“How’s the pressure doing now?” she asked.
“Much better,” Bridgett told her. “One hundred over fifty, and his pulse is down to a hundred and five. His color’s getting better, but he’s not waking up yet.”
“He may not go dancing tonight, then. Please call for another chest x-ray to check the tube and make sure the lung’s re-expanding. And let’s get him over to CT. We’ll do his head and neck, and his chest, belly and pelvis while we’re at it. And call for a bed in surgical intensive care.”
She turned again to the stunned intern.
“Come with me,” she said, crooking her finger. “We need to talk.”
They ran into Humphrey Atwood at the door of the trauma suite.
“Hello, there, Sarah,” he chirped. “What brings you down here?”
XVII
Things Awry
Lights were burning in Wilmer and Joyce Carter’s living room window when Jack drove by at a quarter to eleven. He tooted the horn three times, letting them know he’d be at the hospital all night. The Carters were in their early eighties, both still active around the farm, and Wilmer had been a friend of Jack’s grandfather. He reminded them often to call if they needed help for any reason. In the rearview mirror, he saw the porch light flicker in acknowledgement.
Ten minutes later, he pulled into a parking spot near the ED and saw that something beyond the ordinary was transpiring. The Channel 11 TV van sat near the portico, and vapor rose from the exhausts of three police cars idling at the curb. Police cruisers in front of the ED were not all that unusual, but the news van certainly was, at least at this hour.
He strode inside and found a half-dozen people milling near the entrance. One of them was Suzie Baker, an anchorwoman who often came to interview him for stories.
She intercepted him, her cameraman jogging to catch up.
“Dr. Forester, can you give me a minute?”
“Sorry, I just got here,” he said. “I don’t know any more than you do.”
Curiosity skyrocketing, he cut through registration directly into the clinical area and saw Bryson Witner and Nelson Debussy standing by the charting station. He stopped. Witner was dressed in a baseball cap and navy blue overcoat, and Debussy in a maroon New Canterbury University sweater and duck boots. Witner saw him, alerted Debussy, then motioned Jack over.
“Dr. Forester,” he said. “I take it you are not aware of what happened?”
“No. What’s going on?”
“They’re waiting for us in your office. Come.”
“Who’s waiting? Would you mind telling me what’s happened.”
Neither Debussy nor Witner answered.
He entered his office and was astonished to discover Humphrey Atwood and the Chairman of Surgery, Jacob Hanson. Dr. Hansen was in jeans and Docksiders, obviously roused from home. Hansen nodded a greeting, his expression grim. Atwood’s skin was an alarming yellow-gray, and his attention was fixed on the wall near the Everest poster, as if he were contemplating an ascent.
Debussy spoke first.
“Alright, Dr. Hansen, you know the details better than anyone. Would you bring us up to speed? Especially Dr. Forester here.”
The gray-haired senior surgeon began.
“A little after six this evening, Jim Gavin had an accident and suffered serious injuries.”
Jack felt the blood drain from his face.
“He’s alive,” Hansen continued, “but he’s in a coma.”
Jack looked around in disbelief, unable to speak for a moment, grief mounting in his chest.
“What kind of accident?”
“There were no witnesses,” said Hansen, “so we don’t know, exactly. A passing driver found him on the median strip below the footbridge over Beech Avenue.”
The grief mingled with horror.
“You mean it was a hit-and-run?”
Hansen looked over at Debussy. The university president drew a deep breath.
“Jim and I met in my office just before this happened. He was going back to the hospital, and he would have taken the footbridge.”
“But how could he fall off the footbridge?” Jack said. “The railing’s chest-high.”
“We have reason to believe he tried to take his own life, Dr. Forester,” Debussy said, looking at the floor.
“What reason?” Jack cried. “I don’t believe it.”
“Nevertheless, it’s very possible, and the only reason he didn’t succeed is because he landed in shrubbery on the median and not on the pavement. That’s a two-story drop.”
