by Robin Cook
“I’m Dr. Stapleton,” Jack said. “Do you happen to know who the on-call cardiology resident is?”
“I don’t, but I’ll find out,” he said before bellowing the question to a colleague within the treatment area, which the main desk opened onto on its opposite side. He put his hand behind his ear to catch the response. The other individual was out of Jack’s line of sight.
“Dr. Shirley Mayrand,” the nurse said, redirecting his attention to Jack.
“Do you know if Dr. Mayrand is in the emergency room at the moment?”
The nurse shrugged his shoulders. “No idea.”
“How can I page her?”
“I can do it for you.” Salvador said. He picked up the phone and dialed the page operator. “Should I page her for the emergency room?”
Jack nodded. “I’ll wait right here.” He turned around and gazed at the scene. If nothing else, it was visually entertaining. Spread out in front of him and filling the vinyl waiting-room chairs was an egalitarian slice of New York City life in both its glory and banality. From crying infants to the tottering aged, from homeless bums to folks in fancy clothes, from the drunks to the mentally anguished, from the injured to the sick, they were all there, waiting to be seen.
Hold your horses,” Thea shouted at her jangling phone. She was trying to fill out a supply requisition form. Giving up, she picked up the phone. It was the night shift OR supervisor, Helen Garvey.
“What’s your bed count?” Helen demanded without mincing words.
“Occupied or empty?” Thea questioned.
“Now, that’s one of the dumber questions I’ve heard tonight!”
“You’re in a bad mood.”
“I have a right to be. According to the ER, we’re about to be inundated with trauma cases, and the first wave is on its way up. There was a head-on collision with a bus and a van, and the bus went over a guardrail. As I understand it, they distributed the victims, but we got the lion’s share. I’ve contacted all the on-call people so we can be running up to twenty ORs. It’s going to be a long night.”
“I’ve got thirteen patients with only three empty beds.”
“That’s not encouraging. What are the patients’ statuses?”
Thea let her eyes roam around her domain while she mentally reviewed each case. “Everybody is in good shape except for an abdominal aneurysm re-bleed. He’s got to stay, because he might have to be opened up yet again. He’s still losing blood out of his drain.”
“So the others are stable?”
“At the moment.”
“Then clean house, because you’re next for this tidal wave.”
Thea hung up the phone. She was psyched. Challenges like this were her forte. “Listen up!” she called out to her troops. “We’re switching to disaster mode, and this is no drill.”
The release of the wheels jolted Laurie from her drugged slumber to a semiwakefulness. Her eyes squinted against the bright overhead fluorescent lights, and for a moment, she was disoriented to time and place. There was another jolt when the bed began to move, and the jostling brought a brief but sharp reminder that she had had intra-abdominal surgery. All at once, Laurie knew where she was, and the large clock over the PACU room’s door, which she was approaching, told her the time: It was twenty-five minutes past two.
Turning her head to the side in response to a babble of voices, Laurie caught a glimpse of the flurry of activity at the central desk. Bending her head back so she could see behind her, she looked up at the face of the orderly pushing her. He was a rail-thin, light-skinned African-American with a pencil-line mustache and graying hair. The muscles of his neck stood out as he strained to angle Laurie’s bed toward the swinging doors.
“What’s happening?” Laurie questioned.
The orderly didn’t answer, focusing instead on stopping the bed’s forward motion before backing it up a few steps. The PACU’s doors had burst open. Another bed was coming into the room with a patient fresh from surgery. There was a person at the foot of the bed, pulling, and another at the head, pushing. An anesthesiologist walked alongside, maintaining the patient’s airway patent by holding the individual’s chin back. All three seemed to be talking at the same time.
Laurie repeated her question to the orderly behind her. She felt the stirrings of apprehension in the pit of her stomach. Something was up. Her understanding was that she was not be moved until Laura Riley came in to see her in the morning.
“You’re going to your room,” the orderly said, preoccupied with maneuvering Laurie’s bed to allow the incoming patient to get by.
