Oxygen (28 page)

“How? How will you quit?”

“I throw that stuff away and end it. Today. Now.”

“So you’ll turn yourself in. Go to Phil, or the medical board. Right now—with me.”

“I can quit on my own. I quit the minute I saw you sitting here on my bedroom floor.”

“This is classic, Joe. The classic addict’s response—that you don’t need help. You don’t even see it, do you?”

He stares at the floor, the muscle along his jaw line trembling. And then the last bits of the puzzle fall into place, almost subconsciously, and I freeze.

“What happened to Jolene Jansen?” I say it evenly, so quietly I only know he’s heard me by the way his shoulders tense against the doorjamb. “I asked you to draw up the fentanyl for her surgery before you left that morning. You put something else in the syringe.” He shakes his head, his hands clenched at his sides. “Tell me. I know you took it. They didn’t find any fentanyl in her blood at the autopsy. She died right after I gave her whatever you put in that syringe. What happened to Jolene Jansen?”

“Goddammit, I had nothing to do with Jolene’s death.” His jaw is so tight he nearly hisses. “Nothing to do with it. That kid died because of some problem, some medical problem nobody knew about and
nobody
could have predicted.”

“You want to hear the rest of her autopsy report, Joe? You want to hear what medical problem she had? Oh God. It finally makes sense. Her heart rate slowed down after I injected it. Just like it would with fentanyl. But then it didn’t go back up when her airway started closing. I could never explain that.” I walk across the floor toward Joe. “You switched it for a beta-blocker! That’s why it acted like fentanyl. It lowered her heart rate and her blood pressure, the same as if I’d treated her pain. The dose would have been way too high for a kid her age…She had Turner syndrome, Joe. She had a coarctation of her aorta. Aortic stenosis. The beta-blocker killed her.”

My thoughts are streaming out loud. But Joe knows as much as I do. The narrow stricture across Jolene’s aorta acted like a kink in a hose, and when an adult dose of beta-blocker weakened the force of her heart’s contractions, blood backed up into her lungs, flooded the delicate air sacs that absorb oxygen and suffocated her.

“I did not kill Jolene Jansen.” He speaks slowly, precisely, taking a breath between each word. “You are describing the hypothetical. Even if she got a few milligrams of a beta-blocker—it’s almost unthinkable that would kill her.”

“A few milligrams? I thought the fentanyl was diluted. I gave her half the syringe!”

“You’re saying crazy things. I never heard anything about this autopsy before today—you’re looking for an answer that doesn’t exist.” He takes a step toward me and clenches his fists. Then he slaps the front of his chest so loudly I wince. “I did nothing to hurt that child. I’ve hurt myself with this. And you. I know that. I swear to God I will never touch the stuff again. But this is not what killed her.”

“I have to go. I have to go home.” He is still standing in the doorway and I try to walk by him.

He grabs me by the wrist and holds me against the wall. “What are you going to do?”

“I don’t know. I don’t know what I’m going to do.”

“Do you know what would happen if anyone thought this was connected with Jolene’s accident?”

I nod. “You would be accused of manslaughter.” His fingers are sinew strong around my arm, anchoring me to this pinpoint of time, the only thing holding me upright in a world that is sliding out from under me. His face fills that world—the mouth, wide and pale, the half smile he makes when he perceives hypocrisy; his straight, almost regal nose; his hair, glinting as gold as the tiny earring in the soft, full lobe of his ear. And his eyes—deep-water blue, almost imperceptibly askew, just enough to leave a question about what he sees when he looks at me.

I wrench myself out of his grip and try to get through the door, but he grabs my arm and pulls me back against the wall. Then he swings his balled fist above his head and slams it toward me, just past my face, hitting the wall so hard the Sheetrock caves. “Get out of here then. Get the hell out of here.” He slumps to the floor and his shout breaks into a sob. “Oh God, Marie. Please go.”

