Lost Things

By Ann Dominguez

Dr. Kate Deming is now an emergency medicine intern at a busy Chicago hospital. Between the drug epidemic and the staff shortages, tensions in the emergency department are high. Kate befriends a homeless veteran who lives in her alley, but she can't tell which of the voices he hears are real. When he disappears from the ED during a treatment, Kate tries to enlist the police and his family in the search for him, which jeopardizes her job, her marriage, and even her life. (Book two of the Kate Deming Suspense)

• Language: English
• Publisher: Ann Dominguez
• Release date: Jan 10, 2018
• ISBN: 9780997029727

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

ONE

Walking through the metal detector into the emergency department Saturday night, I could tell it would be a terrible shift. What’s that screaming? I asked the security guard.

Cranker in the hallway. Welcome to the zoo.

Why isn’t he in a psych room?

Psych rooms are full.

The status board had bloomed from one to three screens, and patients waited in various states of pain and agitation in the hallways. Everyone looked up at me hopefully, or angrily, as my rubber shoes squeaked past on the waxed floor. I tried not to meet any of their desperate eyes. I reached the main desk. Where is everybody? I asked.

Dr. Rao is at the back station, Miss Washington said, barely looking up from her Bible, Dr. Smith is covering twenty-six to fifty, and Dr. Fischer’s in trauma three with an overdose.

I’d happily work with Dr. Rao or Fischer, but Dr. Smith was to be avoided. What about all the residents?

She didn’t have time to answer me. Two swearing paramedics bounced out of trauma room three with their gurney, its sheet askew and soiled. I squeezed past them and the curtain into the room, where the regular beeping of the cardiac monitor served as metronome for a scene as carefully choreographed as a dance or military operation. After only four and half months of residency, I knew my part well. I positioned myself where Jack Fischer could see me and waited for him to tell me where to step in.

Kate, he said immediately, motioning me over to the head of the patient, check her pupils. Paramedics said they gave seven migs of naloxone in the field, but we still have apnea.

Naloxone meant the patient had overdosed on heroin, or another opiate. Peggy handed me a pair of blue nitrile gloves from the box on the wall, and I slipped my hands into them before lifting an eyelid. The green eye, its iris enormous, stared up as blind as if it were glass. Two millimeter pupil. I checked the right one to make sure and then pulled my stethoscope from around my neck and set the bell on her abdomen. One of the earpieces had fallen off since yesterday, and the cold metal stabbed my ear. I bit back my curse and listened for bowel sounds under the hum of the team’s work. Carl’s foot tapped a rhythm to a song only he could hear, but it kept the forced breaths he gave with the ambu bag steady. I could hear the patient’s slow heartbeat and the hiss of the artificial breaths, but her bowels were as quiet as an empty room. No bowel sounds. What’s her sugar?

Peggy read from the paramedic’s report. Seventy-four.

Was she found down? I asked. Do we have a CK?

Good thinking, Jack said. We don’t know how long she was down before they found her. Mike, get a CK please.

Where was—

Fifty-seventh Street station. She had a ticket for the ten-twenty from downtown in her hand.

I’d come in at midnight, and it was barely twelve-ten now. If she’d been on that train, she must have been down for at least an hour. Too long, but not long enough to cause the muscle breakdown of rhabdomyolysis. Do we know who she is? Any family?

Wedding ring here, Mike said. He tightened a blue tourniquet on the patient’s left arm and uncapped a needle.

The stretch marks on her belly looked like mine. How many children were waiting at home for this mom?

Another dose, one mig this time. Jack said.

Peggy flicked the orange cap off another vial and drew the liquid into the syringe.

Do we know if she’s pregnant? I asked. She looked old and haggard to me, but I wasn’t sure if that was real, or the heroin.

And a pregnancy test, Jack said to Mike.

