Amanda scribbled notes on an index card. It was unlike Lydia to go into such detail about a patient’s social history, so she assumed it was all relevant. “Has she seen a doctor?”
“That’s the problem. She’s a clinic patient. Been seen there twelve times in the last ten weeks. Workup was all negative, except for a small calcification near her right ovary they found on her upper GI. Incidental finding—probably a feco lith; the rest of her labs have all been normal. They think she has depression, PTSD, and an eating disorder. In fact, she was scheduled to see a psychiatrist today but came in here because of severe vomiting and the worst headache of her life.”
Amanda looked up at that. A headache that bad could mean lots of serious things, including a brain tumor or leaking aneurysm. Or it could be the exaggeration of a teenage girl with underlying psychiatric problems. “Is her neuro exam normal?”
“Yes. And she’s still dry-heaving after three hours of fluids; her electrolytes revealed a bicarb of only twelve, so the vomiting was definitely for real; and her amylase and lipase are slightly elevated.”
“You’re thinking pancreatitis?”
Lydia hesitated—so unlike her. “Maybe a mild pancreatitis, but I don’t think that’s the underlying problem. I called the clinic doc to admit her. I want to get a head CT and if that’s normal, a scan of her belly, but he refused. Won’t even admit her, doesn’t want me to do anything but order a psych consult. Said he’d follow her up in the clinic.”
Now Amanda understood the problem. If the patient’s attending physician refused to admit her, the only way Lydia could keep the girl in the hospital would be to get another attending to admit her—highly unlikely for a clinic patient—or to send the girl to the PICU.
“She sounds sick,” Amanda agreed. Mainly because she trusted Lydia’s judgment. “Question is: is she sick enough for the ICU? It’s gonna be a hard sell since we only have one open bed.”
“Even if it’s only overnight, at least you could make sure she has a proper workup—more than I can do for her down here in the ER. I just have a feeling that there’s something going on. Something bad.”
FOUR
Thursday, 8:21 A.M.
GINA KNEW SOMETHING WAS WRONG AS SOON AS they hit the ER. No nurses waiting for them—hell, knowing Lydia was on today, she’d expected the attending there herself. Instead, Jason, the desk clerk, simply waved them into the isolation room.
The kid’s name was Harold Trenton III, but he’d told them to call him Tank—even though he was a skinny-assed, pimply, pale-faced fourteen-year-old. As they transferred him from the gurney to the hospital bed, Gina glanced through the glass walls. The ER was too quiet. There was no one laughing at the nurses’ station, no one hanging out in the hall, razzing lost interns or med students. Just an irritating quiet that made her palms itch.
Amanda and Lydia stood across the hall, neither looking very happy. She rapped on the window, getting their attention and beckoning Lydia into the isolation room. Lydia nodded, said something to Amanda, then sent the med student into another patient’s room.
“What’s up?” Lydia asked. “This isn’t the mening kid, is it?”
“Yeah, didn’t you get our report?”
Lydia grimaced. “Sorry, things have been a bit crazy around here this morning.”
Trey looked up at that, but Lydia didn’t elaborate. He finished his run sheet as Gina gave the case summary. “Fourteen-year-old from Heinz Prep, previously healthy until this morning he developed body aches, dizziness, and a fever of one-oh-two. School nurse spotted petechiae on his arm, and we found more on his trunk and back.”
Lydia was already examining Tank as she listened to Gina. She lifted his shirt, scrutinized the few lesions he had, looking for petechiae or broken blood vessels under the skin that form a reddish-purple pinpoint. “They don’t blanch, but they’re not classic. No purpura? If these are petechiae, there aren’t very many.” She turned to Tank and smiled. “That’s good news; it means we caught this early. How long have you had these red spots?”
Tank shrugged. “Don’t know.”
“Were they there yesterday?”
He looked blank. Lydia tried again. “When you took a shower yesterday, did you see them? Or these on your shoulder; did you notice them when you looked in the mirror?”
“Don’t remember.” He started his Game Boy again, the volume loud enough to set the IV pole shaking.
Lydia grabbed the game and turned it off, staring him full in the face. “Harold. This is very important.”
“Tank. My name is Tank.”
“Tank. I need you to think hard. When did you first see the rash? Has it been coming and going? Do you remember the first spot? Is it itchy or painful at all?”
