Code Triage (2 page)

Nick stepped forward and cupped his hands around his mouth. “All they want is to make sure your kids are okay, Kristi.”

“They are. Abby got scared. It gave her a headache and a sick tummy. That’s all. She’s okay.” She glanced over her shoulder. “She’s my little trouper. Aren’t you, sweetheart?” She stared down at Nick, her eyes pleading. “Can’t you tell them to go away? I’m here now. This won’t happen again. Please don’t let them put my kids in foster care.”

Foster care.
His gut twisted. “How about we let the medics have a look?”

Kristi glanced out toward the street. “Is one of those social workers down there? from Child Crisis?”

“No,” he hedged, hoping they’d hold off a few more minutes—and praying it wasn’t Samantha Gordon who’d been dispatched.
Not today.
The farther he stayed from her, the better. The clock was ticking, and if he had any hope of saving his marriage, he couldn’t risk having Sam in the picture. Even professionally. He shoved the thought—and an all-too-familiar stab of guilt—aside. “Let the medics have a look, okay?”

“No.” Kristi’s eyes darted back and forth. “You. You come up. Only you. I know I can trust you.”

He turned to Colton, answered murmured questions and agreed to orders, then took the offered radio. He glanced back up at the window. “I gave these officers my word you don’t have a gun.”

“I swear on my baby’s life. You know me. I’m just trying to keep my kids, hold on to a job, pay the bills . . . save my family.” A tear slid down her face. “Please . . .”

“Okay.” Nick nodded. “I’m coming up.”

He took the creaky stairs two at time, feeling the bulk of his off-duty weapon in the holster at his waist and breathing in the familiar smell of the old building. All of them the same: cooking oils, garbage, cat urine, mildewed carpet, soggy newsprint. The cloying stink of poverty, struggle, and hopelessness. He’d breathed it and worked in it—fought against it—from the day he was sworn in. For a large part of his life, in truth; he’d be thirty-nine next month and was no stranger to hard knocks. He had no idea if he’d ever really change things for these people. But just as he’d said a few minutes ago, he wasn’t giving up. He knew what it was like to grow up without parents, a real home. If there was any way to keep Kristi Johnson from losing her kids, he was going to give it a try.

He reached the second-floor landing and saw her peeking through the barely cracked door.

“Nick, are you . . . ?”

“Alone,” he confirmed, hearing what sounded like retching in the apartment beyond. “What’s going on in there?”

“It’s Abby.” Kristi stuck her head out and peered up and down the hallway before she opened the door. “She’s throwing up again. A flu bug, I guess. I wanted to give her some 7UP, but with all those people down there, hassling me . . .”

Nick stepped in, glancing first into Kristi’s red-rimmed eyes—
pupils look normal, not dilated
—then scanning the room: portable crib, sofa bed heaped with toys and a piled-high laundry basket, a flashlight on the pillow next to a stuffed pony and a storybook. The little girl sat in a beanbag chair on the floor, hair in pigtails, eyes closed, face flushed pink . . . and lips so cherry red that he wondered if she’d been playing with her mother’s makeup. She wore a fleece robe and a knit cap and had already dozed off, still holding a vomit-splattered saucepan in her lap. The baby lay quietly in the crib.

Cold in here.
Nick shivered, despite his sweatshirt. The room couldn’t be more than fifty degrees. He glanced around again. No lights. No TV. “Your power’s off?”

Kristi hugged her arms around herself. “Yes, but only for a couple of days. I got my first check from the care home last night, and I’m planning to go down there and pay my bill, get the electricity turned back on. The rent had to be first. My pain-in-the-neck landlord doesn’t cut me any slack.” She moved toward the window, gazing down. “Things have been tight since I broke it off with Kurt, but I’m making it work. I told Abby we just have to pretend we’re camping. That it’s an adventure.” She tried to smile. “Bundle up in extra clothes, play shadow puppet shows with the flashlight, sing songs, sit close to our little stove, and—” She turned to look at Nick, her eyes wide. “I see her. That social worker, the blonde. Miss Gordon.”

Sam.
Nick’s stomach sank.

“She’s the one from before. She wanted to take the kids then, because of Kurt.” Kristi plucked at his sleeve, her eyes pleading. “Don’t tell her about the power, please. I’ll have it on by noon. Like it never happened. I promise.” She jumped as Nick’s radio crackled.

