Illegally Dead

by Gregg E. Brickman

  Twelve

  Tony was in a hurry to get home for dinner with Jennifer and the kids. He'd thought about her all day and tried to contact her several times. She had just called. She was home, and dinner would soon be on the table. He slid the finished staffing schedule into an envelope.

  Chamberlain Thorne appeared in the doorway of Tony's office.

  "What's up?" Tony flicked the lock of hair off his forehead and smiled.

  "Can I come in?" Thorne wore wrinkled green scrubs from the OR, a surgical mask hung from his neck, and his clipped brown hair bore the shape of the close-fitting surgeon's cap donned for surgery. The faint odor of perspiration hung in the air, and a worried look covered his face.

  "Sure, have a seat." Tony motioned to the chairs on the visitor's side of his desk. He pushed his chair back until it touched the wall and watched Thorne. The unexpected visit produced a sensation of dread.

  Thorne pulled the door closed behind him, blocking the noises of the busy ED. He took his time getting settled. "I just left pathology. Kraft called me down to look at Jennifer's slides. The reference lab sent back the slides with the report."

  Anxiety quickened Tony's heart, creating a pounding in his chest. It was Tuesday. He hadn't anticipated the results until the end of the week. He took several deep breaths. "And?"

  Thorne set his square jaw. "The report confirmed the Hodgkin's disease."

  "Couldn't there be some mistake? I can't believe Jen, my Jen, has Hodgkin's. You know I've thought about it. You prepared me. But in my mind, I willed it wouldn't be true." He stared at Thorne.

  "I'm sorry. There's no mistake." Thorne leaned forward and laid a comforting hand on Tony's arm. "The presence of Reed-Sternberg cells gives a definite, indisputable diagnosis."

  "Merda. Damn it." Frustrated tears appeared in the corner of Tony's dark eyes. "How am I going to tell Jen? How? Tell me."

  "I'll tell her. I wanted you to know first, to give you a chance to come to grips with it yourself."

  "It's my job, and I'm her husband. I promised her I'd be the one to give her the news."

  "If that's how you want it. Let me know what you want me to do."

  "Tell me about the disease, please. I've never done much with oncology. I've always worked in critical care or the ED, or in some strategic hell hole in another world." Tony pulled a sheet of lined, white paper from his desk and rummaged in the drawer for a pen. Jennifer would have questions, and he wanted answers. He'd stop at the medical library before he left the hospital and borrow a couple of books, and they could look things up on the Internet. Taking charge of the situation, he felt himself regain a measure of emotional control. He'd need to be strong for Jennifer.

  "The first thing you need to know," Thorne said, "is Hodgkin's disease, we call it HD, is very treatable and very curable. I reviewed a recent study showing only seventeen-percent of the patients died of HD within the first fifteen years. If it's caught and treated in stages I and II, the cure rate is as high as ninety percent."

  "What stage is Jen?" Tony asked, his anxiety surfacing again.

  "I suspect, based on the CT, she's stage III. When I see her, I'll recommend an exploratory laparotomy that will allow us to accurately stage her disease and decide on the treatment. We'll need a bone marrow biopsy, too. The sooner we get started, the better it will be for her."

  Tony needed to master the sinking feeling in his gut before he went home. "Go on. Tell me about the disease." Tony sat, pen in hand.

  "Hodgkin's is the major tumor within the group of lymphomas. Usually it begins above the collarbone, but with Jen, I believe it started under her arms. That's not unusual. In this case, it was lucky because she found the first node when she performed her breast self-examination."

  "She's been faithful about that. Her family has a history of cancers."

  "Anyone with HD?"

  "Her father died from Hodgkin's in his forties."

  "Also not unusual. There's a theory that a combination of genetic and environmental factors causes HD. Does she have any other health problems such as weight loss, night sweats, or fever?"

  "No." Tony held his pen in front of his face, tapping air. "Wait a minute. She just ditched a stubborn cold. Her fever wouldn't cooperate, then it finally went away, and yes, she's having night sweats. She's also losing weight. I noticed it recently. I don't believe her eating habits have changed."

  "Keep track of those extra symptoms. They may mean she's having B symptoms or systemic symptoms, indicating a more severe form of HD. If so, we'll want to treat her with a more aggressive plan."

