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By Patricia Gussin
Oceanview PublishingCopyright © 2007 Patricia Gussin
All rights reserved.
Dr. Laura Nelson bolted through the swinging doors slowing for an instant to thrust outstretched arms into a green sterile gown. Twenty minutes earlier she'd flipped off her bedside reading light and slipped into a deep sleep, but now the familiar surge of adrenaline put all her senses on alert.
"Status?" An order, not a question as latex gloves snapped into place.
"Motor vehicle trauma. Ten-year-old kid." The quaver in the macho chief resident's voice did not bode well. "Truck rammed a car at high speed."
Laura pivoted toward the small patient centered under the glare of the operating room lights. What she saw made her heart quicken. Not waiting for the nurse to tie the back of her gown, Laura rushed to the central position at the surgical table.
The ashen faces of her team told her that the child was in dire shape. Although not a pediatric surgeon per se, Laura was a thoracic specialist and she was the first surgeon called for all major chest emergencies.
"She was thrown from the car. Multiple injuries. Rest of the family —"
"Pressure's falling fast." The gray-haired anesthesiologist at the head of the table interrupted.
Until she'd arrived, the anesthesiologist had been in charge. Surprised at the tremor in his voice, she noticed how frail he looked hunched behind the bank of machines.
In the harsh glare of overhead lights, Laura assessed the small form strapped onto the narrow table. She focused for only a minisecond on the exposed patch of mottled skin surrounded by green surgical drapes. At least the team had the child prepped and ready to go.
"No pressure. Can't keep up with the blood loss." The anesthesiologist spoke urgently from the head of the table. "We're transfusing, but —"
Then Roxanne, the scrub nurse, motioned toward the foot of the table. What Laura saw there made her gasp.
"The drainage bottle – full? That's way too much blood for a child this small. Holy shit, where is it coming from?"
"Two chest tubes in," the anesthesiologist reported. "Neck's immobilized, but the spinal cord's transected at C-6. I'm ventilating her. I'm ready."
"We're going in now."
Roxanne slapped the scalpel into her hand, and with no hesitation Laura excised the child's thin chest straight down the middle. Urgently the surgical team dissected tissue while swabbing the operative field with gauze patches as Laura quickly cut through the sternum with a scissors-like instrument, then pushed aside the tissues that separate the sternum from the heart.
The room was silent except for the rhythmic heaves of the ventilator and whooshing of gases from the canisters. Nobody's favorite music blared. There was no bantering. Just quiet until Laura spoke, "Bright red blood – got to be arterial – pulsatile, but not spurting." Her voice sounded steady, but her heart was pounding. Anger started to creep into her consciousness, but she shoved it back. She had to stay focused. "Have to isolate the source and patch it. I just hope there's time for this. Pressure?"
"None." The voice at the head of the table faltered as the anesthesiologist cleared his throat. "And the EKG's erratic."
"Did anybody detect evidence of a penetrating injury?" Laura asked. Hemostat in one hand and forceps in the other, Laura tried to find her way in the bloody surgical field. She had to find the source of this catastrophic bleeding. She could feel beads of perspiration forming on her forehead. Something unusual was happening here, and she couldn't find it in all this blood.
A young resident from the emergency room stood behind the surgical team, observing. Taking a slight step forward, he responded in a barely audible tone. "Dr. Nelson, when we examined the patient in the ER, she had multiple contusions and lacerations, but then her neck was broken. I mean, we got cervical spine X-rays and all. It wasn't until we got the chest X-ray that we did a thoracentesis. We found blood. We put in chest tubes, but —"
"Wrong priority." Laura snapped, shaking her head. "Thoracic trauma always takes precedence over neuro or orthopedic injuries. I'll bet there's something sharp in there, and deep."
"Laura, I can't keep up with the blood loss," the anesthesiologist announced. "If there's something to fix in there, now's the time."
Amid her crisp orders, the surgical team explored the pleural space that surrounds the lung tissue. Soon, Laura's hands were deep inside the chest, but there was so much blood she couldn't examine the major vessels of the heart. New blood was pooling as fast as the team could remove it, hampering her methodical search for the point of bleeding. When her hemostat struck something hard, she stiffened.
"More suction, please. There it is." She paused. "A shard of glass. Penetrating the intrapericardial portion of the ascending aorta."
"The aorta, Dr. Nelson?" a surgical resident questioned. "Wouldn't she have bled out by now?"
"Consider the tamponade. Pressure within the pericardial sac can plug the hole at least temporarily. But it's broken through. Roxanne, we need an aortic graft."
"Right here," the nurse had the package already in hand.
"We'll take our best shot. What's her name?" Laura asked softly.
Laura sighed. "Hang in there, Wendy."
"We're losing her, Laura. Flat line." The tone urgent now as the anesthesiologist peered over the partition into the operating field.
