The technician attached a ventilating bag to the protruding end and pumped hard.
Bubbles gurgled up through all the blood with each compression.
A nurse placed her stethoscope to the base of Kathleen's lungs. "No air entry!" she called out.
It was interstitial, between the skin and the trachea, like she'd done on the cadavers.
"Any surgeon or intensivist, OR stat!" blared the overhead PA speakers. It kept repeating over and over.
Jorgenson felt as if she would faint.
Richard barged into the room, his eyes wide with fright. "What the fuck have you done?" he shouted, seeing the carnage at Kathleen's neck.
The nurses had him masked, gowned, and gloved in seconds. "Get ready to reintubate her," he told the technician. "I'm set," the man said, already holding a laryngoscope and an endotracheal tube a size smaller than the one he'd just removed.
Shoving Jorgenson to one side, Richard stepped to Kathleen's head and grabbed a wad of gauze pads from the surgical tray full of equipment.
Handing them to Jorgenson, he said, "Put pressure on the trachea with your fingers using a gauze pad, to seal the opening."
She stood, frozen.
"Now!"
She did as he'd ordered, reaching into the blood and finding the opening with her fingertips, then slipping pads into position.
"Got it?"
She nodded.
"Pulse is thirty. No pressure," said the nurse beside her who'd been reading the monitors and checking vitals with a cuff and stethoscope. Scissoring open Kathleen's mouth, the technician slid the blade of the scope along the side of her tongue with one hand and reinserted the tube with the other.
He connected it to the ventilating bag, and gave it a squeeze.
A few bubbles came up around Jorgenson's fingers, but nothing like before.
"Good air entry," said the nurse listening to Kathleen's lungs.
"Pulse and pressure coming up."
"02 sat rising."
Whistles and sighs of relief filled the room.
At that instant, Dr. Gordon Ingram rushed in, his face flushed and gasping for breath. "What's going on?" he said. "I was chairing a meeting and heard the call for an intensivist. When it kept going and no one seemed to be answering it, I thought you might need me."
Richard looked over at him. "Can you still perform a tracheotomy, Gordon?"
"Of course. It's like riding a bicycle. One never forgets stuff like that."
"Then please do me the favor of completing one on Kathleen."
"Of course," he said. "Give me a second to scrub up."
"And when you're finished with that, you can launch an investigation into what happened here, including why the hell Hamlin didn't show up." Richard then turned to Jorgenson, his blue eyes like ice. "As for you, I'll leave your fate to Dr. Ingram," he said. "But Kathleen Sullivan is off limits. Go near her again, and I'll personally make sure you won't get a license to do as much as cut patients' fingernails, let alone their brains."
She swallowed, said nothing, and left the room. She could fix this, she kept thinking as she made it to the surgical lounge on legs as insubstantial as Jell-O. She poured a cup of the stale coffee, slumped into a chair, and began to figure out how she could protect herself. After all, it was the anesthetist who left her on her own. If there were an inquiry, he would be the one who'd have to admit being at fault for failing to supervise her. As to her assertion that Hamlin's arrival had been imminent and that she was to start so as not to lose the slot, surely Tony would understand and corroborate the claim. She'd simply tell him it was her reasonable expectation of what he'd have wanted her to say, since they'd both been hanging around all day ready and waiting to do the case. Just trying to buy him some time so he could get to the OR, she would insist. He couldn't hold her responsible for his not showing up at all, could he? And as it was he who did her evaluation, she reasoned, none of this need follow her on her career path.
Bit by bit she cobbled together a strategy to keep the disaster off her record. Not once did she blatantly acknowledge her biggest advantage in any future battle, that her staff man was fucking her. Rather she avoided thinking through such base thoughts, never putting into words that neither Tony nor the hospital administration, both following their baser instincts to preserve their image and avoid bad publicity, could afford to do anything but bury the incident as quickly as possible. Her disconnect from overt scheming served her need never to see herself as being manipulative or coarse. Instead, she instinctively grasped the fact she had them by the balls, her more venal side able to read a hostile terrain like radar and intuitively plot her position on it with soothing clarity. It was all a reckoning by the subconscious, the defensive reaction of a cornered animal, nothing rational she need ever acknowledge or bother herself with. Nevertheless, the sense she won from all this— that she'd be okay— comforted her, the way a heartbeat does a child.
