Code Triage (34 page)

Leigh wadded the paper towel into a ball and hurled it into the wastebasket, anger snuffing her last vestige of tears. It had been stupid to let it slip that she’d had a miscarriage, but that awful woman had such a uncanny sense of how to push Leigh’s buttons, and . . .
If I’d been honest with Nick, she couldn’t have done that.
She and Nick would be making plans for the future. When he came to the gazebo, she intended to tell him that she’d thought about a lot of things while she’d sat in the chapel. That she thought maybe the Christian marriage counseling might be a good thing after all. But now she wasn’t sure any of it was possible.

Nick had said, “I can’t do this now.” She’d never seen him quit anything in all the years she’d known him, but it sounded like he was giving up on her. On them. That he wasn’t willing to give her the time, the
space
, to be sure about things. And Nick wasn’t the only one who was unwilling. God was treating her the same way. She’d asked him, finally, to help her—talked with him after such a lonely dry spell—and look what had happened.

She ran a comb through her hair, took a deep breath, and headed back to the ER. The other doc had arrived to work the rest of his shift. She was finished for the day. Now all that was left was to grab her things and get out of here. Go to the stables, check on Frisco. Pull on her riding boots, saddle that chestnut mare, and ride and ride and ride. To anywhere that didn’t hurt.

“Dr. Stathos?” The ward clerk caught her as she stepped outside the ambulance bay door and was about to turn her cell phone back on. “Medical records is asking if you could sign that ER record from the other day. The man who got beaten with the high-heel shoe.”

Leigh groaned. “I knew that. They’ve asked twice. Tell them I’m sorry. I’ll run up and do it right now. Telemetry unit, right?”

“SICU bed 6. There wasn’t a bed in the ICU, so they moved him this morning.” She wrinkled her nose. “Alcohol withdrawal symptoms complicated things, I guess.”

Leigh jogged the stairs, signed the chart, and even peeked in on Freddie Barber—asleep with an open Bible on his bedside table. She’d almost escaped the intensive care unit when she heard the shout. Strong, harassing, way too familiar.

“Don’t tell me I’m imagining things! I saw her walk by the desk. Tell her I need to see her.”

It occurred to Leigh to bolt and escape—she was, after all, an accused runner—but she wasn’t about to give Sam the satisfaction. The woman might be winning the war . . .
but this last skirmish is mine.

+++

Nick might not be a horse person, but he knew the moment he set eyes on the big bay gelding that the animal was in trouble.

“He’s dripping with sweat,” he said, turning to Glenna. “I didn’t think horses did that, except under their saddles. Even that white stripe on his face is soaked.”

“It’s the pain,” the woman explained, her expression anxious. “Patrice said to watch for that or pawing and turning in circles.” She grimaced as the big horse turned his head to nip at his flank. “And that. That’s a sign of colic pain too, the way he’s biting himself. I don’t like how he’s holding his head. Hanging it down like—” she glanced at Maria, then lowered her voice to a whisper—“like he’s giving up.”

Nick’s stomach sank. “No word from Leigh?”

“I’ve left several messages, but she hasn’t called back.” Glenna’s lips pressed together. “I’m sorry I didn’t call you, but Patrice said Dr. Stathos left specific instructions that only she and the vet were to be called in an emergency. I had no idea that Maria had even started to talk, let alone phoned you. It’s a day of miracles and disasters, I’m afraid.”

Nick nodded. He couldn’t argue with that.

Glenna rested her hand on the slats of the stall next to Frisco’s, now filled with the one-eyed donkey. “Maria moved Tag in there. She said they’re brothers.” She smiled. “I wasn’t going to touch that one. But I do think that donkey’s been a comfort to your horse.”

Your horse.
“The vet’s on his way?”

“Dr. Hunter will be here as soon as he can. He was in surgery; a rancher’s dog was hit by a car. He said to do what we could to keep Frisco from lying down and rolling. Walk him slowly around; keep him moving without wearing him out. The stable hands have gone for the day and I’m not very experienced.” Maria appeared and peered out from under Glenna’s arm, holding a halter much too large for the donkey. “Maria wants to walk him, but I don’t think that’s wise. He’s so big, and if he tried to lie down all of a sudden—”

“I’ll do it,” Nick heard himself say. “If Maria can show me how to put that halter on Frisco and find us a rope, we’ll do it together.” He smiled at her. “Won’t we?”

