In addition to St. Onge, three others were in the room with Christine—an orderly, the lab technician, and a second nurse. David ignored them all and rushed to the examining table. “Dr. St. Onge, I’m Dr. David Shelton,” he said looking only at Christine. She was lying on her side, sterile drapes over her head. A large patch of hair had been shaved away from her left ear. The drapes surrounded an ugly, three-inch gash that was nearly sutured shut.
“David?” Christine’s voice was the empty whimper of a lost child.
He knelt by the table a safe distance from the sterile field. “Yeah, hon, it’s me.” The reassurance in his voice belied the anger and sadness inside him. “You’re doin’ fine. A few dents, but you’re doin’ just fine.”
“We’re a pair, aren’t we?” she said weakly. The few words were all she could manage.
“And who the hell are you?” St. Onge was obviously not satisfied with David’s introduction. He was a heavy man, barrel-chested with thick hands. His tan was still midsummer dark and his clothes custom made. David guessed him to be about fifty.
“Oh, I’m sorry,” he said, backing off a step. “My name is Shelton, David Shelton. I’m on the surgical staff at Boston Doctors. Christine is a … close friend.”
“Well, right now she’s my patient,” St. Onge growled. “I’m sure you wouldn’t take too kindly to someone barging in on your work. Even if he was a fellow surgeon.”
David swallowed what he really wanted to say, backed off another step, and mumbled, “I’m sorry. Could you tell me how she is?”
St. Onge rummaged through his set of instruments, found a needle holder, and returned to the cut.
“She has another gash I’ve already closed above this one. She’s got a busted arm that Stan Keyes will probably have to reduce in the operating room. That is, providing he doesn’t capsize and drown in that stupid regatta he’s racing in today.”
David tightened. “Is he the only orthopedist available?”
“Yup. But don’t worry. Fortunately, he’s a damn sight better orthopedic surgeon than he is a sailor.” St. Onge chuckled. “The arm will keep until he gets back.”
David turned his attention to the bank of four X-ray view boxes on the wall across from the litter and studied the views taken of Christine’s chest, abdomen, ribs, forearm, and skull. The forearm fracture was a bad one, with multiple fragments, but fortunately did not involve the joint space. The function of her hand would likely be unimpaired. He thought about the superb orthopedic staff at Boston Doctors and began wondering if a transfer there would be possible.
St. Onge finished Suturing the laceration as David was snapping the four films of Christine’s skull into place. The man whipped off his gloves with a flourish, letting them fall to the floor. “Use one of my standard head-injury order sheets, Tammy,” he said. “Keyes will probably want to transfer her to his service anyway when he does the wrist. Any questions, Dr.…”
“Shelton,” David said icily, brushing past him and kneeling by Christine. The sterile drape had been discarded and David could appreciate for the first time the extent of the battering she had absorbed. Despite some attempt to clean her up, patches of dried, cracking blood still remained over her face and neck. Almost the entire left side of her scalp had been shaved, exposing the two angry gashes. Tiny diamonds of glass sparkled throughout what hair remained. Her upper lip was the size and color of a small plum.
“Christine,” he said softly. “How’re you holding up?”
“Oh, David …” Her words were agonized, tearless sobs. David’s fists tightened against his thighs.
“Dr. St. Onge, has a radiologist gone over her films?” He rose with deliberate slowness and turned toward the man.
“Why, no. The radiologist has left for the day. On call, if necessary, but I didn’t see any reason to call him in for findings as obvious as …”
“Excuse me, miss,” David cut in, “could I have an otoscope please. And, while you’re at it, an ophthalmoscope.” The woman had a bemused expression on her face as she handed the instruments over. St. Onge was speechless.
David slipped the otoscope tip in Christine’s left ear. At that moment St. Onge found his tongue. “Now you just wait one goddamn minute,” he said. “That woman is still my patient, and if you …”
“No!” David snarled the word. “You wait one goddamn minute. This woman is being transferred to Boston.”
