The Surgeon (20 page)

In this way, I make Mr. Gwadowski's acquaintance.
It will not be a long friendship.
Angela Robbins was a conscientious nurse, and she was
irritated that Herman Gwadowski's ten o'clock dose of
antibiotics had not yet arrived. She went to the 5 West ward
clerk and said, "I'm still waiting for Gwadowski's IV meds. Can
you call Pharmacy again?"
"Did you check the Pharmacy cart? It came up at nine."
"There was nothing on it for Gwadowski. He needs his IV
dose of Zosyn right now."
"Oh. I just remembered." The clerk rose and crossed to an
in box on the other countertop. "An aide from Four West
brought it up a little while ago."
"Four West?"
"The bag was sent to the wrong floor." The clerk checked
the label. "Gwadowski, Five-twenty-one-A."
"Right," said Angela, taking the small IV bag. On the way
back to the room, she read the label, confirming the patient's
name, the ordering physician, and the dose of Zosyn that had
been added to the bag of saline. It all appeared correct.

Eighteen years ago, when Angela had started work as a newly
minted nurse, an R.N. could simply walk into the ward's supply
room, pick up a bag of IV fluid, and add to it the necessary
medications. A few mistakes made by harried nurses, a few
highly publicized lawsuits, had changed all that. Now even a
simple IV bag of saline with added potassium had to come
through the hospital pharmacy. It was another layer of
administration, another cog in what was already the
complicated machinery of health care, and Angela resented it.
It had caused an hour's delay in this IV bag's arrival.
She switched Mr. Gwadowski's IV tubing to the new bag
and hung the bag on the pole. Through it all, Mr. Gwadowski
lay unmoving. He'd been comatose for two weeks, and
already he exuded the smell of death. Angela had been a
nurse long enough to recognize that scent, like sour sweat,
that was the prelude to the final passing. Whenever she
detected it, she would murmur to the other nurses: "This one's
not going to make it." That's what she thought now, as she
turned up the IV flow rate and checked the patient's vital signs.
This one is not going to make it. Still, she went about her
tasks with the same care she gave to every patient.
It was time for the sponge bath. She brought a basin of
warm water to the bedside, soaked a washcloth, and started
by wiping Mr. Gwadowski's face. He lay with mouth gaping
open, the tongue dry and furrowed. If only they could let him
go. If only they could release him from this hell. But the son
would not even allow a change in the code status, and so the

old man lived on, if you could call this living, his heart
continuing to beat in its decaying shell of a body.
She peeled off the patient's hospital gown and checked the
central venous line skin site. The wound looked slightly red,
which worried her. They had run out of IV sites on the arms.
This was their only IV access now, and Angela was
conscientious about keeping the wound clean and the
bandage fresh. After the bed bath, she would change the
dressing.
She wiped down the torso, running her washcloth across
the ridges of rib. She could tell he had never been a muscular
man, and what was left now of his chest was merely
parchment stretched across bone.
She heard footsteps and was not happy to see Mr.
Gwadowski's son come into the room. With a single glance,
he put her on the defensive--that's the sort of man he was,
always pointing out mistakes and flaws in others. He
frequently did it to his sister. Once Angela heard them arguing
and had to stop herself from coming to the sister's defense.
After all, it was not Angela's place to tell this son what she
thought of his bullying. But she need not be overly friendly to
him, either. So she merely nodded and continued with the
sponge bath.
"How's he doing?" asked Ivan Gwadowski.
"There's been no change." Her voice was cool and

businesslike. She wished he would leave, would finish his little
ceremony of pretending to care, and let her get on with her
work. She was perceptive enough to understand that love was
but a minor part of why this son was here. He had taken
charge because that's what he was accustomed to doing, and
he wouldn't relinquish control to anyone. Not even Death.
"Has the doctor been in to see him?"
"Dr. Cordell comes in every morning."
"What does she say about the fact he's still in a coma?"
Angela put the washcloth in the basin and straightened to
look at him. "I'm not sure what there is to say, Mr. Gwadowski."
"How long will he be like this?"
"As long as you allow him to be."
"What does that mean?"
"It would be kinder, don't you think, to let him go?"
Ivan Gwadowski stared at her. "Yes, it makes everyone's
life easier, doesn't it? And it frees up another hospital bed."
"That's not why I said it."
"I know how hospitals get paid these days. The patient
stays too long, and you eat the costs."

