Chapter 4 - The Pressure Transducer
Trauma Two had cleared out by two in the afternoon, leaving behind the specific, cold wreckage of an emergency neurosurgical intervention: empty saline flushes on the counter, wrappers from three-way stopcocks littering the floor, and the faint, sweet smell of Sevoflurane lingering in the HVAC vents.
I sat on a round vinyl stool in Pediatric Intensive Care Room Four.
The room was dark, save for the bank of monitors hovering above the head of the bed like a shelf of glowing blue clocks. Lily was small in the center of the adult-sized mattress. Her head was wrapped in a thick, white turban of Kerlix gauze, secured with yellow surgical tape that ran under her chin. A clear plastic tube, no wider than a pencil, emerged from beneath the dressing behind her left ear, snaking down to an external ventricular drain leveled precisely with the tragus of her ear on an IV pole.
Every four seconds, a drop of pale, pinkish-orange fluid dripped into the graduated cylinder.
Intracranial pressure: nine.
Nine was good. Nine was low. But the bolt in her skull had been placed through a burr hole because her cerebellum had swollen so fast that Dr. Al-Mansoor had to remove a four-centimeter window of bone from the base of her skull before the scan was even dry.
“The dura was blue when we opened,” Al-Mansoor had told me forty minutes ago in the scrub room, her fingers still stained with yellow Betadine. “There was a subdural hematoma about thirty cubic centimeters in volume. In a five-year-old, thirty ccs is the difference between a headache and an arrest. She had an irregular occipital fracture that crossed the lambdoid suture. That doesn't happen from a child tipping over in a carpeted living room, Claire. That takes mass, velocity, and a hard stop against an unyielding edge.”
I reached out, my fingers trembling slightly as they touched Lily’s right hand.
Her skin was cool from the cooling blanket they had laid across her shins to keep her core temperature at thirty-six degrees. On her middle finger, a small plastic pulse oximeter glowed with a dull, ruby light, pulsing in time with the mechanical click-hiss of the Hamilton ventilator at the foot of the bed.
The glass door of the PICU room slid back with a soft, pneumatic whistle.
Detective Marcus Ray didn't look like he belonged in a pediatric ward. He was six-foot-two, wore an off-the-rack brown suit that smelled faintly of dry cleaning and cheap cigars, and carried a manila folder that had been creased down the center from being shoved into an evidence box.
He didn't speak until the door had fully sealed behind him.
“Claire?”
“Yes,” I said. I didn't take my eyes off the drain.
“I’m Ray. Savannah PD, Special Victims. I’ve been over at the chapel for the last two hours.”
He pulled up the second stool—the gray one near the wall—and sat down with a groan of leather. He laid the folder across his knees.
“How is she?” he asked.
“She’s at nine,” I said. “If the drain clogs, she goes to twenty. If she goes to twenty, they take out more bone.”
Ray nodded once, his chin dropping against his collar. He opened the folder. Inside were twelve eight-by-ten color prints on glossy paper—not the proofs Henderson would have sent to a wedding client, but the raw, unedited frame grabs from the digital raw stream, complete with the timestamp in milliseconds in the lower right margin.
“The photographer gave us the master card,” Ray said. “He signed a chain-of-custody affidavit in the chapel parking lot. He didn't even ask for a lawyer. Said he wanted it on record before someone offered him twenty grand to drop the camera in the Savannah River.”
He laid the third frame on the edge of the mattress, near Lily’s wrapped foot.
The image was sharp enough to count the individual pearls on Vanessa’s sleeve.
Her right hand was not flat against the backrest. Her fingers were curved around the black rubber grip of the push handle. The knuckles were white, the skin stretched tight over the joints. Her shoulder was dropped four inches lower than her left—the unmistakable kinematic signature of a person putting forty pounds of downward and backward torque into an iron lever.
Beneath her hand, Lily’s left shoulder was already lifting off the seat cushion. The child’s face was turned toward the lens, her mouth half-open in an expression that wasn't anger or tears, but total, uncomprehending confusion.
The paper angel was four inches from the camera glass, the yellow construction paper catching the light from the altar candles like a small, flat star.
“Look at the floor,” Ray said, his finger tapping the bottom edge of the print.
I looked.
My mother’s beige pumps were three inches behind my heels. Her left hand was already closed around the crook of my elbow; her right was reached forward, her thumb hooked into the collar of my navy jacket.
“Your mother claims she was reaching to catch the chair,” Ray said, his voice completely flat.
“My mother was holding me so Vanessa could take the shot,” I said. The words didn't have any heat left in them; they were just cold iron. “She’s done it since we were six years old. Every pageant, every recital, every time Vanessa was on the riser. I was supposed to stand by the curtain and keep quiet so the pictures looked clean.”
Ray flipped to the next print.
This one was shot from eighteen inches lower, Henderson’s camera dropping as the chair cleared the frame. It showed the steel footplate of Lily’s chair catching the walnut trim of the pew. The wood had not dented; it had sheared. A four-inch spear of dark walnut had penetrated the nylon mesh of Lily’s seat sling, three inches below where her small spine had been held by the lateral supports.
“We have the sister in interview room three down at Habersham Street,” Ray said. “She brought an attorney from Oliver & Maner. He’s already talking about an unfortunate domestic mishap involving an assistive medical device with defective anti-tip bars.”
I looked up from the print. “Defective?”
Ray reached into his pocket and pulled out an evidence bag containing two small, curved pieces of black steel. They were the anti-tip tubes from the back of Lily’s Tilite chair—the small, wheeled outriggers designed to prevent a pediatric chair from flipping backward if the user hits a curb or leans too far over the backrest.
Both pins were missing. The steel was bright and clean where the tubes had slid out of the receivers.
“These were found in the glove box of your mother’s Lincoln,” Ray said.
The room went so cold I could feel the draft from the oxygen flow meter on my eyelashes.
May you like
“My mother’s car?”
“Your mother’s Lincoln,” Ray repeated. “The sexton says he saw an older lady in a beige coat out by the chapel sheds around nine-thirty this morning, before the service started. She was using a pair of needle-nose pliers from the lawnmower kit. He thought she was fixing a brooch.”
