CATEGORY: LKo/JC/Cast Drama
RATING: PG - some mild language.
SPOILERS: This story is structured as an episode that could have taken place the day following "May Day."
DISCLAIMER: These characters belong to Warner Brothers, etc. and are used without permission. This story is for entertainment only, to occupy our time until Season Seven starts, etc. etc.
AUTHOR'S NOTES: the medical situations in this story were researched and are based on information found on various medical web pages. However, as I am not educated in medical matters, such research does not guarantee a correct interpretation. There are only two items presented as fact that could not be substantiated elsewhere and are presented using a literary license.
Thanks to my friends for reviewing this story and encouraging me to post it.
SUMMARY: This story is structured as an episode that could have taken place the day following "May Day." It follows up on events and hints suggested therein for the entire cast, particularly Luka Kovac and John Carter.
Aftermath - Teaser (Prologue) 5:30am
John Carter stood at the admitting desk of the Talbott Medical Center, trying to summon his courage and trying to follow the instructions of the no-nonsense admitting nurse, the real-life embodiment of Nurse Cratchett less the old-fashioned cap and starched-white uniform.
"Sign here," she said, peering at him closely while handing him a clipboard and pen. "You are agreeing to stay for a minimum of 30 days."
John looked at Peter Benton and saw a stern face that would brook no opposition. Clenching his teeth, John took the pen, and signed the form, his fingers less than steady.
'Nurse Cratchett' took back the clipboard and examined the signature. "We are going to have you go to the introductory room for now. You should try to get a few hours sleep. Dr. Swanson will see you at ten AM to get you started," she explained tersely. "Leave all your clothes and affects outside the door."
"What's an introductory room?" John asked dully, looking around.
The Center was neat and modern, with cool colors that were coordinated on the walls and carpet, in contrast to his disheveled state. His suit was rumpled, his face sweaty, and the uncustomary day-old beard had started to itch.
"A single room, with cameras. You will have no privacy," the nurse tonelessly answered as she filed the admitting papers in a folder.
The nurse looked straight at John. "Do you know why you are here?"
John swallowed and nodded.
"It is a suicide watch room. We want to make sure you do not do anything ... unwarranted." The nurse was leaning down, getting something from under the counter.
The information surprised John and he again looked at Peter.
"Trust them, Carter," Peter said. "That's the only way."
John nodded and again looked at the admitting nurse who was handing him supplies.
"Here are some pajamas and a robe. You will find toiletries in the room." She had a business-like attitude and perfect articulation, but Peter found her avoidance of contractions annoying.
John again turned to Peter, a myriad of questions on his face.
"I'll get some clothes and ship them to you," Peter said quietly. "I'll visit your Grandmother personally and explain things to her."
John looked down, the resolve draining from his face.
"You can do this, man," Peter said, his voice uncharacteristically soft. "You've done hard things in your life. You can do this too."
The admitting nurse broke in as another person approached. "Roberto is the orderly. He will take you to your room. You best say goodbye now."
John looked up again at Peter, fear on his face, the words trying to form on his lips.
"Don't thank me now, do it later," Peter said. He flashed a small smile, reached out and briefly touched John on the upper arm, then turned and headed towards the door.
John watched him go, the dread once again filling him, then followed the orderly.
Peter looked one last time over his shoulder at Carter's retreating form and then walked out the door into the early dawn light, the humid summer morning in Atlanta already heating up the air.
Father Paul opened the giant wooden doors and let the cool Chicago morning dawn into the dark sanctuary. As he walked back down the aisle, he glanced at the rows of pews next to a side altar.
Against the wall, almost snuggled into a corner, a lone figure sat in a pew, his head bent downward and hands folded, as if in prayer. Paul altered his course, his footsteps echoing throughout the sanctuary. At the end of the short pew where the man sat, he paused.
"You have been here all night," Paul said gently. "Is there anything I can do?"
Luka Kovac had heard the footsteps coming and was rousing himself for the inevitable conversation. "Thank you, Father," he answered without looking up, his voice hoarse and low. "But no, I don't think so."
Paul thought for a minute, taking in the man's countenance. His face was drawn and even in the dim sanctuary, Paul could see dark circles under the man's eyes. A shock of black hair had fallen over his forehead. Dressed better than those who often sought shelter in the sanctuary over night, he had loosened the top button of the dark gray dress shirt and the knot of the black tie. A heavy black overcoat lay on the pew next to him.
"I could hear your confession if that's what you want."
Luka shook his head. "No, thank you." He finally looked up at the priest, a young man with an unwrinkled forehead and a desire to help in his eyes.
Paul took eye contact as a small opening and sat down. The coat was not the only thing separating them. "Were you praying for guidance, for help?"
Luka sighed, unsure if he could explain. This young priest looked too earnest and passionate, too fresh from seminary. "No, Father, I don't ask God for anything."
"Why? He wants to help you, be a source of comfort for you." Paul leaned towards Luka, trying to bridge the chasm.
Luka looked away, thought for a while then took a breath. "He is a comfort. But I don't ask."
Paul's face registered surprise. "God works in mysterious ways," he tried to answer, determined to be of assistance.
"Humans work in mysterious ways. God's work is pretty clear."
The priest thought for a moment. "Are you angry with God for something?"
"No, I'm not angry at God." Luka shrugged a little and looked down. "Things ... just happen."
"God never gives you more than you can handle."
"Father," Luka sighed and closed his eyes. "God gives us life and hope for heaven. That's all. It's up to us to find the courage for this life." He looked at the altar in the distance.
The young priest, used to people asking for prayers and blessing, was perplexed at these answers. "Is there anything I can do?"
"No, but thank you, Father." Luka turned towards Paul and gave a small smile that was betrayed by his eyes, then slowly stood up, picking up his coat.
Paul did the same and both stepped into the aisle.
"I must go to work," Luka said gently, then turned, and walked to the door.
Paul watched the man peer into the street, put on the coat, hesitate a moment and then step quietly outside.
