by C. J. Lyons
“Why? Are you planning a procedure?”
“No.” He shifted his weight, obviously uncomfortable.
“It doesn’t look good, does it?” For the first time, Lydia gave her doubts a voice.
“Dr. Stone hasn’t made rounds yet this morning, but he’s probably going to get an MRI angio later today.” A test for brain death. Lydia blinked hard and kept her face as neutral as possible. “We knew the odds were overwhelming,” he continued, almost as if trying to comfort her. “Before anyone even touched her, it was too late. That’s why it’s so hard when you guys in the ER do something heroic like this. Makes the family think there’s hope.”
“Is that why you want me to leave? Because I tried to save her?”
He shook his head, frowning. “No. The father has gotten a lawyer. They have a restraining order against you.”
Lydia straightened so fast she jerked the pulse ox monitor off. She replaced it before the machine could alarm. “A restraining order?” It was crazy. “Why? How could they? The courts aren’t even open yet.”
He shrugged. “I guess it’s not officially a court order. Just a letter on her chart from a law firm. A man brought it this morning, made the charge nurse sign for it. Looks pretty serious to me.”
“They’re going to sue me? For trying to save their baby?” The lights and monitor tracings all blended together in a cascade of colors, as if she’d stepped into an alternative reality.
“You gave the family hope. So when things go wrong, it makes you an easy target. The mom’s bad enough, all wailing and gnashing, but the dad”—his frown deepened to a scowl—“he really has it in for you, claims you assaulted him. Way he talks, you’re worse than the driver of the car that hit him.”
“You mean the car he hit—after running a red light and being drunk enough to have a BAC three times the legal limit.”
“I can’t judge him. All I can do is take care of their child and help them begin to understand the reality of her condition. But for Alice’s sake, I really do have to ask you to leave and not come back.”
Lydia drew in her breath, ready to argue. But the sight of the little girl, still as death, quieted her anger. “Okay. I have my cell—will you ask Lucas Stone to call me, keep me updated?”
“I will.” Lydia began to walk toward the door when he called out, “Be careful of Mr. Kazmierko—I don’t think this is the end of it.”
LUCAS SPRINTED UP THE STEPS TO THE ICU SO fast Amanda wasn’t sure his feet ever touched the ground. By the time she followed him into the ICU, her breath was coming in heaving gasps, but he was already at Tracey’s bedside, surveying the situation and calmly giving orders.
“Get me a gas, lytes, calcium, and magnesium. What’s her bedside glucose? How long was the seizure?” he asked as he examined Tracey.
“Generalized seizure, two minutes, preceded by a spike in blood pressure,” Jim Lazarov answered. His voice was nowhere as calm as Lucas’s. He sounded jittery, like a high-tension wire vibrating in the wind.
Lucas grabbed the EKG rhythm strip revealing the electrical spikes that drove the heartbeat and scrutinized it. “Bradycardia preceded the seizure.” Then he turned to the EEG machine. “Except there’s no sign of seizure activity in her brain.”
“What the hell? I saw it, it looked exactly like a seizure.”
Amanda thought about Becky Sanborn and the way she’d presented to the ER. “Myoclonus and muscle fasciculations,” she suggested. “Severe enough, they’d look like seizures.”
“Myoclonus doesn’t cause a spike in blood pressure or EKG abnormalities,” Jim snapped.
Lucas wasn’t buying any of it without evidence. Amanda watched as he checked and rechecked the EEG and monitor leads, glanced through the nursing notes, and even checked Tracey’s IV.
“Who added bicarb to her IV?” he demanded.
“You did, Dr. Stone,” the nurse said. “Pharmacy sent it up last night; the order was processed”—she flipped through her chart—“at eleven forty-four p.m.”
Lucas was shaking his head, his glasses seesawing on his nose. “Let me see that.”
She shoved the chart at him. “According to the pharmacy it was a faxed order, came directly from you.”
“I never—they must be mistaken, gotten the patients mixed up.”
Now the nurse looked alarmed. “No. Look, it was confirmed with her patient number—it’s all straight from the computer.”
