Do No Harm (2002) Read online

  Ed nodded, a brief movement of his half-buried head.

  David took the chart from Diane and glanced it over. He pulled a pen from behind his ear, crossed out acute anxiety, and wrote acute shortness of breath with a secondary diagnosis of anxiety. He handed the chart back to Diane and winked at her. "Problem solved."

  They banged through some double doors and weaved their way through the labyrinthine corridors of Level B.

  "One of the great advantages of ER medicine is our freedom to exercise our own discretion." David glanced down at Ed. "Isn't that right, Mr. Pinkerton?"

  Ed's beady eyes watched him with amusement from the Ewok swathing of the sheets.

  "Not always," Diane said. "The Director of Health Sciences Communications just issued a memo to all employees reminding us of the 'long-standing policy that all media interaction is to be conducted through the HSC office.' "

  David whistled. "The board must be leaning pretty hard."

  "Having lye flying around probably provides a good pucker factor," Ed said.

  David banked the gurney right into the fluoroscopy suite, and he and Diane donned leads to protect themselves from the radiation. He positioned Ed on his back, swung the X-ray arm over his right buttock, and stared at the small screen of the monitor. The two bullet fragments stood out white against the gray bones, just medial to the head of the femur.

  "You were right," David said. "Two frags."

  From the look on Diane's face, she had put together the patient with the news story. She took a moment to grab the silver forceps David was offering her.

  "The wound is superficial enough that I think we can handle it here," David said. "A lot of tissue protecting the bone back there. Does it hurt?"

  "It's not pleasant." Though beads of sweat dotted Ed's bare scalp, his face showed no sign of pain. When Diane inserted the metal forceps into the wound and angled down toward the first bullet fragment, they too showed up white on the monitor.

  David directed Diane with a gesture, then indicated how she could hold the forceps for better control. She followed his instructions perfectly, her tongue poking out her cheek in a point.

  "How old are you, Mr. Pinkerton?" David asked.

  "Thirty-nine."

  "Have you been screened for prostate cancer?"

  "If this is an excuse for giving me a rectal, I don't date doctors." Ed's first grimace lit his face as Diane dug deeper with the forceps. "No," he said. "I haven't."

  Diane glanced up at David, one eyebrow raised in an unasked question. Probably wondering why he was raising the issue when prostate screening usually didn't start until age fifty. "Any family history?" David asked.

  "No."

  "Well, sometime in the next few years, you might want to get checked out. Think of it as the fifty-thousand-mile tune-up on your car."

  The first bloody bullet fragment plunked down on the metal tray. Biting her lip, Diane eased the forceps back in the wound.

  Ed's hand clenched into a fist, then released. "I'll bear that in mind," he said.

  The curtains separating the five exam areas in Exam Fifteen rippled each time a gurney zipped by. After wheeling Ed behind the fourth curtain to get bandaged, his chart balanced across the bumps of his feet, David had been pulled into the next section, Fifteen-Three, by an imploring Persian mother to examine her little girl.

  With a broad, smiling face and brown, almost liquid eyes, the girl ran circles in the small space between the curtains, singing, her jarring footsteps causing her voice to vacillate as if she were yodeling. She stopped, swaying on her feet, and laughed. Her mother drew her back against her legs, ruffling her hair, then wet a finger and wiped a smudge off the girl's cheek.

  David removed his white coat so as not to intimidate the girl, and crouched so he was eye level. Meeting her on her own terms.

  Following his cue, the little girl squatted also. David laughed. "No, hon, you don't have to crouch. I'm just trying to get a better look at you."

  After an openmouthed burst of laughter, the little girl fell down and sat Indian-style. With one hand on the floor, David eased himself down so he too was sitting, his legs kicked awkwardly to the sides. The girl's mother covered her mouth to hide her smile. The girl laughed again and grabbed his hand with both of hers.

  David slid the stethoscope from his shoulders and around his neck with a single practiced movement, spreading the branch with one hand and wiggling his head until the earplugs settled correctly. There was always some comfort in feeling the heavy instrument fall into place, like a well-worn wallet sliding into a back pocket. "I'm just going to--"

  "Dr. Spier?"

