The Absence of Mercy (4 page)

“What did his chest X-ray look like?”

“His chest X-ray?” Ben thought for a moment. Had he ordered one? “I . . . I don't know. I think they got one when he first came in, but I didn't get a chance to look at it.”

“What do you
mean
you didn't get a chance to look at it?”

“I just . . . he started crashing, and there wasn't enough time . . .”

“For God's sake, Stevenson! Stop doing compressions and go get me the goddamn chest X-ray!”

Ben looked down at his hands, surprised to see that they were still pressing up and down on the patient's chest. He forced them to stop. “Maybe if we tried another shock . . . ,” he suggested hopefully.

“The patient's dead,” Gardner growled. “You can shock him all you want, and he's still going to be just as dead. Now, go get that X-ray. Let's see what you missed.”

Ben left the room and walked across the hallway to the viewing box. A wooden repository hung on the wall containing several manila sleeves of radiographic images. He shuffled through them, found the appropriate one, and returned with it to the resuscitation room. Dr. Gardner stood next to the cooling body, leafing through the patient's chart. Ben noticed that the dead man's eyes remained open, staring lifelessly at the door through which he'd recently entered. Throughout the course of his career, Ben would never forget the look of those eyes, which were not accusatory or vengeful, but simply, unabashedly dead. For some reason, that was the worst of it—the detached finality of that look. It was the first thing he learned that day: When things go bad in this line of work and someone dies, there is always plenty of blame to go around; but there is only one soul who truly no longer cares.

“Let's see that film,” Gardner grunted, and Ben handed him the envelope. He watched the man remove the X-ray from its sleeve and slap it onto the resuscitation room's viewing box. The seasoned physician studied it for a minute, then queried, “Well, what do you make of it, Dr. Stevenson?”

Ben cleared his throat hesitantly. “The lung fields are somewhat hyperinflated. Cardiac silhouette appears slightly enlarged, although that can be an artifact of a single AP view. Costophrenic margins are well visualized. No evidence of an infiltrate or pneumothorax.”

“Uh-huh. And how would you describe the mediastinum?”

“Widened. The aortic knob is poorly visualized.”

“Exactly. What comes to mind, Dr. Stevenson, in a fifty-eight-year-old gentleman with a history of hypertension, who presents with chest pain radiating to his arm and back and has a widened mediastinum on chest X-ray?”

“Aortic dissection?” Ben ventured. “But what about the ST elevation on the patient's EKG?”

Gardner snatched up the EKG, glanced at it perfunctorily, then handed it to Ben. “Inferior ST elevation consistent with a Stanford type A aortic tear dissecting into the right coronary artery. Pushing thrombolytics on this man was a death sentence. He bled into his chest and pericardial sac within minutes. He would've stood a better chance if you'd just walked up to him and shot him in the head with a .38.”

Those last words—Dr. Gardner's final commentary on the case—hung in the air, defying objection. Ben stood in the room between his boss and the dead man, unable to conjure any sort of meaningful response. His face burned with anguish and humiliation. In the corner of the room, a nurse pretended to scribble notes on the patient's resuscitation sheet. She glanced up briefly in Ben's direction, her face cautiously guarded.

“Notify the medical examiner, and submit this case to M & M conference on Friday,” Dr. Gardner instructed him. “Get back to work. You've got three patients in the rack still waiting to be seen. Oh, and Stevenson?”

“Yes?” Ben looked up, needing to hear
some
token of consolation from his mentor, this man he respected.

“Try your best not to kill the rest of them,” Gardner advised him blandly, and left the room without looking back.

