Toxin

SIX

Monday, January 19th

Kim's alarm was set to go off at five-fifteen in the morning, but it was rarely needed. He usually awoke just before the alarm, which allowed him to turn it off before it could shatter the early-morning peace. Kim had been getting up before dawn ever since he'd been a first-year surgical resident. And this particular morning was no exception. He climbed out of his warm bed in the pitch black and dashed stark naked into the bathroom.

Following a routine that needed no thought, Kim pulled open the heavy glass door of the shower and turned on the water full-blast. Kim and Tracy had always preferred showering to bathtub bathing, and the bathroom was the only room they'd wanted renovated back when he and Tracy had first purchased the house ten years earlier. They'd had the tub pulled out, as well as its attached tiny shower stall. In their place a generous five-by-nine-foot custom shower was constructed. Three sides were marble slab. The fourth was half-inch glass, including the door that had vertically oriented, bright brass, U-shaped handles mounted as if they pierced the thick, tempered glass. In Kim's estimation it was a bathing extravaganza worthy of a spread in a design magazine.

Breakfast was a donut and a cup of half-milk half-coffee that Kim stopped for at a Dunkin' Donuts shop near his home. He ate while he drove through the morning darkness. He also used the time to listen to medical tapes. By six he was already in his office dictating consult letters and writing checks for various overhead expenses. At six-forty-five he was in the hospital for teaching rounds with the thoracic surgery residents at which time he made it a point to see his own patients. By seven-thirty he was in the conference room for the unavoidable, daily hospital meeting. That morning it concerned hospital credentials and admitting privileges.

After the administrative meeting, Kim met with the thoracic surgery fellows whose research he supervised and participated in. That meeting went over, so he was a few minutes late to surgical grand rounds, where he presented a case of triple-valve replacement.

By ten o'clock Kim was back at his office and already behind schedule. He found out that Ginger had booked emergency patients for nine-thirty and nine-forty-five. Cheryl Constantine, Kim's office nurse, had the patients already in the two examining rooms.

The morning passed with nonstop patients. Lunch consisted of a sandwich that Ginger had ordered in. Kim ate while he went over cath results and X-rays. He also found time to return a semi-emergency phone call to a Salt Lake City cardiologist about a patient who needed a triple-valve replacement.

The afternoon was a mirror image of the morning, with back-to-back patients, including a few emergencies that Ginger slipped into the schedule. At four o'clock Kim took a short break to dash over to the hospital to handle a minor problem with one of his inpatients. While he was there he quickly did afternoon rounds.

Back at the office Kim vainly tried to catch up, but he never could. Several hours and a number of patients later, he paused for a moment to catch his breath before pushing into what was called exam room A. He used the brief respite to glance at the chart. He was relieved to see it was merely a routine post-op check. That promised the visit would most likely be a "quickie." The patient's name was Phil Norton, and as Kim entered the cubicle, Phil was already obligingly sitting on the examination table with his shirt off.

"Congratulations, Mr. Norton," Kim said, lifting his eyes from the chart. "Your stress test is now normal."

"Thank God!" Phil said.

And thank modern-day cardiac surgery, Kim mused. He bent over and examined the incision that ran down the center of Phil's chest. Gently Kim palpated the raised ridge of healing tissue with the tips of his fingers. By such observation and touch Kim could accurately tell the internal state of the wound.

"And the incision looks great," Kim added. He straightened up. "Well, as far as I'm concerned you can start training for the Boston Marathon."

"I don't think that's in my future," Phil joked. "But come spring I'll certainly be out on the links."

Kim gave the man a pat on the shoulder and then shook his hand. "Enjoy yourself," he said. "But remember to maintain the change we've made in your lifestyle."

"Don't worry about that," Phil said. "I read all the material you sent home with me. And I've taken it to heart. No more smoking for this fellow."

"And don't forget the diet and exercise," Kim added.

"Don't worry," Phil said. "I don't want to go through this again."

"Now, it wasn't that bad," Kim joked.

"No, but it was scary," Phil said.

Kim gave Phil another pat on the back, jotted a quick note on the chart, and left the examination room. He stepped across the hall to exam room B but noticed there was no waiting chart in the rack on the door.

"Mr. Norton was the last patient," Cheryl said from behind Kim.

Kim turned around and smiled at his office nurse. He ran a tired hand through his tussled hair. "Good," Kim said. "What time is it?"

"It's after seven," Cheryl said.

'Thanks for staying," Kim said.

"You're welcome," Cheryl said.

"I hope this chronic overtime doesn't cause you any trouble at home," Kim said.

"It's not a problem," Cheryl said. "I'm getting used to it and so is my husband. He knows now to pick my son up from day care.

