The man in the overcoat sensed the driver’s uneasy feeling about the area. “Relax,” he said from the back seat. “This area has always given me the creeps as well. Don’t worry; I’m not planning to sacrifice you for this wonderful palace on wheels. I just need to take care of some business, and then we can head back to town. Now, if you would kindly stop the car right here, I’ll be back before you can say oh shit.”
The man got of the taxi in the middle of the street. No one was there. Nothing seemed alive in this part of town.
The driver called after him, “Hey, how about you call another taxi when you’re done with this meeting? I’m sure they can get you a driver in just a few minutes. And if not, just give me a call and I-”
The man in the overcoat leaned into the taxi through the
passenger seat window. “How about if you stay and give me a ride to dinner at Pasal’s when I’m finished with this meeting? I’ll make this worth your while.” With that, the man in the overcoat opened his left hand, holding another hundred-
dollar bill.
The driver quickly reached for the money, but the fist closed
before he could grab the bill. The driver looked up at the man in the window.
The man just smiled and took two steps back from the car. “I’ll see you in a few minutes.” He walked down to the corner
and turned right down the next street.
As the man with the overcoat reached the payphone, he cautiously turned around to make sure no one was nearby. This phone was a good spot to call because it always seemed to be deserted, especially at night. The only people out were usually gang-bangers. He wondered if the taxicab driver would actually stay around. There had only been a few drivers who had stayed for the entire phone conversation in the past. Usually he returned to discover that the driver got scared away by kids looking for trouble.
He pulled back his overcoat to retrieve the phone number and then reached for the phone. It was coated with some slimy, sticky scum that was left by a piece of candy. He wiped it off with a Kleenex before dialing.
It was difficult at times to get through, but tonight there were no delays. The operator came on the line with a strong Middle Eastern accent and verified the number. After a short pause, the man heard the familiar voice.
“Hello, my friend. I’ve been waiting so patiently for your phone call. We have located a doctor here that I think will be able to do the job. How about you? We need a doctor from your end to complete the mission.”
The man with the overcoat responded, “I have also narrowed down my applicants to just one. I think he will work out great, but I need to meet with him. I need to discuss the details and go over the initial plan with him. But I’m sure he will accept our offer, and according to his files, he really could use the money.”
“You know if the money is the issue, my people can make sure he never has a chance to make it to the bank.”
The man in the overcoat cautioned, “I don’t think it would be a good idea to make this a bigger deal than needs to be.”
As they talked, the man glanced down at the phone timer.
Fifteen seconds left. He had to end the conversation quickly, just as he had so many others before. “I need to go, but I will talk to you in a few days. I plan to meet with him tomorrow.”
“Very well, my friend. We shall talk soon.”
There was a click on the end of the line. The man was relieved and surprised that they’d had another four seconds left. This had to be one of the first times in a long while that he hadn’t needed to hang up on his contact midsentence. He hung up the phone and started to turn around when he felt a light tap on his shoulder. His heart rate shot up, and he quickly reached for his gun before slowly turning around.
Standing in front of him was a young punk. “Hey mister, got any spare change in that pocket of yours?”
“Sorry I used it on the phone.” He headed back toward the taxi. At the corner, he saw a few gangbangers giving the driver a rough time. He was amazed that the driver stayed, noting that the guy really must be hard up for money. “Hey, this one is taken, so get lost,” he told the group of kids.
“Well, maybe we’re not ready for you boys to leave quite yet,” announced one of the kids in the crowd.
“Sorry, but I am ready to leave.” The man in the overcoat pulled out his gun and shoved it between the kid’s eyes. He cocked the trigger with his index finger and asked, “Do you have any problems with that?”
With fear in his eyes, the kid stared down the barrel. He
quietly shook his head from side to side.
The man proceeded to get into the taxi. “Let’s get back to
Pasal’s.”
“Two hundred, fifty-three times,” said the driver in a very disgusted tone of voice.
