Warning Signs

by C. J. Lyons

  He left again, and Amanda glanced at Lucas, who didn’t look very happy with either her or the situation.

  “What’s wrong?” she asked.

  “Mercury toxicity can’t explain it all. Some of their symptoms, maybe. But not their deaths.” His scowl deepened. “Michelle had the more serious mercury exposure, but why did Becky get her symptoms first? It doesn’t make sense.”

  Amanda blew her breath out. There was just no satisfying the man. “But they all had the boathouse in common. What else is there?”

  He shrugged. “There has to be some other connection between all the women.”

  “You mean besides being young, female athletes with connections to the boathouse and exposure to antique mercury instruments?” She shrugged. “Seems like maybe you have a lot of connections, just none of them related to what killed them.”

  “That’s what worries me. What if I was wrong?”

  Silence lingered between them as thunder grumbled overhead. “You mean what if they all have different diseases?”

  “Diseases I failed to diagnose.” His words were almost swallowed in the sounds of the hazmat RV’s engine starting.

  “Lucas, I don’t believe that. You’re an excellent doctor. We just need to keep looking.”

  Before she could say anything else, the sounds of “Dixie” rang out from Lucas’s pocket.

  “I forgot,” he said, handing her her cell phone. “Jerry Boyle gave it to me to give to you.”

  “My mom.” She opened the phone and glanced at the calls she’d missed while in the ER. Andy. Mama. Andy, twice more. A break with no calls—lunch, no doubt, which reminded her that she still hadn’t eaten. And now Mama again. She hit the button. Better to face the music now. “Hey, Mama. I can’t really talk right now.”

  “Amanda Camille Mason, what did you say to your brother? He’s threatening to cancel the entire bridal shower. Whatever you said, you apologize right away, young lady.”

  “Mama, I’m not coming to the shower. And honestly, I don’t think I have anything to apologize for.”

  “What do you mean, you’re not coming? Amanda, I’m counting on you—”

  Lucas walked away, opening the driver’s door of his Camry. Amanda rushed after him. She wanted—no, she needed—to get back to work.

  “Mama, I have to go now. Love ya, bye.”

  She hung up. Ice water flooded her veins as she realized the implications. She’d hung up on her mother. The boys were bad enough, but Mama? She half expected the ground beneath her to crack in two as she plummeted straight down to hell.

  “Lucas, wait,” she called out. He stopped and turned. “Where are you going?”

  “It’s almost time for Alice Kazmierko’s MRI. I need to get back to Angels.”

  “I’d really like to be there for that too.”

  He nodded grudgingly. “It’s in thirty minutes. I’ll see you back at Angels.”

  She drove Nora’s car back to the hospital and rushed up to the PICU. Outside its glass doors, she stopped. Why was she so excited? In a few minutes she might be giving a little baby a death sentence.

  She sobered, tucking in her scrub pants, taking a moment before going inside. Mr. Kazmierko wasn’t at Alice’s bedside. Inside the mother waited there, openly sobbing, a wadded-up tissue in each hand. “You’re going to be all right,” she crooned to her baby. “Everything’s going to be all right.”

  Alice didn’t move, other than the slight expansion of her chest as the ventilator blew air into her lungs. Mrs. Kazmierko held tight to the edge of the crib, refusing to let go until Amanda gently separated her fingers from it.

  “We’ll be back soon,” she told the mother, taking care not to promise anything. She knew the pediatric intensivists had given up on Alice, but Lucas seemed to hold out some slight hope.

  Good to have something to hang on to until they knew for certain. The nurse and respiratory therapist began to steer the crib out of the unit. Lucas followed them, his attention divided between Alice and the transport monitor that hung from the side of the crib.

  Amanda hurried after them, her numb left foot catching as she crossed the threshold. She stumbled but didn’t fall, catching herself quickly. Sharp electrical shocks flared through her leg and thigh, this time reaching all the way up to her lower back. She felt her muscles quiver with fasciculations, that gruesome writhing-snake’s-nest feeling beneath her skin.

