Kate was a critical-care nurse, one of those purposeful, talented people always dressed in scrubs and lab coat, a stethoscope slung around her neck and pockets filled with penlights, scissors, and trauma-scale charts, who walked through an emergency department with the purpose of MacArthur stepping out of the water at Leyte. Which Kate did. At least until she ended up on her head in a ditch alongside Highway 44 with an ambulance and a candy-apple-red Firebird wrapped around her.

If it had been her Mustang, somebody might have blamed Kate. After all, she did drive it fast—often a little too fast. But that was what Mustangs were for. Besides, Kate was a good driver. She knew all the quirks and eccentricities of her car better than her ex-husband had known hers. Kate would never have let her car land in a ditch.

But Kate wasn’t driving either vehicle. The guy driving the Firebird would have been arrested on the spot for driving under the influence and vehicular manslaughter, if he’d lived long enough for the cops to get handcuffs on him. By the time that determination was made, though, Kate was already on her way to the medical center in critical condition with chest and head injuries.

Within an hour, Kate was in surgery to repair the small laceration she’d suffered to her aorta and the clots she’d collected on her brain from the depressed skull fracture. She had tubes stuck into her chest to reexpand her collapsed lungs, a tube in her trachea to help her breathe, one in her stomach to drain away any digestive juices that could compromise her breathing ability, and another in her bladder to make sure her urine was clear and neatly collected. She had three large-bore IVs in her, one in each arm and one in her subclavian vein, to replace fluids and electrolytes; an arterial line; an intracranial pressure sensor to measure the potential threat to her brain; a Swan Ganz pump to measure her blood volume and cardiac output, and a blood pump to reinfuse her with the red cells she was losing through those chest tubes. And with all that in, she still managed to make hospital history. On February 24, Kate Manion became the only intensive-care patient in medical center memory ever to successfully kill her nurse.

Chapter 1

SHE DIDN’T MEAN
to do it. After all, Kate knew better than most people how badly nurses are needed. Even bad nurses. And her nurse was certainly a bad nurse. But by the time the woman met her fate, Kate wasn’t in any shape to think clearly at all. In fact, by then Kate was so bruised and battered, not just by the accident but by her stay in intensive care, that she wasn’t sure she wasn’t already dead. She wasn’t sure of anything except that she wanted out.

She didn’t exactly wake up in the unit. She became aware, in a series of fits and starts, as if the breakers were being thrown on each of her senses and the janitor in charge couldn’t figure out how to get them all going again at once.

First there was pain, waves of it, bathing her like one of those hot lights at McDonald’s, so that if her body had been a hamburger she would have been a meat briquette. Pain: her head, her chest, her legs; pounding, swirling; sometimes constant, sometimes a red tide that broke over her and then receded.

It rode in and out on sounds. Familiar sounds, noises she knew somehow and hated. Noises that made her want to scream more than the pain.

“Her ICP’s up again, Fran,” she heard somebody snap. “Don’t you think you’d better call the Bagel Man?”

Bagels? Did she want bagels? Kate couldn’t remember. She couldn’t remember anything but how badly she hurt, how she wanted to get away. How she couldn’t move, except she seemed to be doing it against her own volition, turning one way and then another, her joints screaming in protest, the noises following her wherever she went.

“Almost finished,” another voice answered, a voice that tapped some instinctive button in Kate. Something unpleasant. She hated that voice. She wanted it to go away and let her sleep. Somewhere deep in the ooze she’d once called a brain, she wondered why she knew this and nothing more.

Then it came to her that suddenly she could see. And she knew her ICP was going to hit the roof, because she realized what everything else meant.

Acoustic tile. The spidery arms of machinery, IV tubing snaking down from half a dozen plump clear bags and one smaller red one. Labels and tubes and a television turned to
Wheel of Fortune
. Banks of monitors and stock carts piled to the brim. White-coated figures scurrying around in a kind of weird, aimless dance choreographed to the tune of endless ventilator alarms.

She was in the hospital. Her hospital. She was
a nurse, she remembered, this was the ICU, and she hated this place. She hated working here. She hated all the damned beeping noises, the same ones that followed her to sleep, even on a good day. Phones and monitors and ventilators and pagers. Endless, annoying, insistent, just like now. She hated the smell, that cloud of unwashed body, unbrushed teeth, and disinfectant.

She was paralyzed. She couldn’t move, couldn’t talk, couldn’t breathe. Somehow, she was awake, her eyes open, and even without her help she was breathing through a tube hooked up to a machine.

That wasn’t possible.

She must be dreaming. That was it. Nobody would have done this to her. You can’t just intubate a conscious person and put her on a ventilator. And yet she felt tape stretching the skin of her face. She felt the plastic tube against her teeth. She felt the air rush in as the square beast squatting by the bed clicked and whirred.

