by Radclyffe
Mel’s already crashed. I’m going to stay up and wait for the surgeons to finish. Oh...[Note: Episode Title: “In the Trenches.”]
July 5, 3:40 a.m.
Jude was awakened by a knock on the door. Sitting up in confusion, she glanced around, trying to get oriented. Melissa was snoring lightly on the other bed, fully clothed, one arm dangling over the side. Hospital. On-call room. Damn, I fell asleep.
Jude rose hastily, crossed to the door, and shielded her eyes from the light in the hallway as she stepped out of her room. The overhead fluorescents had been turned off; they usually were at night. Only the running lights along the wall provided faint illumination. The change was still enough to make her blink as her eyes adjusted.
“Hey.” Sax could see from Jude’s perplexed expression that she’d been asleep. But even with a pillow crease on her cheek and her hair tangled, she was beautiful. “Sorry to wake you, but we have another one coming. I didn’t know if you wanted to be called...”
“No...yes. I mean, don’t be sorry, I do want to be there, thanks. What is it, do you know?”
“Reports are that it’s a taxi versus bicycle collision. The cyclist lost.”
“At three o’clock in the morning?”
Sax smiled. “It’s the city that never sleeps.”
“Apparently.” Jude watched Sax walk off down the hall. Turning to her roommate, she called, “Wake up, sunshine. We’ve got work.”
July 5, 3:48 a.m.
In the trauma bay, Jude was jolted into a state of hyperalertness by the arrival of the EMTs, all thought of her previous exhaustion gone. The harsh, glaring lights, the clatter of wheels over uneven tiles, the hubbub of voices—the general sense of excitement mixed with anxiety—produced a bizarre kind of high that was oddly exhilarating.
The now-familiar routine began again. A male EMT called, “Vehicle versus cyclist, unresponsive in the field...multiple facial fractures, probable pneumothorax, open left femur fracture...BP 100 over 60.”
Melissa, with Jude practically glued to her back, maneuvered closer with her camera as Deb and Sax, along with Aaron and several other nurses, moved the young man onto the treatment table.
“Anybody got a name?” Sax asked as Deb began the initial assessment.
“There’s a wallet in his pants,” Aaron replied as he slit the garment up the sides with large utility scissors. “Uh...Mark Houseman.”
“Mark,” Sax said forcefully as she leaned close to his face, gently lifting one swollen lid. “You’ve been in an accident. You’re at...”
Bellevue...Can you tell me your name...
Jude shook herself mentally, forcing her focus to the man on the table. The voice is the same, the words are the same, but it is not you. Not this time. Her vision cleared, and the first surge of nausea disappeared. The relief that followed was like a stone lifted from her soul.
“Left pupil’s fixed and dilated,” Sax stated. “Aaron, call neurosurg and get them in here. He needs to be decompressed.”
“Chest tube’s in,” Deb announced as she connected the thick plastic tube to a negative pressure collection chamber that would reinflate his lung and evacuate blood and fluid from his chest. Continuing her exam, she noted, “His mid-face is unstable...feels like there’s an open fracture of the mandible, too.”
“How’s his airway?” Sax asked, although she had already checked.
“He’ll need to be trached,” Deb replied. “There’s a lot of swelling in the posterior pharynx, and with all the facial fractures—”
Pleased that Deb had made a quick, accurate assessment, Sax said, “Let’s do it now, then. Aaron, get the trach tray open.”
“Roger.”
“Have we heard from neurosurg?” Sax asked the room in general as she stepped back from the table.
“Pam Arnold’s on her way in. She said half an hour,” another nurse answered.
Jude edged closer to Sax, waiting for a break in the action. “Can you talk?” she asked when the surgeon seemed to be free.
“Go ahead,” Sax responded, watching Deb prep the man’s neck for the tracheostomy.
“Why isn’t the neurosurgeon here in the hospital like you are?”
“Because state law only requires that subspecialists be available within a reasonable period of time, and if I insisted that the neurosurgeons, orthopedists, and plastic surgeons take call like we do, they’d all quit. We have a bigger staff than those divisions, plus they have much heavier day-to-day elective schedules. They can’t work all night and then all the next day very often without burning out.”
“Okay,” Jude said, acknowledging that detail clarified. “One more question—what about consent for the procedures you’re doing on this guy? How do you handle that with no family here and him unconscious?”
“Deb, make sure you keep the incision right in the midline...there’s a lot of swelling in his neck, so watch your landmarks.” Sax looked at Jude directly for the first time. “In an emergency situation, we can legally perform any life-saving procedure indicated. Once he’s stabilized and upstairs in the TICU, though, we’ll need family or a court order to give permission before we do anything else.”
“Tonight, then, what you say goes?”
“Pretty much,” Sax agreed. “So, how are you doing?”
Jude wasn’t sure what the surgeon was asking, or why, and for an instant, she bristled at the intrusion. The look in Sax’s eyes, though, was too unwavering, and too warm, to be objectionable. “I’m fine—not even tired. And I think I’m past the...personal stuff.”
