by Ella James
Downstairs, it’s a madhouse. All the bays are full and EMTs are pouring in with stretchers.
“Wicked wreck at 8th and Monroe,” I hear someone say. “One van full, no seatbelts, plowed into a smaller car that’s fucking crushed.”
Ten
Evie
Very rarely, I have moments where I just don’t want to help. My enthusiasm for doctoring is nearly unflappable, but once or twice a year, the right—or wrong—mood hits me, and I want to leave a shift. As I wait for the line of ambulances to bring my suspected spinal cord injury, that’s exactly where I am.
Landon’s out there somewhere. I need desperately to find him. I can’t imagine what he must be feeling, and I hate myself so much for not telling him sooner. He deserved to know. He deserved to know before now, regardless of how little his knowing would have changed things, or how much it terrified me.
I deserve this, I think with a knot in my throat. I’ll deserve whatever happens to us.
I keep texting him, and I know he’s really upset—obviously he is—because he hasn’t even looked at my texts.
I’m gritting my molars as yet another stretcher comes in. I hope my guy—or gal—with the suspected SCI isn’t last in line. I need to get them stable, pass them to the night floater, and split.
I hear shouting as the automatic doors swish open, and three EMTs bustle in with another person on a backboard—this one held down low, as if he’s heavy. With my eyes still on the doors, I listen idly to what they’re telling the ER attending, noting something about a mean right hook.
“—wild and talking crazy,” one of the EMTs is saying.
A second later, I hear a low shout echo down the corridor: “I SAID…I WORK HERE!”
Cold sweat washes over me, but I stay rooted to my spot for the next minute, still watching the doors as my brain fails to connect the dots. And then I do connect the dots, and I am flying toward the private rooms because I know that voice, and that was Landon.
Oh my God—Landon! The bolt of shock and fear that shoots through me is so fierce, my legs almost give out as I fly down the hall, toward the row of private rooms. From one of them, I hear his voice, saying, in hoarse, pained tone: “unstrap me…damn it…I’m not gonna fucking…”
EMTs are in the doorway, nurses in the room, I guess, because I hear their sharp tones.
“You’re going to have to calm down, sir, so we can validate your—”
“I’m checking your lung sounds.”
“BP’s through the sky.”
I shove past the EMTs and—God. Oh God.
Landon is lying on his back in a railed bed, still strapped to the ambulance backboard. His head and face are blood-streaked, his mouth and nose are covered by a clear plastic oxygen mask, and his chest…oh Jesus—what happened to his chest?
A burst of heat moves through my own chest as I blink at his. The right side of his diaphragm is black and blue, and clearly swollen. As he breathes, hoarse whimpers come from his throat. Even so, his shoulders lift up off the board, his biceps straining as he fights the thick restraints around his wrists.
“I fucking…told you,” he moans—
Then his gaze hits my face, and his features slacken. “Evie…oh God. Please.” His body stills. His eyes squeeze shut, his face twisting in pain. “Please.”
My heart stops as I remember what he said—about the group home.
“Take them off, right now,” I tell the nurses. “Take the arm bands off.”
“He hit one of my guys,” an EMT calls from behind me.
“He’s a surgeon. If he used his fists, your guy earned it.” I turn toward them, my heart pounding wildly. “I want everybody out. Dr. Jones is my colleague. I’ll triage him.” No one moves. I throw my hands up. “I said everybody out!”
Landon’s legs move as he struggles to breathe, gasping on the inhale, moaning on the exhale. Fuck. The right side of his chest is so dark, there’s no way his ribs are intact.
“Blood pressure is high,” one of the nurses says as she goes. She hands me a syringe: Nitropress.
The EMT mutters something as he leaves, but I don’t even stop him for a report. Landon’s chart will be in my tablet, sent wirelessly from the ambulance to our ER. As soon as the room clears, I rush to him.
“Oh God, Landy…”
My hands tremble as they hover over him, as I realize I have to pull his chart up first. “Oh God, baby, what happened? Don’t talk, though—stay still. I’m gonna check right now.”
