Michael Palmer - The fifth vial

"Listen, Bev, I want to check that guy over and then get a CT scan. Can you arrange that?"

"I can, but I don't think it's such a good — "

"And some bloods. A CBC and Chem-Twelve. I've got to catch him before he gets away. Believe me, if he were a well-dressed businessman at White Memorial, he'd be over having a CT scan right now."

"Maybe, but — "

Before Bev could finish the sentence, Natalie was off. She checked the waiting room, then hurried out the doors to Washington Avenue. The man was a dozen yards away, shuffling slowly toward downtown.

"Charlie, wait!"

The derelict turned. His eyes were bloodshot, but he held his head erect and met her gaze evenly, perhaps even with some defiance.

"What is it?" he growled.

"I'm…Dr. Reyes. I want to check you over a little more and maybe order a test or two."

"Then you believe me?"

Natalie took his arm and gently led him back toward the ER.

"I believe you," she said.

Bev Richardson was waiting just inside the door with a wheelchair.

"Room six is empty," she said in a conspiratorial whisper. "Hurry. I have no idea where Renfro is. Lab is on the way. Hopefully we can get his blood drawn and get him over to CT without anyone seeing."

Natalie helped the man out of his clothes and into a blue johnny. Renfro was right about one thing, she was thinking, Charlie really did smell. She did a modest neurologic exam, which disclosed several definite abnormalities in strength, eye movements, hand-eye coordination, and gait, any and all of which could be due to a brain tumor, abscess, or leaking blood vessel.

A technician had just finished drawing blood when Bev backed into the room hauling a stretcher.

"I pulled some strings," she said. "They're ready for him in CT."

"He has some clear-cut neurologic abnormalities. I'll get him over there, and then get to work in room four."

"I'll clean up in here."

Natalie wheeled the stretcher into the hallway.

"Thanks, Bev, I'll be right b — "

"What in the hell is this?"

Cliff Renfro, livid, stormed toward her from the nurses' station.

"I believe there is something seriously wrong with this man," Natalie said. "Maybe a tumor or a leaking aneurysm."

"So you chased him down after I had discharged him?"

Renfro's voice was raised to the point where staff and patients alike stopped and stared. Several people emerged from the examining rooms, several more from the nurses' station.

Natalie held her ground.

"I wanted to do the right thing. He has some neurologic findings."

"Well, this isn't the right thing. The findings, like everything else about him, are the result of alcohol. You know, I had heard from a number of people that you were too arrogant and hard-edged to be a good doctor. Just because you had fifteen minutes of fame doesn't mean you can step in here and act as if you're in charge of the place."

"And just because you like to keep your clinic coat from getting soiled doesn't mean you can brush off patients like this man," Natalie shot back.

Bev Richardson quickly inserted herself between the two combatants.

"It was my fault, Cliff," she said. "was worried about this man, and thought it would be a good learning experience for — "

"That's nonsense, and you know it. Don't protect her." He stepped to his left to get a clear line of sight at Natalie. "There is no place in medicine for anyone as self-absorbed and conceited as you are, Reyes."

Natalie's jaws clenched. She was furious at being rebuked so publicly, and anxious to have all the witnesses know why Renfro's prejudices had led him to do an inadequate job in evaluating this down-and-outer.

"At least I care enough about people like Charlie here to do a complete evaluation on him."

"Five years as a doctor have made me perfectly capable of deciding what is and is not a complete evaluation. I intend to make sure that anyone at the medical school who will listen learns about you and what's happened here."

"Well, I think before you do that, you should see what this man's CT scan shows."

Renfro's glare could have melted block ice. He looked as if he were going to say something else, then turned and stalked off toward X Ray. Two exquisitely tense minutes later, a CT tech came and wheeled Charlie away. Natalie sighed her relief.

"Whew. I was certain he was going to cancel the test out of spite," she said, as she and Bev walked back to the nurses' station.

The seasoned nurse looked at her and shook her head.

"I'm sorry I couldn't get him to calm down," she said. "There was probably a better way to have done this."

"Renfro could have admitted he was wrong," Natalie said. "The fact that he went ahead with the scan says as much. When they find a tumor behind poor Charlie's eye, he's going to be grateful I saved his bacon."

Tumor, abscess, leaking aneurysm. In her mind, Natalie was already projecting the reactions of Renfro and the staff when her approach to the man was vindicated. Hopefully, whatever the poor guy had would be operable. She thought about how her mentor, surgeon Doug Berenger, would react to her coup. Midway through her undergraduate years at Harvard, well before the incident that tore her Achilles, he had sought her out and offered her a position working in his lab — a job she still held. Later, he had brought together the best sports medicine people around to aid in her recovery, and still later, he had talked her into attending med school.

Berenger, perhaps the foremost cardiac transplant surgeon in Boston, if not in the country, was already talking about a fellowship in his department when her surgical training was complete. He had a framed sampler hung on the wall behind his desk chair: believe in yourself. He would be damn proud of the way she had believed in herself and held her ground against Renfro's unnecessary onslaught, especially when Charlie's diagnosis became known.

Natalie went into room 4 and worked up the three patients waiting there. Her pulse continued to race — in part fallout from the acrid exchange with Renfro, and in part from the excitement of soon getting the re suits of the lab work and scan on her patient. Finally, through the doorway of room 4, she saw Renfro pass by, wheeling Charlie on his stretcher. A manila X-ray envelope was tucked under the thin mattress. Moments later, the resident called out her name.

"Dr. Reyes, staff," he said quite loudly. "Could I have you all out here, please?"

A group of perhaps a dozen stepped quietly into the hallway. Renfro waited until it seemed there would be no more, and then continued, holding up the envelope with the CT scan for emphasis.

"You were all here a little while ago for the…urn…discussion about patient care that occurred between Ms. Reyes and myself. Well, I have all the lab work and the CT back on our patient. I would like to inform you that there is nothing abnormal on any of them. Nothing. Charlie here has just what I said he had — just what he always has, Ms. Reyes — an alcohol-induced headache. He had a blood alcohol of one hundred and ninety when he came in, and I don't suspect it's much lower now, since he just managed to get at the pint of Thunderbird in the jacket in his clothing bag. Bev, please discharge this man for the second time. Be sure to fill out an incident report.

"Ms. Reyes, go home. I don't ever want to see you on my service again."

Early afternoon was clearly one of the better times to shop at the Whole Foods Market. Natalie would have had no reason to know that fact until today. With her mother's grocery list in one hand and hers in the other, she made her way up and down the uncrowded aisles in no particular hurry. It had been three hours since she was booted out of the Metropolitan Hospital ER by Cliff Renfro, and for the moment at least, she had more time on her hands than she had things to do.