“Jesus, mimosa, what’s gotten into you? Let the pobrecita go, please! Think of our own little Juanita!”
O’Malley was worried. His catalyst had turned out to be more of a runaway nuclear reaction. There would be a goddamn meltdown if they didn’t control the situation now.
“Grab her, Valdez! Say something to her in Spanish and shut her up! She’ll blow the whole thing open.”
Even as she spoke, O’Malley knew it was too late. Jesus Romero had heard his wife’s unexpected plea. How he’d react was anyone’s guess. O’Malley had to make a move. His mind whirred into high gear as he grabbed the megaphone from Valdez.
“Jesus, your wife Maria is here. She wants to talk to you.” An eternal second passed.
“Man, you get that cochina out of here, or I blow myself up and take the girl with me! Time’s running out, you know man? You got five minutes, then it’s bye-bye!”
O’Malley heard Jessica’s whimper echoing inside the Penguin Building. He’d never even seen the girl, but her pitiful cry triggered an emotional association in his brain and summoned deep feelings of sadness.
Filthy animal. Donald O’Malley, the ultimate professional, tried his best to suppress his simmering emotions. Donald O’Malley, the grandfather, unfortunately could not.
“Jesus, we’ve got the money, but you know we can’t land a plane here.”
“You just deliver what you said, man, or it’s over. You got that?”
Maria broke loose and ran toward the Penguin Building, her fists stabbing the air in defiance. “You son-of-a-bitch, I’m no cochina!”
The men in black fatigues on the rooftops and behind the columns were ready, laser sights trained on the entryway to the building. Goddamn meltdown, thought O’Malley.
To everyone’s astonishment, Jesus appeared in the doorway, his green Parks Department uniform hanging over his corpulent frame like a soggy sheet, drenched with the sweat of the oppressive New York summer and his raging emotions. His beefy arms were wrapped tightly around little Jessica. Between his hands he clasped the grenade. His dark brown eyes danced wildly.
“I told you to get the bitch away from here. Now! Or I pull the pin!”
Maria stopped dead in her tracks, barely ten feet from the doorway. “Dios mio—”
O’Malley saw an opening. “Take him. Now!”
The first shot came from the sharpshooter stationed on the roof of the restaurant. The bullet hit Jesus just above the right brow, blew out the back of his head and splattered bloody fragments of brain tissue on the stone facade of the building behind him.
It was the second shot, though, O’Malley would live to regret. Fired from the Tropic House walkway, the bullet pierced Jesus’ right hand, the index finger of which had been wrapped securely around the grenade pin. The fiery explosion propelled Jessica violently backward. Her head smacked against the brick column by the entrance. Jessica Humphries lay on the cement like a limp ragdoll.
***
The blue and white Airlift Northeast helicopter maneuvered between the trees and landed with a blast of wind on the slate walkway in front of the Penguin Building. Medic Enrique Santos was the first out of the chopper door, followed closely by Rosey Ceravolo. Rick Davidson, the pilot, remained in the cockpit.
Santos and Ceravolo raced up the walkway, Ceravolo dragging the stretcher behind her. Now ten minutes since the explosion, Jessica had been left untouched by the police. Feeling frustrated and impotent, they knew better than to move a patient with serious head and neck injuries. Jessica’s head was cocked obliquely, resting in a pool of blood at the base of the column. Her extremities, no longer limp, had assumed a rigid, mannequin-like attitude, wrists and toes extended downward. Her skin was a pale, waxy yellow, her cheeks and lips drained of life-sustaining blood and oxygen.
The look of death. Santos had seen it all too many times before.
Her little chest heaved ever so slightly, but with great rapidity, as her brainstem automatically directed the muscles of respiration to suck every bit of precious air they could into her lungs. The two medics knelt on either side of Jessica and went to work.
“Pulse 130 and thready, blood pressure 60/palp,” said Ceravolo as she released the Velcro on the undersized blood pressure cuff. “She must be hemorrhaging internally.”
