“Nell, can you hear me? I’m going to make you sleep. Whenever you wake up, they’ll give you more medication to keep you under. But I’ve got to intubate…”
No response. Whether she ignored him, or had gone beyond hearing anything, he couldn’t tell.
He injected the fast-acting tranquilizer, followed by a shot of succinylcholine, a short-duration paralytic. Together they’d make it easier to open her jaw and visualize her vocal cords despite all the boggy swelling in her upper pharynx. Provided this time he could get by her tongue. The paralytic would also stop her breathing. If he bungled the procedure, he’d have precious little time to go in through the trachea, and Nell might end up with what she wanted in the first place.
He navigated around the tongue to where the lining of her throat bulged like a blackened frog belly. Parting the puffy tissues with the laryngoscope, he slid the endotracheal tube through the V of her cords and attached an Ambu bag, pumping hard and sending squeeze after squeeze of oxygen into her lungs until she recovered enough from the injections to breathe on her own.
Now he had Nell in the odd limbo of morality where doctors, himself included, willingly committed euthanasia, albeit the passive kind, withholding heroic treatment if it’s either futile or against the patient’s wishes, yet doing what’s necessary for comfort. If she continued to breathe by herself, she’d survive. If in the name of controlling her pain or sedation they suppressed her respiration, unintentionally hurrying her to her death, so be it. The law, most physicians, and he could live with that as well. Such were medical ethics in the “gray” zone. To the layperson it might sound like word games. To the one faced with pushing in the plunger, that nuance of intent meant being able to sleep at night. The best Mark could tell himself as he walked out of emergency? He’d saved her the agony of asphyxiation, and bought her a bit of time to have a change of mind about dying. As for the weeks and maybe months of suffering he’d imposed on her, that’s what would keep him awake at night. But for now, perhaps for all eternity, she wouldn’t be telling anyone what “tidbits” or “name” she’d claimed to have for him.
“Make sure someone lets me know if she regains consciousness,” he called back to Carla.
“You were great back there,” Lucy told him.
“I don’t think so.”
They sat side by side on a soft leather couch in the doctors’ lounge at Saratoga General, a room outfitted with tastefully upholstered chairs, potted plants, recessed lighting, and an espresso machine that would have done Starbucks proud. “Those were tough calls, and I doubt even an anesthetist could have pulled off that intubation-”
“That was how my father died,” he said, holding a mug of cappuccino with both hands as he took a sip. The warmth didn’t help the icy grip on his stomach any, nor the cold in his fingers, and his insides were still shaking. “Except there was no one there to help him.”
She went very quiet. “How did it happen?”
Unwanted flashbacks flickered to life: the boom that he heard a mile away, racing toward the smoke on his bike, the circle of people standing around something.
“It was an accident,” he said, trying to shut down the images. “And there’s nothing to talk about. I just wanted you to know why I wasn’t exactly a rock tonight.” The darkest notion of all continued to circle him, but he wouldn’t allow it even to take the shape of thought.
She watched him over the white mound of foam while taking small sips from her own cup, her dark gaze giving him the tell-me-your-story look that he’d seen work so magically with his patients.
Well, it wasn’t going to succeed with him.
Using a tone intended to be all business, he told her only what had been tumbling through his head while he’d worked on Nell, that the gas tank explosion had been deliberately set, intended to kill the three of them. Yet as he talked, his mind veered to the woman on the phone tonight. Whatever else Victor had found, it was what he discovered about the big companies and their executive health plans that seemed to be important. At least she seemed to think so, enough to believe someone could kill him over it.
His thoughts shifted to Charles Braden with those silver-spooned friends of his from the business elites of Manhattan. Maybe one had nothing to do with the other, but he found it impossible not to think that their corporations might be involved.
So he shared all this with Lucy as well.
It didn’t sound so outrageous laid it out in words.
He even talked about his turmoil over how to manage Nell in ER, including the way Braden had intruded on his thoughts because of the set-to they’d had over euthanasia while they were in the man’s library. “I thought he played devil’s advocate last night. But I’m not so sure he wouldn’t have granted Nell’s wish and put her out of her misery if he were running the resuscitation just now.”
“How do you mean?”
“He pontificated about how the line between right and wrong, even life and death, blurs with advances in technology and the times. To prove the point, he raised some pretty troubling issues about euthanasia. It was chilling, hearing him talk about how, in the past, country doctors had smothered deformed newborns to save the family the hardship of raising a handicapped child.”
“What?”
“You heard me right. He’s got this weird collection of medical atrocities he calls his ‘hall of shame’ – twisted eugenics, medical war crimes, that kind of thing – and he uses it to proselytize against deviant science.”
Lucy’s jaw fell, her eyes widened, and she dived for her purse. “Mark, I know what’s wrong!”
“What?”
She hauled out the folded spreadsheets of statistics she’d brought with her and spread them out on a nearby coffee table. “All along you’ve been preoccupied with Chaz, but what if it’s Daddy who has a secret?”
“How do you mean?”
She tapped the papers in front of her. “I didn’t want to tell you my suspicions about what I found here, because they seemed to have no context, and…” She stopped speaking, her cheeks flushed.
“Go on.”
She hesitated, then said, “It’s what we fought about earlier. I wasn’t a total klutz when I came here and stuck my nose in your investigation. I actually bent over backwards not to let my issues with Braden cloud your judgment about the man. So when I saw the discrepancy, I figured my own history with him had made me so biased I might be making too much of it, and I didn’t say anything.”
“Making too much of what?”
“Check this out.” She began to draw her finger down the various columns of numbers. “I think I discovered why your father had been interested in Braden Senior’s charitable works.”
He immediately leaned forward to see what she had.
“These are summaries of the births, deaths, and adoptions at the home; these, births and deaths at the center in Saratoga Springs. Like you, I first looked for the usual indicators of something wrong – a higher mortality-morbidity rate, that kind of thing. But as you said, the statistics are right on the norm for the home, and even lower than normal for the maternity center. In both instances, anyone looking at them would quickly conclude all was well.”
“Right.”
“So let’s say we give the guy credit for superb obstetrical skills on his moneyed patients.” Beside the mortality-morbidity numbers she placed yet another paper full of figures in her handwriting. “This is a synopsis of the actual delivery records your father had requisitioned from both places. I totaled all the infants pronounced normal, and here I itemized those with congenital abnormalities – heart defects; urinary tract anomalies; cleft lips and palates; limb aberrations, including club feet; neuronal tube defects of varying severity, some with only nominally open spines, others with fully open cords; and of course twenty-three trisomy where the mongoloid features were recognizable at birth.”