Do No Harm

Chapter 21

David heard them coming before he saw them-the loud bellow of a wounded animal and a crescendo of shuffling boots. The doors slammed open as the officers shoved the man through, and David lowered his chart and closed the door to the exam room he'd just left.

Jenkins held an animal control come-along pole, the wire noose at the end of the shaft cinched around the wailing man's neck.

"Oh God. Help me. Make it stop help me make it- " Another loud, wavering cry.

Jenkins released the spring catch and pulled the noose free. The man instantly collapsed. He lay facedown on the floor, his arms bent back behind him, wrists cuffed. Still gloved in white latex, his hands stuck up like some sort of plume.

The officers stood in a half circle behind him.

Jenkins flashed a cold grin at David. David looked from the gardeners to the homeless man to Yale and Dalton, realization dawning.

David ran forward and crouched over the man. "What happened? What happened to him?"

"Alkali," Yale said. "During our pursuit, he tripped and spilled on himself."

"His sweatshirt is soaked. Bring me trauma shears. Someone bring trauma shears! How long ago did this happen?" David pulled a pair of gloves from a box on a nearby cart and pulled them on. "Get a stretcher!"

Patients and staff had spilled out of the exam rooms and the Central Work Area into Hallway One, gawking. Leaving her post at the triage desk, Pat strode through the swinging doors behind the officers. Don stood in the middle of the hall behind David, hands stuffed into his physician's coat.

"Clear the hall of patients," Dalton barked. "Now!" Doors slammed shut and patients scurried.

The man's cheek pressed flat against the floor. Saliva sprayed the tile when he whimpered. David checked his pulse, which was racing. At first, he thought the man's face had been burnt, but then he realized the redness was severe acne. Wisps of hair wreathed his scalp, which was shiny with sweat.

David would need to get the patient out of the cuffs to treat him. Right now, the man seemed more scared than dangerous. Posture limp and slumped. In case he became agitated, someone should be standing by with a high-potency neuroleptic for IM rapid tranquilization. However, the sight of someone waiting with a needle might alarm and anger him. If it came down to it, David would try to talk the patient into taking sedatives orally-it would be less violating and would make the man feel as though he were an active participant in his treatment. For now, he needed to be calmed and reassured.

"You're in a safe place," David told him. "I'm here to take care of you. I need to ask you some questions. Are you taking any drugs?"

A long drawn-out groan. Could mean yes, no, or nothing.

"Is this alkali? I need to know if this is alkali."

The man's head rocked up and down against the floor in a nod.

David looked up at the officers. "How long ago did this happen?"

"I don't know," Yale said. "Five minutes maybe."

"Uncuff him. We have to get him out of this sweatshirt."

Dalton shook his head. "No way, Doc. Ain't gonna happen."

"Saline bottles!" David tried tearing the moist sweatshirt with his hands, but it didn't give. His gloves came away blue and he shot them off onto the floor and pulled on another pair. "Trauma shears-where are the trauma shears? And someone call psych-preferably Dr. Nwankwa. Give him a heads-up."

The staff members stood still. Their stares, hardened with hatred for Clyde, were nearly tangible. The hall took on an eerie dream silence.

David turned the man on his side; he rolled willingly. The entire front of his sweatshirt was doused in alkali. A few jagged edges of Pyrex protruded. The fabric smelled heavily of cigarette smoke. "They walked so slow," the man sputtered.

"We'll give you something for the pain," David said. "Some morphine."

The man shrieked and bucked. "No shots," he cried. "No needles."

"Okay, okay. How about pills?"

"I don't take pills," the man moaned. "Pills are for faggots."

Leaning in the doorway of Exam Fourteen, Jill slid her pen into her scrub top. The material above the front pocket was lined with ink from near-misses. "I hope it hurts," she muttered.

"Jill," David snapped. "The patient can hear you."

"I hope so."

David found himself looking for Diane, though he knew it wasn't her shift. He'd have to find support elsewhere.

The man was sobbing. "They made me walk slow and burn."

David tried to quell his rising anger at his staff. Still, no one was moving to help him. "Where the hell are those trauma shears!"

Pat stood behind Jenkins, the overhead lights catching the black hairs peppered through her gray buzz cut. The skin around her eyes was drawn taut, sending a network of wrinkles through her cheeks. Her expression was one David had never seen.

The man flopped and screeched.

"Can someone move? Will someone get to work here?" David's voice was high and thin. Nobody responded.