“What are you so upset about? I just saved your little ass from those hoodlums.”
Again, the driver repeated, “Two hundred, fifty-three times. You assured me that you would be back before I could say ‘oh
shit.’ I said it two hundred, fifty-three shit-ass times!”
“Oh so sorry about that. Here is a hundred dollars for your trouble and another hundred dollars if you can lose those gangbangers.”
The driver quickly glanced up at his mirror, and sure enough, there were two cars behind him. He made a sharp turn down Sixth Street, another turn down an alley, and then behind a warehouse. As the taxi came out from behind the warehouse, it nearly collided with a gold Cadillac. The rear windows were down, and a gun of some sort was brought into view. The driver of the taxi didn’t waste any time before making a quick left followed by another right. The Cadillac was still right on their tail as both cars approached a railroad crossing with the wooden gate down. The whistle of an oncoming train sounded. Both the taxi driver and the man with the overcoat looked to the left to see a train only a short thirty yards away going at least forty miles per hour.
The passenger in the back yelled, “Don’t even think about it!”
There was a moment of deceleration as his foot came off the gas pedal, but the taxi driver felt that there was no other choice to escape the Cadillac. He slammed his foot on the gas pedal, and the instant acceleration slammed both men against their seats. As the taxi broke through the first wooden gate, they both looked to their left to see a huge white light speeding toward them. They both let out a terrified scream. The sound of the train whistle roared past them as they broke through the second gate. They heard the sound of the train wheels going over the train tracks behind them. They glanced back to look at the train and see the Cadillac on the other side. Without hesitation, the taxi driver sped away toward the highway ramp.
After about five minutes of silence, the man in the overcoat yelled, “I told you not to do it. I specifically said not to think
about it! What the hell were you thinking?”
“You saved my little ass, and the least I could do was save your dumb ass in return,” replied the driver. “Do you still want to go to Pasal’s?”
“Yes,” replied the man in the back seat.
They did not talk again until they neared the restaurant.
Just as he suspected, several unmarked cars were in the neighborhood of Pasal’s. The stakeout started two blocks away from the restaurant.
“Do you want to be dropped off at the front door?” asked the driver.
“No, just drive slowly by the front door and then continue on.”
The driver was confused and looked up at the mirror to stare at the man in the back.
The man in the overcoat didn’t care. His hunch was right: they were on to him. At this particular moment, he couldn’t figure how they discovered him. He covered his tracks very well, but somehow they found out. As the taxi slowly drove down the block of Pasal’s entrance, he saw several agents in street clothes. He recognized three of them. Unmarked cars, undercover agents, they were definitely on to him. From now on, he would have to be more discreet.
“You know, I hav
e kind of lost my appetite. Why don’t you
take me to the Whitefish apartment complex downtown?”
As they drove, the man looked through Jake’s file again.
Chapter 6
The room was still. What seemed like a brief period of time with everyone who was involved in a code on Mr. Springer was actually two hours spent trying to save Mr. Springer. From the time Dr. Jenson called the code and declared him dead, the room was silent. It was always difficult to bounce back from a failed code.
The crowd that had gathered in the room a short two hours ago now moved as if in slow motion. The nurses from the Emergency Room began to pick up some of the debris left in the middle of the bed. The nursing supervisor, who had been present to help coordinate the nursing staff, began to go over the flow sheets with the nurse who had recorded all of the activity over the last few hours. The respiratory therapist began to disconnect the ventilator.
Then there was Dr. Jenson. Sally walked over to a chair in the corner of the room, sat down, and held her head as she rested her elbows on her knees. She stared out the window as if she were somehow removed from the cleanup activity going on.
Steve, although still numb from the experience, felt sad for Sally. He walked over to her and knelt next to the chair. “I’m so sorry, Dr. Jenson. You really did a great job running the code, and I’m sure the family would appreciate how much you did in here today.”
