Fredric Stern: The Endorphin Conspiracy

“Pulse 110, BP 95/60.”

“Looks like he’s stabilizing for now,” said Flynn.

From the corner of the curtained area, Dr. George Spiros quietly observed the frenetic scene. His belt weighed down by three pagers and two cell phones marked his rank as commander-in-chief. He was a short man with graying black hair, stocky build with a soft middle. Spiros watched every move keenly, his small but intense, dark brown eyes peering through thick lenses set in tortoise-shell frames, his expression severe as he waited for someone to make an error in judgment.

Think clearly, but act quickly and instinctively , he constantly told his residents. He drilled this into their minds every morning during five a.m. rounds, when he reviewed aloud every single case from the night before, red grease pencil in hand. No one escaped criticism; no case was handled well enough. There was no place for error in judgment in his emergency room, no place for hubris—except his. Fear and respect motivated the residents passing through his ER. It worked remarkably well.

A nurses aid entered the room, bags in hand. “Blood’s arrived.”

“Hang two units and run them in full bore,” said Flynn. He turned to Geoff. “Thanks for the help. You don’t have much time to do your neuro evaluation. The OR will be ready for him in ten minutes.”

“No problem. Dr. Choy and I will take it from here. Why don’t you take a break.” Geoff motioned Karen to approach the head of the bed, while nurses and interns continued about their work.

The victim was fair-skinned, somewhat overweight. His face was swollen to marshmallow puffiness, the white flesh of his cheeks and forehead marked by deep crimson lacerations, as if something had attempted to gouge out his eyes. Sanguineous fluid oozed from his nose and right ear. Dark bruises encircled both eyes, giving him a raccoon-like appearance. Around his neck was a stabilizing neck brace to protect his upper spinal cord from excessive movement. Possible spinal fracture. His blue uniform had been cut away, revealing numerous, large bruises, abrasions, and bite marks on his chest and arms. Were this an ER in Montana, he could have been the victim of a grizzly bear attack. But this was New York, where transit cops patrolled the dusky, fetid bowels of the subways, often in perilous isolation, where the animals were most frequently two-legged.

Penlights and reflex hammers in hand, Geoff and his apprentice evaluated their patient.

“The bloody fluid coming from his nose and ears, that’s spinal fluid, isn’t it?” asked Karen.

“Sure looks like it. That, along with the raccoon’s eyes pretty much point to a basal skull fracture. We’ll know when he has his MRI scan. He must have been smashed on the back of the head with a hard object or fallen down, hitting his occiput. He’s in a bad way.”

“He seems to be losing the little bit of consciousness he had.” Karen checked his pupillary responses.

“What would you say his coma scale rating is?” Geoff asked.

“Moderate to severe head injury. Fair to poor prognosis.”

“Very good. Of course that’s all meaningless in the face of what his PET scan will show us regarding the actual extent of his brain injury.”

“Thorough evaluation, doctors,” interrupted Dr. Spiros, restless with his role of observer. “Now would you like to let me in on his neuro status is and your treatment plan? I don’t think I can put off the mayor, the police commissioner, and the press much longer.”

Karen Choy gladly deferred to Geoff.

“Probable basal skull fracture, brain swelling due to diffuse head injury. We’ll know for sure after his scans. Numerous contusions, lacerations, and probable internal injuries. His neck’s been stabilized with a cervical collar in the unlikely event there’s a spinal fracture. Plan is to take him to the OR for an exploratory laparotomy, place a head bolt to monitor his intracranial pressure, then when he recovers, take him to neuroimaging for his PET and MRI scans. If he makes it, he’ll be spending at least several days in the ICU. Did I miss anything?”

Spiros wore his usual deadpan expression. “No.”

“Then we’ll be taking him now. Can we borrow a nurse for the trip to the OR?” asked Geoff. He raised the bedrails and unlocked the wheels. Spiros nodded his head affirmatively, turned to leave, then paused. “Good job, Dr. Davis, but try and get here more quickly next time.” He left the trauma room.

Karen exhaled. “So that’s the Dr. Spiros.”

“Astute observation, Karen. You’ll go far. Stay here with the patient. I’ll go find a nurse to help.”

Geoff stood at the nursing station, listening to the scramble of activity around him. The interminable electronic ringing of telephones, overhead pages, sirens of police vans and aid cars, the voices of patients, families, and staff. While he had been working it had been tuned out of his conscious awareness by that part of the brain responsible for selective attention. The cacophonous agglomeration of sounds had melded together, nothing more than a symphony of background sound, white noise.

“Any nurses free to help transport a patient?” asked Geoff.

“Only one free is Nurse Creighton,” said Bea Mendelssohn, the ER clerk, gazing up at Geoff over her reading glasses.

“That’s okay, I don’t want to take her away from her more important duties here,” replied Geoff. “Dr. Choy and I will take care of it ourselves.”

“That’s probably the wisest decision you’ve made in your two hours as chief resident, Dr. Davis.” Bea smiled knowingly.

“Thanks Bea. I’ll be seeing you.”

“Oh, Dr. Davis, one more thing. There’s a message from Dr. Howard Kapinsky. He wants to know if he should start rounds without you. He says the team’s been waiting for an hour.”

Detective Donald O’Malley steadied his elbows on the makeshift command post in the Central Park Zoo and peered through the high power binoculars for the tenth time in the last hour. He scanned the red brick facade of the Penguin Building, then focused on the doorway, watching for the slightest hint of movement. Nothing. Four hours broiling in the midday sun, breathing the stench of filthy animals, and not a goddamned thing.

The trumpeting of an elephant cut through the heavy air. The splash of a sea lion in the mammal pool nearby made him flinch. He felt like he was on a fucking safari, instead of a stakeout.

O’Malley lifted the binoculars from around his neck and resolutely placed them on top of the stand. He removed his dusty NYPD baseball cap, wiped the beads of sweat from his brow with his handkerchief. Reaching into his pants pocket, he removed what had been a large pack of Juicy Fruit and stuffed another stick of gum in his mouth—number ten to be exact—adding it to the wad that already produced a large bulge in his cheek. O’Malley’s ritual. The binoculars, the cap, the Juicy Fruit. He had repeated it ten times in the last hour. It usually made him feel secure, in control, though the latter state had thus far eluded him today.

Donald O’Malley, decorated veteran of the NYPD and Commander of the City’s Tactical Response Unit had been involved in scores of stakeouts before, but the waiting still drove him crazy. Next week he would write his last chapter on the TRU after ten years as unit commander. Though he had a perfect record, it was time to hang it up. His ulcer and his wife, Stella, had convinced him of that. He wouldn’t miss the waiting, that’s for sure.

The TRU was ready to be handed over to a young buck like Valdez. For O’Malley, it was back to homicide. Not exactly what Stella had in mind, but she’d live with it as she had with his entire career. Some of his best years on the force had been on homicide, and he had decided that was where he would finish out. Three fucking years to go! He couldn’t believe it.