"I'm only talking about what's best for your father."
"What's best is that this hospital does its job."
Before she could say anything she regretted, Angela turned
and grabbed the washcloth from the basin. Wrung it out with
shaking hands. Don't argue with him. Just do your job. He's
the kind of man who'll take it all the way to the top.
She placed the damp cloth on the patient's abdomen. Only
then did she realize that the old man was not breathing.
At once Angela felt the neck for a pulse.
"What is it?" asked the son. "Is he okay?"
She didn't answer. Pushing right past him, she ran into the
hall. "Code Blue!" she yelled. "Call a Code Blue, Room Five-
twenty-one!"
Catherine sprinted out of Nina Peyton's room and rounded the
corner into the next hallway. Personnel had already crowded
into Room 521 and spilled out into the corridor, where a group
of wide-eyed medical students stood craning their necks to
see the action.
Catherine pushed into the room and called out, over the

chaos: "What happened?"
Angela, Mr. Gwadowski's nurse, said: "He just stopped
breathing! There's no pulse."
Catherine worked her way to the bedside and saw that
another nurse had already clapped a mask over the patient's
face and was bagging oxygen into the lungs. An intern had his
hands on the chest, and with each bounce against the sternum
he squeezed blood from the heart, forcing it through arteries
and veins. Feeding the organs, feeding the brain.
"EKG leads are on!" someone called out.
Catherine's gaze flew to the monitor. The tracing showed
ventricular fibrillation. The chambers of the heart were no
longer contracting. Instead, the individual muscles were
quivering, and the heart had turned into a flaccid bag.
"Paddles charged?" said Catherine.
"One hundred joules."
"Do it!"
The nurse placed defibrillator paddles on the chest and
yelled, "Everyone back!"
The paddles discharged, sending an electrical jolt through
the heart. The man's torso jerked off the mattress like a cat on

a hot griddle.
"Still in V. fib!"
"One milligram epinephrine IV, then shock him again at a
hundred," said Catherine.
The bolus of epinephrine slid through the CVP line.
"Back!"
Another shock from the paddles, another jerk of the torso.
On the monitor, the EKG tracing shot straight up, then
collapsed into a trembling line. The last twitches of a fading
heart.
Catherine looked down at her patient and thought: How do I
revive this withered pile of bones?
"You want--to keep--going?" asked the intern, panting as
he pumped. A drop of sweat slid in a glistening line down his
cheek.
I didn't want to code him at all, she thought, and was about
to end it when Angela whispered into her ear:
"The son's here. He's watching."
Catherine's gaze shot to Ivan Gwadowski, standing in the
doorway. Now she had no choice. Anything less than a full-out

effort, and the son would make sure there was hell to pay.
On the monitor, the line traced the surface of a storm-
tossed sea.
"Let's do it again," said Catherine. "Two hundred joules this
time. Get some blood sent for STAT lytes!"
She heard the code cart drawer rattle open. Blood tubes
and a syringe appeared.
"I can't find a vein!"
"Use the CVP."
"Stand back!"
Everyone stepped away as the paddles discharged.
Catherine watched the monitor, hoping that the jolt of shock-
induced paralysis would jump-start the heart. Instead, the
tracing collapsed to barely a ripple.
Another bolus of epinephrine slithered into the CVP line.
The intern, flushed and sweating, resumed pumping on the
chest. A fresh pair of hands took over the ambu-bag,
squeezing air into the lungs, but it was like trying to blow life
into a dried-out husk. Already Catherine could hear the
change in the voices around her, the tone of urgency gone, the
words flat and automatic. It was merely an exercise now, with

defeat inevitable. She looked around the room, at the dozen
or more people crowded around the bed, and saw that the
decision was obvious to them all. They were just waiting for
her word.
She gave it. "Let's call the code," she said. "Eleven thirteen.
"
In silence, everyone stepped back and regarded the object
of their defeat, Herman Gwadowski, who lay cooling in a
tangle of wires and IV tubing. A nurse turned off the EKG
monitor, and the oscilloscope went blank.
"What about a pacemaker?"
Catherine, in the midst of signing the code sheet, turned
and saw that the patient's son had stepped into the room.
"There's nothing left to save," she said. "I'm sorry. We couldn't
get his heart beating again."
"Don't they use pacemakers for that?"
"We did everything we could--"
"All you did was shock him."
All? She looked around the room, at the evidence of their
efforts, the used syringes and drug vials and crumpled
packaging. The medical debris left behind after every battle.
The others in the room were all watching, waiting to see how

