"Really? Uh, how many times have we made love? A hundred, maybe? And do you remember putting on a new condom each time we sampled seconds? Look, I may have been as lax as you, but we were a team in this one. Do me a favor and spare me the surprise." The impatience she felt surprised her. But what the hell, let it rip. She'd no time for bullshit. Not now.
He gaped up at her as if she were a stranger.
She put a hand on his head, running her fingers through his hair. "Forget kind lies, Thomas. I need to know. Do you want your baby and to be a daddy, or not?" Her voice sounded serene despite the abruptness of her words.
His jaw slipped another notch.
"And I won't beg, damn it. If you don't want to share the child, you're out of here, and I get a lawyer."
He seemed to fold up a little more in his chair.
Think only of the baby, she reminded herself, and the freedom exhilarated her, liberated her in a dozen ways. From Mom's inevitable disappointment in her, from the disapproval of all Grand Forks, from the clucking tongues at St. Paul's- their hold on her slipped like chains to the ground. Second-guessing and hesitation about what to do vanished. Work? She'd keep her job as long as possible. Where to go? She'd stay here in her apartment. Whom to count on for no shit about how she ought to have been more careful? Her little brother, Arliss.
Decisions and answers flew into place- snap, snap, snap. She felt weightless.
Thomas stared up at her in absolute awe.
His expression fueled her exuberance over having taken charge.
"I've never seen you this way," he said, sounding totally incredulous. "You're… you're… radiant."
It's the hormones, stupid, she wanted to say, but didn't. Yet her silence caused a weight to tug on the middle of her chest, as if she'd allowed him to snag her in flight and pull her back toward the ground.
"I mean it, Jane. You're absolutely glowing." He got to his feet, walked to where she stood, and put his arms around her.
She resisted. "No. Tell me what you want."
"I love you."
"Yeah, right. How about the child?"
He grinned. "I'd be proud to be a daddy with you."
She watched his eyes dilate as fully as she'd ever seen, even in lovemaking. But from desire? Not this time. He looked more as if he'd been caught in the middle of telling a joke and a bomb had gone off.
Her scrutiny must have made him feel defensive. "What?" he said, his grin widening.
"Proud?"
"Yeah, proud. I'm surprised but proud." He grinned wider still, seeming to warm to the word he'd chosen, and lowered his head to kiss her.
She ducked out from under his lips and held him at arm's length. "Proud!" she said, as if she found the term repulsive.
All at once he looked even less sure of himself.
It made her want to attack harder. "What the hell does proud mean? You intend to put a notch on your… your… well, your whatever, because you knocked me up?"
The pupils pulsed bigger than ever, then narrowed to pinpoints.
She'd only seen people's eyes do that in a strobe light.
He mouthed air a few times, but no words came out.
Her impatience hit the stratosphere. "Well, here's a news flash, buddy. I'm not your or anyone else's trophy." She knew somewhere in her head that her behavior had careened from bitchy to totally unreasonable and back. Yet as he flinched under her onslaught, she loved it.
"Shit, Jane, I'm sorry-"
"So am I."
"But don't be so angry."
"Why not? I feel angry."
"But-"
"But what? Speak up, Thomas."
To her astonishment, a nervous chuckle bubbled out of him. He tried to stifle it, but instead he broke into a loud, rolling guffaw that rumbled from deep within his chest. "You're a real firecracker tonight," he managed to say, and knelt in front of her. "Forgive me, beat me, scold me, but I am delighted, proud, happy, surprised, eager, ecstatic- stop me if I get the right word- to be the father of your child."
All her anger melted away.
He held out his arms to her, beckoning with that damned seductive grin of his.
She lunged, knocking him on his back, and pinned him under her, then straddled his chest, her knees on his arms. "So you want to be a dad?"
"I want to be a dad."
"And you want me?"
"I love you."
"You want to love, hold, and obey?"
"Oh, yeah. Especially the obey part. Or you kill me, right?"
"Right!"
She felt jubilant, as if she'd won a great victory, stood up to the fates, spat in their eye, seized the brass ring, and cliche of all cliches, done it all her way.
