And All the Gods and Goddesses

By Michael Benne

On the verge of severe burnout after having worked seventeen years in urban settings, Dr. Matthew Johns, an arrogant but wildly talented trauma surgeon and emergency room physician,wants to able to maintain his way of doing emergency medicine in a rapidly changing world impacted by technology advances. For the new millenium, with his career in turmoil as well as his personal life, not to mention his spirit, he has to survive the daily onset of critically ill and traumatized patients,the digital demands of 21st century medicine, and the ambiguous position medicine finds itself in, immersed in regulations and bureaucracy. He personally, is striving to find a place he can call his own. where the staff likes and respects his autonomy, before he self-destructs.

• Language: English
• Publisher: Xlibris US
• Release date: Jan 15, 2016
• ISBN: 9781514450598

Michael Benne

The author is a retired emergency medicine physician with thirty years of experience in the field. He has also written a series of short stories as well as several one-act plays. He divides his time between living in Central Florida and the Florida Keys.

Book preview

CHAPTER 1

I T WAS ALWAYS the same. But different. It didn’t fool him anymore. But why couldn’t he control it better now that he was in on the game. Like that piece of metal in his hand, for instance, or was it wood—no, steel, that’s what it was—and it was cold and melting. Ridiculous! But it was melting down to nothing. Like the Wicked Witch of the––somewhere. I wanted butterfly wings. I asked for butterfly wings, in a nice way, but they refused. They just laughed. I asked again, maybe this time in a not so nice way, and the voice got louder. She could only give me strings. Hey, it’s strings or nothing, baby. But it’s too close to the bristles—those small, fine, delicate hairs—like mother’s. Yeah, those shallow—oh hell, why should I care. What the hell do they mean anyway? Only everything, that’s what. Oh yes. Now, the grin. The grin, lingering long after things stopped being funny. And always it stayed, like the cat in Alice’s Wonderland. Still there even when the rest of it had disappeared. Still grinning. And then the kid came on, came right on time, as usual, with that big hunk of a candy bar in his hand. He took a bite, and it exploded chocolate all over his face. And all over her and her white dress. But she never seemed to mind. She just stood there. Smiling. No, not this time. She was laughing at him, like everyone else. But not the kid. He just dropped down on to the floor and crawled over to a wall and then slouched against it. Waiting, waiting. For what, for christ’s sake!

And then it was dark. Darker than a night in his idea of hell. He fumbled in his pocket for something to cut a hole in the black, but he couldn’t find a knife. Everything else fell all over the ground. And the black became bright. Bright, like a five-thousand-watt bulb hanging from the top of nowhere. A screen dropped down in front of him, or maybe it was a white sheet. The film started unwinding. He could hear it as it moved through the sprockets. And there was a voice sounding over like something out of a pulp novel. It was carrying on about a fat man who was giving a barstool a hard time by sitting on it. There was a tired-looking piano player banging on a piano with some keys missing. A lot of keys missing. But he could have cared less. He was not exactly on loan out from Carnegie Hall. There was a blowsy-looking dame sitting on top of the piano, singing six octaves off key. Then she stopped her shrillness and looked up and smiled. Isn’t this the part where you tell me I’m going to have to take the fall. The fat man fell off his stool and onto his ass; he was laughing so hard. The laughter was so loud, it hurt his ear. It was so loud, it woke him up.

He blinked. Three or four times. Up above him, it looked hazy. He thought he saw some shadows moving. But it was still half a dream playing tricks on his still half awake mind. He was awake all right. And, for just an instant, he wished he wasn’t.

Callie knew he was awake before he did. She was purring so loudly, the bed shook. Then she jumped down. He could hear her batting that goddamned thing around again. He thought she did it just to spite him. Back and forth it went, flying across the room. Then she jumped back up and put her head next to his. She wanted her tuna, and it better be the brand she liked.

It was pitch-dark in the room. It could have been high noon for all anyone could tell. But the view out both windows was the side of a building. He had long ago invested in opaque drapes, always drawn, to keep what little light there was from leaking into the place. He could hear the rain pounding down outside. It hadn’t stopped for five days.

He rubbed the sleep out of his eyes and groped for a pad, pencil, and small flashlight on top of a small desk next to the bed, but all he managed to do was knock a half-empty coffee cup down on to the floor.

