“Jesus, don’t tell me we’re gonna lose her just as she wakes up.”
Rizzoli squeezed into the cubicle, where lights shone down with a brilliance that was painful to her tired eyes. She could not see Sister Ursula, who was hidden within the tight circle of personnel, but she could see the monitors above the bed, the heart rhythm skittering like a stone across water.
“She’s trying to pull out the ET tube!” a nurse said.
“Get that hand tied down tighter!”
“… Ursula, relax. Try to relax.”
“Systolic’s down to eighty—”
“Why is she so flushed?” said Yuen. “Look at her face.” He glanced sideways as the ventilator squealed.
“Too much airway resistance,” a nurse said. “She’s fighting the ventilator.”
“Her pressure’s dropping, Dr. Yuen. It’s eighty systolic.”
“Let’s get a dopamine drip going. Now.”
A nurse suddenly noticed Rizzoli standing in the doorway. “Ma’am, you’re going to have to step out.”
“Is she conscious?” asked Rizzoli.
“Step out of the cubicle.”
“I’ll handle this,” said Sutcliffe.
He took Rizzoli by the arm, and his grasp was not gentle as he led her out of the cubicle. He slid the curtain shut, cutting off all view of the patient. Standing in the gloom, she could feel the eyes of other nurses, watching her from their different stations in the ICU.
“Detective Rizzoli,” said Sutcliffe, “you need to let us do our jobs.”
“I’m trying to do mine as well. She’s our only witness.”
“And she’s in critical condition. We need to get her through this crisis before anyone talks to her.”
“She is conscious, though?”
“Yes.”
“She understands what’s going on?”
He paused. In the low light of the ICU, she could not read his expression. All she could see was the silhouette of his broad shoulders and the reflection of his eyes, glinting green from the nearby monitor banks. “I’m not sure. Frankly, I never expected her to regain consciousness at all.”
“Why is her blood pressure falling? Is this something new?”
“A little while ago, she started to panic, probably because of the endotracheal tube. It’s a frightening sensation, to feel a tube in your throat, but it has to stay in to help her breathe. We gave her some Valium when her pressure shot up. Then it suddenly started to crash.”
A nurse pulled back the cubicle curtain and called through the doorway: “Dr. Sutcliffe?”
“Yes?”
“Her pressure’s not responding, even on dopamine.”
Sutcliffe stepped back into the cubicle.
Through the open doorway, Rizzoli watched the drama playing out only a few feet away. The nun’s hands were balled up in fists, the tendons of her arms standing out in taut cords as she fought the restraints that bound her wrists to the bed rails. The crown of her head was encased in bandages, and her mouth was obscured by the protruding endotracheal tube, but her face was clearly visible. It looked swollen, the cheeks suffused a bright red. Trapped in that mummifying mass of gauze and tubes, Ursula had the eyes of a hunted animal, the pupils dilated with fear, her gaze frantically darting left, then right, as though in search of escape. The bed rails rattled like the bars of a cage as she yanked against the restraints. Her whole torso lifted off the bed, and the cardiac alarm suddenly squealed.
Rizzoli’s gaze shot to the monitor, where the line had gone flat.
“It’s okay, it’s okay!” Sutcliffe said. “She just disconnected one of her leads.” He snapped the wire back in place, and the rhythm reappeared onscreen. A rapid blip-blip-blip.
“Increase the dopamine drip,” said Yuen. “Let’s push fluids.”
Rizzoli watched as the nurse opened the IV full bore, unleashing a flood of saline into Ursula’s vein. The nun’s gaze met Rizzoli’s in a final moment of awareness. Just before her eyes started to glaze over, before the last spark of consciousness flickered out, what Rizzoli saw, in that gaze, was mortal fear.
“Pressure’s still not coming up! It’s down to sixty—”
The muscles of Ursula’s face slackened, and the hands fell still. Beneath drooping lids, the eyes were now unfocused. Unseeing.
“PVCs,” the nurse said. “I’m seeing PVCs!”
Gazes shot straight to the cardiac monitor. The heart tracing, which had been ticking rapidly but evenly across the screen, was now distorted by dagger thrusts.
