by Melissa Yi
It was a tough read, but it boiled down to this: if someone tries to strangle a woman, but doesn't actually kill her, her risk of death rises six or seven times.
So when the woman comes to the ER looking like Rihanna post-Chris Brown, if she's wearing a purple necklace, it's never only a question of Humpty-Dumptying her together again. We have to intervene now, or she may die before she makes it back to one of our stretchers.
More horrifyingly, near-strangling isn't as much of a death risk factor for African-American women because they're already at much higher risk. They are four times more likely to have their partner kill or attempt to kill them, period. Doesn't matter whether the guy tried to strangle them before or not. How would you like to be four times more likely to die, based only on the colour of your skin?
Tori had gone on to research how indigenous women were three times more likely to be attacked, but tonight, the statistics looked grim for the black woman in front of me.
"Alyssa," I said.
She laid on the stretcher with her eyes closed against me.
"I have to ask you this. I ask everyone who comes in hurt, male or female, no matter what age, in honour of a Toronto family doctor who was killed by her husband. Is Patrick hurting you?"
Her eyes shot open. She grabbed her phone, turned it on, and shoved it in my face, pointing at the NO.
"Okay. Is someone else hurting you?"
This time, she hesitated before she pointed at the NO.
The pause could be a sign, however slight. I gestured at her neck and her ear and her body. "Could you please tell me how this happened?"
She paused again.
Tell me, tell me, tell me throbbed in my brain.
I could feel the nurses' and my collective will pulsing at her. I held my breath.
Her eyes broke away from mine. She thumbed the word at me: NO.
I exhaled. Okay. It was hard to trust someone at first glance and confess your deepest secrets, especially when that someone started interrogating you and sticking a finger up your butt.
Maybe she'd tell me later.
More likely, she'd tell one of the nurses.
"If you change your mind, we're here all night," I whispered. "We're good listeners."
She typed another word: patrick
Roxanne tiptoed toward the door. "I'll get him."
"Good idea." Even if Alyssa wouldn't tell us anything right now, Patrick might be scared enough to let something slide.
But as I washed my hands at the sink, I surveyed the ambulance bay and couldn't detect any trace of him.
6
"That's strange," said Kris. "You'd think if he was so concerned about her—"
"I know." I frowned. It made me think of my own Gone Boy, though, so after I dried my hands, I took a quick peek at my phone. Nothing from Ryan, and nothing about Ryan from Tucker. I closed my eyes and prayed.
I love you, man. Be safe.
I wasn't even sure which man I was talking about. Either. Both.
Otherwise, I was hating the parallels on this night shift.
Someone had tried to strangle me, and someone had tried to strangle Alyssa Taylor.
My ex-boyfriend was missing, and Alyssa Taylor's current boyfriend was missing.
To be fair, maybe Patrick had gone back to work, and I didn't have time to look for him. Still, I cast an uneasy glance at Room 13 and 14. Roxanne had returned to room 14 to sedate Lori Goody again.
At least I knew exactly who had tried to wring my neck.
The question was who'd gone after Alyssa Taylor. She wouldn't tell us, but her boyfriend might.
If he hadn't disappeared.
Well, I wasn't sure of his hours, but if he started at 1900, he might do a 12 hour shift and finish at 0700. That gave me over six hours to pry the story out of him, because face it, he'd be easier to crack than Alyssa.
She knew who'd beaten her, but for whatever reason, she wouldn't talk.
Patrick knew. And he'd talk. Because he'd want them punished.
"If we don't have an extra security guard right now, could we at least get a sitter for Alyssa?" I asked Kris. I didn't want Alyssa alone, and bruised, and scared. "Even—what about that, uh, male nurse who usually sits here? Bill, right?" I pointed at the chair at the nursing station nearest the resus room. We have an obese, perpetually irritated male nurse who spends most of his shift parked in the chair at the end of the nursing station near resus A and B. He knows what he's doing, but I try to minimize my interaction with him. He seems to hate residents, or at least me. "Is he working today?"
Kris shook her head. "Bill's gone. He's done."
Her tone was a bit odd, but before I could ask, Lori Goody screeched, "I'M GOING TO SUE YOU! I'M GOING TO SUE EVERY LAST MOTHERFUCKING ONE OF YOU!"
