"... patient female, twenty one years of age. She was alert and oriented to time and place. Speech was slow, with long pauses, indicating some degree of psychomotor retardation; upon questioning, she reported insomnia, lack of appetite, and feelings of profound sadness. Patient had been found by her boyfriend, laying on the bathroom floor, with self-inflicted cuts on arms and wrists ..."
Kim threw down her pen. God she was tired.
What was it about late May that pushed people to try to kill themselves? Four today alone and two the day before. Lately, she'd been spending her whole shift running back and forth to the ER.
"... In interview patient admitted to having inflicted wounds with a razor blade. Mood during interview was extremely dysphoric and I believe that if this major depressive episode is not treated, there is a strong likelihood that she will try to harm herself again ..."
"Are you still having thoughts about hurting yourself?" Kim had asked.
The young woman held Kim's eyes for a long moment before a sad smile crept across her lips. "No," she said and there was a longer pause while her gaze turned inward and she looked blankly at her bandaged arms and wrists. "Of course not."
Kim remembered one truly helpful textbook she had been required to read during her first psych rotation in med school. It advised that, in questioning potentially suicidal patients to, "pay close attention for responses such as, "`I have purchased a gun, have ammunition, made out a will, and plan to use it."
Uh-hunh. Something about having just tried to kill themselves made flesh and blood patients a trifle less forthcoming.
"But Colleen, you do admit you tried to harm yourself tonight, don't you?" Kim grabbed the young woman's gaze and held onto it, trying to neither charge nor retreat.
Colleen sighed. It was a long sigh, full of weariness.
"Yes," she said finally. Another pause. "But that was stupid. I see that now."
Translation: next time I'll do a better job.
Kim kept her best non-threatening smile in place. "But you did cut yourself. Just a few hours ago, right?"
A slow nod.
"So what were you hoping to achieve?"
It took a moment but Colleen's expression changed. Confusion and the ghost of suspicion.
"What do you mean?"
"Nobody does anything without a reason," Kim said, her voice soft. "Today you did this." She indicated the woman's bandages. "You must have had your reasons."
Colleen started to rock slightly and looked past Kim into an empty corner of the small exam room. She was quiet so long that Kim wondered whether or not Colleen remembered that she was still in the room.
"The pills aren't working," Colleen finally said, her voice so quiet that Kim had to lean forward to hear her. "I just can't stand it anymore. I'm so tired." Tears leaking out from under closed eyelids.
"The pills?" Kim said. She flipped through her chart quickly and found nothing about medications. "What pills, Colleen?"
Steady rocking, tears streaming silently down her pale cheeks.
"The pills. The anti-depressants."
"You're on an anti-depressant?" Kim asked. "Have you been seeing a doctor for depression?"
"At school. I saw him two months ago. He gave me ... something, I forget the name. He said to take them and come back when the prescription ran out."
"Two months ago? How long have you felt depressed, Colleen?"
A shrug. "Since school started."
Kim took a deep breath to keep her voice even. "You don't happen to have those pills with you, do you?"
She nodded. "In my purse."
Without getting up, Kim dug through her hospital issued plastic bag for personal effects and found a small leather shoulder bag among the jeans and sweatshirt. With a reassuring look at Colleen, she dug past a U of Chicago daytimer, a wad of Kleenex, a lipstick and a pack of gum to find an orange vial of pills, about four months worth.
Kim examined the label and wanted to scream. "Okay," she heard herself say in an incredibly reasonable tone, as she pocketed the bottle. She put the shoulder bag back in the plastic bag and stowed it under the bed, then rolled her chair forward and put a soothing hand on Colleen's leg.
"Colleen, I think you're very depressed right now and it seems like those other pills aren't working so well for you."
Colleen's eyes were red rimmed and vacant now, exhausted from the effort of talking.
"I have some ideas about how we can help you to get better, okay?" Kim stood up. "I'm just going to go get a nurse and then we're going to find some new medicines that will help a lot faster. And I'd like to keep you here for a couple of days to make sure you're okay." She touched Colleen's shoulder. "Is that all right with you?"
