Chapter 9 The Ghost
The Ghost
Maxwell
The most dangerous pathogens in a hospital are not bacteria. They are rumours.
Bacteria can be killed with antibiotics. Rumours, however, mutate. They spread through the ventilation system, infect the nursing staff, and eventually make their way to the Board of Directors.
I am currently attempting to perform a routine inspection of the Cardio-Trauma Unit, but my path is blocked by a cluster of staff at the central nurses' station.
Indira Singh and Nurse Miller are huddled over a battered, coffee-stained three-ring binder. They are whispering with the intensity of conspirators plotting a coup.
"Current odds on 'Workplace Fistfight' are dropping," I hear Miller whisper. "They’re down to 5-to-1."
I pause. I step into the shadow of a pillar. Eavesdropping is beneath me, but gathering intelligence is a vital command function.
"Too low," Indira hisses, tapping a pen against the page. "They haven't yelled at each other in three days. The tension is shifting. I’m moving the money to 'Secret Dating.'"
I stiffen. Secret Dating? Who is dating? And why is it interfering with my unit's efficiency?
"No way," Miller argues. "Did you see York yesterday? He looked at O'Connell's desk like it was a crime scene. He hates him."
"He bought him a donut," Indira counters.
I freeze.
"What?" Miller asks.
"Tuesday morning," Indira whispers. "I saw it. York walked in with a coffee and a bag from the bakery. He put a glazed donut on O'Connell’s desk. He didn't say anything. He just left it there like a sacrificial offering."
I feel a flush rise on the back of my neck. It was not a sacrificial offering. It was a caloric supplement to prevent Dr. O'Connell from becoming hypoglycemic and making a surgical error. It was a safety protocol.
"A donut?" Miller sounds skeptical. "York doesn't eat carbs. He considers sugar a poison."
"Exactly," Indira says triumphantly. "He bought a poison he despises for a man he supposedly tolerates. That is intimacy, Miller. That is romance. I’m adjusting the spread. 3-to-1 on 'Christmas Miracle Hookup.'"
I have heard enough.
I step out from the pillar. I smooth my tie. I walk toward the desk with the silent, predatory gait that terrifies interns.
"Dr. Singh," I say.
The effect is instantaneous.
Indira slams the binder shut so hard a pen flies off the desk and skitters across the floor. Miller jumps and immediately begins typing on a computer that I can clearly see is turned off.
"Dr. York!" Indira squeaks, pressing the binder to her chest like a shield. "I... I didn't see you there."
"Clearly," I say, coming to a stop in front of the station. I look at Miller, then at Indira. "You look flushed, Dr. Singh. Is there a pathogen circulating in the unit I should be aware of?"
"Pathogen?" Indira stammers. "No. No pathogen. Just... statistical analysis."
"Statistics?" I raise an eyebrow.
"Vital signs," she lies, sweating profusely. "Of the unit. Generally. Tracking the... uh... hypertension rates."
I stare at her. I look at the binder she is clutching. I look back at her face.
She knows. She saw the donut. And she has monetized it.
Part of me wants to confiscate the binder and report them to HR for gambling on hospital property. But another part of me—a treacherous, illogical part—is curiously flattered that the odds of me physically assaulting Dr. O'Connell have decreased.
"Hypertension is a serious concern," I say smoothly. "Carry on, Dr. Singh. And tell Nurse Miller that if he stares at a black screen any longer, people might begin to question his neurological status."
Miller turns the monitor on, looking terrified.
"Yes, sir," Indira whispers.
I turn and walk toward Office 104.
As I reach the door, I glance back. Indira is already opening the binder again.
I suppress a smile.
3-to-1.
I wonder if I can place a bet on myself.
Silence is a diagnostic tool.
If the heart is silent, it is dead. If the lungs are silent, they are collapsed. If the gut is silent, it is obstructed. In medicine, silence is rarely a sign of peace; it is usually a sign of impending failure.
Dr. Jax O’Connell has been silent for forty-five minutes.