  She stomped her foot, hoping to dispel the fasciculations. They’d lasted only a few moments yesterday and earlier today. This spell seemed worse; it wasn’t going away. Lucas and the nurses had reached the patient transport elevator and were waiting for it.

  Hiding her limp and pain as best she could, she hustled down the hallway. The fasciculations stopped during the elevator ride down to radiology but the pain persisted, spiraling up her spinal column, finding new and unexpected places to torment her.

  Stupid, she chided herself. She’d missed lunch—her potassium was probably back down again.

  Jim was waiting for them in radiology. When he saw Amanda, he buttoned his lab coat as if worried she would kick him again. Ha. She could barely stand; the pain was like lightning dancing over her nerves.

  There was a water fountain outside the exam room. She let the others go ahead as she gulped down another potassium pill, hoping it would raise her potassium faster and take away the pain that was now creeping up her arm. They were only twenty milliequivalents each, and she’d just pee out any extra. She flexed and extended her fingers. Still working fine. By the time the test was over, she’d be back to normal.

  At least she hoped so.

  MED SEVEN BOUNCED TO A STOP, ITS TIRES scraping the curb. Gina couldn’t tell where they were from looking out the back window—it was all a haze of dingy gray to her. Maybe somewhere in Garfield or East Liberty. Who knew?

  Who cared? Her brain spun; her stomach was knotted with adrenaline; her pulse hammered so hard that she felt it in her fingertips, making it hard to focus on much of anything.

  The call was for a drug OD—which usually meant puke and shit and urine and steps to climb and patients who would be less than thrilled to see them, if they were even awake or alive.

  Her Kevlar vest felt heavier than ever, pulling her shoulders down, making her drag. It had nothing to do with her attitude, she told herself as Trey wrenched the rear doors open, glaring at her for not already being out the door with their gear. Both medics were giving her the silent treatment, watching warily as if she posed a threat.

  She let Trey and Gecko wrestle with the equipment. Instead of helping them, she climbed out of the ambulance and surveyed the scene. A single-family house, gray with old-fashioned tarpaper siding that looked like it belonged on the roof instead of on the exterior walls. It sat alone on a lot, making its neighbors—a long line of rowhouses—look like ugly stepchildren crowded together. And to be uglier than this squat dog of a house, that was a lifetime achievement—more than most in this neighborhood could boast of.

  A chain-link fence surrounded the house on its pitiful postage-stamp yard. Remnants of bright yellow crime-scene tape billowed in the wind like streamers left over from a party. Cops had been here recently—a lot of them, from the looks of the trampled and muddied front yard. No sign of them now, though.

  “What do you think?” Gecko asked, pushing his ever-present sunglasses higher up on his nose. He nodded to the crime-scene tape. “Maybe she was DOA and they forgot to call us?”

  “Who’d the call come from?” Trey asked.

  “Anonymous—no surprise.”

  Trey nodded, raising his radio to his lips. “Dispatch, what’s the twenty on our LEO backup?”

  Gina paced along the sidewalk, her steps jittery as she regarded the house warily. It was standard procedure to dispatch the police along with a medical unit to an anonymous 911 call. Especially in this neighborhood. Goose-bumps marched along the back of her neck and down her spine as she felt the stares aimed at them from behind closed windows.
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  “It’s just another junkie,” she muttered. “Why should they care? Why should anyone care?”

  “What the hell’s wrong with you?” Gecko asked.

  She couldn’t see his eyes behind his Oakleys—who the hell wore sunglasses on a dreary, rainy day like today anyway? What’d he think he was—some kind of rock star?

  Gina scowled, her lips twisted tight, and resumed her pacing in front of the house. She felt ready to shatter with tension. Better to do something, anything, than just stand here. She rattled the gate. It opened without a sound, swinging back and forth despite the fact that the wind had died. “Hell with this. I’m going in.”

  JIM GOT TO THE CHAIR WITH THE VIEW OF THE MRI monitor before Amanda did, and Lucas was sitting with the radiologist. Which left Amanda pacing the back of the small room, praying for a miracle for Alice.

