Janet heard Earl's car pull into the driveway.
She threw down the Saturday edition of the New York Herald, wanting to swat him with it for coming home so late on a weekend. It especially galled her when politics, not patients, delayed him.
Bloated, bitchy, and mad at the man who had gotten her that way, she thought. She'd better watch it, or she'd soon come across like the wronged woman in a country-and-western song. Still, her two-hours-overdue husband had better have a damn good excuse.
Brendan looked up from where he'd been engrossed in some elaborate game on the kitchen floor involving a toy train and dump trucks. "Daddy's here," he yelled, the noise of his father's arrival finally penetrating his imaginary world. He leapt to his feet and streaked to open the back door.
She levered herself upright. God, she didn't remember being so heavy the first time. No way she'd be able to work right up to the due date lugging this one around. She also admitted to a tinge of relief at having a legitimate excuse to book off on maternity leave earlier than last time. Despite her initial resolve to never abandon her patients because of SARS, she didn't at all like some of the close calls that had been reported in the news lately involving pregnant women exposed to undetected contacts in hospitals.
"Daddy, I listened to my little brother's heart," Brendan yelled from the threshold, eyes wide with the clear blue exuberance that only a six-year-old can have. "Mommy put a radio thing on her tummy and let me hear."
Earl stepped in from the rain and swung him into the air. "She did? Wow!"
"Want to hear what it sounded like?" Without waiting for an answer, Brendan very seriously pursed his lips to make a rapid sucking and blowing sound with his breath- not a bad imitation of fetal blood flow amplified by a Doppler microphone.
Despite her annoyance, Janet had to laugh. Still, Earl should have entered the garage directly and not touched Brendan before discarding all clothing immediately into the washing machine and showering. Shortly after the outbreak they'd installed a cubicle in there just for that purpose. She'd felt paranoid doing it- Earl kept reassuring her that the precautions at work should have been enough- but the fear they might have carried the virus home on their skin or clothing stalked her every time either of them went to hug their son.
Earl glanced her way. He must have read trouble, as he just as quickly put Brendan down and said, "Well, isn't that marvelous? You're sure Mommy doesn't have a little choo-choo engine in there?"
"No, come listen yourself." He reached to pull Earl toward her. "She's been making us spaghetti, for a long time."
Earl stepped back, hands in the air. "Daddy has to go shower," and he disappeared down the basement stairs.
Five minutes later he returned dressed in jeans and a T-shirt, his dark, wet hair slicked back. He wisely stooped to first say hello to Muffy, their large standard poodle, who still considered herself the family's firstborn and Brendan one of her pups. Now twelve, the dog had taken to sleeping a lot, mainly in doorways near entrances so that any new arrivals would have to step over her rather than she having to run to them. He gave her a kitzfe behind her ears- Janet had taught him the word shortly after they first met sixteen years ago. It meant stroking. Muffy had become an eager recipient when she joined the family, and Brendan had learned early to get his fair share too. Kitzle had appeared in his vocabulary almost at the same time he learned "No!"
After a few seconds with the dog, Earl got Brendan on the other side of him, and attempted a make-Janet-smile maneuver with a show of boy-dad-and-poodle funny faces. When that didn't work he led his co-conspirators in a three-abreast charge to where she stood leaning against the table. Muffy jumped her first, front paws stretched shoulder high. Brendan grabbed a leg, and Earl gently slid his arms around her protruding waist, the smell of soap off him tickling her nose.
Her anger drained away. Fifteen years married, and the man could still disarm her with the old playful charm. She grabbed a nearby ladle and waved them off. "Wash your hands and set the table with knives and forks," she commanded, scowling at Earl. "Supper's late enough as it is."
He winced again. "Sorry. Something came up at the hospital."
"On a Saturday night?"
"I'll tell you when we're alone." Scooping up Brendan-"Come on, chum. You're filthy!"- he ducked out from under her blue searchlight gaze.
By 10:30 the storm had passed and the clouds abated enough for the moon to appear. Its misty light percolated through the canopy of trees in front of their house, and the grass beneath, stirred by a strong breeze, flickered between silver and shadow.
She curled up beside Earl on their living room couch, her back to his front and half listening to his explanations as to why he'd been so late.
"I won't be a widow to out-of-hours political crap on a Saturday," she interrupted, having heard all she cared to. "Not for Jimmy, Peter Wyatt, or showing up doctors who can't cut it, understood?"
"Aye, aye, Captain." He slipped an arm around her and softly nuzzled her hair with the side of his face.
