Trauma

by CJ Lyons

  “Then a brain tumor that wouldn’t be seen on CT is highly unlikely. I see she’s from Africa—stool studies?”

  “The clinic has already done them four times. No evidence of parasites. And she’s never had any diarrhea.”

  “Still, those can be pesky buggers to track down. Since the ER already has it set up, I guess we can go ahead with the CT. Write up the orders for her IV and some Zofran, and I’ll take it from there.”

  “Don’t you want to exam her?”

  He beamed down at her. “I’m on the match committee for the pediatrics residency program, Ms. Mason. I’ve seen your application to match here in pediatrics. Excellent recommendations. You’ve garnered some high praise from the attendings you’ve worked under. I think I can trust your exam. Dictate the history and physical and the admission note and I’ll sign them.”

  Lucas appeared from the direction of the nurses’ station. “Dr. Frantz?”

  Amanda was surprised at the deferential tone in Lucas’s voice. Lucas was the youngest attending in neurology, but usually that didn’t stop him from being a stubborn and sometimes loudly intense patient advocate—one of the reasons she’d fallen in love with him.

  Dr. Frantz turned his attention to Lucas as if he were granting Lucas a royal audience. “Stone. Good to see you again. How’d the LP on my little guy look?”

  “Normal opening pressure, fluid was clear. I’m waiting for labs, but I didn’t find any signs of meningitis on exam.”

  “Good, good. Harold’s mother will be pleased to hear that.”

  “I’ll dictate a note, page you if anything shows up on the gram stain.”

  “You’ll go look yourself?” Dr. Frantz made it sound like a statement rather than a question.

  Lucas glanced at his watch. “Sure, no problem.”

  “Very good.” Dr. Frantz turned to leave, then stopped, including both of them in his beaming gaze. “By the way, I understand congratulations are in order. I wish you the best of luck and hope Ms. Mason is able to continue working here at Angels. It would be such a pity if things went awry and she didn’t match here, had to leave us.”

  Amanda watched him walk away, then turned to Lucas. “Why do I feel like I’ve just been threatened?”

  8

  Nora abandoned her paper shuffling and walked down to OR 13. The police had placed a large X of crime scene tape across the double doors, like on TV. The yellow tape looked bizarre, surrealistic. But what had happened behind those doors was all too real.

  She shook herself and looked down the hall. OR 13 was in the back of the ER, at the end of a short corridor. The only other rooms down here were the locker rooms and clean holding. Then was the intersection with one of the main ER corridors: turn left and there was security, the trauma rooms, nursing station, and at the end, the ambulance bay. Turn right and you’d hit the corridor leading to administration, the conference rooms, cafeteria, atrium, and auditorium. Or you could loop back around into the ER.

  The place was a maze. Whoever had stolen the rape kit had to have been someone who knew the ER, could move around without anyone noticing. She sighed, tugging her fingers through her hair, using the pain to focus. If Karen had been in one of the ER’s resuscitation rooms, everything would have been caught on tape—they all had cameras, for teaching purposes. But there was no camera in Room 13.

  She and Seth had only been gone maybe ten minutes at most. And Miguel had been here the whole time. Or had he? She stared at her reflection in the dark glass of the OR doors, trying to visualize the frenzied moments after Karen’s death.

  Miguel had had his trash cart with him when she’d run into him. He would have needed to go back down the hall and around the corner to the janitor’s closet in order to get his mop and bucket. Trying to walk at the same pace as Miguel pushing his cart, Nora went down the hall and turned the corner. It took less than a minute.

  The door to the janitor’s closet was open, cleaning supplies scattered on the hallway floor. The police obviously had had the same thought and searched here already. No crime-scene tape, so she was guessing they didn’t find anything.

  Okay. But if Miguel was down here while the rape kit was stolen, could it have been hidden somewhere in the ER? It would be a gutsy move. Whoever took it could have easily been seen by Miguel or anyone once they turned out of the OR hallway.

  “Nora, what are you doing?” Seth’s voice interrupted her reverie.

  “Trying to find that rape kit.” She didn’t have energy for Seth right now. It was easier to focus on solving the problem of the missing evidence than dealing with their problems.

