The Possible World

by Liese O'Halloran Schwarz

  I was in there a long time, long enough for Kyle’s mom to have called everyone up for pizza, but the basement door is still closed and there’s no sound from the kitchen. I should go tell Kyle’s mom that Elliot can’t eat green peppers. She probably knows that, though. I could tell her instead that I’m hungry, so she’ll call the boys to come upstairs and eat, move us all to the next thing on the list of pizza and cake and presents and movie.

  There aren’t any lights on in the hallway and it’s gotten dark. I make my way by feel, one hand on the wall, toward the living room; the kitchen’s on the other side of that. When I step onto the fringey living room carpet it squelches. Uh-oh, Scooter probably peed and now it’s on my sock. It’s a whole lot of pee—my sock’s all warm and wet—and I step back and lift my foot to peel the sock off. Something in my brain knows that it’s not pee; there’s something flashing Warning in my head, but I’ve already got the alarm there from Charlie and Smelliot and the long, panicked bathroom cleanup, so I take another step onto the carpet, holding my sock in one hand. Almost to the kitchen. Why aren’t there any lights on? There’s a smell of coffee, and a metal taste in my mouth, and a weird distant noise I can’t identify, like a faraway siren. Suddenly I hear another sound, very nearby, that some place deep inside me recognizes—a short gurgle that makes the hairs on my neck stand up.

  Instantly I’m dropped onto my belly and scrambling backward, stopping only when my feet hit a wall and I can’t go farther. I’m under a table, eyes wide open. The blackness in front of me shifts and I realize that what I thought was just more darkness is a standing person, and the person is turning. Toward me? I can’t see details, just shapes. I stare as hard as possible; I hold my breath. My heartbeat shakes my body and I try to press myself into the floor. There’s a voice in my head keeping me still, saying, Bark on the tree, buddy, you’re bark on the tree.

  A motion-detector light comes on suddenly outside the upper windows, making slanted boxes of light across the room, and in one of them I can see Kyle’s mom lying kind of sideways. She’s mostly on her stomach with her hair across her face, and the smile from her coffee cup is on a broken piece beside her. She lifts her head a little and looks at me, hair stuck down across her face so that only one eye is showing. She swallows and coughs and blackness rushes out of her neck.

  There’s another sound right above my head and I look up, into the face of a man who’s bending over me, his face glowing in a stripe of light from the window.

  “You’re not gonna say anything, right? You’re gonna shut the fuck up?”

  I am nodding like a puppet, like a woodpecker, so fast and automatic yes-yes-yes.

  “Thank me,” he says. “You need to thank me for saving you.”

  My jaw feels frozen. I open my mouth but nothing comes out.

  The outside light goes off, leaving the room even darker. Is he gone? I stare hard into the black, not moving.

  After a long time, or after no time at all, everything goes white and there’s a shhhhh in my ears like the ocean and far away someone is screaming.

  CHAPTER TWO

  * * *

  Lucy

  PATIENTS LIE. EVERY DOCTOR KNOWS it. They lie innocently, or out of embarrassment; they lie to get something they want, or to avoid something they fear. Good lies and bad lies, meaningless lies. There must be a limited number of lies in the world, because I hear the same ones over and over again.

  I only had two beers.

  My car got broken into and my Vicodin (codeine/Demerol/Percocet) was stolen.

  I was just walking down the street, minding my own business, and some dude came up and stabbed me.

  Some Dude really gets around. He steals the pills, he stabs and shoots, he sails through red lights and stop signs and smacks into law-abiding cars. Sometimes he blooms cohorts: he is Two Dudes, or even Three.

  I don’t care about the lies or the dudes; I don’t need or want the whole truth anymore. I want to know only the part that matters, that will guide me to discover what needs to be found and fixed.

  In Trauma 2, an ambulance team is transferring a patient to the stretcher.

  “Thirty-five-year-old restrained passenger, car versus tree.” One of the paramedics reads from his run sheet as the other snaps the belts back across the now-empty ambulance gurney. “Prolonged extrication, some delta MS but awake and talking, vitals good.” Delta MS means altered mental status, anything from confused to somnolent to psychotic. “Driver’s on the way.”

