“He’s in shock with a flail chest on the left,” continued Susanne. “X rays have just been taken, but we don’t have the developed films yet. I added a pelvis; there’s blood at the mouth of his urethra, and we can’t get a catheter up more than a few inches. OR’s notified, and ortho and urology were called as well as Dr. Carrington.”
She’d just told me the man had broken enough ribs to detach a section of his chest wall from the rest of his rib cage. I could see the piece—like a deli side of ribs the size of my hand—still held in place by muscle and sinew, flopping in and out uselessly as he tried to breathe. Shock meant he was bleeding from somewhere, and with blood pouring out of his chest cavity, the source could be a lacerated lung, a major vein, or even a ruptured aorta. The trickle of blood from the man’s penis suggested a severed urethra, probably caused by the jagged ends of a pelvic fracture. Susanne’s clinical savvy was better than any other nurse’s.
“You should have been a doctor,” I told her, not for the first time, as I quickly finished gowning and gloving up.
“Who’d be here to tell you what to do then?”
“Speaking of telling me what to do, thanks for calling Michael last night.”
She blushed but smiled her acceptance of my rather awkward acknowledgment, then moved in to hang up the blood she’d brought.
Expressions of profound loyalty and deep friendship could hinge on an instant in ER.
Seconds later I strode up to the head of the gurney and took over the intubation from the struggling technician.
For the next short while the harsh world of blood, sinew, and broken bones chased away any thoughts of Rossit or shadowy notions of a phantom killer. It was particularly satisfying when I secured the man’s airway, an intubation far too difficult for the tech, especially after I’d had to step aside during Sanders’s intubation less than twenty-four hours ago.
Once the patient was properly ventilated, I started firing the questions—the tools of teaching since the time of Aristotle—to focus the residents on what needed doing next. “Okay, gang, where’s he bleeding?”
While they shot back answers about the left lung, I rapidly palpated the sternum, auscultated the rest of the chest, then tossed out more questions. “Is he still in shock?”
“Seventy-five over zip,” answered one of the nurses.
“What about this chest tube pouring blood?”
“Clamp it?” a young man across from me answered hopefully.
“Good show.” I grinned, moving on to palpate the abdomen and to select my next pupil. “Did anyone clear his cervical spine?”
“We took X rays, sir,” replied a young woman on my right. “They’re not back yet.”
“Did you do a rectal?” I asked her.
She flushed above her mask. “Not yet.”
“Now I’m going to show you where else this guy is bleeding out on you.” I slipped on some lubricant and inserted my index finger through the man’s anus. I felt a prostate bobble as free as a floating olive in a martini.
I slipped out and let her perform the same maneuver. Her eyes widened as she confirmed a transected urethra for the first time.
Then I squeezed the pelvis. Both halves slid free of each other and gave a sickening grind.
I stepped back, “Your turn.”
More wide eyes.
“Bottom line, folks: this patient needs a surgeon.”
The nurses busied themselves recording neurological signs, and I slipped yet another needle catheter into the man, this one through his belly to check for free blood in the abdominal cavity. Negative.
Sean ran into the room as I was flipping X rays up on the viewer, and together we confirmed our clinical impressions. “Let’s go!” he cried, reaching through a forest of IV lines and grabbing the head of the stretcher himself to lead the rush to the elevators. The nurses had piled portable monitors and an oxygen tank onto the bed between the patient’s legs and were still securing drainage bottles when they started off. The respiratory technician was on the bed itself, straddling the patient’s chest with her knees, bagging as they all went out the door and disappeared down the corridor.
I stood for a moment in the empty room, savoring the triumph that always follows a successful resuscitation. This is what I do and do well, I thought. There was no other job in medicine I found sweeter than saving a life. But the delicious glow of accomplishment was quickly being replaced by a spreading sense of dread because two days ago I’d sent the wrong woman home. Foul play at University Hospital may have started the infection. Missing it was my fault.
