by Barbara Ebel
Annabel dared to approach. “You can let that one go,” she said waving towards Noah. “In there,” she said, pointing into the room.
The free paramedic looked in. “Oh, shit,” he said.
The doors were still open and two police officers from the 9-1-1 call ran towards them. Not Edgar, Annabel thought, but she knew he would burst in any minute.
“Take that guy,” Annabel said. Both men in blue grabbed one of Victor’s arms with a tight grip, positioned them behind him, and secured handcuffs.
“Are you okay,” she weakly asked Noah. He was bleeding from his forehead and with a look of discomfort, he massaged his forearm with his free hand.
Unsure, Noah shrugged his shoulders and focused towards the room. They both stepped to the doorway. The paramedics were working in unison without a word to each other. Selina’s blood-soaked jacket and blouse were already cut and her forearm exposed. One paramedic was securely taping the tubing of a large bore IV on her skin. The tubing went to a Lactated Ringers bag resting on the examination table.
“Let’s go,” the one said to the other. They picked her up a few inches and laid her on the stretcher they’d placed on the floor. Annabel stepped through the blood, took the IV bag off the table, and placed it on Selina’s body as they hoisted the stretcher. They headed out the door.
“He got her carotid artery,” one of them said to her. “Not good.”
“Come with us,” the other said, “so you can tell the docs and the cops what you know.”
Chapter 31
While Victor huddled handcuffed on the floor against the wall, the two officers split up; one of them began asking Noah questions, the other pursued Annabel and asked, “Are you the person who called?”
“Yes,” she said, trying to keep up with the paramedics going to the elevator. “I’m Annabel Tilson. I was in the room and told the front desk to call.”
“One of us will need to talk to you and will come over to the hospital.”
The elevator opened and they came face to face with Edgar Banks. His eyes darted down to the stretcher and his shoulders slumped. “Selina?” he asked horror-struck.
Annabel nodded.
“Oh my God,” he said.
“Edgar, you know her?” the other officer asked.
Edgar nodded.
“Help us out,” the officer said. “Two of us have our hands full here with the suspect, another witness who also needs medical attention soon, and the crime scene. Can you go with them for details on the victim and get a statement from Ms. Tilson who called it in?”
Edgar nodded again as they all crowded into the elevator and the door closed.
One paramedic had used a long bandage to wrap around Selina’s neck to tamponade her carotid artery but it was like a damn ready to explode. The elevator stopped, they hustled out, and raced across the pedway to the ER. Staff surrounded the moving stretcher as they moved into the major trauma room.
Annabel and Edgar thought it took forever but it was only ten minutes before the stretcher whizzed by again surrounded by an ensemble of trauma surgeons going to the OR. Annabel and Edgar blindly followed by taking the stairs. Upstairs, the procession they had followed had already disappeared into surgery.
Edgar and Annabel sat in the waiting room. He had a dozen questions for her but, at present, couldn’t find the words. A numbness seemed to take hold of his vocal cords.
Feeling disturbed and shocked by the last half hour, a queasiness and light-headedness swept over Annabel … as if her blood pressure had reset to lower numbers. She tried to wring her hands but gave up; it was too much effort. A sadness consumed her. Her favorite attending may not make it to live another day.
Someone was standing in front of her talking to her and she only then realized it.
“Annabel, we just heard,” Bob said. Joshua stood next to him but she stared blankly at them. They sat down in the empty chairs to her right.
As the trauma surgeons tried to save Selina’s life, Annabel and Edgar exchanged all the information they knew with great difficulty: Edgar told her of Marilyn Blake’s death and Victor’s reptile roommate; and she told him of Victor’s stampede into the outpatient room and the attack he waged on Selina.
Edgar finally had the courage to write down Annabel’s witnessed account and filled in all the information about the victim. He could not believe that it was his own girlfriend - the woman he cherished deeply and had only recently come into his life.
