Extreme Measures (1991)

by Michael Palmer

  He entered the office and shut the door. In almost a fugue state, he pulled the envelope from the lower drawer of his desk and held the fine caduceus pin in his hand.

  From beyond the door he heard the sounds of the hospital. He deserved the promotion. The events in Trauma Two merely underscored that truth. He deserved it, and yet it seemed more than likely that in a matter of days, he would be looking for work.

  He ran his finger over the pin. Putting it on would obligate him to nothing. If the work Caduceus was doing was unacceptable, he could simply refuse to participate.

  Eric's pulse was raging in his ears as he ignored persistent pangs of uncertainty and fastened the caduceus to the lapel of his clinic coat.

  Between diving once or twice a day and running five miles several times a week, Laura Enders was in the best shape of her life. Even so, every muscle in her legs ached as she left the subway and climbed the stairs from the Charles Street station to the White Memorial overpass.

  She had spent her first full day in the city--two days ago--making countless lists of the places she would go, and locating those places on her map. Then, late that evening, she had picked up the fliers at the printer and begun her search in earnest, planning to work her way, one at a time, through the grids she had drawn on her map. By eleven the next night she had walked at least twenty miles and had left posters with two hundred bartenders, policemen, hotel workers, hospital clerks, and receptionists.

  The fliers, standard 81/2 by 11, black-on-white, had come out reasonably well, although the blowup of Scott's face was grainy, and flatter than she would have liked. She had stopped by Bernard Nelson's office and left half a dozen with his frowzy receptionist, who accepted them while barely missing a stroke in filing her nails.

  It was nearing nine in the morning, and for the first time since her arrival in Boston three days before, the sun was shining. Charles Circle was alive with traffic, ambulances, joggers, and streams of pedestrians headed from several directions toward the hospital. On a whim, Laura stopped in at the Charles Street jail and left off a flier. Then she fell in with the crowd and followed a stretcher through the emergency doors into White Memorial.

  She had been to the emergency rooms of two hospitals the previous day and was impressed by how busy each had been. But compared to White Memorial, they were serene. Everything and everyone in the broad, fluorescently lit receiving area seemed to be in motion. The scene reminded her of the teeming life above a coral reef.

  Three stretchers, each with a patient and two ambulance attendants, were lined up along one wall. A group of what looked like medical students were clustered in a doorway, listening intently to an older physician. Nurses and doctors in scrub suits crisscrossed to and from the broad semicircular reception counter, dropping off charts, picking up laboratory slips, or just pausing to talk. Behind the counter two women and two men jockeyed past one another, answering phones, responding to questions, and logging patients in and out of rooms diagrammed on a huge white acrylic tote board.

  Laura took a minute to gauge which of the four seemed the least harried. She settled on a slight, pale man with graying sideburns and an easy manner that suggested he was a veteran at his job. Then she timed her approach to coincide with his rotation from the tote board to the counter.

  "Help you?" he asked.

  "I hope so." Laura pulled two fliers from her shoulder bag and set them in front of the man. "My name is Laura Enders. I'm trying to find my brother, Scott. I was hoping there might be a place where I could put up one or two of these."

  "Have you checked to see if he's been a patient here?" the man said, scanning the sheet with no sign of recognition.

  "No. No, I haven't."

  Laura cursed herself for neglecting to do that at the two previous hospitals she had visited. At the same time, she pictured the posters she had left off crumpled in wastebaskets beneath counters similar to this one.

  "Well, why don't you let me call the record room and see if they have anything. Have a seat over there and take in the show."

  Relieved, Laura settled in a blue molded-plastic chair off to one side. At first she focused on the patients, some clutching wounded or aching parts, some strapped to wheelchairs, and some, it seemed, just hanging around. Gradually, though, her attention shifted to the doctors. Most of them, especially those in scrubs, were her age or younger. And all of them, men and women alike, looked exhausted and harried. Still, many paused for brief gestures of caring toward the patients--a touch or a word. And within the shadows surrounding their eyes was a snap and intelligence that made Laura feel she would enjoy working with these people. Several of the letters of inquiry she had sent out were to programs in physical therapy and rehabilitation. At that moment, heading her life in that direction felt right. Perhaps after she had found Scott ...

