Passion's Bright Fury
by Radclyffe
PROLOGUE
It was an ordinary Monday morning in July, and she scarcely took notice of the people around her as she leaned against the metal pole in the center of the subway car. Her briefcase was secured in one hand, the Daily News folded in half length-wise and held up in front of her face with the other. It was seven-thirty a.m., the height of rush hour, and eighty early morning commuters filled every seat and pressed against her in the narrow aisle. She had thirty blocks to ride underground to her destination.
She had given up trying to drink coffee during the trip; she had ruined one too many suits while trying to manage a cup amidst the jostling crowds. Had she stopped to purchase her usual fare of espresso-spiked French roast, she would have taken a different train. Sometimes five minutes can change the course of a lifetime.
"Damn driver's gonna shake us all to death," someone nearby grumbled.
"Excuse me, sorry," her pole-mate mumbled for the third time after losing his balance and stumbling into her.
"No problem," she murmured, lowering her paper and glancing through the thick, scratched glass of the sliding double doors opposite her. Shadows of vertical concrete supports and the gaping mouths of dark recesses flew by quickly in the dimly lit tunnel. Too quickly. When the businessman next to her lurched into her once again, she tucked the newspaper under her arm, pressed the briefcase to her chest with an elbow, and grasped the pole with both hands. The car rocked heavily, and she had to spread her feet to keep her balance. She glanced forward the length of the car and realized that everyone else was having difficulty staying upright, too. Her pulse quickened as she fought to steady herself. The train went into a curve and seemed to tilt up on one side. Over the noise of her own heart pounding erratically in her ears, she heard the reassuring squeal of the brakes being applied. Nothing to worry about.
That was her last conscious thought before the world turned upside down amidst the sounds of rending metal and helpless humanity. Then there were only fragments of words and dizzying images and jostled movements that catapulted her in and out of consciousness, until finally reality coalesced into a blinding light in her eyes and a crimson roar of pain in her head. She struggled to sit up, but just the slight movement she was able to manage caused a new agony in her right leg to surge upward and force the air from her lungs with its terrible intensity. Forcing her eyes open despite the piercing glare, she found herself looking into a huge silver disk with a hot white bulb in its center suspended over her head. Almost instantaneously, she realized that her arms were tied down. Then she began to hear voices, strident tones forming half-sentences and clipped short-hand phrases.
Closed head injury...open tib-fib fracture...
Somebody call the O. R.…another one coming up...
Type and cross her...four units...
We need a CT of the chest and abdomen…STAT...
Fighting down the pain, she gathered all her strength and tried to speak. "What... oh... where am..." Suddenly, a silhouette swam into her field of vision, backlit by the bright light, and she tried unsuccessfully to focus. "Please…"
Gentle hands restrained her as a deep, calm voice spoke. "You were in an accident. You're at Bellevue. Can you tell me your name?"
She tried to shape the sounds of her name but they floated away from her on a new wave of anguish. She continued to stare upward, dimly aware of fingers brushing over her face. Finally, features began to emerge from the shadows above her, giving her something to cling to in the sea of confusion and pain. A face bending near-blue eyes, so dark they were almost purple, intense and penetrating. Black hair, thick and unruly, escaping from beneath the band of a surgeon's cap that slashed across a strong broad forehead. Prominent cheekbones and a bold, nearly masculine jaw.
"You're going to be fine."
She had no choice but to deliver herself into those confident unwavering eyes-and to believe.
Chapter one
Five years later
"I don't have time for interviews," Saxon Sinclair said with barely contained irritation as she walked unannounced into the Chief of Surgery's office late on the last day of June. "And I'd appreciate it if you didn't schedule things for me without discussing it first."
The distinguished-appearing, fifty-year-old man behind the broad walnut desk smoothed his expensively styled, silvered hair, carefully placed his Waterman pen into the chest pocket of his spotless starched white lab coat, and tried to conceal his aversion to his visitor. He leaned back in the padded swivel chair and regarded the intense, dark haired woman in navy surgical scrubs who stood too close to the front of his desk to be respectful. She wore two beepers on her belt, the trauma pager that would summon her to the helipad or the trauma admitting area, and the code beeper that would call her to the trauma intensive care unit in the event that a patient arrested. Rangy and lean, she was too athletic-appearing for his taste, and too aggressive for his liking. She probably wasn't aware of the fact that she was leaning forward with her feet spread and her hands clenched at her sides.
"I'm sorry," he said in his practiced bureaucratic voice. "I thought my secretary had cleared it with your office."
"Apparently not," she said, her tone indicating that she didn't believe him. "Tomorrow is July first, and I've got three fresh attendings, two first-year fellows, and a handful of brand new residents in my trauma unit. I can't leave them to meet with some journalist. You'll have to get someone else to talk to him."
Preston Smith smiled, thinking how much he'd like to fire her arrogant ass. Too bad the university was so concerned about the gender and minority profiles of their department chairs and division heads. A clear bias might have a negative impact on future state and federal funding, and every institution was feeling the financial crunch. The powers that be-more importantly-the powers that controlled his own budget, would not take kindly to him firing one of the few female chiefs in the entire university hospital system. He conveniently ignored the fact that she was also one of the premier trauma surgeons in the state and had been the focus of several newspaper and magazine articles. He couldn't even find anything, professional or personal, to hold over her head to threaten her with. Private and solitary, apparently wedded to her work, her reputation was unimpeachable. She would not be easy to get rid of. "You're the one they want to talk to, Sax," he said solicitously, assuming a familiarity she had never invited. "You're the one with the name recognition."
