One of the undercover cops, dressed as a parking attendant, stepped forward. "Let's go, guys," he said. "Do your jobs."
"Pat," David said. "Bring trauma shears."
Pat glared down at the man. She did not move. An instantaneous sweat covered David's back, and he felt a tingle roll across it. "This is not a choice for us to make." He spoke slowly, his voice shaking. "There is no decision here."
Slowly, Pat crossed her arms.
Choking on rage, he rose and shoved past Jill into Exam Fourteen. Carson watched him from the far side of the hall, shocked. David grabbed some trauma shears from a tray, and holding his stethoscope so it wouldn't slide off his shoulders, half jogged back to the patient. Aside from the crusted red acne, the man's face was corpse-white.
"I have to flip him over. Take off the cuffs."
"No way," Jenkins said. "No fuckin' way."
The cop dressed as a parking attendant stepped forward, but Jenkins placed a hand on his chest. "Don't even think about it, Blake."
The man's shoulders hit the floor with a slap when David rolled him onto his back. His arms were twisted beneath him, and he shrieked.
"I know," David said. "It hurts, but we're doing this to help you."
Don watched, feet planted, hands in his pockets.
"I'm going to cut your sweatshirt off, because it's burning you," David said, fighting to keep his voice level. "I'm going to cut it using these scissors." He slid the open trauma shears up the front of the fabric. "What's your name?"
"Not telling."
"Hey, hey." David leaned over, close to the man's face. It smelled sticky and sweet, like orange-flavored candy. "It's okay. I'm here to help you. What's your name?" The man's eye beat a few times as it pulled over to look at David. David looked away quickly, wanting to avoid eye contact that could be interpreted as confrontational. A shiny puddle of drool had collected on the tile where the man's mouth had been.
"Clyde."
David threw the halved sweatshirt open like a blazer. A few pieces of glass and the broad lip of a Pyrex beaker tinkled to the floor. Luckily for Clyde, the beaker had shattered between his sweatshirt and his scrub top. The stencil on the scrub top featured a seal, below which UNIVERSITY OF CALIFORNIA MEDICAL CENTER: UCLA, UCI, UCSD was written in a jailhouse blue. It could have been stolen from this very hospital. The top yielded easily to the blade, and David saw that the thin layer of material had helped to lessen the damage. The alkali had soaked through, leaving the skin red. In a few spots, white blisters were beginning to rise. Minor cuts covered his chest and lower neck, but little glass had made it all the way through the scrub top into the wounds.
"Try to slow your breathing, Clyde," David said. "We don't want you to hyperventilate." His voice betrayed his anger and exasperation. "We need to irrigate!"
Finally, a hand holding a saline bottle extended toward David, a woven leather bracelet around the wrist. David took the bottle from Carson and began spraying. Carson crouched on Clyde's other side and joined him.
"Missed a spot," Jenkins said sardonically, pointing at a large blister under Clyde's nipple.
David ignored Jenkins, leaning forward so his face was near Clyde's. "We're spraying you off with water now. We're doing this to wash off the alkali that is burning you."
Clyde shifted on his bound hands, squealing with pain. No one else came near them; the staff and officers standing back in their muted ring. "I didn't want to," Clyde whimpered. "I was going to, like before, but I didn't want to do it."
"Let's get him to an exam room. Dr. Lambert, get me a stretcher. A stretcher." David glanced up, his mouth pursed with anger. "Get me a stretcher now!"
Don returned David's gaze for what seemed an eternity, the only sound in the hall that of Clyde's whimpering. Finally, he turned and walked leisurely to retrieve a stretcher. It took him ten seconds to turn the corner, his slow pace mocking David.
Sweat dripped from David's forehead onto Clyde's face, and he leaned back and wiped his brow with an arm. "We have to get him on a bed. We don't have time to wait while Dr. Lambert plays games. Carson, keep irrigating." David turned to the cop Jenkins had referred to as Blake. "And you. Will you give me a hand?"
Clyde was heavy and limp, and David and Blake had to struggle to get him to his feet. He was taller and wider than either of them, and they staggered under his weight. The other officers watched closely.
