Gesturing toward the computer screen, Luke said to her, “Take a look at his X-ray and tell me what you—”
The blare of an alarm interrupted him. All eyes turned toward the monitor.
“Patient’s in V-Tach,” Luke called out as he felt the boy’s neck for a pulse. “No pulse. Susan, charge the defibrillator to forty joules. Megan, start chest compressions!”
6
As the staff elevator rumbled toward the first floor, Henry Barnesdale replayed in his mind the breathless voice of the nursing supervisor who had called him from the E.R. From the sound of things, it seemed that McKenna’s altercation had nothing to do with Josue Chaca. His head shook at the irony of using the bizarre antics of his medical staff—my doctors are brawling with parents, for Christ’s sake—as a pretext for coming to the E.R. to probe his real crisis, the one disguised as a small boy.
Barnesdale choked back the acid taste in his throat. He didn’t believe the Zenavax CEO for a moment. He was certain that the vaccine had triggered the Chaca boy’s illness.
If the boy lived — if somehow, someone discovered the cause of his illness — fear and panic would quickly spread across four continents and the aftershocks would ripple for decades.
His shoulders shuddered. Whatever the problem was, he had to hope that Zenavax had already discovered the cause and corrected it.
When the elevator doors finally opened onto a first-floor corridor just outside the E.R., Barnesdale jinked back like a moth singed by flame. It was chaos. Foot traffic was at a standstill. A growing clot of people filled the hallway. Three security guards in ill-fitting blue uniforms, one on the near side and two on the far side of the crowd, had their arms extended outward, marking the perimeter of the group but accomplishing little else.
Barnesdale stepped out of the elevator and pushed his way through the maze of unkempt humanity that stood between him and the E.R. A mother pleaded with him in Spanish, holding up her sick child and gesturing toward the emergency room. He didn’t understand a word.
He was reminded why he hadn’t chosen emergency medicine. As a practicing surgeon for the first twenty years of his career, he was used to the order and precision of an operating room. It was more like a battlefield down here. Maybe that’s what happens — E.R. doctors start to think of themselves as combatants, and before you know it…
When he emerged on the other side of the crowd, he was just in time to see the ambulance attendants struggling to raise a gurney that was holding—My God! — some sort of man-mountain.
The behemoth’s shoulders spilled over the stretcher like a lava flow. He wasn’t moving. A woman stooping next to him had a badly bruised face and her left eye was swollen shut. A girl with a bandaged head — she was bug-eyed with fear and oddly quiet — was stuffed under the woman’s arm like a bag of dirty laundry.
Why hadn’t anyone mentioned the woman’s injuries? What the hell had McKenna done?
Just then, a squat woman with tired eyes — the hospital’s night nursing supervisor — marched up to him. Before she could speak, Barnesdale said, “Where’s McKenna?”
“He’s in Trauma One,” she said. “They just got Mr. Erickson onto a gurney. We were waiting for an ambulance. It arrived a few minutes ago. He’s being transported to—”
Barnesdale brushed past her in mid-sentence and started toward the Trauma Unit. When he turned the corner onto an adjoining hallway, he found Caleb Fagan fifteen feet ahead of him, passing through the doorway into Trauma One.
He was surprised to see the man who had just last week lunched with the U.S. Surgeon General slumming in their E.R. on a Friday night. It served him right. After all, it was Caleb’s volunteers who had arranged to transport the boy from Guatemala. The man had no inkling that his rat-hole clinic just triggered a cascade of events that had Barnesdale’s career — and life — teetering on a precipice.
He followed in Fagan’s wake. When he stepped through the doors into the trauma suite, a cacophony of alarms and high-pitched squeals hammered his ears. Monitors blared and metal wheels clanged as nurses slammed equipment into position. A respiratory therapist was shouting over the din.
In the eye of the storm, McKenna was standing over the Chaca boy, calling out orders in a clipped tone.
Crash.
An IV pole fell to the floor as a young doctor leapt onto the table and straddled the patient. Probably a resident, judging by her age and dress. And athletic, judging by her movements and taut figure. She started thrusting the heel of her hand into the boy’s chest, shouting the numbers one through five over and over again, in cadence with her compressions. Her voice cracked on the second “five,” jumping an octave.
One of the nurses screamed, “Defibrillator charged to forty.”
The resident jumped off the table, grabbed the paddles, and placed them over bright orange conductive pads on the upper-right and lower-left corners of the boy’s chest.
She shouted, “Clear,” and sent a jolt of electricity through the boy.
Everyone turned to the monitors.
The female resident yelled, “Still in V-Tach,” and sprang onto the table in a motion as fast and graceful as a jaguar. She seemed possessed by an otherworldly force as she repeatedly drove her tightened fist into the boy’s chest.
One of the nurses was yanking syringes and drug vials from drawers in a red crash cart. Another nurse, with spiked orange hair and an idiotic nose ring, injected something into a central line, the next syringe held between his teeth.
Just then, McKenna’s glance swept past Barnesdale without acknowledgment and came to rest on Fagan. “Caleb, what do you know about this patient?”
“Less than you do, I’m afraid. The clinic called me, told me they were sending the boy up here. They said he was stable.”
Barnesdale glanced at the wall clock behind him. It was a large analog-type, like an old schoolhouse clock but with an extra hand — a red one used to measure the elapsed time in a resuscitation attempt. It was approaching the 3. Fifteen minutes had elapsed since the patient had coded.
When he turned back, Fagan was staring at him.
“Henry, what are you doing here?” Fagan said.
Barnesdale lifted his chin in McKenna’s direction. “Ask him. That mess in the hallway is his.”
Fagan’s eyes narrowed in a question, then anger. “Maybe you hadn’t noticed, but the boy on that table is fighting for his life. Whatever you’re here about, it can wait.”
Barnesdale stared at Josue Chaca, feigning an acquiescent expression.
A concealed wave of relief washed over him.
The boy was dying.
Barnesdale was already halfway to the door when the intercom unit sounded: “Dr. McKenna, I know you’re busy in there. I’m just letting you know that a Dr. Tartaglia has called twice since about five o’clock. Says it’s important and she needs to talk to you…”
Megan was engulfed by a sense of gloom. She glanced at Luke. He showed no hint of surrender, no hint of anything.
She saw it in the others, though. Following orders, doing what they were told. But their intensity was waning, the adrenaline leeched away, their movements becoming repetitive and tedious. A monotonous cadence had replaced the raw energy she’d felt earlier.
No single event ever brought these things to an end, just the eventual recognition that nothing was working, and nothing was going to work. Someone had to make the decision to stop their resuscitation efforts.
“How long has it been?” Luke asked.