Germ

by Robert Liparulo

  “An ambulance?” She was having trouble thinking.

  “Wait here,” the nurse said sternly and darted away. Almost immediately she started talking again, but not to Julia.

  “Dr. Parker. You got my page,” she said to a man coming down the hall.

  Everything about the man commanded attention. An unbuttoned white smock blew back under his arms, revealing immaculately tailored clothes: a gray dress shirt with subtle black and purple pinstripes and pleated slacks the color of ancient tombstones. Dishwater blond hair, trendily coiffed long on top and short on the sides, swept back from a broad forehead. Bushy eyebrows rode a strong crest above squinting gray eyes. His nose, straight but with a faint leftward bend at the tip, fit his face well. His stride was long, his gait confident.

  The nurse reached him and turned to escort him toward a door next to one of the treatment rooms, apprising him of the situation as they walked. The pace of her speech had accelerated dramatically. “The trauma team’s tied up in 1 with a boy who fell off his bike and suffered deep head lacerations and a concussion. Dr. Bridges is in 3 with a knife wound—”

  “Somebody finally stabbed Dr. Bridges?” asked the man called Dr. Parker. His voice was deep but somehow soft, as if he’d considered each word and deemed it too important to rush or abuse. In such solemn surroundings, it took Julia a few seconds to realize that the physician was joking, despite the gravity in his tone and the scowl on his face.

  The nurse giggled dutifully, then continued: “I thought you were still in the hospital. We have a GSW en route. Extensive chest trauma.”

  Gunshot wound! She’s talking about Goody!

  “The GSW is to the head, neck, chest, and abdomen,” the nurse explained. “ETA any second. He’s been boarded, intubated, and they got in two large-bore peripheral IVs—”

  The two walked through a windowed door across from the nurses’ station. A hydraulic closing mechanism hissed as it pulled the door shut behind them.

  The wound sounded more severe than Goody had let on over the phone. And why an ambulance? He would have told her if the injury was that debilitating.

  Julia looked through the door’s window. The nurse was talking animatedly while the doctor slipped on green latex gloves. She stepped in. The doctor saw her and flashed a winning and obviously well-rehearsed smile.

  The nurse made a beeline for her: “You can’t come in here. You’re—”

  “I just talked to him,” Julia said to the doctor, sidestepping the nurse. “He said he was hurt bad, but not—”

  The nurse was insistent. “Dr. Parker, the patient’s GCS is eight.”

  Julia turned to her. “What’s that mean, GCS? Eight?”

  Dr. Parker came up behind her and touched her arm. “It means he’s verbally nonresponsive, close to comatose. Not a good sign, but we’ll see when he comes in. I’m Dr. Parker, Allen Parker.”

  The nurse walked up with a glove stretched open and ready for him to insert his hand.

  “Julia Matheson,” Julia answered. She stuck her hand into her jacket pocket for her CDC-LED identification when a warbling siren reached her. It quickly rose in volume. Julia stepped into the hall.

  Within seconds, an ambulance braked hard outside. Car doors slammed, and the automatic doors of the emergency entrance slid open on cue. Two uniformed EMTs, like a toboggan team at the top of a run, bounded noisily into Erlanger’s emergency department pushing a gurney. One attendant held a clear plastic bag of fluid over the patient. The other pressed his hands against the patient’s wounds, afraid, it seemed to Julia, of what might come out if he didn’t. A steady stream of blood poured off the gurney, leaving a thick trail in its wake.

  “Roll ‘im in 2!” the nurse yelled, coming around Julia, pointing at the portal where open double doors revealed a bright, immaculate room waiting to be bloodied. Its tiled floor and walls, the grated floor drain, the smooth metal surfaces of the equipment—all betrayed the gorefest the room was designed to accommodate and contain.

  Julia turned from it and rushed to meet the stretcher, anxious to let Goody know she was there for him. But the body on the gurney wasn’t Goody—it couldn’t be. It was drenched in red. Clothes and flesh hung in strips. She saw an arm that looked filleted. The part of the face she could see was … gone. She ran up to the gurney, in front of the attendant holding the bag. He crashed into her, and the whole production stopped.

