“I haven’t seen a tracheotomy performed on a child before,” Julie said in a tight voice, and Vic gave her a steadying pat on her arm. Working on children was trickier and always more emotional than treating adults.
“We’ve got this, Julie. Just hang close.”
Julie Whitaker was a second-year resident and a favorite of Vic’s. She was smart, a quick learner, confident with the right amount of humility for a doctor still training in her specialty. She was not quite thirty years old, and on a quiet shift in the ER one evening in early summer, she’d come out to Vic and Liv as a lesbian. It wasn’t much of a stretch for Vic to identify with the young resident, because she’d been her a dozen years ago. Working her ass off while trying to navigate a social life and coming out at the same time.
She explained to Julie that with the girl’s oxygen compromised, they didn’t have much time. They needed to get her airway open as quickly as possible, and a tracheotomy was probably their only option, since nothing the paramedics tried was working. “We’ll need to make an incision right below her Adam’s apple and insert a tube into her trachea, hopefully below the lodged piece of candy…” If the candy was lower than that, only surgery could save the girl and she might not make it to the OR. But Vic didn’t voice her thoughts. She felt her own pulse racing as the ambulance’s siren grew louder and louder until it finally stopped outside the hospital.
Snapping on a pair of sterile gloves, Vic stepped out of the way as Angie and her partner deftly transferred the patient to the trauma table.
“Name?” Vic asked without looking at Angie.
“Emily Johnson. Her parents should be here any minute. They were following us.”
“Emily, can you hear me?”
Nothing.
Vic said to the room, “When her parents arrive, I don’t want them in here. Got that?” The last thing they needed were hysterical parents on hand, distracting them, bringing an emotional energy that would act as invisible tripwires to Vic and her colleagues.
“Out, out of my way,” Vic barked at Angie. Then felt bad, but only for a second or two because there was work to be done and her mind was already there.
Pulling on her stethoscope, she listened to the girl’s chest. Faint breath sounds, which was hopeful but not great. “Hand me the laryngoscope,” she said to Julie. “And where the hell is the on-call surgeon, anybody know?”
“He’s busy on an appendectomy,” Liv replied. “Going to be a few more minutes.”
Great, Vic thought. They were on their own. She opened the girl’s mouth and inserted the laryngoscope, using the small light at the end of it to have a look around. And there it was, a red gooey mess lodged at about her vocal chords. She would need a tracheotomy for sure.
Julie handed her a piece of gauze soaked in Betadine. Vic swabbed the girl’s throat with it, took a scalpel from the trach tray and, about an inch-and-a-half up from the sternum, drew a quick and steady incision. With a clang she returned the scalpel to the tray, reached for a blunt instrument so she could separate the tissues covering the trachea, then slid in the plastic tube. Once it was taped into place, she watched Liv attach the other end of it to an oxygen bag.
“Start the O-2 compressions.”
They watched as the girl’s chest wall began to move easily up and down. A minute later she was taking breaths on her own.
“She’s coming around now,” Julie said.
“Emily?” The girl’s eyelids fluttered open. Vic smiled, softened her voice. “You’re in the hospital, but you’re going to be okay. You choked on a piece of candy. Just hang tight, honey, and we’ll get your parents for you.” Vic patted her shoulder. “You’re doing great.”
Out in the hall, Vic took a deep breath, exhaled the tension and adrenaline that had stiffened her neck and shoulders. There was always, in every serious case, a moment of doubt, when she wasn’t sure which way things might go, when it became a tug of war between herself and some other force, the patient the prize at the end of it. The moment things turned on a dime, when the outcome turned predictable and positive, was a moment that could compare to nothing else. It was triumphant, it was validation, it was justice and joy and relief all rolled into one. Most of all, it was a tangible reminder that all her training and education, the sacrifices she’d made, were worth it.
The second best part, she remembered, was telling loved ones that everything was going to be okay. With a spring to her step that she knew would desert her before the next serious call, Vic headed for the waiting room, casting a final glance back at her team. “Nice work, everyone,” she said, noticing, for the first time, that Angie was no longer around.
