Extreme Measures (1991)

by Michael Palmer

  Eric felt himself flush at the surgical chief's rebuke. To either side of him, Terri Dillard and Norma Cullinet were statues. He swallowed the urge to defend his actions and to point out how effective they had been. Teagarden knew as well as he did that he had given the patient good care.

  Then, without warning, the surgical chief reached out a fleshy finger and flicked the pin on Eric's lapel.

  "That's a most attractive pin, Dr. Najarian," she said. "The caduceus--symbol of everything that is noble about our profession. I would suggest that if you are going to continue wearing it, you commit yourself to conformity with the rules. Now, if you'd care to accompany me, we shall see what needs to be done for that patient of yours."

  Darden ... Silver ... Teagarden ... Seated alone in the residents' lounge, Eric doodled the three names over and over again on a blank patient-history form, circling each one. Then he crumpled the sheet up and angrily threw it into the wastebasket.

  It was nearing three in the afternoon. The E.R. was in a rare lull. Ordinarily he could take advantage of such a spell by stretching his legs out on a folding chair and napping. This day he couldn't come close. For years the hospital had been a constant refuge for him. For years, problems outside of work-money, family, women--were all but banished the moment he entered the place. But now, thoughts of Caduceus were making it hard to concentrate fully on anything else.

  After the confrontation with Sara Teagarden he had followed her into Room Four and had watched as she guided her surgical team through the evaluation and treatment of the GI bleeder. Eventually, as he knew she would, the surgical chief abandoned attempts at medical therapy and called the O.R. In just minutes an operating room had been readied.

  As the patient was being wheeled from the room Teagarden had turned and looked at him in a most peculiar way.

  "I know the choices we must make on this job aren't always easy, Eric," she said, with a mellowness in her voice that he had never heard before. Then, before he could respond, she turned quickly and left.

  "Thinking about that brunette?"

  Eric stopped rubbing at his eyes and looked up. Terri Dillard was standing in the doorway.

  "No. As a matter of fact I was wondering whom I might call to take out a contract on a certain gargantuan surgical chief."

  "You might have to wait in line.... I don't know why she needs to behave like that. There was no excuse for talking to you the way she did. None at all."

  Eric shrugged.

  "I've been able to brush it off by imagining how hard it must be for her to stand in front of a mirror after she showers," he said.

  "Ouch."

  "Hey, forget I said that. I long ago vowed that when it came to nasty remarks, a person's family of origin and body habitus were off limits."

  "Forgotten. Although I have to admit, the image is sort of ... amusing."

  "That's not exactly the word I would have picked."

  "Well, guess what. I've been looking at that poster, and I think I remember where I saw that woman's brother."

  Terri poured herself half a cup of coffee, sat down beside him, and smoothed the flier out on the table.

  Eric stared at the photo for a time, then shook his head.

  "Think back," she said. "Remember that day you and your friend used your laser?"

  "Sure."

  "Remember the Code Ninety-nine in the other room?"

  Eric's eyes narrowed. "This guy?"

  "Or a twin," Terri said.

  "I don't see it."

  "Of course you don't. You were only in there for a few minutes, and--don't take this wrong, now--you had other things on your mind."

  "Terri, that guy was beyond saving," he said, with more defensiveness in his voice than he had intended. "He was dead before he hit the door."

  "Hey, easy, Eric. You know that's not what I was saying."

  "Sorry. That scene with goddam Teagarden still has me on edge. Besides, the man in this photo is a computer troubleshooter. That guy was a drunk. He had a bottle of T-bird in his pocket."

  "I'm real good on faces," Terri Dillard said. She stood. "And I think that's the guy."

  "Maybe," Eric muttered. "Maybe so."

  Terri headed for the door.

  "Just in case," she said over her shoulder, "I sent for his chart. It should be up in a few minutes. For that woman's sake, I hope I'm wrong."

  Eric's mind's eye flashed on the scene by the derelict's bedside, and on the slow EKG complexes he had chosen to disregard.

  "I hope so too."

  "Carlisle Hotel."

  "I'd like to speak to Miss Laura Enders, please."

  "One moment."

