22. Dump and Run #2
"Dr. McCall repaired the laceration and controlled the bleeding. He's been transfused and he's stable for now." He paused. "The next several hours are critical. He lost a significant amount of blood before he arrived. His body has been through a lot."
"Is he going to be okay?"
Sullivan looked at me for a long moment. I saw something in his face I'd never seen in all the months I'd worked under him.
"We're going to monitor him closely," he said. "I'll keep you updated."
He turned and went back through the doors.
Knox put his arm around me. I leaned into him and closed my eyes.
Ian woke up at nine fourteen.
A nurse from the surgical floor came to get me. Knox stood up when I did and took my hand.
We followed the nurse down the hallway, up the elevator, and through the doors to the surgical unit. She led us to a room at the end of the hall. Through the window I could see the monitors, the IV lines, the oxygen cannula. And Ian, propped slightly on the bed, his face pale, his eyes open.
I walked in. He turned his head toward me.
"Nora."
His voice was thin. Barely there. But it was his voice and he was looking at me and he was alive.
I sat in the chair beside his bed and took his hand. My eyes were already burning.
"What happened?" I could barely get the words out. "Ian, what happened?"
He swallowed. His eyes moved to the ceiling, then back to me.
"I went to find them."
My stomach dropped. "Find who?"
"The guys. The ones who went after Knox." He winced as he shifted on the bed. "I knew who they were. I still know people, Nora. I heard things. I found out where they hang out."
"Ian, no."
"I wasn't going to do anything stupid. I just wanted to talk to them. Tell them to leave you and Knox alone. That I'm the one they have a problem with. That Knox has nothing to do with any of it."
Tears were running down my face. I couldn't stop them. "Why didn't you tell me?"
"Because you would have stopped me." He looked at me. "And I had to do it. They went after Knox because of me, Nora. Because of what I did. I couldn't let that keep happening to you."
"So what happened?"
"I found them. I said what I came to say." His jaw tightened. "It didn't go well. The guy I was talking to got in my face. I pushed back. It got ugly." He paused. "One of them had a knife."
I squeezed his hand. He squeezed back, but there was no strength in it.
"Some guys I know were nearby. They saw what happened. They got me in a car and drove me here." He tried to smile. "I told them to take me to CCMC. I told them my sister works there."
I put my forehead against his hand and cried.
"I'm sorry, Nora." His voice was quieter now. "I was trying to fix it."
"I know." I lifted my head and looked at him. His face was pale, his lips dry. The monitors beeped steadily behind him. "I know you were."
"Are you mad at me?"
I wiped my face with my free hand. "I'm so mad at you."
He almost smiled. "That's fair."
I held his hand. He held mine. The monitors beeped. The room was quiet.
"Nora?"
"Yeah?"
"I love you."
"I love you too, Ian." I brought his hand to my face and held it against my cheek. "I love you so much."
He closed his eyes. His breathing was slow, steady, the oxygen cannula hissing softly.
I sat beside him, holding his hand, listening to the monitor count his heartbeats. I told myself the worst was over.
Knox was standing by the window. He hadn't said a word since we walked in. His eyes were red and his jaw was locked tight, but he stayed where he was and let Ian and me have the conversation we needed to have. When I looked up at him now, he tried to give me something steady. I took it.
The minutes passed. Ian slept. His chest rose and fell under the hospital gown.
The numbers on the monitor held. Heart rate in the seventies.
Oxygen steady. Blood pressure stable at the low end but stable.
I read them like I'd read a thousand monitors in the department downstairs, except this time the patient was my brother and every number meant whether I got to keep him.
Knox pulled a chair beside mine and sat down. He put his hand on my back, warm and solid, and left it there.
Ian's breathing changed first.
It was subtle. A slight shallowing, a pause between breaths that lasted a beat longer than it should have. I felt it before the monitor caught it. My body went still.
"Ian?"
His eyes didn't open.
The heart rate climbed. Seventy-four. Eighty-one. Eighty-nine. The blood pressure started to drop. I watched the systolic fall from one hundred and two to ninety-six to eighty-eight in the time it took me to stand up.
"Ian." I squeezed his hand. "Ian, look at me."
He didn't respond.
I hit the call button. I was already at the door. "I need help in here! He's decompensating!"
Knox was on his feet. "Nora, what's happening?"
"He's bleeding again." I could hear my own voice and it sounded like someone else's. Calm, clinical, precise. The nurse in me was running the protocol while the rest of me was falling apart. "The repair didn't hold. He's hemorrhaging internally."
The surgical team came through the door. Two nurses, a resident, then McCall. She looked at the monitor, looked at Ian, and started calling orders.
"Get me blood on the rapid infuser. Page the OR and tell them we're coming up. Move."
Sullivan came through the door behind them.
They moved. The room filled with hands, equipment, voices running numbers back and forth. Someone pushed me toward the wall. Knox pulled me against him.
"You need to step back, Nora." Sullivan's voice. The same voice he used on every critical patient. Measured. Controlled. But when he looked at me, something in his face broke for one second before he put it back together. "Let us work."
I stood against the wall with Knox's arms around me and watched them try to save my brother.
His pressure kept dropping. The numbers fell faster than the blood could go in. Sullivan called for more units. The resident was pressing on Ian's abdomen while a nurse hung the next bag. The rapid infuser was running as fast as it could and it wasn't enough.
"Come on," Sullivan said. He was at the bedside with his hands working and his voice steady, but I could see the tension in his shoulders, the set of his jaw. "Come on, Ian."
The heart rate hit forty. Then thirty.
The monitor flatlined.
The sound filled the room. That long, unbroken tone that I'd heard a hundred times in the ER and never once processed as anything other than a clinical event.
Sullivan started compressions. The resident took over after two minutes. They pushed epinephrine. They pushed it again. Sullivan called for another round and the team kept going, and the monitor kept screaming its single flat note into the room.
I don't know how long they worked. It could have been five minutes. It could have been thirty.
Sullivan stopped. He stepped back from the bed. His hands were at his sides. He looked at the clock on the wall.
"Time of death, ten forty-seven PM."
The room went quiet. The team stepped back from the bed. Sullivan stood at the foot of it with his gloves still on, looking at the boy who had been awake and talking an hour before.
Knox's arms tightened around me. I couldn't breathe. I couldn't think. I couldn't make the numbers on the monitor mean what they meant.
I walked to the bed. I took Ian's hand. It was still warm.
I sat down beside my brother and I held on to him, and I didn't let go.