“Then the night nurse made a mistake, took the order from a different doctor—I didn’t order any changes, certainly not at eleven forty-four last night.”
The clerk rushed up, handing Amanda a lab slip. “Her blood gas is back. The pH is seven point four eight; she’s got a definite metabolic alkalosis.”
“Switch the IV to normal saline; let’s run a bolus, get me a repeat gas in an hour.” Lucas tapped his fist against his lips as he concentrated on Tracey’s motionless form. He thought for a few moments, then raised his face to laser in on Jim’s. “How much did you give her total?”
Jim startled, and Amanda was surprised to see him look away, unable to meet Lucas’s gaze. “I don’t know what you’re talking about.”
“The EKG shows that this all started with a run of bradycardia. A sign of Tensilon toxicity.”
Jim shuffled back as if Lucas’s low tone were a barrage. “I didn’t do anything wrong.”
“How much did you give her?” Lucas enunciated each word sharply enough to make Jim flinch.
“I followed your protocol. Started with point one milligram, went up to one milligram, then three and then five when she showed no response.” Jim straightened his shoulders and whirled on Amanda as if this were somehow her fault. “I told you it wasn’t myasthenia gravis.”
“So you gave her only a total of nine point one milligrams?”
“Right. Strictly per your protocol. All I was doing was saving you time. I had everything under control.”
Lucas raised an eyebrow and kept his gaze directed at Tracey without saying a word.
“Jim, you could have killed her,” Amanda protested.
“The main risks of a Tensilon challenge come from airway control and possible anticholinergic syndrome. We have her airway secured, and other than the bradycardia—which responded to a single dose of atropine—she showed no other symptoms. You can’t blame the alkalosis on me; I’m not the one who added bicarb to her IV fluids.”
“No, you’re just the one who almost killed our patient,” Amanda snapped.
To her surprise, Lucas didn’t back her up. Instead he was concentrating on the latest lab results. “He’s right. It’s not myasthenia. We need to resedate her and start over.” Jim practically preened, but Lucas ignored it, swinging around to focus on them both. “You two, get down to pathology. Ken Rosen should have those slides ready for us. I’ll join you as soon as I’m sure she’s stable.”
Jim slumped, his face twisted into a scowl of insubordination—he obviously expected some kind of medal for breaking the rules and doing the Tensilon challenge on his own. The scowl quickly vanished as Lucas edged a glare in his direction. “Come on, Amanda, don’t dawdle.”
NORA RAPPED ON THE TRAUMA RESIDENT CALL room’s door, trying to ignore the churning in her stomach. It was in the room right next door that she had found Seth and Karen, the bimbo nurse anesthetist, together. Naked. Memories ricocheted through her mind: Karen’s smug smile, the way she flaunted her too-perfect-to-be-natural body, her expression of superiority, laughing at Nora … and then Seth, waking up, the look of surprise and guilt on his face—right before Nora slammed the door on him and their future together.
Nora took a breath, holding fast to her resolve. She had to end this cleanly, now, before it started interfering with her work.
Seth’s intern said he was here, but Seth wasn’t answering. Did he know it was her?
She rattled the doorknob of the stout old oak door. It turned easily, but something else was holding it in place. Residents weren’t allowed to p
ut locks on their call rooms—they had private lockers for that.
Nora pounded with the side of her fist, hard enough to rattle the door in its frame. “Seth! Open up, it’s me. We need to talk.”
After a moment she heard furniture moving, being dragged across the floor. Then the door opened and Seth appeared, looking rumpled and haggard as if she’d just woken him. Impossible. He was a surgeon, would have been in the hospital by five-thirty, making rounds. And surgeons didn’t nap, especially not less than two hours into a workday.
As he ran his fingers through his hair, trying to smooth it down, she wondered if maybe the door had been blocked because he wasn’t alone. She craned her neck, trying to look past him, but he was too tall.
“Did I come at a bad time?”
“Uh, no. Of course not.” He rubbed one cheek, his fingers tracing fresh sheet impressions. “I didn’t get much sleep last night, was just trying to get caught up.”
