Work was about the only reprieve Rowan had these days, and she was more grateful than ever to be there that day. Brian’s mother, who she supposed was now her future mother-in-law, was coming to town for the holiday. She liked her well enough. And, in any other circumstance, she probably wouldn’t have minded spending Christmas with her. But now two people in her house would be pressuring her to set a wedding date, pick out a dress, make a guest list…And she didn’t know if she could handle that. It was Christmas Eve, and all she wanted to do was cut into somebody. The elective-surgery schedule was light, so she could only hope an appendectomy or an intra-abdominal abscess would roll into the ER. At least Galen had the day off. She’d been checking the schedule diligently, every week, since the breakup because she absolutely wanted to avoid Galen, and when she couldn’t, she wanted to be prepared for it.
“Ugh. I’m so bored.” Makayla lay stretched out on one of the couches in the lounge, reading a copy of Redbook that was several issues out of date.
“Me too. I know we shouldn’t complain, but God, I wish I had a knife in my hand,” Rowan said.
“What is wrong with us?”
“I don’t know what’s wrong with you, but my soon-to-be mother-in-law is landing at Logan in a few minutes, and I basically want to do everything in my power to stay away from my apartment.”
“Brian’s mom is coming? Ouch.”
“She’s great. But Brian’s been seriously on my case about setting a date for the wedding, basically since the second he proposed. And she’s not going to help things. It’s like he’s afraid if I don’t commit to a date now, I never will.”
Makayla sat up and folded the magazine, staring at Rowan skeptically. “Is he wrong?”
“I…Yes? Yes, of course he’s wrong. I’m going to pick a date, okay? I just haven’t yet.” But Rowan knew Makayla would see right through her like she always did.
“It’s just us in here, Texas. You may have to lie to Brian, and his mammy, and Galen, and everyone else, but there are two people you don’t have to lie to, and that’s me, and you.”
Rowan took a deep breath and leaned forward in her chair, resting her elbows on her knees. “So, I’m having cold feet. So what? That’s normal…Isn’t it?”
“Totally normal. Everyone gets cold feet.”
Rowan nodded, silently reassuring herself. “Great.”
“But you don’t have cold feet.” Makayla straightened her back like she always did when she was about to launch into one of her monologues.
“What? What are you talking about?”
“You have doubts. Big, enormous doubts. And, if I may be frank for a moment—”
“You always are.”
“This goes beyond doubts. You know Brian isn’t the one. You know you shouldn’t be marrying him. And, worst of all, you know exactly who you should be with.”
Rowan felt herself shutting down, not wanting to hear any of what Makayla had to say. “That’s not true. I want to marry Brian.”
“Oh, would you please just cut the shit, Rowan? I love you. But my good God, are you being stupid! Marrying Brian because you feel bad for him, or you think you owe him, or whatever it is, doesn’t make you some kind of saint. It’s downright cruel, actually. You’re letting that boy think you love him. And, maybe just as bad, you’re letting Galen think you don’t. All the while, you’re miserable. You aren’t doing anyone any favors. And all you’re going to end up with is a lifetime full of regret.”
Rowan didn’t respond. Her eyes filled quickly, and in an instant, she was spilling heavy, wet tears onto the carpet. She looked at Makayla, who seemed to be deciphering whether she’d just pushed Rowan too far. But she hadn’t. Rowan needed to hear this. She needed to face the truth.
“I don’t know what to do, Kayla…” The tears just kept coming as Makayla stood, turned the lock on the door to the lounge, and sat beside Rowan, cradling her while she sobbed.
The moment was shattered by the shrill of someone’s beeper—no, two beepers. Both of them immediately swiped the objects from the band of their scrubs.
“Huh, that’s weird. Trauma alert. I’m not on the trauma service today,” Makayla said.
“Yeah, me either. I wonder what’s going on.”
“I don’t know, but we should probably get down to the ER and find out.”
* * *
The first person Rowan saw when she and Makayla descended the stairs was Galen, and Rowan’s heart broke ten times over like it did every time she ran into her.
“Did you get paged to the ER too?” Galen asked, her face grave and her breath short.
“Yeah. What’s happening?” Makayla answered.
“Bus accident. A group of kids were on their way to go caroling at some nursing homes and got hit by a semi. I guess the truck driver was DOA, but twelve elementary-school kids were on that bus.”
Rowan’s heart sank. “How many are coming here?”
“At least half. The rest are going to Mass General and Beth Israel.”
Galen pushed open the heavy fire door that led to the ER, and Makayla and Rowan followed in tow.
