The First Family

by Michael Palmer

  “Sorry, sorry!” Lee called out, leaping to one side.

  The nurse made a startled noise and apologized as well. The brief commotion caught the attention of a repairman farther down the hall, a small ladder slung over his shoulder. He was walking toward the stairwell exit at the opposite end of the long hallway. A flicker of recognition came to Lee and he tried to place the man with blond hair and a thick mustache. He thought he’d seen him before, when Susie was up on the ICU. A repairman on both floors where Susie was a patient nagged at Lee, but he pushed that thought from his mind to make room for other considerations.

  Lee glanced at the repairman as he walked away. Nothing about his behavior was suspicious, and yet …

  He noticed the man wore blue sterile hospital gloves, not the heavy-duty kind he would have expected a workman to need.

  “Is the heat turned down in 5-H?” the nurse in blue scrubs asked. “It was a terrarium in there last I checked.”

  “Maintenance fixed it a few minutes ago,” the other nurse answered.

  “Excuse me, I’m looking for Susie Banks’s room,” Lee said, interrupting.

  “And you are?”

  The nurse in floral screwed up her face. The medical floor did not receive many house calls after hours.

  “I’m Dr. Lee Blackwood, a hospitalist assigned to Susie’s case.”

  He said this with the same authority as before, and again, got no pushback. Hospitalists were a common practice these days, so his coming to see Susie, even at this hour, had a logical explanation.

  Lee took another glance at the repairman, who was walking slowly toward the exit. Again it was probably nothing, but the encounter irritated him for some reason, like the steady ping of radar going off, a sound letting him know something was there. But what?

  At that moment, alarms started to sound. The nurse in floral scrubs studied the telemetry monitors before her.

  “She’s in 5-H. Speaking of Susie, her vitals just took a little dip.” The duty nurse spoke in the flat voice of someone accustomed to vitals dipping all the time. Lee’s internal radar pinged louder when he glanced again at the repairman, walking a bit faster than before.

  First maintenance fixed a heat problem in Susie’s room and now there’s a sudden dip in her vitals?

  The gas exposure was already suspect in Lee’s mind, and this repairman, his presence here and before, congealed to form a worrying picture.

  Did he do something to her?

  The repairman moved along, stepladder slung over his right shoulder.

  “Hey!” Lee called out to him. “Wait a second, please.” Lee wanted him to stop before he disappeared down those stairs.

  Instead of stopping, the repairman quickened his strides. Lee started after him in a trot that soon became a run. He paused to glance into Susie’s room and saw clusters of nurses gathered around her bed, doing what needed to be done.

  Lee hurried his steps. Susie was in capable hands and he had questions needing answers, but the repairman was at the exit now.

  “Hold a moment!”

  Lee’s voice boomed down the hall.

  The repairman glanced back, and the man’s icy blue eyes flared before they cooled. He tossed the full weight of his body (considerable weight, too; all muscle, Lee speculated) against the exit door’s metal push bar, letting the stepladder fall off his shoulder and clatter noisily to the ground. The door swung shut and Lee lost sight of the man.

  Worried he’d lose him entirely in the stairwell, Lee raced ahead, feeling tightness in his knees and chest. “Stop!” he yelled, sounding a bit winded.

  Without slowing, Lee leapt over the discarded stepladder to hit the push bar with both hands. The door sprung open with force and Lee stumbled off-kilter into an echoing concrete stairwell. From below, he heard the sound of fast-moving footsteps, already two or three floors below.

  Lee descended the first set of stairs like a slalom skier bounding down a slope. As he approached the landing, he leapt several stairs to gain ground on his fast-moving quarry. Airborne, he misjudged the distance and had only a second to brace for impact before slamming into an unforgiving cement wall. His shoulder took the brunt of the blow before he ricocheted off. A rush of adrenaline swallowed the sharp pain.

  Reorienting himself, Lee repeated the same speedy descent to the next landing, and to the one after that, trying not to focus on the repairman’s footsteps beating an even faster retreat. The urge to get upstairs and check on Susie was hard to resist. He pushed ahead, paying no mind to the gap between him and the repairman.

