Bloodstream

by Tess Gerritsen

  “I hardly think one incident, tragic as it was, means that this town has a drug problem.” Her gaze suddenly focused on the view through the front window. The boys with the skateboards were gone. The mail carrier had arrived, and was chatting with Vera on the sidewalk. He handed Vera an armful of mail. Was there a letter from Paul Darnell’s attorney in that stack?

  Groome said something, and she realized he had moved closer, and was practically leaning through the open business window.

  “Let me tell you a story, Dr. Elliot. It’s about a perfect little town called Flanders, Iowa. Population four thousand. A clean, decent place where everyone knows everyone else. The sort of people who go to church and join the PTA. Four murders later—all of them committed by teenagers—the shell-shocked residents of Flanders finally got around to facing up to reality.”

  “Which was?”

  “Methamphetamine. An epidemic of abuse in the local schools. It turned that town into the dark side of America.”

  “But what does that have to do with Tranquility?”

  “Haven’t you been reading your own newspaper? Look around at what’s happening to your neighbors. First, there was that street brawl on Halloween night. Then a boy beats his dog to death, and fistfights are breaking out in the school. Finally, there’s the shooting.”

  She was focused on the front sidewalk again, where the mailman was still shooting the breeze with Vera. For heaven’s sakes, bring in the mail!

  “I followed the Flanders story for months,” said Groome. “I watched that town implode on itself. Parents blaming the schools. Kids turning on their teachers, on their own families. When I heard about the problems in your town, methamphetamine was the first thing I thought of. I know you must have run a drug screen on that Darnell boy. Could you just tell me one thing: Did methamphetamine turn up in his system?”

  Still distracted, she answered: “No, it didn’t.”

  “Did anything else?”

  She didn’t answer. In truth, she didn’t know, because she hadn’t heard back from the lab in Boston.

  “Then there was something,” he said, picking up on her silence.

  “I’m not the boy’s physician. You have to ask Dr. DelRay.”

  Groome gave a dismissive snort. “DelRay says it’s Ritalin withdrawal psychosis. Something so rare, there’s only a few anecdotal reports that it even exists.”

  “You don’t accept his diagnosis?”

  He looked her straight in the eye. “Don’t tell me you do?”

  She was beginning to like Mitchell Groome.

  The front door opened and Vera stomped in, carrying the mail. Unceremoniously she dumped the whole pile on her desk. Claire eyed the stack of business-size envelopes, and her throat went dry.

  “Excuse me,” she said to Groome. “I have work to do.”

  “Flanders, Iowa. Just keep it in mind,” he said, and with a wave, walked out of the building.

  Claire picked up the mail, headed straight to her office, and shut the door.

  Sitting at her desk, she swiftly shuffled through the envelopes, then sank back with a sigh of relief. Another day’s reprieve; no attorney’s name was on any of the return addresses. Maybe Paul Darnell had been bluffing; maybe there would be no repercussions after all.

  For a moment she sat with her head tilted back, her tension melting. Then she reached for the first envelope and tore it open. Seconds later she was sitting up, rigid, in her chair.

  Inside was a short note from Rachel Sorkin, the woman who’d reported Elwyn Clyde’s gunshot wound.

  Dr. Elliot,

  This letter came in my mail today. I thought you should know about it.

  Rachel.

  P.S. I don’t believe a word of it.

  Attached to it was a typewritten letter:

  To whom it may concern,

  I am writing to inform you of a disturbing incident. On November third, Dr. Claire Elliot assaulted a hospital patient. Although there were a number of witnesses, this event has not been made public. If Dr. Elliot is your physician, you may wish to reconsider your options. Patients have a right to know.

  A concerned health care professional

  There were three men waiting for her in the medical staff office. She knew Dr. Sarnicki only slightly, but her impressions of him had been favorable. A comfortably rumpled man with a gentle voice, he was known to be a caring physician as well as a skillful diplomat who had helped ease tensions during the hospital’s recent contract negotiations with the nurses. The second man was Roger Hayes, the hospital administrator, whom she scarcely knew at all except as a bland and smiling man.

