“Vickie, I’m up against a wall. I need you to watch Mom for a few hours.”
“You mean . . . now?” Vickie’s laugh was sharp and incredulous.
“I’ve got an emergency meeting at the hospital. I’ll drop her off with you and pick her up again as soon as the meeting’s over.”
“Toby, I’ve got company coming tonight. I’m cooking, the house still needs to be cleaned, and the kids’re coming home from school.”
“Mom’s no trouble, really. She’ll keep herself busy in the backyard.”
“I can’t have her wandering in the yard! We just put in new grass—”
“Then set her in front of the TV. I’ve got to leave now or I’m not going to make it.”
“Toby—”
She slammed the receiver down. She didn’t have the time or patience to argue; Vickie’s house was half an hour’s drive away.
She found Ellen outside, happily mucking around in the compost heap.
“Mom,” said Toby. “We have to go to Vickie’s house.”
Ellen straightened, and Toby was dismayed to see her mother’s hands were filthy, her dress soiled. There was no time to get her bathed and changed. Vickie would pitch a fit.
“Let’s get in the car,” urged Toby. “We have to hurry.”
“We shouldn’t bother Vickie, you know.”
“You haven’t seen her in weeks.”
“She’s busy. Vickie is a very busy girl. I don’t want to bother her.”
“Mom, we have to leave now.”
“You go. I’ll just stay home.”
“It’s only for a few hours. Then we’ll come right back.”
“No, I think I’ll just tidy up here in the garden.” Ellen squatted down and thrust her trowel deep into the black mound of compost.
“Mom, we have to go!” In frustration, Toby grabbed her mother’s arm, and hauled her back to her feet so abruptly Ellen gave a gasp of shock.
“You’re hurting me!” Ellen wailed.
Instantly Toby released her. Ellen took a step backward, rubbing her arm as she stared in bewilderment at her daughter.
It was Ellen’s silence, and the glimmer of tears in her eyes, that cut straight to Toby’s heart.
“Mom.” Toby shook her head, sick with shame. “I’m sorry. I’m really sorry. I just need you to cooperate with me right now. Please.”
Ellen looked down at her hat, which had fallen and now lay on the grass, the straw brim trembling in the wind. Slowly she bent down to retrieve it, then straightened, hugging the hat to her chest. In a gesture of sorrow, she lowered her head and nodded. Then she walked to the garden gate and stood waiting for Toby to open it.
On the drive to Vickie’s, Toby tried to make up with Ellen. With forced cheerfulness she talked about what they would do this weekend. They’d put up another rose trellis against the house and plant a bush of New Dawn, or perhaps Blaze. Ellen did love red roses. They would spread compost and plan a bulb garden. They would eat fresh tomato sandwiches and drink lemonade. There was so much to look forward to!
Ellen stared at the hat in her lap and said nothing.
They pulled into Vickie’s driveway, and Toby steeled herself for the ordeal to come. Vickie, of course, would make a noisy deal about just how big an imposition this was. Vickie and all her responsibilities! A faculty position in the biology department at Bentley College. A snooty executive husband whose favorite word was me. A son and daughter, both in sullen adolescence. Lucky Toby, single and childless! Of course she was the obvious one to take care of Mom.
What else would I do with my life?
Toby helped Ellen out of the car and up the front steps to the house. The door swung open and Vickie appeared, her face flushed with annoyance.
“Toby, this is the worst possible time.”
“For both of us, believe me. I’ll try to pick her up as soon as I can.” Toby urged her mother forward. “Go on, Mom. Have a nice visit.”
“I’m cooking,” said Vickie. “I can’t watch her—”
“She’ll be fine. Sit her in front of the TV. She likes the Nickelodeon channel.”
Vickie frowned at Ellen’s dress. “What happened to her clothes? She’s filthy. Mom, is something wrong with your arm? Why’re you rubbing it?”
“Hurts.” Ellen shook her head sadly. “Toby got mad at me.”
