Do No Harm (17 page)

Dalton returned with the leather restraints. He walked behind Clyde's back, circling the gurney, and Clyde grunted and whipped his head around, trying to keep him in view. Carson and the nurse and lab tech were startled back a few steps. Jenkins grabbed Clyde's legs roughly, and Clyde thrashed as Dalton undid the handcuffs. The two quickly had Clyde flat on his back, strong leather restraints binding his ankles and wrists to the metal rails of the gurney. David directed them to bind one of Clyde's hands up and the other to the railing down by his waist so if something went wrong, they could turn him on his side to minimize the risk of aspiration.

The skin on Clyde's chest was raw and shiny where it wasn't raised in blisters, but it looked as though most of the alkali had been flushed off. He was in a much better position for Carson to access the burns on his chest, and the four leather cuffs held his limbs tight enough that the others weren't afraid to work more closely on him.

"All right," David said. "That's enough. He's not going anywhere. I can take it from here."

"We'll be outside," Yale said.

"Have fun," Dalton added. He had to grip Jenkins's forearm to move him from the room.

The room hadn't been prepped for a potentially violent patient, so David removed both IV poles, sliding them out into the hall and leaving the door slightly ajar. He found some scissors near a bag of O-negative blood that had been left on the counter from the previous trauma, and slid them into his pocket. The lab tech wore a shirt and tie, having not yet changed into scrubs for the day, and David pulled him aside and whispered to him to take off his tie before going near the patient. He caught Carson's eye and gestured for him to remove his yin and yang earring.

"Stand back from the door," Clyde was muttering when David turned his attention back to him. "Stand back from the door." He kept his eyes closed, as though he were praying. His hands were puffy, perhaps swollen from the cuffs.

He repeated certain phrases like mantras, David realized. The recitations seemed to have an obsessive-compulsive element to them; maybe they were uttered for the same reason some people with OCD wash their hands forty times a day--to reduce anxiety.

David crouched so he wouldn't have to lean over Clyde in threatening fashion. "We're going to remove your gloves now--"

Clyde screamed, balling up his hands into fists behind his back.

"Okay, okay," David said. "We'll wait till later. We'll take the gloves off later. How's the pain? Is it better?"

Clyde nodded. "Still burns but it's done eating its way through me. I know. I can tell when it's done."

"Do you want some pills for the pain?"

"I told you, I don't take pills." His crying and screaming had finally stopped, though he was still breathing hard. A small wedge of Pyrex glimmered in a cut near his left armpit.

"I'm going to reach across you," David said. "And I'm going to use these forceps to remove a sliver of glass from one of your cuts."

"Okay," Clyde said.

David leaned over, but Clyde's left arm was locked down by his waist, blocking the cut. He turned to Clyde, again doing his best to avoid what could be perceived as threatening eye contact. "I'm going to untie one of your arms to get at the cut. I'm doing this so I can help you. Remember, you promised not to give me any trouble."

Carson took a half step forward. "Look, I don't know--"

Clyde's sweaty head moved up and down in a nod.

David untied the restraint and raised Clyde's arm, the thick leather band remaining around Clyde's wrist. He bent down, navigated the forceps carefully into the wound, and removed the piece of Pyrex. He lowered Clyde's arm back to the metal rail and secured it again, threading the leather strip through the hasp.

Carson let his breath out in a rush.

Clyde raised his head weakly and stared at David as the others continued to flush his wounds with saline. His voice hitched in his chest. "Thank . . . thank you," he said.

David thought of the Xeroform bolsters stitched into Nancy's face and strongly resisted the urge to tell him to go fuck himself.

"TO say I'm pissed off would be an understatement." By the time David entered the doctors' lounge his rage had turned to disgust. He had pulled most of the staff who had been on the floor during the incident into an impromptu meeting, leaving Carson and a few nurses to oversee the floor. Pat had apparently followed his orders and left. Nurses and interns crammed onto the cheap vinyl couch, leaned against the coffee-stained sink, and sat cross-legged on the floor.

