Of Flesh and Blood (52 page)

The ten-person trauma team—including residents, nurses, and respiratory and X-ray techs—assembled almost simultaneously inside the resuscitation room. People moved with silent purpose while preparing their own equipment.

Erin’s hands shook noticeably as she slipped into the waterproof gown and secured her full facial shield. She panted under the mask, begging herself to slow her breathing before her fingers began to cramp up.

Easy, chick. You can do this
.

A siren’s wail rose in the distance. Erin’s mouth went drier as her chest thumped harder. The latex on her gloves felt sticky against her damp palms.

Keep it together
, she commanded herself, to no effect.

The siren suddenly cut off in mid-cry. A few moments of absolute silence fell on the room and then the doors of the ER burst open and a stretcher hurtled through the gap. A blur of activity joined the clamor of voices. A young female paramedic straddled the stretcher, as though riding a bronco, while she leaned forward and rapidly compressed the patient’s chest, her palms flat and arms locked straight.

People in the room parted as the stretcher flew between them and halted beside the hospital bed. The paramedic hopped off the stretcher. Her partner and two nurses hoisted the young patient from the ambulance gurney onto the hospital bed. The female paramedic immediately slipped back to the right side of the bed and resumed chest compressions.

Dhillon stepped beside her. “What do we have?” he asked.

“Deana Roscoe,” she grunted without slowing her pistonlike pumping motion. “Two half-inch stab wounds with a kitchen knife. Husband stabbed her thirty minutes ago. First wound under left nipple. Second lateral to left breast. One liter blood loss at scene. Cardiac arrest five minutes prior. CPR in progress ever since.”

As Dhillon rapidly ran through the ABC’s—airway, breathing, and circulation, the universal “cookbook” approach to assessing major trauma patients—Erin studied Deana Roscoe from the left side of the bed. Thinness aside, she looked nothing like Sesi, but the flashbacks of that Kenyan murder scene were so intense that Erin almost winced. The pressure across her windpipe intensified and her legs went rubbery as she fought off the urge to turn and flee.

Deana Roscoe had dyed blond hair and narrow cheeks studded with acne scars. Her face had the look of someone who had lived through a lot in her twenty-something years. Two IVs snaked into her tattooed right arm. An endotracheal tube was stuck between her prominent teeth and attached to the breathing bag that the second paramedic squeezed to pump oxygen in and out of her lungs. Her glazed eyes were open but her dilated pupils stared blankly at the ceiling. Roscoe’s shirt had been cut wide open and now lay beneath her like a shed jacket. Caked blood obscured much of her small left breast. With each chest compression, blood leaked out of the puckering wound below her nipple and dripped onto the stretcher.

“Stop compressions,” Dhillon instructed and the paramedic released her hands in mid-thrust. Dhillon palpated Roscoe’s neck in vain for a carotid pulse. After five seconds, he said, “Resume compressions, please.” He looked over to Erin and shook his head gravely.

She stepped forward on a shaky foot. “I am going to crack her chest now,” she announced.

As the patient was technically dead without a measurable pulse or blood pressure, she required no anesthesia. Erin grabbed the open surgical tray
beside her and wheeled it a foot closer to the bed. She shot her right hand out and grasped the handle of the largest of the three side-by-side scalpels. She used her left-hand fingers to walk along the skin over Roscoe’s sternum, which was slippery with fresh blood. On the bony chest, Erin easily found the landmark she sought, where Roscoe’s fifth rib met her sternum.

Erin applied the blade to the skin and pierced it. In one continuous swooping motion, she dug the blade through the skin and muscle, cutting all the way along, following the underside of the rib until her blade almost hit the bed. Dark red blood trailed after the expanding incision.

Erin was surprised to notice how steady her hand was as she tossed the scalpel back on the tray. Her hands felt less sticky, too. The squeezing at her throat lessened. A familiar sense of purpose nudged the panic and nightmarish Kenyan flashbacks from her consciousness.

She picked up a pair of oversized serrated scissors. She dug its teeth into the cartilaginous edge of the fifth rib right where it met the sternum. Squeezing the handles with full force, she felt the scissors gnaw through the rib with a loud pop, freeing it from the breastbone.