“Yeah, well that’s nice and all, but he still came in for an elective procedure and died shortly afterwards. And he still has a family.” She looked at Steve and added, “You just don’t see the whole picture here.” She proceeded to explain her extensive experience with Mr. Springer.
Mr. Springer was a very pleasant man who looked to be in
his thirties but was actually fifty-two years old. He had been blessed with a youthful appearance that so many people admire. His charm was pleasant as well. When he first saw Dr. Jenson walk into the office at his first appointment, he made a small joke to break the ice between the new patient and doctor. It had something to do with a small child and a clown, but Sally couldn’t remember the details.
Mr. Springer and his wife sat across from Sally and told her about the troubles that had been bothering him over the last several months. Sally recalled his history of severe constipation for many years, and the use of laxatives and stool softeners in order to have bowel movements. The Springers had discussed the problem without hesitation, as if they felt this unusual comfort with Sally. Upon further questioning, Sally learned he had developed severe left sided pain after eating popcorn. Every time he and his wife went to a movie and stuffed themselves with the goodies at the concession stand, he would get this severe pain on the left side. The pain seemed to move to the lower area of the left side. Mr. Springer said that he would occasionally get fevers and nausea after the movies. Sally remembered his story so well because it was so typical for diverticular disease.
Diverticula, small herniations of the colonic wall, can form small out pouchings from the colon and can cause a host of problems, including infection and bleeding. Sally told the couple about a man who had elected to let his infection go on without any treatment but developed an abscess along the diverticula, which eventually ruptured. The man almost died and required a few extra operations to resolve the problem. Of course Mr. Springer was concerned, so Sally placed him on some antibiotics and ordered some tests, including a colonoscopy. After just the first visit, the patient, his wife, and the doctor felt at ease with each other, and the Springers asked Sally if she would do the procedure. Sally smiled and, without hesitation, gladly accepted the opportunity to evaluate Mr. Springer’s colon. She turned to his wife and suggested a two-for-one bonus deal, but his wife just laughed and shook her head no.
The colonoscopy was not scheduled for a few weeks, but when it was done, many diverticula were discovered. A CT scan did not reveal any abscess formation but did show areas of acute and chronic inflammation. Sally and Mr. Springer discussed a diet plan that included no nuts, no foods with seeds, and definitely no popcorn. The plan worked for a while, but then Mr. Springer grew frustrated with the new diet and began cheating every so often. This every-so-often was when he would get the recurrent pain in his left side. Eventually, he and Dr. Jenson agreed to remove the portion of colon with the diverticula present.
Since the surgery was not emergent, Sally stressed the importance of abiding by the diet plan for diverticular disease, and she scheduled the surgery electively with Dr. Jake Douglas. The couple was confused by the switch in doctors. Sally tried to describe how the system worked. She explained that the chief resident got to scrub on all the bigger cases as he had more experience. The Springers would have none of that and requested that Dr. Jenson be their surgeon. Sally discussed the scenario with Jake. He didn’t seem to have a problem with it, so Sally called scheduling to tell them she would be the operating surgeon. There was a moment of silence on the other end of the phone. Then the scheduler congratulated her on a job well done. She told Sally she never recalled when a junior resident was able to be the surgeon on such a big case.
During the next several days, Sally met the entire Springer
family as they came in for pre-operative testing and workup. They were a wonderful family, two teenage boys and a ten-year-old daughter. They all seemed to be a close family, but there was a special bond between Mr. Springer and his daughter. Sally empathized with the little girl as she recalled her relationship with her father. “My father is the best father ever,” his daughter said during one visit. Sure enough, there was something very special between Mr. Springer and his baby.
The morning of the operation, Sally went over the plan for surgery with the Springers. They discussed what she was going to do, the small chance for a temporary colostomy, and the risks of surgery. She hated this part because, no matter how you brought it up, people focused the most on the risks and possible complications of surgery. Nevertheless, they got through the discussion without too much trouble. The Springers had all the confidence in the world of Dr. Jenson, so they had no doubt that surgery would go just fine.
