“Hey, Dr. Mackie, I’m sure there’s no Legionella organisms where you’ve looked. It’s where you haven’t looked that I’m worried about.”
“What do you mean?” demanded Cam.
“I’ve had a report that some of your staff at UH go into the abandoned asylum. Maybe for a smoke, maybe for legitimate purposes—I don’t know the reasons why. The point is, I’m sure there are reservoirs of stagnant water throughout that place. If your people are entering those premises on a regular basis, that could be your source.”
From the astonished look on Cam’s face, I could tell the idea had never crossed his mind. “Well, I’ll be damned,” he muttered.
“What do you think, Dr. Rossit?” asked Williams, turning to address the chairperson.
“Me? I think it’s a very perceptive observation and the place should be screened from top to bottom immediately.” From the gleam in his eye I suspected he thought trouble for Cam at UH was good for him and St. Paul’s.
Even Hurst chimed in. “I wholeheartedly agree with Dr. Williams’s and Dr. Rossit’s endorsement of the search.”
“Dr. Levitz, what’s your opinion?” inquired Williams. “After all, it is your call.”
His deferral to her authority was astute. It put her back in charge, and her smile indicated she seemed to appreciate the gesture. “Of course it has to be done,” she replied. “We should make it a priority recommendation.”
“Very clever,” I muttered to Williams out of the corner of my mouth. “All of it’s very clever.”
Rossit adjourned the meeting, Doris scribbled something on a pad, and Cam eyed me angrily before following everyone else out of the room. While I didn’t have a clue why he remained so hostile, his reaction to Williams’s suggestion was in obvious contrast to Rossit’s and Hurst’s enthusiasm for the idea. Obviously for those two, a search of the Phantom’s domain held no fear.
After the meeting I refused to talk to anyone, even Williams, and instead retreated to my office for refuge. I didn’t lock the door, but I sure as hell wasn’t encouraging any visitors. I had too much work to do twisting paper clips into pretzels.
I knew I wouldn’t be fired from my position as chief today. I wasn’t even named in Levitz’s final pronouncement, nor would I or the patient be identified in her published report. That’s not how these things were done. But Hurst had the verdict he needed. In spite of the confidentiality of Death Rounds, whispered conversations afterward would name me and help shape the hospital’s own collective judgment on the part I’d played in Sanders’s death. Time, along with the inevitable gossip surrounding the MMB article, would do the rest. When my annual review for reappointment by the board came around in a few months. Hurst could simply refer to “that unfortunate business in ER,” and everyone would know what he meant. He could then add something about St. Paul’s not being able to afford a hint of scandal or incompetence involving the chief of emergency if its ascendancy over UH was to be assured at this critical juncture in the amalgamation process.
I shuddered, recalling other power struggles in which I’d witnessed the careers of colleagues summarily derailed by similar asides.
My torn cuff caught my eye, reminding me I hadn’t showered or changed yet. Glancing at my watch I was surprised to see it was only 8:25. Death Rounds had lasted a little over an hour. The ordeal had felt like an entire day’s work.
In the end I hadn’t any idea how to counter Hurst’s probable strategy to get rid of me. Nor had I any clearer grasp of whether it was part of a larger conspiracy by him and Rossit to cover up their involvement in the killings. I had to admit, though, that their relaxed demeanor in front of Sanders’s remains and their eager acceptance of a search of the asylum weighed against the idea. In fact, their behavior was so contrary to what I would have expected, it crossed my mind that perhaps the two of them were simply playing their usual dirty hospital politics after all. Rossit wanted the chair. Hurst wanted rid of me, and they made a deal to help each other get what they wanted. That was simple enough to withstand even Janet’s skepticism. But I still couldn’t entirely put the darker possibility out of my mind.