Shit. I must have shoved them into the drawer! he mumbled to no one in particular. Christ, have I gotten into the habit or talking to myself, he thought. Or maybe it was Callie I was talking to all the time. That sounds better. He switched on a light above the bed and opened the desk drawer. Inside, there were three or four unopened, unused condoms, his schedule, Callie’s immunization tag, and the pad and pencil. He grabbed the latter two and angrily scribbled some words down. He told her he would. Then he had made a point of telling her. That he had read Siggy’s The Interpretation of Dreams and thought it was a crock. Old movie stuff—Hitchcockian—was there such a word? Ingrid Bergman and Gregory Peck. Salvador Dali images. That’s all. Psycho babble. He laughed out loud.

He got up and switched on a couple of lamps. Then he put down a plate of fresh tuna from a just opened can. She’d become a tuna junkie to the point where she wouldn’t eat her cat food any more. Even at that, she wanted it fresh and pink, right out of the can, not that ugly mouse gray color that it took on after sitting in the refrigerator. He heated some of last night’s coffee in the microwave and sat down at a small table and lit a cigarette. He looked sleepily around the room. It hadn’t changed one bit since last night. Or, over the last almost a year, for that matter.

The calendar on the wall said it was October 1999. He had no reason to doubt it. It had been raining off and on in the city for two weeks. In another month it would probably turn into snow. Well, push come to shove, he didn’t care. The outside weather meant little to him. If he had it all his way, it would always be at least cloudy. If not dark and raining. He had lived with his share of snow too, being essentially from the area, going to school here, and then working in the area for much of his adult life.

The room was small and sparsely furnished. It lived up to its newspaper want ad moniker. It was efficient. There was something of a kitchen, with a stove, pristine and never used. There was, however, an overused microwave. Also a small fridge. And a coffeemaker, one of those cheap jobs that you threw out when it quit working and bought another. The sink held the residue of last night’s canned ravioli, sticking stubbornly to a plate. There was a table with some unmatched chairs. A cell phone was on top of the table, blinking furiously. He was thinking back of when you just had a phone and then you had a phone with an answer phone, and that wasn’t too bad. Now, you have this monstrous, unforgiving device that you carried around, making incessant demands on you to answer right now. He had heard it ring on two occasions during the night, but he had not felt the urge to answer. Besides, he’d have had to walk clear across the room to do it. Now, it was blinking. Maybe it would stop. After all, it had seen better days and nights. Also, on top of the table were a couple of packs of filtered menthol cigarettes. And an ashtray with exactly six cigarette butts in it. Well, maybe seven or eight.

At one end of the room, there was a desk that held a computer, defiantly unplugged. Against one wall, there was a piano. It was a studio upright he was renting. Not a Steinway but who was complaining. Besides, it had all its keys intact. Strewn about on top of the piano and on the floor were sheets of music in no particular order. He remembered what usually happened at night—loud pounding on the wall from angry neighbors who didn’t appreciate his artistry at two in the morning. Well, he didn’t blame them. But he didn’t stop altogether either.

Against another wall, defining and dominating the room, were shelves of more music and audio tapes. But mainly books. Big books, little books, books of all types and ages. When he moved in, there had been hanging on that wall a picture of a large red flower. He immediately had it taken down. He never replaced it with anything else. There was a worn lounge chair nearby, with an accompanying reading lamp.

There was a small bathroom. A full-size bed, usually unmade, a dresser, and a half-assed clothes rack. All very austere, he thought. And once a week, a tired-looking woman he had hired cleaned up—sort of—and changed linens.

The girl he had been sleeping with, after a loud tirade, had departed in a huff about a week ago. She said she wasn’t coming back. She was quitting school anyway, she said. She didn’t want to be whatever it was she was going to be anyway. She told him he was crazy. He told her he was sorry she was going, but he didn’t add that it was because he was just starting to remember her name. Then she threw her purse at the cat, who dodged it perfectly, having had practice dodging thrown purses and other feminine objects. The purse, however, spilled its contents all over the floor. They were down on their hands and knees retrieving all the flotsam. He was still in that position when she slammed the door. And that was that.

Almost! She left two remembrances. Still on the floor was a small now opened vial of some nameless perfume—not at all pleasant smelling—the smell of which now permeated the room. Also, under a chair, a wrapped brand-new, unused tampon. He threw both objects into a waste basket. This was not lost on the cat, who later upended the wastebasket, ignored the perfume, but retrieved the tampon and started batting it around at very odd hours. Like a toy mouse. Particularly, when she wanted him to do something. Like giving her some more tuna. Of all the real toy mice and toy balls with bells and every other toy he had gotten her, this is what she fell in love with. All the others were piled in a box like so many dead mice, unused and ignored. Why couldn’t that girl have left some of that—what did she call it?—her night-night medicine, which she smoked every night.