Aftermath - Act One 7:30am
Luka drove quickly down the street, both hands on the wheel, the knuckles showing white, his eyes concentrating on the road. He rounded the corner, entered a small parking lot and quickly got out of the car. Heading toward a small, nondescript, unmarked, building, he entered a glass door.
The older woman sitting at the old wooden desk looked up and smiled. "Good morning, Dr. Kovac." She then frowned and started pushing buttons on the keyboard of her computer.
"Mrs. Abernathy," Luka greeted her in return, "is Steven in?" He was unable to bring himself to look at her, but instead examined the plain reception area with a worn rug and old, overstuffed chairs.
There were several pieces of framed art on the walls, none of them comforting -- a contemporary oil in bold colors and disturbing strong lines; a primitive chalk in pastels colors of a sea of faces; and a black charcoal of a prone figure.
"I'm afraid not, Dr. Kovac. He's at a conference this morning." Mrs. Abernathy looked at Luka's profile closely, the stiffness in his posture. "Don is available, if you want." She looked at the computer screen again. "But Steven could see you at seven tonight."
Luka gripped his fists inside his coat pockets and took a breath. "I'll wait for Steven." He turned towards the door.
"Are you sure?" she asked gently.
"Yes, thank you," he answered, trying to keep his voice light. He paused slightly at the door. "Seven tonight." Then Luka opened the door, and walked back into the morning light.
Mrs. Abernathy pulled out a telephone list from a side drawer. After finding the number, she dialed the phone.
"Yes, please leave a message for Dr. Phillips. Tell him he has a seven o'clock appointment tonight with Dr. Kovac. It's important." After a moment, she concluded the call. "Yes, thank you."
"Yeah, I heard Benton and Kovac yelling in the hallway," Malucci said as he opened his locker and put his knapsack inside. "I wondered what was going on."
He looked at Jing-Mei and Cleo for their reactions.
Cleo put on her lab coat. "They were arguing about the triage at the shooting site. Dr. Kovac brought the kid in on the helicopter and the shooter died in the ambulance going to Mercy with Dr. Benton."
"Benton was pretty steamed," Malucci continued. "Guess he thought he deserved the helicopter."
"Well, I heard it turned out the kid needed the extra time for the operation," Jing-Mei noted, reorganizing the top shelf of her locker.
Cleo walked to the window and looked out, her mind divided about the matter. "The dad was pretty upset. I guess it was a judgment call at the scene."
"The news report said the shooter came out of the building and started firing at everybody, while Benton and Kovac were treating the wounded," Malucci offered as he closed his locker then leaned on it. "Must have been something, bullets going overhead." His voice rose with an adrenaline rush as he visualized being there himself.
"You ever been shot at, Malucci?" Cleo turned around and asked pointedly, disgusted with Malucci's obvious opinion.
"No, never have," he answered, shaking his head in disappointment. "Been in some good fights, though." He smiled. "Hey, I wonder if Kovac was in the war in Croatia. It was probably like good old home week for him."
"Malucci, how can you sound like war is enjoyable?" Jing-Mei asked, incredulous as she closed her locker. "I can't imagine what that must be like."
"Good morning everyone!" a sharp voice rose behind them. "It's nice that you are all 'bonding,' but there is work to do. Get to it," Kerry instructed them. "Each of you get a stack of charts and code them."
The three residents scrambled out the door and to the desk where Lilly and Chuny were working. Each took a pile of charts and disappeared.
"Sure is quiet, today," Lilly sighed as she filed some papers at the desk once they were alone again. The halls were unusually deserted and there were no patients waiting in chairs. "Gives us a chance to catch up on this paperwork."
Chuny shook her head. "Small blessing, the way everyone is acting. Dr. Weaver seems really distracted, Dr. Greene is acting weird. I wish we were busier, I don't like days like this."
"Well, maybe it's a good thing with Dr. Carter on 'vacation'," Lilly said, her voice giving away her understanding of Carter's absence. She turned towards Chuny and lowered her voice. "Has Dr. Finch said anything about Gloria?"
Chuny looked up from her work. "No, she hasn't, yet."
Lilly nodded. "I don't think Gloria will. When I took her upstairs last night, all she could talk about was how long she would be here and how she didn't want her parents to know."
"I still can't believe she did it," Chuny said, closing a file. "I'm off to radiology." She headed towards the elevators passing Kerry and Mark coming full-tilt from the other direction, deep in conversation.
"Peter called this morning, asking Elizabeth to cover for him till he got back this afternoon," Mark was saying as they walked towards the desk. "Did he call you?"
Kerry nodded. "He called just before he got on the plane to come back. John checked himself in. He said it went smoothly."
"Good. When Carter stormed out of here, I couldn't believe it."
"Whatever Peter said worked," Kerry shrugged and then looked around. "Have you seen Luka this morning?"
"No. How is the search for a new charge nurse going?" Greene asked, his shoulders bent down to appeal to Weaver.
"I've interviewed two candidates that the head of nursing sent down. Neither was acceptable," Weaver tried to explain, stopping at the end of the desk. "I have another appointment this morning."
"Everyone is doing a fine job filling in, I'm not complaining," Greene offered, rounding the desk and standing on the other side. "But things need to be settled. There's too much gossip."
Weaver cast a disparaging look at Greene.
"You know what I mean," Mark answered the look. "The staff down here will soon start taking about Carter's absence. A new head nurse would give people something else to talk about."
Kerry sighed as Mark went into Exam Two.
"Dr. Weaver?" Frank the desk clerk said from the other end of the desk. "Accounting is on line two. They say they have some questions about some codes."
Kerry nodded and walked to the desk to pick up the phone.
"I took those papers upstairs, like you asked," Frank continued. "Payroll says they have some questions, so you might give them a call as well." Frank picked up another slip of paper. "And you got a call from a Dr. Swanson in Atlanta. Asked that you call him back right away."
Kerry nodded and punched a button on the phone as she saw Luka enter through the bay doors and walk into the lounge. She looked at her watch as she started talking on the telephone.
