Harvest Page 2

  2

  It was midnight, and Karen Terrio was fighting to keep her eyes open. Fighting to stay on the road.

  She had been driving for the better part of two days now, had left right after Aunt Dorothy’s funeral, and she hadn’t stopped except to pull over for a quick nap or a hamburger and coffee. Lots of coffee. Her aunt’s funeral had receded to a two-day-old blur of memories. Wilting gladioli. Nameless cousins. Stale finger sandwiches. Obligations, so damn many obligations.

  Now all she wanted was to go home.

  She knew she should pull off again, should try to catch another quick nap before pressing onward, but she was so close, only fifty miles from Boston. At the last Dunkin’ Donuts, she’d tanked up on three more cups of coffee. That had helped, a little; it had given her just enough of a buzz to get from Springfield to Sturbridge. Now the caffeine was starting to wear off, and even though she thought she was awake, every so often her head would dip in a sharp bob, and she knew she’d fallen asleep, if only for a second.

  A Burger King sign beckoned from the darkness ahead. She pulled off the highway.

  Inside she ordered coffee and a blueberry muffin and sat down at a table. At this hour of night, there were only a few patrons in the dining room, all of them wearing the same pasty masks of exhaustion. Highway ghosts, thought Karen. The same tired souls who seemed to haunt every highway rest stop. It was eerily quiet in that dining room, everyone focused on trying to stay awake and get back on the road.

  At the next table sat a depressed-looking woman with two small children, both of them quietly chewing on cookies. Those children, so well-behaved, so blond, made Karen think of her own daughters. It was their birthday tomorrow. Tonight, asleep in their beds, she thought, they are only a day away from being thirteen. A day further from their childhood.

  When you wake up, she thought, I’ll be home.

  She refilled her coffee cup, snapped on a plastic cover, and walked out to her car.

  Her head felt clear now. She could make it. An hour, fifty miles, and she’d be walking in her front door. She started the engine and pulled out of the parking lot.

  Fifty miles, she thought. Only fifty miles.

  Twenty miles away, parked behind a 7-Eleven, Vince Lawry and Chuck Servis finished off the last six-pack. They’d been going at it for four straight hours, just a little friendly competition to see who could toss back the most Buds without puking it all up again. Chuck was ahead by one. They’d lost track of the total; they’d have to figure it out in the morning when they tallied up the beer cans mounded in the backseat.

  But Chuck was definitely ahead, and he was gloating about it, which pissed Vince off, because Chuck was better at every fucking thing. And this wasn’t a fair contest. Vince could’ve gone another round, but the Bud had run out, and now Chuck was wearing that eat-shit grin of his, even though he knew it wasn’t a fair contest.

  Vince shoved open the car door and climbed out of the driver’s seat.

  “Where you going?” asked Chuck.

  “T’get some more.”

  “You can’t handle no more.”

  “Fuck you,” said Vince, and stumbled across the parking lot toward the 7-Eleven’s front door.

  Chuck laughed. “You can’t even walk!” he yelled out the window.

  Asshole, thought Vince. What the fuck, he could walk. See, he was walking fine. He’d just stroll into the 7-Eleven and pick up two more sixes. Maybe three. Yeah, he could do three, easy. His stomach was iron, and except for having to piss every few minutes, he didn’t feel the effects at all.

  He tripped going in the door—goddamn high threshold, they could get sued for that—but he picked himself right up. He got three six-packs from the cooler and swaggered over to the cash register. He plunked down a twenty-dollar bill.

  The clerk looked at the money and shook his head. “Can’t take it,” he said.

  “What do you mean, can’t take it?”

  “Can’t sell beer to an intoxicated customer.”

  “Are you saying I’m drunk?”

  “That’s right.”

  “Look, it’s money, isn’t it? You don’t want my fucking money?”

  “I don’t wanna get sued. You just put the beer back, son, OK? Better yet, why don’t you buy a cup of coffee or something? A hot dog.”

  “I don’t want a fucking hot dog.”

  “Then just walk on out, boy. Go on.”

