Authors: James Grippando
PEYTON SHIELDS COULD FEEL IT COMING. NO ONE HAD TIPPED HER
off. No neon lights were blinking. But her sixth sense was in high gear.
Peyton was in her first year of residency in pediatric medicine at Children’s Hospital, Boston, one of an elite thirty-seven interns chosen from premier medical schools around the world. She’d vaulted to the top through relentless drive, stellar academic credentials, and a mountain of debt to Harvard Medical School. Good instincts, too, were part of the successful package, and at the moment they were telling her that something strange lay ahead.
She parked her car in the space marked
outside the North Shore clinic, about thirty miles north of Boston in the city of Haverhill. Peyton was at that stage of her professional training where pediatric residents spent three or four days each month at an outlying clinic to broaden their experience. Haverhill was somewhat of a plum as far as clinical assignments went, situated in the affluent Merrimack Valley. Driving out in any direction, you were virtually guaranteed to run smack into a quaint, three-hundred-year-old town whose 98 percent white population earned more than double the state’s median annual income. Though not the most charming in the valley, the city was an interesting mix of one of the finest Queen Anne–style streetscapes in America and blue-collar housing that
had grown from the once-prominent shoe industry. With roughly 10 percent of its population living below the poverty level, the routine medical needs of its Medicaid children were served primarily by the clinic. Today, that meant primarily by Peyton.
“What are you two doing outside?” asked Peyton as she stepped out of the car.
It was a fair question. Even though it was a sunny fifty-six degrees—a heat wave for late February—it was highly irregular for Felicia and Leticia Browning to be caught chitchatting outside the front door at nine-thirty in the morning. The clinic’s two full-time nurses were identical twins with polar-opposite personalities. Felicia was the more serious sister and a frequent pain in the neck.
“Power’s out,” said Leticia, giggling as usual.
“That’s weird. All the traffic lights were working on my way over here.”
“Cuz you was coming from the south,” said Felicia. “Power’s out from here north.”
“Earthquake,” said Leticia. More giggles.
“No joke,” said Felicia. “We’re on the southern edge of what they call the active zone, thirty miles north of Boston and on up to Clinton. Two dozen quakes in the last twenty-one years. Usually little bitty ones, like this.”
“How do you know all that?”
“We’ll always know more than you,” said Felicia, only half-kidding. “We’re nurses.”
Leticia pulled a battery-powered radio from her sister’s coat pocket. “They just interviewed a Boston College seismologist on the air.”
“Shut up, fool,” said Felicia.
“Ah,” said Peyton, seeing they really weren’t yanking her chain.
“I take it there’s no backup generator for this place.”
Leticia just laughed. Her sister said, “Dr. Simons canceled his morning appointments and went home over an hour ago.”
Good ol’ Doc Simons. He ran the clinic, but hands-on he was not. To him, carpe diem meant “seize the day
The three women looked at each other in silence, as if soliciting ideas on how to keep busy. Peyton was about to walk inside when a car sped into the parking lot and screeched to a halt. The driver’s-side door flew open and a teenage girl jumped out with a baby in her arms.
“Somebody—help my son!” She looked barely old enough to drive and sounded even younger. Peyton ran to her and gathered the baby in her arms.
“How old is he?”
“Twenty-one months,” she said in a panicky voice. “His name’s TJ. He got stuck with a needle.”
“Are you his mother?”
“Yeah. My name’s Grace.”
“Take him to Room A,” said Felicia. “It’s got plenty of sunlight.”
Peyton hurried inside, stepping carefully through the dimly lit hall. The baby’s cry was weak, as if he’d wailed to the point of exhaustion. They slid the examination table closer to the window to take advantage of the streaming sunlight, then laid the boy on it.
“Needle went in right there,” said Grace, pointing at his leg.
Felicia aimed a flashlight. Peyton noticed a minor puncture wound inside the thigh. “What kind of needle was it?”
“Sewing needle. About an inch long.”
“Did you bring it with you?”
“It’s still in his leg.”
Peyton looked closely but still didn’t see it. “You sure?”
“The very tip was sticking out at first. I tried to work it out, you know, like a sliver. But it disappeared inside him.”
Leticia slipped a small blood-pressure cuff onto the boy’s right arm and pumped it. “You’re sure it was a sewing needle, child?”
“What else would it be?”
Felicia grabbed the girl’s wrists and rolled up her sleeves.
“Show me your arms.”
Grace resisted, but Felicia was much stronger. “I’m no druggy. Leave me alone.”
