“Tube her?” Dr. Kim asked. David nodded his answer.
As the room filled with still more people, including the inhalation and laboratory technicians, Kim set about his task. He picked up a steel laryngoscope and inserted its right-angle, lighted blade deeply into Charlotte’s throat, lifting up against the base of her tongue to expose the delicate silver half-moons of her vocal cords.
“Give me a seven-point-five tube,” he said to the nurse assisting at his side. The clear plastic tube, with a diameter of three quarters of an inch, had a deflated plastic balloon wrapped just above the tip. Skillfully, the giant slipped the tube between Charlotte’s vocal cords and down into her trachea. He used a syringe to blow up the balloon, sealing the area around the tube against air leaks. Next he attached the black Ambu breathing bag to the outside end of the tube, connected oxygen to the bag, and began supplying Charlotte with breaths at a rate of thirty per minute.
Christine stood just to David’s right and watched as he tried to center the needle on the cardiograph. All at once, her eyes riveted on the slashing up-and-down strokes of the stylus. There was a rhythm—a persistent, regular rhythm. Oh, my God, he’s bringing her back! Her thoughts screamed the words. The one possibility she had never considered, and now it was happening. With every beat a new horrifying image occurred to her. Charlotte, hooked to a respirator. More tubes. Day upon endless day of wondering if the woman’s oxygen-deprived brain would awaken. What had she done?
The finely lined paper flowed from the machine like lava, forming a jumbled pile at David’s feet. The rhythmic bursts continued.
“Hold it for a second!” David called for the resident to halt his thrusting cardiac compressions in order to get a true reading from the machine.
Instantly the pulsing jumps of the needle disappeared, replaced by only a fine quiver. The pattern had been artificial—a response to the efforts of the resident.
Christine had misinterpreted the cardiograph. She felt near collapse.
“Her rhythm looks like fine fibrillation. Please resume pumping.” David’s voice was firm but calm. Christine sensed a measure of control return. “Christine, please get set to give her four hundred joules.”
The order registered slowly. Too slowly.
“Miss Beall!” David snapped the words.
“Oh, yes, Doctor. Right away.” Christine rushed to the defibrillator machine. Was everyone staring at her? She couldn’t bring herself to look up. Turning the dial on the machine to 400, she squirted contact jelly on the two steel paddles and handed them to David.
David motioned the resident away. Then he quickly pressed one paddle along the inside of Charlotte’s left breast and the other one six inches below her left armpit.
“Everyone away from the bed,” he called out. “Ready? Now!”
He depressed the red button on the top of the right-hand paddle. A dull thunk sounded as 400 joules of electricity shot through Charlotte’s chest and on through the rest of her body. Like a marionette’s, her arms flipped toward the ceiling, then dropped limply to the bed. Her body arched rigidly for an instant, then was still. The cardiograph tracing showed no change.
The resident resumed his pumping, but soon motioned to the medical student standing nearby that he was tiring. The two made a smooth change.
Immediately David began ordering medications to be given through Charlotte’s intravenous lines. Bicarbonate to counteract the mounting lactic acid in her blood and tissues, Adrenalin to stimulate cardiac activity, even glucose on the chance that her sugar may have dropped too low for some reason. No change. Another Adrenalin injection followed closely by two more 400-joule countershocks. Still nothing. Calcium, more bicarbonate, a fourth shock. The cardiogram now showed a straight line. Even the fine fibrillation was gone. The resident again took his place over from the student and the pumping continued. At the head of the bed, the mountainous anesthesiologist stood implacably squeezing the Ambu bag, which seemed like little more than a pliant black Softball in his thick hands.
“Hook an amp of Adrenalin to a cardiac needle, please,” David ordered. Although an injection through the subclavian intravenous line should end up in the heart, perhaps the tip had somehow become dislodged. He put his hand along the left side of Charlotte’s breastbone and used his fingers to count down four rib spaces. Holding the ampule of Adrenalin in his other hand, he plunged the four-and-one-half-inch needle attached to it straight down into Charlotte’s chest. Almost immediately, a plume of dark blood jetted into the ampule. A direct hit. The needle was lodged in some part of the heart. Behind him, Christine held her breath and looked away.
