Chapter 1

 

Bonny Blankenship

 

It wouldn’t be a secret much longer.

 

Behind the locked exam room door, I held the phone to my ear with the particular thrill and sense of finishing a job well done. All the planning, all the night shifts and research papers and grueling interviews had finally led to this job offer as the new emergency room director at Emory Hospital in Atlanta. It wasn’t that I didn’t love my job as an ER doc in Charleston; I actually did. It was that I needed to leave Charleston. If I was going to leave my husband, then I needed to leave the city where his family was as entrenched as Fort Sumter.

 

No one knew about this change or move, except of course the administrator on the other end of the line.

 

“Let me ask you something,” she said. “I’m just curious. When did you know you wanted to be a doctor? Your path has been as straightforward and unwavering as I’ve ever seen.”

 

“I knew when I was eight years old.” I fiddled with the oxygen gauge on the wall, straightened the tissue paper covering the exam table. How very many times I’d been here saving a life, or calming a woman who believed her husband was having a heart attack when he was experiencing a panic attack. I’d inserted IVs, administered CPR, stitched and set and soothed. I’d diagnosed correctly and incorrectly, and spent my hours untangling confusing symptoms in this room—the same room where I was accepting my new job.

 

“Well, your dedication has paid off. Congratulations, Dr. Blankenship.”

“Thank you so much,” I said. “I’m thrilled for this new chapter in my life.” I spoke in a low voice, almost a whisper. “Will you please allow me a couple days to inform my hospital before you announce it there?”

 

“Of course. You just let us know when you’re ready and we’ll get things rolling on our end. We look forward to seeing you in thirty days.”

 

“Absolutely,” I said, this time louder. “I will see you then, and I’ll be in touch.”

I hung up with an irresistible need to let out a joyful “yes!” but instead I returned to the emergency room to do my job. I would quietly fulfill my duties while inside I celebrated the last accomplishment before I left my husband and this city.

Make sure Piper was off to college. Done.

 

Fix the old family river house in South Carolina to sell. Almost done.

 

Get a new job out of town. Check.

 

The ER at Medical University of South Carolina, affectionately called MUSC, was as familiar to me as my own home, maybe even more so. There was the squeak of shoes on the linoleum, the beeping of machines and the harsh ringing of phones. The soft swish-hush of the doorways opening and closing, the antiseptic aroma sometimes mixed with the metallic smell of blood and sweat. The nurses and doctors here were like family. I’d spent long hours with them in the intimate confines of small rooms and cramped hallways, but soon I would give them up as I would so many other things—the cost of being free to start a new life without Lucas.

 

When had I known I wanted to be a doctor? The administrator’s question echoed in my mind. There were insights I’ve known slowly, like the need to leave Lucas. And there were others that happened in a flash, like wanting to become a doctor.

When I was eight years old I saw a toddler drown. The lifeguard pulled a lifeless three-year-old body from the deep end’s faraway bottom under the high dive and then screamed for a doctor. A woman, another child’s mother in a pink and green Lilly bathing suit cover-up, appeared and kneeled before the body. She then breathed and pumped life back into the little girl. When the child sputtered and coughed and cried for her mama, the dead risen to life, a true-world Lazarus from Sunday school lessons in a little girl’s body, I knew what and who I would become. I never learned that mom’s name, but I think of her often—a doctor and a mom. In that moment, all the world flowered open with possibility. There was no either/or. There was anything and everything.

 

From that point on, while others had photos of John Travolta and Stevie Nicks on their walls, I’d had anatomy posters labeling the muscles and veins and organs. A full-size plastic skeleton I’d begged my dad to buy me from a flea market in downtown Atlanta stood sentinel on a metal pole in the corner of my childhood room.

 

I became a doctor for the same reasons I imagined others became astronauts—to explore an unknown that spreads into infinity. The body is something that can never be fully discovered, its intricacies astounding and its mysteries boundless. Just when science understands what one organ or cell does—a liver or a stem cell—we are wrong, or partly wrong, and there’s more, always more.

 

I’d never wavered or turned back from the desire.

 

That particular unseasonably warm May afternoon, the air crackled with lightning and the emergency room felt overcharged and electric. I’d filled in an extra shift for another doctor, not only for the extra padding in my paycheck, but also for the itchy need to be away from home as much as possible. The house felt empty and lifeless without Piper in it. Loneliness echoed along the hallways and through the rooms of my immaculate house. But I tasted a new life waiting for me. It was time. I’d been patient and I’d been meticulous.

 

I went from exam room to exam room, writing orders on charts, listening to patients and writing prescriptions with both skill and intuition. Just before sunset, I sat in a cubicle stitching the forefinger of a young mother who had cut herself in the most mundane of ways—slicing carrots. Just one more patient. Just one more shift.

