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Cassie McKay had dealt with her fair share of loss.
She faced death every day in the ER, not to mention the countless friends she’d lost to drugs and alcohol in her young adulthood. Grief had rattled her, torn her inside out, and reshaped her. But this, pinned against an airbag and unable to reach her unresponsive son, was like nothing she’d ever felt before.
The car had come out of nowhere.
It was their first day in a long time where Cassie didn’t have work, and Harrison didn’t have school or summer camp. After a fierce debate over their breakfast of eggs and toast that morning, the two had finally agreed upon a lunch place to celebrate the start of Harrison’s seventh grade year.
“Can you take me to the gym later today?” Harrison asked from the passenger seat.
“Yeah, sure. Just for an hour though, I don’t want you working yourself to death.”
“I’m not. I just really want to make the school team this year. Not just the rec league, I want to play with the older kids.”
“Oh come on, you’re a shoo-in. And I’m not just saying that cuz you’re my kid. You shoot circles around those other boys. They’d be nuts not to let you on the team.”
“I don’t know. Some of those eighth graders are way bigger.”
“Bigger, sure. But clumsier. Like buffoons. You’re smart. Calculated. Nimble.”
“Your favoritism is showing.”
Cassie let out a soft chuckle. “So what if my son just happens to be the best player in the school. That’s not favoritism. It’s just the facts.”
She caught Harrison’s lips turning upward in a slight smile. Before he could respond, the world snapped sideways.
Tires shrieked.
Glass shattered.
Metal crunched against asphalt.
And then, silence.
The smell of burning rubber jostled her from her stupor. She blinked her eyes open, squinting against the harsh September sun. She took a breath in, bursting into a coughing fit as smoke filled her lungs.
Smoke?
Her eyes shot open.
Through the sprawling spiderweb of cracks in the windshield, Cassie saw that the world was tilted on its side.
No. She was tilted.
Panic coursed through her. She looked to her left out the driver’s side window and squinted against the sun shining through. She turned to her right, and her heart dropped. Harrison was next to her (below her?), unconscious.
“Harrison!” she wheezed past the dense fumes filling the car. No response.
She reached toward her son, stopping abruptly as pain flared in her shoulder. Probably dislocated, her doctor brain offered. That won’t do.
An airbag kept her left arm pinned uselessly to the door. She fumbled blindly for anything sharp along the doorframe. Her fingers clenched around a shard of glass wedged into the seat below her. She jabbed the glass into the airbag, which popped with a soft hiss. She leaned forward, resting her dislocated shoulder against the steering wheel, and pushed until the bone slid back into place, letting out an agonized scream. She blinked the spots out of her vision, breathing shallowly through the pain.
She reverted her focus back to her son, unbuckling her seatbelt. She reached for him again with gritted teeth and nudged his shoulder. No response.
“Come on, Harrison, wake up!”
Cassie reached around for her phone. She raised the cracked screen and dialled 911, frantically explaining the emergency when a sudden bang! sent Cassie sprawling to shield her son.
The phone slipped from her fingers. She could faintly hear the operator speaking, but a persistent sparking noise distracted her. She looked back, only to be faced with a raging, unstoppable wall of fire licking at the backseat and spreading fast. She had to get them out of there.
She looked up at the driver's side window. She wouldn’t be able to lift Harrison up that high with her injured shoulder. The passenger’s side window wasn’t much better crushed against the asphalt. Behind her, fire ate away at the remaining doors.
That left one exit: the windshield.
Cassie shifted to rest her uninjured shoulder against the center console, gripping the steering wheel for leverage. Her body was slick with sweat from the late summer heat and blazing fire, but the adrenaline mixed with the unquenchable need to protect her child gave her the strength she needed to bend her right knee toward herself, and shoot it back into the cracked windshield. The window caved slightly as pain surged in her right foot. She ignored the searing pain and kicked again, making a bigger dent. She kicked again with a strained yell, finally breaking through the windshield’s tough glass.
She made quick work of unbuckling Harrison and lifting him into her arms, fighting past the incessant ache in her body. She hoisted Harrison out of the smoking car and placed him gently on the road, following behind him shortly after. Once out of the vehicle, she half-carried and half-dragged her son as far away from the flames as possible, stopping only once her back hit guardrails.
