Urgent Care

by C. J. Lyons

  She returned to the nurses’ station to check the patient board and was surprised to see Tank sitting there, talking with Jason, the ward clerk. “What are you doing here?”

  “Hoping to find you.” He stood, clutching a backpack, obviously nervous. He wore jeans—too expensive and pressed with a sharp crease—and a lightweight polo shirt under a heavy wool overcoat. He looked like a foreign kid dressing up as an American teen for Halloween and failing miserably. As if without his school uniform he had no idea how to fit in.

  Gina could give him some pointers on that—she’d mastered the art of disguise. But apparently Tank wasn’t here for fashion tips. “My grandfather was going to throw out the medicine you gave us, but I kept it, used it just like the directions said. So I’m not contagious now, right? I can go see Narolie and not hurt her, can’t I?”

  “Does your mother know you’re here?” He was silent, looking down at the floor. Guess that answered her question. “How’d you get here, Tank?”

  He brightened at that. “Took a bus. Well, a couple, actually. Consuela, our maid, lives near here and she told me how.” He was beaming, standing up proudly as if he’d just successfully navigated the Kalahari single-handedly. “I stayed up all last night, researching Somalia. Do you have any idea what’s happening there? Especially to the Bantu, like Narolie’s family? What they do to women, to girls? Even little babies?” His voice rose to the soprano range and cracked. “They cut them up, rape them, kill them—for no good reason. Just because they’re girls. They can’t send her back to that, Gina. We have to stop them!”

  Gina couldn’t help but smile at his passion. “You want to see her?”

  “Yes. Please.”

  “You know she’s in a coma, and she can’t talk, probably won’t hear you?”

  “That’s okay. Look”—he dug through his bag and pulled out a wad of paper—“I downloaded a Kiswahili dictionary. Even printed it out because I knew you wouldn’t let me use my laptop or iPhone in the ICU. I translated some stuff.” Now he was blushing. “Stuff I want to say to her, even if she can’t hear.”

  “Okay. Let’s get you a visitor’s pass, make you legit.” The smile he gave her made it all the way to his eyes, giving her a glimpse of the man he might become. Someone strong and brave and ready to fight for what he believed in.

  Gina turned away and began walking toward the elevators, hoping he didn’t see the single tear that escaped before she could blink it away.

  Had she ever been like that?

  AS NORA AND LYDIA LEFT DIGGERS AND WALKED the short distance to Angels, Nora was surprised that drivers didn’t honk at her or swerve their cars to hit her. She felt like every eye was on her, condemning her.

  Foolish thought. No one on the street would know who she was or her role in Karen’s death. But once she entered the hospital . . . everyone would know.

  They reached the ER entrance and she couldn’t help herself. She hesitated.

  “You have to face them sooner or later,” Lydia said in a low voice. The voice of experience, Nora knew.

  “You’re right.” Nora sucked in her breath, the frigid air burning against her dry throat. Together they strode inside.

  “I’m going to go check on Narolie,” Lydia said. “You’ll be all right.”

  She left without waiting for Nora’s answer, and Nora realized it hadn’t been a question. She wished she were as certain.

  “Nora, what are you doing here?” Glen Bakker greeted her when she walked into the nurses’ station.

  “I’m scheduled to work; where else would I be?”

  “Thank God,” Jason put in. His smile buoyed Nora. Either he hadn’t heard the news or he didn’t believe it.

  But Jason’s faith in her obviously hadn’t spread to the other staff—several nurses stopped what they were doing to glare at her.

  “Yesterday Tillman sent Carlene down, and she spent more time interrogating us than she did taking care of things,” Jason continued. Carlene was the head of nursing, and although she’d been a tough-as-nails scrub nurse once upon a time, she’d been behind a desk long enough to be more comfortable with a spreadsheet than a stethoscope. “Oh damn, she’s back again.”

  “Good morning, Nora,” Carlene said with false cheer, her heels clicking on the linoleum. She was taller than Nora, with hair dyed so often its real color was a long-forgotten mystery. Today it appeared honey-brown. “I’m surprised to see you here. My impression was that you were taking more time off. After your ordeal and all. Not to mention the unfortunate press we received this morning.”

