Critical Condition

by Peter Clement

  Again it wasn't anything he didn't know or hadn't already feared. But even doctors escape into false hopes when faced with a catastrophic illness that's personal. Hamlin's words slammed the door on anymore such retreats.

  "Thank you for letting me know, Tony," Richard said, barely able to find his voice.

  When he was alone, the well-practiced grip he usually kept on his nerve broke completely. Sobs came from so deep within they racked him with the cruelty of convulsions, wrenching the air out of his lungs and filling the room with a grotesque, high-pitched, hacking wail. He had cried like this only once before, years ago on the day Luana died. Then it heralded an eighteen-month spiral of grief, drinking, and denial that nearly lost him his son, his job, and his life.

  "Not this time," he whispered through clenched teeth, still doubled over and struggling for breath. "Whatever happens, I won't cop out this time."

  But the cold fear in his belly twisted as if to mock his brave words. Once a coward, always a coward, it seemed to say. Others who loved Kathleen flew to mind— her daughter Lisa, and his own son Chet.

  He had to let them know. He pulled himself together enough to reach for the phone and dial Lisa's apartment first. As he waited for her to pick up, he prayed the iron resolve he'd used when making similar calls to faceless next of kin would help him now.

  "Hello?"

  "Lisa, it's Richard."

  "Hi! What's up?"

  The youthful eagerness of her greeting hung between them. "Lisa, I've got bad news. . . ."

  Where the hell was Richard? Goddamn it, Kathleen thought. Why didn't he come back? And why didn't anyone tell her anything. It seemed as though it had been forever since that Beethoven look-alike and his pack of apprentices finished their methodical tapping and prodding. The tube down her throat continued to keep her perpetually on the verge of gagging, and still the choking never came. A new treat was the catheter in her bladder burning like a line of coals, leaving her feeling a constant urge to pee. The nausea never abated. And the unrelenting spin inside her head so tilted the room that she thought some masochist in white had strapped her to a table designed for training astronauts.

  Worse was how they all talked over her, reducing her to a set of bodily functions and discussing her solely in terms of numbers. To them she wasn't even there.

  "Respirations set at eighteen."

  "02 sat's ninety-six."

  "C02's twenty; pulse seventy; BP one-thirty over seventy."

  Why couldn't she move? Why didn't someone tell her? She blinked furiously, wanting to catch the attention of a passing figure in white.

  No one paid her the slightest heed.

  What had happened to her?

  "Some kind of hemorrhagic stroke," Richard had said. But he'd also promised she'd be okay. This sure as hell wasn't okay. Christ, they'd just parked her, plugged into a bunch of machines.

  Then a woman with short gray hair and small gold glasses loomed into view. "Dr. Sullivan, my name's Josephine O'Brien, but around here they call me Jo. I know you're frightened, and it won't do you any good to hear a bunch of lies about your being fine. But you are what we call stable, and that's the best we can hope for in this place. Richard's gone to get your daughter, Lisa. Blink twice if you're up to seeing her."

  Hearing her name spoken with such simple kindness brought Kathleen hurtling back from the anonymity the others had cast her into. "Yes! Yes!" she blinked through tears. It took her a few seconds more to realize that at least she could still cry.

  Dr. Tony Hamlin's gaze swept the crowded cafeteria until he spotted the man he wanted. He quickly weaved a path through the crowded tables where nurses, orderlies, and residents wolfed down the remains of breakfast. Those already finished raced by him, Styrofoam cups in hand, heading to the wards for the start of another day-shift at New York City Hospital. Everyone was more or less colorcoded— nurses of both sexes sporting pale green, orderlies powder blue, personnel from the OR and critical care areas garbed in scrubs of darker tones to better mask the stains from all the bodily fluids splashed about during invasive procedures. Doctors wore white coats of varying length— short jackets for students, mid-to-long ones signifying increasing seniority.

  Hamlin's coat flowed out behind him like a cape. Matching his mane of white hair, it was a chieftain's regalia in any tribe.

