fuonlyknew

Chapter One

Outside the Surgical Emergency Room

Grady Memorial Hospital, Atlanta, Georgia Kyle McMann groaned as she paced on the Grady Memorial Hospital Emergency Room ramp, her eyes tracking the incoming ambulance. She prayed this wasn’t another twenty-five-year- old—her exact age—stiffened by rigor mortis, still cradling her crying infant son in her arms. She was haunted by the mother’s lifeless stare that sent shivers down her spine. Obviously, some evil bastard shot her close up as she held her baby. Kyle had picked the short straw, as per usual. She was starting her career as an intern in the Surgical Emergency Room of Grady, the Mount Everest of U.S. shock-trauma centers. Unlike most hospitals that had one ER, this godforsaken medical behe-moth had three: the Surgical ER, the Medical ER, and the Pediatric ER. Each had its own unique variants of traumatizing trauma. It was dark by nine p.m. on Thursday, July 5th, and she shielded her eyes from the strobing reds and blues. It was her job to screen the incoming “clients.” Though not specified in the hospital bylaws, inherent in the mission of the lowest of the low on the professional totem pole was ramp duty. Aka processing the worst of the worst and pronouncing the dead bodies dead. Didn’t get much grimmer than that. Her mind flashed back to this morning’s thirty-one-year-old basketball phenom with bacterial meningitis. A day ago, a vibrant human being. Now approaching his maker with a devastated brain failing on a respirator despite the efforts of the best infectious disease minds on the planet. She’d been there for five days, and already it was wearing her out. Facing the families. The tears. The sobbing. Parents collapsing. It was like everyone fell from the tree of horrors and hit each branch on the way down. Her fight or flight reflex kicked in, and she sprinted to the ambulance, sharp brown eyes focused, runner’s body whipping towards the EMS vehicle, coughing out the black exhaust that smacked her face-on and splayed her middle-parted chestnut brown hair in both directions. Staying on the driver’s side, she peered in as the BLS 911 Emergency Ambulance backed into the ramp. “What is it?” she shouted as the driver rolled down his window. “Bad one, doc. Bleeding like a stuck pig. A bunch of kids worked him over with bats and knives. You want to get in here fast.” Kyle’s heart sank as she ran back and yanked open the rear door. She jumped in before the van came to a full stop. Blood. And more blood. A vampire’s wet dream. On the sheets. The floor. Smeared on the windows. “Come on!” she shouted to the half-panicked tech staring at the abdomen. “Let’s get him inside.” The two front EMTs ran around back and pulled the stretcher out. The group slammed through the steel and glass doors into the ER. “WAIT A MINUTE!” Ellen Chu, the hard-as-a-rock head nurse, blocked their path and held up her hand. “What’s going on?” Kyle spoke up from behind. “Let ’em through. We’re going to Trauma, stat.” She pushed the stretcher, sweeping Ellen aside, then looked back over her shoulder. “And call Eli.” The Trauma Room was halfway down the hall. It was larger than the rest, so more people could fit in to stabilize the endless stream of broken bodies in this war zone. Kyle slipped in before the men and slapped the trauma room table. “Here. Let’s move him. One, two, three.” They lifted the patient from the stretcher using the draw sheet underneath him. He was light. Must be a kid, Kyle thought. She peered into the open abdomen. The wound stretched all the way across the belly. “Oh, man,” she cried as she catapulted back. An arterial pumper squirted blood into the air, hitting her directly in the right eye. Everything she learned drained from her mind. She went from flight/fight to freeze. All she could see was that fountain of red shooting up from the patient’s pulsating bowel. Where the hell was Eli? Her stomach dropped from the sheer helplessness of it all. Think, dammit. THINK! Ellen poked her head around the corner. Kyle looked up from the bowel, snapped out of her stupor, and wiped blood from her face with the arm of her white lab coat. “Where’s Eli?” “I told him to get his ass down here stat.” Ellen looked at the spurting blood, then back at Kyle and said, like it was the most obvious thing in the world: “Shouldn’t we start an IV?” “Yeah, yeah, uh, good