Bloodstream (17 page)

“Mrs. Braxton?” She heard a shutter banging in the wind. And she heard something else—the faint patter of footsteps, running in an upstairs room. One of the children?

Claire stepped into the house and closed the door against the cold. No lamps were on, and the fading daylight glowed dimly through thin living room curtains. She felt her way down the hail, searching for the light switch. At last she found it and flicked it on.

At her feet, a naked Barbie doll lay on the threadbare runner. Claire reached down for it. “Mrs. Braxton? It’s Dr. Elliot.”

Her announcement was met with silence.

She looked down at the Barbie doll and saw that half of its blond hair had been cut away. When she had last visited this house, three weeks ago, she had seen Faye Braxton’s seven-year-old daughter Kitty clutching a Barbie doll like this one. It had been dressed in a pink

prom gown and the long blond hair had been tied back with a scrap of green rickrack.

A chill slithered up her spine.

She heard it again: the rapid
thump-thump-thump
of footsteps moving across the ceiling. She looked up toward the stairs, toward the second floor. Someone was home, yet the heat was off, the house was freezing, and none of the lights were on.

Slowly she backed away, then turned and fled the house.

Sitting in her car, she used her cell phone to call the police.

Officer Mark Dolan answered.

“This is Dr. Effiot. I’m at the Braxton residence. Something’s wrong here
.“

“What do you mean, Dr. Elliot?”

“I found the front door open, and there’s no heat on, no lights. But I heard someone moving around upstairs.”

“Is the family home? Have you checked?”

“I’d rather not go upstairs.”

“All you’d have to do is take a look. We’re already swamped with calls, and I don’t know when I can get a man over there.”

“Look, could you just send someone? I’m telling you, it doesn’t feel right.”

Officer Dolan gave a loud sigh. She could almost see him at his desk, rolling his eyes in derision. Now that she had actually voiced her fears, they did not seem significant. Perhaps she hadn’t heard footsteps at all, but merely that loose shutter swinging in the wind. Perhaps the family was away. The police will arrive and find nothing, she thought, and tomorrow the whole town will be laughing at the cowardly doctor. Her reputation had already suffered enough blows this week.

“Lincoln’s somewhere over that way,” Dolan finally said. “I’ll ask him to swing by when he gets the chance.”

She hung up, already regretting the call. Stepping out of the car again, she looked up at the house. Dusk had thickened to night. I’ll cancel the dispatch and save myself the embarrassment, she thought. She went back into the house.

Standing at the foot of the stairs, she gazed up toward the second floor landing, but heard no sound from above. She grasped the banister. It was oak, solid and reassuring. She began to climb, driven upward by pride, by grim determination not to be the butt of the latest town joke.

On the second floor, she turned on the light switch and confronted a narrow hallway, the walls dingy from little hands trailing smudges. She poked her head into the first room on the right.

It was Kitty’s bedroom. Ballerinas danced across the curtains. Scattered on the bed were girl things: plastic barrettes, a red sweater embroidered with snowflakes, a child’s backpack in pink and purple. On the floor was Kitty’s beloved Barbie doll collection. But these were not pampered recipients of a young girl’s love. These dolls had been viciously abused, their clothes ripped to shreds, their limbs splayed out as though in horror. A single doll’s head, torn from its body, stared up at her with bright blue eyes.

The chill was back in her spine.

She backed into the hail, and her gaze suddenly shifted to another doorway, to the unlit room beyond. Something shimmered in the darkness, a strange luminescence, like the green glow of a watch face. She stepped into the room and turned on the light. The green glow vanished. She was in a boy’s room, untidy, with books and dirty socks scattered on the bed and floor. A rubbish can overflowed with crumpled papers and Coke cans. It was the typical disarray left by a thirteen-year-old. She turned off the light.

And saw it again—the green glow. It came from the bed.

She stared down at the pillow, splashed with a bright luminescence, and touched the linen; it was cool, but not damp. Now she noticed the faint streaks of luminescence on the wall as well, just above the bed, and one brilliant emerald splash on the sheet.

Thump, thump, thump.
Her gaze shot upward, and she heard a whimper, a child’s soft cry

The attic. The children were in the attic.

