Warning Signs

by C. J. Lyons

  “What?” Dr. Nelson asked, a frown creasing his brow.

  “Her lab work, dear.” Faith took a slip of paper from her pocket. Unlike physicians and med students, her lab jacket was a pale gray that suited her, made her look professional yet more warm and approachable than the stark white did.

  “Your tests are fine, Amanda.” Faith handed her the lab report.

  “Except the potassium, don’t forget the potassium.”

  “I didn’t.” Faith pulled a dark brown pharmacy bottle from her pocket. “Your potassium is a little low—”

  “Borderline,” Dr. Nelson put in. “Borderline low. But I want you to take this potassium chloride, two pills every six hours.” He took the bottle from his wife and folded it into Amanda’s palm, gripping her hand tight. “I’ll see you back next week, repeat the tests.”

  “That’s it?” Amanda asked. “Just some low potassium?” She felt lighter, as if she were floating a few inches on the other side of her skin as relief flooded over her.

  “That’s it,” Faith said with a smile, patting her arm reassuringly.

  “Now, young lady, you need to take this seriously,” Dr.

  Nelson said. “Hypokalemia can cause weakness, muscle fasciculations, decreased reflexes. And if it persists, I’ll need to do some further testing. Might be Charcot-Marie-Tooth, familial periodic paralysis, or the like.”

  Amanda found herself nodding in agreement. Those diseases were rare but not life threatening. And none had the protein deposits Ken Rosen had found in Becky’s path results. “Yes, sir. Thank you.” She smiled at both of them, blinking back more tears. “Thank you both.”

  “You need to take better care of yourself,” Faith said, already edging toward the door.

  “Yes. You should get plenty of rest and eat healthy.” Dr. Norman remained where he was, at Amanda’s side. “Faith, we should have her over for dinner this weekend.”

  “I thought the same thing. How about Sunday afternoon? Come to the house around four; I’ll make my pot roast, and apple pie for dessert.”

  Images of Amanda’s home in South Carolina, live oaks draped in Spanish moss, bright sunshine splashing on the water, filled her mind. Just the thought of home was enough to calm her. And now, she realized, she had a home here in Pittsburgh as well. She didn’t need to travel a thousand miles to find people who cared about her. “Thank you, that would be lovely. I’m looking forward to it.”

  THIRTY

  Friday, 10:51 A.M.

  THE RAIN CONTINUED AS THE BOAT HURTLED over the waves, speeding back to the pier where Med Seven waited. Gina was soaking wet, her body trembling despite the ninety-degree heat. She tried to tell herself it was seasickness, but even she didn’t buy it—would Trey and Gecko?

  The pilot throttled back and gently nudged them against the bumpers. Gordon leaped out and secured the boat, and within seconds they were back on solid ground. The four men raised the corners of the stretcher, and Gina automatically stepped up to reach for the bag-valve mask to keep breathing for their patient.

  A flash began to strobe, and she looked up. More flashes. A crowd of reporters had gathered behind a police barricade. The men loaded their patient in the back of Med Seven while Gina waited her turn to climb in. As she tugged her life vest off, she heard her name called.

  “Hey, hey Gina!” The photographer lowered his camera and came running, outflanking the police officers guarding the ambulance.

  Gina groaned. It was Pete Sandusky, a blogger who claimed to be Pittsburgh’s equivalent of the Drudge Report. Last summer, Pete had made her the front-page, prime-time Hero of Angels with his video of her carrying a baby to safety.

  “How is he?” he called out, aiming a tape recorder her way. “Did he say why he jumped?”

  “He didn’t jump, he fell,” she said.

  “Really? Surrounded by cops and he fell—that’s fantastic!” His face lit up like a kid at a magic show. “Tell me more.”

  Trey’s hand clamped down on her shoulder, hauling her into the ambulance. Pete snapped a few more photos before the doors slammed shut.

  “You any good at lines?” Trey asked as he climbed past Gecko to the head of the bed and prepared to intubate the patient. Gordon had taken over driving duties, playing the air horn like it was improv night at Heinz Hall.