  “Hello, Doctor?” from the woman on the stretcher.

  “I’m your nurse,” Dennis tells her cheerfully. “Doctor’s right behind me.”

  Scrabbling fresh gloves from the box on the wall, glancing at the EMS note for a name. “Hello, Crystal. I’m Dr. Cole. Does anything hurt?”

  She tries to shake her head but the hard collar around her neck prevents that. “Where are my shoes?”

  “Probably still in the car. Take a couple of deep breaths for me, okay?” Hooking the stethoscope into my ears, I press it against her clothing, then lift it to let the tech’s trauma shears scissor by. The clothes fall away and the patient lies briefly naked, a length of pale gooseflesh, before the tech flicks a hospital gown open over her.

  “Any medical problems?” I ask. Lungs clear, abdomen normal to palpation. “Do you take any medicines every day?”

  “Um, thyroid.” Crystal lets the tech lift her hand and guide it through one of the armholes in the gown. “Where are my shoes?” She puts her other hand through the other hole.

  “She’s been asking that the whole ride here,” says one of the paramedics as they trundle the gurney out of the trauma room. “It was all about the shoes.”

  “What’s the last thing you remember before being here?” I ask Crystal.

  Furrowed brow, pause. “Today is what?” I have to think for a moment myself.

  “Saturday.”

  I look at Dennis, who nods.

  “Okay, breakfast,” says Crystal. “I made chocolate-chip pancakes.”

  A concussion can wipe out everything for a variable period before the trauma, leaving retrograde amnesia—a blank space in recent memory that patients sometimes fixate on trying to fill up. They may say the same thing again and again. Did you let the dog out, I’m late for work, my birthday’s tomorrow, please help me.

  “Let’s roll her.”

  The tech puts firm hands on either side of the head to keep it in-line, the nurse takes hold of her hip and shoulder, and they pull her—one, two, three—up onto her right side, with her back to me.

  “No pain here? Or here?” I ask, pressing my fingers down the spine, pushing hard against each vertebra in turn, pausing briefly to hear each no.

  “Where are my shoes?” says Crystal as they roll her back down.

  There’s a ruckus outside the room, the doors sliding open at the end of Trauma Alley, the voices of paramedics and the overhead call for surgical team to Trauma 3.

  “Tell me if anything hurts,” I say, rocking the pelvis and moving down the extremities. Bending the joints, checking the pulses. Intact, intact, intact. Scraping my thumb up each sole, watching the big toe point on each side. Normal. So just a concussion then, no other injury. Lucky: from the noises next door, the driver isn’t doing so well.

  “Do you have any allergies?” I ask Crystal.

  “Not that I know of,” she says. Strange how precise most patients are about that—as if allergies are stalking them, and it’s just a matter of time before one leaps out from behind the bushes and reveals itself. A fleeting pucker at her brow and she adds, “I was wearing my purple dress.”

  “That’s right.” The dress lying in pieces on the floor is purple.

  She shivers, an involuntary ripple that knocks her teeth together. Dennis looks up from his charting, gets a blanket from the warmer, and tucks it around her.

  “Oh, thank you,” Crystal croons. “Thank you so much.”

  The X-ray tech approaches with the orange metal-jackete
d plate in her hands. “Trauma series plus a head CT,” she sings out, like she’s leading a call-and-response prayer. “Okay, this plate will be cooold, I’m sorry,” she tells the patient.

  “Where are my shoes?” The question is whispered now, urgent.

  “Oh my God,” says Dennis, under his breath. “Enough with the shoes.”

  X ray—the call to evacuate the room. Everyone goes into the hall, the tech dragging the thumb control on a long, curly cord. She presses it and there’s a dull click from the mechanism; then she and Dennis dart back in to place the next X-ray plate.

  Trauma 3 is not doing well; that’s clear from the doorway. Bad sign number one: the entire trauma team is in there, from chief resident (long white coat), through junior resident and intern (scrubs, no white coat), down to medical student (short blindingly white coat). Bad sign number two: the sound of the vent, chuffing breaths down the ridged plastic ventilator tube that snakes through the air and disappears into the cluster of personnel around the stretcher. The worst sign of all: the Level One rapid-infuser has been rolled out of the corner of the room, and it’s running blood. That’s a Hail Mary right there.

