The Inquisitor (8 page)

"I love a thunderstorm at the end of a hot summer day, don't you?" she said after assuring him she felt comfortable most days on her current drug regime. "It's so refreshing, and the air smells wonderfully clean afterward."

"Yes, I know exactly what you mean," he said. Her pleasant manner put him at ease. Normally having nothing to offer a patient but small talk made him feel awkward. "Do you have family?" he asked after a few seconds, mostly to reassure himself she knew someone who cared enough to keep her company. He couldn't imagine anything worse than being confined to a room, with no prospects of a visitor.

"Yes, one son. Donny. He owns a restaurant in Honolulu. I don't see him much, but next week he'll be here- a business trip to New York. And he taught me how to use e-mail." She pointed at a turquoise laptop sitting on her night table.

Pretty lonely, he couldn't help thinking, and tried to come up with something else to say. "Do you know the hospital chaplain, Jimmy Fitzpatrick?"

Her eyes beamed. "Father Jimmy? Of course. He's wonderful. Always says just the right thing to pick up a person's spirits."

Oh, does he now? Earl thought, still shaken by the hiding he'd received.

"Cracking jokes the way he does is wonderful," she continued, "but he can be serious when he wants to be."

"Tell me which you like best about him, jokes or serious." Maybe she could give him some pointers about the man's technique with the patients here.

"That's easy. He never wastes my time. No rubbish about doctors all at once finding a cure or me somehow getting better through a miracle. There's a relief in hearing a person tell bad news honestly and make no bones about what can't be done. It leaves him free to help me in ways he can."

"What are those?"

"Listening, talking about ordinary things, keeping me interested in the world- you know, making me feel I matter to him. Not that he's got a lot of time to do it in. There are so many others who depend on him as well."

Earl started to thank her, not much the wiser about specifics that made Jimmy so great at his job, but she laid a hand on his arm. "Know what's his real secret, now that I think about it?"

Earl waited.

"It's the way he looks you in the eye and says, 'I'm sorry you're going through this.' Twenty seconds face-to-face like that, and I feel he's given me twenty minutes."

The next dozen visits went a little quicker, but he found them no easier. Patients raised questions he couldn't answer and expressed fears he didn't know how to console.

"Why me?" some asked when he inquired about their pain.

"I'm afraid to die," others said.

Not that he hadn't heard those words thousands of times in ER. But there the confused hurly-burly of a resuscitation or the rush to line and intubate whomever he was working on allowed him to get away with brief reassurances. Here people looked him in the eye and expected his undivided attention along with a detailed response.

"I don't know what to say," he repeated over and over, bowing to a growing sense that on this ward, bullshit would be even less forgivable than his ineptness with words. "But I'm sorry for your ordeal."

Still, he pushed on with the rounds. Despite the emotional suffering he'd discovered, he began to wonder if Jimmy hadn't exaggerated his claim about patients being undermedicated, as most seemed free of physical discomfort.

Then they approached the nearest of a string of rooms where the nurses had closed the doors. The sounds he'd heard earlier emanated from here.

He quickly scanned the chart of the patient they were about to see.

Elizabeth Matthews, fifty-eight, terminal cancer of the ovary.

What had sounded like whimpering turned out to be a continuous high-pitched cry once they were inside. The lights were off and the blinds were closed, so he could barely make out her form on the bed. But he could smell the acrid, sour aroma of her sweat.

Swallowing, he drew closer, and his eyes adjusted to the dark. She lay on her side clutching her knees, curled around the point where the tumor, grown from what had once been the source of her seed, would have maximally eaten through the contents of her lower abdomen and into her pelvis. She rocked back and forth, as if her belly were a cradle to the malignancy and her hideous keening could lull its ravages to sleep.

"Mrs. Matthews?"

The piercing sound from her throat never wavered.

A movement in the corner of the room startled him. "Doctor?" a man's voice said.

Earl turned to see a tall, asthenic figure rise from a lounge chair set well back from the bed.

"I'm Elizabeth's husband." He held out his hand. "Thank you for coming."

