Graveyard Shift Page 3

  So Tucker stepped into the breach. After working for 16 hours, he'd jump into a car to track down his rival in another city, with almost no clue where he was going.

  For me. Because he knew that was what I wanted. More than escaping this night shift. More than saving my own skin. I needed Ryan.

  I turned to Tucker. "You'll find Ryan."

  He gave a curt nod.

  "Alive. And sane."

  His lips twisted. After a pause, he said, "Well. He's in love with you, isn't he?"

  I punched his shoulder. It bounced off in a comical, girly way. For once, I didn't care.

  He kissed me and left without saying another word.

  4

  I could breathe again now that Tucker was searching for my private Ryan.

  I raised my hand to rap on the door of exam room 1, but a fiftyish, pretty, pony-tailed brunette nurse named Kris took one look at the chart in my hand and said, "Sore throat? Forget that. You should see the one in 13 first. She's the sickest—at least before the paramedics run out of Narcan, and all the overdoses flood the gates."

  How could they run out of the antidote to narcotic overdoses? They sold Narcan, or Naloxone, at pharmacies. The police stocked up on it. A McGill student made headlines by giving free public workshops on how to deliver it up the nose.

  Still, I didn't have the vocal cords to quiz Kris about anything but the sick patient.

  "What happened to her?" I whispered, obediently taking the chart from her hand.

  Kris shoved the sore throat clipboard back in the pile. "Someone beat her up. She won't admit it, though. Says she fell down the stairs." She grimaced. "Won't see ASAP, either."

  That was our sexual assault team. We were talking big time. "I'll see what I can do," I murmured, but she probably couldn't hear me over her own sneakers as she hurried to bed 1.

  On the acute side, where the ambulances came to play, and where we parked people who couldn't walk anymore, the patients were laid in a clock-like pattern. Beside the barely-used eye room sat our double resuscitation room with two stretchers labelled A and B, also usually deserted, at roughly 10 o’clock.

  Then, around the perimeter of our ambulance bay, starting at 11 o’clock, stretchers with curtains were numbered 1 to 11. Three rooms, 12 to 14, extended to 7 o’clock, before the double doors with the light boxes that divided us from the ambulatory side. The sickest patients were usually in beds 1 to 6, on cardiac monitors. I could still hear Lori Goody yowling from 14, our psych room.

  If this patient lay in one of our few precious rooms, it meant we were giving her more privacy than the patients jammed in the hallway or in any spare spot around the ambulance bay.

  Like anything in the ER, it was a mixed blessing: she got the private room and a doctor's immediate attention because she was in such rough shape.

  Good news for me. In a room, I could whisper my way through the history and physical exam. I wouldn't have to compete as much with the beeping monitors, IV's, alarms, or the chat and laughter from the nursing station in the centre of the ambulance side.

  That was the idea, anyway.

  "You can't beat me up like an Indian," LG called. Then she spotted me heading into the neighbouring room and screamed, "THAT'S HER! Get her!"

  I closed the curtain. It didn't muffle LG's commandments, but it made me feel better as I faced my next patient, 24-year-old Alyssa Taylor.

  Raccoon eyes.

  I sucked in my breath. I'd never seen them in real life before, but her medium brown skin tone couldn't hide the purple, protruding bruising around her eyes.

  Medical school had taught me to check for a basilar skull fracture—a break in the bottom of the skull—when I saw raccoon eyes.

  Yeah, this was more important than a sore throat. I sent a silent thank you to Kris.

  "She's right here. Go grab her. This is your chance to shank her!"

  Alyssa Taylor started, even though I bet Lori Goody was ranting about me.

  Still, it meant that Alyssa Taylor was awake and aware, even if she had a break in her skull.

  "Don't worry, bae. I won't let her touch you. I won't let anyone touch you," said the tall, thin, white, bespectacled guy I belatedly noticed beside her. He wore a blue shirt, navy pants, and various badges, but the handcuffs and baton at his waist, and especially his Adam's apple bobbing up and down, shocked me into recognition.

  He was the younger security guard who'd helped subdue Lori Goody. His badge said PATRICK WARREN.

