Do No Harm (2002) Page 7

"Allison."

  "You like dogs or cats?"

  "Dogs."

  "What's your favorite kind of lesion?" She scowled at him, and he held up his hands defensively. "Just kidding. What do your folks do? Are they doctors?"

  "We don't all come from high-powered medical families. Not all our fathers have grand rounds auditoriums named after them."

  "It was named for my mother, actually," David said.

  Diane whistled. "What was it like growing up in that house?"

  "A lot of pimping at the dinner table. Name the eight bones of the wrist. The twelve cranial nerves. The five components of the Apgar score." He tilted his head. "My mother was chief of staff here at the NPI from '60 to '71, and she recruited a lot of the world's preeminent physicians--in all fields--to come lecture and teach at the Med Center. It wasn't uncommon for a few Nobel Prize-winning physicians to show up for dinner. The instructors and department heads that came through . . . it was truly amazing."

  "Who was the better doctor, your mother or your father?"

  "It's tough to say. They were in pretty divergent fields. My mother was a psychiatrist, my father a neurologist. My father passed away when I was young. Prostate cancer."

  "That's why you asked Pinkerton about a prostate checkup today even though he was only thirty-nine?"

  "We all have our pet illnesses, I suppose." David's mind followed some flight of reason, and he found himself saying, "My mother just went in '99."

  Diane nodded, and he was grateful she didn't offer any platitudes. He'd wanted to share the information with her, not elicit sympathy.

  A man in a wheelchair rolled slowly past, tray cradled on his atrophied knees.

  "My mother was a tough woman. All fire and ambition. I never saw her crack. Not once." David drew his hand down across his face, like a window blind. "When she was in her late sixties, she headed up the Disciplinary Review Board here. She had to call a young male nephrologist into her office to confront him about a claim made against him by a young woman. When she reprimanded him, he rose, locked the door, and beat the shit out of her. Broke two ribs." He watched Diane's slender eyebrows rise and spread. "The only thing my mother was upset about afterward was her lack of medical judgment in not being able to predict she was dealing with an unstable man." He set both hands on his tray and pushed it slightly away. "That was my mother."

  "A lot to live up to?"

  "A lot of people spend their lives trying to overcome their upbringing. I spent mine trying to fulfill it."

  "And have you?"

  "My mother was pretty disappointed when I decided to enter Emergency Medicine."

  "Why's that?"

  "If a surgeon is a glorified carpenter, an ER doc is a glorified carpenter with an inferiority complex." He laughed. "As you know, it's generally not considered the most cerebral field."

  "Your mother might have thought different if she'd seen you in action," she said. Her eyes quickly lowered. "Pardon my schoolgirlish fervor."

  "Medicine was a different thing back then. As has often been said--doctors of my parents' generation were the first for whom medicine was a science and the last for whom it was an art." Pulling a napkin from the dispenser, he wiped all the crumbs on the table into a neat line. "My mother never really forgave me for entering ER. As if it were a slight against her. My father wouldn't have minded, I don't think--he and I were always quite close. He was a charming, handsome man. Tall and broad. When I was a kid, he used to tell me I was the kind of person he wanted to be when he grew up." David smiled at the memory. Suddenly self-conscious, he looked up at Diane. Her blond hair was down across her eyes in front, and she brushed it aside.

  "Jesus, I'm sorry," he said. "Talking about myself all night. I guess it's been awhile since I've talked. Openly."

  His hands were folding the napkin in neat squares, and she reached out and stilled them.

  Leaving the cafeteria, David averted his eyes from the large bas-relief letters over the double doors to the right, as was his habit. He did not have to look to know what they read: SPIER AUDITORIUM. The name hovered overhead, as it did everywhere throughout the hospital.

  Speaking into a walkie-talkie, one of the new security guards breezed by with a female nurse, presumably escorting her to her car. David was glad to see that more precautions were indeed being taken after the assault on Nancy.

  A Mexican woman quietly worked a mop across the lobby floor, bringing the tile to a polished shine. Behind her, a chemotherapy-bald boy ran out of the hospital gift shop, stuffing a stolen Snickers in his pocket. The hefty register lady thundered after him, all but shaking her fist.

