Michael Palmer: Natural Causes

Billy snatched up his test kit and adjusted the holster beneath his left arm.

"You just goddamn keep it together until we're done," he snapped. "Understand?" He noticed the pain in her face, and his expression softened. "Connie, honey, everything will be all right. I promise. I'll finish this business with Diaz as quick as I can. And then if you want, I'll get you the best damn doctor in New York."

"But…"

"Remember, now, keep your door locked, and keep your eye out for trouble. I love you."

"I love you, too," Connie said. But he was already gone.

With great effort, she slid behind the wheel and locked the driver's side door. Having your water break was no great cause for alarm, she thought desperately. The birthing class nurse had stressed that over and over again. Five minutes passed. Then five more. The contractions were hell.

Anxious to distract herself, to check her fingers, Connie again turned on the interior light. The gray, cold hands with their blackened fingertips looked like some sort of Halloween prop. She glanced at herself in the rearview mirror. Something was wrong with her face. It took several seconds for her mind to understand the dark ribbons of blood that had begun winding down from her nostrils, across the top of her lip, and alongside the corners of her mouth.

"Please, Billy. Please hurry," she whimpered.

She was clumsily searching her purse for a tissue when she noticed the deep crimson stain expanding over the groin and legs of her beige maternity slacks. This wasn't the clear or slightly tinged fluid the nurse had spoken of. It was blood! Connie felt dizzy, confused. She tried to dab at the flow from her nose, which now was entering her mouth and spattering down onto her blouse. Her left arm felt leaden.

"Please! Please someone help me," she cried. Then she realized that the words were in her mind, but she could not speak them. Her vision seemed blurred, the left side of her body paralyzed. Terror beyond any she had ever known took hold.

At that moment, the windshield of the Ford exploded inward, showering her with glass. Instantly, from across her brow, blood cascaded into her eyes. She pawed at it with the back of her right hand, managing to clear her vision briefly. Billy's body was stretched across the hood of the car, his shattered head and one arm dangling lifelessly over the passenger seat beside her. Soundlessly Connie screamed and screamed again.

Through the shattered windshield, she could see several men approaching. With no conscious purpose other than to get away, she dropped her hand onto the gear shift, knocking it from park to drive. The Ford shot forward, striking at least one of the men and glancing off several parked cars. As the wagon careened onto Third Avenue, Billy's body fell away. Connie, now more dead than alive, looked to her left in time to see the headlights and grillwork of a bus.

For one brief instant, there was a horrible, grinding noise, accompanied by pain unlike any Connie had ever known. Then, just as suddenly, there was blackness… and peace.

July 1, Changeover Day

It was exactly seven point two miles from Sarah Baldwin's North End apartment to the Medical Center of Boston. Today-a Monday-the roads were dry, the humidity low, and at six A.M., the traffic virtually nonexistent.

Sarah squinted up at the early-morning glare, getting a sense of the day. "Nineteen minutes forty-five seconds," she predicted.

She straddled her Fuji twelve-speedy, adjusted her safety helmet, and set her stopwatch to zero. Just fifteen seconds either way had become the allowable margin in the contest. More often than not, she won. Over the two years she had been commuting by bike to MCB, she had honed her accuracy by factoring into her average time as many arcane variables as she could remember on any given day. Tuesday or Thursday?… Add thirty seconds. Regular coffee at breakfast instead of decaf?… Deduct forty-five. Two nights in a row off call?… A full minute or more to the good. Today she also factored in the need to pedal hard enough to feel she had exercised, but not so hard as to break much of a sweat.

She glanced along the quaint row houses lining her narrow street, keyed her stopwatch, and shoved off. Once a near fanatic about fitness, she had now all but given up on formal workouts. Instead, she would push herself to the limit on the ride to work, shower at the hospital, and then change into her scrubs for rounds. But today nothing would be usual. At the Medical Center of Boston, as at most of the teaching hospitals around the country, this was July 1-Changeover Day.

For every physician in training in every specialty, Changeover Day marked a major rite of passage. Brand-new M.D.s stepping into hospitals as first-year residents. First-year residents one minute becoming second-year residents the next. For Sarah, the changeover would be from second-year resident in obstetrics and gynecology to third year. Suddenly more responsibility. Literally overnight, less supervision, especially in the operating room. It helped put some perspective on the tension she was feeling, to reflect on the fears she had dealt with on Changeover Day a year ago, or worse, the year before that.

Now, all things being equal, in another year Changeover Day would usher in Sarah's tenure as the chief resident of her department. On that day, in most situations, her decisions, her clinical judgment, would become the final word. It was a sobering thought. And although being a chief at a modest facility like MCB was hardly like being one at White Memorial or the other huge university hospitals, it was still impressive-especially considering that less than seven years ago, becoming a physician had been the farthest thing from her mind.

She dropped into third gear for the ride over Beacon Hill and then cruised into the Back Bay. Just a few blocks away was the huge, corner brownstone that had once housed the Ettinger Institute of Holistic Healing. As usual when she passed near that building, she wondered about Peter Ettinger-why had he never answered any of her calls or letters? Was he married? Was he happy? And what of Annalee, the West African girl he had adopted as an infant? She had been fifteen when Sarah left. Sarah had felt very close to her. It was still a source of sadness that their relationship had not survived.

Three years before, when she returned from Italy with her M.D. degree, Sarah had stopped by the institute. The place that had once been her home and the focus of her life was now six luxury condominiums. Peter's name was not among the residents. Months later she had learned of Xanadu, Peter's holistic community set in the rolling hills west of the city. She would drive out there sometime, she thought. Perhaps face-to-face they could set some things straight.

But she never did.

Distracted, Sarah cruised through a yellow light, drawing an obscene gesture from a cabby who was preparing to jump the green.

Be careful, she warned herself. Be very careful. The last place anyone should end up was in an emergency room on Changeover Day.

As she turned off Veteran's Highway onto the MCB access road, Sarah checked the time. More than twenty minutes already. She dismounted and decided to walk the final few hundred yards. Her little contest had no predictive significance that she had ever discerned. Nevertheless, she did make a passing mental note that this Changeover Day had begun with a loss.

Up ahead of her, picketers lined both sides of the drive, jeering those entering to work and occasionally joining in a ragged chant. MCB had gone a week or more without a demonstration-the longest span Sarah could remember. Now some group or other was on the warpath again. Sarah tried to guess which one. Nurses-RNs and LPNs-maintenance, transportation, security, dietary, clerical, physical therapy, nurse's aides, even house staff-at one time or another, each had run some sort of job action at the beleaguered institution. Today it was maintenance.