The Children's Ward (5 page)

Eighteen

Midway through the CAT-scan, the patient, a fifty-three-year-old insurance salesman, stopped breathing.

For a few moments, no one noticed. One of the nurses had gone back to the floor to finish morning report while the other was writing quickly as Dr. Carter listed a series of tests he wanted to be done.

The radiologist had arrived and was standing, drinking a cup of coffee, watching the scan images on the monitor screen.

The technician, mindful of the proximity of both the radiologist and the patient’s physician, was working swiftly and silently.

Then Dr. Carter glanced absent-mindedly at his patient while searching his medical repertoire for any tests he might not have ordered yet. It took a second look before it registered that his patient was turning blue.

Carter had made a career based on covering up his lack of skill as a doctor, ordering test after test to confirm his uncertain diagnoses, and relying on consultations to back him up. He knew, as he looked at his patient’s dusky color, that he was not a good man in a crisis.

“Damn,” he said, “get the radiologist in here and call a code.”

Following his gaze, the nurse’s first instinct was to go to the patient and start resuscitation. But Carter’s reputation was as a by-the-book doctor and one who did not tolerate a nurse taking the initiative. So she turned to follow his orders.

“Damn,” Carter said again, crossing to the patient and praying that the man would start breathing again on his own. He searched for a carotid pulse and was unable to find it. He kept his fingers on the man’s neck, hoping that any second the radiologist would come through the door and take over.

He looked over his shoulder at the door. No such luck.

Gingerly, he tilted the patient’s head back, hyperextending the neck to clear an airway and leaned over, listening for breath sounds. Nothing.

“God damn,” he swore, raising his voice. Where was everyone?

He realized that he couldn’t wait any longer, that to do so would leave him wide open for a malpractice suit. He had to start CPR…

Sweat was dripping off his forehead by the time they came to relieve him.

“Let me take over, doctor,” a voice said.

Gratefully, he stepped back from the table. Immediately the patient was surrounded by the emergency team who within seconds had intubated him, established intravenous lines and were administering the appropriate medications.

Carter moved further back from the line of fire, leaning against the wall. He felt light-headed—he’d probably hyperventilated while breathing air into the patient—and more than a little shaky. His heart pounded.

“Okay, he’s stable; let’s get him to ICU,” someone said.

Carter closed his eyes, smiling faintly. He had done it, then. He had kept his patient alive until help had arrived. All those years since he’d practiced resuscitation techniques and he was still able to save a man’s life.

The voices in the room faded…

He became aware of a dull ache across his chest; he probably had pulled some muscles while doing the chest compressions. He was a little out of shape to be a hero, he thought ruefully.

Well, the excitement was over and he had other patients to see. Opening his eyes, he saw that he was alone in the room. The door had been left open and a little girl watched him from across in the waiting room.

He straightened up and took a step. Pain exploded in his chest with such intensity he was unable to cry out. Eyes wide in amazement, he fell to the floor.

Across the hall, Abigail turned up the sound on the TV.

Nineteen

“What in the world?”

Radiology was swarming with people. The crash cart—resembling a large mechanic’s tool chest but loaded with emergency medical equipment and supplies—was being pushed out of the CT room. Just in view was a shrouded figure on a gurney.

Simon Harrington crossed the room toward them, his face grim.

“What happened here?” Joshua asked when Simon reached them.

“Jim Carter collapsed and died…no one knows for sure what happened. He was alone in the room and apparently he had a massive heart attack. He was dead when they found him.” Simon ran a hand through his graying hair. “I’ve got to call his wife…”

“Where’s Abigail?” Quinn asked, looking around the department.

“We sent her down to the lobby. Carter bumped her scan for his patient. Then this happened and I thought she’d be better off out of the line of fire, so to speak.”

They watched in silence as an orderly pushed the gurney bearing Carter’s body past them and out the double doors. The members of the emergency team began to disperse as well, until they were alone in the department lobby.

Simon frowned. “I’d better make that call.” He shook his head. “I’ve never gotten used to making these calls.”

Twenty

It was his worst nightmare: drawing blood from children. He looked in disbelief at the order slips. Three of them. Three kids with tiny, elusive veins. Three kids who would instinctively jerk their arms at the first sting of the needle. And all three of them in the same ward, eliminating any possibility that he’d have a chance to recover his sanity between sticks.

