Fifty or Sixty Years

January 11, 2003
Define Family

It was mid-January and the weather cold and icy. They had been treating MVAs all morning. Carter and Susan were involved in their third one when Chuny burst into the trauma room, “Carter, phone call for you. They said it was urgent.”

“Malik, I need a chest tube, 32 French. Uh, I’m a little busy right now, Chuny. Can you take a message.”

“It’s a doctor from St. Louis. He thinks he’s treating one of your patients. He says it’s an emergency.” Carter exchanged looks with Susan who was busily intubating the patient. “Put it on speaker.” Chuny punched the appropriate buttons. As Carter finished the chest tube, he said, “This is Dr. Carter. I understand you think you may be treating one of my patients.” To Malik he said, “Page surgery again, I’ve got 1200 in the thoraseal.”

Susan looked up, “Okay, I’m in. Bag him and hang another unit of O-neg. Type and cross for five.”

“Dr. Carter, Steve Thompson, trauma surgeon, St. Louis University Hospital. Sorry to bother you but I’ve got a fifteen or sixteen year old female whose been badly injured in a car accident. The ID says Rachel Greene.” Again Carter looked at Susan; his stomach sank. What they feared was true. “We’ve tried to reach her parents but no luck. One of the nurses found your card in her wallet and thought she might be your patient. Have you treated her?”

“Chuny, pull any old charts on Rachel and check for drug allergies . . . and page Elizabeth. Dr. Thompson, I’m her . . . uh . . . I’m her godfather. She has a stepmother here and we’re trying to get in touch with her now. Can you tell me the extent of her injuries.” To Malik he added, “Let me have that ultrasound.” He began checking the patients abdomen.

“She’s unconscious from a head injury . . . has a hemothorax, and is bleeding into her abdomen, looks like liver, kidney and spleen. We’re prepping her for surgery now. Fractured right tib-fib, and fractured wrists. She wasn’t wearing a seatbelt. The drivers of both vehicles had been drinking. ”

“Blood in the abdomen, possible liver lac. Foley’s clear. Is surgery on the way?”

Susan was finishing the central line when Edson walked in. Looking at Carter, she said, “I’ve got this.”

Carter stripped off his gloves and gown and folded his goggles. Then he picked up the phone. “Have you done a tox screen on Rachel?”

“Positive for marijuana and alcohol but the amounts were minimal. You’re obviously in the middle of a trauma and I don’t want to keep you. Any idea how we can reach her parents?”

“No, it’s okay. The surgeon just arrived. It’s covered.”

Chuny opened the door and looked at Carter, “Dr. Corday is assisting on a heart-lung transplant and there’s no one to cover for her. Romano’s on his way down to cover for you if he can borrow a pair of hands from a decent med student. Corday says Rachel mentioned something about her mom and stepfather going to Australia but she has no idea where to reach them. Here’s Rachel’s chart from last year.”

Carter nodded to Chuny and said, “Get Gallant.” To Dr. Thompson, he explained. “Rachel’s dad died last year. Her stepmother is in surgery and apparently, her mom and stepfather are out of the country. Look, do whatever you think is necessary and I’ll catch the next flight out. In the mean time, if you have any questions regarding her care you can talk to her stepmother, Dr. Elizabeth Corday or Dr. Susan Lewis at this number.” Glancing over the chart, he added, “Her dad treated her last year for a sprained ankle and lists no known allergies on the chart.”

“Okay, Dr. Carter. Thanks. I’ll see you in a few hours.”

“Right.” By the time Carter hung up the phone, Susan had sent their patient to surgery and returned to the trauma room.

“You’re going then?”

“Yeah, I’ll call Katy and catch the first flight out. Any idea how long before Elizabeth gets out of surgery?”

“Chuny said three hours at the earliest.” Carter nodded. “I told her I’d keep Ella tonight if the nanny can’t stay. Carter, call me as soon as you know anything.”

“Yeah.” With that Carter headed to the lounge to get his things. He phoned Katy about flights and then went to find Abby to tell her he was leaving. Abby had already heard from Chuny and was not happy.

“I can’t believe you’re doing this to me!”

“Doing what to you?”

“Leaving me in Chicago, the day after my birthday, to go take care of somebody else’s kid when I need you.”

“Abby we celebrated your birthday last night. You got drunk . . . again. Remember?”

“I was celebrating but after that phone call, I was worried about my family.

“Abby, your mom is staying on her meds, your brother is in a treatment program getting the help he needs, things are relatively stable in your life. Maggie sounded fine when she called to wish you a happy birthday. Even Eric wished you a happy birthday.”


“Abby, you’ll survive without me for a day or so. Rachel has no one.”

“She has parents,” she said indignantly. “Something I never had.”

Carter sighed, “Abby right now they aren’t available. I promised Mark that if she ever needed anything, I’d be there. I intend to keep that promise.”

“You’re keeping a promise you made to a dead guy!”

“Abby, this is not some random dead guy. This is Mark Greene we’re talking about.”

“Why you? Why not Elizabeth?”

“Elizabeth is in surgery right now. Abby, I’m not arguing about this. I promised I would be there if she needed me.”

“Like Susan was there for Mark?

