In Case of Emergency (30 page)

The man gestures to his lower right rib cage, where there is a dark stain, difficult to see because of the dark blue, sweat-soaked uniform shirt he’s wearing. William cuts through the thick shirt with trauma shears, peels the undershirt off of the wound, and my arms dance around William and Tyson in order to place the oxygen mask around the man’s head.

When the wound is exposed we all pause. It’s a deepening gash running in a diagonal line between his eighth and ninth rib, but the amazing thing is that I can hear it: I can hear the hissing, sputtering sound the wound makes as he struggles to breathe.

Captain Greger and the others come up from the back of the bus and
unsling the ECG monitor onto a nearby seat. “We’re calling her,” Greger advises the firefighter with the clipboard. “Too much blood loss; she’s asystole; we checked in two leads. We’re going to focus all our energy on him. What have we—” He turns to Tyson, who is pressing the bell of the stethoscope into several places on the man’s chest. “Sucking chest wound. Dag, set up a needle-D; Sammy, go ahead and throw the leads on him; let’s get a BVM ready…”

My fingertips hover over the medbox, suspended in their reach for an occlusive dressing. The thought that we still need to check for possible exit wounds (because we don’t know how long the knife was) vanishes. For the first time, my eyes register our second patient.

An arm pushes past me, grabs what it needs from the medbox. “What the hell is wrong with your partner?”

William doesn’t answer. He has followed my gaze down the length of the bus.

Her short thick hair is matted from blood. The dark strands plaster themselves across her face. Her head tilts downward, resting against the window, and her shoulders are slouched. Even in death she has bad posture.

“Is that…,” William’s voice—his pretentious, blistering voice—subdued into a child’s hushed awe. “Isn’t that your girl?”

Everything inside me lights up in agony but I can’t move. A red spray coats the back of the gray plastic seat. A dark pool glistens on the floor. She’s wearing a tan, long-sleeved shirt. Her eyes are closed, but if they were open they would be green, because Ayla’s eyes are green.

I start screaming. William turns pale and jumps back. His freckles stand out so sharply from his face I have the absurd thought that I could reach out and pluck them. I could gather a few with my fingertips and roll them around on my palm.

My scream trails off and everyone is frozen in place, including the bus driver, whose ragged breathing punctures the silence. I push past the group and down the aisle. I want to call for help. Someone should call 911. Her
expression would look almost peaceful if it weren’t for all the blood.

A hoarse shout from behind me. “Get her out of here,” Captain Greger begs. “I want her off the bus
now
.”

Even without turning my head I can feel the confusion of the agitated crew, the voices from outside the bus coming nearer.

I get to the end of the aisle. Ayla’s cheekbones sit higher on her face than those of the woman in front of me. Ayla doesn’t wear tan shirts. Or silver rings. The woman’s left ear is nearly severed; what remains of the half-moon chunk of flesh dangles from a deep hole just below her cheekbone. I stare at it, then at the wounded neck still oozing blood. Her arms droop in her lap like helpless offerings. With a trembling hand, I lean over the woman, press a fingertip to her eyelid, and lift up.

Her eye is brown. The pupil fixed and dilated.

Sliding myself into the neighboring seat I wrap my arms around the dead woman. I rock her limp, still-warm body back and forth. The weight of her slick and heavy head swings against my shoulder.

When the police come to remove me from the bus, it takes three officers to peel my arms from their embrace. “It’s not her,” I tell them over and over. Pulling me to my feet, the officers half-drag, half-carry me off the bus.

46

A cop drives me to Crossroads, lets me out in the ambulance parking lot, and never says a word. When I’m standing on two feet again, I stare up at the three gray box towers of CRH, feeling like I’ve never seen them, really seen them, much less the bent sky above or anything else around me. The world is a strange and oblong shape.

Inside, in the hallway near the nurses’ station, William is stripping down the gurney. He halts mid-motion when he sees me. “What—”

For once, he is speechless.

“It wasn’t her,” I say.