I looked around that room where over the years I’d experienced incredible miracles and witnessed unspeakable losses. The litter of a major trauma case that inevitably ends up on the floor—the torn boxes, the wrappings, the needle covers left lying in spatters of blood and pools of various other fluids—suddenly made the place seem forlorn. I’ve had two decades on this stage, I thought, my mouth going dry. I had to swallow repeatedly before I could allow myself to think the unthinkable—that I could lose it all.
* * * *
The call I’d been dreading, but expecting, came early that evening. I was still in my office finishing resident evaluations when Stewart Deloram reached me.
“I thought you’d want to know she died half an hour ago.”
I sighed into the mouthpiece but said nothing.
“Earl?”
“Sorry, Stewart. I knew it was likely, but still...”
After a few seconds of uneasy silence, he said, “I hate to have to say this now, but you’ve got to watch out for Rossit. He was like a vulture dancing around her body. I know he’s usually bad-mouthing someone or another, but I’m afraid he’s after you big time on this, worse than the usual mischief he gets up to. Frankly, he scares me.”
I listened, not knowing what to reply. Although it was only confirmation of what I already knew, his words caused my stomach to tighten.
“He’s gotten the post arranged for tomorrow morning,” Stewart continued, sounding as miserable as I felt, “and somehow he’s gotten the case on the schedule for Death Rounds this coming Monday.”
“What!” I was speechless for a moment.
For us as healers. Death Rounds are our crucible, our place to be judged. There the pathologist’s scalpel has cut into the disease that defeated us and revealed whether we’d been right with our treatments, probings, and tests or we’d been wrong and our patient died because of our mistakes. It’s a rigorous arena where verdicts are rendered starkly and accepted without excuse. Some doctors shunned the process, but I couldn’t have continued as a physician without it. The alternative would be agonizing: to lose patients over the years yet never know for sure if I’d killed them or served them well.
But a case usually didn’t reach Death Rounds until weeks after the autopsy. Preparing and processing the various slides took time, and the backlog in pathology had tripled after Hurst’s repeated budget cuts. “But they won’t have tissue samples back by then!” I exclaimed, totally disbelieving what he’d said.
Stewart sighed heavily before he replied, “Either Rossit’s managed to get some kind of priority, or he figures he doesn’t need slides for a lynching.”
My breath caught midway, and my mouth went dry. Rossit’s launching such an assault on my reputation was bad enough, but it was another matter altogether that he was somehow able to pervert the most serious of hospital forums to his purpose.
“Stewart, what the hell’s going on? How did he get pathology to agree to that?”
“I don’t know. Maybe it’s the amalgamation.”
“What do you mean?”
“Hell, you know these days it affects just about everything everyone does,” he said, disgust thick in his voice. “Everybody’s suddenly got an agenda to protect his own turf. Maybe that’s why Rossit’s doing what he’s doing. He’s got to know he doesn’t stand a chance of winning the ID chair against the likes of someone as reputable as Cam Mackie. Probably he’s try
ing to grandstand this case to show up Cam, suggest yet another hospital-acquired infection in a nurse at UH and that the ID department there was missing something...” he trailed off, said nothing more for a few seconds, then conceded, “but as to why pathology would go along with such an early date, I’ve no idea.” He sounded finished, then added, “Nor, for that matter, do I understand why he’s so rabid about nailing you for negligence.”
His last word made me wince. My silence must have given Stewart a clue as to its impact.
“Hey, Earl,” he quickly reassured me, “I don’t agree with the guy at all; you know that, and I’ll say so, publicly, at Death Rounds.”
“Thanks, Stewart, I appreciate it.” But his declaration sounded forced, and I was feeling more and more alone.
“One other thing,” he interjected. His tone seemed even more uneasy. “I called Miller earlier this afternoon when it was clear his mother was preterminal. He was here when she died. He was certainly expecting her death—he took it very quietly, then signed for the post—but I got the feeling that despite his exterior calm, he was even more angry than he was yesterday.”
