The Last Surgeon

CHAPTER 19

The two biggest shortcuts to disaster in medicine are arrogance and everything else.

Nick knew his focus was compromised. The warning about medical mistakes, from one of his former surgical professors at Brown, ran through his head like a Möbius strip. Arrogance wasn’t the problem with him. It never really had been. But even under the best of circumstances, his thoughts had a tendency to wander. And twenty-four hours after his bizarre encounter with Manny Ferris, this was hardly the best of circumstances.

The RV was back in D.C., and the warming weather had brought with it a flood of patients. Routine… routine… routine… disaster masking as routine. The shattering of a medical career was as simple as a one-minute loss of concentration-a swollen lymph node missed, a rectal exam not done, an abnormal neurologic sign ignored, a telltale answer in the medical history passed over or not asked for at all. It was that easy. And for Nick, the danger increased in direct proportion to his SUD score, which tonight continued hovering around five.

They were on the third and final stop of the evening, parked on the street in the Anacostia section of D.C. Nick and Junie had the help of an experienced volunteer nurse named Kate, who was working beneath the lightweight canopy that served as their annex and at other times as their triage area and waiting room. Slowly but surely, the crush of patients had vanished, and not a moment too soon. Fatigue and Manny Ferris were taking over Nick’s body and mind. For a few brief moments after entering Lucky Bill Pearl’s, it had seemed some answers to Umberto’s disappearance might be at hand. Instead, there were only more questions and more frustrations.

“So, have you had the chance to think about Ferris?” Nick had asked Junie during the ride in from Baltimore to their initial stop at Jasper Yeo’s used car dealership.

“Booze,” she said simply. “When in doubt, always bet alcohol. My money’s on wet brain.”

“Maybe, but for someone who is as much of a zombie as Ferris was, I didn’t see too many of the stigmata that go along with alcoholism-you know, spider veins on the cheeks, a W. C. Fields nose, ascites, liver palms, weakness, impaired gait. Should I go on? Then there’s those scars and lumps on his face. It’s like he was the big loser in a gang fight.”

“What, then?”

“I don’t know. Probably alcohol. I also wonder if someone might have been preparing him for plastic surgery. But how do you explain his reaction to the photo of me and Umberto? It certainly wasn’t me he was reacting to. You should have seen him, Junie. In about a second, he went from Night of the Living Dead to Rambo. Does that seem like wet brain to you?”

“Maybe drugs.”

“I suppose.”

Now Nick was listening to the chest of an anxious twenty-year-old woman who lived in the nearby projects. Junie cleared her throat and shook her head at him disapprovingly.

“Hear anything?” she asked-her way of telling him that he might want to start that part of the exam over again.

“Nothing yet,” he muttered, and focused in.

Their patient had evidence of a loose mitral valve and no other good explanation for her recurrent chest discomfort. Nick asked Junie to run a cardiogram on her. They would have scheduled an echocardiogram and blood tests if she had insurance, but that was wishful thinking. Nick gave her a sheet on obtaining health coverage, and Junie promised to follow up with a phone call to see if she had any luck. That was the best they could do.

Running a clinic like Helping Hands involved compromises, especially when patient cooperation and follow-up were constant variables. Specialist involvement in their cases was more dependable. Through study and courses, Nick was decent at reading cardiograms, but they had several cardiologists who donated their services to Helping Hands. Finally, there was the handout dealing with mitral valve prolapse that one of their heart people had prepared.

“Either of you want coffee?” Nick asked the nurse and patient. “It’s going to be instant, but we have decaf and high test, and white stuff in the fridge.”

Both declined.

“Is that woman out there on the driver’s seat with you?” Junie asked their patient.

“Nope, just my boyfriend. He’s the one sitting at the table.”

Nick glanced toward the front of the RV. He had noticed the woman several times in passing. It was hard not to-very good-looking with short, sand-colored hair and a light spread of freckles across the tops of her cheeks.

“As far as I can tell,” Junie added, “she never signed in to be seen. It’s been like forty-five minutes. I thought she was here with one of our patients.”