 

Exhaustion held tight to me, even as I poured another cup of bitter coffee from the break station and splashed cold water on my face in the doctors’ locker room. The months of double shifts, the many sleepless nights and the low thrum of constant worry had taken their toll. My sympathetic nervous system was on high alert, the fight-or-flight adrenaline pushing me forward against my will. Secret keeping depleted me as if each withheld word and admission rotted the life out of me. Fatigue and blurry-mindedness were the prices I paid for finding my way out of my marriage.

 

But in a breath, the evening shifted. A multi-car wreck and a kite-boarding accident blew through the double doors within minutes of one another. Screams, slamming doors and sirens arrived as the accouterments of emergency.

Time bends and slows for me in emergency situations; I don’t feel the fear until it’s over. I see with acute vision and can tell everyone what to do and when and how. I know the reasons for this are chemical—adrenaline from the adrenals, serotonin from my neurotransmitters—but I also know it’s what I’m meant to do.

 

The first stretcher came through: a man with dark, windswept hair and an arm twisted at such an odd angle that for a moment there was an illusion of two people on the same gurney because that would be the only way that arm would make sense. He was silent, his jaw clenched as he bit down, teeth on teeth—a controlled pain until it wrenched free in a groan.

 

I ran to his side and I felt the world tilting beneath my feet. My heart pulsed high into my throat and my arms tingled. I couldn’t make sense of his face here in my ER—so familiar and in pain—but the electric shock under my ribs told me what I knew before my mind could piece things together. Time warped and stood still, moved backward and then forward.

 

Owen McKay. This was the man who held both my childhood and my heart in his wild hands. My best friend Lainey’s brother.

 

Until he rolled in on a stretcher, I hadn’t seen Owen McKay in over twenty years, since the night before my wedding to Lucas. Why was he here? Wasn’t he somewhere with wilderness and cliffs and silence?

 

“Owen?”

 

“Bee.” He opened his eyes. They were the same deep brown but filmed with pain.

 

“What are you doing here?” I asked as if I’d run into him in a bar or on the street, a casual old friend.

“Kiteboarding.” A low groan escaped as he tried to speak. “The wind took me. I . . .”

“Doc,” the paramedic shouted at me. “What room?”

 

“I got this.” I grabbed the stretcher’s cold metal edge, rolling it into the cubicle with two other nurses. The paramedic rattled off the facts of his injuries: broken collarbone, possible internal bleeding, probable water in his lungs, dislocated shoulder and possibly more.

 

I went into automatic mode and activated trauma protocol: I ordered the ultrasounds, the IV line, the vital signs and the fluids. Owen faded in and out, and the paramedics professed another fact: he’d almost drowned. A surfer on the beach had administered CPR. I hollered orders, desperate to keep him alive. It’s this way with every patient, but I’m not in love with every patient.

 

Past and present blended. He was flat on the stretcher with his eyes closed; he was flat on a splintered warm dock in South Carolina, holding my hand and stargazing. He was calling my name in pain; he was whispering my name to jump into the river. He was holding his arm above his head with a broken bone; he was waving at me across the beach. He was old and he was young and we had all our life ahead of us and then none at all. I would have to tell Lainey, call her. She’d be devastated and worried because that’s what she did—worried about Owen. But first, very first, I would have to save him.

 

Later, maybe ten minutes, another doctor, Marie, called for me. Owen had been wheeled into surgery, and I rushed off to the next urgent need: in cubicle C was one of the victims of the multi-car crash. Others were being treated in separate rooms, doctors and nurses on call from all parts of the hospital to pick up the load. This patient was older, his hair gone gray but wavy and thick, like a young man’s. This patient’s heart rate was high and erratic; his blood pressure was dropping and his pupils were dilated. Same course of action: trauma protocol, and immediately he had two large-bore IV needles in his veins and Lactated Ringer’s coursing through the tubes to his body. I ordered a fast exam ultrasound that showed abdominal bleeding. He needed to go straight to the OR. No CAT scans, no X-rays. “Oxygen sat low. Restless. Blood pressure dropping. We have stage three shock and he needs to get to the OR stat,” I called out.

 

This man screamed, blind in his pain, his gaze searching for help. I didn’t check his chart but drew a dosage of Dilaudid, the same dosage I’d just given Owen, and pushed it into his IV, relief only moments away as it coursed through his blood and dulled the agony.

 

Then his eyes flew open, and his gaze fixed on mine. He reached his hand out, bloody and mangled from the car where he’d been trapped; they’d released him with the Jaws of Life. Fear surrounded him like wavering fog.

 

“If I’m dying,” he said in a voice strangled with pain, “tell my wife and kids I have never loved anyone as I love them. Tell them.”

