Warning Signs

by C. J. Lyons

  Nora grabbed the bunch of flowers and whacked them against the railing of the stairway, quickly decapitating the delicate blossoms and venting her fury as the petals exploded around her.

  TWENTY

  Friday, 6:17 A.M.

  SOMETHING COLD BRUSHED AGAINST AMANDA’S arm, and she startled awake. She’d fallen asleep at a computer in the hospital library. She brushed her hair away from her face and looked around. Then grimaced.

  Lucas Stone stood over her, offering a can of Dr Pepper. She accepted it without thinking and took a gulp to cover her embarrassment. She’d retreated to the quiet refuge the library offered and had spent the rest of the night researching Tracey’s symptoms and trying in vain to correlate them with anything she could have been exposed to through Jared or the boathouse.

  Well, most of the night. Her fingers mashed at her face, tracing the imprint the keyboard had left behind on her cheek.

  “I noticed you seem to like the sweet stuff. You know, that’s got more caffeine than coffee,” Lucas said, leaning against the back of a chair. “Looks like you might need it, though.”

  She looked at him with suspicion. “Are you here to tell me I’m suspended?”

  Ignoring her question, he rustled through the stack of articles she’d printed out. No answers yet, but lots of theories to consider.

  “Good work. I disagree with Friedman and there’s no evidence of heavy metal toxicity, but this article about lupus and progressive multifocal leukoencephalopathy could be promising. Wow, you even got into beta spectrin degeneration; I’m impressed.” He squinted at her over the top of the sheaf of papers. “Guess maybe you’re better off with me than stuck down in the clinic.”

  “Is Tracey okay?” She started to stand, but her foot was asleep and she stumbled, almost spilling the Dr Pepper on Lucas.

  Lucas stepped forward to catch her, then froze, leaning back as she steadied herself on the back of the chair. Like he was afraid to touch her. Who could blame him after the way she’d acted last night? She was never going to mix beer and wine again, she swore.

  “No change.” Handing her the papers, he spun on his heel, not waiting as she grabbed her lab coat. “C’mon, I’ll buy you breakfast. Then we need to make rounds.”

  He was acting as if nothing had changed—yet it also felt as if everything had changed. No surprise after her blatant display of hussiness last night.

  Her neck flushed with embarrassment, and she gulped the Dr Pepper, barely tasting it, but the fizz and cold brought her fully awake. Buttoning her lab jacket over her rumpled scrubs and shoving her notes into her already bulging pockets, she hurried to catch up.

  Then she took a breath and forced herself to slow to a more professional pace. If he could ignore what happened last night, so could she. Nora had been right—it never happened, it never happened was her new mantra. She couldn’t afford to embarrass either herself or Lucas again, not if she wanted to pass this rotation. A mask slid down over her features as she strolled down the corridor beside Lucas. Two professionals going to breakfast, that’s all this was.

  If only her heart would stop galloping so hard that she was sure it was ready to burst free from her chest.

  NORA WAS LATE. SHE WAS NEVER LATE. SHE HAD slept through her alarm—she never slept through her alarm. Heck, usually she woke five minutes before the alarm went off. But last night had been one of her worst nights since she’d left Seth: restless, jittery, barely drowsing, waking every few minutes with a panicked lurch, her heart double-clutching, until sheer exhaustion took over.

  She grabbed her car keys and ran out her door and down the steps that led from her second-story apartment to the rear of Mickey’s house. Almost tripped and fell down the last few when she saw what waited for her below.

  The steps were garnished with bouquet after bouquet heaped together, bright colors popping out from under greenery, the morning sunshine glistening on the cellophane.

  Lavender daylilies. Her favorite. She crouched beside the mountain of color and rustled through the arrangements. No card. Again. But there was no need for a card. Seth knew how much she loved daylilies and that lavender was her favorite color.

  She’d probably heard him returning during the night; that was why she’d kept waking. Had he been watching her? After she’d already run him off once?

  Crushed petals tumbled through her fisted fingers. Nora stood, stomping through the floral offerings as if they weren’t there, and stalked to her car. Her fingers shook as she turned the key in the ignition.

