Sophie's Path

“You’ll be just fine,” she assured him, touching his forearm and holding his hand in hers. “I’m right here.” She offered him more comfort and more confidence than he’d thought possible. He realized he was deeply afraid.

He finally managed to get his eye open, and as he looked at her he realized that in some sacred part of him, he’d hoped this was heaven, and that she might be an angel. Yet his slow and beleaguered consciousness affirmed that he was alive. As his eyes focused through swollen and bruised lids, he saw a beautiful stranger with an illuminated smile and dark eyes that promised a universe filled with hope.

“Hello, Jack,” she said with that voice he knew would haunt him for the rest of his life, even if he never saw her again.

She had a heart-shaped face; naturally, being an angel of mercy and saving lives, she would be all heart. She wore a white lab coat over maroon scrubs. Her name tag rested over her right side, heart pocket.

S. Mattuchi. RN.

“Nurse Mattuchi?” Jack mumbled, feeling a jagged pain saw through his head.

“You can call me Sophie. The doctor has ordered more tests for you. I’ve assured him your heart is stellar.” She leaned close.

Jack caught a floral scent in her dark hair as she fluffed his pillow and continued talking.

“Hearts are my specialty,” she continued. “I’m a cardiac surgical nurse, but I help out in the ER when they need me.” She pulled away and added, “I was off duty but came immediately when I got the call about you and your friends.”

Friends?

Suddenly, Jack’s mind was alert and the jumbled pieces of information in his brain fell into place. He moved his sluggish and swollen tongue. “Owen and Aleah?” He reached for Sophie’s forearm and squeezed it anxiously. “Tell me.”

“Owen is just fine. A broken collarbone and a few bruises. Aleah is being examined by the doctor right now, as is the driver of the other car. We were quite worried about you. You were unconscious and I was afraid you’d been blinded.”

“What else— I mean...” He closed his eyes and felt a scratch across his eyeballs as if they were filled with sand. Even the most minute movement was so difficult. “Please. Sophie. What else happened?”

“You have whiplash. No broken bones, but your ankle is sprained. No internal injuries. We’ll keep you overnight for observation. That concussion is dangerous. The neurosurgeon will be down later to check on you and she’ll probably order a CT scan.”

“Neurosurgeon?” Jack’s fear meter leaped to high alert.

“We have to make sure there are no blood clots or other damage. Best to cover our bases. Yours and ours.”

Jack tried to nod and failed. “Good thinking.” He paused for a moment. Words were reluctant to move from his brain to his lips. “Your insurance carrier will commend you for your prudence.”

Her expression was quizzical. “I wasn’t thinking of our liability—I only want what’s best for all our patients.”

“Don’t...take me wrong—” Jack tried to sit up but failed. He slumped back on the pillows. He groaned as he tried to touch his aching head, but when he lifted his arm he saw the IV and several butterfly bandages over a nasty gash in his forearm. A fleeting worry about scarring shot through his mind, but he dismissed it. He’d come razor-close to losing his eyesight. He was thankful that, in all likelihood, he’d walk away from this with some scars on his arm, a badly sprained ankle and a headache.

A beep went off in Sophie’s lab coat pocket. Anxiety distorted her pretty features and suddenly her entire demeanor changed. Her motions were brusque, hurried, but exact as she tore a plastic wrapper away from a disposable hypodermic needle. She dabbed gauze with alcohol and cleaned his IV site, then took the IV line, unhooked it and cleaned both ends of the plastic connections before injecting a vial of medication into his IV. “This will help with the pain,” she said, glancing into the hallway. She turned back to him. “This is your call button if you need anything. I know you must be thirsty, but we can’t let you have anything to eat or drink for a while. If you feel nauseous, you hit that button immediately. Do you understand?”

Jack nodded, disconcerted by her stern tone, and suddenly realized that the soothing melody of her voice had distracted him from what was going on in the rest of the ER. Sophie peered through Jack’s privacy curtain, and he heard what sounded like dozens of people all talking at the same time. Orders were being shouted. Someone was rattling off clipped, terse instructions. Rubber-soled shoes and sneakers pounded against the linoleum floor. Wheels of gurneys wobbled and screeched.

