The Hole in my Soul

There's a hole in the… soul in the shape of a shot glass, one that has a cracked bottom and can never be filled no matter how much whiskey is poured into it.

– Brian McDonald, My Father's Gun

Michael

"Hey, Kat, I need you to take an admit from the ER."

I look up at the clock, noticing that it's 1:00 AM. Nothing good ever happens at this time of night. It's either an accident, alcohol poisoning or a suicide. I don't feel alert enough to take a patient who is that critical, but I also know from experience that the second my patient arrives, I'll be ready. All it takes is a quick jolt of adrenaline to get me into the zone.

"So, what is it?" I ask, dreading the answer.

"Suicide."

Shit. They're always gut-wrenching, but especially true when you work in pediatrics. No one that young should feel like they have to give up on life.

"Drug ingestion? Trauma?"

"Trauma—slit wrists. He's been given a couple units of blood already in the ER and you'll need to hang another right when he gets here. I'll make sure the release gets sent the to blood bank."

"Mmm," I intone as a form of acknowledgment. "How old?"

"Fourteen."

"Jesus," I shudder. "Do you know his hemoglobin level?"

"Not sure what it is right now, but it was just under seven on his arrival."

"Holy shit."

The adult male body holds approximately twelve pints of blood. You only need to lose about 40% of your total blood volume for it to be lethal. A hemoglobin level less than seven is low enough to be nearly dead. I have no idea what his levels are now, but to raise the hemoglobin level by two to three points, it takes a unit of blood. Our goal will be to get it to climb to more than twelve, so I'm pretty sure I'll hang at least one unit of blood, if not more.

"Guess the parents are kind of a piece of work. Dad was yelling some pretty unsavory stuff at Mom down in the ER. Poor kid."

"What's the ETA?" I ask, wanting to know how much prep time I have.

"About 15-30 minutes. Hand your patient off to your partner and get ready for—" she pauses to read a sticky note fastened to the end of her finger. "Michael Dimir. We'll put him in Room 22."

I nod my head while I'm already in motion; there's nothing more to say. My brain is starting to whirr its gears, thinking through scenarios. That's how it always is—I couldn't turn it off if I tried. It's one of the reasons I'm an ICU nurse.

I log on to my computer to order up suicide carts. They're made especially for suicidal patients—nothing in them that would enable them to turn their failed attempt into a successful one. Kids are at greatest risk of a suicide attempt immediately following an unsuccessful attempt. Once I've done that, I walk into the room and remove anything and everything that could be used to harm oneself. Soap, hand gel, extra sheets all get the boot. I lock the supply cabinets so he can't get into anything there. He'll be on suicide watch, so someone will be in his room with him at all times.

There are still doctors and nurses who use restraints to keep a suicidal patient from further injuring themselves. They are padded with ties that can be strapped to the bed. We usually strap the wrists and the ankles, but Michael's wrists will be sewn up so he'll probably be strapped near his elbows. Personally, I always prefer to calm the environment in order to calm the soul. Turning down the lights, speaking slowly and softly, limiting the number of people in the room can do wonders to keep a patient safe. I can't imagine anything more damaging to one's psyche than to attempt a suicide and wake up in a loud hospital room, restrained and unable to move, surrounded by strangers. That being said, some of these kids end up hugely combative with a horrible look of desperation on their faces knowing they didn't succeed.

While I always hate to see the trauma a suicide victim can wreak on themselves, I'm grateful that my patient cut himself instead of taking Tylenol. So often, desperate kids take Tylenol as a method to kill themselves because it's cheap and readily available. 75% of all suicide attempts are from drug ingestion, but they don't always take a big enough dose to be successful. Sometimes, the body defends itself from the onslaught by causing the victim to vomit before the full dose is absorbed. Too often, we're left with a depressed/suicidal kid who then needs a liver transplant. At least Michael will only have scars to contend with. I wouldn't wish liver failure or a liver transplant on anyone.

I hear the doors to the ICU clank open at the same time my phone rings.

"This is Kat, go ahead."

"Hey Kat. Just letting you know your patient Michael Dimir is en route to you."

"Yeah, they just got here," I say with a tinge of annoyance in my voice. I should have gotten a phone report from the ER before my patient left, not when he arrives at my side.

"Great, they can give you a report."

"Yup. Got it," I hang up before I hear anything else.

I watch them wheel in the boy and he has that gray look of pallor one gets when they're near death. It's hard to describe the color except to say that you know it when you see it.

"Patient Michael Dimir, age 14. Self-inflicted bilateral lacerations to upper extremities. Arrived in ER in hypotensive crisis. Got fluid resuscitation and two units of PRBCs to achieve stabilization. Last BP was 108 over 85. Heart rate remains tachy. Received fentanyl and propofol while lacerations repaired in ER. He's still sedated, but should start to be more responsive over the next hour."

