One Last Chance (The Man on the Mountain #2)

Prologue

ERIN

The fetal monitor starts screaming at eleven forty-seven p.m.

I am thirteen hours into a fourteen-hour shift on the OB floor at Northwest Memorial.

Twenty-eight years old and ten months away from the end of an internal medicine residency, and nothing about the last four weeks has prepared me for what is happening in this room.

I have read my chapter at the end of every day in the call room with a vending-machine sandwich open on my knee.

I know the algorithm. I've watched the simulation.

I have never been on this side of a screaming monitor.

The whole room moves around me. Two L she cannot bag and compress at the same time.

Linden’s hands belong to the woman on the table. There is no one else.

I cross the floor.

My gloved hands find a chest barely the size of my palm.

"Two-finger," the senior nurse says, her eyes fixed on the mask. "I’m bagging at thirty. You’re at ninety. Three and one."

"Three and one," I confirm.

Two fingers on the lower third of the sternum, just below the line between her nipples.

Depth one-third the chest. I count faster than I have ever counted anything.

One and two and three and breathe — the nurse’s hand squeezing the bag, the small chest rising the smallest amount, then falling.

One and two and three and breathe. The rhythm I have never run on a baby, have felt under my own hands. Until tonight.

The warmer’s overhead lamp is hot on the back of my neck. The baby’s skin is cool under the gauze. Her color is wrong in every place — the deep gray-blue of the lips, the dusky violet around the eyes, the pallor at her hands.

Come on. Come on.

Behind me, Linden is asking for more suction and another unit, and someone has the four-by-fours opened on the field already. The voices come through filtered. I am counting in my head and counting out loud.

Thirty seconds. Nothing.

The senior nurse adjusts the seal of the mask with the heel of her thumb. Her own breath has gone short. "Good chest rise," she says. "Keep going."

Forty seconds. A twitch in the right thigh. So small I would have missed it if I wasn’t already looking. So small I do not trust it.

Sixty seconds. The cardiac monitor someone has clipped to her chest flickers off a baseline and finds a beat. A second. A third. Slow. Climbing.

"Heart rate," the senior nurse says. "Climbing through seventy. Eighty. Keep going."

Eighty seconds. The baby’s chest moves underneath my fingers. A small independent rise. She draws her own breath.

The cry is thin and furious and the best sound I have ever heard in my life.

The nurse pulls the mask off. The baby’s color shifts in stages before my eyes — the gray going to gray-pink, the lips coming up, the hands flushing from white to a startled red.

She is screaming now. Both fists balled. Both feet kicking.

"There she is," the senior nurse murmurs, almost to herself.

Hands lift the baby out of mine. The neonatology team is in the room.

I did not hear them come in. They take her in a fresh blanket toward the second warmer, calling out numbers I am no longer required to track.

My palms are empty, but they are still going through the motion of compressions; I have to stare at them and make them stop.

Across the table, sideways, I hear Linden. "Hell of a call, Clark."

She still hasn't looked up. Her hands are still in the field. The mother is still bleeding, but she is bleeding less. The mother is going to live.

The baby is going to live.

I step back from the warmer. I don't remember crossing the floor to the scrub sinks, but I find myself clumsily stripping my gloves off.

I push the elbow paddle for the hot, and run my hands under the water.

Something I've been holding for a couple of minutes lets go all at once — a small involuntary sound, a half-breath, half-laugh that I don't recognize.

The locker room is two corridors away. The fluorescents are dimmer here.

The bench is the same matte gray bench it has been for ten months.

Someone left a paperback face-down on the bench beside me — a thriller, the cover creased white through the spine.

I sit with my hands in my lap. I have washed them three times, but they still smell faintly of iodine and they will not stop trembling.

The door opens. The senior nurse comes in. She sits beside me on the bench, leaves a foot of space between us, and is quiet for a long time.

"Been at this a long time, kid," she finally says. "I’ve never seen a resident run that room." I hear her take a deep breath and release it in a rush. "You felt it, didn’t you?"

"Yes."

"You’re going to need it." She pats the bench between us twice. Two firm pats. Then she gets up and leaves.

I sit on the bench a while longer. The locker room is never quite quiet — the building breathes around me, a cartwheel rattles somewhere down the corridor, the fluorescents hum overhead.

The clock above the door reads twelve twenty-three.

Outside the small window over the lockers it is dark, and somewhere out past the freeway, the night has turned over into the morning of November sixteenth.

My hands have stopped trembling.

I have ten months left in an internal medicine residency I no longer want.

I have a program director whose office is on the fourth floor of the south building and whose door I have passed every morning for the last three years.

In the morning I am going to knock on that door, and I am going to tell her about what I felt in the OR tonight, and I am going to ask to transfer to pediatrics.

I don’t remember the exact moment I decided to be a doctor. But I remember the moment I decided to be a doctor for children.

I was holding a baby I’d just helped pull through. I felt her small heart settle against my palm, and I knew this was what I wanted to do for the rest of my life.

I never would have thought I’d walk away from it.