The Inquisitor (3 page)

Jimmy pointed to the heavens and shook his head. "You know, that's what He keeps telling me."

This got him a round of applause.

"Make your point, Jimmy," Earl muttered none too quietly. He was impatient to say his own piece so he could get the hell back and reassess the man he'd left in ER.

The chaplain gave him a nod. "Not to take up any more of your busy morning, but I'm here to invite you all to our annual Run for Fun this Saturday. That's when you, healthy, young, and strong, get to put your professors, weak, old, and flabby- well, some of them, anyway- to shame by humiliating them in a two-K jaunt through scenic downtown Buffalo, entirely in the name of charity. Oh, by the way, the lot of you will be pushing hospital beds, each complete with a simulated patient and half-full bedpan from which you must not spill a drop. Thanks for your time."

Earl joined in the clapping, ready to take the stage, when the overhead PA crackled to life.

"Drs. Garnet, Deloram, Biggs- ER; Father Jimmy Fitzpatrick- ER stat!"

Artie Baxter, the stockbroker, lay on his stretcher frowning and blinking furiously. He couldn't speak because of the tube in his throat, and he breathed thanks to a respiratory technician who kept ventilating his lungs with an Ambu bag, twelve squeezes to the minute. J.S. provided the chest compressions, five at a time, strands of her thick black hair slipping from under her cap and flopping over her forehead as she worked. A cloying scent of singed flesh hung in the air despite the gobs of contact gel that glistened in the tight curls on Artie's chest, and his cardiac monitor showed the zigzag line of a fibrillating heart.

"We were on him so quickly when he arrested, he never lost consciousness," Susanne whispered to Earl.

At her side stood a heavyset, pear-shaped man with worried, tired-looking eyes and the edges of a salt-and-pepper beard sticking out the bottom of his mask. Dr. Michael Popovitch was a longtime friend, director of the department's residency program, and acting chief of ER during Earl's many absences. He'd once shared the fire in the belly that's a prerequisite for long-term survival in emergency medicine, but lately the cases seemed to weigh heavily on him. Each month his gaze grew a little sadder. "We've maxed him with epi, Lidocaine, procainamide- every antiarrhythmic we have," he said, terse and to the point, "and shocked him silly. Bottom line, nothing's worked."

The causes of refractory V-fib. automatically flashed through Earl's mind. "How's his potassium, sugar-"

"No metabolic problems," Michael cut in, "other than a slightly high glucose after the bolus you gave him-"

"An overdose, maybe?" Stewart Deloram interrupted, inserting himself as part of the huddle. "Tricyclics, aminophylline, speed…" He rattled off the drugs that might precipitate this kind of arrest.

Thomas Biggs stood a little off to one side. He watched the proceedings but offered no suggestions.

Earl found his own attention drawn to Artie's eyes as they blinked more furiously than ever. Leaning directly over his face, he said, "Close your eyes once if you can hear me, Mr. Baxter."

The fluttering stopped. The lids closed and opened.

"Do you see me?"

They closed and opened again. Then he stared at Earl, his pupils wide with fright, seeming to want an explanation.

Earl shivered. This happened every now and then, the patient's heart not beating, the lungs not breathing, but the brain kept alive and conscious with CPR. Only he'd never seen someone in such a state remain so alert before. "Let's be careful what we say, guys," he cautioned.

Stewart continued to expound his list in a much lower voice.

"Tox screen isn't back yet," Michael interrupted, "but I emptied a vial of bicarb into him in case he'd OD'd on tricyclics. Combined with the rest of what we tried, he's had every antidote there is." Again, right to the point. Whatever sapped his spirits these days, his skill stayed as sharp as ever.

But Artie's eyes, so pained and aware, drew Earl's attention away from the discussion.

Jimmy stepped up and spoke into the man's ear. "I'm the hospital chaplain, Mr. Baxter. Is it all right if I say a prayer with you?"

Artie showed no response.

Still locked into the man's stare, Earl felt it pull him in, like a tether. Perhaps he hadn't heard Jimmy's question. "Are you Catholic, Mr. Baxter?" he asked.

Two blinks.

"Is that a no?"

One blink.

"Do you have any pain?"

No response.

The resus team kept pumping and ventilating him.

Stewart discussed options with Michael.

"… float a pacemaker wire into his heart, hook the myocardium, and try to recapture a normal rhythm."

