Chapter 67.
October 8, 2020.
Runaway.
It was too busy for a Thursday.
Alex bounced around the emergency room, giving out quick assessments for intake and placement. A multicar pileup on the highway, a kid who got jumped on his way home from school, a teacher mauled by a dog, a guy whose wife ran his leg over with a motorcycle. Every bed was full. Visitors ignored instructions to stay near their loved ones so often that the charge nurse, Ellie, put a blanket ban on them for several hours. His patience was a thin wire that every patient, resident, and intern was intent to cross.
It was almost seven, almost the end of his shift, when an ambulance called in a gunshot wound.
"Incoming GSW to the chest, ETA two minutes!" Ellie called, flagging a couple of interns, a resident, and Alex as she made her way across the ER. "Patient is a twelve-year-old female, found unconscious."
Twelve.
Kids were the worst.
Alex set a chain in motion, doling out orders, sending interns off in multiple directions – to grab an OR, to inform hospital security of an incoming GSW. He paged cardio and general. Arizona was off, so he was the head of pediatrics in her stead.
Before the two minute ETA arrived, Alex was in the scrub room of OR 3. He had been painfully close to going home on time, his feet ached, he was hungry, and he wanted to see his kid, but he kept all of that away from the surface. On the outside he was composed, ready to face this.
Meredith joined him, swallowing the corner of a sandwich.
He was withdrawing his hands from the sink when the OR doors swung open. An intern guided the front of a stretcher into the room, and on the stretcher was the girl. She was drenched in blood, dripping, so small that she seemed like a doll on the table. A morbid Halloween decoration.
Despite the almost impossible volume of blood on the floor, the monitors displayed a heartrate.
He glanced at Meredith, a split second, a shared weariness, and then they stepped in together.
Alex took charge and the OR team focused on keeping the kid from losing more blood while she was hooked up for transfusion. Her heartrate spluttered three times, leading to a cycle of chest compressions before it picked up again.
"We have to go in," Alex said, loosening his grasp on a fistful of gauze he had wedged in the hole in her chest. "Okay, interns at the back." He got the attention of the six doe-eyed interns crowding the back of the room. "I need one of you on either side of me… Put your hands where my hands are…" Alex withdrew, leaving two interns holding the gauze. "Same for Dr. Grey."
"We have a minute, maybe, before she bleeds out," Meredith said, tugging a tray of instruments toward herself. "Did you page cardio?"
Her question summoned Dr. Mae, a weekend cardio fill-in from Detroit.
"Jesus, do they have different urgency colors in Michigan?" Alex said.
"Sorry, sorry." Dr. Mae wove his way up to the table, taking it all in. "I got lost. This place is a maze. Where do you want me?"
"We don't know what's hit," Alex admitted, gesturing to the interns. "We need to pull the gauze, assess, and repair in… under a minute."
Dr. Mae requested sutures and a delicate needle curved like an expensive fishhook.
Alex took a steadying breath, not happy with the numbers on the monitor, the paleness of the patient – but nothing was ever ideal in a trauma case. He wished Owen were here to deal with this.
When the gauze was pulled, the bleeding was instantaneous. It was the heart. Each time it thrashed, it sprayed, dumping the kid's blood supply into nothing.
Alex cut a line across the wound, Meredith suctioned and dabbed blood away, and Dr. Mae went in, partially cracked the chest, and threw sutures in the heart. Seconds counted down. Her vitals slipped, fumbled, and then barreled downhill.
"Almost… almost…" Mae murmured, working through the beeping. "Suction, right there."
A pool of blood vanished into the tube, and all three surgeons leaned in to look before it could fill up again. And there was the heart, no longer gushing.
"Pack and stabilize," Alex said, taking the gauze he was handed and mashing it into the fresh cut.
One of the interns crept up to his shoulder, still holding the blood gauze she had pulled on first order. "Is she going to live?"
He looked up, finding a herd of scared little mice looking at him for an answer.
"She's still on the table, guys, chill," Alex said, remembering halfway through his answer that this was a teaching hospital. "We'll wait for her to stabilize and then gradually pull the gauze to repair anything else damaged by the bullet."