A wave of terror washed over her as she took in Harrison’s battered form. Blood streaked down the side of his face. White bone poked out of his bleeding right thigh. But what petrified Cassie was the eerie stillness of her son’s chest.
She raised a shaky hand to the side of his neck. Nothing.
“Help!” she called, but the only other cars she could see were covered in unforgiving flames. Something deep and terrible within her hoped and prayed that the driver of the other car was burning to a crisp.
She began chest compressions. She could hear sirens in the distance getting closer and closer with each push into her son’s chest. Nausea rose in her chest as his ribs cracked under the pressure.
“Help!” she screamed again.
Sweat and tears dripped from her face, landing on her son’s unmoving body. Pain flared in her shoulder with every compression, but she didn’t let up. She’d saw her own arm off if it meant there was any chance of saving her son.
Suddenly, two paramedics were at her side. She shrugged a hand off her shoulder as one of the medics tried to ease her off of Harrison.
“Ma’am, please let us get him checked out,” the paramedic said.
“He doesn’t have a pulse. I’m a doctor, I know what I’m doing.”
“Ma’am, we need to check you out as well.”
“I’m fine! You’re wasting time, just take us to the hospital!”
The paramedics reluctantly relented. They loaded the pair into the back of the ambulance, Cassie only stopping compressions briefly for the transfer from asphalt to gurney.
Cassie tuned out the noises of the ambulance: the screaming siren, the paramedics urging her to let them take over, the steady tone of the monitor flatlining. Her gaze never shifted from her son’s bloody face.
She let the rhythm of her hands driving evenly into Harrison’s chest distract her from the impending doom of his prolonged cardiac arrest.
“I’ve got an MVC two minutes out,” Dana alerted Dr Al-Hashimi, who was overseeing an abscess drainage in North 4.
“Thanks, Dana, I’ll be right there.”
Dana rushed to meet the paramedics by the nurses’ station, Al-Hashimi not too far behind her with Mohan and Santos at her heel.
“What do we have?” Al-Hashimi asked.
Dana eyed the gurney as the paramedics gave their report–car crash, mother refused to get off, claimed she was a doctor–where a woman covered in blood, sweat, and ash was desperately performing CPR on a child. She looked closer at the woman.
“McKay?” Dana exclaimed, and several eyes turned to their coworker working gravely to resuscitate her son. The resident didn’t falter, her focus trained on the dying child below her. Dana looked down to the boy on the gurney. Harrison. “Shit,” she breathed.
“You know her?” one of the paramedics asked.
Dana ignored him. “Trauma 2’s open. Let’s move!”
Mateo was already in the trauma room when the team rushed in with a gurney. He faltered as he registered the pair on the gurney: the doctor he’d worked closely with for the past several years performing CPR on the unresponsive form of the child he’d taken under his wing and grown to love like a little brother.
“Dr McKay, let us take over,” Al-Hashimi demanded gently. The words didn’t reach the frenzied doctor.
“Cassie.” Dana lightly reached for McKay’s bicep, hoping to ground her. For the first time since she’d arrived, Cassie looked away from her son and into Dana’s eyes. The resident had a wild look on her soot-covered, sweat-drenched face. Blood trickled down the side of her head and cuts littered her arms and legs. The ends of her hair and right sleeve were charred. Dana had never seen the normally steady and sure doctor look so haunted.
“Dana,” Cassie said softly, exhaustion lacing her words. “He’s not breathing. Open femur fracture in his right leg, probably a concussion, maybe a brain bleed, some bruising from the airbag. We need to check for internal bleeding. He-he’s not breathing.”
“You did good, hon. Why don’t you let Mateo take over for you now?”
“No,” she said firmly. “He’s my son. I can do this.”
“You don’t have to,” Dana replied delicately. “You shouldn’t be the one doing this. You know that. Harrison’s in good hands, you just need to let us take over.”
Cassie’s gaze turned sluggishly from Dana to Mateo. He gave Cassie a slight nod.
“I’m not leaving the room,” Cassie demanded, finally relenting. Dana eased her off of the gurney, and Mateo immediately took over compressions. Cassie stumbled slightly as her feet made contact with the ground. Dana steadied her.
“I’m fine,” she asserted before Dana could ask about her injuries. But when Dana wrapped a supportive arm around Cassie’s waist, she didn’t pull away.
“Charge to 200,” Al-Hashimi ordered.
