Deep Trauma

“Walk with me, Brighton,” Dr. Jackson barked when Riley showed up at four o’clock in his office, as instructed. The man plucked his glasses off his long face, slipped them into the top pocket of his lab coat, and held the door to the hallway open for her.

“Why not?” Riley replied, as if she had any choice. Once they reached the elevator, she finally asked, “Where are we headed?”

“The state medical board has sent a representative to chat with you, my dear.”

“Wait . . . What about?”

“Dr. Bach is insisting the Williams case was all yours. He says he only got involved after the cardiac arrest. So it’s only natural, you see, that the state needs a little clarification from you.”

“What are you talking about?” Riley stopped dead in her tracks, hands balled into fists in the pockets of her coat. “Everyone working that night will tell you differently.”

“Well, the medical board is interested in talking to you right now, Dr. Brighton,” Jackson said, slamming a finger into the elevator down button.

“Wait a minute.” Riley felt a flush of panic rising in her chest. The floor seemed to fall out from under her. “In that case, shouldn’t I have representation with me?”

“That’s my job, Brighton,” he said coolly, putting a hand on her shoulder and directing her into the elevator.

*     *     *

Three people were sitting in the administrative office when Jackson ushered Riley inside. A white-haired stranger caught her eye first. She would soon learn he was a retired surgeon named Karlson. Then there was the puffy-faced Roger Harrison from personnel. And lastly, Riley’s eyes fell on the hospital’s medical director, and agent of misery, Hilary Stephens. The woman sat at the head of the table, leaning back in her chair, arms firmly crossed over her chest.

“Well, well, well . . .” Dr. Karlson’s eyes gave Riley a once-over. He didn’t bother to so much as stand or introduce himself, choosing simply to slip his business card with two fingers across the glossy tabletop in her direction. “I didn’t realize they were making doctors so pretty these days,” he said.

“Perhaps it’s time for another visit to the optometrist, sir,” Riley said flatly, dropping into an open seat at the table, ignoring his card in front of her. Nothing set her off more than dinosaurs of paternalism, oblivious to their own sense of entitlement and sexist idioms.

“Beautiful and witty. Very good, Dr. Brighton, though I’ll have you know I’ve just recently had an eye exam.” The man chuckled, clearly missing her rebuke.

The interrogation lasted twenty minutes, during which Riley explained how, from her perspective, things had gone the night little Leroy Williams died.

Her intention had been to stick to the facts. To steer clear of any leaps of logic or allegations that might incriminate anyone, especially as she had no proof to back up her suspicions. Not yet anyway. But the events should speak for themselves, she thought, once all the appropriate information has been gathered. To say she trusted City’s legal team was perhaps a stretch, but she knew they were tenacious, and the truth would finally out. It would be clear from the child’s lab results and Bach’s actions that night what had happened. Riley just needed to give the process time. It should be an open-and-shut case of negligence—tragic, but indisputable.

Dr. Karlson was taking notes in longhand on a yellow legal pad. Riley heard her own voice as if it were coming from somewhere outside herself. “Leroy Williams was well known to the ER staff. And some of us working that night—myself and two of the nurses—knew him from the first time he was a patient at the hospital. The night of the fire, the night he’d lost his mother.”

Riley’s mind flashed back to that event the previous year. As she spoke, she tried not to let the words catch in her throat the way they threatened to. When she felt the sting of tears in her eyes, she cautioned herself in just the way her late mentor, Marcel, would have: Dry eyes, Brighton. Dry eyes.

“Leroy suffered from asthma ever since the fire,” Riley went on.  “Most of us in the ER at City General have interacted with him over the past year to manage his breathing difficulties.” Riley sat back in her chair, keeping her hands in her pockets. She knew she should make a better effort at holding eye contact with Karlson, but her focus was elsewhere. “On the night he died, he came in by ambulance from his foster home. I was busy in room sixteen with an overdose patient. I don’t usually work the night shift anymore. I just happened to be covering for a colleague, Dr. Wolf, who had called off sick.”

“When exactly did you become aware the child was in the ER?” Karlson asked, adopting a more serious tone. Harrison and Stephens looked on silently as she provided her detailed testimony, their expressions unreadable.

“Well, I don’t know the exact minute. But the charge nurse, Carrie, came into my treatment area and asked if I could help in room eleven with Leroy. Like me, she was familiar with the kid. She knew how he usually responded to his treatments, and she was concerned he wasn’t recovering appropriately. She said his nurse was afraid he might go into cardiac arrest. So, of course, as soon as I could, I left my patient with one of the residents and ran to room eleven just as the code blue was called. When I entered the treatment area, I could see that the respiratory therapist and Leroy’s nurse, Olivia, were already doing CPR on the little guy.”

