Luka breezed into the ER. "Good evening, Jerry," he said.
"Evening, Dr. Kovač."
Another night shift; he'd be working with Jing Mei again. He'd been back at work for two weeks, and was getting back into the swing of things. Just like riding a bike. He was tired, but no longer collapsed with exhaustion at the end of each shift. And while he was still being kept strictly away from anything that could be remotely considered 'trauma', he was taking more challenging general medical cases. He was, he thought wryly, about up to speed with the 4th year med students ... But he was back at work, and he felt good.
The evening started out routinely enough; med students to monitor, and an assortment of lacerations, mysterious fevers, and 'weak and dizzy all overs.'
"Luka," said Jing Mei. "I'm getting buried here. "Can you take the patient in exam 2? Vag bleeding, no fever, I'm guessing a simple miscarriage.
"Sure," Luka took the chart from Jing Mei and headed into the room. Lydia was already there.
The patient was young. The chart said she was 18, but she looked younger, maybe 16. She was very pale. How much blood had she lost? There didn't seem to be a lot of blood on the bed.
"Amanda? I'm Dr. Kovač. How long have you been bleeding?"
Amanda bit her lip. "Not long ..."
"When was your last period?"
"I'm not sure ... I don't remember exactly ... I don't keep real close track ... but this isn't my period."
"Are you late? Do you keep track enough to know if you might be?"
"I don't think I am."
"Are you sexually active? Is there any possibility you could be pregnant?" All the standard questions, the triage notes seemed much more sketchy than usual, but Amanda seemed very nervous, frightened.
"Maybe ... I don't know."
"You know, Amanda, we won't tell your parents whatever you tell us. Even if you are pregnant, ok?" A tiny nod. "But I'm going to have to examine you, to determine why you are bleeding." Another tiny nod.
While Lydia helped Amanda get into the proper position for a pelvic exam, Luka got together what he needed, put on his gloves. He couldn't help noticing that Amanda was shaking, there were tears in her eyes.
"Have you ever had a pelvic exam, Amanda?" he asked her.
"No."
He'd save the canned speech, Luka thought, about how sexually active teens should see a gynecologist regularly until after they were done ... "Well, it won't hurt. Just try to relax as much as you can. I'll be very gentle, and you be sure to tell me if I do anything that hurts you, ok?" No response from the patient. Luka looked at her to give her an encouraging smile, but her eyes were closed. He sat down, picked up the speculum, turned back the drape - and suddenly couldn't move.
Bruises on her thighs. A deep tear at the vaginal opening; it appeared to be the source of much of the blood. And, from Amanda, sudden sobs, and the sound of Lydia gently comforting her. Between sobs came the words "I didn't want to ... they made me ... they made me do it ... they said they would hurt me ... I'd never done it before ... they made me ..."
Luka still couldn't seem to move, couldn't even breathe, but he found himself, somehow, looking into her eyes. And he might have been looking into a mirror. Pain, grief, fear, shame. His head was spinning. He had to get out. He had to say something, do something. Could she see was he was feeling? Was she also looking into a mirror?
His mouth was parched, like paper. He felt himself rise from the stool, strip off his gloves; heard himself say, as if from a long ways away, "I think you'll be more comfortable with a female doctor, Amanda. I'll get someone else to come in and examine you, ok?" And he fled. At the desk he said to Jerry, "Dr. Chen will have to take the woman in Exam 2. And get rape crisis down here for her."
He had to get away. He could feel the panic, the terror that he hadn't felt for so long; in another minute it would overwhelm him - then who could know what he might do? He could still see her eyes - they were Sakina's eyes, and his own.
Where could he go? Every room was full. There would be people in the lounge, in the men's room. The hospital was full of people. He could feel people looking at him. They knew. They had to know. Nobody could ever know, ever see ...
Cold air. He had been walking, almost running. His feet had carried him outside. He was in the ambulance bay. Nobody was around. It was too cold for people to be hanging out outdoors. He could see someone having a smoke along one wall. He walked, almost ran, in the other direction. He couldn't breathe. It was cold, snowing a little. But Luka scarcely felt it. It was hot, sweltering. He was sweating, perspiration ran down his neck. The odor, in his nose, strong; of sweat. His own sweat, theirs ... the odors of ammonia, of blood ... of worse things.
He almost ran into the wall. He hadn't seen it. He couldn't see anything. Blackness swirled around him. He stopped running just before hitting the wall; some sense, not vision, warning him of its nearness. He dropped to his knees; scarcely felt the pain that tore through his right knee. He was going to vomit. He couldn't. He mustn't. Nobody must know ...
How long he knelt there, doubled over in agony, Luka never knew. He was gasping, sobbing. 'They made me ... I didn't want to ... they made me ... hurt me ...' But the words that came out were only "Oh God ... oh God ... oh God ..."
Finally he came to himself again. He was sitting on the pavement. His knee had, apparently, refused to hold him any longer kneeling, and had dropped him into a seated position, though Luka couldn't remember when it had happened. Except for the pain in his knee, his body was numb. His pants were wet at the knees. Melted snow. He was cold, but it wasn't just from the air. He shook with chills. His hands were bleeding. Had he scraped them when he fell? No ... there was a sudden dim memory of pounding his fists on the pavement. But mostly he felt sick. And dirty.
It was happening again. How could he ever get his life back, how would he ever be able to work, if he never knew when it might happen again? When something would trigger the mindless panic? They couldn't keep him away from trauma forever. Away from cases like this ... (Or, if they did, he would have to tell them why.)
The ambulance bay was empty. Nobody had, apparently, seen his panic. But inside the ER they must have seen. Jerry would have seen him flee the building. Jing Mei would be wondering where he was. Lydia couldn't have missed it.
God ... he had to get away. He couldn't go inside, face everyone, see more patients. How could he deal with other people's pain when his own pain was threatening to drown him again? But he couldn't leave. If he left in the middle of a shift, it would tell Kerry that he wasn't ready, that he couldn't work. Or he'd have to tell her why he had run, and he couldn't do that. He could never do that. They already pitied him enough, he knew. If he left now, he could never go back. And his life would be over.
No, he had to go back inside. What would he tell them? He'd think of something.
Luka struggled to his feet, his right leg protesting. Every step, even leaning heavily on the crutch, sent pain stabbing through it. Pain that he didn't need right now. In the doorway he paused, gathered himself, and went in.
Jing Mei was at the desk. "Luka, are you ok?"
"I'm fine. Just went out to get some air." The words came automatically.
"You're soaked, and you're bleeding."
"Oh... I slipped. It's wet out there, and icy. I'm not used to it, with the crutch."
"Did you hurt yourself?"
"Just twisted my knee a little, skinned my hands. I'm fine." A deep breath. "Did you get to ... the girl in 2?"
Jing Mei nodded, looked grim. "Horrible stuff. She's talking to the counselor now. I think she'll go to the police."
"Good."
"Luka, if I'd known it was going to be ..."
"I'm fine, Jing Mei. I'm fine."
"It's still trauma, and you shouldn't have done it. She presented at triage, told Sam it was ..."
"Don't worry about it. It's done. I could have handled it, but she was so upset. I thought she'd rather have a woman doctor." Luka shifted his weight more heavily onto his good leg and crutch. "I'm going to find some dry scrubs, clean up, then ice my knee for a few minutes."
"Want me to look at it?"
"No, it's ok. I just twisted it."
Luka knew that if she touched him, if anyone touched him, he would scream.