"Then they can come back in September and talk to me then," she said as she turned and started towards the door. Pompous idiot. He hasn't actually been in the operating room in so long, he's forgotten how hairy the first few weeks of July can be.
"I thought you'd want to meet with these folks and lay down the ground rules," he called after her, "but it's up to you, of course. You know how you want to run your unit."
These folks? She stopped suddenly and pivoted slowly, her eyes narrowing. "Is there something else you haven't told me, Preston?"
"Image is everything in today's marketplace, and we're no exception. We're not the only level one trauma unit in Manhattan, nor the only cancer center, nor the only tertiary care facility," he said smoothly, as if she weren't aware of these facts. "St. Michael's needs the exposure, and this is a perfect opportunity."
"What is this, exactly?"
He couldn't quite hide his triumphant smile. "One of the independent networks will be airing a documentary medical series, and the production company be filming it here. It's an excellent opportunity for free advertising."
For a moment, she simply stared, rigidly still but for a muscle that jumped along the border of her jaw. Very quietly, in a voice edged in steel, she asked, "And what precisely does that have to do with me?"
"The producers felt that the exposé would have more impact if viewers could identify with a particular individual throughout the episodes, so they're going to present a year-long show based on the life of a surgical trainee."
"Which trainee?"
Smith made a show of moving some papers around on his desk, but Sax knew damn well that he didn't need to search for a name. This had all been decided without her input and had probably been set in motion weeks before.
"Ah...here we are. Deborah Stein."
"My first-year trauma fellow." It was a statement, not a question. Sax rubbed her eyes and contemplated homicide. "Does Stein know about this?"
"Of course," Smith replied, his tone implying surprise. "She agreed to it when she signed her contract." He didn't add that the final contract was contingent upon her agreeing to the project, nor did he add that he had led the incoming surgical trainee to believe that Sinclair was aware of the circumstances.
"Are you trying to tell me that I'm going to have civilians crawling around in my trauma unit with cameras and microphones and God knows what else while I'm trying to triage injured patients? You can't be serious."
Preston Smith stood up, his eyes suddenly hardening. "Actually, Sinclair, that's exactly what I'm telling you. The hospital needs this, and I've already agreed to it. You'll have to find a way to live with it, so I suggest that you meet with the director as planned."
She left without another word, because any longer and she wouldn't have been able to contain her temper. This was a fight she knew she couldn't win, and she had battles of much more importance to wage.
*****
Six A.M. July 1
A figure, back turned, leaned against the wall outside her office, a newspaper held aloft in the traditional lengthwise, half-fold configuration of the habitual New York City subway rider. All Sax could make out was a mass of rich red curls fanning out over the collar of a khaki safari-style shirt and long legs encased in tailored trousers. She slowed as she approached, curious, because she was quite certain she was not expecting anyone. Her orientation with new residents and staff was scheduled for seven.
At the sound of the footsteps in the deserted hallway behind her, Jude Castle turned and got her first look at the elusive Doctor Saxon Sinclair, Chief of Trauma at St. Michael's Hospital in lower Manhattan. The surgeon wasn't entirely what she expected of someone with that title-particularly not with the motorcycle helmet tucked under one arm, the well-worn black leather jacket, and the faded blue jeans. Jude stared, momentarily perplexed, because the woman standing a few feet away, studying her with a raised eyebrow and a slight frown, looked familiar. And she was sure they had never met. She would not have forgotten someone with the simmering good looks and unapologetically self-assured attitude that this woman exuded. Probably a promo photo from somewhere, she thought, dismissing the uneasy feeling of déjà vu.
"Dr. Sinclair?" Jude said, finally finding her voice and stepping forward with an outstretched hand. "Jude Castle, Horizon Productions."
Sax's frown deepened, but she accepted the proffered hand. The redhead's grip was firm and definite. Her green eyes were direct and self-possessed, too. Sax released the other woman's hand and pulled her keys from the pocket of her leather jacket. Fitting them to the lock in her door, she said over her shoulder, "Do we have an appointment?"
"No," Jude said, edging closer to the door, planning to jam her foot in it if necessary, "we don't. I've been trying to set something up for weeks, but your secretary wasn't able to pin you down as to a convenient time."
"Probably because there isn't one," Sax said, turning to block the path into the small room she used as an auxiliary office as well as an on-call sleeping area. She was startled to find the other woman almost nose to nose with her across the threshold. "This is a hectic time of year, and I don't have time for…" She ran a hand through her hair, disheveling the already wild strands of midnight waves. "… public relations."
"Understood," Jude agreed, holding her ground. "I have an entire crew arriving here tomorrow, and I'm short on time, too. Maybe we could do this over coffee?"
"Do what?" Sax asked pointedly, stripping off her jacket and tossing it onto a narrow bed covered with medical journals and a pile of navy blue scrubs. Relenting, she motioned Jude to enter. "Close the door," she said offhandedly as she reached for a pair of scrub pants and began to unbutton her jeans. "You can fill me in while I change."
Jude stared wordlessly for an interminable moment when she thought Sinclair was going to step out of those sexy, nearly threadbare levis right in front of her, and then she hurriedly spun her around to face the opposite wall where an old wooden desk labored under the weight of a modern computer system. She cleared her throat, which was suddenly dry, and replied evenly, "I had hoped we could talk logistics. I don't want to get in your way, Dr. Sinclair…"
"You're already in my way," Sax pointed out, pulling her T-shirt over her head and replacing it with a navy top. Moving around the redhead to her desk, she found a pen, which she stuck in her chest pocket. She leaned her hip against the edge of the desk and regarded her visitor, trying unsuccessfully to stifle a sigh of exasperation. "I'm stuck with this, aren't I?"