  "No luck."

  "Huh?" The emergency ward clerk was standing beside her. "Oh, I'm sorry. I guess my mind was wandering."

  "I understand," the man said. "I've been working here almost twenty years now, and sometimes I still find myself hypnotized by the whole thing. But I'm afraid there's no record of your brother ever having been here--inpatient or out. I checked both names on that poster of yours."

  Laura stood.

  "I really appreciate your help," she said. "Do you think you could put up the posters anyhow? I'm pretty desperate to find him."

  "I can show the picture around. But posting things out here is against hospital regs unless they're approved by--Wait a minute. The place you really want to put this up is in the residents' lounge. If anyone would remember seeing him, it would probably be one of the residents." He turned and called across to one of the doctors. "Eric. Hey, Eric. Got a second?"

  The doctor seated at a desk near the triage nurse turned and looked over at them. Of all those Laura had been watching, he was perhaps the most interesting, and, she acknowledged as he rose and came toward them, the handsomest as well. He was tall--six feet or a bit more. His face was dark and sharp-featured, reminding her a bit of Omar Sharif. And although Laura usually disliked moustaches, his seemed right. But what had impressed her most about the man were the little things she had watched him do with the patients--the warm smiles and reassuring touches.

  "Eric," the clerk said. "I think you might be able to help this woman here. Miss ..."

  "Enders," Laura spoke up. "Laura Enders."

  "This here's Dr. Najarian. He's our chief resident, and the best doc I've seen come through this place. I'll leave you with him."

  "Thank you," Laura said.

  The clerk looked from one to the other of them. Then his mouth turned up in a quick, knowing smile before he headed back to his post.

  Eric Najarian reached out and shook her hand.

  "Pleased to meet you," he said.

  Laura was staring at his face, and actually missed a beat in her response. His eyes were wide and dark and held a special attraction for her. And in the moments that followed, she realized why. They were like Scott's eyes, at once sensitive and intense; eyes that spoke of caring and of wanting to know.

  "I ... um ... I'm looking for my brother," she managed to say.

  "Is he lost?" Eric asked.

  "No. I mean yes. I mean he's missing." Sensing her cheeks beginning to redden, she quickly thrust a poster at him. "I flew up here three days ago to try and find him."

  "From where?"

  Eric continued studying the photo of Scott. For a moment Laura thought she saw something in his eyes--a flicker of recognition. Then, just as quickly, the look disappeared.

  "Little Cayman Island," she said. "It's in the Caribbean."

  "I know. Just south of Cuba. The best diving in the world, I hear. You dive?"

  "As a matter of fact, I'm an instructor. That's what I do there. Do you dive?"

  "I wish. In fact there are a whole bunch of things I wish I had time to do--or at least try."

  "I was watching you with the patients a while ago. Believe me, you do plenty."

/>   "Thanks."

  "For a second there, I thought you recognized Scott's picture. Did you?"

  Eric shook his head. "Something about his face is familiar, but nothing really clicks. I'll be happy to post this in the residents' lounge, though."

  "I'd appreciate that."

  "Where are you staying?"

  Before Laura could answer, a young resident came racing up to them.

  "Eric," he said breathlessly, "that GI bleeder in Four has really opened up. The stuff's pouring out of him, and his pressure's beginning to drop."

  Instantly, the softness in Eric's eyes vanished.

  "Is blood off?" he asked.

  "Off, but not cross-matched for another twenty minutes."

  "What is he?"

  "B-negative."

  "Jesus. Okay. Have them continue the cross-match and send up three units of type-specific. Use O-negative if they're short. I'll sign for them."

  "You coming back there?"

  "Right away."

  The resident hurried off.

  "Look," Eric said, "I've got to go. Let me leave you with someone who can help. Come on."

