Who Illed Jenny Schecter?

Chapter 32 Who Lives, Who Dies

Two doctors, a fourth-year resident who was a woman and a third-year who was a man, sat slouched in their chairs in their rumpled scrubs in the doctor's lounge off the ER of San Francisco General Hospital, watching a re-run of

Grey's Anatomy

. A third doctor, also a resident and a man, slept on the couch, turned with his back to the TV and the room.

It was after 2 a.m. and the hospital had quieted for the night, as it did some nights, not others. The ER had been busy, but not unusually so. The menu had been the usual: several respiratory distress, all predictably of old people; a few broken bones, some flu cases that got more serious than they should have; three different bar fights; the average number of walk-ins. The murder rate around the entire bay region was up slightly, especially in Oakland across the bay, averaging about two murders every three days. There were none in San Francisco this night. So far.

Another young doctor came into the lounge and took a bottle of orange juice from the refrigerator. He uncapped it and took a drink. He looked at the TV. "Which one is this?" he asked.

"The one where Meredith is in the OR, and there's a guy with a bazooka round inside of him. She's got it in her hand. Kyle Chandler's the bomb tech," the male third year said.

"Who's Kyle Chandler again?"

"Coach on

Friday Night Lights

," the woman resident said.

"Right, right."

"And Dr. Bailey's having her baby. George is her birth coach," she said.

The doctor with the bottle of orange juice watched for a moment, then left the room.

"Dammit, we're losing him. Push one of epi," said the third-year.

On the TV screen McDreamy said, "Dammit, we're losing him. Push one of epi."

***

At the ER nurses station a phone rang, and one of the two nurses there picked up. "OR, this is Larkins." She listened. "Got it. Nine minutes out." She hung up and turned to the other nurse. "Three bad ones incoming. Two gunshots and a head trauma. All three airships. Let's scramble everybody."

***

In the ER lounge the female resident said laconically, "O'Malley, stop looking at my va-jay-jay."

On the TV screen Dr. Bailey said, "George?"

George said, "Yes?"

Dr. Bailey said, "Stop looking at my va-jay-jay."

The wall phone rang and the resident reached back without taking her eyes from the TV. "Yeah?" She listened for a moment. "How bad's the head trauma?" She listened. "Okay, get Hopkinson and his team in, stat. We'll take the two gunshots, and stabilize the head trauma until he gets here. What rooms?" She listened, then hung up. "Let's go, guys. Three inbound, first one on the roof in eight minutes. Two sucking chest wound gunshots, one cracked skull."

"Gangbangers?" the third-year asked.

"No. Some kind of domestic, I think. And one gunshot is a cop. Maybe he was trying to break up a spat. Anyway, all three are circling. We could lose all of them. Howard, move your ass." Circling meant circling the drain. She and the third-year hurried out.

Howard, the no-longer-sleeping resident, sat up and rubbed his eyes, watching Meredith Grey hand the mortar round carefully to Kyle Chandler in the

ER

ER. Chandler walked slowly down the hall with the bazooka round in his hands. Grey came out into the hall and watched him walking toward the exit doors. Then the mortar round exploded, killing Chandler and sending Grey down the hall on her back, the blast wave rippling through her hair in slow motion as pieces of who knows what spattered her face.

"Fuck!" Howard murmured. He stood and hurried from the room without turning the TV off.

***

It took the lead paramedic on scene only a minute to look at Shane's head wound, then at Lauren and Gabe's gunshots to validate what he'd already suspected: They all needed a level 1 trauma center, and that meant San Francisco General, the only level 1 in the region. It was 30 miles away by air, by that didn't matter. Flying at 120 knots, it would get there in 15 minutes, and it would take that long to get anywhere else on the ground. They'd already lost half the "Golden Hour." The head trauma looked really bad; that one would go first. The cop was crashing, but he thought she'd probably make it, so she went second. The cops told him the cop shooter was the third one, the other gunshot, wanted for four other murders. The paramedic didn't think the bad guy was going to make it, but fuck it. If the cop shooter was still alive when the third chopper sat down, he'd go to San Francisco General, too. The EMT got on the radio with dispatch and told them that yes, they really did need three airships. Two were already in the air, because the first Napa County sheriff's deputy on scene, who was stationed barely two miles away at the Yountville substation, had confirmed to dispatch that one of the gunshots was a cop, a fellow county sheriff's detective, and they didn't want a one of them dying in the line of duty on their turf. They had to scramble to find a third chopper, but they got one, three minutes behind the first two. When dispatch got that all set up, they started calling, waking up every law enforcement official in Napa Valley above the rank of corporal. Cop and serial murderer perp both shot and both "likely," in police terminology. "Likely" wasn't a good thing. "Likely" meant "circling the drain."

