Bellevue

Chapter 21

Thursday, July 4, 12:35 a.m.

When his phone rang, Mitt wasn’t even certain he’d had the opportunity to fall asleep, especially since he was holding his phone and the last thing he could remember was debating whether to put it on the night table next to the head of the bed or to slip it into his jacket pocket. When he’d gotten back from Latonya Walker’s cardiac arrest a few minutes earlier, relieved to have done so without any repeat hallucinations, he’d immediately stretched out on the bed fully clothed without even kicking off his loafers. It seemed like the next second the phone rang.

“Yes?” Mitt said into the phone after connecting the call. He sensed he wasn’t fully awake, so he must have been asleep.

“This is Carl Higgens, the ICU ward clerk. I’m calling about Elena Aguilar to let you know that she’s just had a cardiac arrest and the resuscitation team is on its way.”

“Thank you,” Mitt said by reflex, and immediately sat up. He could tell the clerk had hung up, so he pocketed his phone. Although it wasn’t surprising that Elena Aguilar had had a cardiac arrest since her course had been steadily downhill since her surgery, it was still a blow, particularly after just returning from Latonya Walker’s even more surprising arrest and death.

Mitt got to his feet and waited a beat for his cardiovascular system to adjust. He knew that of all places in the hospital, the ICU was the most attuned to handling a cardiac arrest and that the resuscitation team was on its way, so he didn’t feel the need to break a speed record getting there. There was no doubt in his mind that, as with Latonya Walker, he’d be more of an observer than a participant, so he took a moment to duck into his bathroom and splash some cold water on his face. The shock of it did wonders, and he felt much more capable of facing the reality that Elena Aguilar might be yet another death, which seemed almost inevitable considering her progressively downward course. After also taking the time to push his hair into a semblance of order to try to counterbalance appearing like “death warmed over,” with his dark circles and pale complexion, Mitt left the on-call room.

As he passed through the deserted on-call lounge area, he didn’t run, but he didn’t take his time, either. He needed an opportunity to think more about Elena Aguilar’s potential passing, remembering his thoughts that afternoon after Bianca Perez’s death. As incredible as it might seem, if there was another death that night, then six out of the first seven patients he’d been assigned would have passed away. It was an incredibly high percentage, and as he had agonized that afternoon, the chances of it happening simply by bad luck were incredibly small, nearly untenable. And if the deaths weren’t being caused by chance, what could possibly be the explanation? Mitt had no idea... none, even though in the back of his mind his sixth sense was suggesting there was.

Upon reaching the empty elevator lobby, Mitt pressed the call button and positioned himself in the middle of the room to wait for whichever of the ten elevators might arrive. While he waited, he struggled to stop agonizing over his apparent personal patient-death rate, vaguely imagining that if future patients had any idea of his atrocious record, he’d be shunned for certain. No one would want him to be involved with their case in any capacity.

With a warning chime from the elevator that was about to arrive, Mitt hustled over and positioned himself inches from the appropriate door. His plan was to jump on even before the door completely opened and quickly hit the button for the tenth floor as well as the close button. The sooner he did, the sooner the door would reverse direction, and he’d be on his way.

As the elevator door began to open, Mitt moved even nearer, his nose now practically resting against the cream-colored metal as it slid past in front of him. The actual moment the door cleared his face on its way to collapse into the wall, he started forward as he’d planned. But in the blink of the eye, he froze. To his horror, he found himself within inches of a ghostly pale man with bloodshot eyes and wild hair who was balancing on a single leg and dressed in what looked like a colonial costume. In his arms was his amputated leg with its bloody, severed thigh muscles, blood vessels, nerves, and sawed-off femur in plain sight.

As Mitt reeled back, he saw that this pitiful person was not alone. The entire elevator was thronged with similar wretched figures, everyone appearing as if they were in agonizing pain although no one cried out and total silence reigned. Completely taken aback, Mitt froze, unable to move a single muscle. For the first time with any of his hallucinations he was close enough to reach out and touch one of the miserable human beings or be touched by them. Thankfully, no one moved. And the people weren’t the only ghastly occupants. The entire floor of the elevator was a writhing mass of rats in constant motion, climbing all over one another and trying to clamber up the legs of the surgerized people.

For what seemed like an eternity although it must have been only seconds, the elevator door remained open. Finally, it began to close, and as it did so, the image of the crowd of sorry human beings progressively disappeared until it was gone, and Mitt found himself staring at a closed elevator door.

