Grave Prognosis
By Daniel Kalla

Chapter Two

The large, bearded man sat in a car parked in the dark lane behind the BeatRoom. The latch on the glove box read GMC, but otherwise he knew precious little about the vehicle. What he did know was that it had gas in the tank and looked sturdy enough, which had been his only prerequisites when he’d stolen it a few hours earlier.

The decision to use one of his own cars or a stolen vehicle to get to and from the nightclubs had weighed heavily on him. He didn’t like either option. However, he’d known that at times he’d have to stay in the club for more than an hour, which was too long to leave a car parked where it could be traced back to him.

He pulled off the beard and felt intense relief as his fingers finally got access to the long-unattended itch. Pulling off his wig, he replaced it with a baseball cap, then unbuttoned his shirt, removed the padding, and changed into a sweatshirt. Finally he turned his attention to his feet. He carefully removed the special shoes, and slipped into a pair of comfortable sneakers. After his change was complete, he leaned back and waited, trying to think of anything but the amateurish poetry that stuck in his head and repeated over and over like a TV jingle he couldn’t shake.

He didn’t have to wait long before he heard the distant wail of a siren. Like the welcome crescendo of a Beethoven symphony, the sound steadily built until he was certain the siren was heading toward the BeatRoom. He lingered about twenty minutes more, and then drove slowly past the nightclub’s entrance. The sight of the crowd surrounding the ambulance on the sidewalk instilled him with a sense of smug satisfaction as he slowly drove away.

The doors swung open to the Acute Area of St. Joseph’s ER, admitting the patient, the ambulance crew, and Mike. The ER staff, notified in advance of their arrival, was waiting expectantly. Janet, the triage nurse, met them at the door. "Put the patient in Cardiac Bed 2," she instructed Joe. Across the room two nurses stood on either side of the bed with wires and tubes dangling from their anxious hands, giving the appearance of a couple of attendants at a car wash waiting for the next vehicle to roll through.

Janet smiled at Mike. "Slow night at the bars?"

As the stretcher wheeled by the nursing station, Dr. John Dirk looked up from his charts. "Hey, Mike, is it true you opened a ruptured aneurysm earlier today without calling me?"

"I did call, John. You were scrubbed in a case."

"You should’ve sent the patient straight up to the OR anyway," Dirk chided.

"For what? An autopsy? The guy died in front of me. The only thing that could have saved him was clamping his aorta then and there."

"But you didn’t save him, did you?"

"No, but then again I’m not Dr. John Dirk—surgeon to the stars and nemesis of the angel of death."

Dirk sighed. "That’s the cross I bear." Then he smiled mischievously at Mike. "How about the one you just brought in? I bet, ‘not tonight dear, I’m having a cardiac arrest’ is a new rejection line even for you."

Mike shook his head. "John, even for a surgeon that’s still pretty weak."

Mike left the nursing station and started walking toward Cardiac Bed 2. Margaret, another nurse, joined him on the short jaunt. At a height of just under five feet, Margaret had to reach up to pat Mike on his shoulder. "So this is what happens when the boss of the Poison Control Center spikes a drink!"

"Margaret, I’m not the boss. I’m just one of the lackeys."

"ER physician, toxicologist, and now I hear you’re a poet. Mike, you’ve just got to father me some children."

"Look, I know nothing about poetry. I only went to that club to meet my friends. Besides, what would your husband and three kids have to say about the whole fathering thing?"

They reached the bed, and Margaret wordlessly fell in step with the other two nurses as they transferred the patient from the ambulance stretcher onto the bed. While continuing to tease Mike, the nurses "organized" Monica, which involved stripping her naked, starting other intravenous lines, examining for any obvious findings, and hooking up numerous monitors.

Then Dr. Alex Rimkovsky arrived. After acknowledging Mike with a wave, she turned to the patient. Mike felt relieved to see Alex on duty. While he trusted all of the ER physicians at St. Joseph’s, he knew that if his life hung in the balance, Alex would be his first choice amongst all of his colleagues.

Alex leafed through the incomplete chart, then performed a brief but thorough physical exam starting from the patient’s head and working towards her toes. As she slipped her reflex hammer back into her lab coat’s pocket, she turned to the paramedics. "Okay, guys, she looks stable enough now. What have we got?"

Mike listened from the corner of the room while Joe presented a concise but accurate medical history of the patient’s seizure and subsequent cardiac arrest. He had little to add to Joe’s history except to fill in a few details, including how healthy the patient had appeared prior to her collapse, and to put forward a few theories as to what might have caused the problems. "My money’s still on some kind of toxin tying all this together," Mike concluded.

"Everything here points to narcotics, most likely cocaine," Alex said. "But you got no corroboration on any kind of drug abuse?"

Mike shook his head.

