by Dawn Brookes
By the time she arrived, Alex and Bernard were already there. A woman stood crying hysterically in the corner, and Sarah saw what looked like a body on the bed.
“I found him lying there,” the woman screamed. “He’s dead.”
Alex quickly examined the body while Bernard prepared the defibrillator and resuscitation equipment. Bernard had already cut away the man’s shirt for easy access to his chest. A couple rushed in, and the woman tried to console the weeping woman.
“Please, can you take the ladies elsewhere and make sure no-one else comes in?” Sarah instructed the man, who ushered the women out into the corridor.
“There’s a pulse,” said Alex, relieved. “It’s weak, but there is a pulse. He’s not breathing, though. Give him some breaths.”
Bernard tipped the man’s head back and attached a mask to his face, connected to an Ambu bag. He squeezed the bag to give some artificial breaths. Sarah attached oxygen tubing to the bottom of the bag and turned the portable cylinder on to give a high concentration of oxygen.
“If he doesn’t breathe, we’ll need to intubate,” said Alex, sounding stressed. “Where’s Dr Bentley?”
They all relaxed as the experienced Dr Bentley arrived and took charge. “What happened?”
“We got an emergency call,” said Bernard. “Just as I was finishing a write-up, Alex got the call. We dashed up here together.”
Alex took over the explanation. “A lady called saying she’d found a man dead. He appeared to be dead, but he has a weak pulse.”
“Any signs of an overdose?” Graham asked.
“Not as far as we can see. According to the woman, he was getting ready to escort her to the captain’s dinner this evening.”
“Any injuries?”
“None. It looks like a heart attack – two young men on one cruise?” Alex sounded exhausted.
“Keep your voice down,” hissed Graham.
“He’s breathing now,” interjected Bernard, “shallowly, but he’s breathing on his own.
Sarah had a horrible feeling in the pit of her stomach and walked around the bed, but she couldn’t see if there was an injection mark as Bernard had attached a blood pressure cuff to the upper arm.
“Okay, let’s deal with what we have.” Graham spoke calmly. “Sarah, get a drip in the arm, then we’ll get him stretchered down to the infirmary and find out what’s happened. For now we’ll work on the premise he’s had a cardiac event.”
Sarah had difficulty putting the needle in the man’s arm as the peripheral circulation rapidly shut down, but managed on the second attempt to find a vein. Bernard attached the drip to the cannula once it was in place, while Alex and Graham got the stretcher ready.
“Call Gwen, ask her to have a bed ready and a CPAP machine available.”
“What is CPAP?” A voice came from the doorway and Sarah noticed the man who had been there earlier.
“Ah, Mr Asimov,” acknowledged Graham. “It’s a machine that will assist with giving deeper breaths without the need for a ventilator – his breathing is shallow, but he’s alive.”
“Who is he?” asked Sarah.
“His name is Nikolai Stepanov,” answered Bernard. “He is the personal assistant to Mr Boris Stanislav.”
At that moment, Boris arrived looking almost as distressed as the woman. Frenzied activity came from the corridor as more and more Russians heard what was happening.
“I think it’s time to go,” instructed Graham as the crowd grew outside the room. “I’ll call you later, Mr Asimov.”
Bernard and Alex wheeled the stretcher while Sarah held on to the drip. Graham cleared the corridor ahead, reassuring passengers on the way that everything was under control. As they arrived at the lifts, Rachel came out of one with an anxious man looking like he might faint. Sarah assumed this to be Thomas. Rachel led the man away, giving her a knowing look and mouthing that she would call down to the medical centre later.
Once in the lift heading down to deck two, Graham became very serious, but gave Sarah a warning stare which she took to mean not to mention foul play. By the time they arrived at the infirmary, Gwen was prepared. They transferred Mr Stepanov on to a bed and attached the drip to a stand. His breathing remained shallow, but the bag of fluid had raised his blood pressure, bringing a little colour back to his face.
“What shall I put up next?” asked Sarah.
“Dextrose/saline,” replied Graham. “Get a clot buster ready as well, just in case.”
