“What about my partner?” I asked. “He lived on junk food, didn’t exactly have the most stress-free of jobs?”
“Possibly indulged in erectile assistive pills,” she interjected, half-asking. To my questioning look, she hastily added, defensively, “You said his libido was running amok since his divorce, and given his age—”
“I don’t know, maybe,” I said, cutting off the rest of her analysis. “I do know he was living healthily since his divorce. Eating better, hitting the gym most nights, cutting down on the alcohol.”
“Even worse.” Gigi stood up, crossed to the wall-mounted machine and started to make coffee. “You hear these stories all the time, people changing their lifestyle so fast their body can’t keep up.”
“So he’s a likely candidate if he’s living like a slob or if he’s cleaning up his act? You can’t have it both ways. Plus he had a buddy who was a trainer and who was overseeing his workouts. I remember Nick complaining about wanting to look better—there was some girl he liked and he wanted the weight to come off overnight—but the guy wouldn’t let him.”
Gigi and Kurt exchanged a quick glance—the subject was maybe too close to the bone, given the new and improved Kurt. Then Gigi turned to me and said, “Reilly. Read my lips. No es posible.”
“How do you know that?” I countered, getting frustrated. “You’re not a doctor.”
“I’m not, but—look, if you could kill someone by triggering a heart attack at will, don’t you think we’d have read about it by now? I mean, at some point, someone somewhere would have used it and got caught doing it and it would have made a lot of noise.” She waved her hands. “We’d know about it.”
Kurt lifted his eyes from the tablet. “You’re talking about doing it by, like, slipping someone some kind of drug? That would show up in an autopsy, surely?”
“What if it doesn’t? What if these bastards have developed something that doesn’t show up? Remember, this isn’t some two-bit outfit we’re talking about. This is spook central.”
That quieted them down for a moment. “You’d have one hell of a cool murder weapon,” Kurt said.
I couldn’t get that idea out of my mind.
But it was more than that. Camacho, the Portuguese reporter, dies in a climbing accident back in 1981. Rossetti, the investigative reporter, dies when his apartment goes up in flames. His editor then dies from a heart attack, as does my partner.
How many others have died to keep secret whatever it is these people don’t want uncovered? And what is it they don’t want us to know about? Was that the reason the CIA was protecting Corrigan and shielding him from me? What was he part of? And what’s the connection to Camacho that goes back more than thirty years?
The same year my dad died.
“OK,” I said. “We need to try and figure out what Rossetti and his editor might have known. What can you do?”
Kurt glanced at Gigi. “We can look at both their digital footprints,” he said. “Have a look at their emails, see what they might have searched for online. Phone records, too. Might get a movement trail from their phones too, see where they’ve been hanging out.”
I went silent for a second. What someone with the right skills could do nowadays, the amount of information they could dig up about our lives—it still boggled my mind. I don’t know that the guys at our Cyber Division could do any better.
“Great, let’s do it. I also need to talk to a heart guy. Someone at the top of his game. I need to know if this is possible.”
As he tapped his screen, Kurt said, “I kind of figured you would. There’s a whole bunch of major cardiologists in this city, but here’s a guy I thought looked interesting.” He flipped his tablet around to show me. “Waleed Alami. He’s at NewYork-Presbyterian—its Ronald O. Perelman Heart Institute, to be exact.”
I perused his bio. Great credentials, to be sure. Looked gregarious, younger than I’d imagined, maybe in his late-forties, with a full head of swept-back hair and thin-framed spectacles. “Why him?” I asked.
“Well, he’s a top cardiothoracic surgeon but he’s also a big cheese in cardiac arrest research.”
There had to be more. “And . . . ?”
Kurt gave it up with a slight grin. “He’s got this cool Frankenstein machine to revive people who get heart attacks. I figured being cutting edge, you know, having an open mind . . .”
