Marker

twenty-one

WITH A BACKHANDED motion, Jack tossed the Cosmopolitan magazine back onto the surgical lounge's coffee table. He was desperate for something to read, but that particular magazine wasn't going to do it for him. He'd been through just about everything else, including old copies of Time, People, National Geographic, and Newsweek, plus Saturday's papers. He'd even tried to watch CNN for a while, but he couldn't concentrate on the TV, especially after the two cups of coffee he'd drunk. It was a quarter to twelve, and Laurie was still in surgery, which made him progressively antsy.

Jack had gone up to the third floor with Laurie, Dr. Riley, and the orderly. He had given Laurie's hand a final, reassuring squeeze before she and the others disappeared into the OR. With the hope that Laura might reconsider his watching the procedure, he'd gone into the men's locker room and changed into scrubs, using an empty locker with no lock for his clothes.

But Laura was steadfast in her insistence that he remain in the surgical lounge, saying that she'd be in as soon as the procedure was over. Jack tried to entertain himself to keep from obsessing about what was taking so long. While he waited, the hospital shift had changed, with an entirely new group manning the OR and rotating in and out of the lounge. No one bothered Jack, which he appreciated. He was in no mood for socializing.

Just before midnight, Dr. Riley finally appeared at the lounge's arched entranceway. When she spotted Jack, she walked over. Jack stood up. She appeared exhausted, but to his relief, she was smiling.

"I'm sorry to keep you in suspense," Laura said. "It took a little longer than we expected, but everything is okay."

"Thank goodness," Jack said. "What was the problem?"

"Continued bleeding. She'd lost a lot of blood, and her clotting wasn't what we would have liked. She's now in the PACU, where I want her to stay so they can follow her clotting status and blood pressure."

"Sounds like a good plan."

"I see you changed into scrubs."

"I was hoping you'd relent and allow me to observe."

"Sorry," Laura said. "I know from Laurie that your association with her isn't just professional. With births, I'm happy to have actual participation of partners, but with operations like this, I'm not."

"You don't have to apologize," Jack said. "She's okay, and that's all that matters."

"Actually, it's good you're in scrubs. I got approval for you to come in and have a quick visit, provided you're okay with the idea."

"I'd love to come in," Jack said. "But tell me, was it an ectopic pregnancy?"

"Yes," Laura said. "In the isthmus of the oviduct, fairly close to the uterine wall, which might be why there was so much bleeding. The oviduct itself was visibly abnormal, and we ended up removing it along with the right ovary. On the positive side, the left oviduct and ovary appear entirely normal, so her fertility shouldn't be significantly affected."

"She'll be pleased to hear that," Jack said. Now that he knew Laurie was on the road to recovery, he allowed himself to think about the lost conceptus, surprised at his emotion. He was saddened, even though he'd anticipated being relieved that the pressure was off, as Laurie had suggested. Although mourning on any level wasn't pleasant, in this situation, he felt there was a positive side, since it lent further credence that he might be more capable of having a child than he would have thought only a few days earlier.

With a wave for him to follow, Laura led him into the main portion of the operating room. Several women were at the main OR desk, bent over paperwork. On the opposite wall was a large dry-erase board scribed like graph paper. On the left were the numbers of all the operating rooms. Across the top, forming columns, were spaces for patient name, anesthesiologist, surgeon, circulating nurse, scrub nurse, and procedure. Jack could see that there were eight cases under way. He saw Laurie's name with a line drawn through it.

The PACU was located just beyond the desk. It was a large, starkly white room with sixteen beds, eight on a side. Each backed up into an array of anesthesia equipment, including banks of monitors for blood pressure and pulse, an EKG lead, and blood oxygenation. Only four of the sixteen beds were occupied. All the patients appeared to be sleeping, despite the bright ambient light and the sense of frenetic activity. Each patient had his or her own nurse, who constantly checked everything, from vital signs to urine output, from respiratory status to core body temperature, writing the results on a clipboard attached to the bed. In between these activities, they were adjusting IV rates, checking surgical drains, or running into a supply closet for IV fluids or medications. A no-nonsense-appearing female charge nurse with frizzed blond hair and a stocky, bulldog habitus manned a centralized main desk. She exuded a drill sergeant's sense of control. Laura introduced Jack. Her name was Thea Papparis.

