Doing Harm (35 page)

That’s when I see the crowd.

A press of people—some appearing subdued and somber, others simply curious—are gathered to one side of the cavernous main lobby. Several cops are milling around with University Hospital security officers, and a local news reporter is talking to one of the cops.

My stomach gives a little lurch.

“What’s going on?” I ask a medical student who’s alternately taking in the scene and thumbing the keys of her smart phone.

“Haven’t you heard? They found one of the residents dead this morning.” She glances up from her phone, and adds, conspiratorially, “Here. In the
hospital.
”

My breath catches in my throat.

“How?”

“Suicide. They think. He was in a call room. There was a note, I heard.”

Luis’s phone slips from my hand and clatters to the floor.

It couldn’t be,
I think frantically, dropping to one knee to scoop up the phone with shaking hands.

And then, as I straighten up, I spot Dr. Collier, ashen-faced, speaking earnestly in hushed tones to a woman dressed in heels and an immaculate gray power suit. She looks pained. It’s Andrea, Sally’s old boss. The CEO of University Hospital.

And I know.

But I ask anyway.

I have to.

“Do you know who?”

“Some guy with, like, a Spanish-sounding name. I’m checking the University Hospital Web site to see if I can figure out who it was.”

“Luis,” I whisper, as the police clear a path through the crowd, through which a man and a woman, blank-faced and wearing bright yellow jackets with the word
CORONER
stenciled on the back, push a body bag on a gurney. The onlookers stir. A few are holding up cell-phone video cameras. Somewhere, I hear a woman sobbing.

“His name was Luis.”

*   *   *

After watching the police cart off Luis’s corpse, the rest of the day flashes by in a series of disturbing images, like when you’re sick in bed, and you’re sleeping, but you keep having disjointed, fever-induced nightmares from which you intermittently emerge, semiconscious and soaked with sweat.

Around lunchtime, I attend a hastily called emergency meeting of our department, at which Dr. Collier, visibly shaken, his voice hushed and quavering, confirms to the faculty, residents, nurses, and administrative staff assembled in the Dome that Luis is indeed dead and that the initial information indicates it was most likely a suicide. He leads us in a moment of silence, and then reminds the stunned audience that, despite our shock and grief, our patients still need us, and that daily routines will continue uninterrupted. He announces which residents will be temporarily assuming Luis’s hospital duties until a more permanent solution is reached. I note, with some bitterness, that my name is not among them. He pledges to provide further updates as more information becomes available.

Afterwards, in the hallway outside the conference room, my colleagues gather into tight groups, hugging one another and crying. I mingle with a few of them, briefly, before splitting off and collapsing against a nearby pillar. I rest my head against the cool marble, and close my eyes.

This sucks.

So what do I do now?

“I warned you not to ask for help, Steve,” a familiar female voice whispers seductively in my ear. “I said there would be a penalty if you did.”

I spin angrily on GG and, unnoticed by our distraught coworkers, guide her firmly by the elbow into a sheltered alcove off the main hallway. “So it
was
you,” I hiss. “You killed him. It wasn’t a suicide.”

“I didn’t say that,” she replies with a coy smile that makes me want to grab her by the neck and throttle her.

“But why
kill
him, GG? What does Luis’s death have to do with keeping patients safe? It doesn’t make any sense. You said you were only interested in patient safety.”

“I am,” she explains patiently. “And his death is all about patient safety. Everyone knows that residents are overworked and fatigued; many are clinically depressed. In fact, the prevalence of drug and alcohol abuse among doctors and residents is much higher than in the general population. Depressed, substance-abusing doctors can, through no fault of their own, make mistakes that kill patients.” She reaches over and casually brushes a piece of lint off my shoulder. “Oh, I’m sure the Safety Committee will be
very
interested in Luis’s death, Steve. The Committee might even make recommendations for further reducing resident work hours and screening for depression. Poor Luis.” She shakes her head in a mockery of sympathy. “He had a history of drug and alcohol problems. Did you know that?”

My cartoonish expression of surprise, complete with slack jaw and wide-set eyes, is all the answer she needs.