  This had to stop. She blinked in fatigue, trying to summon the energy to drive the two miles to Angels, not to mention working a twelve-hour day. He had to leave her alone. She couldn’t keep living this way.

  TWENTY-ONE

  Friday, 6:51 A.M.

  GINA STOOD POISED IN THE DOORWAY TO HER bedroom, smoking a cigarette. She’d avoided temptation all night—other than a shot of Maker’s Mark to help her sleep. Now she was up and fully dressed, even had her Kevlar on.

  She took another drag and blew it out in a stream of smoke, imagining Greta Garbo—now there was a woman with attitude.

  All she needed to do was walk out the door and drive over to meet Med Seven. Prove to Lydia Fiore once and for all that Gina could handle it, that she was in control. She could do it. She would do it—if only to show Lydia how wrong she was, threatening to dump Gina from the residency program.

  After all, Gina was the goddamn Hero of Angels, wasn’t she?

  She didn’t move. Imagined falling back onto her king-sized bed with its thick handcrafted mattress and silk sheets, the weight of her ballistic vest pulling her down, the soft folds of sheets billowing over her, sinking, sinking … finding that warm safe place where nothing could touch her, where she was bulletproof from everything and everyone.

  The temptation was overwhelming. She tugged at the Velcro of her vest, shuffled one step forward. Bed was where she’d spent most of her life lately. At least the hours when she wasn’t marking time at work or with Jerry.

  Jerry. Visions of herself, regal and elegant in a white flowing dress, Jerry beaming at her as they exchanged vows, children racing around, filling a house with laughter as he wrestled with them… . She shook her head. Jerry would make a wonderful father, the best. But she didn’t have what it took to be a wife or a mother. She barely had what it took to take care of herself, much less someone else.

  She crushed her cigarette into her Murano ashtray. The bed filled her vision once more. Another step and she was almost there, had almost escaped. Part of her despised the weakness, the surrender. Most of her was too numb to care. She ripped another swath of Velcro open.

  The phone rang, and her stomach jumped with guilt. She grabbed it. “Hello?”

  “Gina, it’s Trey Garrison. Look out your window.” Puzzled, she crossed the room to the front windows overlooking Gettysburg Street. Double-parked in front of her house was an ambulance. In front of it, waving up to her, stood Trey Garrison, dressed in his district chief’s uniform. Beside him, slouched against the driver’s door, his trademark Oakleys shielding his eyes, was Scott Dellano—better known as Gecko—one of the paramedics who’d been with her during the drive-by shooting.

  “Trey. What are you doing here?”

  “Heard you needed to get back on the streets or you’d never finish your EMS rotation. Figured the least I could do was come along on your first shift.” His voice was jovial, more inviting than pressuring.

  She shook her head, recognizing Lydia’s guiding hand. Lydia might be new to Angels, but she sure as hell seemed to have Gina’s number.

  Gina wasn’t sure whether to be insulted or touched. It wasn’t every day a district chief of Advanced Life Support escorted an emergency medicine resident on a ride-along.

  “How can I say no?” she said, forcing lightness she didn’t feel into her tone. No, she didn’t feel light at all; she felt bloated and heavy, weighted down. “I’ll be there in a minute.”

  She hung up and walk
ed out of the room with one last glance at the bed. As she closed the door, gunfire echoed through her mind, along with the grit of the pavement as she dove for cover, the gleam of the bullet caught by the Kevlar vest.

  Pausing in the hallway outside her bedroom, she bowed her head, sucked in a breath that swelled her chest until her vest tightened like a boa constrictor. She could do this. She could.

  Acid bit her throat. She sprinted down the stairs and out the front door before she could change her mind.

  DURING THE SHORT TIME THEY’D BEEN WORKING together, Amanda had figured out a lot about Lucas Stone. For starters, he was more than a tiny bit compulsive. He was downright germophobic—something manageable on the wards, where sinks and soaps and antibacterial foam dispensers were in easy reach. But here in the cafeteria?

