Do No Harm (18 page)

"All right. I'm sorry. I apologize."

"If you'll pardon the equestrian metaphor, David, you're one of my Thoroughbreds. You were the youngest division chief in the history of this hospital, and I leaned like hell to get you that post, not because your mother was my mentor and dear friend but because you are that good. You're one of maybe three department heads here whom I trust implicitly, across the board, without question." Her voice was hard and driving, as if she were still being challenged.

"Would you like me to apologize again?"

Her lips pursed and pulled to one side in her distinctive smile. "No. Once was sufficient. Now, I agree that your staff's behavior was egregious. I'm merely pointing out that, however misguided and asinine, there are extenuating circumstances here. Now let's talk about this. First of all, what's this man's name? The patient."

"Clyde."

"Clyde? Who the hell's named Clyde?" She looked at David, miffed, as if he were somehow responsible for naming him.

"That's all he'll give up," David said. "No last name either."

"All right. How many staff members refused to help you?"

"Everyone."

"David, if the radiology tech or a desk clerk didn't pitch in, that's not relevant to this discussion. I'm interested in how many members of ER staff who receive and treat new patients refused to help you."

David thought for a moment. "Seven. Four nurses, two interns, and Don Lambert."

"All right. So legally, we're concerned with seven people here."

"My concerns are ethical, Sandy. Not legal."

She finished chewing a bite of burrito. "Hurrah, David. However, what I'm concerned with, in running this facility, is the area where your ethical concerns cross the boundary into legal concerns."

"Or PR concerns."

Her penciled eyebrows pulled up as she appraised him. "You inherited your mother's moral sense, but it's a shame you didn't inherit her overriding grasp of politics. It's the only thing that stands between you and a future post as chief of staff."

David ignored the dig. "How do you intend to handle this issue, Sandy?"

"Well, we've long known that Dr. Lambert is a lazy SOB, but when he's focused he's actually quite competent, and he is very popular among the staff. Do you really want to push this? It'll be a big stink. Do you feel your patient's care was compromised?"

"Well, I couldn't get to him as quickly--"

"Truly compromised?"

He bit his lower lip. "Probably not."

"All right. Now let's bear in mind that we are dealing with a very specific situation. This man was attacking ER workers. While the behavior of your staff is inexcusable, I'm not concerned that they'd withhold care from other patients. And the likelihood of someone else attacking ER workers and then needing medical care at the hands of that same staff . . . well, we know how remote a possibility that is. You have to pick your battles. Now let me ask you again. Do you really want to push this?"

David suddenly felt quite nauseous. "I want them to be formally reprimanded, yes."

A woman trudging slowly past glanced over at him, and he realized the intensity in his voice was making it carry.

"Don't get me wrong, David. I'm as pissed about this as you are. In fact, I'm planning on personally meeting with all seven employees and tearing them each a new orifice. What I'm asking is, do you want to involve the Ethics Committee? Risk Management? The California Medical Board?"

He rolled the soft lining skin of his bottom lip between his teeth. "No."

"All right." She smiled curtly. "I'm quite good at being furious. By the time I'm through with those seven, they'll have the Hippocratic Oath tattooed on their foreheads."

He nodded, somewhat formally, and she returned the gesture, amused.

"Now I've got another tangentially related headache," Sandy said. "As I mentioned before, the media's been crawling all over the hospital, jamming the phone lines. It's not the kind of press we like, but, even worse, it's interfering with the hospital's effectiveness. When can you get this . . . Clyde on his way to the Sheriff's station?"

"It's complicated."

"No, David, it's not. Get him stable and get him moved."

Sandy leaned back and crossed her arms, an amused, attractive little smile playing across her face. "One of the rules when dealing with Thoroughbreds is that you don't rein them in too much. They lose some of their fire, their passion. So I'm making a suggestion, not a directive, and you can throw it out if you'd like."

He knew what was coming, and he knew he deserved it.

"More people look up to you here than you're aware," Sandy said. "You're part of the bedrock of this hospital. I heard you lost your cool pretty badly this morning. That unsettles people. Whether we like it or not, your division is under intense scrutiny because of this case--both internal and external scrutiny."

David took this in, trying to strip away his anger and defensiveness, and find some utility in the information. "Your suggestion?" he asked.

Sandy rose, picked up her tray, which was littered with gutted food containers and fruit rinds, and winked at him. "Keep your clay feet covered."

YALE emerged from Exam Room Fourteen, jotting something in a worn black leather notepad. A rubber band held several yellow sheets to the top cover, marking his place. As David approached from the cafeteria, Yale flipped the pad shut and slid it into his sport-coat pocket. The two LAPD officers had been replaced by UCLA PD cops, who now stood guard at the door.

"Dr. Spier," Yale said. He took a few steps toward David, perhaps so the officers wouldn't overhear the conversation to come. "We'd like to get the suspect moved to the jail ward at Harbor. As I'm sure you're aware, the ward there is a high-security treatment zone, and we think it will be safer for everyone involved when we get him moved there. Is he stable?"

"I'd like to continue irrigation for a few hours. Alkali continues to burn deep within the skin, even when it looks like it's been cleaned off."

"Yes," Yale said. "We've learned that the hard way."

"I also need to get him stitched up."

"Can't that wait and be handled at Harbor?"

The last time David had checked, Clyde was still reporting pain. David had his hesitations about releasing a patient in a fragile state into the hands of officers who were less than concerned about his health and safety. He thought about how slowly they'd sauntered into the ER with Clyde screaming and burning in their hands. Jenkins's execution pose with his pistol. "I need to keep an eye on him for a few more hours, see how things settle. I don't want him moved in this condition."