And gotten herself a sexy woodsman from Tennessee to boot.
Just like Daisy Mae.
Monday, July 14, 9:30 p.m.
Earl leaned back in his study chair and let the speed dial of his cellular ring through to Michael's house. The man would have to run the department during death rounds tomorrow and needed a heads-up. Should the anticipated fireworks take place, it could be a long session.
"Hello?" Donna answered with the throaty slur of someone who's been asleep.
"Donna, it's Earl. Did I wake you? Sorry. I wanted to speak with Michael. I thought you guys would be up." They were one of the last holdouts in his age bracket who stayed up to watch the eleven o'clock news.
"But he's in ER this evening."
Oh, shit. "Of course, how stupid of me. I can't keep up with the schedule anymore," he said quickly, wanting to get off the line. "I'll call him there. You get back to sleep. Good night." He hung up before she could say anything.
He'd made other calls over the years to the homes of staff members only to be told by a puzzled spouse that the person should be in ER. And he always played the absentminded professor, claiming to have forgotten the schedule. But he could no more forget what shifts he'd assigned to people than his own phone number. Everyone had their regular slots. They knew them; he knew them. An ER physician's life revolved around the damn schedule: who gets what vacations, who works Christmas, who does New Year's Eve. There's no steadier headache for a chief than making sure every hour of every day of every year is covered. Michael didn't do Monday evenings. So unless he had pulled a last-minute switch with someone- not a total impossibility- he had lied to Donna about where he'd gone.
Catching someone out always cost Earl. He didn't like knowing the personal problems of people he worked with. But trouble at home often translated into trouble at work. So he kept a close eye on the men and women whose secret lives he'd unintentionally discovered. But to find it out about his friend, colleague, and acting chief of the department meant worry on all three fronts and having to walk on eggshells at a whole new level.
Please let me be wrong about this one, he thought, ringing ER. "Hi, it's Dr. Garnet. Who's on call tonight?"
"Dr. Green and Dr. Kradic," said the clerk, naming the two veterans who had manned the shift for years. "Do you wish to speak to one of them?"
"Actually, I wondered if anyone saw Michael. Maybe he's working in his office?"
"One moment. I'll check."
He took a deep breath and watched the trees outside his window toss in the wind as yet another storm threatened. Their leafy branches swept back and forth in front of the streetlamps, covering and uncovering the lights in a frenzied semaphore.
"I'm sorry, Dr. Garnet, but no one's seen him."
Tuesday, July 15, 7:00 a.m.
Pathology Conference Room, St. Paul's Hospital
The remains of Elizabeth Matthews lay in open Tupperware containers arranged end to end along the length of a massive polished oak table. Earl scanned her ocher-colored liver, a pair of charcoal-tinted smoker's lungs, two glistening gray kidneys, and a maroon heart coated with yellow fat, the four cardiac chambers sliced open like the inner compartments of a large red pepper. A separate tray displayed the piece de resistance: an amorphous knobby-shaped mass of pearl-colored t
umor that had penetrated the ovaries and uterus, reducing much of the structures to an unrecognizable reddish brown mush. The final two specimens, a coil of bowel and the halves of her brain, were parked to one side, too anticlimactic for comparison.
Pre-SARS, the aroma of fresh coffee would partly cut the acrid fumes at these sessions, but not anymore. Nothing was served at morning rounds these days. Signs posted throughout the hospital read NO EATING ON THE JOB, and cartoons of people raising their masks to gobble down donuts bore stamps of big red circles with lines slashed through them. Most found this new form of prohibition harder to take than the clampdown on cigarettes. Smokers were a minority. Restrictions on food left everyone hungry, in caffeine withdrawal, and snarly as hell.
Even so, death rounds remained popular with staff and trainees. A pathologist's knife spared nobody in exposing the final diagnosis and laid bare the mistakes of all, from the loftiest chief to the lowliest student. The combined prospect of picking up teaching pearls and witnessing the great equalizer of a public stripping-down usually packed them in.
