by Robin Cook
For a split second, Jack stared frozen at the screen. Up until that very minute, he’d thought of Laurie’s risk as a potential target for whoever was killing these patients as relatively low, since statistics were on her side. Suddenly, that was no longer the case. Whoever was doing the killing was seemingly targeting people with inherited deleterious genes, and he remembered that Laurie, like Darlene Morgan, had BRCA1.
As if propelled by a rocket, Jack leaped up, dashed out of Laurie’s office, and rushed headlong back down the corridor to the elevator. Luckily, the car was still there when he pressed the down button. As he descended, he fumbled for his cell phone in his coat pocket. He looked at his watch. It was sixteen minutes after four. Quickly, he dialed the Manhattan General Hospital, but he didn’t try to put the call through. He had no signal.
The moment the doors opened on the basement level, Jack ran the length of the hall, passing a surprised Carl Novak for the second time just going in the opposite direction. Again, Jack ignored the man. He had his cell phone plastered to his ear after having pressed the call button the moment he’d emerged from the elevator. The hospital operator answered as he thundered down the short run of stairs from the morgue’s loading dock to the pavement. After identifying himself as a doctor and without slowing down, Jack breathlessly asked to be put through to the PACU. What he wanted was reassurance that Laurie would not be moved until Dr. Riley made rounds. Running full tilt, Jack reached 30th Street and turned west.
Just as he reached First Avenue the PACU phone was picked up. He recognized the charge nurse’s authoritative voice and Jack pulled himself to a stop. It wasn’t raining as hard as it had been a quarter hour earlier when he’d dashed back to the OCME, but it was still raining just the same, such that he felt he had to shield his phone with his free hand. In front of him, relatively infrequent cars raced northward.
Between breaths, Jack identified himself to Thea.
“Wait a second,” Thea said. Then, off the line, Jack could hear her yelling directions about which bed a new patient should be put in. Then she came back on the line. “Sorry, we’re kind of busy here. What can I do for you, Dr. Stapleton?”
“I don’t mean to be a bother,” Jack said. While he was talking, he was looking for a taxi. He’d not seen any. “I wanted to check on Laurie Montgomery’s status.” He finally saw a cab in the distance with its vacant light illuminated. He was about to step off the curb and raise his hand when Thea shocked him with her response.
“We don’t have a Laurie Montgomery.”
“What do you mean?” Jack questioned with a start. “She’s in the bed against the opposite wall. I was in there tonight. You even told me she was a charmer.”
“Oh, that Laurie Montgomery. I beg your pardon. Over the last few hours, we’ve had a revolving-door situation with a bunch of trauma victims. Laurie Montgomery left the PACU. She was doing just fine, and we needed the bed.”
Jack’s mouth went suddenly dry. “When did this happen?”
“Right after I got the disaster call from the OR supervisor. My guess would be about two-fifteen.”
“I left you with my cell phone number,” Jack sputtered. “You were supposed to call me if there was any change in her status.”
“There wasn’t any change. Her vitals were rock-solid. We wouldn’t have let her go if there had been any trouble whatsoever, believe me!”
“Where did she go?” Jack managed, desperately trying to control the anger and dismay in his voice. “To the ICU?”
“Nope! She didn’t need the ICU, and it was full anyway. So was OB-GYN. She went to room 609 on the surgical floor.”
Jack snapped his phone shut and desperately looked out into the mostly empty, dark, wet avenue. The cab he’d seen earlier had gone by during his preoccupation with the shocking, disastrous conversation with Thea Papparis. The idea that Laurie had been out of the PACU in her vulnerable state for two hours while he’d been out running around on his stupid errands was almost too horrible for him to contemplate. The question What have I been thinking? reverberated around inside his mind like clashing cymbals. Overwhelmed with panic, Jack began running northward up First Avenue, mindless of the puddles that appeared like pools of black crude oil. He knew it would take him much too long to run all the way to the Manhattan General, but also knew he couldn’t just stand there.
twenty-four
IT HAD BEEN A BUSY NIGHT, maybe one of the busiest Jazz could remember at her present place of employment. They’d been inundated with trauma patients coming up from the PACU and filling all the empty beds. As the self-appointed acting charge nurse, a status that was soon to change, according to rumor, with the hiring of a new, senior night-shift RN, it had fallen to Jazz by default to divvy the patients up among the current night-shift nurses and the nurse’s aides. There hadn’t been too much complaining, since Jazz had made it a point to take her share. More important, she’d also made it a point to add Laurie Montgomery to her patient roster. Once that had been established and accepted, Jazz relaxed. She knew she’d be able to carry out her Operation Winnow responsibility at her whim.
