Family Practice Read online

  “You’re bound to run into him, don’t you think?”

  “Not if I can help it.” Adam had been her own true love. Except it turned out he wasn’t. The bastard. It was after Adam that she’d taken up with the jerk who couldn’t even put in sewer pipes.

  “I just wondered,” Nadine said, “whether Dorothy’s snit has, you know, anything to do with Adam.”

  “I don’t see how. She never liked him. Made it clear to him if he married me, I’d never see any of the Barrington money.”

  And, Ellen thought, Willis, Marlitta, and Carl wouldn’t be called to attend for that. What could it be that was so important? Ah well, she’d find out soon enough. In the bosom of her family. Ha. If one of them put poison in Dorothy’s sun tea, all Ellen’s troubles would be over.

  2

  SUSAN WREN POURED a glass of orange juice, dropped in two ice cubes—orange juice had to be good for a sick kid—and took it upstairs, where eleven-year-old Jen in blue-and-white-striped pajamas, looking small and miserable, lay in the big bed.

  “How you feeling, Jen?” Susan put the glass on the side table and sat on the edge of the bed.

  “I’m okay.” Jen jammed the extra pillow behind her head, scooted herself higher, and brought up her knees. The pajama legs slid along her thighs, exposing bony kneecaps.

  “I can see that.” The kid’s face was about the color of the rosy flowers on the pillowcase. Susan laid a hand on Jen’s forehead. Hot. Very hot. Oh shit. Call Jen’s mom?

  It’s only a fever. Kids have fevers. Nothing to worry about. Oh, yes? What did she know? Nothing about kids. Fevers could mean something serious. Her first thought was to call her own mother. Mothers know about this stuff. Oh, yeah, real helpful. Susan’s mother lived halfway across the country in San Francisco.

  Let us not panic here. I’m a cop. We’re trained to handle crisis situations. She smoothed Jen’s brown hair, usually braided tight into one long plait, now falling loose across the pillow, away from her flushed face. “Do you hurt anywhere?”

  “No.”

  Susan raised her eyebrows.

  “Well—maybe I’ve kinda got a sore throat.”

  Fever. Sore throat. What did that mean? Some kind of flu?

  “I’m all right,” Jen insisted. Her beautiful yellow-green eyes were too bright.

  Susan didn’t even have a thermometer. Why not, for God’s sake? Every well-ordered household had a thermometer. “It doesn’t look like you’re all right. It looks like you’re sick. I think maybe we better get you to a doctor.” Saturday afternoon. Were they all out playing golf? Didn’t matter. She’d pull one in.

  “It’s just a sore throat,” Jen said. “I’ve had that lots of times.”

  At least I had sense enough to get the doctor’s name, Susan thought, before Jen’s mother went off on her blissful weekend. Should I call her? She’d been nervous about leaving her daughter anyway; this would really freak her.

  Perissa, the kitten, climbed laboriously up the bedsheets and poked her chocolate-brown face in Jen’s ear, then licked her cheek. Jen laughed—Susan could hear the rasp in her throat—and raised a shoulder to rub against her cheek. Perissa clambered over to Jen’s stomach, crouched, and tucked brown paws under her beige chest.

  “I’m really okay.” Jen scratched the kitten’s head and Perissa purred loudly, blue eyes narrowed to slits.

  “I’m sure you are, sweetie, but I’m new at this. You’ll have to make allowances. To avoid frantic worry, let’s just have a doctor take a look at you.”

  Jen sighed, a forlorn sound.

  Susan patted one bony knee and stood up. “Try to drink a little orange juice. I’ll be right back.”

  Downstairs in the small room off the living room that she used as a home office—being chief of police meant work spilled over into off-duty hours—she retrieved the note from under a glass paperweight. Dr. Barrington. Sliding open the bottom desk drawer, she pulled out the phone book and looked up physicians. Four Barringtons were listed under “Barrington Medical Group.” She punched in the number and gazed out the window as she listened to the ringing. The sky was menacing, like a movie shot just before a thunderclap and God started talking to Abraham. Somewhat to her surprise, the phone was answered by a receptionist who said Dr. Dorothy Barrington was in the office today and could see Jenifer Bryant at two.

  All right. Susan looked at her watch—one-ten—and trotted back upstairs.

