ZACHARY
Dr. Cole Moreau trudged down the hall, but he didn’t get far when a rush of static kicked on overhead. The paging system. His phone buzzed as someone shouted his name. He turned to see a flush Dante, the attending MD, jogging toward him. “You’re not answering your phone?”
The men moved in tandem, beelining to the Emergency Department. The shorter Dante was practically running as he briefed Cole: Nine-year-old boy in flight with severe trauma, blunt force to the chest, suspected abdominal aortic aneurysm.
“Fuck, that’s young,” Cole said. Triple As were complicated, with indeterminate blood loss and a shit ton of hidden failures. Cole slowed their pace to absorb as Dante relayed details from his beeping iPad, patient’s BP and heart rate. Cole thumbed favorites on his phone as they moved down the stairs. When the OT answered, he asked for the ready room. He waited ten seconds for the anesthesia tech, enough time to rehearse his plan, figure machine calibration, set the table for the operating surgeon—most likely Powers—and shift into his zone, his Hospital Dom. Felix Ramal had christened Cole with the moniker years ago for the way he lorded over each surgery as if he were the surgeon, as though everyone should submit to him or be punished, a habit from residency, an after effect from Kunduz. Cole’s thoughts twisted with echoes and fatigue.
“Doctor Moreau?” Angela answered, his nurse’s familiar voice snapped him back.
“Ange, we’ve got a little boy to save.” He shot off anesthetic and instrument needs, a deliberate conversation not to be rushed, because mistakes in the tray were unforgivable. Comfortable she was up to speed, Cole used the house phone to reach Navya Goodloe, his chief resident and presented the case. They spent less than ninety seconds tweaking plans and decided Cole would accompany the incoming patient down from the landing pad on the roof. He made some notes, then headed to the elevators to wait for the boy, keen for more insight.
A flurry of activity swept through the floor as awareness grew of the young Level One Trauma. Emergency was Cole's next call to confirm Powers was en route and her ETA. On the roof, he met Dante again. He confirmed the patient was on oxygen and the medevac EMTs had started the two IVs Cole had requested, and a portable monitor was attached.
He processed a new wrinkle. The kid had been mildly sedated on site—the zoo, apparently—in order to transport him. He called Angela back, concerned about the meds and the acute nature of the boy’s bleeding. He wanted assurances the blood bank would come through. “I want both arms out when he gets there, and don’t waste a goddamn second on any arterial lines or CVPs. Get him in the OR.” His mind snapped with memory. “Tell the nurses to prep for stat cesarean. It’s the closest set up.”
When the team lifted the patient down, Cole flinched as he got his first look at the boy. He re-calibrated, reaching for his com. “It’s grave, Navya. Tell them. He’s stuporous and moaning. BP and heart rate same, appears in shock, coma imminent. A statue fell on him at the zoo.” He hung on a moment longer, eyes closed, feeling rain soak his shirt. We’ve gotta save this kid.
“See you at the sink," Navya said and hung up.
His phone buzzed. Finally. Powers was in the building, Cole's cue to change and scrub in. He rode the elevator down with Dante, the boy, and his mother, while his mind thrummed through a virtual NASA-level deck of medical contingencies. When he caught them staring, he smoothed into his bedside manner, introduced himself by his first name. “I’ve been called the sandman because I can put anyone to sleep.” He smiled peacefully and rested his hand on the boy’s head.
“He’s Zachary,” the mom choked.
Cole nodded and met the boy’s glazed-over eyes. His stare was a promise. “You’re going to be all right.” In his periphery, he saw Dante secure the mother’s signature and Cole hummed a mantra: This is the way. This is the only way. Cole met the rest of his team at the sinks. They scrubbed in quietly, routine and rehearsal a wordless conversation.
In the operating theater, minutes passed as training, expediency, and muscle memory kicked in. Cole moved in pathological slow motion. He was built for this, Trauma One’s most valuable asset. With his team assembled, his sterile tools laid out, he internalized the duty countdown from each of his subordinates. Cole monitored over Goodloe’s shoulder as she programmed the machines, checked suction and tubing, while his focus drowned out the anodyne noise of the room.
He took a step back to reset, straightening himself, closing his eyes, meditating on the procedure’s complicated prep and sedation. Each step passed through his mind, like a downhill racer rehearsing gates before the start. He pivoted one last time for a cursory inspection of his team, the attending, nurses and assistants, med students and specialists. They hovered in a semi-circle at the room’s center, surrounding the long table, waiting for their young patient and Powers’ surgical team.
Scanning what he could of their somber faces, he spoke with rippling authority to align everyone’s thoughts. “With triple As, we’re fighting a ninety percent death rate. One in four ruptures into the peritoneal cavity. It’s a tricky procedure, ironically requiring patience and speed. The kid survived to get to us. Be ready.” Almost like a prayer, he added, “It’s a precious thing whenpeople trust you with their child’s life.”
Behind them, at the front of the room, Dr. Powers and her staff entered to be gowned. Their cotton shuffling was interrupted by the wheeled express bed hitting the side doors. In floated Zachary, disinfected and draped. The medical team parted as he was transferred to the table, and the detached voice of the attending narrated the sit.
Even Cole’s flatline calm couldn’t block the surprised gasps from the combined teams. While the boy was prepped and instruments brought forward, he instructed his surgical audience. “In aortic aneurysms, a patient can bleed to death quickly. Sometimes they bleed out in the time it takes the surgeon to cross from one side of the room to the other. Until the chest and abdominal cavities are open, it’s difficult to grade the severity of aortic bruising and tears, impossible to stop the damage.” He turned to Powers, who nodded she was ready.
