Urgent Care (37 page)

“My resident, Dr. Richards—”

“Roberts,” Amanda corrected without thinking, though Dr. Koenig didn’t seem to notice.

“—was telling me about your case. Tell me, what made you think of teratoma-induced encephalitis?”

“It was a case report I read while on your service. You had asked me to investigate the number of ways a benign teratoma wasn’t benign. Unfortunately that case report is the only one I’ve found so far.”

“So far.” He leaned back, finally looking at her, smiled, pulled open a file drawer, and tossed a handful of files onto his desk. “I’ve the largest unpublished collection of cases in the country. Maybe even the world.”

Amanda leafed through the files. All women in comas, all with incidental finding of teratomas, all revived “miraculously” when their teratomas were removed. The cases came from all over the country.

“My colleagues know it’s an interest of mine,” Dr. Koenig said. “I’ve been waiting for years to find a patient of my own. And then I can finally publish definitively.” He stood and opened the door. “Hurry along, Ms. Mason. Our patient is waiting for us to make medical history.”

 

 

NORA WAS MORE THAN READY TO LEAVE THE PICU by the time Lydia arrived and told her about finding the rape kit in Jim’s locker. They began walking down the hall, hoping to grab lunch from the cafeteria.

“So you think Jim was telling the truth?”

Lydia hesitated. “Hate to say it, but yes.”

Nora paused as they approached the corridor leading to the surgical call rooms.

Lydia stopped as well, her gaze zeroing in on the trauma resident’s room. “You should probably go talk to him.”

“I can’t—it will just end up hurting both of us. Again.”

“Ever stop to think that maybe he’s worth a little pain? You’ve sure put him through hell these past few months, refusing to listen to anything he had to say.”

Nora’s shoulders hunched. She knew shutting Seth out of her life, especially right now, was the best thing. The safest thing. But suddenly,
safe
no longer seemed as important as it used to. The feelings she and Seth had shared last night—those seemed much more vital.

“You’re right.”

Seth’s room was the first door. She knocked but didn’t hear him answer. Then came the sound of a thud, like someone had knocked something over. “Seth? It’s me.”

She knocked on the door again, then opened it without waiting for a response.

The smell slapped at Nora. She jerked back, her pulse stampeding. The copper scent of blood fought with the sickly sweet smell of fresh spray paint.

Blood mixed with neon colors in a kaleidoscope of carnage. There was blood on the floor, blood on the walls, blood on the bed, blood still bubbling from Seth’s slit throat.

Saturday, 1:47 P.M.

SETH WAS SPRAWLED ON THE BED FACE UP, SPRAYS of blood coloring his pale blue scrubs. His eyes were open, staring unseeing, one hand pressed to his throat, the other flung out to the side as if reaching for a lifeline.

Above his head, in fresh angry orange spray paint splat tered with blood over the top of it was written
MINE
.

Nora stood frozen at the doorway, hand to her mouth, trying to blink away the scene as a nightmare. But it was real. Her breath coming in gasps, she took a step forward.

From the blood spatter, it was clear there’d been a struggle. Blood covered Seth’s hands, but Nora couldn’t see any other wounds as she leaped to help Lydia, who was applying pressure to the gaping neck wound.

“Airway’s clear.” Inside her mind she was screaming Seth’s name, ordering him to
live
, goddamn it! But panic wasn’t going to save him, so she pushed all that aside.

“Pulse faint, but it’s there.” Lydia grabbed a pillowcase to use as a pressure dressing. “Left carotid and jugular lacerated, maybe the trachea as well. The right side looks okay. He needs to get to the OR. Now.”

Nora ran from the room. The OR was only two doors down, although it was almost deserted on a weekend afternoon with no scheduled surgeries. She barged through the doors marked AUTHORIZED PERSONNEL ONLY, STERILE ATTIRE REQUIRED and raced into the nearest room that had its lights on. An orthopedic surgeon looked up in annoyance, reluctantly turning his saw off so that she could be heard.

“Someone slit Seth Cochran’s throat,” she told the scrub nurse as she grabbed supplies from the anesthesia cart. “Down the hall in the call rooms. Get a stretcher. You”—she pulled on an anesthesiologist’s arm, the man looking as bewildered as if he’d just woken from a coma himself—“come with me. Now.”