  Vince shoved one of the six-packs across the countertop. It slid off the edge and crashed to the floor. He was about to launch another six-pack off the counter when the clerk pulled out a gun. Vince stood staring at it, his body poised in mid-shove.

  “Go on, get the hell out,” said the clerk.

  “OK.” Vince stepped back, both hands raised in submission. “OK, I hear you.”

  He tripped on the damn threshold again as he went out the door.

  “So where is it?” asked Chuck as Vince climbed back in the car.

  “They’re outta beer.”

  “They can’t be out of beer.”

  “They’re fucking out, OK?” Vince started the car and goosed the accelerator. They squealed out of the lot.

  “Where we going now?” asked Chuck.

  “Find another store.” He squinted ahead at the darkness. “Where’s the on-ramp? Gotta be around here somewhere.”

  “Man, give it up. No way you’ll go another round without puking.”

  “Where’s the fucking on-ramp?”

  “I think you passed it.”

  “No, there it is.” Vince veered left, tires squealing over the pavement.

  “Hey,” said Chuck. “Hey, I don’t think—”

  “Got twenty fucking bucks left to blow. They’ll take it. Someone’ll take it.”

  “Vince, you’re going the wrong way!”

  “What?”

  Chuck yelled, “You’re going the wrong way!”

  Vince gave his head a shake and tried to focus on the road. But the lights were too bright and they were shining right in his eyes. They seemed to be getting brighter.

  “Pull right!” screamed Chuck. “It’s a car! Pull right!”

  Vince veered right.

  So did the lights.

  He heard a shriek, unfamiliar, unearthly.

  Not Chuck’s, but his own.

  Dr. Abby DiMatteo was tired, more tired than she’d ever been in her life. She had been awake for twenty-nine straight hours, if one didn’t count her ten-minute nap in the X-ray lounge, and she knew her exhaustion showed. While washing her hands in the SICU sink she had glimpsed herself in the mirror and had been dismayed by the smudges of fatigue under her dark eyes, by the disarray of her hair, which now hung in a tangled black mane. It was already ten A.M., and she had not yet showered or even brushed her teeth. Breakfast had been a hard-boiled egg and a cup of sweet coffee, handed to her an hour ago by a thoughtful surgical ICU nurse. Abby would be lucky to find time for lunch, luckier still to get out of the hospital by five and home by six. Just to sink into a chair right now would be luxury.

  But one did not sit during Monday morning attending rounds. Certainly not when the attending was Dr. Colin Wettig, chairman of Bayside Hospital’s surgical residency program. A retired Army general, Dr. Wettig had a reputation for crisp and merciless questions. Abby was terrified of the General. So were all the other surgical residents.

  Eleven residents now stood in the SICU, forming a semicircle of white coats and green scrub suits. Their gazes were all trained on the residency chairman. They knew that any one of them could be ambushed with a question. To be caught without an answer was to be subjected to a prolonged session of personalized humiliation.

  The group had already rounded on four postop patients, had discussed treatment plans and prognoses. Now they stood assembled beside SICU Bed 11. Abby’s new admission. It was her turn to present the case.

  Though she held a clipboard in her arms, she did not refer to her notes. She presented the case from memory, her gaze focu
sed on the General’s unsmiling face.

  “The patient is a thirty-four-year-old Caucasian female, admitted at one this morning via the trauma service after a high-speed head-on collision on Route Ninety. She was intubated and stabilized in the field, then airlifted here. On arrival to the ER, she had evidence of multiple trauma. There were compound and depressed skull fractures, fractures of the left clavicle and humerus, and severe facial lacerations. On my initial exam, I found her to be a well-nourished white female, medium build. She was unresponsive to all stimuli with the exception of some questionable extensor posturing—”

  “Questionable?” asked Dr. Wettig. “What does that mean? Did she or did she not have extensor posturing?”

  Abby felt her heart hammering. Shit, he was already on her case. She swallowed and explained, “Sometimes the patient’s limbs would extend on painful stimuli. Sometimes they wouldn’t.”

  “How do you interpret that? Using the Glasgow Coma Scale for motor response?”

  “Well. Since a nil response is rated a one, and extensor posturing is a two, I suppose the patient could be considered a . . . one and a half.”