“Why you have your fucking nerve!” St. Onge was crimson. “Ill have you up before the medical board for this, big city credentials and all.”
“Do that, please,” David begged. The marginal control he had maintained disappeared completely. “And while we’re there, we’ll ask why you were too arrogant to call in a radiologist to look at these films. We’ll ask why you missed the basilar skull fracture in two of the views. We’ll also ask how you overlooked the blood behind her left eardrum caused by that fracture. Okay?” The silence in the room was painful. He lowered his voice and turned to the nurses. “Could one of you call an ambulance for us, please?”
The nurse, Tammy, hesitated, then with an unmistakable glint in her eye said, “Yes, Doctor,” and rushed out. St. Onge looked apoplectic.
David turned to the remaining nurse. “I’m going to need some meds and equipment for the trip. I’ll send the stuff back with the ambulance. Meanwhile, could you hang a Ringer’s lactate I.V., please? Fifty cc’s per hour.”
“I’ll have your ass for this, Shelton.” St. Onge hissed each word, then stalked away.
David used the phone at the nurses’ station to call Dr. Armstrong. As he was dialing, he heard giggles and a muted cheer from the staff in Christine’s room.
“David, I’ve been worried sick about you,” Dr. Armstrong said. “What’s going on? Are you all right?”
“I’m fine, Dr. Armstrong. Really,” he said. “But Christine Beall isn’t. Do you remember her? A nurse on Four South?”
“I think … yes, of course I do. A lovely girl. What’s wrong?”
“She’s had an accident. Automobile. We’re at Kensington Community Hospital now, but I’m on my way with her to the Doctors Hospital E.R. Could you meet us there and take over her care? She’s got a fractured arm, a basilar skull fracture, and some chest trauma, so you’ll probably end up being traffic cop for a three-ring circus of consultants. Will you do it?”
“Of course I’ll do it,” Dr. Armstrong said. “Are you sure she can handle the trip?”
“Sure enough to try. Any risk is worth taking to get her out of here. Especially with you there waiting for her. I have a lot to talk to you about, but all of it can wait until you get Christine taken care of. We’ll be there within an hour.”
“That will be fine,” Dr. Armstrong said softly. “I’ll be waiting.”
CHAPTER XXII
At David’s instructions the ambulance ride was made at a steady fifty. No lights, no sirens. The fifty-five-minute drive seemed interminable, but what little time they might save by a dramatic dash to the city was hardly worth the catastrophe of an accident.
Throughout the trip Christine slipped in and out of consciousness. David, seated at her right hand, systematically checked her pulse, respiration, blood pressure, and pupil size, looking for changes that might indicate a sudden rise in the pressure against her brain. Any significant increase, either from bleeding or swelling, and he would have only minutes to reverse the process before permanent damage began.
The tension inside him was suffocating. He had acted decisively in dealing with St. Onge, but had he been too hasty? The thought ate away at him. Any crisis in the moving ambulance would be immeasurably more difficult to handle than in the hospital. It was the sort of decision he had spent years in training to be able to make—the sort of decision he had unflinchingly made many times over the years. But this was different.
“Christine?” He squeezed her hand. There was no response. “Let’s go over the equipment again,” he said to the paramedic riding alongside him. Out of David’s
field of vision, the man, a former corpsman in Vietnam, shook his head in exasperation. Granted it was the first time he had ever carried instruments for drilling cranial burr holes, but this was the third check David had asked him to make.
On an off chance Christine could hear, David turned his back to her and whispered the list of instruments and medications. The paramedic held each, one up or signaled that he knew exactly where it was. Scalpels, drill bits, anesthetic, laryngoscope, tubes, breathing bag, Adrenalin, cortisone, suction catheters, intracardiac needle—they were prepared for the worst.
Reluctant to take his eyes off Christine again, David began asking their location fifteen miles from the hospital without even trying to digest the information.
