Prologue

In my mind, everything was different. Everything.

In my mind, I was standing in the sunshine of a beautiful June morning, and I was smiling and happy. I wasn’t wearing a hat or sunscreen and I didn’t even need them—my nose wasn’t going to burn and I wouldn’t get freckles.

More freckles.

My hair flowed down my back in beautiful, healthy, auburn waves that bounced gently in the breeze. It wasn’t wadded into a knot weighing heavily on the back of my head and maybe in need of washing. Ok, if I considered how long it had been since I’d showered, I realized that its condition wasn’t “maybe” in need of washing, it was just…really dirty.

But in my daydream, my hair bounced and my blue eyes weren’t bloodshot and drooping, either. They were crystal clear. My long, flowered dress softly billowed, just like in all those posts by the women who lived in cottages painted in beautiful colors and filled with perfect accessories. Those women had adorable kids and chickens and goats, all of them happily free-roaming but not ever running away.

In reality, I would have been worried if I didn’t have a sight line on the children and I wouldn’t have enjoyed the smell of those dirty animals and their poop, but I could make up anything that I wanted to. So, there was no smell except for garden roses and there was no poop either, and unlike most of my younger siblings, the adorable kids took really good naps and that was what they were doing right now. My flowered dress might have made me look dumpy except in this fantasy, I was two inches taller, my waist was several inches smaller, and I had no jiggle. Anywhere. My curves were smooth and toned. Also, I was eating a big cone of Mexican chocolate ice cream but it wasn’t going to create any jiggle or adversely affect those perfect curves. In this daydream, I never gained anything but muscle and—

“Wha? Whas happen…” the man in the bed slurred, and I came back to reality.

There was no soft sunshine here, only florescent lights that somehow made everyone look simultaneously tired and startled. No flowing dress, just the familiar ceil blue scrubs, and my body under them wasn’t exactly jiggle-free. There was a smell, but it was the antiseptic miasma of the emergency department rather than the sweet fragrance of flowers. Instead of roses, the stale air (no gentle breeze in here) was filled with the pervasive stench of heavy-duty cleaning materials mingled with an undercurrent of emesis and other spilled bodily fluids. After eight years, I was mostly nose-blind to the hospital, but apparently I carried the odor of it with me. My last boyfriend had always been disgusted when I’d met him after work. It had been several years since I’d been with him, but I still remembered how he’d reacted.

“Nicola,” Grayson had said, waving his hand in front of his face and frowning. “Can’t you shower before we see each other?”

No, because I didn’t have the time, not with all the shifts I pulled. If a guy couldn’t stand me in scrubs, then we weren’t going to last—but I hadn’t been sorry when Grayson had said goodbye, anyway. He’d had little hands with short fingers, very noticeable when he waved them around like that, and they’d made him an automatic “no.” I’d been glad to be free of that loser and his miniature digits.

“Is it…hospital?”

The patient slowly moved his palm and put it over his mouth after he spoke to me, as if he were holding something in. As opposed to my ex Grayson, this man had big hands with long fingers, not thick but strong. I was only interested in what his body language with those hands was telling me.

I held up my own index finger in warning. “Do not throw up,” I told him, and then tried again to adjust the IV line. His skin was clear, no track marks, and his veins were good, so he wasn’t shooting up there and I shouldn’t have had a problem. But he was trembling and I was, too. The tremors in my hands were due to exhaustion, but he was just a typical drunk disaster. He shook. He was dirty. He smelled. I’d seen a million just like him; he was another in a long, sad line.

I didn’t plan for him to ruin my new gym shoes with his puke. I never got new stuff, but my former ones had worn down until there was actually a hole in the sole that let rainwater in. In the emergency department, other substances could have entered too, such as vomit from patients like this guy. These shoes were going to have to last me for as long as I could keep them going, and no drunk idiot was allowed to ruin them on the first night that they were on my feet.

“Hold still and do not throw up on me,” I cautioned again. “If you do, so help me—”

“Where am I?” the guy interrupted. He sounded confused, and his words slurred together: WherumI?

Luckily—luckily?—I had enough experience with inebriated patients to understand him. “You’re at Detroit Saint Raphael. The hospital,” I explained. “Someone pushed you out of a moving car at the ER entrance and drove off.”

