Night Call Page 3

  Tristan barreled through the double doors at L&D and saw Quinn, wearing rumpled navy scrubs, pacing in front of the nurses’ station. From the looks of her, Quinn hadn’t been to bed in quite some time. Her jet black hair was disheveled, and even from the end of the hall, her blue eyes appeared bruised. Tristan couldn’t remember ever seeing Quinn so agitated. Unlike many surgeons, Quinn was the epitome of calm in the midst of crisis. She rarely raised her voice, almost never lost her temper, and had just about the fastest hands Tristan had ever seen. If she ever woke up in the trauma unit needing emergency surgery, she wanted Quinn Maguire to be standing over her.

  “Hey, Quinn, I hear you’re about to add another member to the family.”

  Quinn smiled, but it seemed forced. About Tristan’s height, she ordinarily moved like an athlete, powerfully graceful. At the moment, she looked like all that power was about to roar down the hall with the force of a flash flood in a desert arroyo. Quinn was surrounded by so much nervous energy the air practically crackled. “Honor’s been in labor twenty hours. The baby’s holding up, but Honor’s getting pretty tired.”

  Tristan clapped a hand on Quinn’s shoulder. “Who’s the OB?”

  “Deb Brandeis.”

  “That’s good news.” Since Tristan spent a lot of time in OB and the NICU doing high-risk anesthesia procedures, she knew Deb well, and Deb was that rare mixture of highly competent and deeply caring. At that moment, a small redhead in baby blue scrubs popped out of a patient room and headed toward them like a whirlwind.

  “Hi, Tris.”

  “Hey, Deb.” Tristan grabbed Honor’s chart off the counter and flipped through to the medical intake form. As she scanned it, she said, “How are we doing?”

  “Moving along. Quinn,” Deb said, clasping Quinn’s arm. “We just had a dip in the baby’s heart rate. It only lasted a few seconds but—”

  “No more waiting.” Quinn was already halfway down the hall. “Let’s go.”

  Tristan watched her. “Jesus, she’s wound up.”

  “Normal for the expectant partner at this point,” Deb said easily. “Let me talk to Honor and tell the nurses to get the room set. Are you ready?”

  “How’s the epidural?” Tristan asked. It was standard to insert a catheter into the lower portion of the spinal canal and inject anesthetic directly around the cord to reduce the pain of the labor contractions. The mother remained awake, and the regional anesthetic avoided the need for potent sedatives that could adversely affect the baby’s heart and respiratory rates.

  “The block is working great. Honor’s been pretty comfortable.”

  “Then I just need to get her to sign a consent. Anything else I need to know?” Tristan joined Deb on her way down the hall.

  “She’s healthy. No meds. No significant family history. She had one uncomplicated vaginal delivery about ten years ago.”

  “Piece of cake, then,” Tristan said.

  “Yeah, except both parents are doctors.” Deb laughed. “Why do I get them all?”

  Tristan bumped her shoulder. “Must be because you’re the best.”

  “Must be.”

  *

  “Don’t look so worried, baby,” Honor said, mustering as much strength and positive attitude as she could. God, she was tired. She didn’t remember this being so much work the first time she did it, but she’d been ten years younger then too. Younger and never touched by tragedy. Everything was different now, and remembering what made life so very good, she grasped Quinn’s hand. “I love you. Everything is going to be fine.”

  “I know.” Quinn squatted next to the bed, holding Honor’s hand to her cheek as she stroked her damp, sun-streaked hair. Honor’s collar-length waves were lusterless, her deep chestnut eyes shadowed with exhaustion. “Deb thinks you’ve about had enough hard work for one day. I agree.”

  “She said that dip in the fetal heart rate wasn’t anything to worry about,” Honor said, her eyes going to the monitor by the bedside that beat at a steady hundred and sixty a minute. “The baby’s fine.”

  “Absolutely,” Quinn said, her voice raspy. “But it’s time for you to rest, sweetheart.”

  Honor sighed. “It will take me four times as long to recover if I have a C-section.”

  Quinn grinned. “Then I guess you’ll be out of work eight days instead of two.”

  “I want to be able to take care of the baby when I get home.”

  “You will.” Quinn leaned over and kissed her forehead. “You’ll just need a little extra help for a week or two. Arly and Phyllis will love doing extra baby duty. So will I.”

