Critical Condition

by Peter Clement

  Francesca Downs? he wondered, still not certain, despite what he'd told Norris solely in the hope it would drive the man mad as he died. Whoever it was, he wondered how she or he would like his latest work?

  After rereading everything carefully, he lay down on his bed and thought well into the night about how best to proceed. Despite the fact he suspected this sender of still having a private agenda, it was a good plan, one that would take out the final three targets and wrap everything up in a most public, symmetrical way. At last His message will be unequivocally clear, he told himself, once I make sure the press gets it right. He reviewed his ideas for the communique he would issue, outlining the crimes of the executed and warning there would be more of the same for any doctor, patient, or institution that dared harm human embryos for any reason. And the plan involved his finally meeting the informant.

  So much the better. If it was Francesca Downs, he'd execute her as well.

  He set his alarm for six A.M., and fell into a deep, dreamless sleep.

  Chapter 18

  Friday, June 29, 8:00 a.m.

  ICU

  "Dr. Sullivan, the ambulance is here for your transfer to Dr. Blaine's institute."

  Kathleen struggled to open her eyes. She'd been dozing off and on for an hour since they'd given her breakfast, a bottle of beige sludge through a tube into her stomach. "Now? But I thought . . . Dr. Blaine meant later today ... at least. . . . It's not a full . . . forty-eight hours—"

  "Your numbers are good— the residents cleared them at rounds this morning with the staff doctors— and all the transfer orders are written. I'd think you'd be glad to be out of here."

  "You've got . . . that part right . . . but—"

  "Am I coming, too?" asked the policewoman who'd taken over the morning shift. She gave her red hair a shake. It hung like tiny flames over the collar of her dark blue uniform.

  "I think so. . . . Detective McKnight . . . insisted ... I would have protection . . .there as well."

  "I'll have to check with him." She put on her hat, then walked over to the nursing station and picked up a phone.

  "I'll notify Dr. Steele," said the nurse, busily bundling up the few toilet articles that Kathleen had been allowed to keep at the bedside.

  "Yes ... if you don't mind. . . . He'll want to know. . . . And could you tell Jo O'Brien as well? She'll be ... in ER."

  "What about the patient consent form? We've got strict orders from him that we do nothing with you without his okay. Should I wait until he signs for you and approves the transfer?"

  The question irritated her. "No . . . that won't be necessary. . . . I'm the patient . . . after all. . . . It's me who decides . . . these things now."

  The nurse shrugged. "Suits me. If we lost this ambulance waiting for him, I don't know when we'd get another. Heading into a weekend, they get busy on the road with real emergencies." The nurse helped her with the signature. "What about these personal belongings? Do I ship them with you or pass them onto him?" She somehow found this question annoying as well. "With me, please."

  As they transferred her IV bottles, tubes, and monitors to the waiting stretcher, she wondered about her resentment at their wanting to refer everything to Richard. It shouldn't have bothered her— after all, she'd welcomed his vetting what they did with her in the beginning. But she didn't want that anymore, she thought, oddly troubled at how quickly her emotional reflexes had fallen in line with her decision to ... to what really? Not break off, but rather distance herself so he'd be free to leave. Come on, Kathleen, she told herself. You have to be consistent. She'd always taken pride in making her head rule, so why should this be any different? Of course her feelings toward Richard would shut down as she pulled away. They had to.

  She sighed. She supposed it was all part of the necessary process, even one that started in her head. Yet it saddened her. She'd so loved him and his caring.

  The nurses clamped a set of oxygen tanks to the side frame just in case.

  "All set?" the attendant asked.

  "All set." 8:15 a.m. Department of Radiology "Hi, Doc," said the young man lying on the stretcher in an examining gown. He propped himself on his elbows and added, "Long time no see."

  Richard couldn't reconcile the handsome smile with the distorted features and twisted gaze that had stared up at him during the "Hail Mary" intubation a little over a year ago. He could spot a few subtle asymmetries in the folds bracketing his former patient's mouth, but otherwise saw no major defects in the movement of his head or eyes. A pair of walking canes leaning against a nearby counter, however, testified to more significant permanent damage.