Why? Was she being punished? Had she mouthed off to the wrong person and been caught by a new disciplinary policy she hadn’t heard about? Or was it worse? Could she have died somehow and was being made to pay for her sins?

For the way you’ve talked about my gomers, Kate Manion, I sentence you to an eternity on a ventilator
.

No, no, no! She’d never meant it. It wasn’t as if she’d hurt anybody. But a person could take care of only so many gomers and not go crazy. Patients never getting better, never really going
home, human factories of bodily waste. Endless care, minimal brain power, usually no chance of survival. A syndrome the critical-care vets called P cubed—Piss-Poor Protoplasm—the bane of nurses everywhere, bodies that never seemed to work any better than the brains fueling them.

All right, so she’d done her share of gomer jokes. So on occasion, she’d called a comatose patient Gomer Toes. Maybe she’d even called the step-down unit Beach-Blanket Gomer. But she had never once bad-mouthed a patient to his face. She shouldn’t have to pay like this, for eternity. Hooked up to machines, forced to listen to the endless echoes of even more machinery through the white and surgery-green rooms of the ICU, smelling like a five-day-old fish and annoying every hospital employee in the afterlife.

She wanted to cry. She wanted to run. She wanted to be wrong. Then she saw who her nurse was, and she knew for sure. She was in hell and she was being taken care of by Mr. Spock.

“I’m telling you, Fran,” somebody called out at the edge of her vision. “She needs some kind of pain control.”

“What she needs,” Mr. Spock answered, pointy ears quivering almost as much as his three chins, “is another shot of Tubarine.”

Not Mr. Spock, Kate realized sometime later. Worse. Much worse. At least Mr. Spock could work machinery. She was being cared for by Attila the Buns.

It just proved she was in hell, hurting, terrified, confused, swimming in a sea of technology like a giant man-of-war, no substance, all mass, and she was in the very unstable hands of Attila the Buns.

So-called because of the size of her set and the set of her attitude, Attila had been the only ICU nurse to flunk critical-care training four times. She had bad breath, worse manners, and no skills. And yet, because she never complained about what Administration did, because she could keep a clean station, she would work forever.

Forever. Kate had been right. She had to remember what she’d done to deserve this. She was in hell, and she had to repent.

The question was, was Attila in hell too or in heaven? After all, every time she took the eye patches off Kate to check pupils, she was smiling.

Would God let Attila take her Trekkie ears into heaven? Kate wasn’t sure. But then, she wasn’t sure why she was sharing hell with a whole covey of nuns, either.

Did nuns come in a covey? she wondered giddily. Maybe a gaggle. A nine. A nine of nuns. That was it.

Kate saw them—every time she could see, that is—for those moments Attila let down the patches that were meant to protect her eyes, since with a load of Tubarine on board she couldn’t so much as blink. Fancy name for curare, that time-honored poison for South American spear tips. Used for people going under anesthesia to facilitate the placing of the endotracheal tube. Extended use for people needing to tolerate artifi
cial ventilation or for head-injury patients who needed complete body rest, to keep their intracranial pressure down.

Beep
. Correct answer. You, Kate Manion, go on to Final Jeopardy. With the nuns. The nine of nuns that was even now swinging into formation out in the work lane. The antibiotic ointment that went with the patches smeared Kate’s focus, but she saw them: white on black, some of them; others in expensive brown polyester, as if God demanded you not only give up worldly ways but taste as well, even if you were out of the habit.

They seemed to float at the edge of her comprehension; she thought they were chanting.

Maybe she was in purgatory, and they were there to speed her way north. Kind of like celestial cheerleaders.

“Intercede for her now, Holy Mother and Blessed Octavia, and give her health.”

Kate really appreciated that. Maybe the nuns could talk God into taking away some of the pain. Or maybe they could have a word with Attila, who had elevated patient assessment to the Marquis de Sade Invitational.

She’d be good. Get the nuns over here so she could tell them. Get God down here. But then He was probably sitting up there laughing with all those whiny people Kate had chastised at one time or another.

As if in answer, a man appeared right over her, blocking out the nuns. Short, squat, with hair sticking out his nose and a big mole on his chin. Not God; the wicked witch. The Bagel Man.

“If that intracranial pressure would just ease up,” he was saying to someone else as he flashed a penlight in Kate’s eyes and blinded her even more, “I’d pull the tubocurarine right now. But until I’m sure she’s clear, I’d rather leave her be. Has Martinson evaluated the ARDS?”

Begelman. Neurosurgeon. How could he be in her hell? Kate wondered. He was Jewish. Jews don’t believe in hell. Maybe a cameo appearance to increase the terror. Worse than gomers. She was going to be a vegetable. All matter, no brain. She didn’t want to be a vegetable. She did not want to have gomer toes.