  “I suppose I have to go,” Jen grumbled, and sat cross-legged in the middle of the bed.

  “’Fraid so.” Susan found a yellow raincoat in the neatly packed duffel Jen had brought from home the evening before and held it out for Jen to slip her arms into.

  Jen was aghast. “I can’t go in my pajamas.”

  Despite Susan’s half-hearted murmurs, Jen was insistent, and she pulled on a pair of white shorts with an elastic waistband and buttoned up a shirt patterned in armor-bearing knights.

  “I’m not helpless,” she said when Susan knelt to tie her Reeboks.

  “Right.” She left Jen to her own laces and discarded her sloppy jeans and too-large man’s shirt for blue linen pants and a tailored blue blouse.

  * * *

  In the waiting room, Jen listlessly paged through an ancient National Geographic and scuffed the toe of one shoe against the oatmeal-colored carpet. Outside, rain poured down, relentlessly pounding against the window. Except for Debra Cole behind a counter in the reception area, they were the only ones here, and the building had the empty feel of a Saturday afternoon. Pictures on the walls showed green meadows, leafy trees, and idyllic streams. In one corner stood a metal sculpture with myriad spillways, and water trickled through it in a never-ending cycle.

  “She’ll probably say I have to stay in bed,” Jen muttered.

  Susan had to lean forward to hear through the crash and rumble of thunder. “Sick people are supposed to be in bed.”

  Jen closed the magazine and dropped it on a stack on the table next to her chair. “We won’t get to go to the ballet.”

  Susan gave her a sympathetic smile. Disappointment came with thorns when you were eleven. Weeks ago, when Susan had asked her what she wanted to do this weekend, Jen, in a don’t-dare-to-hope voice, had said what she really really wanted was to see a ballet. She’d never seen one. Somewhat surprised at her choice, Susan had readily agreed. They had a special day planned: drive to Kansas City, have dinner in the fanciest restaurant they could find, and then take in The Sleeping Beauty.

  “We will go,” Susan promised. “If we can’t go this evening, we’ll do the whole thing another time.”

  Jen, wrapping herself in indifference, nodded. Her parents were divorced and much absorbed in creating new lives for themselves. Jen often got lost in the shuffle, and too many times promises weren’t all they were cracked up to be. Slumping back in the chair, she closed her eyes.

  Susan looked at her with worry. What was the holdup here? Shouldn’t they be getting some attention? She was about to ask Debra how much longer they’d have to wait, when Dr. Barrington came through the door that led into a hallway. An angular woman with a high forehead and light hair that fell straight along her thin face and curved in just below her jawline, she wore a tan dress with navy piping and navy buttons.

  She glanced briefly at the folder in her hands, then bent to smile at Jen. The smile softened the severity of her appearance. “Well, Miss Jenifer, what have you been doing to yourself? Let’s take a look at you.” With a hand behind one shoulder, she guided Jen toward the door.

  Susan stood up to follow.

  “You can wait here,” the doctor said in a voice that left no room for argument. “I’ll let you know what I find.”

  Slowly, Susan lowered herself back onto the chair; she was seriously reluctant to let Jen out of her sight. She picked up an elderly New Yorker and perused the cartoons, dropped it and watched the water ripple endlessly through the metal sculpture, listened to the rain beating against the building, picked up anot
her elderly magazine, and read an article on the artistic corruption of the coloring of old black-and-white films. Not a subject she’d ever felt hot about.

  Thunder crashed, making her jump. Why was it taking so long? Jen had something life-threatening. Bubonic plague.

  She lived a few houses from Susan on Walnut Street. A great kid: bright, thoughtful, a lively interest in everything, a touch of hero worship for Susan. Jen had gotten in the habit of dropping in at Susan’s when things got too heavy at home. Three weeks ago, she’d come by in a grumpy mood. Mom was planning a weekend away, and Jen would be staying with a babysitter.

  “I’m not a baby,” she had groused. “And Mrs. Hoffsteader doesn’t like me.”

  “I can’t believe that,” Susan said. “How could anybody not like you?”

  “Mrs. Hoffsteader doesn’t like kids.”

  “Well, what would you think about staying with me?”

  Jen’s face lit up with her sunshine grin.

  “We’ll have to ask your mom,” Susan cautioned.

