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CHAPTER ONE
“How can your liver be this good?” I stood outside Mr. November’s room, watching him stir restlessly. Normal people couldn’t get 20,000 micrograms of fentanyl and 80 milligrams of Versed an hour and live, much less still be attempting another slow-motion escape from their hospital bed.
But I knew Mr. November wasn’t normal. From my assessment, when I’d seen his chipped yellow fangs around his titanium-tipped endotracheal tube, and from the way he was restrained in bed—six soft cuffs, two on each arm, one on each leg, a Posey vest wrapped around his chest and tied beneath the bedframe—and from the fact that he was here on Floor Y4 to begin with. No one here was normal, except for me. I was human and looked it: average brown hair, average blue eyes, average hips. My patients here? Let’s just say “average” was not the first adjective you’d pick for them if you saw them on the streets. Or the twentieth.
Mr. November continued to squirm. I wondered which cheerful member of our daytime staff I’d be giving a report to come seven A. M. with him crawling out of bed behind me. I could almost feel them judging me now.
His IV pump beeped empty and his cuffed right hand made rabbit-punching jabs. Crap.
“Hey, you!” I shouted and leaned into his room to try to attract his glazed attention. “Stay still!” I commanded through the door. Sometimes with agitated patients the voice of nursing authority buys time. I dashed to the supply room, unlocked the narcotics drawer, grabbed a bag of fentanyl, and made it back to his room as he started to thrash his head from side to side.
“Stop that!” I hauled on my isolation gear as fast as I could. If he managed to knock his endotracheal—ET—tube loose, that’d be the end of his ventilator-assisted breathing, which’d be the end of him. I put my gloves on, snatched the bag, and rushed inside. When I silenced the pump alarm’s beeping he visibly calmed.
“You have to stay still, sir. You’ve got pneumonia and you’re in the hospital. ” I switched out the bags and reset the pump. I inhaled to say more, but I saw Meaty, my charge nurse, rise up like a moon behind the nursing station outside, holding one thick hand up in the shape of a phone. It was the international nursing gesture for, “Call the doctor?”
I nodded. “More sedation. Now. Please. ”
Mr. November’s hands spasmed again. I didn’t know if he was reaching for me with a purpose, if he just wanted to be free, or if he didn’t understand what was happening—not unlikely, with all the meds he was getting—but I grabbed his nearest hand in both my own. “You’ve got to rest now, okay?” His grip tensed and so did I—most of the training videos I’d watched before starting this job had emphasized the “minimal patient contact” rule, for vastly good reasons—but then he relaxed, letting me go.
I stepped back from the bed, took off my gown and gloves, washed my hands, and went outside.
“You okay there, Edie?” Meaty asked as I returned to sit behind my desk, just outside Mr. November’s door. I grunted a response and flipped open Mr. November’s flowsheet to hide behind. Meaty didn’t check in on Gina or Charles unless they called for help. But I was new here. Just when I was starting to feel like I knew how to be a nurse at my last job, only a year out of nursing school, my brother overdosed. On heroin. For the third time.
An unknown “friend” (read: dealer) had been kind enough to leave Jake on a curb and call 911, which’d brought him here. By the time I got to the emergency department they were on his second dose of Narcan. They’d put an IV line into his neck because he had too many tracks on his arms to find a vein. Only some cruel miracle had stopped him from getting infected this far. If he kept it up, I knew his luck wouldn’t hold.
I wanted to touch him and I didn’t want to touch him, because it didn’t take being a nurse to know all the diseases he might have. And so, as I was finding some gloves to wear to hold his fucking dumbass junkie hand, a man came by and said, “Wouldn’t you like to see your brother clean?”
I thought he was going to tell me about Jesus, and I was getting ready to tell him where to shove himself, when he offered me a job.
CHAPTER TWO
Before, when I’d worked in a nice private hospital, if someone had done something particularly boneheaded, or exhibited poor nursing judgment, they’d have been asked, “Hey, where do you think you work at, County Hospital?” or, “Looks like you did a County job to me. ”
But what if no one called 911 the next time around? Or Jake ignored a septic sore? Working at County seemed preferable to watching him die, knowing I could have done something to prevent it. I didn’t understand what I was signing away exactly, only that they promised to keep him straight—and unlike all the rehab programs my mom had scrounged to send him to, it’d worked.
