by Daniel Kalla
I took the call. The receiver froze in my hand when the gravelly-voiced dispatcher told me, “I got a crew on its way with a neck stabbing. A drug dealer. Twenty-year-old male Hispanic…”
I swallowed away the dryness. “Status?”
“He lost a liter of blood at the scene. He’s begun to compromise his airway.”
“ETA?”
“Three minutes.”
I looked at the clock. 11:40 A.M. “Who stabs anyone before lunch?”
The dispatcher chuckled. “No such rules in the drug trade.”
“Okay, got it,” I said, but my mind was already elsewhere. Could this stabbing be related to Emily’s?
I’d barely hung up the phone when I heard the faint wa-wa-wa of the siren. Overhead the page of “Trauma—two minutes!” bellowed from the speakers. I raced down the hallway to the Trauma Room. The siren’s wail grew steadily. As I stepped into the room, one of the nurses handed me a yellow waterproof gown, gloves, and the clear face shield we always wear when facing the risk of spraying blood or body fluids. I had just slipped on the second set of gloves when the siren’s noise abruptly stopped.
There was a moment of quiet—the calm before the storm—and then shouts echoed down the hallway. Seconds later, the stretcher burst into the room. One paramedic propelled the stretcher; the other had his hand clamped against the patient’s neck, no doubt trying to plug a leaking dyke.
The Hispanic boy lay remarkably still on the stretcher. His color was dusky, his eyes bulging. He breathed in panicky short bursts, producing the kind of high-pitched gasps that brought an instinctive cringe. Thoughts of Emily evaporated as I hurried over to the critically ill patient.
The able paramedic—who I knew only as Juan—had his hand stapled to the boy’s neck. Without looking up, Juan said, “Kid’s name is Enrique Martinez.” Then he muttered something in Spanish to his patient.
“No English?” I stood on the other side of the hospital stretcher waiting for Juan and his partner to swing the boy over from the ambulance gurney.
“He does.” Juan nodded. “Just trying to reassure him. I told him that everything is okay. The doctor is here.”
I wondered.
Enrique had barely touched the stretcher when the nurse had the rest of his shirt (already cut open by the paramedics) off completely. The spaces between the ribs of his skinny gray chest sucked in with each small grunting breath. Out of the corner of my eye, I noticed that Juan’s hand pulsed back and forth against Enrique’s neck. I didn’t need to lay a hand on the patient to know he had an expanding traumatic aneurysm of his carotid artery. Untreated, the only question was whether the wound would cause him to suffocate or bleed to death first. My money was on suffocation.
“We’re intubating. Now!” I said to the charge nurse, Grace. “Tell ENT and Vascular Surgery. He’s going to the OR stat as soon as we’ve tubed him.”
“Which drugs, Ben?” Grace asked.
“None.” My heart pounded and my mouth dried. I elbowed my way to the patient’s neck. “No time for drugs. And we can’t risk paralyzing him. His vocal cords might be totally obscured by the aneurysm.”
With monitors now attached to Enrique, alarms blared their concern that his pulse was too fast, his blood pressure too low, and his blood critically deprived of oxygen. All the while, Enrique lay wide-eyed and still on the stretcher, his nostrils flaring with each high-pitched gasp.
I leaned closer to him. “Enrique, we need to pass a tube into your lungs to help you breathe. You’re going to feel discomfort in your throat. You might even gag. But it will help. Trust me.”
Enrique either nodded or his head just bobbed in sync with his desperate breathing. I had no time to sort out which.
I took the laryngoscope from the respiratory tech’s outstretched hand, aware of its sobering weight. Enrique didn’t fight as I eased his head back into the “sniffing position” on the stretcher. I opened his mouth and slid in the laryngoscope’s blade. When I pulled his tongue forward with the device’s handle, the sight of a pulsing red glob of tissue met my eyes. As I’d feared, the expanding aneurysm had pushed his normal structures out of the way. All I could see was the relentless pinkish mass.