Toby felt her face redden. “I had to get her into the car. She wouldn’t leave the garden. That’s why she’s so dirty.”
“Well, I can’t have her looking like that. I have company coming at six!”
“I promise, I’ll be back before then.” Toby gave Ellen a kiss on the cheek. “See you later, Mom. You listen to Vickie.”
Without a backward glance, Ellen walked into the house. She’s punishing me, thought Toby. Making me feel guilty for having lost my temper.
“Toby,” said Vickie, following her down the front steps to the car. “I need more warning next time. Isn’t this what we pay Bryan for?”
“Not available. Your kids’ll be home soon. They can watch her.”
“They don’t want to!”
“Then try paying them. Your kids certainly seem to value the almighty buck.” Toby slammed the car door shut and started the engine. Why the hell did I say that? she thought as she drove away. I have to cool down. I have to get back in control and get ready for this meeting. But she’d already blown it with Vickie. Now her sister was pissed at her, and so was Ellen. Maybe the whole goddamn world was pissed at her.
She had the sudden impulse to step on the gas and keep driving, to leave this all behind. Find a new identity, a new town, a new life. The one she had now was a mess, and she didn’t know whose fault that was. Certainly not all hers; she was simply trying to do the best she could.
It was 2:10 when she pulled into a parking stall at Springer Hospital. She had no time to collect her thoughts; the meeting was already under way, and she didn’t want Doug Carey shooting off his mouth in her absence. If he was going to attack her, she wanted to be there to defend herself. She hurried straight to the administrative wing on the second floor and stepped into the conference room.
Inside, all conversation ceased.
Glancing around the table, she saw friendly faces among the six people sitting there. Paul Hawkins. Maudeen and Val. Toby sat down in the chair next to Val, and across from Paul, who gave her a silent nod of greeting. If she had to stare at someone, it might as well be at a good-looking man. She barely glanced at Dr. Carey, who was at the far end of the table, but his hostile presence was impossible to ignore. A small man—in more ways than one—Carey compensated for his short stature by a ramrod posture and a gaze that was threateningly direct. A mean little Chihuahua. At that moment he was looking straight at Toby.
She ignored Carey and focused instead on Ellis Corcoran, the chief of the Med-Surg staff. She didn’t know Corcoran very well; she wondered if anyone at Springer did. It was hard to get past his Yankee reserve. He seldom showed emotion, and he was showing none now. Neither did the hospital administrator, Ira Beckett, who sat with bulging abdomen crammed up against the table. The silence went on a little too long for comfort. Her palms were damp; under the table, she wiped her hands on her slacks.
Ira Beckett spoke. “You were telling us, Ms. Collins?”
Maudeen cleared her throat. “I was trying to explain to you that everything happened at once. We had that code in the trauma room. That took all our attention. We figured Mr. Slotkin was stable enough—”
“So you ignored him?” said Carey.
“We didn’t ignore him.”
“How long did you leave him unattended?” asked Beckett.
Maudeen glanced at Toby with a silent plea of help me out here.
“I was the last one to see Mr. Slotkin,” Toby said. “That was around five, five-fifteen. It was sometime after six when I realized he was gone.”
“So you left him unattended for almost an hour?”
“He was waiting for a CT scan. We’d
already called in the X-ray tech. There was nothing else we were doing for him at that point. We still don’t know how he managed to leave the room.”
“Because you people didn’t keep an eye on him,” said Carey. “You didn’t even have him restrained.”
“He was restrained,” said Val. “Both ankles and wrists!”
“Then he must be some kind of Houdini. Nobody gets out of four-point restraints. Or did someone forget to tie the straps down?”
Neither nurse spoke; they were both staring at the table.
“Dr. Harper?” said Beckett. “You said you were the last one to see Mr. Slotkin. Were his restraints tied?”
She swallowed. “I don’t know.”
Paul frowned at her across the table. “You told me they were.”
“I thought they were. I mean, I assumed I tied them. But it was such a confusing shift. Now I’m—I’m not so sure. If he was tied down, it seems impossible that he could have escaped.”
