Extreme Measures (12 page)

The nurse was breathless.

“Eric, Reed wants to see you in Trauma Two right away.”

“Go,” Darden said. “I’ll help Miss”—he read the
nurse’s name tag—“Baker plow through that waiting room.”

Eric hurried past the medical chief and down the hall to Trauma Two. He could smell the blood and feel the chaos and desperation in the room the moment he cleared the door. Reed, an intern named Stuart Spear, and two nurses were clustered about a litter bearing a woman who appeared to be
in extremis
. She was propped bolt upright and was gasping for breath through the blood cascading from her mouth.

“What gives?” Eric asked, noting Reed Marshall’s pale, wide-eyed face.

Reed motioned the intern over to the head of the bed and handed him the rigid suction catheter.

“Just keep sucking her out,” he ordered. “Jill, get me three units. I don’t care if they’re cross-matched yet or not. I’ll sign. Also, tell the respiratory therapist to get in here.”

He hurried over to where Eric stood.

“She took the steering wheel in her neck,” he whispered. “At first there was just a trickle, but all of a sudden she erupted.”

“She’s drowning,” Eric murmured. “Her larynx has probably been fractured.”

“I tried calling ENT down to trach her, but they’re in the OR.”

“I don’t think it’s wise to put her head back and cut on her neck. Just paralyze her and put a tube in.”

“But … but what if I paralyze her and then can’t see past the blood to get the tube in?”

“Of course you can get it in. I’ll work the suction.”

“I … I’m not so sure that’s the right thing to do,” Reed said.

Eric glanced over at the patient and the two who were working on her. The respiratory therapist entered the room and began preparing his Ambu breathing bag.

“Reed,” Eric said softly, “it doesn’t look like you have much time. A trach will be dangerous, messy as
hell, and probably take too long. The balloon on the tube you put in will tamponade the bleeding. Call for the succinylcholine. You can do it. I know you can. I’ve seen you tube a hundred people.”

“Not like her. You do it.”

“You can do it, Reed,” Eric whispered. “I’ll be right there with you. Just order the sux.”

Marshall turned to the nurse.

“Give her sixty of succinylcholine IV, please, and have respiratory set me up with a seven-point-five tube.” He looked back at Eric, who shook his head a fraction. “Make that a six-point-five,” Reed said. He crossed to the woman, whose respirations were growing less and less effective. “Mrs. Garber, we’re going to put a tube in to help you breathe. In order to do that, we’re giving you medicine that will make it impossible for you to move. Try not to be too frightened. You’ll be breathing better in just a minute.”

Moments after the rapidly acting paralytic was injected, its effects began. The woman’s muscles, including those that were enabling her to breathe, began to twitch, writhing without coordination or pattern. Then, in seconds, they all went slack. Eric set the litter back flat. Instantly, blood welled up in the woman’s mouth. He took the suction and moved to Reed’s right hand. The monitor pattern remained rapid and steady.

“Go for it,” he said, hunching next to Marshall’s ear. “Just think of the anatomy. Look for your landmarks, and concentrate.”

Reed slid the broad blade of the laryngoscope along the edge of the woman’s tongue as Eric stabilized her head with one hand and sucked the blood clear with the catheter in his other.

“Take your time,” Eric whispered, craning to see what Reed was looking at.

“I … I can’t see.”

“Wipe off the laryngoscope light and do it again. It’s only been ten seconds.”

Out of the corner of his eye, Eric saw the monitor rate begin to drop. Reed wiped the blood off the light at the tip of the blade and inserted it again. His left hand, clenched about the laryngoscope handle, was beginning to shake.

Eric reached up and depressed the woman’s larynx a bit.

“There, look,” he said. “That’s her epiglottis right there. Just come up underneath it. Easy does it. That’s it, that’s it.”

Marshall began to nod excitedly.

