by Atul Kumar
With that we left Jacob’s room and allowed the pharmacy to further up the doses for all his antibiotic medications.
I followed Jack into the call room and saw him place a tourniquet on his arm and jab a needle into a large bulging vein! “What the hell are you doing?” I asked.
“Getting Jacob’s morning labs.” He looked at me like I was a retard. “Why do you think I asked you to come in this early? We have to prove his kidney function is normal, so I’ll send down my blood in his chemistry tube. Lucky for us, different tubes are required for all the various tests he needs. The other tests can be his real blood. But my blood will indicate his kidneys are functioning just fine.”
Wow, it was that easy to fake blood results for a patient? Just send down any random tube of blood with the correct label and that was as good as law.
Jacob’s morning labs showed that he was still sub-theraputic on his medication levels, but his kidneys were functioning just fine. Nobody noticed that his urine output was essentially zero. A quick instillation of saline into his catheter collection bag made the urine level appear normal. Because no urinalysis was ordered, the fluid was simply measured and discarded.
The afternoon was uneventful, and Jacob pulled me aside after lunch.
“Here, put this in your pocket. At 8 p.m. tonight Jacob’s going to need another lab draw for his medication levels. I want you to draw his labs and inject this entire syringe into his IV after you get his blood sample. Then meet me in the ICU lounge.”
“What’s in the syringe?”
“Enough steroids to arrest the immune systems of half a dozen guys.”
I quickly shoved the syringe it into my pocket and forgot about it as I busied myself with menial tasks throughout the day.
An hour before show time I was getting nervous and decided to look up the lab results of Jacob’s female friends.
What I saw shocked the hell out of me … three of the four were positive for HIV. I pulled up their detailed health questionnaires and found that all four were HIV negative within the last two years due to required testing for life and disability insurance. Furthermore, one was a lawyer, one was a medical student, and the other two were in college. Only one of the college girls tested negative.
I just knew Jacob was responsible for those three getting infected. My blood boiling, I knew what I was doing was the correct thing. This murderer didn’t need a judge and jury, he just needed an executioner. Lucky for him, we just happened to be on call tonight …
~~~~
Just before 8 p.m., I started chatting with his nurse and mentioned that I was going to check up on him. She was more than happy to oblige an eager med student’s offer to help with Jacob’s lab draw for the evening.
I gowned up to enter Jacob’s room. He was so sedated that he was drooling on himself. He looked pathetic and had a faint odor of ammonia, likely from his recently failed kidneys causing a buildup of the toxic waste product of metabolism. Or was that due to liver failure? I wasn’t certain, but he probably had both from the ridiculous doses of medications he was receiving
As I stood beside Jacob I tried to arouse him with a sternal rub. No go, he was out. I drew his blood into the correct tubes. Next, I unhooked the bag of Amphotericin B from the IV infusion machine for a minute and squeezed it with all my might before re-connecting it. That infusion was supposed to go in over three hours, not less than two minutes. That alone could be enough to potentially kill somebody. Finally, I injected the steroids through his IV and casually walked out of his room and handed his nurse the blood for his p.m. lab draw.
I did not pass go, nor did I collect $200. I beelined for the ICU conference room to find Jack casually drinking a coffee.
“Hey, what’s up Raj, all well?”
I was amazed at how calm I was. I had no mixed emotions or feelings of remorse over what had just transpired. “All’s good in the hood,” I replied, and sat down by Jack to watch the Lakers play against the Celtics.
We watched half the game in silence, and during the beginning of the fourth quarter our code blue pagers went off, announcing that ICU isolation bed two had stopped breathing.
I jumped up; Jack reached his arm out and threw me back in my seat asking, “What’s the rush?”
We got up a full minute later and walked over to Jacob’s bed. The majority of the resuscitation team had already arrived, but Jack instantly assumed the leadership role and asked for a report.
One of the interns yelled out, “Apneic with slightly elevated BP and what appears to be fine fibrillar V-Fib. One of the resident’s is about to start a femoral line. We just started chest compressions and artificial respirations.”
Jack then assumed care, “Forget the femoral line, he already has a PICC. Get whatever you need from there.
“Give him some atropine and bicarbonate IV NOW. Then get the shock paddles charged up and ready to shock at 200 joules.”
“Medications in,” somebody replied.
“Paddles ready,” somebody else yelled after stripping off Jacob’s gown and applying the appropriate goo to the paddles and placing them on his chest.
“Everybody clear! Shock.”
A quick seizure coursed through Jacob’s body, and he was again still.
“No pulse, resume CPR,” Jacob yelled. He glanced at me, we both knew that this was an exercise in futility; his potassium must have been so low that only divine intervention could bring him back from wherever he was headed.
Jacob waited 30 seconds before barking out his next order, “Repeat the shock again at 300 joules.”
Same result.
We repeated it again at 360 joules twice; still he was without a pulse.
“Ok team, stop all resuscitation measures. Time of death 9:28 p.m.” announced Jack. The team quickly dissolved leaving only me, Jack, and the charge nurse in the room.
