Oxygen (27 page)

On a fading Sunday afternoon
in August, First Lutheran echoes of escaping employees. I sometimes wonder if Seattle’s spectacularly brief summertime doesn’t suppress disease until the rains return. Despite threatening skies the offices and lounges are deserted but for the emergency staff. As I’d hoped, I run into no familiar faces on my way into the mailroom.

Envelopes and flyers are so crammed into my box I have to seesaw a thick cardboard mailer out to decompress the lot, uncorking a drift of paper. I sit in the midst of the pile and pull the recycling bin beside me. It’s a treasure hunt to find the fragments of information that matter. Ads for anesthesia equipment and conferences and journals and textbooks, newsletters from city and county and national and international societies, solicitations from investment brokers and real estate agents and political lobbyists. Call schedules and vacation schedules and committee schedules—meetings that have come and gone in my absence like seasonal birds winging over the landscape, mattering only for the moment. The more I get, the less I read.

Resting on top of a mound of new Medicare guidelines is the slip of white paper I’m looking for, folded and stapled and addressed to me in the cursive script of a human hand. I pull it open and read a jotted note from Matt Corchoran, First Lutheran’s pharmacist, asking me to stop by his office to discuss the matter I’d called him about before leaving Houston.

The pharmacy office is tucked into a windowless closet of space behind the cavernous storage rooms of surgical equipment. Matt’s office door is split, Dutch style, and from down the hall I see the bottom half closed; the glow from his computer monitor illuminates the close walls and ceiling like a huge aquarium. The top of his balding head bobs above the lower door. He sees me and jumps, as if discovered among secrets, then laughs at his own startle.

“Dr. Heaton. I get so used to being alone back here on the weekends—only chance I have to work in peace. I didn’t even hear you walk up.”

“Hi, Matt.” We fall into the hierarchy of address so common in the medical world, a taboo against using doctors’ first names even after years of working together. “I got your note. That was quick—thank you. I hope you didn’t spend your whole Saturday reviewing files for me.”

“No problem. Have a seat.” He wedges open the door and I squeeze around it to reach a blue plastic chair tucked beside him under the narrow Formica desk. “Sorry—they keep promising me a new office when we remodel the ORs, but equipment gets more space than people around here.” His Midwestern vowels protrude unabashedly into his language. They suit him in a way, straightforward and methodical—a man used to the meticulous measuring and counting of chemicals. He opens a dented metal file drawer and flicks through cardboard folders until he plucks one forth, stuffed with the pharmacy’s copies of all the anesthesia records I’ve turned in over the last several months. These yellow pages, filled with blurred blue carbon check marks and numerals, are the third sheet of a triplicate form divided among the patient’s chart, the billing clerks and this office. My name is typed across the folder’s plastic tab. It is chilly in here and I tuck my hands in between my knees.

“I looked through them,” he says.

Of course; he must have reviewed the records himself, at least cursorily. I should have guessed he’d do that. I nod at him, finding it hard to look him in the eye. “I know it’s an odd request. With my leave of absence, I just…maybe I’ve had too much time to worry about details lately. I thought I should go over everything.”

He gives me an understanding smile that almost immediately tightens to a professionally polite mask. “I came up with some discrepancies.” He glances up at me over the open folder in his lap. “We almost always find a couple, you know—usually just a recording error in dosing or dilution.” Seven years ago when I started at First Lutheran I’d had a similar conversation with Matt after I mistakenly wrote the number of milligrams of Dilaudid I’d given to a patient on the wrong line of my anesthesia record, and his rigid cross-checking had flagged the gap between drugs used and drugs returned.

Then Matt slips twelve different anesthesia records out of my folder and hands them to me. Twelve records. I’m flustered for a moment—maybe he’s handing me the whole department’s errors. All twelve couldn’t be mine. But my signature is at the bottom of each page. I look back at Matt and see him patiently waiting for my reaction. I’ve made no errors in seven years and now twelve in six months?