  David turned to see Officer Jenkins and another, older officer standing behind him. "This is a private exam area," David said, scrambling to his feet and feeling more than a little foolish. "Your sister has been moved to--"

  "We received a call about a gunshot wound," Jenkins said.

  "You did?" Beneath the curtain beside them, David saw Ed Pinkerton's feet hit the floor. "I don't recall calling one in."

  "You didn't. We were contacted by triage. You know, you're required by law to--"

  "I know, I know. Do you handle all calls involving the hospital?"

  "You might say I've taken a particular interest."

  "I can understand that."

  The older officer, Jenkins's partner, stepped forward, and David noticed two stripes and a star on his sleeve. His name tag read: BRONNER. "We need to question the patient," Bronner said gruffly. "The one who sustained the GSW."

  Ed's foot disappeared and came back down ensconced in an untied shoe.

  "Why don't you follow me out to the CWA?" David said. "We'll check the board and see where he is." David crouched near the girl, and she followed his lead again, laughing. He smiled. "I'll be right back."

  The officers followed him silently down Hallway One into the Central Work Area. David perused the board, finding Ed Pinkerton's name. "Fifteen-Four," he said. "Looks like he was one curtain over from us."

  The cops exchanged a look, which David pretended not to notice. Another silent walk back to Exam Fifteen. David pointed to the curtain to the fourth exam area. "Behind there."

  The curtain rattled on its pegs as Jenkins swiped it aside. An empty gurney. A single spot of blood stood out on the sheets. David feigned exasperation. "I don't know . . . I never discharged him. He must've snuck out on us." He turned to the officers, letting his hands slap to his sides. "I don't know what to tell you."

  Jenkins clenched his jaw, speaking through his teeth. "This patient was one curtain over and you didn't know it?"

  "There are a lot of patients here under my care. It's sometimes difficult to keep track of them all."

  Jenkins held David's gaze. "Right."

  "Sorry about that."

  "Word around the station is you're not always the biggest team player."

  "I guess that depends what team."

  Bronner tapped Jenkins on the back. "This is a jerk-off," he said. "Let's go."

  Jenkins didn't seem ready to leave.

  "You know we don't give a shit about the GSW," Bronner said. "C'mon."

  Jenkins took a step back. "I'll see you around, Doctor."

  David nodded, and Jenkins followed his senior partner out. David realized he'd been holding his breath, and he exhaled deeply.

  A slip of paper beneath the empty gurney caught David's attention, and he bent to pick it up. It was the bookmark he'd noticed earlier marking Ed's place in the small red book. A sketch of a brain, evidently a logo, decorated the top, the cerebral hemispheres slightly misshapen. AMOK BOOKSTORE was written beneath it in an odd Aztec print. David's eyes traced down the length of the bookmark, finding the strange motto at the bottom. THE EXTREMES OF INFORMATION.

  He knew before he glanced beneath the turned-back sheets that Ed's chart was missing.

  Chapter 10

  THE men with their tattoos and glistening muscles worked among the weight machines, pretending not to notice the onl
ookers, who clustered with their Muscle Beach T-shirts, shooting pictures and herding children. The first weight of dusk had settled through the air, but storefront lights illuminated the men through the chain-link fences that set the weight area apart from the Venice Boardwalk and the beach beyond.

  Clyde watched from the anonymity of the crowd, a face among other faces, another body sweating in the August night. He had only recently begun to emerge from his apartment again, and he still found the brief stirrings of breeze to be invasive. Inside the pen, a bald man with a pointed goatee and two hoop earrings broke protocol, turning to the onlookers and spreading his massive arms wide. The prongs of his triceps gripped the undersides of his arms like claws. The crowd erupted with noise; cameras flashed.

  Clyde looked down at his own arms. White and fleshy. In front of him, an overweight little boy with a cardboard-stiff baseball cap pushed up on tiptoes. Kobe Bryant slam-dunked in faded purple and yellow on the back of his T-shirt. The boy's hands, red and sticky with the remnants of some summertime snack, pushed and clutched at the shirts in front of him, leaving colored smudges.

