Do No Harm

Chapter 26

Yale was waiting for David outside Clyde's room, his arms spread. "Well, we're ready to take him off your hands. Press is cordoned, transport vehicle's waiting in the ambulance bay." He thrust a clipboard at David. "Please sign him out."

Diane paced the hall behind Yale, hands tucked into the back pockets of her jeans. His face still flushed, Jenkins congregated with a few officers farther down by the lobby doors. Murmuring to one another and shifting on their feet, they directed their stares toward David and the closed door of Clyde's room. Waiting like jackals for a whisper of opportunity.

David felt the crush of an ugly dilemma. What was already a difficult, complex decision was now enflamed by the agitation of the hospital board, the press, an angry city. He felt the myriad pressures in the heat rising to his face, and he fought to find the correct response. Something flared in him, bright and sharp, and he found himself saying to Yale, "I'm afraid the patient is not ready to be released."

The clipboard smacked against Yale's thigh. "No?" He flicked his wrist and the Rolex appeared. "Eight-fifteen. Your shift is over. Who's the next attending on call?"

"The patient is not improving at a rate that indicates he'll be ready to be moved tonight."

Yale opened his mouth, then closed it. He scratched his forehead with two fingers. Diane was watching David, a puzzled expression on her face.

"When is the earliest he'll be ready?" Yale asked.

"Eight tomorrow morning."

"And it's just a coincidence that that's when your next shift begins?"

"Yes. I'll brief the next attending to contact me in the event of any change in Clyde's condition, no matter the hour. If he has a miraculous recovery in the night that enables him to be moved, I'll come in immediately and sign off on him."

One of the clerks stuck her head out of the CWA but withdrew it quickly when David looked at her. Two nurses whispered to each other in the doorway of Twelve.

"You said you thought he'd be ready to be moved by now," Yale said.

"My patients don't always abide my expectations."

Yale dropped the clipboard on the tiled floor, where it made a startlingly loud bang. "If you insist, I suppose we have little choice."

Jenkins and the other officers stood in a flying wedge at the hall's end, looking foolishly formal.

A grin flashed across Yale's imperturbable face and vanished instantaneously. "We'll be here waiting."

Diane paced tight circles while David signed out to Dr. Nelson, a young attending who'd trained under him. She walked swiftly to keep up with David as he headed through the hospital toward the lobby, avoiding the ambulance bay so he wouldn't have to pass Jenkins.

"What are you doing, David?" she said. It clearly was an effort for her not to raise her voice. "We've released patients to custody in worse shape than that."

"If I release him," David said, "he's likely to die."

"Nobody dies of that kind of alkali burn."

David looked at her, his stomach twisted into a knot. "I'm not talking about the burns."

Removing his cell phone from his pocket, he ducked into the empty fluoroscopy room and had the operator put him through to the University Police. Diane sat on a gurney, waiting patiently.

"I need to reach Officer Blake. Urgently… Yes, I would appreciate it if you'd page him to this number." David rattled off his cell phone number. "No, I'd rather not say what this is regarding, but please tell him it's extremely important."

He snapped his phone shut and faced Diane. She made a circular gesture with her hand. "I'll just ask when this is over," she said.

He glanced at her clothes. "What are you doing here anyway? It's your day off. I'm not used to seeing you dressed."

"I'll take that the way it was intended."

It had been a long time since he'd smiled, and it felt good.

"With all the shit that went down this morning, how could I not come in?" Diane said. "I wanted to make sure you were still in one piece."

"And am I?"

Judging by her expression, he must have looked like something someone coughed up. He fisted his stethoscope on either side of his neck and tugged on it like a scarf. "That bad?" His phone rang.

"Blake here."

"Officer Blake, this is David Spier, the physician who treated Clyde when he came in."

"Oh. Oh yeah. Can I help you?"

"Where are you?"

"Can I help you with something?"

"Yes, I'd like to have an off-the-record conversation with you."

A pause. "Where would you like to not meet?"

"Are you in the area?"

"Yeah, I'm still on campus."

"Can you meet me right now?"

"Where?"

"My car is parked on the top tier of the PCHS lot. It's a green Mercedes. They're not letting press through to that area."

"I'll meet you there in five minutes."

David hung up and gestured for Diane to follow. They threaded through the lobby and out across the dark quad. Dr. Kingston, a white-haired senior member of the board, paused and regarded David judgmentally, but David simply nodded and kept walking.