  Anxious to redeem herself, Gina grabbed the IV kit and began to work on a second IV. The man’s veins were for shit, and being tossed about in the back of an ambulance doing sixty over potholes wasn’t helping. Still, she managed to get a sixteen-gauge into the antecub without blowing it.

  “BP still falling,” Gecko reported after they pushed two liters of saline.

  “We’re here,” Gordon called back as they turned the corner into Angels.

  They backed into the ambulance bay, and the doors were opened by waiting ER personnel. Trey and Gecko jogged alongside the stretcher, heading into the ER.

  Gina found herself alone in Med Seven, surrounded by the detritus of a resuscitation. Her Kevlar vest had gotten shoved under the bench seat. She pulled it free, smoothing the embroidered letters spelling out her name, rubbing away a mud stain.

  The ER’s entrance sign cast a bloodred glow into the ambulance. Gina shuddered, shrugged back into her vest, and climbed down from the ambulance. She hesitated before the doors, but the electronic, all-seeing eye caught her presence and whooshed them open, expelling the raucous jungle noises of an urban trauma center.

  Zipping the vest tight, so tight she could barely breathe, Gina went inside.

  FAITH AND DR. NELSON LEFT AMANDA IN THE exam room as they returned to their patients at the clinic. Amanda took the time to check her appearance in the mirror above the sink. She had red eyes, a red nose, and a goose egg forming on her forehead from where she’d hit the steering wheel; she’d probably have a black eye in a day or so. Smoothing her bangs over the lump, she tried out a smile. It wasn’t all that hard—the news that there was nothing seriously wrong with her made up for the loss of the Love Bug. Well, almost.

  She poured two of the pills into her palm and swallowed, washing them down with more water. She should try to follow Dr. Nelson’s orders and splurge on a real meal in the cafeteria. Tapping her numb foot against the floor, she marveled that a simple little electrolyte imbalance could cause so much worry. Bananas, they had lots of potassium; she’d see if the cafeteria had any bananas.

  Ignoring the dull ache that was already creeping up her neck muscles, she left the room, smiling and feeling better than she had in a while.

  At least she was until she met Nora at the nurses’ station. “Here’s all the paperwork from the tow truck and the police,” the charge nurse told her. “And they fished this out of the backseat.” She handed Amanda her bag with her dress and nice shoes. It seemed so long ago that she’d picked the blue dress from her closet and been so excited about wearing it to work yesterday. “Want me to call you a cab?”

  Right. She’d been dismissed for the day. Amanda rubbed the side of her neck, kneading the muscle knots already forming. What was she going to do, lie around and watch soap operas?

  “No, thanks. But could I borrow your car?”

  “I don’t think you should be driving.”

  “Why not? I didn’t have a concussion, just a little neck strain.” She straightened to prove her point. “I’m fine. I’ll ask Gina to come by to pick you up after your shift.” Nora didn’t look convinced. “Please. I promise, I’ll drive extra careful.”

  “It’s not my car I’m worried about.” Nora scrutinized her with one of her patented don’t-give-me-any-BS looks. Amanda simply smiled. “Okay.” Nora handed her the car keys. “I’ll see you tonight.”

  Amanda walked out the door, slowing considerably once she was out of Nora’s eyesight. Nora’s gray Honda Accord was parked in the employee garage on the first floor, around the corner from the skid marks that were all that remained of Amanda’s Love Bug. She drove out of the garage, quickly learning to turn her entire body to ch
eck her mirrors, not just her neck—too painful.

  She hadn’t intended to lie to Nora, but she couldn’t stop thinking that she’d let Lucas and her patients down. She’d allowed her own worries about her symptoms to cloud her judgment and maybe had sent Lucas on a wild-goose chase. After all, she’d seen herself as part of the pattern linking Becky, Shelly, and Tracey to the boathouse. But in reality it was only two out of three patients, with Tracey having a more tenuous connection.

  Instead of turning toward the house she and Gina shared in Point Breeze, she turned down Penn Avenue and toward the boathouse on Washington’s Landing. In a small city like Pittsburgh, the boathouse seemed less a connection and more an innocent coincidence. Least she could do before taking the day off was to check it out—one way or the other.

