by David Bajo
“Where are we going?”
“To Pathology. The morgue.”
“Shouldn’t you go to Peterson?”
“Peterson is going to Thorpe.”
When they reached the steel elevators, Mendenhall jammed her express card into the slot. The doors opened immediately. Inside, she waved the card at Mullich. “Can you make one that turns back time? Or vaporizes things?”
“Things like what?”
“Like Thorpe.”
He flinched, crossed his arms, pulling his shoulders in.
“Sorry.” She apologized in order to get an explanation. She wasn’t sorry.
“It’s okay.” His accent bent and held the last syllable. “But I have worked on buildings where requests like that were not jokes.”
The elevator was silent, felt still. Mendenhall wondered if they were even moving.
“I love basements,” Mullich said, his breath still quickened from her pace. “The morgue is the only space in this hospital that makes sense.”
4.
Pathology felt quiet. They heard music coming from one end of the ward, something spare, a contemporary chamber piece.
Which meant Claiborne was on duty, which meant hope
for Mendenhall versus Thorpe. She quickened her steps toward the music, enjoying the emptiness, the distilled basement light, no nurses. They saw a lab tech in mask, gown, cap, and gloves cross the center foyer. The glass walls were dark except for one section. Mendenhall led Mullich to that door and reached for the handle.
“Shouldn’t we prep?” he asked her.
“Prep?”
“Like them.” He nodded to the tech and Claiborne, who stood in full surgical garb behind the glass, their hands held still and curled above the bodies.
Mendenhall opened the door. “Just wash your hands after. And try not to breathe.”
Claiborne pulled down his mask when they entered. “Dr.
Mendenhall.” The blue mask bobbed under his chin. He ignored Mullich.
The three bodies were uncovered but still clothed. A violin, a cello, and a piano took turns playing the same phrase. The janitor’s name was Dozier, E.; the patient’s name was Fleming, L. and the visitor with the pretty eyes was Verdasco, R. Verdasco’s face was pretty, too. His hands, which lay straight along his sides, were delicate. He could be playing this music, thought Mendenhall. Any one of the instruments. Then she noticed something about Dozier.
His shoulders were in slightly concave position, a tiny beckon in his arms.
“You see posturing there?” She nodded toward Dozier.
Claiborne dipped his shoulders side to side, sizing up the body.
“That’s a stretch. They found him on his ladder. He was about to replace a fluorescent. I mean, the ladder could be the cause of the shape.”
“No,” she replied. “It’s posturing. Let’s get scans of his head and neck. Right away.”
Claiborne wagged his head. The tech looked at him. She was about to draw blood. Mendenhall had placed Claiborne in a moment, in a decision that might determine whether they all went home tonight or whether they had to spend a night in Castle Thorpe while his ID team ran blood work. If she could find trauma in Dozier, they might be free. Claiborne eyed her. They sometimes saw each other running on the exercise course, a path woven around the hospital grounds. This was the expression he gave her whenever she attempted to pass him. He would check her, a flicker of exasperation across his features, then increase pace and pull ahead. He had the waist of a sprinter.
“I was supposed to be done at seven,” he said. “Surgery sent me three biopsies, then these came down. I got shows to watch tonight. My wife made pad thai.” He widened his hands above the bodies. “But these really do seem to be Thorpe’s. All from here in the hospital, all generally from the same time. All fast.”
“Just give me this one? So we have some leverage on him?”
“They still yours?”
Mendenhall nodded, hoping. “I have to do all their charts.
Except her. ” She motioned toward Fleming, the one with the patient gown and bracelet. “She’s somebody else’s patient.”
“No, her, too,” he told her. “Seems she was officially checked out. Was gabbing with her roommate in recovery, having a Jell-O
together, then collapsed across her roomie’s bed. You get to start a whole new chart.”
Mendenhall sighed, started to raise her hand to her brow, then thought better of touching her face. “What was she in for?”
“Foot surgery.” Claiborne nodded toward Fleming’s right ankle.
