“Right,” she said, a little uncertainly. “So—what’s up?”
“Oh.” I briefly debated with myself. Maybe now was not the best time for this.
“Go ahead, Em,” Zadie broke in. “Out with it. My day is not going to get worse.”
“I talked to Nick. He said he wants to tell you he’s sorry.”
“. . .”
“Zadie? Are you there?”
“My day is getting worse. You called him back? Did he say anything about the dog?”
“I didn’t call him,” I replied. I paused, choosing my words carefully. “He showed up at the hospital. Said he’s getting a divorce, plans to stay here, and he saw us both on the news and he wants us to be friends. I’m sorry. I forgot to ask about the dog’s name.”
Silence, then a faint crashing sound.
“Zadie?”
More silence, then some background rustling. Finally: “Sorry! Going to have to get some more wine here!”
Maybe I should have called Wyatt first after all.
Chapter Seventeen
NONNEGOTIABLE RULES
Emma, Present Day
In contrast to the rules for the residents I trained, there were no limits on how many hours I could work in a week. There were no limits on the number of hours I could work in a row. There were only so many trauma surgeons, and one of us had to be at the hospital at all times. Thus I found myself back on in-house call again on Wednesday night, covering for a colleague whose mother had died, only two days after the marathon call beginning Monday morning that brought me the Packard child.
It was the middle of the night and I was tired. Being tired wasn’t unusual though; I’ve been working this kind of schedule for many years. But yesterday’s interaction with Nick had left me uneasy and unsettled in a way I couldn’t seem to shake. He held the power to upend my life, and I had no idea what to do about it.
But I also lacked the luxury of time to fret about it. If there’s any consistency to trauma call, it’s the likelihood that all hell will break loose at the darkest, most forlorn hour of the night. While most of America sleeps, the ER docs, the anesthesiologists, and the surgeons (among others) are toiling away, trying to stem a tide of catastrophes that can’t wait until morning. (I’m not including the OBs in this list, although they get hammered more than anyone else at night. But at least their nocturnal work is more likely to be happy.)
Three o’clock in the morning: my least favorite time of day. There’s a lull sometime around this point every night, lasting just long enough to bring on an internal debate about whether or not it’s worth it to try to sleep. I used to be able to catnap and get some benefit from it, but after I had Henry, I couldn’t rally like I used to. It was better not to sleep at all than to be forced into action forty-five minutes after you lay down. On the other hand, if I could get a few solid hours in a row, I’d feel much better.
So I eased myself onto the uncomfortably firm bed in my call room, and of course my pager went off a few minutes after I finally fell into a desperate, hard-edged sleep. A dull heaviness encased me as I awoke, as if my metabolism had slowed to a tenth of its normal speed. I jumped up and was forced to bend forward at the waist as a wave of nauseating dizziness pulsed through me.
I panted for a moment, head between my knees. Was I sick? Or was this some physical manifestation of stress? Maybe I was too old for this. I’d always prided myself on my toughness, especially since I work in a field so completely dominated by men. My phone beeped a reminder, and I forced myself upright. Another level-one trauma en route. I started down the hall, staring at the maroon carpet under my feet.
From years of painstakingly patching up people who’d been squashed, shot, stabbed, and mangled, I’d developed a healthy degree of safety consciousness. Everyone who knew me also knew my nonnegotiable rules: no alcohol or cell phone usage if driving, no guns, no climbing on roofs, and of course, you didn’t set foot in my car without a seat belt. (Although my safety measures didn’t quite approach the level of paranoia manifested by one of my med school professors, a guy named Cyril Herring, who insisted on wearing a ridiculously conspicuous NASCAR-type helmet everywhere he drove.) I also privately believed alcohol should be off-limits for anyone who exhibited poor impulse control, although I hadn’t quite worked out how to implement that one.
As I regarded the scene in the ER, I reflected that maybe Dr. Herring had been onto something. Head injuries are the bane of trauma surgeons: most often these patients aren’t fixable. Our brains contain one hundred billion neurons, but exactly how they function is still something of a mystery. Especially when they’ve been flung into a dashboard at forty-five miles per hour.