Sweat beaded on my brow. I repositioned the blade to my left and pulled harder. Enrique groaned in response but his head held still. I caught a glimpse of white—not the usual “pair of white running shoes” view of the vocal cords, but enough to orient me.
Afraid the streak of white might disappear like a ship in dense fog, I barked to the respiratory tech: “Tube!” She slapped the clear snorkel-like device into my right hand. Without waiting, I snaked it into the mouth and aimed it for the white patches. I had to rock the tube slightly before I felt the reassuring thuds of the tracheal rings as it glided down his windpipe.
Enrique coughed, and the sound whistled from the tube, confirming that it was in the right location. Even before the tube was attached to the ventilator, his breathing quieted and his chest relaxed because he finally had an unobstructed passage to breathe through.
While the respiratory tech taped and stabilized the tube and attachments, I turned to Juan. “I want to have a look at his neck wound.”
Juan frowned. “You sure?”
I nodded.
He hesitated and then slowly peeled his hand off Enrique’s neck. A few inches below the angle of his jaw, the skin swelled out like a baseball cut in half. In the center, a tidy incision, no more than a half an inch, cut horizontally across his neck. A drop of blood oozed from the base of the laceration as the wound throbbed in rhythm with the baseball below it.
I glanced at Juan. “Okay, you can put your hand back. Meantime, Grace, let’s get a pressure dressing on the wound while we transfer him up to the OR.”
Before either could respond, a geyser of blood erupted from Enrique’s neck. I stumbled back as it hit me square in my upper chest and splattered my face mask.
“Resume pressure!” I yelled.
Juan’s hand slapped noisily against the patient’s neck. But even with the aid of his other hand, he had trouble holding his grip. The blood swelled between his fingers and cascaded over the top of them, making the skin of his neck as slippery as ice.
“Blood pressure is falling!” Grace said.
Enrique’s eyes rolled back in his head. I knew he didn’t have enough blood reaching his brain to maintain consciousness. “To the OR now!” I shouted. “Let’s go!”
Someone unclamped the brakes to the stretcher. As soon as I heard the click, I shoved the stretcher and hurtled it toward the door. The staff fell into a well-choreographed routine, moving IV poles, bags of blood, and the ventilator in step with the stretcher. We sprinted as a group for the end of the hallway.
At the doors of the surgical suite, Juan shouted, “I’ve lost the pulse!” Like a pole-vaulter, he hopped onto the stretcher. Knees straddling Enrique’s chest, Juan knelt over the patient and began urgent chest compressions.
The surgical team met us at the door. “Okay, we’ve got it from here,” the anesthetist said as he moved into my spot and assumed control of the stretcher. He tapped me once on the shoulder to let me know my job was done. He turned to his OR nurses. “Let’s get him in the room!”
Nodding, I took a step back and watched as the stretcher was wheeled away. With Juan still riding Enrique’s chest, the procession soon disappeared behind the operating room’s closing doors, but I knew they were fighting a battle that was already lost.
I sat at the desk scribbling my notes in the ER’s disheveled and stretcherless Trauma Room. I’d washed my face and neck, but I still had stains on my scrubs from the blood that had leaked around the neck of my gown. The room’s floor had been hurriedly mopped but was still awaiting a proper decontamination. I could see splatters of missed blood. They reminded me of Emily’s apartment, and that solitary arc of AB-negative blood on her wall. Her killer’s blood.
Grace poked her friendly round face through the curtains covering the entry of t
he room. “Enrique didn’t make it,” she announced softly.
“Yeah.”
“We did all we could,” Grace said soothingly.
“You figure?”
“You secured his airway. There was nothing else you could do, Ben.”
“I should have never told Juan to release his grip on the boy’s neck. He should have gone to the OR with that hand in place.”
“He wasn’t bleeding at that moment.” Grace’s voice wavered before regaining its conviction. “The artery could’ve erupted at any time. You can’t plug a burst pipe with the palm of your hand. You know that.”
“True.” I mustered a smile, grateful for her support but wishing I believed her more. “Thanks, Grace.”
“It’s not your fault, Ben.” She withdrew her head from the gap in the curtains.
