Blood Double Read online

  NEIL MCMAHON

  BLOOD

  DOUBLE

  For Dan Conaway,

  whose guidance, patience, and trust made this happen

  Table of Contents

  Title Page

  1

  2

  3

  4

  5

  6

  7

  8

  9

  10

  11

  12

  13

  14

  15

  16

  17

  18

  19

  20

  21

  22

  23

  24

  25

  Acknowledgments

  About the Author

  Praise

  Other books by this Author

  Copyright

  About the Publisher

  If God afflicts somebody,

  we ought all to profit from it.

  —John Calvin

  1

  Carroll Monks was standing on the spot he thought of as the bridge of Mercy Hospital’s emergency room. It was like the command deck of a ship, the point from which he could monitor most of what was going on at any given time: the eight private cubicles, six of which were occupied; the trauma room, which was not; the activities of his resident, nurses, and other staff; the softly bleeping monitors and blinking lights of the complex instruments; and the main desk, where the charge nurse worked at a computer. Monks could glimpse through the glass doors into the waiting room, which held a further group of postulants, most of them in discomfort, none in severe distress. He could hear the ongoing radio report of a team of paramedics in the field, attending to a mild heart attack that did not require his intervention.

  This was the way the ER was most of the time, busy but stable—and tensed for whatever might burst through the doors that would throw it into organized frenzy.

  It was a damp Tuesday evening in March, 7:07 P.M.

  Monks sensed a stir in the waiting room, a tiny ripple of movement that caught his gaze. A woman was coming in. He got an instant impression as she yanked open the door, framed in its light. She was about twenty, pretty, sturdily built, with black hair and golden skin: Asian. Heavily made up, wearing a short black dress. On her own feet, with no obvious injury.

  But moving fast. Half-running, on spike heels, to the desk. Speaking urgently to the receptionist, pointing back outside.

  The receptionist leaned forward, puzzled.

  The Asian woman closed her eyes and quickly placed her palms together beside her tilted face, a child’s gesture of sleep. Then she jabbed her finger toward the outside again.

  Monks said, “Nurse!” and moved for the door.

  The cool wet air of the San Francisco night blurred his eyes, and he squinted to focus in the orange-yellow glow of the parking lot’s lights. Twenty yards ahead, a figure lay sprawled on the sidewalk, with another crouched over it. Their faces were touching. Monks felt an instant of eerie terror, the shocking sense that he had stumbled onto an act of desperate passion gone wrong, or even a vampire ripping into its victim’s throat.

  But then the crouching man’s face lifted, and Monks saw one hand pinching the downed man’s nostrils, the other positioned behind the neck. This was not violence, it was mouth-to-mouth resuscitation.

  Monks turned to yell behind, “I’ve got an unconscious man, he’s not breathing, let’s go,” and dropped to his knees beside the sprawled figure. His fingers touched the neck to find the carotid artery’s pulse. It was barely detectable. He thumbed an eyelid open and could just make out the blank round iris, the pupil shrunk to a pinpoint. The body was shutting down.

  The crouched man, like the woman, was Asian: small, wiry, gaunt-faced. His eyes watched Monks.

  “Ovahdose,” he said. His hands moved to make a quick gesture of jabbing a needle into his arm.

  The other man was Caucasian, in his late thirties. His face was dirty and abraded, as if from falling. But his shirt was hand-woven, tailored cotton, and his shoes leather loafers that also looked handmade. His teeth were beautifully cared for. This was not the sort of junkie Monks was used to, and his first guess would have been respiratory failure from another cause—except for what the Asian man seemed to be telling him.

  Monks said, “Are you sure?”

  The Asian shook his head in incomprehension. “Ovahdose,” he said again, and bent back to the mouth-to-mouth. He was quick and efficient, obviously trained; had sustained the fragile hold on life for critical minutes.

  Monks decided to believe him.

  Monks craned around. Two nurses were coming fast with a gurney, kneeling with the Ambu bag to take over breathing. The Asian man exhaled one last breath into the receiving lungs, then moved out of the way in a crouching roll that made Monks think of a paratrooper’s landing fall.

