Extreme Measures (1991)

by Michael Palmer

  Over the next hour, Bernard's condition seemed to stabilize. The need for Eric's intervention grew less frequent. Laura could see the deep lines of tension across his forehead begin to recede. Finally, four hours after their arrival, Bernard's eyes fluttered open. Minutes later, he reached up and pointed to the endotracheal tube, imploring Eric to remove it.

  "Has he made it?" Maggie Nelson asked.

  Eric took both her hands and helped her up. Then he hugged her.

  "You married one tough guy, Mrs. Nelson," he said. "He's a real bear."

  "I know," she said.

  He stepped back while she bent over, spoke a few words to her husband, and gently kissed him on the cheek. Then he sent the two women out of the room and motioned the nurse in. Laura watched from a distance as Eric whispered in the detective's ear, then quickly pulled out the polyethylene breathing tube. Bernard sputtered and gagged as the nurse suctioned out his mouth and pharynx.

  For a minute, there was total silence as Eric stood poised to replace the tube at the first sign of trouble. Then Bernard cleared his throat.

  "Anyone got a cigar?" he croaked.

  One by one, those Charity victims needing the most care were brought into Moab. The rest were transferred to other facilities. Eric worked through the night alongside the hospital staff, treating infections and other vestiges of malnutrition and neglect.

  Shortly after dawn the next morning, he left Maggie Nelson with her husband and picked up Laura at the motel where she was staying. Together, they walked along the largely deserted streets of the town. To the south, the sunlight of a new day sparkled off the rich red clay of the hills.

  "This place is so beautiful," she said. "And the hospital seems very good."

  "For a place this size, it is," Eric said.

  Laura locked her arm in his.

  "Think you'd ever consider working here?" she asked.

  "I think my lowest gear may still be about ten times higher than the highest one I'd ever need here."

  "Well, maybe that's just what you need."

  He held her close.

  "Maybe. I'll tell you what: If we ever get tired of Boston and White Memorial, I'll think about it."

  "Good. Because I understand real estate around Boston is through the roof, and here there's a whole town for sale, just a little ways down the road."

  ABOUT THE AUTHOR

  MICHAEL PALMER, M.D., is the author of Miracle Cure, Critical Judgment, Silent Treatment, Natural Causes, Extreme Measures, Flashback, Side Effects, and The Sisterhood. His books have been translated into thirty languages. He trained in internal medicine at Boston City and Massachusetts General Hospitals, spent twenty years as a full-time practitioner of internal and emergency medicine, and is now an associate director of the Massachusetts Medical Society's physician health program.

  Turn the page for an exciting preview of

  Michael Palmer's medical thriller

  MIRACLE CURE

  available now in paperback from

  Bantam Books

  It took every bit of her strength, but Sylvia Vitorelli managed to force a third pillow under her back. She was nearly upright in bed now. Yet she still felt queasy and hungry for air. It was the dampness and the mold, she told herself. If she had been in her apartment in Boston rather than her son's farmhouse in rural upstate New York, this would not be happening. Not that her breathing had been all that great in Boston, either. For months her ankles had been badly puffed and her fingers swollen. And over the past few weeks she had been experiencing increasing trouble catching her breath, especially when she lay down.

  Sylvia cursed softly. She should never have agreed to make this trip to Fulbrook. She should have told Ricky that she just wasn't up to it. But she had desperately wanted to come. The ghost of her husband, Angelo, had made living in their apartment a constant sadness. And the dust and noise surrounding construction of Boston's central artery tunnel had made living in their part of the North End most unpleasant. Besides, her daughter-in-law, who had always acted as if her visits were an inconvenience, had actually made the call inviting her to spend almost two weeks away from the city. The kids ask for you all the time, Mama, she had said. And autumn is so beautiful up here.

  Sylvia checked the time. Ricky, Stacey, and the children would be at church for another half hour or so, and then they were going to stop by a friend's. She had begged off going with them, citing a headache. The truth was, she didn't feel she had the strength to get dressed. She should try to get up, maybe make something to eat, watch Mass on TV; but when she tried to move, she suddenly was seized by a violent, racking spasm of coughing, accompanied by a horrible liquidy sound in her chest.

