If only his younger brother, Jose, had allowed Santos into his life, Geoff knew Santos could have gotten him off the streets and made him a productive member of society. But the lure of a street gang seduced him, stole him away. Higher than a kite one night on angel dust, he ended up in the NYTC ER, a victim of a hit and run. A younger Geoffrey Davis, the trauma doc then, spent a good part of the night with Jose, desperately trying to save his life. The bond between the doctor from Connecticut and the medic from Spanish Harlem was forged by sharing that personal tragedy.
“How’s everything going?” Santos asked, his warm, brown eyes searching Geoff’s.
“About as well as it can around this place.”
Santos slapped him playfully on the cheek. “Bueno, bueno, mi amigo. Hey, we’ll have you over for dinner real soon. Gloria will fill you up so good we’ll have to wheel you home in a barrel.”
“I’d love to. Maybe one day next week. You just getting off shift?”
“Yeah, long night. You see that cop Ceravola and I brought in—Smithers?”
Geoff looked toward trauma room one. “I was just on my way there.”
“He’s in bad shape. Looks like he was attacked by a pack of wild dogs. Good luck.”
An overhead page pierced the air. “Dr. Davis, trauma room one, stat!”
Geoff glanced back toward the trauma room. “I’d better get going. Good to see you, Santos. I’m sure we’ll be seeing a lot of each other this year.”
“Hasta luego, Geoffrey.”
Geoff bolted to the trauma room area, met Karen. Trauma room one contained four beds, each separated from the others by curtains suspended from the ceiling. A young black man, in the far bed, diagonally across the room, obviously quite intoxicated, was tied to the bed by four leather restraints and was being tended by an intern, who was grappling to suture his face back together while at the same time dodging the patient’s attempts to bite his hand.
“Makes you feel appreciated, doesn’t it?” Geoff said, pointing to the struggling intern at the far bed. As he neared the room, it became obvious where the real action was. Just beyond bed one stood four New York transit cops, one with sergeant’s stripes.
Geoff knew right away the patient was a cop. Stat calls took on a heightened level of urgency when a cop was involved. Dr. Spiros made sure all residents understood this from day one in his ER.
An organized tumult of activity buzzed around bed one—blood spurting into color-coded test tubes, IV’s dripping frantically to keep up with blood loss, stethoscopes and lights probing for answers. Medicine in the trenches. An army of doctors, nurses and technicians in their green scrubs, each with a task, all coordinated by the trauma doc, a second year surgery resident who acted as field commander, barking out orders, triaging when necessary.
“Get a blood gas, stat,” called out the trauma doc, Dave Flynn. He turned to Lynn Graves, the nurse. “How are his vitals doing?”
“Pulse one-forty and thready. BP holding at ninety over fifty.”
“Run those IV’s wide open, or we’re gonna’ be starting a dopamine drip real quick. Type and cross him for five units whole blood, stat!” Flynn ordered.
“They’re running full bore now.”
“Is the blood gas drawn yet?”
“It’s already gone to the lab,” said an intern.
Lynn Graves glanced at Geoff and Karen approaching the bedside. “There’s no place like home, is there Dr. Davis?”
“There’s definitely no place like this home, Lynn. I missed the ER.” Geoff smiled at Lynn, then turned to Dave. “Need some help?”
“I’d love some, Geoff. You know how it is on July 1.” He looked at Karen. “Too many rookies on the trauma team.”
“What’s the story here, Dave?” asked Geoff.
“Forty-two-year-old transit cop attacked while on duty this morning. Here at the 168th Street subway station, in the elevator, going down to the IRT. Fucking animals out there. He’s been in and out of consciousness. Bad head injuries, as you can see, may have a basal skull fracture. Hard to believe this was done by one fucking lunatic,” said Flynn, shaking his head from side to side.
“Did you do a peritoneal lavage? Any internal bleeding?” Karen asked.
“Do you think we’ve been sitting around playing Xbox, Dr. Choy?”