The first medevac chopper touched down on the roof, met by the two residents, two nurses and a tech, all gowned and gloved. The chopper crew helped them transfer Shane's gurney from the chopper to the hospital's rolling gurney. Her head was turned to the right so the wound on the left side faced up. She was intubated, on oxygen, and had a saline IV. A chopper paramedic cupped his hands and shouted in the third-year's ear, "Depressed skull fracture, hit with a baseball bat, left side of her head. Glascow Scale 7, BP125 over 70, pulse thready. She's O-positive, no allergies. No drugs or alcohol on board." He shouted, "Good luck," but they were already wheeling Shane into the building as fast as they could safely go.

The second medevac airship arrived and hovered nearby, waiting for the first chopper to lift off and get out of the way. When it landed it was met by the resident named Howard, another ER doctor, and more nurses and techs. Lauren was also intubated, getting oxygen and plasma. While they got Lauren's gurney off the chopper a paramedic shouted in Howard's ear, "Gunshot, sucking chest wound, right lung, no exit wound, BP's all over and crashing. Broken right wrist and hand, smashed with a baseball bat. She's A-positive, no drugs or alcohol, no allergies. Oh, she's a cop from LA. Better not lose her."

"No shit," Howard said.

As they were getting ready to move Lauren into the building, the paramedic helped Carmen jump down from the chopper. She was covered with blood.

"You hurt?" Howard shouted over the rotor noise.

"No," Carmen yelled back. "It's her blood. I had my hands over the bullet hole, and I was trying to give her CPR."

"Let's go go go!" One of the techs shouted and they hurried inside with Lauren, Carman hanging on to the gurney.

By the time they got Lauren off the roof Shane was already in an operating room where a neurosurgeon was getting ready to remove a piece of her skull to relieve the pressure of her swelling brain. The best they could do was let Carmen peer into a window of the operating room for a moment, but all she could see was a team of blue- and green-gowned blobs gathered around a table. Several of the ghostly blobs wore colorful, humorous caps with cartoon characters. There were tubes, bright lights, trays of medical tools. Monitors showed squiggly lines, but Carmen had no idea what they meant, other than that Shane was still alive. She could tell from the tension of their body language they were working quickly. Efficiently, but quickly. One of them was throwing bloody swabs toward a small metal tray. When he missed, a nurse picked the swab up and put it in. This was no routine appendectomy; nobody laughed, or chatted about their weekend plans or the last episode of

The Bachelor

.

Lauren was in the next operating room, where a similar scene of organized chaos was going on, doctors, nurses and techs in scrubs going in and out, units of blood arriving.

There were three different people at the nurses' station urgently making phone calls, calling staff and administration people, bringing some in and just keeping others up to speed until daylight.

Gabe McCutcheon was in the third OR, and the only difference between that room and the other two was the police officer at the door, although no one expected Gabe to get up and make a break for it. It was just protocol, that's all.

After a minute a nurse led Carmen away to the waiting room and promised to keep her updated. It was quarter to two in the morning.

"Could I get a blanket?" Carmen asked. The air conditioning had gotten through to her, and all she was wearing were thin scrubs. For the first time in what seemed like hours, she realized she was cold. They had taken her blood-spattered clothes because they came from a crime scene. Protocol.

"Sure, honey," the nurse said, and returned in a moment with a blanket that had come straight from the warmer.

"Do you know who the doctor is working on Shane?" Carmen asked.

"That's Dr. Hopkinson. He's our best neurosurgeon. We called him in when the Medevac told us we had a bad one. Your friend is in good hands."

"What about Lauren?"

"The police officer? I didn't know her name. Dirty Harry's got her."

"Dirty Harry?"

"From the movie. Yeah, they call him Harry Callahan because he's so good with gunshot wounds, but his name is actually Manoosh. He's from Pakistan, but he's the best there is. We say, do you feel lucky today? Because if you are, you get Dr. Manoosh."

