The Inquisitor

Chapter 4

That same Saturday, 5:30 p.m.

The roof of Eight West, St. Paul's Hospital,

Buffalo, New York

Jane Simmons sat at the picnic table, sipping a beer as she chatted with the other ER nurses. A silver medal for the ER team's closer-than-usual second-place finish behind Father Jimmy clinked against the neck of the bottle.

The so-called wind-up party, well into its fifth hour, had lasted six times longer than the race itself, and a hundred or so others still hadn't gone home. Everyone seemed glad to hang out where they could see one another's faces again. But the reason she'd stuck around stood on the other side of the dance floor among a group of residents, too many of them women.

Thomas Biggs leaned against a picnic table, his arms folded across his chest, laughing easily and listening more than talking.

She felt jealous, and hated herself for it. When he eventually came to the makeshift bar, a long cafeteria table laden with drinks in buckets of ice, she walked over to greet him.

"Hi, Thomas. Want to share a beer?"

"Hey, J.S. Sorry, I said I'd go into ER early, starting a few hours from now. Split a juice with you?"

"Cute!"

"Would you like to dance?"

"Sure."

He swung her out onto the platform, where a dozen other couples snaked around to the strains of "Lady in Red." It blared from speakers suspended in a pair of potted trees, all part of the loaned decor that turned the gravel surface on top of the hospital's west wing into what the program described as the "Roof Garden." Mauve velvet ropes strung between chrome posts to demarcate an area well away from the edge looked as if they'd been borrowed from a movie theater lobby. Behind them stood a veritable jungle of more borrowed large plants. These concealed the ten-foot chain-link fence that, according to hospital lore, had been erected around the perimeter six years earlier after the then chief of psychiatry jumped to his death. Without the greenery as camouflage, the place resembled a prison yard.

She settled comfortably into his arms, once more appreciating his ability as a dancer. She also liked the gentle way he held her, and the feel of his firm chest.

Jane knew he was covering ER tonight. She'd checked the schedule, as she often did, to see if they'd be on together. But her slot started at eleven, the regular nursing shift.

Christ! For a grown woman, sometimes she could act so lame about him, she thought, embarrassed at having looked up when he worked. Then she wondered if he ever did the same for her. She'd like that.

An early evening breeze ruffled her hair, and she relaxed her head dreamily against his shoulder. He shifted his arms ever so slightly, enfolding her. She enjoyed the sensation.

She'd barely noticed him his first rotation through ER at St. Paul's. That had been her own rookie year. Scared to death of making a mistake on duty, then preoccupied with studying possible case scenarios on her days off in order to boost her confidence at work, she'd little time for men and didn't enjoy going out much. But after six months she had gained enough competence to look beyond her job and enjoy life a little- enough to keep an open mind as far as hooking up with someone when the Christmas party rolled around. Big mistake. People decompressed so much that most behaved as if they were at Mardi Gras. Wives left their wedding rings at home, husbands forgot where they lived, and singles swung.

Except for Dr. Thomas Biggs. He not only knew a fox trot from a waltz but also didn't use their time on the dance floor as an opportunity to grope her. Better yet, between numbers he actually seemed to enjoy talking about something besides work.

From then on she'd started checking his schedule against her own. They never ran out of anything to say. Movies, music, medicine- the topic didn't matter. And she particularly liked his easy, soft-spoken manner and barely detectable Tennessee drawl. To her mind, he sounded like someone out of Gone with the Wind- a man who knew how to treat a lady. Of course, she never monopolized him, again to avoid tongues wagging. Even at subsequent ER parties she'd danced with him no more than anyone else. But it had bothered her that he hadn't tried to take it further.

Initially she'd presumed he didn't want to date anyone with whom he worked, even though many residents had no such qualms and behaved like free-range rutters whenever they had the chance. Then his rotations took him to other departments- some even out of the city, to rural rotations in the Finger Lakes district, a winemaking area east of Buffalo- and she hardly saw him at all. Occasionally they ran into each other in the cafeteria and would have a coffee together. But he would never initiate anything more, not so much as a dinner invitation. She'd even begun to think he might be gay, then decided probably not. She could usually tell that about a man. It had to do with the carnality of her attraction to him, and Thomas's pull on her definitely rated a ten.

Still, frustrated at his lack of boldness and wondering about the reason, she'd finally asked him outright. "Do you prefer men, or is it me as a woman you got problems with?"

His swarthy complexion had flushed behind the closely cropped beard. "Want to go to my apartment and find out?" His tone carried more dare than invitation.