  "What about treatment?"

  "Depends on the stage of the disease. The oncologist may recommend chemotherapy, chemo with radiation, or radiation alone, depending on the results of the laparotomy and the rest of the tests."

  Tony nodded.

  "Jen's a strong woman."

  "If you ask me, she has to be to put up with me." Tony laughed. "She's been there . . . through the Special Forces, the nightmares . . . she pushed me into nursing, knew I needed something useful . . ." Tony's voice cracked and tears spilled.

  After a minute, Thorne continued. "You'll need to pick an oncologist."

  "Of course. Who? I’m not familiar with them." Tony looked at Thorne, his expression focused and expectant.

  "Jackson, Josh Jackson, is my first choice. He's young and aggressive, and he's shown an active interest in the lymphomas."

  "Okay, Jackson it is. At least, I'll suggest him to Jen. The final decision is hers."

  "Meanwhile, have her call me to arrange an office visit. We'll discuss the surgery then. You'd better come, too."

  "Fine." Tony took a deep breath.

  Thorne was silent as if waiting for Tony to continue. When he didn't comment further, Thorne switched the subject. "Have you heard any more about the Carlson case? I'm scheduled for a deposition in a couple weeks. We were served yesterday."

  Tony looked startled. "What . . . ah . . . Nick and I are both scheduled. In fact, it's being held in the administrative conference room."

  "Convenient." Thorne leaned back, resettling himself in his chair. "I ran into Mark Olson in the hall. He said he lost the case. He thinks the tear-jerker video the plaintiff ran swayed the jury. Said they didn't seem to pay attention to the defense case. Seemed bored."

  Tony felt tense, his muscles as taut as on-pitch guitar strings. He stretched his neck and massaged his own shoulders. "Mark needs to improve his bedside manner. He's remote and uncommunicative, acts uncaring. His patients get angry when they do poorly. They never seem to understand the situation well enough to believe a positive outcome isn't guaranteed."

  "Guess he's getting a lesson. But I always make sure my patients understand—"

  "Yes, you do." Tony warmed to the conversation and relaxed a bit.

  "And still, I'm in court."

  "Merda. Life's a bitch."

  Abigail appeared in the doorway. She touched Thorne on the shoulder and smiled when he turned to her. "Tony," she said, directing her attention to her manager. "Unit Nine is coming in. The patient's convulsing. I sent two staff members to dinner before the call came in. Can you stay and help?"

  Tony stood behind his desk, then worked his shoulders and his back. He knew Thorne and Abigail watched, but he didn't care. He'd grown accustomed to people staring at him when he moved. "Abigail, I'd be happy to help." He made a quick call to Jennifer to tell her he'd be tied up awhile, then hurried around the desk and into the hallway, leaving Thorne sitting alone.

  ***

  The crew from Unit Nine pushed their patient into the major event room located inside the ambulance entrance, first door on the left. The thin man continued to convulse. Tony increased his stride, arriving in the room in time to help transfer the patient to the hospital stretcher.

  "What's the story?" he asked the paramedic closest to him.

  "We found him on his bathroom floor. From the mess, I'd say he ran in and couldn't decide whether to sit down or bend over.
"

  Tony saw Nick Messing hurrying into the room.

  Nick said, "Let get moving. IV Dilantin one-thousand milligrams. STAT."

  Tony twisted the red security-lock to open the crash cart. The top two drawers contained an assortment of emergency drugs. Tony popped the lid on a Dilantin vial with his thumb and plunged in a needle to draw the medication.

  A respiratory therapist laid out the instruments for intubation.

  The first order of business was to stop the convulsion.

  Thorne appeared in the doorway of the room. "That's Henninger. He's the new senior partner in Valentine's firm."

  "No kidding," Nick said.

  The patient's convulsion ceased. He breathing was shallow, the rate slow.

  Nick directed the beam from a small penlight into each of Henninger's eyes. "Pupils fixed and dilated."

  "Need a hand?" Thorne asked, stepping into the room.

  "Sure. We'd better have a central line." Tony pointed to the IV the paramedics had started at the scene. "This one looks like it won't last. Let's get him intubated and the remainder of the Dilantin on board before the next seizure starts."