“Are they…” Makayla started to ask the question she didn’t seem to want to know the answer to yet.
“I don’t know. I heard that at least three are critical. Christ, I hate peds…” Galen’s voice shook, and Rowan had never seen her so unsteady.
“I’m not on trauma call today, though,” Makayla said.
“It doesn’t matter. This is a mass casualty. And it’s kids. It’s all hands on deck. Do what you can. If you need me, find me. Otherwise, just trust yourself. You two are the best first-years I have. You can do this.”
Rowan was instantly touched by Galen’s kindness, and all she wanted to do was hug her until the nightmare scenario would be over. She hoped it wasn’t as bad as Galen said.
The Emergency Room was like a war zone. It was rare for the chaos seen on television interpretations of hospitals to actually manifest in real life. But this time, it did. Rowan could only stand frozen, staring at the scene unfolding in front of her. Nurses and physicians rushed by pushing kids on gurneys, IV bags flying in the wind, as parents screamed after them.
“Hey. You okay?” Galen broke Rowan out of her terrified trance, gently putting her arm around her shoulder.
“Yeah. Sorry. Let’s just go.”
Galen nodded, and the three of them went off on their own, each seeking out the patients closest to death—the patients who needed them the most.
“I need a doctor here!” A robust nurse in Tweety Bird scrubs was shouting from across the department. Rowan looked to her left, and then her right, expecting at least five or six real doctors who actually knew what they were doing to emerge from the wreckage and help. But no one did.
“You. Are you a doctor?” The nurse was talking directly to Rowan.
“I…” Instinctively, Rowan glanced down at the embroidered name on her white coat—Rowan Duncan, MD. Department of Surgery. “Yes. I’m a doctor.”
“Great. Then get your ass over here. This kid’s crashing.”
Rowan rushed to the gurney tucked away in a corner of the hallway, where a small boy about eight or nine years old lay looking pale and motionless. “What happened?”
“He was fine when he came in.”
Rowan glanced at the yellow tag placed on the child’s ankle. This was the triage system used in a mass-casualty situation. A yellow tag meant “walking wounded.” It meant the patient could wait. Apparently, the system wasn’t perfect. “Did he complain about anything when he got here?”
“Just some shoulder pain, but he was stable.”
Rowan glanced at the portable monitor next to the child’s bed, noting the unsettlingly low blood pressure and quick heart rate. “What’s his name?”
“Jack.”
“Jack?” Rowan rubbed across the boy’s chest with her knuckles to try to rouse him, but he hardly opened his eyes. “I’m Dr. Duncan. But you can call me Rowan. Can you tell me what hurts?”
Jack opened his eyes again, an act that seemed to use all of his remaining strength. “My arm.”
“Where, Jack?” Rowan pulled the oversized gown up to his chest, exposing his bony torso.
“Here.” With a notable amount of effort, Jack was able to reach up with his right hand and grab his left shoulder.
Rowan scanned his abdomen with her eyes, noting a faint, evolving dusky discoloration that could only mean bruising. She pushed her palms first into the right, upper portion of his belly, and then the left. Jack immediately cried out in pain. “Go find Dr. Burgess. Right now. Please.” Rowan noticed her hands were trembling, hovering just over the boy. The nurse nodded and went off while Rowan once again checked the vital-sign machine. His blood pressure was low and dropping by the second. God, Galen, please get here quickly.
She couldn’t do anything—at least not without an OR. Jack was in trouble, and if they didn’t act quickly, he was going to die. She searched her mind for something, anything that might buy him a little more time. Glancing at the bag of IV fluid hanging above him, she found the dial and cranked it up as fast as it would go. She then took his stretcher and tipped it backward, allowing what blood that wasn’t sitting in his belly to find its way to his brain. “You’re going to be okay, buddy. I promise.” Rowan immediately wished she hadn’t promised him anything.
“What do you have?” It took Galen what felt like several eternities to arrive, but in reality it must have been only three minutes. Her poise and confidence soothed Rowan’s panic, and she was so grateful Galen was there she could have cried.
“Approximately eight-year-old boy, unrestrained on the bus. Came in complaining of left shoulder pain. He was tagged yellow. I’m guessing someone thought it was just an extremity injury. But he’s tanking his pressure, he’s tachycardic, and he’s minimally responsive. Left upper quadrant is tender with rebounding and guarding and positive Cullen’s sign. He’s got a splenic lac. And he’s bleeding out.”
“Why the shoulder pain, Duncan?” Galen never stopped teaching.
“It was just referred pain from the blood in his belly.”
Galen nodded. “And what have you done for him?”