Annabel interrupted the silence again as the group continued to sit in a daze. She looked at Edgar. “After you called Dr. Keeton this morning about Mrs. Blake’s death, I suppose she realized that Victor was probably not taking his antipsychotic.”
Edgar nodded. “She’s a smart woman. Even if she doesn’t have all the facts, she can put the puzzle together.”
Annabel liked that he used the present tense. It would be unbearable if any of them referred to her in the past.
Edgar pulled out his phone and continued sitting with the group as he called Dustin.
“Dustin, you still at the Blake house?”
“I just arrived at the precinct.”
“Victor Blake stormed into the psychiatric building and attacked Selina. She’s in surgery right now.”
“Hell, no,” Dustin said. “Is she going to be all right?”
“I, I, … don’t know.” Edgar almost choked. He thought of the real possibility Selina may not make it.
“Let’s hope for the best.”
“I’m outside the OR and there are two officers working the crime scene. They have Victor Blake. Try and make some calls. That snake can’t stay in that empty house. Now convicted of a crime, Victor won’t be going home anytime soon. He’ll be in-house on a psychiatric ward and/or facing a prison sentence.”
“I can do that. Is the med student, Annabel, okay?”
“Annabel is sitting next to me. Shaking like a leaf but she escaped with her life.”
Annabel nodded and acknowledged Dustin asking about her.
The OR doors slid open and a surgeon walked over, peeling his mask off.
“The good news is that Dr. Keeton is still alive and is going to the ICU on a ventilator. The ominous news is that she has a fractured skull, her left carotid artery was severed and she lost half of her blood volume, and the other front leg of the chair drove into her right lung and she has a pneumothorax.” He noticed Edgar’s look of bewilderment and added, “A collapsed lung.” He took a big sigh and added, “Anybody aware of any next of kin?”
All of them shrugged. “I’ve been dating her,” Edgar said. “I know one thing for sure, she is married to her profession, these students, and her patients.”
“A common problem some of us have in medicine,” he said. “We close the door to life outside of our work. It’s a double-edged sword.”
The surgeon started to step away but stopped. “Just to prepare all of you … if there is a condition more ominous than ‘critical,’ that’s how I would describe Dr. Keeton.”
Annabel looked at Bob. She was happy he was there next to her.
-----
The rest of the day fell apart. Annabel and Bob had no idea where they were supposed to go. Joshua said he would look in on their patients later in the day and advised them to go home when they were able to; he understood Annabel was in no shape to take care of others. It was bad enough she witnessed a brutal crime, but this was their beloved attending. If she didn’t come down with PTSD, he would be amazed.
Annabel slept little overnight. She tossed and turned as if her mattress kept lighting up with fire. The periods of dreaming were fraught with violence and weird scenarios with monsters and aliens. When she washed up in the morning, she figured they represented Victor’s snake. She was glad, however, she never got to see the damn thing.
A few snow flurries buzzed around her as she ducked into the hospital from the parking lot. She grabbed a mocha from the coffee stand and while she went upstairs, she realized she hadn’t eate
n last night and was behind on fluids. In the lounge, Bob had beaten her in; they both gave each other a solemn glance.
“I wonder … ,” Annabel said. Without saying it, they both knew she referred to Selina’s condition.
“I’m afraid to ask,” Bob said.
“We have to find out what’s going to happen to our two or three days before our exam. Since we don’t have an attending.”
Annabel sipped on her coffee after saying that. A big man with wavy hair and a crooked tie walked in. He wore a white long doctor’s jacket and the students recognized him as one of the other psychiatry attendings.
“I’m Dr. Minor,” he said. “You must be Dr. Tilson and Dr. Palmer. The department called an emergency meeting last night after the events of yesterday. It’s a tragedy what happened to Dr. Keeton. We have decided you two are mostly off between now and your exam Friday morning. I say ‘mostly’ off because from now until then, you and your resident will manage the patients you have been treating and meet me each day only at 10 a.m. to discuss their care. I will also check in on them on the rounds I make with my own group. You two will not be on any type of call and will take no new patients.”