More of what I already knew. My stomach obediently tied itself into a new set of knots anyway. “You think he’s going to sue?” I asked, cutting to the point of Deloram’s warning.
I heard him breathe out again but wondered if it was from his relief at having finished the unpleasant duty of giving me a string of bad news. “I think you can count on it” was his quick reply.
I got locating to track down Janet at UH and told her the news.
“I’m sorry, Earl,” she said softly.
She didn’t have to say anything else. As physicians we both knew that a patient’s death, even an expected death, could force us to confront things we’d rather not—our futility as doctors, our own inevitable demise, the frailty of a human life. But in this case, I was feeling a pretty high octane mix of guilt over my part in whatever killed Phyllis Sanders and rage at whoever might have murdered her in the first place.
“I want to hold you,” Janet said quietly.
“Thanks, love,” I answered, swallowing hard. Like a match added to what I was already feeling, her sudden tenderness had ignited an urge to cry.
“Do you know how Miller took it?” she asked after a few seconds.
I told her what Stewart Deloram had said.
She stayed silent again, then quietly told me, “Michael and I saw Miller today, just before noon, while we were checking out ID procedures in the lab. I was surprised he was there at all, but he said he preferred to work and keep his mind occupied. He admitted then he knew there was little hope, but while it was strained between us, he wasn’t overtly hostile to me. Now Cam was there too, so Miller might have been being careful, keeping his anger under control and out of sight from his boss. Yet as time goes by and his grief runs its course, his judgment of you may be less harsh,” she said, sounding hopeful. I couldn’t tell if she believed what she was saying or was simply trying to comfort me.
“What’s Miller usually like?” I asked, flashing on the tormented look he’d given me this morning.
“Brash and bright. Hell, he’s more up-to-date on the latest in clinical testing techniques than most physicians, including myself. He’s always badgering us to use the lab more appropriately, sometimes to the point of annoyance, but he’s usually right.”
“I overheard him this morning, on my way up to staff health. He was bad-mouthing incompetent physicians to his lab students. Does he often talk like that, or was that diatribe inspired by me?” I found it hard to keep from sounding angry.
“First of all you’re not incompetent,” said Janet dryly.
I snorted, skeptical of her attempt to set me straight but then immediately felt a few of the knots in my intestines untangle themselves while I waited for her to answer the rest of my question. Lady, you do know how to play me.
“Unfortunately, it’s probably a bit of both,” she finally said. “He’s obviously pretty raw about his mother right now, but he also has a reputation for being a bit critical of doctors, especially when he’s teaching. His father used to be an obstetrician here. It was before my time, but the rumors are that Miller senior was an alcoholic and a womanizer who lost his license. Apparently he also died as a result of alcohol, in some kind of drunken fall. Most of us figure that’s why Harold’s the way he is, overcompensating for the mistakes of his old man. I hear he even once applied to medical school but was turned down. He probably still feels he’d be a better doctor than most of those he sees around him, and who knows, maybe he’s right. In any case, he seems to have found a real niche for himself in laboratory sciences. And having a stickler for excellence around the place is nothing to complain about, so we try to take his dedication with a certain grain of charity.”
“But with that kind of background he’s liable to sue simply to make an example of me. Hell, he hardly needs Rossit to stir him up.”
“Possibly,” she said, her voice neutral. It was a tone she always resorted to for telling hard truths. “But don’t jump to conclusions yet about what he may do.”
Good advice, but tell that to my stomach, I thought, as I felt it start to rearrange itself again. “It still sounds like I shouldn’t expect much,” I commented glumly.
“Earl, I want you to do something for me right now.” Janet’s sudden sharp tone snapped me out of my morbid worries. “I’m down in the basement archives, where they keep old records. No one’s here, and I want you to come over. I’ve dug out the records of all the staff who were attacked by the Phantom two years ago. Michael still doesn’t take me seriously, but neither of us found a shred of evidence today that can explain the infections. I’m sure I’m right about this, Earl. I want you to look at the charts with me. Maybe you can find what I’m missing.”