Shrugging, Jude smiled. "'Fraid so. I'll try to make it as painless as possible." She wasn't sure that levity would get her anywhere with the clearly aggravated surgeon, but she just couldn't help herself. Besides, she needed to do something to take her mind off how damned attractive Sinclair was. It wasn't like her to be quite so affected by a pair of deep, brooding eyes and a mane of black hair that begged for fingers to run through it. She tried to ignore the faint flush of heat in her limbs. She had work to do.
Sax pushed away from the desk and strode rapidly to the door, pulling it open. She looked back over her shoulder and called, "Well, come on then. You've got twenty minutes to fill me in."
"Thirty," Jude responded, hurrying after her. "Make it thirty, and I'll buy the coffee." She didn't get an answer, but she could have sworn she saw a grin. It was a small victory, but she'd take it for now.
*****
Chapter Two
Jude was used to running while on the job. She'd filmed almost everything there was to film at one time or another except actual combat, but she'd been close enough to the front in Kosovo to need to sprint to avoid being flattened by falling debris during bombing raids. She was practically racing now to keep up with Sinclair as they rushed through the halls on their way to the cafeteria. As Jude started to turn right around a corner clearly marked with a sign indicating the cafeteria, Sinclair grabbed her arm and pulled her left.
"This way," Sax said, drawing the other woman with her in the opposite direction.
"What…?" Jude started to ask.
"Some things are essential in this business," Sax informed her, fishing a handful of bills out of her shirt pocket, "and good coffee is one of them."
Then Jude saw the tiny kiosk tucked into the corner of the large admissions area waiting room. The top of a brass and chrome espresso machine was visible behind a stack of cups and a plastic bin of pastries. "Ah, I see," she noted. "A real coffee drinker."
Sax leaned over the counter and peered around the cash register down the narrow aisle beyond. Then she smiled in satisfaction. "Terry! Coffee - quick!" Glancing at Jude, she inquired, "What'll you have? Terry's making me a red eye."
"Perfect," Jude replied. A minute later she accepted the cup of coffee with an added shot of espresso with a grateful sigh. When Sax started to pay, she caught her hand. "I've got it, remember?"
For a second they both stared at Jude's hand on Sax's wrist. Jude stared because her fingers were tingling, and that didn't make any sense at all. She had no idea what the surgeon was feeling, because her face was expressionless as she pulled away and said, "Sure. Thanks."
Carrying their cups, they walked across the lobby level public seating area toward the elevators.
"So," Jude began, anxious to take advantage of every minute with the reluctant surgeon, "I need to clarify a few details of the shoot with you."
"So I gathered," Sax responded dryly. She pushed the up button, a little surprised at how easily the persistent director had maneuvered her into a discussion of something that she wasn't at all sure she wanted to happen. Usually not so susceptible to persuasion, she had to admit that the redhead had a subtle charm about her that was hard to resist. To take her mind off that disconcerting thought, she said, "I have an orientation meeting with new staff in forty minutes. We can talk in the conference room before everyone arrives. That's probably the only time I'll have free all day."
"Fine," Jude replied. She sipped her coffee and groaned faintly. "Oh yeah. Nice."
Sax grinned in spite of herself. "Definitely."
When they were seated in the small meeting room adjoining the hospital cafeteria, Sax leaned back in her chair and regarded Jude seriously. "Preston Smith told me last night that you want to film a documentary in my trauma unit."
"Last night?" Jude said in surprise. "You just found out yesterday? We've been negotiating with the hospital for months about this, and I'd been told everyone involved was onboard. Why didn't he tell you before?"
"Probably because he knew that I would refuse," Sax offered mildly, watching her companion over the top of her coffee cup. The other woman so far had been unflappable - confident and capable, but surprisingly nonconfrontational. An iron hand in a velvet glove. Sax was impressed, and she didn't impress easily.
"Really?" Jude commented just as placidly. She thought she understood some of the surgeon's resistance now. She could hardly blame Sinclair for being aggravated if she'd just been informed about the project, and that also explained why she hadn't been able to get an appointment with her sooner. But she sensed something else beneath the other woman's opposition. Something more personal than bureaucratic conflicts. "Mind telling me why you're opposed to it?"
"Because you and your cameras don't belong in a trauma unit. It's an invasion of privacy to film what might be the most intimate and personal moments of someone's life." Her concern about patient confidentiality was true, even if it wasn't her only objection. She had no intention of disclosing her own aversion to publicity.
"We'll get releases for anything that we air. We can block their faces electronically if we need to," Jude pointed out reasonably. She'd had practice fielding these kinds of objections before.
"And what about the ones who can't give consent-the comatose, or the moribund, or the children?"
Jude was about to give another stock answer, but something in Sinclair's voice made her stop. There was an edge of anger, of protectiveness, that intrigued her. She sat forward, meeting Sinclair's admittedly intimidating gaze head on. "What if I guarantee that every precaution will be taken to protect individual privacy? I'll be there myself the entire time the cameras are rolling. I'll talk to the families personally if I have to. No one will be filmed without consent."
"Your presence is going to interfere with Deb Stein's training. She's going to be more worried about looking good for you than about learning to make decisions and exercise good judgment."
"I thought the trauma fellows took call with a senior attending who supervised them," Jude stated.
