It’s spring in Buffalo, New York. At sprawling St. Paul’s Hospital, new interns rush through the halls, staff doctors scramble to catch their protégés’ mistakes, and everyone is aware of one unrelenting threat: A new and vicious strain of severe acute respiratory syndrome (SARS) has hit America hard and is menacing the hospital like a wolf at the door. Wrapped in spacesuit-like garb to search for every possible source of infection, the hospital staff desperately tries to protect the lives of patients–and of each ...
It’s spring in Buffalo, New York. At sprawling St. Paul’s Hospital, new interns rush through the halls, staff doctors scramble to catch their protégés’ mistakes, and everyone is aware of one unrelenting threat: A new and vicious strain of severe acute respiratory syndrome (SARS) has hit America hard and is menacing the hospital like a wolf at the door. Wrapped in spacesuit-like garb to search for every possible source of infection, the hospital staff desperately tries to protect the lives of patients–and of each other. Yet despite St. Paul’s best efforts, people are dying.
In this chilling medical landscape, no one notices the slight spike in the death rate in a palliative care ward. The prevailing attitude is “They’re supposed to die. That’s why we call them terminal.” When these same patients complain of terrifying near-death experiences, the hospital staff attributes it to delirium caused by medication. But when ER chief Dr. Earl Garnet gets blamed for the unexpected death of a patient, he defies protocol and opens an independent investigation. He quickly becomes suspicious that something far more sinister than disease is killing the hospital’s most vulnerable patients.
For Garnet, looking into the deaths means rattling relationships that have been built over years–relationships with several men and women he once trusted but now must doubt. With the SARS epidemic spinning out of control and a storm of suspicion, fear, and mistrust raging through the corridors of St. Paul’s, the hospital is rocked by a horrifying crime: A respected researcher is found brutally murdered. And his executioner may be ready to strike again.
With brilliant pacing, scalpel-sharp suspense, and an unmatched knowledge of the workings of a big-city hospital, Peter Clement is a thriller writer in a league of his own. In his new work, he takes us on a galvanizing, frightening, and constantly fascinating journey set on the front lines of medicine–where some dangers can be prevented and others can only be feared.
Several patients die each day at St. Paul's Hospital, a sprawling complex in Buffalo, N.Y., that takes on the most high-risk cases, including victims of the SARS virus. A few more deaths a week would hardly even be noticed. But hospital vice-president Dr. Earl Garnet, star of Clement's enjoyable line of medical thrillers, perks up when he hears about a strange circumstance in the hospital's cancer wing: a few days before they died, many of the patients reported out-of-body near-death experiences. Someone, Garnet determines, has been taking cancer patients to the brink of death and tape-recording their observations before briefly bringing them back to life. Suspects include the hospital's chaplain, Jimmy Fitzpatrick, who has been lobbying for years to get St. Paul's to relax its policy on withholding pain medication to terminal patients; Monica Yablonsky, the head nurse on the cancer ward whose prickly, unhelpful demeanor makes Garnet wary; and Dr. Steward Deloram, St. Paul's critical care expert who has also done extensive research into near-death experiences. The action in Clement's sixth hospital-based thriller (Mortal Remains, etc.) moves briskly and without an overload of medical jargon. Despite several indistinguishable characters and a few dead-end plot lines-Clement does little with the SARS element after an initial buildup-this entry keeps the author on an ascending trajectory in the genre. Agent, Jay Mandel. (Dec. 28) Copyright 2004 Reed Business Information.
From former ER physician and novelist Clement, who moved into hardcover with 2001's Mutant, a gripping but shallow thriller about mutant genes in the food chain, now does his best work yet, building solid characters and the biggest US epidemic since the Spanish flu outbreak of 1918. SARS (severe acute respiratory syndrome) first appears in China, now hits the States, and strikes Buffalo, where St. Paul's Hospital fights a frightening load of germ-laden cases, usually of the very old, with no cure in sight. Even worse, the Palliative Care unit (patients near death, often in pain) notes an even larger death rate than SARS can explain, as well as clusters of out-of-body experiences (OOBs). As it happens, a shadowy figure slips into the unit at night and injects terminal patients with drugs that take their recipient to the very edge of death. For personal reasons, the figure wants taped anecdotal evidence of OOBs from the dying. By coincidence, Dr. Stewart Deloram, the hospital's resident genius in critical care, is also the world's leading authority on OOBs. The hero, Dr. Earl Garnet, who heads ER, has been boosted to vice president medical, second only to the CEO, and, though forced into a hospital-wide pain-management audit, seems to have overdosed a patient with morphine (but we know better). His wife, Dr. Janet Graceton, the staff's top obstetrician, is eight months pregnant but still works daily and will be the heroine-in-peril. Various suspects include tough-spoken hospital chaplain Father Jimmy Fitzpatrick, who glides about administering humor and prayer, and not so lighthearted Dr. Thomas Briggs, Earl's emergency medicine protege, who laughs and drawls like a Tennessee hillbilly.Smashing ER scenes, code blues, and a masked staff in orange space suits underpin a page-turner plotted for heart. Well done, nearing Tess Garritsen's bone-chillers.