“Immersion therapy?” Sax gave a wry smile. “Every trauma has a lot of similarities. It’s the little details that make the difference.”
“Yes.” Jude realized that viewing it over and over was helping her distance herself in a way that actually healed. “But you’re good with the details, aren’t you?”
Before Sax could ponder what was behind the statement, a stately blond in a silk blazer and slacks walked in, looking as if she’d just left the country club. She promptly set about pulling a cover gown over her clothes.
Excusing herself, Sax approached the neurosurgeon. “Pam.”
“Hello, Saxon,” the blond replied in a throaty tone that reminded Jude of Lauren Bacall. “What do you have?”
Deb answered as she finished tying in the trach tube. “Closed head injury, panfacial fractures, blown pupil.”
“CT scan?”
“Not done yet,” Sax said as Pam assessed Mark Houseman’s reflexes and general muscle tone.
“Can we send him down now?” Pam Arnold was nothing if not efficient. “I’d like to get him upstairs and get this done. I’ve got a lumbar laminectomy scheduled for 8:00, and that patient’s already waited two months. I don’t want that case to be bounced.”
“Deb?” Sax asked.
“He’s good to go,” Deb affirmed with a nod. “Airway’s clear...vital signs are good.”
“Excellent.” Pam shed her cover gown. “You still owe me dinner,” she tossed over her shoulder to Sax as her patient was transferred to a stretcher for the trip to radiology.
Jude couldn’t hear Sax’s reply, but she didn’t need to. The satisfied smile on the blond’s model-perfect face told the story. You didn’t really expect that someone like Sinclair would be unattached, did you? And why should it matter anyway?
Chapter Fourteen
Personal Project Log—Castle
July 24, 10:45 a.m.
I’m finally going to get my official interview with Sinclair this morning. Even though I’ve seen her on and off every couple of days for the last three weeks, there hasn’t been a good time for us to talk at any length. If she isn’t in the middle of a trauma and up to her ears in blood, she’s running to a meeting or unwinding with Deb or Aaron. The term trauma team is apt. When they’re not actually working, they’re playing together. It defuses the tension, I think—the basketball, the chess, hanging around in the OR lounge kibitzing. [Note: Need a segment, or a series o
f sidebars, on their intense personal relationships—the bonding is very reminiscent of groups under severe stress, like police or firefighters, or soldiers. Title it “Officer’s Club,” maybe.]
I just couldn’t cut into that time with more questions for them. Sinclair’s been good about answering technical details. I haven’t been able to get her to fill in the blanks in her CV for me, though...in fact, looking back over interviews she’s given, she manages to sidestep personal questions entirely. There’s something off and I can’t put my finger on it—
“Ms. Castle?” Naomi Riley interrupted Jude’s murmured dictation. “Dr. Sinclair is ready for you.”
“Yes, okay.” Jude hastily pocketed her recorder. “Thanks.”
When she walked into Sax’s office, she was surprised to see how spacious it was, with windows on two walls that commanded a breathtaking view, a small Oriental carpet in front of a decidedly noninstitutional antique mahogany desk, and a matching leather sofa and chair set. Saxon Sinclair, in an elegantly cut dark silk suit, looked perfectly at home in the stylish surroundings. Jude had gotten used to her in scrubs or in the causal jeans she usually arrived in for work. Although she’d always found the doctor attractive, for a moment she was stunned by how striking she appeared now.
Sax glanced up from her paperwork, pushed a pile of folders aside, and smiled a greeting. “Good morning.”
“Thanks for seeing me.” Jude crossed the room and settled into one of the chairs in front of Sax’s desk.
Despite almost daily interaction with Sax, here in these formal surroundings Jude was even more aware of the other woman’s personal magnetism. Though she’d seen her working, had watched her play, and had witnessed her in unguarded intimate moments with patients, she appreciated now how little of Sax she really knew. Virtually every impression she had of her was visceral—emotional—images and reactions formed by being near her, observing her, listening to her.
Jude had never before formed a connection, certainly not an intimate one, in this way. Relationships had always been something that developed from a friendship, or from an intellectual exchange, or from an awareness of shared interests—as it had been with Lori. She had never been touched so primally by anyone, without any reason or rationale, and the enormity of that realization was shocking.
Jude was suddenly aware of the silence in the room, and the fact that she had very probably been staring. What she found strange was that when she focused on Sax’s face, she discovered that the surgeon was regarding her intently as well. Clearing her throat, she said, “I didn’t expect to be able to meet with you today. Aren’t we on call again tomorrow?”
“Yes, we are.” Sax hid a smile at the “we.” Despite her initial misgivings, she had to admit that Melissa and Jude were becoming part of the team. Jude had been true to her word. She took care to preserve patient confidentiality, respecting the privacy of patients who declined to be filmed, and acknowledged the wishes of families who did not want some footage to be used.
And, being honest, Sax enjoyed seeing Jude on a regular basis, even if it was under less than intimate circumstances. She liked her drive, her passion, and her sense of humor. She liked...her.
