by JA Schneider
“What’s a Glock 26?”
“It’s a lightweight nine millimeter, semi auto. Len’s talked to me about it.”
“Oh. It’s a gun. Is there a Glock 27?”
“Yeah, but it’s heavier. The twenty-six is good to carry on ankles. Len was wearing one in the O.R. You didn’t see it?”
“No.”
“Good. He doesn’t like it being noticed.”
Jill looked at him.
David hesitated. “Violence in hospitals happens, especially in E.R.s. When Len was in Houston a resident got shot, killed.”
Jill’s heart dropped.
David took her hand. Both their hands were cold.
“Let’s go,” he said. “If we don’t get some sleep, Psycho won’t have to worry about killing us.”
26
Before leaving the floor they checked on Kassie again. Her body temperature was still normal, antibiotics dripped at full force into her hand vein, but David fretted.
“The C&S won’t be back for twelve hours or more,” he said. “The bacteria may be resistant, start to party, cause fever.”
He had given his best guess about which antibiotic to use. In the bacteriology lab the Culture and Sensitivity was testing twelve different antibiotics to find out which of them - if any - would work against the suspected organism. His worry was that peritonitis can be caused by many different organisms, and be deadly.
Walking back to the on call room, Jill said quietly, “Kassie’s the only one who knows the rapist. Who could identify him.”
David nodded, said nothing in that way of his that meant he was probably thinking the same thing. He had his arm around Jill. They turned a darkened corner. Ahead was bed, but more pieces of the day’s jumbled puzzle began slipping into place.
Jill said, “When I saw Trey Raphael with Kassie today? He was taping her with a patient holding her twins. You should have seen him arranging them all grandly, like…a movie director. Was even too damn loud saying, ‘annnd action,’…‘annnd cut!’ – she imitated – like he was filming The Titanic or something. Kassie was so co-operative. When he was done is when they joshed and he patted her behind. It was odd, like he was thanking her for helping him indulge his grand Hollywood delusion.”
David shook his head. “Let the cops do their investigating. Kassie’s a bit of a flirt, in a sweet way, I mean. I’ve seen her flirt with Mackey…with Ganon, even.”
“Ganon?”
“Believe it or not. I think he likes her - as much as he can like anyone. She’s…worshipful with him. He eats it up.”
Jill grimaced, trying to picture it. Then thought of something else. “At that kids’ party, the guy Walker mentioned Raphael’s website of arty erotic photos. Called the photos he has online his ‘kosher’ stuff. Do we still have Raphael’s card?”
“It’s on the desk.”
They locked and chained the on call room door, found the card, and sprawled on the bed exploring TreyRaphael.com.
“Whoa,” Jill breathed, tapping keys, switching from one photo to the next. David leaned his head on her shoulder, solemn.
Model-type, long-legged women in artsy black and white, naked in erotic, contortionist poses and barely covered by…
…boas. Feather boas.
“Feathers,” David said low.
“Pretty little feathers…” Feeling chilled, Jill peered closely at the screen, the boa’s feathers in black and white. “Think they were pink?” she wondered aloud. Her breathing had speeded up again. “Pink’s a popular color for boas.” She studied a second photo a bit longer, then clicked to the next one: a long-haired blond lying on her back with her legs wide apart, a much bigger-feathered boa barely covering her shaved crotch.
“This is the kosher stuff?” David muttered.
“That’s what Walker said.” Jill blinked hard, studying the photo. Her eyes stung with fatigue. “The model’s face is angled away like Kassie’s was,” she said tightly. “And…this boa’s different. Could those be ostrich feathers?”
“They’re bigger.” David peered closer. “That first rape…an exotic mask with big feathers, which presumably can be dyed any color. Very interesting. This artiste likes feathers.”
They wrote a quick email, linked Trey Raphael’s site, and sent it to the cops.
David was drooping, rubbing his brow, his eyes.
But Jill was stoked. Frightened but stoked with newly thudding heart. As long as they were online, she switched to YouTube. There they were, the FREAKY! photos sneaked that awful night in the museum attic of the fetus in his cylinder. Different usernames had posted different pictures, some from yards away, some closer, all from different angles.
