First Do No Harm

by L Jan Eira

  “What do you think we should offer the patient?” questioned Jack.

  “CRT with ICD backup,” answered the young doctor at the podium.

  “Will you explain what that means?”

  “Cardiac resynchronization therapy, or CRT, also called bi-ventricular pacing, is a procedure whereby we pace the right and left ventricles to force both sides of the heart to contract simultaneously. Because of an electrical delay, this patient’s heart becomes inefficient. Instead of a coordinated contraction, the heart wobbles back and forth. CRT will correct this and make the heart more efficient. This has shown to improve quality of life by reducing CHF symptoms and hospitalizations.”

  “Very good explanation. What about the ICD backup you talked about?” inquired Jack.

  “Because his LVEF is less than thirty-five percent despite optimized medical therapy, he is at high risk for sudden cardiac arrest. An ICD or implantable cardioverter defibrillator, is a device that can be implanted to shock rescue the patient to normal rhythm if he should experience a lethal rapid heartbeat called ventricular fibrillation.”

  “Excellent. Does anyone have any questions for Dr. Hahn?” asked Jack, looking around the room.

  “Is that two devices? One for CRT and another for ICD,” asked Peter.

  “No, one device will have both,” answered Howard.

  “Okay, let’s round on him later today, see how he’s progressing and talk to him about a bi-ventricular ICD. Let’s discuss another case, Howard. How about Pennington?” proposed Jack looking at the form containing all the cardiac admissions of the previous night. Howard looked through the records on the platform in front of him and pulled out the folder labeled ‘Randall Pennington’. After a short recess to review the data, Howard presented the information. At the same time, Mark replaced the electrocardiogram transparency with the new patient’s.

  “Mr. Pennington is a forty-five-year-old man with recurrent symptomatic palpitations. He presented to the emergency department yesterday evening with rapid regular tachycardia.”

  Jack visualized the middle-aged man complaining of the racing heart. As he did, Howard’s voice became drowned in his thoughts. Abruptly, Jack beheld Rupert driving his 745 Li BMW, a bullet from nowhere hitting him squarely in his chest. Blood spurted out draining the doctor of his life essence, the car out of control crashing into a tree. More blood now soaked his entire body, although the spurting had become a trickle, as the soul of the man hastened into the beyond. Ambulance sirens grew increasingly loud culminating in a deafening cacophony of tuneless detonations. The scene gradually became that of an operating room where Jack, sterilely gloved and gowned, operated on Rupert, helped by John Connor and Heather McCormick. Rupert floundered helplessly on the operating table, like a fish out of water. Straps and restrains secured the man to the surgical slab. A scalpel in one hand, a stiletto in the other, Jack prepared to send Rupert to the after-life. John and Heather held the old doctor down with all their might, empowering Jack to precisely and skillfully perform the deadly feat. With a grin, Jack raised both his hands high in the air, to gather momentum in his effort to plunge the sharp objects deep into Rupert’s carcass, finishing off that which the car crash had merely instigated.

  “Jack, do you agree?” a distant faint voice penetrated the grotesquely and outlandish daydream.

  “Jack. Are you all right?” asked Chris, the medical student sitting next to Jack. These words yanked Jack back into reality.

  “Yes, I’m fine,” whispered Jack guilefully.

  “Do you agree, Jack?” asked Howard for the third time still puzzled with the tracing projected on the large screen.

  “It’s AV node reentry,” responded Jack confidently merely five seconds after visually analyzing the rhythm strip. Jack was trembling, a cold sweat easily visible on his forehead.

  “That’s what I thought,” agreed Howard, clueless to the outward physical signs displayed by Jack.

  “Taylor, give us a brief report on this type of arrhythmia tomorrow, okay?” asked Jack, feeling somewhat better and trying to show a business-as-usual attitude.

  “Sure, no problem,” said Taylor.

  Morning Report was over. The pack ambled out of Meeting Room 3 and separated into groups. Those assigned to Jack followed him up the stairs.

  “We’re happy to have you back, Jack,” said Jill Jeffries, a medical resident.

