The Edge of Death: (Sequel to ADRENALINE)

by John Benedict

  Several folks in OR garb had joined him in the small ICU room. One of the nurses, a woman with a kind face, put a hand on his shoulder. “Is it time already?” Doug asked, turning to look at them. She nodded and gave him a warm smile.

  One of the other OR nurses, more businesslike, said, “Don’t worry, we’ll take good care of her.”

  “I know you will.” Doug wiped his eyes.

  A young man with a Steelers OR cap stepped forward, hand outstretched. “Hi. You must be Mr. Landry. I’m Dr. Novacinski—one of the anesthesia doctors.”

  Doug shook the man’s hand. He looked so young.

  “How’d this all happen?” Novacinski asked as he readied the Ambu bag for transport.

  “Biking accident,” Doug said woodenly, watching them hook up Laura’s EKG and art-line pressure tubing to the transport monitor.

  “You don’t say. I bike a fair amount myself,” Novacinski said. “It’s a jungle out there.”

  Doug was hoping he was at least a third year resident. Please God, not an intern. “Who’s your attending?” he asked.

  Novacinski’s jaw tightened at this. “Zimmerman. But I’ll be taking direct care of her.”

  “Zimmerman’s a good man,” Doug said.

  “Do you know Dr. Zimmerman?”

  “Yes,” Doug said. “I’m on staff here.”

  “Oh.” Novacinski failed to completely hide the surprise in his voice. “What department?”

  “Anesthesia.”

  Novacinski’s face reddened. “Gotta go,” he muttered and started to wheel Laura’s stretcher out of the room. “Mustn’t keep the surgeons waiting.”

  “Wait,” Doug said and grabbed the side rail of the stretcher. He took Laura’s hand and squeezed it gently. “It’ll be okay, Laura. I’ll be right here waiting for you. I love you.”

  Doug could’ve sworn he felt a weak squeeze in return this time, and he thought he saw her eyelids flutter a bit, as well. He felt the burn of new tears as they wheeled her out.

  C H A P T E R 2 5

  Saturday, 8:20 a.m.

  The woman’s vitals were surprisingly stable despite what she had been through recently, Dennis Novacinski observed as he hooked his patient up to all the monitors. He reached for the propofol syringe, then thought better of it. Better use Amidate, he thought. This lady’s pretty sick and just my luck, her husband’s a frickin’ anesthesia attending. He drew up 20 ccs of Amidate.

  “Why are you using that?” asked the nursing student on rotation with him.

  “How about you tell me,” Dennis said, never failing to miss an opportunity to pimp the students. Kind of like his attendings would grill him. “I’ll give you a hint. The generic’s etomidate.” He didn’t want to be too much of a prick with her—she did have a nice ass, after all.

  “Is it a new muscle relaxant?” she asked in her high, squeaky voice.

  “No . . . I’m going to give it first.”

  “A narcotic?”

  “No.” How she ever got into nursing school, he didn’t have a clue.

  “I give up. I never heard of it.”

  “Didn’t you read the chapter in Miller on induction agents?”

  She hit him with her big brown eyes. “I was busy,” she said, and then looked sheepishly at the floor.

  “Look, Miss, uh—”

  “It’s Tara.”

  “Look, Tara, we don’t have a whole lot of time to talk right now. After we get things settled, I’ll try to teach you some stuff. Emerick’s gonna come storming in here any minute, wanting to go.”

  “Emerick?”

  “He’s the ortho attending. You haven’t heard of Emerick?”

  “No, not really.”

  “Well, here’s the skinny.” Dennis glanced around furtively. “Orthopods are basically all cut from the same mold. They’re always in a goddamned hurry and then they’re cranky to boot, because they feel everyone is trying—on purpose, mind you—to slow them down. As if their time is more precious than anyone else’s. Of course, that’s when they even realize there is anyone else. And Emerick’s got a bad case of it.”

  “Great,” Tara said with zero enthusiasm.