Jazz stretched her arms over her head and rotated her head a few times to loosen up her neck muscles. She was tense. She’d just finished the last of some paperwork and was looking at some well-earned downtime from patient care, which she intended to put to good use. Even the lunch break had been truncated for everyone because of patient demand, forcing Jazz to skip eating altogether. Instead, she used the time to disappear into the ladies’ room outside the cafeteria to load a syringe with the potassium chloride she’d pilfered from the ER stock and to dispose of the empty ampoule. From her perspective, the preparation for a sanction had become routine.
It was four-forty A.M., and all was ready. She had been waiting for the right moment, and it had arrived. Elizabeth, who had been sitting there with Jazz two seconds earlier, doing her own paperwork, had been called to help a patient in room 637 and had just disappeared from view. At the same time, all the other nurses and aides were likewise out of sight, tending to their assigned patients. The dimly lit corridors had that peaceful nighttime tranquility that Jazz had come to appreciate. She looked up one corridor and down the other. It was a perfect opportunity.
Pushing back from the desk, Jazz stood up. Her hand went into her right jacket pocket for a reassuring fondle of the full syringe. Taking a deep breath to control her excitement, she set off. With quickening steps, she silently hastened down to room 609. Pausing outside the door, she cast yet another glance up and down the long corridor. Once she’d started a mission, she preferred not to be seen to avoid any talk after the fact.
Conveniently, no one was in sight. The only sound was the quiet, metronomic beeping of a monitor in a nearby room. Jazz smiled. Sanctioning Laurie Montgomery was possibly going to be the most effortless assignment she’d done, both because she’d been able to pick the time and because the target was sedated and in restraints. What could be easier? Jazz questioned under her breath.
Jazz stepped into the room. A half hour earlier, when she had found herself passing by on her way back to the nurses’ station after tending another patient, she’d ducked in to make certain the sedative had taken effect. It had. While she was there, she’d lowered the back of Laurie’s bed so she was horizontal. She had also turned off the overhead fluorescent lights. Now, similar to the corridor, the room was bathed in a gentle incandescent glow from the recessed nightlights positioned just above the baseboard.
Without a sound, Jazz moved over to Laurie’s bedside. Laurie was in a deep, drug-induced sleep. Her mouth was slightly open, and Jazz could see that her lips and tongue were dry and crusted. “Oh, poor dear,” Jazz whispered scornfully. Jazz was enjoying herself. Of all the patients Jazz had so far sanctioned, she felt Laurie deserved it the most, with all her demands and poor attitude. For Jazz, Laurie was the quintessentially entitled, rich bitch who was the female equivalent of all the Mr. Ivy Leagues Jazz had to endure. And on top of that, she was
a doctor who was still ordering Jazz around while she was a patient! From Jazz’s perspective, Laurie Montgomery with her silver-spoon past “had it coming to her” to be taken down one big, ultimate peg.
Jazz eyed the restraints binding Laurie’s wrists and felt a shiver of pleasure. There was no doubt that the restraints made the mission easier, and she was confident that Laurie wouldn’t be scratching her arm like that bastard Stephen Lewis. But beyond the practical, she thought the restraints had an appeal similar to what she felt when she watched the collection of bondage movies she had downloaded off the Web. For her, it was a control issue.