He turned his back to her and lowered his voice. “I’m in,” he told Colton. “So far, so good. Give me a few minutes.” He turned back as Abby began to cry.

“My head hurts, Mommy.” She moaned, then retched, her shoulders shaking. Kristi hurried to hold the saucepan, crouching in the narrow space between the beanbag chair, the porta crib, and . . . Nick’s gaze fell on the round metal object on floor beside them. A sickening sense of dread washed over him. Did Kristi say
stove
?
Camp stove?
His mind flashed to the image of her at the window holding the baby, his little legs dangling limp as a doll’s.

“Wait,” he said, crossing toward her. “Have you been running a camp stove in here? Is that propane?”

“Mm-hmm.” She nodded, stroking her daughter’ cheek. “Kurt left it behind. It was his father’s. But don’t worry; Abby knows it gets hot, don’t you, honey? She’s real careful not to touch it.”

“Turn it off!” Nick ordered. “And pull Abby up; get her over here in the fresh air while I . . .”

He dropped the radio on the bed and scooped up the baby, his anxiety increasing as the infant’s arms and legs drooped, flaccid and still.
Please, Lord, don’t let . . .
Cradling the boy in the crook of his arm, he moved toward the open window and popped open the chest snaps on the fleece sleep suit. He watched the baby’s chest for movement, searched for signs of respirations while holding his own breath for an endless moment.
Cherry red lips like his sister’s . . . Carbon monoxide?
Nick slid a sleeve away and felt for a brachial pulse—it was there. But the breathing was too slow, weak.

Kristi tugged at the sleeve of his sweatshirt. “What are you doing? What’s wrong with Finn?”

“Pick up my radio, Kristi.” He kept his voice steady as an aimed weapon. “Hold the button down. Tell them to send up the medics. Don’t argue with me.” He held her terrified gaze for an instant longer, insisting she trust him one last time. “Do it. Now.” He exhaled. “Tell them your baby’s barely breathing.”

“Oh no—”

“Do it,” Nick ordered again, pointing toward the radio.

He raised the baby in the crook of his elbow, bent low, and covered the tiny nose and lips with his mouth, his brain scrambling to recall CPR protocols.
Short breaths. Puff your cheeks; careful, careful . . . Twenty times per minute.
He gently filled the fragile lungs, saw the small chest rise. He did it again and then over again. He’d do it until the medics got there, and then he’d keep at it as long as they needed him to. He’d do it; he had to. Inhale; exhale; raise the little chest, one breath at a time, over and over.
Hang on, Finn. I won’t give up on you.

+++

Dr. Leigh Stathos brushed back a strand of dark hair and nodded to the nurse readying the gastric lavage tube—rigid, transparent plastic, thick as a snake. She looked down at her patient. “We’re going to wash out your stomach. Remove what’s left of the pills and then inject a charcoal slurry to absorb the rest.”

“Can’t we wait until . . .” The woman’s eyes, red and tear-swollen, darted toward the door of Golden Gate Mercy ER’s code room. Sirens wailed in the distance. “My husband—is he here?”

Leigh glanced at the young assistant chaplain on the other side of the gurney.

Riley Hale shook her head, streaked blonde hair brushing the shoulders of her gabardine suit jacket. She cradled a hand under her dark arm sling and gazed down at the patient. “I’m so very sorry, Mrs. Baldwin,” she said, her Texas cadence stretching the words like pulled taffy. “I left messages, but unfortunately your husband hasn’t responded.”

“And we can’t wait,” Leigh added firmly, checking the vital sign display on the monitor mounted above the gurney. “Acetaminophen is liver toxic. We don’t know how many were left in that bottle, and in combination with the other pills and the alcohol you ingested . . .”

The woman clutched the sleeve of Leigh’s white coat, fingers sinking into her forearm. Her eyes searched Leigh’s face, chin shuddering. “Please, you have to understand. I’ve never done anything like this,” she insisted, her voice thickened by the drugs, breath pungent with alcohol. “I don’t drink. Ever. But I haven’t slept since my husband left me two weeks ago. I can’t eat. I can’t work. I can’t . . .” Her voice dissolved into a wrenching moan. Tears splashed down her face. “We said
vows
. He made promises before God. Twenty-three years. Two children. We’re a family. He can’t be with that woman.” She trembled, her eyes riveted to Leigh’s. “You have to understand.”