For a moment he contemplated switching the order slips with one of the other techs, something he had done on other occasions with limited success, but decided against it. The supervisors tended to become a little annoyed with unauthorized work changes, which ultimately resulted in retaliation by scheduling; if he got caught, he could count on working every holiday and weekend for at least three months.

Grabbing the venipuncture tray, he started out the laboratory door. He would stick the kids first, get it over with. Maybe he’d get lucky and hit the veins on the first try. Maybe.

Aguilar was the nurse on duty at the ward and he breathed a sigh of relief; she was very good at holding a struggling child still.

“Delano, White, and Vincent,” he said, reading the lab slips.

Aguilar handed him a clipboard with a dated sheet which indicated scheduled lab work. He wrote his initials in the box beside three of the names. There was a fourth child, Ballard, but no morning lab work had been ordered, thank God. Four would kill him for sure.

“I’ll be with you in a minute,” Aguilar said, phone in hand.

“I’ll wait,” he said, and sat on a corner of the desk.

The boy had good veins and the needle slid in effortlessly. Dark blood began to fill the first tube.

“How are you doing?” he said to the boy, whose eyes were closed tightly.

A slight nod. “Okay.” Perspiration beaded his forehead.

“Almost done,” he lied, grabbing the second of five tubes. He did not like the kid’s color at all. The last thing he needed was for the kid to pass out on him. It would be a lousy beginning to a long day.

The third tube and the blood was flowing slower. With his free hand he tugged the tourniquet a little tighter.

“Pump your fist,” he instructed the boy. Better.

The boy’s skin was cool and clammy as he started the fourth tube. He could see the pulse throbbing in the kid’s thin neck.

“Almost done,” he said again, looking over his shoulder for the nurse, who had apparently left the ward. The fourth child had returned and she was sitting on her bed, watching him.

He looked back at the boy. The last tube. “Hold on,” he said under his breath. He could feel the girl watching him.

Finally the last tube was filled. He extracted the needle and held pressure on the puncture wound.

“Done,” he said, leaning closer to the boy.

“Piece of cake,” the kid said, but he did not open his eyes.

The blond girl surprised him by offering no resistance as he maneuvered the needle in search of her vein. She lay as if dead, staring up at the ceiling, while he probed under her skin.

The morning was getting worse by leaps and bounds. Where in the world was the kid’s vein? It didn’t help that he was drawing from the left side of the bed and was facing the fourth child— Ballard?—who watched him through narrowed eyes.

Just as he was ready to pull out the needle and try another spot he found it; a gentle thrust and he was in the vein. Blood swirled into the tube.

At least this was a small draw, two tubes. And he’d be two down, one to go. A few more minutes and he’d be out of the children’s ward.

He looked at the girl’s face. Very pretty, delicate features, striking in spite of her blank expression. A heartbreaker, for sure.

“Finis,” he said, certain that a child who looked like this one did would appreciate his choice of words.

No response. Either she had not heard him or she chose, as had every beautiful female he had ever known in his life, to ignore him.

His luck did not hold. The third child began to cry before he even unwrapped the venipuncture needle.

“No, no…” she whimpered pathetically.

“Just a little stick and you won’t feel a thing.” He was suddenly very tired. This was too much.

“I’m gonna be sick,” she cried and began to gag.

“No, you won’t,” he said.

She leaned over the bed and vomited on his shoes.

He finally managed to draw the blood with Aguilar’s help. He could smell his shoes which did not make him happy, so he was not as gentle as he might have been. The kid cried through the entire procedure.

“Fun and games in the children’s ward,” he said when he was done.

Aguilar was soothing the little girl and did not answer.

He grabbed the tray and turned to leave, glancing in the direction of the fourth child. He could swear that her eyes had not left him since she returned to the ward. There were no words to express how glad he was that he didn’t have to stick her, too.

She smiled at him.

Twenty-one

Abigail pretended to be asleep. She turned onto her side, facing away from the others. She could hear Tessi sniffling behind her, still upset about having her blood taken, and she would have liked to comfort the other child, but she needed time to think about what had happened while it was still fresh in her mind.

She wasn’t even sure what
had
happened. Sitting in the waiting room in Radiology, she had been angry at the doctor, Carter, who had disregarded her so easily. He should not have done that. She was there before he and his patient arrived, and she had an appointment, making her doubly entitled to being first.

Then the headache had started.

