Panic at the thought of capture spread through me like rot. And for the millionth time I silently railed at having been fool enough to think I could get away with it, that I'd be so clever and outsmart them all.
But I'd had this plan, this technique, my ability to wall off what I didn't want to be or feel, I would remind myself. I'd perfected it trying to separate me from her pain, her scars. Except back then I'd learned it too late- I hadn't gotten the barricades up in time to keep her anger from becoming mine. But now, with the trick down pat, I had a cloak to wrap around myself between murders and make me invisible, an entity able to move about like a ghost. Or to paraphrase the philosopher, I don't think, therefore I am not. If Garnet or anyone else ever did realize that a killer had been at work, they'd be after someone who'd vanished, ceased to exist. At least that was what I told myself until I lapsed and thought about what I'd done, like now.
A slow, cold chill shuddered through me despite the heat and extra clothing, and I broke into a clammy sweat.
Shit! If only I'd never started. Or quit at the first death. No one would have known. But instead I pushed on, certain that Algreave had been a fluke, that I could still pull the rest through their sessions. Now I'd no choice but to continue, just to stay clear of the living death of being buried in a prison cell forever or, worse, awaiting execution.
Through half-closed eyes I watched Garnet lounging in a seat nearby, and a surge of resentment grabbed me by the throat. Leave it to old Goody Two-shoes Earl, making this into a roof garden for staff and patients. Rumor had it that he'd arranged for the greenery to be on permanent loan, or at least until the snow flew in the fall. What a fucking god he'd become around here!
My bitterness toward him and his good works surprised me. But why should it? After all, I'd condemned myself to seeing him across a moral divide, the man's inherent decency a luxury I would never again enjoy. Little wonder I envied and hated him for it.
The warmth of my mask and gown grew sweltering, my skin hot and sticky. Nevertheless, I stayed put, glancing around the rest of the area.
A gaunt-eyed woman whose few remaining wisps of hair floated on the breeze like gossamer sat nearby in a wheelchair parked under one of the potted trees. Perfect place for her, I thought.
From a distance of ten yards I could make out the telltale red stripe on her wristband that Palliative Care attached to signal a DNR case. She also had the necessary IV, probably because chemo or radiotherapy had left her unable to drink and eat adequately. Yet she didn't seem gorked. Now and then a nurse or orderly paused to say hello and chat for a while.
That's the kind I would have to select from now on. People who still had their marbles, but for whom there'd be no code when the nurses found them after I'd finished the session. I could no longer allow my subjects to survive and spread tales of near-death experiences. They might recall one detail too many and give me away. At least DNRs meant there'd be no resuscitation team to raise suspicious questions about too many people dying before their time. I doubted their doctors would raise questions either. That would entail an admission their prognoses had been wrong. Or maybe they'd be so grateful for the empty beds they wouldn't entertain many second thoughts about how they had become available.
I continued to study her.
At one point I overheard a snatch of a person's greeting.
"Hello, Sadie…"
I'd need at least a dozen more subjects. Out of them I might get a couple of usable tapes- so many had turned out garbled. But added to the few other good ones I'd managed to record, that could finally be enough to convince everyone. Just the same, the added risks of being discovered scared me shitless. I still had no idea whom I'd seen prowling around Friday night or why the person had been there. No telling when that one might show up again. And since Garnet had decided to stick his nose into the business of that ward, he posed the biggest obstacle of all to my pulling off more undetected sessions.
So how would I get around him?
Until now Palliative Care had been a place where no one thought twice when a person died. Doctors hardly ever ordered autopsies, and family, in their heart of hearts, were secretly relieved at their loved one's passing. In other words, my perfect hunting ground.
And it still could be, despite talk of audits and the bad luck that Earl had taken a particular interest in the place. Because the new VP, medical, fastidious as he might be, had also created his own problems. With a little help, those difficulties might prove useful in several ways. At the very least they should keep him distracted. If they didn't…
I looked at Janet, who lay sprawled on a lawn chair nearby, her protective wear outlining the swell of her stomach.