Kim reversed direction and went into his private office. He collapsed into his desk chair and eyed the stack of phone messages he'd have to respond to before leaving. He rubbed his eyes. He was exhausted yet on edge. As per usual the stresses of the day had accumulated. He would have loved to play some tennis, and he vaguely thought about stopping in at the athletic club on his way home. Maybe he could at least use a StairMaster.

The door to his office opened and Ginger leaned in.

" Tracy just called," she said with an edge to her voice.

"What about?" Kim asked.

"She wouldn't say," Ginger reported. 'All she said was to have you call."

"Why are you upset?"

Ginger exhaled and shifted her weight. "She's just rude. I try to be nice and all. I even asked how Becky was."

"And what did she say?"

"She said just to have you call."

"Okay, thanks," Kim said. He picked up the phone and started to dial.

"I'm leaving for aerobics class," Ginger said.

With a wave, Kim acknowledged that he'd heard.

"Call me later," Ginger said.

Kim nodded. Ginger left and closed the door behind her. Then Tracy answered.

"What's up?" Kim asked with no preamble.

"Becky is worse," Tracy said.

"How so?"

"Her cramps are worse to the point of tears and there's blood in her diarrhea."

"What color?" Kim asked.

"For chrissake, what do you mean what color?" Tracy demanded.

"Bright red or dark?" Kim asked.

"Chartreuse," Tracy said impatiently.

"I'm serious," Kim said. "Bright red or dark red, almost brown?"

"Bright red," Tracy said.

"How much?"

"How am I to tell?" Tracy responded irritably. "It's blood, and it's red, and it's scary. Isn't that enough?"

"It's not so abnormal to have a little blood in diarrhea," Kim said.

"I don't like it," Tracy said.

"What do you want to do?"

"You're asking me?" Tracy questioned with disbelief. "Listen! You're the doctor, not me."

"Maybe I should try to call George Turner in Boston," Kim said.

"And what is he going to do a thousand-plus miles away?" Tracy complained. "I want her seen, and I want her seen tonight!"

"Okay, okay." Kim said. "Calm down!"

Kim paused for a moment to gather his thoughts. With George gone, he didn't have any handy contacts in pediatrics. He considered having one of his internal medicine acquaintances take a peek at Becky but was reluctant. It seemed excessive to call someone out at night because of mild diarrhea of a couple days' duration even if it were tinged with a small amount of bright red blood.

"I'll tell you what," Kim said. "Meet me over at the University Med Center emergency room."

"When?"

"When can you be there?" Kim asked.

"I guess in about a half hour," Tracy said.

"I'll see you then," Kim said.

Since he was only about ten minutes away from the hospital now that peak traffic time had passed, Kim used the intervening twenty minutes to return as many phone calls as he could. When he got to the emergency room, he discovered he'd still beat Tracy, so he stood out on the receiving dock and waited. While he stood there, several ambulances pulled up to the platform with their screaming sirens trailing off. Hurriedly the EMT's unloaded a couple of patients in dire need of emergency care. One of them was being given CPR. Kim watched them disappear inside, and it made him nostalgically recall his days as a surgical resident. Kim had worked hard and had been rewarded by being told repeatedly he was one of the best residents who had ever come through the program. It had been a heady time and in many ways more fulfilling than now.

Kim was just about to use his cell phone to try to contact Tracy when he saw Tracy 's Volvo station wagon round the corner and pull to a stop. Kim dropped to the pavement and trotted over to the car as the doors were being opened. He went directly to the passenger side and helped Becky. She smiled at him weakly as she got out.

"Are you okay, Pumpkin?" Kim asked.

"My cramps are worse," Becky said.

"Well, we'll get them taken care of," Kim said. He glanced at Tracy. who'd come around the car. Kim noticed she looked as irritated as she had the night before.

Kim led the way back to the platform and up the half dozen steps. He pushed open the swinging doors, and they entered.

As the major emergency room in a large, sprawling, Midwestern city. the unit was so jammed it looked like a busy, urban bus station. Monday nights tended to be particularly busy because of a leftover effect from the weekend.

With his arm around his daughter, Kim steered her through the throng in the anteroom where the main admitting desk was located and past the crowded waiting room. He was almost past the nurses' desk when an enormous, Brunhild-type nurse stepped out from behind the counter. Her bulk effectively blocked Kim from proceeding any further. Her name tag read: MOLLY MCFADDEN. Her height was such that she just about looked Kim in the eye.

"Sorry," Molly said. "You can't come in here on your own. You have to check in at the receiving desk."

Kim tried to push by, but Molly held her ground.

"Excuse me," Kim said. "I'm Dr. Reggis. I'm on the staff here, and I'm bringing my daughter in to be seen."

