by Robin Cook
With hesitation, Laurie slowly got to her feet. It had been the sudden motion of half standing a few minutes earlier that had brought on the current episode, and she was eager to avoid a repeat. Luckily, there was no reoccurrence. Her perspiration was another matter. That had actually gotten worse.
Cautiously, Laurie took a few steps out of her office and into the hallway while continuing to support herself with her hand against the wall. The pain remained bearable. With gathering confidence, she walked slowly down the length of the corridor to the ladies’ room. Inside, she got some toilet tissue and wiped herself. The spotting had reappeared, and there was more blood than there had been earlier. She knew she didn’t have appendicitis.
With gathering anxiety, Laurie retraced her steps back to her office and returned to her chair. She eyed the phone. She was still hesitant to call Dr. Riley, though now she felt she had little choice. The spotting ruled out appendicitis, and along with the location of the pain, suggested a possible ectopic pregnancy, which was far more serious than a mere threatened miscarriage. Finally, she reluctantly picked up the phone and called Laura Riley’s office number. When the operator answered, Laurie gave her name and direct-dial number. Thinking it might expedite the callback, she included her M.D. title and said she needed to talk with the doctor. She said it was an emergency.
As Laurie put the receiver back down, she noticed a new sensation: vague shoulder discomfort. It was so mild that she wondered if she was imagining it, yet it added to her already considerable anxiety. If it was real, it suggested the ominous development of peritoneal irritation. To test the possibility, Laurie carefully pushed in on her abdomen with her index finger, then suddenly took her hand away. She grimaced with a fleeting stab of pain. What she had felt was called “rebound tenderness,” and it also suggested peritoneal irritation, which now made her worry that not only might she have an ectopic pregnancy, but that it might have already ruptured. If so, it was a true medical emergency for which time could be a critical factor. She could be hemorrhaging internally.
The phone’s harsh ring interrupted her obsessing, and she snapped the receiver up to her ear. She was relieved when Dr. Riley identified herself. Laurie could tell she was on a cell phone and in a public place. Loud conversation could be heard in the background.
Laurie began by apologizing for calling on a Saturday night and said that she had resisted because she worried it was a bad way to start out a professional relationship, but she believed she truly had no choice. Laurie went on to describe her symptoms in detail, including the rebound tenderness. She admitted she’d had discomfort prior to speaking with her on the phone the previous day, but had forgotten to mention it and had thought it could wait until her scheduled visit the following Friday.
“First of all,” Laura said when Laurie had finished, “there’s no need to apologize. In fact, I would have preferred you call sooner. I don’t want to alarm you, but it we should consider an ectopic pregnancy until we can rule it out. You might be bleeding internally.”
“I thought as much,” Laurie admitted.
“Are you still diaphoretic?”
Laurie felt her brow. It was damp with perspiration. “I’m afraid so.”
“What’s your pulse, approximately? Is it fast or normal?”
Using her shoulder to hold the phone, Laurie felt her pulse at her wrist. She knew it had been fast earlier, and she wanted to be certain it had remained so. “It’s definitely on the fast side,” she admitted. She had hoped the sweating and the rapid heartbeat had been due to her anxiety, but Laura’s questions had made her acknowledge that there could be another explanation: She could be going into shock.
“Okay,” Laura said in a controlled, businesslike voice. “I want to see you in the emergency room at the Manhattan General Hospital.”
Laurie felt a shiver descend her spine at the thought of being a patient at the General. “Could we pick another hospital?” she questioned.
“I’m afraid not,” Laura said. “It’s the only hospital where I have privileges. Besides, they are fully equipped if we have to be aggressive. Where are you at the moment?”
“I’m in my office at the Office of the Chief Medical Examiner.”
“On First Avenue and Thirtieth Street?”
“Yes.”
“And where is your office in the building?”
“It’s on the fifth floor. Why do you ask?”
“I’m going to send an ambulance.”
Good God! Laurie thought. She didn’t want to ride in an ambulance. “I can take a taxi,” she suggested.
“You are not going to take a taxi,” Laura stated unequivocally. “One of the first rules about being a patient in an emergency medical situation, a rule which is particularly hard for doctors to accept, is that you must follow orders. We can argue about the necessity later, but right now we are not taking any chances. I’m going to send an ambulance ASAP, and I will meet you in the ER. Do you know your blood type?”
“O positive,” Laurie said.
“See you in the emergency room,” Laura said and disconnected.
With a shaking hand, Laurie hung up the phone. She felt shell-shocked. Upheavals were becoming the norm. In a single day she’d been forced to identify a friend’s corpse and now face the terrifying prospect of a medical emergency and possibly surgery at a hospital where a suspected serial killer was killing patients like her. The only consolation was that the most likely suspect was in custody.
Laurie snatched up the phone. She’d been reluctant to call Jack for a variety of reasons, but with this new development, her hand was forced. She needed his support, she needed him as an ombudsman or guardian in the hospital if she did end up having emergency surgery.
The phone rang once, then twice. “Come on, Jack!” Laurie urged. “Answer it!” The phone rang again, and Laurie knew he wasn’t there. As she suspected, after the next ring, his answering machine picked up. As Laurie waited to leave a message, she felt a wave of resentment wash over her. It seemed uncanny how Jack managed to irritate her in so many different ways. Undoubtedly, he was out on his neighborhood basketball court, pretending he was a teenager. Laurie knew she was being unreasonable, but she couldn’t help it. She was actually angry that he wasn’t there. Although she knew it was an unfair comparison, she couldn’t help but think that had Roger not been killed, he would have been available.
