Twisted Justice

TWISTED JUSTICE

Also by Patricia Gussin

Shadow of Death

A NOVEL

PATRICIA GUSSIN

Copyright © 2007 by Patricia Gussin

FIRST EDITION

All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

This book is a work of fiction. Names, characters, places, and incidents either are the products of the author's imagination or are used fictitiously. Any resemblance to actual events or locales or persons, living or dead, is entirely coincidental.

ISBN 978-1-933515-08-3

Published in the United States by Oceanview Publishing,

Ipswich, Massachusetts

Visit our Web site at
www.oceanviewpub.com

10 9 8 7 6 5 4 3 2 1

PRINTED IN THE UNITED STATES OF AMERICA

This book is dedicated to my wonderful kids

Ben

Wayne

Lynne

Joe

Lisa

Bill

Jeff

I am so appreciative of my two editors, Stacey Donovan of Amagansett, New York, and Enid Perll of Sarasota, Florida. More than editors, they are valued friends. Also thanks to Mary Bole, Denise Janiak, and Connie Flasher, who so generously volunteered to read my manuscript in its formative stage. Susan Greger, Maryglenn McCombs, and Mary Adele Bogden of Oceanview Publishing, and Susan Hayes are simply the best, and I can never thank them enough. But most of all, I thank my fabulous husband, Bob Gussin, medical scientist, fellow author, and the one who reads my manuscripts first draft though last. And finally, I want to pay tribute to my mother, Gerry Plese, who was a wonderful, gentle lady, beloved by all.

Dr. Laura Nelson bolted through the swinging doors slowing for an instant to thrust outstretched arms into a green sterile gown. Twenty minutes earlier she'd flipped off her bedside reading light and slipped into a deep sleep, but now the familiar surge of adrenaline put all her senses on alert.

“Status?” An order, not a question as latex gloves snapped into place.

“Motor vehicle trauma. Ten-year-old kid.” The quaver in the macho chief resident's voice did not bode well. “Truck rammed a car at high speed.”

Laura pivoted toward the small patient centered under the glare of the operating room lights. What she saw made her heart quicken. Not waiting for the nurse to tie the back of her gown, Laura rushed to the central position at the surgical table.

“And?”

The ashen faces of her team told her that the child was in dire shape. Although not a pediatric surgeon per se, Laura was a thoracic specialist and she was the first surgeon called for all major chest emergencies.

“She was thrown from the car. Multiple injuries. Rest of the family —”

“Pressure's falling fast.” The gray-haired anesthesiologist at the head of the table interrupted.

Until she'd arrived, the anesthesiologist had been in charge.
Surprised at the tremor in his voice, she noticed how frail he looked hunched behind the bank of machines.

In the harsh glare of overhead lights, Laura assessed the small form strapped onto the narrow table. She focused for only a minisecond on the exposed patch of mottled skin surrounded by green surgical drapes. At least the team had the child prepped and ready to go.

“No pressure. Can't keep up with the blood loss.” The anesthesiologist spoke urgently from the head of the table. “We're transfusing, but —”

Then Roxanne, the scrub nurse, motioned toward the foot of the table. What Laura saw there made her gasp.

“The drainage bottle – full? That's way too much blood for a child this small. Holy shit, where is it coming from?”

“Two chest tubes in,” the anesthesiologist reported. “Neck's immobilized, but the spinal cord's transected at C-6. I'm ventilating her. I'm ready.”

“We're going in now.”

Roxanne slapped the scalpel into her hand, and with no hesitation Laura excised the child's thin chest straight down the middle. Urgently the surgical team dissected tissue while swabbing the operative field with gauze patches as Laura quickly cut through the sternum with a scissors-like instrument, then pushed aside the tissues that separate the sternum from the heart.

The room was silent except for the rhythmic heaves of the ventilator and whooshing of gases from the canisters. Nobody's favorite music blared. There was no bantering. Just quiet until Laura spoke, “Bright red blood – got to be arterial – pulsatile, but not spurting.” Her voice sounded steady, but her heart was pounding. Anger started to creep into her consciousness, but she shoved it back. She had to stay focused. “Have to isolate the source and patch it. I just hope there's time for this. Pressure?”

“None.” The voice at the head of the table faltered as the anesthesiologist cleared his throat. “And the EKG's erratic.”

“Did anybody detect evidence of a penetrating injury?” Laura asked. Hemostat in one hand and forceps in the other, Laura tried to find her way in the bloody surgical field. She had to find the source of this catastrophic bleeding. She could feel beads of perspiration forming on her forehead. Something unusual was happening here, and she couldn't find it in all this blood.

A young resident from the emergency room stood behind the surgical team, observing. Taking a slight step forward, he responded in a barely audible tone. “Dr. Nelson, when we examined the patient in the ER, she had multiple contusions and lacerations, but then her neck was broken. I mean, we got cervical spine X-rays and all. It wasn't until we got the chest X-ray that we did a thoracentesis. We found blood. We put in chest tubes, but —”

“Wrong priority.” Laura snapped, shaking her head. “Thoracic trauma always takes precedence over neuro or orthopedic injuries. I'll bet there's something sharp in there, and deep.”