Jack pulled the sheet over his face and nodded to the charge nurse and we left the room.
“That’s all?” I asked.
“May he go to hell,” Jacob replied, a sound of satisfaction in his voice.
The rest of our call night was much more relaxed.
~~~~
Nobody ever questioned the cause of Jacob’s death. Though when I told Cindy about it a couple weeks later, she wasn’t at all relieved or happy like I thought she might be. I think she was even saddened that he didn’t make it.
She didn’t have that burning desire for revenge, the ‘eye for an eye’ mentality that had burned within me and Jack. She was a good person to the core.
I never saw Cindy again. She didn’t return to complete the year, and through the grapevine I heard that she withdrew from the residency program and returned to New York. I called her several times, but the calls were never returned and her voice mail was eventually full and not accepting any further messages.
A couple months after Jacob’s death, I came across the following article in the New York Times:
Chapter Six: Holey Man
He keeled over while reaching for the handle of the new German sports sedan he had recently bought outright. Feeling lightheaded, he wasn’t sure if he should drive or not. Moments later, he didn’t even know if he’d make it to the driver’s seat.
On his knees with beads of sweat forming upon his brow, he was barely able to raise a shaky hand to open the door of the sleek 500+ hp sedan. It was his pride and joy. An even more prestigious ride than his former boss had in his garage.
Using the handle for support he pulled himself off the ground. He wasn’t in the best neighborhood and showing any signs of weakness would quickly get him mugged and his $150k car jacked.
A wave of heat coursed through him and he nearly fell again from the weakness. Despite the warm weather, he was shaking from chills.
Patting his right pocket, which was bulging from a wad of Bennie Franklins, his stamina suddenly increased, the diaphoresis subsided, and he managed to slump into the cockpit, realizing it was all worth it.
Business had been bo
oming recently. His referrals kept increasing and repeat business was at nearly 90 percent. He’d even recently considered using business cards. But he thought better of it. His business was best done discretely with a very select clientele.
Perhaps a rate increase was in order. He simply couldn’t keep up at the pace required of him. And bringing on a new associate wasn’t so easy in his line of work.
No, he’d definitely have to increase his rates, perhaps just for new clients initially. It’d likely be a moot point; money wasn’t such as issue for most of those he serviced.
It was nearing sunset in his former stomping ground, East L.A. While he’d love to cruise for a bit, he had an 8:30 p.m. engagement in Beverly Hills. It was already the eighth client of the day, and his was a predominantly night business.
In addition to the Beverly Hills appointment, he had four more West L.A. engagements before calling it a day. Of course another client might call anytime.
Perhaps a personal assistant was what he needed to bring more order to his life. A good assistant who could keep her mouth shut would cost him some big bucks, but business was just too good right now to be stuck dealing with phone calls and schedules.
As it was, he hadn’t had a day off in over 3 months. Sleep, when he actually obtained some, was frequently interrupted with phone calls and requests for urgent meetings. The very nature of his business hinged on customer service, punctuality, and complete and utter confidentiality. Thus, a call going to voicemail was lost wages. As his former bosses always used to say, “If you ain’t working, you ain’t earning»—a creed he now embraced wholeheartedly.
Arriving 20 minutes early, “J” as his clients knew him, parked on the street a block away and reclined back in his plush leather seat. He welcomed the much needed respite.
The pain in his right lower abdomen returned as soon as he stopped driving. It intensified and was followed by a wave of nausea. Cringing, he popped three more Advil. He couldn’t be in pain for his rendezvous.
The pain had been steadily increasing over the past three days. The fevers started only yesterday but had also been increasing. Advil was losing its effectiveness and barely took the edge off. But the real problem was the sweats; the rest he could handle. He needed to be suave, prim, and proper for his clients. Especially for the Westside clientele. His old stomping ground near Skid Row had less discerning tastes.
J took his mind off the pain thinking how much better his life would be once he moved out of Huntington Park, the shithole where he was born. It was bordered by the illustrious South Central Los Angeles on one side and Skid Row on the other side. It managed to combine the least appealing aspects of both.
One day he’d show everybody at home that he wasn’t a nobody loser like they all thought. Right now J had enough cash to get a small pad in Beverly Hills. If business continued like it was, in a couple months he might even be able to spring for a house on Rodeo Drive itself! The problem was he’d have to buy it outright. His credit score was nonexistent, and he’d long since maxed out any credit card someone was dumb enough to give him.
As his appointment time neared, J washed himself with a towel doused in Evian. He donned a new tailored shirt with those stupid French cuffs he could never understand; designer slacks, shoes, and a cashmere sweater rounded out his attire.
Grabbing his fully stocked valise from the trunk he strode to the mansion’s gate at 8:29 p.m. where he was greeted by the butler. They walked in through the side entrance avoiding the main entrance’s surveillance cameras. J’s clients usually didn’t want any records of his visitations.
With his recent visions of grandeur and mansions, J thought he’d try increasing his prices right now. Peter Winnick was a long term client and CEO of some big corporation. If he didn’t like the price hike J might lose some business, but he wouldn’t mind a short break right now either.
