“Ellie,” Rob said. “Grab that syringe of atropine and inject a milligram. That’s one cc.
Hurry
.”
Julie’s pulse had dwindled to twenty-one. She was seconds away from flat-lining.
The nurse snatched the labeled syringe off the drug cart and aimed the needle at the injection port. Her hands shook so badly she almost dropped the syringe. Then she got it and plungered the drug home.
Rob’s gaze was glued to the bank of monitors. Alarms shrieked in a maddening chorus. Julie’s BP was now fifty-three over thirty.
Ward said, “Talk to me, Rob.”
“Just finish up in there, Bill—
fast
.”
Finally the atropine began doing its thing. Julie’s pulse crept up to forty, then spiked to a hundred and twenty-eight.
“The blood’s pretty dark down here,” Ward said.
Rob fought the panic that tried to slither up his throat. He cranked the oxygen, increased his rate of ventilation...then he noticed Julie’s temperature. It was a hundred and one degrees now, three degrees higher than it had been only five minutes ago.
“Jesus Christ,” Rob said, his guts turning to mud again. “We’ve got a crisis here.”
* * *
...a crisis here...a crisisssss...
The words buzzed and echoed in Julie’s ears. It was a nightmare.
She could see Dr. Hardie through her fluttering eyelids, could read the fear in his eyes.
But you promised...
His hand was on her face, clamping a smelly rubber mask over her nose and mouth; she could feel air squeezing out around its edges, but none of it was going into her lungs. Her chest felt as if an enormous rubber band had been cinched around it.
She was suffocating.
Hot...so hot...
(tracheostomy)
This new word joined the rising cacophony in Julie’s ears, she knew what it meant, and she sent a fierce command to her body:
Get up! Get away!
They’re going to cut your throat!
But she couldn’t move a muscle.
* * *
Rob said, “Bill, she’s stiff as a board. I can’t ventilate her and there’s no way I’m going to be able to intubate her. You’re going to have to trake her.”
Bill nodded. “Ellie, get me a tracheostomy tray, pronto. And call a code blue.” He looked at Rob. “I’ll leave her belly open. That way we can cool her intra-abdominally.”
The code was called over the PA system. Within seconds other staff members began filing into the room, looking to Rob for instruction.
“Harry,” Rob said to a senior anesthesiologist. “Start drawing up the Dantrolene.” Dantrolene is the first line of defense in an MH crisis. To a nurse he said, “Judy, grab a few liters of cold saline and change that IV.” The nurse responded without hesitation, dropping the contaminated bag into the trash, inadvertently discarding the evidence. To another physician Rob said, “Karl, find a nurse and get her started on a central line tray. Bill, how’s that trake coming?”
“Don’t worry about me,” Ward said. “Just keep trying to ventilate her.”
“I hear you,” Rob said. His mind was a buzzing whirlwind. He was desperately afraid he was going to lose this girl.
The room around him teetered on the edge of chaos, people jostling for position, shouted commands going unheeded, instruments clattering to the floor. He thought he might pass out.
Come on, kid.
It was a silent prayer.
Come on, come on, come on...
* * *
Her lungs were on fire, her muscles bunched into excruciating knots—but she was fully conscious, completely aware.
“Scalpel,” the surgeon said.
Please help me...
The knife sunk into the tender flesh of Julie’s neck and her nerve endings exploded. The tip of her tongue was between her teeth and she bit into it, the raw, coppery taste of blood flooding her mouth.
The knife was cutting, and now cold steel clamps grasped the wound edges and wrenched them apart, making them gape. She could feel it, oh God she could
feel
it, the pain, blood pooling in the soft hollow of her throat—and now they were forcing something
in
, it felt like a hard plastic hook, twisting it, jamming it into her cut throat—
Julie fainted dead away.
* * *
Rob connected the tracheostomy tube to the anesthetic circuit while Ward was still sewing it into place. He set the ventilator at eighteen breaths a minute, then placed the bell of his stethoscope over Julie’s lung fields, listening for the passage of air. It was there, but pitifully diminished. The muscle rigidity was impeding the inflation of her lungs.
Rob opened Julie’s left eye. The pupil was dilated, unperturbed by the light. He let the lid slide shut.
The surgical drapes were stripped away and now Julie lay naked under the glaring spots. Even her intestines were exposed, turning black inside the wound. Her body temperature had soared to a hundred and six degrees. The oscilloscope showed ventricular tachycardia. Alarms shrilled accusingly.