The arms were trackless, but Felicia wasn’t finished. “You shoot between your toes, girl? Or is it your boyfriend who does the drugs and leaves his needles laying around?”
“Nobody is on drugs, so just go to hell!”
Peyton was about to side with the girl, but then she noticed the marks on the backs of her legs just below the hemline of her skirt. “Is that blood behind your knees?”
Grace backed away. The nurse grabbed her and hiked up her skirt. The backs of her thighs were pockmarked with bloody needle holes.
“What is going on here, child?” said Felicia.
“My boyfriend did it.”
“Did what?” asked Peyton.
“We got in a fight. He started jabbing me with this stick of his, so I grabbed TJ and ran out the door. He got TJ in the leg, and the needle broke off when I jerked away.”
“What kind of stick has a sewing needle on it?”
“He made it himself. A broomstick with a needle on the end of it. He uses it when I jog.”
She lowered her eyes, as if embarrassed. “I got fat when I was pregnant and couldn’t lose it after TJ was born. So he makes me jog. He uses the stick to keep me going.”
“You mean like a cattle prod?” asked Leticia.
“Who the hell is your boyfriend?” said Peyton. “I want to meet this chump.”
“Believe me. You don’t want to meet him.”
The baby started crying. Peyton sterilized her hands and gently palpated the leg, starting at the entry wound and inching her way up. “Does it hurt here, little fella?”
“What are you doing?” Grace asked.
“Trying to locate the needle. It seems to have traveled beneath the skin away from the point of entry. It if doesn’t exit on its own, it might work its way into the bloodstream.”
“Gross,” said Grace, grimacing. “It’ll rip up his little veins.”
She was still too much of a kid to grasp the gravity of it. Peyton said, “My real concern is that it could travel to his heart.”
“Then you gotta get it out.”
Leticia said, “We can’t X-ray without electricity. He has to go to the hospital.”
“No way,” said Grace. “It could hit his little heart by the time I get him there.”
“Hold on,” said Peyton. “I think I got it.” Gently, she pressed two fingers against his inner thigh. TJ cried as it poked from beneath. Peyton could feel the blunt end of the needle just below the skin.
“Get me a little lidocaine, please.”
“You’re not going to cut him open,” said Felicia.
“With his mother’s consent, I will. Just a teeny incision, and it will pop right out.”
“Do it,” said Grace.
“Don’t you dare,” said Felicia. “You’re an intern in pediatric medicine. Even surgical residents can’t do surgery without a supervisory physician.”
“This isn’t surgery. You’re being silly.”
“Silly is a know-it-all doctor who oversteps her authority and puts this clinic at risk of losing its malpractice coverage.”
Peyton simply injected the local anesthetic and said, “Scalpel, please.”
“This is your neck,” said Felicia. “You know this is against the rules.”
Leticia held the flashlight. Peyton made a minuscule opening, more of a poke than a slice. It barely bled. With the slightest encouragement, the needle’s eye emerged.
“Tweezers,” said Peyton. She grabbed the end and pulled it straight out, then placed it on the table in front of Felicia. “There you go. I think I’m ready to move on to kidney transplants now, don’t you?”
“Go for it,” said Felicia. “I’ll add it to my incident report.” She left the room in a huff.
Peyton shook her head and finished the job. The baby’s crying was plentiful, but the bleeding was minimal. A Band-Aid might have been sufficient, but to be safe, Peyton closed the small incision with liquid stitches. It took only a minute. Leticia dressed it with sterile gauze.
Grace hugged her. “Thank you. You saved TJ’s life.”
“Well, I wouldn’t exactly say that.”
The young mother held her son tightly. His crying soon turned to coos.
Their contentment ended with a skidding sound from the gravel parking lot outside, followed by the slamming of a car door. Grace ran to the window.
“Grace!” he shouted as he started across the parking lot.
“Hide me. He’s crazy!”
Peyton glanced outside. A young, muscular man was charging toward the door, armed with that infamous pointy stick. “In the closet,” said Peyton. She pushed the mother and her baby inside and shut the door.
“I know you’re in here, Grace!” He was in the reception area.
Leticia grabbed Peyton’s cell phone. “I’m calling nine-one-one.”
Grace shouted from inside the closet, “We’ll all be dead by the time they get here!”
Peyton feared she was right. She knew Doc Simons had faced situations like this before, and she knew where he kept his gun. She hesitated for an instant, then ran to his office and unlocked the drawer. There was barely enough light, but she found the Smith & Wesson. She checked, and it was loaded.