“Good bet she is, but that may be the least of her problems.” Santos removed his flashlight from the red tackle box and gently pried her lids open. “Pupils are mid-dilated, barely reactive. Not a good sign. How are her breath sounds?”
“Okay on the right side, decreased on the left. She may have a collapsed lung. Could be from a rib fracture.” Ceravolo examined the large bruise over the child’s left rib cage.
“Large scalp laceration, but her skull seems all right,” said Santos, carefully wrapping her head with gauze.
Ceravolo started a saline IV and ran it in as fast as it would drip. She got the neck brace and the backboard out of the chopper.
Gently, they lifted their fragile cargo into the compact, high-tech quarters of the helicopter. As the chopper began its ascent, Santos and Ceravolo applied the electrodes that would monitor all of Jessica’s vital signs, including her heart rhythm. Rick momentarily glanced over his shoulder and signaled for them to put on their headsets. There was no other way to communicate easily over the thunderous noise of the helicopter.
“She gonna make it?” he asked.
“Too soon to tell, but her chances are better than they were ten minutes ago,” Ceravolo said.
“Her vitals seem to be stabilizing,” said Santos.
“Looks like you two have things under control. Don’t you think it’s time to call in? Wouldn’t want to piss off the boss on a Sunday night,” said Rick.
“Guess you’re right. I’m sure he’s going nuts waiting to hear from us. Patch us in. Tell him the radio was out for a while,” said Ceravolo.
“You tell him. He’s on the line now,” said Rick. “Good luck.”
“Shit,” muttered the medics in unison.
“What the hell’s been going on? How’s the girl?” boomed the voice of Dr. George Spiros.
“Vitals weak but stable. Probable closed head injury, pupils five millimeters and sluggish. May have a collapsed lung and internal hemorrhaging. This pobrecita has had better days, Dr. Spiros,” Santos said.
“Have you given her any dopamine?”
“No. Just normal saline, as much as her little vein can take. Her pulse is regular at 120, her BP 75 over 35. We’re bagging her at 24 breaths per minute.”
“Ceravolo, you there? I haven’t heard from you today. How’s the girl’s cardiac rhythm?”
“A little fast, but regular.”
“Sounds like we’ll need the neurosurgeons as well as the general surgeons on this one. What about that crazy Parks Department guy? Anything left of him?”
“The coroner’s picking up the pieces,” Santos said.
“Can’t say I’m upset about that. What’s your ETA, Davidson?”
“Two minutes, sir.”
“Good job. But call me sooner next time. See you at the landing pad in two.”
“Roger.”
They breathed a shared sigh of relief, and the helicopter thundered north, flying high above the once- majestic Hudson River.
Enrique Santos, seasoned medic, devout Catholic, and father of five, reached into his pocket, and clutched his rosary beads in one hand, caressed little Jessica’s blood-stained, bandaged forehead with the other. Dios mediante—God willing—you will make it, pobrecita.
Chapter 4
“Nice job assisting in the OR, Karen,” said Geoff. “You’ve really gotten your feet wet in a big way on the first day.”
Geoff looked at his wrist, checked his watch. One-thirty p.m. So much for morning rounds. H
e inserted his ID card into the security panel outside the NSICU. A green “enter” sign illuminated, and with a whoosh, the doors parted.
“Thanks. I really like being in the OR, and it helps to have a good teacher.”
Geoff and Karen entered what amounted to a decompression chamber, where white coats had to be removed and kelly green jumpsuits donned. They cleansed their hands with the disinfectant soap, then put on surgical gloves.
“Ready?” Geoff asked. The door opened and he stepped into the room, Karen following right behind him. The antiseptic aromas of iodine cleanser and surgical adhesive wafted their way, the distinctive scents reassuring, familiar, to Geoff.
“Well, Dr. Davis, I thought you’d never get here,” said Cathy Johannsen, charge nurse of the day shift. Cathy was about thirty-eight, had long white hair pulled back in a pony tail, sparkling blue eyes and a fine, chiseled nose emphasizing her Scandinavian decent. She was a bit too big bottomed for Geoff’s taste, though many of the male residents considered her a knockout. “Cathy, with you in charge, I knew everything would be under control. All I have to do is sign the orders.”
