“No,” Anil said. “I don’t want to move him. He might have a neck or spinal injury.” He took Baldev’s wrist and felt for his peripheral pulse: weak but steady. He held Baldev’s hand up to the light, but Mahesh stood in the way. “Get out of the light!” When Mahesh didn’t move, Anil glanced up. Mahesh wore a vacant expression. “Take him over there,” he said to Amber, nodding toward Mahesh. “He’s in shock. Make him sit down and put his head between his knees.”
As Amber urged Mahesh to the side, Anil inspected Baldev’s fingers and hands. He pressed on a fingernail, watching for any response from his friend. “Come on, bhai, open your eyes.”
“He won’t open his eyes?” Amber called out. “What does that mean? Is he unconscious?”
“Possibly. His eyes might just be swollen shut.” Anil pressed gently on Baldev’s brow bone. “He has so many other injuries, we have to be careful.” He rubbed his own forehead, then grabbed Baldev’s hand again and pressed as hard as he could on his thumbnail. “Baldev, come on, man. Give me a sign.”
An indistinct moan, barely audible, came from his friend. Anil leaned in toward him. “Okay, I heard that. I heard you, Baldev. Do you know where you are?” Anil placed his ear next to Baldev’s mouth, but if a response came, it was drowned out by the wailing of the ambulance siren in the distance. “Amber, go out to the street! Show them where we are.”
Amber glanced at Mahesh, who was sitting on the grass, head hanging between his knees, a blanket draped over his shoulders. Then she sprang up and ran across the parking lot, waving her arms overhead.
“Stay with me, bhai,” Anil said, gripping Baldev’s fingers. “I’m right here.” He looked over at Mahesh, who still had his head down and was rocking back and forth. “I’m right here with you.” As the ambulance approached with its blaring siren, neighbors began gathering in the passageway. Amber ran up, her face glistening with sweat. A medic jumped out of the ambulance and Anil stood up to meet him. “Anil Patel, PGY-4 at Parkview,” he introduced himself. “Is the Parkview ER accepting?”
The medic pulled on latex gloves. “Yup. That where you wanna go, doc?”
Anil nodded. “Patient suffered severe and repeated trauma to the chest, back, and face. Possible neck or spinal injury, so you’ll need to put him on a board.” Anil hammered out stats as the medic moved toward Baldev, while Amber tried to hold back the spectators. “BPM twenty. Pulse fifty-six. Minimally responsive. GCS below eight: E1c, V2, no motor response yet.” Anil was relieved neither Amber nor Mahesh could decipher his medical shorthand describing Baldev’s dangerously low level of consciousness. He caught Amber’s eye and pointed at Mahesh. “Make sure he drinks something with sugar.”
A second medic brought over the back board and, working in unison, the two of them stabilized Baldev’s head and neck and transferred him to the board. “Step back, clear out, folks,” one yelled to the gathering crowd.
Anil climbed into the back of the ambulance after them. Before yanking the doors shut, he called out to Amber. “Hey!” he yelled, unable to say her name. “Follow us to the hospital.”
19
IN THE AMBULANCE, THEY GAVE BALDEV OXYGEN AND IV FLUIDS, but he remained unresponsive except for a few muted groans escaping from the back of his throat. When they pulled into the Emergency bay at Parkview, the trauma team was waiting outside. The medics carried out Baldev’s gurney, relaying his vital stats. Anil looked around for the ER team leader and spotted a familiar stocky figure: Eric, the extreme athlete, pizza-sandwich eater, senior resident from Anil’s inaugural rotation who’d witnessed his inexperience firsthand.
“Patel!” Eric called at him across the gurney. “Dispatch radioed it in. Friend of yours?”
Anil nodded. “Severe trauma to chest, abdomen, and back. Multiple lacerations to face and hands. Glass shards still embedded.” He ran alongside the gurney through the hospital doors.
“Weapons?” Eric asked.
Anil’s vision swirled with the embroidery pattern on the toe of the cowboy boot, the beer bottle shattered under bare skin, the clenched fist as hard as a brick. The taunting voices echoed through his mind. Nigger. Paki. Towel head.
“Christ,” Eric said, shaking his head. “Your buddy really took a beating.”
