Life Support (6 page)

"Dr. Carl Wallenberg."

"Oh, he's away at a medical conference. He'll be back in clinic on Monday."

"May I look at the patient's record? It might clear up a few medical questions for me."

"I'm sorry, but we can't release records without authorization from the patient."

"The patient's unable to give consent. Couldn't I talk to one of your other clinic doctors?"

"Let me pull the chart first." The nurse crossed to a filing cabinet.

"The last name?"

"Slotkin."

The nurse slid out a drawer and flicked through the folders. "Harold or Agnes Slotkin?"

Toby paused. "There's an Agnes Slotkin? Is she related to Harry?"

The nurse glanced at the chart. "She's his wife."

Why didn't Harry's son tell me there was a wife? she wondered. She reached in her purse and found a pen. "Could you give me the wife's phone number? I really need to speak to her about Harry."

"There's no phone in her room. You can just take that elevator there."

"Where?"

"Agnes Slotkin is right upstairs in the skilled nursing facility. Room three four one."

Toby knocked at the door. "Mrs. Slotkin?" she called. There was no answer. She stepped into the room.

Inside a radio was playing softly, its station tuned to a classical program. White curtains hung at the window, and through the gauzy fabric, the morning sunlight shone in with a softly diffuse glow.

On the nightstand roses in a vase shed pink petals. The woman in the bed lay unaware of any of this. Not the flowers nor the sunlight nor the presence of a visitor in her room.

Toby approached the bed. "Agnes?"

The woman didn't stir. She was lying on her left side, facing the door.

Her eyes were half-open but unfocused, her body positioned by pillows propped behind her back. Her arms were curled into a fetal self-embrace.

Above the bed, a bag of creamy white liquid dripped into a feeding tube that snaked into the woman's nostril. Though the linens looked clean, an odor hung in the air, undisguised by the scent of roses. It was the smell of the stroke ward, of talcum powder and urine and Ensure. The smell of a body slowly involuting.

Toby reached for the woman's hand. Gently she tugged the arm straight.

The elbow extended with only slight resistance. No permanent contractures had set in, the nursing staff had been diligent with the passive range-of-motion exercises. Toby lay the hand down, noting the plumpness of the flesh. Despite her comatose state, the patient had been kept well nourished, well hydrated.

Toby focused on the slack face and wondered if those eyes were looking at her. Could the woman see anything, comprehend anything?

"Hello, Mrs. Slotkin," she murmured. "My name is Toby."

"Agnes can't answer you," a voice said behind her. "But I do believe she can hear you."

Startled, Toby turned to face the man who'd just spoken. He was standing in the doorway�in truth, hefilled the doorway, a giant of a man with a broad black face and a gleaming wedge of a nose. It was a nice face, she thought, because he had kind eyes. He was wearing a white doctor's coat, and he held a medical chart.

Smiling, he extended his hand. His arm was so long the wrist poked out beyond the sleeve's edge. Did they make lab coats large enough for a man this size? she wondered.

"Dr. Robbie Brace," he said. "I'm Mrs. Slotkin's doc. Are you a relative?"

"No." Toby shook the man's hand, felt it engulf hers like a warm brown glove. "I'm an ER doc at Springer Hospital, down the road. Toby Harper."

"Professional call?"

"In a way. I was hoping Mrs. Slotkin could tell me about her husband's medical history."

"Is something wrong with Mr. Slotkin?"

"He was brought into the ER last night, confused and disoriented.

Before I could finish my workup, Harry left the hospital. Now we can't find him, and I have no idea what was wrong with him. Would you know his history?"

"I just take care of nursing home inpatients. You might check with the doctors in the outpatient clinic downstairs."

"Harry's a patient of Dr. Wallenberg's. But Wallenberg's out of town.

And the clinic won't release records to me without his approval."

Robbie Brace shrugged. "That's the standing policy here."

"Do you know Harry? Is there some medical problem I should be aware of ?"

"I only know Mr. Slotkin in passing. I see him when he comes to visit Agnes."

"So you have spoken to Harry."

"Yeah, we'd say hello, that's all. I've only been working here a month, and I'm still trying to put names to faces."

"Do you have the authority to release Harry's records to me?"

