Lethal Practice

by Peter Clement

  * * * *

  The call came minutes after I’d entered my office. “Dr. Garnet, you’re wanted two-three in the morgue.” I needed a second to get it. “This is a joke, right?” “No, sir. Call came a few seconds ago. Said you were in your office and wanted you called, to come down two-three.”

  “Who?”

  “They didn’t say.”

  “Why?”

  “Just said it was urgent.”

  A 2-3 call would get me running, normally, no questions asked. But this was weird. A macabre joke in hospitals is about mistakenly sending a live one to the morgue. Had one of Watts’s tenants suddenly sat up?

  “Sir, are you going?”

  “Yes, operator, but have security meet me there right away.”

  I grabbed my stethoscope and was out the door and halfway through emergency before I saw a nurse.

  “Sandy, grab the resus cart and meet me in the morgue!”

  She was taken aback. Obviously she also presumed this was a bad joke.

  “I mean it!” I snapped, and headed for the door. I grabbed a ventilator mask and intubation gear hanging there for resuscitations off the premises.

  The stairwell was empty for my run to the basement. The echoes of my own steps followed me down. I had a bad feeling about this. The only way someone could have known I was in my office at that minute on a Sunday afternoon was by watching.

  The thin line of overhead bulbs led off into the distance toward Watts’s lab. No one else should be here on a weekend, but I listened and peered down that string of light pools inviting me farther in. I had thoughts of a spider and a fly. I took a breath, remembered with relief that a security guard and a nurse were on their way, and picked up my pace.

  The anteroom was just a pocket off the hallway right in front of the lab doors. Two stretchers were parked on either side of the narrow passage. There were no bulbs suspended above this area, but there was enough light from the hallway behind to show me that one of the stretchers was occupied. To me, the shrouded figure was more suggestive of death than an uncovered corpse would have been. Obviously Watts planned a weekend dissection. I edged my way around the body and approached the lab entrance. To my right was the heavy wooden door of the walk-in freezer, where bodies waiting to be picked up are kept. It was ajar. Instinctively, I clicked it shut. My mother had always taught me to close the refrigerator. Ahead were the double swinging doors to the dissection room. Light seeped under the sill. I knocked, feeling foolish, especially for still keeping an eye on the sheeted figure behind me.

  “Hello? Anyone there? Robert?”

  There was no reply, but coming from inside the lab I could hear a fast, steady beeping that was familiar, yet out of place.

  I opened the door and stepped into the bright interior.

  Watts was spread-eagled on his own autopsy table, naked from the waist up, white, not breathing, and wired to a portable monitor. He had a large bruise on the side of his head, but it was his sightless stare, the wet mark at his crotch, and the stench of fresh excrement that told me he was clinically dead. The jagged run of ragged peaks across the monitor screen meant ventricular fibrillation. I could still bring him back.

  At the far end of the counter that surrounded the room a tap was open full, and water was sloshing over the edge of the sink, spilling onto the floor. Damn, but the place would be flooded soon. What the hell was going on? I didn’t have time for that question—or anything else, if I was going to save Robert.

  Quickly, but still moving carefully so as not to slip on the wet floor, I stepped to the monitor and grabbed the paddles. They were already greased, and the machine was charged to 360 joules, ready to fire. None of this made sense. But my training took over. Though hardly necessary, I checked his neck pulse and verified its absence. I placed the paddles at the appropriate landmarks on the chest and got ready to attempt to recapture a normal heart rhythm with a jolt of direct current. These moves in preparation for discharge were automatic. I leaned over Watts to assure a good electrical contact, but inside I was recoiling. What monster had set this up, made Watts a specimen, like a drill dummy, and then readied everything to lead me through his resuscitation like a training exercise?

  Positioned, not even having to think about it, I moved my thumbs over the red discharge buttons. Even though I was alone, I automatically glanced around the table. We give our residents holy hell if they miss taking a look around and calling “stand back” to prevent a member of the team who may still be touching the patient from getting shocked. This omission can result in having two cardiac arrests to deal with. In spite of myself, to no one I muttered, “Stand back.” The harsh dissecting light glinted off the steel surface of the autopsy table and the wet floor as I completed my look around. Maybe that glint was what broke my unthinking rush through the steps.