"Go for it," Michael said, pivoting on his heel and rushing toward the door. "I'll get the pacemaker."

Earl remained barely aware of them, transfixed instead by the black, bottomless pools at the center of Artie's eyes that beckoned him closer. What did he want? "Dr. Biggs, if you'll help me get a line through the right subclavian," Earl said, turning away, "Stewart can go in with the pacemaker from there." In order to function he must distance himself. A lifetime in ER had taught him how. But he knew that Artie was still looking at him. He could sense the patient's stare burrowing into the back of his skull.

Thomas must have felt it too. He hesitated, and the surface of his mask rippled as he clenched his teeth. Then he snapped on a sterile pair of gloves over his regular ones and got to work.

In seconds Thomas and Earl had inserted a needle the size of a three-inch nail through the skin below Artie's right clavicle and into a vein the caliber of a small hose.

Michael returned with the pacemaker equipment, and the three ER physicians stood back to let Stewart perform his magic.

Already double-gloved and -gowned, he delicately threaded a sterile pacemaker wire through the needle sticking out from beneath Artie's clavicle. Throughout the entire procedure, he eyed the monitor for evidence that he'd passed the wire through the vein, maneuvered it into the heart, and hooked its tip into the wall of the first chamber. He asked J.S. to stop pumping, and the sounds of her exertions ceased. The hiss of the ventilating bag as the technician squeezed a volley of air into Artie's lungs and the lilting beauty of Jimmy's voice while he murmured the Twenty-third Psalm became the only noises in the tiled chamber.

Earl watched the priest stroke Artie's head and thought, A special kind of man. He could laugh and joke, yet remained fearless when it came time to comfort the sick, the suffering, and the dying, and he pulled it off day after day. That took a rare brand of courage. Even people of faith could get too close to the ones they tried to help. Earl had seen the fear and suffering in ER overwhelm men and women of God as often as it broke many fine physicians. Yet Jimmy never appeared to flinch from it.

Stewart continued to manipulate the pacemaker wire, but the monitor showed no change, and the pattern remained ragged as a saw's edge.

He nodded to J.S., and she resumed pumping.

A familiar icy tightness gripped Earl in the pit of his stomach as the sense they weren't going to make it crept through him.

But Artie's eyes remained open. Imploring. Beseeching.

Stewart laid down the wire, glanced over to Earl, and silently shook his head.

J.S. continued to pump, her expression questioning him whether to stop for good.

Artie began to blink wildly again.

He knows he's going to die, Earl thought. Time to sedate him. Otherwise the instant they called off CPR, he'd suffocate, awake and aware. It would be like strangling the man.

"Get me ten milligrams of IV midazolam," he told Susanne.

Her eyes widened, but she went to the medication bin and proceeded to draw up the syringe.

"For the record," he said quietly, scanning the aghast eyes of those watching him,

"I'm going to make him comfortable, then withhold any further treatment, including CPR, on the grounds it's futile." Without saying it outright, he'd declared they were not about to commit active euthanasia. To the lay person it might sound like word games, but because he was invoking a physician's right not to inflict useless interventions on a patient, Artie's resulting death would be considered natural under the scrutiny of law.

The frowns on everyone told him they felt otherwise. "Anybody have a better idea?" he asked.

Michael, Stewart, and Thomas grimly shook their heads.

Susanne, J.S., and the respiratory technician did the same.

"Mr. Baxter objects," Jimmy said.

Earl bristled. "For the love of God, Jimmy, you know the rules as well as anyone."

"At least have the decency to look at the man while you decide his fate."

Nobody else said a word.

Earl forced himself to meet that dark, fluttering stare.

Artie repeatedly blinked his eyes in couplets. No! No! No! they screamed, brimming with agony.

Earl's heart gave a wrench. "But we can't help him," he whispered to Jimmy. "At least I can make sure he doesn't surfer."

"Tell your patient, Earl."

Artie stopped blinking and glared at him.

Oh, God, thought Earl. "Mr. Baxter, you know we tried everything?"

He blinked yes.

"I'll make you comfortable-"

Two quick blinks cut him off.

"But-"

"I think he wants something," Jimmy said.

A single blink. Yes.

"You want what?" Earl asked. He couldn't think of anything else to say.

Artie responded with a scowl of disgust.

"Something medical?"

No.

"What then?"

The desperation in Artie's stare grew.

Then Earl knew.