Though it sounded like pandemonium to Jack, an outsider, he knew these were professionals. He believed in this hospital and its very qualified staff. After all, it was only a few months ago, thanks to Katia Stanislaus’s expertise, that he and his company had landed the insurance contract for the Indian Lake Hospital. He’d met with President Emory Wills himself. Jack also knew cardiac surgeon Nate Barzonni personally. He was an excellent surgeon and could have had his pick of positions at Sloan-Kettering in New York, but being the altruistic man he was, Nate chose to divide his work between the Indian reservations up in Michigan and here in Indian Lake.

It eased Jack’s nerves to know that he, Owen and Aleah were in very capable hands.

Still, Jack wanted to talk to somebody who knew what had happened to him and his employees in the fog on Highway 421 tonight. Had he gone off the road? Had he fallen asleep? Was this his fault? What could have caused all this suffering?

Just considering that he could be responsible in the slightest degree was intolerable. Guilt flooded him like a tsunami, taking over his thoughts and causing more agony than his physical pain.

His whole life, he’d tried to do the right thing in every circumstance. From striving to live up to his marine father’s demanding and impossible expectations to taking care of his sister and mother after his father’s death. He chose insurance as a career to help others protect their lives and their possessions. Jack Carter was a guardian.

In the blink of an eye, he had placed the people in his charge in jeopardy.

Now Jack had to face his darkest hour.

Just then, the air was split again with screams of human pain that Jack would never have imagined, even in his worst nightmares. He heard a man, a young man, yelling for help. Then he screamed again with such agony, Jack thought he must be torn in two. Jack wanted to cover his ears, but even if he could have, he knew he would never forget that scream for the rest of his life. It was so terrifying it sounded inhuman.

But above it all, he heard the high-pitched wail of a young girl’s terror that turned his blood to ice.

“That’s Aleah!” Jack growled as tears burned his swollen and bruised eyes.

A voice came over the loudspeaker. “Code Blue. Code Blue. Dr. Barzonni to the ER, stat.”

Sophie glanced back at Jack with pleading eyes as she burst away from his bedside. She flung back the curtain and said, “I want to help you, but I have to go to her.”

Jack reached out his aching arm to Sophie and motioned her away. “Save her, Sophie. Save her.”

CHAPTER THREE

SOPHIE RUSHED AROUND the nurse’s station to the ER bay on the opposite side. Bart Greyson, an RN with a decade of ER experience, had just gone in there with a stainless steel defibrillator cart.

Bart ran the ER with an iron fist and more stamina than the entire staff combined. He could pull over forty-eight hours on duty with only a half dozen, ten-minute catnaps while sitting at his computer. Bart had brains, insight and skill...and a case of Red Bull in his locker. He was a legend at Indian Lake. No one second-guessed Bart or his orders.

“You’re the first of the cardiac team here,” Bart said to Sophie as he shoved a medical chart into her hands.

“Dr. Barzonni is on call?” Sophie asked, never taking her eyes from her patient.

“I just got word he’s upstairs with an emergency surgery. We’ve paged Dr. Caldwell. I left a message at the nurse’s station, as well. I don’t know who will show up,” Bart replied with a huff of exhaustion. He stuck his hands on his hips. “Figures. It’s a full moon. It’s always an asylum here during a full moon.”

Sophie gently lifted Aleah’s eyelid and examined her. “I heard her scream but she’s unconscious,” Sophie observed.

“She was unconscious on arrival and except for that one time, she’s been unresponsive.”

Sophie turned to the defibrillator. “She’s in arrest?”

“No. Arrhythmia. The Code Blue was for the other victim. Dr. Hill had to leave Aleah and see to the John Doe. He was the driver of the other car. The cops are working on getting an ID for us.”

Sophie had worked with Dr. Eric Hill nearly every weekend since she’d begun her ER duties six months ago.

Dr. Hill was five years past his internship and residency at Cook County Hospital in Chicago. He’d told Sophie that in those five years, he felt he’d seen everything emergency medicine could throw at a person. He’d come to Indian Lake for a change of pace. Well, he’d gotten it. Unless there was a major accident like this one, most weekends in the ER were run-of-the-mill household accidents—falls or injuries with tools—and relatively minor illnesses where the patients or their parents didn’t have medical insurance.

Sophie watched Dr. Hill and three nurses work on a tall, overweight man in the next bay. He appeared to be in his late thirties. “He’s hardly got a scratch.”

“Drug overdose. Cops said he had heroin in the car with him and as the paramedics were tending to the three other victims, he shot up.”

