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Sophie flipped the pages of Aleah’s chart as Bart continued.
“Dr. Hill said Aleah’s suffered a blunt chest trauma which is quite obvious from the bruising. He ordered the requisite round of tests.”
“Did he mention cardiac contusion?”
Bart and Donna shook their heads.
“No, but it’s my guess...” Donna winced. “Sorry. It’s not my place to—”
“Don’t apologize.” She held up her hand, though she didn’t take her eyes off the chart. “If she’s ruptured the cardiac chamber or if there’s a disruption of the heart valve that could be the cause of her dysrhythmia.”
Sophie assessed more of Aleah’s condition. Her skin was growing more pale and gray by the second. The bruises on her chest were turning a deep purple. Sophie pressed lightly on Aleah’s ribs. “She’s broken nearly every rib on the right side.”
“Dr. Hill thinks her lung may be punctured,” Bart said. “He ordered thoracentesis.” He began inserting the catheter into Aleah’s chest while Sophie went around to the other side of the bed.
Sophie stuck the earpieces of her stethoscope into her ears and listened to Aleah’s chest. It rattled like a freight train and Aleah’s breathing was labored. She was bleeding internally, but until all the tests were run, they wouldn’t know the extent of the damage.
In the meantime, they had to get her stabilized. Aleah’s chest cavity was filling with blood and fluid, which would be putting pressure on her heart and lungs. Sophie didn’t want to guess how much time they had to prevent respiratory arrest or another—this time deadly—heart attack.
First, she needed do a thorough examination. In a trauma case like this, every nanosecond counted.
Sophie glanced at Bart as he continued to work. “She’s lost a lot of blood. Transfusion?”
“It just came down from upstairs.” He nodded to the stainless steel counter where the IV bag of blood sat. Donna was rushing with her EKG cart out of the bay. “Sophie, can you hook up the plasma for me?”
Immediately, Sophie attached the plasma bag to the IV and regulated the monitor. Then she felt for Aleah’s pulse. It was almost imperceptible it was so weak.
Bart finished with the catheter and Sophie turned to him. “Her chart says that she was born in this hospital. She had coronary artery abnormalities at birth.” She paused as Bart nodded gravely. “I’ll need Dr. Barzonni to confirm, but because of the trauma to the chest wall, blood flow to her heart could be severely diminished.”
As she spoke, she saw Nate Barzonni race into the ER. Dr. Hill quickly gave him the specifics about the addict’s condition. They both hung over the patient, assessing.
Sophie had worked with Nate for over a year now, and she knew his professional moves better than anyone. Though Nate always showed an implacable expression to his staff and the patient, when he raised his left eyebrow even a fraction, it meant he was concerned. If he dipped his chin to his chest, his brain was analyzing input like a computer. The longer his head remained bowed, the more difficult the case. The minute his head snapped up, Nate had made his diagnosis and decisions on how to proceed.
While Nate’s head was still lowered, the attending nurse said, “Blood pressure is ninety over fifty. Pulse is dropping, as well. Fifty. Forty-eight. Doctor, I have no pulse!”
The addict’s heart monitor flatlined. The alarms beeped. Sophie’s head shot up. Most people thought those sounds signaled pandemonium, but to her it meant action. All hands on deck. It was the moment when everyone’s skills, talents and expertise were paramount. They were like fine-tuned mechanics in a precision Swiss watch. Each cog, each spring was essential to the whole. Except they were not marking time as a clock would. They were racing against time. Trying to beat it to save a life.
“Defibrillator!” Nate shouted. He locked eyes with Sophie and nodded abruptly, with almost a jerk.
Sophie turned to Bart. “I’m going with Dr. Barzonni. You got this?”
“Go!” Bart said and continued his efforts to stabilize her.
As Sophie rushed between the beds, her gaze shot across the room. Jack Carter was sitting ramrod straight in the bed, staring at the action around him. His eyes bore into hers. For a fleeting second she thought she could read his mind.
What about Aleah?
Icy chills shot down her spine. She nearly turned and went back, but Nate needed her. The patient did, too. Once in the bay, she sprang into action. She pulled the paddles out of the defibrillator dock and spread them with lubricating gel. She handed the paddles to Nate. Holding her breath, she stood back as he placed one paddle on the left side of the man’s heart. The other he placed to the right over the sternum.
“Clear!” Nate said loudly as the attending nurse and Dr. Hill backed away.
Sophie hit the defibrillator’s button and watched the needle on the monitor jump as the electrical shock was discharged into the dying man.