“V tach!” said Yuen.
“I can’t get any pressure! She’s not perfusing.”
“Get that bed rail down. Come on, come on, let’s start compressions.”
Rizzoli was shoved backwards, out of the doorway, as one of the nurses pushed toward the doorway and called out: “We’ve got a Code Blue!”
Through the cubicle window, Rizzoli watched as the storm swirled around Ursula. She saw Yuen’s head bobbing up and down as he performed CPR. Watched as drug after drug was injected into IV ports, and sterile wrappings fluttered to the floor.
Rizzoli stared at the monitor. The tracing was now a line of jagged teeth cutting across the screen.
“Charged to two hundred!”
In the cubicle, everyone stepped back as a nurse leaned forward with the defibrillator paddles. Rizzoli had a clear view of Ursula’s bared breasts, the skin blotchy and red. It struck her as somehow startling, that a nun would have such generous breasts.
The paddles discharged.
Ursula’s torso jerked, as though tugged by strings.
The woman cop standing beside Rizzoli said softly: “I got a bad feeling. She’s not gonna make it.”
Sutcliffe glanced up, once again, at the monitor. Then his gaze met Rizzoli’s through the window. And he shook his head.
An hour later, Maura arrived at the hospital. After Rizzoli’s phone call, she had rolled straight out of bed, leaving Victor asleep on the pillow beside her, and had dressed without showering. Riding the elevator up to the ICU, she could smell his scent on her skin, and she ached from the rawness of the night’s lovemaking. She had come straight to the hospital while reeking gloriously of sex, her mind still focused on warm bodies, not cold. On the living, not the dead. Leaning back against the elevator wall, she closed her eyes and allowed herself to savor the memories for just a while longer. One more moment of remembered pleasure.
The opening of the door startled her. She jerked straight, blinking at the two nurses who stood waiting to step in, and she quickly exited, her cheeks flushing. Do they notice it? she thought as she walked down the hall. Surely anyone can see, in my face, the guilty glow of sex.
Rizzoli was in the ICU waiting room, slouched on the sofa and sipping from a Styrofoam cup of coffee. As Maura walked in, Rizzoli gave her a long look, as though she too detected something different about Maura. An unseemly flush to her face, on this night when tragedy had called them together.
“They’re saying she had a heart attack,” said Rizzoli. “It doesn’t look good. She’s on life support.”
“What time did she code?”
“Around one. They worked on her for almost an hour, and managed to get a heart rhythm back. But she’s comatose now. No spontaneous breathing. Unreactive pupils.” She shook her head. “I don’t think there’s anyone home anymore.”
“What do the doctors say?”
“Well, that’s the controversy. Dr. Yuen isn’t ready to pull the plug yet. But hippie boy thinks she’s brain dead.”
“You mean Dr. Sutcliffe?”
“Yeah. The hunk with the ponytail. He’s ordered an EEG in the morning, to check for brain activity.”
“If there’s none, it’ll be hard to justify maintaining life support.”
Rizzoli nodded. “I thought you’d say that.”
“Was the cardiac arrest witnessed?”
“What?”
“Were medical personnel present when her heart stopped?”
Rizzoli looked irritated now, put off by Maura’s matter-of-fact questions. She set down the cup, sloshing coffee onto the table. “A whole crowd of ’em, in fact. I was there, too.”
“What led up to the code?”
“They said her blood pressure shot up first and her pulse went crazy. By the time I got here, her pressure was already falling. And then her heart stopped. So yeah, the whole event was witnessed.”
A moment passed. The TV was turned on, but the volume was muted. Rizzoli’s gaze drifted to the CNN news banner scrolling across the bottom of the screen. Disgruntled employee shoots four in North Carolina auto plant.… Toxic chemical spill in Colorado train derailment … A running tally of disasters across the county, and here we are, two tired women, struggling just to make it through this night.
Maura sat down on the couch beside Rizzoli. “How’re you doing, Jane? You look wiped out.”