  Honor frowned at the mention of their daughter. “Have you talked to Arly? Is she okay? She’s not scared, is she?”

  “Arly? Scared?” Quinn laughed. “I can’t answer her questions fast enough, starting with, why can’t she visit, followed by when can she see you and the baby. She’s waiting by the phone for my hourly updates. Phyllis said she refused to go to sleep until Phyllis promised to wake her up for my calls.”

  “Thank God for Phyllis.” Honor sighed. They’d all be lost without Arly’s grandmother. “Don’t tell Arly about the surgery. I’ll explain that when I see her.”

  Quinn kissed her again, this time on the lips. “I won’t.”

  Quinn looked over her shoulder at the knock on the door. Deb entered with Tristan right behind her.

  “Honor, honey,” Deb said. “It’s time to get this little camper some daylight.”

  “Okay,” Honor said, finally giving in to the inevitable. “Hi, Tristan.”

  “Hi, Honor.” Tristan put Honor’s chart on the bedside table and swung her stethoscope from around her neck. “Let me listen to your heart and lungs real fast, then I need you to sign this consent.”

  “I’ll see you in the OR.” Deb patted Honor’s hand and disappeared. A moment later, Tristan followed her out.

  “Don’t go anywhere, okay?” Honor gripped Quinn’s hand more tightly. She was used to being in charge, making hard decisions quickly, and accepting responsibility. She’d been alone, raising her daughter, for a long time before Quinn, but in the last two years she’d come to accept that having a shoulder to lean on when she was tired or frightened didn’t make her weak. And that she could always trust Quinn to be there.

  “I’ll be right beside you the whole way,” Quinn whispered.

  Honor nodded and closed her eyes. She was safe. And she was ready.

  Chapter Three

  Quinn stroked Honor’s face as she watched over the sterile barricade that separated the operating field from Tristan and all her anesthesia equipment. The scene was as familiar to Quinn as her own face in the mirror, but everything this time was different. The operating field was Honor’s abdomen, and as Deb made the first horizontal incision just above the pubis, the bright red blood was Honor’s blood. Quinn looked down into Honor’s face, trying to put every ounce of the love she felt into her eyes, aware that was all Honor could see. Tristan had allowed Honor to have one arm free so she could hold Quinn’s hand, even though ordinarily both arms would be strapped to the supports on either side of the operating table. Quinn squeezed Honor’s fingers.

  “Everything looks great, sweetheart,” Quinn whispered.

  Honor smiled sleepily. “Can you see the baby yet?”

  “Not yet. Soon.”

  “Go check. Make sure everything’s okay…all the parts.”

  Quinn laughed quietly. “I will.” She glanced at Tristan and raised an eyebrow, not wanting to ask aloud if Honor was doing all right. Ordinarily, she was too busy operating to worry about what anesthesia was doing, and she trusted them to do their job as well as she did hers. Now, with nothing to do but watch everyone else take care of Honor, she felt helpless. Useless. And more anxious than she could ever remember feeling.

  “Mama is doing fabulously,” Tristan said, leaning down so Honor could hear her.

  “Wonderful stuff, whatever you gave me,” Honor said, her voice slightly slurred. She frowned. “Shouldn�
��t give me drugs.”

  Tristan laughed. “Don’t worry, Dr. Blake, that baby is going to be out before any of what you’re getting gets down there.”

  “All right then,” Honor proclaimed. She blinked and frowned again. “Quinn?”

  “Right here.” Quinn pulled her gaze away from the surgical field. Deb had delivered the uterus, which glistened a deep purple under the overhead lights, into the field. Deb murmured something to the nurses that Quinn didn’t hear, then made a one-inch incision in the lower portion of the distended muscle. Quinn bent down. “The baby’s coming in a second, sweetheart.”

  “Go. Go look.”

  “Okay. I’ll be right back.”

  Quinn stepped around the barrier and moved behind Deb to the end of the table where the scrub nurse waited with her instruments. “Can you toss me a gown?”

