Читать книгу: «Between You and Me», страница 2

Now his face felt carved in stone as he glared at his father. “They’re taking him,” he said simply. “I’ ll allow it.”

“Sir, you’ll have to step aside,” a man shouted, jostling in front of Asa. “We’re going to load him hot, while the chopper’s still going.”

“These people will take care of you,” Caleb said to his nephew, climbing to his feet. “I love you, Jonah, don’t ever forget I love you.”

“Uncle Caleb, don’t leave me.”

Despite the noise of the beating rotors, Caleb heard his nephew’s faint plea, piercing his heart.

The nurses and paramedics of the life flight lifted the board as the pilot did a walk around the helicopter, checking the landing area. Jonah was lost amid a pile of blankets and gear. His blood stained the ground everywhere.

“I’m going with him,” Caleb said loudly. “I have to go with him.”

A nurse in a utility vest looked at him, then over at Jonah.

“Please,” Caleb said. “He’s just a little boy.”

“It’s the pilot’s call. I’ll see what she says about the fly-along.”

Caleb turned and found himself face-to-face with his father. Asa held his hat clapped on his head to keep it from being blown away by the rotors. His straight-cut coat and broadfall trousers flapped in the wind. He stood flanked by the neighbors, forming a somber wall of fear and disapproval.

The last thing on Caleb’s mind was Amish Ordnung. Clearly it was uppermost in the minds of his father and the elders.

“If it’s God’s will that the boy is to survive,” Asa stated, “then he will do so without being lifted into the sky.”

Caleb didn’t trust God’s will, and he hadn’t in a long time. But he didn’t argue with his father. He hadn’t done that in a long time either.

Hannah rushed to his side. Her face was pale gray and awash with tears. “You have to go, Uncle Caleb. You have to.”

Alma Troyer stepped forward, her mouth set in a firm line. She cut a quick glance from Asa to Hannah. “You go, Caleb. I’ll keep Hannah with me while you’re away.”

The flight nurse touched his arm. “You’re in. The pilot said you can come.”

Caleb nodded and turned to his father. “I’ll call.” The Amish families shared a phone box in the middle of the village, its use limited to necessary business and emergencies. Without waiting for a reply, he turned on his heel and followed one of the EMS technicians to the chopper.

In a tangle of tubes and monitors, Jonah was being loaded into the side bay of the shiny blue helicopter. “Whoa, you’re a tall one. Keep your head low,” a technician cautioned Caleb, pointing upward. “Stay to the front and left of the chopper.”

Hardwired to her radio equipment, the pilot glanced at Caleb. “You’re a big fella,” she yelled. “What do you weigh?”

Caleb never weighed himself. “Two hundred pounds,” he estimated, aware of the broad blade swinging overhead. He was nineteen hands tall, judging by the draft horses he worked with. Well over six feet. He was definitely at risk of having his head lopped off by the rotating blade.

“Our weight limit’s two-twenty,” the pilot said. “Let’s do it.”

The technician kept his hand on Caleb’s shoulder and guided him aboard. Someone tossed his hat to him. They showed him where to sit and how to strap himself in. In the cramped space, he was close enough to Jonah to reach the boy, but he couldn’t figure out a place to touch. He rested his hand somewhere—the kid’s foot. Even through layers of thermal blankets, it was cold as ice.

“Jonah,” he said, “I’m with you. Hear me? I’m coming with you.”

He was given a set of headphones with spongy earpieces. Radios crackled and screeched. Monitoring equipment beeped, straps and clamps were locked into place. A mask was put over Jonah’s nose and mouth, and one of the workers squeezed an air bag at regular intervals. In minutes, the doors were pulled shut. The pilot rattled off a series of orders, simultaneously checking things in the cockpit and snapping a series of switches and levers. With a roar of increasing power, the chopper lifted straight off the ground.

Caleb’s stomach dropped, and the breath left his lungs. Through a rounded glass opening, he saw the people gathered near the landing site. Neighbors and friends, his father still holding his hat to his head, growing smaller and smaller as the copter ascended into the sky. They looked like a black-and-gray cloud against the golden fields. Hannah lay crumpled on the ground, her skirts surrounding her like an inkblot. Someone should go to her, put a hand on her shoulder to reassure the girl. But no one did.

