Excerpt
PROLOGUE
Manhattan Hospital
Intensive Care Unit
Early August--the present
At night the ICU dropped its daytime hustle for a quieter, more passive personality.
No distraught families waiting in the corridor to talk with the doctor. No clusters of attendings, residents, and medical students on rounds, making their slow march in and out of patients' rooms.
The very emptiness highlighted objects that usually receded into the background.
Now one's eyes were drawn to the mirrors, like huge silver bowls, that hung at intervals from the ceiling, there to prevent an around-the-corner collision between a linen cart and a trauma team.
Now one noticed the rough-lettered sign at the nursing station--REMEMBER! SIGN OUT YOUR PATIENT'S NARCOTICS ASAP!!--and above it the monitor, its continuous display of moving lines showing the electrical impulses of each patient's heart. The symmetrical red rows of peaks and valleys stood out boldly against the black of the monitor screen. At night, the watcher, drawn to the screen, was inclined to feel uneasy, almost breathless, fearful of peaks that suddenly inverted, of valleys that suddenly peaked, of a sudden conversion from a neat pattern to wild scribbling, or a sudden collapse into a futile straight line--changes that triggered triple beeps or Klaxon honks.
At night one could hear the sounds of silence--the compression and release of ventilators that breathed for some patients, the soft sighs of patients who could breathe on their own, the muted conversation from the lounge, where the staff had gathered to watch Letterman.
At night one looked more closely at the patients' rooms that lined the corridor. With their glass-windowed sliding doors, they resembled the compartments of a European train--a train that one could enter unobserved.
The head nurse, alone at the station, picked up the phone and called X-ray. "Hey! You were supposed to be here half an hour ago. . . . Well, speed it up!" Then, with an occasional glance at the monitor, she resumed writing progress notes and nibbled popcorn.
Unseen in the conference room, watching the nurse as she wrote her notes, was someone wearing a gray lab coat, a stethoscope protruding from a pocket. How much of life is based on trust, the person was thinking. Trust that the driver of the oncoming car would stop at the red light. Trust that the uniformed man really was there to read the meter. Trust that a lab coat, with stethoscope, automatically entitled its wearer entry to any hospital floor. Suddenly, from a far room came a high whine. Labcoat watched closely as the nurse went to replace a near-empty IV bottle. Once the nurse was out of sight, Labcoat rushed out of the conference room and entered a room at the near end of the corridor.
Quickly drawing the curtains over the windows, Labcoat turned to scan the room. Below the bed a network of hoses led to oxygen, suction, dialysis units, and other life-preserving devices. Above the bed the hanging metal apparatus for the intravenous looked like two hoses. Two IV's--that was convenient.
On the bed the patient lay sleeping, her hair, the pure white of a former blond, straggled over the pillow. The sheet clung to the long thin body.
Labcoat stood watching the patient.
Slowly, her eyes opened. She gave a sigh, looked up, saw Labcoat--and stared. "But I--you--" Mumbling something that sounded like "Can't talk," she gestured for water and was handed a glass with a straw. She drank eagerly. "But I know you--you're--"
"Shh"--lightly a finger was put over her mouth--"you don't want to wake anyone."
"Hell, I don't care. Then it's night?"
"Yes."
"I'm so upset--thought it was daytime." She lay there, looking up. "So many years. Where have you been?"
"You've kept busy, Dewey. Your book--"
Her hands clutched the sheet. "The collection?"
"I found it--enthralling."
Warily--"You read it?"
"There's something the matter with your IV. Let me fix it."
"Oh"--less wary now--"you work here?"
"Yes."
"Didn't know--so confused--so upset."
Out of a lab-coat pocket came a syringe. In one smooth movement, the syringe was injected into the IV plug. A split second later the color drained from the patient's face. Her eyes rolled upward, her head fell back.
Instantly the Unit was hit with an earsplitting blast of warning beeps.
Yelling "Code Blue," Labcoat raced out of the room and almost collided with an X-ray cart. The X-ray tech hardly noticed. The loudspeaker was announcing "Code Blue--7152," and all hell had broken loose.
"How long has it been?" said the chief resident.
The nurse checked her notes. "Four and a half minutes."
"Let's shock her one more time."
The nurse put the defibrillator paddles against the chest. An electric shock went into the heart. Dewey's body arched, almost jolting off the bed.
There must have been twenty people in the room by this time--all staring glumly at the monitor.
Still a straight line.
"Oh shit," said the chief resident. "It's hopeless. Might as well stop. Probably brain dead now."
At the nursing station, the chief resident was saying, "Know who she was?"
"Who?"
"Cob Conner's daughter."
"Who's Cob Conner?" said the medical student.
"Forget it. Someone has to notify the family. Get the chart."
In Dewey's room, the aides had removed the tubes, the catheter, the EKG leads. They had cleaned the body and wrapped it in a sheet. Now the crew came in to clean the room. They emptied the wastebaskets and were about to toss the EKG strips when the resident came back to the room.
"No," he said. "Save that."
He stood, threading the long EKG strips through his fingers. Strange, he thought. Why were the T-waves so peaked just before she died? Well, maybe tissue necrosis. But I want a post.
Labcoat, in street clothes now, stood on Fifth Avenue and hailed a cab.