The Queen of Hearts

by Kimmery Martin

  “People don’t usually accuse me of being calm,” I answered honestly, although I was pleased. I had been doing a good job so far on trauma; the rhythms and technicalities of the procedures made an innate sense to me.

  Dr. X’s eyes crinkled behind his mask. “Maybe ‘cool’ was the wrong word,” he acknowledged. “You do strike me as fairly . . . vivid. But it’s good to have a med student so fired up about trauma.”

  The usual bright lights of the OR had been dimmed way down so we could all see the TV monitor, which featured a vast yellow sea bounded by pinkish blobby walls. The patient’s abdomen had been insufflated with carbon dioxide, blowing it up like a balloon, which, from the outside, gave him the appearance of a late-stage pregnancy. The inside of the abdominal cavity had a bright, weird illumination from the fiber-optic light source. Dr. X demonstrated to me how to manipulate the instruments and pivot the camera so I could see. Clancy, holding his freshly scrubbed hands out in front of him, bumped open the OR doors with his ass and marched up to the circulating nurse for her to gown and glove him.

  As things progressed, visualization of the intestine should have been good. Clancy, assuming control, repeatedly drove the camera in exactly the opposite direction as he intended. Consequently, all we had on the monitor screen was a super-close-up view of something that looked like half-squashed yellow grapes, which turned out to be a bunch of globular fat.

  “Doh!” X said. “Clancy, get us out of this fucking fat forest. You’re going left when you mean to go right and up when you mean to go down. Your instincts here are bass-ackward.”

  “Erpmpth,” said Clancy helplessly, as the camera pivoted wildly and crashed into a glistening maroon structure.

  “Attaboy,” X said encouragingly. “You still completely suck, but that sucks a little less. Maybe.”

  On to the next case: a colostomy takedown and bowel reanastomosis for a perennial trauma patient named Clarence Higginbottom. Clarence, who had been shot on no fewer than five separate occasions, actually listed his profession as “street pharmacist” on hospital paperwork.

  I was fascinated by Clarence’s intestines. Seeing a disemboweled person up close was unnerving. The color, for one thing, was a bright, shiny pink, and the intestines were constantly in motion throughout the case, like a great snake hell-bent on escape. It was gross, but I found myself more mesmerized than repulsed. I was also acutely aware of Dr. X’s presence across the OR table from me, his eyes intent windows into his thoughts, isolated from the rest of his face by his mask. We were doing the case together, just the two of us operating, alongside the scrub nurse, the circulator, and the nurse anesthetist. Clancy had been dispatched to handle some urgent pages emanating from the unit. It was a busy day in the OR, with trauma season kicked into high gear by the last gasp of miserable summer heat. We were on call today, so the circulator kept busy answering pages.

  Dr. X showed me how to do the anastomosis. “Here,” he offered. “You can take a couple of the sutures. No, use bigger bites. Yes, there. Angle the needle driver a little more. If Clarence develops an anastomotic leak, he will be your private patient for the rest of the year. I don’t care what service you’re on. I will hunt you down whenever he shows up to trauma clinic.”

  “I thought he was going to jail.”

  “Oh, the prison van has worn a groove in the road going back and forth to the clinic. It knows exactly how to find us. They all come to trauma clinic; it’s a fun outing for them. There you go; that looks nice.” His eyes scrunched up; he must have been smiling under his mask. He looked directly at me, then put his hand on mine, guiding my final suture with the needle driver. I could feel the warmth of his hand even through all our gloves (we were both double-gloved, on the theory that Clarence must have been a hepatitis factory by this point), and I felt a thrill. He left his hand on mine, kept his eyes on mine; we stared at each other and I knew, suddenly, that he wanted me too.

  —

  My pager was going off. I fumbled in the darkness to silence it, but it would not shut up. It dinged out its stupid little melody, which somehow transformed in my mind to an annoying ditty: Someonespagingme, someonespagingme. Oh, someonespagingme. Why would it not stop? Dimly, I realized that it was Ethan’s pager, and thank the Lord, he had finally risen out of his coma to answer it. I could hear him murmuring obediently into the phone from his Spartan cot next to mine. I waited for my pager to start blaring too, while Ethan lumbered away, shutting the door behind him with a gentle nudge. Maybe I was safe for a while. My pager was strangely silent; I might as well catch another few winks while I could . . .

