Chapter 5 - The Reduction
The small trauma room on the third floor of the hospital was too bright, too cold, and smelled entirely of iodine. They had used trauma shears to cut the dusty-blue dress off my torso, the stainless-steel blades slicing through the delicate chiffon and the water-bloated neoprene brace with the dry, rhythmic crunch of someone cutting thick paper.
I was lying on an adjustable gurney, wearing an open-backed hospital gown, while a young resident named Henderson examined the x-rays on the wall-mounted screen.
"The good news," Henderson said, his finger tapping the bright white ghost of my humerus on the lightbox, "is that the bone didn't fracture through the surgical neck. The bad news, Ms. Cole, is that the head has slipped completely over the anterior lip. See that notch? That’s where the bone hit the glenoid rim when you landed on the water. It’s wedged."
"How much sedation?" Ryan asked from the corner of the room. He had refused to leave the room despite three different nurses telling him the waiting area had television and free decaf. He had washed his hand at the sink, slapped a butterfly bandage over the cut, and was now leaning against the lead-lined door with his arms folded across his chest.
"We can do conscious sedation with fentanyl and Versed," Henderson said, looking between us. "Or we can try a gentle traction-countertraction reduction right now with a local lidocaine block into the joint space. The block takes five minutes to set, but you don't have the four-hour recovery from the systemic drugs."
"Do the block," I said, my voice shaking so hard the paper sheet over my thighs rustled. "I want to be awake. I have to... I have to be able to talk when my father’s lawyers call."
"They're not calling your phone, Marissa," Ryan said quietly. "I turned it off three miles outside of Gordonsville. It’s in the glove box."
"Ryan—"
"Your father called thirteen times between the estate gate and the county line," he said, not moving from the door. "Elaine called eight times. Brooke Ellison sent a text that I won't repeat in front of a physician because it contains several words that would violate the hospital’s code of conduct. You don't have to talk to anyone until your shoulder is back in its socket."
Dr. Henderson looked at Ryan’s morning coat, then at my cut-up bridesmaid dress lying in a blue plastic biohazard bin in the corner.
"He your brother?" the doctor asked.
"No," I said.
"He your fiancé?"
"No," Ryan answered before I could find the breath. "I’m the guy who was supposed to marry the woman who put her in this gurney."
Henderson paused with an eight-inch spinal needle half-drawn from its sterile paper sleeve. He stared at Ryan for three seconds, his face completely flat, then let out a slow, appreciative whistle through his front teeth.
"Right," Henderson said, turning back to the tray. "Well. Let's make sure we get this shoulder back in before that family finds out where Charlottesville is."
The lidocaine injection felt like boiling water being forced into an already burning pipe. I bit down on the rolled-up washcloth the nurse had wedged between my back teeth, my eyes watering until the fluorescent ceiling tiles smeared into an abstract painting of white and silver.
Then Henderson took my right forearm.
"Okay, Marissa," he said, his voice dropping into that calm, rhythmic cadence that emergency doctors use right before they do something violent. "I’m going to apply steady, external rotation. You’re going to feel a pop. It’s not bone breaking; it’s just the capsule releasing the vacuum. Ryan, take her left hand. Keep her hips flat against the vinyl."
Ryan stepped to the side of the bed. His hand was large, dry, and warm, completely enclosing my left fingers. He didn't squeeze hard; he just anchored me. He was the only thing in the room that wasn't sliding, wasn't humming, wasn't threatening to break under tension.
"Look at the clock, Marissa," Ryan said.
I looked at the circular plastic clock above the door. It was 4:48 PM.
"The ceremony was supposed to start at four-thirty," he murmured, his thumb moving slowly over the back of my knuckles. "Right now, the minister is probably eating the little cucumber sandwiches behind the organ. Dennis is probably trying to figure out if he can get his deposit back on the ice sculpture. And your mother is explaining to forty cousins from Atlanta that the wedding has been postponed due to 'an unforeseen municipal water emergency.'"
"A water... emergency?" I managed through the cloth in my mouth.
"That's what she'll call it," Ryan said softly. "Elaine will never admit her daughter got dumped over a fistful of chlorine. She’ll tell everyone the pipes broke at the venue."
Henderson pulled.
The universe shrank to a point of white-hot needles behind my temples. My spine arched off the mattress, my ribs screaming for air that wouldn't come, and then, deep inside the meat of my right shoulder, came a sound like an old leather boot being pulled out of wet clay:
THUNK.
The relief was so sudden, so violent, that my entire body went completely limp. The nerve pain didn't vanish—it was still a dull, throbbing ache like a bruised tooth—but the agonizing, breathless pressure behind my collarbone was gone.
My head dropped back onto the thin pillow. The washcloth fell from my lips onto the paper sheet.
"Good girl," Henderson muttered, wiping his brow with his forearm as he checked the symmetry of my shoulders. "Good girl. Look at that. The deltoid has its contour back. The pulse is strong at the wrist."
He turned to the nurse. "Get the immobilizer on her. The heavy canvas one with the swathe around the waist. Four weeks minimum, Ms. Cole. No reaching, no driving, no lifting anything heavier than a butter knife. I’ll write the script for the Percocet, but you need an orthopedic follow-up on Tuesday to schedule the MRI."
When the doctor and the nurse left the room to process the discharge paperwork, the silence of the hospital closed in around us again.
The small monitor beside the bed was beeping—a slow, steady fifty-eight beats per minute.
I lay there in the oversized canvas sling, my right arm strapped across my abdomen like an infant in a papoose, staring at the ceiling.
"You really aren't going back, are you?" I whispered.
Ryan was sitting in the vinyl chair beside the bed now, his elbows on his knees, his morning coat discarded over the back of the trash can. He had unbuttoned his collar, the silver collar stud sitting on the stainless-steel tray beside my broken earrings.
"There's nothing to go back to, Marissa," he said. He looked at his bandaged hand, turning it over once to look at the blue cotton fibers sticking to the adhesive. "A woman who can look at her own sister—a sister who has spent seven weeks trying to avoid surgery—and push her into five feet of water just to clear a camera angle... that's not someone you build a life with. That's someone who leaves you when the first roof leak starts."
"She’s going to destroy you," I said. "You don't understand how my father works. He’ll call the state licensing board. He’ll find an inspector in Henrico County who will hold up your water permits for eighteen months."
Ryan looked up.
For the first time since he had dragged me out of the decorative basin at Willow Creek, the corner of his mouth twitched into something resembling a real smile—cold, certain, and entirely unbothered.
"Your father’s jurisdiction ended at the county line, Marissa," he said. "And my family has been building dams in this state since 1882. If Richard Cole wants to play games with water permits, he’s going to find out very quickly that the river flows downhill, and I’m the one who controls the gate."
He reached into his pocket and pulled out my smartphone.
The screen was black, the battery drained, but the glass was intact.
"You need a place to sleep tonight," he said. "You can't go back to your apartment on Franklin Street. Elaine has a key, and she’ll be sitting on your sofa with two bottles of gin and a guilt speech by eight o'clock."
"I have eighty dollars in my checking account until Friday," I said, my voice barely audible over the hum of the air ducts. "And my purse is currently sitting on a stone bench beside the pool at Willow Creek."
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Ryan stood up, walked to the bed, and slid his hand under my left elbow to help me sit upright.
"You have a guest bedroom in Midlothian," he said. "It has three locks on the front door, four dogs that don't like visitors from Elm Street, and a refrigerator full of groceries that were paid for by an engineer who doesn't give a damn about the Virginia social register."