  “Shit!” I shouted, slapping the paddles back in their holders as if they were snakes.

  I had to insulate him—and myself—from the water and steel. An uninsulated shock would hit me and stop my own heart.

  Far off down the hall I heard the distinctive crashing noise our elevator makes to announce its arrival. Then came the excited chatter of the security guard and Sandy running down the long tunnel pushing a squeaky resuscitation cart.

  To buy time, I positioned Watts’s head, sealed his lips with my own, and gave him two quick breaths. Then I moved my hands to his midchest and gave fifteen brisk compressions. At one moment I felt the dry snap of his ribs, but if he lived, I knew he’d forgive me. It took three cycles of this before Sandy and a puffing, fat security guard pulled the cart inside the room.

  “Sandy, call a ninety-nine. You, sir, we’ve got to insulate him, and us.” I was speaking between puffs. Watts’s chest rose each time I blew into his lungs. “Grab that backboard!”

  The guard moved to the cart. On it was a folded six-foot board for lifting people with back injuries. Sandy made the call, then came to Watts’s side. She started pumping his chest. That left me free to assemble the bag and mask, slip in a curved airway to keep his tongue from blocking his throat, and start ventilating him. The guard wrestled the board to the table. Sandy pumped. I bagged. The rigors of giving compressions loosened a few buttons on Sandy’s blouse. She wasn’t wearing a brassiere. The guard slipped on the floor trying for a better angle.

  “Okay, here’s what we’ll do.” I got his attention away from Sandy. “On three, we’ll stop, roll him toward us, and you’ll slip the board under him.”

  We got the count right, but rolling Watts on the narrow table nearly dropped him over the edge. The guard dinged the overhead light and then nearly hit me trying to get the board into position while watching the developments of Sandy’s blouse. With our feet sliding in the water and all three of us pushing Watts onto the board, we landed on his stomach, but at least the board was between Watts and the metal table.

  “Right, Sandy, keep pumping.” I kept bagging. The guard kept ogling.

  “You!” I snapped. “Quit that crap.” He went red. Sandy rolled a stare of contempt his way but kept quiet and continued pumping.

  “We have to insulate our feet!” I ordered. “We’re still too wet to shock him. Turn off the water, then go out to the hallway and grab a mattress from a stretcher. Hurry!”

  I was watching the monitor. The ragged activity persisted, but it was weaker. We were running out of time.

  The guard went without protest. He didn’t seem to mind that he’d be alone with a corpse out there.

  Sandy was getting flushed and breathing hard.

  “You want to switch?” I asked her.

  “No! Just keep that bozo away from me.”

  “You’re just too sexy when you save a life.”

  “Creep. Watch it or I’ll tell Janet.”

  The banter. Whistling past the reaper.

  While pumping, she took a look around the room. “What’s the story here?”

  I kept bagging. “I don’t know. I found him like this.”

&nbs
p; “Like this!” The surprise interrupted her rhythm.

  The guard stumbled in the door with the mattress and plopped it at our feet.

  We stepped up on it. I took a final glance at the monitor; the tracing was a mere flicker. I reached for the paddles, placed them, and glanced around. “All clear!” Sandy stopped pumping and stood back, still on the mattress. I pressed the red buttons.

  The charge arched Watts’s back. He smacked back down on the board like a slab of sirloin hitting a butcher block. But I was watching the monitor. The zigzags flattened into a wandering straight line, nothing else. “Come on, Watts, come on!” Still a flat line. The steady whine of the machine mocked our effort.

  “Shit! Keep pumping.”

  Sandy resumed chest compressions.

  “Grab that high stool over there,” I told the guard.

  He dragged it over. “Up you go. Sandy. You’ll have more downward force on your push.”

  I squeezed four full puffs of air into Watts, then dropped the bag and foraged in the cart for an ET tube and a working laryngoscope. I found the size I wanted, flicked the blade of the scope open to activate the light, and stepped to Watts’s head.