"Please do," said Roxanne, as she left room 14, shaking her head.
"You gave her Haldol and Ativan?" I asked.
"Twice," she said, her brown eyebrows drawing together. "She's skinny, but she's like an elephant. We're waiting for her drug screen to come back."
Right. Who knew what she'd mainlined at home while waiting for a refill. "We'll have to step it up with benzos, at least. Let me talk to Dr. Chia, if she's still here."
I made my way to the ambulatory side desk, where Dr. Chia had abandoned her lab coat on her chair. I knew it was hers. Not only did it have her name embroidered above the front pocket and EMERGENCY MEDICINE across the back, which was useful when patients kept asking if you're a nurse, but she'd paid extra to have a red rhythm strip embroidered between her shoulder blades, with a spazzed-out V tach rhythm defibrillated into sinus rhythm. Made me laugh the first time I saw it.
A few seconds later, Dr. Chia popped out of the eye room, Purelling her hands.
An older nurse named Linda held up a notebook with two St. Joseph’s stickers on them: "Your family-oriented hospital away from home" and "The heartbeat of Côte-des-Neiges." Before I could giggle to myself at their cheesiness, I tuned into what Linda was saying: "I don't wear my stethoscope when I have a psych patient."
She meant me. I stopped mid-step, in front of the exit doors between the ambulance and ambulatory side, near the old light boxes. They used to print X-rays and CT's and MRI's on actual film and hang them on this wall of opaque panels to illuminate them. Right now, I felt about as smart as these opaque panels.
"Me neither," Dr. Chia answered. "Not my first rodeo."
I flushed. Lori Goody hadn't been a psych patient. She'd been a drug-seeking patient with chest pain and palpitations. Was I not supposed to do a physical exam, even when a patient claimed she was having a heart attack?
"I've been kicked, I've been punched, I've had patients tried to strangle me. I don't wear my stethoscope to Code Whites anymore," said Kris, who'd joined us.
Then how do you listen to their hearts? I shouted in my head, but I was already mentally kicking myself.
I could have held my stethoscope in my hands as I advanced on LG. Why had I looped it around my neck? I found that position more comfortable, but what was more important, comfort or survival?
I could have kept my distance from her, monitoring her body language. As soon as she'd lunged at me, I could have darted away.
I could have asked for someone to come with me while I examined her, although that might have taken a good twenty minutes, given our almost non-existent night shift staff.
At the very least, I should have left the door open.
I'd had a few options. Bottom line, I hadn't been wary enough.
What the hell was wrong with me? It wasn't even the first time someone had tried to strangle me, although it was the first attempt with my own stethoscope.
"Oh, well. Maybe you won't have to wear your stethoscope at all soon, right, Val?" Kris said.
Huh? I knew that Dr. Chia's first name was Valerie, and I'd heard ultrasound called "the stethoscope of the 21st century," but none of us had given up stethoscopes completely. For one thing, we were always fighting over the few ultr
asound machines, which seemed to be located on the opposite side of wherever I was working.
"I know I'd retire right away!" Roxanne chimed in. She'd rolled up behind us with her WOW.
"Better than getting walked out," muttered Julie, the little preposée, which is what they called orderlies in Montreal.
"And you don't even have to rip off drugs from the OR! Your million is legal!" Kris called, before Dr. Chia shushed her.
I felt like my hair was standing straight up from my head. Someone had stolen drugs from the OR? How'd I miss that memo?
But in more exciting news, Dr. Valerie Chia was a millionaire. Recently and legally. That meant...
"It's not me. It's Mark's, okay?" Dr. Chia typed on her WOW, trying to ignore them.
"He's your conjoint." Kris used the French slang for partner. "You live with the guy. It's yours too. If he says anything else, you take him straight to a lawyer."
"She's already got one," Roxanne said, and Dr. Chia threw up her hands and asked the ceiling, "Are there no secrets around here?"
"Not a lot," said Kris. "What happened? He's already being a dick about it?"
"No, nothing like that. I just—I wanted him to claim it anonymously. You can hire a lawyer to claim it. The lottery corporation wants photos of the winners. It's part of their conditions, but for privacy reasons, it's better not to do them."
