Without Remorse (1993)

by Tom - Jack Ryan 08 Clancy

"Shit ... " the resident breathed.

  They wheeled him into the capacious emergency room, selecting a cubicle in the corner. The five men moved the victim from the gurney to a treatment table, and the medical team went to work. Another physician was standing by, along with a pair of nurses.

  The resident, Cliff Severn, reached around delicately to remove the cervical collar after making sure the head was secured by sandbags. It took only one look.

  "Possible spine," he announced at once. "But first we have to replace blood volume." He rattled off a series of orders. While the nurses got two more IVs started, Severn took the patient's shoes off and ran a sharp metal instrument across the sole of his left foot. The foot moved. Okay, there was no immediate nerve damage. Good news. A few more sticks on the legs also got reactions. Remarkable. While that was happening, a nurse took blood for the usual battery of tests. Severn scarcely had to look as his well-trained crew did their separate jobs. What appeared to be a flurry of activity was more like the movement of a football backfield, the end product of months of diligent practice.

  "Where the hell's neuro?" Severn asked the ceiling.

  "Right here!" a voice answered.

  Severn looked up. "Oh--Professor Rosen."

  The greeting stopped there. Sam Rosen was not in a good mood, as the resident saw at once. It had been a twenty-hour day for the professor already. What ought to have been a six-hour procedure had only begun a marathon effort to save the life of an elderly woman who'd fallen down a flight of stairs, an effort that had ended unsuccessfully less than an hour before. He ought to have saved her, Sam was telling himself, still not sure what had gone wrong. He was grateful rather than angry about this extension to a hellish day. Maybe he could win this one.

  "Tell me what we have," the professor ordered curtly.

  "Shotgun wound, several pellets very close to the cord, sir."

  "Okay." Rosen bent down, his hands behind his back. "What's with the glass?"

  "He was in a car," Eaton called from the other side of the cubicle.

  "We need to get rid of that, need to shave the head, too," Rosen said, surveying the damage. "What's his pressure?"

  "BP fifty over thirty," a nurse-practitioner reported. "Pulse is one-forty and thready."

  "We're going to be busy," Rosen observed. "This guy is very shocky. Hmm." He paused. "Overalt condition of the patient looks good, good muscle tone. Let's get that blood volume back up." Rosen saw two units being started even as he spoke. The ER nurses were especially good and he nodded approval at them.

  "How's your son doing, Margaret?" he asked the senior one.

  "Starting at Carnegie in September," she answered, adjusting the drip-rate on the blood bottle.

  "Let's get the neck cleaned off next, Margaret. I need to take a look."

  "Yes, doctor."

  The nurse selected a pair of forceps, grabbed a large cotton ball, which she dipped in distilled water, then wiped across the patient's neck with care, clearing away the blood and exposing the actual wounds. It looked worse than it might really be, she saw at once. While she swabbed the patient off, Rosen looked for and got sterile garb. By the time he got back to the bedside, Margaret Wilson had a sterile kit in place and uncovered. Eaton and Marconi stayed in the corner, watching it all.

  "Nice job, Margaret," Rosen said, putting his glasses on. "What's he going to major in?"

  "Engineering."

  "That's good." Rosen held his hand up. "Tweezers." Nurse Wilson set a pair in his hand. "Always room for a bright young engineer."

  Rosen picked a small, round hole on the patient's shoulder, well away from anything really vital. With a delicacy that his large hands made almost comical to watch, he probed for and retrieved a single lead ball which he held up to the light. "Number seven shot, I believe. Somebody mistook this guy for a pigeon. That's good news," he told the paramedics. Now that he knew the shot size and probable penetration, he bent down low over the neck. "Hmm . . . what's the BP now?"

  "Checking," another nurse said from the far side of the table. "Fifty-five over forty. Coming up."

  "Thank you," Rosen said, still bent over the patient. "Who started the first IV?"

  "I did," Eaton replied.

  "Good work, fireman." Rosen looked up and winked. "Sometimes 1 think you people save more lives than we do. You saved this one, that's for damned sure."