Carmen nodded and thanked her. She wrapped herself in the warmed blanket and lay down on a sofa in the empty waiting room. She turned her back to the room, and although she had intended to remain awake however long it took, she cried herself to sleep.

She was awakened shortly after 6 a.m. by someone gently shaking her shoulder. She turned over and was startled to see a tall, thin man in blue hospital scrubs leaning over her. He was in his late forties, and had hairy arms. He still had his scrub cap on his head, and his mask dangled down around his chest.

"The nurse says you're the person waiting to hear about Miss, ah, Mc..."

"McCutcheon," Carmen said, rubbing her eyes and sitting up on the sofa.

"Yes, McCutcheon. Shane, that's her first name, is that right? I apologize. I take it you are a relative of hers?"

"I'm her life partner," Carmen lied, knowing full well that if you weren't a relative, spouse or life partner the doctors wouldn't talk to you. Fortunately, they were in San Francisco, where everyone knew about life partners and dealt all the time with gay and lesbian couples, married and unmarried. All you had to do was say the magic words, life partner, and you were in like Flynn in the city by the bay.

"Scoot over," the doctor said. Carmen made way for him and he sat down next to her. She could tell he was tired. He removed the scrub cap from his head and ran his hands through his hair. "I'm Dr. Hopkinson, I'm a neurosurgeon, I was her main surgeon, and I'll be in charge of her case for a while, at least. Unfortunately, I don't have too much to tell you, Miss...?"

"Morales, Carmen Morales. Please, tell me everything."

"Miss Morales. Your partner came through the operation, in terms of her vital functions. She's stable, and I think she's going to stay that way. We lost her once during the night--"

Carmen gasped and her hand flew to her mouth in horror. Dr. Hopkinson gently put his hand on her arm. "It's all right," he said, "we brought her back right away with the paddles. No big thing, happens all the time. She wasn't gone but for maybe twenty, thirty seconds at most. But what I was saying is we don't know yet how she's doing in terms of the brain injury, and it's way too soon to do any testing. She's in a coma. Right now it's a medically induced coma to reduce swelling. But after we stop keeping her in our coma, she might or might not stay in the coma longer. But how long she'll be that way no one can say. A day, a week, a month, no one knows."

"Maybe forever?"

He looked her in the eyes and nodded. "Yes, it's possible. With these kinds of injuries you just can't tell. She might wake up in a two or three days and be perfectly fine, her normal self, except for a world-class headache. Or there could be some damage and loss of functions, although we can't predict in her case which ones. Speech, language, movement, memory, who knows. The chances are very high that she'll have some retrograde amnesia, and won't remember what happened, but for how long before nobody knows. Could be she won't remember just the two or three minutes before she got hurt, or a few hours, or even a few days, but by and large that's not too important as long as she remembers all the important things, like who she is and who you are, and so on.

"In injuries like this, the brain swells, so we cut out a piece of her skull to relieve the pressure. Her skull was fractured, which actually turns out to be a good thing, in a way, because that actually helped relieve the swelling. The bones themselves will eventually knit back together, and that won't be a problem. When the swelling goes down in a day or so, we'll put back the bone we took out to create the gap. Also, to help reduce the swelling, we put her in a special cooling apparatus that significantly lowers her body temperature, so she's in artificial hypothermia. We'll be closely monitoring her for infection, of course, and hemorrhaging and swelling, but by and large those are pretty manageable and I don't anticipate any problems. In a day or two, when the swelling is gone, we'll warm her back up and remove her from the medical coma. Then it's just a guessing game after that. What I want to tell you is, she has a skull fracture and serious concussion, which is certainly serious enough, but I want to immediately also say to you it could have been one hell of a lot worse. Here's what you need to know. Inside the skull the brain is surrounded by three layers of membranes. The outermost one is called the dura. It's where we get the word subdural from, if you've ever heard of a subdural hematoma, which just means bleeding beneath the dura, between the dura membrane and the inner membrane. You with my so far?"

Carmen nodded, but Hopkinson could see the fear in her eyes was still there.