That can go on the red tube with the acetaminophen level, Mike said, pulling the green-top vacuum tube off the needle and sliding the IV catheter over it into the patient’s vein. He connected it to a bag of lactated ringer’s and dialed the rate fast enough to keep the vein open in case her other vein blew with the pressure of the naloxone boluses.

I didn’t see any needle tracks, which made me think the patient preferred prescription drugs over heroin. I looked at her belly again, but if she was pregnant I couldn’t tell. Like that meant anything. If she is pregnant, won’t the naloxone—

My first patient is the mom, Jack said, unusually tense.

She shuddered with a spontaneous breath then, and we all froze to see if she’d do it again. She did. Come on, Mike said, slapping labels onto the tubes of blood and heading out toward the desk. I stole a glance at the monitor to see the patient’s name. Jane Doe. Wondering how many members of the Doe family we’d see tonight, I indulged for a minute the anger that bubbled up inside me against a mom who would sneak off to a train station to do drugs while her children slept.

Another stuttering breath made Carl lift the mask an inch from her face. Her oxygenation was good at ninety-four percent. Peggy handed Carl a non-rebreather mask and turned the oxygen to ten liters. We counted to five-Mississippi, and she breathed again. What’s our goal? Jack asked me.

Twelve breaths a minute, oxygen ninety percent or above. Titrate to ventilation, not mental status.

Good. Jack scanned the monitor again, where lines of red, blue and white indicated Jane Doe’s heart rate, breathing, and oxygen saturation. Her blood pressure, in red, was eighty-four over fifty. Where would you start her infusion?

What did she get, between the paramedics and here? I asked.

Peggy added up the doses. Twelve milligrams.

Start the infusion at eight mig per hour. Please.

Peggy typed it into the computer as a verbal order.

The patient’s respiratory rate had climbed to fourteen. Not great, but it would do. Jack gave me a nod as he left the room, and I began my secondary survey. I found the fresh bump on the back of her head, but since her pupils started to react to my light, I didn’t think the bump was too serious. No step-offs on her neck, lungs clear, no obvious abdominal trauma. She didn’t have any skin or debris under her fingernails, or scars on her arms or legs. No tattoos we could use to identify her, to a family or a gang. No jewelry apart from her wedding ring, although a circular rash on her wrist told me where her watch usually sat, and that her skin was sensitive to nickel.

Peggy had already put in the standard narcotic overdose orders, so I typed my electronic signature onto them and thanked her. What else do you want? I asked.

New shoes and Dr. Smith to take a vacation, she said, which drew a laugh out of Carl.

I’ll see what I can do, I said, badging out of the computer and walking back out to the nurses’ station.

She’s not pregnant, Jack said from the desk. CK is normal, and there’s no Tylenol in her system.

Small mercies, I said. What a crappy way to begin a Saturday night shift. I wondered how long it would take us to identify her. Would her husband call, asking if we had a blond woman with startling green eyes who might have overdosed at a train station? Or had she managed to hide her addiction from her family, who wouldn’t know where to start searching for her, and no one would know who she was until she woke up and realized what she’d done?

I went to the desk, where Jack was running a hand through his hair and blinking hard against fatigue. What a waste, I said. Her poor kids.

How is it any different from alcohol, except that beer is legal?

I didn’t have an answer for that.

The police said to expect some crazies tonight, he said. There’s a bad batch of a synthetic out there. Swedish is already full of it.

Which hospital is closest to Swedish?

Depends on the traffic. Miss Washington, I’ll be in room nine if you need me.

I still had my blue gloves on. My hands were hot and sweaty. I threw the gloves in the trash and began to wash my hands when Lorraine came around the corner. Muttering, she glanced in my direction. Her curly hair was wilder than usual, and her bloodshot eyes scanned the room in distress.

Are you okay? I asked. She’d been edgy and tearful all week.

I lost my wedding ring. She bit her lip, but the tears brimmed over anyway.

Where did you take it off? I wiped my chapped hands and looked around for some lotion to stop the burning.

It went down the drain in room six.