The toes were thin and pale, the nails freshly painted red, post-op no doubt.
Mullich finally spoke. “How come you know everything?”
Claiborne only glanced at him before going back to Mendenhall.
“Because this is Hell. We end up knowing everything that happens.”
He motioned toward the ceiling but kept his eyes on Mendenhall.
“Up there.”
He kept looking at Mendenhall as he spoke to Mullich.
“Following her will give you the wrong impression of this building.
I wouldn’t advise it. Dr. Mendenhall still does the footwork. No one does that anymore. Not even the nurses. Just like now. Just like she came here.” With his gloved hand still curled, he motioned to the laptop on a side table. “On that screen there are probably five requests—orders—sent by Thorpe. Blood work. But right there,” he punched his hand toward Mendenhall, “is her. In person. Here to see me. Pay us a visit. Help us.” He extended the last two words. “I haven’t even seen Thorpe for over a year. To him, I’m a name at the bottom of a result.”
“It’s because I like people so much.” Mendenhall looked at Claiborne’s tech.
“It’s because you like bodies. The body.” Claiborne blew a hard breath, then gave orders to the tech. “Start blood work on Verdasco and Fleming. Zap Dozier.”
“Thank you, Dr. Claiborne.”
“Just get us out of here before midnight.”
She started to reply, but Claiborne raised his hand and closed his eyes. He held a gloved finger near his lips, shushing. He pointed up to the music, the weave of the violin, cello, and piano. “This is the best part.”
They listened to the quiet music and watched as the tech rolled Dozier to a corner of the lab. Mendenhall couldn’t really see the posturing anymore, any real lift in his shoulders that might indicate trauma. Infection was most likely, given the timing, place, and disparate persons. A janitor, nurse, patient, visitor. But the timing was almost too good. All must have been found within the same five minutes or so. All must have died fairly quickly, fairly together, either before or during their transport to the ER. A janitor slumped over a ladder. A patient slumped over another’s bed. Where had Peterson and Verdasco been found? How long had each of them lain undiscovered, unattended? . . . How bad was this hospital? She looked at Mullich, who was scanning the room, using Claiborne as a pivot for his gaze. How sick was this building?
5.
She returned to her ER cubicle to do charts. Mullich was no longer following her, no doubt more intrigued by Claiborne’s Hell. Doctors hated charts because charts were menial, below a physician’s station. Mere data entry, what her mentor had called paperwork. But the most profound cause of that hatred was the fact that charts acknowledged an overseer, reminded a physician that all her decisions and acts were up for assessment, even though 99 percent of those decisions and acts were repetitions, determined by precedent. And that last fact was the most difficult part of the acknowledgment, that what they were all doing was mimicking, robotics, child’s play.
But these four new charts tagged on to the end of Mendenhall’s long day were different; she saw them as an act of organization and self-checking, probably what charts were originally meant to be, way back when Mercy General had been built, when the telescope on the roof had been whole and aimed toward the Milky Way.
Enry Dozier was a fifty-three-year-old janitor with a
clean work record during seven years of employment at Mercy. His medical history was in the system and showed nothing unusual, nothing more than a slightly elevated BP, almost average for a black male. He never missed the hospital’s required checkup. He had been found slumped over his ladder in the seventh floor hall, one fluorescent tube leaning against a rung, the other shattered along the floor, presumably dropped. He was at the far end of the hall, past the patient rooms, so it was unknown how long he had been like that before being discovered by a patient taking a prescribed hall walk.
He had been unresponsive during transport to the ER.
Lana Fleming, a sixty-three-year-old retired middle school teacher, had been admitted for surgery to scrape bone chips from her talocrural joint. The procedure had been successful. Her medical history was in the system and showed nothing unusual, nothing more than being overweight, average for a white female over sixty.
The bone chips indicated that she had been athletic until her fifties. On the fourth floor, she had slumped over her roommate’s bed while sharing tea and dessert. She had been standing over the woman’s bed, making plans to get together after recuperation.
Fleming had been checked out but hadn’t changed out of her gown.
