Lethal Incision

by Dobi Cross

  No one else was available to come in at such short notice, and the shift was extra busy today. Her director had already okayed it since Christina had significant OR experience at Lexinbridge Regional. So Christina had jumped at the chance. She figured being on duty at the same time as Zora even if not in the ER would still allow her to watch over her.

  And then it turned out Zora had a Jane Doe to operate on. The missing name alerted Christina that this case might be similar to the one Zora had talked about. Perfect. Christina kept her eyes open as she prepped for the surgery. She’d never seen the anesthesiologist before which was strange. Most anesthesiologists-on-call would typically come to the ER to see patients that were going up for emergency surgery, and yet this was the first time she’d met him. She couldn’t be certain about the other scrub nurses since she didn’t work in the OR regularly.

  By the time Jane Doe’s surgery was over, her colleague had returned. Her aunt had arrived to look after the child, so Christina had been let off the hook. She hadn’t been ready to go home yet. It had been an easy decision to offer to look after Jane Doe on Zora’s behalf.

  But a noise had woken her up. Christina listened and heard the sound again—the squeaky sound a reminder that the associated bed caster wheels needed additional lubrication. And it came from the direction of Jane Doe’s cubicle. She looked at her watch. It was two a.m. She looked around but couldn’t see Nurse Keller. Was she the one in there making adjustments to Jane Doe’s bed? It was time to find out.

  Christina walked over to the cubicle and tapped her badge against the reader on the wall. It slid open and she stepped in. There was no one else in the room and Jane Doe was still lying there, the rise and fall of her chest a reminder that all was as it should be. Yet she was sure she had heard the sound coming from the room.

  After looking around once more, Christina left the room and looked down the hallway. She noticed a gurney a few feet away and she walked over to it. She pushed it and it made a squeaky sound. So this is where the noise was coming from. But why was it in the hallway? She hung around for a few minutes to see if anyone would claim it. No one came.

  She felt a pressure in her lower abdomen. Not now. But the increasing strain told her she couldn’t put it off. And it would only take a few minutes. She left the SICU, passed the waiting area, and walked to the bathrooms located outside the area. Once she was done, Christina headed back to the SICU. On her way in, she noticed two burly men wearing scrubs, surgical caps and masks wheeling a patient on a gurney toward the back elevators used for transporting patients to other areas of the hospital. She heard the squeaky sound again. It’s the gurney. But what gave them away were their shoes. They wore regular leather shoes, something that health professionals who worked in the SICU would never wear. And they were uncovered.

  Her heart rammed against the wall of her chest. Something was wrong with this picture. Could it be Jane Doe on the gurney? Christina hurried into the SICU and checked her cubicle. Jane Doe was gone, her bed empty. She turned to see Nurse Keller working at one of the computer terminals at the central nursing station.

  “Where is Jane Doe?” Christina asked.

  “She was just transported to radiology for an MRI,” Nurse Keller responded.

  “By two guys?”

  “Yes.” So it was as she thought.

  “But I don’t recall Dr. Smyth putting in an order for one.”

  “I wondered too, but the order is in the system. Come and see.”

  Christina hastened around the central station and sure enough the order was there signed off by Zora Smyth. Yet something smelled fishy about the whole thing. She thanked the nurse and ran to the elevators. She looked up and noted the elevator they had entered had stopped at parking level one instead of the basement level where the MRI center was located.

  Bingo. Her instincts were right. Christina jabbed the buttons for the second elevator and jumped in when the doors slid open. She rode it down to parking level one, all the while praying that she could still catch up to them. She pulled her phone and called Zora’s number but it went to voicemail. Zora, pick up your phone!

  The elevators opened on the parking floor and Christina ran out. She looked left and right, but didn’t see anyone. The garage seemed silent as a grave. She made to turn back to the elevator when she spied what looked like an open door of an ambulance swinging closed. Christina sprinted in that direction and saw one of the men walking toward the passenger side of the ambulance.