"They do," Sax agreed. "Deb Stein will be on duty with me most of the time."
"And you're concerned that…what? That she's going to pay more attention to me than to you?" Jude's voice rose in a way that suggested she was trying not to laugh.
Sax was forced to grin again. The dynamic director was proving hard to resist. "She'll be distracted at least."
Jude regarded her intently, aware that this confrontation could spell success or failure for a project that she had invested all her energy and considerable resources into for six months. She could do it without Sinclair's cooperation if she had to. She had a signed contract from the hospital, and it would stand up in court if it came to that. But if she went that route, going over Sinclair's head to get the job done, it would make the work hellishly difficult. And she didn't want this woman as an enemy - for a lot of reasons, not the least of which was that she found the surgeon's obvious lack of concern for diplomacy refreshing. "What is it that really bothers you about all of this?" she asked quietly.
"There are some things people don't need to know, maybe don't even want to know," Sax said, surprising herself. I don't even know this woman and she has me admitting things I wouldn't say to a single living soul before now. "What happens in that unit-not always-but often enough, in those few seconds when life hangs in the balance are not things to be exposed for the sake of curiosity. These patients aren't just naked and defenseless-they're helpless. And sometimes what we do in there is not pretty."
"This is human drama, Dr. Sinclair. This is real life. Don't you think that the public can appreciate that and understand how special it is?"
The public's right to know-the relentless pursuit of the story in the name of truth-is often just a convenient excuse for invasion, Sax thought, but didn't say. She shrugged instead and answered flatly, "I don't know. I'm not a sociologist-I'm a surgeon."
"Yes," Jude agreed, thinking that Sinclair was much more than that. "And it's your trauma unit. But can we agree to give it a try?"
"Do I have a choice?"
"I'm sorry," Jude said, to her surprise, meaning it. "No."
*****
Personal Project Log - Castle
July 1 - 7:50 a.m.
Sinclair stood up at seven a.m. on the dot and every person in the room grew quiet. There were a dozen people present - six senior staff, two first year trauma fellows, two general surgery residents, and two medical students. I was the only outsider-the only non-physician. She walked to the front of the room, leaned against the edge of the conference table and crossed her arms over her chest. She looked relaxed in just a scrub shirt and pants - like she didn't have a care in the world. She never said a word until every eye was on her. I felt like I should jump up and salute. I thought a couple of the younger residents might. God, she looked tough.
I expected a speech. She didn't give one.
She laid out the ground rules instead. [Note: Title First Episode Rules of Engagement]. Twenty-four hours on, forty-eight hours off. Rounds in the trauma unit at eight a.m. and no one goes home until they're over. Which by my calculations turns out to be somewhere in the range of thirty hours straight without much sleep. I lost track of what she was saying after that, because I was trying to imagine that kind of schedule. I'm used to working hard, sometimes days at a time when a story is breaking. But I'll be the first to admit I don't function at my peak the whole time. And I'm not cutting into people.
She got my attention with the very last thing she said-the only direct order I can remember her giving. She said, "Some will die in the field, and there's nothing you can do about it. Those you let go. But if they come into my trauma unit warm and with a pulse, you'd better not lose them."
*****
Jude caught up to Deborah Stein just outside the conference room. "Deb," she called, pulling even with her as they started down the stairwell.
"Hey, Jude," the blond, two-time basketball Olympian answered with her trademark effervescent grin and sparkling blue eyes. "Good to see you again."
"What happens now?" Jude asked, hurrying along beside her. They exited on the first floor and double-timed down an intersecting corridor off the main hallway. Doesn't anybody walk at a normal pace around here?
"You heard the Chief. Rounds in the trauma intensive care unit in five, and then we wait for a trauma call. I'm assigned to the admitting unit this month, so I don't have any floor responsibilities."
"Gotcha," Jude affirmed, mentally reviewing what she remembered from the all too brief synopsis the surgical department had provided her. She had a feeling, however, that Sinclair didn't adhere to any script. "So once the patients are transferred from the trauma intensive care unit to a regular floor bed, you don't have any responsibility for them?"
"Well, I'll be involved in that aspect of things during the weeks I'm not taking trauma call. It's an either-or kinda deal because you can't really do both at once." Deb held open the heavy gray windowless door with the red rectangular sign announcing the TICU - Trauma Intensive Care Unit. "Grab a cover gown. I'll get you some scrubs later so you don't have to worry about your street clothes getting ruined, and you won't have to keep covering them up every time we go in and out of the units."
"Thanks," Jude replied absently, standing just inside the door and scanning the length of the brightly lit rectangular room. A u-shaped counter area just inside the entrance to her right was empty save for a few swivel chairs left askew in the middle of the space, a plethora of charts scattered over the countertops, and a misshapen box of fossilized donuts. What captured her attention were the ten beds lined up along the opposite wall, separated from each other by a few feet of space and featureless curtains on ceiling tracks that were all pushed back to expose the occupants to anyone who happened to be looking.
Almost every spartan, steel-railed adjustable bed contained a genderless, nearly naked form dwarfed by the dispassionate machines of modern medicine. Free-standing ventilators the size of dishwashers flanked every bed, delivering a predetermined volume of gas ten to fifteen times a minute through the hard plastic breathing tubes jutting from the vicinity of every patient's mouth. Arms were strapped akimbo to extremity immobilizers or tied by soft cotton restraints to the bed rails. Tubes of all sizes ran from every orifice, delivering salvation in the form of antibiotics and liquid nutrition or removing the waste of injury and decay. Monitors occupied every available space, metering out lifetimes in monotonous beeps and flashings pinpoints of light.