  The group of doctors and students followed Jack. The others conversed amongst themselves. Someone described an event; something funny about a TV program from the evening before. They talked and laughed. Jack was not listening. Deep inside, he was fearful that the sudden tragic loss of his friends was affecting him more profoundly than he had imagined. He was having vivid daydream nightmares. He was distracted. He was unfocused.

  “Maybe it’s time to take this seriously and get shrunk,” thought Jack. Getting shrunk was Jack’s usual comments when he thought the patient needed a shrink. A psychiatrist. A psychologist. Claire was right. He was going to need serious professional help. There was no denying it.

  The group reached the sixth floor medical unit, the main place cardiac patients would be hospitalized. The group would start rounds there.

  *****

  4:32 PM

  Jack was worried. He was worried that his professional work was being affected by the murders. The daydreams of horror persisted and he wanted them to go away completely. He vowed to discuss the issue with Claire and seek her help. It was clear the dreadfulness of it all was not over for him, psychologically. He was also confident that his best way to cope with the situation was to help catch the mastermind behind it all. Rupert was most definitely involved. No question of it in Jack’s mind. Now, he was dead. He was conveniently murdered. Who would gain from it?

  Jack had taken time to catch up with the piling up work at his office. He reviewed laboratory results, signed previously given verbal orders and patient files, dictated patient histories and discharge summaries that had been neglected due to a busy case load and labored over the on call schedule for the doctors in training.

  Keeping his mind busy was marvelous. It kept the Boogie Man away. It was time to go home.

  The car ride was peaceful, chill time. Cars were moving rather well, although the peak hour of heavy traffic was still to come. The phone rang.

  “Jack, it’s Herb.”

  “Hi, Herb. What’s up?”

  “I did what you told me. I’ve been researching and watching detective Mike Ganz. You may have something with your suspicions. I think Mike has been giving us bad information. You know how he called us yesterday to tell us that he found out Rupert was the owner of the mysterious gun used to commit the heinous crimes at Memorial Hospital?”

  “Yeah,” said Jack perplexedly.

  “That’s the thing, Jack. We’ve been looking for where the gun came from. We all thought the gun was the key to the whole case. Mike volunteered to do a check of the FBI database and told us we didn’t need to do our own check here locally. He told us repeatedly that the gun was not reported on the database. He finally discovers that Rupert purchased the weapon and calls us to tell us that the moment the poor slob shows up dead. How opportune. I went behind his back and found out he never checked at all. Also, he comes to the morning meetings everyday except for the day Rupert ends up dead.”

  “What are you going to do now?

  “I’ll talk to Susan first thing in the morning. I will interrogate Mike and see what he has to say. First, I want to gather as much evidence as possible. And Jack, thank you.”

  “No problem.”

  “Did I tell you that Rupert’s home here in Evansville was ransacked?” asked Herb.

  “No, I wonder why?”

  “I don’t know yet. The neighbors reported suspicious men at the house. On their arrival, the police officers found it totally rummaged.”

  “I wonder what they were looking for?” asked Jack rhetorically.

  “Don’t know. Jack, please do not talk to
anybody about any of this for your own protection. I think whoever is behind all this is dangerous.” He hung up the phone.

  Jack glanced at his rearview mirror. He spotted the black sedan again a few cars behind him. Unsurprisingly, despite great efforts, Jack could not see who the driver was. Jack accelerated. The sedan followed suit. Jack suddenly turned hard right, almost recklessly. The sedan mimicked the turn. As the cars sped down the highway passing all other vehicles, a road sign gave Jack an idea. It read Evansville Airport. Jack pulled out his Treo and dialed.

  The race continued with the mysterious vehicle closely behind Jack’s car. The covert driver of the sedan was obviously a pro at this, pursuing with impeccable precision and timing. Despite best efforts, however, the distance between the two automobiles increased little by little. As he approached the airport, Jack spied a police car parked on the side of the road. Jack contemplated stopping and reporting his pursuer, but then thought better of it. There was no wrong doing yet, nor would he actually be able to prove he was being followed, although that was clear to Jack. He would persist with his plan. A traffic light turned red as Jack crossed the intersection. The dark car, now two cars behind, would be forced to stop, especially with the cop car nearby. Waiting for the light to turn green for what seemed to be an eternity, the man was able to see Jack turn left. A sign pointing in that direction, read Evansville Airport.