"But we're so close." Laura held up her hand for the Teflon patch that would be sewn over the hole when the glass was removed.
"Flat line," repeated the anesthesiologist. "I'm giving epinephrine, but —"
"Just give me the patch," ordered Laura, ignoring him. Without looking up, she jerked her head in the direction of the senior resident stationed across from her. "You pull out the piece of glass. I'll slap this on and secure it while you suture it into place."
"No response to the epi, Laura." The grim tone spoke defeat. "Total flat line."
"Sutures ready, Dr. Nelson," said Roxanne. Despite the fact that they were best friends, Roxanne Musing always addressed Laura as "doctor" during surgery.
"On the count of three," Laura said. The resident angled the hemostat while an intern retracted the child's ribs to give the team maximum working space within the small chest cavity.
Laura waited for the brief interlude between respirator heaves and started her count. She anticipated a gush of blood. There was none. Instead, a piece of glass the size of a roofing nail was extracted from the large blood vessel leading to the heart. A slow flow of blood mixed with soft clots began seeping out, which made Laura hesitate momentarily before applying the patch out of sheer desperation. But it was too late. The child had exsanguinated. How could that have happened in a major trauma hospital like City Hospital?
"It's over," she said. "We just lost a ten-year-old kid."
Laura looked at the stricken expression on the ER resident's chubby face.
"Why didn't the ER call me in sooner?" she asked, ripping off her gloves. "The accident happened two and a half hours ago for God's sake. I only live ten minutes from here. This child should not have died."
"The severed spinal cord —" he began. "We tried."
"We should've diagnosed pericardial tamponade, and we should've known by the blood from the chest tubes that there was massive intrathoracic bleeding." Laura tossed her gloves on the instrument table in disgust. "The ABC's of trauma," she continued, "dammit. 'C' means circulation."
The team stood motionless amid the mingled odors of blood and gases and sweat. Finally the anesthesiologist started writing in his clipboard. "Time of death: 1:45 a.m., June 3, 1978."
"That poor child." Laura blinked away a lone tear. "Shouldn't have happened."
Laura and Roxanne had waited for the orderly to remove the body. A meaningless act of humanity, but Laura felt they owed the child that much and that Roxanne would feel that way too.
"I know. Though she would've been paralyzed if she'd lived. Tough life for a kid."
Shedding their surgical gowns, the two women headed for the doctor's lounge.
"We have got to do a better job here at trauma management," Laura said, letting her shoulders slouch and averting her eyes to the ground. "When I was a med student in Detroit, we developed the fastest, most comprehensive trauma response in the country. Maybe the world —" Laura stopped speaking abruptly. What was this "we"? She'd been a mere student. No she hadn't played a role, not personally.
Roxanne put an arm around Laura's shoulder. "Hey, two thirty in the morning is no time to solve all the problems of the world."
"Wendy Ruiz was the same age as my twins. My God, the Ruizes were coming back from Disney. I took the kids there just last week. I-4, same route. I mean, it could have been us."
Roxanne frowned. "It's late. Why don't you head on home?"
"One cup of tea to unwind," said Laura as they stepped into the empty lounge. "After I pop out my contacts — I've had them in way too long. And one of your mother's chocolate chip cookies would help right now."
Roxanne nodded, a complicit smile on her face.
At thirty-four, Laura Nelson was already a respected thoracic surgeon in the Tampa Bay area. In the operating room, she exuded self-confidence without the theatrical outbursts made prototypical by her male colleagues. Outside of it, her optimism and energy made her popular with administrators and patients alike. But despite admiring colleagues, Laura had no real friends. Roxanne was the only exception, but even with Roxanne she could not share confidences. Not that she didn't long for a confidante, but she had unspeakable secrets, dangerous secrets. Besides, Roxanne had never been married. How could she even begin to understand the complexities that underpinned her relationship with Steve.
"I'll make the tea," Roxanne offered. Placing the Ruiz chart on the coffee table, she picked up the kettle from the small stove in the doctor's lounge. "I've only been on since three this afternoon, so that makes me the fresher of the two of us walking zombies."
"Thanks, Roxie." Laura sank into one of the vinyl chairs. "I've got to speak to the family before I leave."
Frowning again, Roxanne sat in the chair across from her. "I hate to tell you this, but that child's mother and an eight-month-old baby girl were DOA. The father's still in the OR with major orthopedic and abdominal injuries. Two of the other kids are in surgery, and a five-year-old boy with only mild contusions is in the ER. He's ready for discharge if they could find a relative."
"So this man lost his wife, his baby, and little girl," Laura sighed deeply. "This part will never — it just gets harder."
Roxanne gestured to the chart. "Listen, why don't you just write the operative note? The bad news can wait a bit, you know? Mr. Ruiz was still in surgery when we started the case, so at best he'll be groggy right now. I'm doing a double, so I'll check in with him and cover for you until you get in for rounds tomorrow."