  Breakfast was the one meal when the cafeteria could be counted on to prepare something that tasted better than sautéed cardboard, so it was always the most crowded time of day. When they finally found an empty table, Amanda sat down with her tray piled high with eggs, hash browns, sausage, oatmeal she tried to pretend was grits, and a glass of milk.

  Lucas, on the other hand, balanced his tray on the flat of his palm with one hand as he efficiently wiped his side of the table before sitting. His breakfast consisted of a packaged blueberry muffin, a banana, and a cup of coffee, along with a package of plastic silverware and a stack of napkins.

  Amanda dug in, watching as Lucas stirred a package of sugar into his coffee, then unwrapped a straw.

  “I’ve never seen anyone drink coffee with a straw,” she said.

  “Doesn’t burn your mouth this way.” He gestured to the length of the bendy straw. “Gives it time to cool.”

  “Right. Surprised more people don’t use straws with their coffee.”

  He glanced around the crowded cafeteria, flinching as someone sneezed at the table beside them. “So am I.”

  He ate his banana first, finishing the entire thing without putting it down. “Did you find anything?”

  She was halfway through a mouthful of eggs and sausage and had to swallow before answering. “About Tracey?”

  “Or the others.”

  From the way he stared at her, she had the feeling he was trying to decide whether to lump her in with Becky and Michelle. She started to tell him about the possible connection to Jared and the boathouse, but stopped. It was too vague. She’d just regained his trust; she couldn’t afford to look like a fool.

  “No. Nothing fits. That case study of shattered nerve syndrome was the closest thing I found.”

  He didn’t look too surprised at the unusual diagnosis. What was she thinking, that she could come up with something that Lucas Stone couldn’t? The man was a genius, and everyone marveled at his diagnostic acumen—if he couldn’t figure out what was wrong with their patient, what hope did she have?

  “What about your symptoms?” He fiddled with his straw, gazing into the coffee cup as if it held the answers. “Don’t you think it’s about time you told me what’s going on?”

  “Our patients”—she stressed the pronoun—“had a much more precipitous course. I’m sure I have nothing in common with them.”

  “Why don’t you let me be the judge of that?” he snapped, jerking his chin up in irritation. “Damn it, Amanda, why won’t you trust me, let me do my job?”

  “Maybe because my symptoms aren’t your job. Besides, Dr. Nelson is taking care of things.”

  His face clouded and a flush colored his cheeks, highlighting the early stubble of a beard, reminding her that she wasn’t the only one losing sleep over their patients. “You trust him more than you’ll trust me?”

  She laid her hand flat over his and felt his muscles bunch as he suppressed a flinch. She pulled away, chiding herself. Everyone in her family was always touching, hugging, reaching out—but now it was a dangerous habit. She had to make him see her as a professional, a colleague. It should be easier because it was so very obvious he had no interest in her, but it wasn’t.

  “I trust you, Lucas. But we need to focus on Tracey—I don’t want my little medical student hypochondriasis or stress or whatever to distract you.”

  He narrowed his eyes at her, well aware that she had avoided his question.

  “Did you talk to Tracey’s boyfriend, Jared?” she asked, hoping he’d change the subject.

  “He was gone last night, but left a message that he’s coming back this morning. We couldn’t find any other family.” His eyes took on a faraway expression and his mouth tightened. “I’m hoping that maybe I can give him some good news when he gets here, but—”

  “Hey, no change is good news.” Amanda wondered at her need to comfort him. He was an attending, had probably lost more patients than she had seen in her short career, but he just seemed so vulnerable. As if it were his fault Tracey wasn’t better. “At least she’s stable, not deteriorating like Becky did.”

  “For now. Who knows for how long.” He took another sip of his coffee and tossed his still-wrapped muffin from hand to hand, crushing the poor thing to a mass of sticky crumbles. “I asked Ken Rosen to consult.”

  “He’s an immunologist, right?” The one who’d been with Gina during the drive-by shooting last summer. Amanda had often wondered about the man but hadn’t met him herself.