The helicopter passed the silo in the blink of an eye, but in one glimpse Caleb could see the conveyor slanting up to the opening, the shredding machine positioned at the top. And on the ground, on the green-and-brown earth where the farm had stood for generations, he saw the livid stain of his nephew’s blood, oddly in the shape of a broken star.

The helicopter nurse was yelling information into a radio, most of which Caleb barely understood. Jonah’s BP and respiration, absent pulses distal to the injury site, other things spoken in code so rapidly he couldn’t follow. He did catch one word, though, loud and clear.

Incomplete transhumeral amputation.

Amputation.

The helicopter lurched and careened to one side. Caleb pressed his hand against the hull to steady himself, and his stomach roiled. Another feeling pushed through his terror for Jonah, a feeling so powerful that it made him ashamed. Because in the middle of this devastating trauma, he felt an undeniable thrill. He was up in the air, hovering above the earth, flying.

All his life he had tried to imagine what it was like to fly, and now he was doing it. So far, the experience was more amazing and more terrible than he’d ever thought it would be. The land lay in squares made of different hues of green and yellow and brown, stitched together by pathways and irrigation ditches. Shady Creek was a slick silver ribbon fringed by bunches of trees. There were toy houses connected by walkways and white picket fences, a skinny single-lane road with a canvas-topped buggy creeping along behind a horse. Caleb could tell it was the Zooks’ Shire, even from the sky. He knew practically every horse in Middle Grove.

The chopper moved so fast that the view changed every few seconds, sweeping over the Poconos. The nurse finished punching buttons on some piece of equipment. “Sir,” she said to Caleb, “I need to ask you some questions about your son.” Her voice sounded tinny and distant through the headphones.

No time to explain that Jonah wasn’t his son.

“Yeah, sure.” At her prompting, he reported Jonah’s name, his age, the fact that he didn’t suffer from any allergies Caleb knew of. She wanted to understand the nature of the accident and he did his best to explain how the equipment worked, how the blades shredded the corn and blew it into the silo, how sometimes a piece got fouled up and needed an extra push with the next stalk in line. From the look on the woman’s face, he could tell his explanation was as incomprehensible to her as her medical jargon was to him. Another thing he could see on her face was the real question, the one she would not ask.

How could you let a child work around such dangerous equipment?

Caleb couldn’t even answer that for himself. It was the way things had always been done on the farm. From the time they learned to walk, kids helped out. The tiniest ones fed chickens and ducks, weeded the garden, picked tomatoes and beans. When a boy got older, he helped with plow and harrow, the hay baler, sheaves, fetching and carrying from the milk house, anything that needed doing. It was the Amish way. And the Amish way was to never question tradition.

He tried to check on his nephew, but there was little of Jonah to see amid the tangle of tubes and wires and the guy squeezing the big plastic bulb into the boy’s nose and mouth. The chopper veered again, and the landscape quickly changed. Philadelphia was a bristling maze of steel and concrete giants arranged along the wide river and other waterways. The city had its own kind of strange beauty, made up of crazy angles and busy roads. Atop one of the buildings, a series of markings seemed to pull the chopper from the sky like a magnet.

“They’re going to do a hot unload,” the nurse explained. “They’ll get him out even before the chopper stops. You just wait until it stops, and the pilot will tell you when it’s safe to get out.”

“Got it.” Caleb was startled when he looked down and saw that his hat was still clutched in his bloody hand.

His other hand lay on the blanket covering Jonah’s bony bare foot. Please, Jonah, he said without speaking. Don’t die on me.

The Amish never prayed aloud except at meeting. They were a people of long, meditative silences that made folks think they were slow-witted. Caleb begged, with wordless contemplation, for mercy for his nephew.

He’s only a little boy. He sings to the ducks when he feeds them in the morning. He sleeps with his dog at the foot of his bed. Every time he smiles, the sun comes out. His laughter reminds me that life is beautiful. I can’t lose him. I can’t. Not my Jonah-boy.

Caleb was praying for the first time in years. But for him, prayer had always been like shouting down a well. Your own words were echoed back at you. Only the truly faithful believed someone was actually there on the other end, listening.

3

In Philly, traumas were plentiful and Reese had attended her share. Gunshot wounds, stabbings, and automobile wrecks accounted for most of them. But every once in a while, something new and unexpected came through the heavy doors of the trauma bay—a guy crushed in a logrolling contest. A window washer who had fallen from a scaffold. A skydiver whose chute hadn’t opened properly in midair and who had hit the ground at seventy-five miles per hour.

