Wendell Black, MD

by Gerald Imber, M. D.

  Contents

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Chapter 28

  Chapter 29

  Chapter 30

  Chapter 31

  Chapter 32

  Chapter 33

  Chapter 34

  Chapter 35

  Chapter 36

  Chapter 37

  Chapter 38

  Chapter 39

  Chapter 40

  Chapter 41

  Chapter 42

  Chapter 43

  Chapter 44

  Chapter 45

  Chapter 46

  Chapter 47

  Chapter 48

  Chapter 49

  Chapter 50

  Chapter 51

  Chapter 52

  Chapter 53

  Chapter 54

  Chapter 55

  Chapter 56

  Epilogue

  Author’s Note

  About the Author

  Copyright

  About the Publisher

  1

  Airline pilots sound like old-time radio announcers over the PA system. This one had a voice near the bottom of the baritone register, with a pleasant cadence and flat regional accent. The kind that didn’t jump out and grab you by the throat. I figured him to be from somewhere west of the Mississippi, and maybe just north of a Southern drawl. He had interrupted the soundtrack of the film with the usual series of annoying pings, and illuminated the seat-belt icon before he spoke. There wasn’t much need to tell passengers to buckle up; anyone with any sense at all had already strapped in. According to the captain, the rough ride was due to temporary clear-air turbulence, whatever that meant. He didn’t sound disturbed. When things got worse ten minutes later, he delivered another bit of pilot balm, which did even less to reassure me. The sky was clear, that was obvious, and an occasional white puff against the endless blue made a beautiful picture when it was possible to focus.

  We had been tossed around for an unpleasant twenty minutes, when the cabin staff was ordered to give up trying to serve lunch and take their seats. It was rough. My Côtes du Rhône would have spilled all over the place if I hadn’t had the common sense to chug it down. I stuffed the empty glass into the seat pocket and made it my business not to glance out the window at the waving and shaking of the flimsy-looking wing. It scared the shit out of me. Other than that, I’m a pretty good flier.

  The physical principle of wind over airfoil generating lift is basic stuff, and I understand it. It all goes back to Bernoulli: air flowing over the convex upper aspect of the wing has farther to go than the air under the wing, so it flows faster, creating lower pressure on top of the wing, higher pressure under it. Enough lift to overcome gravity, and away we go. I also know that the wing box attaching it to the fuselage, as well as the wings themselves, are incredibly over-engineered and wings simply do not come off aircraft. Planes can lose speed in rapid wind shear and stall, but wings don’t come off. I get it. I studied all this stuff in college and I get it, but it still scares the shit out of me.

  A distinguished-looking man in full pilot dress sat across the wide aisle in the business/first section. He was tall and thin, with straight-edge posture, airline-issue black hair streaked with gray, and enough squint lines alongside his eyes to be taken seriously. He was probably deadheading back home or scheduled to pick up a plane in New York. I kept sneaking looks over there as he read quietly through most of the turbulence. Then he tilted back his glass of Coke for the last few sips and put it, and the paperback, into the seat pocket just as I caught his eye.

  “It doesn’t get much worse than this,” he said, in a voice not unlike the captain’s, and not quite smiling. And then it did.

  The 747-400 hit an air pocket and dropped what seemed like a thousand feet, launching all sorts of objects. Plates and drinks hit the overhead, passengers screamed, luggage compartments sprang open, bags and clothing were everywhere, oxygen masks dangled and bounced on their plastic leads, interior panels rattled and shook, and all hell broke loose. Flight attendants held on to seat backs, scrambling hand over hand, and people were mumbling prayers. Then, quick as it started, it stopped.

  Smiles of relief replaced white-lipped terror and most of us were unembarrassed about congratulating ourselves on surviving. Cheering from a group of high school kids in the back of the plane finally made me laugh, and I was starting to settle back and chat with my new friend across the aisle when a new voice came across the PA system.