David looked over Jenkins's shoulder at Pat. She held her head high on her slender neck, stately and pitiless. Disdain and hatred twisted her face into an ugly mask. "Get the hell out of my ER," David said. Her face crumpled, and he felt a flash of satisfaction move through the molten haze of his anger.
He and Blake pivoted and began to drag Clyde toward Exam Fourteen, Carson continuing to douse him with saline, Yale and Dalton walking on either side. Clyde was unsteady on his feet. Jenkins followed closely behind, palm resting on the butt of his pistol, and the other officers dissipated slowly, heading back out through the doors. By flanking David and Clyde, Yale, Dalton, and Jenkins created the illusion they were assisting.
"We're going to help you," David said. "Do you understand that I'm here to help you?"
Tear tracks streaked Clyde's cheeks like clown paint. He nodded, his chest heaving.
"What else can we get you, Doctor?" Jenkins asked quietly. "A plumber's snake to clear out his throat? A bag for his head, maybe?"
"Should we give him five, one, and one?" Carson asked.
Five milligrams of Haldol, one of Cogentin, and one of Ativan. He'd be out in ten minutes and stay that way for hours. "I don't want to go there yet," David said. "I'd like him lucid. He's been fine so far."
"That's because he's in handcuffs," Jenkins interjected.
David turned to Clyde. "You won't give us any trouble?"
Headshake.
"You promise?"
"Promise," Clyde cried. "I promise." He closed his eyes, muttering, "Three, two, one."
David felt a burning sensation along the tender skin inside his biceps. Alkali. He wiped it off hastily on his scrub top. "Watch your arms," he warned Blake.
Clyde finally found his feet and helped them the last few steps into the room, snuffling and yelping, and then they had him seated at the edge of the gurney. Carson continued spraying Clyde down, the saline pooling in his lap. His scrub bottoms turned dark with the liquid, clinging to his thighs and crotch.
David grabbed two saline bottles and stepped into the hall. Many of the staff members were standing around, rubberneckers milling in the wake of an accident. Don had just returned with the stretcher David had requested. He tossed it on the floor. David took in each face, the cold, peering eyes.
He and Carson would need help. Given the patient's history of violence against women, selecting male staff seemed clearly the right course. "You two." David snapped his fingers and pointed to a male nurse and a male lab tech, neither of whom he recognized. "In here and help Carson. Move it. Now!"
The nurse took a step forward, then the lab tech followed. David handed them each a saline bottle as they shuffled past.
David regarded the others for a moment. "In my seventeen years practicing medicine, this is the most horrifying thing I've seen." His voice sounded foreign to him. "On top of which you've allowed the floor to come to a standstill. Get back to work immediately."
He stepped back in the room and faced Yale. Jenkins's hand hovered over his Beretta, making David intensely nervous. Blake stood to the side, clearly uneasy. "Uncuff him," David said. "You've had your fun, now we need to get at him to treat him."
"No, sir," Jenkins said. "You're dealing with a dangerous man."
"We're dealing with a patient injured with alkali under suspicious circumstances who hasn't even been booked, let alone convicted of anything."
"The guy got caught stuffing alkali under his shirt. I think we both know-"
"Uncuff my patient!" David stepped forward, eye to eye with Jenkins.
Yale pressed a hand against
David's chest, which David knocked aside. "The best we can do is put him in four-point restraints," Yale said. "Would that be better?"
"We handle a lot of potentially violent patients."
"Would it be better if we got the suspect in four-points?" Yale repeated calmly.
David took a deep breath. "Yes."
"Hard restraints."
"Fine. The security guard up front can get them for you. Please hurry."
Dalton strolled out to fetch the restraints, as David scribbled the order. The nurse and lab tech were standing a few feet back from Clyde as they sprayed him down.
"What do you mean, restraints?" Jenkins asked. "Throw some water on him and let's haul his ass to Harbor."