  “Hey!” the attendant yelled.

  She leaned over the body, straining to see more of the face. An eye fluttered open, stared at her, closed again.

  It was Goody.

  She nearly screamed. Her hand clamped over her mouth. She felt her body go limp, as though someone had popped her spirit the way you pop a balloon.

  The attendant pushed passed her. She stumbled backward, watched the gurney glide into Trauma Room 2. Then the door closed and she was standing in the corridor, numb and coated from waist to nose in Goody’s blood.

  thirteen

  The bodily damage was as devastating as any Allen Parker had ever seen. Instantly, nothing else mattered: the room, the equipment, the trauma staff, his own physicality all fell away, sacrificed to the intense focus with which he attended to the patient’s injuries. Everything around him paled as blood became more vivid, wounds more apparent, the needs of life more demanding. Information about the patient—called out by the staff or communicated as tones, bleeps, lights, and graphs by various machines—fell into the periphery of his awareness, absorbed without effort or recognition, but acted upon or mentally cataloged for later consideration. This was what it was all about: this one life, here and now.

  His head darted to within inches of the gaping, bubbling wounds, then reared back to evaluate the injuries from different perspectives. He leaned over the body, then stood erect and slowly walked from head to belly and back again. As he went, he sealed holes in the body with squares of gauze, taping down three sides.

  “Focus that light here. Four units RBCs, right? And get an operating room ready, fast.”

  He guessed that the carotid artery was intact, though only a surgical exploration could tell for sure. The internal and external jugular veins appeared ripped and oozing. He stepped around an intern who was busy injecting local anesthesia, skirting another who was tying off bleeding veins and arteries.

  “He’s 100 percent dead in the extremities,” another nurse called out. “Fingers and toes are white.”

  “Bring that instrument tray over to me,” Parker said.

  The patient breathed spontaneously, but only barely. He hissed through shattered teeth, and air seeped out in gurgling bubbles through a dozen holes. Whatever had caused this damage was efficient and as ruthless as a starving shark.

  “Where’re the chest tubes? Come on, people!”

  A section of ribs had turned into tiny fragments, which had shredded the right lung and disintegrated the liver.

  “We need another surgeon. Find someone. Now!”

  Blood pooled in open cavities. Pieces of flesh hung in strands.

  “Get me suction. Clean here, here, and here. We’re going to need more blood. Get the blood bank down here.”

  Parker didn’t have to examine the abdomen to know the damage he would find there. A fetid stench suggested multiple perforations in the intestines. When he looked at the intestines protruding from the abdominal wall, he realized some would have to be removed altogether.

  “Make it two surgeons … as many as we can get!”

  Blood splashed and dripped and snaked toward the drain. Shock-induced endorphins probably—mercifully—prevented the man from feeling pain: a temporary reprieve at best, unless death snatched him from pain’s grasp first.

  Parker shook his head.

  “If he codes, make it a DNR,” he called out.

  The Do Not Resuscitate order told the medical staff what they needed to know. Pulling out all stops to restore life upon cardiac arrest would most likely lead to an endless cycle of rescuing the poor soul from the br
ink of eternity, until he finally teetered over the edge forever. Restarting the heart could fool clinical death for only so long before the injuries caused biological death, in which all tissue dies: the end.

  As a nurse blotted a section of the chest wound, Parker caught a glimpse of something too symmetrical to be organic. It appeared firmly embedded in the man’s sternum.

  “Whoa, whoa,” he said. “What’s this?”

  Using forceps, he clamped the small, round object and tugged on it. He had to apply more force than he’d expected, but it finally popped loose. It was a black metal disk, razor sharp.

  “Yow.”

  He dropped it into a stainless steel bowl. “Listen up, people,” he announced. “It appears somebody has turned this man into a radial saw. Nobody sticks their hands in, got it? Use instruments—forceps and clamps. I want to see survey films of this whole area. Let’s find out how many of these ugly buggers we’re dealing with, and where they’re hiding.”