Meredith was generally uninterested in teaching, but she chimed in, "A good outcome is more likely now that we've stopped the bleeding in the heart. Her vitals look promising."
"If you guys have it from here, I have another page coming in," Mae said, sighing. "Busy city."
"Usually quiet, must be you," Alex said.
Meredith snorted. "We can handle it."
Over an hour passed. Alex and Meredith meticulously worked through the wound, giving the girl a break whenever her vitals started to waver.
Her skin gradually went from blueish to pale white, and as he put the last stitch in, Alex placed a hold on the blood transfusion.
"Quiz time," Alex said. "What can happen if you transfuse too much blood?"
A brief, thoughtful silence.
And then one of the interns said, "TACO – transfusion-associated circulatory overload."
Alex said, "Which results in…"
"Um…" the girl stumbled over it.
Another intern picked it up, "Undue stress on the heart?"
"Are you telling me or asking me?" Alex said.
"Undue stress on the heart," he repeated.
"Good." Alex stepped away from the table. "Is it fatal?"
The interns exchanged weary looks.
Meredith said, "It can cause fluid buildup in the lungs that can be dispersed through a diuretic. It's usually only dangerous in people with heart conditions, because it compounds the edema associated with heart failure."
"That's cheating," Alex said.
She shrugged.
A nurse appeared at the door.
"Dr. Karev, you're needed in the ER."
"Whoa, no, I'm off after this," Alex said.
"Someone wanted to speak to you," she clarified.
Alex glanced at Meredith. "Keep me posted, huh?"
"Sure."
Detective Terry Swartz was waiting for him in the ER. He stood out like a sore thumb – tall, dark-skinned, wearing dress pants and a button-up, a shiny detective badge displayed on his hip, right next to his gun.
Alex never saw him in the hospital these days. Homicide detectives were generally more interested in already-dead bodies.
"Somewhere we can talk?" Swartz said.
Alex took him into a private waiting room and shut the door. "Is this about the kid?" he said.
Swartz nodded grimly.
Alex had a sinking feeling. He remembered what Ellie said when the call came in. Found unconscious. "What happened to her?"
"She was found on a sidewalk with a hangman symbol drawn in chalk beside her."
The Hangman was a serial killer. He piled up victims and drew symbols next to their bodies. But it had been over a year since Alex had heard anything about him.
It was hard to imagine anyone could be cruel enough to walk up and shoot a twelve-year-old in the chest, and then just leave her dying on the ground. But the world was a horrible place sometimes.
"I need to know where the wound was located," Swartz said.
Alex crossed his arms, "Just to the right of the heart. Nicked it."
Swartz jotted it down in a tiny notebook.
"Why does that matter?" Alex said.
"It's how it started last time – gunshot wound to the chest, almost exactly over the right side of the heart. How is the girl?"
"Stable, for now."
"She got lucky, then."
"Lucky isn't the word I would use."
XxX
A serial killer in his city.
Alex found himself scanning the sidewalks, alleys, and baseball fields on his drive home, wondering what would happen next. Seattle was divided on whether the Hangman was a single killer, or just a series of copycats who liked using the symbol – either way, people were being killed, and someone was doing it. Shootings, stabbings, beatings.
Some violence could be rationalized, at least – but where was the logic in shooting a kid?
Alex was almost on his street when he saw her.
He hit the brakes, pulled to the curb.
Sofia paused, startled, ready to bolt like a little rabbit.
And she should be.
"What the hell are you doing out here?" Alex said, throwing his arms up to emphasize on how 'out here' she was. It was after dark on a quiet street. Half the streetlights were out.
And there she was, dressed like Xena, with a rainbow backpack on her shoulders.
Sofia had wide eyes. "Nothing."
Alex carefully controlled his tone, realizing he might be scaring her. "Seems like something."
She shrugged again, looking away from him.
"Hey, kid, I need a real answer." Alex took her by the shoulders, giving her a once-over. She seemed fine, apart from the chill on her skin. "What happened? Why are you out here alone?"
"I was just going for a walk."
Alex poked her backpack strap. "Oh, yeah? Whatcha got in there, then? I bet if I opened that, I'd find some clothes, a stuffed animal, maybe some snacks."
Sofia twisted her lips, lowered her voice, "I ran away."