 

I’d been here before with patients who’ve said the same thing. It’s a natural instinct—don’t let me leave this world and let those I love have any doubt that I love them. Love—it’s the final word of so many and ultimately all that remains.

Not very often do humans get to see all that truly matters, but I often do. Those fearful of death don’t say, “Tell my wife to check my bank account.” Or “Do I look okay?” They talk of love and making sure those around them know of their love. Mostly.

 

“Stay with me,” I said to him, motioning to the nurse to grab the end of the stretcher. “You can tell them.”

 

He winced as the nurse and orderly prepared to move toward the OR, but he didn’t release my hand. Sometimes patients don’t realize they’re holding on to me as they hold on to life.

 

He closed his eyes and spoke on an exhale. “God, please let me live. I haven’t done the one thing I meant to do.”

 

“What?” I asked as we ran down the hallway. The surgical suite doors swished open and we pushed his gurney inside. I bent over and he focused directly on my eyes, steady.

 

I’ve seen people die before, many times. I’ve seen the light fade slowly or sometimes in an instant, how the body becomes only that—a body, a vessel, which once held animation or spirit. And he was fading.

 

“Tell me about your one thing. What is it?” I needed to keep him talking, let him find a reason to live. “Tell me.”

 

But this was not a slow fade; it was instant, immediate and final. He was gone. Completely. His pupils dilated, filling the blueness of his eyes with darkness. He exhaled without inhale. His mouth slackened and his limbs fell free to dangle from the sides of the stretcher.

 

“Code blue,” I screamed.

 

They arrived quickly—the nurses and the other doctor, Marie, with the paddles and the intubation tubes, but I knew it was no use. You come to know these things. This would be one of those times when I would grope my way through the darkness and into the waiting room to gather the family. I wasn’t up for it. I wasn’t ever up for it. I needed to save, not lose.

 

His wife ran into the emergency room; she’d come after she received a call from the police. In the consulting room with her, I was so detached and alert it was as if I’d left my body with the gray-haired man on the stretcher. Her name was Tory, and she wore cropped white pants and a pale blue button-down; her long white hair was pulled back in a tortoiseshell barrette.

 

“His wounds were too traumatic. He didn’t make it,” I said. “We’ll know more after an examination, but we did everything we could. Everything. He was on his way to the OR when he died.”

 

Already, even as I spoke to her in the robotic words I’d had to say before to others, I felt the hum of something amiss. What med had I ordered? Had I done it for Owen or for the gray-haired man or both? It was a vertiginous feeling, as if I were jumping from the cliffs of the Grand Tetons with Owen, where I’d last known him to be, but without the wings or the parachute. Nausea rose and I clenched down on my throat to talk to Tory.

“No,” she said quietly. “No.”

I was silent and untethered. Owen was still in surgery; the night, elongating and spreading out like an oil stain, already changing my life.

 

“Did he say anything? Was he in pain? Did he . . .” She dropped her head into her hands and the wracking sobs began. “He’s my world.”

 

“He did,” I managed. “He did say something.”

 

“What?” She lifted her gaze as if this might change everything, maybe whatever he said would bring him back to life.

 

“He said to make sure that you and your kids knew how much he loved you. That he had never loved anyone as he did all of you. Those were his last words.” It was a partial truth.

 

The next sob seemed to tear her into two, and she fell to her knees. She shook her head so violently that her barrette fell loose, clattering to the floor.

I dropped my hand onto the back of her head, felt the warmth of life and the living. “I’m sorry.”

 

The overhead speaker bellowed my name over and over. Dr. Blankenship. Dr. Blankenship.

 

“Someone will be in shortly to help you.” This was where the nurses and social workers and chaplains took over; this was where I exited.

 

For all my training, despite all I knew, all I could know, I couldn’t save a gray-haired man who bled and suffered. It seemed the simplest thing in fact—car wreck; internal injuries; broken bones—but it wasn’t ever simple. I hobbled back to the exam room where he’d been and flipped his chart open: he’d been given the same dose of pain medicine in the ambulance. I hadn’t checked and they hadn’t told me. A slow tingle of panic began in my fingertips and worked its way to my lungs, where it stole the air. Had I given him an overdose of pain med?

Later that night, almost into morning, I stood in the parking lot of the hospital, the sky folding over me, and I bent over to be sick. The wracking heaves felt like food poisoning or flu, but I knew it was neither—this was fear and its minions of shame and desperation. Maybe, for the first time, I’d contributed to death instead of life. But I knew that if I’d been given a choice in that moment, if someone had said, “You can save only one of these men,” I would have chosen Owen. There wasn’t a heartbeat’s hesitation.

 

But no one had asked. A choice hadn’t been offered. In fact, there’d never been a choice; I’d done my best for both. Yet still a dark cloak of fear fell over me: Oh, dear God, did I make a mistake?