“At least we’re finally being honest about this,” said Carey.
“I’ve never not been honest!” she shot back. “If I screw up, at least I admit it.”
Paul cut in, “Toby—”
“Sometimes we’re juggling half a dozen crises at once. We don’t remember every single detail of what goes wrong during a shift!”
“You see, Paul?” said Carey. “This is what I’m talking about. I run into this defensiveness all the time. And it’s always the night shift.”
“You’re the only one who seems to complain,” said Paul.
“I can name half a dozen other docs who’ve had problems. We get called in at all hours of the night to admit patients who don’t need to be admitted. It’s a judgment problem.”
“Which patients are you referring to?” asked Toby.
“I don’t have the names in front of me now.”
“Then you get the names. If you’re going to question my judgment, I want specifics.”
Corcoran sighed. “We’re getting off the subject.”
“No, this is the subject,” said Carey. “The competence of Paul’s ER staff. Do you know what was going on in the ER that night? They were having a goddamn birthday party! I went into the staff room for a cup of coffee and they had streamers hanging all over the place! A cake and a bunch of burned candles. That’s probably what happened. They were so busy partying in the back room, they didn’t bother to—”
“That is a bunch of crap,” said Toby.
“There was a party, wasn’t there?” said Carey.
“Earlier in the shift, yes. But it didn’t distract us from our jobs. Once that tamponade case came in, we were up to our asses in alligators. She required all our attention.”
“And you lost her too,” said Carey.
His comment felt like a slap, and heat flooded Toby’s cheeks. The worst part of it was, he was right. She had lost the patient. Her shift had turned into a disaster—and a very public one. New patients had walked into the waiting room to hear an angry monologue by Harry Slotkin’s son. Then an ambulance had pulled up with a chest pain, and the police had arrived—two squad cars called in to help search for the missing patient The first law of physics had taken over as Toby’s tightly regulated ER had devolved into a state of chaos.
She leaned forward, her hands pressed to the table, her gaze not on Carey, but on Paul. “We didn’t have the backup to deal with a tamponade. That patient belonged in a trauma center. We kept her alive as long as we could. I doubt even the wonderful Dr. Carey could have saved her, either.”
“You called me way too late in the game to do anything,” said Carey.
“We called you as soon as we realized she had a tamponade.”
“And how long did it take you to realize that?”
“Within minutes of her arrival.”
“According to the ambulance record, the patient arrived at five-twenty. You didn’t call me until five-forty-five.”
“No, we called you earlier.” She glanced at Maudeen and Val, who both nodded in agreement.
“It’s not in the code record,” said Carey.
“Who had time to take any notes? We were scrambling to save her life!”
Corcoran cut in: “Everybody, please! We’re not here to get in a fistfight. We need to talk about how to handle this new crisis.”
“What new crisis?” said Toby.
Everyone looked at her in surprise.
“I didn’t get a chance to tell you,” said Paul. “I just heard about it myself. Some newspaper’s picked up the story. Something along the lines of ’Forgotten patient vanishes from ER.’ A reporter called a little while ago, asking for details.”
“What makes this newsworthy?”
“It’s like that surgeon cutting off the wrong leg. People want to hear about things that go wrong in hospitals.”
“But who told the newspapers?” She looked around the table, and just for an instant, her gaze met Carey’s. He looked away.
“Maybe the Slotkin family told them,” said Beckett. “Maybe they’re laying the groundwork for a lawsuit. We really don’t know how the newspaper got word of it.”
Carey said, with a quiet note of venom, “Screwups do get noticed.”
“Yours usually manage to get buried,” said Toby.
“Please,” said Corcoran. “If the patient’s found unharmed, then we’ll be okay. But it’s going on two days now, and as far as I know, there’s been no sighting. We’re just going to have to hope they find him alive and well.”
“A reporter’s already called the ER twice this morning,” said Maudeen.
“No one talked to him, I hope?”