So that was what was in his confidential folder.

She blinks innocently. “I see that you didn’t. Well, I guess his inner demons finally overtook him. Once an addict, always an addict. At least, that’s what everyone is going to say.”

“You
bitch
,” I snap, incensed by her smugness, inadvertently launching flecks of spit at her nose in irregular arcs. My fury over her complete disregard for Luis’s life—
all
life—almost overcomes me, and it is all I can do to keep myself from smashing my fist into her face. And then another thought occurs to me. “You planned this from the beginning, didn’t you? As part of your patient safety thing. You were going to kill Luis whether I talked to him or not.”

Unmoved, and without taking her eyes off me, she placidly and methodically wipes the spit off her cheek with her shirtsleeve. “The important thing is that you
did
talk to him. Didn’t you think I’d notice? Since when had the two of you ever spent
any
time together outside the hospital? Whatever it was the two of you were up to, all alone talking in that bar over by the Commons last Wednesday, it’s over now. Yes, Steve. I was there. I even saw you grab that poor girl by the shoulder. Did you think she was me?” She giggles. “She did look a little bit like me, I guess. I honestly thought her father was going to kill you.” Now her voice becomes low and menacing. “I warned you that there would be a penalty, Steve, for breaking the rules. Now, here’s another one: I’m moving our timetable up. The next patient is going to die this week.”

“What?” My anger deflates, like a popped balloon. “But … you said it wouldn’t happen until next week.”

“You broke the rules, so I’m altering them. Try to stop me.” She shrugs. “Or not. It doesn’t matter to me at this point. It’s up to you.” And then she levels an icy gaze at me that makes the hairs on the back of my neck stand up. “And you alone. No more violations, Steve. Don’t give me a reason to link patient safety to Katie and Annabelle. Do you understand what I’m saying?”

Jesus.

If she was able to get to
Luis
, for God’s sake—with all of his training, military experience, paranoia, and preparations—then how safe are Sally and the girls?

Seeing my expression, she smiles and leans in toward me.

“That’s right, Steve,” she whispers. “Be scared. Be very, very scared for your family.”

I need to get away from her.

Right now.

I stumble out of the alcove and take off down the corridor, away from GG and the Dome, weaving in and out of the dense flow of midday human traffic. I don’t know where I’m going and really don’t care. I don’t look back, but I can feel her eyes following me, and I can picture the smirk on her face.

As I turn a bend in the corridor, I pull out my phone and call Sally. It’s a hollow gesture, I know—I mean, if GG was really determined to hurt them, there’s no doubt in my mind that she’d track my family to Providence. But when Sally picks up, sounding surprised and a little touched that I would be checking in so soon after their departure, it nevertheless makes me feel better to hear that she and the girls made it to her sister’s house just fine. The sound of her voice alone is comforting. We chat briefly about nothing in particular. I don’t tell her about Luis, knowing that now is not the time to open up that particular can of worms. Some kind of dispute between Katie and Annabelle draws her attention; before hanging up, she promises to call tomorrow.

With nothing else to do, and Luis weighing heavily on my mind, I wander to the cafeteria. I sit at an empty table in a depopulated corner and call Jason—guessing, correctly, that he would be an informed and sympathetic source of information about Luis’s death.

It quickly becomes clear by his pressured speech and anxious tone, so unlike his normally carefree persona, that Jason is well and truly freaked out over Luis’s death. It’s also obvious that, probably because of his position on the Safety Committee, Jason is up to speed on everything that University Hospital currently knows about the situation, the details of which he freely offers up in a manic, stream-of-consciousness soliloquy. I’m not really sure why. Maybe he just needs to unload on someone as a kind of mental therapy. In any event, I think he ends up telling me a bunch of shit he probably shouldn’t.

Luis, Jason confirms, had a troubled past and a documented history of drug use. He had started out as a teenage gang leader and spent his late teens drifting into and out of prison, mostly for dealing and doing drugs. But around the age of twenty, Luis had managed to turn his life around: He had dried out, received his high school equivalency degree, joined the Marines, and earned a spot in one of their elite units.

