The Inquisitor

by Peter Clement

  The trouble was she hadn't added more foam.

  Thirty seconds.

  She looked out the open door at the rest of her apartment. It didn't seem so bright anymore. The paintings she'd chosen for color rather than any specific artist looked drab and cheap, every bit the pathetic imitations they were. Strange how baubles meant to comfort lost their luster when real trouble hit.

  Ten seconds.

  She felt so stupid sitting there on the tile floor, her future in the hands of a reagent to detect the chemistry of an embryo implanted in her womb. It would be six weeks old now, little more than a ball of cells, but the tissue already beginning to differentiate into what would become brain, heart, and skin. She hugged her knees and began to rock slightly, the way she had as a little girl whenever something worried her.

  Such little problems then: homework, what boy would or wouldn't talk to her, exams. Even her worries an hour ago now seemed insignificant: paying bills, what groceries to get. All little stuff. Her only big concern had been what would happen to Dr. G. That still mattered.

  Shit, what would he think of her now? And Dr. Graceton. She'd been so kind, taking her on as a new patient- doubtless because Dr. G. had spoken to her.

  Or her mother. She'd been ecstatically proud to have a daughter who would be the first woman in the family to have a profession, as opposed to her own lifetime of waiting on tables at the local Denny's, double shifts galore after Dad died.

  Now this.

  And how would Arliss, her little brother, take it? They'd planned to escape Grand Forks together. First she'd get out through nursing, then he'd follow, and she'd help with the money for his college tuition. He'd been crazy about animals since they got their first puppy, and he dreamed of becoming a vet. If she stopped work, his future crashed as well.

  And most of all, what would Thomas think?

  Or would she tell anyone? She could just get rid of it privately, with no one she cared about the wiser.

  She stared at the indicator dot.

  It turned blue as a newborn's eyes.

  Chapter 8

  Later that same evening, 5:45 p.m. CEO's office, St. Paul's Hospital

  Dr. Paul Hurst threw down the article Earl had shown him. "But they're supposed to die. It's a terminal ward."

  "I still thought you should know."

  "On the basis of… what did you say? A fall in average length of stay from twenty-seven days to twenty-four about three months ago, and a point-five increase in the number of deaths reported each morning? That's infinitesimal."

  "Not exactly. It's a rise of fourteen deaths a month, all of them occurring at night. And three months before that there had been a similar change, an increase of about eleven deaths a month, again mainly at night. In the previous years, the rate appeared to hold steady, about three-point-three deaths a day, and only half of them on that shift."

  Hurst rolled his eyes at the ceiling. "Will you listen to yourself? You sound like my stockbroker pitching nonexistent returns. Besides, it could be that patients are admitted at a later stage of the disease these days and therefore die sooner once they're here. Hell, it sounds like something you should applaud, a reduced length of stay and more efficient use of beds. You spearheaded that trend everywhere else in the hospital to keep ER from getting overcrowded. Why not in palliative care?"

  Most doctors were comfortable with inevitable death, considering it as natural as life, but Earl had never heard one of his profession suggest it be celebrated as part of efficient bed use. The majority were aware enough of their own mortality not to be so callous. However, there were exceptions.

  Paul Hurst, originally a general surgeon, had had his first heart attack in his mid-forties and had looked ashen ever since. That had been twenty years ago. At the time he stopped practicing medicine and assumed the post of VP, medical, having made the dubious calculation that hospital politics would be less stressful than the OR.

  It hadn't worked out that way.

  Earl had become his enemy a decade ago by exposing an accounting scandal Hurst had attempted to cover up. In the aftermath Hurst had tried to get Earl fired more than once, and failed.

  But during the last few years, once Hurst had succeeded in getting what he'd been after all along, to be CEO of St. Paul's, a watchful state of quiet had existed between the two men. Not a truce exactly, but more an admission that Earl Garnet gave as good as he got- that had been the consensus of those who followed hospital power games the same way they did baseball.

  Their pronouncement had given Earl no small amount of satisfaction.

  "Sure, it could be later admissions," he conceded, picking up the New England Journal article and shoving it back at Hurst. "I just want to make sure we haven't got our own angel of death up there taking it on herself to ease their suffering."

  The report had made national headlines in the mid-eighties. It appeared after a case in New York City where police charged a nurse with poisoning children on a pediatric ward with intravenous digoxin, yet a court of law found her innocent. A group of epidemiologists subsequently looked at several hospitals with clusters of unexplained cardiopulmonary arrests; their goal was to provide a tool that would prevent such wrongful accusations in the future or, in the case of actual foul play, more accurately pinpoint the culprit. For each of the institutions they examined, they plotted all such mysterious occurrences against the work schedule of the nurses who'd had access to the patients; in several instances they found a particular nurse who had been on duty when most of the deaths occurred. The results led to the successful prosecution of four serial killers, one of whom had been active in two states. Ever since, any unexplained rise in a hospital's mortality rate had administrators nervously eyeing their nursing rosters.