That information didn’t seem to help him because he was still totally befuddled, because he was still totally drunk. I’d already typed that into his chart, EtOH on board, but anyone within ten feet of him wouldn’t have needed to read it. You could see it and you could definitely smell it. His blood alcohol had come back extremely high, at a level that would have killed a normal person—but that number didn’t actually matter much. Their bodies could tolerate a lot more liquor and continue to function. I hadn’t ever seen this guy in here or in the other hospital where I worked either, but only someone with a long history with the bottle could have swallowed so much and still woken up, alive.

“Who puss…pussed…” He gave up on the word. “Who did it?” he asked. Whodudut?

I understood him to mean, “Who pushed me out of a moving vehicle and left me here?” so I answered accordingly. “Shockingly, they didn’t leave their names as they committed a crime. They were probably the friends you were partying with today.” Judging by the level of filth on him, his problems hadn’t started today and he’d been “partying” for a while. “Our security guard said that they slowed down a little as they dumped you out, which was fortunate. You ended up with only abrasions and a fractured ankle, not a fractured skull. We checked your brain, and you’re good.” Cleared medically, I meant, but still chronically dumb.

He looked at me and I could tell that he was trying to focus. “I have shitty friends,” he said fairly clearly, and despite everything, I wanted to laugh.

“Yes, they really suck. They don’t care about you at all. In fact, maybe they’re not friends. Right?”

He didn’t bother to answer. “What are you doing to my arm?” he asked instead, with several of those words entangling.

“This is an IV. If you would stop moving, it would be easier for me. Stop moving your arm,” I said sharply.

But he either didn’t comprehend my order or he just couldn’t comply. “You my doctor?”

“I’m a nurse,” I explained, and he was in one of my beds. Since he’d arrived with a bang and had been unconscious, he was separated from the rest of the drunks who were having a sandwich and then sleeping it off. So far, there were only three others, but it was still fairly early on a Saturday night and I’d be here until morning. We’d fill up with weekend partiers and our chronic crowd soon enough.

“Fuck.”

He’d closed his eyes and slumped back. “Spending your weekend in the ER is no one’s idea of a good time,” I agreed. “Maybe you shouldn’t drink so much.”

Then I shook my head at myself, because I had no reason to interact with him in that way. After so many years of dealing with people exactly like him, I hardly ever said anything that wasn’t absolutely necessary. Nothing I could tell them would matter. I remembered how, in my first year in the emergency department, I’d believed that I had made a real difference in one patient’s life. We’d talked about the changes she wanted to implement when she was discharged, like how she was going to take care of her kids, how she was going to stop stealing her father’s disability money and spending it on drugs, how she was going to be the mother, daughter, sister, and friend that everyone wanted her to be. I’d glowed with pride at the end of my shift, positive that our serious discussion would have an effect. I remembered going home and writing about it in my journal, underlining the words, “This is why I went into nursing!!!”

She’d shown up again a few nights later, high as a kite, and she’d headbutted me as hard as she could and called me a lot of names that weren’t very creative but were awfully mean. We’d talked again after she’d sobered up, and again a week later when she’d been back after passing out in a bar bathroom, and again a month after that when the police had brought her into Midtown General Medical Center, the other hospital where I worked. She’d bitten one of them hard enough to draw blood, so we’d treated the officer, too.

Not too long later, I heard news about her from the cop who’d had the misfortune to get his arm too close to her mouth: they’d found her dead in an alley. That woman hadn’t totally squelched my proselytizing spirit but it had been the beginning of its march toward zero. I’d reread the journal entry about her and then had drawn a thick X over the page. I’d also added another word at the bottom: “Wrong.”

Now, seven years later, all the idealism with which I’d started my career was gone, and I kept my helpful tips to myself. I had other things to worry about besides problems that people didn’t want to solve or that were so insurmountable that I could only look at them and think…sorry. Sorry, it’s too late for you. There’s nothing that we’re going to fix in your short time in this emergency department that will ever make a difference. You’re screwed.

Except, according to the license we’d found in his wallet, this guy was younger than a lot of our regulars. Beneath the dirt and dishevelment, he wasn’t bad looking, either. He wasn’t too thin, as sometimes happened when people weren’t getting any food down along with the liquor; he also wasn’t too fat, which happened because the booze could make them bloated and swollen. His thick, dark hair was shaggy and greasy, but he didn’t have a puffy, saggy face yet. He didn’t have rough, red skin like the other frequent fliers. He hadn’t yet been combative, not physically or verbally. He hadn’t puked, either, but I kept an eye on him. These were new shoes, after all.