I nod my head while processing what the ER nurse is telling me. I'm working on getting Michael hooked up to the monitor so I can keep track of all his vital signs.

"Oh, and just a word of warning," the ER nurse says as he finishes up his report. "The parents are pretty wound up. We had to ask the father to hold it down."

I raise my eyebrows at that. The ER gets pretty intense in general, so when the nurse notes that someone is wound up, you stop to take note.

"Wound up. Got it. Thanks."

"Good luck. Let us know how he does, yeah?"

"Of course."

Once he's settled and I'm finally alone with him, I lean over to whisper soothingly into Michael's ear. It's something I repeat a variation of to every one my patients:

Michael, my name is Kat. I'm your nurse, and you're in the ICU. I'm right here and I promise to protect you for as long as you're my patient. No matter what happens, we're in this together.

It's important for me to communicate this message, because I believe that no matter how sedated or out of it my patient may be, I know they can hear me on some level. I want to acknowledge that so I'm never taking anything for granted. I want this beautiful boy to understand that no matter how dire his situation may be, there is at least one person in the world who cares about him, cares what happens to him.

I start my head to toe assessment, moving to get through it quickly before his parents arrive. I take in his general appearance along with his injuries. He has thick, jet black hair, the kind many women would kill to have. It's completely tangled up from all the ER activity; I make a mental note to comb through it when I get a minute. His lips are dry, so I grab a new tube of chapstick and apply it. It would be a shame to let such beautiful, full lips get cracked. Not on my watch, anyway.

I need to check his pupil response to light and notice he has killer long lashes. God, this boy is striking. I note that his pupils are still small as pinpoints, so he's good and stoned from all the sedation he's received. I'm grateful for that, because his injuries are going to hurt like hell once he wakes up.

Noting how gorgeous Michael is, I'm even more curious about why he made a suicide attempt. I wonder if maybe he's gay, or bi, or even transgender. A lot of GLBT kids end up this way—they're three times as likely to attempt suicide as are their straight peers. For transgenders, the rate is even more extreme. I file that thought for later.

I put my stethoscope on his chest, listening to his heart and lungs, noticing his color. You can tell he was pale to begin with—his blood loss only accentuates this feature. He's tall and skinny, just starting to grow into his adolescent frame. I imagine he's probably very shy; sometimes, you get a feeling about a person.

His wrists are still covered in betadine, the orangish-brown cleaning solution we use to prep the skin surface for surgical procedures. The ER report mentioned that the cuts were particularly deep, which is why he bled so profusely. Using warm water, I wet a washcloth and clean around his sutures. The ER doc did a good job—he's going to have some nastyass scars, but they won't be too bad, considering. A rush repair isn't focused on beauty; it's focused on saving a life.

He managed to cut both of his wrists, so he must have used his non-dominant hand to make the first cut. If he hadn't, he wouldn't have been able to use his dominant hand to finish the job. I look for hesitation wounds—a shallow first cut, since they don't yet know how deeply they need to force the knife against their skin. Michael has no hesitation wounds, just two incredibly deep cuts, one on either wrist. I make a mental note to assess his nerves once he's awake for signs of damage.

Thank god he didn't get into the bathtub or cut from wrist to elbow. That alone causes me to suspect that this wasn't a well-planned attempt. That doesn't mean Michael wasn't serious, but it's different when the kid has a plan that they follow. I don't usually get to see many of those, because they don't end up in the hospital, they go straight to the morgue.

I work on Michael, carefully looking over his body for other signs of injury. Sometimes things get so hectic in the ER no one has time to look over everything carefully. In the quiet of the PICU at 1:00 AM, I have the time to really take it all in. I want to look for signs that he may have tried doing this before. Sometimes, they're habitual cutters who accidentally make a cut too deep as they try to chase their pain threshold. I notice a few scars on his arms, so I get the sense that this isn't the first time he's tried to hurt himself.

His parents arrive at the doorway and I wave them into the room. I explain the situation to them: how he's doing, what I'm doing, what they can expect. I help them to understand he's at risk for a stroke or a transfusion reaction and that he's going to need more blood products before the shift is over. I quickly dress his sutures in gauze—seeing the wounds can have a profound and traumatic effect on the family and I scold myself internally for not having covered his wrists sooner.

His mother doesn't stop sobbing the entire time she's there. I learn that she's a nurse, too, and that makes my heart break a little bit more. She already knows most of what I have to say to her, but I still need to say it. His father, on the other hand, has body language that practically screams out DISAPPOINTMENT. It doesn't take a rocket scientist to figure out who's probably the crux of lovely Michael's issues with the world.