Her statement dumbfounded Carter. He realized nothing had happened between Susan and Mark but he did not like Abby’s implication. “Abby, I’m going to pretend you didn’t say that. Rachel is alone and scared. I’m not going to let her go through this by herself.”

“She’s not scared, Carter. She’s unconscious!”

Carter was infuriated. “Abby, I have a plane to catch. I’ll call you when I get to St. Louis.” He turned and walked out, leaving Abby standing in the hallway fuming.

* * * * * *

When he arrived in St. Louis, Carter took a cab straight to the hospital. Checking with information at the front desk he learned Rachel was still in surgery. A candy striper had shown him the way to the surgical waiting area. After letting the volunteer at the desk know whom he was there to see, he phoned Abby and left a message. Then he phoned Susan to let her know Rachel remained in surgery and learned that Elizabeth should arrive in a few hours.

“You know Carter, Elizabeth wasn’t exactly thrilled about assuming this responsibility.”

“Why am I not surprised? She wasn’t thrilled about taking care of Mark as I recall. What did she say?”

“She said Rachel is not her daughter and not her responsibility.”

“So what convinced her to come?”

“Not what, who. Robert Romano pointed out that Rachel is the daughter of her dead husband as well as the half sister of her own daughter and that if Elizabeth had any respect for her dead husband at all she owed it to Mark to take care of Rachel.”

“Somewhere underneath that devious mind there is a heart.”

“He keeps it well hidden.”

“So what can I expect when Elizabeth arrives?”

“Oh, I think she is resigned to her duty and she plans to locate Rachel’s mother ASAP.”

“Well, I had already planned that myself just as soon as I know Rachel is stable. She’s bound to have a key and there must be a note somewhere around the house.”

“Or maybe you could ask Rachel.”

“Yeah, if she wakes up. Susan, she was unconscious when she came in.”

“I know. I wish there was something more I could do, Carter.”

“Yeah, me too. But at this point Susan, all we can do is pray. I’m sure the doctors are giving her the best care possible.” He glanced up as he noticed a man in scrubs enter the room and say something he could not understand to the volunteer. The volunteer was pointing to him. “Uh, Susan. I’ll call you back. I think the surgeon just walked in.”

He stood as he put away his phone. The man walked toward him. “Dr. Carter?” He nodded and shook the man’s extended hand. “Steve Thompson. We spoke on the phone.”

“Yes. How is she?”

“Her condition is serious. You’re a doctor so I’m sure you understand that. We saved the spleen and the kidney. She has some rib fractures. That’s what caused the hemothorax but we were able to control the bleeding in her chest fairly easily. Unfortunately we had more problems with her abdomen. As I said, we saved her spleen and kidney but she was losing so much blood, we thought it prudent to remove a lobe of her liver rather than waste time trying to repair it. Ortho is finishing with her now. She’ll have both wrists and her ankle in casts for a few weeks. She’ll probably need physical therapy but the fractures should heal normally. Head CT reveals a concussion in the right temporal, frontal and occipital lobes. I’ve ordered an EEG and called in neuro. Plastics is doing her face. I told the trauma nurse to come and get you as soon as she’s settled in recovery. I have another surgery waiting but I’ll be in to check on her as soon as I finish.”

“Okay, thanks.”

“Any idea how soon her parents will arrive?”

“Her stepmother should be here sometime tonight. We’re not sure how to reach her mom.”

“Well, let me know when someone arrives.”

“I will, and thanks again.” Carter sat back down and ran his hands through his hair. He had delivered the same type of speech hundreds of times but being on the receiving end was a whole new experience. He understood everything the doctor had said. He could even picture her injuries as the doctor described them. However, it was still a lot to comprehend. This was not even his daughter. How did families manage to cope with news like this? He glanced up at the sound of his name and saw a volunteer standing in front of him.

“Dr. Carter, would you like some coffee?” she asked.

“Yeah, thanks,” he nodded.

“Sugar or cream?”

Remembering he had not eaten since morning he said, “Both, thanks.”

The plump gray-haired lady returned with his coffee and sat down beside him. Apparently she had overheard most of the conversation because she knew Rachel was not his daughter. “Is she your sister or your niece?” she asked politely.

“Thanks,” he said as he took the cup from her. Carter knew she was not really interested in their relationship, she was just trying to console him by starting a conversation. “She’s . . . uh Rachel’s my . . . my godchild,” he replied for lack of a better term. How could he begin to explain to a stranger that Rachel was the daughter of one of his best friends and mentors . . . someone who had trained him and stood by him through some of the roughest moments of his life? How could he explain that he had promised Mark he would be there if Rachel ever needed him or that he had made that promise because his own parents had never been there for him?

“It’s a lot to take in . . . when the doctors rattle off that much information so fast,” she smiled compassionately. She patted his hand, “I know you’re a doctor so you understand but it’s different when you’re the one on the receiving end of that speech.”

“Yeah it is,” he agreed.

“Is there anything else I can get for you now? Something to eat maybe?”

“No, I’m fine thanks.” He shook his head.

“Well, I won’t keep you. I saw you talking on the phone and I know you have some more calls to make. Just let me know if there’s anything else you need.”

“I will thanks.”