  Eric cradled the phone against his ear and stared down at the notes he had made describing the unsuccessful resuscitation of a patient known to White Memorial only as John Doe. Despite Terri Dillard's confidence, he had been unable to match the face in the poster with the unshaven derelict he had briefly worked on that day. Even if it was the wrong man, he rationalized, he might be of some help to Laura Enders. Terri had, as usual, been right. He had noticed.

  "Hello?" She sounded a bit breathless.

  "Laura Enders?"

  "Yes."

  "It's Eric Najarian. We met earlier today at--"

  "White Memorial. I remember. How did your patient do?"

  "My patient? Oh, the GI bleeder. He's in the recovery room right now."

  "Do you always refer to your patients by their diagnoses?"

  Eric smiled at the woman's perceptiveness.

  "The leg in Seven, the stroke in Ten--I caution the medical students not to do it; then, when I'm not paying attention to what I'm saying, I do it too. Please don't hold it against me."

  "Don't worry. I watched you work, remember?"

  "Thank you."

  "Sorry if I sound out of breath. I just ran in to change before hitting the street for my evening rounds. Boston's only supposed to have half a million or so people, but right now it seems like ten times that. I guess I should be grateful Scott didn't disappear in New York."

  For a few moments there was silence. Eric was looking down at John Doe's hospital record, wondering if it would be cruel to hand the woman even an ort of information, given the doubts he had.

  "So," she said finally, "did someone at White Memorial recognize my brother's picture?"

  "I, um, no. Not that I know of."

  "Oh." There was disappointment in her voice.

  "But we put them up in the lounges."

  "That's great. Thank you."

  "I'll see to it that some copies get posted in other parts of the hospital as well."

  "That would be good of you."

  For a few interminable seconds there was only silence.

  "Laura," he said finally. "I ... I was wondering if you might be free for dinner."

  "Tonight?"

  "No, I'm working, and I don't ever know when I'm going to get out. How about tomorrow?"

  "Well ..." She drew the word out, as if trying to find the most tactful way to turn him down. "Well, sure," she said suddenly. "I'd like that very much. I could be ready by seven."

  "That's great. I'll pick you up at your hotel. Any special kind of food?"

  "My choice, huh. Okay, let's see ... Do you know of a good Armenian restaurant?"

  "Armenian?"

  "You are Armenian, yes?"

  "Yes, but--"

  "I grew up with a girl named Suzy Rupinian. One of my favorite things about having her for a friend was eating over at her house."

  "The woman wants Armenian, the woman gets Armenian," Eric said. "Tomorrow night, we eat at Pariegam. It's in the neighborhood where I grew up, so I'm not exactly invisible there. Can you handle that?"

  "Sounds perfect. Is it dress up?"

  "Dress down," Eric said. "The food at Pariegam is of the gods, but we're talking sawdust on the floor, not linen on the table."

  "I can do sawdust. Is Pariegam someone's name?"

  "No, it's the Armenian word for friendship."<
br />
  "Good start," Laura said.

  ... Initial assessment found patient with no pulse, respiration, or blood pressure. Pupils mid position and nonreactive. Standard CPR with endotracheal intubation begun at 10:17 A.M. by Dr. Gary Kaiser, later relieved by Dr. Eric Najarian. Treatment consisted of intravenous epinephrine, atropine, and Isuprel per American Heart Assn. protocol. See nurse's flow sheet for times and dosages. Throughout the resuscitation attempt, patient's cardiac rhythm remained agonal end-stage beats at 8/minute (see rhythm strips). Patient pronounced dead by Dr. Eric Najarian at 10:40 A.M. Transferred to morgue pending identification and notification of next of kin.

  The cardiac rhythm tracing was as Eric had remembered: broad, slow complexes that could not possibly have been electrically capable of generating contractions of the heart muscle. Certainly there was more he could have tried: a pacemaker, another series of drugs, more aggressive attempts to measure and balance blood pH. But even if, by some miracle, he had succeeded in restoring a pulse, John Doe was brain-dead. The signs were all there. And for that, there was no therapy.

  ... the choices we must make on this job are not always easy....