  A hand covered my mouth, and I struggled up in terror. “Ethan!” I tried to scream, but I could only manage a garbled “Eeef.”

  “Shhh, it’s okay. Don’t yell,” a whispered voice instructed, and the hand on my mouth moved away to my hair.

  “Who—”

  “It’s me,” Dr. X said quietly. “I’m so sorry I scared you.”

  “Oh, but Ethan—” I whispered.

  “I took care of Ethan. He’s going to be tied up for a long time. Zadie, I hope I’m not reading you wrong. Is it okay if I’m here?”

  “Oh,” I said. “Yes.”

  I had a fleeting—well, very fleeting—moment of remorse that Ethan’s one pathetic hour of sleep had been stolen by his own chief for purposes so completely selfish, but then Dr. X kissed me, hyperextending my neck by pulling my hair, his other hand pinning my wrists back against the wall. I had never been so turned on in my life. The adrenaline surge from my fright and my sanity-stealing exhaustion were now fueling a monstrous lust. It was pitch-black in the room, and dead silent, and I barely recognized his whispered voice. I entertained the unpleasant idea that this could be someone else, anybody at all, even, but discarded it. Nobody else had the power to summon Ethan away without repercussion.

  The proper thing to do here would have been to scream and slap him sideways, but I did not. Instead I wrenched a hand free and felt his face, realizing how much I had been longing to touch him. Not being able to see him intensified my other perceptions: surely, nothing had ever felt as good as this. I felt myself spinning in giant slow circles; my lips and fingers and toes were tingling. It was like falling in slow motion from a skyscraper: air whooshing past me, but gently, softly, currents of warm, sweet oxygen, somehow still roaring past my ears. There was this terrible urgency, too. Any second now our pagers could go off, Ethan could return, or we could make enough noise to rouse Allison Kalena or Clancy in their adjacent rooms. I grasped Dr. X’s back, feeling the broad muscles that I’d memorized in anatomy class brought to spectacular life under my fingers. I raked my hands through his hair, something I’d wanted to do since I’d first seen him, and closed my eyes against the darkness.

  —

  When he turned on the light, I was motionless, sprawled on the bed, rendered docile. My hair and skin were both the color of honey in the yellow glow of the little bedside lamp, my lips just parted. I was still breathing quickly. He looked at me for a moment, his expression unreadable, and then bent and kissed my forehead.

  “I wish you weren’t so lovely,” he said, and walked out.

  Chapter Ten

  THE CAPRICIOUS WHIM OF THE TRAUMA GODS

  Emma, Present Day

  Another Monday on call, another day without Wyatt or Henry or sunshine. Even after years of this routine, I still enjoyed the adrenaline blast of a new case; it was missing my family and missing the outdoors I minded. It was scorching hot outside, but the hospital remained stubbornly climateless, with the same unnatural fluorescent light and the alien sensation of twenty-four-hour time, an endless clock rotating and rotating without the sweet opiate of sleep to break it up. I imagined a giant heart hidden in the mysterious center of the sprawling building, pumping away metronomically, a slave to exigency, with thousands of humans flowing through the corridors and staircases and ORs and ERs like little
red blood cells circling through arteries and veins and organs. The same dramas and emergencies and life-altering catastrophes kept happening to new patients, and the same players inside kept working tirelessly to save them or patch them or at least figure out what in tarnation could be wrong with them.

  I clipped my pager to my scrubs and headed for the doctors’ lounge, hoping to scrounge a bit of food before I was summoned back to the OR. It was shaping up to be the kind of day where you get thumped from beginning to end; in other words, a fairly normal day on trauma call.

  I’d thought there might have been a break after we finished our last case, but just as my team of residents and medical students was sitting down to a very delayed lunch of prepackaged sushi, our pagers went off. These days we carried cell phones in addition to pagers; they’d been converted to summoning devices, thus producing the stimulus-response effect of everyone lurching in dismay at the sound of our ringtones. Mine was standard-issue Apple Marimba, which was foolish because everyone else over the age of thirty had that ringtone too, resulting in all of us reaching for our hips in synchronization whenever anyone else’s phone went off.