"Yeah," she'd said, double-daring him right back.

And they'd become lovers.

"Why'd you wait so long?" she'd asked him afterward.

"Because I didn't want us to be the latest gossip morsel for the hospital to chew over. I hate that."

"Me too."

"So what do we do?" He'd seemed genuinely lost for ideas.

"Continue to act like friends in public," she'd told him, surprised at how easily he'd let her take charge. "Can you keep a secret? I mean really keep it. Not a peep about us to anyone?"

He'd shrugged. "Watch me."

So they'd sealed the bond.

That had been eight months ago, just before last Christmas.

They'd been lovers ever since, except when he'd had to go off to the Finger Lakes district again, at the beginning of the year.

The music ended, and she opened her eyes. The summer dusk promised a long, languid sunset. "I want to be more than just your chum tonight," she whispered.

"You mean in the hospital? We might blow our cover."

"There's tomorrow morning. After sign-out, come on over, and I'll make you breakfast."

His dark good looks lit up with that infectious grin of his that she loved to see.

"You mean ol" hillbilly me finally is considered housebroken enough to be allowed into that new apartment of yours?" he teased. "What happened? Someone cover it all in plastic?"

She'd just moved into a new place. For reasons of her own, she'd hesitated at inviting him over. "Something like that. How about it?"

"Love to," he said, and walked away, rejoining the residents he'd been talking with earlier.

Feeling miserable, she wandered over to the end of the table, away from her nursing friends. Did he want her as much as she did him? At times she suspected his aversion to gossip simply gave him the excuse he needed to keep her at a distance- handy when he needed her, but out of sight when it suited him.

"You look as if you've lost your best friend," said a voice behind her.

She turned to see Father Jimmy, beer in hand. He gave her a lopsided grin that lifted her spirits despite her foul mood. "Hi, Father. No, it isn't anything like that."

He glanced across the room and nodded toward Thomas. "You're sure?"

She felt her face grow warm. He couldn't possibly know about Thomas and her. They'd been so careful. "What are you talking about?"

"You seem unhappy. Tis a shame, a woman of your talent and beauty."

The burn in her face increased. "I'm fine."

"Are you? I'd say that the usual J.S. spark is missing tonight."

"Just tired, is all."

"Ah, well, if that's the problem, I'm not surprised. You work hard."

"No more than the next person."

"Oh, I disagree. I can tell the good ones, and you're right up there, J.S. You pour heart and soul into what you do, and haven't backed off it since the day you arrived. I like that in you."

His candid praise surprised her. While he'd always been friendly and spoke of the good job that nurses did, she'd never heard him single one out for special mention before, let alone her. Probably figured she needed cheering up. "Thank you, Father. That's very kind."

"Kindness has nothing to do with it." He walked over and sat down beside her. "A lot of the patients talk about the special 'pierced angel of ER.'"

She started to laugh. "The what?"

He grinned again and took a swig of beer. "I've been wondering if maybe I should get an earring. What do you think?"

She laughed some more. "Come on."

"But I never get a clear answer whether right or left is a message. Needless to say, I can't go around giving the wrong idea."

"You're not serious."

"Sure. I figure it'll help bridge the gap between me and some of the street kids."

She searched his face for a hint that he'd engaged her in one of his games of zany banter, but he seemed quite pensive. And for the first time she found herself guessing about his age. Probably mid-thirties. Not at all too old for jewelry, though she couldn't remember ever seeing a priest wear any. She would have thought there'd be a rule against it.

"So which is it, right or left?"

She laughed. "Right or left ear. It doesn't matter anymore," she said. "And I could do it for you if you like." She immediately felt shy at making the offer.

But he let out a deep chuckle. "Why, I can't think of anyone I'd rather trust my earlobe to. Just tell me when and where."

His ready acceptance relaxed her. Apparently he hadn't found the offer out of line. "Good. I'll check with Susanne about using a treatment room in ER. It won't take more than a few minutes. But bring the ring with you, so I can insert it to keep the perforation open."

"Done. Let me know when you're ready. And thanks, J.S." He held out his hand to shake on the deal. The firmness of his grip didn't surprise her, given his physique, but the roughness of his palm did. It had the calluses that only years of physical labor could produce. Like her father's.

She realized her hand had lingered in his when he said, "Not the soft skin you expected?"

"Oh, sorry." She felt her cheeks grow warm.

"Hey, I'm proud when someone notices. They got like that prior to divinity school, when I bummed around out west for a few years. Worked as a ranch hand in several places. Say, you're from the prairies too, aren't you?"

