We quickly clear the waiting room of non-emergent cases. Then we help the nurses move existing patients into the outpatient and ambulatory wings. Anyone who can be admitted, is done so swiftly, and anyone who can be referred to another hospital or clinic, is asked to leave to make room for the trauma cases headed our way.
Within fifteen minutes, everything is cleared out and ready. We worked like a well-oiled machine. And now we all stand here, gowned and gloved in the calm before the storm. We look at each other, knowing full well we will lose patients today. We look at each other knowing some of us may be changed forever by what we’re about to experience.
Gina grabs my hand again. “We’ll get each other through this,” she says. “We always do.”
I walk out to the ambulance bay expecting to hear sirens. But—nothing. I look around at the other residents and attendings who are all standing at the ready. We quietly wait for the shitstorm we know is coming.
The charge nurse pushes out through the double doors, carrying her emergency radio. She shakes her head. “Many of the injuries were fatal,” she says, clearly feeling emotional pain. “They are still pulling people out, but I was just told not to expect more than two dozen or so.”
Faint sirens in the background get louder and overtake the collective gasps and cries of everyone absorbing the nurse’s words.
“Okay, people,” Dr. Manning says, shouting over the sirens and sad murmurs. “We still have twenty-four people who need our help. Let’s not let this tragedy take any more than necessary. Deal with your emotions later.”
Three ambulances pull up one after the other. “Nelson, Jameson, and Stone, you’re with me,” Dr. Neill says, opening the back of the third one.
There is a rush of acrid smell. Burning hair and flesh that even the Vicks can’t mask.
I’ve smelled minor burns before; and in surgery, they sometimes use electrocautery to cut tissue, but it’s nothing like this. It’s not like burnt pork or beef as most people imagine, it’s a charcoal-like smell with a sulfurous odor that has a fog of humanity to it. And because you know it’s human flesh, it’s haunting. The smell is so overwhelming I know it will be burned into my memory forever.
Craig Nelson, a first-year intern, runs to the outer wall of the ambulance bay, bracing himself with his hands as he vomits onto the concrete.
My own stomach turns due to the vile smell, not to mention the horror of what we’re seeing. I can’t even tell if our patient is a man or a woman due to the extensive burns. But as we wheel the gurney through the doors, I can see long hair matted against the shoulder of what I assume is a woman’s body. The other half of her hair is gone, burned off along with much of the skin on her scalp.
The entire left side of her body is charred, her clothes having melted right into her flesh. She’s conscious and in pain, but probably not in excruciating pain. Not from the burns anyway. Her nerve endings are mostly likely deadened.
She reaches up with her good arm and grabs onto me, her eyes filled with fear.
One of the EMTs briefs us on her condition as the charge nurse directs us to an open room. As I listen to the EMT describe her injuries, I once again feel ill. He estimates third-degree burns over seventy percent of her body. He shakes his head at us.
It’s a death sentence.
“What’s her name?” Neill asks.
“I think it’s Rosita,” the EMT says.
Neill looks at the commotion behind us as more critical cases are being wheeled into the ER. People are starting to arrive to look for loved ones. Many are crying, some screaming, patients are yelling out in pain, hospital staff are scrambling about. It’s a scene from a war zone.
He looks at our patient and then at me. “Dr. Stone, Rosita is your patient now.” He pulls me to the side. “I need to be out there helping those who might survive. There is nothing we can do but make her comfortable. Start her on oxygen. Give her morphine and cover the burns with towels soaked in saline. Debridement of the wounds would just cause her unnecessary pain, and an IV would simply lead to more swelling. It’s possible you’ll have to perform a fasciotomy, but we’ll play that by ear. Keep her warm—she’ll feel chilled. And contact family if you can.”
I nod. “Yes, sir.”
He takes Nelson and Jameson with him. Probably to find the next dying victim to assign them to. He closes the door behind him, closing us off from the mayhem beyond.
Rosita is crying, rattling off words in Spanish that I fail to understand.
“Do you speak English, Rosita?”
“Yes.”
“You’ve been badly burned, but we need to see if you have other injuries. Can you tell me where it hurts?”
“Here,” she says, putting her hand over her lower right-side ribs where a large bruise is forming.
“I’ll give you something for the pain. Is there anyone we can call?”
“Sí, my husband, Raul,” she says in a heavy accent muffled by the oxygen mask I put on her. Her voice is hoarse as her throat is most likely swelling from smoke inhalation.
I write down the number she gives me and hand it to the nurse who comes in.
We get busy cutting off what clothing we can so we can get Rosita into a gown. Then I give her morphine to take the edge off her pain.
“See if we can get an ultrasound machine,” I ask Sandra. “And call her husband, please.”
I remove the mask and look down Rosita’s throat. It’s bad, but not bad enough to intubate her yet. She needs to be able to speak to her husband. Once she gets intubated, that’s it, there’s no going back.