Callie had finished her breakfast and was back on the bed, sleeping. She was a calico. He had come up with that less than imaginative name himself. Anyone who knew anything about calico cats, which he didn’t before Callie, knew that you rarely had to look underneath to determine sex. Somewhere there were said to be males, but females all of a sudden showed up in a litter of other types.

She came into his life one rainy evening when he was returning home from work. She was sleeping by his front door. He had no idea where she came from or how she got into the building. She woke up as he was reaching over her to unlock the door, and when he opened it, she marched right in as if she owned the place, and maybe she did. Maybe because she looked so wet and disheveled as he was, he felt an immediate kinship with her. He had never had a pet before, not even as a child, but he certainly had one now.

She never mewed. He took her to a vet who removed something called a botfly from her throat. He said it probably affected her vocal cords. She also was missing a left front paw, but she ran around the place like an Olympic runner.

At first she slept on a stack of music he had on the floor. Then she took to sleeping with him at the head of the bed, unless he had company, and then she retreated to the floor, reluctantly. She didn’t much care for his choice of female sleep mates, except for her. She had a proprietary interest in him. Since she came on the scene, she had not shown the slightest inclination to leave.

He was fairly wide awake now. The digital clock read 2:30 p.m. Christ, how could it be that late. He thought again about the dream. The dream, the same goddamned dream, over and over again. Only with different objects and different faces. Always changing but always the same. And then those—what did she call them? The frustration dreams. Jesus, what does it mean when your dreams are more interesting than your personal life? Well, hell. Anything would be more interesting than his personal life. He thought about the old joke about the guy who was falling from a high building and his whole life flashed before him as he was falling and it wasn’t even interesting.

Of course, only his work kept him alive. But his dream used to scare the hell out of him. He’d wake up, sweating, chest pounding. Now, they had all condensed or maybe conflated into this one confusing pattern. What did it all mean? It was recurrent at more frequent intervals now, and it kept revisiting him like some unwanted acquaintance.

He drank some more coffee and had another cigarette. That’s two down. All right! All right! So he would spread out the other five. Well, he meant four. He’d spread them out. He’d spread them out, he said to the little bean counter inside his head. Big deal. He got up and went to the sink and shoved the rest of the pasta on the plate in the sink down the disposal, which was working for a change. Then he looked expectantly in the small pantry consisting of two shelves. Nada. Well, he wasn’t hungry anyway.

The cell phone rang. No caller ID. He let it ring a few times. Then he pushed Send and mumbled a garbled hello. Nothing. He waited. Still nothing. And then a click. This was getting to be a damn pain in the ass—it was happening every day. Sometimes twice daily. The phone company’s only answer was to change his number. He did that one other time. Not smart. Amazing just how many people needed his new number.

Then he checked his messages. One was a hang up, probably another call like he just answered. That one was from last night. The second was from a guy he worked with who wanted to shift some hours around and a third, from someone named Annabelle, who said she didn’t know where Skip was and another from whoever Anabelle was wanting to know why he hadn’t called her back. He switched on his TV, an old one, small screen. It sat on top of one of the bookcases. It was a local channel. Some well-coiffed girl was droning on about continuing rainfall and flooding. Why was it always the worst something or other in history. Until next week, when it would be the worst something else again. Anyway, no relief in sight. He switched it off.

He went over and got comfortable in the lounge chair. Too comfortable. He nodded off. Some loud thunder woke him up. He didn’t know how much time had passed. Callie was trying to hide under the bed, but her tail was sticking out. Then the power went off for the third time that week. He grabbed his flashlight and went to one of the windows. He parted the drape slightly; the rain was pelting down in sheets, which were bouncing off the walls of the nearby building. It was going to be an interesting night.

He followed the flashlight beam into the bathroom and took a quick shower. Mouthwash. Damn that tooth that needed a root canal. It still ached like a bastard. Electric razor—lucky it was still charged and on battery. Just then, the power came back up. He dressed in a desultory manner: black slacks, a long-sleeved white sweater—this one had a red pony on it—a pair of slightly worn Italian loafers. He went back to the mirror for one last look. He stared disapprovingly at himself. Vital stats, age 41, 6'2½", 180 pounds. When and if he ever quit smoking, his weight would probably soar, he thought. Brown hair, green eyes, reasonably good-looking. No scars. That is, external ones.