“I’ll bet you didn’t get much sleep. What did you do? Ransack the gift shop and all the patients’ rooms?”
His forehead creased. “What did I do?”
She knew it was going to be painful, but she had to see for herself. She pushed past him, stomping into the room, ready to confront Karen or whoever the bimbo of the week was.
The room was empty. The sheets were tangled on the bed, Seth’s shoes sat beside his OR clogs, and his lab coat was draped over the back of the only chair in the room. The door to the minuscule bathroom was open and it was obviously unoccupied.
Unless Karen was hiding under the bed with the dust bunnies, Seth was alone.
Nora was surprised at the disappointment she felt. This time she’d been ready—instead of the speechless, stunned, simpering fool she’d played last time, this time she knew exactly what she wanted to say. Only there was no one to say it to.
Robbed of her chance to confront Karen, she whirled on Seth. “This has to stop. Now.”
He turned slowly, holding onto the door. “What? Nora, I don’t know what you’re talking about.”
“The flowers. You. Standing around, watching my house all night. Stop it.”
He shook his head, a stray lock of hair falling unnoticed into his eyes. “I haven’t been watching your house—well, maybe I’ve driven by Mickey’s a few times, just to make sure you were all right …” His voice trailed off.
“Seth, don’t play games. I know you left them.” She took a step back. “If you don’t stop, I’m going to the police.”
“Nora.” He straightened, lumbered toward her. “Do what you have to do.” He spoke slowly, resignedly, as if each word were painful.
His expression was serious, his voice level, his gaze open and without deceit. Exactly the way he had looked when he assured her that he and Karen weren’t sleeping together.
She bit her lip, as angry at herself for being sucked in by his Huck Finn gosh-shucks playacting as she was at him. “Go to hell, Seth.”
Stalking past him, she took advantage of the solid oak door and slammed it. Hard. A satisfying bang echoed down the hallway, but it did little to quiet the turmoil that raged through her. She saw the elevator doors begin to close down the hall and sprinted, catching them just in time, and found herself alone inside the steel box with its mirrored walls.
The woman who faced her was a stranger. A stranger with the bruised look of a victim.
Nora turned her back on that strange woman and pounded the button for the first floor with her fist.
TWENTY-THREE
Friday, 7:47 A.M.
“I CAN’T BELIEVE YOU DID THAT,” AMANDA told Jim as they rode the elevator down to the basement.
“Hey, I did my homework. I knew Stone was being overly cautious by insisting that he be there for the challenge. I might have saved her life by ruling out myasthenia before we wasted any more time on chasing zebras.”
“Zebras are all we have left.”
“Says you. Maybe Lucas Stone isn’t the genius everyone makes him out to be. I’ve heard he’s lost other patients lately.”
“Which is why we need to help him figure out what’s wrong with Tracey.”
“Please,” he said, rolling his eyes and using a mock Southern accent. “You mean it’s why you want to help him. You don’t really give a shit about our patient.”
“How dare you! Of course I care about Tracey.”
“I know what you’re doing and it won’t work.” He snatched the sheaf of articles from Amanda’s lab coat and thumbed through them with disdain. “You’re wasting your time.”
Amanda retrieved her research and shoved it back into her pocket as they exited the elevator. She was barraged by smells of mold, burned laundry, and a sickly sweet scent that she suspected meant a rat had died somewhere nearby. She hated being down here, and she was annoyed with Jim and worried about their patient. It was clear Tracey was starting the same downward spiral that had led to Michelle Halliday’s and Becky Sanborn’s deaths. “I have no idea what you’re talking about.”
“Sure you do.” Jim stopped at an intersection where two large steam pipes branched out overhead. “Lucas Stone. You’re trying to seduce your way into a good grade. Too bad he’s gay.”
It took a second for Amanda to process what Jim was saying. He started down one corridor, stopped, turned around and began down the opposite one, Amanda rushing after him.
She’d never seen anyone sputter in indignation before, but she was pretty sure that was exactly what she was doing. Wouldn’t be surprised if there was steam shooting out her ears like in the comics. Only problem was, Jim didn’t seem to notice or care.