  The third man she knew only too well. It was Adam DelRay.

  They greeted her with polite nods as she sat down at the conference table. She was already strung so tight she felt close to snapping in two. On the table in front of Sarnicki was a copy of the same anonymous letter that Rachel had forwarded to her.

  “You’ve seen this already?” he said.

  She gave a grim nod. “One of my patients sent me a copy. I’ve called around, and so far I’ve confirmed that at least six others have received it.”

  “Mine arrived in the departmental mail this morning.”

  “This has been blown completely out of proportion,” said Claire. “I certainly did not assault the patient. The letter’s designed to do only one thing, and that’s to damage my reputation.” She looked directly at Adam DelRay. He returned her gaze without flinching, without even a flicker of guilt in his eyes.

  “What exactly happened on November third?” asked Hayes.

  She answered evenly: “I drew blood from Taylor Darnell, to send off for a comprehensive drug and tox screen. I’ve already told Dr. Sarnicki who else was in the room. Who witnessed it. I didn’t abuse the patient. It was just a blood draw.”

  “Tell them the rest,” said DelRay. “Or are you going to leave out the most important detail? Which is, you had no authority to draw his blood.”

  “So why did you?” asked Hayes.

  “The boy had a drug-induced psychosis. I wanted that drug identified.”

  “There is no drug,” said DelRay.

  “You don’t know that,” she said. “You never ran the test.”

  “There is no drug.” He slapped a sheet of paper on the table. She stared in dismay at the letterhead: Anson Biologicals.

  “I have the the results right here. Apparently, Dr. Elliot managed to get a blood tube out to the reference lab without the father’s knowledge. Or permission. Anson faxed the report to the hospital this morning.” He added, with a note of smugness, “It’s negative. No drugs, no toxins.”

  Why had the lab disregarded her instructions? Why had they sent the report to the hospital?

  She said, “Our own lab found an unidentified peak on gas chromatography. There was something in his blood.”

  DelRay laughed. “Have you seen our lab’s gas chromatography machine? It’s an antique. A hand-me-down from Eastern Maine Medical Center. You can’t trust our results.”

  “But it did need a followup test.” She looked at Sarnicki. “That’s why I drew the blood. Because Adam refused to.”

  “She made an unauthorized blood draw,” said DelRay.

  Hayes sighed. “It’s a mountain out of a molehill, Adam. The boy wasn’t harmed, and he’s doing fine at the Youth Center.”

  “She ignored the father’s wishes.”

  “But one blood draw does not make a lawsuit.”

  Claire’s chin snapped up in alarm. “Is Paul Darnell talking about legal action?”

  “No, not at all,” said Hayes. “I spoke to him this morning, and he reassured me he wasn’t suing anyone.”

  “I’ll tell you why he’s not suing,” said DelRay. “It’s because that ex-wife of his threatened to sabotage any lawsuit. It’s an automatic reflex for bitter ex-wives. Whatever the husband wants, the wife blindly opposes.”

  Thank you, Wanda, thought Claire.

  “Then this whole incident i
s now a nonissue,” said Sarnicki, looking relieved. “As far as I can see, no action is necessary.”

  “What about the letter?” said Claire. “Someone is trying to ruin my practice.”

  “I’m not sure what we can do about an anonymous letter.”

  “It’s signed ‘A health care professional.’” She looked pointedly at DelRay.

  “Now wait a minute,” he snapped. “I had nothing to do with it.”

  “Paul Darnell, then,” she said.

  “There were a couple of nurses who were there too, remember? In fact, this sort of sneaky letter is more a woman’s style.”

  “What the hell does that mean?” she shot back in outrage. “‘A woman’s style?’”

  “I’m just calling it as I see it. Men are upfront about these things.”

  Sarnicki warned, “Adam, this isn’t helping.”

  “I think it is helping,” said Claire. “It shows us exactly what he thinks about women. Are you implying, Adam, that we’re all liars?”

  “Now this really isn’t helping,” said Sarnicki.

