Tori Spinelli shifted on the unforgiving metal chair. Too warm under the bright June sun, she squinted into the painfully blue sky above the flag draped coffin. She swallowed the scream that clawed the back of her throat trying to escape as a filmstrip of jerky memories flashed through her head. Her brother's teasing smile as he tossed her a beer from the fridge, his grief at their parents' funeral, the arguments they'd had over his desire to join the police academy--each moment as lifeless as his body.
With slow, precise movements, two members of the honor guard removed the flag from Alex's casket and began to fold it--corner to corner as the red and white stripes blurred before her eyes. Officer after uniformed police officer stiffly saluted her brother's remains before removing a pristine white glove and adding it to the growing pile atop the coffin.
Her heart contracted painfully as the last cop brought his hand to his forehead with an almost mechanical motion as he stared at the mahogany box in front of him. From her vantage point in the front row, she could see how tightly he clenched his jaw and how his eyes shone with unshed tears. Removing his glove, he laid it on the polished wooden surface of the casket, his hand resting there as if he gathered strength from it.
Finally, he pulled back and turned to the honor guard member who held the folded flag. With an economy of motion, the flag changed hands and the officer moved to kneel before her. The pain in his eyes rivaled her own. He opened his mouth to speak, but the only thing she heard was a repetitive electronic beep.
Tori sat up straight in the hospital bed and swung her legs over the side as she fumbled for her pager and shut off the alarm. Three fucking years and she still had this dream regular as clockwork. She wiped angrily at the tears that covered her face and returned the pager to her pocket as she headed to the emergency room. Seven hours into the second half of her double shift and she'd only gotten a forty-five minute nap. She was beat, but she still had three hours to go before she was off for the next two days.
As soon as she rounded the corner by the triage station, Sarah, one of the nurses, handed her a file. "Present for you, Dr. Spinelli. Motorcycle versus guardrail and thorn bush."
A string of slurred curses exploded from exam room two.
Sarah rolled her eyes."Oh yeah."
Tori scanned the intake information as she stepped toward the room. Stable vitals, lacerations, fractured femur and a blood alcohol level twice the legal limit. No surprise there considering the guardrail and thorn bush. Before she could push the door open, the ambulance bay exploded into frantic activity as paramedics rushed a gurney inside.
Shoving the file back at Sarah, she sprinted to meet the paramedics. "What do you have?"
"Seventeen year-old male, BP is one sixty-eight over ninety-two, temperature is one-oh-three point seven, pulse is one thirty-nine and pupils are fixed and dilated. Shallow breath sounds and tachycardia."
"Who called it in?" she asked.
"No clue. He was lying outside The Cell on Division. Couldn't get anyone to tell us anything. I'm guessing ecstasy, though. There were a couple crushed tablets near his body."
As if on cue, the boy's skin flushed a deeper red and his eyes rolled back into his head. His right arm jerked outward, catching her in the abdomen as he began seizing. Flailing around, he caught the IV catheter on the side rail and ripped the needle from his arm. Blood spurted across her pants and lab coat as they wheeled him past the intake desk.
"Exam room three's open," Sarah said, darting in front of them.
Tori nodded at the other woman. "Run a new line. I need a full draw. Run a chem lab, tox screen and liver function."
After the seizure had passed, she helped the paramedics lift the patient to the bed on a three count while the rest of her team scurried to gather the necessary supplies. She disconnected the leads from the ambulance's portable heart monitor and reconnected them to the one in the room. As soon as she'd gotten a steady sinus rhythm, he began gasping. His airway was closing.
She nudged one of the EMTs out the way. "Intubating," she called out. Using the laryngoscope, she cleared the way to slip the endotracheal tube down the patient's throat. This was the third kid this month who'd presented with a suspected ecstasy overdose, and she'd be damned if she'd tell another set of grieving parents that their child had died pointlessly.
As soon as the tube was in, Sarah was at her side to bag him. Holding the mask over his face, she rhythmically pumped oxygen into his lungs. His temperature seemed to shoot up several degrees in as many seconds.