Luka stood at his locker in the deserted room, staring at the photograph of the Croatian coast. He was unshaven and still in the previous day's clothes. Slowly, he opened the locker, shed his coat and hung it up, then grabbed his lab coat. After examining it for suitability, he shrugged it on and found his stethoscope on the top shelf.
Closing the locker, he turned and crossed the room to the coffee area. It was messy but a pot of coffee sat on the warmer. Luka poured a half-cup of coffee and sipped it gingerly. He headed to the desk.
"Is Kerry here?" he asked Frank. The place was still quiet.
"No, she's upstairs with the head of nursing," the desk clerk answered, seeing Luka examine the board. "Only Dr. Greene has a patient. Everything's quiet and we're all just doing paperwork."
Luka simply nodded. He went to another spot at the desk and took two folders and a stack of clipboards and retreated back to the lounge, settling on the couch in the corner and opening the first file.
Elizabeth Corday stood with her hands in a man's chest, trying to avoid the inquiring look Robert Romano was giving her.
"Funny vibes coming out of the ER last night and today," Romano fished, looking over his mask.
Elizabeth sighed and shook her head. "I still don't know of anything out of the ordinary, Robert."
"You said that last night, and you say it again this morning, Lizzie." Romano gave a false laugh that make Elizabeth's skin crawl. "I see John Carter is on an extended leave of absence."
When Elizabeth had no response, he continued. "And you're covering for Dr. Benton this morning."
"A favor, that's all," Elizabeth answered. "More suction," she ordered and the nurse responded.
"You're doing favors for Benton? Not a good habit to get into."
Elizabeth held her tongue.
"Saw the news accounts of that shooting yesterday," Romano continued as he sutured. "Heard about some shouting match between Benton and Kovac in the hall."
"Don't know anything about that, Robert," Elizabeth responded.
"If you say so," Romano said again, his voice still inquisitive. "But I still get these vibes."
Elizabeth tried to concentrate on the surgery.
John sat in a chair in the office of Dr. Swanson with his hands folded, his robe wrapped securely around him as if the thin cotton would protect him from what was next. This office was a little warmer than the pastels of the reception area and the cool blue of the introductory room. There was some original art on the walls and family photographs on the credenza behind Swanson.
"John, let me explain a few things to you. I've looked at your chart and talked to your boss," Swanson said, looking at the chart. He was a tall, thin man, with a face lined of experience and a full head of gray hair. "We're going to put you on the fast track here and get you back to work as soon as possible."
"Good," John mumbled, brightening a little.
"That means we are going to be direct and insistent. Some therapies take a sequential approach, but presumably you've already studied this condition in med school. So we're going to take a simultaneous route to address both the physical and mental issues."
John nodded but looked up. "Condition?"
Swanson continued, not ready yet to name it. "We will get you off the narcotics and give you a healthy lifestyle, help you treat your body better. We'll do a complete physical and if you have still having pain from your injuries and the surgery that can't be corrected with a little additional surgery, we'll teach you some pain management techniques."
"Concurrently, you are going to address the incident that lead to your injury. You are going to learn about post traumatic stress disorder ... the reasons, the symptoms and the treatment."
John looked surprised. "You think I have PTSD?"
"I'm not entirely positive, but probably. We'll see. You'll study it clinically, just like medical school. It looks like you've already lived the reasons and the symptoms. But now you are going to live the treatment. You will talk about what happened, how you feel and what you are going to do in the future, in both group and individual settings. You'll keep a journal and you'll do something for yourself, perhaps take up art classes or jogging."
"We'll see what interests you when the time comes." Swanson sat back. "I won't kid you, John. You are going to feel anger, you are going to be scared. Something happened that will affect you for the rest of your life, but we are going to teach you how to manage it, how you can live with it. And you will find a reason to carry on, a way to resume your life as a doctor."
John nodded again, not sure if he believed this man.
Aftermath - Act Two 1pm
Standing against the wall of the Exam One, almost in the corner, with his arms folded, Luka brought his gaze back to Abby working on the knee of a fifteen-year old boy. The young man, at least five-foot-five and one hundred and fifty pounds, was squirming on the table while Lydia tried to calm him down.
"Hold still, Alex," Abby tried to say gently. "I just have to clean these cinders out of your knee. This is what you get for riding your bike no-handed."
"It hurts," the young man complained, acting more like a child than a fifteen-year-old.
Abby looked at Luka. "More lidocaine?"
Luka stood for a moment with a blank face, then smiled briefly, and nodded at both of them. Lydia moved to give the injection. Luka's smile faded and his gaze returned to the distance.
The boy struggled with the injection and kicked out his other leg, sending a tray full of instruments scattering. The noise startled everyone.
Abby saw Luka from the corner of her eye as he reacted to the noise. He moved a step further into the corner, his face not really changing but a look appeared in his eyes that she only saw in men when she had delivered bad news. His fingers gripped his folded arms a little tighter. After a moment, Abby's view of his face disappeared as Luka looked at the floor, and then left the room.
She turned her attention back to the patient. "Alex, Alex," Abby started in, her voice firm. "Settle down and grow up. This doesn't hurt that bad." Lydia returned with another tray, sharing a look of surprise with Abby as they continued to work on the young man.
Luka stepped quickly from the Exam One and crossed the space to the desk, his face dark, and his body stiff. He stopped to look at the board.
Chuny looked up from her work on a chart to notice his unshaven face and sunken eyes. "There's nobody waiting."
Luka nodded and picked up some charts from a pile.
"Dr. Kovac?" Chuny started gently. She wanted to say something but was unsure of what to say. "It was hard yesterday, with Gloria," she offered. "I went to confession after I got off work."
"Did you feel you had sinned?" he asked in a tired voice, slowing down to stand to the side and a little behind her, avoiding her gaze.
"The priest said it was not my sin because we all did what we could to prevent it under the law."
