“Only you,” Eli admitted, pleased by Lauren’s immediate smile. “No problem; we’re fine in the clinic. But how about if we go get some real coffee after work? Emma’s been drooling ever since I told her you had that chocolate-cherry scone at Ben’s Beans. I promised I’d take her. We could come by and get you.” He lowered his voice as the triage nurse passed them pushing a wheelchair. “I have to pick her up from the Donnellys’. So maybe around—”
“No. I mean, I don’t know,” Lauren said with an expression that made Eli’s stomach sink. “I’m not sure tonight’s good. It’s Jess’s day off. She might want us to do something together. And . . .”
“And she doesn’t know we’re seeing each other. Because you haven’t told her.”
“No.” Lauren reached around the doorway, dumped her full coffee cup into his office trash can—an obvious stall. When she faced him again, her expression looked anxious. “I’m not sure how Jess will react.”
“And you won’t know that until you tell her.” He reminded himself, the way he had last night on the Barclay porch, that this relationship was too important to risk messing up. “I know I’m going to have to work at changing your parents’ opinion; I’ll do my best with that. But I told you that Jessica and I have never been more than friends. It’s not like you need her permission to—”
“You don’t understand,” Lauren insisted, cutting him off. “It’s complicated with my sister.”
He did understand. Far better than Lauren did—that was the problem. And there it was again, that blasted elephant. Wedging its bulk between them. He had a bad feeling that in the end this would all be about Jessica.
“She’s having a rough time right now.” Lauren swept her hand across her forehead, snagging a stray wisp of hair. Her beautiful blush was long gone. “She’s been upset about some things. I’m not at liberty to say. But I know her, Eli. I know how sensitive she is. I have to be careful how I handle these things so I don’t make it worse.”
He hated that he’d just thought of that ill-tempered shih tzu. All the doggy-treat bribes and that chewed-up nursing magazine. Dancing around her sister’s problems was chewing up Lauren’s entire life. And breaking her heart. Eli wanted to sit her down, make her finally listen, finally accept the fact that Jessica’s problems needed clinical intervention. But the truth was if he did that now, when this relationship was so new, it could mean losing Lauren. He had to wait until she trusted him more.
“Jess didn’t come home after work last night,” Lauren confided. “I tried to call her, but it kept going to voice mail. All sorts of awful things went through my mind. I’m sure you can imagine. Then after midnight I got a text from Fletcher. I guess she talked him into driving her to Galveston. She wanted to run the beach. With a major storm approaching. Of course, that’s our Jess . . .” Lauren’s voice broke. “Thank God for Fletcher Holt.”
- + -
“You saw it,” Fletcher told his rookie partner as he steered the patrol car into a U-turn. “Situation’s changed.” The computer update was more than clear; the call had taken a dangerous turn. “That domestic dispute turned out to be an ADW—the male was stabbed. Fire has first responders and an ambulance on scene. Sounds like our guys have it under control. But we’re close enough. Might see what we can do to help out.”
“Let’s go.”
In less than three minutes they joined two other PD units who were on scene, along with a Houston Fire engine and an ALS ambulance—a light show of red, blue, and white strobes competing with the merciless afternoon sun.
“Looks like we’ll be backing up the backup,” Fletcher observed as he and his partner made their way up the driveway. He glanced at the gathered crowd being kept back by a trio of firefighters; most of the neighbors were young, several with children in their arms. All of them had that inevitable mix of horror and fascination on their faces. “Not exactly a block party.”
“Not even close.”
The residence was one of those too-big brick and Georgian column houses packed crayon-tight in one of the many neighborhoods that had grown like weeds in the prerecession real estate boom. Most of them were rentals now. The lawn was brown as shredded-wheat cereal, and what few shade trees existed were still in nursery pots.
“Coming through!” a medic shouted, clearing the way for paramedics exiting onto the porch. There was an immediate buzz from the crowd of neighbors as a stretcher emerged from the open doorway: a middle-aged, burly man with close-shaved hair, face pale and sweaty under the breath-fogged oxygen mask. Blood leaked through the sheet partially covering his bare, equally pale chest. One of the paramedics held two IVs overhead as he hurried alongside.