“Cool down, Dave. Karen’s question was a good one,” said Geoff.
“Sorry. It’s been a long night.” Flynn’s hand massaged his brow. “We did a lavage. Fluid was bloody. He’s probably got a lacerated liver or spleen. We’re waiting for the general surgeons to evaluate that. Best we can do here is keep up with the blood loss.”
Flynn was a good man, but obviously under a lot of pressure already today. A cop on his first day in the trauma unit. A lot for anyone to handle. Still, he was doing what he had to do. Geoff stepped back and let him work.
Geoff remembered his own days in the ER all too well. Call nights eternal, living in a time warp. The world went on outside the glass cage—people laughing, playing, loving—but for the resident on call in the ER, the world was a constant barrage of the downtrodden and abused—heads slashed, bashed and blasted away, limbs busted and dangling, faces contorted in anguish. Stealing life back from the brink of death, a day’s work in the ER. Days with little sleep, few breaks, irregular meals. Geoff loved the adrenalin, the camaraderie.
What he hadn’t liked was the toll it had taken on his marriage. Sarah had been his lifeline to humanity, had forced him to remember his priorities daily. A part of him seemed to have died with her.
“Better get a central line in right away,” Geoff said. “You’re going to need it to keep up with his fluid—”
“Pulse 150, BP’s down to 70/palp.”
The cardiac monitor alarm sounded. “He’s in V-fib! One milligram of epi,stat!”
Flat line. Nothing. Geoff grabbed the paddles out of the intern’s hands, placed them on the cop’s chest. “Set it at two hundred. Stand back, everybody clear?”
“Two hundred,” Lynn said.
“Clear!” Geoff pressed the button. The patient’s torso arched in the air and flopped back down on the bed board with a thud. The monitor did not change.
“Continue chest compressions!” said Flynn.
Still no pulse.
“Charge it again!” ordered Geoff.
“Ready.”
“Hold on,” said Geoff. The silence was broken by rhythmic beeping. Smiles broke out all around.
“Pulse 110, BP 95/60.”
“Looks like he’s stabilizing for now,” said Flynn.
From the corner of the curtained area, Dr. George Spiros quietly observed the frenetic scene. His belt weighed down by three pagers and two cell phones marked his rank as commander-in-chief. He was a short man with graying black hair, stocky build with a soft middle. Spiros watched every move keenly, his small but intense, dark brown eyes peering through thick lenses set in tortoise-shell frames, his expression severe as he waited for someone to make an error in judgment.
Think clearly, but act quickly and instinctively, he constantly told his residents. He drilled this into their minds every morning during five a.m. rounds, when he reviewed aloud every single case from the night before, red grease pencil in hand. No one escaped criticism; no case was handled well enough. There was no place for error in judgment in his emergency room, no place for hubris—except his. Fear and respect motivated the residents passing through his ER. It worked remarkably well.
A nurses aid entered the room, bags in hand. “Blood’s arrived.”
“Hang two units and run them in full bore,” said Flynn. He turned to Geoff. “Thanks for the help. You don’t have much time to do your neuro evaluation. The OR will be ready for him in ten minutes.”
“No problem. Dr. Choy and I
will take it from here. Why don’t you take a break.” Geoff motioned Karen to approach the head of the bed, while nurses and interns continued about their work.
The victim was fair-skinned, somewhat overweight. His face was swollen to marshmallow puffiness, the white flesh of his cheeks and forehead marked by deep crimson lacerations, as if something had attempted to gouge out his eyes. Sanguineous fluid oozed from his nose and right ear. Dark bruises encircled both eyes, giving him a raccoon-like appearance. Around his neck was a stabilizing neck brace to protect his upper spinal cord from excessive movement. Possible spinal fracture. His blue uniform had been cut away, revealing numerous, large bruises, abrasions, and bite marks on his chest and arms. Were this an ER in Montana, he could have been the victim of a grizzly bear attack. But this was New York, where transit cops patrolled the dusky, fetid bowels of the subways, often in perilous isolation, where the animals were most frequently two-legged.