"I hope you understand you can only stay a few minutes," Thea said. Her voice was as commanding as her physical presence.

"I appreciate you letting me come in at all," Jack said, showing uncharacteristic respect for the rules. Under more normal circumstances, he viewed bureaucratic edicts as mere guidelines, but with Laurie's potential care possibly dependent on his behavior, he was being particularly circumspect, as evidenced by his restraint in not having run down to Laurie's OR when her case had dragged on.

"You got a fine wife there, doctor," Thea said. "She's a charmer, even under the influence of the anesthesia." For a second, her attention switched to a monitor built in over the desk. One of the patients had had an extra heartbeat with a compensatory pause. Jack used the opportunity to glance at Laura, who flashed him an exaggerated expression of guilt, meaning she'd fibbed about marital status to get Jack invited into the PACU.

Thea redirected her attention back to the visitors. "What was I saying? Oh, yeah! Your wife is one amiable individual. Most of the people we see in here are just out of it, although some can be uncooperative and even belligerent. Not your wife. She's just as nice as pie."

"Thank you," Jack said. "I appreciate the attention you've given her."

"That's our job," Thea said.

Laura motioned for Jack to follow her, and they walked over to the bed farthest against the wall. A male nurse with an impressive tattoo of a mermaid on his left upper arm was adjusting Laurie's IV. She was also getting another unit of blood.

"How's she doing, Pete?" Laura asked. She glanced briefly at the clipboard before walking up along the right side of the bed.

"Smooth as silk," Pete said. "Blood pressure and pulse hanging in there just fine. She's putting out urine, and nothing has come out of the drain."

"Good," Laura said. She grasped Laurie's forearm, gave it a little shake, and called her name.

Laurie's eyes popped open, but only about halfway. Her forehead was wrinkled as if she was struggling keep them open. She looked at Laura, then over at Jack, who'd come up along the left side. She smiled placidly and reached out and laid a limp hand in Jack's.

"Do you remember me telling you that your operation is over?" Laura asked.

"Not really," Laurie admitted without taking her eyes off Jack.

"Well, it is," Laura said. "You're doing fine. The bleeding has been stopped. I'd tell you to relax, but you are already doing that."

Laurie turned her head slowly toward Laura. "Thank you for all you have done, and I'm sorry about your Saturday night."

"Don't you worry," Laura said. "It's been a blast."

"Am I in the PACU at the moment?"

"Yes, you are."

"And I'm going to stay here overnight."

"That's affirmative. I've asked for them to keep you here and monitor you until I come in and make my rounds. The intensive care unit happens to be full, but this is just as good and maybe better. I hope you don't mind. It might be hard to sleep with all the activity."

"I don't mind in the slightest," Laurie said, giving Jack's hand a squeeze.

"Now," Laura added. "I'm going to leave you two, and, Laurie, I'll see you in the morning at seven. I'm sure everything will be fine, and we can move you to a room on the OB-GYN floor, provided they have a bed. I know they are overbooked tonight, but we'll worry about that tomorrow. Okay?"

"Okay," Laurie responded.

With a final wave, Laura walked away.

Laurie turned back toward Jack. "What time is it?"

"Around midnight," Jack said.

"My gosh! Where did the evening go? Time really does fly when you're having fun."

Jack smiled. "It's good to hear you haven't lost your sense of humor. How do you feel?"

"Great. I know that sounds ridiculous, but I've got no discomfort whatsoever. The worst thing is a dry mouth. Whatever they gave me has me on cloud nine. And now that it's over, I can admit I was pretty darn scared. I was foolish to let the problem get out of hand."

"I don't think you should be blaming yourself."

"I do. My not reacting to incriminating symptoms is a prime example of one of my not-so-wonderful character traits: namely, putting out of my mind anything potentially unpleasant, physically or emotionally. I'm more of my mother's daughter than I'd ever cared to admit."

"You're starting to scare me with this kind of insight under the influence of anesthesia," Jack joked. "What did they give you, some kind of truth serum? Don't answer! Let's talk about something a bit more topical. Did they tell you had a ruptured ectopic pregnancy?"