The streets are empty now,
people driven from the summer night by the fine pelting spray. I cross to my car and peel a sodden parking ticket from beneath the wiper blade. I keep expecting Joe to splash through to the passenger door, expect or wish or fear—I’m not sure. I look up at his bedroom windows, now dark, and drive away.

My balcony doors must have blown open; rainwater has bled into a damp crescent of carpet. In the distance, the black sea and black sky are slit by a necklace of man-made stars.

There is no ache, no welling of tears, no exhaustion. I can’t imagine ever feeling hunger again, or thirst, or physical desire. I am hollow, scooped raw.

How many accident victims have I treated in the emergency room, slashed by power saws or crushed by cars or burned by gasoline spills? In those first minutes of shock they sail on a zephyr of endorphins that extinguishes pain and time like a snuffed candle. When they ricochet back into the horror of it all, it is only the narcotic—the morphine or Dilaudid or fentanyl I inject into their veins—that makes the pain bearable. And how many heart attacks have I prevented by giving a hypertensive or tachycardic patient a beta-blocker, a cardiac drug designed to regulate the rate and force of the heartbeat?

It was ingenious of Joe. His unique medical genius. In an unconscious patient the effects of the beta-blocker would mimic those of a narcotic—the heart rate would slow down, the blood pressure would fall, and there would be no suspicion that the clear solution in the syringe had been swapped.

In the morning I will make the calls I have to make, and tell the people who need to know. I imagine myself standing before hospital committees and department heads. Within days everyone will have heard—Matt Corchoran will have his explanation and uncover, almost certainly, other records whose sums don’t tally, other anesthesiologists unwittingly used to channel fentanyl to Joe. Frank Hopper will begin garnering experts to defend First Lutheran’s reputation, and prepare sincere and convincing press releases. Don Stevenson and Mindy and Alicia can all take deep breaths of confirmed innocence. Even though they have long been dropped from the suit, an unexplained death haunts anyone whose signature is on the chart.

I’ll tell Phil Scoble everything. He can salvage my career and see that Joe gets treatment along with punishment. Our profession is so adept at planning, so proficient in controlling even the seemingly uncontrollable, that we have developed protocols for handling the “impaired physician.” In only a few hours I will call Charlie Marsallis and hold out the key to my vindication. I will flay Joe’s betrayal and expose him to the hospital and the lawyers and the state medical board. Joe’s demise will be my rescue.

I’m finally free. All the nightmarish hours I’ve spent retracing my choices in operating room 5 while Jolene Jansen died are over. I don’t have to struggle any longer with what natural phenomenon might have taken her life, or what unnatural catastrophe I might have caused. I won’t have to sit before a grim-faced jury listening to my own pronouncement of guilt. Maybe, someday, I will even stop seeing Jolene’s mother swallowed in an empty life. And the only thing I have to pay for my freedom is Joe, and the life we might have made together.

Joe, this many-layered man whose determined will and fortressed privacy define him. If I’ve loved his strong reserve, his dimly lit corners, then I have also loved his secret demons. And perhaps in loving them I have allowed them, even nurtured them, making me complicit in his dependence.

I reach up to my neckline and slip the sapphire pendant from beneath my blouse. It is warm from my skin. The finely woven gold chain reaches just to my mouth and I trace the outline of my lips with the sharp surface of the stone, run it along the sensitive boundary. I squeeze it in my closed palm. What did Lori say about love? “Love is a choice”? What choice do I have? Even to save him by staying silent is to sacrifice him. I know the pitiful statistics of doctors who abuse their own drugs. Like every other anesthesia resident, I sat through the required hours of education telling me the mortality figures, when those who believe they’re in control edge too close to the margin between peace and death, and inject too much narcotic. Euphoria must settle like a thick cloud, calm their conscious frontal lobes, quiet aggression in the amygdala, then sink like a stone into the brain stem until it becomes too numbed to trigger the automaticity of breath. They suffocate in their pleasure.