I am sitting at my desk in the Fishbowl, pretending to read a journal article on aortic dissections, but I haven't turned a page. Across the room, Jax’s chair is empty. His jacket is gone. His keys are gone.
Technically, his shift ended at 6:00 PM. It is now 11:30 PM.
I should go home. My apartment is clean. My sheets are Egyptian cotton. My refrigerator is stocked with sparkling water.
But I have a nagging feeling in my gut—a clinical intuition—that something is wrong.
Jax has been manic for the last three days.
He has picked up two extra shifts. He covered for a resident who had the flu.
He volunteered for a triage shift in the ER.
He is moving faster, talking louder, and laughing harder than usual.
To the casual observer, he is high-energy.
To me, he looks like a centrifuge spinning out of control.
I stand up. I button my coat.
I leave the office and walk down the hall toward the elevators. I tell myself I am going to the parking garage.
I do not go to the parking garage.
I walk past the elevators, down the long, dimly lit corridor that leads to the On-Call Rooms.
The hallway is quiet. The night shift staff are clustered at the nurses' station, laughing softly at a video on a phone. They don't see me.
I stop outside Room 3B.
The door is closed. There is no light spilling from underneath.
I hesitate. This is an invasion of privacy. If he is in there with someone—a distinct possibility given his charm and lack of inhibition—I do not want to know.
But then I hear it.
A sound. Not the rhythmic squeak of a bedspring, but a rhythmic tapping.
Tap. Tap. Tap. Tap.
It is fast. Irregular.
I knock once.
"Jax?"
The tapping stops instantly.
"Occupied," a voice croaks. It sounds like gravel.
I open the door anyway.
The room is small, smelling of industrial detergent and stale air. A single bunk bed is pushed against the wall. A desk lamp is on, but it’s turned toward the wall, casting long, weird shadows.
Jax is sitting on the edge of the lower bunk.
He hasn't changed out of his scrubs. He is leaning forward, elbows on his knees, head hanging down. His hands are clasped together, but his right leg is bouncing up and down with enough kinetic energy to power the hospital’s backup generator.
He looks up as I enter.
He looks wrecked.
I have seen exhaustion before. I have seen residents hallucinate after forty-eight-hour shifts. But this is different. This is a man who is being eaten alive from the inside out.
His eyes are bloodshot, rimmed with red. His skin is greyish under the tan. He is vibrating.
"I said occupied, York," he mutters, rubbing his face with both hands. "Go polish your stethoscope somewhere else."
I close the door behind me. I lock it.
"You have been awake for thirty-eight hours," I state.
"Who’s counting?"
"I am."
I walk over to the bed. The small space forces intimacy. I am standing directly in front of him.
"Jax," I say softly. "Go home."
He laughs. It’s a broken, jagged sound.
"Home," he repeats. "Right. Home is quiet. I can't do quiet right now, Max. Quiet is loud."
He looks at the wall.
"If I go home," he whispers, "I have to lie in the dark. And if I lie in the dark, I start doing the math."
"The math?"
"The ledger," he says, tapping his temple. "Who made it. Who didn't. Why the kid in Bay 4 died this morning but the drunk driver lived. Why I’m here and my unit isn't."
He looks up at me. His eyes are wide, unblinking.
"I can't turn it off, Max. The noise. It’s just... screaming."
Survivor’s Guilt.
I recognize it instantly. It is not the PTSD of flashbacks and violence; it is the frantic, desperate need to justify one's own survival by saving everyone else. He is running a race against a ghost that he can never beat.
"Insomnia," I diagnose.
"Combat insomnia," he corrects. "Hyper-vigilance. My brain thinks we’re still in the sandbox. It thinks if I close my eyes, the perimeter gets breached."
He stands up abruptly, pacing the three feet of available floor space.
"I just need to work," he says, his voice rising. "I need another shift. If I keep moving, I don't have to think. I’m fine. I’m functional."
He moves to push past me.
I catch him.