  Good for you, kid, David thought. Run, Forrest, run.

  He trudged down to his car, passing a few security guards on the way, and headed lethargically for home. He was glad to see the news vans had finally cleared out. On to the next tragedy, the next big story. Just past San Vicente, David pulled into a corner Shell station, swiped his credit card through the slot, and started to fill up his tank.

  While the gas pumped, he sat in the car, his mind playing through the cases of the day, picking at them from all angles to see if he'd made any mistakes. His mind kept returning to Diane, and from there, to Elisabeth.

  There is no way to predict an embolus. A perfectly healthy thirty-five-year-old, not even into middle age, no family history of disease, no hypertension, no diabetes, no vascular disease. One day she throws a clot, it lodges in her basilar artery, and for seventeen crucial minutes the brain is denied blood. Seventeen crucial minutes are enough to suck a loving, intelligent woman dry of thought and emotion, to leave her a living husk. Sometimes it takes less time than that.

  David had been the chief attending the night Elisabeth had been wheeled in--sick call on his birthday--so, knowing his medical judgment would be impaired, he'd let Don Lambert take lead. Of the first few hours in the ER, he remembered only scurrying bodies and the thick numbness of his tongue. Awhile later, his wife had lain in a limp recline upstairs in the MICU, the sheets humped over her inert body.

  The pattern of her gown had been repetitious and infantile, pale blue snowflakes on a white background. David recalled certain images vividly--the drops of urine inching dumbly along her Foley catheter like items on an assembly line; the hum of the ventilator pushing air down the endotracheal tube and through the snarl of plastic into her throat; her thin gown wrinkling slightly as her chest rose and fell, rose and fell.

  They'd EEG'd her promptly at David's request, his legs trembling beneath his scrubs. It had shown no activity at all, no wave forms. A still sea.

  She'd been tracheotomied and G-tubed, the monitor showing sound vitals. Her body was stable. A perfect life-support system for a dead brain.

  Elisabeth had signed a living will. David had maintained his composure, perhaps due to the fact that he was a physician practiced in high-intensity, emotional decision-making, but more likely because he'd seen too many times the other roads that lay ahead. They'd given him some time alone with her body before removing her from life support.

  He'd sat in a typical bedside post--leaning forward in the padded chair, chin resting on the union of his fists. He remembered being struck anew by how different the MICU was from the sunken B Level of the ER, in which nurses and doctors scurried among the wounded like industrious ants. The unit exuded a calm, almost peaceful air. Here it was easy to forget that one moved among the sick and dying. The scents were better contained, the nurses more personable, the floors and walls better scrubbed.

  Elisabeth's skin had been pale and smooth, like porcelain. Her arm had protruded from the papery cuff of her gown, her skin gray against the white sheets. Her simple wedding band provided the only stroke of color against her flesh.

  David had flattened his hand across her forehead and studied her eyes, but he'd seen nothing in them but the faintest flicker of his own reflection. It had taken him only a few moments to determine that Elisabeth's presence did not reside in her body any more than it did in the hospi
tal room.

  He had not been moved to tears. He had not been sure what he'd been expecting, but it hadn't been the cold nothingness in his wife's eyes.

  The neurologist had been waiting outside the door. He'd rested a hand on David's shoulder. "Are you ready?" he'd asked.

  "I'm not going to stay," David had said.

  The nurses and doctors on the floor had seemed surprised by how briskly he'd left.

  As David had driven home, the first edge of morning had leaked over the horizon, imbuing the air with a dreamlike quality. He'd pulled into the garage, removed his shoes, and stood motionless in the foyer for a full minute.

  It hadn't been until he'd walked down the long hallway and sat on their large empty bed that he'd broken down. His hands had started shaking first, then his arms, and then he'd wept softly and erratically, his wife's pillow pressed between his hands.

  A blaring horn on Wilshire brought David back from his thoughts. He put the car in drive and pulled away, but slammed on the brakes when he heard an awful metallic clunk. He got back out and picked up the broken gas handle from the ground; he'd pulled away with the handle still in the tank and torn it cleanly off.

  He walked slowly back to the well-lit booth.

