Mercy (3 page)

A loud beeping startled Trevor. For a few seconds nobody moved, no sound other than the incessant churning from the dialysis machine as it cleaned Max’s blood. Trevor moved back a few steps as Max let out a soft moan.

Julie felt her pulse quicken.

“Trevor, please wait in my office.” There was no room for negotiation. Trevor departed with haste.

We’re giving him fluid, max vasopressors, lowered dialysis, and he’s still shitting the bed …

A monitoring nurse out in the hall yelled, “Hey, is anybody seeing this? The BP in room fifteen is dropping like crazy.”

Lisa yelled back, “Yeah, we’re seeing it!”

“When was he last fine?” Julie asked Lisa. “Was he okay after the line went in?”

“Yeah, he was fine then,” Lisa said. “Then the nurse turned on the dialysis and he got worse, so she turned down the flow, thinking that would help.”

Max took several short, sharp breaths that barely moved air, and let out another moan. Julie eyeballed the monitor, taking in the oxygen saturation reading, and saw it was within the normal range. She reviewed Max’s heart rhythm as measured by the telemetry and noted an increased heart rate that often accompanied episodes of low blood pressure. The rhythm in his pulse gave no indication of any cardiac trouble. The usual culprits appeared not to be at play here.

What the hell is going on?

Julie slipped her stethoscope into her ears. She listened carefully for the telltale rubbing sound that signals when renal failure causes fluid to build up in the sac around the heart, essentially squeezing the life out. She heard the fast lub-dub of Max’s heart racing to send blood to his vital organs.

“Did you get a chest X-ray?” she asked Lisa.

“Yeah, we did the X-ray,” Lisa said. “But it hasn’t been read yet.”

“Dammit,” Julie said. “Well, get someone to read it, will you?”

Setting the diaphragm of the stethoscope on Max’s back, Julie gave a careful listen to the chest posteriorly. Next, she put it near the armpit, and then to the front of the chest, hearing bilaterally symmetrical breath sounds. Even with those normal sounds, Julie could not rule out the possibility that the insertion of his central venous catheter might have caused a pneumothorax. If air were leaking into the space between the lungs and the chest, it would explain Max’s hypotension. She needed those X-rays pronto.

Lisa soon returned, while Julie continued to listen with her stethoscope. A second nurse and a monitoring tech also entered the cramped quarters.

“We got a rush on the read,” Lisa said. “I’m trying to pull it up on the computers, but the system is down for maintenance.”

“Damn computers,” Julie muttered.

“They said it won’t be long before the system is back online,” Lisa said. “We can try to get it from the backup.”

“No, by then the main system will be back. Did he ever spike a fever?” Julie asked.

“It’s been gradual,” Lisa said.

A series of alarms sounded louder than any previous alerts. The BP monitor rang loudest and grew in volume as Max’s blood pressure sank lower, to sixty-two.

“Should I call a code?” Lisa asked.

Julie had been thinking the same herself.

She needed that damn radiological read.

Julie’s composure began to fracture. The code blue seemed a likely course of action. She shot Lisa a fierce look.

“Get someone to call down to radiology and tell them we need that reading now! Fix whatever they have to fix, but get me that read! Lisa, tell me again, what dose of Levo is he on?”

“Thirty micrograms,” Lisa answered.

“Are you
sure
that’s the right stuff?” Julie asked.

Lisa looked at the bag and nodded.

“We’ve already given fluid,” Julie said as the calm returned to her voice. “Let’s get a second vasopressor going. This time use vasopressin.”

You are not going to die, young man. No way!

Max was groaning incoherently and sweating profusely. Lisa got the new medicine hooked up while the second nurse left the room to call radiology. She returned a few moments later.

“The system is back online. Radiology said no pneumothorax,” the nurse said, glancing at her note. “‘New dialysis catheter in place adjacent to previously seen subclavian line.’”

This struck Julie as odd. Typically the catheter for the vasopressors and the one for the dialysis would have been positioned opposite each other. There was a computer in Max’s room, and this time Julie was able to pull up his X-rays and read them for herself. The frontal X-ray showed that the lines were in fact overlapped, easy for her to see.