  “I’ve got the passenger next door,” I tell Kim, the documenting nurse. “How is he?”

  “His GCS was five when he came in,” says Kim, looking up at the monitor above the stretcher, then down again to copy numbers onto the chart. “His pressure’s dropping.”

  Tame words to contain such disaster. The Glasgow Coma Scale boils brain function down to eye opening plus verbal response plus limb movement, and predicts prognosis after head trauma. A normal GCS is fifteen, meaning alert and responsive, opening eyes spontaneously, following commands. You get a point in each category even if you do nothing: a doorknob has a GCS of three. But GCS is a luxury for this patient at this moment, an unnecessary frill: pressure dropping in the setting of blunt trauma means imminent death.

  “We need to take him,” says the surgical chief resident, striding to the foot of the stretcher. A crack as he steps on the brake there, releasing it. “We need to take him now.” He puts a hand on each stretcher siderail and begins to pull.

  The cluster of white coats breaks apart as the stretcher rolls toward the door. Hands jerk monitor leads from the patient’s chest; more hands snap open the Level One and pull out the bag of blood inside, hold it up high in a two-fisted squeeze. An instant piercing shriek of alarm from the ventilator as the connection is detached, and then other hands are there with the Ambu bag, puffing manual breaths down the endotracheal tube. I get a glimpse of a purpled bleeding face, the eyes swollen to slits, as the stretcher goes by. It accelerates down the hall toward the OR elevator in a tense, tight company, a nurse running alongside and fumbling for the elevator key hanging around her neck.

  Trauma 3 is now empty, its floor littered with the detritus of rescue: wads of bloody gauze, wrappings from the central line kit, the Foley kit, the endotracheal tube, the nasogastric tube, the IV bags. The monitor whines from the wall, leads drooping down, all of its lines flat. The ventilator still screams from the corner. I walk over to punch all the power buttons off.

  “They musta been going a hundred,” says a voice behind me. I turn to see one of the paramedics. He takes a cell phone from his front shirt pocket. “I got pictures.”

  “Jesus,” I say as his index finger pushes the images by. For all the ER trauma I’ve managed during my residency, I haven’t seen too many accident scenes. My EMS ride-alongs required back in internship were three years ago, and most of those were nontrauma runs. Dizzy old people, chest pain, asthma attacks.

  “Took twenty minutes to get his door open,” he says. I can see why: the vehicle in the pictures is impossibly compacted.

  “Passenger’s okay.”

  “She was belted. He wasn’t.” He lowers his voice. “And look at this.” Pushing his fingers apart on the phone screen and homing in on an area behind the car. “No skid marks.”

  That meant the driver hadn’t stepped on the brakes before the crash; he wasn’t trying to stop. March in Rhode Island swings between stolid midwinter and the earliest fringe of spring; the recent thaw means that the ground in the image, between tired filthy fragments of snow, is soft enough to have taken tire marks.

  “He could have been unconscious,” I say, looking at the clean twin impressions, unblurred by skid. “Maybe he passed out before the crash.”

  “Nope.” He swipes to the next photo. “See?”

  It’s hard to tell what he’s showing me. The car isn’t even in this picture.

  “Turn marks,” he says, and then I see them. Curved gouges in the ground. “Like you get when you make doughnuts on a lawn?” He traces an eight in the air with his index finger. “The road went straight, but the car turned. About fifty yards from the tree.” He sees that I’m getting it. “So he stepped on the accelerator until they were going a hundred miles an hour, then he cut the wheel hard. Aiming for that tree.” His voice is thick with disgust. “Unbelted, trying to die. With his fucking wife in the passenger seat.”

  “She doesn’t remember anything. Although I don’t know how long that will last.” Postconcussion amnesia will usually lift after days or weeks, but sometimes blank patches remain forever, the events right around the trauma never completely restored. “Maybe it’s best if those memories don’t ever come back.”