Minutes later, she and Lydia, the anesthesiologist, and two surgical nurses were wheeling Seth’s body into a vacant OR. It was a scene eerily reminiscent of Karen’s failed resuscitation, made worse as a scrub nurse pushed Nora from the room, gesturing at her bloody street clothes.

“We’ve got him,” she said, closing the door.

Her fists pressed against the window, Nora watched as Lydia barked commands, racing to save Seth.

“Hang on,” she whispered, her voice choked.

Diana DeFalco, the trauma attending, ran past her, banging through the door as she snatched up clean gloves, not stopping to scrub. Soon more people crowded around the small window in the door, jostling Nora and asking what happened.

She didn’t answer, despite several pointed remarks that somehow this was her fault. Lydia glanced up and gave her a quick, reassuring nod before going back to work.

“Hey, Nora! Nora Halloran!” A man’s voice called her name. The crowd parted long enough for her to see a civilian at the entrance to the OR. Pete Sandusky. Complete with camera. The flash flared several times in a row, Nora reflexively raising her bloodstained hands to shield her eyes.

“Someone get him out of here.” Glen Bakker latched on to Pete’s shoulder and propelled him into the arms of one of his security guards. “Anyone see anything?” he asked the assorted surgical staff.

They all shook their heads, looked away. Glen frowned at Nora, appraising her as if she were a victim rather than a witness.

She wasn’t a victim. Breathing deep, she blinked away the veils of gray that shadowed her vision, fighting against panic. Glen took her hand and led her away. “Nora, what happened?”

 

 

“WHAT HAVE WE GOT?” DIANA DEFALCO ASKED as she rushed into the OR.

Lydia looked up from where she was holding pressure on the left side of Seth’s neck. “Zones one and two penetrating neck injury,” she told the trauma surgeon. “Carotid nicked at the very least and the external jugular as well. No crepitus and airway seems intact. He was bradycardic, but heart rate is up after a fluid bolus.”

“Don’t overload him,” Diana said. “I don’t want that blood pressure above seventy. Get the cell saver hooked up to suction and tell the blood bank to wake up. I need six units O neg up here now.”

“He’s moving air well,” the anesthesiologist said.

“Get him on a pulse ox and monitor; let’s make sure we’re getting oxygen to his brain,” Lydia ordered.

“I’ve got it, Dr. Fiore,” Diana said in a low tone. Not con frontational, just reminding Lydia that there was a reason why there was only ever one command doc in a trauma.

Lydia wanted to snap at the surgeon but swallowed back her adrenaline-fueled retort. “He was unconscious when we found him, barely had a pulse, so who knows how long he was down.”

A security guard poked his head in the door, holding a mask to his face. “We’re evacuating the operating rooms. You all will need to get out.”

“Hell you are,” Diana told him, not yelling like most surgeons would, simply stating a fact. “Post a security guard outside all the ORs where there are still cases going and search the others.”

“But, lady, Mr. Tillman said—”

Diana looked up from where she was exploring the wound between Lydia’s fingers. “I’m no lady, I’m a surgeon. You tell Mr. Tillman if he doesn’t post those guards and guarantee my staff’s safety I’ll make sure JCAHO hears of it and that this hospital loses its trauma certification.”

The guard frowned, shook his head, and left. A few minutes later, another took his place but simply stood outside the door, watching.

“Okay,” Diana said. “Let’s get him prepped. Include his legs in case I need a saphenous graft from there. Lydia, once I scrub, I’m going to come back and relieve you. And we’ll get this under control.”

 

 

AFTER RETURNING TANK TO THE PICU AND Narolie’s side, Gina realized that her dress for the gala was at Jerry’s. No better time, she thought, walking out to her car. He’d be gone for the day, working; she could clean out all her stuff, make it easier on both of them.

She barely noticed the snow falling; already there was a few inches on the ground, making the roads slick as she drove over to Jerry’s East Liberty apartment. She knocked and got no answer, then turned her key in the lock and opened the door. Before she could finish the movement, the door flew from her hand and she was yanked inside.