"When the skull fractures, things start to get really serious when the dura is ruptured and bone fragments break through it, and also if and when there's bleeding beneath it, like from a stroke. So here's the good news, and I want you to hold onto this. Shane's dura was not broken, only bruised. That means nothing got into her brain, which is a really good thing. However, there was some bleeding, which is usually what happens in a case like this. Now, what I'm going to tell you sounds a lot worse than it really is. When there's bleeding inside the brain, we sometimes have to drill a hole through the dura to drain the blood out, and that's what we did with Shane. I had to drill a hole and let the blood drain out."

Carmen's face turned pale and he put an arm around her.

"I'm sorry, I know I'm scaring you to death, but I'm actually trying to reassure you. I drill holes in people's heads all the time, and I'm really good at it. Some day a few years from now you guys are going to have a joke about how Shane had a hole in her head. How she just chilled out. You'll laugh. Okay?"

Carmen nodded.

"Good. So what she has is called a traumatic brain injury, we called it a TBI. You hear about them all the time now from car crashes, and also from place like Afghanistan, from those roadside bombs, and those football players whose brains have been traumatized by all those tackles. So you're going to be seeing the initials TBI a lot from now on. Shane's TBI seems to be pretty mild, as far as we can tell right now, and we'll do a lot of testing in the next day or two, but we need to see what happens after she wakes up to make a full assessment of how much damage there might or might not be."

"What kind of odds?" Carmen whispered. The truth was, Dr. Hopkinson had frightened the wits out of her.

He shrugged. "Case like this, I'd say, oh, sixty percent chance she comes out fine, twenty-five percent there's some temporary loss of function, maybe five or ten percent chance of permanent, debilitating long-term damage, and maybe five percent chance of permanent irreversible coma. But look," he said, taking both her hands in his, "I want you to think about the 60 percent chance she'll be good as gold, okay? She needs you to do that, to keep thinking good thoughts, and I need it, too, okay? Can you do that?"

Carmen nodded.

"Good," he said.

"When can I see her?"

"You can look in the window, but that's all today and probably tomorrow. The day after, when the bone is back in place and she's warmed up and off the coma drugs, we'll let you in the room for a few minutes, although you'll be wearing gloves and scrubs and a mask, and so on. We're really serious about the risk of infection. But just as soon as possible, I want you to hold her hand and talk to her; I want her to hear your voice, okay?"

Carmen nodded. "Can she hear me?"

"Nobody knows, but a lot of us in the field think that unconscious people, even in comas, at some level hear what's going on. I believe some do, some don't. There's been some reports by people who wake up from comas, saying they heard everything. If I'm right, then it's important for her to know you are there. If I'm wrong and she doesn't hear, well, there's no harm done. But until I learn otherwise, let's operate on the assumption she can hear you and needs to hear you. You with me?"

Carmen nodded again. "Yes, oh yes, anything. I'll be here every day, all day every day."

"I know you will," he said, "but you have an additional responsibility, which is to take care of yourself, too. Too many relatives and spouses and partners burn themselves out and get exhausted keeping the vigil. You need to go home, get some rest, take a shower, probably make a bunch of telephone calls, right? Nothing's going to happen today and tomorrow, so you need to prepare yourself for when you come back. Understand what I'm saying? It's going to take its toll on you. So you need to be fit and rested and strong. You have to pace yourself. You ever play sports?"

"I was captain of my high school volleyball and basketball teams," Carmen said.

"Okay, so then you know. We don't do sprints, we do marathons where we don't know how long the course is. You're a long-distance runner on my team, now, and we're both on Shane's team. I want Shane's team in top shape and ready to go. But like long-distance runners, we have to pace ourselves."

Carmen gave him a weary smile.

"Go home," he said. "I know it's hard, but get some rest. We'll call you if anything happens, but nothing will. I've got this, okay?" He put his hand under her elbow and helped her to her feet. He took her blanket from her. "Do you live far? Do you have a car here? Do you need a ride? The concierge desk can get you a taxi, if you need it."

"I'll be fine," Carmen said. "Do you know anything about Lauren Hancock?"

"That the police officer? No, I don't know anything except she's still in OR and people are working on her."

"So she's still alive," Carmen whispered. "Thank god."

"Yes. I can tell you this much. She must be fairly stable, because all the panic has stopped and people are just going about their work quietly and calmly. That's always a good sign. But I'll find someone to give you a proper update."