“Butcher knife,” an officer explained as Fletcher moved into the foyer. “Got a lung, medics say. I could’ve predicted that. Blood was bubbling like somebody salted a snail.”
“You have the assailant in custody?” Fletcher’s gaze moved toward officers at a doorway in the distance. A crime scene investigator passed by, laden with equipment. “The wife?”
“Yeah, we have her. There in the kitchen, not making a lot of sense. Burning up with fever. And ranting about tow trucks and Valentine’s Day.” The officer shook his head. “Beat up fairly bad herself and—”
“Need help in here!” an officer shouted, beckoning at the kitchen doorway.
Fletcher jogged into the kitchen, where he saw a single paramedic struggling to control the airway of a woman convulsing on the floor. Her wrists cuffed, body arched, and spine lifting away from the floor with the cruel spasms. Her eyes had rolled back, and pink froth escaped between her clenched teeth.
“Get one of the other medics in here!” Fletcher shouted to the officers as he dropped to his knees. He pulled safety gloves from his pocket, connected with the medic’s gaze. “Tell me what to do.”
“Help me turn her to her side.” The paramedic yanked a portable suction canister from his rescue bag. “I’m going to need those cuffs off her wrists. But right now we need to keep her from choking, and—ah, there, seizure’s over.”
“I’ve got her. Go ahead.” Fletcher steadied the woman’s limp body as the medic slid the hissing suction catheter between her teeth. “That seizure . . . from drugs?”
“Could be several things. Drugs, fever, or a head injury. From the looks of those bruises, I’d say this battle went both ways. But I also get the feeling something else might be going on here.” He pressed his fingers beneath her jaw, glanced at his watch.
“What’s up?” Another medic hurried through the door as Fletcher was removing the woman’s cuffs.
“Seizure. And . . . I’m not sure.” The first medic’s brows drew together. “Grab that oxygen. We’ll need an IV, but let’s get her on the monitor right away. This heart rate’s so fast I can’t even count it.”
Fletcher slid the cuffs away, then stepped aside to give the medics room. He watched for a moment before taking a step closer again. Really studying the unconscious, battered, and blood-smeared woman for the first time. Tall, he’d guess, and painfully thin despite those shapeless gym sweats. Lank brown hair and big eyes, even half-closed. Something about her features nagged at him. Almost like he knew—
Fletcher’s breath caught. “That’s Gayle Garner, the emergency department manager at Houston Grace.”
HOW CAN THIS BE HAPPENING?
Lauren stepped close to the trauma room gurney, fighting an involuntary shudder. “I’ve cleared it for you in the clinic; your nurses will order any obviously necessary X-rays and labs.” She watched as Eli lifted his patient’s eyelid to test pupil response with his penlight. Gayle’s eye. Their department manager, lying there semiconscious. And in police custody . . . for the attempted murder of her husband? It was impossible to grasp. “I made a general announcement to the waiting room,” she continued. “Told them both you and the ER doc are tied up with an emergency and they should expect a delay in treatment until our on-call staff arrives. The triage nurse will advise us of anything that looks serious.
”
“Sounds good.” Eli had stripped off the white coat long ago; there was a trace of perspiration at the neckline of his green scrubs. They’d all been running nonstop since the first Code 3 ambulance stretcher swept through the doors. “I appreciate your handling that.”
He met Lauren’s gaze, his expression saying he was as shaken as she was. All of Houston Grace was feeling it. Lauren didn’t want to imagine the media frenzy their public information officer must be handling. She only hoped she could get a minute to warn Jess before it interrupted storm coverage on the local news.
The EKG technician peeled the electrode pads from Gayle’s arms. Lauren caught a glimpse of the red marks on her wrists . . . from handcuffs.
A radiology tech pushed a portable X-ray machine through the far door, its wheels squeaking on the speckled vinyl tile floor. Chaplain services was paged overhead.
“I’ve ordered the initial tests,” Eli continued, “and I can keep a lid on things until Mike has that chest tube in to stabilize the hemopneumothorax on . . .” He grimaced slightly. “On Mr. Garner.”
A hemorrhaging lung collapse, possibly a dangerous nick to the sac around his heart . . . because Gayle shoved a butcher knife into his chest. Lauren pushed down a wave of nausea. What on earth led up to this tragedy?
