Do No Harm (2002) Read online

  Composites of Clyde had been posted in the lobby and the CWA. David removed one and gazed at it. The artist had failed to capture Clyde's dead, flat eyes, but she'd managed to sketch the mouth and chin perfectly. David stared at the wide neck and acne-scarred cheeks and felt a faintness ripple through him.

  After making sure the floor was under control, he found Ralph in the rear hall of the ER. "Anything?" David asked.

  Ralph shook his head.

  David pulled the sketch of Clyde from his pocket. "Did you send these around to staff?"

  "We posted them just about everywhere."

  "I think we should circulate copies through the internal mail, make sure every single staff member sees this. We should write on it that Clyde is a possible hospital worker, so people give it more than a cursory glance."

  "Yale told me about the worker angle," Ralph said. "But it would take me awhile to get a request like that through the bureaucratic bullshit."

  "Put my weight behind it. See if that helps. If not, let me know and I'll get into it personally." David walked briskly through the network of halls across the hospital and into the connected Neuropsychiatric Institute. He unfolded Clyde's composite and examined it on the elevator down to the Badge Center in the basement. In order to move freely within the hospital, every employee of the UCLA Hospital was required to wear a photo badge. All pictures were taken passport style at the Badge Center, with a digital camera and a blue backdrop.

  An obese woman manned a computer behind the terminal, her monitor cluttered with family photos and stickers featuring anthropomorphic animals. A plaque adhered to a bulletin board behind her read: SEXUAL HARASSMENT WILL NOT BE TOLERATED. BUT IT WILL BE GRADED. David shuddered.

  The woman looked up with a wide grin. "Hello, Dr. Spier." She glanced him over, then waved a finger at him in scolding fashion. "I see you're not wearing your badge."

  David found it difficult to force a smile. "You keep all employee photographs on computer file, right?"

  "Did you lose your badge again? Do you need us to make you up another new one?"

  "No, I have mine right here." He removed his badge from his coat pocket and brandished it at her. "I was wondering how many years back your photo files run."

  "Five years, three months . . . " she recited proudly. She leaned over and checked a Far Side day-by-day calendar propped on her desk. ". . . and six days. Ever since we switched to a digital camera."

  David laid the police sketch on the countertop and smoothed out the creases. "The man who escaped . . . I have reason to believe he works here at the hospital."

  She picked up the sketch and shivered, her weight shifting beneath a stretched yellow sweater. "That's the guy, huh? The acid thrower."

  "He said his name is Clyde, though I'm not certain he was telling the truth. Can you run a computer check and see if you can match the sketch to a photo?"

  "Well, jeez, Doctor, I don't know. There's really no way to do that. I mean, it's not a big fandangled program or anything. I'd have to run through every entry click by click. And there are thousands of photographs in here. Plus, I can't run a search without a first and last name. That's how the badge search engine operates." She picked up the composite and stared at it, as if it contained the solution to the predicament. "Sorry, Doctor."

  David took back the flyer, refolded it, and began to walk away before being struck by a new thought. The woman looked back up with the same wide grin when he returned. "Hello again," she said, with a short burst of laughter.

  "You get a lot of people through here, I'd imagine, from all the departments, right? New employees and people who need replacement badges?"

  "Yessirree. Why just this morning I've had five lost badges, including--"

  "Would you mind running copies of this flier and handing them out to people to pass around their departments? Just in case it gets lost in the mass mailing. Ask people to look at it, really look at it, and see if they remember this guy working here. Will you do that for me . . . " He glanced on the counter for a name tag, but couldn't spot one. When he looked back at her, she was holding up her badge proudly for him to read. ". . . Shirley?"

  She seemed taken aback by the intensity in his face. "Um . . . it's not normally our policy to distribute non-badge-related information."

  David took a deep breath. "I think the risk of more women becoming horribly disfigured probably outweighs this breach of badge etiquette. Would you concur, Shirley?"

  The color seemed to wash out of her face, leaving only the two splotches of rouge that capped her cheeks. "Yes, Dr. Spier," she said tightly. "Though I don't see why you have to be so rude."