“What are you doing?” asked Felicia, her eyes wide with panic.
“We can’t stand by and watch a teenage mother get beat to death with a stick.”
“You’re crazy to get in the middle of this.”
Grace screamed in the next room. Peyton wasn’t a big fan of guns, but there was no time to wait for the police. “Maybe I am,” she said, almost to herself.
She ran as fast as she could only to find Jake—all six foot six of him—yanking Grace from the closet, poised to slam her head against the wall.
“Stop right there!” Peyton held the gun with both hands, aiming at his chest.
He released his grip. Grace grabbed her crying baby and rushed to Peyton’s side. Jake took a half-step forward, challenging them.
“Not another move!” said Peyton.
“As if you know how to use that thing,” Jake said, smirking.
“The jar!” she shouted, and with one quick move she fired a shot that shattered the jar of cotton balls resting on the shelf behind his ear.
His eyes turned the size of silver dollars.
“My daddy was a cop, jerk. Now get down on the floor, face-first.”
He quickly complied. “How much do you weigh?” Peyton demanded.
“Just answer the question.”
“What?” came the muffled reply. She was hiding under a desk.
“Get me the secobarbital sodium. Full adult dosage plus five milliliters.”
In thirty seconds, Leticia had the syringe in hand. “Stick him,” said Peyton.
The nurse glanced at Grace and her needle-pricked baby. “With pleasure,” she said, then gave him a good jolt to the right buttock.
He flinched and muttered a few obscenities, and then his body slowly relaxed. The room fell silent. It seemed to take a long time, but in ninety seconds he was out.
“Thank you,” said Grace.
Peyton began to shake, finally hit by the full impact of what she’d just done. “Where the hell are the cops?”
“I’ll call nine-one-one again,” said Leticia. “Must be lots of calls with the power outage.”
A groan suddenly emerged from Dr. Simons’s office down the hall, followed by intense cursing. Peyton hurried out, opened the unlocked door, and froze. Felicia was hunched over the examination table, feet on the floor. Her pants were pulled halfway down her large buttocks, and she was applying gauze to the left side. Across the room, Peyton noticed the waist-high bullet hole in the wallpaper. The warning shot she’d fired at the jar of cotton balls had passed through two interior walls. It couldn’t have been traveling very fast by the time it reached Dr. Simons’s office on the other side of the clinic, but evidently it had been going fast enough.
“You shot me in the ass,” said Felicia, groaning.
“Let me help you.”
“Stay away. It barely nicked me. Lucky for you.”
She didn’t feel lucky. Just the fact that it could have been serious made her queasy. “It was…an accident,” she said, her voice cracking. “I didn’t want to hurt anybody. He was coming at me. If I hadn’t fired a warning shot, he might have grabbed the gun from me.”
“You should have thought of that before you went running for the gun in the first place.”
“Felicia, I am so sorry.”
“Don’t give me sorry.”
Peyton stepped into the hall, as if driven back by Felicia’s glare. Outside were police sirens, finally. Peyton held her breath, dreading what Felicia might tell them.
“Oh, boy,” she said quietly, dying inside.
A nurse rushed by with a girl in a wheelchair. Peyton quickly dodged out of the way with a nifty little two-step. It was a familiar dance in these busy halls. Emergency was no place for lead feet.
Children’s Hospital was one of the largest emergency/trauma centers in New England, each year treating more than 12,000 injured children and recording more than 50,000 patient visits in its emergency department. Peyton felt like 49,000 of them had been recorded in the last week, though this morning was relatively quiet. A teenager in Exam 1 was vomiting nonstop, partly into a big green bucket, mostly onto an intern. The little girl in Exam 2 was crying with a broken arm. The infant in triage was screaming inconsolably, her concerned mother rocking her in her arms. Experience had taught Peyton to enjoy the occasional morning lull, the one time of day when staffing was relatively high and the caseload might actually approach some level of sanity. Like it or not, the emergency department was one of thirteen required rotations for interns over the course of the year. Peyton was just one week into it with three more to go. Her only break so far had been the one-day trip to Haverhill and Nurse Felicia. Some break.
It had been four days since the shooting at the clinic. Felicia’s butt was fine, but she was after Peyton’s in a big way. Nothing like being on the wrong end of a million-dollar civil lawsuit to launch
a young doctor’s career. The fight was now in the hands of lawyers. She’d be reassigned to a new clinic, for sure. She just prayed to God she wouldn’t get fired.
