Diagnosis Death (11 page)

The voice on the phone yesterday hadn't been Lillian's, was never Lillian's. The letters hadn't come from her. She hadn't manipulated Pulliam's death to cast suspicion on Elena.

But, if not Lillian . . . who? And why?

E
lena's exit interview with Amy went as expected. They both said all the right things, while they carefully ignored the elephant in the room: the person who tried to throw the blame for Chester Pulliam's death onto Elena.

The mechanics of "clearing the campus" mainly involved shuttling between buildings and offices. Elena collected signatures on a form, gave a forwarding address only when it was absolutely necessary, said a few heartfelt "good-byes" and a lot of "see ya"s. Then it was over. She'd severed her connection with the medical center that had been her home for the past six years with less ceremony than the lowering of the flag at day's end. In her head, she began humming "Taps." Well, tomorrow was a new day, and she'd better get ready for "Reveille."

She wasn't really hungry, but she knew if she didn't eat something her blood sugar would dive, and she'd be even more depressed than she was now—if that was possible. Automatically, Elena reached for her cell phone. She stopped with it halfway out of her purse. David was in surgery all day. Was there anyone else whose company she'd enjoy? Not really.

So she'd have lunch on her own. Where? She could go back to one of the cafeterias on campus. Bad idea. She'd see people who'd want to know how she was doing. They'd offer sympathetic words as sweet as cotton candy, but with no more substance.
Poor Elena. Her husband died—she may have killed him, you know—and now she's been asked to leave the campus before her residency is up. Wonder what's behind that?

Elena climbed into her car and said a silent "See ya" of her own to the campus. She navigated down Harry Hines Boulevard and turned onto Maple Avenue, sad that this might be her last trip along this street that boasted so many excellent Tex-Mex restaurants. She hoped Dainger offered a few of its own.

David wadded his surgical mask and paper head-cover into a ball. Without breaking stride, he dropped them in the trash can outside the operating room.

"You handled that case very well. Removing a tubal pregnancy via laparoscope requires good hand-eye coordination and a smooth touch, and you have them both." Dr. Steve Cobb accompanied his words with a manly slap on the back.

David appreciated the praise of the staff surgeon, although he could have done without the slap. Although Cobb was now a part of the medical school faculty, only a decade ago he'd been an All-American linebacker at SMU, and while many college football players tended to get soft after their playing days were over, Cobb not only stayed in shape, he bragged that he could bench-press more now than in his football heyday. Based on what he'd just felt, David had to agree. He shrugged his shoulder and rubbed his left arm.

"You want to write the orders and op note?" Cobb asked.

"Sure. Seems fair, since you let me do the whole case."

"Got to get you ready for private practice. Tell me again where you're going."

David fished his wallet from the hip pocket of his scrubs and extracted a card. "I'm going into practice with Milton Gaines."

Cobb glanced at the card and nodded. "Good man. He trained here, you know. Finished a year ahead of me. Tell him 'Hi,' will you?"

David hung back at the swinging doors to the recovery room, mainly because there wasn't room for anyone to walk through them side-by-side with Dr. Cobb. He cleared the doorway in time to hear, "This woman's going into shock."

The anesthesiologist, Ron Ward, was at the patient's bedside. "I extubated her in the OR. Her vital signs were stable when we started the transfer to the recovery room. But as soon as we got in here, her pressure had dropped twenty points systolic. Pulse rapid and thready."

Cobb was the first to respond. "Run that Ringer's full speed. Start another IV in the other arm." He turned and called to the ward clerk. "She's got three units of blood holding in the blood bank—send for them and start one as soon as it gets here."

The nurse adjusted the IV while Dr. Ward hurried around the bed to insert a second intravenous line. David didn't wait to be told. He started toward the door. "I'll scrub up."

Minutes later, the patient was back on the operating table, her abdomen reduced to a rectangle of skin colored a muted orange by the antibacterial prep solution, outlined by green drape sheets, and illuminated by strong overhead lights.

"She's under, but very lightly. Let me know if she moves." Ward's voice was steady. "Fluids running full. First unit of blood going up in a minute."

Cobb motioned David to stand on the patient's right, the spot reserved for the surgeon. "Your case, doctor, start to finish. I'm here to help."

David breathed a silent prayer and held out his hand for a scalpel. His brain riffled through hundreds of mental index cards, each the product of countless hours of study. Anatomy, physiology, surgery, everything had to be collated and applied.

Here goes.
David cut through the skin of the patient's abdomen in a ruler-straight vertical incision. He dropped the scalpel onto the instrument tray and held out his open hand. "Deep knife. Get the Bovie up to co-ag the bleeders."

Cobb was the perfect assistant. He was a big man, but his hands were those of a concert pianist—fast and accurate. The dissection went smoothly: skin, fat, muscle. Suddenly, dark blood mixed with clots welled out of the incision.

David's words were crisp and confident. "Suction."

Cobb held out his hand for the suction tube and inserted it into the wound.

"Lap pads."

David took moistened gauze packs from the scrub nurse and shoved them into the depths to absorb blood.

"Self-retaining retractor."

David spread the incision widely, and almost immediately saw a tiny scarlet fountain spurt with every beat of the patient's heart.

