Lethal Incision

by Dobi Cross

  She studied the girl’s features further and noted that her facial bone structure looked a little different. More rounded at the jaw. It wasn’t her sister. Even though it had been years since Zora saw her, her sister had been a facial replica of her mother so it was easy to guess how she might look now.

  The patient looked to be about nineteen years old. A quick glance at the monitor showed she had a respiratory rate of twenty-five breaths per minute, a systolic BP of ninety-five mmHg, and sinus rhythm.

  Zora heard the sound of feet and turned. It was Charlie Newman, a fourth-year general surgical resident who was on call with her.

  “What do we know about the patient?” Zora asked.

  “Not much. No name.” At Zora’s surprised look, “She’s been abandoned. A guy who claimed to be her brother brought her, but he disappeared before we could get her details. Big muscular dude with a sneer on his face.”

  The description matched the person who had bumped into her. “Did you notice anything else about him?”

  “He had a tattoo at the side of his neck that was partly hidden.”

  It was definitely the guy she had met. “Hmmm. I wonder why he took off.”

  Zora checked the patient’s pulse. It was elevated. Her olive skin was hot and clammy to touch. Her abdomen stretched out like a semi-inflated balloon on her small frame.

  “She’s not pregnant,” Charlie said. “We ran a pregnancy test before the CT scan. Her abdomen is taut with no bowel sounds. Paracentesis yielded blood.”

  Zora noticed an angry reddened slash with botched stitches on the left upper quadrant of her abdomen. She froze. Impossible. There was no way two patients could appear with missing kidneys within a few days of each other.

  Alarm bells rang in her head. She grabbed the CT scan film from the foot of the bed and examined it. The left kidney appeared to be missing, but she couldn’t be certain.

  The hair on her neck rose and she shivered. She felt the eyes of the resident on her.

  “What do you think?” she asked him, her calm voice belying her she felt.

  “Hypovolemic shock from a botched kidney removal, and possible splenic rupture complicated by sepsis. We’ve already sent the bloods for analysis and cross-match.”

  “We need to get her to the OR immediately.”

  The resident nodded and left to make the arrangements. Zora walked over to the nursing station and placed a call to the attending-on-duty. He was leading a complicated elective surgery that had extended into the night, but he gave Zora the go-ahead for the surgery and asked her to keep him updated.

  Zora left the ER and made her way to the OR where the patient had now been moved. As she scrubbed her right forearm with the brush in the pre-op section of the OR suite, Zora could not shake off the feeling that there was a connection between this patient and John Doe. Maybe there were other similarities she was missing. She sighed, switched the brush to her other hand, and scrubbed her left forearm. Just then, Dr. Graham walked in.

  Zora’s face froze. “What are you doing here?” Her voice sounded altered from the surgical mask she wore.

  Dr. Graham refused to meet her eyes and walked to the other scrub sink. “I’m here to be your first assist. Charlie fell sick and had to go home.”

  She fixed a cold gaze at him. She didn’t believe the story for a second—Charlie had looked fine in the ER. Something else was going on.

  Zora finished scrubbing, rinsed her hand all the way to the elbow and walked with her hands held up into the sterile section of the OR suite. The automatic doors opened with a swoosh. The anesthesiologist already sat at the patient’s head. Bags of blood and frozen plasma hung on IV lines next to him and dripped life into the patient, and a systolic blood pressure of ninety mmHg registered on the monitor. He looked up and she recognized him as the mystery anesthesiologist, the one who had worked on John Doe.

  Zora felt her chest tighten and she broke out in a sweat. The room seemed to close in on her. She stopped walking and took several deep breaths as she looked around the room. She didn’t recognize any of the scrub nurses. It was like Jane Doe all over again. Then a certain nurse who had been busy with the instruments looked up at that moment.

  Christina. Zora felt the white walls of the room recede. Her heart slowed its frantic pace. But what was Christina doing in the OR? Well, it didn’t matter. She was just glad to have her in the room.