"Yeah, but further east. I grew up in wheat country- Grand Forks, North Dakota, right on the Minnesota border."

"I know where it is. Just north of where they made that movie Fargo a few years back, and gave everyone Norwegian accents."

She laughed again, knowing exactly the film he meant. Everyone in Grand Forks had busted a gut laughing at it. "l-ya do-on't kno-oo wh-at yo-ou me-an," she mimicked, summoning up her best singsong rendition of the lead actress's portrayal of a local female cop's speech.

He threw his head back and guffawed so loudly it stopped conversations and attracted more than a few looks. "That's perfect," he managed to say, still chortling, oblivious to the reactions around him. "Say something else."

Carried away by his exuberance, she added, "Be-ee ca-re fu-ull, o-or yo-ou wi-ill pu-uke."

This time he nearly doubled over, and she started to giggle, finding his easy enjoyment of her joke infectious.

They settled down, and he asked, "Are your mom and dad still in Grand Forks?"

A twinge of sadness cut through the happy moment. "My father died in a construction accident twelve years ago. Mom's there, though," she added, brightening, "along with my kid brother, Arliss, who's now six foot and in his final year of high school. To think I used to beat him up."

He reared back in an expression of mock horror. "Did ya now?"

His Irish brogue made her giggle again.

"And you look like you could still handle yourself," he continued, bringing his head closer to hers. His eyes alight with playfulness, he held a hand to the side of his mouth in an obvious parody of someone about to reveal a secret. "Your speed as a runner actually had me worried during the race today. Fast as a cheetah, ye are. Nobody's come so close to beatin' the Flying Angels in years."

They chatted a few more minutes about the prairie, and then he excused himself.

As he walked away, she thought it odd that she found him so likable. Her attitude toward God's existence amounted to little more than a willingness to keep an open mind on the subject. Yet during her encounters with Father Jimmy in ER, she had never once sensed that he had an underlying agenda to show her the error of her loosely held beliefs. He just seemed friendly and fun. In fact, if he weren't a priest… She immediately shut down that line of thought. My God, what could she be thinking?

She nevertheless continued to watch the man as he wandered the room, joking with whomever he met, until she saw Dr. G. corner him. The two exchanged a few words, their expressions tightened into frowns, and they left together, joined in an animated discussion. At the door leading back into the hospital they stopped where boxes of protective clothing had been stacked and suited up again, but the ritual failed to interfere with their conversation.

She scanned the crowd, looking for Thomas. He stood against the setting sun, head tilted in easy laughter, evidently finding the woman he talked to exceedingly funny. The pleasant warmth of her interlude with Father Jimmy vanished instantly, replaced by a longing she'd come to resent.

"Do you want him, girl?" Susanne whispered in her ear and sat down beside her. "This time next year he'll be gone."

Jane felt herself flush. "What are you talking about?"

Susanne gave a dismissive wave. "You're a lot like me," she said. "A woman who likes to keep private things private. But I can tell what's up between you two."

"Really, Susanne, you've got the wrong impression-"

Susanne cut her off with a skeptical arch of an eyebrow that made it clear further protests were pointless.

Jane shook her head and took a swig of beer. She also felt an overwhelming urge to unload her secret to a sympathetic ear. She'd once carried her feelings for Thomas effortlessly, but they'd become all too heavy lately, the price of bearing them in private. It left her isolated and lonely, and she didn't like that. Maybe the time to talk was here. "How'd you know?"

"Just by watching. There's something different between the two of you when you dance. I didn't see it before last Christmas, but since…" She grinned with a shrug.

"See what?"

"You're more relaxed."

"And him?"

Susanne shrugged again. "Hard to tell. He's already so loosey-goosey with that hillbilly facade he puts on."

Jane laughed, then felt depressed again. She peered through the gaps between nearby buildings and glimpsed the blue sparkle of Lake Erie. A line of dark clouds floated across the horizon, their tops swollen into great round caps like a patch of mushrooms. The sight reminded her of the prairie skyline and carefree days back home in North Dakota.

"He seems like a good guy, though," Susanne added. "I can see why you like him."

The confirmation of her own instincts picked Jane up a little. She trusted Susanne's judgment and especially liked her ability to share insights without appearing to give advice. That bond had been established early, within days of her arrival in ER.

Despite her decision not to date anyone, Jane had started to let her guard down with the guys in the department, hoping to fit in. Nothing serious, just played along with their lighthearted chatter and teasing in the way she would have with her buds back at Grand Forks. But then came the comments laced with sexual innuendos.

