Carlucci's Heart

by Richard Paul Russo

  Vashti nodded, then turned and walked slowly out of the clinic.

  Madelaine sighed. “Third probable cholera case today,” she told Cage. “We’ll know for sure later this afternoon, but I wouldn’t bet against it. We may be in for another epidemic this summer.”

  “Christ,” Cage said. “Sometimes I think we’re living in a goddamn Third World country.”

  Madelaine smiled. “Face it, Ry, most of the U.S. is a Third World country these days.” She shook her head. “Come on, get out of here. Paul’s coming by to help for a few hours, we’ll be falling over each other.”

  “When’s he coming in?”

  “About an hour.”

  “Maybe I’ll just stay until he gets here, help you get through these people.” Franzee was leading the old man into the examination room from which Vashti had just emerged.

  “Ry, we don’t need you. It’s a beautiful day, go somewhere and relax. Get the hell out of the Tenderloin, go have a good time.”

  Cage smiled and nodded, giving in. “Yeah, I guess I will. All right, I’ll…” He stopped, seeing Madelaine’s eyes widen and her face tense.

  “What the hell…?” Her voice trailed off.

  Cage turned around. Just inside the clinic doors was a man who could barely stand. He was Hispanic, Cage guessed, but it was hard to know for sure with all the large, bright red patches blazing across his skin. The man groaned, staggered a few steps, his movements palsied and unsure, eyes blinking frantically.

  Before Cage could moved toward him, the man dropped to his knees, then lunged forward and vomited blood across the waiting-room floor. Someone screamed and people scattered, trying to get as far from the man as possible. Cage couldn’t tell if any of them had been splashed. Then the man vomited again, pitched forward, and collapsed in his own blood.

  Cage ran behind the counter, where Madelaine was already pulling out gloves, masks, and oversuits. They both suited up, pulled on gloves and masks and booties they were going to have to walk through the blood just to get to the man.

  “Franzee!” Madelaine shouted. “Get the KillSpray! Now!”

  Cage and Madelaine hurried to the man and knelt beside him. They turned him over and checked his air passage; it seemed to be clear, and the man was breathing almost normally. They rolled him onto his side so he wouldn’t choke to death if he vomited again, and Madelaine checked his eyes while Cage checked the pulse. The man’s heartbeat was strong, but fast, maybe a little irregular; nothing too serious yet. He glanced up at the man’s face as Madelaine was shining a penlight into the man’s left eye. The eye was severely injected, the vessels gorged and broken. Like Stinger?

  “He needs to be in a freaking hospital,” Madelaine said. She was just talking. They both knew no hospital would take him now; most would have dragged him out onto the street even if he’d collapsed inside their emergency rooms. No hospital would take him in, and no ambulance would pick him up unless he had a wad of cash or a nice fat insurance chip on him, and Cage was pretty damn sure the man didn’t have either; that meant “no” for any of the private clinics. Only the organ scavengers would be willing to take him.

  “The iso rooms?” Cage asked.

  “Both empty. Let’s go.”

  They picked the man up between them, Cage under the man’s arms, Madelaine under the knees. The man was out. Franzee had suited up and started spraying down the bloody floor with the KillSpray, filling the room with the smell of bleach and sour lemon. Buck was suited up right behind her, dragging in the cleaners. Half of the people who had been waiting were gone; those who remained huddled in one comer of the room, watching with fear or exhausted complacence.

  Cage and Madelaine carried the man through the waiting room, along the right corridor, and into the first isolation room. They laid him out on the bed and pulled his shirt off. Cage slapped vitals strips across the man’s chest and arm and connected them to the wall-mounted monitors, which would give them heart rate, O2 and CO2 levels, and a running blood pressure. He grabbed a b.p. cuff to get the man’s pressure; Madelaine started on a temp and went to work with a stethoscope on the man’s chest.

  “One-oh-five over fifty-five,” Cage said. “No problem there.”

  Madelaine frowned. “Pulse is okay, but his temp’s a hundred and six. Shit.” Then she squeezed the tip of his finger, and they watched. Cap fill time was almost five seconds. Frown deepening, she said, “Let’s get him on oxygen. His blood volume’s crap right now.”