Gently, Jazz lifted Laurie’s head and slipped out the pillow. She was confident with the sedative she’d given her that Laurie wouldn’t stir, and she didn’t. Jazz tucked the pillow under her arm. She wanted it handy to slap over Laurie’s face in the eventuality that Laurie made any untoward noises like pain-in-the-neck Sobczyk. She didn’t expect Laurie would; the IV was a central line, meaning the concentrated potassium would be dumped into a major vein and would be less painful than a superficial one, but Jazz wanted to be prepared. She prided herself in being a quick learner, and the fewer the surprises, the better.
Reaching up, Jazz grasped the IV line and opened it so it flowed freely. She waited for a few minutes, to be sure it was running well. When she was certain the IV was functioning perfectly, she got out the syringe with the potassium. Using her teeth to take off the needle cap, she inserted the needle deep into the IV port.
After looking back at the door to the corridor and listening for a moment for any suspicious sounds, Jazz made the injection with strong, sustained pressure. It only took five seconds. She knew that the more the potassium arrived at the heart in a concentrated bolus, the more effective it would be. As usual, as she injected, she saw the fluid level rise in the micropore chamber below the IV fluid bag.
As soon as the syringe was empty, Jazz withdrew the needle and replaced the cap. She then pulled the pillow from under her arm as Laurie stirred, moaned, and popped open her eyes.
“Bon voyage!” Jazz whispered. With the pillow in her right hand poised for action and the syringe in her left, Jazz then bent over Laurie because she thought Laurie had mumbled something. Jazz started to ask her to repeat herself when Jazz recoiled in shocked surprise at the sound of the door to the room being slammed against its doorstop. In the next instant, an apparent maniac dashed into the room. Jazz was momentarily dumbfounded by the sudden, whirlwind arrival in the silent and dimly lit environment, particularly because she was tense and engrossed in what she was doing, and also because she thought she’d been so careful to avoid surprises. Except for taking a reflexive defensive step back, Jazz was momentarily paralyzed.
“How is she?” Jack barked as he rushed to the foot of Laurie’s bed. His breaths were coming in noisy heaves. His hair was dripping and plastered to his forehead. He appeared like a wild man with an unshaven face, red eyes, wet clothes, and soggy shoes. He leaned with both hands on the metal foot of the bed as if exhausted but quickly revived. It was apparent he immediately didn’t like what he saw. His eyes darted to Jazz, who had not answered him. He saw the pillow and the syringe in her hands. His attention reverted back to Laurie, who was softly moaning and fighting weakly and futilely against the wrist restraints.
“What’s going on?” Jack demanded. He rushed around the side of the bed to Laurie’s right, across from Jazz. “Laurie!” Jack yelled. His hand briefly clutched Laurie’s wrist, but then shot up and gripped Laurie’s forehead to keep her from moving her head from side to side. “What the hell are the restraints for?” Jack cried, but he didn’t wait for an answer. On closer inspection, it was apparent Laurie was in a worsening, desperate state and possibly agonal. Her face reflected a mixture of terror, confusion, and pain.
“Hit the lights!” Jack yelled. “Call a code!”
Jazz still didn’t respond other than to take yet another step back, stunned by the unexpected events.
“Fuck!” Jack screamed at the nurse’s paralysis. His voice reverberated off the sleeping hospital’s walls. He needed help fast, but he didn’t want to leave Laurie alone even for a few seconds.
In frantic, desperate frustration, Jack yanked the bed away from the wall. Its locked wheels made a screeching sound on the composite flooring. After pushing the night table to the side, causing the collection of objects on its surface to crash to the floor in a clatter, Jack squeezed himself between the head of the bed and the wall. With his foot, Jack released the wheel locks. Gritting his teeth and allowing a battle-like yell to escape from his lips, he pushed the bed farther from the wall, yanking out its power cables in the process. With a grunt, he angled the rolling bed toward the door. It picked up speed, and although it hit the door and then the opposite jamb, they were glancing collisions and didn’t interrupt his forward progress. In seconds, he was out in the hall, and using all his strength, he got the bed rolling at a good clip down the hallway toward the bright lights of the nurses’ station.