  By contrast, all the younger doctors and medical students had overly personalized ringtones, so now a cacophony of disparate music blasted through the room, ranging from some narcissistic Kanye West song to that ominous Darth Vader riff. A glance at my screen revealed this one was a gunshot wound.

  “Who’s up for the pin?” I asked the team.

  We kept a giant map of Charlotte fixed to the wall at the rear of the lounge, back by the dictation booths. Whenever anyone got shot, we stuck a red-topped pin in the map at the location of the shooting, assuming the victim was coherent enough to confirm the spot. If not, we had to rely on EMTs, or, occasionally, news reports. Since this map had been in place more than fifteen years, some areas of the city were so overrun with red pins that they looked like they were hemorrhaging, appropriately enough.

  “I’ve got it, Dr. Colley,” said Sanjay Patil, the fourth-year resident. He was one of my favorites, because he was so self-possessed and polite. Many of the male surgery residents made me uneasy with their aggressive joking and their incessant urges to control everything. But Sanjay always kept it professional. I bestowed a small smile on him as we hustled down to the ER.

  This code turned out to be a nonstarter. The patient was DOA, and by the time we got down there, the ER attending had already called it. A quick glance at the patient’s body and it was evident why: he was riddled with entry and exit wounds from at least a dozen bullets, one of which had exploded his head and another of which had cratered his chest. Staring at the chest wound, I repressed a shudder of recognition. I hated GSWs to the chest.

  My reaction aside, this was an unusual amount of violence for Charlotte. “What in the world?” I said to the ER attending. “Somebody wasn’t concerned about overkill.”

  “He’s MS-13,” she answered, gesturing to one of his arms, which was so inked up it looked reptilian. I nodded, recognizing one of the tats: this boy belonged to Mara Salvatrucha, a notorious gang that had metastasized across the country to Charlotte from Los Angeles. MS-13 members weren’t known for subtlety when it came to their hits. If they wanted you dead, going down in a haze of gun smoke was probably the best end you could hope for.

  “Well,” I said to no one in particular, realizing the futility of expressing concern for the multifaceted tragedy in front of me. “Maybe now we can grab something to—”

  My pager went off, along with everyone else’s pager. “Incoming,” said the ER gal. Her round blue eyes blinked as she contemplated the bloody mess in front of her. She motioned to some techs. “Let’s clear this guy out, since we’re all already in here. Can we get the floor mopped real quick?”

  “Dr. Colley,” said Sanjay, my resident. He cast his eyes down at his pager. “It’s a kid.”

  I nodded. I disliked pediatric trauma patients, especially the really young ones. Their little bodies were such a shock to behold after legions of high-mileage adults: smooth, unblemished skin; round little tummies; tiny pristine lungs and livers, as yet unmarred by lumpy adipose tissue and self-inflicted decay and the ravages of disease. They looked incredibly helpless on the OR table, with their lush eyelashes taped against fat cheeks, their small arms splayed out in surrender on IV boards.

  They healed well, though. Their cells, accustomed to the vigorous demands of new people, went into ferocious overdrive when injured. A child could survive injuries that would send the average adult spiraling down in flames. Of course the stakes were higher when a child was hurt, but I could handle that kind of pressure. And the technical challenge of operating on miniature organs secretly pleased me; I liked demonstrating my competence in a difficult case.

  It was dealing with the parents I didn’t like.

  All relatives of trauma victims were difficult, but none more so than the parents of a child. They wailed or stared sightlessly or collapsed in dramatic heaps. In any case, they never absorbed anything I said to them, which had led to multiple misunderstandings in the past. I understood why, of course. Some grief blots out the world.