“I wish it were that simple,” she said, “It’s good to have you back, Geoff. I hear you had a long morning.”
“A typical day at the Trauma Center. Good experience for Dr. Choy, here.” He motioned to introduce Karen Choy. “Sorry. Let me introduce you two properly. Cathy Johannsen, Dr. Karen Choy, first year resident.”
The two women shook hands. “Pleasure,” said Cathy. “You’re lucky. You have a great teacher.”
Geoff smiled, cleared his throat. “Where’s the team? We need to be briefed on recent admissions.”
“Over by bed eighteen, the little girl with the head injury,” she said, pointing to the opposite end of the ward.
Geoff looked around the room. It had been a long time. The scene was surreal, not unlike a modern version of Dr. Frankenstein’s laboratory. There were rows of bodies, all ages, shapes, sizes and colors, in various states of consciousness. Most were comatose, having lost control of their bodily functions to machines—machines that did their breathing, filtered their blood, regulated their IV infusions, monitored their core temperature, pulse, and blood pressure. Other machines measured the pressure inside their skulls caused by brain swelling from injuries. Connecting these bodies to each of these machines were tangles of tubes, wires, bolts, and needles protruding from skulls and every natural and man-made orifice imaginable. All of the machines and monitors were linked by cables to a central computer at the nursing station staffed by a team of monitor technicians twenty-four hours a day. No bodily function escaped detection and control.
Except the brain. Brainwaves had been studied for years with the electroencephalogram, and changes in brain pressure could be followed with intracranial pressure monitors, but the physiology of consciousness had remained a great mystery. Until the PET scan. Geoff and Karen drifted toward bed eighteen, where they joined up with the rest of the team.
“Ah, Geoffrey, my friend, good to see you back in the saddle,” Kapinsky said. “We almost gave you both up for lost.” He put his arm around Geoff’s right shoulder.
Geoff stiffened, grabbed Kapinsky’s arm and removed it from his shoulder. “Sore shoulder. Hurt it working out the other day.”
“Sorry, chief. Hey, let me introduce you to your team.”
Introductions were made all around, Geoff analyzing the new group of doctors he’d be responsible for. There were two first year residents: Karen Choy, whom he had already spent half the day with, and Brian Phelps, bearded, intense, humorless, and at thirty-two, older than usual for a first year neurosurgical resident.
Geoff acknowledged the two medical students assigned to the team. Both were women, wide-eyed, uninitiated to a brutal, clinical rotation like neurosurgery. Then there was the gnat, Howard Kapinsky. Short,with thinning, frizzy brown hair, mud brown eyes, a substantial nose, and his perennial, pencil-thin attempt at mustache. Kapinsky, the momma’s boy from Sheepshead Bay.
The rift between Geoff and Kapinsky had developed over the years, Kapinsky envious of Geoff’s strapping good looks, accomplishments and family background, Geoff disgusted with Kapinsky’s servile behavior and endless brown-nosing.
Kapinsky had a photographic memory for minutia and could reference obscure journal articles and list differential diagnoses ad nausea. This behavior was nurtured by the system at an institution like the NYTC, but the bottom line was he was an horrendous surgeon, all thumbs in the operating room, even after six years of surgical training.
It wasn’t as if Geoff hadn’t tried to befriend him early on. Their first year working together Geoff had tried to loosen up Kapinsky’s tight-assed personality, taking him out on the town, to bars and nightclubs, even a foray to Geoff’s favorite Times Square strip joint—The Palomino—a place that would rouse a hard-on even with a eunuch like Kapinsky. But to no avail. For a while, Geoff had wondered if Kapinsky was gay, but he finally wrote him off as just an asexual bookworm with a fudgy nose.
Mark Jackson, the only black in the program, joined them, having finished his note on the patient in bed seventeen. Mark had a sharp mind and excellent surgical skills. He exuded a quiet confidence, not unlike Geoff in the early years of his residency.