Then, before he could recover from the shock, another elevator arrived. As its door collapsed back into the wall, Mitt hesitantly checked its interior and, with tremendous relief, saw that it was empty.

With great strength of will and needing more time than he would have liked, Mitt finally managed to break free from his shocked paralysis. By then he had to lunge for the empty elevator and bang against the closing door to get it to reverse itself.

Once inside, Mitt pressed the button for ten, and then let himself lean his back and head against the elevator wall. Desperately, he tried to make sense of what he’d just witnessed. He had no idea if it was the same group of sad people that he’d seen in the OR and the surgical conference room, but they appeared similar. Regardless, in his mind they certainly represented the same pitiful constituency that Mitt imagined had been operated on at Bellevue Hospital in the distant past. How his mind was capable of mentally imagining such a crowd, he had absolutely no idea. Nor why, which seemed an important question, his hallucinations were coming more frequently and with increasingly realistic details. The vision of the young girl had been shocking enough, but these crowds of tortured souls were far worse. And what about the rats? A few years ago, when he’d read a book about the history of Bellevue Hospital, he’d learned that rats coming in through the sewers had been a major problem in the hospital over many, many years, partially due to its location along the East River. He’d been appalled that the vermin had been known to climb over bedridden patients at night, possibly gnawing people and even infants. As awful as that sounded, why was his creative mind adding those creatures to his hallucinations? It certainly hadn’t been something he’d spent a lot of time thinking about.

The elevator door opened on the tenth floor, and Mitt exited. He’d mostly recovered from the fright of his hallucination, even wondering anew what would have happened had he simply ignored what he’d seen and just boarded the elevator despite it appearing jammed full. Would they have physically blocked his way or just instantly disappeared? It was an interesting thought, but he doubted he’d have the courage to put it to the test.

When Mitt pushed into the ICU proper, he felt significantly better than he had on his previous visits. He imagined the resuscitation team was already present, so he was confident he wouldn’t be expected to do something beyond his abilities. He was also just becoming more acclimated purely by repetition.

As he approached Elena Aguilar’s ICU room, he again saw a clutch of people observing just outside the door, but it was a significantly smaller number than had been outside Latonya Walker’s room. When he got close enough to see within the bay, he could tell it was the same team that had responded to Walker’s arrest. He wasn’t surprised, as he imagined there was only one resuscitation team on during the night, but he didn’t know that for sure.

First he looked for Dr. Madison Baker either inside the room or in the hallway, even though he didn’t expect her to be there. He knew she’d been at Walker’s arrest by chance. Although he wished she was there for the support she offered, he didn’t want to call her if he didn’t have to.

“How is the resuscitation going?” Mitt asked one of the few ICU nurses observing the action from the hallway. She was a youthful Hispanic woman who was about Mitt’s age. He was impressed she was working in the ICU, where most of the other nurses appeared older and more seasoned.

“Not well,” the woman said. She briefly eyed Mitt, making him suspect she was thinking the same thoughts about his age. “I think they are about to call it quits.”

“So soon?” he questioned. He tried to see this youthful nurse’s name tag, but it was covered by the surgical gown she was wearing over her scrubs like Elena’s earlier nurse.

“I understand there’d been some disappointing new developments in the patient’s condition,” she added. “And that’s in addition to her reverting back into ventricular fib after every defib attempt.”

“Oh?” Mitt questioned. “Like what kind of new developments?” Elena Aguilar not breathing on her own for more than twelve hours was certainly serious enough. He couldn’t imagine what could have been more “disappointing” than that. He noticed some of the ICU staff who had been watching the proceedings were turning to leave.

“I heard she’s been exhibiting some decerebrate posturing,” the nurse said. “And that’s serious stuff, especially when it’s progressive as it’s been. It certainly goes a long way to explain why she hasn’t made any attempts to breathe on her own the whole time she’s been here.”

“I’m not familiar with decerebrate posturing,” Mitt admitted. “What is it exactly?” He tried to rally his tired brain, but it was difficult. He vaguely remembered the term from his medical school neurology rotation, but all that came to his mind was it being seriously bad news and generally incompatible with life.

“You don’t know what decerebrate posturing is?” The nurse eyed Mitt with surprise, but then her expression changed, ushering in a smile of sudden understanding. “Wait a second! Are you perchance a new resident? I mean, it is the beginning of July.”

