“I hardly think Dr. DiMatteo is so easily coerced,” said Parr.
“What about Lim?” said Mark. “He was in the OR too. Are you going to kick him off the staff?”
“Lim had no idea what was going on,” said Parr. “He was just there to harvest the kidneys. All he knew was that Mass Gen had a recipient on the table. And there was a directed donation form in the chart.” Parr turned to Abby. “Drawn up and witnessed by you.”
“Joe Terrio signed it willingly,” said Abby. “He agreed the heart should go to the boy.”
“Which means no one can be accused of organ theft,” Mark pointed out. “It was perfectly legal, Parr. Vivian knew exactly which strings to pull and she pulled them. Including Abby’s.”
Abby started to speak, to defend Vivian, but then she saw the cautionary look in Mark’s eyes. Careful. Don’t dig yourself a grave.
“We have a patient who came in for a heart. And now we have no heart to give her. What the hell am I supposed to tell her husband? ‘Sorry, Mr. Voss, but the heart got misplaced?’” Parr turned to Abby, his face rigid with anger. “You are just a resident, Dr. DiMatteo. You took a decision into your own hands, a decision that wasn’t yours to make. Voss has already found out about it. Now Bayside’s going to have to pay for it. Big time.”
“Come on, Parr,” said Mark. “It hasn’t reached that point.”
“You think Victor Voss won’t call his lawyers?”
“On what basis? There’s a directed-donation consent. The heart had to go to the boy.”
“Only because she coerced the husband into signing!” said Parr, pointing angrily at Abby.
“All I did was tell him about Josh O’Day,” said Abby. “I told him the boy was only seventeen—”
“That alone is enough to get you fired,” said Parr. He glanced at his watch. “As of seven-thirty—that’s right now— you’re out of the residency program.”
Abby stared at him in shock. She started to protest, but found her throat had closed down, strangling the words.
“You can’t do that,” said Mark.
“Why not?” said Parr.
“For one thing, it’s a decision for the program director. Knowing the General, I don’t think he’ll take to having his authority usurped. For another thing, our surgical house staff is already stretched thin. We lose Abby, that means thoracic service rotates call every other night. They’ll get tired, Parr. They’ll make mistakes. If you want lawyers on your doorstep, that’s how to do it.” He glanced at Abby. “You’re on call tomorrow night, aren’t you?”
She nodded.
“So what do we do now, Parr?” said Mark. “You know of some other second-year resident who can just step right in and take her place?”
Jeremiah Parr glared at Mark. “This is temporary. Believe me, this is only temporary.” He turned to Abby. “You’ll hear more about this tomorrow. Now get out of here.”
On unsteady legs, Abby somehow managed to walk out of Parr’s office. She felt too numb to think. She made it halfway down the hallway and stopped. Felt the numbness give way to tears. She would have broken down and cried right then and there, had it not been for Mark, who came up beside her.
“Abby.” He turned her around to face him. “It’s been a battlefield here all afternoon. What the hell did you think you were doing today?”
“I was saving a boy’s life. That’s what I thought I was doing!” Her voice cracked, shattered into sobs. “We saved him, Mark. It’s exactly what we should have done. I wasn’t following orders. I was following my own instincts. Mine.” She made an angry swipe at her tears. “If Parr wants to get back at me, then let him. I’ll present the facts to any ethics committee. A seventeen-year-old boy versus some rich man’s wife. I’ll lay it all out, Mark. Maybe I’ll still get fired. But I’ll go down kicking and screaming.” She turned and continued down the hall.
“There’s another way. An easier way.”
“I can’t think of one.”
“Listen to me.” Again he caught her arm. “Let Vivian take the fall! She’ll do it anyway.”
“I did more than just follow her orders.”
“Abby, take a gift when it’s offered! Vivian accepted the blame. She did it to protect you and the nurses. Leave it at that.”
“And what happens to her?”
“She’s already resigned. Peter Dayne’s taking over as chief resident.”
“And where does Vivian go?”
“That’s her concern, not Bayside’s.”