She left the boy’s room, stumbling over a tennis shoe as she reemerged in the hallway. The attic stairs were steep and narrow; she had to grasp the flimsy handrail as she climbed. When she reached the top, she was standing in impenetrable darkness.

She took a step forward, and brushed past a hanging light chain. One tug, and the bare lightbulb came on, its dim glow illuminating only a small circle of the attic. In the shadowy periphery she could make out a jumble of old furniture and cardboard boxes. A coat rack, its prongs wide as elk’s antlers, cast a threatening shadow across the floor.

Next to one of the boxes, something moved.

Quickly she shoved aside the box. Behind it, curled up on a bundle of old coats, was seven-year-old Kitty The girl’s skin felt icy, but she was still alive, her throat issuing soft little moans with every breath. Claire reached down to pick her up, and realized the girl’s clothes were saturated. In horror she lifted her glistening hand to the light.

Blood.

The only warning she had was the creak of the floorboard.
Someone is standing behind me.

Claire turned just as the shadow exploded toward her. The impact slammed hard against her chest and she flew backwards, pinned under the weight of her attacker. Claws grappled at her throat. She tried to tear them away, frantically thrashing left, then right, a dozen shadowy images swirling before her eyes. The coat rack slammed to the floor. Under the swaying light, she caught sight of her attacker’s face.

The boy

He tightened his grip around her throat, and as her vision began to blacken, she saw his lips curl back, his eyes narrow to angry slits.

She clawed at his eye. Shrieking, the boy released her, stumbling away. She scrambled to her feet just as the boy lunged at her again. She dodged sideways and he flew past her and landed among the cardboard boxes, scattering books and tools across the floor.

They both spotted the screwdriver at the same time.

Simultaneously they sprang toward it, but he was closer. He snatched it up and brought it high over his head. As it came stabbing down, she raised both hands to catch the boy’s wrist. His strength shocked her. She was forced down to her knees. The blade of the screwdriver wavered closer, even as she fought to keep it at bay.

Then, through the roar of her own pulse, she heard a voice calling her name. She screamed out: “Help me!”

Footsteps thudded up the stairs. Suddenly the weapon was no longer stabbing toward her. The boy pivoted, his weapon redirected as Lincoln flew toward him. She saw the boy fall backwards, sprawling to the floor. Saw the boy and Lincoln rolling over and over in a blur of thrashing limbs, furniture and boxes scattering around them. The screwdriver skittered off into the shadows. Lincoln pinned the boy facedown on the floorboards and Claire heard the metallic click of handcuffs snapping shut. Even then, the boy continued to struggle, kicking out blindly. Lincoln dragged him over to an attic support post and tightly lashed him there with his belt.

When at last he turned to Claire, he was breathing hard, and a bruise was swelling up on one cheek. For the first time he noticed the girl, lying among the boxes.

“She’s bleeding!” said Claire. “Help me get her downstairs, where there’s light!”

He scooped the girl into his arms.

By the time he lay her on the kitchen table, she had stopped breathing. Claire gave her three quick breaths, then felt for a carotid pulse, but could not detect one. “Get an ambulance here now!” she said to Lincoln. Positioning her hands over the girl’s sternum, Claire began chest compressions. The blouse was soaked, and her hands kept slipping as she pumped. Fresh blood seeped through the fabric.
She is only seven years old. How much blood can a child lose? How much longer can I keep her brain cells alive?

“Ambulance is on the way!” said Lincoln.

“Okay, I need you to cut off her blouse. We have to see where she’s bleeding.” Claire paused to give the girl three more breaths. She heard fabric ripping and saw that Lincoln had already bared the girl’s chest.

“Jesus,” he murmured.

Blood dribbled from half a dozen stab wounds.

She placed her hands back on the sternum and resumed cardiac compressions, but with every pump, more blood spilled out of the girl’s body.

A siren wailed closer, and through the kitchen window they saw strobelike flashes of light as the ambulance pulled into the front yard. Two EMTs swept into the house, took one look at the child on the table, and threw open their emergency kit. Claire continued pumping on the chest as the EMTs intubated, inserted an IV, slapped on EKG leads.

“Have we got a rhythm?” Claire asked, holding compressions.

“Rapid sinus tach.”