"Of course," said Kris. "Not our first rodeo. But he wouldn't let you do the lawyer thing?"
"It was his ticket," said Dr. Chia.
"I saw your picture with him, though. It's right on Facebook!" said Roxanne.
Dr. Chia's shoulders sagged. "He really wanted me to be there. You know. Celebrate it together."
Strange. I regarded her with new eyes. Dr. Chia didn't have to slog in the ER, risking a boot to the face from Lori Goody. She could be at home, snuggling with her newly-minted millionaire common-law husband and glorying in her 1.2K Facebook likes!
It was strange to me that they weren't married, but I'm from the province of Ontario. In Quebec, people don't tend to marry as much. Something to do with rebelling against the church.
Man. If I were a millionaire, or as good as married to a millionaire...
My thoughts drifted to Tucker and me, him shirtless and sunburned on the beach, grinning as he handed me a fruity drink.
And there was Ryan sliding his arms around me from behind, kissing my shoulder.
Um. My turn to blush. Instead, I made a point of asking, "Do you mind if I give more Ativan to bed 14? I thought one or two milligrams IV."
"Oh, yes, I already told Roxanne to get it," said Dr. Chia, who had also turned red and started typing again. "I want 14 sedated. She might need a lot more. I think the order's in. Hang on." She clicked a few times. "Yes, there it is."
"I'm not seeing it. That's what I came to tell you," said Roxanne.
"Did you hit refresh?"
"Only a billion times. I'd take it as a verbal order, but you know we're not supposed to do that any more."
"I know. SARKET," Dr. Chia said, with loathing. "At this rate, Dave will finish his night shift before I compile my charts or get any orders in!" She started clicking. "There. Can you see that?"
"No. Hang on, I'll refresh. Again."
Meanwhile, I perked up. Dave meant Dr. Dave Dupuis, also known as God, because he heroically manages the worst cases, the busiest shifts, the craziest call karma. Things no one else gets at a relatively sleepy community hospital when all traumas are automatically diverted to UC, the University College Hospital.
Someone fell off a bridge?
Dave's on.
Someone pulled a knife?
Dave's on.
If I'm going to stay up 24/7 on a night shift, I'd rather learn from "God" and get some cool stories out of it than endure Dr. Callendar complaining that I hadn't spent 20 minutes thoroughly examining a pimple.
I couldn't resist whispering to Dr. Chia, "Congratulations."
"On what?" She yanked her head up from the screen to bind me with her dark eyes.
"Your partner winning the lottery."
Her cheeks reddened, and she avoided my eyes. "Thanks."
Clearly, she was embarrassed about the money and wanted everyone to ignore it. If I'd won the lottery, though, not only would I yell, "I'm king of the world!" and do a victory dance, I'd—well, I don't know if I'd abandon medicine, but I'd at least go home and take a good, long nap.
I suppressed a yawn. No time for sleep. Dr. Dupuis had already swept in through the doors beside the old light boxes and started signing over with the evening doctor.
This is the deal, as a resident. You work longer hours than the staff doctor. You start at 11, you finish at 8, and on weekdays, you have to go to teaching afterward. If you're very unlucky, you might have to give the teaching session at 0800, fielding questions on the epidemiology of measles in an age of idiotic anti-vaxxers, when you're so tired that you can barely figure out which way is the bathroom.
The staff doctor comes on at midnight and finishes at 7:30. Much more tidy. And you can bet your ass they skip teaching rounds afterward if their neurons aren't firing.
As I approached Dr. Dupuis, Dr. Callendar cut in front of me, already jabbering about bed 5.
I grimaced. Callendar never moves as fast as when he's finishing a shift.
"Walk with us, Hope." Dr. Dupuis gestured me toward them with a long, thin hand. He reminded me of a stork, all arms and legs and pale feathers (blond hair), more Bill Gates than Hollywood hunk, but "God" was my favourite doctor, bar none.
Dr. Callendar didn't pause in his narration as I caught up with them at bed 6. "...a 70-year-old asthmatic who came in with a sat of 89. I gave her three Ventolins and Atrovents."
I perked up. The vast majority of asthmatics turn around quickly. It's rare for them to desaturate. And you don't see elderly asthmatics. Many of them are children or, at most, in their fifties. Maybe pollution wasn't as bad back then, or maybe smoking and emphysema carry them away first.