  While Henninger lay motionless, the medical team worked. Abigail inserted a Foley catheter into his bladder. Nick slipped a tracheal tube through his mouth and into his lungs to assist with breathing. Thorne punctured Henninger's right shoulder with a large bore needle and slid a catheter through the lumen into the subclavian vein. Tony prepared several IV bags with medications and started them flowing into the new central line. The team worked in a coordinated effort to save the life of their patient, their routine efficient from repetition.

  "Before we give him anything else, let's get a urine and blood sample for toxicology. I think he's been poisoned." Tony finished setting the flow rates for the medications, and reached for a basket of color-coded specimen tubes. "What else do you want, Doc?" He glanced at each physician in turn.

  "CBC, SMA 21, draw a couple extra for drug screens and toxicology. We need to get him to imaging, STAT. Get in a Sump and empty his stomach. Tony, why do you think he's been poisoned?" Nick placed a stethoscope on Henninger's chest.

  "Hunch." He surveyed the room, determining who was available. "Abigail, get the urine and call CT. Then let's take advantage of the calm and get him cleaned up."

  "Good idea." She capped off the urine specimen container and reached for the wall phone.

  Thorne faced Nick. "Anything else I can do for you?"

  "No. Now, we wait and see. We have everything happening that needs to happen . . . until we know what caused the seizures. He'll have his CT in a few minutes, then we'll have another piece of information. I'll call in a neuro consult while we wait."

  "I'll be in the surgeon's lounge if you need me. Abigail, page me when you're done."

  "Okay." Abigail pulled on a new pair of vinyl gloves.

  Tony said, "V Fib." The tracing on the cardiac monitor looked like the melody line for the nineties guitar tune Eruption—jagged and erratic.

  "Defibrillate," Nick ordered. He applied the pre-gelled pads Tony shoved into his hands to two locations on the Henninger's chest. "Stand back. You're clear. I'm clear. All clear."

  Nick pushed the button on the defibrillator, sending a surge of electricity through Henninger's chest. His body contracted and jerked in response to the jolt.

  Tony watched the monitor. "V Fib. Resuming CPR. "

  "Give the Epi. Let's try shock again. Stand back." Nick repeated the routine to keep the staff away from the patient during defibrillation.

  Tony set the machine, and Nick delivered the shock. Again the patient contracted and jerked on the stretcher.

  "Nothing. V Fib. Resuming CPR." Tony continued CPR while Abigail gave another drug.

  After the another shock, Nick said, "Still nothing."

  The respiratory therapist squeezed the Ambu bag and delivered two breaths through the breathing tube.

  "One, two, three," Tony counted. With machine-like precision, he depressed Henninger's breastbone. As Tony worked, his mind drifted to his concerns about Jennifer. Thorne had called it HD. That didn't sound as fatal. He tried different phrases in his head, phrases to tell Jen, but none sounded right. "One, two, three." He blocked out everything except the familiar rhythm of CPR.

  "Tony, you can stop now." Nick pushed Tony's hands aside. "Stop. I'll pronounce him. We're not going to get anywhere here. He's expired."

  Tony shook his head. "Okay. Sorry." He waved an hand around the room. "Get this place straightened a little. Don't clean Mr. Henninger. Leave all the tubes and lines. Abigail, please call the Medical Examiner. Be sure to tell him it's Henninger, the current senior partner in the same law firm as Valentine."

  "Okay." A quiet ripple of assent spread through the staff. Their mood was somber, but they would do what they needed to do.

  "Anything else?" Abigail asked.

  "Let's all make sure we document this carefully. Perfectly. You never know what you might have to read aloud in court."

  ***

  Tony hurried home, leaving the task of notifying Henninger's family to Nick and Abigail. He wanted to help Jen put the kids to bed—then they would have plenty of time to talk.

  "Jen, Ma, kids, I'm home," he called as he opened the front door.

  "Ciao, come sta?" Elena welcomed him from the kitchen with a hello, how are you?

  "Non so. Where's Jen?" Tony bent and kissed his mother on the forehead. "Where are the kids?"

