Bloodstream

by Tess Gerritsen

  In the next room, the phone rang. Floyd reappeared in Lincoln’s doorway. “The cashier from Cobb and Morong’s just called. Dr. Elliot, you might want to head over there.”

  “Why?” asked Claire. “What happened?”

  “Oh, it’s that old Warren Emerson again. He’s having another seizure.”

  A crowd of bystanders had gathered on the sidewalk. At their center lay an old man dressed in frayed clothes, his limbs jerking in a grand mal seizure. A scalp wound was oozing blood, and in the bitter wind, an alarming splash of red had flash-frozen on the sidewalk. None of the bystanders had attempted to help the man; instead they were all standing back, as though afraid to touch him, afraid even to approach him.

  Claire knelt down, and her first concern was to prevent him from injuring himself or aspirating secretions into his lungs. She rolled the man onto his side, loosened his scarf, and wedged it under his cheek to protect it from the icy sidewalk. His skin was florid from the cold, not cyanotic; his pulse was rapid but strong.

  “How long has he been seizing?” she called out.

  Her question was met with silence. She glanced up at the by standers and saw that they had backed away even farther, that their gazes were focused not on her, but on the man. The only sound was the wind, blowing in from the lake, whipping at coats and scarves.

  “How long?” she repeated, her voice now sharp with impatience.

  “Five, maybe ten minutes,” someone finally answered.

  “Has an ambulance been called?”

  There was a shaking of heads, a collective shrug of shoulders.

  “It’s just old Warren,” said a woman whom Claire recognized as the cashier from the general store. “He never needed an ambulance before.”

  “Well, he needs one now!” snapped Claire. “Call one!”

  “Seizures are slowing down,” said the cashier. “It’ll be over in a minute.”

  The man’s limbs were jerking only intermittently now, his brain firing off the final bursts of its electrical storm. At last he lay flaccid. Claire again checked his pulse and found it still strong, still steady.

  “See, he’s okay,” said the cashier. “Always comes out of it fine.”

  “He needs stitches. And he needs neurological evaluation,” said Claire. “Who’s his doctor?”

  “It used to be Pomeroy.”

  “Well, someone must be prescribing seizure meds for him now. What’s his medical history? Does anyone know?”

  “Why don’t you ask Warren? He’s waking up.”

  She looked down and saw Warren Emerson’s eyes slowly open. Though he was surrounded by people, he gazed straight up at the sky, as though seeing it for the first time.

  “Mr. Emerson,” she said. “Can you look at me?”

  For a moment he didn’t respond; he seemed lost in wonder, his eyes following the slow drift of a cloud overhead.

  “Warren?”

  At last he focused on her, his brow wrinkling as though he was struggling to understand why this strange woman was talking to him.

  “I had another one,” he murmured. “Didn’t I?”

  “I’m Dr. Elliot. The ambulance is on its way, and we’ll be taking you to the hospital.”

  “I want to go home …”

  “You’ve split open your scalp and you need stitches.”

  “But my cat—my cat’s at home.”

  “Your cat will be fine. Who’s your doctor, Warren?”

  He seemed to be struggling to remember. “Dr. Pomeroy.”

  “Dr. Pomeroy has passed away. Who is your doctor now?”

  He shook his head and closed his eyes. “Doesn’t matter. It doesn’t matter anymore.”

  Claire heard the wail of the approaching ambulance. It pulled to a stop at the curb and two EMTs stepped out.

  “Oh, it’s just Warren Emerson,” one of them said, as though he ran into the same patient every day. “He have another seizure?”

  “And a pretty deep scalp wound.”

  “Okay, Warren, ol’ buddy,” said the EMT. “Looks like you’re going for a ride.”

  By the time the ambulance drove away, Claire’s fury was boiling over. She looked down at the blood, solidified on the ice. “I can’t believe you people,” she said. “Did anyone try to help him? Does anyone give a damn?”

  “They’re just scared,” said the cashier.

  Claire turned to look at the woman. “At the very least you could have protected his head. A seizure’s nothing to be afraid of.”

