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In a Heartbeat
By Rosalind Noonan
KENSINGTON BOOKSCopyright © 2010 Rosalind Noonan
All right reserved.
Chapter OneKate McGann Woodstock, New York
That night Kate McGann slid between the cool sheets of her bed, thinking of ways to escape her life. Her job, her daily routines, her ragtag marriage ... the whole package cried out for an overhaul, a radical makeover, Pygmalia to Princess. She turned on her side, her body aching from planting the small pine trees in the yard that day. Heavy work, desperate work designed to exhaust her physically and keep the hillside around the house from eroding. Now, as she lay awake despite her exhaustion, she worried that her plan would fail on both counts.
She thought of those houses on television that were gutted, a new design rising on the same lot. If only you could employ architect, designer, and carpenter to remake a life. Her dark hair, now streaked with white, seemed mousey, the A-line cut far too cute for a woman of undetermined age. She wasn't fat, not really, but the flesh on her petite frame had shifted and pooled in ways she didn't want to face in the mirror. And her wardrobe, faded denim or khaki shorts with washed-out T-shirts, would qualify her for that other show, the one where the fashionistas wrest your favorite pair of jeans from your hands and toss them into a trash bin. Apparently, she'd spent too much of her free time this summer watching television, but movies, books, and even her survival gardening helped her avoid the task at hand, the challenge that probably faced every woman on the threshold of fifty.
It seemed to her that she was in need of one of those lyrical twists of fate, the proverbial lightning strike that blocks the familiar road with a felled tree and lights up a street you've never considered traveling. Her thoughts flowed to various pockets of possibility: a move to Baltimore to live with her sister, a tour with the Peace Corps that would take her to a small village in Africa or South America, a fellowship at some university that would allow her to do, well, something creative. Resident artist-gardener.
She tried to concoct the perfect fantasy, but each scenario had its thorns of trouble, tight vines that would inevitably choke off all possibility.
And why was that? she wondered as the full moon bled bold color through the stained-glass windows in her room. Her room now; her own personal space. It had been that way for almost a year, ever since she had dropped Ben off at college in Boston and returned to find Eli's drawers emptied, his jeans and sweaters and T-shirts piled into boxes in the guest room. It had happened so quickly, or at least it seemed that way at the time. Strange how Eli, a passive-aggressive person, had stepped up and taken action on the one thing she'd hoped was negotiable.
The vacuous disintegration of their relationship was unlike her parents' divorce, which had been a hot, passionate drama. Funny, but she still remembered that terrible scene some forty years ago. Although at the time she was just a kid in second grade, she remembered the loud argument of that momentous night. Voices quivered in rage, and profanity was flying, lots of "bad words," some of which she'd never heard before. Her father turned up "Moon River" on the hi-fi so that no one could hear the arguments, but Kate moved to the top of the stairs where, peering through the balusters, she caught the words, flying like shards of glass.
"That woman," her mother kept saying. "Moon River" was punctuated by smashing glass and sobs before the needle ripped across the record. That ended the song.
"Now you've done it." Her father's growl was low and deadly. Kate shrank behind the balustrade at the sight of his face, beet red with fury. A railing monster in her seven-year-old world.
Even now, nearly a decade after his death, that image of her father was branded in Kate's memory. It seemed shameful, unfair to define a man by one bad moment, maybe one of the worst moments of his life, but Kate didn't have a vast collection of memories to draw from, as he had packed a suitcase the next day and withdrawn from Kate's life. Although she'd seen him many times after that night, his visits with Kate and her sister Erin well staged and sweetened with little gifts, their relationship was always distant, two people reaching across a fence, their arms straining, the connection only halfhearted.
Yes, her parents' divorce had been explosive and quick, so different from the slow, torturous fizzle she'd been going through with Eli, who said there was no reason for divorce. He liked things the way they were, status quo.
Methodical, infuriating Eli.
Kate punched her pillow and flopped over in bed.
When she finally found sleep it was the restless variety; the purgatory of sleep where fitful dreams have you kick or cry out for the turmoil to end.
Night was still wrapped in itself when the bleating phone sliced into Kate's subconscious.
The noise split the night, a clear division between life as she has known it and uncertain jeopardy on thin ice.
Instinctively she turned toward the digital clock on the nightstand, her eyes straining to focus in the dark. Just after four a.m. Who would be calling in the middle of the night?
Maybe a wrong number ... or something important. Eli calling from the sheriff's office, or Ben out of gas.
Pushing up from the mattress, she stretched to reach the phone, snatched it from the charger. It took her a few seconds to find the right button, her mind racing even as her body lagged.
"Hello?" A jagged vein of sleep ran through her voice.
"I'm calling from Cross College in Syracuse, trying to reach the parents of Benjamin McGann."
No one called her son Benjamin. Only strangers. She threw off the sheets and slid out of bed.