ARDS. She knew that from somewhere too. Maybe he was spelling something so she wouldn’t understand. Speaking Latin. She knew she should have taken it in high school.

He never noticed that anybody was home and replaced the patches without once addressing her.

She hurt. She was scared. She was in the dark, and the nuns were at it again.

And on the other side, some rail banger was whining “Nurse, nurse, nurse” without stop. No doubt about it. She was doing the big time.

Somewhere along the way, Kate must have gained a fuzzy comprehension of what was going on. She did her best to behave so the monitors would stop beeping, so her chest would stop screaming. She did her best to float into a kind of nothingness, dipping into unconsciousness when things got too hot topside.

She knew somewhere back in her swollen, sore mass of brain tissue that she’d been injured badly and was being therapeutically paralyzed to control the needs of her body so it could heal without her interference. She remembered that ARDS was Adult Respiratory Distress Syndrome, a potentially fatal complication of trauma that demanded prolonged use of the machines. She knew other nurses came and went, things got better and worse, and Begelman was followed by Martinson, whom she liked and tried to talk to, although he couldn’t hear her either.

She knew co-workers drifted in and out, familiar faces she tried to smile for. Some were friends who laughed as if nothing was wrong even while their eyes lied. A few showed up, she thought, just to make sure she was helpless. She didn’t try to smile for them.

B.J. was there, off and on like the nuns, except that he kept holding her hand and scowling at her as he drank his Dr Pepper. And of course Tim came, everpresent in unusually rumpled scrubs, his forehead tight with a fear that wasn’t just show.

But it was hard to hold on to sense in the unit. Kate never really slept. There was never silence or darkness or peace. There was never quite a respite from the pain, although the Bagel Man evidently agreed with the unseen voice about pain control and her ICP and put Kate on a morphine drip, which did blur the edges. It also provoked a few unexpected visitors that only Kate—and maybe the nuns—seemed to see. Kate was, after all, a cheap date.

The nuns never did talk to her. At least she didn’t think they did. They were too busy praying over a little girl in the next bed, the daughter of a local leader whose devout Catholicism was matched only by his ardent social climbing. The nuns, members of the Order of the Sweet Savior, were looking for a miracle for their founder, Blessed Octavia Van Peebles, that might nudge the church into considering her for sainthood. The little girl, the nurses whispered angrily, had died of Reye’s syndrome six days ago. Only the machines kept her alive—the machines and those damn nuns, who had imposed on a grief-stricken family so they could claim fame for a grim-faced exduchess who had devoted her life to training rich little girls to be rich social doyennes.

But then, maybe the nurses had it wrong. Because one night when the patches were down Kate could have sworn she saw old Octavia herself wandering through.

She tried to say hi, but evidently dead blesseds can’t hear damned souls either. So Kate watched the nun, smaller than she’d imagined, wander through the unit, stop to check something out at the charting table, and then pause by the little girl’s bed.

“Dedicate yourself,” she said in sonorous tones that echoed in Kate’s head.

“Okay,” Kate agreed, figuring it was the thing to do, although she was sure that happened in her head, too.

The nun just nodded solemnly and left.

But then, maybe the nun hadn’t been there at
all, because only a little while later Kate found herself conversing with her grandmother, and her grandmother had died when she was ten. Come to think of it, her grandmother wasn’t any more fun now than she had been then. Next, her mother made an appearance, and Kate decided morphine wasn’t all the fun it was cracked up to be.

She gave up and invented patterns in the ceiling tile, whether she could see it or not.

And then Attila was back. Without the ears, this time. Somebody must have noticed and suggested she ditch them while handling heavy equipment. Attila was a Trekkie, Kate remembered. Devoted enough to use the
Star Trek
theme as the bride’s dance at her wedding to the supervisor down in processing. Must have been a real visit to Vulcan. Kate thought she might have been there last night as well.

“Good morning,” Attila chirped, her cheer as determined as her actions. She already had a cup of coffee handy as she pulled down the patches and checked the monitors. Attila drank coffee like the rest of the world breathed, a brew so strong you could lose spoons in it.

Kate stared. She felt herself already starting to sweat; she didn’t know why. Maybe because she knew it was time for turning and torture. She hated Attila. She wanted out. She thought maybe, if she could just move, she could get past her and out the door into heaven. At least plead her case.

Whatever her case was.

She couldn’t think very well. She tried to brace for the pain. She didn’t think she’d ever be
free of it again. I promise, she thought fervently, seeing the grim enthusiasm on Attila’s face. I will never ignore a patient’s story about pain again. I will never in my life say the words, “This is going to be a little uncomfortable now….”

“This is going to be a little uncomfortable now,” Attila announced, and Kate saw she was sweating too. Probably couldn’t wait to get on with the torture
du jour
.

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