  “Hey!” Christina shouted.

  The man turned and looked at her.

  The next thing Christina knew, a muscled arm grabbed her from behind and the other covered her mouth. She had forgotten about the second guy. Christina struggled with all her might to free herself. But from the way she was held, these were arms that knew what they were doing. She readied to throw a backward leg kick at her assailant’s groin when she felt the cold metal of the assailant’s gun pressed against her temple. A black town car appeared, and the arms holding her shoved her toward it.

  Christina’s mind raced as she landed in the backseat of the car and the assailant followed her in. It had been foolhardy to tackle this on her own, and now nobody knew she’d been taken.

  As her eyes darted to see if there was some weapon she could use, something hit her at the back of her neck.

  Her world went black.

  CHAPTER FOURTEEN

  “Help me!” Zora’s sister’s hand reached out to her. A black windy force grabbed her sister’s feet and pulled her away. A primal scream erupted from her as she flailed her hands.

  Zora scrambled to move, but her legs were held down. She stretched out her hands to reach for her sister. They came away empty.

  “Help me!” her sister moaned.

  Zora’s heart pounded and she pulled at her legs to release them from what held them down. But she couldn’t move no matter how much she tried.

  Then her sister’s hands slowed their dance as if drained of life. The black wind dragged her, flinging her like a ragged doll.

  Zora’s heart leapt, threatening to erupt. She struggled and jerked against what held her feet.

  “Help me!” her sister whispered. “Help me …” she continued, her voice now hoarse and monotonous. Then her face morphed into Jane Doe.

  Zora jerked awake on the bed. Her heart pounded in her chest, and rivulets of sweat ran down her face. A feeling of foreboding enveloped her. She only dreamt about her sister when something bad was happening in her life.

  It took her a minute to orient herself. She looked around as she took deep breaths. She was in the call room and light streamed in between the curtains. She must have fallen asleep after leaving Jane Doe.

  Jane Doe. Zora scrambled from the bed, put on her slip-on shoes, and raced to the SICU. She reached Jane Doe’s cubicle and rushed in. The bed was empty.

  Zora’s heart picked up its pace. She hurried back to the SICU central station and met a different nurse sorting through some notes.

  “Do you know where Jane Doe is?” Zora asked her.

  “Jane Doe? Give me one second.” The nurse typed into the computer in front of her. Then she lifted her eyes at Zora. “There is no Jane Doe here.”

  Zora’s chest tightened. This couldn’t be happening again.

  “She was the patient in the cubicle on the far right.” Zora pointed to the cubicle.

  The nurse shook her head. “No patient was handed over from that cubicle,” she insisted.

  What the name again? That’s right, Keller. “What about Nurse Keller that was on duty last night?”

  “She’s gone. Her shift is over.”

  “Can you reach her? It’s important. Please.”

  “Let me call her cellphone number.” The nurse pulled out a phone from her pocket and called a number she had saved. The phone went straight to voicemail. She tried again. Same thing.

  Zora swallowed hard and sagged against the counter. Not again. Nurse Keller and Christina had promised her they’d
look after Jane Doe. Christina.

  “What about Christina?” she asked the nurse.

  “Christina who?” The nurse gave her a blank stare. “I just started here last week, and I don’t know her.”

  Zora gripped the edge of the counter tightly.

  She needed to find Christina. Now.

  CHAPTER FIFTEEN

  Zora pulled out her phone to call Christina and saw the missed calls. They were from a few hours ago. Her heart quickened. Maybe it was about Jane Doe. She called Christina’s number. The number went straight to voicemail. Strange.

  Though Christina seemed to have worked an OR call, Zora expected her to be back either at the ER or at home by now. So she called the ER next. The nurse-on-duty stated that Christina had probably left for the day since she wasn’t working the morning shift, but she hadn’t seen her when she left. It was possible she was still in the hospital.