The patient’s barrel chest heaved. His back arched as it rose off the gurney with the shock and then flopped back down. He remained still. Nate listened to his heart with the stethoscope. He checked the monitor.
Still flatlined.
Dr. Hill’s eyes were filled with defeat. He spun on his heel and rushed over to Aleah.
Sophie knew Dr. Hill was desperate to save all his patients. This loss was going to hit him hard.
“Again!” Nate said and presented the paddles to Sophie for more lubrication gel. He positioned the paddles.
“Clear!”
Sophie’s eyes were wide as she depressed the defibrillator’s button again. The monitor jumped.
This time the man’s body arched only slightly.
“Epinephrine!” Nate barked, holding out his hand for the vial that Sophie knew was the last hope.
Sophie reached over to the stainless steel tray where one of the nurses had already prepared the syringe. She grabbed it and properly placed it in Nate’s hand the way she did with all his surgical instruments. They worked well together. She knew it. And she knew he knew it, too.
Nate jammed the long needle straight into the patient’s heart and depressed the plunger. Sophie watched as the lifesaving serum left the syringe and hopefully did its job.
She checked the monitor.
Flatlined.
She hit the blood pressure machine hoping it would show even the tiniest indication of life.
Nothing.
Nate put his stethoscope to the man’s chest. Sophie knew what he was hoping to find—a blip. An echo. A whisper of life.
Nate straightened. He shook his head.
“I need you in the next bay, Doctor. She’s cardiac contusion I believe, with a history of dysfunctional coronary arteries from birth,” Sophie said to Nate.
“How old?”
“Twenty-one. Punctured lung. We’re doing thoracentesis now. She’s A-fib,” Sophie explained in soft but professional tones as they walked over to where Aleah clung to life.
Sophie struggled not to glance over at Jack, but noticed he was now sitting on the side of his gurney, legs over the side, hands clenched on the edge of the bed. He looked like a man ready to bolt.
His eyes were dark with anger, pain and confusion. She saw his mouth move. She realized that the word he kept saying was “Please.”
Bart handed the catheter over to Dr. Hill. They had now siphoned over a quart of fluid from Aleah’s chest cavity.
“Sophie,” Dr. Hill said. “Take over for me. Bart, get Donna back here.”
Bart bolted from the bay.
Sophie went to work while Dr. Hill and Nate conferred. Nate listened to Aleah’s heart.
Sophie depressed the button on Aleah’s blood pressure machine, which squeezed the cuff on her upper arm. “Ninety-five over sixty.” She looked up at Nate. “She should be improving with the tube in her chest. Not getting worse.”
Sophie needed Nate’s brilliance to take the lead in Aleah’s case. The girl’s lips were turning blue. Sophie took her pulse and then her blood pressure once again to be certain. “She’s dropping.”
Suddenly, the heart monitor flatlined.
“Get me those paddles!” Nate motioned to the defibrillator at the head of the gurney.
Sophie grabbed the paddles, lubricated them and handed them to Nate, who placed them on Aleah’s chest.
Just as she’d done only minutes ago, she pressed the button to send the electrical current into Aleah’s body.
Sophie felt as if she were falling over a rushing waterfall. The sounds in the room, the alarm of the heart monitor, Dr. Hill’s voice and Nate’s commands swam together and created an undecipherable cacophony. Her motions were rote.
Sophie could almost feel Aleah’s soul leaving her body. She glanced above Aleah’s head to see if there were any odd lights in the room. Her grandmother had told her that souls exited the body through the top of the head. Probably an old wives’ tale from Italy. But something was happening here. Sophie could feel it.
Nate shocked Aleah’s body a second time, but to no avail. Again, he called for the injection of epinephrine and Sophie watched as he rammed it into Aleah’s small chest.
Aleah was completely lifeless, but Nate didn’t give up. He placed the paddles again and commanded Sophie to hit the button.
The heart monitor was still flatlined.
They’d lost. Death had won. The monitor’s long, droning alarm was telling her she hadn’t performed her duties correctly.
Dark thoughts filled her mind, putting an acrid taste in her mouth. She couldn’t find the strength to beat them back to their cave.
She felt utterly inadequate. She wished she’d continued with school. She should have become a doctor. Maybe with more knowledge she would have known how to save this young woman. Though she was certain that Aleah’s chances had been worse than the man in the next bay, and he hadn’t made it, either.
Sophie blinked slowly. Time trudged forward as though she was moving through a thick gelatin. She felt weightless and leaden simultaneously. She would have liked to sit right down on the floor and go to sleep.
“Nurse Mattuchi!” Nate shouted.
“Yes, Doctor?” Sophie snapped out of it. Whatever it was.