  Glen stepped beside Nora. It was nice to have his bulk shielding her from the stares of her co-workers. “That wasn’t Nora’s fault. That reporter had no right—”

  “Nevertheless, it’s our problem now. We can’t have patients worried that their nurse is putting a personal vendetta above their needs. Or worse, that she’s so incompetent that she can’t keep track of vital evidence.” Carlene glared at Nora, baring her lips in an illusion of a smile. “Not saying either is true, of course.”

  “Of course.” Nora forced a smile to match Carlene’s. “But you wouldn’t want to validate a false story by preventing me from working, would you?”

  “She has a point, Carlene,” Glen said.

  Carlene raked Nora with her gaze, seeking out her vulnerable spots. “All right. But I want Tommy Z to do a complete evaluation of her response to the recent stress.”

  “I’d prefer her working someplace where we can protect her,” Glen said. “My men are stretched thin.”

  “Stop talking about me like I’m a child. I’m fine,” Nora protested. She was beginning to hate those two words.

  Carlene ignored her. “If there are any problems, Tommy will report directly to me. And Mr. Tillman, of course. He won’t be happy to hear you’re back at work so soon.”

  “Tillman has a problem, he can take it up with the union. I’m scheduled, so I’m working. You can’t force me to go home.”

  “If that’s the way you want to handle it, fine. Work. We’ll see what happens.” Carlene’s arch smile made it clear that she expected Nora to break down into a bundle of nerves before the morning was out. “After the news this morning, we’ll need to keep your exposure to the public to a minimum. You can work utilization review; I’ll take your shift in the ER.”

  “UR? That’s your job.” Utilization review was the worst—relegated to reviewing charts of ICU and long-term patients to make sure they were still sick enough to qualify for the services they were receiving. It was a way to anticipate denials by insurance companies with a preemptive strike.

  “Today it’s yours.” Carlene’s smile was so forced that Nora was surprised she didn’t start cackling like the Wicked Witch of the West. “You can start with the Somali girl in the PICU. Mr. Tillman wants her case expedited. I’ll call and tell him you’re on your way up for the file.”

  Great. Thanks to Pete Sandusky, not only did everyone in the hospital now hate her guts, but she might be the one who had to sign the order to send Narolie back to Somalia.

  AFTER ROUNDS, AMANDA ESCAPED TO THE MEDICAL library. She was starting to remember more of her dream from last night—and the real case that had inspired it. When she’d been on her OB-GYN rotation, she’d done an ER consult on a college student with abdominal pain and a calcified mass on ultrasound. Dr. Koenig had grilled her mercilessly about the differential diagnosis, which was vast, and had taunted her when she included ovarian teratoma as a possibility.

  “And what is a teratoma?” he’d asked.

  Amanda had been surprised by the lowball, basic question. “A benign tumor composed of several tissue types, rising from the ovary.”

  “Benign?”

  “Ninety-eight percent of the time. Rarely, like any tissue in the body, they can develop malignancies.”

  “But if there’s no cancer, there’s no reason to worry?”

  She’d stalled for time, looking to her resident to jump in, but the resident looked a
s mystified as Amanda. Dr. Koenig had sighed and dismissed them with instructions to catch up on their reading before they saw him in the morning, when he wanted to know all the complications a “benign” teratoma could cause.

  That night Amanda had scoured the OB-GYN journals. She’d found lots of information on teratomas, including a single case report from a Scandinavian journal about a woman who had an acute episode of coma that resolved after removal of a benign teratoma.

  She’d made notes and shared them with her resident, prepared for the next day’s pimping, but Dr. Koenig had forgotten all about his assignment and had instead interrogated them about the enervation of the bladder wall.

  Could a single case from halfway around the world hold the key to Narolie’s illness? Amanda hoped so.

