Life Support Page 11

  In a phone booth she found a Boston directory. In the Yellow Pages was a listing for a Planned Parenthood clinic, on the other side of town.

  I’ve gotta think about myself. Because no one else does. No one ever has.

  She rode the bus, transferring twice, and got off a block away from her destination.

  There was a crowd of people standing on the sidewalk. Molly could hear them chanting, but she couldn’t understand the words. It was just a noisy chorus of voices, rhythmically punching the air. Two cops stood off to the side, arms crossed, looking bored.

  Molly halted, uncertain whether to approach. The crowd suddenly turned its attention to the street, where a car had just pulled up at the curb. Two women emerged from the building and moved swiftly, defiantly, through the gathering. They helped a frightened-looking woman out of the car’s passenger seat. Locking arms around her, they started back toward the building.

  The two cops finally moved into action, pushing into the fray, trying to clear a path for the three women.

  A man yelled: “This is what they do to babies in that building!” and he threw a jar down on the sidewalk.

  Glass shattered. Blood splashed across the pavement in a bright, shocking spray of crimson.

  The crowd began to chant: “Baby killers. Baby killers. Baby killers.”

  The three women, heads ducked, blindly followed the cop up the steps and into the building. The door slammed shut.

  Molly felt a tug on her arm, and a man shoved a brochure in her hand.

  “Join us in the fight, sister,” he said.

  Molly looked down at the brochure she was holding. It was a printed photo of a smiling child with wispy blond hair. We are all God’s angels, it said.

  “We need new soldiers,” the man said. “It’s the only way to combat Satan. We’d welcome you.” He reached out to her, fingers bony as a skeleton’s.

  Molly fled in tears.

  She caught a bus back to her own neighborhood.

  It was nearly five when she climbed the stairs to her room. She was so tired she could barely move her legs, could barely drag herself up that last flight of stairs.

  A moment after she’d flopped onto her bed, Romy shoved open the door and walked in. “Where you been?”

  “For a walk.”

  He gave her bed a kick. “You’re not doing a little on the side, are you? I got my eye on you, girl. I’m keeping track.”

  “Leave me alone. I want to sleep.”

  “You fucking around on your own time? That what you been doing?”

  “Get out of my room.” With her foot, she shoved him off the bed.

  Bad mistake. Romy grabbed her wrist and twisted it so savagely she thought she could feel her bones snapping.

  “Stop it!” she screamed. “You’re breaking my arm—”

  “And you’re forgetting who you are, Molly Wolly. Who I am. Don’t like it when you go off without telling me where you are.”

  “Let me go. C’mon, Romy. Please stop hurting me.”

  With a grunt of disgust he released her. He crossed to the old rattan dresser where she’d left her purse. Turning the purse upside down, he emptied the contents on the floor. From her wallet he pulled out eleven dollars—all the money she had. If she’d been turning tricks on the side, she sure wasn’t getting paid for it. As he stuffed the bills in his pocket, he suddenly noticed the brochure—the one with the picture of the little blond child. We are all God’s angels.

  He snatched it up and laughed. “What’s this angel shit?”

  “It’s nothing.”

  “Where’d you get it?”

  She shrugged. “Some guy gave it to me.”

  “Who?”

  “I don’t know his name. It was over by the Planned Parenthood. There was a whole bunch of crazy people out on the street, yelling and shoving folks.”

  “So what were you doing there?”

  “Nothing. I wasn’t doing nothing.”

  He crossed back to her bed and grabbed her under the chin. Softly he said, “You didn’t go and do something without telling me?”

  “What do you mean?”

  “No one touches you without my permission. You got that?” His fingers dug into her face and suddenly she felt afraid. Romy was speaking softly, and when he got quiet was when he got mean. She’d seen the bruises he left on other girls’ faces. The bloody gaps where their teeth had been. “Thought we got that straight a long time ago.”

  The pressure of his fingers brought tears to her eyes. She whispered, “Yeah. Yeah, I. . .” She closed her eyes, steeling herself for the blow. “Romy, I messed up. I think I’m pregnant.”