One thing she couldn't deny— any chances she might have had of a future position at New York City Hospital once she completed her residency were finished. Whisperings of how she blew a trach on Steele's lady, the famous Kathleen Sullivan, would be all over the floors by morning. That would invite counter whisperings from those who suspected her affair with Tony. By week's end the story would be woven into the fabric of hospital lore like a scarlet thread. Bryant Park, an acre of green space that fits like a postage stamp behind the New York City Public Library between Fortieth and Forty-second Streets, was packed for the Monday evening outdoor film series. Hamlin skirted the hundreds of people lounging on the grass in front of the large movie screen erected for the occasion and approached the restaurant Edwards had chosen. It was the most prestigious of the eateries huddled under the magnificent stone facades and high windows of the library building. Of course it would be, Hamlin thought. Edwards was always sure to pamper his stomach whatever the occasion.
The waiter showed him to his table, one at the corner of the upstairs terrace that commanded a perfect view of the throng below. He barely looked at the menu, ordering the first item he saw. He wasn't in the least hungry, but saw no other way to appease a jittery waiter who kept hovering over him and jabbering about the kitchen closing soon. Edwards would probably eat whatever Hamlin ordered anyway.
The evening air hung motionless, the trees trapping the stagnant heat of the day and the brown fumes from the continually circling traffic. Tasting the benzenes, he wondered how many other pollutants would seep into his system tonight.
What did Edwards want? He fretted, taking a gulp of ice water. Surely by now Edwards realized that his crazy idea to discredit Sullivan had backfired, that if she lived, it would be the ruin of him, Tony Hamlin. Did the big fool think he could persuade him to take the fall alone? If so, he had news for the idiot.
Hamlin looked at his watch. Eight thirty-five. Rachael should have taken Sullivan to the OR by now. Would she botch it?
He'd wrestled all day about tricking the ambitious resident into trying the procedure on her own. On the one hand it would have been easy enough to set in motion. Simply fabricate some reason to be held up on the floors at the last minute, and hope her eagerness, plus the usual impatience of an anesthetist to keep the cases moving, led her to start in alone. On the other, he hadn't the stomach for even so minimal a degree of premeditation, because despite everything else he'd done, he wouldn't commit murder. Then as they kept getting bumped, he realized he didn't have to arrange anything. If he just let events take their course, it would be after regular hours when they got to Sullivan, and he'd be out of the hospital meeting Edwards. If a resident was stupid enough to try something so risky as a trach without her staff supervisor present, and the anesthetist agreed to oversee her, albeit spottily while running between ORs, it wouldn't be his fault.
He could live with that, or at least rationalize it to the point where he wouldn't feel guilty, he'd initially tried to convince himself, so desperate was he to escape Sullivan's informing on him. Now he wasn't s
o sure. Killing was killing, and clever moral semantics couldn't protect him from his conscience. Nor could he say for certain his troubles would subside if Sullivan did die. He'd still have Steele to contend with. Besides, the chances that an anesthetist would be so irresponsible he'd let Rachael proceed, yet he wouldn't actually stay in the room with her, were pretty slim. He took another belt of ice water, and savored the cold as it cut a path through the burning in his gut.
At eight-forty the crowd below began to whistle and clap rhythmically, delivering their verdict that it was as dark as it would ever be in downtown Manhattan and time to get on with the show.
Once the movie started he barely paid it any attention, continually rechecking his watch and scanning the sidelines for Edwards. The silvery glow from the black-and-white images made it relatively easy to see, so he shouldn't have any difficulty spotting him walking toward the restaurant. But where the hell was he?
