Doing Harm (24 page)

“I know where the potassium came from,” I hear myself say.

This is crazy.

“What?” He shifts his weight and regards me curiously.

“The potassium. I know where the potassium came from.”

“Okay.” He crosses his arms. “Try me. From where?”

And suddenly I’m telling him. Everything. At first, I just mean to give him a few snippets, carefully edited pieces that play down the absurdity of my predicament. But then, my tongue loosened by the IPA, it all comes tumbling out in a steady stream of consciousness, my mouth speaking before my brain even knows that it’s forming the words. It’s like somebody else is doing the talking for me.

Luis listens attentively, leaning in close, his face emotionless and unreadable, bland even, as I quickly relate all of the events of the past forty-eight hours. He reacts only once: when I get to the part about having sex with GG, he blinks long and hard and offers a noncommittal grunt.

It takes less time than I would have thought. Or maybe it’s just my inebriated perception of time. In any event, when I’m finished, I don’t know whether to feel relieved to get it off my chest or horrified by my impulsiveness. I try to stop the shaking in my hands with a big swallow of beer.

For his part, Luis simply nods, uncrosses his arms, runs a hand over his smooth scalp, finishes his soda, and says, “Okay.”

“
Okay?
That’s all you have to say?”

“At the moment.” He places the empty soda can on a nearby table. “Yes.”

“B-but!” I sputter, “Don’t you—”

“Not now,” he mutters. “Here comes Dan.”

Dan McIntosh—the general-surgery resident married to Nancy the lawyer, the same one who called me last night from the OR to help with the gunshot wound and who I saw screwing around with a nurse outside the call rooms—is indeed ambling toward us across the lawn, holding a beer and greeting guests along the way. Dan is handsome in a bland kind of way. He’s like a preppy high-school bully from a 1980s teen movie, an impression accentuated today by his unfortunate choice of wardrobe: an untucked pink Izod shirt with the collar turned up, turquoise-colored shorts, topsiders without socks, and mirrored aviator sunglasses. He’s fit but not bulky, with straight blond hair combed over in a neat part and sharp, all-American features lifted directly from fraternity row or the varsity locker room.

He flashes a toothy smile that stretches beneath his mirrored glasses in a configuration reminiscent of the Cheshire cat. A smaller, distorted version of myself regards me from each separate lens of the glasses.

Dan is the type of guy who walks around with a perpetual self-satisfied smirk on his face. I’ve always kind of liked him though. A lot of general surgeons like Dan have attitude. I don’t really hold it against them. They are what they are. It takes balls to cut people open for a living, and I think the size of the balls required to get the job done right is in direct proportion to the chances of killing the person you’re cutting open. General surgeons routinely do some of the biggest, riskiest operations on some of the sickest people around. So attitude? No big deal, in my book.

“Steve. Luis. How’re you guys doing? Thanks so much for coming.” Dan’s back is ramrod straight, broad shoulders square, chest puffed out.

“Hey, Dan.” I take his extended hand. His grip is strong, and I surrender to a juvenile urge to exert a manly squeeze in return. Or what I hope in my intoxicated state passes as manly. The awkward pause that follows, with him grinning his Cheshire-cat grin, makes me realize that he’s waiting for me to say something. “Uh, thanks for having us over.” I cough. “This is a great party. The kids are having a blast, especially with the jumpie.” I wave my hand toward the moonwalk, in which a bunch of kids are bouncing around like popcorn popping in a tub. A corner of my mind hazily notes that Katie is no longer with them and wonders if I should track her down.

She’s fine. Whatever.

“No problem, no problem,” Dan says silkily. “It’s all about the kids. Kids love jumpies.” His head is already swiveling toward Luis, and the distorted, dual images of me in his sunglasses are replaced by reflections of Luis. “What’s up, man?”

For the first time since I’ve known him, Luis breaks into a genuine, unguarded smile. He and Dan exchange an affectionate and bearish man hug, replete with several thunderous back swats.

“Just talking with my boy here,” Luis says casually.