Earl took it, touched by the simple dignity of the gesture. Either the man had nerves of steel to remain so composed in the face of his wife's suffering, or witnessing it had left him numb. "Mr. Matthews, I'm so sorry."

"Nothing's helped, Doctor. She's been this way for the last two days. The residents tell me they're giving her the maximum amounts of morphine possible…"

As he talked, Earl flipped to the medication sheet and looked at the orders.

Morphine sulfate, 5 mg sc q 4 hrs prn.

Maximum, his ass. A medical student must have written it, copying word for word from the Physicians' Desk Reference, the bible of medications and their standard dosages. But Elizabeth Matthews didn't have standard pain.

He immediately felt back on his turf. "Get me ten milligrams of midazolam," he said to Yablonsky. This kind of suffering he could dispatch in seconds.

"But-"

"Now!"

One of her younger assistants darted out the door.

"When did she get her last dose of morphine?" he asked, walking over to check that Elizabeth Matthews's IV line remained functional. He opened the valve full, and it ran fine.

Yablonsky flipped to the nurses' notes. "At three this afternoon," she said, "during our usual medication rounds."

"And it's now nearly eight, five hours later. Her order says every four hours, as needed. I think we agree she needs it."

"Well, yes…"

"And you gave her only five milligrams?"

"Subcutaneous, as prescribed."

"You didn't request her doctor raise the dose, even though you could easily see she required more?"

"More is not what's on the chart, Doctor. Besides, we don't want her to get used to it so the drug no longer has an effect-"

"You call this an effect, Mrs. Yablonsky?" He gestured to the crumpled shape on the bed.

She fidgeted with the chart, fuming at being confronted. "No, but I-"

"What do you say we give her ten, then? And if that doesn't work, make it fifteen." He grabbed the file out of her hand and wrote the order, scrawling his signature with an angry flourish. "And once we find out how much is enough, we'll make it an IV infusion. Even street junkies know that popping narcotics under the skin doesn't hold a candle to mainlining."

Yablonsky turned scarlet all the way to the tips of her ears. "Really, Dr. Garnet, her oncologist says she could linger like this for months. She wi//grow tolerant to morphine, and-"

"Then we'll sedate her, just as I'm about to do now."

As if on cue, the young nurse who'd gone to fetch the midazolam returned and handed him a syringeful of the fast-acting sedative. He swiped the rubber portal at the side of Elizabeth's IV line with an alcohol swab, jabbed in the needle, and slowly pushed on the plunger. "Whatever it takes to make her comfortable," he continued, "especially if she's got months. My God, is that your policy, the longer a patient has, the longer they don't get sufficient morphine?"

Yablonsky's younger colleagues, standing behind her back, nodded tellingly.

Yablonsky snapped her head high and threw back her ample shoulders. "Of course not."

Earl wondered if she had once been an army nurse.

Elizabeth's cries lessened as he slowly injected the contents of the needle, keeping a sharp eye on the rise and fall of her chest.

Mr. Matthews walked over to the other side of the bed, leaned over, and stroked his wife's head. "It will be better now, Elizabeth. You'll get some rest." The fatigue in his voice weighted the words like rocks, but they must have fallen as gently as tears on her ears. She smiled, released her hold on her knees, and reached up to pat his hand.

A few seconds more, and she slept peacefully.

"Thank God," Mr. Matthews said, and pulled her mask from down around her neck back up over her nose. By the light from the hallway, his haggard eyes appeared gouged out by worry and exhaustion.

"Why not grab some shut-eye yourself?" Earl told him. "I promise you, she'll be fine for the night. Go home and get to bed." He put his hand on the old man's shoulder, and felt it slump in defeat. "Mrs. Yablonsky will sponge-bathe Mrs. Matthews and change her nightie and bedding." He turned to face the nurse. "And open the blinds, shall we? Let her see it's night should she wake up, right, Mrs. Yablonsky?"

She sucked in a mouthful of air. "Yes, sir."

"During the day, we'll continue to make sure they stay open and that there's natural light in here, so she'll be less confused. Agreed?"

The nurse nodded.

