CHAPTER 6
Elena
◆
I check the rails of the gurney as I walk past it because the trauma bay stays empty for another hour and counting is a thing I am allowed to do here, where every nurse counts something.
Six rails along the right side. Six along the left.
Twelve drop-down latches. Three IV pole brackets welded to the headboard.
The wheels are locked. The sheet is fresh from the warmer.
Seven in the evening. The rain has been hard for an hour. Trauma bay six holds the kind of stillness a body knows will break.
The lights are at three-quarter overhead, the bay's resting setting; the rectangular spill of fluorescents under the white-tiled ceiling, the green stand-by glow of the monitor at the head of the bed.
My scrub top has the chlorhexidine smell already worked into the cotton at the cuffs.
The pediatric pin on my lanyard is a small gold flash at my collarbone.
Beatriz is on nights, which means six hours have passed since I felt her dry hand on my shoulder.
"Doctor."
He is at the charting station, head down. He is left-handed and he is writing left-handed across a paper chart he should be entering in the EHR, and the knurled steel ring on his right thumb catches the bay light at the second knuckle as he turns the page.
"Volkov."
He nods once. The pen keeps moving.
"They paged me back at six. I will be on the floor with you for the rest of the night."
He puts the pen down. He turns the ring on his thumb a half-rotation and looks up.
Smoke-gray eyes. The four-inch scar on his left jaw is faded silver under the two-day stubble — the place where a knife in Murmansk almost finished what it was sent to do.
He has the kind of stillness men have when they have run into more rooms than they have walked out of.
"Hayes paged me at six-twenty," he said. "He wanted to know if you'd been moved off his service. I told him you had been on mine since the trauma fellowship started borrowing pediatric nurses. That's a lie. He didn't ask me to verify."
He picks the pen back up. The corner of his mouth holds the shape a smile arrives in before it becomes one.
I name six rails again because the room is still saying I am allowed to.
---
The board lights up at twenty after eight.
Hunts Point stabbing, single victim, ETA seven minutes by ambulance, the night-shift charge nurse calling it out in the corridor like a cup of coffee she has just remembered to drink. I am at the warmer when the board hits. Alexei is on his feet before the page has finished. He moves as he writes.
Left hand on the gown stack, right hand on the glove box; the box is the size he wears and I take a half second to register that he has bought boxes in his own size and put them in this bay because he is here often enough to mind.
"Gown."
"Got you."
"Gloves on me first."
I gown him the way Sister Mary Catherine taught me at twenty, hands above the waist and below the chin in the same breath. The ring is under the right glove now, a small bright knurl at the second-finger knuckle's print. I gown myself.
The ambulance bay door bangs.
Twenty-six-year-old male, two stab wounds left chest, BP eighty-six over forty, tachy at one-thirty, intubated en route. Alexei is at the patient's left side before the stretcher locks; I am at the right with the saline.
"Bleeding time," Alexei said, and that was the only thing about him that moved fast. The rest of him went so still that I felt the shift in the room temperature.
"Saline up. Two units O-neg on the line.
Hold his left wrist down. Tell him my name.
Patients live longer when a Rossi tells them what to do. "
"My name is Elena," I told the kid, with my right hand on his left wrist and my left palm flat across his sternum. "You are at St. Jude's. The doctor here is Dr. Volkov. His hands are very fast. Mine are going to be the ones on your hand the whole time. Eyes here. I am the one in the room."
The kid's left pupil shrank one millimeter. He had heard me.
Alexei opened the gown. He worked the way knife-makers work — with the certainty of a man who has held the same instrument so many times he no longer thinks about where it is in his hand.
He found the second wound at the fourth intercostal, packed the first, called for a left-handed needle driver, sutured the lower edge of the cardiac lac at the ventricle in three throws, never once raised his voice.
Twenty-two minutes. The bay smelled of chlorhexidine and the particular metallic warmth of a chest opened on a gurney.
At twenty-two minutes Alexei went still again. His left thumb was inside the chest. His right thumb was at the patient's collarbone with the ring catching the bay light.
"There," he said. "There is the heart."
He looked at me.
"There's blood on your ring," I said.
It was the kind of thing you say to a colleague when you have been working for twenty-two minutes and your eye has been free for one second to land on a detail not load-bearing.