As for Cam’s behavior, I again refused to let my speculation about him go any further until I talked to Janet. Her perspective would keep me from straying into nightmare scenarios. Thinking of her, I immediately remembered she didn’t know about Michael yet. I knew no matter what I said she’d be horrified and would once again blame herself for instigating a hunt for the Phantom without having anticipated the possibility of a backlash. Michael’s grave condition only confirmed that this maniac, despite some twisted mission to avenge cruelty, would kill any innocent who threatened him with exposure.
I called locating at UH and, while waiting on the phone for Janet to answer her page, toyed with the idea of delaying telling her that I’d gone back to the archives. I knew she’d be furious with me for going in there alone, especially after she learned what happened to Michael. But I quickly realized I had to warn her about Cam’s reaction to that visit. He might assume that she’d put me up to it and tear a strip off her the same way he had torn one off me.
I decided definitely not to tell her about following someone into the asylum. For that bonehead play, she’d kill me herself.
The receiver clicked in my ear. “One moment please, Dr. Garnet,” said the operator. “I’ll connect you with the nurses’ station in the case room.”
After more waiting and more clicks, a woman’s voice answered, “Case room.”
“Hi, it’s Dr. Garnet. I’m looking for Janet. Is she busy?”
“Oh, I’m sorry. Dr. Garnet, but she’s down in emergency. I’ll transfer you—”
“No, don’t bother. Just tell her to call me as soon as she’s free.” I wasn’t going to break my news to her while she was in the middle of some case.
“No, Dr. Garnet, you don’t understand. She’s in emergency as a patient. She signed herself in this morning because she woke up with a cough and a bit of fever. We were a bit surprised because she didn’t sound too bad when she called in to transfer her cases—”
Whatever else the woman said, it was to air. I didn’t even hang up the receiver before I darted out the door.
Chapter 15
The emergency department at UH was one of the areas the hospital had renovated recently. Countertops and work spaces were pleasing curves, the color scheme blended soft pinks with pale greens trimmed by gray, and plants were everywhere. The effect no doubt made the people working there feel better, but it didn’t do a thing for my fear. Nor did the sight of everyone wearing surgical masks make it easy to stay rational.
Still breathless after running in from the parking lot, I said to the clerk at the receiving desk, “My wife, Dr. Janet Graceton, is here. Can you tell me which bed she’s in?”
“Oh yes, Dr. Garnet, she’s already been transferred to ICU, but if you wish to speak with the doctor who saw her—”
“No thanks,” I uttered, spinning around and heading toward the elevators. Here, as in my own hospital, ICU was on the fourth floor. But when I got into the main corridor leading to the elevators, I saw a crowd of people already waiting in front of the large brass doors. I took the stairs instead.
I kept telling myself that Janet had to be okay, that if she’d contracted Legionella it was in the early stages yet, that we’d be starting the treatment early the way we had with Stewart. But what if she also had the other, the staph? “Please, no, not that. Not that!” I pleaded to myself as I pounded up the stairs.
Behind me I heard the door that I’d just gone through fly against me wall with a bang. “Dr. Garnet!” came an echoing shout accompanied by the sound of whoever it was running up the steps after me.
I leaned over the railing and saw it was someone in isolation garb. The instant he looked up I recognized him from his close-cropped blond hair, even with his surgical mask on. Already in a state of near panic over Janet I groaned out loud at the prospect of another encounter with Harold Mille
r. “Look, Mr. Miller, this isn’t really the time to talk to me. My wife’s just been—”
“I know, Dr. Garnet,” he interjected, jogging the rest of the way up to where I was standing. “When I heard she was in, I did the sputum cultures on her myself. I’ve been helping out with the screening program here, so I was around—”
“You’ve seen her? How is she?” I almost grabbed his shoulders. He was a head below me, standing one step down.
“That’s what I wanted to tell you, not to worry. She looked how my mother must have been that first visit, you know, not too sick.”
I felt a jolt of anger. If he was going to start putting me on the defensive about his mother again, I was past being empathetic about it. I turned away and continued on up the stairs, hoping he wouldn’t follow.
