The Match

By Ann Dominguez

Medical student Kate Deming isn’t sure her marriage will survive till graduation. She hasn’t seen her husband or daughters in days, and her reclusive sister has stopped answering her calls. The turf war between the gangs and the mafia has made this Chicago’s deadliest winter on record, and every case that rolls into the emergency department is worse than the last. Kate recognizes the danger in her supervisor’s smile, but he’s so hot she may just take him up on it anyway. When the CEO of the hospital dies in front of her, Kate reaches out to his widow. But the murdered man is not what he seemed, and Kate’s own sister is trapped in his web of lies. Will Kate be able to extricate her sister before the killer comes back to finish what he started?

• Language: English
• Publisher: Ann Dominguez
• Release date: Nov 10, 2015
• ISBN: 9781311150929

Ann Dominguez

Ann Dominguez lives in Colorado with her husband and children. Her writing has appeared in JAMA and Medical Economics. She was a contributor to Let Us Keep the Feast, published by Doulos Press. Online, her work can be found at The Well, Venn Magazine, and HuffPost, and http://anndominguezbooks.wordpress.com.When she’s not writing, parenting or doctoring, she enjoys reading and running. She hopes someday to finish a cup of tea before it gets cold.

Book preview

The Match

by Ann Dominguez

Copyright © 2015 Ann Dominguez

Smashwords edition

Cover design by JT Lindroos

Cover photograph by Matthew Nichols

To Sam, always

One

Tuesday night I made my fourth appearance in the emergency department. I arrived in my obligatory green scrubs, tired Nikes, ponytail, and bags under my eyes. Emergency Medicine was my destiny, and I had just told the residency committee I couldn’t imagine doing anything else with my life. Apparently that was only true on Thursdays. Tonight I could think of a hundred other things I’d rather be doing.

Just get through tonight, I told myself, you can do anything for one night. This had been my strategy through two labors as well—sixty seconds, just sixty seconds, I can do anything for sixty seconds. Probably it didn’t hold true for extremes, like holding onto a frozen glacier with one hand, or talking to my sister without starting an argument. But ten hours in the ED I ought to be able to do.

So, I said to my third patient. How long has this vaginal discharge been bothering you?

About four months. She texted with the pads of her thumbs—or maybe she was snapping a selfie—and chewed neon green gum in the side of her mouth.

And why did you come in tonight?

She glared at me. "Because of the discharge."

"But why was it an emergency tonight?" Why now, at eleven o’clock, in the snow, was this discharge you’d had for four months, suddenly so urgent? Behind me Dr. Sprague coughed softly. I took a breath and fixed my face in neutral.

Cause my man just told me he was doin’ the nasty with the ho down the street.

Oh. Yeah, I could see how that would change things.

When I finished the pelvic exam, Mindy and I walked out of the room. Dr. Mindy Sprague, my medical school advisor, was my favorite attending to work with. Granted, this was only my fourth shift. Thick green discharge, I said. Friable cervix. But no fever.

Cervical motion tenderness?

No. Or yes, but she was too busy texting to tell me that it hurt.

You’re just jealous, Mindy said, putting orders for STI testing into the computer.

Or she’s come in for the same complaint one too many times. But Mindy was right. I wouldn’t have been so cranky if I hadn’t lost my phone in a bucket of biohazard trash the night before.

Half an hour later, the lab confirmed gonorrhea with a PCR test, and I sent the patient back out into the storm with two antibiotics and a bag of condoms. After that, things slowed down. Maybe the snow was picking up and everyone in his right mind settled in under the covers to go to sleep—where I should have been. When I taught high school, a night like this would have been heaven. Dan and I would make lazy love in front of the fire, then fall asleep with the windows open just a crack. Actually, he’d fall asleep. I’d lie there listening to the stillness and hoping the next day would be a snow day. I felt sad for a moment, thinking of Dan alone in our bed. I’m not sure if I felt sorry for him or for myself.

What’s on your mind? Mindy asked.

I bit back a sigh. Just thinking of my husband.

