I tried to turn my head and wipe my nose on my shoulder, but it didn’t seem to help.
She continued. “I also had to get rid of Kathleen and the kids. I put rivaroxaban in the lasagna and in the cookies and the brownies. If they hadn’t gone to Boise, I could have finished them off too.”
She crawled back to me and leaned over. It was completely dark now, and her face was outlined only by the flashlight beams. I couldn’t read her expression, but I was pretty sure it wasn’t all sweetness and light. It didn’t really matter, did it? “Now I can go be Mrs. Mildred Atterbury,” she said, “and live in a villa in Barbados, overlooking the ocean, with all that lovely money. Have a nice death.”
She pointed the butane lighter at the trash pile and lit it. The cardboard flared up nicely, and the sudden warmth actually felt rather pleasant. She looked at it dispassionately. “Gosh,” she said, “that really is a sorry little pile of trash, isn’t it? That’ll never catch. I guess I’d better help it along.” With that, she directed the butane lighter at the floor above her. Then I became aware of the sounds above my head. The house above me was already burning merrily; I could hear the wood crackling. No wonder Ruthie got so mad at me for interrupting and slowing her down; I was keeping her from getting out before the floor caved in. Isn’t that just like me, always wanting to be the center of attention?
Ruthie put the butane lighter back in her pocket and pulled a cloth out of her pocket. She shoved it into my mouth and covered my mouth with duct tape. She wrapped the duct tape all the way around my head. “Maybe that will shut you up, Doctor Smarty Pants. That sucker’s not coming off any time soon. I’m out of here.”
“Ciao,” I tried to say, my voice muffled. My nose was running down the back of my throat. If I kept swallowing all that blood, it was going to make me …
Suddenly I knew I was going to vomit. I couldn’t help it. Maybe if I could direct it out my nose instead of my mouth, I could keep from choking. Retching, I rolled back onto my side and forced the vomit out my nose. So far so good. Another spasm. Out the nose. Another spasm, and another. Then I realized that my nether region was soaked too. Oh, shit. Literally. I could smell it.
“Ugh,” Ruthie said. “That’s gross. I’m glad I don’t have to stay around and watch. It was bad enough watching Jay do that, and he wasn’t even gagged.” She turned and crawled away from me. By the light of the flashlight she carried, I saw her get to her feet, straighten up, and climb back up the ladder to the back porch. I heard the trapdoor fall back into place, leaving me alone with the bonfire.
With my clothes soaked, I felt colder than ever. My belly felt like it had doubled in size, and it hurt. It was getting really hard to take a decent breath without pain. I tried to breathe in little, shallow breaths, which helped a bit. Maybe lying on the other side would be more comfortable. But no, it wasn’t. It felt like the time I fell off the teeter-totter in the first grade and landed right smack across the iron frame on my stomach, knocking the wind out of myself.
But now I hadn’t had the wind knocked out of me. I took another breath to demonstrate that to myself, and it gurgled. Why would that be? I coughed. That hurt my belly. It hurt my chest too. Which was worse? I couldn’t tell. Liquid ran out of my nose, and I couldn’t wipe it because my hands were restrained. Warm wetness soaked my gag. It was better wet than dry, but it tasted like blood.
You know, being a doctor, I always think the worst. It’s perfectly obvious, I told myself. I’ve got broken ribs, and they’ve punctured my lung, and that’s why I’m coughing up blood. There’s a word for that: hemoptysis. I’m having hemoptysis. Sure I am, and Hal will tease me about it, like he always does when I say things like that.
I was now shivering so violently that my muscles were cramping. My abdominal muscles in particular. I had never experienced such pain. My entire belly seemed knotted, making it even harder to breathe.
And now there were cramps in my lower pelvic region too. Oh, no, you’ve got to be kidding, I thought. What a rotten time to be getting my period. But it never fails. Hal and I plan a trip, and I get my period. That time we went camping in Montana with bears around, I got my period. Swimming in the ocean off Huntington Beach, I got my period, announcing, “Come and get it!” to any sharks that might be cruising by.
So naturally, I end up tied up in a crawlspace with broken ribs and hemoptysis, and I get my period. Stands to reason.