But follow he did, and his insistence on talking as he kept pace behind me set my nerves on edge. “I wanted to tell you. Doctor Garnet,” he went on, “that I don’t think anything could have saved my mother, even if she had been diagnosed properly at the very beginning, given what the second organism turned out to be.”
I couldn’t quite make out if he was blaming me or forgiving me, or even if I’d heard him right, but I remained focused solely on getting to Janet. “Mr. Miller, please, not now,” I told him as nicely as I could, speaking to him over my shoulder without slowing down. We were passing the second-floor landing.
“I’m just trying to apologize, Dr. Garnet, for accusing you the way I did!” he practically shouted from a few steps behind.
There was something desperate in his voice that stopped me. When I turned to face him, I found the pain in his eyes above the edge of his mask hard to look at, and I immediately regretted my initial abruptness. “Mr. Miller,” I stammered, “please excuse me for snapping at you, but we both have great personal problems at the moment and—”
“That’s why I wanted to tell you now. Dr. Garnet, so you wouldn’t have to worry about me and be wondering what I was going to do. You’ve got enough pressure on you, given the scare of the outbreak and now with Dr. Graceton’s falling ill. I want you to know I realize you were up against an unstoppable organism that had never been encountered before. I even understand better now about your missing the Legionella prodrome.”
Some of his words sounded a little rehearsed, as if he’d written certain phrases out and then memorized them to use on me. But however clumsily he was going about it, he seemed determined to put me at ease—a gesture that was as surprising as it was magnanimous—even if it was not something I had time for at the moment.
I forced myself to stand there and listen, despite my wanting to get to Janet. After all, I reminded myself, although I hadn’t seen a notice, it was likely he’d only just buried his mother on the weekend. Janet herself would blast me if I showed the smallest sign of cutting short any effort on his part to make peace. She had predicted that he would soften and that his hostility would subside while I’d remained skeptical. I certainly never expected an apology. I didn’t deserve one.
He seemed to relax as it became evident he wouldn’t have to chase me anymore. His choice of words became less stiff. “Dr. Mackie explained to me that sending my mother home had been an error in judgment, not outright negligence on your part, and that I shouldn’t try to damage you in court.” He stopped for breath. “Everything I’ve learned about you since tells me you’re a first-rate doctor. That’s all I wanted to say. I know you want to see Dr. Graceton, and I won’t hold you up a second longer. She’s also tops in my book. If there’s any need of more laboratory work for her, it would be an honor if you’d let me handle it personally. When it comes to testing procedures, I’m known for not hurting patients. That’s one of the reasons I was named chief technician. Dr. Mackie’s a real stickler about us not hurting patients.”
Without another word he turned, descended the stairs, and went out the ground floor door.
I should have been relieved, but I felt guiltier than ever. The whole time he was talking, beyond the sound of his insistent way of speaking, I kept being reminded of his mother’s voice. At first I wasn’t sure what it was they had in common—a pattern of inflection, certain rhythms of speech, shared phrasings—but I found it annoyed me. Then I had it. There was a certain tone that the two of them shared. In him it was only a hint, a vocal ghost of what had been a blatant trait in his mother. I probably would never have picked it out in his speech at all if I hadn’t met Phyllis Sanders first. But what I’d heard an echo of was her whining, the note of discontent that ran through everything she said, her means of announcing her disappointment in life, her way of implying the question Are you going to disappoint me too?
Disgusted with myself, I resumed my climb to the third floor. In the face of a difficult and generous deed by her son and in the light of what that same resentment of mine might have cost his mother, I still had enough spite in me to dislike even a reminder of her voice.
As I ran the rest of the way to ICU, I had a fleeting thought about Cam’s speaking to Miller on my behalf. Maybe, after having gone to the trouble of defending me, he felt betrayed by my breaking into his files, and that was why he was so angry this morning. But my preoccupation with Janet quickly shoved aside any further questions about his strange behavior.