"Aberrant branch of the ovarian artery." There was no condemnation in Cobb's voice. Just a simple statement of fact.

"I don't recall coming close to it," David said, as much to himself as to his mentor.

"Well, it didn't cut itself, but we can talk about that later. Tie it off, then put a stick tie on for good measure."

After both he and his staff man were satisfied the problem was corrected, David closed the wound. But while his fingers were busy with catgut and nylon, his mind churned over other matters. Again and again, he went through the sequence of the laparoscopic operation. Had he seen that artery? Was there a possibility he'd nicked it? An injury to an artery could cause the tiny ring of muscles in the wall of the blood vessel to go into spasm. Sometimes this was sufficient to staunch any bleeding. Later, as the vessel wall relaxed, hemorrhage could occur. That must have been the sequence here.

"I know what you're thinking." Cobb's off hand comment made David look up from tying a suture.

"What?"

"You're going over and over the laparoscopy. You want to know what you might have done to cause this. More important, you want to be sure it doesn't happen again."

David focused on finishing the knot. "How do you know that?"

Cobb snipped the suture to the proper length. "Because that's what I'd do. It's what any surgeon worth his salt would do."

"So, what's the answer?" David dropped the needle holder on the instrument tray. "Staples, please."

Cobb blotted the incision line, although there was only a bit of blood there. "There's no magic formula. Personally, before every operation I review a mental checklist of the things that could go wrong. Then I try not to let them happen."

"And if they do?"

Cobb used a pair of fine-toothed forceps to pinch the skin of the incision closed while David applied staples. "Good surgeons know they're human, and they operate in a less-than-perfect world. Mistakes happen. When they do, good surgeons admit it and address them."

"And bad surgeons?"

"A bad surgeon is the one who says he never makes mistakes. That's a doctor I don't want holding the knife if I'm on this table."

"Drat!" Elena dropped the cardboard box and picked her way among its mates, through the maze from her bedroom to the living room, toward the ringing phone.

She stretched out her arm and snatched the receiver off the cradle. "Hello."

She heard only silence.
Oh, don't hang up just when I get here.

"Hello," she repeated.

"Elena?"

"David?"

"I meant to call earlier, but I had a complication in the OR this afternoon, and after that everything ran late. How about dinner?"

She looked at her watch. Six o'clock. "I don't know. I still have quite a bit of packing to do. And I'd have to clean up, change clothes."

"Why don't I pick up some Chinese and bring it over? I won't stay long. I might even be able to help you pack."

"Sure, why not?"

Elena figured she had maybe an hour before David arrived. That should give her time to clean out Mark's clothes. After his death, she couldn't bring herself to give them away. It seemed too final. Now, the move made the decision for her. Any clothes David couldn't wear were headed to the Goodwill drop-off box in the morning.

She decided to start with things she was sure David wouldn't want. Underwear and socks went into the box first. Then pajamas. Handkerchiefs.

How about shirts? Mark had some nice ones. She'd put them aside and let David decide.

The shirts were folded because, in the days when he traveled, Mark found it easier to pack them. The habit carried forward, and now she stared at a large drawer filled with folded dress shirts. She carefully transferred the three stacks to the bed.

She opened the closet. Suits, pants, sports coats—each of them bore the scent of Mark's cologne. Elena's eyes filled and overflowed. She couldn't do this. Not even this long after Mark's death. She'd ask David to go through them. He could choose what he wanted and put the rest in boxes for her.

Her stomach knotted as she considered the finality of her actions. Mark wasn't coming home. Ever. That had been true before she started to clean out his things. It would still be true when she was in the car with her suitcases and boxes, on the way to a new life. But right now it was too much to contemplate.

Enough! She had to put an end to the pity party and get back to packing. While she was staying with Will's parents— and she still wondered about that—she'd determined to get by with a few boxes and a couple of suitcases of clothes. A mover was coming to pack and move the rest.

She pulled a large suitcase out of the closet and opened it on the bed. When she shoved the shirts aside, one stack toppled, uncovering an envelope. Elena pulled it out and studied it. No address. The flap had come unsealed. Was this some sort of message from the grave? Or just a letter Mark had picked up that was trapped between clean shirts when he put them away?

She pulled a single sheet of paper from the envelope. As she did, she noticed that her hands trembled a bit. Who could blame her? This might be a love letter Mark had meant for her.

Elena opened the sheet. It was computer-generated, covering about half a page. She scanned it, then dropped to the edge of the bed and read it again. A third reading didn't change the words that by now were burned into her retina and her heart.

I've struggled with this for days and weeks. In the end, maybe I'll deliver this news in person. But in case I'm weak and take the coward's way out, I'll say it here.

It's over between us. I can't continue living a lie. There once was passion in our relationship, maybe even love. But there's someone else whom I love even more. And if I'm to be true to her, our relationship has to end.

That was it. No salutation. No signature. Just simple words that spelled the end of a love she thought would last a lifetime.

Elena wondered how long Mark had put off delivering this news to her. If he'd lived, how would their marriage have changed? Would he have destroyed the letter and devoted himself to her once more? Or could he have summoned up the courage to deliver this deathblow to her in person?

The doorbell rang. That would be David. Could she share this latest development with him? Could she admit that her husband had gone outside their marriage because he found her so lacking? No. Not to David. Not to anyone.