Do No Harm (4 page)

THE modern Greek-style house peeked out from behind bunches of pampas grass and fan palms, the leaves throwing perfect shadows against the white stucco. Between the home's windows, vines of split-leaf philodendron snaked up the walls, the glossy dark-green leaves flapping in the breeze like atrophied wings. On the front lawn, two large palm trees crisscrossed like necking flamingos. Situated on Marlboro Street in Brentwood, David's house was a few blocks south of Sunset but still close enough that the occasional passing semi ever so slightly vibrated the paintings on the walls. The house seemed almost shy, set back a good twenty yards from the street.

A blaring car horn in the distance awoke David at 5:30. He turned beneath his comforter, removing his earplugs and placing them in a nightstand drawer. He heard the traffic immediately, and wondered if there was a more effective brand of earplug that might rescue him from the all-hour sounds of Sunset Boulevard.

His king-sized bed sat centered beneath a window that overlooked the thin side yard. No blinds or drapes dressed the window; he liked to awaken with the gathering sunlight. Aside from a solitary padded chair in the corner on which David hung his white coat, the room was entirely bare. He still slept on the right side of the bed--he'd never felt comfortable making the migration to the middle. The sheets on the left side remained almost perfectly smoothed. He found something immensely depressing about the blank strip of still-made bed beside which he slept every night.

David reached for the phone immediately and dialed the ICU.

"Yes, hello, Sheila. Dr. Spier here. We sent a woman upstairs yesterday, and I wanted to check in on her. Nancy Jenkins."

"Oh." Sheila exhaled loudly. "What a thing. Such a sweet woman." The tone of her voice was not heartening. "She was doing better in the late evening," she continued. "She even regained consciousness and spoke briefly with some detectives, but then things went to hell in the middle of the night. Her temp shot up; we took a portable upright chest, saw she'd developed free air, and rushed her to the OR."

Despite David's efforts, the alkali had won out. Dr. Woods's endoscopy yesterday evening had revealed that Nancy had sustained 3a grade esophageal injury. It had been a mess down in her throat. Exudates gooping the membranes, deep focal and circumferential ulcers, and black blisters of necrotic tissue, waiting to slough, heal over, or simply give way. One of the focal necrotic patches in her esophagus had finally blown out in the night, allowing air and infection to escape into her body.

David swung his legs out of bed and rested his feet on the thin beige carpet, careful not to disturb the perfect pattern the cleaning lady's vacuum had left last Wednesday.

"Unfortunately, Dr. Freedman had to do a subtotal resection of the esophagus," Sheila continued. "I believe he pulled up a segment of small bowel to replace it." She paused, and David heard a sheet rustling. "Small bowel?" she said. "Why not colon?"

"The small bowel has more active peristalsis," David said.

"Oh." He could hear the nurse breathing during the long pause. "We did everything we could," she said, more sadly than defensively. "As you know, everyone's really following her closely. I've had more phone calls checking up on her. Nurses, lab techs, docs, reporters calling every five minutes . . . " When she spoke again, the sharp anger in her voice startled David. "What kind of a bastard does a thing like this?"

"Well," David said, letting the hypothetical question hang and fade, "I'm glad she's in your hands now."

"Yeah . . . " Sheila sighed again, and David heard the phone rustling against her cheek. "To tell you the truth, Doctor, I'm getting tired of giving out bad news on this one. Dispensing misery is a tough way to make a living."

He rubbed one eye with the heel of a hand. "Pretend you're an IRS agent."

Her laugh was soft, but genuine. He said good-bye and hung up the phone, then stared at it for a moment. Three minutes into Monday, and he already felt like shit.

By now, with all he'd seen, perhaps he should have grown desensitized to medical emergencies. Suicide attempts where the bullet blows out the cheekbone but leaves the brain intact; motorcycle wrecks ending in near-decapitation-by-stop-sign; children beaten so frequently about the mouth that their frenula are torn, the stringy halters no longer connecting the upper lips to the gums. But every time he thought he'd seen it all, something found its way through the swinging ER doors to push the limits of his experience a few inches further. His experience was his strongest ally and darkest companion, a pupil ever dilating. Yesterday morning had once again proven that the world had an inexhaustible hoard of surprises. What kind of sickness had to fester in the coralline whorls of a human's brain to cause him to direct a viciously corrosive substance into another human being's face?

