by M. D. Thomas
Lee said little, but Jon suspected the deaths of Harvey and Sarah was a burden. Perhaps that was part of the reason he asked about that day so often. Sarah’s sacrifice was painful, but at least understandable. Aiello’s death was another matter. The media had lambasted him as a crooked cop who’d had a mental breakdown, but a lone interview with his grandmother painted him as a well-intentioned man, and so understanding why he’d tried to kill Lee only to help rescue him was confusing. Jon had tried to speak with the grandmother, but she’d politely refused.
Of course Lee wasn’t the only one with burdens. Every day Jon thought he should’ve passed Lee to Sarah somehow, that he should’ve been the one to let go. All three of them probably would’ve drowned if he’d attempted it, but still he thought it. He thought it, he heard her last words as she was pulled away, and it ate him up inside—because he’d loved her, and because no matter the terrible things she’d done, she was Lee’s mother and she'd done the best she’d known how for her son. No one could ask more of any parent.
When Jon finished the story, Lee was quiet for a long time, his hand caressing the baseball. “Sometimes I think I remember his face. That guy… Harvey.”
Jon glanced at Lee, who stared at the creek below. “You’ve seen pictures of him.”
“Yeah. But that’s not what I mean. I can remember him carrying me into the water and sometimes I think I can remember his face above me.”
“Maybe it’s just your brain trying to make sense of it all.”
“Maybe.” Lee took his eyes off the creek and looked at Jon. “Dad, do you think he did it to wake me up?”
Jon stared at him in surprise. “I don’t know, Lee. I never thought about it like that before. Do you think he did?”
Lee’s fingers grew still on the baseball. “No. No, I guess I don’t.” He was silent for a moment, perched the ball on the back of his fingers and left it there. “It’s like it was all a weird dream. And sometimes in the dream I was Arky Vaughan and sometimes I was me. But that doesn’t make any sense either.”
They were silent for a few minutes before Jon could think of what to say, his own mind turning back to the night Lee had appeared in his car. “I wish we had answers Lee, but we don’t. And unfortunately we probably never will. All I know is that it happened, that your mother loved you more than anything else in the world, and that you woke up.”
Lee looked at him for a moment and then returned his gaze to the Accotink. Jon put his arm around Lee’s shoulders and gazed ahead as well, wondered and marveled at the absurdity of existence that one little creek had played such a large role in his life.
“Dad?”
“Yeah?” Jon answered, thinking Lee wanted to hear the story again.
“Do you think the Nats have a chance at the pennant this season?”
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Acknowledgments
The Butterfly Tattoo wouldn’t exist in its current form without the superb editing of Melissa K. Starr and Clarissa Goenawan, as well as the input of Michael W. Farmer, Brett Starr, and Brooke B. Thomas—emergency physician extraordinaire and, as always, my indefatigable source of medical knowledge, who also happens to be my wife.
BONUS MATERIAL
LAST WISH
Chapter 1
I assumed my life had already hit bottom on the day that Elizabeth Bauer’s car was T-boned by an early morning drunk. That’s melodramatic, and I was very, very wrong, but I don’t think it’s reaching to say my life could’ve been better.
The call came in at nearly six in the morning, close to the end of my twelve-hour shift, but not close enough that I could duck and run. Not when Dicky Smith was the only attending. He was obnoxious—and certainly deserved the name—but you didn’t get to choose who you worked under. You just had to shut up and deal.
Three weeks before I’m out of here and now this… Residency graduation was close and most of the time I loved my job, but I could almost see myself walking down the street without looking back, leaving the approaching ambulances behind and giving up on the whole damn thing. Forget the new job in rural New Mexico, forget emergency medicine, forget it all. If I had known what was about to happen I would have.
The department had been quiet and calm for the past couple of hours. Nurses, techs, janitors, volunteers, everyone moved at the lackadaisical pace that meant the night had been blessedly slow, their shoulders relaxed, their fatigue softened by smiles as they waited to punch out and meet at the nearest pancake house before they went home, drew their blackout curtains, and crashed, another night in one of the craziest job atmospheres in the world survived.
But that call was the kick that knocked the top off the anthill.
I walked through a swirling mass of people toward the ambulance bay, hitting the switch on my way by that would keep the doors open. There was no need to check on the preparations behind me. I would only get in the way, and everyone knew their job.
The street behind the emergency department was deserted, and although the hum of morning rush hour traffic filled the air there was no sound of sirens yet. The sky was cloudless, and despite the early hour it was going to be another hot July day in Washington, the air so humid it made my throat feel tight.
“You take the kid, Davies,” a grating voice said, my surname only as usual—perhaps Linh was too Asian for him. “You could use the practice.”