“Ok, you’re done,” I announced finally, and stepped away. I fisted my hands because they still shook and I’d taken about ten times longer than I should have. “I’ll be back later to check on you.”

“I’m cold,” he said. He didn’t whine the words in the way that always annoyed me, but just stated them as fact. He also didn’t seem to be hoping for a solution, but this time? I had one.

“I’ll get you a heated blanket.” And that was something I wouldn’t have normally done, but it wasn’t like it was so far out of my way to walk to the warming cabinet. I used to get them all the time for patients—when had I stopped that? I couldn’t remember, but it had probably been around the time that I’d also stopped giving out advice and phone numbers for different services. “I’ll be right back.”

Then, as I turned to go…he whistled. It was a long, slow, unmistakable sound of male appreciation.

“What?” I asked in confusion, because it had sounded like he’d seen something he liked. Was he whistling at me? “What?” I asked again.

“Damn,” he slurred. “That ass.”

Sexual harassment by patients was something that I didn’t tolerate. Even the ones in their sickest, most pain-filled moments sometimes managed to come up with truly awful things to say. Like, there had been the one guy (later involuntarily committed to our psych unit upstairs) who had told me that he wanted to put his wang in my ear and screw me there—but he’d used terms that were a lot more graphic and detailed. He’d tried to grab my hair, too, in an effort to make it happen.

But this guy’s comment about my butt didn’t make me as angry as it should have. He was only beer-goggling, of course. Although, from the smell of him, it hadn’t been only beer that he’d taken down...

Holy Mary. I realized that I was still standing next to his bed because this dirty addict had just expressed some drunken admiration for me! It just showed how far I’d fallen, how truly bad things had gone. I shook my head in disgust of him and of myself. “I’m here to help you, Mr. Bowers. I’m doing my job, not entertaining you.”

“Jude,” he said, and yes, I knew that was his name. I was the one who’d entered it into his chart. Sometimes speaking more formally reminded people that we were all adults here, or at least I was. I was a professional, not eye candy.

Eye candy? When had I ever used those words? Probably never, and they’d also never been spoken before in connection to me, Nicola Curran.

“You must get tired.” Youmushgittired.

“I must get tired of what?” I asked tartly. “Of patients being obnoxious?”

“Hearing it,” he mumbled. “You’re so beautiful.”

Did he really think that? I stepped closer to the gurney to catch the reflection of my face in the curve of the metal siderail. I looked even worse than I had the morning before, when I’d also caught a glimpse of myself in a mirror as I’d entered my house. Even in the fun-house image in the metal, I could see how gross my hair looked. Just terrible. My eyes were even more sunken than they had been sixteen or so hours ago. My lips were pale and cracked. Did I own a tube of gloss anymore? When was the last time I’d put on any makeup at all? And who was I to call someone else “dirty” when I was walking around like this?

“Beautiful,” he muttered under his breath. Beyoufull.

“Well, thanks,” I said. “I suppose. But keep your comments to yourself.”

“K.”

“Do you have family I can call? Is there anyone who you want to inform?” I asked.

“No. Nobody.” He opened his eyes and they seemed to focus better than before. “Are you going? Don’t go.” Dongo.

“I have more patients I need to see. If I’m not here, there are other nurses who can help you, too.” I wasn’t moving, though. “Are you still cold? I was going to get you a heated blanket.”

“Doesn’t matter. I’ve been cold before,” he answered. That was what I thought he’d said, but a lot had been under his breath. “Are you married?”

I’d heard that question loud and clear. “That’s none of your business. Are you?”

“None of your business,” he echoed, and his lips turned up a little. “Am I right?” AmIrigh?

I only sighed. I’d always thought it was funny that patients tried to hide things from their nurses, since we literally saw everything. We usually knew a lot about what they were thinking, too. “I meant, if you had a wife then I could talk to her,” I said. I’d checked his hand already, though, and there was no ring and no tan line that indicated there had been one in the past.

“No,” he said. “Kids?”

“Are you asking if I have kids? Again, none of your business,” I told him. “How about you?”

“No.” He put his palm on his face again, this time over his eyes. “No kids, no kids.” He breathed deeply and then coughed. “I don’t know what I’m doing anymore.” That came out low and was still slurred, but I understood him. “Don’t know how I ended up like this.”