Heading into the shower, David scrubbed methodically from his forehead to his toes, washed his hair, and let the hot water steam him for a few minutes before getting out. His feet perfectly centered on the white bath mat, he stared at his reflection in the mirror. By most estimations, he was a handsome man--the kind of handsome that comes not from distinctive or striking looks, but from features that are even and predictable, and therefore pleasing. A square, masculine jaw, light brown hair cropped short and worn slightly mussed, not-too-thin lips with a pronounced Cupid's bow, and two eyes that were a light shade of blue, just short of interesting. His crow's-feet were not quite visible from this distance unless he squinted. His neck seemed less firm and muscular than it had been five years ago, but he wasn't sure if that was based on a glorified remembrance. He decided he was holding up okay. Still attractive, if a little ordinary.

Drying his back, he headed into his bedroom and placed his pajamas neatly in their drawer before dressing in his scrubs. He lifted his white coat off the chair in the corner and pulled it on, then removed his stethoscope from the inside pocket, and laid it across his shoulders. Until he felt the weight of the stethoscope around his neck each morning, he felt partially unclothed.

Walking into the study, he admired the perfectly even shelves, the rows of books organized by size and genre. Diplomas lined the far wall, framed in a cherry wood. Harvard undergrad and medical school, equally pompous with their scrolled Latin, started the row, followed by his UCSF residency certificate and board certification for Emergency Medicine. One of his Outstanding Clinical Instructor plaques hung slightly crooked. He straightened it with the edge of his thumb.

Turning to the large brass birdcage in one corner, he sighed before removing the drape. The Moluccan cockatoo awakened instantly on its perch, shifting from one black claw to the other. A bright salmon-pink crest protruded from behind its head, a flair of color on its otherwise cream body.

"Hello, Stanley," David said flatly.

"Elisabeth?" it squawked. "Where's Elisabeth?" David's wife had spent three painstaking weeks one summer training the cockatoo to ask for her when it wanted to be fed. Stanley's repertoire of comments had not since been expanded.

"On vacation in the south of France," David said.

It nodded its head to gnaw at something in its breast feathers, the long erectile crest spreading behind its head like an exotic fan.

David sprinkled some birdseed into the small cup secured to the cage bars, grimacing when some fell to the hardwood floor.

"M&M's," the cockatoo squawked. "Where's Elisabeth?"

"Took off for Mexico with embezzled funds."

The cockatoo regarded him suspiciously with a glassy black eye. "Where's Elisabeth?"

"Training Lipizzans in Vienna," David said.

His mother, were she still alive, would not have been pleased with the fact that David drove a Mercedes. Along with Doberman pinschers and von Karajan, they were, in his mother's mind, forever associated with the Third Reich. And though David would never admit it, the cast of the back-tilted headlights of his E320 sometimes reminded him of the requisite round spectacles perched on every Nazi nose in bad '50s films.

He passed the imperious Federal Building on Wilshire, the perpetual protesters outside imploring commuters to honk to free Tibet, and drove into the heart of Westwood. Turning onto Le Conte, he steered wide to avoid the grime kicking up from the jackhammers at the site across from the hospital. For two months, construction crews had been working day and night converting the building next to the Geffen Playhouse into a large retail store. A burly worker swung a sledgehammer at a 4-by-4 supporting a section of defunct scaffolding, and the section keeled over slowly, sending a burst of dust across the road. The olive hood of David's car dulled with the pollution. He made a note to schedule a trip to the car wash on his next free afternoon.

A thought seized him, and he pulled over and approached the crew of construction workers. The muscular worker stood in the midst of the fallen scaffolding, a sledgehammer angled back over one shoulder. He wore a goatee that tapered to a point. His white undershirt was soaked with sweat, permitting an enormous swastika tattoo to show through. Covering his torso from his clavicle to the top of his belly button, the tattoo had been poorly inked. A black box of a probation-and-parole monitor was strapped to his ankle on a thick metal band.