“You betcha, Mr. Nick.”

+++

Sam wondered if Leigh knew there were smudges of mascara under her eyes—not enough to spoil her looks, but proof she’d been crying.
I know the feeling.

“I don’t want to play games,” Leigh said, crossing her arms. “If you called me in here to rub my nose in the fact that you told Nick about the miscarriage . . .”

“I thought you’d want to know why.”

“I’m not going to bite this time, Sam. The only reason I came in here is to tell you I’m through with this. It’s a waste of time for all of us, and it’s inappropriate. I should never have engaged in personal conversation with you. You’re a patient, a fairly sick one, and I’m—”

“The woman Nick thinks he wants. Or wanted. I’m guessing that’s past tense now from the way you look.” She shivered, felt a strange wave of dizziness, and glanced toward the new IV antibiotic they’d started minutes earlier. She hoped this one would work. “Nick was upset?”

“I’m not discussing that with you.”

“I don’t blame you for hating me.” Sam scratched at her ear. “I can’t count the number of times over the past year that I’ve wished you’d break your neck on that horse or fall in love with a brain surgeon.” She was surprised by a rush of tears. “I . . . I only wanted a chance. It sounds idiotic . . . pathetically corny, but I wanted what everyone else has—a happy ending.” She thought of Elisa and her LEGO castle and her throat tightened. “Nick understands that feeling. But I don’t think someone like you can.”

“Someone like me?”

Sam cleared her throat, rubbed her tongue over the tingling roof of her mouth. “You’ve had it good all your life. Parents, great schools, nice clothes . . . people who protected you, cared about you. Nick didn’t have that. Neither did Toby and I.” She closed her eyes for moment and felt her lids scratch oddly over the surfaces, as if her eyeballs had been roughened by sandpaper. “Let me tell you how it was at my house when your father was helping you with your math, and your mother was wearing pearls to bake sugar cookies for the PTA.” She stared hard at Leigh. “No dad at the Gordons’. Plenty of men, though. And the ziplock bags hidden under the lid of our toilet weren’t filled with sugar cookies. No one helped Toby and me with our homework. But if we kept quiet while Mom thrashed around in her bedroom, we’d get a candy bar. If Toby tried to interfere, he’d get a split lip.” She narrowed her eyes, fighting a wave of nausea she thought she’d left behind two decades ago. “And if I was really nice to those men and didn’t tell anyone what they did to me after Mom passed out . . .” She saw Leigh flinch and knew she’d hit her mark.

Sam scratched her forehead and grimaced against a wave of itching. “I’m not trying to get pity. I’m tough. Tougher than that punk who shot me.” She smiled grimly. “Only not so fast on my feet anymore. All I’m trying to tell you is that I’ve only met two men in my entire life that I think are worth something. Toby was one. Nick is the other. I’m not kidding myself that your husband climbed into my bed because he loved me, but I swear I won’t give up . . . trying . . . to . . .” Her voice choked and she struggled to swallow. “Something’s . . . wrong.”

Leigh stepped to the bedside. Her eyes widened and then her gaze darted to the IV fluids. “Sam, you’ve got hives. All over you. Give me your arm.” She grasped Sam’s arm, slid the clamp on the IV closed. “Are you itching?”

“Yes . . . I’m on fire.” Sam scraped her fingernails against the side of her neck. “My throat itches, too. I think my lips are swelling.” She gasped for a breath and wheezed.

Leigh crossed to the door and shouted, “I need a nurse! Bring IV Benadryl and epinephrine. Grab the crash cart and get respiratory therapy here. We’ve got an allergic reaction. A bad one.”

Sam struggled to sit upright, felt searing pain in her incision but didn’t care. She had to get up, stop what was happening. The blood pressure cuff inflated on her arm, making the itching turn to unbearable burning. Tighter, tighter. She thrashed, tried to pull it off, tried to—

“Hold still, Sam. Let us put this oxygen mask on. The nurse is going to get your IVs pumping faster. Hold still. Don’t fight us.”

Acrid plastic covered her face and Leigh’s voice sounded farther away, like it was coming from a tunnel. “Fifty of Benadryl, IV. Pull out some Solu-Medrol. Is that the BP reading—72 over 40? Check it again. Saline wide open, pour it in. She’s anaphylactic.”