"I'm serious, Earl." She looked up at him. "There are others who deserve your time." She placed his hand on her rounded stomach.
He smiled and explored her pregnant curves with his palm.
His fingers released a craving that caught her by surprise. She felt her face flush.
He continued to caress her, very slowly, in ever widening circles.
She relaxed, first letting her body mold itself against his, then beginning to follow his movements with her hips.
"Do you think your passenger would mind?" he asked after a few more minutes, their gyrations becoming more urgent.
She arched her back and lifted her arms, slipping her hands behind his neck. "Just be gentle," she whispered in his ear, drawing him to her and setting him on fire.
He reached around to the lamp and turned it off, then began to unbutton her blouse.
Afterward, in the darkness, they held each other, and he felt the cool night air flow gently over them through the open windows. Savoring the rise and fall of her breathing against his chest, he thought of all the other times like this when he'd cherished the extraordinary blessings in his life- Janet, Brendan, and now a new son on the way- but always with a glance over his shoulder. He knew from a lifetime in ER how quickly joy and love could be snatched away by fate, bad luck, or raw malice. Working emergency had ingrained it in him. While he could recount victories, the defeats, like permanent toxins in human tissue, embedded themselves the deepest and stayed with him the longest.
"Hey, you have to trust life more," Janet had told him shortly after their first encounter sixteen years ago when she'd gotten her initial glimpse of his dark take on the brutal laws of chance. "For all the victims who end up in your ER, there's thousands more who make it safely home to bed. Besides, people like us, you and me, we'll make our own luck." Such unswerving optimism suited a woman who brought new life into the world for a living. It also counterbalanced his own daily workload of lives lost or torn apart.
Lately his tendency to think the worst had taken a new twist. Although he hadn't said anything to her yet, he worried about Janet giving birth at St. Paul's. Nobody had exposed the OB units to SARS, but it had happened in other hospitals. The culprits were usually residents who came from a ward where they'd unknowingly been around an infected patient who hadn't been diagnosed. The result was that newborns arrived only to be slapped into isolation. Only a matter of time, he kept telling himself whenever she went to work in her own department. But she knew that as well as he did, would be no less worried about it, and didn't need the extra pressure of hearing him lay it out.
He'd started to read up on home deliveries instead.
The breeze from outside picked up slightly, and he savored a sweet fragrance of nicotinia that wafted into the living room. It came from the front garden where she had planted an entire bed of the white, star-shaped flowers. Their pleasing, clean scent made him think of the lonely woman in Palliative Care who had confided how she loved the freshness in the air following a rainstorm. What was her name? Sadie Locke? Tomorrow, weather permitting, he'd have one of the orderlies take her out onto the roof garden in a wheelchair. Maybe maintenance could even spruce the area up a bit, perhaps bring in a few pallets of annuals. Janet would know what varieties might do well up there. Then patients who were strong enough could escape the walls and odors of the hospital.
He smiled and indulged in a rare moment of feeling pleased with himself. Why not? He seemed to have a knack for this VP, medical stuff. It gave him a rush of satisfaction, the prospect of having all that power and using it to do good things.
So there, Jimmy.
Sunday, 6:00 a.m.
Palliative Care Unit, St. Paul's Hospital
Monica Yablonsky dashed for the bedside phone. "Code blue!" she yelled, the standard order to bring a resuscitation team running to the aid of a cardiac arrest victim. "And I want the R-three in ICU or Emergency."
Not just a bunch of beginners, she added to herself, slamming down the receiver and reaching for the gray face with the staring eyes. It felt cold and rubbery. God knew when she'd died. Not recently. But with no DNR order on the chart, and given the stunt Earl Garnet had pulled last night, she'd better play this one by the book. Damn him, sticking his nose in where it didn't belong.
She plopped a pocket breathing mask over the dead woman's lips and nose, then blew.
The breath squeaked out the sides of a rubber seal that should have molded itself to the face.
Elizabeth Matthews's chest barely rose.
Monica tried again.
The same resistance blocked her effort.
Still, she had to go all out. Or would that only make her appear more guilty? Garnet would be looking ultra close at what happened here. And given his reputation for digging up shit, he'd be bound to discover the others. If he did, the nurses on the night shift would have to watch out.
She swiftly positioned her hands on the midpoint of Elizabeth Matthews's sternum and began the compressions. It felt stiff, so she applied more force to get the required inch of downward thrust that would squeeze the heart's ventricles and pump blood through the body.
Ribs snapped with a crunch under her palms.
"Shit," she muttered, easing off a bit. Still, she continued, not at all sure her efforts wouldn't make Garnet more suspicious.