  "You said it, lady," Eric muttered, reflecting on Sara Teagarden's uncharacteristically sensitive remark. "You said it."

  In twenty-four hours he was going to have to sit across from a woman he wanted very much to get to know, and tell her that a nurse who was seldom wrong about such things had identified her brother as the derelict he had failed to resuscitate.

  He put his notes and the EKG tracing aside and turned to the nurse's notes. At the bottom of them was a notation, signed by Norma Cullinet: DR. T. BUSHNELL, MEDICAL EXAMINER, NOTIFIED. REQUESTS TRANSPORT OF BODY TO GATES OF HEAVEN FUNERAL HOME FOR HIS EXAMINATION. HE WILL MAKE OUT DEATH CERTIFICATE THERE, AND ATTEMPT TO LOCATE NEXT OF KIN.

  Eric checked the receiving area to ensure that the triage nurse was keeping up with the crush of patients. Then he went back to his office and pulled out the Boston Yellow Pages. The Gates of Heaven Funeral Home, Donald Devine, director, was located not far from White Memorial. He had opened this can of worms by calling Laura Enders. Now there wasn't much choice but to try to put the lid back on.

  Reluctantly, he picked up the phone.

  It was nearly nine before the E.R. was quiet enough for Eric to sign out to the senior on duty. He undressed in the on-call room, and then wrapped a towel around his waist and forced himself through a few minutes of stretching exercises. It had been a long and draining fourteen-hour shift, and every muscle in his body seemed to be in some phase of contraction.

  The exclamation point on the trying day had been a prolonged but unsuccessful attempt at resuscitating a fifty-seven-year-old coronary victim, brought in by ambulance in full cardiac arrest. From a purely technical standpoint the Code 99 had been handled well enough. But far more often than not, efforts in such cases were doomed. From the loss of blood pressure to the onset of effective CPR, the window to prevent irreversible brain damage was only four to six minutes, if that. And at some point during most resuscitations, physicians went from hoping they would get an effective heartbeat back to praying that they wouldn't. Intellectually Eric had never had a problem with that reality. Emotionally, though, he still tended to take every failure personally.

  How had he reacted to the death of the drift diver? he wondered now.

  As he showered and dressed he tried to reconnect with his actions and emotions that snowy February day. He had been completely immersed in Russell Cowley's emergency and in the use of the new laser. That much he remembered clearly. But had he reacted at all to the death of the derelict in the next room?

  Distracted by the question, he made a final brief check of the E.R., then headed across the largely deserted lobby toward the library. He had an hour before he was due at the Gates of Heaven Funeral Home, and he wanted to review some data on the complications of using less-than-fully-cross-matched blood for emergency transfusions.

  His call to the home earlier that day had been answered by a tape in which Donald Devine, to the accompaniment of strings, had introduced himself and promised to be back by ten. The music and the man's unctuous telephone voice bordered on parody, and Eric had formed an image of him that included an elongated face, sloping shoulders, and a waxed moustache. He had left a message outlining his interest in John Doe and stating that, unless he heard otherwise, he would stop by the Gates of Heaven between ten and eleven.

  He was entering the long corridor from the lobby to the Bigelow Building when Dave Subarsky fell into step beside him. Subarsky was dressed in jeans, sneakers, and an MIT sweatshirt. He had an armload of bound journals and textbooks wedged between his forearm and his beard.

  "Library?" he asked.

  "Where else?"

  Subarsky shrugged. "At this hour? How about home?"

  "You mean this isn't my home? Damn, now he tells me."

  "You look a little more tired than usual, old buddy."

  Subarsky used his key-card to open the library door.

  "I am, I guess," Eric said. "There's just been a lot going on. Tonight they brought in this fifty-seven-year-old guy with four kids. He was up and walking around one moment, collapsed and dead the next. I explained to his wife that we were working on him, but that he was essentially brain-dead. She begged me not to call off the resuscitation. So we tried. For more than an hour we tried just about everything, but there wasn't a damn thing we could do."

  "That's just the way it is," Subarsky said, setting his pile of journals on a reading table. "God shoots ... He scores!"

