John Burley - The Absence of Mercy

“Over and out,” Nat saluted, and terminated the connection.

“Over and out,” Ben sighed to himself as he returned the phone to his pocket and turned back to his wife and son. A moment later, he heard the sound of an approaching diesel engine, and as it rounded the corner they were silhouetted in the headlight beams of the approaching bus.

Fifty minutes later, Ben found himself sitting in the darkened interior of the Honda as he headed east toward the Coroner’s Office. A tentative drizzle had begun to fall from the sky as his family walked home together from the bus stop, and by now it had progressed to a steady drumming that pattered the car’s rooftop insistently with its heavy, hollow fingers. A light fog clung to the ground, and Ben was forced to negotiate the dark, rain-slickened streets slowly and with exceptional caution. He’d habitually turned on the radio as he started the car, but most of the local stations were running news of the murder, and the more distant ones that he could sometimes pick up on clear days were reduced to static in the mounting storm. He flipped the knob to the off position and decided to simply concentrate on driving.

Thomas had stepped off the bus that evening to the warm embrace of his relieved and grateful parents, and to the boundless questions of his spellbound younger brother. As it turned out, Thomas didn’t have much more information on the identity of the victim or the details of the crime than his parents had already received from Phil Stanner. This stood to reason, since the police were remaining tight-lipped until after they’d had a chance to notify the victim’s family.

What was clear from the moment Thomas stepped off the bus to join them was that he regarded the day’s events with a certain quiet thoughtfulness that Ben had not anticipated. He spoke very little during the walk home, and let his family’s questions wash over him without much comment. Ben wondered whether his son might be in a mild state of shock, or simply trying to wrap his mind around the idea of a violent attack so close to home and school. Ben felt that children of Joel’s age tended to regard death as an obscure and distant entity, far removed from their own daily lives and therefore relatively inconsequential. This view seemed to change as children entered their teenage years and began to explore and sometimes even to court this previously intangible eventuality. Popular movies often romanticized the notion with blazing shoot-outs among beautiful people against an urban backdrop at sunset, or titanic ships that slowly sank in the freezing Atlantic while lovers shared their final fleeting moments together aboard a makeshift life raft only buoyant enough for one. This was not the type of death that Ben encountered as a physician. He supposed it could be described as many things, but mostly his experience with death was that it was impersonal, and seldom graceful.

During his intern year as a medical resident, Ben had been working his third shift in the emergency department when paramedics brought in a fifty-eight-year-old man with crushing substernal chest pain radiating to his left arm and neck. Ben had examined the patient quickly in the limited time available, and after reviewing the EKG he’d decided that the man was having a heart attack. Emergency treatment for heart attack patients with certain specific EKG changes called for the administration of thrombolytic agents: powerful clot-busting drugs designed to open up the clogged blood vessel and restore adequate blood flow to the heart. The supervising physician was not immediately available, the patient’s clinical condition seemed tenuous, and Ben had given the order for the nursing staff to administer the thrombolytic drug to his patient. The results had been almost immediate. Within five minutes, the patient was complaining of worsening pain, which was now also radiating to his back. Eight minutes later the patient’s blood pressure plummeted, his heart rate increased to 130 beats per minute, and he vomited all over himself and the freshly pressed sleeve of Ben’s previously impeccably clean white coat. Several moments later the patient lost consciousness, and Ben could no longer palpate a pulse. He attempted to place a breathing tube into the patient’s trachea but couldn’t see past a mouthful of emesis. Instead, the tube slipped into the patient’s esophagus, and each squeeze of the resuscitation bag aerated the patient’s stomach instead of his lungs. Ben began CPR, and the first several compressions were accompanied by the sickening feel of cracking ribs beneath his interlaced hands. “ Call Dr. Gardner! ” he shouted to the charge nurse standing in the doorway, and he soon heard the overhead paging system bellowing: “ Dr. Gardner to the ER, stat! Dr. Gardner to the ER, stat! ”

For eight minutes Ben pumped up and down on his patient’s chest, attempting to circulate enough blood to generate some sort of blood pressure. Every so often, he paused long enough to look up at the patient’s heart rhythm on the monitor. “ Shock him, two hundred joules! ” he ordered the nurse, who would charge the paddles, place them on the patient’s chest, yell “ CLEAR!, ” and press the two buttons that sent a surge of electricity slamming through the patient’s body like an electric sledgehammer. “ No response, Doctor, ” the nurse reported each time, and Ben would order another round of electricity to be delivered like a mule kick into the patient’s chest before resuming chest compressions over splintering ribs. Somewhere during the nightmare of that resuscitation—Ben’s first resuscitation as a physician—the patient’s bladder sphincter relaxed and about a liter of urine came rushing out of the man’s body and onto the bedsheets. A small rivulet of urine began trickling steadily onto the floor. Ben continued his compressions on the patient’s mottled chest, which was now tattooed with burn marks from the defibrillator paddles, as the nurse had failed to place enough conductive gel on the paddles before delivering each shock. The room stunk of burnt flesh and a repugnant potpourri of human sweat, urine, and the vomited remains of a tuna fish sandwich that the patient had apparently eaten shortly prior to his arrival. The endotracheal tube, temporarily forgotten, slipped out of the patient’s esophagus and fell onto the floor with a resounding splat.

“ What in the hell is going on here, Dr. Stevenson?! ” Dr. Jason Gardner, Ben’s supervising physician, stood in the doorway, gaping in disbelief at the scene. He appeared to be moderately out of breath from having run across the hospital from the cafeteria on the other side of the building. Ben noticed a small bit of pasta clinging like a frightened animal to his yellow necktie.

“Heart attack.” Ben’s voice was hollow and uncertain, small and desperately apologetic, and his words fell from his mouth in a rush as he tried to explain. “He came in with chest pain radiating to his arm, neck, and back. Only history was hypertension. He had EKG changes—an ST-elevation MI, I thought. I gave him thrombolytics. I was going to call you, but I didn’t think there was enough time. He coded shortly after I gave the ’lytics. I tried CPR and defibrillation, but I couldn’t get him back. I don’t understand it. I had the nurse call for you as soon as he lost his pulses, but—”

“What did his chest X-ray look like?”

“His chest X-ray?” Ben thought for a moment. Had he ordered one? “I… I don’t know. I think they got one when he first came in, but I didn’t get a chance to look at it.”

“What do you mean you didn’t get a chance to look at it?”

“I just… he started crashing, and there wasn’t enough time…”