“BP is fifty-nine!” the tech reported. The alarms were really going.

Julie looked at Lisa. “Why did the radiologist put the dialysis line on the same side as the subclavian line for the vasopressors?” she asked.

Lisa thought before answering. “Max had a broken collarbone that ripped the subclavian vein, so that’s why they switched to the right. They capped the port and he was fine.”

A thought tingled. “Fine until when?” Julie asked, an edge to her voice.

“Um, for a while after we started the dialysis. I don’t know exactly how long.”

Julie studied those lines on the X-ray once more. It was uncommon but not unprecedented for the two catheters to be on the same side of the body. In optimal placement the catheter tips would be right next to each other, but on Max’s X-ray Julie observed a noticeable gap between them.

The image called up a memory of a time she ran out of gasoline while on a long ride with Sam. To get her bike started, Sam had to siphon the gas from his tank into hers using a tube he carried in a satchel for just such emergencies. The siphon did not function at all until Sam got the tube positioned properly, but once he did, the suction it generated was impressive.

Max was fine for a while after we started the dialysis … after …

Julie felt a surge of excitement. She had never encountered something like this, but those cath lines might be positioned in such a way to create a siphon inside Max’s body. If that were the case, the blood filled with the vasopressors needed to keep Max’s blood pressure up during dialysis was being siphoned into the very machine that was purifying his blood, removing all traces of the medication he needed.

“Shut off the dialysis!” Julie barked. “Shut it off right now! This is not the time to be dialyzing our patient. That can wait!”

“BP is fifty-five!” the tech called out.

Max’s eyes rolled back into his head and his mouth fell open as he became unconscious. All sorts of alarms continued to sound, and several more nurses and two residents rushed into the room.

With the push of a few buttons, Lisa shut down the machine. Almost immediately, Max’s blood pressure spiked to seventy. Then seventy-five.

Julie realized she had been holding her breath. She let out a long exhale. Max’s eyes fluttered open, but he was groggy, completely out of it.

“BP is up to ninety,” the tech said.

Julie let herself relax a little only when Max began to move his extremities spontaneously and became somewhat responsive. Lisa set her hands on her hips and struck a pose as if to say that she’d filled her quota of excitement for the day.

“How did you know, Dr. Devereux?” Lisa asked. “Even the radiologist didn’t think of that when he put in those lines.”

“Well, maybe he doesn’t ride motorcycles,” Julie said.

When it was obvious that Max had stabilized, Julie went out into the hallway. To her surprise she found Trevor lurking nearby, with a clear view of the action. He looked at his mother with awe, a look Julie had not seen since her son was six years old. It erased all of her anger over his disobedience.

“That was pretty amazing, Mom. You saved his life, didn’t you?”

Julie just smiled.

CHAPTER 4

Roman Janowski—Romey, to everyone who knew him—sat at his expansive desk fingering the embossed invitation. The black-tie celebration would honor Charles Whitmore as the “Hospital Administrator of the Year.”

Anger and resentment rose in Romey’s throat. Whitmore was a fraud, the exact sort of asshole John Fogerty sang about in “Fortunate Son,” one of Romey’s favorite Creedence Clearwater Revival tracks. Whitmore got the job at Boston General because his family had been at the center of Boston’s illustrious medical history since the 1850s.

Big deal, Charlie,
thought Romey as he gazed out his massive office windows at the green emerald square of the hospital quad five stories below.
Daddy got you a job running an internationally renowned medical center with arguably the best medical staff anywhere and a patient service area that includes every millionaire in the world, and so you succeeded. Bully for you!

Romey knew
he
was the real deal. White Memorial had been a second-rate hospital before he took over. By instituting some unique and unusual methods, he had managed to make the hospital one of the best-run medical facilities in the state.

“Anybody can do a Whipple procedure on a sheik with pancreatic cancer who will die in a year anyway,” Romey had said during a board meeting. “The real trick, the reason you pay me so well, is because I can take the bread and butter of medicine—arthroscopy, gallbladder removal, and pneumonia—and create a margin of fifteen percent. Let the other hospitals battle to attract top doctors who want their egos affiliated with a worldwide organization. I’d rather have enough funds to give bonuses to my physicians so they will do what it takes to improve our bottom line.”