She stood and patted his shoulder before she walked over to speak to the lady on the other side of the room. As he watched her walk away, Carter decided he would never take any of those nameless volunteers for granted again. Until today, he had no idea how important these people were to the families that needed their assistance.

* * * * * *

Carter was finishing his second call to Susan, when a nurse wearing scrubs and a labcoat approached him. “Dr. Carter?”

Carter stood and offered his hand. “Yes.”

“My name is Cynthia Mitchell. I’m the trauma care coordinator assigned to Rachel Greene.”

“John Carter. Trauma care coordinator?”

“It’s a fairly new protocol that appears promising. I’m a trauma nurse specialist. Whenever we have a patient, such as Rachel, who requires the care of more than three services, the patient is assigned to an APRN. My job is to supervise and coordinate Rachel’s care from the time she leaves surgery until she is dismissed or goes to rehab. I work closely with the trauma surgeons and serve as a liaison between the trauma team and the family.” She smiled revealing a dimple in her right cheek; “It helps prevent overlapping and conflicting orders among the various services and keeps the focus on Rachel Greene and not just her liver or lungs.”

“I see. Must be a daunting task.”

“Some days. Dr. Thompson tells me you’re a doctor at County General in Chicago and you were in the middle of a trauma when he phoned.”

“Yes, I’m chief resident of emergency medicine.”

“So you understand the seriousness of Rachel’s condition.”

He nodded, “All too well.”

“And you’re Rachel’s godfather?”

“Um hum. Until his death last year, Rachel’s dad was one of my supervisors . . . since med school.” Anxious to find out about Rachel’s condition, he asked, “So, I take it Rachel is in recovery. Is she conscious?”

The green-eyed brunette shook her head. “She’s in recovery but she remains unconscious. However, she is triggering the vent and her vital signs are stable. Her urine output is good but pink and there has only been 50cc drainage from her chest tube since surgery.” Anticipating his next question, she added, “And yes, I milked the chest tube myself just to be sure. Her dressings are clean and dry and the tech just finished her EEG. Neuro has yet to read it but the tech felt it looked fairly normal. I can take you to see her if you like?”

“Yes, please.”

As Carter followed the slender woman into the recovery room she asked, “So, any idea when her parents might be arriving?”

“No, I’m not even sure how to locate them. Rachel’s stepmother is on her way but we think her mom is in Australia. Perhaps you could help with that. If I can locate a house key among Rachel’s personal belongings, I thought there might be a note or something at the house.”

“Sure, I’ll get them for you. She was staying there alone while her mother and step-father were out of the country?”

“Apparently. Not exactly the best situation.”

“Well, she’s fortunate to have you.”

They entered the unit and Carter surveyed the surroundings noting that while the equipment was similar, the walls and cabinets looked much less worn. Speaking to the nurse caring for Rachel, Cynthia said, “Cathy, this is Dr. John Carter. He is Rachel’s godfather and an emergency physician at County in Chicago. Dr. Thompson has written orders that he can stay with Rachel as long as he wishes.” She pulled one of the chairs from the desk over to Rachel’s bed. “Thought you might like to sit down.”

“Thanks,” he responded as he methodically began to check the readings on the monitors and the various labels affixed to the IV bags. Finally realizing that Cynthia was speaking to him again, he said, “I’m sorry. What did you say?”

“I asked when was the last time you ate. I know most of our chief residents usually keep very irregular schedules.”

“Uh, it’s been awhile,” he admitted as he stood looking at Rachel and feeling helpless. He was a doctor; he should be doing something, not standing idly by watching.

“I’ll see what I can find. You’re not a vegetarian are you?”

“No, anything is fine, thanks.”

Carter stepped to the right side of the bed, Rachel’s left. There were tubes and bandages everywhere. Her face was swollen beyond recognition. From her condition he was sure Rachel’s side of the car had taken most of the impact and that the car was probably an older model with no airbags. With casts on both wrists, he could not even hold her hand. Carter lightly brushed her left cheek with his fingers. It was the only patch of skin not covered or attached to something. “Rachel, sweetheart. It’s Dr. Carter. I’m here.”

* * * * *

The sudden silence of Rachel’s ventilator awakened Carter abruptly. He felt the familiar rush of adrenaline as he raised his head from the bed rail where he had been sleeping and jumped to his feet. However, his heart began to slow when he noticed the slight rise and fall of Rachel’s chest and noted the nurse standing on the other side of the bed. Observing his alarm Cathy reassured him, “I turned it off to see how she does on room air. She was beginning to get restless and her blood pressure was up. I gave her a boost from the PCA a couple of minutes ago.”

“How long?”

Cathy smiled, “I just turned it off, Dr. Carter. Either you weren’t sleeping soundly or you are accustomed to listening for the slightest change in noise level even in your sleep.”

“Probably both,” he admitted as he returned her smile. “Has she opened her eyes?”

“Just a few flutters.”

Carter softly touched her cheek, “Rachel, Rachel, sweetheart, can you take a deep breath and open your eyes?”

He watched as she began to respond to his request. Cathy glanced at the pulse-ox. “Holding steady at 98%.”

Carter nodded. “Rachel, Rachel.”