  There was a ripple of uneasy laughter among the circle of residents.

  “There is no such score as a one and a half,” said Dr. Wettig.

  “I’m aware of that,” said Abby. “But this patient doesn’t fit neatly into—”

  “Just continue with your exam,” he cut in.

  Abby paused and glanced around at the circle of faces. Had she screwed up already? She couldn’t be sure. She took a breath and continued. “Vital signs were blood pressure of ninety over sixty and pulse of a hundred. She was already intubated. She had no spontaneous respirations. Her rate was fully supported by mechanical ventilation at twenty-five breaths per minute.”

  “Why was a rate of twenty-five selected?”

  “To keep her hyperventilated.”

  “Why?”

  “To lower her blood carbon dioxide. That would minimize brain edema.”

  “Go on.”

  “Head exam, as I mentioned, revealed both depressed and compound skull fractures of the left parietal and temporal bones. Severe swelling and lacerations of the face made it difficult to evaluate facial fractures. Her pupils were mid-position and unreactive. Her nose and throat—”

  “Oculocephalic reflexes?”

  “I didn’t test them.”

  “You didn’t?”

  “No, sir. I didn’t want to manipulate the neck. I was concerned about possible spinal dislocation.”

  She saw, by his slight nod, that her answer had been acceptable.

  She described the physical findings. The normal breath sounds. The unremarkable heart. The benign abdomen. Dr. Wettig did not interrupt. By the time she’d finished describing the neurologic findings, she was feeling more self-assured. Almost cocky. And why shouldn’t she? She knew what the hell she’d been doing.

  “So what was your impression?” asked Dr. Wettig. “Before you saw any X-ray results?”

  “Based on the mid-position and unreactive pupils,” said Abby, “I felt there was probable midbrain compression. Most likely from an acute subdural or epidural hematoma.” She paused, and added with a quiet note of confidence, “The CT scan confirmed it. A large left-sided subdural with severe midline shift. Neurosurgery was called in. They performed an emergency evacuation of the clot.”

  “So you’re saying your initial impression was absolutely correct, Dr. DiMatteo?”

  Abby nodded.

  “Let’s take a look at how things are this morning,” said Dr. Wettig, moving to the bedside. He shone a penlight into the patient’s eyes. “Pupils unresponsive,” he said. He pressed a knuckle, hard, against the breastbone. She remained flaccid, unmoving. “No response to pain. Extensor or otherwise.”

  All the other residents had edged forward, but Abby remained at the foot of the bed, her gaze focused on the patient’s bandaged head. While Wettig continued his exam, tapping on tendons with a rubber hammer, flexing elbows and knees, Abby felt her attention drift away on a tide of fatigue. She kept staring at the woman’s head, recently shorn of hair. The hair had been a thick brown, she remembered, clotted with blood and glass. There had been glass ground into the clothes as well. In the ER, Abby had helped cut away the blouse. It was a blue and white silk with a Donna Karan label. That last detail was what seemed to linger in Abby’s memory. Not the blood or the broken bones or the shattered face. It was that label. Donna Karan. A brand she herself had once purchased. She thought of how, sometime, somewhere, this woman must once have stood in a shop, flipping through blouses, listening to the hangers squeak as they slid across the rack . . .

  Dr. Wettig straightened and looked at the SICU nurse. “When was the hematoma drained?”

  “She came out of Recovery about four A.M.”

  “Six hours ago?”

  “Yes, that would make it six hours.”

  Wettig turned to Abby. “Then why has nothing changed?”

  Abby stirred from her daze and saw that everyone was watching her. She looked down at the patient. Watched the chest rise and fall, rise and fall, with every wheeze of the ventilator bellows.

  “There . . . may be some postop swelling,” she said, and glanced at the monitor. “The intracranial pressure is slightly elevated at twenty millimeters.”

  “Do you think that’s high enough to cause pupillary changes?”

  “No. But—”

  “Did you examine her immediately postop?”

  “No, sir. Her care was transferred to Neurosurgery Service. I spoke to their resident after surgery, and he told me—”

  “I’m not asking the neurosurgery resident. I’m asking you, Dr. DiMatteo. You diagnosed a subdural hematoma. It’s been evacuated. So why are her pupils still mid-position and unreactive six hours postop?”