He shook his head. "Only Dr. Wallenberg can, and he requires a patient's written consent before he'll release any information."

"But this could affect his patient's medical care."

He frowned. "Didn't you say Harry walked out of your ER?"

"Well yes, he did�"

"So he's not really your patient anymore, is he?"

Toby paused, unable to contradict that statement. Harry had walked out of her ER. He had left her care. She had no pressing reason to demand his records.

She looked down at the woman in the bed. "I guess Mrs. Slotkin can't tell me anything, either."

"I'm afraid Agnes doesn't talk at all."

"Was it a stroke?"

"Subarachnoid hemorrhage. According to her chart, she's been here a year. Seems to remain in a vegetative state. But every so often, she'll sort of look at me. Don't you, Agnes?" he said. "Don't you look at me, honey?"

The woman in the bed didn't stir, didn't even flutter an eyelash.

He moved to the bedside and began to examine his patient, his black hands a startling contrast against the woman's pallor. With his stethoscope he listened to her heart and lungs, and checked her abdomen for bowel sounds. He shone a light in her pupils. He extended her limbs, checking for resistance to range of motion. Finally he rolled her toward him and examined the skin on her back and buttocks. No bedsores. Gently he repositioned her against the pillows and folded the sheet over her chest.

"Looking' good, Agnes," he murmured, patting her on the shoulder. "You have yourself a nice day."

Toby followed him out of the room, feeling like a midget tagging at a giant's heels. "She's in good condition for someone who's been vegetative for a year."

He opened the chart and scribbled his progress note. "Well, of course.

We give genuine Rolls-Royce care."

"At Rolls-Royce prices?"

Brace glanced up from the chart, the first hint of a grin on his lips.

"Let's just say, we don't have any Medicaid patients."

"They're all private pay?"

"They can afford it. We've got some pretty wealthy residents."

"Is this place exclusively for retirees?"

"No, we have a few active professionals who've bought into Brant Hill just to guarantee that their future needs are taken care of. We provide housing, meals, medical care. Long-term care, if it becomes necessary.

You probably saw we're already expanding the nursing home."

"I also noticed a very nice golf course."

"Along with tennis courts, a movie theater, and an indoor pool." He closed the chart and grinned at her. "Sorta makes you want to retire early, doesn't it?"

"I don't think I could afford to retire here."

"I'll let you in on a secret, neither one of us could." He glanced at his watch. "It was nice meeting you, Dr. Harper. If you'll excuse me, I've got a lot of patients to see."

"Is there any way I could find out more about Harry?"

"Dr. Wallenberg's back on Monday. You can talk to him then."

"I'd like to know now what I was dealing with. It's really bothering me. Couldn't you review the outpatient record? Call me if you find anything relevant?" She scribbled her home phone number on a business card and handed it to him.

Reluctantly, he took the card. "I'll see what I can do," was all he said. Then he turned and walked into a patient's room, leaving Toby standing alone in the hallway.

She turned from the closed door and sighed. She'd done her best to track down the information, but Brant Hill wasn't cooperating. Now hunger and fatigue were dragging her down, and she could feel her body issuing demands. Food. Sleep. Now. In slow motion, legs sluggish, she began to walk toward the elevators. Halfway there, she halted.

Someone was screaming.

It came from one of the patient rooms at the end of the hall� not a cry of pain, but of fear.

As Toby ran toward the screams, she heard other voices spilling into the hallway behind her, heard footsteps following at a run. Toby reached the room ahead of everyone else and shoved open the door.

At first all she saw was the elderly man crouching on hands and knees on the bed. He was naked below the waist, and his wrinkled buttocks were bobbing up and down in a doglike mating dance.

Then Toby saw the trapped woman underneath him, her frail body almost hidden among the tangle of blankets and sheets.

"Get him off me! Please get him off me!" the woman cried.

Toby grabbed the man's arm and tried to drag him away. He responded

with a shove so powerful it sent Toby sprawling backward to the floor. A nurse ran into the room.

"Mr. Hackett, stop it! Stop it! The nurse tried to pull the man away, but she too was flung aside.

Toby scrambled back to her feet. "You grab one arm, I'll get the other!" she said, circling around to the far side of the bed. Together, she and the nurse took hold of the man's arms. Even as he was dragged off the woman, he kept thrusting like a grotesque sexual robot without an off switch. The woman on the bed curled up into a fetal position and began to cry as she hugged herself among the blankets.

