Fiction contest winner: Deborah Prum

TRIAGE

 Thursday Night (Emma)

 Upstairs in bed, Emma hears the front door creak. She stiffens. It's Alex coming in late.

She listens to him open the refrigerator. Something tumbles out and hits the tile floor.

Through a heating vent comes the sound of paper towels ripping, water running. Then, a few minutes of quiet. Maybe he's making a sandwich.

The stairs groan loud and low as he climbs, probably two at a time. She hears Alex turn the handle on the bedroom door and push it open. Emma lies still, tries to modulate her breathing. In, out. Don't move a muscle.

"Honey, you awake?"

Emma doesn't answer.

Alex walks into the bathroom. He flips on the light, leaving the door ajar, so that it beams onto her pillow, her face.

"Sorry I'm back so late. Got tied up. Two drunk guys in a pick-up truck collided with a car full of equally drunk sorority girls. Bad trauma.

Emma stays quiet, but she thinks, "Bad trauma at home, buddy. One seven-year-old girl in a class play waiting for her dad to show up."

"Emma, are you awake?" He sounds irritated now.

She doesn't answer.

"I just couldn't leave. The resident didn't know his ass from his elbow. A psych intern. God knows what he's doing in medicine."

She hears him flush the toilet and wash his hands. Then Alex starts brushing his teeth, loudly, vigorously. She wonders if he will have any gums left.

Emma thinks about how she took Mattie to Ben & Jerry's after the play. The child sat with her chair facing the door, still hopeful that her dad might arrive.

She hears the frame creak as Alex climbs into bed. Emma is suddenly cold when he pulls most of the covers off her. She glares at him.

"Sorry. I didn't mean to disturb you."

Friday (Alex)

In the morning, Alex is lying in bed, groggy, trying to will himself awake. He squints up at Emma, who is fully dressed an on her way out. Her loud voice slams against his eardrums. "Al, remember tonight is Jim's party at McLoury's Bar downtown. It's at nine. Jim is driving all the way in from the city. He says your old frat buddies will be there."

Alex went to college with Jim. Seems like a million years ago now.

"Don't be late. I don't want to be on my own with that crew. They're so loud and wild. I get a headache within ten minutes."

Alex nods, then drifts back to sleep for a few minutes.

That evening, the other attending doctor on Alex's shift goes home with the flu. At least Alex hopes it is the flu. During the past four years, he's had to cover while she's had two babies. Alex thinks about her nausea. He wonders if a third baby is on the way. They are trying to recruit another attending. Maybe Emma is right. Maybe he should scream and yell at the administrators, demanding that they hire two more people, not just one. He hates to seem like a whiner, but he is never home anymore.

Without much help from anyone else, Alex goes on to manage two lacerations, one overdose, a case of appendicitis, and a heart attack.

Just as he is about to head out at the end of his shift, an ambulance arrives. The medics carry in a 32-year-old single mom. A small boy tags behind, holding the ambulance driver's hand.

Alex says to the EMT, "What's this?"

"The woman reached above her head to get a package of flour. The bag dropped, then burst when it hit the counter. The woman inhaled all the flour dust. Triggered a real bad asthma attack. Couldn't breathe. The little kid dialed 911."

"Flour? Does she have a prior history of asthma?" Alex begins checking vital signs after the medics wheel her into an exam room.

"Oh yeah. Between gasps, she told us she's got a long history of breathing problems."

The woman's skin is blue. Even though the medics have been giving her oxygen, she's struggling for breath. The medics show Alex what they know of her medical history. He reads it then listens to her chest again.

Alex steps outside the exam room to speak with the resident, a first year named Barnes. "Her breath sounds are bad. She's not getting much air. What would you do?"

"Increase the oxygen?"

"That's right, but that's not all. She's not moving air. She needs more help."

Alex thinks the guy should know this stuff cold. He tries to remember which medical school Barnes attended.

"Steroids?" Barnes looks uncertain.

"Yes, steroids are what she needs over the long haul, but that won't help her acutely."

Barnes looks blank.

Alex feels an urge to shake him. "Increase the oxygen and start her on nebulized albuterol. Watch her pulse-ox."

A nurse walks into the room. "Need help?"

"Yeah, see if you can find a hospital chart on this woman. Also, get someone to track down relatives for the boy."

