“It’s a wagon wheel,” Brett mused.
“How many days does that take?” Nathan asked.
“In learning, memory retention is solidified based on daily practice. In the control group it was five days until the memory was formed, until the rat had learned that the wood was always in the middle of the pool.
“In the research,” Reeves continued, “what they did next was administer two drugs; Epinephrine, which is essentially adrenaline, and Inderal, which is a drug that blocks the effects of epinephrine in the body. Rats that were given epi would swim to the wood plank an average of two days sooner than the control group. Rats that were given Inderal never learned the direct route to the wood. They would constantly swim in circles, repeating the same experience every day, not retaining what they had learned the day before. So they continued on in happenstance, swimming in circles until they stumbled upon their saving grace. Rats given adrenaline solidified the memory significantly earlier. It was curious that the rats given Inderal were not able to form the memory at all.”
“And this helps humans how?”
“For one, it shows that in PTSD, the surge of adrenaline locks the memory of the traumatic event clearly in the mind relatively quickly. It was thought that, like the rats, if people were given Inderal to block the effects of the adrenaline, they wouldn’t retain the memories and many of the symptoms associated with PTSD would nullify.”
“This is where your research now lies.”
“Yes, and Celia was one of my patients in a trial that looked at the effect of Inderal in PTSD.”
“What have you been finding?”
“We’ve found that, if we can identify the people who are more at risk for PTSD shortly after their traumatic experience and give them a short course of Inderal, they have a significant reduction in the flashbacks and nightmares associated with the event. Many of the physical symptoms—fast heart rate, heightened senses—are reduced as well.”
“So you wipe out their memories?”
“No, definitely not, but the Inderal seems to prevent the memory from having such prominence, from being so easily recalled. In the case of Celia, she will always know that she was raped. She may just have more difficulty recalling specific details, sensations, and emotions that other victims will be able to recall with ease.”
“I’m not sure that’s a good thing, Doc,” Brett said.
“How could you possibly say that? I know my daughter must be one of these rape victims if you’re here to speak with me about her as well. As a doctor, how can I not want to relieve her suffering?”
Nathan placed a fisted hand on top of the desk. “How about as her father? I would think that would come first.”
Brett’s mouth gaped open a few seconds before he followed Nathan’s comment. “From a police perspective, excellent recall of events is what puts people in jail. The more those memories are diminished, the harder it will be to rely on their testimony. It wouldn’t surprise me at all if a loony judge looked at this research and threw out the witness’s testimony because her memory could no longer be considered reliable.”
Nathan stood up and backed away from the desk. The pressure in his chest caused his breath to funnel hard through his nostrils. “I think the other issue is that the traumatic event, sometimes in a very cruel fashion, makes us the people we are today. Do you think Lilly would have ever become a doctor if these other things hadn’t happened? Life is supposed to be hard; it builds strong people.”
“There is a difference between strength and suffering. If you cannot function in your life because you are so disabled by these memories, what good is that? When we spoke, you said that I had something of Lilly’s that she wanted back. This is what she speaks of.” He slid a white journal forward. Grime had settled into the natural cracks of the leather, giving it a lacy appearance.
Nathan approached the desk and swiped it from the surface. “I’ll be sure Lilly gets this. I wish I could say it’s been a pleasure to meet you.”
Reeves gripped Nathan’s forearm. “I don’t mind your disdain for me as long as you help Lilly.”
Brett stood as well and eased the men apart. “I’m not against helping people, Dr. Reeves, but I want to be sure the bad guys go to jail for what they do.”
“We’ll be sure to tell Lilly about your research. Maybe she’ll seek treatment … from someone else.”
“It won’t make any difference. After she reads that”—he pointed to the book in Nathan’s hand—“in her life, I’ll be as good as dead.”
November 27
L
ILLY ENTERED THE
central workroom and ran headfirst into a bouquet of white balloons. Streamers twisted like licorice looped from each corner of the space, crisscrossing in the middle. From the center of the intersection hung a paper stork with a baby wrapped in a fuchsia blanket clutched in its beak. A mountain of presents wrapped in pink, yellow, and green accessorized with all manner of straight and curly ribbons crowded the main worktable. Someone placed a paper plate with a piece of cake into Lilly’s hand.
