Warning Signs Read online

  “No elevated temp?” Amanda knew heatstroke could cause similar symptoms.

  “Not here.” Lydia raised a questioning eyebrow at Elise, the transport nurse.

  Elise shook her head, her usual calm, commanding expression clouded by the mystery of why the girl had gone downhill so fast. “None at the scene either.”

  Descending paralysis? Amanda had never heard of that—usually paralysis hit one side of the body as in a stroke, or started at the feet and moved up the body as with Guillain-Barré. It didn’t start at the head and work down.

  “Normal temp on scene,” Elise continued. “The sodium is coming down nice and slow, so you can’t blame that. Besides, according to her friends, she had the neuro symptoms before she collapsed. Complained of trouble swallowing, uncontrollable muscle tremors, blurred vision.”

  Amanda pursed her lips and checked the patient’s reflexes. Nothing. Except the girl did have a normal Babinski reflex, which meant her nerve impulses could make it from the brain to the big toe and back again. She appeared to be sleeping, although her respiratory rate was a little slower than normal.

  Amanda stepped back out of Lydia’s way, clutching her stethoscope with uncertainty. If Lydia couldn’t figure it out, what chance did Amanda, a lowly medical student, have? “I think I’d better call my attending.”

  “Already paged,” Elise told her.

  “Drop an NG,” Lydia ordered. A nurse grabbed the nasogastric tube designed to prevent aspiration. “There’s nothing on exam. I can’t find a reason for this girl to be unresponsive.” Lydia glanced at Elise. “Any past medical history? Drug use? Current meds?”

  Elise shook her head. “Friends didn’t know of any. Sorry.” She sounded genuinely regretful that she didn’t have the answers needed to help their patient.

  “We’ll have to wait for a tox screen. What else? Tick paralysis? Botulism? Miller Fisher variant?” Lydia muttered, drumming a reflex hammer against her palm in time with her words. She quickly gained control of the situation, completing a head-to-toe assessment of her patient and ordering repeat labs.

  Elise moved to one side, leafing through her paperwork as if searching for an answer from her records. If the girl on the gurney in front of them hadn’t been so sick, Amanda might have been pleased to see the transport nurse flustered for once.

  Instead, Amanda looked down at their patient and had the sudden image of herself lying there lifeless.

  The door banged open and the neurology attending barged into the room, shattering her reverie: Lucas Stone, the one person she’d been hoping to avoid.

  TWO

  Thursday, 6:52 A.M.

  GINA FREEMAN SHIFTED HER SHOULDERS, shrugging the weight of her bulletproof vest into place. The living room walls spun around her as a sudden urge to run to the bathroom, a need to feel the cool, reassuring, porcelain toilet hugged against her body, jolted through her faster than lightning.

  Jerry’s arms curled around her, pressing his body against hers, and she was able to beat back the panic, ignore the sweat gathering at the small of her back.

  “You don’t have to go,” he told her, planting a kiss along the side of her neck, resting his face against her shoulder-length mass of frizzled ebony curls.

  “I do if I want to finish my residency.” She’d already traded all the shifts she could in order to postpone her EMS rotation.

  All she’d dreamed of for the past two years was the chance to get out on the streets, to see real action. Now she was a third-year emergency medicine resident, finally able to run with the med squads, and the dream had turned to dust.

  Getting shot at during her first time riding with an ambulance crew probably had something to do with that.

  Jerry stiffened. She knew he was thinking of the shooting as well. If he hadn’t given her a Kevlar vest, hadn’t insisted she wear it, she’d be dead.

  Her toes curled with the need to purge the dark memories, these crazy, out-of-control feelings threatening to consume her. She tried to pull free of Jerry’s embrace, but he held her tight.

  “So don’t finish your residency.” His voice caught. “Marry me, Gina. Be Mrs. Jerry Boyle. You don’t have to work, you don’t have to do anything you don’t want to. Stay with me, stay home, safe and sound, have my children, lots of beautiful children who will be as gorgeous as their mother.” He wove his long, pale, slender fingers between her dark ones as if weaving their futures together.