  "I'll bill the usual account," the attendant said.

  David managed a weak nod. "That'll be fine."

  Chapter 12

  CLYDE woke up a few minutes past three, though he'd been squirming in the sheets since two, his scrub bottoms twisting around his legs. The pillow, smudged with sweat, had claimed a few more strands of his hair. His wide feet pattered across the dirty floor to the bathroom. He pissed heavily for nearly a full minute, splattering the toilet seat, which he'd neglected to raise.

  A rind of soap clogged the sink drain. He picked up a plastic McDonald's cup from the floor--filled and drank, filled and drank, filled and drank. He avoided his reflection in the medicine cabinet mirror when he swung it open. A box of orange lozenges remained half-full. He popped two from the foil sheet and sucked them hungrily, working up saliva to swish around in his mouth.

  Opening another can of cat food, Clyde added it to the slop overflowing the bowl, scaring up a swirl of flies. Pacing around the small apartment, bits of cheese and crumbs sticking to the bottoms of his feet, he smoked two cigarettes simultaneously, which seemed to quicken his step. He covered his eyes with the heels of his hands, his breathing intensifying until his chest heaved up and down. Climbing into bed, he pulled the dirty sheets up to his chin. He ground the orange lozenges into a paste and swallowed it.

  He lowered the sheets and sat up, staring at the footlocker at the base of the table. It lay open, rolls of gauze visible among the glistening medical equipment. A container of DrainEze sat out, casting a solitary shadow on the scarred tabletop. He struck his head with the flats of his hands. A few more strands of hair came out, stuck to his sweaty palms.

  A frightened whine started in the back of his throat and rose to a deep bellow. He stood up and shuffled through the mound of dirty clothes to the far wall. He'd stolen a snapdragon from the retarded home, potted it badly in a soggy ice-cream carton, and set it in the corner. Now, he pushed the plant to one side, revealing a disused heating vent. He fumbled in his pockets and removed a money clip. A cheap Mexican design with two fake-turquoise horses rearing on a hammered brass nub, the money clip hid a thin penknife in its side. He dug the knife open with a dirty nail, then slid the blade behind the edge of the vent for leverage.

  The surrounding wall crumbled a bit when he pulled the vent out, and Clyde stared reverently at the solitary bottle of pills before touching it. The bottle was unmarked, the pharmacist's label removed and the underlying gum scraped off with a fingernail. He tapped three pale yellow capsules into his palm and took them there on his knees, swallowing them without water. Before returning to bed, he replaced the vent and the plant.

  Lying back, he closed his eyes. "Three, two, one," he murmured. "Step back from the door. Three, two, one, step back from the door back from the door back from the--"

  Tears pushed their way out under his eyelids, streaking down his temples to the pillow. His hands pushed and clawed at the sheets, fisted and loosened. Finally, he sat up, the key swaying from his ball-chain necklace like a pendant.

  Throwing the sheets aside, he crossed quickly to the table, seized the container of DrainEze, and hurled it into the footlocker with such force it nearly bounced out. Slamming the lid shut, he fisted the key and yanked, his necklace breaking easily. His hands were shaking so severely, it took him several tries to slide the key into each of the smooth circular locks, but finally he had the footlocker secured.

  Storming across the musty room, he slid the window open with a grunt, tore the screen from its pegs, and hurled the key outside. It bounced once on concrete and lost itself in the strip of thick weedy grass beside the sidewalk.

  The beads of sweat that had formed on his forehead were starting to run, stinging his eyes. He dashed to the heat vent again, skinning his bare knees as he slid, and pulled aside the snapdragon, his fat fingers digging into the soft plaster around the vent. He dug two more capsules from the translucent orange bottle and swallowed them. He had the bottle back in its hiding place and the vent pushed into the wall when he tore it aside again, unscrewed the bottle, and swallowed two more pills.

  He went to the bathroom and urinated again, then drank three more glasses of water and got back into bed. His fingers tapped his chest several times, lightly, where the key usually rested. His breathing quickened into an animal's whine. He got back up and stood at the window, forehead and hands pressed to the pane, eyes searching the weedy strip below.