“I don’t know, I don’t know, I don’t remember, no, and no.” He held out his hand for his video game. Lydia didn’t relent.
“Any vomiting, diarrhea?” she asked.
Tank gave up talking, his face set in a sullen stare, responding to her questions with a mere nod or shake of his head. Lydia ran through a litany of questions, trying her best to get an accurate history—she got further than Gina had, but in the end Tank’s symptoms were still irritatingly vague, other than the documented fever and the rash. Finally Lydia returned the game to him.
She joined Gina and Trey in the corner. “We’ll get blood, do a spinal tap, but I don’t know, it doesn’t feel like meningococcemia to me. Although with the rash, I can see why the school wanted him checked out.”
“Oh, they want more than that,” Gina said.
“Didn’t Dr. Frantz call you?” Trey asked.
“No. Who’s Dr. Frantz?”
“Kid’s private physician. Ordered the school nurse to give him a slug of ceftriaxone—”
“He already got antibiotics?” Lydia yanked the chart from Trey, scanning through his notes. “That changes everything—we’ll never be able to culture any bacteria. What was that bozo thinking?”
“It gets worse,” Gina said. “He’s also reserving a PICU bed for our ‘critical’ patient.”
“Amanda said they only have one bed left, and I have another patient who needs it.”
“Hate to say it, but I have a feeling Mr. Memory here is gonna trump whatever patient you have—unless he or she’s related to the governor.”
“Why don’t we get some labs back, by that time one of the parents might get here and we can get a better picture of things. In the meantime, I’m going to check on my other PICU patient.”
“Translation: you’re going to try to grab the PICU bed before Tank here takes it.”
Lydia gave her the barest hint of a smile.
“You okay here, Gina? I’ll be right back,” Trey said, moving to follow Lydia out of the room.
Gina watched him intercept Lydia. The way he brushed against her and suddenly the two of them were in perfect sync, strolling down a public corridor yet obviously in a world of their own. Gina touched the simple gold chain that hid Jerry’s ring beneath her shirt. Why was it that when she saw couples like Lydia and Trey, or even Amanda and Lucas, she felt empty inside? Like maybe she just wasn’t meant for that kind of love.
Tank’s video game let out a bone-crunching shriek. “Aw shit!” he shouted, flopping back against the pillow. “Son of a bitch!”
“Hey.” Gina whirled on him, tired of his wannabe-punk attitude. “This is a hospital. You will play quietly or not at all.”
At first she thought he was going to call her bluff and stick out his tongue at her, but something in her body language must have given him second thoughts because all she did was take one step toward the bed and he sat up straight, silenced the machine, and nodded his head. “Yes, ma’am.”
Ma’am? Hmmm . . . she liked that. “Okay, then.” Still no nurses—where was everyone today? It wasn’t her job, but as Lydia was constantly reminding her, in the ER every patient was everyone’s job, so she hooked him up to the monitor. “Let’s get a set of vitals on you.”
“Am I going to be okay?” He didn’t sound scared, but he didn’t sound too cocky about his chances, either.
Before Gina could answer, the door was flung open by a high-heeled, high-polished woman wearing a power suit. Armani.
High-class wannabe
, Gina’s mother would have categorized her.
“Harold!” She clattered across the room, heels clicking like a metronome on overdrive. “What happened? Are you okay?”
Tank hid his face in his game, brushing her embrace aside. “I’m fine, Mom.”
“No, you’re not. Oh, my poor baby!” Mrs. Trenton stood, clutching the bedrail but not touching her son. She did an about-face to address Gina. “Are you his nurse? Where’s Dr. Frantz? Why isn’t he up in the ICU yet?”
“I’m Dr. Gina Freeman. I helped transport Harold”—Tank winced at her use of his real name—“from Heinz Prep. If you’re his mother, we have a few questions.”
“Of course I’m his mother!” Mrs. Trenton seemed unable to avoid exclamations, her chin bobbing with every sentence, adding emphasis—and threatening to make Gina dizzy. “I know you! You’re LaRose and Moses Freeman’s daughter! We’ve met before, at your parents’ club. They’d said you’d gone off and done something crazy like joining the Peace Corps—I never dreamed they meant you’d be working here! If Angels didn’t have the best pediatric specialists, we’d never come—”
Gina’s glare interrupted her. Great, friends of her parents. Just what she didn’t need. “Mrs. Trenton, the school nurse, wasn’t able to give us any information about Harold’s vaccination status. Did he receive the meningococcemia vaccine?”