  Nurses rushed to the table with masking tape and started marking off the edges of the wound.

  The patient sputtered, and what came out sounded like a word. Parker turned to see the man’s remaining eye focused on him. The gaze was piercing, intense. Jaw muscles bulged with effort, and the patient’s mouth parted slightly. He was trying to talk.

  Parker leaned his ear close. Hot, vile breath washed over him, then spatters of blood. Words followed. He bent lower, until his ear was nearly touching the man’s mutilated lips. Parker’s eyes narrowed, then grew wide. He tried to pull away, but the man’s left hand had incredibly reached over Parker’s head, holding him. The patient continued to speak in stuttering gasps.

  After a long moment, Parker turned his face toward the patient’s. “When?” he asked, a raspy whisper. He listened.

  Blood bubbled out of the patient’s mouth. His arm dropped off the table.

  Parker looked around. The trauma team was busy; no one was looking, no one had heard.

  “Who is this man?” he called above the cacophony. “Does anyone know?”

  “A cop,” someone said. “His partner is outside.”

  He gazed at the devastated face. He lowered his head again, turning his ear back toward the man. As he did, the electrocardiogram ceased its slow, rhythmic beeping to hum in endless, monotonous finality. The patient’s heart had stopped.

  “He’s PEA!” somebody yelled out. Pulseless electrical activity, the condition that usually precedes asystole, or flatline. No one moved; everyone knew resuscitation was hopeless. They watched as Parker, still with his ear pressed to the man’s mouth, gripped the patient’s tattered shirt. He gave it a little shake, as if to rattle some words out of him. Then, slowly, Parker stood, staring at nothing, deep in thought.

  “Doctor?” a nurse said. “Dr. Parker, are you all right?”

  “Yes … of course.” He rubbed his ear, smearing blood. “Uh … mark the time.” He looked at the wall clock. “Seventeen-oh-nine.”

  Nurses began stripping off gloves, shutting down machines, collecting gore-encrusted instruments. The various clamps, tubes, and lines still in the body would remain with the corpse until a forensic pathologist conducted an autopsy and declared the cause of death.

  Parker tugged down his face mask and pushed through the doors to find Julia Matheson.

  She was gone.

  fourteen

  Two minutes earlier, She had watched Goody die. Gazing through the small windows in the trauma room doors, she had known there was nothing the doctors, nurses, and technicians could do to repair the injuries she’d seen. As soon as she had heard the cardiac monitor drop into a flat tone and someone call out, “PEA!” she felt a heavy weight drop in her stomach. Blood rushed to her head. The edges of her vision darkened. She felt herself sway, and she reached out, found something steady, and held herself up.

  “Ma’am?” a voice asked.

  She was gripping a young nurse’s arm.

  “Can I get you something?”

  “Restroom?” Julia managed.

  “Around the corner, down the hall, on the right.”

  The nurse raised her voice for the last three words—Julia was already around the corner, out of sight.

  She barely reached the toilet when the contents of her stomach came up. She rose and leaned against the wall of the toilet stall, her cheek pressed to the cold steel, and wept. Her body hitched violently whenever she tried to stop, so for now, she let the tears flow. Images of Goody, of Jodi and the kids, kept swimming up from her memory, fueling her wracking sobs.

  After a long time—ten minutes, maybe fifteen—the worst of it was over. Slowly, sadness gave way to anger; she felt it and seized on it. If emotions were drugs, sadness would be a depressant, anger a stimulant. She needed a heavy dose of drive to get through the next few hours, and eventually to find Goody’s killers. If anger helped dull the pain of losing him and spurred her on, so be it.

  She wiped her eyes and blew her nose. She hardly recognized herself in the mirror. She was pale, her hair disheveled, her eyes red. Somewhere along the way, her lip biting had drawn blood. A dark brown layer of it had formed on her lower lip. She splashed cold water on her face and tried to appear at least somewhat less homeless.

  When she left the bathroom, her stride was strong, her shoulders square: she was on a mission to find whoever had slaughtered Goody, and why.