“No. In fact the nurses hung up on him.”
Paul gave a rueful laugh. “Well, that’s one way of handling the press.”
Corcoran said, “If they can just find the man, we might squeeze through this without any damages. Unfortunately, these Alzheimer’s patients can wander for miles.”
“He’s not an Alzheimer’s,” said Toby. “The medical history wasn’t consistent with that.”
“But you said he was confused.”
“I don’t know why. I didn’t find anything focal when I examined him. All the blood work came back normal. Unfortunately, we never got the CT scan. I wish I could tell you his diagnosis, but I never finished the workup.” She paused. “I did wonder, though, if he might be having seizures.”
“Did you witness one?”
“I noticed his leg jerking. I couldn’t tell if it was a voluntary movement or not.”
“Oh, God.” Paul sank back in his chair. “Let’s hope he doesn’t wander onto some highway, or near a body of water. He could be in trouble.”
Corcoran nodded. “So could we.”
After the meeting ended, Paul asked Toby to join him in the hospital cafeteria. It was three o’clock and the food line had closed down an hour ago, so they resorted to the vending machines, which were stocked with crackers and chips and a never-ending supply of coffee as strong as battery acid. The cafeteria was deserted, and they had the choice of any table in the room, but Paul crossed to the corner table, farthest from the doorway. Farthest from any listening ears.
He sat down without looking at her. “This isn’t easy for me,” he said.
She took one sip of coffee, then set the cup down with careful concentration. He was still focused not on her but on the tabletop. Neutral territory. It was not like Paul to avoid her gaze. Over the years they’d settled into a comfortable, plainspoken friendship. As with all friendships between men and women, there were, of course, the small dishonesties between them. She would never admit how strongly attracted she was to him, because it served no purpose, and she liked his wife, Elizabeth, too well. But in almost every other way, she and Paul could be honest with each other. So it hurt her now, to see him staring down at the table, because it made her wonder when he had stopped being entirely truthful.
“I’m glad you were there,” he said. “I wanted you to see what I’m up against.??
?
“You mean Doug Carey?”
“It’s not just Carey. Toby, I’ve been asked to attend the Springer board meeting next Thursday. I know this business is going to come up. Carey has friends on that board. And he’s out for blood.”
“He has been for months, ever since the Freitas boy died.”
“Well, this is the payback he’s been waiting for. Now the Slotkin case is out in the open, and the hospital board’s primed to hear all of Carey’s complaints about you.”
“Do you think his complaints are valid?”
“If I did, Toby, you wouldn’t be on my staff. I mean that.”
“The problem is,” she sighed, “I’m afraid I did screw up this time. I don’t see how Harry Slotkin could have escaped with his restraints tied down. Which means I must have left him untied. I just can’t remember. . .” Her eyes felt gritty from lack of sleep, and the coffee was churning in her stomach. Now I’m losing my memory, she thought. Is this the first sign of Alzheimer’s disease? Is this the beginning of the end for me as well? “I keep thinking about my mother,” she said. “About how I’d feel if she was lost somewhere on the streets. How angry I’d be at the people responsible. I got careless and I put a helpless old guy in danger. Harry Slotkin’s family has every right to come after me with their lawyers. I’m just waiting for it to happen.”
It was Paul’s silence that made her look up.
He said, quietly, “I guess now’s the time to tell you.”
“What?”
“The family’s asked for a copy of the ER record. The request came through their attorney’s office this morning.”
She said nothing. The churning in her stomach had turned to nausea.
“It doesn’t mean they’re going to sue,” said Paul. “For one thing, the family hardly needs the money. And the circumstances may prove too embarrassing to air. A father wandering naked in the park—”
“If Harry’s found dead, I’m sure they will sue.” She dropped her head in her hands. “Oh, God. It’s my second lawsuit in three years.”
“The last suit was a crock, Toby. You beat it.”
“I won’t beat this one.”
“Slotkin’s seventy-two years old—not much of a life span left. That could lessen the monetary damages.”