Fatal

CHAPTER 16

Matt seldom awoke remembering a dream and even less often was aware he was dreaming while one was still in progress. But this time, at some level of his mind he did know. He was at once a participant and observer, legitimately terrified, yet strangely detached and analytical.

It was a huge Gila monster, orange scales glinting in patchy sunlight. The venomous lizard, tall as a building, was swaying through a dense forest, its thick tail knocking over trees, its stubby legs crushing everything in its path. Its black tongue snapped out like a whip, shearing the tops off pine trees. Again and again it slammed itself against a rocky hillside, sending boulders hammering down close to where Matt was standing. All at once there were men with guns — indistinct shadows firing continuously, burying shot after shot into the lizard. The Gila reared up on its hind legs, balancing on its tail, searching for the source of its pain. More men… more guns… more shots… more flashes… more bellowing… and now blood, spewing from a hundred wounds along its flank. The massive orange and black head swayed from one side to the other, powerful jaws opening and closing on nothing but air.

"Noooo!" Matt heard himself scream. "No more!"

Mortally injured, the beast toppled over, roaring at its killers, flailing out with its front claws, ripping at Matt's arm again and again. It was then he sensed he had awakened. His eyes opened a slit. The clawing against his arm persisted. Then he became aware that it was nothing more malevolent than a hand, scratching at his elbow. He was in a chair in a glass-enclosed cubicle in the ICU — Dr. Nikki Solari's cubicle, he realized. Slumped to one side, he had been asleep, his head resting half on his shoulder, half on the bed. The touch that had awakened him from his bizarre nightmare was Solari's. Through the glass, Julie Bellet, one of the night nurses, waved to him, smiling. The wall clock behind her read five-thirty.

Matt's thoughts quickly cleared. The stiffness in his neck suggested he had not moved for some time. His patient, arms restrained with leather straps, was silently imploring him through the gloom. Her eyes were wide with fear and confusion. The polystyrene tube he had slid between her vocal cords was still in place. The bedside ventilator attached to it whirred and hissed as it forced air into her lungs with every breath. Julie Bellet stepped into the room.

"Hi, there," she said. "You've been out for almost three hours. But you looked so peaceful that none of us had the heart to wake you up."

"I… um… was a little tired," he managed. "I guess it's time to ditch the decaf and go back to super."

He grinned sheepishly and turned back to Solari. He knew from the accounts of many who had woken up on a ventilator that having a half-inch tube down the back of their throat and into their trachea was as unpleasant and frightening a sensation as any they had ever experienced, especially with their hands lashed down as well. He switched on the overhead fluorescents.

"Dr. Solari, sorry about falling asleep like that. It's been a tough couple of days. I'm Matt Rutledge, your doctor. Do you understand?" Nikki nodded, her eyes still fixed on his face. "Good," he said. "You're in Montgomery County Regional Hospital in Belinda, West Virginia. The tube is in because you nearly drowned in a lake yesterday. You've been unconscious for more than twelve hours."

Nikki, ignoring the throbbing in her temples, moved her hand as far as the restraint allowed, and pointed desperately back at her face.

The tube. Get it out! Please, get it out. It's choking me!

Nikki prayed her doctor understood.

Matt Rutledge was probably a few years older than she was, with a kind, rugged face. His dark hair was pulled back into a ponytail that came down just over the collar of his shirt.

"I know you want that tube out this instant," he said. "I know it's awful. But please, please try your best to relax and breathe easily. Do you think you need some medicine to help you do that?… Good. Give me a signal if you change your mind about that. The vent's on assist, so all you have to do is breathe. I promise I'll get the tube out as soon as I can. First, I need to get a film and check your blood gases. If I loosen the straps on your wrists, do you promise you'll keep them away from the tube?"

Nikki nodded. The nurse who was in the doorway came over, introduced herself, and undid the restraints.

"Nikki," she said, "the balloon on your tube is still blown up. Please don't try and pull it out. It can damage your vocal cords if you do. Okay?"

Nikki forced herself to nod. The tube felt like a garden hose in her throat. Intellectually, she knew what it was and what it was doing for her, but at some uncontrollable, primal level, she was positive she was choking. She closed her eyes as her doctor listened to her heart and lungs, examined her belly, and checked the pulses in her arms and feet. Then he had her open her eyes and checked them with an ophthalmoscope. His manner was reassuring and his touch gentle. From what she could tell, he seemed to know what he was doing. She settled back into her pillow and forced herself to breathe more slowly. Piece by piece the events on the highway and in the woods floated into place.

Why"? The question burned in her thoughts. Why'?