In a whirlwind of motion, her legs were swept from under her. Her breath whooshed out as she slammed against the floor. Then a man’s weight pinned her down, one hand over her mouth.

Stunned, she couldn’t even think to fight back. The blitz attack left her helpless, unable to think of more than her next breath.

“Make a sound and you’re dead,” a man’s voice rasped into her ear.

Fear jolted through her. It was the rapist, the man who had killed Karen. He was going to rape her, cut her like he had Karen. A primal instinct for survival propelled her to squirm beneath his weight, fighting to break free.

It was useless. The man knew what he was doing, enough to hold her still with little effort. She relented, stopped struggling, a small whimper escaping her throat.

She was going to die.

The man ground her face into the doormat. “Hold still.”

She complied. The sound of tape tearing filled her ears. He wrenched her arms behind her and with cruel efficiency bound her wrists. Then he rolled her over, one hand still over her mouth.

They were face to face. He straddled her, his weight crushing her. The other hand now held a knife.

She couldn’t look away from the knife. It filled her vision.

“If you scream, I’ll kill you.” His tone was casual, as if this were an everyday affair for him. “Do you understand?”

She nodded.

“Where’s your boyfriend?” he asked, removing his hand but keeping it near enough to squelch any shouts for help.

“I don’t know.” Her mouth was dry enough that it took her twice the effort to produce the choked whisper.

The knife hadn’t wavered, but her vision finally expanded enough for her to get a good look at him. He wasn’t wearing a mask or any attempt at disguise. Her insides chilled as she realized this was a death sentence. If he was going to let her live, he’d hide his face.

He was a white guy, late twenties, with sharp, hawkish features and a cruel twist to his mouth. Or maybe it was the knife and the empty gaze that made her think that. His eyes were dark brown, as was his hair, but his gaze was a barren void. No hope there.

Especially when she realized that she’d seen him before. Just last night.

The delivery man with the flowers. He must have been following her, knew about her and Jerry, just as he’d followed Karen and Nora. Panic ricocheted through her, and she bucked and strained, fighting for her life.

But it was no use. She was helpless.

 

 

AMANDA FOLLOWED DR. KOENIG DOWN THE STAIRS from the OB-GYN floor. As they emerged from the stairwell, she was surprised to see several security guards gathered at the elevator banks at the far end of the hallway.

Dr. Koenig didn’t notice; he was too busy telling Amanda about his other “largest, unpublished case series” that he’d collected over thirty years in practice. He seemed inordinately proud of collecting case reports from all over the world even though he had never published any of them. His excitement at finding his own—Narolie had already become “his” case—unique medical oddity had added a touch of mania to his speech and gait. He almost knocked over Zachary Miller’s parents as he barreled into the PICU.

“Let’s get the ball rolling,” Dr. Koenig said as he plowed past the ward clerk to grab Narolie’s chart. “You go tell Stone, I’ll get consent and arrange for an OR.”

Like a fast-moving squall, he was gone. Amanda shook her head, feeling dizzy. The atmosphere in the PICU had changed. She looked around. Families were present at every patient’s bedside, all looking fearful. In no rush to face Lucas and let him know that Dr. Koenig was commandeering Narolie’s case, she joined the Millers at Zachary’s bed. His vitals were good—better than this morning, even.

“Everything okay?” she asked.

“They said someone got hurt,” Mrs. Miller said, clutching the bed railing. Her husband had his arm around her.

“Stabbed,” Mr. Miller put in. “The guards told us all to leave the family room and stay here with our children while they searched the floor.”

“Stabbed? Who? Where?” Amanda glanced at the nurses’ station. The clerk and two nurses there were all on the phone. The rest of the staff was nervously hovering near the entrance, as if ready to guard their patients against any attack.

“They didn’t say. No one here seems to know anything more.” Anger undercut Mr. Miller’s tone—the most emotion she’d seen from him all week. He’d seemed stunned by Zachary’s accident, unable to do more than react to the situation.

“Well, the good thing is that Zachary is doing better. In fact, from the looks of his last blood gas, it looks like his lungs are starting to work again.” She stopped herself before giving them too much hope—after all, she was just the medical student, not the attending. But it was remarkable how much better the boy was this afternoon. Maybe the tincture of time was more powerful than all their technology.