He led Mr. Matthews to the door and delivered him to one of the younger nurses with instructions to give the man a taxi voucher.
Then he and Yablonsky wrapped up the rest of the rounds in an hour, during which Earl made similar adjustments to the medications of another seven patients, who all had little more than days, if not hours, to live. Still, there'd definitely be fireworks over what he'd done here tonight. One of the seven, unfortunately, belonged to Wyatt.
Yablonsky, on the other hand, had become much less hostile by the time they returned to the nursing station. Her initial rigidity now made her seem more brittle than hard, almost fragile. Not that he could excuse the indifference he'd witnessed here, but little wonder she and her colleagues armored themselves with it, seeing people face death, day in and day out.
"Tell me, Mrs. Yablonsky- or may I call you Monica?" He sensed he might have won her over a little and that now might be the best time to get her talking, before Wyatt declared him public enemy number one.
"Of course, Doctor."
"There's something else Dr. Wyatt brought to my attention that perhaps you could help me with."
"If I can."
"He described a cluster of odd occurrences."
Immediately her body stiffened again, as if she was holding her breath in anticipation of bad news. "Clusters?"
"Yes. He said that over the last few months some of your patients were reporting near-death, out-of-body experiences."
"Oh, that!" She immediately exhaled and gave a little laugh. "Yes! It's most strange. And some of them weren't that near death."
"Do you have any ideas as to the cause?"
She shook her head. "I'd guess the effects of morphine or whatever other medication they were on. I actually looked up near-death experiences on the Internet. There's quite a lot there, you know, all about the neurotransmitters that may be behind it and what receptor sites in what part of the brain, if stimulated, will produce the experience-"
"What did Dr. Deloram think about it?" he interrupted, having no use for medicine culled off who knew what Web sites. "Didn't he come to interview some of the patients a few days ago?" Earl tried to make the question sound as innocent as possible.
Surprise deepened the wrinkles on her forehead. "You heard about that visit?" She leaned closer to him, her eyes all at once betraying the delighted eagerness of someone ready and willing to gossip. "Now there we had a really strange event. He arrived yesterday morning, pleasant as can be, took the list of patients' names, and went off to talk with them, at least the ones who are still alive. An hour later he stormed out, face so livid I thought his mask would burn off, and not so much as a word to any of us. Never did find out what made him so angry. The patients he talked to didn't know either." She leaned back and gave a little nod, as if daring him to come up with a logical explanation for such a bizarre display.
Earl asked if she could prepare the list again, intending to speak with those patients himself later. He also would ask Stewart what happened. But as he took the elevator down to the main floor, something other than near-death experiences began to bother him.
Why had Monica Yablonsky reacted so apprehensively when he first mentioned a cluster of odd occurrences, then been clearly relieved when he asked about the near-death experiences?
He walked to the front entrance, where he dumped his protective garb in the prescribed disposal bin, stepped outside, and raced through a warm summer downpour to his car.
Yet he remained preoccupied.
What kind of clusters could she have thought he meant?
Chapter 5
Janet heard Earl's car pull into the driveway.
She threw down the Saturday edition of the New York Herald, wanting to swat him with it for coming home so late on a weekend. It especially galled her when politics, not patients, delayed him.
Bloated, bitchy, and mad at the man who had gotten her that way, she thought. She'd better watch it, or she'd soon come across like the wronged woman in a country-and-western song. Still, her two-hours-overdue husband had better have a damn good excuse.
Brendan looked up from where he'd been engrossed in some elaborate game on the kitchen floor involving a toy train and dump trucks. "Daddy's here," he yelled, the noise of his father's arrival finally penetrating his imaginary world. He leapt to his feet and streaked to open the back door.
She levered herself upright. God, she didn't remember being so heavy the first time. No way she'd be able to work right up to the due date lugging this one around. She also admitted to a tinge of relief at having a legitimate excuse to book off on maternity leave earlier than last time. Despite her initial resolve to never abandon her patients because of SARS, she didn't at all like some of the close calls that had been reported in the news lately involving pregnant women exposed to undetected contacts in hospitals.