“Her heart rate’s still hovering close to 170,” Lauren noted. “Isn’t that unusual, even taking into account her fever?” Gayle had been given a Tylenol suppository and was lying on a cooling blanket. “Of course 104.8 is a high temp for an adult, but—”
“She’s dehydrated.” Eli pinched up the skin on Gayle’s forearm above the site of one of her two normal saline IVs; the skin remained tented, a further sign that she was far too dry. “We saw some of that yesterday, when she nearly fainted after vomiting in your triage office. But I think it’s more than can be explained away by a stomach flu.” He glanced toward the cardiac monitor as an alarm sounded. Her heart rate had increased to 180 beats per minute. “Her pressure’s too high for this to be only dehydration.” He walked a few steps to the head of the gurney and gently grasped Gayle’s neck between his fingers. Her eyelids fluttered with her barely audible moan. “She said her doc’s been following her thyroid. But . . .”
Lauren’s breath snagged; in her entire nursing career, she’d never seen a case of—“Thyrotoxicosis? Thyroid storm? Is that what you think?”
“It fits. The enlarged gland. Hyperactive reflexes. That protrusion of her eyes—we’ve seen it so long I expect we all thought that was just part of her features. But I have to consider Gayle’s dramatic weight loss and the recent shakiness she kept blaming on coffee, lack of sleep, and all those extra shifts. She’s been working herself to death because of her financial situation.” Eli sighed. “We were all too close to notice the progression of symptoms. But when you add staff complaints about Gayle’s irritability, yesterday’s episodes of vomiting and diarrhea, the fever, and the seizure tonight . . . yes, I think we need to seriously consider a diagnosis of thyroid storm. I already ran it by Mike. He agrees.”
“Gayle said she has medication for her thyroid condition.”
“Has it prescribed and took it in the past. But taking it now? I’d guess not. She’s not coherent enough yet to give us reliable information.” Eli glanced at the monitor: steady, regular, but rapid at 148 beats per minute. “She’s been under a lot of stress. That’s a trigger in itself. And if she stopped her medication abruptly . . .”
“It could throw her into thyroid storm.” Lauren scraped her teeth across her lower lip. It was rare and a true medical emergency. One that could lead to heart attack, stroke, pulmonary edema . . . death.
“One of the internists is on his way down from the ICU. He’s already put in a call to endocrine. If this is a storm, they won’t wait for blood tests to come back. Or for a Doppler ultrasound. No time. She’ll need aggressive multidrug treatment: thioamides, iodide, beta-blockers, glucocorticoids.” Eli frowned as he caught a glimpse of the uniformed officer outside the trauma room door. “Our friend’s in deep trouble, Lauren—on all counts.”
- + -
“She what?” Jessica’s mouth sagged open. She set Hannah’s brush on the couch, stared at him. “You can’t be serious, Fletcher.”
“I wish I wasn’t. And at this point it’s still an alleged stabbing. But I wanted to swing by and tell you before you saw it on the news.”
“Oh . . . right.” Jessica glanced toward the darkened TV.
No TV or music on. Still in her pajamas at nearly 5 p.m. Fletcher knew it was a bad sign. Especially in the wake of Jessica’s tearful episode last night. She’d closed the shutters and was sitting in near darkness with her dog on her lap—considering Hannah’s tendencies, riskier than running on a storm-path beach at midnight.
“Her husband claims she attacked him with a knife,” Fletcher continued. “From a set he gave her for Valentine’s Day—Gayle must have said that a dozen times. It was one of the few clear things she was able to convey. They say she was pretty incoherent, even before the seizure.”
“I don’t get it.” Jessica played with the sleeping dog’s ear. “Was she drunk?”
“Don’t know. Fever could account for some of the confusion, but I’m sure she’ll be drug tested.”
“You think drugs made Gayle turn violent? And caused her seizure?”
“No idea.” Fletcher raised his hands. “I’m not even close to being a medical expert. You know that.”
Jessica was quiet for a moment. She shook her head, the sleep-tossed tumble of hair brushing the shoulders of her cotton pajamas. “What I know, Fletcher, is that Gayle Garner’s been acting like aliens hijacked her brain. I don’t mean that as a joke. It’s really sad. Everybody’s been worried. I’m sorry all of this is happening to her now. But . . .” She picked up the dog brush and sighed. “Drugs might explain it.”