“First of all, it’s none of your business. Second of all, you’re an idiot. Third, that’s rude, crass, insensitive, and ignorant. And finally—” She broke off, her thoughts galloping faster than her words. “And finally, you’re an idiot.”
Jim only smiled. Smug, superior, confident—not even a smile, a smirk. “Whatever.” He stopped again, straining to read a faded sign. “Shoot, this isn’t right, we’re heading toward the cemetery.”
“Cemetery?”
“Sure. See that dark tunnel with the low ceiling and brick walls? In the old days, they’d bring the corpses directly from the hospital over to be buried. Saved time, especially during times like the Spanish flu and polio epidemics when folks were dropping like flies.”
She backtracked, throwing a worried look over her shoulder toward the darkness that lingered behind her, ready to pounce on unsuspecting medical students. “You’re just trying to scare me.”
He stopped and flashed a toothy grin at her, one that didn’t make it to his eyes. “It’s working, isn’t it? Never knew you were superstitious. Or is it claustrophobic? You’ve been skittish ever since we came down here.”
“I just don’t like wasting time, is all. Tracey Parker is counting on us to find the answers we need to help her.”
“Tracey or Dr. Stone? I told you, it’s a lost cause. I’m more his type than you are.”
“What’s with you and this obsession with Dr. Stone’s sex life?” she asked as he led her down another corridor, this one more modern and brightly lit.
“Hey, I just call them like I see them. Makes no matter to me—I can get any woman I want, anytime I want.”
“Right. Mr. Studmuffin.” Amanda laughed, picturing the blueberry muffin Lucas had crushed into a blob during breakfast this morning. A soft, doughy blob with blueberry pimples—that’s what Jim reminded her of. Despite his clean-cut preppy good looks, he really was just a blob. No one to take any account of.
“What?” he demanded, his voice bouncing off the concrete walls and echoing down the corridor. He spun on his heel, trapping her against the wall. He hadn’t touched her, but his body was so close she could count the pores on his cheeks, see the faint stubble his razor had missed. “You don’t believe me? What are you laughing at?”
Jim seemed to feel that the rules didn’t apply to him, that he had the right to badmouth the hardworking people around him,
but he was really an arrogant, lazy ignoramus who took credit for other people’s work while avoiding his own and who didn’t give two shakes of a possum’s tail about his patients.
She straightened, meeting his gaze dead on. “You, Jim Lazarov. I’m laughing at you.”
He raised his hand, and she realized too late that his eyes had narrowed. Before she could move, he grabbed her arm.
Amanda reacted instinctively. She shoved off the wall, driving her knee into what she hoped were Jim’s genitals. He squealed—a real, honest-to-goodness full-blown hog squeal—and let her go.
Jim slumped against the wall, both hands hugging his crotch. “What the hell! I was just trying to help you—your hand, it’s twitching.”
She looked down at the arm Jim had grabbed. Muscle fasciculations rippled below the skin, coiling up and down the back of her left hand and forearm. Gingerly, she touched her hand. It was numb. She tried to make a fist but couldn’t; instead, the movement produced shocks of electricity spiraling into her elbow.
Amanda stood rigid, the adrenaline that had propelled her moments ago flushed away by embarrassment.
“What’s wrong with you?” Jim asked, barely able to stand upright.
She wasn’t sure whether he meant her reaction to his touch or what was going on with her arm. “Everything’s fine.”
She shook her arm from the elbow, let it hang for a moment, and slowly feeling returned. She made a fist, released it, and wiggled her fingers. No more tingling; everything seemed to be back to normal.
“Didn’t look that way—looked a lot like what that patient had.”
“It’s nothing. Just forget about it.”
Jim managed to stand, although he still leaned against the wall. “Not very likely. That was some kick. Maybe I should press charges or something.”
“Wuss,” she muttered. Any one of her brothers could pound him into the ground without breaking a sweat. “Heck, my great-aunt Nellie could whoop you. Even without her white cane.”
“Still, I’d bet Stone would like to hear about your ‘nothing’ symptoms. Especially the way you tend to overreact when someone tries to touch you. What if I’d been a patient?”