  After several more minutes of street racing, the sedan arrived at the airport’s parking lot and parked briskly without any delay. Jack’s car was in one of the stalls. The mysterious man immediately got out of the sedan and ran towards the gate leading to the tarmac. As he did, the Bonanza slowly gathered velocity as it sped down the runway. In a few heartbeats, the airplane was airborne. The landing gear retracted as the aircraft disappeared into the beautiful blue sky.

  Dispirited, the unknown man stood looking skyward for a long moment.

  “Shit. Damn it!” he exclaimed in disappointment. The man made a cellular call, as he furiously walked back to his car. He opened up the trunk of the parked vehicle, removed a round object and carried it towards Jack’s car. All the while, he appeared steaming mad. He got on his knees next to Jack’s auto and attached the small round object to the undercarriage of the vehicle. He performed this task seamlessly in a matter of seconds. Before finishing the job, the stranger looked in all directions underneath the parked vehicles. Satisfied that no shoes were discernible near his location, he stood up inconspicuously looking in all directions through his dark sunglasses. Seeing no one in sight, he proceeded to his sedan.

  Behind a parked truck, Jack kneeled down on the large protruding bumper crouching down to avoid detection. In a few heartbeats, the stranger entered his car and sped out of the parking area.

  “I owe you one, Steve,” murmured Jack to no one in particular, as he got on his feet and searched for his mobile phone.

  *****

  7:53 PM

  Several parked vehicles crowded the parking lot. Additionally, two patrol cars, one unmarked police car and one Crime Scene Investigation van loitered about displaying a myriad of flashing emergency lights resembling a kaleidoscope from afar.

  Claire arrived, her speeding car rushing into the area. She stopped the vehicle, put it in park and rushed to Jack’s arms.

  “Are you okay, baby?” she asked anxiously.

  “I’m fine. The police are investigating the object. They removed it from under the car. It appears to be some sort of tracking device. They are now getting pictures, fingerprints and so forth. But, I’m okay.” Jack reassured and calmed her with his composed tone. Claire took a cleansing deep breath. How good it felt to be in Jack’s protective arms. As they hugged, Claire regained her sense of tranquility.

  Herb, Susan and Mike walked towards the couple.

  “Are you guys okay?” asked Susan.

  “I’m still shaking, but I’ll be fine,” answered Claire.

  “Good. There’s no reason for alarm,” reassured Susan, as the men looked on approvingly.

  “Jack, for your safety, we’d like to give you police protection. I’ll have a police car parked outside your house until we get to the bottom of this,” declared Herb authoritatively.

  “Okay, sure,” answered Jack, looking at Claire for approval. She nodded.

  “We’ll take the device and your car to our station for full analysis,” interjected Susan.

  “Are we in danger?” asked Claire.

  “I don’t know, but we’d like to take precautions. Whoever is behind these heinous murders knows you are involved, Jack, and is following you. So, please be careful and stay out of the investigation,” said Herb. Mike stood tall, in silence.

  Susan took Claire by her arm and gently guided her to her car. Herb put his hand on Jack’s right shoulder walking with him behind the women. Mike stood still watching all walk towards the vehicle.

  “This may be an FBI-issued tracking device,” whispered Herb, so that only Jack could hear. Jack remained quiet and continued to make full eye contact, as the detective spoke.

  “Be careful. Don’t take any chances. We’ll talk tomorrow morning,” continued Herb, sensing Jack’s apprehension.

  Mike Ganz looked on from a few feet away, where the group had initially met. He was calm, cool and collected.

