Darkness peering (23 page)

Yale struggled for breath, knees buckling, and clutched the sides of
the gurney. This grotesque creature, this mutilation was not his
daughter. Couldn't be. Not in a million years. Forcefully, he
reminded himself he was the attending physician and, regaining his
composure, he proceeded to examine the woman's body. Her skin was cold
and clammy. He checked for capillary refill, applying pressure to the
palmar tip of one of the fingers until it blanched, then releasing it.
A nurse timed the interval until the fingertip "pinked up."

"Let's assess tissue perfusion, not just the BP," he said. "Monitor
with pulse oximetry."

The patient snorted loudly at the sound of his voice. Her hair was
caked with dirt, and there was ground-in grime on her elbows and knees.
He refused to admit to himself that he knew that long red hair. Knew
it intimately, in fact. That he recognized, more importantly, the
small dark mole on the underbelly of her chin. All those years he'd
tickled it with his finger, saying, "You know what this isr It's an elf
freckle. Definitive proof you're my

little elf." He stood still, in shock, a tiny scream ricocheting
around inside his stubborn skull.

"Oh my God." His voice barely registered.

"What is it, Yale?"

"It's my daughter."

Claire. His precious Claire. Short of breath and wheezing through her
nose. He recognized the expiratory and inspiratory wheezing ...
hyperventilation, dyspnea. She was having an acute asthma attack.

"Blood pressure's up to one-thirty over ninety," Hurley, the surgical
resident, said. "She's having a little trouble breathing."

"No shit. She's got asthma." Overwhelmed with panic now,
uncomprehending and trembling, he started barking orders. "Draw up
some epinephrine, stat! We need blood. O-negative! Monitor peak
flow, oxygen saturation and respiratory rate."

The paramedics moved her body in one fluid motion onto the table, and
the surgical team worked both sides of the bed, swiftly and silently
placing her on a warming blanket, hooking her up to the machines. The
stillness was interrupted only by the swish of the respirator and the
beep of the cardiac monitor.

"Her temp is up," the nurse said. Her name, he vaguely recalled, was
Casey. "Color looks okay."

"Give me 0.3 ml epinephrine, subcutaneous."

"But Doctor--" the nurse said.

"What?" he snapped.

"Her vitals are still okay."

"She's having an asthma attack!"

The nurse backed off.

"I want SC epinephrine, 0.3 ml. Hand me those scissors!"

The patient... his daughter ... struggled for breath, not getting
enough oxygen into her lungs. Her legs kicked in panic as two nurses
pinned her down while Yale attempted to cut the sutures from her mouth.
He worked by rote, his hands jerking mechanically in response to
instructions from his brain. He worked as

quickly as he could, trying to forget that this gruesome creature was
his daughter, his beautiful, headstrong, adorable little girl.

"Her pressure's down to one-ten over seventy. Pulse one-ten."

The epinephrine wasn't working quickly enough. "Give me another SC
epi, 0.3 ml, and a hundred-milligram bolus of IV methyl prednisolone

He managed to remove some of the sutures as she tossed her head from
side to side, fighting him off. "Hold steady ... steady, please." She
moaned like a wounded animal. He wanted desperately to look into her
eyes, her lovely almond-shaped eyes, but they were stitched shut,
swollen and blood-encrusted. God, how awful, how awful. No time, not
vital.

"Calm down, Claire. Daddy's here. You're going to be all right,
everything's going to be all right, just calm down ..."

The voices in the room grew distant as he struggled to save his
daughter's life. Her exposed body was a pathetic sight, a conduit for
various tubes and wires. Hurley was feeling her belly to assess for
internal trauma, the X-ray techs were trying to get a chest. She
became combative, kicking them away. A hideous shriek came rattling
from her oxygen-starved lungs.

"Another SC epinephrine 0.3 ml. Start an IV administration of
magnesium sulfate 2 gin five hundred of saline."

Suddenly she lost strength in her limbs. With rising panic, he sensed
that she was inexplicably slipping away from him.

"Claire! Wake up!"

She stopped breathing. He needed to intubate. His hands were shaking
violently now.

"Doctor--r"

"What?" he snapped.

They were all staring at him.

