Gemini by Carol Cassella Page B

a.m., when Jane’s vital signs had deteriorated again. Charlotte looked at the crossing numbers on Jane’s flowchart—the Neosynephrine dose going up and her blood pressure declining—and knew she was in for a rocky day again. It was like the child who plays happily at nursery school all day until she senses her mother’s approach and begins to wail, but as soon as Charlotte registered that thought, she consciously stepped back from the attachment. She’d been in this job long enough to know it did no one any good—not the family, not the patient, and certainly not herself.
    Anne was on duty again—that was a relief. She saw Charlotte re-creating the night from the numbers on the chart and said, “Not out of the woods. Lower the dose and she tanks. BUN and creatinine are going up.”
    “No surprise. We’re saving her heart and brain at the expense of her kidneys.” Even as Charlotte said this, she looked at Jane, who lay as inanimate as the day before, and knew they were possibly not saving her brain at all. She pulled the sheet down and rubbed her knuckles hard against Jane’s sternum.
    “Anything?” Anne asked.
    “Barely. Could be the high BUN, though.” Charlotte wouldn’t consider a diagnosis of brain death until Jane’s lab values were normalized. She read Otero’s notes and Wong’s notes, ticking off what test results to check and what tests were still to go. Then she read the nursing notes—brief, often rote phrases that filled in the continuum of hours between physicians’ assessments. Over the years Charlotte had discovered how much they added to her general sense of her patients’ progress, comments ranging from when they were bathed or how they responded to physical therapy, to what visitor had evoked some response no white coat ever witnessed. One note in particular stood out to her this morning. “Who’s Blake Simpson?” she asked Anne.
    Anne flipped to the back of Jane’s chart and pulled out a card. “Police? He left this with Jody, the night nurse.”
    Charlotte picked up the business card. “Jefferson County. Have they identified her?”
    “Jody would have told me. If they told her. Call him.”
    “After rounds I will. Has Orthopedics been by yet?” She went over her list of consults and orders with Anne, gearing up for the day. Her mission for this next phase of Jane Doe’s care would be to identify problems that could be solved. It sounded straightforward on the surface—what else would a doctor be doing? But the truth about her job was that much of medicine was still a mystery and a patient with multiple failing organs could overwhelm one’s capacity to be decisive and effective; it was easier to measure what was wrong—lungs that couldn’t suck enough oxygen out of the air, kidneys that couldn’t balance the blood—than to specify the cause. And even when the cause was obvious, there was often no obvious cure. So in the tangle of abnormal labs and scans and tests Charlotte found clarity in deciding what she was capable of fixing and going after it “with the fangs of a bulldog,” as Otero would say. Charlotte would say that she hoped he was referring to her medical acumen and not her body type, and she herself saw it as a way of buying time. Fix the problems you can fix, do your best not to cause any new problems, and buy time for the brain and body to heal themselves. Then Otero would usually try to begin a conversation about God and fate and Charlotte would spew that God better damn well wait in line for her patients, which Otero seemed to find the best joke of the day, no matter how often he heard it.
    A little after nine she called the number on Blake Simpson’s card. A woman answered, “Sheriff’s office.” But when Charlotte asked for Sheriff Blake Simpson there was a pause and the woman asked, “You mean Deputy Simpson? Out in the field. Would you like his cell number?”
    Charlotte looked at the card again. “Yes. Sorry. Deputy Simpson,” but in the