Luka let out a breath and glanced at the ceiling. "Beyond what the church teaches, in France, in Croatia, I would have been prosecuted for not saving that baby."
Chuny turned to look at Luka, surprised at hearing him speak so many words at once.
"America must be the only country where there is a law like that," he said, still not looking at her.
"We did get the court order," Chuny offered.
"Yeah," Luka sighed. He looked at the floor and began to walk away as Malucci approached the desk.
"Hey doc," Dave began with his characteristic exuberance. "What was it like with the bullets flying yesterday? You look like hell today!"
Luka looked up quickly at the annoyance. "Yeah, I'm just a walking, breathing hell," he answered and continued walking past the resident.
Chuny was taken back as she watched Luka walk away, and then she looked appraisingly at Dave. "You don't know how to read people at all, do you?" she said.
Undeterred, Dave shrugged then picked up a stack of charts and walked to the nurse's station where he found Jing-Mei sitting with a similar stack.
"So do you know where Carter is?" he asked, speaking low as he sat on the edge of the desk.
"As much as you do," she answered, not looking up. "Vacation."
"I didn't think residents got vacation," Dave continued, angling for information. "Just seems sorta strange, he didn't mention anything about it?" When Jing-Mei remained silent he continued. "He mention anything to you?"
"No, he did not."
"Look Dave, just go about being the best doctor you can and stop bothering me," she finally retorted in a louder voice.
"I see you are back from lunch, Dr. Malucci," Kerry said from behind him. "I suggest you stop prying into matters that are no concern of yours, and get those charts done."
"Yes, chief," he responded, leaping to his feet and moving down the hall towards the trauma rooms without looking at either of them.
Kerry looked at Jing-Mei. "I appreciate your discretion. I know it is hard to keep it quiet."
Jing-Mei nodded and then looked up, her face revealing a problem.
"Keep what quiet?" Romano said from behind Kerry.
Kerry slowly turned around to face him as Jing-Mei stood and quickly walked away.
"Just a small matter I'm handing down here, Robert," she answered evenly.
Romano considered Kerry's neutral face. "Isn't it customary for a subordinate to report 'problems' to their superior?"
"Only if such a 'problem' could not be solved," she smiled.
"Seems to me you've got several problems, Kerry." Romano leaned against the wall and folded his arms. "Let's see, you have a resident on an extended leave of absence. Very strange. You've got doctors fighting and yelling in the hallway. You are without a head nurse. Have I missed anything?"
Kerry tried to think of an appropriate answer. "Robert, when I can't handle things, I'll let you know. Now, if you don't mind, I have work to do."
"By all means, do your work," Romano echoed and walked away.
Kerry briefly leaned against the wall wondering what she could do, then headed back to the desk to see Peter waiting there, an intense look on his face
"I need to talk to you," he began.
"Get in line," Kerry answered dryly. She didn't need this either. "How's John?"
"Scared, but I think he'll be okay," Peter answered, his face loosing some of its intensity for only a moment. "Are we going to talk about the triage or are you going to sweep it in under the rug?"
Kerry took Peter's arm and moved him away from the desk. "And just what do you want to talk about Peter? I've looked at the charts."
"You should have seen Kovac out there," Benton began, squaring his body with Kerry's, ready for the argument. "He was an uncaring, cold son-of-a-bitch. He wouldn't listen to my recommendations."
"He was the senior physician there. It was his decision to make."
"But he made an moral decision!" Benton said, his voice rising.
Kerry shook her head. "You know perfectly well that the ACEP defines triage as an allocation of resources based on survivability, the capacity of the destination hospital for the patient, as well as critical medical need," Kerry said carefully.
"He abandoned the patient!"
"He left the patient with you, an experienced surgeon, several paramedics and an ambulance. Mercy was close. I called Mercy and they read me the chart. He provided extra blood from the chopper for the ambulance."
"Are you defending him?" Benton was incredulous.
"Not necessarily. I'm just outlining the argument that can be made in both directions," Kerry sighed.
Peter looked at Kerry, undeterred. "And something funny happened with his next patient. I talked to Cleo on the phone from Atlanta this morning and she was upset about a case yesterday but wouldn't talk about it."
Kerry did not respond.
"I think the man's a danger to patients."
"Do you want to file charges?" Kerry was blunt.
Her directness surprised Peter. "That's a big step." Peter took a breath and thought for a moment. "Even Elizabeth said she would have had difficulty at the triage." He shifted the weight on his feet. "For right now, I just want you to hear my concerns."
Kerry appraised the situation and made a decision. "I do hear you. And I will talk to him. But you should not. I don't want the two of you getting into another shouting match."
Peter looked dubious.
"I'm going to let the emotions settle a little, get into a routine with John gone. Then I will handle it. All right?"
Benton finally acquiesced and nodded, but the fire was still in his eyes. "All right."
"Thank you, Peter," Kerry said, then slowly turned and went back to the desk
Peter headed towards the elevators and saw Cleo coming down the hall from Exam Three.
"You're back," she greeted him smiling, perhaps a little wary.
"Yeah," he smiled, taking her to the corner across from the elevators. He leaned in and gave her a quick kiss. "Tell me what happened that upset you so much," Benton insisted.
Cleo shook her head. "It would violate a patient's confidentiality."
"Not if it helped us get rid of a poor doctor."
Cleo was a little taken back and shook her head. "It is not what Dr. Kovac did. It is what the patient did. I've worked with him many times. He's a fine doctor."
"I have my doubts. I think he is a possible threat to patients," Benton declared firmly.
Cleo put her hands on her hips and leaned forward, her voice low. "I've figured out what you all did for Carter. Whatever Dr. Kovac did, it did not come any where near to Carter's actions." Suddenly, Cleo realized that what she said gave away a little too much, but she regained her composure quickly.
Benton was surprised. "How did you know about Carter?" he asked, looking hard at Cleo. "Tell me."
"You know how hospital gossip goes," Cleo said, shrugging. "Then, all the big-wigs in a meeting in Curtain Three, across from the trauma room I was in. You disappear suddenly, won't tell me where you are. I put two and two together."
