Harvest

CHAPTER FIVE

I'm holding Josh O" Day's life in my hands, thought Abby as she clutched the Igloo in her lap. Boston traffic, heavy as always at the noon hour, parted like magic before the flashing ambulance lights. Abby had never before ridden in an ambulance. Under other circumstances, she might have enjoyed this ride, the exhilarating experience of watching Boston drivers — the rudest in the world — finally yield the right of way. But at the moment, she was too focused on the cargo she held in her lap, too aware that every second that ticked by was another second drained from the life of Josh O" Day.

"Got yourself a live one in there, huh Doc?" said the ambulance driver. "G. Furillo' according to his nametag. "A heart," said Abby. "A nice one."

"So who's it going to?"

"Seventeen-year-old boy."

Furillo manoeuvred the ambulance around a row of stalled traffic, his loose-jointed arms steering with almost casual grace. "I've done kidney runs, from the airport. But I have to tell you, this is my first heart."

"Mine too," said Abby.

"It stays good — what, five hours?"

"About that."

Furillo glanced at her and grinned. "Relax. I'll get you there with four and a half hours to spare."

"It's not the heart I'm worried about. It's the kid. Last I heard, he wasn't doing so well."

Furillo focused his gaze more intently on the traffic. "We're almost there. Five minutes, tops."

A voice crackled over the radio. "Unit twenty-three, this is Bayside. Unit twenty-three, this is Bayside."

Furillo picked up the microphone. "Twenty-three, Furillo." "Twenty-three, please return to Bayside ER."

"Impossible. I'm transporting live organ to Mass Gen. Do you copy? I'm enroute to Mass Gen."

"Twenty-three, your instructions are to return to Bayside immediately."

"Bayside, try another unit, OK?" We have live organ on board-'

"This order is specific for Unit twenty-three. Return immediately."

"Who' s ordering this?"

"Comes direct from Dr. Aaron Levi. Do not proceed to Mass Gen. Do you copy?"

Furillo glanced at Abby. "What the hell's this all about?"

They found out, thought Abby. Oh God, they found out. And they're trying to stop us…

She looked down at the Igloo containing Karen Terrio's heart. She thought about all the months and years of living that should lie ahead for a boy of seventeen.

She said, "Don't turn around. Keep going."

"What?"

"I said, keep going."

"But they're ordering me-'

"Unit twenty three, this is Bayside," the radio cut in. "Please respond."

"Just get me to Mass Gert!" said Abby. "Do it."

Furillo glanced at the radio. "Jesus H.," he said. "I don't know-'

"OK, then let me off!." ordered Abby. "I'll walk the rest of the way!"

The radio said: "Unit twenty-three, this is Bayside. Please respond immediately."

"Oh, fuck you," Furillo muttered to the radio.

And he stepped on the gas.

A nurse in green scrubs was waiting at the ambulance dock. As Abby stepped out carrying the Igloo, the nurse snapped: "From Bayside?"

"I have the heart."

"Follow me."

Abby had time for only a last wave of thanks to Furillo, then she was following the nurse through the ER. Moving at a near-jog, Abby caught a fast-forward view of corridors and busy hallways. They stepped into an elevator, and the nurse inserted the emergency key.

"How's the boy doing?" asked Abby. "He's on bypass. We couldn't wait." "He coded again?"

"He doesn't stop coding?The nurse glanced at the Igloo. "That's his last chance you've got there."

They stepped off the elevator, made another quick jog through a set of automatic doors, into the surgery wing.

"Here. I'll take the heart," said the nurse.

Through the suite window, Abby saw a dozen masked faces turn to look as the container was passed through the door to a circulating nurse. The Igloo was immediately opened, the heart lifted from its bed of ice.

"If you put on fresh scrubs, you can go in," said a nurse. "Women's locker room's down the hall."

"Thanks. I think I will."

