Harry had seen and experienced enough ofwhat could go wrong in hospitals to fear ever being a patient in one. Each day,every day, thousands of patients were cared for at hospitals in and aroundManhattan. Most physicians, nurses, aides, and technicians were dedicated,competent, and focused. But invariably, on any given day, some weren't. Therewere simply too many patients, too many illnesses, and too many caregivers withhuman frailties for the system ever to be perfect.
Over his twenty-five years in medicine,Harry had confronted or heard about all manner of disasters, many of thembeyond anything he could have imagined. Orange juice given intravenously by anurse who had misunderstood a physician's telephoned orders and was toointimidated to call back and question them. A lethal dose of medicationadministered to a child because a harried physician omitted a decimal point.B-positive blood inadvertently finding its way into the bloodstream of anA-negative patient. Then there were the countless IVs that emptied far morerapidly than they were supposed to, the bedrails carelessly left down, and theunanticipated psychoses in response to tranquilizers or sleeping medication.
Along with the preventable disasters werethe so-called complications — the documented and accepted 1 percent, or0.1 percent, or 0.001 percent adverse reactions to medications and invasiveprocedures that were enumerated in the textbooks, PDR, and packageinserts, and were only of concern if they happened to happen to you.
With such thoughts refusing relegation tothe back of his mind, Harry made his way through the corridors of MMC to theneurosurgical unit on Alexander 9. It was five past eight in the evening.Visitors were streaming toward the exits. He had hoped to make it up to thefloor earlier, but a long-standing patient of his had been brought to the ERvomiting blood. Now, having stabilized the man's bleeding ulcer, he had finallybeen able to sign out to the doc on call.
Earlier in the day, he had met Evie at themain lobby and walked with her to the admissions office. He offered to staywith her during the pre-admission ritual, but she declined. She seemedpreoccupied and distracted, just as she had the night before. Certainly thesurgery was on her mind. But there was something else. Harry felt certain ofit.
The evening before, they had walked fromtheir apartment to the SeaGrill in virtual silence. Although they talked someduring dinner, only one topic of substance was discussed. Evie made him promiseto fight any attempt to prolong her life if there was brain damage of any kind.And as they were walking back to the co-op, she apologized for not having putthe energy back into their marriage that she might have. There was abittersweet finality to the way she said it. Harry acknowledged the apology,but could not read its significance.
Alexander 9, an 'L' with fifteen rooms oneach arm, was in transition from evening to night. The corridors were emptyexcept for a nurse's aide wheeling a patient back from the lounge and a janitorreadying his large, metal-enclosed floor buffer. The nurse's station was midwaybetween the elevators and Evie's room. An attractive, redheaded nurse withhigh-gloss crimson nail polish was seated behind the counter writing notes.Harry had never seen her before.
'Hi, I'm Dr. Corbett,' he said.
'I know,' the woman said. 'Your wife'sdoing fine.'
'That's great. I spoke to her on the phonea while ago and she sounded okay, except she was a little distressed about herroommate.'
The nurse's face wrinkled in distaste.'She's not the only one. We've all just about had it up to here with MauraHughes. I really think there ought to be a hefty tax on alcohol to pay for themedical treatment of people like her. Don't you?'
'I don't understand.'
'Alcoholics. Oh, I thought your wife toldyou. Her roommate, Maura's, in the DTs. Unfortunately, there are no other emptybeds on the floor.'
'Evie said she wasn't too bad.'
'As long as the Librium is working sheisn't. She came to the floor from the OR three days ago. She was on a bigbender and fell down the stairs of her building and fractured her skull. The CTscan showed a collection of subdural blood, so she had to have it drained. Shedid great until yesterday when she suddenly began complaining about the spiderscrawling along the ceiling and the ants under her sheet.'
'That certainly sounds like the DTs.'
'Oh, it is. Believe me. She's disruptedthe whole floor. Those people are so self-centered and inconsiderate. Theynever stop to think of the consequences of their drinking, if you know what Imean.'
Harry had heard enough. Where had thiswoman been for the last fifteen years?
'Sorry to get here after visitors' hours,'he said, 'but I had a man in the ER with a GI bleed. Is it okay if I visit withEvie for a while?'