"Things sound good," Matt said. "I'm going to write some orders and splash some water on my face. Then I'll be back."

After he had gone, the nurse, Julie, straightened the sheets and wiped off Nikki's face and hands.

"You're going to be fine," she said. "Dr. Rutledge may not look like a med school professor, but trust me, he's a really great doctor — the best in this hospital. I understand you're from Boston. Well, he grew up here, but he trained at Harvard. He actually rode out to the lake with the ambulance and put that tube in you out there."

Nikki nodded that she understood and made a weak thumbs-up sign.

Doctor. Just before the fat guy in the business suit had attacked her, he had called her "Doc." Who could have told him that? The two men weren't out to rob her or even to rape her. They were going to kill her.

Why?

Matt returned to Nikki Solari's bedside after washing, shaving, and gathering the things he had appropriated for Lewis Slocumb. The hours of sleep had served him well and, at least for the moment, he felt sharp and focused. Yesterday he had planned to return to the Slocumbs' farm to replace the jury-rigged chest tube after just a few hours of work in the hospital. Now nearly a full day had gone by. Well, he reminded himself, he could only do what he could do and hope that Frank Slocumb had the sense to drag his brother into the hospital if he was in trouble.

Solari looked alert and a bit more animated. Her X ray had showed no pneumonia and her blood gases were excellent. It was time to keep his promise and remove the tube. Hopefully, then, the questions surrounding the events at Crystal Lake would be answered. One mystery that had already been answered was the bizarre dream in which Matt had been immersed. On the top of Solari's left foot was a tattoo, orange and black, of a Gila monster. Matt had noticed it during his initial exam, but was far too engrossed in trying to save her life to give it much thought.

The woman with the elegant, long-fingered hands, who he'd guessed might be a potter, had turned out to be a coroner. And the coroner, who played bluegrass music, had an orange and black Gila monster tattooed on her foot. As popular as tattoos had become in the general public, they were still not that common among middle-of-the-road med students and doctors. Was she offbeat enough to be into drugs in some way? he wondered. Maybe dealing? Is that why she was being chased through the woods near Niles Ledge?

Matt considered the possibility as he prepared to remove the breathing tube from her throat. He also pictured his own tattoo — injected into his arm as a constant, permanent reminder of love and loss. No, he decided, glancing up at Nikki Solari's expressive eyes, whatever the significance of the odd tattoo, it had nothing to do with drugs.

The technique for removing the endotracheal tube was as straightforward as the potential complications of the procedure were life-threatening. Suction out the trachea, deflate the balloon, have the patient attempt to cough, and pull out the tube. Simple. Lurking in the shadows, however, was the specter of a reactive spasm of the larynx severe enough to shut off the airway, and tight enough to make reinsertion of a breathing tube near impossible.

Matt had never actually performed an emergency tracheotomy, but he had the equipment to do so near at hand. At that moment, there was nothing in the world he wanted to do less.

"Dr. Solari, we're all set," he said.

Nikki nodded and gave him a weak A-okay. The woman was tough, he was thinking. Whatever else she was, she was tough.

"Good," he said. "I know this next part isn't pleasant, but we've got to do it. Suction, please, Julie."

The nurse snaked a small suction catheter down beyond the tip of the tube into Nikki's trachea. Nikki reacted to the intrusion with violent coughing, tears overflowing her eyes and running down her cheeks.

"I'm really sorry," Matt said, deflating the balloon on the tube. "Let's get this part over with. Just take a breath and cough."

Nikki did as he asked. A slight tug and just like that the tube was out. The nurse moved to suction out Nikki's mouth and throat, but Nikki pushed her hand away.

"Bless you," Nikki croaked.

The nurse slipped a clear, polystyrene mask over Nikki's mouth and nose. For a minute, then another, no one spoke as Nikki took long, grateful draughts of humidified, oxygen-enriched air. Her blood oxygen level, as measured by the oximeter clipped around her fingertip, remained good, and her cardiac monitor pattern, steady. There was no significant laryngeal spasm.

"You all right?" Matt asked finally.

"Ugh, that was just awful," Nikki said. "Hardly the way to greet a new patient. Where I come from, doctors usually start by asking who their insurance company is."

Lights in the ICU cubicle were dimmed once again. The nurses had gone off to prepare for another admission — an admission who would probably be given Nikki's room. Haltingly, dozing off every few minutes, Nikki shared the story of the faked accident on the roadway, the chloroform, the gunshots, and the subsequent chase through the forest. She had no recollection whatsoever of the events immediately surrounding her plunge into Crystal Lake.