I don’t look at him as I scroll through my tablet with a sweat-damp finger, but I can hear him panting—breathe, then moan; gasped breath, then strangled moan. I can tell he’s trying to hold in the groans, but he must be in awful pain.
With blurry eyes, I scan his chart—he was in a car wreck. Suspected trauma to the abdomen. Vitals don’t suggest internal bleeding, but lung sounds are off. Reflexes slightly abnormal but seemed better on arrival. I glance up at his monitors: BP is coming down. He seems stable for now. I feel as if I’m floating as I grab the room’s phone and put in for the portable CT scan.
When I hang up the phone and allow my eyes to rest on Landon, I find his arms folded around his head. He’s got one knee pulled up, the other straight, and his whole posture screams pain. His breaths are more controlled now, but still sound raspy and uneven. His chest rises on a deep one, and he groans.
“It’s okay,” I murmur, moving to his bedside. My mind and my emotions war. I want to wrap him in my arms and cry for help—but logic wins: I am his help. Landon’s really hurt. I have to fix him. Calm down. Hold it in, I tell myself, as I put on my stethoscope and hold the diaphram to his chest. Landon’s arms go to his sides.
I can’t meet his eyes. I can’t. I shut my own and listen. My throat closes as I hear abnormal chest sounds: evidence of a lung problem. I repeat on his unhurt side. Fine there.
Damn it.
His oxygen saturation is at 92, his pulse is 115. Low-borderline. What really troubles me is that his eyes are closed. He’s motionless except for winces when he breathes.
With shaking fingers, I reach down and touch his blood-streaked hair. His gray eyes open, the pupils slightly dilated. He looks dazed—but when my thumb brushes his forehead, he groans softly.
“Hey…Landy, can you—”
“Go,” he mumbles.
“What?” My heart is beating so hard that I feel faint, but Landon doesn’t need to know. I use my softest voice when I say, “I’ve got to ask you a few questions.”
“No…you don’t.” His teeth grit as his face twists. “Go.”
“You want me to go?”
He groans again, and when his eyes squeeze shut, a tear drips down his temple.
My heart shatters.
I breathe deeply to hold back a sob. “Don’t think of me as Evie, let me check you like a doctor. As soon as we see scans, I’ll shoot you full of morphine—okay?” I stroke his hair again, and Landon’s lips form a tight line.
“I’m going to touch your chest,” I whisper. I hold my breath as I run the pads of my fingers over the swollen, bruised spot, trying to get a read on the ribs. Landon grunts.
I shake my head as tears obscure my vision. “I’m so sorry.”
Just as I get ready to step back and make a more urgent call for CT, he grabs me by the shoulders, pulling me down over his chest as he starts to tremble. “Evie…” His mouth is near my cheek, his breathing faster.
“Landon—I’m so sorry.”
He just pants beneath me, and I want to die with helplessness.
“I’m so sorry.” I stroke his hair. “I love you.”
I’m so distracted by my feelings that I don’t even notice something’s wrong until the monitor starts dinging. His BP is at 80 over 40.
SHIT!
I rush to push some Levophed into his IV and call for ICU. Fuck it—I’m not holding out for the CT. I want the rescue team.
In the seconds between my call and their arrival, I lean over Landon, pressing m
y lips to his forehead as a single sob bursts out. “I am so, so sorry. Landon, please forgive me.”
His hand grips my shoulder. As two nurses and the ICU chief burst into the room, his eyes roll and he says, “My legs.”
This is not real life.
Dr. Peterson, one of the attendings in the ICU, is not muttering about pneumothorax as he runs the portable CT over Landon’s unconscious body.
I’m not sponging his pale face and sweaty forehead, looking down at his closed eyes and swollen chest while I struggle not to vomit or sob.
It can’t be.
When images fan out on the CT screen, and Peterson starts to narrate them for the packed room, his words do not seem real.
“I’m seeing a lower-level pneumothorax from one of these ribs. Hairline fracture of the clavicle, but most significant—this fracture of L1.” His mouth tightens as he peers at the screen, at the vertebrae near the bottom of Landon’s spine, where, to my horror, I can see the fracture. He leans closer to the screen, frowning. “Not looking too stable from here. I’m going to page Billards.”