Damn it. Where were the police? My cell phone battery must have died. I couldn’t think of any other reason why Hal hadn’t called them. If he had called them, why weren’t they here? “Help!” I yelled, or attempted to. I couldn’t get much sound past that gag; plus it hurt. It kept getting harder to breathe, and everything smelled like blood. The gag in my mouth tasted disgusting. A sudden cold breeze blew the smell away, but it came back.
Eventually I noticed that I had stopped shivering. My muscles weren’t hurting so much. I was getting sleepy. I guess I’ll just go to sleep, I thought, and when I wake up it’ll be morning.
Wait a minute! I screamed at myself in sudden realization. I can’t go to sleep! If I do, I’ll never wake up. This is hypothermia. I need to keep moving and stay awake or I’ll die. A new bout of abdominal cramping seized me, and with it came the nausea. I vomited again, remembering to force it out my nose, but I couldn’t vomit and control my bowels at the same time. Oh God, what a mess. The renewed odor of fresh, warm blood assailed my nostrils, mixed with a strong fecal smell, a stench reminiscent of the contents of Jay Braithwaite Burke’s gastrointestinal tract that had sent Bernie Kincaid out of the room, hand over mouth. Holy shit, I thought, at this rate I’ll bleed to death before morning.
Somebody should be missing me by now, I thought. Surely Hal has reported me missing. Even if he didn’t hear Ruthie’s confession over my cell phone. Somebody should show up soon.
And what was it with the crawl spaces, anyway? When Hal had been kidnapped three years ago, he’d been trapped in a crawl space. Now I was trapped in a crawl space. Both times in the dead of winter. Some originality was definitely called for here. On the other hand, black widow spiders were unlikely to be down here at this time of year. I failed to derive much comfort from that, though, under the circumstances.
Maybe, I thought, if I could roll until I hit an outside wall, I could get to one of those spaces with the lattice work. It was just lath. Surely I could break it and get out. I tried. Too bad I had to keep stopping because it hurt so fucking much. But you know, it pretty much hurt all the time, so I figured I could just as well suck it up and keep on rolling.
No doubt it would force the ends of my broken ribs right out through my skin, resulting in a comminuted compound rib fracture. Was there such a thing? Perhaps it’d be reportable. Perhaps they’d name it after me: Shapiro’s fracture.
Such a phenomenon would also let air into my chest cavity, resulting in that bane of emergency room physicians everywhere, the Sucking Chest Wound—and possibly also the dreaded Flail Chest.
After about five revolutions, I came up against a wall. The effort left me breathing hard, or trying to. Each breath felt like a knife in my chest. My belly cramped up again, and then there was a huge wave of nausea. I vomited again, which resulted in more fecal incontinence and more pain. If this keeps up much longer, I thought, I’ll die and be glad of it.
Hell used to be hot. But now, post-Exorcist, it’s supposed to be cold and smell like shit. Maybe I’m already dead and gone to hell.
Okay, what did I do to deserve that? I didn’t actually commit adultery, although it was a close thing. It must have been all that taking the Lord’s name in vain. Shit. I’m here in hell, doing time on a cussing rap.
I’m trapped in the crawlspace of a house that’s on fire. Well, at least I’ll be warm for a while, before it all falls in on me or I die of smoke inhalation, whichever comes first.
The smoke smell got stronger. I
began to hear a crackling noise—a really loud crackling noise. And then a crash.
The fire, having burned through the floor, dropped a chunk of burning material into the crawl space several feet from me, possibly right where I had been lying before I started rolling. It provided enough light that I could see my surroundings. I saw a gap in the wall, and I saw flames through it. Shit! Wouldn’t you know my escape hatch would be surrounded by flames! I quickly ran through the options open to me: stay put and die of smoke inhalation, exsanguination, or having the burning floor cave in on me, whichever came first; or force my way through the opening and hope that my blood-soaked clothing and the snow outside would protect me from the flames.
Well, that’s a no-brainer, I thought.
Gritting my figurative teeth—since I couldn’t actually grit my real ones around the fucking gag—I rolled toward the gap, feet first. I thrust my feet and legs through the hole, which tore at my clothing. There was a sharp metal edge of something that gleamed in the firelight. Ha! Maybe it’s sharp enough to cut my bonds, I thought.