Rachel’s eyelids fluttered again as she tried to focus on her surroundings. When she finally focused her gaze on him, he could see fear in her eyes. “Rachel, it’s okay. You were in an accident and you were hurt pretty bad but you’re going to be okay. Can you move your feet for me?”

He watched as the covers moved slightly at the foot of her bed. “Blink twice if you know who I am.”

She blinked twice in rapid succession. Satisfied that she was awake, Cathy said, “I’ll go find someone to take out the tube.”

Rachel turned her eyes briefly Cathy’s direction as she spoke, then looked back to Carter. “You were in a car accident and you’ve had surgery,” he explained. “Elizabeth is on her way and we’re trying to get in touch with your parents.”

Rachel nodded her head ever so slightly. Carter was not sure how much of this she was comprehending but he was hoping to keep her awake for a few minutes so he could further assess her mental status as soon as she was extubated. Presently, Dr. Thompson appeared. “Okay Rachel. I’m going to remove this tube. I want you to take a deep breath and cough when I say three. He deflated the balloon and counted, “One, two, three.”

She coughed and sputtered. “Dr. Carter. You came,” she whispered hoarsely as she tried to smile.

“I told you I’d be here if you ever needed someone,” he grinned. “Though this wasn’t exactly what I had in mind.”

Cathy handed him a cup of ice chips and a spoon. Carter carefully fed Rachel a small bite, trying to avoid the cuts around her lips in the process. “Do you remember what happened?”

“Party . . . left early. Screeching tires then . . . nothing. How bad?”

It was obviously difficult for her to talk. “How bad are you hurt?” he asked.


Rachel began to dose as he answered her question. From his own experience, he realized she might remember asking but she probably would not remember the answer, so she would ask the same questions again and again. However, she had regained consciousness and that was a very good sign.

* * * * * *

Three hours later Carter was again dozing against the bedrail when another nurse awakened him. Evidently he had slept through a shift change. She introduced herself as Brenda Dixon, SICU night supervisor and then added, “There’s a phone call for you at the desk.”

“Thanks. How’s she doing?”

“She’s stable.”

Carter walked toward the desk took the phone offered by the desk clerk. “This is John Carter.”

“John, it’s Elizabeth. My plane just landed. How’s Rachel?”

“She’s extubated. I haven’t talked to the neurologist yet but she appears alert when she wakes up. According to the CT report, the frontal lobe is the worst. Her vital signs are stable and urine output looks good.”

“Have you located her mother yet?”


“Where are you staying?”

“Oh, I made reservations for both of us at the Hyatt Regency near the hospital. I’m okay here if you want to go there first and drop off your bags. They should have a shuttle from the airport unless you want to rent a car.”

“I’ll take the shuttle. I have enough trouble navigating around Chicago when I’m this tired.”

“I haven’t checked in yet but I guaranteed the rooms. You can probably get a taxi to the hospital. She hasn’t been awake enough to tell me much but I have Rachel’s house key. I thought I would go over to the house and look for some information on how to reach Jenn after you get here.”

Wearily Elizabeth responded, “Fine Carter, see you shortly.”

* * * * *

Rachel was not quite as alert as Carter had hoped; the security code she gave him turned out to be her home phone number. It took four hours and a trip to the police station to convince the authorities that he was in fact Jonathan Truman Carter, III and not some common criminal. Arriving back at the house, it took another hour and a half to learn that Jenn and Craig were no longer staying at the hotel listed on the refrigerator. Through the concierge he learned they had taken a side trip to New Zealand. It was almost eleven on Sunday morning, St. Louis time, before Carter reached Jenn in Christchurch. However, her irritation at having her sleep disturbed was hardly a match for the irritation Carter felt after staying up all night trying to locate Jennifer.

“John, do you have any idea what time it is here?”

“No Jenn, I’m sorry but I don’t. However, under the circumstances, I’m not sure it matters.”

“Maybe not to you but it does to me. It’s three in the morning. I was asleep. You know Carter, I had thought this might be a good idea but I’m beginning to think Rachel calling you is a mistake. What overblown crisis has she called you about now?”

Carter had spoken with Jenn twice since Mark had died. Though he talked to Rachel quite often, most of their conversations were about Mark. Rachel missed her dad and wished that she had known him better. Rachel wanted to know any scrap of information Carter could remember about her visits to Mark at work when she was little. They had enjoyed reminiscing about Rachel’s scout troupe visiting the ER. All the kids had agreed that it was the best field trip they had taken.

Now a sophomore in high school, Rachel had begun to worry about her grades. She was having trouble in several subjects and had talked with Carter about it. The first time he spoke to Jenn he had gently suggested that Rachel might benefit from a tutor. However, Jenn informed him that the only thing wrong with Rachel’s grades was that Rachel refused to apply herself and Jenn refused to waste money on hiring a tutor. Thinking that Jenn might understand the situation better than he, Carter had dropped the matter. When Rachel continued to express her frustration with her studies, Carter suggested Rachel ask her mom again about getting a tutor. That resulted in their second conversation. Jenn had called to inform him in no uncertain terms that he should stay out of the matter. Rachel was perfectly capable of bringing up her grades and her only problem was that she refused to put forth the necessary effort.

