Extreme Measures (22 page)

“Well, for what it’s worth, I think you’ve made the right decision—even at the price you might have to pay.”

“I hope so. You said last night that the worst thing that can happen if I don’t get what I want is that I get something else instead. I just hope that whatever that something turns out to be carries a paycheck.”

“That is a definite not-to-worry,” she said. “We need doctors badly in the Islands, and I’d love the chance to teach you to dive. How’s that for a place to start?”

“You mean I can be a doctor and actually do something else at the same time?”

She smiled and kissed him lightly.

“Lots of other things,” she said. “Listen, I’ve got some coffee that’s getting cold up in the room, but I wanted to speak with the desk clerk first. Look what he handed me a few minutes ago.”

Eric read the note.

“Where did this come from?” he asked.

“That’s what I wanted to find out.”

The desk clerk, a thin, wiry Iranian, looked at the envelope, then shrugged and handed it back.

“I couldn’t tell you, ma’am,” he said. “I came on at six-thirty, and it was right here. Perhaps the night clerk knows something.”

“Could you call him?” Laura asked.

“I could, but he’s got a day job and I don’t have any way to reach him. Why don’t you check with him tonight?”

“All right,” she said.

Eric stepped forward and placed a ten in view on the counter.

“We’d love it if you could try,” he said.

The man hesitated and then took the bill.

“No guarantees,” he said.

“You’d think by now I would have learned,” Laura said as the man headed to the back room.

“Actually, I never did that before,” Eric replied.

Two minutes later the clerk was back.

“Malik says the note was dropped off by a guy with a tan jacket on. Forty or so, dark hair. He says he’s seen him hanging around the hotel lately, but he doesn’t know who he is.”

They thanked the man and headed for the elevators.

“I saw him, too,” Eric said suddenly.

“What?”

“The guy in the tan jacket. I’m sure I saw him last night. He was sitting right over there. My friend Wendy tried to proposition him, but he brushed her off just like that.”

“Would you recognize him?”

“Doubtful.”

They entered Laura’s room and stretched out on her bed.

“What do you make of this latest twist?” she asked, setting the muffins out on a towel between them.

“The note doesn’t say anything about when Scott was supposed to have been on the docks, and it doesn’t say anything that would prove the guy who wrote it actually knew him.”

“So what’s your guess?”

“My guess is the guy in the jacket picked up on you, somewhere in your travels, and has been following you around.”

“But why didn’t he try to set up a meeting? And why the East Boston docks? Surely there are more secluded places he could lure me to if he wanted to. And why did he write what he did about people lying to me?”

“I don’t know.”

“So, what should we do next?”

“Well, I think we should go and poke around the East Boston docks, and be persistent because people will be lying to us.”

“What about Donald Devine?”

“We can hit the docks this morning. Before we leave, I’ll call and arrange for us to enter the Gates of Heaven after lunch.”

“What’s Devine like?”

“He has Muzak violins playing in his mortuary even when there’s no funeral.”

“Sounds creepy.”

“Let’s just say that when I go, he’s not the route I want to take.”

Laughing, Laura rolled over on top of him. She stroked her lips across his and then kissed him deeply.

“You know,” she said, “I really like you.”

Eric glanced down beside them.

“Enough to replace that half a muffin of mine you just flattened?”

She pressed her body tightly against his and kissed him with increasing longing.

“Enough to make you forget you were ever hungry,” she said.

Reed Marshall glanced out at the crowded waiting room. Then he pressed his fingers against his temples and repeated the word
serene
over and over to himself. He had started in mind-body treatment two years ago, after the stomach pains he had been having were diagnosed as a slowly bleeding ulcer. The abbreviated relaxation exercise, which his therapist had taught him, helped greatly in getting him through times like this in the E.R.

Because of the scheduling change he had made with Eric Najarian, it was his second straight brutally long shift. And of course the volume of patients had been far greater than average. Every room was full. In one of them, still unconscious and awaiting a CT scan, lay Norma Cullinet, the nursing supervisor. She had
fallen down a flight of stairs, fracturing her arm and the base of her skull. Now, as if the fates had decreed that he hadn’t yet been stressed to the breaking point, there was a Priority One on the way.

From his earliest days at Harvard, Reed had carefully cultivated his unflappable façade. Besides himself, his wife, his therapist, and perhaps Eric Najarian, no one knew how inaccurate that image truly was. Ulcers, migraines, insomnia, periods of profound depression—if not for the mind-body therapy, he might well have come unglued long ago.

Now, though, with the selection of the new associate E.R. director due any day, and Carolyn so desperate for him to get the position, Reed knew he had to maintain. It was ironic that the biggest edge he held over Eric was his perceived coolness under fire. More than once, though, following his “cool” handling of a particularly harrowing case, Reed had gone off to one of the men’s rooms and thrown up. In fact, after nearly freezing up with the woman who had ruptured her larynx, he had done just that.

“They’re two minutes out, Reed.”

The nurse’s voice and touch on his shoulder snapped Reed out of his reverie.

“Everything ready?” he asked.

“Ready and waiting.”

“Do we have a name?”

“Leone. Loretta Leone. All we have for an old record is an E.R. sheet from two days ago. The orthopedists put a cast on a minimally displaced wrist fracture.”

“And she’s already intubated?”

“Uh-huh. The rescue squad can’t give us a down time, but they think she’d been out for a while when they arrived. Apparently the policemen who found her didn’t do much in the way of CPR while they were waiting around.”

“What’s the latest rhythm?”

“Agonal, idioventricular beats at about eight a minute.”

“No response to the epi or Isuprel?”

“None.”

The nearby radio crackled to life. “This is Boston Rescue Seventy-Eight, off at White Memorial.”

“They’re here,” the nurse said.