Gwen started up the CPAP which would cut in, giving Nikolai Stepanov deeper breaths if his own weren’t enough. “Thank goodness for that,” said Bernard. “My hand has cramped from squeezing the bag.”
“Wuss!” Sarah laughed as the tension lifted because the situation had become less critical.
“Connect the heart monitor,” instructed Graham, but Gwen was already on the case. “I’m going to need some blood. Let’s do cardiac enzymes, but I want a complete blood screen. We need to know what’s going on here.”
“We’re too far away for an evac aren’t we?” asked Alex.
“Maybe, but he’s stable now anyway, so let’s give it until morning, if anything changes we’ll need to consider speeding up or diverting.” Medical evacuation was not an option from where they were in the Atlantic and wouldn’t be ordered unless necessary and Graham was right: Nikolai Stepanov appeared stable.
“Telephone call for Sister.” Raggie appeared in the doorway. Gwen left the room.
Bernard’s radio sparked into life again, calling him to a crew member who had trodden on broken glass. “Drunk, I bet,” he said. “Is it okay for me to go?”
Graham nodded assent and asked Alex to check the blood results. As soon as they were alone, Graham sprang into action.
“Right, Sarah. You know what we’re looking for.”
Sarah examined the upper right arm while Graham removed the blood pressure cuff from the left. He let out a deep breath.
“Thank God, nothing.” He put the cuff back over Nikolai’s arm and relaxed. “For a brief moment, I was terrified we might have a serial killer on board.”
Sarah nodded, acknowledging she had been thinking exactly the same. Gwen came back, chuckling to herself.
“Well, I’m glad you’ve got something to laugh about,” snapped Graham.
“I’m sorry. Rachel’s just phoned – she found an empty tablet bottle in the man’s room and she had to ask Mr Asimov the name of the tablets as the label was written in Russian.” She giggled again.
“And?” Graham said impatiently.
“Viagra.” She laughed out loud, almost losing control. “The label read Viagra.”
Sarah thought Graham was about to lose it, but then he smirked.
“I see. My, my – do we know how many party pills he took?”
“No, but the bottle was empty. Rachel’s going to make discreet enquiries and ask his female escort for this evening. He doesn’t have a girlfriend – some of the ladies in the group are, erm, paid escorts. Rachel’s not sure if that includes sex at present.”
“The plot thickens! Next we’ll have a brothel on board. The symptoms could be those of a Viagra overdose, but I don’t think so. We’ll bear it in mind. He could also have had illegal tablets concealed in the bottle which seems more likely, his ECG is normal so are the cardiac enzymes. Is Rachel going to bring the bottle down?”
“Yes, later,” replied Gwen.
“Where’s Lauren?” asked Sarah.
“Where indeed?” growled Gwen. “She would have got the call at the same time as everyone else. I’ve just asked for her to be paged again.”
Sarah detected Gwen struggling to contain her anger. All medical staff had a duty to respond to a code blue, without exception.
The door to the infirmary opened and Lauren breezed in wearing her formal evening uniform.
“There you are,” grumbled Gwen, her tone sharp. “Where have you been?”
Graham excused himself while Sarah checked on Nikolai.
“To the captain’s party – it was great—” She stopped and looked over at the bed, her face paling. “What happened?”
“What happened is that I called you to an emergency along with every other member of the medical team. As you can see, they are all here, while YOU have only just arrived.”
“Who’s that in the bed?” Lauren appeared oblivious to Gwen’s frustration.
“For your information – his name is Nikolai Stepanov, and had you turned up earlier, you would be fully aware of that and what has happened.”
Sarah had never seen Gwen angry and busied herself with Nikolai’s charts, pretending not to listen.
“Why did you not respond to your radio?” Gwen appeared to be softening slightly as Lauren looked like she might be ill.
“I muted it.”
Whoops, wrong answer! Sarah cringed. She almost felt sorry for the idiotic woman, who hadn’t appeared stupid before that moment. Gwen’s face reddened and her lips pursed tightly together as she shook her head in disbelief.
“You muted it?” she repeated through gritted teeth. “Perhaps we should continue this conversation in my office.” Gwen turned on her heels. Lauren looked over at the man in the bed again, avoiding any eye contact with Sarah, before following Gwen.