He looked over at Callie. She knew he would be leaving. There was another thunderclap, this one louder than the first. It seemed like a good time to leave. He slipped on a light jacket and grabbed a rolled-up raincoat; Callie was not happy. He went out anyway.

It was raining hard, but he was able to catch a cab quickly. He told the driver that he wanted to go to that mall that he liked. He had two reasons. There was a deli that served a great pastrami sandwich—with Russian dressing. Also a whole tray of free kosher dills, coleslaw, and other assorted stuff. And then he could go to the store, his store, the store that he liked. Then he told the driver to stop; the rain had let up some, and he felt like walking. The rain felt good. And when he walked into the mall, it was like coming out of a tunnel.

Forty-five minutes later, he walked into the store. He asked the owner if he could try the one on display. The salesgirl winked at him and continued their ritual. She led him to the big ebony one. The six-foot grand with a Steinway trademark. He sat down on the padded bench, adjusted it, and made himself comfortable. Well, today, he would give them four gems. Well, why not, he knew them all well.

The first was Tolstoyan—War and Peace—hard and fast and then soft, then hard and fast again with a big finishing flurry of notes and a scale. It all sounded terribly difficult, but it wasn’t.

The second, The Favored One, the soft quintuplets like a charnel house. The Divine One once said that it was supposed to sound like that. Then those finger-twisting passages that sounded easy but weren’t.

The third had treacherous octaves, then deep sonorous chords, and then rippling descending bells.

The fourth, the best, his favorite, the only one in a major key, springlike—gentle as a zephyr—not too fast, not ever too fast, or it’s just a mishmash of empty notes.

And then he was finished. A crowd had gathered and was clapping like always. Maybe there were even some customers. The owner smiled at him just like he did last time and the time before that and just like he would the next time. As he was leaving, a man said he thought he recognized him, but he convinced him that he was wrong, and then he was gone from the store.

Walking back into the mall, he knew he had some time. He looked occasionally at some stores—nothing new—and absently at a booth or two. He stopped and looked into a store window. He had a feeling someone was following him. He started walking again and then stopped at one of those leather chairs on demonstration. The kind that moved and vibrated. He sat down and pretended to be interested.

She stopped at an ice-cream shop nearby and kept peeking at him while she nibbled on her ice-cream cone. She was blonde, looked like a teenager. He didn’t think he knew her, but she looked vaguely familiar. He glanced at her occasionally for a while and then got up quickly and disappeared into a crowd of people. He started walking again. He didn’t think that she was behind him anymore. He left the mall.

It was still raining hard again. He unrolled the raincoat and put it over his jacket and pulled the jacket up over his head. He didn’t own an umbrella. He left the last one he had in a cab. He didn’t own a car either. Very few people did. Nobody drove; you walked, or you took a cab wherever you went. Besides, there were never any parking spaces anyway. There was something paradoxical about that.

Back on the street, he didn’t have to wait long. A cab pulled up, and he jumped in ahead of a man running from the other direction who gave him the universal gesture of displeasure with his right middle finger. He sat back and listened to the rain pelting on the roof of the cab and thought about last time. He had to help subdue a crazy guy who fired off two random shots. One went over the girl’s head. Someone else finally coldcocked him with a nightstick, opening his head up big-time. Then there was a lady crying because she had shot and killed her husband who had beaten her up once too often. She kept saying that he was a good man. And the baby, who had been beaten to a pulp and then drowned in the bathtub. And the young waitress who had been raped, beaten, and left to die on the street. He saw them all.

He closed his eyes and tried to think of that visual mantra an ethereal type he once knew taught him. Think of green fields and happy unicorns. Since both of those were in short supply in the city, he couldn’t always pull them up easily. And tonight was definitely not a night for them. The cab kept pushing through the rain, and he thought of his latest sleepover. She of the perfume bottle and wayward tampon. But he still couldn’t remember her name.

Oh, but Chopin always got them where they lived, and he did tonight. He got a sudden frisson of pleasure he would never admit to, even to himself, especially not to himself. He looked at his fingers. They were starting to get those nasty little nodes on the distal phalanxes. He knew they were called Heberden’s nodes. He would like to strangle Heberden. He didn’t know who he was or where he was, but he would still like to strangle him. His fingers had always been his livelihood, child and man, and now they were betraying him with those nasty little growths.

The cab kept pushing through the rain. It suddenly swerved, bringing him back to reality. The cabbie apologized. He wondered what for. And then, quite unexpectedly, he thought about a blonde girl and an ice-cream cone.