  Making up her mind to go look for Christina herself, Zora hurried down the hallway that led to the ER. She met Stewart on her way in. He was about to leave, his hands in the pockets of his medical coat.

  “Dr. Smyth, is everything okay? You don’t look too good.”

  “I’m looking for Nurse Christina. Have you seen her?”

  “Your roommate, right?” At Zora’s widened eyes, “It’s no secret. Everyone knows. I saw her last night when I came by to pick up something from the hospital. Do you want me to help you look for her?”

  “Could you?”

  “Sure. Why don’t you look for her on this side of the ER and I’ll take the other side?” He gestured to the right.

  “Thank you.” Zora strode down the left side and checked each cubicle. Some cubicles were empty, but most were filled with patients that had been admitted overnight. Christina was not in any of them. She checked the last cubicle and then turned back to the central station. She spoke with the nurses. No one had seen Christina that morning. She had them look up Jane Doe’s records. Nothing. And the nurses had never heard of a Dr. Latam—a different anesthesiologist had been on-call. Zora’s hand tugged her pendant. It was happening all over again. She checked for her operative reports. They were missing too. But this time Zora had been ready; she had printed a copy of her operative report after she had submitted it into the system. They were in her locker in the call room.

  Stewart ran up to meet her. “Did you find her?” he asked. Zora shook her head. “She wasn’t in any of the cubicles. I even asked one of the other nurses to check their break room and the bathroom. She wasn’t there. Are you sure she hasn’t gone home?”

  “She might have. Thanks for helping out. Let me not keep you.”

  Stewart smiled at her. “No worries. Glad I could help. I’ll see you later.” He walked out of the ER.

  Zora walked back into the hallway. Where was Christina? She tried her number again. Pick up, Christina, pick up. It went to voicemail. This was not good. Now, two people were missing—Jane Doe and Christina. Had something bad happened to Christina? Zora fiddled with her pendant and prayed that wasn’t the case. Maybe there was no need to worry yet. She could just be at home sleeping off the call and had switched off her phone. Yes, that was it. There was no way Christina would have disappeared.

  So where was Jane Doe? Zora had no idea where to look next. This was the second missing patient. She could not turn a blind eye to it anymore. Something was going on, and it was time to bring it to the attention of the hospital leadership.

  But she still needed more evidence; the operative reports were not enough. There were three people she had interacted with in regards to Jane Doe—Dr. Graham, Nurse Keller, and the attending who had been on-call. She hadn’t been able to reach Nurse Keller which left two people in the hospital she still needed to talk to. There was no way one of them couldn’t serve as a witness. Her thoughts were preoccupied as she walked down the hallway and by the time she looked up, she had ended up in front of Dr. Edwards’ office. She might as well go in and get his advice.

  Zora knocked on his door and stepped in to see Dr. Edwards staring at a set of CT scan films clipped to the screen on the wall of his office.

  “Zora, what do you think?” Dr. Edwards gestured at the films. He was distinguished-looking with a strong angular jaw, square chin, and greyed temples.

  Zora stepped closer to the screen to examine the films. “Is this for a new patient?”

  “No, a patient I’ve seen a few times in my clinic.”

  Zora’s eyes moved slowly from one film to the next. “Isn’t this pseudomyxoma peritonei?” she asked. She could see indications of voluminous mucinous ascites—the scalloped indentation of the liver and spleen, and the rim-like calcifications with some septation. Her fingers traced the surface of the film.

  “But it could also be peritoneal mucinous carcinomatosis,” Dr. Edwards replied.

  “True. But see,” Zora pointed to an area on the film, “there are no tumor nodules in the peritoneum and there is no invasion of the small bowel. Those are signature effects of peritoneal mucinous carcinomatosis.”

  Dr. Edwards nodded, his eyes twinkling.“So what would you do for this patient?”

  Zora turned to face Dr. Edwards. “It depends on the condition of the patient. My first preference would be a modified cytoreductive surgery, in which you would first debulk the mucinous buildup, then remove the affected tissues, and finally, insert the chemotherapy drugs. Patients not qualified for surgery would receive chemotherapy only, though it may not cure the disease.”