So now I really was at County. Only worse. Floor Y4 was for the daytime servants of vampires, sanctioned donors, werewolves, zombies, you name it—and purgatory for us, their staff. We were in the bowels of County, off the records and off the charts. I signed forty things in triplicate, got special badge access to the special elevator, and when I took the special ride down, I found myself in an ominous hallway where my badge opened just two doors. One led to our locker rooms and bathroom. The second went here to Y4, an eight-bed intensive care ward with an institutionalized appearance: exposed ducts, dim lights, and where everything could use a fresh coat of a lighter shade of paint.
Peeking over my flowsheet and into the room, I saw Mr. November at it again, this time kicking himself off the bottom bedrail. “Be still!” I scolded. Reminded anew, he relaxed. That’s the hassle with Versed. It’s an amnesiac. On the plus side, it helps patients forget the horror of having an ET tube sit in their lungs and a ventilator helping them breathe. On the downside, it means that every time you warn them they have Tubes in That They Should Not Pull On, that warning has a half-life of about thirty seconds before they forget and try pulling again.
“Meaty, any word?” I asked, as Mr. November switched gears and tried to reach his ET tube, one millimeter at a time.
Meaty gave a negating grunt. While Meaty was likely not Meaty’s actual name, he or she was Y4’s charge nurse, which meant they were the resident expert on all nursing-related chores, the general patient coordinator, and our physician liaison. With an androgynous face and an abdominal drape that almost reached the floor, Meaty brought scrubs from home to accommodate his or herself, the bathroom in the locker room wasn’t sexed, and I hadn’t had the balls yet, metaphorically, to ask.
Frustrating as it was, it wasn’t Meaty’s fault the doctor hadn’t called back. They probably wouldn’t ever call back, and Mr. November would be squirrelly all night.
“Damn. ” I flipped through the nursing chart to write another note on the restraint form, choosing “restless” and “continually pulling” for Mr. November’s past hour of activities. Too bad there wasn’t a form for my opinion on the state of things—I would have written “bleak” and “undersupported by other hospital staff. ” I hoped the call had woken the doctor up.
Even though he’d been here for a few days, Mr. November’s chart was mostly empty, except for his tox screen. The emergency department here surreptitiously checks people for various conditions—such as “porphyric hemophilia” (likely vampire-exposed), “leprosy” (likely zombies), “rabies” (likely were), and “sisters of junkies who were suckers” (me). Everything else, all of our plans, treatments, and patient response, was unofficial. But surely some actual records were kept somewhere, if only for accounting’s sake. The drugs we used alone must cost a fortune. And even if my fellow nurses were getting paid just as poorly as I was, someone was footing our bill. The only thing in other charts that gave me any clues was t
he patient information page saying patients belonged to a health insurance group I’d never heard of before, the Consortium.
But not Mr. November—we didn’t even have his real name. Hence being named for the month. He’d been found outside, dehydrated, with a kicking case of pneumonia, too run-down to move. He looked eighty. Thin white skin hung in empty folds around his sharp features, like ice melt off a glacier, so thin that lifting tape wrong would tear it. During my assessment I could smell the bad breath of a body going metabolically awry. He had a central line going into the femoral vein on his thigh, channeling in medications and, of course, blood.
Not because he’d bled out—but because technically he’s almost a vampire. Not a full one, but a “vampire-exposed human,” some real vampire’s daytimer.
Despite all the legends about instantaneous infection, it usually takes repeated exposure to vampire blood for it to change you—assuming you weren’t allergic and didn’t just die instantly from anaphylactic shock.
Mr. November had been exposed to a lot of vampire blood at some time. His fanglike canine teeth, which I could see now as he tried to work his ET tube out with his tongue, meant he had to have come close to changing. I wondered why nobody had ever finished the job and wished they had; it would have saved me this night of work. Because now, even though he was probably three hundred and twelve, vampire blood having life-extending properties, he could still die on my watch. People who’ve been exposed live long, but they aren’t full vampires, and they don’t get to live forever. As if fighting this fact, Mr. November started leaning forward in bed again.
I went back in the chart to see what medications I could give him. He was maxed for now, but come four A. M. if Dr. Turnas hadn’t called back, I planned to reintroduce him to my friends lorazepam and oxycodone in a big, big way.
Charles walked over from his side of the ward. His patients were asleep or quietly watching TV. “Need any help, new kid?”
I was fairly sure Charles knew my name by now, and just as sure that it wasn’t worth letting it get to me. “Not unless you’re hiding an extra bag of fentanyl,” I said. He laughed. Charles was my height and older, with brown hair turning gray. I’d noticed that no matter how hectic the night felt to me, Charles never let it show. I was jealous of his ability to keep his act together, but I’d like him more if he didn’t pretend I was twelve.
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