Erin grabbed for the rib spreaders, which resembled a long, flat car jack. Breathing easier, she maneuvered the device’s blades into the space of the incision she had just created. As soon as the edges were securely positioned, she began turning the small crank dial. With a series of audible clunks the blades spread wider apart, exposing more and more of the inside of Roscoe’s chest. Blood gushed out along the lower edge, but Erin kept spreading until she had exposed a ten-inch gap.

Spongy pink lung tissue poked out of the wound. She grabbed a retractor off the tray and stuck it inside, pushing the lung out of the way. She let go of the handle and gravity held the retractor in place for her.

“More light please,” Erin ordered.

Someone adjusted the overhead light and Roscoe’s chest cavity was bathed in brightness. Blood continued to well up from inside the chest and run over the edge of the wound, obscuring Erin’s view of the heart. “Suction,” she said, aware that every second lost would reduce the chances of getting the heart restarted.

A gloved nurse handed Erin sterile hoselike clear suction tubing that hissed in her hand. She stuck it into the back of the wound and threaded it
behind the lung. On contact, it made a sloppy slurping noise and the tubing turned instantly red with blood.

With the blood cleared, Erin finally saw the shiny gray outline of the pericardium, the thin tissue that covered the heart. She reached for a pair of forceps with her left hand and fine scissors with her right. She slid the tools inside the chest and grabbed the edge of the pericardium with the forceps. She tented up the tissue, freeing it from the heart, and cut through it with the scissors.

The red muscle wall of the heart poked out as she peeled the pericardium away. Deflated like a torn wineskin, the heart twitched away ineffectively. Erin eyeballed the wall of the heart but could not spot the hole in the muscle that she knew had to be present. She put her hand in the wound and ran her fingers along the slippery side until she felt a small defect in the left ventricle, the biggest of the heart’s four chambers. She poked her finger through the gash and slipped it inside the heart.

“Stapler!” she cried.

A nurse passed her an instrument that looked like a small white staple gun. With her right hand, Erin applied the nose of the stapler to the far edge of the one-inch gash. Using her left index finger to guide her, she ran the nose along, stapling the wound shut with click after click as though slowly closing a zipper.

Finished, she dropped the stapler on the tray and palpated the edges of the wound, satisfied she had closed the defect. She wrapped her palm around Roscoe’s heart and felt it reinflate with blood. She squeezed the big muscle in her hand and then released it. She repeated the internal compressions every second for almost a minute. When she felt the heart contracting on its own in her hand, she let go.

She adjusted the light again and watched the big muscle. A wave of satisfaction overcame her as she saw how vigorously Roscoe’s heart pumped.

Dhillon placed his fingers back on Roscoe’s neck. “We have a very good pulse,” he announced happily.

Erin wasn’t surprised. What floored her was the blissful realization that she had just performed cardiac surgery again. And she had done so with a calm that, a week earlier, she despaired she would never again find.

The night was hell.

Nikki spent more than half of it on the toilet or throwing up into it. The cramps were unrelenting, but the craving was worse—so intense that she thought she would pluck out her own eyeballs in exchange for a single hydromorphone pill.

And between bouts of narcotic hunger came the recriminations that accompanied the shame of being an addict who had again stooped to stealing drugs from children with cancer. That she had returned the drugs to the dispensary without swallowing them brought her no solace.

What have I become?

Past ghosts visited throughout the night. Nikki saw little Nate’s brave, sad face. Snippets of her intimate conversation with Tyler at O’Doole’s looped in her head. The memories of her dead fiancé only intensified the guilt. Even Glen, with his boundless compassion, might have had a hard time forgiving her—the nurse who tried to seduce a married doctor and then stole painkillers from sick children.

Nikki was sitting at the kitchen table, sipping tepid tasteless tea, when the first light of dawn leaked through her window. She was so emotionally and physically beaten down that she hadn’t even realized the symptoms of her withdrawal had abated. The cramps and cravings had subsided. Only the worthlessness and self-loathing remained.

I’ve made it through the worst
, she tried to encourage herself, but her words were hollow. She felt like such a failure for having ever fallen off the wagon in the first place.

