Postmortem Read online

  Postmortem

  Medicine and Magic Book 2

  SA Magnusson

  Copyright © 2018 by SA Magnusson

  Cover art by Rebecca Frank

  All rights reserved.

  No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the author, except for the use of brief quotations in a book review.

  If you want to be notified when SA Magnusson’s next novel is released and get free stories and occasional other promotions, please sign up for the mailing list by going HERE. Your email address will never be shared and you can unsubscribe at any time.

  www.samagnusson.com

  Contents

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Author’s Note

  Also by SA Magnusson

  1

  Screams echoed along the hall, the kind of piercing screams that seemed determined to penetrate beyond my eardrums and straight into the back of my skull, lodging there and leaving me with a pounding headache. Some were tolerable, but when they rose in intensity, becoming shrill the way this one did, there was nothing tolerable about having a child screaming in your face.

  It was just another day in the ER.

  Times like this, I thought it might almost be better to fight demons. At least when I’d fought the demons, I could shut them up, even if it meant cutting through them.

  My shift was nearly over, and I was tired. Today had been an avalanche of abdominal pain. Medicine was strange like that, with spurts of certain diagnoses. Yesterday had brought the run of COPD exacerbations, and I think I filled the pulmonary ICU myself. Two ended up on vents, taking far more time than I liked, and the rest were just old smokers, too tough or stubborn to know that it was nearly the end of the line.

  Days like today reminded me why I hated seeing abdominal pain, especially when they all came at once. Two cases of appendicitis were made all the worse by the fact that Dr. Tewal took the calls. It would have been better had I been able to punt them to the surgical residents—at least they answered when I paged and made it down to the ER—but Dr. Tewal was a private practice surgeon and somehow both of these cases had wanted her. And I was happy to let them have her if only she’d answer her damned pager.

  “I’ve tried reaching Dr. Tewal several times, but she’s unavailable,” I said. It felt as if I’d been repeating myself, and maybe I had been. I couldn’t remember what I’d already told this woman. Her irritation was understandable—it was her sweet little boy who shrieked in my ears—but there was a limit to what I could tolerate.

  “Isn’t there anyone in her office you can call to try and get a hold of her?” the mother asked. She had to be mid-twenties, and her blond hair was frazzled and her makeup streaked below her eyes.

  I’d done my best to reassure her that this was only a simple appendicitis, not a rupture, so we had time, but she had refused. Worse, Dr. Tewal preferred her patients not be medicated before she had a chance to examine them. That was fine when she came in a timely fashion, not so fine when it meant a little boy would suffer for another hour.

  “I’ve paged her directly twice,” I said. I’d been lucky that she’d answered within a reasonable time when the last appy had come in, but this time she’d gone MIA. Were it not Dr. Tewal, I would have suggested having the surgical residents assume care, but Tewal would learn. I’d seen her question attendings when she hadn’t been called on a case she later decided she could have managed, grilling the attendings about why they’d chose a specialist over her. I never understood why she cared, especially as she seemed to hate coming in for simple things like this. “I can try again, or I can have one of the surgery residents—”

  “There’s no need.”

  I turned to see Dr. Tewal stride in. She was a bigger woman, nearly fifty, and her glasses were slightly crooked on her nose. A stethoscope hung around her neck, but God only knew why. It wasn’t like she ever bothered to use one.

  “Can you tell me what happened?”

  Dr. Tewal made a point of ignoring me, going so far as to push me out of the way with her considerable girth. I stepped off to the side, debating whether I should stay or whether I should take off. Some specialists preferred the ER residents stay in the room with them when they were evaluating a patient. Dr. Tewal hadn’t made her preference clear, and without knowing, it was usually best to simply wait and see.

  “Oh, thank God you’re here. He’s been crying and holding his stomach for the last day. I tried waiting, but he said it hurt so bad.”

  Dr. Tewal stood over the boy and began to mash on his stomach. The kid screamed, his cries loud enough to wake the dead.

  “They didn’t give you anything for pain, Matty?”

  The mother glared at me, as if it were my fault.

  “I know how you prefer to evaluate before your patient gets any pain medications,” I said. There was a part of me that hated throwing her under the bus like this, but a comment like that did the same to me.

  Dr. Tewal glanced over her shoulder, shooting me an icy glare. “You made a patient suffer on my behalf?”

  I considered arguing and telling her that the patient only suffered because she had taken so long to get here, but there wasn’t any point in that. I wouldn’t win in a battle between the two of us. She not only was an attending, so had the upper hand, but it seemed the patient knew her.

  Maybe it was a good thing I hadn’t called the surgical resident on call. If I had, I would have gotten more than an earful.

  “Why don’t we give him 2 mg of morphine. That should take the edge off. I’ll check with the OR, but I don’t know when we’ll be able to squeeze you in. Hopefully soon. I don’t want to see Matty suffer any more than you do.”