“Is it safe?” Graham appeared from the lab area of the ward.
“Coward! Yes, they’ve gone into Gwen’s office,” Sarah replied. “I don’t expect Lauren will miss a code blue again.”
“Nor should she,” Graham said. “I realise she’s new and all, Gwen and I will make allowances for that, but between you and me, one more strike like this and she’s out. She’s already stepped outside of protocol once – now this.”
Sarah wanted to ask what else Lauren had done, but Graham would not be likely to tell her, so she just nodded. Ship policies and procedures were paramount and had to be obeyed without exception. All staff had this drilled into them at induction, and many crew members learned the hard way with misdemeanours resulting in them being escorted off the ship at various ports around the world with no means of getting home. They all knew the rules.
Sarah felt exhausted. She’d only been back for two days, and there had been one suspicious death, one crew member missing, and now the near death of a passenger who was part of an important tour party. Graham looked worn out too – it must be hard for him. He carried the responsibility for the health and wellbeing of all passengers and crew, answerable only to the captain.
Gwen and Lauren came back to the ward.
“You can go now, Sarah,” said Gwen. “Lauren will take the night shift and care for Mr Stepanov. Is the patient stable?” Gwen checked with Graham.
“Yes, his cardiac enzymes are normal, as is his heart rhythm, and he’s breathing better – I have just stopped the CPAP. He’s out of the woods. There doesn’t seem to be anything remarkable with the blood results we have so far, either. It’s a mystery. Alex will need to repeat the enzymes in a couple of hours.”
“Okay, well I’ll call it a night, too. Bernard is on call with Alex. Where is Alex?”
“He’s gone to visit the passenger with chronic airways disease who might have a chest infection,” replied Graham, turning to Lauren. “Any problems, call me, and as soon as he wakes up, I want to speak with him. I don’t care what time that is – call me.”
“Yes, sir,” muttered Lauren, and this time Graham didn’t correct her for calling him sir.
Sarah left Lauren after handing over and reminding her where everything in the treatment room was kept. “Give me a shout if you’re unsure, I won’t mind,” she said, trying to be kind.
Lauren rolled her eyes. “I’m a very experienced nurse. I was qualified when you were still at school.”
“Of course you are.” Sarah walked away. One who doesn’t respond to emergency calls and tries to seduce my friend. The sympathy train had well and truly left the station as far as Sarah was concerned.
On her way out, she caught sight of Rachel.
“I almost forgot you were coming. Let’s go – my room, if you don’t mind. I’m beat.”
Chapter 20
Rachel went back to Nikolai’s room after calling the medical centre and found Thomas and Natalia Fenenko, the woman who had found him. Natalia told them she worked as a paid escort. Boris joined them, jittery and agitated, pacing the room.
“How could this happen?” he repeated over and over.
“Did he have any illnesses?” Rachel asked.
“Not that I knew, he hasn’t worked for me too long.”
“Is he likely to have taken an overdose?”
“I don’t think so – but who knows what goes on inside another man’s head?”
“He would not have taken an overdose,” said Natalia, emphatically. “I saw him fifteen minutes before to confirm time to meet for dinner. He looked – how you say? – smug. He hummed well-known Russian song; he was happy.”
“Perhaps he had a hidden illness,” said Boris. “Anyway, I need to find papers Nikolai had, so please excuse me, ladies. See you later, Thomas.” He took what appeared to be Nikolai’s briefcase and left.
Thomas’s colour had returned, but he still seemed incapable of doing anything, so Rachel took over.
“Can I get you a cup of tea?” she asked Natalia.
“I heard you British believe tea is answer to everything, but I would like vodka, please – there is some on his table there.” She pointed towards the coffee table.
“Scotch,” muttered Thomas, sitting himself down on Nikolai’s sofa bed.
After pouring their drinks and opting for bottled mineral water, Rachel sat down next to Thomas and focussed on Natalia. “Thomas will need to write a report for his company. Do you mind telling us exactly what happened this evening? My name is Rachel, by the way.”
