Death Rounds (15 page)

Stewart Deloram, who had been sitting beside Sean, stood up, seemed to sway a few minutes, then recovered his balance and strode to the podium. I recognized a few other chiefs in the front row, who over the years had been willing to oppose Hurst when it had been necessary. Sean must have recruited the lot of them to help him lead today’s effort. I wondered why he hadn’t approached me, since we’d been so effective joining forces for these battles in the past. The proof of our successes was the enmity of Hurst that we’d incurred in the process, and without a doubt we were certainly considered his two most vexing chiefs.

I glanced over at our old adversary again. He still seemed to be smoldering in his chair since the board members had obviously responded positively to Sean’s opening remarks. Watching him fume, I quickly got a pretty good idea why Sean hadn’t included me in his offensive this time. If he’d heard about the Sanders case, he probably figured I had enough trouble as it was.

“To the members of the board, welcome,” said Stewart when he reached the microphone. He broke off to cough into his hand, then continued, turning to face his guests but pointedly ignoring Hurst. “I’m Dr. Deloram, chief of Intensive Care at St. Paul’s. My job today is to help you better understand our grave concerns over the way this merger is shaping up. In a minute, I’m going to let you ask questions or say anything...”

As Stewart spoke, he kept having to clear his throat and turn away so as not to cough into the microphone. He must be getting a cold, I thought, and noticed he looked a bit pale under the stage lights. I absently gazed around the audience and spotted here and there some of the chiefs Hurst had in his hip pocket. They were slouched down in their chairs, probably hoping their master wouldn’t see them but no doubt just as scared of what their own department members would do to them if they’d skipped the meeting.

Stewart had another coughing fit, took a sip of water, and went on speaking.

“...but let me first ask you, if you were a patient in our ICU, who could best assure that the equipment and personnel needed to pull you through were there? An accountant? An absentee chief looking out for his own department at UH? Or a chief who was present...”

Then I saw Rossit sitting a few rows ahead of me leaning forward with his chin resting on his hands. Even in the half light I could see the continual movement of his jaw muscles. He mustn’t be too happy with something, I thought, watching the familiar chewing motion.

Stewart finished speaking with an apology to his audience for sounding so wretched, joked about being a shoemaker poorly shod, then croaked an invitation for questions.

“Jesus, someone should send him home to bed,” I muttered to no one in particular while watching him give his microphone to one of the visitors on the stage who’d raised his hand. This man had his chair closer to Hurst than the rest, and I’d noted he hadn’t been among those nodding and taking notes at the end of Sean’s remarks. He, like the others, seemed vaguely familiar.

“Thank you. Dr. Deloram,” he began, “but I feel compelled to explain why this merger is necessary...”

There were groans and the sounds of shuffling feet throughout the auditorium. We’d had these explanations ad nauseam, and the familiar phrases were like Sominex. “Partnerships,” “greater efficiencies,” “better clout with HMOs and regular insurers”—the mantra went on against the rising mutter around me. “Can it!” “Give it a rest!” “Christ, not again!”

But this speaker seemed undaunted by the hostility he was incurring. In fact, he seemed encouraged by it, raising his voice and bulldozing on while the volume of the protests around him increased. “... their bargaining power means lower rates, and that means less income for the hospitals...” I suddenly recognized him. He wasn’t a member of the board but one of the hospital lawyers. He’d once accompanied Hurst to a meeting with other lawyers to discuss the hospital having been named in a lawsuit against ER.

I quickly looked over at Hurst. He was in the same fixed position as before, his fingertips at his lips, but his eyes were roving over the increasingly unruly audience and he was starting to smirk. Suddenly he placed his hands on the sides of his chair and appeared to be about to get up. But he paused halfway out of his seat, and as I watched, his expression changed. He raised his eyebrows, dropped open his mouth, and, bringing his hands up from his chair, raised his palms to the heavens—a perfect parody of shock and dismay. But that little smirk had given him away.

“Excuse me!” I said, rising from my place on the stairs. “I want to know who you are, sir.” I pointed at the man with the microphone. He stopped in midsentence and stared at me. “Yes, you,” I insisted. ‘Tell us who you are!” I continued to point at him. But out of the side of my eye, I could see my outburst had been in time to catch Hurst still halfway out of his chair. His white face instantly went crimson, but he slowly sank back into his seat.