"And she gets her next morphine as soon as she starts to stir from the midazolam wearing off, which will be in about an hour…"

As Earl rattled off his instructions, tears rippled down the haggard circles beneath Mr. Matthews's eyes to where the crescent contours of skin bunched up by the top of his mask. From there wet marks spread through the material until it grew damp enough to stick against the hollow contours of his cheeks. He reached across his wife's sleeping form and held out his hand to Earl again, except this time it trembled slightly. "Thank you," he repeated, but much more softly than before.

Earl clasped it in his as he finished outlining to Yablonsky a regime that had more to do with simple human dignity than medicine. Yet he couldn't be sure she wouldn't screw it up somehow, to put him in his place.

"Yes, Doctor," she repeated over and over.

Her sullenness worried him. "And make sure the next shift gets it right as well. I want no more problems."

She bristled, almost standing at attention. "I'm doing a double and will be here until dawn."

Resentment had probably prevented her from adding a "sir" this time. Earl pegged her former rank as at least a sergeant.

He led Mr. Matthews to the door and delivered him to one of the younger nurses with instructions to give the man a taxi voucher.

Then he and Yablonsky wrapped up the rest of the rounds in an hour, during which Earl made similar adjustments to the medications of another seven patients, who all had little more than days, if not hours, to live. Still, there'd definitely be fireworks over what he'd done here tonight. One of the seven, unfortunately, belonged to Wyatt.

Yablonsky, on the other hand, had become much less hostile by the time they returned to the nursing station. Her initial rigidity now made her seem more brittle than hard, almost fragile. Not that he could excuse the indifference he'd witnessed here, but little wonder she and her colleagues armored themselves with it, seeing people face death, day in and day out.

"Tell me, Mrs. Yablonsky- or may I call you Monica?" He sensed he might have won her over a little and that now might be the best time to get her talking, before Wyatt declared him public enemy number one.

"Of course, Doctor."

"There's something else Dr. Wyatt brought to my attention that perhaps you could help me with."

"If I can."

"He described a cluster of odd occurrences."

Immediately her body stiffened again, as if she was holding her breath in anticipation of bad news. "Clusters?"

"Yes. He said that over the last few months some of your patients were reporting near-death, out-of-body experiences."

"Oh, that!" She immediately exhaled and gave a little laugh. "Yes! It's most strange. And some of them weren't that near death."

"Do you have any ideas as to the cause?"

She shook her head. "I'd guess the effects of morphine or whatever other medication they were on. I actually looked up near-death experiences on the Internet. There's quite a lot there, you know, all about the neurotransmitters that may be behind it and what receptor sites in what part of the brain, if stimulated, will produce the experience-"

"What did Dr. Deloram think about it?" he interrupted, having no use for medicine culled off who knew what Web sites. "Didn't he come to interview some of the patients a few days ago?" Earl tried to make the question sound as innocent as possible.

Surprise deepened the wrinkles on her forehead. "You heard about that visit?" She leaned closer to him, her eyes all at once betraying the delighted eagerness of someone ready and willing to gossip. "Now there we had a really strange event. He arrived yesterday morning, pleasant as can be, took the list of patients' names, and went off to talk with them, at least the ones who are still alive. An hour later he stormed out, face so livid I thought his mask would burn off, and not so much as a word to any of us. Never did find out what made him so angry. The patients he talked to didn't know either." She leaned back and gave a little nod, as if daring him to come up with a logical explanation for such a bizarre display.

Earl asked if she could prepare the list again, intending to speak with those patients himself later. He also would ask Stewart what happened. But as he took the elevator down to the main floor, something other than near-death experiences began to bother him.

Why had Monica Yablonsky reacted so apprehensively when he first mentioned a cluster of odd occurrences, then been clearly relieved when he asked about the near-death experiences?

He walked to the front entrance, where he dumped his protective garb in the prescribed disposal bin, stepped outside, and raced through a warm summer downpour to his car.

Yet he remained preoccupied.

What kind of clusters could she have thought he meant?

Janet heard Earl's car pull into the driveway.