Diane kept her eyes on the ground. "You really think they'd kill him?"

"I think Jenkins would, yes."

"What are you gonna do?"

"That's what I'm figuring out. But I just bought myself-and Clyde-twelve hours. And this guy, Blake, there's no love lost between him and Jenkins. I'm hoping he can help."

They reached the top tier of the parking lot, and David saw Blake leaning against the trunk of his Mercedes. He was glad Blake's police car was not in evidence.

David had parked at the far side of the tier, away from most foot traffic and passing cars. He unlocked the doors to his car, and they all got in, Diane sliding in the back.

Blake cupped his hand and ran it over his thick mustache. "What would you like to not discuss?"

"I appreciated your helping today in the ER."

Blake nodded, continuing to regard David a bit impatiently.

David took a deep breath. "I'm concerned that if I release Clyde to the LAPD, he'll be killed."

Blake's eyebrows rose and spread. "Jenkins is a live wire."

"I'm holding him through the night for medical reasons. Is there any way I could release him to your custody? To the university police?"

With a fingernail, Blake worked something out from between his teeth, his mustache bristling. "No. No way. He's in LAPD custody. He has to be released to LAPD."

"And they're taking him to Harbor for further treatment. In a transport vehicle."

"Yeah. A squad car."

"Probably Jenkins's?"

Blake studied David for a moment, his face textured and leathery under the light of the lampposts. "That's not quite how it would work," he said.

"How would it work?"

"If it was gonna work? Someone else's squad car. Jenkins following, off-duty or on. Yale and Dalton eating at a diner somewhere, somewhere with high visibility. A near-escape in a dark alley. A mix-up." Someone walked by and Blake turned away so his face couldn't be seen. "Of course, I don't much buy into conspiracy theory."

David realized he was sweating. He turned on the car and put the air-conditioning on low. Blake reached over and turned the key, then looked to see if anyone had taken note of the car starting up.

"Do I have any options?" David asked. "Could a judge do anything?"

Blake shrugged. "Shit, I'm no lawyer, but I'd doubt it on your time line. A case this big, there'd be a huge inquiry and investigation."

Diane leaned forward. "How about Sheriff's Medical at USC Med? We send critical patients there sometimes. Does that fall under a different jurisdiction?"

"If the patient is critical, as in critical critical, he'd get sent there and signed in to the Sheriff's custody. But he'd still have to be transferred."

"How?"

"By the city, actually. They'd send an LA City fire paramedic unit with a uniformed police officer over to haul him off. But LAPD won't let that fly. They're not gonna want to lose custody-it's a big fucking collar. They'll want him under their thumb at Harbor. Plus, the dude walked into UCLA-if they're walking at all, they go to Harbor, not County. And you can't bullshit this one. The LAPD chief would be over there with a second opinion from one of his guys before they'd let him roll to County." His eyes were a weary blue. Washed out. "Once you clear him, he's going to Harbor, all right. Unless you want to fuck him up more with drugs or something, make it so he has to roll out on a gurney."

David shook his head. "Can't do that."

"How about if we contact the Sheriff?" Diane asked. "Does he have any kind of intervening authority? Wouldn't he want the collar too? Could he send his guys over?"

Blake laughed a smoker's laugh. "Shit, you guys don't get it. You really think the Sheriff's gonna step on the Chief's ass like that? On this case? No sir."

Blake turned away as a security guard approached, and David quickly got out and regarded the man across the top of his car. He was relieved to see it was Ralph. "It's me," David said. "We're having an impromptu staff meeting." Diane cleared the fog from the back window and waved.

"Okay, Doc. Just keeping an eye out around here."

David nodded and ducked back in the car.

Blake shook his head. "Security jackasses." He pressed his hands together. "Is that it, then?" He started to get out.

"How about a psych hold?" David asked. "If he got put on seventy-two-hour hold, would he still have to be transferred?"

Blake cocked his head, silent for a moment. "I don't know. Let me look into that for you. My chief's throwing a party for his wife's birthday tonight. I can sneak over there once things wind down, bend his ear for a bit." He turned so he could take in both David and Diane. "If I'm looking into this, you keep a lid on things till I get back to you."

"Okay," David said.

"Keep your cell phone on." Blake got out from the car. Resting his arms on the roof, he leaned back in. "Hey. I'm just dispensing information, not recommendations. Got it?"

"Absolutely," David said.

The door slammed shut, and David took a deep breath and exhaled hard, puffing out his cheeks. He regarded Diane in the rearview mirror. "Where to, ma'am?"