  “I wanted to see if you were okay.”

  “I’m fine.” She shoved the cleaning supplies back into the closet and shut the door. Miguel wouldn’t appreciate the mess, but patient safety came first.

  “Hey, look at me.” Seth touched her elbow. “Are you sure?”

  She could feel his gaze on her, but she didn’t look up to meet it. “I told you, I’m fine.”

  “That’s what you always say.” He tipped her chin up so that their eyes met. “This is me, remember? You can’t lie to me. It’s your freckles, they give it away.”

  She shook her head at his attempt at levity. Leave it to Seth to make a joke at a time like this. Life was one long beer commercial to him.

  “Did you tell them, um, about before?” he asked. “That it was the same guy?”

  “No.” The single syllable fell like a lead weight between them. “No,” she repeated. “I didn’t tell them. But I will.”

  Seth shifted his weight, fiddling with the hemostat clipped to his waistband. “Anything I can do to help?”

  “I didn’t tell the police about you and Karen, either. But it came up when I was talking to Tommy Z. The police are going to find out.”

  “What makes you think I didn’t already tell them?”

  “Did you?”

  He looked down at the floor, worrying at a seam in the linoleum with the toe of his shoe. “No. I didn’t think it mattered. Karen and I weren’t together. I keep trying to explain that to you, but you won’t talk to me unless it’s about a patient.”

  “Yeah, right.” She turned her head, refusing to look at him. He’d tried to get her to believe that same old malarkey after they broke up, had even come close to stalking her, leaving her favorite flowers for her day after day. “Whatever.”

  He surprised her by touching her arm. Startled, she jerked away so hard she hit the wall behind her.

  Seth stepped back, giving her room. “No. It’s not all right. I’m sick and tired of you not listening—I didn’t push things before because it seemed to only hurt you more, but I can’t let you keep thinking—”

  “Thinking?” Nora straightened, staring at him head on. “How about seeing? I saw you, Seth. Naked. In Karen’s bed.” She spun on her heel, walking away. “Leave me alone.”

  He followed her. “Damn it, I did not sleep with Karen.”

  His voice was loud enough that a passing X-ray tech turned to stare at them as he walked past. Nora felt herself blush—more fodder for the rumor mill. The anger that had been building in her all day seeped past her restraint. She whirled on him. “Shut up. I don’t want to hear your excuses.”

  “It’s not an excuse. It’s the truth.” He grimaced. “I was sleepwalking.”

  She stopped, frowning at him. Then laughed. “Sleepwalking? That’s the best you can come up with? We lived together for three months and you never walked in your sleep.”

  He flushed. “I haven’t done it since I was a kid.”

  “Yeah. Right. Why even bother denying it? I saw you and Karen together, Seth. Naked.”

  “You saw me in her bed. You did not see us having sex. I swear to God, nothing happened. I guess I stripped naked while I was on call and started wandering the halls. Karen took me to her room, tried to make me think we had had sex. She wanted to break us up, so when you came along . . .”

  Nora shook her head, trying to make sense o
f all of this. “C’mon, Seth, do you really expect me to believe any of that?”

  “That’s why I didn’t tell you before. I knew you’d never believe me. Ask Lucas if you want.”

  “Right, like your best friend isn’t going to lie for you.”

  He clenched his fists, his face flushing with frustration. “But now I can prove it.”

  “Don’t bother. It’s too late for us, Seth.”

  “No. It’s not.” Seth’s trauma pager blared through the air between them. “Shit. I have to go.”

  He didn’t move, waiting until she finally met his gaze. Dark brown eyes that warmed her despite the distance between them. “I have never lied to you, Nora. Never have, never will.”

  “Right. Like my own eyes lied instead.” Nora wasn’t sure what she felt—anger, disbelief, or betrayal that he’d continue to argue the facts. How could he? She’d seen Seth and Karen together. It wasn’t rumor or gossip or innuendo. It was the truth.

  Seth merely shook his head as the trauma alert sounded once more. “Someday you’ll believe me.”

  He turned and sped down the hallway toward the resuscitation rooms.

