by Lyle, D. P.
“Which brings up a question,” Evan said. “About costumes.”
Good grief.
“What costumes?” Nathan asked.
“I couldn’t decide what to be,” Evan said. “What do you think?”
Nathan eyed him. “Maybe a banker or a silversmith. Or I think a bookkeeper would be perfect.”
“Why does everyone keep saying that? Is it because I’m an accountant?”
“No,” Nathan said. “It’s because you look smart. Bookish.”
“You think so?” Evan asked. “Not like a superspy?”
Nathan studied Evan for a minute and then shook his head. “I’d go with bookkeeper.”
One of the workers walked up. “Mr. Zimmer, should we go ahead and move the piano?”
“Sure.”
The man nodded, and he and three of his coworkers began rolling the huge Steinway out of the room.
“It’s beautiful,” Evan said.
“It was a gift,” Todd said. “From Van Cliburn.”
“The Van Cliburn?”
Nathan shrugged. “A guy I did business with—actually a guy who invested with me—was a friend of Mr. Cliburn’s. I offered him some free advice. On a couple of investments. It worked out. This was his thanks.” Nathan waved a hand toward the piano.
“Do you play?” Evan asked.
“When I was younger. Too busy now.”
“Which is unfortunate,” Todd said. “He’s very good.”
“Maybe at one time, but not so much now.”
“Isn’t it like riding a bicycle?” Evan asked. “Once you know how to do it you can do it forever?”
“Perhaps, but that doesn’t qualify you for the Tour de France. The piano is the same way. I can still play, just not at the level I would like.”
Divya returned with the restocked crash kit just as two of the workers appeared with a lounge chair. Divya and I hooked Jimmy up to our portable cardiac monitor and then settled him on the chair. Four workers carried him and his makeshift stretcher to the helicopter pad, a hundred yards away. The copter’s rotors were spinning, the pilot busy with his instruments. We loaded Jimmy through the side door.
The helicopter was large and plush. The passenger area probably held a dozen people. A row of dark brown leather captain’s seats stretched along one side and a matching bench seat along the other. We set the stretcher on the bench and strapped it in with a pair of the seat belts. Divya rechecked Jimmy’s blood pressure while I adjusted his IV.
“Blood pressure is still good,” Divya said.
“How’s the discomfort?” I asked.
“Better.”
“You guys ready?” the pilot asked.
“Yeah.”
We buckled ourselves into a pair of the captain’s chairs and held on as the copter jerked skyward. I looked out the window toward Nathan, Todd, and Evan, who stood watching, each shielding his eyes from the rotor blast. They rapidly shrank as the copter nosed up, turned out over the ocean, gained more altitude, and whipped around, aiming for Hamptons Heritage.
Nathan was right. His copter was fast. Very fast. It seemed to take only a minute to gain altitude and reach cruising speed.
We learned that the pilot’s name was Vinnie Conner. Call sign Con-Man. A former marine copter pilot who had seen duty in both Iraq and Afghanistan.
“This baby’s a Sikorsky S-seventy-six. Top of the line. She’ll do about one-seventy. We should be there in no time.”
I watched the terrain whip by below. Once we settled into straight-line flight I unbuckled my belt and reexamined Jimmy. He was lethargic and poorly responsive to my questions. His pupils were small and poorly reactive from the morphine. His blood pressure was now low. Too low. Seventy over forty.
Divya mixed up a Dobutamine drip and I plugged it into his IV.
“Jimmy? Look at me.”
His eyes fluttered open and he looked toward the ceiling, unfocused.
“Jimmy?”
He jerked in a deep breath and then his gaze landed on me. “Doc? How am I doing?”
“Blood pressure’s up to one-oh-five,” Divya said.
“Better. Just hang in there, Jimmy. We’ll be at the hospital shortly.”
“Never been in a helicopter before,” Jimmy said. “Wish I could see out the window.”
I laughed. “Maybe next time.”
“ETA is four minutes,” Vinnie said. “They’ll have a crew waiting on the roof for us.”
“You sound like you’ve done this before,” I said.
“After the Marines, I flew a medevac copter for a while. Out on the West Coast. That’s what I was doing when Nathan hired me.”
“You like this better?”
“Who wouldn’t? This Sikorsky is a great rig, Nathan is an easy boss, and the pay is off the charts. Not to mention some pretty nice digs.”
“I take it you live on the property?” Divya asked.
“One of the guesthouses is part of the deal.” He raised a hand and then spoke into the mouthpiece of his headset. “Three minutes. We’re passing over the freeway right now.” He listened a beat and then, “Roger that.”
“Roger that,” Jimmy said and then he laughed.
Morphine is a great drug. It’ll make you giddy in even the direst of situations.
The freeway, packed with traffic, slid by beneath us. Good thing we took the air route. Wouldn’t want to be sitting in that. The copter now began to rock and bounce.
Turning his head toward us, Vinnie said, “There’s always a bit of wind with these rooftop landings.”
“Roger that,” Jimmy said and giggled again. “Roger that, Roger.”
“You guys might want to make sure he’s secure and then buckle up again. It can get a little rough.”