One of the undercover cops, dressed as a parking attendant, stepped forward. "Let's go, guys," he said. "Do your jobs."

"Pat," David said. "Bring trauma shears."

Pat glared down at the man. She did not move. An instantaneous sweat covered David's back, and he felt a tingle roll across it. "This is not a choice for us to make." He spoke slowly, his voice shaking. "There is no decision here."

Slowly, Pat crossed her arms.

Choking on rage, he rose and shoved past Jill into Exam Fourteen. Carson watched him from the far side of the hall, shocked. David grabbed some trauma shears from a tray, and holding his stethoscope so it wouldn't slide off his shoulders, half jogged back to the patient. Aside from the crusted red acne, the man's face was corpse-white.

"I have to flip him over. Take off the cuffs."

"No way," Jenkins said. "No fuckin' way."

The cop dressed as a parking attendant stepped forward, but Jenkins placed a hand on his chest. "Don't even think about it, Blake."

The man's shoulders hit the floor with a slap when David rolled him onto his back. His arms were twisted beneath him, and he shrieked.

"I know," David said. "It hurts, but we're doing this to help you."

Don watched, feet planted, hands in his pockets.

"I'm going to cut your sweatshirt off, because it's burning you," David said, fighting to keep his voice level. "I'm going to cut it using these scissors." He slid the open trauma shears up the front of the fabric. "What's your name?"

"Not telling."

"Hey, hey." David leaned over, close to the man's face. It smelled sticky and sweet, like orange-flavored candy. "It's okay. I'm here to help you. What's your name?" The man's eye beat a few times as it pulled over to look at David. David looked away quickly, wanting to avoid eye contact that could be interpreted as confrontational. A shiny puddle of drool had collected on the tile where the man's mouth had been.

"Clyde."

David threw the halved sweatshirt open like a blazer. A few pieces of glass and the broad lip of a Pyrex beaker tinkled to the floor. Luckily for Clyde, the beaker had shattered between his sweatshirt and his scrub top. The stencil on the scrub top featured a seal, below which UNIVERSITY OF CALIFORNIA MEDICAL CENTER: UCLA, UCI, UCSD was written in a jailhouse blue. It could have been stolen from this very hospital. The top yielded easily to the blade, and David saw that the thin layer of material had helped to lessen the damage. The alkali had soaked through, leaving the skin red. In a few spots, white blisters were beginning to rise. Minor cuts covered his chest and lower neck, but little glass had made it all the way through the scrub top into the wounds.

"Try to slow your breathing, Clyde," David said. "We don't want you to hyperventilate." His voice betrayed his anger and exasperation. "We need to irrigate!"

Finally, a hand holding a saline bottle extended toward David, a woven leather bracelet around the wrist. David took the bottle from Carson and began spraying. Carson crouched on Clyde's other side and joined him.

"Missed a spot," Jenkins said sardonically, pointing at a large blister under Clyde's nipple.

David ignored Jenkins, leaning forward so his face was near Clyde's. "We're spraying you off with water now. We're doing this to wash off the alkali that is burning you."

Clyde shifted on his bound hands, squealing with pain. No one else came near them; the staff and officers standing back in their muted ring. "I didn't want to," Clyde whimpered. "I was going to, like before, but I didn't want to do it."

"Let's get him to an exam room. Dr. Lambert, get me a stretcher. A stretcher." David glanced up, his mouth pursed with anger. "Get me a stretcher now!"

Don returned David's gaze for what seemed an eternity, the only sound in the hall that of Clyde's whimpering. Finally, he turned and walked leisurely to retrieve a stretcher. It took him ten seconds to turn the corner, his slow pace mocking David.

Sweat dripped from David's forehead onto Clyde's face, and he leaned back and wiped his brow with an arm. "We have to get him on a bed. We don't have time to wait while Dr. Lambert plays games. Carson, keep irrigating." David turned to the cop Jenkins had referred to as Blake. "And you. Will you give me a hand?"

Clyde was heavy and limp, and David and Blake had to struggle to get him to his feet. He was taller and wider than either of them, and they staggered under his weight. The other officers watched closely.

David looked over Jenkins's shoulder at Pat. She held her head high on her slender neck, stately and pitiless. Disdain and hatred twisted her face into an ugly mask. "Get the hell out of my ER," David said. Her face crumpled, and he felt a flash of satisfaction move through the molten haze of his anger.