The frightening account was totally engaging to Matt, but no more so than the woman who was sharing it. Exhausted and clearly dealing with a headache, dizziness, and other effects of a concussion, Nikki (she insisted he call her that) had a spirit, intelligence, and wry humor that even her compromising condition could not diminish.

He had questions, dozens of them, and undoubtedly, Grimes would as well. But for the moment, he had no desire to deal with the man. Soon, after she was persistently awake, he would call the station. For now, he sat quietly and waited while she rested. He was actually surprised to realize he was studying her face. Why did it appeal to him so? There was little if anything about it that was reminiscent of the woman he had loved for so much of his life. If Ginny was beach sand and midday sun, Nikki was more moonlight and the still, dark water of a lake at night. Ginny's mouth was innocent and childlike, Nikki's full and sensual. Over the years since Ginny's death, he had, from time to time, been with one woman or another. But never had he been drawn to any of them this way. He felt awkward, strange, and a little disloyal. What was he doing contrasting and comparing this woman with Ginny?

… Have those memories remind you of how wonderful life can he again. Isn't that what Mae had said to him?

At that moment, the voice that bothered him with such things reminded him that he was her physician. Romantic involvement by a doctor with his or her patient was prohibited not only by the Hippocratic Oath, but by most states' legislatures as well. For too many docs, such involvement ended up being a shortcut to grocery clerkdom.

"Hey there, still here?" she asked dreamily.

"I… um… may have dozed off."

"Again?"

"I aced nap one-oh-one in med school. Tops in my class."

"Me, too. I was slated to be a surgeon, but they booted me out after I fell asleep at the operating table."

"I can picture you toppling face first into an open abdomen. Nikki, tell me, why did all this happen to you?"

"I have no idea. But those men knew who I was. I'm sure of that."

"Could they have been after drugs?"

"Anything's possible, I suppose. But from what I recall, I think they were after me, pure and simple. I think I heard them say each other's names, but I can't remember."

Matt rose from his chair.

"I'll be back," he said.

"Where are you going?"

"To call the police. Chief Grimes will want to know you're awake, and until we know what this is all about, I want a guard next to your door."

Nikki rubbed at her eyes.

"I think I spent some time with the police chief."

"You did. He told me."

"From what I remember, he was very friendly."

"That explains it," Matt said, flashing on Grimes's totally inappropriate, thinly veiled threat in the ER.

"What?"

"Nothing. Nikki, we haven't contacted your family. Just give me the numbers and I'll call your husband or parents or anyone else you want."

"My dad's recovering from a small stroke, my mom gets hysterical at the sight of a robin eating a worm, and the candidates to be my husband are still out there fighting one another to the death for my favor. Since I'm probably going to make it, why don't we just not upset anyone? Oh, except my job. I was supposed to be at work."

Matt wrote down the number.

"I'll be back," he announced in a woeful Schwarzenegger accent.

"You're… very… nice," she said.

He started to reply, then realized she was out again, breathing evenly and deeply.

When Matt explained what he wanted, the desk officer at the Belinda police station patched him through to Bill Grimes.

"Has she told you what happened?" Grimes asked.

"I haven't asked her much. I wanted to call you first."

"Don't tell me you've gone sensible on me."

"Very funny. She did say it was two men — one real fat, in a business suit. One athletic. Ring any bells?"

"Maybe."

"She also said they were shooting at her."

"So that was a bullet wound by her ear."

"I would say so."

"I'll have someone over there within the hour," Grimes said. "And I'll be by later to speak with her."

"Just go easy," Matt said, wanting instead to tell him to just stay the hell away from her. "She's got a fairly severe concussion."

"How long do you think she'll be in the hospital?"

"I don't know for sure. A couple of days, maybe. I'm going to have the neurologist see her and maybe get an MRI if he thinks it might tell us anything more than the emergency CT scan we did."

"Fair enough. One of the guys will be over there shortly."

"Round the clock, okay?"

"Rutledge, how about you just do your business and let me do mine."

"Nancy," Matt said to the nursing supervisor, "are you sure you can't keep Dr. Solari in the unit any longer?"

"Matt, you know I'd walk over hot coals for you," Nancy Catlett said, "but we have four criticals in the unit right now, and a post-op abdominal aneurysm repair due up soon. There's just no way I can justify keeping a patient who's awake and alert — even one of yours."

"In that case, a private room."

"That depends on her insurance."

"Just find one for her. We're going to have a guard posted outside the door. I want only people essential to her care going in there. If she needs a specific order, I'll write it. If her plan still won't cover the private, I will."