  Gina’s breath snagged in her throat, banishing memories of ambulances and riots and gunfire from her mind. Jerry had asked her before, had done the traditional bended knee, candlelight, roses, and wine last month—despite her parents’ forbidding it. A fact Jerry didn’t know she knew about. A fact that before the shooting would have sent her racing into his arms.

  She’d answered by asking for time. Almost dying had changed everything. She just had no idea what it all meant yet.

  The rest of the world seemed the same, everyone picking up and moving on, cleaning up the mess the riots that overwhelmed the city on July 4 had left in their wake. All Gina had survived was a near miss by a drive-by shooter. A single bullet, that was all. Yet nothing was the same.

  She could fake it during her shifts in the ER, where there were other residents and attendings to take up the slack. But riding in an ambulance …

  “I can’t,” she whispered, her voice torn. “I can’t.”

  Jerry’s sigh vibrated against her body, and he released her. He obviously thought her words were meant for him and his proposal of a happily-ever-after life with a great guy who loved her. She missed his warmth immediately, turned to explain, but then clamped her mouth shut. As she watched him check his gun and holster it, clip his badge onto his belt, and shrug into his suit jacket, sorrow weighed her down.

  Jerry was the hero, a real hero. How could he love her, a coward, a fake, a liar?

  Gina watched helplessly as the thought branded itself into her brain. Then he was gone. And she was alone once more.

  This time when the urge to run and hide in the bathroom struck, she surrendered.

  AMANDA’S RELIEF THAT HELP HAD ARRIVED quickly morphed into dismay when she saw who it was. Dr. Lucas Stone strode into the room, ignoring the flurry of activity and focusing on their patient.

  Lucas was a thin, sandy-haired man who exuded intensity. He also had the most gorgeous blue-gray eyes, eyes that reminded Amanda of the ocean back home after a storm had blown through, gleaming and clear and yet with hidden depths. Not that she’d noticed or anything. In fact, she’d been trying hard to forget everything about Lucas Stone. When they’d first met, it had been a disaster.

  “What are you doing here?” she blurted out without thinking.

  He raised his face enough to meet her gaze from across the bed. “Switched with Campbell.”

  There was a moment of silence before she could force a polite smile, but his attention had already returned to the patient lying between them. Did he even recognize her? Remember who she was?

  Following Lucas into the room was Jim Lazarov, an emergency medicine intern with aspirations of someday evolving into a Neanderthal. Jostling Amanda aside, Jim plowed his way directly through to the head of the bed, where Lydia was preparing to intubate the patient in order to take control of her breathing.

  “Hey, can I tube her?” Jim asked, grabbing the laryngoscope.

  Lucas paused in his exam. “Give me a moment.”

  He was talking to Lydia, but Amanda knew it was her job to bring the attending up to speed. She quickly gave him a report, ending with, “Now she’s lost her gag reflex as well.”

  “And her sats are dropping,” Lydia added, reaching past Jim for a bag-valve mask to force oxygen into the patient. “She’s hypoventilating.”

  Lucas was efficient, quickly completing his examination and stepping back to give Lydia room. Then he glanced at Amanda. “Maybe my student could do the intubation?”

  Wow, maybe he did remember her after all. It wasn’t usual to allow a m
ere medical student to perform an intubation in a patient this ill. But she hung back. Not that Jim Lazarov deserved any consideration from her—he’d given her hell the last time they’d worked together in the ER—but, as odious as he was, he had asked first. “That’s okay.”

  Jim nudged her and said in a voice too low for the attendings to hear, “Yeah, scut-monkeys should be seen and not heard. Don’t try poaching my patients or procedures.”

  So much for altruism. Jim clearly still resented her having been assigned the “better” patients while she was on her ER rotation.

  Nora pushed the door open and stuck her head in, gesturing to Lydia, releasing the sounds of a woman screaming and the clatter of metal on metal into the room.

  “You’ve got things covered here?” Lydia asked Lucas.

  “No problem. Go.” Lucas stood over their patient, arms crossed and one eye squinted, thinking hard.

  Jim leaned forward, ratcheting open the girl’s mouth with a twist of gloved fingers. He began to slide the lighted metal laryngoscope blade over her tongue when Lucas lunged and grabbed the intern’s arm.