"I can intubate," Hurley said in the calm, efficient voice Yale had
used himself on hundreds of hysterical patients.

"I've got it," he stubbornly insisted, somehow managing to snip the
rest of the sutures from her purplish lips. He pried open

her mouth and, using the laryngoscope blade to push her tongue to one
side, lifted the jaw and exposed the vocal cords. He slipped the tube
between the cords into the trachea, forcing 100 percent oxygen into her
lungs with a bag.

A nurse took over, squirting medication directly into Claire's lungs
and ventilating her with the bag. He breathed a sigh of relief. At
last he was regaining some measure of control, even if it was
controlled confusion.

His voice was tight. "What's her blood pressure?"

"Dropping ... I'm getting ninety over palp ..."

"Dropping?"

"... down to seventy ..."

The roomful of faces fell simultaneously.

The monitor suddenly flat lined and she went into cardiac arrest.

"Full arrest!"

Yale stared in horror at the arm sewn across her chest. "Remove these
sutures, now!" he screamed.

Everybody grabbed a pair of scissors. Precious minutes passed as the
room filled with the sound of snipping. Yale felt sickened by the
intimate frenzy of the people around him. When they freed her arm, he
began frantic resuscitation efforts, first hitting her in the
sternum.

"The rhythm's V-fib."

"Paddles," he said, placing them on her chest. "Clear!"

Her body spasmed with the two hundred joules of electricity.

"Pulse?"

"No pulse."

"Clear!" He defibrillated at three hundred joules. "Pulse?"

"Still no pulse."

"Let's try 340. Clear!"

"Epi in. No pulse."

"Clear! Check pulse."

"No pulse, Doctor."

"Goddammit!"

"No pulse, Doctor."

There was no spontaneous breathing or movement. Her lips were blue and
her pale, clammy skin was already beginning to cool. He couldn't
understand what had gone so terribly wrong. They'd done everything in
their power to save her, they'd done even thing right. She'd been
intubated, she was breathing just fine, when all of a sudden there had
been a dramatic lowering of blood pressure. In an instant, he went
over the entire procedure in his mind, questioning each decision in
turn. Her wounds were not terminal. There were no fractures, no
internal bleeding, no ... He glanced at the heart monitor where a
faint, irregular pattern danced listlessly--electrical-mechanical
disassociation, the electrical impulses of the dying heart. Her vital
signs were pre terminal He knew without even thinking about it that his
daughter was going to die.

"Code Blue!" he screamed. "Clear!"

His mind raced, his hands trembled. He worked on her for twenty
minutes more, but she failed to respond. Everything around him seemed
to slow way down. He knew it was over but couldn't stop himself, he
had to resuscitate. At some point, he felt a hand on his shoulder.

"Yale," Hurley said softly.

He let go of the paddles, a sickening sense of helplessness engulfing
him.

Everybody stood in silence around the gurney.

"Let's pronounce it," Hurley suggested.

Yale opened his mouth but the words died in his throat. He emitted a
hissing sound, the full weight of his daughter's death crushing the air
out of his lungs.

"Time is one-thirty-three A.M." Wednesday, November first. Hurley
said.

The code team dispersed, leaving only Yale, Casey and the tech who
cleaned the bodies and straightened the rooms in

anticipation of family viewings. The tech, whose name Yale couldn't
recall, braided his hair in cornrows and had the kind of disposition
Yale distrusted; he never had anything bad to say about anyone and was
always quoting Scripture. Yale stood watching helplessly while the
tech mopped up blood from the floor and threw out used needle caps and
IV bags. Casey was carefully removing the rest of the sutures. She
cleaned the wounds, and Claire's face became suddenly recognizable
again. Yale gazed down into the cornflower blue eyes of his first
child eyes fixed and dilated--and felt like a fraud. How had he not
managed to save her?

In moments, the chaotic room was cleared.

"Excuse me, Doctor." Gladys poked her head in. "Your wife's here."

Feeling like a condemned man, Yale trudged down the long
ammonia-smelling corridor toward the waiting room. When she saw him,
Jackie shot up from the sofa.

"How is she?" She clutched his arm, an ugly tension in her face. "Is
she okay, Yale?"