Following that call, Carter had taken a different approach. Having forgotten how much homework a high school student usually had, he offered to help Rachel with her homework, either by phone or E-mail. When she sent her first paper, Carter thought perhaps Jenn was right; although Rachel’s ideas were good, the paper was a grammatical disaster. However, in talking with Rachel, he realized that somehow there were basic rules of grammar that she had missed. Uncertain of where to begin, Carter had simply corrected the first paper and sent it back along with an explanation of each correction. He also suggested that she show her teacher both papers and ask for extra help. He honestly had not expected Rachel to follow through with his suggestion but evidently she had for, at Rachel’s request, her teacher had phoned him to let him know that Rachel was coming in early one day a week for tutoring. Since he was not a parent, neither Carter nor Mrs. Smith was sure of the legality of their conversation. When Carter explained the situation, both he and the teacher agreed that Rachel was going to need more help than he had time to offer by phone or Internet. Mrs. Smith was impressed with Rachel’s initiative and agreed to speak with Rachel’s other teachers on her behalf. The second paper she E-mailed him was much improved; she received a C and Rachel had been attending early morning sessions with her teachers three to four days a week. Though her grades were nothing to brag about, they were improving. Yet, Carter realized there were days when Rachel missed her dad and had trouble focusing.

Taking a deep breath, Carter quietly answered, “Actually Jenn, this time the call didn’t come from Rachel, it came from a doctor at the university emergency room.”

“Great, I leave town and she manages to get herself into trouble again. What’s she on this time?”

Ignoring her sarcasm and her comment about drugs, Carter said, “Jenn, Rachel has been injured in a car accident. When the hospital personnel were unable to locate you they phoned me. I flew to St. Louis and have been at the hospital with her most of the night. Elizabeth is with her now.”

“Oh my God! Has she wrecked my new Lexus?”

Carter clinched his fists and tried to remain calm. Rachel lay in SICU close to death and her mother was concerned about her car. “Jenn, I’m fairly certain that she was not in your Lexus. She wasn’t driving and from the extent of her injuries, I would say she was in a car without airbags. She was at a party and she left early. She was riding with a friend.”

“But she’s going to be all right?”

“Rachel’s injuries are severe. She has damage to her kidney, her spleen, her liver, and one lung collapsed. Her right ankle and both wrists and several ribs are fractured; she also has a severe concussion. She’s out of surgery and stable at the moment but her condition is critical. She did recognize me when she woke up but there is still a chance that she may have some brain damage. I haven’t seen the neurology report yet.”

“Brain damage? How bad?”

“The frontal lobe was the most severely injured. That affects higher levels of thinking . . . things like math, science, reasoning skills . . .”

“Great! So now she may have a legitimate excuse for her poor grades.”

Ignoring her comment, he inquired,“Jenn, how soon can you be here?”

“You expect me to fly home in the middle of a vacation that we have planned for years!”

“Jennifer, Rachel is critical. There are medical decisions that have to be made and you are her next of kin. She needs you.”

“First of all, I don’t know anything about making medical decisions. Mark always handled that. Second, Rachel got herself into this mess and she can just get herself out of it. I told her not to go to any parties while I was gone. She needs to grow up and start taking responsibility for her actions. If I come running home and bail her out what kind of lesson is she going to learn?”

Interrupting he said, “She’s a teenager. Almost all of them are irresponsible at one time or another. That’s why they have parents to supervise them.”

I was not finished, Carter. Third, it would take at least two days for me to make travel arrangements and fly back. I’m sure she’ll be fine by then.”

“Jennifer, if you don’t come back the only lesson Rachel is going to learn is that when she needed her mother the most, her mother wasn’t there.”

“Oh, and now you’re the expert on child rearing! Just how many children do you have, John Carter?”

“None at the moment.”

“What does that mean?”

Carter adamantly replied, “It means that the son I adopted died a little over a year ago and though I didn’t have him long, I cherished every moment.”

“Obviously he wasn’t a teenager.”

“No, he was twelve.”

Softening her tone slightly, Jenn continued, “Carter, I’m sorry for your loss. But that does not change the fact that I think Rachel needs to accept responsibility for her actions and I’m not going to ruin my vacation. I don’t know that much about medicine. I’m sure you or Elizabeth would be much better at making those decisions than I.”

“Jenn, Rachel remains in critical condition; she needs her mother.”

“Carter, she needs to grow up. Look, you seem to be the expert on Rachel and you are certainly qualified to make medical decisions. Mark trusted you and so do I. I’ll draw up the necessary papers to make you Rachel’s temporary guardian and fax them to you as soon as I can. Where can I reach you?”

“Elizabeth is her stepmother. Don’t you think it would be more appropriate for Elizabeth to . . .”

“Elizabeth was her stepmother. No Carter, Mark trusted you. We’ll be back the first week in February.”

Since she had no sympathy for her daughter, he tried another approach. “Jenn, Rachel is going to be hospitalized for a minimum of three weeks. She doesn’t need to be left here alone. I care about Rachel but I have a job in Chicago. I’m not sure I can be away that long.”

“Surely Elizabeth can help out or you can transfer Rachel to County. People do it all the time.”