  "Well look at you," Richard exclaimed. He stepped over and shook the man's hand. The returning grip had half the strength of normal. The patient's wristband read ABRAHAM PAXTON.

  "Not bad, eh? And I'm still in therapy. My walking continues to improve, though not as quickly as at first."

  Richard shook his head. "I'd say you've done one hell of a gutsy job getting yourself better. I'd no idea how great it was when we talked on the phone yesterday. And I want to thank you again for agreeing to come in."

  "Hey, I never would have had a chance at all without what you did, and Dr. Hamlin of course. Jesus, I was shocked as hell to hear about his being murdered. And all that stuff in the papers, about the killer maybe being an antiabortion fanatic. Then this morning's news linking it all with stem cells— I mean, what the hell is going on?"

  Richard sighed. They were alone in the anteroom to the MRI, or magnetic resonance imaging chamber, and while he intended to be candid with Paxton, he was determined not to fuel anymore rumors by letting the technicians who were preparing the machine in the next room overhear what he had to say. He lowered his voice. "I'm afraid no one is too sure, but Hamlin, along with some other doctors, may have prematurely been using stem cells on patients without their knowledge or consent."

  "What?"

  "The reason I suggested you submit to an exam is that it's possible you were one of his subjects."

  Paxton looked as if he'd been kicked in the gut. "You've got to be kidding."

  Richard said nothing, letting him digest the fact.

  "What does it mean, if he has? Are there side effects?"

  "We don't know. In fact, your incredible recovery may have been on account of what he did."

  He flopped back and kept his eyes fixed on the ceiling, his pleasant expression of a few seconds ago replaced by a wooden stillness. "What about other patients he may have done this to? Did you find anything in them?"

  "They're going to be called as well, through hospital channels. I took it on myself to suggest we start with you, since I was familiar with your case."

  Paxton continued to look at the ceiling, seeming to withdraw into himself. "Then let's get started," he said about half a minute later.

  She hadn't inhaled air free of hospital smells or felt the sun against her skin for over two weeks. Both felt like a bath in honey for the thirty seconds it took for the attendant to wheel her across the parking lot to where the ambulance waited.

  "Glad to see the light of day?" the policewoman who walked beside her asked.

  "You bet. . . . What's your name?"

  "Carla Reid."

  "Carla ... I like your hair. ... It catches the light ... so beautifully."

  "Why, thank you."

  "It reminds me ... of my daughter's."

  They loaded her in the back, leaving the head of the stretcher upright, and through the small rear windows she could see the hospital recede in the distance as they drove north on First Avenue. She felt a spark of defiance at having survived the place, and relief to be out of there. Even the familiar sight of the line of flags snapping in the breeze along the curved facade of the United Nations gave her a marvelous sense of freedom.

  At Seventy-second they cut a block east to York Avenue, then continued north, and she got to see the rows of shops and Irish pubs where Lisa had often insisted they go shopping together and have a beer
afterward. The memory made her smile, reconnecting her with what might be possible again. God, she missed those times.

  Another right turn at Seventy-ninth, then north again, this time on East End Avenue, and soon they were racing under the trees hanging out over the street from Carl Shurz Park. She could see small children playing within its gates under the watchful eyes of women standing about in groups or sitting on benches chatting. She envied the shady serenity.

  The vehicle slowed down and swung left. As it turned, she caught a glimpse of the East River, its gray surface gleaming slick as grease, yet sparkling at her from the other side of the park grounds. She even saw Gracie Mansion, the stately wooden house with peeling yellow paint where the mayor lived.

  Then they pulled inside an ambulance entrance, the attendant recruited the help of an orderly lounging nearby to unload her stretcher, and Carla carried the small bag of belongings. As they wheeled her to the front door, she saw it was a modern building a half dozen stories high made of gleaming white stone, the brightness offset by layers of black smoked glass running the full length of each floor. Like a vanilla layer cake with chocolate filling, Kathleen thought. It also looked as if it had been dropped on the otherwise leafy neighborhood lined with red-brick homes resembling country cottages. It sure was a well protected area, she thought, looking at the contingent of dark blue uniformed police stationed at the mayor's gate across the road.