  "Touchingly put, David. You are a true nonclinician. But fortunately, every so often, if we do things right He hits the post."

  "Mayhap," Subarsky said. "Listen, how about a beer after we finish here?"

  "Can't. I'm going over to see a guy at the Gates of Heaven Funeral Home."

  "Always planning ahead. I like that in you, Eric."

  "I'm trying to track down a John Doe we worked on back in February. In fact, it was that day we used the laser."

  "God, I hope he's not still there." Subarsky held his nose.

  "He might be actually. The M.E. won't release a body until they have a signed authorization from a next of kin. Sometimes they hang on to them for six or seven months before they give up and have the Commonwealth spring for a burial. And unless foul play is suspected, they won't ever do an autopsy. They're as terrified of lawyers as the rest of us."

  "I can see the headlines now: PATHOLOGIST BOTCHES AUTOPSY, GETS SUED FOR MALPRACTICE."

  "Believe it or not, it happens."

  "I've never been to a funeral home. Want company?"

  "Actually, I could do with a little moral support. On tape at least, the proprietor of the place sounded mondo bizarro. Digger O'Dell, the friendly undertaker."

  "Sounds like my kinda guy."

  "In that case, you're on. Between the resuscitation we just called off and the Gates of Heaven Funeral Home, I have a feeling I'm going to need a beer or two tonight."

  "My treat," Subarsky said.

  The Gates of Heaven Funeral Home was hardly a place to inspire poetic thoughts about the eternal. It occupied a shabby building on a dingy side street six blocks from White Memorial. The windowless facade was painted black, and the ornately lettered sign above the entryway was peeling. Beside the door was a small wooden plaque, hand-painted with the ambiguous motto:

  ENTER HERE IN COMFORT: GO IN PEACE.

  D. DEVINE, DIRECTOR

  Several windows in what seemed to be an apartment on the second story were lit.

  "Nice place," Eric said.

  "Positively inspirational," Subarsky added. "Makes one want to rush right out and die."

  Eric gestured at the doorbell. "Want to do the honors?"

  "Be my guest. But first check around your feet for any signs of a trapdoor."

  Eric depressed the small lacquered button, setting off a series of six or seven chimes which were loud enough to echo down the e
mpty street. They were playing a melody he recognized, but could not identify.

  "Dr. Najarian, I presume?"

  Donald Devine's voice flowed forth from a speaker built in over the doorway. Eric swore he could hear violin music playing in the background.

  "That's right," Eric said. "I hope this isn't too late."

  "Hardly. Hardly. I'll be right down."

  "Perry Como," Subarsky whispered. "And a damn good Perry at that."

  A pair of lights recessed beside the speaker flicked on, and moments later Donald Devine opened the Gates of Heaven. Had there been a contest to design a mortician, Devine might well have been the winning entry. Thin, almost cadaverous build; sallow complexion; round, wire-rimmed glasses; coal-black three-piece suit; thinning hair, pomaded to his scalp; he was at once prototype and caricature, a man in his forties trying diligently to look sixty.

  Eric introduced himself and David. Devine led them inside. The decor of the Gates of Heaven was baroque and musty, and generic string music played through speakers in every room. The air was heavily perfumed, but through the bouquet Eric could still detect the familiar, unmistakable odor of formaldehyde.

  "Can I get you gentlemen anything?" Devine asked, escorting them past a small chapel to a reception area. "Some wine? A little tea?"

  Both declined. Devine poured himself a goblet of burgundy and then turned down the music from a panel on the wall.

  "Pardon me for asking," Eric said, "but is Devine your real name?"

  Devine turned to him, his fingertips touching to form a steeple.

  "Donald Devine is, in fact, my real name now. I had it legally changed a number of years ago."

  "Well, it does go nicely with the job."

  "Yes, I think it makes a statement of sorts. It helps put my clients' loved ones at ease."

  Devine. Eric wondered if the misspelling was intentional.

  Donald Devine motioned them to a pair of heavily brocaded love seats. Then he withdrew a file from the drawer of a small writing desk with glass-ball feet.

  "Now then," he said, "you mentioned in your message that you were interested in the ultimate fate of Mr. Thomas Jordan."