She threw down the Saturday edition of the New York Herald, wanting to swat him with it for coming home so late on a weekend. It especially galled her when politics, not patients, delayed him.

Bloated, bitchy, and mad at the man who had gotten her that way, she thought. She'd better watch it, or she'd soon come across like the wronged woman in a country-and-western song. Still, her two-hours-overdue husband had better have a damn good excuse.

Brendan looked up from where he'd been engrossed in some elaborate game on the kitchen floor involving a toy train and dump trucks. "Daddy's here," he yelled, the noise of his father's arrival finally penetrating his imaginary world. He leapt to his feet and streaked to open the back door.

She levered herself upright. God, she didn't remember being so heavy the first time. No way she'd be able to work right up to the due date lugging this one around. She also admitted to a tinge of relief at having a legitimate excuse to book off on maternity leave earlier than last time. Despite her initial resolve to never abandon her patients because of SARS, she didn't at all like some of the close calls that had been reported in the news lately involving pregnant women exposed to undetected contacts in hospitals.

"Daddy, I listened to my little brother's heart," Brendan yelled from the threshold, eyes wide with the clear blue exuberance that only a six-year-old can have. "Mommy put a radio thing on her tummy and let me hear."

Earl stepped in from the rain and swung him into the air. "She did? Wow!"

"Want to hear what it sounded like?" Without waiting for an answer, Brendan very seriously pursed his lips to make a rapid sucking and blowing sound with his breath- not a bad imitation of fetal blood flow amplified by a Doppler microphone.

Despite her annoyance, Janet had to laugh. Still, Earl should have entered the garage directly and not touched Brendan before discarding all clothing immediately into the washing machine and showering. Shortly after the outbreak they'd installed a cubicle in there just for that purpose. She'd felt paranoid doing it- Earl kept reassuring her that the precautions at work should have been enough- but the fear they might have carried the virus home on their skin or clothing stalked her every time either of them went to hug their son.

Earl glanced her way. He must have read trouble, as he just as quickly put Brendan down and said, "Well, isn't that marvelous? You're sure Mommy doesn't have a little choo-choo engine in there?"

"No, come listen yourself." He reached to pull Earl toward her. "She's been making us spaghetti, for a long time."

Earl stepped back, hands in the air. "Daddy has to go shower," and he disappeared down the basement stairs.

Five minutes later he returned dressed in jeans and a T-shirt, his dark, wet hair slicked back. He wisely stooped to first say hello to Muffy, their large standard poodle, who still considered herself the family's firstborn and Brendan one of her pups. Now twelve, the dog had taken to sleeping a lot, mainly in doorways near entrances so that any new arrivals would have to step over her rather than she having to run to them. He gave her a kitzfe behind her ears- Janet had taught him the word shortly after they first met sixteen years ago. It meant stroking. Muffy had become an eager recipient when she joined the family, and Brendan had learned early to get his fair share too. Kitzle had appeared in his vocabulary almost at the same time he learned "No!"

After a few seconds with the dog, Earl got Brendan on the other side of him, and attempted a make-Janet-smile maneuver with a show of boy-dad-and-poodle funny faces. When that didn't work he led his co-conspirators in a three-abreast charge to where she stood leaning against the table. Muffy jumped her first, front paws stretched shoulder high. Brendan grabbed a leg, and Earl gently slid his arms around her protruding waist, the smell of soap off him tickling her nose.

Her anger drained away. Fifteen years married, and the man could still disarm her with the old playful charm. She grabbed a nearby ladle and waved them off. "Wash your hands and set the table with knives and forks," she commanded, scowling at Earl. "Supper's late enough as it is."

He winced again. "Sorry. Something came up at the hospital."

"On a Saturday night?"

"I'll tell you when we're alone." Scooping up Brendan-"Come on, chum. You're filthy!"- he ducked out from under her blue searchlight gaze.

By 10:30 the storm had passed and the clouds abated enough for the moon to appear. Its misty light percolated through the canopy of trees in front of their house, and the grass beneath, stirred by a strong breeze, flickered between silver and shadow.

