Tess Gerritsen - Bloodstream

Claire absorbed this dismaying news in silence. It was not uncommon for patients to switch physicians, sometimes for the most trivial of reasons. Two of Adam DelRay’s patients had transferred to Claire’s practice as well. But she was surprised that this particular patient would choose to leave her care.

Sixteen years old, and mildly retarded, Katie Youmans had been living with her father when she was brought in to see Claire for a bladder infection. Claire had noticed at once the circumferential bruises on the girl’s wrists. Forty-five minutes of gentle questioning and a pelvic examination had confirmed Claire’s suspicions. Katie was removed from her father’s abusive household and placed in foster care.

Since then, the girl had thrived. Her bruises, both physical and emotional, finally faded. Claire had counted Katie as one of her triumphs. Why would the girl switch doctors?

She found Katie in X-ray. Through the small viewing window, Claire saw the girl lying on the table, her lower leg positioned beneath the X-ray tube.

“Can I ask what the admitting diagnosis is?” Claire asked the tech.

“They told me cellulites of the right foot. Her chart’s over there, if you want to look at it.”

Claire picked up the medical record and flipped to the admission note. It had been dictated by Adam DelRay at seven A.M. that morning.

Sixteen-year-old white female who stepped on a tack two days ago. This morning she awakened with fever chills, and swollen foot…

Claire skimmed the history and physical, then turned the page and read the therapeutic plan.

Quickly she picked up the phone to page Adam DelRay.

A moment later, he walked into X-ray, looking crisply starched as Usual in his long white coat. Though he had always been cordial toward her, he had never displayed any real warmth, and she suspected that under his Yankee reserve burned a masculine sense of Competition, perhaps even resentment, that Claire had lured away two of his patients.

Now he had laid claim to one of hers, and she had to suppress her own feelings of competitiveness. Only the well-being of Katie Youmans should concern her now.

“I’ve been following Katie as an outpatient,” she said. “I know her pretty well, and-”

“Claire, it’s just one of those things.” He lay a reassuring hand on her shoulder. “I hope you don’t take it personally.”

“That’s not why I paged you.”

“It was just more convenient for me to admit her. I was in the ER when she came in. And her guardian felt Katie needed an internist.”

“I’m perfectly capable of treating cellulites, Adam.”

“What if it turns into osteomyelitis? It could get complicated.”

“Are you saying a family physician isn’t qualified to take care of this patient?”

“The girl’s guardian made the decision. I just happened to be available.”

By now Claire was too angry to respond. Turning, she stared through the window at her patient. At her ex-patient. Suddenly she focused on the girl’s N, and she noticed the handwritten label affixed to the bag of dextrose and water. “Is she already getting antibiotics?”

“They just hung it,” said the X-ray tech.

“But she’s allergic to penicillin! That’s why I paged you, Adam!”

“The girl never said anything about allergies.”

Claire ran into the next room, snagged the IV line, and closed off the infusion.

Glancing down at Katie, she was alarmed to see the girl’s face was flushed. “I need epinephrine!” Claire called out to the X-ray tech. “And IV Benadryl!”

Katie was moving restlessly on the table. “I feel funny, Dr. Elliot,” she murmured. “I’m so hot.” Wheals had swollen on her neck in bright blotches of red.

The tech took one look at the girl, muttered “Oh, shit,” and yanked open the drawer for the anaphylaxis kit.

“She didn’t tell me she was allergic,” said DelRay, defensively.

“Here’s the epi,” said the tech, handing Claire the syringe.

“I can’t breathe!”

“It’s okay, Katie,” soothed Claire, uncapping the needle. “You’ll feel better in just a few seconds She pierced the girl’s skin and injected a tenth of a cc of epinephrine.

“I-can’t-breathe!”

“Benadryl, twenty-five milligrams IV” Claire snapped. “Adam, give her the Benadryl!”

DelRay stared down with stunned eyes at the syringe the X-ray tech had just slapped in his hand. In a daze, he injected the drug into the line.

Claire whipped out her stethoscope. Listening to the girl’s lungs, she heard tight wheezes on both sides. “What’s the blood pressure?” she asked the tech.

“I’m getting eighty over fifty. Pulse one-forty.”

“Let’s move her to ER, STAT?’

Three pairs of hands reached out to slide the girl onto the gurney.

“Can’t breathe-can’t breathe-”

“Jesus, she’s really swelling up!”

“Just keep moving!” said Claire.

Together they propelled the gurney out of X-ray and ran it down the hallway.

They careened around the corner and banged through double doors into the ER. Dr.

McNally and two nurses looked up, startled, as Claire announced:

“She’s going into anaphylactic shock!”

The response was immediate. The ER staff swung the gurney into a treatment room.

An oxygen mask was pressed to the girl’s face and EKG leads clapped to her chest. Within minutes a hefty dose of cortisone was dripping into her IV

Her own heart was still pounding when Claire finally left the room to let McNally and his staff take over. She saw Adam DelRay standing at the nurses’ desk, furiously scribbling in Katie’s hospital record. As she approached, he quickly shut the chart.

“She never told me she was allergic,” he said.

“The girl is borderline retarded.”

“Then she should be wearing a MedMert bracelet. Why isn’t she?”

“She refuses to.”

“Well, I can’t guess these things!”

“Adam, all you had to do was call me when she came in. You knew she was my patient, and that I’m familiar with her history. All you had to do was ask.”

“The guardian should have told me. I can’t believe it never even occurred to that woman to-”

He was interrupted by the loud squeal of the ER radio. They both looked up as the transmission came crackling through.

“Knox Hospital, this is unit seventeen, unit seventeen. We have gunshot victim en route, ETA five minutes. Do you copy?”

One of the nurses darted out of the treatment room and snatched up the microphone. “This is Knox ER. What’s that about a gunshot wound?”

“Multiple victims en route. This one’s critical-more on the way.”

“How many? Repeat, how many?”

“Uncertain. At least three-”

Another voice cut into the frequency. “Knox Hospital, this is unit nine. En route with gunshot wound to the shoulder. Do you copy?”

In panic, the nurse grabbed the telephone and hit 0. “Disaster code! Call a disaster code! This is not a drill!”

Five doctors. That was all they could round up in the building during the frantic moments before the first ambulance arrived: Claire, DelRay, McNally from the ER, a general surgeon, and one terrified pediatrician. No one knew any details yet, not the location of the shooting, nor the number of victims. All they knew was that something terrible had happened, and that this tiny rural hospital was not prepared to deal with the aftermath. The ER turned into a maelstrom of noise and activity as personnel scrambled to prepare for the injured. Katie, now stabilized, was whisked out and shoved into the hallway to free up the treatment room. Cabinets clanged open, bright lights flared on.

Claire pitched in to hang IV bags, lay out instrument trays, and rip open packets of gauze and sutures.