  His target, Dr. Jim Norris, had his own singular dress code— a dark brown bomber jacket, the leather cracked and weathered to the point it almost matched its owner's well-worn, bearded face. The man sat alone, his lean six-foot figure hunched over a porcelain cup of steaming water into which he repeatedly dunked a tea bag. When he saw the older man approaching, he narrowed his dark eyes, the way a bad-tempered dog might signal it doesn't want to be disturbed. "Now, why is the chief of neurosurgery descending on me at this hour?" he said as soon as Hamlin got within earshot. "Don't tell me you've another of your catastrophic cases, Tony, and I can't finish my tea."

  "Go on, Norris. You love it when I pull you away from your rats and give you a chance to do some real medicine. Don't pretend otherwise."

  The researcher flashed a smile that looked surprisingly brilliant amidst the wiry tangle of hairs in his salt-and-pepper mustache. "So what is it this time?"

  "We've got to hurry," said Hamlin, leaning over the otherwise deserted table and lowering his voice. "I just examined the famous girlfriend of our esteemed chief of ER. She's had an intracranial bleed— I take it they were going at it rather vigorously in the sack at the time. The hemorrhage is localized to the pons, and she's got a locked-in syndrome. She's also young, not yet forty, and otherwise healthy with no risk factors, according to him. That makes her a candidate, just like the others—"

  "You're not suggesting we do her!"

  "Of course I am."

  "Are you nuts? What if Steele finds out? We'll be finished."

  "Not necessarily. In fact, saving her may give us a way out of our current mess."

  "How?"

  "If the infusion works in her case, we'll have a chance to get him on board. Think how beneficial it would be— his alerting us anytime a patient of ours comes into ER, before some other doctor or resident gets a closer look at the old records. It'll be one less way we can get caught."

  "What if the infusion doesn't work?"

  "Then she's probably dead anyway, or worse, a vegetable in a wheelchair. It'll be the outcome he expects."

  "And if he still finds out what we did to her?"

  "The only way he'll find out is if this stuff works. Because then I'll tell him myself. And make it clear that unless he goes along with us she won't get the second round of treatment she'll need."

  "That's nuts. He could still refuse to go along and turn us in. How do you know he won't?"

  "Because I'm betting he'll do anything not to lose this woman. Remember what happened to him when he lost his wife?"

  Norris scowled, clasped his cup between both hands and took a sip of tea, then said, "I don't know."

  "Damn it, it's my name on those patients' charts, and if anyone gets suspicious, it's me they're going to come after with all their questions. Shall I refer them on to you?" The bearded man went still, his white smile once more coming into view, but slowly this time, tooth by tooth. "Threats don't become you, Hamlin, or did I misunderstand your point?"

  "We're all under threat here. The only way you and the rest stay safe is to keep me safe. And that means we need Steele. Christ, if I'd known it was going to be like this I never would have gone along with your crazy scheme."

  "My crazy scheme?" Norris's forced grin never wavered. "Hey, we're victims of our own success. Who knew our subjects would do so damn well at first that we'd have to let them go home?"

  "You call what happened to them a success? Christ, it's got all of us living like fugitives. And you're damn lucky I've been able to talk the families out of autopsies so far."

  Norris chuckled. Anyone paying him any attention would have thought him the happiest guy in the room. "
So someday we'll be heroes, and you'll be a star in Neurology Today just the way you've always wanted." He downed his tea and shoved away from the table. "But let's just hope you're right about Steele being a good friend in ER. If you want me, I'll be in my lab, preparing what you'll need. I assume you're going to slip it to her during an after hours angiogram, as usual." Hamlin bristled at the researcher's cavalier attitude, detesting the man's arrogance. Or was it sarcasm? With Norris he could never tell. Yet he remained professionally cold toward him, long resigned to being dependent on the brilliant prick. "That's right. And the rest during surgery, if she lives that long. I'll call you when we're ready."

  "This is the last one I do for you, Tony," he said, his expression all at once deteriorating to a lipless grimace. The leathery features made Hamlin imagine fangs and venom concealed within.

  She thought it was night, but wasn't sure.

  "Hell of a time for an angiogram," said the nurse who wheeled Kathleen out of ICU and down a corridor.