“I was supposed to stay here in the PACU,” Laurie said with building alarm.
“Here we go,” the orderly said as if he’d not heard Laurie. He grunted as he managed to get the bed rolling forward again.
“Wait!” Laurie yelled. The effort of her outcry made her wince with pain from her incision.
Shocked by Laurie’s outburst, the orderly halted the bed yet again. He looked down at her with concern. “What’s the matter?”
“I’m not supposed to be leaving here,” Laurie stated. She had to talk loudly to be heard over the general level of conversation in the room. To keep the pain to a minimum, she had to press her hand gently over the upper part of her abdomen to avoid jostling the lower part. Earlier, when Jack had visited, she’d had very little discomfort from the operation. Unfortunately, that had changed.
“I got strict orders to take you to your room,” the orderly said. His expression was half defiant, half confused. He took a piece of paper out of his pocket and glanced at it. “You’re Laurie Montgomery, aren’t you?”
Ignoring the orderly’s question, Laurie lifted her head off her pillow and looked over at the central desk, which was a beehive of activity. Ahead, the doors to the hall burst open again and another patient, fresh from surgery, was whisked into the room. Once again, the orderly had to back Laurie’s bed up to allow them to pass.
“I want to talk to the charge nurse,” Laurie demanded.
With obvious indecision, the orderly looked back and forth between Laurie and the central desk. He shook his head with frustration.
“You’re not taking me anywhere,” Laurie stated. “I’m supposed to stay here. I need to talk with a supervisor. Anyone in control.”
Shrugging his shoulders in resignation, the orderly walked over to the counter, leaving Laurie and her bed stranded in the middle of the room. He was holding in his hand the piece of paper he’d taken from his pocket. Laurie watched as he tried vainly to get someone’s attention. When he did, the person pointed out a square-built woman with a helmet of blond hair. Laurie watched as the orderly showed Thea his paper then pointed in Laurie’s direction.
Thea bounced her palm off her forehead as if dealing with this new problem was the last thing she needed. She rounded the edge of the central desk and walked directly up to Laurie, the orderly a few steps behind.
“What’s your problem?” Thea demanded. She had her hands on her hips.
“I was supposed to stay in the PACU until Dr. Riley saw me,” Laurie said as she struggled to think what to say. Coupled with having been just awakened by such an urgent situation, the lingering effects of the drugs and anesthesia were causing her mind to work in slow motion.
“Let me reassure you that you are doing just fine. You’re as stable as the rock of Gibraltar. You don’t need the PACU, and unfortunately, we have a slew of patients who do. We’d love to entertain you all night, but we have work to do. So, until next time, be well!” With a final reassuring squeeze of Laurie’s forearm, she turned back to the central desk, immediately barking orders about another patient to one of the other nurses.
“Excuse me!” Laurie called after her vainly. “Can you call my doctor, or can you let me make a call?”
Thea didn’t even turn around. She was already immersed in the next problem.
The orderly returned to his position behind Laurie’s head and once again got her bed rolling. He aimed it a
t the PACU double doors, and the bed collided with them and pushed them open. Out in the hall, he struggled to orient the bed parallel with the corridor before getting it to move forward. Laurie noticed several gurneys parked against the wall, with patients waiting to be taken down to operating rooms.
“I need to make a phone call,” Laurie said as they passed the surgical desk.
“You’re going to have to wait until you get in your room,” the orderly said. He aimed the bed at the doors leading from the operating room.
A sense of desperation gripped Laurie as they reached the bank of elevators. She was being rudely removed from her promised sanctuary and thrust out in harm’s way, and she was powerless to prevent it. Suffering the double whammy of weakness from blood loss and pain with the slightest movement made it hard for her to imagine herself any more vulnerable. And remembering her list of how the patients in her series had been related, she knew she fit the profile. She was the right age, she was healthy, she was on an IV, she’d had surgery, and she was a relatively new subscriber to AmeriCare. Her only consolation was in statistics and the fact that Najah had been arrested.
