Foreign Threat

by Mitchell Goldstein

  Although nobody was visible, he didn’t want to take a chance. The mission was a go. He couldn’t make any mistakes at this time. He decided to use the emergency escape route to ensure that he was not followed. He left his fourth-floor apartment via the front door but walked swiftly to an apartment door on the other side of the hallway. He unlocked the door and walked in. With a quick glance over his shoulder, he closed the

  door.

  He stared out the peephole in the door for several minutes without noticing any suspicious activity. Finally, he walked through the empty apartment to the window in the back bedroom. He propped open the glass with a spare piece of wood, the only thing stowed in the apartment.

  Outside the window was a cable wire that went across to the adjacent apartment building. It was attached to the next building near a window on that third floor so there was a slight slope downward. He had portrayed himself as a cable man before he lived there. He selected wires with strength and placed them with care so he could slide down to the next building and escape from two blocks away if ever he needed to.

  Although this was not an emergency, Thomas felt the phone call to Douglas and his own travel arrangements needed to be completed with the utmost security. He slipped his legs through a body harness that was in the bedroom. He carefully stepped up on the window ledge and secured the harness to the cable with a mountaineering rig. With a gentle push, he was on his way to the next building. He always left that window open just in case. As a result, when he arrived now, he was not at all surprised to see bird markings and smelled mildew from recent rainstorms. He spent little time in the apartment, so he really didn’t care. He unhooked himself from the harness and glanced down at the alley to make sure there was not any unusual activity. It was incredibly quiet, but as he started to make a move toward the door, he heard some garbage cans clang together. He quickly leaned out the window to evaluate.

  There was no visible movement below. This made Thomas quite anxious. He could see no dogs, cats, or other animals scurrying around causing mischief. He stared out the window for several moments until he saw a cat jump out of a garbage can that was lying down. Apparently, that was the commotion. Now the cat was done scrambling for food. Thomas still watched for a few minutes, but the lack of other activity left him comfortable to continue with his morning plans.

  He crossed the filthy bedroom, opened the door, and entered a much cleaner living room. He left through the front door and took the stairs outside. He hailed a taxi and asked the driver to take him to a phone booth about eight blocks away at Tenth and Lapont Street.

  They came across a Stop-N-Go, and he then got out. He handed the driver a twenty to persuade him to stay. Thomas quietly walked over to the phone and called the University Hospital. He paged Jake Douglas.

  An unfamiliar voice answered the phone. “Hello, this is Nurse Anders. I am answering a page for Dr. Douglas. He is currently in surgery, but I would be more than happy to take a name and phone message.”

  “No, that won’t be necessary,” replied Thomas. “Do you have any idea how long this case will take him to complete?”

  The nurse replied, “One moment, please.” Thomas could hear the phone being muffled by her hand as she asked how long he was going to be. “Dr. Douglas should be done in about two hours.”

  Disgusted, Thomas replied, “Thanks. I will call him back later.”

  He returned to the taxi and had the driver return him back

  to his apartment. He decided to get ready for work and not bother Douglas until later in the day. It would be nice to let the doctor know immediately that a man would be coming to the hospital seeking his assistance, but Thomas didn’t want to leave a verbal message. It was too important to have someone leave a message or bring another person in contact with the whole

  process.

  When Bill Thomas arrived back at his home, he found a message on the answering machine. He tried to see where the call came from on the caller ID, but it was an unfamiliar number. He quickly played the message, thinking that Douglas might have taken a moment to call him back.

  Instead of the doctor’s voice, the only thing he could hear on the machine was a man breathing deeply. This lasted for fifteen seconds, and then a soft whisper said in a foreign accent, “Oh shit.” A click sounded, and the message ended.

  That was the contact. The man was smart enough not to leave a message and not to stay on the line too long. However, Thomas had no way to reconnect with him.