Natalia explained how Boris had asked her earlier in the day to escort Nikolai to the captain’s dinner. “I shouldn’t say this, but Nikolai is not nice man, nobody likes him. He keeps requesting me, though, and the pay is good, so I do my job and give him good time.”
Rachel assumed that the good time involved staying overnight. “Go on,” she encouraged.
“I came to room at six-thirty prompt and knocked. He didn’t answer, so I knocked again, loud. When he didn’t come, I asked room steward from other room to unlock for me. She swiped door open, then I saw him lying on bed and told him to hurry. He wasn’t moving. He looked white like sheet; I was sure he was dead. I screamed and pressed emergency button on telephone.”
“Can you remember anything else? Did you notice this tablet bottle on the floor?” Rachel held up the empty bottle.
“No, I saw nothing except body on bed. I panicked and ran to door after calling for help, waiting for doctor. Male nurse and doctor arrived, then more people. Lucretia and Mr Asimov came to help me and other nurse who arrived asked him to clear room.”
“Have you seen the tablet bottle before?” Rachel persisted.
Natalia looked embarrassed. “Yes, last night. He took pill out of drawer before going to bathroom to change.”
“Did you see how many pills were in the bottle?”
“Yes, full bottle. I opened drawer to find out what he had taken. I suspected it might be drugs, but realised he needed pills to be man.”
Ignoring the scorn, Rachel continued. “Can you think of anything else that appeared strange tonight? Did he seem unwell?”
“He looked well. He was gloating like he had won on horse or something – that is all.”
Asimov turned up and suggested they leave Nikolai’s room. He advised Natalia to join some of the others in the main restaurant for dinner.
“Thomas, we need to go for the captain’s dinner.”
Thomas followed him out of the room.
Rachel decided there was nothing more to discover and returned to her room, surreptitiously. She didn’t want Asimov to know how close her room was to his.
The evening’s events and wondering what had happ
ened to Nikolai were giving her brain ache. What about the empty tablet bottle? An overdose seemed unlikely, considering Nikolai’s mood, if Natalia was telling the truth. Unless the bottle contained illegal drugs, and he’d taken an accidental overdose of those.
Perhaps he had a heart attack – it happens.
Rachel headed down to the medical centre and bumped into Dr Bentley on his way out.
“Good evening, Rachel.”
“Good evening, Doctor. How is he?”
“Recovering and stable. Sarah’s in the infirmary if you’re looking for her.”
“Thank you. This is the empty pill bottle I found under Nikolai’s bed. Natalia, the woman who found him, said it was full last night.”
Dr Bentley took the bottle. “Curious! Thank you, Rachel. I don’t think it’s an overdose, and certainly not with these – the symptoms are all wrong, but I will ask Mr Stepanov about the empty bottle when he wakes.” He slipped the bottle into his trouser pocket. Rachel noticed how fatigued he looked.
It can’t be easy.
She proceeded through to the waiting room just as Sarah was leaving. They stopped by the buffet on the way to Sarah’s room as neither of them had eaten anything substantial since lunchtime.
“I managed a few canapés before everything kicked off,” remarked Rachel as she filled a plate with pizza and salad.
“You’re lucky, I didn’t even manage that. Surgery ran late, and I went to change into formals, but then had to change back when I got the emergency call. Seriously, what a day – again. First Bernard and Lauren, and then this. And Jefgeny is still AWOL – I guess he jumped after all.” Sarah didn’t pause for breath while filling a plate, choosing a high-fat, high-carbohydrate combo.
“What about Bernard and Lauren?” asked Rachel.
“It’s a long story. Last night, Bernard got to his room and passed out, only to find Lauren in his bed this morning. He called me first-thing, beside himself.”
“I can’t believe it! He seems so happily married.”
“Me neither, and what’s more, I’ve never seen him drunk, let alone pass out. But as it turns out, once he explained to Lauren that there would be no repeat – of an event he couldn’t remember, by the way – the wretched woman told him nothing had happened anyway because he’d flaked out. He’s been floating on air since hearing that news. I still don’t understand how he let himself get that drunk, though.”