- + -
“Th-thank . . . you.” Gayle’s tongue moved across her lower lip, seeking moisture left by the sponge swab. One of her eyes had narrowed to a bruised and swollen slit; the other was struggling to focus on Lauren. “So . . . thirsty.”
“I wish I could give you some water, Gayle. But it will have to wait. Maybe after they move you to the ICU.” Lauren glanced at the IV bags, a much-needed fluid load. Thankfully there was no evidence of pulmonary compromise. “Your temperature’s below 103 now. And the propranolol has brought your heart rate far closer to normal—thank heaven that run of a-fib didn’t last.”
“Mmm.” Gayle reached up with a shaky hand to touch the oxygen cannula in her nostrils. There was still some dried blood on the side of her hand. After they’d collected evidence, the forensic team had given the okay to clean her up; Vee missed a spot. It could be Leo Garner’s blood or maybe even Gayle’s from the small finger lacerations she’d apparently sustained during that unimaginable scene in her kitchen.
Guilt prodded again. Lauren worked with this dedicated, caring woman almost every day. How could she have missed how sick she was?
“I’ll check with Eli, see if we can give you a few ice chips or—”
“Leo needed the pills,” Gayle whispered suddenly, reaching out to grip Lauren’s arm. “I shouldn’t have lied. Shouldn’t have . . . done it.” Tears welled. One slid down her cheek, disappeared under the oxygen tubing. “Please . . . pray for me.”
- + -
“Thanks for helping me out over here.” Eli handed Vee a cup of coffee, the aroma of French roast wafting. “It’s fresh. Made it myself. Lauren said the old batch melted her spoon.” It seemed impossible that moment was only a few hours ago. What a nightmare of a day.
“I’m glad things finally settled down for her in the ER. Getting Gayle moved up to the ICU helped.” Vee’s sigh parted the steam from her coffee. “It’s so hard to see Gayle like that, to take it all in. Have you heard any word about her husband’s condition?”
Eli saw a tech pushing the ortho cart past them toward the ER. “Mr. Garner’s in the recovery room. No dam
age to the vessels or pericardium. The knife was probably deflected by a rib.” The gritty reality struck him again; he’d heard the officers describe the Garners’ blood-spattered kitchen. “His vital signs stabilized after the second unit of blood. And the most recent X-ray shows the chest tube is doing its job.”
“Good to hear.” Vee took a sip of her coffee, then was quiet for a while. “Gayle looks like she’s been beaten.”
“Looked like that to me, too.” Eli heard it was Gayle who’d placed the call to 911. Reporting domestic abuse. The stabbing likely happened afterward. Gayle’s secondary exam showed she’d sustained a wrist fracture. It all fit.
“We can’t really know the pain in other folks’ lives. In their hearts and souls. Sometimes that troubled water’s so deep all you see is the pieces of wreckage that float up top.” Vee shook her head. “Families—not easy. Ever.”
“I won’t argue that.” Eli met her gaze. “I’m sorry mine’s been such a pain in the rear for yours at Mimaw’s. It sounds like my father made a scene.”
“We’ve seen worse. Having a family member in a care home is hard. I expect your father’s doing what he thinks is right to protect his son. And you’re doing your best for the brother you love.” Her expression was far too wise for her tender age. “I try not to judge the debris floating on top.”
Troubled waters. Eli thought of his conversation with Lauren. About Jessica.
A blonde woman wearing a light-blue blazer walked briskly by, casting a warm smile at Vee as she passed.
“Our on-call chaplain.” Vee watched as the woman continued down the hallway toward the ER. “Angela. Have you met her?”
“I saw her outside the trauma room.” He decided Vee didn’t need to know that he didn’t customarily make time to converse with chaplains. But then, sharp as this tech was, she’d probably already guessed that.
“She’s a licensed family therapist; the hospital work is something new for her.” Vee smiled. “Got to love a small world—Angela goes to the same church as the Barclays. She was hoping to get a chance to talk with Lauren once things settled down.”
Life Support Page 21