Sax caught her mind wandering down avenues she did not want to travel and reminded herself of the purpose of their meeting. Striving for a businesslike tone, she continued, “But I don’t particularly like to make appointments when I’m on call for the trauma unit. Half the time I end up in the operating room with a patient, and the meeting has to be canceled. It just clogs up my schedule down the line.”
“Why aren’t you off today?” Jude asked. “I thought when you were on call in the unit you went home the next day.”
“Actually, only Deb’s off the next day. New York state limits the number of hours a resident can work during the week or at any one time without a break.” She smiled a little wryly. “There aren’t any such regulations for staff. If I didn’t come in today, I’d end up buried in paperwork, and Riley would probably leave me. And then I’d have to quit myself, because she’s the only one capable of keeping me organized. Besides, I have to be in Albany this afternoon for a state review of funding allocations for level one trauma centers. I need to present our numbers for the last year and do the appropriate amount of glad-handing to see that we continue to get financial support.”
“I never realized how much nonmedical work there was in being the division chief,” Jude said. Aware that time was at a premium, she lifted her recorder. “Do you mind if I tape this?”
For a moment, Sax debated. She had agreed to meet formally with Jude simply because Jude had requested it. It wasn’t something she would ordinarily have done, and she wasn’t entirely comfortable with an uncensored conversation being recorded. Even though Jude had proven to be respectful and sensitive to the needs of the patients when filming, there were still some things about the institution, and herself, that the public did not need to know. She’d worked too hard to protect her privacy.
“You can tape any part of the conversation that deals with Deb’s training.”
“All right,” Jude agreed, although it hadn’t escaped her notice that Sinclair had deftly limited the scope of their interview and effectively placed anything about herself off-limits. On the other hand, Jude’s professional interests did not include the trauma chief other than for background highlights, and she should rightly focus on Deborah Stein. You just wanted to talk about her because you want to know more about her.
“And I can only give you a half hour,” Sax added with a genuinely apologetic shrug. “We’re driving upstate to the meeting.”
“I understand. I’ll make this as brief as possible.”
Jude had prepared a list of issues that she wanted to clarify regarding the hierarchical structure of surgical training, the factors that affected eligibility for the trauma fellowship, and the nationwide impact of level one trauma units on health care delivery and hospital financing. She worked her way through them quickly and efficiently. For her part, Sax answered cogently, having testified multiple times at the state and national level about similar issues.
“Out of all the residents whom you interviewed,” Jude asked after the full half hour had nearly elapsed, “why did you choose Dr. Stein?”
“Because she was the best qualified candidate,” Sax answered immediately. “She performed well in medical school; she had excellent recommendations from one of the top ten general surgical training programs in the country; and she demonstrated a clear and focused intention to pursue a career in trauma surgery.”
“What about personal qualifications? How do they influence your decision-making?”
“Obviously, we try to choose individuals with a philosophy and work ethic that will mesh well with that of our team. As you’ve seen, we work very closely for hours at a time together, and it is helpful to have individuals with similar visions and expectations.”
“Does gender affect your choice?”
“No, and neither does any other personal characteristic.”
“I understand that’s not always the case, even today. Surely, it was different when you were training,” Jude suggested. “There are still very few female surgeons in this country and definitely not very many division chiefs. Certainly, you must have encountered difficulties because of your gender in view of your choice of specialties.”
“The face of medicine is constantly changing, and the place of women within this sphere is well established now,” Sax responded neutrally and entirely noncommittally. Then she glanced pointedly at her watch.
“Just a couple more questions,” Jude said quickly. “I was doing the back stories on both you and Dr. Stein, and I need you to fill in a few of the details for me.” Actually, she needed a lot more than that. While doing the routine back searches on Sax, she’d literally run into a blank wall. All the information in the CV Naomi Riley had provided her was verifiable, but it seemed to dry up completely when she looked for anything before college. “It’s helpful fo
r viewers to form a connection to you. That way they can look forward to returning week after week, because they feel as if they know you. You know the kind of thing—what your life was like growing up, why you wanted to be a surgeon—the sidebar type of story that was done so effectively with Olympic coverage recently.”
“I’m sure the viewers enjoy that sort of thing,” Sax said blandly, but her shoulders stiffened with sudden tension. “And I’m sure Dr. Stein will be happy to provide you with that information. However, this project is not about me, and I don’t see where these questions are pertinent.”
“You’re nearly as visible as Dr. Stein throughout this documentary, and you need to be, because you’re her mentor and her...guide...for this year. Her relationship with you is probably the most important one she has during this period in her life. Who you are matters.”
“Does it?” Sax stood and began to push folders into her briefcase. “I think we’re done here.”
Jude stood also, stunned by the change in Sax’s tone and expression. The surgeon had very clearly closed a door, and the action was as swift and lethal as a scalpel cut. It left Jude nearly breathless. She had never felt so completely and brutally shut out. It shouldn’t have bothered her, because she’d gotten most of the information that she needed. In the course of her career, she’d certainly worked with difficult individuals before, and she’d never taken their rudeness or lack of cooperation personally.