David shot in the Adrenalin, For a moment the cardiograph needle began jumping, and with it his own pulse. Then he noticed that the medical student was rocking back and forth, inadvertently bumping into Charlotte’s left arm each time. He motioned the student away from the bed. Instantly the tracing was again a flat line.
Christine felt the tension in the room begin to dissolve. She stared at the floor. It was almost over.
David looked at the anesthesiologist with a shrug that asked, “Any ideas?”
Dr, Kim stared back placidly and said, “Will you open her chest?”
For a few seconds David actually entertained the thought. “How are her pupils?” He was stalling, he knew it.
“Fixed and dilated,” Kim replied.
David gazed off into one corner of the room. His eyes closed tightly, then opened. Finally he reached over and flicked off the cardiograph. “That’s it. Thank you, everybody.” It was all he could manage.
The room began to empty. David stood there for a time looking down at Charlotte’s lifeless form. Despite the tubes and the bruises and the circular electrical burns on her chest, there was something beautifully peaceful about the woman.
At last, peaceful.
All at once, some of the impact of what had happened began to register. His hands and armpits became cold and damp with sweat.
As he walked out of Room 412 to call Wallace Huttner, David was shaking. Deep inside him was the chilly feeling that somehow he had just struck the tip of a nightmare. He glanced at the wall clock. How long had they worked on her? Forty-five minutes? An hour? “What the hell difference does it make,” he muttered as he sat down at the nurses’ station to write a death note in Charlotte Thomas’s chart.
“You all right?” Christine asked softly as she set a cup of muddy coffee in front of him.
“Huh? Oh, yeah, I’m okay. Thanks,” David said, resting his chin on the counter and studying the Styrofoam cup at close range. “Thanks for the coffee.”
“I’m sorry she didn’t make it through for you,” she said.
David continued staring at the cup, as if searching for the answer to some kind of cosmic mystery.
“Potassium!” he exclaimed suddenly.
Christine, who had moved to leave the uncomfortable silence, turned back to him. “What about potassium?”
He looked up. “Something wasn’t right in there, Christine. I mean over and above the obvious. I’m probably wrong, but I can’t remember handling a cardiac arrest where I couldn’t get a flicker of cardiac activity back—even when quite a bit of time had elapsed between the arrest and the Code Ninety-nine. Shit! I wish there had been time to get a potassium level on her. Potassium, calcium—I don’t know what, but something felt like it was out of whack.”
“Can’t you get a potassium level done now?” Christine asked.
“Sure, but it won’t be much help. During the resuscitation and after death potassium is released into the bloodstream from the tissues, so the levels are usually high anyway.” He clenched his fists in frustration.
Christine felt an ache building inside her. “How could her potassium level have gotten out of line in the first place?”
“Lots of ways.” David was too distracted to notice the change in her expression. “Sudden kidney failure, a blood clot, even a medication error. It makes no difference now. I’m probably way of
f base anyway. Dead is dead.” He realized the anguish that she was feeling. “I … I’m sorry,” he said. “I didn’t mean that. I’m afraid the pleasant task of calling Dr. Huttner on the Cape has me a little rattled. I don’t think this is the sort of news he’d be too happy about having me save until he gets back. Look, maybe sometime we can sit and talk about Mrs. Thomas. Okay?”
Christine looked away. “Maybe sometime …” she whispered to herself.
David fished out the number Huttner had given him. After the usual hassles with the hospital switchboard operator, his call was put through. Huttner’s hello left no doubt that he had been asleep.
“Great start,” David muttered, looking upward for some kind of celestial help. “Dr. Huttner, this is David Shelton,” he said into the receiver.
“Yes, what is it, David?” Even his first words held an edge of impatience.
At that moment David knew that he should have waited until the next day to call. “It’s Charlotte, Dr. Huttner, Charlotte Thomas.” He felt as though his tongue was swelling rapidly and had already reached grapefruit size.