Richard Smith stepped up beside me, already lighting a cigarette. He was a pack-a-day guy, a habit not as unusual in the medical profession as you might think. Anytime somebody called him out on it he would just say that you had to die from something, so why not something you loved? I disliked him, but after witnessing so many deaths over the years I could see the logic in that.
He was a tall man, and—I hate to say it—striking. Dressed only in scrubs, his wavy brown hair just covered the tops of his ears and the nape of his neck, framing a face that made me think of a Roman emperor, all noble brow and hatchet nose. His blue eyes were intimidating, and he never seemed to blink. His shoulders were wide, his waist as trim as a man half his age. It was a shame he could be such an ass.
“There’s two?” I asked. That I needed the practice was likely only a provocation, but while I wasn’t adverse to picking a fight with Dicky there wasn’t enough time.
“Three,” Dicky said as he exhaled acrid blue smoke through his nostrils like a snorting bull. He gestured with the hand that held the cigarette. “Kid, her father, and the douche who hit them. Said douche is pretty much fine of course. He won’t need much. The other two sound like roadkill. EMS had to open the car up like a can of tuna.”
Anyone who hasn’t worked around the dead and the dying might be offended by his tone, much less his words, but I had lost that luxury years before. People get used to anything if they’re around it long enough, even horrible things, and human nature compels many of us to joke about the horrors we can’t control. I can’t give you any statistics, but I’m pretty sure the kind of people that crack jokes in the face of death are over-represented among emergency department workers—either it’s the personality type drawn to the profession or the ones who can’t joke tend to get weeded out of the job before they take root. Either way, we all have to watch our tongues when we’re around normal people.
“You wanna paper, rock, scissors for the dad?” I asked, aware it was futile, but unable to stop myself. “I’m sure the trauma surgeon will be down here any minute now to take the kid off your hands.”
Dicky snorted and took a long drag on his cigarette. The sound of the ambulan
ce sirens had grown irritating. “Too late, Davies. I know you wouldn’t want to leave here feeling like you hadn’t learned everything you could.” He flicked the half-burnt cigarette down the sidewalk that stretched toward the street. The first ambulance rounded the corner just as the butt rolled to a stop, a thin curl of smoke rising from its tip.
Two ambulances roared into the bay, one in front of the other, sirens off already but their emergency lights still dancing across the roof and the walls. Rear doors swung open before they had even come to a complete stop and the medics jumped out, pulling the gurneys after them.
I stood there long enough to see which ambulance carried the kid, then started moving as Dicky stepped toward the other gurney. I can remember what it felt like the first time I was the only doc to meet a trauma. Sheer terror doesn’t adequately describe it. There was sweat on my palms and the tight, dizzying feeling of the blood draining too rapidly from my head as I tried to recall what I was supposed to do first, second, third, at all. But as I met the gurney bearing Elizabeth Bauer training took over and deliberate thought faded.
“What do we have, DeSean?” I asked as I fell in beside the gurney which the medic had started toward the doors at a rapid walk. A second medic I didn’t know was using a bag valve mask to keep her oxygenated.
“Not good, doc,” DeSean said. He was a veteran, one of my favorites. The man should have been a doctor but said he could never stand the thought of being cooped up in a hospital. “Some old rich guy Mercedes, no airbags. Right lateral head contusions. Right chest trauma. Abdomen distended and rigid. Right femur is snapped and her arm is like a jigsaw puzzle. We had to sedate the father on scene because even he could tell it was bad.”
Part of me listened to DeSean as he began to rattle through the list of meds they had pushed, but the greater part of me took in the patient. New residents tend to focus on the numbers—blood pressure, pulse, Oxygen saturation—but over the years I had learned to really look at the whole patient first, then move on to the numbers and the treatments. What I saw didn’t look good. The girl was thin and petite and at first glance could have passed for twelve or thirteen. But a closer look at her face and chest suggested she was probably fourteen or even fifteen. The broken arm and leg made her look like a worn rag doll, but weren’t too worrisome by themselves. They could wait. What mattered was her distended abdomen, suggesting an internal bleed, and the way her head looked slightly flat on the right side, the symmetry of her face gone awry. Not good was an understatement.
This is bad, I thought. Real bad...
The girl went into trauma bay one while Dicky and the father went straight through to A pod, one of the four pods that made up the emergency department. If there was any chance the father might come to again they wouldn’t want him anywhere near his daughter. That kind of drama would be good for no one.
Before I even started giving orders the girl was swarmed, nurses and a couple of techs flanking the sides of the gurney, where they started new IV’s and prepped for a central line. I took my place at the head of the gurney and got ready to intubate her. The airway was always first. Our job wasn’t to fix the girl but to stabilize her so that the trauma surgeons could take over. But getting an operating room ready always took time, even if it wasn’t a lot. Until then I had to keep the girl alive.