"Where's that line?" Tori shouted. "I need cooled fluids in here. Now!" Grabbing a pair of scissors off the surgical tray, she sliced through his jeans and shirt, stripping the clothing from his body. "Get the cooling blankets too!"
Bodies raced in and out of the room, a blur of varying shades of blue and white. Someone drew blood while two more people entered the fray loaded with IV bags and blankets. The boy started to seize again as the intern tried to find a new vein to replace the IV.
Tori nodded toward the struggling intern as she took the bag from Sarah. "Take over. I need that line now!" She nodded to the intern. "Hold his arm for her. As soon as the line's in, get me a ventilator."
Tinny beeping filled the room and Tori's heart sank like a rock to her stomach. His heart rate was dropping. Rapidly.
"Crash cart! He's flat-lining." She checked the clock. Nine fifteen.
Sarah turned the IV on full and took Tori's place at the bag. Tori shoved the blankets aside and started chest compressions while the intern charged up the paddles.
"Charged to two-hundred," the intern announced. "Clear."
Tori lifted her hands from the boy's body as the electronic pulse was discharged into his heart. She glanced at the monitor. Nothing. Continuing compressions she waited for the defibrillator to recharge.
"Charging to three hundred," the intern said.
As soon as the charge was restored, Tori removed her hands from the patient. "He's still asystole. I need an amp of epinephrine," she called to Andrew, the nurse adjusting the IV drip.
He hurriedly unlocked the cabinet and grabbed the bottle and drew the medicine into the syringe before administering it into the IV tube. The only sound in the room was the whoosh of air as Sarah bagged the patient and the mournful alarm as they watched the monitor, waiting for a blip--anything to show he was responding.
She restarted compressions. "Again!" she said to the intern, who held the paddles loosely in her hands.
The intern upped the defibrillator to four hundred joules and shocked him again.
Arms aching, Tori lost track of how long they'd worked on him. Finally, Sarah laid a hand on her arm.
"It's been forty-five minutes. We're not getting him back."
The nurse was right. There was no chargeable rhythm and there hadn't been for a while. Tori looked at the clock. Her stomach clenched and her hands stilled on his chest.
"Are you going to call it?" Sarah asked.
Tori's arms dropped to her sides. "Time of death ... ten-oh-eight PM." She looked at the boy's lifeless eyes. A complete waste. "Has his family been notified?"
Andrew nodded. "The paramedics left his info at the desk and Deb took care of it. They were on their way in."
"Okay. You guys go on. See if the biker's been taken care of. I'm going to clean him up a little before his parents see him." It was typically the duty of one of the floor nurses, but she wasn't quite ready to face his parents.
"You okay, Dr. Spinelli?" Sarah asked.
"Yeah, I just need a minute."
"If you're sure."
Tori nodded and unscrewed the bag from the trach tube as Sarah and the rest of the team quietly left. Tori moved around the room and turned off the monitors and stopped the IV from dripping before turning her attention to wiping up the excess blood. She couldn't remove his ruined clothing, but she could cover his nearly nude body.
As she adjusted the blankets, her lab coat caught on the remnants of his jeans and a clatter of metal hit the floor. Bending, she scooped up his car keys and a tiny plastic bag. Peering closer, she recognized the three pale green pills. The EMT had been right. Ecstasy. She turned over the bag and saw they were embossed with a four leaf clover.
She knew that symbol--had seen it often enough when her brother was still alive. The ecstasy was compliments of a dealer named Lucky. Rage tightened her grip around the keys until the metal bit into her flesh. Ignoring the pain, she slipped the baggy into her pocket. She was supposed to file a report and turn the drugs over to a cop. She definitely planned on giving it to a cop. It just wouldn't be the uniformed officers that kept an eye on the hospital. Not this time.
Sarah stuck her head in the door. "His parents are here," she murmured.
Tori set the keys down. Stepping into the hallway, she motioned for the family to follow her into an empty exam room.
Sometimes she really hated her job.