Between You and Me

The team members stood poised in their designated positions. Reese felt a surge of adrenaline course through her, starting in her chest and spreading like a drug through her neck and shoulders, arms and legs. She understood the physiology of the human body, but no textbook could adequately describe certain things—the heady rush of anticipation, for one thing.

Stone-cold fear, for another.

During this rotation, she was learning that in a trauma situation, there was almost no time to think. Though her head was crammed with facts and procedures, she shut down everything except that which would help the patient. In a trauma, she didn’t feel hunger or fatigue or even the need for the bathroom. She got so focused that she didn’t even feel emotion, which worried her.

Mel said it was a good thing. When a patient was coded, the doctor needed cold algorithms, not empathy. He’d told her to consider a residency in trauma, but she had dismissed the suggestion. That wasn’t where she was headed.

But in moments like this, she caught herself reconsidering.

“Keep an eye on Jack,” Mel murmured in her ear. “Watch and learn. He is the maestro.”

Reese nodded. There were a few more moments of breath-held anticipation, tingling with the awareness that everything was about to change. Then the wire mesh doors exploded open with a loud thud, and the patient arrived.

“Coming through,” someone said, walking backward and pulling the gurney along a hallway marked with a red line on the floor and the words All Trauma. “Clear a path.” More paramedics ran with the stretcher between them, preparing for the transition into the trauma bay. Reese craned her neck but couldn’t see the boy amid the cluster of personnel and equipment—just an oversize C-collar and two vacu-splints painted with fresh blood.

Behind the stretcher was a man so large he dwarfed everyone else. His shirt and hands were covered in blood. Beneath a dramatic wave of golden blond hair, his expression was a mask of agonized worry—a guy facing every parent’s worst nightmare.

The stretcher was angled into the middle of the trauma bay and the team went to work.

“How’s he holding up?” Jack asked, positioning himself at the foot of the bed.

“Not so hot.” Irene, the life flight nurse, stepped back from the rig, consulted dual tablets, and gave a swift MIVT report—mechanism, injuries, vitals, treatment. She stated that the boy had been given blood agents to lower the risk of hemorrhage. Monitors beeped and screeched off-key as the patient was transferred to the X-ray table. In the corner, a server’s lights flashed green and gold.

Reese tried to make out his features with the clear mask cupped over his nose and mouth. Deep lacerations slashed one cheek, as though he’d been clawed by a huge bear. His eyes were blue, darting from side to side.

“Dear God,” she whispered. “He’s conscious.”

“Been that way since it happened,” Irene said. “You’re an amazing guy, Jonah. You’re doing great.”

“I’m Dr. Tillis,” Jack said, looking straight down into the kid’s face. “We’re going to take good care of you.”

The boy’s lips moved inside the mask, fogging the plastic. He wasn’t crying. Reese suspected that shock had pushed him well past that point.

“Right,” said Jack. “Let’s have a look at that arm.”

The field dressing was removed and the arm exposed, and even the seasoned members of the team gaped in awe at the injury. It was a ragged horror of a wound, the tissue and bone and bloody dressing so tortured that it hurt just to look at it.

He never even lost consciousness, Reese thought. What the hell kind of kid was this?

“Jonah, can you move the fingers of your left hand, buddy?” asked Dr. Tillis.

The hand lay unresponsive.

“How about a thumbs-up or an okay sign,” Tillis suggested. “Can you do that?”

The boy’s eyes narrowed in pained concentration, but there was still no response. Everything had been shredded or severed. “Completely ablated,” someone nearby murmured. “Oh, man …”

“Get in here, Powell,” said Dr. Tillis. “Move in closer. This is something you don’t see every day. Let’s have you remove the lower-extremity clothing and do the blood draw.”

Most of the kid’s clothes had already been removed, cut or ripped off by the EMTs, or maybe in the accident. His skinny chest and pelvis looked as pale as marble. He wore jockey shorts, plain white turned gray from laundering, which she scissored away, looking for further injuries to report to the lead doctor. “No sign of bruising or trauma to the pelvis,” she said.

Then she prepped the site with Betadine and palpated the femoral artery with her fingers. “You’ll feel a pinch, Jonah,” she said, then felt ridiculous warning him about a pinch while his arm was hanging in shreds. She inserted the needle at a right angle. The slender curl of tubing filled with bright red blood, filling the syringe. While another student applied pressure to the site, Reese carefully labeled the blood draw and handed it off to a lab tech.

Jack rapped out orders for further assessments and pain management along with X-rays, piles of warm blankets, a Foley for urinalysis. Reese had a powerful urge to touch the boy—somewhere, somehow—but focused instead on following instructions. IVs were connected, and the surge of fluids and drugs worked quickly. Reese wasn’t sure whether or not she imagined it, but she thought the boy looked directly at her as she leaned forward to check a line and a monitor. Then his eyes fluttered closed. She wished she’d touched him.

