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Prologue
There’s an unconscious man in front of me on the hospital stretcher, and a familiar sickness washing through my stomach. His long messy hair is tied up in a knot on his head, and sinewy muscles rope all over his body, long winding tattoos running down his arms and up his neck. Young. Rail-thin.What’s wrong with you?The notes on my clipboard swim in front of my eyes: airway, breathing, circulation. No obvious signs of trauma. The form says: “found lying on a bench next to Prospect Park.”
Breathe, Kate, breathe. You’re all he’s got.Above the oxygen mask strapped to his face, long dark lashes sweep down his cheeks. Will everything I’ve worked for go down the tubes if I don’t lose this jitteriness that appears every time the doors to the emergency department swing open?
The new nurse, whose name I’ve forgotten, starts attaching him to monitoring. I pull out my stethoscope and listen to his lungs and the thump-thump of his heart. I check his pulse, lift his mask to check his airway and smell his breath for alcohol, and finally add to his notes. The nurse finishes placing the sensors on his chest, and the monitors spring to life. No arrhythmia. His blood pressure is low, but not unreasonably so. He’s either incredibly fit or … I study the wiry muscles again.Okay.
“Sir, can you hear me? Sir?” I say, bending down and touching his hand. I’m sure the paramedic tried this. His tattoos are a blend of script, scenes, and birds that swirl into elaborate patterns.
The nurse glances at me as she moves around the bed.
“What blood tests do you want?” she asks, chin jutting as she checks the canula in his right arm.
Think, Kate. Think.
“Do a full set,” I say, stalling for time, and she frowns.
“I guess he could be hypoglycemic?” She raises her eyebrows.
Of course.Sugar.Diabetes.I grab the glucose meter and test strips. “Yes. Did the EMT find anything in his pockets that might indicate anything about him? Diabetes or allergies? His name? We might be able to contact family.”
“I think they searched him.”
“No other belongings? Nothing at the scene?”
She shakes her head. “We should check him for drugs.”
Jesus. Young guy … unconscious … of course! Where’s my head? “Good idea,” I say. “Let’s take a urine sample.”
I’ve never done this on an unconscious patient before, but she nods as if she understands, and I stare down at his translucent skin.I’m sorry you got an intern.
“How did he get here?” I say. What a stupid question. I wonder how long he’s been unconscious.
She shrugs. “Someone called an ambulance. They couldn’t find anything wrong with him, put an IV in his arm, put him on oxygen because they were concerned about his breathing, and monitored his vital signs. They wondered if he’d been hit by a car, but there’s no bruising.”
I look up as John Harvey sticks his head around the curtain.
“All right in here?” he says.
I purse my lips at him, and he comes through to stand beside me. As an attending physician, he’s bailed me out on more than one occasion, so I give him a quick rundown of where we are and what I’ve done. He nods, bending over the patient.
“Pupils? Reflexes? Breathing pattern?” He leans forward and lifts the guy’s eyelids. “Hmmm. Pinprick pupils,” he says.
And my stomach drops. I didn’t check those, and we’ve covered them time and again. I bite my lip.That’s so basic, Kate!Every day I’m skipping over stuff like this. I nod at him slowly.
But John’s gaze just flicks over the monitor and then scans his body. “Normal stats, no obvious trauma … hmmm.”
He gives a long sigh, like this night has been too long already. “Well, you seem to have followed protocol.” And he’s being generous here, so I open my mouth to protest, but he carries on, “unless this is something unusual or he has an unknown preexisting condition, then I’d guess narcotics of some kind.” He peers over my shoulder at the form. “Prospect Park? Drugs then. Sometimes people bring a bug or tropical disease back from abroad because New York is a travel hub, but given where he was found … He’s stable, is he?”
His eyes flicker over the monitors again.
“So far,” I say.
He nods. “Then follow the drugs angle, give him some naloxone, and let’s see where that gets us.”
I need to do a whole ton of research on drugs along with brushing up on basic protocols.
I open my eyes to a low beeping noise and blink up at round stains on square ceiling tiles.Not my apartment.The bedcovers are bathed in a dim green light. Unmistakably a hospital.Fuck. How did I get here? I was on the street next to the park. As I sit up, the room tips alarmingly, and I grab at the side rail, swallowing down the nausea. Something tugs on my chest, and I look down at pads and wires before ripping them off one by one as an angry beeping starts from the bank of machines by the bed. Examining the catheter going into my arm, I apply pressure and pull it out: I’m very comfortable with how to get things out of my veins.