At first she'd taken offense. That kind of talk angered her. As early as high school she'd had to endure the "nice T and A" comments the boys whispered behind her back but loud enough for her to hear. It drove her to start dressing tough, all the while feeling far from it inside. Even now, being what her mother called "amply endowed," whenever she wore a swimsuit the old self-consciousness about her body remained. So when the males in ER cracked that J.S. had better not go near old men with pacemakers, she might have grinned good-naturedly, but the joke set her cheeks on fire.

"They're assholes," Susanne had told her in the nurses' lounge after the first incident. "Not one of them would know what to do with a gorgeous woman like you, and that's your weapon. Zing their kind right back, and they fold."

The next time some wit resorted to that same refrain, Jane had run her fingernail down the front of his lab coat, unhooking the buttons as she went, and looked him scornfully in the crotch. "No danger letting you near the female patients, with or without pacemakers."

He'd turned tomato red.

The others had oohed and laughed.

But she'd felt elevated a notch in how the males treated her after that.

And Susanne had become a combination older sister and aunt who watched over her without ever seeming to interfere.

"He says he doesn't want to do anything more about us right now," Jane found herself admitting to her. "That he couldn't stand the busybodies picking our lives apart."

"They won't if you don't let them," Susanne said.

"And how do I manage that?"

Susanne smiled and shook her head. "I suppose the same way you already have, silly- by continuing to keep your mouth shut. It's worked."

"But you knew."

"I'm different. What I picked up on had to do with seeing a kindred spirit, you might say. No one else is likely to find out."

Jane again wondered if Father Jimmy might not suspect the truth. "Yeah, right."

"Ask yourself why you know so much about who the people in this department are sleeping with," Susanne said.

Jane shrugged. "I don't know. Word gets around."

"Because most people, when they become lonely or down enough, brag about whom they love as a way to raise their confidence. I guess it somehow makes their being loved back feel more real. So far, honey, you've resisted that urge. As a result, you fall off everyone else's radar as soon as you walk out of here."

Susanne ought to know, Jane thought. Hardly anyone in the department ever gossiped about her private life. Oh, a few might have guessed at the possibilities of whom she might be with, but they didn't get far, there being no rumors to feed the mill. She wore no wedding ring, never discussed anything personal, and when sAewent out the door of ER, it might as well be into a black hole.

"So it beats me why he'd still be worried about gossip this stage of the game," Susanne continued. "You've both proven you can put up a good enough front to keep your business private. What's to stop the two of you from making plans for after next year?"

Hearing someone else articulate what she'd been telling herself, Jane felt something release deep inside her. Susanne, as usual, hadn't advised her what to do, but rather nudged her to see for herself what ought to be done. Not that she didn't already know. Anyone with half a brain could see that the time had come to press Thomas for the real reason he'd been stalling about their future. What held her back had to do with her fear of the truth and the practical prairie philosophy she'd learned from her mother: never ask questions when the answers might make you more miserable.

"You what?"

"I had to, Jimmy. Wyatt would have tried to kick you out of the hospital."

The priest jumped up from the visitor's chair in Earl's cramped ER office and started to pace. "But to have him lead a hospital audit on pain? That's as stupid as… as… as if you put bin Laden in charge of human rights at the UN."

"Or you telling the prickly fart how to practice medicine. Why'd you pull a boneheaded play like that?"

Jimmy froze and gave Earl a withering look. "Because I won't sit at any more bedsides and try to give spiritual comfort to poor wretches who die screaming."

"You're exaggerating-"

"Goddamn it, Earl, wake up. You see something that atrocious in ER, and you'd move in with morphine, ketamine, fentanyl- whatever it takes. I can't do that. For me it's beg the nurses, who ask the residents, who don't prescribe enough, then beg them to get their staff supervisor. Even then a third of them won't budge from the guidelines, but I beg them as well anyway, and all the time the screeching goes on. I tell you, there ought to be a court for medical atrocities, just like there is for atrocities of war, and this kind of torture by omission should be made a crime…" He seemed to run out of breath and simply stood there, panting as heavily as if he'd just completed one of his runs.

Earl sat stunned. He knew that crap happened, as hideously as described, and he condemned it whenever he could, but he'd never before seen it from so stark a point of view. At first he didn't know what to say. Finally he asked, "It's really getting to you?"

Jimmy nodded. "Sometimes." His eyes focused on something Earl couldn't see.

Judging from the pain reflected in the priest's gaze, Earl didn't want to see it. "You still could have come to me, Jimmy," he said softly. "Brought me patients' names and chart numbers. That's the kind of documentation that would have nailed Wyatt and others like him."