I worked myself painfully into position and began rubbing my wrists against the metal edge. It wasn’t easy since they were tied behind me. It’d be a lot easier if they were in front—hey! I had seen someone on TV curl his body and slide it between his arms and get his bound wrists in front of him. Well, I’d always been pretty limber—at least without a sore belly.
I worked my butt through my arms, then my thighs, endeavoring to ignore the excruciating pain in my chest and belly. I felt a new and even more painful sensation of something ripping inside my chest, undoubtedly more rib action. Oh goody, I thought, a new place to bleed from.
Finally, I got my wrists in front and started sawing. After what seemed like an eternity, the duct tape tore and my wrists were free. They were also bleeding profusely from cuts and scrapes. Terrific, I snarled to myself, yet another source of blood loss; just what I needed.
That baseball mitt of a bandage on my thumb hadn’t been much help. In fact, I had cut through some essential part of it that held it onto my hand and was in imminent danger of losing it. If it isn’t one thing, it’s ten others.
Toni, for God’s sake, quit bitching and get your butt through that hole before the floor caves in. I stuck my head out the hole. The metal edge caught on the duct tape holding my gag in place. I reached back to free it and found that it was already nearly cut through. With energy dredged up from I-knew-not-where, I ripped it the rest of the way and spat the blood-soaked rag out onto the snow. Now I could vomit through my mouth like a normal person for a change.
Okay, now start by breaking off some rotten boards, make the hole bigger. Then put my head and an arm through, then the other arm, push with my still-bound feet, get both shoulders through. Now for the hips—oh God, wouldn’t it be a bitch if I got stuck now. Wait a minute, it was my coat that was bunching up. If I could just take it off—but no, I couldn’t. What if I just slid back in until it was looser and then pulled my coat up around my waist? There, that was better. Without the folds of the heavy wool coat, my hips slid out easily, and I rolled as fast as I could away from the house and toward the street, trying to ignore the pain in my chest that was making it harder and harder to breathe.
Not a minute too soon, either. Behind me, the house collapsed with a roar and a spray of sparks and burning embers, some of which landed on me. I kept rolling and thanking God for the snow, the blessed snow that quenched all the sizzling embers and sparks that kept landing around and on me.
When I judged that I was far enough from what was left of the house to be safe, I stopped and rolled over on my back, arms spread out on the snow, looking up at the sky and all the beautiful stars. I felt imbued with a lovely sense of warmth and well-being, which I knew was the beginning of the end, but I didn’t seem to care. I coughed and blood ran out of my mouth. Bloody hell, I thought with my last remnant of consciousness, I really have punctured my lung.
Saturday, December 27
Chapter 35
Who shall decide when doctors disagree,
And soundest casuists doubt, like you and me?
—Samuel Pope
Next time I woke up, I was in the hospital, snug and warm, with lights and a nice dry bed—one that was, at the very least, softer than the packed dirt of Ruthie’s crawlspace—and people tending to me who weren’t brandishing butane lighters or five irons.
I looked up and saw clustered bags of clear fluid hanging overhead, and a bag of blood, nearly empty. My hands were restrained but attached to the bed rails this time, not behind me, so I wasn’t lying on them, and there were no intravenous lines attached to my hands or my arms. Both my wrists were bandaged. My thumb bandage had been replaced too. So where the hell were all those intravenous lines going?
I had a tube in my throat and another one in my nose. A machine was breathing for me. I heard it behind me. My chest still hurt, but it seemed to be a dull ache rather than the unbearable ripping, tearing, stabbing pain it had been before. The clicking I heard next to me came from the IVAC, which was regulating how fast the IV fluids were running into me. I couldn’t turn my head on account of the endotracheal tube, but I could roll my eyes and see it. Next to it was a morphine pump, or at least I assumed it contained morphine, with a button I could push if I needed more—that is, I could if I wasn’t restrained. I guessed I’d need to address that at some point, but not now.