We did. It was.
The copter pitched and yawed, but Vinnie handled it like a master. My heart not so well. It seemed to take refuge in my throat. Finally I felt the runners contact the roof and the engine drop to idle. I realized I’d been holding my breath and exhaled loudly. Through the window three men and a woman, each wearing dark blue surgical scrubs beneath white coats, ran toward us, a stretcher in tow.
When I stepped out of the copter, I saw that one of the white-coated men was Dr. Lloyd Baransky, Hamptons Heritage’s best cardiovascular surgeon.
The other two men moved Jimmy from the lounge chair to a real stretcher, the woman holding the IV bag in one hand and our cardiac monitor in the other. They headed toward the entry door.
Dr. Baransky, Divya, and I followed.
“I understand it’s an aortic dissection?” Baransky asked.
I went through the story with him as we followed the stretcher into the pre-op holding area.
“Let’s get a CBC, SMA Twenty, PT, PTT, and type and cross for eight units stat,” Baransky said. “EKG and chest X-ray, too.”
The nurses transferred Jimmy to a bed and switched his leads over to their monitor. Divya took our portable unit and set it on the floor beside our crash kit.
I removed my laptop from my bag and popped it open. “Here’s the X-ray we took twenty-five minutes ago.” The image appeared on the screen.
Baransky slipped on a pair of half-glasses and studied it. His brow furrowed. “Based on the mediastinal shadow, it looks like a Type One. Guess that rules out an endovascular approach.”
Aortic dissections—tears and rips in the aorta—are of three basic classifications. Type 2 involves the part just above the heart, the ascending aorta; Type 3 the descending aorta, the part past where the left subclavian artery branches off and heads toward the arm. Type 1 involves everything. The ascending, the descending, and most important, the aortic arch, the loop in the chest where the carotid arteries that supply blood to the brain come off. By f
ar the most dangerous of the three types.
Endovascular treatment is the placing of a stent in the aorta to repair the tear. Perfect for Type 3 dissections and those involving the abdominal aorta. Not useful for the Type 1 that Jimmy Sutter had. He needed to be opened up. Soon.
“Somebody want to tell me what’s going on?” Jimmy asked.
While blood was drawn, X-rays and an EKG taken, that’s what Baransky did, even drawing a diagram on the back of Jimmy’s medical chart to help explain what had happened and what needed to be done.
“Sounds serious,” Jimmy said.
“Very,” I said. “But you’re in the right place. Dr. Baransky and his team will fix this.”
“I owe you, Doc.”
“You just get better. I’m going to call your wife again and let her know we’re here and that you’re heading for the operating room.”
“I know she’s freaked out. Tell her to take her time if she’s going to drive here.”
“Will do.”
Chapter 7
With Jimmy Sutter off to the OR, Divya and I headed down to the ER. It was quiet and calm, with only a handful of patients and neither of the major trauma rooms occupied. I remembered days like this from when I ran an ER. Moments like this, when you actually had time to think, were treasured gifts to any ER physician or nurse. Moments when you weren’t so swamped with the injured and the ill that sitting down and reflecting was actually possible. Moments when you weren’t jumping from crisis to crisis, catastrophe to catastrophe, barely finding time to breathe. These moments never lasted long, but they were always a welcome respite.
We each made a few calls, one of mine to Jimmy’s wife. I told her Jimmy was on his way to surgery and that Dr. Baransky would talk with her as soon as he finished.
“How long does this type of surgery take?” she asked.
“Hours,” I said. “Could be five or six or could be twelve.”
“Twelve? Is it that serious?”
“Very. It’s a complex surgery and takes time.”
“Is he going to be okay?”
“He’s in good hands. He’ll do just fine.”
I left it at that. I didn’t want to tell her that the mortality associated with this type of dissection was not a small number. She didn’t need to hear that right now. She needed comforting. She needed not to panic. After she promised to take her time driving over, I hung up.
Finally, Evan arrived in the HankMed van. Divya and I dropped him at Shadow Pond and headed out to do the follow-up visits we had delayed due to Jimmy’s emergency.
Divya and I made it back to Shadow Pond just before six p.m. Divya packed up our computers and went inside while I restocked the emergency kit from the supplies in the back of the HankMed van. Just as I closed the rear and clicked the lock, Jill pulled up. I held her car door and she stepped out, purse over her shoulder, bottle of wine in her hand.
“I was hoping you’d make it back in time for dinner,” she said. “How’s your patient doing?”
“He’s in surgery. It’ll be a long one so I don’t expect to hear anything until very late tonight or more likely tomorrow.”
“I heard Dr. Baransky is doing the surgery.”
“That’s right.”
“He’s one of the best, so it should go well.”
“As well as this type of surgery can go.”
“A bad one?”
“The worst. Any aortic dissection is tricky, but the one Jimmy Sutter has is at the high end of tricky.”
Jill’s gaze settled beyond my right shoulder. I turned to see Boris’s Bentley moving up the drive toward where we stood.
