The Patient

by Michael Palmer

  “We can push the pressors and start pumping on his chest,” Milano said. “If we do that, we’re sort of committed to a balloon pump assist as well. As usual, it’s hard to know where to draw the line.”

  “The family wants everything possible done,” Jessie said.

  “Is it worth trying to put a shunt into his head? It’s almost certain the fallout from his cerebral hemorrhage is causing this, along with some underlying cardiac disease.”

  “There’s no evidence for an acute obstruction of the outflow of spinal fluid from his brain. That would be the only neurosurgical condition we might be able to remediate in the OR. His problem is massive brain swelling, not acute hydrocephalus. A shunt wouldn’t help.”

  “And his brain swelling’s not going away?”

  Jessie shook her head. “No,” she said, glancing over at the doorway and wondering when Gilbride might appear. “It doesn’t look like it.”

  “In that case it seems like we’re swimming against the tide regardless of what we do.”

  “Pressure’s down to seventy again,” the nurse said.

  Her tone was a none-too-subtle request that one of the physicians in charge make a decision whether to plow ahead with meds and chest compressions or stand back and let Hermann’s pressure keep on dropping.

  “It’s too bad,” Milano said softly. “The guy comes all the way over here from Germany to have his operation, and ends up like this.”

  “Sixty-five,” the nurse said.

  “I don’t know,” Jessie said. “My head is telling me we’d better pull out all the stops. My heart says that doing that is a cruel and expensive exercise in futility.”

  She looked past the crowd to the hallway again. Carl Gilbride wasn’t there, but Alex Bishop was, dressed in his brown security force uniform. He caught her eye and asked the obvious question with a gesture. She replied with a barely perceptible shake of her head. At that moment, Gilbride strode past Alex and into the room. Despite having left the hospital at ten last night for what Jessie assumed was a decent night’s sleep, and despite his spotless lab coat and designer shirt, he looked haggard and edgy.

  “What’s going on here?” he demanded.

  “Pump’s failing,” Milano said.

  “So, get it going.”

  Gilbride looked reproachfully at Jessie.

  “How long have you been here?” he demanded.

  “Ten minutes or so.”

  “And you’re not doing anything?”

  “We were just discussing whether it was appropriate and fair to send for a balloon assist pump.”

  “Milano, get him through this,” Gilbride ordered. “I don’t care what you have to do.” He turned to Jessie. “Because of you, I’ve canceled appearing on a panel in New York City that was very important to me. And now I get here and find you just standing around.”

  “Begin compressions,” Milano said to the medical resident, the resignation in his voice making it clear the order was against his better judgment. “Someone please call down to the CCU and have the intra-aortic balloon pump brought up here. Might as well call the cardiac surg people as well to help with the insertion.”

  “I’ll call them,” Jessie said quickly, anxious to get out of the room.

  She was furious at Gilbride’s public rebuke, but she was also a bit sheepish that she hadn’t been as aggressive as he was being. Still, dead was dead. And the most exhaustive, expensive interventions in the world weren’t going to bring back Rolf Hermann’s brain or, for that matter, his heart.

  She hurried past Alex with just a brief nod that he should follow. Then she stopped at the ward secretary’s desk, called the coronary care unit, and asked to have a nurse wheel up the balloon pump. The apparatus, a long balloon that was inserted into the abdominal aorta through an artery in the groin and inflated with each heartbeat, could raise the blood pressure in some cases of pump failure. Next Jessie put in a page for the cardiac surgery team. Finally, she walked down the hall to a small alcove opposite the only empty room in the NICU, and motioned to Alex that the coast was clear.

  “Is he going to make it?” he asked at once.

  “Define make it,” Jessie replied. “Joe Milano, the cardiologist, is damn good, but I don’t think anyone’s that good. Do you know that I called you early this morning?”

  “I do, yes. I’m sorry. They just reached me with the message.”

  “What were you doing?”

  “I was off getting a hearse.”

  “A hearse?”