  His girlfriend got beat up? When?

  I started to touch her shoulder. She winced, so I stopped mid-air. Tucker once patted a trauma patient's arm and then realized that it was broken. "Sorry. Hi. I'm Dr. Hope Sze. Do you want to talk to me alone first?"

  She started to shake her head.

  "Don't move your head, please. Just use your voice," I said.

  She wore a C-spine collar in case any of her neck bones had fractured along with her skull. The collar did allow some range of motion, though, which is why we always shouted at patients to stay still.

  "When did this happen?" I asked, deliberately avoiding Patrick Warren's eyes. If Alyssa had been attacked in the past few minutes, he had an alibi: Lori Goody, who was currently demanding an optometrist, because I'd turned her into a cyclops.

  I did feel bad about that. I'm useless without glasses myself. I made a mental note to order an ophthalmology consult.

  Alyssa blinked. She fought to breathe through her nose, which was cocked to her right. Dried blood caked her nostrils.

  She had to inhale and exhale through her teeth, which were clamped together. She might be in pain in general, or she could have a jaw fracture.

  She pointed at Patrick, the security guard and the bae, who jumped in, "She wasn't answering my texts, so I went to check on her on my break—we have a sublet right next to the hospital—"

  "When did you have time to do that?" He'd had his hands full with the human AK-47 named Lori Goody.

  He bit his lip. "Well, I started at 1900. I was worried, because usually we check in with each other, and she didn't—anyway. At 2200, I popped over. Just to make sure she was okay." He turned his eyes on me, enormous behind his glasses. "Charles covered for me. He's my boss. We're a two minute walk."

  Charles must be the grey-haired guy at the Code White. And a pretty good guy, because judging from the way Patrick twitched, either it wasn't an authorized break, or he was nervous about how long it had taken. "And where did you find her?"

  "We're in a basement apartment. The door was hanging a bit open. I started yelling her name. She's really careful about locking the door. I thought something happened to her—"

  Alyssa's eyes burned at him. It looked even creepier with the bruising ringing her orbits, like she was an angry purple panda.

  He broke off and swept a hand through his hair. "But, uh, she says that she fell down the basement stairs. And she couldn't get to her phone."

  Alyssa's body relaxed slightly in the stretcher, under her thin sheet. Yes, that was the story she wanted to tell.

  "How many stairs was that?" I asked. Most of the housing around the hospital is, at most, two stories high.

  "Like I said, we have a basement apartment," Patrick said uncertainly.

  "So one flight of stairs," I said, trying not to sound too cynical. Young people have fast reflexes. Even if they fall down a full flight, at most, they fracture their wrists or ankles.

  Older women, like in their 60s, don't put their hands out as fast and break their humeruses (humeri?). And the elderly, maybe 70 plus, break their hips.

  I'm no trauma expert, but I'd never seen a 24-year-old smash her face like this.

  I itched to search for the Battle sign, which is bruising around the mastoid bone, behind the ear. I'd have to wait until a nurse appeared to stabilize her neck. Then we could remove the cervical spine collar long enough for me to check.

  "Are you able to talk?" A normal voice is an excellent sign of a good airway, and if she were coherent
, I could do a full neurological exam.

  "Yes," she mouthed, but she hitched her shoulders and glanced at Patrick.

  He turned red. "She asked me to, uh, give the history." History is the medical term for the patient's verbal account of what happened, and physical means the physical exam. Patrick wasn't used to medical words, but he was trying.

  "Does your throat hurt?" I asked Alyssa. Mine sure did. Although I tried to keep it to a whisper, I had to override Lori Goody, who had started singing next door. As far as I could tell, it was a mangled version of "The Final Countdown."

  Alyssa's mouth shaped another yes, but there was no power behind it.

  Falling down the stairs doesn't damage your vocal cords. Lori Goody had injured mine when she tried to strangle me. That's a direct, compressive force.

  You shouldn't hurt your throat falling down the stairs. You'll instinctively tuck your chin and roll. There are so many other things to bang instead: your head, your limbs, your butt.