Tired as she was, she decided that the sunlight and some light exercise might perk her up. After a quick shower, she changed into a pair of shorts
and a T-shirt, grabbed her Rollerblades, and headed out. She only skated half her normal route but, with her reduced speed and energy level, it took almost as long as the full loop.

By the time she returned to her apartment, she had begun to emerge from the fog of narcotic withdrawal. She saw the indicator light flashing on her phone. Even before she listened to the message, she knew it had to be the SFU calling to beg her to come in to work another overtime shift. With three of the specialized oncology nurses on maternity leave and five others out on disability—ranging from caregiver burnout to work-related back injuries—the ward was chronically short-staffed.

Not today. I just can’t
.

Still in her blading gear, Nikki lay down on top of the bedspread expecting sleep to come easily. But her mind raced faster than her skates had. An hour later, she heard the faint ringing of her phone, which she kept out of the bedroom so as not to be disturbed after night shifts. Giving up on sleep, she rolled off the bed and wandered out to answer it.

She found herself hoping that it was Erin McGrath calling to arrange the coffee they had discussed earlier. Nikki instinctively trusted Tyler’s sister. She could imagine herself opening up to Erin, even about her addiction to painkillers and her feelings for Tyler. She knew it would be reckless to discuss either, especially with Tyler’s sister of all people, but she felt the need to unload her secrets. Still relatively new to Oakdale, Nikki couldn’t think of anyone else in whom she could readily confide, short of a public confession at a Narcotics Anonymous meeting, which did not appeal to her at all.

But it wasn’t Erin on the phone. “Is this Nicola Salazar?” asked a man whose voice she didn’t recognize.

“It’s Nikki.” Heart galloping, she immediately assumed someone at the Alfredson had discovered her aborted attempt at narcotics’ theft.

“I am Denny Rymer with the
Times
.”

A flood of relief washed over her but then she made the connection to the reporter who had written the vicious exposé on Tyler. She scowled at the receiver. “Where did you get my number?” she snapped.

“The phone book.”

“Why are you calling?”

“I understand you were involved in the care of a young patient named
Nate Stafford?” Rymer’s tone was obsequious. “His parents spoke incredibly highly of your professionalism and compassion. They said you shared a special bond with . . . little Nate.”

She wasn’t taken in by his flattery. “So?”

“They feel indebted to you.” Rymer paused and his voice lowered. “However, they have serious concerns about Nate’s medical care—”

“I am not going to comment on that!”

“Of course not,” Rymer agreed quickly. “Wouldn’t ask you to, either. I assume you know there is a lawsuit pending?”

“Yes.”

“Dr. McGrath won’t talk to me, Ms. Salazar. His father won’t cooperate, either. It’s making it really tough for me to report his side of the whole sad case.”

“Why are you reporting this at all?”

“A family lost their child to a medication they would have never approved of, had they known its risks. It’s tragic. If I can help prevent this from happening again to another patient—if for only
one
other patient or family—then don’t you think it’s worthwhile to let people know?”

You self-righteous bastard!
Nikki calmed herself, before she fired back a knee-jerk response. That was probably what Rymer wanted.

“Ms. Salazar? Are you still there?”

“I don’t buy your public service line,” Nikki said evenly. “I think you are taking advantage of a very vulnerable family after they’ve gone through hell.”

“You can believe whatever you want,” Rymer said, unperturbed. “Besides, I didn’t find them. The Staffords came to me. Regardless, I’m still trying to give our readers an unbiased—”

“You really think I’m that naïve?” she said. “You’re hanging Ty—Dr. McGrath out as a scapegoat to sell papers and further your career.”

“I’m doing my job, Ms. Salazar,” he said with a hint of indignation.

“Let me tell you about Dr. McGrath,” Nikki said through gritted teeth. “He is the most caring pediatric oncologist I have ever met. He would never choose to do anything that wasn’t in a patient’s best interest. Ever. Period.”

“And I’ve heard others rave about him, too,” Rymer encouraged. “Sometimes, doctors believe they’re the best ones to make difficult decisions for patients and their families. I’ve seen it so many times.” He sighed. “Sometimes
even the very best of them wind up playing God. Wouldn’t you agree?”