"Who is this?" Kate raked back her hair and paced to the wall of windows as the man gave his name, said he worked security at the school, and that he needed to speak to one of Ben's parents.
Moonlight fired the colored glass, slanting colored patterns on the fabric of the chaise. Blue and green diamonds. Eerie light. The stained glass seemed inordinately bright, but then she remembered there was a full moon tonight.
"I'm Kate McGann ... his mother." Her rapid heartbeat punctuated the momentary pause.
"Mrs. McGann, your son was injured in the dormitory. He just left here by ambulance, and I suggest you meet him in the Emergency Room at Good Samaritan Hospital."
"Yes, yes. Of course." The wood floor felt cold and grainy under her bare feet as she opened her bedroom door and headed down the hall, past Ben's old room, which had remained intact since he left for college. Her heart pinged in her chest as she raced through the open living area. It wasn't until she flew into the guest room and approached the couch that she realized where she had been running: to Eli, her husband.
Thank God he was there. A blanket sloped over his back, his face pressed into the pillow, he was lost in sleep.
"Eli, wake up." Her voice quavered as she held the phone to her chest. "Something happened to Ben. He's in the hospital."
She felt him come awake even before his arm swept the blanket away and he sat up. "What happened?"
"I ... I don't know." She asked the man on the phone, "What happened to him?"
"I'm sorry, Mrs. McGann, but I don't have the details."
"But he's okay? I mean ..." She closed her eyes, searching for the reassurance that would allow her to shake loose from this thorny panic. "He's going to be okay, right?"
The silence on the line was like a weight dropped on her spirit.
Panicked, Kate scurried back across the house, back to her room to get dressed and go-fly!-to her son's side.
"You'll want to talk to the doctors at Good Samaritan," the voice on the phone said.
"Good Samaritan," she repeated, finding it difficult to hear him over the roar of her heartbeat. "Yes, yes, we're on our way."
As she crossed the dining room her gaze fixed on the circular stained-glass window in the living room, Eli's masterpiece. It was a mandala, Sanskrit for "essence," and the intricately designed circle was said to contain a primal pattern, this one colored to reflect Eli's past, present, and future. Moonlight fired its panels of pearlized and colored glass, brilliant triangles of orange, inlaid amber, and brown surrounding crescents of ruby-red glass. Although she had passed that window a thousand times, never before had she seen moonlight strike the glass so that it resembled a crimson heart, engulfed in flames, aglow with anguish.
An illumination of the terror swelling in Kate's chest as she darted down to the hallway to dress and go after her son.
Chapter TwoDr. Theodora ("Teddy") Zanth Good Samaritan Hospital
So much blood ...
When the doors flew open to reveal paramedics wheeling in a man strapped to a backboard, the blood was all Teddy could see. Red and clotted, it covered the man's entire head, which looked sticky and slick.
Teddy let her eyes shift back to the entrance to keep from gaping at the patient. She wished she could escape to the cool night beyond those doors, but she was held in place by subtle reminders: the button-down smock hanging loosely around her, the stethoscope around her neck, and the ID card that read, as of yesterday, "Dr. Theodora Zanth, Good Samaritan." She was a resident now, a doctor. Before someone on the trauma team at Good Sammy smelled her fear, she had better step up and take charge.
Especially with interns like Max Sanchez around. Teddy had been here little more than a week, but she already had a solid handle on the players in Good Sammy's ER. What she lacked in medical savvy she more than made up for in observation skills, and her powers of observation indicated that Max Sanchez was a risk taker, a self-promoter, and a bully. Not very endearing qualities in Teddy's book. If Max didn't have those dark, exotic good looks going for him, he surely would have been bumped off by the nursing staff in his first year.
"Bay three is open," Goldy shouted as she pointed behind her, grabbed the gurney, and tugged it her way. Goldy had probably prepared bay three when they got the call that the male trauma patient was in transit from a dorm at the college. Nurse Tonya Goldman was almost psychic in her anticipation of the next step of trauma medicine. Teddy suspected that Goldy could run this place single-handedly if the doctors would let her.
"What do we have?" Teddy asked.
"Head trauma. GCS is two-two-five." The petite female paramedic had to shout to be heard over a beeping monitor and an argument in the waiting room between two intoxicated men. "The guy who found him said that he was talking, but we haven't gotten a verbal response. Sounds like someone came at him with a baseball bat."
Teddy processed the information as she hurried alongside the gurney. "GCS" stood for the patient's Glasgow Coma Scale, a standard assessment of how the trauma had affected his consciousness. The GCS measured response to stimuli, such as whether the patient could close or open his eyes on command or respond to questions. Two-two-five meant nine out of fifteen; not so good. This guy had suffered a major injury. His verbal responses were poor, though he was still responding to physical stimuli.
"What's his name?" Teddy asked.