  “A hearse, the black dress suit, the subdued tie, the works—all courtesy of the greedy folks at Bowker and Hammersmith Funeral Parlor. They have even offered their cooler to stash Hermann’s body in until Jorge Cardoza gets here.”

  “Very clever. When will he be arriving?”

  “This afternoon. His plane lands at three. Is Hermann still going to be among the living by then?”

  “Define living. I was ready to call it quits on the resuscitation before Carl got here. But he canceled an appearance in New York because of the Count, and now he’s determined the guy’s going to survive this.”

  “It’ll be dangerous bringing Cardoza into the hospital. There’s a chance one or another of Hermann’s so-called family knows him.”

  “Well, speaking as a betting woman, my money’s on your not having to.”

  “Will you help me get Hermann out of the hospital? I know where the morgue is, but I don’t know much about the protocol.”

  “Jesus, Alex. I’m still not even certain who you are, and you want me to risk my career by stealing a body from my own hospital?”

  “Forget I asked.”

  “I’ll do it. I’ll do it. But listen. You’ve got to help me, too. I’m very frightened about my nurse practitioner, Emily.”

  “What do you mean?”

  “She’s disappeared. According to her son, yesterday evening she got a phone call, then said she was going to the hospital. He assumed it was me calling, but it wasn’t. She hasn’t been heard from since, and I’m very worried.”

  “Has her family called the police?”

  “Yes, but they won’t do anything until she’s been missing at least twenty-four hours.”

  “Missing, huh. That is a little worrisome. She’s never done anything like this before?”

  “Never. That’s why I called you. I want to make a deal. If I help you with Hermann, I want you to get your FBI friends involved right away in finding Emily.”

  “I don’t know if—”

  “No deal, no body. And I mean it. I want them on the case today no matter what the Brookline police say.”

  “I’ll do my best.”

  “Look at me, Alex. Right here in my eyes.… Dammit, I wish I could tell when you’re lying.”

  The nurse from the coronary care unit raced by, pushing the orange-crate-sized intra-aortic balloon pump ahead of her.

  “Go ahead back in there,” Alex said. “I won’t be far away.”

  “Why don’t you use the time right now to keep your end of the bargain and call your FBI friends? Emily DelGreco. Her number’s listed in the Brookline directory under Edward DelGreco.”

  “Okay. Okay. You’re like a frigging pit bull.”

  “There’s a side of me that pit bulls run away from. You came dangerously close to bringing it out once. For both our sakes, don’t do it again.”

  She hurried away without waiting for a response, and rejoined the throng in room 2.

  The blood pressure readout on the monitor showed 50 now. Rolf Hermann’s skin was gray, mottled with deep violet. His eyelids were taped closed. A respiratory tech was using a breathing bag to supply him with 100 percent oxygen. By any definition, the Count was far more dead than alive. Still, the team, driven by a frantic Carl Gilbride, pushed on. The resident continued pumping on Hermann’s chest while Joe Milano gave med orders to the nurses. And now a cardiac surgical resident was on the scene as well, preparing Hermann’s groin for the insertion of the intra-aortic ballo
on, and calling out his supply needs without checking to see if anyone was listening. It was a medical circus maximus, and at the center stood Carl Gilbride, no more effective than Nero might have been while watching Rome burn around him.

  Jessie was torn between diving in to relieve the exhausted resident who was doing the chest compressions, and simply skulking off to a quiet corner of the hospital until the madness was over. Finally, she decided on a compromise, and moved to a spot next to Gilbride. There was a particular favor she wanted to offer him when it was appropriate to do so.

  “Any change?” she asked.

  “You might have started all this sooner,” Gilbride said, never turning away from the action.

  “I’m sorry,” she replied, unwilling to take the bait and start up an argument about the definition of futility.

  “It doesn’t look good.”

  The pressure was down to 45—poor even for artificial external cardiac compressions.

  “That chest pumper’s running down,” Jessie said. “I think I’ll take over.”

  “Nonsense. You’re an assistant professor. Pumping is a resident’s job.”