Alarms buzzed above her, persistent as bees. The stinging and itching worsened until she wanted to scratch her skin bloody. She was smothering to death.

She tried to focus, couldn’t see through the fog, then struggled again to sit up so that she could suck air, barely, past her swollen throat. Her voice emerged like the last gasp of a strangler’s victim.

“I . . . can’t . . . breathe.”

Chapter Twenty-Six

Leigh bent close, trying to reassure her—Sam was panicked.

“Sam, listen to me. The epinephrine’s making your heart race and causing your shakiness, but that’s okay. Hang in there. We’ve got to stop this reaction. You’re allergic to the antibiotic. I know this is frightening, but—”

Sam gagged and Leigh snatched the misting treatment mask away as she began vomiting, each retch followed by a shrill, whistling wheeze when she struggled to get a breath. Sam’s lips had gone gray. “Suction!” Leigh ordered. “Clear her airway!”

Leigh’s gaze darted toward the monitor display as the nurses and respiratory therapist worked: BP 78 over 38, pulse 146, oxygen saturation . . . 81 percent? She gestured to one of the nurses. “Set me up for intubation. Is that steroid on board?”

“Yes, Doctor. Plus the diphenhydramine and a second dose of epi. The saline’s running wide open, but—”

“I see the blood pressure,” Leigh interjected, her mouth going dry.
And I know she’s getting worse instead of better.
She leaned over the bed again, very aware of Sam’s stridor and wheezes, despite the medication infusing through the mask. There was terror in her eyes.

“I’m . . . going . . . to die.” Her hand, grasping Leigh’s, was cold, clammy with sweat—her face, lips, and eyelids were rapidly swelling.

“No. We’ve informed Dr. Bartle, but there isn’t time to wait. Your throat’s swelling inside. I need to put a tube in to help you breathe.”

“Oh . . . God, help . . . me.” Sam’s eyes swam upward and then she focused again, gripped Leigh’s hand even harder. “Elisa . . . tell Nick . . .” Tears filled her eyes, spilled over, but her gaze stayed riveted to Leigh’s. The anguish in them made Leigh’s heart ache.

Lord, please help me help her.

“I’m . . . going . . . to die,” Sam repeated as the monitor alarms shrilled.

The nurse stepped close. “Your intubation tray is ready, Doctor.”

“I’m . . . sorry . . . ,” Sam whispered. “I only . . . wanted . . .” Her eyes rolled back and her head sank against the pillow.

Leigh grasped Sam’s hand, leaned close. “I won’t let you die. Do you hear me? Nick can’t lose you too. You stay with me—fight, Sam!”

She whirled, nodded to the respiratory therapist. “Let’s hyperventilate her so I can get this tube in.”

In less than two minutes, she slid the laryngoscope blade over Sam’s swollen tongue and saw with dread that the entire back of her throat was massively edematous. It was impossible to visualize the necessary landmarks—epiglottis, vocal cords . . . “Suction!”

Leigh suctioned the saliva away and held her breath as she tried to slide the tube past . . . “Too big—give me a cuffed number five,” she ordered, seeing with dismay that her patient’s face had gone grayer. “Bag her, please!”

Heart pounding nearly as fast as her patient’s, Leigh tried again with the child-sized tube, but the swelling had progressed. “Did the OR call back? Is anesthesia—”

“The anesthesiologists are all in surgery. I could call downstairs and see if they can pull the ER doctor away, or—”

“No. No time. Bag her again,” Leigh said, pulling the tube away. “Give me a number four tube. I’ll try to insert it nasally.”
It won’t work. She is going to die. Unless . . .
“Never mind. Get me a number fifteen scalpel, some hemostats, and prep her neck fast. I’m doing a cricothyrotomy.”

In minutes the staff had Sam, mercifully unconscious from shock, positioned with a rolled towel under her shoulders, head lolled back and throat exposed. Leigh said a prayer under her breath and touched a gloved finger to Sam’s Adam’s apple—the thyroid cartilage. She identified the cricothyroid membrane beneath, reminding herself of the underlying anatomy location of associated blood vessels.
Don’t let me hit a vessel . . .
She lifted the scalpel, held her breath, and quickly made a two-centimeter vertical slice, sponged away the blood and widened the opening with the hemostat, then inserted a number six endotracheal tube.