  Two floors from the bottom, Lee heard the exit door bang shut. Dismayed, he knew there was no way to catch the repairman now, but he went to the bottom anyway. There he paused, hands on his knees, panting to catch his breath. Soon, he was moving toward the exit, thinking he’d make a quick check of the first-floor hallway, when a gruff voice spoke to him from behind.

  “Hey, guy.”

  Lee turned and came face-to-face with the repairman. He must have opened and closed the exit door to make Lee think he had gone. Without another word, the repairman uncorked a punch to Lee’s chest, just below the midline. The blow turned his vision white as he fell to his knees.

  A gauzy film descended over Lee’s eyes, but he could still see the repairman lift one of his big black work boots. His body tensed, fearing a devastating strike to his side. A tattoo on the repairman’s muscled forearm came into sudden and sharp focus. A skull head wearing a spiked helmet appeared to be grinning right at Lee.

  Instead of giving him a steel toe to the ribs, the repairman placed his boot on Lee’s back, applied pressure, and pushed him to the floor. Lee turned his head to the side. Air, blessed air, had finally begun to work its way down his throat.

  “I don’t like doctors and I don’t like being chased,” the man said in a raspy voice. He kept his boot on Lee’s back. “You try following me, and I’ll kill you.”

  The repairman stepped over Lee. The stairwell door opened and closed. Just like that, he was gone.

  Eventually, Lee managed to get to his hands and knees, his breathing still severely compromised. Gripping the banister for support, Lee pulled himself to a standing position. He checked the hall. The repairman was gone. He took out his phone to call security as he started up the stairs to check on Susie. There was still time to hunt the repairman down. As he climbed higher he heard a strange, muffled sound from above—screaming, he thought. He climbed higher. The voice sounded familiar, and if he was right, Susie Banks was in terrible agony.

  Lee put his phone away. There was no time for phone calls. He had to get back upstairs, had to help, do anything and everything he could. Whatever the repairman had done to Susie, it was not going to hurt her.

  It was going to kill her.

  CHAPTER 28

  Lee felt as if a sledgehammer had bludgeoned his chest. He struggled up each step, moving as quickly as his rubbery legs would allow. Eventually, he returned to the bright lights and harsh glare of the medical floor. The antiseptic odors acted like smelling salts, bringing him more fully back to his senses. He rushed toward Susie’s room, battling for balance. Orderlies, visitors—basically, anyone not confined to a bed—lurked in the hallway, listening to Susie’s primal screams.

  The scene inside Susie’s room was utter chaos. On her bed, the girl thrashed about wildly. Not only had she pulled out the leads to her monitors, she had managed to rip out her IV as well. Blood spurted from the open vein, splattering the floor and spraying the white hospital sheets crimson. Nurses moved quickly to get the bleeding under control.

  A nurse heroically managed to reattach Susie’s IV, but the floor was now slick with blood. The room warmed with the heat of many bodies. Nurses gathered around Susie’s bedside, fighting what appeared to be a losing effort to keep her limbs contained. She wanted out of her bed, out of this hospital, and was willing to do anything to break away from those attempting to hold her down.

  “Let me go!” she screamed. “They’re
crawling all over my legs!”

  She unleashed a bloodcurdling yell.

  Surveying the room, he noticed no white lab coats present. Everyone here was a nurse. As if to put an exclamation mark on his observation, the nurse in blue scrubs, the one Lee had almost knocked over, cried out, “Dammit, page Dr. Rajit again. We need him here, STAT!”

  Lee stepped forward.

  “I’m a doctor at the MDC,” he announced. “I’ll take over until Dr. Rajit arrives.”

  One of the nurses recognized Lee and nodded vigorously, encouraging him to take charge. Susie’s agitation was intensifying—a funnel cloud forming into a tornado.

  “Get them off me! Get them off! I hate spiders!”

  Susie shrieked while violently brushing her arms and legs, as if arachnids actually were crawling on her limbs.

  “Susie, sweetheart, you need to calm down. There’s nothing on you.”

