The Inquisitor

Chapter 2

Three months later

Dr. Earl Garnet sensed it the instant he stepped inside the marbled front entrance.

St. Paul 's Hospital buzzed with a palpable nervousness and excitement unlike the feel of any other morning.

July 1.

Changeover day.

All over North America flocks of freshly minted medical graduates wearing crisp white coats streamed into their respective teaching hospitals, ready to begin the arduous residencies that would forge them into physicians.

And more staff doctors showed up at 7:00 a.m. than at any other time of the year. Ostensibly they'd come to welcome their charges, but he knew their early arrival had more to do with protecting patients from the newcomers and scrutinizing the latest batch of future healers for early signs of who would bear watching. Earl found himself exchanging pleasantries and brushing shoulders with colleagues he hadn't seen in months.

Except this July 1 would be like none St. Paul 's had ever experienced before.

He lined up to be screened for fever alongside the rest of the employees. With four tables working, the crowd moved through quickly today. Nurses already dressed in OR gowns, shoe covers, surgical hats, goggles, gloves, and tight-fitting thick masks greeted him. One applied a thermal strip to his forehead: normal. Another asked a few quick questions that he and everyone else now knew by heart, and he just as quickly rattled off the answers: no cold symptoms, no foreign travel, no unprotected contact with suspect or probable cases. That done, he received a dated stamp on his hand, the kind that discos and theme parks use- except instead of opening the doors to fun-filled entertainment, it granted him admission to his own ER for another day on the job. He moved on to the next stop, where similarly attired porters dispensed a complete set of protective gear to every single person entering the hospital.

Welcome to the "new normal" of SARS in America.

Severe acute respiratory syndrome, the scientists had named it the year it first appeared in China. At the time residents took to calling it SCARES.

An electron microscope mug shot of the suspected cause, a smudged-looking sphere surrounded by a ring of tiny balls, had made the front pages of newspapers all over the world. The crownlike appearance allowed it to be recognized as a member of the coronavirus family, a microbe with many different strains, some responsible for up to 30 percent of common colds in people, but most infected only the lungs and bowels of livestock, such as chickens, pigs, or cows. Yet somehow one of these latter strains had acquired a genetic makeover and jumped the species barrier to take on humans in a deadly new way. Similar events with other organisms had given rise to some of our most lethal diseases- the so-called swine flu of 1918 is thought to have come from pigs, AIDS from monkeys, avian influenza from chickens. Humans, having never had prior exposure, lack immunity to these invaders, so the prospect of a brand-new bug that's highly contagious always grabs the scientific world's attention.

The real kicker is that researchers couldn't isolate the coronavirus from over half the cases, which left the possibility that this disease might be a multiheaded monster that attacked its victims in ways not yet understood, or that some other completely different unknown, a deadly X, could be floating around out there killing people.

That first year the outbreaks were beaten back. But just when the world thought itself safe, the organism mutated, the new vaccines against it were suddenly obsolete, and pockets of infections began to crop up again. Even then, until a few months ago, it had been largely the problem of other countries, the few cases that occurred in the United States being relatively mild. Everything changed after a busload of tourists returning from a religious meeting in Toronto, Canada, center stage for the initial North American endemic and center stage for its reappearance, brought back more than a few Mountie souvenirs.

According to the latest count, there were 169 confirmed cases admitted to designated Buffalo hospitals, 31 of them under treatment at St. Paul 's, and most of them health care workers.

In the first wave of infections among hospital staff, two nurses and a doctor died. After that, there'd been no containing it. People broke quarantine, others lied about having symptoms or where they'd been, and while the number of new cases leveled off in the community, the virus continued to strike doctors, nurses, orderlies, and residents all over the city. Even now, every few days at St. Paul 's someone with a fever would be pulled out of line at the screening station to be put in isolation for observation. Most turned out to have nothing more than a cold, but with a 15 percent mortality rate, no cure, and some survivors left so short of breath they could barely walk across a room, fear had become the norm for those who treated the sick.

Fortunately, no one who'd gone through with Earl this morning got tagged. After suiting up, they broke into smaller groups and hurried off to their respective departments.

"Heads up, guys."

"Eyes sharp."

"And cast-iron stomachs all around."

Their parting banter reminded Earl of soldiers moving out on patrol.