“I’ve got it.… I’ve got it,” he said, slipping the polystyrene tube into place. “Sweet Jesus, I’ve got it.”

Quickly, the respiratory therapist blew up the balloon on the tube, attached the breathing bag, and began a series of rapid ventilations. Eric checked the woman’s chest with his stethoscope to ensure the proper placement of the apparatus. Then he looked up at Reed and smiled.

“Hell of a good shot, old boy,” he said.

Almost immediately the flow of blood began to abate. The woman’s color improved. The relief and elation in the room were nearly palpable.

“Yes, sir,” Eric said, patting Reed on the shoulder, “one hell of a shot.”

“What gives?”

The team turned toward the doorway, where Dr. Joe Silver stood appraising the scene.

Unable to contain her enthusiasm, the nurse rushed over to him.

“Dr. Silver,” she gushed, “you just missed it. Reed just intubated this woman through a massive hemorrhage. One minute she was dying; the next …”

She gestured at the patient, who now was being ventilated quite easily.

“Nice going, Reed,” Silver said, striding to the bedside.

“Actually, I don’t think I could have done it without—”

“What was it? Steering wheel to the neck?”

“Exactly.”

“Gutsy move.”

“Eric here was the one who—”

“Does she have any other injuries?”

“We’ve only had time for C-spines and a chest film, but they were normal.”

“Excellent, Reed. Really fine work. Well then, why don’t you get on with your secondary survey of her.” He turned to Eric. “It’s a madhouse out there. Your stand-in, Dr. Darden, has apparently forgotten how frantic our kind of work is. He left to examine his patient after seeing about three people in the time we see ten.”

“I’ll get on it now,” Eric said.

“It doesn’t look as if you ever had to leave.”

Eric started to respond, then just nodded and left the room.

The flow of patients into the E.R. slowed, then virtually stopped. With Joe Silver pitching in, Eric was caught up in less than two hours. The E.R. chief gave no indication that he knew of Eric’s role in the Garber woman’s resuscitation. Instead, he told almost anyone who would listen about Reed Marshall’s heroics. Eric was sure that Reed had spoken up for him, but it was clear that Silver had heard only what he wanted to hear.

With a few final words to the triage nurse, Eric headed down the hall to his office, his back and legs aching from the long day. He glanced back at the front desk, where Joe Silver was orchestrating the care of what patients remained, and tried to imagine what life would be like for him should he be forced to leave White Memorial.

He entered the office and shut the door. In almost a fugue state, he pulled the envelope from the lower drawer of his desk and held the fine caduceus pin in his hand.

From beyond the door he heard the sounds of the hospital. He deserved the promotion. The events in Trauma Two merely underscored that truth. He deserved it, and yet it seemed more than likely that in a matter of days, he would be looking for work.

He ran his finger over the pin. Putting it on would obligate him to nothing. If the work Caduceus was doing was unacceptable, he could simply refuse to participate.

Eric’s pulse was raging in his ears as he ignored persistent pangs of uncertainty and fastened the caduceus to the lapel of his clinic coat.

B
etween diving once or twice a day and running five miles several times a week, Laura Enders was in the best shape of her life. Even so, every muscle in her legs ached as she left the subway and climbed the stairs from the Charles Street station to the White Memorial overpass.

She had spent her first full day in the city—two days ago—making countless lists of the places she would go, and locating those places on her map. Then, late that evening, she had picked up the fliers at the printer and begun her search in earnest, planning to work her way, one at a time, through the grids she had drawn on her map. By eleven the next night she had walked at least twenty miles and had left posters with two hundred bartenders, policemen, hotel workers, hospital clerks, and receptionists.

The fliers, standard 8½ by 11, black-on-white, had come out reasonably well, although the blowup of Scott’s face was grainy, and flatter than she would have liked. She had stopped by Bernard Nelson’s office and left half a dozen with his frowzy receptionist, who
accepted them while barely missing a stroke in filing her nails.