How’s he holding up? You’ve had a tough schedule.

Yeah. I had already finished the harder rotations, with three months in emergency departments at other hospitals, a month each in the adult and pediatric intensive care units, and a surgical elective. But the rest of the year should be easier. After February in the ED, I had a two-week vacation, and then the Match, when every graduating medical student in the country would find out where he or she was going to do residency. I would have almost a month off between graduation and residency, and we had plans to take a long road trip to camp in a bunch of national parks. Or move four hundred miles to Minneapolis. Then July first, I’d begin four more years of these crazy hours. I had doubts our stamina would hold out. Dan was a good sport about it, but he was getting tired of being the do-everything parent. I was just tired.

Have you put your Match list in yet?

No.

Can’t decide?

I managed a smile. We just haven’t had time to talk about it. That and the fact that deep down, I wasn’t sure I wanted to go anywhere for residency.

Mindy pulled two clipboards off the rack and glanced at both. Do you want to come in on the shooting with me, or see the injured toddler?

Toddler. No hesitation there. Mindy handed me the clipboard with a smile. I struggled to read the chief complaint on the form, which was as crowded as my grandma’s basement. Ebony ivory? I read.

She laughed. Your guess is as good as mine. If I’m still in eight, feel free to staff it with Jack. He should be here any minute. Jack Fischer was the residency director and a favorite with many of the medical students. Somehow I had never met him, but we were sure to meet tonight. Mindy waved to the policeman outside eight, and I knocked on the drywall next to the sliding door of room four.

Come in, a woman said. The child at her side started to wail. The woman’s make-up had smudged into shadows around her eyes, and her hair was frizzy on top from her hat.

Hello, I’m Kate Deming, a medical student. I held out my hand. She gestured with the parka toward her son. I’d like to ask you a few questions and examine you, and then I’ll come back with my supervising physician. Is that all right?

No! No! No! The boy, clad in Spiderman pajamas, moved behind his mother.

It was an accident, I swear. She spoke so quickly, I could tell she didn’t hear I was a student. Her son wouldn’t care if I were a student or a quack. Either way he wasn’t going to want me to touch him.

What happened? I sat down on the rolling stool and tried to look non-threatening.

She fought back tears and kneaded his parka on her lap as she tried to tell the story. It’s Will. She reached for him, but he dodged her hand. His sister—she’s eight—was refusing to go into class—

Will, invisible from his hiding place behind the exam table, stopped screaming long enough to mutter, Bad Alexa Marie.

Somewhere inside me, I felt a little sorry for plain Will, when his sister was Alexa Marie. Then he started yelling again, and I stopped feeling sorry for him.

See, her purple pants weren’t clean. They’re the only ones she ever wants to wear. And I said she had to wear the gray ones instead. But they’re corduroy, and she hates them.

Ugly pants, Invisible Will said.

But I wouldn’t let her wear a skirt, because it’s so cold, and she… Her voice trailed off as she fought a sob.

And Will?

Yes. She wiped her nose on her sleeve and looked fleetingly to see if Will had seen her. I was so focused on trying to get her into school—the late bell had already rang... is it rung, or rang? So we were late, and Will wanted to play on the playground, but I had to get Alexa Marie in... so I was pulling him by his hand—not hard, I promise—

I knew exactly what she was saying. We lived through a similar scene at our house two or three days a week with my daughters Genie and Molly. Will’s mother broke down in sobs again. Will emerged from the danger zone of outlets and cords behind the gurney to pat her arm with his chubby hand. His left arm hung straight at his side. The abrupt silence echoed off the green tile.

Was it his left arm? I rolled slowly toward Will, hoping not to unplug the noise dam.

I think so. She patted her pockets looking for a Kleenex. He just dropped like a stone and put all his weight on it.

I handed her a box of tissues. He probably dislocated his elbow. The confidence in my voice startled me.

How did he do that? She looked at me with big eyes.

When he dropped his weight on the arm you were holding up.

Her eyes filled with tears. She hugged him, moving his arm and restarting the howling. Oh, I’m so sorry, so sorry. Her words picked up speed. Mommy’s so sorry.