I nodded. “OK. Sounds good.” I checked the big clock on the wall. It was four in the afternoon. I didn’t think Alami would be at the Hospital today. But I knew how I could get him to meet with me on a late Sunday afternoon. It was a small gamble, but I didn’t think he’d call the office to check if “Nat Lendowski” really was with the FBI—or still alive, for that matter.
Before I called him, I needed to make another call. I didn’t want to waste one of my throwaways, which I knew I’d need to discard if I used it now.
I turned to Kurt. “I need to make a call. Untraceable. Can you set me up?”
“Hai, mochiron,” he said with a little bow.
I gave him Deutsch’s number and he did his usual party trick of putting it through a VPN’d fake Skype account that was billed to the credit card of some random woman in Japan. Moments later, Deutsch picked up.
“Are you still outside the house?” I asked without an introduction.
“Reilly!” she exclaimed. “Where are you?”
“Is Tess all right?”
“Yeah, she’s—well, she’s OK right now. She’s in the house—I think. I mean, I can’t be sure any more, can I?”
I didn’t rise to the bait. “I need you to look into something. Are they doing an autopsy on Nick?”
She went quiet for a breath, then said, her tone soft, “ I don’t know, but . . . I’d expect so, given how he died, no? Why?”
“Tell the ME to look for anything that shouldn’t be there that might have caused it.”
“What do you mean?”
“I don’t know,” I told her. “Just get them to run a full tox on him. Make sure they look for anything unusual—anything that could bring on a heart attack.”
She paused again—clearly, she wasn’t expecting any of this. “You think he was murdered?”
“It’s a possibility.”
Her tone went low, muffled, like she was cupping the phone for privacy. “Shit. Who—and why?”
“I’m looking into it. In the meantime, do me a favor. Keep it to yourself. Just ask the ME yourself and get him to call you directly if he finds anything unusual. And Annie?”
“Yes?”
“Stay alert. Keep Tess and the kids safe. And keep yourself safe too. These guys don’t mess around.”
I could hear the tension reach her throat. “Reilly, we should tell Gallo. If you’re right, we need to—”
“No. If you say something, they’ll know we communicated and they’ll take you off the detail and I want you there. I want you looking after Tess. Plus I don’t want to put you at risk by having them think you might know something you don’t. OK?”
She thought for a beat, then, without sounding overly convinced, said, “OK.”
“Annie, you’re going to need to be super-vigilant. Don’t take anything for granted. Don’t trust anything—not a phone call, not a badge—without checking it through.”
“I hear you,” she said.
“We’re going to get those bastards,” I told her. “Every last one of them.”
I hung up, wondering if I believed my own words.
A thousand miles south, Sandman exited the United Airlines Airbus that had brought him down to Miami.
He picked up the waiting rental car and drove off, feeling a familiar tingle, the one that preceded the adrenaline spike of a well-executed kill. He sensed a clean, strong bite there, one that could well lead to his quarry. He’d be getting that spike before, of course, here in Miami. He wouldn’t be there for long. Then he’d fly back to New York and, with a bit of luck, he’d finally put the Reilly saga to bed.
38
NewYork-Presbyterian Hospital, Manhattan
I strode across the limestone oasis that doubled as the reception area of the Perelman Heart Institute, my footsteps echoing across the vastness of its five-story atrium. A muzak-free ride up the elevator later, I was on the fourth floor and being ushered into the office of Waleed Alami, MD.
In keeping with his gregarious bio pic, he was very welcoming and didn’t scrutinize my creds, only giving them a cursory glance. In truth, only the guys who had something bad to hide ever did. I felt bad lying to him about who I was, but I didn’t have a choice. We shook hands and I thanked him for coming in to talk to me at such short notice, and on a Sunday too. I then told him I was investigating some recent deaths and asked him, straight up, if there was a way for someone to commit murder by giving someone else a heart attack besides using the old movie trope of scaring the crap out of them.
“That does really happen,” he said. He wasn’t smiling or taking it lightly in any way, which didn’t surprise me. In my experience, guys like him who were at the top of their game never did when discussing their field of expertise. “Are we talking heart attack, or cardiac arrest?” he asked. “’Cause you do know there’s a big difference, right?”