  Chapter 21

  The OR crew didn’t take long to respond to the stat call. Within ten minutes, the whole team was at the hospital getting ready for emergency surgery. Jake had ordered some labs in the mean time but realized that whatever the labs were, surgery still needed to be preformed. He realized that this was serious business. Whatever this Ziamuddin character had inside him would certainly shock the OR staff. He couldn’t begin to imagine the impact it would have for the CIA and nationally. He wondered if the thing inside was a bomb and Thomas had gotten the whole thing mixed up. It could detonate while Jake was taking it out. What if the guy died before the surgery, what would Thomas do then? A host of questions and scenarios were playing in Jake’s mind when he heard a familiar voice.

  “Well, Jake, for what did you bring us in tonight? Maybe a ruptured abdominal aortic aneurysm or another pancreatic case?”

  Jake looked up from his deep thoughts and saw A.J. standing above him. A.J. was a great anesthetist who was hoping to retire soon. He had been doing call and anesthesia for years and was tired of it. He was only in his fifties but ready for a less hectic life.

  Jake responded with a smile. “I see they brought in the cavalry for this one! Well A.J., you better hang on tight to the reins because this one is sure to give you a rough ride. He is totally dehydrated, his electrolytes are all screwed up, and I’m sure his white count is sky high. We just don’t have time to wait or he’ll die.”

  A.J. became more serious and asked some questions about the patient. Jake offered most of what he knew about Ziamuddin’s health issues but left out the fact that the man had something intentionally planted in his belly.

  “Alright, Jake. We’ll get this guy straightened out and set for surgery in a few minutes. Not that I was looking for a challenge tonight, but since you found one for us, we’ll go for it.”

  As A.J. walked over to the gurney to ask Ziamuddin some questions, Jake felt two delicate hands on his shoulders.

  “Well Dr. Douglas, what did the cat bring in?”

  Jake looked back to find Karla, the scrub nurse, massaging his shoulders. Karla was in her late thirties, divorced with two kids, and determined to find a doctor to take home. Take home permanently. She was so desperate that even Jake Douglas was a target. Jake and most of the doctors knew what Karla was up to, but Jake was still trying to piece his complicated life together. He didn’t need extra baggage at this point.

  “So you didn’t have anything else going on either tonight?” he teased. “It’s so nice we could all be together on this happy occasion.”

  “Frankly, Jake, after that shit case today, I was kind of hoping for a reprieve, but I guess not,” replied Karla. She turned to begin the wonderful job of completing paperwork in which only lawyers were ever interested after surgery.

  A.J. returned to the desk with the patient’s chart and handed it to Karla. “Knock yourself out, kid. I’m ready when you are. I’ll see you two in the OR.”

  Karla gathered some papers and put them with the chart. “If you’re ready, I’ll take him over?”

  Jake replied, “That sounds great, Karla. I’m going to pick

  up a sandwich on the way over, and I’ll meet you in the OR. Don’t get started without me,” he joked.

  Karla smiled and offered a polite but fake laugh.

  Meanwhile, Steve was begging Agusta in the ICU not to blow his chance to go to the OR. “Come on, Agusta. Both Jake and I will be right over in the OR, and Roger, who happens to be one of the best medical studen
ts ever – at least since me – will be right here the entire time I’m gone. If you need anything, I will run back just as quick as you could call Rosberg. Please, Agusta. I’ll do anything for you, I promise.”

  “I can’t stand it when a grown man whines. It is so sickening. But I tell you, a third year medical student doesn’t really count for jack shit when the patient is coding!”

  Steve began to plead his case again when the station clerk answered the phone and relayed that the ER patient was on his way to the OR. Steve looked at Agusta, gently blinking his eyes until she gave in.

  “Fine! Fine, Dr. Carmichael, but if you turn into a Jake Douglas by the time you’re a chief resident, I will remember this moment and make your life pure hell. Do you understand, young man?”

  “Yes ma’am, thank you so much!”

