ADRENALINE: New 2013 edition

by John Benedict

  “That would be highly unusual—we don’t give out that kind of information,” she said. The words came out in a clump, slurred together, suggesting it was a well-worn phrase.

  “No, you don’t understand,” Doug said, working to keep his voice calm. “He works for Keystone Anesthesia in the corporate account. You send us the monthly bill all the time. I need to check to see where he called yesterday.” Doug hoped he didn’t sound too pleading.

  “I’m afraid I still can’t help you sir,” she said cheerily.

  “Well, can you find someone who can?” Doug asked, beginning to lose his patience.

  “I’ll have to check with the manager,” she said huffing and sighing so, it sounded like she had been asked to scale Mount Everest.

  “That would be fine.”

  “Can you hold?” Click. She didn’t wait for an answer.

  Doug drummed his fingers on his desk; he commanded himself not to look at Mike’s desk. He glanced at the TV. MSNBC was on with the afternoon Street Sweep; the NASDAQ was in record territory again. Great—Mike and he always dreamed of riding the tech wave and retiring early.

  “Hi, Doctor Landers—”

  “Landry.”

  “Doctor Landry. This is Mister Jenkins, and let me just say that we do appreciate your business, and I’ll help you any way I can. Now, what can we do for you?”

  Thank God—that’s more like it. “I need to check some phone calls on one of our corporate mobile phones,” Doug said.

  “We can fax over the corporate billing statement, if that would help?”

  “Yes, great. Our account is Keystone Anesthesia Associates. Thanks a lot.”

  “You’re welcome—”

  “Is this record up to date?” Doug interrupted. “I mean will it show calls made as late as yesterday?”

  “Oh, yes! Here at ConTel we employ the latest in computer tech—”

  “Great! Thanks! Just send it.” Doug hung up. While waiting for the fax, Doug grabbed some Advil to dull the pain in his head and swallowed them dry. He didn’t think he was over his self-imposed daily limit of six yet. He sat down at his desk and massaged the back of his neck and his temples. Shortly, the fax machine hummed to life and spewed out several sheets. Doug jumped up and ripped off the flimsy paper, still warm to the touch. He quickly located Mike’s car phone number near the bottom of page two.

  The first number was Mike’s home phone. He must’ve called when he was leaving the hospital as late man.

  Doug didn’t have a clue about the second long distance number, but he would call it shortly. The third listing was Mercy Hospital OR. Doug knew Mike had been called in last night; it had been in the newspaper. He figured Mike must’ve been telling the hospital he was on his way back in—standard procedure.

  He dialed the second number.

  “Hello, Wyeth Labs,” came a pleasant female receptionist voice. “How may I direct your call?”

  Wyeth Labs? What the heck? Doug thought fast. “Uh, this is Doctor Landry from Mercy Hospital in Lancaster. Did you receive a specimen yesterday on a Bob Lehman?”

  “You want the clinical lab department, sir. I’ll transfer you.”

  “Thanks.” What in the world would Mike have sent to Wyeth Labs?

  “Lab,” came a male voice. Not so pleasant.

  “Hi, I was wondering whether you received a specimen on a Bob Lehman from Mercy Hospital?” Doug asked politely.

  “Hospital number?”

  “Uh, wait a minute.” Doug cradled the phone between his ear and shoulder and rummaged through the disorganized pile on his desk, searching for the missing scrap of paper. He located it and read off the number.

  “Please hold.” Click. Doug drummed his fingers in time to lousy elevator music. “Yes, just arrived this morning.”

  Bingo! “What was it for?” Doug realized his mistake as soon as the words left his mouth.

  “Sorry, sir. That’s confidential.”

  Oh shit, here we go again. “But, it’s a matter of great importance!”

  “I’m sorry, sir,” replied the male voice, sounding anything but sorry. “Just following policy,” he added, the delight over these three words plainly evident in his voice.

  Doug slammed the phone down. Obnoxious twerp! He punched the redial.

  “Hello. Wyeth Labs—”

  “Laboratory, please.” He had a new idea and fervently hoped for a different, less officious lab tech.

  “Lab,” answered a female voice.

