Trauma Read online

  The flash of a camera blinded Nora for a moment. Elise lowered the camera. “Sorry.”

  “No, good thinking,” Lydia said as an anesthesia resident took her place at the head of the bed. “Document as much as possible. I have to get back to the ER. Nora, can you do the rape kit?”

  “While you’re at it, I need a Foley,” Seth said, starting a vertical incision that extended from Karen’s chest down to her pubic bone.

  Nora grabbed a sterile gown and wrapped it around her body, then changed her gloves. Elise held Karen’s legs apart to help Nora insert the bladder catheter.

  Seth glanced up, scalpel poised. “Any time now, ladies.”

  “Give her a break,” Elise snapped at him. “He used a knife on her. Everything’s messed up down here.”

  Nora ignored them, instead focusing on the small, intimate space before her. “Foley’s in. Elise, take photos while I start the rape kit.”

  She turned away, shaking her head until the room stopped blurring before her. Small, tiny shakes, casting away her feelings so that she could focus.

  The sounds of machinery and the murmur of voices faded into the distance. Blocking out everything around her, Nora carefully collected as much evidence as possible. She swabbed and combed and plucked and dried and labeled and sealed everything into the shoebox-sized evidence kit.

  It was easier to move around the blood and paint and people if she simply denied their existence. A roaring noise commandeered her brain, but her hands continued to function, to do their job of caring for her patient.

  Seth’s hand fell onto her shoulder just as she finished clipping Karen’s fingernails, dropping them into a white envelope and sealing it, scrawling her name across the seal. “Nora, did you hear me?”

  She glanced at his bloody hand on her shoulder. Blinking, she realized the room had gone silent; she and Seth were the only ones remaining. There was no whoosh of the ventilator or beeping of the cardiac monitor. Only the sound of her gown rustling as she straightened.

  “She’s gone,” he said, his voice cracking. He swallowed hard, his gaze darting toward Karen, then ricocheting back to Nora. “I tried everything, but the bastard trashed the vena cava. I couldn’t get her back.”

  He turned his back to her, stripping the gloves from his hands, snapping them into the garbage. His shoulders hunched together as he gripped the edge of the biohazard container for a long moment before facing her again.

  The neon graffiti desecrating Karen’s body sparked in Nora’s vision. Seth’s scrubs, neck, and face were speckled with blood. His brown hair was long and shaggier than she remembered it—they saw each other every day, but she’d forced herself not to notice these things that were the purview of a girlfriend, telling herself that he had someone else to take care of him.

  That he didn’t need her. That he had Karen—sexy, skinny Karen with her extensive knowledge of the Kama Sutra. Karen who smiled and laughed all the time and who Nora bet never cried when Seth made love to her, who never freaked out and refused to leave the house without his checking the shadows and holding her hand.

  Karen who lay cold and dead on the table before her.

  God, Seth, how he must feel, to be the one who lost her, who couldn’t save her . . . Pushing aside her own emotions, Nora looked at him, wanting to help but too numb to know what she could do. She stared at the evidence envelope gripped between her fingers. She still had work to do. For Karen.

  “Nora? Are you all right?” He tilted his head, a heart-breakingly familiar little-boy expression that could mean anything from guilt to concern wrinkling his eyes. “Why don’t you leave that for the police and medical examiner?”

  She dropped her envelope into the evidence kit and reached for the oral swabs. “I need to finish.”

  “No. You don’t. C’mon, leave it.”

  She turned her back on him and walked around the table to the head of the bed. The drape had been dropped, covering Karen’s once-perfect body. Her once-perfect face was marred by scarlet paint, sprayed across her closed eyes and forehead with the word whore. One eye was swollen and bruised, as were both cheeks. Red marks circled Karen’s neck along with more bruises.

  Nora slipped her fingers between Karen’s jaw and the endotracheal tube, felt the jaw slide sideways, and knew it was broken in at least two places. Seth made a choking noise and turned away.

  Nora collected the swab, resting the fingers of her free hand against Karen’s eyes. Shiny material crusted the lashes, sealing them shut. Superglue. Nora remembered the pain, eyelashes ripping free, corneas abraded.