After 45 minutes, the woman is only slightly better; she's still struggling for breath. She starts to gasp and sob. "This isn't working... I still can't breathe... can't you help me?"

Just then, one of the nurses comes in. "Your wife is on line three." Alex looks at his watch: 9:45. He's missing Jim's birthday party.

"Oh man. Just tell her that I'm in the middle of something. I'll get back to her. Get a number."

Alex tries to calm the woman. Away from her hearing, he asks Barnes, "She needs more relief than the albuterol is providing. What next?"

Barnes is silent.

"Theophylline! Intravenous theophylline! You'd better spend some time reading on your days off. I've never worked with someone so badly prepared."

After another 30 minutes, Alex decides that the woman is stable on the new combination of medicines. Finally, she seems to be breathing more easily. He leaves instructions for the resident coming in for the next shift. He has more confidence in this guy.

Then Alex asks the orderly, "Where's the boy?"

"He's sitting next to the nurse's station. The grandparents are driving down from Vermont. They should be here in 20 minutes.

Alex finds the child, pulls up a chair and sits next to him. Alex thinks the boy must be five, or maybe six at the most. "I'm Dr. Alex. I've been taking care of your mom. What's your name?"

"Tony. Is my mom all right?"

"She was very sick. She's much better right now. We have to keep her here overnight so she can get some strong medicine. She's going to be okay."

The boy begins to cry. Alex lifts him onto his lap and holds him. "You did a very brave thing, calling the ambulance like that. Don't worry, now. Your grandma and grandpa are coming soon." Alex stays with the child another 10 minutes until his grandparents arrive.

Before Alex leaves, he looks for the message from his wife. Nothing in his box. He tries to find the nurse who took the call, but she's long gone.

Alex can't remember where the party is. He doesn't try too hard, figuring it must be over by now anyway.

Alex shows up at home at 11 to find the lights blazing in every room of the house.

The babysitter greets him. Well, not exactly greets him. He finds her asleep in front of the television in the family room. Alex tries to remember: Is he is supposed to know where his 16-year-old son is? As he pays the girl, he asks if his wife mentioned when she might return.

"Didn't say."

The girl finds her purse and keys and goes.

He takes a beer out of the refrigerator and sits in front of the TV. Boring news on all the major networks. Alex switches to the Travel Channel. Unfortunately, no babes on Brazilian beaches this time. Instead, it's something about the top-10 bathrooms in the world.

Alex wonders why his wife hasn't come home. The bars are in a bad section of town. About a month ago, he took care of a woman who had been assaulted down in that neighborhood. A sickening feeling hits the pit of his stomach. Then he thinks, "No, Emma is smart. She'll have someone walk her to the car." Alex drifts off, sitting up with a beer bottle in hand.

A loud squeal in the driveway wakes him. He jumps, spilling beer on his pants and the sofa. "Got to have the brakes fixed on that car," he thinks. He glances at his watch– midnight.

He hears his wife come in, slamming the front door behind her.

"You're late." He shouts so as to be heard from the family room at the back of the house.

"I'm late?" She walks into the room, throws her coat and purse onto a chair. "I didn't know I had a curfew."

He sits up straighter, trying to cover the beer stains on his pants and the cushion. "I just mean, you're coming in late."

He feels like crawling under the couch as Emma stands there staring, hands on her hips. "Late for what?"

"I was worried. People get jumped down there." Alex suddenly has a headache, over his left eye. He rubs the spot with the palm of his right hand.

"If you were so worried, why didn't you show up so you could protect me?

Alex looks at her with only one eye now. The glare of the light is bothering him. She sits on a stiff chair at the other side of the room.

"I got stuck... you know. Did you have a good time?"

"Just peachy. Everyone asked for you. Jim says he'll never forgive you for missing his birthday party. I called you."

"Sorry. I was trying to stabilize a 32-year-old single mom. Bad asthma attack. She didn't respond to the meds for a long time."

"Is she okay?"

"Finally. It took a long time to get her steady."

"Good. Why didn't you call later? I kept waiting."

"Janelle the nurse who took the message went off shift. I couldn't find the number anywhere. I'm sorry."

"Right. I'll bet you'll have a good excuse for not showing up at your own funeral."

"How was the band? Did you dance?"

Alex watches Emma stand and walk toward the kitchen. He guesses she isn't in the mood to engage in light friendly conversation.