The oddest thing—when she closed her eyes, it was like she was in the room with those people. Details were a little hazy but she could make out who was who. The sounds were distorted, too. It was sort of like listening to a conversation through a wall; she could hear just enough to keep her interest.

At first she just observed. She was able, somehow, to move about the room and she circled the smaller room where the CT images were reconstructed on a video monitor. The air was cushiony and warm and it took some effort to pass through it.

Carter, at that point, was watching the monitor and drinking coffee. He repeatedly clicked a ball point pen, the sound echoing in the heavy atmosphere of the room.

She watched him, certain that the real reason he had insisted his patient be taken first was for his own convenience. The look on his face was much like the look her grandmother often had when she had to deal with what she called “Abigail’s problem.” Boredom mixed with resentment and more than a little annoyance.

Carter was not concerned with anyone’s welfare but his own.

The scan was finished then, and he passed by her on his way into the examination room, the cloying scent of his aftershave wafting behind.

Abigail could feel her anger growing, the pressure inside her head increasing until she thought it would explode.

She was back in the waiting room, watching through heavy-lidded eyes as Carter tended his patient. The light sent piercing slivers of pain through her brain. In contrast to the blurred haze of seconds before, she could see with brutal clarity, see the perspiration on Carter’s face as he breathed into the other man’s mouth.

She narrowed her eyes against the light, watching him still.

She could smell him now, the aftershave partially masking the scent of fear. It was not fear for the patient, she knew, but for himself. Nothing he did was for anyone else and even as he worked to save a life, it was to protect himself from his accusers.

The others came into the room, taking over.

Carter moved away then, putting distance between himself and his patient. Abigail could sense his relief.

It was not right, she thought.

Then they wheeled the patient out of the room, everyone moving alongside. In seconds they were gone. The department secretary stood in the main doorway, watching as they disappeared down the hall.

Abigail turned her attention to Carter who leaned against the wall with a look of smug satisfaction on his face.

It was a look she knew very well, having seen it on a hundred faces since she was very young. A look that served to remind her that she was a child nobody wanted. A look that closed her out of a world for those who had.

In that instant, her hatred for him was complete.

In that instant, he fell to the floor.

Dead.

Her headache was gone.

Twenty-two

“I’m not a radiologist,” Quinn said, “so I might be missing it, but I don’t see anything in Abigail’s CT scans that indicate a tumor.”

“The radiologists can’t find it either,” Joshua acknowledged. “She could be hypersensitive or perhaps the tumor is not dense enough to show up on the scans. But her symptoms are very specific…”

“You’ve ruled out a pseudotumor?”

“Every clinical finding…indicates something much more critical than intracranial hypertension.”

Quinn returned the scans to him, watching as he put them in chronological order. “How are you going to proceed?”

“She’s scheduled for the magnetic resonance scanner…if anything can image a tumor, the MR scanner can. I’m considering requesting a consult for mapping the electrical activity of her brain at Children’s Hospital in Boston. We need to locate the mass, if there is one; there’s not much we can do medically until we determine location.”

“Until then…?”

“At this point, my priority is not to do anything to make her worse.”

“She seems to be doing fairly well,” Quinn commented, recalling Abigail’s bright-eyed vigilance of the night before.

Joshua nodded. “She has periods of relative normalcy, but when she has a spell, as she calls it, she is one very sick little girl.”

“It’s odd that her headaches come and go, sometimes without treatment.”

“That’s why they initially suspected that it might be psychosomatic. But there is no pattern to the spells, no trigger that they could identify.”

“What was the date of onset?”

“She was six…about two and a half years ago.” He walked to the filing cabinet, opened the top drawer and placed the file folder containing the CT scans behind Abigail’s other records. “We haven’t made a lot of progress in two and half years.”

“If the magnetic resonance scans don’t locate the tumor,” she said, “what’s the next step?”

“Without an identifiable tumor? Treat the symptoms and wait, I suppose, until the next development.”

“Seems risky to do nothing.”

“Our best bet right now is to sit tight. She’s stable at the moment, and with any luck we’ll know soon what the problem is.”

Quinn hesitated. “I took the copy of her chart home last night…”

“And?”

“With her family history, she’s an ideal candidate for some form of hysterical illness.”

“Granted. But I can’t believe that a child—six years old when she first presented the symptoms —could fool a legion of neurologists and psychiatrists, all of whom are aware of the same questionable background.” He shook his head slowly. “She’s a clever child, but not
that
clever.”