He and Blake pivoted and began to drag Clyde toward Exam Fourteen, Carson continuing to douse him with saline, Yale and Dalton walking on either side. Clyde was unsteady on his feet. Jenkins followed closely behind, palm resting on the butt of his pistol, and the other officers dissipated slowly, heading back out through the doors. By flanking David and Clyde, Yale, Dalton, and Jenkins created the illusion they were assisting.

"We're going to help you," David said. "Do you understand that I'm here to help you?"

Tear tracks streaked Clyde's cheeks like clown paint. He nodded, his chest heaving.

"What else can we get you, Doctor?" Jenkins asked quietly. "A plumber's snake to clear out his throat? A bag for his head, maybe?"

"Should we give him five, one, and one?" Carson asked.

Five milligrams of Haldol, one of Cogentin, and one of Ativan. He'd be out in ten minutes and stay that way for hours. "I don't want to go there yet," David said. "I'd like him lucid. He's been fine so far."

"That's because he's in handcuffs," Jenkins interjected.

David turned to Clyde. "You won't give us any trouble?"

Headshake.

"You promise?"

"Promise," Clyde cried. "I promise." He closed his eyes, muttering, "Three, two, one."

David felt a burning sensation along the tender skin inside his biceps. Alkali. He wiped it off hastily on his scrub top. "Watch your arms," he warned Blake.

Clyde finally found his feet and helped them the last few steps into the room, snuffling and yelping, and then they had him seated at the edge of the gurney. Carson continued spraying Clyde down, the saline pooling in his lap. His scrub bottoms turned dark with the liquid, clinging to his thighs and crotch.

David grabbed two saline bottles and stepped into the hall. Many of the staff members were standing around, rubberneckers milling in the wake of an accident. Don had just returned with the stretcher David had requested. He tossed it on the floor. David took in each face, the cold, peering eyes.

He and Carson would need help. Given the patient's history of violence against women, selecting male staff seemed clearly the right course. "You two." David snapped his fingers and pointed to a male nurse and a male lab tech, neither of whom he recognized. "In here and help Carson. Move it. Now!"

The nurse took a step forward, then the lab tech followed. David handed them each a saline bottle as they shuffled past.

David regarded the others for a moment. "In my seventeen years practicing medicine, this is the most horrifying thing I've seen." His voice sounded foreign to him. "On top of which you've allowed the floor to come to a standstill. Get back to work immediately."

He stepped back in the room and faced Yale. Jenkins's hand hovered over his Beretta, making David intensely nervous. Blake stood to the side, clearly uneasy. "Uncuff him," David said. "You've had your fun, now we need to get at him to treat him."

"No, sir," Jenkins said. "You're dealing with a dangerous man."

"We're dealing with a patient injured with alkali under suspicious circumstances who hasn't even been booked, let alone convicted of anything."

"The guy got caught stuffing alkali under his shirt. I think we both know-"

"Uncuff my patient!" David stepped forward, eye to eye with Jenkins.

Yale pressed a hand against David's chest, which David knocked aside. "The best we can do is put him in four-point restraints," Yale said. "Would that be better?"

"We handle a lot of potentially violent patients."

"Would it be better if we got the suspect in four-points?" Yale repeated calmly.

David took a deep breath. "Yes."

"Hard restraints."

"Fine. The security guard up front can get them for you. Please hurry."

Dalton strolled out to fetch the restraints, as David scribbled the order. The nurse and lab tech were standing a few feet back from Clyde as they sprayed him down.

"What do you mean, restraints?" Jenkins asked. "Throw some water on him and let's haul his ass to Harbor."

"Back off, let us do our job. You can do yours later." Seeing his words were having little impact, David tried a more pragmatic approach. "You want him to stand trial wrapped in bandages?" he asked. "What do you think that'll do for jury sympathy?"

He turned around and examined the patient. The fact that the scrub top had remained between the alkali spill and Clyde's flesh had really limited the damage. The irrigation was coming along nicely-there would be some painful blistering and a few cuts, but nothing too serious. Morphine would have helped Clyde's pain, but he'd reacted violently earlier when David had mentioned giving him a shot, and David didn't want to risk agitating him again now that he'd calmed down.

David stepped forward, again careful to avoid Clyde's eyes. Clyde's lips were moving slightly, and David realized he was counting backward from three, over and over.

"We're just spraying the alkali off you," David said. "We're trying to make the burning stop."