I can fix it right now. Our own family doctor had shown me how to pop Genie’s elbow back into position when she was three. Will’s mom looked at me as if she didn’t understand my words. Maybe she thought it was broken and would need a cast for six weeks. More likely, she was waiting for me to call the police for child abuse. This happened to my daughter all the time when she was little. It usually goes right back into place. I moved toward her son. She looked at my scrubs and, as if they equaled a medical degree, turned so that I had better access to his arm. Lucky for me, his Spiderman pajama shirt had short sleeves.

Will, I’m Doctor Kate, and I’m going to look at your fingers. Okay? He sniffled but didn’t scream, which I took as progress. I held his hand steady and wiggled each of his fingers in turn, to show him that I wasn’t going to hurt him. He watched me closely from under dark brows while I told Will’s mom about a tantrum Genie had thrown over mashed potatoes. No laugh, but she stopped sniffling. I touched all the bones in Will’s wrist without moving it. Is that okay? Speaking without any inflection, as if trying not to scare off a small animal, I explained how the three bones in the elbow weren’t full length yet and that the quick yank on Will’s arm had slipped them apart. I told her I was going to move the bones back into alignment by flexing it rapidly. I hoped Will wouldn’t know what flex, alignment, or rapid meant, so he wouldn’t panic. He’s not going to want to move it even when I’m done, because moving it is what hurts. Right, Will?

Will made a muffled mmm-hmm into his mom’s lap, but he didn’t pull away from me.

So when I finish, I went on, I’ll have you sit here for a bit, and in half an hour, it’ll be all better. I knew I had to explain it all before I popped it back into place, or Will’s screaming afterwards would drown out all my talking.

Little by little, I worked my fingers up the two bones in his forearm toward the offending elbow. None of the bones bothered him. He resisted for a second when I got to his elbow, but I moved my fingers across his skin in a deliberate line, murmuring to him about how it was all going to be all right. At last I had extended his straight arm out in front of him.

Okay, Mom, you sing his favorite song.

Will’s mom sang, Twinkle, twinkle little star.

Will didn’t join in, but his eyes went to her instead of me. With my left hand on his elbow, I swung his arm into tight flexion and felt the satisfying pop under my thumb. Will wailed, glaring at me for my treachery.

Oh, Will. Will’s mother cried into his hair.

That’s it.

It’s fixed?

I’m pretty sure.

His hair was sweaty and his skin slick from all the crying. He’d sleep well tonight. I rolled back from them and took the clipboard from the gurney. It would take a good twenty minutes before Will would forget about the injury and use the arm, but I was sure I had felt the bones slip back into position. Then I realized I had just done the whole history and exam without talking to Mindy or Jack, breaking medical student rule number one.

Will continued to cry, but he had to work to keep it up, the breaths between sobs lasting longer. I nodded to his mom and gave her a smile. It’s okay not to wash the purple pants. I’ll be back in a few minutes.

Outside the curtain, I looked around to see if anyone was watching. I could see Mindy Sprague through the open door of room eight, but another doctor—probably Jack Fischer—leaned casually against the counter. The tips of his nose and ears glowed red, his hair shone wet as if he’d just come inside. Well done. He turned his back to the curtain that hid Will and his mother.

I set the clipboard on the counter next to him. Sorry, I got so involved in her story—I knew just what it was—I forgot to come out... He smelled terrific. Like leather.

We usually X-ray them before we reduce them. But he was smiling.

Of course.

Just because they came to the ED, he said. People who come to the ED expect X-rays.

Right.

Did you get the pop?

Yes.

So we’ll X-ray it now and prove that it’s back in place, and then we’ll give him a popsicle.

And what do I get? I asked, expecting suspension or a lecture.

Usually we save the popsicles for the patients. One of his blond eyebrows went up.

I meant, do I get my wrist slapped for not precepting it with you?

If you’re into that. He had a beautiful smile.

My mouth went dry. I’m Kate Deming.

