Chapter Three
MORE TUBES THAN THE UNDERGROUND
Late Summer, 1999: Louisville, Kentucky
Zadie
“What are you waiting for? Stab him in the chest.”
I was pretty certain this was the first time in my life I’d heard those precise words spoken in my vicinity. I didn’t stab—mainly because I didn’t think I was competent to stab anyone in the chest—but also because I wasn’t certain the chief resident was talking to me. In case he was, I tried to banish the excitement I felt flitting across my face.
Clancy got it, however. He was our team’s intern, and he was a notorious procedure hog, known for prematurely dashing in and inserting lines and tubes while everyone else was still fumbling to get their booties and gowns on. “She can’t do the tube. She’s a third-year med student,” he protested, his words emerging behind his mask in a muffled whine.
“There are two more incoming,” said our chief, as he ripped open a chest tube kit. He looked amused. “Get over to bay two and get ready for the next one. You can call it.”
Clancy shot me a hostile look and huffed out.
“Go ahead, Sadie,” said the chief. “Better hurry up. He’s dying.”
“Ah,” I said, panicked. No time to correct him on my name. “When you say ‘stab him in the chest . . .’”
“Well, it’s a little more nuanced than that.” He began squirting a brown antiseptic fluid over the patient’s chest wall. “I’m assuming you’ve got more sense than Clancy. Can you locate his nipple? And his armpit?”
“Yes,” I said, with complete confidence.
Dr. X, the chief, wheeled around to face a nurse standing behind us. “Eva,” he commanded, “throw us two packs of sterile gloves.” He grabbed one of my hands, which looked spindly and uncertain next to his. “Size six,” he evaluated. To me, he said, “We’ll do it together as soon as he’s intubated. Then the next one’s all you. Okay?”
I nodded, pleased. Insertion of a chest tube was a procedure I was anxious to learn.
Above me, a bank of monitors beeped hysterically. The room we were in—one of the emergency department trauma bays—had floor-to-ceiling shelves, which contained a slew of medieval-appearing implements: fat eight-inch needles to insert into the heart, instruments to slice open the chest and saw through ribs, IVs to thread into the central veins in the neck and chest and groin, and even horrifying giant needles designed to screw into the marrow of the bones. Hanging from the ceiling were swiveling cinema-quality spotlights. Who knew how many patients had regained consciousness with those blinding lights boring down on them, convinced they were facing the radiant blaze of the tunnel to heaven only to realize they were actually alive and naked in a roomful of strangers?
Only a few moments earlier, the EMTs had barreled in with a crushed, unconscious teenager. (“. . . Trauma code name is Silver,” one of them reported as he and his burly partner had heaved up the metal stretcher. “Young male, unbelted driver of a T-bone MVC, no airbag deployment, GCS 3 on initial eval, decreased breath sounds on the right . . .”)
I’d learned earlier in the day the hospital assigned random nouns as code words for the trauma patients—in this case, Silver—since some were unconscious without ID, some were in need of protection from whatever sinister force had caused their plight, and some were high-profile enough to require privacy. None of us yet knew Silver’s real name.
“Lidocaine, etomidate, succinylcholine,” the ER resident called out. He was a skinny guy with a prominent Adam’s apple, which bobbed up and down in nervous commiseration as he manipulated a breathing tube through Silver’s vocal cords and into his trachea. A respiratory tech attached the tube to a bedside ventilator, which began pumping air into Silver’s lungs, forcing his chest up and down at regular intervals.
Dr. Allison Kalena, our third-year surgery resident, held a stethoscope to Silver’s chest. She was trim and self-contained, with symmetrical features and hair bundled into a crisp, precise bun. I found her inscrutability a little worrisome. I’d known her only one day, but I’d yet to see her have an actual expression. Her onyx eyes were smooth and alert over her mask as she instructed an XR tech to shoot a film, but she didn’t bother to wait for the results to motion for Dr. X to set up the chest tube kit. I perked up. This confirmed his initial suspicion that something bad—maybe a big blood or air collection—was impeding Silver from expanding his lung on one side.