  THIRTY-ONE

  Friday, 11:18 A.M.

  GINA HOVERED OUTSIDE THE CRITICAL CARE room, listening to the familiar cadence of a full trauma resuscitation. Airway, breathing, circulation. ABC.

  “I’m thinking spinal shock in addition to the head trauma,” Seth Cochran said after completing his assessment and stepping outside as the X-ray techs wheeled their portable machine into the trauma bay. “For what it’s worth.”

  His tone was grim, and with good reason. Gina winced, remembering the sound the man had made when he hit the water. Almost as loud as the sound of a gunshot. No surprise his spine had snapped.

  “The boys stick you with the paperwork?” Seth said with a smile, gesturing to the chart Gina clutched. “Don’t worry. It’s a rite of passage. They’ll let you on board for the fun stuff if you don’t whine too much, be a good team player.”

  She nodded, his words passing her in a blur. The X-ray techs finished shooting, and he disappeared back inside. She hugged her arms around her chest, leaning against the wall, avoiding eye contact with everyone.

  Trey and Gecko emerged from the room, hauling their stretcher. She hadn’t had the guts to go with them into the room, but had waited here in the hall. Useless.

  “Cops said he has a wife, two kids,” Gecko told her. “Said he’d just lost his job, lost their house, everything. Gambling.” He shook his head. “Don’t see how killing himself was gonna solve any of that.”

  Gina decided she was better off not knowing the intimate details of the man’s life. Treat ’em and street ’em—that was the ER way. No need to get involved. She scratched at the inside of her wrist, staring at the red welts her fingernails produced.

  Trey said nothing, his focus on Gina. Finally the weight of his gaze forced her to look up and meet his eyes. “Gina, we usually do a critical-incident debriefing after a case like this.”

  He surprised her. She’d been waiting for him to ream her a new one.

  So she did it for him. “I don’t want to sit around talking about a dying man and how I screwed up.”

  Gecko did a double take at her raised voice. Trey gave him a nod and he scurried away, taking the stretcher with him.

  “Why do I get the feeling you care more about how you screwed up than you do about that man’s life?” Trey asked.

  “Because it’s the truth. I don’t know him—I don’t need to know anything about him. Why should I? Why should I give a damn? People want to throw their lives away, go drinking or gambling or jumping off bridges or shooting at each other, what’s it to me?” She was close to shouting. Close enough that Tommy Z emerged from the family room across the hall, frowning.

  Gina whirled, ready to unleash more of her pent-up frustrations, only to see Lydia coming from the nurses’ station. Damn it, wouldn’t you know Lydia would show up on her day off, just in time to hear about Gina’s screwup? Or had Trey had something to do with that?

  Trey stepped back, arms open wide as if giving up on her, letting Lydia take the lead.

  “Sounds like a tough case,” Lydia said. Sympathy from her only made things worse. “Maybe we need to talk about taking you off the streets.”

  Translation: take her out of the residency program. Warmth crept up Gina’s neck, a slow burn that added to her anger. Damn it, she’d thought Lydia actually cared, gave a shit what happened to her.

  “You can’t do that! I’m the best damn resident you have.”

  “Not right now you aren’t,” Lydia snapped back.

  Gina opened her mouth, ready to spew out a probably career-ending retort, when Tommy Z stepped into the fray.

  “Gina was just getting ready to join me for her stress debriefing,” he said, smoothly pivoting her toward the family room. “I’m sure everything will be fine.”

  Lydia glared at the social worker, obviously skeptical. “All right. We’ll give that a try.”

  “I don’t need any debriefing,” Gina protested, tired of people treating her like a child.

  “Can I have her for a few minutes, Trey?” Tommy asked, ignoring her.

  “She’s all yours. I’ll let you know if we get a call.”

  Gina started to balk, saw the look on Lydia’s face, and stomped past Tommy into the family room. Tommy closed the door and turned to face her. “So. Where should we start?”

  She straightened to her full height, rocking her weight forward. Usually a five-foot, ten-inch black woman scowling at them intimidated men, but Tommy seemed impervious. Just as Ken Rosen had yesterday. Damn, she was losing her touch. “How about we start with you telling everyone I’m fine so I can get back to work?”

