Mercy 6 (3 page)

The bone chips indicated that she had been athletic until her fifties. On the fourth floor, she had slumped over her roommate's bed while sharing tea and dessert. She had been standing over the woman's bed, making plans to get together after recuperation.

Fleming had been checked out but hadn't changed out of her gown.

The roommate had buzzed for the nurses immediately. Fleming had been unresponsive during transport to the ER.

Marley Peterson, a forty-one-year-old surgical nurse had been at Mercy for ten years. Her work record was stellar; her medical history, which was in the system, was marred by a smoking habit that had yet to exhibit any health repercussions. She had never missed the hospital's required checkup. The only prescription after every six-month checkup was to stop smoking. She had been treated for staph infections twice during her Mercy career: one MRSA, one VRSA. She had been discovered in a second-floor ventilation room that was also used for water storage. A worker from the physical plant, retrieving a jug for a water cooler, had found her slumped on the floor and alerted nurses. She had shallow breathing and pulse during transport to the ER.

Richard Verdasco, in his early thirties, had been visiting his mother in ICU. His medical records were not in the system. The mother, Lupita Verdasco, was in post-op ICU, not conscious after surgery to remove a brain tumor. Richard Verdasco had been found slouched in an armchair in the visiting area, a magazine across his lap. Another visitor sitting in the same area at first had thought he was sleeping but had alerted nurses after noticing that his eyes were open and unblinking. Verdasco had been unresponsive during transport to the ER.

It was infection, Thorpe's domain. She should take advantage.

The ER would go still without incoming. She could run on the treadmill in PT, have a yogurt, granola, and apple at the cafeteria, take a whirlpool in fourth floor recovery, nap in the surgeons' lounge on Two. Claiborne would be furious about having started things with the Dozier case, but she never needed Claiborne because by the time stuff got to him, the patient was no longer hers, was either dead or parsed out to a real specialty. Claiborne needed her. He needed her for any decent consultation on trauma.

She petted her screen, scrolling down the four charts. Did they make it feel like skin on purpose? All first-year med students are assigned virtual patients. Some create avatars, whether allowed or not. That was one of the biggest changes in medicine, her mentor claimed. They often argued over whether this was good or bad, changing sides depending on what they'd seen that day in the ER.

She looked at Dozier's chart. Then she gazed unfocused over the bay. This was what she did instead of closing her eyes. She pictured Dozier three ways, recalling him in the ER and Pathology, then imagining him slumped over his ladder. She hadn't really seen any posturing, any signs whatsoever indicating disconnection.

We see what we are, her mentor had told her. Take one patient complaining of headache and fatigue and send him to four different specialists. You will receive four different diagnoses, four different prescriptions. Throw in one meddling aunt and receive another diagnosis and another prescription. Pathologists are different—

different but not exempt. They see pathology. But is there always a pathology? Believe in life, Dr. Mendenhall, he told her. That there is something beyond diagnosis and pathology.

Pathology buzzed her, one word from Claiborne: Come.

Pathology seemed darker. Maybe it was the increased coolness and the change in music, an even more spare solo violin piece.

Maybe it was the bodies, now naked, with a fourth steel bed empty and waiting. Maybe it was the way Claiborne, Mullich, and the tech were standing. Claiborne now had Mullich in gloves and mask. At first she thought the architect was a cutter. The three stood in waiting formation, turned toward her entrance.

The mix confused her. The coolness meant Thorpe was setting things up for a long haul. The garb for Mullich indicated this also.

The presentation of the bodies appeared Thorpe-ready, propped with limb angles measured and even. The empty bed—“Don't call them tables,” Claiborne had insisted the first time she had made the mistake—held intrigue. Thorpe would keep Peterson alive on paper for as long as possible to get the best cultures, even if she had a DNR. Peterson was too young for a DNR. But she was a nurse, no doubt a human petri dish, perfect collateral for Thorpe.

Mendenhall put on fresh gloves when she entered but ignored the crisply folded mask. She eyed the empty bed, then checked Claiborne.

“That one's for you,” Claiborne told her.

She'd been awake for twenty hours straight. This was a dream.

