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  Chapter Three

  Personal Project Log—Castle

  June 30, 10:45 a.m.

  My first morning of rounds in the trauma unit just ended. I’m exhausted, and all I had to do was move from bed to bed and watch the process. I didn’t understand everything that was being said, especially when they began reeling off blood gas values and talking about Glasgow coma scores. [Note: get Deb to explain this rating scale for head injury on film, preferably with a patient in the background. Get Sinclair’s okay to film in TICU. Get DP to check lighting in there with film compatibility.]

  What I did understand loud and clear is that trauma rounds are where the real business of the day gets done. It’s the only time during the day that the whole team is together, and it’s the time when Sinclair fine-tunes the treatment plan for every patient in the Trauma ICU. Each patient’s status is summarized for her by the resident covering that person, and whatever needs to be done—consults, studies, medication adjustments, etc.—is discussed and ordered. Sinclair signs off on all decisions.

  Now, at midmorning, the doctors assigned to the less sick patients on the regular patient floors will go see to them, and those doctors responsible for incoming trauma emergencies—Sinclair and Stein today—will go down to the Trauma Admitting area. And I—

  “Ms. Castle?”

  Jude jumped and clicked off her recorder. She smiled at Sinclair, who was leaning with one shoulder against the wall just outside the TICU, watching her. “Sorry. I didn’t know you were there. Do you need me for something?”

  “I want to show you the admitting area. I’m on my way down there now.”

  “Great.” Jude slipped the small recording device into her trouser pocket as they walked. “Thanks for letting me tag along on rounds this morning.”

  “Were you recording then, too?”

  “No,” Jude said as they entered the stairwell. “I usually record notes to myself—impressions, reactions, reminders. Things I might use for voiceovers later in the film. If I want to tape you or anyone else, I’ll ask first.”

  Sinclair didn’t say anything for a moment, then asked, “How did you come to pick Deb Stein as the focus of your project?”

  They exited on the first floor and passed the emergency room waiting area, already crowded with walk-ins—mostly mothers with children and middle-aged people with minor injuries. Individuals with potentially serious medical conditions usually arrived by ambulance and were delivered directly to treatment rooms. Ahead, down the hallway, was yet another set of windowless doors with a keypad lock restricting entry.

  “She and I met three years ago at the Olympics,” Jude said. “I was doing a piece on female athletes, and we started talking about her plans after the Games were over. When I began working on this, I thought of her.”

  “And she agreed?” Sax pushed in the code on the door lock. “It’s the same as the phone extension—two four two zero.”

  “Yes, she did. Why?”

  Sax shrugged and led the way along another sterile beige corridor. “That’s what I’m wondering. Why?”

  “You’ll have to ask her. I’d like to talk to you, though—on tape—about your own training. Background information, personal experiences, that kind of thing.”

  Sax stopped walking. “Everything you need is on my CV. My secretary can get that for you. You have her number.”

  There was a note of finality in her voice that left no room for discussion. Jude kept her surprise, and her curiosity, to herself. She’d pushed enough for the first day. “All right, thanks.”

  “This,” her companion said, leading her through a small alcove that contained scrub sinks and cupboards with surgical hats and gowns into another unadorned room that appeared to be a hybrid operating theater and treatment area, “is the trauma admitting area. Every trauma patient is brought in here, stabilized, and triaged.”

  There were three operating tables lined up in the center of the space, each of which could be enclosed by curtains for privacy if necessary. Above each narrow, stainless steel table hung large, circular silver lights containing brilliant halogen bulbs capable of lighting the area adequately for surgery.

  Jude stared at the silver domes and flushed with a sudden wave of heat and dizziness. Her vision narrowed and spots danced across the darkening landscape. Reflexively, she reached out a hand to steady herself and was dimly aware of an arm encircling her waist.

  “Ms. Castle,” a quiet, calm voice murmured. “Are you all right?”

  Jude forced herself to take a deep breath, knowing that this would pass quickly if she just kept breathing. Her legs were unsteady, and she held on hard to the warm solid body next to hers. “Yes,” she whispered faintly. “Just...I’m sorry...just a minute.”