"You've got to hire more people and take fewer shifts."

"I'm working on it. I know you're right. Let's hope that guy we interviewed will accept the offer. I'm thinking maybe I should ask for even another person."

"How about another five people? Maybe then you might wind up working a 40-hour-week for once."

Alex feels another throb of pain pulse through his forehead. "Where's Ben? The babysitter was here where I got home."

"He's staying at Jeremy's house tonight."

"Jeremy?"

She sighs. "Yeah, Jeremy. You know. His best friend."

Saturday Night (Ben)

Ben glances at his watch: 11:30. He can make it home by midnight, no problem. His house is only 15 minutes away. A girl from his French class has been talking to him non-stop for the past 20 minutes. At least 20 kids are wedged into the small basement, shouting at each other over the music.

Ben takes a sip from a beer he's nursed all night. Here's his technique: He wants to look like everybody else, so he gets a beer, dumps half of it, then sips the rest for a couple of hours. Much as he hates to admit it, his father's ER stories the ones about drunk teens who wind up getting killed affect him.

He puts his hand on the girl's shoulder. It's the only way to make her stop talking. "Gotta go to another party. See you at school."

Ben heads for the door, picking his way though beer bottles and dirty paper plates.

Once outside, he sees his buddy Greg on his knees throwing up into holly bushes. Greg looks up at Ben. "Oh man, I'm wasted. Got to get home before curfew, or my father will go ballistic."

Greg's father is an ex-military guy, the no-nonsense type. They boys stands unsteadily. "Hey, Ben. Help me find my wheels."

The boy staggers toward Ben, trips and falls. Ben says, "You can't drive like this."

Holding his head with both hands, Greg says, "I can't go home like this either. I'm in deep shit."

"Look. I'll drive you home. You can say your car wouldn't start." Ben helps his friend lie down in the back seat of his car. "If you've got to throw up again, tell me. I'll pull over."

On the way to Greg's, they stop at the Waffle House. Ben goes in alone to buy a large cup of coffee, black, and brings it out. It's a struggle, but after a few minutes, Greg is seated upright sipping the coffee.

Ben glances at his watch. He thinks about calling. But then, he'd have to explain that there was a party where there was drinking. He decides to take a chance that his mother's asleep and his father is still at the hospital.

Saturday Night (Alex)

Alex lies in bed, staring at the glowing red numbers on his digital clock. Midnight. Ben's curfew is midnight. State law says that 16-year-old drivers have to be off the road by midnight. Where is he?

He pictures Ben's car, a 10-year-old Taurus, a hundred thousand miles on it, peeling paint and no pick-up to speak of. It's a solid car– not pretty, but crashworthy.

Crashworthy. He thinks about his phone call to that sorority girl's family the other night. Usually, the nurse makes those calls. But he knew the family, went to medical school with the mother. So, he dialed the number, mouth dry and heart pounding.

"I'm sorry to tell you that your daughter has been in an accident. Her injuries are serious. You should come to the emergency department right now...."

His own daughter is safe in her bed. He tucked her in himself, first time in a month. Seven years old, a great age. She still thinks he's a hero.

He listens for the crunch of gravel in the driveway but hears only the low whine of his neighbor's dog. He looks at the clock again: 12:15. "Where the hell is that boy? I shouldn't have given him a car."

He thinks about how tired he is and how much he needs to sleep. He tries to remember where his wife said Ben had gone. He looks at Emma. She's asleep. Dead out. He is amazed. Usually, she is the one fretting and fussing. Maybe her therapist has her on sleeping pills again.

12:30. He should call someone. Alex can't think of Jeremy's last name. He doesn't even know if Ben is with Jeremy tonight. What's the point of waking Jeremy's parents?

Alex goes to the living room and stares out the window. Now he's angry. "No car for a week. No, a month."

Ben usually gets in on time. If he's going to be late, he usually phones. Alex considers calling the police or maybe the emergency department to see if there have been any accidents. Then Alex realizes he's over reacting. The kid is only half an hour late.

Ten minutes later the Taurus pulls up. Alex decides he will stay calm and not attack Ben the minute he walks in. Maybe he has a good excuse.

Despite himself, Alex springs from the couch and stands in the foyer, waiting.

