To the Bone (8 page)

“That old cabin down there?” he said. The neighboring place had been abandoned decades ago and had mostly fallen into the creek, a couple hundred yards down the steep hill. “I forbade the kids to go near it, but of course it was a magnet. One day, I'd worked all night and was trying to get some sleep, and I heard this shriek. I ran down there and found poor little Stephanie, she was maybe eight, screaming bloody murder. She'd jumped off something and landed on a rusty old fence post, broken off to a point, sticking a couple inches out of the ground. Went right through her tennis shoe and clear up through her foot.”

Stephanie, his daughter, was now in medical school at UCSF. She and Martine had gotten quite close.

For a minute or so, Martine was silent. He could see her head moving, her gaze wandering the woods, but not turning to him.

Then, abruptly, she said, “I don't
think
I want a kid. My
mind
doesn't. I don't even think my body does. I don't know what it is.”

She was forty-three. Monks was long since vasectomized and out of the child-raising mode. He did not consider that he had done all that good a job the first time around.

“Sorry I can't help you there,” he said.

“No, you're not.”

“You're right. I'm not.”

“Have any of your women ever told you you're too honest?”

“No,” Monks said. “You're the first.”

“Liar.”

He smiled gravely. They turned and started back. He knew, and supposed she did, too, that this had been a last-ditch attempt to woo her—offering the things that made him what he was.

When they had first been together, there were words of passion, each assuring the other that this was what they had been waiting for. But it was useless to invoke that. The problem was not any single one of the obstacles, or even all of them together. The affair was just something that had run its course, and this was like the point in a really great party that had gone on most of the night, when a silence touched the room, and everybody knew that there might be a few more drinks and laughs, but the good-byes were going to start soon.

If he hadn't pushed, it might have lasted longer—maybe quite a while. But Monks could not leave things like that in general, and she was right. Today's events had put him in the mood to have it out. He could have pushed it the other way, and asked her to marry him. But that would only be trying to bind her, to keep her from what she wanted—another chance at the kind of life most people considered normal, the kind of life that he had pretty much let go.

He had not thought he would ever live with a woman again. But once he had started, he had come to realize that when she was not here, he felt a sour gnawing absence.

They managed to keep up small talk while they ate. She asked more questions about what had happened today and Monks told her, but it was dutiful from both sides. Afterward, with his belly full and drowsiness coming quickly, he turned on the TV and settled back on the couch, head in her warm lap and her hand stroking his hair.

“I do love you,” she murmured. “You know that.”

Monks nodded. “I love you, too,” he said, in a voice that was thick with exhaustion.

H
er voice leads you to a different street, another doorway. It's darker and quieter in here than the last place. The bottles lined up on the back-bar shelves glitter with dusty colored light.

She's a silhouette, alone at the bar, posed for you.

She gives you a quick smile when you walk up next to her. She's in her late twenties, thin, wearing a tank top and jeans. She's probably been hit on several times already tonight, by men and women both. You look better than most of what she sees.

You order a glass of wine, a Clos Pegase merlot this time. Then you admire the bracelet on her right forearm. It wraps around, a silver and turquoise snake crawling up her skin. The silver seems liquid, but not from the room's light. From her.

“Where'd you get it?” you ask.

“In LA. It's Navaho.”

You touch it, feeling her warmth shoot up through it into your finger.

“It looks alive,” you say. She smiles again and tosses her hair.

She tells you she's from the Midwest. She's been traveling, working part-time here and there, crashing with people she meets. Her name is Lynn. You tell her a name, too, and let her know right away that you're a doctor.

Her eyes flicker. That could mean drugs.

She chatters on, but you listen past her words to what her voice is telling you in your head—what has hurt her all her life. She's almost pretty, but her chin recedes, and her nostrils flare at the tip.

You'll start with a rhinoplasty—remove a little cartilage from the base of each nostril, then tighten them together. Then implants in the mandible to move the chin bone forward. When it's finished, her face will have a beautiful balance. She'll wish you'd found her years ago.

“Are you really a doctor?” she asks teasingly.
Are we really talking drugs?

“Really.” You show her your medical license, making sure she also sees plenty of credit cards and crisp cash.

Then you lean close, lips just brushing her ear, and say very quietly, “Look, we're both grown-ups. Let's not be coy. I like to party, and I've got a whole pharmacy at my clinic.”

She doesn't say anything, doesn't even look at you, but it's just what she wanted to hear.

“Why don't we talk it over in my car?” you say.

You're parked several blocks away, and the two of you don't talk much on the walk. She's wondering whether she made a bad move.

But when she sees the car, her eyebrows rise.

“Nice,” she says.

You unlock the passenger door for her. As she's getting in, you press a folded hundred-dollar bill into her palm.

“Just a little fun money,” you say.