  The nurse, a dark-haired, stout woman, had managed to pin Susie’s arms to her sides using significant force. Susie fought hard to free herself, and when that failed, tried to get one leg over the bed rail so she could climb out.

  “They’re biting!” She yelled as if in extreme pain, staring at her legs with horror in her eyes. She was seeing something though nothing was there.

  What are these hallucinations all about? Lee wondered. He knew it was not a symptom of CO poisoning. Could it be a bizarre reaction to a medication? Or did the repairman do something to cause her delusions?

  “They’re all over me,” Susie whimpered, her body convulsing as she bucked and writhed in an effort to rid herself of these imaginary creatures.

  “What’s been her status?” Lee asked. Basically, he wanted to know what had happened during his footrace with the repairman.

  “This! This has been her status!” The nurse holding Susie’s arms sounded exasperated. “We’ve tried reasoning with her, but she’s completely delirious.”

  Crazed is more like it, thought Lee. He had seen The Exorcist plenty of times, and the way Susie flailed and contorted was terrifyingly reminiscent of the film.

  “They’re in my ears! I feel them crawling in my ears! Biting me!”

  Susie’s bloodcurdling scream caused several nurses to jump.

  “No, nothing is biting you, sweetheart.” The stout nurse did her best to sound reassuring.

  No good. If anything, Susie’s paroxysms intensified. Sweat glistened against her pale skin. She was warm to the touch, probably febrile, but no one could get a temp on her just yet.

  “We need to restrain her, right now,” Lee said.

  He spoke in a commanding voice, but tried not to sound overly aggressive. He had to keep everyone calm. Or maybe he was trying to keep himself calm. A flutter of nervousness came and went. He’d been a resident the last time he triaged a patient in crisis. On a daily basis Lee dealt with sore throats, fussy kids, odd ailments; not what appeared to be delirium tremors on steroids.

  Lee joined three other nurses in holding down each of Susie’s limbs, while another nurse lashed restraints onto the metal bed frame. Susie resisted with the strength of a wrestler escaping a pin. She arched her back, bucked her hips, and swiveled violently from side to side, all while groaning and shrieking incoherently. With Lee’s help, the team won the battle and got her secured. Thick fabric straps, impossible to rip, bound her wrists and ankles.

  “Is she on any new medications?” Lee asked.

  “No,” a nurse replied, as she worked to reapply the leads for the telemetry monitors.

  “Has her blood sugar been stable?”

  “Stable,” another nurse said. “But she’s anuric.”

  Indeed, the bag used for collecting and measuring urine output through the Foley catheter that had been inserted into Susie’s bladder was empty.

  “Forty milligrams furosemide. Increase the IV to one fifty cc’s per hour. D-five normal. How about renal function?”

  “BUN thirty-six, creatinine two point eight,” a nurse said.

  “K?” Lee said, meaning potassium.

  “Five point one.”

  Borderline, but likely on its way up too, thought Lee. Any higher could mean a potential fatal cardiac arrhythmia. Trouble. But what was doing all this?

  Susie grunted and groaned, then violently rolled her head from side to side.

  “Please, please, they’re in my hair, they’re crawling toward my eyes—please—” Her voice had softened to a whimper.

  “Haloperidol five milligrams,” Lee ordered, hoping that would stop the hallucinations. “Got those leads back on?”

  “Almost there,” a nurse replied, her voice a bit breathless.

  The monitor showed Susie’s heart racing at 160 beats per minute. There were frequent premature beats, PVCs. Her BP was 176 over 112, way too high, but not high enough to worry about an imminent brain hemorrhage.

  “Labetalol twenty milligrams,” Lee called out. “Then start a drip at two per minute. Get a twelve-lead ECG.”

  They had to get her BP down.

  “Temp’s one oh two point four,” shouted one of the nurses.

  “Get me a tox screen, and blood cultures. And a stat thyroid panel. Repeat her chemistries and CBC. Let’s check blood gases.”

  Lee paused to review the cardiogram. Brief runs of ventricular tachycardia. The T-waves were inverted in the inferior leads, worrisome for myocardial ischemia, a heart attack. In a nineteen-year-old? He felt baffled.