  When she reached the ER, the trauma room doors were still closed. She pushed one open enough to peer in. The room looked like a battleground. Blood was everywhere, as were discarded gauze wrappers, bloody sponges, rubber gloves, strips of paper, and soiled towels. On a table in the center of the room, Goody’s body lay under a stained white sheet, awaiting transport to a refrigerated cell, an autopsy room, then the ground. She thought she should slip in, touch his hand, but she couldn’t do it.

  I’m sorry, Goody. I’m sorry.

  She wanted to continue talking to him like that, sending words like a prayer to wherever he was, but she understood the damage it would do to her composure, her resolve. She moved her hand and let the door close.

  She heard a noise and looked through a series of glass doors to see the physician who had worked on Goody. Dr. Parker, she remembered. She strode through the doors, not noticing until she stood before him that he had stripped down to his underwear. He was holding the gray pants she had seen him wearing earlier, but they were stained with blood. It had soaked through to his underwear and stomach. The image of a battlefield returned; this man was one of the combatants, away from the front, grateful to find that the blood all over him wasn’t his.

  For a brief moment, surprise contorted his face. Then he smiled, that same smile she’d caught before.

  She spun around, saying, “Sorry … sorry …”

  “Job hazard, I guess,” he said calmly. “The blood, I mean, not being caught with my pants down by a pretty woman. That doesn’t happen enough, I’m afraid.”

  She heard the snap of elastic and assumed that he had just removed his underwear.

  “Do you …” she started, getting over her initial shock through the realization that he was flirting with her. His lack of humility riled her, especially considering what had just happened, whose blood he was ridding himself of. “Do you always take your clothes off in public?”

  “Only after surgery. It’s kind of a ritual we surgeons have.”

  “I need to talk with you. The person you worked on, the one who died—”

  “He was your partner, I know.”

  “He was my friend.”

  “I’m sorry.”

  “What can you tell me about his injuries?”

  She heard the rustle of clothes.

  “You can look now,” he said.

  She turned apprehensively, not convinced his invitation to look meant he was decent. To her relief, he had donned surgical pants.

  “Actually,” he said, “these scrub rooms are usually fairly private. I’d go up to the locker rooms, but they’re on the sixth floor a
nd, well, this is just more convenient.” He opened a drawer, pulled out a folded smock, and handed it to her. “You’d better play doctor until you can change.”

  She looked down at her blood-soaked clothes. “Thank you.”

  “Are you a cop here in Chattanooga?”

  “Federal. Out of Atlanta.” She pulled out her identification and held it up to him.

  He looked at it closely. “Centers for Disease Control,” he said slowly.

  His face paled, but she decided it was a trick of the light.

  “I didn’t know they had a law enforcement division.”

  “Part of Homeland Security. Mostly we’re FBI special agents on permanent reassignment.” She removed her business card from behind the ID card, jotted her mobile number on the back, and handed it to him.

  “I see.” He picked up a smock from a shelf, thinking hard about something. “So you investigate … what? Threats involving diseases, viruses?”

  “Among other things. Doctor, what killed my partner?”

  Parker shook his head. “Well, that’s up to the medical examiner to decide, but an educated guess? Couple dozen razor-sharp disks, probably shot into his body from a large-bore firearm, like a shotgun.”

  “Disks?”

  “Wait here.” He walked through a glass door she had not seen before, which led directly into the trauma room. He picked up a small metal pan and returned.

  Julia looked in and inhaled sharply.

  “My thoughts exactly,” said Parker. “Some of the disks were penetrating. That is, they entered his body and stayed there. This one”— he raised the pan, indicating the disk inside—“was lodged in his sternum. I suspect most of the disks probably went right through him and are embedded in whatever was behind him. By the looks of the injuries, they took a lot of his body with them when they exited.”

  “May I have this one?” she asked.

  He squinted at her. “Is that okay?”

  “We haven’t established jurisdiction on this case yet, but we will. I might be able to get a jump on it if I can run this through our database, see if something like it has been used before in a crime.”