  “She’s putting words in my mouth! I didn’t send those letters, and neither did Paul! Why should we? Everyone in town’s already heard the gossip!”

  “I’m cutting off this meeting now,” said Sarnicki, banging on the table for silence.

  That’s when they all heard the announcement over the hospital address system. It was barely audible through the closed doors of the meeting room.

  “Code blue, ICU. Code blue, ICU.”

  Instantly Claire shot to her feet. She had a stroke patient in the ICU.

  She bolted out of the meeting room and ran for the stairwell. Two flights up, she stepped into the intensive care unit and was relieved to see that her patient was not the one being coded. The crisis was in cubicle six, where a crowd of personnel had massed around the doorway.

  They parted to let Claire enter.

  The first thing she noticed was the smell. It was the odor of smoke and singed hair, and it came from the massive, soot-streaked man lying in the bed. McNally from the ER was crouched behind the patient’s head, trying without success to insert an endotracheal tube. Claire looked up at the heart monitor.

  The rhythm was sinus bradycardia. The patient’s heart was beating, but slowly.

  “Does he have a blood pressure?” she asked.

  “I think I’m getting a systolic of ninety,” said a nurse. “He’s so big, I’m having trouble hearing it.”

  “I can’t get him intubated!” said McNally. “Go ahead, bag him again.”

  The respiratory tech clapped an oxygen mask on the patient’s face and squeezed the reservoir bag, forcing oxygen into the lungs.

  “His neck’s so short and fat I can’t even see the vocal cords,” said McNally.

  “Anesthesia’s coming in from home,” a nurse said. “Should I also call a surgeon?”

  “Yeah, call him. This one’s gonna need an emergency tracheotomy.” He looked at Claire. “Unless you think you can intubate him.”

  She doubted she could, but she was willing to try. Heart pounding, she circled around to the patient’s head and was about to insert the laryngoscope into his mouth when she noticed the man’s eyelids were flickering.

  She straightened in surprise. “He’s conscious.”

  “What?”

  “I think he’s awake!”

  “Then why isn’t he breathing?”

  “Bag him again!” said Claire, stepping aside to let the respiratory tech back in. As the mask was replaced, as more oxygen was forced into the man’s lungs, Claire swiftly reviewed the situation. The man’s eyelids were indeed twitching, as though he was struggling to open them. Yet he was not breathing, and his limbs remained flaccid.

  “What’s the history?” she asked.

  “Came in through the ER this afternoon,” said McNally. “He’s a volunteer fireman who collapsed at the scene. We don’t know if it was smoke inhalation or a cardiac event—they had to drag him out of the building. We admitted him for superficial burns and a possible MI.”

  “He’s been doing fine up here,” an ICU nurse said. “In fact, he was talking to me just a little while ago. I gave him his dose of gentamicin and he suddenly went bradycardic. That’s when I realized he’d stopped breathing.”

  “Why’s he getting gentamicin?” asked Claire.

  “The burns. One of the wounds got pretty contaminated.”

  “Look, we can’t keep bagging him all night,” said McNally. “Did you call the surgeon?”

  “Done,” a nurse answered.

  “Then let’s get him prepped for the tracheotomy.”

  Claire said, “He may not need one, Gordon.”

  McNally looked skeptical. “I couldn’t get that ET tube in. Can you?”

  “Let’s try something else first.” Claire turned to the nurse. “Give him an amp of calcium chloride, IV.”

  The nurse glanced questioningly at McNally, who shook his head in puzzlement.

  “Why on earth are you giving calcium?” he asked.

  “Just before he stopped breathing,” said Claire, “he got the antibiotic, right?”

  “Yeah, for the open burn wound.”

  “Then he had the respiratory arrest. But he hasn’t lost consciousness. I think he’s still awake. What does that mean?”

  Suddenly McNally understood. “Neuromuscular paralysis. From the gentamicin?”

  She nodded. “I’ve never seen it happen, but it’s been reported. And it’s reversed by calcium.”