  Thank God a different voice, although she didn’t sound much friendlier. “Hi, uh, this is Doctor Carlucci. How are you today?”

  “Fine. How may I help you, sir?”

  “I need to check on that blood specimen I sent you yesterday on a Mister Robert Lehman.”

  “Hospital number?”

  Doug repeated the number again.

  “Yes, I see it.”

  “Your form was a little complicated, and I’m afraid I may have screwed it up.” Doug smiled as he laid it on thick with his best absent-minded professor voice. “Did I remember to check the plasma pseudocholinesterase box? I really need that.”

  “No, sir,” she said impatiently. “You just have D-epinephrine checked.”

  Gotcha! “Damn! I knew I forgot.” Doug smiled again and couldn’t resist adding, “Do you think you could run them both?”

  “I’m afraid not. That would be against policy. You’ll have to send us another order form.”

  “That’s what I thought. Thanks anyway.” There’s more than one way to skin a cat. “You’ve been most helpful,” Doug said and believed he could almost see her face pinch into a bewildered frown.

  D-epinephrine! What the hell was that for? Doug knew what D-epinephrine was and also understood that D referred to a dextro-rotary optical isomer, but beyond that he was lost. He couldn’t recall ever hearing of D-epinephrine being a useful clinical lab value. He picked up the phone fax again while he pondered the D-epi mystery.

  He turned to the next page and realized with a jolt that there was one more phone entry under Mike’s number and it was for December 18th—today!

  This last call must’ve been made right before Mike’s accident! The paper had said 2:30 a.m., but this was close enough. The number looked familiar, but he couldn’t place it. He dialed rapidly.

  “You’ve reached the residence of Doctor J. Raskin. At the sound of the tone, please leave your name and message . . . BEEP . . .

  Raskin! “Hi, uh, Joe. This is Doug Landry. I, uh—” He stopped when he heard the receiver being picked up.

  “Hello, Doug,” Raskin said. “I’m here. What the devil are you calling me at home for? You know I’m off-call.”

  “Sorry—hey, did you hear about Mike? Have you seen the news?”

  Raskin paused, then asked slowly, “No, what happened?”

  “He’s dead. Killed in a car wreck driving home last night,” Doug said. “Paper said he fell asleep at the wheel.”

  “You don’t say. Tragic. Dammit, I told him he looked tired. Had to call him in for a fucking epidural. Tried to get him to drink some coffee, but he wouldn’t have it—said it would keep him up the rest of the night. God, I feel awful.”

  “Not your fault, Joe. Well, listen I won’t bother you anymore. I’ll let you know if we hear anything about funeral arrangements.”

  “Thanks for calling, Doug. Tragic, simply tragic. See you later—”

  “Uh, Joe, one more thing,” Doug said before Raskin could hang up. “Did Mike call you at home late last night?”

  Raskin again paused. “I was in the hospital working all night, Doug—you know that. Why would he call here?” There was silence for a moment. Doug could make out Raskin’s wheezy breathing; he sounded somewhat out of breath. Raskin worked through a coughing fit and continued. “But I know of no call. Phyllis would’ve told me if anyone had disturbed her sleep.”

  “OK. Thanks.” Doug hung up the phone, mystified. He wondered why Mike had called Raskin at home last nig
ht. Doug had heard about Raskin’s bad case and knew he had stayed in the hospital until at least four or five in the morning. Mike clearly would’ve known this. He would’ve had no reason to call Raskin’s home at two in the morning and wake up his bear of a wife, Phyllis. It didn’t make any sense. Maybe it was just a phone malfunction caused by the accident.

  The intercom squawked again.

  “Doctor Landry—induction room 2.”

  “Doctor Landry—pre-op room 4.”

  “Doctor Landry—recovery room needs a patient evaluation.”

  Doug reluctantly put his growing concerns away. Maybe tomorrow he could give them some more thought. He groaned as he hoisted himself out of the chair and headed toward the OR.