She acts surprised, even offended. “This isn't really what I do. What do you—you know—want from me?”

“Maybe you can help me with a fantasy.”

“Well, maybe,” she says warily. “But nothing weird, okay?”

“Of course.” You start the engine. It has a smooth, reassuring purr.

“You mind if I smoke?” she asks.

“Go ahead.”

She takes cigarettes from her purse and lights up, then relaxes back into the seat. This is looking good. There's money and drugs.

You're a doctor. You can give her what she wants.

W
hen Monks woke up, the house was dim, with the only light coming from down the hall. He was still on the couch, covered with a blanket. Memory of the earlier hours began to return, and then, the fear that Martine had gone home.

But she was still here, a small mound in his bed, buried under covers in the now cool night. He put a hand on her lightly to assure himself and heard a slight pause in her breathing before it evened out again. Omar, the big Persian, was curled at her feet, looking almost half her size. There was the sense that he had been posted as a guard while the other two were out taking care of nightly cat business.

Monks went to the bathroom to urinate, rinse his face, and brush his teeth, then back to the kitchen to put out fresh spoonfuls of cat food in their bowls. He turned out the light. The green LED numbers on the microwave clock said 1:08
A.M.
The previous day's events were flickering through his mind like a videotape now.

He stood in the dark room, grappling with the urge to start drinking again, to blast on through the night, to reach that feverish black edge between this reality and a further one that lured, promising that it was realer still. He had been there many times, but not in several years.

He walked back down the hall to the bedroom. When he undressed, he realized, with surprise, that he was half-hard. He lay down beside Martine and touched her small breasts, an exploratory caress, not sure how welcome he would be.

But she stretched luxuriantly, then turned and cupped his tightened scrotum, hefting it curiously, as if judging its weight. Her hand moved to stroke his shaft, using the inside of her wrist, then pricking it with her fingernails.

Her touch was exquisite. He adored her. He tried to concentrate all his being on her, knowing that this would soon be gone, too.

And yet some lewd uncontrollable part of his mind kept playing the image of Eden Hale as she had been in that film, luscious, intense, braced on hands and knees and wide open to the ramming bursting need of men.

T
he night is yours now. You move through the pitch-dark woods without light or sound. The trail is steep and overgrown, but your steps are sure. Power surges through your veins and pounds inside your skull, burning and brilliant and supreme. You are beyond all limits.

Inside the plastic bag you carry is a warm limp weight.

You come to a deep cleft in the mountainside, a spring that was diverted years ago, to fill the swimming pool for the mansion below. No one comes here anymore. You pull away the rocks and brush that you had piled in the entrance. A strong odor seeps out, but musty, like copper and wet earth. The lime has done its job.

This is where you keep the leftover parts.

You lay her down on top of the others, then remove her silver-and-turquoise bracelet and wind it around your own arm. It burns with her heat, right through your skin.

Your body is tired, but your mind is full of her song, a song of worship, for the beauty you have given her.

M
onks arrived back at Mercy Hospital before eight o'clock the next morning. He had slept poorly—had lain awake beside Martine for a long time after making love, finally dozing a little. But the memory tapes had kept playing in his head, and he was wide awake by six. He had gotten up, showered and shaved, and driven to the city.

He stopped first at the Emergency Room to check for messages. There were two. One, a hand-scrawled note from Roman Kasmarek, just said, “Stop by.”

The second was an official hospital message, typed by a clerk and computer-printed: “Dr. D'Anton wishes to extend the courtesy of examining the records of Eden Hale. Please call at your convenience.”

Monks rolled the paper up and tapped it against his thigh as he walked down to the morgue. There were such things as changes of heart, but by and large they made him suspicious.

 

The hospital's cafeteria food was good and usually tempted Monks, but this morning he settled for a scoop of scrambled eggs and toast. He and Roman found a table in a corner. The place was busy, filled with staff in different colored uniforms and a few visitors who were early, or who had spent an anxious night waiting with an ill friend or relative and were not done with their vigils yet.

“The initial tox screen is in,” Roman said. “And I had a chance to look at the body before the city took her. This isn't all official, but here's what I'm sure of.” He held up his forefinger, ticking off points. “She had a relatively high level of Valium in her system, but nowhere near lethal. There's no direct connection to the death.” A second finger appeared. “You were right about the DIC. She bled out. That's what killed her.”

Monks felt a measure of relief. His diagnosis had been correct.

But there remained the question of his treatment. “What caused the DIC?”

Roman's ring finger rose to join the other two. “I saw no evidence of surgical infection. No pregnancy, no obvious signs of trauma, carcinoma, any of the other usual causes. It's possible they'll turn up on autopsy, but I doubt it. But there was an infection. We found salmonella in her bloodstream.”

“Salmonella,” Monks said, laying down his fork. “Salmonella doesn't cause blood clotting. Just the opposite.”