Brooding theme music filled the night, making him feel edgy. Up on the screen Fred MacMurray lurched into a deserted office building and began taping a message intended for a man named Keyes. Flashbacks rolled.
Again he thought of Sullivan. By some fluke could she have had the trach after all? And made it? He checked his cell phone to make sure it was on. Surely they'd have called him if she had died. He found himself waiting for either result with equal dread.
By nine-thirty Hamlin started to suspect that maybe Edwards wasn't coming. Had he met with the others instead? Decided to turn him over to the cops after all in exchange for a deal? No! Surely they wouldn't do that yet, not while they still believed there was a chance no one would take Sullivan seriously. The cost to themselves would be too great.
He tried watching the movie to distract himself, but the menacing score swelled louder, feeding his uneasiness, and the story, one of shadowy characters pursuing a fated scheme of murder and treachery, only increased his sense of doom.
Feeling as slated as the characters were for a bad end, he nervously peered past the fringes of the crowd in yet another vain attempt to spot Edwards. Staring into the dark, he heard Fred MacMurray say, "Walking down the street, suddenly it came over me that everything would go wrong. It sounds crazy, Keyes, but it's true, so help me. I couldn't hear my own footsteps. It was the walk of a dead man . . ."
He lay in the dark, listening for the watchman. Even in the heart of the stone building, he could hear the distant strains of music and the murmur of dialogue. After observing Hamlin on Friday afternoon, he'd figured it safe enough to at least lay the groundwork for taking further action. The accusations, e-mailed to him from an unknown source, were serious enough to warrant that. Whether they were also true never once entered his mind.
Anonymity was the fundamental tenant and key to security in his army, messages and directives arriving from untraceable informants the standard practice. As to authenticity, as long as the information gave fodder to their preformed beliefs and didn't seem to be a trick by the cops, his brothers in arms took it as true. The indictment regarding Hamlin fit his suspicions about doctors to a T, and the instructions detailing passage of sentence whetted his appetite for justice.
He had selected the spot later that same day, carefully reconnoitering the building, still not entirely certain if he'd go through with the scheme, intending to back off if anything interfered with his preparations. But they went flawlessly.
As a result, on Saturday he had set the plan in motion, using an Internet cafe to send the e-mail signed P.E. that he had been told would bring Hamlin running. Sunday he spent collecting and preparing the equipment he would need. Again everything went without a hitch.
Four hours ago, around five-thirty, he had slipped into the library's Forty-second Street entrance. In his hand was a briefcase, over his arm a raincoat, the pockets containing a bottle of water, a penlight, and a library floor plan he'd picked up at the information desk on his previous visit. Sewn in to the lining of his coat was the gun barrel of a disassembled M-4 carbine positioned to remain upright when he draped the garment over his arm. The rest of the weapon, stock, trigger works, and magazine, were in the case, along with two large suction cups, a glass cutter, and a box of hollow-point bullets. The only uniformed guard stationed at the door sat in a little wooden booth reading a magazine. She didn't even look up.
Instead of going upstairs to the massive Astor Hall foyer, he had turned left and entered an area of beige lockers where the staff kept their personal belongings. No signs told him to keep out. Several men and women resting on benches while drinking coffee and chatting not so much as glanced at him. He walked on through, unchallenged, into the bowels of the building.
Eventually he had reached a massive indoor loading dock big enough to fit a transport truck. It was empty at the moment, the entire space closed off from the street by a pair of giant iron doors that could have kept out King Kong. Stepping down into the parking bay he crossed to the other side, avoiding the large patches of oil so as not to slick the soles of his shoes and leave tracks. He then mounted a short flight of steps, ending up in front of an entrance marked SHIPPING AND RECEIVING. He peeked in. A group of workmen moving crates at the back of a voluminous storage area paid him no heed. He slipped inside and navigated around head-high stacks of boxes. Finding a staircase at its far end that led upward, he went over and quietly climbed to the first landing. The entry hallway was deserted. He was at the doors of the microfilm reading room on the main floor. He quickly retreated down to the storeroom, found a stack of boxes near a back wall, and sat down behind them to wait.
