Jack and Claire slowly ambled toward them. Introductions were made. Jack learned that Kate’s parents, Bill and Barbara, were farmers and that Amelia, Kate’s middle sister, was a soccer enthusiast and player. She was quite an accomplished defender. The younger sister, Maggie, soon joined Nick and the other small kids in play. The group spoke awhile and then disbanded, Kate and her family going in a different direction.
Jack noticed Nai Trepur approach. “Gud morneeng, everybody,” he said, announcing his arrival.
“Hello, Nai. Let’s get a cheeseburger. I’m hungry,” said Jack, walking toward the grills. The group followed as Nai greeted the others.
“Did you play soccer in France, Nai?” asked Jack after swallowing a bite of his cheeseburger.
“I never played,” said Nai.
“A Frenchman who never played soccer? No way!” said Jack.
“Come on, honey. We can talk about something other than soccer, can’t we?” asked Claire.
“Speaking of significant others, where’s that boyfriend of yours, Shelley?” said Kate, trying to change the subject.
“Oh, he couldn’t come. He’s tied up at work,” said the young secretary.
“You haven’t told me anything about him yet. Do tell. When can we meet him?” said Lori.
“I don’t know. Sometime soon.”
“Bring him in to work. We all want to meet him,” said Kate.
“I will,” said Shelley.
“What’s the schedule like on Monday, Dr. Norris?” asked Kate.
“Frank and I are performing an ablation. Right, Frank? Are you ready for it?”
“I’m ready, Dr. Norris. I’ve been reading up on it. I’m all keyed up,” he said.
“That’s all he’s talked about the last couple of days. I think he’s a bit nervous about it,” said Kate.
“Don’t be nervous, Frank. I’ve got you covered,” said Jack, with a smile. As he spoke, the smile on his face faded, and wrinkles appeared on his forehead. In the distance, he saw a figure standing by a tree, looking in the direction of the group. Between the sun in his eyes and the distance between them, Jack couldn’t be certain as to the identity of the man.
“Hey, who’s that man over there in the shade?” he asked of the group, temporarily taking his eyes off the figure.
“Where?” asked Nai and then Claire, all looking in the direction Jack was spying.
“I can’t see him any longer. He was there a second ago,” said Jack, perplexed.
“Probably some guy wishing he was here eating one of these delicious burgers,” said Frank. Jack continued to look in the vicinity of his mysterious visions.
“He’s gone now. You may be right,” said Jack.
• • •
Behind a large group of trees, Lance Lantz hid from view. He was thin and tall and in his midtwenties. He was a true believer in love at first sight. Ever since he met Nurse Kate, as he called her, he became irreversibly hooked. She was all he could think about. Her eyes were enchanting, and he would not live without her. Unbeknownst to Kate and the whole world, he had acquired a large collection of pictures of her, taken by him clandestinely. This compilation was Lance’s most precious possession. He was hoping to add several images to his collection today. Kate’s photographs were prominently displayed on a corkboard in his apartment. She would become his, no matter what. He would find a way to win her hand.
From a distance today, he realized that Kate Fanning had become engaged to Dr. Frank Hanes. This drove a dagger through his heart and drained color from his face. He climbed up a large oak tree and sat back on a branch about eight feet off the ground. From that vantage point, Lance removed his camera from its pouch and attached the long zoom lens. He photographed Kate multiple times, concentrating on her awesome face and sparkling eyes. As the click-click-click sound resonated softly and repeatedly, rivulets of tears flowed down his face.
“You will be mine, Nurse Kate,” he promised himself, sobbing. “One day, you will belong to me.”
• • •
The BBQ party turned out to become the much-needed gathering Jack needed. Rejoicing in the goodness of his family and coworkers again began to erase his horrible reminiscences of the events of yesteryear that so plagued him even now.
The group ate, played, and conversed until it was time to go home. Nick and Trinity were exhausted, and bedtime tonight came without much fanfare. Jack and Claire, completely worn out, too, sat on the couch in front of the TV, winding down after such an exciting day.