“Of course not! Harold has never had any vaccines! His grandfather is Harold Trenton, you know, the chiropractor? So we know all about the dangers of vaccines! I’d never allow any of my children to risk their lives to satisfy a government bureaucracy. Do you have any idea how much harm vaccines cause each year?”
As opposed to the millions of lives saved? Gina kept her face neutral—she’d had tons of practice holding her tongue around her father and his cohorts. Why was it rich people thought they knew everything without ever actually bothering to learn anything? “When did you notice your son’s fever and rash?”
“Rash? What rash?” She laid her hand against Tank’s forehead. “Oh my God, he has a fever! He’s burning up! Why haven’t you people done anything for him?”
Gina gave up. Let the ER sort it out. Luckily she could escape with Trey and Gecko on the ambulance. “Later, Tank,” she said, opening the door.
“Wait! You can’t leave us. Dr. Frantz isn’t here yet. Who’s going to take care of Harold?”
“The ER staff will take good care of him. I have to go.”
“Gina, please. You can’t. I’m sure your parents would want you to stay and help us out. In fact, we’re sitting at their table on Saturday. They invited us to watch you get that award. I’m sure someone brave enough to save all those children can bend a few rules and help out a friend.”
“I’m so sorry, Mrs. Trenton. But I have to go save lives. I’m sure everything will work out just fine for you and Tank—in fact, I’ll send in Dr. Fiore.”
“Dr. Fiore? I heard about her! She almost killed a man!”
“Really? Well, I’m sure he deserved it. Good luck.” Waiting until the door was closed behind her, Gina chuckled. The rich were so easy to mess with—one of life’s simple joys.
“YOU OKAY?” TREY ASKED AS HE AND LYDIA walked down the hall. They stopped inside the ambulance bay where the cold wind whipped at the doors, some of it sneaking past, but it was otherwise quiet. “You look upset.”
Lydia turned her face to the outside doors, searching for any hint of sunlight. The day had turned an impenetrable gray; she couldn’t even tell if it was still morning or close to sundown. So typical of this town. “We lost a patient this morning. It was bad.”
Trey took her hand in his, gave her time. He was good at that.
“It was a nurse,” Lydia continued. Her emotions leached into her words. She couldn’t afford to break down, not with almost an entire shift left. She clamped down on the memory of Karen’s body—somehow it was mixed up with the memory of her mother’s. “She was attacked in the cemetery. Raped, stabbed, beaten. And then they sprayed graffiti over her—like she was a piece of garbage, worthless.”
She stopped. She couldn’t go on, not without letting loose all the emotions roiling inside her. Clenching a fist so tightly that her fingernails cut into her palms, she tried to squeeze all her sharp and dangerous feelings into a ball, roll them out of the way so she could focus on her job.
Trey pulled her into a tight hug. She couldn’t return it at first, afraid that if she relaxed her guard she wouldn’t be able to stem the tidal wave of emotions, but Lord, how she needed it. After a long moment, she was able to squeeze him back and actually take a deep breath again.
Someone called her name from the ER. “Thanks,” she told Trey, reluctantly pushing away from his embrace. She squared her shoulders and trudged back to the nurses’ station.
Despite her best efforts, she still couldn’t banish the vision of Karen’s body.
GINA , TREY, AND GECKO LEFT THE ER AND WERE walking back to the ambulance when Gina stopped short. The ER entrance and ambulance bay were on a slope, elevated enough that she could spy yellow ribbons of crime-scene tape fluttering around the statue of a weeping angel across the street in the cemetery. The angel was covered with neon-colored graffiti. Jerry crouched among the tombstones, measuring off distances and checking sight lines.
“What the hell?” She was half-tempted to shout out to Jerry, get the inside scoop from him, but knew how he hated to be disturbed at work. Besides, if he saw her dressed like she was, she’d have to lie about her bulletproof vest.
“They found a nurse over there.” Trey opened the rear doors to allow Gina and Gecko to slide the gurney back inside. “Raped and stabbed. She died.”
“Did they catch the guy?”
“Lydia didn’t say, so I’m guessing not.”
Gina shivered and wrapped her arms around herself, wishing she’d grabbed her jacket for the short run into the ER. “Who was it?” Then she saw Jerry jogging across the street, coming toward them. “Oh shit.”