He paused and waited for any questions, then said, “Dr. Keeton thought highly of her group. Come talk to me if there are any questions or concerns and try to focus on your test. Also, since you will have some extra time, we want both of you to hand in your project papers when you sit for your exam on Friday.”
“Thank you, Dr. Minor,” Bob said. “I think we can handle that. Plus, we will probably be tag-teaming visiting Dr. Keeton.”
“Yes,” he said. “This is indeed a tragedy.” Although he had tried to maintain a scholarly presence, his large eyebrows slumped down as well as his mouth. “See the three of you at 10 a.m.”
After morning rounds, Annabel and Bob went upstairs to the ICU. They stood on either side of Selina’s white bed, the tubes and hoses and plastic monitors all coming out of or disappearing under the sheets. Her blood pressure was low … bordering on ninety … despite all the vasopressors running into her IVs to keep her alive. They both pulled up chairs and sat quietly for twenty minutes. Annabel said a prayer; her dad would do the same and she felt relieved to do as he would.
After all the days of huddling around her, absorbing her wise psychiatry lessons and case discussions, and now pulling for her life at her bedside, they were missing her already. When rounds were finished and Annabel arrived home, Joshua called both students with the news that Selina Keeton was dead.
-----
In the solitude of her small apartment for the next three nights, Annabel polished off studying all the psychiatric diagnostic categories that the rotation covered as well as other minor material in her specialty book. Breaks from huddling over her books came easy because she kept looking out at the big tree standing solid and majestic at her front window. The street lights glowed and a rare leftover leaf glistened in the light, holding on as best it could before plummeting to the ground.
Over time, she imagined the events of Monday would loosen their grip on her thoughts. But no such luck right now. Visualizing Victor barging in the room and attacking Selina would not go away. Nor would her attachment and fondness for her attending. She thought over and over of days on rounds, the woman’s devotion to her patients and their illnesses, and the respect and caring she showed the team. She thought over her wise sayings, such as, “Don’t believe everything you think.” Overall, perhaps Dr. Keeton would be the most complete and nourishing attending she would ever have.
Annabel also smiled to remember the personal time she’d shared with her attending and cherished that unusual circumstance of going on a double date with Edgar and Dustin. How Edgar must feel, she thought. They seemed like they had gotten very close very fast.
She peeled her eyes away from the stately tree and shifted gears. Her project paper was finished but now it needed more than the clinical aspects. She went over to her desk, opened up her computer, and began an additional piece to add to the beginning of her paper.
-----
Annabel had plenty of time Friday morning as she strolled down the hallway towards the classroom where the final exam was being given. Inside, Dr. Minor and a secretary from the department sat at a long table. About half the students taking the test were already there.
“Good morning, Annabel,” Dr. Minor said.
“Good morning, sir,” she said. “Here is my paper.”
“Tests will be graded this afternoon and the chairman will be looking at your paper as well as Bob Palmer’s. Written scores will be up on the bulletin board by five o’clock.”
“Thank you,” she said, and selected a seat in the middle of the room.
Bob came in, also handed in his paper, and positioned himself next to her. “The funeral is tomorrow morning. Why don’t we go together?”
Annabel nodded and frowned with the thought of saying a final good-bye to Selina.
The last student arrived and Dr. Minor handed out the tests.
Chapter 32
Saturday morning a long line of cars drove along a winding entrance to an old, established cemetery. People poured out of vehicles and headed over the frosted grass to the site where the casket waited to be put in the ground. Selina’s parents had their daughter in a closed casket during a preliminary evening at the funeral home but wanted all tributes for her done at her gravesite. The old couple from the northeast looked as forlorn as the cloudy sky.
Bob and Annabel walked close to each other and Annabel tugged her warm hat further down over her ears.