CHAPTER 2

H E WALKED INTO the building through a downstairs entrance, walked farther up some steps and down a corridor, then paused a moment. The big room—one of two—the other somewhat smaller. It was almost always full, usually, twenty-four hours a day. Some people were sitting—the lucky ones. Others were standing; others were walking about nervously. Still others—the unlucky ones—were lying on some vacant spot on the floor. Some were occasionally summoned and diverted into another area, devised for a certain type of person, but most were called into the main area in time, usually after a long time.

He looked at their faces. In twelve hours or so, when he left, the faces would be different, but the room would still be full. Different people, different faces. Sometimes the same people and faces, still waiting, sitting silently, sometimes crying, always hoping.

He walked into anteroom A. There were two others, but this was the largest, which really wasn’t saying much. And it wasn’t much. Two beat-up couches—almost embarrassingly extruding their stuffing out of cracked vinyl—several chairs and a table, one leg of which was broken off, and the vacant spot propped up on a stack of books. There was a rickety metal bookcase, with more books in it than it would normally hold, most with broken covers, torn pages with coffee stains, some with bloodstains on the pages. Well-worn pages.

A worn-out coffeepot sat on a warmer with the dregs of coffee made hours earlier. There was a half-eaten sandwich lying on the floor that looked like it was beginning to attract flies. Various people of various stripe wandered in and out.

He was thirsty; the pastrami was extra salty today. There was a small refrigerator, and he took out a small container of milk and took a swig. Shit! Christ! It’s sour. He spit it out. Hell, damned refrigerator’s not even plugged in, he shouted angrily. The spray of saliva and milk went all over the sandwich on the floor.

Hey, doc, somebody said as she walked in. Don’t drink that stuff, it’s liable to be sour.

He tried mopping up his face with his clean handkerchief as nothing else seemed to be handy and then walked toward the bathroom. It was unlocked for a change. Just then, a paramedic walked in the room.

Hey, doc, those cigarettes can kill you. How many are you down to?

Six.

What’s the point?

You ever smoke?

Nope.

Then shut up.

He went in and locked the door. He looked at himself in the mirror. He lit up a cigarette and thought to himself that anyone who has never smoked can’t possibly understand what those six cigarettes mean. You relish them. You savor each one, right down to the last goddamned puff. Sometimes, you burn your lip on that last one. Dropping down to five was a huge jump. That’s when you want to start smoking again. Sure—you kidded yourself. You know, the one about the ninety-year-old guy who still smokes three to four packs of unfiltered a day and breathes like a ten-year-old while his daughter who quit twenty years ago and only smoked for fifteen was rolling around in a wheelchair with prongs in her nose and a green tank for a companion. Oh yeah, and the same ninety-year-old guy who ladled bacon fat on his pork chops for extra flavor while his thirty-eight-year-old next-door neighbor collapsed and died on the jogging track. It’s all genetics. That and it’s one big gigantic floating crap game as well. Sure.

He took one last drag and then dumped the butt into the toilet. You weren’t supposed to smoke in there. He turned on the fan resolutely as if it was going to do any good. Well, this was sure better than walking twenty feet or was it thirty feet past the building and doing it. You’d be lucky if you came back alive these days. Somebody began pounding on the door.

Hey, doc, no smoking, and definitely no jacking off. Hurry up. He changed into a set of plum-colored scrubbinies. He thought of the last COPD he saw, came puffing in like a steam engine. Skin hot pink. After he’s all connected to devices, what does he want?

Please somebody roll me outside for a cigarette. I mean, away from all this oxygen. Hell, I can’t breathe the stuff anyway. When he got the negative nod, he looked at me, smiled, and said What’s the point? Then he turned his head and was gone. He even got screwed out of the last one.

He came out and was somewhat startled to see a PA sitting on the couch. His computer was on his lap. This one had a badge on his white coat that said assistant physician. He never looked up from the computer.

Hey, doc, what’s the algorithm for cyanide poisoning?

Algorithm? You mean besides the Lord’s Prayer?

That’s funny.

Look, it’s simple. You get a handful of amyl nitrite ampoules, see. Then you crush them in your hand. But don’t get too close to them, or you’ll be on your ass.

Whoa, stop right there. A handful? That’s a trip.

Did you miss the last part?

What?

Right, then somebody is picking your ass off the floor. Or let’s say you don’t sniff them. You stick them under the poor bastard’s nose. That’s if he’s still breathing. Then you or somebody finds a vein and pumps in some sodium nitrite.

