Mortal Remains (35 page)

She sucked in a deep breath. “Dr. Roper, before telling you what he found, I have to know. Did someone kill Victor because of this?”

Mark’s official line that he couldn’t give out confidential information sprung to his lips, but he didn’t speak it, knowing he might spook an already frightened woman. Instead he told her the truth. “I don’t know.”

“Oh, God! So it’s possible.”

“Listen. We can get you protection. I’ll take you to the police myself, right now if you want. And we mustn’t say anything more-”

He was listening to a dial tone again.

As he slowly lowered the phone, he sat staring straight ahead, trying to think what he should do. His gaze swept north, pulled by a glowing orange smudge that pulsed and waned above the trees against the nighttime skyline. It took him a second to realize it must be coming from a huge fire, and a heartbeat more to think it could be near Nell’s cabin.

A wall of flames rose above the back half of the structure; smoke engulfed the front.

She lay in the snow before the door where she’d crawled, naked, the skin on her head and the left side of her torso covered in carbon. But within the blackened face, white eyes glittered, alive, the nightmare from his childhood.

He thought her wrist had a weak pulse. As he reached into the flesh of her neck to palpate her carotid to be sure, that same cloying smell that could send his heart pounding came off her in waves and filled him with terror. Swallowing to keep from gagging, he felt the artery fluttering beneath his fingertips. In the headlights of the Jeep he could see the burns weren’t that deep. The black was mainly soot.

Her darkened lips parted, revealing a slash of creamy teeth, and she screamed.

“Help me get her to the back of the Jeep,” he told Lucy, his voice quivering and barely able to keep from breaking.

Seconds later they careened out of the driveway, Lucy at the wheel as he huddled over Nell’s body, muttering words of encouragement, at the same time punching in the number for the fire department, summoning them to a lost cause. Then he called Dan, briefed him on the details, and dispatched him to the scene.

Her screams continued, and her pulse grew weaker.

“She needs morphine and IV fluids, or she’ll never make it to Saratoga. Go to Mary and Betty Thomson’s,” he yelled at Lucy. Then he called their number, told them he’d be there in five minutes and what to have ready for him.

Betty stood at the door with the vials, bags, needles, and tubing in a plastic bag. “I’m praying for her,” she told Mark as he scooped up the equipment.

“Me too,” he heard Mary call from the back room.

Lucy spun the Jeep back out on the highway and they were off again.

The burns on her head, shoulders, and left trunk were less than he originally thought, first- and second-degree at the most, the same for the side of her face. It puzzled him how she’d protected that part of her body from more severe damage. The mucosal membranes inside her mouth, however, were blackened as well, and he feared most for her airway. The soft tissues there were much more vulnerable, and even with less deep burns, they could swell up to obstruct her breathing. An explosion must have accompanied the flames, as only hot gases would penetrate orifices to damage them like that.

He easily inserted an angiocath needle into her right arm and opened the IV full, to raise her pressure, then adjusted it to replace the bodily fluids that would leak from her charred skin. To quiet her shrieks and cries, he injected half an ampule of Mary’s morphine.

To his astonishment, her eyes fluttered open, she moaned, and said, “Some dinner party, eh, Doc?”

“What happened, Nell?”

“The back of my cabin blew… where propane tank is.”

He reached for her hand, feeling the need to hold it, not just to comfort her, but to keep his own from trembling.

“Was in the tub taking my bath,” she continued. “That’s what saved me.”

Her voice kept fracturing into different pitches, all of them high, as if forced through a strainer. The soft tissues near her vocal cords were swelling closed. She’d need a tube to keep breathing, and fast.

Like a drowning man clinging to a single plank, he focused solely on what he knew best: checking her pulse – weak; assessing her breathing – labored and noisy; fine-tuning her IV – running fine. The routine momentarily kept his larger questions at bay, and all their ramifications. “We’ll soon be at the hospital,” he said, reassuring her and hitting the numbers for ER on his phone.

She began to moan again, and mutter incoherently.