The isolation rooms in ICU were identical to the glass coffins at St. Paul’s—elevated, situated against an end wall, and brightly lit compared to the subdued lighting throughout the rest of the unit. They also appeared small and claustrophobic, and as I approached the only chamber that was occupied, I felt my stomach knot. Through the windows I could see the backs of half a dozen residents wearing protective gear crowded around the bed, blocking my view of Janet. But nearing the door, I could hear her well enough. “Please stop, stop it,” she sobbed, then her plea exploded into a retching cry followed by gagging, coughing, and the rasp of stridor—the rattling wheeze of indrawn breath through an obstructed windpipe. The sound sent a chill through me. Something must have blocked her upper airway.
One of the residents uttered, “Christ! Get some atropine.”
“What’s happened?” I demanded from the doorway, frantically grabbing a gown from a pile on a cart and reaching for a mask. But as I pulled them on none of the residents answered me. Instead they started barking out panicky orders to each other and remained bent over the bed where I heard Janet continue to cough and struggle for breath.
“Turn her on her side!”
“Suction her!”
“It’s laryngeal spasm. She needs atropine!”
‘Tell me what’s going on!” I shouted as I strode into the room still pulling on a pair of surgical gloves.
A nurse turned from the bed and tried to block my way. “Sir, you aren’t allowed in here right now,” she snapped at me, placing the flat of her hands on my chest and pushing.
I brushed them off. “Like hell I’m not,” I snarled, shoving by her. “I’m Dr. Garnet, her husband.”
“You are not a doctor here!” she cried out in a shrill voice.
Ignoring her, I slid between the residents and saw Janet lying on her side, her face practically purple, and her entire upper trunk and neck straining to draw a breath. A thin plastic suction catheter dripping with saliva and vomit lay hissing on the covers in front of her. Scattered across the bed were unused culture bottles, swabs, and slides. My alarm rocketed. These dolts must have been trying to suction her trachea for a sputum sample. The muscles in her larynx and vocal cords had responded by locking into a protracted spasm and cutting off her airway. She might even have aspirated vomit into her lungs.
Fighting back my own panic, I reached for her neck. It was bulging with strands of tendons and webs of muscles as she struggled to gasp in a breath. I managed to palpate the pulse of her carotid artery, but I could count two seconds between each beat beneath my fingers.
Through clenched teeth I ordered the nurse who’d tried to bar my way, “Get me two milligrams of IV atropine stat!”
She simply stood
there.
“Move, you idiot!” I screamed at her, beside myself with fright.
She flinched, then turned toward a set of open shelves at the head of the bed where there were labeled trays of different drugs in single-dose vials.
Janet’s eyes were bulging at me. I didn’t know if she could see, but she grabbed at the front of my gown while her entire body bucked rhythmically in her continuing struggle to draw a breath. I clasped her hands to my chest. They were cold and slippery with sweat. “Janet, it’s Earl. I’m going to give you something to restore your airway. Just a few seconds more and you’ll be breathing.”
The nurse slapped two small brown vials down onto a nightstand and glared at me over the top of her mask.
Fuck you, I thought, turning for help to the residents instead. “Get me a ten-cc syringe and twenty-two needle filled with normal saline,” I snapped at the young man on my right To the woman beside him I added, “You get the crash cart ready and prepare to intubate, in case what I’m going to try here doesn’t work.” I spun around to face their colleague on my left, “You draw up ten milligrams of midazolam and a hundred milligrams of succinocholine. We may yet have to sedate and paralyze her.” They jumped to obey. After the mess they’d made, it obviously mattered little to them who I was, as long as I saved their patient and their asses.
More hideous rasping noises continued to come from Janet’s throat—the sound of air sucked through an opening in the vocal cords no bigger than a slit We probably had another thirty seconds before she’d start to seize. Cardiac arrest would follow. Right now she was still conscious and in agony.
“Hold her firmly and keep her head steady,” I told the three remaining residents, “but don’t hurt her, you hear me!”
“Yes, sir,” they mumbled in unison under their masks.
Death Rounds Page 23