  Cage reached around the bed rail and pulled out a non-rebreather mask, stretched the line, then worked the mask over the man’s face and turned on the oxygen.

  They stood back a moment and looked at the man. His skin was almost completely covered with red rashes, the kind that were bleeding into the skin, and was peeling off around the nails. Almost all the lymph nodes were noticeably swollen, even those by his elbows.

  “I want to get some blood work done on him immediately,” Madelaine said. “I know, we can’t do shit here, but we have Patricia do what she can. CBC and diff, general tox screen, whatever. And I want to get a drip going, normal saline, and run some Chill and mycosatrine into it. And get some hemo going into him. Who knows how much blood he’s lost.” She looked at Cage. “What do you think?”

  He nodded. “Sounds good. The mycosatrine can’t hurt, but I wouldn’t count on it helping any.”

  Madelaine nodded. “But it could be bacterial.”

  Cage shrugged. “It’s something infectious. Something nasty.” He shook his head. “Maybe viral.”

  “What? Some hemorrhagic fever?”

  “Christ, I hope not. But I’ve heard about another similar case right here in the Tenderloin, a lot of the same symptoms. I don’t know.” He kept seeing Stinger’s injected eyes, kept thinking about Tiger’s story and his description of Stinger, the red patches all over his skin, vomiting blood. Stinger’s symptoms seemed awfully close to those of the man lying on the bed in front of him, and they were only half a block from the Core. And Cage could not get Nikki out of his mind. A bad cold or flu, he told himself again.

  “Okay, let’s see if he’s chipped.” Madelaine pulled the scanner from the portable diagnostics, got on-line, then pressed the scanner to the man’s shoulder and shifted it around. The scanner beeped, and Madelaine said, “I’ll be damned.” She turned to the monitor as the info came up on the screen. “Tito Moraleja,” she read. “Mexican national, expired residency permit. Great. He’s got AIDS. No known medical allergies.”

  Cage shook his head and waved at the rashed and fevered body in front of him. “It isn’t the AIDS that’s doing this to him.”

  “No,” Madelaine said. “But it’s not going to help him fight this, whatever the hell it is.”

  Cage stared down at the man, then looked up at Madelaine. “He’s going to die.”

  Madelaine nodded without looking at him. “Okay, Ry. Let’s draw some blood, get the drip going, the hemo. But don’t use too much of anything that might be crucial to someone else.” She sighed heavily. “Then let’s get cleaned up and out of here. I’ve got other people to take care of.”

  An hour later, the clinic was almost back to normal. Paul Cardenas, the third regular clinic doctor, had arrived, and Patricia, the med tech, was in the tiny makeshift lab in back, running Tito Moraleja’s blood work. The waiting room still smelled of bleach, but it was clean. Madelaine had tried to get Cage to leave, but he wanted to stick around and see if anything turned up with Tito’s blood.

  He was sitting in one of the waiting-room chairs, drinking coffee and listening to a middle-aged woman mumble incoherently at him, when the phone rang. Franzee answered it, talked to someone for a minute, looked up the corridors at the closed examination-room doors, then over at Cage.

  “You want to talk to this guy?” she asked. “He’s a cop. He wants to talk to someone who’s in charge here.”

  “You talk to him, Franzee, you’re always in charge. You run this place.”

  Franzee scowled.
“Very funny, Dr. Cage.” She held up the receiver. “Now, you want to talk to him, or you want me to go bust in on Dr. Samione or Dr. Cardenas?”

  Cage got up from the chair; the woman didn’t stop mumbling. “I’ll talk to him.” He put his coffee cup on the counter and took the phone from Franzee. -This is Dr. Cage.”

  “Dr. Cage, this is Lieutenant Carlucci, with the San Francisco Police Department.”

  “Yeah? Is there a problem?”

  “About an hour ago you ran an ID scan on someone. Tito Moraleja.”

  “That’s right.”

  “Was he a patient?”

  Cage hesitated, wondering what this was about. He’d never been a big fan of cops. But he went ahead and answered. “Yes, a patient.”

  “I don’t suppose there’s any chance he’s still there?” The man didn’t sound hopeful.

  Cage hesitated again, even considered lying. But he just didn’t have the strength for it right now. “Yes, he’s still here.”

  “He is?”

  “That’s what I said.”