“Well, what about her?”
“About an hour and a half ago she was found pulseless in her bed. We worked on her, a full Code Ninety-nine for nearly an hour, but nothing. She’s dead, Dr. Huttner.”
“What do you mean you worked on her? What in the hell happened, man? I checked on her before I left this morning and she seemed stable enough.”
David had not anticipated an easy time of it with Huttner, but neither had he expected a war. His tongue passed grapefruit and headed toward watermelon.
“I … I don’t know what happened,” he said. “Maybe hyperkalemia. She had a brief period of fine fibrillation on her cardiogram, then nothing. Flat line. No matter what. Absolutely nothing.”
“Hyperkalemia?” Huttner’s tone was now more one of bewilderment than anger. “She’s never had problems with her potassium in the past.”
“Do you want me to call Mr. Thomas?” David asked finally.
“No, leave that to me. It’s what he wanted anyway.” Huttner’s voice drifted away, then picked up with renewed intensity. “What you can do for me is to get in touch with Ahmed Hadawi, the chief of pathology. Tell him there’s going to be a postmortem on this woman tomorrow. I want to know exactly what happened. If for some reason Thomas won’t consent, I’ll notify Hadawi myself that it’s off. You tell him we’ll be at the Autopsy Suite tomorrow morning at eight sharp with a signed permission from Peter Thomas. Good night.”
“Good night,” David said a minute or so after Huttner had hung up. He set the receiver down, then added, “Good grief.”
The nurses’ station was quiet—deserted except for David and a ward secretary who was painfully trying not to notice him. Eyes closed, he sat, rubbing his temples, struggling to sort out the unpleasant emotions swirling within him. Confusion? Sure, that was understandable. Depression? A little, perhaps. He had just lost a patient. Loneliness? Dammit, he wished Lauren were home.
But there was something else. It was hazy and diffuse. Difficult to focus on. But there was something, some other feeling. Several minutes passed before David began to understand. Underlying all his reactions, all his emotions, was a vague nebula of fear. Trembling for reasons that were not at all clear to him, he dialed Lauren’s number, hanging up only after the tenth ring. Even though he had unfinished business in the hospital, he felt the urgent need to get out. He would call Hadawi from home, he decided.
* * *
Christine leaned against a doorway and watched David leave. She had no qualms about the rightness of what she had done, but his discouragement was painful for her.
Later, she excused herself from shift report and walked down the deserted corridor to the pay phone. The number she dialed was different from the one she had used the previous day. God, had it only been a day? No voice answered this time only a click and a tone.
“This is Christine Beall of Boston Doctors Hospital,” she said in a measured monotone. “In the name of compassionate medical care and on instructions of The Sisterhood of Life, I have, on October second, helped to end the hopeless pain and suffering of Mrs. Charlotte Thomas with an intravenous injection of morphine sulfate. The prolongation of unnecessary human suffering is to be despised and to be terminated wherever possible. The dignity of human life and human death are to be preserved at all costs. End of report.”
She hung up, then on an irrepressible impulse picked up the receiver and dialed Jerry Crosswaite’s number. With the sound of his voice, the impulse vanished.
“Hello,” he said. “Hello … Hello?”
Christine gently set the receiver back.
In the shadows at the far end of the hall, Janet Poulos observed Christine as she left report and made the call that Janet felt certain was her case report on Charlotte Thomas.
“Sound her out about The Garden,” Dahlia had urged. “Be careful what you say, but sound her out.”
Janet countered with her belief that Beall was far too new in The Sisterhood to be ready for The Garden, but Dahlia insisted.
“Just remember,” she said, “what would have happened to you three years ago had I decided you weren’t ready. As I recall, you were thinking about taking your own life before I phoned.”
In fact, Janet had passed beyond the thinking stage. At the moment of Dahlia’s call she had more than a hundred sleeping pills laid out on her bedspread. Self-loathing and a profound sense of impotence had pushed her to the brink of suicide.