Upstairs, the nurses would be adopting an edgy alertness as well, scanning their wards the way ship captains keep a lookout at sea, always ready for trouble. If a rookie went alone into a patient's room, they'd keep tabs on him or her. When a novice wrote a medication order, they'd double- and triple-check it for mistakes. And during any attempt by a first-timer to perform a procedure, they'd hover over the event with the anxious scrutiny of spinster chaperones. They also would set their radars to home in on any of last year's junior trainees who might stride through the corridors a little too cockily, lording it over those who'd replaced them on the bottom level of the teaching pyramid. Arrogance could kill as readily as inexperience, and the two together were even more lethal; no one could pop them both faster than veteran nurses. Their weapon of choice: sidle up to any offender who showed off to the newfound underlings and say, "So, you finally brought me someone on the floors who actually knows less than you do. Remember, honey, that ain't saying much."

The result of it all?

Already anxious patients clutched their blankets and hoped for the best every time a new masked face with youthful eyes came near them. And they soon learned the surest way to spot a beginner: even under the surgical gowns all the clinical manuals and packets of cue cards these kids invariably kept stuffed in their pockets made telltale bulges. Earl sometimes fantasized these junior doctors pulling no end of things out from under them- suture kits, crutches, their lunch- like Harpo Marx in OR gear.

He tried not to smile as another throng filed by. The bulges of this bunch stuck out like tumors, indicating pockets laden well past the bursting point. Through the backs of their badly tied outfits he spotted their short white clinical jackets, trademark for the lowest of the low.

Medical students.

Their rapid-fire chatter, typical of first-day jitters, bounced off the walls.

u… orientation's in the basement auditorium…"

"… but where do we meet our chief residents…"

"… me, I'm following my nose to the coffee…"

Surgical masks couldn't hide that they seemed younger than ever, he thought, indulging in a twinge of melancholy. He'd been through twenty-five changeovers and found the day marked the passing of yet another year with more impact than his own birthday.

He continued at a brisk pace toward the emergency department and pressed a large metal disc on the wall, setting off a loud hiss as the frosted glass barrier that separated his domain from the rest of the hospital slid open.

Just like Captain Kirk on the Enterprise, he thought, stepping through with a grin, only to have the volume of chatter coming from inside wipe it away.

That much sound meant a lot of patients. Too many.

"Morning, Dr. G.," the triage nurse greeted him. She was a cheery woman in her mid-twenties. He knew her mask hid three rings in her right nostril, and slightly spiked but short black hair stuck out from beneath her surgical cap. She glanced up from taking the blood pressure of an elderly lady who had frizzy white hair and lay gasping for breath on an ambulance stretcher, a red handbag clutched to her chest with both hands. She also was masked, and her frightened eyes stared at him over its tight-fitting rim. The material puffed in and out with each respiration.

To the left the walking wounded, equally well masked, kept their distance, prowling a waiting room meant to hold half their number. On the right another sliding door led to the inner sanctums of ER, where patients unable to sit or stand would be parked on stretchers.

"Morning, J.S.," he replied, raising his voice to make himself heard above the chatter of a hundred conversations.

The initials stood for Jane Simmons. They'd used call letters to address each other since shortly after she came on staff. It began, as did many traditions between people in ER, during the rush of a resuscitation. The intensity often cemented first impressions- for better or worse- and her impact on him had stuck for the better. Despite dressing the part of a punk rocker, she had good hands when it came to starting IVs in the worst of veins, and her calm never cracked- not then as a new kid, and not since, even during the toughest cases.

"Need any help?" he asked her. The elderly woman's rapid breathing had automatically put him on alert.

" Nan." J.S. reassuringly patted the lady's arm. "Meet Mary."

"Hi, Mary, I'm Dr. Garnet, the guy who runs the joint." He placed his gloved hand over hers and gave it a gentle squeeze.

"Only a touch of heart failure," J.S. continued, "but this little sweetie's going to be just fine as soon as we give her oxygen, relax her airways, and get her peeing."

Some of the fear drained from the old woman's gaze, and she appeared less forlorn despite the puffy circles drooping over the upper edge of her mask. An orderly whisked her through the inner door and down the hallway to a treatment room.

"Ready to whip another crop of greenhorns into shape?" Earl asked J.S. while glancing over the ambulance sheet to see what calamities the city of Buffalo had delivered up overnight. He mentally ticked off the cases that he could use as good teaching material for introducing first-year residents to ER.

The corners of her eyes crinkled, and he knew her infectious, crooked grin had appeared. She lifted an upper tie to loosen the corner of her mask and blew a strand of loose hair off her forehead. "Just let me at 'em."

Before he could remind her that she shouldn't breathe unfiltered air, even for a second, a single low growl from a siren announced the arrival of another ambulance. The signal meant they'd brought in a patient still breathing, but barely, who needed help fast.

J.S. pivoted and charged out the door leading to the garage.

Several nurses darted from the inner corridors to follow her. They passed where a teenage boy sat clutching a skateboard and doubled over in pain. J.S. must have deemed him stable enough to wait, but Earl didn't like the greenish tinge and sheen of sweat that no mask could completely hide. "Do you need to lie down?" he asked, walking over and kneeling at the young man's side.