“You were pushed out of a vehicle—” I started to explain again, but he kept mumbling.

“Is the bottom? Bad as it gets?”

“Maybe the bottom was you unconscious in a car with people who didn’t care about you,” I suggested. “Maybe it’s time to start choosing better people to party with.” Who was I, Clara Barton? What was I doing? There were a lot of other things to take care of and I wasn’t his social worker. There was nothing anyone could really do for him, anyway. “I’ll get you that blanket and I’ll be back.”

“I had a good thing,” he told me. “I did.”

“That’s nice. You were lucky.”

“It’s gone.” Izgun.

I understood. “Maybe you can get it back,” I suggested. Right. The idea that you could recreate what you’d destroyed was a fantasy usually promulgated by people who had never messed up before themselves. I’d seen it go the other way so many times in the emergency department. Patients were sorry, they wanted a second chance, or a third, a tenth, a fiftieth. But at one point, the people who had supported them were over it. Those families had tried so hard, fought for years, hoped and prayed and thrown money at the problems. I’d heard different iterations of the same old story from moms and dads, wives and husbands, or the kids who’d grown up with it. They would relate their sad histories over the patients’ prone bodies, about multiple stints in rehab, trips to the hospital, wrecked cars, lost jobs, empty bank accounts, ruined relationships. Total destruction.

I wondered what bridges this guy had burned.

His eyes slid closed. “I’m sorry,” he told me, but I didn’t think he was actually speaking to me. “So sorry. What am I doing?”

“Are you sure there’s no one that I can call?”

“No.” The word was quiet and I hardly heard it. “No, I’m alone.”

I felt an odd stirring in my chest. It had been so long since I’d experienced the emotion that it took me a moment to recognize what it was: sympathy. I felt sorry for this guy, drunk and dirty, by himself here in a hospital and feeling like crap, sad and regretful of the problems he’d caused. “You may think that you’re alone,” I told him, “but I bet there’s someone who cares.”

“Bullshit. Why would they?”

“Because you’re a human being. You’re not irredeemable,” I said, and realized that I meant it. Why couldn’t this guy have another chance? Why couldn’t I hope for it? “If there isn’t anyone in your corner right now, there could be in the future.”

“Who?”

I thought for a second. “You could find someone who also did terrible things so she won’t mind how you messed up too, or a woman with very low standards or poor self-esteem. Probably a combination of those qualities would work.”

His lips quirked up again. Beneath the scraggly beard and moustache, I thought he could have a nice mouth, but it was hard to see.

“You’re only thirty-three,” I pointed out, because I’d seen his driver’s license. “Things can turn around, so you can’t just quit. Your life can be better and—”

His eyes flew open and he said, very, very clearly, “Oh, damn.” Before I could move at all, he’d leaned over the bed rail, obscuring my reflection there, and he puked. He threw up everything in his stomach. It sprayed all over my legs, all over my new shoes, and it splattered across the floor.

That was exactly what my advice was worth to this guy. Before I sloshed my way out, I put a basin on his chest. “There you go. I’ll be back to clean up,” I told him, but his eyes were now closed.

“Make sure you chart that, Nicola,” I heard someone say as I walked toward the bathroom. I didn’t stop to answer but I knew that the speaker was Cleo, a woman who’d been hired the year before and had immediately tried to take over the emergency department. She had kissed up to all the other people who worked with us, especially the idiot nurse manager who “ran” things and did a terrible job. She couldn’t have managed the plastic pieces of a board game.

“What does vomit indicate?” Cleo called. “I’m sure you’ve told me. A few times!” I heard laughter, too, and they definitely weren’t laughing with me.

“If I told you something, it was because you didn’t know it,” I said over my shoulder. And she didn’t know it because unlike me, she was a terrible nurse. Despite that and also unlike me, she was very popular, always chatting and making plans with everyone else. I didn’t have friends here at DSR or any at another place, either. I kept up with two of my sisters and I texted sometimes with a few people from high school and college, but there was no one that I cared for in the least at Detroit San Raphael or at the other hospital where I worked, Midtown General Medical Center.

