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  First Wish

  M.D. Thomas

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  Copyright © 2020 by Matthew D. Thomas

  All rights reserved.

  No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the author, except for the use of brief quotations in a book review.

  This is a work of fiction in its entirety. All names, settings, incidents, and dialogue have been invented, and when real places, products, and public figures are mentioned in the story, they are used fictionally and without any claim of endorsement or affiliation. Any resemblance between the characters in the novel and real people is strictly a coincidence.

  For B, J, C, and G, always

  Contents

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  BONUS MATERIAL

  About the Author

  One

  I’d been an emergency medicine physician for almost three years on the night that Vivian Barnet forced her way into my life and upended everything. I still had a ridiculous amount to learn, but, with medical school fading behind me, I finally felt comfortable in my white coat, didn’t find it odd when people called me Doctor Linh, or Doctor Davies, or even just Doctor. I felt comfortable with the patients who shouldn’t be there but were, and had to be dealt with, and felt pretty confident dealing with the patients that were actually sick, and definitely belonged there. Despite all that, the one thing I hadn’t gotten used to was how a shift in the emergency room could be humming along one minute and then the next everything could go sideways—one moment you were checking an elderly patient for a cough and the next you were up to your elbows in blood.

  “You sure you’re ready for this?” Madison Wagner asked for at least the third time since the call had come in that there’d been a multi-vehicular accident on one of the beltway feeder roads, not far from Arlington Cemetery—we were about to get slammed. We’d just finished a case and were hurrying through the emergency room toward the trauma bays, where everyone would be scrambling to prep for the shitstorm about to descend on us. “What in the hell were you thinking volunteering for a night on your first shift back after being sick?”

  “It was an open shift and I was scheduled for tomorrow night anyway,” I said with a shrug. “I didn’t want you to get swamped.” I checked my pockets for the odds and ends I liked to have on hand during trauma cases—quick reference drug book, extra gloves, trauma shears for cutting through clothing. “Besides, it’s been almost two weeks since I got sick.”

  “Since you damn near died,” Madison said. She was a physicians assistant about five years older than me, with years more experience in the emergency department, but still, that sounded a bit dramatic to my ears.

  “It wasn’t that bad,” I said.

  Madison snorted. “Bullshit.”

  “I’m fine,” I said, realizing I sounded defensive. Hopefully one of the bouts of fatigue I still had daily wouldn’t decide to come on me in the next few minutes. Meningitis is always serious, especially once it hits the brain-swelling stage as it had towards the worst part of my case, but antibiotics had quickly reined that in.

  “I hope so.” Madison kept checking her stethoscope as we walked, a sure sign she was anxious about what was coming. Some healthcare providers are pretty stoic in the face of an emergency, but even for those people it was hard not to get hit by a wave of adrenaline during a severe case—fighting back imminent death had a way of getting you revved up.

  We reached the trauma bays, the staff buzzing like a stirred up beehive, and I spotted my residency director checking equipment. “I’m going to check-in with Dr. Vasquez.”

  “Ok.” Madison squeezed my arm as she went past. “If I’m not in your room I’ll see you on the other side.”

  “Sure you’re feeling well enough for this, Linh?” Doctor Vasquez asked when I entered the trauma bay. In addition to running the emergency medicine training program, Vasquez was probably the most talented physician I’d ever worked with.

  “I’m sure, Doctor Vasquez,” I said, fighting off a sigh. Fucking meningitis. Though in fairness, I was his responsibility, and if I wasn’t at a hundred percent when the meat wagon rolled up in a few minutes then it would be on his head more than it would be on mine.

  “Good.” Vasquez didn’t look entirely convinced, but he sounded sure enough. “Five patients are coming in, three of them with life-threatening injuries. You’re going to have to run one of those three yourself, and depending on what comes in the trauma docs might not be able to help much either.”

  “Which one do you want me to take?” I asked, feeling a bit of sweat pop out on my forehead—I’d helped with more traumas than I could remember, but I’d never run one completely on my own.

  “Twenty-something female that was ejected from her vehicle. She’ll be in the third rig, number two-seventy-three.”

  An ejection.

  Shit…

  I tried not to react, but obviously failed because Vasquez frowned.

  “You’ll do fine.” His voice was as grim as I’d ever heard it, from a man who was often obnoxiously upbeat. “The other two sound worse, so Doctor Novak and I will take them.”

  Shit shit shit…

  What Vasquez wasn’t saying was that I was getting the road rash victim because they had the least chance of survival. Therefore, there was a smaller chance I might fuck up a potential life-saver. It didn’t exactly inspire confidence.

  No. Don’t think about it that way. Think about what you can accomplish, not what you can’t…

  I was still trying to believe that load of baloney when Doctor Vasquez stopped fiddling with the equipment and straightened up.

  Sirens were approaching.

  “Let’s go,” Doctor Vasquez said as he hurried out of the trauma room toward the ambulance bay doors. I took a deep breath and trotted after him into the cold, February night.