"I need to vomit, sir."

"Just hang on." He rummaged through the equipment racks behind J.S.'s triage area, dug out a bedpan, and shoved it into the youngster's lap.

The sounds of more ambulances pulling into the unloading area reached his ears.

Busy day to break in a fresh crew, he thought, hurrying inside to marshal his staff for the onslaught. At the door he stopped to double-glove and double-gown, the added body armor required for anyone working ER. He also donned another prerequisite for anyone on the front lines of medicine these days: a cast-iron attitude of que sera sera.

An hour later they'd diuresed a liter of pee from the woman in heart failure, identified a ruptured spleen in the skateboard kid, and resuscitated the case that had so alarmed the ambulance technicians: a diabetic stockbroker in his fifties named Artie Baxter. He'd skipped breakfast after his morning insulin, then collapsed and seized. "I had a great tip before the market opened," he'd explained when a shot of IV glucose woke him up. "So I phoned all my clients instead of eating my usual toast and cheese…"

A few of the nurses scribbled down the company's name and ran for the wall phones.

"Can I see you outside a moment?" Earl said to Susanne Roberts, the head nurse, and led her by her elbow to a quiet spot in the hall.

"What's up?" Her pixie haircut peeking out from under her OR cap made her appear young, and only the lacework of tiny lines that fanned out at the corners of her eyes hinted at her age. She'd been on staff in ER for nearly as many years as he had, but she'd kept her passion for the job long past the point at which most lose it. Like all gifted leaders, she brought out the best in those around her.

"I'm going to try to make the end of the orientation session for the residents," he told her. "But I'm worried about this guy. Keep him on the monitor with the IV running."

"You expecting trouble?"

"His story doesn't add up. A man who's been on the needle for years and he pulls a stunt like that? I think he's not telling us something. And all that stock talk- a little too smooth for my liking. He got a wife?"

"She's on her way in."

"Ask her if he's been as well as he claims."

The speeches were almost over when he let himself in through a side door near the front of the auditorium stage. The audience occupied a steeply raked semicircle of seats, providing a wall of OR green before the speaker at the podium, Dr. Stewart Deloram, St. Paul 's resident genius in critical care. His mop of jet-black hair sprang out from the sides of his headgear like burst springs, flopping about as he animatedly extolled the virtues of a quiet, calm demeanor while dealing with life-and-death situations. "Especially when working on a patient who has suffered cardiac arrest," he emphasized in a grave, sonorous voice.

As the director of the intensive care unit, and one of the hospital's biggest screamers, he ought to know.

The two-thirds of the audience who were familiar with Stewart's antics tittered. Those who weren't dutifully jotted down what he'd said. Yet every single resident who had just laughed would also willingly double their allotted time with him in ICU, so brilliantly did he teach the art of critical care, or "raising the dead," as he called it.

Earl didn't care how loud Stewart got during a resuscitation, so long as he got the job done. The patients sure were in no state to hear him, and besides, other geniuses made noises when they worked. Just listen to undoctored recordings of Glenn Gould. Or to Monica Seles when she served.

Earl spotted the chief of surgery, Sean Carrington, a giant of a man seated in the front row, and slid in beside him. He wielded enormous influence in the hospital and more than once had used it to save Earl's hide politically. But Earl appreciated him most for his zany sense of humor. Sean could cut through the suffocating bureaucracy of academic medicine like a blast of oxygen. And his bushy red eyebrows, highlighted by his mask, whipped up a laugh all by themselves when his jokes failed.

He nodded to Earl, leaned over, and whispered, "Stewart must be in anger management classes again. You know, the ones where they chant, 'Teach it, and the shit you spout will come true.'"

Earl swallowed a chuckle. "Did he brief them about SARS yet?"

The fun went out of Sean's eyes. "Yeah."

"Who's left to speak?"

"Just you, Dr. Vice President, Medical, sir, and chief poo-bah, or whatever it is we get to call you these days."

"Now don't you start. I get razzed enough by my department."

Sean reached over and pretended to knuckle-rub the top of his head. "Hey, what are old friends for but to keep you from getting too high and mighty up there among the ruling class?"

Earl knew that Sean took the epidemic as seriously as anyone, but apart from the mandatory discussions about it at meetings, he never dwelled on it, let alone voiced his personal fears. If anything, his joking had increased as the hospital hunkered down to meet the crisis. What with the general atmosphere of gloom, they could do with more like him. And Earl read this latest tease as a hint to lighten up himself. "High and mighty, with the bellyfull of problems you bums dump on me every day? Fat chance."