  Hurst grabbed the article from him and tapped the opening paragraph with his gloved hand. Even enclosed in latex, his surgeon's fingers matched the rest of him- long and thin. "I suggest you take another look at the criteria for what you're insinuating." He peered over the top of stylishly small eyeglasses with wire frames and read, " 'Suspicions should be raised only when clusters of deaths and cardiopulmonary arrests occur that are either unexpected in timing or inconsistent with a patient's previous clinical course.'" He broke off and again threw the paper back on his massive mahogany desk. "You haven't shown any of that."

  "I intend to check further."

  "Oh, Jesus!" He reached up as if to rub his eyes, then, as if the sight of the gloves made him think otherwise, made a pyramid with his fingers in front of his mask.

  Earl had watched this gesture at hundreds of meetings over the years, albeit without the protective gear. It usually preceded Hurst making a calculated move to undercut anyone who dared oppose him. He braced for what his longtime opponent would say next. As he waited, the incongruity of two men completely garbed in OR wear amid the luxurious setting of a wood-paneled room, inch-thick broadloom, and floral-covered antique chairs that any museum would die for made the moment surreal.

  "You know, Earl," Hurst began, his voice uncharacteristically weary, "despite our former differences, I welcomed your appointment as VP, medical, even spoke on your behalf to the board."

  A chill ran through Earl. When Hurst started to butter someone up, look out. "Yeah, right," he said with a sarcastic laugh, to serve notice he wouldn't be fooled.

  "No, I'm serious. You care about this old place as much as I do. We just sometimes differ on what's best for it."

  Really? That would be because you're a control freak who cares a little too much about St. Paul's and much too little about patients, Earl quipped to himself, keeping his mouth shut.

  "And I couldn't think of a tougher team than you and me to get St. Paul's through this SARS mess. So what do you say we bury the hatchet and fight the real enemy together?" He stood, reached across the cluttered broad expanse of the desk, and held out his hand.

  Earl hadn't expected the gesture. He looked at the waiting palm as if regarding a venomous snake.

  "Co
me on, Earl. It's the right thing to do, and you know it. You're the most brilliant, hardheaded son of a bitch I ever went up against. There's no telling what we could accomplish by working together."

  Earl made the shake, though tentatively.

  "Now, about this business in Palliative Care. Let me ask you something: would you be so ready to investigate the place if you weren't the doctor involved in the Matthews case?"

  Earl immediately went back on the defensive, feeling suckered. "Now wait a minute, this isn't about me trying to save my ass."

  "Just give me an honest answer. That's all I ask. Would you press ahead, or wait and see what happens at death rounds?"

  Earl hesitated, taken by the earnestness in Hurst's voice, yet not sure that the man wouldn't try to snooker him.

  "Come on now. The evidence of clusters isn't that strong. And you know the effect that kind of inquiry would have on the nurses. Do you really want to distract them like that now, when the slightest lapse in the SARS protocol could be a death sentence?"

  Earl hesitated, then reluctantly conceded that Hurst had a point. "No, I guess I'd wait."

  "Good. Then I'll see you at death rounds. How's Janet doing, by the way? Planning to work until the last minute, same as last time?"

  "She's fine," he replied, feeling as uneasy with the old man's new friendliness as he ever had with their previous snarling matches.

  6:50 p.m.

  The pathology lab occupied a cul-de-sac in the subbasement that had to be the oldest, most out-of-the-way part of the hospital. Though the facilities themselves had been renovated, the passageway leading to them hadn't. Residents called it "the tunnel." Even the lighting belonged to another era. Naked bulbs in green metal shades provided cones of yellow illumination at fifty-foot intervals while the spaces in between remained in relative darkness.

  Janet Graceton hurried along the poorly lit corridor. The faint yet unmistakable aroma of decomposition emanated from the heavy wooden door to the morgue. She paid the scent little heed, being more aware, as always, of the plexus of pipes and cobwebs that ran the length of the ceiling not a foot above her head. She'd never seen the spiders that made their home up there, but more than once she'd wondered how they survived where no other insects flew or crawled. What did they eat? She refused to believe the lore handed down through generations of technicians- that scraps from the dissecting tables provided the necessary nutrition and that the resident arachnids had achieved the size of bread-and-butter plates. But inevitably, each time she walked through here on her way toward the pathology labs, scurrying noises from those darker recesses sounded all too close, and she picked up the pace.

  Farther on, the autopsy suites stood empty with their doors open, the stainless-steel tables gleaming and ready for business. Here the pungent odors of chemical preservatives lingered in the air, easily breaching her mask. The sting that spread along the lining of her nose brought on a case of watery eyes.

  Next were several large rooms lined with workbenches, their silver surfaces also spotlessly shiny. On them stood dozens of microscopes, stacks of flat, wide cases containing rows of glass slides, and innumerable racks loaded with bottles of reagents or stains in colors that rivaled those of Brendan's first-grade art class.

  The people who used all these tools to make diseased tissues and cells yield up their secrets had long since left for the day.

  She walked up to the door with Len Gardner's name on the opaque glass and knocked.

  No answer.

