Читать книгу Good Medicine - Bobby Hutchinson - Страница 7

DOCTOR JORDAN BURKE walked over to the automatic sliding glass doors and peered out at the wet April night, not really seeing the eerie fluorescent glare or the deserted cement apron that led to St. Joseph’s Emergency entrance.

It was her birthday. A glance at her watch told her it was 12:40 a.m. She had no idea the exact hour she’d been born, so she might as well make it midnight on the nose. Which meant she was now thirty-two.

Spending the first six hours of her birthday working the graveyard shift in Emerg suited her fine. John Frankel, one of the other doctors, had the flu, and since Jordan was on her long break from day shift, she’d eagerly volunteered to fill in.

It wasn’t as if she’d be sleeping much, anyway. She might as well be working tonight as lying in bed tossing and turning, wide-awake and worrying.

She shivered, even though it wasn’t cold, and crossed her arms, hugging the front of her white lab coat.

Where the hell are all the patients? On most nights, the E.R. was so busy there wasn’t time to do anything except concentrate on the stream of desperate, frightened people needing medical assistance. But it had been nearly an hour since Jordan’s last patient was treated and released, and she was restless. Anxious.

She ought to be used to the anxiety. It never really went away these days.

“Quiet tonight, eh? Downtown Vancouver must be closed for spring break or something.” The tiny Asian nurse was new, and she laughed at her own joke.

“It is quiet.” Jordan nodded and attempted a smile. When did smiling become such an effort? “Calm before the hurricane,” she commented, aware of how callous it was to long for patients. It was just that she needed action, needed the degree of intensity that drove everything else out of her head.

“At least it gives us time to think,” the young woman replied.

“Yeah.” Jordan forced herself to nod, even though time to think was the very last thing she wanted. She glanced at the ident tag pinned to the nurse’s shirt. Jordan had been introduced when they came on shift, but now she couldn’t remember the woman’s name.

Lola. Her name’s Lola, numskull.

Forgetting things had become the norm. She’d lost her keys today, she’d misplaced her cell phone yesterday, she hadn’t remembered what she needed when she got to the grocery the day before last. Thirty-two was nowhere near menopause, but she knew that constant low-level anxiety could cause memory lapses. Eight months of anxiety. Ever since her husband’s accident.

She thought of Garry now, and her gut heaved as an all too familiar mixture of emotions coursed through her: anger, sadness, guilt, longing and an overwhelming sense of frustration and futility.

Two years, is that all it had been? She felt as if she’d been Garry’s wife for at least two long, painful lifetimes. She wanted desperately to help him, she longed for an end to the problems they were having, she—

Stop. Stop.

She would not obsess over her personal problems here, not while she was on shift. She turned away from the doors and walked over to the admitting desk. So there were no patients, okay, she could catch up on patient files. That tedious task was every doctor’s least favorite activity.

“No point getting your blood pressure up doing paperwork, Jordan.” Eddie, the desk clerk, grinned at her, revealing crooked teeth. “There’s an 18-year-old female on her way, severe headache, vomiting, recent history of stomach pain. Her dad called, he’s bringing her.”

A few moments later the patient arrived, a college student named Ardyth Malone, slender and very fit looking, but obviously in severe distress. Jordan escorted the girl to a cubicle and began taking a history.

Ardyth responded with negative answers to questions about drugs, alcohol, allergies, blows to the head. A careful physical examination ruled out appendicitis, inflamed ovaries, gallbladder problems. Each successive test was normal, until Jordan examined Ardyth’s eyes with the ophthalmoscope. There was a slight papillidema, a swelling of the optic nerve.

By now Jordan was beginning to feel really concerned, wondering if this was a brain tumor, but there were a few questions she still needed to ask.

“Ardyth, has there been any change in your diet recently?”

The girl shook her head. “I’m a vegetarian. I’m very health-conscious and careful about what I put in my body.” Her expression was virtuous. “I take tons of vitamins and I don’t eat sugar or saturated fat. Oww! Oh my God, do something! It hurts.” Bent double, she cradled her stomach, moaning.