That’s saltpeter, right?

No, that’s potassium nitrate.

Then what?

Well, you’ve taken his hemoglobin and made methemoglobin—has a great affinity for cyanide. Then if he’s still actually alive, which is extremely doubtful, you squirt in some sodium thiosulfate that makes sodium thiocyanate—nontoxic—poof, it’s all gone.

What does cyanide do and don’t tell me it kills you.

Well, it screws up the cells’ ability to utilize oxygen. You get anaerobic metabolism and killer lactic acidosis in a matter of seconds. The body literally smothers to death.

Computer writes about vitamin B12.

A fragment of it has the capacity to chelate cyanide.

Chelate, like ties it up?

Why don’t you look it up? He spells it, C-H-E-L-A-T-E.

Where do you find all this stuff to treat?

You get two choices. One, go in the tox room and find the cyanide kit. It’s the one with all the cobwebs on it. Or the stuff you need is in any of the acute rooms.

Have you seen cyanide poisoning? He looked up.

Sure, and so have you—but you may not have known it.

How’s that? He looked down again, punching keys.

Firefighters, smoke inhalation. Fires involving plastics, fabrics. You also get carbon monoxide and hydrogen sulfide. Remember the Bhopal, India, incident? One of the worst industrial disasters in history. Union Carbide. Isocyanate gas released into the atmosphere. Thousands killed. He stopped talking. He seemed to be talking to himself then started again quickly. Or you can grind up a bunch of apricot pits and knock yourself out. He made a quick exit. Several minutes went by. The PA looked up.

Huh? What did he say—what was that about apricots or something?

Don’t ask me, said an entering nurse. I just walked in.

Dr. Johns, all resplendent now in his plum scrubs and white shoes, walked into the mail room. He grabbed his handful of mail, tossed a half handful into file 13, and scrutinized the other eight or ten. One was a letter addressed to him personally from the toxicology department.

The naloxone room will continue to be operated by its current staff and continue using its present protocol. Any attempt at disruption will not be tolerated. This was undoubtedly because he had turned over a table and smashed several vials of the stuff when a patient woke up unattended, vomited, and among other things, developed a nasty lung abscess.

Then he read a less provocative general letter. Neurology residents are to see all patients who may have had a thrombotic stroke—please page the ones on call—there are approximately five to seven or more such patients per day. We are doing thrombolytic protocols on thrombotic strokes in this institution. Seven or more, he thought. You don’t say. And try getting a neuro resident to come bopping down there at 3:00 a.m. Of course, they’ll already want a CAT done, hell, maybe even an MRI done, before they see the patient. He stuffed the rest of the mail in his back pocket for later.

Dr. Matthew Johns walked into anteroom B—a room pretty much used for between-shift reports. He had noticed that things were pretty hectic out there, so it looked like he’d get his report on the fly. He was the director of the ER, so it was up to the other ER docs—three in number—coming off the current shift to report to him. Basically, after a brief summary of the day, he would have to be apprised of deaths, patients in x-ray, residual patients in rooms, possible acute patients who might need to be seen immediately, and other problems.

Tonight, only one ER doc showed up, two nurses, and scattered residents and interns. He would have two ER docs with him tonight—one on each side. He would be in the center doing the most acute cases and troubleshooting in between.

It had been hectic all day. The rain had brought their share of car and motorcycle accidents. Luckily most of them had been cleared, only to make room for a new crop of three smashups in the last hour. There had also been an explosion at a nearby factory with several blast injuries, one still pending, and three deaths. One had half his chest blown away; another half his head blown away. He was getting a report on one still there—one in x-ray. A cop who was shot with a .45 magnum in the abdomen—up in surgery—miraculously was still alive; however, he had severe damage to the liver and liver bed. They were still tying vessels when he coded about 5:00 p.m. There had been a ruptured ectopic pregnancy that went to surgery and survived so far. There were six poisonings, two of which were children—ten or twenty narcotic overdoses and another fifty or sixty patients with injuries and illnesses varying from critical to benign.

And that was on the main side. The fast track had already seen seventy or eighty and transferred five to the main section earlier.

Just then, Julie Anders walked in. Julie was the head ER nurse always assigned—or almost always—to work with Dr. Johns. It was usually hard to tell just exactly what she looked like since she was almost always dressed in oversized scrubs, her eyes hidden by glasses, and usually goggles as well. She had a mass of black hair piled high on her head and covered over