My face gets hot and I keep my eyes down on the papers in my lap, encoded with a jumble of dashes and scribbles. “What kind of errors did you find?”

“In a few, the drugs missing from your narcotics box didn’t match up with what you recorded using. That’s an easy enough mistake.” He scratches at the side of his temple and then loosely clasps his hands across his knees as he leans toward me. “But what caught my attention is the amounts you used. Calculated out by the body weights of these patients, some of them shouldn’t have woken up for days. Not unless they had quite a drug habit already.” He slips the sheets out of my hands and deals them out across the desk like a poker hand.

I shuffle the pages on the desk and in my lap, picking out numbers and words. My eyes fly over them until they tangle in a jabberwocky of drugs and procedural notes, blood pressures and pulse rates. Matt’s unasked questions burn through the top of my head as he waits for me to give him some rational answer—something he can believe, anything that will let him shrug away the doubt materializing like a third entity in the room. He’s right. It’s plain. The doses are way out of line, two and three times what would be normal. The silence between us is becoming tense. Then one fragment of print in the bottom corner of a record makes me suck in my breath.

“Matt.” My voice sounds muffled by my own pulse. “Can you give me a couple of days to look through these? I want to look back at the charts. Maybe there’s an explanation I just can’t recall without seeing the whole record.”

He’s still watching me. He has hazel eyes—kind eyes; he wants me, I sense, to find a way out of his oblique accusation, knows I wouldn’t have set myself up for this by asking him to pull these records. It seems to take him forever to respond. I can almost see him weigh how much to believe, how much faith he can afford to invest. He looks at me for such a penetrating moment I have to concentrate to keep from turning away. Then he gives the smallest nod. “Two days, then.”

“Can I make a copy of these? Please?” I ask, sweeping the papers up.

He takes the pile to a desktop copier in the corner of the office and its rhythmic whir and zing churn out duplicates of the shorthand scrawls that sketch twelve people’s surgical histories. I watch the pages peel out in a neat black and white stack and suddenly, without thinking at all, I know his discovery is no coincidence.

“Matt, you’d already started an audit, hadn’t you?” I ask, before considering whether I can endure the answer. I must have given over six hundred anesthetics in these last six months—it would have been impossible for Matt to review all those surgeries since I’d called him yesterday morning.

His mouth goes taut, just for an instant, as if tempering self-censorship. “You were flagged. I was asked to start an audit two weeks ago.”

I feel like I’ve been slapped by a friend, even though I’d already guessed the truth. I want to ask him who it was, but I know he won’t—or can’t—tell me. I’ve already compromised his job by asking him for two days of silence.

He holds the copies out toward me, gripped between his thumb and curled fingers. I start to take them, but he doesn’t let go. “Dr. Heaton, you have a right to this information, as far as I’m concerned. But I can only keep this conversation confidential until Tuesday.”

“I know. Thank you, Matt. I promise—no more than two days.” Then he lets the papers slip into my grasp and I leave before he can question his decision.

There is only one secretary
working in medical records today. She is balanced on a stepladder, squeezing a chart back into its alphabetically regimented slot on a metal shelf. I ask her to pull the chart matching the name stamped on one of the twelve Xeroxed pages, and she frowns at me before thudding her girdled bulk to the floor.

“I need to see some ID.” I dig through the bottom of my bag until I find my hospital badge. She glances from the picture to my face twice, readjusting a strap beneath her blouse. Then she takes the page from me and wanders into the endless, fluorescent-lit labyrinth of patient records. Five minutes later she slaps a chart into my hands and heaves herself back up on the stepstool with another armload.