Molly gave a short laugh. "I don't care if you're Pope John whatever," she snorted. "Everyone, and I mean everyone, checks in at the front desk unless they're carried in here by the EMT's."

Kim was so shocked he was rendered momentarily speechless. He could not believe that not only wasn't he being deferred to, he was being openly challenged. Kim stared disbelievingly into the woman's defiant blue eyes. She seemed as formidable as a Sumo wrestler dressed in white. If she'd heard Kim identify himself as a member of the professional staff she gave no indication whatsoever.

"The sooner you check in, Doctor," Molly added, "the sooner the girl will be seen."

"You did hear me, didn't you?" Kim questioned. "I'm a senior attending in the department of cardiac surgery."

"Of course I heard you, Doctor," Molly said. "The question is: Did you hear me?"

Kim glared at the woman but she was not to be intimidated.

Tracy sensed an impasse. Having an all-too-good idea of her former husband's temper, she took it upon herself to defuse the situation.

"Come on, dear," Tracy said to Becky. "Let's follow orders and get you checked in." She guided Becky back the way they'd come.

Kim shot one more nasty look at Molly, then turned and caught up to Tracy and Becky. Together they joined the ragtag line of patients waiting to check in. But Kim was still fuming.

"I'm going to complain about that woman," Kim said. "She's not going to get away with that kind of insolence. The nerve! I can't believe it."

"She was only doing her job," Tracy replied, content to let the incident drop. She was relieved that Kim hadn't caused more of a scene.

"Oh really?" Kim snapped. "Does that mean you're trying to defend her?"

"Calm down!" Tracy said. "She's undoubtedly just following orders. You don't think she makes up the rules, do you?"

Kim shook his head. The line inched ahead. At the moment there was only one clerk taking admissions. It was her job to fill out the check-in sheet with all the pertinent information, including insurance coverage if the patient was not a member of AmeriCare's health plan.

Becky's face suddenly contorted in pain. Pressing her hand into her abdomen, she whimpered.

"What's the matter?" Kim asked.

"What do you think?" Tracy said. "It's another cramp."

Perspiration appeared on Becky's forehead and she became pale. She looked pleadingly at her mother.

"It'll pass like the others, dear," Tracy said. Tracy stroked Becky's head and then used her hand to remove the moisture from Becky's face. "Do you want to sit down?"

Becky nodded.

"Keep our place!" Tracy said to Kim.

Kim watched Tracy lead Becky over to one of the molded-plastic chairs along the wall. Becky sat down.

Kim could tell that Tracy was talking with her because Becky was nodding her head. Becky's color returned. A few minutes later Tracy came back.

"How is she?" Kim asked.

"She feels better for the moment, Tracy said. Tracy noted how little the line had advanced since they'd joined it. "Can't you think of an alternative to this?"

"It's Monday night," Kim said. "A tough night anywhere."

Tracy exhaled noisily. "I certainly miss Dr. Turner."

Kim nodded. He rose up on his tiptoes to see if he could figure out why the queue wasn't moving, but he couldn't.

"This is ridiculous," he exclaimed. "I'll be right back!"

With his mouth set in a grim line, Kim skirted the people in front of him to reach the counter. Immediately he could see why they had not moved forward. An inebriated man in a soiled and wrinkled business suit was struggling through the process of checking in. All his credit cards had fallen from his wallet. On the back of his head was an angry scalp laceration.

"Hello!" Kim called out, trying to get the receptionist's attention. She was an African-American woman in her mid-twenties. "I'm Dr. Reggis. I'm on staff in the department of cardiac surgery. I have my…"

"Excuse me," the receptionist said, interrupting Kim. "I can only deal with one person at a time."

"Listen!" Kim ordered. "I'm on the staff here…"

"It doesn't matter," the woman interjected. "We're an equal-opportunity server. It's first-come first-served for all routine emergencies."

"Routine emergencies?" Kim questioned. It was a ridiculous oxymoron. All at once the idea of trying to talk to this clerk reminded him of the frustration of having to deal with medically untrained people when he called insurance companies or managed-care plans to get clearance for patients. That chore had become one of the truly exasperating problems of modern office practice.

"Please wait at the end of the line," the receptionist said. "If you'll allow me to concentrate and get these people before you signed in, I'll be able to take your information sooner." She then directed her full attention to the drunk. In the interim he'd managed to gather the contents of his wallet.

Kim started to protest, but it was all too obvious it was a waste of time to try to talk with this woman. It occurred to him that she might not even know what the term "on staff" meant. With growing frustration, humiliation, and irritation, Kim returned to Tracy.

"I don't know where they find these people," Kim complained. "They're like automatons."

"I'm impressed by how your exalted position in this hospital has greased the skids for us."