"You got the X-ray?" Dr. Dupuis asked Dr. Callendar.
"Yes. No pneumonia."
"What about a D-dimer, a trop, or BNP?"
Dr. Dupuis was also thinking about a differential diagnosis, like a pulmonary embolus, heart attack, or congestive heart failure.
Dr. Callendar waved his hand. "You can add those if you choose. In bed 7..."
If Dr. Callendar had been a resident, he would have had his ass handed to him for doing slipshod work. But as a staff, he could almost literally wave his hand and say, "I leave this as an exercise to the reader," a line that Ryan and I used to joke about from math textbooks, and the other staff wouldn't bother him. They'd sigh and clean up after him.
Dr. Dupuis took the crappy handover as I would have, straight-faced and unsmiling, making a mental list of what he had to add in once Callendar got out of the way.
I took notes on a clipboard, which Dr. Dupuis recognized with a flick of an eyelid. I wasn't doing it to win brownie points, though. I wrote things down because I tend to get tired and forget which bed needs Tylenol on a night shift.
I hung back near the nursing station once we reached room 14. I didn't want Lori Goody to recognize me.
"Who's this?" said Dr. Dupuis, noting my hesitation.
"It's the one with the scalpel," I said, before Dr. Callendar could. "You probably heard about it on your way in. I'll let you two talk about this one."
"We can do it now," said Dr. Dupuis, facing Dr. Callendar. "What's the patient still doing here? Why didn't the police take her away, or at least port her up to psych? She shouldn't be in the same area as Dr. Sze."
"What're you gonna do about it, FIRE ME?" Lori Goody hollered.
Dr. Callendar shrugged and took a step backwards, receding from Lori Goody's hearing range. "You know how it is. No psych beds, and the police are overwhelmed. They'll take her away as soon as possible."
"She shouldn't be in the same area as Dr. Sze," Dr. Dupuis repeated, and turned to our nurse, Roxanne.
"What can we do about this?"
"Call the Glen," she said. "That's her sector."
So the patient was already known to psych and had been assigned to the new superhospital.
Dr. Callendar wrinkled his forehead. "I put a call out, and they never answered."
"Keep calling," said Dr. Dupuis. "You can't have an attacker and victim in the same area. It's not safe. How come there's no police, or even a security guard, at the door?"
I squiggled inside. I didn't want to be known as a victim, and I didn't want people to think they had to stand up for me. I could take care of myself.
On the other hand, it was nice to have people take charge after you got the crap kicked out of you, and Callendar got away with too much. Dr. Dupuis had let the clinical errors slide, knowing he'd fix them afterward, but he was pulling definite rank to protect me.
Roxanne gave me a slight wink.
The corner of my mouth lifted up. She really was one of my favourite nurses.
"I'm on my way out," said Dr. Callendar, glancing at the clock, but he snapped at the secretary, "Get me the Glen. What have you been waiting for?" like it was all her fault.
I knew he hadn't bothered pushing them to transfer Lori Goody out because, unlike Dr. Dupuis, he couldn't care less about me. Seriously, for him, I ranked lower than smegma. But Dr. Callendar was on his way out, in more ways than one.
I'd rather work a night shift with Dupuis than a day shift with Callendar.
"Call the police too," said Dr. Callendar. "Get everyone. I haven't got all day!"
Dr. Dupuis ignored him. "Start seeing patients, Hope," he said, and I grabbed a chart, happy to return to work and avoid the drama.
Dr. Dupuis plucked the next two charts without checking the chief complaints. "Let's motor. The paramedics had six overdoses tonight already, and they're running low on Narcan." He shook his head.
Narcan was amazing. I saw one patient go from complete coma to sitting up in bed, trying to take a swing at us, thanks to the narcotic antidote.
Six overdoses before midnight was a lot. Way more than I'd ever heard of.
"How come we're running out?" I managed to ask. "'Cause of the drips?" Narcan's antidote effect wears off. You often have to give more than one dose, and then an infusion. I felt for the paramedics. While you're saving one person's life, you give whatever it takes. But when the next call comes in, and the next call, and the next, you can run out of Narcan. And then, like Kris pointed out, their only option is to ship them to the ER.