“Today’s Sonya’s surprise baby shower.”
Immediately, Lilly’s heart sank. “I forgot her present.”
“It’s no problem. Bring it next shift.”
In truth, she hadn’t remembered at all. Sonya was beautiful, dressed casually in blue jean maternity pants and a pink cotton sweater. Her eyes moistened as she opened each gift, placing the clothes on her belly and jiggling side to side in happiness. Lilly felt ill, set her cake down, grabbed a chart, and left. Outside the door, she leaned against the wall, eyes clenched, trying to keep the tears at bay. It was obvious that she wasn’t good to anyone anymore. She could barely remember what shifts she was scheduled to work. Three times in the last two weeks, they’d call, waking her up, asking if she’d remembered that she was supposed to be on duty. Dana hadn’t called all week, nor had Lilly reached out to her. Every day was a cloudy, alcohol-induced haze that never cleared. She felt a faint rumble in her tummy and the threat of nausea. Biting the inside of her cheek to quell the sensation, she flipped through the chart in front of her.
“Lilly! That detective is here to see you. I put him in the family room.”
“Thanks.”
She went to the small room that was meant to be cozy, fitted with overstuffed furniture and soft lighting, along with tissue boxes in every nook. Lilly wasn’t sure how much it helped when she told families their loved one had died.
“Detective Long, you should have called. I could have set some time aside for you.”
“Lilly, call me Nathan, please. You want to sit? I brought you coffee, a nice expensive cup from an obnoxiously pretentious store.” He motioned to the small sofa, and she felt her shoulders relax as she sat, putting the chart aside and taking the warm cup in her hands.
“How have you been?” Nathan sat first on the arm then eased into the small loveseat next to her. A girlish lilt tipped Lilly’s heartbeat up, a short relief from its general heaviness. Was this a well-practiced move from his youth?
“Managing—somewhat poorly, my friends would say.” Lilly rolled the cup between her hands.
“Did you call the person on that card I gave you?”
“No. I would say I didn’t have the time, but that would be a lie. I’m just not the counseling type.”
“What about a support group?”
Lilly shook her head, setting the cup aside. “Not me, either. What would help is getting this guy off the streets. Are you making any progress?”
Nathan rested his arm across the back of the furniture. Lilly’s first instinct was to fit herself into the crook of it.
Where did that come from?
She grabbed her cup and took a quick drink.
“We don’t have a suspect yet. We’re focusing on the victims and his process, working it backward in a sense. We’ve contacted the FBI. We’ll be meeting with one of their behavioral specialists soon.”
“Any new victims?”
“Not that we’re aware of. Hopefully not.” He paused and took a sip. “I’m sure you know not all women come forward.”
The quiet was comforting to Lilly, and she found herself wanting to stay here with Nathan. He made her feel safe. In addition to being physically strong, he had an underlying confidence that spoke of sureness and resilience. It was the first time she’d ever felt that she wouldn’t want to stop knowing him after everything was over.
If it would ever be over.
“The reason I came was to give you this.” He reached to the table beside him. Lying there was her mother’s journal.
Lilly held her breath as she took it. White leather, gold gilded edges now faded. Opening the cover, she found a black-and-white photo taped to the inside, taken when she was just one or two years old. Her mother held her in her lap, wrapping her in a hug with a gerbera daisy in one hand, her face nuzzled into Lilly’s neck. Small trembles quivered in Lilly’s fingertips as she traced her mother’s outline. She wanted her face to be up, so she could see and refresh her memory of every detail.
“There’re more pictures. Ones where you can see her clearly,” Nathan said, his voice low and soothing.
“How did you know that’s what I was thinking?”
“People lose the details over time that they most want to hold onto. It’s not strange you’d want pictures showing her face.”
Lilly closed the cover and smoothed her hand over the top. “How is my father?”
“He’s well. Very accomplished, wealthy, and lonely.”
“Lonely?”