  Inside the foyer what first greeted her was a delicious aroma of fresh coffee and cinnamon. It came from the direction of a sitting area where a dark green-and-white awning sheltered a few dozen small tables. Behind them stood a lunch counter lined with plates of bagels amongst rows of glass jars filled with brown beans and metal scoops. The place resembled a bistro more than a hospital cafeteria.

  "A cafe latte," said a man with a walker to a woman whose uniform matched the canopy above her head. She punched the order into an espresso machine, and it responded with a guttural hiss. A host of other people, some in housecoats, most fully dressed, sat around talking, sipping from cups, or reading the morning papers. A nearby array of sofas and comfortable chairs filled the rest of the space, everything gently illuminated by recessed lighting. Vases full of fresh flowers and a few plants added color and life.

  Kathleen's mouth watered, and for the first time since the stroke she felt hungry. She would down one of those coffees, the real way, through her mouth, within a week she determined.

  The Admissions Department could have been a check-in desk for a luxury hotel, she thought. The room was wood paneled, and the staff was dressed in business suits with not a white coat in sight. But the tedious process of taking all her personal information, starting with her mother's maiden name, proved typical.

  "I'll just leave her on my stretcher," she heard the driver whisper to Carla as the clerk started filling out her forms, "and go for one of those great javas they got out front."

  "No problem," replied the policewoman. "Looks like this will take a while."

  "And I'll need the patient's social security number, plus health care information," the woman who was checking Kathleen in continued.

  Kathleen reamed off the numbers she now knew by heart after giving them so many times.

  Richard peered up at the images on the viewing screen. Each no bigger than the size of a passport picture, they showed cross sections of Abe Paxton's brain as clearly as if they'd dissected it open and taken photos of it.

  "That's where he had the previous bleed and Hamlin operated," said the radiologist, indicating an area under the swell of the frontal lobes. "But look here," he continued, pointing to a round dark spot much smaller than a pea. "If I didn't know Hamlin had removed the ruptured aneurysm, I'd swear this guy had another one."

  "Could he have missed it the first time?"

  "No." He shoved another sheet of images up on the screen alongside the first. "Here are the post-op films from last year. Everything's resected." Richard had to agree. The area they were looking at was clear in the previous scans.

  "It sounds crazy," said the man at his side, "but it's as if this guy Paxton has grown a second vascular anomaly. That's impossible. At least, I've never heard of such a thing. Whatever that is, it's still very small, but we'll do an angio to make sure we're looking at a lesion in a vessel—"

  "Thanks," said Richard, breaking off and rushing out the door. "Call me as soon as it's done." He knew what had happened.

  "Look, slow down. You're losing me," said Gordon Ingram.

  "It's because the stem cells Hamlin used took their cues of what to become from the surrounding vascular anomalies as well as the neurons. They became arteries in addition to brain tissue, and must have copied the same structural abnormalities that had led to the vessels bursting in the first place."

  "That's a hell of a supposition."

  "Isn't one of the fears about stem cells that they could copy errors? Hell, does anybody know for sure how these things will work on humans in any given circumstances? That's what research is for."

  "Okay, okay. One thing's for sure, it's got to be checked out. And what you found in Paxton will fast-track getting all Hamlin's other patients in here. Heaven knows what we're going to do with them if we do find recurrences—"

  Richard's new cellular rang. He fumbled getting it open to turn it on, not used to the more recent model. "Hello?"

  "Get down to the morgue, pronto," McKnight said into Richard's ear.

  "Why?"

  "Just do it, and fast. We found Edwards's body."

  "Shit!"

  "Hurry, and bring your ER team. We also got Norris. Our killer's cut him to pieces, but I think the poor son of a bitch may still be alive." The temperature of the locker was set as low as a fridge, intended to preserve meat, not freeze it. Hypothermia had saved Norris.