  “If there is a doctor on board would you please identify yourself.”

  This happens now and again, and much as I would like to hide under my blanket, I do my duty. In-flight emergencies are rarely significant. When they are, I do what little I can until we land; mostly it’s just treating anxiety. I unbuckled and stood and identified myself, feeling a bit self-conscious. But at the end of the day it usually adds up to extra drinks and a lot of attention from the flight attendants. One time I actually got lucky enough to end up with someone nice, and that lasted for a few months. But flight attendants were stewardesses then, and seriously attractive. The one that came up to my seat didn’t do much for me. He was dressed in dark blue trousers, shirt, tie, and vest, none of which contained a single natural fiber. He was about my height, just about six feet, rail-thin and doused with cologne that snapped my head back. With all of that, he was efficient.

  “I’m the purser, are you a medical doctor, sir?”

  “I am.”

  “Can you show me some identification please?”

  Now I was getting annoyed, and I guess he read my glance.

  “We have to be sure you are a physician.”

  I fumbled with the button on my left hip pocket and finally fished out the battered wallet. The New York State Physician ID got an approving glance, but my NYPD card earned a second look I wasn’t comfortable with. Anyway, he was right. There are all sorts of doctors, and there’s no limit to the stupidity and ego of people when it comes to titles. It’s a rare in-flight emergency that requires a PhD in philosophy or a podiatrist.

  “Now you know my secret. What’s the problem?”

  “Could you follow me, please?” He hadn’t answered my question, but I hadn’t expected him to. He knew his job. The heads cranked toward us withdrew in disappointment as we made our way past the over-wing exit to the back of the plane. Other flight attendants were reorganizing the galley, and passengers were rearranging clothing and baggage that had been uprooted. Most eyes were on us, and I could feel the intense scrutiny until we were stopped a dozen rows from the rear by a flight attendant kneeling in the aisle. She was busy adjusting a wet towel on the head of a young woman stretched across three seats with the armrests raised. The scene immediately commanded all my attention.

  “Marjorie, this is the doctor.”

  I smiled at the solid, middle-aged woman when she looked up at me over half-glasses, with obvious relief. Her glasses were secured around her neck on a long gold chain that looped lazily down either side of her neck. It looked like the tasting cup worn by sommeliers in fancy restaurants, and I smiled.

&n
bsp; “Thank you, doctor,” she said, pointing her nose at the woman beneath her. “Just a minute ago she was sobbing and babbling nonsense. Then suddenly she stopped . . . and now she’s quiet, but she doesn’t look so good.”

  That was an understatement.

  “Excuse me.” I eased Marjorie out of the way, lifted the wet towel from the stricken woman’s eyes, and saw a young, pale face with a broad, high forehead, small nose with a wide tip, and flaring cheekbones. Her color was more than pale, a kind of odd, pasty look of pigmented skin gone white. I brought the tips of my right index and long fingers to the middle of her neck, feeling for a carotid pulse. It was there, but it was faint and rapid and irregular. The skin of her neck and cheek was wet with sweat and unhealthily cold to the touch. From habit, I asked where it hurt, but there was no response. I didn’t expect one, but I asked again, this time louder, “Where does it hurt?” She was beyond conversation. There wasn’t enough blood getting to her brain and she was drifting away. Far away. Struggling with the inert weight, I managed to pull her onto the floor and laid her flat in the aisle. The move wasn’t graceful, and she hit the carpet hard. She didn’t seem to care, and it got her into a position where emergency measures were possible. I lifted her chin, turned her head to me, and felt for her breath against my cheek and ear. She was breathing, but her breaths came shallow and rapidly. Not normal, and barely effective enough to keep her alive. What the hell was going on?

  Crewmembers arrived with a small oxygen tank and plastic mask and laid them on the floor beside her. The control wheel on the tank was tight, and I struggled for a few seconds to get the flow started. I put the mask over her mouth and strung the elastic band over her head. She didn’t help at all and occasionally threw her head from side to side.