  “I’m giving the calcium chloride now,” said the nurse.

  Everyone watched. The prolonged silence was broken only by the intermittent whoosh of oxygen being bagged through the mask. The patient’s eyelids responded first. Slowly they fluttered open, and he looked up, struggling to focus on Claire’s face.

  “He’s moving air!” said the respiratory tech.

  Seconds later, the patient coughed, took a noisy breath, and coughed again. He reached up and tried to push away the mask.

  “I think he wants to talk,” said Claire. “Let him speak.”

  The patient responded with a look of profound relief as the mask was removed from his face.

  “Sir, did you want to say something?” Claire asked.

  The man nodded. Everyone leaned forward, eager to hear his first words.

  “Please,” he whispered.

  “Yes?” prompted Claire.

  “Let’s not … do that … again.”

  As laughter broke out all around her, Claire patted the man on the shoulder. Then she looked at the nurses. “I think we can cancel the tracheotomy.”

  “I’m glad someone around here still has a sense of humor,” McNally said as he and Claire walked out of the cubicle a few minutes later. “It’s been pretty grim recently.” He paused in the nurses’ station and looked at the bank of monitors. “I don’t know where we’re going to put anyone else.”

  Claire was startled to see eight cardiac rhythms tracing across the screens. She swung around, her gaze sweeping the ICU in disbelief.

  Every bed was filled.

  “What on earth has been going on?” said Claire. “When I made rounds this morning, there was only my one patient in here.”

  “It started on my shift. First a little girl with a skull fracture. Then a wreck up on Barnstown Road. Then some nutty kid sets his house on fire.” McNally shook his head. “It’s been going nonstop in the ER all day, and the patients still keep coming in.”

  Over the hospital address system, they heard the page: “Dr. McNally to the ER. Dr. McNally to the ER.”

  He sighed and turned to leave. “It must be the full moon.”

  Noah shed his jacket and lay it across the boulder. The granite felt warm, a day’s worth of sunshine radiating back from the stone. Turning, he squinted across the lake. The afternoon was windless, the water a glassy, brilliant mirror reflecting sky and leafless trees.

  “I wish it was summer again,” said Amelia.
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  He looked up at her. She was perched on the highest rock, chin resting on her blue-jeaned knees. Her blond hair was tucked behind one ear, revealing the streak of healing flesh on her temple. He wondered if she’d have a scar, and almost wished there would be one—just a small scar, so she would never forget him. Every morning, looking in her mirror, she’d see that faint trace of the bullet and would remember Noah Elliot.

  Amelia tilted her face toward the sun. “I wish we could skip winter. Just one winter.”

  He clambered up onto her rock and sat down beside her. Not too close, not too far. Almost, but not quite, touching. “I don’t know, I’m kind of looking forward to it.”

  “You haven’t seen what it’s like here.”

  “So what is it like?”

  She stared across the lake with what was almost an expression of dread. “In a few weeks, it’ll start to freeze over. First there’ll be patches of ice along the shore. By December, it’ll be frozen all the way across, thick enough to walk on. That’s when it starts to make these sounds at night.”

  “What sounds?”

  “Like someone moaning. Like someone in pain.”

  He started to laugh, but then she looked at him, and he fell silent.

  “You don’t believe me, do you?” she said. “Sometimes I wake up at night and I think I’m having a nightmare. But it’s just the lake. Making those horrible sounds.”

  “How can it?”

  “Mrs. Horatio says …” She stopped, remembering that Mrs. Horatio was dead. She looked back at the water. “It’s because of the ice. The water freezes and expands. It’s always pushing, pushing against the banks, trying to escape, but it can’t because it’s trapped. That’s when you hear the moaning. It’s the pressure building up, building until it can’t take any more. Until it finally crushes itself.” She murmured: “No wonder it makes such terrible sounds.”

  He tried to imagine what the lake would look like in January. The snow drifting against the banks, the water turned to a glaring sheet of ice. But today the sun was bright in his eyes, and with the warmth radiating off the stone, the only images that came to mind were of summer.