Cole ran a rapid sequence induction and two bolus injections with a cocktail of drugs. Goodloe intubated, then Angela dosed a fat IV for amnesia. Cole zoned in on his patient’s reactions, his shallowing sounds, the fading warmth of his breath, the shift to sedation. On Cole’s nod, Powers began her midline incision and within minutes the chest cavity was opened and the aorta clamped. She’d made an educated guess because there hadn’t been time for X-ray. Smart move. She bought the team two minutes, maybe three to locate tears. Cole noted the blood was lower in the abdomen.
Next steps, monitor BP and start a volume resus with O-neg. Goodloe placed a radial arterial line and sent a blood gas. Cole added echo to monitor the volume of the left chamber of the heart, then took a breath.
Powers hesitated. “I don’t like the blood here. Clamping the proximal aorta to control the bleed.” Angela confirmed cardiac function and started the acid-base status.
Lungs. Cole considered adding a pulmonary artery catheter as quickly as possible but stopped. The abdomen was flooded. Something, the color was off. Powers gaped at him, lost.
“The liver!” he yelled. “Must be crushed. Move. Now Powers.”
In seconds, which was all they had, the team shifted to flurry. Only moments left, the boy’s luck would collapse, morphing the team to another procedure. With probing fingers, Powers and her chief pinpointed the injury, severity, what to remove, how much to stent to stem the bleeding. “Clotting off,” she announced.
Cole started to sequence the lung catheter to get the right resistance data and he prayed. Prayed they’d caught it. Prayed for a break. All their preparations, the wise and swift movements from medevac, the coordination in the ED, to incision, and Zachary might simply bleed to death. He gritted his teeth and stared into Angela’s eyes.
“Success!” The word echoed off the theater walls and the subdued energy of the team exploded.
“Navya.” Cole’s eyes instructed over his mask. She nodded and commenced the next steps.
“Two lives in one day, Doctor Moreau. It’s been a while.” Angela said, referring to a sneaky myocardial infarction Cole’d diagnosed on an ED walk-in earlier, and now young Zachary.
He bristled. He didn’t need this shit. He worked in a hospital for fuck’s sake. In war zones, saving lives was routine, never celebrated, because everything, every fucking thing weighed against a sliding scale of death.
This was Trauma One. The luxury of controlled chaos. The ideal environment for easing pain and saving life. This kid was DOA in a war zone. “It was teamwork,” Cole said. “EMTs got to him fast, gave us time to improvise. The handoff was seamless. Anyone—”
“That’s bullshit, Moreau and you know it,” Powers snapped under her mask. “No one makes that call. Who diagnoses a liver injury with this kid’s presentation? Upper aortic rupture from blunt trauma? The clamping worked. With the lights and our goggles, no one reads that blood the way you did. Give yourself some credit, doctor. You saved his life.”
Cole nodded, but fifty minutes later, he disengaged. Hours of surgery remained, but the boy was out of danger. The sound of the machines suddenly rang in his skull. He turned to Goodloe and Barrow. “ICU, sedated and ventilated.” He nodded and rotated out of the OT only to stumble back in when he leaned against the doors. Then he walked away, reeling.
He would never verbalize his rattled reaction to this kind of trauma. A dying kid to save? He’d smelled Zachary’s flesh, listened to his heart. Fucking Christ, he’d breathed for him. It was his job, and for a fleeting moment, it was wonderfully rewarding. And the worst feeling in the world. What did it mean to save a life? He barely managed to live his own.
At the floor’s west end, he pulled the door to the women’s toilet, squeezing the grip to steady his hand. This is the only way. He checked his time, only needed forty minutes. He locked the door and turned off the lights before he shot a text to Goodloe. He was exhausted and ashamed, head pounding with heartbeats and dread.
In less time than it takes to use the urinal, he recovered the small pouch hidden under his scrubs behind his knee.Then he sat on the toilet in his underwear. His movements were choreographed, poetic. Shifting hands, he set his phone on his thigh and started the timer for ninety seconds.
Ninety seconds.
Cole Moreau, Assistant Professor of Clinical Anesthesiology at Weill Cornell Medical College, Chief Attending Anesthesiologist at New York-Presbyterian Hospital, board-certified in plastics and reconstructive surgery, cardiothoracic, pediatric, perioperative and critical care, veteran of a dozen Médecins Sans Frontières missions, French National Order of Merit, King Faisal Prize, Honorary Flemish citizen, GQ’s Man of the Decade, Lasker Awardee, International Red Cross Humanitarian, Carnegie Medalist, designated Citizen of the World™, laid his foot across his knee, dosed a syringe with propofol and exposed his ankle. Sixty seconds. Five doses. Forty minutes. A prick and a push.
It worked. Thalamic waves extended, cortical loops wound down. Thank Christ, his consciousness let go. He slumped back and wedged himself to remain upright between the grab bar and the flush handle. His phone lit up.
Sasha was texting? Can we talk between us?
“Fuck.” His world dissolved. His pain-free patients, the charity, the collateral attention and faux fame he’d buried with his dad, his dead mother and brothers, all the dead, the corporeal demands of his foolish relationship with Lina, the taxing, narcotic haze he’d bathed in for months, the diarrhea, the paranoia, Zachary, the suture kit, Tudor, Jules fucking Divine.
Like clockwork, he fell into nothingness as everything went white.
Thank you for reading.
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