idea.” Kyle shook her head and mentally kicked herself. Four years of working her ass off, and she couldn’t even think of an IV? What kind of a moron was she? “I’ll put in the IV,” Ellen said hard and fast, “but you’ve gotta get that bleeder, or he won’t last until Eli gets here.” The ambulance attendants backed off while Ellen tossed Kyle a large Kelly clamp, then ransacked the drawers for an IV. “Kyle?!” she barked, “C’mon, let’s go.” Kyle faced the patient, ready to save his life. Then she froze. Again. Sure, she’d been through the surgical rotation, but only as a second or third assistant. She’d read all the books. But books didn’t shoot blood at you while you tried to stop them from dying. It was her first week in the ER, for fuck’s sake. She wasn’t even a real doctor yet. Real doctors knew what they were doing. “Kyle, SNAP OUT OF IT!” Ellen shouted. “Okay, sorry…” Kyle muttered as she sprang out of her stupor. She pulled on a pair of surgical gloves and yanked the suction catheter from the wall. The long plastic tube slurped the liquid blood and dark clots from the open wound to expose a glistening bowel. There it was. The base of the bleeder. She took the Kelly clamp and went for it. Blood splattered her face again. Now it was in her left eye. What if he had AIDS? Or hepatitis? “Damn!” She missed. The blood was pooling. And the bleeder was going down again. In another second, it would disappear below the surface of a new red pond. She went for it once more, holding her right wrist to steady her hand. “Gotcha, you little bastard.” “What’s going on?” Kyle squinted to keep more blood from rolling into her eyes as she growled at Eli, finally strolling in like the cool customer he was. “Nice of you to stop by.” The second-year surgery resident leaned over to inspect the wound. “Looks to me like you’re doin’ a-okay to me, Newby.” A clot dislodged from another severed vessel. Blood spewed two feet and caught Eli in the cheek. “Okay, well, maybe you do need a little help from your friends.” He wiped his face with a green towel and snapped on a pair of tan gloves. “Kyle, gimme the suction catheter. I’ll work here. You put a second IV in his other hand. Ellen, call the OR. Tell them we’re coming up stat.” Kyle was happy to slide aside. She grabbed the patient’s right hand and smacked the back of it a half dozen times to raise a vein. It was no easy matter considering the scar tissue covering the vessels. Strange. She’d given her little brother a scar like that once. Brian had been chasing her in the house, and she slammed the bathroom door on his hand as hard as she could. The poor kid. She remembered it like it was yesterday. She’d cried for nights when she saw the skin torn back and the tears running down his little pink cheeks. She stared at the patient’s face. Except there was no face. No pink cheeks. Nothing close to normal human features. Only bloated purple lips, swollen shut eyes, and the disfigured pulp left by the vicious stomping. His facial bones had to be fractured beyond recognition. Eli clenched his teeth, his casual nonchalance gone. “Son of a bitch!” “What? What’s the matter?” Kyle asked. “Every time I grab a damn vessel, another pops up.” Even Eli, the king of chill, was sweating. Something he rarely did. “We’ve gotta get this bowel fixed, or we won’t have to worry about the rest of him.” Ellen careened around the doorway corner on one hand. “They gave us the okay. Said to bring him right up.” “Unlock this stretcher. LET’S GO!!!” Eli threw another clamp on the exposed gut. The trio wheeled the stainless-steel stretcher as fast as they could into the main corridor of the ER, then down the dim hallway, with Kyle sprinting at the side. She looked down at the abdomen. Blood was oozing everywhere. She ran ahead and punched the erratically blinking, red “UP” button. Twice. Three times. Four…Eli, Ellen, and the patient arrived in seconds. Kyle’s foot tapped on the floor, and she bit her lower lip as she stared at the patient’s hand. Was she going to lose this one, too? Her mind disassociated as she waited for the clanking elevator. She needed to stop after work to stock up on Fritos. Brian was visiting on Monday. Just out of tenth grade, this was his first solo trip by train. It was a wonder Mom let him come, especially for two days. She hated being alone since Dad died. But she’d finally relented when he