"Yeah, right. Case by case, committee by committee- it takes forever that way."

Earl exhaled long and hard. "But keep at it enough, and even the thickest-skulled dinosaurs change their ways in the end."

"Then why didn't you do it?"

"Me?"

"Yeah. You're a physician. Nothing stopped you from stepping up with charts and patient names these last twenty-five years."

Earl bristled. "Nobody dies like that in my department. Certainly not since I've been chief."

Jimmy's eyes narrowed into a hard, unjoking glare. "And that's the trouble with you, Earl. You hide in ER."

"Hide?"

"Yes, hide. It's a domain as black and white as any in the hospital. The sicker the patients, the easier your job. Stabilize 'em, medicate 'em, and ship 'em upstairs. Don't get me wrong, you're great at it- decisive, skilled, and courageous. But one of the reasons the job suits you isn't so noble. The patients don't hang around, and you like it that way. The ones who don't make it, you can honestly tell yourself they died while you were trying everything possible. The ones who do, their pain, fear, and despair are muted by shock or postponed by drugs. The long and short of it all is that you get to keep your losses more cut-and-dried. No having to deal with the long, messy aftermath that survival involves."

"Whoa. Now wait a minute, Jimmy. I find out how people did after they left ER. Their doctors tell me-"

"I'm not talking about the clinical results or satisfying your medical curiosity."

"Jesus, Jimmy, what the hell's the matter with you?"

"What's the matter is, you can't be VP, medical and bury yourself in a mentality that has a fix for everything."

Earl leapt to his feet. "That's not fair!"

"What's fair got to do with it? You want to face a patient's lingering, share in his or her long-term agony, witness their slow settling for a fraction of a former life, then watch your successes as they piece together what they lost from the heart attack or stroke or car accident that derailed them."

"Damn it, Jimmy, how dare you-"

"Why, in all the years I've been here, I never once saw you up on the floors visiting with any of the people you saved."

Earl felt he'd been gut-punched.

He stood behind his desk as a tiny prickle of sweat dampened the back of his shirt despite the chill of cold air pouring over his head from a ventilation duct in the ceiling.

The black of Jimmy's eyes increased its hold on him. "If you'd had any inkling at all for that part of the game, Earl, now and then I would have found you on the wards where it plays itself out. And maybe, just maybe, when you came across wretched souls with barely days left to live, bellowing like wounded beasts, you might have acquired the same compassion for them that you found for the likes of Artie Baxter when you made sure he didn't suffer in ER."

With that, the priest released him from the tractor-beam grip of his stare, quietly opened the door, and disappeared into the darkened corridor.

The head nurse slid her glasses to the tip of her nose, peered at him, then let them drop on their silver chain. "Dr. Garnet! We don't usually see you up here."

"Here" referred to the Palliative Care Unit, or "terminus," as some of the more callous residents called it.

"Then it's about time," he answered, straining to read the woman's name tag. "Mrs. Yablonsky, would you be so kind as to grab the chart cart and accompany me as I see the patients?"

Crinkles at the corners of her eyes lessened. "See the patients?"

"Yes."

"All of them?"

"Yep."

"Now?"

He nodded.

"But why?"

"I want to check their pain medication."

The visible portion of her face corrugated itself into a frown. "You mean without their doctors knowing?"

Jesus, he'd be here all night answering her questions. "We're going to be doing an audit on pain management throughout the whole hospital. Dr. Wyatt himself will be chairing it. I thought I'd get a head start."

The far smoother foreheads of two younger nurses who had approached from behind her scrunched up in amazement.

"Dr. Wyatt knows about this?" the supervisor asked.

Earl smiled in response.

"Well, it's most peculiar…" She pushed herself out of a swivel seat, surprising him with her height. With eyes nearly at the same level as his, she also possessed the big shoulders and sculpted build of someone who swam laps across Lake Erie.

While he waited for her to prepare the charts his gaze drifted along the polished, barren corridor, and he shuddered at the thought of being stuck here to die. Just park him under a tree with a nice view and a bottle of whisky when his time came.

He'd never admitted it to anyone, but deep down he hated hospitals, felt claustrophobic in them. As a patient, he'd loathe every part of surrendering to any regime that a place like St. Paul's would impose on him, especially with his butt hanging out the back of a tie-up gown.

Through windows at the far end of the unit he watched the sun as it slipped behind a column of thunderheads that had been piling up over the lake. Immediately the passageway darkened, and everything became cast in a thin yellow light. Low rumbles sounded outside, and a crackle of static interrupted the quiet music from a radio on the work counter.