At six the lights had started going out. The chatter of workers slowly subsided in the distance, then ended altogether as they slammed doors behind themselves, entombing him in the utter silence and darkness of the place. At nine he crept halfway back up the stairs to the microfilm reading room, this time using his penlight to find the way. There he waited, listening for the approach of a night watchman above.
At nine-fifteen he heard some echoing footsteps approach in the hallway, and retreat just as they had when he'd hidden in the building overnight on Friday to time the rounds of the guards. He waited another ten minutes, and when he heard nothing more, crept the rest of the way out of hiding. The corridor itself was dimly lit, but on his previous scouting trip he'd noted the complete lack of video surveillance here, so he knew he wouldn't be seen.
The reading room door was secured by an electronic lock that he guessed would be on an alarm system, but its upper half was essentially a window. He stepped up, secured the large pane with a suction cup, and removed it with his glass cutter. Using his raincoat as a padding along the remaining glass in the lower edge of the frame he hoisted himself up and crawled through the opening. On his right a wall of mahogany behind a long wooden counter infused the harsh white probings of his light with a rich hue of red.
He shone his beam toward the far end of the room. Illuminating bench after bench loaded with rows of viewers the size of computer screens, he satisfied himself that nobody had made any surprise changes, such as moving a giant bookcase up against the rear window that he needed access to. He'd seen on Friday that it could be opened by hand and looked out on the terrace of the restaurant outside.
But before going over to it, he inspected the row of windows to his left overlooking Fortieth Street and located the fifth one from the end. When he'd cased the building from outside, he had spotted an aluminum awning about five feet below the sill. From there it was an easy jump to the top of a stone wall and a final seven-foot drop to the sidewalk. In the pandemonium that would be going on back at the movie, no one would notice him escaping out there, he figured. Once more using his suction cup and cutter, he made himself an opening, then tiptoed the length of the room to his chosen vantage point and looked outside.
The silver screen in the distance dominated the night. The light from it rippled back over a thousand heads, but he sought only one. Turning the crank to open a tall narrow pane that would give him a good angle of sight, he felt the w
arm air against his face as it filled his nose with the scent of exhaust fumes. The constant honking of horns and sounds of cars formed a backdrop to Edward G. Robinson's giving Fred MacMurray a stark prognosis for all killers: ". . . They've committed murder. It's not like taking a trolley ride together where they can get off at different stops. They're stuck with each other and they've got to ride all the way to the end of the line and it's a one-way trip and the last stop's the cemetery . . ."
From the dialogue he could immediately tell how much time remained for him to get ready. He'd already watched the video version a half dozen times in order to pick the scene that would best cover the noise of his shot. Yet he didn't hurry. In fact he deliberately took his time assembling his gun, experiencing an odd sense that his success tonight was inevitable, since everything so far had gone perfectly. He almost felt like testing his good luck, seeing if his lack of haste could make him miss his cue. After all, for the last few days he'd half considered the whole exercise as little more than a dress rehearsal, a trial to see if he could actually pull it off. Yet here he was, everything successfully in place, and only the act itself to be done. Working leisurely, he had the weapon put together within five minutes.
Up on the screen, in glorious black and white, Barbara Stanwyck was issuing her ultimatum: ". . . Nobody's pulling out. We went into this together and we're coming out at the other end together. It's straight down the line for both of us. Remember?"
He got up on the bench that ran under the window to better see the terrace of the restaurant. Using his scope to survey the seated patrons from behind, he began to think the mission might end because he wouldn't spot Hamlin given the size of the crowd. It was also possible the man hadn't come at all, or if he had, he'd grown impatient and left. Such a shame, he thought, to fail at the last minute. But he also felt a twinge of relief. For as much as he was prepared to serve his cause, he preferred to be a hero in waiting, not one on the run.
Critical Condition Page 10