  Agusta walked over to Steve and gave him a big motherly hug. “Go enjoy yourself and learn a lot. You certainly have earned the right to the OR tonight.” She patted him on his back and released her grip. As he walked out of the unit, she shouted, “Don’t forget my warning, Dr. Carmichael!”

  Steve smiled over his shoulder and waved his hand.

  Steve kept a steady pace as he walked toward the OR.

  He was not particularly looking forward to working with

  Jake, but he was excited to operate again. Besides, Jake seemed to be beaten down after Dr. Rosberg’s lecture, so he might be much more congenial tonight. Either the beating by Rosberg had him down, or that very stressful case all day left him just plain tired. Whatever it was, Steve didn’t really care. He knew that he was on his way to the OR for surgery. It didn’t even matter to Steve what the case was.

  Steve and Jake arrived at the entrance to the OR at almost exactly the same time. The automatic door opened, and they walked in.

  Steve asked excitedly, “So what is the plan of attack for this guy?”

  “Well, Steve, you didn’t get a chance to see this guy, but he already has a McBurney incision, so I suspect that he had an appy recently and that he developed an abscess. We don’t have any information on him, so as far as we know, he could have had a perforated appendix with abscess intraperitonealy. We’ll just have to wait and see.”

  They were already in scrubs, but each grabbed a surgery cap and mask. They quickly walked to OR 2 where A.J. was putting Ziamuddin off to sleep. Karla was standing next to the patient both to calm any anxiety the patient may have had as well as to assist A.J. with the breathing tube. Jake was always impressed with how sensitive the OR nurses were with the patients, despite knowing nothing about them. The nurses would try to relax the patient as they came into the room and would make a strong effort to calm any fears. Some patients would often ignore their fears.

  Ziamuddin was like this. He was stoic as he entered the operating room and remained so as A.J. put the black oxygen mask over his face.

  Sue, the scrub tech on call tonight, was busy organizing

  her table with surgical instruments as the patient drifted off to sleep. Sue was the most inexperienced in the group, having only worked there for two years. She was in her twenties: vivacious, cute, and innocent. She grew up in a small town and continued to have a small-town personality. She trusted everybody and was very gullible when people were telling stories. Nonetheless, she won the heart of most everyone she worked with, especially the medical students. She wasn’t searching the way Karla was for a husband, but she didn’t think it was right the way medical students and interns would get hassled by chief residents and staff. She would often stand up for a student who was getting abused. Consequently, she knew Jake very well.

  “Hi, Sue.” Jake waved from the door.

  “Hi, Dr. Douglas. Are you going to be nice tonight, or do I have to set you straight from the get go?”

  “I think I’m too tired to do much except get this case done and get home.”

  “That sounds like a great plan,” Sue replied.

  A.J. motioned Jake and Steve to scrub. “Jake, this guy is septic, big time. His WBC is nearly 28,000. We’re talking a major left shift with a bandemia of about twenty percent. Not to mention the fact that despite the volume you gave him, his blood pressure was still only in the 90’s and his pulse, the 130’s. I think we should have a foley for this case, and maybe when you are done, either you or Steve should put a central line in for him. Why don’t you two move it so we can get this septic foci out of him before his septic shock is out of control.”

  “Alright, we’ll be right in.”

  While they scrubbed, Jake spoke. “Steve, there are cer-

  tain times when you shouldn’t do the full ten-minute scrub, and I think this is one of those times. I trust A.J., and if he says move it, then we need to move it.” With that, Jake washed his hands as one would do before dinner. He opened up a scrub brush and lathered his hands for about thirty seconds before rinsing. “Let’s go, Steve. He has the tube in. This guy will be prepped and with a foley in about a minute. Let’s not waste any time. Your scrub is over, man.”

  Steve followed Jake into the OR suite as they dried their hands.

  “Since this guy probably has an intraabdominal abscess,” Jake continued, “I think you should make a midline incision. That way we can get a good look at everything to make sure we know what we’re dealing with.”

