Warning Signs

by C. J. Lyons

  “The fluids and oxygen did that. But I need to monitor you. You could be having what we call a STEMI; it’s a type of heart attack.”

  “Told you, my heart feels fine.” Mrs. Grey sat up, pulling the oxygen mask away from her face. “And this air blowing in at me smells disgusting.”

  Lydia switched her to a more comfortable nasal cannula. “I really need to watch you for a few hours. We’ll get lunch for Deon; he can stay with you.”

  Too late she realized that Nora Halloran stood behind her. Providing food for patient’s families was against the rules—as was allowing unaccompanied minors to remain with a patient.

  “Dr. Fiore, I need a word,” Nora said.

  Lydia winked at Deon, handed him an extra copy of the EKG to ponder over, and closed the curtain behind her before joining Nora. She spotted Lucas Stone and Amanda escorting her neuro patient down the hall.

  “Lucas was able to get her into an MRI slot,” Nora explained.

  “Helps to have a neurologist pulling strings.” Lydia grabbed Emma Grey’s chart and began signing off her verbal orders. No matter how urgent a case, there was always paperwork to contend with—and now with all the charts computerized, also additional time spent with the electronic medical record.

  “You want me to call social services?” Nora asked.

  “For what?”

  Nora stopped short of rolling her eyes. They both knew Lydia wasn’t that dense. “When they signed Deon in, they used an outdated medical assistance card and gave a fake address and phone number. We don’t even know if the grandmother has legal custody.”

  “Do you think social services is going to magically find them health insurance, a home, and a phone?” Lydia was jaded when it came to the power of social workers to cause more good than harm.

  Nora blew her breath out, twisting her fingers through her shoulder-length red hair. She ignored the clerk trying to hand her a phone. “Odds are the grandmother—if she even is his grandmother—will be admitted. What’s going to happen to Deon then? He can’t stay with her in the ICU. Not even on the regular floor.”

  “Let me see what I can do.” Lydia hated that Nora was probably right. She didn’t want to think of separating Deon from Emma. “In the meantime, since Deon is technically signed in as a patient, why don’t you order him a breakfast tray. And a lunch one.”

  Nora shook her head and shrugged in surrender, taking the phone from the clerk. Lydia moved on to her next patient, but couldn’t resist a quick peek at Deon and Emma as she passed their curtained space. Deon was curled up in the hospital bed with his grandmother, reading Harry Potter to her as she patted his shoulder in encouragement.

  Maria, Lydia’s mother, would never have allowed anyone to take Lydia away from her. Lydia closed the curtain and drew in a deep breath. The scent of the hibiscus tea Maria brewed whenever she found a client willing to pay for her “psychic” services wafted through Lydia’s mind. She could almost imagine the feeling of Maria’s hand rubbing the back of her neck, soothing her tension and fears.

  If only it could be that easy …

  Alarm bells shrieked from one of the telemetry beds across the hall. “Dr. Fiore!” a nurse called out. “We need you.”

  NORA HALLORAN JUGGLED NONSTOP PHONE calls, a waiting room stacked with patients, the cops now camped out with Mr. Crackhead—aka John “It Ain’t None of Your Damn Business” Doe—in Exam Four, the acute coronary syndrome in telemetry, and the three admits waiting for beds upstairs. Kind of slow for a Thursday morning.

  Best of all, there hadn’t been any traumas—which meant no trauma surgeons, including her ex-almost-fiancé, Seth Cochran, who was a fourth-year surgical resident doing his trauma rotation. Things were still awkward, though to tell the truth, awkward was an improvement after her initial meltdown when she’d found Seth cheating on her.

  “Hey, Nora,” Elise Avery called as she restocked her flight bag from the medication room behind the nurses’ station. “Got a minute?”

  Nora nodded, hung up from the permanent hold sixth-floor med/surg had put her on, handed a stack of labs to the desk clerk, asked him to page the nursing supervisor to expedite the patients waiting for admission, and steered a lost OB-GYN intern in the right direction before joining Elise. “What’s up?”

  Elise raked her blond hair back from her eyes. A sure sign she was upset—usually Elise looked like she just stepped from the pages of a fashion magazine: tall, blond, and perfect.