"Your sarcasm doesn't help one iota," Kim snapped. "It's all because of the merger. I'm not known down here. In fact, I can't remember ever coming to this ER."

"If you'd taken Becky's complaints seriously over the weekend, we probably wouldn't have to be here now," Tracy said.

"I took them seriously," Kim said defensively.

"Oh, sure," Tracy said. "By giving her some over-the-counter diarrhea medications. That's really an aggressive approach! But you know something? I'm not surprised you didn't do more. You've never taken seriously any symptoms Becky has ever had. Or mine either, for that matter."

"That's not true," Kim said hotly.

"Oh, yes, it is," Tracy said. "Only someone married to a surgeon would know what I'm talking about. From your perspective, any symptom less than what would call for immediate open-heart surgery is a kind of malingering."

"I resent that," Kim said.

"Yeah, well, so do I," Tracy said.

"All right, Miss Know-It-All," Kim snapped. "What would you have had me do with Becky over the weekend?"

"Have her be seen by somebody," Tracy said. "One of your many colleagues. You must have a thousand doctor friends. It wouldn't have been too much to ask."

"Wait a second," Kim said, struggling to control himself. "All Becky had was just simple diarrhea and some cramps, both of short duration. And it was the weekend. I wasn't going to bother someone with such symptoms."

"Mommy!" Becky called. She'd come up behind Kim and Tracy. "I have to go to the bathroom!"

Tracy turned and, reminded of her daughter's discomfort, her anger immediately mellowed. She put her arm over Becky's shoulder. "I'm sorry, dear. Sure! We'll find you a bathroom."

"Wait," Kim said. "This could be helpful. We'll need a sample. I'll get a stool-sample container,"

"You must be joking," Tracy said. "I'm sure she has to go now.

"Hold on, Becky," Kim said. "I'll be right back."

Kim walked deliberately and quickly into the depths of the ER. Without Becky and Tracy, he wasn't challenged as he passed the nurses' desk. For the moment the mammoth Molly McFadden was nowhere to be seen.

The interior of the ER was a series of large rooms divided into separate cubicles by curtains that hung from overhead tracks. In addition, there were individual trauma rooms replete with state-of-the-art equipment. There were also a handful of examination rooms used primarily for psychiatric cases.

Like the outer waiting area, the ER proper was packed and chaotic. Every trauma room was occupied and staff physicians, residents, nurses, and orderlies swirled between them in continuous motion.

As he walked, Kim searched for someone he recognized. Unfortunately he didn't see anyone he knew. He stopped an orderly.

"Excuse me," Kim said. "I need a stool-sample container ASAP."

The orderly gave Kim a rapid once-over with his eyes. "Who are you?"

"Dr. Reggis," Kim said.

"You got an ID?"

Kim produced his hospital identification card.

"Okay," the orderly said. "I'll be right back."

Kim watched the man disappear through an unmarked door that apparently led to a storeroom.

"Coming through," a voice called.

Kim turned around in time to see a portable X-ray unit bearing down on him. He stepped to the side as the heavy machine was trundled past by an X-ray technician. A moment later the orderly reappeared. He handed Kim two clear plastic bags with plastic containers inside.

"Thanks," Kim said.

"Don't mention it," the orderly said.

Kim hurried back the way he'd come. Tracy and Becky were still in line although they had moved up a few feet. Becky had her eyes shut tight. Tears streaked her face.

Kim handed one of the plastic bags to Tracy. "Cramps?" he questioned.

"Of course, you lunkhead," Tracy said. Tracy grabbed Becky's hand and led her back to the restroom.

Kim held their place in line as it advanced by one more patient. Now there were two check-in clerks. Apparently the other had been off on break.

By nine-fifteen the ER waiting room was filled to overflowing. All the molded-plastic chairs were occupied. The rest of the people were leaning up against the walls or sprawled on the floor. There was little conversation. In one corner, a television hung suspended from the ceiling. It was tuned to CNN. A number of unhappy infants drowned out the newscaster. Outside it had started to rain; the smell of wet wool filled the air.

Kim, Tracy, and Becky had eventually found seats together and had not moved, except for Becky, who'd made several more trips to the restroom. Kim was holding the stool-sample container. Although there had been some spots of bright red blood originally, now the contents appeared a uniform light brown. Becky was miserable and mortified. Tracy was exasperated. Kim was still seething.

"I don't believe this," Kim said suddenly. "I truly don't believe this. Every second I think we'll be called, but it doesn't happen." He glanced at his watch. "We've been here an hour and a half."

"Welcome to the real world," Tracy said.

"This is what Kelly Anderson should have done her merger story about," Kim said. "This is ridiculous. AmeriCare closed the ER at the Samaritan to cut costs and make everyone come here. It's all just to maximize profits."