I can’t read his expression very well. His jaw muscles ripple, his face swinging between pity and disgust.

“How’s the other patient?” I ask.

William jerks his chin toward one of the trauma rooms. “See for yourself.”

In Room 1, Bed A, the bus driver lies unconscious. Curtains create a circular perimeter around the room, and I watch through the gap as the doctor and nurses prep the man’s right side for a chest tube. He’s covered up to his waist by only a thin sheet, and both of his arms have been raised above his head and folded across the top of the pillow. He would look like he was lounging or taking a nap if it weren’t for all the activity around him.

“We’ll need bilateral entry,” the doctor says through his light blue mask as he coats rust-colored iodine in a broad circle just below the man’s right armpit. “A 32-French for his right and a 30-French for the left.”

“Prepping both now,” a nurse says. “That was a 30-French for his
left
side, correct? And a 32-French for the side of the injury.” From somewhere in the room: snickering.

Tyson stands outside of the inner circle, watching them, his face more pale than the patient’s.

“You mean the side with the actual stab wound?” another nurse calls out. More snickering.

“Enough,” the doctor says. “Janeen, hand me a Kelly clamp.” He has created an incision over the man’s fourth rib, and he uses the curved instrument to stretch wider the opening of the cut, to separate the layers of skin and muscle from each other, before reaching the entire length of his gloved index finger into the hole. When he removes his finger and picks up the chest tube for insertion, a stream of clear red pleural fluid dribbles down the man’s side, escaping from the lining of his injured lung. Inch after inch
of a thick plastic tube gets shoved into the man’s chest, and then sutured in place. The bus driver’s face is empty, close to death, hovering in the balance. But his vitals begin to rise upon the initial drainage of air and blood from his lung cavity.

Tyson is looking at me, his face convoluted by hatred.

I can picture the whole thing. How Tyson was so flustered on scene that when he went to perform a needle-decompression, he plunged the needle into the wrong side, the uninjured side. I can picture the tip of the needle entering the man’s healthy lung, just below the clavicle and above his heart, and how it created a second pneumothorax there. I can picture the crew in the back of the ambulance, or perhaps the ER team that received him, realizing the mistake. They would have had to place a second needle and begin the management of not one but two pneumothoraces. One is enough to kill a person.

This isn’t me. I haven’t made a mistake this big before.

The curtains get pushed back, and members of the ER team shout to each other as they wheel the man out of the room and upstairs to the OR for surgery. Soon the hallway is empty and quiet. Tyson stands directly in front of me. A call everyone will be talking about for months, and he blew it. My fists hang at my sides, someone else’s blood smeared on my arms.

“Piper, that woman back there, did you know her?”

My voice is flat, unmoved, unapologetic. “No, sir. I thought I did. But no.”

“Well, listen, I don’t know what’s gotten into you, but you better pull your shit together.” His voice shakes a little. “You got that?”

“I got it.”

He leaves, pushing the swinging door so hard it creaks in protest before settling back on its hinges. I take a few steps into the blue-white light of the trauma room. Over a confetti of discarded dressings and crumpled tape, the plastic encasements for IV bags and the no-longer-sterile needle wrappers litter the floor like shelled husks. Despite the silence, the stillness, the
room is riddled with evidence of what happened in here. There is a void in the center of the room, free of any debris or paraphernalia: a rectangular-shaped vacancy where the bed had been standing.

I stumble to the double doors of the ER, push them open, and step outside. The cool night air hits the sweat on my temples and neck. I try to stiffen my shape into a less flimsy one as I descend the ramp. My hand on the railing, one wobbling, unwilling foot in front of the other, I manage not to fall down.

What does it matter, anyway? Fuck it. What does any of it matter? People die every day.

There is an oak tree near the hospital entrance, healthy and tall despite the fact that no one ever waters it, its broad branches partially covering the sign that reads
CROSSROADS HOSPITAL
. It is the only tree for about a mile around and the only tree of its kind in this area: a magnificent, lonely, lumbering beauty.

