by Susan Stoker
“What about his wife?”
“She didn’t seem to be injured in the accident.”
“I don’t give a shit about either of them. They’re not my patients, but I do need them sober enough to sign the damn surgery permit for their son.”
“Well, she was a little incoherent when they came in, but I think she’s more frantic about her son than alcohol impaired. Him? I wouldn’t let him sign anything. I can’t be sure he’s clear-headed enough to give informed consent.”
“Fine. I’ll trust your judgment on that. Get the consent signed for an exploratory lap and call the OR team in. Make sure the blood bank stays two units ahead on packed cells. Oh, and, John, see if you can badger radiology into fresh pictures for the OR. I’d like to have a better idea of what the hell I’m getting into before I cut the kid open.”
“Will do, Tess.”
Tess slammed the phone back on the dresser. “Sonofabitch thinks laws don’t apply to him. Never has thought about anybody but himself. Asshole,” she muttered as she stomped across the room. She jerked open a drawer, snatched out fresh underwear, a pair of fresh scrubs, and marched into the bathroom. As she shut the door, she heard Kyle’s phone ringing. She wasn’t surprised the deputy on duty would call the sheriff when the county district attorney was involved in an accident where there were injuries.
Sheriff Kyle Monroe was stomping his feet into a pair of cowboy boots when Tess walked out of the bathroom. In the time she’d been in there, he’d gotten dressed.
“You don’t need to drive me,” she said.
“Wasn’t planning to. Our district attorney and his family were hit by a teenage driver who happens to be one of the Worthington boys. Texas State Police will take it, but the sergeant on duty thought I might want in the loop on this. What a mess this’ll be.”
She frowned. “Not the first time one of Judge Worthington’s boys been in trouble, is it?” She gave him a quick kiss. “I’ve gotta go. It’s quite a drive from here.”
“I’ll run blue lights to the hospital. Stay on my tail and we’ll be there in less than ten minutes.”
“Appreciate it, Kyle.”
He missed his time estimation by two minutes. Eight minutes after they left her house, Dr. Tess Sweeney blew through the ambulance bay doors and raced down the emergency department hallway of St. Michael’s Hospital. The doors to trauma room two were open, and she glanced in. Blood-soaked towels and four-by-four gauze pads littered the floor, along with paper and boxes from medical supplies. An empty IV bag lay among the waste, its tubing curled like a snake on the floor.
Opening the door to the nurses’ station, she saw Martha Womack, the shift charge nurse.
“Martha. Where’s the Lloyd child?” Tess knew she sounded brusque and harried, but she’d have to apologize to Martha another time. She was losing precious time to save her patient.
Martha Womack, a gray-haired woman well into her fifties, looked over her shoulder. “Hey, Tess. Upstairs in the OR. Once Tanner got the blood pressure stabilized, the OR staff picked him up. Tanner went along since we have nothing down here needing his attention at the moment. He wanted to have a word with the anesthesiologist.”
“Great. Where are the parents? John get the consent form signed?”
“Got it. Parents went with the child during transport. I think they were going to the chapel.”
“Good. I’ll talk to them after the surgery. Thanks.” Tess raced for the elevators.
*
When Tess had turned in to the hospital’s physician parking, Kyle had tapped his siren once and flown on past. If he hurried, he might get to the crash site before the state police. Sure, his guys would secure the scene while they waited for state to swoop in and take over the investigation. Most of the time, it would have bugged the crap out of him to have the state tromping around his territory, but not so much tonight. The reality was he didn’t care much for their county district attorney. Lloyd was arrogant with an elitist view of the world. They’d butted heads on more than one occasion.
Still, he didn’t wish harm to the man’s son.
An accident investigation team from the state police was already on site when he arrived. Blue strobe lights from a gaggle of law enforcement vehicles lit up the surrounding trees and road. In front of his SUV, a Texas state trooper walked with a flashlight along dark tire skid marks. Shards of broken glass glinted under the beam and Kyle could hear the crunch of glass under the trooper’s heavy boots. He recognized the man by his stride and nodded to himself.