The work of prepping Jonah Stoltz for surgery was done swiftly, each member of the team playing a part. They debrided and dressed wounds, scanned and tested the slender, broken boy, stabilizing him as best they could and seeking secondary injuries. Three floors up, the surgeons of the OR scrub team were already gearing up for the most likely outcome—amputation. The mobile bed was pushed out into the gleaming stainless-steel maw of the elevator.

With a rubbery squeak, the doors whisked shut and silence filled the trauma bay again. In a vacuum of silence, the adrenaline rush subsided.

People in the emergency department, and especially members of the trauma team, had a brief but vital relationship with the patient. It was like a missed encounter on a bus—they had minimal details about what preceded the trauma, an intense flurry of total focus and attention, during which the patient was the center of their universe. And then, once the patient was rushed off to surgery, everyone moved on. There was no closure. They glimpsed a single page from the narrative, never the whole story.

The room emptied quickly. The once pristine suite now resembled a bloody field in the aftermath of battle. Orderlies appeared to clear the area. Reese glanced around the room. She spotted something on the floor—an elongated penny that had been flattened on a train track, or maybe in one of those machines. The words Old Blakeslee Sawmill had been pressed into the copper.

She slipped it into the pocket of her lab coat. Then she went out to the garden adjacent to the emergency department, where there was an outdoor seating area favored by the staff. From here she could see the river, its banks flanked by long green swaths of parkland populated by kids playing Frisbee and shooting hoops, people lying on the grass in the sunshine, strolling tourists and cyclists rolling by.

She thought of the boy being rushed to surgery, and a shiver passed over her. At the far end of the garden, one of the trauma nurses stood alone, smoking a cigarette and staring into space as she blew a thin stream of smoke into the warm, unmoving air. Reese didn’t judge her for the habit, nor did she remind her of the property’s ban on smoking. After a major trauma, everyone involved seemed to deal with it in their own way. Some were chatty, expending the excess adrenaline in conversation, while others stayed quiet, floating in some placid reflection pond in their mind until balance returned.

Reese was still discovering what sort of trauma team member she was, but this rotation would probably end before she figured it out. She stood mulling over the incident, putting it into the context of her long-term plan.

For as long as she could remember, she had been focused on this career. She didn’t even recall choosing it. Perhaps it had chosen her, or more accurately, it had been chosen for her. Sometimes she felt like a stranger in her own life, like Rip Van Winkle waking up twenty years in the future. She blinked and looked around, wondering, How the hell did I get here?

On paper, the journey was as clear as a road map. Her parents were physicians, hugely successful in their fields of infertility and neonatology. Her father had an endowed chair at Penn. Hector and Joanna Powell were known for their groundbreaking work. Reese was their most successful experiment of all. She had been a test-tube baby, the result of her parents’ in vitro fertilization. She owed her very existence to their efforts and expertise.

It wasn’t anything she thought about too often, but every once in a while it made her feel … different. On the one hand, she knew she had been so desperately wanted that her parents had gone through an amazing medical ordeal to bring her into the world. On the other hand, the idea of having started life in a petri dish was downright strange.

Her parents had sent her to the best schools in the country, financed by their work for other infertile couples. That she would be a doctor was a foregone conclusion. There was never any other decision to be made. After completing her BS in premed, she went straight into the MD program and was now aimed like a straight arrow toward a career in pediatric surgery, the perfect complement to her parents’ practice. A five-year surgical residency followed by two years of peds surgery would bring her into the fold.

Sometimes thinking about the journey ahead gave her a migraine.

Mel came outside, his affable, slightly disheveled presence a welcome interruption. He was a good doctor and a good teacher, and he was happily married, for which she was grateful. No danger of come-ons or late-night gropings in the on-call room, something she’d dealt with far too often in medical school.

“So what did you think of that?” he asked. “Pretty intense, huh?”

“Yes. That team is incredible.” She shook her head. “Poor kid. His life will never be the same.”

“The flight nurse said he’s an Amish kid.”

She frowned, digesting the info as she pictured horse-drawn buggies, bonnets, barefoot children. “No shit. So how did he get mangled by a piece of machinery? I thought the Amish did everything by hand.”

He shrugged. “I guess not everything. But the nurse said some of the neighbors and family made a big stink about the chopper. They didn’t want him to fly. It broke one of their rules.”

“I’m glad the father went ahead and broke the rules, then. Is that why the media showed up?” She gestured at the parking lot. News vans from the local affiliates had already disgorged cables, gear, and primped on-air reporters. This was what was known in the hospital as a “drama trauma”—an unusual and often tragic event that drew the local press and created a storm on social media.

“Probably,” said Mel. “A hospital spokesman will handle it.”

“Good. The last thing the family needs is the local news hounding them.” She glanced through the broad windows into the building. In the ER consultation rooms and waiting area, people huddled in worried clumps or paced the floor. A tall blond man, as upright and still as a tree on a windless day, stood looking outside, his face seemingly carved in stone.

Reese frowned. “Isn’t that the father?”