  “Wouldn’t you want to know if your husband tried to kill you?” He clicks the phone off and drops it back into his pocket.

  Would I? There are a few things my husband did that I wish I didn’t know.

  “Lucy, I need you in room 19.” Grace, the charge nurse, comes up to us. She adds, seeing my expression, “No, it’s not that.” Nineteen is one of the pelvic rooms, the one usually used for rape cases.

  “Thank God,” I say, wishing my relief were purely compassionate. Rape kits once begun have to continue until they are finished, to preserve the chain of evidence. Forty minutes of evidence collection can totally torpedo a shift.

  “Don’t speak so soon,” says Grace. She offers me a chart. “It’s a kid.”

  “Okay,” thinking so? The nurses, most of whom are mothers, can get weepy about kids. Childlessness has its benefits for an ER doc. Not something I can say to the people who are forever telling me, You’ll never know what love is until you have a child. I want to tell them: Okay, got it, I’ll never know.

  “Brought in from the scene of a multiple homicide, needs a medical eval before he goes to Psych.”

  “Psych? Is he the perp?”

  “Perp?” says Grace. “Somebody’s watching too much cable. No. He’s a child, maybe five or six. It’s not clear what he saw, or if he saw anything. He’s not talking. We don’t even have his name.”

  “Is he injured?” Looking over the front sheet of the chart I see there’s no triage note, just vitals and in the name field, Johnny Doe.

  “We didn’t find anything. We’ve already taken pictures for evidence. If you clear him, we can send him up to the floor and Psych can see him there. Social Work’s on the way.”

  Outside room 19, two male detectives are sitting in chairs on either side of the closed door, one a tired, tweed-suited sixty, and the other a tall, pink-faced blond who cannot be as young as he looks.

  “Dr. Cole’s gonna see him,” Grace tells them.

  “Psych?” says the older detective, perking up.

  “ER,” I say, and he slumps disappointedly back into his chair. “I’m going to medically clear him so he can go upstairs. You can talk to him there.”

  “I’m gonna need coffee,” says the cop. He scrubs a hand over his face. “Listen, get his name if you can. We don’t know if he lived at the house, or if he was one of the party guests.” I raise my eyebrows at party and he adds heavily, “There was a birthday cake in the dining room.”

  “Any more vics on the way?” I ask.

  The younger detective, who’s been leaning forward with elbows on his thighs, staring down at his shoes, lifts his head. />
  “He was the only one alive,” he says. The horror of the scene is stamped onto his face. The older cop rolls his eyes and turns away. Probably thinking what I am thinking, some version of yes, this is awful, but seriously, dude, reconsider your life choices; there are a lot of bodies ahead of you.

  “We need to find next of kin ASAP,” says the older detective. “I don’t want the family getting the news from Twitter. Seriously, get his name and I’ll bring you Dunkin’s your next shift.” In New England, Dunkin’ Donuts is king. Distances are measured, and driving directions given, by the pink and orange stores.

  “I’ll try.” I tuck the chart under my arm and go through the door.

  He’s small, even if he’s only five or six, and looks even smaller here. Room 19 is the largest room in the Department. It has space for a pelvic table and ultrasound machine, for counselors and chaperones, for a counter with a sink, cabinets above and drawers below to hold a stock of rape kits, plus its own private adjoining bathroom. Grace has dimmed the overhead light and turned on the one in the bathroom. The boy is lying back against the pillow, and at first I think he’s asleep, but as I close the door he turns his head toward me. I roll a stool over. Patients relax and give a better history if the doctor is seated, rather than looming over them or seeming poised to flee.

  “Hi. I’m Lucy.” It feels good to sit down; the popping sounds my spine makes as I do are somewhat alarming. Is this normal for thirty-three?

  The boy doesn’t react; it’s as if I haven’t spoken. His pupils are so large that his eyes look like dull black buttons; his dark hair is spiked up on half of his head and slicked down on the other. What weird hairstyles little boys have now. Immediately I chide myself for the thought; maybe after a few years of parenting I too would be driving through McDonald’s for dinner and fauxhawking my kid along with the rest of them. I’ll never know.