"That was my business," Peter said. He shifted gears, trying to intimidate Cleo. "I'll find out about Kovac. It sounds like he did do something." He examined her face for any sign of weakness and found none. "I've got a surgery scheduled. I'll call you later." He turned and walked off towards the stairs.
Cleo gave a long sigh as she watched him go.
Elizabeth rounded the corner on her way down and greeted him, smiling. Cleo saw Peter's speed slow and stop as they engaged in jovial conversation on the landing. Once again, Cleo had an uncomfortable feeling.
"Cleo, I have some more charts for you," Mark said from behind her.
"All right," Cleo answered softly, holding her look at Peter and Elizabeth.
Mark looked at the stairs to see what Cleo was starring at and had a similar reaction. He looked at Cleo. "Come on, let's get back to work."
She nodded, and the two of them walked back to the desk.
"Peter," Romano greeted him. "Glad to see you're back."
Benton looked up from scrubbing his hands, unsure of what Romano knew or not. "Dr. Romano," he greeted coolly. "I just had a little personal business."
"How personal?" Romano asked, leaning in, starting his own scrubbing routine.
"Personal," Peter answered quickly and rinsed his hands.
Romano nodded and adopted a conspiratorial smile. "How'd you like your little adventure yesterday?"
Peter looked back at the man and stared at him. "It was no adventure."
Romano's smile faded quickly and he squinted. "No, it probably wasn't."
Peter dried his hands and started to back out the door.
"But if you ever want to talk about your 'adventure,' just let me know." Romano looked at him across the room. He waited for Peter's response.
"I'll do that," Peter answered, trying to keep his voice calm as he entered surgery.
Aftermath -- Act Three 3:30pm
"John, we're waiting on the results of all your tests," Dr. Swanson explained.
John sat back in the chair in the private office, his arms crossed. "I'm not feeling well."
"I know. I've ordered an analgesic prescription for the pain."
"I'm afraid it won't be strong enough. How you do know how much pain I feel?" John's voice rose with his bravado.
"We don't. And you are going to feel badly, both physically and emotionally, as you withdraw from the narcotics."
"I wasn't taking them that long," John tried to explain.
"How long, John?"
John looked down. "Three months."
Swanson nodded. "Do you want to tell me why?"
"What's to talk about? It was the pain and the stress," John said, looking up, his voice rising a little.
"And what was causing the stress?"
John put his hands on his knees and leaned forward. "The medical student's death, of course. And, working in the ER drives everyone a little crazy."
"We try not to use the term 'crazy' here, John." Swanson sat back in his chair and eyed John. "Of course, you are upset about Ms. Knight. But there's more."
"How do you feel about being attacked?"
John sat back and shrugged. "How am I supposed to feel about that?"
"Vulnerable?" Swanson suggested.
"Things happen. It's a dangerous world." John's tone of voice was flat, without emotion. He looked away from Swanson's direct gaze.
The bay doors burst open with the gurney and two EMT's. Luka fell into a pace with the procession, listening to the information, with Cleo, Malucci, Jing-Mei, and Abby immediately behind as they moved to Trauma One.
"Thirty five year old man, robbing a liquor store, shot by the owner," Chris explained as they moved.
Luka looked at her.
Chris continued. "GSW to the left upper abdomen, a hand-gun from about ten feet. Pressure is ninety over seventy, heart rate is ninety-five and respiration is twenty-five. Ten liters by mask; pressure dressing of the wound. He's increasingly in pain," Chris explained.
"How much blood loss at the scene?" Luka asked.
"At least one liter," Chris answered.
The assembly moved the patient to the trauma gurney and the EMT's left the room. Haley, Malik and Yosh were waiting.
Luka gave instructions calmly. "OK, since we are all here ..."
"It's the only show in town," Malucci interrupted.
"Yosh, trauma panel, type and cross for four," Luka continued as if not hearing Malucci's comment. "Cleo, check his breathing and then the bowel sounds. Malucci, start a single large bore IV and give him one unit of saline. Abby, set up the ultrasound then order an x-ray, then one shot IVP. Malik, new vitals. Jing-Mei, set up the Foley. Haleh, call for a surgeon and tell them we need an OR immediately, and then two grams of cefotetan. Let's roll him."
Everyone helped to roll the patient. Luka examined the exit wound for just a moment. Then they released him and began working as Luka cut open the man's shirt to examine the entrance wound.
"Good bi-lateral breath sounds," Cleo reported.
"Continue the mask," Luka said.
"Why just one liter of saline?" Malucci asked.
"On an abdominal wound like this, fluid resuscitation will not help and will worsen hypothermia and coagulopathy. He needs immediate surgery to control the hemorrhage and they will resuscitate at the same time," Luka patiently explained.
Cleo stood up from her examination. "No bowel sounds."
"Get some blankets to keep his temperature up," Luka said.
"His pressure is falling," Malik said. "Pulse ox is eight-five. He's unresponsive."
"Cleo, tube him," Luka said. "What about the surgeon, Haleh?"
Haleh put the phone down. "Everyone is in surgery. Someone will be here in fifteen minutes."
"Get Kerry," Luka said to Haleh, urgency taking over his voice. "Malik, prepare a laparotomy tray."
Haleh rushed from the room while Malik prepared the instruments. Very quickly, Kerry came in with Haleh at her heels.
"What do you want to do?" Kerry asked.
"Open the belly and repair the aorta. Given the angle and the exit wound, I think the bullet path goes from the liver to the pancreas, to the aorta to the spleen. With this much blood loss, the aorta has to be hemorrhaging."
"Why not a thorocotamy and cross-clamp the descending aorta there?"
"The surgeons are at least ten minutes from getting here, and they'll have to open his belly anyway."
"It's a surgeon's job."