The dramatic, over-the-top traumas had a peculiar effect on the team. Everyone felt the sting of the razor’s edge, reminding them that anyone could be a hair’s breadth from death. The sole purpose of the team was to reel the victim back from tragedy.

According to the advance reports coming from the life flight crew, this boy, too, balanced on the edge. On the one hand, he was young and strong and in a good general health. But on the other, he had suffered a devastating injury and had lost a lot of blood. If the shock didn’t kill him, sepsis or secondary injuries could.

“They’re bringing him down now,” the lead trauma nurse reported.

“Get ready, people,” Jack added. The trauma chief worked the team like a drill sergeant, preparing the high-tech bay with painstaking attention to detail—airway, IV, monitoring equipment, essential personnel, lab and radiology backup. With everything in readiness, the area resembled the inside of a strange, futuristic cathedral, the bed in the center like an altar where victims were brought forth to appease a pantheon of wrathful gods.

The last moments were silent, team members’ minds weighted by the tension of expectation while their bodies were physically weighted by the heavy purple X-ray vests. Everyone was alone with their thoughts—the team leader, primary physician, airway team, nurses and patient care techs, radiology tech, CT, pharmacy, recorder, support staff, chaplain. Reese imagined that some were praying. She herself clung to her mantra: do right.

The team members stood poised in their designated positions. Reese felt a surge of adrenaline course through her, starting in her chest and spreading like a drug through her neck and shoulders, arms and legs. She understood the physiology of the human body, but no textbook could adequately describe certain things—the heady rush of anticipation, for one thing.

Stone-cold fear, for another.

During this rotation, she was learning that in a trauma situation, there was almost no time to think. Though her head was crammed with facts and procedures, she shut down everything except that which would help the patient. In a trauma, she didn’t feel hunger or fatigue or even the need for the bathroom. She got so focused that she didn’t even feel emotion, which worried her.

Mel said it was a good thing. When a patient was coded, the doctor needed cold algorithms, not empathy. He’d told her to consider a residency in trauma, but she had dismissed the suggestion. That wasn’t where she was headed.

But in moments like this, she caught herself reconsidering.

“Keep an eye on Jack,” Mel murmured in her ear. “Watch and learn. He is the maestro.”

Reese nodded. There were a few more moments of breath-held anticipation, tingling with the awareness that everything was about to change. Then the wire mesh doors exploded open with a loud thud, and the patient arrived.

“Coming through,” someone said, walking backward and pulling the gurney along a hallway marked with a red line on the floor and the words All Trauma. “Clear a path.” More paramedics ran with the stretcher between them, preparing for the transition into the trauma bay. Reese craned her neck but couldn’t see the boy amid the cluster of personnel and equipment—just an oversize C-collar and two vacuum-splints painted with fresh blood.

Behind the stretcher was a man so large he dwarfed everyone else. His shirt and hands were covered in blood. Beneath a dramatic wave of golden blond hair, his expression was a mask of agonized worry—a guy facing every parent’s worst nightmare.

The stretcher was angled into the middle of the trauma bay and the team went to work.

“How’s he holding up?” Jack asked, positioning himself at the foot of the bed.

“Not so hot.” Irene, the life flight nurse, stepped back from the rig, consulted dual tablets, and gave a swift MIVT report—mechanism, injuries, vitals, treatment. She stated that the boy had been given blood agents to lower the risk of hemorrhage. Monitors beeped and screeched off-key as the patient was transferred to the X-ray table. In the corner, a server’s lights flashed green and gold.

Reese tried to make out his features with the clear mask cupped over his nose and mouth. Deep lacerations slashed one cheek, as though he’d been clawed by a huge bear. His eyes were blue, darting from side to side.

“Dear God,” she whispered. “He’s conscious.”

“Been that way since it happened,” Irene said. “You’re an amazing guy, Jonah. You’re doing great.”

“I’m Dr. Tillis,” Jack said, looking straight down into the kid’s face. “We’re going to take good care of you.”

The boy’s lips moved inside the mask, fogging the plastic. He wasn’t crying. Reese suspected that shock had pushed him well past that point.