A half nod and long sigh.
That was all the consent Kim needed for now. She went to find a nurse to sit with her while she arranged her admission. And then she was going to track down the genius that had prescribed six months of tranquilizers for a major depression.
"... Admitted on 05/28/01 to psych. Her parents have been contacted and will arrive 05/29/01. Family session on 05/30/01 at 2:00 p.m."
She closed the chart and tried vainly to stretch the tension out of her neck. She needed a break. Maybe she'd go and check up on that new resident who was parading about like God's gift to psychiatry. She didn't trust the little pissant yet, especially in the ER where you were never sure what you were dealing with.
She glanced at her watch and instantly felt terrible because she had realized that she was still subconsciously timing her days based on Kerry's shifts, breaking the work day into times that were "safe" and "not safe."
It was a "safe" time right now, Kerry's shift having ended an hour ago, but she still felt bad as she punched her code into the security door and left the psych ward. She felt bad all the time where Kerry was concerned. Talking to her didn't seem right, but avoiding her felt worse. She didn't know how to broach any subject with her anymore but felt sad that Kerry had given up trying to engage her in conversation. It seemed that the best thing and the worst thing were the same thing -- they were becoming regular co-workers again. She punched the elevator button with a bit more force than it needed and sighed.
She didn't know what she wanted anymore.
Kerry swung through the ambulance bay doors and took in the scarcity of people in chairs and the small cluster of nurses, relaxing and chatting at the desk. She shook her head. Why did it always get quiet when she was off? She suspected some elaborate conspiracy but couldn't prove it yet.
"Hey, Chief, your shift is over, go home!" Malucci called.
"And yours isn't over, don't you have some work to do somewhere?"
Malucci spread his arms wide. "What can I say? Nice and quiet since you left."
Kerry rolled her eyes and pushed her way into the lounge. She'd gotten all the way home and into comfortable pajamas with a lovely glass of Bordeaux at her elbow when she'd realized that she'd forgotten some budget documents at work for an early morning admin meeting. She fiddled with the combination, yanked her locker open and dug around, looking for a thick file folder.
There was no way in hell she was going to a meeting chaired by Romano without having her t's crossed, her i's dotted and her ass covered. This little game of chicken they were involved in was not to be taken lightly. She didn't care how hard she had to work, she was not going to be the first one to blink.
She left the lounge and was headed for the back door, when it suddenly occurred to her that Romano might try to sneak scheduling issues onto the meeting's agenda. She'd best be prepared.
A little ripple swept through the staff at the admit desk, as she doubled back and walked by. She was never sure why that was now. Was it the fact that she was their boss that made them drop their voices to a quieter tone when she walked by? Or was it the now fairly common knowledge that she was a lesbian and had at one point been involved with Dr. Legaspi? (Hell, the way the grapevine grew in this place, probably the guy who sold papers on the corner had heard the story.)
She hated that it bothered her, but if she was honest, she had to say that it did. Less out of a sense of shame than a sense of sorrow, now though. It was one more thing that separated her from them, it seemed, like her crutch had always done, like her brains and her drive had done. It was sad, that was all.
She turned into the exam room hallway to find Luka slouched in the desk chair, a pile of charts beside him.
"Well, it's nice to see someone working tonight," Kerry said, with enough of a smile that he knew she was teasing.
"I thought you were off a while ago," he said.
"I forgot some things for a meeting tomorrow morning," she said.
He nodded and pushed the chair away so that she could reach the desk drawers. He watched while she shuffled papers about, trying to find what she needed.
"You know you work too much," Luka said with that easy smile of his.
It stopped her and she looked over at him. "I know I do," she said, shifting her weight onto her crutch.
"It's been a stressful few months for you. No one would blame you if you took some time for yourself. Had some fun."
She chuckled. "Fun. Yes. Well, as soon as I figure out how exactly one does that, I'll look into it." She went back to searching for her schedules.
"Dr. Kovac," a voice called, from down the hall. "I have the labs on your MI in five."