  “Rollover MVA, restrained driver, twenty-seven years old, no LOC, complaining of substernal chest pain and right shoulder pain.” Trey called the bullet to Lydia as he and Gina wheeled a man strapped to a stretcher into the trauma bay. “Two large-bore IVs in, one and a half liters LR, O2 by mask, pulse ox ninety-eight, pulse one twenty-eight, resps twenty-two, BP one twelve over seventy-two.”

  “Move on three,” Lydia directed her team as Seth Cochran rushed in. They transferred the patient to the ER’s bed and she allowed Seth to take command, following along behind him to make sure he didn’t miss anything. The nurses kept looking to her for confirmation of his orders as he ran the resuscitation. She remained silent, reinforcing Seth’s authority.

  He did a good job. Thorough, efficient, not distracted by the chest pain or seemingly normal vitals, quickly making a diagnosis of a subcapsular splenic bleed.

  “Nice work,” she told Seth as they stepped outside while the nurses packaged the patient for transfer up to the OR.

  He leaned against the wall, one hand twirling his trauma shears, looking down at the floor. “Wish I could have done as well with Karen.”

  “You did everything you could. We all did. We just got to her too late.”

  He shook his head, glancing over to the nurses’ station, where several nurses stood, arms crossed over their chests, glaring at him. “Too late for a lot of things.”

  Glen Bakker strolled past them, making yet another highly visible circuit of the ER. Lydia understood that he was trying to reassure the staff, but it was getting damned annoying bumping into him every ten minutes. Seth stepped forward into the security head’s path.

  “When the hell are you going to tighten security in the garage?” he demanded. “My car got keyed again.”

  Glen stopped, hooked his thumbs in his belt loops, and rocked back, angling his gaze down at Seth, who was shorter by several inches. “Dr. Cochran, right?”

  “Right. Remember me from last month when someone bashed out my taillight? I keep filing reports, but nothing is ever done and my insurance premiums are going through the roof.”

  “Well now, doc, you could always park on the street if you don’t like the hospital parking accommodations.” Glen’s mouth twisted. “I’m sure you understand that I need to place the safety of the people who work here over a few dings and scratches to your car.”

  A small round of applause broke out at the nurses’ station with that pronouncement. Seth reddened, then stepped forward into Glen’s space.

  “I’m not worried about my car, you idiot,” he said, not backing down despite the fact that Glen had several inches and about twenty pounds on him. “I’m worried about the people who work here. Like Karen. And Nora Halloran, the nurse who found her this morning. What are you doing to protect them?”

  Glen glowered at Seth, who responded by taking another step closer to the head of security. Lydia put her hand on his arm, stopping him before things could escalate into an all-out war—one the surgical resident was sure to lose. “They’re ready for you up in the OR, Seth.”

  He did a double take and backed down. With a parting glare at Glen, he followed the stretcher with his patient down the hall to the elevators.

  “That boy needs an attitude adjustment,” Glen said in a conspiratorial tone.

  “He’s had a rough day. And he has a point. Better security in the garages might have prevented what happened to Karen.”

  “So I keep hearing. Don’t you think I want to do my job the best I can? But I also have to answer to Tillman and the board,” Glen said as Tommy Z emerged from the family room. His demeanor changed instantly from defensive to amicable. “You talk with Tommy yet, Dr. Fiore? He’s real good.”

  Lydia remembered the crushed expression Nora had worn after her chat with the crisis counselor. “I’ll pass, thanks.”

  Tommy joined them and exchanged a glance with Glen. “I have time now, Dr. Fiore,” he said, gesturing to the family room with a sweep of his arm. “No waiting.”

  “Crisis counseling is voluntary. I’ll take care of things on my own,” she said, wondering at the way the two men had teamed up. Then she realized who had to be pulling their strings. Oliver Tillman, the hospital CEO, had a habit of barreling into situations with his swayback gorilla tactics. “Tillman told you two to keep an eye on me, didn’t he? What, does he think that I can’t keep control of things down here in my department?”

  Glen frowned and cleared his throat. “Uh, you might want to go ahead and talk with Tommy, doc. Would be a good example for the staff, good for morale and all.”

