Michael Palmer: The fifth vial

"At least he'll have someone working on him who gives a hoot, if that means anything."

"It means plenty," Bev said. "Go ahead in there. I'll get you set up with some six-oh nylon suture. Even though most of them aren't, we assume everyone down here who is bleeding is HIV-positive, so best wear a gown and plastic face shield. If I think you're going wrong in any way, I'll clear my throat and you can come away and we can talk. Keep your fingers away from the needle. Straight instrument ties, double overhand knots about an eighth of an inch apart. Don't pull them so tight that the skin edges bunch, and don't shave his eyebrow because they never grow back right."

"Thank you."

"Welcome to the ER," Bev said.

"You doin' a good job, Doc?"

Natalie looked up at Bev Richardson, who nodded proudly that she was. From the moment Nat had numbed up the skin edges, Darren Jones had been talking nonstop. Nerves, she guessed. If he only knew that he was hardly the only one. The procedure had taken probably three times what it one day would, and Natalie was still just through the forehead and eyebrow, with the cheek yet to go, but the repair looked quite decent.

"Yes, I'm doing a good job," she replied matter-of-factly.

" 'M I gonna have a scar?"

"Every time skin is cut there's a scar."

"Women like scars. They're mysterious. Besides, I'm tough, so why not announce it. Right, Doc?"

"You seem pretty smart. Smart is more important than tough."

"Tough men like me scare you?"

"The guy who cut you would probably scare me," Natalie said, smiling beneath her mask. "You still in school?"

"I have a year to go, but I quit." "You should think about starting up again."

"Fat chance." Darren laughed. "You wouldn't know about such things, Doc, but where I come from, the only thing that matters is being tough."

Again, Natalie grinned. Matched up against this boy in almost any measure of toughness, she would win hands down. She reminded herself that it wasn't the first person who had suggested she get back into school that had led her to the Edith Newhouse Academy for Girls, or even the second. But somewhere along the line, thanks to those who had tried before, someone had finally been able to breach the ramparts of her own toughness.

"Tough is swimming against the stream and having the courage to be different," she said, tying off the last of the sutures. "Tough is realizing that this is the only life you're going to have, so you might as well do what you can to make the most of it."

"I'll keep that in mind, Doc," the teen said with little sincerity.

Natalie glanced over her shoulder at Bev, who gave her technique a thumbs-up and mouthed the words, "Steri-strips," motioning at the packets of paper stitches she had placed on the instrument tray. After ineptly fumbling several of the strips into useless balls, Natalie figured out how to cut and place them across the incision to reduce scarring by taking the tension off of her suture line.

"Five days," Bev mouthed, holding up one open hand.

"These stitches will probably be ready to come out in five days," Natalie said, grateful for the hedge inherent in the word "probably," at least for the time being.

"You got soul, Doc," Darren said. "I can tell."

Natalie stripped off her face protector and gloves. Another milestone, she was thinking. It was a huge advantage to be thirty-five and a med student — especially one who had seen more than her share of life. Decisions came easier to her than to most of her classmates, many of whom were a decade younger or, in a few cases, even more. Her perspective was often more finely honed? confidence in her convictions was stronger.

"Don't sell yourself short, my man," she replied.

"Stick around, Darren," Bev said. "I have a tetanus shot, some instructions, and some medication for you."

"Pain meds?" Darren asked hopefully.

"Sorry, antibiotics."

"Hey, you claim you're tough," Natalie said, heading out the door. "Tough guys don't need no steenking pain medicine."

She wrote her note at the nurses' station, feeling very pleased with the way she had performed under pressure. Renfro had issued the challenge and then had walked away, but she had more than measured up. She had set high school, college, and national records on the track, and had made it to within one unfortunate step of being on the Olympic team. Along the way, she had dealt with any number of Cliff Renfros, bent on feeding their egos off the insecurity of others. Well, she was still the same woman who had run 1,500 meters in 4:08.3. Let this particular Cliff Renfro keep trying. She hadn't knuckled under to any of the others, and she wasn't going to be intimidated by him either.

Bev materialized at her elbow.

"Saralee just came over from room four. You know what that is?"

"Yes, for the alcoholics."

"And other street people," Bev added. "Patients are put there when they're particularly…um…grimy."

"I know. I worked in there for a while yesterday. It wasn't so bad." "Well, apparently the ER got a little backed up while you were off suturing and a code was going on in the other wing. So, much to his chagrin, Cliff is holding down the fort in room four. He wants you to take over in there as soon as you're done."

"I'm done now."

"Good. You handled that kid well, Nat. I think White Memorial made a good choice. You're going to make a fine doctor."

"That hospital may be the best of the best, but they're still a decade or two behind when it comes to accepting women into their surgical programs."

"So I've heard. Well, like I said, you'll do great. Take it from one who's seen them all come and go."

At that moment, they turned toward the sound of a commotion coming from down the hallway.

"I'm telling you, Doc, you're wrong! There's something the matter with me. Something bad. Right here behind my eye! I can't stand the pain!

A man was being escorted out of room 4 by an orderly. Even at some distance, there was no doubt that he qualified to have been there. Grizzled and worn, he was in his forties, Natalie guessed, or maybe even his fifties. He had on a tattered windbreaker, stained chinos, and sneakers without laces. An oily Red Sox cap with its brim pulled low still failed to hide the sad hollows of his eyes.

Hands on hips, Cliff Renfro appeared in the doorway and glanced to where Natalie and Bev stood before addressing the man.

"What's wrong with you, Charlie, is that you need to stop drinking. I would suggest you get yourself over to the Pine Street Inn and get them to show you to the shower. They'll probably have some clothes for you, too."

"Doc, please. This is serious. I've got lights flickering in this eye and the pain is killing me. Everything keeps going black."

Clearly irritated almost beyond words, Renfro ignored the man and stalked down the hallway past where the two women were standing.

"You've got to move faster down here, Dr. Reyes," he paused long enough to say. "Now, please take over in four. I'm going to get washed up and," he muttered, "maybe fumigated."

Natalie caught the briefest spark of anger and frustration in the patient's eyes before he turned and allowed the orderly to lead him toward the waiting room, and beyond that, the street.

"I'll bet Renfro didn't even examine him," Natalie whispered.

"Possibly, but he usually — "

"There's something seriously wrong with that man, I just know it. Horrible pain, flickering lights, lost vision. I just finished six weeks on neurology. That guy has a tumor, or maybe a leaking aneurysm, or even a brain abscess. These people deal with pain and discomfort every day. If his symptoms are bad enough to have him drag himself in here, something's the matter. Did Renfro order any tests?"

"I don't know, but I don't think — "