The other injury I detest in trauma patients is a bunch of broken bones. I couldn’t do anything for broken bones, and the people who could—orthopedic surgeons—intimidated me. A race of overgrown, jocular, self-appointed surgical overlords, they lumber around the hospital confident in the belief that nothing trumps a fracture. As an illustration of this, the orthopedic surgeon standing in the ER right now had once stormed up to me in the TICU, commanding me to book an operating room for him stat so he could fix our mutual patient’s femur fracture. I declined to call the OR for him, which prompted a condescending lecture about the time-critical nature of restoring a pulseless extremity. I listened without interrupting and then politely informed him (a) I was the trauma surgeon, not the nurse, and (b) perhaps the patient’s leg was pulseless because he had died several hours ago, a fact that had escaped this doctor but not the family of the patient, who were watching this exchange with open mouths. I was right, of course, but despite this, none of the ortho guys here seemed to like me.
So this patient had a nonoperable head injury and a broken leg and some spine fractures and was going to be absolutely uninteresting from a management standpoint, but he was my responsibility because he had multiple body systems involved. Neurosurgeons and orthopedists don’t manage patients who have other injuries. I nodded to our midlevel resident and intern to take over the workup, and I headed for the door.
Before I could get ten feet outside the ER, my pager informed me the EMTs were five minutes out with another one. I resigned myself to yet another night without sleep.
This one was more palatable: another guy, another drunken car crash, but at least he had chest and abdominal injuries instead of a head injury. I wasn’t particularly fired up about going back to the OR, but it would have the benefit of keeping me awake. And it would make the time pass quickly until morning. Sanjay, along with our med student, barreled off to scrub; I limped along behind them, battling another surge of nausea and fatigue. I straightened my shoulders and told myself not to be a wimp.
But I felt even worse when I got to the OR. One of the scrub techs, a vapid, tattooed woman named Darla, cut off her droning chatter midword as I entered the room. She might as well have worn a sign around her neck: I WAS COMPLAINING ABOUT YOU, DR. COLLEY. I waved a tired hand at her.
The circulating nurse mistook this for permission to resume their conversation. Ignoring them both, I buttressed my leaden body against the solidity of the OR table, trying to breathe deeply enough to stave off the urge to crumple up in the fetal position.
Some of Darla’s giggly words filtered out to me: “. . . foxy and nice . . . Sherry says . . . just divorced . . .”
“Can we get it quiet in here?” I said, my tone harsher than I intended.
All conversation ceased.
Trembling, I considered my options. I could let Sanjay and the medical student do the case, but it was too early in the year for that: the medical student, eager though he was, was only one step up from the average fool on the street when it came to surgical ability. I trusted Sanjay as much as I trusted anyone who wasn’t me, but that wasn’t saying a lot: it’s widely acknowledged that I have control issues.
But I should have. I should have. I should have le
t Sanjay take over. Something was wrong with me—fatigue, or sickness, or stress—and only a few minutes into the case, I made a mistake. A big mistake, a stupid, completely avoidable mistake: I wasn’t careful enough as we cut open the lining of the abdomen, and I sliced a hole, a very big one, in the patient’s small intestine. At this hour of the night, one might hope for a relatively empty GI tract, but unfortunately this was not the case here. Not only had this man gotten all liquored up before wrecking his car, but at some point in the evening, he’d apparently ingested a meal gigantic enough to power an entire NFL team, which was now enthusiastically coursing its way out of the unexpected opening in the bowel. I stared, horrified, for a second before Sanjay grabbed the loop of bowel and elevated it, calling for the scrub nurse to give him some irrigation.
“Ah,” I stuttered. What had been a relatively straightforward case had suddenly veered off into unexpected territory, placing the patient at much greater risk of complications. He might even have to have an ileostomy, or an artificial opening made along his abdomen to allow waste to exit his body.
