She went out the door and everything started going wrong at once. Her car wouldn't start, not for the first time in memory. She heard the sickening sound of the battery going completely dead, and remembered that the mechanic who'd jumped the car to start it just recently had warned her to replace it. She'd been saving up to do that, hoping it would last just a bit longer. She groaned, checking her watch. She'd have to run to catch the bus and she was already late.
She locked the car door and slammed it shut angrily, forgetting in her haste that she'd left the keys in it, and her purse. She stared at her bag through the glass with a sense of despair. Her wallet, her credit cards, her apartment keys, everything she had was in there.
Well, first things first, she decided. This was a good neighborhood and the owners of the apartment house where she lived looked out for her car and the medical student's. She'd worry about her car and purse later.
She had on her raincoat, which contained all the money she would need for bus fare on Marta and snacks at work. She could do without her makeup, or borrow some at the hospital when she needed it. She wouldn't need her keys until she got back home, and anyway, the owner had a passkey and he and his wife lived downstairs.
She trudged out to the street, made it breathlessly to the crowded bus stop on the corner and climbed aboard the bus that would take her right past the hospital where she worked.
It was another cold and rainy morning. With her mind on getting to work on time, she hadn't noticed that the breathlessness, which usually passed, hadn't. She could barely breathe. Her heartbeat felt different. Strange. Frightening.
She saw the people around her as a blur that became brighter and brighter and then, suddenly, vanished.
Ramon was already scrubbed at St. Mary's when they brought the emergency patient into the operating room. A Jane Doe, he thought irritably, on whom he'd have no background information whatsoever. One of his colleagues had already done a catherization. That had indicated a leaky heart valve, which had, over time, deteriorated past saving. He would have to replace it with a prosthetic valve and hope that the unknown woman had no medical conditions that would complicate his surgery. He had no idea of her medications or her state of physical health beyond the heart problems he could see for himself. It was always a risk to operate on a stranger, he thought, but he had no choice.
The oxygen mask was already over her face when his team was assembled and he was ready to begin. Her skin was creamy, very pink and soft, and he regretted the long scar this surgery would leave after he opened and closed the chest cavity.
The surgery took almost four hours. Ramon straightened his back with a grunt at the end of it, satisfied not only with the surgery, but with the closure of the incision he'd made. She'd only have a slight scar. Later, he could recommend a good plastic surgeon, if she could afford it. He knew nothing about her circumstances. She might be a street person, for all he knew. The only part of her he saw was her creamy, soft skin. She had a strong heart and her lungs were in excellent condition, except for a mild bronchitis. She seemed in good health otherwise.
She was taken away to the intensive care unit and he went on to the next case, without giving the identity of his patient another thought for the moment.
Hours later, still in his surgical greens, he went to ICU to have a look at the young woman his skill had saved. She was hooked up to the usual machines and the huge breathing tube of the heart-lung machine was still in her mouth. But when he paused at the side of the bed, his own heart almost stopped. He choked on his own breath. A technician was staring at him with open curiosity. He knew the blood had drained out of his face. That was Noreen. And she'd collapsed with a damaged heart valve. She had a bad heart, and he hadn't known. Nobody had known!
Shaken out of his normal calm, he motioned for the floor nurse to join him. "I was told that this woman's identity was unknown!" he said harshly.
"She had no identification on her at all," the nurse began.
"She's my late wife's cousin!" he raged, his fist clenched at his side. "I would never have performed surgery on her if I'd had any idea in the world who she was!"
She felt the whip of his anger and winced. "I'm sure if anyone had known... We thought she was an indigent?''
"She's a nurse." He interrupted irritably. "She works at O'Keefe's in the cardiac care unit." Even while he spoke the words, he was remembering his own unjust treatment of her when she'd been desperately ill and hiding it. He hated remembering how unfair he'd been to her. She might have died...
"But how did she get here?'' the nurse was asking. "And without any identification on her? Surely she had a wallet?"
"I don't know." He stared down at her white, drawn face, expressionless from the anesthesia. He glanced at her small hand, from which tubes rose above the shunts. The nails were short, rounded, unvarnished. She had elegant, but capable hands. She had a bad heart, a damaged valve. She hadn't told him. Why? Had she truly been afraid to let him operate on her, afraid that in his contempt and dislike, he might fail her? It was sheer torture to think about it!
"I'll see if I can find out how she came to be here," the nurse assured him.
"Never mind," he said shortly, turning on his heel impatiently. "I'll find out myself. Let me know if there's any change, any change at all."
He paused to check another of his surgical patients and then, with a last worried glance toward Noreen, went down to the emergency room.
It took several minutes to discover that Noreen had collapsed on a Marta bus and had been brought to the emergency room by ambulance without a scrap of
identification on her. Possibly when she'd passed out, someone had taken her purse, he surmised.
The clothes she'd been wearing were in a plastic bag. He took them out to his car when he went, with plans to return them to her apartment. He didn't have a key, so he found the owner of the apartment house instead.
"Locked her keys in her car this morning, I noticed," the man said dryly. "Purse and all. I saw her take off after that Marta bus. She had to run to catch up with it. I expect she's upset."
"She had a close call," Ramon said curtly. "She had heart surgery this morning. She won't be home for several days."
The owner was shocked. "Such a quiet, nice young woman," he remarked. "Always had a kind word for everyone, and a smile. She'll be missed. Please tell her that my wife and I wish her the best, and we'll look after the apartment until she gets back. Anything you want from her apartment?''
"Later, perhaps. I'll be back to get anything she needs after I've spoken to her." He'd not only have to do that, but he'd have to do something about that kitten, too. It would die if he left it. Besides, she hadn't wanted the apartment owner to know she had it. Pets were against the rules.
"I'll be around, if I'm needed. You a relative?" he asked.
"Yes," Ramon said without explanation.
He left, with the intention of driving himself home for dinner. But he couldn't. Involuntarily he turned back in the direction of the hospital.
She hadn't regained consciousness. It wasn't unusual, but it worried Ramon. He checked her carefully
with the stethoscope, noting the steady rhythm of her brand-new metal valve, which made a soft chink-chink sound as it opened and closed. The valve would last for many years, and her quality of life would be enhanced by it. No more breafhlessness at the slightest exertion, no more erratic heart rhythms, no more fatigue.
He frowned, wondering when she'd first known about it. Surely she'd had some sort of warning and had seen a doctor when she started having trouble. Judging from the condition the valve was in, she had to have noticed that something was wrong. Her bad color alone had alerted him to a physical problem.
That line of curiosity led him further along. He sat in the cafeteria, eating without tasting his food, and his mind continued its meandering. Why had she never told anyone of her condition? Had she had some violent episode with it? Did her aunt and uncle know anything was wrong? Did they care?
He couldn't help noticing the difference in the way the Kensingtons had treated Noreen since Isadora's death. Like himself, they'd blamed her for that. None of them had ever considered anything save neglect as the cause of Isadora's untimely passing. But Noreen's present condition opened the whole subject up again.
He finished his meal and got up to take his tray to the moving belt assembly in the canteen, frowning thoughtfully. He put it down and then checked his watch. It was going on eight hours since he'd operated on Noreen.
He went back up on the staff elevator to the. ICU, and moved right along past the automatic door to the cubicle where Noreen was settled.
With a rough sigh, he went into her small cubicle and checked the many monitors to which she was connected. She seemed to be in acceptable ranges on all of them. But why hadn't she regained consciousness?