CHAPTER THIRTEEN
WEDNESDAY, FEBRUARY 19
In Laura’s place, Tim hoped he’d be as brave as she was. Laura had opted for on-demand pain relief rather than continuous infusion of pain meds. She said she didn’t want to live in a narcotic fog. She was accustomed to control, didn’t abdicate it easily. Neither would Tim, under the circumstances.
He napped on a narrow cot set up in the far corner of her hospital room. Even though her condition was listed as stable, she needed care on an hourly basis. Besides routine vital signs, nurses checked her intravenous lines, changed her dressings, and monitored her pain.
Each time Laura stirred throughout the night, Tim instantly awoke. A skill left behind from his training, all those thirty-six-hour call schedules. Drop off to sleep in an instant. Wake up on demand. On each occasion, he pressed the button for the pain nurse. Compartment pain in the hand is excruciating. She’d need a long course of pain meds; narcotics, unfortunately.
Once during the night when Laura’s pain started to break through the drugs, she seemed particularly agitated. As she awoke, she murmured a man’s name. Not Tim. Not the name of her dead husband Steve. But, David.
Tim’s heart plummeted.
What else could it mean? So, Laura has been seeing another man. No wonder she didn’t say “yes” when he’d asked her to marry him. How could he have been so stupid not to know? To allow himself to think that they’d had an exclusive relationship?
But Laura had seemed to want him there with her. She’d dismissed her kids, but not him. And, he’d promised the kids he’d stay with her. Yes, even if she did have another guy, he vowed to see her through this. The accident happened in front of his house. If only he’d gone down to the car with her, been there to stabilize her on that black ice.
At eight in the morning, food service brought Tim a tray. Typical hospital food, no different here at Hahnemann than at CHOP—Children’s Hospital of Philadelphia—where he was the senior cardiac surgeon, trained under the best, C. Everett Koop, who made it to surgeon general of the United States.
Tim picked at the soggy scrambled eggs, nibbled the crispy bacon and the fresh orange slices, but mostly he appreciated the hot, caffeinated coffee. Laura was a true caffeine addict. She needed it to jump-start her breathing in the morning. He’d tease her about refilling her cup nonstop, marvel at how she could drink coffee just before she went to bed. Even if she wasn’t suffering from a concussion, she’d have a headache from caffeine withdrawal. How long did caffeine withdrawal symptoms last? How do we know if her headache is related to the concussion or the caffeine withdrawal? Tim mentally slapped himself in the face. How stupid can you get, obsessing over Laura’s simple caffeine headache when she faced horrible pain in her hand as well as the loss of her career?
“Tim,” Laura’s muffled voice told him they both were awake. “You still here?”
“I am,” said Tim, setting down his coffee cup.
“Is it morning? Wednesday? With these meds in my system, I can hardly think.”
“Yes. Wednesday. Looks like it’ll be brighter than yesterday. Philadelphia could use a little sunshine in February. We’re not spoiled like you Floridians.” Talking small talk to Laura when her whole life was at stake? For a moment, Tim wondered about his competence to deal with adult patients; his patients were children, babies mostly. A nurse’s voice interrupted Tim’s insecurity.
“Dr. Nelson, you slept about sixteen hours. Do you need another dose of pain meds?”
“No,” Laura said, “not yet, but thanks.”
The nurse turned to go, and Laura said, “Tim, I have to think. About what I should do with my life. I can’t be groggy. I have to call my office…”
“Hey,” Tim pointed to her elevated arm. “Just try to be as still and quiet and as pain free as you can. You don’t have to deal with anything else right now.”
“A doctor advising ‘be still’? You’re supposed to say, ‘Move around. Get up and out of bed. Prevent blood clots.’ You know, the way we force our patients to function through the pain.”
When she attempted to ease herself upward without moving the suspended right limb, Tim rushed to Laura’s side. “Easy. Let me help you.”
The grimace on her face and her panting breaths signaled her level of pain. Tim gently urged her forward so he could tuck in a pillow to support her back. She was quiet for a moment, then rewarded him with a wan smile.
“Thanks, Tim. You know—about our last night, when…”
The night when she did not say “yes.”