I turned back to the chart. Grace had a point. Regardless of my decision to expose his neck, Enrique was unlikely to have survived. The odds had been stacked against him. And long before the knife pierced his neck, too. Enrique wasn’t so much a victim of my medical mismanagement as he was of his unsavory and lethal trade. Fucking junk!
“Dr. Dafoe?” The small voice grabbed my attention through the curtain. It sounded familiar, but I had trouble placing it. “It’s Lara Maxwell. I’m on my way home. The nurse out front said I could find you here.”
“Of course, Lara,” I said, genuinely pleased to hear her. I stood up and pulled back the curtains.
In a T-shirt and sweats, with her hair tied in a ponytail and a mouth full of gum, Lara could have passed for even younger than fourteen. After having seen her suffer through some very adult afflictions, both an overdose and associated heart attack, I was tickled to see the childlike innocence back on her face.
Lara’s jaw fell open as her wide eyes took in the messy surroundings. “Is this where I was…when…after the ambulance?”
“Only for a couple of hours.” I smiled and folded my arms across my chest, conscious of the bloodstains on my scrubs. “A long tense couple of hours, mind you.”
She appeared dumfounded.
“How are you?”
“Good.” She chomped on her gum, unable to take her eyes off the floor. “I’m going home today.”
“I’m glad.”
She looked up at me shyly. “Dr. Dafoe, I just wanted to say thanks again for…” She cleared her throat. “You know…”
“I know.” I nodded. “You’re welcome, Lara. Cases like yours make this job feel worthwhile.”
“That’s good,” she said vaguely. Her eyes fell to the ground again, and her feet shuffled in place.
“Lara? Is there something else?”
“You know what you told me and Isabelle about…um…your brother?”
I tensed at the mention of Aaron. “Yes?”
“Did that one time using drugs…” She cleared her throat again and looked up at me plaintively. “Did it really ruin his life?”
I inhaled slowly. I studied the spatters on the floor. Now they reminded me more of Aaron’s burned and bloodstained car. “I was exaggerating, Lara.”
She squinted at me in confusion. “The drugs didn’t ruin his life?”
“It was more complicated than that,” I said, struggling to explain. “It wasn’t just one time with him. Aaron got heavily into drugs. And if not me, someone else probably would have introduced him to the junk. But it’s still hard not to feel responsible.”
“Okay,” she said, but her eyes begged for more reassurance.
“Lara, you don’t need to worry,” I said. “You dodged a bullet—granted, a big and pointy one—but you’re going home healthy. I suspect you’ll never look at those ‘harmless’ rave drugs the same way.”
“I’m not going to look at them at all!” Lara spat. Her eyes moistened and her voice cracked. “I’m going to warn my friends, too. No one tells us that this stuff can kill you.”
“You’ll make a good spokesperson.”
She flung her arms around me and gave me a quick hug. Embarrassed, she turned away without making eye contact. “I’m sorry about your brother, Dr. Dafoe,” she mumbled. “But thanks for saving me.” Without waiting for a reply, she hurried out of the room.
I tallied the week’s ER scorecard in my head: one win, one loss. Batting five hundred might be a good stat in baseball, but it wasn’t very impressive in an Emergency Department. Still, Lara’s visit lifted my spirits after Enrique’s demise.
I felt even better when I stepped out of the Trauma Room and bumped into Alex heading the other way. She stood close enough that the floral scent of her shampoo drifted to me. She pointed to the collar of my scrubs. “What the hell, Ben?”
“Neck stabbing.”
“Oh.” She nodded. For a fellow ER physician, that was explanation enough.
“You got time for a coffee?”
“Depends.” She grinned. “You got a new shirt?”
“You’re so damn superficial.” I chuckled. “But yeah, I’ll go slip into something less conspicuous. I think I’ve got another one in my locker with only urine and vomit stains.”
Alex rolled her eyes. “You’re all class, Benjamin Dafoe.”
