking carbon monoxide? What was the exposure?”

  “That crummy apartment was closed down tight with newspapers around the windows to keep out the drafts. While an old propane camp stove was cranked up full blast. For at least two days, I hear. Baby’s crib was right next to it.” The paramedic glanced over his shoulder as a second gurney passed by the doorway. “That’s Mom and the four-year-old now. There was talk on scene about the kids being left alone all night, so be warned that you have PD on the way. And Child Crisis.”

  Child Crisis. Not that woman, not . . .

  “I can handle it,” Leigh said quickly, refusing to start down that old path of nerve-racking paranoia, confusing nightmares, searing anger. It was over now. Ended, same as her marriage would soon be. Pointless to waste energy on ugly confrontations that wouldn’t happen.

  The medics moved the baby to the hospital gurney, and the nurse connected him to their monitoring equipment. Leigh pressed her stethoscope to the baby’s chest, listening to his lungs top, bottom, front, and back. The paramedic was right, a slight expiratory wheeze right upper lobe. But no grunts, no retraction of sternum or ribs. She looked up. “Rescue breathing was started by a first responder?” The TV image of Nick’s face intruded and she pushed it away.

  “Right. Off-duty PD officer. He said the patient was limp and the respirations were barely visible. A little better when I got up to the apartment, like—” he consulted his run sheet—“about twelve spontaneous breaths per minute initially. Heart rate 98. The officer said he felt a strong pulse, so he didn’t start compressions. I saw him doing the rescue breathing; competent job.”

  Leigh nodded. Nick gave everything his best. Except our marriage.

  “But then—” the paramedic glanced toward the door again—“if you want to hear it firsthand, I could probably find that cop for you. He’s following us in.”

  Nick’s coming? Leigh squeezed her eyes shut for an instant, then turned to instruct the respiratory therapists. “Let’s keep him on humidified high flow for now. Restrain his hands if he tries to pull the mask off. Let me know if his respiratory rate drops. I’ll need some blood gases.” She signaled to the nurse. “Get lab here—I’ll want a carboxyhemoglobin along with a blood count and metabolic panel. Chest X-ray as soon as we can. Bag him for a urine, and let’s put that IV line in.” She draped her stethoscope around her neck and checked the monitor again. “I’m going to take a peek at Mom and the other child, and then I’ll be right back. I’ve got a call out to the peds intensivist. Call me if you need me.”

  The paramedic caught her as she turned to leave. “Dr. Stathos, what about that police officer? You need him?”

  “No. I don’t.”

  +++

  Nick parked his Z4 in a space assigned to emergency vehicles after getting an okay signal from Cappy Thomas, Golden Gate Mercy’s longtime security guard. The tall, gray-haired African American limped toward him, and Nick was reminded of Leigh’s concern about the hospital’s security team. Their average age was late sixties, at best. Helpful and congenial, all of them, but she often felt that paging security fo
r “Mr. Strong,” the hospital code for a violent and unruly patient, seemed at odds with reality. Though Cappy was still muscular for his age, he’d had recent cardiac bypass surgery and a knee replacement. Tackling a belligerent patient or visitor was the last thing he should be doing.

  Nick smiled at Cappy. “Hey, friend. How’re you doing?”

  “Can’t complain.” The guard’s engaging grin widened. “And if I did, who’d listen?” He raised his hand and scratched his brow with a key, one of a heavy cluster strung on a ring decorated with plasticized family photos. His age-lined eyes studied Nick’s for a moment, his concern palpable. “Long time no see, Officer Stathos. When Dr. Stathos came back to the city, the Mrs. and I were hoping it meant good news.”

  Nick shook his head. “She came back to help her sister for a while,” he explained, touched by the man’s kindness. Whether Leigh knew it or not—or even wanted it—her hospital staff was as much a family as the people in his workaday world. “But tell your wife I appreciate her thoughts.”

  Cappy clapped him on the arm. “Prayers too. That woman’s praying for all of us. Best thing I ever did was marry her.”

  “That’s great. You’re one lucky man, Cappy.” Nick raised his hand, and the guard’s knuckles bumped his. He glanced toward the emergency entrance, at the paramedics busy reloading their gear. “I promised I’d check on some folks. The mother and kids who just came in Code 3.”

  “Right.” Cappy nodded. “That social worker told me you’d be coming. Miss Gordon said to tell you she’d meet you in the ER.”

  +++

  “Doctor—” Kristi Johnson’s translucent green mask fogged as she tried to speak—“can I take this oxygen off now?” She watched with an anxious expression as Leigh examined her daughter on the adjacent gurney.