“How are they bringing him down?”

“Paramedics gave him naloxone on site. Nasal spray was all they had. They didn’t get to him right away because he didn’t seem injured, just confused. It wasn’t until he dropped to his knees and passed out that they noticed the dilated pupils and white patches on his mouth. Once they got him here, we gave him more naloxone by injection. What a mess.” Bart shook his head but continued to work.

Sophie scanned Aleah’s reed-thin, very still body while two other members of the ER team hurried in to assist. Donna Jessup was one of Sophie’s coworkers on Dr. Caldwell’s team and worked one weekend a month in the ER. With her was Rob Seymore, a lab technician who quickly began drawing blood for the usual tests.

Aleah’s brown hair was matted to her head with glass and blood, much like Jack’s had been. She was still in her street clothes, though her blouse had been cut away and twelve electrodes had been placed on her chest.

“Donna, did you run an EKG yet?” Sophie asked.

“We had another cardiac patient just after these accident patients. It’s been bedlam, but I’m on it. I’m on it.” Donna attached the leads and turned on the EKG machine. She held the printout. “Infarction and atrial fibrillation.”

“A-fib?” Sophie circled the gurney and studied the printout. “Did Dr. Hill order an echocardiogram?”

Rob continued, “Yes. He was in the middle of examining her when the other patient started convulsing. And his heart stopped.”

Sophie flipped the pages of Aleah’s chart as Bart continued.

“Dr. Hill said Aleah’s suffered a blunt chest trauma which is quite obvious from the bruising. He ordered the requisite round of tests.”

“Did he mention cardiac contusion?”

Bart and Donna shook their heads.

“No, but it’s my guess...” Donna winced. “Sorry. It’s not my place to—”

“Don’t apologize.” She held up her hand, though she didn’t take her eyes off the chart. “If she’s ruptured the cardiac chamber or if there’s a disruption of the heart valve that could be the cause of her dysrhythmia.”

Sophie assessed more of Aleah’s condition. Her skin was growing more pale and gray by the second. The bruises on her chest were turning a deep purple. Sophie pressed lightly on Aleah’s ribs. “She’s broken nearly every rib on the right side.”

“Dr. Hill thinks her lung may be punctured,” Bart said. “He ordered thoracentesis.” He began inserting the catheter into Aleah’s chest while Sophie went around to the other side of the bed.

Sophie stuck the earpieces of her stethoscope into her ears and listened to Aleah’s chest. It rattled like a freight train and Aleah’s breathing was labored. She was bleeding internally, but until all the tests were run, they wouldn’t know the extent of the damage.

In the meantime, they had to get her stabilized. Aleah’s chest cavity was filling with blood and fluid, which would be putting pressure on her heart and lungs. Sophie didn’t want to guess how much time they had to prevent respiratory arrest or another—this time deadly—heart attack.

First, she needed do a thorough examination. In a trauma case like this, every nanosecond counted.

Sophie glanced at Bart as he continued to work. “She’s lost a lot of blood. Transfusion?”

“It just came down from upstairs.” He nodded to the stainless steel counter where the IV bag of blood sat. Donna was rushing with her EKG cart out of the bay. “Sophie, can you hook up the plasma for me?”

Immediately, Sophie attached the plasma bag to the IV and regulated the monitor. Then she felt for Aleah’s pulse. It was almost imperceptible it was so weak.

Bart finished with the catheter and Sophie turned to him. “Her chart says that she was born in this hospital. She had coronary artery abnormalities at birth.” She paused as Bart nodded gravely. “I’ll need Dr. Barzonni to confirm, but because of the trauma to the chest wall, blood flow to her heart could be severely diminished.”

As she spoke, she saw Nate Barzonni race into the ER. Dr. Hill quickly gave him the specifics about the addict’s condition. They both hung over the patient, assessing.

Sophie had worked with Nate for over a year now, and she knew his professional moves better than anyone. Though Nate always showed an implacable expression to his staff and the patient, when he raised his left eyebrow even a fraction, it meant he was concerned. If he dipped his chin to his chest, his brain was analyzing input like a computer. The longer his head remained bowed, the more difficult the case. The minute his head snapped up, Nate had made his diagnosis and decisions on how to proceed.

While Nate’s head was still lowered, the attending nurse said, “Blood pressure is ninety over fifty. Pulse is dropping, as well. Fifty. Forty-eight. Doctor, I have no pulse!”