Claiborne motioned his mask and gloves toward Mullich. “His idea. A fourth bed just to give you the best perspective.”

Claiborne went to Dozier, who was first in line. That was strange, too, the way the beds were ordered: Dozier, Fleming, Verdasco, then the empty steel for Peterson, the four aligned in a neat slant rather than squared.

“Him again,” said Claiborne, nodding toward Mullich. “They're arranged according to the floors they were found on.”

The others followed him to Dozier.

“Look at him first,” he told Mendenhall. “Head and neck. Then go to the scans.”

“Scans? You took scans?”

“You'll see.”

She crouched to get a level profile of Dozier. The skull was balanced on the occipital, cleanly presenting throat and nape. His beard had been combed into a point. His lips were in repose, not yet slipping into grimace. With two fingers, she palpitated what could have been slight swelling beneath his Adam's apple. “Maybe something there.” She shrugged. “Not worth a scan. I thought you would just run an X-ray.”

Claiborne led her to the side table, a stand-up metal desk, out of place because of the lamp and pens and books and paperweights, little gifts. He flicked on one display above the desk, showing the X-ray. He left the one with the CT dark.

“I did what you just did,” Claiborne told her. “I looked at him, pressed his throat, then walked to the X-ray.” He nodded to the X-ray. “So I wasn't expecting that.”

The display showed diagonal occlusion from occipital to throat, the point of minor swelling. Mendenhall squinted. There was a path of displacement and internal bleeding through the neck.

“So we ran this.”

The scan clearly showed that the spinal cord and vertebrae were clean. The trauma was all capillary bleeding, all in the tissue, the major vessels and bone clean and undamaged. The skin appeared intact, certainly no wounds.

“Does that mean no infection?” asked Mullich.

“Nuh-uh.” Claiborne kept looking at the scan. “It just seems a little too clearly defined for infection.”

“You'd expect it to wander more,” Mendenhall explained.

“Infection.”

“But I have seen linear infection paths.” Claiborne drew the diagonal across the scan.

“Yeah,” said Mendenhall. “Following a stab line. A long puncture.”

“I've seen fungals a little like this.” He looked at the tech. “I showed you that one. Absolutely geometric. Crystalline.”

Mendenhall grabbed a horn-rimmed magnifying glass from the desk and went back to Dozier's body. Only after she began the move did she sense transgression on her part, a passing of Claiborne. The tech and Mullich turned with her but did not step, just broke formation, torn and hesitant.

She bent close to Dozier's throat, lens held above the tiny swelling.

Claiborne led the others to Dozier, bringing a wireless otoscope.

With precision, he took the magnifying glass from Mendenhall's fingers and gave her the scope. It was laser-aimed. The halogen light was intense enough to turn Dozier's dark skin translucent.

Mendenhall's pan was transmitted to a large overhead screen. They saw what she saw. The view was near-microscopic: dead skin cells sloughing, pores gaping, curled whiskers rooted.

“I see a line.” Mendenhall drew the laser along a straight path of sloughed skin cells. She lifted her eyes to Claiborne.

“From shaving,” he said. “A week ago, I'd guess. You can find a dozen of them on his throat. You'll find some more on the nape, especially around the occipital. When we turn him over.” He nodded to the tech. “Tilt him.”

With a delicate lift of Dozier's shoulder, the tech presented the nape and the base of the skull for Mendenhall.

“I need to get me one of these,” said Mendenhall. She raised the scope a little to clarify that she was speaking about it, not the tech, though she might have meant both. She sought refuge in the close view of Dozier's skin, the epidural landscape. She did see more of those lines, not cuts, not scarring, just cells scraped evenly by a razor, days ago, weeks ago. She saw the salt crystals of Dozier's dried sweat.

Claiborne cleared his throat. The tech shuffled her feet. Mullich remained quiet. She could sense him waiting, not just watching.

She found a cluster of blood cells clinging to the corner of a salt crystal. Moving diagonally just below the occipital, she found another. Following the same line, she slid her view up the periphery and found a third cluster, dried purple, trapped in a sheer on the base of a salt crystal.