They arrived in one of the trauma rooms, where a team of nurses and residents swarmed around Baldev’s gurney, pushing Anil out to the periphery.
“Okay, Patel, we’ll take it from here,” Eric said. His eyes traveled from Anil’s face to his bloody shirt. “You should get checked out too. Wait in Exam 2—”
Anil shook his head. “No. I’m staying here.” A nurse leaned past him to attach EKG leads to Baldev’s chest. “It’s not my blood, it’s his.” Both words and courage came easily for once. “Listen, Eric, I think he may have traumatic pneumothorax caused by a fractured rib on the right side.”
Eric put his stethoscope into his ears and listened. “No shortness of breath. Did you hear something with the scope?”
In his mind, Anil saw the thick black heel crashing down on Baldev’s unprotected spine. He heard the reverberation of the crack ring in his ears. “No,” Anil said. “But I noticed his chest rising unevenly when I checked his breathing, a little lower on the right than the left.”
“Okay.” Eric wrapped his stethoscope around his neck. “Let’s get him to Radiology for a CT scan. We can also rule out spinal injury, and see if he has broken bones—”
“No!” Anil interrupted. The nurse looked up at him, surprised. The rules of seniority clearly dictated Eric make the calls here; Anil was not even on duty tonight. “We can’t wait for a scan,” Anil continued. “He might need a chest tube. We should do an ultrasound right now. Right here, bedside.”
Eric stared at him for a moment. The protocol for a stable patient was a CT scan, and they were both well aware of it. Anil mentally prepared his defense. He knew he was crossing the line with Eric, two years his senior. And he didn’t give a shit.
“All right, Patel. We’ll do it your way,” Eric said. Over his shoulder, he bellowed, “Get me an ultrasound and chest tube cart.”
AMBER AND Mahesh were in the ER waiting area when Anil came out. As he crossed the room, other patients eyed his blood-stained clothes. Mahesh was staring at the floor, tapping his feet, a can of 7UP balanced between his knees. Amber leaped out of her chair when she saw Anil and threw her arms around his neck.
Mahesh stood up, looking weary but no longer dazed. “How is he?”
“He’s badly injured,” Anil said. “But he should make a full recovery.”
Mahesh exhaled, put his hand on Anil’s shoulder, and bowed his head slightly toward the floor. Amber covered her entire face with her palms and began crying.
“Fortunately, there was no damage to his neck or spine,” Anil said. “He does have a broken leg, a dislocated knee, a torn rotator cuff, and two fractured ribs, which caused his lung to collapse.”
Amber’s mouth dropped open, and she covered it with her hand.
“I know it sounds bad, but it could have been much worse. He regained consciousness briefly and was fairly lucid, so we don’t suspect any brain damage.”
Mahesh’s face contorted, as though he hadn’t considered this possibility. “What did he say?”
“He knew his name and what year it is,” Anil said. “He remembered what we ate for dinner at the restaurant and . . . what happened in the parking lot afterward.”
There was a long silence while they all considered whether this memory recall of Baldev’s was good or bad. Finally, Amber spoke. “Can we see him?”
“He’s under pretty heavy sedation for the pain right now,” Anil said. “We’re admitting him to the ICU, and he’ll probably stay there a few days. You should go home and get some rest. I’ll call you tomorrow when he wakes up.”
“Okay,” Mahesh said. “I’ll call his parents and his office.”
“Yes, good,” Anil said, relieved to see Mahesh back to his reliable self. He couldn’t bear any m
ore responsibility this evening.
After Mahesh and Amber left, Anil returned to the central desk where Eric stood, writing Baldev’s admitting orders. Anil waited for him to finish, bracing himself for censure.
When Eric looked up from his papers, his gaze rested on Anil’s battered cheek for a moment before he spoke. “Good call, Patel.”
Anil swallowed, a knob rising in his throat.
“On the ultrasound, it was a good call you made,” Eric explained. “I was more focused on possible spinal injury, but that occult pneumothorax would have expanded with ventilation. And without the chest tube, it probably would have escalated to tension pneumothorax in the CT scanner, which would have been . . . well, you know.” Eric scribbled his signature on the papers. “Really, really bad.”