“I don’t, but—either one, if it’s fatal,” I said.
He thought about it for a moment, then decided he needed to take me through the basics.
Like most people, I guess, I had assumed both were synonymous, but he explained how they aren’t at all the same thing. A heart attack is a circulatory problem and occurs when the blood flow to part of the heart is blocked. Over time, coronary arteries that supply the heart with the oxygen and nutrients it needs to keep doing its job typically get blocked by fatty deposits—plaque—and the clogging eventually leads to heart damage. The injury can lead to electrical conduction defects in the form of blocked beats or disrupted electrical circuits. Surprisingly, he told me the heart usually didn’t stop beating during a heart attack. Some heart attacks, though, did lead to cardiac arrest.
The latter, though, is different. It, and not the proverbial “heart attack,” is the leading cause of death in our country, and it’s very prevalent—over a third of a million out-of-hospital cardiac arrests in the US alone each year. It’s an electrical problem, meaning it’s triggered by an electrical malfunction in the heart that causes an ineffective heartbeat. The heart’s pumping goes haywire, the brain, lungs and other vital organs get starved of blood and the victim stops breathing. Death occurs within minutes if CPR, or a defibrillator, aren’t used.
“It sounds to me like what you’re asking about is an SCA—a sudden cardiac arrest, when the heart just suddenly and unexpectedly stops beating.”
“Yes,” I said.
“Well, the heart has an electrical system of its own. It’s not like other muscles in the body that rely on nerve connections to get the electrical stimulation they need to function. The heart has its own battery, it’s called the sinus node and it’s in the upper right chamber of your heart. This is what controls the rate and rhythm of its heartbeat. If something goes wrong with the node or with the flow of electric impulses through your heart, you get an arrhythmia, which is when the heart starts beating too fast or too slowly or not at all. In the worst of these cases, your heart comes to a sudden stop—sudden cardiac arrest.”
I asked, “So is there something that can disrupt these electric signals—something someone could be given without knowing it, in one shot, one dose, not over time? Someone who’s in good health, who doesn’t have any kind of underlying heart disease?”
“Well, arrhythmias that cause cardiac arrests don’t just happen on their own, but they can happen to people who don’t have any pre-existing conditions.”
“How?”
“Stress. Strenuous exercise—you’ve read about young athletes who suddenly collapse in the middle of a game. An electric shock.”
I shook my head. “No. I’m talking about something like a drug, a pill—an injection, maybe. Some kind of toxin. One shot.”
Alami shrugged. “Well, an overdose of cocaine will do it. Or a bad reaction to any number of illegal drugs. You could also have a drug-to-drug interaction that could lead to a fatal arrhythmia. It could be a number of things.”
I shook my head again. “It needs to be something that won’t show up in an autopsy.”
Alami’s expression shifted. I felt like he was suddenly a bit wary, even suspicious, of me.
I raised my hands defensively. “Doc, please. I’m only asking because I’m trying to understand if it’s possible. ’Cause if it is, there could be a whole raft of murders that have gone unnoticed. And the people behind them need to be stopped before they can use it again.”
He studied me for a moment, his expression clouded. “Well, if someone has come up with something like this . . . I can’t imagine.” He thought some more. “Undetectable in an autopsy? That rules out a lot of compounds.”
“But do you think it’s possible?”
“I come from a school of thought that believes everything is possible. Whether or not we’ve discovered it yet, that’s the question.”
“Where would you look?”
He thought about it for a few seconds. “There are compounds that could trigger a bad reaction that might not be detected in an autopsy because we already have them. It’s just a question of how much is there, I suppose. Something based around calcium gluconate, maybe. At a much higher concentration than normally found in the body, it’s conceivable that it might create an electrolytic imbalance. Or potassium chloride. It’s in a lot of prescription drugs, and both potassium and chloride are present in the body. A spike of potassium could trigger ventricular fibrillation, which could lead to cardiac arrest, like they sometimes use in state executions. But again, the difficulty is in figuring out what the right dose is, being able to concentrate it into a small enough dose so it passes unnoticed when you’re administering it, I suppose . . . and figuring out how to not have it break down and get absorbed into the body quickly so it doesn’t show up in an autopsy. We’re talking about much, much higher concentrations than you’d normally find.”