  The door flew open, ending their exchange. Dr. Emerick stomped in, his oversize orthopedic wader boots clumping on the floor. “Jesus, Novacinski, put her to sleep, for chrissakes! I’ve been watching you through the window at the scrub sink for the last ten minutes. Quit yakking it up with your lady friend there and get to work. Who’s your attending and where the hell is he?”

  “Zimmerman,” Novacinski said, glancing over at Tara. “But I’m an R3 and can induce on my own.”

  “Well, by all means then, do it. Just hurry the eff up.”

  “Sir, yes sir,” Novacinski fired back with a crisp military salute. He injected the syringe of etomidate into his patient’s IV.

  Thirty minutes later, with Mrs. Landry playing by the book and things proceeding smoothly, Dennis Novacinski started to relax. Time to make good on his promise to teach his nurselet something.

  “So, Tara, what do you think?”

  “Cool,” she said. She was seated on a little metal stool next to Novacinski, who sat on the more comfortable chair at the controls of the anesthesia machine. He noticed her pretty brown eyes again.

  Novacinski stood and offered her his seat. “Want to drive the bus?” he asked.

  “Sure,” she said with glee. “If it’s all right?” she added in a lower voice, shooting a look over the drape toward Emerick.

  “Yeah, it’s fine. Don’t worry, I’ll help you.”

  They switched seats. Emerick seemed preoccupied with the large power drill he was using to ream out the central shaft of Mrs. Landry’s shattered femur. The drill made a horrible racket only to be outdone by the Rover machine as Emerick suctioned the blood pouring out of her bone.

  “Want to squeeze the bag?” Novacinski said.

  “Definitely,” Tara replied.

  Novacinski reached around her to turn off the ventilator control, his arm brushing against her bare arm as he did. He squeezed the two-liter rubber bag a couple of times. “Here, you try.” He guided her hand to the bag.

  She looked up at him. “How hard?”

  “Not too hard,” he said, scooting his stool closer so he was only inches away from her. He put his hand over hers and helped her squeeze the bag. “Just like I was doing.”

  “Like this?”

  “Perfect. I see you have a good gentle touch.”

  Tara giggled but kept squeezing.

  Novacinski reached out with his other hand, so that his arms now encircled her—the patented Novacinski squeeze play, perfected over years of residency with many female nursing students—and pointed to the monitor screen. “Here, you see? You’re breathing for her. That’s the end-tidal CO2 waveform. Every time you relax on the bag, the patient exhales and we get a CO2 wave.”

  “Very cool,” Tara said. “It’s reading thirty-six. Is that good?”

  “Yes, perfect,” he said, sampling the fragrance of her dark hair. “It means you’re squeezing the bag just right.”

  “Thirty-six what?” Tara asked. “No wait—don’t tell me,” she said excitedly. “Centimeters of water, right?”

  “You got it.” No need to correct her and tell her it was millimeters of mercury. What’s a little metric system difference between friends?

  Emerick was now grunting as he hammered a long flexible rod up the proximal end of Mrs. Landry’s busted femur.

  “What’s he doing now?” Tara asked as she stood on her tiptoes to peer over the drape.

  “He’s placing the IM rod—intramedullary rod,” Novacinski said, admiring her tight ass again.

  “Seems like he’s banging it awfully hard,” Tara said.

  “I was thinking the same thing,” Novacinski said, and chuckled. “Well, that’s ortho for you. Hey, are you going to the med student party in the kennels tonight?”

  “Yeah, I think so. Are you—”

  One of Nova
cinski’s alarms rang out, interrupting her.

  “What’s that?” she said.

  The end-tidal CO2 monitor was registering a low value of 25.

  “Am I doing something wrong?” Tara asked nervously.

  “Probably just squeezing the bag a little too much,” Novacinski said. “Let’s put her back on the vent.” Novacinski flipped the appropriate switches and the ventilator came back to life. “There, that should fix it.”

  “It’s now fifteen. Is that better?” she asked.

  “No, of course not,” Novacinski said, nettled. An end-tidal CO2 of 15 was definitely an odd reading. Perplexed, he stood and Tara quickly vacated her seat at the controls. He looked closely at the screen to make sure he wasn’t missing anything. He still had a waveform, it was just markedly reduced. EKG and oxygen saturation still looked normal. But the CO2 now read 10!