“Some of the richest people, speaking financially, are lonely. They would give up all the money for a few good relationships.”
“Then why has he never come to me?”
“My sense is that he desperately wants to but is fearful that you’ll reject him.”
“Maybe he should be.” Lilly checked her watch. “Thanks for bringing this over, but I should get back to seeing patients.” She stood and gathered her things. “Thanks for the coffee.”
Nathan approached her and took her elbow into his hand, pulling her toward him. At first, she wanted to resist, but his embrace soothed her. “I am here for you, Lilly,” he whispered. He let her go and laid the palm of his hand on her cheek, looking briefly into her eyes as if he wanted to say something more, then relented and left her.
Lilly stood in the middle of the room for several minutes before the feel of the chart in her hands pulled her from remembering the peace she felt in his arms. Placing the journal behind the clipboard, she flipped up the top cover.
Sixty-five-year-old female with complaints of headache, right-sided weakness. Patient recently diagnosed with lung cancer.
Great. She checked the chart for the patient’s room number and left, relieved to see Luther running down the hall toward her.
“Lilly, can you take this trauma coming in? Anderson is off the floor, and the other two are at the baby shower. Hate to make them leave if we don’t have to.”
“Sure.”
She entered the room as the patient arrived. A young male was wheeled by her with C-spine equipment in place. The EMS crew and two nurses grabbed the backboard and placed him on the gurney.
“Lilly, how have you been?” Mike asked.
“Fine.” Lilly put on her gown and gloves.
“It’s been a few months. You don’t look well.”
She glanced at both of them. They looked at one another; sincere questions played between them.
“Did you transport me that night?” Lilly asked.
“We haven’t said anything,” Raul replied, holding his laptop computer open.
“Good, then we don’t need to discuss anything here.” Lilly’s short reply caused each of the men to physically take a step back. “You can go on with your report.”
Raul turned away.
“Lilly, we only want to make sure you’re all right. You’ve always been good to us in here.”
“Mike, your report.”
He looked down at his notes, rubbing his left bicep with a gloved, bloody hand.
“This is David Lusk, a twenty-one-year-old celebrating his birthday with some excess. Alcohol on board. Wrapped his car around a tree, was ejected through the front windshield. Found approximately twenty feet from his vehicle. Presumed head, neck, and back injuries. PT has been unresponsive but maintaining his airway. Breath sounds diminished on the left side. Abdomen tense. Obvious left femur fracture. Respiratory rate 12. Heart rate 140. BP 90/40. Pulse ox 92 percent. Anything else?”
“No, that’s fine, thanks.”
“Lilly …”
“It’s fine, Mike.”
He shrugged her off and left the room. Radiology was just completing the bedside films. She neared the patient and began her assessment. He was a crew-cut, blond-haired boy, though difficult to tell with the dirt, grime, blood, and leaves covering his head. His age was hidden by his appearance. She pushed open his eyelids and shone her penlight at each dark circle.
Pupils were large and unresponsive.
“David, can you hear me?”
No response. Likely there never would be again. She made quick work of listening to his chest, palpating for further fractures, checking his response to pain.
“The films are up, Lilly.” Luther stepped aside from the computer. She clicked through each of the series.
Spine okay. Chest okay.
“Luther, let’s prepare to get him intubated. He’s going to need scans of his head and belly. Page surgery and ortho.”
“Got it.”
Lilly pulled a blank progress report from the file cabinet and began making a few notations.
“We’ve got a problem here,” Luther warned, and the patient’s alarms sounded as Luther finished hanging up another bag of IV fluid. “Oxygen level and heart rate are dropping.”
Lilly was surprised to see Dana come through the doors.
“That was quick for a surgery response.”
“I was at Sonya’s shower when they paged me.”
“Luther, start bagging him. Let’s get him intubated.”
“Doesn’t look like he’s doing so well,” Dana replied.
“Nothing an airway won’t fix.”
“Meds?” Luther asked.
“Not with him decompensating. Let’s just get his airway secured.”
