Flatline (Medicine and Magic Book 1)

  Flatline

  Medicine and Magic Book 1

  SA Magnusson

  Copyright © 2018 by SA Magnusson

  Cover art by Rebecca Frank

  All rights reserved.

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  www.samagnusson.com

  Contents

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Author’s Note

  Also by SA Magnusson

  1

  I’m drawn to death.

  It’s not something morbid, like the annoying kids I grew up around who pretended they were into the macabre, or something sociopathic where I like to watch things suffer as they die. I’m truly drawn to death. I can feel it and know when it’s about to occur.

  Like now.

  The monitor beeped loudly nearby, and I jerked my head around to stare at it. The heart rhythm fluctuated between a steady sinus rhythm and an irregular pattern, enough irregularity that I knew it would stop altogether, even if I couldn’t feel the change coming. Death came with a cold grip working up my spine. I’d grown to hate it, but now that I was an ER resident, I couldn’t deny that it had helped me.

  “Damn it!” I grabbed the stickers—not paddles anymore, not like in the old TV shows—and slapped them onto the kid’s chest and back. He couldn’t have been much older than me, maybe twenty-two at the most, and the bullet had gone into his side and out again. A straightforward GSW, but what had it hit?

  I didn’t have time to call for my attending—and since today it was Dr. Locks, I doubted it would matter. Locks didn’t seem to care too much for GSW, blaming them on the gangbangers, but this kid didn’t look like a gangbanger.

  Staring at the monitor, I noted that the waveform started to change. It was enough for me to act on. If I didn’t, this guy would be dead soon. That much I could feel.

  “Charge to 120 joules,” I said to Derek, the nurse working with me on the patient.

  Derek was as good as they got in the ER at Hennepin General—he’d been doing this for five years, practically a lifetime when it came to ER nursing—and glanced at the monitor before shaking his head. “It’s not a shockable rhythm, Kate.”

  “It’s ventricular. Look at it.”

  “I see a sinus rhythm with some arrhythmia. You shock him now, you’re likely to induce an arrhythmia. He’s stable. In and out wound.”

  In and out, but Derek couldn’t feel death coming, not the way that I could. He couldn’t feel the cold slowly building around us, like the Grim Reaper making his way toward us. And I didn’t dare tell him that. Who would believe it anyway? Hell, there were times when I wasn’t certain I believed it.

  I watched the monitor. It was mostly regular—what’s called a sinus rhythm in the medical world—but not entirely. The pauses that could be normal in some had slight widening to them. It was the sign of the ventricle firing, getting ready for a ventricular rhythm that was potentially life threatening. Or, in this guy’s case, life ending.

  “Trust me on this,” I said. “He’s not awake. If he were stable, he’d be talking.”

  As I said it, the waveform changed.

  The widening shifted and became variable as well. Not a simple ventricular arrhythmia, but one we referred to as torsades de pointes, an old French term for it.

  “Grab the magnesium,” I said.

  Derek’s gaze flicked for a moment to the monitor before he nodded and reached into the crash cart for supplies. If the rhythm were sustained, we’d have to shock him, but if he snapped out of it, drugs would be enough. The problem was that I already knew drugs weren’t going to be enough. The only question was whether I could save him at all.

  Sometimes when I sensed death, I could stop it altogether. That was rare. Most of the time, I only delayed it, if I succeeded at all. In someone like this—someone with a correctable problem—I thought I could stop it.

  But why would he have torsades?

  My mind raced through the differential diagnosis, thinking through what I’d learned in medical school. So much of that knowledge felt useless at times. What did I care about various biochemical profiles of drugs when all I needed to know was whether they worked? Torsades was unique, and not common enough that a guy his age should suffer from it. Maybe congenital? Could he be on some kind of medication that would trigger it?

  “Kate?” Derek asked, pulling me from thinking through the differential.

  “Push the mag,” I said.

  “He’s not converting,” he said, reaching for the IV bag.

  “I know.”

  The cold in the room had increased, now moving along my spine and squeezing around my chest. I was the only one who could feel it, and I was thankful that my scrubs and long white coat hid the goosebumps on my arms. Maybe this would be one that I wouldn’t be able to save.

  “We’re going to have to defibrillate,” I said.

  “Mag is in.”

  “Charge to 120 joules,” I said.

  Others had joined us, and I realized that Derek had triggered the Code Blue alert. Nurses came running, and even lazy Dr. Locks managed to bring his fat ass our way. I could see the annoyance in his eyes as he wobbled toward us. As attending, he’d probably take charge, which didn’t bother me at all, not so long as he managed to do what was needed. I didn’t want to feel the final death pull. It always left me weakened and nauseated, something I did my best to hide, though enough had seen me do it that they knew. Some thought I wasn’t cut out to be an ER doc because of it. Locks didn’t use that against me. His was straightforward sexism.

