“He’s crashing again,” a nurse said.
Anika didn’t need to ask for epinephrine in a cardiac needle. Another nurse had it ready without being told.
The needle was long, an instrument better suited for a nightmare than a hospital, but Anika slid it between his ribs without pause, pressing it directly into the patient’s heart muscle.
Once she’d injected the drug, she removed the needle. “Shock him again.”
For the third time Heimann greased the paddles and applied them to the man’s naked chest, upping to 360 joules. At this stage, the dangerously high current couldn’t hurt him any longer.
“Clear,” he said with less anxiety. They all knew the outcome of this battle.
The jolt of electricity arched the patient’s back as though he was a bow being drawn taut. He fell back to the table, and somehow, miraculously, his heart began beating with an anemic rhythm. Anika and Petr began to work on the other injuries.
Checking his eyes, she discovered the pupils were pinpricks and did not respond to the penlight she flashed into them. He was in a deep coma. She ran her gloved hands through his hair and discovered a knot the size of an egg on the side of his skull. Closed head injury. They needed a CAT scan to determine the amount of brain damage. Judging by the other injuries, she believed it was safe to assume his head had taken a brutal pounding.
Anika crushed down her suspicions. Her job was to keep the patient alive long enough for the surgeons to take over. Once he left the ER, the future of the young joyrider was out of her hands.
“Tell radiology we need full trauma series X rays and a CT,” she told a nurse. “What do you think, Petr?”
“He’ll lose the legs even if he has enough mind left to control them.”
“The arm?”
Dr. Heimann glanced at the shattered limb. “Hamburger.”
The two doctors looked at each other, both silently thinking that maybe they should have called the patient when they had the chance. Was the Hippocratic oath meant to cover saving the life of a brain-dead triple amputee?
“Surgery is ready anytime we are,” a nurse announced.
“Okay, thanks.” Anika opened the tourniquets to allow blood to seep to the open wounds, returning natural color to the skin. Before the flow turned into a torrent she retightened the bands.
The patient’s heart rate was steady but shallow, and no matter how much saline they forced into him, his pressure remained low. He had internal injuries. Knowing the violence of the accident, Anika felt that some of his organs had likely detached, and that was where the bleeding was. A ruptured spleen was common with this type of crash. She sounded his abdomen and found it tight with the stress of blood filling the cavities.
She was about to confer with Heimann about a chest tube when the patient went into cardiac arrest for the third time. No matter how heroic the efforts, there was nothing they could do but watch him die. After a further ten minutes of frantic work Anika felt a touch on her shoulder. Petr’s stern eyes said enough.
“Call him.”
Angered, she looked at the wall clock, stunned to see they’d been working for a half hour. “5:18 P.M.” Her shift had ended eighteen minutes ago.
Anika stripped off her latex gloves and yanked the cloth cap from her head. More than anything she wanted to wash the sweat from her spiky black hair but there would be police outside the ER waiting to speak with her. The patient had been a criminal, after all.
As an emergency doctor, she knew the importance of distancing herself from her patients, yet losing even one pained her in a secret place she told no one about. She had to force herself to push back those feelings until she gained the perspective of time. Anika washed her hands in the scrub sink outside the trauma bay and changed into fresh scrubs in the doctors’ lounge, taking a moment to soothe her hair back against her head. In the mirror, her eyes were surprisingly clear considering what had just happened and that she’d just finished a twelve-hour Saturday-night shift. Heimann met her on her way out.
“Go start your vacation. I’ll handle the police and the paperwork.”
“Are you sure?” She was startled. Heimann wasn’t known for his bedside manner toward patients or coworkers.
“Thank you, Petr. I owe you one.”
Anika decided to go to her apartment for her shower rather than do it at the hospital. She wanted to avoid Dr. Seecht, her boss, at all costs. She threw the laundry that had accumulated in her locker into a shoulder bag. Since her apartment was across the street from the huge medical center, she’d wear scrubs home.
Her mind was on the last-minute details she needed to finish before leaving for her trip. She had to get a key to her neighbor, a surgical nurse here at the Klinikum, so she could water the plants. She also needed to clean a week’s worth of leftovers out of her refrigerator. Then there was tomorrow’s trip to the town of Ismaning for her grandfather, and then on Monday it was time to leave for Greenland.
“Dr. Klein, just the person I wanted to see.” Dr. Heinz Seecht had been waiting in ambush outside the women’s changing room. “I was afraid you had already left.”
“I was just leaving. My shift’s been over for a while.” A moment ago, she had been hyped up on adrenaline, but now she felt nothing but exhaustion. She crossed her arms over her small breasts.
“Yes, I just spoke with Petr. You lost the patient.” It was said with condescension, as if the kid’s death had been her fault.
Her body stiffened. “We did everything we could.”
“I’m sure you did,” Seecht said absently. “Petr’s a good doctor.”
By force of will, Anika remained silent. She and Seecht had been at odds since she first came to the hospital. He was nearly sixty and believed that only men made good doctors. His was an extreme form of sexism that was pervasive in Germany. However, now was not the time to lash out.
“I wish to be blunt with you, Anika,” Seecht said as though he’d been any different with her in the past. “Your performance is not up to the Klinikum’s standards and hasn’t been since you first arrived.”
Anika hadn’t suspected he’d take this tack and she was thrown off for a moment. She quickly recovered. Rather than let him complete his thought, she went on the attack. “It isn’t my skills as a doctor that are substandard,” she stated. “Every review places me near the top of all the trauma teams. I have been honored by the medical boards and I have been singled out by the mayor when his daughter came in with a ruptured appendix. I am more current on new techniques than anyone on your staff, and I did a year of ER work in Los Angeles before coming here. I saw more trauma in a weekend there than doctors here see in a month. So please tell me, in what way am I not meeting your standards, Dr. Seecht?”
She took a deep breath.
“I don’t question your surgical abilities.”
A pair of technicians approached from down the hallway, and Seecht touched Anika on the elbow to lead her away. She resented the touch. He wouldn’t have done it to a male doctor. He wouldn’t even have done it to a male janitor.
He continued when they were alone again. “There is more to being on my staff than skills. I demand dedication from my people, and that is something you lack. In your year and a half here, you have taken leaves of absence totaling six months. I encourage doctors to have interests outside their field, but not when it interferes with their work. Your little adventures have become such an interference, I’m afraid.”
“My little adventures,” Anika snapped acidly, “have given me the research material for two published papers on the chemistry of stress.”
Seecht was not impressed. “You were not hired to be a research doctor. And even if you were, you didn’t need to go on a four-week climbing expedition to the Himalayas to gather that information and you know it. The papers you write are just your excuse, your cover story.”
He spoke as though on a telephone, looking at a spot over her head so he didn’t see the aggressive flare in her eyes. It was at times like this she hated being just over five feet tall. In a confrontation, being short gave others