  An enormous black man lined large metal disks on each side of a weight bar until it bowed under the weight. He sat on the edge of the bench press, crossing his arms in front of him. The crack of his shoulders was audible even over the noise of the crowd. He leaned back, taking the bar from the cradle, bringing it to his chest, and hammering it back up in the air with triumphant grunts.

  Standing in the crowd, a face among faces, Clyde watched the man labor and imitated his grunts, softly at first, then growing louder. He didn't realize he could be overheard until a blonde in front of him turned, eyes aglitter with sparkling makeup, and stifled a giggle with a hand. He looked quickly away from her eyes, staring silently at the gum-dotted pavement, and she whispered something to a friend before turning her attention back to the muscular men. Clyde's hand found the key around his neck, his thumb working it over like a rabbit's foot.

  Gradually, his eyes lifted from the pavement, studying first the blonde's straw-bottomed clog that raised her foot so her ankle flexed, then the split sheath of her capri pant leg, which embraced the pink cylinder of her calf. Her bottom, firm and rounded, protruded abruptly from beneath her blouse. He leaned forward until he could smell her hair spray. He leaned forward until he was pushing up against her full behind, a face among faces in the press of a crowd.

  Her thin shoulder blade pushed back ever so slightly into his soft chest as she jockeyed for space, not yet aware that his jostling was directed. Ahead, the weights clinked against each other; the men strained and flexed. His breathing quickened, taking on a faint groaning. Her neck firmed with realization. Her head started to pivot, slowed with shock.

  Before the eyes could reach him, Clyde turned and pushed through the crowd, head lowering on the wide stalk of his neck, hands sinking into his pockets. People spread and closed behind him.

  "Fucking pervert!" she yelled from somewhere in the crowd. She yelped, a short hiccup of disgust and fear. "You fucking sicko! Goddamn it!"

  Clyde left the lights of the boardwalk behind and threaded through the darkening streets and alleys. The ocean breeze had left a staleness on everything--cardboard boxes slumping curbside, rusting hoods of abandoned cars, the soft, rotting wood around doorjambs. He slid his thumb across his filmy fingertips, the motion growing quicker and quicker until his hand was a blur.

  He stepped onto Main Street and joined a current of people at a crosswalk. An old blue Civic had pulled too far into the intersection, blocking the crosswalk, and the woman sat foolishly at the wheel as the stream of pedestrians split around her car. His footsteps grew firmer as he approached, the bustle of people flowing all around him. With a grimace, he altered his step when he reached the car.

  His hand flew forward, smashing palm down on the blue hood. The woman jerked back in her seat. He stood perfectly still, leaning toward the windshield, glowering, the front license plate hitting him midshin. Fear replaced shock in the woman's face, and she opened her mouth, but then caught a closer look at his red-rimmed eyes, the angry heaving of his chest. Her mouth dangled open, like that of a broken doll's.

  The crowd continued to move around the car, people glancing and then moving on or not even noticing him at all. And suddenly he was gone, a dying whisk of movement, the sweaty imprint of his hand slowly evanescing from the metal of the hood.

  Chapter 11

  SHIFTING the stack of files in his lap, David lay back on the exam table he'd adjusted like a chaise longue, propping his feet on one of the gynecologic stirrups. He continued with his paperwork, enjoying the quiet serenity of Exam One.

  Diane barged in, startling him. "Oh sorry. Didn't realize you were . . . What are you still doing here?"

  David checked his watch: 21:25. He hadn't realized he'd been there for an hour and a half after his shift ended. He was accustomed to working late, preferring the excitement of the ER to the solitude of his too-large house, but it alarmed him how quickly the habit had grown. Arriving a few hours early, leaving later and later, shouldering extra days on call--anything to avoid reconstructing a personal life without Elisabeth. His house was quickly becoming a million-dollar stopping place between shifts.

  He looked at the paperwork before him. Nothing important, nothing pressing. Exhaustion pooled through him all at once, jumbling his thoughts. He squeezed the bridge of his nose. When he released it, he was touched by the concern in Diane's eyes.