Sitting against the broad end of one rack, I flip the chart open across my lap. The surgical notes are all together at the back; the graphed lines of the anesthesia record are easy to spot. With the records side by side, the discrepancy is so obvious. But, of course, the original top page and the bottom pharmacy copy would never be held side by side. They would be torn apart and sent on their separate pathways as soon as the patient left the operating room. So when extra doses of fentanyl were logged onto the pharmacy page later, no doctor or nurse handling the original would question the dose, and no pharmacist reconciling the narcotics count from the copy would find a gap.

Jolene Jansen’s pharmacy page is not among the records Matt gave to me. I ask the clerk to pull her chart and she harrumphs in annoyance, but drags her stepstool to the J aisle, then drops the manila folder into my hands. It is thirteen pages thicker than it was three months ago because the autopsy report, identical to the copy sent to me, has been added to the laboratory section near the back. I flip past the anatomical descriptions of Jolene’s heart and aorta, past the chromosomal analysis that confirmed her Turner syndrome. On the last page is a list of chemicals found by the toxicology lab when her blood was analyzed after death. I hadn’t even read it before today. Even if I had, I would only have paid attention to what was listed there, the drugs I knew I had given her—everything I expected to find. Today I see what is missing.

The secretary starts turning out lights. I stack up the sheets of paper and follow her out. At the doorway she takes the charts out of my hand and puts them on a table. “We’ll be open at six tomorrow. If you need these, you can fill out a requisition slip.”

Rain has turned the gutters in front of the hospital into milky streams and I splash through puddles with the pharmacy records tucked against my chest as I run to my car. I push the front seat back as far as it will go and hold the first record up in the gray light. The patient’s name is only vaguely familiar; his surgery was months ago—a colon resection with Don Stevenson. My handwriting details an unremarkable anesthetic, the wavy horizon of checks and dots that reflect a sleeping brain’s normal reaction to a surgeon’s scalpel.

I search all twelve pages, looking at every mark on each page. The handwriting is all my own, and I’ve written these words so many times they’ve become interchangeable across a thousand anesthetic records. No extraordinary dissections were made, no raging blood pressures or skyrocketing heart rates are here. No reason to need so much narcotic. All of the pages are like this, cases so routine they have become as banal for the surgical team as they are unique for the patient. Only the illusion of a pattern coils at the base of my consciousness, daring me in my father’s voice to read what isn’t written there. Only the faintest difference in pen pressure, a slight shift in the curve of a numeral. No one but me would even suspect it. No one would believe it.

Beyond the windshield the flat gray sky gives little clue about what time it is. I start the car and pull into the sparse evening traffic. The steep streets dropping down to the waterfront feel unfamiliar, the way one’s childhood home seems altered by the days strewn between then and now. Something inside of me is sinking with the landscape. My condo is close—four blocks south of here. But I turn north almost unconsciously. Five minutes later I am winding up again, toward the crest of Queen Anne Hill.

Joe’s building dominates the hilltop neighborhood, massive as an overbearing monarch. Just as I reach for his bell at the entry gate a loose-limbed teenager hauled by four leashed dogs pulls the doors open and the tangled animals surge through.

The doors slam shut behind me and the halls are silent, as if the last living occupants had deserted. Joe loves the privacy of these thick plaster walls and solid doors. His own is locked. I ring his buzzer. After waiting five minutes I step into the nearest fire escape and reach under the metal railing above the top step, working my fingers into a crevice between the handrail and the wall support. His key is still tucked into the notch there, as it was years ago when I came and went from this home as frequently as my own.

The western wall of glass in Joe’s living room lets in more sound than comes from either neighboring flat. Children holler from a jungle gym in a nearby playground; a woman begs them to stay out of the mud. Such a contrast, these high young voices singing through this half-furnished, unattached man’s home. Breakfast dishes—several days’ worth, I suspect—clog the sink, and half a pot of cold coffee stands on the stove. The leather duffle he brought to Houston is open and unpacked, slung over the back of a kitchen chair.

