'I'd like that very much. I could be ready by seven.'
'That's great. I'll pick you up at your hotel. Any special kind of food?'
'My choice, huh. Okay, let's see… Do you know of a good Annean restaurant?'
'Armenian?'
'You are Armenian, yes?'
'Yes, but-' 'I grew up with a girl named Suzy Rupinian. One of my favorite things about having her for a friend was eating over at her house.'
'The woman wants Armenian, the woman gets Armenian,' Eric said.
'Tomorrow night, we eat at Pariegam. It's in the neighborhood where I grew up, so I'm not exactly invisible there. Can you handle that?'
'Sounds perfect. Is it dress up?'
'Dress down,' Eric said. 'The food at Pariegam is of the gods, but we're talking sawdust on the floor, not linen on the table.'
'I can do sawdust. Is Pariegam someone's name?'
'No, it's the Armenian word for friendship.'
'Good start,' Laura said. … Initial assessment found patient with no pulse, respiration, or blood pressure. Pupils midposition and nonreactive. Standard CPR with endotracheal intubation begun at 10:17 A.M. by Dr. Kaiser, later relieved by Dr. Eric Najarian.
Treatment consisted of intravenous epinephrine, atropine, and Isuprel per American Heart Assn. protocol. See nurse's flow sheet for times and dosages. Throughout the resuscitation attempt, patient's cardiac rhythm remained agonal endstage beats at 8/minute (gee rhythm strips). Patient pronounced dead by Dr. Eric marian at 10:40 A.M. Transferred to morgue pending identification and notification of next of kin.
The cardiac rhythm tracing was as Eric had remembered: broad, slow complexes that could not possibly have been electrically capable of generating contractions of the heart muscle. Certainly there was more he could have tried: a pacemaker, another series of drugs, more aggressive attempts to measure and balance blood pH. But even if, by some miracle, he had succeeded in restoring a pulse, John Doe was brain-dead. The signs were all there. And for that, there was no therapy. … the choices we must make on this job are not always easy…
'You said it, lady,' Eric muttered, reflecting on Sara Teagarden's uncharacteristically sensitive remark. 'You said it.'
In twenty-four hours he was going to have to sit across from a woman he wanted very much-to get to know, and tell her that a nurse who was seldom wrong about such things had identified her brother as the derelict he had failed to resuscitate.
He put his notes and the E.K.G tracing aside and turned to the nurse's notes. At the bottom of them was a notation, signed by trina Cullinet:
DR. T. BUSHNELL, MEDICAL EXAMINER, NOTIFIED. REQUESTS TRANSPORT OF BODY TO GATES OF HEAVEN FUNERAL HOME FOR HIS EXAMINATION. HE WILL MAKE OUT DEATH CERTIFICATE THERE, AND ATTEMPT TO LOCATE NEXT OF KIN.
Eric checked the receiving area to ensure that the triage nurse was keeping up with the crush of patients. Then he went back to his office and pulled out the Boston Yellow Pages. The Gates of Heaven Funeral Home, Donald Devine, director, was located not far from White Memorial.
He had opened this can of worms by calling Laura Enders.
Now there wasn't much choice but to try to put the lid back on.
Reluctantly, he picked up the phone.
It was nearly nine before the E.R. was quiet enough for Eric to sign out to the senior on duty. He undressed in the on-cite room, and then wrapped a towel around his waist and forced himself through a few minutes of stretching exercises. It had been a long and hard fourteen-hour shift, and every muscle in his limbs seemed to be in some phase of contraction.
The exclamation point on the trying day had been a prolonged but unsuccessful attempt at resuscitating a fifty-seven-year-old coronary victim, brought in by ambulance in full cardiac arrest. From a purely technical standpoint the Code 99 had been handled well enough. But far more often than not, efforts in such cases were doomed. From the loss of blood pressure to the onset of effective CPR, the window to prevent irreversible brain damage was only four to six minutes, if that. And at some point during most resuscitations, physicians went from hoping they would get an effective heartbeat back to praying that they wouldn't.
Intellectually Eric had never had a problem with that reality.
Emotionally, though, he still tended to take every failure personally.
How had he reacted to the death of the drift diver? he wondered now.
As he showered and dressed he tried to reconnect with his actions and emotions that snowy February day. He had been completely immersed in Russell Cowley's emergency and in the use of the new laser.
That much he remembered clearly. But had he reacted at all to the death of the derelict in the next room?
Distracted by the question, he made a final brief check of the E.R then headed across the largely deserted lobby toward the library.
He had an hour before he was due at the Gates of Heaven Funeral Home, and he wanted to review some data on the complications of using less-than-fully-cross-matched blood for emergency transfusions.
His call to the home earlier that day had been answered by a tape in which Donald Devine, to the accompaniment of strings, had introduced himself and promised to be back by ten. The music and the man's unctuous telephone voice bordered on parody, and Eric had formed an image of him that included an elongated face, sloping shoulders, and a waxed mustache. He had left a message outlining his interest in John Doe and stating that, unless he heard otherwise, he would stop by the Gates of Heaven between ten and eleven.
He was entering the long corridor from the lobby to the Bigelow Building when Dave Subarsky fell into step beside him. Subarsky was dressed in jeans, sneakers, and an M.I.T sweatshirt. He had an armload Of bound journals and textbooks wedged between his forearm and his beard.
'Library?' he asked.
'Where else?'
Subarsky shrugged. 'At this hour? How about home?'
'You mean this isn't my home? Damn, now he tells me.'
'You look a little more tired than usual, old buddy.'
Subarsky used his key-card to open the library door.
'I am, I guess,' Eric said. 'There's just been a lot going on.
Tonight they brought in this fifty-seven-year-old guy with four kids. He was up and walking around one moment, coughed and dead the next. I explained to his wife that we were working on him, but that he was essentially brain-dead. She begged me not to call off the resuscitation. So we tried. For more than an hour we tried just about everything, but there wasn't a damn thing we could do.'
'That's just the way it is,' Subarsky said, setting his pile of journals on a reading table. 'God shoots…
He scores!'
'Touchingly put, David. You are a true nonchnician. But fortunately, every so often, if we do things right it hits the post.'
'Mayhap,' Subarsky said. 'Listen, how about a beer after we finish here?'
'Can't. I'm going over to see a guy at the Gates of Heaven Funeral Home.'
'Always planning ahead. I like that in you, Eric.'
'I'm trying to track down a John Doe we worked on back in February. In fact, it was that day we used the laser.'
'God, I hope he's not still there.' Subarsky held his nose.
'He might be actually. The M.E. won't release a body until they have a signed authorization from a next of kin. Sometimes they hang on to them for six or seven months before they give up and have the Commonwealth spring for a burial. And unless foul play is suspected, they won't ever do an autopsy.
They're as terrified of lawyers as the rest of us.'
'I can see the headlines now: PATHOLOGIST BOTCHES AUTOPSY, GETS SUED FOR MALPRACTICE.'
'Believe it or not, it happens.'