Jack Fischer.

His handshake was warm and strong, and he held my hand a moment too long. Jack took the clipboard from the counter and ordered the X-ray for Will. I can’t wait till we switch to a full electronic system, he said under his breath. When we sat down, he took a sip of coffee from a travel mug. My first thought was to wonder what sort of invisible flesh-eating bacteria was growing on it. My second thought was that my husband would have a fit if he saw the coffee next to the computer.

Didn’t you interview here? he asked. I think I saw your name on a list.

I did.

Why didn’t we meet?

I shook my head. I don’t know. I met with Dr. Dennis and Dr. Rao.

You’re not quite the typical med student.

That’s true.

What’s your story?

I didn’t know I wanted to be a doctor until I’d tried teaching high school.

Let me guess—you taught... English.

Chemistry.

That makes sense. He nodded, one finger absently rubbing the cleft in his chin.

The tech wheeled Will, on his mom’s lap, out of their room toward radiology. Like a grocery cart, the gurney had a wheel that wouldn’t cooperate, and the tech swore under his breath.

You were great with them, Jack said.

Thanks. I wished he would go on.

He did. You must have kids. You disarmed him completely before you examined him. Excellent. His eyes went from my left hand, to my face, and down my scrubs. My skin prickled. Bang—like a tornado warning with alarm bells—I saw Jack’s Fischer’s puppy-under-the-Christmas-tree smile.  And he was looking at me like I was lunch. I started to feel warm all over, even in places that didn’t usually get cold.

I had to be mistaken. It had been years since someone looked at me like that.  Was Mindy behind me? I turned around to see who he was looking at.  The only thing behind me was a crash cart in front of room two. Uh—thanks.

How's the ED so far? He sat back in his chair, and it squeaked a little rhythm.

Fine.

Jack's eyes left my face for a moment, and I managed to take a breath.  What was wrong with me?  It felt like ninth grade when Todd Karwicki talked to me in the cafeteria line.

The squawk of a two-way radio sounded from the clerk’s desk, and Jack went still. If he’d been a cat, his ears would have swiveled toward the noise. I couldn’t hear what was said on the radio, but the ED started to hum with action: techs clearing the curtains away from the doors to trauma bay one, nurses checking the carts in the room. Jack Fischer stood up and wiped his hands on his scrub pants. Without looking up Miss Washington said from the desk, Trauma alert, ETA two minutes. Feeling mechanically for his stethoscope, Jack nodded his head toward the trauma bay. I was suddenly very aware of the pulse in his brachial artery as he pushed the chair away.

Where’s Mindy? he asked her.

Still in eight.

Jack nodded. C'mon, Kate Deming. This’ll be great experience for you.

I followed him toward the trauma bay, and we stood on the far side, away from the ambulance doors. I felt weak and wondered if I would ever get used to this. Don’t let it be bad, I thought, though that was ridiculous. Of course it would be bad.

What d’you think? Jack asked one of the nurses.

Probably another MVA, she said. You?

My money’s on a shooting. The turf war between organized crime and the Bloods is getting bad.

She shook her head. That would be the second one this week.

Third, Jack said, fingering his stethoscope.

The EMTs coasted through the open doors with the gurney. It bounced several times under its cargo’s weight, as if it needed new shocks. They turned it smoothly into the first bay, and the ED team swept in after them like vultures. These people lived on trauma. Maybe emergency medicine wasn’t the right field for me.

Sixty-three-year old male with multiple gunshot wounds to the chest. Glasgow three at the scene.

I tried to remember whether Glasgow three meant just unconscious, or nearly dead. They rattled off his blood pressure, other vitals, and the medications they had given him at the scene. The paramedic at the head of the bed swore as they transferred the patient to the ED bed. The patient’s silk pajama shirt was open, revealing his sternum and the EKG leads the paramedics had put on in the field. His skin was hairless, and his chest rocked unevenly with ragged breathing. Bill, the charge nurse, dismissed the paramedics with a nod and began to cut away the victim’s other clothing. I didn’t know where to stand. Everyone else had their routine down, and I was like a mouse at a catfight. Jack put his plastic safety goggles on and morphed into his trauma-doctor self, calmly giving orders and performing his exam.