“Call a code!” Jack shouted at the top of his lungs as he pushed. An unfortunate housekeeping cart loomed in the way, but Jack ignored it. The bed with Laurie in it had considerably more inertia, and the hapless cart was bowled over with a crash, spilling its supply of individual hand soaps and other material out onto the floor. Next came a walker, which was nearly crushed by the bed’s momentum. “Call a code!” Jack yelled again. Nurses, nurse’s aides, and even ambulatory patients began appearing in doorways to see Jack streak by.
Jack tried to slow the bed down as he closed in on the nurses’ station with only partial success. The bed caromed off the counter, taking with it all the charts that had been left on the top, as well as a vase of cut flowers that had yet to be delivered to one of the patients. In the bright light, Jack could see how bad Laurie looked. She was ghostly pale and unmoving. Her eyes, with dilated pupils, blankly stared up at the ceiling.
Stripping off his wet coat and jacket and letting them fall to the floor, Jack moved to Laurie’s side. After quickly determining that she was definitely not breathing and had no pulse, he pulled Laurie’s chin back, pinched her nose and sealed his mouth over hers. He breathed into her several good breaths, then vaulted up onto the bed and began closed-chest cardiac massage. Seconds later, several nurses were at his side. One produced an Ambu bag and began respiring Laurie, carefully pacing herself with Jack’s compressions. She inflated Laurie’s lungs after Jack had applied five compressions. Another nurse wheeled over a bottle of oxygen and connected it to the Ambu bag.
“Has a code been called?” Jack yelled out.
“Yes,” the nurse said who was breathing for Laurie.
“Well, where the hell are they?” Jack demanded.
“It’s been less than a minute since they’ve been called.”
“Damn, damn, damn,” Jack sputtered through clenched teeth. He was out of breath from the running, the pushing, and now the compressions. Silently, he lambasted himself for having left Laurie, even if it had been her suggestion. He should have parked himself outside the PACU as he had threatened. From his position looming over her, he could tell her color was a tiny bit better prior to starting the CPR, so they were making a little progress. “What are her pupils doing?” Jack asked the nurse who was bagging her.
“Not a lot of change.”
Jack shook his head in frustration. “How long does it usually take for the resuscitation team to get here?” he yelled between compressions. If what he had suspected had happened to Laurie, her life was clearly in the balance until resuscitation team arrived, and even then, he didn’t know what the chances were. One thing he was dead certain of: CPR alone wasn’t going to hack it. She had to be treated.
As if an answer to a prayer, an elevator door opened out in the lobby and a cardiac crash cart rattled out. Accompanying it were four medical residents, two women and two men who came running. The leader of the pack was Caitlin Burroughs, who looked as if she had been in Shirley Mayrand’s med
ical-school class for gifted toddlers. If Jack had seen her on the street, he would have thought she was a high-school senior, not a senior medical resident. The men looked young, too, but not nearly in Shirley or Caitlin’s league.
One of the residents immediately took over the Ambu bag from the nurse. Two of the others started attaching EKG leads. They obviously knew how to work as a team.
“What’s the story here?” Caitlin barked, checking Laurie’s pupils.
“Hyperkalemia,” Jack shot back.
“That’s a rather specific diagnosis,” Caitlin exclaimed. She spoke in a rapid, staccato fashion. She might have looked young to Jack, but she exuded confidence that could only have come from experience. “How do you know her potassium is too high? Is she a renal patient?”
“No renal disease,” Jack snapped back. He wasn’t one hundred percent sure Laurie was suffering from high potassium, but he was a hundred percent sure that if they didn’t act immediately, and it turned out that she was hyperkalemic as he suspected, they’d lose her for certain, and she’d end up a statistic in her own series. “It would take too long right this minute for me to tell you how I know, but I know,” Jack continued emphatically. “We have to treat for high serum potassium, and we have to do it now! This second.”
“How come you’re so sure? And, by the way, who are you?”
“I’m Dr. Jack Stapleton,” Jack blurted. “I’m a medical examiner here in the city. Listen! You’ve had a series of unexpected cardiac deaths in this hospital since January. All have been unsuccessful resuscitation attempts on young healthy people just like this patient. A red flag has gone up over at the OCME. We think it’s purposeful, iatrogenic hyperkalemia.”