“Where am I going?” Laurie asked, trying to find a ray of hope. “To ob-gyn?”
The orderly consulted his piece of paper. “No! They’re full in OB-GYN. You’re going to room 609 on the general surgical floor.”
Laurie closed her eyes as she felt a shudder pass through her.
twenty-two
DR. STAPLETON! HEY, DR. STAPLETON!”
Hearing his voice over the buzz of conversation and the sound of crying infants, Jack looked back at the emergency-room desk. With all the caffeine on board, he’d been pacing back and forth from the desk to the front doors, intermittently staring outside at the rain falling on the cement of the wheelchair ramp. As the time had passed, he had begun to think of switching to plan B, which was to give up on the Post-it quest, run back to the OCME, grab the material in Laurie’s desk, and beat it back to the Manhattan General. It was two-thirty in the morning and he’d already been away for an hour and a half.
Jack could see Salvador waving for Jack to come back to the desk. Next to him was a girl who looked as if she were fifteen. She had straight, shoulder-length, light brown hair, parted in the middle and swept back on either side behind conveniently large ears. Her eyes were huge and separated by a narrow, upturned nose.
“This is Dr. Shirley Mayrand,” Salvador said, motioning toward the cardiology resident as Jack quickly returned to the counter.
Jack was momentarily mesmerized by the woman’s youthfulness. For the first time in his life, he felt old. Although he was pushing fifty, playing basketball with kids half his age made him forget how old he really was. As the cardiology resident on call, this woman in front of him had to have been through college, medical school, and a significant number of years as a resident.
“What can I do for you?” Shirley asked. To Jack, even her voice sounded prepubescent.
After Jack introduced himself, he fumbled with the page from Sobczyk’s chart, placed it on the countertop, and folded out the electrocardiograph tracing.
“I’ll leave you two,” Salvador said and walked away.
“I know this is not much,” Jack said, pointing to the strip of EKG, “but I was wondering if you could comment on it.”
“It’s awfully short,” Shirley complained while bending over the tracing.
“Yeah, well, it’s all we have,” Jack said. He noticed that the part in Shirley’s hair meandered around as it made its way from her forehead over the crown of her head.
“What lead is it?”
“Good question. I have no idea. It was a strip taken at the outset of an unsuccessful cardiac resuscitation.”
“Probably one of the standard leads,” Shirley remarked.
“Maybe so,” Jack said.
The resident looked up. Jack realized one of the reasons her eyes appeared so big was that he could see the whites all the way around her corneas. It gave her the look of continuous, innocent surprise.
“I don’t know what I can say,” Shirley said. “You’d really have to show me more for me to be able to comment with any confidence.”
“I assumed as much,” Jack said. “But this tracing is from a patient who unfortunately is already dead, which you know since I said it was taken at an unsuccessful resuscitation attempt. My point is, it’s not going to be to the patient’s detriment if you take a wild guess, say, if you were forced to come up with some opinion. Anything.”
Shirley looked back at the tracing. “Well, as you certainly have already noticed, it does suggest a widening of both the PR interval and the QRS complex, while the QTRS seems to have been fused with the T wave.”
Jack gritted his teeth. Somehow, it seemed unfair that this petite, youthful woman made him feel both old and stupid. “Maybe,” Jack suggested, “it would be best if you could limit your comments to something that I can understand. I mean, you could tell me your impression without telling me how you came to it.”
“Well, it does suggest something to me,” Shirley said, looking up at Jack. “But I have an idea.”
“Okay! What is it?”
“Dr. Henry Wo, one of my attendings, happens to be here in the ER at the moment. He’d been called in to do an angiogram on a suspected acute myocardial infarction. Why don’t we show it to him.”
Jack was pleased. The possibility of getting an attending’s opinion in the wee hours of the morning hadn’t even occurred to him.
“Come on around into the ER proper!” Shirley said while leaning over the counter to point out the route Jack would have to take. “I’ll meet you and take you back to the cath room, where he is working.”
