Do No Harm (6 page)

THE iridescent fish caught the glimmer of the sun even through the store window. Separated in bowls sitting side by side on a table in a window display, the two Siamese fighting fish swam tight, excited circles. Every few seconds, they darted back to face each other through the glass, like compass needles pulled north.

Clyde pressed his face against the outside of the window. The fish were all the more ferocious for their elegance. Long, flowing fins, scales shimmering red and blue, they drifted, tensed, drifted, Samurai warriors fighting in loose robes.

The cheap cardboard sign folded name tag-style on the table beside them read BETTA SPLENDENS. KEEP SEPARATED.

The bells on the door jangled as a gaunt man with wispy hair and round spectacles exited. He pulled a full ring of keys from his pocket and locked the dead bolt.

"What're you doing?" Keeping his forehead pressed to the glass, Clyde rolled his head so he could see the store owner.

"Closing up for lunch."

"I want those fish." His puffy finger pressed into the glass, pointing.

"Be back in twenty minutes."

"I want them now."

The store owner smiled curtly, pushing his glasses back up the bridge of his nose with a knuckle. "I'll be back in twenty minutes. I'll be happy to help you then."

The store owner was a few steps around the corner when the loud crash startled him. He nearly lost his footing, one hand spreading wide across his chest. It took him a minute to catch his breath, the pale skin beating above his temple. He hesitated before taking small tentative steps back around the corner.

He gasped. The store window had been smashed, and bits of glass were scattered through the display area. The man who'd stood out front was gone. A few curious pedestrians threw the store owner glances from across the street as he neared the window fearfully.

A brick, pulled from the loose walkway of the arts and crafts shop next door, had been hurled through the window, smashing one of the fish bowls. The other lay on its side, water dripping off the table.

The two magnificent fish flopped among the shards of wet glass on the tabletop. The blood leaking from the blue one's gills rouged its scales. It paused between movements, gills fluttering.

The vermilion betta flipped itself off the table's edge, landing in an open bag of teal aquarium rocks. It wiggled a few times more, then lay still, its streamers limp like wet toilet paper.

SANDRA Yee, the most animated of the ER residents, flashed David dueling thumbs-up as he walked down Hallway Two to the Central Work Area. She was literally bouncing in her white Reeboks. The fact that she was only 5'2"; made her excitement all the more endearing.

"I caught a big-ass triple a on a fifty-five-year-old. Surgery just swept him upstairs." She bent gracefully in an operatic bow.

"Abdominal aortic aneurysm? Good catch. Probably saved his life." David squeezed her shoulder, and she put her arm across his lower back.

"Thank you, thank you." Sandra turned, heading down the hall, whistling her theme song, "Look at me, I'm Sandra Dee" from Grease.

An elderly radiologist snapped his fingers after her. "Excuse me! You wanted the read on the broken arm?"

"I'm sorry," Sandra called over her shoulder. "You must have me confused with some other short Asian." She jogged off, sneakers squeaking on the tile.

David turned away to hide his smile. He entered the CWA, where a potpourri of scrub tops gathered around the main desktop, heads riveted on the portable TV the clerks kept on a cabinet near the board. "Any update on the alkali thrower?"

A clerk glanced up from the phones, shaking his head. "Only good scoop was some guy stopped a robbery at the Kinko's on Wilshire. Scared off the robbers, took a bullet in the ass, then split before the cops showed. But no new word on the fuckhead who attacked Nancy."

David felt his good mood instantly dissipate.

One of the nurses shook her head. "I hope they nail the bastard soon."

Two interns crashed through the door and jockeyed for position around David.

"Fifty-two-year-old female presents with--"

"Nineteen-year-old comes in with a nickel lodged in his--"

David held up his hand, fighting his way to the board. "One at a time." A prescription order appeared in front of his face and he glanced at it, then signed it. Somewhere down the hall, someone moaned, a loud sound that grew to a scream.

David slowed to accommodate the throng around him. "Who's screaming and why?"