I do.
Leigh took a breath, pushing memories down, then extricated herself from the woman’s grasp. “Please cooperate. If you swallow the stomach tube willingly, the process will be easier.” Her heart tugged at the painful vulnerability in her patient’s expression. “But regardless, we’re doing this procedure now. Even if it means restraining your arms and holding you down. We have to.”

Leigh watched her patient’s eyes for a moment and knew, with familiar and painful certainty, that this ugly, uncomfortable procedure was nothing compared to what this poor soul had already suffered. And would continue to endure over the sad months ahead.
I’ve been there—I’ve been you.
She squeezed the woman’s hand gently. “We want to help you. Help us do that.”

She stepped away from the bed so that the nurse could raise the head of the gurney and explain the procedure. Then watched as she applied lubricant to the end of the tube, slid a bite block inside the patient’s lips, inserted the tube, and checked its placement. The nurse released the clamp on the attached tubing to start the flow of liquid from the distended bag hanging above the gurney. Into the stomach from the bag and back out into a collection container near the floor—one liter, two, or more, whatever it took to wash out the pill fragments, to save this woman’s life.

Riley Hale moved close, took hold of the patient’s hand, and murmured words of encouragement. The woman was cooperating; that was good. That made it easier. But . . .

Leigh saw her patient’s eyes move expectantly again to the exam room door. Hoping for a glimpse of her husband. Praying, perhaps, that the promises of love and fidelity made before God would be restored. Leigh knew how that felt. And she knew, too, that though this shattered woman had chosen to cooperate with having her stomach pumped, swallowing the truth was much, much harder.
Even with vows . . . nothing lasts forever.

She glanced at the large clock on the code room wall, designed to accurately time resuscitations, ticking second by second during a fight for life. She sighed, thinking of her own timetable, her own life. So much to do now that she was back in San Francisco full-time. Finish clearing out the house, turn it over to the leasing company, schedule job interviews, make sure her sister was settled in a new apartment . . . and following through with her counseling appointments. Then Leigh could move on with her life. Give up—quit once and for all—the painful struggle she’d endured for nearly a year. One more week—
October 3, and we’re over, Nick. I need this to be over.

She repeated her orders to the nurse, gave Riley an appreciative smile, and strode across the ER’s main room toward the doctors’ desk. She glanced at the large assignment board, then around at the circular arrangement of patient rooms, frowning. Half of the patients were “campers,” waiting endlessly for admission to rooms upstairs. All too common these days, but nonetheless frustrating. A large part of the reason she’d gone into emergency medicine was the fast patient turnover. Many of her friends were internists, family practice specialists, or pediatricians with office walls full of fading patient photos. They loved it that way, wanted the long-term relationships—and accepted the turmoil and grief that often came with that—but that’s not what Leigh signed on for.

She liked it fast, furious, fully caffeinated, and adrenaline-pounding. And as uncomplicated as possible. “Treat them and street them.” The old ER mantra. Not that she didn’t care—of course she did, and she wanted to help, use her skills to save lives. But she needed to walk away when her shift was over and leave it all there. That’s what felt best; that’s what worked for her. She needed that cushion to keep the job, the people, from getting too close. For anything more, there were chaplains like Riley. And when Leigh wanted companionship, uncomplicated, pain-free, no strings, she went to the stables and flung her arms around the neck of her horse.

“Dr. Stathos?”

Leigh glanced toward a nurse at the door of an empty patient exam room. “Yes?”

“Looks like we’ve got a heads-up on patients coming our way.” She beckoned, pulling the red stethoscope from around her neck. “Come take a look at the news.”

Leigh walked into the room, and the nurse turned up the volume on the small patient TV mounted on the wall. “I’m pretty sure they said they’d be coming to Golden Gate. Possible carbon monoxide poisoning.”

Leigh watched as the reporter, a familiar woman from a local channel, spoke into the camera. “. . . initially relayed to 911 operators in a heart-wrenching call from a four-year-old girl. Thought to be a case of child abandonment, but officers discovered—oh, wait, folks.” Her face disappeared for an instant, then returned. She nodded eagerly. “In fact, I’ve just located the officer who first discovered this medical emergency. SFPD patrol officer Nick Stathos.”

Leigh’s breath caught. The camera panned over a group of uniformed officers, a woman in a steel gray blazer with spiky blonde hair, and focused in on . . .
Nick.
His face filled the TV screen. Black hair mussed, shadow of beard growth, and the oh-so-familiar dark-lashed eyes.