  He strode ahead into the ER, calling orders, stepping into gloves and barrier gown. The nurses prepped the patient, putting a rolled towel behind his neck, hooking him to a cardiac monitor, preparing an IV. A respiratory therapist took over the Ambu bag, now hooked to an oxygen source. A third nurse arrived with a clipboard to note procedures and times.

  His gaze swept the room. His daughter Stephanie, in her first year of medical school, was working part-time as a hospital attendant. When Monks was on duty, she liked to visit the ER, getting a feel for it. She was standing against a wall, hands clasped like a shy girl waiting to be asked to dance: eager to help, afraid to interfere.

  He called to her, “Take over recording.” It would free up the nurse, and give Stephanie a look at why she might want to choose another specialty.

  “I’m having trouble breathing for him, Doctor.” The therapist was holding the mask against the patient’s face with one hand and squeezing the plastic sack hard with the other, but the lungs were not inflating well. Monks stepped in, pulled the jaw forward, and leaned close to listen. Over the weak breaths came the harsh sound of stridor: vocal cords or tongue had swollen, obstructing the passage.

  He said, “Let’s get an oral airway in.” He held the mouth open while she inserted the device, a flanged four-inch tube, to allow air past the tongue. He realized he was taking deep breaths himself, that he was unconsciously resisting what was happening, reassuring himself that it was not happening to him. He braced himself for the next step, the insertion of an endotracheal tube. It was a risky procedure under any circumstances, and if the constriction was severe, the ET tube would not work; it would require a cricothyrotomy, cutting a hole through the throat into the trachea.

  He scanned the vital signs: blood pressure at 90/60, heart rate showing on the monitor at 45, oxygen saturation meter, clipped to a finger, at 80 percent.

  Not good.

  “Give me an intubation tray.” He started to add, Let’s make this fast: the Ambu bag could remain off the face for perhaps fifteen seconds. But everybody knew.

  He prepared the laryngoscope and tube and positioned himself over the patient’s head. He nodded to the therapist. She gave the Ambu bag a couple of rapid squeezes, then lifted it. Monks pulled up on the tongue with the lighted scope and tried to ease the tube between the vocal cords. They were tight, resisting. He tried again. They still would not yield.

  “Get a scalpel ready,” he said.

  One nurse held out the gleaming knife in her fingers for him to grip. The other leaned in to towel sweat off his forehead. The fifteen seconds were up.

  He probed the tube between the vocal cords once more and said, “Give me a Selleck’s.” The therapist pushed down on the larynx. Monks felt the cords part slightly. He pressed harder, and closed his eyes in relief as the tube slid home.

  “I’m in,” he said.

 
He spent a minute catching up on his own breathing while the apparatus was secured, a balloon inflated to seal air in and vomit out, the tube taped into place. Now the chest rose and fell easily.

  “Breath sounds symmetrical, good on both sides,” Monks said, listening with his stethoscope, speaking to Stephanie. She looked a little shell-shocked. The whole thing had taken less than two minutes. “Oxygen saturation and blood pressure are starting to rise. He should be okay now.” He added kindly, “You’re supposed to be writing that down, hon.”

  “Sorry.” Flustered, head lowered, she started scribbling.

  To the others, he said, “Get a chest X-ray to make sure of that tube position.” It could still slip: into the right-stem main bronchus, inflating only the right lung, or back above the vocal cords, doing no good at all. “Start lab and an IV. Give one milligram Narcan, IV.” He caught surprised looks from the nurses; this was not the sort of junkie they were used to either.

  “I have a reason,” he said. “Let’s try it.”

  While they set up the IV and drew blood samples to take to lab, Monks gave the patient a once-over, looking, touching, listening. There were no apparent injuries besides the facial lacerations. Monks unbuttoned the left sleeve and pulled it up, noting, besides the expensive clothes, a heavy silver and turquoise bracelet and a similar ring, both of fine workmanship. The inside of the forearm was bruised and pocked, with several needle marks. But it was not the flesh of a serious user, and offered a possible explanation for the overdose: a well-to-do thrill seeker getting more than he could handle.