  Just as she knew the pain of the swollen throat. It was days before her voice had returned to normal; to her colleagues she’d blamed the winter flu bug. She remembered countless showers and baths and hours scrubbing at spray paint with turpentine and mineral spirits, leaving behind red, raw, burning skin.

  And the pain. Not just the bruises and aches and scrapes, but the pain inside, deep inside. The same pain that sometimes returned to haunt her even now, three years later.

  “I’m sorry,” she whispered to the dead woman. “I’m so sorry.”

  She stroked Karen’s hair, the once long, shining tresses now hacked haphazardly as if by a scissors-wielding toddler throwing a tantrum.

  No, not scissors. A knife. Long, wide, one edge serrated, the other razor sharp.

  “We’re all sorry.” Seth caught her arm, pulling her away from the corpse. “You’re shivering. Come with me; I’m getting you out of here. Lydia never should have asked you to do that rape kit.”

  Nora wrenched away from him. “She didn’t know. I’m the sexual assault examiner on duty. It’s my job.”

  “Not today. Leave it.”

  She glared at him, then spun on her heel, sealing her evidence kit. Her handwriting was shaky as she finished signing her name. “It’s all my fault.”

  “No. It’s not. There was nothing more you could have done for her.” His voice sounded distant even though his hands held hers tight, pulling her away from the sexual assault kit. The neon graffiti blared through her vision; she couldn’t look away.

  Seth was the only person alive who knew Nora’s secret: that on New Year’s Eve three years ago, long before she’d ever met Seth, she’d been raped. But she hadn’t told Seth everything. Not about what had happened to her, not about what she had done. She’d thought she had left it all behind, had created a new life, one where the rape was a secret buried forever.

  “Who could have done this?” he said, his voice shredded. “A gang—high on crack or meth?”

  Slowly she raised her glance to meet his. “It wasn’t a gang.”

  She glanced at the corpse beside her, sucked in her breath until her chest was tight and there was no room for anything else. She needed to tell him the truth.

  “It was the same man, Seth.” Her voice rang hollow, echoed from the tile walls of the empty OR.

  “What?” He squinted at her as if that would help him hear more clearly. “You mean—” He shook his head violently. “No. It couldn’t—”

  “It was. It is. The same man.”

  Seth’s stared at Karen’s ravaged body, his face morphing into a mask of horror and confusion. “You—Karen—”

  With his hand clamped to his mouth, he rushed past her, his face splotched with crimson. He raced down the hallway and slammed open the door to the clean holding room.

  Snapping her gloves off and tossing them into the red biohazard bag, Nora started to follow him, but she stopped outside the OR’s doors. She couldn’t leave Karen’s body unattended.

  Miguel from housekeeping turned the corner, whistling as he pushed his cart.

  “Miguel, could you do me a favor? Watch that door, okay?” She barely waited for his nod before she followed Seth’s path to the clean holding room.

  She knocked on the door, opening it without waiting for his response. He was bent over the sink in the corner, heaving up his breakfast. His body shook violently even after he stopped vomiting. />
  Nora grabbed a towel from the shelves, ran cool water over it, and wiped his face clean. She let the water run, rinsing the acrid smell away. She didn’t look him in the eyes, but gave him some semblance of privacy as she kept one hand always on his body, ready, waiting.

  Finally he inhaled, straightening as the air filled his body. He pressed his hand against his eyes for a long moment. Then he exhaled, a plaintive whoosh that echoed above the sound of running water. He opened his eyes, met her gaze.

  “Are you all right?” She gave his arm a quick squeeze.

  She immediately let him go, realizing the familiarity was no longer her prerogative. An awkward silence passed between them. She’d never felt awkward around Seth before—furious, sad, irritated, yes, but never this blind, stumbling, knowing-too-much feeling.

  “I’m so sorry,” she tried again, but her words sounded hollow and meaningless.

  She wanted to comfort him, to help, but she didn’t know how. All she could do was stand there, staring, hanging onto a dirty, wet towel instead of reaching for him. He wasn’t tall, only five-ten, but compared to her five-three he’d always felt tall enough. Just right for tiptoe kisses or for him to lift her in his arms. Once upon a time.