  “Hold it, please!” I ordered.

  Sandy stopped pressing down on his chest. The guard held his breath. I scissored Watts’s mouth open with the fingers of my right hand, inserted the blade with my left, and slid it back to the base of his tongue. There were the cords, clear, no vomit. I threaded them with the tube. The monitor was barely quivering now, almost flat. “Okay, pump.”

  Sandy moved to compress, and I’d just hooked up the bag to give more air, when we heard the first beep, and a healthy complex leaped to the screen. “Hold on,” I said quietly. This would be it. A few salvos and then death was sometimes all we got. Another beep, another complex, then more line, then another beep. “Any pulse with that?”

  Sandy touched his neck. A beep came and went; she shook her head and started pumping again.

  “He needs help.” I grabbed three ampules of Adrenalin, drew them into a syringe, and emptied it down the ET tube. Then I bagged that little cocktail home. There was another beep, then a line again. I heard loud clanking at the door. Our 99 summons was beginning to produce help. The respiratory technician struggled in with oxygen tanks, saw Watts, and silently hooked up his cylinders. In seconds he took over the ventilation, bagging pure oxygen into the lungs instead of air. “What happened?”

  “I don’t know.”

  Beep, then another, then a few staggered beats, then, like a car in winter, they started and kept coming in a steady, regular stream.

  “Yes!”

  “A pulse.”

  “Great.”

  “We got him!”

  Sandy dived into the cart to start an IV. “Put some Xylo through that, will you, Sandy? Seventy bolus and two a minute drip?”

  A resident touched my arm. “Did you inflate the cuff?”

  I hadn’t. “Sorry, is it leaking?”

  He answered by injecting a syringe full of air through a catheter running down the outside of the tube in Watts’s trachea. This would inflate a small balloon around the tube and block any oxygen from escaping instead of going on down to the lungs.

  Two more residents charged in.

  “Pull some bloods and a gas, you two,” I said.

  I moved to take Watts’s pressure. Not bad. Hundred over sixty, and getting stronger.

  Ever-increasing numbers of residents, nurses, and students swarmed over the now-alive Watts, securing lines, slipping in catheters, hooking up monitors, and cleaning up spilled blood and other bodily fluids. He even began to look a little pink, but he needed a respirator. Whether or not he still had a brain was the real question.

  Stewart Deloram from the ICU arrived. I gave him the story of the resuscitation, added I’d just found him, and left out the peculiar details. He slipped the strap of the portable defibrillator over his shoulder, and I stood back as the whole chattering, caring collection clanked and bumped their way out the door. I followed them into the hallway and watched the stretcher shrouded in a web of IVs and winking monitors recede through the dark like a departing train. They reached the end of the corridor and turned into the elevator.

  Alone, I stood in the antechamber. Dripping noises were coming from the dissecting room behind me. I felt a coolness at my side and turned to find the freezer door open again, this time wide enough that I could see the interior. All the racks were empty. I was about to close it when I noticed a bunch of half-melted boot prints outlined in the frost on the floor just inside. I leaned against one of the stretchers. It held a stained, rumpled sheet It took a few seconds before I remembered that twenty minutes earlier, on my way into the morgue, the stretcher had held a corpse.

  * * * *

  A quick call to the nursing supervisor, Mrs. Quint, confirmed my growing fear. No one had died in the last twenty-four hours. No autopsies were scheduled for the weekend.

  “So far,” she added, probably thinking of Watts. “By the way, good work.” She paused, then asked, “Is it true what Sandy told me, about you finding him, hooked up and all?”

  I didn’t know what to say. Tales of missing corpses and hidden killers were not going to assuage Hurst’s attempts to keep me categorized as the resident nut.

  I minimalized. “I don’t know who called me, but whoever found him and hooked him up probably was goofing off and shouldn’t have been down there. Maybe a smoker.” I waited to read the silence on how this was going over. It was a pretty skeptical silence. I tried putting her on the defensive. “Maybe a nurse,” I added softly.