Despite his shock, Jack thought of the letter Gavin had mentioned, and Gavin’s words echoed in his head.
“I still don’t believe it,” he insisted. “You’re wrong.”
Witner cleared his throat pointedly.
“Regardless of your opinion,” Debussy continued, his voice rising in anger, “what happened to him outside is only one issue. We need to talk about what happened after he got to this emergency room.”
Jack didn’t like the sound of this at all.
“What do you mean?”
“Keep going, Jacob,” said Debussy, his voice still simmering.
“Jack, I find the idea of Jim Gavin trying to commit suicide hard to swallow myself,” said the surgeon. “But, in any case, when he got to the ED, he was coming around. Steve Brasio, one of my interns, was working on him. Unfortunately, being just an intern, he failed to appreciate the presence of a developing tension pneumothorax, and Jim went into cardiac arrest.”
“Explain what that is again, for my sake,” said Debussy.
“When Jim fell, he suffered, along with a concussion and a scalp laceration, three broken ribs. One of the broken ribs punctured his lung, which caused air to escape and build up pressure inside his chest cavity to the point his heart couldn’t pump blood. The condition is easily reversed by relieving the pressure with a needle. Sarah Hopper, the chief resident, immediately did the right thing, and Jim’s blood pressure normalized. If someone had done it five minutes sooner, Jim would probably be talking to us right now.”
Jack felt as if his own chest had just been punched.
“Humphrey,” he said, after a few seconds, trying hard to contain his voice, “you were the attending on duty. What happened?”
“Dr. Atwood had left the department,” said Hansen. “He couldn’t hear his page.”
“Mother of Christ,” Jack hissed.
“Which brings us to the issue concerning you, Dr. Forester,” said Debussy. “I understand you had been charged by Dr. Witner with installing a special paging system for Dr. Atwood. Would you mind telling us what happened to that?”
Jack looked around, his face prickling.
“I’m waiting for an answer, Dr. Forester,” said Debussy.
“It was against departmental policy.”
“What the hell is that supposed to mean? How does your policy trump what the dean tells you to do? What kind of place is this? Unsupervised interns running around killing people? Jesus H. Christ.” Debussy turned to Witner. “Bryson, would you untangle this for me?”
“I do not like pointing fingers of blame,” Witner replied calmly, “but Dr. Atwood told me some time ago there are too many internal dead spots for his standard pager, and we all know the overhead speaker system can’t be heard everywhere. So, in light of the fact Dr. Atwood’s administrative duties sometimes necessitated his leaving the ER, I authorized Dr. Forester to install a special paging system for Dr. Atwood. I sent a memo authorizing it and gave him an account number to utilize.
“Unfortunately, this evening I learned that no steps had been taken in this direction and, in fact, that Dr. Forester had decided of his own volition to leave it undone.”
“Is this true, Forester?” said Debussy.
“Mr. Debussy, when I took the job as director, long before Dr. Witner became the interim dean, I set a policy mandating the on-duty emergency medicine attending stay in the ED with the trainees, whether it was busy or not. Nobod
y else has problems with it. The overhead speaker is sufficient when the attending remains in the ED.”
“So, you disagreed with Dr. Witner’s decision?”
“Very definitely. The attending needs to be in the ED supervising.”
“Did you personally discuss this disagreement with Dr. Witner?”
Jack paused, his mouth dry.
“No, sir, I did not. It is part of my job description to set policies like this, and I saw no reason for making an exception.”
“You saw no reason to follow a directive from the interim dean of the medical center, and you saw no reason for discussing it with him—is that what you’re saying?”
Jack swallowed.
“That’s correct.”
Debussy now turned on Atwood, pointing at him.
“Dr. Atwood,” he growled. “Yes, you. Despite the fact you knew you might be unreachable given the lack of this new paging system, you decided to leave the department anyway?”
Atwood’s mouth opened, and his eyes darted to Witner.
“Tell him where were you, Humphrey,” Witner advised him.
