The Sinner: A Rizzoli & Isles Novel

actually conscious? Aware of what was going on?”
    “She squeezed the nurse’s hand. She was following commands. But I never got the chance to talk to her. I was standing right there, and she
looked
at me, just before . . .” Rizzoli paused, as though shaken by that thought. “I’m the last person she saw.”
             
     
    Maura walked into the ICU, past monitors pulsing with green heart tracings, past nurses who stood whispering outside curtained patient cubicles. As an intern on critical care rotation, her late-night visits to Intensive Care had always been occasions for anxiety—a patient in extremis, a crisis that required her swift decision. Even all these years later, walking at this hour into an ICU made her pulse quicken. But no medical crisis awaited her tonight; she was here to view the aftermath.
    She found Dr. Sutcliffe standing beside Ursula’s bed, writing in the chart. His pen slowly came to a stop, the tip pressed against the page, as though he was having trouble forming the next sentence.
    “Dr. Sutcliffe?” she said.
    He looked at her, his tanned face creased with new lines of fatigue.
    “Detective Rizzoli asked me to come in. She said you were planning to withdraw life support.”
    “You’re a little premature, once again,” he said. “Dr. Yuen’s decided to hold off for a day or two. He wants to see an EEG first.” He looked down, once again, at his notes. “It’s ironic, isn’t it? How there are pages and pages devoted to her last few days on earth. But her entire life takes up only one short paragraph. There’s something wrong about that. Something obscene.”
    “At least you get to know your patients while they’re still breathing. I don’t even have that privilege.”
    “I don’t think I’d like your job, Dr. Isles.”
    “There are days I don’t care for it, either.”
    “Then why do you choose it? Why the dead over the living?”
    “They deserve attention. They’d want us to know why they died.”
    He looked at Ursula. “If you’re wondering what went wrong here, I can tell you the answer. We didn’t move fast enough. We stood around watching her panic, and we should have sedated her. If we had just calmed her down sooner . . .”
    “Are you saying she coded from panic?”
    “That’s how it started. First a spike in blood pressure and pulse. Then her pressure dropped just like that, and the arrhythmias started. It took us twenty minutes to get her rhythm back.”
    “What does her EKG show?”
    “An acute myocardial infarction. She’s now deeply comatose. No pupillary reactions. No response to deep pain. She’s almost certainly suffered irreversible brain damage.”
    “It’s a little early to say that, isn’t it?”
    “I’m a realist. Dr. Yuen’s hoping to pull her through, but then, he’s a surgeon. He wants his rosy statistics. As long as his patient survives the operation, he can chalk it up as one of his successes. Even if she ends up as a vegetable.”
    She moved to the bedside and frowned at the patient. “Why is she so edematous?”
    “We poured fluids into her during the code, to try and bring up her pressure. That’s why her face looks swollen.”
    Maura looked down at the arms and saw raised and reddish wheals. “This looks like some fading urticaria here. Which drugs did she get?”
    “The usual cocktail we give during codes. Antiarrhythmics. Dopamine.”
    “I think you need to order a drug and toxicology screen.”
    “Excuse me?”
    “This was an unexplained cardiac arrest. And this urticaria looks like a drug reaction.”
    “We don’t usually order tox screens just because a patient codes.”
    “In this case, you should order one.”
    “Why? Do you think we made a mistake? Gave her something we shouldn’t have?” He sounded defensive now, his fatigue turning to anger.
    “She’s a witness to a crime,” Maura pointed out. “The only witness.”
    “We just spent the last hour trying to save her life. And now you’re implying you don’t trust us.”
    “Look, I’m only trying to be thorough.”
    “Okay.” He snapped the chart shut. “I’ll see the tox screen gets done, just for you,” he said, and walked out.
    She remained in the cubicle, gazing down at Ursula, who lay bathed in the soft, sepulchral glow of the bedside lamp. Maura saw none of the usual litter that followed CPR. The used syringes and drug vials and sterile wrappings that always resulted from resuscitation efforts had been swept away.