'Sure. If Maura-the-moaner gets to be toomuch for you, we'll just tighten her restraints and move her into the hall. Asa matter of fact, she's due to have a visitor soon, too. Her brother called alittle while ago. He's a policeman, of all things. He doesn't get off duty fora while and he wanted to see her. I almost told him to bring in a whip and achair.'
'Well, Miss' — he checked her name tag — 'Jilson, I appreciate your bending the rules for me.'
'Anytime. Your wife is very beautiful, Dr.Corbett.'
'Yes. . yes, thank you.' Harry hurriedaway from the woman and down the hall to room 928.
'. . so they're just mean to me. Meanand nasty. They don't like me because they think this goddamn floor is clean asa whistle and I keep pointing out the bugs that are crawling everywhere. God, Ihate bugs. I hate them. Stuck-up, snobbish, know-it-alls …'
Several doors from the room, Harry couldhear Maura Hughes's steady stream of babble. He had treated every form ofalcohol withdrawal during his residency at Bellevue and over his years ofprivate practice in one of the more indigent areas of the city. DTs — deliriumtremens — while at times amusing, was potentially lethal: heart rate up,respiration up, core temperature up, nervous system irritability marked, fluidloss through perspiration and hyperventilation intense, fluid intake minimal tonone. He had seen studies showing a mortality rate from DTs as high as 25percent. And Maura Hughes was three days post craniotomy as well. She was amedical time bomb, the last roommate he would have chosen for Evie.
Harry glanced down the hall at thejanitor, placidly working his buffer from wall to wall. He had on a Walkman andwas bobbing his head in time to the music, totally oblivious to thelife-and-death dramas being played out all around him. Harry wondered what itmust be like to have a shiny floor be the extent of one's professionalresponsibility.
Evie had the bed next to the windows andfarthest from the door. The curtain separating the two beds was pulled. Harryglanced at Maura Hughes as he passed. She was restrained to the bed with acloth Posy harness. Her wrists were secured to the bedrails by broad leatherstraps. She wasn't old. He could tell that much about her, but little more.Below her turban bandage, dense, violet bruises enveloped both of her eyes andran down to the corners of her mouth. Her oxygen prongs had dislodged from hernose and were ventilating her left ear. Her cracked, arid lips were drawn backin a strange, twisted rictus. Harry's first impression was that she wassnarling at him. Then he realized that she was smiling.
'Hi,' he said. 'I'm Evie's husband,Harry.'
'Double, double, toil and trouble, fireburn and cauldron bubble,' she replied.
Harry managed a smile of his own andstepped beyond the curtain. Evie accepted his kiss on her forehead withoutreaction.
'She knows Shakespeare,' he whispered.
'Actually, she knows a lot of things. It'sjust that the insects and snakes and spiders keep getting in the way.'
'The creepy crawlies. It would be sort ofhumorous if the insects and such weren't so damn real to her. She should bethrough this in another day or so.'
'Ouch! Get off my sheet, you filthy bug!Hey, will someone please come over and help me!'
'Go say something,' Evie urged. 'Try andcalm her down.'
Harry walked back around the curtain.
'You're too late, Gene,' Maura said tohim. 'It bit me and it's gone.'
'Sorry.' Harry realized now that she waseven younger than he had originally thought — possibly in her mid-thirties. 'Myname's Harry. Not Gene.'
'Well, you look like Gene Hackman.'
'Thanks. I like Gene Hackman.'
'So do I. I thought you were an actor.'
'I'm not. Why would you think that?'
'Your pin.'
For a moment, Harry had no idea what thewoman meant. Then he remembered the pin his niece — Phil's oldest daughter,Jennifer — had given him. It was a tiny depiction of comic and tragic faces — aprize she had won for drama at school. A year or so ago he had helped her placeit on the lapel of this particular sports coat, and there it had remained. Herarely even thought about it being there. Maura Hughes had identified it fromeight feet away.
'I'm impressed that you saw this,' hesaid.
'I notice things.'
Suddenly she began squirming and fightingher restraints.
'Dammit, Gene,' she snapped, 'do you haveany Southern Comfort on you or not? You promised and — Shit, Gene, watch out!Right there on the wall by your head. What is that? A scorpion? A shrimp?'
In spite of himself, Harry glanced at thewall.
'Try and get some rest,' he said.