  “We’re not afraid of that. It’s him.”

  She shook her head in disbelief. “You’re afraid of an old man? What possible threat could he be?”

  Her question was met with silence. Claire looked around at the other faces, but no one returned her gaze.

  No one said a thing.

  By the time Claire arrived at the hospital, the ER physician had already sutured Warren Emerson’s lacerated scalp and was scribbling notes on a clipboard. “Needed eight stitches,” said McNally. “Plus he had some minor frostbite of the nose and ears. Must’ve been lying in the cold for a while.”

  “At least twenty minutes,” said Claire. “You think he needs admission?”

  “Well, the seizures are a chronic problem, and he seems to be neurologically intact. But he did hit his head. I can’t tell if the loss of consciousness was due to the seizure or the head bonk.”

  “Does he have a primary care physician?”

  “Not currently. According to our records, his last hospitalization was back in ’89, when Dr. Pomeroy admitted him.” McNally signed off on the ER sheet and looked at Claire. “You want to take him?”

  “I was about to suggest it,” she said.

  McNally handed her Emerson’s old hospital chart. “Happy reading.”

  The file contained the record for Emerson’s 1989 hospitalization as well as the summaries from numerous ER visits over the years. She turned first to the 1989 admission history and physical and recognized Dr. Pomeroy’s spidery handwriting. It was a skimpy entry, recording only the essential facts:

  History: 57-year-old white male, accidentally struck left foot with ax while chopping kindling five days ago. Wound has turned swollen

  and painful and patient now unable to bear weight.

  Physical: Temperature 99 degrees. Left foot has two-inch laceration, skin edges closed. Surrounding skin is warm, red, tender. Enlarged groin nodes on left.

  Diagnosis: Cellulitis.

  Rx: Intravenous antibiotics.

  There was no past medical history, no social history, nothing to indicate that a living, breathing human was attached to that infected foot.

  She flipped to the ER records. There were twenty-five sheets for twenty-five visits going back thirty years, all the visits for the same reasons: “Chronic epileptic with seizure …” “Seizure, scalp wound …” “Seizure, lacerated cheek …” Seizure, seizure, seizure. In every case, Dr. Pomeroy had simply released him without further investigation. Nowhere did she find a record of any diagnostic workup.

  Pomeroy may have been beloved by his patients, but in this case, he had clearly been negligent.

  She stepped into the exam room.

  Warren Emerson was lying on his back on the treatment table. Surrounded by all that gleaming equipment, his clothes seemed even more frayed, more shabby. A large patch of his hair had been shaved, and the newly sutured scalp laceration was now dressed with gauze. He heard Claire enter the room and slowly turned to look at her. He seemed to recognize her; a faint smile formed on his lips.

  “Mr. Emerson,” she said. “I’m Dr. Elliot.”

  “You were there.”

  “Yes, when you had the seizure.”

  “I wanted to thank you.”

  “For what?”

  “I don’t like waking up alone. I don’t like it when …” He fell silent and stared at the ceiling. “Can I go home now?”

  “That’s what we have to talk about. Since Dr. Pomeroy died, no one’s been followi
ng you. Would you like me to be your doctor?”

  “Don’t much need a doctor anymore. Nothing anyone can do for me.”

  Smiling, she squeezed his shoulder. He seemed buried, mummified beneath all those musty layers of clothes. “I think I can help you. The first thing we have to do is get your seizures controlled. How often do you have them?”

  “I don’t know. Sometimes I wake up on the floor, and I figure that’s what happened.”

  “There’s no one else at home? You live alone?”

  “Yes, ma’am.” He gave her a sad wisp of a smile. “I mean, except for my cat, Mona.”

  “How often do you think you’ve had seizures?”

  He hesitated. “A few times a month.”

  “And what medicines do you take?”

  “I gave them up years ago. Weren’t doing me any good, all those pills.”

  She gave an exasperated sigh. “Mr. Emerson, you can’t just stop taking medications.”

  “But I don’t need them anymore. I’m ready to die now.” He said it quietly, without fear, without the faintest note of self-pity. It was merely a statement of fact. I am going to die soon, and there’s nothing to be done about it.