  At least what was left of him.

  His ear, the remains of an eye, and his hand, all taken from the right side of his body, lay in a little pile by his head, along with a stack of twigs.

  He had no palpable pulse, and his respirations were so shallow they were barely noticeable. His skin could be kneaded and drawn into tufts like cold Plasticine, and he responded neither to words or pain. To the uninitiated he'd have been pronounced dead.

  But the observant McKnight had picked up the clues. Norris's remaining eye, though staring straight ahead, had a normal-sized pupil. His limbs, though stiff and difficult to bend, weren't rigid with rigor mortis. He was mottled blue, but his underside had none of the deep purple coloring called lividity, the pooling of venous blood in the lowest points of the body when a person is dead.

  Richard bent over the man's chest and listened with a stethoscope while he was still on the sliding steel tray. About every three seconds he heard a faint heartbeat. "Let's go, people," he said. "This guy's not dead until he's warm and dead." Within a minute the man had IVs in his arms and legs, heated saline infusions coursing through his veins, and a slew of monitors wired to his chest. Richard did the intubation himself, prying open the man's jaw with about the same force it might take to manipulate a frozen chicken leg. Using the illuminated blade of a laryngoscope he pushed aside Norris's tongue and visualized the V of his vocal cords. In went the tube as usual, except he had the added sight of seeing its tip pass by the hole in the front of his patient's trachea.

  "He's eighteen degrees centigrade," shouted one of the nurses wielding a freshly used rectal thermometer calibrated for low temperatures.

  The lowest on record who had ever survived was fifteen, according to the journals.

  As they wheeled him out of the morgue and rushed to the elevator, they attracted more than a few comments and stares from the pathology staff. But Richard and his team were too busy ventilating the man and briefing the residents to pay any mind.

  ". . . heat the oxygen to about forty-five centigrade . . ."

  ". . . raise his temperature no faster than one-point-five degrees an hour. The key word here is slow, and it's only the core temperature we boost.
No hot blankets once you get him upstairs. That'll dilate the peripheral circulation and put him in shock for sure . . ."u. . . no unnecessary manipulation of the heart, so don't go shoving in any central catheters. The slightest irritation at this temperature will set the myocardium fibrillating, and we'll be pumping this guy for hours . . ."

  As the door of the elevator slid closed, Richard heard someone in the hallway quip, "Slabbed another live one, have you?"

  "She's left already?"

  "Yeah, the ambulance came early, Dr. Steele. I left a message for you in ER."

  "But I was supposed to be notified personally."

  "I'm afraid Dr. Sullivan overruled you. She insisted on signing her own consent form. You know that's to be expected. She's making progress and isn't willing to be dependent anymore."

  He stiffened at the free insight.

  "Hey, she's okay," interrupted McKnight, slamming down the phone. "My officer's with her right now. Rode in back at her side the whole way, and they're admitting her as we speak. I've ordered a few more squad cars of cops to scout out the place to see what security we'll need there, and until they get on the scene, some of the guys watching the mayor's place are going to wander over and man the front entrance. But it's this place we got to worry about the most. Imagine that son of a bitch operating right under our noses. How soon do you think Norris will be able to talk?" He jerked his thumb in the direction of the cubicle where the residents continued to work on him.

  "I'm not even certain he's going to live. But it would take days before he'd be alert enough to tell us anything."

  "Shit! How the hell could this happen? Two extra bodies in the morgue, one of them for more than an entire day and headless, yet nobody noticed?"

  "In a word, cutbacks. They're so far behind on posts, you're lucky they didn't wait until next week to pull those particular slabs."

  "Jesus, this place is screwier than the NYPD! Well, let me tell you, there's going to be so much security around here from now on not even a cockroach will get in or out. As of immediately, all the exits are manned, and I don't care how many people it takes. Plus we're searching the whole building again. Maybe with a bit of luck the creep will still be here."