  Christina smiled at her and Zora nodded in return. With Christina around, there was no way this could be a repeat of the previous case. And if it was, at least she had a witness she could trust.

  She turned to the anesthesiologist. “I don’t think we’ve been introduced,” she said.

  “I’m Dr. Latam,” the man said, his eyes boring into hers.

  Zora studied him. “You were the anesthesiologist on the John Doe case.”

  The man said nothing, and instead turned to look at the screen of the monitor.

  “Do you work here? I don’t recall seeing your name on the on-call list,” Zora pressed.

  The blare from the monitor pierced the air.

  “BP is crashing!” the anesthesiologist called out as he increased the flow of the fresh blood and frozen plasma into the IV lines.

  Zora would have loved to question the anesthesiologist further, but she had a patient to save.

  She strode to the patient’s side. Dr. Graham was now in the room standing on the other side of the patient. She nodded to the rest of the team, passed her arms into the sleeves of the operating gown held out in front of her by a surgical tech, and allowed him to cover her hands with a pair of surgical gloves. Then Zora snapped on a second set of gloves like she was going into battle. Because that’s what the OR was to her. A battlefield. A place where she was the general who always had to win the war.

  Zora looked at the monitor. The BP was still dropping. Dr. Latam confirmed that the patient had been given an antibiotic.

  Jane Doe had been prepped so Zora made a vertical cut down the length of her abdomen. Blood splattered as she cut through the peritoneum and inserted the retractors. She worked quickly, packing laparotomy pads into all four quadrants of the abdomen to soak up the excess blood, while Dr. Graham inserted a suction catheter, which gurgled bright red blood into a glass reservoir.

  Zora looked up. “How’s the rhythm?”

  “Sinus tach. Rate is up to one-forty,” Dr. Latam responded.

  Her hands searched quickly in the upper left quadrant for the bleeder. She found it—it was the left renal artery. Its edges were jagged as if cut off in a hurry, and it had not been tied off properly. Like the person who removed the kidney knew just enough about anatomy to be dangerous. It was leaking blood slowly but surely into the abdomen, spreading blood into all four quadrants.

  “Systolic at seventy!” the anesthesiologist called out.

  Zora clamped the bleeder down and tied it off properly, while Dr. Graham removed the laparotomy pads and inserted fresh ones. They quickly turned red. Christina now held the suction catheter in place.

  “She is still bleeding,” Dr. Graham said.

  “Systolic at fifty!” the anesthesiologist called out. The erratic beep from the monitor filled the air.

  Zora’s face remained still like granite. There was still another errant bleeder and she needed to find it fast. Her hands moved with military precision to check the liver and the spleen as Dr. Graham kept replacing the laparotomy pads. She didn’t bother with the aorta; if it was the culprit, the patient would have been a goner by now. No bleeding from the liver. Check. Zora moved to the spleen. She first divided the avascular ligaments to mobilize the spleen into the operating field, and then applied an atraumatic clamp to the splenic pedicle to secure the splenic artery and vein. She inspected the spleen and noted a major laceration on the side. Whoever had removed the kidney seemed to have been careless and injured the spleen. A hack job.

  “Systolic is now at sixty.”

  Zora forged on. Her work was not done. “Three-oh prolene,
” she barked.

  Christina handed it to her. Zora used horizontal mattress sutures and pledgets to quickly stitch the lacerated edges together. She then applied fibrin glue to the raw edges. The bleeding was now barely visible.

  “BP is back at ninety-five over fifty.”

  The steady beep of the monitor now reigned. The room seemed to heave a sigh as normalcy returned, as if it knew the critical part of the work had been completed.

  Dr. Latam and the OR nurses had refused to say another word to her till the surgery ended and by the time Zora was closing up the patient, the anesthesiologist was gone. The OR nurses had disappeared shortly thereafter till only Christina had remained.

  This time Zora followed the nurse as she wheeled Jane Doe from the recovery room into the SICU. Once Jane Doe was all set up and hooked to the monitor in her cubicle, Zora straightened the sheets covering her torso, rechecked her IV lines, and fiddled with her chart.

