Between You and Me Read online

  Reese blinked away the last of the foiled nap and took a deep breath. I will do right by my patients. This was her mantra, the one she’d adopted as a fourth-year medical student. I will do right by my patients. She had spent three years studying, cramming her head full of knowledge, memorizing, observing, but this year, the year she would earn the title of doctor, she set one simple, powerful task for herself: do the right thing.

  One of the things she liked about working in the ER was the element of surprise. You never knew what was coming through the door next. Her parents had been appalled when she’d informed them of her interest in the ER. They had been pushing her toward pediatric surgery, and they expected her to explore something closer to that field. But for once, she had dared to inch a little to the left of their proposed path. She wanted more experience in emergency medicine. And Mercy Heights had a level-one trauma center, the best in Philadelphia.

  Patients, family members, and personnel were clustered around the admittance center, the nucleus of the ER. As she scanned the area for Mel, a nurse stuck her head out of an exam room.

  “Oh, good, you’re here,” she said. “We need someone who speaks Spanish. We’ve got a one-woman shitstorm.”

  Reese hurried into the small room. “What have you got—oh.” For a second, she just stood there, trying to take in the scene. The patient was a young dark-haired woman in a stained dress, crouched on the bed, her posture defensive and her eyes cloudy with fear and distrust. Someone was asking her what she took, when she took it, but she recoiled from the questions.

  “They found her wandering on the street,” said the nurse. “All we know so far is that she’s pregnant. And probably altered. She told the EMTs she was intoxicated. We’re trying to find out what she took.”

  A security guard stood ready, restraints in hand. Mel shook his head. Reese knew he feared things would escalate if they tried to restrain her.

  “This is not a place of healing,” the woman said in rapid-fire Spanish. “This is a place of death, a place of eternal curses.” Then she lapsed into a muttered prayer.

  Reese’s Spanish kicked in. She spoke the colloquial version she’d learned from Juanita, her childhood nanny. Growing up, she’d spent more time with Juanita than she had with her busy, ubersuccessful parents. Putting on a warm, professional smile, she slowly walked toward the woman. “Hola, señora,” she said softly. “¿Qué pasa?”

  At the sound of her native tongue, the woman stopped speaking and glared at Reese. “I’m Reese Powell,” Reese continued in Spanish, never losing eye contact. “My colleagues and I would like to examine you, and make sure you’re all right.”

  “Get away from me. These are bad people.”

  “We want to help you,” Reese said. “Do you understand English?”

  “No. No English.”

  “Please, may I ask you some questions?”

  “My secrets are mine to keep.”

  “Sometimes it is best to share a secret. Is this your first baby?”

  “Yes.” The woman unfurled a little, dropping her arms from her drawn-up knees.

  “What is your name, ma’am?”

  “My name is Lena Garza.”

  “How old are you, Lena?”

  She hesitated. “Nineteen.”

  “Ask her what she took,” someone said. “We heard her say she’s intoxicated.”

  Reese studied the drawn, olive-toned face. The girl looked older than nineteen, her deep brown eyes haunted and scared.

  “You were wandering around in traffic,” Reese said, rapidly translating for one of the EMTs. “Why were you doing that? Did you take something?” She had been taught to practice empathy—direct eye contact, a physical touch—and at first, reaching out to a stranger in this way had felt strange to her. Now that she’d been at it for a while, the gestures felt natural. It was gratifying to see the woman relax slightly, taking a deep breath before she spoke.

  Lena Garza twisted the band of silver she wore on her forefinger. “Estoy intoxicada.”

  “Ask her what—”

  “Wait,” Reese said. “Intoxicada just means that she ingested something. Could be food, a drug, anything that makes a person sick.” She turned to Lena. “Can you tell me what you took?”

  “My mother told me I will burn in hell,” she whispered. “I am not married. That is why I took the herbs.”

  Reese’s heart skipped a beat. “She took something,” she told Mel in English. “What did you take, Lena?”

  The girl reached into the pocket of her faded dress and drew out a crinkly cellophane bag. “She said this would cause my period to start.”

  Reese grabbed the bag and showed it to Mel. “Angelica. Said to have abortifacient properties.”