PETER CLEMENT, M.D., is a physician who headed an emergency room at a major metropolitan hospital. He is also the author of Mortal Remains, Critical Condition, Mutant, The Procedure, Death Rounds, and Lethal Practice. He is married to a physician and has two sons.
Wednesday, April 2, 5:30 a.m.
Palliative Care Unit, St. Paul’s Hospital
Buffalo, New York
The air on the ward hung thick with the smell of flatulence, body odor, and sweat-soaked sheets. What little light could be seen curdled in pools of shadow. The cries that rose and fell against the outside of her door might as well have been a wail of wind, because here no one would heed them. The nurses paid attention only when the moaning stopped.
Somewhere someone retched with a force that must have stripped the stomach bare. The sound echoed along the hallway.
That might bring them.
Soon the squeak of crepe soles on linoleum would announce their approach.
“Store up all the tiny details. Let me smell, taste, hear, see, and touch through your telling of them.” The command, issued to me so long ago, resurfaced, resonating in memory with the freshness of an order spoken on the spot and not to be disobeyed. As always before a mission, it marshaled a frame of mind fine-tuned to observe, the ideal state to be in for keeping myself and the records sharp.
“Can you hear me?” I whispered, holding back on the plunger of my syringe.
“Yes.” Her eyes remained shut.
I leaned over and brought my ear to her mouth. “Any more pain?”
“No. It’s gone.”
“Do you see anything?”
“Only blackness.” Her whispers rasped against the back of her throat.
“Look harder! Now tell me what’s there.” I swallowed to keep from gagging. Her breath stank.
“You’re not my doctor.”
“No, I’m replacing him tonight.”
She didn’t respond.
I gave her a gentle shake. “Mrs. Algreave?”
“Just leave me be. It doesn’t hurt anymore.”
Leaning back, I studied her gray, skeletal face. The moonlight cast a silvery blue tinge over her pallid skin, making her appear already dead. As for the rest of her, so much had wasted away that the soft material of her lace nightgown clung to the hollows between her ribs and reminded me of white gloves on bony fingers.
I glanced toward the closed door—the nurses shouldn’t start their rounds for another half hour yet—and reapplied my thumb to the plunger. A slow push, and her pulse grew weaker. “Do you see anything yet?”
“Tell me what you see.”
“It’s too dark.”
“But I can’t see.”
“Do you sense yourself rising?”
Again no answer.
I shifted my mouth closer to her ear. “Talk to me, Mrs. Algreave.” The words must have sounded like a shout.
“Leave me alone.”
“Not until you tell me what you see.” I gradually increased the pressure on the plunger. Her pulse diminished to clusters of barely discernible bumps, readable only to experienced fingertips, like Braille. It shouldn’t be long now. Her failing circulation would abandon the lesser organs—kidneys, ovaries, digestive tracts, large and small—and reroute itself entirely to spare the more essential meats, the lungs, heart, and brain. A perfectly orchestrated sequence, designed to save neurons so that they could record the final seconds. Anyone bold enough could tap the knowledge hidden in those moments. “Are you looking down on us yet?”
At first I thought she hadn’t heard me. Then her lips moved but emitted no sound. Turning my head, I hovered an inch above her mouth. She exhaled against my cheek, sending another whiff of rot drifting through my nostrils to play at the back of my tongue. “What did you say?”
“I . . . see . . . me . . .”
Her words filled my ear one breath at a time, elongated and no louder than a puff of breeze. But I could just make them out, having become a practiced listener to messages from this plane. Excitement mounting, I turned on the tiny tape recorder in my breast pocket. “What else can you make out?”