“Gruber,” he called as he exited his truck.
The man turned and raised his arm, bringing the daylight brightness from his flashlight directly into Kyle’s eyes. Kyle shielded his eyes.
“Monroe,” the trooper said. “Come out to see the clusterfuck?”
Kyle shook his head with a knowing chuckle. An accident involving two prominent families with a serious injury was nothing but a logistical nightmare for whatever office drew the short straw. Tonight, since it was the county district attorney, the state police had the honors.
The two men shook hands. “Clusterfuck is probably as accurate a description as any,” Kyle said. “Thought I’d drop by and see if you guys needed anything from us.”
“We’re good,” Shade Gruber said. “Your guys did a great job securing the scene, with one exception.”
“Oh? What’d they miss?”
“We can’t find the boy’s car seat. Lloyd said his son was ejected from the car seat when it flew out of his car with the child still inside.”
Kyle pursed his lips. “That’s interesting. What about Lloyd’s car? Was there damage to the seatbelts?”
“Nope. Lloyd said his wife never got the hang of putting the seat in correctly.”
“What did she say?”
“Not much. She was too distraught to give us any help. Both of them left in the ambulance with their son.”
“Alcohol?”
“Who? Lloyd or the judge’s kid?”
“Either. Both. Whatever. Just thinking out loud.”
Gruber shook his head. “Worthington kid’s a little slurry and shook up. Second ambulance left with him right behind the Lloyds. Preston Lloyd smelled like undiluted bourbon, but there was a broken bottle in his car. Said his wife was carrying it home from a fundraiser and it broke in the crash.”
“I’ll let you get back to work. I’ll check in with my deputies and be on my way. Let me know if you do decide you need anything from us.”
“Will do. Thanks.”
Gruber went back to measuring the skid marks. Kyle walked over to a fresh-faced deputy. New guy hired recently.
“Adams,” Kyle said, reading the name on the officer’s nametag.
“Sir.” The deputy, who must have been all of twenty-four, straightened.
“Appreciate the heads-up about Lloyd,” Kyle said.
“Yes, sir.”
“Give me a quick report of what happened once you arrived on the scene.”
“The cars were where you see them. The Lloyds were out of their car and on the ground next to their son. The teenager was out of his truck, sort of swaying and holding on the hood, as though he was using it to hold himself upright. As soon as Lloyd identified himself, I contacted the state police while Anderson—” he tilted his head toward his partner near the creek, “—looked for the child’s car seat.”
“I know this is not our accident to cover, but could you do a write up for me tomorrow with all the details you have? Probably won’t ever need it, but if I’ve learned anything over the years, it’s when lawyers are involved, have all the facts you can documented while they’re still fresh.”
“Yes, sir.”
The sheriff clapped the deputy on the shoulder. “See you tomorrow. Have dispatch notify me if you need me back out here tonight.”
Chapter Two
‡
The hospital elevator doors slid open on level two and Tess rushed out, banging through the double surgery doors.
“Dr. Sweeney,” a scrub tech called from the end of the hall. “We’re in OR three.”
Tess sighed. Operating room three was typically used for the worst cases. Quickly donning a hat, mask, and eye covers, she followed the tech through the doors to the OR suites. After popping open a soap-infused brush, she placed her hands beneath the motion-sensor water faucet and went to work on them.
The scrub tech moved alongside Tess. “We’ve got him on the table. We were lucky that Dr. Madison was in Labor and Delivery putting in an epidural.”
Tess nodded. Dr. Guy Madison was an excellent anesthesiologist, exactly the person she wanted for a complicated case. Glancing through the OR window, she spotted him chatting with Sue Johnson, the circulating nurse, while she prepped a very small abdomen.
“Got some current films?” Tess asked, continuing to coat her hands and arms in white foamy lather.
“Yes, ma’am.” She pointed to the large digital viewer on the wall in the operating room. Tess studied it through the OR window as she scrubbed and shook her head. Blood surrounded most of the vital organs.
“I know,” Nina said. “Even I can see the blood. The kid’s lucky to have made it this far.”