"And maximize inconvenience," Tracy added.

"It's true," Kim agreed. "AmeriCare definitely wants to discourage emergency-room usage."

"I can't think of a better way," Tracy said.

"I can't believe that not one of the staff people has recognized me," Kim growled. "It's incredible. Hell, I'm probably the best-known cardiac surgeon in the department."

"Isn't there something you can do?" Tracy pleaded. "Becky's miserable."

Kim stood up. "All right," he said. "I'll try."

"But don't lose your temper," Tracy admonished. "It might make everything worse."

"How can it be worse?" Kim replied.

Kim walked out of the waiting room on his way to the nurses desk. He'd gone only a few steps when the wailing of an ambulance siren reverberated through the main swinging doors to his left. A moment later a flashing red light was seen through the doors' glass panels. The siren died off and soon the doors burst open. Several bloodied people – apparently auto-accident victims – were rolled in and whisked into the ER proper.

Kim could not help but wonder if these new arrivals meant Becky would have to wait that much longer.

Kim approached the nurses' desk. Again he looked for Molly McFadden, but she was still out of sight. The people there were a clerk, who was on the phone transcribing laboratory values, and a solitary nurse doing paperwork while sipping coffee. Her name tag read: MONICA HOSKINS, ER Staff Nurse.

Forcing himself to be civil, Kim got her attention by gently tapping the countertop.

"Good evening," he said when she looked up at him. "Perhaps you recognize me?"

Monica narrowed her eyes slightly as she gazed at Kim.

"No, I don't think I do," she said. "Should I?"

"I'm on the surgical attending staff," Kim said. "But right now I'm here with my daughter, and we've been waiting for over an hour and a half. Could you tell me when she'll be seen?"

"It's been a busy night, especially with auto accidents," Monica explained. "What's the name?"

"Dr. Reggis," Kim said. He squared his shoulders.

"No, the patient's name," Monica said.

"Rebecca Reggis," Kim said.

Monica picked up a stack of ER sign-in sheets. After wetting the tip of her index finger with her tongue she rapidly flipped through the papers.

"Okay," she remarked as she withdrew one of them. "Here it is." She read the chief complaint and then raised her face to Kim. She arched her eyebrows.

"Diarrhea, two days' duration," she commented. "Not exactly a four-plus emergency."

Kim lifted the stool-sample container to bring it into her line of sight. "She's been passing a little bit of blood this afternoon," Kim said.

Monica leaned forward. "Doesn't look like blood."

"It did earlier." Kim said. "And it has her mother upset."

"Well, we'll get to her as soon as we can," Monica said noncommittally. "That's about all I can say." She replaced Becky's sign-in sheet to its former location in the stack.

"Listen," Kim said in a deliberately controlled voice. "As a member of the staff, I expect some consideration, and after waiting this long already, I want her to be seen shortly. I hope I'm making myself clear. She's in considerable discomfort."

Monica treated Kim to a patently false smile. "As I said a moment ago, we'll get to her as soon as we can. We have limited resources. If you've been here for an hour and a half, I'm sure you've seen the auto accidents that have come in, and now the police have alerted us a shooting victim is on his way.

No sooner had these last words escaped from Monica's lips than the familiar sound of an arriving ambulance could be heard.

"In fact, I'd wager that's them now," Monica said as she got to her feet. She moved over to an intercom and pressed a button. Talking to someone in one of the trauma rooms she informed them to get ready. Then she herself disappeared back into the depths of the ER.

With little satisfaction for his latest efforts, Kim headed back to the waiting room. As he passed by the main entrance doors, a team of EMT's rushed in with the shooting victim on a gurney. The patient had an oxygen mask strapped over his face and an IV running. His color was ashen.

"Well?" Tracy asked as Kim reclaimed his seat.

"They said they'd see her as soon as they could," Kim said. He was embarrassed to relate the rest of the conversation. He noticed that Becky had curled up in her seat as best she could and had her eyes closed.

"That's pretty vague," Tracy said. "What does it mean? Fifteen minutes, an hour, tomorrow morning?"

"It means exactly as soon as they can," Kim snapped. "A shooting victim just came in and victims from an auto accident came in a few minutes ago. It's a busy night."

Tracy sighed and shook her head in frustration.

"How's Becky doing?" Kim asked.

"She just had another bout of cramps," Tracy said. "So, you guess. You're the doctor."

Kim looked away, gritting his teeth. It was hard not to lose his temper. And on top of everything else, he was hungry.

For the next hour Kim was sullenly silent. He was busy brooding over this ridiculous ER experience and eager to complain to his colleagues about it. They would understand. Tracy and Becky seemed more resigned to the wait.