  I heard her breath hiss in. “Now, really. Dr. Garnet, you’ve no call to implicate my girls and boys.” Some of her “girls” were forty-eight-year-old women, her “boys” about the same age, and too many of them still snuck off to smoke since cigarettes had been totally banned. At least we were arguing about who was goofing off and I wasn’t having to explain killers and corpses.

  I let her run on, then picked my spot and made my pitch. “Look, relax. What I’m saying is, it was probably one of your ‘girls’ who saved Dr. Watts’s life, and she can’t come forward about it.”

  The silence returned. It held a “maybe.”

  I pushed. “Whatever she or he was doing down here, that person’s a hero.”

  More silence. She knew I’d just inferred her “girls” and “boys” sometimes did other secret deeds in hidden places besides illicit smoking. Sometimes the cigarette was included, after. Long ago, as a resident, I’d had my own induction to these liaisons, and, a half century ago, so probably had Mrs. Quint.

  “Amazing” was her only comment, and then she hung up.

  I’d made the call from the wall phone in Watts’s lab. As I replaced the receiver, it dawned on me I might have smudged fingerprints left on it by the person who had called locating. But now I wanted out. With the dark corridor outside the door, the weight of the hospital over my head, and my second near-miss, I began to get the creeps.

  An unknown killer was still hunting me, already setting up the next attack. Was it Hurst? But what did he care about ER stats? Had it been Kradic? He’d know how to set up Watts, but he had no connection with Kingsly. Yet he would have a connection with the ER data. For that matter, could it be someone else in the ER? I began to wonder if maybe, just maybe, Kingsly’s death and the ER stats were completely unrelated. I had to get away— had to run. My breathing was openmouthed, and I kept trying to find some saliva for my dry tongue, but fear wouldn’t have it. We learned as students in physiology how the adrenaline response mustered a fight-or-flight syndrome. I was all flight.

  But I made myself do one last thing: I went to the edge of the locker and kneeled to see the boot marks better. At first they seemed indistinct and blurred together, but the warmer air through the open door increased the icy condensation over the prints and made them clearer. I could see two definite sizes.

  Then I started out. The nearer I got to the stairw
ell leading up to light and air, the faster I moved. I heard nothing in the dark behind me, but I straight-armed the door leading to the steps and went up three at a time.

  Adrenaline, we were also told, gives us a sense of impending doom. I was getting a good dose. That, and a full-blown panic attack.

  I blew out of the stairs and halfway across the hospital front lobby before I pulled up to a trot. The same lone man, tethered to his IV, and the gift shop lady, equally elderly, gawked together at my noisy entrance. I could see her thinking “escaped psych patient,” but before she could reach for a phone, I waved my stethoscope at her. “It’s okay, I’m a doctor,” I said, and made for the ER. “Emergency,” I called after me, and felt like an idiot.

  I managed to reach my office without the nurses getting a good look at what must have been a white and sweaty face. Had they, I would have found myself tied to a monitor and en route to the CMU. Instead, I pulled an old paper bag out of our recycling box and started breathing into it. I don’t know how long it had been there, but it still held a faint odor of onions and something fishy. Nevertheless, rebreathing my own carbon dioxide began to slow my heartbeat and alleviate the numb tingling in my fingers. I’ve treated hundreds of patients with panic attacks, but now I know why they all think they’re going to die.

  My own chest finally lightened up by thirty pounds, and my breathing slowed. Okay, I thought, I’m okay. Then the fish smell and my own stress got me, and I barfed into the bag.

  * * * *

  “The horny-nurse story will make more sense to Bufort than a killer still running around.” It was Riley over the phone. After cleaning up my mess, I had decided, for the record, to report what happened. In case I could ever prove any of this, I wouldn’t be nailed for withholding evidence.

  I’d figured the shrouded body back at the morgue was alive and well as I slipped by it heading in to find Watts. The open freezer might have held a couple more buddies, all ready to finish me off if I didn’t zap myself first. I’d inadvertently shut them in on my way past. They were wearing boots, probably rubber, to protect themselves from the water if they had to “help me” fibrillate myself. Their shrouded buddy was likely letting them out to come in after me when the noisy elevator door announced Sandy’s arrival and scared them off.