"Why don't you let me take you to dinner? Somewhere real."

"I don't think I have the energy to go somewhere real."

"Fine. We'll grab a six-pack and some Taco Bell. Oh-and David? Just in case the press is on the lookout for the ER chief's car… " She flashed a grin. "I'm driving."

Diane drove a maroon Explorer, which was bad enough, and drove it too fast for David's taste. After they picked up some food, she'd raced up Coldwater Canyon to a brief, dusty plateau. They sat on the hood of her vehicle amid a clutter of taco wrappers, sipping beer and following the headlights' gaze out to the hazy Century City skyline. The August heat informed the evening cool, wrapping around them, fresh yet stuffy as only LA air is. Diane listened silently as David finished filling her in on the day's events.

She popped open her second Heineken and took a sip. "Wow. Sounds like an episode of ER. Never underestimate vengeance."

"I guess not." David let the beer dangle from two fingers and wondered if it made him look younger. He took a sip and remembered he didn't like beer. A car drove by behind them, its headlights briefly illuminating the windshield at their backs. "This is a nice area. There's a little Italian restaurant down that way." He pointed. "I just ate there last week."

"Oh? Who'd you go with?"

Reaching into the brown paper bag, he surreptitiously switched his beer for a Coke. He studied her as he took a sip. "I went alone."

She peeled the label off her beer, her fingernail lifting the gum from the green bottle. "I go out to dinner alone a lot too. A thirty-one-year-old resident. Kind of in that dead space between normal-age house staff and the older docs. I mean, it's not like I'm gonna date Carson. And you've made it clear you're way too old."

David smiled. "I'm sure you have plenty of options. For company, I mean."

"I suppose." She smiled self-consciously. "I've never really dated much. No real relationships, so to speak. Not that I haven't wanted to. I guess I'm something of a… " After a moment, it became clear she wasn't planning on finishing the sentence.

"Men are a stupid breed," David said. "They're intimidated by intelligence in a woman, particularly when paired with beauty. God knows why. Maybe it makes them feel less virile."

"I suppose that's a compliment."

"One subtle enough that you're supposed to pretend you didn't notice."

"I didn't." She sipped her beer again. The silence seemed to make her uneasy. "So, what else do you do? I mean, with your time."

He shrugged. "Read. Work. Take walks. Work. Masturbate." He looked over at her. "That was a joke."

"Really?"

He set the Coke bottle down beside him on the hood. "No."

Her eyes took a pensive cast. "It must be hard," she said. "Being alone after not being alone."

The blinking light of an airplane cut through the distant haze, descending. "It's the little things," David said. "It's always the little things, isn't it? Like now, I turn on the answering machine when I take a bath." He smiled sadly, to himself. "We had a good, solid marriage. Full of honesty and openness and all the things most marriages aren't. It was a real relationship, with a lot of caring and compromise. Did you know I was working the night she came into the ER?"

Diane shook her head slowly, as if afraid any abrupt gesture would knock David off course.

Bitterness overlaid the pain in his voice, hiding it beneath a sharper veneer. "An embolus. Why not a car, a plane, a fire? A goddamn embolus. Her slipping away and me just standing there with my useless, useless hands."

His hands, thin, smooth, and unlined, were indisputably the hands of a professional. No scars or thick calluses from the kind of work men toiled at year after year, hauling crates or fighting shovels into the ground. He was fortunate. Despite everything else, he had his work.

Diane's voice startled him from his reverie. "What do you miss?" She was staring out across the tree-darkened valley to the floating lights of the high-rises. Her face was heavy, somehow, weighed down with melancholy, or sadness, or both. "From your relationship. What do you miss the most?" A soft vulnerability hid within her curiosity.

The answer was there waiting, though he didn't know it until he started speaking. "I miss that feeling when you're out, and the night is softly lit, and you know that after the smiles and the glances and the red wine, you're going to go home and make love. That's what I miss."

Diane looked at him, a soft noise of appreciation escaping her throat, then they watched the hazy skyline together for a while, sipping their drinks.

David pulled out his cell phone, called the ER, and had the clerk put him through to Dr. Nelson. "How's the patient?" he asked.

"Looks fine. I just poked my head in. I'm doing my best to avoid any formal assessments."

"LAPD giving you any trouble?"

"Actually, no. They've retreated to the ambulance bay."

David thanked him and hung up.

"What time do you think Blake'll call?" Diane asked.