  He called out and caught the attention of the neurosurgical resident. Then he pointed at Hermann’s chest and pantomimed the order that the man take over the cardiac compressions. To Jessie, it was as if Nero was now demanding that a bucket of water be tossed on the conflagration. The personnel transfer took place on the bed without missing a beat, but the pressure readout remained essentially unchanged. Five more minutes passed. Fifteen people—residents, students, nurses, technicians, faculty—had been tied up for the better part of an hour now. Thousands of dollars in equipment, medications, and lab tests had been expended.

  “Balloon’s in and functioning well,” the cardiac surgery resident announced.

  “Stop pumping, please,” Joe Milano requested.

  The room was suddenly silent save for the beeping of the monitor, the puffs of the Ambu breathing bag, and the soft thump of the intra-aortic balloon assist. Every eye was fixed on the monitor. For a time, maybe a minute, maybe two, the blood pressure reading stayed at 50. Then slowly, like the orbit of a dying satellite, it began to deteriorate. Down to 47 … 42 … 40. Seconds after the pressure hit 40, Rolf Hermann flat-lined. No one moved. The silence in the room continued as everyone on the resuscitation team waited for Carl Gilbride to decide whether or not it was over.

  There was nothing from him. Not a word.

  Finally, Joe Milano spoke up.

  “Dr. Gilbride, I appreciate how much you want this guy to make it. But I’m not sure what else we can do.”

  “This all should have been started sooner,” Gilbride said.

  He turned and stalked from the room.

  Jerk.

  “That’s it. Thank you, everyone,” Jessie blurted, hurrying after Gilbride, and catching up with him at the nurses’ station.

  “Sorry,” she said, wanting to throttle the man.

  “Where’re his wife and the others?”

  “Waiting in the family room.”

  “Well, I suppose I’d best get this over with.”

  “Be careful. Remember what I told you about her.”

  “What you told me is nonsense. Killers! Fake security guards! I just want to get this whole business over with. I never should have canceled my appearance in New York. Never. And now Mrs. Levin has developed a headache and a fever on the day she was supposed to be discharged. As soon as I finish with the Countess, I’m going to have to perform a spinal tap on her.”

  “Would you like me to do it?”

  “I think you’ve done enough for one day.”

  “How about Orlis? Do you want me in there with you when you speak to her?”

  “I think I can handle that myself as well.”

  “Okay,” Jessie said. She crossed her fingers for luck and went for the brass ring. “How about the death certificate? Can I fill that out for you?”

  Gilbride mulled the request over, then finally said, “I suppose so. As long as you make sure the cause of death is listed as cardiac, because that’s what it was.”

  “Cardiac arrest, due to arteriosclerotic heart disease, with meningioma as a coincidentally existing condition. How does that sound?”

  “It sounds like the way it should be. Now, if you’ll excuse me, I have a great deal to do.”

  “So do I,” Jessie murmured as he walked away.

  CHAPTER 26

  IT TOOK NEARLY TWENTY MINUTES FOR THE nurses to clean up room 2. They removed all the tubes and lines from Rolf Hermann’s body and untaped his eyelids. Jessie offered to help, but was shooed away. Instead, she sat behind the counter of the nurses’ station filling out the death certificate—the one piece of paperwork that would be necessary to remove the Count’s body from the hospital.

  Please print in black pen only.

  Cause of Death: Cardiac Arrest

  DUE TO: Cardiogenic Shock

  DUE TO: Arteriosclerotic Cardiovascular Disease

  Co-existing Condition: Subfrontal Meningioma

  A few properly placed words and poof, Gilbride’s wish had been granted. A surgical calamity would go into the books as a coronary. And unless the family demanded the certificate, no one would be the wiser. Difficult though Orlis was, Jessie did not think that idea would occur to her. Deservedly or not, Gilbride was off the hook.

  The pen is mightier than the scalpel.

  Jessie smiled at the thought as she block printed in the final pieces of demographic data. She looked up just as Orlis Hermann and Rolf’s daughter came down the hall and entered his room. A minute or so later, they emerged and approached her.