  “IV started, Narcan in,” Monks told Stephanie, and added, “Let’s get restraints on those wrists.” Narcan worked fast, often within a couple of minutes or even less. Once, early in his career, he had seen a patient sit bolt upright some thirty seconds after the Narcan went in, grab the endotracheal tube in her throat, and yank it out, inflated balloon and all.

  With the patient stable, there was time to think about other things, such as who he was. Monks patted the front pants pockets, then slipped his hand beneath each buttock, but could not feel a wallet. The obvious explanation was that he had been rolled, but it was hard to understand how a thief would have missed the bracelet and ring. Monks stepped to the cubicle’s door to see if he could find out anything from the people who had brought him in.

  The young Asian woman was standing at the main exit, gripping her purse, in intense conversation with Mrs. Hak, a receptionist whom Monks knew to be a native South Korean. He turned to tell the nurses that he was going to talk to them. But at that moment, the patient wheezed and tried to sit up, yanking at the restraints, hacking and gagging around the tube.

  Monks let the nurses handle it, laying soothing hands on the struggling man, pressing him gently back down, talking: “You’re in the emergency room, you’re going to be okay.”

  When the man was settled, Monks stepped into his line of sight. “You overdosed,” Monks said. “You stopped breathing.”

  The eyes widened. It gave him a fishlike look that quickly went from incomprehension to dismay. Narcan brought lucidity almost immediately.

  That sweet narcotic high was gone, and trouble was here.

  Monks said, “Relax. You’re fine. Just stay still a few seconds and we’ll get that tube out. Okay?”

  He stared at Monks, eyes bulging, then nodded.

  Monks made sure the suction apparatus was ready in case of vomiting, then reversed the procedure, deflating the balloon, withdrawing the tube. It went smoothly this time. The patient coughed and gagged, but recovered. Monks released the restraints, and the man sat up, sagging forward with his face in his hands.

  The respiratory therapist left, her work done. Monks motioned the nurses to the door and said quietly, “Give me a minute alone with him, huh? You can call off X-ray.”

  “Do you still need me?” Stephanie said. Monks could not quite tell whether she hoped the answer would be yes or no. He considered. This had happened so fast that the phlebotomist, who usually drew and handled blood samples, had not yet appeared.

  “Why don’t you go ahead and take those samples down to lab,” he said.

  She glanced around nervously. The tubes of blood were usually transported by cart, but there was no cart to be had. “You mean, like, just carry them?”

  Monks nodded. “Try not to drop them,” he advised. “They make a hell of a mess.”

  She moved away practically on tiptoe, the tray with its half dozen tubes encircled in her arms and cradled to her bosom, as if it were a relic being borne to worship.

  Monks walked back into the cubicle, went to the sink, and wet a hand towel with warm water, then pulled a stool to the bedside and sat.

  “I’ll clean up those cuts,” Monks said.

  “I’m all right,” the patient said. “I’ve got to get out of here.” He shifted his weight, preparing to stand.

  Monks put a hand on his shoulder. “Not just yet.”

  The return stare was stubborn. This was a man not accustomed to being crossed.

  “Is this about money?” he demanded.

  “This is about the fact that you came into my emergency room nearly dead, call it five minutes ago,” Monks said. “Not breathing. Heart almost stopped. Another minute or two, and we wouldn’t be having this conversation, that’s how close it was.

  “And it’s not over. You might still have enough dope in your system to kill you. It will last longer than the reversal drug I gave you. Meaning you could walk out of here and two hours from now drop dead of another OD. For real this time.” Monks watched the words register. “Is that what you wanted? Was this a suicide attempt?”

  The patient looked away and shook his head.

  “I’m Dr. Monks. This will be easier if I know your name.”

  “Smith. John.”

  Right.