“Clear.”
Harrison’s body jolted violently. Cassie flinched despite herself. She knew the drill, she’d lived this a thousand times but now it was her son under the harsh jolt of electricity. Dana squeezed her shoulder, hoping to mollify her fear.
“Epi’s in.”
“Pulse check in ten.”
Ten seconds passed like ten years. She’d made split-second, life-altering decisions in less time, but now all she could do was wait.
“Still no pulse.”
“Keep going,” Cassie begged.
She hadn’t realized she spoke until Al-Hashimi regarded her evenly. “We’re doing everything we can.”
Another round of epi.
Compressions resumed.
Flatline.
“Time of death, 1:46 pm,” Al-Hashimi announced somberly.
“No,” Cassie muttered.
The atmosphere felt thick.
“Keep going. Please. Another round of epi,” Cassie pleaded.
“He’s gone, Dr McKay,” Al-Hashimi said gently. Perlah silently shut off the whining monitor.
Cassie stared at her, the words sliding past her head as if they belonged to someone else. Her fingers tightened around Dana’s hand. This was her son. “No, you’re wrong. He’s just–he’s not–” Her voice cracked. “Please.”
No one moved to comply. It was too late.
Dana caught Cassie as her knees buckled beneath her. “It’s not fair! It’s not fair!” she wailed. The pair sank to the floor. Dana held the weeping mother as cries tore from her chest. Dana faintly registered Al-Hashimi ushering everyone out of the trauma room.
Cassie’s wails diminished to sobs, then to soft hiccuping, until she finally went limp in Dana’s arms. Dana silently sat in Cassie’s grief, one hand steady at her back as the last tremors subsided.
Dr Al-Hashimi softly entered the eerily silent trauma room with a wheelchair. She shared a grim look with Dana, who was still holding the broken woman.
“Cassie,” Dana whispered, lightly shaking the semi-conscious woman leaned against her chest.
McKay opened her bloodshot eyes, expression blank and carved with tear tracks through a thin layer of ash. Al-Hashimi caught her gaze.
“We’re going to move you into an exam room so we can treat you,” she explained. She searched Cassie’s features for any sign of understanding.
Her eyes flashed with fear. “I can’t leave him,” she said timidly, looking at the small corpse on the exam table.
Dana’s composure threatened to crumble at the resident’s sorrow. “You’re not leaving him. Perlah’s gonna get him cleaned up, and then you can see him after we check you out. How’s that sound?”
Dana felt Cassie nod slightly against her chest. She shifted her arms to wrap under Cassie’s shoulders, lifting her with Al-Hashimi’s assistance into the wheelchair. Cassie’s face contorted silently in pain.
“What hurts, hon?” Dana asked.
Cassie’s left hand moved shakily to her right shoulder. Al-Hashimi stretched the neck of Cassie’s shirt to the side, mentally taking note of the extensive purple bruising along her shoulder.
“Let’s get her into a room,” Al-Hashimi said, sharing a grim look with the charge nurse. Dana eased Cassie’s feet into the stirrups and pushed her out of the trauma room. Al-Hashimi walked next to the wheelchair, forming a wall between the well-intended stares from the hospital staff and the forlorn doctor. Cassie was oblivious to the shift her presence caused, her mind working in overdrive to maintain her composure.
Once inside the exam room, Al-Hashimi and Dana helped Cassie transition from the wheelchair to the stiff bed, careful not to disturb her injured shoulder. Dana eased her out of her soiled clothing and into a hospital gown as Al-Hashimi shone a penlight in her eyes. Dana’s eyes travelled to the crook of McKay’s left arm, where faded track marks spotted the slightly discolored skin, and Dana realized she’d never seen the doctor’s bare arms before. She tried to ignore the marks, suddenly feeling like she’d invaded Cassie’s privacy, and inserted an IV. Cassie didn’t even flinch.
“Can you tell me what happened to your shoulder?” Al-Hashimi asked.
Cassie took a second for the question to make its way past the fog clouding her brain. “Dislocated. I reduced it myself.” She paused again to think. “Probably tore something.”
Dana eased off Cassie’s left shoe, and then moved to do the same to her right when a sharp gasp halted her movements.
“I kicked in the windshield,” she explained distantly. The scene flashed in her mind.