“But if no autopsy were performed there wouldn’t be any obvious external signs anyway, right? It would just look like a cardiac arrest.”
“Yes.” He had a worried look on his face, like it had sunk in. “You really think someone’s doing this?”
“More so than before I walked in here.”
He went pensive for a moment, then said, “Is there a recent victim? Someone you suspect this might have been do to?”
“Yes.”
“And is an autopsy being done?”
“Yes.”
“Can you get me in to see the body?”
“You’re not a coroner. I don’t know.”
“Get me in. Let me have a look and run some tests of my own. The best way to figure out how it’s being done—if it’s being done—is by examining the body.”
It made sense. Of course, I couldn’t arrange it, not in my current persona non grata status. But I couldn’t tell him that. Not yet, anyway. “OK. I’ll see what I can do. In the meantime, will you think about it some more and let me know if you come up with anything?”
He let out a dry chuckle. “You think I can help it?”
I shook his hand and thanked him for his time, then I said I wasn’t carrying an extra card, you know, it being Sunday and all. It didn’t look like it worried him in the least. I gave him my burner’s number and the office line at Federal Plaza. It was a risk, but I had to give him a working number in case he did come up with something, and it would have been odd not to give him the office number too. I hoped it wouldn’t come back and bite me in the ass.
As he was showing me out, he said, “Next time you get someone you think this was done to, get the paramedics to bring them here as fast as they can. To the cardiac care unit, not the ER.”
“Why?”
“Maybe we can help where others can
’t.”
I wasn’t sure what he meant, then I remembered what Kurt/Cid/Snake had mentioned. “Someone at the office said you had some kind of Frankenstein machine?”
He chortled. “Hardly. Come, I’ll show you.”
He led me to a medical ward and onto an OR that was unoccupied, and showed me a wheeled trolley that was packed with equipment—several monitoring readouts, pumps, and all kinds of tubes running between them. It looked like a robot someone put together in their garage.
He patted it. “This is it. And it doesn’t need lightning to work.” His face barely cracked into a smile, which was probably as much as I was going to get out of him today. “It’s an ECMO. An Extra Corporeal Membrane Oxygenation. Since we’ve been using it, we’ve had twice the success rate of other hospitals in bringing people back from ‘death.’” He used air quotes on that last word.
I didn’t quite understand what that meant. I mimicked his quotes. “‘Death?’ You’re dead or you’re not, no?”
“It depends on what you mean by ‘dead.’ That’s a whole other discussion … what I can tell you is, based on my research and after talking to a lot of people who we and others have brought back after their bodies were considered ‘dead,’ when any monitor you hooked them up to showed zero life in their bodies or brains—many of them had clear recollections of those lost hours. Their consciousness was still there, even if their brains didn’t exhibit any signs of life—at least, none that we can detect. We can’t explain it, neurologically. But it’s a fact.”
I would have loved to tell him about what I’d experienced over the summer in Mexico with Alex and El Brujo and how open-minded I’d become on the subject of our souls and their ability to transcend time and live beyond our physical bodies. But now was not the time for it.
“The thing is, at some point,” he continued, “you, me, all of us—we’re all going to experience cardiac arrest. That’s ultimately the cause of death for most people. Usually, it’s because something else in the body fails, maybe from an advanced cancer, and the heart is overstretched without getting what it needs to keep pumping. But if it happens when the rest of the body has the ability to keep going, which is very common, then the minutes and hours after your heart stops are critical. And right now, I’m sad to say, in most of the hospitals out there, the way they respond in that most crucial moment hasn’t really evolved since the sixties.”
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