I grabbed a T-shirt from my locker and slipped it on. Heading out of the hospital in the steady rain, I regretted not taking my jacket. The late afternoon was even colder than the morning. I was shivering by the time we stepped into the coffee shop across the street and grabbed a booth.
Sitting with coffees in front of us, I asked, “How’s kindergarten working out for Talie?”
Alex’s eyes lit up. “Much better than preschool!”
“How so?”
“She’s called a truce with Ella, her archenemy from preschool.”
“I didn’t know you can have an archenemy in preschool.”
“Me neither.” Alex laughed. “But those two were oil and water. Until a couple of weeks ago when they discovered a mutual love of those tiny Polly Pocket dolls. Now they’re the bestest of friends.”
“Ah, if only Disney and Mattel ran the world…”
“I think they already do,” she groaned.
I had a sip of my coffee. “And Marcus? What’s he up to?”
At the mention of her husband, the joy drained from her face. “He’ll be tied up in New York for a while longer,” she said with an evasive shrug.
“That blood bank business of his is really taking off.”
“I guess,” she said distantly. “Seems like all new parents want to store their children’s umbilical cord blood.”
I knew that umbilical cord blood contains stem cells that, if stored at birth, can be used later to repopulate the bone marrow with healthy cells in the event a bone marrow transplant is ever required. It represented another form of insurance for parents, and I understood the demand for it. If I ever had a child, I would probably want the same.
“So let’s hear about your trauma patient,” Alex said, clearly trying to divert the conversation away from the topic of her husband.
I told Alex about Enrique Martinez’s stabbing. She said all the right things—the same things I would have said, but not necessarily believed, if our roles had been reversed. Still, I felt better for having vented to her.
She reached out and squeezed my hand supportively. “So, how are you?”
I looked away and bought some time with a long sip of coffee. “Okay, thanks. Better, really.”
“Hmmm.” She let go of my hand. “The cops still don’t have any leads?”
“I pulled myself or I was pulled—I’m not sure which, actually—from the case. I haven’t heard in a couple of days.”
Alex studied me intently. “And that’s killing you, isn’t it?”
I smiled. “You have me pegged for a control freak, huh?”
“No,” Alex said, stone-faced. “I know how much Emily meant to you. If I were in your shoes, I would be desperate to know who did that to her.”
“You’re not far off,” I said. “I’m half tempted to start my own
investigation.”
A smile broke through Alex’s tight lips. “What with all your training and expertise.”
“Alex, I can’t shake this sense that somehow Emily’s death and Aaron’s—” I stopped the moment I saw Rick step through the door.
Alex turned to look over her shoulder, and we silently watched as Rick and Helen approached.
I introduced Alex to the detectives. She glanced at her watch. “Oh, darn. My shift started five minutes ago.” She reached over and tapped my hand. “Ben, call me later, okay?” She snatched up her coffee and hurried for the door.
Helen stood and fingered her chunky necklace that had so many big colorful stones it looked as if it would strain her neck just to hold it up. “A nurse in the ER told us we’d find you here. May we join you?”
“Sure.”
Helen eased herself into the booth. Rick dropped into the spot beside her.
“You already heard about Enrique Martinez?” I said.
Helen grimaced. “Enrique who?”
“The neck-stabbing victim. Killed the same way J.D. was.” I glanced from one blank face to the other. Suddenly, I felt on edge. “Isn’t that why you’re here?”
Looking particularly subdued, Helen simply shook her head. Even more unsettling, Rick hadn’t yet smiled.
“What is it, then?” I asked.
“We wanted to follow up on a few loose ends,” Rick said.
My sense of alarm rose another notch. “Like what?”
As if overpowering his restraint, Rick’s lips curled into a slight smile. “For starters, Ben, do you happen to know your blood type?”
Chapter 8
“I’m a suspect?” I struggled to keep my tone under control.
“We’re dotting ‘i’s and crossing ‘t’s, Ben,” Helen said sheepishly, but her reassurance brought me no comfort.
This can’t be happening.
Rick scratched his chin, unperturbed. “Do you have any idea what percentage of murders are committed by the significant other or the ex?”