“Laura, we can talk more when you feel better.” But did he really want to talk? Was he ready for her to tell him about another man? About David?
“No. I want to say this. I understand if you want to change your mind. Under the circumstances, I mean. So much has changed…”
Tim bent over to kiss her dry lips, moving carefully so as not to jiggle anything that would threaten her suspended arm.
“What’s going on in here, kids?” They were interrupted by Laura’s hand surgeon, not Dr. Corey who’d already returned to Denver, but the orthopedic specialist on staff at Hahnemann, Dr. Hanover. He entered, trailed by a cadre of medical residents and students.
“Neuro has cleared you, Dr. Nelson,” he said with a forced smile. Tim knew what would come next. Ambulation. Hydrotherapy. Physical therapy. Pain piled upon pain. The goal: to salvage as much function in the hand as possible. Laura may not be able to use a scalpel, but working hard with an occupational therapist, she could relearn to pick up a coffee cup, cutlery.
“I know that it’s hard to appreciate right now, but you are fortunate to have an uninjured alternate hand. You’re going to get good in the near term at using your left hand. Believe me, so many hand injuries are bilateral. Burns are the worst.”
For Tim, this guy’s use of the words “fortunate” and “lucky” in relation to Laura was inappropriate, at best.
“I appreciate everything you’re doing, Dr. Hanover,” Laura said. “Please, could you give me some idea of how long I’ll be in here?”
“Far too early to say.” He turned to his entourage. “This patient is a surgeon—”
Tim could feel the collective intake of breath as sets of eyes stared upward at Laura’s hand.
“Our chore today is to take her to the operating room to debride the wound. Assess the tissue viability. Then decide on a physical therapy plan.”
“Is that necessary?” Tim knew his question came out like a groan and tried with little success to keep his tone professional. “Back to the OR?”
Before the doctor could respond, Laura said, “Well, there’ll be an anesthesiologist in there.”
Laura had a point. She wouldn’t feel a thing as they probed her mangled tissues with a scalpel. Bit by bit, they’d scrape away dead tissue so new tissue could grow back. Problem was, how much of that new growth would be scar tissue?
Dr. Hanover spoke as much to his entourage as to his patient, “We debride surgically as often as necessary; once we see healthy tissue, we’ll debride mechanically.” He turned to the student on his right, a tall, thin young man in a short white coat. “What other debridement methods can we use?”
The young man reminded Tim of himself twenty-five years ago. “Chemical and autolytic.” The student hesitated before adding, “And live maggot debridement?”
Dr. Hanover grinned. “Not to worry, Dr. Nelson, no maggots for you, although maggot therapy is approved by the FDA. Mechanical therapy with wet to dry dressings should be adequate, provided we get all the necrotic stuff out.” He turned to Laura. “And that we will do, Dr. Nelson, in the operating room.”
Laura nodded her appreciation, but Tim could read her concern over the agonizing pain she’d face when she emerged from anesthesia. Laura had been right not to want her kids hanging around. What good would it do for them to see her suffer? I will be here for you, Laura. I will try to earn your love.
Later that morning, after Laura’s debridement p
rocedure, Dr. Hanover assured Tim that the surgery had gone as well as could be expected. How many times had Tim himself used exactly those words to tell anxious parents their baby’s condition was guarded?
“We think we got most of the debris. We’ll go back in tomorrow, and if all looks clean, move to mechanical. We’ll use pulsed saline at the bedside. Lots of pain, which we’ll manage with parenteral narcotics.” Dr. Hanover shrugged. “Gotta go see more patients. Your wife will be back in her room soon.” He turned to go, but turned again to Tim. “You are her husband, aren’t you?”
“Fiancé,” Tim said. “Fiancé” just came out of his mouth, like saying it aloud would make it true.
CHAPTER FOURTEEN
WEDNESDAY, FEBRUARY 19
Jake lurked behind the front door of his home, back pressed against the coolness of the hall mirror, waiting. Calm had replaced frantic planning. He mentally reviewed his checklist. He’d settled on the means and on the weapon—a Smith & Wesson Saturday night special with a suppressor. He’d won it in a in a card game and it had no identifying markings. The basis of his uncomplicated plan: KISS. Keep It Simple, Stupid. Karolee arrives home by cab. Unlocks the front door. Walks into a robbery in progress. Takes a bullet to the chest. Point black. Two bullets—just to be sure.