“Pulse: one ten and firm; respiration: twenty; B.P.: one sixty over sixty; pupils: four millimeters, equal and reactive.” The words became a litany, every two minutes. Dutifully, the paramedic repeated then charted them. There was no banter between the two men. No communication at all, in fact, other than the numbers, every two minutes. Pulse … respiration … B.P.… pupils.
As they entered the outskirts of Boston, the tension grew. David, constantly moving, checking, rechecking, rousing Christine. The paramedic, nervous in spite of himself, fingering the instruments of crisis. The driver, a burly young man with thick brown curls, growled a few words into the two-way radio and toyed with the control switches for the lights and siren. They were close enough now. Any sign of trouble in back and he would make a run for it, doctor’s order or not.
Suddenly the trip was over. The ambulance swung a sharp U-turn and backed up to the raised receiving platform. The rear doors flew open. A nurse burst into the ambulance and, with a glance at Christine, went straight for the intravenous bag. Right behind her, an orderly grabbed one side of the collapsible litter. A quick nod from the paramedic and they were gone, the nurse, running to keep up, holding the I.V. bag aloft.
David moved to follow, then sank back on the seat. He caught a brief glimpse of Margaret Armstrong as she met the team halfway across the cement platform and began her examination even before they reached the entrance. Her white clinic coat, unbuttoned, swung behind her like a queen’s cape. Her every movement, every expression exuded control and competence.
They had made it. They were home. The decision to move, however hasty, had held up. As relief swept through him, David began to shake.
He weaved his way across the busy receiving and triage area and headed straight for the trauma wing. Real or imagined, it felt as if everyone—staff and patients—was staring at him. Phoenix, rising from the ashes; Lazarus from the dead.
Pausing outside Trauma Room 12, he glanced inside. The room was empty. He shuddered at the memory of Leonard Vincent’s knife gliding across his throat. Then he thought about Rosetti. As soon as Christine was out of immediate danger and he had finished speaking with Dr. Armstrong, he would go see Terry.
As David approached Trauma 1, Armstrong emerged and beckoned him inside. Christine was awake. Through a sea of white coats—residents, technicians, and nurses—her eyes—sunken shadows—met his. For a moment all he saw was pain. Then, as he drew closer, he saw the sparkle—the flicker of strength. Her swollen, discolored lips pulled tightly as she tried to smile.
“We made it,” she whispered. David nodded. “Now you won’t have to do burr holes on me.”
David’s eyes widened. “You were awake during the trip?”
“Awake enough,” she managed. “I … I’m glad we’re here.”
Her eyes closed. A reed-thin surgical resident moved in, swabbed russet antiseptic over her right upper chest, and prepared to insert a subclavian intravenous line. As the man slipped the needle beneath Christine’s collarbone, David grimaced and turned away. He came face to face with Margaret Armstrong, who was standing several feet behind him, watching quietly.
“David, I’m so relieved to see that you’re all right,” she said. “The stories that followed your brief visit here the other night were quite frightening.’
“There’s some trouble in this hospital—in a lot of hospitals, in fact. I have a great deal to talk about with you, Dr. Armstrong,” David said. He glanced over his shoulder at the resident, who was calmly suturing the plastic intravenous catheter in place with a stitch through the skin of Christine’s chest. “What about Christine?”
“Well,” said Dr. Armstrong, leading him out of the room, “I’ll examine her more carefully as soon as the crowd in there has finished. My initial impressions add little to yours. She has a definite skull fracture and some blood behind that drum, but so far she seems neurologically stable. I have both a neurosurgeon and an orthopedic man waiting in the house, but I think we’ll hold off on the wrist until we’ve had a chance to watch her. Ivan Rudnick is the neurosurgeon. Do you know him?” David nodded. Rudnick was the best on the staff, if not in the city. “Well, Ivan will see her and do a CAT scan as soon as possible. If there’s no evidence of active bleeding, we’ll wait and hope.”
“What about her chest trauma?” David asked.
“No problem as far as I can see. EKG shows no cardiac injury pattern. My more extensive exam should help confirm it.”