  “Pretty smart guy. I asked him to set up some special immunofluorescent stains from Becky’s tissue specimens. They should be ready for us to review later this morning. Hopefully they’ll show us something we—I—missed. Or at least point us in a definite direction.”

  Amanda liked it when he used the plural pronoun; it felt like she was an important part of the team, not just a student there to do scut work. Or worse, a liability.

  “Lydia and I were talking,” she started, hoping that by invoking another attending’s name she wouldn’t look too foolish, “and she suggested you might look at environmental causes. Maybe mercury toxicity.”

  “Lydia said that?” His tone made it obvious that he’d seen through her. “What’s going on, Amanda? If you found something—”

  “It’s nothing, just a rough theory. Not even a theory.”

  “Tell me.”

  “We were going through Becky’s and Michelle’s charts and realized that they both rowed.”

  “Rowed?”

  “You know, like crew? Becky was on CMU’s team, and Michelle worked at the same boathouse.”

  “Hmm … a boathouse? I guess they might have cleaners and other chemicals. But that doesn’t explain Tracey or her symptoms.”

  “Jared, Tracey’s boyfriend, works at the same boathouse.” She plunged on. “So when we saw that Michelle had an elevated mercury level—”

  “I’m waiting on Tracey’s test results, but I’m sure you’re well aware that mercury doesn’t explain their deaths.”

  “Well, not alone. Maybe there’s something else?”

  “Leaving us exactly where we started.” He looked downright glum.

  “So you’re still going to do the Tensilon challenge this morning?” She hated the thought of Tracey waking up, paralyzed, unable to communicate, but they had run out of options.

  “Yes. Jim’s getting everything ready upstairs.” His pager went off. He glanced at the readout and cursed, almost dumping his tray as he jumped up. “It’s the ICU. Tracey Parker is crashing.”

  TWENTY-TWO

  Friday, 7:14 A.M.

  EMMA GREY’S PACEMAKER SURGERY WASN’T scheduled until nine, giving Lydia enough time to check on her patients in the ICU before she retrieved Deon.

  Spending her day off babysitting a kid wasn’t top of her list of things to do—she had planned on spending the day in the medical library or pathology, looking into the cases Nora had brought her to review.

  What the heck was she supposed to do with a ten-year-old kid, anyway? She could barely take care of a cat—and No Name wasn’t even her cat, pretty much fended for himself.

  But she had taken care of her mother for all those years—t
hat gave her hope that she wouldn’t screw up too badly. Besides, it was only for a day or so, how bad could that be?

  Maybe Trey had left one of his shoot-’em-up movies at the house? No, too much violence. She’d ask the folks in Child Life to recommend one that was age-appropriate. Besides, it was too warm to keep a kid inside. But she doubted a ten-year-old street kid would like to go for a run—much less keep up with her seven-minute miles. Hmmm …

  The nerve-grating, low-pitched subliminal buzz that permeated the peds ICU pushed all thoughts of Deon from her mind. She hated this place with its bright, cheerful colors surrounding families hovering between hope and despair. Hated the careful whispers, the smiles the nurses wore like death masks, the too-tiny beds eclipsed by machinery and monitors.

  Here and the neonatal ICU were the two places Lydia usually tried to avoid. But she wanted to see how Alice Kazmierko was doing, if her gamble had paid off.

  There was no one else at the baby’s bed space. She grabbed the flow sheet with the information collected overnight. Not good; Alice’s EEG showed slowing and minimal variability, and her sodium was dropping—a sign that her brain was going into SIADH and producing the wrong hormones.

  Lydia dropped the clipboard back on the table and washed her hands. She automatically reached for the stethoscope hanging from the monitor railing but then pulled back. This baby didn’t need someone else listening to her heart. Her heart was fine.

  Instead of examining the baby, Lydia simply laid her palm over the girl’s forehead, taking care not to disturb the EEG leads. She stroked Alice’s leg with her other hand, hoping the human touch might do more than the machines had.

  “Dr. Fiore.” The pediatric fellow joined her at Alice’s bedside. “I’m going to have to ask you to leave.”