Reviewing my meager knowledge, I pulled the sterile gloves over my regular latex ones, being careful not to allow the outside of them to touch my skin. Trauma victims were evaluated according to the ABCs, starting with airway (A), breathing (B), and circulation (C). These were sequential actions taken to address life-threatening injuries, and the team had just handled the airway. Things were now hung up on B, because despite the breathing tube, he still wasn’t getting enough air. All the alarms were blaring: Low oxygen! Low blood pressure! Fast heart rate!
Silver was dying.
Dr. X spoke up. “Sadie,” he said to me. “Let’s do this.”
I nodded. He was directly behind me, guiding my hands as he talked me through the chest tube insertion. I watched, mesmerized, as my own hands performed the small operation: incising through Silver’s skin, just over a rib, punching through the muscle to his chest cavity, releasing an angry crimson splash, which sprayed the front of my yellow plasticized gown and dripped down past my shoe covers. The cellular dimming of Silver’s life reversed course as I piloted the tube in place through the gaping hole in his chest wall. An entirely new emotion surged through me: part exhilaration, part glorious relief, part absurd pride. I beamed at Dr. X, who stood assessing the action, his posture easy, arms folded loosely across his chest.
He gave me a thumbs-up. I was hooked.
From what I could see of him, Silver was young and slender. He’d been wearing jeans and a faded T-shirt with a picture of Stephen Hawking on the front, which puddled on the floor as the nurses finished clipping off his clothes with big shears. One of his shoes was missing, and the other was pointing almost backward, indicating a horrific fracture that seemed to have twisted his leg nearly off. I brought my gloved hand down gently to touch his broken face. A drop of fluid squeezed out of his left eye and ran down his cheek: a single bloody tear.
Practicing medicine had not been my lifelong goal, unlike for my roommate, Emma, who’d had a determination to be a surgeon since the age of three. Meanwhile, as a toddler, I’d aspired to be a bulldozer, a career plan that received the enthusiastic support of my older brother. There’s something so appealing about the notion of achieving your aims by pulverizing obstacles into rubble, isn’t there? Unfortunately, it soon became evident I did not have what it took to be an actual bulldozer, what with being human and all. I moved on, dreaming of jobs inspired by beloved literary influences: ballerina, wizard, authority on unicorn behavior. My interest in a more realistic career didn’t manifest itself until my senior year of high school, when I was eating with a friend whose father was a family doctor in our small Kentucky town. I could still recall the reverence accorded to him from surrounding diners as he murmured into the restaurant’s phone in response to a page, bolting midmeal for the hospital. The restaurant manager made a big show of comping our bill.
Doctors were beloved. This struck a nerve in my healthy imagination. They zipped around learning everyone’s secrets, delivering babies, soothing the sick, showing up in the nick of time to save the day. When the shit really rains down, who needs a ballerina?
“Sadie.”
I snapped to attention at the sound of my name. Or a name that was similar to mine, anyway. Apparently, I hadn’t made a tremendous impression on my team yet, since none of them seemed to realize my name was Zadie.
But maybe I was wrong about making an impression, because I looked up to find the chief’s eyes locked on me: a long, deliberate appraisal. I resisted the urge to squ
irm.
“Pay attention,” he said finally, but his tone was mild. “This is Sandford Pelley.” He gestured to a hulking Sasquatch with massive shoulders and animated chest hair spewing up from the V of his scrub top. “He’s from ortho.”
“Nice to meet you,” I said.
“You too,” rumbled the Sasquatch. “Have you ever reduced a fracture?”
“Not yet,” I said hopefully.
“I’m sure Sadie can help you, Pelley, if you need some real muscle,” Dr. X offered. “Send her to me when you’re done; I’m going to check on whatever fresh hell just rolled in before Clancy manages to terminate somebody.” He strode toward the curtain separating the trauma bay from the rest of the ER, but then swiveled around and directed his last comment to me.
“You were good,” he said. “This kid owes you his life.”
—
“. . . excuse me, Doctor? Excuse me, Doctor?”