Airway, breathing, circulation, I repeated to myself. Take your own pulse first.

Jack moved to the head of the bed. Bill, you do meds. Kate, come here. Get a blood gas.

A nurse who smelled like cigarettes put a blood pressure cuff on the patient’s right arm. Jack positioned me at the left wrist, and someone handed me an ABG kit. I fumbled into the sterile gloves and tried to concentrate.

The man’s palm had a hole through it, and his hand was covered with black powder, like spray paint. His fourth finger showed a wide band of paler flesh that was clearly missing its ring. I put my finger on his wrist and took a look at his face.  He looked vaguely familiar to me, and I was sure I would figure out in a minute whom he resembled. First, however, I concentrated on breathing through my nose and trying not to be sick. It wasn’t the sight of the blood—that, I was finally used to. It was the smell—an unquestionable odor of dying. Not finished death, like anatomy lab, but still-working-on-it death. Poop and blood and something fresh, like sewage. My hands felt clammy, and my fingers slid around inside the vinyl gloves. I was hot and cold at once.

Shit, Bill said.  It's Frank Oberholzer.

Frank Oberholzer.  The name, too, sounded familiar.

The nurse who had bet on the MVA over a shooting asked, The head of hospital admin? She sounded a little nasty, like she might stop what she was doing if the answer was yes.

Do you know another Frank Oberholzer?

Bastard, Chris said. The efficient sound of teamwork stopped for a second while everyone contemplated what was happening.

Asystole. We all perked up at that. Frank Oberholzer's heart had stopped, and not in one of the pleasanter ways. I focused on finding the artery, which had become ten times more difficult when his heart had stopped pumping blood through it.  Bill hopped up on the gurney next to Frank to start chest compressions.  Frank’s girth didn’t leave a lot of room for Bill’s knees. At least now I had a pulse, albeit an artificial one, to put my needle into. A spout of purple blood popped into my syringe. Too dark to be arterial.

What’s on the chest? Jack asked. We may have tamponade.

Three bullet holes here. Bill sounded almost cheerful.

That would explain the tamponade.

I had never seen a gunshot wound to the chest, but I knew that if the sack around the heart filled with blood, the pressure would stop the heartbeat pretty quickly. I tried to keep my eyes from looking at his chest.  Alas, Bill was on the opposite side from me, so I had a clear view.  The holes had clean edges until Bill compressed, and then a dark, purple squirt came right at my face.  I closed my eyes just in time, but I could taste the salt of Frank Oberholzer's blood on my lips.

Crap, Jack said.

I wiped my mouth on my sleeve. I’m all right.

Kate, go wash!

I'm okay, I blathered. I was wondering which would be the less conspicuous course of action—to vomit or faint. A rush of wind sounded in my ears.

GO WASH! No million-dollar smile on Jack’s face now.  He was deadly serious. I turned from Oberholzer’s body, still alive only because of the bag forcing air into his lungs and Bill's chest compressions.

Chris, Jack said, send that sample for the needle stick protocol.

Mindy Sprague, smelling of Altoids, put her hand on my clean shoulder when I turned.  She took the art kit from my hands and handed it to Chris before diving into the Code.

Two

The Student Lounge lurked in the basement at the furthest possible edge of the hospital. Even the morgue was closer to the patient-care areas, which was reasonable, really. Why should they have to wheel all the bodies through half a mile of hallway, when the med students could walk? And the morgue workers probably had a union.

I jogged as fast as my lungs would let me, my squeaky footsteps echoing in the empty corridors as I passed the ubiquitous framed Impressionist prints on the walls. I fumbled with my ID to open the door and ran into the locker room. If I had been thinking, I would have washed my face in the ED before streaking down the halls in the dead of night—but I wasn’t thinking.