Jason tells me that Luis had reportedly seen a lot of combat and served with distinction for many years in Iraq, Somalia, Afghanistan, and probably a bunch of other places that would never appear on his official record. He also had a documented history of PTSD, which was successfully treated prior to his beginning medical school.

The suicide note Luis allegedly left behind—neatly typed and folded in an envelope found next to his body—is apparently pretty convincing. In it, Luis admitted to doing drugs again, heavily, to cope with a resurgence of his PTSD and the stresses of residency. He professed self-loathing over his perceived lack of control and discipline, and expressed an inability to bear the shame of his weaknesses.

“Christ, Steve,” Jason says, his voice shaking. “The cops think he pumped himself with enough meds to bring down a bull elephant. He put a central line in his own femoral vein to inject them, for Christ’s sake. I mean, there’s precedent for that kind of thing. There’s a report of at least one anesthesiologist who accidentally killed himself injecting drugs into his own femoral vein. But—
Christ.
Luis? Who would have guessed? We just saw him the other night at Dan’s house. It hits so close to home. Christ. He seemed perfectly fine.”

That’s because he was.
“What drugs?”

“It’ll take weeks to get the definitive results back. Between you and me? There were so many different kinds, he had to label all of his drug vials so that he could keep track of what was what. The cops found bottles marked as narcotics and benzos. Some lidocaine. Oh, and ketamine.”

“Ketamine?”
That’s an unusual choice.
“You mean the anesthetic also used as an animal tranquilizer?”

“One and the same. It’s got hallucinogenic properties and pretty decent street value.”

“Didn’t anybody see or hear anything?”

“Nobody else used that call-room suite last night. One of the residents found him after he didn’t show up for morning rounds or the operating room.”

A virtuoso, brutal maneuver.
GG engineered a perfect setup with a completely credible backstory: a doctor with a troubled past, unable to cope with the stresses of residency, who overdoses in a hospital call room. She played the former Force Recon Marine as if he were a puppet on strings.

Which, of course, raises some nagging questions. Like, how was she able to get to Luis? And what was he about to tell me this morning?

And, most important, if Luis couldn’t beat her—how can I? All on my own?

“I mean,
fuck
, Steve. You worked with him every day. Did you see this coming?”

“No,” I answer honestly. “No. I didn’t.”

Jason keeps talking, but I’m no longer listening.

What else can’t I see coming?
I wonder.

What else does she have planned?

*   *   *

Mrs. Samuelson is asleep.

Not in a coma. Not unconscious. Not sedated. But in a real, honest-to-God state of deep slumber. The SICU doctors took the breathing tube out this morning. She’s hoarse, but otherwise, remarkably, none the worse for the wear.

It’s evening now, and I’m sitting next to Mrs. Samuelson’s bed in the SICU. I don’t remember how I got here. In fact, I don’t remember much of what happened today after my conversation with Jason. I know I somehow ended up in my office, but I don’t remember exactly what I did there. I think I might have napped, but I’m not sure. My waking and sleeping states feel like they’re merging.

I should be happy, I guess, watching Mrs. Samuelson sleep. I should be as ecstatic as her family, grateful that she most likely is going to make it out of the hospital alive, despite my best efforts in the OR to bleed her to death.

But, instead, I’m scared.

Scared as much, maybe, as I’ve ever been at any point in my life.

My fear is like a nest of snakes in my stomach, their slick coils writhing and twisting as they slide over and across one another, again and again. It kind of feels like I want to puke, but I know that puking won’t make the sick feeling in my stomach go away. My hands are cold. I keep rubbing them together, trying to warm them up, but the cold comes from the inside, so no amount of rubbing helps. My breathing is quick and shallow, and my heart pounds away in my chest.

I try to calm myself down by thinking about the physiology underlying these symptoms: the catecholamines, secreted by my adrenal glands, that are flooding my body and activating the same so-called fight-or-flight mechanism we share with our animal cousins inhabiting other branches of the evolutionary tree. But my basic instincts win out, and the fear remains.