I dreaded what it might be necessary to do. But a personal tragedy to anguish over- that would sidetrack Garnet.
My own loss once more exerted its iron grip on me, stirring a rage that wouldn't die, not since all those years ago when my world fell apart. The hesitation I'd felt vanished.
I would make it appear accidental. After all, pregnancy could still be a risky business.
1:07 p.m.
Not too bad, Earl thought, surveying the inner corridors of his department.
The line of stretchers in the hallway, once a temporary measure to handle the occasional overflow but now an all too permanent fixture, stood empty, and the modest volume of chatter told him that his staff had the rest of the place under control.
He ducked into the nursing station, and J.S. looked up from where she leaned against the counter riffling through a magazine. "Hi, Dr. G."
"Finally, a bit of rest for the wicked, I see."
"It's about time," she said with a wink, and returned to flipping pages.
He spotted Thomas huddled in a corner with the rest of the residents conducting an impromptu Q &A session. The man had the knack of all good ER teachers, knowing to seize spare moments whenever he could and turn them into mini seminars.
Earl waited for a pause in the proceedings, then signaled him to one side. "If you need me, I'll be in pathology. They're doing a case I want to see."
Thomas's eyes seemed to draw a bead on him. "The Matthews woman?"
Earl nodded. "I saw in the chart you answered the resus call. If it's not too busy here, you could join me-"
"Thanks, Dr. Garnet, but this bunch is pretty green." Thomas gestured with an extended thumb toward the members of his group as they continued an animated and somewhat misinformed discussion about the proper technique for pelvic exams. The corners of his eyes crinkled. "As you can hear, I'd better stay with them." He chuckled, hesitated a second, then glanced right and left, as if making sure no one stood within earshot.
Inadvertently Earl did the same.
All clear, apart from J.S.
"There's something you should know about Palliative Care that might help," Thomas said in an only slightly hushed voice. Her presence didn't seem to bother him.
"Oh?"
The resident proceeded to tell him about a pattern, a concentration of codes that occurred on that ward just before dawn.
Earl didn't find it all that surprising. Even on nonterminal floors overnight supervision could be notoriously lax, and patients were occasionally found dead in bed having obviously died hours before. Sometimes it got so bad that residents referred to morning rounds as a body search. He nevertheless thanked Thomas for the information, touched by his concern, and headed downstairs to the pathology department.
He approached the autopsy suite and pushed through a door marked ABSOLUTELY NO ADMITTANCE. The thin, high-pitched whine of a rotary bone saw set his back teeth on edge, and Len Gardner, a man of medium build even when swathed in full protective gear, looked up as the steel blade bit into one of Elizabeth Matthews's ribs. He'd already made a sweeping Y cut of her overlying skin, having sliced it open with a scalpel from beneath her collarbones down the sternum and all the way to her pubis.
"Hi, Earl," he greeted him, as casually as if they were meeting to have lunch. "I thought I'd better
do this one myself."
At St. Paul's Len had a reputation as the man who would not be chief. One of the most gifted pathologists in Buffalo, yet having no time for the political niceties that accompanied such appointments, he'd steadfastly refused the honor of heading his department. He also, more than anyone, knew all the dirty secrets about who got it wrong when it came to diagnostic and therapeutic mistakes at St. Paul's. Since Len made it his personal mission to bluntly confront doctors with their errors, Earl suspected he went out of his way to remain unpopular as added insurance against ever getting stuck with an administrative title. Maybe he should have taken Len for a role model. "Thanks. I'm glad you're here," Earl told him, and meant it. Above all, Len would be scrupulously honest.
"My pleasure." He went to work on another rib.