The sliding doors delivered a gust of wind and Anil crossed his arms, cradling his elbows. He became aware, for the first time, of a throbbing pain on the left side of his face.
“Not to mention, the fractured rib could have punctured his diaphragm if we hadn’t found it until he got to Radiology,” Eric said. “You saved your buddy, Patel. You probably saved his life.” He reached out one of his muscular arms and put a hand on Anil’s right shoulder. Anil winced. “Come on, man, you’ve gotta let somebody take a look at your face and arm—”
Anil shook his head. “After he’s admitted. Should I page ICU?”
“I already did. Your friend’s in good hands,” Eric said. “Mehta’s on call. You can wait for her down here if you want.” He held out the admitting orders to Anil. “Page me if you need anything.” He touched Anil’s arm lightly as he walked away. “Anything, okay?”
THE TRAUMA room where Baldev lay sedated was otherwise empty; the nurses, interns, students, and extra equipment had all been cleared out, leaving behind the wheezing and beeping machinery. Anil grazed his hand on Baldev’s shoulder and down along his arm. Less than an hour ago, he had made a one-inch incision into the chest under the armpit and inserted an intercostal drain to relieve the gas, which had leaked into the pleural cavity. In that moment, when he found the right position for the tip of his scalpel and felt for the opening between the ribs, he had not thought of it as Baldev into whom he was cutting.
Baldev, with the big grin and the hearty laugh. Baldev, who had challenged Mahesh to eat as many raw jalapeños as he could earlier that night at the restaurant, then ate one more himself, just for fun. Baldev, who had taught Anil to lift weights, play videogames, and talk to girls. Baldev, who had warned Anil on his first day in this country not to get caught in the wrong place in the great state of Texas. How were they to know the wrong place was right outside their own home on a pleasant spring night? How were they to know the wrong place would find them?
A shudder traveled through Anil’s body and he stepped backwards, away from the gurney and the patient who lay there. The patient who was not just a patient. The way they referred to everything in the hospital—the patient, the pneumothorax, the fracture, the seizure, the bowel obstruction—it was as if medical conditions were disconnected from the people who suffered them. Anil leaned against the wall of the trauma room and moments later, Sonia Mehta came flying through the swinging doors. He was unaware he’d been crying until he saw the look in her eyes, which lingered not on the injuries to his face or his bloodied clothes but on his wounded eyes.
Sonia approached the gurney and studied Baldev’s face, his injuries. She lightly touched his forehead, the one small spot not covered with a bandage, then walked over to the wall where Anil stood. “I’m so sorry.”
With his good hand, Anil rubbed his forehead and looked down at the floor. He shook his head, slowly at first, then faster, and bit down on his lower lip.
“Eric told me what happened.” Sonia moved closer and peered at him. “Are you all right?”
Anil cleared his throat. “Fine. Just superficial lacerations.” He gestured with his right hand and felt the sharp pain there again.
“That’s not what I meant,” Sonia said. She watched him for a moment, her eyes searching his face. “You.” She tapped his elbow gently with two fingertips. “Are you okay?”
Anil stared at the floor and chewed on his lower lip, trying to stem the emotions erupting inside him.
Sonia swiveled and leaned against the wall beside him. She stared up at the ceiling. “I had to spend a couple of nights in the hospital once, as a patient. It was awful. I was a terrible patient. But I learned more about medicine from that experience than anything else in my residency. Everyone tells you not to get personally involved with your patients, but sometimes you have to. And sometimes you should. Not too involved or you’ll lose objectivity or burn out. But it’s good to remember that each of these patients we treat is a real person—with dreams and talents, and a family and friends who love him.”
Anil looked up at the ceiling. He took deep breaths. In and out. In and out.
“I can’t imagine what it was like for you to be there, Anil,” Sonia said. “But you could help him because you were.”
“But I didn’t help him,” Anil cried. “Those guys, these . . . huge guys, they kept punching him and kicking him, over and over again. I couldn’t do anything.” He pounded his heel into the wall behind him and took a deep breath to steady himself. “Nothing,” he said softly. “I just stood there and watched it happen.”