"Homeless Harry," a nurse said. "We've had to keep him in four-point restraints ever since Diane did a rectal on him."

"You'd have to keep me in four-point restraints if Diane did a rectal on me," one of the medicine interns joked.

David said, "She'll be flattered to hear that."

"I need sign-offs in Six, Nine, and Fifteen-One," a resident said.

David checked the board to see what patients they had where. "Why are we so far behind? Where's Don?"

"Our other attending is, as usual, missing in action."

Sandra swung her head around the corner. "I take odds on the lounge."

"I'll take the cafeteria," someone else shouted out.

David fought to keep his anger at Don from showing. "Excuse me for a minute." He walked down the hall to the doctors' lounge, but there was no sign of Don Lambert, the missing attending. As David left the lounge, Don nearly collided with him, cradling a banana, two bags of chips, a can of Coke, and an El Pollo Loco burrito in his arms. The banana slapped to the floor, and Don crouched to pick it up.

"Goddamn it! Watch where you're--" Don stood up and looked at David's face for the first time. "Oh, Dave. I'm sorry. I didn't realize it was you."

"You were in the cafeteria?"

He nodded. "I haven't taken a break since--"

"Dr. Lambert, we always have two attendings from three to eight because these are generally the busiest hours. No one--not even those of us who have been on since eight--have taken a break yet. Just because we aren't completely slammed today does not give you an excuse to go AWOL for half an hour at a time. Plus, you know the staff's been upset about Nancy's attack. You should be keeping a closer eye on them."

Don set down his food on a nearby chair and skimmed a hand across the top of his perfect ledge of blond hair, a red stone glinting from his gold chunk of an alma mater ring. His piercing blue eyes and relaxed, apathetic air made him irresistible to the women on staff. He rarely walked through the hospital corridors without being accosted by female patients and visitors. "I was gone for fifteen minutes," Don said, doing little to hide his irritation.

"Fifteen minutes is enough for two traumas to roll in here and put me on overload," David said. "Surely you've paid enough attention during your shifts to notice that things heat up rather quickly when they heat up."

"Don't treat me like an imbecile."

"Then don't give me reason to treat you like one." David sighed, then took a calmer tone. "Look, Dr. Lambert, I'm a relatively flexible guy--"

At this, Don snickered.

"--but there is one thing for which I will not stand and that is compromising the care in this facility. You've been irresponsible on more than a few occasions, and I'm reaching the end of my rope. As an attending, you should be setting an example."

"Name one time I've put a patient at risk." Don picked up his banana and peeled it. "Well?"

David could feel his face growing red, but he fought down his anger. "Think of it as taking preventative measures." He was walking away when he heard Don call his name. He took a moment before turning around.

"When your wife came in here," Don said, "didn't I take excellent care of her? I mean, didn't I do everything that any excellent doctor would have thought to do? That you would have thought to do?"

It took David a moment to find his voice. His right hand instinctively went to his wedding band, which he still wore. "Yes," he finally said. "You did."

Don took a bite of banana and David felt his impatience growing as he waited for him to chew and swallow. Don gestured with his hand, the banana peel flopping over his thumb. "Let's just give the devil his due, all right?"

Too disgusted to respond, David walked back toward the CWA. In the hall, Diane was talking Carson through the process of putting a shoulder back in joint, letting him use her arm to practice the motion. David passed the nearest doorway and saw a young man in a UCLA tank top on the gurney inside, cradling his right arm, the shoulder clearly out of joint. If the kid knew the medical student resetting his arm was practicing the gesture for the first time two feet from his line of sight, he probably would've gotten up and walked out of the building.

"I hear you ducked out of tying sutures again this morning, Dr. Donalds," David said.

Carson looked up sheepishly. "The kid was a little uneasy. I didn't want to cart out a big needle or anything and freak him out."

"Oh. So you used Dermabond for his benefit."

"Exactly."

David pointed at him, mock authoritatively. "You're going to be my first professional embarrassment if you don't learn to stitch by the end of this rotation. Next windshield job we get in here, you're tying every last suture."

