"Hey, you have to trust life more," Janet had told him shortly after their first encounter sixteen years ago when she'd gotten her initial glimpse of his dark take on the brutal laws of chance. "For all the victims who end up in your ER, there's thousands more who make it safely home to bed. Besides, people like us, you and me, we'll make our own luck." Such unswerving optimism suited a woman who brought new life into the world for a living. It also counterbalanced his own daily workload of lives lost or torn apart.
Lately his tendency to think the worst had taken a new twist. Although he hadn't said anything to her yet, he worried about Janet giving birth at St. Paul's. Nobody had exposed the OB units to SARS, but it had happened in other hospitals. The culprits were usually residents who came from a ward where they'd unknowingly been around an infected patient who hadn't been diagnosed. The result was that newborns arrived only to be slapped into isolation. Only a matter of time, he kept telling himself whenever she went to work in her own department. But she knew that as well as he did, would be no less worried about it, and didn't need the extra pressure of hearing him lay it out.
He'd started to read up on home deliveries instead.
The breeze from outside picked up slightly, and he savored a sweet fragrance of nicotinia that wafted into the living room. It came from the front garden where she had planted an entire bed of the white, star-shaped flowers. Their pleasing, clean scent made him think of the lonely woman in Palliative Care who had confided how she loved the freshness in the air following a rainstorm. What was her name? Sadie Locke? Tomorrow, weather permitting, he'd have one of the orderlies take her out onto the roof garden in a wheelchair. Maybe maintenance could even spruce the area up a bit, perhaps bring in a few pallets of annuals. Janet would know what varieties might do well up there. Then patients who were strong enough could escape the walls and odors of the hospital.
He smiled and indulged in a rare moment of feeling pleased with himself. Why not? He seemed to have a knack for this VP, medical stuff. It gave him a rush of satisfaction, the prospect of having all that power and using it to do good things.
So there, Jimmy.
Sunday, 6:00 a.m.
Palliative Care Unit, St. Paul's Hospital
Monica Yablonsky dashed for the bedside phone. "Code blue!" she yelled, the standard order to bring a resuscitation team running to the aid of a cardiac arrest victim. "And I want the R-three in ICU or Emergency."
Not just a bunch of beginners, she added to herself, slamming down the receiver and reaching for the gray face with the staring eyes. It felt cold and rubbery. God knew when she'd died. Not recently. But with no DNR order on the chart, and given the stunt Earl Garnet had pulled last night, she'd better play this one by the book. Damn him, sticking his nose in where it didn't belong.
She plopped a pocket breathing mask over the dead woman's lips and nose, then blew.
The breath squeaked out the sides of a rubber seal that should have molded itself to the face.
Elizabeth Matthews's chest barely rose.
Monica tried again.
The same resistance blocked her effort.
Still, she had to go all out. Or would that only make her appear more guilty? Garnet would be looking ultra close at what happened here. And given his reputation for digging up shit, he'd be bound to discover the others. If he did, the nurses on the night shift would have to watch out.
She swiftly positioned her hands on the midpoint of Elizabeth Matthews's sternum and began the compressions. It felt stiff, so she applied more force to get the required inch of downward thrust that would squeeze the heart's ventricles and pump blood through the body.
Ribs snapped with a crunch under her palms.
"Shit," she muttered, easing off a bit. Still, she continued, not at all sure her efforts wouldn't make Garnet more suspicious.
"We got a code, eighth floor!" Jane Simmons yelled. She turned from the phone and ran to where they kept a portable bag of airway equipment. Grabbing it, she sprinted for the door, right behind Thomas and the rest of the team. At the elevators they commandeered a car with an override key.
In less than a minute they were on the ward. Jane arrived at the patient's room to find the night supervisor, Mrs. Yablonsky, and a nursing aide administering CPR, both women red-faced from the exertion.
Out in the hallway the sounds of running feet and a familiar wobble of wheels announced the arrival of ICU residents with the crash cart. This chorus of youngsters with fear in their eyes followed Thomas through the door and swarmed the patient. Some ripped open her nightgown, while others slipped a board under her back. One of them applied well-lubed defibrillation paddles to her bony chest.
The monitor screen showed a flat line.
"I've got the airway," Jane said, shouldering Yablonsky aside and flipping off a pocket mask that the aide had been using to provide ventilation. As she worked, the sticker bearing the patient's name at the head of the bed caught her eye.
Questions flew.
"She's not a DNR?"
"When did she arrest?"
"What's her diagnosis?"
Amid a flurry of hands, additional IVs went up.
Jane tried to pry open the mouth; she found it unusually stiff but slid a curved airway into place anyway. She then connected a ventilation bag and mask to an outlet in the wall, sending a hiss of oxygen into the room. But when she applied the mask over the patient's face and squeezed, the bag remained rigid in her hand. She couldn't force air into the lungs. The woman's tongue must be blocking the way, she thought. She tried to reposition the head, but it resisted manipulation as much as the mouth had.
A pretty blond girl who had attempted to take over the chest compressions, her long hair repeatedly flopping in the way, slowed after a dozen thrusts. "This one doesn't feel right!" she said, her eyebrows bunched into a frown, but she continued to labor over the dead woman's chest.
Thomas walked over to the bed, reached through the crowd, and placed the tips of his fingers along Elizabeth Matthews's neck. "You're not producing a pulse." He signaled the young intern to step back- she'd already grown flushed from trying- and attempted a few compressions himself. A puzzled expression crept across his forehead. He stopped pumping, threw the covers entirely off, and turned the woman's body to reveal large purple blotches on her hips and the back of her shoulders. He looked up at the supervisor. "The woman's been dead four hours, minimum." He pointed to the discolorations and turned to the residents. "These markings take at least that long to appear. We call the phenomena lividity, where venous blood pools at the lowest point of the body once a person has died." His voice had slipped into the clipped tones most seniors used when teaching. He threw the bedsheet back over Matthews, allowing it to float down on her like a shroud. "A code blue never should have been called."
Yablonsky's cheeks burned red at the rebuke.
As the others cleaned up their equipment, Thomas Biggs led her to the corner of the room. "Why'd you do it?" he asked.
He may have intended their conversation to be private, but Jane easily overheard them.
A flicker of alarm shot through Mrs. Yablonsky's eyes. "I beg your pardon?" she puffed with indignation.
"Why'd you call the code? You could feel and see her as well as I did. The skin had gone cold. The lividity formed where she lay."
Mrs. Yablonsky's face flamed further, and the cords of her neck muscles tightened.