“You helped him the best way you could.” Sonia nodded toward the gurney. “You helped him here. I know this might be news to you, Patel, but you are not perfect. You’re not going to be good at everything. So you can’t win a street fight, so what? Who gives a shit? You can do this.” She held her hands up, indicating the trauma room. She rotated toward him and Anil met her warm brown eyes. “You’re good at this.”
Anil breathed slowly, trying to absorb her words so they could heal whatever was now broken inside him.
“Now,” Sonia said, pushing herself off the wall. “Let’s get him upstairs.” She walked toward one end of Baldev’s gurney, Anil moved to the other, and together they pushed it through the doors of the trauma room.
After they boarded the elevator, Sonia looked Anil up and down. With a quick movement of her head, she flipped away the hair that had fallen over one eye. “You look like shit, Patel,” she said. “And you’re going to scare my patients. Once we get your friend settled, we’re going to clean up your face and get an X-ray of that arm.” Anil didn’t protest this time. There were blades of pain shooting through his right arm, and his head was throbbing around his eye socket.
AS IT turned out, Anil needed four stitches on his cheek and another two outside his eyebrow, all administered by Sonia’s assured hand. There was something very calming about sitting passively on the hospital bed, allowing her to clean and treat his wounds. “So, is everything okay now?” he asked, after Sonia numbed him with topical anesthetic. He held her eye for a moment, before she looked away. “After your hospital stay, is everything okay?”
Sonia rolled her stool sideways to get some gauze from the counter. “Yeah, fine. It was a long time ago.” She rolled back. “Hold still.”
Anil flinched at the pinch of the needle on his cheek. “Sorry, was it unprofessional for me to ask that question?”
Sonia finished sewing up his cheek before answering. Did he detect a slight smile as she ripped off her latex gloves? “You think I stitch up all my junior residents for free, Patel? We’re already way past professional.”
An X-ray confirmed Anil had sprained both his wrist and elbow in the fall onto the concrete, and he would have to wear a brace on his right arm until it healed. Casper O’Brien gave him a few days off to recover at home, but Anil refused to take the painkillers Sonia had prescribed. It seemed unfair to numb the pain of the few mild injuries he had sustained while Baldev was suffering in the ICU and would endure weeks of pain and rehabilitation.
THE NEXT day, Anil was sitting by Baldev’s side in the ICU when he was paged to the visitors’ lounge. Amber was waiting there for him, perched on th
e edge of a chair. Her hair hung in a limp ponytail, and she wore sweats and no makeup. She looked as if she hadn’t slept at all. Anil held open the door that separated the visitors’ lounge from the inner chamber of the ICU and Amber followed him back to where Baldev lay sleeping. She gasped when she saw his discolored face, the bandaged eye, the swollen lip. “God,” she said, covering her mouth. “Has he woken up yet?”
“Yes, and he’s fine, just sleeping a lot, which is normal.” Anil pulled over another chair and they sat together, listening to the steady drum of Baldev’s heart monitor, the robotic breathing of the ventilator.
Amber reached over and took Anil’s hand in hers; he could feel her body relax with the gesture, but his did not respond the same way. “Have you . . . do you want to get some food in the cafeteria?” she asked. “Have you eaten anything today?”
Anil shook his head and stood up abruptly. “No, you go ahead. I’ve got some things to do.” He glanced at his pager. “See you later, okay?”
Despite the leave he’d been given, Anil spent most of his time at Parkview, sitting in the ICU with Baldev or consulting with his physicians on his progress and treatment plan. When he came home after dark, for a change of clothes or a few hours’ sleep, he parked his car illegally along the red curb right outside their front door and sprinted the few steps to safety. He was fully prepared to get a parking ticket, or even to find his car towed come morning, but neither ever transpired. How many other criminal activities went unpunished every day?
At home, Mahesh took care of everything that needed to be done. Before Baldev’s parents arrived from Houston, he readied Baldev’s bedroom, taking down the posters of women from the walls, removing the obscene magazines and movies, putting fresh sheets on the bed. Once they arrived, he made chai for them the proper way, boiling loose tea leaves together with water and milk on the stovetop, rather than simply using the microwave as he normally did. He drove them to the hospital every day, and to the Hindu temple afterward, where the pandit performed special prayers on Baldev’s behalf.