“Right,” said Jack. “Let’s have a look at that arm.”

The field dressing was removed and the arm exposed, and even the seasoned members of the team gaped in awe at the injury. It was a ragged horror of a wound, the tissue and bone and bloody dressing so tortured that it hurt just to look at it.

He never even lost consciousness, Reese thought. What the hell kind of kid was this?

“Jonah, can you move the fingers of your left hand, buddy?” asked Dr. Tillis.

The hand lay unresponsive.

“How about a thumbs-up or an okay sign,” Tillis suggested. “Can you do that?”

The boy’s eyes narrowed in pained concentration, but there was still no response. Everything had been shredded or severed. “Completely ablated,” someone nearby murmured. “Oh, man …”

“Get in here, Powell,” said Dr. Tillis. “Move in closer. This is something you don’t see every day. Let’s have you remove the lower-extremity clothing and do the blood draw.”

Most of the kid’s clothes had already been removed, cut or ripped off by the EMTs, or maybe in the accident. His skinny chest and pelvis looked as pale as marble. He wore jockey shorts, plain white turned gray from laundering, which she scissored away, looking for further injuries to report to the lead doctor. “No sign of bruising or trauma to the pelvis,” she said.

Then she prepped the site with Betadine and palpated the femoral artery with her fingers. “You’ll feel a pinch, Jonah,” she said, then felt ridiculous warning him about a pinch while his arm was hanging in shreds. She inserted the needle at a right angle. The slender curl of tubing filled with bright red blood, filling the syringe. While another student applied pressure to the site, Reese carefully labeled the blood draw and handed it off to a lab tech.

Jack rapped out orders for further assessments and pain management along with X-rays, piles of warm blankets, a Foley for urinalysis. Reese had a powerful urge to touch the boy—somewhere, somehow—but focused instead on following instructions. IVs were connected, and the surge of fluids and drugs worked quickly. Reese wasn’t sure whether or not she imagined it, but she thought the boy looked directly at her as she leaned forward to check a line and a monitor. Then his eyes fluttered closed. She wished she’d touched him.

The work of prepping Jonah Stoltz for surgery was done swiftly, each member of the team playing a part. They debrided and dressed wounds, scanned and tested the slender, broken boy, stabilizing him as best they could and seeking secondary injuries. Three floors up, the surgeons of the OR scrub team were already gearing up for the most likely outcome—amputation. The mobile bed was pushed out into the gleaming stainless-steel maw of the elevator.

With a rubbery squeak, the doors whisked shut and silence filled the trauma bay again. In a vacuum of silence, the adrenaline rush subsided.

People in the emergency department, and especially members of the trauma team, had a brief but vital relationship with the patient. It was like a missed encounter on a bus—they had minimal details about what preceded the trauma, an intense flurry of total focus and attention, during which the patient was the center of their universe. And then, once the patient was rushed off to surgery, everyone moved on. There was no closure. They glimpsed a single page from the narrative, never the whole story.

The room emptied quickly. The once pristine suite now resembled a bloody field in the aftermath of battle. Orderlies appeared to clear the area. Reese glanced around the room. She spotted something on the floor—an elongated penny that had been flattened on a train track, or maybe in one of those machines. The words Old Blakeslee Sawmill had been pressed into the copper.

She slipped it into the pocket of her lab coat. Then she went out to the garden adjacent to the emergency department, where there was an outdoor seating area favored by the staff. From here she could see the river, its banks flanked by long green swaths of parkland populated by kids playing Frisbee and shooting hoops, people lying on the grass in the sunshine, strolling tourists and cyclists rolling by.

She thought of the boy being rushed to surgery, and a shiver passed over her. At the far end of the garden, one of the trauma nurses stood alone, smoking a cigarette and staring into space as she blew a thin stream of smoke into the warm, unmoving air. Reese didn’t judge her for the habit, nor did she remind her of the property’s ban on smoking. After a major trauma, everyone involved seemed to deal with it in their own way. Some were chatty, expending the excess adrenaline in conversation, while others stayed quiet, floating in some placid reflection pond in their mind until balance returned.

Reese was still discovering what sort of trauma team member she was, but this rotation would probably end before she figured it out. She stood mulling over the incident, putting it into the context of her long-term plan.