Mitt raised his hands in mock surrender. “Third-day surgical resident,” he confessed. He was happy to admit it, particularly there in the ICU.

“Of course! Well, welcome to the team! To answer your question, decerebrate posturing is a hyperextension reflex. Usually, the arms are tensed with the palms rotated outward and wrists flexed, which you can see some of if you look in at this patient. What it probably means is that she’d had a major stroke that involved the brain stem.”

“Good grief,” Mitt said, wondering if Elena Aguilar had had a stroke during her surgery, which no one suspected, particularly Anesthesia.

“Are you following this patient, or are you here just being curious, like me?”

“I assisted with her vein stripping this morning.”

“Well, that’s nice to hear. At least she no longer has any varices.”

Mitt regarded her. He was mildly taken aback by what seemed like an insensitive comment, but he saw a slight rise to her eyebrow, suggesting she was indulging in a bit of “insider” black humor.

“Well, nice chatting,” the nurse said. “I have to get back to my patient who luckily is doing a lot better than this poor woman. Sorry about your patient, but good luck in your residency!”

“Thank you,” Mitt said. As the nurse walked away, he moved into the relatively crowded room and found a place to stand off to the side behind the medical resident, who was clearly the captain of the resuscitation team. Since the ventilator was respiring Elena Aguilar, no one needed to be manning an Ambu bag, and everyone was watching the monitor except the medical resident, who was kneeling on the bed and doing the chest compressions. By moving slightly side to side, Mitt was able to get a reasonable view of Elena’s body and confirm what the nurse he’d been talking to outside the room had told him, Elena’s arms were rigidly held along her sides with her wrists flexed and palms directed outward. Also, from his perspective, it appeared as if her back was slightly arched. Her legs, still covered with Ace bandages, were definitely straight out, with the toes extended and pointing medially. Mitt made a mental note that what he was looking at was an example of decerebrate rigidity, suggesting that Elena Aguilar had suffered a major stroke, or maybe even a series of major strokes that had been missed.

“All right, everyone, clear,” the captain of the resuscitation team called out. “Let’s try one last defibrillation attempt.” In either hand, she was holding up the charged paddles of the defibrillator. As soon as everyone backed away, she placed the paddles against Elena’s chest and discharged the defibrillator. Elena’s body reacted stiffly, very different from Latonya Walker’s when she’d been shocked.

At that point everyone in the room, now including Mitt, watched the overhead monitor to see the result. Within seconds the blip reappeared, tracing a wildly abnormal pattern as it moved across the screen.

“Is there a pulse?” the captain asked while keeping her eyes glued to the monitor.

“No, there’s no pulse,” one of the team said, feeling against Elena’s neck.

“Okay, that’s it,” the captain said, throwing up her hands. “We’re done. I think this should have been a DNR from the word ‘go’ with this amount of decerebrate symptomatology. But who’s to say? Let’s close up shop and get out of here in case we get another call.”

Almost the moment the woman finished her little speech, the cardiac alarm went off, indicating that Elena Aguilar had yet again fallen back into fibrillation. Several of the resuscitation team members reacted to the alarm, but the captain raised her hands to stop them. “Hold up! As I said, we’re done here.”

As the resuscitation team packed up their equipment, which mostly involved tending to the defibrillator and its paddles, the monitor alarm kept sounding until one of the ICU nurses turned it off. Not too long after the resuscitation team had pushed the crash cart out of the room and away down the hall, Mitt noticed that the monitor’s blip changed from its chicken scratch — like tracing to a perfectly flat line. Elena Aguilar was now dead by definition.

Mitt watched the straight-lined monitor for several beats until one of the ICU nurses turned it off along with the ventilator, which had mechanically continued respiring the patient despite her heart having stopped. Then everyone but Mitt left the room. He remained rooted to his spot, staring at his assigned patient’s motionless body.

Although he’d expected for a number of hours that Elena Aguilar was going to die, now that she had, it weighed on him anew that six out of his seven initially assigned patients had passed away. Once again, his mathematically oriented mind struggled to deal with the reality of such a statistic, especially now that he couldn’t get any potential traction out of the Dr. Geraldo Rodriguez connection since Latonya Walker and Elena Aguilar had been with Dr. Kevin Singleton. Now, as far as Mitt knew, he was the only person or circumstance that connected the deaths together, and he struggled to try to understand what, if anything, that could possibly mean. The only idea that came to his mind was rather preposterous: Maybe a medical serial killer was on the loose in Bellevue Hospital and was plotting for Mitt to take the fall if he or she were to be discovered.