"I'm sure they did, but my short-term memory is not up to speed."

"As soon as I heard you were all right, I felt a curious emotion."

"Now, that's a weird thing to say," Laurie said with a slight smile on her lips. "What were you, disappointed I was going to pull through?"

"That didn't come out right. What I meant to say was that when I didn't have to worry about you, I felt sad that we had lost a child."

Laurie didn't say anything for a moment, and her smile faded. She stared at Jack with a look of disbelief.

"Hello!" Jack called. "Are you still with me?"

In slow motion, Laurie lifted her free hand to her face and used a finger to wipe away a tear. She shook her head as if she still couldn't believe what Jack had said. "If I heard correctly, under the circumstances that might have been the dearest thing you've ever said to me. You're going to make me cry."

"Don't cry!" Jack said nervously as he noticed Laurie's pulse rate quicken on the LCD screen behind her bed. He certainly didn't want to be disturbing her in her fragile state. "Let's talk about something less emotional, provided we have time." He glanced first at Pete, who pretended he wasn't listening, and then back at Thea at the central desk to make sure she hadn't caught Laurie's reaction. Luckily, the charge nurse was momentarily preoccupied with another problem. With a sense of reprieve, Jack redirected his attention to Laurie. "I'm not going to be able to stay in here very long, and I might not be able to come back. Normally, I wouldn't be so restrained, but they have you as a hostage. I'm afraid if I step out of line, they'll take it out on you in some way. I know it's a ridiculous idea, but it seems to me this place is run by the Gestapo."

"What did you do with yourself for three hours?" Laurie asked.

"I had a ball," Jack said. "I…" He tried to think of something witty, but nothing came to mind. Embarrassed, he gave a short laugh. "I can't believe it. My sense of humor has abandoned me."

"You're bored and exhausted. Why don't you go home and get some sleep."

"Sleep?" Jack questioned. "That's out of the question. I had several cups of coffee in the surgical lounge. I'm not going to sleep until about Tuesday."

"You can't just sit here in the hospital," Laurie said. "If you really think you can't sleep, why don't you do what I suggested earlier and go back to my office? If you have to be awake, you might as well make use of the time."

"You know, I might just do that," Jack said. It crossed his mind that he could bring all that material back to the surgical lounge. After all, the night shift was in the hospital. It might help to pass the time if he tried to talk to a couple of the people on Roger's lists, although, when he thought about it again, he had to admit that Roger's fate took away some of his enthusiasm for the idea.

"Sorry to interrupt here," Thea said. She had appeared at the foot of the bed. "You people are going to have to wind things up. We've got a couple of cases coming in imminently."

"Just a moment longer," Jack said to Thea, who nodded and retreated back to her command post.

"Listen," Jack said to Laurie, bending over to be close to her ear. "Before I go, I want to be absolutely sure you feel comfortable here. Be honest! Otherwise, I'll just park myself right outside the door and refuse to budge."

"Perfectly comfortable. You should get some sleep."

"I'm telling you, I'm not going to sleep! I'm charged up, ready to do a triathlon."

"Okay! Calm down! Then go back to my office so you can at least keep yourself busy. Bring everything back here."

"You're sure you're comfortable?"

"I'm very sure."

"Okay," Jack said, giving Laurie's forehead a kiss before straightening up. "You can get some sleep for both of us. I'll be back and try to come in here in a few hours if that Brunnhilde lets me." He hooked a thumb over his shoulder.

"I'll be fine," Laurie said. "Don't worry!"

With a final squeeze of Laurie's hand, Jack walked back to the central desk. While Thea was on the phone, standing behind her desk chair, Jack wrote down his name and cell phone number.

"Thanks again for letting me come in here," Jack said when she hung up and looked at him.

"Don't mention it," Thea said. She went up on her tiptoes, looking at something over Jack's shoulder, and shouted: "You got it, Claire. That's the line I was talking about. I don't think it's running right." She looked back at Jack. "Sorry! Don't worry about your wife. We'll take good care of her."

"I've written down my cell phone number," Jack said. He handed the paper to Thea. "If there is any change in her status in any way or form, I'd appreciate hearing about it."