Chapter Six
October ushered in nights that were cooler and longer. In the Cullen family, autumn was a welcome time because the backbreaking fieldwork of grape harvesting and putting the vines to bed was over for another season while the winemaking—the fun part—was in full swing. Most years, the patterns at the winery didn’t register much with Angie. Out of high school, she’d gone away to college, then it was eight years in the military as a medic. The last seven, her work as a paramedic with North Flight EMS had pretty much consumed her.
And then there was Brooke. Brooke had demanded an inordinate amount of her attention, her energy. One of their cars needed to go into the shop or a plumber needed to be called, it was always Angie who saw to it. Birthdays that needed remembering, bills to be paid were all details left to Angie. Along with the laundry and most of the cooking and cleaning. Brooke was always too tired for this or that or too busy with her own important work (as if Angie’s wasn’t), her own friends.
Angie’s buddy Vince, not trying to sound like a judgmental ass but nevertheless coming across as exactly that, asked her point-blank one day why the hell she put up with Brooke. “Is she that good a lay or what?” Of course Brooke wasn’t—not that Angie would admit that to Vince. Her attraction to Brooke wasn’t easy to explain. How could she put into words the bright light and its magnetic warmth cast by Brooke when she was in the mood to be fun, adventurous, spontaneous, affectionate? Alternatively, that same dazzling light was mercurial sometimes, too hot, too arbitrary, too unpredictable.
But Angie had been willing to pay the price, to make the sacrifices, because she’d gotten things out of the relationship. Of course she had. Every day she got to look at someone and not see a soldier whose legs had been blown off by an IED. She got to look at someone whose eyes didn’t reflect back the bodies destroyed by war or by car crashes or by drugs or illness. Brooke was from a different world, and Angie was nothing if not loyal; she’d made her bed and she would lie in it.
Until Brooke decided to toss a hand grenade into their relationship.
She rolled her window down an inch to let in some of the cool air. It was late, she needed the little jolt to stay awake. Shattenkirk was in the ambulance’s driver’s seat tonight, and they’d just come from a call that turned out to be a waste of time. It had come in as a stabbing, but when they arrived at the scene, there was no sign of anything. The people had either scattered or it was a hoax, leaving the two of them and a couple of cops milling around for a few minutes looking like they were having a coffee break in the middle of the street.
A be-on-the-lookout bulletin for all emergency services in the city crackled on the radio. A middle-aged suicidal woman had fled Munson’s mental health lockdown on foot. A description followed.
Jackson groaned. “Must have missed her happy pill tonight. I mean, I know budgets are tight, but jeez, do they really need to cut back on the meds for the suicides?”
Angie grunted her agreement. She was not only used to the ribald humor in her line of work, but often a participant in it. Cops, firefighters, ER nurses, and doctors shared it as well, this defense mechanism against the ugliness and insanity of their jobs. Making light of a dark situation was sometimes the only thing that buffered them from the pain.
“North Flight to four-three-seven.”
Angie picked up the m
ic. “Four-three-seven, go ahead.”
“You clear for a call?”
“Ten-four, North Flight.”
A Priority One drug overdose, the dispatcher said, and gave them the address of what Angie knew was a three-story dilapidated rooming house that she’d been called to before. When they arrived, they found an unshaven man in ragged clothes bent over a young woman in a hallway that looked like it hadn’t been swept in years. The woman was half sitting, half lying against the stained wall. Angie plugged in the eartips of her stethoscope and put the diaphragm to the woman’s chest. Shallow breath sounds. Pulse sixty. Completely unresponsive.
“What did she take?” she said to the man, who wouldn’t look her in the eye and who smelled like rancid food.
“She might-a been snortin’ heroin earlier. I dunno, man.”
“How long has she been like this?”
He tapped a wrist that bore no watch. “Beats me. A few minutes?”