“I feel like hell. Like it’s sucking up every ounce of my energy. And there’s nothing left for me.” She drained her coffee in one last gulp and threw the empty cup at the trash can. It missed. She simply stared at it, too tired to get up and retrieve it from the floor.
“The girl ID’d him,” said Rizzoli.
“What?”
“Noni.” She paused. “Gabriel was so good with her. It kind of surprised me. Somehow, I didn’t expect that he’d be good with kids. You know how he is, so hard to read. So uptight. But he sat right down with her and had her eating out of his hand.…” She looked off wistfully, then gave herself a shake. “She recognized Howard Redfield’s photo.”
“He was the man who came to Graystones? The one with Jane Doe?”
Rizzoli nodded. “They were both there together. Trying to get in, to see her.”
Maura shook her head. “I don’t get it. What on earth did these three people have to do with each other?”
“That’s a question only Urusla could have answered.” Rizzoli rose and pulled on her coat. She turned toward the door, then stopped. Looked back at Maura. “She was awake, you know.”
“Sister Ursula?”
“Just before she coded, she opened her eyes.”
“Do you think she was actually conscious? Aware of what was going on?”
“She squeezed the nurse’s hand. She was following commands. But I never got the chance to talk to her. I was standing right there, and she looked at me, just before …” Rizzoli paused, as though shaken by that thought. “I’m the last person she saw.”
Maura walked into the ICU, past monitors pulsing with green heart tracings, past nurses who stood whispering outside curtained patient cubicles. As an intern on critical care rotation, her late-night visits to Intensive Care had always been occasions for anxiety—a patient in extremis, a crisis that required her swift decision. Even all these years later, walking at this hour into an ICU made her pulse quicken. But no medical crisis awaited her tonight; she was here to view the aftermath.
She found Dr. Sutcliffe standing beside Ursula’s bed, writing in the chart. His pen slowly came to a stop, the tip pressed against the page, as though he was having trouble forming the next sentence.
“Dr. Sutcliffe?” she said.
He looked at her, his tanned face creased with new lines of fatigue.
“Detective Rizzoli asked me to come in. She said you were planning to withdraw life support.”
“You’re a little premature, once again,” he said. “Dr. Yuen’s decided to hold off for a day or two. He wants to see an EEG first.” He looked down, once again, at his notes. “It’s ironic, isn’t it? How there are pages and pages devoted to her last few days on earth. But her entire life takes up only one short paragraph. There’s something wrong about that. Something obscene.”
“At least you get to know your patients while they’re still breathing. I don’t even have that privilege.”
“I don’t think I’d like your job, Dr. Isles.”
“There are days I don’t care for it, either.”
“Then why do you choose it? Why the dead over the living?”
“They deserve attention. They’d want us to know why they died.”
He looked at Ursula. “If you’re wondering what went wrong here, I can tell you the answer. We didn’t move fast enough. We stood around watching her panic, and we should have sedated her. If we had just calmed her down sooner …”
“Are you saying she coded from panic?”
“That’s how it started. First a spike in blood pressure and pulse. Then her pressure dropped just like that, and the arrhythmias started. It took us twenty minutes to get her rhythm back.”
“What does her EKG show?”
“An acute myocardial infarction. She’s now deeply comatose. No pupillary reactions. No response to deep pain. She’s almost certainly suffered irreversible brain damage.”
“It’s a little early to say that, isn’t it?”
“I’m a realist. Dr. Yuen’s hoping to pull her through, but then, he’s a surgeon. He wants his rosy statistics. As long as his patient survives the operation, he can chalk it up as one of his successes. Even if she ends up as a vegetable.”
She moved to the bedside and frowned at the patient. “Why is she so edematous?”
“We poured fluids into her during the code, to try and bring up her pressure. That’s why her face looks swollen.”
Maura looked down at the arms and saw raised and reddish wheals. “This looks like some fading urticaria here. Which drugs did she get?”
“The usual cocktail we give during codes. Antiarrhythmics. Dopamine.”
“I think you need to order a drug and toxicology screen.”
“Excuse me?”
“This was an unexplained cardiac arrest. And this urticaria looks like a drug reaction.”