I jumped in the shower without waiting for it to get hot. Wishing I had some antibacterial scrub, I used the all-in-one shampoo-conditioner the last bather had left in the shower. I have Code blood in my mouth! But it’s the CEO of the hospital. He can’t have anything too bad. Dr. Fischer sounded really mad. But he remembered my name. Who would shoot the CEO of the hospital? I never noticed before he was so fat—I guess he was so tall, I always thought of him as muscular. But lying on the gurney, he definitely looked fat. He had the biggest hands I’ve ever seen. How did anyone get such big hands? How big did his ring and his gloves, have to be? And why do dying people poop—what a waste of energy when you’re trying to stay alive. Dr. Fischer has great hands. How long can I stay in the shower before I have to go back? Will the hot water hold out for four more hours until my shift ends? My mouth was full of a dead man’s blood, while my head was full of Jack Fischer. Why did he look at me like that? Dan hadn’t ever looked at me like that. Wouldn’t have washing my face taken care of the blood on my mouth?

Suddenly, I had the feeling of something contagious growing in my mouth. I doubted even Chicago water had enough chlorine in it to kill what might have been in his blood. What if lead had seeped into his blood from the bullets and was going to give me lead poisoning? I wanted mouthwash, peroxide, or stomach acid to wash it out. I thought of brushing my teeth, but what if my gums started bleeding? Then whatever he had would shoot straight into my bloodstream. Having neither mouthwash nor peroxide, I washed my mouth out with the all-in-one shampoo.

The water had run clear down the drain for a long time when I turned off the shower and hurried over to the cart that held the stiff towels. My socks and undies were still relatively clean, so those went back on, but my bra strap had blood on it. I couldn’t quite visualize how that had happened until I turned the scrub shirt over in my hands. The blood made a stellate pattern on it like a Pollack painting, and the right side of the collar was nearly black with blood. Probably from when I wiped my mouth on it. Could I put bloody scrubs in the machine, or did they have to go into a special laundry? Without old scrubs to feed into the machine, though, I wouldn’t be able to get new ones. I threw my bra in the trash and shivered over to the scrub machine to trade my dirties in for cleans. Stuffing my dirty scrubs into the secured drop box, I requested a small top and medium pants. The machine beeped twice and dispensed an XL top and XXL bottoms.

* * * *

Everything was quiet, too quiet, in the ED. The curtain to trauma bay one was closed, and the light was off. Bad news for Frank Oberholzer. I couldn’t see Jack Fischer. He was probably with Mrs. Oberholzer, breaking the news. Not a job I’d want. Then I remembered that wanting his job someday was exactly why I was here.

A phone rang, and the spell broke. The ED began to recover its normal busy buzz. Chris, the angry nurse, refilled the code cart outside the trauma bay, and Mindy was talking quietly to one of the surgery residents at the workstation. I pulled a chair up next to her and sat down. The smell of her last cigarette lingered under the aroma of her mint. Mindy turned to me. Are you okay?

I nodded.

Did it go in your eyes, or just your mouth?

Mouth and nose, I think. Swallowing the bad taste in my mouth, I wondered if I had put enough soap in my nose. Do they know who attacked him?

She shook her head. A break-in, somebody said. Not that he wasn’t asking for it, but it’s awful.

I hoped nobody ever felt that way about me.

I don’t mean that exactly. Mindy shivered. He was just such a bastard. So much for not speaking ill of the dead. I think it’s easier when you don’t know the patients.

Yeah. I rubbed my eyes, still stinging from the shampoo. That’s why I couldn’t do internal medicine or family practice.

Didn’t you rotate through Medicine first? she asked.

I nodded. "Yeah, but I couldn’t stand the continuity of it. We spent all this time with people, and I found myself liking them. Then it turned out they had some awful cancer or secret drug addiction, and I was crushed. It was the same as teaching. I could see what was coming, but I had no way to stop it."

She held the mint between her yellowed teeth for a moment before crushing it. People do the damnedest things to themselves.

Exactly. I had a wonderful husband and two daughters. I didn’t need someone else to go and break my heart. I thought of Frank Oberholzer, who’d had the bad luck—bad