The roommate had buzzed for the nurses immediately. Fleming had been unresponsive during transport to the ER.
Marley Peterson, a forty-one-year-old surgical nurse had been at Mercy for ten years. Her work record was stellar; her medical history, which was in the system, was marred by a smoking habit that had yet to exhibit any health repercussions. She had never missed the hospital’s required checkup. The only prescription after every six-month checkup was to stop smoking. She had been treated for staph infections twice during her Mercy career: one MRSA, one VRSA. She had been discovered in a second-floor ventilation room that was also used for water storage. A worker from the physical plant, retrieving a jug for a water cooler, had found her slumped on the floor and alerted nurses. She had shallow breathing and pulse during transport to the ER.
Richard Verdasco, in his early thirties, had been visiting his mother in ICU. His medical records were not in the system. The mother, Lupita Verdasco, was in post-op ICU, not conscious after surgery to remove a brain tumor. Richard Verdasco had been found slouched in an armchair in the visiting area, a magazine across his lap. Another visitor sitting in the same area at first had thought he was sleeping but had alerted nurses after noticing that his eyes were open and unblinking. Verdasco had been unresponsive during transport to the ER.
It was infection, Thorpe’s domain. She should take advantage.
The ER would go still without incoming. She could run on the treadmill in PT, have a yogurt, granola, and apple at the cafeteria, take a whirlpool in fourth floor recovery, nap in the surgeons’ lounge on Two. Claiborne would be furious about having started things with the Dozier case, but she never needed Claiborne because by the time stuff got to him, the patient was no longer hers, was either dead or parsed out to a real specialty. Claiborne needed her. He needed her for any decent consultation on trauma.
She petted her screen, scrolling down the four charts. Did they make it feel like skin on purpose? All first-year med students are assigned virtual patients. Some create avatars, whether allowed or not. That was one of the biggest changes in medicine, her mentor claimed. They often argued over whether this was good or bad, changing sides depending on what they’d seen that day in the ER.
She looked at Dozier’s chart. Then she gazed unfocused over the bay. This was what she did instead of closing her eyes. She pictured Dozier three ways, recalling him in the ER and Pathology, then imagining him slumped over his ladder. She hadn’t really seen any posturing, any signs whatsoever indicating disconnection.
We see what we are, her mentor had told her. Take one patient complaining of headache and fatigue and send him to four different specialists. You will receive four different diagnoses, four different prescriptions. Throw in one meddling aunt and receive another diagnosis and another prescription. Pathologists are different—
different but not exempt. They see pathology. But is there always a pathology? Believe in life, Dr. Mendenhall, he told her. That there is something beyond diagnosis and pathology.
Pathology buzzed her, one word from Claiborne: Come.
6.
Pathology seemed darker. Maybe it was the increased coolness and the change in music, an even more spare solo violin piece.
Maybe it was the bodies, now naked, with a fourth steel bed empty and waiting. Maybe it was the way Claiborne, Mullich, and the tech were standing. Claiborne now had Mullich in gloves and mask. At first she thought the architect was a cutter. The three stood in waiting formation, turned toward her entrance.
The mix confused her. The coolness meant Thorpe was setting things up for a long haul. The garb for Mullich indicated this also.
The presentation of the bodies appeared Thorpe-ready, propped with limb angles measured and even. The empty bed—“Don’t call them tables,” Claiborne had insisted the first time she had made the mistake—held intrigue. Thorpe would keep Peterson alive on paper for as long as possible to get the best cultures, even if she had a DNR. Peterson was too young for a DNR. But she was a nurse, no doubt a human petri dish, perfect collateral for Thorpe.
Mendenhall put on fresh gloves when she entered but ignored the crisply folded mask. She eyed the empty bed, then checked Claiborne.
“That one’s for you,” Claiborne told her.
She’d been awake for twenty hours straight. This was a dream.
Claiborne motioned his mask and gloves toward Mullich. “His idea. A fourth bed just to give you the best perspective.”