“Ahh, welcome back, J, punctual as usual,” greeted Peter. He was a dashing man of about 50 or so, a good 20 years older than J. His clients varied in age from about 35 to almost 80, with professions ranging from celebrity to scientist. While some were noble professionally, all morality was extinguished the moment they made an appointment with J.
“Great to see you again, Peter, it’s been a while.”
“Yeah, well the wife’s been in town this past month and work’s been busy. She’s gone to her parents in New York for the weekend, and she took the kids. So I might need another … consultation tomorrow if you have time?”
Peter quickly ushered J in to minimize any peeping toms from seeing anything they shouldn’t. Walking briskly past the library, through the long hallway, into the reading room, Peter was barely able to contain his anticipation.
“I’ll see what can be arranged to accommodate your request. However, before we go any further, I must inform you due to a serious increase in business and the limited nature of my time and services, the rates have doubled. I hope you …”
“No problem.” Peter handed J some bills from one pocket and peeled off another five hundred dollar bills from his billfold, handing them over without thinking twice. “The usual before we get down to business?”
“Hell yeah, I’ll take a double.” The rush had gone straight to J’s head. He’d just doubled his price and Peter didn’t even bat an eyelash. If all his clients were like this, he’d be moving into town sooner than he imagined.
Peter returned carrying two snifter glasses containing more than a dollop of Macallan 25. Peter was now shaking with anticipation and clearly wanted to get started right away.
Handing J the glass, they toasted and quickly downed their drinks, bastardizing the nearly hundred dollars of amber colored liquid they just consumed, which should have been sniffed and savored, not shot. But such was the nature of the supremely wealthy. Time was money, and J was more than ready to get down to business.
“Why don’t you just use the bathroom here, J, so we can get started right away,” instructed Peter, with a glazed look on his face, like a puppy dog ready to pounce on a long-awaited treat.
“Sure thing, Boss.” J entered the bathroom, which was about half the size of his current apartment. He placed his valise on the ample countertop and removed his supplies. His abdomen was starting to get a little more tender, so he popped another three Advil. The next 15 minutes might hurt more than normal given Peter’s obvious expectancy.
Finishing his preparations, he closed up his case and exited into the reading room where Peter was already standing at attention on the couch and ready to begin.
J put down his valise, untucked his shirt, and before he could even fully lift up his sweater, Peter was already ravenously underway.
~~~~
J arrived at his hovel, if one could even call it that, at just after 3 a.m. He parked his ride in the underground storage area for which he paid dearly every month. The dumpster had to be displaced to accommodate his Benz, else it’d be car-jacked within the hour if he left it on the street.
The effort required to extricate himself from the cockpit caused him to grimace. His abdomen was now throbbing and much more tender than it had been during the evening.
He barely made it up the three flights of stairs; only thoughts of dollar signs kept him going. J had progressively charged his clients more and more after he saw how easy it was with Winnick. His last client didn’t even balk at the two thousand dollar price tag. And that visit only required 20 minutes of his time.
Getting in bed was a chore due to the pain; any sort of movement seemed to aggravate it. The only thought keeping J from passing out, from both exhaustion and pain, was that he had made nearly fifteen grand today, almost double what his previous best day had been. With renewed thoughts of riches, and an additional handful of Advil, J allowed sleep to envelop him until his 10 a.m. rendezvous with Winnick.
J awoke at 7 a.m. in a cold sweat with shaking chills and severe abdominal pain, so bad that he couldn’t even sit up in bed.
He reached under his shirt and found hi
s stomach burning hot and damp to the touch. Rolling out of bed, he bent over and dry heaved for almost ten minutes, sending his head spinning and making his vision blurry.
Slowly regaining composure, J realized he needed something stronger than Advil. J crawled over to his three-legged dresser, held up with the assistance of a cinder block, and opened up his sock drawer. There was a small Altoids tin in the back corner, but the white powder inside wasn’t the residue of breath fresheners.
J tapped some of the powder onto his dresser and did a quick line of coke. He immediately followed it with a second and a third. As the rush hit him, his eyes glazed over, and the pain was no longer so much a part of him as something that existed in the periphery of his consciousness.
He much preferred the uncut pure white coke favored by the rich Hollywood crowd than the tan powder cut with battery acid he used in his past, especially now since he could afford the good stuff without having to steal it. It was much better than the black tarry heroin that he started on many years ago, though discolorations on his white walls were still reminders of his past.
Strangely enough, now that he was earning, his drug use had gone way down. He preferred to be alert and oriented when visiting clients, preferring them to be the junkies. It gave him the advantage of negotiating better rates. Not to mention having his faculties together to evade a hairy situation when one arose, which thankfully was not as often as he expected—and much less than when he used to deal drugs for his last boss.
Once again feeling in control, J packed some of the powder in a small vial, figuring he’d need it to get through the day. He already had nine meetings scheduled, with a few more that were likely to call.
With dollar signs running through his head, J got in the shower and decided today he’d wear a power suit with his best tie and shoes, appropriate attire for the increased wages he was about to charge everyone on the docket for the day.
