The Inquisitor

by Peter Clement

  Earl sat stunned. He knew that crap happened, as hideously as described, and he condemned it whenever he could, but he'd never before seen it from so stark a point of view. At first he didn't know what to say. Finally he asked, "It's really getting to you?"

  Jimmy nodded. "Sometimes." His eyes focused on something Earl couldn't see.

  Judging from the pain reflected in the priest's gaze, Earl didn't want to see it. "You still could have come to me, Jimmy," he said softly. "Brought me patients' names and chart numbers. That's the kind of documentation that would have nailed Wyatt and others like him."

  "Yeah, right. Case by case, committee by committee- it takes forever that way."

  Earl exhaled long and hard. "But keep at it enough, and even the thickest-skulled dinosaurs change their ways in the end."

  "Then why didn't you do it?"

  "Me?"

  "Yeah. You're a physician. Nothing stopped you from stepping up with charts and patient names these last twenty-five years."

  Earl bristled. "Nobody dies like that in my department. Certainly not since I've been chief."

  Jimmy's eyes narrowed into a hard, unjoking glare. "And that's the trouble with you, Earl. You hide in ER."

  "Hide?"

  "Yes, hide. It's a domain as black and white as any in the hospital. The sicker the patients, the easier your job. Stabilize 'em, medicate 'em, and ship 'em upstairs. Don't get me wrong, you're great at it- decisive, skilled, and courageous. But one of the reasons the job suits you isn't so noble. The patients don't hang around, and you like it that way. The ones who don't make it, you can honestly tell yourself they died while you were trying everything possible. The ones who do, their pain, fear, and despair are muted by shock or postponed by drugs. The long and short of it all is that you get to keep your losses more cut-and-dried. No having to deal with the long, messy aftermath that survival involves."

  "Whoa. Now wait a minute, Jimmy. I find out how people did after they left ER. Their doctors tell me-"

  "I'm not talking about the clinical results or satisfying your medical curiosity."

  "Jesus, Jimmy, what the hell's the matter with you?"

  "What's the matter is, you can't be VP, medical and bury yourself in a mentality that has a fix for everything."

  Earl leapt to his feet. "That's not fair!"

  "What's fair got to do with it? You want to face a patient's lingering, share in his or her long-term agony, witness their slow settling for a fraction of a former life, then watch your successes as they piece together what they lost from the heart attack or stroke or car accident that derailed them."

  "Damn it, Jimmy, how dare you-"

  "Why, in all the years I've been here, I never once saw you up on the floors visiting with any of the people you saved."

  Earl felt he'd been gut-punched.

  He stood behind his desk as a tiny prickle of sweat dampened the back of his shirt despite the chill of cold air pouring over his head from a ventilation duct in the ceiling.

  The black of Jimmy's eyes increased its hold on him. "If you'd had any inkling at all for that part of the game, Earl, now and then I would have found you on the wards where it plays itself out. And maybe, just maybe, when you came across wretched souls with barely days left to live, bellowing like wounded beasts, you might have acquired the same compassion for them that you found for the likes of Artie Baxter when you made sure he didn't suffer in ER."

  With that, the priest released him from the tractor-beam grip of his stare, quietly opened the door, and disappeared into the darkened corridor.

  The head nurse slid her glasses to the tip of her nose, peered at him, then let them drop on their silver chain. "Dr. Garnet! We don't usually see you up here."

  "Here" referred to the Palliative Care Unit, or "terminus," as some of the more callous residents called it.

  "Then it's about time," he answered, straining to read the woman's name tag. "Mrs. Yablonsky, would you be so kind as to grab the chart cart and accompany me as I see the patients?"

  Crinkles at the corners of her eyes lessened. "See the patients?"

  "Yes."

  "All of them?"

  "Yep."

  "Now?"

  He nodded.

  "But why?"

  "I want to check their pain medication."

  The visible portion of her face corrugated itself into a frown. "You mean without their doctors knowing?"