  She had heard other patients make such predictions. They would enter the hospital in far-from-terminal condition, yet they’d say to Claire, with quiet conviction, “I am not going home this time.” She would try to reassure them, but would already be feeling that premonitory chill of death. Patients always seem to know. When they say there are going to die, they do.

  Looking into Warren Emerson’s calm eyes, she felt that chill. She shook it off, and proceeded to do the physical exam.

  “I have to look in your eyes,” she said, reaching for the ophthalmoscope.

  He sighed in resignation and allowed her to examine his retinas.

  “Have you ever seen a neurologist about your seizures? A brain specialist?”

  “I saw one way back. When I was seventeen.”

  She straightened in surprise and flipped off the ophthalmoscope light. “That’s almost fifty years ago.”

  “He said I had epilepsy. That I’d have it for the rest of my life.”

  “Have you seen a neurologist since then?”

  “No, ma’am. Dr. Pomeroy, he took care of me after I moved back to Tranquility.”

  She continued her exam, finding no neurologic abnormalities. His heart and lungs were normal, his abdomen without masses.

  “Did Dr. Pomeroy ever do a brain scan on you?”

  “He did an X-ray, few years ago, after I fell down and hit my head. He thought maybe I’d cracked my skull, but I didn’t. Got too hard a head, I guess.”

  “Have you been to any other hospital?”

  “No, Ma’am. Been in Tranquility most all my life. Never had call to go anywhere else.” He sounded regretful. “Now it’s too late.”

  “Too late for what, Mr. Emerson?”

  “God doesn’t give us a second chance.”

  She had found nothing abnormal. Still, she felt uneasy about letting him go home to an empty house.

  Also, what he’d said still bothered her: I’m ready to die now.

  “Mr. Emerson,” she said, “I want to keep you in the hospital overnight and run a few tests. Just to make sure there’s nothing new causing these seizures.”

  “I been having them most of my life.”

  “But you haven’t been checked out in years. I want to start you on medication again, and get some pictures of your brain. If everything looks fine, I’ll let you go home tomorrow.”

  “Mona doesn’t like to go hungry.”

  “Your cat will be fine. Right now you have to think about yourself. Your own health.”

  “Haven’t fed her since last night. She’ll be yowling—”

  “I’ll make sure your cat’s fed, if that’ll keep you here. How about it?”

  He studied her for a moment, trying to decide whether he could entrust the welfare of his best, perhaps only, friend to a woman he scarcely knew.

  “The tuna,” he said finally. “Today, she’ll expect the tuna.”

  Claire nodded. “The tuna it is.”

  Back in the nurses’ station, the first call she made was to the X-ray department. “I’m admitting a patient named Warren Emerson, and I want to order a CT scan of his head.”

  “Diagnosis?”

  “Seizures. Rule out brain tumor.”

  She was writing Warren’s history and physical when Adam DelRay strolled into the ER, shaking his head. “I just saw them wheel Warren Emerson out of the elevator,” he said to one of the nurses. “Who on earth admitted him?”

  Claire looked up, her feelings of dislike for him stronger than ever. “I did,” she said coolly. “He had a seizure today.”

  He snorted. “Emerson’s had seizures for years. He’s a lifelong epileptic.”

  “One can always grow a new brain tumor.”

  “Hey, if you want to take him on, you get the halo. Pomeroy complained about him for years.”

  “Why?”

  “Never took his meds. That’s why he keeps seizing. Plus he’s on Medicaid, so good luck getting paid. But I guess there are worse ways to spend our tax dollars than serving old Emerson breakfast in bed.” He laughed and walked away.

  She signed her name so hard the tip of her pen almost sliced through the paper. All these tests she’d ordered, plus a night’s stay in the hospital, added up to an expensive hunch on her part. Perhaps Emerson’s memory was faulty; perhaps Dr. Pomeroy had performed a recent diagnostic workup, though she doubted it. From what she’d seen of his charts, Pomeroy had been a lackadaisical clinician, more likely to write a prescription for some new pill than to painstakingly investigate the reasons for a patient’s symptoms.