  "Thank you, doctor." Eaton didn't know Rosen well, but he made a note that the man's reputation was deserved. It wasn't every day that a fireman-paramedic got that sort of praise from a full professor. "How's he going to--I mean, the neck injury?"

  Rosen was down again, examining it. "Responses, doctor?" he asked the senior resident.

  "Positive. Good Babinski. No gross indications of peripheral impairment," Severn replied. This was like an exam, which always made the young resident nervous.

  "This may not be as bad as it looks, but we're going to have to clean it up in a hurry before these pellets migrate. Two hours?" he asked Severn. Rosen knew the ER resident was better on trauma than he was.

  "Maybe three."

  "I'll get a nap out of it anyway." Rosen checked his watch. "I'll take him at, oh, six."

  "You want to handle this one personally?"

  "Why not? I'm here. This one is straightforward, just takes a little touch." Rosen figured he was entitled to an easy case, maybe once a month. As a full professor, he drew a lot of the hard ones.

  "Fine with me, sir."

  "Do we have an ID on the patient?"

  "No, sir," Marconi replied. "The police ought to be here in a few."

  "Good." Rosen stood and stretched. "You know, Margaret, people like us shouldn't work these kind of hours."

  "I need the shift-differential," Nurse Wilson replied. Besides which, she was the nursing-team leader for this shift. "What's this, I wonder?" she said after a moment.

  "Hmph?" Rosen walked around to her side of the table while the rest of the team did its work.

  "A tattoo on his arm," she reported. Nurse Wilson was surprised by the reaction it drew from Professor Rosen.

  The transition from sleep to wakefulness was usually easy for Kelly, but not this time. His first coherent thought was to be surprised, but he didn't know why. Next came pain, but not so much pain as the distant warning that there would be pain, and lots of it. When he realized that he could open his eyes, he did, only to find himself staring at a gray linoleum floor. A few scattered drops of liquid reflected the bright overhead fluorescents. He felt needles in his eyes, and only then did he realize that the real stabs were in his arms.

  I'm alive.

  Why does that surprise me?

  He could hear the sound of people moving around, muted conversations, distant chimes. The sound of rushing air was explained by air-conditioning vents, one of which had to be nearby, since he could feel the moving chill on the skin of his back. Something told him that he ought to move, that being still made him vulnerable, but even after he managed a command to his limbs to do something, nothing happened. That's when the pain announced its presence. Like the ripple on a pond from the fall of an insect, it started somewhere on his shoulder and expanded. It took a moment to classify. The nearest approximation was a bad sunburn, because everything from the left side of his neck on down to his left elbow felt scorched. He knew he was forgetting something, probably something important.

  Where the fuck am I?

  Kelly thought he felt the distant vibration of--what? Ship's engines? No, that wasn't right somehow, and after a few more seconds he realized it was the faraway sound of a city bus pulling away from a stop. Not a ship. A city. Why am I in a city?

  A shadow crossed his face. He opened his eyes to see the bottom half of a figure dressed all over in light-green cotton. The hands held a clipboard of some sort. Kelly couldn't even focus his eyes well enough to tell if the figure was male or female before it went away, and it didn't occur to him to say anything before he drifted back to sleep.

  "The shoul
der wound was extensive but superficial," Rosen told the neurosurgical resident, thirty feet away.

  "Bloody enough. Four units," she noted.

  "Shotgun wounds are like that. There was only one real threat to the spine. Took me a little while to figure how to remove it without endangering anything."

  "Two hundred thirty-seven pellets, but"--she held the X ray up to the light--"looks like you got them all. This fellow just got a nice collection of freckles, though."

  "Took long enough," Sam said tiredly, knowing that he ought to have let someone else handle it, but he'd volunteered, after all.

  "You know this patient, don't you?" Sandy O'Toole said, arriving from the recovery room.

  "Yeah."

  "He's coming out. but it'll be a while." She handed over the chart which showed his current vitals. "Looking good, doctor."

  Professor Rosen nodded and explained further to the resident, "Great physical shape. The firemen did a nice job holding up his BP. He did almost bleed out, but the wounds looked worse than they really were. Sandy?"