“The . . . bed . . . nightstand . . . pictures . . . all my pictures . . .”
On the small bedside table a silver-framed black-and-white shot of a young man in uniform stood propped behind an array of more recent, color snaps, the kind processed in an hour: a dark-haired couple, three grinning boys in front of a Christmas tree, a woman holding a baby. Only the soldier interested me. “Is that your husband?”
“Yes . . .”
“What’s his name?”
I barely made out the word that followed. It sounded like “Frank.”
“Is he dead?”
Her breath diminished to a point it wouldn’t have fogged a mirror. “Yes . . .”
“Do you want to find him?” Most did. The yearning to meet up again never died.
“Yes . . .”
“Are you still looking down on yourself in bed?”
“Yes . . .”
“Let go. Allow yourself to float, escape the hospital, go high above the building. You must do this before you can see Frank.”
“Yes . . .”
“No . . .”
“Look up and you’ll see Frank. He’s waiting.”
“I . . . won’t . . . get . . . back. . . .”
No reply. Had I forced her too far? No, she still had a pulse. Nevertheless, I eased off the plunger. “Can you hear me?”
“Yes . . .”
“What do you see?”
“Too . . . vast . . .”
“What? Night? Space? Stars?”
“Gray . . .”
“Cold . . .”
“Tell me what’s there.”
“Nothing . . .”
My insides tightened. “You’ve got to see something.”
“It’s horrible . . .”
“Help me. . . .”
Damn her, why didn’t she tell me? “Describe where you are, or I’ll leave you there. Frank won’t ever find you.”
This time I heard a sharp intake of breath. “No . . . please . . .”
“Then tell me.”
“Nothing . . . to . . . tell . . .”
The pulse under my fingers raced stronger. Her breath blew against my ear with more force.
“It’s . . . terrible. . . . Get . . . me . . . out. . . . Please . . . get me out. . . .”
The faint sounds became a cry. Her eyes shot open, wide with terror.
No one had ever come to before now.
I clamped my palm over her mouth and watched the door again. Had one of the nurses heard?
No footsteps approached.
She looked straight at me.
“You recognize me now?” I asked, my thumb still on the plunger.
She nodded and tried to say something, but the sound vibrated against my palm. It tickled.
“Shh! Don’t speak!” I advanced the plunger. Just give her a little more, enough to subdue her again. “You’ve been having a bad dream.”
She shook her head and fixed her stare on where I’d stuck the syringe through a rubber portal in her IV. Her brows shot upward and her forehead furrowed with alarm, and the squeals she made against my hand pierced the quiet. I pressed down harder. “I said quiet!”
She started to buck, making the bed squeak.
Oh, God, where did she find the strength? The others hadn’t. I leaned on her, pinning the emaciated form to the mattress. “I warn you, stop it!” I had meant to whisper, but my voice rasped out of me in a crow’s squawk.
The bed rattled as she writhed under my weight.
I pushed more forcefully against her mouth.
Her movements continued. The iron frame began to creak in off-key squeals, the noises grating along the inside of my skull. Any minute a nurse would be sure to hear.
I increased the pressure on the syringe.
Flailing at me, she struck my arm, and the plunger lurched ahead, injecting the entire contents of the chamber into her IV.
I gaped at the emptied cylinder in horror.
She gradually stopped moving. Her pulse vanished. The respirations slowed to a standstill. Yet her brows remained raised, and she continued to glare at me, but with the flat dilated pupils of the dead.
Nausea swept through me, and my heart rate bounded into triple digits. I’d never killed one before. Just kept them in limbo as they died.
Swallowing until I had no more spit, I pulled out the syringe, replaced the safety cap, and pocketed it. A quick check of the covers and floor verified that nothing had been dropped or left behind. But as I bent over, the microcassette recorder slipped out of my breast pocket and clattered to the linoleum. Retrieving it, I clicked the off button. Close call. Had it hit a mat or her bedding without a sound, I might not have noticed.
I steadied my breathing and, surveying the scene, satisfied myself that everything would seem natural.
As I backed toward the door, the moonlight shone across her face at a low angle, filling the hollows and depressions with deep shadows. Her eyes, still open, glittered from the bottom of gaunt sockets. Despite my knowing better, I could have sworn they watched me every step of the way.