  “Charged.” This came from someone other than Derek.

  “Clear,” I said.

  As one, everyone stepped away from the cot. Usually it happened that way, though I’d been present when one overeager medical student made the mistake of staying too close to the cot and got a little zap as well. Served the little gunner right. Took him most of the day to recover and gave me a break from him.

  As the shock rolled through the patient, he twitched.

  TV shows made it seem like it was more impressive than it was. With enough sedation—or, as in this man’s case, someone who is unconscious—there is little more than a single twitch.

  I looked over at the monitor as the shock worked through him. It was still torsades.

  “Charge to 200,” Locks said, stepping forward and taking charge.

  He pushed his way through the others in the room, nudging me out of the way without so much as a glance. Locks was large—probably three hundred pounds and all belly and chin—and swung his weight around.

  Derek pressed on the defibrillator and the soft whine of it whirring up was the only sound in the room other than the monitor’s steady beep. When it was ready, he said, “Charged.”

  “Clear,” Locks said.

  The next shock caused a slightly greater twitch.

  The cold breath through the ER room intensified. Maybe it was only my imagination, but with as many people as were here—most only watching, the morbid curiosity of medicine disguised as learning—it should be warmer.

  Nausea began to eat at my stomach.

  I knew that sense all too well.

  The man wasn’t going to make it. And when he didn’t, when death claimed him, the nausea would pass. It was easier when it happened away from me, though I would still be aware of it. This was more potent than I’d experienced in a while.

  “Charge again,” Locks said. He stood with his hands behind his back, belly thrust out, not making an effort of placing his hands on the patient. For him, that was the work of the residents—or the students. Certainly not what an attending should do.

  “You could repeat the mag,” I said.

  Locks shot me a withering stare. I’d seen it enough times that I no longer wilted, not the way that I had when I had first met him. The nurses on either side of me made a point of looking elsewhere. “Magnesium? Shock to save, Dr. Michaels.”

  “He’s only had a single dose.”

  “Epi is in,” someone said.

  “Charged,” Derek said.

  Locks held his gaze on me a moment longer before turning away. “Clear.”

  I stepped over to the crash cart and reached for the magnesium. Derek gave me a look that attempted to warn me off, but even if the shocking stabilized the rhythm for a moment, we needed to maintain it, and that wouldn’t happen without the magnesium. Locks was one of the old guard, docs who refused to evolve and who still thought that yelling and intimidating those around them meant good teamwork.

  Without meaning to, I brushed up
against the patient’s leg as I was reaching for the magnesium.

  The shock went through him and into me.

  It made my muscles twitch, but nothing more than that. Were I anyone else, it would likely have stopped my heart, even momentarily, especially at 200J. Given that I descended from a pair of powerful mages and that dark magic coursed through my blood, it was little more than a painful jolt.

  “Kate?” Derek asked, grabbing my arm.

  I pulled away. Had he seen that I’d gotten shocked? I didn’t need for him to start spreading rumors. There were enough about me the way that it was, most about how I wasn’t cut out to be an ER doctor.

  “I’m fine.”

  “Your arm—”

  “What about my arm?” I glanced at it long enough to see the fabric of my white coat singed where my watch had come into contact with it. The jolt must have gone through the patient, me, the watch, and then into the coat.

  I twisted it so that no one else could see it, but don’t think that I fooled Derek. Given the way he watched me, I was pretty sure that I didn’t.

  “Epi is in,” another nurse said.

  I looked over to see Maggie working with the IV, a syringe of epinephrine in hand. Someone else had hooked up a bag of saline and had it pouring into the man.

  “Rhythm restored,” one of the nurses said.

  The monitor showed a sinus rhythm.

  I stared at it, waiting for the cold in the room to dissipate, but it didn’t.

  The man might have stabilized, but it would be temporary. Were it not, the cold would have eased and I would no longer feel nausea in the pit of my stomach the way that I did.

  “Good work, team,” Locks said.

  “Dr. Locks,” I said, unable to shake the sense I felt. I couldn’t explain it to them, but the return of sinus rhythm wouldn’t be enough to save this guy. It was possible that nothing would. But why? The GSW wasn’t enough to kill him— not given where he’d been struck —and it certainly shouldn’t have caused torsades.

  “Dr. Michaels, you can finish with your patient. As you seem to think…”

  I didn’t hear the rest of what I seemed to think.

  Icy cold gripped my chest.

  Then I vomited.

  I could barely breathe and turned away from the stretcher and raced out of the room, trying to get distance between me and the patient. I’d never felt it so strongly before, but with what I felt, there was nothing that could be done. The man was gone.