“She did exactly what she should have done. She saved her patient’s life. You don’t fire someone for that!”
“She violated the number one rule here. And that’s play with the team. This hospital can’t afford loose cannons like Vivian Chao. A doctor’s either with us or against us.” He paused. “Where does that put you?”
“I don’t know.” She shook her head. Felt the tears beginning to fall again. “I don’t know anymore.”
“Consider your options, Abby. Or your lack of them. Vivian’s finished her five years of residency. She’s already board-eligible. She could find a job, open a surgical practice. But all you’ve got is an internship. You get fired now, you’ll never be a surgeon. What’re you going to do? Spend the rest of your life doing insurance physicals? Is that what you want?”
“No.” She took a breath and let it out in a rush of despair. “No.”
“What the hell do you want?”
“I know exactly what I want!” She wiped her face with a furious swipe of her hand. Took another deep breath. “I knew it today. This afternoon. When I watched Tarasoff in the OR. I saw him pick up the donor heart and it’s limp, like a handful of dead meat. And there’s the boy on the table. He connects the two and the heart starts beating. And suddenly there’s life again . . .” She paused, swallowing back another surge of tears. “That’s when I knew what I wanted. I want to do what Tarasoff does.” She looked at Mark. “Graft a piece of life onto kids like Josh O’Day.”
Mark nodded. “Then you have to make it happen. Abby, we can still make this work. Your job. The fellowship. Everything.”
“I don’t see how.”
“I’m the one who pushed your name for the transplant team. You’re still my number one choice. I can talk to Archer and the others. If we all stick by you, Parr will have to back down.”
“That’s a big if.”
“You can help make it happen. First, let Vivian take the blame. She was chief resident. She made a bad judgment call.”
“But she didn’t!”
“You saw only half the picture. You didn’t see the other patient.”
“What other patient?”
“Nina Voss. She was admitted at noon today. Maybe you should take a look at her now. See for yourself that the choice wasn’t so clear. That it’s possible you did make a mistake.”
Abby swallowed. “Where is she?”
“Fourth floor. Medical ICU.”
Even from the hallway, Abby could hear the commotion in the MICU: the cacophony of voices, the whine of a portable X-ray machine, two telephones ringing at once. The instant she walked through the doorway, she felt a hush descend on the room. Even the telephones suddenly went silent. A few of the nurses were staring at her; most were pointedly looking the other way.
“Dr. DiMatteo,” said Aaron Levi. He had just emerged from Cubicle 5, and he stood staring at her with a look of barely suppressed rage. “Perhaps you should come and see this,” he said.
The throng of personnel silently moved aside to let Abby approach Cubicle 5. She went to the window. Through the glass, she saw a woman lying in the bed, a fragile-looking woman with white-blond hair and a face as colorless as the sheets. An ET tube had been inserted down her throat and was hooked up to a ventilator. She was fighting the machine, her chest moving spasmodically as she tried to suck in air. The machine wasn’t cooperating. Alarms buzzed as it fed her breaths at its own preset rhythm, ignoring the patient’s desperate inhalations. Both the wom
an’s hands were restrained. A medical resident was inserting an arterial line into one of the patient’s wrists, piercing deep under the skin and threading a plastic catheter into the radial artery. The other wrist, tied to the bed, looked like a pincushion of IV lines and bruises. A nurse was murmuring to the patient, attempting to calm her down, but the woman, fully conscious, stared up with an expression of sheer terror. It was the look of an animal being tortured.
“That’s Nina Voss,” said Aaron.
Abby remained silent, stunned by the horror she saw in the woman’s eyes.
“She was admitted eight hours ago. Almost from the moment she arrived, her condition deteriorated. At five o’clock she coded. Ventricular tachycardia. Twenty minutes ago, she coded again. That’s why she’s intubated. She was scheduled for surgery tonight. The team was ready. The OR was ready. The patient was more than ready. Then we find out the donor went to surgery hours ahead of schedule. And the heart that should have gone to this woman has been stolen. Stolen, Dr. DiMatteo.”