  The woman looked to be twenty-five, maybe thirty, fairly tall, and dressed like most everyone else around her, in blue jeans and sneakers. She wore a black cotton T-shirt under a zipped sweatshirt. My mind was spinning as I tried to run through the possibilities. Some sort of abdominal crisis: ruptured ovarian cyst, ectopic pregnancy, perforated appendix. What else could make a young woman so sick so quickly? I loosened her belt and pulled the shirts up to touch her abdomen. If my guess was right, her belly would be hard as a board and tender to touch. Laying my hand lightly on her mid-abdomen, I felt that it, too, was soaked in perspiration. I pushed against the muscles. Her belly was soft, and she didn’t respond. I looked into her eyes, hoping to see some sign, but her pupils were closed down to a pinpoint even in the low light of the cabin. She began to shake. Three seconds later, the shudder became a full-blown seizure, and she lost control, throwing her head from side to side, kicking and moving her body oddly and without purpose. In twenty seconds it was over. I reached for her face to see if any damage had been done just as she began to vomit up clear liquid and bile. Instinctively, I pulled away. She made no effort to clean herself and I began to wipe her face with a wad of cocktail napkins someone had handed me. I felt moisture through the knees of my pants as she lost control of her bladder. I looked at her face, and in that instant her wide eyes went blank and she died.

  Airlines now carry automated defibrillators that are easy to use and have saved many lives. There was one on the floor beside us. Marjorie had already anticipated the need. She held the two big electrode pads, ready to pass them to me, and activated the unit. There was little doubt in my mind about whether our patient was dead or alive, but experience had taught differently. The machine would determine whether there was a dangerous irregular rhythm that wouldn’t circulate blood or a normal condition that demanded to be left alone. It was better than any doctor’s finger on the pulse, and I welcomed the help.

  I struggled to get the woman’s arms out of the sweatshirt, which I managed with Marjorie’s help; then I pulled her T-shirt up to her neck and Marjorie unhooked the clasp on the front of the white lace bra, which looked unusually feminine and out of place with the rest of her clothing. All this couldn’t have taken more than fifteen seconds. There was still time. I attached the electrodes according to the diagram clearly printed on the back of each pad. It didn’t call for precision. One went below the lower right chest, the other high on the left chest. A computerized voice from the machine instructed what a half-blind person could easily see, but I guess that was the purpose. The point was to keep cool and do it right. Thirty seconds had passed. The AED told us to stand away from the patient, which we did. It computed the information it was receiving and diagnosed no cardiac activity. She had straight-lined. The defibrillator advised SHOCK. We stood away from the patient and I pushed the SHOCK button, as instructed. The jolt and the patient movement shouldn’t have surprised me, but I reacted like the others and jumped back. The machine failed to restart her heart. I shocked her again, and again, and again. We were getting nowhere. Every year the ACLS guidelines seem to change. The rule is external cardiac massage right from the start. Artificial respiration has been abandoned. That had been the worst part of trying to help. Mouth-to-mouth contact with someone from God knows where, with God knows what disease, who had recently vomited, strains the will to serve. We had the oxygen and now a breathing bag, and I gave her a few breaths before handing it off to Marjorie as I straddled the patient, preparing for external massage. Almost two minutes. There was still time to save her.

  When I settled on my knees and started to position my hands at the bottom of her sternum, I noticed strips of adhesive dressing under both breasts. I hadn’t registered the flesh-colored tape before, but there were matching wounds or, more accurately, matching dressings under both breasts. I set the heels of my hands and started massage. Fifteen pumps and I signaled Marjorie to squeeze the oxygen bag; then I started the cycle again. I was sure the woman beneath me had had recent breast implants and I made every effort to avoid them, though in all likelihood it wasn’t going to matter if my body weight crushed them or not.