"We'll do our best," Thea said. She glanced at the paper, then tossed it onto the desk in front of her. She flashed Jack a brief smile and a quick wave, then turned to one of the nurses who'd approached with a question.

With a final look in Laurie's direction, Jack walked out of the PACU. He crossed through the surgical lounge. The faces had changed, but the scene hadn't. Inside the men's locker room, he quickly changed out of the scrubs and put on his clothes.

The main lobby of the hospital was eerily quiet and a far cry from its daytime bustle. As he exited through the front door, he was pleased to see that a few taxis were patiently waiting in the taxi line. The rain that had been forecasted had started.

The cab dropped Jack off at the morgue's loading dock, and he walked in past the security office. Carl Novak, the night security officer, bounded out of his chair as if caught unawares, causing the paperback book he was reading to fall to the floor. He leaned out his door and called after Jack, "Is something up that I should know about, Dr. Stapleton?"

"Nope," Jack called over his shoulder.

The night mortuary tech, Mike Passano, had a similar reaction when he heard Jack's voice echo about the tiled morgue and Jack passed the mortuary office. While Jack waited for the elevator, Mike's head appeared. "Is a case coming in that we'll be posting?" he asked.

"Nope," Jack said. "I just love this place so much, I can't stay away."

The fifth floor was barely illuminated, such that the orange office doors appeared a muddy gray-brown. Once inside Laurie's office, Jack flipped on the overhead light and squinted in its relative glare. He sat down in Laurie's chair and surveyed all the series material on her desk. There were two neat piles of hospital charts. Next to them were Roger's lists and a ruled notepad. On the pad was a list of the ways Laurie had determined that the cases were related. On the wall above the desk were two Post-it notes: one a reminder to show Sobczyk's EKG segment to a cardiologist, and the other questioning what kind of lab test an MASNP was. Looking down on the desk was another Post-it wrinkled enough to make it hard to read. Jack spread out the wrinkles. On it was written in Laurie's handwriting: "positive MEF2A," followed by a large question mark. Jack had no idea what MEF2A stood for.

What Jack didn't see was the CD that he remembered Laurie making in Roger's office, and he briefly looked under the charts and under Roger's lists. He even opened Laurie's desk drawers, which were extraordinarily neat, in sharp contrast to his. There was no CD. He scratched his head. Where would she have put it? Then he glanced at his watch. It was almost one-thirty in the morning.

After taking a deep breath, Jack tried to organize his thoughts. His heart was racing from the coffee and his mind was going a mile a minute. It was hard to concentrate on anything. He didn't like being away from the Manhattan General Hospital with Laurie in such a vulnerable state, yet it truly would have driven him crazy to sit in the surgical lounge hour after hour, staring at the clock. As Laurie had suggested, he had it in his mind to take all the material on her desk back to the surgical lounge. But before he did that, he had another idea. He thought he could take the time to possibly get answers to the three Post-it questions. With several hospitals literally next door, it would be a quick errand and might have some significance.

Getting to his feet, Jack shuffled through the charts until he found Sobczyk's. The EKG segment was easy to find, since Laurie had it marked with a ruler. He looked at it again, and again admitted that it made no sense to him. In fact, it was his opinion that no one would be able to make any sense of it. It was essentially the serendipitous recording of cardiac conduction cells in the throes of cellular death. Carefully, he extracted the page with the recording from the rest of the chart. Taking it and the other two Post-it notes, he stepped out of Laurie's office, leaving the light on, and walked back to the elevator. When he pressed the button, the door immediately opened. That never happened in the daytime. It was as if he was the only person in the building.

As he rode down to the basement level, he mapped out his strategy, despite his mind jumping all over creation. He thought he'd run over to the NYU Bellevue medical center, pop in to the ER, and have the on-call cardiology resident paged. Jack couldn't imagine that that would take too long, as the resident might very well be in the emergency unit already. Then Jack thought he'd head to the laboratory and see if he could find the night supervisor. If anybody could tell him what kind of test an MASNP was and what a positive MEF2A meant, it would be a hospital laboratory supervisor. Vaguely, he wondered if the two unknowns were related.