  She was surprised to see Emma Grey, the patient librarian, working in the small cubicle she and the medical librarian shared. “Emma, it’s a Saturday morning, what are you doing here?”

  The white-haired librarian looked up with a smile. “Good morning, Amanda. Saturday’s my busiest day—families visiting, looking for answers.”

  Emma had transformed the patient library from a mere lending library into a valuable resource for families. The medical staff would alert her to a family’s questions about their loved one’s care or diagnosis, and Emma would find easy-to-understand information for them to provide. It saved the staff time and effort, and in only a few months Emma had become an essential part of the medical team at Angels.

  “Where’s Deon?” Amanda asked.

  “In his favorite comfy chair by the radiator, reading.” Emma beamed at her great-grandson, a certified genius according to Emma—and the school. “Deon, say hello to Dr. Amanda.”

  Deon glanced up from his thick book—the last Harry Potter, Amanda saw—to wave at Amanda. She smiled back, envying him the time to read for pleasure.

  “Can I help you find something, dear?” Emma asked.

  “Yes, I’d love some help if you’ve the time. I’m looking for a case report of a teratoma causing coma or maybe encephalitis. It was a Scandinavian journal, but I can’t remember which one. Only the abstract was translated—I’m hoping to find a translation of the full text.”

  Emma nodded, already typing search terms into her computer. “Here’s one from six years ago. Acta Obstetricia et Gynecologica Scandinavica.”

  “Yes. That’s it! Can you find me a translation?”

  “Hang on a second. French, Italian—here we go, the full text in English. I’ll print it out for you.”

  While the paper was printing, Amanda skimmed the essence of the case. She had remembered correctly. The woman’s teratoma had been found years before during an ultrasound while she was pregnant. Because it was a benign tumor and she was asymptomatic, it was never removed. Decades later, she began experiencing strange, psychotic behavior and motor tics thought to be seizures. Her EEG and CT scans were normal, but she deteriorated and fell into a coma.

  No medications worked, and nothing revived her. She lay comatose for weeks until a feeding tube perforated her small intestine and required surgery to repair. The surgeon found the teratoma and removed it as well. The next day, to everyone’s surprise, the woman woke up and was mentally back to normal.

  “Thanks, Emma. This is wonderful,” Amanda said as she reached the end of the report. “Now all I have to do is prove that Narolie’s calcification is a teratoma and find a surgeon willing to remove it.” She rushed toward the door, that Eureka! feeling filling her once more, buoying her steps.

  NORA LEFT THE ER, TRYING TO IGNORE THE SENSATION that everyone was staring at her. Tillman’s offices were on the top of the research tower, giving him an eagle-eye view of the entire medical center. She walked past the cafeteria, intending to cut past the auditorium and cross the enclosed atrium to the tower entrance.

  No such luck. She’d forgotten about the gala preparations. The auxiliary had large privacy screens set up, blocking the corridor past the cafeteria doors, with a sign that read PRIVATE FUNCTION. Past the screens she could hear the chatter of volunteers draping the walls, hanging decorations, and converting the doctors’ dining room, auditorium, and atrium into a venue for tonight’s black-tie affair.

  No way in hell was she going to be able to attend the gala after everything that had happened. And what kind of respect did that show Karen, still having it as scheduled? No doubt Tillman would turn it into a media circus, a public memorial for Karen—raising even more money while trading on the dead nurse’s memory.

  As she turned around and headed toward the stairs to take the tunnel over to the tower, Nora chuckled at her Scrooge-like thoughts—great way to get into the holiday spirit! Despite everything that had happened, she found herself actually looking forward to Christmas. Even New Year’s.

  Taking her life back had a lot to do with that. So did Seth.

  She wasn’t foolish enough to think that figuring out the sexual part of their relationship meant the rest would magically fall into place, but learning that he hadn’t lied to her—that was a huge step forward.

  Her good mood continued as she remembered the things Seth had told her last night. She didn’t want to dive right into the same mistakes—and there was the little fact of a killer who might or might not be obsessed with her—but she felt hopeful.

  Something she hadn’t felt in a long, long time.

