Another siren. Megan glanced at Susan, who was attaching strips of tape to the edge of the treatment table where she could easily grab them when needed. The nurse didn’t look up from her work.
The siren abruptly stopped sounding, turned off because the ambulance had reached its destination.
A woman’s voice squawked through the loudspeaker above the door. “Ambulance in the bay, ambulance in the bay.”
Megan took in the room and winced as an uneasy feeling visited again. Where is Luke?
A minute later she heard the gurney’s clanging wheels, then muffled voices. Her stomach tightened.
Whoosh. The heavy metal doors opened and a small platoon of blue jumpsuits — each sporting a rainbow insignia and the letters UCH — trotted into the room with their stretcher and its diminutive cargo.
Blankets covered all but the patient’s head. The transport team’s gear was strewn along the edge of the gurney: beige monitors spewing green squiggly lines, bright orange fishing tackle boxes stuffed with drug vials, and a pair of oxygen tanks lying on their sides.
All that Megan could make out was the boy’s brown hair, the oxygen mask covering his face, and two dark eyes darting around the room.
Transport personnel were just beginning to disconnect their equipment when the trauma team went to work. Everyone was jockeying for position. A tangle of arms crisscrossed the table as instruments, tape, syringes, IV bags, tubing, and cords passed back and forth at a furious pace. Their work slowed for just an instant when they lifted the boy onto the treatment table.
That was when Megan got her first glimpse of the boy. His features were Indian — a round face with high cheekbones and straight black hair — and his limbs were emaciated. Whatever his illness was, it had been ravaging his body for many months.
Susan called out, “Orders, Doctor?” even before Megan could get close enough to examine the patient.
Megan squeezed in closer to the table and reached over someone’s stooped shoulder to place her stethoscope on the boy’s chest.
Behind her, the transport physician had already started into a highly regimented account of his team’s assessment and therapy. It yielded no clues that pointed to a diagnosis and revealed only what they had not found — the boy had no fever, and no abnormal breath sounds.
“A few minutes after I called you from the airport,” the transport doctor continued, “the patient’s O-2 sat dropped to eighty percent. We increased his oxygen — it’s now running at ten liters a minute — and gave him nebulized Albuterol to open up his airways. But his sat’s are still hovering around eighty-five percent.”
The boy’s oxygen saturation — O-2 sat — merely quantified what she already knew by looking at him. He was oxygen starved. The question was why? Pneumonia was an obvious possibility, but she’d have expected to hear wheezes or crackles in his lungs, and she didn’t.
Megan’s head turned to the transport physician. “You start antibiotics?”
“I wanted to, but our IV came out and we couldn’t get a new line into him.”
Susan interrupted them. “Doctor, orders?” This time the request sounded more like a command.
Megan saw the nurses connect with a glance.
It didn’t help that everyone in this room had more experience than she did, and would instantly jump in and take over if they sensed the slightest hesitation on her part. Working to keep her voice even, Megan called out a long list of blood tests and ordered “shotgun” antibiotics to cover a broad spectrum of possible infections. She glanced back at the transport physician, who shrugged his indifferent agreement.
“And call radiology, stat,” Megan added. “They were supposed to be here when the patient arrived.”
“Be sure to let us know if he turns out to have some exotic infection,” a transport nurse said. “We were in pretty tight quarters on the way over here.”
Susan said, “I’ve heard enough. Everyone puts on a mask and gown.” She opened a cabinet and started tossing the infection control gear into waiting arms.
“O-2 sat is slipping, now at seventy-eight percent,” the respiratory therapist called out. “He’s working way too hard to breathe. I’m starting full-strength Albuterol.”
As she slipped on her mask, Megan swept the length of the boy’s body with her eyes, looking for some physical sign that hinted at the cause of his illness. The skin over his ribs was drawn tight from exertion, skewing a crude crescent-shaped tattoo on his upper chest.
But what seized her attention was his face, which was turning ashen. Oh, God.
“Put him on a non-rebreathing mask,” she said. The specialized mask’s one-way valves and balloon reservoir would allow them to deliver twice as much oxygen as a regular mask.
“Already working on it.” The therapist held it up for Megan to see as she dug into one of the drawers of her portable cabinet and came up with a connector of some type.
Susan grabbed for the wall phone. “I’m calling to find out where McKenna is.”
Megan wasn’t listening. “What’s the boy’s name?” she asked.
“Josue Chaca,” the transport nurse called out.
Megan looked into his eyes, enormous brown eyes teeming with fear.
She laid a hand on his forehead. “No se preocupe, Josue. Vamos á tomar el buen cuidado de tú,” she said, using the passable Spanish most residents learned while working at University Children’s. “Don’t worry, Josue. We’re going to take good care of you,” she repeated to herself.
The boy locked eyes with Megan. He didn’t say anything. He couldn’t say anything. He was too busy gulping air.
It was happening too fast. She was losing him.
4
As soon as McKenna emerged from the treatment room, his eyes fixed on the hulking figure standing over the E.R. check-in desk.
Smack. The man’s fist slammed onto the desktop as he shouted across the counter at the desk clerk. “Where’s my wife? Goddammit, I wanna see my wife and kid. Now.” His voice was as gargantuan as his bulk.
A nurse standing off to the side grabbed a red wall-mounted phone — Security.
Luke walked toward the desk. A nervous crowd of onlookers edged in the opposite direction.
Chewy Nelson, a skinny young intern to McKenna’s left, plopped a handful of M&Ms into his mouth and mumbled through a mouthful of chocolate: “Damn, that’s Lloyd Erickson.”
Luke recognized the name. Anyone who had even a passing familiarity with professional football had heard of the NFL linebacker. His career-ending tackles on the field drew almost as much media attention as his erratic, violent behavior during the off-season.
Erickson stood at least six-foot-four and had a thickly sculpted physique that reeked of steroids. He was big for a linebacker, even an NFL linebacker, and his blazing red hair sat on a head that was three sizes too small for his body.
When Luke reached the desk, he gestured with his eyes and signaled the desk clerk to leave. She rocketed out of her chair and disappeared around a corner.
Erickson was sputtering with rage, shaking his arms wildly in convulsive spasms, half his words unintelligible. He leaned into McKenna’s face, his massive torso dwarfing Luke’s wiry six-foot frame.
Luke just stood there, staring back at the linebacker, trying to restrain his own swelling rage.
This he was able to do until Erickson grabbed his white coat.
Then reflexes took over and McKenna discharged like a coiled spring.
His left hand clutched the linebacker’s wrist while his right forearm came up from below and slammed into Erickson’s locked elbow.