Except today Earl had invoked his powers as VP, medical and limited participation to the players directly involved in the case. What he had in mind required them and only them, not a general audience. Hurst had gladly gone along with the ruling, never even questioned it, always eager to keep anything controversial as secret as possible, SARS or no SARS. And it still wasn't clear if Mr. Matthews would launch a lawsuit.
Earl looked around at the invited guests.
On this side of the table Thomas Biggs sprawled in a chair a few spaces away. Dressed in a crisp white coat, he sleepily inspected the open containers from under drooping eyelids, the aftereffect of a recent string of night calls.
Beside him Jimmy sat upright and alert, leaning forward and raring to go, but wearing a king-sized frown, obviously baffled at why he'd been included.
Everyone else had chosen to sit opposite Earl, face-off style.
Midpoint in the lineup, Paul Hurst formed his graceful fingers into an elongated triangle and absently beat a tattoo with them on the front of his mask.
His sister, Madelaine Hurst, director and chief of all things to do with nursing at St. Paul's, occupied the place at his right side. No surprise there. She always took that position, either oblivious of or indifferent to its symbolic right-hand-man implication. An asthenic woman with austere gray eyes, and known to protect her domain as fiercely as her brother defended the hospital, she clamped her steel gaze on Earl. It felt cold and hard as shackles.
Next to her sat Mrs. Quint, seemingly relaxed, her expression a thousandfold more congenial than her boss's. Earlier she'd even wished Earl good morning. But her corpulent figure exuded an air of authority, and as acting supervisor at the time of the incident, she'd be defending her "girls" just as vigorously as Madelaine
Hurst would.
The most openly hostile pair, Peter Wyatt and Monica Yablonsky, glared at him in unison from the far end of the table. Having placed themselves near the large, wall-mounted video screen that would be used for the upcoming presentation, they'd picked the prime spot to make sure everyone else would witness their show of disapproval.
Predictable, Earl thought.
Stewart Deloram, however, surprised him. He'd positioned himself at Paul Hurst's left elbow and, with surprising charm, cozied up to him from the minute they sat down together, chatting breezily while studiously avoiding eye contact with Earl.
Now what could that be all about?
Len Gardner, habitually occupying the oversized chair at the other end of the table, rose to his feet. "We might as well begin," he said, and with a touch of a finger to his laptop computer, the wall-mounted screen sprang to life. A swirl of pink lines and blue dots appeared, the primal color scheme pathologists use when staining body tissues so that they will be visible under a microscope. This particular pattern, wavy mauve strands reminiscent of a van Gogh, were woven beneath an array of tiny purple dots worthy of a Monet. Together they depicted normal uterine muscle lined with disintegrated mucosa.
Len clicked through a series of such images- the strands of muscle and sheets of mucosa appearing successively more shredded- to document the tumor's relentless progress. "Invasion by increments," he described it, "destroying Elizabeth Matthews's reproductive system cell by cell."
Earl recalled the ghastly distortions on the woman's wan face as she'd endured what they were seeing.
As the demonstration continued, Stewart occasionally whispered something in Hurst's ear and pointed to the screen, seemingly adding his own spin to the narrative. He still hadn't looked in Earl's direction.
Len moved on to pictures that confirmed the cancer hadn't yet disseminated throughout the rest of her body, flicking through shots of the other vital organs and showing them to be free of any metastatic spread. "Certainly her neoplasm had not reached a stage such that it would be incompatible with life," he emphasized.
Laying down his laser pointer, he removed the tumor from its container and, sticking here and there with a steel stylet as long as a knitting needle, demonstrated in macroscopic terms the assault on Elizabeth Matthews's womb.
"Any questions?" he asked when finished.
No takers.
Earl often worried how voyeuristic and sicko these sessions would seem to the outsider. Yet they remained at the heart of learning medicine, exposing the profession's victories and errors with a certainty that no other part of the discipline could provide. Should they ever suffer the ax of public outrage because the media exposed them to lay scrutiny, doctors wouldn't be flying blind, but it would be as if they'd lost an eye.