“Is Billards here?” I hear myself ask. He’s our most experienced neurosurgeon.
“He is,” Peterson says. He looks at me. “Do you know the details of what happened? Why did Jones leave campus?”
Tears flood my eyes as I tell him I don’t know.
I’m such a liar. This is my fault. My fault. It’s because of me that Landon’s lying here struggling to breathe, unable to move. His lower body seems to have sensation, but maybe not normal sensation. If there’s pressure on his spinal cord…I wipe my pouring eyes. Please don’t let there be damage to his spinal cord!
I continue wiping his temple while Peterson speaks with Billards on the phone. He steps into a corner, and I can hear him say, “I’m no neruo guy, but—” He says something I can’t hear, followed by, “it doesn’t look stable.”
Blood roars in between my ears as I look at Landon’s oxygen-mask-covered face, at his poor chest, now striped by wires and marked with probes.
I want to beg him to wake up, and at the same time, I’m so thankful he’s asleep and out of pain.
“No, it’s not,” Peterson is saying, with the phone still to his ear. “That would be a lot of pressure on the cord.”
A moment later, Eilert bursts in. “How’s he doing?”
I can’t stop stroking Landon’s hair as I try to fill her in. I rub his shoulder before I realize I should probably stop, but no one seems to notice as Peterson catches Eilert up and we start unplugging monitors and locking bed rails in place so we can wheel Landon to the third floor.
As we do that, more people flood into the room. Billards, a nice guy about my dad’s age, arrives eating a granola bar and quickly reviews the images. He tosses his wrapper and says, “OR four is open. Let’s get this done.” He looks from Peterson to Eilert. “Let’s push more fluids on the trip up. I want to know more about reflexes, spasms, weakness if he rouses.” Then he looks to me. “You’re in his cohort group?”
I nod.
“Scrub in. Sometimes you’ll find it’s someone that you know,” he says in a cryptic tone. “This is good training.”
“What about the pneumothorax?” Prinz asks.
“I don’t think we’ll need a chest tube,” Peterson says.
I’m swimming through time. I’m moving, helping, but I’m somewhere else. In the basement of my parents’ house. In Landon’s bedroom here in Denver. In a car wash. All I can think about is the look on his face after we scrubbed out together earlier today. The way his face tenses as he moves inside me. His eyes and his mouth in beautiful motion.
I don’t want him to have an L1 fracture!
He’s a surgeon, not a patient!
As we walk upstairs—I’m near the head of his bed—I play out his surgery and have to grab his bed rail when I realize we’re probably going to have to take a left-sided thoracolumbar junction approach. It’s a brutal way of getting to the spine, going through everything in front of it first—a heavy-duty surgery with a brutal recovery. I can’t stand to think of doing such a thing to Landon. I’d rather cut my arm off.
By the time we start to scrub in, everyone is discussing point of entry. I’m swallowing back bile.
I make it into the OR and see him spread out on the table, being shepherded through early anesthesia by Pat and Wynn, the anesthesiologist/nurse anesthetist pair we scrubbed in with earlier.
He’s positioned on his right side, with his arms extended straight out, zombie-style, and strapped down to a board. They’ve got his lower leg flexed, a pillow between his legs, and his hips strapped to the table. His sleeping face looks grave and solemn as Wynn adjusts his breathing tube and Billards gets another CT.
I move with the pack, analyzing the results of this new CT, listening through a haze as Billards discusses his game plan, which I’m relieved to hear is a significantly less invasive VATS approach for L1 body reconstruction.
“Not every patient at this hospital gets the VATS treatment,” he says with a shake of his head. “Only the lucky ones when Dr. Briggs or I am on call. Or perhaps, one day, when you are on call.”
VATS is the ideal procedure for an easier recovery, so this news has me shaking with relief.
As Billards talks, I can’t take my eyes off Landon. I hate the sight of him up on the table with that cruel tube down his throat, and props and blankets positioning him so unnaturally.