Every time one of the nurses or residents came to the waiting-room threshold to call out a name, Kim expected it to be Rebecca Reggis. But it never was. Finally Kim looked at his watch.

"It's been two and a half freaking hours." He stood up. "I truly can't believe this. If I were the slightest bit paranoid, I'd think it was some kind of screwy conspiracy. This time I'm going to make something happen. I'll be right back."

Tracy glanced up at her former husband. Under more normal circumstances, she'd be concerned about Kim's temper, but after having been kept waiting so long, she didn't care. She wanted Becky seen. She didn't comment as Kim stalked off.

Kim marched directly back to the nurses' desk. A number of the ER staff was scattered about the station, engaged in desultory conversation punctuated by laughter.

Upon reaching the counter, Kim scanned the group for a recognizable face. No one looked familiar and none seemed to recognize him. In fact, the only person to notice his presence was the clerk, a young college-aged boy who was most likely a student at the university.

"I'm Doctor Reggis," Kim said. "What's happening?" He motioned to all the people.

"They're just taking a breather," the clerk said. "The shooting victim and the last car-accident patients just went up to surgery.

"Who's the acting head of the emergency department for the evening shift?" Kim asked.

"That would be Dr. David Washington." the clerk said.

"Is he here at the moment?" Kim asked.

The clerk glanced around the area to be sure. "No," he said. "I believe he's back with an orthopedic case.

"How about a head nurse or nurse supervisor?" Kim asked.

"That would be Nora Labat" the clerk said. "She's with a psych patient."

"I see," Kim said. "Thanks."

Kim proceeded down the counter until he was at the very center. Raising his hand, he called out: "Excuse me, everybody! Hello!"

No one acknowledged Kim's voice or gesture.

For another moment he glanced around, trying to make eye contact with anyone. It was impossible. Instead he reached across the counter and lifted a metallic in-and-out basket from the desk top. Holding it above his head for a moment, he thought someone might notice. They didn't.

Kim brought the metal basket down to crash onto the Formica counter. He smashed it down twice again, each time with more force until the basket became distorted to the shape of a three-dimensional parallelogram.

That got everyone's attention. Conversations stopped in mid-sentence. Residents, nurses, and orderlies all stared at Kim. A security man who'd been standing over near the bank of elevators came running over, his hand holding the clutch of keys attached to his belt.

Having worked himself up to a fury, Kim's voice was tremulous. "I know you all are busy, but you certainly don't look busy at the moment. I've been waiting here for two and a half hours with my daughter. As a professional man myself, my time could be spent in much more valuable ways."

"Excuse me, sir," the security man said. He took hold of Kim's arm.

Kim yanked his arm free and spun around on the man. "Don't you touch me," Kim snarled. The security man wisely stepped back while he grappled for his two-way radio. Kim was not only a half a foot taller but also significantly more muscled.

"No need to contact anyone," Kim said. He pulled out his hospital ID and held it up to the security man's face. "I'm on the staff here, even though no one here in the emergency department seems willing to concede it."

The security man's eyes narrowed as he read Kim's ID card. "Sorry, Doctor," he said.

"That's quite all right," Kim said with a controlled voice. He turned back to the desk. Monica Hoskins had stepped forward.

"I'd like to talk with Dr. David Washington." Kim said.

"I'm sorry you've had to wait," Monica said. "We're doing the best we can."

"Nonetheless I'd like to speak to the acting head of the department," Kim said.

"Dr. Washington is tied up with a pneumothorax," Molly explained.

"I want to see him now," Kim said evenly. "I'm sure there must be at least one resident competent to handle a pneumothorax."

"Just a moment," Monica said. She stepped back, and out of earshot from Kim, conferred with Molly and several of the other staff. In less than a minute, she returned to Kim. In the background one of the nurses she'd been talking with picked up a phone.

"We'll have someone here in authority to talk with you momentarily," Monica said.

"It's about time," Kim remarked.

Kim's mini-tantrum had unnerved the staff and most of them vacated the nurses' desk for the interior of the ER. Monica took the in-and-out basket Kim had bent and tried to bend it back. She was unsuccessful.

Kim's pulse was racing. A sudden commotion behind him made him turn around. A teenage girl was being escorted by a vanguard of EMT's. She was sobbing. Both wrists were bound with bloody dishtowels: a clear suicide attempt, no doubt in this young woman's case a desperate cry for help.

Kim looked expectantly into the ER depths after the teenager was taken in. He expected to see the doctor-in-charge appear at any moment. Instead he felt a tap on his shoulder.

Turning around, he was surprised to see Tracy.

"Where's Becky?" Kim asked.

