The cemetery was closing in ten minutes, and Lilly Reeves was going to be late. She searched through her black tote bag for the third time and rifled through medical reference cards, hemostats, and lipstick tubes, frustrated that her means of escape had disappeared. An alarm toned at the bank of ECG monitors that sat at the nurse’s station and a quick glance assured her that no one was dying.
“Is everyone sure they haven’t seen my keys?” She secured coils of black hair behind her ear.
“Dr. Reeves, you need to keep your bag locked up. Someone may be trying to teach you a lesson,” her senior attending said. The man who’d hired her onto the ED staff at Sage Medical Center.
She eyed him evenly. His gray hair and washed blue eyes did little for his pale skin. Was the look on his face amusement or condemnation?
“Wouldn’t be you, would it, Dr. Anderson?”
The ER pager at her hip vibrated. Lilly pulled her lab coat aside and checked the message. “Trauma Code—one minute out.”
“You might as well take that.” He closed the chart he held in his hands.
“My shift is over. I have other plans.”
“Like what, Lilly? Family event?”
She let the comment drop. “If you’re understaffed tonight, I’ll stay.”
“My guess is you won’t be going anywhere for a while anyway. Maybe in the interim, your keys will turn up.”
Lilly blew the stray hair from her eyes and then left her bag under the desk before she made her way down the corridor. From the hall cart, she gathered her safety equipment and pushed through the swinging doors. Two nurses were on either side of the bed. Towering over all of them, Luther waited with one hand holding cords for the monitor. Regan, petite, with brown hair and eyes, hung IV fluids into the rapid infuser. Sonya, one of their newer nurses, stood near the head of the bed. The paperwork from the trauma folder slipped to the floor as she worked to organize it on the mayo stand.
“Someone get that? I don’t like to bend over unless I have to.” She stroked her pregnant midsection.
Lilly pulled her stethoscope from under her gown. “What do we know?”
“Not much.” Luther offered Sonya the stray chart sheets.
“Twenty-eight-year-old female involved in a high-speed MVA,” Regan said.
Luther shook his head. “Their radio cut out. Don’t think they had time to try cell phones.”
The EMS crew pushed through the doors.
The patient’s breath misted inside the oxygen mask, eyes closed, blond hair snaked and tangled around her pale face. Thick, clotted blood covered the left side of her head. As the medics transferred the patient to the bed, a rounded midsection on the thin woman caught Lilly’s gaze.
She frowned and pushed the blanket to the side.
“Hey, Mike . . . Raul. She’s pregnant?”
Mike yanked the oxygen tubing from the transport tank and connected it to the wall source. They tilted the backboard up so the patient rested on her left side.
First responders used the left-side position to prevent compression of the vena cava by a pregnant woman’s enlarged uterus, thereby improving blood flow to the growing baby.
“Two for the price of one.” Mike, the shorter of the two men, confirmed. “This is Torrence Campbell—”
“Torrence?” Sonya’s startled gasp paused Lilly’s movements.
“You know her?” Regan asked.
“She’s a friend. Our babies are due on the same day.” The color drained from Sonya’s cheeks. She fanned her face with the chart.
“Can you do this?” Lilly asked.
“I’ll be fine.”
“Twenty-eight-year-old restrained driver was T-boned by a truck moving at a high rate of speed,” the paramedic continued. “Her car then slid into a lamppost at the corner of the intersection. No air bags. Significant incursion of the vehicle into the passenger compartment.”
Lilly looked down at the woman on the table. What was going to happen to the little one inside? Experience had shown her there was no guarantee for either of them. Would she have to choose which one lived or died?
“Her head hit the side window—shattered the glass. Initially alert and oriented but now we can’t get her to wake up. Both femurs with obvious deformities. Splints in place. Heart rate 130. Respiratory rate 32. Blood pressure 90/50. Pelvis feels stable. She stated on scene she is 28 weeks pregnant. Was able to get fetal heart tones at 140. Two large-bore IVs in each AC with saline wide open.”
“Thanks, guys. You’re clear.” Lilly said to the EMS team. She helped Regan pull off the layers of linen, placed her palms lightly on the woman’s abdomen, and pressed inward at various stations, her practiced hands testing for firmness that might indicate a collection of blood. The muscle tensed under her fingers. A contraction?
“Sonya, I need a page out to OB for an imminent delivery.”