Only the lights of the shipping port are bright now. An orange and white skyline of cranes floating on the black horizon. Finally I am washed through with fatigue and begin to drift in and out of sleep. Just before I close my eyes for the last time I think of the other person who will be told that Jolene did not die inexplicably, that her asphyxiation in the operating room was the consequence of a deliberate drug swap by a doctor entrusted to take care of her. I try to block an image of Bobbie Jansen’s face when she hears this news.

I wake from sleep as if being dragged from underwater. It’s only 7:40—too early for Charlie Marsallis’s office to answer, but not too early for an anesthesiologist. I sit up and pull the phone into my lap, begin punching the numbers to my own department. At the sixth digit I press my finger on the button and cut the connection. My hand trembles. I dial again and wait for Phil Scoble’s secretary, Pamela, to answer, practice the words I’ll use. When I hear her voice I almost hang up again, then tighten my fingers into a fist around the telephone.

“I’d like to speak to Dr. Scoble, please.”

“May I say who’s calling?” Pamela asks.

“It’s Dr. Heaton, Pamela.”

“Oh. Dr. Heaton.” A catch of surprised embarrassment in her voice. “Good morning. Can you hold for just a minute?” I cringe hearing her stall. I wish I hadn’t called now. I should have waited until I could see him in person.

Pamela clicks onto the line again. “Dr. Heaton, Dr. Scoble won’t be in the office until late tonight. He’s out of town. Can I take a message?” An almost imperceptible tension edges her voice, like a veil dropped between us.

“No. Wait. Yes,” I stutter, caught off guard. “Tell him I need to speak to him as soon as he gets in. Tell him it’s urgent, please.”

Three miles across town Joe is waking, if he slept at all, knowing I have the power to expose him, knowing that I’ll have to tell someone, time cinching around him like a noose. The only person I can trust besides Phil is Charlie Marsallis. I throw on slacks and a jacket and brush my hair in front of the mirror. Deep lines are etched between my brows. What is the French saying? “After a certain age, each of us wears the face we have earned.” I press my thumb against the two furrows above my nose, to see if they have become a permanent scar.

Charlie’s building lobby is just opening. A man in faded blue work clothes sprays the sidewalk clear of cigarette butts and city soot and vagrants’ urine. He turns the hose into the gutter to let me pass, rivulets of water jigsawing across the cement. Counselors and clients, prosecutors and plaintiffs are already lined up at the espresso stand outside the front doors. They chat in hushed morning voices and scan newspaper headlines. I wonder if I will ever again feel connected to the world they are reading about. I scan the crowd for Charlie, but see instantly that none here are tall enough to be him.

Charlie’s office is still dark. Saturday’s mail is spilled across the carpeting beyond the letter slot, and a blinking red light on his secretary’s desk reflects off the back wall. I pace in the hallway, conjuring a purgatory of anticipated scenes. Who will talk first? Will Charlie rush to tell me whatever news called me back from Texas—the name of my accuser and my alleged crime, perhaps? Or an offered settlement? Or will I be the first to declare news and tell Charlie that indeed Jolene Jansen’s death was needless and completely avoidable, the result of a selfish and senseless compulsion by a doctor I trusted, a man I believed I knew—a man I’d begun to believe I loved.

At 8:35 the elevator opens and I hear Charlie’s secretary detailing appointment conflicts and court dockets before I see her. Charlie answers. Both stop talking as soon as they see me leaning against the glass panel of his door.

I stand up and pull my purse higher on my shoulder, feeling unexpectedly awkward about surprising them. “Hello, Mr. Marsallis.”

He lifts his briefcase up under his arm and holds his hand out to me. It is warm and dry and I am uncomfortably aware of my own perspiring palm against his.

“I hope it’s all right that I’ve come without calling first.”