  Her pacing was interrupted by calls from all of the oldests: Andy, then Adam, Andy again, Tony, and Andy one more time. She let them all go to voice mail and turned her phone to vibrate instead of ring. Guilt at ignoring her family gnawed at her, but she needed to concentrate all her attention on her patient.

  The MRI chunked and clunked and made angry machine noises. Poor Alice was swallowed up inside the belly of the beast. There was a pause as they reset everything for the angiogram part of the study.

  “Looks like reduced ADC with cellular edema,” Lucas announced after reviewing the first set of scans. The radiologist nodded his agreement. “The angio will tell us for sure.”

  Cellular edema was a sign of diffuse damage—damage that may be permanent. Or not. It was hard to predict in babies. But the angiogram would show the amount of blood flow to the brain. Normal flow was good. Too much meant a risk of swelling and secondary inflammatory damage—exactly what Lydia had attempted to prevent with the cerebral cooling.

  And no blood flow, well, that was bad. No blood meant no brain left to save.

  Amanda watched as the tech injected the dye. The potassium seemed to be working; the electrical shocks had disappeared, although her hand was still tingly and numb along the pinkie finger. No big deal, she didn’t need a pinkie finger for anything anyway.

  Her phone rang twice more, buzzing through her lab coat like a hungry locust. She ignored it, trying to get a glimpse of the computerized results. She couldn’t see anything past Jim and Lucas, and their expressions gave nothing away.

  Finally the clanging stopped and the scan was over.

  “Amanda and Jim, help them get her ready for transport while I go over these,” Lucas ordered.

  Amanda wanted to stay behind and see the results, but the grim look on his face changed her mind. A few more minutes of denial wouldn’t hurt anyone.

  She joined Jim and the transport nurse outside the scanner where the transport ventilator, monitor, and bed waited.

  The MRI magnetic field was always on, so transporting patients in and out of the scanner took several steps. First, the respiratory tech, who wore scrubs and carried nothing with her, took an MRI-safe bag-valve mask into the room and helped the MRI nurse extricate Alice from the machine.

  “I’ll lift her out of the scanner if you get ready to hook her back up to the vent,” the nurse told the tech as Jim and Amanda watched from outside. It was a delicate procedure with all the IV lines, monitor wires, and endotracheal tube connected to Alice. The respiratory tech disconnected Alice from the MRI’s ventilator and bagged oxygen through Alice’s endotracheal tube and into her lungs.

  The nurse skillfully scooped Alice into her arms, taking care not to tangle any of the many wires and tubes. She did a graceful pirouette and carried Alice out of the MRI field to the transport crib. She laid Alice onto the crib, where the respiratory tech bagged a few extra breaths into her.

  Amanda held the PICU’s ventilator extension ready. Once the respiratory tech pulled back, Amanda reached for Alice’s endotracheal tube with her left hand, ready to switch the baby back onto the breathing machine.

  Her numb pinkie finger brushed the tube, setting off a lightning storm of electrical shocks that made Amanda’s entire arm jump, knocking out the endotracheal tube.

  Without the tube, Alice had no oxygen.

  Fear clenched Amanda’s gut, twisting it mercilessly. Damn. “Someone grab a mask, bag her.”

  The respiratory tech was already replacing the endotracheal adapter with a mask to force oxygen through Alice’s mouth. Amanda reached to stabilize Alice’s head, but now both her hands were quaking with myoclonic jerks.

  “Amanda.” Jim pulled her away from their patient before she could do more damage. “What the hell is wrong with you?”

  Amanda tried to answer him but her breath was coming in gasps, choking her. Her vision blurred and she realized she couldn’t blink. Her entire body felt as if it were sparking with pain, muscles firing haphazardly, jerking uncontrollably.

  She fell to the ground, her last vision the worried look on Lucas’s face as he ran in from the outer room.

  THIRTY-FIVE

  Friday, 3:29 P.M.

  STRONG ARMS CRADLED AMANDA. DADDY? NO—he was a thousand miles away, back home. She forced her eyes to focus. They seemed to be stuck open; everything seemed blurry unless it was right in front of her. She tried to blink but couldn’t. A face appeared. Lucas?