Luka hesitated, uncertain as to whether he should continue with this conversation, or whether he wanted to keep his job. He decided the safest route for everyone was to go check in on his patient.
"Have a good night, Kerry," he said over his shoulder as he walked away.
"You, too, Luka," Kerry said.
She laid her hand on the last document she needed and stuffed it into the file folder, then straightened up and flipped her crutch around, ready to go.
She heard the footsteps and then for a flash, she felt like laughing. Imagine it being so quiet in here that she could hear footsteps.
And then, from the corner of her eye, she registered blue silk and long legs, flowing blonde hair. She did a double take and there was Kim, at the end of the hall, just off the elevators probably, pinning her in place with those glacial blue eyes. She had an overwhelming urge to run away.
That was the last image Kerry remembered.
Kim rode down to the ground floor, leaning against the back wall of the elevator, arms crossed. Officially her shift was over, most of her paperwork was done and she was not the supervisor of this new little baby resident, so she was not obligated to come down here and see what the hell he was up to now. But, she'd told Carl she'd keep an unofficial eye on him and truth be told, she hadn't wanted to be home much, lately. It didn't have the same feeling it used to have. Mainly, she stayed at the hospital, worked really long hours, took other people's shifts and ... had no idea why she was doing this. The elevator chimed to announce the ground floor.
Some psychiatrist you are, she thought.
She headed for the ER.
The words "deer in the headlights" took on a whole new meaning when they spotted each other. Kim was torn by a sudden and not very grownup urge to just turn and march straight back up to the psych ward. The only thing that kept her there that extra moment, eyes locked with Kerry's, was the knowledge that Kerry was no doubt struggling with the same thing. Kim's face softened into a smile -- it was such a silly situation, surely they could both just laugh at this.
Kim never saw him coming.
Her mind knew he must have roared out of one of the exam rooms, but his appearance was so sudden and unexpected that at the moment he burst into the hall, it seemed like he should have been accompanied by a puff of smoke.
He was massive, football player sized and filthy. Long, dark stringy hair and layers of clothing that weren't identifiable colours anymore. In the instant that she could see his face and his eyes, she thought, `Schizophrenic, very high on drugs. We'll have to admit him." And then she realized that he was moving toward Kerry. Her heart skipped a beat.
"JESUS WILL PUNISH YOU!!" he bellowed in an otherworldly voice and he snatched Kerry up as if she was weightless and then threw her face first into the wall beside the desk, the papers she held fluttering slowly to the ground. "HE WILL PUNISH YOU FOR WHAT YOU DO TO ME!!!!" he screamed, his face red with fury and exertion.
Kerry's body slid slowly and awkwardly down the wall, leaving a trail of mucus and blood, her hand flailing blindly for her lost crutch.
Kim bounded forward, a stifled scream in her throat. Two strides and someone grabbed her by the waist and was holding her back, pulling her backwards. It was Luka, out of breath and speaking quietly. "No, you have to stay here!"
Kim struggled out of his grasp. "She's hurt! I have to -- "
"He's too big. Stay behind me." Luka stepped in front of her, then crept forward along the wall, slipping in behind a huge rolling cart of supplies. Kim followed.
"Hey, buddy, it's okay, settle down, settle down." Malucci's voice, coming from the other end of the hallway near the admit desk.
The giant man turned to look at him then pointed a trembling finger. "YOU'RE ALL SINNERS! SINNERS!! JESUS WILL PUNISH YOU FOR WHAT YOU DO TO ME!!"
"Yeah, well, that's not the first time I've been told that," Malucci said. "Hey, Chief? You okay down there?"
Kerry dragged herself to a sitting position, her head reeling. She couldn't find her crutch and she was having a hard time focusing ... goddamit where was this blood coming from? She clumsily got on all fours and began to crawl slowly out from behind the side of the desk. Malucci caught sight of her, blood streaming out of her nose and he panicked. He took a step toward her and the giant erupted.
