Prologue

Five-year-old Bridger Hamilton lay on the table. A 22 gauge IV trailed from his left hand, an endotrachial tube protruded from his mouth, and I was pounding on his chest for all I was worth, sweat dripping off the end of my nose.

“When was his last bicarb?” A voice by my right ear asked.

Someone answered but I didn’t hear it.

Bridger’s skin was pale, far too pale, and slightly blue under the glare of the surgical lights

“Those compressions need to be deeper, he’s not profusing.” A male voice to my left called.

I redoubled my efforts and was rewarded by a slight pinking of Bridger’s skin. But I couldn’t keep it up.

“Em,” someone, Sharon I think, tapped on my shoulder, “you need a break?”

I nodded, I had no breath to speak.

“Switch,” someone said.

I stopped chest compressions and quickly moved out of the way so that my relief could administer CPR in my place

Chapter 1

“So what can you tell me about what happened last night?” My boss, Maxine peered intently at me across her desk.

“I don’t know what to say,” I answered. “I don’t think I labeled it wrong. I mean I read the bottle.” I must have read the bottle. I always read the bottle and repeat it back. I always do, so I must have, right? I just couldn’t entirely remember. “And I’m kind of nuts about labeling. I even label my water and my saline for every case.” No one does that. “I’m sure the syringe must have been labeled before I pulled the Bupivicaine.”

“Must have been labeled?” she asked. “Do you actually remember it being labeled?”

“Maxine,” I said, slumping, exhausted. “You’ve looked at my schedule; you know what my day was like yesterday. By the time we were putting the line in that kid I had been working for nineteen hours and awake for forty-five of the previous forty-eight. I couldn’t swear that I remembered what my name was.” Pause. “But I must have labeled the Bupivicaine syringe, I always do.”

“And the syringe with the heparin?” Maxine asked.

“Of course,” I said, sounding lost even to my own ears.

It was now eleven o’clock in the morning and I had been called in to the hospital on my day off to talk to Maxine about the hell that had broken out early that morning,

Work in the operating room at St. Mary’s Children’s Hospital in Washington, D.C. is generally very routine. Last night it wasn’t.

“How is he?” I asked, hardly daring to look Maxine in the eye.

“Bridger Hamilton is breathing on his own this morning. The liver laceration seems to have stopped bleeding and miraculously none of the broken ribs appears to have punctured his lungs. Overall he seems to be doing well.” She paused as if it was necessary to remind me of the seriousness of the situation. As if I’ve thought of anything else since last night. “The tests aren’t back yet on the condition of his heart though.”

“Listen, Emery,” she said, leaning forward. “You’re one of our best techs and I think it may be that there’s another explanation of what happened but Dr. Shand is very concerned. I asked you in here to gather preliminary information. This is just the beginning of the investigation. I want you to think about yesterday. Try to come up with anything you can remember. I’m afraid it’s going to be important for you to remember every detail. Why don’t you take a few days to concentrate on it?”

“What do you mean? I’m supposed to be working tomorrow.”

“No, you’re not,” she said. “Joe and I think it’s best if you take a few days off, at least the rest of the week.”

I was stunned, almost speechless. Yes, in the middle of one of my cases the patient had gone into full arrest. And it appeared to have been from an injection of Bupivicaine into his central line, and the only reasonable explanation was that I had screwed up, but I had spent more than an hour doing CPR, with every other available person, to make sure he’d be alive this afternoon. And… well, there had to be another explanation.

“OK.” I managed to croak before I got to my feet and headed out the door. I refused to sit in Maxine’s office and cry.

I made it to my car before I started crying. Before I started sobbing anyway. I sat for a good half an hour racked by sobs and rocking back and forth in my car in the parking garage before I could even think at all.

I was exhausted. I had worked my usual twelve-hour shift the day before but I had been on call at the end of it. It had been a beautiful day and there had been lots of kids outside playing. Getting hurt. Most of it was no big deal, the usual broken bones, elbows mostly, but enough of them that I had had to stay at work. And stay and stay. By the time 1:00 a.m. rolled around there were only two more cases on the board and I was mostly delirious. But I just had a line placement; they’re easy, I can do them in my sleep. I really tried my best to stay awake though.

It was a chore for the first part of the case but once that poor boy’s heart stopped mine certainly sped up.