  She turned back. "Yes, doctor?"

  "This one is a friend of mine. Would you mind terribly if I asked you to take--"

  "A special interest?"

  "You're our best, Sandy."

  "Anything I need to know?" she asked, appreciating the compliment.

  "He's a good man, Sandy." Sam said it in a way that carried real meaning. "Sarah likes him, too."

  "Then he must be all right." She headed back into recovery, wondering if the professor was playing match-maker again.

  "What do I tell the police?"

  "Four hours, minimum. I want to be there." Rosen looked over at the coffeepot and decided against it. Any more and his stomach might rupture from all the acid.

  "So who is he?"

  "I don't know all that much, but I ran into trouble on the Bay in my boat and he helped me out. We ended up staying at his place for the weekend." Sam didn't go any further. He didn't really know that much, but he had inferred a lot, and that scared him very much indeed. He'd done his part. While he hadn't saved Kelly's life--luck and the firemen had probably done that--he had performed an exceedingly skillful procedure, though he had also annoyed the resident, Dr. Ann Pretlow, by not allowing her to do much of anything except watch. "I need a little sleep. I don't have much scheduled for today. Can you do the follow-up on Mrs. Baker?"

  "Certainly."

  "Have someone wake me up in three hours," Rosen said on the way to his office, where a nice comfortable couch awaited.

  "Nice tan," Billy observed with a smirk. "I wonder where she got it." There was general amusement. "What do we do with her?"

  He thought about that. He'd just discovered a fine way to deal with bodies, much cleaner, in its way, and far safer than what they'd been doing. But it also involved a lengthy boat trip, and he just didn't have the time to be bothered. He also didn't want to have anyone else use that particular method. It was too good to share with anyone. He knew that one of them would talk. That was one of his problems.

  "Find a spot," he said after a moment's consideration. "If she's found, it doesn't matter much." Then he looked around the room, cataloging the expressions he saw. The lesson had been learned. Nobody else would try this again, not anytime soon. He didn't even have to say anything.

  "Tonight? Better at night."

  "That's fine. No hurry." Everyone else could learn even more from looking at her for the rest of the day, lying there in the middle of the floor. He took only a little pleasure from it, and people had to learn their lessons, and even when it was too late for one of them, others could learn from that one's mistakes. Especially when the lessons were clear and hard. Even the drugs wouldn't block this one out.

  "What about the guy?" he asked Billy.

  Billy smirked again. It was his favorite expression. "Blew him away. Both barrels, ten feet. We won't be seeing him no more."

  "Okay." He left. There was work to be done and money to collect. This little problem was behind him. It was a pity, he thought on the way to his car, that they couldn't all be solved this easily.

  The body remained in place. Doris and the others sat in the same room, unable to look away from what had once been a friend, learning their lesson as Henry wished.

  Kelly vaguely noted that he was being moved. The floor moved under him. He watched the lines between the floor tiles travel like movie credits until they backed him into another room, a small one. This time he tried to raise his head, and indeed it moved a few inches, enough to see the legs of a woman. The green surgical slacks ended above her ankles, and they were definitely a woman's. There was a whirring sound, and his horizon moved downwards. After a moment he realized that he was on a powered bed, hanging between two hoops of stainless steel. His body was attached to the bed somehow, and as the platform rotated he could feel the pressure of the restraints that held him in place, not uncomfortable, but there. Presently he saw a woman. His age, perhaps a year or two younger, with brown hair stuffed under a green cap and light eyes that sparkled in a friendly way.

  "Hello," she said from behind her mask. "I'm your nurse."

  "Where am I?" Kelly asked in a raspy voice.

  "Johns Hopkins Hospital."

  "What--"

  "Somebody shot you." She reached out to touch his hand.

  The softness of her hand ignited something in his drug-suppressed consciousness. For a minute or so, Kelly couldn't figure out what it was. Like a cloud of smoke, it shifted and revolved, forming a picture before his eyes. The missing pieces began to come together, and even though he understood it was horror that awaited him, his mind struggled to hurry them along. In the end it was the nurse who did it for him.