"Storm's coming," said one of the younger nurses, reaching up and snapping the off button.

Only then did he hear the weak moans and wailing. Mere wisps of sound that floated out from the semidarkness of the hallway, they were the kind of noises that, once gotten used to, could easily be ignored- with the help of a radio. "Are they always crying like that?"

"Oh, this is nothing," Yablonsky said. "Sometimes they get to screaming so loud you can't hear yourself think." Oblivious to her own callousness, she never paused in pulling out charts and placing them on a pushcart.

A twist of anger turned his stomach.

In the first room they stopped in, he found an old man curled in bed, as withered and emaciated as a mummy. His skin had yellowed with jaundice, and, either comatose or sleeping soundly, he didn't respond when Yablonsky called his name or slipped the mask that had fallen off his face back into place. Earl let him be.

Next door to him lay an elderly lady in similar shape.

In the third room, a gaunt, gray-faced woman with the wisps of her remaining hair combed neatly into place sat in a chair and stared out at the approaching rain clouds. Her upper face brightened as soon as she saw him. "How nice, a new doctor."

A glance at her chart before coming in revealed her name to be Sadie Locke and that she had metastatic cancer of the breast that neither chemotherapy nor radiation could halt. As he stepped up to shake her hand and introduce himself, the sleeve of her housecoat slipped up her arm to reveal a swarm of florid red blotches where the tumor had seeded itself to her skin, and a sniff of decay floated down the back of his nose.

"I love a thunderstorm at the end of a hot summer day, don't you?" she said after assuring him she felt comfortable most days on her current drug regime. "It's so refreshing, and the air smells wonderfully clean afterward."

"Yes, I know exactly what you mean," he said. Her pleasant manner put him at ease. Normally having nothing to offer a patient but small talk made him feel awkward. "Do you have family?" he asked after a few seconds, mostly to reassure himself she knew someone who cared enough to keep her company. He couldn't imagine anything worse than being confined to a room, with no prospects of a visitor.

"Yes, one son. Donny. He owns a restaurant in Honolulu. I don't see him much, but next week he'll be here- a business trip to New York. And he taught me how to use e-mail." She pointed at a turquoise laptop sitting on her night table.

Pretty lonely, he couldn't help thinking, and tried to come up with something else to say. "Do you know the hospital chaplain, Jimmy Fitzpatrick?"

Her eyes beamed. "Father Jimmy? Of course. He's wonderful. Always says just the right thing to pick up a person's spirits."

Oh, does he now? Earl thought, still shaken by the hiding he'd received.

"Cracking jokes the way he does is wonderful," she continued, "but he can be serious when he wants to be."

"Tell me which you like best about him, jokes or serious." Maybe she could give him some pointers about the man's technique with the patients here.

"That's easy. He never wastes my time. No rubbish about doctors all at once finding a cure or me somehow getting better through a miracle. There's a relief in hearing a person tell bad news honestly and make no bones about what can't be done. It leaves him free to help me in ways he can."

"What are those?"

"Listening, talking about ordinary things, keeping me interested in the world- you know, making me feel I matter to him. Not that he's got a lot of time to do it in. There are so many others who depend on him as well."

Earl started to thank her, not much the wiser about specifics that made Jimmy so great at his job, but she laid a hand on his arm. "Know what's his real secret, now that I think about it?"

Earl waited.

"It's the way he looks you in the eye and says, 'I'm sorry you're going through this.' Twenty seconds face-to-face like that, and I feel he's given me twenty minutes."

The next dozen visits went a little quicker, but he found them no easier. Patients raised questions he couldn't answer and expressed fears he didn't know how to console.

"Why me?" some asked when he inquired about their pain.

"I'm afraid to die," others said.

Not that he hadn't heard those words thousands of times in ER. But there the confused hurly-burly of a resuscitation or the rush to line and intubate whomever he was working on allowed him to get away with brief reassurances. Here people looked him in the eye and expected his undivided attention along with a detailed response.

"I don't know what to say," he repeated over and over, bowing to a growing sense that on this ward, bullshit would be even less forgivable than his ineptness with words. "But I'm sorry for your ordeal."

Still, he pushed on with the rounds. Despite the emotional suffering he'd discovered, he began to wonder if Jimmy hadn't exaggerated his claim about patients being undermedicated, as most seemed free of physical discomfort.

Then they approached the nearest of a string of rooms where the nurses had closed the doors. The sounds he'd heard earlier emanated from here.