David's immediate thought was that this man could be the alkali thrower. He worked in the vicinity--he would have had easy access to the ambulance bay. David immediately reproached himself for having such a severe and unfounded first impression. The man turned a hard gaze in David's direction as David approached, and he noticed a slight facial asymmetry. The other men continued to work.

"Hello, I'm Dr. David Spier. I work in the Emergency Room at UCLA."

"Zeke Crowley."

David watched Zeke's large, callused hand envelope his own. David pointed to the monitor on Zeke's ankle. "I had to cut one of those off once."

"Not your own, I'd guess." Zeke's voice, gruff and forceful, fit his appearance.

David smiled. "No, for a procedure on a patient, back when I was a resident. It kept getting in my way. I called the number on the tag. The operator was a bit of a pain."

"They tend to be." Zeke coughed into a fist. "Spier. That Jewish?"

"Sometimes. I'm sure you heard about the alkali attack that took place here yesterday. I was wondering . . . well, I just thought given your location here, you might have seen something."

"Sometimes," Zeke repeated. "How about in your case?"

"Yes. It is. Anyone here see anything?"

Zeke ran his fingers down his goatee and twisted the end. "Nope."

Zeke seemed to have too much confidence to have committed the attack on Nancy. His aggression, David guessed, would be more direct and muscular. Fists and kicks. If he assaulted someone, Zeke would want them to know it was he who was punishing them. From what David knew of the alkali throwing, it was pathetic and cowardly. Repressed, somehow.

David studied Zeke closer. His right eyelid drooped, and the pupil was constricted. There was a decided lack of sweat on the right side of his face. Ptosis, miosis, and anhidrosis. The probable diagnosis came to David, quick and gratifying. He pushed his medical thoughts aside. "What time do you guys start?" he asked.

Zeke crossed his arms, his thick forearms flexing. He studied David for a moment. "A lot of you guys are doctors, huh? Doctors and bankers. Crafty bunch."

"Did you not hear my question?"

"Cops already came through here, stirred the shit, asked for alibis. The way I see it, I don't have to answer to a smart-ass doctor."

David felt suddenly foolish about his hunch. Of course the police would have thought to interrogate the construction workers to find out if they saw anything. He was glad they were covering their bases; it wasn't his place to be out here beating the bushes.

"You're right." David turned to go, then stopped. "You've had a recent trauma to your neck."

Zeke rocked the sledgehammer on his shoulder. "How the hell do you know that?"

"What's occurring in your face, I'd bet, is Horner's syndrome. It's a result of disruption of the sympathetic nerves in the cervical neck."

Zeke studied David long and hard, then broke eye contact. "I got whacked by a falling 2-by-4. About two weeks back. My face has been kinda messed up since."

"It might resolve on its own, but why don't you come into the ER so we can take a look. You'll probably need a referral to see a neurologist, just to be safe." David reached in his coat pocket for a business card. "Don't worry--if you're uptight about it, we'll be happy to find you a doctor of whatever ethnicity you prefer."

Zeke's smile was surprisingly soft, despite the sharp edges of his facial hair. The card looked minuscule in his palm. Zeke folded it and shoved it in his back pocket.

David headed back to his idling car.

He zipped around the kiosk and into the parking lot for the Center for Health Sciences, a tiered outdoor structure that stepped its way down from the medical plaza to Le Conte Avenue. Walking through the concrete maze of stairwells and levels, he emerged from the lot and headed along the sidewalk that curved down into the underground ambulance bay and ER entrance. Checking his watch, he saw he was five minutes late to be twenty minutes early.

Halfway down, he paused and regarded the small strip of grass and plants to his left. A waist-high light stuck out from a row of bushes. He realized he was standing in precisely the same spot that Nancy Jenkins had been when assailed with the alkali. What had she seen? A movement in the bushes, a flash of a face? And then a sudden, blinding pain.