The elevator doors opened, and with a grunt, the orderly got Laurie’s bed to roll out into the lobby on the sixth floor. Since there was a slight discrepancy between the level of the floor of the elevator and the lobby floor, there was a jolt, and Laurie grimaced from the pain it caused. It was apparent that whatever she’d been given for pain had all but worn off.
Although Laurie felt just as panicky as she had when she’d first left the PACU, she’d at least reconciled herself to the reality that there was little she could do until she got to use a phone. She’d asked the orderly where her belongings were, with the idea of getting a hold of her cell phone. Unfortunately, he’d said he had no idea.
The orderly pushed her down the short corridor from the elevator lobby toward the nurse’s station, which loomed like a beacon of bright light in the dimmed and mostly sleeping hospital. The recessed nightlights with frosted glass were spaced at intervals along the walls, about two feet off the floor.
After getting the bed up to the speed of a brisk walk, the orderly had to struggle to get it to stop abreast of the nurse’s station. Once he did, he engaged the foot brake before leaving Laurie and approaching the counter over the nurses’ station desk. Laurie could see the tops of two female heads—one with cropped hair, the other with a ponytail. Both women looked up when the orderly plopped Laurie’s metal-covered hospital chart on the countertop.
“Got a patient for you people,” the orderly said.
Laurie saw the woman with the cropped hair take the chart and read the name emblazoned on the front. She immediately stood up. “Well, well, Miss Montgomery. I must say, we have been wondering where you were.”
The two nurses came around from behind the desk while the orderly walked back toward the elevators.
Laurie watched as the women approached her bed, each going to a separate side. Both were dressed in hospital scrubs. The one with the cropped hair had dark skin, almond-shaped eyes, and a narrow, aquiline nose. The other’s complexion was paler, with broader features that gave a hint of an Asian mix. Since both faces were illuminated from below by the nightlights, only the bony prominences were clearly visible. The rest of their faces was lost in relative shadow. To Laurie, who was already anxious, they looked decidedly creepy.
“I need to use a phone,”
Laurie said, looking from one to the other, unsure if one was more senior than the other.
“Jazz, I’ll take her down to the room and get her settled,” the Asian-appearing woman said, ignoring Laurie’s comment.
“That’s good of you, Elizabeth,” Jazz said, “but I think I’ll take care of Miss Montgomery personally.”
“Really?” Elizabeth questioned. She was obviously surprised.
“Hello!” Laurie said with some annoyance. “I need to use a phone!”
“Suit yourself,” Elizabeth said to her colleague and walked back toward the nurses’ station.
Jazz tossed Laurie’s chart onto the foot of Laurie’s bed and went behind to start pushing.
“Excuse me!” Laurie said, rolling her head back to keep Jazz in view. “It is very important for me to use the phone.” She grimaced as the bed’s brake was released, and again when the bed lurched forward down the long, dark hall.
“I heard you the first time,” Jazz said. Her voice reflected the strain of pushing the bed. “I think I should remind you it’s two-thirty in the morning.”
“I know what time it is,” Laurie snapped. “I have to call my doctor. I’m not supposed to be here. I was supposed to stay in the PACU until she came in to do her rounds in the morning.”
“I hate to break this news to you,” Jazz said. “But your doctor, like all the other doctors, is fast asleep. She doesn’t want to be disturbed about some logistics problem.”
“Stop this bed at once,” Laurie commanded. “I’m not going to this room.”
“Oh?” Jazz questioned, but she didn’t so much as hesitate. She continued pushing Laurie’s bed at a speed significantly quicker than the orderly. She was eager to get Laurie to her room. Earlier that evening, when Jazz had first come into the hospital, she had trouble locating Laurie. At first she thought perhaps Mr. Bob had made a mistake about the name of the hospital, but it turned out the problem was only a delay in Laurie’s name being entered into the hospital computer system. Jazz had figured that out when she’d checked the ER log while getting the potassium ampoule.