  Two

  I’d just reached the back of rig two-seventy-three when the doors opened and a medic named Manny hopped out, moving fast. His partner was using a bag-valve mask to give the patient extra air.

  “This the one that was ejected?” I asked, still unable to see the patient.

  “Yep,” Manny said, as I took one side of the gurney and he took the other—the legs flipped down into position as we pulled it out. “Blunt trauma to the head. Neck might be broken.”

  Once all four of the gurney’s wheel were on the ground I got my first good look at the girl—she was a terrifying mess.

  Pavement—asphalt, macadam, concrete, whatever—acts like a cheese-grater when human skin is drug across it at thirty or forty miles an hour. Speeds higher than that and sometimes there isn’t even skin left on the body parts that take the brunt of the landing.

  The girl’s face was a mask of black and red, so torn up it was nearly impossible to tell where flesh stopped and blood began. The hair on the left side of her skull was gone, leaving a bloody swath behind. Bits of broken glass were embedded in her flesh. The only part of her head that wasn’t a beat up mess was the right side, where you could see she had two-tone hair, one of those blond-on-top, brunette-on-bottom styles—it looked like an at-home job.

  Manny recited the girl’s vitals as we trotted the gurney toward the emergency room entrance. “Heart-rate fifty-eight, blood-pressure seventy-five over fifty, pulse ox ninety percent. Failed attempt at I.V. times two.”

  Madison intercepted us as we entered the department, a slight widening of
her eyes the only indication that she’d noticed the patient’s condition. “Trauma Two Doctor Davies.”

  “We need someone from Anesthesia right away,” I told Madison, and she nodded, darting away. The patient would need to be intubated, but with the mess that was her face and neck I knew I’d have trouble getting the tube in her airway myself—I’d only done a few during residency, always with an attending to hold my hand, but the docs in anesthesia did fifteen or twenty a day.

  Manny and I wheeled her into the middle of the trauma bay, the lights right overhead, and Manny used his foot to put the brake on before backing away from the onslaught of staff that swarmed over the girl.

  “Two IV’s wherever you can get them in,” I said, taking a deep breath and getting down to it. The patient’s heart-rate and her blood oxygen saturation popped up on a nearby monitor as a nurse applied the sensor to one of her fingertips—heart-rate now a dismal forty-five, pulse ox at seventy-five percent. “Continue bagging and prep the ventilator. Get the EKG leads hooked up. Hang a bag of O neg, she’s going to need it, and suction her mouth. Prep the ventilator as well.”

  I took a deep breath and tried to step outside of myself for a moment to really take in what I was seeing. She was still wearing her coat, but one sleeve had been shredded off, and her forearm had an extra right-angle. She had on an immobilizing neck collar to prevent any farther injury to her spinal column, but whether her neck was actually broken or not would have to wait—during a trauma my role was to stabilize the patient, not to fix them. To do that I had to focus on her airway, breathing, and circulation—her brain would have to wait.

  “First IV in,” someone called, and a moment later, “Second IV in.”

  “Hang a liter of saline, and get twenty milligrams of etomidate ready,” I said as we started cutting her clothes off. The beep of the heart monitor seemed steady in the background for the moment. “One-hundred and twenty milligrams of Sux as well.”

  Madison poked her head in the room a moment later. “Anesthesia is on the way.”

  “Thanks,” I said as I finished cutting off her shirt. “Is the intubation tray ready?” I asked of no one in particular.

  “Yes,” answered one of the nurses.

  The rest of the girl’s clothes were finally cut off, revealing more skin damage on her left leg. Like her arm, there was blood all over, but there were no bleeds active enough to require a tourniquet.

  “Pulse ox is dropping,” Madison called out just as the alarm went off.

  Shit… I’m going to have to try and intubate her myself…

  I was dodging around a nurse who was applying the EKG leads to the patient’s chest when a tall man I didn’t recognize rushed into the room, his white coat flapping as he pulled on gloves. He was already wearing a mask and he hurried straight to the head of the bed.

  “Ah, jeez,” he said, grimacing as he saw the girl’s face. “Sorry it took me so long.”

  “You’re right on time,” I said, more than willing to let him intubate her.

  He grabbed the laryngoscope and an endotracheal tube off the intubation tray and bent over the patient’s face. “Suction please.” One of the nurses handed him the Yankauer and he applied the tip to the inside of the patient’s mouth, the suction tubing gurgling. He returned the Yankauer to the nurse, and, seemingly ignoring the woman’s face and the brace around her neck, pushed her bottom jaw down and inserted the laryngoscope in her mouth.

  “Mind if I watch?” I asked, moving closer before he even answered. You had to take advantage of learning opportunities when they arose.

  “Not at all.”

  Despite the suction there was still blood in her mouth, and her vocal cords were hard to see.

  “My name is Conner,” he said as he worked the patient’s tongue out of the way. “Conner Quick. I don’t think we’ve met before. Sorry for blathering, but it actually helps me to focus.”