"In the restroom" Tracy answered. "It's a routine visit this time, but I have to get right back. I just came in here to beg you not to have one of your narcissistic rages. When you stood up in the waiting room to come in here, I didn't think I cared whether you got into a furor or not, but I do. I'm convinced it won't improve an already bad situation. In fact it might cause Becky to have to wait even longer."

"Spare me your psychobabble," Kim spat. "All I'm planning on is a sane but pointed conversation with the man who runs this place. I mean, this is unacceptable. Plain and simple."

"Just try to control yourself," Tracy said icily. "When you're done, you'll know where to find us." Tracy turned around and walked back toward the waiting room.

Kim drummed his fingers impatiently on the counter. After a while he looked at his watch. Another five minutes had passed. Once again he leaned out into the corridor to peer back into the ER depths. He saw plenty of staff but no one came striding in his direction. Kim's eyes met the clerk's who immediately averted his gaze. The rest of the ER staff avoided looking at Kim, instead busying themselves with paperwork.

A muffled bell sounded to herald the arrival of an elevator. Kim looked over to see a hefty man dressed in a conservative gray business suit disembark. To Kim's surprise, he came directly up to him.

"Dr. Reggis?" the man inquired. His voice was robust and commanding.

"I'm Dr. Reggis," Kim agreed.

"I'm Barclay Bradford," the man said stiffly. "I'm a vice president of the hospital and the acting chief administrator for the evening shift."

"How convenient," Kim said. "What I'd advise you to do is to go back into the ER, locate the asshole acting head of the department, and drag him out here. He and I have something to talk about. You see, I've been waiting for two and a half hours to have my daughter seen.

"Dr. Reggis," Barclay began as if Kim had not even spoken, "as a member of our professional staff, particularly a surgeon, you of all people know that triage is necessary in a busy ER. Life-threatening problems have to take precedence over simple juvenile diarrhea."

"Of course I understand triage," Kim shot back. "I've worked in ER's all through my training. But let me tell you something. When I walked in here ten minutes ago, there had to be a dozen ER staff hanging out behind this counter drinking coffee and chitchatting."

"Appearances never tell the whole story," Barclay commented condescendingly. He fluttered his eyelids. "They were probably conferring with each other over particularly difficult cases. But regardless, your childish behavior of pounding a letter box on a countertop cannot be tolerated. It's entirely inappropriate for you to demand special treatment."

"Special treatment!" Kim sputtered. "Childish behavior!" His face reddened and his eyes bulged. The administrator in front of him suddenly embodied his frustrations about the present emergency-room experience, the hospital merger, AmeriCare, and modern medicine in general. With a sudden fit of fury and losing all semblance of control, Kim struck the administrator with a lightning blow to the chin.

Kim shook his hand and clasped it with his other in response to the sudden pain in his knuckle. At the same time, Barclay rocked back on his heels, teetered, then fell heavily to the floor. Kim was stunned by his violent reaction. Taking a step forward, he looked down at Barclay and felt an impulse to help the man up.

A collective gasp arose from the staff behind the desk. The security guard came running. The clerk grabbed the intercom to announce: "Mayday at the nurses' desk."

From the depths of the ER, residents, nurses, and orderlies came streaming out. Even Tracy appeared after hearing the announcement. A crowd gathered around Kim and Barclay. The hospital VP had pushed himself up to a sitting position. He touched a hand to his lip. It was bleeding.

"Damn it, Kim!" Tracy said. "I warned you!"

"This is totally unacceptable," Monica said. She turned to the clerk. "Call the police!"

"Hold up, don't call anybody!" a deep, resonant voice called. The crowd parted. A powerfully built, handsome African-American man appeared. He snapped latex gloves from his hands as he walked into the center of the ring. The name tag pinned to his scrub top read: DR. DAVID WASHINGTON, ACTING CHIEF EMERGENCY DEPARTMENT. His eyes went from Kim down to Barclay. "What's going on here?"

"Mr. Bradford was just struck by this man," Monica said, pointing at Kim. "And that was after he destroyed a letter box by bashing it against the counter."

"Believe it or not, he's a doctor on the hospital staff," Molly added.

David put out a hand and got Barclay to his feet. David glanced at the man's split lip and palpated along the line of his jaw.

"Are you all right?" David asked the administrator.

"I think so," Barclay said. He got out a handkerchief and dabbed at his bloodied lip.

David turned to Monica. "Take Mr. Bradford back and get him cleaned up. And have Dr. Krugger take a look at him to see if we should get an X-ray."

"Sure," Monica said. She grasped Barclay's arm above the elbow to guide him through the crowd. Barclay glared at Kim before allowing himself to be led away.

"Everyone else, back to work," David said, with a wave of his hand. Then he turned to Kim, who'd recovered his senses.