“I see a blood line.”

She knew Claiborne was wagging his head.

“She found three dried blood-cell clusters on a hospital janitor.

On a guy who'd been doing repairs all day. And the day before. And the day before that. In fact, you're just finding a case for Thorpe.

Blood contact.”

“The three form a line,” replied Mendenhall. She traced the laser along the line. It wasn't quite perfect, with one cluster just on the other side of the line. Then she straightened to address Mullich.

“Any two points form a line. But a third point determines, no?”

Mullich shrugged.

Claiborne stepped closer to her.

“You've gone myopic, Dr. Mendenhall. You've lost the big picture. You want to argue—
to Thorpe
—that maybe a microscopic blade lanced a janitor while he was on a ladder? Or that an intense burst of air went off inside his neck? And what about the others?”

He motioned to the other bodies. “A serial killer with a light saber is loose in the hospital?”

Mendenhall passed the scope to the tech. She sighed and pressed the back of her sleeve to her brow. She badly wanted to rub her eyes with her fingers.

“The, what did you call it? Posturing?” said Mullich, his mask thickening his accent. “She saw that.” He pointed back to the lighted displays.

Mendenhall looked down at her gloved hands, empty. She didn't know what she was doing. She couldn't really say that she had seen posturing in Dozier. We see what we are. She saw what she was.

She was a dream-deprived trauma specialist, one who had never escaped the ER, forever moonlighting to pay off loans that no longer existed. She didn't even want to go home. She wanted the hospital to open, to let in more, to let in the outside.

“Can infection cause posturing?” asked Mullich. He was looking at the tech. She answered only with lifted eyes. Her eyes held still, almost black above the dark blue mask.

“Maybe a sudden bloom against the brain stem,” Claiborne answered. “Something like that, I could imagine.”

“Imagine?” Mullich pulled his mask down.

“Better than I can imagine a Jedi in a hospital.”

Mendenhall was still bowed. “I'll go rest,” she told Claiborne.

“I'll come back down if you want.”

Claiborne let his mask fall away with a simple stroke behind his neck. His expression opened to her. “If I do a bunch of digital scans before Thorpe's work, he'll send people down. I like it down here like this. Quiet.” He pointed back to the displays. “You led me to that. We have that to show Thorpe. To put him on his heels a bit.”

He waved toward the other bodies and the empty bed. “You gave me something to look for in them. Later. Soon, but later.”

Mendenhall returned to her cubicle. She fussed with papers and journals, squared them, then struck them all, swiping outward with both hands. Atop the resulting mess lay the most recent issues of
Tennis Magazine
and
Golf Digest
. She recognized the tennis player but not the golfer. She wouldn't have guessed that he was an athlete. Despite the airbrushing, she noticed a basal cell on the edge of his left temple. He should come see her. The subscriptions were gifts from her mentor, who knew well enough to have them mailed to the ER, where they would have some chance of being noticed.

She had played tennis in college. Maybe the golf was supposed to be her future—her present.

She put the magazines on a stack of previous issues on the floor, all unread save for the letters-to-the-editor sections. She hunched into her space. The cafeteria had been too crowded, people gathering and lingering there during containment. She swiveled her chair to assess the bay. Pao Pao stood in the center, directing the EMTs on where to push the remaining gurneys, where to set up any new patients coming from within Mercy.

A young woman with straight black hair interrupted the nurse.

She wore a lab coat. Even from this distance Mendenhall could see that she was extremely pretty, exotic. The EMTs peeked back at her. She must have said something important to Pao Pao because the nurse gave her immediate attention, no back, no resistance, no hesitation in her sturdy shoulders. The woman was even shorter than Pao Pao. She tapped notes into a hand tablet. When she finished with Pao Pao she came directly to Mendenhall.

She wore a name tag on her lab coat. The tag was porcelain with engraved black letters: Silva. She was the tech from Pathology, the tag a gift. It felt good to look at her face, oval now without the mask and cap. To look at her hands without the gloves, fingers balancing the tablet. Her expression appeared haughty, which also soothed Mendenhall. The tech was bracing herself.