“Who knew?” said Jack.
“Who knew what?” said Claire, intrigued.
“A Frenchman who doesn’t love soccer.” Jack was hit on the head with a pillow from the couch. “Thanks, I needed that,” he said, grabbing the pillow and placing it under his head, augmenting his comfort. “That’s better. Much better.”
“I did notice the whites of his eyes have a yellowish tinge, just like you said,” said Claire.
“Did you notice the scars?” said Jack.
“No. What scars?”
“There are four scars on his abdomen. I saw them when we were playing basketball.”
“I didn’t notice any scars. What are they from?”
“Who knows? They’re probably knife wounds. They’re thin, like puncture marks. They must be battle wounds,” said Jack.
“He was in the French Secret Police or something like that, wasn’t he?”
“Yeah. Something like that.”
“Vat else deed you noteece about Monsieur Nai Trepur?” asked Claire, imitating his French accent.
“He’s got tiny scars on his face, too,” said Jack, disregarding Claire’s attempt at humor. “Those are hard to see. He must have been in a bunch of fights during his lifetime.”
“What I noticed most of all today was how much Frank and Kate are in love. They make a great couple.” Claire sat back in the sofa next to Jack.
“Yeah! They do seem happy. Like us,” said Jack, placing his arm behind her neck. Claire smiled, agreeing. They kissed.
“This party really helped me today,” said Jack. “I’ve been thinking a lot about the Rat Poison ordeal. Having nightmares. Today, seeing normal, good, kind people at play helped me put things into perspective.” He nodded as he thought this over.
“Do you think Simon Lagrange will be back for revenge?” said Claire, her smile fading into a frown.
“I don’t know. I just don’t know!”
CHAPTER 6
Jack and the cardiology fellows were about to start ward rounds. The young doctors gathered the patient charts on an ambulatory chart rack, consulting a list of patient names as they went. The group walked toward room 801.
“We were consulted on this sixty-two-year-old woman who has a diagnosis of multiple personality disorder,” said Gary Lewis, a young doctor in training. “I spoke with her a few minutes ago. Right now, her name is Sarah. When she’s Sarah, she is pretty normal, including a heart rate that ranges from high sixties to low eighties at rest. When she’s Nanette, she becomes agitated and anxious, and her heart rate is in the thirties and forties. She feels faint and weak. So, in short, Nanette needs a permanent pacemaker, but Sarah does not. Sarah does not want a pacemaker, since she doesn’t need one. Nanette does need one but won’t consent because she’s crazy. What should we do?”
“We’ll need to talk to her psychiatrist about who and how we should get consent from for the pacemaker implantation surgery. Do you think the slow heart rate is the cause of the multiple personalities or a result of it?” asked Jack.
“Good question,” said Gary. “I don’t know.”
“I guess if we put in a pacemaker and Nanette never comes back, the multiple personalities were caused by the slow heart rate, maybe due to decreased blood flow to her brain,” said Jack. “This is an interesting case. Let’s talk to her psychiatrist.�
�� Gary nodded his head and left to make the call.
“I’m next,” said Archana Desai.” The beautiful long-haired East Indian woman gathered her notes and began her case presentation. “This is a seventy-year-old woman with chest pains and atrial fibrillation…”
The young doctor’s words continued but became increasingly distant and undecipherable and then were interrupted by the clatter of a man running in their direction from the elevator located on the opposite side of the corridor. He looked like the new janitor. Hispanic. Mysterious. Malevolent. The guy was wild eyed and crazed. He yelled something unintelligible. The man removed a small unidentifiable instrument from his pocket as he approached the group of doctors. He attempted to spray its contents into Jack’s nose.
From behind, Nai Trepur stepped in, quickly disarming the untamed beast of a man. Nai kicked the spraying device from the man’s hand, causing it to slide several feet down the hall. Nai and the intruder faced each other, ready to engage in hand-to-hand battle. As this posturing progressed, the Hispanic man pulled out a knife. Nai remained calm and alert. The man advanced, rapidly sinking the knife into Nai’s chest. Blood spurted out of the wound. The man located the spray device, picked it up, and swiftly directed its deadly mist of molecules toward Jack. Instantaneously, Jack felt the stinging sensation down his respiratory tree. With this came an uncontrollable feeling of confusion and terror. Jack started to perspire and breathe deeply and rapidly.