* * * *
It was after 7:00 when I once again pulled into the grounds of UH. The weather hadn’t changed much since my visit that morning. It had stopped raining for the moment, but the mist had graduated to fog and now descended all the way down the walls of the building. The dimming effect, added to the dusk, had been enough to trigger the sodium lamps. Inverted cones of yellow light illuminated the gray haze that drifted through the parking lot and the many footpaths surrounding the hospital. In a few weeks it would be fully night by this hour, after we’d all adjusted our watches and stopped saving daylight for yet another year. Maybe I wouldn’t do it this time; I hated surrendering to winter darkness.
As I walked to the front doors from my car, the air felt cool against my face, and I enjoyed a few brisk lungfuls before flashing my identity card at the sole security guard. A dozen other people carrying bouquets of flowers and food baskets entered the large vaulted lobby with me, but the huge echoing chamber seemed empty compared to the rush I’d seen at the start of the day.
A woman with two children, each of them clutching a small bunch of roses, studied a map of the hospital mounted on the wall. A massive directory listing the locations of all the hospital departments was hanging beside it; there was no one else around to give directions. A nearby glass booth marked INFORMATION was dark and had a handwritten sign taped on the door, BACK IN THIRTY MINUTES.
I’d already called home to say Janet and I would be late. Amy, our nanny, was having dinner with Brendan.
“He likes the spinach, and I prefer the carrots,” she’d told me as I’d listened to his happy cries and smacks in the background. “But if you two don’t hurry, we’ll eat all the applesauce and leave you the yellow stuff. Neither of us likes that.”
Then she’d held the receiver up to his ear and I’d gotten to say, “Hi, Brendan,” and listen to him gum the mouthpiece.
I found the archives on the directory and learned they were in the subbasement by the old psychiatric wing. Terrific, I thought, studying the map and figuring roughly how to get there.
The elevator took me down two floors and let me out in the middle of a long deserted corridor that seemed to r
un forever in both directions. While lit with occasional overhead lights, the passage had an arched low ceiling, giving it more the feel of a tunnel than of a hallway. There wasn’t a soul in sight, and after the elevator doors closed behind me, the place was silent as death.
“Jesus, Janet,” I muttered under my breath, setting out in what I thought was the right direction after my study of the map, “could you have brought me anywhere more creepy?”
The air in the passage was absolutely still, the result of being two floors below ground. The stone walls and ceiling only added to the sense of weight pressing down from the hospital above. I wasn’t usually claustrophobic, but this place made the basement hallways at St. Paul’s feel absolutely spacious.
I came to an intersection. The archives should be off to the left, but that hallway didn’t look as used as the one I was in. It was certainly less well lit, and the lights were spaced farther apart. The corridor to the right was in complete darkness. The air at its mouth had a damp musty smell, and a sign hanging from the arched ceiling warned, DANGER! OFF LIMITS TO ALL PERSONNEL. I stared up that dark passage and wondered if it led into the old abandoned asylum. Shivering, I turned left.
The floor was concrete, and my shoes made muffled tapping sounds as I walked. There were occasional doors set in the stone walls, and what would be behind them besides storage rooms I couldn’t imagine. I passed two more intersections, then turned right at the third. The microfilm archives should be at the end of the corridor.
But I came up to a blank wall.
Shit! The map had indicated left at the first intersection, past two corridors, and then right, exactly as I’d done. I should be standing in front of a door marked HOSPITAL ARCHIVES. Instead it was beyond a doubt the proverbial blank wall.
I retraced my steps a bit, trying the doors that I’d passed on my way down the corridor. Most were locked, and those that weren’t simply opened into musty rooms stuffed with everything from boxes to old beds and shelves of outmoded clinical equipment.
Death Rounds Page 7