He noticed there were splotches of blood on his shoes. He'd seen lives
wasted daily: babies sealed inside plastic bags, men with their brains
blown out. He'd broken the news to countless families, always managing
to numb himself to their externalized pain.

"She's gone," he said flatly.

"What?" She squinted up at him, uncomprehending.

"I did everything I could."

She shook her head, and suddenly he felt a thousand years old. "What
are you trying to tell me, Yale?"

"I don't know what went wrong."

"So what happened?"

"She didn't make it."

"I don't understand."

His face flushed, voice going flat with anger. "She's dead,

Jackie."

Jackie stared in disbelief. Then the raw sound of her grief filled the
stuffy waiting room. She lost her balance and had to be propped
upright, and Yale was forced to endure every bone chilling, unrelenting
sob.

After a while, she deflated in his arms. Became compliant. "I'm
okay," she said, but she was trembling.

"I don't know what went wrong ..." His voice trailed off. He stroked
her hair, going through the motions, dead inside.

Now Casey came hurrying down the hallway toward them, holding out
something for him to inspect. "Dr. Castillo?"

He looked at the object in her hand. It was a necklace, a high school
ring looped through a long silver chain. Dinger's ring. Nicole's
necklace. "Where'd you get this?" he demanded to know.

"It was clamped in her fist."

"Whose fist?"

"Your daughter's fist. I removed the sutures and this dropped out."

He answered her with stunned silence.

RACHEL STARED AT THE LONG SILVER CHAIN WITH THE

school ring looped through it, now coiled in the doctor's hand.

"It belongs to Nicole," he whispered. "Dinger gave it to her." His
eyes were wide with raw fear. "Nicole refused to take this off. She
even wore it to bed."

Rachel turned to the nurse, a makeup less naturally pretty woman in her
thirties. "Where did you find this?"

"Clenched in her fist." She demonstrated. "I was removing the
sutures, and I pried the fingers open and this fell out."

The fact that the nurse had removed the sutures before the medical
examiner had arrived was water under the bridge now. A more urgent
issue was at stake. Turning to the stunned parents, Rachel asked,
"Where's Nicole?"

They exchanged a narcotized glance.

"At a friend's house," Jackie said uncertainly. "Shelly Patton's."

"Call her." Rachel handed Jackie her cell phone, then told the nurse,
"Don't touch anything else. And get the medical examiner over here
right away."

The nurse hurried back up the wide corridor, scuffed white shoes
thudding dully against the beer-colored linoleum.

"Hello?" Jackie Castillo spoke into the phone. "Shelly? It's
Nicole's mom, could I speak with her please?" Cupping her hand over
the receiver, she said with visible relief, "She's in the bathroom."

"Tell her you'll wait," Rachel instructed.

Jackie put the phone to her ear again. "Shelly? I need to talk to
Nicole. It's okay, I'll wait. What?" The fine lines of her face
creased like folded tissue paper. "What do you mean she can't

come to the phone? Shelly," she said in a panicked, cold cadence,
"let me speak with your mother."

SHELLY PATTON SOBBED HYSTERICALLY IN THE SPACIOUS,

antique-filled living room of her home, just five doors down from the
Castillos'. A petite brunette whose dull, edge less features found
their mirror image in the faces of family members gazing out of
expensive frames mounted on the living room walls, Shelly spoke
haltingly between sobs. "Nicole said that ... she and Dinger were
gonna ... meet someplace secret..."

"Did she say where?" Rachel asked as the girl cringed beneath
McKissack's steely scrutiny like some cornered animal. "Where were
they going to meet?"

Shelly's thin-lipped mother stood off to one side. "Shelly," she said,
"sit up straight and answer the question."

Shelly shook her head, mucus bubbles dangling from her nose.

"So you agreed to cover for her?"

"Yeah," she sniffed, daubing at her wet face with trembling fingers.
"She told me they wanted to be alone for like a whole night ... she
said, "Do me a favor, okay? "And I said, "Yeah, okay," and it was like
no big deal ..."

McKissack loomed over the girl like a pure floating spirit of
malevolence. "It's extremely important that you tell us the truth,
Shelly. Nicole could be in serious trouble."

"I know," she wailed, burying her face in her hands.