  To her surprise the blow never came. Instead he released her and made a sound almost like a chuckle. She didn’t dare look at him but kept her head bowed in supplication.

  “I don’t know how it happened,” she said. “I was scared to tell you. I figured I’d just, you know, take care of it. And then I wouldn’t have to tell you nothing.”

  His hand came down on her head, but the contact was gentle. A caress. “Now you know that’s not the way we do things. You know I take care of you. Gotta learn to trust me, Molly Wolly. Gotta learn to confide in me.” His fingers slid down her cheek, soft as a tickle. “I know a doctor.”

  She stiffened.

  “I’ll take care of it, Moll, just like I take care of everything else. So don’t you go making other arrangements. You got that?”

  She nodded.

  After he left the room, she slowly unfolded her limbs and let out a deep sigh. She’d gotten off easy this time. Only now, after the encounter was over, did she realize how close she’d come to getting hurt. You didn’t go against Romy, not if you wanted to hold on to your teeth.

  She was hungry again; she was always hungry. She reached under the bed for the bag of Fritos, then remembered she’d eaten them all that morning. She got up and rooted around the room for something else to eat.

  Her gaze fell on the picture of the blond baby. The brochure was lying on the floor, where Romy had tossed it.

  We are all God’s angels.

  She picked up the brochure and studied the baby’s face. Was it a girl or a boy? She couldn’t tell. She didn’t know much about babies, hadn’t been around one in years, not since she was a girl. She had only a vague recollection of holding her younger sister on her lap. She remembered the crackle of plastic pants over Lily’s diaper, the sweet powdery smell of her skin. How Lily had no neck, just that soft little hump between her shoulders.

  She lay down and placed her hands on her belly, felt her own womb, firm as an orange, bulging under the skin. She thought of the drawing in Linda’s picture book—the baby with the perfect fingers and toes. A Polly Pocket baby you could hold in one hand.

  We are all God’s angels.

  She closed her eyes and thought wearily: What about me? You forgot me, God.

  Toby stripped off her gloves and tossed them in the rubbish can. “All stitched up. Now you’ll have something to show the other kids at school.”

  The boy finally got up the nerve to look at his elbow. He’d had his eyes closed tight, had not dared even a single peek while Toby was suturing. Now he stared in awe at the nubbins of blue nylon thread. “Wow. How many stitches?”

  “Five.”

  “Is that a lot?”

  “It’s five too many. Maybe you should retire the old skateboard.”

  “Nah. I’d just bang myself up some other way.” He sat up and slid off the treatment table. Immediately he swayed sideways.

  “Uh oh,” said Maudeen. She scooped him up under the arms and lowered him into a chair. “You’re moving too fast, kid.” She shoved the boy’s head between his knees and rolled her eyes at Toby. Teenagers. All brag and no backbone. This one would probably strut into school tomorrow morning and proudly wave his new battle scar. He wouldn’t bother to mention the part about nearly fainting into a nurse’s arms.

  The intercom buzzed. It was Val. “Dr. Harper, they’ve go
t a Code Blue up on Three West!”

  Toby shot to her feet. “I’m on my way.”

  She jogged up the hall toward the stairwell, bypassing the elevator. She could make it faster on her own two feet.

  Two flights up, she emerged in the Three West corridor and spotted a nurse wheeling a crash cart through a doorway. Toby followed her into the patient’s room.

  Two ward nurses were already at the bedside, one holding a mask to the patient’s face and bagging oxygen into the lungs, the other nurse administering chest compressions. The nurse with the crash cart pulled out EKG leads and slapped contact pads onto the patient’s chest.

  “What happened?” said Toby.

  The nurse pumping on the chest answered. “Found him seizing. Then he went flaccid—stopped breathing—” Her words came out in rhythmic bursts as she leaned forward, released. “Dr. Wallenberg’s on his way.”

  Wallenberg? Toby glanced at the patient’s head. She hadn’t recognized him because the oxygen mask had obscured her view of the face. “Is this Mr. Parmenter?”

  “Hasn’t been doing so well the last few days. I tried to get him transferred to the ICU this morning.”