I’m losing her
, Rob thought.
God help me, I’m losing her...
* * *
Two new IVs had been started and cold fluids poured in. The scrub nurse bathed Julie’s exposed viscera with icy saline. Another performed closed chest massage. A freezing, water-filled blanket had been snugged around her and still her temperature climbed. It was a hundred and eight degrees now, incompatible with life. Heat came off her in waves. There was no pulse.
Every face in the room was blank.
They’re giving up
, Rob thought, sick to the depths of his soul. The next step was a drastic one, a last ditch maneuver, and everyone was waiting for his signal.
“Rob,” Ward urged.
“I know,” Rob said, verging on tears. He was reaching the outer marker of control. He took a deep breath and gave the order. “Okay. Open her chest. There’s no other way.”
“Knife,” the surgeon said, and the scrub nurse snapped a scalpel into his palm.
Bill Ward was not a religious man; he had no time for it. But as he pressed the scalpel into the innocent flesh of Julie’s chest he recited a silent prayer.
The blood that leaked from the incision was the color of plum juice, almost black. It seeped into the wound without vigor.
Rob looked away.
“Bone cutters,” Ward said.
The nurse handed him a bulky instrument that looked like a felon’s bolt cutter. He used it to snap through the struts of Julie’s ribs to the left of her sternum. Then he exchanged the cutters for a retractor, which he fitted to the margins of the incision. He cranked a lever and the chest cavity yawned open.
Ward took Julie’s exposed heart in his hands and squeezed. It was like squeezing a small dead animal, baked by a desert sun. He took his hands back out.
Rob said, “Why are you stopping?”
“I’m sorry,” Bill said, his soft eyes fixed on Rob’s. “But it’s over.”
The temperature monitor had joined the chorus of alarms. It read a hundred and eight point six degrees now. Julie’s body was hot to the touch.
“No,” Rob said. “She’s just a kid. I promised her...”
The surgeon only shook his head.
Tears flooded Rob’s eyes. His shock was total.
One by one the staff members left the room. Bill Ward was the last to go before Rob. He peeled off his bloody gloves and placed a hand on Rob’s shoulder. Rob flinched under his touch.
“Come on, chum,” Ward said, “let’s get out of here.”
Rob shook his head. He was in a daze. “I can’t leave her like this.” He turned to his drug cart and began arranging the syringes. “It’s a mess in here...”
“Come on,” Bill said. “We have to leave everything as it is. It’s a coroner’s case now. Let it go, Rob. You did all you could.”
Rob’s promise to Julie came whirling back at him:
If you trust me, you will not die.
“Liar,” he said, weeping openly now.
“Liar...”
“Please, Rob. Come on.”
Rob shook his head. “You go ahead. I’ll be right out.”
Bill nodded and turned away. He did not look back. What he was leaving behind was the saddest sight in medicine, one he’d seen too often before.
Alone in the room, Rob touched Julie’s cheek. Her complexion was still flushed, giving the impression of high summer color. If you ignored the blood that had spattered her face from the mutilating bone cutters, you could almost imagine she was sleeping.
“I’m sorry, sweetheart,” Rob whispered, dabbing the blood from her cheeks with a square of gauze. “So sorry...”
He turned the ventilator off and left the room by the back door. He wanted to avoid the central corridor, where he knew they would all be waiting. He wanted to avoid their eyes.
He crossed the hallway to the anesthesia staff office and locked himself inside.
* * *
In the darkened observation booth above suite 5, Julie’s killer looked down on her savaged corpse through the sloping Plexiglas panels, his gaze impassive and unblinking.
It was Friday, June 6, 2007.
JENNY FALLON PRESSED A SELECTION button on the old Wurlitzer jukebox. Assorted clicks and whirs followed, then a tray popped out of the vertical stack and the turntable rose to meet it, lifting the vintage 78 from its aluminum ring. The tone arm settled on the record’s edge and Little Richard’s voice came belting out of the speaker. Jenny and her adopted daughter, Kim, sang along.
“Long tall Sally, she’s—built for speed, she got—everything that Uncle John need...”
Laughing and singing, the girls began to jive in Jenny’s plant-ringed solarium. Peach, Jenny’s cat, lounging in an oblong of sunlight, observed them with lidded indifference.