"HE WILL PUNISH YOU! HE WILL PUNISH YOU!!" he screamed and he grabbed Kerry off the floor like a rag doll, swung her around and slammed her into the observation window to exam room two. There was an explosion of glass and when he stepped back, Kerry was slumped over his beefy forearm. "I WON'T ABIDE THIS!! YOU WILL NOT HURT ME!!" He smashed his way through a pile of sterile trays on one of the supply carts with his free hand until he found a scalpel.
"Ohmygod, Kerry. Kerry!" Kim whispered and she struggled to push past Luka again. He grabbed her by the wrist and reeled her in, pulled her back against the wall with him.
"No," Luka whispered.
"He's going to kill her!!"
"And you think you running in there will stop him?" Luka spat back. "Just stay behind me."
He checked the man's position again and continued his steady pace forward, pushing Kim back with one arm.
Kim held her breath and found herself reciting some long forgotten childhood prayer.
Kerry was draped limply over the man's arm, her face bleeding profusely. Malucci was gripped with a sudden urge to beat this guy to the floor, cut off his testicles and feed them to him. But he couldn't do that until he got the Chief away from him.
"So, uh, mister. This punishing ... is this going to be your average lake of fire, never ending torture sort of hell punishment ..."
The man looked blankly at him. "You're a blasphemer."
"Oh, gosh, no. If there's one thing my mother insisted on at our house it was no blaspheming." Malucci took a couple of slow steps forward, got himself closer to the fire extinguisher on the wall.
"YOU WILL BE PUNISHED FOR HARMING ME!" the man screamed again and he made a slashing gesture by Kerry's throat with the scalpel. Her head bobbed lazily.
"Whoa, whoa, whoa! Let's get finished punishing me first, shall we?" A small step forward. Where the fuck was security?
The man stared at him, unmoving, the scalpel perilously close to Kerry's bleeding face. "I FEAR NO MAN," he screamed.
"Actually, I think that there is one man you should worry about." He pointed behind the man to Luka. "Him."
The man spun, whipping Kerry limply with him. Luka lunged and grabbed for Kerry's boneless form just as Malucci snatched the fire extinguisher off the wall and nailed the giant in the back of the head.
The huge man teetered, then righted himself. Shrieking and cursing, he held on to Kerry and dragged Luka off balance with him, then slashed at him with the scalpel. Luka pulled back to avoid the blade and lost his grip on Kerry. The man twisted around to face Malucci who delivered a glancing blow with the fire extinguisher.
The man's knees buckled and he wavered and was on the verge of regaining his balance when Luka tackled him. The force knocked them both over and slammed them into the floor. Malucci landed on top, pinning limbs and yelling for Haldol, frantically trying to find the scalpel. There was a tangle of arms and legs on the floor and when Abby arrived moments later with a syringe, she wasn't entirely sure which leg to inject.
"Goddammit, give him the drugs," Malucci yelled, straining to peel the man off Kerry, who appeared to be on the bottom of the scrum.
Kim lunged for the syringe, grabbed the man's leg and shot. Thirty seconds later, the struggling stopped.
Luka untangled himself and was up in a flash, out of breath. He and Malucci dragged the giant off Kerry's tiny form. "Malucci, take Malik, and get him into four point restraints, now!" Luka said.
"Yeah," Malucci muttered, "and I'm gonna make `em hurt."
Kim had pushed her way through and knelt beside Kerry's prone form. Kerry's face was washed with her own blood and one eye was swollen shut.
"Kerry? Kerry?" she called loudly. "I need you to talk to me, Ker. Come on."
Luka dropped to his knees beside Kerry and quickly assessed. "Get a gurney and a collar over here, move!"
Abby said, "Luka?"
He looked at Abby who was at Kerry's feet.
She carefully lifted the leg of Kerry's cotton pants to reveal an oozing wound just below her knee. A ragged bone end stuck out at a grotesque angle.
"Oh, Christ, we broke her leg," he muttered.
"I'll get a traction splint," Abby said as she got to her feet.
Kim stroked Kerry's head and vainly wiped blood away from her face, trying to make contact somehow, to let her know she was there. She lowered her face to within inches of Kerry's and spoke her name loudly. In response heard Kerry's laboured, uneven breathing.