  Nora focused all her attention on wringing out the towel. Suddenly the room felt too small for the two of them and everything that lay between them.

  His hand reached out for her, then dropped back to his side, empty. “You said you’d been drinking that night,” he started, then faltered to a stop. “New Year’s. Three years ago.”

  She nodded, concentrating on hanging the towel from the sink’s edge. She turned the water off. Silence fell. She tugged on the hem of the towel, making it line up, perfectly even. “I had a few drinks.”

  “I thought you meant you were both drunk, things went too far—”

  “That I said no, and he heard yes? Just another date rape, nothing too disturbing, right?” Fury colored her words. “And so you didn’t ask any more questions, didn’t need the details since they’d put the blame on me, too drunk to keep a guy’s filthy hands off me. I made it easy for you, didn’t I, Seth? Maybe too easy.”

  He backed away, banging into a metal shelving unit, sending a stack of suture trays to the floor. “I didn’t—I couldn’t—” His Adam’s apple bobbed as if something sharp and painful were caught in his throat. “Tell me. Tell me what really happened.”

  She was tempted to. But even after everything that had happened between them, she couldn’t. It was bad enough he’d seen Karen’s body, seen the outward evidence. No way would she burden him with more details. Or the fact that Karen had obviously suffered even more than Nora had. The rapist had terrorized Nora with his knife but had never cut her, not like he had Karen.

  “You don’t really need to know all that. What you really need to know is that it’s my fault Karen was killed.” She licked her lips, but it didn’t help; her tongue grated against them like sandpaper. “It’s my fault. Because I never told anyone. Not until I told you.”

  “The police?”

  “No, Seth. I never went to the police. And now I have to face the consequences.” Her vision wavered, but she didn’t sway or fall. She stayed in control, finished her confession.

  “Karen is dead because of me.”

  2

  Thursday, 7:32 am

  The savory aroma of coffee drifted from the front of the ambulance, inviting Dr. Gina Freeman to abandon the oppressive gray of the Pittsburgh winter and fly away to exotic lands populated by wandering bands of baristas toting portable espresso machines. She turned sideways in her seat in the rear of the ambulance, the better to keep an eye on the two paramedics up front—and the coffee they’d just picked up from Eat’n Park.

  Trey Garrison, the EMS district chief, was riding with Gina and paramedic Scott “Gecko” Dellano. The two men couldn’t appear more different from the outside—Trey a little over six feet, with skin even darker than Gina’s own, while Gecko was wiry, tattooed, laid back and never without his signature Oakley shades—but when they worked together it was like watching a symphony in action.

  A symphony so well rehearsed that Gina sometimes felt like a kazoo player thrown into the mix. Working with the medics was part of her duties as a third-year emergency medicine resident, but she’d missed some shifts and was now making up for lost time.

  Trey always seemed to arrange things so that he worked with Gina when she did her EMS ride-alongs. Gina wasn’t sure if it was because Trey felt protective of her after she’d almost died in a drive-by shooting during her first ride-along last summer or if he was keeping tabs on her and reporting back to her boss in the ER, Lydia Fiore. Whom he also happened to be living with.

  After Trey pulled a cup of heavenly brewed caffeine from the cup holder and handed it to her, Gina decided she honestly didn’t care.

  She gulped her first sip. It was still hot enough to scald, but too good to resist. “Thanks, Trey. You’re a lifesaver.”

  Gina was exhausted. Squeezing in the ride-alongs in addition to her regularly scheduled shifts in the ER had put a definite crimp in her free time—including time to sleep. And personal grooming time. She patted her mass of braids, which she’d pulled back with a scrunchie. Antonio, her stylist, was going to shriek when he saw her.

  She prayed the jolt of caffeine would keep her eyes open through her shift. Her medical student roommate, Amanda, hadn’t helped—flouncing around the house at an ungodly hour as if a stint in the pediatric ICU were more fun than sex (something Gina had about given up on these last two weeks) and grinning like the twenty-five-year-old in love she was. Amanda was engaged and looked the part.

  Gina was engaged and looked like a hag.