“Dr. Armstrong, I’m really grateful to you for handling this.”
“Nonsense,” she said. “I can’t tell you how flattered—and pleased—I am that you would ask me. By the way,” she added, “there is one small problem.”
“Oh?” David’s eyes narrowed.
“Nothing critical, David, but there are no ICU beds. Not a one. We’re checking on one postop patient now, but he’s been very unstable and I doubt we’ll be able to move him. I’ve decided we’ll be all right putting Christine on a floor. There’s a private room available on Four South. I know the girls up there will give hier closer attention than she would ever get anywhere else, including the ICU. She’ll be moved up there as soon as possible.”
“That sounds fine,” David said. “If the nurses don’t mind, I’ll hang around and do what I can to help monitor her. That is, after you and I have had our discussion.”
“Yes,” said Dr. Armstrong distantly.
“Well, you go ahead and finish. I’ll wait in the doctors’ lounge until you’re free to talk. By the way, which room will she be going to?”
“Excuse me?”
“The room,” David said. “What room is she going to?”
“Oh, ah, I have it right here. It’s Four twelve. Four South Room Four twelve.” The cardiologist smiled, then disappeared into Trauma 1.
Four twelve! David swallowed against the sudden fullness in his throat. Charlotte Thomas’s room! Step one on the bloody brick road that had led through one land of madness after another. He fought his sense of superstition and tried instead to focus on the irony. Room 412 would serve as the first command post in their battle to bring The Sisterhood of Life to an end. The exercise worked well enough, at least, to keep him from racing back to Dr. Armstrong to demand a room change. He wandered across the triage area to the doctors’ lounge and stretched out with a copy of the monthly periodical Medical Economics. The lead article was entitled “Ten Tax Shelters Even Your Accountant May Not Know.” Before he had settled into shelter number one, David was asleep.
An hour later, the phone above his head jangled him free of a frightening series of dreams—Charlotte’s cardiac arrest and the bizarre events that followed, replayed with all of the characters interchanged—all, that is, except Christine, who died again and again in one grisly manner after another.
His clothes were uncomfortably damp and the sandpaper in his mouth made it difficult to speak.
“On-call room. Shelton here,” he said thickly.
“David? It’s Margaret Armstrong. Did I wake you?”
“No, I mean yes. I mean I wasn’t exactly …”
“Well,” she cut in, “our Christine is safely in her room. Nothing new for me to add to what we already know. I think she’ll be all right.”
“Wonderful.”
&
nbsp; “Yes … it is.” Armstrong paused. “You said you wanted to talk with me?”
“Oh, yes, I certainly do. That is, if you …”
“This would be an excellent time,” she interrupted again. “I’m in my office—not the one in the office tower, the one on North Two.”
“I know where it is,” said David, at last fully awake. “I can be there in five minutes.”
The cardiac exercise laboratory doubled as Margaret Armstrong’s “in house” office.
David knocked once on the door marked STRESS AND EXERCISE TESTING, then walked in. The small, comfortable waiting room was empty. He hesitated, then called, “Dr. Armstrong? It’s me, David.”
“David, come in.” Armstrong appeared at the door. “I was just making some coffee.”
As he passed where she had been standing, David breathed in the distinctive odor of liquor.
Instinctively he checked his watch. It was not yet one. He ran through a number of explanations as to why the chief of cardiology might be drinking under such circumstances, especially at such an hour. None were totally acceptable. Still, the woman seemed quite in control. For the moment, at least, he forced the concern to the back of his mind.
The lab was spacious and well equipped. Several treadmills and Exercycles, each with a set of monitoring instruments, were lined up across the room. The required emergency equipment and defibrillator unit were placed inconspicuously to one side—an effort, David knew, to avoid additional apprehension in patients already nervous over their cardiac testing.
One end of the suite had been set aside as a conference area, with a maple love seat and several hard-backed chairs encircling a low, round coffee table. Armstrong motioned David to the love seat, then brought a percolator and two cups. She seemed more subdued than David could ever remember.
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