The credits for King of Queens were rolling now on the TV. Colby lifted his head from the rug and eyed her curiously as if to say, You okay? She debated whether to wake Luke or not. He would help her get through this—as a support person, he excelled. But he had to work tomorrow and needed his rest, especially if this was just preterm labor. He had been having trouble sleeping recently, which was way out of character for Luke.
He had been having nightmares. Just last week he had awakened her by bolting upright, drenched with sweat, and screaming, “Dad, Dad!” over and over. When she had asked him about it in the morning, he looked away and said he couldn’t remember anything. She doubted it. And it wasn’t like him not to be completely truthful.
Another lancing pain put an end to her musings and forced a yelp from her lips. Kim was fully awake now and felt herself tensing up. She had thought she would’ve been spared the whole pain of labor ordeal because of having a scheduled C-section. She hadn’t considered her labor starting early.
Finally, the pain subsided. In a flash, she got the whole nastiness of this labor thing that had plagued womankind since time immemorial. It wasn’t just the pain, per se. God knew that was bad. It was more than that; it was the mind games the intermittent nature of it played on you. The horrible pain would retreat, but all too soon, you started counting the seconds until the next one would strike. This was what could overwhelm even the most stoic, stable minded of people—the relentless promise of future waves of pain.
Even though Kim was only in the early stages of labor, she grasped all this labor lore en bloc in the moments between contractions. Just as Luke had a gift, this was her gift—her mind was an ultra-fine tool, well suited for intuiting things. This was why all of her life she had been good at codes, computers, chess, and puzzles.
She also recalled there was a time when she had despised her gift; she had referred to it as the curse. She had been convinced that no guy would want to date a girl who was the fastest multiplier in high school. She remembered going to her father in tears one day. He’d hugged her with his big, hairy arms and told her not to worry—God had given her this gift for a reason and someday she would understand. He kissed her gently on the forehead and told her that the guys would wise up shortly. After all, she was a beautiful young lady and she’d soon have to beat them away with a stick, he had said. She remembered giggling through her tears at this silly image.
Dad proved to be right. By the time she was a computer science major at MIT, she was bombarded with male attention. So Kim eventually came to view her mind as a true gift from God, rather than a curse. Luke, of course, had helped her on this score as well. He constantly told her he loved her because of her mind, not in spite of it. Plus, it didn’t hurt that he told her often how pretty she was and that he found her to be the sexiest creature alive.
She also knew it was time to wake Sleeping Beauty up.
“Luke, it’s time,” she said, even as the sweat beaded on her forehead. He groaned in response. She reached over and stroked his arm. “Honey, I’m having contractions.”
The word contractions seemed to get through to him. He opened his eyes wide and shook his head. “Contractions?”
“Yeah, about five minutes apart.”
“Shit, for real?” He looked at her with a mixture of sleepiness, concern, and cluelessness.
“Yeah, we gotta go.” No sooner had she said this than she doubled over with the worst pain so far. She practically shrieked. Control it, Kim. Don’t panic. Advice from her prenatal class instructor flowed unbidden into her mind. Concepts that had sounded so rational at the time, such as concentrate and focus and breathe through the contractions, now sounded absurd. It’s hard for your mind to get a grip on anything once panic has greased your thoughts.
Colby got up and started pacing around the room, tail between his legs.
“Honey, are you okay?” Luke asked, staring at her helplessly.
“No,” she gasped. “It hurts really bad. Can we go?”
Luke finally seemed fully awake. “Yeah, let’s get you in there.” He jumped off the sofa and took her hands. “Can you make it to the car? I’ll drive. Where did I leave my keys?”
Colby stopped pacing and eyed them both intently, looking scared.
“Shit, nothing’s packed!” Luke said to the air. “I’ll throw some things together and meet you in the car.” He ran back toward the bedroom.
Kim smiled for a second while she imagined what he might bring, but dread of the oncoming wave of pain quickly drained the humor from her. “Hurry, Luke,” she got out, and headed to the front door. She turned and said in a gentle voice, “Don’t worry, Colby—it’ll be okay.”
CHAPTER THIRTY-THREE
MONDAY, NOVEMBER 22, 11:05 P.M.