It was nearing nine in the morning, and for the first time since her arrival in Boston three days before, the sun was shining. Charles Circle was alive with traffic, ambulances, joggers, and streams of pedestrians headed from several directions toward the hospital. On a whim, Laura stopped in at the Charles Street jail and left off a flier. Then she fell in with the crowd and followed a stretcher through the emergency doors into White Memorial.

She had been to the emergency rooms of two hospitals the previous day and was impressed by how busy each had been. But compared to White Memorial, they were serene. Everything and everyone in the broad, fluorescently lit receiving area seemed to be in motion. The scene reminded her of the teeming life above a coral reef.

Three stretchers, each with a patient and two ambulance attendants, were lined up along one wall. A group of what looked like medical students were clustered in a doorway, listening intently to an older physician. Nurses and doctors in scrub suits crisscrossed to and from the broad semicircular reception counter, dropping off charts, picking up laboratory slips, or just pausing to talk. Behind the counter two women and two men jockeyed past one another, answering phones, responding to questions, and logging patients in and out of rooms diagrammed on a huge white acrylic tote board.

Laura took a minute to gauge which of the four seemed the least harried. She settled on a slight, pale man with graying sideburns and an easy manner that suggested he was a veteran at his job. Then she timed her approach to coincide with his rotation from the tote board to the counter.

“Help you?” he asked.

“I hope so.” Laura pulled two fliers from her shoulder bag and set them in front of the man. “My
name is Laura Enders. I’m trying to find my brother, Scott. I was hoping there might be a place where I could put up one or two of these.”

“Have you checked to see if he’s been a patient here?” the man said, scanning the sheet with no sign of recognition.

“No. No, I haven’t.”

Laura cursed herself for neglecting to do that at the two previous hospitals she had visited. At the same time, she pictured the posters she had left off crumpled in wastebaskets beneath counters similar to this one.

“Well, why don’t you let me call the record room and see if they have anything. Have a seat over there and take in the show.”

Relieved, Laura settled in a blue molded-plastic chair off to one side. At first she focused on the patients, some clutching wounded or aching parts, some strapped to wheelchairs, and some, it seemed, just hanging around. Gradually, though, her attention shifted to the doctors. Most of them, especially those in scrubs, were her age or younger. And all of them, men and women alike, looked exhausted and harried. Still, many paused for brief gestures of caring toward the patients—a touch or a word. And within the shadows surrounding their eyes was a snap and intelligence that made Laura feel she would enjoy working with these people. Several of the letters of inquiry she had sent out were to programs in physical therapy and rehabilitation. At that moment, heading her life in that direction felt right. Perhaps after she had found Scott …

“No luck.”

“Huh?” The emergency ward clerk was standing beside her. “Oh, I’m sorry. I guess my mind was wandering.”

“I understand,” the man said. “I’ve been working here almost twenty years now, and sometimes I still find myself hypnotized by the whole thing. But I’m
afraid there’s no record of your brother ever having been here—inpatient or out. I checked both names on that poster of yours.”

Laura stood.

“I really appreciate your help,” she said. “Do you think you could put up the posters anyhow? I’m pretty desperate to find him.”

“I can show the picture around. But posting things out here is against hospital regs unless they’re approved by—Wait a minute. The place you
really
want to put this up is in the residents’ lounge. If anyone would remember seeing him, it would probably be one of the residents.” He turned and called across to one of the doctors. “Eric. Hey, Eric. Got a second?”

The doctor seated at a desk near the triage nurse turned and looked over at them. Of all those Laura had been watching, he was perhaps the most interesting, and, she acknowledged as he rose and came toward them, the handsomest as well. He was tall—six feet or a bit more. His face was dark and sharp-featured, reminding her a bit of Omar Sharif. And although Laura usually disliked moustaches, his seemed right. But what had impressed her most about the man were the little things she had watched him do with the patients—the warm smiles and reassuring touches.