He looked blankly from face to face. Almost all of them lowered their eyes from his stare. "A patient comes into our division in acute pain, requiring emergency treatment, and we withhold care. A top-notch medical facility withholds care. I can't . . . " The words were jumbling in his mouth, so he paused and took a breath. "I'm meeting with Dr. Evans today, but I can't even begin to figure out how I'm going to present this."

A few of the interns stiffened at the mention of the hard-nosed chief of staff.

He couldn't recall ever seeing the staff so uncomfortable. Nervous shuffling, regretful expressions. One of the nurses looked up to stop her moist eyes from leaking. A medicine intern raised a fist to stifle a cough.

"Outside these doors, the world can be as vicious and cold as it wants. People don't help each other. People don't have to help each other. In here, we take care of them, trite as that may sound."

"That man is a vicious mutilator of women who got a taste of his own medicine." The anger in Don's voice surprised him.

"That man is a suspect" --David emphasized the nouns with jabs of his open hand-- "but that's the cops' concern. To us, he's a person with a serious injury, like any other."

"Just doing our job, huh? That's the philosophy you want to rely on?"

David's stomach was awash with acid and rage. "The Hippocratic Oath, Dr. Lambert, is the philosophy I rely on. We took an oath, every one of us, that we would work by our medical ethics and hold them above everything else. What does it mean if that oath ends beyond the point that someone is appealing, or mentally sound? Or likable?"

"It's not that black and white."

"It is precisely that black and white. If we can reduce the pain of another human being, we do it."

"How can you want to show that man compassion?"

"Compassion? It has nothing to do with compassion. This is our job. If you don't like it, go be a goddamn accountant. But you can't stay here and think you can call your own shots."

The others watched the exchange with stunned expressions.

David took another moment to gather his composure. "It is not our place to question our patients' morality. Do you really think you can keep your footing on that slippery slope? What next? We stop treating criminals? How about people who cheat on their income taxes? Do we let them lie in pain? The mentally ill? Do we deny them medical care? Do we?" David's arms were tensed before him. "That man in Fourteen could very well be mentally incapacitated. Leave judgment to the courts, and do the jobs you swore under oath to do."

"I never abandon my own instincts," Don said. "Not for any code of ethics."

"Fine," David snapped. "If that code of ethics doesn't work, try this one. I'm the division chief, and you will listen to me. So do your fucking job. All of you. Now."

He walked out and left the door standing open, the murmurs following him a few yards up the hall. Whether the confrontation had done any good or not, he felt considerably better.

He returned to the CWA and checked in with Carson, noting the emptiness of the ER's main axis. Aware that he had just acted like the kind of manager he'd sworn he would never be, he focused on the board as the other staff members trickled back to work.

Preoccupation stayed with him for the next few hours. His concentration wandered; his movements were mechanical. He forgot a patient's name during an examination for the first time since June of 1987.

The rest of the staff gleaned the fact that he didn't want to interact with them. Except for essential exchanges, the nurses left him alone. The interns went to Don to present cases and have their orders signed. Don spent his time alternating between gloating over his newfound popularity and sulking like a scorned girl.

When David stopped by the CWA later, the room quieted as he entered. He glanced at the board. Aside from an MI and a severed finger, things appeared to be quiet, so most of the staff were hanging out on the stools or leaning on the counters, catching up on paperwork.

Don's hand rasped over the stubble he kept Miami Vice length. His eyes, beneath his perfect brow, were intensely angry. Jill touched David's arm, a gesture he thought was apologetic. The others ignored him.

He nodded at Jill, a bit awkwardly, and walked from the room. Before heading to his lunch meeting, he went to check on Clyde. He was just about to turn the corner when he overheard Jenkins talking to the two LAPD cops stationed outside the closed door to Clyde's room. They looked tall and hard in their uniforms, their black belts laden with tools and weapons. Yale stood by also, silent and seemingly uninvolved in the conversation.