  Chapter 33

  DIANE'S scrubs shifted when she leaned over, the fabric holding tight to her body in spots--across the rounded band of her lower back, at the curve where her buttocks met her legs, on her right scapula--before fading back into folds and wrinkles. A wisp of hair had settled in a crescent along her cheek, the bottom point lingering near the corner of her mouth. She spoke a soft, badly accented Spanish as she placed the bell of her stethoscope on the boy's distended belly. The father looked on, as did David from his eavesdropper's post at the door.

  "?Dolor aqui?" Diane asked, palpating the boy's midabdomen.

  "!Ay, pinche cabron bendejo maricon!" the boy hissed through clenched teeth.

  The father scratched his forehead, hiding his eyes. "He say yes."

  Despite the shimmer of moisture rising in the boy's eyes, David couldn't help but grin at the exchange. He waited for Diane to finish and approach him, then lowered his voice. "Since Clyde knew where the kick-pedal release was on the gurney, maybe he has some job that involves transporting patients. I'm already covering the orderly angle. Can you think of any other-- " David stopped when he heard hard footsteps on the tile, then turned and saw Jenkins and Bronner heading his way.

  With a single brisk motion, Jenkins whipped a pair of handcuffs from their pouch on his belt and locked them around David's wrists. David looked down at them, dumbfounded. "What the hell is this?"

  "Obstruction of justice. You had a suspect in here five days ago, August Fourteenth, with a gunshot wound from the Kinko's shooting. We've been looking for him for some time, but you deliberately misled us, giving him time to escape."

  "Oh," David said, "this is brilliant. I thought we were through with that business." He had to raise both hands to scratch his nose.

  "I reconsidered," Jenkins said.

  "What the hell is going on here?" Diane asked.

  Jenkins ignored her, continuing to address David. "We're taking you in. I'm gonna have a field day on your ass."

  "On my ass?"

  "It's a figure of speech."

  "And a rather charming one at that."

  "Save your breath for the station. You'll need it to tell us about the suspect you aided."

  "Well, you see, there's this little thing called patient confidentiality. Your only out on that front is the Tarasoff ruling in '76 and it's less than irrelevant here."

  "We'll throw you in a room with the Captain, see how quiet you are then."

  "Captain Billings? Feel free. I haven't seen him since the Getty Center dinner in March. I'd love to catch up." David glared at Bronner, and could see the older cop was getting uneasy. "Plus, you're harassing me on a false civil charge, not a criminal one--you have no right to arrest me. If you pull me out of here mid-shift, I'll sue your asses. Loudly."

  "You have the right to remain silent-- " Jenkins began.

  "Uncuff the attending physician immediately," Diane said. "Handle whatever grudge you have later. The other attending is on lunch, and I'm not qualified to run this department myself."

  "Well, Ms.--"

  "It's Doctor."

  Jill came running down the hall, her yellow hair bouncing. "We have a horror show rolling in. A forty-year-old male sustained a penetrating trauma to the chest wall, ninety over sixty in the field, heart rate one-thirty, respiratory rate forty." She paused when she noticed the
handcuffs around David's wrists. "Be careful with those hands," she said to Jenkins. "They're worth more than you are."

  "Uncuff me," David said.

  "--anything you say can be used against you in a court of law. You have the right to an attorney--"

  Jill looked from David to Diane to Jenkins and Bronner, as if unsure to whom to address the medical information. "Two-minute ETA by ground transport." The familiar screech of gurney wheels, followed by the bang of the swinging doors. "Or right now."

  Two paramedics sprinted toward David, pushing the gurney, the lead one shouting, "Code trauma! He was moaning and groaning in the rig, but we lost vitals in the ambulance bay. We got nothing."

  A bent piece of rebar protruded nearly two feet from the man's chest on the left side. Strapped to a backboard, the man's head was secured with a C-collar. His visible flesh was pale blue.

  David held up his hands, the chain tight between his wrists. "Uncuff me. Now."

  "They were blasting out a section of the building across the street," the other paramedic said. "Someone forgot he was in there and let fly."