"What is your name?" David asked.

"Dr. Kim Reggis."

"Did you really hit Mr. Bradford?" David asked incredulously.

"I'm afraid so," Kim said.

"What on earth could have provoked you?" David asked.

Kim took a deep breath. "That prick condescendingly accused me of demanding special treatment when my sick child has been waiting for two and a half hours."

David stared at Kim for a beat. He was mystified at such behavior from a colleague. "What's the child's name?" he asked.

"Rebecca Reggis," Kim said.

David turned to the clerk and asked for Rebecca's sign-in sheet. The clerk fumbled through the stack.

"Are you really on staff here at the University Med Center?" David asked while he waited for the sheet.

"Since the merger," Kim said. "I'm one of the cardiac surgeons, although you'd never know it the way I've been treated here in the ER."

"We do the best we can," David said.

"Yeah, I've heard that excuse several times tonight," Kim said.

David eyed Kim again. "You know, you should be ashamed of yourself" he said. "Punching people out, smashing letter boxes. You're acting like some malcontent teenager."

"Screw you," Kim said.

"For the moment I'm going to chalk that remark up to stress," David said.

"Don't be patronizing," Kim said.

"Here it is," the clerk said. He handed the sign-in sheet to David.

David glanced at it, then looked at his watch. "At least you're right about the time. It's been close to three hours. That's certainly no justification for your behavior, but it's too long to wait."

David looked at Tracy. "Are you Mrs. Reggis?" he asked.

"I'm Rebecca Reggis's mother," Tracy said.

"Why don't you get the young lady. I'll personally see to it she's seen immediately."

"Thank you," Tracy said. She hurried out to the waiting room.

David went behind the desk to get a clipboard for the sign-in sheet. He also used the intercom to get a nurse to come out. When he reemerged, Tracy was back with Becky in tow. A moment later a nurse appeared. Her name tag identified her as Nicole Michaels.

"How are you feeling, young lady?" David asked Becky.

"Not too good," Becky admitted. "I want to go home."

"I'm sure you do," David said. "But first let's check you out. Why don't you go ahead with Nicole. She'll get you situated in one of the examination cubicles."

Tracy, Becky, and Kim started forward. David reached out to restrain Kim.

"I'd prefer that you wait out here, if you don't mind," David said.

"I'm going with my daughter," Kim stated.

"No, you are not," David said. "You've proved yourself emotionally stressed. You're acting like a loose cannon.

Kim hesitated. As much as he didn't want to admit it, David had a point. Still, it was irritating and demeaning.

"Come on, Doctor," David said. "Surely you understand."

Kim cast a glance at the receding image of Becky and Tracy. He looked back at David, who was not about to be intimidated, physically or otherwise.

"But…" Kim began.

"No buts," David said. "Don't make me call the police, which I'll do if you don't cooperate."

Reluctantly Kim turned around and walked back to the waiting room. There were no seats, so he leaned up against the wall by the entrance. He tried to watch the television but couldn't concentrate. He raised his hand and looked at it; he was trembling.

A half hour later Tracy and Becky emerged from the treatment area. It was by chance that Kim happened to see them as they pushed through the exit door. They were leaving without even having tried to find him.

Kim quickly gathered his coat and gloves and hurried after them. He caught up to them just as Tracy was helping Becky climb into the car.

"What are you going to do?" Kim demanded. "Just ignore me?"

Tracy didn't say anything. She shut the door behind Becky and then walked around to the driver's-side door.

Kim followed and put his hand on the door to keep it from opening.

"Please, don't cause any more trouble," Tracy said. "You've already embarrassed both of us."

Taken aback by this new and unexpected affront, Kim took his hand away. Tracy got into the car. She reached for the door but then didn't close it. She looked up into Kim's surprised and hurt face. "Go home and get some sleep," she said. "That's what we're going to do."

"What happened in there?" Kim asked. "What did they say?"

"Not much," Tracy reported. "Apparently her blood count and electrolytes, whatever they are, are fine. I'm supposed to give her broth and other fluids and lay off the dairy products."

"Is that all?" Kim asked.

"That's it," Tracy said. "But, by the way, they said the culprit could very well have been Ginger's chicken. They see a lot of food poisoning secondary to chicken."

"It wasn't," Kim shot back. "No way! Ask Becky! She was feeling sick the morning before the chicken." Kim leaned over to talk directly to his daughter. "Isn't that right, Pumpkin?"

"I want to go home," Becky said, staring out through the windshield.

"Good night, Kim," Tracy said. She pulled the door shut. started the car, and drove away.

Kim watched the car until it had disappeared behind the corner of the hospital. Only then did he start walking toward the doctors' parking area. He felt alone, more alone than he'd ever felt in his life.