  She'd had a pass card to his premises for years, always needing to slip in after hours to pick up path reports. Using it now, Janet entered the anteroom where his secretary normally worked. She had also done what sensible folks did in the evening: gone home to her family. At least Janet presumed so, having delivered all three of the woman's children, two girls and a boy. Their pictures adorned an otherwise empty desk. The sight of them set off a pang for her own son, and for the ten millionth time she grappled with her anxiety over being an absent mother. From the beginning she'd refused to try to rationalize her guilt. The only explanation that mattered she owed to Brendan, and while words might comfort adults, the sole language that soothed his psyche involved the feel of her arms and the sound of her voice as she held him.

  She crossed to the inner door and knocked again.

  Still no answer.

  She opened it a crack and peeked in. Not that she expected to find Len, but he'd promised to leave her a pathology report on one of her patients. The woman waited upstairs with her husband to know if her ovarian cancer had spread beyond what Janet had been able to remove.

  Among the clutter of papers she saw an envelope with her name on it propped against a stack of files.

  She ripped it open, scanned the contents, and knew that the woman would be dead in six months.

  She walked back out to the deserted corridor and slumped against the wall.

  Nothing loomed heavier than the task of saying, "I'm sorry, but the news is bad." She steeled herself, preparing to give the support required from her, yet dreaded the moment when, as soon as she walked in the room, the couple's last hopes would shatter against the look in her eye. She'd never learned to mask that dark gaze. It inevitably emerged when it came time to pass a death sentence.

  Her unborn son stirred in her and delivered a sharp kick, a reminder of his presence, as if she'd needed any. By this time of day, her belly pulled so heavily on her that she felt it had doubled in weight and size. But such a cherished load to carry and a lifetime of working with thousands of other pregnant women didn't lessen the wonder of it any. She'd pretty well decided to take maternity leave much earlier this time. Why not? She could be with Brendan more, and when he came home from school they could make plans together for his new little brother. They'd also enjoy evenings and weekends uninterrupted like never before in his young life. Hell, why not give him that-

  An odd popping noise and the tinkle of falling glass interrupted her thoughts. The sounds had come from the far end of the tunnel, near the elevators. As she looked along the islands of light, she realized that that section of the corridor had fallen into complete darkness.

  Had a lightbulb blown down there?

  She heard more glass break, but heavier, like that of a jar or bottle, and this smash had some force behind it.

  What the hell?

  She pushed off from where she'd been leaning. "Hello? Is somebody there?" She peered toward the distant murk but could see no one.

  Yet a soft brushing shuffle no louder than a whisper echoed out of the darkness. Paper shoe covers on the floor? She couldn't be sure. "I said, is someone there?"

  In the distance the door to a lit stairwell swung open and a silhouetted figure left the basement.

  "Hey!"

  The door closed behind, leaving her alone once more.

  Somebody must have knocked something over in the dark, somebody who shouldn't have been down here in the first place, judging by their quick exit. No matter. She'd advise maintenance to clean up the broken glass before anyone got cut.

  She started toward the elevators, hoping there'd be enough light to see her way once she got that far.

  She'd walked well past the wooden door to the morgue, her mind focused on what she'd say to her patient, when she noticed a peculiar yet familiar odor that hadn't been there when she came in. Mildly irritating at first, it soon penetrated her nose and seared the back of her throat.

  That's awful, she thought, and pressed her mask to her face, hoping to block out the fumes.

  But the irritation continued, and her eyes began to burn.

  She squinted into the darkness ahead, wondering if she could make the elevator. Probably. She couldn't see it directly, but the soft glow of the button looked to be about fifty feet away. Hold her breath and run for it, she decided.

  After a few strides she immediately felt worse. What had that idiot spilled? She knew the storerooms down here contained no end of toxic liquids. The fluids that preserved organs an
d tissues in death were lethal to them in life, and any woman working down here who got pregnant went on immediate leave.

  The button seemed to be only thirty feet away. Should she go back? She sprinted faster. Hell, ten seconds more and she could be out of here. All she had to do was hold her breath a bit longer.

  As she ran, her free hand outstretched, she tried to remember where she'd smelled this before. It had a medicinal aroma, so strong she could practically taste it, and a cool, bitter sensation on her tongue. So familiar, yet-

  Oh, my God!

  Now she remembered it from her med school days- when they'd done basic lab experiments on white rats and anesthetized them with chloroform!

  Jesus Christ, she thought, her head rapidly growing woozy. What felt like an ice cream headache began to set itself up in her temples.

  She tried to stop and turn back but skidded, no longer finding any traction. At first she thought it must be the paper coverings on her shoes, but then noticed the floor glistening in the half-light, covered with fluid. At the same instant particles of glass crunched under her soles. She'd blundered into the middle of the spill.

  Like a cartoon character trying to reverse direction, she ended up running on the spot; then, losing her balance, she fell heavily on her hands and knees. She cried out, and her lungs emptied, but she struggled not to breathe in. A stinging pain pierced her palms, and patterns of crimson spread under the latex of her gloves like petals. My hands! she thought, they being as precious to a surgeon as to a pianist. She instinctively flexed her fingers, verifying no tendons were cut, despite feeling about to faint more from trying to hold her breath than breathing in the anesthetic. The sparkling fragments that had sliced into her skin glittered up at her. She'd pull them out later.