Her son’s still, bloody form lay slumped next to her, the fire licking at the back of his seat. She kicked and kicked at the windshield but it wouldn’t budge. It wouldn’t budge, until it did but it didn’t even matter because her son was dead. Dead. Dead. Dead.
“Dr McKay, look at me,” Al-Hashimi demanded gently. Cassie sluggishly ripped her gaze from the wall to meet the attending’s. “Based on your exam, it looks like you may have a concussion, along with some significant bruising to your shoulder and abdomen. FAST exam is negative, but I’m ordering a CT for your head and abdomen just to be safe. Do you have any questions for me?”
Cassie shook her head. Al-Hashimi left with a reassuring smile.
“Cassie, what can I do?” Dana asked.
“I need to call Chad. And my parents. They need to know.” Cassie couldn’t bring herself to look into Dana’s kind eyes.
“I’ll call them. You just worry about getting better.”
Cassie lay alone on a stiff bed in Central 8.
Her parents had stayed for as long as they could, and even longer than hospital policy allowed, but eventually a night shift nurse ushered them out of Cassie’s room so she could rest. Despite the nurse’s good intentions, Cassie loathed her actions. The silence threatened to swallow her whole.
Through the glass window she watched the bustling ER thrum, alive with activity, as if the world hadn’t just come crashing down around her. The noise was muffled through the glass door, like she was underwater. Drowning in her own grief.
Cassie couldn’t take it anymore.
She sat up slowly, careful not to disturb her injuries. She tentatively set her feet on the ground, testing the durability of her fractured foot. It hurt like hell. She pushed her foot harder against the ground, relishing in the pain flaring up her calf.
She stood clumsily, catching herself on the bed. Her body screamed in protest, but the physical pain was a welcome distraction from her unbearable inner turmoil.
She walked forward slowly, sliding open the door and slipping into the flurry of motion flooding the Pitt. She let herself get washed away in the steady stream of movement along the hallway before detaching herself and sneaking through the back staircase.
She climbed up countless stairs, past the OR, cardiology, oncology. Her body began to fail on the fifteenth floor. She leaned against the wall, sweat dripping down her face and blinked the spots out of her eyes.
LABOR AND DELIVERY was the first thing she saw when her vision cleared. The fifteenth floor. Three more flights of stairs before she hit the roof. But the bright red letters enticed her, drawing her forward through the entrance.
She looked out into the sea of newborn babies wrapped in blankets, some fussing, some sleeping, and finally let herself breathe.
A baby wrapped in a yellow blanket caught her attention. He looked just like Harrison did, as much as any newborn babies could look alike. Fine, blond hair splotched across the baby’s head. He was red in the face from crying, and Cassie felt a pang of pensive longing in her heart as the child’s screams echoed in her head. What she wouldn’t give to hold Harrison once more. Hear him laugh, hear him cry, hear him breathe.
A gentle hand on her shoulder thrust her back into reality. Dr Abbot?
“Hi, Dr McKay,” he began with an almost absurdly casual inflection.
She glanced up momentarily, acknowledging his presence, before turning her attention back to the nursery.
Abbot continued, undeterred by McKay’s silence. “I’ve seen a lot of people walk up those stairs, myself included, with the intention of…seeing how close they could get to the edge. To feel more in control, I guess, of their own fate. I thought I’d be talking you off the ledge right now. I’ve gotta say, I like the view down here a lot better.”
She let out a slight huff, a chuckle that didn't quite reach her face.
“What’re you doing here, McKay?” he asked, concern lacing his voice.
Cassie shook her head slightly, eyes flitting from cradle to cradle. She began speaking dazedly, “You know I’m sober? Almost 10 years. I don’t really tell a lot of people here.”
Abbot moved closer to Cassie, silently offering his support without crowding her.
“I quit–for the first time at least–when I got pregnant with Harrison. I made it almost 29 weeks, and then I went into preterm labor.” Her head snapped to a baby girl whining to her left. “He weighed 3 pounds, 8 ounces. He was tiny. And I…I had never been more terrified. And I just–I couldn’t help but blame myself, and I relapsed. Harrison got better, in the NICU, and I…” she trailed off. “I got worse.