  “Okay, John Smith. I’ll release you as soon as I’m satisfied you’re out of trouble. Is there someone you’d like us to call, to come get you? Family, friend?”

  “You haven’t called the police?” The question was quick and wary.

  “I have no reason to. The legal aspects of this are somebody else’s job.”

  John Smith’s relief was evident. “How long are we talking?”

  “If everything looks okay on your lab tests, and you stay awake?” Monks said. “Maybe four hours.”

  John stiffened in outrage. “That’s impossible. You have no right to keep me here.” He moved again to swing his feet to the floor. Monks placed a palm in the center of his chest, less gently this time.

  “I know you’re trying to cover your ass, John, with the phony name and all,” Monks said. “You don’t want this made public, and I don’t blame you. Let’s face it, you’d look like a dork.”

  John’s face tightened. A dork was not something he wanted to look like.

  “But I’ve got to cover my ass too,” Monks said. “If I let you out of here and you go down again, I might as well put a gun to my head. There’d be lawyers all over me and this hospital like coyotes on a bunny. So you’re going to stay where I can see you, and if you give me a hard time, I will call the cops. Now settle back, this is going to sting.”

  “Why don’t you give me a shot?” John Smith mumbled. “For the pain.”

  “For Christ’s sake,” Monks said. “The whole reason you’re in here is because you took a shot that just about killed your pain for good. Grit your teeth, it won’t take long.”

  Monks carefully cleaned around the facial lacerations, with John wincing as the crusted blood and bits of grit came free. The impression was that he had been raked with a concrete cheese grater, leaving a patchwork of bloody furrows.

  “You took a pretty good header,” Monks said. “What happened?”

  “I don’t remember,” John said sullenly.

  None of the wounds was severe enough to require stitches. Monks applied Bactroban and taped on a bandage.

  “You don’t look like an addict,” Monks said. “How does a guy like y
ou start shooting up?”

  “I don’t want to go into it.”

  “Did you do your usual dose?”

  “Yeah. Are you finished?”

  Monks went to the sink to wash his hands. “For now.”

  “Then how about giving me a phone. And some privacy.”

  Monks had been working on his temper for the last forty years or so. It was getting better.

  He said, “If you’re going to go out and blast yourself again, do me a favor: Get far enough away so you won’t end up back in my ER.”

  Monks got a cordless phone and took it to John Smith, who accepted it without thanks. When Monks left the cubicle this time, he found Stephanie waiting, peering in. She beckoned him a few steps away. Her whisper was urgent, her eyes wide.

  “Daddy, I mean, Doctor, I didn’t mean to spy, but I saw him when you were taping him up. You know who he looks like?” Her voice was brimming with excitement. “Lex Rittenour.”

  Monks blinked in surprise. “That guy in there? With the vomit stains on his shirt?”

  “Just because he’s brilliant doesn’t mean he’s a Boy Scout. He did a lot of wild stuff. There’s been at least one paternity suit.”

  Dinosaur that Monks was, even he knew the name. Lex Rittenour was a legend of the computer world, a wunderkind who had started designing revolutionary software while still in his teens. But he had raised eyebrows—and hackles—by a glaring disregard for the corporate world, often appearing at important functions barefoot, wearing ragged jeans and beads. Monks seemed to recall that there was a publicized association with eastern religions too. But then, for the past several years, Rittenour had dropped out of sight.

  Monks took an unobtrusively closer look at John’s face, trying to resurrect the glimpse he had gotten between the crusted blood and Ambu bag and the bandage that now covered most of one cheek from temple to jaw. It was clean-shaven, with a somewhat beaky nose and a thick brown shock of hair that was long but obviously carefully cut. The overall impression was of a rich forty-year-old hippie. Monks recalled photos of Rittenour and admitted the resemblance. But it was a look that was in vogue; there were plenty of men around who had it. As far as the ER was concerned, John Smith was a John Doe junkie who had caused them some moments of serious tension, and in spite of his assurances, was likely to cost them a fair chunk of money.