  “Here you go, Doctor,” the nurse said, holding up a sterile gown for Quinn to slide her arms into. The nurse handed off a packet of sterile gloves, which Quinn pulled on. Because she hadn’t scrubbed first, she wasn’t technically sterile enough to step up to the operating table, but she could get close enough to Deb to see, and she could hold the baby without any concerns. She watched over Deb’s shoulder as Deb inserted a large pair of scissors inside the uterus and cut the rest of the way through the muscular wall. Quinn held her breath, knowing that occasionally the scissors would lacerate the baby as the baby moved around inside the uterus. Then a tremendous gush of blood-tinged fluid poured out. A second later a tiny arm poked out of the gap in the muscular uterine wall. Deb reached into the uterus with one hand, found the head and directed it up toward the incision, and the baby came swimming out on another spurt of blood and amniotic fluid. Quinn had seen cesarean sections dozens of times, but somewhere around the time the scissors had gone into Honor’s uterus, she’d stopped breathing. Now her breath whooshed out in a gasp of relief. Then her stomach plummeted. The baby was blue and not breathing. Quinn struggled not to panic.

  “Get the suction up,” Deb said calmly to the nurse as she deftly clamped and cut the cord, freeing the baby from the placenta, which remained inside Honor’s uterus. As soon as Deb inserted the suction catheter inside the baby’s nose and mouth, the child cried. The scrub nurse scooped the baby up, turned, and handed it off to the waiting pediatric nurse, who carried the child to a waiting bassinet underneath a heat lamp.

  “Is Honor okay?” Quinn murmured close to Deb’s ear.

  “Doing fine,” Deb said. “Go see your baby.”

  My baby, Quinn thought, suddenly unsteady. How life had changed. A few short years ago she’d seen herself as the star of a big-city hospital trauma center, her life one adrenaline rush after another. She’d never been one for serious relationships, but she hadn’t played around either. She’d focused on work. So she hadn’t seen a woman in her future. All that had changed when illness had nearly derailed her surgery career permanently. Then, when she thought she’d lost everything, she discovered what had been missing in her life all along. A family of her own. Now she had Honor and Arly and Phyllis. And a new baby. From behind her, she heard Honor’s voice, sleepy but clear.

  “Quinn? Tell me.”

  Quinn stood next to the bassinet and looked down, amazed. They hadn’t wanted to know the baby’s sex until now, and that seemed the least important thing at the moment. “Sweetheart? Solid Apgars—all systems go. Ten fingers, all perfect. Ten toes. Equally perfect. Oh—and some extra little bits, also perfect.”

  “Little bits? A boy?” Honor laughed. “We have a boy?”

  “Yep. Arly has a brother. You can see him in a minute.” Quinn watched the nurse record the various vital signs, documenting the baby’s neurologic and cardiovascular status. He was crying and waving his arms and legs. He had a thatch of hair, just a shade lighter than Honor’s. His eyes were brown. “He’s beautiful, sweetheart.”

  “Tris,” Deb said, “can you push some more Pitocin, please?”

  Quinn suddenly realized that the room behind her had grown very quiet. She turned, heart pounding. Her eyes went first to the monitor behind Tristan’s head. Honor’s heart rate was 140, her blood pressure was down, her O2 saturation below normal. For one dizzying second, the room spun, and then Quinn’s mind snapped into sharp focus and she took three rapid strides back to the operating table. “What’s wrong?”

  “She’s bleeding and the Pit doesn’t seem to be working,” Deb said, kneading the uterus between her hands, trying to coax the sluggish muscle to contract. The vessels supplying the uterus were as large as Quinn’s thumb, having increased in size during pregnancy to meet the demands of the growing fetus for blood and nutrients and oxygen. Now the inner surface of the uterus had been stripped of the placenta, and if the muscle didn’t contract, closing off the open ends of the vessels, the vast volume of blood that had gone to supply the baby would simply pour out through the opening of the uterus. At this rate, Honor would bleed to death in a matter of minutes.

  Quinn wanted to push Deb out of the way and grab a clamp, a suture, anything to stop the river of blood pooling in Honor’s abdomen. She forced herself to move to the head of the table, to Honor. Honor’s eyes were closed, and she was very pale.

  “It’s okay, sweetheart,” Quinn whispered, kneeling so her face was close to Honor’s. “It’s going to be okay.”

  Honor didn’t answer.