She curled up beside Earl on their living room couch, her back to his front and half listening to his explanations as to why he'd been so late.

"I won't be a widow to out-of-hours political crap on a Saturday," she interrupted, having heard all she cared to. "Not for Jimmy, Peter Wyatt, or showing up doctors who can't cut it, understood?"

"Aye, aye, Captain." He slipped an arm around her and softly nuzzled her hair with the side of his face.

"I'm serious, Earl." She looked up at him. "There are others who deserve your time." She placed his hand on her rounded stomach.

He smiled and explored her pregnant curves with his palm.

His fingers released a craving that caught her by surprise. She felt her face flush.

He continued to caress her, very slowly, in ever widening circles.

She relaxed, first letting her body mold itself against his, then beginning to follow his movements with her hips.

"Do you think your passenger would mind?" he asked after a few more minutes, their gyrations becoming more urgent.

She arched her back and lifted her arms, slipping her hands behind his neck. "Just be gentle," she whispered in his ear, drawing him to her and setting him on fire.

He reached around to the lamp and turned it off, then began to unbutton her blouse.

Afterward, in the darkness, they held each other, and he felt the cool night air flow gently over them through the open windows. Savoring the rise and fall of her breathing against his chest, he thought of all the other times like this when he'd cherished the extraordinary blessings in his life- Janet, Brendan, and now a new son on the way- but always with a glance over his shoulder. He knew from a lifetime in ER how quickly joy and love could be snatched away by fate, bad luck, or raw malice. Working emergency had ingrained it in him. While he could recount victories, the defeats, like permanent toxins in human tissue, embedded themselves the deepest and stayed with him the longest.

"Hey, you have to trust life more," Janet had told him shortly after their first encounter sixteen years ago when she'd gotten her initial glimpse of his dark take on the brutal laws of chance. "For all the victims who end up in your ER, there's thousands more who make it safely home to bed. Besides, people like us, you and me, we'll make our own luck." Such unswerving optimism suited a woman who brought new life into the world for a living. It also counterbalanced his own daily workload of lives lost or torn apart.

Lately his tendency to think the worst had taken a new twist. Although he hadn't said anything to her yet, he worried about Janet giving birth at St. Paul's. Nobody had exposed the OB units to SARS, but it had happened in other hospitals. The culprits were usually residents who came from a ward where they'd unknowingly been around an infected patient who hadn't been diagnosed. The result was that newborns arrived only to be slapped into isolation. Only a matter of time, he kept telling himself whenever she went to work in her own department. But she knew that as well as he did, would be no less worried about it, and didn't need the extra pressure of hearing him lay it out.

He'd started to read up on home deliveries instead.

The breeze from outside picked up slightly, and he savored a sweet fragrance of nicotinia that wafted into the living room. It came from the front garden where she had planted an entire bed of the white, star-shaped flowers. Their pleasing, clean scent made him think of the lonely woman in Palliative Care who had confided how she loved the freshness in the air following a rainstorm. What was her name? Sadie Locke? Tomorrow, weather permitting, he'd have one of the orderlies take her out onto the roof garden in a wheelchair. Maybe maintenance could even spruce the area up a bit, perhaps bring in a few pallets of annuals. Janet would know what varieties might do well up there. Then patients who were strong enough could escape the walls and odors of the hospital.

He smiled and indulged in a rare moment of feeling pleased with himself. Why not? He seemed to have a knack for this VP, medical stuff. It gave him a rush of satisfaction, the prospect of having all that power and using it to do good things.

So there, Jimmy.

Sunday, 6:00 a.m.

Palliative Care Unit, St. Paul's Hospital

Monica Yablonsky dashed for the bedside phone. "Code blue!" she yelled, the standard order to bring a resuscitation team running to the aid of a cardiac arrest victim. "And I want the R-three in ICU or Emergency."

Not just a bunch of beginners, she added to herself, slamming down the receiver and reaching for the gray face with the staring eyes. It felt cold and rubbery. God knew when she'd died. Not recently. But with no DNR order on the chart, and given the stunt Earl Garnet had pulled last night, she'd better play this one by the book. Damn him, sticking his nose in where it didn't belong.