  “What’s wrong?” Tara said.

  Novacinski shushed her with one hand and quickly followed the sample line from the patient’s breathing tube that carried the exhaled gasses to his monitor. Sometimes these little tubes got kinked or became disconnected, leading to bogus readings. The sample line looked fine. Shit! The patient’s endo tube also looked fine—again no kinks, secretions, or disconnects. Novacinski heard her pulse rate rising—she was now definitely tachycardic, with a rate of 120 bpm and climbing. Shit again. He cycled the BP monitor, hoping for some sign of stability. Thank God, her O2 sat. was still 100%.

  Novacinski’s mind raced. What could possibly have caused her end-tidal CO2 to drop that fast? He drew a blank. Then it dawned on him—an air embolus. She could easily be sucking air into her bloodstream via her shattered femur. That would lead to a drastic fall in CO2. But his monitor was equipped with a mass spectrometer system as well as infrared gas detection. Novacinski quickly pushed some buttons on the monitor and studied it for the presence of nitrogen in her exhaled gasses—the hallmark of an air embolus. The mass spec read out only the three gasses he was using:

  Oxygen: FiO2—.50

  Nitrous Oxide: FiN20—.42

  Desflurane—. 08

  No nitrogen. This effectively ruled out an air embolus.

  The sat. started to drop. 95%. Novacinski quickly shut off the nitrous, thereby boosting the inspired oxygen to 100%. What was happening?

  He surveyed the operative field. Emerick continued to hammer away viciously at the IM rod and alternately take C-arm x-ray pictures. Blood was spattered everywhere. Novacinski felt a wave of nausea descend upon him. What should he do? BP came back as 85/50. Not horrible, but down significantly from what it had been minutes earlier.

  “Did I do something wrong?” Tara asked, her voice even more high pitched. “I’m sorry.”

  “Not now,” Novacinski snapped at her. “I’m trying to think.”

  “Should we call for help?”

  “Shut up,” he said forcefully. Tara started to cry. Novacinski gave ephedrine to treat the lower BP and turned down the ventilation, then threw in a couple of Hail Marys. He hoped things would turn around soon. He didn’t want to hit the panic button just yet and have all the residents laugh at him in Morbidity and Mortality conference. He cycled the BP machine and watched the sat. monitor intently, hoping against hope for a good sign.

  The oxygen sat. began to drop precipitously.

  C H A P T E R 2 6

  Saturday, 8:45 a.m.

  “So, he called you at home?” Kristin asked.

  “Yes, early this morning,” Chip said.

  “What did he say?”

  “He said that it was vitally important that he talk to us—he used that word, vitally. But he said he didn’t want to get into it on the phone.”

  “How would Mueller even know your number?” she asked.

  “I’m a hospital employee, I guess.” Chip pushed the button for the basement and the elevator door slid shut. “He said he wanted to talk to you too, but didn’t know your name. I told him—hope you don’t mind?”

  “No, no, that’s fine.”

  “Thanks for coming, by the way.”

  “Sure,” she said. “Sorry about the emergency scan.”

  “No problem. It was interesting—especially the MRI stuff.”

  They got off the elevator and headed left, down a narrow corridor, their footsteps echoing loudly on the concrete floor.

  After several minutes, Kristin asked, “You sure this is the way?”

  “Yes. I know it’s in the basement . . . somewhere.”

  “That’s comforting.” She frowned at him. “I didn’t know this place was so big. Or had so many stupid hallways.”

  “Relax, I know where I’m going. I used to pass his lab on the way to the animal research facility.”

  She stopped walking. “Animal research? What were you doing there?”

  “Nothing—just basic grad school stuff.”

  “They don’t have dogs, do they?” Her voice definitely sounded accusatory.

  “Naw, just rats and mice,” he lied. Chip figured he wouldn’t bother to mention that some med students—including himself—practiced surgery on dogs. “Let’s keep going—I think we’re close.”

  “It’s kind of spooky down here,” she said.

  “Well, I don’t want to creep you out, but we just passed the morgue.”