she would handle this.
She set down the clipboard she'd been writing on, angry
words already forming on her lips. She never got the chance
to say them. Instead she spun toward the door.
Somewhere on the ward, a woman was shrieking.
In an instant Catherine was out of the room, the nurses right
behind her. Sprinting around the corner, she spotted an aide
standing in the hallway, sobbing and pointing toward Nina's
room. The chair outside the room was vacant.
There should be a policeman here. Where is he?
Catherine pushed open the door and froze.
Blood was the first thing she saw, bright ribbons of it
streaming down the wall. Then she looked at her patient,
sprawled facedown on the floor. Nina had fallen halfway
between the bed and the door, as though she had managed to
stagger a few steps before collapsing. Her IV was
disconnected and a stream of saline dribbled from the open
tube onto the floor, where it formed a clear pool next to the
larger pool of red.
He was here. The Surgeon was here.
Though every instinct screamed at her to back away, to flee,
she forced herself to step forward, to drop to her knees

beside Nina. Blood soaked through her scrub pants, and it
was still warm. She rolled the body onto its back.
One look at the white face, the staring eyes, and she knew
Nina was already gone. Only moments ago I heard your
heart beating.
Slowly emerging from her daze, Catherine looked up and
saw a circle of frightened faces. "The policeman," she said.
"Where is the policeman?"
"We don't know--"
She rose unsteadily to her feet, and the others backed
away to let her pass. Heedless of the fact she was tracking
blood, she walked out of the room, her gaze darting wildly up
and down the hallway.
"Oh my god," a nurse said.
At the far end of the corridor, a dark line was creeping
across the floor. Blood. It was trickling out from beneath the
supply room door.

thirteen
R   izzoli stared across the crime scene tape, into
Nina Peyton's hospital room. Spurted arterial blood had dried
in a celebratory pattern of tossed streamers. She continued
down the corridor to the supply room, where the cop's body
had been found. This doorway, too, was crisscrossed by
crime scene tape. Inside was a thicket of IV poles, shelves
holding bedpans and basins, and boxes of gloves, all of it
zigzagged by blood. One of their own had died in this room,
and for every cop in the Boston PD the hunt for the Surgeon
was now deeply, intensely personal.

She turned to the patrolman standing nearby. "Where's
Detective Moore?"
"Down in Administration. They're looking at the hospital
surveillance tapes."
Rizzoli glanced up and down the hall but spotted no security
cameras. They would have no video footage of this corridor.
Downstairs she slipped into the conference room where
Moore and two nurses were reviewing the surveillance tapes.
No one glanced her way; they were all focused on the TV
monitor, where the tape was playing.
The camera was aimed at the 5 West elevators. On the
video, the elevator door opened. Moore froze the image.
"There," he said. "This is the first group to come off the
elevator after the code was called. I count eleven passengers,
and they all get off in a rush."
"That's what you'd expect in a Code Blue," said the charge
nurse. "An announcement goes over the hospital speaker
system. Anyone who's available is expected to respond."
"Take a good look at these faces," said Moore. "Do you
recognize everyone? Is there anyone who shouldn't be there?"
"I can't see all the faces. They step off in one group."

"How about you, Sharon?" Moore asked the second nurse.
Sharon leaned toward the monitor. "These three here,
they're nurses. And the two young men, at the side, they're
medical students. I recognize that third man there--" She
pointed to the top of the screen. "An orderly. The others look
familiar, but I don't know their names."
"Okay," said Moore, weariness in his voice. "Let's watch the
rest. Then we'll look at the stairwell camera."
Rizzoli moved closer until she stood right behind the charge
nurse.
On the screen, the images backed up, and the elevator
door slid shut. Moore pressed Play and the door opened
again. Eleven people stepped out, moving like a multilegged
organism in their hurry to reach the code. Rizzoli saw urgency
in their faces, and even without sound the sense of crisis was
obvious. That knot of people vanished to the left of the screen.
The elevator door closed. A moment passed, and the door re-
opened, discharging another gush of personnel. Rizzoli
counted thirteen passengers. So far a total of twenty-four
people had arrived on the floor in under three minutes--and
that was just by elevator. How many more had arrived by the
stairwell? Rizzoli watched with growing amazement. The
timing had been flawless. Calling a Code Blue was like
setting off a stampede. With dozens of personnel from all over
the hospital converging on 5 West, anyone wearing a white
coat could slip in unnoticed. The unsub would no doubt stand