  CHAPTER TWENTY-EIGHT

  Joe Raskin hung up the phone and felt like he was going to vomit. He staggered over to the kitchen table where the newspaper was spread out and sat down hard. He ran his trembling fingers through his hair several times and took in some deep breaths. He reread the article to see if he had missed anything. Phyllis had complained to him that someone had disturbed her precious beauty sleep. His mind raced and his heart pounded in his chest. Could it actually have been Carlucci? He played with his beard, twirling sections of it into tight little knots. How could Landry have possibly known about a call to my house made by a dead man? It doesn’t make any sense.

  No, no, that’s absolute bullshit. Landry, that asshole, must be bluffing. He’s trying to flush me out. Raskin got up and began to pace. His shoes clip-clopped loudly on the Grecian ceramic tile in his spacious, Mediterranean-style kitchen. Thank God, Phyllis was out this afternoon at one of her silly Ladies’ Auxiliary meetings. He needed time to think, plan his next move. He went over what he knew.

  He had never liked Landry from day one, that much was clear. Landry was so goddamned confident, never made a mistake—Mr. Perfect. People were always making special requests for Landry to do their anesthesia. It was disgusting. Joe used to get lots of requests, well some anyway, before Landry and Carlucci came.

  He walked into the expansive dining room and had to shield his eyes. The large crystal chandelier appeared to be on fire, as it caught the rays of the setting sun streaming through the two large bay windows. The entire room was bathed in bright orange. It reminded him of Carlucci in his burning truck and he frowned. Not a pretty way to go.

  He felt bad about Carlucci. People thought he didn’t care, but they were wrong; he had feelings too. Except, nobody cared about his feelings—Phyllis certainly didn’t. Raskin felt his stomach churn and his nausea intensify. Carlucci reminded Raskin a little of himself. He wasn’t perfect like Landry; he was always too goddamned nervous —should have been a dermatologist or something.

  Raskin eyed the doors to the study; he was being drawn there. He walked over and reached out to open the door. The door was halfway open when he stopped, struck motionless by a powerful thought. What about King David from the Old Testament? Wasn’t he, himself just like King David, who’s practically a saint? He recalled the story of how King David, lusting for Uriah’s wife, Bathsheba, had put him on the front lines. Uriah was immediately killed in battle.

  The point was, that King David didn’t actually kill him—the Ammonites did. Likewise, he hadn’t killed Carlucci—that dimwit trucker, Marty Johnson had. Why, he never even intended for him necessarily to die. A good crack-up, a good scare would’ve been just fine by him.

  He walked all the way into the study and closed the door. Framed photographs of his three children, now grown or in college, immediately caught his attention. He remembered that Carlucci was a family man, too—the paper had said two girls. Raskin felt a stab of remorse. Blessed are the little children for they shall inherent . . . something. He shook his head and took in several deep, cleansing breaths, letting the odor of incense and candle wax wash over him. This was where he came for comfort.

  Raskin knelt down and turned his gaze toward the exquisite oil painting taking up half of the far wall. He remembered when he had first laid eyes on the painting at some stupid art exhibit Phyllis had dragged him to. He just had to have it. It didn’t matter that the painting was an original and outrageously expensive. The painting had spoken to him then as it continued to do so now. It embodied the central philosophy of his life, ever since he was a young boy.

  He studied the anguished face of Jesus on the cross. Jesus was looking toward a man to his right, the thief, who was also being crucified. The man appeared to be pleading with Jesus. The expressions were so lifelike, the lines and detail so perfect, the colors so vibrant that Raskin thought he was staring back through a window in time.

  Raskin closed his eyes and stilled his breathing. He believed he could hear Jesus speaking. “Your sins are forgiven. Today, you shall be with me in paradise.” He opened his eyes and made the sign of the cross. He smiled and felt his nausea subside. After the unfortunate accident with Melissa, he had visited the study several times—the painting had worked its magic then, too. It was simple, really. You could do all this bad stuff, anything actually, and as long as you asked for forgiveness before you died, you would wind up in heaven—just like the thief.

  There was only one catch, however—you couldn’t die too quickly. But what were the odds of that? He’d seen lots of people die over the years. Normally they had time—it would only take a couple of minutes for Chrissakes to say a quick prayer. He figured he’d take his chances. Even Carlucci probably had time to make it right with his maker before he roasted. Raskin felt much better; he always did when he knelt at the foot of the cross. He decided he was wrong to get all broken up over Carlucci—he was a friend of Landry after all. And Landry was the real evil one.