I make her as comfortable as I can. She looks down at her burned arm. Then her good arm comes across her body to feel the horribly disfigured left side of her head.
She gasps. “¡Dios mío!” She grabs my hand and looks at me. “How much is burned?”
“Don’t worry about that, Rosita. Let us take care of you.”
She squeezes my hand. “How much, doctor?”
I blow out a deep sigh, trying to keep the awful truth out of my eyes. “Over seventy percent.”
She nods, failing to fight back her tears. “I don’t have much time, especially if my liver is damaged.”
I stare at her, confused. She was working in a garment factory. “Are you a doctor?”
“I was a nurse,” she says, taking a big breath that I know is hard for her. She removes her mask so she can speak more clearly. “Fifteen years ago in Guadalajara, before we came to America. But Raul wanted our child to be born here.” She covers her mouth to muffle her cries. “¡Oh, mi hijo! Julio will be devastated. He is so young.”
I sit with Rosita as she breaks down and comes to terms with what is happening to her. I don’t tell her it will be okay, because she knows it won’t be. I just hold her hand and let her go through all of the emotions.
Sandra finally comes back with the ultrasound machine. “You have to be quick. They need it elsewhere.”
It doesn’t take me long to confirm Rosita’s self-diagnosis. She has a substantial laceration on her liver. She’s right. She doesn’t have much time.
“And her family?” I ask Sandra.
She shakes her head sadly. “I left a message.”
“My Raul is good man. He won’t waste time on phone when at work.” She looks at the clock on the wall. “Two o’clock is his lunchtime. He will call then. He always call me then.” Then she looks around frantically. “¡Mi teléfono!”
“I’m sorry,” I say. “We don’t have your phone, but Sandra told him how to contact us.”
I pull Sandra to the side. “Call him back, have him bring their son, Julio, if he can. She doesn’t have a lot of time. Maybe a few hours at best.”
I make note of the time. It’s 1:50. I pray Raul is a man of his word.
“Doctor,” Rosita calls me back over.
“Dr. Stone,” I tell her, taking her hand in mine. “What can I do for you, Rosita. Anything.”
She must be in a huge amount of pain because of the injury to her liver. I up her morphine, hoping that will help.
“Just sit,” she says. “Back in Guadalajara, I sit with dying patients. Talking helps. You talk.”
Normally, I’d encourage her to talk. In medical school, they taught us it’s good to have terminal patients reflect on their lives. It helps them make the transition. But whenever Rosita speaks, it puts strain on her already swollen airway.
So, I put the oxygen mask back over her mouth and do what she asks. I talk. I tell her about my childhood and some of the antics my brothers and I had shared. She smiles weakly and I know she’s thinking of Julio and how she hopes he will still have a normal childhood despite the fact he’s about to lose a parent.
I tell her about my mom and dad and my nephew, Eli. I even tell her about Elizabeth. I tell her much more than what I shared with Cameron. I’m not sure why. Maybe I just needed to tell someone. Like a confession to a priest.
Rosita pulls down the mask and then grabs my hand. “Don’t wait, doctor. Life is too short for worries about such things. Love will find a way, even if you no want.”
Her breathing becomes more ragged and I check her throat. “Rosita, I may need to intubate you.”
Sandra comes back in the room. “Her husband is on his way.” She looks sadly at Rosita. “I’m sorry, but your husband can’t get in touch with your son. He said something about a field trip.”
Rosita nods. “Sí, Sí. Better this way.” She turns to me. “No tube.”
“But—”
She grabs my hand again, firmer this time. “I know you want to do everything to help. But I tell you—no tube. My Raul come. He is all I need.”
I nod at her, my own throat becoming thick with tears.
“No heroic measure,” she says, looking me square in the eyes. “Do you understand? I cannot put Raul through that.”
“I understand,” I say, making the note in her chart. “You heard that, Sandra, right?”
“Yes, Dr. Stone.”
I watch Rosita try to fix her hair with her good hand. Hair that is matted and singed and only half there. It’s surreal watching people die. Once they accept it’s going to happen, they are only worried about those around them. And Rosita, being a nurse, knew the score immediately.
She knows that even without the laceration on her liver, it won’t take long for the lactic acid building up in her body to cause major cell damage. She knows she’ll go into hypovolemic shock due to reduced blood circulation. She also knows it won’t take long for her organs to start shutting down, starting with her kidneys.
I steal a moment away from her bedside to talk with Sandra. “What’s it like out there?” I ask.
Sandra shakes her head. “It’s better now, but it got really bad for a while. Mostly because we don’t know what to do with all of the friends and family who are demanding answers. There were so many dead at the scene, a coroner went over there to pronounce them. People are scrambling to find their loved ones. And some people are still trapped in the rubble.”