  Jerry, her fiancé—just thinking the word made her panic—was being patient with her request to keep their engagement a secret. But even his patience had an end. He wanted her to announce their engagement at the big Angels of Mercy gala on Saturday night, where Gina was receiving a Carnegie Medal for heroism.

  That plan had a few problems. First, Gina was no hero—she felt like a fraud accepting the medal. It was actually another doctor, Ken Rosen, who had been the real hero back in July, during the riots. Unfortunately a reporter had caught her on film. The media and public—not to mention her father’s lobbying with his influential friends—had done the rest. And despite Gina’s urging, Ken refused to step up and take the credit that was rightfully his.

  Second, her parents were expecting her to announce that she was leaving her emergency medicine residency to join her mother at the Freeman Foundation, raising money for causes deemed worthy and spending a lot of time in designer gowns associating with the “right” kind of people—a group that most definitely did not include Jerry Boyle, a detective with the Major Crimes squad.

  Suddenly working double shifts to avoid thinking about the mess she’d got herself into felt like a blessing.

  “Heard you were late in the ER last night.” Trey’s tone had a faint ring of disapproval, but she ignored it.

  “Was supposed to get off at twelve, but a drug OD kept me there until two.” Which meant home and to bed around three and back up again to ride in the ambulance by seven.

  “You okay to work? I’d rather have you take a day off than compromise patient care.”

  “I’m fine.” She took another sip of coffee, mainly to hide her yawn. She craved a smoke, but Jerry had finally persuaded her to quit, so instead she jammed a piece of nicotine gum into her mouth.

  A call came through, interrupting Trey’s interrogation. Gecko, who was driving, glanced back at her in the rearview mirror. “How come no bulletproof vest today? You must have a good feeling about riding with us.”

  Gina glanced down at the navy polo she’d tucked into her cargo pants. “I forgot it,” she admitted. As long as they didn’t run into Jerry, who was overprotective even for a cop, it wouldn’t matter.

  “Surprised you’re talking to us peons, what with being given the key to the city o
n Saturday. You know Ollie and I have to be there, full dress uniform and everything.”

  “I didn’t ask for it.”

  “Well, least you can do is introduce me to a few cute nurses when the dancing starts.”

  Gina wasn’t sure she’d even make it through to the dancing—half the time she found herself fantasizing ways to escape Saturday’s gala all together. “No problem.”

  Trey hung up the radio. “Make a U-turn, we’re heading to Heinz Prep,” he instructed Gecko. “Code Two.”

  “What’s up?”

  “School nurse thinks a kid might have meningococcemia. He came in with a fever, and she sees a rash. Kid’s acting fine otherwise.”

  “Shit.” Meningococcemia was a highly contagious bacterial disease that could quickly go from no symptoms to near death. “Any other kids with the same symptoms?”

  “They’re going to check. Might be nothing—you never know with school nurses—but she got verbal permission from the mom for us to transport him for a full eval. In fact, the mother insisted on it, has her personal physician on his way to meet us at Angels’ ER.”

  “Personal physician? Who are these folks, the Rockefellers?” Gecko asked.

  “Could be,” Gina said as a stately white-brick mansion surrounded by several other large buildings came into sight. A wrought-iron gate announced their arrival at Heinz Prep, her alma mater. “Rockefellers, Kennedys, Carnegies, they’ve all attended.”

  “Are those dormitories?” Trey asked as they parked between two colonial-style brick houses.

  “Yes. Students come from all over the world.”

  “If it is meningococcemia—” Trey began.

  “Then we might have a disaster on our hands,” Gina finished for him.

  Dr. Lydia Fiore took advantage of a few moments of calm and sat at the ER nurses’ station, completing Karen Chisholm’s death certificate.

  She filled in the tiny spaces on the crowded form, writing as neatly as possible, worrying the fingers of her free hand through the uneven layers of her dark hair. She hated paperwork. Especially the way it diminished a person to a few sterile facts. She hadn’t known Karen, but that didn’t matter. Karen had been one of their own. She deserved more than meaningless words on a smudged form destined for a dusty drawer in some bureaucrat’s office.