“Ha! Your boy. Well,
your boy
and I were up late last night in the OR patching up a gangbanger whose dick ended up on the wrong side of a .38 Special. A newly minted member of the gun-and-knife club who’s half the man he used to be.” He throws his head back and laughs and claps me on the shoulder. At the same time, something flits across Luis’s face, like a dark cloud racing across the sun on a summer day. It’s gone almost as soon as it appears.

Dan doesn’t notice. “Apparently, some of his buddies came looking for him late this morning hoping to finish off whatever it was they had started out on the street. Did you hear that?” I shake my head. “Yeah.” He nods sagely. “I wasn’t there, either, but I heard that Security kept things from getting out of hand.” Because of a continuous stream of patients like Male X, the University Hospital Security team is like its own police force: armed to the teeth, well trained, and intimidating as hell. “It’s a good thing they keep the SICU locked down so tightly,” he continues. “Between the nurses and the Security guy at the front desk, nobody so much as sneezes in there without someone’s say-so.”

“Hey, speaking of things going wrong,” Luis says conversationally. “I heard you guys had a big flail back in May. Something about a patient’s dying because of a major medical mistake? A patient-safety thing?”

Despite the heat of the day, and the alcohol percolating through my system, I suddenly feel very cold and struggle to maintain a straight face.

What’s Luis doing
?

Dan grimaces. “It was ugly. A total fucking flail, bro’.”

“Really?”

Dan’s wife Nancy, she of the scheduling board and tight white skin, appears with Sally, who is drinking Perrier from a glass bottle. Nancy and Luis hug, and I introduce Sally to Dan and Luis. Sally explains that Annabelle and Katie are now inside under the watchful eye of Nancy and Dan’s nanny.

“What are you guys talking about?” Nancy asks.

“That patient who died in May. Did I tell you about him? No? Well, we were rounding one morning when we found one of our patients completely unresponsive. We tried to resuscitate him, but it was no good.”

“So what happened?” Luis prompts.

“The central line. One of the unused ports was uncapped. It was completely open to the air for at least an hour. Maybe more.”

Luis grunts. At the same time, I suck air into my mouth while gritting my teeth, which produces a loud and protracted hiss—
much
louder than I anticipated or intended. Sally glares at the half-empty beer bottle I’m still clutching. The others stare politely. I cough and self-consciously place the bottle on a nearby patio table … and promptly knock it over as I clumsily, drunkenly, draw my hand away. I try to pin it down and right it as it rattles noisily over the top of the glass table, but I only make things worse, and it’s about to roll off the edge of table and smash on the concrete when Luis adroitly snatches it and throws it in a garbage can.

“Pulmonary air embolus?” Luis asks, wiping the beer off his hands with a napkin. Dan nods.

“What’s an air bolus?” Sally asks.

“Air
embolus,
” Dan gently corrects, smoothly launching into an impromptu lecture. “An embolus is something that blocks a blood vessel. If you think of blood vessels in the body, arteries and veins, as pipes, and blood as water flowing through those pipes, an embolus is like a big hairball clogging a pipe. An air embolus is a clog made out of air. So just like when water backs up in a clogged pipe, and overflows the toilet or kitchen sink, the blood backs up behind the air bubble and bad things start to happen.”

“What kinds of bad things?”

“It depends on where the blockage is. Most of the time, it’s something called a pulmonary embolus, when the flow of blood from the heart to the lungs is blocked.”

“How can air get into the blood?”

“The bends. If a diver comes up too fast, nitrogen in the bloodstream that’s been compressed by the pressure of being deep underwater suddenly expands and forms air bubbles. Or, in this case, it was a central line going into the patient’s internal jugular vein.” He taps the right side of his neck. “We put large catheters in big veins a lot, especially in the ICU. It’s real important to keep air from getting inside them. In this case, somebody left the cap unplugged, which means that there was a direct connection between the patient’s bloodstream and the air in the room.”

“Was the patient upright?” Luis asks.

“Yeah. He was sitting in a chair.”

“Makes sense. Each time he inhaled, negative pressure formed between his chest and the atmosphere. It would have sucked air through the catheter and into the internal jugular vein like a big vacuum cleaner.”

This lecture’s getting old.
“So what happened?” I ask Dan impatiently.

“We ran the code and everything, but the patient never really had a chance. He was already dead when we found him.” He shrugs. “What’s really been killing me is the paperwork. Have you guys heard of the Safety Committee?”