Jill and Boris had at one time had a strained relationship. Boris had given a very generous donation to Jill’s community clinic. An anonymous donation. Something the very private Boris Kuester von Jurgens-Ratenicz takes seriously. Jill had mistakenly leaked his name in an attempt to garner more donors and word filtered to Boris. He felt Jill had betrayed his trust, which of course she had. She apologized, Boris accepted, and now all was back in balance.
Dieter parked next to the HankMed van and Boris climbed from the backseat.
“How is your patient doing?” he asked me.
It never failed to amaze me how Boris seemed to know things. Like he had a fly on every wall in the Hamptons. Who knows, maybe he did.
“You heard about that,” I said, more a statement than a question.
He shrugged.
“He’s in surgery, so we’ll see.”
He turned to Jill. “And you, Miss Casey? I imagine you’re quite busy with your health fair preparations, no?”
“There’s a lot to do.”
“And your fund-raising? Has it gone well?”
“Very. We’re ahead of our goal.”
“Excellent.” He hesitated for a beat. “Perhaps I could help? If it isn’t too late.”
“It’s never too late for donations.” She stopped suddenly, eyes wide. “I’m sorry. I assumed that’s what you meant?”
Boris gave a curt nod. “That’s exactly what I meant. I’ll have Dieter bring a check around.”
“That’s very kind of you.”
“Anonymous, no?”
“You can count on it.”
“I do.” He nodded toward the bottle of wine. “And perhaps a second bottle of wine.”
“That’s not necessary,” I said.
He casually waved a hand. “Something that will go with the excellent meal Evan is preparing.”
Boris nodded again, turned, and walked toward the front door. Dieter gave a half bow and followed.
I watched them go while wondering how Boris could know what Evan was making. If he did, that is. But if he didn’t, how would he know which wine to select?
Boris the enigma.
Even I didn’t know what Evan had planned. I wasn’t sure Evan did. I think more often than not he simply opened the fridge and threw together whatever was in there. Usually not much. But somehow he always seemed to make it work.
My brother the chef.
“What was that all about?” Jill asked.
“I guess he wants us to have an expensive wine with our dinner.”
“Not that. I was talking about his offer to donate money to the health fair.”
“It’s just Boris being Boris,” I said. “You know he’s always giving money in situations like this.”
“I know. But I didn’t ask him for money.”
“Maybe Evan did.”
“Maybe. Anyway it’s very generous of him to offer.”
“Like I said, Boris being Boris.”
“Have you talked to Boris recently?” I asked Evan as I walked into the kitchen.
Evan stood at the stove, spoon in his hand, wearing a dark green apron that said KISS THE COOK in white lettering.
“No. Why?”
“He just offered Jill a donation for the fair and I thought maybe you had talked with him about it.”
“Nope.”
“So how did he know we were gathering donations?” Jill asked.
“Because Boris knows everything,” Evan said.
I shrugged. “It does seem that way.”
“He’d make a good spy,” Evan said. “Like me.”
I let the editorial comment slide and said, “Maybe Boris is a spy.”
Evan stopped and stared at me. “You think so? That would be so cool.” He looked at Divya. “Make a note to ask him.”
“I think not,” Divya said.
“Why not?”
“Because what Boris is or isn’t is none of your concern.”
“But us spies have to stick together.”
My brother’s delusions know no bounds. I started to point that out b
ut instead said, “I think most real spies don’t advertise the fact that they’re spies.”
“Unlike you,” Divya said to Evan.
Evan shook his head but somehow managed to stifle any retort.
Jill placed the wine on the table. “What are you making? It smells delicious.”
Evan ran through the menu.
While Divya and I were seeing our follow-ups, Evan had finally settled on what to cook for dinner. He had apparently gotten the 1776 theme in his head and decided to make a Williamsburg dinner.
I couldn’t help but think part of his culinary decision was a remnant of the trip we had taken to Williamsburg when we were kids. Evan had been fascinated with all the workshops—the blacksmith, the tailor, and the glassblowers, but mostly the bread makers. We had stayed in a small off-the-beaten-path bed-and-breakfast with our dad and had dinner at one of the colonial taverns. That was where Evan was introduced to Sally Lunn bread. He obsessed about that for at least a year.
So tonight he decided to make roast chicken breast, apple-and-cranberry cornbread stuffing, stewed apples, and of course Sally Lunn bread. The aroma of the baking bread made my stomach growl.
“I think I like this new domestic side of you,” I said to Evan.
“What domestic side? Just because I like to cook?”
Jill opened the wine and poured four glasses. She asked Evan if she could help, but he said he had everything under control, so she, Divya, and I sat at the counter and watched him finish things up.
“I got a brief break today and went by a cool costume shop,” Jill said. “They have some pretty amazing stuff.”
“Any bookkeeper outfits?” I asked.
Evan turned, glared at me, and then returned to stirring the pot of simmering apples.
Jill laughed. “Didn’t see any of those. But I did like their highwayman outfits. That might be pretty cool for us.” She looked at me.
“Maybe that would be better for Evan,” Divya said. “After all, he’s the money man.”
Evan turned and looked at her. “Somehow I don’t see the CFO of HankMed dressed as a highwayman. It might send the wrong message.”