For as long as she could remember, she had been focused on this career. She didn’t even recall choosing it. Perhaps it had chosen her, or more accurately, it had been chosen for her. Sometimes she felt like a stranger in her own life, like Rip Van Winkle waking up twenty years in the future. She blinked and looked around, wondering, How the hell did I get here?

On paper, the journey was as clear as a road map. Her parents were physicians, hugely successful in their fields of infertility and neonatology. Her father had an endowed chair at Penn. Hector and Joanna Powell were known for their groundbreaking work. Reese was their most successful experiment of all. She had been a test-tube baby, the result of her parents’ in vitro fertilization. She owed her very existence to their efforts and expertise.

It wasn’t anything she thought about too often, but every once in a while it made her feel … different. On the one hand, she knew she had been so desperately wanted that her parents had gone through an amazing medical ordeal to bring her into the world. On the other hand, the idea of having started life in a petri dish was downright strange.

Her parents had sent her to the best schools in the country, financed by their work for other infertile couples. That she would be a doctor was a foregone conclusion. There was never any other decision to be made. After completing her BS in premed, she went straight into the MD program and was now aimed like a straight arrow toward a career in pediatric surgery, the perfect complement to her parents’ practice. A five-year surgical residency followed by two years of peds surgery would bring her into the fold.

Sometimes thinking about the journey ahead gave her a migraine.

Mel came outside, his affable, slightly disheveled presence a welcome interruption. He was a good doctor and a good teacher, and he was happily married, for which she was grateful. No danger of come-ons or late-night gropings in the on-call room, something she’d dealt with far too often in medical school.

“So what did you think of that?” he asked. “Pretty intense, huh?”

“Yes. That team is incredible.” She shook her head. “Poor kid. His life will never be the same.”

“The flight nurse said he’s an Amish kid.”

She frowned, digesting the info as she pictured horse-drawn buggies, bonnets, barefoot children. “No shit. So how did he get mangled by a piece of machinery? I thought the Amish did everything by hand.”

He shrugged. “I guess not everything. But the nurse said some of the neighbors and family made a big stink about the chopper. They didn’t want him to fly. It broke one of their rules.”

“I’m glad the father went ahead and broke the rules, then. Is that why the media showed up?” She gestured at the parking lot. News vans from the local affiliates had already disgorged cables, gear, and primped on-air reporters. This was what was known in the hospital as a “drama trauma”—an unusual and often tragic event that drew the local press and created a storm on social media.

“Probably,” said Mel. “A hospital spokesman will handle it.”

“Good. The last thing the family needs is the local news hounding them.” She glanced through the broad windows into the building. In the ER consultation rooms and waiting area, people huddled in worried clumps or paced the floor. A tall blond man, as upright and still as a tree on a windless day, stood looking outside, his face seemingly carved in stone.

Reese frowned. “Isn’t that the father?”

“Yeah, I think so.”

“Why isn’t he up in surgery?”

Mel shrugged again. “Maybe nobody told him.”

Reese felt a hitch of irritation. A big hospital was a wonder in many ways. But sometimes things slipped through the cracks. “Damn. I’ll go tell him where the surgery waiting area is,” she said.

Mel nodded, and she went back into the building. The boy’s father looked wildly out of place in the high-tech trauma center, with his pinned-on dark clothes and a flat-brimmed hat clutched in his hands. There were smears of blood on his shirt and hands and boots. This man had set aside his principles to save the boy, but clearly at a cost, for he looked miserable.

She felt a well of sympathy for the guy. Thanks to her parents’ profession, the hospital had always been a familiar environment, the place where they worked. For most people, it was an alien world—and not a friendly one.

“Excuse me,” she said. “Are you Jonah Stoltz’s father?”

The man turned. This one didn’t have the big U-shaped beard she associated with Amish men. Blond guys always seemed to look younger than they actually were, and special, somehow, a breed apart. He had the same clear blue eyes as the boy. His mouth was set in a grim line of suppressed fear.

“I’m Caleb Stoltz,” he said in a rich, slow voice. “Jonah’s uncle.”

“My name is Reese Powell.” The guy inspired a welling of sympathy within her, perhaps because he seemed so alone. “Will his parents be coming soon?”

“His parents are dead.” The blunt words fell into the silence between them.

“Oh … I didn’t realize,” she said, the warmth in her throat turning into an ache. She wondered if some awful farm accident had taken them. Were such things common in an Amish community?