“I went to rehab when Harrison was 2 and I’ve been trying to make it up to him for his entire life. We had some really bad years, especially at the beginning, but he was always…him. Kind, caring, and god, he’s the funniest kid. He was so proud when I got into med school.” A slight smile shone through her melancholic features. “He told his entire kindergarten class that his mom was gonna be a doctor.” She rubbed her hands together, subconsciously wiping Harrison’s long-gone blood from her hands. “I did it all for him. Rehab, therapy, med school. He’s the reason I kept going. To give him a good life. And it was finally–” her voice cracked. “It was finally getting better.” She took a shaky breath in and breathed, “It should’ve been me.”
“Don’t do that. You’ll waste away your entire life thinking about the should’ve’s. It’s not fair at all what happened. But I don’t want you losing yourself in your grief.”
Cassie took in Abbot’s words, unable to meet his gaze. She responded quietly, “I think I’ve already lost myself.”
Abbot moved closer, wrapping an arm around the resident. She tensed slightly, before leaning into his warmth.
“I want to go home,” she said.
Abbot nodded in understanding. “In the morning, if your vitals are normal and nothing pops up on the CT scan, we can discuss the discharge process.”
Cassie turned to face him, a faint spark flickering in her dull eyes. “Really?”
Abbot nodded again. “I also know a good grief counselor, if you’re interested. She’s really helped me through some dark times. I think it could be good for you, too.”
“I have a therapist.”
“Just a suggestion.”
She paused. “I’ll think about it.”
“Good. If it gets dark, I want you to reach out. To me, to Dana, your family, anyone. Please.”
Cassie nodded hesitantly. “I will,” she said, but she knew she wouldn’t.
And even though Cassie hadn’t made it up to the ledge, Abbot couldn’t help but feel like all he’d done tonight was delay her inevitable end.
Dana went to church like she always did on the Sunday after Cassie McKay overdosed.
The service had ended long ago. Fellow church-goers moved around her, chatting casually amongst themselves while she sat alone in her pew. She’d listened attentively to the sermon, knelt to pray, and rose to sing with the congregation but it didn’t feel adequate. She still felt a gaping hole in her heart left behind by the tragedy that had befallen Cassie McKay.
She knelt forward again, now completely alone in the sanctuary, and began to pray.
“Hail Mary, full of grace, the Lord is with thee.
It had been ruled as an accidental death, but Dana knew better. Cassie hadn’t wanted to be alive anymore, not after losing Harrison. And when Cassie set her mind to something, she always got it done. Maybe it was for the best, as much as that hurt Dana to think. Cassie had gone through the motions of healthy grieving, but every time Dana talked to her it seemed like her mind was already gone with Harrison, waiting for her body to catch up.
“Blessed art thou amongst women,
Two months after Harrison died, Cassie had disappeared. Her parents declared her as a missing person, but her extensive history of mental illness and substance abuse diminished her case to low priority. Dana, along with several of her coworkers, had joined the street team on the slim chance they’d find her, but they never did. Every patient who came into the ED matching her description sent heads turning, but she never showed up again until that fateful day in mid-November.
“Dana!” Javadi exclaimed slightly out of breath. Dana looked up from her computer to meet the young resident’s frantic gaze. “It’s McKay. She was just brought in. Overdose. Trauma 2.”
Dana sprinted toward the trauma room. Cassie looked small and fragile against the gurney and LUCAS system attempting to resuscitate her.
“and blessed is the fruit of thy womb, Jesus.
Dana couldn’t help but picture Harrison in this exact position three months earlier. Harrison and Cassie had always looked similar, but inches from death, they looked almost identical. Like mother, like son.
“Holy Mary, Mother of God,
Cassie looked more at peace now than she had at any point following Harrison’s death, even despite her dirty, tangled hair and the deep, dark circles beneath her closed eyes. She no longer looked haunted, her soul finally resting.
“pray for us sinners,
Abbot entered the room slightly out of breath. He joined the small crowd watching the life slowly seep out of Cassie McKay, unable to save her. Dana followed his gaze to Cassie’s bare arms, her years-old track marks now contrasting multiple newer injection sites.
“now and at the hour of our death.”
Dana’s coworkers flitted around her, but she was cemented in place. The LUCAS system worked with inhuman precision, thrusting against Cassie’s chest in steady intervals. It didn’t falter. It didn’t feel. And it didn’t help. Cassie was gone.
Abbot turned off the LUCAS, and called Cassie’s time of death.
“Amen.”