  Jesus, he'd be here all night answering her questions. "We're going to be doing an audit on pain management throughout the whole hospital. Dr. Wyatt himself will be chairing it. I thought I'd get a head start."

  The far smoother foreheads of two younger nurses who had approached from behind her scrunched up in amazement.

  "Dr. Wyatt knows about this?" the supervisor asked.

  Earl smiled in response.

  "Well, it's most peculiar…" She pushed herself out of a swivel seat, surprising him with her height. With eyes nearly at the same level as his, she also possessed the big shoulders and sculpted build of someone who swam laps across Lake Erie.

  While he waited for her to prepare the charts his gaze drifted along the polished, barren corridor, and he shuddered at the thought of being stuck here to die. Just park him under a tree with a nice view and a bottle of whisky when his time came.

  He'd never admitted it to anyone, but deep down he hated hospitals, felt claustrophobic in them. As a patient, he'd loathe every part of surrendering to any regime that a place like St. Paul's would impose on him, especially with his butt hanging out the back of a tie-up gown.

  Through windows at the far end of the unit he watched the sun as it slipped behind a column of thunderheads that had been piling up over the lake. Immediately the passageway darkened, and everything became cast in a thin yellow light. Low rumbles sounded outside, and a crackle of static interrupted the quiet music from a radio on the work counter.

  "Storm's coming," said one of the younger nurses, reaching up and snapping the off button.

  Only then did he hear the weak moans and wailing. Mere wisps of sound that floated out from the semidarkness of the hallway, they were the kind of noises that, once gotten used to, could easily be ignored- with the help of a radio. "Are they always crying like that?"

  "Oh, this is nothing," Yablonsky said. "Sometimes they get to screaming so loud you can't hear yourself think." Oblivious to her own callousness, she never paused in pulling out charts and placing them on a pushcart.

  A twist of anger turned his stomach.

  In the first room they stopped in, he found an old man curled in bed, as withered and emaciated as a mummy. His skin had yellowed with jaundice, and, either comatose or sleeping soundly, he didn't respond when Yablonsky called his name or slipped the mask that had fallen off his face back into place. Earl let him be.

  Next door to him lay an elderly lady in similar shape.

  In the third room, a gaunt, gray-faced woman with the wisps of her remaining hair combed neatly into place sat in a chair and stared out at the approaching rain clouds. Her upper face brightened as soon as she saw him. "How nice, a new doctor."

  A glance at her chart before coming in revealed her name to be Sadie Locke and that she had metastatic cancer of the breast that neither chemotherapy nor radiation could halt. As he stepped up to shake her hand and introduce himself, the sleeve of her housecoat slipped up her arm to reveal a swarm of florid red blotches where the tumor had seeded itself to her skin, and a sniff of decay floated down the back of his nose.

  "I love a thunderstorm at the end of a hot summer day, don't you?" she said after assuring him she felt comfortable most days on her current drug regime. "It's so refreshing, and the air smells wonderfully clean afterward."

  "Yes, I know exactly what you mean," he said. Her pleasant manner put him at ease. Normally having nothing to offer a patient but small talk made him feel awkward. "Do you have family?" he asked after a few seconds, mostly to reassure himself she knew someone who cared enough to keep her comp
any. He couldn't imagine anything worse than being confined to a room, with no prospects of a visitor.

  "Yes, one son. Donny. He owns a restaurant in Honolulu. I don't see him much, but next week he'll be here- a business trip to New York. And he taught me how to use e-mail." She pointed at a turquoise laptop sitting on her night table.

  Pretty lonely, he couldn't help thinking, and tried to come up with something else to say. "Do you know the hospital chaplain, Jimmy Fitzpatrick?"

  Her eyes beamed. "Father Jimmy? Of course. He's wonderful. Always says just the right thing to pick up a person's spirits."

  Oh, does he now? Earl thought, still shaken by the hiding he'd received.

  "Cracking jokes the way he does is wonderful," she continued, "but he can be serious when he wants to be."

  "Tell me which you like best about him, jokes or serious." Maybe she could give him some pointers about the man's technique with the patients here.