“Jennifer, Rachel is your child. She’s stable now but with injuries this severe there is always the possibility that something could happen . . . that she could . . . ”

“Well, I’ll trust you not to let that happen. Look Carter, she is my child and I think she needs to learn that her mother is not going to be manipulated. You can call me again if her condition worsens. Now, where can I fax the papers?”

With a sigh of resignation, Carter asked, “Do you have a fax machine here at the house?”

“You’re at my house?”

“Yes, I used Rachel’s key. That’s how I learned where to start tracking you down.”

“So she was able to give you the security code?”

“No, she wasn’t.” Carter took a deep breath and counted to ten before saying, “Jenn, I’ve been up for over twenty-four hours. I have left from work and flew to St. Louis. I sat for hours waiting for your daughter to come out of surgery and the only sleep I’ve had was leaning against the rail of Rachel’s bed, praying that she would wake up. I’m tired and if I begin to describe how much trouble I have had finding you, I’m likely to lose my temper. Just fax the papers. I’m going to crash here until they arrive.”

Not waiting for her reply, Carter hung up the phone. As he climbed the stairs to find a bedroom, Carter wondered why people like Jenn were allowed to have children. He showered and crawled into bed just as his phone rang. It was Susan.

“Carter, did you locate Jenn?”

“I found her.”

“How soon will she be back?”

“Three and a half weeks.”


“She’s not going to ruin her vacation.”

“You’re not serious?”

Susan could hear the fatigue and frustration in his voice as he replied, “Susan, I’m too tired to be anything but serious. I’ve barely slept since Friday night. Jenn thinks Rachel needs to learn that her mother cannot be manipulated. She’s making me temporary guardian until she returns.”

“So you’re supposed to move to St. Louis until she returns?”

He sighed heavily, “No, I’m supposed to transfer Rachel to County as soon as she’s stable enough to move.”

“It’s a shame that she doesn’t have any other family.”

“Define family.”

“What did Elizabeth have to say about this?”

“She doesn’t know yet. Susan I’m too exhausted to talk.”

“Okay. Where are you now?”

“At Jenn’s . . . waiting on a fax.”

“Well, get some sleep and I’ll take care of as much as I can from this end. I’ll call Elizabeth and check on Rachel. I’ll talk to Weaver and Romano about schedules and I’ll see what I can find out about transferring Rachel. I’m sure they are going to want one of you back soon.”

“Susan, I don’t have a return flight.”

“When I get the schedule straight, I’ll make reservations. By the way, who is paying for all of this?”

“Bill Gates . . . John Allen . . . take your pick.”

“John, wherever Mark is, I’m sure he appreciates everything you’re doing. Now get some sleep; that’s an order from your supervisor.”

“Pulling rank are you?”

“Whatever it takes. Call me when you wake up.”

* * * * * *

February 3rd, Carter again found himself at the airport. This time he was dropping off Susan and Rachel. Upon returning to the States, Jenn had phoned and requested that they put Rachel on a plane and send her home. Susan was furious and volunteered to accompany Rachel to St. Louis.

From her wheelchair Rachel looked up and said, “I wish I could stay here with you guys.”

Carter shook his head, “Rachel, we’ve already discussed this.”

“I know, I just wish . . .”

Susan smiled at her sadly, “Yeah me too.”

Leaning down, Carter gave her a gentle hug and kissed her forehead. “Concentrate on getting well and call me whenever you need to talk. Oh, and try to keep Susan calm. She hates flying.”

“She can squeeze my cast.”

Carter hugged Susan and said, “Pick you up at the bus station tonight.”

“I can take a cab.”

“I’ll be there.”

Post: A Boy Falling Out of the Sky
Breaking Up

“Your mother can be eccentric . . . maybe a little embarrassing at times.”
“She has a debilitating mental disorder.”
“Having her live with you would be a major inconvenience, wouldn’t it?”
“We’ve tried it before. It doesn’t work . . . she loses control. I can’t take care of her.”
“Can’t or won’t?”

Conversation between Mr. Nesmith and Abby Lockhart: Fear of Commitment

“I’ve only been dealing with this for thirty years . . . Maybe next time you’ll do it right and then it will be the coroner’s problem.”

Abby Lockhart yelling as she leaves courtroom: Fear of Commitment

“I am his mother.”
“Oh come on. Come on, you’ve been in an out of the hospital for the past thirty years. You’re not anybody’s mother.”

Exchange between Maggie Wyzcenski and Abigail Lockhart: Next of Kin

“Abby, have you seen Sara?”
“The girl who fell asleep on the El. The cops brought her in . . .”
“We’re in the middle of a trauma, Harkins, what would you like us to do, stop and help you look for your patient?”

Conversation between Erin Harkins and Abby Lockhart: One Can Only Hope

“Abby, Abby. I still can’t find her”
Abby in a dismissive and irritated voice, “Jerry could you help Harkins find her patient?”
Knowing that Jerry is not going to help either, Abby then takes time to go outside and discuss the dangers of not smoking with her brother.

