Bloodstream

He stood up and shoved his chair to the floor. ‘Fuck you!’

‘You are suspended as of right now! You’ve been sullen and disrespectful all week. This is it, buddy. You’re out of here!’

He kicked the chair. It bounced up the aisle and crashed into a desk. Grabbing his shirt, she tried to march him toward the door, but he twisted free and shoved her backwards. She fell against a desk, toppling the jar. It shattered, and frogs leaped free, scattering away in a writhing carpet of green.

Slowly Mrs Horatio rose to her feet, fury blazing in her eyes. ‘I’m going to have you expelled!’

Taylor reached into his backpack.

Mrs Horatio’s gaze froze on the gun in his hand. ‘Put it down,’ she said. ‘Taylor, put it down!’

The explosion seemed to punch her in the abdomen. She staggered backwards, clutching her belly, and dropped to the floor with a look of disbelief. Time seemed to halt, frozen for one interminable moment as Noah stared down in horror at the bright river of blood streaming toward his sneakers. Then a girl’s terrified shriek pierced the silence. In the next instant, chaos exploded all around him. He heard chairs slam to the floor, saw a fleeing girl stumble and fall to her knees in the broken glass. The air itself seemed misted with blood and panic.

Another gunshot exploded.

Noah’s gaze swept around in a slow-motion pan of fleeing bodies, and he saw Vernon Hobbs tumble forward and crash into a desk. The room was a blur of flying hair and churning legs. But Noah himself could not seem to move. His feet were mired in a waking nightmare, his body refusing to obey his brain’s commands of Run! Run!

His gaze panned back across the chaos to Taylor Darnell, and to his horror he saw that the gun was now pointed at Amelia’s head.

No, he thought. No!

Taylor fired.

A streak of blood magically appeared on Amelia’s temple and the rivulet slowly dripped down her cheek, yet she remained standing, her eyes wide and focused like a condemned animal’s on the gun barrel. ‘Please, Taylor,’ she whispered. ‘Please, don’t…’

Taylor raised the gun again.

All at once, Noah’s legs broke free of their nightmare paralysis, his body moving of its own accord. His brain registered a multitude of details at once. He saw Taylor’s head come up, face rotating toward Noah. He saw the gun slowly sweep around in an arc. He saw the look of surprise in Taylor’s eyes as Noah came flying at him.

Another bullet exploded out of the barrel.

‘I’ve just noticed my patient was admitted. Why didn’t anyone call me?’

The ward clerk looked up from her desk and seemed to shrink when she saw it was Claire asking the question. ‘Uh…which patient, Dr Elliot?’

‘Katie Youmans. I saw her name posted on one of the doors, but she’s not in the room. I can’t find her chart in the rack.’

‘She was admitted just a few hours ago, through the ER. She’s in X-ray right now.’

‘No one notified me.’

The clerk’s gaze dropped like a stone to her desk. ‘Dr DelRay’s taken over as attending physician.’

Claire absorbed this dismaying news in silence. It was not uncommon for patients to switch physicians, sometimes for the most trivial of reasons. Two of Adam DelRay’s patients had transferred to Claire’s practice as well. But she was surprised that this particular patient would choose to leave her care.

Sixteen years old, and mildly retarded, Katie Youmans had been living with her father when she was brought in to see Claire for a bladder infection. Claire had noticed at once the circumferential bruises on the girl’s wrists. Forty-five minutes of gentle questioning and a pelvic examination had confirmed Claire’s suspicions. Katie was removed from her father’s abusive household and placed in foster care.

Since then, the girl had thrived. Her bruises, both physical and emotional, finally faded. Claire had counted Katie as one of her triumphs. Why would the girl switch doctors?

She found Katie in X-ray. Through the small viewing window, Claire saw the girl lying on the table, her lower leg positioned beneath the X-ray tube.

‘Can I ask what the admitting diagnosis is?’ Claire asked the tech.

‘They told me cellulitis of the right foot. Her chart’s over there, if you want to look at it.’

Claire picked up the medical record and flipped to the admission note. It had been dictated by Adam DelRay at seven A.M. that morning.

Sixteen-year-old white female who stepped on a tack two days ago. This morning she awakened with fever, chills, and swollen foot…

Claire skimmed the history and physical, then turned the page and read the therapeutic plan.

Quickly she picked up the phone to page Adam DelRay.

A moment later, he walked into X-ray, looking crisply starched as usual in his long white coat. Though he had always been cordial toward her, he had never displayed any real warmth, and she suspected that under his Yankee reserve burned a masculine sense of competition, perhaps even resentment, that Claire had lured away two of his patients.

Now he had laid claim to one of hers, and she had to suppress her own feelings of competitiveness. Only the well-being of Katie Youmans should concern her now.

‘I’ve been following Katie as an outpatient,’ she said. ‘I know her pretty well, and –’

‘Claire, it’s just one of those things.’ He lay a reassuring hand on her shoulder. ‘I hope you don’t take it personally.’

‘That’s not why I paged you.’

‘It was just more convenient for me to admit her. I was in the ER when she came in. And her guardian felt Katie needed an internist.’

‘I’m perfectly capable of treating cellulitis, Adam.’

‘What if it turns into osteomyelitis? It could get complicated.’

‘Are you saying a family physician isn’t qualified to take care of this patient?’

‘The girl’s guardian made the decision. I just happened to be available.’

By now Claire was too angry to respond. Turning, she stared through the window at her patient. At her ex-patient. Suddenly she focused on the girl’s IV, and she noticed the handwritten label affixed to the bag of dextrose and water. ‘Is she already getting antibiotics?’

‘They just hung it,’ said the X-ray tech.

‘But she’s allergic to penicillin! That’s why I paged you, Adam!’

‘The girl never said anything about allergies.’

Claire ran into the next room, snagged the IV line, and closed off the infusion. Glancing down at Katie, she was alarmed to see the girl’s face was flushed. ‘I need epinephrine!’ Claire called out to the X-ray tech. ‘And IV Benadryl!’

Katie was moving restlessly on the table. ‘I feel funny, Dr Elliot,’ she murmured. ‘I’m so hot.’ Wheals had swollen on her neck in bright blotches of red.

The tech took one look at the girl, muttered ‘Oh, shit,’ and yanked open the drawer for the anaphylaxis kit.

‘She didn’t tell me she was allergic,’ said DelRay, defensively.