“Laura, I can't keep up with the blood loss,” the anesthesiologist announced. “If there's something to fix in there, now's the time.”

Amid her crisp orders, the surgical team explored the pleural space that surrounds the lung tissue. Soon, Laura's hands were deep inside the chest, but there was so much blood she couldn't examine the major vessels of the heart. New blood was pooling as fast as the team could remove it, hampering her methodical search for the point of bleeding. When her hemostat struck something hard, she stiffened.

“More suction, please. There it is.” She paused. “A shard of glass. Penetrating the intrapericardial portion of the ascending aorta.”

“The aorta, Dr. Nelson?” a surgical resident questioned. “Wouldn't she have bled out by now?”

“Consider the tamponade. Pressure within the pericardial sac can plug the hole at least temporarily. But it's broken through. Roxanne, we need an aortic graft.”

“Right here,” the nurse had the package already in hand.

“We'll take our best shot. What's her name?” Laura asked softly.

“Wendy Ruiz.”

Laura sighed. “Hang in there, Wendy.”

“We're losing her, Laura. Flat line.” The tone urgent now as the anesthesiologist peered over the partition into the operating field.

“But we're so close.” Laura held up her hand for the Teflon patch that would be sewn over the hole when the glass was removed.

“Flat line,” repeated the anesthesiologist. “I'm giving epinephrine, but —”

“Just give me the patch,” ordered Laura, ignoring him. Without looking up, she jerked her head in the direction of the senior resident stationed across from her. “You pull out the piece of glass. I'll slap this on and secure it while you suture it into place.”

“No response to the epi, Laura.” The grim tone spoke defeat. “Total flat line.”

“Sutures ready, Dr. Nelson,” said Roxanne. Despite the fact that they were best friends, Roxanne Musing always addressed Laura as “doctor” during surgery.

“On the count of three,” Laura said. The resident angled the hemostat while an intern retracted the child's ribs to give the team maximum working space within the small chest cavity.

Laura waited for the brief interlude between respirator heaves and started her count. She anticipated a gush of blood. There was none. Instead, a piece of glass the size of a roofing nail was extracted from the large blood vessel leading to the heart. A slow flow of blood mixed with soft clots began seeping out, which made Laura hesitate momentarily before applying the patch out of sheer desperation. But it was too late. The child had exsanguinated. How could that have happened in a major trauma hospital like City Hospital?

“It's over,” she said. “We just lost a ten-year-old kid.”

Laura looked at the stricken expression on the ER resident's chubby face.

“Why didn't the ER call me in sooner?” she asked, ripping off her gloves. “The accident happened two and a half hours ago for God's sake. I only live ten minutes from here. This child should not have died.”

“The severed spinal cord —” he began. “We tried.”

“We should've diagnosed pericardial tamponade, and we should've known by the blood from the chest tubes that there was massive intrathoracic bleeding.” Laura tossed her gloves on the instrument table in disgust. “The ABC's of trauma,” she continued, “dammit. ‘C' means circulation.”

The team stood motionless amid the mingled odors of blood and gases and sweat. Finally the anesthesiologist started writing in his clipboard. “Time of death: 1:45 a.m., June 3, 1978.”

“That poor child.” Laura blinked away a lone tear. “Shouldn't have happened.”

Laura and Roxanne had waited for the orderly to remove the body. A meaningless act of humanity, but Laura felt they owed the child that much and that Roxanne would feel that way too.

“I know. Though she would've been paralyzed if she'd lived. Tough life for a kid.”

Shedding their surgical gowns, the two women headed for the doctor's lounge.

“We have got to do a better job here at trauma management,” Laura said, letting her shoulders slouch and averting her eyes to the ground. “When I was a med student in Detroit, we developed the fastest, most comprehensive trauma response in the country. Maybe the world —” Laura stopped speaking abruptly. What was this “we”? She'd been a mere student. No she hadn't played a role, not personally.

Roxanne put an arm around Laura's shoulder. “Hey, two thirty in the morning is no time to solve all the problems of the world.”

“Wendy Ruiz was the same age as my twins. My God, the
Ruizes were coming back from Disney. I took the kids there just last week. I-4, same route. I mean, it could have been us.”

Roxanne frowned. “It's late. Why don't you head on home?”

“One cup of tea to unwind,” said Laura as they stepped into the empty lounge. “After I pop out my contacts — I've had them in way too long. And one of your mother's chocolate chip cookies would help right now.”

Roxanne nodded, a complicit smile on her face.

At thirty-four, Laura Nelson was already a respected thoracic surgeon in the Tampa Bay area. In the operating room, she exuded self-confidence without the theatrical outbursts made prototypical by her male colleagues. Outside of it, her optimism and energy made her popular with administrators and patients alike. But despite admiring colleagues, Laura had no real friends. Roxanne was the only exception, but even with Roxanne she could not share confidences. Not that she didn't long for a confidante, but she had unspeakable secrets, dangerous secrets. Besides, Roxanne had never been married. How could she even begin to understand the complexities that underpinned her relationship with Steve.

“I'll make the tea,” Roxanne offered. Placing the Ruiz chart on the coffee table, she picked up the kettle from the small stove in the doctor's lounge. “I've only been on since three this afternoon, so that makes me the fresher of the two of us walking zombies.”