  For the first time she began to feel panic. The dreadful gurgling in her lungs persisted. Now she was gasping for breath. Sweat began to pour from her forehead, stinging her eyes. Her purse was right beside her, on the bedside table. She fumbled through it for her pills, with no clear idea of what she would do once she found them. Her fingers were stiff, obscene sausages, bluish and mottled.

  The air in the musty room seemed heavy and thick. An extra diuretic pill might help, she thought. Perhaps one of the nitroglycerins too. Desperately, she emptied her purse out onto the bed. Alongside several vials of pills was an appointment card from the clinic at Boston Heart Institute. Drops of perspiration fell from her face onto the ink. Her next appointment was a week from tomorrow. In order to fly to Ricky's, she had had to skip a Vasclear treatment--the first one she had missed in almost six months. But the missed medication couldn't possibly be the reason she was having so much trouble breathing now. She was down to only one treatment every two weeks, and was due to drop to once a month before much longer. Besides, her cardiologist had told her when she called that it was perfectly okay for her to go.

  Oh my God, she thought, as she frantically gulped down one pill from each of the medication vials. Oh my God, what's happening to me? Suddenly she remembered that the nitroglycerin, which she had not had to take since the early days of her Vasclear treatment, was supposed to be dissolved under her tongue, not swallowed. She tried to get a tablet into place under her tongue, but her hands were shaking so badly, she spilled the tiny pills all over the bed and onto the floor.

  Her left ring finger was beginning to throb now. The gold band she had worn for over fifty years was completely buried in her flesh. The finger itself looked dark and violet, almost black in color. Oh please, God, help me.... Help me!

  Drowning now, she struggled to force air through the bubbling in her chest. A boring, squeezing pain had begun to mushroom outward from beneath her breastbone and up into her neck--angina, just like before she began the treatments. She had to try and call Ricky. Or was it better to call 911? She had to do something. Her nightgown was soaked with sweat now. She was breathing and coughing at the same time, getting precious little air into her lungs. There was no telephone in the guest room.

  Gamely, she pushed herself off the side of the bed and lurched across to the bureau. Her feet were like water bottles, her toes little more than nubs above the swelling. Another spasm of coughing took away what little breath remained. She clutched the corner of the bureau, barely able to keep herself upright. The cough was merciless now, unremitting. Perspiration was cascading off her. Her head came up just enough for her to see that the mirror was spattered with blood. Behind the scarlet spray was her ashen face. She was a terrifying apparition. Her hair was matted with sweat. Bloody froth covered her lips and chin.

  Seized by fear unlike any she had ever known, Sylvia turned away from her reflection, stumbled, and fell heavily to the floor. As she hit, she heard as much as felt the snapping of the bone in her left hip. Sudden, blinding pain exploded from that spot. Her consciousness wavered, then started to fade. The agony in her hip and chest began to let up. Ricky ... Barbara ... Maria ... Johnny ... One by one her children's faces flashed through her thoughts. The last face she saw was her Angelo's. He was smiling ... beckoning to her.

 
; Two years later

  Brian Holbrook squeezed into the ambulance for the short ride from the Back Bay to White Memorial. His father's chest pain was down to a two or three from a ten by the time they left the Towne Deli. Still, throughout the ride, Brian kept a watchful eye on the monitor. The absence of extra beats was a good sign, but the shape of the cardiogram wave pattern strongly suggested an acute coronary.

  Jack's cardiologist at Suburban was Gary Gold, one of Brian's former partners--the only one of the four partners who had suggested that Brian's recovery from addiction was the same as recovering from an illness and that he should be readmitted to the practice as soon as he was ready. Silently, Brian cursed himself for not insisting that Gary be more aggressive with Jack in pushing for a repeat cardiac catheterization and surgical evaluation. But then again, with Jack so adamantly against repeat surgery, what was there to do?