"Well now, I don't think we'll need to go that far," Catlett said. "But if that's the way you care for all your patients, I'm switching doctors to you. My HMO is terrible about paying for private rooms."

Matt made quick rounds on the patients he had in the hospital, and then brought the chest tube insertion kit, drainage system, intravenous bags, antibiotics, and other purloined equipment to his motorcycle. Thoughts of Nikki Solari and questions surrounding the assault on her had now bivouacked in his mind, making it difficult to concentrate on much else. When he returned to the unit, the nurses reported that Nikki had been asleep since he left, drifting back out again immediately after each of the two neuro checks they had done. Still, the moment he stepped through the doorway, she moaned contentedly and opened her eyes.

"Welcome back," she said, yawning.

"How did you know I was here?"

"Sometimes I just know things."

"How's your headache?"

"Did you ever see Riverdance?"

"Ouch. I can have them give you some Tylenol, but I'd rather stay away from anything stronger."

"Tylenol will be fine. I'm tough."

"You don't have to convince me of that. The police guard is all set. You were right about Bill Grimes. He feels very protective toward you."

"I hope he can get to the bottom of this," she said.

"He's a pretty good cop." When lie wants to \›e. "Listen, I've got a house call to make, but I'm going to wait around the ICU until the guard gets here. You just go ahead and sleep. Right now that's the most therapeutic thing you could do."

"In a minute. Right now I'm wide awake. Can you sit for a little while? I sort of feel like Dorothy when she looked out the window and discovered she wasn't in Kansas anymore."

"I'd much rather talk with you than write progress notes."

"Thanks. The nurses tell me you trained at Harvard."

"I did my residency in medicine at White Memorial."

"I'm impressed. I wasn't accepted for their surgical program."

"Surgery?"

"I did a year of surg at Metropolitan then switched to pathology. I wanted my patients to lie really, really still when I was operating on them. Where did you live when you were there?"

"Beacon Hill. The poorer part at the bottom. I liked Boston pretty much, but my heart has always been here in the mountains. I couldn't wait to get back."

"That's not hard to understand. It's very beautiful here."

"When you're not being chased by a pair of crazed killers it is. Can I ask you something?"

"Sure."

"It's about your tattoo."

"What about it?" she asked with a slightly defensive edge to her voice.

"Oh, nothing. I just wanted you to know that I run into Gila monster tattoos on the top of doctors' feet all the time around here."

Nikki's eyes narrowed. Are you making fun of me they asked.

Matt leapt in to save the situation.

"Uh-oh, I'm sorry," he said. "Sounding flip when I shouldn't is one of my less desirable talents. It gets me into more hot water than a boiled lobster. Mea culpa." He pushed up his sleeve to reveal his own tattoo. "I'm into hawthorn trees, myself."

Nikki's expression softened.

"Sometime, you're going to owe me a story," she said. "Well, let's see. I had the tattoo put on a few years ago. Some of my musician friends were getting them and I decided I wanted one, too. I picked the dorsum of my foot so that I could see it whenever I wanted to, but I could also hide it whenever I wanted. I might have thought of some other location if I had known how much that one was going to kill. It's actually only half Gila monster. The front half is a salamander."

"Many of our doctors choose that variation," he commented in spite of himself.

Her eyes laughed. No problems this time.

"I once saw the combination on a clay pot at a Navajo reservation in Arizona," she went on, "and after the artist explained it to me, I ended up adopting the creation as sort of my totem. The salamander is shy, porous, vulnerable, weak, and secretive. The Gila is fearless, compact, warriorlike, determined, and so tenacious that when it grasps something with its thick jaws, one must often cut its head off to get it to let go."

Matt flashed on the horrible death of the beast in his dream and shuddered. He had never been one to reject the mystical or supernatural, beginning with dreams, and this one was bothering him more every second. Was the unsettling scenario merely replaying a version of the events recently past, or was it a vision of things yet to be?

"I can see how those two men on the highway got more than they bargained for," he said.

There was no response. Nikki's eyes were closed again, her brain muffled by exhaustion and the physiology of her concussion. The lingering effects of blunt head trauma were absolutely unpredictable and potentially devastating. Matt had seen professional athletes forced to the sidelines permanently, and others — intellectually sound initially with no visible changes on their MRIs — become significantly impaired over just a few days.

Silently, he prayed for Nikki Solari and the music that she made — with and without her violin. He stood, and before he turned away, impulsively reached out to touch her hand. At the last moment, he pulled back. The gesture would be perfectly innocent and natural with nearly all of his patients. But not, he had to admit, with this one.