Oh. Really lost. Is there a patient in there now?

I don’t know…

Room six was empty, waiting to be cleaned. The sink and the foot pedals to control the water were shiny stainless steel, but the plumbing was old fashioned PVC pipe under the basin. Sure enough, the little grate that should have covered the drain was missing. I turned on my phone’s flashlight and shone its white beam down the hole. Alas, no ring. I grabbed a pair of gloves and a vomit bag. Can you hold the bag under here while I unscrew this?

She knelt next to me and tried not to cry. Where did you learn how to do this?

I grunted, fighting to unscrew the plastic coupling. You can find a tutorial for anything on YouTube. Plus, I’ve seen my husband do it enough times… I should’ve been able to pull it off. Would this be grosser than a bunch of food stuck in the kitchen drain? Lorraine moved the plastic bag back and forth under my hands as I struggled to loosen the nut. I really hoped I didn’t have to remove more than the trap. Did you take your ring off? I asked.

She shook her head. I’ve lost so much weight that it slips off.

You should wear it on a chain or something. As if she hadn’t thought of that already. Or leave it at home. Or I should shut up. Other than the ring, I ventured carefully, are you doing okay? You seem a little… What was I going to say? Upset barely touched it.

After a pause she said, Kate, can I ask you a question?

Sure.

When you and Jack— The first coupling nut came loose suddenly, and my elbow rammed her side. Oof!

Sorry. I started on the second one and held my breath, hoping she wasn’t going to ask me about Jack again.

Like the proverbial devil, Jack’s voice sounded behind us, chuckling. What’s going on in here?

Lorraine stifled a sob.

Just a little basic plumbing, I said.

Should I call Plant Management? he offered.

Not yet. The second coupling nut came more easily than the first, and I pulled the trap off with a promising rattle. A trickle of water dripped into the blue plastic bag and the ring, followed by what might have once been a cotton ball, slid into my gloved palm with a smell of vomit.

Oh, thank you. Lorraine’s voice was barely more than a whisper.

You’re welcome, I said. I’ve got it from here. Don’t need the bag anymore. Lorraine stood up, and I heard the trash can shut with a clap. She squeezed past Jack in the doorway without saying anything. I might have imagined it, but he looked sad. It took me a minute to reconnect the pipes, but when I finished he was still standing there waiting for me.

You’re full of surprises, he said.

Hopefully you won’t be saying the same thing when there’s water all over the floor in here. I washed my hands, conscious of my own wedding ring, and studied the plumbing with a wary eye. I pressed the foot pedal and watched two minutes of water swirl down the drain without a leak on the floor. Can I ask you a question? As I said the words, I heard Lorraine’s voice asking me the same thing five minutes earlier. She hadn’t finished her question.

Of course.

If Henry can’t get into the liver service here—

Henry, your private patient? We walked back to the desk. Lorraine was gone.

Henry Shulski, I said, trying to sound professional.

I didn’t see him on the census tonight.

He’s not here, at least I don’t think he is. I was just thinking.

This is what you do when you’re not working? Think about Henry?

Can I finish my question? If the liver service here won’t see him, what are his chances at the VA?

I always forget he’s a vet.

Vietnam.

Jack rubbed his chin, his thoughts far away. I don’t know. They have to take him, but nobody’s going to give him a liver transplant until he quits drinking.

Who needs a transplant? Kim Martinez asked.

Kate’s personal patient, Jack said, his eyes twinkling. When you’re done signing out, go into room nineteen and then find me after.

I’m not signing out, she said. It’s about Dequan.

What about him? I looked around, but he wasn’t in sight.

What happened to your ear? It’s bleeding.

It wasn’t much. I held a paper towel on it while we talked. My stethoscope is missing an earpiece.

I have a spare in my locker, Kim said. I’ll grab one for you. Small or medium?

Either, thanks. What’s up with Dequan?

Oh, his grandmother’s in the ICU. He needs a few shifts covered.