Jill clicked and brought her face close to each photo, squinting. “Look at this, they’re all too dark to see his feet. Because the attic was semi-dark. The photos came out murky and you can’t see his teeny feet in them. Psycho would have to have been there.”
David was up and pulling off his scrub top. “That covers a lot of people. After they got us out people kept running in.”
“Trey Raphael could have been among them. He’s full-time in the hospital’s P.R. office.”
A long sigh, closer to a grunt. “Cops need more than naked models and feather boas, Jill. C’mon, bed.”
Still in her scrubs, still reading, she put her head on the pillow. “Oh, you should see the Comments under the photos: ‘Awesome! Painless new way to have a kid;’ and, ‘Asshole, you want a Frankenstein baby?’ and, ‘Do we still get to fuck?’ and, ‘Bet none of you shitheads ever heard of Brave New World-‘”
“Bed, Jill.”
David had crawled under the light blanket. She undressed and climbed in with him, melting into him, resting her head on his shoulder. He started to conk out right away. She couldn’t make her mind stop.
She rolled onto her back again.
“What rage Raphael must feel,” she breathed softly. “From Soho hot artiste to P.R. flunky.”
David pulled her back to him. “It’s 1:15,” he whispered with half-asleep patience. “We’re on call. A delivery could come in any minute. An hour’s sleep…would be nice.” His whisper fell into deep breathing.
Jill tried hard to unwind. Inhaled, and closed her eyes.
Opened them again. Heard again Brand say, We’re nowhere.
And Pappas: He’ll attack again soon. You’re his real targets.
And Len Akers in Houston…a resident got shot, killed.
She felt it coming, like a hot, wet balloon inside her chest getting bigger, and then she raised her hands to her face and started to cry, hating herself because she caught herself praying…selfishly! Please God, help Kassie Doyle survive, because only she can I.D. the Psycho. He’s hurt others, he’s coming for us…
David’s heavy breathing finally lulled her, and after a while she was back in Kassie’s ICU room. Pink boas floated over and around Kassie’s bed, swirling in time to the beeping heart monitor. BEEP! BEEP BEEP! They danced, and one boa wrapped itself like a floaty, feathery snake around Kassie’s IV tube, winding, pulling it out. “Wouldn’t have helped anyway,” laughed the high, silvery voice of another boa. “They’re using the wrong antibiotic.” Jill ran through dark hallways to find the right antibiotic, then turned over and burrowed closer to David. Now she and Tricia were at a CVS buying Mace, with Tricia saying “I’ll blast anybody who looks at you cross-eyed,” so that made her feel a little better, especially when David hugged her in his sleep.
They were lucky. Their phones never beeped and they weren’t called.
Their alarm still went off five hours later.
Buck Loki painted. It helped his fury, his getting-worse depression. Looking at her in his computer didn’t work anymore. And seeing her hot SHOT boyfriend made him crazier than ever, worse out of control. It was their fault tonight had gone badly!
He had done Kassie, but they had him so freaked that he’d lost it, hadn’t found what he was looking for. There’d been…someone coming up the sta
irs! Stopping outside her door, listening - he was sure of it!
He had stilled every muscle, scarcely breathing, until the steps walked away. Nosy neighbor? No! It must have been someone they sent to thwart him, who would call the cops. Keep him from finding the last thread that could save him – not that he could still ever forgive them. For destroying his life? His BIG dream? No, there’d be no penance for that.
He raged, he raged, and painted faster. Stabbed his brush into bright red and painted the dummy’s cheeks, widened the mouth into a leering grin that even scared him a little. Oooh, yes, scary, this wooden head no longer but – a brother to Loki! A brother to his beloved, shape-shifting, killer Norse god who could transform himself into a fly or a snake or an old woman or…this!
And a wooden face who was coming alive. The dark, wary eyes now looking at him, locking gazes with him, the smirk widening…
“Er, too much rouge,” the dummy said. “You make me look like a girl.”