“We don’t usually order tox screens just because a patient codes.”
“In this case, you should order one.”
“Why? Do you think we made a mistake? Gave her something we shouldn’t have?” He sounded defensive now, his fatigue turning to anger.
“She’s a witness to a crime,” Maura pointed out. “The only witness.”
“We just spent the last hour trying to save her life. And now you’re implying you don’t trust us.”
“Look, I’m only trying to be thorough.”
“Okay.” He snapped the chart shut. “I’ll see the tox screen gets done, just for you,” he said, and walked out.
She remained in the cubicle, gazing down at Ursula, who lay bathed in the soft, sepulchral glow of the bedside lamp. Maura saw none of the usual litter that followed CPR. The used syringes and drug vials and sterile wrappings that always resulted from resuscitation efforts had been swept away. The patient’s chest rose and fell only because of the air forced into her lungs with each whoosh of the ventilator bellows.
Maura took out a penlight and shone it into Ursula’s eyes.
Neither pupil responded to the light.
Straightening, she suddenly sensed someone watching her. She turned and was startled to see Father Brophy standing in the doorway.
“The nurses called me,” he said. “They thought it might be time.”
He had dark circles under his eyes, and beard stubble darkened his jaw. As usual, he wore his clerical garb, but at that early hour, his shirt was wrinkled. She imagined him, newly roused from sleep, rolling out of his bed and stumbling into his clothes. Reaching automatically for that shirt as he left the warmth of his bedroom.
“Would you like me to leave?” he asked. “I can come back later.”
“No, please come in, Father. I was just going to review the record.”
He nodded and stepped into the cubicle. The space suddenly felt too small, too intimate.
She reached for the chart, which Sutcliffe had left behind. As she settled onto a stool near the bed, she was suddenly aware, once again, of her own scent, and she wondered if Brophy could smell it too. The scent of Victor. Of sex. As Brophy began to murmur a prayer, she forced hers
elf to focus on the nurses’ notes.
00:15: Vitals: BP up to 130/90, Pulse 80. Eyes open. Making purposeful movements. Squeezes right hand on command. Drs. Yuen and Sutcliffe called about change in mental status.
00:43: BP up to 180/100, Pulse 120. Dr. Sutcliffe here. Patient agitated and trying to pull out ET tube.
00:50: Systolic BP down to 110. Flushed and very agitated. Dr. Yuen here.
00:55: Systolic 85, Pulse 180. IV rate to wide open …
As the blood pressure plummeted, the notes grew terser, the handwriting more hurried, until it deteriorated to a barely legible scrawl. She could picture the events as they unfolded in this cubicle. The scramble to find IV bags and syringes. The nurse, scurrying back and forth to the medication room for drugs. Sterile wrappings torn open, vials emptied, correct dosages frantically calculated. All this while the patient thrashes, her blood pressure crashing.
01:00: Code Blue called.
Different handwriting, now. Another nurse, stepping in to record events. The new entries were neat and methodical, the work of a nurse whose duty during the code was only to observe and document.
Ventricular fibrillation. DC cardioversion at 300 joules. IV Lidocaine drip increased to four mg/min.
Cardioversion repeated, 400 joules. Still in V. Fib.
Pupils dilated, but still reactive to light.…
Not giving up yet, thought Maura. Not while the pupils react. Not while there’s still a chance.
She remembered the first Code Blue that she had directed as an intern, and how reluctant she had been to concede defeat, even when it was clear that the patient could not be saved. But the man’s family had stood waiting right outside the room—his wife and two teenage sons—and it was the boys’ faces that Maura kept thinking of as she’d slapped on the defibrillator paddles, again and again. Both boys were tall enough to be men, with enormous feet and spotty faces, but they were crying children’s tears, and she had continued resuscitation efforts long beyond the stage of futility, thinking: give him one more shock. Just one more.
She realized that Father Brophy had fallen silent. Looking up, she found him watching her, his gaze so focused that she felt personally invaded.
Tess Gerritsen's Rizzoli & Isles 8-Book Bundle Page 84