  But I was ill-equipped to deal with other people’s incapacitating heartache. It wasn’t that I’m too emotionally cool to relate to their pain; it was that I relate so much I choke. How can I, a stranger, presume to comfort anyone in their position? I become so awkward, so frozen, so unable to reach out, other than offering a dry, mechanical recitation of what was wrong and what I’d try to do to fix it. Everything I could possibly say to a devastated parent seems too inadequate, or sometimes, too blatantly false. I can’t bring myself to tell them the only thing they want to hear.

  The EMTs arrived, toting a gurney with a very small person strapped to it. I jumped aside to let the residents do their thing as the EMTs gave their report: bike versus car, abdominal injuries. This child, who looked to be three or four, was conscious and whimpering, managing a single half-strangled word (“Mommy!”) before we drugged her.

  Everyone performed their roles efficiently and tersely, all the usual intensity of a trauma code amplified into something almost superhuman. The ER people inserted a breathing tube, the residents obtained central IV lines and started fluid, and my intern ran the portable ultrasound probe over the child’s distended little belly. No one spoke an extra word as we headed to the OR. I instructed Sanjay to call ahead to prepare them for an ex lap—an exploratory laparotomy—a surgery in which we’d open the little girl’s abdomen to assess her internal injuries and try to fix them. I ran upstairs.

  Steeling myself, I trotted down the empty corridor toward the family room, resolving to give the little girl’s parents as encouraging a word as I could while the OR was being readied. Unusually, the parents had gotten here at the same time as the ambulance and had been moved upstairs, closer to the ORs.

  To my dismay, I realized as soon as I entered the room that I knew them. Or not knew them, really, but recognized them: they were Betsy and Boyd Packard, one of Charlotte’s most prominent couples. He was the scion of one of the banking overlords—his father had founded an investment bank that had merged with another behemoth financial institution, which he now ran. Betsy oversaw their philanthropic foundation and chaired all the important auxiliaries and charity boards in town. They belonged to our club, where I’d often seen Boyd ringed by a crew of powerful cronies, smoking cigars and throwing back scotches like a 1950s cliché returned to relevance. I hadn’t known they had a daughter, although I did know they had a son—he was friends with Zadie’s boys, and I remembered Zadie and Betsy were friends. Or maybe they shared a carpool. If their kids had any heart problems, Zadie was probably their doctor too. Unlike me, she has no problem commiserating with parents—she throws her arms open and people leap into them, unhesitating. It was impossible these days to get Zadie as your pediatric cardiologist—her schedule was clogged with Packards and the children of NASCAR drivers and other
local luminaries. Somehow she’d become the specialist to the stars.

  I told myself I was not intimidated. Reeling under the colossal weight of their fear, the Packards were ashen and gaspy. No amount of money can insulate you from the capricious whims of the trauma gods: they fling their lightning bolts at the rich and poor alike. You could bring trauma upon yourself, certainly, but you couldn’t always protect yourself from it, a fact that was currently hammering Boyd Packard like an anvil to the head. He staggered toward me.

  “Where did you train?” he demanded as soon as I’d introduced myself and explained the injuries I thought their daughter had suffered.

  “I—I did my residency here,” I said, wincing internally at the icy note that crept uninvited into my voice. “And I did a fellowship in trauma surgery at Vanderbilt.”

  “Vanderbilt, okay,” said Boyd, as if he had the first clue which surgery programs were any good.

  His wife, Betsy, placed a restraining hand on his arm. She turned to me, focusing her clear gray eyes on mine, her beauty stunning. She had jet-black hair and a sculpted, full-lipped face of such perfect symmetry it was hard to look away from her. She reminded me of Snow White.

  “Will she be okay?” she asked, her voice distorted.

  “I’ll do my best,” I said stiffly. “It depends on what we find. I need to go—they’ll have the OR ready any second. I’ll send one of the circulating nurses out with an update as soon as possible.”

  “Wait.” Betsy Packard transferred her hand from her husband’s arm to mine, causing me to involuntarily recoil. Her hand, white and smooth, capped with flawless pale nails, felt like an icicle. “Ten seconds,” she said. “Please.”

  She dug around in her handbag, an autumn-hued buttery Birkin, and extracted a cell phone. She punched a button and thrust the phone into my hand. I accepted it automatically, realizing as I did that she had turned on a video.