I walk through the rooms, touching nothing, noticing everything: a battered box holding the harmonica he bought on an earlier trip to New Orleans—I remember him cupping it at his mouth, warbling an off-key accompaniment to Charles Brown; a reading lamp I gave him one Christmas so his midnight insomnia would no longer waken me. His favorite terry bathrobe, frayed to transparency at the neck and cuff, is draped over the claw-foot bathtub rim. Traces of his aftershave hang in the air and ruffle my memories like the breath of passing spirits. It is the expected bachelor’s home, decorated with the clutter of daily living.

I begin opening drawers—aspirin and Motrin and Tylenol and crumpled, uncapped toothpaste tubes, prescription bottles of antibiotics and antihistamines and antacids; empty toilet paper rolls and plastic boxes of dental floss; a razor with dried blue shaving cream clotted between the blades. The linen cupboard is stuffed with mismatched towels and sheets—plaids and stripes all wound into the crumpled piles of a man who doesn’t have to share his cabinets and closets.

In the kitchen I paw through spatulas and paring knives and plastic forks and bamboo chopsticks. Wedged behind the silverware caddy is his old baby spoon, rubber coated at its tip and engraved with a teddy bear and his initials. He used it at a New Year’s party once, I remember, for caviar. A tea bag has spilled open and the drawer smells of jasmine.

The bedroom closet is filled with his standard apparel—T-shirts from bike races and music festivals and 10-K runs, jazz clubs and local microbreweries. A few pairs of pressed trousers are still in their plastic dry cleaning bags. Four ties are knotted around the neck of a wire hanger. The top shelf sags beneath a jumble of canvas backpacks and battered luggage, one jelly jar of small change and another of pastel-colored beach glass, dust-covered medical textbooks on biochemistry and cell biology and pathology. I drag his desk chair over to the closet and balance on it while I grab the bags and suitcases and heave them onto the floor. When the shelf is cleared I push the books aside and look behind them, grope into the corners I can’t see. Then I step down and begin to unzip the packs, unlatch the clasps and buckles, unsnap the flaps of toiletry compartments and shoe pouches and collapsible handles.

Tucked into the bottom of a nylon shoulder bag is a black leather fanny pack embossed with a pharmacy logo—one of the thousands handed out by drug companies at national meetings and annual conferences. There is a rattling of plastic when I turn it over to find the zipper. The sound startles me out of my crouch and I sit back on the floor, leaning against Joe’s unmade bed. Light as it is, the weight of the pack presses against my thighs. I want, more than anything I’ve wanted in years, to be wrong about what’s inside.

I unzip it and the two halves fall easily open across my lap. Laid out upon cotton gauze are five syringes—neatly tucked inside this small black womb, unlike the casual neglect given his other possessions. I lift up one plastic cylinder and hold it up to the light. The crystal clear fluid inside casts a tiny rainbow over my leg—pure and sterile, invisible as water, odorless and tasteless and lethal. I place the syringe back into its nest.

In a movie, hours would pass until Joe comes home. The room would grow dark and I could spring out of some shadowy corner surprising him with my find, or slip unseen out his door to keep his secret. But it’s only minutes later when I hear his key slide into the lock and pivot, hear the door open and then shut behind him. He walks into the kitchen and opens the refrigerator, then the freezer; a cabinet closes, rattling the glass panels. Ice clinks into a tumbler and liquid splashes in a rising pitch, the frozen cubes crackle in the clash of temperatures. I hear him turn the pages of a newspaper. The carpet is so dense I can’t tell he’s come into the bedroom until he says my name.

“Marie!” Pure, honest puzzlement is in his voice. But then he doesn’t say any more and I know he’s seen the open bag in my lap. I can’t look up at him, even when I feel the bed sag beside me under his weight.