  "It's all that 'minimizing downtime' and 'maximizing efficiency' they keep harping on," Kathleen heard a man's voice reply. His job seemed to be steering the portable respirator they were pushing alongside her. Occasionally she saw his ebony-colored hand reach into view and steady the monitors they'd piled onto her bed for the trip. The woman let out a hoot of laughter. "Tell me about it. Hell, I got a cousin over in Jersey who works in a hospital where they rent out their MRI machine to veterinarians from midnight till dawn."

  "No! What about fleas?"

  Their voices drifted in and out as the effects of the morphine they'd been giving her kicked in, and she watched the ceiling roll by. She felt them turn a succession of corners until they passed through a set of doors marked RADIOLOGY.

  Wait! she wanted to shout. She needed Richard with her. Because only when Richard was around did they really take care and treat her with respect.

  It had been good in ER. Richard's nurses had comforted her when they could, and Jo had taken the time to hold her hand, stroke her forehead, and explain whatever they were about to do to her. But once they transferred her to Intensive Care, soon as he left the room, the medical personnel became more inhuman. She'd overheard their snide remarks between Richard's visits.

  "What gets me is how they expect special treatment for her."

  "She's not even his wife."

  "Just because she's some big shot geneticist on TV, and the chief of emergency's got the hots for her . . ."

  Once even the word mistress came up.

  How quaintly old-fashioned, she had thought during one of her more morphine-suffused interludes.

  But in the harshly jagged interval after the medication had worn off when they left her shot long past its due, she took the delay personally.

  Why not just carve a bloody A on her forehead, you self-righteous cows, she had wanted to scream, certain that they'd withheld the injection because of their resentment of her. Straining in mute fury against the unyielding sheath in which her failed nerves and muscles so brutally trapped her, she pulsed her eyes up and down and put her lids through a good imitation of a butterfly's wings. But the tiny movements caught no one's attention, and claustrophobia tightened its grip, suffocating her as surely as a pillow to the face. After what seemed an eternity, a perky young nurse with spiked blond hair and a diamond stud in her nose popped in. She emptied a syringe full of relief into Kathleen's arm through the IV line.

  And Kathleen had drifted again. Sometimes she'd thought of Lisa.

  It had broken her heart to see the teenager trying so hard to be brave when Richard brought her to the bedside earlier in the afternoon. Lisa's eyes were as strikingly green and her hair was as vibrant an auburn gold as her own, but today, with her daughter's face drained white, ghostlike, her eye and hair color looked garish.

  "Does it hurt?" Lisa had asked.

  No, she had blinked, telling a lie.

  "You're going to be all right, Mummy."

  Yes, she had agreed, willing to join in any fabrication that would comfort her daughter, who hadn't called her "mummy" in the last thirteen of her nineteen years. Kathleen could see Richard standing behind Lisa, his hands on her shoulders. She liked that.

  Yet she had felt relief when the visit ended and Richard led Lisa away. At least I kept from crying, she thought.

  "Chet will want to see you as well," Richard had said when he returned, referring to his own fourteen-year-old son. Will he? she'd thought, knowing the boy had endured watching his mother die of cancer a little more than three years ago.

  Her eyes had flooded with tears despite her determination not to get weepy. One of her great pleasures during this past year with Richard had been growing to love Chet and discovering that he returned her love. Seeing her so near to death probably would rip open Chefs old wounds, and he'd be terrified about being abandoned again by death . . . her death. He might be even more devastated than Lisa.

  "Are you strong enough to see him?" Richard had asked.

  No, she'd blinked, thinking only of what an ordeal it might be for the boy. And the real question was whether Richard would be strong enough this time.

  Feeling the stretcher come to a halt, she opened her eyes. They'd parked her under a bright OR lamp alongside a large beige-colored machine and what looked like a television screen. Hamlin leaned into view from her right wearing a surgical mask. He swabbed the side of her neck with something cold that smelled sickeningly medicinal. "Thank you," he called to the man and woman who had brought her. "We'll phone when she's ready for the trip back."