Carson gloomily returned to practicing on Diane's arm. David saw her cringe when he rotated it too briskly, and felt a fresh wave of sympathy for the injured kid. Hands-on training. Despite its drawbacks, the only way to train doctors.

When David swung into the CWA, Don was fielding questions and folders from a flurry of clerks and nurses. Pat was holding Don's arm a little too firmly, her face drawn tight. "I really think you should give Lembeck in Three something for the pain."

Don tapped Pat's shoulder with the chart and gave her a brief smile. "If you want to fly the plane, you really oughta be a pilot." Using the chart, he pushed her gently toward the door. "We need a vaginitis whiff test in Exam Eight."

"Carson told the wrong Martinez she was pregnant," one of the clerks said.

"I did not," Carson yelled from the hall.

"Poor girl was only fifteen." The clerk imitated a girl's crying voice: "But I only kissed him," he wailed.

"Jesus," Don said. "Always double-check the Martinezes and the Ramirezes. They all lo-- " He caught David's glare and cut off his sentence midthought.

Jill appeared before David out of nowhere. "Houston, we have a problem. Gunshot wound in Four. He claims he has no insurance and would like to pay in cash."

"A GSW?" She nodded, and David quickened his pace to keep up with her. "Location of the wound?"

She swung open the door, revealing a man with a clean-shaven head, lying facedown in a gown on the gurney. He did not look up.

"Rear end," Jill said.

WHEN David closed the door, the man rolled onto his side and regarded him with red, mouselike eyes. Though his scalp was shaven clean, David could see from his eyebrows and the tint of the stubble that he was a redhead. The Kinko's hero.

"What's your position here?" he asked.

"Why?" David said. "Am I in trouble?"

"Are you the attending?"

"I am." David picked up the chart, noticing much of it was blank. "And you are . . . ?"

The man glanced nervously at the closed door. "Ed Pinkerton."

"Ed Pinkerton," David said, writing it down. "That'll do."

"Look, I had an accident cleaning my gun and shot myself."

"In the ass?"

"Yes. In the ass. I would prefer that we handle this quickly, and with as few people as possible. Getting through the press outside made me nervous enough."

"Depending on how deeply that bullet is lodged, I may have to call surgery."

Ed swung his legs down, leaning heavily on his hands to keep the weight off his rear end, and found his feet. "I'm sorry," he said. "Maybe this wasn't such a good idea."

He grabbed his shirt from the chair and started putting it on. The shirt had been covering a red book. The title caught David's eye--Wiretapping and Electronic Surveillance. A bookmark with a logo that appeared to be a brain protruded from between the pages. Ed quickly draped his pants over the book, hiding it again.

David went to rest a hand on Ed's shoulder, then thought better of it. "Listen," he said, "let me take a look. Maybe I can handle it down here."

Ed held his eyes for a moment, as if deciding whether he could trust him. "You won't call PD?"

"I'm vaguely familiar with your history," David said. "This was a gruesome copy accident, correct?"

Ed grimaced. "A day at Kinko's gone terribly awry." His skin was almost impossibly pale; the blue cubital veins forked through the soft underside of his forearm like roads on a map. Ed studied the ceiling for a moment. "I won't bullshit you," he finally said. "I'm on parole, and I've been making good for me and my little girl. I shouldn't have gotten involved the way I did, breaking up that robbery. I wanted to protect the workers in there, but I don't know how this'll play to my PO. It'll probably be fine, given the eyewitnesses and all, but I'm not eager to find out. I'd appreciate your help here."

David studied his face, searching for signs of dishonesty. He decided he liked what he saw. "If I report the gunshot wound, you're going to limp out of here before the cops show up. Given that your injury was sustained on the right side of the law, I'd rather have you walk out upright." He nodded once, slowly. "Deal?"

Ed ran a hand over his bald scalp. "Deal."

He lay back down and David parted the gown in the back and examined the wound. "Someone's been prying at this," David said.