  In addition to the executive administration offices, the research tower also held the clinics and research labs and so, except for the rare lab assistant, should be deserted on a weekend. She was surprised Tillman was in today. Damn, she was hoping that when Carlene sent her up here for Narolie’s UR chart, the place would be deserted.

  As she opened the door to his outer office, she realized it wasn’t only the CEO making an appearance on a Saturday. His receptionist was there, as was a secretary typing dictation. And through the window behind the receptionist desk she saw Tillman holding court with several hospital board members.

  None of whom appeared very happy. Pete Sandusky’s story probably had something to do with that. If Lydia was right, they had Jim Lazarov to thank. She still couldn’t believe the emergency medicine intern would stoop so low as to steal a rape kit and auction it off to the press.

  “I’m here to pick up Narolie Maxeke’s chart for utilization review,” Nora told the receptionist, avoiding giving her name. She still wore her street clothes, jeans, and a sweater, and her coat hid her hospital ID hanging from a belt loop.

  “Right. I have it here.” The phone rang and the receptionist grabbed it and began speaking even as she handed Nora Narolie’s UR paperwork. Nora was about to leave when the receptionist covered the phone with her hand and called out, “Mr. Tillman wants that done ASAP!”

  Nora merely nodded and left, feeling like a thief escaping into the night as the door shut behind her. Narolie’s information was spread throughout the hospital computer system, so it could be reproduced if need be, but usually the UR chart was the definitive collection of all the administrative information.

  As vital as the actual medical record, the chart she held now contained the insurance and legal paper trail Tillman would need to deport Narolie. Maybe she could help Narolie after all. At least buy her some time.

  Hugging the chart to her chest, she fled down the hall to the elevator bank. With practically no one in the building today, it arrived quickly. Getting to any patient care floor in the other tower meant crossing the eighth-floor skyway, going back down to the first floor, or using the tunnels again. Nora chose the aerial route and hit the button for the eighth floor.

  She took her time crossing the skyway. Usually she avoided the eighth floor, which held the rehab units: long-term patients in vegetative states, patients with spinal cord and traumatic brain injuries, stroke victims. The place where a lot of her patients from the ER ended up. The professionals there did great work, but it was no place for anyone used to the instant gratification of emergency medicine.

  The rehab floo
r kind of spooked her, in fact. Patients and medical staff working so hard to achieve so little. Depressing as hell.

  When she was a kid, they used to drag the school choir around to all the area nursing homes to sing Christmas carols. She’d always try to find a way out of it, but her folks made her go. All those blank faces, lined up to see the carol ers, some tied to their chairs . . .

  “Hey, bitch!” Halfway across the skyway, a man plowed into her from behind, sending Narolie’s file flying. Nora careened into the glass wall.

  Fear stampeded through her. She bounced off the glass and spun to face her attacker, her arms raised in a primitive protective reflex, eyes half closed, anticipating pain.

  “You think you can push me around and get away with it?” Jim Lazarov held her against the glass, his hands pushing against her shoulders. His face was an inch from hers, twisted with fury. “How do you like it, bitch?”

  TWENTY-NINE

  Saturday, 8:54 A.M.

  NORA’S FEAR MIXED WITH ANGER—AND THEN THE fear returned, multiplied, as she realized that Jim could be the killer. He’d gone to medical school here in Pittsburgh, would be familiar with hospitals. Jim seemed shorter than her attacker, but she’d been blinded, so she wasn’t certain. He definitely had the anger and strength the killer had.

  She forced herself to remain calm. That was what had saved her life last time.

  “Let me go,” she told Jim, using a voice of command. Her tone was a little shrill, so she hauled in another breath and tried again. “Now, Jim.”

  His chest heaved as he caught his breath—as if he were the one afraid for his life. More likely excited, she thought with disgust. But his expression cleared, and he released her. He didn’t move back, though, still blocking her.

  “I’m tired of taking your shit,” he said, his words accompanied by spittle that sprayed her face. “Humiliating me in front of an attending yesterday.”