He returned to his wife, who was lyingalmost flat in bed, staring up at the ceiling.
Don't shut me out, he wanted to insist. Afternine years, on this of all nights, why can't you share some of what's going oninside you?
'There are no empty beds on the wholefloor,' he said instead. 'No place to move either of you. If the nurses can'tmedicate her anymore, perhaps they can give you something.'
'I don't want anything,' she said, withoutturning her gaze from the ceiling. 'I want my brain functioning at maximumcapacity right up until the last possible moment.'
'I understand. You're going to do fine.'It was then Harry saw the IV — a bag of 5 percent dextrose in water, hangingfrom a ceiling hook nestled in the dividing curtain, delivering tiny dropletsthrough flow-control tubing. 'When did that go in?'
'A few hours ago.'
'I didn't even notice it. I wonder whythey put it in tonight and not in the OR tomorrow. Do you know who ordered it?'
'The anesthesiologist, I think the IVnurse said.'
'Hmm.'
'What difference does it make?'
'None, I guess.'
A prolonged, uncomfortable silencefollowed.
'Look, Harry,' she said suddenly, 'I thinkI need to be alone.'
The words hit him like a slap. He staredat her, uncertain how to respond.
'Could you please tell me what's goingon?' he said finally.
'Nothing's going on. I … I just have alot on my mind.' She took a deep breath. Her tension seemed to ease a bit.'Look, they said I could eat until midnight. I'll tell you what. I'm dying foran extra-thick chocolate malt from Alphano's. Pick me up one, then we'll talk.Okay?'
Alphano's Ice Cream Emporium was twoblocks beyond their co-op — a fifteen-minute drive from the hospital if thetraffic was reasonable. But Harry felt grateful to have something — anything — to contribute.
'Done,' he said, rising. 'I'll be backwithin the hour. And we don't have to talk. I'll be happy just to hang with youfor a while.'
He bent to kiss her but again there was noresponse. He settled for another peck on her forehead.
'Gene, Gene, lean and mean. Keep him looseand keep him clean,' Maura Hughes sang as he passed.
Out in the hall, the buffer man hadstopped his work and was kneeling down, Walkman still in place, scowling at themotor of his machine when Harry walked by. Harry felt strangely pleased to seethat the man's life wasn't so uncomplicated after all.
Farther down the hall, the nurse, SueJilson, smiled up at him as he approached.
'Leaving so soon?'
'My wife asked for a milk shake that'sonly made at a place on West Ninetieth. I can be back by nine-thirty, if that'sokay.'
'No problem.'
'Would you like one?'
'Thanks, but no thanks. I made a deal withmy jeans to keep fitting in them. How's the moaner?'
'Agitated and a bit disoriented. She couldprobably use some more medication if it's ordered.'
'I'll check. There's nothing any of uslike better than sedating Maura.'
'Thanks. See you in an hour.'
Harry drove to the West Side through a mistyrain and fairly heavy traffic. The line in Alphano's was longer than usual, theservice slow enough to be irritating. He ordered an extra-thick chocolate malt.Then, wondering if Maura Hughes might be lured out of orbit, he ordered asecond one. If she couldn't handle it, he would make the sacrifice.
It was nine-thirty by the time he left theice-cream parlor, and close to ten when he reentered the hospital. Aftervisitors' hours, only the main entrance was open. Harry crossed the desertedlobby and flashed his plastic ID at the security guard, whose desk blocked themain corridor to the hospital.
'I've got to have you sign in, Doc,' theman said. 'After nine.'
Harry scribbled his name and destination.The guard glanced at it.
'Alexander Nine,' he said. 'You going upthere for the Code Ninety-nine?'
At that instant, the overhead page beganurgently summoning Dr. Richard Cohen to Alexander 928.
Harry hurried toward the elevators.Something had happened to Maura Hughes, he was thinking. She hadn't looked thatgreat when he left, but she certainly hadn't seemed in imminent danger. Thensuddenly he remembered that Richard Cohen was a member of the sameneurosurgical group as Ben Dunleavy, Evie's neurosurgeon. Cohen was undoubtedlycovering for the night. Gripped by an intense foreboding, Harry kept jabbing atthe elevator call button until one of the doors slid open. The ride up toAlexander 9 took an eternity.