By the time Abby had donned new greens, cap, and shoe covers, the team in the OR had already removed Josh O" Day's diseased heart. Abby slipped in among the throng of personnel, but found she couldn't see a thing over all those shoulders. She could hear the surgeons' conversation, though. It was relaxed, even congenial. All OR's looked alike, the same stainless steel, the same blue-green drapes and bright lights. What varied was the atmosphere for the people working in that room, and the atmosphere was determined by the senior surgeon's personality.

Judging by the easy conversation, evan Tarasoff was a comfortable surgeon to work with.

Abby eased around to the head of the table and stood beside the anaesthesiologist. Overhead, the cardiac monitor showed a flat line. There was no heart beating in Josh's chest; the bypass machine was doing all the work. His eyelids had been taped shut to protect the corneas from drying, and his hair was covered by a paper cap. One dark tendril had escaped, curling over his forehead. Still alive, she thought. You can make it, kid.

The anaesthesiologist glanced at Abby. "You from Bayside?" he whispered.

"I'm the courier. How's it going so far?"

"Touch and go for a while. But we're over the worst of it. Tarasoff's fast. He's already on the aorta." He nodded towards the chief surgeon.

Ivan Tarasoft, with his snowy eyebrows and mild gaze, was the image of everyone's favourite grandfather. His request for a fresh suture needle, for more suction, were spoken in the same gentle tone with which one might ask for another cup of tea, please. No showmanship, no high-flying ego, just a quiet technician labouring at his job.

Abby looked up again at the monitor. Still a flat line. Still no sign of life.

Josh O" Day's parents were crying in the waiting room, sobs mingled with laughter. Smiles all around. It was 6 p.m., and their ordeal was finally over.

"The new heart's working just fine," said DrTarasoff. "In fact, it started beating before we expected it to. It's a good strong heart. It should last Josh for a lifetime."

"We didn't expect this," said Mr O" Day. "All we heard was that they moved him here. That there was some kind of emergency. We thought-we thought-' He turned away, wrapped his arms around his wife. They clung together, not speaking. Not able to speak.

A nurse said, gently, "Mr and Mrs O" Day? If you'd like to see Josh, he's starting to wake up."

A smiling Tarasoff watched as the O" Days were led towards the Recovery Room. Then he turned and looked at Abby, his blue eyes glistening behind the wire-rim glasses. "That's why we do it," he said softly. "For moments like that."

"It was close," said Abby.

"Too damn close." He shook his head. "And I'm getting too damn old for this excitement."

They went into the surgeons' lounge, where he poured them both cups of coffee. With his cap off, his grey hair in disarray, he looked more the part of the rumpled professor than the renowned thoracic surgeon. He handed Abby a cup. "TellVivian to give me a little more warning next time," he said. "I get one phone call from her, and suddenly this kid's on our doorstep. I'm the one who almost coded."

"Vivian knew what she was doing. Sending the kid to you."

He laughed. "Vivian Chao always knows what she's doing. She was like that as a medical student."

"She's a great Chief Resident."

"You're in the Bayside surgery programme?"

Abby nodded and sipped the hot coffee. "Second year."

"Good. Not enough women in the field. Too many macho blades. All they want to do is cut."

"That doesn't sound like a surgeon talking."

Tarasoft glanced at the other doctors gathered near the coffee pot. "A little blasphemy," he whispered, 'is a healthy thing."

Abby drained her coffee and glanced at the time. "I've got to get back to Bayside. I probably shouldn't have stayed for the surgery.

But I'm glad I did." She smiled at him. "Thanks, Dr. Tarasoft. For saving the boy's life."

He shook her hand. "I'm just the plumber, Dr. DiMatteo," he said. "You brought the vital part."

It was after seven when the taxi delivered Abby to Bayside's lobby entrance. As she walked in the door, the first thing she heard was her name being paged on the overhead. She picked up the inhouse phone.

"This is DiMatteo," she said.