I vomit somewhere near the base of it.

47

When conducting the triage of a multi-casualty incident—

Green, green, red. Black, yellow, red, yellow.

Start by taking charge.

The mechanism behind memory isn’t fully understood. How your brain works remains the fundamental scientific question of our time.

Airway, breathing, circulation. Skin signs, vitals, level of consciousness.

An entire skyscraper filled with peer-reviewed scientific textbooks can’t explain a child small enough to fit in your palm.

Consider the events. An unknown number of people traveling on a public bus were stabbed by one of the passengers.

Nothing in you is reliable. Your memory disintegrates, your eyes lie, your inner ear lets the horizon slip away.

Ask for permission to treat. Ask: “What seems to be the problem today, sir/ma’am?”

Green to heal, blue to soothe. The oldest form of medicine is the white pill, made of sugar, designed to be nothing.

Height, weight, age, address, zip code, date of birth, telephone number. You are an abacus. A license plate. A chi square.

The “walking wounded” are the people capable of exiting the bus.

Your only thought is:
Here we go
.

Walk around; take no more than thirty seconds to determine the status of each victim; decide who is dead; decide who isn’t.

The most you can do is describe how much it’s been hurting and for how long. Perhaps it’s a leftover piece of your evolution, a souvenir still lodged within your head, an inner voice screaming for flight.

If there is no spontaneous breathing, put a black tag around the necks or toes so other rescuers will know not to treat them.

If they are breathing at a rate of over thirty breaths a minute, or have a weak pulse and can’t follow commands, they are immediate.

Do your best to stick to protocol. Do not treat; only label.

Triage is simple.

Assign colors.

48

Our shift supervisor is waiting for me at the station when we arrive. He gives me just a few minutes to get ready—enough time to remove my uniform shirt, wash the blood off my arms, throat, and face, and pull on an A & O sweatshirt. His name is Jonathon, but everyone calls him Johnny Be Good.
I’ve seen him only a couple times, dropping off fresh supplies at Station 710. He resembles a weasel with a crew cut, zipped up into an overly starched uniform. His boots have an unholy shine to them.

We sit in a greasy spoon diner, the only late-night diner in the area, whose name is actually Greasy Spoon. We have ten minutes before the place closes. Ten minutes for him to fire me, or scold me, or tell me the meaning of life, or whatever it is he is going to tell me. All I want is a shower.

Johnny Be Good orders us coffees to go, and soon a white paper cup sits in front of me, looking entirely too expectant with its wafts of steam, patiently awaiting the company of cream and sugar. As the supervisor talks, I watch the spiky patch of skin to the right of his Adam’s apple, the patch that escaped this morning’s shave and has a crew cut of its own. The thick dark hairs reverberate with each syllable.

“Piper?
Piper
.”

I meet his eyes for the first time.

“Is there anything you want to talk about?”

“No.”

“Okay. Well, listen, you’re not alone in this.” He reaches into his jacket pocket, pulls out a pamphlet, and slides it across the table to me. “Feel free to call the numbers in here anytime.”

The cover of the pamphlet shows a laughing couple captured with a soft-focus lens, the young woman riding piggyback, her arms wrapped loosely around the shoulders of a cheerful man. Underneath, a caption: “Learn to celebrate life in every moment.” Inside, there is a phone number for some kind of support group, and a number for a suicide hotline, and more pictures. Smiles all around. I close the pamphlet and place it next to the untouched coffee cup.

“Death is hard,” he is saying. “And we see it all the time on this job.”

The inside of my left elbow itches. I wonder, again, if I got all the blood
off, or if the itch is simply paranoia. I picture all the ways I could direct violence at the glossy folded paper in front of me. Drive over it with the ambulance, turn it into a shish kebab on a syringe, burn cigarette holes into it, heat it in the microwave until it catches fire, drown it in saline. I want to ask him for more than one copy so that I can prolong the pleasure of destroying it.