“Are you okay?” He pulled off his latex gloves.
She looked down at Aleah’s lifeless body. “She...”
“Never had a chance,” Nate said. “I’m surprised she lasted this long. Your assessment was on target. So was Dr. Hill’s. I also think she was anorexic.”
Sophie’s eyes flew to Aleah’s body. She understood what Dr. Barzonni was saying. The improper balance of electrolytes alone, in an anorexic person, was enough to bring on a heart attack. Aleah had a congenital heart condition, anorexia and blunt chest trauma. “I thought she was rather thin. It just didn’t register.”
“This was a massive trauma. She was hit very hard. I’ll get more about it from the cops outside. But with her birth defect and the punctured lung...” He shook his head and put his hand on her shoulder. “You did all you could.”
“I wonder...” she started.
“No,” Nate said and turned to Dr. Hill. “Eric, you and I will have a lot of paperwork. Do you know if either family is here?”
“Just the girl’s,” Bart interrupted. “We’re still searching for the John Doe’s family. He was driving without a wallet or any papers. Maybe the cops have an update.”
“I’ll talk to the police,” Dr. Hill said.
“And I’ll handle Aleah’s family,” Nate volunteered.
“We still have Mr. Carter here overnight,” Dr. Hill said. “Nurse Mattuchi, you’re on duty?”
“Yes, Doctor. I’ll see to him.”
“I want a CT scan. I want no other—” He swallowed hard. “You know what I mean.”
“I do,” she replied, softly feeling a flood of empathy for both these highly trained professionals who had lost not one, but two patients in a matter of minutes.
Sophie checked the clock. It had only been twenty-five minutes since all three victims had been brought in. She’d been assigned to Jack Carter first. She’d spent fifteen of those minutes with him. Then five minutes with Aleah before the John Doe flatlined. In the final five minutes, they’d lost both of them.
Time. Sophie had never taken time for granted. She trained hard and worked hard. She spent time with her family and helped them out whenever she could. But this absurd, needless loss of two lives shocked her to her core. Aleah had only been twenty-one. The man was in his late thirties. They both had a lot of life in front of them. They could do anything they wanted to with their time. Laugh. Love. Try to find happiness and joy...
Odd that Sophie would think of happiness at a time like this, but she did. She felt tears fill her eyes as she covered Aleah’s body, but not her face, with the sheet. Her parents would want to come in to see her. Sophie would meet with them and try to comfort them. She hoped she would find the right words to say. Good words. Or maybe no words. Maybe they would just ask her to go away.
Sophie wiped the tears off her cheeks with her fingertips. She wasn’t just crying for this young woman. She was crying for herself. She believed she’d done all she could as part of the team tonight. These were tears of self-pity. They came from a deep and lonely place inside of her. A place she seldom visited and barely acknowledged. She guessed these tears had been trying to form for a long time, but she’d told herself that crying was for weaklings. She was strong. She was able to handle just about anything, including injury, illness and death.
But happiness? That was really tough.
Sophie’s twenties were nearly behind her and she’d done little to grab happiness for herself.
She couldn’t afford to wait any longer. Tonight had shown her how lives could be snatched away in an instant. Oh, she’d begun her self-evaluations and internal makeover, but she’d only stuck the spade into the first few inches of her psyche. She had a lot of digging to do before she’d find treasure.
For the first time, though, she thought she knew what she was looking for.
Happiness.
She just hoped she recognized it when she uncovered it.
CHAPTER FOUR (#ulink_d8bc3095-50ae-5834-8a82-cebf3a7b25b0)
JACK WAITED ON teetering legs for some definitive word about Aleah. He’d heard the commotion. He’d heard the second round of instructions for a defibrillator. He’d heard the second heart monitor announce the dreaded flatline bleep, but he couldn’t see around the heads of the doctors and nurses. He watched people going in and racing out. Then suddenly, they all stopped moving and became still.
Aleah was dead.
Jack’s mouth had gone dry and his blood had turned cold. It had been a long time since he’d experienced death that was close to him. Not since his father died. He’d mourned him deeply, but his father had battled cancer for over two years. The family had expected him to die. He’d been prepared.
Jack battled the biting tears and thunder in his chest. He’d liked being a mentor to Aleah. She and Owen were only a decade or so younger than he, but right now, he felt ancient.
All his concerns from earlier in the day came back to him suddenly: his banter with his sister and brother-in-law, his anxiety over the White Sox’s loss to the Yankees. Even the ambitions he’d been mulling over after the seminar seemed trivial compared to what he was facing now. He would give everything he had to save his sweet, unsuspecting assistant from death.