One of the nurses handed me the laryngoscope and tracheal tube and before I could even bend over my muscles locked up and I felt like I might vomit. I wanted to touch that girl about as much as I wanted to touch a viper. Normally I don’t hesitate to do my job, but my head was already full of voices that weren’t my own. Not metaphorical voices. Not tumor-induced hallucinations. Not some psychobabble problems from my past that expensive hours of therapy couldn’t banish. Real voices, not mine, but those of former patients who’d died while I was touching them. All of them with a last wish they wanted to lay on me, a wish I couldn’t refuse if I wanted to get them out of my head.
“Is something wrong, Dr. Davies?” asked the nurse who had handed me the laryngoscope.
Because of the frenzy that surrounded the girl the only other person that noticed my hesitation was the nurse who had taken over the bag valve mask. That level of activity made me want to run. The staff never put work like that into the average druggy, or geriatric on their way out—most of us didn’t invest much emotion in those patients. But it was always different with kids. The staff cared. You could tell. There was atmosphere in the room. They didn’t want her to die.
“Just taking a breath,” I said to the nurse, swallowing hot bile as I forced myself to bend near the girl. The other nurse removed the bag from the girl’s face and I took her chin in my right hand, opened her mouth, and inserted the laryngoscope.
I was just about to slide past the vocal cords when the Surgeon’s voice erupted in my head. Don’t tube the ‘goose!’
The laryngoscope blade slipped in my hand and I just barely avoided banging into the girl’s teeth as the Surgeon chuckled with delight.
Do you really think you can help this one? he asked. She’s a lost cause...
I ignored him as I inserted the laryngoscope again, getting it in place straight away. The tracheal tube in, I backed away so she could be hooked up to oxygen. I replaced the laryngoscope on its tray and went to the side of the gurney where the nurses shifted smoothly out of my way.
It won’t matter, you know, the Surgeon said. This one’s a goner.
The Surgeon was the worst of the three voices in my head, with all his advice and all his know-how. Always telling me how to treat my patients. Residents are an insecure bunch, so the last thing I needed was the most arrogant of specialists telling me how to manage my cases. I had learned how to tune him and the others out, but it required a focus that was difficult to maintain at the best of times, much less when I was treating a patient. It was far easier - though no small feat - to just ignore them.
“Pressure’s tanking,” the tech called out. “Eighty-five over fifty, doc.”
“Damn,” I said, suddenly afraid the Surgeon was right. No way are you going to die on me, girl...
That’s right, Linh! chimed in Amanda. God helps those who help themselves! You can do it!
I had no idea whether I believed in God or not, but I figured even if I was wrong he sure as hell didn’t have any interest in helping me out. But Amanda was right to a degree. The girl’s life was in my hands and I wasn’t going to let it slip away.
But if there was a God he was laughing at me right then because the kid started to drop. I knew what we could do—we could give her air, give her fluids, fill her up with someone else’s blood. And when that failed? What then? Shock her heart when it crashed. Maybe, if the case called for it, crack her chest and pump her heart by hand. But really, what good would that do? What would that result in other than bloody hands and a butchered body? And if I kept my hands on her and she died then I was going to get another voice in my head and then what would I do? I couldn’t forget what had happened the last time - the Surgeon. He’d been nothing but a disaster.
No, I thought. No, that won’t happen. I won’t let it happen. She may die, but she won’t die here with me. I can do this...
“Mannitol,” I said. “And two units uncrossed blood up, now. All we have to do is stabilize her long enough for the trauma surgeon to put her back together. I’ll get the central line in.”
Mannitol? Really? said the Surgeon. I think that ship has sailed, honey.
I could see the fear and the hope in the staff’s eyes as they complied with my orders. I started on the central line and said, “We can do this people. We’re okay.”
But we weren’t okay, because a second later her pulses disappeared and her heart rhythm changed and of course my hands were on her, touching her. The blare of the heart monitor cut through the air. It didn’t matter if the cause was a massive intra-abdominal injury or a traumatic aneurysm, either way she was toast.
“Shit,” I muttered, fighting the urge to cry or hit myself on
the head, the fantasy of saving the girl slipping away.
There was more after that of course. More pumping, more drugs, more everything, because it was a kid and we wanted to bring her back. All of it useless. None of it mattered.
I told you! said the Surgeon as he cackled with glee.
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About the Author
M. D. Thomas grew up in the middle of nowhere Louisiana, a locale that let him spend most of his free time reading. When that got old he left, eventually earning a Ph.D. in Microbiology at the University of Virginia. He ditched a career in science a few years later, became a stay-at-home dad, and settled in Tidewater Virginia, where he’s been writing ever since. His works have won writers conference awards and were selected for the Pitch Wars mentoring program in both 2017 and 2018.
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