Earl leaned back against the counter where a row of open Tupperware containers half filled with formaldehyde stood ready to receive Elizabeth's major organs. The fumes wafted up his nose, then tingled the back of his throat despite the double mask and a noisy overhead hood designed to suck out such noxious odors. Farther along, racks of test tubes, each one aligned at attention, awaited the more fluid specimens: blood, urine, stomach contents, even her cerebrospinal fluid, the liquid that bathed the brain. These Len would send to the biochemistry lab for a determination of their morphine levels.
Earl turned back to the body and studied Elizabeth Matthews's face. Under the glare of the overhead surgical lamp, it resembled a shiny wax likeness, not flesh at all. He wished he could say she finally looked peaceful, but her features remained taut, accenting the bones beneath, and her mouth, pulled into a grimace, seemed about to emit that thin, piercing cry he couldn't get out of his head.
2:30 p.m.
The nausea hit without warning.
Ripping off her mask, Jane barely made it to the toilet before her stomach muscles started to undulate like a belly dancer's. Her entire lunch hurled into the porcelain bowl as if shot from a fire hose.
She nearly fainted from the force of it, and had to support herself with both hands on the tank.
Then she felt fine.
What the hell? she thought, and waited a few more minutes to be sure.
As she stood there swaying, a crazy, impossible notion crossed her mind.
No, it must have been the tuna salad they'd served in the cafeteria.
She quickly flushed the evidence and returned to the nursing station.
3:35 p.m.
ICU at St. Paul's and casinos had a lot in common, Earl had once joked. Both had no windows, making it impossible to tell night from day. Both had luminescent screens that beeped and flashed fluorescent numbers for winners and losers 24/7. And with both, all results were final.
Carrying a beige folder stuffed with papers, he walked the length of the dimly lit room, past curtained-off cubicles where bags of IV medication and banks of machines kept the hospital's sickest patients from shuffling off this mortal coil. At least that's how it seemed when Stewart ran the show. With his skills he could blur the lines between life and death more than any other intensivist on staff. A few people clucked their tongues and accused him of playing God, but not many. And most of them wouldn't have anyone else if their time to be a guest here turned up.
Earl had recognized Stewart's passion for critical care when they had been residents together at New York City Hospital. Back then Stewart's determination to combine clinical research with practical training showed in his choice of electives. He spent them with a fledgling group of physician-scientists dedicated to evaluating what treatment protocols worked best for an array of life-threatening conditions in ICU. After completing his specialty requirements, he accepted a faculty position at both the hospital and university, eventually becoming director of that same group, only to abandon them a few years later in 1989.
Out of the blue he'd called Earl and asked if there were any openings at St. Paul's. Aware of Stewart's impressive publication record, and having received a stack of sterling recommendations for him from NYCH, Earl pitched him to the credentials committee at St. Paul's. They immediately snapped him up.
But Earl had never fully understood why a man with such a narcissistic appetite to be recognized for his genius would make the jump from the Big Apple to a place like Buffalo.
"Pollution," Stewart had told him at the time.
Earl approached a row of four brightly lit glass chambers that stood along the end wall and instinctively grew wary. They were negative-pressure isolation units, designed to house patients with serious airborne infections. Any time the door opened, air rushed in, the idea being to prevent deadly microbes from floating back into the rest of the hospital where staff and patients could inhale them into their lungs. Up until three months ago, the rooms almost always had a vacancy. Today, every bed held a SARS victim.
He drew closer.
Through the window of the nearest compartment he watched a team of green-clad figures wearing both goggles and full plastic visors. They worked feverishly on a muscular, ebony-skinned man who had fought similar battles shoulder to shoulder with Earl in ER but now struggled for his own life. Teddy Burns had been a respiratory technician at St. Paul's for over twenty years. Just weeks ago the two had joked how neither of them was getting enough sleep, and they'd shared bragging rights over who had the bigger circles under his eyes.
"Too damn proud to let the ship sink- that's us in a nutshell," Teddy had said with a wink, and rushed off.