  She left the hospital and drove back to Tranquility. By the time she reached her office, she was focused on only one thing: reviewing Emerson’s outpatient chart and proving to herself that her decision to admit him was justified.

  Vera was on the telephone when Claire walked in. Waving the phone, Vera said, “You’ve got a call from a Max Tutwiler.”

  “I’ll take it in my office. Could you get Warren Emerson’s file for me?”

  “Warren Emerson?”

  “Yes, I’ve just admitted him for seizures.”

  “Why?”

  Claire halted in her office doorway and turned to glare at Vera. “Why does everyone in this town question my judgment?”

  “Well, I was just wondering,” said Vera.

  Claire shut the door and sank behind her desk. Now she’d have to apologize to Vera. Add it to her ever-growing list of mea culpas. She was in no mood to talk to anyone right now; reluctantly she picked up the telephone.

  “Hello, Max?”

  “Good time to call?”

  “Don’t even ask.”

  “Oh. I’ll keep it short, then. I thought you’d want to know they’ve confirmed the identity of that blue mushroom. I sent it to a mycologist, and he agreed it’s Clitocybe odora, the anise funnel cap.”

  “How toxic is it?”

  “Only mildly so. The small amounts of muscarine wouldn’t cause much beyond some mild gastrointestinal upset.”

  She sighed. “So that’s a dead end.”

  “It would appear so.”

  “What about those lake water samples? Are the results back?”

  “Yes, I have some of the preliminary findings here. Let me get the printout …”

  Vera knocked on the door and came in with Warren Emerson’s chart. She didn’t say a word, just dropped the folder on the desk and walked out again. While waiting for Max to come back on the line, Claire opened the chart and glanced at the first page. It was dated 1932, the year of Emerson’s birth. It described the uncomplicated labor and delivery of a healthy boy to a Mrs. Agnes Emerson. The doctor’s name was Higgins. The next few pages were devoted to wellbaby checks and routine childhood visits.

  She turned to a new page in the chart and frowned at the date: 1956
. There had been a ten-year gap between the previous entry and this one. For the first time, Dr. Pomeroy’s signature appeared in the chart. She started to read Pomeroy’s entry, but was interrupted by Max’s voice on the line.

  “Bacterial cultures are still pending,” he said. “So far I see that dioxin, lead, and mercury levels are all within safe limits …”

  Claire’s attention was suddenly riveted on the chart. On what Pomeroy had written in the last paragraph: “Has committed no other violent acts since his arrest in 1946.”

  “… by next week, we should know more,” Max said. “But so far, the water quality seems pretty good. No evidence of any chemical contamination.”

  “I’ve got to to go,” she cut in. “I’ll call you later.”

  She hung up and reread Pomeroy’s entry from beginning to end. It was written in the year Warren Emerson had turned twenty-five years old.

  The year he’d been released from the State Mental Hospital in Augusta.

  Nineteen forty-six. In which month had Warren Emerson committed violence?

  Claire stood in the basement archives room of the Tranquility Gazette, staring at a wooden cabinet that took up an entire wall. Each drawer was labeled by year. She opened the drawer for 1946, July to December.

  Inside lay six issues of the Gazette. In 1946, it had been a monthly newspaper. The pages were brittle and yellow, the ads adorned with wasp-waisted women in bouffant skirts and smart little hats. Gingerly she leafed through the July issue, scanning the headlines: RECORD HEAT MAKES UP FOR RAINY SPRING … BIGGEST SUMMER VISITOR COUNT EVER … MOSQUITO ALERT … BOYS CAUGHT WITH ILLEGAL FIRE-WORKS … JULY 4TH PARADE DRAWS RECORD CROWDS. The same headlines that seem to appear every July, she thought. Summer has always been the season for parades and biting bugs, and these headlines brought back memories of her first summer in Maine. The crunch of sweet corn on the cob and snap peas, the tang of citronella on her skin. It had been a good summer, as it had been in 1946.