  Sax stood perfectly still, letting the other woman lean on her, holding her so close it might have been an embrace. A fine sheen of perspiration filmed Jude’s forehead, and she was very pale. “Let’s get you lying down,” Sax said softly. She could feel her tremble.

  “No,” Jude responded quickly, pressing one hand to Sax’s shoulder, straightening up with obvious effort. “I’ll be fine. I’m okay, really.”

  Sax studied her, still not releasing her hold as she rested two fingers on the pulse in Jude’s wrist. Fast but strong. “I agree. You will be fine, but right now, you still need to at least sit down.”

  “I’m sorry,” Jude said again, laughing self-consciously as she allowed herself to be walked to a chair in front of a long counter that edged the rear wall. Her vision had cleared, and she was acutely aware of the arm around her waist. She was also aware of the hard length of Saxon Sinclair’s body against her side and the soft swell of the surgeon’s breast against her own. Her legs trembled again, and it wasn’t from dizziness. She stepped away quickly and settled into the chair.

  One of the nurses asked Sax if she needed anything, but she shook her head. Pulling another chair over close to Jude’s, she asked, “What happened?”

  Embarrassed, Jude blushed. “Nothing. I just got a little light-headed. Guess I should have had breakfast.”

  “That could be,” Sax acknowledged, but she didn’t really think that it was hypoglycemia. That usually gave some warning—a racing pulse, tremors, the gradual onset of faintness. Jude Castle had seemed perfectly fine until she walked into trauma admitting. “Has this ever happened to you before?”

  “No.” Jude was uncomfortable under the scrutiny of those penetrating eyes. At least, it’s been so long that I thought it was over.

  “We should get an EKG. One of the nurses can do one right down here.”

  “Really, that’s not necessary. I feel fine now.” To prove it, Jude stood and walked a few feet away, wanting to escape Sinclair’s searching gaze. She needed to walk off the anxiety that clung to her like a bad dream, and she needed to forget the swift surge of desire she had experienced in Sinclair’s innocent embrace. This is not a good start. Steadying her voice, she asked, “How many patients do you see through here every year?”

  “Fifteen hundred, approximately.” Sax watched Jude pace. The abrupt change in subject hadn’t escaped her notice, but she understood the need for privacy. She understood secrets. “When we have a trauma alert, there’s not much room in here. There will be EMTs, nurses, radiology techs, respiratory therapists, anesthesiologists, at least three surgeons, and assorted consultants.”

  “The families?”

  Sax shook her head. “Not in here. There’s a waiting room just down the hall where they can stay. Families usually can’t see the patient until after they’re transferred to the ICU or finished in the OR, depending on the severity of the injuries. This is a modern day MASH unit—we evaluate and ship as fast as possible.”

  “But sometimes you operate down here?” Jude found she was starting to forget her own discomfort as they talked. She’d drifted back to where Sax still sat and sat down opposite her again.

  “Only in the case of a life-threatening emergency.”

  “Which wo
uld be...what?” Jude asked. “May I record this, by the way?”

  Sax realized that she had been deftly maneuvered into giving an interview, and assented with a grudging grin of defeat. “A number of things can constitute an emergency. Anything that impairs breathing—a fractured larynx, for example—could require a tracheostomy. Sometimes, in the face of major blood loss from the pelvis or ruptured internal organs, we cross-clamp the aorta to send what blood there is to the brain.”

  As she listened, Jude continued to study the physical layout of the room as well as its contents. This was her set; this room would be the backdrop for most of the action she filmed. She would be spending a great deal of time here in the next year.

  “What do you do between trauma alerts?”

  “I’m usually in my office, taking care of administrative things, or at committee meetings, or making rounds in the unit. On a busy day when things are jumping down here, I work in my on-call room down the hall.”

  “Or,” a male voice observed from behind Jude, “she tries to sucker someone into playing chess with her.”