"Ben. Benjamin McGann. Nineteen years old," the female paramedic answered. "He's at Cross College for the summer. Plays for the Lakers."
"Ben, can you hear me? Do you know where you are?" He was unresponsive as the trauma team hustled him down the hall. His left eye was swollen, the skin bruised blue. "Let's get a CT scan," Teddy said, wanting pictures of his neck before she took him off the backboard and removed the collar.
Glancing up, she saw Dr. Chong, the ER attending physician, catch up with the moving gurney. Cold and reserved, Dr. Chong had a schoolmarmish approach to overseeing her staff that rattled Teddy's nerves. "Go ahead," Chong said with a quick nod, indicating that Teddy was to run the procedures.
Teddy's heartbeat quickened as they pulled the gurney into the bay and one of the paramedics locked the wheels. For the first time in her career since she'd walked across the stage and been given the name of "Doctor" at med school graduation, she was the lead doctor calling the shots. It was scary.
"Cross match! Let's get two units O negative in here," Teddy called. Although his blood pressure was in the normal range, they would replace some of the blood he'd lost, just to be on the safe side. While they worked, the lab would match his blood type; in the meantime, he would receive two units of O negative, the blood type that was compatible with all blood.
"Any other tests, Dr. Zanth?" Chong prodded.
"Get me a CBC, coag panel, Chem seven, and a tox screen," Teddy ordered. She interpreted Dr. Chong's silence to mean that these were the right tests. The CBC would measure the red and white blood cells and the platelets in the blood. The coag panel would test his blood's ability to clot, the Chem 7 would record seven aspects of the blood chemistry, and the tox screen would test for alcohol and drugs in his blood.
Teddy helped Goldy and the paramedics lift the patient and backboard onto the bed, then the organized chaos began. First the portable CT scan. Then Goldy took vital signs while another nurse, a guy they called Welch, started cutting off his clothes. Goldy inserted an intravenous line in his right arm. Welch started a Foley catheter. The paramedic was still pumping oxygen from a bag mask.
Members of the trauma team were well versed in their duties.
Teddy was the rookie here.
What's next, what's next? Each second was loaded with decisions, jam-packed with activity. Panic teased the edge of her confidence, but she tamped it down and gloved up.
Primary survey. She needed to stabilize any immediately life-threatening injuries. First things first: ABC. Airway, Breathing, Circulation. "How's his breathing?"
The paramedic squeezing the bellows of the bag mask shook his head. "He's struggling."
"You'll have to do an emergency trache," Max offered. "With his facial injuries, his airways will be compromised. We need a trache kit," he ordered, stepping on Teddy's toes.
Max was going to drive her crazy. "I've got it," Teddy told the intern, looking over to the computer monitor behind her. "Results of the CT scan?"
"He's clear," said the radiologist, a young, bearded man Teddy had never met.
"Okay, then." Teddy removed the c-collar and examined the patient's neck for soft tissue or ligament injury that wouldn't show up in a picture. So far so good. She leaned over to assess the patient, his face tinged red from dried blood. Not a man, but a boy. A kid. A laceration near the patient's left eye oozed fresh blood into a coagulating black scab. His breaths were shallow and rapid.
"Let's move him off the backboard," she ordered. "In three, two, one." Together the staff lifted and shifted the patient onto a gurney.
Airways, airways! a voice in her head prodded Teddy. A sensor clipped onto his finger measured his oxygen level at 88 percent. Normally a person's [0.sub.2] stat measures 95 percent or better. "Oxygenation is not good," Teddy said.
"And it's falling. Don't waste your time and his," Max advised. "Order a trache kit and tube him. Do it now."
"I'll be calling the shots, Max." Teddy tried to sound authoritative but knew her agitation was slipping through. She didn't want to look to Dr. Chong for advice, felt sure the attending would cut in if Teddy chose the wrong thing, but she sure as hell didn't need a med student like Max shouting orders.
Besides, right now a trache was the last thing she wanted to do. Panic sizzled under her skin at the thought of performing a tracheotomy, an incision into the neck to insert a breathing tube into the trachea. It was surgery, damn it, and she'd learned from her surgical rotation that she had not been gifted with the "beautiful hands" her mother possessed.
"Let me take a look," Teddy said.
"Dr. Chong, you're needed at curtain two," someone called, but Teddy didn't acknowledge the interruption. She needed to focus on the patient, filter out the unnecessary.
The paramedic pumping the ambu-bag removed the breathing device, and Teddy opened the patient's mouth, her purple-gloved hands floundering on his chin for a moment before she reached into his mouth. "No foreign object blocking his airway." The bag mask went back on his mouth as she placed her stethoscope on his chest, checking both sides. "Good breath sounds. No sign of lung collapse," she reported.
Excerpted from In a Heartbeat by Rosalind Noonan Copyright © 2010 by Rosalind Noonan. Excerpted by permission.
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