The Queen of Hearts(15)

Zadie was clearly about to query further when I noticed some sort of commotion over by the bar. Two men were standing there, one hugging the other from behind, which was odd; the man in front began waving his hands around frantically. The hugger was shouting, but I couldn’t quite make out the words. Behind the bar, a couple of servers were also gesticulating wildly, and there was an accumulating crowd of people. Were they fighting?

I craned my neck. As I did, Zadie jumped up, and in one fluid motion she was on her feet and running hard, yelling over her shoulder for me to follow her. As I rose, I saw the man who was getting hugged slump forward. Two women, one of them Mary Sarah, rushed forward and eased him to the ground.

Zadie was on her knees. The man on the ground was unconscious, his face a florid blue. I elbowed my way through the throng of horrified people and joined them.

Instantly, I assessed the situation: he was choking. I looked up at the bartender. “Get me a sharp knife, right away, and some napkins and straws. Also a couple forks.” I looked back at Zadie. “Do you remember how to cric somebody? I need you to hold pressure if there’s a lot of bleeding. Okay?”

“Okay,” Zadie said, her eyes wide, but then she flashed me a resolute look. I was accustomed to cutting holes in people’s tracheas—in this case, in the cricothyroid membrane of the trachea—but it wasn’t a procedure that occurred in a cardiology office. It had been at least a dozen years since Zadie had seen this done, but in med school she’d been a competent assistant surgeon. I’d been surprised and then—almost—jealous when the class rankings for our surgery rotation had come out: I’d been ranked first, of course—no one was going to get a higher score than I was in my favorite subject—but when I realized Zadie was ranked second, I’d had to control an unattractive feeling of dismay.

I looked down at the unconscious man and realized I knew him. It was Buzzy Cooper, the owner of a local commercial real estate firm and the father of Sumner, who Zadie had informed me was Delaney’s bitee. This needed to go well; imagine Caroline Cooper’s wrath if Zadie was involved in both the repeated biting of her daughter and the grotesque mauling of her husband as he choked to death.

Buzzy was bluer by the second and twitching slightly, his face a dusky parody of itself. I nodded briskly when the bar server arrived with a tray of the items I’d requested, along with a bottle of gin and an entirely superfluous thermometer. Zadie upended the alcohol over Buzzy’s outstretched neck and swiped it dry as I used the knife to cut a small bundle of the straws in half. I then palpated the thyroid and cricoid cartilage rings, which wasn’t easy, given the blubber that ringed Buzzy’s corpulent form, and made an unhesitating incision between them, cutting through the skin. Blood oozed out from some peripheral vessel, obscuring my view. Using the blunt end of the forks, I positioned them as makeshift retractors to hold the edges of the incision open, handing them to Zadie, while I used my finger to dissect down through the subcutaneous tissue. Meanwhile, there was no sign of any respiratory effort at all from Buzzy; were we too late? No, he was bleeding, and his heart was still pumping. We still had time. After making a horizontal incision through the cricothyroid membrane, I thrust my finger into the incision, widening it and holding it open. With my other hand, I positioned a few of the cut straws into the opening between the tracheal cartilage and blew gently into them.

There was an agonizing moment of nothing. Then I blew again, then waited . . . and waited . . . and then, with a lurch, Buzzy’s chest rose a little and sank. There was an odd whistling sound from the straws as air moved through them. The color in Buzzy’s hypoxic face improved slightly.

Now I became aware of the people around us; dozens of spectators were clustered in a vibrating hive, watching the impromptu surgery with wide eyes and still faces. A cry went up from the crowd when they realized Buzzy was alive.

Two EMTs appeared, toting a backboard. One was a smallish Asian man, the other a borderline obese white female, both of them moving swiftly. The crowd parted for them, and they knelt beside Buzzy, taking in the scene.

“Dr. Colley?” said the female, hitching at her pants. “I didn’t recognize you!”

“Hey, Jen. I dress better at work,” I said as casually as I could, despite having stabbed a man in the throat in front of half the club. While wearing a bikini, no less. “This here”—I motioned at the makeshift tube—“is not stable. Can you give me the smallest ET tube you’ve got, and something to use as a guide wire? And a suture, if you’ve got any. Meanwhile, let’s get some blow-by oxygen going toward these . . . straws.”

“Will do, Dr. C,” said the man, turning and sprinting toward something behind them, while the chubby woman started fiddling with an oxygen mask.

Hurriedly, I managed to get a legitimate endotracheal tube in place, although it was not the correct size and was meant to be inserted through the mouth, so it looked completely wrong. I tried not to let this bother me; it did look better than a handful of straws. I threw a quick suture to stabilize the tube so we wouldn’t lose the precarious airway on the way to the hospital.

The sun was beating down on us from directly overhead, and the pavement was scorching hot. A frozen margarita appeared, as if by magic, in my hand as I boarded the ambulance; I looked at it stupidly. “Drink up, honey,” said Mary Sarah. “I think you need that.”