One of the hardest things about being a physician, Ben now thought as he recollected this horrendous experience in the ER as a young intern, was forcing yourself to continue along in the wake of such catastrophic events as if nothing had happened. The three patients still waiting to be seen turned out to be a child with a common cold, a drunk teenager who was brought to the emergency department by her friends, and a forty-two-year-old man with a wrist fracture. Routine, mundane cases, in other words. Ben attempted to clear his head as best he could, and he interviewed and examined them all carefully and professionally. But while looking into the child's ears with an otoscope, he thought to himself,
I just killed a man.
While ordering an anti-emetic for the teenager now puking through the slots between the side rails of her gurney, he thought,
There's a man in Resuscitation Room 2 covered by a white sheet because I was in too much of a hurry to look at a simple chest X-ray.
In the middle of examining the man's broken wrist, he recalled holding the wrist of the dead man in his hands as he searched for a pulse that was no longer there. During these moments, his patients were aware of none of this. Two more people arrived in the department during the time he took to examine and treat the previous three patients. After that, an ambulance showed up with a moderately severe asthmatic, and four more people checked in to triage.

In most jobs, when something horrible and traumatic happens to an employee, they are instructed to take the rest of the day off and are possibly sent for counseling. There is time to process what has happened, to remove oneself from the environment. There is time to take a breath, to discuss the incident with your spouse, or to simply get wasted at the local pub. In medical training, you are instructed to notify the medical examiner and to get back to work. You are given the helpful advice “
Try not to kill the next one,
” and you are desperately afraid that you will. Recovery from such events occurs on your own time, in private, once you've fulfilled all of your other duties and obligations. And in medicine, those duties are never truly fulfilled. There is always another patient, another conference, another presentation, another emergency in the middle of the night, another fire to be put out.
Always
.

The night's precipitation continued to fall on the darkened street ahead. Neon headlights cast their artificial glare on a hundred tiny rivers of water racing desperately toward the town's sewers, and wherever they might lead beyond that. Four miles from here, Nat was preparing the body of a young boy for his final medical examination. It was going to be a long and exhausting night, and Ben was pretty sure there would be more to follow. Things would get worse before they got better. Things like this always did. He didn't want to be here, driving away from his family on a night like this. It didn't feel like the right thing to do, and he wondered to himself, not for the first time, exactly where his allegiances were. He could feel the storm tugging at the hole inside of him, another chunk of earth pulled loose by the water's greedy fingers. He imagined himself being swept away into the sewers, one nearly imperceptible piece at a time.
What will it feel like when there's nothing left?
he asked himself.
And will I even know when that moment comes?
Within the car there was only silence, except for the steady thrum of the rain falling all around him.

Nat had been right about one thing: The press was going to have a field day with this one—a regular three-ring circus. Ben could make out the congregation near the front entrance to the Coroner's Office from a quarter mile away. The usually dimly illuminated front steps of the CO were now bathed in bright artificial light as at least three different television crews jostled for position. Two patrol cars were parked just across the street, and a third one blocked the left lane of traffic to allow room for the news crews to set up their equipment without running the risk of being plowed over by a distracted motorist. Ben quickly decided there was no way he'd attempt to enter through the CO's front entrance; instead, he turned left on Broadway and right on Oregon Avenue, hoping to sneak in through the building's rear delivery access.

He parked the car on Oregon and hopped out. Shielding himself from the downpour with his jacket as much as possible, he trotted the half block through the gathering puddles toward Brady Circle. The rear of the CO stood mostly in darkness. The parking lot behind the building was vacant except for two vehicles. One was the coroner's van that Nat had used to transport the body. Beside it, a second van, which Ben didn't recognize, sat idling, a white plume of exhaust rising up in a dissipating cloud from its tailpipe. As he approached, the side door of the vehicle slid open and two men stepped out, making their way toward him across the parking lot.

“Dr. Stevenson?” one of them asked from the darkness.

“Yes?” he replied cautiously.

Ben was suddenly bathed in the bright light of a television camera.

“Dr. Stevenson, is it true the victim was stabbed forty-seven times? Has a positive identification been made yet?” asked the reporter, thrusting a microphone in his face.

“I haven't examined the victim yet. That's what I'm here to do now.”

The man with the microphone didn't seem to appreciate the finer points of Ben's statement, for he continued to fire off questions one after the other. “Is the victim a resident of the town, Dr. Stevenson? Someone you happen to know? Was there any weapon found at the scene?”

“How am I supposed to know
that
? You should be talking to the police.” Ben fumbled for the keys in his pocket.