Clyde's lips stopped their quiet chant for a moment. "Thank you," he said.

"We have some questions for him," Yale said.

"Uncuff him and let us treat him," David said over his shoulder. "You can question him in an hour."

Jenkins grabbed David's shoulder from behind. "This guy fucked up two of your nurses-"

"A nurse and a doctor, and we don't know the patient is responsible."

"Why don't you stop worrying about him so much and let us get what we need. We brought him in here."

David stared down at Jenkins's hand until he removed it from his shoulder. He looked around for Blake, his sole ally among the cops, but he'd left the room. "That was your legal responsibility," David said. "Not a favor."

"He is not the victim here," Jenkins shouted through clenched teeth, jerking a finger violently in Clyde's direction.

"We need you out," David said. He turned to Yale. "I need him out. He's agitating the patient."

"We'll get the suspect secured, then give you a little space," Yale said.

Dalton returned with the leather restraints. He walked behind Clyde's back, circling the gurney, and Clyde grunted and whipped his head around, trying to keep him in view. Carson and the nurse and lab tech were startled back a few steps. Jenkins grabbed Clyde's legs roughly, and Clyde thrashed as Dalton undid the handcuffs. The two quickly had Clyde flat on his back, strong leather restraints binding his ankles and wrists to the metal rails of the gurney. David directed them to bind one of Clyde's hands up and the other to the railing down by his waist so if something went wrong, they could turn him on his side to minimize the risk of aspiration.

The skin on Clyde's chest was raw and shiny where it wasn't raised in blisters, but it looked as though most of the alkali had been flushed off. He was in a much better position for Carson to access the burns on his chest, and the four leather cuffs held his limbs tight enough that the others weren't afraid to work more closely on him.

"All right," David said. "That's enough. He's not going anywhere. I can take it from here."

"We'll be outside," Yale said.

"Have fun," Dalton added. He had to grip Jenkins's forearm to move him from the room.

The room hadn't been prepped for a potentially violent patient, so David removed both IV poles, sliding them out into the hall and leaving the door slightly ajar. He found some scissors near a bag of O-negative blood that had been left on the counter from the previous trauma, and slid them into his pocket. The lab tech wore a shirt and tie, having not yet changed into scrubs for the day, and David pulled him aside and whispered to him to take off his tie before going near the patient. He caught Carson's eye and gestured for him to remove his yin and yang earring.

"Stand back from the door," Clyde was muttering when David turned his attention back to him. "Stand back from the door." He kept his eyes closed, as though he were praying. His hands were puffy, perhaps swollen from the cuffs.

He repeated certain phrases like mantras, David realized. The recitations seemed to have an obsessive-compulsive element to them; maybe they were uttered for the same reason some people with OCD wash their hands forty times a day-to reduce anxiety.

David crouched so he wouldn't have to lean over Clyde in threatening fashion. "We're going to remove your gloves now-"

Clyde screamed, balling up his hands into fists behind his back.

"Okay, okay," David said. "We'll wait till later. We'll take the gloves off later. How's the pain? Is it better?"

Clyde nodded. "Still burns but it's done eating its way through me. I know. I can tell when it's done."

"Do you want some pills for the pain?"

"I told you, I don't take pills." His crying and screaming had finally stopped, though he was still breathing hard. A small wedge of Pyrex glimmered in a cut near his left armpit.

"I'm going to reach across you," David said. "And I'm going to use these forceps to remove a sliver of glass from one of your cuts."

"Okay," Clyde said.

David leaned over, but Clyde's left arm was locked down by his waist, blocking the cut. He turned to Clyde, again doing his best to avoid what could be perceived as threatening eye contact. "I'm going to untie one of your arms to get at the cut. I'm doing this so I can help you. Remember, you promised not to give me any trouble."

Carson took a half step forward. "Look, I don't know-"

Clyde's sweaty head moved up and down in a nod.

David untied the restraint and raised Clyde's arm, the thick leather band remaining around Clyde's wrist. He bent down, navigated the forceps carefully into the wound, and removed the piece of Pyrex. He lowered Clyde's arm back to the metal rail and secured it again, threading the leather strip through the hasp.

Carson let his breath out in a rush.

Clyde raised his head weakly and stared at David as the others continued to flush his wounds with saline. His voice hitched in his chest. "Thank… thank you," he said.

David thought of the Xeroform bolsters stitched into Nancy's face and strongly resisted the urge to tell him to go fuck himself.