  Abby hesitated. The General watched her. So did everyone else. The humiliating silence was punctuated only by the whoosh of the ventilator.

  Dr. Wettig glanced imperiously at the circle of residents. “Is there anyone here who can help Dr. DiMatteo answer the question?”

  Abby’s spine straightened. “I can answer the question myself,” she said.

  Dr. Wettig turned to her, his eyebrow raised. “Yes?”

  “The . . . pupillary changes—the extensor posturing of the limbs—they were high midbrain signs. Last night I assumed it was because of the subdural hematoma, pressing downwards on the midbrain. But since the patient hasn’t improved, I . . . I guess that indicates I was mistaken.”

  “You guess?”

  She let out a breath. “I was mistaken.”

  “What’s your diagnosis now?”

  “A midbrain hemorrhage. It could be due to shearing forces. Or residual damage from the subdural hematoma. The changes might not show up yet on CT scan.”

  Dr. Wettig regarded her for a moment, his expression unreadable. Then he turned to the other residents. “A midbrain hemorrhage is a reasonable assumption. With a combined Glasgow Coma Scale of three”—he glanced at Abby—“and a half,” he amended, “the prognosis is nil. The patient has no spontaneous respirations, no spontaneous movements, and she appears to have lost all brain stem reflexes. At the moment, I have no suggestions other than life support. And consideration of organ harvest.” He gave Abby a curt nod. Then he moved on to the next patient.

  One of the other residents gave Abby’s arm a squeeze. “Hey, DiMatteo,” he whispered. “Flying colors.”

  Wearily Abby nodded. “Thanks.”

  * * *

  Chief surgical resident Dr. Vivian Chao was a legend among the other residents at Bayside Hospital. As the story went, two days into her very first rotation as an intern, her fellow intern suffered a psychotic break and had to be carted off, sobbing uncontrollably, to the loony ward. Vivian was forced to pick up the slack. For twenty-nine straight days, she was the one and only orthopedic resident on duty, around the clock. She moved her belongings into the call room and promptly l
ost five pounds on an unrelenting diet of cafeteria food. For twenty-nine straight days, she did not step out of the hospital front doors. On the thirtieth day her rotation ended, and she walked out to her car, only to discover that it had been towed away a week before. The parking lot attendant had assumed it was abandoned.

  Four days into the next rotation, vascular surgery, Vivian’s fellow intern was struck by a city bus and hospitalized with a broken pelvis. Again, someone had to take up the slack.

  Vivian Chao moved right back into the hospital call room.

  In the eyes of the other residents, she had thus achieved honorary manhood, a lofty status that was later acknowledged at the yearly awards dinner when she was presented with a boxed pair of steel balls.

  When Abby first heard the Vivian Chao stories, she’d had a hard time reconciling that steel-balls reputation with what she saw: a laconic Chinese woman who was so petite she had to stand on a footstool to operate. Though Vivian seldom spoke during attending rounds, she could always be found standing fearlessly at the very front of the group, wearing an expression of cool dispassion.

  It was with her usual air of detachment that Vivian approached Abby in the SICU that afternoon. By then Abby was moving through a sea of exhaustion, every step a struggle, every decision an act of pure will. She didn’t even notice Vivian was standing beside her until the other woman said, “I hear you admitted an AB positive head trauma.”

  Abby looked up from the chart where she’d been recording patient progress notes. “Yes. Last night.”

  “Is the patient still alive?”

  Abby glanced toward Bed 11’s cubicle. “It depends what you mean by alive.”

  “Heart and lungs in good shape?”

  “They’re functioning.”

  “How old?”

  “She’s thirty-four. Why?”

  “I’ve been following a medical patient on the teaching service. End-stage congestive failure. Blood type AB positive. He’s been waiting for a new heart.” Vivian went over to the chart rack. “Which bed?”

  “Eleven.”

  Vivian pulled the chart out of the rack and flipped open the metal cover. Her face betrayed no emotion as she scanned the pages.