Lilly took position at the head of the bed and grabbed the airway. Opening the patient’s mouth, she visualized the vocal cords and slipped the tube between them. She removed the stylet, a plastic-coated piece of wire to keep the device straight during placement, as an additional nurse stepped up alongside her, placing the respiratory bag to the tube, giving the patient several breaths. Lilly looked expectantly at Luther as he listened to lung sounds.
“I’m not hearing any breath sounds on the left.” Luther met her gaze.
“The tube must be in the right bronchus. I’ll pull back a little. Now can you hear breath sounds of the left?” Lilly asked.
Luther continued to listen, shaking his head. Lilly could see the patient’s right chest rising with each ventilated breath.
“This doesn’t make any sense. If I pull this tube out anymore, I’m going to extubate him.”
“Heart rate 40.”
Lilly put her free hand to her head. She knew intuitively that she should be able to quickly make sense of why her patient was dying. Something she should be able to fix.
“Let me see his films.” Dana turned the monitor screen her direction, quickly scanning each X-ray.
“Lilly, he has a collapsed lung on the left side. Now he’s shifted. He needs a chest tube.”
Luther placed his stethoscope around his neck and grabbed a chest tray. Dana stepped up to the bedside and poured iodine over the young man’s chest. Brown and red dripped off of the gurney onto the floor. She made a small incision into the left rib cage, placed a hemostat into the cut and threaded a large, clear tube into the lung space. Lilly heard the rush of air. Dana began to suture the tube in place.
“Heart rate is coming up. Oxygen level increasing.”
Lilly still had the breathing tube clenched between her fingers.
“Let’s secure this and get an additional chest X-ray.” Someone took Lilly’s place. Her stomach flopped like dozens of butterflies turning within her. She clenched her lower abdomen. Dana dressed the chest tube.
“We need to talk outside.” Dana pointed her to the door. Lilly followed like a reluctant child.
“What is wrong with you? A pneumo? You miss a pneumothorax on X-ray! Lilly, it’s as plain as the nose on your face on that film. Your dysfunction is beginning to affect your patients.”
“What can I say to you? You’ve never made a mistake?”
“Of course I’ve made mistakes, but this wasn’t a little pneumo, either. His whole left chest was black. A med student could read it from a mile away. I’m trying to tell you that the way you are managing your life is affecting your work and your patients. You have to step up and fix this.” She paused as the patient was wheeled by.
“We’re on our way to CT.” Luther pulled the gurney through the doorway.
“Great, I’ll meet you guys down there,” Dana said.
She waited until Luther was out of earshot. “If you don’t fix this, I’m going to Anderson. I love you, Lilly. You know that, but I cannot have you jeopardizing patients.”
She turned and followed Luther to radiology.
Lilly felt a quake shudder from the center of her being. She sank to the floor, placing her head between her knees and covering it with her arms as she sobbed. There was not one good thing she could claim. She was failing as a person, as a friend, as a doctor.
I want this to end.
“Lilly?”
She raised her head and wiped her eyes quickly.
“Are you all right?” Rachel, another of the ER nurses asked.
“I’m just having a bad day. I’m not really feeling so well.”
“I’m so sorry. Do you want me to give this to another physician?”
Lilly had completely forgotten the chart she set down to receive the ambulance patient. “No, I can take it.” Lilly pushed herself up against the wall, trying to take the clipboard from her hands.
The nurse held it.
“Are you sure? Maybe you should just go home.”
“I’ll see this patient and make a decision, all right?”
Rachel relinquished the chart. Lilly scanned for the room number and made her way to the opposite side of the department. Knocking softly on the door, she waited for a verbal response before entering.
“Mrs. Richards?” Lilly grabbed the low-set stool and rolled it to the patient’s bedside. A bright multi-colored crocheted afghan covered her legs.
“I haven’t been a Mrs. for a long time. You can call me Caroline.”
“Caroline then. Did you make this?” Lilly fingered the yarn between her fingers.
“Yes, it’s one of my hobbies.”
“I’m Dr. Reeves. What brings you in today?”
“I’ve been having these headaches and the right side of my body just doesn’t seem as strong. I’ve been tripping and falling a lot.”