In fact, surgery went better than fine. It was perfect. Sally was able to resect the affected colon without a problem and was able to connect it together without the need for a colostomy.
The first several days passed without a problem. Mr. Springer was out of bed the first day and walking the hallways by the second. The nursing staff was impressed with his sense of urgency to get better and out of the hospital. He pushed himself so hard the first few days that on the third day, his incision was tender, so he just lay in bed. Sally thought that resting would be sensible after he worked himself so hard the first couple of days.
But the next day, postoperative day number four, Mr. Springer woke up feeling unwell. He was not able to describe the discomfort to his nurse that morning. He said he felt a little nauseous, a little short of breath; his legs felt a little tired, and overall he just didn’t feel well. When Sally saw him that morning, she agreed that he didn’t look like the upbeat Mr. Springer she knew. Everyone including Sally felt that it was merely a result of his hard work on postoperative days number one and two.
Sally didn’t think twice when she saw him on morning rounds because the fourth day after colon surgery tended to be a difficult hurdle to get past. Unfortunately, Jake never rounded on Mr. Springer. His reasoning was that since Sally declared herself the primary surgeon, she should then manage the patient after surgery. He thought it would be a good learning situation for her, and if she had any problems, she would ask.
She had no questions until she heard the overhead page to Mr. Springer’s room. She wondered desperately why he would code. Could it be a heart attack, could it be a pulmonary embolus, could it be late postoperative hemorrhage, could it be, could it be, could it be? The fact was that it could have been any number of things, and without an autopsy, no one would ever know.
At this moment, Sally could not even think about asking
the family for an autopsy. She could not even imagine the difficult conversation that lay ahead when she had to tell the family what happened. His wife and children had left around lunchtime to complete some errands. They left unexpectedly because he was doing well. Sally was in the room when they all were saying goodbye. No one could sense this was their last farewell to their father and husband.
Dr. Jenson slowly turned to Steve and said, “So now you know the whole picture. Once you know these patients, it’s not just a code. It’s a heart-splitting challenge to save someone who you grew to care for as a person, not just an operative case.” She put her head back into her delicate hands and began to sob. Steve didn’t know what to do. He looked up to see if one of the nurses would be able to console Dr. Jenson, but no other warm human being was even paying attention to the two of them. He slowly raised his arm to put around her slumped shoulders but suddenly stopped. Wait, he told himself, Just a few hours ago this bitch was reaming you over the coals. And now she wants some sympathy? Well, screw it.
But Sally didn’t want sympathy; she needed it. Steve, a sincere person, perceived her pain and slowly put his hand around her shoulders. He leaned over and said in a very gentle way, “I’m so sorry, Dr. Jenson. I didn’t realize the attachment you had with Mr. Springer.”
Sally responded, “I can tell you just started your surgery residency.” She sniffled. “You’re still nice and compassionate.”
They both giggled.
Steve was thinking as he consoled Sally. She was right. He just saw this code as an adrenaline stimulating experience. He hadn’t given a moment’s thought to the fact that the patients were real people involved with families, friends, husbands, wives, and children. He was so scared about his own risks that he didn’t realize the true implications of a code.
Steve attempted to recount the ordeal from his point of
view.
When he had dashed into Mr. Springer’s room behind Dr. Jenson, he saw several nurses doing this and that. He saw a respiratory therapist trying to bag the patient. The ambu bag was filling with secretions rapidly, and the RT yelled at Sally that she could no longer bag him anymore. This just added to the mayhem. Sally scrambled to the head of the bed and asked for an endotracheal tube. “Give me a size 8 ET tube and a laryngoscope, now!” she screamed. It must have been a difficult intubation because Sally kept on yelling for suction. “Why don’t you people ever have the fuckin’ suction ready in these codes? Damn it, where’s the fuckin’ suction? I needed it yesterday!”
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