Chapter One

“Don’t let my baby die.”

Monica stared into the desperate eyes of a mother on the verge of losing her seven-year-old daughter. The little girl made the unfortunate mistake of riding her bike in the street and into the path of a passing car. A mistake that would most likely end her life.

“We’ll do everything we can,” Monica told the mother. Her reassuring smile was a pathetic attempt, but she had to do something to give the woman hope.

Monica ducked into the trauma room, where no fewer than fifteen people worked feverishly to save the child’s life.

With the help of the ER staff, the paramedics moved the child from the stretcher to the gurney and whisked their stretcher from the room.

Dr. Chuck Meeks, the trauma surgeon on call, stood at the patient’s head and listened to the report from the medic. Monica listened while she helped the emergency medical technician and another nurse remove the remainder of the child’s clothing.

“The car struck her and tossed her thirty feet from the point of impact. Her friend said she was moaning after it happened but when we got there she was unconscious.”

As the medic spoke, Monica ran down her own list. A, airway… the child was already intubated. B, breathing… the doctor was listening to the patient’s lungs as the medic spoke. Blunt force trauma could result in a collapsed lung, internal bleeding… any number of injuries. But Monica was getting ahead of herself.

C, circulation. The patient’s heart rate was too fast with a blood pressure of 68/50. Monica systematically moved down the child to check for pulses.

“Let’s get her off the backboard,” Dr. Meeks instructed. “X-ray, I need a chest film here to check this tube. Did CT clear?”

“CAT scan is ready when you are.” Patricia Keller, the nursing supervisor, stood at the door and informed the doctor.

Monica cut through the child’s jeans. D, disability and neuro status. A CAT scan would let them all know the extent of the head trauma, but some less life-threatening injuries could be seen with the naked eye.

“What’s her name?” Monica asked the medic. Using a pronoun for her patients, instead of a name, didn’t feel right.

“Bethany. Her friend called her Beth.”

When removing the jeans from Beth’s lower limbs, Monica noticed an obvious break above her right knee. “Dr. Meeks?”

Meeks glanced Monica’s way with a nod. “Pulses?”

Monica checked for pulses distal from the injury, found a faint rapid tap to match the child’s heart rate.

“Faint, but they’re there.”

“Get a box splint on it until we see what else is going on. I don’t like the sound of her right lung. Get a chest tube ready, X-ray, push in and let’s get a picture.”

“Pressure’s dropping, Chuck.”

Valerie, the other ER nurse in the room pulled everyone’s attention to the monitors at the head of the bed. Beth’s blood pressure dropped dangerously low.

The chatter that had hummed over the room stopped, and everyone moved faster.

Thirty minutes later Monica walked out of the operating room where she’d given Bethany’s report to the nurse taking over. Shattered femur, collapsed lung, internal bleeding, most likely spleen but the doctors would have to determine that in the OR and work to fix it. The bump on Bethany’s head turned out to have no significance, which begged the question as to why the child was unconscious. It was as if God swept down and said, “Time for you to take a little nap, sweetheart.” Maybe, just maybe, with the skills of the surgical staff Bethany would live to ride again.

So Monica hoped.

Back in the ER, the noise of the department swelled up inside of her until her ears rang with the energy of the room. New patients moved into the halls, while others walked, rolled, or limped their way out.

Just another day. She loved it. All of it. Well, most of it anyway. There were some things she didn’t love about her job at Pomona Valley Hospital. Like the sunken eyes of a loved one when they learn that someone hadn’t made it, or the politics that forced non-emergent cases into the ER on a daily basis. Understaffing… union battles. OK, maybe she didn’t love all of her job.

The computerized board indicated a couple of vacant rooms and highlighted a number of patients in the waiting room. Seemed like the number of patients in need always outnumbered available space. There were two ER doctors on, a dozen nurses, and several EMTs.

Monica nodded to the clerk, Nancy, and asked, “Do we have any runs coming in?”

“Nope.” Nancy had an ear to the phone and was simultaneously entering orders for the doctors into the computer system. They’d yet to go paperless. Most of the hospital was completely computerized, but so far, the ER had resisted the change. Monica couldn’t wait for a shift in management to recognize the benefits of computerizing and streamlining their system. Anything to help move people through faster.

Monica grabbed a chart from the rack and moved to the lobby door to call in the patient.

She glanced at the name the triage nurse had written on the assessment, recognized the name, and cringed. Owens! She looked at the complaint. Stomach pain.

Gary Owens was a frequent flyer who didn’t have a mileage card. He visited the ER no less than once a week, most of the time coming through the back door via ambulance. The man was an alcoholic who’d brushed aside death more times than Monica could count.

The man had a death wish. As much as Monica hated herself for thinking it, she wished he would just get it over with already. It was hard to feel sorry for someone who self-inflicted nearly every medical problem he ever had.