  When I reached the lounge at the back of the ER, I staggered inside, wiping my mouth on my jacket and slumping onto the couch. It was leather, easier to wipe clean from all the nastiness we saw, and probably from the time when Dr. Locks had trained here. Resting my head in my hands, I stared at the ground, not able to lift my head, waiting for the nausea to subside.

  This wasn’t like the usual attacks I felt when someone died. This was worse. Much worse. Normally, I’d feel a wave of nausea and that would be it. The cold that clutched my chest had been more painful, too, though that had begun to abate.

  “Kate? Christ, what happened to you?”

  I dragged my head up. Derek leaned on the door, watching me. “I don’t know what hit me. I’m sorry. Hope I didn’t spray you, though I doubt it’s the first time a woman has puked on you.”

  Derek glanced over his shoulder and stepped a little more into the room. “Not me. Like you said, I’m a pro. You got Locks, a little. Then the bastard made a joke about you being pregnant.”

  “Not pregnant.” I looked back down. It felt better when I stared at the ground.

  “Are you sure? You’ve been a little off—”

  “Pretty sure. You have to be having sex to get pregnant.”

  “Well, Locks wanted you to deal with this guy’s family when you’re feeling better.”

  At least he didn’t offer to help me that way. Derek never hit on me, not that I would respond. He was attractive and funny and we got along well, but I refused to mix with anyone while at work. I knew better than to shit where I ate.

  “He has family here?”

  “From the looks of them, I doubt they’re family. More likely they’re friends. But you get to deal with them.”

  “Great.” That was the worst part of the job. I didn’t mind talking to patients—though it was often easier when they came in unconscious—but the families were often another matter and most of the time much worse than the patients. “Can you let them know I’ll be a few minutes?”

  He nodded and bit his lip before shaking his head. “Maybe take some meclizine. I’m sure I could sneak you some from the Pyxis. I’ll just put it in for Mr. Travis Dorn, recently deceased.”

  “That was his name?”

  Derek nodded.

  “I’ll be fine. I just need a minute.”

  “I could hook you up to an IV. If you were out too late…”

  I shook my head again. “Not pregnant. And not hungover. It’s probably just a bug.”

  Derek watched me for a moment before closing the door behind him.

  I sat on the couch for a few minutes, taking long breaths. When death came, it could be unpredictable, but this time I had known it was coming early—much earlier than usual. Was it because of the rhythm? There had been times when I had managed to save people I would otherwise swear would die, and the strange pull of death would retreat, though it would linger, leaving me tired and drained, as if pushing away death took a toll on me.

  Maybe I really was sick.

  When the nausea finally began to let up, I went to the water cooler and filled a paper cup with water. Since it was only a resident lounge, there weren’t the fancier accommodations found in the staff lounge, leaving us with water, bread, and peanut butter. Occasionally, someone brought in a hoard of graham crackers, though that was infrequent and typically taken from the ambulance bay and meant for the EMTs.

  Travis Dorn.

  I looked at my jacket while framing up what I would say to his family. At least I hadn’t splattered myself. Somehow, other than the burn mark on the sleeve and the trail of saliva when I’d wiped my mouth, my jacket was clean.

  “Do you know which two were with Travis Dorn?” I asked Betty, an older woman who had been manning the desk in the ER for as long as anyone could remember.

  She didn’t lift her gaze from the screen and didn’t try to minimize what she’d been doing—shopping again; the woman was always shopping—and pointed to a corner of the waiting room. “Another one not make it?”

  “Something like that,” I said.

  I headed out into the waiting room. The two men were only a little older than Dorn and were both dressed in all black. They stood in front of the TV but didn’t seem to be watching it. I don’t know that I would be watching either. It was only some talk program where the hosts yelled at each other. I had enough of the yelling at work.

  “Are you with Travis Dorn?” I asked.

  The men looked up. The nearest man, an attractive dark-haired man with a square jaw and the kind of body that spoke of regular exercise, looked over at me. Crystal blue eyes met mine and I suppressed a shiver.

  “We are.”

  He had a hint of an accent in his words. In this part of Minneapolis, it wasn’t uncommon. There were plenty of immigrants into the city, and we got them all at Hennepin General. As a county hospital, we got everything, which made it a great place to train.

  “Can I ask what relation?” I didn’t want to push for proof, but there had been times when shooters would come in, pretending to be family, and want confirmation that their target had died. The first time that happened, we nearly had a shootout in the waiting room.

  The man frowned. “Brothers,” he said.

  I looked over at the desk. Betty would have gathered the necessary documentation, so I didn’t need to be worried about it. Besides, I was tired and ready to get back to work. The only way I was going to get away from the rumors that likely were spreading about me in the ER was to get back at it.

  Turning my attention back to the man, I readied my spiel. I’d given it enough times that it was practiced, but I hoped that it still sounded genuine. “I’m so sorry, but we weren’t able to save him.”