Room 928 was halfway down the far arm ofthe 'L.' The nurse's station and near corridor were deserted. Harry set downthe bag from Alphano's and sprinted down the hallway, his heart pounding in histhroat. It took only a moment after he rounded the corner to have his worstfears confirmed. There were half a dozen nurses and med students standing outsideroom 928, craning to catch a glimpse of the action. Maura Hughes, stillrestrained in her bed, had been pulled to the far side of the corridor.Standing beside her, stroking her hand, was a young, uniformed policeman.
Harry raced past them all and into theroom.
The scene was one he had witnessed orparticipated in hundreds of times over the years. The monitors, the lines, thecrash cart, the defibrillator, the nurses, physicians, and technicians movinggrimly from equipment to bedside and back like a platoon of army ants. Onlythis time, at the center of the controlled chaos, intubated through her noseand being ventilated by a rubber bag, was his wife. The cardiac monitor showeda regular rhythm. Every ten seconds or so, though, her arms extended to the maximumand rotated inward, turning her palms away from her body in an eerily unnaturalposition. Decerebrate posturing. A horrible prognostic sign. Almostcertainly, her aneurysm had blown. He moved to the bedside. The nurse, SueJilson, was the first to realize he was there.
'When did this happen?' he asked.
The neurosurgical resident who was runningthe resuscitation looked up.
'This is Dr. Corbett, her husband,' thenurse explained.
'Oh, sorry,' the resident said. 'Heraneurysm appears to have ruptured. Dr. Cohen is covering for Dr. Dunleavy. Ijust got word that he's on the way up.'
'What happened?' Harry asked. 'I left herjust a little over an hour ago and she was fine.'
Sue Jilson shook her head.
'About half an hour after you left I wentin to medicate Maura. I heard a moan from behind the curtain. When I looked,your wife had vomited and was barely conscious. The initial blood pressurereading I got was three hundred over one-fifty. One pupil was already largerthan the other.'
Harry stared down at Evie, his mindunwilling to connect what he was seeing with what he knew of cerebralhemorrhaging. He reached down and gently lifted her eyelids. Both of her pupilswere so wide that almost no iris color could be seen. He felt numb, dreamlike.It was already over.
Dr. Richard Cohen rushed into the room. Healready knew the patient's history, he breathlessly told the resident. Theresident gave him a capsule summary of the past thirty-eight minutes.
'You've done everything right,' Cohen saidas he examined the inside of Evie's eyes with an ophthalmoscope.
He quickly checked her reflexes andresponse to pain. Then he used the end of his reflex hammer to firmly stroke anarc along the soles of her feet from heel to great toe. The Babinski reflex — the great toe pulling up instead of curling down — was a grave, grave sign thather cerebral cortex, the thinking part of her brain, was no longer influencingthe movements of her body. Harry watched, stunned.
'We'll get a CT scan,' Cohen said grimly,'but in all honesty, I don't think we can get her to the OR. The brain swellingis enormous. Both of her optic discs are showing severe papilledema.'
Papilledema — the optic nerve engorgementcaused by marked, usually irreversible pressure within the skull. The findingmade the evolving scene even more surreal.
'She. . she doesn't want any heroicmeasures,' Harry heard himself saying.
'Arterial line's in,' another residentcalled out. 'Her systolic is still two-ninety.'
'That's very strange,' Cohen said. 'We'vegiven her a huge amount of antihypertensives already, but her pressure hasn'tbudged.'
'But wouldn't you expect her pressure tobe up like this with a large hemorrhage?' Harry asked.
Temporarily, maybe. Most CNS bleeds dohave a period of marked rise. But they almost always respond to conventionaltreatment, and the residents have already gone well beyond that.'
'Oh, God,' Harry whispered, still feelingdetached and unreal.
'We'll keep trying to get her pressuredown,' the neurosurgeon said. 'And we'll get a CT to document what we alreadyknow. Meanwhile, Harry, difficult as it is under these circumstances, there'ssomething you should be thinking about.'
'I understand,' Harry murmured.
Evie was a young, completely healthywoman, whose only organic problem was her aneurysm. At the moment, she was thesort of prize coveted by every organ transplant specialist — a source of lifeor sight for any number of people.
'Let's get the scan and then I'll let youknow,' Harry said. 'Meanwhile, go ahead and begin tissue typing.'