"Your wife?"

Tears welled out of Artie's eyes. Yes, he blinked. Yes! Yes! Yes!

"Is she here?" Earl asked.

"In the waiting room," Susanne replied. Her voice sounded as if her windpipe had tightened to the size of a straw.

"You want to see her, Artie?"

The hideously slack face of the dying man had already acquired the consistency of cold mud. Yet it shifted ever so slightly, and Earl swore he glimpsed relief in those amorphous features. Yes! he blinked.

"Then we'll get her for you," Earl said.

Susanne hurriedly retrieved a chair from the corridor and placed it by the stretcher in case Artie's wife couldn't stand.

The other physicians quickly wiped the blood from IV sites and covered the needles sticking out of him with plasters, much the way they would clean up a body before letting the family view it.

Artie's eyes strained to follow the preparations, then stared at the ceiling with a spine-chilling calm.

Earl tried not to imagine his state of mind. "Your arms must be getting tired," he said to J.S., whose forehead glistened with sweat. He found the heat of the extra wear suffocating at the best of times. It would be near unbearable with the sustained physical effort she'd been making.

"I'm fine."

He believed her. She'd kept the rhythm of her chest compressions rock steady the whole time.

When they had everything set, he went to meet Mrs. Baxter. A few of Susanne's nurses had stayed with her in an interview room.

When she looked up as he entered, tiny lines feathered out from the corners of her eyes in her attempt to smile. The rest of her tanned, round forehead had the leathery look of someone who spent a lot of time outside. Petite and lean, she appeared at least a decade younger than her husband.

As he took a breath to speak, he cursed what he hated most about the new reality at St. Paul's. His gloves, mask, and gown created more than a stifling physical barrier to keep germs from passing between people. It blocked communication. She couldn't read his face any more than he could read hers, and she would hear the worst possible news from an invisible voice. He loosened the ties and tugged his mask below his chin.

Unbidden, she did the same. Her cheeks and mouth were as fine-lined as the rest of her, and rigid with fright.

As Earl explained Artie's hopeless situation, her features seemed to implode, and he took her arm to offer support. She felt as flimsy as a hollowed-out husk.

"I'm all right," she insisted.

He didn't think she even noticed when he replaced her mask and redonned his own.

At the door to the resuscitation room she gasped when she saw Artie, but her step never faltered.

Artie's eyes bulged at her approach and filled with tears again.

"Oh, baby," she whimpered, and sank into the chair, then leaned forward to cradle his face between her hands. She looked up briefly at Earl. "How long do I have?" she asked, her voice faint yet eerily smooth, almost matter-of-fact.

"For as long as he's conscious," Earl said.

J.S. nodded in agreement.

The woman once more lowered her mask and started to murmur Artie's name, over and over. Then she leaned forward and kissed his eyes, enclosing him in the privacy of her dark hair as it cascaded around his face. She began to speak of love, of all she adored in him, of forgiving the hurts they'd caused one another, of how proud she'd always been to be his wife…

Jimmy withdrew and herded anyone else out of the room who no longer had anything to offer.

J.S. and the respiratory technician continued to work in tandem.

Earl attempted to back out of earshot, yet stayed close enough to intervene if Artie started to seize or choke. Without trying to, he heard enough to think Mrs. Baxter couldn't have been more eloquent if she'd had years to compose her words.

Twenty minutes later Artie Baxter peacefully closed his eyes for the last time.

"I wish I could have asked him a few questions," Stewart said to Earl afterward as they wrote up the chart in the nursing station.

"What?"

"In all my research with post-cardiac-arrest survivors, I've always doubted how accurately they recall what they experienced. That's the trouble with after-the-fact retellings."

Stewart held the dubious honor of being America's expert on the near-death experience, having interviewed over a hundred patients who'd been resuscitated. Their accounts were all remarkably similar, echoing stories that individuals had related since the advent of modern resuscitation methods- rising above their own bodies, passing through tunnels, approaching bright lights- and Stewart claimed he'd demonstrated that these experiences had some basis in reality. But while his work on the topic had been in all the major newspapers and made him the toast of the afternoon talk shows on network TV, serious scientific journals savaged him for his articles. They accused him of betraying his reputation for serious science and considered his data to be the equivalent of alien abduction stories, nothing more than anecdotal evidence of mass hysteria better suited to the National Enquirer than the National Science Review.