It was still sprinkling outside, so Jack literally ran up First Avenue with the page from Sobsczyk's chart protected under his coat. The emergency room looked pretty much the same as Manhattan General's had looked when Jack had gone in to see Laurie. The crowds generally didn't thin out until after three in the morning. Jack went to the main desk and caught the attention of one of the nurses, who looked like he could have been a bouncer in a club. His name was Salvador, and he had on what looked like a dozen gold chain necklaces nestled on a remarkably hairy chest.

"I'm Dr. Stapleton," Jack said. "Do you happen to know who the on-call cardiology resident is?"

"I don't, but I'll find out," he said before bellowing the question to a colleague within the treatment area, which the main desk opened onto on its opposite side. He put his hand behind his ear to catch the response. The other individual was out of Jack's line of sight.

"Dr. Shirley Mayrand," the nurse said, redirecting his attention to Jack.

"Do you know if Dr. Mayrand is in the emergency room at the moment?"

The nurse shrugged his shoulders. "No idea."

"How can I page her?"

"I can do it for you." Salvador said. He picked up the phone and dialed the page operator. "Should I page her for the emergency room?"

Jack nodded. "I'll wait right here." He turned around and gazed at the scene. If nothing else, it was visually entertaining. Spread out in front of him and filling the vinyl waiting-room chairs was an egalitarian slice of New York City life in both its glory and banality. From crying infants to the tottering aged, from homeless bums to folks in fancy clothes, from the drunks to the mentally anguished, from the injured to the sick, they were all there, waiting to be seen.

"Hold your horses," Thea shouted at her jangling phone. She was trying to fill out a supply requisition form. Giving up, she picked up the phone. It was the night shift OR supervisor, Helen Garvey.

"What's your bed count?" Helen demanded without mincing words.

"Occupied or empty?" Thea questioned.

"Now, that's one of the dumber questions I've heard tonight!"

"You're in a bad mood."

"I have a right to be. According to the ER, we're about to be inundated with trauma cases, and the first wave is on its way up. There was a head-on collision with a bus and a van, and the bus went over a guardrail. As I understand it, they distributed the victims, but we got the lion's share. I've contacted all the on-call people so we can be running up to twenty ORs. It's going to be a long night."

"I've got thirteen patients with only three empty beds."

"That's not encouraging. What are the patients' statuses?" Thea let her eyes roam around her domain while she mentally reviewed each case. "Everybody is in good shape except for an abdominal aneurysm re-bleed. He's got to stay, because he might have to be opened up yet again. He's still losing blood out of his drain." "So the others are stable?" "At the moment."

"Then clean house, because you're next for this tidal wave." Thea hung up the phone. She was psyched. Challenges like this were her forte. "Listen up!" she called out to her troops. "We're switching to disaster mode, and this is no drill."

The release of the wheels jolted Laurie from her drugged slumber to a semiwakefulness. Her eyes squinted against the bright overhead fluorescent lights, and for a moment, she was disoriented to time and place. There was another jolt when the bed began to move, and the jostling brought a brief but sharp reminder that she had had intra-abdominal surgery. All at once, Laurie knew where she was, and the large clock over the PACU room's door, which she was approaching, told her the time: It was twenty-five minutes past two.

Turning her head to the side in response to a babble of voices, Laurie caught a glimpse of the flurry of activity at the central desk. Bending her head back so she could see behind her, she looked up at the face of the orderly pushing her. He was a rail-thin, light-skinned African-American with a pencil-line mustache and graying hair. The muscles of his neck stood out as he strained to angle Laurie's bed toward the swinging doors.

"What's happening?" Laurie questioned.

The orderly didn't answer, focusing instead on stopping the bed's forward motion before backing it up a few steps. The PACU's doors had burst open. Another bed was coming into the room with a patient fresh from surgery. There was a person at the foot of the bed, pulling, and another at the head, pushing. An anesthesiologist walked alongside, maintaining the patient's airway patent by holding the individual's chin back. All three seemed to be talking at the same time.

Laurie repeated her question to the orderly behind her. She felt the stirrings of apprehension in the pit of her stomach. Something was up. Her understanding was that she was not be moved until Laura Riley came in to see her in the morning.

"You're going to your room," the orderly said, preoccupied with maneuvering Laurie's bed to allow the incoming patient to get by.