There's blood on your ring. I said it as I would have said your stethoscope tubing has flipped, or your gown is unsnapped at the back, or the kid's blood pressure is coming back up. It was a working remark.
Alexei kept his eyes on the chest.
He looked at me for a full second as a man looks at a person he has decided to keep, and then he went back to the kid's chest and finished the third throw of his suture.
"I will put it down later," he said. "Stay on his wrist. We are not done yet."
"I'm not going anywhere."
"No," he said. "You are not."
---
The kid goes up to OR-3 at five past nine.
The cardiothoracic resident takes him up with Stefan finishing the mitral at the other table.
The bay falls quiet behind them. The brother is in the family room with a chaplain who has kind eyes and the news is going to be good.
The kid is going to live. Alexei told me three minutes before he said it out loud to the brother.
I have been a nurse for six years and I have never seen a man know that before the heart told him.
I peel my gown. I peel my gloves. I wash to the elbows. I dry my hands. I take the pencil out of my hair and put it back.
Alexei is at the charting station again. The pen lies flat under his palm. He is turning the ring on his thumb. He is looking at the corridor.
"Hayes is here."
He said it without looking at me. He said it as he had said bleeding time — flat, registered, the volume of fact.
I followed his line of sight. The corridor outside trauma bay six is fluorescent-bright and Floor 9’s after-hours quiet is on it.
Marcus Hayes is at the corner. He is in his attending coat.
He has the expensive haircut. He has the French cuff.
He has a chart in his hand he does not need; the chart belongs to the kid we have just sent up.
He sees me see him.
He holds his ground in the corridor's mouth.
The metal taste of fear is suddenly in my mouth — a copper-iron coating at the back of the tongue, the same taste I had at nineteen with my forehead on a NICU window, and this hospital has stayed clean of it until now, the body's memory of it so exact that I take a small inhale and hold it without meaning to.
My eyes stay on Hayes. I check the rails of the gurney behind me. Six. Six.
I touch the medallion with the back of my own knuckle as I learned to touch it when I want to keep my fear from it.
Alexei has stood up.
His neck stays unrolled. His thumb stays still at the ring.
He does the thing he does when he is dangerous, which is go quiet.
The bay's dim hum settles into the silence.
The leaking O-two regulator at the bay's emergency rack hisses very softly, a sound that surfaces now from a register I had been tuning out.
"Volkov. " Hayes is in the corridor's mouth.
"Hayes."
"I needed the chart."
"You have it."
"I wanted to make sure Nurse Rossi was being utilized appropriately tonight. Trauma is a hard service for a pediatric transfer."
"She is being utilized appropriately."
"I just thought I would ask."
Alexei takes one step into the corridor. One step only. His voice drops further as the corridor gets quieter. The fluorescents above Hayes give him the color of a man who has paid for his haircut and not for his decisions.
"Hayes," Alexei said.
The corridor was very still.
"Touch her and die."
He said it as he had said there is the heart.
Flat. Registered. No volume. No flex of the jaw.
The four-inch silver scar at his left jaw stayed still.
The ring on his right thumb stayed still.
He had said three words and the cap on Hayes's fountain pen clicked once in the silence — a small dry sound from the chart Hayes was carrying — and that small dry sound was the second time in five days I had heard it.
The first was in the OR-3 corridor on Wednesday. The cap-click was a tell, not a tic — the body of a man holding a pen too tight.
Hayes stayed silent.
He turned. He went up the corridor with the chart he had used as cover. His eyes stayed front. He pressed the elevator button. He got in. The doors closed.
Alexei held the doorway for the forty-two seconds it took.
Then he turned and walked back into the bay and locked the trauma bay door behind him with the badge reader's three-tone chime and the manual deadbolt at the door's center that nobody used anymore.
The bay went silent.
There is a moment, when a room I have known clinically goes silent, that the body remembers another room.
The trauma room across the lightwell. The fluorescents were the same color.
The tile was the same color. The sheets had been folded at the foot.
The metal taste at the back of my tongue had been the same metal taste.
I was nineteen. I was on the wrong side of the glass.
The attending called time at eleven forty-seven.
That room belonged to my sister.
This room is mine.