I rested my head on the back of my seat and winced. I had no idea CPR was so tiring or so painful. Between our team, the night team, and whomever else we could find at two in the morning we had kept the CPR going for more than an hour, but by the end of that time there was not one person in the room who wasn’t panting and sweating. The average person can only do chest compressions for about 15 minutes. It’s amazingly taxing on the muscles. And today every muscle in my upper body and back ached.

I closed my eyes and concentrated. Maxine wanted me to think about the day before so I started with the previous morning. ­­

The alarm went off as usual at 5:30. I groaned and rolled over, but as always some part of my brain was awake and I knew I’d have to get up. I’m not much of a snooze hitter. I never have been. I set my alarm for as late as I possibly can but I get up when it goes off. That was unusually hard that morning since I had been at work late on call and had only gotten to bed about three hours before.

I got up and pulled on a pair of track pants and a t-shirt, pulled on some shoes. I got my breakfast of yogurt and trail mix out of the fridge, checked the diaper bag, made sure there were clothes and diapers for Gus and opened the door leading to the apartment of Justin, my landlord and best friend so that Gus could get in when he woke up.

My apartment in Alexandria is in a house that’s been divided into four not-so-spacious-but-better-than-some-I’ve-seen apartments. Justin’s mother owns it and Justin lives in one of the apartments rent-free as long as he takes care of the place. I think it’s his mother’s way of supporting him without actually giving him money. My apartment is half the bottom floor and Justin has the other half.

Just before leaving I looked in on my son, Gus. (His name is Angus but somehow Gus stuck.) He’s the light of my life and pretty much the only reason that I pulled myself together after his father died. If I hadn’t had him to look after I would have gone off the deep end two years ago. I kissed him softly, tiptoed out the front door, making sure it was locked behind me, hopped in my car and went to work.

When I got to work I checked the assignment board and saw that I was working with Dr. Kopf in Urology and luckily there was no resident with him. Thank heaven for small favors. There was, however, another tech in the room. Normally that would be a good thing, but as soon as I saw Teresa’s name on the board I knew I’d get no help from her. Luckily the first case was a short—I mean fast—circumcision and when we were done I took a minute to call Justin to check on Gus.

“How’s my boy?” I asked when Justin answered.

“Well, I slept a little funny but other than that I’m okay,” he answered.

“Funny. But hey, looks aren’t everything.”

“Words can hurt, you know,” Justin said and I knew he was making his sad face. “Gus is great,” he said. “We’re just watching some Looney Tunes.” I could hear the Roadrunner Beep-Beep in the background, followed by Gus’s giggle.

“Hey, want to talk to your mama?” Justin asked my son.

“No,” I heard Gus answer.

I smiled. I wouldn’t mind talking to him but to be honest, phone conversation with a three year old isn’t overly interesting.

“He’s very into his Looney Tunes.” Justin said to me.

“That’s OK,” I said. “Is Laura there yet?”

On days that I work I open the door in my kitchen that adjoins Justin’s kitchen and Gus knows to go in and wake Justin when he gets up. Justin feeds Gus breakfast and gets him dressed and then my sister Laura comes over and picks Gus up, usually around 8:30 and tends him until I get off work. Usually.

“I’m on call again tonight so you might have to pick Gus up and put him to bed, remember?” I asked

“Sure, no problem, I’m planning on it” he answered. “In fact don’t worry about picking him up. I’ll go get him about 6:30 and we’ll have dinner ready for you when you get home.”

If I get home, I thought and then shook my head. I’m a firm believer in the power of positive thinking; it was working with Teresa that had me so grumpy.

I’m not the hardest worker in the OR but Teresa brings slacker to a whole new level. She shows up late, let’s me do all the prep work and then invariably “doesn’t feel well” or she scraped her leg on something. Today she tripped over a cord on the floor and bruised her knee. As if you can’t work with a bruised knee.

Usually when there are two techs in the room we split the work, switching off, and doing every other case but, well, with her hurt knee and all, Teresa just couldn’t seem to work at all.

“It hurts to stand,” she said.

“If you can’t work maybe you should go home.” I helpfully suggested.

“Maybe I’ll give it a while and see if I feel better.”

I think I was grinding my teeth at this point.

By lunchtime, when she still wasn’t doing anything, the roots of my hair were starting to singe. I usually eat my lunch in the OR lounge with whoever else is around but today I was pretty sure I wasn’t fit for company, so I went down to the cafeteria to eat there. Alone.