Under the Dome

For a moment he and Rusty looked at each other over the boy's sheet-swaddled form. Haskell's eyes were clear and with-it—this was not the same stethoscope-equipped time-server who had been plodding through the rooms and corridors of Cathy Russell for the last couple of years like a dull ghost—but he looked terribly old and frail.

'We tried,' Rusty said.

In truth, Haskell had done more than try; he'd reminded Rusty of one of those sports novels he'd loved as a kid, where the aging pitcher comes out of the bullpen for one more shot at glory in the seventh game of the World Series. But only Rusty and Ginny Tomlinson had been in the stands for this performance, and this time there would be no happy ending for the old warhorse.

Rusty had started the saline drip, adding mannitol to reduce brain swelling. Haskell had left the OR at an actual run to do the bloodwork in the lab down the hall, a complete CBC. It had to be Haskell; Rusty was unqualified and there were no lab techs. Catherine Russell was now hideously understaffed. Rusty thought the Dinsmore boy might be only a down payment on the price the town would eventually have to pay for that lack of personnel.

It got worse. The boy was A-negative, and they had none in their small blood supply. They did, however, have O-negative—the universal donor—and had given Rory four units, which left exactly nine more in supply. Giving it to the boy had probably been tantamount to pouring it down the scrub-room drain, but none of them had said so. While the blood ran into him, Haskell sent Ginny down to the closet-sized cubicle that served as the hospital's library. She came back with a tattered copy of On Neurosurgery: A Brief Overview. Haskell operated with the book beside him, an otiscope laid across the pages to hold them down. Rusty thought he would never forget the whine of the saw, the smell of the bone dust in the unnaturally warm air, or the clot of jellied blood that oozed out after Haskell removed the bone plug.

For a few minutes, Rusty had actually allowed himself to hope. With the pressure of the hematoma relieved by the burr-hole, Rory's vital signs had stabilized—or tried to. Then, while Haskell was attempting to determine if the bullet fragment was within his reach, everything had started going downhill again, and fast.

Rusty thought of the parents, waiting and hoping against hope. Now, instead of wheeling Rory to the left outside the OR—toward Cathy Russell's ICU, where his folks might be allowed to creep in and see him—it looked like Rory would be taking a right, toward the morgue.

'If this were an ordinary situation, I'd maintain life support and ask the parents about organ donation,' Haskell said. 'But of course, if this were an ordinary situation, he wouldn't be here. And even if he was, I wouldn't be trying to operate on him using a… a goddam Toyoto manual.' He picked up the otiscope and threw it across the OR. It struck the green tiles, chipped one, and fell to the floor.

'Do you want to administer epi, Doctor?' Ginny asked. Calm, cool, and collected… but she looked tired enough to drop in her tracks.

'Was I not clear? I won't prolong this boy's agony' Haskell reached toward the red switch on the back of the respirator. Some wit—Twitch, perhaps—had put a small sticker there that read BOOYA! 'Do you want to express a contrary opinion, Rusty?'

Rusty considered the question, then slowly shook his head. The Babinski test had been positive, indicating major brain damage, but the main thing was that there was just no chance. Never had been, really.

Haskell flipped the switch. Rory Dinsmore took one labored breath on his own, appeared to try for a second one, and then gave up.

'I make it…' Haskell looked at the big clock on the wall. 'Five fifteen p.m. Will you note that as the TOD, Ginny?'

'Yes, Doctor.'

Haskell pulled down his mask, and Rusty noted with concern that the old man's lips were blue. 'Let's get out of here,' he said. 'The heat is killing me.'

But it wasn't the heat; his heart was doing that. He collapsed halfway down the corridor, on his way to give Alden and Shelley Dinsmore the bad news. Rusty got to administer epi after all, but it did no good. Neither did closed-chest massage. Or the paddles.

Time of death, five forty-nine p.m. Ron Haskell outlived his last patient by exactly thirty-four minutes. Rusty sat down on the floor, his back against the wall. Ginny had given Rory's parents the news; from where he sat with his face in his hands, Rusty could hear the mother's shrieks of grief and sorrow. They carried well in the nearly empty hospital. She sounded as if she would never stop.

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