The Queen of Hearts(25)
This code turned out to be a nonstarter. The patient was DOA, and by the time we got down there, the ER attending had already called it. A quick glance at the patient’s body and it was evident why: he was riddled with entry and exit wounds from at least a dozen bullets, one of which had exploded his head and another of which had cratered his chest. Staring at the chest wound, I repressed a shudder of recognition. I hated GSWs to the chest.
My reaction aside, this was an unusual amount of violence for Charlotte. “What in the world?” I said to the ER attending. “Somebody wasn’t concerned about overkill.”
“He’s MS-13,” she answered, gesturing to one of his arms, which was so inked up it looked reptilian. I nodded, recognizing one of the tats: this boy belonged to Mara Salvatrucha, a notorious gang that had metastasized across the country to Charlotte from Los Angeles. MS-13 members weren’t known for subtlety when it came to their hits. If they wanted you dead, going down in a haze of gun smoke was probably the best end you could hope for.
“Well,” I said to no one in particular, realizing the futility of expressing concern for the multifaceted tragedy in front of me. “Maybe now we can grab something to—”
My pager went off, along with everyone else’s pager. “Incoming,” said the ER gal. Her round blue eyes blinked as she contemplated the bloody mess in front of her. She motioned to some techs. “Let’s clear this guy out, since we’re all already in here. Can we get the floor mopped real quick?”
“Dr. Colley,” said Sanjay, my resident. He cast his eyes down at his pager. “It’s a kid.”
I nodded. I disliked pediatric trauma patients, especially the really young ones. Their little bodies were such a shock to behold after legions of high-mileage adults: smooth, unblemished skin; round little tummies; tiny pristine lungs and livers, as yet unmarred by lumpy adipose tissue and self-inflicted decay and the ravages of disease. They looked incredibly helpless on the OR table, with their lush eyelashes taped against fat cheeks, their small arms splayed out in surrender on IV boards.
They healed well, though. Their cells, accustomed to the vigorous demands of new people, went into ferocious overdrive when injured. A child could survive injuries that would send the average adult spiraling down in flames. Of course the stakes were higher when a child was hurt, but I could handle that kind of pressure. And the technical challenge of operating on miniature organs secretly pleased me; I liked demonstrating my competence in a difficult case.
It was dealing with the parents I didn’t like.
All relatives of trauma victims were difficult, but none more so than the parents of a child. They wailed or stared sightlessly or collapsed in dramatic heaps. In any case, they never absorbed anything I said to them, which had led to multiple misunderstandings in the past. I understood why, of course. Some grief blots out the world.
But I was ill-equipped to deal with other people’s incapacitating heartache. It wasn’t that I’m too emotionally cool to relate to their pain; it was that I relate so much I choke. How can I, a stranger, presume to comfort anyone in their position? I become so awkward, so frozen, so unable to reach out, other than offering a dry, mechanical recitation of what was wrong and what I’d try to do to fix it. Everything I could possibly say to a devastated parent seems too inadequate, or sometimes, too blatantly false. I can’t bring myself to tell them the only thing they want to hear.
The EMTs arrived, toting a gurney with a very small person strapped to it. I jumped aside to let the residents do their thing as the EMTs gave their report: bike versus car, abdominal injuries. This child, who looked to be three or four, was conscious and whimpering, managing a single half-strangled word (“Mommy!”) before we drugged her.
Everyone performed their roles efficiently and tersely, all the usual intensity of a trauma code amplified into something almost superhuman. The ER people inserted a breathing tube, the residents obtained central IV lines and started fluid, and my intern ran the portable ultrasound probe over the child’s distended little belly. No one spoke an extra word as we headed to the OR. I instructed Sanjay to call ahead to prepare them for an ex lap—an exploratory laparotomy—a surgery in which we’d open the little girl’s abdomen to assess her internal injuries and try to fix them. I ran upstairs.
Steeling myself, I trotted down the empty corridor toward the family room, resolving to give the little girl’s parents as encouraging a word as I could while the OR was being readied. Unusually, the parents had gotten here at the same time as the ambulance and had been moved upstairs, closer to the ORs.
To my dismay, I realized as soon as I entered the room that I knew them. Or not knew them, really, but recognized them: they were Betsy and Boyd Packard, one of Charlotte’s most prominent couples. He was the scion of one of the banking overlords—his father had founded an investment bank that had merged with another behemoth financial institution, which he now ran. Betsy oversaw their philanthropic foundation and chaired all the important auxiliaries and charity boards in town. They belonged to our club, where I’d often seen Boyd ringed by a crew of powerful cronies, smoking cigars and throwing back scotches like a 1950s cliché returned to relevance. I hadn’t known they had a daughter, although I did know they had a son—he was friends with Zadie’s boys, and I remembered Zadie and Betsy were friends. Or maybe they shared a carpool. If their kids had any heart problems, Zadie was probably their doctor too. Unlike me, she has no problem commiserating with parents—she throws her arms open and people leap into them, unhesitating. It was impossible these days to get Zadie as your pediatric cardiologist—her schedule was clogged with Packards and the children of NASCAR drivers and other local luminaries. Somehow she’d become the specialist to the stars.