"My buddy got the slug out with a pair of snub-nosed pliers."

"A .38?"

"Yeah. But it wasn't a full slug."

"How can you tell?"

Ed looked up at him, blank-faced.

"Okay," David said. "Stupid question. So we're dealing with fragments."

David spread the wound slightly to examine it, and Ed didn't so much as flinch. David removed a blanket from a cupboard and tossed it to Ed. "I'm going to have to get you down to fluoroscopy."

"Is it on this floor?"

"Yes." David kicked the foot paddle on the gurney to the right, releasing the brake, and slowly backed the gurney out the door. Lying on his side, Ed pulled the blanket up tight to his chin so it blocked most of his face, and turned his head into the pillow.

David signaled Diane to follow him when he wheeled Ed past the CWA, and she came quickly, tapping a chart against her thigh. He immediately noted the firm set of her mouth. "What's the problem?"

"Fifty-five-year-old Greek woman came in with some acute anxiety. I'd like to hold her until she settles but her insurance won't cover it." Diane looked down at the gurney as it rolled along, noticing Ed for the first time. "Hello."

Ed nodded, a brief movement of his half-buried head.

David took the chart from Diane and glanced it over. He pulled a pen from behind his ear, crossed out acute anxiety, and wrote acute shortness of breath with a secondary diagnosis of anxiety. He handed the chart back to Diane and winked at her. "Problem solved."

They banged through some double doors and weaved their way through the labyrinthine corridors of Level B.

"One of the great advantages of ER medicine is our freedom to exercise our own discretion." David glanced down at Ed. "Isn't that right, Mr. Pinkerton?"

Ed's beady eyes watched him with amusement from the Ewok swathing of the sheets.

"Not always," Diane said. "The Director of Health Sciences Communications just issued a memo to all employees reminding us of the 'long-standing policy that all media interaction is to be conducted through the HSC office.' "

David whistled. "The board must be leaning pretty hard."

"Having lye flying around probably provides a good pucker factor," Ed said.

David banked the gurney right into the fluoroscopy suite, and he and Diane donned leads to protect themselves from the radiation. He positioned Ed on his back, swung the X-ray arm over his right buttock, and stared at the small screen of the monitor. The two bullet fragments stood out white against the gray bones, just medial to the head of the femur.

"You were right," David said. "Two frags."

From the look on Diane's face, she had put together the patient with the news story. She took a moment to grab the silver forceps David was offering her.

"The wound is superficial enough that I think we can handle it here," David said. "A lot of tissue protecting the bone back there. Does it hurt?"

"It's not pleasant." Though beads of sweat dotted Ed's bare scalp, his face showed no sign of pain. When Diane inserted the metal forceps into the wound and angled down toward the first bullet fragment, they too showed up white on the monitor.

David directed Diane with a gesture, then indicated how she could hold the forceps for better control. She followed his instructions perfectly, her tongue poking out her cheek in a point.

"How old are you, Mr. Pinkerton?" David asked.

"Thirty-nine."

"Have you been screened for prostate cancer?"

"If this is an excuse for giving me a rectal, I don't date doctors." Ed's first grimace lit his face as Diane dug deeper with the forceps. "No," he said. "I haven't."

Diane glanced up at David, one eyebrow raised in an unasked question. Probably wondering why he was raising the issue when prostate screening usually didn't start until age fifty. "Any family history?" David asked.

"No."

"Well, sometime in the next few years, you might want to get checked out. Think of it as the fifty-thousand-mile tune-up on your car."

The first bloody bullet fragment plunked down on the metal tray. Biting her lip, Diane eased the forceps back in the wound.

Ed's hand clenched into a fist, then released. "I'll bear that in mind," he said.

The curtains separating the five exam areas in Exam Fifteen rippled each time a gurney zipped by. After wheeling Ed behind the fourth curtain to get bandaged, his chart balanced across the bumps of his feet, David had been pulled into the next section, Fifteen-Three, by an imploring Persian mother to examine her little girl.