“By the way,” Bob said softly, “we both passed the written. I went by last night. You scored a ninety-six and I made a ninety. I guess we weren’t too worried but you tied with someone else with the best grade. Nice going.”
Annabel smiled for the first time all week. “Thanks and congrats to you, too.”
“We’re basically finished,” he said, “because the paper doesn’t count for too much and there’s no way we botched them up.”
“So true,” Annabel said. “Psychiatry may be finished but its application will always be in our thoughts with future patients, especially because of what happened.” More sadness swept over her and, like feeling for a security blanket, her fingers curled around a tissue in her pocket. To be ready for her tears.
They stopped and positioned themselves in a deep gathering of dark coats. The department’s office personnel, psychiatry attendings, doctors from private practices, and all the rotation students stood in clusters. Friends and relatives lined a circle around the casket and many of Dr. Keeton’s former and current patients still came and extended the back rows.
Annabel felt a tug on her sleeve and turned to see Edgar and Dustin in their blue uniforms and leather jackets. Edgar embraced her and then Dustin did the same.
“I’m so sorry,” Annabel said to Edgar.
“Yes, aren’t we all,” he said softly.
Due to the closeness of the onlookers, everyone stayed warm and comfortable as the family began. Selina’s parents were too fraught with despair so her only brother spoke. After two more personal eulogies, Dr. Renner, the Psychiatry Chairman, took the spot next to the casket covered in flowers.
“I had my own eulogy prepared but I have decided to cut it short and say that Dr. Keeton was beloved by us all and was an iconic clinician that we all admired for the right reasons. The department and all those who know her from the field of psychiatry are going to miss her immensely.
“I’ve bumped most of my remarks to give another talk … one which came to my desk yesterday.” He pulled out a stapled paper and unfolded it. “This was written by one of the medical students, Annabel Tilson, who was on Dr. Keeton’s team the last few weeks. It was an addendum to her department paper because of this tragedy.”
Annabel swallowed and, for a second, Bob squeezed her forearm.
“This is what Dr. Tilson wrote:
“Words cannot describe the impact a mentor, a
teacher, a doctor like Selina Keeton has on those people who come in and out of her life. In the short period I worked with Dr. Keeton, she taught me many things. And … it is because of her that I am alive today.
At the beginning of our rotation, Dr. Keeton informed us of her ‘rules.’ Rules for health care providers working with psychiatry patients because, although it’s rare, their illness can cause them to lash out at others either verbally or physically.
All of her rules were for our safety. She made it clear that when we saw patients, we should always sit by the exit door rather than close to them. If she had not been adamant about that, I would have been in the third back room chair when our paranoid schizophrenic patient entered unannounced and I would not be here today.
While mourning my attending’s death, I searched medical reports and journals for the type of incident that occurred this week. It is sad to think that some doctors should and do fear some of their patients. Some doctors have been killed by angry patients or their loved ones, but ‘some’ is too many. Most doctors are unprepared for when a patient suddenly goes ballistic and are put in harm’s way.
Although Dr. Keeton practiced an awareness about that, most doctors never go into a patient encounter thinking how to defend themselves, but rather with the mindset of curing and helping.
That is what she did: cured and helped. She is a true hero. One who managed the mentally unstable day after day, knowing the consequences, taking the risks, and making the world safer for her patients, her students, and for the rest of society.”
The chairman closed the paper and slipped it back into his coat. The casket was lowered into the ground and everyone began to disperse with sorrow in their hearts. Annabel and Bob said good-bye to Edgar and Dustin and walked under the canopy of trees to Bob’s car.
A call came from behind them and they turned to see Orange, Timmy, and Jonah from their Wednesday group therapy sessions.
“Dr. Tilson,” Orange said, “we all feel terrible about what happened. We’re going to miss her.” Her long hair flowed down out of her woolen hat and she held her head at eye level.