The vice president, medical held authority over all doctors in their practice of medicine at St. Paul's Hospital. Only the CEO had more power. The position also meant a mountain of trouble for whoever filled it, especially in times such as these. Yet two weeks ago, under pressure from most of the other chiefs, Earl had accepted the appointment. Why? "Because it's a responsibility I can't refuse," he'd told most people who asked. And he hadn't lied, just dressed up the real reason: it would be easier to run ER with himself in charge rather than some of the other bozos who might get the job.

"How's Janet taking you being named boss of bosses around here?"

"Cutting me down to size, as usual. I don't think she got the memo-"

A gentle cuff to the back of his head cut him off. "Hey, quit bad-mouthing your superiors," Janet whispered, loud enough for people two rows away to hear, as she slipped into a seat behind him. She whipped off her surgical cap, setting a sunburst of blond hair free with a shake. Then, quickly replacing the headgear, she gave him a masked kiss on his masked cheek. "And no memo's going to make me treat you differently."

Earl heard a few snickers.

Dr. Janet Graceton, obstetrician and recently named director of the hospital case room, held command over him as friend, lover, and wife. Some in the hospital eagerly awaited an issue where the VP, medical would have to confront the case room director over something or other. According to the rumor mill, odds of that matchup stood at eight to five for Janet.

"Hey, you look great," Sean told her.

"That's because OR greens and gowns make perfect maternity wear, don't you think?" She molded the layers of material over her abdomen, accentuating the swell of her stomach. Even with her in her thirty-fourth week of pregnancy, operating room garb hung so loosely on her tall and normally slim frame that nobody believed her due date could be six weeks away. Nor would her workload tip them off. Some women might have cut back their time on the job by now. But Janet would have gone nuts staying home at this stage under any circumstances. She relaxed through work, finding a contentment in it that her colleagues, male and female, envied. "And a happy mom usually means a contented fetus," she'd told thousands of women, helping them discover their own unique needs during pregnancy. Little wonder she gave herself the same right to decide what would be best for her baby. While carrying their first son, Brendan, now six, she'd done her last delivery a mere twenty-four hours before going into labor herself.

Not that her bravado didn't worry Earl.

"Now a word as to your night schedule," Stewart droned, and flipped open his laptop computer, where he kept house staff duty rosters. On the screen behind him a barely decipherable set of lists came into view. "As in last year, only second- and third-year residents will be on for ICU, the intensive care unit, CCU, the coronary care unit, and SICU, the surgical intensive care unit. If you learn nothing else, you'll at least be able to impress family and friends with all these neat acronyms."

A third of the audience laughed. The remainder groaned. Stewart made this same joke every year.

"And if you lose your handouts, feel free to make yourself floppies. This laptop is at your disposal, and the password is Tocco, T-o-c-c-o, my dog's name…"

Earl tuned it all out, mentally preparing what he would say to sum up the session. The SARS outbreak had catapulted doctors into a level of risk that hadn't existed in North America since the 1918 flu epidemic, and forced them to adopt protective measures unprecedented in modern hospitals. No one in this room had planned to take on that kind of danger when they chose medicine as a career. How the hell did he address that?

"… and while during the day you may be internists, surgeons, gynecologists, et cetera, residency cutbacks necessitate that at night you will cover a multitude of services, again like last year…"

This time Stewart got a howl of disapproval from the newcomers. High up in the back row a kid who had black Brillo pads for eyebrows and who looked lost in his voluminous OR gown leapt to his feet, teetering over the similarly attired confreres sitting in front of him. "What if we need help?" he yelled.

Equally youthful looking colleagues joined in.

"… yeah…"

"… a lack of supervision…"

"… violates our contract…"

Earl marveled at how they could get so exercised over such a traditional complaint as the on-call roster when the new normal they faced loomed so large. Odds were that the first-year people, with so much to learn, would slip up more than anyone else when it came to all the protective measures they must practice. As a consequence, no other group in the room stood a greater chance of ending up sick, maybe even dead.

Stewart waved them quiet with the palms of his hands. "Easy, people, easy. We'll also have full-time staff doctors in the critical care areas I mentioned. That frees the R-twos and R-threes on duty there to come and assist you on the floors when you call them. It's a system that's worked well."

A few of the rookies continued to mutter, and some rolled their eyes in exasperation. The second- and third-year people remained silent and slumped in their chairs. They were all too aware that scheduling arrangements didn't matter much against an unseen threat ready to get you on any shift, at any time.

"What about ER?" a lone voice inquired from somewhere behind and above. "Will R-two and R-three people there be expected to back up arrests on the floors as in the past, or did you finally get that note from my mother saying we needed our sleep?"

This brought a much-needed laugh from everyone.