“I wear many hats, Mr. Debussy,” Atwood said, then paused.
“One of them being to supervise the interns, I assume?” Debussy persisted. “Where, exactly, were you?”
“I was working on a study in a room no more than a hundred feet from the ED,” Atwood said.
“Calm down and answer accurately, Humphrey,” Witner ordered. “You told the unit secretary where you’d be, didn’t you?”
Atwood looked at him and swallowed. He nodded.
“Yes, sir. I told the unit secretary where I’d be.”
“That’s a load of crap,” Jack blurted.
Debussy glared at him.
“Keep a civil tongue in your mouth, Dr. Forester, damnit,” he spat.
“The nurses could easily have located me,” Atwood continued, his words coming out in a rush now. “Easily! But I don’t think they really tried. Mr. Debussy, you can ask anybody about the negativity of the nurses here.”
“Negativity!” Jack shouted. “How would you know? You never talk to them except to give commands.”
“This ER has nothing but problems,” Atwood pronounced. “It’s a hellhole, and I’ve been unable to improve things.”
“Shut up, both of you,” Debussy cried. “I’ve heard enough. You stand here blaming each other while the great man who gave his soul to make this hospital what it is lies mortally injured upstairs—and I think both of you are at fault.”
“I agree,” said Hansen. “I feel sorry for my intern, too. He deserves no blame for this.”
Debussy rubbed his face and shook his head.
“We have failed Jim Gavin at his time of greatest need. What are we going to tell those news people out there? What are we going to tell the rest of the world? Bryson, for God’s sake, give me some reasonable thoughts.”
Face grave, but calm, Witner nodded.
“The issue of responsibility will be easier to settle in the cool light of day,” he said. “I agree with Jacob that his intern should not bear any blame.”
“Give us your honest prognosis, Dr. Hansen,” said Debussy. “What are the chances he’ll come out of this?”
“There’s no way to tell at this point. It’s a matter of how long his brain was deprived of oxygen during the resuscitation. He could make a complete recovery, or he could stay in a vegetative state. We’ll have a better idea in a day or two. It is to be hoped he’ll wake up and be able to tell us exactly what occurred.”
“Yes,” Witner concurred. “That is what we’ll pray for. And when he recovers from the physical trauma, we’ll make sure he gets the help he needs from a psychiatric standpoint.”
“I talked to him yesterday, and I know you’re way off-base,” Jack protested, staring at him. “Dr. Gavin did not try to commit suicide. He was in the process of checking out something that was going to change things around here. People with suicidal intent don’t talk like that.”
“What makes you an authority on the subject, Dr. Forester?” Debussy wanted to know. “Maybe this was what he was talking about. I’m personally grief-stricken about this,” he added, looking at Witner. “His behavior was strange, and I never should have let him leave my office.”
“Nelson, don’t second-guess yourself,” Witner assured him. “As you know, he was acting disturbed when I met with him, too, so I’d be equally responsible. The fact is that you and I were talking on the phone and coming to the same conclusion about the time he did it.”
“No,” Jack insisted. “I can’t believe you’re jumping to this crazy idea.”
Debussy glanced at him with unmistakable dislike.
“You, Dr. Forester, can believe whatever you want,” he said. “In the meantime, we need to speak with a single voice to the media. We keep comments about what happened out there—and what happened in here—to an absolute minimum. Dr. Gavin suffered a complication following a fall. Nothing more. Both the complication and the fall are under investigation.”
Jack looked at the wall clock.
“If there’s nothing more for me to say, I need to get to work,” he said gruffly.
“You’ll stay until we’re finished,” Debussy commanded. He reached over and put a hand on Witner’s shoulder. “Bryson, you and I will go and make a statement along those lines to the press. Has anyone contacted Jim’s family yet? Did he have any relatives in the area?”
“No,” said Hansen. “Jim had some distant cousins in Canada, but his closest kin would be Daphne, his son Colin’s wife, and I believe she’s living in California now.”