Tess rinsed her hands and then held them up so excess water dripped off her elbows. “Poor kid. Thrown from the car. No way was he in a booster seat.”
She backed into the OR and accepted the sterile towel offered by the first scrub tech. “Morning, Pete,” she said, drying her hands.
“Morning, Doc,” he answered, his voice grave. He held up a sterile gown and she shoved her arms through the sleeves. He pulled latex gloves over her hands.
Her patient’s body had already been draped with blue sterile sheets. At her first look at her patient, her heart sank. The normally pink skin was pasty white. The small chest and abdomen were the only parts of his tiny body visible to her. A unit of blood was dripping into his system.
“Guy,” Tess said. “Good to have you here. You got our boy ready?”
“Morning, Tess. He’s as stable as I can get him, which isn’t saying much I’m afraid.”
She nodded and shifted her eyes toward the sterile-clad scrub nurse beside her. “Scalpel,” she said, holding out her hand.
Surgery was a disaster from the start. No amount of suction or copious volume of sponges could control the hemorrhage. Tess repaired, stitched, and removed as much of the organ damage as she could, but within the first thirty minutes of surgery, the child’s heart beat became erratic and his blood pressure bottomed out.
“Damn it,” she muttered, shoving another sponge into the small abdominal cavity. Her heart pounded painfully against her chest. Losing a patient was bad enough. Losing a child always took a piece of her soul.
“Do something, Guy. We’re losing him.”
“I am,” the anesthesiologist answered from behind the drape. “You do your job, and I’ll do mine,” he snapped. “Call the night supervisor to get another two units of blood over here, STAT,” he yelled at the circulating nurse.
Tess’s vision momentarily blurred. Her stomach fell to her knees as she realized the odds were against her saving this child. Shoving her emotions back into their lockbox, she refocused on the task at hand, jerking out a soaked sponge and jabbing in another.
“Suction,” she ordered.
The suction tube tip snaked into the cavity. Red fluid flowed through the clear tube and dumped into the receiver. Out of the corner of her eye, Tess saw the anesthesiologist hang yet another bag of blood. The bleeding in the child’s abdomen continued unabated by anything she did.
Damn it! It looked like the fresh blood was racing straight from the bag into her surgical field. She lifted his stomach and found another small oozing tear.
“Suture,” she said and, without pause, a threaded needle was slapped into her hand. The hole was tiny and stitched easily, but then her patient was tiny also. Even damage this slight was significant to a child of this weight and age.
“Blood pressure dropping,” Guy said, his voice tight with tension. “Down to fifty over thirty. I’m increasing fluids, now.”
The child’s heart sputtered and stilled. The alarm on the heart monitor screamed. The sound echoed off the tile walls.
“Pushing epinephrine now,” Guy said, his words clipped.
“Damn it.” Tess began chest compressions. “Crash cart,” she snapped at the circulator, who’d already begun rolling the four-drawer cart.
“Charge to 200,” Tess directed.
Sue powered up the defibrillator and handed the paddles to Tess.
“Clear.” Tess waited a couple of seconds for the surgery team to break contact with the patient before delivering the electrical shock to the heart. The heart monitor continued its prolonged squeal in the background.
“Charge to 300. Clear.”
She delivered a second jolt and waited for the heart to beat. When the small heart continued to remain motionless, she restarted chest compressions.
“Pushing magnesium,” Guy said, raising his voice to be heard above the loud drone of the heart monitor.
“Charge to 300 again,” Tess said.
Sue handed her the paddles.
“Clear.” Tess shot another electrical jolt to the heart.
No response. She restarted manual heart compressions. Blood gushed with each compression. She was losing him. She knew it. She didn’t want to accept it, but deep down in her soul, a chunk broke off and lodged in her throat. It was impossible to swallow the lump when she had no saliva in her mouth.
“Don’t leave us now,” she coaxed through pursed lips. “Come on, baby. Come on.”
For just a second, the child’s heart thumped. The beat was slow and it was thready, but his tiny heart was beating on its own. Tess’s own heart leaped in jubilation.