Angie ordered Jackson to prepare a dose of naloxone. When he presented her with the syringe, she stabbed it into the woman’s upper thigh and depressed the plunger. Within a minute she stirred, opened her eyes, started mumbling.
Wide-eyed, the man mumbled in surprise, “It’s a miracle. A fucking miracle.”
“Sometimes it is,” Angie replied, taking the woman’s vitals again. She was coming around quickly, almost back to normal—whatever that was.
She told the woman she needed to be transported to the hospital to get checked out, but her suggestion was met with a stream of profanity. Jackson looked at Angie with raised eyebrows and Angie shrugged back. They couldn’t force her, not without the cops and a special form.
“Suit yourself,” Angie said, leaving the young addict with a hard stare and a warning to stay off the drugs. She knew it was wasted breath.
Minutes later, driving near the Eighth Street bridge near Boardman Avenue, Angie spotted a woman on the bridge. The wrong side of the bridge. She was on the concrete ledge, not holding on to the railing, teetering a little, hugging herself against the chill.
“Holy shit, isn’t that the suicide from Munson?”
“Yup. Fits the description,” Jackson said.
“Stop the rig. And call it in. Get the cops here.”
Angie opened the door, but Jackson tugged the sleeve of her jacket. “Wait, where are you going?”
“I think we got a jumper.” Angie pulled away from his grip and sprang from the ambulance, figuring her short declaration explained everything, even though she didn’t exactly have a plan. She sprinted to the bridge, which spanned the Boardman River. It wasn’t more than eighteen, twenty feet to the water, not enough to kill you, but the water had teeth this time of year.
“Don’t do it, ma’am,” she yelled into the darkness. “I’m here to help. Give me a minute to try to help you, all right?”
The woman, little more than a bundle wrapped in a pink jacket too light to be of much help, disappeared into the dark abyss. “Wait!” Angie’s heart pounded against her ribs at the sound of a heavy splash. “Goddammit!”
“Dr. Turner, we’ve got two patients arriving in about two minutes,” Olivia Drake said to Vic through the intercom. She’d been happily dozing in the doctors’ lounge but was now instantly alert.
“What’ve you got, Liv?”
“Our Code White from a couple of hours ago. She jumped off a bridge into the Boardman. Plus we’ve got a paramedic.”
“What?” She rubbed the last of the sleep from her eyes and swung her legs over the cot. A paramedic was one of the patients? She didn’t wait to press Liv for more. “I’m on my way.”
By the time she reached the emergency department, Julie Whitaker and a nurse had escorted the mental patient into a treatment room. Liv pointed Vic to Room Two. Inside stood Angie Cullen, shivering and wet, a blanket loosely around her shoulders. Her EMS partner was dry, but he paced around and nearly jumped out of his skin when Vic greeted them.
“What happened?”
“Nothing, Doc,” Angie said with the kind of expression that said she’d rather be anywhere else but here as a patient. “Nice night for a little swim, that’s all. Everything’s fine.”
“She saved the woman who jumped,” said Jackson, his voice infused with adrenaline. “Jumped right in after her and pulled her out of the river!”
Why does this not surprise me? Vic thought. Angie had been to war and was a seasoned paramedic, which meant she was most definitely the hero type. A little cold water wasn’t going to scare her. Nor even, probably, the prospect of getting seriously injured. “All right. Jackson, I’m going to need you to step out of the room so I can examine Angie.”
Angie held her hand up like a traffic cop. “Oh no, I don’t need to be examined. I’m fine. I’m only here because of protocol.”
“Protocol or not, we need to make sure you’re all right. Jackson? Please inform your supervisor that there’ll be a delay in getting you two back into service.”
“Um, actually, Doc, Cull here is our crew chief.”
Vic shook her head at Angie’s nickname. Really, can’t these guys do better than that? Then she tilted her chin defiantly at Angie and leveled her with her no-bullshit look. “I’m not clearing you to return to work until I check you over. So it’s either that or you two can sit here all night until your shift ends.”