"We got a code, eighth floor!" Jane Simmons yelled. She turned from the phone and ran to where they kept a portable bag of airway equipment. Grabbing it, she sprinted for the door, right behind Thomas and the rest of the team. At the elevators they commandeered a car with an override key.
In less than a minute they were on the ward. Jane arrived at the patient's room to find the night supervisor, Mrs. Yablonsky, and a nursing aide administering CPR, both women red-faced from the exertion.
Out in the hallway the sounds of running feet and a familiar wobble of wheels announced the arrival of ICU residents with the crash cart. This chorus of youngsters with fear in their eyes followed Thomas through the door and swarmed the patient. Some ripped open her nightgown, while others slipped a board under her back. One of them applied well-lubed defibrillation paddles to her bony chest.
The monitor screen showed a flat line.
"I've got the airway," Jane said, shouldering Yablonsky aside and flipping off a pocket mask that the aide had been using to provide ventilation. As she worked, the sticker bearing the patient's name at the head of the bed caught her eye.
Questions flew.
"She's not a DNR?"
"When did she arrest?"
"What's her diagnosis?"
Amid a flurry of hands, additional IVs went up.
Jane tried to pry open the mouth; she found it unusually stiff but slid a curved airway into place anyway. She then connected a ventilation bag and mask to an outlet in the wall, sending a hiss of oxygen into the room. But when she applied the mask over the patient's face and squeezed, the bag remained rigid in her hand. She couldn't force air into the lungs. The woman's tongue must be blocking the way, she thought. She tried to reposition the head, but it resisted manipulation as much as the mouth had.
A pretty blond girl who had attempted to take over the chest compressions, her long hair repeatedly flopping in the way, slowed after a dozen thrusts. "This one doesn't feel right!" she said, her eyebrows bunched into a frown, but she continued to labor over the dead woman's chest.
Thomas walked over to the bed, reached through the crowd, and placed the tips of his fingers along Elizabeth Matthews's neck. "You're not producing a pulse." He signaled the young intern to step back- she'd already grown flushed from trying- and attempted a few compressions himself. A puzzled expression crept across his forehead. He stopped pumping, threw the covers entirely off, and turned the woman's body to reveal large purple blotches on her hips and the back of her shoulders. He looked up at the supervisor. "The woman's been dead four hours, minimum." He pointed to the discolorations and turned to the residents. "These markings take at least that long to appear. We call the phenomena lividity, where venous blood pools at the lowest point of the body once a person has died." His voice had slipped into the clipped tones most seniors used when teaching. He threw the bedsheet back over Matthews, allowing it to float down on her like a shroud. "A code blue never should have been called."
Yablonsky's cheeks burned red at the rebuke.
As the others cleaned up their equipment, Thomas Biggs led her to the corner of the room. "Why'd you do it?" he asked.
He may have intended their conversation to be private, but Jane easily overheard them.
A flicker of alarm shot through Mrs. Yablonsky's eyes. "I beg your pardon?" she puffed with indignation.
"Why'd you call the code? You could feel and see her as well as I did. The skin had gone cold. The lividity formed where she lay."
Mrs. Yablonsky's face flamed further, and the cords of her neck muscles tightened.
Oh, boy, thought Jane, who knew from other visits up here that the woman had a temper. And Thomas could be less than diplomatic when pointing out someone else's mistakes.
But thankfully, this morning Yablonsky seemed set on avoiding a fight. Her rigid posture relaxed a notch. "Sorry," she said, "I should have checked."
Thomas studied her, then his eyes crinkled good-naturedly as he gave her a smile. "That's okay. We can all forget something sometimes. It just surprised me. Calling a code on her"- he gestured at Matthews's body-"is a rookie move."
Yablonsky's eyes hardened.
Ah, shit! Jane thought. Now why did he have to add that? He seems set on provoking her.
The supervisor adopted a time-to-put-this-smartass-on-the-defensive look. "Oh, really? Well, I'd advise you to write it up by the book, Dr. Biggs, because Dr. Earl Garnet himself is going to be taking a big interest in her death."
The merriment in the corners of his eyes slipped a notch. "What do you mean?"
"Just what I said. Dr. Garnet will want to know what happened here, believe me."
"Why would Dr. Garnet be interested in a terminal cancer case?" he asked. The cockiness in his voice had faded a bit more.
"Because he personally doubled her morphine dose last night without her physician's knowledge."
Thomas's mask elongated as his jaw sagged in disbelief. "What made him do that?"