  “We’ll take care of her.”

  Zora turned to see the SICU nurse-on-duty assigned to Jane Doe standing by her side. “You don’t have to worry.” The nurse smiled at her. “We’ve got this.” Zora looked at her name tag. It said Keller.

  “I know what you are worried about. Zora’s lip turned up at the familiar voice. Christina’s head bobbed into view. “I can also check her every hour if you like,” she said.

  “Would you?”

  “Sure. Anything for my bestie.” Christina swung her arm over Zora’s shoulders. “Now, go rest. You look like death warmed over.”

  Zora wanted to stay. Jane Doe might disappear like John Doe. But she trusted Christina. And she really needed to sleep.

  She covered her mouth as a yawn escaped from her.

  “See, I’m right. Now get out of here.” Christina placed her hands on Zora’s shoulders and pushed her toward the door.

  Zora took a last look at the patient before leaving.

  And prayed that Jane Doe would still be there when she came back.

  CHAPTER ELEVEN

  Drake thought about last night as he waited for the minutes to countdown before his call with his business partner. He hadn’t been surprised at the cool reception he had received at the H Club. Most folks didn’t know how to deal with him, and he was sure the rumors were everywhere about what had happened with Anna Hammond. Some called out a greeting; others pretended not to have seen him.

  Drake’s jaw muscle tightened. They were all pretenders. Some of them had done worse. He’d only been unfortunate that his situation had come to light. But no one had been bold enough to say anything to his face. They guessed he was still unforgiving of anyone who crossed him. And they were right.

  He’d been seated in one of the private alcoves, a step down from a private room. It had been a slight but he pretended not to notice. It was a mistake that in the future they would have no choice but to correct. By then, he’ll show them how unforgiving he was.

  One of the hostesses had made a joke about his sexual prowess. The comment had made other guests at the H Club look away or cough to clear their throats. A few had hidden their smiles. Drake had waved off the comment, a thin smile plastered on his face. But that had been the last joke the girl would make. Her body was probably at the bottom of the river by now, her sexual parts slashed to bits. Her disappearance from the club would send a clear message—Drake was not someone to mess with.

  He looked at his watch. It was time. As if on cue, a special grey burner phone that he had secured for the business, started ringing. Drake picked up the phone from the top of his desk and pressed the answer button. The caller on the other end went straight to the point. “I see our plan is doing very well,” he said, his voice distorted on purpose. Drake hated that he couldn’t identify who his business partner was, but the money was too good, so he ignored it as a minor inconvenience.

  “I’ve heard there has been no problem,” Drake responded.

  “Of course not. Your latest payment has been deposited into your account as usual. We’ve also gotten more buyers who are interested, so I held back some of your funds like we had agreed. This is going to allow us to expand even more.”

  “Are you sure they are clean? Secrecy is of the utmost importance here.”

  “Not a problem. These guys are not saints. We have enough on them to keep them quiet if they ever think about betraying us.”

  “I hope so.”

  “You don’t need to concern yourself with them. You continue to play your part and I’ll take care of mine.”

  “Anything else?”

  “I can see our friend Zora is getting flustered.” The guy on the other line chuckled. “She’s interesting to watch.”

  For some reason, the guy’s tone annoyed Drake. He had no business being fascinated about Zora. Zora belonged to Drake and him alone. And he never shared his women. He’d only brought Zora into his plan because he needed to punish her. “Let’s stick to the plan, shall we?” he said.

  A tinge of anger laced his partner’s voice. “I can do whatever I want with her. Don’t ever tell me what to do.”

  An uncomfortable silence stretched between them. Drake hadn’t known it in the beginning, but he’d come to suspect that he was dealing with a lunatic—someone who sometimes couldn’t be reasoned with. I can’t believe I have to be the one to back down. But the money from the business had become too important—he needed a lot of cashflow in the near future, and this business would provide it. It was unfortunate that this mad man was in the driver’s seat.

  “Just take it easy with her,” Drake said finally.