Len gestured to Stewart. "Dr. Deloram has volunteered to present and interpret the biochemistry of the case, including the postmortem drug screens."
"Thanks, Len." Stewart stood up, and with a click of a remote, a slide projector mounted on a steel table began to whir noisily. A few more clicks, and its carousel advanced with a loud rattle. Pushing another button, he caused a movie screen to descend from the ceiling and come to a stop above the video monitor.
It's a wonder he didn't play the theme from 2001, Earl thought.
Enlarged charts of lab values sprang into focus on the white surface.
"As you can see, aside from a raised calcium level, the result of the tumor having eaten into the bones of her pelvis," Stewart began, "the hematological and biochemical values remained mostly normal until the time of death. In other words, as Dr. Gardner has so elegantly demonstrated, multiple organ failure had not yet become part of the picture." More numbers flicked by. "Specifically, I draw your attention to the patient's normal liver and kidney function, since this will have a bearing on our ruling about the cause of death." He turned to address the nurses. "You no doubt recall that morphine is broken down in the liver and excreted in the kidney. After looking at these standard values, a physician might reasonably conclude the patient ought to have been able to metabolize a dosage increase of the magnitude Dr. Garnet ordered, especially since previously prescribed amounts of the narcotic hadn't treated the woman's pain."
He paused and cast a glance at each of the women, eyebrows raised like a mime telegraphing that he expected a response.
Mrs. Quint gave a reluctant nod of agreement.
Madelaine Hurst simply stared back at him, unwilling to yield up so much as a blink.
Monica Yablonsky had the startled look of deer blinded by a poacher's light. She started to fidget with her glasses.
Attaboy, Stewart, Earl thought. So far so good.
"And I take it that all present are aware of the sequence of events leading up to this woman's demise," Stewart continued, "Dr. Garnet's doubling of her morphine dose, the times that the nurses administrated it, and the patient's vital signs throughout?"
Nobody indicated otherwise.
"Fine. Now while a lethal level of morphine undoubtedly killed this woman, the source of that toxic concentration is not at all clear."
What?
"T
he amount present in her blood at the time of death might indicate that approximately double the amount Dr. Garnet prescribed may have been administered to the patient, but this explanation isn't that certain."
Wait a minute. What's this "not all that clear" and "isn't that certain" crap?
"A fall in blood pressure could have resulted in a delayed uptake of the first injection that had been given around nine that evening. Later, should the pressure recover and the uptake of the drug into the patient's bloodstream return to normal, both the remnants of that shot and the entirety of the second dose would enter the circulation simultaneously, leading to the toxic levels that killed her."
No! Wrong! Wrong! Wrong!
"Even though the nursing records indicate no such fluctuations in her vitals," Stewart continued in a fluid, singsong delivery more appropriate to a travelogue than a death review, "they might have come and gone undetected. And to reiterate Dr. Gardner's findings that the woman's cancer, while undoubtedly painful, had not yet brought her near death, it's a known fact that morphine itself can drop a patient's blood pressure. So we are left with two possible scenarios: either someone doubled the second injection, or undetected fluctuations in blood pressure led to a delay in the absorption of the first, leading to an accumulation of the two shots."
Earl leapt to his feet. "What the hell are you talking about?"
Stewart sat down and studied the table between them.
"That's garbage, Stewart, and you know it."
Stewart said nothing, still avoiding eye contact, but Earl saw the black of his pupils grow wider.
Like a variation on Pinocchio's nose, the lying son of a bitch. "Why are you doing this, Stewart?"
"Doing what?"
"You know damn well. All that 'fluctuating pressure' bullshit." But Earl had already guessed the reason: to provide a scenario that could give Hurst an out. Not a good one with legs, but enough to confound the findings and keep the table from reaching a definitive conclusion. Then the whole mess would end in limbo, and he'd avoid a public scandal.
"Patients fluctuate wildly near death," Stewart said with a shrug. "They can be nearly comatose one day and rally the next, the improvement there for no more apparent reason than a need to say good-bye, and it all happens with no change in their metabolic numbers. It's a part of cancer we don't understand, almost as if bad humors were at work-"
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