He was tired. It had been a long, long day. He had showered before he left the hospital, but he still felt like he had blood on his hands. And his eerie talk with Swartz had been the horrible cherry on top. The caveman part of him wanted to throw Sofia in the car and deliver her home, no muss, no fuss. But these days, most of him was gentler, more understanding – especially with kids.
So he sat on the curb and patted the ground beside him.
Sofia plopped down, tugging her backpack off and hugging it to her chest. "Can you leave your car like that?" she asked.
"I'm a doctor, I can do whatever I want."
Sofia smiled a little.
Alex held out his hand, "Come on, I know you have snacks in there. Fork 'em over."
Sofia pulled out a bag of crackers and they sat there for a few minutes, munching.
He said, "Why'd you run away?"
Sofia took a cracker, sighing. "I don't know."
She sounded like a stressed adult, not a kid.
"Is something going on at home?"
She shrugged, and then nodded.
"Something with your moms?"
Sofia heaved another heavy sigh, running a hand through her curly black hair. "Yeah… they're fighting about Manny."
Emmanuel was her brother. His hands were mangled in a car accident and he was abandoned. Callie and Arizona fell in love with him, adopted him, and took on all of his health problems. He was almost three, and so far none of the prosthetics they had tried were successful. Arizona wanted to keep trying. Callie wanted to stop, and let Manny learn to live with his amputations for now. It was push and pull with them, stop and go.
He had tried not to take a side because both Callie and Arizona were his friends. Manny was not his responsibility, and none of it was his choice.
But he would have sided with Callie.
"It's all they do," Sofia said, huffing. She drew her bag back up to her chest and rested her chin on it, staring across the street at a pampered suburban lawn.
"Parents suck sometimes," Alex said. "What were you planning to do without them?"
"I don't know. I was going to go see Zola."
"You were going the wrong way for that."
"Oh." Sofia looked up and down the road, her eyes getting a little big. "Where are we?"
"Suburbia."
"What does that mean?"
"Nothing. Look, you can't just run away. Trust me, I tried. It never worked. One, you're not old enough to open a credit card. Big speedbump. And two, you can't just hop on a railroad car like in the cartoons. You walk far enough, and you see there's nothing out there."
Sofia deflated a little.
"But you don't want to run away," Alex went on. He nudged her. "Do you? Do you wanna leave your moms?"
"No," Sofia murmured.
"You just don't wanna be there right now," he said.
She nodded.
"I get that."
His mother killed herself with a pistol a few years ago. His dad was in the wind. His early life was made up of moments he wished he could forget, peppered with the occasional smile. It was mostly drunken fistfights, shouting at ghosts in the corners. He used to drive his bike for miles and miles, hoping he would have the guts to keep going.
But he always turned around.
"Manny needs a lot of attention right now," Alex said. "I feel for you, kid, but you gotta muscle through it. I ran away like a hundred times when I was a kid."
"You did?"
"Oh, yeah. And when I…" he hesitated, wondering if he was being too honest with her. "When they actually took me away from my mom, all I wanted to do was get back to her."
Sofia stared at him, her eyes making her look just like Callie. And she looked afraid. "They took you because you ran away?"
"No, no. Well, sort of." He cleared his throat. "I'm just trying to say that you can get through this. I did. And look at me now. I'm awesome."
Sofia smiled.
He stood, groaning, and held out his hand. "Come on, let's go spray your moms with a hose."
She brightened, "Really?"
"Not literally. Maybe. Come on, hop in."
He called Arizona on the way, blasting the heat to warm up the little runaway.
She was less than thrilled to hear what he found.
Callie and Arizona were at the end of the driveway when he pulled up. Callie yanked open the passenger door and pulled Sofia into her arms, eyes shut, giving a suffocating hug. She spoke rapidly in Spanish, and then in English, "What do you think you were doing? Sofia, baby. Oh, my baby. Don't ever do that again."
"Thank you, Alex," Arizona said, one hand on Callie, one on the kid.
"Yeah, no problem," Alex said.
Callie and Arizona took the kid inside. Callie mouthed a 'thank you' to Alex between scolding and cooing over Sofia. He wondered if an incident like this was enough to make them cool down for a little while, or if the bell would ring as soon as the door shut.