“Okay, I’ll fix it.” Buck wiped off some of the acrylic paint, dipped a different brush into another dab on his board, and painted back in flesh color.
“That’s better,” the dummy snorted. “Now fix my mouth. You’ve made it too wide. And about this broken tooth, don’t you think that’s going too far? I look creepy enough.”
“I’ll fix it, I’ll fix it.”
The painted dark eyes watched him working, moving brushes from his palette on the table back to the face.
“Surprised I talked to you?”
“No.”
“Because I’ve been talking to you, right? I’m your goddamn manager. You’ve been hearing me telepathically, right?”
“Right.”
“But you didn’t listen. I said you were going at this too fast. I also said you didn’t need them dead. Just move on, you’ve got what it takes-“
“No. The whole world would find out.” Buck gritted his teeth and plowed his brush through more color. “I’m screwed so they’re dead, almost, just a few hours. I hate them so goddamn much. They have everything. Everyone loves them.”
The puppet sighed dramatically. “Come on. You can be charming too. And you could change your name.”
“Wouldn’t work. Everybody would find out.”
An exasperated sigh. “You really are seriously nuts. A split personality getting worse. You realize that, don’t you?”
“Bullshit. I’m in control.”
“Yeah, until you’re not in control – and then you go to pieces.” The dark eyes scowled. “So? You disagree? You got nothing to say to that?”
Stubborn silence. The brushes dipped, dug, changed colors, fixed smears.
“Okay, I’ll stick to neutral subjects. Such as, I adore your red wig.”
“Thanks. You’ll have one to match.”
“Gasp! You’re kidding! A red wig on a clown? Such a cliché! And don’t tell me I have to wear big biker goggles like yours.”
“No. The light hurts my eyes.”
More silence. The painted, wary eyes watched the brushes work. “The bedroom door is locked?”
“Yes.”
“No one’s gonna come tapping and bug ya? Say, ‘What are you doing? Up at this hour?’”
“No one’s coming. The door’s locked.”
“Hurry up. This is getting boring.”
“I am hurrying. Tomorrow night’s the night.”
“I still don’t think you’re gonna get away with it.”
“My plan is perfect. The guilty must pay. Tomorrow night, all three of them. Maybe more, but them first.”
27
A call to the floor nurse at 6:45 confirmed David’s fears. Kassie Doyle’s temperature had started to spike. At five a.m., a night nurse noted Kassie’s fever at 102. Now, less than two hours later, her temp was 103.
He had chosen the wrong antibiotic.
Would any antibiotic work?
Next he called the bacteriology lab. “One of them seems to be starting,” said the lab tech, “I can’t be sure...”
A quick call to Sam MacIntyre to lead rounds, and David practically pulled Jill out of the shower. “We’re going up to Bacteriology.”
Minutes later they were running into the lab next to the Pathology Department.
On one of the long slate counters, between microscopes, test tube racks, and stacks of agar plates, sat a small, square incubator. Pulling on latex gloves, David opened it and removed two labeled agar plates, each about five inches in diameter. He peered through the two glass lids as Jill pulled on gloves too.
“Growing, dammit,” he said. “Bacteria on steroids.”
Last night, swabs had been taken from Kassie Doyle’s vaginal lacerations, and smeared back and forth across both plates’ red, nutrient-for-bacteria agar. Then twelve different, marked antibiotic pills had been dropped onto the smears, six in each plate. They’d been covered and incubated, and the bacteria in the swabs had…partied; grown into spreading, bumpy colonies to the edge of the plates. Amoxicillin, doxycycline, and about ten different cephalosporins…every one of them, a useless little pill just sitting in the middle of spreading, pale yellow bacteria.
With one exception.
Around one little pill was a barely visible, clear red agar ring. Jill started to peer down at it, pointing, excited.
David pulled her back. “Masks,” he said.
They both pulled up their surgical masks from around their necks. Then looked closely. The moistened pill was killing bacteria closest to it; the clear red ring around it seemed already to have enlarged.
Jill checked its label. “One of the cephalosporins!”
“Right, cefepime. The only one.”
