Chapter 1: December 2016

I’ll be somewhere down in Texas if you’re looking for me - drinking in that great wide open ... soaking up the summer breeze, kicking back, and settled in with my family. I’ll be somewhere down in Texas if you’re looking for me. – George Strait

“Ambulance in-bound ETA ten minutes. No trauma code. Ambulance in-bound ETA ten minutes. No trauma code.”

At the words, ‘ambulance in-bound, ‘ from the overhead speaker, Doctor Sarah Evans started out of an exhausted sleep, but almost as quickly relaxed into the large over-stuffed chair in the Emergency Care Center’s staff lounge as she heard the words, ‘no trauma code.’

Her sleep-deprived brain realized she had plenty of time to get ready, since the ER surgical team didn’t need to prep for whatever the para-medics were bringing. If she was lucky it was some woman in labor that she could pretty much hand off to the duty resident and interns.

It was Saturday night, well now it was Sunday morning she realized as she forced one eye open to look at the big white-faced clock on the wall. A horrendous traffic accident had taken up much of her night as the ER surgical team had labored to save three drunken college students who had mixed too much alcohol with a desire to see how fast their compact Toyota could go. It had ended badly for all of them, especially the unbelted teen girl in the back seat. Sarah felt fortunate that the State Patrol would notify the next of kin.

Weekend night shift was a mixed bag. The police would always bring in a few college students who had tried to poison themselves with alcohol. She rarely saw the same students twice – a stomach pump seemed to make an impression on even the most inebriated young person. Then there were the traffic accidents. There were over twenty thousand students at the various centers of higher education in a metropolitan area that contained about two-hundred thousand, which meant that a disproportionate number of the patients that passed through her emergency department were young and careless, reckless or stupid. There was a joke about rednecks which went something like this, ‘What’s a redneck’s last words? ‘Hey Bubba, hold my beer and watch this!’ Well in Tyler the redneck would be replaced by a college student – with the same tragic results.

Ah, to be young again. She was only thirty but at three thirty in the morning, and after hours of frantic surgery, she felt like ninety. Even as deputy chief of the Emergency Care Center she had to pull her weight and that meant she was on rotation once a month for a week of nights.

Widowed at twenty-four and pregnant and in medical school at the David Geffen School of Medicine at UCLA, Sarah kept at it. Her parents lived in Los Angeles and were a godsend of emotional and financial support, and her daily babysitters. Her late husband’s parents lived in San Diego and never got over the loss of their eldest son, and it seemed they blamed her and their child. Not long after the funeral they withdrew from her, and other than a holiday card once a year they showed no interest in their granddaughter. Sarah would also occasionally hear from members of Mike’s SEAL Team but they were deployed a lot, and they had lives of their own.

“Sarah, you functional?” She coaxed her eyes open again to see her chief nurse Emily Anderson. Emily, ‘Em’ to her friends, was five years older and very pretty in an all-American Texas girl sort of way. She was a bit too tall and thin to fit in the Dallas Cowboy Cheerleader category, but the redhead would still turn heads as she went by, even in scrubs. That was just downright unfair, Sarah thought.

Emily ran a tight ship in the Emergency Department when she was on shift, and Sarah was particularly glad they had become friends. When she had come to Tyler two years ago fresh out of an Emergency Medicine Residency in LA, Emily and her husband Greg had all but adopted her and her daughter Amelia. They had made the transition for Sarah from urban ‘left coast’ California to more rural east Texas, go much smoother, and had eased her through the culture shock into a very different lifestyle that Sarah had now came to appreciate, and in fact embrace.

Dressed in light green scrubs, like Sarah, Emily stood in front of her sipping the foul brew that passed for coffee in the wee hours.

“Don’t know how you can drink that stuff,” Sarah mumbled as she began to stir.

“The stuff we drank in Afghanistan was worse...” She watched Sarah tense and quickly apologized, “Sorry.”

“That’s okay Em ... that was a long time ago. Sometimes it seems like it happened to someone else, but I thank God every day that I have Amelia. She’s a treasure.”

Emily considered her coffee for a moment and eventually smiled and said, “You wouldn’t like to trade for my twins would you? Some days I’d probably throw in Greg too!”