  Mel sniffed the yellowish-brown herb. “Also called dong quai. When did she take it? Was it within the last four hours? How much did she take?”

  Reese asked the patient.

  “I don’t remember. I will burn in hell,” she moaned.

  “Only if you die,” Reese said in Spanish. “And we are not going to let that happen, not today.”

  Mel said, “We’re going to need a gastric lavage, stat.”

  While the techs prepared the lavage tray and measured activated charcoal into a beaker, Reese coaxed a bit more information from the patient—When did she have her last period? Had she seen a doctor? Where did she live?

  Reese reported the answers, then convinced the woman to lie back and be connected to monitors. “I’m going to have a listen to your baby, all right?” She gently lifted the dress and slid the gel-slicked Doppler wand over Lena’s flat belly, trying to detect heart sounds.

  “Ay!” the patient yelled. “That is cold. You torture me.”

  “I’m sorry,” Reese said. “We need you to be still and be quiet. We’re trying to hear your baby’s heart sounds . . . There it is,” she said as the Doppler emitted a rhythmic wow-wow-wow. “That’s the sound of your baby’s heart.”

  Lena went limp on the table and laid her forearm over her eyes. “Yes,” she said. “I hear it. I can hear it. My mother says it’s a sin to have a baby before I’m married.”

  Reese let the moment stretch out a few seconds longer. Then she said, “Mothers aren’t always right about everything.” She offered a brief conspiratorial smile. “Mine thinks she is, though. Let us take care of you, and when you’re feeling better, someone will talk to you about your options.”

  She explained the lavage process and convinced the girl to cooperate by swallowing the gastric tube. The girl gagged and fought, but Reese kept up a soothing patter, the way Juanita used to when Reese was small and scared of the dark.

  A short time later, Lena’s eyes were closed, and her hands lay slack on the sheeting. Mel gestured, and Reese followed him out to the corridor. “You did a good job in there,” he said. “She’ll be ready to turf out before you know it.”

  Reese thought about the disturbed young woman, her frightened eyes and the strange, deep knowing that lived in her like an old, old soul. “Before you turf her, let’s get someone to talk to her about her choices. I’ll be the interpreter.”

  “That’s a great idea,” Mel said. “I’ll call social services and OB/GYN.”

  Moments like this gave Reese a feeling of satisfaction. An overachieving fourth-year at the end of a long rat race, she was full of plans, but full of questions, too. Her parents had their own plan for her—acceptance into an elite residency program, a path to join their carefully built practice. But sometimes, the wall of her armor cracked open to reveal a glimpse of something else—another dream, maybe. A different dream, not her parents’ goals.

  At the end of the hallway, the double doors burst open and Jack Tillis, the chief of trauma, swept through. His lab coat wafted open like a set of wings. He was surrounded by his team of devoted acolytes—the residents, nurses, support staff, and technicians who made up the trauma team.

  “What’ve you got?” Mel asked, perking up.

  “Just had a
red phone pre-alert. Major trauma, coming in by life flight,” another resident said. “ETA twenty minutes.”

  Reese exchanged a glance with Mel. She felt a twist of anticipation in her gut. “Can I help?”

  The resident nodded. “You don’t want to miss this one. Some kid had his arm ripped off in a farming accident.”

  The helicopter descended from the sky like a huge metallic insect, its giant rotors beating the cornstalks flat against the dusty field. Kneeling on ground soaked by his nephew’s blood, Caleb instinctively leaned forward over the boy’s body, which lay on the rescue workers’ shiny yellow board. The shadows of his neighbors and the rescue workers fell over him, blocking out the morning sun. Above the violent rhythm of the chopper blades, he could hear crackling radios and shouts, but all his attention stayed focused on Jonah.

  Only a short time earlier, Jonah had been racing across the field to help fill silo, something he had done dozens of times before. Now he lay broken and bleeding, his left arm and his boyish face slashed by the vicious metal teeth of the shredder. And despite the injuries, Jonah was sweetly, horrifyingly conscious.

  White-faced, blue-lipped, his eyes dull with shock as his life drained away, the boy tried to speak through chattering teeth. “Cold,” he kept saying. “I’m ssso . . . cold.”