Angie huffed and sat down on the exam table, making a show of her displeasure. “All right, fine.” As Jackson shut the door behind him, she added, “You don’t play nice, do you?”
“I play exactly as nice as you.”
“That’s what I was afraid of,” Angie mumbled.
“I want you to take off those wet clothes and put on a disposable gown. I’ll go find you some scrubs to wear after we’re done. What are you, about five-foot-nine? A hundred and fifty-five pounds?”
“Add half an inch and another seven pounds.” Angie almost smiled. “But not bad, Doc.”
“I’ll be right back.”
From the supply closet, Vic grabbed a set of pale green scrubs slightly larger than her own. As much as she didn’t want to be reminded of the night when Karen’s affair with Brooke had come to light, it seemed she couldn’t escape it. Certainly, she couldn’t escape it as long as she saw Angie here, in uniform, looking exactly the way she’d looked that night in late August—strong, capable, yet slightly frazzled and out of sorts at the same time. Which, she was sure, was probably driving Angie nuts. Anything that wasn’t controlled chaos probably drove her nuts, and that was why she wanted to get straight back to work, wet clothes and all.
Back in the treatment room, Vic set the scrubs on a chair, noticing that Angie was trying not to shiver in the thin paper gown. As much as she wanted to dislike this woman, to not have to be reminded of that shitty night two months ago whenever she saw her, the sane and sympathetic part of her understood that they were both innocent victims. Angie had done no more wrong, had done nothing to deserve what had happened, than she herself had. It was Angie who had reminded her of that when she’d driven her home from the winery a few weeks ago, and now it was her turn to put on her big girl pants.
She retrieved a heavy flannel blanket from a cupboard behind the exam table and handed it to Angie, the other, thinner blanket now saturated with moisture. “Tell me everything that happened tonight. From the beginning, please.”
In a calm voice but with slightly chattering teeth, she said she tried to talk the woman off the bridge, but then she jumped without warning. It wasn’t a huge drop, but the woman was flailing around in the water, yelling something about not being able to swim. There wasn’t time to run around to the riverbed on foot, so she jumped, then hauled the woman to shore.
“Does it hurt anywhere?”
“No, I don’t think so. I’m…it’s too cold to tell for sure.”
With her stethoscope, Vic listened to Angie’s heart and lungs. “Did you ingest any water?”
“I don’t think so, not much anyway.”
Vic took
an electronic thermometer from the wall and had Angie insert it into her mouth. While she waited, she placed her hands gently on Angie’s jaw and turned her head from side to side, then up and down. It was then she noticed an abrasion behind her ear.
“Do you remember what you hit your head on?”
“No, it was nothing,” Angie said around the thermometer in her mouth. “There was a tree limb in the water. It wasn’t very big, but it was dark and I didn’t see it.”
“Headache?”
Angie shook her head as the thermometer beeped. Vic read it. Her body temperature was too cold by more than two degrees.
She examined her back, her shoulders, had her move her limbs, checked her reflexes, and with a scope she looked in her mouth, nose, ears, and eyes.
“Okay, I think we’re done. You do know that jumping off a bridge isn’t perhaps the wisest thing to do?”
“Save the lecture, Doc. There wasn’t an alternative.”
If this patient were anyone but a former soldier, given what had happened in Angie’s personal life lately, Vic would suggest a psych consult, because her heroics could be an indicator that she cared little for her own personal safety, that she might be depressed or despondent. But she strongly suspected it was simply the way Angie was wired. The woman was action-oriented, consequences be damned.
“So am I going to live?”
Vic sighed lightly, not at Angie but at herself. She’d come to a decision and one that she didn’t particularly like. “Yes, you’re going to live. But you may have a concussion. You’re also a bit hypothermic.” She glanced at the wall clock. It was 12:31 a.m. “I want you to put those scrubs on and book the rest of your shift off sick. And then you’re coming home with me.”
“Excuse me?” Angie’s draw dropped open; it was almost comical.
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