The addict’s heart monitor flatlined. The alarms beeped. Sophie’s head shot up. Most people thought those sounds signaled pandemonium, but to her it meant action. All hands on deck. It was the moment when everyone’s skills, talents and expertise were paramount. They were like fine-tuned mechanics in a precision Swiss watch. Each cog, each spring was essential to the whole. Except they were not marking time as a clock would. They were racing against time. Trying to beat it to save a life.

“Defibrillator!” Nate shouted. He locked eyes with Sophie and nodded abruptly, with almost a jerk.

Sophie turned to Bart. “I’m going with Dr. Barzonni. You got this?”

“Go!” Bart said and continued his efforts to stabilize her.

As Sophie rushed between the beds, her gaze shot across the room. Jack Carter was sitting ramrod straight in the bed, staring at the action around him. His eyes bore into hers. For a fleeting second she thought she could read his mind.

What about Aleah?

Icy chills shot down her spine. She nearly turned and went back, but Nate needed her. The patient did, too. Once in the bay, she sprang into action. She pulled the paddles out of the defibrillator dock and spread them with lubricating gel. She handed the paddles to Nate. Holding her breath, she stood back as he placed one paddle on the left side of the man’s heart. The other he placed to the right over the sternum.

“Clear!” Nate said loudly as the attending nurse and Dr. Hill backed away.

Sophie hit the defibrillator’s button and watched the needle on the monitor jump as the electrical shock was discharged into the dying man.

The patient’s barrel chest heaved. His back arched as it rose off the gurney with the shock and then flopped back down. He remained still. Nate listened to his heart with the stethoscope. He checked the monitor.

Still flatlined.

Dr. Hill’s eyes were filled with defeat. He spun on his heel and rushed over to Aleah.

Sophie knew Dr. Hill was desperate to save all his patients. This loss was going to hit him hard.

“Again!” Nate said and presented the paddles to Sophie for more lubrication gel. He positioned the paddles.

“Clear!”

Sophie’s eyes were wide as she depressed the defibrillator’s button again. The monitor jumped.

This time the man’s body arched only slightly.

“Epinephrine!” Nate barked, holding out his hand for the vial that Sophie knew was the last hope.

Sophie reached over to the stainless steel tray where one of the nurses had already prepared the syringe. She grabbed it and properly placed it in Nate’s hand the way she did with all his surgical instruments. They worked well together. She knew it. And she knew he knew it, too.

Nate jammed the long needle straight into the patient’s heart and depressed the plunger. Sophie watched as the lifesaving serum left the syringe and hopefully did its job.

She checked the monitor.

Flatlined.

She hit the blood pressure machine hoping it would show even the tiniest indication of life.

Nothing.

Nate put his stethoscope to the man’s chest. Sophie knew what he was hoping to find—a blip. An echo. A whisper of life.

Nate straightened. He shook his head.

“I need you in the next bay, Doctor. She’s cardiac contusion I believe, with a history of dysfunctional coronary arteries from birth,” Sophie said to Nate.

“How old?”

“Twenty-one. Punctured lung. We’re doing thoracentesis now. She’s A-fib,” Sophie explained in soft but professional tones as they walked over to where Aleah clung to life.

Sophie struggled not to glance over at Jack, but noticed he was now sitting on the side of his gurney, legs over the side, hands clenched on the edge of the bed. He looked like a man ready to bolt.

His eyes were dark with anger, pain and confusion. She saw his mouth move. She realized that the word he kept saying was “Please.”

Bart handed the catheter over to Dr. Hill. They had now siphoned over a quart of fluid from Aleah’s chest cavity.

“Sophie,” Dr. Hill said. “Take over for me. Bart, get Donna back here.”

Bart bolted from the bay.

Sophie went to work while Dr. Hill and Nate conferred. Nate listened to Aleah’s heart.

Sophie depressed the button on Aleah’s blood pressure machine, which squeezed the cuff on her upper arm. “Ninety-five over sixty.” She looked up at Nate. “She should be improving with the tube in her chest. Not getting worse.”

Sophie needed Nate’s brilliance to take the lead in Aleah’s case. The girl’s lips were turning blue. Sophie took her pulse and then her blood pressure once again to be certain. “She’s dropping.”

Suddenly, the heart monitor flatlined.

