By Dee Ann Palmer

It had begun again. Ever since childhood when she had been disciplined with her stepfather’s cattle prod and locked with the rats in the dark root cellar without food or water, there had been episodes when it hammered her brain against her skull and threatened to close off her throat unless she acted. Since the beginning it had been this way--intolerable until she satisfied it. It was what she, Margo Lindsey, RN, called The Urge.

It would kill her someday if she let it.

On Friday, at 10:43 p.m., at the east end of the 14th floor of St. Martin’s Hospital, Margo, who was always early for her shift, looked out over a magical San Francisco. From this height, through glass that rose from floor to ceiling, the Tinkerbell lights of the city below winked through a fairyland of mist under a blue-black sky. Sadness welled in her chest. Thanks to The Urge, she had to say goodbye.

A man who smelled of stale cigarettes, a lone visitor in the chair nearest where she stood, spoke. “No place like this city.”

“No, there’s not.” She turned her smile on him, the smile everyone told her lit up her face and revealed what a beautiful young woman she was.

“I’m going to miss it. Time for me to move on.”

“Too bad,” the man replied, with a tired shake of his head. “Too bad.”

Her New Balance running shoes made cushioning sounds as she turned and walked across corridor floors that gleamed from polishing. As she entered the intensive care unit, the silken whooshes of a ventilator filling lungs and sucking the air out again welcomed her.

Satisfaction filled her. This was where she belonged.

The overhead lights illuminated the white desk where Lila Montgomery, the registered nurse who worked evenings, sat at the computer charting.

Margo, a natural ash brunette whose hair gleamed under the lights, found it hard to understand why Lila didn’t do something about the lifeless color of her hair. She lifted the clipboard with the nurse’s notes from the hook at the foot of the first patient’s bed. Margo had been off for three days, but she knew this woman.

The patient’s urinary output was good. The ventilator was functioning as expected. The pacemaker monitoring the woman’s weakening heart was set on capture, not kicking in unless her heart skipped a beat, which it did now. Margo glanced at the monitor above the bed. The device should be sending a minuscule jolt of electricity down around the damaged pathways. She watched as the heart contracted. And beat again.

Pleased, she checked the central line that dripped normal saline solution into the subclavian artery in the woman’s neck. Without it the woman’s blood pressure hovered at 90/60, the shock level. The line was clear, flowing at the rate indicated.

There was no signal from The Urge at this bedside. Margo relaxed. Squeezing the comatose woman’s hand, she leaned to whisper in her ear. “Hi, Lois. It’s Margo back again to take care of you. Rest well, love.”

Replacing the clipboard, she approached the nurse’s station, stepping around the back-and-forth movement of the floor mop wielded by Victoriana Sanchez, the new custodian from Housekeeping.

The stooped housekeeper, dressed in blue scrubs two sizes too large for her, bent over her mop as if she were married to it. Her dark eyes flickered upward then down again as Margo passed--small, calculating eyes with what Margo had once described acerbically as a “marmoset size” brain behind them.

As Margo filled the white fanny pack at her waist with alcohol wipes, hypodermic syringes, penlight, and pen, Lila looked up at her replacement and sighed. “God, how you manage to look so great in scrubs is beyond me.”

Margo flashed her her smile, a less dazzling one than that she’d shown the man at the window. If Lila would have her scrubs tailored to fit, as Margo did, she’d look better in them. Not as good as Margo, of course, but better than she did now.

Margo didn’t tell her that, however. She changed the subject. “What happened to old Mr. Samson in bed two?”

“Expired. This afternoon.”

“Really.” A little frisson of pleasure, a slight pulsation from The Urge, flashed through Margo, but she kept it from her face.

“That infection overwhelmed him. He died at about thirteen hundred hours. No one seems to know how he contracted the bacteria that killed him.”

“Sad. What about this new patient?” She meant the one now occupying Bed 2.

“Robert Crays, 28. Motorcycle accident. Had emergency surgery and was admitted to the post-op unit, but was sent to us because he isn’t doing well. They haven’t figured out why.”

They lapsed into silence for several minutes as Margo pulled up his chart on a second monitor and studied it. “He’s got a slow bleed somewhere internally.”


”Look at the pattern in his daily hemoglobins.”

“Shit. They’ve been dropping slightly each day for the last three, and no one noticed.” Lila turned toward her, and Margo basked in the admiration in Lila’s eyes. “Super Nurse here saw what no one, not even the surgeon, did.”

This time Margo allowed herself to blush. As if the compliment embarrassed her. Which it most definitely did not. She was brilliant. Why should she be embarrassed?

“Incompetents.” Crays spat it out, startling both nurses.

The word triggered hammering inside Margo’s skull as the monstrous Urge awoke. Dizziness threatened as her throat tightened. She fought to relax it and breathe. The night RNs read and interpreted lab results, and, yes, the nurses on the post-op floor had missed this, but Margo allowed no one to malign her profession.

While Lila notified the physician and they scheduled emergency surgery, Margo began a pre-op assessment on the motorcyclist. “They’ll find that bleed and have you fixed up in no time.”

“Yeah, like puke. The incompetents.”

Even her most dazzling smile hadn’t erased the anger from the young man’s face.

The hammering in her brain intensified.

It was his fault really. Hadn’t other injured bikers told Margo that when they’d bought their hogs, the salesmen, the very ones who profited, had discouraged them from the purchase? Had warned them that everyone who rode a motorcycle ended up in the hospital at some point, and you didn’t have to attempt to jump the Snake River to be hurt?