Earl smiled, recognizing the easy drawl of Dr. Thomas Biggs, his own emergency medicine protege. He looked around and saw the lanky Tennessee native sprawled in his seat a few rows from the top with the laid-back air that he had made his trademark. Even with his mask on, the bottom margin of his black beard could be seen under his chin. On either side of him sat the other men and women in the ER program. Thomas, in his last year of training as an emergency medicine specialist, would serve as Earl's chief resident and supervise teaching during the next three months. After that he'd begin a final rotation through all the other critical care areas Stewart had just mentioned. Judging by his performance so far, he had the potential to be a real star and would undoubtedly make a major contribution wherever he ended up.

Stewart stiffened. "Right, Thomas. I should have included ER. Night coverage there will be the same as in the critical care units- a staff presence twenty-four seven plus second- and third-year folks who'll offer backup on the floors." His voice took on an edge that hadn't been there before. "Now, before I turn over these proceedings to Dr. Earl Garnet," he went on, his tone even more clipped, "our chief of ER and recently appointed VP, medical- in other words, the other guy around here whom you should listen to besides me-" He paused for the expected laugh, but the coldness in his voice had drained any fun out of the crack. He shrugged and continued. "Our hospital chaplain, Jimmy Fitzpatrick, would like to have a moment with you." Stewart unceremoniously gathered up his notes and plumped himself down in a chair behind the podium.

The atmosphere went flat.

Earl had long since stopped trying to figure out Stewart's mood swings, having concluded years ago that the man had a narcissistic personality to go with his prodigious talent. But diagnosing him didn't render him any less annoying. He could take the simplest inquiry as a personal affront, as if whoever questioned him questioned his competence. Yet everyone also excused this prickly side of him, just as they did his tendency to yell a lot, again because of his extraordinary ability to pull off miracles. Thank God, he would usually apologize afterward when he did lose his cool and pull one of his snits. "I'm just not used to anyone challenging me," he'd once told Earl. "Most of my patients have tubes down their throats." But sometimes he could prolong holding a grudge, and over the stupidest things.

Jimmy, a muscular man wearing the same protective gear as everyone else, stepped up on the stage. His square jaw stood out beneath the covering of his mask, and not even layers of green could hide his well-proportioned physique. "Top o' the mornin' to you," he began when he reached the microphone, sweeping the audience with intense black eyes that had a magnetic pull to them. "Oh, I bet you're thrilled t' hear from a preacher. The ones fresh out of medical school, having never found the human soul in all those studies, are always the most skeptical that it exists." His lilting Irish brogue and mischievous squint instantly reanimated the room. People leaned forward to hear what he had to say. "So I'll keep it short. The Pastoral Services Department is here to serve the emotional and spiritual needs of patients, family, and staff. To learn more, give me a call. I want to stress we're open to all, whether a person has a formal religious affiliation or not. Remember, people of all stripes get scared in here, and even if we just provide a sympathetic ear…"

But Earl kept his gaze on Stewart, then glanced back at Thomas. Presumably Stewart's display had to do with Thomas's question. Understandably the resident remained oblivious to any wrongdoing on his part, and chatted easily with the R2s immediately to either side of him, both female. No surprise there. He had a way with the ladies.

Yet Stewart kept scowling toward the young man, as if trying to catch him in some other act of inexcusable insolence. After a few seconds, however, the ridges in his forehead flattened, and his expression softened.

Good, Earl thought.

Stewart's pique over imagined slights occasionally grew to the point that it interfered with work. One time the tension in ICU had gotten so bad that Earl slapped a notice in red ink above the entrance: PROS LEAVE THEIR GUNS AT THE DOOR. The job of setting him straight usually fell to Earl because no one else in the hospital would dare criticize Stewart about anything. Earl figured he got away with it because of the year he'd been Stewart's chief resident at New York City Hospital twenty-five years ago. That kind of seniority over a junior can stick for life.

"… in other words, don't be shy about using our help," Jimmy said, sounding as if he'd concluded his remarks.

Janet bent forward to whisper into Earl's ear. "It's not fair, the good looks on that man. Even covered up, they might give a woman ideas."

Earl turned and raised an eyebrow at her. "You'll be making me jealous," he murmured out of the corner of his mouth.

"I'm glad I still can." She leaned back and clasped her round belly with both hands again.

"Now I have one other announcement," Jimmy continued, "but first, such a serious bunch as yourselves will frighten the sick into a relapse, so here's a joke to lighten the mood." He lifted the microphone off its stand and walked free of the podium. "Did you hear the one about the priest, the minister, and the rabbi who went to Disneyland together?"

Everybody waited for the answer.