expressed such a strong interest in Emory University. He so wanted to follow his big sister’s path, only on the veterinary side. “No pulse,” Ellen said as she felt the patient’s neck and looked up from the head of the stretcher with wide eyes. Eli reached for a confirming feel, then looked back toward the ER, hesitant for a moment. “We gotta get him to the OR,” he decided. “Kyle, you pump. I’ll breathe him.” Kyle jumped onto the stretcher and straddled the patient with her legs, half-standing, taking care not to put weight on the open abdomen. Knees flexed, she pushed down on his chest with both palms, counting off one-per-second thrusts that forced blood through his oxygen-starved body. One of the clamps slipped, and blood squirted, spraying the crotch of her white house officer’s pants over and over. She kept going. Unless they got this poor kid’s heart started again, he’d be a brainstem preparation in ten minutes. Eli sighed deeply and shook his head. “Not good, guys. Where’s a phone to call a code?” He glanced left, then right. “Not even a fucking phone?” Cells were useless down here. Ellen scowled and ran back to the ER, mumbling something unintelligible, though her tone needed no explanation. “I don’t think I’m pumping him well,” Kyle said between heavy breaths. “Why not?” Eli asked. “There’s no support under his back.” “God DAMNIT!” Eli dropped the breathing mask, pushed the stretcher against the wall for stabilization, and pulled a sideboard out from underneath. “Turn him so I can put this under.” Kyle stopped her thrusts and, standing on the stretcher with her back against the wall, lifted the left side of the patient’s body while Eli tried to slip the flat board underneath. The awkward position set off horrific pounding in her head, but not before she had him halfway over. “Almost. Just a little more.” The patient’s shirt slipped up. The birthmark! The brown oval over his right kidney! Kyle’s shocked mouth dropped open. Instead of pulling harder, she dropped him. The patient fell back on Eli and the board with a thud. Kyle’s head snapped back and slammed against the hard tile wall abutting the stretcher. She could hear a crack as her head bounced. The birthmark. The mark on his back—Brian’s mark. And with the hand scars? NOOOOO!!! Eli yanked his right hand out from between the board and the stretcher and shook it. “Kyle! What the hell are you doing? Why’d you let go?” The board crashed to the ground. Kyle climbed down and grabbed the side of the stretcher, her head exploding with the worst pain she’d ever felt. Eli held his hand and grimaced. “What’s wrong with you? Get moving, or he’s gonna die.” “I—I can’t. I just can’t, I’m not, I don’t… I just can’t…” “Why not?” “I-I can’t.” “Jesus Christ!” Eli uttered. Then he shouted, “HELP, STAT!!! WE NEED HELP DOWN HERE!!!” He hit a red wall alarm and climbed onto the stretcher. He pumped with his good hand while Kyle hugged the wall for support. Brian. Dear God, NOOOOO! What was he doing here four days early? He never showed up anywhere early in his entire life. Personnel poured from the stairways and into the hallway. Eli jumped off and ran down the corridor, waving at the people pushing the stretcher back to the ER. “Come on, move it, MOVE IT!” Kyle stumbled after them in a daze. The seat of her pants dripped blood that splattered down to her green and white Nikes. Normally, the wetness would’ve driven her crazy. Now she watched and felt a cold nothingness. While her head throbbed with an excruciating ache. As if it were on fire. People ran past. Someone was shouting in the distance. Bodies crowded the main ER. Their faces were blurs. She stopped outside the door to Trauma. Inside, it was alive with a flurry of activity, but the noises were far away. Kyle stood alone, the Ghost of Christmas Past, looking in on people illuminated by the powerful overhead beams. As she stood there wobbling, the noise stopped. Suddenly, the frenzied motion ceased. White coats and pants came out singly and in pairs, silent, their heads hanging low. Eli came last, biting his lower lip. Only the solitary monotone of the cardiac monitor echoed through the door. Kyle dropped back against a wall and slid to the ground, a hand pressing into each temple to try and hold in the jackhammer pounding inside her head. Her mental and physical pains faded as she passed out into a black void.

