Michael Palmer - The Last Surgeon

This had been an especially challenging afternoon. Beds on the psych unit, and throughout the hospital, for that matter, were filled. The interns and residents on the ER were nearing the end of their training year, and were shipping patients up to the wards with minimal workups. Jillian’s feet had begun swelling beyond what her white canvas work shoes could comfortably contain. And now she had been assigned a new admission for whom there would not be a bed available for several hours, if that. A somnolent, jaundiced, alcoholic man, probably in his sixties, he should have been admitted to a medical floor. His right eye was discolored and swollen almost shut. Diagnosis: Acute and chronic alcohol intoxication. Possible impending delirium tremens.

Typical. The diagnosis of alcoholism of any kind would not have gotten the fellow past the managed care gatekeepers and off the ER, but “impending DTs” would, despite the fact that the condition only occurred after cessation of drinking. Technically, every active drinker had impending DTs. Now, instead of offering him privacy, Jillian had no choice but to treat the poor guy in the hallway. It was not that Shelby Stone was a bad hospital. The nursing service had won many awards and national acclaim. It was more that the sprawling institution was just unwieldy much of the time, and the patient population was so ill.

She had taken the man’s vital signs and was in the midst of changing his IV bag when Nick, wearing jeans, sneakers, and a plaid Western shirt, appeared at her side. He reminded her of Trapper John, M.D., from M*A*S*H , with his bushy reddish brown hair that seemed extra wild today. Actually, she acknowledged, she liked that look. A lot.

“Hey you,” Jillian said, “this is a fun surprise.”

“We brought the RV in early to pick up some supplies and have it serviced at a place that does it for free.”

“Sign me and my Honda up.”

Nick nodded down at her patient, lying quietly on his hospital gurney. Jillian had pushed the rolling bed up against the wall so at least they weren’t blocking foot traffic.

“I always believed that if there were no alcohol, there would hardly be any hospitals,” Nick said. “I haven’t worked inpatient for a while, but I’m guessing triage to the hallway isn’t exactly HIPAA compliant.”

“It’s not exactly Joint Commission sanctioned either. But we had our JCAHO certification approved last month, so I think we’re all safe to behave badly for another year. What brings you to paradise?”

I haven’t stopped thinking about you since we met, that’s what.

“That bizarre tour we took of the medi-spa just won’t clear out of my head,” Nick said instead. “I’m just not sure what our next move should be.”

“It’s been haunting me, too. Between Manny Ferris’s freak-out, Daintry getting her signals crossed about the whereabouts of the surgeons, those mysterious unaccounted-for two floors, and the nurse showing up in the deserted operating room, I think there is cause for concern. Besides, Daintry just seems like someone with secrets.”

Nick was paying attention, but he was also reflexively checking the battered man’s pulse at the wrist and neck, then pulling open his lids and examining his eyes with a penlight he had plucked from Jillian’s breast pocket. Next he gently palpated his belly. Finally, he glanced at the plastic ID bracelet on his wrist and bent close to his ear.

“Ray, it’s Dr. Nick Garrity. Can you hear me? Open your eyes if you can hear me.” He put some uncomfortable pressure on Ray’s breastbone with the knuckle of one index finger. “Ray? Come on, Ray, open your eyes. Jillian, have you or any of the docs examined him yet?”

“I assume they looked at him downstairs. Maybe not as carefully as they might have. I heard it’s a zoo down there. I was getting ready to go over him when you got here. Something the matter-I mean other than the obvious?”

“Dunno for certain,” Nick said, “but I think his right pupil is slightly larger than the left.”

“Subdural?” Jillian asked, referring to the life-threatening collection of blood expanding between the skull and brain that often followed head trauma.

“A lot of folks have gotten CT scans of their heads for less indication than this,” Nick said. “I think he could certainly use one, and I would say sooner rather than later.”

“If you’re right, Doc, you didn’t just drop by to see me, you were sent by a higher power.”

“Nonsense. We’re a team. The Jefferson Collinses. If a subdural’s there, you would have picked it up.”

To the hospital’s credit, within five minutes of Jillian’s call, residents from psych and neurosurgery were on the scene, and ten minutes after that, Ray Goodings was on his way down for a CT scan.

“When this place works, it works,” Jillian said, looking up at him with an expression he wanted to capture and bottle for future use. “How about you wait in the lounge if you have time? I have some reporting to do about how poor Ray could have just made it off our service before he was ever really on it.”

Thirty minutes later, she entered the lounge, unable to contain her excitement.

“Subdural,” she said simply. “Pretty big one, too, according to the psych resident who went down with him. Ray’s on the neurosurgery service now. What a man you are. Five minutes in this hospital and you save a patient’s life and make a heroine out of one of the nurses. No wonder they call you Dr. Fury.”

Mentioning the words sent a shadow across her face.

“Hey, nice going,” Nick said, clasping her shoulders and hoping he could soften her thoughts of Belle. “You were connected to that guy. That’s what this caregiving stuff is all about. Connection.”

Jillian glanced about, then stood on her tiptoes and kissed him gently.

“There’s more where that came from,” she whispered. “Now, where do you want to start?”

“Well, let’s step back some and look at what we already know. We think poor Manny might have some connection to Umberto, based on what McBean told me, and we believe Umberto has some connection to Belle based on the Nick Fury comic books you found in her apartment. We also believe that Manny’s reaction to the photographs is a result of his having been a patient at the medi-spa.”

“And?”

“Umberto is between Manny and Belle. He’s the one linked to each of them.”

“So what are you getting at?”

“I think we need to take a close look at what happened at the medi-spa around the time Umberto and Manny disappeared.”

“By that you mean…”

“Check out the patient records from four years ago. See if we can learn anything.”

“Do you think Umberto was also a patient there?”

“I don’t know, but it’s worth investigating to see if the timing might be a missing link.”

“Four years. Excuse me for saying so, but that’s a stretch.”

Jillian rose and walked over to the single, narrow window. The panoramic view of Virginia and the Potomac from the seventh floor was breathtaking. She followed a sailboat skimming across diamond ripples. When Belle was a child, the two of them loved to go out together on their family’s Sunfish. Then, suddenly, they were orphans, and now, Belle herself was gone. Jillian felt completely adrift. When-if-they found Belle’s killer, would it really put an end to the profound emptiness she battled each day? The possibility gave her hope and, at the moment, that hope was all she could really ask for.

Fighting the fullness in her throat, Jillian returned to the table.

“I agree it’s worth looking into,” she said.

“Okay. I spent a little time on the Internet. The Singh medi-spa is a joint venture between Paresh Singh and your employer, Shelby Stone Memorial Hospital. Remember that badge on the security guard?”