  "That's easy. He never wastes my time. No rubbish about doctors all at once finding a cure or me somehow getting better through a miracle. There's a relief in hearing a person tell bad news honestly and make no bones about what can't be done. It leaves him free to help me in ways he can."

  "What are those?"

  "Listening, talking about ordinary things, keeping me interested in the world- you know, making me feel I matter to him. Not that he's got a lot of time to do it in. There are so many others who depend on him as well."

  Earl started to thank her, not much the wiser about specifics that made Jimmy so great at his job, but she laid a hand on his arm. "Know what's his real secret, now that I think about it?"

  Earl waited.

  "It's the way he looks you in the eye and says, 'I'm sorry you're going through this.' Twenty seconds face-to-face like that, and I feel he's given me twenty minutes."

  The next dozen visits went a little quicker, but he found them no easier. Patients raised questions he couldn't answer and expressed fears he didn't know how to console.

  "Why me?" some asked when he inquired about their pain.

  "I'm afraid to die," others said.

  Not that he hadn't heard those words thousands of times in ER. But there the confused hurly-burly of a resuscitation or the rush to line and intubate whomever he was working on allowed him to get away with brief reassurances. Here people looked him in the eye and expected his undivided attention along with a detailed response.

  "I don't know what to say," he repeated over and over, bowing to a growing sense that on this ward, bullshit would be even less forgivable than his ineptness with words. "But I'm sorry for your ordeal."

  Still, he pushed on with the rounds. Despite the emotional suffering he'd discovered, he began to wonder if Jimmy hadn't exaggerated his claim about patients being undermedicated, as most seemed free of physical discomfort.

  Then they approached the nearest of a string of rooms where the nurses had closed the doors. The sounds he'd heard earlier emanated from here.

  He quickly scanned the chart of the patient they were about to see.

  Elizabeth Matthews, fifty-eight, terminal cancer of the ovary.

  What had sounded like whimpering turned out to be a continuous high-pitched cry once they were inside. The lights were off and the blinds were closed, so he could barely make out her form on the bed. But he could smell the acrid, sour aroma of her sweat.

  Swallowing, he drew closer, and his eyes adjusted to the dark. She lay on her side clutching her knees, curled around the point where the tumor, grown from what had once been the source of her seed, would have maximally eaten through the contents of her lower abdomen and into her pelvis. She rocked back and forth, as if her belly were a cradle to the malignancy and her hideous keening could lull its ravages to sleep.

  "Mrs. Matthews?"

  The piercing sound from her throat never wavered.

  A movement in the corner of the room startled him. "Doctor?" a man's voice said.

  Earl turned to see a tall, asthenic figure rise from a lounge chair set well back from the bed.

  "I'm Elizabeth's husband." He held out his hand. "Thank you for coming."

  Earl took it, touched by the simple dignity of the gesture. Either the man had nerves of steel to remain so composed in the face of his wife's suffering, or witnessing it had left him numb. "Mr. Matthews, I'm so sorry."

  "Nothing's helped, Doctor. She's been this way for the last two days. The residents tell me they're giving her the maximum amounts of morphine possible…"

  As he talked, Earl flipped to the medication sheet and looked at the orders.

  Morphine sulfate, 5 mg sc q 4 hrs prn.

  Maximum, his ass. A medical student must have written it, copying word for word from the Physicians' Desk Reference, the bible of medications and their standard dosages. But Elizabeth Matthews didn't have standard pain.

  He immediately felt back on his turf. "Get me ten milligrams of midazolam," he said to Yablonsky. This kind of suffering he could dispatch in seconds.

  "But-"

  "Now!"

  One of her younger assistants darted out the door.

  "When did she get her last dose of morphine?" he asked, walking over to check that Elizabeth Matthews's IV line remained functional. He opened the valve full, and it ran fine.

  Yablonsky flipped to the nurses' notes. "At three this afternoon," she said, "during our usual medication rounds."