  He shook his head. “Why are you in such a rush to get out on the ambulance anyway? Haven’t you been shuffling shifts to avoid it?”

  “Who told you that?”

  “Does it matter? You know, Gina, during debriefings lots of people will talk about anything except the elephant in the room.”

  Elephant? Exactly what she felt like, stumbling and bumbling and fat, everyone staring at her, most jumping to get out of her way when she went on a rampage. Most—except Jerry. Seemed like he was the only one left who really gave a damn about her.

  She lost the staring battle with Tommy. To cover it, she dumped herself into a chair, hanging her legs over the arm. Her best defense against most headshrinkers—pouty silence. It both irritated and agitated them. Shrinks were used to asking all the questions and getting answers. In Gina’s experience, they didn’t handle silence all that well, despite their protests to the contrary.

  And she’d had a lot of experience with them. She kept her face blank as Tommy slid into the chair opposite her. Her fingernail scratched a furrow on the inside of her wrist, out of his sight. The stinging pain felt good, let her breathe.

  “Nice vest. Did Jerry Boyle give that to you?” Tommy’s voice broke into her thoughts.

  She hid her triumphant smile. Tommy was no better than the expensive shrinks her parents had smuggled her to after she almost flunked out of college sophomore year. Her fingers traced the monogram on her new Kevlar vest. It was heavy and hot, but one just like it had saved her life back in July. No way she was going out on the streets without it. She’d joked to Jerry that she might just start wearing it to the grocery store.

  Jerry’s laugh hadn’t made it all the way to his eyes. Instead, he’d given her that worried look, the one that said he’d do anything to have been the one under fire, the one who had gotten shot at. A guy like that, she had to be crazy not to marry him, right?

  “What’s your position on mixed couples?” she asked Tommy.

  He took the non sequitur in stride. “You mean different races? Like you and Jerry? I don’t think there’s a problem as long as both parties are prepared to face any obstacles together. A united front, so to speak. How do you feel about a mixed marriage?”

  She hadn’t been thinking about the race thing at all. More the “my family has money and are a bunch of self-righteous pricks and yours aren’t” kind of thing. Or something along the lines of “I’m so screwed up, used to having everything my own way and done for me, but you’re so damn sweet and normal and sane and loving… .”

  She sat up straight, the vest bunching up
around her throat threatening to strangle her. She tugged it back into place. “I’m against them. Don’t think they’re a good idea at all. You’d have to be crazy to want to live that way the rest of your life.”

  She paused, scrutinizing Tommy’s face. He caught her gaze and returned it with that smug and superior “go on” look common among shrinks. Hah. He had no idea what she was talking about. She bounced to her feet; she didn’t have time for this shit. “Who in their right mind would want to live that way?”

  She was out the door before Tommy could answer.

  TREY WALKED BACK WITH LYDIA TO THE nurses’ station. She leaned her elbows on the countertop, watching Deon zap space invaders on a handheld game that Jason, the ward clerk, had lent him. She still didn’t have a plan for Deon, and with Tommy Z on the prowl, she’d have to get him out of the ER. Maybe she could con a nurse into letting him sit with her while Lydia got some work done on those strange neuro cases. Except she really should talk with Gina again …

  She didn’t realize that she was bouncing on her toes until Trey laid a hand on her shoulder, quieting her. “Hey, relax. It’s your day off.”

  She scrunched up her face, reaching a hand up to cover his, intertwining their fingers on her shoulder. She twirled beneath their joined hands in a move he had taught her, and was rewarded with a smile. “How bad did Gina do?”

  “Not too bad, considering.”

  Lydia translated that as pretty darn bad—Trey had a soft spot for Gina.

  “She froze,” Trey conceded. “But not everyone’s equipped for life on the streets. Not to mention the sight of a guy falling from a bridge and landing right in front of them.”

  “You’re saying I should cut her a break?”

  “I’m saying maybe you should back off. Give her a little breathing room. I’ll talk to her if I need to.”

  She considered that. Backing off wasn’t in her nature, but she could trust Trey. “Okay.”