  Jude swung around on her chair and stared at a man in pale blue scrubs, a color she was sure he had chosen to match his eyes if his two-hundred-dollar haircut and startling good looks were any indication of the care he took with his appearance. He might have been a male model posing for a uniform catalog.

  “Jude Castle, meet Aaron Townsend, the head trauma nurse,” Sax said.

  Aaron gave Jude a friendly smile and a frankly appraising look as he took her hand. “Nice to meet you. I’ve heard rumors that we are going to be immortalized on film.”

  “I certainly hope so,” Jude replied with a laugh, aware that he was trying to charm her in an inoffensive way that was probably second nature to him. Nevertheless, she didn’t prolong the eye contact.

  “Excellent,” the handsome nurse said enthusiastically. “And I was serious about the chess thing. When the good doctor gets bored, she likes to humiliate people at games.”

  Jude shrugged, hoping she appeared more nonchalant than she felt. “Don’t worry, chess is not my game.”

  Sax regarded her silently, wondering why, for the second time in less than an hour, Jude Castle was lying.

  Chapter Four

  June 30, 12:42 p.m.

  “You’ll need to work with the bare minimum of people in here,” Sax said after Aaron Townsend left to give lunch relief in the TICU, which was short a nurse on the day shift. “Space is at a premium.”

  “I’ll want at least two camera people, a sound tech, and a script assistant with me,” Jude responded immediately. She was still thinking about the nurse’s comments about Sinclair being a chess player. Great. One more complication.

  “Not a chance.” The tone was uncompromising, almost dismissive. Saxon Sinclair could not have made her contempt for both the project and Jude’s professionalism more apparent if she’d announced it over the intercom.

  Stung, Jude glared at her from a foot away. Under other circumstances, she might have handled things a little more diplomatically, but she was still shaken by her near fainting spell and off her stride. Without thinking, she said, “I don’t need your permission, you know. I’m just trying to be polite here.”

  “You don’t need to be polite, Ms. Castle.” Sax stood up, never raising her voice, her blue eyes glacially cold. “What you have to do is be certain not to interfere with the work that needs to be done down here, or I’ll have you thrown out on your ass.”

  Of all the arrogant, dictatorial... Jude fumed as Sinclair strode swiftly from the room. She rubbed her temples and tried not to curse out loud. Lovely, just lovely.

  June 30, 4:42 p.m.

  “Why did you decide to do your fellowship with Dr. Sinclair?” Jude placed the small recorder on the table in the conference room.

  “Because she’s the best,” Deb Stein answered with a look that said Jude should’ve known the answer to that silly question.

  “Define best,” Jude probed, wanting to get a feel for her star and to lay the foundation for what was to come in the weeks ahead. “What makes her different from any number of other trauma surgeons?”

  “On the record?” Deb asked, nodding toward the recorder. “Because her unit has the best survival statistics in the state, and I’ve seen her in the operating room. I rotated here as a junior general surgery resident, and she’s amazing. She’s got hands like lightning. Awesome.”

  Jude had a feeling that there was something else, because Deb had a little grin on her face. She reached to push the stop button on her tape recorder. “What about off the record? Come on, Deb. I can tell you’re holding back on me.”

  “Well,” Deb conceded, her eyes twinkling, “she’s so godawful hot. Every dyke resident I know wanted to work with her.”

  “Aha.” Jude hoped she wasn’t blushing. “Okay, we’ll keep that off the record.” What in hell is the matter with me? It’s not as if I didn’t think practically the same thing the minute I saw her. So what if she’s hot. She’s a royal pain in the—

  Deb Stein jumped up as the pager at her waist beeped, and without another word, she charged from the room. Overhead, the intercom blared. Trauma alert STAT, trauma admitting. Trauma alert STAT...

  Jude grabbed her tape recorder and ran.