“How many did we get?”
“Two dozen or so, but several of those died en route. We’ve lost a few more since. But the remainder are stable.”
“Children?” I ask. “I heard Dr. Manning say there were children there.”
She nods sadly. “A few.”
Her pager goes off. “Looks like her husband is here,” she says, reading it. “I’ll go get him.”
I walk back over to the bed. “Rosita, Raul is here. Sandra is bringing him back.”
A tear trickles down her cheek and she removes the oxygen mask, taking it completely off her face for what we both know will be the last time.
“Do I look okay?” she asks, trying to pretend she’s not in terrible pain.
I grab her hand. “You look beautiful, Rosita. Raul is a lucky man.”
Through the window, I see Sandra escorting a man to the door. I slip out and tell him what’s going on and what to expect, including his wife’s wishes for us not to use heroic measures.
He starts to break down, chanting something in Spanish as his back meets the wall and then his hands meet his knees.
“Raul,” I say, holding him up as he peers through the window at his dying wife. “You can fall apart later. Rosita needs you now. She needs to say goodbye. You need to say goodbye. I’ll be right there if you need me.”
He straightens up and wipes his tears. Then he takes several deep breaths and walks through the door.
I go into the room with him and stand over in a corner. They both start speaking in their native tongue, but I don’t need to speak Spanish to know they are saying words of love and comfort and sorrow.
Raul climbs onto the bed next to her, on the side with the fewest burns, and he cradles her in his arms. I hear their son’s name several times. I hear him sing to her softly. Then, her breathing becomes labored, and the monitors start to beep.
I quickly shut the monitors down knowing there is no use for them anymore.
As Rosita struggles to take her last breaths, Raul leans down and kisses her. He kisses her as she passes from this world to the next.
When her body goes limp, he screams out in pain, burying his head into her chest. I walk over and put a comforting hand on him. There are simply no words.
I give him a few minutes. He needs this time. I need this time. I’m not even sure I could use my stethoscope with the way my hands are shaking.
Finally, he pulls himself together and lifts his head. “I need to make some calls,” he says.
“There is a family lounge down the main hallway. It should be quiet in there.”
He nods, peeling himself away from his wife. He leans down to give her one last kiss and then he walks out of the room.
I go to the bedside and listen to her heart. Sandra walks in just as I pronounce Rosita dead. Then I sit in the chair and put my head between my legs.
“I’ll finish up in here, Dr. Stone.”
I nod, taking a few deep breaths before heading out to ground zero, where I see that over the past few hours, everything else has been handled. There is nothing left for me to do. Gina sees me from across the room and runs over.
“Manning’s telling the residents to take a break. Re-group. Even go home if we need to. This was a lot to handle.”
I turn away from her, walking and then running to the residents’ lounge where I just barely make it to the bathroom before I wretch into the toilet.
I wipe my face and then use mouthwash to rinse out my mouth. Then I sit down in a chair and breathe.
Gina comes up behind me. She runs her hands down my chest and then walks around and kneels between my legs. She takes my head in her hands.
“It was a tough day,” she says, right before kissing me.
I should want this. This is what we do for each other. This is how we numb the pain. This is how we handle our stress and our grief. So why can’t I kiss her back? Why can’t I do what we’ve always done?
She pulls back, sensing my hesitation. She stands up and holds out her hand. “Come on, Kyle. Let’s find an on-call room. We both need this after what we’ve seen.”
I let her pull me up. Her hands in mine don’t feel right anymore. Her fingers are long and slender, her hands a bit dry from all the washing we do, her nails short and bare.
I find myself needing different hands. Ones that are soft and small. Ones that have pink nails to match a certain pair of pink pajamas.
“I’m sorry, Gina. I can’t do this anymore.”
I break her hold on me and walk out the door of the lounge.
She calls out after me. “Kyle!”
But I keep walking. I walk to the elevators, but when I see they are all up on top floors, I walk to the stairway. Then I walk up the stairs. Then I run up the stairs, taking them two at a time. I race up to floor seven and don’t stop running until I hit the very end of the hallway.
I barge into her room and shut the door behind me.
“Kyle. Oh, my God, what’s wrong?” Elizabeth asks.
I don’t even hesitate before walking over to sit on the edge of her bed. I can’t stop the tears from falling. Painful tears that I held in all afternoon. Sobs bellow out of me as Elizabeth runs a soothing hand down my back.
Small arms come up to embrace me when I start shaking uncontrollably. “Shhh,” she whispers, her hot breath flowing over my ears. “It’s okay, Kyle. It’s okay. Whatever it is, it’ll be okay.”
She consoles me like this for what . . . minutes? Hours? I lose track of time being in her arms. I lose myself in them. And by the time I come around and realize the colossal inappropriateness of the situation, I know—I know for sure this is the only fucking place I ever want to be.