"Doctor, we've been paging you for hours," said the operator.

"Vivian Chao was supposed to cover for me. She's carrying my beeper."

"We have your beeper here at the operator's desk. Mr Parr's the one who's been paging you."

"Jeremiah Parr?"

"His extension is five-six-six. Administration."

"It's seven o'clock. Is he still there?"

"He was there five minutes ago."

Abby hung up, her stomach fluttering with a sense of alarm. Jeremiah Parr, the hospital president, was an administrator, not a physician. She'd spoken to him only once before, at the annual welcoming picnic for new house staff. They'd shaken hands, exchanged a few pleasantries, and then Parr had moved on to greet the other residents. That brief encounter had left her with a vivid impression of a man who was unflappable. And he wore great suits.

She'd seen him since the picnic, of course. They'd smile and nod in recognition whenever they met in elevators or passed in hallways, but she doubted he remembered her name. Now he was paging her at seven o'clock in the evening.

This can't be good, she thought. This can't be good at all.

She picked up the phone and dialledVivian's house. Before she spoke to Parr, she had to know what was going on. Vivian would know.

There was no answer.

Abby hung up, her sense of alarm more acute than ever. Time to face the consequences. We made a decision; we saved a boy's life. How can they fault us for that?

Heart thudding, she rode the elevator to the second floor.

The administration wing was only dimly lit by a single row of fluorescent ceiling panels. Abby walked beneath the strip of light, her footsteps noiseless on the carpet. The offices on either side of her were dark, the secretaries' desks deserted. But at the far end of the hall, light was shining under a closed door. Someone was inside the conference room.

She went to the door and knocked.

It swung open. Jeremiah Parr stood gazing at her, his backlit face unreadable. Behind him, seated at the conference table, were half a dozen men. She glimpsed Bill Archer, Mark, and Mohandas. The transplant team.

"Dr. DiMatteo," said Parr.

"I'm sorry, I didn't know you were trying to reach me," said Abby. "I was out of the hospital."

"We know where you were." Parr stepped out of the room. Mark came out right behind him, both men confronting Abby in the dim hallway. They'd left the door ajar and she saw Archer rise from his chair and shut the door against her gaze.

"Come into my office," said Parr. The instant they stepped inside, he slammed the door and said, "Do you understand the damage you've done? Do you have any idea?"

Abby looked at Mark, but his face told her nothing. That's what scared her most: that she could not see past the mask, to the man she loved.

"Josh O" Day's alive," she said. "The transplant saved his life. I can't consider that any kind of mistake."

"The mistake lies in how it was done," said Parr.

"We were standing over his bed. Watching him die. A boy that young shouldn't have to-'

"Abby," said Mark. "We're not questioning your instincts. They were good, of course they were good."

"What's this crap about instincts, Hodell?" snapped Parr. "They stole a goddamn heart! They knew what they were doing, and they didn't care who they dragged into it! Nurses. Ambulance drivers. Even Dr. Lim got suckered in!"

"Following the orders of her Chief Resident is exactly what Abby was supposed to do. And that's all she did. Obey orders."

"There have to be repercussions. Firing the Chief Resident isn't enough."

Fired? Vivian? Abby looked at Mark for confirmation.

"Vivian admitted everything," Mark said. "She admits that she coerced you and the nurses to go along with her."

"I hardly think Dr. DiMatteo is so easily coerced," said Parr.

"What about Lim?" said Mark. "He was in the OR too. Are you going to kick him off the staff?."

"Lim had no idea what was going on," said Parr. "He was just there to harvest the kidneys. All he knew was that Mass Gert had a recipient on the table. And there was a directed donation form in the chart." Parr turned to Abby. "Drawn up and witnessed by you."

"Joe Terrio signed it willingly," said Abby. "He agreed the heart should go to the boy."

"Which means no one can be accused of organ theft," Mark pointed out. "It was perfectly legal, Parr. Vivian knew exactly which strings to pull and she pulled them. Including Abby's."