“What was the last homicide of this nature that you investigated, Doctor? Have you spoken with the County Coroner's Office or the state police?”

“I haven't spoken to anyone except my assistant.” Ben turned the key in the dead bolt and swung the door open just wide enough to step inside. “Now if you'll excuse me . . .”

“Dr. Stevenson, you have a son of your own that attends Indian Creek High School. How did he take the news of a murder only a few blocks away from the school?”

“He seems to be handling it much better than you are,” Ben replied, then closed the door against the deluge of questions from the overzealous reporter. He flipped on the light in the back hallway. It was blessedly quiet inside the building. He could hear the faint sounds of Nat moving around in the autopsy room beyond the door at the end of the hall. His assistant had the habit of humming softly to himself as he went about the task of laying out the equipment and preparing the body for examination. It was mildly endearing, although Ben could never recognize the melodies, which belonged to a musical generation that was not his own. Ben hung up his jacket on the coatrack to his left and proceeded down the hallway.

“Hi, Nat,” he said as he entered the room.

“What's up?” Nat responded cheerfully. “Did you get hit by the reporter brigade on your way in?”

“Of course,” Ben replied. “I thought that I might outsmart them by coming in the back way, but they had their sentries waiting for me.”

“No doubt, no doubt. They were on me like flies on sh—, like flies at a picnic, you know, as soon as I pulled the wagon into the back parkin' lot. ‘
Tell us this! Tell us that!
' Those guys are pretty damn . . .”

“Importunate? Unremitting?” Ben offered.

“Pretty damn
annoying,
if you ask me. Hell, I don' know the answers to any of those questions. Might as well be askin' me who's gonna win the Kentucky Derby. And if I
did
know, I wouldn't be tellin' 'em nothin' anyway. Just like you said, Dr. S: ‘
No muthafuckin' comment!
' Right?”

“I think that was actually
you
who said that.” Ben glanced at the shape on the examination table, still zipped up inside of the black cadaver bag. “How are we doing?”

“I just got back about ten minutes ago. Fog's gettin' thick out there, and the wagon's front windshield defroster ain't workin' so hot. Rainy days—and rainy nights especially—you've got to drive slow, or else you might find yourself joinin' the gentleman in back, if you catch my meaning.”

His assistant continued to move about the room as he spoke, laying out instruments and checking connections. He was a study in controlled chaos: his light blond hair eternally tussled as if he had just recently climbed out of bed, the tail of his shirt tucked into his pants in some places but left free to fend for itself in others, one shoelace frequently loose and on the brink of coming untied—and yet within the autopsy room he was highly organized and efficient, as if the manner with which he conducted his personal life did not apply here.

“I'll ask Jim Ducket to take a look at it,” Ben told him. “If you're having trouble with the wagon, maybe we can get a replacement from the county until we get it fixed.”

“Aw, the wagon ain't no trouble. Just needs a little kick in the nuts every now and then. If you want Jimmy Ducket to take a look at anything, have him check out the radio. Hell, half the stations were set to classic rock when I climbed in it tonight. I take one five-day vacation and the whole place has gone to hell.”

Ben smiled. Nat had gone on a ski trip to Utah with his father last week, and Ben had been left making the pickups himself, just as he'd done before his assistant had come on board with him full-time several years ago. A few radio station adjustments had been the first order of business on his way out to pick up Kendra Fields, who'd died in her home last week of a ruptured cerebral aneurysm. When Ben arrived at the residence, Kendra's husband, John, had been waiting for him at the front door. “
Guess she's gone and done it this time, doc,
” the old man had said matter-of-factly. John was eighty-nine and belonged to the congregation at Ben's church. Kendra had been three years his elder, and during the course of her life had survived two heart attacks, a serious stroke, breast cancer, and a small plane crash. All things considered, it was time for her to pack up and head for home. Ben had chatted with John for a half hour. Then he'd loaded Kendra's body into the back of the wagon and had treated her to some Creedence Clearwater Revival on the short ride back to the CO, cranking the volume up enough to turn people's heads as he drove past. Hell, on top of everything else, Kendra Fields had also been a touch deaf during her final ten years on this earth.