“You would not! That man adores you.”

Emily fixed her with a mock-serious face, “Well how about just the twins for Amelia and a player to be named later?”

Sarah got to her feet. “Oh, does that mean you and Greg are working on having a ‘player to be named later?’”

Emily almost spit out her coffee. “Heaven forbid! Having the twins around is the best form of birth control there is. Sorry, the offer of a player to be named later is off the table!”

Sarah laughed at the look on her friend’s face. “So how about an undisclosed amount of cash?”

“Sorry, no cash.”

“Dang, I could really use some right now.”

“Couldn’t we all,” Emily agreed.

“Anyway Em, your girls are twelve now, so I really think the trading deadline has already passed, especially since they’re about to become teens.”

“Oh ... yeah. Well, there goes my bargaining position!” They both laughed.

Still smiling, and trying with only some success to get her short blonde hair back into a ponytail; Sarah turned from the mirror in the break area. “So what have we got inbound?”

Moving instantly to her professional mode, Emily said, “The para-medics called it in ... said twenty-five year old male. He works at Bailey’s Guns downtown. His boss came into the shop because the lights were still on and found him on the floor. That was about forty-five minutes ago.”

“Drugs, alcohol?”

“No sign. He’s running about a 104 degree temp – lots of congestion, maybe pneumonia they think. He’s also pretty dehydrated. They’ve started fluids and ice packs.”

“Good. Who’s on the run tonight?”

“Pat King.”

“Even better, she’s solid.”

“Yeah, the best.”

They walked down the corridor toward the main part of the Emergency Department.

“Any word on the kids we patched together tonight since they went to ICU?” Sarah asked.

“Touch and go for the passenger, but he’s young and will probably pull through. The driver, he’ll be well enough to stand trial for vehicular homicide in a couple of months.”

“Never ends, does it?”

“No, they all think they’ll live forever.”

Sarah’s heart jumped as her mind conjured Mike’s smiling face. He thought he’d live forever too. So had she.

“I’m sorry, what’d you say?” She’d completely missed Emily’s question.

Emily stopped and turned to face her. “I should make you drink some of this so-called coffee if you’re going to zone out on me.”

“Sorry. So?”

“I said, have you got a date for the Hospital Holiday Gala yet?”

Sarah just looked at her friend. “No, as usual I’ll be with you and Greg. He always saves a few dances for me.”

Emily took her elbow. “Let’s see ... you got here two years ago and each year you’ve attended by yourself. Is that ever going to change? I know several members of the staff who would love to be your escort.”

Sarah just shook her head. “No one has asked me yet and some of those interested parties are married!”

“Well besides that...”

“Em, I’m really happy to just go with you and Greg. He’s the best looking man around, especially in a tux, and on top of that he’s interesting, funny, and when necessary can keep the wolves at bay. Come to think of it, he’d make a great husband. Too bad he’s already taken!”

“No slow dances with Greg this year girl!”

They laughed. “Anyway I’m too busy for a man in my life right now.”

“Sounds like too busy ever...”

“Look Em, with Mike, it seemed like love at first sight. We met on a friend’s boat on a beautiful day as we sailed out of San Diego Harbor for a trip up the coast, and from that moment we just were. I don’t know if that will ever happen again or if I even want it to...” Her voice trailed off and the gaiety that had been there moments before evaporated.

Emily hugged her.

“Sorry Em ... just tired.”

After a moment Emily smiled and said, “But if gorgeous Doctor Adams asks, you’d go with him, right?”

Sarah recognized her friend’s attempt to cheer her up and replied, “Guess I’ll just change your name to ‘Emma’ if you insist on matchmaking. You’re as bad as my mother, and I happen to know that Doctor Adams already has a date for the gala.”

“What? How’d that happen without me knowing about it?”

The tension broken, they laughed.

“Anyway, I’d just as soon avoid the whole thing. Standing around all evening in hose and heels isn’t my idea of fun, even with you and the ever-handsome Greg.”

Emily looked at her. “Listen Sarah, when you put on your little black dress and those stiletto FMP’s you’re the envy of most of the women in the place and the lust object of every straight male. It’s a good thing you’re so nice and a mom, because I think a number of those trophy wives, and not-so-trophy wives, would like to do you in!”