Abby started to speak, to defend Vivian, but then she saw the cautionary look in Mark's eyes. Gareful. Don't dig yourself a grave.

"We have a patient who came in for a heart. And now we have no heart to give her. What the hell am I supposed to tell her husband? "Sorry, MrVoss, but the heart got misplaced?."' Parr turned to Abby, his face rigid with anger. "You are just a resident, Dr. DiMatteo.You took a decision into your own hands, a decision that wasn't yours to make.ross has already found out about it. Now Bayside's going to have to pay for it. Big time."

"Come on, Parr," said Mark. "It hasn't reached that point."

"You thinkVictorVoss won't call his lawyers?"

"On what basis? There's a directed donation consent. The heart had to go to the boy."

"Only because she coerced the husband into signing!" said Parr, pointing angrily at Abby.

"All I did was tell him about Josh O" Day," said Abby. "I told him the boy was only seventeen-'

"That alone is enough to get you fired," said Parr. He glanced at his watch. "As of seven-thirty — that's right now — you're out of the residency programme."

Abby stared at him in shock. She started to protest, but found her throat had closed down, strangling the words. "You can't do that," said Mark. "Why not?" said Parr.

"For one thing, it's a decision for the Programme Director. Knowing the General, I don't think he'll take to having his authority usurped. For another thing, our surgical house staff is already stretched thin. We lose Abby, that means thoracic service rotates call every other night. They'll get tired, Parr. They'll make mistakes. If you want lawyers on your doorstep, that's how to do it." He glanced at Abby. "You're on call tomorrow night, aren't you?"

She nodded.

"So what do we do now, Parr?" said Mark. "You know of some other second-year resident who can just step right in and take her place?"

Jeremiah Parr glared at Mark. "This is temporary. Believe me, this is only temporary." He turned to Abby. "You'll hear more about this tomorrow. Now get out of here."

On unsteady legs, Abby somehow managed to walk out of Parr's office. She felt too numb to think. She made it halfway down the hallway and stopped. Felt the numbness give way to tears. She would have broken down and cried right then and there, had it not been for Mark, who came up beside her.

"Abby." He turned her around to face him. "It's been a battlefield here all afternoon. What the hell did you think you were doing today?"

"I was saving a boy's life. That's what I thought I was doing!" Her voice cracked, shattered into sobs. "We saved him, Mark. It's exactly what we should have done. I wasn't following orders. I was following my own instincts. Mine." She made an angry swipe at her tears. "If Parr wants to get back at me, then let him. I'll present the facts to any ethics committee. A seventeen-year-old boy versus some rich man's wife. I'll lay it all out, Mark. Maybe I'll still get fired. But I'll go down kicking and screaming." She turned and continued down the hall.

"There's another way. An easier way."

"I can't think of one."

"Listen to me." Again he caught her arm. "LetVivian take the fall! She'll do it anyway."

"I did more than just follow her orders."

"Abby, take a gift when it's offered! Vivian accepted the blame.

She did it to protect you and the nurses. Leave it at that."

"And what happens to her?"

"She's already resigned. Peter Dayne's taking over as Chief Resident."

"And where does Vivian go?"

"That's her concern, not Bayside's."

"She did exactly what she should have done. She saved her patient's life. You don't fire someone for that!"

"She violated the number one rule here. And that's play with the team. This hospital can't afford loose cannons like Vivian Chao. A doctor's either with us or against us." He paused. "Where does that put you?"

"I don't know." She shook her head. Felt the tears beginning to fall again. "I don't know any more."

"Consider your options, Abby. Or your lack of them. Vivian's finished her five years of residency. She's already Board-eligible. She could find a job, open a surgical practice. But all you've got is an internship. You get fired now, you'll never be a surgeon. What're you going to do? Spend the rest of your life doing insurance physicals? Is that what you want?"