Heads at nearby tables turned toward them. Monks lowered his voice.

“She might have
had
salmonella, but I can't believe that's what did it,” he said.

Roman's hand opened, palm out, for patience. “Take it easy, Carroll. I'm just telling you what the tests show.”

“Have
you
ever known salmonella to act like that?”

“Not the common stuff,
enteritidis,
” Roman said. “Which is what this is, or at least what it looked like. There are other kinds.”

“You're sure it's not typhoid?” Monks said. “I thought about that.” Typhoid fever was caused by a type of salmonella, and he feared that he might have missed it after all.

“Almost positive. I'm doing cultures, so we can verify it. But there are no other indications of typhoid, and it doesn't fit with the DIC.”

Monks waited.

“But we've got to keep in mind, there are new strains of everything cropping up all the time,” Roman said. “It's possible that this is some form of salmonella that looks like the regular thing, but has a much more severe effect.”

“Do you really buy that?”

Roman shook his head. “I'm stumped,” he admitted. “Maybe some other factor. Maybe a preexisting condition that's not obvious.”

“I'm going to look at her records today,” Monks said. But he doubted that D'Anton would have missed something like that.

“There's only one other thing I can think of that might have had that general effect,” Roman said. “Some kind of toxic substance.”

Monks focused a click. Toxins had been listed as a possible cause of DIC, but he hadn't given it much thought. So soon after the surgery, Eden would have eaten little or nothing.

“Such as?” Monks said.

“I thought about a contaminated drug.”

So had Monks. “Everything the paramedics brought in was prescription, or looked that way,” he said. “Pharmaceutically stamped pills.” A bad batch was possible but highly unlikely. She might have taken something homemade. But both men were very familiar with the effects of street drugs, including those cut with dangerous fillers, like strychnine in heroin. And anything common would have shown up on the tox screen.

“What else?” Monks said.

“Not something you'd find around the house. I'd recognize anything from cleaning fluids to rat poison. Maybe in agriculture, or industry. She wasn't involved in anything like that, was she?”

Monks felt the insane urge to laugh. “Industry, but not that kind.”

“What do you mean?”

“She was an adult film actress. Look, she was recovering from surgery. She'd have gone straight home from the clinic. She wouldn't have been out wandering around.”

“Any indications that she was suicidal?”

Monks had never spoken with Eden Hale, never seen her really alive. There might have been a dark, despairing side to her. But it didn't jibe with what he knew, and it didn't seem to follow that a woman who had just gone through an expensive, painful treatment to become more beautiful would want to kill herself immediately afterward. Particularly in a protracted, agonizing way.

“No,” he said. “Not yet, anyway.”

“Well, I'm afraid that's not much help,” Roman said. “I can run more tests or request the city coroner to. But it's tough when I don't know what I'm looking for.”

“You think anything will turn up on the autopsy?”

“It'll bear out the DIC, Carroll. But I wouldn't hang too much on anything more.” Roman hesitated, then said, “Just on the off chance it did turn out to be some particularly virulent strain of salmonella, was your treatment consistent with that?”

Monks pushed his plate away and leaned his elbows on the table, pressing the heels of his hands into his eyes.

“The intial phase was,” he said. “Somebody comes in dehydrated and bleeding in an unknown location, you start by replacing fluid volume, then blood. Next step is to locate the source of the bleeding and treat that—if you can. That's where I diverged.”

“Diverged how?”

“There was no way to treat it, except to try to break up the clotting. I gave her heparin.”

“Seems reasonable to me,” Roman said.

“If you look at it that way, yes. But going by the book—about the last thing you want to do with something like salmonella is thin the blood.”

 

Monks took the elevator up to Baird Necker's office. This time he was uninvited.

His mind was stepping up its analysis, reviewing what he knew, eliminating some possibilities and considering others further. It was a little more satisfying with the new information, although still frustrating as hell.

Salmonella was a bacteria, a prime cause of what was generically called food poisoning. There were several exotic strains and modes of infection, but by far the most common cases seen in the States came from ingesting tainted food. Poultry was a major carrier.

Salmonella didn't cause clotting, but the opposite—if it was advanced enough, there was copious intestinal bleeding, discharged via characteristic bouts of bloody diarrhea. Usually there wasn't much that could be done, beyond replacing fluids and blood, and keeping the patient stable until the attack ran its course. With proper treatment, the disease was rarely fatal.

In short, if he had not given Eden Hale the heparin, he would be safely off the hook now. She would have died anyway, and the cause of the DIC might remain forever a mystery. But no one would be able to point a finger at Monks and accuse him of doing the wrong thing.

It was futile to think about whether he could have stood there and let her go, without trying
something.
That way lay madness.