"Daddy, I listened to my little brother's heart," Brendan yelled from the threshold, eyes wide with the clear blue exuberance that only a six-year-old can have. "Mommy put a radio thing on her tummy and let me hear."
Earl stepped in from the rain and swung him into the air. "She did? Wow!"
"Want to hear what it sounded like?" Without waiting for an answer, Brendan very seriously pursed his lips to make a rapid sucking and blowing sound with his breath- not a bad imitation of fetal blood flow amplified by a Doppler microphone.
Despite her annoyance, Janet had to laugh. Still, Earl should have entered the garage directly and not touched Brendan before discarding all clothing immediately into the washing machine and showering. Shortly after the outbreak they'd installed a cubicle in there just for that purpose. She'd felt paranoid doing it- Earl kept reassuring her that the precautions at work should have been enough- but the fear they might have carried the virus home on their skin or clothing stalked her every time either of them went to hug their son.
Earl glanced her way. He must have read trouble, as he just as quickly put Brendan down and said, "Well, isn't that marvelous? You're sure Mommy doesn't have a little choo-choo engine in there?"
"No, come listen yourself." He reached to pull Earl toward her. "She's been making us spaghetti, for a long time."
Earl stepped back, hands in the air. "Daddy has to go shower," and he disappeared down the basement stairs.
Five minutes later he returned dressed in jeans and a T-shirt, his dark, wet hair slicked back. He wisely stooped to first say hello to Muffy, their large standard poodle, who still considered herself the family's firstborn and Brendan one of her pups. Now twelve, the dog had taken to sleeping a lot, mainly in doorways near entrances so that any new arrivals would have to step over her rather than she having to run to them. He gave her a kitzfe behind her ears- Janet had taught him the word shortly after they first met sixteen years ago. It meant stroking. Muffy had become an eager recipient when she joined the family, and Brendan had learned early to get his fair share too. Kitzle had appeared in his vocabulary almost at the same time he learned "No!"
After a few seconds with the dog, Earl got Brendan on the other side of him, and attempted a make-Janet-smile maneuver with a show of boy-dad-and-poodle funny faces. When that didn't work he led his co-conspirators in a three-abreast charge to where she stood leaning against the table. Muffy jumped her first, front paws stretched shoulder high. Brendan grabbed a leg, and Earl gently slid his arms around her protruding waist, the smell of soap off him tickling her nose.
Her anger drained away. Fifteen years married, and the man could still disarm her with the old playful charm. She grabbed a nearby ladle and waved them off. "Wash your hands and set the table with knives and forks," she commanded, scowling at Earl. "Supper's late enough as it is."
He winced again. "Sorry. Something came up at the hospital."
"On a Saturday night?"
"I'll tell you when we're alone." Scooping up Brendan-"Come on, chum. You're filthy!"- he ducked out from under her blue searchlight gaze.
By 10:30 the storm had passed and the clouds abated enough for
the moon to appear. Its misty light percolated through the canopy of trees in front of their house, and the grass beneath, stirred by a strong breeze, flickered between silver and shadow.
She curled up beside Earl on their living room couch, her back to his front and half listening to his explanations as to why he'd been so late.
"I won't be a widow to out-of-hours political crap on a Saturday," she interrupted, having heard all she cared to. "Not for Jimmy, Peter Wyatt, or showing up doctors who can't cut it, understood?"
"Aye, aye, Captain." He slipped an arm around her and softly nuzzled her hair with the side of his face.
"I'm serious, Earl." She looked up at him. "There are others who deserve your time." She placed his hand on her rounded stomach.
He smiled and explored her pregnant curves with his palm.
His fingers released a craving that caught her by surprise. She felt her face flush.
He continued to caress her, very slowly, in ever widening circles.
She relaxed, first letting her body mold itself against his, then beginning to follow his movements with her hips.