The body language between his parents is telling, too. His mother pulls in on herself, trying to become invisible—a jumble of guilt, shame, sadness. She flinches every time he touches her. The way he holds her arm in place makes me want to smack him in the face, and I'm not a violent person by nature. Well, unless you pick on animals or children, then I'll kick your ass to the gates of hell and leave you there without looking back.

"He's nothing but a sicko, Melissa," he spews. "You know he did it just to get attention."

"Excuse me, Mr. Dimir?" I say it in a syrupy sweet voice to get his attention. When you're nice and respectful, it throws the assholes off.

"Yeah?"

"While your son might be sedated, please be assured that on some level, he can still hear you."

He just shrugs at me. Fucking shrugs. In that moment, I know how to illustrate this cause and effect to him. I point my finger at the bedside monitor to show him just what it is he does to his son every time he opens his mouth.

"This is an electronic monitor. It shows us Michael's heart rate in red, blood pressure in green, respiratory rate in blue and oxygen saturation in white," I explain. "Say something. Anything, and then watch the red numbers."

"What the hell do you want me to say?" he says in a sour voice.

Michael's heart rate climbs when Mr. Dimir speaks.

I cross my arms and raise an eyebrow at him.

"What does that prove?"

I turn to Mr. Dimir and look him straight in the eyes. "Parental criticism is radioactive and has a long half-life. I don't allow anything radioactive in my patient's room unless it involves chemotherapy. Please, why don't you have a seat outside?"

"But this is my kid."

I don't justify his contempt with a reply; I merely hold out my arm to point the way out of the room.

When I look outside of Michael's room, my eyes land upon one of the tallest men I've ever seen. Even with the dimmed lights in the hallway, the man's attractiveness is clearly evident. Based upon his apparel, I can see he's a priest. He looks as though he'd like to come in. I notice that his arrival makes Mr. Dimir shut up almost instantly—thank heavens for small favors.

I turn to Michael's mother with a questioning look on my face. She nods gently her assent, so I address the priest.

"Hello, Father. Please, come in. Michael is stable but sedated for the moment."

As the priest stops to murmur a few words to the parents in a low tone, I lean over to Michael's ear.

"I promised you that we're in this together, Michael. I'll do what I can to keep this room calm."

I look up and see the priest towering over me, his presence as awesome as it is intimidating, but I'm not about to let that get to me. As an ICU nurse, I need to be firm and assertive—there are plenty of people who try to bully you or boss you around. You either learn how to stand up to those people, or you go to work somewhere else.

"Father, my name is Kat; I'm Michael's nurse tonight. He's already had a blood transfusion in the ER, and I'm about to give him another. You're welcome to do whatever it is that you do while I prepare the transfusion. The only thing I ask is that you be aware that Michael can hear you, so please try to keep your rhetoric to words that are calming and non-judgmental. He's been through a great deal today, and I don't want to hear about him going straight to hell; neither does he."

"My name is Father Stearns," he reaches out his huge hand to shake mine, and engulfs it so I can no longer see my hand at all. "I take it you're not a fan of my church."

"I'm sorry, Father, it's difficult for me to be positive when I've seen what some of your colleagues have done to patients of mine, and kids throughout the world."

He nods his head, looking weary. It's then that I see the blood on his sleeve. It's not so noticeable on the black fabric, but it's all over the white cuffs of his shirt.

My eyes dart from the bloodstains to his face as I narrow my eyes. "What happened?"

The priest looks at me for a moment then gives me a sad smile. "You think this is my fault."

"Is it?"

"The only thing I'm guilty of is not being more adamant about replacing the broken stained glass window. It had been a pet project of mine that I was pushing through the proper channels, but not fast enough, apparently."

"Oh god, he did this at church?"

"Yes. I'm the one who found him."

My gut falls to the floor at his admission. I'm ashamed of my own prejudice.

"Oh, Father, I'm sorry," I tell him, feeling incredible remorse. My eyes dart toward the chairs where Michael's parents are seated then back to Father Stearns. He nods, sadly, to acknowledge my suspicion.

"I made him leave the room. He was being a huge asshole," I half-whisper my explanation then put my hand over my mouth realizing my curse too late. My swearing is legendary, but I didn't mean to swear in front of a priest. "Sorry about that."

Father Stearns gives me a smile. "No, you were right. He is an asshole."

"I see parents like that more often than I should," I tell him. "I'm sure you see all kinds of abuse, too."

"I think we just see it at different stages; you get the more desperate ones."

"Yeah, the suicides are always tough. From what I hear, Michael barely hung on in the ER. He's such a beautiful kid. It eats me up that he thought this was a good idea."

"I'm going to speak to him."

I nod my head in acknowledgement as I finish hanging more packed red blood cells for Michael.

"I'd like some privacy, please," he tells me. It's not a question.

"Of course. Just give me a second," I tell him, while I finish programming the IV pump for the transfusion.