Penlights and reflex hammers in hand, Geoff and his apprentice evaluated their patient.
“The bloody fluid coming from his nose and ears, that’s spinal fluid, isn’t it?” asked Karen.
“Sure looks like it. That, along with the raccoon’s eyes pretty much point to a basal skull fracture. We’ll know when he has his MRI scan. He must have been smashed on the back of the head with a hard object or fallen down, hitting his occiput. He’s in a bad way.”
“He seems to be losing the little bit of consciousness he had.” Karen checked his pupillary responses.
“What would you say his coma scale rating is?” Geoff asked.
“Moderate to severe head injury. Fair to poor prognosis.”
“Very good. Of course that’s all meaningless in the face of what his PET scan will show us regarding the actual extent of his brain injury.”
“Thorough evaluation, doctors,” interrupted Dr. Spiros, restless with his role of observer. “Now would you like to let me in on his neuro status is and your treatment plan? I don’t think I can put off the mayor, the police commissioner, and the press much longer.”
Karen Choy gladly deferred to Geoff.
“Probable basal skull fracture, brain swelling due to diffuse head injury. We’ll know for sure after his scans. Numerous contusions, lacerations, and probable internal injuries. His neck’s been stabilized with a cervical collar in the unlikely event there’s a spinal fracture. Plan is to take him to the OR for an exploratory laparotomy, place a head bolt to monitor his intracranial pressure, then when he recovers, take him to neuroimaging for his PET and MRI scans. If he makes it, he’ll be spending at least several days in the ICU. Did I miss anything?”
Spiros wore his usual deadpan expression. “No.”
“Then we’ll be taking him now. Can we borrow a nurse for the trip to the OR?” asked Geoff. He raised the bedrails and unlocked the wheels. Spiros nodded his head affirmatively, turned to leave, then paused. “Good job, Dr. Davis, but try and get here more quickly next time.” He left the trauma room.
Karen exhaled. “So that’s the Dr. Spiros.”
“Astute observation, Karen. You’ll go far. Stay here with the patient. I’ll go find a nurse to help.”
Geoff stood at the nursing station, listening to the scramble of activity around him. The interminable electronic ringing of telephones, overhead pages, sirens of police vans and aid cars, the voices of patients, families, and staff. While he had been working it had been tuned out of his conscious awareness by that part of the brain responsible for selective attention. The cacophonous agglomeration of sounds had melded together, nothing more than a symphony of background sound, white noise.
“Any nurses free to help transport a patient?” asked Geoff.
“Only one free is Nurse Creighton,” said Bea Mendelssohn, the ER clerk, gazing up at Geoff over her reading glasses.
“That’s okay, I don’t want to take her away from her more important duties here,” replied Geoff. “Dr. Choy and I will take care of it ourselves.”
“That’s probably the wisest decision you’ve made in your two hours as chief resident, Dr. Davis.” Bea smiled knowingly.
“Thanks Bea. I’ll be seeing you.”
“Oh, Dr. Davis, one more thing. There’s a message from Dr. Howard Kapinsky. He wants to know if he should start rounds without you. He says the team’s been waiting for an hour.”
Chapter 3
Detective Donald O’Malley steadied his elbows on the makeshift command post in the Central Park Zoo and peered through the high power binoculars for the tenth time in the last hour. He scanned the red brick facade of the Penguin Building, then focused on the doorway, watching for the slightest hint of movement. Nothing. Four hours broiling in the midday sun, breathing the stench of filthy animals, and not a goddamned thing.
The trumpeting of an elephant cut through the heavy air. The splash of a sea lion in the mammal pool nearby made him flinch. He felt like he was on a fucking safari, instead of a stakeout.