“I’ll ask. She doesn’t look like she’s in any trouble, but it is a little weird she hasn’t spoken up. Maybe she’s a reporter or one of MacCandliss’s secret agents.”

Nick, doing his best to appear nonchalant, stopped by the refrigerator for a Coke. Now that he could look directly at the woman in the driver’s chair, he wondered how he had ever made it past her in the first place. She was wearing jeans and a white barn jacket with a brown collar-from L.L.Bean or Eddie Bauer or someplace like that, he guessed. She was facing slightly away from him, gazing out of the massive windshield. Then, as if sensing his attention, she turned and smiled-not a broad smile, but still enough to light up the whole front of the RV.

Special. That was the word that came initially to his mind, followed closely by interesting, intelligent, and unusual. As he approached her, Nick stumbled enough to slosh some Coke onto the carpet. Nice start. Leave it, or mop it up? Grinning sheepishly, he went back to the galley and returned with some paper towels.

“Hi,” he said, looking up from one knee and sensing he was speaking an octave higher than usual.

“Hi, yourself,” she said, seeming totally at ease.

It felt awkward to be so close to her. As incredible as was her smile, her eyes, an unfathomable blue-green, were even more so. He made it to his feet and braced his leg against the console between the front seats to gain some breathing room.

“Are you here to be seen by the medical staff?” he asked.

Medical staff! Give me a break! he chastised himself. Just tell her you’re the doctor.

“Nope,” she said. “Healthy as a horse. But you can help me with this.” She reached into a thin brown paper bag and held up a copy of Nick Fury and His Agents of S.H.I.E.L.D. “My name’s Jillian Coates. I’m a psych nurse at Shelby Stone Memorial. Got a moment to talk, Dr. Garrity?”

IT TOOK forty-five minutes to pack up the canopy and wipe down the interior of the van. Jillian pitched in and got to know Junie as she did. Nick stayed close to the women and entered the conversation when he could. “Special” was right. There was a femininity and wisdom to her, coupled with a sharp wit that he found totally appealing. Nick, who hadn’t really broken through his PTSD enough to become interested in any woman since Sarah, was surprised to find himself making some comparisons. Junie exchanged enough glances with him to make it clear she was thinking the same things.

Finally, with the nurse, Kate, off to her home in the suburbs, and the shades pulled, Nick and Junie sat at the fold-out table and listened with empathy and quiet astonishment to the sad story of the death of Belle Coates, and her odd connection to the medical director of the Helping Hands Mobile Medical Unit through an almost forgotten nickname.

“You say your sister had actually written in M.D. and Dr. and Ph.D. next to Nick Fury’s name on the covers of these comics?”

“She seemed to be trying out every form of doctor.”

“Like she heard it rather than read it.”

“I wish I had the issues to show you,” she said, “but they were destroyed when my apartment burned down a few days ago.”

“Your sister was murdered and then your apartment burned down? Do you think the two are connected?”

“How can I not, Nick, except the arson people didn’t find anything.”

“Well, unless you’re incredibly unlucky, it seems suspicious to me,” Nick said, wishing he could come up with something, anything, to help the woman. “Wait a minute,” he said suddenly, “I have a friend, a detective with the D.C. police. He is incredibly well connected. I wouldn’t be a bit surprised if he knew the arson people in Arlington, or at least here. Can I put you in touch with him?”

“That would be great. I have the number of one of the insurance inspectors who looked at my place. Maybe I can get a copy of his report over to your friend.”

“I’ll get a hold of Don first thing in the morning,” Nick said, feeling his knees beginning to go to Jell-O from the woman’s eyes.

In the end, it seemed obvious that Belle Coates had come across a reference to the name Umberto Vasquez had given to his friend a million miles and a hundred thousand years ago-not just come across the name, but had been impressed enough by what she had heard to go out and buy more than forty different copies of the comic book.

Dr. Nick Fury.

At one o’clock, Junie encouraged them to keep talking and wandered off to lie down in the aft examining room.