"She's having trouble breathing," Kim said quietly, her voice choked with fear and helplessness. The chaos raged on around her. Somebody was helping the new psych resident to walk out of exam two where apparently he'd been interviewing the schizophrenic giant. He held an ice bag on his head and even from here she could tell he was whining. She drew in a ragged breath. "She's having trouble breathing!" she shouted and Luka's head turned quickly.
"Where's that gurney?! We need it NOW!"
They flew threw the doors to the trauma room, pushing the tiny figure on the stretcher.
"Dr. Legaspi," Luka said, as he pulled on gloves, "she has a bad cut on forehead, near the scalp. I want you to apply pressure to it."
Abby wrapped a paper gown around Kim and handed her gloves and Kim quickly took up residence at the head of the gurney and promptly staunched the flow of blood from the cut. From where she stood, she could see the tiny fragments of glass embedded in Kerry's cheek. A sob caught in her throat and she forced it down.
Lydia and Chuny were cutting off Kerry's bloodstained clothing and Kim stared at the khaki pants with big square pockets on the legs that they were slicing open. She recognized those pants and the realization hit her like a fist to the stomach. She had been with Kerry the day she had bought those. Kim had dragged her into the Gap and made her try on pair after pair.
"When am I ever going to wear these?" Kerry had said about this very pair of pants. "Look at the pockets. They're way too casual."
Kim had rolled her eyes. "That's exactly the point, Ker. They're casual. To wear when not working. You know, that having-a-life part of your life." She'd looked the tiny woman up and down. "Besides, they look great on you."
Kerry had bought them.
"Abby, order a CBC, UA, lytes, blood gas and type and cross match two -- no, three units. Those scalp wounds are bleeding a lot." Luka was listening to Kerry's lungs and then checking her mouth as he hollered instructions. "Somebody get X-ray in here. I want head, chest, c-section and right tib-fib shots."
"Hey!" Abby shouted at the crowd of people at the trauma room door. "Get the hell out of here! This isn't a show!" She pushed the doors shut. "Chuny, pull those blinds over there, would you?"
Kerry's clothes lay on the floor in blood-soaked rags now and Kim watched Lydia pull a pristine sheet up over Kerry's blood spattered body.
At least she's not cold. She gets cold so easily and that always makes her hip ache. She was so surprised when I bought her that down duvet, she didn't know it would --
A trill from the heart monitor made everyone stop and look.
"Dr. Kovac, heartbeat is at 110," Lydia said. "Puls/ox dropping slightly to eighty-eight." She glanced at Kim then looked away.
"What's her pressure?"
"Ninety over fifty-five."
"She hasn't lost that much blood, but she's getting shocky. Give her a minute, we're replacing fluids, now." He never looked up from Kerry's leg, which he was covering with sterile gauze.
Kim heard the sudden change in Kerry's breathing. Like she was at the bottom of a lake and was fighting to get a lungful of air. The machine caught it a heartbeat later.
"She's in respiratory distress," Abby said. "Tachy at 143, resps shallow. Puls/ox 84."
No, no, no, no, no. Don't do this Kerry, please, don't do this.
Luka was there in a stride, pushing Kim aside. "Dammit, we need to intubate. Lydia, push an amp of epi."
Kim stepped back, both hands clasped to her mouth as if she was trying to hold something in.
It wasn't supposed to happen like this.
That's why I can't be your friend, Kerry.
Don't you ever talk to me in front of a resident like that again...
"I can't see what I'm doing, Lydia, suction this blood," Luka barked.
Kim, I want you to stay.
I just want to move on with my life ... so should you.
"Okay, I'm in," Luka said. "Bag her."
Abby applied pressure to Kerry's scalp lac as she squeezed the blue bag and forced air into Kerry's lungs, keeping one eye on the heart monitor all the while.
Are you gonna watch me again?
That shy, seductive smile as she nodded.
Have a nice life. Goodbye, Kerry.