  Steve was surprised but pleased to hear that he was going to make the incision. “That sounds like a good plan, Jake. By the way, did you have a chance to call staff in on this one?”

  “Oh, shit,” whined Jake. “I totally forgot. Thanks, Steve. Karla, would you please call whoever is on call for staff? I’ll talk to them.”

  “That would-be Dr. Rosberg tonight. Aren’t you feeling lucky, Douglas?”

  “Shit,” whispered Jake under his breath. “Well, call him anyway, and I’ll talk to him when he's on the line.”

  After she tied their gowns, she dialed Dr. Rosberg’s number. “Hello? Hi, Dr. Rosberg. This is Karla from the OR. Jake Douglas asked me to call you. Hang on one minute please.” She held the phone to Jake’s ear.

  “Hi, Dr. Rosberg. I have this unusual situation.” It was more than unusual. “There is this young foreign man who looks as if he recently had an appy. He comes in tonight septic with a great deal of rebound and belly tenderness. He had a major left shift with a bandemia. I called in the OR crew immediately and plan to do an exp lap with Steve.”

  Dr. Rosberg responded, “Go right ahead, Jake. If you encounter any problems, please give me a call right away. I can be back in three minutes.”

  “Alright, that sounds fine.” Jake turned as Karla hung up

  the phone. “Thanks, Carmichael. I would have forgotten to call Rosberg. I owe you for this one.”

  Karla then quickly washed Ziamuddin’s abdomen and then stepped back as Jake and Steve draped the sterile field. Next came the suction device, followed by the electrocautery. After everything was set up, Sue brought up the scalpel.

  Steve stared, unsure if he should grab it or not.

  “This would be the time to get going,” ordered Jake. “Otherwise I’ll start for you, Dr. Carmichael.”

  “No, no, that will be fine. I just wasn’t sure if you wanted me to start or- I don’t know.” Steve’s voice was barely audible as he reached forward.

  As Steve took the scalpel from Sue, Jake drew an imaginary line from above the umbilicus to about six centimeters below. “Let’s do it, Carmichael!”

  Steve was a little anxious but he knew this was his chance to operate. That’s why he put up with all the bullshit: to operate.

  He made a generous incision and watched the blood ooze from the fatty tissue under the skin. He used the electrocautery to control the bleeding. The electrical current created a small cloud of smoke above the patient’s belly as it burned the blood vessels. The smell of burnt tissue crept in the masks of everyone in the operating room, but it didn’t faze anyone.

  Steve continued to carefully burn tissue as he went deeper into the caverns of Ziamuddin’
s belly. Finally, the fascia was visible. Steve continued until the thin layer of tissue that covered the abdominal contents was protruding through the incision. Then he looked up at Jake as if to ask, “Should

  I keep going?”

  Jake motioned impatiently for Steve to continue.

  Steve sharply entered the peritoneum and opened it with a

  pair of fine scissors.

  A flood of stool contents mixed with pus erupted from the incision as the thin layer of tissue was cut. A fowl stream of vapor reached everyone’s mask, no longer the familiar cautery smoke.

  Steve called out for a culturette, a small Q-tip that could be used to swab the pus and test it on separate culture plates in a special incubator found in the lab.

  “Very good, Carmichael,” commended Jake.

  Next Steve asked for a pool tip suction, which was a long device that could be placed into an area blindly to suction out the contents.

  Before the suction device was placed in the abdomen, Jake halted the surgery. He was afraid Steve was going to ram the device into whatever might be tucked away in Ziamuddin’s belly. He quickly shouted, “No, Carmichael! What the hell do you think you are doing? We have no idea as to what is going on there. What happens if you slam the suction into his aorta or liver? You need to see where you are putting things or you will be asking for big trouble.” Jake was saying whatever it took to keep Steve from damaging whatever was in this guy’s abdomen. “What I would do in this situation, since I didn’t do the initial surgery, would be to place my hand in his abdomen like this, and then protect abdominal structures with your hand while you are suctioning out the fluid, pus, and stool.”