"No." She took a breath and let it out in a rush of despair. "No." "What the hell do you want?"

"I know exactly what I want!" She wiped her face with a furious swipe of her hand. Took another deep breath. "I knew it today. This afternoon. When I watched Tarasoft in the OR. I saw him pick up the donor heart and it's limp, like a handful of dead meat. And there's the boy on the table. He connects the two and the heart starts beating. And suddenly there's life again. ." She paused, swallowing back another surge of tears. "That's when I knew what I wanted. I want to do what Tarasoft does." She looked at Mark. "Graft a piece of life onto kids like Josh O" Day."

Mark nodded. "Then you have to make it happen. Abby, we can still make this work. Your job. The fellowship. Everything."

"I don't see how."

"I'm the one who pushed your name for the transplant team. You're still my number one choice. I can talk to Archer and the others. If we all stick by you, Parr will have to back down."

"That's a big if."

"You can help make it happen. First, let Vivian take the blame.

She was Chief Resident. She made a bad judgment call."

"But she didn't!"

"You saw only half the picture. You didn't see the other patient." "What other patient?"

"Nina Voss. She was admitted at noon today. Maybe you should take a look at her now. See for yourself that the choice wasn't so clear. That it's possible you did make a mistake." Abby swallowed. "Where is she?"

"Fourth floor. Medical ICU."

Even from the hallway, Abby could hear the commotion in the MICU: the cacophony of voices, the whine of a portable x-ray machine, two telephones ringing at once. The instant she walked through the doorway, she felt a hush descend on the room. Even the telephones suddenly went silent. A few of the nurses were staring at her; most were pointedly looking the other way.

"Dr. DiMatteo," said Aaron Levi. He had just emerged from Cubicle Five, and he stood staring at her with a look of barely suppressed rage. "Perhaps you should come and see this," he said.

The throng of personnel silently moved aside to let Abby approach Cubicle Five. She went to the window. Through the glass, she saw a woman lying in the bed, a fragile-looking woman with white blonde hair and a face as colourless as the sheets. An ET tube had been inserted down her throat and was hooked up to a ventilator. She was fighting the machine, her chest moving spasmodically as she tried to suck in air. The machine wasn't cooperating. Alarms buzzed as it fed her breaths at its own preset rhythm, ignoring the patient's desperate inhalations. Both the woman's hands were restrained. A medical resident was inserting an arterial line in one of the patient's wrists, piercing deep under the skin and threading a plastic catheter into the radial artery. The other wrist, tied to the bed, looked like a pincushion of IV lines and bruises. A nurse was murmuring to the patient, attempting to calm her down, but the woman, fully conscious, stared up with an expression of sheer terror. It was the look of an animal being tortured.

"That's Nina Voss," said Aaron.

Abby remained silent, stunned by the horror she saw in the woman's eyes.

"She was admitted eight hours ago. Almost from the moment she arrived, her condition deteriorated. At five o'clock she coded. Ventricular tachycardia. Twenty minutes ago, she coded again. That's why she's intubated. She was scheduled for surgery tonight. The team was ready. The OR was ready. The patient was more than ready. Then we find out the donor went to surgery hours ahead of schedule. And the heart that should have gone to this woman has been stolen. Swlen, Dr. DiMatteo."

Still Abby said nothing. She was translured by the ordeal she was witnessing in Cubicle Five. At that instant, Nina Voss's eyes lifted to hers. It was only a brief meeting of gazes, an appeal for mercy. The pain in those eyes left Abby shaken.

"We didn't know," Abby whispered. "We didn't know her condition was critical…"

"Do you realize what will happen now? Do you have any idea?"

"The boy-' She turned to Aaron. "The boy's alive."

"What about this woman's life?"

There was no reply Abby could make. No matter what she said, how she defended herself, she could not justify the suffering beyond that window.