Alex turned to the nursing team and started delegating. "Tammy, I want vitals every five minutes and the ventilator set up. Cindy, I need the whole slew of blood work, including tox screen, cross-match, and ECG. I want a head CT scan ASAP. Margaret, make sure we’ve got three good IV lines going, then start a Dilantin drip. And alert ICU and get the on-call intensivist to come see the patient." She completed her checklist of immediate medical interventions, then asked, "Could somebody find out who this patient is? Get someone—family, lover, or friend—down here to talk to us."

Mike had nothing further to add, so he quietly excused himself. Unfortunately for him, though, he had to walk through the center of Emergency to get to the exit

"You’re not bartending next year’s Christmas party, are you?" one nurse asked with a smirk.

"Give me back my sister’s phone number!" another called out.

"We don’t need your make-work projects here!" someone else yelled.

He ran the gauntlet and left through the main doors that led to the ambulance bays, where he found Joe and Juan. Mike could never get accustomed to the ironic scene of two paramedics smoking cigarettes as they stood beside their ambulance, but this was one of the most common sights in front of any ER.

"Joe, I’m curious. How did the staff get the impression the patient was my date?" Mike asked.

"I have no idea." Joe’s mouth widened into a sheepish grin. "I did mention you were already with her when we got to the nightclub."

"Or it could have been when you announced on the radio that ‘we just saved the life of Mike’s new girlfriend,’ " Juan added helpfully.

Joe’s grin got bigger. "Oh, I don’t think it was that."

"Before you do something as unprofessional as that, Joe, can’t you at least check your facts?" Mike suggested. "Didn’t I tell you at the club that I’d never met the woman before?"

"Us Irish have a saying . . ."

Juan dropped his cigarette and stamped on it. "You Irish have no end to bloody sayings!"

Joe glared at his partner. " ‘Tis better to kiss the Blarney Stone than to share with others the secrets of love.’ "

"I’ve been listening to your Irish aphorisms for years now, Joe," Mike said. "Be honest, you make every damn one of them up."

"Look, Mike, I’m sorry I caused you a little grief. I probably shouldn’t have said anything, but I got the impression back there that something was going on between you two."

Mike sighed. "Joe, I didn’t come out here to tell you what a gossip-mongering bastard you are. I mean, that’s about as useful as telling my dog that her tongue’s been places it shouldn’t have."

Juan let out a rare laugh.

"I came to tell you guys you did excellent work out there. You probably saved her life. Also I wanted to ask you about a girl brought in a month ago. Similar story—seizing, unstable rhythm, collapsed on a street. Ring any bells?"

"Not our call, but I heard about it." Juan thought for a moment. "I think Chuck and Greg did her. They’ll be on day shift tomorrow."

"Thanks, guys. I’ll see you later."

"She’s going to make it, isn’t she, Doc?" Juan called after him.

"I give her three to one odds."

"Hey, Mike," Joe yelled, "if you really didn’t meet her before, maybe you should after she recovers."

Mike looked at the paramedic. "You’re kidding, right? I mean, on top of everything else, she and I now have a professional relationship."

Joe raked a hand through his thinning hair. "My aunt and uncle, Sara and Angus, started with a professional relationship. She was a lovely whore with a heart of gold and he a poor farmer. Once a month he’d scrape together enough to purchase her services. Her career was cut short, literally, when a crazed john slashed her up with a carving knife. Old Angus took her into his home and nursed her to health. Fifty-five years later, they’re still as happy as newlyweds. So don’t tell me professional relationships can’t work."

Mike chuckled. "We non-Irish have a saying. ‘There’s simply no end to your bullshit!’ " Then he walked back into the hospital through the ER entrance.

Inside he found Virginia, his favorite Emergency clerk, at the first registration desk. " ‘Leave Virginia alone,’ " he sang to her. This had become their ritual greeting ever since Mike had first heard the little-known Rod Stewart song a few years back. Virginia had never heard the song, but she appreciated the sentiment and smiled every time he sang it.

"Dr. Todd, you couldn’t be on tonight because it’s way too quiet."

"Yeah, and I’m way too dressed up," he said, indicating his blue jeans and sweater with a sweep of one hand. Usually he worked in blue OR scrubs and never wore a lab coat.

"Virginia, I need you to call up an old chart for me. She died here about a month ago. Twenty-fivish. I think her name was Katie P-something. She presented with seizures and a query drug overdose."

"Dr. Todd, we see 5,000 patients a month. That’s a lot of P’s. How come you never remember a name?"

Mike knew Virginia would locate the chart, probably within a few minutes. "Leave the chart in my box in the docs’ office please. Oh, and can you call me a cab? I’m going to wait outside."

"Oh, sure, ‘leave Virginia alone,’ " she sang out after him, mimicking his tune.

To Be Continued . . .

Daniel Kalla practices emergency room medicine in Vancouver, Canada. He co-wrote the film script To Love and To Perish for Highwire Entertainment (now in pre-production). His forthcoming novel is entitled Lethal Assistance. He can be reached via e-mail at [email protected].