“I’m raising Jonah now.” He focused briefly on her name and school embroidered on her lab coat. “Is there news? How is he?”

“Mr. Stoltz,” she said, “has someone given you a report on Jonah’s progress? Has a social worker talked to you?”

“They said he needed surgery. I already signed the papers.”

Hadn’t anyone bothered to explain things to this man? Reese’s irritation returned. “The trauma team stabilized him, and he was taken up to the surgical unit. It’s in a different part of the hospital. If you like, I’ll show you to the waiting area.”

“Yeah,” he said. “Okay. I’ll wait there for as long as necessary.” As he spoke, she noticed two things about him. He maintained a curious stillness in the way he held himself. And when he looked at her, his gaze was rock steady, never wavering.

She walked with him to the elevator. People glanced at him and some did a double take, noting his height, his bloodied clothes, the hat of woven straw he held in his large hand. He was wildly out of place here. But then, maybe it wasn’t such a bad thing to be out of place in an emergency ward.

She pressed the button for the elevator and a moment later the doors cranked open. She thought he might hesitate before stepping inside, but he didn’t. She pushed the fourth-floor button and the car glided upward.

At a loss for words, she cast a surreptitious glance at him. He had put his hand against the wall as if to steady himself, and his gaze focused on the lighted buttons. She knew very little about the Amish, but their clothes were distinctive—flat-front trousers, a plain shirt with rolled-back sleeves, suspenders, a brimmed hat, and work boots.

Reese felt something she didn’t recognize. Surprise, maybe, and a funny warm sense of compassion. He was absolutely striking. He had a face she knew she would never forget, as perfectly made as a sculptor’s masterpiece, with square jaw, high cheekbones, piercing eyes.

He caught her staring, and she felt a flush rise in her cheeks. “My colleague told me you’re Amish.”

“That’s right.”

Amish. What did she know about the Amish? Quilts and bonnets, the Plain people. “Where do you live? Over in Lancaster County?” The area was known for its Amish population. People from the city took weekend trips to poke around the markets and craft shows there, to sample the homemade goods and stay in cozy inns. Reese had never visited. Her spare time was mostly devoted to studying or networking with people her parents thought she should meet. Every once in a blue moon, she found time to go on a date.

She’d read somewhere that a blue moon occurred twice a year.

That was about right.

He shook his head. “Not Lancaster. We live north of here and a little west, in a place called Middle Grove.”

“So, um, the flight nurse said you came in the helicopter,” she ventured. “Was that your first time to fly?”

“It was. The Amish have rules against flying in the air,” he said. “I understand that. But I have rules against a little boy bleeding to death.”

Reese winced at the anguish she heard in his voice. “I’m sure everyone would agree you made the best choice for Jonah.”

“I’m not sure of that at all,” he said, sending her a dour look.

The conversation was going brilliantly, thought Reese. Well, she had better things to do than make small talk with this guy. When the elevator whispered to a stop at the fourth floor, she led him past the nursing station and to the waiting lounge, furnished with green sofas, low tables, hopelessly dog-eared magazines and books. A large monitor displayed coded updates of the ongoing procedures.

“You can have a seat here,” she said. “I’ll let them know at the nursing station that you’re here for Jonah.”

“Okay. Thanks.” He made no move to sit down.

“Well,” she said, backing awkwardly away. “I know they will take excellent care of Jonah. The surgeons here are the best in the country.”

He sent her a curt nod. She couldn’t blame him for being skeptical of such a common platitude. Ask anyone at any hospital, and the likely answer was that this was the best in the country, and the patient was in good hands.

She hurried to the nursing station. The three nurses present were lined up at the counter, all staring drop-jawed at Caleb Stoltz. Under different circumstances, Reese would have laughed at their transparent lust.

“That man is—”

“—grade-A eye candy,” said one of the nurses.

“Mr. Stoltz,” she said, lowering her voice. “Caleb. He’s the uncle and legal guardian of Jonah Stoltz.”

One nurse, whose name tag read ALICE, glanced at a monitor. “The boy is in OR seven.” She gave Reese a dismissive glance. Med students were distinguished by their short white coats and afforded no special privileges.

“So somebody keep him filled in, okay? I found him still waiting around in the ER, lost. Show him how to track his nephew on the big monitor board.”