“Nice job, Stu,” Jason Katz said, patting him on the shoulder. “Little different putting a United States senator to sleep, isn’t it? Gives the old coronaries a squeeze, huh?”
Dr. Stuart Whitman exhaled deeply while taping Senator Pierce’s endotracheal tube in place. “Thanks for your help.” As he bent down, he got a whiff of a strange scent coming from the senator’s body—eucalyptus or jasmine or something. Strange cologne, he mused, for a manly man like the senator. “I’m just not used to having Secret Service agents with guns in the OR.”
“I know what you mean.” Katz checked his watch. “You okay now, Stu? They should be wheeling Mrs. Daulton into the C-section room right about now.”
Stu dialed up his anesthetic agent, adjusted the ventilator settings, and scanned his monitors; all was in order. “Yeah, everything looks copacetic—should be smooth sailing.” He was a little reluctant to see Katz leave; it always felt reassuring to have a colleague in the room on a stressful case like this. He sat down and began filling out his chart.
Before Stu had gotten very far, one of the Secret Service agents on his right interrupted him. “How long you been doing this, Doc?” he asked in a conversational tone.
“About ten years now,” Stu answered without looking at the agent. Stu was definitely on edge and recognized this fact.
“Okay to go, Stu?” came the general surgeon’s voice over the drapes.
“Yeah, go ahead,” Stu answered, but he was bothered by the senator’s high end-tidal CO2 reading. What’s up with that? Stu increased the vent settings and continued scribbling on his chart. He also noticed with dismay that the fentanyl he had given hadn’t lowered the senator’s pulse. In fact, the heart rate had sped up to 120 bpm. He gave more fentanyl.
“I thought about being a doctor, once,” the Secret Service agent continued. “Your job looks pretty easy. How much do you get paid?”
Stu didn’t answer. The first ten minutes were the most critical part of the anesthetic.
The agent asked a little louder, “How much money do you make?”
Stu sighed and turned from his monitors to face this guy. The agent’s ID badge identified him as Mike Jensen and he sure was a big dude, but Stu didn’t feel like shooting the shit with him. “Look, can we talk later? I’m kinda busy.” Stu refocused on the end-tidal monitor and watched with disbelief as it climbed from 42 to 45 mm mercury, even after he had increased the vent settings. How is that possible? he asked himself.
“What’s the matter?” Jensen asked. “Cat got your tongue?”
Stu chuckled nervously, but his eyes never left the CO2 monitor, willing it downward. He would’ve told the guy to shut the hell up, but he had to admit the gun was intimidating. The CO2 continued to climb. Damn!
Then it hit Stu like a ton of bricks—the horrifying thought of potential malignant hyperthermia. Was it possible? He had only seen it once or twice as a resident and had hoped to God he would never see it again. MH was so rare that you hardly ever thought of it—although Katz just had an episode of MH two weeks ago. He felt a wave of nausea sweep through him and his palms began to sweat. Still, the odds against MH were huge. The temperature would be key. He hadn’t even gotten around to putting the temp probe in yet.
He turned around quickly to get it from his cart and bumped into Jensen.
“Easy, Doc,” Jensen said. “If I’m in your way, just say so—I’ll move.” The agent backed up a step. “You must make a hundred grand, right?”
“Not now,” Stu said.
“Look, if you don’t want to talk, why don’t you just say so?”
Stu grabbed the esophageal temp probe and stuffed it down the senator’s mouth. He tried hard to ignore the agent, who wouldn’t shut up, and concentrate on the senator.
“I guess being a prick goes along with the territory,” Jensen said. “I’m not sure I got what it takes in that category, if you know what I mean.”
Stu hooked up the wire from the probe to the electronic meter box on top of the anesthesia machine. The needle jumped all the way to 38.5 degrees Celsius. Holy shit! They say if you think MH, you must treat it. MH rapidly becomes untreatable and fatal—50 percent mortality, at best. This just wasn’t possible. Not the fricking senator!