  Toby squeezed around to the head of the bed. “Get those EKG leads on. I’ll put the airway in. Number seven ET tube.”

  The crash cart nurse passed her the laryngoscope and ripped open the ET tube packet.

  Toby crouched down by the patient’s head. “Okay, let’s do it.”

  The oxygen mask was removed. Tilting the head back, Toby slid the laryngoscope blade into the patient’s throat. At once she identified the vocal cords and slid the plastic ET tube into place. The oxygen line was reconnected, and the nurse resumed bagging.

  “I’ve got a tracing,” said the crash cart nurse. “Looks like V. fib.”

  “Charge to a hundred joules. Hand me the defib paddles! And get a lidocaine bolus ready—a hundred milligrams.”

  It was too many orders at once, and the crash cart nurse was looking overwhelmed. In the ER, every task would have been done in the blink of an eye, without a doctor uttering a single word. Now Toby wished she’d brought Maudeen upstairs with her.

  Toby placed the paddles on the chest. “Back!” she ordered and pressed the discharge buttons.

  A hundred joules of electricity coursed through Angus Parmenter’s body.

  Everyone’s gaze snapped to the monitor.

  The heart tracing shot straight up, then slid back to baseline. A blip appeared, the narrow peak of a QRS complex. Then another, and another.

  “Yes!” said Toby. She reached down to feel the carotid. There was a pulse, faint but definitely present.

  “Someone call ICU,” said Toby. “We’ll need a bed.”

  “I’m getting a BP—eighty-five systolic—”

  “Can we draw some stat electrolytes? And hand me a blood gas syringe.”

  “Here, Doc.”

  Toby uncapped the blood gas needle. She didn’t waste her time on the wrist searching for the radial artery; she went straight for the femoral. Piercing the groin, she angled the needle toward the pulse. A flash of bright red blood told her she’d found her target. She collected 3 cc’s in the syringe, then handed it to a nurse.

  “Okay. Okay.” Applying pressure to the groin puncture, Toby took a deep breath and allowed herself a precious moment to review the situation. They had a patent airway, a heart rhythm, and an adequate blood pressure. They were doing all right. Now she could address the question: Why had the patient coded?

  “You said he was seizing before he lost his blood pressure?” she asked.

  A nurse answered, “I’m pretty sure it was a seizure. I found him on my ten o’clock med rounds. His arm was jerking and he was unresponsive. We have a standing order to give him IV Valium as needed, and I was getting the dose ready when he stopped breathing.”

  “IV Valium? Did Wallenberg order that?”

  “For the seizures.”

  “How many has he had?”

  “Since he was admitted? Maybe six. About once a day. It’s usually his right arm that’s affected. He’s been having trouble with his balance, too.”

  Toby frowned at the patient. She had a sudden, vivid memory of Harry Slotkin’s jerking leg. “What’s their diagnosis? Do they know?”

  “He’s still being worked up. They’ve had a neurology consult, but I don’t think he’s figured out the problem yet.”

  “He’s been here a whole week and they have no idea?”

  “Well, nobody’s told me.” The RN glanced at the other nurses, and they all shook their heads.

  They heard Wallenberg’s voice before they realized he had walked into the room. “What’s the status here?” he said. “Have you got him stabilized?”

  Toby turned to face him. As their gazes met, she thought she saw a flash of dismay in his eyes. It was just as quickly gone.

  “He was in V. fib,” said Toby. “Preceded by a seizure and respiratory arrest. We cardioverted him, and he’s now in sinus rhythm. We’re waiting for an ICU bed.”

  Wallenberg nodded and automatically reached for the patient’s chart. Was he avoiding her gaze? She watched him flip through the pages and couldn’t help envying his unflappability. His elegance. Not a hair out of place, not one unseemly crease in his white coat. Toby, dressed in her usual baggy scrubs, felt like something dragged up from the dirty clothes hamper.

  “I understand he’s had a number of seizures,” said Toby.

  “We’re not certain they are seizures. The EEG didn’t confirm it.” He set down the chart and gazed at the cardiac monitor, where a normal sinus rhythm continued to trace across the oscilloscope. “It looks like everything’s under control. I can take over from here, thank you.”