He quickly scanned the chart of the patient they were about to see.

Elizabeth Matthews, fifty-eight, terminal cancer of the ovary.

What had sounded like whimpering turned out to be a continuous high-pitched cry once they were inside. The lights were off and the blinds were closed, so he could barely make out her form on the bed. But he could smell the acrid, sour aroma of her sweat.

Swallowing, he drew closer, and his eyes adjusted to the dark. She lay on her side clutching her knees, curled around the point where the tumor, grown from what had once been the source of her seed, would have maximally eaten through the contents of her lower abdomen and into her pelvis. She rocked back and forth, as if her belly were a cradle to the malignancy and her hideous keening could lull its ravages to sleep.

"Mrs. Matthews?"

The piercing sound from her throat never wavered.

A movement in the corner of the room startled him. "Doctor?" a man's voice said.

Earl turned to see a tall, asthenic figure rise from a lounge chair set well back from the bed.

"I'm Elizabeth's husband." He held out his hand. "Thank you for coming."

Earl took it, touched by the simple dignity of the gesture. Either the man had nerves of steel to remain so composed in the face of his wife's suffering, or witnessing it had left him numb. "Mr. Matthews, I'm so sorry."

"Nothing's helped, Doctor. She's been this way for the last two days. The residents tell me they're giving her the maximum amounts of morphine possible…"

As he talked, Earl flipped to the medication sheet and looked at the orders.

Morphine sulfate, 5 mg sc q 4 hrs prn.

Maximum, his ass. A medical student must have written it, copying word for word from the Physicians' Desk Reference, the bible of medications and their standard dosages. But Elizabeth Matthews didn't have standard pain.

He immediately felt back on his turf. "Get me ten milligrams of midazolam," he said to Yablonsky. This kind of suffering he could dispatch in seconds.

"But-"

"Now!"

One of her younger assistants darted out the door.

"When did she get her last dose of morphine?" he asked, walking over to check that Elizabeth Matthews's IV line remained functional. He opened the valve full, and it ran fine.

Yablonsky flipped to the nurses' notes. "At three this afternoon," she said, "during our usual medication rounds."

"And it's now nearly eight, five hours later. Her order says every four hours, as needed. I think we agree she needs it."

"Well, yes…"

"And you gave her only five milligrams?"

"Subcutaneous, as prescribed."

"You didn't request her doctor raise the dose, even though you could easily see she required more?"

"More is not what's on the chart, Doctor. Besides, we don't want her to get used to it so the drug no longer has an effect-"

"You call this an effect, Mrs. Yablonsky?" He gestured to the crumpled shape on the bed.

She fidgeted with the chart, fuming at being confronted. "No, but I-"

"What do you say we give her ten, then? And if that doesn't work, make it fifteen." He grabbed the file out of her hand and wrote the order, scrawling his signature with an angry flourish. "And once we find out how much is enough, we'll make it an IV infusion. Even street junkies know that popping narcotics under the skin doesn't hold a candle to mainlining."

Yablonsky turned scarlet all the way to the tips of her ears. "Really, Dr. Garnet, her oncologist says she could linger like this for months. She wi//grow tolerant to morphine, and-"

"Then we'll sedate her, just as I'm about to do now."

As if on cue, the young nurse who'd gone to fetch the midazolam returned and handed him a syringeful of the fast-acting sedative. He swiped the rubber portal at the side of Elizabeth's IV line with an alcohol swab, jabbed in the needle, and slowly pushed on the plunger. "Whatever it takes to make her comfortable," he continued, "especially if she's got months. My God, is that your policy, the longer a patient has, the longer they don't get sufficient morphine?"

Yablonsky's younger colleagues, standing behind her back, nodded tellingly.

Yablonsky snapped her head high and threw back her ample shoulders. "Of course not."

Earl wondered if she had once been an army nurse.

Elizabeth's cries lessened as he slowly injected the contents of the needle, keeping a sharp eye on the rise and fall of her chest.

Mr. Matthews walked over to the other side of the bed, leaned over, and stroked his wife's head. "It will be better now, Elizabeth. You'll get some rest." The fatigue in his voice weighted the words like rocks, but they must have fallen as gently as tears on her ears. She smiled, released her hold on her knees, and reached up to pat his hand.

A few seconds more, and she slept peacefully.

"Thank God," Mr. Matthews said, and pulled her mask from down around her neck back up over her nose. By the light from the hallway, his haggard eyes appeared gouged out by worry and exhaustion.