She heard the
whiff, whiff
of the blood pressure cuff, then the answer: “Barely palpable at fifty. Ringer’s lacate going wide open in this IV Having trouble getting this second line started.

Another siren screamed into the yard, and more footsteps banged into the house. Officers Mark Dolan and Pete Sparks crowded into the kitchen. Dolan met Claire’s gaze, and he quickly looked away, sensing her reproach.
I told you something was wrong!

“There’s a boy upstairs in the attic,” said Lincoln. “I’ve already got him cuffed. Now we have to find the mother.”

“I’ll check the barn,” said Dolan.

Claire protested, “Faye’s in a wheelchair! She couldn’t get out to the barn. She’s got to be somewhere in this house.”

Ignoring her, Dolan turned and headed straight out the door.

She focused her attention back on the girl. Now that they were getting a pulse, she could stop pumping on the chest, and she was acutely aware that her hands were sticky with blood. She heard Lincoln and Pete running from room to room in search of Faye, heard the EMT’s radio crackle with questions from the Knox Hospital ER.

“How much blood loss?” It was McNally’s voice on the radio.

“Her clothes are saturated,” answered the EMT “At least six stab wounds to the chest. We’ve got sinus tach at one-sixty BP palpable at fifty. One IV in. We can’t get a second line started.”

“Breathing?”

“No. She’s tubed and we’re bagging her. Dr. Effiot’s here with us.”

“Gordon,” Claire called out. “She needs immediate thoracotomy! Get a surgeon there, and let’s just
move
her!”

“We’ll be waiting for you.”

Though it took only seconds to transfer the girl into the ambulance, Claire felt as if everything were moving in excruciatingly slow motion. She saw it all through a cloud of panic: the heartbreakingly small body being strapped into the stretcher, the tangle of EKG wires and IV line, the tense faces of the EMTs as they ran the girl down the porch steps and slid her into the ambulance.

Claire and one of the EMTs climbed in beside the girl and the door slammed shut. She knelt beside the stretcher, bagging the lungs and fighting to keep her balance as they bumped down the Braxton driveway, then swung onto the main road.

On the cardiac monitor, the girl’s heart rhythm stumbled. Two premature ventricular beats. Then three more.

“PVCs,” said the EMT

“Go ahead with the lidocaine.”

The EMT had just started to inject the drug when the ambulance hit a pothole. He sprawled backwards, his arm snagging the IV line. The catheter slid out of the girl’s vein, sending a spray of Ringer’s lactate into Claire’s face.

“Shit, I’ve lost the line!” he said.

An alarm beeped on the monitor. Claire glanced up to see a string of PVCs skipping across the screen. At once she began cardiac compressions. “Hurry with that second line!”

Already he was ripping open a package, pulling out a fresh catheter. He tied a tourniquet on Kitty’s arm and slapped the flesh a few times, trying to get a vein to plump up. “I can’t find one! She’s lost too much blood.”

The girl was in shock. Her veins had collapsed.

The alarm squealed. Ventricular tachycardia was racing across the screen.

In panic, Claire gave Kitty’s chest a sharp thump. Nothing changed. She heard the whine of the defibrillator. The EMT had already punched the charge button and was slapping contact pads on Kitty’s chest. Claire pulled away as he positioned the paddles and discharged the current.

On the monitor, the tracing shot up, then slid back to a rapid sinus tachycardia. Both Claire and the EMT released loud sighs of relief.

“That rhythm’s not going to hold,” said Claire. “We need the IV.”

Fighting to keep his balance in the swaying ambulance, he wound the tourniquet around the opposite arm and again searched for a vein. “I can’t find one.”

“Not even the antecubital?”

“It’s already blown. We lost it trying to get the IV started earlier.”

She glanced up at the monitor. PVCs were beginning to march across the screen again. They were still miles away from the ER, and the girl’s rhythm was deteriorating. They had to get an IV in her now.

“Take over CPR,” she said. “I’ll start a subclavian line.” They scrambled to switch positions.

Claire’s heart was hammering as she crouched beside Kitty’s chest and stared down at the collarbone. It had been years since she’d inserted a child’s central venous line. She would have to insert a needle under the clavicle, angling the tip toward the large subclavian vein, while running the danger of puncturing the lung. Her hands were already trembling; in the swaying ambulance, they would be even less steady