The trauma intensive care unit, one of the triumphs of medical technology, was a cold and impersonal place. Jude shivered.
"You okay?" Deb Stein asked, noticing Jude's reaction.
"What? Oh…yes, I'm fine. Sorry," Jude replied, dragging her gaze away from the silent tableau. She searched the room, trying to shake the eerie sensation of having stepped into a nightmare, and finally found something to occupy her attention. Sinclair stood at the center of a group of figures wearing white coats or rumpled scrub suits who were crowded around the bottom of the first bed. Her foot was up on the seat of a wheeled chair, one arm propped on her raised knee. She held a long sheet of paper in her hand as she leaned forward, her face sharply focused on the figure in the bed as she listened to what a young man next to her was saying.
"Let's go, then," Deb whispered urgently. "Sinclair's already started."
"Will I be able to film in here?" Jude interjected, because she wanted this on tape. Sinclair, with every eye upon her and every expression expectant, looked like a commander surveying a battlefield.
"Probably," Deb said as they approached the people clustered around Sinclair. "We'll figure it out later-after rounds."
Jude had no choice but to agree, because she could see that she couldn't interrupt what was underway, and besides, she wanted to watch this. No one seemed to object, or even particularly notice that she was there. Nurses moved efficiently between the beds, going about the business of administering meds, adjusting fluid pumps, and drawing blood. XRay techs threaded there way through the residents and staff who were blocking the aisles, sliding rectangular film plates under the patients, then shouting clear with complete disregard for what was happening nearby. At the sound of the technician's warning, everyone shuffled behind the nearest person wearing a lead apron to shield themselves as much as possible from the radiation, waited for the tech to shoot the XRay, and then moved back to their places with barely an interruption in their rhythm.
A deep commanding voice caught her attention.
"How high is his intracranial pressure?" Sax asked the fair-haired young man standing just in front of Jude.
"38."
"Up 10 in the last two hours?" the trauma chief queried, a faint edge to her voice.
"Yes."
"And what does that indicate to you, Dr. Kinney?"
Jude craned her neck to see Sinclair, whose blue eyes were fixed, laser like, on the young man's face. He was a first year surgery resident according to the ID badge clipped to his pocket. His voice was taut with strain as he replied.
"It means that something is causing the pressure to rise inside his skull."
"Such as?" The edge had progressed to razor sharp now.
Jude thought she could hear him swallow.
"Uh…cerebral edema, subdural hematoma, uh…epidural bleed."
Sinclair set her foot down from the chair she had been leaning on and straightened, her fierce gaze still on the younger physician. She seemed taller than Jude remembered, but she knew that they were very nearly the same height. It had grown very quiet, although activity still teemed around them.
"Are any of those conditions surgical emergencies?"
The resident blanched. "The subdural and the epidural bleeding."
"Then why don't I see the neurosurgeons here looking at him?"
"We called...they said they'd be by," he offered tentatively. He glanced right and left as if looking for assistance, but his fellow residents studiously avoided his gaze. He was on his own.
"And if he herniates his brainstem while we're waiting? Who will be responsible for that, Dr. Kinney?" Sinclair turned her head a fraction and met Deborah Stein's eyes. "Call neurosurg. Tell them I want them here now. Contact radiology and let them know we need an emergency head CT on this guy. Check the chart and find out who signs the consents for his procedures, but don't call the family until we know for certain he's going to the OR."
"Right," Deb answered briskly and moved off toward the nurse's station on the far side of the room.
"Okay, who's next?" Sinclair asked, already stepping to the next bed. Someone pushed the wheeled chair over to her. She absently propped one leg up on it and leaned forward to study the patient in bed two while a different resident began to give report.
Chapter Three
Personal Project Log - Castle
July 1-10:45a.m.
My first morning of rounds just ended. I'm exhausted and no one even asked me any questions. All I had to do was move from bed to bed and watch the process. I didn't understand everything that was said, especially when they began reeling off blood gas values and talking about Glasgow coma scores [Note: get Deb to explain this rating scale for head injury on film, preferably with a patient in the background. Get Sinclair's okay to film in TICU. Get DP to check lighting in there with film compatibility]. What I did understand loud and clear is that trauma rounds is where the real business of the day gets done. It's the only time during the day that the whole team is together, and it's the time when Sinclair fine-tunes the treatment plan for every patient in the Trauma ICU. Each patient's status is summarized for her by the resident covering that person, and whatever needs to be done - consults, studies, medication adjustments etc - are discussed and ordered. Sinclair signs off on all decisions. Now the doctors assigned to the less sick critical patients on the regular patient floors will go see to them, and those doctors responsible for incoming trauma emergencies - Sinclair and Stein today - will go down to the Trauma Admitting area. And I…
"Ms. Castle?"
Jude jumped, startled, and clicked off her recorder. She smiled at Sinclair, who was leaning with one shoulder against the wall just outside the TICU, watching her. "Sorry. I didn't know you were there. Do you need me for something?"
"I want to show you the admitting area. I'm on my way down there now."
"Great," Jude replied, slipping the small device into her trouser pocket as they walked. "Thanks for letting me tag along on rounds this morning."
"Were you recording then, too?"
"No," Jude said evenly. "I usually record notes to myself-impressions, reactions, reminders. Things I might use for voiceovers later on the film. If I want to tape you or anyone else, I'll ask."
Sinclair didn't say anything for a moment, then asked, "How did you come to pick Deb Stein to focus your project on?"