“Lust object huh?” Sarah smiled and shook her head trying to get that idea to fit with how she looked and felt at the moment. She desperately needed a shower.

“Yes, and why do you think the CEO drags you around all evening to chat up the wealthy donors? Fortunately his wife is one of your biggest fans.”

“Hey, all I did was to be the first to diagnose her ruptured appendix. One of the interns could have done that!”

“But they didn’t. You did, so now she’s in your corner and won’t allow any crap from the prima donna wives and girlfriends. Or even any of the backbiting staff.”

“Backbiting staff? How could you say such a thing? At a hospital?” She failed to suppress a laugh.

“You know Sarah, with your legs, if you shortened the hem of that little black dress a couple of inches you could probably get those donors to pony up another half mil!”

“Yeah right!”

“And why not? You look like that tennis star who’s in all those ads. What’s her name anyway?”

“Venus Williams?”

Emily let out a snort. “Very funny! No, the Russian one ... Maria something...”

“I do not look like Maria Sharapova!”

Emily pulled out her phone and soon was showing Sarah a photo. “You said your mother’s family was originally from Russia, maybe you’re related.”

“Hardly! And maybe there is some resemblance, but it says she’s six-two and only twenty-eight. I think I’d have to put on a growth spurt and take two years off my age!”

“In heels you’re six-two, easy!”

“I’ve never been easy,” Sarah deadpanned.

Emily just chuckled. “Okay, I give up.”

“You should. That swill you’re drinking is making you nuts!”

“Is that a professional opinion doctor?”

“Yup, with lots of evidence to back it up!”

Sarah looked at the young man on the exam table. He was bare-chested with his lower half covered with a sheet. He had close cropped dark hair, and looked awfully young. There was a pronounced surgical scar down his right shoulder. It looked recent – within the last few months anyway. His skin was hot to the touch and his heart was racing. Her stethoscope told her what she had already suspected - that his labored breathing was due to fluid in his lungs. The paramedics had done a good job getting a line in despite the fact he was dehydrated. She also noted he was very thin. There didn’t appear to be an ounce of fat anywhere. His upper body was well defined though. Swimmer maybe?

“Give me the rundown Pat,” she said to the senior para-medic who was across the exam table from her. Pat King was mid-thirties, and like Emily, a Texas Army National Guard Medical Command Afghan vet. She was dressed in her paramedic uniform – white shirt, dark blue pants, and black shoes. Tonight she was also wearing a dark jacket because of the sudden December chill.

“His driver’s license says he’s James Cavanaugh. He’s twenty-five – and he lives at the address where we picked him up...”

“He lives at the gun shop?”

She smiled. “Well sort of. According to his boss he lives in a room upstairs from the shop.”

“Got it.”

“So about an hour ago the owner, Ed Bailey came back to the store. He’d left for dinner and then to visit his wife - she’s here on the sixth floor. Then he went home and went to bed, but sometime later he got a call from one of his friends. Apparently Ed doesn’t drink but he has a standing offer to a few of his friends that he’ll come get them anywhere, anytime, if they’re too drunk to drive. He was on his way home from dropping someone and as he drove by the store he noticed the lights were still on. He found Mr. Cavanaugh in the shop lying on the floor unresponsive. By the way, Mr. Bailey is in the waiting room if you need to talk to him. He assured me that Cavanaugh’s an employee with health insurance.”

Sarah and Emily exchanged knowing looks. The Emergency department treated people first and it was up to the billing department to sort out the rest.

“Anyway, when he couldn’t arouse Mr. Cavanaugh he called us. We checked him for tracks and any sign of alcohol poisoning, but from his high temp and pulse and dehydration I’m thinking pneumonia, maybe brought on by the flu. Mr. Bailey said Cavanaugh hadn’t complained to him about being sick, but he said Cavanaugh might not have told him anyway. We were damn lucky to get a line in him as dehydrated as he is. I started IV fluids and O-two and we packed him in some ice on our way. In the unit he was in and out, mostly out.”

“Thanks. You guys did a great job as usual. Guess we’ll take it from here.”

“Thanks Doc, always glad to be of service - keeps us from being bored.”