Skin : the X-files (2 page)

“All right, let’s start with the basics. Airway, Breathing, Cardio.”

He knew he sounded like an idiot to the experienced nurse, but he had to begin with what he knew—and that meant the ABCs of medicine. He watched the man’s chest rise and fall, and knew that Crow had done a good job with the intubation. Then he turned toward the EKG—the cardiac monitor—and focused his eyes on the small screen on top of the waist-high steel cart.

“Holy shit,” he whispered.

Crow followed his gaze, his eyes widening. The screen was covered with frantic green lines. “He’s all over the place! It looks like his heart’s doing cartwheels!

Is that V-fib?”

Alger stared at the screen, then shook his head. The man wasn’t in arrest yet—but he was certainly close.

Alger had never seen anything like it before. One second, the monitor showed an elevated cadence—and the next second a prolonged skip. One second he seemed to be in normal, sinus rhythm—and the next second he was bouncing through a combination of arrhythmias. Alger had no doubt that if the paramedics had seen such a bizarre EKG reading in the ambulance, they would never have handed this patient over to two interns. They would have brought him straight to the chief resident.

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Alger turned back to the patient. The man looked calm, still unconscious, but there were visible spasms beneath his skin. His muscles seemed to vibrate in con-cert with the readings on the screen. No doubt about it, something weird was going on. “Jesus, this isn’t good.

What’s his BP?”

Maria Gomez looked up from the blood-pressure gauge strapped around the man’s right arm. “Two-twenty over one-twenty.”

“What?”

The nurse looked at the gauge again. She shrugged, her face slightly pale. “Two-twenty over one-twenty.” Alger coughed, his stomach churning. Two-twenty over one-twenty was extremely high. Along with the erratic heartbeat, it was a dangerous sign. The man’s circulatory system was completely out of whack, and his heart was enormously overstimulated.

“An acute MI?” Crow tried. “Maybe a pulmonary embolism?”

Alger shook his head. The EKG didn’t look like an MI or an embolism. Alger rubbed sweat out of his eyes.
Stay
calm. Stay focused.
It was a mystery—but that was the thrill of the ER, wasn’t it? Solving the mysteries? “Okay, we need a blood workup, a Chem 7—”

“His BP’s rising!” Gomez blurted. “Two-fifty over one-fifty!”

Shit.
How could his BP be rising? It was already off the map! Alger cursed. Thrill or no thrill—he knew it was time to bring the Duke over. Any second, this patient 8

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was going to arrest. Alger was about to call out across the ER when Crow shouted at him. “Now
that’s
V-fib! That’s definitely V-fib!”

Alger whirled back toward the EKG screen. The bright green lines had become completely disjointed and frantic, indicating that the man had gone into ventricular fibrillation. His heart was responding to random electrical impulses, and was no longer capable of pumping blood to the rest of his body. In other words, this patient was failing. Fast.

“BP dropping!” Gomez chimed in. “He’s crashing!” Alger leapt for the crash cart, while Crow called the Code. Normally, doctors and nurses would have rushed toward the crashing patient—but tonight there were so many tragedies filling the ER, the Code barely registered.

Alger knew that the Duke would make his way over when he realized his two interns were in charge of the dying man—but Alger didn’t have time to wait for the chief resident to take over.

He grabbed the defibrillator paddles off the crash cart and slipped them over his hands. He rubbed the conductive fluid over the pads, then scraped them together in a circular motion. He had no choice but to shock the man and pray that his heart resumed a work-able rhythm. He had never used the paddles before—

but he had watched the procedure a dozen times during medical school.

“Three hundred joules,” he declared, trying to keep the emotion out of his voice. He knew three hundred 9

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was a high place to start—but this was a big, muscular guy. Probably worked out every day of his life.

“Clear!”

Everyone stepped back from the stretcher. Alger pressed the paddles against the man’s bare chest and hit the triggers with his thumbs. The man’s body spasmed upward, then crashed back down onto the stretcher.

Alger turned to the EKG machine.

Still nothing. He turned back toward Gomez, who was now standing by the defibrillator. “Three-sixty.

Stat!”

“Jesus,” Crow mumbled. “Where the hell is Duke?” Alger ignored him. There wasn’t anything the Duke could do at this point—either they got this guy’s heart started again, or he was finished. Gomez upped the voltage, and Alger readied the paddles. “Clear!” This time, the man arched a full four inches off the stretcher. His neck twisted back and his arms convulsed beneath the Velcro straps.