“Dr. Colley,” said the circulating nurse on the other side of the room, oblivious to what I’d just done. “It’s Dr. Garber.” She gestured behind her, where the cord of the phone looped down from the wall onto a long counter. Dr. Garber was Melinda Garber, our team’s intern. “She says she keeps getting paged about one of the patients—something about a falling urine output—and she wants to know if somebody can go evaluate.”
“Why can’t she do it?” I snapped, aggravation momentarily eclipsing my distress. Melinda had a reputation for trying to pawn off her work onto other people. “How long have they been paging her?”
“She says she’s with the other trauma patient you guys got tonight. A head injury.”
“I know that,” I said. “So?”
I returned my attention to the unfolding disaster in front of me as the circulator murmured into the phone. Caustic bowel contents were flooding everywhere, along with what appeared to be several dozen kernels of intact corn. I shuddered, close to vomiting.
“She says he’s not stable,” the circulator said, as the medical student reared up behind me for a better look.
“Wow,” he said.
“Not stable? What does that mean?”
More murmuring. “She says she has to go,” the circulator announced, hanging up the phone. “She said she and Dr. Schreiber”—Dr. Schreiber was the midlevel resident—“are going to work on him.”
“What? Work on him? What does that mean?” I said. “Call her back.” The only part of Sanjay’s face I could see behind his mask was his eyes, but I could tell he was grimacing, although whether from Melinda’s uselessness or the fiasco in front of us, I couldn’t tell. We worked in grim silence.
“She’s not answering,” the circulator said several minutes later, at the same time as Sanjay announced, “I think we need to divert him, Dr. C.” Silently I concurred with the need to place an ostomy; without an artificial opening from the intestine to the outside of his abdomen, the patient was now at risk of a giant, festering infection if this leak continued. Shame crept up my body in a wave of heat.
The anesthesiologist popped his head over the blue curtain. “We’re having trouble ventilating here,” he said. “We sure there was no pneumo?”
He wanted to know if the lung could be collapsing. “No, there—”
“One of the ICUs is calling you, Dr. Colley,” interrupted the circulator.
“Because we’re getting a really high airway pressure here.” An alarm began to sound behind the anesthesiologist.
“Dr. Colley, look out,” said Sanjay suddenly, ignoring the anesthesiologist. “We’ve got a bleeder somewhere.”
“Suction,” I ordered, reeling. I turned to the medical student. “Break scrub and call the radiologist; ask him to review for a small pneumothorax that we might have missed when we read the films originally.” At his look of befuddlement, I added, “Pneumothorax. It’s an air leak that’s compressing the lung so it can’t expand. Every time we blow a breath into him with the ventilator, we’re making the pneumo bigger and collapsing the lung further. We think.” To the circulator, I barked, “Get a chest tube kit.”
“What do you want me to tell the ICU?”
“Tell them to handle it, or to page Melinda if it’s urgent.”
“Oh my, where is this coming from?” said Sanjay, suctioning furiously. Blood burbled up at us in a hostile spew. “We need to pack this.”
“They can’t reach Melinda, Dr. Colley. They say they need you to come now.”
“Emma.” The anesthesiologist again. “We’re starting to deoxygenate here. I’m pretty sure he’s got a tension pneumothorax.”
“Put them on speaker,” I yelled at the circulator. To Sanjay, I said, “Forget the bowel injury for now. You pack. I’m going to decompress his chest.”
The circulator held up the phone, which crackled anticlimactically for a moment. Then we could hear a panicked voice. “Dr. Colley?”
“Yes, what?” I said. I moved laterally along the patient’s body, preparing to stick a large needle in his chest wall, as the scrub nurse tore open the chest tube kit.
More crackles. “. . . the little girl. Packard.”
I stopped, my hand arrested just above the middle of my patient’s chest wall. “Hurry,” said the anesthesiologist. The loud beeping behind him began to accelerate, followed by a second, continuous alarm sound.
“What about the Packard girl?” I yelled. I plunged the needle into the left side of the chest, a few inches below the clavicle. Nothing.