"I know it crosses the line of policy, Kerry. His belly is swelling. I've worked on this kind of wound before, under much worse conditions." Luka looked at her, his eyes intense but his voice even. "I was a surgical resident during the war. I wouldn't ask if I did not believe I could do it."
The residents in the room looked at each other and Malucci gave a self-congratulatory grin.
Kerry nodded, oblivious to the reaction. "I'll assist," she said, putting on a pair of gloves.
"Get the suction ready," Luka ordered.
"Lydia, we're running low on suture kits," Mark said as he came out of the storage closet and joined her as they headed towards the desk.
"I'll get a requisition prepared," Lydia answered, "as quickly as I can."
"Things are really disorganized around here," he continued. "Can you try to get the nurses to pull together, get some discipline back?"
"Dr. Greene," Lydia sighed, "if I may say so, this isn't like you, to be concerned about a little disorganization."
"Well, maybe if we were taking inventory and getting the paperwork out, folks wouldn't be standing around gossiping about things that don't concern them."
"Dr. Greene, you've been in the ER too long to not realize that everything going on here concerns the nursing staff. We'll talk about 'things' if we're taking inventory or filing papers." Lydia looked at him, and at his surprise, continued. "We know what happened to Dr. Carter. We know what happened to Dr. Kovac."
"Kovac?" Mark asked, surprised.
Lydia nodded. "We don't know where Dr. Carter is, but we know why. We know about Dr. Kovac and Dr. Benton, and about the Milton baby."
"Well, try to keep the rumors down about Carter. We don't want it spread all over the hospital," Mark said.
"Don't worry, Dr. Greene," Lydia answered. "The ER staff sticks together." She looked at him as they stopped at the desk. "Or, at least we should."
"Yeah," Mark nodded as he exchanged some charts and moved off.
Lydia watched him go with a sad look on her face.
"What the hell is going on in here?" Benton raised his voice as he entered the trauma room and saw the procedure under way.
The residents and Abby reacted, backing away from their position at the table, but Luka, Kerry and the nurses held their ground.
"Peter, I authorized him to proceed," Kerry said. "And I'll defend it at the M and M."
"This is against policy," Benton continued, peering around her to see the procedure Luka was doing. "And certainly no procedure I've ever seen."
Kerry raised her voice. "All the surgeons were busy, including you. We've reduced the blood loss and now you are here to take over."
"Where did you learn this technique?" Benton demanded, walking around the gurney to where Luka was working.
"In the field," Luka answered, looking up briefly, his eyes hard, but he quickly returned to his work.
"What field?" Benton replied, his voice rising. "You have a lot of trouble with ethics and policy, Dr. Kovac."
"Peter, I don't know a doctor who does not," Kerry tried again to intervene.
Benton started putting on fresh surgical gloves. "Step aside," he ordered.
Luka looked at Kerry who nodded in agreement. "He's here now. Let him finish," she said.
Luka set the suturing forceps down and stepped back.
Benton filled the space. "We're not done yet, Dr. Kovac," he said, glaring at Luka.
Luka looked at Benton, forcing his face to be unreadable, gripping his fists to keep his emotions intact.
The lack of response infuriated Benton. "I don't trust you as a doctor. Too many times, you are a danger to the patients."
"Peter, that's enough," Kerry's voice rose. "You've got a patient with an open belly!"
Luka, his face devoid of expression, continued to look at Benton for only a moment longer, then turned and left the room as he stripped the bloody gloves from his hands.
Benton bent over his work while the rest of the room exchanged looks and then started responding to the orders.
The blue surgical scrubs flapped behind him as Romano charged down the hall. "Jing-Mei," he greeted the resident as she took some supplies from the cart.
Jing-Mei looked up in surprise as the man called her by her chosen name.
"I just wanted you know that your petition for newborn genetic screening is going before the administrative committee," Romano said as he stopped next to her.
Again, Jing-Mei was surprised. "But I thought you were not in favor of the idea," she said.
"Well," Romano smiled. "Doesn't mean we can't discuss it, does it?"
"Thank you," she answered.
Romano leaned against the wall. "I'm a firm believer in open discussion. The sharing of information." He paused. "I could support your proposal if I had a little more information."
It finally dawned on Jing-Mei what Romano was after. "I think my proposal should stand on its own merits."
"Let's just say I'm conducting an evaluation, gathering formal evaluations on the residents, fellows and attendings in the ER," Romano tried another tack. "Where's John Carter today?"
"I don't know," Jing-Mei answered, not looking at Romano.
"What's going on between Benton and Kovac?"
"They had a professional disagreement. You probably should ask them."
Romano's beeper started going off and he disgustedly pulled it from his pocket. Then he looked back at Jing-Mei. "I'll do that," he said, walking off.
Jing-Mei continued to the admit desk to find Luka writing the back of a form. He folded the paper and put it in Kerry's mail slot.
"That was an interesting procedure, Dr. Kovac," she said as she stopped next to him. "I'm interested in learning more about it."
Luka looked at her sideways. "Okay," he answered, but without enthusiasm. He looked away. "Please tell Kerry I've left her a note. I'm going out."
"Sure," Jing-Mei answered as she watched Luka walk quickly into the lounge. A few seconds later, he came out and walked equally as quickly out the bay doors, his heavy coat slung over his shoulder. Jing-Mei turned to see Kerry approaching.
"Dr. Weaver, Dr. Kovac just left you a note. But," Jing-Mei hesitated, "I think he's upset about something. He just came out of the lounge and left through the bay doors."
Kerry grabbed the note and glanced quickly at it, then moved as quickly as she could through the doors. He was nearly to the end of the bay.
"Luka, can I talk to you?" Kerry shouted.
He stopped and turned around. "Did Benton get the patient to surgery?"
"Yes," Kerry answered. "They should be out by now. I think the patient should make it."
"Good," Luka answered, but did not smile. "I've done my paperwork. I ... I need to leave a little early. I left you a note."
Kerry nodded as she came near. "Things are slow. But I need to talk to you for a moment."
Luka stepped into the shade, leaned against the wall, and crossed his arms around his coat.