“Are you a member of the board?” I persisted, continuing to face the startled lawyer.

“Me?” he asked, glancing nervously at Hurst.

Everyone had gone absolutely still, the doctors probably more than a little uneasy about what I was up to and no doubt wondering whether I would embarrass or hurt their attempt to win over the board members. The businesspeople themselves looked puzzled, and one of them volunteered, “This is Norman Baker, an attorney for the hospital. His law firm is representing St. Paul’s in the merger.” His tone of voice clearly implied he hadn’t a clue why there would be anything wrong with the lawyer being here.

“I simply want us all to know who he is,” I countered. “As a member of the law firm handling the merger, he obviously has a vested interest in the process quite different from that of the board members,” I explained.

“Now just a minute!” exploded Baker.

“Dr. Garnet!” roared Hurst, leaping out of his chair.

“Relax, Dr. Hurst,” I interjected before he could get started. “And you too, Mr. Baker. This meeting was called, among other things, to allow the physicians to express their deep concern over the merger, not to give yet another lawyer another chance to lecture us on why legal takeover specialists think it’s a good idea. That the board is also present to hear these concerns, and hopefully to ask questions about them, gives added value to this meeting. It’s simply too good an opportunity to waste—an opportunity to assure that the choices made in the coming weeks are fully informed choices. What better way to assure that the best possible decisions will be taken for the future of St. Paul’s?”

I’d only intended to stop Hurst from scuttling the meeting. I’d been sure he was going to engage in a show of mock outrage at our rudeness in front of the board and then lead the lot of them out of there. He knew full well how fed up we all were with proclamations from above, and he certainly could predict how we’d react to yet another harangue about why the merger was good for us. I even suspected Baker had been told to deliberately try to antagonize us to give Hurst the excuse he needed. I’d seen Hurst pull similar stunts and engineer his acts of indignation before but had learned to keep an eye out for that little smirk which always preceded them.

But what I hadn’t counted on was the applause that followed. Even some of the board members rose to their feet and clapped. Hurst remained seated, his hands once more in the shape of a pyramid and his fingers rapidly tapping his lips. But there was no trace of a smirk now as he glared up in my direction. Baker leaned forward, whispered in his ear, then picked up his briefcase and stalked off the stage. Around me my colleagues went on clapping. I caught Sean’s eye as he stood at the front of the stage. He raised his arms, joined his hands over his head, and pumped the air with them like a triumphant boxer. Then, still smiling at me, he used his right index finger to point at his temple and make little circles—the universal sign that he thought I was crazy.

I might have found Sean’s gesture more humorous if I hadn’t seen Rossit arrive at the front of the stage at that moment and exchange a few words with Hurst as he pointed toward where I was sitting. The two men then looked in my direction, while Hurst nodded and spoke into Rossit’s ear.

“A regular pair of lagos,” I muttered to myself. When Hurst turned to leave through a door down at the stage level, I watched Rossit push his way back to the foot of the aisle I was in and start up the steps toward me, scowling the whole way.

As he jostled past, he snarled, “Fuck up this merger. Garnet, and you’ll make yourself a lot of powerful enemies!”

I was halfway to my feet and trying to control an urge to run after the little bastard and pummel him. He had reached the top of the stairs when I heard a crash on the stage below and someone screamed. I whirled in time to see Stewart Deloram fall onto the podium, toppling it over, and roll off it onto the floor.

Chapter 9

Six hundred doctors and nobody moved for the space of a few heartbeats. Then about a hundred of us tried to take charge.

I sprinted down the steps two at a time but was so stiff I nearly took a tumble myself.

Stewart was being swarmed by his rescuers.

“Get a stretcher!”

“Is he breathing?”

“Get a pulse?”

“Get back!” Sean was yelling as he knelt at Stewart’s head.

Elbowing my way through the circle of white, I could see Stewart himself struggling to sit up. His face was the color of paste, and glistening dots of perspiration spread across his forehead.