A warning bell went off in Jordan’s brain. Taking iron tablets on an empty stomach could lead to excruciating cramps.

“Exactly what vitamins do you take, and how many?”

As the pain eased, the girl rattled off a dozen or more names, adding that she swallowed massive quantities.

“Have you taken any new ones recently?”

“Only more vitamin A.”

“How much more?”

“Seven extra pills. My skin’s been breaking out—vitamin A cures acne.”

“How long have you been taking that dose?”

Ardyth shrugged. “A couple of months now, I guess.”

“How many international units per pill?”

“Five thousand.”

“And when did you take your last mega dose?”

“A few hours ago.”

Thirty-five thousand units of A, ten to twenty times a normal dose, taken daily for sixty days. Jordan was pretty sure she had the answer to Ardyth’s symptoms, and it gave her a feeling of satisfaction. At least her personal problems weren’t interfering with her diagnostic ability. Yet.

“My guess is you have acute vitamin A intoxication, Ardyth,” she said gently. “I think if you stop taking it, your symptoms will disappear. We’ll run some tests, though, just to be absolutely certain we’re not missing anything here.”

Jordan was jotting down orders for a CAT scan and an upper GI series when Lola stuck her head into the cubicle.

“Jordan, a guy’s just been dumped outside Emerg. He’s unconscious—whoever brought him sped off in a car. They’re bringing him in now. Billy says he’s got track marks, so it’s probably an overdose. Can you come?”

“Be right there.” Jordan handed orders to an aide and then sprinted after Lola. There’d been a series of drug overdoses in the past two weeks, a result of exceptionally strong heroin having hit the downtown Vancouver streets. Usually the Emergency Response Team brought the victims in, but sometimes bodies were dumped at the door by people who didn’t want to get involved.

Orderlies and nurses were lifting the limp male figure onto a stretcher when Jordan arrived. The patient’s face was obscured by a nurse’s arm, but Jordan saw at a glance that this wasn’t the usual skid-row addict.

Caucasian, well-dressed, charcoal sports jacket, black trousers, blue silk shirt—

She struggled to get her breath as a wave of dizziness swept over her. She recognized that shirt. Reaching past the nurse, Jordan took hold of the man’s jaw and turned his slack face toward her, and her worst fears were confirmed.

Garry. It was her husband. She’d bought him the shirt for Christmas.

Someone on the medical team was calling out his vitals, but Jordan barely heard it. One of the nurses was holding Garry’s wallet, going through it to determine his identity.

“Hughes, Garry M., DOB 1968, March 13.” As the woman read out the information on his driver’s license, for one shameful instant Jordan was relieved she’d retained her maiden name.

“I’ll see if he’s listed in the book,” the nurse said. “We may need next of kin.”

The number was listed, but Jordan knew there was no one home in their Kitsilano apartment. The nurse would get the message Garry had recorded for the answering service.

“Jordan? Hey, Jordan, what’s up? You okay?”

She suddenly realized everyone was waiting for her, looking at her—puzzled, impatient.

She should tell them about Garry and have someone else take over. It was against policy to treat a relative. Instead, like an automaton, she began the necessary assessment, even though she knew beyond a doubt what was wrong. Of course he’d taken an overdose. Her husband was a junkie.

“Pulse forty, respiration down to eight,” Lola reported. “We’re not getting a BP, Jordan. This guy’s on his way out…. He’s flat! Now we’re not getting much of a pulse at all.”

“Establish a line. Let’s give him Narcan.” She felt cold and detached and far away as she picked up the syringe with numb fingers and inserted naloxone hydrochloride into the IV valve.

In cases of overdose, the drug’s effect was miraculous. It instantly reversed the action of narcotics, and a patient who’d been on the verge of death only seconds before suddenly became awake and alert, just as if nothing had happened. In the E.R., they called it the Lazarus Effect. Except Lazarus had probably been grateful.

Everybody watched and waited. It only took a few seconds.

“Brace yourself, boys and girls,” someone murmured.

The instant the powerful drug reached Garry’s bloodstream, his sky-blue eyes flew open. A frown flickered across his smooth forehead as he stared up at the faces of the medical team grouped around the stretcher.