  “Have you ruled out toxins? Infectious agents?”

  “We’ve had a neurology consult.”

  “Has he looked specifically for those things?”

  Wallenberg shot her a puzzled look. “Why?”

  “Because Harry Slotkin presented in exactly the same way. He had focal seizures. Acute onset of confusion—”

  “Confusion, unfortunately, is something that happens in this age group. I hardly think it’s something you can catch like the common cold.”

  “But they both lived at Brant Hill. They both presented with the same clinical picture. Maybe there’s a common toxin involved.”

  “Which toxin? Can you be specific?”

  “No, but a neurologist might be able to narrow it down.”

  “We have a neurologist on the case.”

  “Does he have a diagnosis?”

  “Do you, Dr. Harper?”

  She paused, startled by his hostile tone. She glanced at the nurses, but they studiously avoided her gaze.

  “Dr. Harper?” A nurse’s aide poked her head in the doorway. “ER’s on the line. They have a patient downstairs. Headache.”

  “Tell them I’ll be right down.” Toby turned back to Wallenberg, but he had put on his stethoscope, effectively cutting off any further discussion. In frustration, she left the room.

  As she descended the stairwell, she kept reminding herself that Angus Parmenter was not her patient, not her concern. Dr. Wallenberg specialized in geriatrics; surely he was better qualified to manage the patient’s care than she was.

  But she could not stop fretting over it.

  For the next eight hours she attended to the usual nightshift parade of ailments, the chest pains and the stomachaches and the babies with fevers. But every so often there would be a lull in the pace and her thoughts would snap right back to Angus Parmenter.

  And to Harry Slotkin, who had not yet been found. It had been over three weeks since his disappearance. Last night the temperature had dropped into the thirties, and she had sat up thinking about the cold, had imagined what it would be like to wander naked in that wind. She knew it was just another way of punishing herself. Harry Slotkin was not suffering on that cold night. He was, almost certainly, dead.

  At dawn, the E
R waiting room finally emptied out, and Toby retreated to the doctor’s room. Over the desk was a bookshelf of medical texts. She perused the titles, then pulled out a neurology textbook. In the index, she looked up Confusion. There were over twenty entries, and the different diagnoses included everything from fevers to alcoholic DT’s. She scanned the subheadings: Metabolic. Infectious. Degenerative. Neoplastic. Congenital.

  She decided that Confusion was too broad a term; she needed something more specific, a physical sign or a lab test that would point her to the right diagnosis. She remembered Harry Slotkin’s leg, thrashing on the gurney. And she remembered what the nurse had said about Mr. Parmenter’s jerking arm. Seizures? According to Wallenberg, the EEG had ruled that out.

  Toby closed the textbook and rose, groaning, to her feet. She needed to review Mr. Parmenter’s chart. There might be some abnormal lab test, some physical finding that had not been pursued.

  It was seven o’clock; her shift was finally over.

  She rode the elevator to the fourth floor and walked into the ICU. At the nurses’ station seven EKG tracings fluttered across monitor screens. A nurse sat staring at them as though hypnotized.

  “Which bed is Mr. Parmenter in?” asked Toby.

  The nurse seemed to shake herself out of her trance. “Parmenter? I don’t know that name.”

  “He was transferred here last night from Three West.”

  “We didn’t get any transfers. We got that MI you sent us from the ER.”

  “No, Parmenter was a post–Code Blue.”

  “Oh, I remember. They canceled that transfer.”

  “Why?”

  “You’d have to ask Three West.”

  Toby took the stairwell down to the third floor. The nursing station was deserted and the telephone was blinking on hold. She went to the chart rack and scanned the names but couldn’t find Parmenter. With mounting frustration, she went up the hall to the patient’s room and pushed open the door.

  She froze, stunned by what she saw.

  Morning light shone through the window, its hard glare focused on the bed where Angus Parmenter lay. His eyes were half open. His face was bluish white, the jaw sagging limply to his chest. All the IVs and monitor lines had been disconnected. He was quite obviously dead.