“This is Dr. Mark Roper, and I’m bringing in an eighty-year-old woman who’s been in an explosion and has first- and second-degree burns to the head and trunk, but with more severe airway involvement…”

His own voice sounded far away as he continued to brief the triage nurse, kneeling over Nell and watching Lucy at the wheel as they sped along the deserted road. Riddles and ghosts continued to circle, threatening to come in from the darkness.

He continually had to reposition Nell’s head to prevent her tongue from falling backward where it might obstruct her breathing; only then did he realize she’d finally worn her damn plate.

“Roper’s special,” the triage nurse called into her intercom the minute she saw Mark jump out of the Jeep in the ambulance bay.

Lucy frowned.

Instantly orderlies, nurses, and two doctors arrived to help.

“I thought only doctors who didn’t want your patients called them Roper’s specials,” she said to him as they transferred Nell to a stretcher and raced her down the hall.

One of the physicians, a tall ebony-skinned woman with a long gray braid down to her waist gave her an incredulous look. “Where are you from, gal? In ER it means when Mark sends us someone he can’t handle alone, we better be on our toes.”

“Dr. Lucy O’Connor, meet Dr. Carla Moore, one of the few in this establishment who don’t always consider me and my patients to be a pain in the ass.” He tried to sound calm, yet he still quaked inside, trying to keep memory from intruding on what had to be done now.

Nell’s respirations were already down to a squeak. “Seems like we need to intubate this one,” Carla said, as they skidded into a resuscitation room the size of a shoe box lined with racks of equipment, everything – lines, monitors, IVs – within easy reach.

Carla shoved an anesthetic tray at him. On it were different-sized endotracheal tubes spread out in a semicircle around a laryngoscope. “Will you do the honors? I could use your help.”

He nodded, slipped on a pair of sterile gloves, then positioned Nell’s head and neck as if she were leaning forward to sniff a flower, maximally opening her airway. He reached for a silver suction probe to clear away her saliva, his fingers fumbling the instrument as he worked.

Stepping to his side, Lucy quickly grabbed a ventilation bag and mask. “Let me help you,” she said, handing them to him. For a second, he felt her hands linger on his and give them a squeeze. The orchestrated chaos and noise of a resuscitation swirled about them – people shouting orders, running to draw bloods, sticking in needles, snapping on electrodes.

Her touch steadied him.

He placed the mask on Nell’s face and squeezed a few trial puffs of oxygen into the woman’s lungs. There was a lot of resistance, the effect of her airway closing off. He scissored her mouth open with his fingers, removing the partial plate. But his thoughts finally slipped his control and streaked unchecked toward reckless conclusions he never would have even considered twenty-four hours ago.

The explosion must have been deliberate, to prevent her from telling him anything, just as someone had silenced Victor Feldt and Bessie McDonald. What’s more, he and Lucy would also have been in the blast had they arrived on time. That couldn’t be an accident either.

Lucy handed him the laryngoscope, snapping it open and illuminating the blade.

Taking it with his free hand and keeping Nell’s mouth pried wide apart with his fingers, he slid the instrument along the side of her cracked and swollen tongue. This was going be a difficult intubation. As calculating as a computer, his brain flashed to the alternative, a tracheotomy, or cutting a hole directly into her windpipe.

Nell’s eyes snapped open, her pupils wide with fear, and she grabbed at his hand. Her lips moved around the blade of the scope as if she were trying to say something.

He took it out.

Her attempts to form words continued.

He bent down to hear, once more fighting back his nausea at the terrible smell.

In a high-pitched whisper no louder than a breath, he heard her say, “What’s my chances?”

He involuntarily glanced along a length of her blackened skin where it had split open and glistened in its own juices. The rest remained intact. She might survive the burn, the tub having protected her, but not the ordeal on the respirator that lay ahead, pneumonia being the most likely cause of death. Beyond that, if the burns were truly just second-degree, she’d avoid painful skin grafts and a protracted recovery. Comfort her with a lie, or give her the truth? Or a bit of both. He usually had more time to make such calls.

She seemed to sense his hesitation, widening her eyes and imploring him with her gaze to answer.

Before he hooked her lungs up to a machine, before he submitted her to the indignities of ventilators, catheters, and mind-numbing drugs, before he stole her voice by sticking an tube through it, she’d a right to say “Yes” or “No.”