Kerry took in her breath and dove in. "We didn't get a chance to talk about the Milton baby last night. I read the chart."
Luka nodded, knowing what was coming.
"She could file charges for the ketamine," Kerry said.
"I know," Luka finally spoke.
"I don't think she will. Why did you do it?"
Luka sighed. "I was hoping, even as the baby's heartbeat stopped, that she would change her mind."
Kerry broached the subject. "And you were still carrying a lot of anger for the disagreement with Benton?"
Luka's face turned to stone and he looked at the ground.
"As you heard, he's rather upset." When Luka did not respond, Kerry continued. "I told him you were the senior physician on site and had the right to make the decision, but there are concerns."
There was silence for a moment. Even the traffic on the street seemed subdued.
When Luka finally spoke, his voice was low and tight. "I am sorry that the man died. And that Dr. Benton is upset. I made a judgment under difficult circumstances that I will always have reservations about, but it turned out to be the best one for the boy." Luka took a breath. "But most importantly, if you think the judgment was in error, do what you think is appropriate."
Luka looked at Kerry and she could not read what was in his eyes. Then he nodded to her in a way that said goodbye, turned and walked away. Kerry fought down the impulse to call to him again and watched him go.
When he was out of sight, Kerry turned and went back through the doors to find Benton watching.
"You spoke to him?" Benton asked.
"A preliminary conversation, Peter, if you must ask," Kerry said sardonically. "How did the surgery turn out?"
Peter expelled a deep breath. "Fine."
"The procedure worked," Kerry noted calmly.
Almost grudgingly, Peter answered. "Elizabeth said it was a variation on a maneuver that is taught in Europe."
"Does that allay your concerns?" Kerry's voice softened as she recognized the significance of Peter's admission.
"Only a little."
Kerry decided to allow Peter a little pride, but not too much. "You know that patient was robbing a liquor store. The owner shot him."
Peter looked at her, surprised. Kerry nodded to affirm her statement, then went back to the desk while Peter stood looking out into the ambulance bay.
Aftermath - Act Four 7pm
Swanson guided John by the elbow through a door into a room where a number of men were gathered. "This will be your first group meeting. You can talk if you want, or just listen," Swanson explained.
The eight men began sitting down on the couches and chairs gathered in a small circle.
"Gentlemen, this is John," Swanson said. He turned to Carter. "John, you'll learn everyone's names in a little bit." He pointed to an empty chair. "Here, sit down."
John nodded and joined the group, his face giving away his nervousness.
"Now, where were we last time?" Swanson asked, looking at the rest of the group. "Sandy, I think it is your turn."
One man, the size of a football linebacker, leaned forward. "John, I'm Sandy. I was an EMT, one of the first on the scene at the Oklahoma City bombing." The man took a breath, hesitated. "And I still don't believe it." Sandy looked at the men in the circle.
"Why Sandy?" Swanson asked.
"These were innocent people, just doing their ordinary jobs. And children in a day care center." Sandy pursed his lips, took another breath, and tried to steady his nervous hands. "Nothing could protect them, they weren't safe, even in America. It's as if ... there is no place to be safe anymore."
Dr. Steven Phillips looked carefully at Luka as he quietly came in the room, closing the door behind him. Luka crossed quickly to the overstuffed chair, his shoulders stiff, his face grim. He settled in the chair and seemed to relax a little.
"I can see you didn't get any sleep last night," Dr. Phillips noted. "What did you do?"
"I sat in a church all night." Luka shrugged. "It was the safest place I could think to go."
"Not a bad choice," Phillips answered, keeping his voice light. "What happened?"
Luka looked at the floor and took a breath. Phillips let the silence hang between them until Luka was ready to talk.
"I was sent to that armored car robbery."
"I saw the news reports. I thought that might be you."
"Men aren't suppose to be afraid," Sandy whispered. "My dad always said life was like football. You go out there, take a stand, take the hit. Or hit them first, with everything you got." He looked around the room again. "You never let the other team see you be afraid."
"And men are never afraid?" Swanson asked.
Sandy shook his head. "We're not suppose to be. I never saw my dad or my uncles ever look afraid."
"Is this the first time you've been in such close physical danger since you left Croatia?" Phillips asked.
"Why did you agree to go?"
"I didn't think there would be any shooting, that the police would let us in if there was any danger like that."
"And when there was?"
"I could taste the fear in my mouth."
"And it reminded you of the siege and the internment?"
Luka nodded again.
"So what happens to your fear, Sandy?" Swanson leaned forward on his elbows.
"I guess I stuff it down inside."
"It comes back out as anger. A man can get angry. That's OK." Sandy shrugged with the explanation.
"But you already have a righteous anger, don't you?"
"About McVeigh and Nichols bombing the building? For killing and maiming all those people? Sure. Who doesn't?" Sandy searched the other men's faces for agreement and got it.
"So inside you, what do you have?"
Sandy stood up and walked behind his chair. Finally he looked at Swanson. "I guess I have two kinds of anger."
John shifted uncomfortably in his chair but kept watching the story unfold.
"And how did you express all this anger?"
"I was abusive to my family. I abused alcohol. I cheated on my wife. I was fired from my job." Sandy's voice was soft, withdrawn. "I acted as if I didn't have any fear."
"So where does your fear go, Luka?" Phillips asked leaning forward towards the man with his head on his hands.
Luka grimaced. "It comes out in a way that isn't me."
"Well, it is a distorted you," Phillips suggested gently.
"Yeah," Luka nodded. "It's ironic. I want to fix everything, make it safe, but I ... become a tyrant doing it. Tyrants by their own nature cannot make things 'safe'."
"True," Phillips nodded.
"The fear overruled everything I know, everything I believe in."
"You protected Nicholas and the nurse during the shooting," Phillips offered.
Luka looked away for a moment, started to say something but stopped. He shook his head and looked back at his doctor. "But after the shooting was over, all I could think was getting that boy to safety. Getting myself to safety. Getting that unborn baby to safety."