David squinted at his watch, a plastic digital thing from Longs Drugs. He wore bad watches to work because he constantly misplaced them; he had a drawerful at home. It was nearly 11:30 P.M. "Any minute."

"What's Plan B?"

"Depending on what Blake says, I can gather some other opinions. I have a friend on the board at Mass General-attorney. I'd rather not overexpose myself, but I do trust him. And Peter, of course. He's excellent with this sort of thing."

"What about Dr. Evans?"

"The last thing Sandy wants is a big fiasco, but if I don't come up with any better options by morning, I'll talk to her first thing."

"Can I ask you a question you probably don't want to answer?"

"You just did."

"Why are you doing all this? I don't mean to sound callous, but this isn't your mess."

"I can't release a patient when I believe he's going to be killed."

"But you're beyond your domain, David. Your job is to treat him and hand him over. You're a doctor, not a vigilante. A bunch of cops are probably fucking up some guy in custody somewhere right now. Why is this any more your business?"

"Because I can do something to prevent this."

"Not as a physician, you can't."

He finished his Coke and crumpled the can.

"Plus, what about Jenkins? If he's really as rash and unstable as you think, what's to say he won't go after you?"

"He might."

"Who knows how far he'll push this? You're stepping into a different world here, David."

"So you disapprove?"

"God no. Not at all." She finished her beer and set the empty on the hood behind her. "There are no easy answers here. But I do know the dogma of a physician is the same as the dogma of a soldier. It's just better articulated. Think beyond the rules and oaths of the profession. Know what you're getting into. Then, whatever you decide, fine."

David's phone rang in his jacket, and he pulled it out and flipped it open. "Hello?"

"Blake here. Even if you throw a psych hold on your boy, he'd still have to be transferred, and since he's not critical, LAPD would be the guys to do it. But he could go to USC, not Harbor, since Harbor doesn't have a secure psych ward."

"So he'd end up in the Sheriff's custody?"

"If he gets there. And be advised-the Mayor's got this one in his roundhouse. His approval ratings are down. You do the math."

As if there weren't enough stresses already in play. "Thanks for calling back."

"I didn't."

David hung up and looked over at Diane. "A psych hold gets him to USC, but he'd still have to be transferred. In an LAPD squad car."

"Why don't we call Dash? Might as well see if a psych hold is even plausible."

Dash answered after four rings, his voice heavy with sleep. "Yeah?"

"It's David. Sorry to wake you."

"What's up?"

David explained the situation in its entirety while Dash listened in silence.

"Why didn't you say anything to me this afternoon?"

"I didn't want to get ahead of myself. Plus, I was waiting to get a better handle on just how real this threat was. What do you think? Do we have any options?"

"Well, clearly I'm not going to put him on a psych hold without a complete and formal assessment."

"Of course."

"And even if I determined he could only be released to a secure psychiatric facility, that doesn't get you around the transfer problem."

"Unless… " David pressed his lips together, thinking hard. "Unless you determined he was so unstable he had to remain in four-point restraints. Four-points would buy us an ambulance. And a supervising physician inside it."

"You know the cops will believe he can be transferred just fine in handcuffs." Dash exhaled long and hard. "I understand the predicament, David, but a formal psych assessment goes on record. There could be ramifications for the trial. He is highly unstable, but I don't know that he demands psychiatric supervision versus incarceration."

"Just come in for an official psychiatric evaluation. That's all I ask. I'll figure out how to get you past the cops and buy you the time you need. You can get him to talk…?"

Hurwitz, Gregg

Do No Harm (2002)

"I'm confident I can, yes. With some more time. But even if I can't, I've made assessments on uncooperative patients before, David."

"I'll meet you at the hospital now and get you in with him."

"I can't do it unless I'm the psychiatrist on call. It'll smell bad. In the paperwork and in the courts."

"Who's on tonight?"

"Bickle. Asshole clock puncher."

"Are you on call tomorrow?"

"Seven A.M."

"Meet me at Clyde's room."

"I'm not promising anything, David."

"I understand that."

David hung up and looked over at Diane, who was watching him intently. "Dash will make an assessment in the morning. If he puts Clyde on psych hold, and if he wants him kept in four-points, we're in the clear."

"And if not?"

"I get into it with my lawyer friend and Sandy."

"What do we do now?"

David leaned back, accidentally knocking one of Diane's empties. It rolled off the hood and shattered on the ground. "Wait until morning."