  “Linh Davies,” I muttered, intent on watching what he was doing—no one was better at intubating than anesthesiologists.

  “Pulse ox still dropping,” Madison called out. “Down to Forty-percent.”

  “We’ll have that taken care of here shortly. Everything’s swollen but…” Conner said, and sure enough he slipped the endotracheal tube right between her beat up vocal cords. “There.”

  He removed the laryngoscope and stepped back, holding the tube until a respiratory therapist grabbed it—she gingerly applied an adhesive holder to secure the endotracheal tube, then hooked up the ventilator.

  “I’m going to see if anyone else needs any help,” Connor said as he slipped his mask down. He stripped off his gloves and tossed them in the medical waste receptacle. “If something comes up let me know.”

  “Thank you,” I said, giving him a nod as he left, which earned me a smile that was kind of dangerous.

  “CXR is up,” a nurse called out. I checked the tube placement on the X-ray film and it looked good, squarely down her windpipe. Her heart rate was still slow, but would hopefully pick up as soon as she started getting more oxygen. What was more important was her heart rhythm—it was off, the beats irregular. I was about to tell the nurse to double-check the monitor and get an EKG when the patient’s heart-rate plummeted.

  “Chest compressions!” I said, and one of the male RN’s across from me started right away. “One milligram epinephrine.”

  I’m losing her…

  Of course she was pretty much lost when she’d come in, but that wasn’t going to make her family, or me, feel any better if she died.

  “Charge the defibrillator to two-fifty,” I said.

  “Epi in at twenty-three-fourteen.”

  “Charging.”

  Once the external defibrillator was charged I placed the pads on her chest, double-checked the button, and said, “Clear.”

  Everybody backed off, including the nurse performing chest compressions, and everything went still for a moment as I pushed the red button.

  The girl’s body bucked slightly on the table and all eyes turned toward the heart monitor—it remained flat for a moment and then returned, thirty-seven beats per minute, barely climbing.

  “Push one amp of atropine,” I said. “Restart chest compressions.” I doubted her returning heart-rate was going to last—it was weak and erratic. Normally a trauma surgeon would’ve been in the room already, but they must’ve all been occupied with the other patients. With the ones that might actually stand a chance. Still… “We need a trauma surgeon in here. Somebody go see if you can pry one away from another room.”

  “I’ll go,” said one of the nurses and he hurried out. The doors were still swinging when the patient’s heart stopped for the second time.

  I charged the defibrillator again. “Clear.”

  Shock. Buck. Nothing.

  I handed the pads to a tech and started chest compressions myself. “Charge it again. One more milligram of Epi if we’re due.”

  “Charged,” the tech said less than a minute later.

  I moved and we shocked her again, but again there was no response.

  “Come on, dammit,” I said, starting chest compressions again, pushing as hard as I could, her ribs creaking and cracking beneath my hands.

  The nurse returned and informed me that no trauma surgeon was available. We kept at it for fifteen more minutes, but it was obviously done—I could see it in the faces of the rest of the people around the gurney. I stilled my hands, left them resting on her unmoving chest as I panted from the effort of the compressions.

  “Time of death twenty-three-thirty-four,” I said. Feeling exhausted and defeated I reluctantly removed my hands. “Let’s see if the others need help.”

  No one else needed help—the two other critical patients had already been moved upstairs to surgery and the two patients with non-life-threatening injuries didn’t need another doc standing around.

  I leaned against a hallway wall, feeling jittery and out of sorts. The girl wasn’t the first person I’d had die under my car
e, but it’d happened fewer times than the fingers I had on one hand. The loss hurt in a mess of feelings that were hard to untangle.

  Madison emerged from a patient room and looked me over. “You don’t look so good. You feel okay?”

  “Yeah,” I said, rubbing my face and levering myself off the wall. I didn’t have the luxury of sitting around and moping over the loss of the woman—there were still patients in the waiting room that needed to be seen and they didn’t care about some stranger dead in the back or that I might benefit from a moment of grieving.

  “You sure? You look pale.”

  “There’s nothing new about that.”

  “Smartass,” Madison said, but without her usual smile. We hadn’t known each other long but our personalities meshed and we’d gotten close quickly, which was often the case in the emergency room—it wasn’t unlike the bonds that soldiers form during war. “Sorry you lost her.”

  “There wasn’t much we could’ve done anyway,” I said, not believing it, knowing I was rationalizing to protect myself and knowing that was necessary. “Her neck was shot, I’m sure she had brain damage. It never ends up well for the ones that take flight after an accident.”

  Madison nodded. She knew as well I did how to play the game so you could move forward and not be paralyzed by failure. “It sounds like everyone in the family will make it.”

  “It was only a two car accident?”

  “Yep,” Madison said with a frown. “Our lady ran a red light and broadsided the family sedan. She was driving an old beater without airbags and wasn’t buckled up. They were.”

  “Doctor Davies?” The voice belonged to one of the triage nurses. “I need you in room seven.”