"I was supposed to stay here in the PACU," Laurie said with building alarm.

"Here we go," the orderly said as if he'd not heard Laurie. He grunted as he managed to get the bed rolling forward again.

"Wait!" Laurie yelled. The effort of her outcry made her wince with pain from her incision.

Shocked by Laurie's outburst, the orderly halted the bed yet again. He looked down at her with concern. "What's the matter?"

"I'm not supposed to be leaving here," Laurie stated. She had to talk loudly to be heard over the general level of conversation in the room. To keep the pain to a minimum, she had to press her hand gently over the upper part of her abdomen to avoid jostling the lower part. Earlier, when Jack had visited, she'd had very little discomfort from the operation. Unfortunately, that had changed.

"I got strict orders to take you to your room," the orderly said. His expression was half defiant, half confused. He took a piece of paper out of his pocket and glanced at it. "You're Laurie Montgomery, aren't you?"

Ignoring the orderly's question, Laurie lifted her head off her pillow and looked over at the central desk, which was a beehive of activity. Ahead, the doors to the hall burst open again and another patient, fresh from surgery, was whisked into the room. Once again, the orderly had to back Laurie's bed up to allow them to pass.

"I want to talk to the charge nurse," Laurie demanded.

With obvious indecision, the orderly looked back and forth between Laurie and the central desk. He shook his head with frustration.

"You're not taking me anywhere," Laurie stated. "I'm supposed to stay here. I need to talk with a supervisor. Anyone in control."

Shrugging his shoulders in resignation, the orderly walked over to the counter, leaving Laurie and her bed stranded in the middle of the room. He was holding in his hand the piece of paper he'd taken from his pocket. Laurie watched as he tried vainly to get someone's attention. When he did, the person pointed out a square-built woman with a helmet of blond hair. Laurie watched as the orderly showed Thea his paper then pointed in Laurie's direction.

Thea bounced her palm off her forehead as if dealing with this new problem was the last thing she needed. She rounded the edge of the central desk and walked directly up to Laurie, the orderly a few steps behind.

"What's your problem?" Thea demanded. She had her hands on her hips.

"I was supposed to stay in the PACU until Dr. Riley saw me," Laurie said as she struggled to think what to say. Coupled with having been just awakened by such an urgent situation, the lingering effects of the drugs and anesthesia were causing her mind to work in slow motion.

"Let me reassure you that you are doing just fine. You're as stable as the rock of Gibraltar. You don't need the PACU, and unfortunately, we have a slew of patients who do. We'd love to entertain you all night, but we have work to do. So, until next time, be well!" With a final reassuring squeeze of Laurie's forearm, she turned back to the central desk, immediately barking orders about another patient to one of the other nurses.

"Excuse me!" Laurie called after her vainly. "Can you call my doctor, or can you let me make a call?"

Thea didn't even turn around. She was already immersed in the next problem.

The orderly returned to his position behind Laurie's head and once again got her bed rolling. He aimed it at the PACU double doors, and the bed collided with them and pushed them open. Out in the hall, he struggled to orient the bed parallel with the corridor before getting it to move forward. Laurie noticed several gurneys parked against the wall, with patients waiting to be taken down to operating rooms.

"I need to make a phone call," Laurie said as they passed the surgical desk.

"You're going to have to wait until you get in your room," the orderly said. He aimed the bed at the doors leading from the operating room.

A sense of desperation gripped Laurie as they reached the bank of elevators. She was being rudely removed from her promised sanctuary and thrust out in harm's way, and she was powerless to prevent it. Suffering the double whammy of weakness from blood loss and pain with the slightest movement made it hard for her to imagine herself any more vulnerable. And remembering her list of how the patients in her series had been related, she knew she fit the profile. She was the right age, she was healthy, she was on an IV, she'd had surgery, and she was a relatively new subscriber to AmeriCare. Her only consolation was in statistics and the fact that Najah had been arrested.

"Where am I going?" Laurie asked, trying to find a ray of hope. "To ob-gyn?"

The orderly consulted his piece of paper. "No! They're full in OB-GYN. You're going to room 609 on the general surgical floor."

Laurie closed her eyes as she felt a shudder pass through her.