"They got in a fight about where to go first. I mean, it got loud. The priest shouted, 'Fantasylandl' The rabbi, 'Tomorrowlandl' The minister, 'Frontierlandl' They even started pulling on the map, pushing and shoving each other, kicking up the dust. Grown men, squabbling like you wouldn't believe. Then Goofy walks up. 'Hey, Mickey,' he says, 'look! It's Holyland.'"

Groans filled the air again, but this time they were good-natured.

Jimmy continued to walk the stage. "Sorry, but when I entered the seminary, it was a toss-up between that and being a stand-up comic. I'm still working on my act, in case I get the call. What'd'ya think?"

"Don't give up your day job," someone shouted.

A few people chuckled.

Jimmy pointed to the heavens and shook his head. "You know, that's what He keeps telling me."

This got him a round of applause.

"Make your point, Jimmy," Earl muttered none too quietly. He was impatient to say his own piece so he could get the hell back and reassess the man he'd left in ER.

The chaplain gave him a nod. "Not to take up any more of your busy morning, but I'm here to invite you all to our annual Run for Fun this Saturday. That's when you, healthy, young, and strong, get to put your professors, weak, old, and flabby- well, some of them, anyway- to shame by humiliating them in a two-K jaunt through scenic downtown Buffalo, entirely in the name of charity. Oh, by the way, the lot of you will be pushing hospital beds, each complete with a simulated patient and half-full bedpan from which you must not spill a drop. Thanks for your time."

Earl joined in the clapping, ready to take the stage, when the overhead PA crackled to life.

"Drs. Garnet, Deloram, Biggs- ER; Father Jimmy Fitzpatrick- ER stat!"

Artie Baxter, the stockbroker, lay on his stretcher frowning and blinking furiously. He couldn't speak because of the tube in his throat, and he breathed thanks to a respiratory technician who kept ventilating his lungs with an Ambu bag, twelve squeezes to the minute. J.S. provided the chest compressions, five at a time, strands of her thick black hair slipping from under her cap and flopping over her forehead as she worked. A cloying scent of singed flesh hung in the air despite the gobs of contact gel that glistened in the tight curls on Artie's chest, and his cardiac monitor showed the zigzag line of a fibrillating heart.

"We were on him so quickly when he arrested, he never lost consciousness," Susanne whispered to Earl.

At her side stood a heavyset, pear-shaped man with worried, tired-looking eyes and the edges of a salt-and-pepper beard sticking out the bottom of his mask. Dr. Michael Popovitch was a longtime friend, director of the department's residency program, and acting chief of ER during Earl's many absences. He'd once shared the fire in the belly that's a prerequisite for long-term survival in emergency medicine, but lately the cases seemed to weigh heavily on him. Each month his gaze grew a little sadder. "We've maxed him with epi, Lidocaine, procainamide- every antiarrhythmic we have," he said, terse and to the point, "and shocked him silly. Bottom line, nothing's worked."

The causes of refractory V-fib. automatically flashed through Earl's mind. "How's his potassium, sugar-"

"No metabolic problems," Michael cut in, "other than a slightly high glucose after the bolus you gave him-"

"An overdose, maybe?" Stewart Deloram interrupted, inserting himself as part of the huddle. "Tricyclics, aminophylline, speed…" He rattled off the drugs that might precipitate this kind of arrest.

Thomas Biggs stood a little off to one side. He watched the proceedings but offered no suggestions.

Earl found his own attention drawn to Artie's eyes as they blinked more furiously than ever. Leaning directly over his face, he said, "Close your eyes once if you can hear me, Mr. Baxter."

The fluttering stopped. The lids closed and opened.

"Do you see me?"

They closed and opened again. Then he stared at Earl, his pupils wide with fright, seeming to want an explanation.

Earl shivered. This happened every now and then, the patient's heart not beating, the lungs not breathing, but the brain kept alive and conscious with CPR. Only he'd never seen someone in such a state remain so alert before. "Let's be careful what we say, guys," he cautioned.

Stewart continued to expound his list in a much lower voice.

"Tox screen isn't back yet," Michael interrupted, "but I emptied a vial of bicarb into him in case he'd OD'd on tricyclics. Combined with the rest of what we tried, he's had every antidote there is." Again, right to the point. Whatever sapped his spirits these days, his skill stayed as sharp as ever.

But Artie's eyes, so pained and aware, drew Earl's attention away from the discussion.

Jimmy stepped up and spoke into the man's ear. "I'm the hospital chaplain, Mr. Baxter. Is it all right if I say a prayer with you?"

Artie showed no response.

Still locked into the man's stare, Earl felt it pull him in, like a tether. Perhaps he hadn't heard Jimmy's question. "Are you Catholic, Mr. Baxter?" he asked.

Two blinks.

"Is that a no?"

One blink.