He hears Ben slip in the key, slowly turn the handle, and inch open the door. Alex knows Ben is trying to avoid that nasty squeak.

Ben gasps and jumps back when he comes across his father looming in the foyer.

Alex sees the boy clench his jaw and pull back his shoulders.

Ben takes a deep breath, smiles, then says, "You're home! Slow night at the hospital?"

"Don't be a smart-ass." Alex feels anger rising up in him.

"Well, it's just that I don't expect you to be around...." Ben tries to slip around his father and head up the stairs. Alex blocks him.

"Where have you been? Midnight is the curfew." Alex's voice is loud now.

Ben hesitates for a moment. "Jeff's party in Wethersfield. A girl needed a ride home to Windsor. I got lost."

"You drove all the way out to Windsor?"

"She needed a ride. You taught me to be a gentleman."

"You've just gotten your license. You don't have permission to drive that far."

"Look, I'm going to bed."

"We'll talk about this in the morning."

Ben smirks. "Yeah, right. Like you'll be around in the morning."

Same Night (Mattie)

From her room at the top of the stairs, Mattie hears voices. She sits up in bed. First she hears her father yell, then her brother. Someone runs up the stairs. Probably Ben. A door slams. Oh boy, she thinks, Mom hates it when Ben slams his door.

Then there's a slow creak up the stairs. Mattie lies still, waiting for the next sound.

Mattie gets out of bed and walks down the short hall to her parents' room. The light is on in their bathroom. Daddy must be there. She crawls under the blanket and snuggles next to her mother.

The little girl feels safe when her mother turns and draws her close. Mattie says, "Mommy?" When her mother doesn't respond, Mattie realizes that she is still asleep.

After a few minutes, Mattie sees the bathroom light go out. Her father lifts the covers, then jumps a little when his elbow touches her. He says, "Mattie! Honey, what's wrong?"

"I had a bad dream. People were fighting."

Mattie slides next to her father. He kisses her forehead and says, "It wasn't a dream. I was scared when Ben didn't come home on time. I was afraid he might be hurt. So, when he did come in, I got angry."

"Angry because he came home?"

"No, angry because he came home late. I didn't know if he was okay. I always want to make sure that you and Ben and Mommy are okay."

"Like your patients at the hospital?"

Her father is silent for a moment. "No, more than that. Much more than that." Alex reaches over Mattie and rests his hand on Emma's shoulder, encircling both of them in his embrace.

He says to Mattie, "You can stay for a little while, but then you need to go back to your room, all right?"

Mattie nods, and within a few minutes they both fall asleep.

Same Night, Emma

In her dream, Emma hears men shouting in another room. What are they arguing about? She tries to walk toward the shouting, but it's as if she is trying to move in water that's above her shoulders. She stops.

The dream shifts. She's lying in tall grass under warm sun on a mountainside. She senses someone talking next to her. Emma half wakes and murmurs to Mattie. She draws the child closer.

Then Emma hears Alex's voice and feels the weight of his hand on her shoulder. Now she's more awake than not. The warm touch of his hand brings her back to another time, just after they got married and just before medical school.

A memory floats back to her. She recalls a hike across Haystack and Liberty in the White Mountains. As Emma falls back to sleep, her memory is interwoven into a new dream which encompasses all that happened that day long ago. On their way back down the mountain, they climb off the trail because Emma wants to get a closer look at a patch of wild flowers. As they scramble up a short steep cliff to get on the trail again, Emma stumbles and falls backward. Alex tries to break her fall, but ends up losing his balance, too.

Although the tumble is short, maybe six feet, they land on rocks. Alex hugs his bruised and bleeding knee. Emma tries to stand but can't because her right ankle is too sore and weak.

For a minute, they sit and laugh at their own clumsiness. Alex creates a make-shift splint out of their two bandanas. He secures it around Emma's ankle, cinches it, then leans over to kiss her.

Emma finds the first-aid kit in her pack. She uses an alcohol pad to wipe off Alex's bloody knee. Gently, she cleans the wound, removing bits of grass and stone. The cut is so large that a single band-aid cannot cover it, so, she uses several small ones.

They sit for a moment, shoulder pressed against shoulder, quietly enjoying the warmth of the sun on their backs, the mingled fragrance of wild flowers, sweet grass and their own sweat. Then they stand, bracing themselves for the long limp down the mountain.