“Of course. I guess this means you got our message. I’m glad you’ve come.” He reaches into his pocket and pulls out a set of keys to unlock the door, a jarring clatter in the stillness of the hallway. “Jean, could you get us some coffee? Come on in.” He steps across the scattered envelopes on the floor, then squats and scoops them into a stack, which he deposits on Jean’s desk.

“Let’s sit in here,” he says, and clears some files off the long wooden conference table in the room adjoining his office. He pulls out a rolling chair for me, takes off his coat and hangs it on the rack, folds his long frame into his own chair.

“I’m sorry we had to call you like that. So urgently. I had to be sure you got the message. I appreciate your getting back here so quickly.” I recognize in his tone the same intentional serenity I use to interview a frightened patient: a tone of comfort offered to calm someone who can’t even hear the words. He clears his throat and snaps his briefcase open, pulling forth a sheaf of papers.

Jean comes in with a tray of coffee and doughnuts. She sets ceramic cups on saucers and fills them. Charlie draws in a breath to speak, and suddenly I know that I have to speak first—that whatever he has to tell me, before he condemns or consoles I want him to have already heard the truth. I put a hand out to interrupt him. “Wait.” I inhale and look directly into his eyes. “I know you must have news for me. I know that’s why you called. But I have something to tell you first.” Charlie sits back in his chair and pushes away from the table to turn toward me, patient and expectant. “I’ve learned something new. About what happened that day in the operating room. Something that changes the whole suit.”

Charlie watches me as I tell him about Joe, his face a receptive but unreadable mask. Words rush out of me almost uncensored, laying out what I know about the fentanyl, and what I suspect about the beta-blocker causing Jolene’s death. I talk faster and faster, trying to explain how only this makes sense physiologically, how only a drug swap could answer the questions I could never figure out, questions no one else has even seemed concerned about. The room pulsates with silence after I stop. I feel myself flushing. I try to look at his face but can only watch his hands, steepled fingertip to fingertip across the arms of his chair. He sits impassive and still for a long while. Then he exhales, as if he’d been holding his breath while I spoke.

“This changes everything, doesn’t it?” I ask.

He nods before speaking. “Yes. Yes, it changes things.” He sits quietly again, and I look up into his eyes, search his expression for some glimpse of what I expect—a complete relinquishment of any fault. He places a hand on top of the primly stacked papers sitting between us on the table; his fingers hover above as if beckoning the words forth, telling him what to tell me. “We’ve been notified by the district attorney. The state is filing a criminal charge against you. That’s why I asked you to come back to Seattle.”

My throat tightens, even knowing that I hold my own proof of innocence. “What are they accusing me of?”

Charlie slides the white papers toward himself, realigning their edges. “They are saying they have evidence you’ve been using narcotics, and that you were using fentanyl when you treated Jolene.” He looks up at me as he finishes the sentence, color rising into his cheeks.

“Charlie.” My fingers tighten over the seat of my chair and I lean closer, blinking back tears. “This can’t just be coincidence. Matt Corchoran told me someone at the hospital had already asked to have me audited. He must have talked to someone about the drug discrepancy even before I saw him.”

“Do you think he did?”

“He said he hadn’t. But how else could someone come up with that accusation?”

“Maybe.” Charlie flares his hands open briefly, then locks them together on top of my charges. “But now we’ll have to prove this was Joe, not you. Unless you think Joe is willing to testify to that.”

“I don’t know.” I shake my head. “I don’t know.”

“Well, if you arrange an intervention today, it’s possible his urine would still test positive for narcotics. Do you think you can make a credible enough case to get support for that? Have you talked to anyone at First Lutheran about it yet?”

“I called the chief of my department, but I didn’t reach him. He would believe me.”

“The chief of anesthesia. That’s Phil Scoble, right?”

“That’s right.”

Charlie’s expression doesn’t flicker, but his eyes darken, like some fraction of light has been extinguished. “Marie, Phil Scoble is the one who’s filing the charges against you.”