“Blood pressure forty over ten,” Guy said, a hint of optimism coloring his words. Then, “Shit! Heart rate dropping. Blood pressure thirty-five over zero.”
The tiny heart stopped again. Nothing Tess or Dr. Madison tried got it restarted. Twenty minutes of CPR left Tess sweating. Every muscle in her body was so rigid it was painful, but the extended CPR couldn’t get her patient’s heart going. She’d lost him.
Tess drew in a deep breath, glanced at the wall clock, and then called it. “Time of death, two twenty-two a.m.” Her voice choked on unspent tears. Now was not the time and it certainly wasn’t the place.
“I never even saw his face,” she said, her voice dropping.
The anesthesiologist unclipped the divider sheet and Tess got her first glimpse of her patient’s face. She gasped. The muscles in her legs shook and threaten to collapse under her. She grasped the OR table for support. Oh, God. A sob caught in her throat.
She saw this face in her dreams almost every night.
Preston’s son’s looked so much like her son who’d died at birth.
*
Tess looked through the window into the surgery waiting room. Only two people occupied the area, so moving them to a private consultation area wouldn’t be necessary.
The woman sagged over the arm of the waiting room sofa. Tears flowed steadily down her cheeks; long lines of black mascara streaked her pale face. Her blond hair, once in a stylish chignon, hung in lifeless strands around her shoulders. Her black—and obviously expensive—cocktail dress was wrinkled with dirt around the hem and on the skirt. The black stockings on her legs were torn with numerous runs. A pair of expensive Jimmy Choo shoes lay on the floor in front of her.
The man, with his dark hair and olive skin tones, stood wide-legged looking out a window into the darkness. His hands were clasped tightly behind his back. Like his wife, his clothes bore the rips and embedded dirt from the accident.
Tess’s heart seized and she bit back her tears. She hated giving bad news. It was part of her job, without doubt the worst part. And as much as she hated the man in the waiting room—and she did despise him—and as awful as he and his wife felt now, Tess was gett
ing ready to blow their world apart even more. She took no pleasure in that.
She glanced toward Sue, who had come from the OR with her. “God, I hate this.”
Bringing the nurse from the OR with her was out of the ordinary, but given her history with her patient’s father, she needed the support.
“You ready?”
Sue’s lips pressed into a thin line and she nodded.
Tess took a deep breath and opened the door.
At the sound of the door opening, Preston Lloyd whirled around. His gaze met Tess’s and the muscles in his face pulled as his jaw tightened. He walked over and sat by his wife.
“Mr. Lloyd. Mrs. Lloyd,” Tess began.
His eyes hardened as his glare hit her. She fought to maintain her professional attitude and tone.
Constance Lloyd looked at her, hope flashing in her eyes. Tess hated that look, especially knowing she would be delivering the worse news a mother could receive.
Tess pulled up a chair across from the couple and sat. “I’m Dr. Sweeney. I am so sorry but—”
“No!” Constance’s scream reverberated off the walls. “No. No. No. No. No.” She let out a loud wail of pain, and hit her husband’s arm with her fist. “No. Not my baby. My baby.” She socked his arm again before collapsing on the sofa cushions away from him.
Preston leaned forward, both hands resting on his knees like a cat ready to pounce.
Sue hurried over, sat on the arm of the sofa, and wrapped her arms around the hysterical mother, holding Constance Lloyd as her body shook in anguish. The woman’s cries and shrieks echoed off the walls of the large waiting room.
Tess looked at Preston. “I am so sorry. When Hunter landed, his internal organs were jerked around violently. There were numerous tears in the blood vessels that fed the organs. There was just too much organ damage and too much blood loss. We did everything we could. I am sorry.” She looked at Constance. “I am so sorry for your loss, Mrs. Lloyd,” she said and glanced back at Preston.
He glared at her, black hate flaring in his eyes. “He was my son, my only son.”
Her heart tore at his pain, even as her revulsion of being in the same room with him pressed her to leave. “I know, and I’m sorry. If I can do anything please let me know.”