Jake’s busy morning had been productive. The rest of his scene staged. He’d selected the burglar’s entry point and he’d gone through the house to make the home invasion look realistic. He hadn’t armed the alarm. “Never do when I’m home alone,” he’d tell the cops. He’d rummaged through Karolee’s jewelry and picked a few expensive pieces to report as missing. Jake wanted to keep Karolee’s more valuable pieces for Addie, but he couldn’t take the chance. He’d put the chosen pieces in one of her jewelry bags, close it securely, and drop it in a public place. If whoever picked it up turned it in, great, he’d get it back. If not, he wouldn’t fucking worry about it.
As soon as he’d made that decision, the traffic diversion idea he needed came to him suddenly and clearly. Ingenious scenario: on his way from the FDA to his house, his Jeep breaks down. He’d get it towed to a garage, hang around until it was fixed. Alibi established, he’d head home and literally stumble on his wife’s corpse.
The plan in place, all he had to do now was hope her flight landed on time. He figured when he didn’t show at the airport, Karolee would grab a cab. He didn’t think she’d try to call anyone else for a ride. Karolee was not high on patience, wouldn’t want to wait the extra time for someone to get to the airport. By the time she stormed in through that door, she’d be pretty blind with rage.
Jake straightened at the sound of a car door slamming. His senses on alert, his gun at the ready, Jake stepped back behind a partially open closet door. From there he’d be hidden from view as she stepped inside. He checked his watch. Twenty after five, only a few minutes after his estimate. Jake heard the key turn in the door, could see the door move. Karolee kicked it open with her boot. Her head was turned so she faced the street as the cab pulled away.
“Fuck,” he heard her say as she wrestled her suitcase over the doorsill.
Jake suspended his breathing as he waited behind the door for her to shove the luggage inside the entryway, let the door slam, and click the bolt into place.
“That asshole bastard better—”
“Good afternoon, Karolee.” Jake had planned to just shoot her, but the temptation to relish the look on her face proved too much. As he spoke, he extended his arm with the gun, locking his aim on the second button on her camel-colored cashmere coat.
Her gaping stare registered a quick progression of her disdain, then disbelief, then shock. Her cowhide messenger-style bag slid off her shoulder. As the weight of it hit the ground with a thud, she did not shift her gaze, kept it locked on Jake. Before she could say a word, he shot her point blank in the chest. A lethal shot, but he shot her again.
CHAPTER FIFTEEN
WEDNESDAY, FEBRUARY 19
Dr. Adawia Abdul sat in the small office off her lab at Replica, perplexed and perturbed. She must talk to Jake about Immunone. Ever since the Advisory Committee last Friday, he had been evading her questions about the drug’s status. She’d attended the meeting, sitting in the first row seat Jake had secured for her, even though she and Jake had to conceal their relationship. The Advisory Committee of outside experts in organ transplant surgery, academicians primarily, had been tasked by the FDA to review the data on Immunone’s safety and efficacy, both data as prepared by Keystone Pharma and as prepared by FDA reviewers. After listening to the company’s and the FDA’s prepared presentations, the committee responded to a list of questions compiled by the FDA.
A titular chairperson conducted the meeting, but Jake, as the FDA Immunone project manager, ran the show behind the scenes. He had selected the questions, chosen the order of presentation, controlled the timing, and compiled the notes. He had to know everything. So why wasn’t he telling her?
No one was more pleased than Addie with the meeting outcome. The FDA panel of consultant scientists clearly indicated the drug should be approved. Naturally, the company scientists did too, but of all the presenters, Addie thought Keystone Pharma’s consultant, Dr. Laura Nelson, made the most compelling argument. A transplant surgeon who led the Immunone clinical studies, her data highlighted the number of lives that would be saved if the drug were approved. Her message: the transplant process is so arduous for recipients and donors that when the body rejects the organ, failure amounts to tragedy. Immunone decreased the chance of rejection, according to Dr. Nelson’s studies, by more than 70 percent. The thought made Addie shiver with pride. Immunone was her drug. She’d discovered it when she was a grad student at Michigan, and she’d nurtured it through its development at Replica until Keystone Pharma acquired all rights for an insane amount of money.