  "Were you drinking or doing drugs?" That, at least, would dull your reflexes to throw your hands out as you fell.

  She pressed her lips together. The bottom one had split down the middle. I'd have to check her teeth, too.

  "Lyss doesn't do any of that stuff. She doesn't smoke, either," Patrick said immediately.

  I watched Lyss's eyes. She didn't blink.

  No one wanted to admit to drugs except marijuana, but Alyssa showed no signs of overdose. Her pupils were 3 mm, or normal. She seemed alert and intelligent as she followed the conversation.

  She glowered at Patrick. If I read her right, she was clean, or clean enough that she wouldn't contradict anything in front of her boyfriend.

  I should interview her alone. But I also needed the complete history, which she was unwilling or unable to give herself. Drug and alcohol use weren't the biggest deal, because we'd screen her urine and blood for those.

  I wanted the bigger kahuna, which was what had happened to her tonight.

  What were the chances that a doctor who couldn't really talk had to take a history from a patient who couldn't really talk?

  On a night shift, maybe as high as 20 percent.

  I decided to move on to less threatening questions and circle back to the big kahuna. "Are you hurting anywhere else? Your neck?"

  She made a face, so I ventured back into the ER to grab a nurse or three.

  As soon as I exited the doorway, Lori Goody screeched, "You guys get off on beating us up. I'm going to sue the fuck out of you!"

  I tried not to turn toward her or even break my stride. Lori Goody couldn't squeeze any cash out of me. Student debt R Us.

  Kris volunteered to stabilize Alyssa's neck while I gently undid the Velcro of her C-spine collar. Roxanne and Andrea, my other favourite nurse, stood by.

  I liked to check the neck while the patient was lying flat on her back. If she had absolutely no pain, numbness, tingling, or weakness, even on neck movement, and she wasn't intoxicated or otherwise mentally incompetent, then she could roll herself on her side when I checked the rest of her spine ("the log roll").

  Raising my voice made me cough, but I needed Alyssa to hear me and not Lori Goody. "When I touch you, I want you to say yes, I have pain, or no, I don't have pain. Don't nod or shake your head. Say yes or no. Only use your mouth. Okay?"

  She started to nod, caught herself, and mouthed, "Yes."

  I found two spots of tenderness, C2 and C3. She'd just bought herself a longer stint in the cervical spine collar and some neck X-rays, if not a CT.

  I sucked in my breath when I checked her eardrums. The good news was that I couldn't detect any hemotympanum, or blood behind the eardrums, which would have been another sign of a basal skull fracture.

  The bad news was that her left ear had been partially ripped off. She cried out when I touched it.

  I bit my lip. I've never seen that before. "I'll sew it back on," I promised, but I knew it would be tricky to suture between her ear and her skull. "Let me check for blood clots. You don't want a cauliflower ear."

  Boxers used to get those. You had to drain the blood, or the blood clot could cut off the blood supply to the ear cartilage, shrivelling the ear. She did have a centimetre-wide bruise on her left outer ear, but it wasn't a big hematoma, probably because her lacerations had bled it out already.

  Then I had to blink back tears when I got to her neck and spotted the tell-tale purple necklace of bruises, with two thumbprints at the base of her throat.

  Someone had tried to strangle her.

  5

  "Could you leave us for a moment?" I asked Patrick Warren, staring into Alyssa Taylor's eyes. I'd redone the C-spine collar, but we all knew what I'd seen and what it meant.

  "Um, she doesn't, uh—"

  "Just for a few minutes. While we do the log roll," I said.

  It wasn't a question. Three nurses stood with me in silent solidarity.

  "Um, I guess, if Lyss doesn't mind—"

  "I always take some time alone with each patient," I said. It wasn't quite true, but he didn't need to know that. As a security guard, he wouldn't watch us do patient exams.

  "I'll step out, but Dr. Sze?" said Patrick.

  I realized that I'd been breathing too loudly through my nose. "Yes?"

  "I think that—well, she doesn't want me to say this, but—"

  "No," said Alyssa Taylor. It was the first word she'd spoken out loud. She had a high voice, but she spoke like iron.

  "Lyss, she should know—"

  "NO."