“And was there anyone else in the room?” Stephens cut in brusquely. Up until that point, she hadn’t acknowledged Riley outside of providing her with a flat, two-dimensional stare from across the table.

Riley turned her attention to Stephens. This was a question she was ready for.

“Yes, things got hectic once the code was called,” she replied. “But naturally, Dr. Bach and his resident were present, of course.” And she would leave it at that. She would be careful from there on out to answer only direct questions.

Karlson’s brow furrowed. “What happened after that? How were you specifically involved?”

“Well, I immediately set about evaluating the child, checking for a pulse to see if the CPR was effective. Dr. Bach’s resident, Dr. Li, had already intubated Leroy, so I listened to both his lungs to make sure the breathing tube was placed correctly.”

“And was it?”

“It was in the lungs, but it was in a little too deeply.” Riley flinched at having to criticize a trainee’s efforts. She knew how stressful it could be to intubate a six-year-old in an emergency. In fact, it could be challenging enough under controlled circumstances. “It’s easy, if you’re rushed, to put the tube down past the bifurcation and accidentally ventilate only one lung. So I untied the tape securing the tube and pulled it out a few millimeters until I could hear air movement on both sides of the chest, indicating that both lungs were inflating. Then I secured the tube again and asked Carrie to call for a portable chest X-ray to document it was now in the correct position.”

“And what was Dr. Bach doing at this time?” It was Stephens again. But before Riley could answer the question, the woman cut her off. “Why did you feel the need to intervene? Dr. Bach has more experience than you do, doesn’t he? Wasn’t he your program director?”

Riley kept her cool, recognizing she was in the eye of the storm.

“Marcel . . . Dr. Benoit was the director when I was in training . . . before he passed,” Riley said, her voice dropping to almost a whisper. Her eyes darted accusingly to Jackson as she went on. “Dr. Bach was appointed residency director just two years ago.” She ignored the obvious rebuke Stephens had intended and effectively skirted the question about Bach’s competence.

Riley had wanted to say that Tobias Bach had been utterly useless during the child’s cardiac arrest. He’d stood in the corner, watching her and a second-year resident direct the failed resuscitation, offering no input or help. It had almost been as if he were in a stupor. At the time, Riley had even wondered if he had been somehow impaired. Or perhaps he simply had nothing to offer in the way of saving a six-year-old’s life. And in the days that followed, Riley’s suspicions had grown about Bach’s conduct and what had really transpired before she’d entered room 11 that night.

“But the boy only deteriorated after your intervention. Isn’t that correct?”

It was Jackson who spoke now. Riley gave him a long, hard look. Something in her chest tightened as she wondered how he could justify asking such a question. Wasn’t he supposed to be her representative? Hadn’t he said that was what his role would be in the interview?

Of course, she’d known better than to trust Jackass Jackson. Out of sheer curiosity, she had wanted to ask him how he managed to live with himself.

“I wouldn’t say he further deteriorated, Dr. Jackson,” Riley went on, keeping her tone neutral. She knew if Jackson sensed blood in the water, he would go in for the kill. “The child was in grave condition before I got to his bedside. As a team, we continued resuscitation efforts for over an hour, but Leroy’s heart just never responded to any of our interventions.”

“And why do you think that was, Dr. Brighton?” Karlson asked. Just like a surgeon. Riley almost groaned, deducing the man’s former specialty must have been in orthopedics.

“Because he was dead, Dr. Karlson.” She did her best not to sound condescending but fell short. “And unfortunately, we still haven’t figured out how to reverse that condition.” At once, Riley knew she’d crossed a line. But for crying out loud, was Karlson really the best the state had to offer?

The room fell silent then, except for Harrison from personnel. Riley could have sworn she heard him softly snickering behind a closed fist, but she dared not shift her gaze from Karlson.

She stood, pushing her chair back under the conference table calmly. “Now I have an emergency room full of patients to attend to, and my colleagues could no doubt use my help. So I’ll be on my way. I suggest you let me know if you have any further questions after you’ve interviewed everyone else involved. And by everyone, I mean everyone,” she said, directing her gaze coolly toward Jackson. “Including the inexplicably absent Tobias Bach, our esteemed residency director.” She turned to Karlson, softening her tone slightly. “I recommend starting with the nurses, sir. They’re generally the most truthful.”

She was halfway to the elevator when she realized what she’d done. Her heart was threatening to jump straight out of her chest as she altered her course and slipped instead through the doorway to the stairwell. She expected Jackson to be on her heels, demanding she return to the interview immediately, but she knew he probably couldn’t take the stairs two at a time as she observed herself now doing.