"Do you have any pain?"

No response.

The resus team kept pumping and ventilating him.

Stewart discussed options with Michael.

"… float a pacemaker wire into his heart, hook the myocardium, and try to recapture a normal rhythm."

"Go for it," Michael said, pivoting on his heel and rushing toward the door. "I'll get the pacemaker."

Earl remained barely aware of them, transfixed instead by the black, bottomless pools at the center of Artie's eyes that beckoned him closer. What did he want? "Dr. Biggs, if you'll help me get a line through the right subclavian," Earl said, turning away, "Stewart can go in with the pacemaker from there." In order to function he must distance himself. A lifetime in ER had taught him how. But he knew that Artie was still looking at him. He could sense the patient's stare burrowing into the back of his skull.

Thomas must have felt it too. He hesitated, and the surface of his mask rippled as he clenched his teeth. Then he snapped on a sterile pair of gloves over his regular ones and got to work.

In seconds Thomas and Earl had inserted a needle the size of a three-inch nail through the skin below Artie's right clavicle and into a vein the caliber of a small hose.

Michael returned with the pacemaker equipment, and the three ER physicians stood back to let Stewart perform his magic.

Already double-gloved and -gowned, he delicately threaded a sterile pacemaker wire through the needle sticking out from beneath Artie's clavicle. Throughout the entire procedure, he eyed the monitor for evidence that he'd passed the wire through the vein, maneuvered it into the heart, and hooked its tip into the wall of the first chamber. He asked J.S. to stop pumping, and the sounds of her exertions ceased. The hiss of the ventilating bag as the technician squeezed a volley of air into Artie's lungs and the lilting beauty of Jimmy's voice while he murmured the Twenty-third Psalm became the only noises in the tiled chamber.

Earl watched the priest stroke Artie's head and thought, A special kind of man. He could laugh and joke, yet remained fearless when it came time to comfort the sick, the suffering, and the dying, and he pulled it off day after day. That took a rare brand of courage. Even people of faith could get too close to the ones they tried to help. Earl had seen the fear and suffering in ER overwhelm men and women of God as often as it broke many fine physicians. Yet Jimmy never appeared to flinch from it.

Stewart continued to manipulate the pacemaker wire, but the monitor showed no change, and the pattern remained ragged as a saw's edge.

He nodded to J.S., and she resumed pumping.

A familiar icy tightness gripped Earl in the pit of his stomach as the sense they weren't going to make it crept through him.

But Artie's eyes remained open. Imploring. Beseeching.

Stewart laid down the wire, glanced over to Earl, and silently shook his head.

J.S. continued to pump, her expression questioning him whether to stop for good.

Artie began to blink wildly again.

He knows he's going to die, Earl thought. Time to sedate him. Otherwise the instant they called off CPR, he'd suffocate, awake and aware. It would be like strangling the man.

"Get me ten milligrams of IV midazolam," he told Susanne.

Her eyes widened, but she went to the medication bin and proceeded to draw up the syringe.

"For the record," he said quietly, scanning the aghast eyes of those watching him,

"I'm going to make him comfortable, then withhold any further treatment, including CPR, on the grounds it's futile." Without saying it outright, he'd declared they were not about to commit active euthanasia. To the lay person it might sound like word games, but because he was invoking a physician's right not to inflict useless interventions on a patient, Artie's resulting death would be considered natural under the scrutiny of law.

The frowns on everyone told him they felt otherwise. "Anybody have a better idea?" he asked.

Michael, Stewart, and Thomas grimly shook their heads.

Susanne, J.S., and the respiratory technician did the same.

"Mr. Baxter objects," Jimmy said.

Earl bristled. "For the love of God, Jimmy, you know the rules as well as anyone."

"At least have the decency to look at the man while you decide his fate."

Nobody else said a word.

Earl forced himself to meet that dark, fluttering stare.

Artie repeatedly blinked his eyes in couplets. No! No! No! they screamed, brimming with agony.

Earl's heart gave a wrench. "But we can't help him," he whispered to Jimmy. "At least I can make sure he doesn't surfer."

"Tell your patient, Earl."

Artie stopped blinking and glared at him.

Oh, God, thought Earl. "Mr. Baxter, you know we tried everything?"

He blinked yes.

"I'll make you comfortable-"

Two quick blinks cut him off.

"But-"

"I think he wants something," Jimmy said.

A single blink. Yes.

"You want what?" Earl asked. He couldn't think of anything else to say.

Artie responded with a scowl of disgust.

"Something medical?"

No.

"What then?"

The desperation in Artie's stare grew.

Then Earl knew.

"Your wife?"

Tears welled out of Artie's eyes. Yes, he blinked. Yes! Yes! Yes!