“Flat line!” Crow yelled. “He’s down! Brad—”

“Again!” Alger shouted back. “Clear!” He shocked the man a third time. The smell of burned flesh filled Alger’s nostrils, and he frantically turned back to the EKG machine. Still nothing. He tossed the defibrillator paddles aside and leapt halfway up the stretcher, placing his palms roughly near the center of the man’s chest. The muscles of his forearms contracted as he started the most vigorous CPR of his life. The man’s chest felt strangely stiff beneath his 10

Skin

fingers, his skin rough, almost leathery. He worked in near silence, the minutes ticking by as he tried to coax the man’s heart back to life. He ignored the sweat running down his back, the ache in his arms and shoulders. His mind raced through everything that had just happened, searching for some reason why things had gone so drastically wrong. Was there anything he had missed? Was there anything else he could have done?

Did he make the right choice when he went for the defibrillator paddles?

“Well?” he asked, desperate, already knowing the answer.

“Still nothing,” Crow responded. “He’s gone, Brad.

You’re just pumping beef.”

Alger looked at the EKG screen, then back at Crow.

He glanced at Gomez, who nodded. He felt his shoulders deflate, his arms going limp.
Damn it.
It had all happened so fast. He glanced toward the Duke, who was still working on a patient near the front of the room.

Either he hadn’t heard the Code, or he was handling an emergency of his own.

Alger swallowed, telling himself that he had done everything by the book. The Duke wouldn’t have handled the situation any differently. The guy had gone into arrest less than two minutes after he had been wheeled into the ER. The paddles could have saved him—and they certainly didn’t kill him. Still, Alger felt awful.
A
man had just died in front of him.
He lifted his hands off the man’s bare chest and took a step back from the stretcher.

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Why the hell had he chosen emergency?
He glanced up at the clock over the double doors. “Time of death—three-fifteen.”

He peeled off his gloves as Gomez rolled the stretcher toward the elevator at the back of the room. The elevator was a straight shot downstairs to pathology, then on-ward to the hospital morgue. There would probably be an autopsy, because of the mysterious circumstances behind the man’s death, and maybe the pathologist would be able to tell him what had really happened. But it wouldn’t make any difference to the man on the stretcher.

Alger’s face went slack as he watched Gomez push the corpse away. His eyelids suddenly seemed as if they were filled with lead. He felt Dennis Crow’s hand on his shoulder. “We did everything we could. People die, and despite what the Duke might think—sometimes it’s not our fault.”

Alger looked at him, then toward the double doors at the front of the room. He sighed as he watched another stretcher skid into the ER.

Twelve hours later, Mike Lifton fought back nausea as Josh Kemper yanked open the heavy steel drawer. The thick scent of dead flesh mixed with the antiseptic chill of the refrigerated storage room, and Mike grimaced, wishing he had never agreed to accompany his classmate on the harvest.

“You get used to it,” Josh said, as he pulled the 12

Skin

cadaver drawer forward with both hands. Josh was tall, gangly, with oversize ears sticking out from beneath long, stringy brown hair. “It helps to remind yourself how much money you’re making. Twenty bucks an hour beats the hell out of pouring coffee at Starbucks.”

Mike tried to laugh, but the sound caught somewhere in his throat. He nervously pulled at the sleeves of his green scrubs, rubbing the soft material between his gloved fingers. He could feel the sweat cooling against his back, and he shivered, staring down over Josh’s right shoulder.

The body in the drawer was wrapped in opaque plastic with a zipper up the front. Mike took a tiny step back as Josh drew the zipper downward. “Here we go. One stiff, medium rare.”

Mike blinked hard, his mouth going dry. Then he ran a gloved hand through his short, auburn hair. He had worked with cadavers before; as a first-year medical student, he had poked and prodded enough dead bodies to fill a zombie movie. But he had never seen a body so
fresh
.

The man inside the plastic bag was unnaturally pale, almost a blue-gray color, with fuzzy blond hair covering his muscular chest. His eyes were closed, and his face was drawn, the skin tight against his cheekbones. Early rigor mortis had begun to set in, and his square jaw jutted stiffly forward, his neck arched back against the steel storage drawer. There were no obvious signs of injury, no 13

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gaping wounds or visible bruises. The only distinguishing mark was a colorful tattoo high up on the man’s right arm.