“I cranked up his fluids full speed. That brought his pressure up to about 78 systolic, but he needs the OR.”
“Anything else?”
“Yes. He needs to be intubated. But we don’t have time to do it here. His airway is maintained so they can do it in the OR.”
“Good work.” Galen offered a small smile. “I’ll call over and get him in right away. Go find the next kid you can save.”
Rowan bobbed her head emphatically and took off toward the main area of the ER, leaving Galen to make sure Jack made it off to surgery.
“I’m Dr. Duncan with surgery. Who’s next to be seen? How can I help?” Rowan had tracked down the charge nurse, who stood in front of the slammed patient list, looking frazzled and exhausted.
“Good. Go see the little girl in room 9. I think she’s a head injury.”
“Is she stable?”
“Yes.” But Rowan knew that wasn’t any guarantee today.
Inside room 9, she found a girl around the same age as Jack playing on an iPad with her parents flanking her bed.
“Is this Ms. Adelaide?”
The girl had a head of fiery red hair and freckles for miles. She gave Rowan a big, toothy smile complete with several empty spaces. “Yes. Who are you?”
“I’m Dr. Rowan. It’s very nice to meet you. So what are you watching there?”
“I’m not watching anything. I’m doing a puzzle.”
Rowan told herself that was probably a good sign, in the setting of a head injury.
“Addy isn’t allowed to watch TV. Well, except for PBS.” The round woman sitting to Adelaide’s left, with identical hair, finally spoke up. Rowan groaned internally. A major trauma probably wasn’t the time to get on your high horse about parenting skills. But she let it go. Adelaide was her patient. And, like they were so often, her parents were just going to be an inconvenience.
“Right. Well, Adelaide, can you tell me what happened today?”
“Honey, put the game down,” her mother snapped.
Adelaide did as she was told and looked directly at Rowan while she explained the accident in great detail. “I was on the bus. We were going to sing for the old people for Christmas. But then, some big truck came out of nowhere and hit us right on the bus’s nose! I flew forward like this!” Adelaide lunged forward, her arms splayed out, as she made a sound that reminded Rowan of lasers or light sabers.
“Honey. Stop that.”
Rowan was losing patience with Adelaide’s mother. The man she presumed was her father just sat there, silently scrolling through his cell phone, clearly disinterested in the situation.
“It’s fine. So what happened after that?”
“My head went BOOM. Right into the wall. And then, it was black.”
“You don’t remember anything after that?” Rowan took a penlight out of her coat pocket and ran it across Adelaide’s eyes, watching her pupils grow and constrict equally.
“Nope. I just remember the nice men in the black uniforms carrying me on the bed. And then I was in the ambulance.”
“Does anything hurt you right now?”
“My head.” Adelaide pointed to a large egg on the left side of her forehead that appeared to have grown larger since Rowan first entered the room.
“Has she thrown up at all? Or been acting strange?” Rowan asked the mother.
“Not at all. Why? Do you think something’s wrong with her? Tell me what’s wrong with her right now.”
“I don’t know.” Rowan responded calmly.
“What are you, anyway? Like, a student or something?” The woman’s face contorted with disgust.
“No. I’m a doctor. And right now, I’m the only doctor your daughter has. And I’m going to make sure she doesn’t have a serious head injury. I want to send her down for a CT scan to check for bleeding.”
“Bleeding?! But she just bumped her head!”
“I know that. But she lost consciousness. And that can sometimes be a sign of something more dangerous. Adelaide was involved in a serious accident, and I need to scan her head.” Rowan was getting irritated having to rationalize the safety of a young girl to her own mother. The father barely looked up from his smartphone.
“John, don’t you have an opinion about this? CAT scans cause cancer! I don’t want her to have it,” her mother said.
“We should listen to the doctor, Susan.” John finally spoke, his voice as soft and tentative as his demeanor.
“Look. Mrs. O’Rourke, Mr. O’Rourke, I wouldn’t be doing this if I didn’t think it was worth the very small chance that the dose of radiation could be problematic. Believe me, the chance of a traumatic head injury is much higher and has much more severe consequences today.”
The couple looked at each other silently for several seconds before Susan O’Rourke spoke.
“Okay. Fine. Just do it.”
“Great. I’ll get that ordered right away.” Adelaide had gone back to playing with her iPad. “You’re going to be okay, my friend. I just want to get a picture of your head, okay? Maybe you can hang it on your fridge when we’re done?” Rowan said.
Adelaide smiled and nodded her head emphatically, and Rowan left the room, feeling confident in her judgment and proud of the doctor she was becoming.