Still Abby said nothing. She was transfixed by the ordeal she was witnessing in Cubicle 5. At that instant, Nina Voss’s eyes lifted to hers. It was only a brief meeting of gazes, an appeal for mercy. The pain in those eyes left Abby shaken.
“We didn’t know,” Abby whispered. “We didn’t know her condition was critical . . .”
“Do you realize what will happen now? Do you have any idea?”
“The boy—” She turned to Aaron. “The boy’s alive.”
“What about this woman’s life?”
There was no reply Abby could make. No matter what she said, how she defended herself, she could not justify the suffering beyond that window.
She scarcely noticed the man crossing toward her from the nurses’ station. Only when he said “Is this Dr. DiMatteo?” did she focus on the man’s face. He was in his sixties, tall and well dressed, the sort of man whose very presence demands attention.
Quietly she answered, “I’m Abby DiMatteo.” Only as she said it did she realize what she saw in the man’s eyes. It was hatred, pure and poisonous. She almost backed away as the man stepped toward her, his face darkening in rage.
“So you’re the other one,” he said. “You and that chink doctor.”
“Mr. Voss. Please,” said Aaron.
“You think you can fuck around with me?” Voss yelled at Abby. “With my wife? There’ll be consequences, doctor. Damn you, I’ll see there are consequences!” Hands clenched, he took another step toward Abby.
“Mr. Voss,” said Aaron, “Believe me, we’ll deal with Dr. DiMatteo in our own way.”
“I want her out of this hospital! I don’t want to see her face again!”
“Mr. Voss,” said Abby. “I’m so sorry. I can’t tell you how sorry I am—”
“Just get her the hell away from me!” roared Voss.
Aaron quickly moved between them. He took Abby firmly by the arm and pulled her away from the cubicle. “You’d better leave,” he said.
“If I could just talk to him—explain—”
“The best thing you can do right now is leave the ICU.”
She glanced at Voss, who stood squarely in front of Cubicle 5 as though guarding his wife from attack. Never before had Abby seen such a look of hatred. No amount of talking, of explanation, could ever get past that.
Meekly she nodded to Aaron. “All right,” she said softly. “I’ll leave.”
And she turned and walked out of the MICU.
Three hours later, Stewart Sussman pulled up at the curb on Tanner Avenue, and from his car he studied number 1451. The house was a modest cape with dark shutters and a covered front porch. A white picket fence surrounded the property. Though it was too dark for Sussman to see much of the yard, instinct told him the grass would be trim and the flowerbeds free of weeds. The faint perfume of roses hung in the air.
Sussman left his car and walked through the gate and up the porch steps to the front door. The occupants were home. The lights were on, and he could see movement through the curtained windows.
He rang the bell.
A woman answered. Tired face, tired eyes, her shoulders sagging under some terrible psychic weight. “Yes?” she said.
“I’m sorry to disturb you. My name is Stewart Sussman. I wonder if I might have a word with Joseph Terrio?”
“He’d rather not speak to anyone right now. You see, we’ve just had a . . . loss in the family.”
“I understand, Mrs. . . .”
“Terrio. I’m Joe’s mother.”
“I know about your daughter-in-law, Mrs. Terrio. And I’m very, very sorry. But it’s important I speak to your son. It has to do with Karen’s death.”
The woman hesitated only a moment. Then she said: “Excuse me,” and shut the door. He could hear her call: “Joe?”
A moment later the door opened again and a man appeared, eyes red-rimmed, every movement sluggish with grief. “I’m Joe Terrio,” he said.
Sussman extended his hand. “Mr. Terrio, I’ve been sent here by someone who’s very concerned about the circumstances surrounding your wife’s death.”
“Circumstances?”
“She was a patient at Bayside Medical Center. Is that correct?”
“Look, I don’t understand what this is all about.”
“It’s about your wife’s medical care, Mr. Terrio. And whether any mistakes were made. Mistakes that may have proved fatal.”
“Who are you?”
“I’m an attorney with Hawkes, Craig and Sussman. My specialty is medical malpractice.”