With a start, I realized the voice was addressing me. It belonged to a tiny, wizened man with a corona of wispy white hair. He was gimping along the hall, clutching a faded floral-print pillow, a Bible, and a leather strap attached to some kind of steamer trunk on wheels. “I can’t find anybody,” he told me plaintively. “Where did they go?”
“Oh,” I began, but stopped as he turned to me, his withered hand suddenly clutching mine in a fierce grip.
It was after midnight. Silver had finally been stabilized and sent to the ICU, and I’d been slinking through the ER with my head down, hoping to sneak in a short sleep before someone recognized my white coat and handed me a laceration tray. I’d been blasted from an uneasy slumber at four o’clock yesterday morning by my roommate, who was also assigned to the trauma service this month on a different team. Emma is the kind of person who can effortlessly transition from sleep into a well-oiled machinelike functionality. By contrast, I have to be poured out of bed each morning like human syrup, and I lurch around, emitting miserable squeaks until I’m caffeinated. It was going to be a brutal month.
Patients were crammed into every thin-walled room of the ER, wheezing or bleeding or clutching their chests, spilling out into the halls, bellowing for somebody to bring some Dilaudid, or at least some fucking morphine. My new friend stared at me, ignoring the sideshow, his watery blue eyes locked on mine with the intensity of someone who has just discovered the key to cold fusion. Then his eyes clouded in a baffled fugue. “Where is Bertie?” he asked.
“I don’t— Who is Bertie?” I tried.
My friend slowed his wobbly shuffle and began to cry. “Oh no,” I said. His thin shoulders shuddered. I cast a desperate look around, but everyone seemed preoccupied with their own issues: stemming a torrential hemorrhage, or warding off asphyxiation, or whatever. The elderly man had now come to a complete halt, sobbing piteously in the middle of the hall.
“Oh no,” I said again. I scooted his huge trunk over to the side, where it was less likely to cause a traffic jam, and then returned to him. Not knowing what else to do, I wrapped my arms around his frail torso and guided his weepy head onto my shoulder, patting the back of his neck ineffectually from time to time. A musty smell, like an old couch, wafted off him. He embraced me back, and I thought he might have felt some comfort by the hug, because after a while his cheek burrowed against my coat and the volume of his cries lessened a little. Still, there was no way to detach.
It’s possible I might have stood there until I became petrified, but rescue arrived in the form of an amused but disembodied voice just out of my line of sight. I knew immediately who it was, though.
“Sadie? What are you doing?”
“He’s lost,” I explained.
“Bertie,” howled my friend, wiping his nose on my sleeve with extravagant abandon.
“He can’t find Bertie.”
“Yes, I see,” said Dr. X. “Well, let me help you out a bit.” He disengaged my neck from the elderly gentleman’s death grip and gently led him down the hall to an empty nurses’ station, handing him a pack of crackers and a small generic lime soda before tucking him into a swivel chair. “There you are, sir,” said Dr. X, extending his hand for a shake. He leaned in as the man said something, and laughed in delight.
“What was that about?” I asked as Dr. X returned.
“Can’t tell you,” he replied, smirking. “Male-bonding thing.”
“Who’s Bertie?” I asked.
Dr. X frowned. “Bertie was his wife,” he said. He slowed and glanced at me, his attention apparently caught by the photo on my hospital-issued badge, which featured a goofy image of me smiling in midblink. Deftly, I turned the badge around.
Everyone—nurses, patients, hospital administrators—called him Dr. X. I wasn’t sure if this was because he was mysterious, or if it was part of his unpronounceable name, or possibly a reference to the TV show X-Files. He had a reputation around the hospital for being a man’s man: profane, cocky, decisive; but I decided I liked him. Just as you’d expect from a surgeon, he had authoritative hands and arms. And he was tall; he peered down at me now, trying to remind himself of the embroidered last name on my white coat.
“Sadie . . . Fletcher.” He grinned. “Well, not much of a chance for us to chat today, so I’m glad we’ve got a little unexpected free time. Welcome to trauma call.”
I smiled, running my fingers through my hair, which had responded to its release from the ER cap by springing out in all directions in a belligerent pale brown explosion. “Thanks for letting me do the chest tube.”