The other residents had started to pay attention.
"Ask the man yourself," she answered, making no attempt to lower her voice. "All I know is, he intended to jump-start some kind of audit into how we medicate pain. Well, it backfired. He'll get his audit, but now it'll be him on the hot seat."
"But surely a terminal patient's death won't be questioned." Thomas sounded more incredulous by the second.
"Oh, but it will, Dr. Biggs, because according to her doctor, she still had months to live."
"Nobody can predict that sort of thing with any certainty."
"That may be. But I advise you to write this one up without skipping any details. It's going to be gone over with a microscope, I promise you."
The ridges in Thomas's forehead thickened a little. "I see," he said.
"I should hope you all do," she added, addressing everyone in the room as if they'd all been errant schoolchildren.
The bitch! Jane thought, as wide-eyed with astonishment as everyone else at what she'd just heard. But the part that most shocked her was not that the woman had pulled a classic shift-the-focus-and-cover-your-own-behind move but that she'd done it specifically at Dr. G.'s expense. Thanks to her big mouth, rumors of his having possibly overmedicated the woman would be the talk of the hospital by breakfast. In the court of innuendo, he'd be convicted before noon. Getting out from under that kind of cloud, even if the official verdict cleared him, could be a struggle, and Yablonsky had been around long enough to know it. So why the hell would she do something so vicious?
If anyone hadn't heard about his connection to Elizabeth Matthews, Earl Garnet didn't run into them on his way to the eighth floor.
Among the groups of nurses, residents, or doctors he passed in the corridors, conversations stopped dead as he rushed by, replaced by whispers and embarrassed glances in his direction. Some he encountered avoided eye contact altogether. Even the janitors looked away. But everybody had a good gawk at him behind his back. He could feel their stares like a thousand arrows.
Thanks to small mercies, he got to ride the elevator alone. Sunday mornings, even at shift change, tended to be quieter than the start of other days. As the floors ticked by, he braced himself for the imminent confrontation with Peter Wyatt. Earl had hung up on the man rather than listen to him scream threats over the phone, but not before he'd heard a good part of what the oncologist had planned for him. For starters there'd be charges of unprofessional conduct; a motion to suspend his appointment as VP, medical; and, after confirmation of lethal morphine levels in Elizabeth Matthews's blood, an official coroner's inquiry. Wyatt then pledged to lead a push that would see Earl prosecuted by law for gross negligence at best, manslaughter at worst. And of course he'd indicated a willingness to leak every savory detail of the process to the media.
But what Earl dreaded most had nothing to do with facing Peter Wyatt.
The door slid open, and he stepped into the ward. His welcome committee stood waiting for him by the nursing station, but he focused only on the elderly man with the gaunt eyes who sat hunched in a chair, looking out the window at a dreary gray dawn.
Monica Yablonsky, her brow furrowed like a gathering storm, tried to glare at him, faltered, and fidgeted with her glasses. Two nurses whom he hadn't seen before flanked her, their expressions expectant, as if he might be there to fix the mess. Wyatt, dressed for the occasion in his three-piece churchgoing best, bolted forward like the leader of a lynch mob in a bad western.
"Shut up, Peter," Earl said before Wyatt could open his mouth. Then he walked right by him, focusing solely on the frail figure by the window. "Mr. Matthews," he said, kneeling by his side.
The old man made no reply and didn't even glance his way.
Earl hesitated, uncertain whether to take the lack of response as a refusal to speak with him, or as the paralyzing impact of grief.
"Mr. Matthews," he repeated.
"Go away, please." The wavering voice sounded hollow, as if emanating from a gourd that had had the insides gouged out.
Earl swallowed. "Mr. Matthews, I know you have every right to be angry…" He trailed off, overwhelmed by how useless his words sounded. They always did when he attempted to comfort the living in the aftermath of a death, and this time he'd more than usual to account for. "I'm so sorry," he said again. He cast about for something to add, then let it be, resigned that nothing he could say would help.
In the depths of Matthews's eyes, previously so blank and lifeless, a dark glow began to burn, angry and hot. "I left her alone because you promised me she'd be all right." His voice rose barely above a whisper yet cut like steel. "From the day she got sick, that's what frightened her the most- my not being there at the end…" A sob convulsed him, choking off the rest of his lament, and left him struggling to draw breath. The jagged cry that finally burst from his throat resonated loudly along the corridor. Earl imagined it penetrating the elevator shafts and extending through the morning gloom to permeate the final seconds of every patient's awakening dream. This, it warned, is how much they can hurt you here.