Stu wanted to call Katz back to help, but he knew he was busy upstairs doing Kim Daulton’s C-section. There was nobody but an anesthesia tech and that dimwit Russian orderly around, this time of night. A feeling of profound helplessness spread through him that threatened to immobilize him, sucking away his ability to react.
He had to pull himself together and think—the senator’s life hung in the balance. No time to panic. Maybe it wasn’t MH. A rotten gallbladder could cause a fever, which in turn could explain the elevated CO2 and tachycardia. A blood gas would seal the diagnosis. But he knew he didn’t have much time to waste. If he waited, fiddling with the diagnosis until it was clear, then it could be too late. Stu turned to the circulator and forced his voice to be as calm as possible. “Page the anesthesia tech. Tell her to bring me art line equipment, blood gas syringes, and dantrolene. And hurry!”
“Hey, Doc,” Jensen chimed in, “you sound a little worried.” He paused to look at the monitors as if he could actually make sense of them. “Everything going okay?”
CHAPTER THIRTY-FOUR
MONDAY, NOVEMBER 22, 11:15 P.M.
As he left the OR where Senator Pierce lay unconscious, about to have his gallbladder removed, Katz passed by one serious-looking Secret Service agent standing guard outside the room. Katz nodded to him and couldn’t help chuckling. Sure, the man appeared formidable and his weapon looked just as deadly as the big guy’s inside, but it really didn’t matter. All the guards in the world weren’t going to save the senator now.
Katz exited the main OR complex and reached into his pocket. His fingers brushed over the smooth metal barrel of the Makarov 9 mm pistol. He closed his hand lovingly around the knurled handle and was once again comforted by the reassuring weight of it. He was glad he had the gun; it gave him a sense of security and he drew strength from it. After all, he reflected, the weapon was a metaphor of his life. The Makarov was a beautifully machined and honed instrument, whose efficiency of design and diminutive size belied the destructive force contained within. The pistol was a marvel, surely one of his master’s favorites—just as he was.
But Katz was no fool. He certainly had no intention of shooting it out with these professionals—that would be suicide. Thanks to his carefully crafted plan, he wouldn’t have to. A well-thought-out scheme trumped brute force any day. Their physical prowess and firepower were virtually useless in the medical arena where he ruled. Kind of like taking a shark on, in the water.
Katz didn’t head directly for OB, but rather made for his office. He still had a few minutes before the Daulton C-section and he had several pressing details to attend to. First he needed to send an urgent, encrypted message to his employers that all was proceeding according to plan. These people were sticklers for details and they wouldn’t transfer the money unless he followed their instructions to the letter. After that, he would hurry up to the delivery room and tend to the Daultons. Only then could he relax—the fuses would finally all be lit and he could sit back and admire the fireworks.
The hallways were empty tonight and Katz smiled. The ruse was so simple, yet deadly effective. He had first demonstrated the technique on that lawyer’s alcoholic wife several weeks ago. Adding a lethal amount of carbonic acid to one of her IV bags had quickly put her into acidotic shock. As her body struggled to metabolize the acid load, it sent her end-tidal CO2 levels skyrocketing. He had chosen carbonic acid because it was a common compound found naturally in the bloodstream, so it wouldn’t show up as a poison or drug on any tox screen.
But the real beauty was that high CO2 levels and acidosis were the hallmarks of malignant hyperthermia. So it appeared for all the world that she’d died from a very rare, but very deadly, reaction to her anesthetic. There wasn’t even any negligence or liability attached—Katz had made the correct diagnosis and administered appropriate treatment without delay. MH carried a 50 percent mortality, in spite of treatment. The only thing missing in the diagnostic triad of MH was the presence of a high fever. But he had addressed this as well. Only the illusion of a fever had been required. Nikolai had made sure the bogus temp gauge, which read four degrees higher than normal, was in the room and ready to go.
The test run had been very successful, if he did say so himself. Profitable, too. Although he had to admit that Daulton had almost spoiled the plan, driven by his damned desire to help. Luckily, he bought the phony temp gauge reading and the whole diagnosis of malignant hyperthermia. But Daulton had come back into the hospital later to sniff about, obviously suspicious about what had happened. He had even questioned whether the woman actually had a fever. How could he possibly have guessed that she didn’t, in the face of overwhelming evidence to the contrary? That had been a little too close for comfort. Katz reminded himself that he had correctly foreseen that Daulton was trouble for him. So, he thought, having the Daultons involved with having their baby tonight was just what the doctor ordered—he needed to keep Daulton out of his hair just a bit longer.