  White Memorial Hospital was an architectural polyglot of a dozen or more buildings crowding four square blocks along the Charles River. All around, as with most large hospitals, there was construction in progress. Earthmovers and other heavy equipment were as much a part of the scene as were ambulances, and two towering cranes rose above all but the tallest building. A new ambulatory care center, one sign proclaimed. The twenty-story future home of the Hellman research building, boasted another. Like the patients within, the hospital itself was in a constant cycle of disease and healing, decay and repair, death and birth.

  The ER was on the southwest side. As they backed into the ambulance bay, Brian wondered what it would feel like to be back in a hospital for the first time in eighteen months. A mixture of shame and the time pressures of his jobs and his daughters had kept him from attending regular cardiac rounds at Suburban. Instead, he had kept up his continuing education credits through tapes, certified journals, and two in-depth courses, both paid for by fade.

  The vast ER was in noisy but controlled disarray. The two triage nurses were backed up, and the waiting room was full. Brian took in the scene as they rushed Jack to a monitor bed in the back. The drama and energy of the place was palpable to him--his element. Merely walking into the ER made him feel as if he had been breathing oxygen underwater and had suddenly popped through to the surface. He had anticipated heightened emotions at reentering this world, but even so he was surprised by the fullness in his chest and throat and the sudden moisture in his eyes. Not that long ago he had been part of all this, and his own actions had caused it to be taken away. Now there was no telling when, or even if, he would ever get it back again.

  "How're you doing, Jack?" Brian asked, taking his father's hand as they waited for a clean sheet to be thrown over the narrow gurney in room 6.

  "Been better. The pain's gone, though."

  "Great."

  "Two bucks says I don't get dinner."

  Brian glanced at the monitor. The elevation in the ST segment of the cardiographie tracing was less striking--definitely a good omen.

  "If this place serves the typical hospital food," he said, "you stand to win twice."

  He helped the team transfer Jack to his bed, then stood off to one side as a resident named Ethan Prince began his rapid preliminary evaluation. Brian grudgingly gave the young man high marks for speed and thoroughness. Then he remembered where he was. Suburban was a decent enough hospital, but not one of the interns or residents there would ever get a callback interview at White Memorial. Slip below the top ten percent of your medical school class and you didn't even bother applying.

  "You know anybody here?" Jack asked Brian.

  The resident, listening through his stethoscope, shushed him.

  I hope not, Brian thought.

  "I don't think so," he whispered.

  As if on cue, he heard his name called and looked over to the doorway. Standing there, hands on hips, was Sherry Gordon, not much older than Brian's thirty-eight but a grandmother several times over. She was also right up there with the sharpest ER nurses Brian had ever worked with.

  "Hey, you're a Suburban girl," he said, crossing to her and accepting a warm hug and a kiss on the cheek. "What're you doing here?"

  "Cream rises to the top. They've had my application on file for years. Openings don't come too frequently in this place."

  "You like it?"

  She gestured to the chaos and smiled.

  "What do you think?" Her expression darkened. "You okay?"

  Brian held her gaze.

  "It took three months in a rehab," he replied, softly enough for only her to hear, "and about a billion AA and NA meetings, but, yeah, I'm okay."

  "I'm happy to hear that, Brian. Real happy. That's your dad, right? I remember that bypass nightmare he went through at Suburban."

  "Six years ago. He's probably having a small MI now."

  "Well, he's got a crackerjack resident going over him. Kid reminds me of you."

  "I wish."

  "Tell him to look into getting your dad put on Vasclear. Everyone around here has started talking about it all of a sudden. Listen, I've got to get back to help Dr. Gianatasio. He's got a real sick lady down the hall."

  "Phil Gianatasio?"

  "That's right. You know him?"

  "From years ago, when we were interns and then residents together. I can't believe it. This is like old home week for me. Please tell him I'm here, Sherry. I'll stop by when I'm certain my pop's stable. Would that be okay?"

  "I don't see why not. Got to run. Good luck with your dad."