I supposed too that I’d need to move at some point, but I was unwilling to face the pain that would undoubtedly ensue if I tried. At least I was warm—at least I thought I was, until the first of many rigors shook me. They had me wrapped in a Bair Hugger, which was a kind of super-heavy electric blanket. I knew they used those in the Recovery Room—or as they call it these days, PACU, or Post-Anesthesia Care Unit—for that very reason. Those post-anesthesia shakes were not pleasant, particularly considering the state of my abdominal area, and because I was having them, I deduced that I’d had some kind of surgery.
I tried to raise my head and look down at myself, but I couldn’t raise it much because of the endotracheal tube, not to mention my sore belly. The intravenous tubes seemed to lead under my hospital gown, so I deduced that I had a PICC line or Port-a-Cath or some other kind of central venous access. There was a nasogastric tube in my nose, and a chest tube was leading out of my right side. The tube had bloody fluid in it. The nasogastric tube did too.
It was all too much. Drained of energy, I let my head flop back on the pillow.
Two nurses came to my bedside with a new blood bag and went through a ritualistic review of the information on the blood bag, the paperwork attached to it, and my hospital wristband before they hung it and took the old one away. I was fuzzily gratified that they had correctly performed the transfusion patient identification procedure required by the College of American Pathologists, which accredited our lab, and hoped that they weren’t just doing it for my benefit. Idly I wondered how many of those I’d gone through. Had I broken Lance’s record yet?
Conveniently, and just in time to answer that question, Jeff Sorensen appeared and lifted up my gown to check my dressing. It was a big one, reaching from my right chest all the way around to my back, or at least to where I could no longer see it. Apparently I’d had a thoracotomy. Below the dressing my entire abdomen was almost black with hemorrhage. No wonder it hurt.
“How many does that make?” Jeff asked the nurse, whose name I knew was June, as he picked up the clipboard hanging on the bedrail.
“Ten,” she answered, “and eight of fresh frozen plasma.”
“And the last hemoglobin?”
“Eight point five, Doctor.”
Yikes, I thought. Ten units of blood and my hemoglobin’s only eight point five? That sucks.
“How’s the I&O?”
“Fifteen eighty-five in, twenty-five forty out.”
“Hang another lite
r of Ringer’s and two more units packed cells, and check the hemoglobin again after thirty minutes.”
“Okay, Doctor.”
Jeff left without saying anything to me. No doubt he hadn’t even noticed I was awake and listening to every word he said. Surgeons! I ask you …
George Marshall, on the other hand, noticed right away. “Toni? Oh good, you’re awake. You really had us hopping there for a while. Did you know you’d nearly bled out? You’ve got three broken ribs, and one of them really did a number on your lung. That jug’s nearly full, June. How long since it’s been changed?”
“Four hours, Doctor.”
“That’s not good,” George said. “She’s still bleeding from the stomach. How’s the hemoglobin?”
“Eight point five, Doctor,” June said.
“That’s all? How many units packed cells?”
“Ten. And eight FFP.”
“And the anti-Xa?”
“About the same, Doctor.”
“Damn,” George said. “It’s all going right out that chest tube.”
“Doctor,” June said, “do you want more FFP?”
“Sure,” George said. “One more unit of packed cells and another FFP. Then check the hemoglobin again.”
“Dr. Sorensen said the same thing, Doctor.”
“This doesn’t make any sense,” George said. “She’s had an exchange transfusion and then some. How about the platelets? Only thirty thousand? Okay, another ten platelet packs as well. How’s the urine look?”
“Bloody.”
“I guess that figures. Keep on with the antibiotics.”
“Yes, Doctor.”
He patted me on the shoulder. “I’ll stop by this afternoon, Toni. Hang in there. We’ll get it figured out; don’t you worry. Try to get some rest.” And he was gone.
Well, that was encouraging, I thought. The blood’s pouring out of me as fast as it’s going in, but it shouldn’t be. And I only have thirty thousand platelets, when I should have about two hundred thousand. Was it just dilutional from the ten units of blood, or did I have DIC? Why wasn’t all that fresh frozen plasma replacing my clotting factors like it should? I suppose one reason was that it was pouring out of me right along with the blood transfusions.
Too Much Blood Page 28