Exchange between Erin Harkins and Abby Lockhart: One Can Only Hope

In the middle of a trauma, Abby receives a phone call from her brother. Chuny steps into the room and says,”Abby, your brother’s on the phone.”
“Hey, sounds like your busy. Should I call back?”
As the trauma conversation continues, Abby keeps talking to Eric, “What’s wrong?”
“I was wondering about the blender . . . yeah, we’re making milk shakes.”
“The blender?”
“Uh, I think it’s in the cabinet, underneath the coffee maker.”
Elizabeth finally interrupts. “ . . . Abby, get off the phone and call for a CT scan.”

One Can Only Hope

After he talked to Abby, Carter had traveled all night, barely sleeping on the plane. He was worried about her; any time she was under pressure she got drunk. Carter had to concede that finding out your bipolar brother’s plane had disappeared from radar was near the top of the list for stressful events. So, he had returned home to rescue his damsel yet again. Carter had really been looking forward to this vacation with his fraternity brothers. He had not been anywhere with them in a couple of years, since before . . . before his life fell apart. After helping care for Rachel and having to deal with Jenn, he needed a vacation. Besides, he had thought talking with his fraternity brothers might give him a new perspective on things. His relationship with Abby was not going as he had hoped. Things between them had been gradually falling apart since before Christmas. Then, out of the blue she worked a split shift the day he was scheduled to leave so she could see him off. After that, he felt obligated to call and let her know he had arrived safely. That was when she told him about Eric. His first thought was that it was just a ruse to ruin his vacation. Even though she said she did not mind him going, he was not sure whether she was telling him the truth or being a martyr. However, she sounded genuinely distressed; although, with Abby it was hard to tell.

Carter drove straight from the airport to Abby’s apartment and let himself in with his key. As expected, he found her passed out drunk. The place was a mess. When he could not wake her, he showered; then, he started cleaning the kitchen and living area. Two hours later, when Abby stumbled into the living room, he had barely made any improvement. Despite his protests, she insisted on going to work. He knew it was a bad idea. She had a hangover and her mind was on her brother. However, she assured him that she would be fine; she was only working triage. As soon as she left, he fell asleep on the sofa.

Then Maggie had arrived. There was nothing to do but take her to the hospital to find Abby. Unfortunately, Abby had been pulled into a trauma. As usual, Abby did not want to deal with her mother. First, she refused to talk to her. Then she asked, “Can’t you deal with her?”

To which Carter had replied, “She’s not my mother.”

Carter had become extremely frustrated with the situation. Of course Maggie was going to be upset; her son was missing. Yet, Abby should be the one to deal with it, not him. Kerry even suggested that Abby leave. She should have; she certainly was not giving her patient or his family her undivided attention. Abby had run out of the trauma room to hide from her mother. That was when Carter had been pulled in to the trauma.

The boy had irreversible brain damage. His mother was only asking that they keep him alive until his father arrived to say goodbye. When Abby returned, she kept asking if the mother was sure that she wanted to do this. Carter wanted to yell at Abby to stop. The woman felt guilty enough. She had just backed over her son and all she wanted was a chance for his dad to say goodbye. Sometimes you had to keep the patient alive, exhaust all efforts to save them, to give the family time to accept what was happening. The boy was in no pain. There was no need to rush them; no need to keep questioning her except that Abby had other things on her mind. Knowing that, Carter had remained silent and focused his attention on the Krolls, explaining as gently as he could what they could expect. Abby was too fragile to reprimand at the moment. Yet, if Abby was that worried about her brother, she should have stayed home. The kid was dying; the Krolls were spending their last few moments with their son. They deserved some respect. Then, as if things were not bad enough, Abby’s cell phone rang. Carter recalled his conversation on the roof with Lucy so long ago.

You don’t need to make me feel bad, I feel horrible.”

Well, that would work if this were about you but rule number one down there is, ‘It’s never about you.’

Carter lived by that rule. He continued to teach it to students. Just last year he had told Gallant that taking care of patients was more important than how we feel. Carter had family problems too but he tried to deal with them at home. At work he focused on his patients or he had until recently.

Fortunately, Abby’s brother was apparently safe. For one brief moment she was happy and then she was gone again. Carter finished up with the Krolls. They had just lost their only son; Carter knew no matter what he said, it would not ease their pain. He arranged for the grief counselor to come in and finished up the chart. Kerry tried to get him to stay and work a swing shift but Carter refused. He was on vacation and he planned to stay that way. He located Abby on the roof. That was when they had their argument. Abby was in one of her self-pitying moods again. Carter was not exactly sure how it started but he remembered well how it ended.

“I block out about half of what you say.”

“Only half?”

“The negative half.”

“I’m sorry. You’re right. I am negative. It’s hard not to be when you attract misery everywhere you go.”

Carter was trying to be patient. “I’m not going to let you do this.”

“I’m like a magnet for it and you shouldn’t have to deal with this. Maybe you should just cut your losses . . . ”

“Now you’re pissing me off. You know Eric is alive. You could take two seconds and rejoice in that.”

“I did. I hugged you and I ran away to find my crazy mother.”

“Right, your life sucks, now and forever and there’s nothing you can do about it. You know Abby. I don’t know how to deal with you.”

“Deal with me. You don’t know how to deal with me,” she retorted.

Keeping his voice calm, he tried to explain. “I wanted a relationship with you. I wanted to make this work. But . . . no matter what I do, it’s always wrong. You don’t want help. You shut me out. You are wrapped up in your own miserable little world and you won’t let me in.”