  "I can't believe you're doing this," said a thin-faced man in a white coat who bent over her from the left. His name tag read DR. MATT LOCKMAN and he, too, was masked, but the material outlined a pointed nose and thin receding chin making her think of a lab rat. A cornered one, she decided, given how wide with alarm his eyes seemed to be.

  "Shut up!" said Hamlin, all trace of his elegant manners from earlier in the day gone. "Cases like this can hear, even when they're completely unresponsive, and sometimes they can remember."

  Rodent-face studied her uneasily. "I thought you said she was full of morphine."

  "She is. And IV midazolam. But you know how hard it is to tell just how deep those drugs have taken a stroked-out patient. Some only look gorked and remember the damnedest things."

  "Christ," Lockman muttered, turning his attention to her thigh and giving her groin an equally frigid swab.

  Straining to glance down, Kathleen saw in his gloved hands what looked like a three-foot length of tubing with a tiny wire loop on its end, the whole thing enclosed in a plastic sheath attached to a huge needle. She felt a piercing sting as he jabbed the point into her groin, and would have flinched if she could move. He proceeded to feed the long device out of its cover and through the needle, until only a few inches remained sticking out of her, the rest of it having disappeared up into her trunk. From her own work on lab animals she knew he was putting in some kind of central line, probably arterial, judging by the spurting backflow of blood she'd caught a glimpse of in the lumen.

  "Tony, if you tell Steele even part of what we've done," Lockman said, "he could get us all sent to jail— and the fines. Jesus, we'd be ruined."

  "Hey! I said shut up."

  "But once more DOAs roll into his ER—"

  "Can it!"

  Lockman scowled. "I warn you, I won't let him or anyone else bring the cops down on us when it comes to homicide charges, understand? Even if it means silencing the man myself—"

  "Jesus Christ, what does it take with you?" said Hamlin, shooting him an angry glance. "I told you to zip your fuckin' mouth!" Then he abruptly bent over her. As he brought his hand near her neck, she saw the glinting point of the large needle he was holding. It looked half a foot long. Oh, my God! she thought, and strained her eyes further downward, yet couldn't see what he was doing. She felt a sting as the tip pierced her skin over the major arteries and veins in her neck, the pain making her eyes water. Terrified, and h
aving no idea what they were up to, she blinked furiously in protest.

  Ignoring her, Hamlin lifted up a small, threadlike catheter, connected it, plastic wrapping and all, to the needle he'd just inserted, and began to feed it from its sheath into her head. Lockman pulled the beige-colored machine closer until a cone-shaped cylinder protruding from it was aimed at a point below her ear. He pressed a button, and on the television screen she saw an X-ray image of a human brain in varying shades of black and gray.

  He reached down and injected a syringeful of something through the larger catheter in her groin, then he and Hamlin turned their attention to the TV screen. A white lacework of pumping vessels branched into view. What appeared to be a large dark worm coming up from the bottom of the picture seemed to thread through the vessels. A much finer filament coiled horizontally from the front toward the "worm."

  A sickening wave of fear roiled through her. It was her head they were looking at, and she was watching two catheters thrust into the depths of her brain.

  What were they doing to her, she wanted to cry out, feeling the inside of her skull suddenly grow warm.

  "Where'd you learn to fish about with a microline through the carotid like this?" asked Lockman, giving her another squirt from his syringe. He sounded annoyed.

  She watched a new pattern of white spread into a morass of branches on the screen, and realized he'd been injecting her with dye.

  "We once had a research project where we thought we could plug arterial leaks with a well-placed squirt of cyanoacrylate, the Krazy Glue they use on cuts in ER," said Hamlin, never taking his eyes off the screen. "It didn't work, but I sure got to know my way around the arteries in people's heads."

  They weren't going to put Krazy Glue in her head! Kathleen screamed in silent disbelief. She was at the mercy of madmen.

  "You think there'd be an easier way," Lockman muttered.

  "There," said Hamlin, ignoring the remark. "That's the spot. Through the posterior communicating branch and into the posterior cerebral. Now bring your loop up, and let's see if you can snare me with your balloon. . . ."