  Landry was probably in league with the nuns. They had no doubt cooked up this whole merger thing along with the Pinnacle deal to force him out. They would throw him out on his ear in disgrace after all he had done for Mercy. It just wasn’t right. Besides, what really galled him was that Landry was such a sleazebag—he should get the axe. Didn’t they know Landry was shacking up with that SICU bitch? Whereas, in contrast, he had never cheated on Phyllis in thirty-five long years of marriage. Well, maybe once or twice, but he had been drunk, so they didn’t count.

  So, Landry thinks he can call here and play his little game of mind-fuck. Well, it was time to get even, settle the score. No more Mr. Nice Guy. His hands were clenched and he was breathing hard as he stood up, knees creaking. The painting looked ordinary now and no longer captivated him. He left the study and closed the door.

  Raskin walked back to the kitchen and sat down at the table, the newspaper picture of the burning wreck in plain sight. It occurred to him that he had been lucky with Carlucci; Midazolam was metabolized slowly and might easily have been detected in Carlucci’s blood. Lucky for the fire. He needed something better—he closed his eyes again and rested his head in his hands, hoping for inspiration.

  His mind wandered back to his days at State College, and he saw himself seated in a large lecture hall, noisy and crowded with students. Professor Herbrandson was droning on about some aspect of organic chemistry; Raskin couldn’t quite make out what he was saying. The professor’s head dodged in and out of the powerful light beam coming from the overhead transparency projector; it reflected in bursts off his spectacles and shiny, bald head. Herbrandson wrote the words “Hoffman elimination” in big block letters, and then wrote it again and again. Raskin could even hear his felt-tip pen squeaking over the vinyl sheet.

  What the hell does Hoffman elimination have to do with anything? The answer came to him in a flash—Atracurium. He smiled. Atracurium was a devilishly clever molecule. He became excited and quickly ran through what he knew of the drug. Atracurium was of a class of short-acting, non-depolarizing muscle relaxants. Muscle relaxant was a nice way to say it induces a full-blown muscular paralysis. Death by asphyxiation occurs quite rapidly, in the order of three or four minutes, following a paralyzing dose of Atracurium.

  But the beauty of the drug w
asn’t its neuromuscular blocking qualities; other drugs paralyzed equally well, if not better. Raskin remembered the drug rep, the skinny blond with platform shoes and a short dress, telling them, in her New York accent, why Atracurium was worth such a premium price. She had called Atracurium a “pharmacologic time-bomb.” It was specifically designed for use in people with impaired liver or kidney function. The drug wears off entirely by itself, not relying on any organ function, in about thirty minutes. As the drug heats up to body temperature, it undergoes what’s known in organic chemistry parlance as spontaneous Hoffman degradation. That translates into a heat-sensitive, molecular self-destruction.

  Raskin felt his smile stretch wider: even a corpse, at room temperature or above, would clear Atracurium from the blood. He took the stairs down to his office in the basement where he kept his medical bag and some supplies.

  CHAPTER TWENTY-NINE

  Brrring!

  Doug stared at his watch as he picked up the phone, but his eyes were too blurry to make out the small numerals. “Hello. Doctor Landry here.”

  “Is this anesthesia?”

  Doug yanked the receiver away from his ear—the caller’s voice seemed way too loud. “Yes, I’m the anesthesiologist on call.” He hated when they referred to him as anesthesia.

  “We need a labor epidural up here.”

  Super. “What’s up?” His stubborn eyes finally deciphered the little lines on his watch—11:00 p.m.—eight hours to go. Might as well have been an eternity, the way he felt.

  “We have a twenty-two-year-old, Mrs. Concepcion, who’s about four CMs and on pit.”

  “OK, I’ll be up. Man, you guys have been busy up there at night. Can’t you give it a rest?” Doug reluctantly threw off the thin, scratchy hospital blankets.

  “Whatd’ya mean? Last night we were empty.”

  “No, they called down for an epidural last night too. I’m sure of it.” Doug sat up on the lumpy pullout sofa bed and shivered. Normally, he wouldn’t have bothered to argue, but tonight, he felt especially irritable.