"Back off, let us do our job. You can do yours later." Seeing his words were having little impact, David tried a more pragmatic approach. "You want him to stand trial wrapped in bandages?" he asked. "What do you think that'll do for jury sympathy?"
He turned around and examined the patient. The fact that the scrub top had remained between the alkali spill and Clyde's flesh had really limited the damage. The irrigation was coming along nicely-there would be some painful blistering and a few cuts, but nothing too serious. Morphine would have helped Clyde's pain, but he'd reacted violently earlier when David had mentioned giving him a shot, and David didn't want to risk agitating him again now that he'd calmed down.
David stepped forward, again careful to avoid Clyde's eyes. Clyde's lips were moving slightly, and David realized he was counting backward from three, over and over.
"We're just spraying the alkali off you," David said. "We're trying to make the burning stop."
Clyde's lips stopped their quiet chant for a moment. "Thank you," he said.
"We have some questions for him," Yale said.
"Uncuff him and let us treat him," David said over his shoulder. "You can question him in an hour."
Jenkins grabbed David's shoulder from behind. "This guy fucked up two of your nurses-"
"A nurse and a doctor, and we don't know the patient is responsible."
"Why don't you stop worrying about him so much and let us get what we need. We brought him in here."
David stared down at Jenkins's hand until he removed it from his shoulder. He looked around for Blake, his sole ally among the cops, but he'd left the room. "That was your legal responsibility," David said. "Not a favor."
"He is not the victim here," Jenkins shouted through clenched teeth, jerking a finger violently in Clyde's direction.
"We need you out," David said. He turned to Yale. "I need him out. He's agitating the patient."
"We'll get the suspect secured, then give you a little space," Yale said.
Dalton returned with the leather restraints. He walked behind Clyde's back, circling the gurney, and Clyde grunted and whipped his head around, trying to keep him in view. Carson and the nurse and lab tech were startled back a few steps. Jenkins grabbed Clyde's legs roughly, and Clyde thrashed as Dalton undid the handcuffs. The two quickly had Clyde flat on his back, strong leather restraints binding his ankles and wrists to the metal rails of the gurney. David directed them to bind one of Clyde's hands up and the other to the railing down by his waist so if something went wrong, they could turn him on his side to minimize the risk of aspiration.
The skin on Clyde's chest was raw and shiny where it wasn't raised in blisters, but it looked as though most of the alkali had been flushed off. He was in a much better position for Carson to access the burns on his chest, and the four leather cuffs held his limbs tight enough that the others weren't afraid to work more closely on him.
"All right," David said. "That's enough. He's not going anywhere. I can take it from here."
"We'll be outside," Yale said.
"Have fun," Dalton added. He had to grip Jenkins's forearm to move him from the room.
The room hadn't been prepped for a potentially violent patient, so David removed both IV poles, sliding them out into the hall and leaving the door slightly ajar. He found some scissors near a bag of O-negative blood that had been left on the counter from the previous trauma, and slid them into his pocket. The lab tech wore a shirt and tie, having not yet changed into scrubs for the day, and David pulled him aside and whispered to him to take off his tie before going near the patient. He caught Carson's eye and gestured for him to remove his yin and yang earring.
"Stand back from the door," Clyde was muttering when David turned his attention back to him. "Stand back from the door." He kept his eyes closed, as though he were praying. His hands were puffy, perhaps swollen from the cuffs.
He repeated certain phrases like mantras, David realized. The recitations seemed to have an obsessive-compulsive element to them; maybe they were uttered for the same reason some people with OCD wash their hands forty times a day-to reduce anxiety.
David crouched so he wouldn't have to lean over Clyde in threatening fashion. "We're going to remove your gloves now-"
Clyde screamed, balling up his hands into fists behind his back.
"Okay, okay," David said. "We'll wait till later. We'll take the gloves off later. How's the pain? Is it better?"
Clyde nodded. "Still burns but it's done eating its way through me. I know. I can tell when it's done."
"Do you want some pills for the pain?"
"I told you, I don't take pills." His crying and screaming had finally stopped, though he was still breathing hard. A small wedge of Pyrex glimmered in a cut near his left armpit.