With a broad, smiling face and brown, almost liquid eyes, the girl ran circles in the small space between the curtains, singing, her jarring footsteps causing her voice to vacillate as if she were yodeling. She stopped, swaying on her feet, and laughed. Her mother drew her back against her legs, ruffling her hair, then wet a finger and wiped a smudge off the girl's cheek.

David removed his white coat so as not to intimidate the girl, and crouched so he was eye level. Meeting her on her own terms.

Following his cue, the little girl squatted also. David laughed. "No, hon, you don't have to crouch. I'm just trying to get a better look at you."

After an openmouthed burst of laughter, the little girl fell down and sat Indian-style. With one hand on the floor, David eased himself down so he too was sitting, his legs kicked awkwardly to the sides. The girl's mother covered her mouth to hide her smile. The girl laughed again and grabbed his hand with both of hers.

David slid the stethoscope from his shoulders and around his neck with a single practiced movement, spreading the branch with one hand and wiggling his head until the earplugs settled correctly. There was always some comfort in feeling the heavy instrument fall into place, like a well-worn wallet sliding into a back pocket. "I'm just going to--"

"Dr. Spier?"

David turned to see Officer Jenkins and another, older officer standing behind him. "This is a private exam area," David said, scrambling to his feet and feeling more than a little foolish. "Your sister has been moved to--"

"We received a call about a gunshot wound," Jenkins said.

"You did?" Beneath the curtain beside them, David saw Ed Pinkerton's feet hit the floor. "I don't recall calling one in."

"You didn't. We were contacted by triage. You know, you're required by law to--"

"I know, I know. Do you handle all calls involving the hospital?"

"You might say I've taken a particular interest."

"I can understand that."

The older officer, Jenkins's partner, stepped forward, and David noticed two stripes and a star on his sleeve. His name tag read: BRONNER. "We need to question the patient," Bronner said gruffly. "The one who sustained the GSW."

Ed's foot disappeared and came back down ensconced in an untied shoe.

"Why don't you follow me out to the CWA?" David said. "We'll check the board and see where he is." David crouched near the girl, and she followed his lead again, laughing. He smiled. "I'll be right back."

The officers followed him silently down Hallway One into the Central Work Area. David perused the board, finding Ed Pinkerton's name. "Fifteen-Four," he said. "Looks like he was one curtain over from us."

The cops exchanged a look, which David pretended not to notice. Another silent walk back to Exam Fifteen. David pointed to the curtain to the fourth exam area. "Behind there."

The curtain rattled on its pegs as Jenkins swiped it aside. An empty gurney. A single spot of blood stood out on the sheets. David feigned exasperation. "I don't know . . . I never discharged him. He must've snuck out on us." He turned to the officers, letting his hands slap to his sides. "I don't know what to tell you."

Jenkins clenched his jaw, speaking through his teeth. "This patient was one curtain over and you didn't know it?"

"There are a lot of patients here under my care. It's sometimes difficult to keep track of them all."

Jenkins held David's gaze. "Right."

"Sorry about that."

"Word around the station is you're not always the biggest team player."

"I guess that depends what team."

Bronner tapped Jenkins on the back. "This is a jerk-off," he said. "Let's go."

Jenkins didn't seem ready to leave.

"You know we don't give a shit about the GSW," Bronner said. "C'mon."

Jenkins took a step back. "I'll see you around, Doctor."

David nodded, and Jenkins followed his senior partner out. David realized he'd been holding his breath, and he exhaled deeply.

A slip of paper beneath the empty gurney caught David's attention, and he bent to pick it up. It was the bookmark he'd noticed earlier marking Ed's place in the small red book. A sketch of a brain, evidently a logo, decorated the top, the cerebral hemispheres slightly misshapen. AMOK BOOKSTORE was written beneath it in an odd Aztec print. David's eyes traced down the length of the bookmark, finding the strange motto at the bottom. THE EXTREMES OF INFORMATION.

He knew before he glanced beneath the turned-back sheets that Ed's chart was missing.