She plopped a pocket breathing mask over the dead woman's lips and nose, then blew.

The breath squeaked out the sides of a rubber seal that should have molded itself to the face.

Elizabeth Matthews's chest barely rose.

Monica tried again.

The same resistance blocked her effort.

Still, she had to go all out. Or would that only make her appear more guilty? Garnet would be looking ultra close at what happened here. And given his reputation for digging up shit, he'd be bound to discover the others. If he did, the nurses on the night shift would have to watch out.

She swiftly positioned her hands on the midpoint of Elizabeth Matthews's sternum and began the compressions. It felt stiff, so she applied more force to get the required inch of downward thrust that would squeeze the heart's ventricles and pump blood through the body.

Ribs snapped with a crunch under her palms.

"Shit," she muttered, easing off a bit. Still, she continued, not at all sure her efforts wouldn't make Garnet more suspicious.

"We got a code, eighth floor!" Jane Simmons yelled. She turned from the phone and ran to where they kept a portable bag of airway equipment. Grabbing it, she sprinted for the door, right behind Thomas and the rest of the team. At the elevators they commandeered a car with an override key.

In less than a minute they were on the ward. Jane arrived at the patient's room to find the night supervisor, Mrs. Yablonsky, and a nursing aide administering CPR, both women red-faced from the exertion.

Out in the hallway the sounds of running feet and a familiar wobble of wheels announced the arrival of ICU residents with the crash cart. This chorus of youngsters with fear in their eyes followed Thomas through the door and swarmed the patient. Some ripped open her nightgown, while others slipped a board under her back. One of them applied well-lubed defibrillation paddles to her bony chest.

The monitor screen showed a flat line.

"I've got the airway," Jane said, shouldering Yablonsky aside and flipping off a pocket mask that the aide had been using to provide ventilation. As she worked, the sticker bearing the patient's name at the head of the bed caught her eye.

Questions flew.

"She's not a DNR?"

"When did she arrest?"

"What's her diagnosis?"

Amid a flurry of hands, additional IVs went up.

Jane tried to pry open the mouth; she found it unusually stiff but slid a curved airway into place anyway. She then connected a ventilation bag and mask to an outlet in the wall, sending a hiss of oxygen into the room. But when she applied the mask over the patient's face and squeezed, the bag remained rigid in her hand. She couldn't force air into the lungs. The woman's tongue must be blocking the way, she thought. She tried to reposition the head, but it resisted manipulation as much as the mouth had.

A pretty blond girl who had attempted to take over the chest compressions, her long hair repeatedly flopping in the way, slowed after a dozen thrusts. "This one doesn't feel right!" she said, her eyebrows bunched into a frown, but she continued to labor over the dead woman's chest.

Thomas walked over to the bed, reached through the crowd, and placed the tips of his fingers along Elizabeth Matthews's neck. "You're not producing a pulse." He signaled the young intern to step back- she'd already grown flushed from trying- and attempted a few compressions himself. A puzzled expression crept across his forehead. He stopped pumping, threw the covers entirely off, and turned the woman's body to reveal large purple blotches on her hips and the back of her shoulders. He looked up at the supervisor. "The woman's been dead four hours, minimum." He pointed to the discolorations and turned to the residents. "These markings take at least that long to appear. We call the phenomena lividity, where venous blood pools at the lowest point of the body once a person has died." His voice had slipped into the clipped tones most seniors used when teaching. He threw the bedsheet back over Matthews, allowing it to float down on her like a shroud. "A code blue never should have been called."

Yablonsky's cheeks burned red at the rebuke.

As the others cleaned up their equipment, Thomas Biggs led her to the corner of the room. "Why'd you do it?" he asked.

He may have intended their conversation to be private, but Jane easily overheard them.

A flicker of alarm shot through Mrs. Yablonsky's eyes. "I beg your pardon?" she puffed with indignation.

"Why'd you call the code? You could feel and see her as well as I did. The skin had gone cold. The lividity formed where she lay."