Abby caught Kim's eye and smiled reassuringly. "She's going to be okay. Don't worry."
Kim nodded numbly.
She's so small, lying there on the stretcher. And so exposed. This is her worst nightmare, being so vulnerable.
Kim watched the monitor, saw the pounding rhythm slowing and the blood pressure slowly climbing. "Come on, Kerry," she muttered, her eyes darting between Kerry's blood streaked face and the monitors.
Two gut wrenching minutes later, a normal sinus rhythm and regular respiration. "All right," Luka said. "Who's on call for surgery?"
"Anspaugh," someone said.
"Good. Stat page him and tell him to bring someone from ortho down here. They're going to need to debride this leg in the OR. And call somebody from plastics to come and do her sutures. I don't want those facial lacs to scar." Lydia nodded and scurried to the phone. "Abby, I need to reduce this fracture. Can you help me?" Luka said.
"Be right there. I'm just finishing with the respirator," she said. She taped the last tube in place, then glanced over at Kim.
"Do you want me to get you a chair? You could sit with her," she said.
Kim nodded and tried to find her voice.
Abby rolled a stool over to the side of the gurney and looked back at Kim, a question in her eyes.
"Dr. Legaspi? Are you all right? You look really pale."
"I'm -- I'm fine. I just need to -- uh--"
She turned and strode out of the trauma room, peeling off her paper gown and blood stained gloves as she went. Dodging gurneys and carts and the maintenance people mopping up the blood in the hallway. She turned a last corner, slammed the door to the women's room open, ran the last two steps and dove into a stall where she emptied her stomach several times.
A few minutes later, a quiet whine as the door slid open. Muted footsteps and tapping on the stall's door.
"Dr. Legaspi?" Abby called softly. "You okay?"
Kim opened the door and emerged, disheveled and very pale. "Yeah, I'm okay. I had to ... I, uh, just got sick."
Kim went to the first sink and ran the cold water hard. One glance up at the mirror and she saw the blood she'd inadvertently smeared on her cheek in the trauma room. Kerry's blood. She spun around and lunged back into the stall.
Abby waited quietly until the retching had stopped.
A flush of water and Kim reappeared. She went directly to the sink and splashed water on her face a few times, then took the paper towels that Abby held out. "I guess I'm not cut out for the ER," Kim said and she forced a half-smile.
"Oh, if that was true, you wouldn't have made it out of medical school," Abby said. "Uh, you've still got some on your face ... there." She pointed to her own cheek to guide her. Kim scrubbed at it with the rough towel.
"I brought you some scrubs," Abby said. "I thought you might want to change." She pointed at the dark stains on her blouse and pants.
Kim let out a measured breath and took the pile of clothes. "Thank you, Abby. I appreciate it."
"Sure," Abby said and she headed for the door. "I think Dr. Weaver will be coming around in the next few minutes. Might be good if you were there."
Kim nodded. A real smile this time.
Abby pulled open the door and then turned. "Oh and don't worry about feeling sick. It's not the blood, you know. It's the fact that it's someone you care about that gets to you."
She left and Kim stared at the door for a long time.
The sound of the respirator comes first. Hissing and clicking and such pressure in her chest, pain in her side. She just wants to sleep, just fall backwards and sleep and sleep, and why can't someone turn down the noise?
The ache is so deep down inside of her she thinks it will consume her. It hurts, her leg, her head, her chest. She doesn't want to move but she's so cold.
People talk and she doesn't even try to listen.
She forces her good eye open to find her.
Kim is there, holding her hand. Kim is talking to her, telling her things and she knows she should listen but she just can't seem to stay awake. She looks like hell.
A shiver and then she drifts on.
Kerry's eyelid bobbed once more then shut for good and Kim barely resisted the urge to shout for her to come back. They were taking her to surgery soon anyway. There would be time to talk later. And there was a lot to say.
"Abby?" Kim said.
Abby looked up from her chart.
"Could you get her another heated blanket? She's cold."
Abby paused, cast a glance at the still form of Dr. Weaver, then nodded. "Sure," she said.