"I'd really prefer--"

"Maybe tonight."

"What time?"

"We'll see how he's doing at eight, nine o'clock."

That would give David more time to observe the burn's course and make sure the gashes were stitched and cleaned up. Plus, Jenkins's shift should be over by then. David would be less concerned about turning Clyde over to a more impartial officer.

Yale glanced over his shoulder, and the two officers at the door looked away quickly, pretending they hadn't been eavesdropping. "I'm gonna be honest with you," Yale said. "It's not going well in there. He won't talk to me."

"Maybe you alienated him too much during the arrest."

"Perhaps."

"What took you so long getting him to the ER?"

"We were busy subduing and frisking him. Minor considerations like that." Yale tapped his pen, a cheap Bic ballpoint, against his lips. "I'm thinking maybe you could try to loosen him up for me."

"That's really not my job, Detective Yale. The psych consult will be along shortly, and I'm sure--"

"Dr. Nwankwa. I'm familiar with him and not optimistic he'll be looking to advance our cause."

"Advancing your cause is not his job. Or mine. Our job is to treat patients."

"In any event, I'm not permitting Dr. Nwankwa to see the suspect. This is not the time for a psychiatric assessment."

"Fine. I need Dr. Nwankwa to assess the patient's need for antipsychotic medication. If we can keep Clyde calmed down, that benefits both our agendas." David crossed his arms. "My treatment of this patient will be unimpeded."

Yale studied David with clever, shiny eyes. "You know, Dr. Spier, our jobs share certain similarities. We're both exposed to elements of society few people deal with. We both see people at their worst--in pain, terrified, furious, suicidal, dead. Just like you think I don't know my ass from . . . Just like you think I don't know much about what goes on in the ER, I can tell you, you don't know much about how things work on the street. Your code of ethics holds up just fine in here, between the scrubbed white walls, but there are different kinds of choices, different kinds of pressures and stresses and concerns out there. This man is a predator--"

"A suspected predator."

"Please keep your voice down, Dr. Spier. I'm saying that this man is a suspected predator, and when you deal with predators at large, free from restraints and backup, you might find your politics sliding slowly to the right."

"My politics are irrelevant to my ethics. I'm sorry you don't understand that."

"I learned my ethics wading through dismembered bodies, drug labs, and homemade torture chambers."

"So tell me, then," David said. "How do you think a suspect should be treated?"

"Is this the issue at stake? You wouldn't be holding this patient for reasons other than to provide critical medical care? As you're well aware, that would be overstepping your bounds, Dr. Spier."

"The patient is still in need of critical treatment."

"I see." Yale took a step back.

David cleared his throat. "Will Jenkins be involved in the transfer?"

Yale studied him closely. His pupils were dark and smooth; in the sterile overhead light, they resembled obsidian. "Jenkins will be involved as long as he wants to be involved." His little smile was cold and efficient. "He's got a first-class crush on the suspect. Won't leave him alone, even for a minute. He's sitting out in his patrol car on Le Conte right now, just in case we need him for anything."

"In medicine, physicians don't treat their family members." He did his best not to picture Elisabeth's face. "There's too much emotion there. Might make a bad decision."

"Dalton and I are running the show, not Jenkins. But I'm not going to take away his involvement. This is his way of dealing. So we let him drive behind the transport vehicle, let him twirl his lights and run his siren. He needs this."

"He's under a great deal of stress, and he's highly unstable. What are you going to do if he comes undone? Acts rashly?"

"There are any number of things about me that are questionable, Dr. Spier. My competence is not one of them."

David pointed to the closed door of Exam Fourteen. "That is a sick individual in there. Sick and violent, but also confused and scared. He needs your protection."

"And why do you trust me and not the others?" Yale said. Through all David's dealings with Yale, this was the first hint of anger he'd heard in his voice. "Because I can afford the same suits as you?"

"You wear better suits than I do, and no. I trust you more because you're the only one not acting like you want to treat my patient like Rodney King."

"Let me tell you something," Yale said, stabbing a finger at David. "You can take your classist disdain and shove it. You think you understand what goes on in our lives? Do you think you even understand what went down in the Rodney King fiasco? There were twelve officers on the scene for a reason. Why don't you look into it?"

The two officers by the door listened intently, leaning to make out more of the conversation.

A sharp noise of disdain escaped from the back of Yale's throat. "Patrol officers can get killed any minute of any day. Especially in this city. Why do they do it? What's your knee-jerk answer to that? They're all just power-hungry pigs, right? Bullshit." His hand rested lightly over the badge clipped to his belt. "They do it to protect and serve civilians. Even arrogant bastards like you."

His usually stoic face lined with emotion, and in that instant David saw right through him. The defensiveness, the pressured speech, the hint of hurt that found its way into his voice--it all reeked of regurgitated argument. Anger ossified by rejection. His wealthy background was betrayed by the split-toe stitching of his Cole Haan loafers, his family's reception of his choice of vocation by the contentious set of his mouth. His affluence came at a cost; it was thorny-stemmed. Yale seemed to sense he had given too much up, for he looked away and took a step back, his lips twitching like a boxer's.

"I don't want to argue about Rodney King," David said.

"Then don't bring him up."

"I'd just like your reassurance that there won't be any vigilante retribution against my patient."

The two men studied each other, still-faced and tense. "A suspect has never come to harm under my command," Yale finally said. "Never."

David extended his hand. "Is that a guarantee?"