"Why not grab some shut-eye yourself?" Earl told him. "I promise you, she'll be fine for the night. Go home and get to bed." He put his hand on the old man's shoulder, and felt it slump in defeat. "Mrs. Yablonsky will sponge-bathe Mrs. Matthews and change her nightie and bedding." He turned to face the nurse. "And open the blinds, shall we? Let her see it's night should she wake up, right, Mrs. Yablonsky?"

She sucked in a mouthful of air. "Yes, sir."

"During the day, we'll continue to make sure they stay open and that there's natural light in here, so she'll be less confused. Agreed?"

The nurse nodded.

"And she gets her next morphine as soon as she starts to stir from the midazolam wearing off, which will be in about an hour…"

As Earl rattled off his instructions, tears rippled down the haggard circles beneath Mr. Matthews's eyes to where the crescent contours of skin bunched up by the top of his mask. From there wet marks spread through the material until it grew damp enough to stick against the hollow contours of his cheeks. He reached across his wife's sleeping form and held out his hand to Earl again, except this time it trembled slightly. "Thank you," he repeated, but much more softly than before.

Earl clasped it in his as he finished outlining to Yablonsky a regime that had more to do with simple human dignity than medicine. Yet he couldn't be sure she wouldn't screw it up somehow, to put him in his place.

"Yes, Doctor," she repeated over and over.

Her sullenness worried him. "And make sure the next shift gets it right as well. I want no more problems."

She bristled, almost standing at attention. "I'm doing a double and will be here until dawn."

Resentment had probably prevented her from adding a "sir" this time. Earl pegged her former rank as at least a sergeant.

He led Mr. Matthews to the door and delivered him to one of the younger nurses with instructions to give the man a taxi voucher.

Then he and Yablonsky wrapped up the rest of the rounds in an hour, during which Earl made similar adjustments to the medications of another seven patients, who all had little more than days, if not hours, to live. Still, there'd definitely be fireworks over what he'd done here tonight. One of the seven, unfortunately, belonged to Wyatt.

Yablonsky, on the other hand, had become much less hostile by the time they returned to the nursing station. Her initial rigidity now made her seem more brittle than hard, almost fragile. Not that he could excuse the indifference he'd witnessed here, but little wonder she and her colleagues armored themselves with it, seeing people face death, day in and day out.

"Tell me, Mrs. Yablonsky- or may I call you Monica?" He sensed he might have won her over a little and that now might be the best time to get her talking, before Wyatt declared him public enemy number one.

"Of course, Doctor."

"There's something else Dr. Wyatt brought to my attention that perhaps you could help me with."

"If I can."

"He described a cluster of odd occurrences."

Immediately her body stiffened again, as if she was holding her breath in anticipation of bad news. "Clusters?"

"Yes. He said that over the last few months some of your patients were reporting near-death, out-of-body experiences."

"Oh, that!" She immediately exhaled and gave a little laugh. "Yes! It's most strange. And some of them weren't that near death."

"Do you have any ideas as to the cause?"

She shook her head. "I'd guess the effects of morphine or whatever other medication they were on. I actually looked up near-death experiences on the Internet. There's quite a lot there, you know, all about the neurotransmitters that may be behind it and what receptor sites in what part of the brain, if stimulated, will produce the experience-"

"What did Dr. Deloram think about it?" he interrupted, having no use for medicine culled off who knew what Web sites. "Didn't he come to interview some of the patients a few days ago?" Earl tried to make the question sound as innocent as possible.

Surprise deepened the wrinkles on her forehead. "You heard about that visit?" She leaned closer to him, her eyes all at once betraying the delighted eagerness of someone ready and willing to gossip. "Now there we had a really strange event. He arrived yesterday morning, pleasant as can be, took the list of patients' names, and went off to talk with them, at least the ones who are still alive. An hour later he stormed out, face so livid I thought his mask would burn off, and not so much as a word to any of us. Never did find out what made him so angry. The patients he talked to didn't know either." She leaned back and gave a little nod, as if daring him to come up with a logical explanation for such a bizarre display.

Earl asked if she could prepare the list again, intending to speak with those patients himself later. He also would ask Stewart what happened. But as he took the elevator down to the main floor, something other than near-death experiences began to bother him.

Why had Monica Yablonsky reacted so apprehensively when he first mentioned a cluster of odd occurrences, then been clearly relieved when he asked about the near-death experiences?

He walked to the front entrance, where he dumped his protective garb in the prescribed disposal bin, stepped outside, and raced through a warm summer downpour to his car.

Yet he remained preoccupied.

What kind of clusters could she have thought he meant?