  “Would you be able to keep him there for a while? Not by force… uh, you could tell him Caroline’s looking for him, that her father…”

  “He’s not going anywhere, Lieutenant. He’s critically ill, and we’ve got him in an isolation room.”

  “I’ll be there as soon as I can.”

  “What’s this all about?” Cage asked. But the lieutenant had already chopped the connection. Cage handed the receiver back to Franzee. “I guess he’s coming here to see our mystery patient.”

  “Maybe he’ll get the guy into a hospital,” Franzee said.

  Cage snorted. “Not fuckin’ likely. Probably a jail cell.”

  A patient alarm went off behind the counter, a high-pitched squeal. Cage bent over the counter, but couldn’t see the panel. “Who is it?” he shouted at Franzee, already knowing.

  “The mystery man!”

  “Goddamnit.” And he was at it again, hurrying around the counter and grabbing the suit Franzee handed him, ignoring the booties, jamming hands into gloves as Franzee tied the mask behind his head. Then he was running to the isolation room and crashing through the door.

  The mystery man, Tito Moraleja, was convulsing violently. Tonic clonic, rocking the bed. The Ivs had been ripped out of the shunts, and his eyes were half open, eyeballs completely red now and rolled up under the lids. Cage moved to the man’s side and grabbed his upper arms, holding him down so he wouldn’t take a flier off the bed. Hold on and wait, he told himself.

  Madelaine came through the door, hurried around to the other side of the bed. Franzee and Paul rushed in behind her.

  “Let’s get him intubated,” Cage said. “We still got some paralytics?”

  Franzee nodded. “Pavulon. I’ll get it.” She shook her head. “But we don’t have anything else for a rapid sequence. Maybe a sedative.” Then she was gone

  Cage grabbed Tito’s left arm, got an IV back into the shunt, which had, amazingly, stayed in the guy’s arm. Franzee came back, and Madelaine first gave Tito a sedative, then injected the Pavulon. Almost immediately he stopped moving, though Cage knew that the poor bastard’s brain was probably still seizing like mad; now they just weren’t seeing it.

  They got Tito intubated, then tried Ativan to stop the seizure. But the guy’s vitals were bad the fever was spiking, blood pressure was dropping. Then bam, he went into cardiac arrest before they could do a damn thing.

  They worked hard on him. CPR, several shocks with the paddles, epinephrine and atropine; they did everything but crack him open. Cage even considered doing that, for about five seconds; here, that was an absurdity. But nothing worked, and fifteen minutes later it was over. Tito Moraleja was dead.

  Madelaine looked up from the body, glanced at Cage, then turned to Franzee. “Get a blood tray over here now. Let’s get some more blood out of him while we can, see if we can’t find out what the hell it was that killed him.”

  “What we really need,” Cage said, “is an autopsy.”

  “I know,” Madelaine replied. “You’re not suggesting we do it ourselves, are you? Here?” She cocked her head at him. “You’re not that whacked, are you?”

  Cage shook his head. “No. I know we can’t do it. I just wish we knew someone who could. Or at least somewhere we could store the body.”

  Franzee came in with the blood tray. Madelaine took the syringe, lined it up just under and to the left of Tito’s sternum, then plunged it in and up at an angle and right into the left ventricle of the heart. She got eight vials of blood out before it started clotting.

  After the blood came nose, throat, and rectal swabs, and finally a sample of the vitreous humor from the left eye for toxicology. Franzee and Paul left to label and store all the specimens.

  Cage and Madelaine stood on either side of the bed, gazing down at the body.

  “Any more ideas?” Madelaine asked.

  Cage just shook his head. “Who do we know who can test for weird bugs and viruses?”

  “Why the hell are you hung up on this thing?”

  “Gut feeling. Some things I’ve seen recently. So, who do we know who could do it?”

  “Unless Tito turns out to be someone rich and famous, no one. You still have connections to the CDC?”

  “Yeah.”

  “Think you could get any of them to do something?”

  “On the blood of a dead Mexican who had AIDS? Not a chance.”

  “That’s what I thought.”

  Cage stepped back from the body. “But we keep the blood and the other stuff, even if we lose the body. I’ve got a bad feeling Tito isn’t going to be the only one to die this way.”