“Yes. I remember hearing about her. Wasn’t there a scandal of some sort?”
“She supposedly had an affair while Colin was dying of ALS,” Hansen explained.
“Colin Gavin had Lou Gerhig’s disease?” Debussy asked.
“That’s correct,” said Witner. “It was four years ago, Nelson, long before you arrived.”
“Good Lord, was it true?”
“To the best of my knowledge, it was all circumstantial,” Hansen said. “But the rumors took on a life of their own. You know how it goes. Jim felt it was true.”
“I really need to get out there to see patients,” Jack said.
“Believe it or not, Dr. Forester,” Debussy said, “life will go on without you.”
“Jacob’s right.” Witner was still focused on the alleged scandal. “It was all circumstantial. Colin was a brilliant surgeon, but he lacked his father’s conservative morals, and his wife Daphne was a little unstable and flamboyant. Jim never liked her.”
“We’ll still have to get in touch with her, of course,” Debussy insisted.
“Leave that to me,” Witner said. “It should be easy to track her down. I’ll personally make sure she’s informed, and I will also contact any other relatives we can locate. She can probably help with that.”
“Thank you, Bryson. I can’t thank you enough.” Debussy then spun to confront Jack. “What time are you done working in the morning?”
“Seven-thirty.”
“Please come straight to my office. And, Dr. Atwood, you are not off the hook. Not by any stretch.”
* * *
After the others left, Jack closed the door and sat on the edge of his desk. A few minutes later, the door swung slowly open.
“Can I come in?” Darcy asked.
Jack looked up, still numb, and nodded.
“I saw the muckety-mucks leave. Does this mean you can fire Humphrey Atwood now? We couldn’t find him, Jack. He came prancing in after it was all over.”
“How busy is it out there now?”
“We’re backed up about twenty patients, and they’re getting hostile.”
“I’d like to go up and see Dr. Gavin.”
“Maybe you could wait until there’s a lull?”
Jack rubbed his eyes and sighed to the bottom of his chest. His first duty was to the patients in the department now.
“You’re right. I’ll go up later.”
“Hey, I bet he’ll do fine, Jack. They give great care up there. You should have seen Sarah in action.”
Jack looked up at her, a thought crossing his mind.
“Darcy, do you know if anyone took away Dr. Gavin’s garments yet?”
“I’m pretty sure. Why?”
“He was carrying a letter with him yesterday. I remember him reaching into his pocket and touching it.”
“Something important?”
“I don’t know, but I wouldn’t want it to get mislaid. It meant a lot to him.”
* * *
After speaking with the press, Witner and Debussy left the ED.
“I’m parked by the old entrance,” Debussy said.
“I’ll walk you there, Nelson. I’m parked beyond it in the west ramp.”
“As long as it’s not out of your way.”
“No, no, no,” Witner insisted.
“Lord, what a way to end a day that started out so beautifully.”
“Nelson, as tragic as this is, I don’t see it holding us back. I’m sure the excellent publicity we enjoyed today will help outweigh this situation, and in a month or so, it will be a distant memory. We’ll move beyond this, I’m sure. We just need to keep encouraging people to focus on our bright future.”
“It’ll be an uphill battle for a few days.”
“As they say, the wheel of fortune keeps turning,” Witner said. “We’ll survive.”
“Bryson, I’ve never seen a man take things in stride the way you do. You’re a born leader. I want you to get that ER straightened out. Do whatever the hell it takes. Both of them need to be out of there.”
“Understood.”
“Tomorrow morning, I’m going to order that footbridge be fully enclosed.”
“Excellent. Visible evidence of our commitment to safety.”
When they reached the old lobby, Debussy stopped and looked intently at the interim dean.
“You’re convinced it was a suicide attempt, Bryson? I need to hear you say that.”
“As painful as the idea is, yes.”
“You don’t think he might have run into some lunatic out there?”
Final Mercy Page 14
