John Burley - The Absence of Mercy

They were silent for a moment before Sam turned to Ben. “The Dresslers would like to return to their daughter as soon as possible. I told them it might help our investigation if you had a chance to look at some of the injuries. They’ve kindly agreed to give us a few minutes to do that, and have consented for some photographs to be taken.”

Ben nodded. He looked down at Joel. “I’d like for you to wait out here for us, son. We shouldn’t be more than about fifteen minutes.”

“We’ll keep an eye on him,” Paul assured him.

“I appreciate that,” Ben said, and he headed through the large double doors with Sam and the two detectives.

The pediatric ICU, Ben noted as they stepped inside, was more tranquil than he recalled. His time as a medical student and resident in such settings had been one of frenzied data gathering, countless procedures, extensive documentation, and protracted bedside discussions. It had been a whirlwind of endotracheal tubes and central lines, of ventilators and IV pumps—a seamless blur of medical histories and physical exam findings amid weeks of sleepless nights, as the pager attached to his belt beeped endlessly with its voracious, intractable demands. By comparison, the unit this afternoon seemed hushed, almost silent, as if the patients around them struggled to live or die on their own private battlegrounds, far removed from this physical place in which they lay.

Sam led them toward a room in the far corner. Its sliding glass door stood open, and as they approached a technician maneuvered a large portable motor-driven X-ray machine from the room with surprising grace. He smiled politely at the four of them before steering the contraption down an adjacent hallway. Ben and the officers exchanged glances and then proceeded into the room.

Inside, a young girl lay supine on a gurney. A thin blue hospital gown covered her chest, shoulders, and abdomen, her long black hair disappearing beneath the upper ridge of her torso. The remainder of her small frame was obscured beneath the crisp white linen. She lay motionless, except for the slight rise and fall of her chest in step with the measured mechanical pace of the ventilator. A plastic breathing tube protruded from between her pale, cracked lips, and numerous medication lines hung from an assortment of IV pumps attached to two metal poles at the head of her bed. From beneath the gown, an additional two large plastic tubes emerged, one on each side of her body, and descended into multichambered canisters, which bubbled softly. A bulky dressing covered her right ear.

Sam and the two detectives stood near the wall at the foot of the bed. None of them spoke, and the officers now seemed hesitant, as if waiting for something to happen. It took Ben a moment to recognize that they were waiting for him. To these men, this was a foreign place about which they had little understanding, and the young woman lying unconscious in the bed in front of them—held together by a bewildering assortment of tubes and instruments that doggedly sustained her tenuous existence—was an inexplicable enigma. He could sense their tension, their careful restraint, as if the slightest action might inadvertently tip the scales of recovery against her, as if her broken body might suddenly disintegrate and scatter like ash in the wind. This was his world, he realized, or at least it had been at one time in his training. They had asked him to come here to examine her injuries, yes—but they also needed him as a liaison to orient them to what they were seeing and its significance, to broker this space between those who would live and those who would die, and to tell them in which direction to go from here.

He was about to speak when a female voice behind them interrupted the silence.

“Hard to believe she made it.”

They simultaneously turned to encounter a woman in her mid-thirties dressed in blue scrubs and a white lab coat. Her dark hair was slightly disheveled, as if she’d been wearing a cap for most of the day. A stethoscope had been tucked into a side pocket of her lab coat, its earpieces peeking curiously out at them. The clogs she wore on her feet were enveloped by thin blue shoe covers, and there was a large orange stain—Betadine, Ben presumed—on the front of her left pant leg. A single black pen poked out from the front pocket of her lab coat above a hospital ID badge that dangled from a small metal clasp. She thrust out a hand in Ben’s direction.

“Karen Elliot,” she announced. “I’ve been in the OR with Ms. Dressler for a good part of the morning.”

Ben shook hands with the surgeon. Her skin was cool and dry, her grip firm and assertive. He introduced himself, Sam, and the two detectives. “The case is being investigated as an attempted homicide,” he explained. “We’ve received the parents’ consent to examine her injuries… if it’s okay with you, that is.”

“If her parents are fine with it, then so am I,” the physician replied. She stepped to the bedside, retrieved the stethoscope from the pocket of her lab coat, and listened to the girl’s chest for a moment. She wound the stethoscope into a loose circle, returned it to her pocket, then pulled an otoscope light from its resting place on the wall. As they watched, she pulled back the girl’s upper eyelids to shine the light into first one pupil and then the other, noting the response. The otoscope was returned to its wall mount, and the surgeon bent down on one knee to examine the plastic chambered canister to which each of the tubes exiting the girl’s chest was attached.

“Could you tell us about her injuries?” Ben inquired.

Dr. Elliot lifted the girl’s hospital gown to expose her abdomen. The skin along a midline surgical incision site had been left open, the wound packed with gauze. Ben spotted three Jackson-Pratt drains exiting the skin from other areas of the abdomen, their small chambers partially filled with a thin reddish fluid.

“Jesus,” muttered Detective Schroeder. “You haven’t even stitched her up yet.”

“There’s no point in it,” the surgeon replied, her eyes remaining on the patient. “The first surgery in cases like this is strictly damage control. Get in, do what needs to be done, and get out. The liver and small bowel were lacerated in several places. The spleen was bleeding so badly it had to be removed. The left kidney also took a hit,” she said, pointing to a urine reservoir bag hanging on the side of the bed. Like the fluid in the abdominal drains, the urine had taken on a bloodied maroon color. “Anyway,” Dr. Elliot concluded, “we’ll have to go back in at least once more to take a look at things—to make certain the bleeding from the liver is under control, to take another look at the bowel anastomoses, and to be sure nothing else was missed. So there’s no point in closing the abdomen yet.”

Ben nodded. “What other injuries did she sustain?”

“You name it, she’s got it,” she said. “Bilateral hemopneumothoraces, a small right ventricular puncture wound through the pericardium that I have no idea how she survived, multiple small bowel injuries, a grade III liver laceration, grade IV splenic injury requiring splenectomy, left renal laceration, facial bone fractures, tracheal contusion, a left ankle dislocation and medial malleolar fracture that was reduced in the OR, multiple soft-tissue avulsion injuries, and traumatic amputations of two fingers on the left hand.” She sighed, brushing the hair back from her patient’s forehead. “Most of her right ear is missing. Whoever did this did not intend for her to live.”

“How’s her brain?” Ben asked. “Any intracranial injuries?”

The doctor shook her head. “That’s one thing her assailant didn’t get around to. She’s pharmacologically sedated now, but provided her blood pressure holds and she survives these other injuries, I have no reason to believe she won’t wake up once she’s weaned off the sedative agents.”