  “Stop.” Lucas kept hold of Jim’s arm, his gaze fixed on the monitor. The patient’s heart rate was in the eighties, then as Jim backed away it dropped to the seventies. Her oxygen level remained the same, but her blood pressure, which had gone up a small bit, also dropped.

  “What’s the problem?” Jim demanded, shaking free. “Her heart rate’s dropping. I need to tube her now.” He bent over the patient again, but Lucas swung his arm to barricade the patient.

  “I said stop.” Lucas’s voice was low but intense enough that everyone in the room was now staring at him. “Give her two milligrams of Versed and start a Propofol drip. Now!”

  The nurses jumped to obey him. From the looks they gave him, Amanda had the feeling Lucas didn’t shout orders very often.

  “Why are you putting her under?” Jim argued. “She’s already gorked.”

  Lucas ignored him, surprising them all by squatting down so that his mouth was almost touching the girl’s ear. He whispered something Amanda couldn’t hear. Everyone in the room stopped what they were doing to stare at Lucas, the nurses with curiosity, Jim Lazarov with disdain.

  Amanda edged closer, one hand on the girl, absently stroking her hair as the nurses gave her the sedatives.

  “She’s an athlete; her resting heart rate is probably in the sixties or lower,” Lucas explained.

  “Okay, so technically she’s not bradying down, but why snow her more than she already is?” Jim asked, pinching the flesh of the girl’s upper arm. There was no change in her vital signs. He arched an eyebrow at Lucas, who nodded his consent and allowed the intern to proceed with the intubation.

  “With those drugs on board, you’re going to lose your neuro exam until she wakes up,” Amanda noted as Jim inserted the artificial airway.

  “That’s the problem,” Lucas said, pulling Amanda away, out of earshot of the patient. “She is awake. Probably has been all along.”

  Amanda stumbled and looked over her shoulder at the girl. “You mean, she’s paralyzed but she can see and hear everything?”

  A grimace passed over Lucas’s face. “Yes. Can you imagine?”

  She could. All too well. Being buried alive, unable to communicate with anyone, was a recurrent childhood nightmare. The dreaded “locked-box” syndrome defined Amanda’s greatest fear.

  “Lucas, we have to help her. What are you going to do?”

  “Wish to hell I knew.” His voice was low enough that she was sure she was the only one in the room who heard him. He turned away, his shoulders hunching.

  Amanda stepped forward, pivoting to face him square on. “What did you tell her? Before you put her under?”

  His eyes darkened to a stormy shade of gray as he looked past her to their patient. “I told her everything would be all right. I told her, ‘Don’t be afraid.’ ”

  She could tell from his expression that he didn’t believe his own words.

  THREE

  Thursday, 7:26 A.M.

  LYDIA EMERGED FROM THE RESUSCITATION room and immediately shoved thoughts of her puzzling neuro patient aside. In her short time here at Angels, she’d worked with Lucas Stone enough to know she could trust her patient to him, and right now there were plenty of other patients to focus on. The stocky well-tattooed man throwing punches and kicking at the two police officers and the security guard trying to restrain him was the most obvious.

  Nora circled the quartet at a safe distance, a syringe of Haldol at the ready. Two other men, an EMT and a nursing assistant, jogged down the hall, eager to join the fray.

  Lydia ignored the ruckus. The cops muscled their captive into an exam room where he wouldn’t be a threat to anyone. And from the way his bellowed curses seared the air, it was obvious his lungs and heart were working just fine.

  She wasn’t so sure about the very pale gray-haired woman slumped in a chair in a curtained bed space, her palms pressed against the arms of the chair, fingers curling and uncurling with every breath. A boy, maybe ten or twelve, sat on the exam bed, anxiously watching the woman.

  Lydia grabbed the EMT, a guy named Williams who was working part-time in the ER. He gave her only the briefest of frowns. Most of the EMS guys knew her because she was their new medical director. The fact that she also happened to be involved with Trey Garrison, their district chief, didn’t hurt either. She pulled Williams into the woman’s bed space. The medic scooped the boy from the bed to clear it and turned the monitor and oxygen on while Lydia knelt beside the woman, feeling for her pulse as she patted her hand.