  Why was this girl acutely delirious? He needed answers, but those would have to wait.

  Susie’s bucking and thrashing had finally begun to subside. She gazed unblinking at the overhead fluorescent lighting. The haloperidol and restraints were doing the job.

  At that moment, a team of doctors burst into her cubicle. The one of Indian descent, who a nurse identified as Dr. Rajit, glared at Lee.

  “Who are you?”

  He did not sound pleased.

  “Dr. Lee Blackwood, I’m with the MDC. I was here to speak with Susie when she crashed.”

  Dr. Rajit’s eyes widened, his body tensing as he readied for a confrontation. “Speak with her? What on earth for?”

  The answer would have to wait. Susie’s back arched as her limbs stiffened. She moaned loudly, a strange wounded noise that escaped her pale lips just before her face turned crimson. She started to tremble, imperceptibly at first, and then with larger synchronous jerks. The restraints kept her from hitting herself.

  “She’s seizing!”

  “Get anesthesia in here! We’ve got to intubate!” Dr. Rajit yelled the order, sending the nurse closest to the door scrambling for the phone.

  Turning Susie’s head to one side, Lee prevented her from aspirating the foaming saliva into her lungs. Could anything more go wrong?

  “Two milligrams lorazepam IV and load her with fosphenytoin IV. What’s her weight?” Lee asked.

  “Forty-nine kilos,” a nurse replied.

  “Okay. Eight hundred milligrams phenytoin equivalents at one hundred per minute. Now!”

  Dr. Rajit nodded at Lee. He would have ordered the same.

  Susie’s seizure subsided quickly, but in a matter of minutes she was yelling out again, pulling at her restraints, talking about spiders.

  “Let’s get her sedated,” Lee said. “Start her on a ketamine drip. Labs back yet?”

  Suddenly, Dr. Rajit seemed blindsided by Lee’s orders. “Dammit, this is my patient!” he growled at Lee. “And who ordered labs?”

  “Dr. Blackwood did,” a nurse said.

  Lee returned a slight shrug before ordering an increased dosage of haloperidol, which seemed to quiet Susie down.

  Before anesthesia arrived, the labs came back. A nurse read the results.

  “BUN forty-eight, creatinine four point six.”

  Lee did a double take. Her creatinine was rising too rapidly, crazily so, from two point eight to four point six. He had never seen anything like this. It made no sense.

  “Her blood gases show a metabolic acidosis,�
� one of the residents intoned. “PH seven point ten.”

  “It’s got to be lactic acidosis,” Lee said. “Give her two amps of bicarb in the IV.”

  “I’m still confused. Is this your patient, Dr. Blackwood?” Dr. Rajit’s eyes bored into Lee.

  “Listen, Dr. Rajit, you’re a resident, right?” Lee made the guess solely based on Rajit’s young-looking face.

  “Yes, so?”

  “Where’s the intensivist on call?”

  “Dr. Sears is in the surgical ICU,” Dr. Rajit said. “I’ve got this.”

  “I’m sure you do,” Lee said. “But I’m an attending here at MDC. I’ve got the experience to help you. Let me help. Please. This patient—she’s—she’s very important to me.”

  For a moment, Lee was not sure which way Dr. Rajit would go. Was he another Gleason? To his relief, Lee got the consent he wanted.

  The anesthesiologist, a silver-haired man with wire-rimmed glasses, stormed into Susie’s room. A female resident pushing the anesthesia cart, along with a nurse anesthetist, came in soon after.

  “I’m Dr. Cochran,” said the anesthesiologist. “And what’s happening here?”

  Lee summarized the essentials. Dr. Cochran listened while giving Susie 100 percent oxygen through an Ambu breathing mask.

  “I’ve given her ketamine, one hundred milligrams,” Lee said.

  Dr. Cochran nodded his approval while he extended Susie’s neck to advance the laryngoscope over the back of the tongue and epiglottis. He worked the tube beyond her vocal cords, inflated the cuff to ensure a seal, and listened for breath sounds through his stethoscope.

  “Sounds good,” he said. “Let’s get a portable chest to confirm the tube’s placed right.”