Yet almost the moment Mitt entertained the implausible idea of a medical serial killer being somehow involved, he dismissed it out of hand. In his mind such an unlikely explanation was evidence of his desperation. There was no way the idea made sense, as the patients were too disparate, with no association other than being Bellevue patients. If these deaths were related, it had to be by something else. But what, he had absolutely no inkling whatsoever.

“Excuse me!” a voice said. “Can I help you?”

Mitt took a breath as if coming out of a trance and turned to see a nurse enter the room carrying a fresh bedsheet. He’d noticed her earlier during the resuscitation attempt and now assumed she’d been originally assigned as the night nurse for Elena Aguilar.

“No, I was just leaving,” Mitt said, finding his voice. But he didn’t leave. Instead, he watched the nurse cover the body with the sheet and otherwise prepare the room for the arrival of housekeeping. “I was the surgical resident assigned to Ms. Aguilar and assisted with her surgery,” Mitt added. “Tell me, do I need to fill out the death certificate or anything like that here in the ICU?” Since Critical Care had its own physicians and residents, Mitt wasn’t sure.

“No, I’m certain that’s being taken care of. I can assure you that everything is under control and you are free to go. Sorry about the outcome with your patient, but it had never looked good from the moment she arrived here in the ICU from the PACU.”

“She never was able to breathe on her own after her surgery,” Mitt said.

“So I heard,” the nurse said. She had now moved to the head of the bed and was detaching the intravenous line.

After a further brief conversation to be personable, Mitt set out back through the ICU on his way to his on-call room. As he walked, he felt numb, still mulling over the disturbing issue of trying to explain six out of seven patient deaths, but falling short. Yet by the time he’d passed through the swinging doors out into the empty elevator lobby, he’d come to accept that the situation had to have been chance despite its very low probability. After all, he reasoned, in the course of human history there’d been many unexpected and surprising events of extraordinarily low probability that had nonetheless happened. He also found himself thinking about his one remaining patient, Diego Ortiz. Mitt was briefly tempted to stop by the fifteenth floor just to make certain he was okay but then changed his mind. The patient would undoubtedly be asleep, and Mitt would be understandably reluctant to wake him. Besides, Mitt would have heard from the nurses if everything wasn’t copacetic.

As he pressed the elevator button his mind instantly switched from thinking about statistics to the horrid image of the ragtag surgerized people he’d been confronted by on his way to the ICU. He tried to prepare himself if there was a repeat, again wondering if he should or could ignore the apparitions as fanciful constructs and just pretend they weren’t there. Mitt couldn’t decide, nor did he have much chance because a moment later, the chime sounded at one of the elevator doors, indicating the car was about to arrive.

Quickly moving down to the appropriate spot, Mitt positioned himself about three feet back and tried to brace himself in case there was a repeat episode. As the door began to slide open, he tensed despite not having decided exactly what he was going to do if the hallucination of the disgusting crowd and rats returned. But then he let out a sigh of relief. The elevator was empty.

Within minutes, he was walking through the deserted on-call lounge area and, a moment later, keying his room. Once inside, he took off his jacket and draped it over the lone reading chair. Before collapsing on the bed, he needed to use the toilet.

Already fantasizing about what it was going to feel like to lie down and allow himself to fall asleep, he turned on his bathroom light with the wall switch, opened the bathroom door, and went to step inside. But then he froze with his foot suspended in the air and his hand still holding the doorknob. Inside the bathroom, hundreds of rats were emerging from the toilet and crawling all over one another, filling the entire floor, the shower, and even the sink with a seething mass of vermin.

With a shudder Mitt frantically yanked the door shut and reflexively stepped back, momentarily terrified that the rapidly expanding army of rats was about to break through and swarm the room. But then he quickly recovered. Remembering how his hallucinations had a tendency to disappear, he forced himself to step forward and regrasp the bathroom door handle.

After a brief hesitation to build up his courage, he cracked open the door. Seeing no vermin whatsoever, he pushed the door completely open. As he’d hoped, the room was free of the disgusting creatures. Allowing himself to enter, and despite significant unease, he quickly relieved himself. As he did so, it occurred to him that the more exhausted he became, the more frequently the hallucinations seemed to be appearing. They were now even invading his personal space. Whatever that meant, he had no idea, but he didn’t like it nor did it bode well for the future.