“Get me those paddles!” Nate motioned to the defibrillator at the head of the gurney.

Sophie grabbed the paddles, lubricated them and handed them to Nate, who placed them on Aleah’s chest.

Just as she’d done only minutes ago, she pressed the button to send the electrical current into Aleah’s body.

Sophie felt as if she were falling over a rushing waterfall. The sounds in the room, the alarm of the heart monitor, Dr. Hill’s voice and Nate’s commands swam together and created an undecipherable cacophony. Her motions were rote.

Sophie could almost feel Aleah’s soul leaving her body. She glanced above Aleah’s head to see if there were any odd lights in the room. Her grandmother had told her that souls exited the body through the top of the head. Probably an old wives’ tale from Italy. But something was happening here. Sophie could feel it.

Nate shocked Aleah’s body a second time, but to no avail. Again, he called for the injection of epinephrine and Sophie watched as he rammed it into Aleah’s small chest.

Aleah was completely lifeless, but Nate didn’t give up. He placed the paddles again and commanded Sophie to hit the button.

The heart monitor was still flatlined.

They’d lost. Death had won. The monitor’s long, droning alarm was telling her she hadn’t performed her duties correctly.

Dark thoughts filled her mind, putting an acrid taste in her mouth. She couldn’t find the strength to beat them back to their cave.

She felt utterly inadequate. She wished she’d continued with school. She should have become a doctor. Maybe with more knowledge she would have known how to save this young woman. Though she was certain that Aleah’s chances had been worse than the man in the next bay, and he hadn’t made it, either.

Sophie blinked slowly. Time trudged forward as though she was moving through a thick gelatin. She felt weightless and leaden simultaneously. She would have liked to sit right down on the floor and go to sleep.

“Nurse Mattuchi!” Nate shouted.

“Yes, Doctor?” Sophie snapped out of it. Whatever it was.

“Are you okay?” He pulled off his latex gloves.

She looked down at Aleah’s lifeless body. “She...”

“Never had a chance,” Nate said. “I’m surprised she lasted this long. Your assessment was on target. So was Dr. Hill’s. I also think she was anorexic.”

Sophie’s eyes flew to Aleah’s body. She understood what Dr. Barzonni was saying. The improper balance of electrolytes alone, in an anorexic person, was enough to bring on a heart attack. Aleah had a congenital heart condition, anorexia and blunt chest trauma. “I thought she was rather thin. It just didn’t register.”

“This was a massive trauma. She was hit very hard. I’ll get more about it from the cops outside. But with her birth defect and the punctured lung...” He shook his head and put his hand on her shoulder. “You did all you could.”

“I wonder...” she started.

“No,” Nate said and turned to Dr. Hill. “Eric, you and I will have a lot of paperwork. Do you know if either family is here?”

“Just the girl’s,” Bart interrupted. “We’re still searching for the John Doe’s family. He was driving without a wallet or any papers. Maybe the cops have an update.”

“I’ll talk to the police,” Dr. Hill said.

“And I’ll handle Aleah’s family,” Nate volunteered.

“We still have Mr. Carter here overnight,” Dr. Hill said. “Nurse Mattuchi, you’re on duty?”

“Yes, Doctor. I’ll see to him.”

“I want a CT scan. I want no other—” He swallowed hard. “You know what I mean.”

“I do,” she replied, softly feeling a flood of empathy for both these highly trained professionals who had lost not one, but two patients in a matter of minutes.

Sophie checked the clock. It had only been twenty-five minutes since all three victims had been brought in. She’d been assigned to Jack Carter first. She’d spent fifteen of those minutes with him. Then five minutes with Aleah before the John Doe flatlined. In the final five minutes, they’d lost both of them.

Time. Sophie had never taken time for granted. She trained hard and worked hard. She spent time with her family and helped them out whenever she could. But this absurd, needless loss of two lives shocked her to her core. Aleah had only been twenty-one. The man was in his late thirties. They both had a lot of life in front of them. They could do anything they wanted to with their time. Laugh. Love. Try to find happiness and joy...

Odd that Sophie would think of happiness at a time like this, but she did. She felt tears fill her eyes as she covered Aleah’s body, but not her face, with the sheet. Her parents would want to come in to see her. Sophie would meet with them and try to comfort them. She hoped she would find the right words to say. Good words. Or maybe no words. Maybe they would just ask her to go away.