Reed pulled off his glasses and rubbed at the strain in his eyes.

“Is someone still in with Norma?”

“Dr. Teagarden came in about fifteen minutes ago and took over. Apparently she and Norma have been friends for years. She’s got the whole neurosurgical service standing by, waiting for the CT results.”

“Did she have any complaints about the way we handled the case?” Reed asked.

“None that I heard.”

“Okay, then,” Reed said, more relieved at that news than the nurse would ever know. “Let’s have a look at this Priority One.”

The electronic doors to the ambulance bay slid open, and the rescue squad, continuing cardiac compressions and mechanical ventilation, hurried back to the assigned major medical room. Reed met them at the gurney and assisted them in the transfer of Loretta Leone. His initial assessment was not optimistic.

She was the dusky violet color of death. Her pupils were midposition and unresponsive to light.

“Get some EKG leads on her,” he said. “We’ll run the strip off that. Keep the monitor going as well. It doesn’t look good. Not good at all.”

This was the moment when Reed had to make a decision as to whether they should proceed with attempts at resuscitation. The rescue team leader, Judy Kelly, was one he had worked with many times. She was perhaps the very best of a group of excellent paramedics.

“Any change?” Reed asked.

Judy shook her head. “This is the rhythm we
found her in.” She handed over an EKG strip. “It looks the same as the one now.”

“Do you have a good IV?”

“Excellent.”

Reed listened to the patient’s chest to ensure that the endotracheal tube hadn’t been pushed so far down the trachea that it was occluding one of the main bronchial tubes.

“She’s full of fluid,” he said. “Full to the brim. Let’s hang in there just a bit, everyone. Give her an amp of bicarb and another amp of epi. And send off a set of blood gases, just in case. I don’t think we’re going to be at this too long, though.”

He glanced up at the monitor screen. The woman’s rhythm remained the same—slow, wide complexes at eight or so a minute.

“Call cardiology down here,” he said. “We may want to put in a pacemaker.… Pupils?”

“Fixed,” someone called out.

“Keep pumping. Someone check her femorals to be sure we’re generating a decent pulse. Judy, give me your best guess at a down time.”

“Twenty minutes minimum before effective CPR was started,” the paramedic said.

“What do you think?”

“Honestly?” She glanced over at Loretta Leone and the team that was working on her. “I think it’s not fair to this woman to continue.”

Reed rubbed at his chin and wondered for a moment how far backed up the waiting room was getting.

“Anybody know if she has any family?” he asked.

“No next of kin,” the nurse said. “It’s right here on her last E.R. sheet.”

“She’s like a bag lady, only with a one-room apartment,” Judy said. “The place was full of empty bottles waiting to be returned, and junk in every corner.”

“Jesus,” Reed muttered. “Give her one more amp
of epi and call for those gas results. Oh, and you might as well try an amp of calcium as well. I want to keep going until the cardiologist gets here.”

The cardiology resident, an overweight, abrasive man named Jason Berger, entered the room with two medical students in tow. One was an attractive young woman.

“Fucking place looks like a war zone out there,” Berger said. “What do you have?”

“Fifty-five-year-old woman found pulseless on the floor of her apartment,” Reed said. “No medical history except a broken wrist fixed here two days ago. Twenty minutes minimum before CPR was started. There’s been no change in anything despite Isuprel, bicarb, and several amps of epinephrine.”

Berger looked up at the monitor. “Did you give her calcium?” he asked.

“Yes.”

Berger pushed past the resuscitation team and listened briefly to Loretta Leone’s heart and lungs. Then he put his arm around the waist of the female medical student. Reed saw her stiffen as Berger led her over to the monitor.

“What do you see?” Berger asked.

The young woman looked flustered and uncomfortable.

“Slow rhythm,” she managed. “Very broad complexes. I … um … I don’t know what else.”

“What you see,” Berger said theatrically, “is a dead heart. We call that an agonal rhythm—the rhythmic flow of sodium, potassium, and calcium in and out of cardiac cells, creating an electrical impulse. It is unresponsive to drugs, it doesn’t generate a heartbeat, and it bears absolutely no relationship to life as we know it. What do you want me to do, Reed?”

“I don’t know,” Reed said. “I just wanted your opinion on a pacemaker before I made a decision.”

Berger laughed out loud.

“Have there been any signs of life in this woman?”

He tried once again to work his arm around the medical student’s waist, but this time she managed to spin out of his reach.

“Just what you see,” Reed said.

“So she’s dead. I can slip a wire into her if you really want me to, but I promise you it will be an exercise in futility. What does her family want?”

“She has none.”

“None at all?”

“Apparently not,” Reed said.

“Reed, I have two caths waiting for me and a full clinic this afternoon. You really want me to put a wire in her?”

“What about that?” Reed gestured to the monitor.

“That?” Berger said disdainfully. “My friend, you know as well as I do that you could just stand here and do no CPR, and watch that rhythm pop along for half the fucking morning. There’s no heartbeat under there.”

“Thank you,” Reed said.

“Then we’re free to go?”

Reed hesitated. “You’re free to go,” he said finally. “That’s it, everybody. Thank you very much.”

The cardiologist led his small entourage out of the room as the team backed away from the bed. Reed reached up and flicked off the monitor.

On the litter, Loretta Leone’s open eyes stared blankly at the ceiling.

“Who’s the nursing supervisor?” Reed asked.

“It
was
Norma. Irene Morrissey’s taken over for her.”

“Get her, please. Have her call the M.E. Thank you once again, everyone. You all did a good job.”

Reed Marshall felt the gnawing tightness in his gut begin to abate. Berger was an asshole, but he was also right. There was simply nothing to work with. And even if they did somehow manage to generate a pulse, all they would have created was a vegetable
with no next of kin, and nothing to go back to except a bunch of empty bottles.