She scarcely noticed the man crossing towards her from the nurses' station. Only when he said, "Is this Dr. DiMatteo?" did she focus on the man's face. He was in his sixties, tall and well dressed, the sort of man whose very presence demands attention.

Quietly she answered, "I'm Abby DiMatteo." Only as she said it did she realize what she saw in the man's eyes. It was hatred, pure and poisonous. She almost backed away as the man stepped towards her, his face darkening in rage.

"So you're the other one," he said. "You and that chink doctor."

"Mr Voss. Please," said Aaron.

"You think you can fuck around with me?" Voss yelled at Abby. "With my wife? There'll be consequences, doctor. Damn you, I'll see there are consequences!" Hands clenched, he took another step towards Abby.

"MrVoss," said Aaron, "Believe me, we'll deal with Dr. DiMatteo in our own way."

'! want her out of this hospital!! don't want to see her face again!"

"Mr Voss," said Abby. "I'm so sorry. I can't tell you how sorry I am-'

"Just get her the hell away from me!" roared Voss.

Aaron quickly moved between them. He took Abby firmly by the arm and pulled her away from the cubicle. "You'd better leave," he said.

"If I could just talk to him — explain-'

"The best thing you can do right now is leave the ICU."

She glanced at Voss, who stood squarely in front of Cubicle Five, as though guarding his wife from attack. Never before had Abby seen such a look of hatred. No amount of talking, of explanation, could ever get past that.

Meekly she nodded to Aaron. "All right," she said softly. "I'll leave." And she turned and walked out of the MICU.

Three hours later, Stewart Sussman pulled up at the curb on Tanner Avenue, and from his car he studied number 1451. The house was a modest cape with dark shutters and a covered front porch. A white picket fence surrounded the property. Though it was too dark for Sussman to see much of the yard, instinct told him the grass would be trim and the flowerbeds free of weeds. The faint perfume of roses hung in the air.

Sussman left his car and walked through the gate and up the porch steps to the front door. The occupants were home. The lights were on, and he could see movement through the curtained windows.

He rang the bell.

A woman answered. Tired face, tired eyes, her shoulders sagging under some terrible psychic weight. "Yes?" she said.

"I'm sorry to disturb you. My name is Stewart Sussman. I wonder if I might have a word with Joseph Terrio?"

"He'd rather not speak to anyone right now. You see, we've just had a… loss in the family."

"I understand, Mrs…"

"Terrio. I'm Joe's mother."

"I know about your daughter-in-law, Mrs Terrio. And I'm very, very sorry. But it's important I speak to your son. It has to do with Karen's death."

The woman hesitated only a moment. Then she said: "Excuse me," and shut the door. He could hear her call: "Joe?"

A moment later the door opened again and a man appeared, eyes red-rimmed, every movement sluggish with grief. "I'm Joe Terrio," he said.

Sussman extended his hand. "Mr Terrio, I've been sent here by someone who's very concerned about the circumstances surrounding your wife's death."

"Circumstances?"

"She was a patient at Bayside Medical Centre. Is that correct?"

"Look, I don't understand what this is all about."

"It's about your wife's medical care, MrTerrio. And whether any mistakes were made. Mistakes that may have proved fatal."

"Who are you?"

"I'm an attorney with Hawkes, Craig, and Sussman. My speciality is medical malpractice."

"I don't need any attorney. I don't want any goddam ambulance chaser bothering me tonight."

"Mr Terrio-'

"Get the hell out of here." Joe started to close the door, but Sussman put out a hand to stop it.

"MrTerrio," Sussman said quietly. Calmly. "I have reason to believe one of Karen's doctors made an error. A terrible error. It's possible your wife didn't have to die. I can't be certain of that yet. But with your permission, I can look at the record. I can uncover the facts. All of the facts."

Slowly Joe let the door swing open again. "Who sent you? You said somebody sent you. Who was it?"

Sussman gazed back with a look of sympathy. "A friend."