  “I’m not sure, just a feeling I have, but …”

  It also wasn’t like the flight nurse to hesitate. Elise had definite opinions on just about anything and usually wasn’t afraid to speak up.

  “That girl this morning, the neuro case,” Elise began again, “Tracey Parker?”

  Nora didn’t know the girl’s name, but she remembered the case. “Lucas Stone is doing an MRI-angio on her right now. Said maybe it was a thalamic stroke. But he didn’t seem too certain.”

  Another weird thing about the Tracey Parker case—first Elise and Lydia Fiore were puzzled, and now Lucas. Elise and Lydia were both smart, but Lucas was a bona fide genius.

  “It’s Lucas Stone I’m worried about.” Elise’s voice sounded more certain. And more than a touch hostile.

  “Lucas?” Nora leaned against the counter, crossing her arms in front of her, waiting for Elise to air her grievance. As charge nurse, she’d heard many a complaint about doctors, but Lucas?

  The man couldn’t hurt a fly—literally. Every August he would tear down the adhesive fly strips the maintenance guys hung in the ambulance bay, proclaiming them cruel and unjust. Strange behavior for a man who washed his hands a hundred times a day or more—even if he hadn’t touched a patient. But that was Lucas.

  “Why are you worried about Lucas?” she asked Elise.

  “Back in July, I brought in another patient, similar symptoms to Tracey. Stone was her doctor. She died the next day.”

  “I remember her. Becky something—”

  “Sanborn. Becky Sanborn.”

  “Right. I was in the ICU when she died. Lucas worked his butt off trying to save her.” Nora’s cheeks grew warm—that had been the same day she’d found Seth in the call rooms upstairs, in bed with another woman. Something everyone in the hospital was still talking about.

  “Maybe.” Elise zipped her bag closed, the sound tearing through the air. “But there was another girl, Michelle Halliday, with the same weird symptoms a few weeks ago. Another patient of Stone’s. And she also died within a day of his admitting her.”

  Elise paused, leaning her weight on the bulky transport bag between them, jutting her chin forward. “For no good reason, Nora. For no good reason, they both died.”

  FOUR

  Thursday, 8:49 A.M.

  AMANDA WATCHED THEIR PATIENT THROUGH the thick glass of the MRI suite while Lucas juggled the phone and the computer, rapping on the monitor screen with impatience whenever he needed the radiologist’s attention.

  While the rest of the hospital attempted to project a bright and cheerful atmosphere, the radiology department seemed to take pride in providing its suites of rooms with the least amount of illumination possible. Every time she came here, Amanda felt as if she were entering a different realm, one made up of small, dark, enclosed caverns. No wonder Gina called radiologists vampires, saying they were allergic to sunlight and came out only at night—or to play golf.

  “What’s that?” Lucas pointed to a minuscule speck of white that looked like a stray flake of dandruff clinging to the monitor. “In the thalamus?”

  The radiologist huffed at Lucas’s intrusion into his carefully scheduled workday and scrolled back and forth, zooming in. “Nothing. Just a ditzle, a movement artifact.”

  Lucas leaned forward, squinting, still holding the phone to one ear. He took control of the computer and rotated the image. “Hmm. Okay, I guess. I can’t find it on any of the other cuts.”

  He slumped back and focused on the phone. “It’s about time,” he sna
pped into the receiver, making Amanda—and, she was certain, the person on the other end of the line—wince. “I want a continuous EEG, nerve conduction velocity, and EMG all waiting for me when we get up to the ICU. I don’t care if the tech is working with Hansen in the clinic today. Get me the machines, I’ll run the damn things myself.”

  He hung up, dialing a new number as Amanda’s cell phone blurted out a tinny rendition of “Dixie.” Damn, Gina had reprogrammed her ringtones again. Amanda grabbed it, answering the call simply to shut off the annoying music. Lucas, the radiologist, and the tech all swiveled to stare at her. Her cheeks warmed with a flush that turned scorching when her mother’s voice greeted her.