“Rat Poison. Not again!” yelled Jack, reliving the horrid sensation of three years back. His heart hammered loudly and forcibly inside his rib cage. Jack grabbed the trespasser with both hands and threw him against a nearby wall. The man fell on the tile, unconscious. Jack then turned to the students, feelings of rage beginning to percolate inside his being. He had a strong yearning for blood and annihilation. Insurmountable desires within him compelled him to destroy all those young men and women. Jack, the strength of ten men sustaining him, effortlessly snatched the assailant’s knife now embedded deep in Nai Trepur’s corpse. Armed and dangerous, with acid running through his veins, Jack advanced toward the terrified group of innocent doctors and students, prepared to cut and squish them to death one by one.
• • •
It was then that Jack took a deep breath and sat up in bed. He perspired profusely as he looked at his hands, his mind still muddled in tangles. The commotion woke Claire up. She turned on the bedside light and looked at Jack. He was sitting in bed, short of breath and dazed.
“You had another nightmare, honey. You’re OK.” Claire hugged Jack, helping ease him into reality. Little by little, Jack’s mind began to accept the ephemeral, strange phenomenon.
“Another nightmare. I’m OK,” Jack told himself, his breathing less erratic now. His heartbeat was becoming gentler and less hurried. “When will this be over? Why can’t I shake this?”
Claire hugged him tightly, though she remained quiet. How she wished she could give him a firm answer. The truth was he probably would never be able to shake it. The two sat in silence for a long moment.
“Maybe, when Lagrange is brought to justice,” said Jack, breaking the stillness of the night. Claire remained wordless, supporting him with her presence.
“We’ll get through this, Jack. Together, we’ll conquer this,” she finally said.
CHAPTER 7
Bad nights were fewer and fewer now but still striking unpredictably.
It was Monday morning. Jack was assigned to the electrophysiology laboratory, and today, he was doing an ablation.
“Watch and learn, grasshopper,” he said as they began. Dr. Frank Hanes was at his side. Vijay and Tracy, the EP lab nurses, had administered sedation, and the patient lay comfortably on the table in the center of the room. Jack inserted long tubes, or catheters, first into the right femoral vein in the groin and then up the vena cava, the largest vein in the body, guiding them into the right atrium and ventricle. In no time, Mrs. Ana Janheri’s cardiac electrical system was hooked up to the lab’s computer. Different electrical structures displayed different signatures on the computer. These were analyzed for timing and shape. Frank took it all in, understanding most of it but not all. Some of it would have to come in time. Jack promptly induced the rapid heartbeat disorder as he pushed different buttons on the electrical stimulator.
“This is the clinical tachycardia,” he informed Frank. “The morphology is identical to the rapid heartbeat she had when she visited the emergency department last month.” The doctors analyzed the tracing. Frank nodded.
“This is what we thought she had, AV node reentry. I’m going to map it in the triangle of Koch,” Jack said.
“I read about it this weekend. This is cool,” said Frank in astonishment.
“Follow what I’m doing on the fluoro screen and on the mapping display,” said Jack. Frank complied.
After several applications of cryo to the appropriate area, the rapid heartbeat could no longer be induced. A freezing burn had been delivered in the area that previously short-circuited Ana’s electrical system. She was now cured, forever rid of this problem.
“This is cool,” repeated Frank in awe. “Thanks for letting me watch. May I come back sometime?”
“Of course, grasshopper. As many times as you’d like,” said Jack, removing his surgical gloves and snapping them into the garbage can. “Thanks, Vijay and Tracy. I’m going to talk to her family.” The two doctors exited the lab, finished the paperwork in the dictation area, and walked out to the waiting suite in search of the patient’s relatives.