  "Release him immediately. This is no time to fuck around," Diane yelled over her shoulder as she ran toward the gurney, meeting it halfway, only to turn and run with it toward Trauma One. David jogged after her into the resuscitation suite, handcuffs jingling, and the two cops reluctantly followed. Diane moved alongside the body. "No spontaneous respirations, no pulse, and he's cyanotic."

  David reached his cuffed hands out and felt the man's stomach, pushing gently. It gave with a soft crunching sound, as though he were pressing on a bag of Rice Krispies. Air had escaped from the man's lungs and moved beneath his skin. "Crepitance," he said.

  Several hands grabbed the backboard when they reached the wider hospital gurney.

  "On my count," Diane yelled. "Three, two, one." They slid the man safely over onto the new gurney, and the paramedics backed out to make more space.

  By the time David glanced up at the man's face, Diane already had him intubated and hooked up to one hundred percent oxygen. She helped the nurse scissor off the man's clothes. "We're gonna have to open him up. Someone get me a thoracotomy tray!"

  People scurried about the body. The superficial veins had collapsed; they had a rapid infuser going on the right arm. Jenkins watched them working on the body, his face angry and distant.

  "Someone find a line in the femoral," David said. A junior nurse responded, digging in the hip with a needle. She got a flash of blood in the syringe. "Good," he said. "Now feed a guide wire through the needle. Right, right." The nurse slid a blue number-eight French catheter over the guide wire into the vein. "Don't let go of the guide wire."

  Six units arrived from the blood bank. Diane pulled on a gown and gloves. "Switch the saline for O-neg."

  David turned and shoved his hands at Jenkins. "Enough already. Take these things off me. Now." Lab techs and nurses darted around them to get to the gurney.

  The thoracotomy tray arrived, swathed in blue towels. Pulling the towels aside to reveal a forceps, rib spreader, rib cutter, and an array of gleaming scalpels, Diane paused and turned to the officers. David's hands were inches from Jenkins's chest, but Jenkins didn't so much as look down at them; he kept his cold, hard gaze locked on David's face.

  Diane crossed her arms. "I can't do this without him," she said. "Get ready for a lawsuit."

  The activity around the body seemed to stop. For an instant, all eyes were on David and Jenkins. Bronner broke the silence, stepping forward to unlock the cuffs. Jenkins tried to restrain him, but Bronner shoved him away fiercely. "You'd better settle down there, pup," he growled.

  Jenkins's face was alive with emotion--rage, frustration, humiliation. He glared at Bronner, then turned and banged out through the doors. Bronner quickly unlocked David's cuffs and walked out also, his boots creaking.

  David had his stethoscope off his shoulders and into place immediately. He set the bell over the man's left lung, then his right. Miraculously, there were no decreased breathing sounds--neither lung had collapsed. "What are our three major concerns with a penetration to the mediastinum?" he asked.

  "Tension pneumothorax, pericardial tamponade, lacerated aorta." Using a squirt bottle, Diane doused the man's left side in Betadine, the antiseptic falling across the ribs like an orange drape. Her gloved fingers felt their way into position on the man's side, finding his fifth intercostal space. Using a scalpel, she sliced downward from the man's sternum, carving an arc that ran the length of his ribs. Blood gushed over her hands, coating her white gloves crimson as she continued to cut down to the muscle.

  Jill's patterned scrub top, a cheery Amazon green number decorated with frogs, seemed oddly discordant. She leaned over with the spray bottle to clear the wound for Diane. A spurt of blood caught a poison arrow frog across the face.

  A flash of aqua green scrubs to David's left. "Surgeon's stuck in a mess of an appendectomy," he heard the clerk say. "The junior surge resident is on his way down."

  Diane finished scissoring through the intercostal muscles, then wedged a rib spreader into the bloody gap. The pronged tool was silver and ratcheted, and she flipped out the handle and cranked it like a winch. The man's ribs stretched, then snapped, sending a splattering of blood across her surgical gown and Jill's face.

  "How's the left lung?" David asked.

  Diane peered into the hole in the man's body. "Looks fine."

  "Now feel your way in there. Check to make sure the aorta isn't lacerated."