Heads nodded, and no one objected to Romey’s raise—a raise that pushed his salary into seven-figure territory and gave him another seven in bonuses. With that kind of income, Romey could be short and bald, with a noticeable belly and ears like radar dishes, and still attract plenty of leggy blondes, including the two who were his current mistresses. Nancy, his wife of thirty-five years, was willing to accept her husband’s indiscretions in exchange for her cushy lifestyle as long as he had the courtesy not to flaunt the girls in her face. Romey obliged happily. He would do anything to keep Nancy from making good on her longstanding threat to divorce him in the most costly way possible.

Romey folded the invitation in half, then tore it in two. The difference between Romey and Charles Whitmore, Romey knew, was flash and renown. The time had come for Romey to step out of the shadows and build his empire.

He looked at the pile of folders on his coffee table and knew where to begin. Romey slipped on his headset and dialed the direct line for the president of Suburban West Medical Center.

“Allyson Brock’s office,” said the friendly voice on the other end.

“Is Allyson in? It’s Roman Janowski from White Memorial.”

“Just a minute, Mr. Janowski, she’s just ending a meeting, but I know she will want to take your call.”

Of course she will. She’s drowning.

A brief interlude of insufferable elevator music followed before Allyson picked up the line.

“Romey, to what do I owe the honor of this call? You city boys rarely give us folks toiling in the hinterlands the time of day,” said Allyson, her voice almost dripping with honey.

“Not true, my dear. I always think that those who run small suburban hospitals have a lot to teach us all.”

“Well, what can I do for you, Romey?”

“Word on the street is that one has never played golf until they have played with you. A history with the LPGA, I understand.” In fact, Romey knew everything about Allyson’s brief time on the tour—just as he knew everything about her divorce; her two kids in college; her over-mortgaged houses in Wellesley, Martha’s Vineyard, and Loon Mountain; and her addiction to Nordstrom and Saks.

“I didn’t know you played.”

“Well, I am just learning, but I figure I might as well learn from the best, so I am hoping you might be able to find some time next Wednesday for a round with an old duffer.” Romey was sixty-five, hardly old, but Allyson was fifteen years his junior.

“Sounds like fun. I generally play at Beechwood.”

“Actually, Allyson, I want to show you my home course in Duxbury. Shall we say two o’clock?”

Allyson’s voice grew a bit tense as she agreed to Romey’s offer. She was shrewd enough to know Romey had something else planned. Why else would he want her at a club where she had never played before, and would know no one?

Romey moved to his couch, where a stack of files sat in front of him. He had a lot of homework to do before the round of golf, and none of it involved a ball, club, or tee. He opened the files to review the audited financial statements of Suburban West Medical Center, its Medicare cost report, IRS 990 forms, and notes from physicians who’d once worked at SWMC. Plenty of ammunition to guarantee the only one who would score an eagle on Wednesday would be Roman Janowski.

CHAPTER 5

Back again, for the second time in a week.

Tommy Grasso had become a regular at White Memorial. Bad luck combined with bad choices had turned the hospital into his version of
Cheers,
a place where everybody knew his name. Nobody wanted to boomerang in and out of the hospital, occasionally multiple times in the same month. Nobody wanted COPD either, but everybody wanted to breathe, so the hospital was where he had to go.

This was Tommy’s tenth trip to White Memorial since he rang in the New Year. Ten times Tommy had been processed through hospital admissions and wheeled into a bland and standard room where he would spend a few days, or maybe longer. Sometimes he was brought to the ICU and placed on BiPAP, a breathing apparatus that helped get air into the lungs. He was even placed on a ventilator a couple times. But they always sent him to rehab, then home for a short stint, only for the cycle to repeat.

What Tommy really needed was a new pair of lungs. What Tommy got was a spot on a waiting list that would probably never call his name because of his O-negative blood type. Even if they did find him a match—and that was a 7 percent possibility on the outside—he was saddled with an equally uncommon tissue type.