  Good God, it was Lucas carrying her. She tried to squirm free but her legs wouldn’t move; they felt disconnected from her body, her muscles gyrating like a bucket full of worms trying to avoid the fishhook.

  Something had crawled inside her throat, sealing it shut. She couldn’t speak. Even swallowing was hard to do, as though she had a big old cat’s-eye marble trapped in her windpipe.

  Panic surged through her as she tried to move, to shout, to scream. Nothing. She was trapped, locked in as certain as when Andy had trapped her in that hateful attic trunk so many years ago. At least then she could fight. This time she was helpless.

  Terror made her retch on her own secretions. Lucas looked down at her, his face creased with worry. “Don’t worry; everything is going to be all right.”

  The same words he’d whispered to Tracey Parker. He pushed through a door, and voices barraged her with the force of an ocean wave. The ER.

  Other hands, strangely disembodied because she couldn’t focus past Lucas’s face, began to touch her, drawing her down onto a hard surface, wheeling her down the hall, fluorescent lights rippling through her vision.

  Lucas never left. Her hand was numb, but if she forced her vision down—strange how much work it was shifting her eyes—she saw his hand gripping hers.

  The baby—was Alice okay? Had Amanda killed her when she extubated her? Guilt and shame flooded over her. How could she have let her pride risk a patient’s life? She should have listened to Lucas last night when he’d questioned her ability to safely care for patients. What kind of a doctor was she, putting herself before her patients?

  A little baby—innocent, deserving of her best—could be dead because of her.

  “Alice is fine,” Lucas reassured her, but his worried look didn’t ease. “We reintubated her and she’s back upstairs.”

  Amanda swallowed hard—this time her throat was blocked by tears. She couldn’t blink, so she tried to move her eyes up and down, as if they were nodding her understanding. It didn’t feel like they moved at all, but Lucas seemed to comprehend.

  “Don’t worry about Alice,” he said as the stretcher came to a halt beneath the glare of lights in an examination room. “We need to find out what’s wrong with you.”

  “Amanda.” Nora’s voice came from her other side, but it was just too much effort to shift her eyes over that way.

  “What happened?” Lydia asked, also out of eyesight.

  “Fasciculations, myoclonus, paresthesia.” Lucas rattled off her symptoms. “She collapsed in radiology.”

  “Sounds a lot like Tracey Parker.”

  Vaguely, as if her arms and legs were a long distance away—all the way back home even—Amanda felt strange
hands brush against her skin and realized they were undressing her. Shame threatened to smother her. She couldn’t let Lucas see her naked, not as a patient. Things would never be the same between them again.

  There was a pinch and a flood as ice filled her veins. An IV, fluids wide open, she understood. Who knew room temperature actually felt freezing cold to a patient? More fumbling, disembodied hands jerking her arms and legs, thumping, rearranging, pushing, poking, prodding. Being a patient was bad enough, but feeling all these sensations and not being able to protest, to cooperate, to give consent … it was maddening.

  Through it all Lucas remained constant. He’d disappear for a moment, and she would hear his voice giving commands, but he’d always return, standing directly over her face where she could see him. After the initial flurry of activity, he began to talk her through everything, his voice punctuated by the regular bleep of her heartbeat on a monitor out of sight.

  Amazing how quickly her other senses chimed in. The smell of Betadine as they prepped her arm for an arterial blood gas. The sounds of footsteps, voices, the monitor beeping, IV dripping. All of these helped her fill in the missing blanks. But none of them could replace losing her voice, not being able to express her thoughts, feelings, desires, pain … Ouch! Like the stab of the second IV being started.

  “Why’s she so damn alkalotic?” Lucas asked, vanishing from her narrow field of vision.

  “She must have been hyperventilating.” Jim’s voice came from her left side.

  Great, Jim got to see her stripped almost naked, lying here helpless. He’d better not try anything … the thought faded as she wondered at their initial question. Alkalotic? That meant her blood pH was high—that wasn’t linked to a low potassium, was it?

  Tracey had gotten worse after the accidental dose of bicarb had raised her blood pH. Amanda tried to keep the thought in her head, to remember later when she could ask Lucas about it. But then everything went woozy.