  "I don't know," he said. His stomach grumbled so loudly both he and Diane glanced at it.

  "Come on," Diane said. "Let me buy you dinner."

  A hospital cafeteria is a depressing place at night. Spouses with vacant, grief-haunted eyes, children pulling IV poles, parents slurping inconsolably on tepid coffee, the sleepless hours gathering in half-moons beneath their eyes. Their lethargy draws a sharp contrast with the bustle of the interns and nurses in scrubs. But even the grieving and the dying have to eat.

  David stared at the food on his tray--a Milky Way, a half-eaten chicken sandwich, a small container of apple juice. Diane bit into an apple and shrugged. "What did you expect on a resident's salary?"

  "This is perfect," David said. "I wouldn't have made it any farther afield without falling on my face." He studied his reflection in the back of a spoon. "Jesus, maybe I should check myself in."

  "You don't look that bad. Mrs. Peters still swooned when you checked her eyes this afternoon."

  "She's ninety years old. With glaucoma."

  "She told me she thinks you look like George Clooney."

  David pursed his lips to keep from smiling. "And what did you say?"

  Diane twirled her straw in her Coke. "I told her no one looks like George Clooney."

  "True," David said. "True."

  Diane cocked her head slightly, amused. "I'd bet you were a great womanizer before you got married."

  He shook his head.

  "No? Why not?"

  He shrugged. "I guess I liked women too much." He fished a crumb of some sort from his apple juice and wiped it on the tray. "And I married young."

  "What did your wife look like?"

  A web of images entangled him. A white snowball smudge on her winter sweater. The first movement of her face in the morning, sleep-heavy and gentle. His hands lifting her wedding veil. He imagined her the night of their fifteenth anniversary. The twin strokes of her hips beneath a sleek black dress. They'd gone to a gallery opening in Venice where Elisabeth, as the LA Times art critic, had been fawned over by dealers and struggling artists alike. After a few hours, David had snuck her off to Shutters in Santa Monica, where they'd sat out on the balcony of their hotel room, holding hands, listening to the waves rush the shore in the darkness.

  "Her smile made me weak," he said.

  "David . . . " --Diane looked away-- ". . . am I delusional in thinking there's something going on between us?"

  "Positively schizophrenic. It must be your Yale education."

&nbs
p; "It's a tough question to ask. Why don't you answer it seriously?"

  "You're right," he said. "I'm sorry." He pried at the hard bun of his chicken sandwich as if he'd developed a sudden intense interest in baked goods.

  "The few times we've been out . . . " Diane squeezed one hand with the other. "For the life of me, I can't figure out if they're dates or just an attending and a resident talking shop outside work. I mean, we're alone . . . we're at dinner . . . but we're talking about lesions and contusion fractures."

  "An attending and a resident," he repeated.

  "Well?"

  "We've worked side by side, hands in the mud, for--what?"

  "Almost three years."

  "Three years now. You're one of the best residents I've ever had the pleasure to train. I consider you a colleague. Not a resident."

  The glimmer of a smile cut through the discomfort on Diane's face, just for a moment. "I didn't know that," she said. "But it still doesn't answer my question."

  "Look . . . " David realized his voice was shaking ever so slightly. "I've definitely thought about . . . but we can't. . . . I can't. . . . "

  "Why not?"

  He leaned back in his chair, trying to find what he wanted to say. "Diane, I'm almost twice your age."

  "I'm thirty-one and you're forty-three. That's nothing. Elizabeth Taylor has married men twenty years younger."

  "She doesn't have the same performance anxieties, I'd imagine."

  Diane played with her straw some more, poking at ice cubes. "All right," she finally said, with a slight hint of humor. "Why don't we make a deal? I won't call you on your lame-ass excuses, but when we do overlap socially, no more talk of lesions and contusion fractures."

  She extended her hand across the table and he shook it, mock formally, before settling back in his chair. He crossed his arms and fought off a grin. "So what's your middle name?" he asked.