  Franzee stuck her head into the room. “Dr. Cage? Lieutenant Carlucci is here to see you. And to see him.” She pointed at Tito Moraleja’ s body.

  Cage nodded. “Tell him I’ll be right out.”

  Franzee let the door close. Cage looked at Madelaine. “Let’s go tell the lieutenant the wonderful news.”

  CHAPTER 11

  The RadioLand Street Clinic smelled of bleach, sour lemon, unwashed bodies, and the faint, cutting aroma of incense. A weird mix, Carlucci thought, but strangely not unpleasant. He stood at the counter, sweating, waiting for the doctors, hip and elbow against the rough plastic. A dozen people sat around the stifling waiting room, and most of them looked pretty sick. None of them looked at him; they probably didn’t like cops. He imagined they had good reason for the sentiment.

  Carlucci was damn glad he didn’t have to come to a place like this for his own health care. The Police Department had its own fully staffed, fully equipped clinic and hospital, which made being a cop a highly desirable job, despite the risks and the bad hours and the low pay. Most of these people, on the other hand, were probably happy to have any kind of place to come to.

  A man and a woman emerged from a doorway along the right hall and proceeded to strip off gloves and suits, tossing them into a molded plastic container built into the wall. The woman was older, her hair almost completely white, and her thin face was striking still quite handsome. The man was probably in his thirties, though his hair had some pretty good streaks of gray. Carlucci could buy the woman as a doctor, but this other guy, with his faded black denims and boots and color-slashed T-shirt and neck tattoo even if the tattoo was a caduceus couldn’t be. A street medico, maybe. The two of them approached the counter, and the man put out his hand.

  “Lieutenant? I’m Dr. Cage, I talked to you on the phone. This is Dr. Samione.”

  Dr. Cage. Carlucci shook hands with each of them. Then the man said, “Madelaine, I’ll talk to him about all this.” The woman smiled and nodded. “He’s all yours, Ry.” Dr. Cage turned to Carlucci and raised an eyebrow.

  “You want to see him?”

  Carlucci nodded. “Sure.”

  “Follow me.” The young man led the way back along the corridor, then stopped in front of a large glass observation window.

  Carlucci looked inside the roo
m. A figure lay on the bed, sheets and blankets thrown back and bunched across his legs, his upper body and face exposed. The man’s eyes were closed, but his mouth was open, rigid in a silent scream; his dark skin was covered with enormous red patches and blistered welts, spotted with blood.

  “Dead?”

  “Dead,” the young man replied.

  “He had AIDS,” Carlucci said.

  “It wasn’t AIDS that killed him.”

  Carlucci nodded, but didn’t say anything. He had a feeling there was more to come, and that he wasn’t going to like it.

  “So, is that Tito Moraleja?”

  Carlucci shrugged. “I suppose. I’ve never seen him before. He was a friend of my daughter’s.”

  Dr. Cage breathed in deeply, then slowly and loudly let it back out. “So you Weren’t planning on throwing him into a cell.”

  “No.”

  “I think we need to talk about this.”

  “All right, Dr. Cage.”

  “Just call me Cage. And let’s go on back to the staff lounge.” Cage smiled to himself. He continued along the corridor, and Carlucci followed after taking one more long look at the body of Tito Moraleja.

  The “staff lounge” was a small, cramped room with a table and chairs, cheap plywood cabinets, a countertop stove, three or four cots stacked on top of each other with pillows and blankets, and two large refrigerators. A couple of Vornado fans circulated the hot, stuffy air, providing at least the illusion of relief.

  “Have a seat,” Cage said. He went to the larger refrigerator, which was covered with black and white photos cut from newspapers, magazines, or books. All of the pictures showed people with the weirdest expressions on their faces, all of them with food or drink in their hands. “You want something to drink? A beer, Coke, or something?”

  Carlucci sat in one of the hard, wooden chairs. “A beer would be great,” he said.

  Cage opened the refrigerator. Inside, the shelves were packed with labeled vials and jars and tubes and plastic bags, blood and fluids and drugs. On the bottom shelf were bottles of beer and soft drinks. Cage pulled out two bottles of Black Orbit, closed the refrigerator, and brought the beer to the table, handing a bottle to Carlucci. The cap was a twist-off; the beer was cold and very bitter.