"Thanks, Rox. You know the worst part —"
"You did everything you could."
Laura signed the necessary paperwork. Sipping her tea and munching her third cookie, she changed into white slacks and a pale yellow shirt, pulling her hair quickly into a ponytail. Checking her watch, it was now after three.
"Steve should be home by now. I called him at the station before I came in to let him know about the accident — that I wouldn't be home until morning."
Roxanne sighed. "Your life is a logistical nightmare."
"That it is," said Laura.
At Channel Eight News, Steve Nelson loosened his silk maroon tie beneath the hot studio lights as the crew closed down the set.
"'Stagflation' — Jimmy Carter sounds more boring every day. Slow night for national. Good thing we got the tip on the Ruiz crash. Local stuff is always good for ratings, right, George?"
George Granger, the burly director of Nightly News at Eleven, scowled at Steve. "Goddamn tragedy is what it is."
"Drunk driver wipes out a whole family in one split second," Kim Connor, Steve's coanchor, added from her corner of the set. Dabbing a sheen of sweat from her face, Kim fingered the bangs of her short black hair. At thirty-two, she was the younger, albeit senior, member of the studio anchor team. A Tampa Bay celebrity known for her Latin beauty and sharp wit, Kim's dark eyes sparkled off screen, yet when reporting the litany of human disasters that made up the news, those same eyes reflected a depth of sincerity that had endeared her to her audience. Recently, however, Kim had seemed disinterested, even apathetic, and both Steve and George were concerned.
"Yes, it's very sad," Steve went on, tugging off his navy blue blazer.
Steve's blonde wavy hair and deep blue eyes complemented his partner's more flamboyant looks. While Kim was popular with just about everyone – particularly the masculine gender — Steve was popular with the more senior Tampa Bay audience. Handsome in an all-American kind of way, he was conservative in his dress and demeanor, and less passionate, more predictable than Kim. George had moved Steve up from field reporter last year, gambling that the two would make a good team. Kim's dynamism and experience would carry Steve's adequate, ultimately mediocre, performance. As it turned out, Steve's ego had far overshadowed his talent.
"Speaking of ratings," George added, "I don't have to tell you two about the ratings. Still falling."
"We'll get 'em back." Steve stood at the mirror, smoothing his hair. "We were number one just a couple of months ago, remember?"
"Nobody remembers in this business. Management wants to know what's happening now," George persisted. He was a behind-the-scenes pro who had worked his way up from location producer to news room director. "They're on my ass. Is it the in-house coverage? The editors? The field coverage?" With his two index fingers, he pointed straight at Steve. "Is it the anchors?"
"C'mon, George." Steve glanced across the table to Kim, but she remained silent, sorting papers in her briefcase. "We've both got plenty of fans all over the Tampa Bay area."
George shrugged. "It's late. I'm headed to my place on Longboat Key for the weekend." He pointed at Steve once more. "We'll talk about it Monday, when we're fresh. Kimmie over there looks beat. Lemme tell you though, we don't get the ratings up, my ass is in a sling, which means —"
"Got it." Steve cut him off. "Maybe I can get the inside scoop on the Ruiz family from my wife. She's operating on one of them right now."
George waved a hand. "That'll be old news by tomorrow night. Have her give me a call at the condo if she has anything special, but don't bug her. And you," he turned toward Kim, "you get some rest. If I didn't know you better, I'd think you were someone else."
Kim responded with a thin smile as George slung his sports jacket over his shoulder and walked out of the studio.
"You know, Kimmie, the boss has a point." Steve hovered over Kim's desk, hands in his pockets. "You weren't at the top of your game tonight."
Kim finally looked up from her briefcase. "So the bad ratings are all on me? Up yours, Nelson." She slammed her case shut and gave him a universal gesture.
"Hey, I didn't mean that." Steve plunked down on the chair beside her and gave her hand a quick squeeze. The studio lights had dimmed as technicians covered the cameras and adjusted the set for the morning news, but Steve still noticed the bronze smudges on the tissue Kim had used. She always wore heavy makeup on the air, but tonight it seemed even thicker. He tried to look more closely at her face and thought he could make out a definite bruise across the left cheek. Her eyes looked okay, but she was also wearing more eye makeup than usual and, for the first time, he questioned the uncharacteristic cut of her clothing. Kim was known for her low, teasing necklines, intended to highlight her tanned shoulders and to expose just enough cleavage to invite those head-turning stares. Tonight she wore a red turtleneck cotton sweater over a black knit skirt.
"Kim, will you tell me what's going on?"
"I don't know what you're talking about."
"Look at you." He traced a finger over her cheek and Kim flinched, pulling away. "Come on, we've been working together for more than a year. Those are bruises, goddamn it."
Excerpted from Twisted Justice by Patricia Gussin. Copyright © 2007 Patricia Gussin. Excerpted by permission of Oceanview Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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