  "And it's now nearly eight, five hours later. Her order says every four hours, as needed. I think we agree she needs it."

  "Well, yes…"

  "And you gave her only five milligrams?"

  "Subcutaneous, as prescribed."

  "You didn't request her doctor raise the dose, even though you could easily see she required more?"

  "More is not what's on the chart, Doctor. Besides, we don't want her to get used to it so the drug no longer has an effect-"

  "You call this an effect, Mrs. Yablonsky?" He gestured to the crumpled shape on the bed.

  She fidgeted with the chart, fuming at being confronted. "No, but I-"

  "What do you say we give her ten, then? And if that doesn't work, make it fifteen." He grabbed the file out of her hand and wrote the order, scrawling his signature with an angry flourish. "And once we find out how much is enough, we'll make it an IV infusion. Even street junkies know that popping narcotics under the skin doesn't hold a candle to mainlining."

  Yablonsky turned scarlet all the way to the tips of her ears. "Really, Dr. Garnet, her oncologist says she could linger like this for months. She wi//grow tolerant to morphine, and-"

  "Then we'll sedate her, just as I'm about to do now."

  As if on cue, the young nurse who'd gone to fetch the midazolam returned and handed him a syringeful of the fast-acting sedative. He swiped the rubber portal at the side of Elizabeth's IV line with an alcohol swab, jabbed in the needle, and slowly pushed on the plunger. "Whatever it takes to make her comfortable," he continued, "especially if she's got months. My God, is that your policy, the longer a patient has, the longer they don't get sufficient morphine?"

  Yablonsky's younger colleagues, standing behind her back, nodded tellingly.

  Yablonsky snapped her head high and threw back her ample shoulders. "Of course not."

  Earl wondered if she had once been an army nurse.

  Elizabeth's cries lessened as he slowly injected the contents of the needle, keeping a sharp eye on the rise and fall of her chest.

  Mr. Matthews walked over to the other side of the bed, leaned over, and stroked his wife's head. "It will be better now, Elizabeth. You'll get some rest." The fatigue in his voice weighted the words like rocks, but they must have fallen as gently as tears on her ears. She smiled, released her hold on her knees, and reached up to pat his hand.

  A few seconds more, and she slept peacefully.

  "Thank God," Mr. Matthews said, and pulled her mask from down around her neck back up over her nose. By the light from the hallway, his haggard eyes appeared gouged out b
y worry and exhaustion.

  "Why not grab some shut-eye yourself?" Earl told him. "I promise you, she'll be fine for the night. Go home and get to bed." He put his hand on the old man's shoulder, and felt it slump in defeat. "Mrs. Yablonsky will sponge-bathe Mrs. Matthews and change her nightie and bedding." He turned to face the nurse. "And open the blinds, shall we? Let her see it's night should she wake up, right, Mrs. Yablonsky?"

  She sucked in a mouthful of air. "Yes, sir."

  "During the day, we'll continue to make sure they stay open and that there's natural light in here, so she'll be less confused. Agreed?"

  The nurse nodded.

  "And she gets her next morphine as soon as she starts to stir from the midazolam wearing off, which will be in about an hour…"

  As Earl rattled off his instructions, tears rippled down the haggard circles beneath Mr. Matthews's eyes to where the crescent contours of skin bunched up by the top of his mask. From there wet marks spread through the material until it grew damp enough to stick against the hollow contours of his cheeks. He reached across his wife's sleeping form and held out his hand to Earl again, except this time it trembled slightly. "Thank you," he repeated, but much more softly than before.

  Earl clasped it in his as he finished outlining to Yablonsky a regime that had more to do with simple human dignity than medicine. Yet he couldn't be sure she wouldn't screw it up somehow, to put him in his place.

  "Yes, Doctor," she repeated over and over.

  Her sullenness worried him. "And make sure the next shift gets it right as well. I want no more problems."

  She bristled, almost standing at attention. "I'm doing a double and will be here until dawn."

  Resentment had probably prevented her from adding a "sir" this time. Earl pegged her former rank as at least a sergeant.