He would never know it, but Margo had no use for this young, foul-mouthed fool in the bed before her.

She fought nausea as the pounding in her head threatened to blow it apart.

Lila stayed over to help prep the patient for surgery. When he was almost ready, Margo asked, “Can you stay until I take my medication? I think I’m getting a migraine.”

“Oh, those are so painful. Go ahead. Staying’s no problem.”

In the staff lounge, Margo once more dodged Victoriana’s mop after it swept over the tips of her white shoes.

“Hey. These are new shoes.” She was curt because she couldn’t keep the annoyance out of her voice. Tomorrow she’d report this stupid worker to the head of Housekeeping. The old woman lacked good sense. Mopping, mopping, mopping--always in someone’s way.

Margo took a couple of headache pills from her locker and swallowed them with a cup of water although she knew the only thing that would ease her head was to act on The Urge.

She slipped into one of the stalls, shut the door and removed a syringe from her fanny pack. Drawing up 10 cc of water from the toilet bowl, she recapped the needle to prevent sticking herself, flushed the toilet, and left the stall. As she approached the sink to wash her hands, she slipped the hypodermic into the pack once more.

Back in ICU, she thanked Lila.

Together they went through the change of shift ritual of counting the controlled drugs in the narcotics box, but Margo’s mind wasn’t on it. She was deciding when she would leave St. Martin’s for good, finally settling on Sunday as her last night. After her shift, she’d change in the staff lounge into jeans and T-shirt, toss all her tailored scrubs into the trash, and walk out of the hospital into the fresh morning air. This headache would be gone, and she would be able to breathe freely.

She smiled a soft smile.

“Headache better?” Lila handed the keys to the narc box to her.

Margo pulled her thoughts back to the present. “Not yet.”

“Want me to stay until your medication kicks in?”

Margo shook her head more violently than intended. She wanted the woman out of there. “I’ll be okay. You’ve spent enough time here. Go home and get a good night’s sleep.”

“Well, if you’re sure . . . .”

“I’m sure. By the time we finish the pre-op checklist I’ll feel better.”

They began. Margo read the list aloud and Lila answered. “Any known allergies?”




So it went, but again Margo’s mind was only half on the work. The Urge was increasing. It was as if the syringe in her fanny pack would leap into her hand at any moment and cry out to be used. She tensed, afraid Lila could read her thoughts. Glancing at Crays, she was sure the pre-op Valium injection had put him to sleep and he wasn’t aware they were at his bedside.

Margo imagined wiping his IV port with alcohol and injecting the toilet water. He would snuffle slightly as the cold liquid hit his vein. Then he would settle, not ever knowing what had been done to him.

In a way, Margo could thank her college microbiology professor for how she satisfied The Urge. The professor had made the students culture toilet water, so Margo had learned what pathogens were in it. Two years ago, people had died ingesting the same type of germs in hamburger meat. By then Margo had already known how effective they could be.

When the door finally closed behind Lila, Margo could hardly stay upright because of the suffocating, pounding Urge. Hands trembling, she tore open an alcohol wipe and swabbed the port. Tugging the syringe from her pack, she uncapped it. Steadying the IV line with her left hand, she poised to plunge the needle with its lethal payload home with her right.

A vice-like grip stopped her.

Someone wrenched the hypodermic out of her hand.

“NO!” Margo’s cry was guttural, anguished. Kicking and biting, she pulled free and flung herself away from the arm that held her. Facing her opponent, she saw the blue scrubs of Victoriana Sanchez. Disgust rose in her throat. What did the woman want? Money? Whatever it was, it couldn’t be good.

Victoriana’s face twisted into a smile, then she extended her left hand to show a clear plastic bag. It held a used syringe. Next, she held up the one she’d just wrested from Margo.

Syringes Margo had handled without gloves. Syringes from which the murderous organisms could be grown.

Rage at this betrayal, this intrusion into her private world ricocheted through Margo. She launched herself at the grinning figure facing her just as Sanchez metamorphosed before her eyes. The stooped figure straightened, a wig came off, and a woman as young and as tall as Margo emerged, flashing the badge of a homicide detective with the San Francisco Police Department.

Before Margo could reach her and claw the detective’s eyes out, two male officers grabbed Margo from behind. As ferocious as a caged animal, she fought them, and as she fought she heard the door clang open, saw the supervising RN stride through with a surgery attendant.

Robert Crays and his bed were whisked out of her reach to safety. Another ICU nurse arrived to take over the unit.

She couldn’t satisfy The Urge. Margo uttered a feral moan as the officers took her down.

“Super Nurse made two lousy mistakes, didn’t she, Margo?” Sanchez said. “No gloves, so she left fingerprints. And, worst of all, something no professional should ever forget-–she didn’t put the hypodermic syringe used on Mr. Samson into the hazardous waste container.”

The contempt, the triumph in the detective’s voice curdled something inside Margo as she lay handcuffed. Her cheek rested on cool vinyl flooring that looked clean, but which every hospital employee knew was covered with potentially virulent pathogens.

“Margo Lindsey, I’m placing you under arrest for . . . .”

As she descended into darkness, Margo shut them all out. Nothing Sanchez said was important. The idiots. The absolute idiots. They didn’t get it: The Urge would kill her before the state could. That was what was important.

It was the only thing that was.