“Even before our parents died, Belle and I were reasonably close,” Jillian said, “but there was a fairly wide difference in our ages, and I really didn’t know all that much about her and what she was into. By the time of the accident, I had already been married for like a year and divorced, and was out there in the big, wide Washington world making up for the time I lost by getting married so young. The truth is, I was living on the edge a great deal, partying, always first in line for anything that would provide a rush, and chasing my passion for photography to some pretty dangerous places.”

“Then suddenly you were the parent of a teenage girl.”

“It sounds like that would be the case, and that’s what I expected when I somewhat reluctantly agreed to stay home with Belle. But that’s hardly what happened. Belle was the most centered, spiritual person I had ever met. Yoga, flute, painting, athletics, gardening, cooking. Whatever there was to experience, she wanted to try it. She didn’t care if she ever became the best at anything, except maybe nursing, but she wanted to know things, to feel them in her own way, not necessarily to master them. And she was without a doubt the best listener I ever knew.”

“She sounds pretty incredible.”

“She was. Even at fourteen it was like being around some sort of advanced life-form. In the end, before she chose nursing and moved into the dorms in D.C., she was the one who was teaching me how to live-I mean really live. Not loud or big, but softly and passionately, with a delight in the details of things and of people.”

Jillian’s eyes filled, then overflowed. She made no attempt to wipe aside her tears, nor was she at all embarrassed by them.

“I never tried to stop the tears when I used to cry over Sarah,” Nick said. “I felt they might be, I don’t know, cleansing. Then the PTSD took hold and all of a sudden I wasn’t crying anymore. I just stopped.”

“I don’t think that’s good.”

“I guess. As devastated and grief-stricken as I was, I don’t think I even felt sad.”

“Just empty.”

“That’s right. I can’t believe you said that. Just empty. It’s an almost indescribable feeling. Umberto used to say that as long as I could cry, there was hope. More than anyone else, including my therapist, he was upset when I stopped. At some point he also told me that he hadn’t cried a single time since his discharge from the hospital after the explosion. He went from being the best soldier I’ve ever known-a man who ran back instead of running away, and risked his life to keep me from being blown to bits-to being an aimless alcoholic. He didn’t have any physical wounds like I did, so they refused to consider his PTSD reason enough for a Purple Heart.”

“I’m so sorry.”

“Thanks, I can tell you are, and that really means something to me.”

“Then he disappeared.”

“Then he disappeared,” Nick echoed, shrugging helplessly.

“Listen, Nick,” she said. “I want to help you find Umberto. Meeting you, and thinking about the strangeness of all those comic books Belle wrote on, makes me believe there has to be a connection. Somehow or other, her path and Umberto’s had to have crossed. And if getting through to this Manny Ferris will move you closer to finding Umberto, then I want to help you with that as well. I’ve got ten years as a psych nurse that says I can help there.”

“I’d love the help,” Nick said, wondering if he should have delivered the words more forcefully.

“You told me that Manny Ferris had an almost violent reaction to one of the photographs of Umberto.”

“Not almost violent. He went berserk. It was nothing special-just a photo of me and Umberto standing by the RV. There was at least one other of Umberto and me. But Ferris took one look at that picture, heaved a jar at me, and bolted.”

“Do you think I could see the photos?”

Nick retrieved the envelope from one of the drawers in the galley and passed it across. Now, instead of her eyes, he became fixated on her hands-smooth, pale skin, nails not too long, with a clear coating except for the ends, which were quarter moons of white polish. He studied the movement of her long, delicate fingers as she went from photo to photo.

“Umberto has a very kind face,” she said.

He would love yours, Nick thought.

“That’s the photo,” he said, “the one that set Ferris off.”

Jillian appraised it with the concentration of one used to examining art.

“I self-published a book of my photos of the great buildings and monuments of D.C. Gave it to friends for Christmas. The shots of the Lincoln were my favorites.”

“I’d love to see it.”

“You may get your chance,” she said, this time lighting up the galley with her smile. “I wonder…”

“What?”

“Maybe it wasn’t the clinic or you or Umberto that upset Ferris so. Maybe it was the setting-the Lincoln itself.”

“How could we ever prove that?”

“Well, how about we do a little photo shoot of our own. Interested?”