"--business end of my nine-millimeter," Jenkins was saying. David peered around the corner and saw him remove his pistol and aim it at an imaginary victim, execution-style. The hall was momentarily deserted; David had decided to direct new patients to the rooms off Hallway Two until Clyde was moved.

One of the uniformed cops muttered something, though David picked up only snatches. ". . . doc releases him . . . get your hands on . . . "

"That's right," Jenkins said. "We'll file it under DSAF: Did Society a Favor."

David was unsure how to gauge the severity of Jenkins's grandstanding, but he felt his face tingling with the panic mixture of anger and sudden dread. Yale leaned against the door but didn't comment. Was he complicit in Jenkins's scheming, or did he believe Jenkins was simply venting?

David pulled silently back from the corner and headed to his meeting. It took him nearly ten minutes to negotiate the cafeteria lines and locate two opposing seats at a table, and he found himself fondly recalling the days of the separate physicians' dining room. He had already finished eating when he spotted Sandy Evans crossing the cafeteria toward him, juggling a soft leather briefcase and a forest-green tray covered with a mound of food. She wore a well-tailored charcoal suit, and wore it well for a sixty-five-year-old. Her hair, chestnut with auburn highlights, was shag-styled down around her neck.

He was glad to have pinned her down for lunch; the last time he'd needed to speak to her on short notice, he'd had to scrub in and catch up to her in the OR. Speaking through surgical masks tended to blur the words, and though surgeons never seemed to mind, David had always found a certain stark irreverence in discussing unrelated issues over an opened patient. To accent her points, Sandy had pointed at him with a Kelly-clamped segment of resected bowel.

David rose slightly in the black cafeteria chair, and he and Sandy touched cheeks in a semblance of a kiss. Aside from her husband, David was the only person she permitted closer than a handshake, an indulgence granted him only because she'd had an exceedingly close relationship with his mother. She was much like David's mother in many regards--the stern attractive looks, the insatiable ambition, the aggressive set of the shoulders. Even their faces sometimes blended in David's memory; both had a hard-shelled, resilient cast, the result of weathering myriad broadsides early in their careers from male colleagues and superiors. But David felt Sandy's similarity to his mother most keenly in something unexpected and unsettling--his desire to please her.

Sandy dropped her briefcase on an empty chair and lowered the tray to the table, a bottle of Gatorade rolling toward the edge until David grabbed it. Her voice was deep and throaty, a smoker's voice, though she'd never smoked a single cigarette. "The Board of Directors wants a complete media blackout, and rightly so. One suture untied, and we'll have a scandal on our hands. ABC, CNN, MSNBC, and Fox News are all pressing my office for comment, and they're expecting me to roll over. Little do they know." Her vivid green eyes gleamed. "They'd better gear up for one hell of a dogfight, 'cause this old bitch don't roll over unless she's in the mood." Her eyebrows, lightly penciled, rose beneath her bangs. "Oh, it's true. You can ask Stephen."

David absentmindedly bent a plastic fork in half. "I'll take your word."

Sandy opened two containers of yogurt, unwrapped a burrito, and lifted the lid of a cardboard box from the grill. Sandy still jogged five miles every morning, and ate like an NFL linebacker. "Sounds like you've had your hands full today," she said around a mouthful of chickwich.

"More than you know," he muttered.

"What?"

"Nothing." David shook his head. "What happened this morning--the entire division not stepping in to provide care--I've never seen anything like it."

"People react violently when friends and colleagues have been injured."

David looked up, shocked. "You're condoning this?"

"Hey!" She pointed at him with the end of a banana. "Direct that righteous Spier anger elsewhere, David. I'm on your side here. If I condoned your staff's behavior this morning, I'd be perfectly capable of expressing that sentiment, so don't get pissy with me over implications."