“My pleasure, Sadie,” he said.
Again, I considered correcting him on my name. But his pager chirped, and he glanced at it with a slight grimace. “I think you’re going to be more useful than our intern this month, actually,” he said, “not that there’s a big hurdle there. Clancy is a pestilential twit. You’re a better surgeon than him already”—his grin returned—“and you’re definitely better looking.”
Hmm. Although scrubs seem designed to render the wearer as rectangular as possible, I knew that my figure still came across as feminine. I was lucky: I was curvy but slender, even though I ate like a starving carnivorous beast.
Dr. X took a step toward me. He had dark blond eyebrows that reminded me of Jack Nicholson or the Grinch, perching with attractive malevolence above a face with deep linear dimples. “Let’s grab a coffee and get acquainted,” he offered. “The chance of sleeping is minimal. Trust me.”
I was mildly surprised. Was this normal, or was this some kind of ambiguous flirtation? I mean, who wants to get acquainted in the middle of the night? Like every other industry, the hospital was awash in sexual harassment prohibitions crafted by committees who might look askance at a chief resident—who wielded considerable power in the training program—hitting on a lowly medical student. And we barely knew each other; how presumptuous of him to assume that I wouldn’t be offended, whether it was, um, true or not.
Before I could answer, my pager went off. It had been only one day, but already I was beginning to loathe this device. Dr. X’s pager blared too: something awry in the ICU. He’d been on the verge of saying something else, but now he bowed to the inevitable and stopped midword to silence the beeping at his hip. He brushed his hair back with his thumb and said, “Well, damn, Sadie.”
—
The Trauma Intensive Care Unit was laid out in a rectangle, with a workstation full of nurses in the middle and robust orange walls probably deemed invigorating by some institutional decorator. Invigoration was sorely needed in here. The patients were, to a man, all unconscious. They lay, misshapen and inflated by edema, some swollen to three or four times their usual size from resuscitation fluid and overtaxed kidneys, hooked to ventilators and infusions. The current composition of my team’s patients tilted toward the young: there were two teenage boys, both of whom were unbelted car crash victims with brain injuries; one drug-addled fool who had blundered onto an interstat
e; a fireworks-gone-wrong case; a guy in his thirties who had sawed down an oak tree, which promptly crushed him; and my guy, Silver. Looking at his huge foamy hospital bed, I struggled to suppress an irrational, selfish burst of envy: yes, Silver was shattered and comatose, but at least he was resting on something soft.
Across the room, I could see Emma, her pale blond hair gleaming with nuclear intensity under the fluorescent lights of the TICU, filling in her chief on the status of Team B’s patients. I returned my attention to the bed closest to us, which held the ill-fated lumberjack. This guy had more tubes than the London Underground. There were tubes in his bladder, his groin, his chest, his neck, his radial artery, his nose, his abdomen, and even one ghastly line going straight into his brain. There was a breathing tube in his trachea, which was connected to a scary bedside ventilator that had as many dials as a cockpit in a DC-10. I stared in horror.
“What’s up?” Dr. X said to the charge nurse, a fit woman named Val. She adjusted a delicate pair of glasses on her nose and began spewing numbers on Lumberjack, none of which I understood. Dr. X nodded. “Book the OR,” he said.
Before she could reply, Dr. X’s gaze sharpened. Across the long room, a cluster of nurses surrounded Silver’s bed, their raised voices competing with the jarring sounds of alarms. I followed Dr. X, edging my way into a space at the middle of the bed, uncertain of the cause of the commotion. I looked at the monitor: Silver’s heart rate was thirty-two.
“What’s happening to him?” I whispered.
Dr. X inspected Silver’s eyes with a light. “Intracranial pressure’s too high,” he said shortly. “His brain stem is herniating.”
“What does that m—”
Emma materialized at my side and took my hand. “His brain is swelling,” she said softly. “See, his pupils are blown.”
I looked. Silver’s eyes were a featureless black, the green irises nearly eclipsed by the enlarged pupils.
The Queen of Hearts Page 3
