Chapter 4 - The Triage on South State
The cardiac catheterization lab at Intermountain Medical Center in Murray smelled of heparin, fluoroscopy ozone, and cold steel.
It was three-fifteen on Christmas morning.
The corridors of the second floor were completely silent except for the low, rhythmic hum of the pneumatic tube system and the soft, pneumatic shuffle of surgical booties on the seamless blue vinyl floor.
I sat in the consultation alcove outside OR 4, wearing a pair of hospital-issue green scrub pants and an oversized gray sweatshirt that one of the triage nurses had pulled from the lost-and-found locker in the basement. My navy cashmere sweater had been cut off by the paramedics in the driveway, soaked through with Calvin’s sweat and the pink pulmonary foam they had suctioned from his trachea before they slipped the seven-millimeter endotracheal tube between his vocal cords.
My hands were clean.
I had spent eight minutes at the scrub sink in the hallway, washing them with chlorhexidine soap until the skin on my knuckles was raw and smelled of hospital floor stripper, trying to get the scent of the canyon study out of my pores.
The heavy motorized doors of the surgical suite hissed open.
Dr. Gregory Vance-Pendleton—no relation to the auditor, but a third cousin of my father’s who had spent thirty years as the senior interventional cardiologist for the LDS Church health system—stepped into the hallway, pulling his blue surgical cap from his thinning gray hair.
He was sixty-four, his face lined with the deep, horizontal trenches of a man who had spent four decades looking at occluded coronary arteries on black-and-white television screens at four in the morning.
"Naomi," he said, pulling down his paper mask.
I stood up.
My knees made a soft, cracking sound in the empty corridor. "Did you get the wire across?"
Gregory walked over to the small vinyl sofa, sat down with a heavy, pneumatic sigh, and rubbed his eyes with his thumb and forefinger.
"We got two drug-eluting stents into the left anterior descending," he said, his voice carrying the dry, raspy cadence of a veteran mechanic discussing an engine block that had run twenty miles without oil. "It was ninety-nine percent occluded at the bifurcation. What we call the widow-maker. The myocardium had been ischemic for at least four hours before you started compressions, Naomi. He’s got an ejection fraction of maybe twenty-five percent."
"Is he in cardiogenic shock?"
"He’s on two pressors—levophed and epinephrine—and we put an Impella heart pump across the aortic valve to unload the left ventricle," Gregory said. He looked up at me, his sharp blue eyes assessing my face with the clinical clarity of a man who knew the Vance family history better than we knew it ourselves. "He’s alive, Naomi. But he’s not going to be driving a backhoe on Monday morning. He’s not going to be sitting in a deposition room with the city attorneys, either."
"How long on the ventilator?"
"Three days minimum. Maybe five. We’re cooling him to thirty-four degrees for twenty-four hours to protect the neurology. His brain was down for at least six minutes before the medic unit got the Lucas device on his chest."
Gregory reached into his scrub pocket, pulled out an apple, and turned it over in his hand without eating it.
"Your mother is in the family waiting room on the first floor," he said softly. "She’s got three members of her church relief society down there with thermoses of hot cider and prayer quilts. She told the admissions clerk that you attacked Calvin at the dinner table over a software dispute."
A short, dry laugh escaped my throat—a sound like dry twigs snapping under an iron tire.
"Of course she did."
"She told Marcus from the DEQ that you were having an emotional breakdown," Gregory added, looking directly into my eyes. "Marcus called my personal cell twenty minutes ago from his home in Draper. He asked me if Calvin was competent to sign an emergency corporate proxy before the banks open on Monday."
I went completely still.
The corridor seemed to contract down to a twelve-inch tunnel between my eyes and the gold signet ring on Gregory’s finger.
"Marcus from the DEQ called you?" I asked.
"He did."
"At three in the morning? On Christmas Day?"
"He said Russell was at his house," Gregory said, his voice dropping into a whisper that barely cleared the hum of the air handlers. "He said Russell had the paperwork for the corporate restructuring ready to sign. They want to remove Calvin as managing director of Vance Contracting on medical disability and appoint Russell as sole operating trustee before the state auditor files the lis pendens."
"If Russell is appointed trustee," I said, my voice cold as an irrigation ditch in January, "he can file for Chapter Eleven bankruptcy under the small business reorganization act. It stays the state audit for sixty days. It puts the company into the jurisdiction of a federal bankruptcy judge who doesn't know a ductile-iron pipe from a garden hose."
"And the money?" Gregory asked.
"The money is already in St. George," I said. "Six hundred acres of red dirt in Washington County. If Russell gets the stay, they can transfer the land to an offshore trust in Belize before the state attorney general can attach the liens."
Gregory stood up, tossing the apple into the stainless-steel waste receptacle beside the water fountain with a sharp, hollow thump.
"I am the attending physician of record, Naomi," he said, his hand resting on the heavy electronic badge reader beside the ICU doors. "Under Utah medical power-of-attorney statutes, an intubated patient under therapeutic hypothermia cannot be evaluated for legal competency, and no corporate proxy can be executed without the concurrence of the primary healthcare surrogate."
"Who is the surrogate, Gregory?"
Gregory pulled a single sheet of paper from the clip on the back of his clipboard—a yellowed, dog-eared document bearing the notary seal of Salt Lake County, dated June 14, 2018.
"Your father updated his advance healthcare directive after his hip surgery eight years ago," Gregory said. "Darlene wanted Russell named. Calvin came to my office at the clinic on South Temple by himself, on a Tuesday afternoon, and paid fifty dollars to have the clinic notary certify this."
He pointed to the signature line at the bottom of the page.
PRIMARY HEALTHCARE AGENT: NAOMI RUTH VANCE.
SECONDARY AGENT: GREGORY VANCE-PENDLETON, MD.
"He knew," I whispered.
"Calvin was an old ditch-digger, Naomi," Gregory said, stepping back through the double doors toward the recovery bays. "He wasn't an idiot. He knew which one of his children understood how to keep the water running, and he knew which one was going to sell the pumps for scrap."
The doors hissed shut.
I stood alone in the hallway, the fluorescent lights buzzing above my head like high-voltage transmission lines in the fog.
I pulled my phone from the pocket of my scrub pants.
There was a new message on the screen.
Not from Darlene. Not from Russell.
It was from Arthur Pendelton at the State Auditor’s Office:
03:42 AM: Ms. Vance. We have received an anonymous transmission containing twelve bank routing sheets and three land conveyance deeds registered to Virgin River Crest Developments LLC. The files originated from an IP address registered to your brother’s residence in Draper. He is attempting to liquidate the escrow account before 8:00 AM on Monday. We need your acoustic data now.
May you like
I looked down at the keycard in my palm.
"Arthur," I typed back, my fingers steady as steel pins. "I'm coming to your office at sunrise. Bring the state marshals."