  Before Laura could tell him not to bother, he had led her to a nurse who was standing across the receiving area.

  "I've got trouble in Four," he said. "Do me a favor and see what you can do to help this woman out. Nice to have met you, Laura. Good luck with your brother."

  "Thank you," she said. But he had already hurried off.

  The nurse, a woman in her early fifties, watched him go, and then turned to Laura.

  "Now then," she said. "I'm the shift supervisor here. My name's Norma Cullinet. How can I help you?"

  It was all Norma Cullinet could do to maintain a facade of detachment and to concentrate on what Laura Enders was saying. Her hands were shaking so, that at one point the fliers she held in them actually began to rustle.

  "What did you say your brother did for a living?" she asked.

  "Computers. Scott's a computer genius. He works--I should say worked--for an international communications company. He traveled a lot in his work. The last time I heard from him was in February. The last card he sent me and the few before it were mailed from Boston. I'm leaving these all around the city, including the police stations and hospitals."

  "I see.... Well, I'll be happy to put one of them up for you in our nurses' lounge."

  "That would be great. Dr. Najarian also suggested the residents' lounge. Do you think you could tack one up there as well?"

  "Of course." Najarian. He was on that day. He handled the Code 99!

  "Thanks a lot. You've all been great."

  "No problem," Norma Cullinet said. "No problem at all."

  "Well, I'm off to canvass some computer stores," Laura said.

  "I wish you luck."

  Norma turned away as Laura was leaving, and then turned back to be sure she had gone. She stared at the face on the flier. Computer genius? With a sister? How could that be? The man with this face was a bum with no family. A wino. Perhaps she was wrong, though. It had been several months, and the snapshot wasn't all that clear. Perhaps it was coincidence--a marked similarity but nothing more. Two years, and dozens of cases without a hitch. Now this.

  Did Najarian make any connection? He'd given no indication that he had, but he was distracted by the GI bleeder. Is there anything to do? Anyone to tell? Craig Worrell would have known what to do. He always knew. Why in the hell did he have to screw everything up so badly?

  Once again Norma studied the photo. There was, to be sure, a strong likeness to the man who had called himself Phillip Trainor. But from what she remembered, there were differences as well. She was blowing things out of proportion--the way she always did.

  Blowing things out of proportion. That was it. Pure and simple. Still, she decided, until someone had been found to take over Worrell's role, she would refuse any further requests from Caduceus.

  Her neck and underarms damp with sweat, Norma Cullinet folded the fliers and thrust them into her uniform pocket.

  Fourth unit's up and running, Eric. Two more are on the way from the blood bank. What do you think?"

  Eric watched the steady spatter of blood from their patient's nasogastric tube into the suction bottle on the wall. They had tried medication, fresh clotting factors, and direct examination through a gastroscope, but nothing had slowed the bleeding, which was almost certainly from an ulcer, and possibly from an ulcer within a cancer.

  "I think we punt," he said to the resident. "Go ahead and get the surgical team that's up for the next case. This guy's reasonably stable right now, and I know they'd rather take over while he is. I'm going to take a break and get some coffee. Call me when the surgeons get here."

  Eric entered the reception area rubbing at a nagging stiffness along the base of his neck. He couldn't remember how many days it had been since he had last worked out. As with almost everything else in his life, there simply wasn't enough time. Perhaps if he got the associate's job, life would begin to normalize.

  Absently he fingered the pin on his clinic-coat lapel. This was his first full day in the E.R. since pinning it on. From what he could tell, no one had even taken notice of it.

  "You sore?"

  Charge nurse Terri Dillard, five foot one if that, looked up at him with concern. She was a crack E.R. nurse who spent her off-hours instructing at a school of holistic healing. Eric had no real feeling for the things she knew and taught, but it was common knowledge around the E.R. that her massage and therapeutic touch often had patients diagnosed or actually cured before a physician had even entered the room.

  "Accelerated aging," he said.