  “Great, thanks for sharing. That accounts for the yucky smell, I guess.”

  “Yep,” Chip said. They walked a bit farther in silence. “And here it is,” he announced, stopping before a glass door stenciled with frosted white letters identifying the room as:

  Postmortem Laboratory

  Director: Gunter Mueller, MD, PhD

  Chip opened the door for her and walked in behind her.

  Dr. Mueller was standing behind what appeared to be his secretary’s desk. He looked up and came around the desk to greet them. “Thanks for meeting me.” He extended his hand.

  After they shook hands and introduced themselves, Mueller ushered them back to his office. “Have a seat,” he said, gesturing to several chairs as he walked behind his desk, which was piled high with books, manila folders, and mail. He didn’t sit, but immediately began to pace.

  Chip pulled up a chair for Kristin, then took his own seat. Mueller kept running his fingers across his bald scalp while pacing, but remained silent.

  “That was a very interesting lecture,” Chip finally said.

  “Thank you.” Mueller stopped and studied them with hazel eyes that danced behind his spectacles. He cleared his throat and started to speak, but abruptly stopped.

  “How can we help you, sir?” Chip asked.

  Mueller walked over to the large bookcase behind his desk, then turned toward them. “I’m told you two were the last to see Chandler—the patient in Room 237—before he . . . uh, before he left the hospital.”

  “Yes, we saw him run out,” Kristin said.

  Mueller stared at them; his eyes appeared larger than normal, magnified by his thick glasses. “Let me be blunt,” he said. “Are you sure he—Chandler—was the one who overpowered and killed that poor nurse? I mean, he was literally on death’s door. His heart was basically ruined and so were his kidneys and lungs.”

  “It was him, all right,” Chip said.

  “Last I saw him,” Mueller said, “the day before the incident, he was unconscious and on full life support.”

  “It was definitely him.” Chip whipped out his phone and started pushing buttons. “I think I might even have a picture.”

  “What?” Kristin asked incredulously. “What are you talking about?”

  “You took it,” Chip said.

  “Huh?” Kristin rolled her chair closer to Chip and leaned over his cell phone. “Let me see that.”

  “Here, look.” Chip held his phone out.

  “Oh, right,” Kristin said, relaxing. “The birthday picture.”

  “Watch. Let me blow it up.” Chip fiddled with the phone some more. “In the background, you can clearly see Room 237. And through the window, you can se
e Heather standing at the bedside. And you can see Chandler sitting up in bed. The resolution’s not that good, but it sure looks like his eyes are open.”

  “That’s amazing,” Kristin said. Chip handed the phone to Mueller.

  “Hmmm,” Mueller said as he studied the picture. “Okay, I see he’s awake. But he still should’ve been weak as a pussycat.”

  “Dr. Mueller, he was far from weak,” Chip said. “He tossed me aside with ease—I’m close to two hundred pounds—and threw me into the countertop. Look at this bruise on my head.”

  Mueller peered over his glasses at Chip’s forehead. He sat back down and ran his hand over his head before continuing. “Look, I couldn’t say this in front of the press—you saw how it went out there. They’re like sharks in the water when they smell blood.”

  “Say what?” Chip asked.

  “This treatment could save thousands, potentially tens of thousands of people every year. People that don’t need to die.” Mueller’s eyes were blazing. He stood again and resumed pacing. “I can’t let them shut me down now. Now that I am so close. You understand.”

  Chip exchanged a worried glance with Kristin.

  Mueller continued. “I had some misgivings about this one—this Chandler.”

  “Misgivings?” Kristin said.

  “No one was ever as far gone as he,” Mueller said.

  “What do you mean?” Chip asked.

  Mueller stopped and fixed them with another intense stare. “He was dead, I tell you. Dead!” He slapped his hands down on his desk.

  Chip began to have a bad feeling about this. “So, shouldn’t you be happy with your technique? I mean, isn’t that the point, to keep people alive?”

  “Yes, yes.” Mueller waved the comment away. “But his EEG and—” Mueller stopped; his brow furrowed, then a pained expression crossed his face.