“Shit! It’s not this side. Where’s the tube kit?”
“She’s coding,” said the voice on the phone.
I was reaching across my patient’s body, ready to decompress the other side of the chest as soon as the scrub nurse handed me another catheter. I froze again. “What did you say?” I said, the burning in my cheeks so extreme I thought I’d be consumed by their fire. I plunged the second needle into my patient’s chest, my hand shaking.
“I said, Eleanor Packard is coding,” the nurse on the other end cried. Dimly, we could all hear shouting and the tiny, plucky sound of alarms through the phone’s speakers, adding to the nerve-jangling shriek of our own alarms. “Please come. She’s coding.”
Chapter Eighteen
COMBAT WITH THE MAXIMUM BAD GUY
Late Summer, 1999: Louisville, Kentucky
Zadie
I was holding the phone between my chin and shoulder, lying with my head propped up on a pile of Emma’s pillows, which she’d transposed to the foot of the bed. Graham, who was omnipresent these days, was lounging outside the open bedroom door, watching some stupid movie. I could hear a steady drone of racing car engines, which were no doubt engaged in a superfluous violent cross-city car chase. Emma faced me, reclining against the headboard, watching the call transpire with undisguised interest. Her entire body had perked up; even her hair seemed to be magnetized with concentrated attention. I felt too weary to hide anything. I wanted comfort, and the best place to be for that right now was curled up with my beloved roommate, wearing my oldest, softest, and least flattering pajamas, trying to distract myself with some bad TV. Well, some bad TV other than whatever ridiculous testosterone-fest Graham was watching. The last thing I felt like doing was romancing it up outside the hospital, even though I’d been clamoring for this for weeks.
“Ah, c’mon, Z. You got me all excited about the date night, and I want to celebrate your last day on the rotation. I had lots of flowery things to say,” X offered.
“Ooh,” I blurted, momentarily intrigued in spite of myself. “Give me a little illustration.”
“Not happening, unless you get your hot little ass over here.”
“We-ell . . .” I said, torn. Maybe I should have rallied. Maybe the best way to erase my blues would have been dist
raction.
Sensing weakness, X pounced. “I got you something, Zadie,” he said, his voice softening. “You’ve been on my mind all day, and I know I should be more courtly to you, especially when it was such a rough day. I know you’re upset”—he hesitated—“and I really want to comfort you.”
Yes, that sealed it. For all his many virtues—brilliance, wit, dedication, scorching talent in bed—X was a man most comfortable in a world of other men; he didn’t normally seem given to expressing emotion or producing spontaneous gestures of thoughtfulness. I know I should be more courtly was, in X parlance, akin to saying I feel a passionate connection of our souls. Or something like that. High drama on a normal day for him might have consisted of a creative cursing streak if a scrub tech dropped his hemostats.
But I knew he was capable of caring deeply about things; I had seen his face go white late this morning when Lima Trauma, the young father with the neck injury, suddenly had a massive stroke and died. X had summoned Lima’s wife, a woman in her early twenties with that kind of pale English skin that is more pink than white. Her hair had been reduced to the consistency of pillow stuffing from repeated bleaching and she was built like a dumpling. Nevertheless, she was a pretty thing, and friendly, even despite the ordeal of her husband’s injury. I could hear her anguished sobbing through the thick family room door as Dr. X broke the news. Lima’s body was gone by the time we finished afternoon sign-out. Dr. X had stood silently by the empty unit bed, expressionless, until the charge nurse Val had walked up behind him and slipped something into his pocket.
I snuck back in and asked Val about it. I suspected Val might be the one person at the hospital who knew about our affair. She was always perceptive, and her glance had gone straight to me a few times during rounds when Dr. X had thrown out some subtle double entendres. But then, charge nurses generally knew everything. When I asked about the item Val had given Dr. X after Lima’s death, I’d been surprised to hear the answer. “Lima’s wife’s name and address,” Val told me. “He always writes to their families. And they almost always write him back; some of them have been corresponding with him for years. He rarely ever talks about it.”
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