  Dr. Edwards nodded, his face wrinkling into a smile. “Good work, Zora.”

  “This is such a rare case. I’ve never being in a surgery for it.”

  Dr. Edwards laughed. “Okay, okay. I’ll pen you down as a first assist. Happy now?”

  “Yes!” Then Zora’s face morphed into a frown. “I actually came to see you about something else.”

  Zora told him about Jane Doe and how she had disappeared.

  “This is serious.” Dr. Edwards folded his arms over his chest and leaned against his desk.

  “I know. I think it’s time I mentioned it to Dr. Anderson.”

  “Do you have enough evidence?”

  “Well, I have a copy of my operative report.”

  “That’s a good start but I’m not sure it is enough. Getting evidence is what is most important. Remember you need to tread carefully with him. There is no need to rock the boat unnecessarily, I say.”

  “But this is about a patient’s life!” Her outburst shocked her. She ran her hands through her hair as she removed the hair tie. “I’m sorry. It’s just that the patient has sepsis and needs close monitoring. She could die otherwise.”

  Dr. Edwards’ eyes scanned her face through his oval glasses. “Have you spoken to Dr. Graham about it? You said he was the first assist for the surgery.”

  “Not yet. I plan to ask him before the round, though I’m not very optimistic about what he’ll say.”

  “Okay, speak to him. And then try and get any other evidence you can.”

  Zora glanced at her watch. “Speaking of rounds, I need to head out now in order to make it. I’ll talk to you later.”

  Zora felt Dr. Edwards’ eyes on her as she left his office. But she had made up her mind. It didn’t matter at this point what the department chair thought about her. A patient disappearing from the hospital was a big deal and needed to be reported.

  And no one could tell her otherwise.

  Zora met Dr. Graham outside the entrance to the acute care general surgical unit on her way to the round. He was speaking in Russian to someone on the phone. Zora had had a roommate from Russia in college so she recognized the language. Zora shook her head. Unbelievable! Who would have thought that Graham could speak Russian so fluently? Clearly, she didn’t know enough about him after all the years they had worked together. But that wasn’t why she was here waiting for him. Time to refocus.

  She waited for his call to finish and then pulled him to the side before he could enter the surgical unit. />
  “Zora, what is this about?” Dr. Graham brushed off Zora’s hand from his arm like he was swatting a fly and straightened the sleeves of his long white medical coat.

  “Do you remember the patient we operated on last night?”

  The corners of his lips curled downward. “What patient are you talking about? I wasn’t in the hospital last night.”

  If it was possible for Zora’s jaw to drop open to the floor from where she stood it would have. “What are you talking about? You mean you don’t remember Jane Doe?”

  “Zora, this must be some kind of joke. And it’s not funny.” Dr. Graham let out a deep sigh. “Look, the round is going to start in the next five minutes and I cannot stand here listening to this gibberish.” He tugged at his mustache. “Let’s be frank here, Zora. I’ve been hearing odd things about you. And I’m sure I’m not the only one.”

  “What sort of odd things?”

  A sardonic smile filled his face. “You performing surgery on patients that do not exist, asking the medical staff strange questions about patients. Even the junior residents have been whispering behind your back. Don’t you think you need some sort of help? You are giving chief residents a bad name.” He tucked his hands into the pockets of his medical coat. “Go see a therapist before it’s too late.” He shook his head and walked off into the unit.

  Zora tensed and her nostrils flared. She had never really cared for Graham. Now, she thoroughly disliked him. She should have known nothing good could come from talking to him.

  She took a couple of deep breaths. She had a job to do first and her patients were waiting.

  But she would not give up.

  She still had one more person to ask.

  Zora’s mind wandered as the round went on. Luckily, there were other patients apart from hers that the group could focus on. And when she was called upon, she knew enough about her patients to present on autopilot.