“I’m assigned to the outpatient office. I should have been there ten minutes ago. I’ll see you there later today,” said Frank as he ran ahead to the clinic.
Jack had a few stops to make first. He was due at the office but not for another twenty minutes. He walked toward room 309 to speak with a patient he had seen earlier and whom he promised he’d visit later in the day. While walking there, he passed a door labeled Security. He had noticed this area before but had never entered to see what was beyond the entryway. He welcomed a chance to rethank Nai for his help with the inebriated man in the outpatient clinic a few days earlier.
He crossed the threshold to find a small waiting area. No one was around. Another door was ajar. A sign on it announced Nai Trepur, Director of Security. He knocked. No answer. He pushed the door open and entered the director’s office. There was a desk with a computer and many plaques on the walls.
Impressive, reflected Jack, admiring the wall decorations as they told the story of Nai Trepur, the retired French law enforcer. He walked around to the plaques and stopped at the computer. Internet Explorer was on. The Internet address tabs were familiar to Jack: www.FlightAware.com on one and www.FltPlan.com on the other. These were websites often used by pilots. The first allowed tracking of flights; the second permitted pilots to check the weather and file information with the FAA.
Jack’s beeper went off loudly, its display showing the phone number of the office, followed by 911, acknowledging that the need for his presence was urgent.
“Gotta go,” said Jack to no one as he departed the area briskly. He soon arrived at the outpatient clinic. The place was like a zoo. That is to say, everything was normal.
“Can I present this patient to you, Dr. Norris?” asked Gary, who had just exited one of the clinic rooms.
“Sure, Gary. Did you page me nine-one-one?”
“Yeah, that was me. This sixty-four-year-old woman moved here from Ohio recently. She called the office on Friday to be evaluated for several episodes of fainting. She was seeing a cardiologist in Ohio for a while, but since she was stable, only her family practitioner followed her up. She had a heart attack two and a half years ago. She had atrial fibrillation and was put on quinidine. She is also on digoxin and Lasix. A week ago she went on a family hike and soon thereafter started herself on over-the-counter Advil for muscle aches. She’s been having dizzy spells an
d increasing shortness of breath with activities. On Thursday last week, she fainted unexpectedly. On Friday, she fainted again and three more times over the weekend.”
“What are your thoughts? What do you plan on doing for her?” asked Jack.
“When she arrived here, I put her on the monitor.” Gary paused for a moment, searching the stack of papers in the chart for the rhythm strips he had collected. “I don’t like her meds. Quinidine is not a good idea in a patient with known coronary artery disease. She’s on Lasix without potassium or magnesium supplementation. I’d like to stop all these drugs and get some blood work and a stress test to evaluate her heart function. Ah, here it is.” He handed Jack a strip showing the patient’s heart rhythm.
“No question,” said Jack, looking through the graph. “She should be on a statin, aspirin, ACE inhibitor, and beta-blocker. I don’t think quinidine is a stellar idea for her, either. What do you think of this?”
“This lady is lucky to be alive. These are runs of torsades.” Gary appeared apprehensive and distraught.
“Runs of what?” asked Samantha Shuman, a medical student passing by who overheard the exchange between the two doctors.
“Torsades de pointes,” said Gary. “This is a sometimes deadly heartbeat disorder. In this situation, it is iatrogenic.”
“Ia whata?” she inquired, even more puzzled.
“Iatrogenic. That means her medications are causing it.” Drs. Frank Hanes and Maria Butler, along with several nurses and medical students, had arrived and were now listening in. The tone was tense, attracting medical passersby.
“Let’s go talk to your patient.” Both doctors and their growing entourage entered the room. Mrs. Josephine Winterman looked uneasy and troubled.
“You didn’t know you were going to be a pop quiz today, did you?” asked Jack to put her at ease. “I’m Dr. Norris, one of the cardiology attendings.” He extended his right hand, and she shook it with a forced smile. “Your fainting spells are due to a rapid heartbeat. This can be dangerous, but we’re going to take care of it for you. We’ll need to put you in the hospital right away.”
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