I sighed. My husband Dan would be as excited about that as a root canal. I pulled out my phone and looked at the calendar. I can cover Thursday if he’s on then.

Great, thanks. I can take Wednesday, and Luis can cover tomorrow. She was already writing the email on her phone.

Room nineteen contained a high school student with blue hair who had lost a bristlebot in her vagina. What’s a bristlebot? I asked, trying to sound open-minded.

Her boyfriend pushed his bangs off his forehead. It’s a tiny vibrational robot. We made them in physics class yesterday.

The girl looked as eager about it as he did. You cut the head off a toothbrush and attach a button battery to it.

I was beginning to understand. I tried to disguise a laugh by coughing in my sleeve and cleared my throat. Do you take any medications?

Absolutely not. And I only eat organic.

Do you have any allergies?

Strawberries give me a rash.

I hope it was a new toothbrush, I said.

Of course.

Their nurse, Tamika, came back with me and set up a cart with a small speculum, ring forceps, and a glob of exam jelly. Watch, she whispered to me, they’ll post a photo of it on Instagram when you’re done.

Explaining the pelvic exam, I slid on my gloves and rolled my chair to the end of the gurney.

Is this going to hurt? the girl asked.

Maybe a little, I said. But it should be quick.

The two junior physicists held hands while I slid the speculum in place. I must have hit the bristlebot, because its vibration traveled up the speculum into my hand. I almost dropped the speculum. As I eased the metal lips into place around the cervix and locked them with my thumb, the toy jiggled around inside the speculum, making a humming sound. Tamika slapped the ring forceps onto my palm. I extracted the miniature vibrator and set it on the metal stand, where it chattered in irregular circles. The button battery sat exposed on top. I did a second inspection internally for chemical burns as I withdrew my instrument, but the tissue looked healthy.

Did you want to keep this? Tamika asked the girl.

No, thanks, she said. I can make another one. The boy pulled out his phone, though, and snapped a photo before Tamika could dump it in the trash.

An hour later the deluge of hallucinating kids arrived, one of them already having convulsions Dr. Rao couldn’t stop. The nurses flowed back and forth as regularly as pendula, fetching sedatives and clear bags of IV fluids. My patient cowered on his bed, trying to avoid the demon trying to get him. The friend who had brought him in sat, stoned and snoring, next to the gurney. When I woke him up to ask my questions, he left. I turned to my patient, whose glance ricocheted around the room like a cue ball. What did you take, exactly? I asked again.

He glared at me. Who wants to know?

I do, Jeffrey. I’m Dr. Deming, and you’re in the emergency department. I’m trying to help you.

You won’t let them get me? he asked in a stage whisper.

No, I won’t.

He said it was White Lightning. Oh, God! He flopped back on the gurney and gripped the rails. Can’t you turn the lights off?

The last thing I wanted was to be alone in the dark with him. As soon as we’re done, I can. I’d like to listen to your heart. Grateful for Kim’s replacement earpiece, I put my stethoscope in my ears and leaned toward him. Normally I closed my eyes to listen for murmurs, but tense for any violence on his part, I kept them open. His breathing whistled by so quickly I could barely hear it. His heart pounded at almost one hundred-sixty beats a minute.

They’ve been watching me all night. His hands covered his eyes, and he started to sob. Oh, make it stop!

He flinched when I put my hand on his arm. What’s going on? Tell me.

The bleeding—make it stop! I’m going to die.

No blood anywhere that I could see. In fact, aside from his terror and tachycardia, he looked as healthy as any of my former students. He suddenly sat up and vomited more than a quart of what had once been pizza and beer onto the bed between his legs. I stepped back in time to dodge the splatters.

Feel better? I asked.

Shit! They’re coming!

You’re safe here. Let me find someone to clean this up. I turned his lights off but left the curtain open, in case his paranoia made him do anything crazy.