She reached for a patient chart, but a senior resident beat her to it.
“I got it,” he said. “Dr. Landau is looking for you.”
Her heart sank. Landau was the residency program director.
“I don’t know. I just ran into him in the lounge. He was grumbling to Dr. Sheffield about some meeting you missed. Not in a good mood.”
Sheffield was the chief resident. This wasn’t looking good.
“If you hurry you might catch them.”
Butterflies churned in her belly.
This is it. I’m getting canned
She crossed the main lobby, passing the huge saltwater aquarium and the life-size ceramic giraffe that was perched behind the reception desk. The giraffe usually made her smile, but too much was on her mind as she opened the door and entered the pavilion lounge.
Peyton started, then smiled at the group of nurses and doctors that had squeezed into the small lounge to surprise her. Inflated latex gloves dangled from the ceiling as makeshift balloons. A computer-printed banner from the billing department read
HAPPY BIRTHDAY, PEYTON
! She recognized almost everyone, a few from the ER but most of them from prior rotations.
“My birthday was last week,” said Peyton.
“But then you wouldn’t have been surprised,” said one of the interns.
“Good point.” She smiled, then subtly rolled her eyes. “Sort of.”
A nurse poured her a glass of sparkling grape juice, the on-duty version of champagne. The door swung open, and in marched a clown to a round of applause. Clowns were a common sight at Children’s, where laughter was a proven therapy for ailing children. This one was a mime dressed in a black tuxedo with a
matching bow tie and cummerbund of red-and-white polka dots. The hair was slicked back. His face was painted white with stars on both cheeks.
He set his boom box on the floor and, without a word, pointed to Peyton from across the lounge. With encouragement from her friends, she stepped forward. The mime switched on the music—the tango.
Peyton shrank with embarrassment at the thought of tangoing with, literally, a clown. But he was suddenly Valentino, circling her, giving her the eye. From inside his jacket he snatched a single red rose. Down on one knee, he presented it to Peyton.
“Go for it, girl!” a nurse shouted.
As if on cue, she assumed the classic tango pose, the rose clenched between her teeth. Her friends roared as, cheek to cheek, the dancers darted from one end of the room to the other in surprisingly smooth tango steps. He laid her back over his arm for the final pretend kiss.
The crowd hooted. The chief resident smiled and said, “Peyton, please, this
a children’s hospital.”
The mime snatched the rose and, like magic, handed her a cupcake with a burning candle. The impressed crowd ooohed and broke into an impromptu rendition of “Happy Birthday” in various keys. Peyton blew out the candle to more applause.
“Thank you, all of you.”
The door swung open once more, this time for one of the trauma nurses who’d stayed behind in the ER. The expression on her face said it all. “Auto accident. Looks pretty bad. Four kids, one adult. Paramedics are bringing them inside.”
The fizz was suddenly gone from their sparkling grape juice. Peyton’s trauma-team leader said, “Fun while it lasted. Let’s go.”
The others stayed put as the ER folks quickly dispersed. Peyton rushed for the door with the rest of them. Out of the corner of her eye she caught sight of the mime, his bemused expression evident even through the thick clown makeup and painted-on stars.
“Thanks,” said Peyton.
He just looked at her, ever silent. The lack of response made her slightly uncomfortable, but she kept moving forward. On her way out, she glanced back. He was still watching her.
She sprinted across the main lobby to the ER. The adrenaline kicked in immediately, sparked by the paramedic’s announcement of the first victim’s arrival: “Eleven-year-old white male. Head trauma, numerous lacerations, broken right fibula.”
“Shields, with me! Trauma One.”
Nearly at full speed, Peyton followed a team of paramedics wheeling the gurney down the wide hall. Behind her, a cold winter wind poured in from the open emergency entrance, where another ambulance was pulling up. Ahead, the team leader shouted out commands and led the way to the trauma center. In her mind Peyton was already envisioning the patient, the injuries, the treatment. Just before her team made the final turn around the corner, however, she spotted him again.
Her birthday mime was standing outside the hospital’s main entrance, peering into the ER through the curved wall of plate-glass windows that lined the separate ER waiting room. She kept moving, trying to focus on the crisis at hand, somewhat unsettled by all that staring. Perhaps he was just intrigued by the general chaos, though he seemed fixated on her, the way she could almost feel his gaze.
She started at the sound of her team leader’s voice, then ducked into the trauma room, no more distractions, no more looking back.