  "She took them to the park with Bella. She came home from work early. I found Jeff watching the little ones while Jennifer slept in the recliner." Her expression showed concern.

  "Ma," Tony sat at the table. "Jen is sick, real sick."

  "I know. She told me she was sure she had cancer. She's only waiting to find out what kind." She stood back a step and gazed into her son's face. "You have news for her."

  "I do. It could be worse. At least what she has is treatable, but she'll be sick during treatment."

  "She told me how sick her dad got before he died. She's worried."

  "So am I, Ma." Tony saw Jennifer and the children crossing the backyard.

  Bella stood off leash and waiting, tail wagging, at the screen door. When Tony opened the door, she accepted his hug and ear rub before licking him across the mouth and moving on.

  Tony stayed crouched in the doorway to hug Monica, Jeff, and Joey. "A little dark at the park, don't you guys think?" He looked at Jennifer and then stood to greet her.

  "You have news, I see." Jennifer slipped into Tony's outstretched arms. "Your face tells me all, my love."

  "Let's wait and talk after the kids are in bed."

  "Okay. Don't worry, baby, we'll handle it. We always do."

  Later, with dinner over and the kids in bed, Tony and Jen cuddled on the family room sofa talking in muted tones.

  Jennifer said, "What you're telling me is I may not die from this?"

  "Yes, that's what Thorne said. He wants to do the surgery as soon as possible, then start treatment. You'll be sick, but you'll recover. We can look up HD on the Internet."

  "Tomorrow. Right now, I'd rather go to bed."

  "You tired?" He was concerned.

  "Not exactly." She ran her hands under his tee shirt. "Hum, you're nice and warm." She nuzzled closer to his chest.

  "I'll be warmer yet if you keep that up."

  "Then I'll keep it up."

  "That's a plan." Tony pulled her close and kissed her. He suspected her desire was more for distraction than passion, but he didn't comment. "Want to share a shower?"

  "You already showered. I can tell."

  "It doesn't count. You weren't there to wash my back. Only Bella was there wanting to lick the water off my legs."

  "I'd rather wash your tight little butt."

  "Oh, woman." Tony blushed until his face was a deep purple. He drew her up from the sofa and led her in the direction of the master bedroom.

  Later, Tony awakened bathed in sweat in the dar
k of night. His muscles twitched and trembled as vague recollections of the nightmare flashed through his mind—babies crying, fire, women screaming in terror as their men died before their eyes, his own body bleeding from the broad gash running from his neck to his chest. He reached out for Jennifer's hand, but she wasn't there. As he jumped out of the bed, Monica's wails brought him into the present. Through the intercom, he heard Jennifer cooing and singing to the baby.

  Jennifer never heard the baby awaken before he did. Tony was a light sleeper, always on guard, tense and ready. It meant she hadn't slept. After their love making, they talked for a long time before kissing goodnight. Tony had fallen to sleep. Now he looked at the clock. Three in the morning. He'd slept a couple of hours.

  He pulled on a pair of boxer shorts and a tee shirt and was halfway down the hall when Jennifer appeared at the top of the stairs. She motioned to him to go into the kitchen instead of coming up.

  "She settled down. She must have had a dream. Bella is on her bed, and they're dozing."

  "Bella?"

  "We didn't close her cage, and she climbed onto her favorite bed."

  "I hope Monica doesn't kick her in the head too often."

  "They're cute with their heads together on the pillow. Monica's brown ringlets blend right in with Bella's fur."

  Tony sat at the table and pulled Jennifer onto his lap. "You weren't asleep, were you?" He rubbed her back.

  "I have a lot to think about. I can't believe this is happening to me, to us. I thought if I went to sleep and woke up again, I would find out my being sick was all a bad dream. But then, I couldn't go to sleep."

  "I wish it was a dream."

  "Me too, baby." She kissed him on the forehead and brushed his hair out of his eyes. "Let's go to bed. I have a busy day tomorrow at work."

  "Maybe you'd should ask them for some time off. You'll have a lot to do, planning for surgery, getting better." Tony rubbed her neck with his strong hand. He felt the knots of tension in her muscles.

  "I need to work as long as possible. If I have chemotherapy, I'll be too sick to work for a while. We need all the money we can get until then."