I grab his shoulders. He is solid, tense as a wire.
"Jax," I say firmly. "Stop."
"Let go, Max."
"No."
I tighten my grip. I force him to look at me.
"You are not functional," I say. "You are trembling. Your pupils are dilated. Your reaction time is compromised. If you touch a patient right now, you are a danger to them."
That stops him. The "Savior" in him overrides the panic. He slumps.
"I can't sleep," he admits, his voice breaking. "I physically can't. I tried. I lay down for an hour. I just stared at the ceiling until the patterns started moving."
"Sit down," I order.
He looks at me, defiant for a second, then the fight drains out of him. He sits back down on the bunk.
I look around the room. It is stark. Cold.
"Scoot over," I say.
"What?"
"Move."
Jax shifts to the wall.
I sit down next to him on the narrow mattress. Our shoulders press together. His heat seeps into my arm through the layers of my wool coat.
"What are you doing?" Jax asks, confused.
"I am anchoring the perimeter," I say.
He blinks. "What?"
"You said you feel like the perimeter will be breached if you close your eyes," I say calmly. "I am watching the perimeter. I am the Chief of Cardiothoracic Surgery. I am widely considered to be a control freak and a tyrant. Nothing gets past me. Not even ghosts."
Jax stares at me. A small, incredulous smile tugs at the corner of his mouth.
"You’re ridiculous."
"I am effective," I counter. "Lie down."
"Max—"
"Lie down, Jax."
He hesitates. Then, slowly, he swings his legs up. He lies back against the thin, flat pillow.
I stay sitting on the edge of the bed. I am close enough to touch him. I rest my hand on his shin, a grounding weight.
"It’s too quiet," Jax whispers, staring at the ceiling. "The vent makes a noise, but it’s not enough."
"I will talk," I say.
"About what?"
"Anatomy," I decide. "It is boring. It is structured. It is finite."
I take a breath. I start speaking in my low, lecture-hall voice.
"The heart is suspended in the mediastinum," I begin, keeping my tone rhythmic, monotonous. "It is enclosed in the pericardial sac. The wall consists of three layers: the epicardium, the myocardium, and the endocardium."
I can feel the tension in his leg under my hand. He is fighting it.
"The right atrium receives deoxygenated blood from the superior and inferior vena cava," I continue. "It passes through the tricuspid valve."
I trace the path of the blood with my words. I describe the valves. The pressure gradients. The electrical conduction system.
Minutes pass.
Jax’s breathing shifts. It goes from shallow and jagged to deeper, slower rhythms.
"Max?" he mumbles, his eyes fluttering shut.
"Yes?"
"You have a nice voice."
"I know."
"Keep going."
"The Bundle of His divides into the right and left bundle branches," I drone on. "These branches extend through the interventricular septum..."
I watch him.
The lines of strain around his eyes begin to smooth out. His hand, which was clenched in a fist on his chest, relaxes. His fingers uncurl.
He twitches once—a hypnic jerk—and then he settles.
He is asleep.
Real sleep. Not the passed-out exhaustion of the alcohol he sometimes drinks to numb the noise, but actual, restorative sleep.
I stop talking.
The room is silent, save for the rattle of the vent and the soft sound of Jax’s breathing.
I should leave. I have "anchored the perimeter." My job is done.
But I don't move.
I look at him.
In sleep, the "Trauma Cowboy" mask is gone. He looks young. He looks vulnerable. The scar on his forehead stands out white against his skin. The tattoo sleeve on his arm seems less like war paint and more like a bruise.
I realize, with a sudden, terrifying clarity, that I am not just observing a colleague.
I am guarding him.
I reach out. I brush a curl of dark hair off his forehead. His skin is warm.
"The perimeter is secure, Major," I whisper.
I settle back against the wall, pulling my phone out to check emails, but I don't read them. I just sit there, in the dark, listening to him breathe, ensuring that for at least a few hours, the ghosts don't dare to enter the room.
Because if they do, they’ll have to get through me.