  Jen’s mother wasn’t so thrilled with the idea, nor did she like Susan all that much—Jen’s admiration roused some maternal jealousy—but she had, after Jen’s pleading, finally agreed.

  Susan had arranged her schedule to be off duty the entire weekend. The big plans she and Jen had made didn’t include sitting in a doctor’s office.

  Thunder rumbled. Behind it was a pop. She jerked her head up and listened intently. She caught a puzzled look from Debra. Four, five seconds passed.

  A sharp crack. Gunshot. Oh, Jesus.

  Grabbing the Smith and Wesson from her shoulder bag, she ran past Debra to the inner door and slammed it open against the wall.

  The hallway went straight back, offices on each side. As she dashed down it, a frantic buzzing started up in her mind.

  Two doors before the hallway turned off to the right, Jen lay sprawled on the floor. Susan knelt beside her. The girl had fallen forward, partially on her side, one arm flung out beside her head, the other tucked under her body.

  No pulse. Breathing in short, agonized rasps. Small blood stain on the blouse, left side of chest.

  Beyond Jen, just outside the open office door on the left, Dorothy Barrington lay in a pool of blood. Susan stood and took several steps closer. Chest wound, left side. Shot at close range. Dropped as soon as she’d been hit. Dead almost before she fell, Susan thought.

  She heard mewling whimpers and looked up at Debra, whose gaze was fixed on Jen.

  “Is there another physician here?”

  Debra continued to whimper.

  Susan got in her face. “Another doctor!”

  Debra tore her glance from Jen and stared at Susan, eyes wide with shock. “Only Dr. Dorothy. She’s the only one—” Her eyes rolled up and her knees started to buckle.

  Susan caught her, eased her to the floor, and left her propped against the wall.

  Using the phone in the empty office across from the one where Dorothy Barrington’s body lay, Susan called the police department. “Chief Wren,” she said to Hazel, the dispatcher. “Shooting. Two victims. One fatality. Send an ambulance.” In a voice so tight it didn’t even sound like hers, she gave the address. “Round up Parkhurst and Osey.”

  “On the way,” Hazel said.

  Susan hurried back to Jen. Still making horrifying noises in her struggle for air. Again, Susan could find no pulse. How could she be breathing and have no pulse?

  Susan was trained in CPR, but CPR was used on victims with no respiration.

  Abruptly, the noises stopped. The silence was even more horrifying.

  Hand under neck. Four quick puffs. Check for pulse. Five pushes on chest.

  The ambulance screamed up outside. Three paramedics came in at a run. Susan got out of their way. Both victims got attention, but they immediately focused on Jen. Two young males zipped her into trauma trousers, strapped her to a backboard, and hoisted her to a gurney. They raced toward the door, the third rushing alongside rhythmically pushing down on her chest.

  The ambulance tore off, siren wailing, and swayed around the corner.

  The driver grabbed the radio mike. “Medic One. Brookvale.”

  “This is Brookvale. Go ahead.”

  “En route. Eleven-year-old girl, gunshot wound left chest, no pulse, CPR in progress. ETA two minutes.”

  “I read you, Medic One. Two minutes. We’re ready.”

  3

  DR. ADAM SHEFFIELD hung up the phone and set off for ER at a flat-out run. He had about sixty seconds before the patient arrived to assemble a team and check for needed supplies.

  “Set up the thoracic tray,” he told the nurse, then turned to his assistant. “Cutdowns. Don’t piss around with IV’s. Use the largest tubes you got.”

  A cutdown was an open door into the circulatory system. Slice through muscle, isolate the biggest vein available and shove a tube in it. Enough cutdowns and, no matter how massive, hemorrhaging can be compensated for.

  “We got blood?”

  “Two units,” the nurse said. “More coming.”

  Two paramedics slammed the gurney through the doors hard enough that it bumped against the table.

  “No pulse,” the third paramedic said, never pausing in his rhythmic pressure on the girl’s chest. “None.”

  The backboard bounced as the patient was half-shoved, half-slid onto the table.

  “Stay with CPR,” Adam told the paramedic as he looked at the girl; her chest jerked spasmodically.

  From the head of the table, the anesthesiologist slapped two heart monitors onto the exposed chest. The bullet wound was a small hole, dark and puckered, very little blood. Adam glanced at him. “Ready to intubate?”