But he had seen plenty of salmonella, and whether this was some new super mutant or the plain old garden variety, he still couldn't believe it was responsible. Something else, some terrible unseen pump inside her, had driven all her bloodstream's clotting factors into the smaller vessels, leaving the larger ones to bleed unchecked.

He thought about what Roman had said. His mind turned the word
toxin
over and over. But how the hell would she have gotten into something that virulent, and rare enough that it wouldn't show up on the tox screen, or be recognized by a highly experienced pathologist?

He had to admit: if he was looking at himself objectively, he would have seen a man clutching at straws.

 

“There's a new wrinkle,” Monks said to Baird, and told him about the conversation with Roman.

“Salmonella, huh?” Baird said. “I wouldn't think she'd have been hungry, that soon after surgery.”

“It only takes a taste. She probably wasn't thinking too clearly, with the Valium. Maybe she nibbled at something, chicken salad from a deli that she'd kept too long. Maybe her boyfriend will know. Did you know he was supposed to stay with her at least twenty-four hours, but he left her alone?”

“He seems like a putz, no argument there. But that doesn't have anything to do with us. This is escalating, Carroll. The young lady's mother and father were here yesterday. They're stunned. They didn't even know she was having the breast surgery.”

Monks felt another heavy brick settle onto the load. He had a troubled son of his own, last heard of living on the streets of Seattle. But so far, no one had called on Monks to tell him that his child had died in a hospital far from home and family.

“I got the pretty clear sense that they're not going to make things easy,” Baird said. “I told them there were complications that haven't been identified yet. Her father got seriously pissed off. They more or less walked out.”

“I could explain it to them more clearly.”

“I don't think that would do any good. By the way, one of your nurses has also commented that she didn't think the heparin was appropriate. She says she questioned it at the time.”

“With all due respect to Mary Helfert,” Monks said, “she's not a physician, and she's certainly not qualified to provide an emergency diagnosis. She didn't know what DIC
was.
”

“It's another thing that doesn't help,” Baird said. “I'm starting to look at damage control. If it comes to that, I hope you'll cooperate.”

“Meaning, stand still and take the blame?”

“Nobody said anything about blame. But if we had to settle out.”

“Before we start convicting, Baird, let's wait till the jury's in. Autopsy, final lab, and tox screen. Her history, any preexisting conditions. And there's still a possibility that this is related to the surgery.”

Baird looked away, drumming his fingers on his desk. “D'Anton called me again—told me you went by his clinic. I wish you hadn't done that.”

“Why the hell not? Physicians consult with each other when they're treating the same patient. Besides which, the surgery's going to be examined in the postmortem. It's not like there's any secret involved.”

“I don't want to bring him into this.”

A sour taste rose in Monks's mouth. “An ER doc is expendable,” he said. “But not your golden boy–cash cow plastic surgeon?”

“I've got to think of the hospital, Carroll. He's world famous.”

“There doesn't seem to be any doubt in anybody's mind about that. Especially his.”

“He's bringing in millions of dollars' worth of business to this place. Which helps cover what the ER loses.”

Monks's eyes widened in outrage. “The ER's in the business of healing the sick. Not scheduled elective surgery.”

“Knock off the self-righteous bullshit. Are you telling me reconstructive surgery's not important?”

“I have all the respect in the world for reconstructive surgeons,” Monks said. “But D'Anton caters to rich women's vanity. Period.”

“People are entitled to any kind of health care that makes them feel good.”

“As long as they can pay for it?”

“This hospital cannot operate as a charity,” Baird said, speaking the words one angry syllable at a time. It was a line Monks had heard him say many times.

“Not to mention the fact that the ER provides sixty percent of all admissions, plus lab and other spin-offs,” Monks said. “Which makes it possible for this hospital to survive, no matter what your bean-counter computer programs say.”

“If they come in electively, they pay for what they get.” Baird's forefinger jabbed at Monks's chest, an imaginary skewer. “But in the ER, we've
got
to take them whether they pay or not. So a lot of the time, they don't.”

“We should start letting them die in the streets? Have the feds and the state close us down?”

There was a pause. Monks realized that they had both almost been shouting.

Baird pushed his chair back and stood up. “Let's cool off. This isn't doing either of us any good.”

Several responses flashed through Monks's mind, but they all rang of adolescent bluster. Baird was right—this was not doing any good.

He left without speaking, went outside, and leaned against the building in the shade. It occurred to him that a red beer would taste just fine. He heaved himself off the wall and started walking to a bar called Charley's, just two short blocks away.

 

Charley's was an old-fashioned tavern, a long narrow room with a scarred bar, a burger grill, and worn vinyl booths. It was quiet, dark, inviting, the kind of place where you could easily spend a day or three.

But by the time he was inside, Monks had calmed down. There was too much going on. He could not afford a dull mind. He got a club soda and took it to a booth at the back.