  "Okay." He sounded defeated, and his magnified eyes darted from side to side. "Okay. Lyss. Whatever you say. I love you. Call me when you want me back in."

  The curtain clicked open and closed behind him, and Lori Goody exploded at his retreating back, "Come on! You want to kick me again? Have at it. More money for me!"

  I turned back to Alyssa Taylor. "I'm going to check the rest of your spine now. And a rectal exam, which is a finger in your bum."

  Her lips shaped some words. I'm not good at lip reading, so I frowned in puzzlement. She seemed to be saying I can't...

  "You can't," I repeated out loud.

  She sighed in exasperation and held up her phone in her right hand.

  "She wants to type to you," said Kris.

  Sometimes patients used their cell phones to talk, but usually not in the middle of a log roll. I was tying up three nurses, one to secure the neck and two to roll the body, on a night shift, when we had skeletal staff. Still, this was the first time she was trying to communicate with me.

  "Sure, no problem. Do you want to type after we roll you?"

  "No." She forced the word out.

  "Okay. Tell me what you need." I lowered my voice and coughed. If I whispered, it didn't strain my throat too much.

  Lori Goody had no such problem next door. "I'm calling the police. I'm charging you with...hospital brutality!"

  Well, that was a step up from cutting off my breasts.

  Roxanne helped hold Alyssa's phone where she could see it and type. The screen was cracked. I wondered if that had happened before or after her face.

  I murmured, "If there's anything else you want to tell me. For example, if you were sexually assaulted—"

  She winced and wrote one word.

  NO

  Well, thanks be for that. Andrea and I exchanged a look.

  I said, "You know, if you ever need to call 911, and your broken screen is glitchy, you can activate it with other keys. On my phone, if I press and hold the power button and a volume button, I’ll get emergency services. Even if you can’t talk, they’ll send someone."

  Alyssa tapped on more keys, and Roxanne turned the damaged screen toward me. I squinted to read the letters behind broken glass.

  just xray me

  "I'll do that too," I said, silently adding, After your pregnancy test. "Do you want anything for pain while you're waiting?" We should take her urine test beforehand, so that it didn't pick up iatrogenic (hospital-given) narcotic
s.

  Alyssa blinked in agreement before she moved on to the more crucial bit.

  I'm going home

  "No. You're probably going to be here all night."

  no way

  I sighed.

  "Look," said Kris, in a no-nonsense mom voice. "You're here for us to help you. Let us help you."

  Alyssa pursed her torn lips.

  I said, "Alyssa, I have to test you. I have to scan your head and neck, I have to X-ray your body, I have to check your throat, sew up any lacerations, and splint any fractures. If anything is too serious, you're going to a trauma centre, and you probably won't be out for days."

  She closed her eyes. The lids fused so tightly, I couldn't be sure, but I thought tears shone behind them.

  She was hurt, she was tired, and she was alone.

  I said, more gently, "Trust us, okay?"

  She tried to shake her head before all four of us roared, "Don't shake your head. Say yes or no!"

  Finally, Alyssa let Kris count to three while the two other nurses rolled her.

  I ran my fingers down Alyssa's spine. She didn't seem to have any point tenderness on her thoracic, lumbar, or sacral spine, but she had bruises on her back, her legs, and her arms.

  "Okay. Now I'm going to do the part that nobody likes. It's a finger in your bum."

  "No!"

  "It's more uncomfortable than painful. I use lubrication," I said. Roxanne had already torn open a pack of Muco Gel and squeezed it on the disposable square piqué pad covering the mattress. I mouthed my thanks at her as I double-gloved, smeared my index finger in gel, and gently inserted it in her rectum, searching for a tear, blood, or a mass.

  She cried out.

  "I know," said Kris. "Almost done. Almost there. Hang in there."

  "I'm sorry. No blood," I reported to the nurses, and threw away my soiled glove. That was why I wore two for the rectal exams.

  Andrea helped pull up Alyssa's pants while I searched for words. My mind was locked on an emergency medicine article my friend Tori had showed me, "Non-fatal strangulation is an important risk factor for homicide of women."