Addie was impressed by how well Keystone had done by Immunone. For the last year it had been their number-one priority, and they’d convinced the FDA to fast track it. She had every reason to feel optimistic, yet she didn’t. There was something Jake wasn’t telling her. He acted like he was trying to protect her, to shield her from bad news. She wondered if it had anything to do with the death of Dr. Minn, the Keystone scientist who got killed last weekend? But how could it? The FDA had all the data. All that remained was the final approval.
Addie glanced at the clock on the wall. Almost five. Jake’s wife would be away for two more nights. She’d better get home before he got to her place. She didn’t want him lurking outside her apartment, attracting the neighbors’ attention. She started to pack her notebook in her briefcase when a business card fell out. She picked it up, turned it over: “Dr. Laura Nelson, Chief of Surgery, Tampa City Hospital.”
During the break at the Advisory Committee meeting, Addie had approached the attractive doctor, introduced herself; they’d exchanged cards, and Dr. Nelson had encouraged her to call if she ever had any questions about Immunone’s performance in the clinical studies. Addie had considered her offer most generous, and she would have liked to talk to her longer, but the FDA committee chairman had interrupted.
What about calling Dr. Nelson? Would she reveal whether there could be any problems with Immunone? No, better wait to see what Jake had to say. She’d put more pressure on him tonight—like female spies did in espionage movies. Jake may be old, but he was a sex machine. If something were wrong with the Immunone approval process, she’d find out tonight.
CHAPTER SIXTEEN
WEDNESDAY, FEBRUARY 19
“Hey there, sleepyhead.” Tim stood at Laura’s side, gazing down on her. “About time you woke up. Never had such boring company.”
Laura drifted into consciousness as the sky outside her lone window displayed muted shades of orange. Sunset comes early in February in Philadelphia, earlier than in Tampa. She must have slept the entire afternoon. What day must it be? She tried to raise her head just a fraction, pleased that at least her head did not throb.
“Still here?
” Her voice sounded raspy and weak but, she hoped, not unappreciative. Truth be told, she’d never been so grateful to see anyone.
“You kicked out your kids, but not me.” Again, that smug grin. “But I did have to promise to call them the minute you woke up.”
The last thing she remembered was being wheeled into the operating room; the pain in her hand was agonizing, but not to the excruciating point she had feared. “Tim, can you help me sit up? And before you talk to the kids, can we talk?”
“Are you okay? Your pain, do you—?”
“I don’t want any pain meds. Not now.”
Tim added a pillow, gently elevated her head to a forty-five degree angle, careful to stabilize her right arm.
“You can’t imagine how good that feels, just to sit partway up.” Laura inspected her IV line. “Guess I’m getting my nutrition. Foley catheter, so no bathroom trips. What’s to complain about?”
Tim puttered around, arranging pillows, straightening her sheets, adjusting her thin blanket. Finally, she said, “Please, Tim, will you sit down?”
He pulled a chair up to the bed opposite her elevated right arm. “Laura, I did promise—”
“They can wait,” she said, reaching with her good hand to touch his.
“Dr. Hanover was in not long ago,” Tim said. “You were out cold, but he checked the wound—”
“How did the procedure go?” she asked.
Tim glanced upward at her suspended, heavily bandaged hand. “The surgery went well. As far as they could tell, they got all the necrotic tissue. They don’t think they will have to go back in. They’ll keep you pumped up on antibiotics. Physical therapy later. Overall, good news.”
Laura knew it was. If the necrosis had not been controlled, she would have lost her hand. But good news was relative, wasn’t it? Her right hand would remain attached to her arm, but even with rigorous physical therapy, it wouldn’t be able to do much of anything. Not enough to sustain her career. She’d made up her mind. She’d take the Keystone Pharma job. No reason that a hand injury would affect an administrative job. A head injury, another story, but her thinking was clear, concussion symptoms waning.
After the Fall Page 6