He turned away, pulled his mask down, and phoned one of the OB floor nurses to change Kassie’s antibiotic, stat. “Cefepime,” he said tightly. “Two grams, IV, every twelve hours.”
Jill was thrilled and doing a little boogie. “It works! It works!”
David’s mask went back up. “Now we gotta find what bug it’s working on.”
With his naked eyes he examined the color, shape, and size of the bacterial colonies: they looked like tiny mushroom caps, each a quarter inch in diameter. “Weird,” he muttered; then used a wire loop to spread a swab on a glass slide, which he examined under a microscope.
“Damned if I know. They look like crowded, yellow mini-hotdogs.”
Jill asked one of the lab techs to come over. The woman’s mask went on and she peered into the ‘scope.
“Whoa,” she said, jerking her head back. “It’s Pseudomonas aeruginosa. Really nasty.”
David and Jill traded looks. Pseudomonas?
Dreaded by hospitals almost as much as resistant staph. Causes lung infections.
David’s cell phone went off.
Pappas. He’d received their email about Trey Raphael. “Interesting,” he said. “Raphael also has a rap sheet for drugs. Sale and possession.”
“Here’s something else.” David paced excitedly. “Your rapist might be coughing.”
Surprised silence at the other end. “Coughing?”
“Check every hospital for males with a cough and early signs of pneumonia. Tell them too to be sure to get the culture report.”
“Culture report…?” More silence; Pappas was probably writing. “How would a cough connect with rape?”
“He may have coughed on his condom. Or on his hands when he put it on.”
Seconds passed, then: “Wow. This is something.” Pappas said he’d start contacting hospitals immediately.
“It can take three or four days to develop,” David said, pacing, “but this guy may already be on day two. Not symptomatic but contagious on day one, last night, when he raped Kassie.”
It took another few seconds to spell Pseudomonas aeruginosa; then Jill and David hurried out.
28
They caught up with the end of rounds - happy, healthy new moms in OB - then led everyone back down the long hall to Kassie’s room in Gyn.
MacIntyre
had saved that visit for David to teach. “I wouldn’t know how,” he said. Jim Holloway, also there, bandaged, and insisting he felt fine, said the same. It was a big group: the interns, plus first and second year residents and med students including Evan Blair, looking more exhausted than usual. Peritonitis caused by super nasty Pseudomonas was an extreme rarity in Ob/Gyn, and young doctors had to learn.
Entering, they tried not to gape at the young cop, stationed just outside Kassie’s room for her safety.
She was sedated, and looked deathly pale in her blue hospital gown. She had two IVs going, one into each hand. A beeping monitor near the head of the bed had three busy readouts showing heart rate, respiratory rate, and blood pressure.
Jill anxiously pulled on gloves and took Kassie’s hand. It was deathly limp.
“Okay, update,” David said solemnly, checking Kassie’s temperature on the chart at the bottom of the bed. “Patient is now 103.4, not good, but the antibiotic was just changed minutes ago.” He walked past Tricia and Gary Phipps to the head of the bed, glancing briefly at Kassie’s monitor. “This bug’s resistant to most antibiotics. Out of twelve tries we found that only cefepime, one of the cephalosporins, seems to work.”
He hesitated, exhaling. “Fingers crossed.”
Fingers softly typed “cefepime” into their notebooks. Evan Blair came awake and rather showily helped another med student with the spelling.
Jill lowered Kassie’s sheet to her hips.
“Jeez, more red letters?” Gary Phipps said, grimacing.
“Like Elaine Wheeler,” someone else said.
Tricia and Sam stared open-mouthed at the scrawled red letters on Kassie’s belly. It was HI J this time, not HI D like on Lainey Wheeler, and they understood. Stunned, they switched their gazes to Jill.
Barely breathing, she laid her gloved hands lightly on Kassie’s belly, and looked questioningly to David.
He nodded, watching her.
Very gently, she pressed on the area.
Even sedated, Kassie moaned in pain.
“Inflamed peritoneum,” David said, looking back to the group. “Exquisitely painful.”