Claiborne went to Dozier, who was first in line. That was strange, too, the way the beds were ordered: Dozier, Fleming, Verdasco, then the empty steel for Peterson, the four aligned in a neat slant rather than squared.
“Him again,” said Claiborne, nodding toward Mullich. “They’re arranged according to the floors they were found on.”
The others followed him to Dozier.
“Look at him first,” he told Mendenhall. “Head and neck. Then go to the scans.”
“Scans? You took scans?”
“You’ll see.”
She crouched to get a level profile of Dozier. The skull was balanced on the occipital, cleanly presenting throat and nape. His beard had been combed into a point. His lips were in repose, not yet slipping into grimace. With two fingers, she palpitated what could have been slight swelling beneath his Adam’s apple. “Maybe something there.” She shrugged. “Not worth a scan. I thought you would just run an X-ray.”
Claiborne led her to the side table, a stand-up metal desk, out of place because of the lamp and pens and books and paperweights, little gifts. He flicked on one display above the desk, showing the X-ray. He left the one with the CT dark.
“I did what you just did,” Claiborne told her. “I looked at him, pressed his throat, then walked to the X-ray.” He nodded to the X-ray. “So I wasn’t expecting that.”
The display showed diagonal occlusion from occipital to throat, the point of minor swelling. Mendenhall squinted. There was a path of displacement and internal bleeding through the neck.
“So we ran this.”
The scan clearly showed that the spinal cord and vertebrae were clean. The trauma was all capillary bleeding, all in the tissue, the major vessels and bone clean and undamaged. The skin appeared intact, certainly no wounds.
“Does that mean no infection?” asked Mullich.
“Nuh-uh.” Claiborne kept looking at the scan. “It just seems a little too clearly defined for infection.”
“You’d expect it to wander more,” Mendenhall explained.
“Infection.”
“But I have seen linear infection paths.” Claiborne drew the diagonal across the scan.
“Yeah,” said Mendenhall. “Following a stab line. A long puncture.”
“I’ve seen fungals a little like this.” He
looked at the tech. “I showed you that one. Absolutely geometric. Crystalline.”
Mendenhall grabbed a horn-rimmed magnifying glass from the desk and went back to Dozier’s body. Only after she began the move did she sense transgression on her part, a passing of Claiborne. The tech and Mullich turned with her but did not step, just broke formation, torn and hesitant.
She bent close to Dozier’s throat, lens held above the tiny swelling.
Claiborne led the others to Dozier, bringing a wireless otoscope.
With precision, he took the magnifying glass from Mendenhall’s fingers and gave her the scope. It was laser-aimed. The halogen light was intense enough to turn Dozier’s dark skin translucent.
Mendenhall’s pan was transmitted to a large overhead screen. They saw what she saw. The view was near-microscopic: dead skin cells sloughing, pores gaping, curled whiskers rooted.
“I see a line.” Mendenhall drew the laser along a straight path of sloughed skin cells. She lifted her eyes to Claiborne.
“From shaving,” he said. “A week ago, I’d guess. You can find a dozen of them on his throat. You’ll find some more on the nape, especially around the occipital. When we turn him over.” He nodded to the tech. “Tilt him.”
With a delicate lift of Dozier’s shoulder, the tech presented the nape and the base of the skull for Mendenhall.
“I need to get me one of these,” said Mendenhall. She raised the scope a little to clarify that she was speaking about it, not the tech, though she might have meant both. She sought refuge in the close view of Dozier’s skin, the epidural landscape. She did see more of those lines, not cuts, not scarring, just cells scraped evenly by a razor, days ago, weeks ago. She saw the salt crystals of Dozier’s dried sweat.
Claiborne cleared his throat. The tech shuffled her feet. Mullich remained quiet. She could sense him waiting, not just watching.
She found a cluster of blood cells clinging to the corner of a salt crystal. Moving diagonally just below the occipital, she found another. Following the same line, she slid her view up the periphery and found a third cluster, dried purple, trapped in a sheer on the base of a salt crystal.