Before I made it to the desk, room twenty-three exploded with shouting. The medical student stumbled out backward, tripping on his own feet, and I heard the Mayo stand clatter to the floor. Another shriek followed, and the curtain came down around Dr. Rao. The patient jumped on top of him, and I scrambled for the panic button under the desk. I knew the whole point of the panic button was its silence, but that mattered only if it worked. Ours did nothing. No flood of security officers came from the main hospital or outside. There was no siren and no flashing lights, though maybe I didn’t know where to look. I ran around the corner, where a cop sat dozing outside the room with the jail clearance patient. Help, I said. We need you—

He struggled to his feet, said something to his partner, sitting next to the incarcerated patient, and hurried behind me to where Dr. Rao’s patient had gone berserk.

Get off me! someone shouted, and Dr. Rao crashed to the floor again with a smack that made me wince. He extricated himself with difficulty from the curtain and turned back toward the patient. Carl hustled down the hall and dove into the room. From where I stood, it looked like a cross between a Code and a bar brawl. Above me, several patient alarms beeped and chimed. I picked up the phone to call for hospital security.

My patient streaked past me, his IV pole clattering behind until it caught on the desk, toppled, and stopped. His IV ripped out of his arm, and he turned around, shouting unintelligible nonsense. No one had picked up the phone in Security. I hit speaker in hopes that when they did answer, they would hear the chaos and come to help. Jeffrey, I said, putting the headset down and walking slowly toward him, it’s all right.

He crouched with his arms out, blood dripping from his left hand onto the linoleum, and his eyes widened at me.

Let me help you get back to your room. You’re bleeding. He was wound tight as a spring, and I stood very still not to frighten him further.

With a loud cry, he lunged at me. I had barely enough time to dive around the desk. Jeffrey got his hands on my shoulders and shook me hard enough to smack my ponytail on the floor. His bloodshot eyes stared unblinking as I yelled for help, and the veins in his neck bulged.

Stop it! Stop! Heart pounding, I wedged a knee up to increase the distance between us. Even drug-wasted and dehydrated, he had twenty pounds on me, and I couldn’t budge him. Stop it!

He put his hands around my throat. Demon! You demon!

I managed to grab his wrists, though the blood on his left made my grip precarious. I didn’t have the leverage to pull them off my neck, but I wasn’t in danger of suffocating. Help!

I saw a flash of green, and then Jeffrey flew off me. Jack had picked him up and swung him around, prone, on the floor. I fought the urge to cry and sat up, my head spinning. Jack had a knee in the patient’s back and his hands in a tight grip. Looking back over his shoulder at me, Jack asked, Is that your blood or his?

His, I think. Both my neck and my palm were sticky with it. If I hadn’t been so dizzy, I would have run to the sink. My breath came loud and harsh, and a wave of adrenaline-induced heat flooded me, too late to do any good. The damp of the cellar in which my sister and I had been trapped six months ago came back to me, and I kept my eyes open, trying to convince my panicking mind that I was in familiar surroundings. Thank you. Thank you so much.

He waved off my gratitude. Where are the police? Damned broken panic button. They have to fix that. The security guards arrived with a slapping of heavy soles. About time, Jack said. They bent down to pick Jeffrey up, but the patient managed a last, vicious kick that sent Jack stumbling back toward me. I broke his fall as best I could, but he still hit the desk with enough force to rattle us both.

None of that, the guard said, twisting the patient’s wrist hard behind him. Which room was he in?

Twenty-one. I pointed with a shaking hand. Jack looked sideways at me but made no effort to get up. Behind us, the shouting in Dr. Rao’s room abated for a second. What happened in there?

Jack shook his head. They were too close to Taser him, so he smashed everyone and everyone in sight. Stupid kids. A muscle in his jaw pulsed. I tried not to stare. Are you ready to stand up?

I couldn’t believe he couldn’t hear my heart pounding like the patient was still after me. Either I was really out of shape, or I was really rattled. Or it was the Jack effect, which I had sworn off last spring. Is it time to go home yet?

