Dr. Malachi Ross stopped at the door to the intensive care unit and took a last look to make sure everything was as it should be. The large, circular room had seven individual bed stations for critical cases, and all of them were filled, as they were at all times every day of the year. The odds said that five of the patients in them, and possibly all seven, would not live. Ross knew that this was not for lack of expertise or expense; indeed, the expense factor had become the dominating element of his life over the past years. He was the chief medical director and CFO of the Parnassus Medical Group and keeping costs under control while still providing adequate care (which he defined as the minimum necessary to avoid malpractice lawsuits) was his ever more impossible job.
Which was, he knew, about to enter another period of crisis. In the short term at least. For occupying one of the beds here today was his colleague and chief executive officer, Tim Markham, struck down on his morning run, an exercise he practiced with religious zeal in an effort to stay vigorous and healthy to a ripe old age. Ross supposed there was irony in this, but he had lost his taste for irony years ago.
The monitors beeped with regularity and the other machines hummed. All around the room, white shades had been pulled over the windows against the feeble spring sun.
Markham was in the first bed on the left, all hooked up. He'd been up here for three hours already, the fact that he'd lived this long with such serious injuries some kind of a miracle. Ross took a step back toward the bed, then stopped himself. He was a doctor, yes, but hadn't practiced in ten years. He did know that the bag for the next transfusion hung from its steel hook next to the bed, where it ought to be. The other IV was still half-full. He had to assume everything was in order.
Exhausted, he rubbed his hands over his face, then found himself looking down at them. His surgeon's hands, his mother used to say. His face felt hot, yet his hands told him he wasn't sweating.
Drawing a deep breath, he turned and opened the door to get out.
He stepped out into the hallway where three more ICU candidates, postsurgery or post-ER, lay on their own gurneys attached to monitors and drips. They'd arrived since Markham had been admitted; now, as the beds in the ICU became available, these patients would be transferred inside for theoretically "better" intensive care.
Dr. Eric Kensing was supervising the unit this morning, and now he stood over one of the beds in the hallway, giving orders to a male nurse. Ross had no desire to speak to Kensing, so he crossed to the far side of the hall and continued unmolested the short way down to the ICU's special waiting room. Distinguished by its amenities from the other spaces that served the same basic purpose, the intensive care waiting room featured comfortable couches and chairs, reasonably pleasant art, tasteful wallpaper, shuttered windows, and noise-killing rugs. This was because a vast majority of the people waiting here were going to hear bad news, and the original architects had obviously thought the surroundings would help. Ross didn't think they did.
It was just another waste of money.
At the entrance, he looked in, noting with some satisfaction that at least Brendan Driscoll had left the immediate area for the time being and he wouldn't have to endure his reactions and listen to his accusations anymore. Driscoll was Markham 's executive assistant and sometimes seemed to be under the impression that he, not his boss, was the actual CEO of Parnassus. He gave orders, even to Ross, as though he were. As soon as he'd heard about the accident, Driscoll had evidently left the corporate offices at the Embarcadero to come and keep the vigil at Markham 's side. He'd even beaten Ross himself down here. But now, thankfully, he was gone, banished by an enraged Dr. Kensing for entering the ICU for God knew what reason, probably just because he wanted to and thought he could.
But, disturbing though he could be, Driscoll was nowhere near as serious a problem to Ross as Carla Markham, Tim's wife. Sitting at one end of the deep couch as though in a trance, she looked up at him and her mouth formed a gash of hostility and sorrow, both instantly extinguished into a mask of feigned neutrality.
"He's all right," Ross said. Then, quickly amending it. "The same."
She took the news without so much as a nod.
He remained immobile, but his eyes kept coming back to her. She sat stiffly, her knees pressed together, her body in profile. Suddenly, she looked straight at him as though she'd only then become aware of his presence. "The same is not all right. The same means he is near death, and that is not all right. And if he does die…"
Ross stepped into the waiting room and put up a hand as though physically to stop her. "He's not going to die," he said.
"You'd better hope that's true, Malachi."
"We don't have to talk about that. I've heard what you said and you're right, there were troubles. But no crisis. When Tim comes out of this, we'll talk it out, make some adjustments, like we have with a thousand other issues."
"This is not like any of them."
His mouth began to form a knowing smile. She was so wrong. Instead he cocked his head and spoke with all the conviction of his heart. "Don't kid yourself," he said. "They've all been like this." He stared down at her, watching for any sign of capitulation.
But she wouldn't hold his gaze. Instead, shaking her head once quickly from side to side, she reached some conclusion. "He wasn't going to make adjustments this time. The adjustments were what kept tearing him apart. If he doesn't live, I won't, either."
He couldn't be sure if she was referring to living herself-she'd threatened suicide the last time Markham had left her-or to making the kind of adjustments her husband had learned to live with. "Carla," he began softly, "don't be-"
But she wasn't listening. Suddenly, she was standing up in front of him, the semblance of neutrality dropped for now. "I can't talk to you anymore. Don't you understand that? Not here, maybe never. There's nothing to say until we know about Tim. Now excuse me, I've got to call the children." She walked by without glancing at him on her way out of the room.
Ross sat in one of the leather settees and pushed himself back into the chair. He gripped the edges of the armrests to keep his surgeon's hands from shaking.
Ross heard first the monitor alarm, then the code blue for the ICU. For twenty minutes, the commotion nearly reached the level of bedlam even out in the hallway, when almost as abruptly as it had begun all the activity and noise came to a halt.
And then, suddenly, Tim Markham was dead.
Ross had gotten up out of his chair and was waiting outside the ICU, standing there when Doctor Kensing appeared from inside, his handsome face stricken and drawn. He met Ross's eye for a moment, finally looking down and away. "I don't know what happened," he said. "I thought we might have got him out of the woods, but…" The words trailed off and the doctor shook his head in defeat and misery.
If he was looking for commiseration, Ross thought, he was barking up the wrong tree. In fact, Ross found himself fighting the urge to say something spiteful, even accusatory. The time would come for that. Kensing had been Ross's particular nemesis for a couple of years, questioning his medical and business decisions, defying his edicts, crusading against his policies with the rest of the medical staff. Kensing's presence on the floor now, in the ICU directing Markham's ultimately failed care, was from Ross's perspective a bitter but not unwelcome act of fate that he would exploit if he could after the initial impact of the tragedy had passed. But it would have to wait.
Now, Ross had business to which he must attend. He didn't wait for Kensing to reappear in the hallway with his no doubt self-serving postmortem analysis of what had gone wrong, as if he could know by now. He had no stomach for the condolences, hand-holding and-wringing that he knew would attend the next hours at the hospital. Instead, he left the floor by elevator and got out in the basement parking garage, where he got in his Lexus and contacted his secretary, Joanne, on his cell phone. "Tim didn't make it," he said simply. "I'll be there in ten minutes."