  Lydia wasn’t sure of Tillman’s angle—and she didn’t really care.

  “Mr. Tillman was—er—concerned,” Tommy said. “Especially after what happened last month when you refused counseling then.”

  “Excuse me? Tillman blames me for some lunatic breaking into my house and trying to kill me?”

  “It reflected poorly on the hospital when you nearly killed the man. I think he was hoping you’d be more of a team player this time around,” Glen said, having the good grace to at least look embarrassed at having to do Tillman’s dirty work. “The staff is a bit nervous. Mr. Tillman doesn’t want anything to cause further—”

  “Consternation,” Tommy Z finished for him.

  “He asked us to—er—help you see the light,” Glen added.

  “I’m sure you understand. We can talk about anything, really,” Tommy Z said, placing his hand on her arm as if leading a blind woman.

  “Tell you what, boys,” Lydia said, shaking off Tommy’s hand. “I’ll attend counseling as soon as Mr. Tillman does.”

  Both men watched her with mouths gaping open as she strolled back to the nurses’ station and picked up another patient’s chart.

  Jason gave her a thumbs-up and handed her the phone. “Line two is for you.”

  Lydia answered the phone, expecting it to be an update on one of her patients. “Dr. Fiore.”

  “Lydia! It’s Pete Sandusky. How the heck are you?”

  She barely avoided a groan. Sandusky was Pittsburgh’s answer to the Drudge Report—a blogger who occasionally grabbed headlines in other media as well. “I’m busy, Sandusky.”

  “Wait, don’t hang up. I heard on the scanner this morning that the cops were responding to a sexual assault case over there.” His voice sped through the line with the force of a freight train. If she hadn’t met him in person and known that was his usual breakneck pace, she’d wonder if he was on drugs.

  “Didn’t think much of it, but happened to be driving by and saw crime-scene tape in the cemetery, and lo and behold there was our favorite homicide detective, Jerry Boyle, digging in the mud. So,” he paused for effect, “what kind of assault was it? Some kind of warped vampire cult? Maybe a voodoo ceremony gone awry? None of the papers or TV channels have squat yet. C’mon,
Lydia, give. You owe me.”

  “I don’t owe you anything, Sandusky. Good-bye.” She hung up, his sputtering protestations still echoing from the receiver.

  Lydia leaned back in her chair and closed her eyes for a brief moment. When was this day going to end?

  9

  While Gina waited for Trey and Gecko to finish restocking after their MVA patient, she glanced through Tank’s chart. He was still in the ER, waiting to go upstairs—from the orders, it looked like Dr. Frantz had won the battle over the PICU admission.

  “Reading anything interesting?” A familiar voice made her smile despite herself. Ken Rosen, an immunologist and infectious-disease specialist. And the real Hero of Angels. Ken had saved a bunch of kids during the riots last July, even though it was Gina who had gotten the public credit.

  Ken smiled back—he was almost always smiling, this small I-know-something-you-don’t-know, infuriatingly Zen-like smile that drove Gina nuts.

  When Gina had once tried to explain the way Ken made her feel, Amanda had said it sounded like chiggers: an itch just under your skin that you could never scratch and irritating as hell.

  “I see Dr. Frantz called in the big guns, consulting neuro and ID. You tell him your thoughts about pretreating with broad-spectrum antibiotics?” she asked Ken.

  “Didn’t have the chance. He was too busy schmoozing the mom.” He took the chart from her but didn’t open it, instead holding it between them like a shield. “So, Gina. How are you?”

  “I’m fine.” Now she had to force her smile. “Got a great dress for Saturday night. You’ll be there, right?”

  A swift frown shadowed his face, gone before she was even sure it was there. “No. Sorry.” Now he opened the chart and seemed intent on studying it, drifting away from the nurses’ station as he headed toward the isolation room.

  Gina watched him go, annoyed that she even cared. But damn it, she wanted to try to get things right—this time. Ken was the real hero. He was the one who deserved a medal, not her. She rushed after him. “Are you certain you won’t reconsider and come to the gala?”