  She reached up and dug her thumbs into the muscles at the base of his neck.

  "Spasm," she said. "Everything's all knotted up. It's tension."

  "Me? What do I have to be tense about?"

  "Well, let's see." She continued to dig. "You're waiting to hear if you got a big promotion, you've got an active GI bleeder in Room Four, and a drop-dead-gorgeous brunette with an off-season tan just left before you could get her phone number. How's that for starters?"

  "Drop-dead-gorgeous? How could I have missed that?"

  "You didn't. That's what these muscles are telling you."

  "Are you a witch?"

  Terri stopped her massage. "Maybe," she said. "What'd the lady want?"

  "She was looking for her brother. She had a bunch of posters with his picture on them, and she wanted us to--Wait a second." He noticed Norma Cullinet crossing from the waiting room, and motioned her over. "Hey, Norma," he said, "did you put up those posters from that woman, Laura?"

  "Laura, huh?" Terri Dillard murmured.

  Beneath the rouge on her cheeks, Norma Cullinet paled.

  "I ... I didn't want to post anything without getting Dr. Silver's approval," she said.

  "That rule doesn't apply to the lounges," Eric countered. "Do you still have one?"

  Norma hesitated and then quickly pulled the folded fliers from her pocket and opened one up.

  "See," Terri said, "you're in luck. Laura Enders. There's her phone number. Right there."

  She and Eric continued to examine the photograph, unaware of Norma, anxiously watching their reactions.

  "Looks like he's wearing a wet suit," Terri noted.

  "It's possible. His sister's a diving instructor in the Caribbean," Eric said.

  Terri glanced up at him and smiled. "I can see that you took no notice whatsoever of how good-looking she was."

  "Witch."

  "So, any bells?" Norma asked.

  "It's a lousy photo."

  "Yeah," said Terri, "but I've seen that guy. I swear I have."

  "Norma," Eric asked, "why don't you stick one up on our bulletin board and one in the nurses' lounge? Maybe Terri'll think of where she saw him. Who knows, Ter, maybe you'll get the reward."

  Terri Dillard pointed to the telephone number.

  "Maybe you will, too," she said, "if you can get your head out
of medicine long enough to make a call."

  "Fat chance."

  "Well," Norma said cheerily, "let me know if you figure out who this fellow is."

  "Sure," Terri said. "But why?"

  "No reason. I'm just interested. There was something about his sister that ... that reminded me of one of my favorite students."

  At that moment the corridor doors flew open, and a large group of surgical residents and medical students entered the E.R. Leading the entourage, erect as a post, was Dr. Sara Teagarden.

  "So, where's this bleeder of yours, Dr. Najarian?" she asked.

  She was wearing a knee-length clinic coat over her scrubs, and paper booties over her O.R. shoes. And as usual when she entered a room, the idle chattering and random movement of people lessened dramatically. Although he didn't particularly like her, Eric had to acknowledge that Grendel was a force--one hell of a presence.

  "He's in Four, Dr. Teagarden," he said.

  Teagarden motioned her team toward the room with a shake of her head.

  "How many units so far?" she asked, nudging her gold-rims back onto the bridge of her nose.

  "Probably six by now."

  "We would have preferred being called at three."

  "I understand."

  In spite of himself, Eric felt intimidated by the woman. Five units before a surgical referral was pretty much standard practice, but he made no comment.

  "You called the GI fellow down to scope him?"

  "We thought he might be able to get at the bleeding point," Eric responded, already sensing the next volley.

  He had, under the stress of a life-threatening emergency, made certain decisions. And now, even though the patient had been skillfully stabilized, those decisions were being challenged by one of the three people in the hospital he least wanted to confront.

  "We'd rather scope our own patients," Teagarden said. "I thought I'd made that clear at the last residents' meeting."

  "What can I say?"

  Teagarden looked at him coolly.

  "What you can say, Dr. Najarian, is that when a system is in place with established guidelines, and you have contracted to be part of that system, you are willing to follow those guidelines."