  Vasclear. Brian knew next to nothing about the drug, and most of what he did know he had learned from the newspapers. He wasn't as medically current as in the days when he was attending cardiology rounds twice a week and reading or skimming a dozen different journals. But he had kept up fairly well, and Vasclear, the latest in a long line of experimental drugs aimed at reducing arteriosclerosis, simply hadn't been written about widely.

  Ethan Prince freed his stethoscope from his ears, reviewed Jack's EKG again, then passed it over to Brian. Brian accepted it calmly, consciously trying to keep his eagerness and gratitude hidden from the younger physician. There was still a persistent two-millimeter elevation in the ST segment in several of the twelve standard views in the tracing.

  "Looks like some persistent anterior injury," Brian said.

  "I agree. I'll get the wheels in motion for his admission. Meanwhile, we've got to decide whether to try and melt the blockage. Before we do that, I'll try and get him a cardiologist. Dr. Gianatasio is on first backup, but he's got all he can handle with a very sick woman in four. I'll have to find out who's on second call." He turned to Jack, whose color had improved significantly. "Mr. Holbrook, it appears you're having a very small blockage, and as a result a part of your heart is not getting enough blood."

  "A heart attack," Jack said. "It's okay. You can say it."

  "Actually, we won't be certain it's a full heart attack until we see some blood tests and another cardiogram."

  "Two bucks says it is."

  "Pardon?"

  "Never mind him," Brian said, taking Jack's hand again. "He was a football lineman in school--offense and defense. Too many blows to the helmet."

  "I see.... Well, I'd better get going. I need to find out who's on cardiology backup and I need to get back in with Dr. Gianatasio."

  "Just one quick thing. Sherry Gordon said I should look into Vasclear."

  The resident shrugged. "You probably know as much about it as I do. It's a Boston Heart research drug. Rumor has it the results have been really promising."

  "Thanks."

  "Anesthesia ..." The overhead page sounded. "Anesthesia to the ER stat ..."

  "That lady in four must be going down the chute. I guess they're calling Anesthesia to intubate her."

  Prince hurried away, leaving the nurse tending to Jack. Brian shifted uncomfortably from one foot to the other, aware of feeling impotent and embarrassed. Just down the hall a cardiac patient was in serious trouble. Brian was another pair of skilled hands, another cardiologist for Phil
Gianatasio to bat ideas off of. Yet for all the good he could do anyone at this point, he might as well be a high school dropout.

  "Dr. Holbrook?"

  The stocky, dark-haired nurse standing by the door had the bearing of someone with authority. Her expression was grim.

  "Yes?"

  "Dr. Holbrook, I'm Carole Benoit, the head nurse down here. I'm sorry to interrupt, but Dr. Prince told me your father was quite stable. Could I speak with you for a moment?"

  "Of course."

  "Dr. Holbrook, there's a critically ill woman in room four. Dr. Gianatasio asked if you'd mind going in there."

  Brian felt an immediate adrenaline rush.

  "I'd be happy to."

  He glanced back at Jack, who was resting comfortably, then took a step forward. The head nurse continued to block the doorway. She motioned Brian to a spot in the hall, out of earshot of both Jack and the staff.

  "Before you go in there," she said in a stern half-whisper, "I want you to know that I insisted Sherry Gordon tell me who you are and at what hospital you are working. She told me you had lost your license."

  "So?"

  "And when I pushed her for an explanation, she told me why."

  Brian's reaction to the woman had blossomed from a kernel of wariness into full-blown mistrust. He pulled himself up to his full height plus half an inch or so.

  "Get to the point," he said.

  "I don't want anyone without a valid license practicing medicine on any patient on my emergency ward."

  "Frankly, I don't see where sharing my experience and ideas is practicing medicine."

  Carole Benoit's eyes were hard.

  "I'll be in there watching," she said.

  Brian stepped back into the room to reassure Jack that he'd be nearby and would be right back. Then he flexed a bit of tension from his neck and headed over to room 4.