“I don’t need any attorney. I don’t want any goddamn ambulance chaser bothering me tonight.”
“Mr. Terrio—”
“Get the hell out of here.” Joe started to close the door, but Sussman put out a hand to stop it.
“Mr. Terrio,” Sussman said quietly. Calmly. “I have reason to believe one of Karen’s doctors made an error. A terrible error. It’s possible your wife didn’t have to die. I can’t be certain of that yet. But with your permission, I can look at the record. I can uncover the facts. All of the facts.”
Slowly Joe let the door swing open again. “Who sent you? You said somebody sent you. Who was it?”
Sussman gazed back with a look of sympathy. “A friend.”
6
Never before had Abby dreaded going to work, but as she walked into Bayside Hospital that morning, she felt she was walking straight into the fire. Last night Jeremiah Parr had threatened repercussions; today she’d have to face them. But until Wettig actually stripped her of her hospital privileges, she was determined to carry on as usual with her duties. She had patients to round on and cases scheduled for the OR. Tonight she was on call. Damn it, she was going to do her job, and do it well. She owed it to her patients—and to Vivian. Only an hour ago, they had spoken on the phone, and Vivian’s last words to her were: “Someone there has to speak up for the Josh O’Days. Stay with it, DiMatteo. For both of us.”
The moment Abby walked into the SICU, she heard the instantaneous lowering of voices. By now, everyone must know about Josh O’Day. Though no one said a word to Abby, she could hear the nurses’ quiet murmurings, could see their uneasy looks. She went to the rack and gathered her patients’ charts for rounds. It took every ounce of concentration for her to complete that one task. She placed the charts in a rolling cart and wheeled it out of the station, to the cubicle of the first patient on her list. It was a relief just to step inside, away from everyone’s gaze. She shut the curtains, blocking the view through the doorway, and turned to the patient.
Mary Allen lay on the bed, her eyes closed, her sticklike arms and legs drawn up in a fetal position. Mary’s open lung biopsy two days ago had been followed by two brief episodes of hypotension, so she’d been kept in the SICU for close observation. According to the nurse’s notes, Mary’s blood pressure had remained stable for the past twenty-four hours and no abnormal cardiac rhythms had been noted. Chances were, Mary could be transferred today
to an unmonitored room in the surgery ward.
Abby went to the bedside and said, “Mrs. Allen?”
The woman stirred awake. “Dr. DiMatteo,” she murmured.
“How are you feeling today?”
“Not so good. It still hurts, you know.”
“Where?”
“My chest. My head. Now my back. It hurts all over.”
Abby saw from the chart that the nurses had been giving morphine around the clock. Obviously it wasn’t enough; Abby would have to order a higher dose.
“We’ll give you more medicine for the pain,” said Abby. “As much as you need to keep you comfortable.”
“To help me sleep, too. I can’t sleep.” Mary gave a sigh of profound weariness and closed her eyes. “I just want to go to sleep, doctor. And not wake up . . .”
“Mrs. Allen? Mary?”
“Couldn’t you do that for me? You’re my doctor. You could make it so easy. So simple.”
“We can make the pain go away,” said Abby.
“But you can’t take away the cancer. Can you?” The eyes opened again, and regarded Abby with a look that pleaded for undiluted honesty.
“No,” said Abby. “We can’t take that away. The cancer’s spread to too many places. We can give you chemotherapy, to slow it down. Gain some time for you.”
“Time?” Mary gave a resigned laugh. “What do I need time for? To lie here another week, another month? I’d rather have it done and over with.”
Abby took Mary’s hand. It felt like bones wrapped in parchment, no flesh at all. “Let’s take care of the pain first. If we do that, it could make everything else seem different.”
In answer, Mary simply turned on her side, away from Abby. She was closing her off, shutting her out. “I suppose you want to listen to my lungs,” was all she said.
They both knew the exam was merely a formality. It was a useless ceremony, the stethoscope on the chest, on the heart. Abby went through the motions anyway. She had little else to offer Mary Allen except this laying on of hands. When she was finished, her patient still lay with her back turned.