“The skin doesn’t appear to be too bad, Nell. Your airway, though, needs help.”

“Odds?” she whispered back.

“Four to one against, for most eighty-year-olds. But you’re way better than most. And once the swelling goes down in your throat, they get way better.”

He wasn’t sure she’d heard him as a darkness seemed to gather behind her eyes again. But then she shook her head. “No lingering… on a chest pump… and don’t let me… choke to death.”

The sounds in the resuscitation room seemed to grow very distant.

“You understand what that means-”

Her stare silenced him.

What she wanted was clear as a shout. To be put out of her misery, pure and simple. He imagined Charles Braden leering over his shoulder. “Nell, I can’t do that,” he whispered.

She retreated into the black recesses where such final decisions are made, but not before he saw an unmistakable flash of contempt in her gaze.

“What’s the delay, Mark?” Carla asked.

“She refuses a respirator, but asks us to keep her from choking to death.”

“Wants to go to heaven, but doesn’t want to die,” muttered a young nurse behind him.

He ignored her and, agonizing over the ordeal he was sentencing Nell to, made his decision. “That means I sedate her with midazolam, we intubate to protect her airway, and you keep her topped off with morphine to combat her pain. Remember, she gets the same compassion you would give your own grandmother…”

As he spoke, looks of distaste spread over the faces of Carla and her staff. It was a gray call. No one in ER was ever comfortable with half measures that violated their pull-’em-back-from-the-brink-no-matter-what mentality. Little wonder. They didn’t see what some of their successes had to go through once they got upstairs. At the same time Nell would feel betrayed by his sticking a tube down her throat. Yet he wouldn’t give in to what she asked. He could no more commit active euthanasia than will his heart to a standstill. So he’d do what he could live with, no matter how anybody else in the business might second-guess him, or his patient despise him on her deathbed. And Charles Braden could go to hell.

“Nell, can you hear me? I’m going to make you sleep. Whenever you wake up, they’ll give you more medication to keep you under. But I’ve got to intubate…”

No response. Whether she ignored him, or had gone beyond hearing anything, he couldn’t tell.

He injected the fast-acting tranquilizer, followed by a shot of succinylcholine, a short-duration paralytic. Together they’d make it easier to open her jaw and visualize her vocal cords despite all the boggy swelling in her upper pharynx. Provided this time he could get by her tongue. The paralytic would also stop her breathing. If he bungled the procedure, he’d have precious little time to go in through the trachea, and Nell might end up with what she wanted in the first place.

He navigated around the tongue to where the lining of her throat bulged like a blackened frog belly. Parting the puffy tissues with the laryngoscope, he slid the endotracheal tube through the V of her cords and attached an Ambu bag, pumping hard and sending squeeze after squeeze of oxygen into her lungs until she recovered enough from the injections to breathe on her own.

Now he had Nell in the odd limbo of morality where doctors, himself included, willingly committed euthanasia, albeit the passive kind, withholding heroic treatment if it’s either futile or against the patient’s wishes, yet doing what’s necessary for comfort. If she continued to breathe by herself, she’d survive. If in the name of controlling her pain or sedation they suppressed her respiration, unintentionally hurrying her to her death, so be it. The law, most physicians, and he could live with that as well. Such were medical ethics in the “gray” zone. To the layperson it might sound like word games. To the one faced with pushing in the plunger, that nuance of intent meant being able to sleep at night. The best Mark could tell himself as he walked out of emergency? He’d saved her the agony of asphyxiation, and bought her a bit of time to have a change of mind about dying. As for the weeks and maybe months of suffering he’d imposed on her, that’s what would keep him awake at night. But for now, perhaps for all eternity, she wouldn’t be telling anyone what “tidbits” or “name” she’d claimed to have for him.

“Make sure someone lets me know if she regains consciousness,” he called back to Carla.

“You were great back there,” Lucy told him.

“I don’t think so.”

They sat side by side on a soft leather couch in the doctors’ lounge at Saratoga General, a room outfitted with tastefully upholstered chairs, potted plants, recessed lighting, and an espresso machine that would have done Starbucks proud. “Those were tough calls, and I doubt even an anesthetist could have pulled off that intubation-”