"Do you think your passenger would mind?" he asked after a few more minutes, their gyrations becoming more urgent.
She arched her back and lifted her arms, slipping her hands behind his neck. "Just be gentle," she whispered in his ear, drawing him to her and setting him on fire.
He reached around to the lamp and turned it off, then began to unbutton her blouse.
Afterward, in the darkness, they held each other, and he felt the cool night air flow gently over them through the open windows. Savoring the rise and fall of her breathing against his chest, he thought of all the other times like this when he'd cherished the extraordinary blessings in his life- Janet, Brendan, and now a new son on the way- but always with a glance over his shoulder. He knew from a lifetime in ER how quickly joy and love could be snatched away by fate, bad luck, or raw malice. Working emergency had ingrained it in him. While he could recount victories, the defeats, like permanent toxins in human tissue, embedded themselves the deepest and stayed with him the longest.
"Hey, you have to trust life more," Janet had told him shortly after their first encounter sixteen years ago when she'd gotten her initial glimpse of his dark take on the brutal laws of chance. "For all the victims who end up in your ER, there's thousands more who make it safely home to bed. Besides, people like us, you and me, we'll make our own luck." Such unswerving optimism suited a woman who brought new life into the world for a living. It also counterbalanced his own daily workload of lives lost or torn apart.
Lately his tendency to think the worst had taken a new twist. Although he hadn't said anything to her yet, he worried about Janet giving birth at St. Paul's. Nobody had exposed the OB units to SARS, but it had happened in other hospitals. The culprits were usually residents who came from a ward where they'd unknowingly been around an infected patient who hadn't been diagnosed. The result was that newborns arrived only to be slapped into isolation. Only a matter of time, he kept telling himself whenever she went to work in her own department. But she knew that as well as he did, would be no less worried about it, and didn't need the extra pressure of hearing him lay it out.
He'd started to read up on home deliveries instead.
The breeze from outside picked up slightly, and he savored a sweet fragrance of nicotinia that wafted into the living room. It came from the front garden where she had planted an entire bed of the white, star-shaped flowers. Their pleasing, clean scent made him think of the lonely woman in Palliative Care who had confided how she loved the freshness in the air following a rainstorm. What was her name? Sadie Locke? Tomorrow, weather permitting, he'd have one of the orderlies take her out onto the roof garden in a wheelchair. Maybe maintenance could even spruce the area up a bit, perhaps bring in a few pallets of annuals. Janet would know what varieties might do well up there. Then patients who were strong enough could escape the walls and odors of the hospital.
He smiled and indulged in a rare moment of feeling pleased with himself. Why not? He seemed to have a knack for this VP, medical stuff. It gave him a rush of satisfaction, the prospect of having all that power and using it to do good things.
So there, Jimmy.
Sunday, 6:00 a.m.
Palliative Care Unit, St. Paul's Hospital
Monica Yablonsky dashed for the bedside phone. "Code blue!" she yelled, the standard order to bring a resuscitation team running to the aid of a cardiac arrest victim. "And I want the R-three in ICU or Emergency."
Not just a bunch of beginners, she added to herself, slamming down the receiver and reaching for the gray face with the staring eyes. It felt cold and rubbery. God knew when she'd died. Not recently. But with no DNR order on the chart, and given the stunt Earl Garnet had pulled last night, she'd better play this one by the book. Damn him, sticking his nose in where it didn't belong.
She plopped a pocket breathing mask over the dead woman's lips and nose, then blew.
The breath squeaked out the sides of a rubber seal that should have molded itself to the face.
Elizabeth Matthews's chest barely rose.
Monica tried again.
The same resistance blocked her effort.
Still, she had to go all out. Or would that only make her appear more guilty? Garnet would be looking ultra close at what happened here. And given his reputation for digging up shit, he'd be bound to discover the others. If he did, the nurses on the night shift would have to watch out.
She swiftly positioned her hands on the midpoint of Elizabeth Matthews's sternum and began the compressions. It felt stiff, so she applied more force to get the required inch of downward thrust that would squeeze the heart's ventricles and pump blood through the body.