Suddenly the man twisted, elbowing Toby under the chin. The jab slammed her jaw shut, ramming a bolt of pain straight through her skull, She saw a burst of white and almost released him, but sheer rage kept her holding on. He lashed out at her again. They were grappling like animals now, and she could smell his sweat, could feel every muscle in his body straining against her. The nurse lost her footing and stumbled, releasing her grip. The old man reached behind Toby's head and grabbed a fistful of her hair. He was thrusting at her now, his erect penis stabbing at her hip. Disgust and fury boiled up in her throat. She tensed her thigh, preparing to knee him in the groin.

Then her target was gone. The man was lifted away by a pair of huge black hands. Robbie Brace hauled the man halfway across the room and barked to the nurse, "Get me some Haldol! Five milligrams IM STAT!"

The nurse ran from the room. She came back a moment later, syringe in hand.

"C'mon, I can't hold him forever," said Brace.

"Let me get at his butt�"

"Do it, do it!"

"But he keeps squirming away�"

"Man, this guy's strong. What've you been feeding him?"

"He's a protocol patient�plus he's got Alzheimer's�I can't get at him!"

Brace shifted his grip, turning the man's rear end toward the nurse.

She pinched a fold of bare buttock and stabbed it with the

needle. The old man shrieked. Bucking, he yanked away from Brace. In a blur of motion, he grabbed a water glass from the nightstand and swung it at the doctor's face.

The glass shattered against Brace's temple.

Toby lunged, catching the old man's wrist before he could swing again.

Viciously she twisted his hand and the broken shard tumbled from his grasp.

Brace wrapped giant arms around the man's shoulders and yelled, "Give him the rest of the Haldol!"

Again the nurse jabbed the needle into the man's buttock and squeezed the plunger. "It's all in! God, I hope this works better than the Mellaril."

"This guy's on Mellaril?"

"Around the clock. I told Dr. Wallenberg it wasn't holding him. These Alzheimer's patients need to be watched every second or they�" The nurse took in a sharp breath. "Dr. Brace, you're bleeding! " Toby glanced up and was alarmed to see blood trickling down Brace's cheek and splattering his white coat. The broken glass had sliced open the skin on his temple.

"We have to stop that bleeding," said Toby. "It's obvious you'll need stitches."

"First let me get this guy into a nice tight Posey restraint. Come on, sir. Let's get you back to your room."

The old man let fly a glob of spit. "Nigger! Let me go!"

"Oh man," said Brace. "You're trying to get on my good side, aren't you?"

"Don't like niggers."

"Yeah, you and everyone else," said Brace, sounding more tired than angry. He half-dragged, half-marched the old man out of the room and into the hall. "Buddy, it looks like you've earned yourself a date with a straitjacket."

"Ouch. Don't make me look like Frankenstein's monster, okay?" Gently Toby emptied the syringe of Xylocaine and withdrew the needle. She had injected local anesthetic along both edges of Robbie's laceration and now she gave the skin a gentle prick. "Feel that?"

"Nope. It's numb."

"Are you sure you wouldn't rather have a plastic surgeon stitch you up?"

"You're an ER doc. Don't you do this all the time?"

"Yes, but if you're concerned about the cosmetic result�"

"Why would I be? I'm already so damn ugly. A scar will be an improvement."

"Well, it'll give your face character," she said and reached for the needle forceps and suture. She'd found all the supplies she needed in the well-stocked treatment room. Like everything else at Brant Hill, the equipment was spanking new and top of the line. The table where Robbie Brace lay could be adjusted to a wide variety of positions, which made it convenient for treating anything from scalp wounds to hemorrhoids.

The overhead lights were bright enough for surgery. And in the corner, ready for emergencies, was the cardiac crash cart, a state-of-the-art model, of course.

She swabbed the wound again with Betadine and poked the curved suture needle through the edges of the laceration. Robbie Brace lay on his side, perfectly still. Most patients would have closed their eyes, but he kept his wide open and staring at the opposite wall. Though his size was intimidating, his eyes seemed to neutralize any threat. They were a soft brown, the lashes thick as a child's.