For years she had lived on hatred—hatred toward physicians in general and one in particular. She had joined The Sisterhood to use the organization in order to put certain M.D.’s in their place. Where necessary, she had even manufactured data on patients to get the Regional Screening Committee’s approval and recommendations.
However, after six years and nearly two dozen cases, what little sustenance she had gained from such activities had disappeared.
Then, with a single phone call, everything had changed. Somehow, Dahlia knew about the falsified laboratory and X-ray reports, about Janet’s hatred for physicians and their power, about many intimate details of her life. She knew, but she didn’t care.
In the course of the year after she joined The Garden Janet was brought along slowly. Every few weeks Dahlia would transmit the name of a patient in the northeast who had been approved by The Sisterhood for euthanasia. Janet would arrange a meeting with the distraught family of the patient and offer a merciful death for their loved one in exchange for a substantial payment. The contract, once made, was then unwittingly honored by The Sisterhood nurse who had initially proposed the case.
It was a wonderful, lucrative diversion, but The Garden had much, much more in store for Hyacinth. Other flowers blossomed within Doctors Hospital. One of them, Lily, was transplanted from the ranks of The Sisterhood by Janet herself. Soon both women were given other responsibilities, primarily in the area Dahlia referred to as “direct patient contact.” They were no longer bound to Sisterhood cases—euthanasia was not a concern; the new cases had proven more rewarding in every sense. John Chapman and Carl Perry were just two of them.
As Christine rang off, Janet moved toward her. Dahlia had reasoned that after handling a case as traumatic as Charlotte Thomas’s, Beall might be ready. Hyacinth still had strong doubts. She would talk with the woman, but only until her own suspicions were confirmed. Beall would need a few more years of tongue lashings from physicians who, as often as not, were deadly weapons in their own right. She would need a few more thankless Sisterhood cases.
Then she might be ready.
Christine spotted Janet coming and waited.
“It’s done?” Janet asked solemnly. Christine nodded. “Talk for a few minutes?” Again a nod. In silence they walked to the visitors’ lounge. Christine dropped onto the sofa and this time Janet sat next to her.
“It’s never easy, is it?” Janet folded one leg beneath her and watched as Christine picked at a sliver
on the edge of the coffee table.
“I’m okay, Janet. Really. I know what I did—what we’re doing—is right. I know how badly Charlotte wanted it to end. Cancer throughout her liver, and Dr. Huttner wanted to keep sticking tubes in her. It was right.” Her voice was strained but under control.
“You’ll get no arguments from me, kid,” Janet said, reaching over and squeezing her hand reassuringly. Christine squeezed back. “It’s just too bad that we’re the ones who have to shoulder all the darn responsibility, that’s all.” Christine responded with a nod and a rueful shrug.
Perhaps Dahlia was right. Janet elected to push a bit further. “All that responsibility, and what do we have to show for it? Nothing.”
Christine spun toward her, eyes flashing. “Janet! What on earth do you mean, nothing?”
Time to retreat, Janet decided. For once in her life, at least, Dahlia had misjudged. Beall’s naive, idealistic flame had not yet been doused. She took pains to meet Christine’s gaze levelly. “I mean that after all these years, after all the hundreds, and now I guess thousands, of Sisterhood recruits, nothing has changed in the attitude of the medical profession.”
“Oh.” Christine relaxed.
“So until things change, we do what we have to do. Right?”
“Right.”
“Listen, Christine. Let’s have dinner sometime soon. We have a lot in common, you and I, but this is hardly the place to discuss our mutual interests. Check your schedule and I’ll check mine. We’ll set something up in the next few days. Okay?”
“Okay. And, Janet, thanks for your concern. I’m sorry I snapped at you. This day’s been a bitch, that’s all.”
Janet smiled warmly. “If you can’t snap at your sister, who can you snap at? Right?”
“Right.”
Janet rose. “I’ve got to get Charlotte taken care of. Her husband left word he won’t be coming in to see her. Call me at home anytime you need to talk.” With a wave she left. At least Dahlia would know she had tried. Beall simply wasn’t ready. Too bad.
The Sisterhood Page 11