"You have seen a lot of 'innocents' mistreated, slaughtered. You have been mistreated," Phillips offered. "You have a reason to have fear."
Luka shook his head. "But not to be a coward. Not to be a tyrant."
"And then what happened to your fear?"
"It goes in here," Luka answered, putting his hand over his heart.
"Everything does. The fear, my grief, my failures."
"So last night, you went to the church because you would feel safe there?"
Luka nodded again. "Safe from someone with a gun." He paused and looked away. "Safe from myself."
"Did you consider suicide?"
Slowly, Luka shook his head. "Last night, I did not have enough courage for anything."
Phillips raised his eyebrows at the answer. "You want my assessment?"
Luka nodded, his eyes searching Steven's face.
"In the last year, I've watched you start feeling again, start getting involved in life again."
At first, Luka was surprised but then slowly nodded his agreement.
Steven continued. "And now, three difficult things happened in a short amount of time. Carol left. The shooting. The baby."
Luka looked down. "And now it's coming undone."
"There is no place to be safe. And every part of me wants to change that." Sandy sat back down in the chair, as if defeated. "And I know I can't."
"What was your breaking point, Sandy?" Swanson asked.
"I was sent by chopper to a multiple MVA on the freeway," he answered slowly. "A school bus and a semi. Twelve children were dead, two of them decapitated. Three were so badly mangled you could not tell if they were boys or girls."
The other men in the room sat in silence, some looking at the man telling the story, some staring at the floor, as did John who also kept stealing glances at Swanson.
"And now," the man continued softly. "All I see is the dead children everywhere. From the bombing. From the accident."
"When is the last time you cried?"
Luka turned from looking at the framed photographs that hung on the office wall. "The day the UN got us released from the camp."
"You demand a lot from yourself, Luka."
"I don't know any other way to be. I've always just wanted to be a good doctor." Luka looked at Phillips and shrugged.
Phillips stood up and returned to his desk. "Are you self-medicating? Over-doing alcohol?"
"No." Luka looked at the floor.
"Here's a prescription to help you sleep. Use it. If you want, I can give you an antidepressant."
"I don't want it. Besides, they take too long to work."
"For a doctor, you sure don't like taking pills," Steven smiled, and Luka gave a weak grin. "You just can't think of yourself needing help. Take this one at least."
Luka reached out and took the paper. "I don't like to ask for help."
"I know," Phillips agreed. "What are you going to do?"
Luka sat back down in the chair and looked at Phillips. "I'm not going to commit suicide. I don't know where it comes from, but I keep getting up each morning."
"You will have to deal with this Dr. Benton sooner or later, and your boss."
"It takes courage to face the present, to ask for help, just as it does to accept the past."
Luka slumped a little in the chair again. "Today, it feels like I have used it all up."
"Luka, you don't hesitate to tell a patient the truth, and you are particularly direct when their disease is by their own choice."
"Yeah," Luka answered.
"Then I'll treat you the same. Your courage is not gone," Phillips said, his voice firm but soft. "Courage, like love, does not come with a limited supply. It is endless. You have enough love to love your wife and children in memory and to love again. Of anyone I know, you have a deep, endless reservoir of courage, enough to survive the last ten years and to find meaning for your life. You have it now to go on."
Luka took a deep breath and slowly nodded.
"The prescription is for three sleeping pills. Will you make an appointment for three days from now?"
"Sure," Luka said, standing up.
"And of course there is group in, what, a week and a half. Go home and get some sleep. Then go to work tomorrow."
"I'm off for a couple of days," Luka responded.
"Good. Then you know the drill," Phillips instructed. "Write in your journal. Go sailing or for a walk near the water. Do something nice for yourself. Buy yourself a new shirt, something for summer, perhaps something in light blue?"
Luka gave a small smile.
"But use my pager number if you need to talk. I'll call you back immediately. Don't wait."
"Okay," he said. "Thank you."
"You are welcome, Luka," Phillips responded as he watched Luka go out the door.
"Well, John, any impressions?" Swanson asked as they walked down the hall.
John shook his head. "My problems are not anywhere near what that man had to face. I don't know that I need to be here."
The two men arrived at a door and Swanson looked directly at him. "John, the size of the tragedy does not matter. Think of sorrow, or grief, or anger as a gas in a vacuum. The molecules distribute evenly in that space, filling it, saturating everything. Yours is no worse or no easier than that of anyone else. But it is yours. It is what you know."
John nodded slowly, then turned, and entered the open room. He sat on the edge of the bed, took the two pills set out for him on the nightstand, and washed them down with a glass of water from the pitcher. Taking off his robe, John crawled under the covers and stared at the ceiling, his eyes noting the camera in the corner of the ceiling.
He tried lying on his side, his face away from the camera but it was uncomfortable. He resumed the position on his back, but turned his head as far as it was feasible so that the preying camera could not see his eyes.
Luka sat on his couch, flipping channels on the television set. He paused on CNN to listen to a report on the trials of accused war criminals at the international court. A story began on Kosovo, but when the report noted how the atrocities still existed on both sides of the ethnic divide, he turned the set off and sat in the dimness of the single lamp.
After a moment, he reached out and opened a prescription vial, taking one of the three pills. He took the pill with some water from the bottle that was sitting on the small coffee table amidst the Croatian and English newspapers, the medical journals and several books. Then he reached out, took his wallet, from the table, and removed the photograph. He sat for a long time looking at the picture.
"I gladly accept this burden rather than you have it," he said softly, speaking to the picture. After a moment, he sighed. "I work every day to honor your faith in me. But ... sometimes ... " his voice trailed off, unable to finish the sentence and he closed his eyes.
After a few moments, Luka looked again at the photograph and whispered a few words in Croatian, his face revealing the words of love. Then he carefully returned the picture to his wallet and sat back, turning on the TV again and flipping channels. The illumination of the TV screen shone in his eyes until he laid his head back and closed them.
Sequel: Uncharted Territory