Now those same dark, deep-set eyes desperately searched the masked faces who towered above him. Teddy's chest heaved as he bucked the tube his rescuers had inserted down his throat to hook him up on a respirator. His gaze found Earl's, and the creases in his face furrowed, angrily funneling in on the outrage that protruded from his mouth, as if ending up like one of his past patients meant the ultimate indignity.
Earl shuddered and placed the palm of his gloved hand against the pane separating them, hoping that Teddy would see it as a gesture of wishing him well.
But Teddy looked away instead, seemingly in disgust that such niceties would be offered in the midst of his agony.
Stewart Deloram, recognizable from the others by black eyebrows that were equally as unruly as his hair and which no protective gear could hide, expertly inserted a clear plastic tube between Teddy's left ribs.
It instantly filled with a foamy, pink fluid.
Kir royale, Earl thought, remembering Teddy's own unique turn of phrase to describe bloody pleural exudates when he taught medical students. Its presence meant the virus had attacked the lining of his lungs.
And a quick glance at his biochemistry results posted on the windows told Earl the infection had also damaged his liver, kidney, and muscle tissue.
Multisystem failure.
The faces of two teenage sons whom Teddy had so proudly brought to work from time to time flashed to mind, and Earl's stomach gave a sickening lurch.
Stewart emerged minutes later, having discarded his outer layer of contaminated gear just inside the airtight door, then immediately double-gowned, double-gloved, and masked himself again, including shoe and hair covers.
So many steps, so easy to miss one, Earl thought.
After nurses and doctors in Toronto started getting infected, mostly in ER and ICU despite wearing full protective gear, he and Stewart had sat side by side in each other's units, trying to figure out what extra precautions might prevent the same thing from happening at St. Paul's.
"You look like a pair of Georgia crackers sittin' on the veranda," Thomas had teased them, exaggerating his southern drawl.
Earl had laughed, then fired back, "And I suppose guys from Tennessee never pulled up a couple of chairs on a porch?"
"Ah, but we call them deep thinkers."
"Well, sit yourself down, Mr. Deep Thinker, and help us out."
Within fifteen minutes the three of them had identified a half dozen obvious breeches, from masks being improperly tied to people scratching their heads or raising their
goggles and rubbing their eyes. Around infected patients during airway procedures- the spray zone, they called it- one cough and the virus could land on hair, eyewear, shoes, anywhere. If staff took off their gloves first before removing head and footwear, or if they retied a lace before taking off their gloves and then went home and pulled off their shoes, or did any of a number of variations of the same scenario, the SARS virus could end up on their fingers.
"Then it's pick your nose and die," Thomas had drawled, driving the point home to anyone who disputed the possibility. The phrase became their watchword in a campaign to heighten people's vigilance against contaminating themselves.
Teddy Burns had been the latest proof that they hadn't done enough.
"What are his chances?" Earl asked when Stewart finished changing.
The weariness in Stewart's gaze trebled. "I don't know." He pulled Teddy's chart from a wall slot beside the test result sheets and flipped to the progress notes. "Did you hear the latest rumors out of the CDC?" he asked while scribbling a few lines to describe what he'd done. "That intensive care and emergency staff will have to wear Stryker suits all the time?"
Earl's heart sank. Critical care workers across North America had been dreading it might come to that.
Stewart was referring to the outfits with self-contained oxygen supplies that personnel in level four virology labs or investigators at the hot zone site of a virulent outbreak would wear. "Space suits," the residents called them. The thought of ending up in one as a part of the new normal for ER left Earl feeling defeated. Gloves and masks created barriers that were distancing enough, but at least he could still speak to those under his care, allay their fears with the sound of his true voice. But to confront already frightened patients while dressed like something out of a science fiction movie and talk to them with the muffled tones of a voice coming through a completely enclosed hood- that tore it, stripped the final human touches from the profession he loved. People like Teddy Burns would die in total isolation, barely able to see, feel, or hear the ones taking care of them.
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