They passed the Emergency Room waiting area, already crowded with walk-ins, mostly mothers with children and middle-aged people with minor injuries. Those individuals with potentially serious medical conditions usually arrived by ambulance and were delivered directly to treatment rooms. Jude looked ahead down the hallway and saw yet another set of windowless doors with a keypad preventing entry except via a combination. "We met three years ago at the Olympics. I was doing a piece on female athletes, and we started talking about her plans after the games were over. When I began working on this, I thought of her."
"And she agreed?" Sax asked, pushing in the code on the door lock. "It's the same as the phone extension - two four two zero."
"Yes," Jude replied, following her in. "She did. Why?"
Sax shrugged. "That's what I'm wondering-why?"
"You'll have to ask her. I'd like to talk to you, though-on tape-about your own training. Background information, personal experiences, that kind of thing."
Sax stopped walking and faced her. "Everything you need is on my CV. My secretary can get that for you. You should have her number."
There was a note of finality in her voice that left no room for discussion. Jude kept her surprise, and her curiosity, to herself. She'd pushed enough for the first day. "All right, thanks."
"This," Sax said, leading her through a small alcove containing scrub sinks and cupboards with surgical hats and gowns into another unadorned room that appeared to be a hybrid operating theatre and treatment area, "is the trauma admitting area. Every trauma patient is brought in here, stabilized, and triaged."
There were three operating tables lined up in the center of the space, each of which could be enclosed by curtains for privacy if necessary. Above each narrow, stainless steel table hung large, circular silver lights containing brilliant halogen bulbs capable of lighting the area adequately for surgery. Jude stared at the silver domes and flushed with a sudden wave of heat and dizziness. Her vision narrowed and spots danced across the darkening landscape. Reflexively she reached out a hand to steady herself and was dimly aware of an arm encircling her waist.
"Ms. Castle," a quiet calm voice asked, "are you all right?"
Jude forced herself to take a deep breath, reminding herself that this would pass quickly if she just kept breathing. Her legs were unsteady and she held on hard to the warm solid body next to hers. "Yes," she whispered faintly. "Just…I'm sorry…just a minute."
Sax stood perfectly still, letting the other woman lean on her, holding her so close it might have been an embrace. A fine sheen of perspiration filmed Jude's forehead, and she was very pale. "Let's get you lying down," Sax said softly. She could feel her tremble.
"No," Jude responded quickly, pressing one hand to Sax's shoulder, straightening up with effort. "I'll be fine. I'm okay, really."
Sax studied her, still not releasing her hold on her as she rested two fingers on the pulse in Jude's wrist. Fast but strong. "I agree. You will be, but you still need to sit down."
"I'm sorry," Jude said, laughing self-consciously as she allowed Sax to walk her to a chair in front of a long counter that edged the rear wall. Her vision had cleared and she was acutely aware of the fact that Saxon Sinclair still had an arm around her waist. She was also aware of the hard length of Sinclair's body against her side and the soft swell of the surgeon's breast against her own. Her legs trembled again and it wasn't from dizziness. She stepped away quickly and settled into the chair. "Thanks."
One of the nurses asked Sax if she needed anything, but she shook her head no. She pulled another chair over close to Jude's and asked, "What happened?"
Embarrassed, Jude blushed. "Nothing. I got a little light-headed. Guess I should have had breakfast."
"That happens," Sax acknowledged with a nod, but she didn't really think that it was hypoglycemia. That usually gave some warning - a racing pulse, tremors, the gradual onset of faintness. Jude Castle had been perfectly fine until she walked into trauma admitting. "Has this occurred before?"
"No," Jude said, uncomfortable under the scrutiny of those penetrating eyes. At least not for so long I thought it was over.
"We should get an EKG. One of the nurses can do one right down here."
"I feel fine now." To prove it, Jude stood and walked a few feet away, needing to escape the other woman's searching gaze. She needed to walk off the anxiety that clung to her like a bad dream and she needed to forget the swift surge of desire she had experienced in Sinclair's innocent embrace. This is not a good start.
Jude cleared her throat and asked, "How many patients do you see through here every year?"
"Fifteen hundred, approximately," Sax replied, watching Jude pace around the forty-foot square space. The abrupt change in subject hadn't escaped her notice, but she understood the need for privacy. She understood secrets. "When we have a trauma alert, there's not much room in here. There will be EMTs, nurses, radiology techs, respiratory therapists, anesthesiologists, at least three surgeons, and assorted consultants."
"The families?"
Sax shook her head. "Not in here. There's a waiting room just down the hall where they can stay. They usually can't see the patient until after they're transferred to the ICU or finished in the OR, depending on the severity of their injuries. This is a modern day MASH unit-we evaluate and ship as fast as possible."
"But sometimes you operate down here?" Jude asked, forgetting her own discomfort as they talked. She'd drifted back to where Sax still sat, and sat down opposite her again.
"Only in case of a life-threatening emergency."
"Which would be what?" Jude questioned. "Can I record this, by the way?"
Sax realized that she had been deftly maneuvered into giving an interview, and she nodded her assent with a grudging grin of defeat. "A number of things. Anything that impairs breathing - a fractured larynx, for example-could require a tracheostomy. Sometimes in the face of major blood loss from the pelvis or ruptured internal organs we cross-clamp the aorta to send what blood there is to the brain."
As she listened, Jude continued to study the physical layout of the room as well as its contents. This was her set; this room would be the backdrop for most of the action she filmed. She would be spending a great deal of time in this room in the next year.