  “Can you tell me what’s wrong?” she asked.

  The woman’s eyes were wide as she struggled to breathe. “Not. Me.” She reached her other hand out to the boy. “Deon.”

  “I’m fine, Gram,” the boy said, a single tear escaping as he grasped her hand. “I only said my stomach hurt so you’d come see the doctor.”

  The woman frowned and sent a stern glance at the boy only to have it deflected as Lydia and the medic hauled her up and onto the gurney. She started to bat their hands away, feebly protesting, then sank back against the head of the bed, greedily sucking in the oxygen Lydia attached to her via a face mask.

  “Room air pulse ox is seventy-eight percent,” Williams said, attaching monitor leads to the woman. “With O2, it’s up to ninety-four percent, respirations sixteen, heart rate eighty-eight, but her blood pressure is only sixty-eight over forty-four.”

  “Get me cardiac enzymes, a CBC, and chemistry panel,” Lydia said, stethoscope in her hand. “Start a liter of saline and get an EKG as well.” She listened to the woman’s chest. Clear, no murmurs, no abnormal heart rhythm. “Do you have any medical problems?”

  The woman nodded, obviously more comfortable with the oxygen. “Blood pressure and diabetes.”

  “Do you take insulin shots or the pills?”

  “Pills.” Before she could say more, the boy, Deon, had opened his knapsack, spilling out several changes of underwear, a rain poncho, clean socks, a well-loved copy of the first Harry Potter book, a tablet and some broken crayons, a plastic bag filled with wipes, shampoo samples, toothpaste and two toothbrushes, and another bag brimming with loose pills and medication samples.

  “Here,” he said, emptying the pill bag into Lydia’s waiting hands. “These are her sugar pills. And these are for her heart. And these”—he pulled out the sample medication, sealed in its plastic bubbles—“are the new ones the clinic gave her last week.”

  He met Lydia’s gaze with an expression that brimmed over with hope, despair, and helplessness, as if he simply didn’t have room to keep any more emotions bottled up inside. She gave him a smile. “Good work, Deon. My name’s Lydia and we’re going to help your grandmother.”

  “Actually,” he said in a whisper, “she’s my great. But we don’t say that.”

  “Okay, her secret’s safe with me.”

  As Lydia examined the pills, Deon efficient
ly repacked his knapsack. She winced at the familiar sight. She and her mother had spent the first twelve years of her life on the streets of L.A. How well she remembered hauling everything important to them in a small bag that seemed all that separated them from total destitution. As long as they had clean underwear and toothbrushes, they weren’t really homeless. Just occasionally without a roof over their heads.

  Better that way, Lydia’s mother, Maria, used to say, making a game of it all, preferring to camp on Venice Beach whenever possible. Stars above, no one to tell you when to turn out the lights, and the ocean was better than any lullaby.

  Of course, in L.A. they never had to worry about snow like folks here in Pittsburgh did. Thank goodness it was still warm out, the city enjoying an Indian summer that felt more like August than October.

  Deon zipped up his bag, slinging it onto his shoulder, and grabbed his great-grandmother’s hand once more as the medic wheeled up the EKG machine. “What’s that?”

  “A machine that’s going to record the electricity in your gram’s heart.”

  Deon watched the ink needles dance across the pink-and-white-checked paper, riveted by the small squiggles they produced.

  “Did you know it takes electricity to keep your heart beating?” Lydia asked as she scrutinized the EKG results. ST elevation and T-wave inversion in the precordial leads. Not good. “Are you having any chest pain?” she asked the woman.

  “No. Never. Just dizzy all the time, past few days. Nothing to worry about.” She frowned at Deon, but her eyes were filled with pride. “Wouldn’t even have come in if he hadn’t said his stomach was paining him so.”

  “I’m glad you did.”

  The admission clerk wheeled her computer to the bedside and hastily registered the woman, Mrs. Emma Grey. Lydia distracted Deon while the medic drew blood and started an IV.

  “What’s wrong with her, Lydia?” Deon asked, his voice tight and high-pitched.

  “It looks like her heart might need a little help.”

  “Don’t listen to her, Deon, I feel better already,” Mrs. Grey protested.