  His partner laughed, his voice grating on Drake’s nerves. Then he ended the call.

  Drake replaced the phone in his desk drawer and scoffed. The mad man had no idea that his business arrangement with Drake would end very soon. Drake just needed to hold on a little longer and then everything would be over. He would ask Monkey to find out all he could about the guy. He needed some evidence over the guy’s head to be able to walk away whenever he wanted. And now he had to keep a closer eye on Zora. His instincts told him that his business partner was up to no good. He didn’t care if Zora got hurt or not, just that he had to be the only one with the power to punish her.

  He pulled out the black burner phone and called Monkey. He didn’t answer so Drake disconnected the call. He then pressed a hidden button under the surface of his desk and leaned back in his swivel chair.

  The door to his office opened and Tiny stepped in looking like he had just showered in sweat.

  Drake crinkled his nose in disgust. Seeing Tiny these days irritated him, but he was still useful. “I need you to keep a closer eye on Zora,” he barked. “I want a thorough update.”

  “Any specific reason?”

  “I pay you to obey not to ask questions!”

  Tiny kept silent.

  “It’s time to set up the meeting with my father.” Drake continued.

  Tiny nodded in assent.

  Drake waved him away. “You can go.” Tiny left the room.

  Drake ran his hands through his hair. This was what he got for working with someone for too long. One of these days he would get rid of Tiny.

  In the meantime, he’ll get Monkey to get him the information he needed and also watch Zora.

  The final decision about her rested with Drake alone.

  CHAPTER TWELVE

  The man’s phone buzzed in his pocket. He ignored it, but it kept ringing. “Excuse me,” he said to his colleagues. He strode out of the room and walked down the hallway to the small conference room on the left. The white walled room with a small oval table, black swivel chairs, and a projector from the ceiling was empty. He entered and locked the door behind him, and then pressed the green button on the phone. “You know better than to call me here,” he said.

  “I’m sorry, boss,” Erik said. “It’s Monkey. You said for him to call immediately if he had important information.”

  “Yes?”

  “Mr. Pierce asked him to watch over Dr. Smyt
h.”

  The man rapped his fingers on the conference table. That slime ball. So he thinks Zora is his. The man chuckled.

  “What would you like him to do, boss?”

  “Tell Monkey to share whatever he wants to know about Zora. Anything else?”

  “Well …”

  “Spit it out already.”

  “Mr. Pierce also wanted him to find out whatever he could about you.”

  The man cursed under his breath. So Pierce was trying to get a one up on him. Which only meant one thing—Pierce wanted to end the arrangement. Unfortunately for Pierce, this was the man’s one no-no in this business. Anybody who’d tried to find out who he was had ended up in a watery grave. Pierce had crossed the line.

  “What should he do, boss?”

  Too bad that this was an arrangement that Pierce would never be able to walk away from. He’d chosen him for that reason. No one would miss the guy when he disappeared. Besides, something irked him about the pompous rapist. “Tell him to take care of Pierce. Nice and clean.”

  “Yes, boss.”

  “Hold on. You know what? Let him string him along for a few days. I’ll let him know when to go ahead and take care of him.”

  “I’ll tell him, boss.”

  “And don’t call me here again.”

  “Sorry, boss.”

  The man ended the call and checked his watch. He’d been gone for too long. He was sure his colleagues were looking for him.

  He straightened his coat. Time to get back to work.

  He opened the door to the conference room and walked away.

  CHAPTER THIRTEEN

  Christina woke up with a start. She’d fallen asleep on the chair she was sitting on at the SICU nursing station. Instead of coming and going, she’d chosen to remain and watch over the patient, and the SICU nurses had been kind enough to allow her to stay.

  She wasn’t supposed to have been on-call. It had been one of those days where her schedule couldn’t be matched with Zora’s no matter how much she had tried. But the heavens must have been watching because she’d gotten a call from a friend and colleague who was on the schedule today. She had to rush home to attend to her young child after the babysitter called her about an emergency. Could Christina stand-in for her?