"What do you do between trauma alerts?"
"I'm usually in my office, taking care of administrative things, or at committee meetings, or making rounds in the unit. On a busy day when things are jumping down here, I work in my on call room down the hall."
"Or," a male voice interjected from behind Jude, "she tries to sucker someone into playing chess with her."
Jude swung around on her chair and stared at the man in the pale blue scrubs, a color she was sure he had chosen to match his eyes if his hundred-dollar haircut and startling good looks were any indication of the care he took with his appearance. He might have been a male model posing for a uniform catalog.
"Jude Castle, meet Aaron Townsend, the head trauma nurse," Sax said.
Aaron gave Jude a friendly smile and a frankly appraising look as he took her hand. "Nice to meet you. I've heard rumors that we are going to be immortalized on film."
"I certainly hope so," Jude replied with a laugh. She was careful not to let her gaze linger too long on his face. She did not want to give him any ideas if he didn't have them already.
"Excellent," the handsome blond said enthusiastically. "And I was serious about the chess thing. When the good doctor gets bored she likes to humiliate people at games."
Jude shrugged, hoping that she appeared more nonchalant than she felt. "Don't worry, chess is not my game."
Sax regarded the redhead silently, wondering why for the second time in less than an hour, Jude Castle was lying.
*****
Chapter Four
"You'll need to work with the bare minimum of people in here," Sax said after Aaron Townsend left to give lunch relief in the TICU, which was short a nurse on the day shift. "Space is at a premium."
"I'll want at least two camera people, a sound tech and an assistant besides myself," Jude responded immediately. She was still thinking about the nurse's comments about Sinclair being a chess player. Great--one more complication.
"Not a chance."
Jude glared at her from a foot away, irritated by the uncompromising tone in her voice. Under other circumstances she might have handled things a little more diplomatically, but she was still shaken by her near fainting spell and off her stride. She spoke without thinking. "I don't need you permission, you know. I'm just trying to be polite here."
"You don't need to be polite, Ms. Castle," Sax said as she stood up, never raising her voice, but her blue eyes were glacially cold. "What you have to do is be careful not to interfere with the work that needs to be done down here or I'll have you thrown out on your ass."
Of all the arrogant, dictatorial … Jude fumed as she watched Sinclair stride swiftly from the room. She rubbed her temples and tried not to curse out loud. Lovely, just lovely.
*****
July 1 - 4:42 p.m.
"Why did you decide to do your fellowship with Saxon Sinclair?" Jude asked, placing the small recorder between them on the table in the conference room.
"Because she's the best," Deb Stein answered with a look that said Jude should know the answer to that silly question.
"Define best," Jude probed, wanting to get a feel for her 'star' and to lay the foundation for what was to come in the weeks ahead. "What makes her different than any number of other trauma surgeons?"
"On the record?" Deb asked, nodding toward the recorder. "Because her unit has the best survival statistics in the state, and I've seen her in the operating room. I rotated here as a junior general surgery resident, and she's amazing. She's got hands like lightning. Awesome."
Jude had a feeling that there was something else, because Deb had a little grin on her face. She reached to push the off button on her dictaphone. "What about off the record? Come on, Deb. I can tell you're holding back on me."
"Well," Deb conceded, her eyes twinkling, "she's so god awful hot. Every dyke resident I know wanted to work with her."
"Ah ha," Jude replied, hoping that she wasn't blushing. "Okay - we'll keep that off the record." What in hell is the matter with me? It's not as if I didn't think practically the same thing the minute I saw her. So what if she's hot. She's a royal pain in the…
Deb Stein jumped up as the pager at her waist beeped, and without another word, she charged from the room. Overhead the intercom blared, Trauma alert STAT…trauma admitting. Trauma alert STAT…
Jude grabbed her dictaphone and ran.
*****
Sax stood gowned and gloved as the double doors to the trauma admitting area slid open and a stretcher bearing a mound of equipment, blood-soaked clothing and an EMT straddling a human body rolled in. The female EMT kneeling astride the man was counting aloud as she rhythmically compressed his chest. One, two, three, four, five … one, two, three, four, five… slowing at the end of each sequence so her partner could deliver a breath through the inflatable Ambu bag attached to the endotracheal tube protruding from the man's mouth.
"GSW to the left chest," her partner called to no one in particular, his voice shrill with the adrenaline rush as he ran beside the stretcher, squeezing air into the unresponsive patient's lungs. "Intubated in the field. He's had five liters of ringer's solution. Initial BP eighty palpable. We lost the pulse and pressure about three minutes ago."
"Exit wound?" Sax called as she and several nurses slide the large man from the gurney onto the treatment table. She quickly assessed his pupils. Unresponsive to light. If he isn't brain dead already he will be in two minutes if we don't get some oxygen to his brain.
"None that we saw, Doc. The bullet went in but it didn't come out."
Swiftly, she moved her stethoscope from one side of his chest to the other, listening for air movement as she watched the paramedic ventilate the patient. Deb Stein, followed closely by Jude Castle, ran in as Sax straightened up. "No air flow on either side. Stein, put a chest tube in on the right. Nancy, open the thoracotomy tray."
Nurses worked efficiently, nearly silently, repeating a drill they had performed hundreds of times. One cut off the remnants of the patient's clothing; another slipped a sterile catheter into his penis and attached it to a urine collection bag; still another drew half a dozen vials of blood for laboratory analysis. A surgical intern pulled a tall metal stand up to the bedside and began folding open the layers of sterile linen covering a vast array of surgical instruments. A radiology technician arrived pushing a huge portable xRay machine and stood waiting, calmly labeling individual film plates with the date and the letters 'UWM', which is what the patient would remain until someone had time to identify him. Unidentified White Male.
