"Any change?" Reed asked.
Judy shook her head. "This is the rhythm we found her in." She handed over an E.K.G strip. "It looks the same as the one now."
"Do you have a good IV?"
"Excellent.
Reed listened to the patient's chest to ensure that the endotracheal tube hadn't been pushed so far down the trachea that it was occluding one of the main bronchial tubes.
"She's full of fluid," he said. "Full to the brim.
Let's hang in there just a bit, everyone. Give her an amp of bicarb and another amp of epi. And send off a set of blood gases, just in case. I don't think we're going to be at this too long, though."
He glanced up at the monitor screen. The woman's rhythm remained the same-slow, wide complexes at eight or so a minute.
"Call cology down here," he said. "We may want to put in a pacemaker… Pupils?"
"Fixed," someone called out.
"Keep pumping. Someone check her femorals to be sure we're generating a decent pulse. Judy, give me your best guess at a time."
"Twenty minutes minimum before effective CPR was started," the paramedic said.
"What do you think?"
"Honestly?" She glanced over at Loretta Leone and the team that was working on her. "I think it's not fair to this woman to continue."
Reed rubbed at his chin and wondered for a moment how far backed up the waiting room was getting.
"Anybody know if she has any family?" he asked. next of kin," the nurse said. "It's right here on her last E.R. sheet."
"She's like a bag lady, only with a one-room apartment," Judy said. "The place was full of empty bottles waiting to be returned, and junk in every corner."
"Jesus," Reed muttered. "Give her one more amp of epi and call for those gas results. Oh, and you might as well try an amp of calcium as well. I want to keep going until the cardiologist gets here."
The cardiology resident, an overweight, abrasive man named Jason Berger, entered the room with two medical students in tow. One was an attractive young woman.
"Fucking place looks like a war zone out there," Berger said.
"what do you have?"
"Fifty-five-year-old woman found pulseless on the floor of her apartment," Reed said. "No medical history except a broken wrist fixed here two days ago. Twenty minutes minimum before CPR was started.
There's been no change in anything despite Isuprel, bicarb, and several amps of epinephrine."
Berger looked up at the monitor. "Did you give her calcium?" he asked.
"Yes."
Berger pushed past the resuscitation team and listened briefly to Loretta Leone's heart and lungs.
Then he put his arm around the waist of the female medical student. Reed saw her stiffen as Berger led her over to the monitor.
"what do you see?" Berger asked.
The young woman looked flustered and uncomfortable.
"Slow rhythm," she managed. "Very broad complexes. I… um…
I don't know what else."
"what you see," Berger said theatrically, "is a dead heart. X % call that an agonal rhythm-the rhythmic flow of sodium, potassium, and calcium in and out of cardiac cells, creating an electrical impulse.
It is unresponsive to drugs, it doesn't generate a heartbeat, and it bears absolutely no relationship to life as we know it. What do you want me to do, Reed?"
"I don't know," Reed said. "I just wanted your opinion on a pacemaker before I made a decision."
Berger laughed out loud.
"Have there been any signs of life in this woman?"
He tried once again to work his arm around the medical student's waist, but this time she managed to spin out of his reach.
"Just what you see," Reed said.
"So she's dead. I can slip a wire into her if you really want me to, but I promise you it win be an exercise in futility. what does her family want?"
"She has none."
"None at all?"
"Apparently not," Reed said.
"Reed, I have two caths waiting for me and a fun clinic this afternoon.
You really want me to put a wire in her?"
"What about that?" Reed gestured to the monitor.
"That?" Berger said disdainfully. "My friend, you know as well as I do that you could just stand here and do no CPR, and watch that rhythm pop along for half the fucking morning. There's no heartbeat under there."
"Thank you," Reed said.
"Then we're free to go?"
Reed hesitated. "You're free to go," he said finally.
"That's it, everybody. Thank you very much."
The cardiologist led his small entourage out of the room as the team backed away from the bed. Reed reached up and flicked off the monitor:
On the litter, Loretta Leone's open eyes stared blankly at the ceiling.
"Who's the nursing supervisor?" Reed asked.
"It was Norma. Irene Morrissey's taken over for her.
"Get her, please. Have her call the M.E. Thank you once again, everyone. You all did a good job."
Reed Marshall felt the gnawing tightness in his gut begin to abate.
Berger was an asshole, but he was also right. There was simply nothing to work with.
And even if they did somehow manage to generate a pulse, all they would have created was a vegetable with no next of kin, and nothing to go back to except a bunch of empty bottles.
He glanced at the motionless body. There was a waiting room full of patients needing his attention, and a member of the search committee camped out in the E.R probably already blaming him for the chaotic backup. With a shrug he turned his back on Loretta Leone and left the room. For as long as he had been in medicine he had hated this part of the job more than any other.
The crystal morning had the Toyota off the East Boston ir drive from the rearview mirror for any car that seemed to be following them.
But as far as he could tell, none was.
Although he had never been on the docks, the area was one he knew fairly well. At one time he and Reed Marshall had split a weekly moonlighting shift in the East Boston satemte emergency clinic run by White Memorial.
Most of the staff at the clinic was hard-nosed Italian, like East Boston itself, and the spirit in the place was the best of any such facility in which he had ever worked. He smiled at the memory of one battle-hardened night nurse named Falano, who had taken to referring to him and Reed as "Dr. Hot" and "Dr. Cool."
Cradling the hundred or so remaining posters on her lap, Laura sat quietly in the passenger seat, gazing out at the panorama of Boston Harbor and the city beyond. After calling Donald Devine and making an appointment to see him that afternoon, they had stayed in her room for more than an hour, talking and holding each other in ways that made her more certain than ever that there was a future for them together.
She had expected Eric, as a never-married doctor in a large city, to be experienced and worldly. But in fact, with most of his life spent getting himself educated and then trained, he was in many ways still very young and tentative.
"It's ironic," he had said as his shyness and uncertainty were becoming clear to her, "that they take a bunch of twenty-four or twenty-five-year-old kids who have spent most of our lives in school or summer camp, Present us with diplomas, and pronounce us M.D."s, and suddenly we're supposed to be qualified to help people with the most difficult and deep-seated problems in intimacy and sex. The most frightening moment I think I've had in medicine wasn't from some traffic accident or shooting. It was two months into my internship, when a bank president with a wife and two kids suddenly started unburdening himself to me about discovering he was homosexual."
In many ways, Laura began to realize, the two of them had led similar lives. Countless people had passed through their worlds, yet both of them remained isolated. White Memorial was no less a haven, no less an escape for Eric than Little Cayman had been for her.