  I turned and scurried out of the room and grabbed a nurse waiting nearby. “Dr. Tewal ordered morphine for the child in Room Three.” Joan was nearly sixty, slow as a sloth, and would drive Dr. Tewal nuts. It was perfect that I’d run into her. At least she’d get the child the medication quickly. That much I didn’t want to delay.

  “Tewal? You managed to drag her ass into the ER on a Friday afternoon?”

  “Barely.”

  Joan glanced at the room. “Sounds like a fun one. You can let her know that I’ll be there in a minute.”

  “Oh, I don’t intend to go back there while Tewal is in there. She blamed me for not giving the kid pain meds to begin with.”

  “Not the first time, and it won’t be the last,” Joan said. “She never wants patients to know it’s her idea not to give the meds. It gives the ER a lower rating and then she can come in and say she’s doing everything possible to help with their pain. As if I didn’t try to get pain meds when they were necessary.”

  “Good luck,” I said.

  Matty was still screaming when I reached the nursing station. My head throbbed. There was only so much screaming I could take before I snapped, and I was verging on that point now.

  Dr. Roberts leaned over one of the nurses, as if reading the screen. It was obvious to me he was trying to see down her scrubs, but Alison didn’t mind. She liked the attention, even more that it came from Roberts. He glanced over at me and must have seen the disapproving look on my face.

  “Michaels. You look like shit.�
��

  “I’d say the same to you, but then I’d have to say it every day.”

  He glared at me. “Did you take care of that appy yet or do you need me to—” He straightened suddenly, flashing a wide smile. Damn if he couldn’t look handsome, if he weren’t so slimy. “Dr. Tewal. It’s good to see you.”

  I turned slowly. Tewal had her phone to her face and barely lowered it to pay any attention to Roberts. At least I had that going for me.

  “Did you order the morphine?” she asked me.

  “I passed on your order to one of the nurses. Joan was going to be right on it.”

  Tewal lowered her phone. “The order was to you. Not Joan.”

  “I figured you’d enter the order yourself.”

  She shoved her glasses up on her nose. “When I was a resident, I never challenged the attendings. You’d better be careful, Dr.”—she leaned close to read my nametag, though I know she knew my name—”Michaels. I bet you still have time on surgery before you’re done with residency.”

  I don’t know which bothered me more—that she pretended she didn’t know who I was or that she knew I still had a surgery rotation to go through. Maybe both.

  Rather than say something that would end up with me getting in more trouble, I chose to say nothing at all. Tewal watched me for a moment before taking a seat at the nursing station and pulling her phone back up to her face. She’d probably post how she’d just put a resident in her place.

  “Dr. Tewal, if there’s anything I can do…”

  She looked up and smiled at Dr. Roberts. The bastard had a way with people like her, which made me dislike both of them that much more. “Is this your last year, Roberts?”

  “My last year of residency,” he said. “I’m thinking about fellowships.”

  “What fellowships are there for ER?”

  She said it in a way that made it seem as if she couldn’t believe anyone in the ER would want to do a fellowship. And most didn’t. Most of the time, residents left after their three years and went on to a successful practice. It wasn’t that they were ready—I’d heard from plenty of the former graduates that they felt as if they could have used another year—but after three years, they all felt as if they could practice without supervision.

  “I’m thinking about trauma.”

  I looked at him in shock. Trauma would mean that he’d be hanging around the ER even more, and as a fellow, he’d act even more entitled. It was competitive, but Roberts was smart and I didn’t doubt that he’d have the recommendations for it, especially with the way he sucked up to everyone, including Tewal.

  Rather than stay and listen to him work her over, I left, stopping at a computer along the hall to document. There were only a couple of hours left in my shift. Long enough that anything could happen, but hopefully I could avoid more abdominal pain.

  Derek came racing up the hall and stopped next to me. He was an attractive nurse, with sandy blond hair and deep blue eyes, and the kind of build that said he spent time in the gym. If I didn’t have to work with him so closely, I might be attracted to him. That, and the fact that my grandparents had asked him to watch over me.

  He was like me. Not completely like me. There weren’t too many people who chose to avoid the magical world on the other side of the Veil. But he had magic, though his wasn’t dark like mine.

  “Michaels. I’m glad to see you here.”

  “Me, or any resident?”

  He shrugged. “Any resident?” At least he was honest. “I’ve got something for you.”

  I sighed. We hadn’t talked about the fact that I knew about his connection to magic and he knew about mine. Both of us preferred to ignore it, pretend that the other didn’t know, and continue our usual working relationship.

  “What is it? If it’s another abdominal pain, I think I’m going to walk out.”

  “That kind of day?”

  I glanced down the hall to see Tewal and Roberts still chatting away happily. That was just what I needed. “Bad enough that I had to call Tewal twice today. She took an hour to come in for an appy.”

  “Sometimes she doesn’t come in at all.”

