Nightwatch

“Not that we saw. She’s lethargic, but arousable. BP’s 110 over 65, pulse 80.”

“Julie,” Rachel said, trying to get a response. “Can you hear me?” She looked back at the paramedic. “How long?”

“Maybe an hour. A friend found her.”

“Where is she?”

“A tree fell on her car—she couldn’t get out.”

Rachel turned back to her patient as they hit trauma two. “Julie, what did you take? What kind of drugs?”

“I picked up everything I could find on the floor,” the paramedic said, handing the bag to John.

They moved her parallel to the E.R. bed, and Amy Sherwood, a first-year resident, and two nurses, Katya and Karen, spaced themselves to make the transfer.

“On three,” Rachel instructed, and they lifted the young woman with practiced ease.

“We’re out of here,” the paramedic said. “It’s a nightmare out there. I wouldn’t be surprised to see Noah building the ark. Man, I’ve never seen anything like this.”

Rachel nodded at the man, then turned back to her patient, who’d roused enough to try to sit up.

“Leave me alone,” she said, her voice slurred and wet.

“Lie back, Julie. We’re going to help you, but you need to help us. What kind of drugs did you take?”

“Nothing, let me go.”

“CBC, chem panel, blood and urine tox screen,” Rachel instructed Katya. “We’re going to have to pump her stomach.”

“I’ll get a tube.”

“Wait.” Rachel raised her hand, stopping Katya. “What were the drugs?”

The nurse opened the bag the EMTs had left. “Diazepam, doxepin, amaryl, aspirin.”

“Pulse ox is 96 on 2 liters. I’ll run an EKG. It could be tricyclics.”

“She’s tachy at 120,” Katya said.

Rachel bent over the girl. “Julie!”

“Sats down to 81.”

“Okay,” Amy said, “She’s lost her gag reflex.”

“Let’s intubate.” Rachel grabbed the tube and got it into position. “Push flumazenil, .2 mil.” Just as she prepared to open the girl’s mouth, Julie stirred, then sat up.

Rachel took a quick step back. “All right, then. That’s good.”

“What’s going on?” Julie asked.

“Do you remember taking pills?”

“What?”

“Let’s give her charcoal and get her something dry to wear, please. Amy, you take it from here.” Rachel walked out of the trauma room, shedding her gown and gloves. It had been like this for almost ten hours now, only most of the patients had storm-related injuries. Blunt trauma, electrical shock, traffic accidents. Which wouldn’t have been so bad if any of the damn medical staff were here.

She wasn’t completely alone, but every doctor who had made it in had been pushed to the limits of endurance, literally running from patient to patient, and there was no end in sight.

“Incoming!” John Wilkins yelled as he stepped on the floor pad, activating the automatic door. A man in a uniform stumbled in carrying a drenched woman. She had passed out or was dead.

Rachel ran to the woman while Wilkins and two others got a gurney. “What happened?”

“She’s pregnant,” the man said, gasping for air. “She was in my cab and she started having seizures. She passed out about ten minutes ago. Before that, she said her head was killing her.”

“Thank you,” Rachel said, shoving the Good Samaritan aside. She’d immediately recognized the symptoms of preeclampsia.

Katya came running to help, and as they pushed the gurney, Rachel told her to get a CBC and do a chemstrip. “And get me an OB.”

Thunder rumbled as they headed toward Trauma 3. The girl, name unknown, roused when they transferred her from the gurney. She looked very young, pasty and full-term. She opened her eyes briefly, then shut them tightly as if the lights were terribly painful.

Rachel moved to the bedside. “What’s your name?”

The girl mumbled incoherently.

“That’s okay. We’re going to take care of you and your baby.”

The ghost of a smile flickered briefly as the nurses, Lydia and Katya, got busy with her vitals.

“BP is 250 over 70, and oh—”

The girl went into a seizure, her body spasming as if she’d been hit by a live wire.

“Give her 5 milligrams Dilantin. And get respiratory down here. We have a precipitous delivery, people, so let’s get the kit and the crash cart. Where is my OB?”

“There is no OB.”

Rachel looked up to see her resident, Amy Sherwood, at the door, donning her gown. “They have no one to send. We have to do it here.”

Rachel held back her curse. She could do this. She would do this.

Lydia, one of the best E.R. nurses Rachel had ever worked with, moved in close, preparing the woman for a C-section.

“Amy, work on her BP,” Rachel said, as she picked up the scalpel. “Where’s anesthesia?”

“Right here, Dr. Browne.”

Rachel didn’t even look up. She knew it was Dr. Reid, and he could handle the next step. She pushed a stray hair from her young patient’s face. “You’re going to be okay, honey. What’s your name?”