"Is she here?" Earl asked.

"In the waiting room," Susanne replied. Her voice sounded as if her windpipe had tightened to the size of a straw.

"You want to see her, Artie?"

The hideously slack face of the dying man had already acquired the consistency of cold mud. Yet it shifted ever so slightly, and Earl swore he glimpsed relief in those amorphous features. Yes! he blinked.

"Then we'll get her for you," Earl said.

Susanne hurriedly retrieved a chair from the corridor and placed it by the stretcher in case Artie's wife couldn't stand.

The other physicians quickly wiped the blood from IV sites and covered the needles sticking out of him with plasters, much the way they would clean up a body before letting the family view it.

Artie's eyes strained to follow the preparations, then stared at the ceiling with a spine-chilling calm.

Earl tried not to imagine his state of mind. "Your arms must be getting tired," he said to J.S., whose forehead glistened with sweat. He found the heat of the extra wear suffocating at the best of times. It would be near unbearable with the sustained physical effort she'd been making.

"I'm fine."

He believed her. She'd kept the rhythm of her chest compressions rock steady the whole time.

When they had everything set, he went to meet Mrs. Baxter. A few of Susanne's nurses had stayed with her in an interview room.

When she looked up as he entered, tiny lines feathered out from the corners of her eyes in her attempt to smile. The rest of her tanned, round forehead had the leathery look of someone who spent a lot of time outside. Petite and lean, she appeared at least a decade younger than her husband.

As he took a breath to speak, he cursed what he hated most about the new reality at St. Paul's. His gloves, mask, and gown created more than a stifling physical barrier to keep germs from passing between people. It blocked communication. She couldn't read his face any more than he could read hers, and she would hear the worst possible news from an invisible voice. He loosened the ties and tugged his mask below his chin.

Unbidden, she did the same. Her cheeks and mouth were as fine-lined as the rest of her, and rigid with fright.

As Earl explained Artie's hopeless situation, her features seemed to implode, and he took her arm to offer support. She felt as flimsy as a hollowed-out husk.

"I'm all right," she insisted.

He didn't think she even noticed when he replaced her mask and redonned his own.

At the door to the resuscitation room she gasped when she saw Artie, but her step never faltered.

Artie's eyes bulged at her approach and filled with tears again.

"Oh, baby," she whimpered, and sank into the chair, then leaned forward to cradle his face between her hands. She looked up briefly at Earl. "How long do I have?" she asked, her voice faint yet eerily smooth, almost matter-of-fact.

"For as long as he's conscious," Earl said.

J.S. nodded in agreement.

The woman once more lowered her mask and started to murmur Artie's name, over and over. Then she leaned forward and kissed his eyes, enclosing him in the privacy of her dark hair as it cascaded around his face. She began to speak of love, of all she adored in him, of forgiving the hurts they'd caused one another, of how proud she'd always been to be his wife…

Jimmy withdrew and herded anyone else out of the room who no longer had anything to offer.

J.S. and the respiratory technician continued to work in tandem.

Earl attempted to back out of earshot, yet stayed close enough to intervene if Artie started to seize or choke. Without trying to, he heard enough to think Mrs. Baxter couldn't have been more eloquent if she'd had years to compose her words.

Twenty minutes later Artie Baxter peacefully closed his eyes for the last time.

"I wish I could have asked him a few questions," Stewart said to Earl afterward as they wrote up the chart in the nursing station.

"What?"

"In all my research with post-cardiac-arrest survivors, I've always doubted how accurately they recall what they experienced. That's the trouble with after-the-fact retellings."

Stewart held the dubious honor of being America's expert on the near-death experience, having interviewed over a hundred patients who'd been resuscitated. Their accounts were all remarkably similar, echoing stories that individuals had related since the advent of modern resuscitation methods- rising above their own bodies, passing through tunnels, approaching bright lights- and Stewart claimed he'd demonstrated that these experiences had some basis in reality. But while his work on the topic had been in all the major newspapers and made him the toast of the afternoon talk shows on network TV, serious scientific journals savaged him for his articles. They accused him of betraying his reputation for serious science and considered his data to be the equivalent of alien abduction stories, nothing more than anecdotal evidence of mass hysteria better suited to the National Enquirer than the National Science Review.

Earl fought the urge to tell him he had the sensitivity of a rock to even think he could turn the ordeal they'd just witnessed into more fodder for his television junkets. "So what, Stewart? You still got a pile of publications out of those accounts," he said instead, hoping it would shut him up.

"But today," Stewart continued, "we could have had something I've repeatedly said this kind of research really needs."

Jesus, Earl thought, give it a rest. "What's that?" he asked, knowing he shouldn't.

"An interview with a dead man."