  The anesthesiologist nodded and reached for a laryngoscope. Adam cast a glance over his team. The paramedic continued the pressure on the girl’s chest. The assistant was probing the right groin with a scalpel in search of the saphenous vein.

  Adam studied the heart monitor; electrical activity moved across it, but no pulse, no regular heartbeat.

  A pulse that disappeared so fast meant only one thing; the bullet had penetrated the heart. The membrane around the heart filled with blood and prevented the heart from beating. Cardiac tamponade. Only one thing to do. Cut. Fast.

  No time for anesthetic. Didn’t matter. The girl was unconscious, for all practical purposes dead.

  Adam grabbed a bottle of reddish-brown antiseptic liquid and sloshed it over the girl’s chest, clamped gauze pads in a hemostat, and swabbed the liquid around.

  The nurse held out a latex glove. Adam jammed his hand in, other hand in the second glove. No time to prep the patient, drape her, or scrub. Aw shit.

  If the kid had any chance at all, he had to move. He sloshed around more antiseptic and grabbed a scapel. Leaning into it as hard as he could, he sliced through muscle and gristle between the fifth and sixth ribs.

  Not surgery, he thought. More like butchery.

  No blood; the kid had no blood pressure.

  A lab tech rushed in with two more units of blood. The assistant snatched a unit, attached it to a cutdown, and handed it over to the nurse. “Squeeze,” he ordered.

  Adam kept cutting deeper through layers of muscle until he reached the chest cavity. Blood gushed. As he worked the incision wider more dark blood, partially clotted, splashed over the table, soaking into his pants and shoes.

  “Jesus,” the assistant said, and hooked up another unit.

  Adam stuck three fingers in the incision, couldn’t get his hand inside. “Scissors.” He held out a hand, palm up.

  The nurse smacked heavy shears in his palm. He started snipping. When he ran into a rib, he wrapped both hands on the shears and gripped down hard, felt the rib snap. He stuck his hand in the incision, let it slip through, and took a breath. Okay.

  “When I yell,” he told the paramedic, “stop CPR.”

  He squatted, peered in the incision, and saw the pericardium. Dark blue, swollen with blood. Oh boy. He neede
d to cut into it and let that blood out. And he’d damn well better not cut heart tissue when he did.

  “Give me better forceps. With teeth.”

  The nurse smacked a hemostat in his waiting palm. He tried to nip the pericardium with the hemostat; it kept slipping free. “Damn it.”

  After several frustrating attempts, he felt the teeth grip and hold. Yes. Gently, he tugged the membrane up to create a small pocket and snipped it open. Blood poured out.

  All right, kid. This is it. Hang in there for me.

  “Now,” he said to the paramedic. “Stop CPR.”

  The paramedic stepped back, sweating, breathing hard.

  Quickly, Adam extended the cut in the pericardium, stuck his hand through, and curled his fingers around the heart. It quivered.

  Yes! Now, let’s be very careful here. Slowly and with great care, he tightened his fingers, relaxed them, tightened, relaxed.

  The heart made a spontaneous contraction. Yes! All right! Hooray, kid!

  He felt blood trickle against his palm and with his fingertips explored the heart’s surface. There it is. Hole. Right near the top. He slid his thumb over it and began a fingertip feel toward the back of the heart. Yep. Exit wound. Back of the heart. He moved his middle finger over it. The heart made another beat.

  “Pulse!” the anesthesiologist said. “There’s a pulse!”

  “Don’t celebrate yet,” Adam said. “I’ve got my fingers in two holes.” He looked at the clock on the wall. Five minutes had elapsed from the time the kid was brought in until her heart had started beating on its own. Her blood pressure had started to rise, dark blood oozed up in the incision.

  He was forced to stoop in an awkward position to keep his thumb and middle finger over the holes in the left ventricle. Already his shoulder ached. He tried to relieve it by moving slightly. Didn’t help. Great. He couldn’t hold this position for long, and he dared not move either.

  Mentally, he pictured the anatomy of the heart. The entrance wound was awful, goddamn close to one of the major blood vessels. He eased his forefinger across the surface of the pulsing muscle, searching for the vein. Christ, if the bullet ripped it, my finger is stopping blood to that area of the heart. The kid, as near as made no difference, would be undergoing a heart attack.