It’s only three, but who’s counting? He stood and held a hand out to me. I came up too quickly and stumbled, and Jack held me for a minute till I could open my eyes without feeling the room spin. I tried to ignore how great he smelled. He grabbed a roller chair and settled me in it. Don’t move. I would rather have stayed in his arms.

I watched the commotion in room twenty-three. The curtain lay in a heap on the floor. The patient had begun shouting again and straining against his leather restraints, and the policeman held his head. Dr. Rao held a gloved hand to his own head. Jack stood with the other officer, who nodded and went to the phone. Jack shouted at the clerk to get the head of hospital security on the phone. In room twenty-one, the two hospital guards who had come from the lobby held my patient on his gurney and talked over his head as if he couldn’t hear them. Jeffrey moaned and sobbed on the bed.

I listened to Jack’s tirade to security with half an ear. I don’t care about the budget shortfall, he said. Your job is to keep my staff safe. His voice dropped then, and I struggled out of my chair to wash my hands and neck. My scrubs were bloodied too, but not much, and I could wait to change them until the dizziness passed. One of the nurses wheeled my patient’s IV pole back into his room and returned with a chux to mop up the blood, vomit and saline on the floor. I sat down at a computer to begin my charting on Jeffrey’s exam. Ten minutes later, four more police officers arrived, and the normal ED flow of movement in and out of patient rooms began again.

Jack leaned against the desk where I was working. His smile returned. What’s the capital of Denmark?

Copenhagen. The last time he had asked me that, we were in my sister’s condo, and the only thing that had kept my marriage from disappearing down the drain in room six were the mafia guys after my sister.

Are you all right?

Yes. No concussion this time. Though the lingering dizziness made me want to close my eyes.

What time is your shift done?

Not till eight.

You should go wash up and change your scrubs.

Yeah. The skin on my neck felt tight where Jeffrey’s blood was drying.

When you come back, you can do the stitches on Dr. Rao.

But—

You know you sew better than anyone here. He put his hand on my shoulder, and I ignored the shiver in my belly. Even if they hate to admit it.

TWO

I called my mom from the car on the way home. It was a short drive, and the transition at the end would give me a good excuse to get off the phone if I didn’t like where the conversation was headed.

I’m so glad you called, she said. Let me just … She was out of breath but sounded cheerful.

Why? What’s up?

First, how are you? You’re up early.

I just got off work.

Oh. Was it a good night?

Hmmm… not so much.

What happened? You didn’t lose a patient, did you?

Yeah, Mom, a few people died.

That’s terrible. Chicago’s homicide rate is all over the news.

I know. Last night, however, it wasn’t about homicides. Last night was all overdoses. What about you? How are you?

Good, I’m good. I’ve made a decision. I’m going to move to Maryland to be with your sister.

Are you kidding?

Of course I’m not kidding. Why would you say that?

But the house. You’ve lived in that house forever.

Forty years is not forever. It only feels that way because it’s the only house you ever knew.

What brought this on? I asked, waiting at the crosswalk for a man in an enormous parka to cross with his dog.

Lara got a job at the University of Maryland.

That’s great.

Child care is so expensive, especially for a single parent—

It’s not more expensive because she’s single, Mom.

You know what I mean, she said. She doesn’t have Dan to take care of everything for her.

Another not-so-subtle dig at my job. When are you moving?

Not for a bit. Lara’s job won’t start till the fall, so she’ll go out in May to find a place for us.

You’re going to live with her?

We haven’t decided yet. But the reason I called—

You didn’t call me. I called you.

"But I meant to call. What difference does it make? The reason I’m glad you called is that I wanted to ask you if there’s anything from the house you’d like to have. I’m going to clean it all out. Make a fresh start."

She was getting rid of everything? My whole childhood happened in that house, and I was supposed to pick one thing I wanted? How was I supposed to boil