Beat the Reaper: A Novel by Josh Bazell Page B

to take care of them. But on the other hand, if they come back to the emergency room less than forty-eight hours after we’ve discharged them, we have to take them back onto our service. Whereas if they come back, say, forty- nine hours after discharge, they get assigned randomly, as if it were their first visit, and odds are five to one they’ll be someone else’s problem.
    The art is in spotting the exact moment when a patient is sufficiently well to survive a full forty-nine hours outside, then flushing them. It sounds harsh—actually, it is harsh—but the second Akfal and I stop doing it, our job will become impossible.
    It’s almost impossible already. Some insurance executive long ago found the precise line past which it won’t pay to push us—our own forty-nine-hour mark, if you will—and is doing an expert job of keeping us there. Between admitting new patients and discharging old ones, both of which are paperwork nightmares, we barely have time to manage the patients who are staying around.
    This means that checking on any one of the patients we’ve already seen for the day—like Assman and Duke Mosby—is a pure waste of time. Unless the patient is in immediate, fixable trouble.
    Which is always an outside possibility, and in this case sends me back to the fire stairs, then running down the hall to their room.
    There’s a crowd just inside: the Attending Physician from rounds (of all people), Zhing Zhing, our four med students, and the Chief Resident. There are also two male residents I don’t recognize. One, who’s darkly handsome but also crazed-looking, has a giant syringe in his hand. The other one is birdlike and looks annoyed.
    “No way,” the Chief Resident is saying to the one with the syringe. “Unh uh, Doctor.” She’s standing between him and the bed.
    I say, “Hi,” and hold a fist out for Assman to knock with his knuckles, but he just glares at me. “Who are you guys?” I say to the residents.
    “ID,” says the one with the hypodermic. Infectious Disease.
    “Pathology,” says the other one. “Did you page me?”
    “Maybe an hour ago,” I say. “Did you page me? ”
    “I did, sir,” one of the medical students says.
    “This guy wants to biopsy the lesions,” the Chief Resident says to me, meaning the ID guy. *
    “Okay,” I say.
    “Okay?” the Chief Resident says. “This patient has an unknown pathogen that’s spreading, and you want to risk disseminating it farther?”
    “I want to find out what it is,” I say.
    “Did you think about informing the CDC?”
    “No,” I say.
    Which is true.
    “It’s already gone from his glute to his upper thorax,” the ID guy says. “How much farther can it disseminate?”
    “How about through my whole fucking hospital ward?” the Chief Resident says.
    The birdlike Pathology guy breaks in. “Why did you page me? ” he says.
    The Chief Resident ignores him and turns to the Attending. “What do you think?”
    The Attending looks at his watch and shrugs.
    “I’m going in,” the ID guy says.
    The Chief Resident says, “Wait—”
    But the ID guy gets an elbow around her and moves in with the needle. Taps twice on Assman’s upper chest, raising a scream with the second tap. ID keeps his finger there and sinks the needle in right next to it, then quickly tugs at the plunger. Assman’s howl rises in pitch, and the chamber of the hypodermic fills with blood swirled with yellow fluid.
    “God damn you!” the Chief Resident shouts.
    The ID guy yanks the needle out and turns to her, smug, but overestimates the distance between them. Actually there is no distance between them. As the Chief Resident gets knocked backwards, she and ID guy flail into a tangle and start to fall together.
    Right toward me.
    I shift sideways, but there’s a med student under me, yapping beneath one of my clogs. I jam into the wall, and all I can do to protect my face is raise a forearm. Which the hypodermic hits, sinking up to the