  She paused for an instant, her gloved hand hovering near the gap. David had walked her through this move on a cadaver, but she'd never had a live run. She looked up, her brilliant green eyes catching David's, and he nodded once, reassuringly.

  Lowering her shoulder, she slid her hand into the man's living body.

  "You feel the lung along the back of your hand?" David asked. "Bumpy and soft?"

  She nodded. "I have my bearings."

  Her arm disappeared midway to her elbow as she slid her hand down along the inside of the man's back.

  David's hand twitched at his side as he mentally undertook the maneuver with her. "Did you check the aorta?"

  She shook her head.

  "How can you restrain yourself?"

  Her eyes widened. "I've got it!" A smile bloomed on her face, a child's smile at sighting something wondrous. "Under my fingertips. It's firm and full of blood."

  "Good," David said. "Now let's check for a pericardial tamponade." If the heart had sustained a trauma, which David guessed it had from the angle of the rebar, it was probably bleeding into the pericardium. And if the sac around the heart filled with blood, it would interfere with the heart's mechanism, preventing it from pumping effectively.

  Someone banged into a rapid infuser and it nearly capsized.

  "Where the hell is surgery?" Diane said. She readjusted her hand, and a soft sucking noise emerged from the wound.

  "It's all right," David said. "Focus on the task."

  Diane twisted her body so she could better maneuver her hand. "Got it! The pericardial sac is full and tense. The heart must've bled into it."

  She removed her right hand to grab a tiny pair of scissors, picked up a pair of tongs with her left, and went back in with both.

  "Okay," David said. "Grab the edge of the sac with the tongs and make a small vertical incision." He strained to look around her and saw blood spill into the chest. "Good. Now deliver the heart."

  Her arm moving with exquisite care, she gripped the heart and pulled it out through the small incision, holding it in her hand. "It's beating," she said, ducking her head to see through the mess. "It's got a small hole."

  "It's trying to push blood but can't. Put your thumb over the hole."

  She adjusted her thumb, then turned and looked to David again. He held her gaze as they waited. Now that she'd plugged the heart's hole, blood should begin pumping more effectively. A nurse near the man's head looked up triumphantly. "I got a pulse!" A ca
rotid pulse meant the blood pressure had just hit sixty.

  "Me too!" another nurse exclaimed. "Femoral pulse!" The blood pressure had risen to seventy.

  A wisp of hair fell across Diane's eyes, and she flicked it aside with a quick jerk of her head. Her lips were trembling ever so slightly--David was sure he was the only one who noticed. Her face had taken on the fervent, confounded cast of one in extreme grief or ecstasy. She held a man's beating heart in her hand, and her thumb plugging its hole was the only thing keeping him alive.

  The junior surgeon jogged into the room. "Call OR," Diane said. "Tell 'em we're on our way."

  The gurney took off with a lurch as Jill shoved it toward the door, several others grabbing for the connecting gear and making sure it moved with the body.

  Keeping her thumb firmly pressed over the hole in the heart, Diane threw one leg over the man's body as she hopped on the gurney. David stepped back as the gurney and its attendant mob swung out into the hall and rattled along at an impromptu sprint, the junior surgeon barking orders, nurses dragging rapid infusers on IV poles, and Diane straddling the patient's unconscious body, her arm inside him, seeming to ride the entire mob like a cowboy.

  Looking up across the bobbing heads and waving poles, she caught David's eye. She winked just as the gurney turned the corner, and he realized he was in love with her.

  Chapter 34

  AFTER checking that Clyde's composite was indeed being circulated through internal mail, David rode up to the fifth floor and entered the ICU ward. It was busier than the last time he'd visited Nancy, two days ago. A frail woman called out to him from a bed, wanting more morphine, and he smiled at her as he passed. "I'm sorry, ma'am, I don't work in this department, but I'll get the nurse for you."

  The curtains were drawn in a tight oval around Nancy's bed, like a coffin pall. The rattle of the rings woke her. She turned her face, and he did his best not to let his horror show despite the fact that she couldn't see him. If shock found its way into his face, it would find its way into his voice.