had written a poem about her and stitched it into a sampler sometime during the long hours she was at work and he was not. The sampler hung in the study, and now each time she looked at it she wondered how the warmth Paul had felt for her one short year ago could have disintegrated so quickly.
“Turkey’s falling off the bone,” he said now. “Should I take it out?”
Olivia started to answer, but just then the police radio in the hall outside her office coughed to life.
“Hold on, Paul.” She held the receiver away from her ear and listened as Kathy sat down in front of the radio.
“Kill Devil Hills Emergency Room,” Kathy said.
“We’ve got a gunshot wound to the chest.” A male voice broke through the static. “Female. Mid to late thirties. Pulse one-fifty and thready. B.P. seventy-five over forty.”
“What’s your ETA?” Kathy asked.
“Fifteen minutes. Maybe twenty. It’s fucking snowing out here.”
Olivia stood up. “Paul, I’ve got to go.” She hung up the phone and raced to the treatment room. “Call Jonathan,” she said as she passed Kathy. Jonathan Cramer was not Olivia’s favorite physician to work with, but he was the back-up physician tonight and he lived closest. He could be here in seconds.
She was soaping her hands and wrists at the treatment room sink when Jonathan arrived. “Gunshot, huh?” he said as he rolled his shirtsleeves over his beefy forearms. “We’ll stabilize her and fly her up to Emerson.”
Olivia turned on the EKG monitor. “We haven’t even seen her yet.”
“She’s going to need a trauma unit.”
Olivia began setting up the intubation tray. Jonathan had last worked in a sleepy Louisiana hospital. Gunshot wounds were probably not his area of greatest confidence. He had been here a little over a year, the first physician hired by the new free-standing emergency room, the only emergency facility serving North Carolina’s Outer Banks. She’d been told she’d be on an equal plane with him, with equal say in all decisions made. Yet she often wondered if someone had neglected to pass that information on to Jonathan. “Let’s see her first,” she said.
They had the treatment room ready by the time the two paramedics wheeled the woman into the ER. Her shirt and bra had been cut off. The bullet hole in her left breast was deceptively small and bloodless. That could mean only one thing—the bullet had penetrated the heart. Olivia felt a rush of adrenaline. Surgery was the only possible course of action and they had no time to waste.
“Get the surgical tray,” she said to Kathy.
“What?” Jonathan was helping one of the paramedics fit the inflatable MAST trousers on the woman’s legs. “Forget it, Olivia. Let’s get her out of here and up to Emerson.”
“Get me two units of O-negative packed cells,” she said to Lynn as she checked the woman’s vital signs. It would take the helicopter forty minutes to fly her to Emerson, probably longer in the snow, and at least another fifteen minutes before she could get into surgery.
“She won’t make it,” she said.
Kathy produced the surgical tray. The instruments rattled against one another in her trembling hands. She had pinned her dark hair up, and Olivia wished she’d thought to do the same. Her fine brown hair was a little longer than chin-length, and each time she lowered her head it slipped forward, like blinders.
“You can’t be serious,” Jonathan said. “We’re not set up for anything like this.”
“Fifty over thirty,” Lynn said. “I can’t get a radial pulse.”
“Hang normal saline wide open. And do a cutdown, please, Jonathan,” Olivia said. This woman needed blood fast.
“Olivia, this isn’t the goddamned District of Columbia. She needs a trauma unit.”
“Start a bicarb bolus,” she said to Lynn. “And epinephrine. And get that blood hung.” Then she turned to Jonathan. “Look. We can ship her up to Emerson and you and I both know she’ll die on the way. Working on her here might not be ideal, but it’s the only chance she has.” She turned back to the table and did the cut-down herself, slipping the scalpel into the blue vein in the woman’s groin. She picked up the large bore needle.
“I can do it.” Kathy took the needle from her and fit it into the vein. Her hands no longer trembled and Olivia admired her for getting her fear under control so quickly.
Jonathan glowered at her. “I won’t be a part of this. I’m calling the helicopter.” He turned on his heel and walked out of the room.
Olivia stared after him, dumbfounded. “I don’t believe it.” She turned to one of the paramedics. “Call Dr. Shelley,” she said. “Tell him to get over here stat.” She began swabbing Betadine on the woman’s chest and side. Then she slipped her hands into the sterile gloves Lynn held out to her.
“Maybe we should send her up,” Lynn said quietly. Perspiration glowed on her forehead.
“We’re going to do our best for her, Lynn.” Olivia picked up a second scalpel from the tray and noticed the tremor in her own hand. She was suddenly aware of being the only physician in the room. Steady, come on, steady. She set the scalpel between the woman’s ribs and felt all her concentration flow into the task ahead of her. She bore down. No blood at all. She cut deeper, through the layers of muscle, until she reached the heart cavity. Blood suddenly gushed from the wound she’d created. It poured down the front of her scrubs and onto the floor, and the paramedic standing nearest her let out a moan.
“No BP,” Lynn said. “And no pulse.”
Olivia looked up at the flat green line on the monitor behind the patient’s head. She felt a film of sweat break out across her own forehead. They were losing her. She had to widen the incision. She looked at the tray of instruments. “No rib spreader?”
Kathy shook her head.
Of course they had no rib spreader. Olivia set the scalpel again and forced it through the woman’s fifth rib. Once the wound was wide enough, she slipped her hand inside. She cautiously curved her fingers around the woman’s heart, then slid her thumb over the surface, hunting for the bullet hole. She found it quickly—a little dimple in the heart’s smooth surface—and held her thumb over it to block the flow of blood. Then she found the exit wound in the back of the heart. She covered it with her middle finger and felt the heart contract in her palm. She looked at the monitor as a cheer went up in the room.
“We’ve got a pulse!” Kathy said.
Olivia smiled and let out her breath. There was little they could do now except wait for Mike Shelley, the director of the ER, to get over here. She wasn’t sure how long she could hold her position. It was painfully awkward. She was nearly crouching, her spine twisted to keep her hand in the right position on the heart. If she moved her fingers, the woman would die. It was that simple. The muscles in her thighs began to quiver, and her shoulder ached.
She could hear the helicopter making its approach, the familiar thud as it landed on the roof. She hoped they would need it, hoped they could repair the damage to this woman’s heart and stabilize her well enough to make the trip.