Ribs snapped with a crunch under her palms.
"Shit," she muttered, easing off a bit. Still, she continued, not at all sure her efforts wouldn't make Garnet more suspicious.
"We got a code, eighth floor!" Jane Simmons yelled. She turned from the phone and ran to where they kept a portable bag of airway equipment. Grabbing it, she sprinted for the door, right behind Thomas and the rest of the team. At the elevators they commandeered a car with an override key.
In less than a minute they were on the ward. Jane arrived at the patient's room to find the night supervisor, Mrs. Yablonsky, and a nursing aide administering CPR, both women red-faced from the exertion.
Out in the hallway the sounds of running feet and a familiar wobble of wheels announced the arrival of ICU residents with the crash cart. This chorus of youngsters with fear in their eyes followed Thomas through the door and swarmed the patient. Some ripped open her nightgown, while others slipped a board under her back. One of them applied well-lubed defibrillation paddles to her bony chest.
The monitor screen showed a flat line.
"I've got the airway," Jane said, shouldering Yablonsky aside and flipping off a pocket mask that the aide had been using to provide ventilation. As she worked, the sticker bearing the patient's name at the head of the bed caught her eye.
Questions flew.
"She's not a DNR?"
"When did she arrest?"
"What's her diagnosis?"
Amid a flurry of hands, additional IVs went up.
Jane tried to pry open the mouth; she found it unusually stiff but slid a curved airway into place anyway. She then connected a ventilation bag and mask to an outlet in the wall, sending a hiss of oxygen into the room. But when she applied the mask over the patient's face and squeezed, the bag remained rigid in her hand. She couldn't force air into the lungs. The woman's tongue must be blocking the way, she thought. She tried to reposition the head, but it resisted manipulation as much as the mouth had.
A pretty blond girl who had attempted to take over the chest compressions, her long hair repeatedly flopping in the way, slowed after a dozen thrusts. "This one doesn't feel right!" she said, her eyebrows bunched into a frown, but she continued to labor over the dead woman's c
hest.
Thomas walked over to the bed, reached through the crowd, and placed the tips of his fingers along Elizabeth Matthews's neck. "You're not producing a pulse." He signaled the young intern to step back- she'd already grown flushed from trying- and attempted a few compressions himself. A puzzled expression crept across his forehead. He stopped pumping, threw the covers entirely off, and turned the woman's body to reveal large purple blotches on her hips and the back of her shoulders. He looked up at the supervisor. "The woman's been dead four hours, minimum." He pointed to the discolorations and turned to the residents. "These markings take at least that long to appear. We call the phenomena lividity, where venous blood pools at the lowest point of the body once a person has died." His voice had slipped into the clipped tones most seniors used when teaching. He threw the bedsheet back over Matthews, allowing it to float down on her like a shroud. "A code blue never should have been called."
Yablonsky's cheeks burned red at the rebuke.
As the others cleaned up their equipment, Thomas Biggs led her to the corner of the room. "Why'd you do it?" he asked.
He may have intended their conversation to be private, but Jane easily overheard them.
A flicker of alarm shot through Mrs. Yablonsky's eyes. "I beg your pardon?" she puffed with indignation.
"Why'd you call the code? You could feel and see her as well as I did. The skin had gone cold. The lividity formed where she lay."
Mrs. Yablonsky's face flamed further, and the cords of her neck muscles tightened.
Oh, boy, thought Jane, who knew from other visits up here that the woman had a temper. And Thomas could be less than diplomatic when pointing out someone else's mistakes.
But thankfully, this morning Yablonsky seemed set on avoiding a fight. Her rigid posture relaxed a notch. "Sorry," she said, "I should have checked."
Thomas studied her, then his eyes crinkled good-naturedly as he gave her a smile. "That's okay. We can all forget something sometimes. It just surprised me. Calling a code on her"- he gestured at Matthews's body-"is a rookie move."
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