Sneering, she replied, “My own world! Carter my family is crazy.”

“And mine isn’t?”

“Not certifiably. And I’m accustomed to being on my own. I’m not accustomed to having help.”

“And I am?”

“Well, yeah. Maybe your parents deserted you but you grew up in a mansion surrounded by people ready to meet your every need,” she answered derisively.

He shook his head and said softly, “Abby, it wasn’t exactly like that.”

Disparagingly she raised her voice at him. “Yeah, right. Don’t tell me you were neglected. You had people taking care of you.”

Carter was having difficulty controlling his temper. “Yeah, like the maid?” he commented sarcastically.


He had not wanted to compare sob stories with Abby. There was no point. He was trying to get past it and she would probably win anyway. He took a deep breath and counted to ten. “Nothing Abby. Forget it. You’re right. I had everything and you had nothing.”

“You make it sound like I’m wallowing in self-pity.”

“Aren’t you?”

“No Carter, you don’t understand what it’s like.”

He had his temper under control now. He wanted to understand . . . to make this relationship work. “So tell me, Abby. Make me understand,” he pleaded.

“Carter, I’m used to doing things on my own. I take care of myself and everyone around me.”

Gently he asked, “And I don’t?”

Her tone was contemptuous. “Not like this. You don’t know what it’s like.”

Unruffled by her comment, he continued, “So you keep saying. Look Abby, I’ve been by myself . . . on my own for years . . . emotionally anyway but at some point I realized that I’m tired of being by myself. I want someone to share my life . . . the good times as well as the bad.”

“Well, I’m not there yet. Maybe I’ll never be there.”

Maintaining his composure, Carter went on. “You don’t have the corner on the market when it comes to crappy families Abby. Look around you. People come in here everyday . . . people whose lives are a lot worse than either of ours.”

“And that’s supposed to cheer me up. Somebody else has a sucky life and therefore I should feel better about mine!”

Patiently he said, “It’s supposed to make you realize that everyone has problems.”

“Yeah, well, I don’t want to know about them or deal with them right now.”

“Abby, I understand that. I’m just saying that at some point you grow up. You realize you can’t change the past . . . you can’t make everything be like you want it to be . . . you accept things the way they are . . . life isn’t perfect but you learn to get help when you need it and you move on.”

Oh, and I have so many people waiting in line to help me!” she exclaimed cynically.

“You do, Abby but you won’t let us in.”

Us . . . us . . . like there are a bunch of you!

Tenderly he said, “Abby, I care. Susan cares. The people at AA care. Maggie cares. Hell, even Luka cares.”

“Luka? Now you want me to run to Luka.”

“No, I just meant . . . “

“I know what you meant, Carter. You think I should realize that I’m not in this alone. Well, get a clue, John Carter. We are all in this alone. Life sucks! All right? And mine sucks worse than most. And the only reason anyone even tries to look like they care is because they are getting something in return.”

Exasperated, he inquired, “Oh, and what am I getting out of this relationship at the moment?”

“Sex, Carter! You get sex!”


“Get a clue Carter, we’re not all in this together . . . we’re all in this alone! The difference between us it that I’m adult enough to realize that and you’re not. You’re still living some childish fantasy that somewhere out there, there is someone who gives a damn! Well, grow up Carter. There isn’t. I’m alone. You’re alone. We are all alone. And the bottom line is that no one cares!


Ignoring him, Abby continued her tirade. “Carter, did it ever occur to you that maybe I like the way I am? Maybe I like not being close to anyone. Maybe I don’t want to change. Quit trying to fix me, Carter. I’m not broken! You are! You keep looking for someone to love you . . . to share your fantasy of a happy family. Well, maybe you should look somewhere else. I don’t do fantasy; I’m into reality.”

“Abby, the reality is that we can choose to make a difference. We can choose to be happy.”

“Oh, I should just ignore my family and choose to be happy.”

“You can’t ignore your family, Abby. I know that. But you can try and find something, some small part of your life that makes you happy and hang on to that so that you can cope with the rest of it.”

“I should focus on the bright spot in my life?”


She raised her voice, “Carter, there are no bright spots in my life!” She lit another cigarette. “Maybe I am happy. I’m happy being a drunk! I’m happy wallowing in self-pity! I don’t want your idea of happiness. I like my own. Go away, Carter. You’re the one that’s broken . . . not me.”

Carter’s musings were interrupted by the flight attendant. “Can I get you anything, Dr. Carter?”

“Uh . . . no. Uh . . . yeah, I could use a blanket. I need a little sleep before I begin my vacation.”

“No problem. Going on vacation alone?”

He shook his head, “Meeting some college buddies in Balize. We’re going scuba-diving.”

“Yeah. I’ve always wanted to try that.”

Carter responded with a polite but dismissive smile. She was flirting and he did not need any more complications in his life at the moment. The flight attendant got his message. She left and returned shortly with a blanket and another pillow. Carter reclined his seat and began to dose. There had to be someone, somewhere, easier to maintain a relationship with than Abby Lockhart. Things had never been that difficult with Susan except, he reminded himself, that they kept breaking up.

Parts 70-71
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