Inevitably his gaze came to rest on Jordan. As recognition dawned, his features contorted with rage. He grasped the sides of the gurney and pulled himself up as staff members struggled to control him. He was a big man, and it looked as if they were going to lose the battle.

“Call a code white,” someone yelled. “He’s freaking on us.”

Code white was an emergency call to security.

“Jordan?” Garry spat her name out. “What the hell have you done to me?”

Her mouth felt numb, her throat dry. She cleared it, amazed that her voice still worked. “You overdosed. I used Narcan to bring you out of it.”

It took a moment for Garry to react to that, and when he did Jordan wanted to turn her back and run from the room.

“You bitch!” he screamed at her. “You filthy bitch, you ruined my high, what the hell’s wrong with you? Do you have any idea what you’ve done, you stupid fool?” He tried to shake off the hands restraining him so he could climb off the table.

Jordan couldn’t move. She saw shock on the faces of her co-workers. They were staring at her, some of them open mouthed.

She was surprised when her voice burst out loud and strong. “Call a code white and get him out of here,” she ordered.

“You know this guy, Jordan?”

“Yes.” Her voice was unnaturally calm now. It seemed to come from a long distance away and belong to someone else. “I know him. Of course I know him. He’s my—he’s my husband. Get the equipment off him, I’m discharging him.”

She saw the glances that passed among the staff. They knew she could have committed him to the psych ward for treatment. They probably figured that’s what she ought to do, and maybe it was, but she just wanted him gone.

She had no energy left to deal with Garry and his problems. Over the past weeks she’d made appointments with the best drug treatment clinics in the city, appointments that she pulled strings to arrange and Garry hadn’t bothered to keep. She’d spent hours talking to him, trying to understand, to reason with him. She’d tried every way she knew to help him make the decision to stop. Nothing had worked.

Now, she was worn out. She’d done her best to keep her work and her personal problems separate, and look where that got her. She hadn’t wanted her co-workers to know how desperate and degrading her personal life had become. Garry had managed to take away even that last tiny shred of dignity.

Two security guards hurried in, and between them they restrained Garry as the staff quickly removed the IV apparatus from his body.

“Escort him to the exit and see that he gets a cab,” Jordan instructed the men.

The guards flanked him, and Garry’s broad shoulders sagged as they started to hustle him out of the treatment room. Over his shoulder he gave her the look she’d come to despise in the past months, the contrite, little-boy-lost look from under long, curling blond lashes. Those baby blues had charmed her when she first fell in love with him. At this moment they made her stomach churn with nausea.

Yesterday morning he’d begged her to write him yet another prescription for morphine. She’d refused, and he’d sworn at her, just as he had a moment ago. For a man with an expensive education, he had a limited vocabulary.

“Hey. Hey, Jordie,” he called over his shoulder as the guards hustled him out. “I’m sorry, babe, I’m really sorry. I didn’t mean it, it was just, you know, the shock of coming to in this place.” He dragged his feet, going limp.

“Jordie, tell these goons to back off me, okay? Please, honey?”

She didn’t reply. The security guards had stopped, holding him upright. They turned and looked at her, questioning. Her co-workers were all pretending hard to be busy with other things. By morning the whole episode would be all over the hospital, probably posted on some Web site.

“Jordie, talk to me here, okay?” Garry’s voice dropped, and he assumed the wheedling tone she’d come to despise. “See, the thing is, I’ve got no money for a cab. I shot the whole wad on that fix. Could you maybe—? Please, honey?”

Amazed that her legs worked, she hurried to the staff locker room and got twenty dollars from her handbag. She had to keep swallowing, and her hands were shaking so much she could hardly get her handbag opened or the door to her locker closed.

Security had escorted Garry to the exit by the time she got back, and Jordan marched into the rain and wordlessly held the money out to him.

He glanced at it and his mouth turned down petulantly before he snatched it, jamming the single bill into his pocket. “Twenty isn’t enough, not when I’m really in pain like this. I told you how bad it hurt this morning, Jordie, you could have given me something then and this wouldn’t have happened.” In one lithe motion, he twisted out of the guard’s grip.