“That’s it, kiddo,” Jenny said. “Let it
all
hang out.”
Kim smiled happily, for the moment unaware of her mouthful of braces, her chunky figure or her painful shyness, all the things that made her life so difficult outside the circle of her mother’s love. Jenny cherished these moments and often wished her husband, Jack, could share in them, too.
Kim swooped into a dip and Jenny almost dropped her. Laughing, Kim said, “C’mon, Mom. Gotta stay alert.”
Jenny countered with a dip of her own and the two of them went down in a giggling heap. Jenny’s hands went to her pregnant abdomen, but her landing was soft, Kim’s stout legs cushioning her fall.
The Little Richard tune ended and the solarium was quiet again.
“Another one,” Kim said. “Jerry Lee this time.”
Jenny got up and studied the selection windows. The jukebox, a beautifully restored model 1015, was one of numerous treasures Jenny had discovered in the basement after buying the house. Before his death the previous owner had been in the amusements business—pinball machines, jukeboxes, slot machines—and had stored all sorts of relics from the forties and fifties in a dusty corner of what was originally intended as a bomb shelter. Jack now used the area as a target range for his extensive collection of handguns. The man’s widow told Jenny to keep whatever she wanted from down there and have a yard sale with the rest. Jenny had done exactly that, hanging onto the Wurlitzer and about three hundred 78 rpm records and selling the rest. She’d made enough to have the 1015 professionally restored.
Jenny selected Jerry Lee’s “High School Confidential”. As the needle hit the record the telephone rang. Jenny noted Kim’s complete lack of reaction and was dismayed by it, aware that with most fourteen year old girls you ran the risk of losing an arm trying to get to a ringing phone ahead of them. She picked it up in the adjacent living room. It was her husband.
She said, “Hi, Jack, can you hold on a sec?” and covered the mouthpiece with her hand. To Kim she said, “It’s your father,” and waited for her to turn down the music.
Kim rushed to the jukebox and hit the reject button, her happy, be-bopping smile dissolving so abruptly Jenny wanted to cry. She could actually see her little girl withdrawing into a thick, dull shell. Her face was a careful blank and she stood rigid by the silenced Wurlitzer, fearful of her father’s disapproval even over the phone.
“Listen,” Jack said, all business. “Will and I are running late. Rob Hardie had an MH death this afternoon and I’ve got to stick around until the coroner gets through with her preliminaries.” As head of the anesthesia department it was Jack’s job to coordinate all such investigations.
“Oh, no,” Jenny said. “How’s Rob taking it?”
“Not well. The patient was only seventeen.”
“That’s awful,” Jenny said. “Is there anything we can do? Should we invite him up to the cottage for the weekend?”
“I already talked to him,” Jack said. “He wants to just lay low for a couple days. He had a talk with the kid’s parents and I understand it was a pretty bad scene. The girl’s mother slapped him, bloodied his nose. I suggested he avoid spending the weekend alone and he agreed. Said he already had plans to spend it with his girlfriend.”
“Okay, then. How long do you think you’ll be?”
“Couple hours, tops. All packed and ready?”
Jenny knew she was, but the question induced a brief, fretful uncertainty. “Yep, we’re all set,” she said. “Kim’s heading for the Goodmans’ at six.” The plan was for Kim to spend the weekend with her friend, Tracy Goodman. “She was hoping to see you before we left—”
“Jen, I’ve got to go. Please be ready.”
“Okay, Jack. ’Bye.”
Jenny returned to the solarium, hoping to recapture the mood with her daughter; but Kim was slumped in a rattan chair with the cat in her lap, staring out sullenly at the yard, her iPod headphones socked into her ears.
* * *
At five-thirty that afternoon Dr. Jack Fallon spoke with the coroner, Dr. Ellen Kolb, over the phone. Kolb said she’d completed her preliminaries and suggested that she and Jack meet with Rob Hardie to hear his version of the afternoon’s tragic events. Jack agreed, setting the meeting for a quarter to six in his office.
He’d just hung up when the department’s deputy chief, Will Armstrong, came into the office. Will was a big man of thirty-eight with a thick crop of prematurely silver hair. Jack offered him a seat, but Will waved him off.
“So,” Will said, “are we getting out of here on time?” The men had plans to spend the weekend at the Fallons’ Gatineau Hills cottage with their wives and a few other guests, one of whom was a potential new recruit, a top gun intensivist from Atlanta.