  “So,” Orlis said with chilling matter-of-factness, “my husband is dead.”

  “We’re all very sorry,” Jessie replied, standing.

  “Your Dr. Gilbride didn’t seem all that remorseful when he spoke to us just now.”

  “I assure you, he was. He kept everyone in there doing the resuscitation long after most doctors would have stopped.”

  “What do we do now?”

  “If you were local, I would say all you needed to do was call a funeral home. Coming from another country, I’m not sure. If you don’t mind waiting in your room out there on the floor, I’ll speak to the nursing supervisor. She knows all the rules. I assume you’re planning to take the Count back to Germany.”

  “We are.”

  “I’m sure that complicates things somewhat, but I think the first step is still calling a funeral home. There’s paperwork that needs to be done here as well. Dr. Gilbride has quite a caseload, so I’ve offered to do it for him. But there may be some delay—a few hours, perhaps.”

  Jessie was rambling deliberately, hoping that Orlis would agree to stay around the hospital, as Alex needed her to.

  “I don’t mind,” Orlis said. “I need to get my husband’s things together anyway.”

  “Will the Count’s sons be in to see him?”

  “No. They are off on business right now. They should be back shortly, but there is no need to keep Count Hermann’s body up here until they arrive. Although they were very close to their father, they are not sentimental in that way.”

  “Fine. I’ll take care of everything, and I’ll be in to see you as soon as I have information.”

  “Do that.… Dr. Copeland?”

  “Yes.”

  “Your chief killed my husband. You do know that.”

  A knot of tension materialized in Jessie’s chest. Whether or not Alex was right about Orlis Hermann being Arlette Malloche, the woman was absolutely chilling. Jessie chose her words carefully. She had no desire to defend Carl Gilbride, but this was hardly the situation in which to allow principle and emotion to get in the way of common sense. Even if Orlis Hermann was nothing more than the Count’s distraught wife, she was still a potential litigant against Gilbride, EMMC, and probably Jessie as well. If she was, as Alex believed, a murderer capable of extreme vengeance, then there was no reason to provide her w
ith any more justification for violence than she already had.

  “What I know, Mrs. Hermann,” she said, “is that your husband had a large brain tumor that was unfortunately situated in a spot that was technically very difficult to reach. The more difficult the location of such a tumor, the more likely there will be complications. We really are sorry.”

  “Tell me something honestly, Dr. Copeland. Would this have happened if you had done the surgery?”

  The question caught Jessie by surprise. In all her dealings with Orlis Hermann, she never once felt the woman had the least interest in what she could or could not do in the operating room. A myriad of responses to the question flashed through her head—none of them truthful.

  “I hope you will understand that I cannot possibly answer that question,” she said finally. “I’ve had my share of surgical triumphs just as Dr. Gilbride has, but I’ve had some surgical tragedies as well.”

  For a few moments, Orlis Hermann stood there silently, her eyes locked on Jessie’s. Then, almost imperceptibly, she nodded.

  “We will be waiting in our room for word from you,” she said.

  She took her stepdaughter by the arm and led her away. Moments later, Alex appeared at Jessie’s side.

  “What’d she say?”

  “She’ll be waiting to hear from me about what to do with the body.”

  “Time frame?”

  “I told her it could be a few hours before I have any information.”

  “Great. Nice going. If worse comes to worst, the body will just be missing, and she’ll have to wait around until it’s found.”

  “Unless that makes her suspicious and she takes off.”

  “I have that possibility covered, I think. She’s being watched.”

  Jessie looked at him queerly.

  “Watched by whom?” she asked.

  “I’ll tell you soon.”

  “Oh, I just love secrets,” she said with unbridled sarcasm.

  “I gave my word.”

  “As long as I can count on your word, too. You know, Alex, as hard a woman as Orlis is, and as many awful things as you think she and her husband have done, I believe she’s feeling a deep and genuine hurt over what’s happened to him. And you know what? So am I.”