Regardless of Daulton, this time Katz wanted the senator’s death to be more believable—this death would be scrutinized to a far greater extent than Mrs. Hinkle’s. No amateurish attempts here. The MH diagnosis had to stick. No questions about poisoning or murder or anything like that. His employers wouldn’t pay for a botched job.
With this in mind, Katz had made two adjustments to the formula. First he had cut back the percentage of the carbonic acid solution in the special IV bag. Mrs. Hinkle’s acidosis had been a little too severe to be totally explained by a metabolic process—even one as out of control and deadly as malignant hyperthermia. But you couldn’t just go to the journals and look up the minimum lethal dose of carbonic acid—no one had seen fit to run these studies yet. So the downside of the reduced acid was that the whole liter would have to be infused to ensure a fatal outcome. And, this time, Nikolai would retrieve and destroy the tainted empty bag of IV fluid and replace it with a normal empty bag.
The second modification was sheer genius. He had added a trace quantity of reagent quality E. coli endotoxin that he had lifted from Micro. The lab used these standard endotoxins as control substances to check their sterility protocols on their equipment. This substance, when infused into a human in minute quantities of around 200 parts per trillion, was capable of rapidly producing a high fever as the immune system activated in response to a challenge by bacterial wall lipoproteins.
The bottom line: a perfectly mimicked episode of malignant hyperthermia. The carbonic acid would quickly put the senator in acidotic shock, producing high CO2 levels and acidosis. And the pyrogen would provide the fever, so there was no need for the modified temp gauge they had used last time. An open-and-shut case of malignant hyperthermia.
He knew Stu Whitman was a serious play-it-by-the-book anesthesiologist and couldn’t fail to reach the diagnosis. Once he started administering the dantrolene, the senator’s fate was sealed. Not because the dantrolene itself was toxic and would kill him, but because it meant Whitman totally bought the diagnosis. Once you bought i
nto a diagnosis, you stopped looking for other possibilities, your mind closed and you concentrated on treatment. Plus, there were a lot of steps in the mixing and giving of dantrolene—enough to keep several anesthesia personnel busy.
Katz entered his office, locked the door behind him, and sat down at his computer. While waiting for the machine to boot up, he leaned back in his chair, folded his arms behind his head, and let out a satisfied sigh—his plan was finally coming together. He marveled at the staggering immensity and sheer audacity of it. Although he had to admit, he had been wrong when he had made his initial list of human flaws and placed adultery at the top. There was one bigger weakness: the lure of political power—the naked lust for absolute power was the ultimate human weakness.
The computer came alive and Katz logged on to a special, anonymous IM service where there would be no record of the conversation and it would be completely untraceable. Just in case the NSA or CIA or Homeland Security had snooping capabilities Katz was unaware of, he also used a prearranged code. He knew his employers would be anxiously awaiting word from him.
Katz typed: PIE IS IN THE OVEN.
He didn’t have to wait long for the reply: How LONG UNTIL THE PIE IS READY?
30 MINUTES.
Good.
Katz stared at the screen, practically holding his breath, waiting for more. Good? What about the fucking money! Shit, no mention of payment. He thought for a moment, calmed himself down, then typed: PAYMENT FOR THE PIE?
AS SOON AS THE PIE IS DONE, PAYMENT WILL BE SENT.
Katz banged his fists on the desk and howled. Damn! This was a deviation from the original agreement. A major fucking deviation! The money was supposed to be transferred to his offshore account upon initiation of the MH episode. That was now. That way he could verify receipt of funds before things were irreversible. Damnation! He jumped up from his chair and paced around the office. He sure hoped he wasn’t being double crossed here. Finally, he settled himself down. Honesty in business is so hard to come by these days. The irony of this was not lost on him. He supposed they had a right to be cautious. Fifty million was a lot of money.
Fatal Complications Page 18