  “What time will you be here on Saturday?” Amelia Mason’s dulcet tones sang out. “The earlier the better, I’ll need help with the icebox cookies and thought you could bake the red velvet cake. Plus the china will need cleaning, and—”

  “Mama, this isn’t a good time. I’m with a patient.” Amanda turned to the corner, wishing she could crawl through the drywall and vanish. The MRI suite was too small to escape the attention of the others—there were only two chairs at the console and scant room behind them. On the other side of the thick glass wall, the scanner filled the room like a great gray whale, ready to swallow anything that came within range. It clanked and boomed, making the walls and floors shake.

  “You’re always with a patient. Never any time for your own flesh and blood anymore. Well, this is an emergency too, Amanda. Your family needs you.”

  Amanda frowned, trying to piece together what her mother was talking about. Mama always assumed other people were as involved with her life as she was herself—and if not, they’d best hurry and catch up, ’cuz the train wasn’t stopping. “Are you talking about the wedding shower? I already told you I can’t come home for it.”

  Home was a fourteen-hour drive away, a small town on the coast just south of Beaufort, South Carolina. There was no way she could make it there and back just to attend a silly bridal shower.

  “Of course you can. Andy’s your last brother to get married, you have to be there.”

  “Why? Andy won’t.” Andy, her father, and her two oldest brothers were all going on their annual hunting trip—three days shacked up in a remote cabin, drinking beer, and telling dirty stories.

  “All the more reason why you need to come. I can’t do this by myself. Lord knows I’ve tried, but the honest truth of the matter is that I’m not as young as I used to be. I think I spoiled all you children, you expect I can perform miracles …”

  Amanda turned back to the monitor, watching her patient’s vital signs as her mother droned on. Mama could teach a doctoral-level class in guilt, but distance helped diminish its effect on Amanda.

  “Mama, I’m sorry. We’ll talk about this later. I really need to go.”

  “Amanda Camille Mason, whatever has happened to your manners? You do not speak to your own mother that way. We need to discuss this now.”

  “Good-bye, Mama.” She flipped the phone shut, shoving it deep into her lab jacket pocket. Guilt trickled through her and she knew she’d regret her actions, probably end up driving all night Friday to make it home for the bridal shower from hell and even then wouldn’t receive absolution.

  The boys would be boys, could get away with anything short of mass murder, but a lady—well, according to Amelia, her only daughter, Amanda, had little hope of ever becoming a lady. Even less now that she’d moved away from home and decided to embark on a career instead of settling down and giving her parents more grand-children like a dutiful daughter should. Amanda tried to focus on her patient, shaking her mind free from her mother’s recriminations, as clinging and invasive as kudzu.

  Lucas had swiveled back to the computer screen, peering past the radiologist, the phone wedged between his ear and shoulder. “No leakage at all, no bleed, no clots.”

  The radiologist smirked. “Sorry, Stone. Looks like you wasted your time. Her brain is perfectly normal.”

  “Take a quick look at her cervical spine and neck for me. Include the thymus.”

  “I have patients waiting—”

  “Are they paralyzed, trying their best to die?”

  Everyone in the control room stared at Lucas. He hung up the phone, rubbed a hand over his face, and took a deep breath. “Look, I know you’re busy, but it will save you time to do it now instead of me bringing her back later.”

  The radiologist scowled, seeing his ten o’clock tee time vanishing with Lucas’s implied threat, and nodded. “Okay, we’ll need to recalibrate.”

  “She doing okay?” Lucas asked Amanda without looking at her, his eyes focused past her to what little of the patient they could see.

  “Vitals are stable, no sign that she’s waking up.” Given the terrific noise banging around inside the MRI machine, that meant the drugs had worked. Amanda shuddered, hoping they kept working. To be trapped in your own body, alone, unable to speak—or scream… .

  “When we get upstairs to the ICU I’ll need to wake her.”

  “Why? You can’t extubate her,” Amanda protested. “Not until she regains her reflexes. Why would you let her wake up? It’s cruel.”

  “She has sudden onset of general paralysis preceded by difficulty swallowing and speaking. We’ve ruled out anatomic causes; so far her labs show no sign of any infection or toxic reaction. Even her spinal tap was normal. What’s left on our differential diagnosis?”

  “Rabies, botulism, Miller Fisher variant of GBS,” Jim Lazarov said from behind Amanda. She whirled around.