"I'm going to reach across you," David said. "And I'm going to use these forceps to remove a sliver of glass from one of your cuts."
"Okay," Clyde said.
David leaned over, but Clyde's left arm was locked down by his waist, blocking the cut. He turned to Clyde, again doing his best to avoid what could be perceived as threatening eye contact. "I'm going to untie one of your arms to get at the cut. I'm doing this so I can help you. Remember, you promised not to give me any trouble."
Carson took a half step forward. "Look, I don't know-"
Clyde's sweaty head moved up and down in a nod.
David untied the restraint and raised Clyde's arm, the thick leather band remaining around Clyde's wrist. He bent down, navigated the forceps carefully into the wound, and removed the piece of Pyrex. He lowered Clyde's arm back to the metal rail and secured it again, threading the leather strip through the hasp.
Carson let his breath out in a rush.
Clyde raised his head weakly and stared at David as the others continued to flush his wounds with saline. His voice hitched in his chest. "Thank… thank you," he said.
David thought of the Xeroform bolsters stitched into Nancy's face and strongly resisted the urge to tell him to go fuck himself.
Chapter 22
"To say I'm pissed off would be an understatement." By the time David entered the doctors' lounge his rage had turned to disgust. He had pulled most of the staff who had been on the floor during the incident into an impromptu meeting, leaving Carson and a few nurses to oversee the floor. Pat had apparently followed his orders and left. Nurses and interns crammed onto the cheap vinyl couch, leaned against the coffee-stained sink, and sat cross-legged on the floor.
He looked blankly from face to face. Almost all of them lowered their eyes from his stare. "A patient comes into our division in acute pain, requiring emergency treatment, and we withhold care. A top-notch medical facility withholds care. I can't… " The words were jumbling in his mouth, so he paused and took a breath. "I'm meeting with Dr. Evans today, but I can't even begin to figure out how I'm going to present this."
A few of the interns stiffened at the mention of the hard-nosed chief of staff.
He couldn't recall ever seeing the staff so uncomfortable. Nervous shuffling, regretful expressions. One of the nurses looked up to stop her moist eyes from leaking. A medicine intern raised a fist to stifle a cough.
"Outside these doors, the world can be as vicious and cold as it wants. People don't help each other. Peop
le don't have to help each other. In here, we take care of them, trite as that may sound."
"That man is a vicious mutilator of women who got a taste of his own medicine." The anger in Don's voice surprised him.
"That man is a suspect" — David emphasized the nouns with jabs of his open hand- "but that's the cops' concern. To us, he's a person with a serious injury, like any other."
"Just doing our job, huh? That's the philosophy you want to rely on?"
David's stomach was awash with acid and rage. "The Hippocratic Oath, Dr. Lambert, is the philosophy I rely on. We took an oath, every one of us, that we would work by our medical ethics and hold them above everything else. What does it mean if that oath ends beyond the point that someone is appealing, or mentally sound? Or likable?"
"It's not that black and white."
"It is precisely that black and white. If we can reduce the pain of another human being, we do it."
"How can you want to show that man compassion?"
"Compassion? It has nothing to do with compassion. This is our job. If you don't like it, go be a goddamn accountant. But you can't stay here and think you can call your own shots."
The others watched the exchange with stunned expressions.
David took another moment to gather his composure. "It is not our place to question our patients' morality. Do you really think you can keep your footing on that slippery slope? What next? We stop treating criminals? How about people who cheat on their income taxes? Do we let them lie in pain? The mentally ill? Do we deny them medical care? Do we?" David's arms were tensed before him. "That man in Fourteen could very well be mentally incapacitated. Leave judgment to the courts, and do the jobs you swore under oath to do."
"I never abandon my own instincts," Don said. "Not for any code of ethics."
"Fine," David snapped. "If that code of ethics doesn't work, try this one. I'm the division chief, and you will listen to me. So do your fucking job. All of you. Now."
He walked out and left the door standing open, the murmurs following him a few yards up the hall. Whether the confrontation had done any good or not, he felt considerably better.
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