  “I’m here, little man,” Caleb said, his voice a rasp of panic. “I’ll keep you warm.”

  The rescue workers had immobilized the arm with an air bladder and enclosed his neck in a stiff collar. They covered him with every blanket they had, but it wasn’t enough to keep Jonah from shivering like a leaf in the wind. Then they prepared to load the stretcher into the helicopter.

  “You cannot take him in that . . . that thing.” Caleb’s father stepped forward, thumping his hickory cane on the ground. “I won’t allow it.”

  From the moment the county rescue crew had declared that Jonah’s only hope of survival was to be airlifted to a trauma center in Philadelphia, there had been a division in the community. Dr. Mose Shrock, who supervised the emergency services of the local hospital, had been contacted by phone. He’d confirmed the rescuers’ plan, and Caleb had approved the transport without hesitation.

  Now his face felt carved in stone as he glared at his father. “They’re taking him,” he said simply. “I’ll allow it.”

  “Sir, you’ll have to step aside,” a man shouted, jostling in front of Asa. “We’re going to load him hot, while the chopper’s still going.”

  “These people will take care of you,” Caleb said to his nephew, climbing to his feet. “I love you, Jonah, don’t ever forget I love you.”

  “Uncle Caleb, don’t leave me.”

  Despite the noise of the beating rotors, Caleb heard his nephew’s faint plea, piercing his heart.

  The nurses and paramedics of the life flight lifted the board as the pilot did a walk around the helicopter, checking the landing area. Jonah was lost amid a pile of blankets and gear. His blood stained the ground everywhere.

  “I’m going with him,” Caleb said loudly. “I have to go with him.”

  A nurse in a utility vest looked at him, then over at Jonah.

  “Please,” Caleb said. “He’s just a little boy.”

  “It’s the pilot’s call. I’ll see what she says about the fly-along.”

  Caleb turned and found himself face-to-face with his father. Asa held his hat clapped on his head to keep it from being blown away by the rotors. His straight-cut coat and broadfall trousers flapped in the wind. He stood flanked by the neighbors, forming a somber wall of fear and disapproval.

  The last thing on Caleb’s mind was Amish Ordnung. Clearly it was uppermost in the minds of his father and the elders.

  “If it’s God’s will that the boy is to survive,” Asa stated, “then he will do so without being lifted into the sky.”

  Caleb didn’t trust God’s will, and he hadn’t in a long time. But he didn’t argue with his father. He hadn’t done that in a long time either.

  Hannah rushed to his side. Her face was pale gray and awash with tears. “You have to go, Uncle Caleb. You have to.”

  Alma Troyer stepped forward, her mouth set in a firm line. She cut a quick glance from Asa to Hannah. “You go, Caleb. I’ll keep Hannah with me while you’re away.”

  The flight nurse touched his arm. “You’re in. The pilot said you can come.”

  Caleb nodded and turned to his father. “I’ll call.” The Amish families shared a phone box in the middle of the village, its use limited to necessary business and emergencies. Without waiting for a reply, he turned on his heel and followed one of the EMS technicians to the chopper.

  In a tangle of tubes and monitors, Jonah was being loaded into the side bay of the shiny blue helicopter. “Whoa, you’re a tall one. Keep your head low,” a technician cautioned Caleb, pointing upward. “Stay to the front and left of the chopper.”

  Hardwired to her radio equipment, the pilot glanced at Caleb. “You’re a big fella,” she yelled. “What do you weigh?”

  Caleb never weighed himself. “Two hundred pounds,” he estimated, aware of the broad blade swinging overhead. He was nineteen hands tall, judging by the draft horses he worked with. Well over six feet. He was definitely at risk of having his head lopped off by the rotating blade.

  “Our weight limit’s two-twenty,” the pilot said. “Let’s do it.”

  The technician kept his hand on Caleb’s shoulder and guided him aboard. Someone tossed his hat to him. They showed him where to sit and how to strap himself in. In the cramped space, he was close enough to Jonah to reach the boy, but he couldn’t figure out a place to touch. He rested his hand somewhere—the kid’s foot. Even through layers of thermal blankets, it was cold as ice.