  *

  Sax stood gowned and gloved as the double doors to the trauma admitting area slid open and a stretcher bearing a mound of equipment, blood-soaked clothing, and an EMT straddling a human body rolled in. The female EMT kneeling astride the man was counting aloud as she rhythmically compressed his chest. “One, two, three, four, five...one, two, three, four, five...” slowing at the end of each sequence so her partner could deliver a breath through the inflatable Ambu bag attached to the endotracheal tube protruding from the man’s mouth.

  “GSW to the left chest,” her partner called to no one in particular, his voice shrill with the adrenaline rush as he ran beside the stretcher, squeezing air into the unresponsive patient’s lungs. “Intubated in the field. He’s had five liters of Ringer’s solution. Initial BP eighty palpable. We lost the pulse and pressure about three minutes ago.”

  “Exit wound?” Sax called as she and Nancy Stevenson, one of the trauma nurses, slid the large man from the gurney onto the treatment table. She quickly assessed his pupils. Unresponsive to light. If he isn’t brain dead already, he will be in two minutes if we don’t get some oxygen to his brain.

  “None that we saw, Doc. The bullet went in, but it didn’t come out.”

  Swiftly, Sax moved her stethoscope from one side of his chest to the other, listening for air movement as she watched the paramedic ventilate the patient. Deb Stein, followed closely by Jude Castle, ran in as Sax straightened up. “No air flow on either side. Stein, put a chest tube in on the right. Nancy, open the thoracotomy tray.”

  The team worked efficiently, nearly silently, repeating a drill they had performed hundreds of times. One nurse cut off the remnants of the patient’s clothing; another slipped a sterile catheter into his penis and attached it to a urine collection bag; still another drew half a dozen vials of blood for laboratory analysis. A surgical intern pulled a tall metal stand up to the bedside and began folding open the layers of sterile linen covering a vast array of surgical instruments. A radiology technician arrived pushing a huge portable X-ray machine and stood waiting, calmly labeling individual film plates with the date and the letters UWM, which is who the patient would remain until someone had time to identify him. Unidentified White Male.

  All the while, Aaron Townsend continued chest compressions, having relieved the exhausted EMT. It was fatiguing work pushing the chest hard enough so that the force was transmitted to the heart, and harder still to get the heart to squeeze out blood with enough pressure to travel to the brain and other vital organs when it was almost empty. And this man’s heart had to be almost empty. Most of his blood volume had poured out the two-inch hole in his chest.

  Her back pressed to the wall, Jude maneuver
ed as close to the action as she could get. No one paid her the slightest attention. She glanced at the clock. Forty-five seconds had elapsed since the stretcher had been wheeled in.

  Peering around the anesthesiologist at the head of the table, she watched Sinclair. The surgeon’s gaze as she studied the patient was hard and unwavering, her eyes nearly purple with intensity. Everything about her was ferociously focused. Had Jude been more aware of her own body, she would have released the breath she was holding, but she was too absorbed by the trauma chief.

  “Hang that blood and squeeze it in by hand,” Sax said sharply. She glanced quickly across the man’s body at Deb. “Have you got that tube in, Stein?”

  “Almost.” Deb forced an oversized clamp between the fifth and sixth ribs with one hand while holding a clear plastic tube a half inch in diameter in the other, ready to guide it through the tunnel she was creating into the chest cavity.

  “Push it in—you’re not going to hurt him,” Sax said while pouring Betadiene directly from a bottle onto the man’s torso. “As soon as you’ve got it in, get over here and give me a hand cracking his chest.” Even as she spoke, she was slashing a ten-inch curve between the ribs on the left side. “Rib spreader,” she said tersely as a flood of dark congealed blood cascaded out onto her.

  She held out her right hand, and a nurse passed her a ratcheted double-bladed retractor. Sax forced it between the ribs and cranked it open, exposing a deflated lung and a flaccid heart. Deb stepped up next to her, breathing hard, but her hands were steady.

  “Open the pericardium and massage the heart manually,” Sax instructed. She leaned away slightly so Deb could move closer, bending a bit to watch as her fellow made a slit in the protective covering enclosing the heart. “Not too deep, now. Stay away from the coronaries. That’s it...nice. Get your hand around it.”