  Jack nodded slowly, as if in a trance. By then, they were by Claire’s car. Jack helped Claire get into the passenger side of her vehicle then got in, sitting behind the steering wheel. The investigative crowd was not quite done poking and prodding at Jack’s car. A police officer would drive the car to the police station and Jack agreed to pick it up the next morning. They slowly drove off in utter silence, mesmerized by the latest sequence of events. This had turned personal and the stakes had become much higher.

  Behind them, in the rearview mirror, the misty autumn evening and the dimming sunlight exaggerated the luminous effects of the flashing emergency lights on the roofs of the police vehicles.

  *****

  8:12 PM

  Once the car carrying Jack and Claire departed the area, the detectives went back to work. Susan approached Todd Turner, head of the CSI team, and engaged him in professional conversation. Mike had attempted to follow her, but was asked to stop.

  “Mike, I have some questions for you,” said Herb.

  “Yeah, what’s up, Herb?” answered Mike turning back to face the older detective.

  “I checked with the FBI headquarters in Indianapolis. You never accessed the database to check on the gun. How did you find out it was Rupert’s gun?”

  “I asked one of my cohorts to check. He finally did it and called me with the results.”

  “What’s his name? Your cohort?”

  “Are you checking up on me, Herb?”

  “I guess I am,” answered the local detective, slowly.

  As they spoke, Mike turned his body away from the investigating crowd, causing Herb to naturally shift in the same direction. Mike put his hand on Herb’s shoulder and gently guided him away from the area and into the darkness of the late evening. This was done with such flare and grace, that Herb never realized he was being escorted away from the others.

  “I don’t know what you think I did. I’m just helping you get the bad guy,” said Mike with an angelic shit-eating grin on his face.

  “I find that hard to believe. The gun was our main focus. You told me repeatedly you had checked on the gun and the ballistics and neither were in the database,” persisted Herb. Incredulously, Herb grew increasingly astonished by Mike’s testimony, becoming more convinced with each answer that Mike was implicated.

  “I don’t know what to tell you, Herb. I was busy.”

  As the dialogue progressed, the two slowly and imperceptibly walked deeper into the parking lot and away from the lighted area of intense investigation. Mike suddenly removed a mask from his right jacket pocket and placed it over his own mouth and nose. In rapid succession, he also withdrew an apparatus from his left pocket, which he pointed at
Herb’s face. An aerosolized mist swiftly entered Herb’s nasal passages, causing an almost pleasant tingling cooling sensation. Mike removed another gadget from his right pocket. This had the appearance of a remote control which he pointed at Herb and pressed a button. The initial pleasant awareness in Herb’s nasal passages grew rapidly into a stinging impression, which Herb felt deeper and deeper into his airways. First the trachea, then bronchi, and finally the alveoli, where the chemicals would speedily enter the blood circulation en route into the heart then brain.

  *****

  8:23 PM

  “Jack, come back. Herb collapsed. Please hurry,” yelled Susan into the cell phone, seeing her partner and best friend slip away in front of her eyes.

  “Call 911. I’m turning back.” Jack threw the phone at Claire, who sat apprehensively with growing agitation, looking at Jack.

  “What’s going on, Jack?” she asked as the car raced back to the scene where they left only minutes before.

  Soon the vehicle entered the parking lot. To the side, a group of people gathered around. In the middle of it all, Herb lay on the ground motionless. Susan knelt down next to him supporting his head on her thighs. Concerned looks abounded.

  “Give us some room, please. Will everyone step back?” yelled Jack, taking control of the situation. A quick visual assessment of the detective clearly indicated that the man was in serious trouble. There was blood around his lips. His airway was patent but he was cyanotic, a bluish discoloration of his lips and tongue.

  “Who can tell me what happened?” asked Jack of the audience then looking at Susan.

  “He walked out here on his own. The rest of us were out by the car talking to the CSI people. We suddenly heard a grunting noise and ran here. When I got here, Herb was on the ground having a seizure. He was foaming at the mouth. These officers held him down and we placed him on his side to avoid aspiration. I called you right away. And 911. He stopped having a seizure as you arrived.” Susan’s words showed obvious distress and feelings of helplessness.