“Nice dragon,” Josh continued, pointing. “That’s about three hundred dollars of wasted skin.” Mike shivered at the macabre thought. He knew that the part-time job with the skin bank was a good way to make money—and great practice if he decided to go into surgery after med school—but he couldn’t help feeling ghoulish. His classmate’s attitude didn’t help matters. It was more than just cynicism bred by experience; Josh Kemper had been born without a deferential bone in his body. During his first year at Columbia Medical School, he had nearly gotten himself suspended for playing catch with a pancreas during anatomy section. No doubt, he was heading straight for a career in pathology.

Mike had always been more sensitive than his classmate. His first day of anatomy, he had nearly fainted when his professor had made the first “Y” incision. And although he had grown stronger over the past three years, he still had a long way to go before he was ready to hold a surgeon’s scalpel.

“Aside from the tattoo,” Josh continued, unzipping the bag the rest of the way, “he looks pretty good. Both arms, both legs. And the eye bank hasn’t gotten here yet.

He’s still got both peepers.”

Mike turned away from the corpse as he steadied his nerves. It’s necessary and important work, he reminded 14

Skin

himself. The human body was recyclable. And that meant someone had to do the recycling. Heart, liver, kidneys, eyes, skin—someone had to harvest the raw material.

Still, the thought didn’t make it any easier. He bit down against his lower lip, trying not to count the steel drawers that lined three walls of the deserted storage room.

“If you’re going to puke,” Josh interrupted, “do it now. Once we’re in the OR, we’ve got to keep things sterile.”

“I’m not going to puke.”

“Well, you look worse than our buddy here. Mike, you’ve got to get used to this sort of thing. It’s just a hunk of meat. And we’re the guys behind the deli counter.”

“You’re disgusting.”

“That’s why you love me. Check the toe tag.” Josh started across the storage room, toward a filing cabinet by the far wall. “I’ll get the chart.” Mike breathed through his mouth as he circled around the open drawer.
Don’t overthink. Do your job.
He reached the back end of the drawer and pulled the plastic bag down on either side. The dead man’s legs were long and muscular, covered with more downy blond hair. His feet were heavily callused, his toenails yellowed like an old man’s. Mike wondered if he had suffered from some sort of fungus.

Now you’re thinking like a doctor.
He smiled inwardly, 15

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then searched the big toes for the tag. The skin above his eyes wrinkled as he realized it was missing. He searched the drawer beneath the man’s callused heels, but there was no sign of the plastic ID. “Hey, Josh. I don’t see the tag.”

Josh returned from the other side of the room. He had a manila folder open in his gloved hands. “Sometimes it falls down below their feet.”

“I’m looking everywhere. There’s no tag.” Josh stopped at his side, cursing. He held the manila folder under his arm and lifted the corpse’s feet with both hands. Working together, the two students searched the drawer, but came up empty.

“Fuck,” Josh said. “This is just great. Eckleman is such a moron.”

“Who’s Eckleman?”

“The ME’s assistant. He runs the storage room. Tags the bodies, makes sure the files are coded correctly. He’s a big fat piece of shit, and he drinks.” Josh retrieved the folder from under his arm and leafed through it with gloved fingers. “Derrik Kaplan. Caucasian, mid-thirties.

Blond hair, blue eyes. Acute aortic dissection, died in the ICU.”

Mike glanced down at the body in the drawer. “Well, he’s blond, and he’s got blue eyes. But he doesn’t look like he’s in his mid-thirties. Does it say anything about the tattoo?”

Josh shook his head. “No, but like I said, Eckleman is a moron. Look, this is locker fifty-two. Eckleman blows 16

Skin

the tags all the time. Especially when the ER is jumping, and after the accident last night—”

“Josh, are you sure we shouldn’t ask somebody? What if it’s the wrong cadaver?”

Josh paused, rubbing a gloved finger under his jaw.

He glanced toward the elevator in the corner of the room, where a stretcher waited to take the body up to the OR for the harvesting. Then he shrugged. “We’ve got consent, we’ve got a body. More importantly, we’ve got an OR reserved for the next hour. So let’s go slice up some skin.”