“Lie back, Stewart,” I commanded, pushing gently on his chest and reaching for his wrist. The front of his shirt was damp with sweat, and his pulse, difficult to feel, was rapid. I noticed blood starting to pool on the floor from a gash behind his ear. Sean grabbed a packet of tissue from his lab coat pocket and applied pressure to slow the bleeding. There was also a stench of feces in the air.

“Let’s get him to ER!” I yelled. “Call them for a stretcher stat!”

“This’ll need a few sutures,” added Sean calmly.

My main concern was for Stewart’s vital signs. Still coughing, he seemed to be breathing okay, but clearly he had a low pressure. He moaned, looked around with a puzzled expression on his face, then reached for his head with his right hand. “Hold it, Stewart,” I restrained him. “You fainted and have a cut there. Do you feel pain anywhere else?” I knew he was in his late thirties, so a heart attack was unlikely but not impossible.

“Earl,” he said weakly. “What happened?”

I repeated, “I think you just fainted. Do you have pain anywhere?”

“Only my head,” he answered, reaching for it again.

“Hold it, Stewart,” said Sean. “I’ve got to keep pressing until we sew you up in ER.”

Stewart obediently but weakly let his hand flop to his side.

“Stewart, do you have a history of heart trouble or of any other medical problems, like diabetes, ulcers, or lower GI bleeding?” The differential for dizziness and fainting snapped into my head— cardiac, metabolic, vascular.

“No, nothing, Earl, just this cold, and—Oh Christ!” he exclaimed, raising his head and looking down with disgust at the wet crotch of his trousers.

“Don’t worry about it,” I tried to reassure him. “It happens.” But not usually with a simple faint. With a seizure or a full cardiac arrest, yes, but I hadn’t seen any shaking movements and he’d obviously had a pulse from the moment I got there,

“I’ve had diarrhea since a few hours ago.” He groaned. “It’s part of this flu I picked up, but this is embarrassing.”

He’d not been coughing on the phone last night, I thought.

“I only felt dizzy when I got up to speak,” he continued. “Until then, apart from the usual muscle pains and a slight headache, I didn’t feel that bad, for a cold.”

His words sent an icy shiver up my back.

The stretcher arrived, and as we hurried toward-emergency I kept my fingers on his pulse while Sean kept up his chatter as he continued pressing on the laceration. “You know, I usually let the students practice on cuts like this. You’re getting pretty VIP care for a simple case of the runs, what with two chiefs taking...”

But my insides were turning to ice. “While Sean’s doing his artwork, I’m going to run a few tests, Stewart,” I told him breezily when we got to ER, hoping my
everything’s-going-to-be-all-right
tone kept him from realizing what I was suspecting.

Two days ago I never would have thought about it, because until two days ago, it would have been impossible. But any doubts I had that I was overreacting vanished moments later. As we worked on Stewart, starting IVs, drawing bloods, and rechecking his vitals, I happened to glance up and saw Rossit standing at the door, looking on. The expression on his face looked as grim as I felt. There was no trace at all of the hostility and anger that had been part of whatever game he’d been playing over the last few days. In fact, if I had to put a name to what I saw in his black unblinking stare, it would be fear.

Well, this is a change, I thought rather bitterly, knowing full well that he’d resume our hostilities whenever it next suited him and I couldn’t ever drop my guard against the little troublemaker. But for that moment I was willing to bet we both expected the same results from Stewart’s tests—a low white count, a low sodium and albumin, and a near normal chest X ray.

* * * *

“I don’t have to explain it, Michael, and I don’t have any more time for this kind of crap.” Locating had finally found him for me in the general records department at UH. Our conversation was not going well. “I’ve just admitted Stewart Deloram to his own ICU with a presumptive diagnosis of
Legionella,
I could have been killed last night by whoever came after me in the subbasement, and I don’t even want to think about what he might have done to Janet if I hadn’t come along. Now when me hell are you going to admit there’s something more going on than a missed water sample?”

“Is Stewart going to be okay?” he asked, refusing to answer my challenge.

“Who knows. He’s loaded to the gills with erythromycin and the infection’s early, but it’s alarming as hell he could even have contracted
Legionella
in the first place. And if it is
Legionella,
we’re also just seeing the prodrome. The pneumonia won’t develop until tomorrow. So far there’s no evidence of staph.”