“Well, Mark, it doesn’t look as though you got much sleep last night,” Geoff said.
“Sleep? What’s that? I spent yesterday afternoon in the OR with some poor junkie named Jose whose friend shot him in the face, last night with an unfortunate twenty-five year old hang-glider who got in the way of a telephone pole. This little girl with a head injury just came in. The good news is someone else is on call tonight.”
“Tell us about the hang-glider first,” said Geoff. He looked to his right, at the patient next door in bed seventeen. The man was tall, probably about six-two, muscular. A surgical dressing was wrapped around his ribs and upper torso. He had bruises around his eyes, and the lids were swollen shut. Sprouting from the top of his shaved head was a metal bolt with IV tubing connecting to a toaster-size box, on the front of which was a modulating digital readout. “By the looks of things, seems like he’s going to be off to the ward pretty soon.”
The team drifted next door and assembled around the hang-glider in bed seventeen. The medical students raised pens to clipboards, their attention focused on Mark Jackson.
“In a nutshell, John DeFranco is a twenty-five year old man who was in his usual state of good health until yesterday afternoon when he was hang-gliding up in Westchester County and caught a bad wind that sent him crashing into a utility pole. He was taken to Basset Hospital, where he was stabilized, then transferred here for observation. On admission, he was noted to be in a moderately deep coma due to a closed head injury. Amazingly, there was no spinal fracture or any other life-threatening injuries. Just a few broken ribs and a ruptured spleen.”
“What did his admission PET scan show?” asked Geoff.
“Moderate brain edema with a low level of endorphins in the brainstem.” Mark pointed to the intracranial pressure monitor next to the head of the bed. “His ICP has been hovering around fifteen all morning. That’s an improvement from yesterday. All in all, a decent prognosis,” said Mark.
“Then why is he still comatose?” asked Karen Choy.
“We have him snowed in a medically induced coma on phenobarbital to lessen his brain cells’ metabolic rate and need for oxygen. Once we drop the phenobarb level, he should wake up, hopefully by tomorrow.” Mark grasped the metal bolt protruding from the top of the patient’s head between his thumb and forefinger. “Then we can remove this ICP bolt and transfer him to the neuro ward where his rehabilitation can start.”
“Good job, Mark,” said Geoff. “Let’s hear about the new patient in bed eighteen.”
The team members regrouped around the little girl’s bed, Mark holding the
clipboard, Geoff standing next to him near the head of the bed.
“This one’s not so rosy.” Mark cleared his throat. “I’m sure we’ll hear about this on the news tonight, if not sooner. Jessica Humphries, an eight-year-old girl, was in otherwise good health until she was taken hostage earlier today by a lunatic at the Central Park Zoo. He threatened to blow himself and the girl up. The grenade exploded ripping him to shreds—that’s all that remained of the guy according to Suzanne Gibson in pathology—and throwing Jessica twenty feet in the air. Unfortunately, she landed on her head.”
Geoff felt a pang of sadness. He studied the patient carefully. Her face was round and moon like, features swollen and distorted. Dark, bruised lids were taped tightly shut, and her lips were dry and cracked at the corners of her mouth where an airway tube had been taped to one side connecting her to the respirator that controlled her breathing. A patch of her fine, blood-crusted hair had been shaved on top for the ICP bolt, which had been inserted through the hole drilled in her skull, to monitor her intracranial pressure, as with the hang-glider in the next bed.
“What is the extent of her injuries?” asked Karen Choy.
“Her primary problem is the closed head injury,” replied Jackson. “Pupils are mid-position, but sluggishly reactive, eye movements spontaneous. She responds to localized painful stimulation, and over the last few hours seems to be attempting to make some sounds—”
“Sounds? You must be exhausted Mark,” interrupted Kapinsky, “this girl is deeply comatose.”
“What’s her coma scale rating, Mark?” asked Geoff. He fixed his gaze in Kapinsky’s direction.
“Nine out of fifteen, consistent with moderate head injury.”
The Endorphin Conspiracy Page 3