  I stared at Tewal for a moment longer before looking back at Derek. “What did you need my help for?”

  “A psych patient.”

  “Come on, Derek. After what I’ve been through today, I don’t need a psych patient now.”

  “Hey, I don’t know what you’ve been through, but I thought that you could help me with this patient. We need to get him moving, that’s all. If you prefer otherwise, I could go ask Dr. Roberts….”

  Derek knew just how to hurt me. There was no way I was going to allow him to go to Roberts and ask for help, especially knowing that I had passed on taking the case. “Show me the patient,” I said.

  Derek smiled. “It’s down here. Room Seven.”

  I followed him. “How do you know it’s a psych patient?”

  “He came in complaining of his mood, and now all of a sudden he can’t walk.”

  “That could be something else,” I said.

  “It could, but the guy is twenty-one. Far too young for anything significant.”

  “Had he been sick?”

  Derek shook his head. “He said he was running yesterday. He’s in pretty good shape, and he’s not the kind of person I would expect to suddenly fall ill like this.”

  I squirted a handful of hand-sanitizing foam onto my palm and began rubbing my hands together before entering the room. “What is his name?”

  “Tony,” Derek said.

  My mind started going through the possible causes of sudden onset weakness, but in a twenty-one-year-old, those diagnoses were much less likely. There weren't too many twenty-one-year-olds who had a stroke. I thought of things like MS, but that's pretty unlikely, too. Maybe Derek was right and this simply was some psychosomatic reaction, but typically we saw those and people who had other underlying mental health issues; most of them were frequent flyers who we were familiar with.

  The guy lying on the ER cot was young. He had dark hair and the body of a runner. He was toned, but not overly muscular. He stared up at the ceiling, his eyes blinking almost too much, as if he were attempting to exaggerate it intentionally.

  “I’m Dr. Michaels,” I said, stepping up to the side of the cot so that I got into his field of vision. “Derek tells me that you aren’t able to walk.”

  Tony nodded. He wasn't that much younger than me, but young enough. Working in the ER prematurely aged me, and it certainly had jaded me, regardless of how much I fought that. Maybe it was working with people like Roberts and Locks.

  “My legs. They just stopped working. You need to help me.”

  I did a brief survey, scanning him from head to toe. Other than his general appearance of good health, his skin tone and coloring looked normal. I touched his feet, which were warm. His dorsalis pedis pulses were prominent, which meant his circulation was good. “Can you feel this?” I asked, touching the bottom of his feet. I should have put on gloves.

  He shook his head. “I don’t feel anything. What happened to me?”

  I glanced over at Derek. He grabbed Tony’s hand and patted it reassuringly. “I'm sure it's nothing,” Derek said. “Dr. Michaels is really smart and she’ll figure it out.”

  He gave me a look that seemed to try to encourage me. I suspected this was psychosomatic, but we needed to rule out other potential causes. I couldn't very well call down a psychiatry consultation without fully evaluating his neurologic system. If I did, I would end up with an angry psychiatrist, and after dealing with Dr. Tewal today, I didn't need any other angry specialists. Taking a reflex hammer out of one of the cabinets, I tested his ankle reflexes and found that they worked fine. I checked his patellar reflex, and it was not nearly as prominent. That could be normal. There were plenty of people who didn’t have a prominent reflex, but maybe there was something more taking place.

  A chill worked up my spine.

  I frowned, looking over at D
erek. It had been a while since I had noticed a sensation like that. It meant magic was being used, but around Derek, it could simply mean he was the one using it.

  There was another possibility, but it meant Tony was the one using magic.

  “Try to raise your leg,” I said.

  I held Tony's leg, feeling for any attempt to move. It could be difficult to tell if someone was faking weakness, but there were a few techniques I knew of to try. “See if you can raise your leg while I hold onto it.”

  “I told you it’s not working,” Tony said.

  “I understand, but I want you to try.”

  Tony looked over at Derek, practically beseeching him to have me do something else.

  Derek smiled and patted his hand again. “It's okay. She just needs to understand what’s going on so she can help you.”

  Why couldn't Derek have found anyone else to bring into the room? Why did he need to bring me in on something like this?

  The chill continued to build, but there wasn’t the same sense to it that I had when someone else used magic near me. This was different somehow.

  What was going on?

  “Let’s try again,” I said carefully.

  “I’m trying,” Tony said.

  His muscles didn’t contract at all, which could mean that the signal wasn’t getting down to them or that he wasn’t trying.

  I placed my hand under the heel of his right foot and tapped his left. “See if you can raise that one.”

  He shook his head. “It doesn’t work.”

  “Just try.”

  If it was only one side, this test could determine whether or not there was any effort that went into the attempt. I remembered learning about it in medical school, and my attending called it Hoover's test. If someone was faking weakness on one side, the heel of the other side wouldn't press down during the attempt, not as it should. I didn't know if it worked when someone was feigning weakness on both sides.