I turn the leather pouch over in my hands and run my finger along the stitching, smooth out the buckled strap across my legs. “I called Matt Corchoran yesterday, before I flew back. I asked him to pull my narcotics records for the last six months. Turned out I didn’t even need to call. He’d already been asked to audit me. He can’t account for all the fentanyl I’ve been using in my cases. In a couple of charts the numbers didn’t add up right. But in almost a dozen, the doses were out of line—way more than anybody who wasn’t addicted could take. I checked the pharmacy copy against the original, and I could tell someone had tried to match my handwriting. Did you figure nobody would ever compare them? Or did you just count on them blaming me for it?”

My voice sounds like it’s coming from a stranger. I scrape my finger along the zipper of the black bag until it hurts, trying to feel something. “My dad saw it. Not the fentanyl—just…that something was off with you. It’s kind of amazing I’ve been so blind. I don’t think I believed it even after I talked to Matt. I could see how you’d tried to keep it hidden—using my pen, never signing the chart where you’d given me a break. I never called you on that, despite all the rules. I only knew for sure because of the way you mark your blood pressures—with a heavier stroke right at the end, almost like you’re impatient with it all. It’s such a little thing, nobody else will see it.” I wipe tears off my cheeks with the back of my hand. They’ve come before I’m conscious of an emotion, like the empty expanse of shore before a tidal wave. “You’re so good, such a good anesthesiologist, I never worried about my patients when I left the room.”

Joe is silent. He seems to sink more heavily into the bed. Then he speaks so softly I almost can’t hear him. “I didn’t mean to do this to you, Marie. I didn’t…I didn’t single you out.”

I put my hand up to stop him. “How long? How long have you been using?”

He leans over his knees holding his head. “I don’t know. A year, maybe more.”

“While we were dating? Were you using fentanyl while I was dating you?”

“No. It started after that.”

“What do you mean ‘it started’? ‘
It
’ didn’t start anything, Joe.
You
started. You put—You
injected
this drug into your veins. God, what were you thinking?” Tears roll over my face, dampen the front of my blouse. I don’t try to wipe them off anymore.

“I got off work one morning. I’d been up all night. You know what it’s like. I could hardly drive home I was so exhausted. I didn’t even change clothes at the hospital—came home in my scrubs. And I found it in my pocket. I must have drawn some up for an epidural and then she delivered before I gave it. I don’t know…I don’t remember. It was just there, in my pocket. And I wanted to see what it felt like. I watch the faces of patients after I give it to them, how everything melts away. I wanted to feel that.”

“And then you did it again. You kept on. You plotted and you lied and you stole this drug. You drew it up into a syringe and put a tourniquet around your arm, stuck a needle into your vein and injected it into your bloodstream. That takes a lot of conscious intent. That doesn’t happen by accident.”

“I never lost control of it. It’s never hurt anyone else. It doesn’t interfere with my work—you see that. You admit I’m good at what I do. It’s
my
problem. My choice to use it and my choice to stop.” He sounds like he’s practiced these words, saying it all so persuasively.

My stomach turns over and something explodes inside. I hurl the bag against the closet door and stand up. The room spins; I almost lose my balance. “Don’t talk to me about choices. Your choice is your delusion. You’re an addict! That’s why your hands shake. That’s why you woke up sweating in my bed—why you left without a word to me. You had to run out and get your fix. You lied to me. God damn you, Joe. You set me up!”

He thrusts himself up from the bed and storms over to the doorway, braces himself in the frame as if to keep from coming at me. “I. Am. Not. Addicted,” he shouts. “I’ve never let it go there. I used it sometimes. It made me feel good, it made things tolerable when they were intolerable. You want the truth? It made me better at my work. I focused better. I stopped worrying about how tired I was, or whether First Lutheran’s endless political bickering would finally drive me out of my job. It’s a drug. A medication. How many people do you work with every day who use Prozac or Xanax or Ritalin or caffeine or nicotine or their own nightly cocktail hour to get by? How many of them call themselves addicts? Wake up and look around you. We haven’t been able to live with our unadulterated minds since we first brewed mead, too terrified to admit how fucking inconsequential it all is. I can quit whenever I want to.”