I try to tell myself that he’s asleep, and he has no idea what’s going on, but that thought makes me feel ill, too. He doesn’t know yet that the car wreck—where he was a victim of a run stop sign, I’ve heard—could end his career, even his life if something goes badly wrong.
I watch silently in my surgical getup as Eilert marks his torso in four spots, for port insertion sites. We’ll need a working channel, an optical channel, a traction channel, and a suction channel. Even though Billards is in charge, I get the sense that Landon’s surgery will be mostly Eilert’s—and I kind of hate her for it. Eilert is one of our chiefs, but she’s a resident. I want Billards at the helm.
I listen as he tells us, “We’ll be using an expandable Synthes cage. It’ll be placed in the vertebrectomy defect, gradually distracted, and locked into place to stabilize the cord.”
He and Eilert discuss the four channels at length, as he explains pitfalls of the positioning to her.
“Rutherford, I want you to construct the suction channel. That’s your job here. You do that well, you’re scrubbing out if you don’t want to do more. How do I know Rutherford is uncomfortable?” He looks around the room as he points to his head. “She’s sweating. Pale. She looks like she’s the patient. This is why we don’t perform surgery on an acquaintance or a loved one if that’s an option. At a smaller hospital, it is not always an option.”
Somehow, I remain standing as Billard talks ad nauseum and Landon lies there, stuck in anesthesia sleep, being hovered over, poked, and prodded. Prinz arrives in surgical gear as Billard explains that for VATS to be advantageous for the patient, the surgeon must be experienced in restoring the diaphragm with the use of an endoscope.
“This is a developing subspecialty of thoracic surgery. You master this, you’ve got a gold star on your resume.” Moving closer to Landon, he continues, “Decompression will be performed using laminectomy. We have one broken fragment we’ll push forward, toward the body, before inserting screws from the rear. In a more severe fracture, we might come back in a few days later and remove the destroyed part of the body with thoracic endoscope, but in this case we’ll be doing all that now. If all goes well, our colleague will get his chest tube out in four to five days and be discharged in maybe ten. Surgery like this might take a toll on a geezer like me, but Jones here is a young man. He’ll probably be just fine.”
I hold my stomach as he explains routine opening procedures. Billard is too specialized to deal with first or second year residents much, and I can tell he views the situation as something of a novelty.
So much of what he says makes me flinch—things I hear daily without batting an eye, like the warning he gives us to properly restore the diaphragm in order to avoid pneumonia and herniation of the large intestine.
He means Landon’s large intestine.
Somehow, somehow, somehow…I stay on my feet for three hours. After the first two, I’m just watching—mostly watching Landon’s vitals and the mortal hands that work the gear that’s rearranging my love’s insides. Every semi-sigh from Eilert or grunt or complaint from one of the techs makes my head spin. Every spurt of blood and BP fluctuation make my knees wobble.
I’m standing near his head, wanting so badly to touch him—just his forehead—when Eilert announces that she needs a bathroom break and grabs my elbow. She leads me gently from the room.
“Rutherford, scrub out,” she says, as she starts doing so herself. “You look like you’re about to collapse.”
Eleven
Evie
I’m in the donut room, waiting for a page to tell me Landon’s been transported to ICU, when Eilert comes in. Her eyes are red. Her face is drawn. I notice tears on her cheeks, and I almost faint.
“Did something happen?” I jump up from where I’m sitting.
She gives me a look. “Your cohort just got sliced and diced. What do you mean, did something happen?”
“Is he okay?” I ask her, seeing stars.
“Jones?” She shakes her head, confused. “What do you think?”
“Did it go okay?” I half gasp.
“If by okay you mean I operated on a guy I shoot the shit with every day, a guy who hours ago was grinning his fool head off, and then I walked down to the ICU and watched him start to wake up, moaning from the surgery that I just did, then yeah, it went great.”
A sob bursts from my throat.
“Also,” she says slowly, “two of my interns have been having a relationship. If you think that’s okay, then yeah, we’re good.”
My heart stops at her words.