“C’mon, babe, don’t be chippy with me, surely you can spare another couple twenties?”

She jerked her head from side to side and then turned her back on him, fleeing through the doors that led into Emerg. Inside, not one person looked at her, but their curiosity was like a scent in the air.

She couldn’t remember anything about the rest of that shift except that the trembling and nausea grew more and more difficult to control. She felt disoriented, far away, watching herself go through the motions of treating one patient after the other, amazed that she looked and sounded so normal.

When morning finally came, she had trouble driving home to the apartment. Fortunately the morning rush hour hadn’t really started yet, because she drove through a red light and sat through a green one. She scraped the side of her red Toyota against a cement beam when she tried to park it in the underground lot, and when she got out she didn’t even bother to check the extent of the damage.

She took the elevator to the second floor and after three tries, unlocked the door. The apartment was empty; Garry wasn’t there. She hadn’t expected him home. She’d hoped he wouldn’t be.

She knew he wasn’t at work, he hadn’t been all week. It was Thursday, and his secretary had left increasingly desperate messages for him every day. Up until this week, he’d managed to keep up a relatively professional facade at his law office. The partners had been lenient with him, blaming his erratic behavior on the accident. They’d covered for him the same way Jordan had, she mused as she walked through the rooms she’d painted and decorated with such care.

It felt as if she were seeing her home clearly for the first time in weeks. A great many things had disappeared lately, and she’d tried to believe it had nothing to do with Garry, but now she forced herself to face the truth.

In the living room, an empty CD holder stood beside the equally empty space where the expensive audio system had been. They’d bought it on their first anniversary. Several weeks ago, the apartment had been broken into while they were both supposedly at work. Her few good pieces of jewelry had been taken as well as all the electronic equipment—even the damned microwave.

Garry had taken them. She’d known it even then, but hadn’t been able to face the fact that her husband was an addict who’d steal and lie and cheat to get drugs.

Slowly and painfully as though she were old and brittle-boned, Jordan lowered herself to the dove-gray sofa and forced herself to look at what her life had become.

It had started with that damned car accident. Garry had been driving home late, undoubtedly going too fast. The expensive little sports car he’d insisted on owning had been struck by a pickup truck at an intersection. Garry had come away with a compound fracture of the left arm and a concussion. He’d also complained of excruciating pain from torn muscles in his back, pain that nothing seemed to alleviate.

Garry’s physician, Albert Mayborn, had finally prescribed morphine.

Jordan blamed herself for not recognizing that Garry was becoming addicted. She ought to have known, the signs were all there. Garry complained of pain long past the time when any muscle strain should have healed. She’d finally seen the physical signs of drug abuse in her husband’s bloodshot eyes, his jumpiness, his inability to sleep, his hair-trigger temper.

At last she’d confronted him about it, and of course he’d denied it. Until tonight, she’d managed to deny the extent of the problem herself.

The awful scene in the E.R. kept replaying in her head, and Jordan’s humiliation and shame grew. She drew her knees up to her chest, trying by sheer force of will to impose control over her shaking arms and legs.

She couldn’t get a deep breath. Her heart hammered against her ribs. She began to cry, deep, tearing sobs that scared her. Try as she might, she couldn’t stop them. Soon her stomach and chest hurt, her lungs felt as if they were on fire, and still the wrenching sobs went on and on. She was completely alone.

Hours passed. The phone rang, and she couldn’t answer it. She couldn’t move. She was thirty-two today, and she didn’t want to live. She began to think of the many ways there were to die.

And then the physician in her recognized that she needed help.

She forced herself up off the sofa, dialed the telephone and ordered a cab.

Sweating and shaking, still gulping back sobs, she found her handbag and made her way outside.

The Native driver gave her a concerned and wary look. “You okay, lady? Where you want to go?”

“St. Joseph’s Medical Center,” she gasped.

St. Joseph’s was an old building, and she knew every inch of it, having interned there. She dragged herself up a set of stairs at the back of the building to the third floor. It was the only place she could think of to get help.

The psych ward.