O’Malley lifted the binoculars from around his neck and resolutely placed them on top of the stand. He removed his dusty NYPD baseball cap, wiped the beads of sweat from his brow with his handkerchief. Reaching into his pants pocket, he removed what had been a large pack of Juicy Fruit and stuffed another stick of gum in his mouth—number ten to be exact—adding it to the wad that already produced a large bulge in his cheek. O’Malley’s ritual. The binoculars, the cap, the Juicy Fruit. He had repeated it ten times in the last hour. It usually made him feel secure, in control, though the latter state had thus far eluded him today.
Donald O’Malley, decorated veteran of the NYPD and Commander of the City’s Tactical Response Unit had been involved in scores of stakeouts before, but the waiting still drove him crazy. Next week he would write his last chapter on the TRU after ten years as unit commander. Though he had a perfect record, it was time to hang it up. His ulcer and his wife, Stella, had convinced him of that. He wouldn’t miss the waiting, that’s for sure.
The TRU was ready to be handed over to a young buck like Valdez. For O’Malley, it was back to homicide. Not exactly what Stella had in mind, but she’d live with it as she had with his entire career. Some of his best years on the force had been on homicide, and he had decided that was where he would finish out. Three fucking years to go! He couldn’t believe it.
“Get the full background check yet? We got a sheet on him?” asked O’Malley as he turned toward Lieutenant Valdez, who had just returned to the command post.
“Best we can tell, sir, he’s clean. Nothing, not even a parking ticket. Married, five kids, goes to church on Sundays, worked in the Parks Department for fifteen years. Same place, right here in the Zoo. Personnel record’s clean, too.”
O’Malley shook his head in disbelief. “You mean this loony tune’s been chugging along on the straight and narrow for the last forty-nine years of his life and all of a sudden he goes bananas?”
“That’s right, sir.”
“Doesn’t make sense.”
“No, it doesn’t seem to, sir.”
“Check the city hospital logs?”
“Yeah. No psych admissions. Hit by a car going home from work a few months ago. Spent a week in the intensive care unit at the Trauma Center, but I guess he came out okay.”
“Except for his scrambled brains.” O’Malley glanced at his watch. “When’s his old lady getting here? It’s already 1310.”
“The guys at the service entrance are expecting her any minute.”
What better way to smoke out a hot-headed, crazy man than to bring in his esposa. Get his emotions revved up, cloud his thinking, force him to make a careless move. The wife was O’Malley’s catalyst.
“If she doesn’t arrive soon, my men are in a good position to take him out—”
“Goddamnit, Valdez!” O’Malley crumbled up the wrapper from the last stick
of Juicy Fruit and threw it to the ground. “When I’m ready to sacrifice that little girl, I’ll know who to call! That lunatic has a grenade and is loco enough to blow up both himself and the girl. We have to let him think he’s making the first move. Get it straight now, Valdez. Next week you’re on your own!”
Although angry at Valdez’ impatience, O’Malley had been in enough of these situations to sense there was a healthy tension building. Something would happen soon. The impasse was nearing an end.
“Commander O’Malley,” crackled the voice over the walkie-talkie, “Señora Romero is at the gate.”
“Well, Rispoli, roll out the red carpet.” O’Malley replaced the radio in his holster. “Valdez, alert the sharpshooters. No one moves until I give the word.” O’Malley watched the woman approach with her police escort.
“And, Valdez, get on the radio and tell the men to let her walk to us alone. We don’t need to make Jesus any more paranoid than he already is.”
“Yes,sir!”
O’Malley and the men of the TRU tracked Maria Romero as she turned right and passed between the weathered stone eagles on her way to the makeshift command post, which had been just four-and-a- half hours ago merely another hot dog stand at the zoo.
O’Malley knew the Romero woman was forty-eight, but she looked ten years older. Her bright yellow tent dress rippled with each step as she walked anxiously past the sea lion pool and headed toward them.
The shrill call of a macaw pierced the air.
Señora Romero was speaking in Spanish—a language O’Malley never quite grasped and therefore considered babble—rapidly and loudly. Her plump face was beaded with sweat, her hair flying wildly as she walked past them, not to them. She dropped to her knees in a position of prayer.
The Endorphin Conspiracy Page 2