  “Jonah,” he said, “I’m with you. Hear me? I’m coming with you.”

  He was given a set of headphones with spongy earpieces. Radios crackled and screeched. Monitoring equipment beeped, straps and clamps were locked into place. A mask was put over Jonah’s nose and mouth, and one of the workers squeezed an air bag at regular intervals. In minutes, the doors were pulled shut. The pilot rattled off a series of orders, simultaneously checking things in the cockpit and snapping a series of switches and levers. With a roar of increasing power, the chopper lifted straight off the ground.

  Caleb’s stomach dropped, and the breath left his lungs. Through a rounded glass opening, he saw the people gathered near the landing site. Neighbors and friends, his father still holding his hat to his head, growing smaller and smaller as the copter ascended into the sky. They looked like a black-and-gray cloud against the golden fields. Hannah lay crumpled on the ground, her skirts surrounding her like an inkblot. Someone should go to her, put a hand on her shoulder to reassure the girl. But no one did.

  The helicopter passed the silo in the blink of an eye, but in one glimpse Caleb could see the conveyor slanting up to the opening, the shredding machine positioned at the top. And on the ground, on the green-and-brown earth where the farm had stood for generations, he saw the livid stain of his nephew’s blood, oddly in the shape of a broken star.

  The helicopter nurse was yelling information into a radio, most of which Caleb barely understood. Jonah’s BP and respiration, absent pulses distal to the injury site, other things spoken in code so rapidly he couldn’t follow. He did catch one word, though, loud and clear.

  Incomplete transhumeral amputation.

  Amputation.

  The helicopter lurched and careened to one side. Caleb pressed his hand against the hull to steady himself, and his stomach roiled. Another feeling pushed through his terror for Jonah, a feeling so powerful that it made him ashamed. Because in the middle of this devastating trauma, he felt an undeniable thrill. He was up in the air, hovering above the earth, flying.

  All his life he had tried to imagine what it was like to fly, and now he was doing it. So far, the experience was more amazing and more terrible than he’d ever thought it would be. The land lay in squares made of diffe
rent hues of green and yellow and brown, stitched together by pathways and irrigation ditches. Shady Creek was a slick silver ribbon fringed by bunches of trees. There were toy houses connected by walkways and white picket fences, a skinny single-lane road with a canvas-topped buggy creeping along behind a horse. Caleb could tell it was the Zooks’ Shire, even from the sky. He knew practically every horse in Middle Grove.

  The chopper moved so fast that the view changed every few seconds, sweeping over the Poconos. The nurse finished punching buttons on some piece of equipment. “Sir,” she said to Caleb, “I need to ask you some questions about your son.” Her voice sounded tinny and distant through the headphones.

  No time to explain that Jonah wasn’t his son.

  “Yeah, sure.” At her prompting, he reported Jonah’s name, his age, the fact that he didn’t suffer from any allergies Caleb knew of. She wanted to understand the nature of the accident and he did his best to explain how the equipment worked, how the blades shredded the corn and blew it into the silo, how sometimes a piece got fouled up and needed an extra push with the next stalk in line. From the look on the woman’s face, he could tell his explanation was as incomprehensible to her as her medical jargon was to him. Another thing he could see on her face was the real question, the one she would not ask.

  How could you let a child work around such dangerous equipment?

  Caleb couldn’t even answer that for himself. It was the way things had always been done on the farm. From the time they learned to walk, kids helped out. The tiniest ones fed chickens and ducks, weeded the garden, picked tomatoes and beans. When a boy got older, he helped with plow and harrow, the hay baler, sheaves, fetching and carrying from the milk house, anything that needed doing. It was the Amish way. And the Amish way was to never question tradition.

  He tried to check on his nephew, but there was little of Jonah to see amid the tangle of tubes and wires and the guy squeezing the big plastic bulb into the boy’s nose and mouth. The chopper veered again, and the landscape quickly changed. Philadelphia was a bristling maze of steel and concrete giants arranged along the wide river and other waterways. The city had its own kind of strange beauty, made up of crazy angles and busy roads. Atop one of the buildings, a series of markings seemed to pull the chopper from the sky like a magnet.