Chapter Two

Seven Years Later

Pennsylvania Hospital, Eighth Street, Philadelphia, Pennsylvania Graham Kurland, 6’ 5”, 230 pounds of sinew and muscle, strolled in the Pennsylvania Hospital parking lot like the former Purple Heart winner he was, a world-class warrior who’d traded his weapons for a scalpel and become a rising star surgeon of the medical world, as well as a renowned transplant researcher. If you looked closely, you could see his assurance and graceful gait almost concealed the limp he’d had after a grenade’s shrapnel shredded his leg. He was greeted by the occasional nurse who flirted, or a doctor who was in awe and/or jealous of the famous Dr. Kurland. But no matter how much attention he got—professional or personal—none of it ever went to his head. He either didn’t know or care how brilliant and easy on the eyes he was. He was excited about the surgery he was scheduled to perform. A double renal artery in a recipient kidney. Much more difficult to implant than a single renal artery. So his XXL brain was working out each detail, making contingencies for everything that could go wrong. The donor kidney had two arteries supplying it, rather than the typical one. This anomaly made it more difficult to connect the donor kidney into the kidney recipient. Couldn’t be done without a great team. They were very good. But were they great? He thought so. This was his last year of internal medicine residency. He had already finished his surgical residency and would be one of the select few in the country with Boards in Surgery and Medicine. He couldn’t have done it without his photographic memory. And his years as a kill-or-be-killed warrior. And a CEO who turned his dead father’s business into a cash cow. While raising his teenage brother. BAM! A car backfired loudly, like a shot being fired just outside the hospital. Suddenly, Graham was in the middle of a raging battle in the desert outside Kandahar, missiles and bullets flying. Eddie Severs, his ride-or-die best friend, was by his side. Eddie took one step towards him, and the whole world exploded as he stepped on an IED. Graham was thrown back, even as he saw Eddie blow up, blood and flesh flying as he screamed in agony and horror. Graham felt a hand on his shoulder, and he whipped around, fists clenched, fire in his eyes, face full of rage, in full fight mode. He snapped back to reality when he saw he was face-to-face with Nurse Beth Kelly, a fifty-something veteran of twenty-five years at Penn, the sweetest, kindest soul here. She was looking horrified at Graham’s hard, furious face, his body spring-loaded and ready to kill. The look of terror on Nurse Kelly’s face jolted Graham back to sanity. He saw what he was doing and was overcome with shame and embarrassment. He forced his face into a disarming, charming grin. “Sorry, Beth, oh my God, you scared the bejesus outta me. My apologies, I get a little wonky sometimes. I didn’t mean to scare you. I’m really sorry.” Beth’s face changed from scared to neutral to thoughtful to understanding to kind. She nodded and smiled her sweet smile. “PTSD,” she said with an understanding nod. “My husband served in Desert Storm. Gee willikers, I know trauma’s a killer. I hope to heck you’re getting help.” “Oh yeah, I went through the program, I just get a little sketchy when I hear, uh…” “Loud noises? Like a gunshot. Or a car backfiring?” she gave him a wry little smile. “I get it.” “Thanks, Beth, I really appreciate that. Maybe we could keep this, uh, you know…” She made a funny little locking-her-lips-with-a-key gesture and did a slightly silly mock whisper. “What happens at Penn stays at Penn.” Graham laughed. Beth laughed. “Shall we?” Beth nodded and gestured towards the hospital. “Yes, we shall,” Graham said with his trademark aw-shucks animal magnetism as they walked through the parking lot and into the rest of their lives. *** Excerpt from Invisible Justice by Gary Brown, M.D. Copyright 2026 by Gary Brown, M.D. Reproduced with permission from Gary Brown, M.D. All rights reserved.