  Sandy O'Toole had left her mask on for a reason. An attractive woman, like many nurses she felt that male patients responded well to the idea of someone like her taking a personal interest in them. Now that Patient Kelly, John, was more or less alert, she reached up and untied the mask to give him her beaming feminine smile, the first good thing of the day for him. Men liked Sandra O'Toole, from her tall, athletic frame to the gap between her front teeth. She had no idea why they considered the gap sexy--food got caught there, after all--but as long as it worked, it was one more tool for her business of helping to make sick people well. And so she smiled at him, just for business. The result was like no other she had encountered.

  Her patient went ghostly pale, not the white of snow or fresh linen, but the mottled, sickly look and texture of Styrofoam. Her first thought was that something had gone gravely wrong, a massive internal bleed, perhaps, or even a clot-driven thrombosis. He might have screamed, but couldn't catch his breath, and his hands fell limp. His eyes never left her, and after a moment O'Toole realized that she had somehow caused whatever it was. O'Toole's first instinct was to take his hand and say that everything was all right, but she knew instantly that it wasn't true.

  "Oh, God ... oh, God ... Pam." The look on what ought to have been a ruggedly handsome face was one of black despair.

  "She was with me," Kelly told Rosen a few minutes later. "Do you know anything, doc?"

  "The police will be here in a few minutes, John, but, no, I don't know anything. Maybe they took her to another hospital." He tried to hope. But Sam knew that it was a lie, and he hated himself for lying. He made a show of taking Kelly's vital signs, something Sandy could have done just as well, before examining his patient's back. "You're going to be okay. How's the shoulder?"

  "Not real great, Sam," Kelly replied, still groggy. "How bad?"

  "Shotgun--you took quite a bit, but--was the window on the car rolled up?"

  "Yeah," Kelly said, remembering the rain.

  "That's one of the things that saved you. The shoulder muscles are pretty beaten up, and you damned near bled to death, but there won't be any permanent damage except for some scarring. I did the job myself."

  Kelly looked up. "Thanks, Sam. Pain isn't so bad . . . worse the last time I--"

  "Quie
t down, John," Rosen ordered gently, giving the neck a close look. He made a mental note to order a complete new set of X rays just to make sure there wasn't something he had missed, maybe close to the spine. "The pain medication will kick in pretty fast. Save the heroics. We don't award points for that here. 'Kay?"

  "Aye aye. Please--check the other hospitals for Pam, okay?" Kelly asked, hope yet in his voice though he knew better, too.

  Two uniformed officers had been waiting the whole time for Kelly to come out from under. Rosen brought in the older of the two a few minutes later. The questioning was brief, on doctor's orders. After confirming his identity, they asked about Pam; they already had a physical description from Rosen, but not a surname, which Kelly had to provide. The officers made note of his appointment with Lieutenant Allen and left after a few minutes as the victim started to fade out. The shock of the shooting and surgery, added to the pain medications, would diminish the value of what he said anyway, Rosen pointed out.

  "So who's the girl?" the senior officer asked.

  "1 didn't even know her last name until a couple minutes ago," Rosen said, seated in his office. He was dopey from lack of sleep, and his commentary suffered as well. "She was addicted to barbiturates when we met them--she and Kelly were living together, I suppose. We helped her clean up."

  "Who's 'we'?"

  "My wife, Sarah. She's a pharmacologist here. You can talk to her if you want."

  "We will," the officer assured him. "What about Mr. Kelly?"

  "Ex-Navy, Vietnam vet."

  "Do you have any reason to believe that he's a drug user, sir?"

  "Not a chance," Rosen answered, a slight edge on his voice. "His physical condition is too good for that, and I saw his reaction when we found out that Pam was using pills. I had to calm him down. Definitely not an addict. I'm a physician, I would have noticed."

  The policeman was not overly impressed, but accepted it at face value. The detectives would have a lot of fun with this one, he thought. What had appeared to be a simple robbery was now at least a kidnapping as well. Wonderful news. "So what was he doing in that part of town?"