That was fine because I was here to do my job and collect a paycheck, not to gossip on smoke breaks. I didn’t want to listen to their problems with their car payments, their mortgages, their husbands and kids. As I’d just told that patient, I didn’t have a spouse or children and I didn’t want to go out to bars with the single, unencumbered ones, either. It was impossible for me to relate to the other men and women who worked in the emergency department—not that I wanted to relate. I wasn’t interested in them at all.

I changed and cleaned up my shoes as well as I could, which wasn’t very well. My new shoes, on the first night I wore them…I was still staring down and trying to convince myself that they were ok as I went back to the critical care beds. When I looked up, I saw all the movement around him, the patient I’d just been talking to. Jude Bowers.

“What happened?” I asked at the desk.

“What does it look like? I thought you knew everything. He coded, duh,” Cleo answered. She didn’t bother to watch the scene, because this really wasn’t uncommon where we worked. It wasn’t like the hospital shows, where everyone started yelling, “Code blue!” and a cute doctor would rush in and save the day, and then afterwards, we’d walk away and return to our relationship drama. This looked chaotic, but the staff had all been here at Detroit Saint Raphael for long enough that it wasn’t, not really. Everyone around his bed was working and doing their part and I didn’t need to be over there getting in the way. I shouldn’t have gotten anywhere near it, in fact, because too many bodies just made things worse. I still took a few steps in that direction, though, before I realized what I was doing.

“He was fine,” I muttered as I backed up. He had been awake after he’d puked on me, and I knew that other nurses had been there while I was gone.

Cleo didn’t bother to respond. We didn’t speak to each other unless it was absolutely necessary, which this wasn’t. People could die at any time and sometimes we expected it, but they could sneak up on you, too.

I watched them get the paddles ready. Ok, he was probably done. This also wasn’t like the hospital shows in which someone got shocked, woke up, and was ready to go home the next day. If his heart had stopped and they were doing CPR, then the chances were slim that he’d survive. I’d done everything that I was supposed to do, and he was just another guy who’d made bad choices and had ended up dying in a hospital bed, cold and alone. That shouldn’t have made me upset, but I gripped my hands together in front of me, like I was preparing for a fight.

“Is there family?” one of the techs asked.

“No. He doesn’t have anybody,” I answered. I turned away from the window so I wouldn’t see the second round with the defibrillator. There was a funny burning in my eyes, as if I’d gotten alcohol or hand sanitizer in them. I blinked hard, trying to rid them of the feeling.

“What in the hell is wrong with you, Nicola?” Cleo asked, staring up at me.

“Nothing.”

“Why are you standing there crying? Did you know him personally?”

“No,” I said, and then added, “I’m not crying, I got soap in my eyes. That idiot just threw up on me and I had to go wash it off. He ruined my new shoes.”

“Yeah, he deserves to die for ruining your shoes,” she said, and made a disgusted noise as she swiveled the chair away. “You always have that big heart. What makes you act like a bitch all the time?”

I saw the tech nodding slightly, as if she agreed, but she took off when she spotted my frown. “I’m a professional. You should try it,” I recommended to Cleo.

“Is that what you are? You just left another post-it note on my cooler bag in the break room refrigerator. Soooo professional,” she sneered.

“If you keep packing tuna fish and leaving it in the communal appliance, I’m going to keep saying something,” I informed her. “The smell is permeating the rest of our food and do you know how much mercury is in one serving of that?”

“I do, because you already told me! It’s none of your damn business what I bring,” she said. “Stay away from my bag.”

“Either leave your crap in your car or start eating stuff that doesn’t reek—”

“Nicola, cover the beds in peds for me,” another nurse said, and I nodded. I looked back over my shoulder as I walked away, not to continue the argument about the tuna fish sandwiches, but to peer through the glass door that led to the critical care area. It looked like they were still working on Jude Bowers. Maybe he would make it and things would turn out ok. Maybe he would be able to do what I said and clean himself up, start again. Most likely, none of that would occur and his life would end tonight.

“Did someone just puke?” a paramedic asked as he passed by me. “Phew, it’s bad in here tonight.”

“It’s Nicola,” I heard Cleo gleefully tell him. “She got new shoes and…”

I kept going, because I had other things to do besides getting insulted and watching a guy die. There were plenty of other people in the emergency department who needed help. It was too bad that the patient was in this position, but even he admitted that he had put himself here.

Nicola, with the big heart. I closed my eyes for a moment. Then I opened them and went towards the pediatric beds and I didn’t look back again.