All the while, Aaron Townsend continued chest compressions, having relieved the exhausted EMT. It was fatiguing work pushing the chest hard enough so that the force was transmitted to the heart, and harder still to get the heart to squeeze out blood with enough pressure to travel to the brain and other vital organs when it was almost empty. And this man's heart had to be almost empty. Most of his blood volume had poured out the two-inch hole in his chest.
Jude pressed along the wall and maneuvered as close to the action as she could get. No one paid her the slightest attention. She glanced at the clock. Forty-five seconds had elapsed since the stretcher was wheeled in. Peering around the anesthesiologist at the head of the table she watched Sinclair. The surgeon's gaze as she studied the patient was hard and unwavering, her eyes nearly purple with intensity. Everything about her was penetratingly, ferociously focused. Had Jude been aware of her own body, she would have realized she was holding her breath, but she was too absorbed by the trauma chief to notice.
"Hang that blood and squeeze it in by hand," Sax said sharply. She glanced quickly across the man's body at Deb. "Have you got that tube in, Stein?"
"Almost," Deb grunted, forcing an oversized clamp between the fifth and sixth ribs with one hand while holding a clear plastic tube a half inch in diameter in the other, ready to guide it through the tunnel she was creating into the chest cavity.
"Push it in-you're not going to hurt him," Sax said while pouring Betadiene directly from a bottle onto the man's torso. "As soon as you've got it in, get over here and give me a hand cracking his chest."
Even as she spoke, she was slashing a ten-inch curve between the ribs on the left side. "Rib spreader," she said tersely as a flood of dark congealed blood cascaded out onto her. She held out her right hand and a nurse passed her a ratcheted double-bladed retractor. Sax forced it between the ribs and cranked it open, exposing a deflated lung and a flaccid heart. Deb stepped up next to her, breathing hard, but her hands were steady.
"Open the pericardium and massage the heart manually," Sax instructed. She leaned away slightly so Deb could move closer, bending a bit to watch as her fellow made a slit in the protective covering enclosing the heart. "Not too deep now-stay away from the coronaries. That's it …nice. Get your hand around it."
Without raising her head, Sax announced, "The heart's still empty. Come on, people, pump the blood." Quietly, she encouraged, "That's it, Stein. Hold it in the palm of your hand and keep the pressure even."
"We're getting something on the EKG," Aaron announced.
"Rate?" Sax asked without looking away from the gaping hole in the man's body.
"Still only 40."
"Push some atropine," Sax instructed. She and Deb Stein were so close their bodies were practically fused. "Keep going, Deb. You've got it."
Jude tore her gaze from Sax's face and looked at the clock. Two minutes and ten seconds.
"I've got a blood pressure," one of the nurses called.
"The heart's beating," Deb murmured, almost as if she didn't believe it."
"Stop the compression and see if he flies," Sax ordered.
For a minute no one breathed. The EKG beeped steadily, the arterial line read a blood pressure of one hundred, and the blood flow from the chest wound slowed to a trickle.
"Tell the OR we're coming up," Sax said, a victorious note in her voice. She glanced up then, her gaze meeting Jude's. A grin flickered at the corner of her expressive mouth.
Jude saw the triumph dance in Sinclair's blue eyes. It was one of the sexiest things she'd ever seen.
*****
July 1 - 7:35 p.m.
Sax raised an eyebrow in surprise as she walked through the surgeon's lounge toward the door leading into the women's locker room. The common space between the locker rooms and the operating room proper was empty save for Jude Castle, who sat writing in a notebook at the long wooden table that held remnants of a pizza and a white layer cake.
"You're here late," Sax remarked, stopping opposite the filmmaker, who glanced up and smiled.
"I was waiting for you." Jude pushed her work away and studied the surgeon, noting the dark patch on her thigh that could only be blood and the sweat dampening the shirt between her breasts. She looks tired, Jude thought, and the thought surprised her. She realized that she hadn't imagined the formidable trauma chief being vulnerable to something so common, and then wondered where that idea had come from.
"Really," Sax remarked, her tone curious. "Why?"
"Because I owe you an apology."
Sax rubbed her face briefly, blew out a breath, and pulled out a chair opposite the redhead. She recalled their last heated exchange now, although it seemed longer than just a few hours ago. She remembered being angry, but certainly couldn't remember anything that required an apology. And somehow the idea of this woman apologizing to her seemed wrong. They'd both been rather hot. "Look, Ms. Castle-"
"No, let me finish," Jude interjected, amused to see a quick flash of annoyance in the other woman's eyes. Not used to being interrupted, are you? "You were right about limiting my crew in the admitting area. It's a zoo in there during a trauma alert. I should have waited to assess things myself before I told you what I needed. I'll work something out."
"Okay, I appreciate you making the adjustments. Thanks," Sax said. Then she added, "I notice you're not apologizing for threatening to pull rank on me."
"No, I'm not."
Sax stood. "Fair enough. Deb Stein is on call tomorrow night. You'd better get some rest if you're going to start keeping surgeon's hours."
"Are you done for the day?" Jude called as Sax walked away.
"Soon," Sax said as she pushed open the door to the locker room. She knew that she'd probably spend the night on the narrow bed in her on call quarters, because it was somehow less impersonal there than the space she called home, but that wasn't something she wanted to share.