  How the hell did he do that, always sneaking up on her? He reminded her of Andy, her youngest older brother and chief tormentor—he was constantly jumping out at her, scaring her, calling her a baby if she told anyone.

  At least Jim didn’t throw clumps of Spanish moss, riddled with spiders and chiggers, in her face. Instead he flung her own research at her—straight from the admission note she’d dictated before they left the ER.

  Lucas nodded in approval. “Anything else?” he asked Amanda, obviously expecting more from her.

  Like what? Jim had used everything she knew—unless … she thought back to what Lucas had said earlier. Difficulty swallowing and speaking followed by generalized weakness. And he’d forced the radiologist to examine Tracey’s neck.

  “Myasthenia gravis?” she ventured.

  “No way,” Jim scoffed, leaning on the console between her and Lucas. “The onset was too sudden and generalized.”

  “She’s right. It can happen. Rarely.” Lucas ignored the tug of war between Jim and Amanda, focusing instead on Tracey’s form beyond the glass. “It will take days to get antibody results back. If the EMG and nerve conduction are consistent with myasthenia, I’ll have to risk it.”

  “A Tensilon challenge? Cool.” Jim was practically drooling.

  “She’ll need to be awake when you give her the Tensilon,” Amanda argued. “And it will only work if she does have myasthenia gravis.”

  “Hence the name, ‘challenge,’ ” Jim put in.

  “But if it doesn’t work, she’ll still be paralyzed. And awake.” A sudden shudder raced up Amanda’s spine. Ghosts waltzing on her grave, they’d say back home. She glanced into the darkened room. Tracey had been repositioned for the neck scan; now only her naked feet could be seen, the rest of her body sealed into the machine.

  Like a body in a coffin.

  Amanda’s stomach felt empty, as if it had been turned inside out. Andy had once locked her inside an attic trunk. How much worse to experience that feeling of being buried alive for real? “Isn’t there something else we can try first?”

  “Find me something and I’ll do it,” Lucas replied grimly.

  Jim smirked, happy about adding a new procedure to his repertoire with the Tensilon challenge. Amanda wanted to wipe the grin off his face almost as much as she wanted to help her patient. She thought about another patient she and Jim had shared during their ER rotation. Another young, healthy woman with
strange neurological symptoms. Myoclonic movements, numbness, weakness that appeared and disappeared without warning.

  Symptoms frighteningly similar to the ones Amanda herself had exhibited on occasion. But not lately, she reminded herself, looking down at her own feet as if verifying that they weren’t twitching. Not for weeks.

  “What about Becky Sanborn? Are all the results from her autopsy back?” She should have recalled that case earlier. The gross examination of Becky’s body hadn’t revealed a diagnosis, but often tissue analysis took longer to complete.

  “Who’s Becky Sanborn?” Jim asked.

  “You know,” Amanda told him. “Our patient with the strange paralysis. From this summer?”

  He glared at her, remembering. Jim still blamed Amanda for “poaching” Becky’s case—which was totally unfair; she’d just been in the right place at the right time. “The college girl? Oh yeah, I remember now. She died?”

  “Yes.” Lucas grimaced. He straightened and turned to them. “You two go track down Becky Sanborn’s path results. All of them—no excuses about work backlogs or whatever else the pathologists come up with. And go through her chart, compare it to Tracey’s. Question everything, question everyone who knew these girls. Find me something to work with.”

  “Certainly, Dr. Stone,” Jim said. “We’ll get right on it.”

  Amanda knew what that meant. She would do all the work and Jim would take all the credit. She gathered her notes, glancing one last time through the window at Tracey.

  “This is a fascinating case, Dr. Stone.” Jim put the finishing touches on his boot-licking. “I’d love to write it up for the Annals.”

  He threw his shoulders back, obviously excited by the prospect. Amanda wasn’t sure if it was the potential publishing credit or the opportunity to avoid scut work in the ER that was more enticing to the intern.

  “Don’t you have patients waiting in the ER?” she said to him.

  Jim merely smiled at her—a smile that was more a leer than anything, revealing his too-white-to-be-natural teeth. “I’m on neurology this month, just like you.”