  Three more tries at jump-starting her heart failed, and after nearly thirty minutes of massage and artificial respiration she was more obviously dead than when we started. Time to accept the ugly reality. I nodded and mouthed a sad “no” to the young flight attendant who had replaced Marjorie, vigorously pumping the breathing bag, and she seemed to sag. Her heavy makeup was a mess and I noticed for the first time that she had been quietly weeping during our futile exercise. I felt like crying myself. Sitting up and stretching before attempting to straighten my knees, I stared at the firm, round breasts and the skin that seemed enflamed, particularly against the dead pallor around them. I got up slowly, thinking, but the information didn’t compute. Nothing made sense. Still staring at her breasts, I pulled the T-shirt down to cover her and got to my feet. I had no idea what the people around me were saying, but they seemed to be offering condolences. I must have looked like I lost the big fight. I guess I had.

  The captain, or first officer, I don’t know which, then took control of the situation and the passengers were ordered back to their seats. I don’t remember walking the aisle, but there I was, strapped in the seat with a large glass of scotch in my hand. My knees were shaking, and my shirt felt uncomfortably wet in the cool air. I turned off the overhead ventilation duct, pulled the blanket around my chest, and took a sip of whiskey. The whole thing was weird. But I had no idea how weird.

  2

  The flight from Heathrow was overbooked, as it usually is around the weekend, and the prospect of a body in the aisle didn’t exactly thrill the passengers. The crew had covered and moved her to the tail between the lavatories, but the thin blankets could not hide the outline of a body, and the sight of feet frozen in a V position was disturbing. Passengers were divided between those whose eyes were locked forward to erase evidence of a life having been dramatically lost, and those who kept glancing back over their shoulders at the motionless mound under the blue blankets. For my part, I was too far forward to have to make that decision, and I tried to put the whole episode out of my mind by quickly sipping down what had to be four ounces of pretty goo
d Scotch whiskey. The captain and the crew were my new best friends, and after listening to the guy in uniform across the aisle I knew more than I wanted to about airline procedures for on-board deaths. Probably the single fact of this conversation that will stay with me is that only Singapore Airlines has a corpse cabinet built into their planes; otherwise, it’s the aisle, a seat, or the head.

  Since the woman in question was already dead, there was no cause for diverting the flight, and we arrived at JFK on time. An EMS team met the plane and rushed down the aisle, further disrupting an already disorderly disembarkation. It seemed an unnecessary exercise, since I had officially declared the woman dead and released the crew from further action or diverting. But those are the rules.

  I stayed back, identified myself, and answered the few questions they asked. There didn’t seem to be much else to do, so I waited for my bags with everyone else on VS045. A good number of my fellow passengers made their way over to me with a comment or question, and I could feel the sense of community that the shared tragedy brought on. It does that to people, brings the humanity out. I was among the last stragglers around the carousel in terminal 4 by the time my black Tumi bag finally slipped down the chute. I upended it, grabbed the handle, and hefted it over the metal lip. The red, white, and blue ribbons on the grip made it distinctive enough, but I snuck a look at the name tag before making my way to the customs inspectors. I chose the line being inspected by a very attractive, slim black woman with a lively bit of attitude in her body language. I always choose the women, and they are invariably the most difficult. This time it was more than a pass-through, but not difficult.

  “How long have you been out of the country?”

  “Four days.”

  “Have you been anywhere other than England?”

  “No.”

  “You only spent ninety dollars?”

  “No. I made a ninety-dollar purchase. I spent a lot more than that.”

  That made her smile. “Right. I’ll have to look through your bag.”

  I didn’t really care, although all the dirty underwear and soiled shirts weren’t going to make a good impression. “Have a go. The purchase is right on top in the DR Roberts bag. It’s a shaving brush.” I watched while she rummaged through my things with her gloved hands. She looked at my new shaving brush, tossed it back into the bag, signed my declaration, and said, “Welcome home.” Apparently, the intelligence grapevine wasn’t concerned with the story of the deceased.