He could see that she was surprised, but ready.
"Give her ten thousand units of heparin IV, and hang a drip at a thousand units per hour."
Mary, the recording nurse, lowered her clipboard and stared at him. "You're going to give her a blood thinner? When she's already bleeding?"
"She's bleeding because she's clotting" Monks said. "If we don't break that cycle, she's dead."
"Are you sure it's DIC, Doctor?"
Monks's temper jumped another notch toward the snapping point. "I'm not sure of anything, except that we've got minutes. Everybody get moving, please"
Jackie, stable, competent, and obedient, was already taking out a vial of the clear heparin and drawing it up. But she looked worried, too.
She had a right to be. It was a very long shot. If Monks was correct about the DIC, Eden Hale was probably going to die anyway.
If he was wrong, the heparin might kill her.
Monks pushed down hard with the heels of his hands on Eden Hale's sternum, five times, at one-second intervals. Then he leaned close to her face, his head turned to the side and his ear to her lips, listening for a sound of life. He straightened up and stared at the monitors, willing a miracle. He had been doing this for fifteen minutes. CPR was like running a race, a desperate physical effort to stay ahead of the enemy, death.
Finally, he admitted that he had lost. He stepped back, shoulders sagging with fatigue.
"All right," he said. "We'll stop now."
In fact, it had been all over for at least the last five minutes. The nurses knew it, and were quietly tidying up. Their body language said it all.
"What time are you pronouncing her, Doctor?" Mary Helfert said. She was stiff, all business, holding her clipboard like a shield. Her body language was unmistakable, too. She did not approve of his decision to use heparin.
Monks looked at his watch. 'Tour forty-three a.m.," he said. "I can't sign a death certificate. The DIC killed her, but I don't know what caused that."
"Will this be a medical examiner's case?"
He nodded. The death fit several criteria that automatically put it in the city's jurisdiction for autopsy. It was unexpected, and she was young and healthy.
"Keep trying to find the family, and have them notified," Monks said. This was usually done by contacting local police or sheriffs and having them send an officer to the house. It was considered more humane than a phone call from a hospital. "And call Dr. D'Anton's clinic as soon as it opens." Any history that D' Anton might have been able to give them was academic now, and probably would not have helped anyway. But he might know how to contact the family, and he should be informed.
The recent surgery was one more criterion that made Eden Hale a city ME's case. The possibility remained that the DIC had been caused by surgical infection.
Monks walked out of the cubicle, washed, and went to the ER physicians' room.
They had come close to saving her. The heparin had started to dissolve the clotting, and her circulation had started flowing properly again – but by then it was just too late. Weakened by the long lack of blood and God knew what else, her heart had stopped. The coroner's report would help them fill in the blanks.
Monks hated to lose a patient, and hated like hell to lose one who was essentially healthy – hated the helpless anger at not being certain what was wrong. It was like being sniped at by an enemy he could not see.
What had come in from Lab and X Ray so far had confirmed what he already knew or guessed. Her hemoglobin was very, very low, at 3.7 grams per deciliter. Normal ran at about 15. The platelet count was 2,880, with normal upwards of 150,000. The coagulation panel showed prolonged PT and PTT. All of which meant that she had almost no blood, and what she did have wasn't clotting. Her urine was dark orange, 4+ for blood, negative for white cells. That was a reasonably sure indication that she did not have a urinary tract infection as the source of the DIC. The X rays showed nothing unusual except the two whitish circles of the breast implants.
Monks looked again at the material the paramedics had found in her purse, from the clinic of Dr. D. Welles D'Anton – a discharge form from the surgery, and a glossy informational pamphlet. Its cover featured a stunningly beautiful woman, smiling in invitation to the world of glamour. Several pages of text, with drawings, briefly described available procedures. The back flap showed a photo of D'Anton himself. He had a handsome patrician head and a confident stare.
D' Anton – pronounced Dan-ton, and heaven help the fool who said it wrong in his presence – had spent some fifteen years developing a reputation as a miracle worker for models, actresses, and socialites. They came from all over the globe to his luxury San Francisco clinic, to be transformed by him.
And D'Anton had graced Mercy Hospital by making it his venue of choice for more extensive procedures. He contributed generously to the hospital and had helped to fit out a top-flight reconstructive surgery unit that brought in a lot of money and prestige.
Apparently, Eden Hale had been one of his devotees.
Monks lingered in the physicians' room a minute longer, wishing to Christ he could pack it up and go home. But his shift was not over until seven a.m. He walked back out to the triage desk to take the next case in line, acutely aware of the closed curtain of the trauma cubicle where Eden 's body would lie until the morgue attendants came to get her.
Chapter 2
Just after seven a.m., Dr. D. Welles D'Anton looked over notes for his first consultation of the day. The patient's name was Lucia Canter. She was new to the clinic. She was forty-three and recently divorced from a husband who had left her for a young trophy wife. Lucia had been born rich and had come out of her marriage richer still. Her children were almost grown. Now she wanted a new life. D' Anton stepped briskly into the procedure room where Lucia was waiting. She was standing in a corner, wearing only a loose, open-backed examination gown. Stripped of clothes and makeup, she was nervous, even a little frightened. But her eyes were trusting. D'Anton had long since realized that the more naked and vulnerable women felt beneath his hands, the more they adored him. It was strange but exhilarating, and he used that power confidently.
"Good morning, my dear," he said, and gestured at the padded table in the center of the room. "Please sit."
She did, fingers fidgeting at the hem of her short robe, but then leaving it alone. She wanted to please him.
"Look straight ahead, Lucia," D' Anton said. She obeyed like a schoolgirl, folding her hands in her lap. He pulled up a chair and leaned close to her, studying her face, his manicured fingers tracing its contours. She was attractive, her skin and figure good. She had had the time and money to take care of herself through the years. But her face was on the gaunt side – a little horsey, in fact, and lined by stress.
D'Anton's words were more tactful. "You're lucky; you have good bones," he murmured. "Yes, we can do you a world of help. The Miriam Elena look, do you think?"
Her nervous smile widened, almost into a giggle, at the mention of the supermodel's name.
"I'm afraid nothing could make me look like her," she said.
"Don't be so sure, Lucia," D'Anton said archly. "After all, I gave her her face." He pulled the skin gently tighter at the corners of her eyes. "A browlift. A bit of AlloDerm here and there. And cheek implants. They'll soften these grooves beside your nose."
He sat back. "I'll take some facial measurements, then computer-image projections. You'll have several options. Now, you wanted to consider a breast augmentation?"