In the hallway, Michael's father is still speaking in a raised voice, giving his wife a hard time. I'm officially pissed off now.

"Mister Dimir, you're in a pediatric intensive care ward. It's almost three a.m. You need to keep your voice to a whisper. In fact, perhaps you should go to the family lounge—the doors shut out the noise," I point toward the exit.

"I won't leave my son here alone."

"He'll be safe; I'll be in his room all night. Why don't you go try to get a little rest, okay? I'm sure it's been a long day for you," I soothe, seeing if a sympathetic approach will earn some cooperation from him.

I can see Mrs. Dimir tugging at her husband's arm, but he merely crosses his arms and stays right where he is.

Okay, so sympathy doesn't work either.

"I'm happy to call security for you, sir, if you're uncertain how to find the family lounge," I say in my most cheerful voice with a smile painted on my face, crossing my arms right back.

He gives me the angriest look I've ever seen then stomps off. When I know he's gone, I say "good fucking riddance, asshole" under my breath and turn to get to my computer. I'm going to catch up on my charting while the priest is with Michael.

Before I even set a foot forward, I see a striking, tall man with long black hair sitting at my computer with cocky smirk on his face. What the hell is going on here? I've gone for years without seeing anyone hot in the ICU, and I get these two men within fifteen minutes of each other? While the man in front of me may be fucking gorgeous, I need to know exactly who he is and how the he got in here—he doesn't have a clearance badge.

Unsmiling, I walk up to him. "You're sitting at my computer, sir."

Now that I can see him more closely, I notice that he's wearing a gorgeous suit—long coat, tailored pants, and the most beautiful pair of riding boots I've ever seen in my life.

When my eyes move up from his boots to his face, I notice his amused smile.

"You like the boots, chérie?"

Well fuck me. I took French in high school and I can tell this man's accent is genuine. "Vous êtes Français?"

"Mais bien sûr, ma belle…" he pauses, looking down at my I.D. tag which happens to rest on top of my left breast. "… Kat," he over emphasizes the pronunciation as he leans over to kiss my hand. I stand there with my mouth momentarily agape, taken completely by surprise; this has never happened to me before. It takes me a few seconds to recover my senses.

"Who are you and what are you doing sitting at my work station at three in the morning? You need either a parent or employee badge to be back here," I warn.

He laughs quietly to himself. "I don't need a badge to do anything. I am Kingsley Edge," he says, as if that's some type of universal knowledge I should have.

"Well, it's a pleasure to meet you, Mr. Edge," I say politely. He is gorgeous hot, after all. "But you're still not supposed to be here."

It's about that time I see Dr. Jacoby round the corner. He takes one look at Kingsley and freezes, terrified.

"Kat?" Dr. Jacoby says with a shaky voice.

"Yes, Jac?"

"Um, why don't you give me a few minutes here…" his voice trails off.

"Can't. I need to do some charting and keep an eye on my suicide," I explain, pointing at Michael's room. "He's getting a transfusion and I have to keep assessing him for any signs of a reaction."

Kingsley's smooth voice breaks up our conversation.

"Actually, docteur, I think I've found exactly what I need," he says, nodding over at me.

He needs me? I look outside to see if there's a full moon tonight. Nope, just a Cheshire Cat grin, my favorite kind of moon.

"Can I ask what the fuck is going on here, Jac?"

Dr. Jacoby looks like he's going to puke.

I watch as this Kingsley dude pats J on the back like a little boy and actually tells him to vas-y.

Ouch.

"Exactly who are you, sir?"

"I told you, chérie, I am Kingsley Edge."

"And that's supposed to mean something to me?"

"Oui. If not right now, it will in the next 24 hours."

He hands me a business card. Black, with nothing more than the name Kingsley Edge on it.

"When you are finished with your shift, chérie, we will talk."

"I don't even know who you are."

He sighs a bit as if he's getting tired of explaining things, when he's explained nothing at all.

"Je suis Kingsley Edge, little kitty Kat."

If anything, his exasperation makes him even hotter. I know I should be very creeped out right now, but instead I find myself incredibly aroused.

He takes my hand and kisses it again, then pokes his head into Michael's room. Without saying a word, the priest and the man in riding boots trade messages via eyebrow semaphore. At the end, Kingsley nods silently at the priest and strides away.

I go back into the room to check on Michael.

"Is, um, everything okay in here?"

"Yes," he answers with complete authority.

"So, the French dude is with you?"

The priest nods silently.

I look at him long and hard, trying to read through his intense and controlled exterior. I'm really not sure what to think. It's hard to throw me for a loop, but that's exactly the effect he's had on me tonight. As if he knows exactly what I'm thinking in that moment of doubt, he slips his hand onto my shoulder. For some reason, that's exactly the reassurance I need.