  *

  “You want me to tube her, Deb?” Tristan waved to the circulating nurse to get her attention. “Get an anesthesia tech in here STAT.”

  God damn it. She hated when an easy case went bad. She hated it whenever that happened, but it was always so much worse when it was someone she knew, or the family or friend of someone she knew. This time, she couldn’t even think about Quinn just inches away, fear seeping from her pores. Quinn had pulled off her sterile gloves and had one hand on Honor’s face. Her fingers trembled, something else Tristan had never seen.

  Tristan checked the O2 saturation. It had fallen dangerously low. Now the call was hers, not Deb’s. “I’m going to intubate. Where the hell’s the tech?”

  “I can help,” Quinn said, straightening up. “What do you need?”

  “Get me a number seven ET tube. Second drawer in my cart,” Tristan said without bothering to look up from her drug box. She pulled out ampoules and drew up the medication to paralyze Honor so she could insert the breathing tube into her trachea. “Did someone call down for blood?”

  “Do we have a type and screen on her?” Deb called out. “Someone hook up another suction. I can’t see anything in here.”

  “She’s A positive,” Quinn said. She held the tube next to Tristan’s right hand while Tristan inserted the laryngoscope into Honor’s mouth to hold her tongue out of the way and expose her epiglottis.

  “Nice clear view for a change,” Tristan muttered, taking the endotracheal tube lightly between her thumb and first two fingers and easing it past the epiglottis, through the vocal cords, and into the trachea. “Blow up the balloon. Eight cc’s.”

  When Quinn fumbled with the thin plastic tube attached to the balloon at the end of the trach tube, Tristan realized Quinn was in no shape to be assisting her. Carefully, she extracted her laryngoscope while supporting the tube with her other hand. “Here, I’ll do it.”

  “I got it,” Quinn said gruffly. “Eight cc’s, right?”

  “Right.”

  Quickly, Tristan connected the endotracheal tube to a ventilator, cycled in the appropriate amounts of general anesthetic and oxygen, set the volume on the respirator, and started to relax just a little. There wasn’t much she could do now but wait, which was never easy, but Deb was a good surgeon on top of being a good obstetrician. “How are things going over there, Deb?”

  “Slowing down, but not enough. How is she?”

  “She needs volume, but otherwise looking good.”

  “Quinn,” Deb said, her attention still on the surgical field.

  “Yes?” Quinn said sharply.

  Tri
stan felt Quinn stiffen beside her. Someone probably should’ve gotten Quinn outside, but Tristan wasn’t quite certain how anyone would have.

  “If I can’t get this bleeding stopped in another minute, I’m going to have to do a hysterectomy,” Deb said. “You’re next of kin. Do you consent?”

  “I…” Quinn drew a shaky breath. “Honor and I haven’t talked about more kids…I don’t know what she wants.”

  The room was silent except for the sound of the suction removing the blood that continued to flow. Tristan understood that in that moment, Quinn Maguire was no longer a calm, cool, collected trauma chief. She was a woman faced with losing everything that mattered to her, vulnerable and alone.

  “You and Honor have two kids, Quinn,” Tristan said quietly. “They need Honor. So do you.”

  Quinn met Tristan’s eyes, hers filled with misery.

  “Quinn?” Deb repeated.

  “Yes,” Quinn said firmly. “Yes. Do it.”

  *

  Tristan stepped off the elevator onto the top floor of the parking garage and blinked in the early morning sun. For a few seconds, she struggled with the disorientation of returning to the normal world, where most people were on their way to work on Monday morning while she was on her way home to bed. At least, she should be on her way home to bed, but she knew she wouldn’t be for a while. She’d barely finished with Honor when she’d been called back to trauma admitting. Healthstar had made another run and brought in a second patient from the turnpike accident. Until Tristan’s relief had arrived at eight, she’d been in the operating room with a nineteen-year-old girl who’d been trapped in the front seat of her Mazda Miata underneath the back wheels of the tractor-trailer for forty minutes before the EMTs could extricate her. She’d lost her right leg below the knee and might lose the other, if she didn’t bleed to death from a ruptured spleen, fractured pelvis, and lacerated inferior vena cava. Her blood pressure had bounced from 40 to 200 with the rapidity of a ping-pong ball in a championship match, keeping Tristan constantly on edge.