  Within the hour, he was out hunting on his hands and knees, the beam of his flashlight playing like a small beacon through the tall blades of grass.

  Chapter 13

  CLYDE parked at a metered spot on Le Conte and walked up toward the Medical Plaza, turning so the construction workers across the street couldn't make out his face. He wore scrubs and a loose gray sweatshirt. His scrub bottoms, like most, had a hidden pocket inside the waist on the left side, a simple stitched flap of fabric designed to keep credit cards or prescription pads safe from grabbing hands and aortal spurts. Clyde had wedged his money clip inside.

  One of his hands was hidden beneath the sweatshirt, causing it to bulge. He tugged on the bill of his blank navy-blue corduroy hat, pulling it low so it shadowed his features. The early-morning air was crisp, though there was little breeze.

  Ducking behind some foliage near the PCHS lot, he watched the attendants in the kiosks about thirty yards away. For the most part, they kept their eyes on the cash registers and the incoming cars, paying little attention to the walkway that sloped down to the ambulance bay. Located at the rear of the small underground parking area, the actual entrance to the ER was not visible from street level.

  A security guard emerged and headed up the walkway, whistling, his eyes on the bushes to his right. He reached the top of the slope and turned into the covered section of the PCHS lot, the section that led back into the hospital. There were no news vans in sight.

  Clyde's latex-gloved hand emerged from beneath his sweatshirt, holding a Pyrex beaker, its gradations marked in white. It held a blue viscid liquid. Breathing heavily, he removed the foil covering, balled it up, and tossed it into the gutter. It rolled a few feet before falling down a sewer grate. Clyde withdrew back into the bushes, hidden by a cluster of palm fronds, and used his cheap digital watch to time the security guard's patrol.

  It took the guard five minutes and twenty-four seconds to walk a full loop through the hospital and reappear. The guard emerged from the ambulance bay again, heading up the walkway, head swiveling like a dog tracking prey.

  Pressing the beaker of alkali to his stomach, Clyde crouched in the bushes, waiting for the security guard to disappear once again into the larger lot. Then, mopping his forehead with the sleeve of his sweatshirt, he stepped from the bushes. The rise and fall of his
chest quickened.

  He walked casually past the kiosk, keeping his eyes on the ground. A harried woman was loudly voicing her objections to the parking rates, pulled up so the black-and-white striped arm nearly rested across the hood of her Taurus. Neither of the parking attendants noticed Clyde.

  One hand staying beneath his sweatshirt, Clyde shuffle-stepped down the walkway into the subterranean ambulance bay, careful not to sway too much. Three rivulets of sweat arced down his left cheek. At the bottom of the ramp, two ambulances had been left deserted along the curb. He slid between them and the wall.

  A couple lingered by their car in the parking slots across the ambulance bay, and Clyde pressed his cheek against the cold metal side of the ambulance until their engine turned over. His breath came quick and pressured, like a sprinter's. The car chugged up the ramp toward the open sky and disappeared from sight.

  The ambulance bay was silent.

  The automatic glass doors to the ER stood about fifteen yards to his left. He watched the doors and waited, trying to get his breathing under control. He had about three more minutes before the security guard would reappear. He held the Pyrex beaker with both hands, gripping it so tightly his knuckles whitened. The blue liquid lapped up the sides as his hands trembled.

  A sudden noise as the ER doors pushed open. He ducked, peering through the ambulance windows. The driver-side window was down, and the ambulance interior smelled of pine disinfectant.

  An Asian woman emerged from the doors, her clogs echoing off the enclosed walls. She wore blue scrubs.

  Clyde's nostrils flared as he drew breath. His eyes were dark and flat, stones smoothed in a river's bed. He did not blink.

  Pulling a cigarette from a pack she kept hidden in the inside breast pocket of her scrub top, she lit it and inhaled deeply, throwing her head back. An indulgent moan accompanied her exhalation.

  His pounding footsteps alarmed her. The lighter dropped on the asphalt and bounced up, almost knee-high. Her face spread in a scream and both arms went up, intercepting most of the blue liquid. A spurt found its way through, dousing the left side of her face as she turned. She yelped and fell over, her palms slapping the asphalt.