I scratch my ear and look the other way. Luis silently straps on a poker face.

“Yeah, well, be grateful. What a bunch of freakin’ Nazis. They had me fill out a ton of reports, then grilled me until they were convinced I had nothing to do with what happened. Anyway, it’s been a pretty big deal. I heard the family was already talking major lawsuit and that University just anted up right away.”

“I don’t doubt it,” says Nancy in a crisp, lawyerly voice. “It’s the smart move. University wouldn’t have had a chance with a jury. Not to mention all the negative coverage in the media. Who left the cap off the line?”

“Nobody’s talking.” His eyes are unreadable behind the glasses. “Maybe a nurse.” He shrugs. “We all make mistakes.” But something about his shrug conveys a tacit
except me.

Nancy politely excuses herself, hugging and air kissing Sally before floating off to greet other guests. Dan and Luis start talking baseball, good-naturedly ribbing each other about the Dodgers and Red Sox, respectively.

Sally grabs my elbow. Her fingers dig into my skin as she leans over and hisses in my ear that it’s time for us to go. We say our good-byes. Dan smiles his shark smile and crushes my hand in his. Luis, betraying no acknowledgment of our prior conversation, offhandedly tells me he’ll see me in the cafeteria tomorrow morning.

Sally and I collect Annabelle and Katie from the nanny and walk out to the car. Sally maintains her composure for the girl’s sake, but I can tell from the subtle accents in her body language that she is
pissed.
“So,” she quietly fumes, as we settle the kids into their seats. “Did you have a good time hanging out with your drinking buddies?”

“I had—a bad week,” I return lamely.

“And the mature and appropriate response is, of course, to get drunk in the middle of the day. In front of everybody. Leaving me to keep an eye on the girls. What were you thinking, Steve?”

“I’m sorry. I’m really sorry.”

Her face is as dark and forbidding as a line of thunderheads on an August afternoon as she secures Annabelle into her car seat. “Nancy and Dan invited us over here for a dinner party next Saturday. So I sure hope next week goes better for you.” She secures the last strap in place with a decisive click, slams the door closed, and climbs into the driver’s seat.

The mood in the car on the ride home is silent and dreary. Sally grips the wheel, clenching and unclenching her fingers, staring intently at the road. Katie and Annabelle are uncharacteristically quiet, perhaps sensing the tense atmosphere.

I gaze out through the open car window. The air blowing in is warm and comfortable, laced with the earthy scent of summer foliage. Afternoon sunlight plays through bright green leaves. The pleasant scenery stands in mocking contrast to both the bleak ambiance inside the car and the wreckage of my life.

Confiding in Luis was definitely a roll of the dice, and I don’t know quite what to make of his reaction to my story earlier. How tomorrow will play out at work, with me and GG and Luis all thrown together under this new and utterly bizarre set of circumstances, is anyone’s guess. And then there’s the whole matter of that confidential file in his personnel folder. What the hell is that all about?

I try to figure out my next step. But my beer high is wearing off, and fatigue creeps through me, like a late-day fog moving inland from the ocean, probing and spreading vines of mist across the coast. Biochemically speaking, alcohol is a depressant, which is why people can so quickly yo-yo from life of the party to passed out senseless on the floor. I’m quickly heading for the passed-out-senseless-on-the-floor phase.

And it’s more than just the alcohol. I’m tired. Bone tired. Every limb in my body aches. The human brain and body can only take so much punishment at a time. It’s a physiologic fact. My brain and body, racked by stress, are running on fumes and are starting to shut down.

When we get home, I help Sally unload the girls from the car and get them settled inside. By now, I’m so mentally and physically exhausted that I’m barely able to help Sally feed the girls, bathe them, and get them in their pajamas before I stagger to our bedroom, kick off my shoes, sprawl across the bed with my clothes on, and give myself over to a dreamless sleep.

CHAPTER 10

Monday, August 10

I decide that I can’t handle my usual breakfast meeting in the cafeteria with Luis and GG. It would be too much weirdness all at once, trying to keep up some pretense that things are somehow still normal after the events of the last seventy-two hours—particularly in front of the only other two people in the world who know they’re not.