“Luther, let’s get a couple of liters of Lactated Ringer’s running in. See if that helps her blood pressure and fast heart rate.” Lilly motioned to one of the ED techs. “Pull the bedside ultrasound in here. I don’t see it.”
“The cops are right behind us.” Raul tossed the dirty linens into the laundry bin. “They don’t think it was much of an accident.”
“What do you mean?” Luther connected the ECG cords to the patient’s chest. Lilly watched the tracing come up on the monitor.
“They’re saying someone was after her. That she was hit on purpose.” Mike followed his partner out the door.
Lilly catalogued the comments in the back of her mind. The patient’s clothes lay on the floor in a shredded heap. Trauma protocol dictated a systematic approach to assessment so nothing was missed. First, responsiveness.
She shook Torrence’s shoulder.
“Torrence, can you hear me?”
Not even a flicker of an eyelid. Lilly pulled a hemostat from her pocket and pushed the metal into the base of her patient’s fingernail.
“Sonya, she’s unresponsive.”
“I don’t have a good feeling about her, Lilly,” Luther whispered as he secured a blood pressure cuff around her flaccid arm.
“Regan, we’re going to need an airway.” She positioned her stethoscope in her ears. Techs began placing films for X-ray.
Next, breathing and circulation. Breath sounds quick and shallow. Heart tones distant. Pupils were unresponsive black discs as Lilly shone her penlight into the vacant stare.
One was larger than the other.
Reaching to the wall, she grabbed an otoscope.
Blood behind the left eardrum.
Lilly’s years of practiced training edged over the panic that enticed her heart into a faster rhythm. She began an injury checklist in her mind
Head injury probable. The blown pupil could indicate an epidural bleed. A torn artery near the brain could be devastating. That meant a CT scan and neurosurgery consult. The lower blood pressure and increased heart rate could be blood loss caused by the presumed femur fractures or other internal bleeding. Add an ortho doc to the list. Disruption of blood flow to the uterus was Lilly’s next concern as it could mean death for the baby. OB should be on the way.
“Where are ortho and neurosurgery? Is anyone getting their pages today?” Lilly asked.
“The system’s been a little twitchy,” Luther said. “I’ll call the desk and have the service specialist page it out again.”
A man unknown to her entered the room. Regan pulled a stand of airway equipment near the head of the bed. Lilly tested her patient’s jaw to see how easily she could get it open to place the tube.
“Luther, I’m going to need a dose of Etomidate.”
“Is she coherent?” the stranger asked.
Lilly glanced his way. His height topped hers by a couple of inches. Tousled brown hair and bloodshot blue eyes alluded to his lack of sleep.
“You are?” She guided him back toward the door as they shot the last X-ray.
“Detective Nathan Long.”
“You know you can’t be in here until we give you clearance.”
“I know, I’m sorry. I just need to ask her a few questions.”
“What’s your interest in my patient?”
The radiology tech tugged Lilly’s gown to get her attention. “We’ll have these in the computer soon.”
His voice drew her attention back. “We think she was intentionally hit by the man she was going to ID as her rapist. Can she talk?”
“She’s not responsive, and we’re getting ready to stick a tube in her throat. I doubt he’ll show up here.” Lilly turned back to the patient.
“He might be crazy enough.” Long stepped closer to the bed.
Lilly took two strides and faced him, putting her fisted hand in the center of his chest. “Since you were wondering, I’m her doctor, Lilly Reeves. Perhaps you didn’t hear me when I told you she’s not responsive. I need you to wait outside.”
“I have to try. She’s the only one so far who’s come close to identifying this man.”
“Meaning there are multiple victims?”
Detective Long was silent.
“The police department is keeping quiet about a serial rapist?” She pushed her nose within an inch of his face. “You need to release that information to protect other women.” He stood his ground.
“I’ll keep someone outside this door.” He turned and left. Lilly watched as he spoke with a uniformed officer.
“Her pressure’s dropped into the 70s,” Regan said.
It was much too low for mom and baby.
“Have the two liters of LR run in?” Lilly asked.
“All the way,” Luther noted.
“Let’s get some blood running.”
Lilly unlocked the bed and pulled it away from the wall until she could step behind it to access the patient’s airway. “Luther, we’re going to roll her supine.”
They eased the backboard down.
“Ready for the Etomidate?” he asked as he pulled the metal stand with airway equipment within her reach.
Lilly looked over the tray to ensure each piece of equipment was ready. “Give it now.”
Luther injected the medication. A respiratory therapist pulled the oxygen mask off and began to assist the patient’s breathing.