“A major problem has come up,” Laurie said when it was time for her to speak. “I need your help again. At the moment, I am waiting for an ambulance to take me to the Manhattan General. Dr. Riley thinks I might have a ruptured ectopic pregnancy. On the plus side, it will mean that the pressure will be off you, but on the negative side, I’ll be facing emergency surgery. I need you to be there. I don’t want to become part of my own series. Please come!”
After pressing the disconnect button, Laurie dialed Jack’s cell phone. She went through the same process, leaving a similar message in hopes he’d get one or the other. Then she pushed away from the desk with the idea of getting her coat before heading down to the basement level, where she expected the ambulance to arrive. As she stood up, she kept her hand pressed against her lower abdomen, hoping to avoid another severe cramp. Instead, she heard ringing in her ears and felt a wave of dizziness.
The next thing Laurie was aware of was voices, particularly the voice of a man seemingly talking on the telephone. He was saying something about the blood pressure being low but steady, the pulse at one hundred, and the abdomen being slightly tense. Laurie realized her eyes were shut, and she opened them. She was on the floor of her office, facing up at the ceiling. A female EMT was busily taping an IV line against her left arm. A male EMT was standing to the side while speaking on his cell phone. Behind him, she recognized Mike Laster. Alongside Laurie was a collapsed gurney with an IV pole.
“What happened?” Laurie asked. She started to get up.
“Easy,” the female EMT said, placing her hand on Laurie’s chest. “You just had a lit
tle fainting episode. But everything is okay. We’re going to be getting you out of here in two seconds.”
The male EMT snapped his phone shut. “All right, let’s go!” He walked around behind Laurie’s head and insinuated his hands beneath Laurie’s back and into her armpits. The woman went to her ankles. “On three,” the man said, and then quickly counted.
Laurie felt herself lifted over onto the gurney. The EMTs quickly secured her with straps, raised the gurney to waist-height, and jockeyed it out into the corridor.
“How long was I unconscious?” Laurie questioned. She’d never fainted before. She had no recollection of falling to the floor.
“It couldn’t have been for very long,” the woman said. She was at the foot pushing, while the man was at the head, pulling. Mike walked alongside.
“Sorry about this,” Laurie said to Mike.
“Don’t be silly,” Mike responded.
They took the elevator down to the basement level. As they passed the mortuary office, Laurie saw the evening tech, Miguel Sánchez, standing in the doorway. Laurie waved self-consciously. Miguel waved back.
The gurney bumped across the morgue’s concrete floor, past the security office, and out onto the loading dock. The ambulance was parked next to one of the Health and Hospital’s mortuary vans. Laurie thought of the irony that she was going out the same way the bodies came in.
Once in the ambulance, the female EMT inflated a blood-pressure cuff around Laurie’s right upper arm.
“What is it?” Laurie asked.
“It’s fine,” the woman said, although she reached over and opened the IV a little more.
For Laurie, the ride over to the Manhattan General Hospital was surprisingly rapid. She’d felt detached enough to close her eyes. She could hear the siren, although it seemed as if it were in the distance. The next thing she knew, the doors of the ambulance were flung open, and she was rolled out into bright light.
The emergency room was typically chaotic, but she didn’t have to wait. She was whisked into the depths and directly into the acute care section. As she was being transferred onto an examination table, Laurie felt a hand grip her forearm. Laurie turned and found herself gazing up into the face of a youthful woman dressed in scrubs, complete with a hood.
“I’m Dr. Riley. We are going to be taking good care of you. I want you to relax.”
“I’m relaxed,” Laurie responded.
“Since we’ve not met before tonight, I need to ask if you have any medical problems, whether you are taking any medication, or whether you have any allergies.”
“No to all of those questions. I’ve been blessed with very good health.”
“Good,” Laura said.
“Wait a second,” Laurie said. “There is something I wanted to mention to you. I’ve recently been tested positive for the BRCA1 marker.”
“Have you seen an oncologist about it?”
“Not yet.”
“Well, I don’t think that is going to influence what we need to do in this situation. Let me give you the game plan. First, we’ll do a rapid culdocentesis, which is to confirm if you have any blood in the space behind your uterus. It’s done with a needle through the apex of your vagina. It sounds worse than it is. You’ll feel a pinch, but that’s about all.”
“I understand,” Laurie said.
True to her word, Laura quickly did the procedure, with little discomfort to Laurie. The result was positive.
“This pretty much makes the decision about surgery for us,” Laura said. “My biggest concern is that you are continuing to hemorrhage into your abdominal cavity. We’ve got to stop that. We also will need to give you some blood. Do you understand everything that I’m saying?”
“I do,” Laurie said.
“I’m sorry you’ve had to experience a problem like this. I want to make certain you don’t think it is your fault. Ectopic pregnancies are more common than people realize.”
“There is something in my past that may have contributed. In college, I had an episode of pelvic inflammatory disease associated with an IUD.”
“That may or may not have contributed,” Laura said. “Meanwhile, is there anyone you would like us to call?”
“I’ve already called the person I’d like to be here,” Laurie said.
“Okay, I’m going up to the surgery floor to make sure everything is ready. I’ll see you in a few minutes.”
“Thank you again. I’m sorry if I’ve ruined your Saturday night.”
“What are you talking about? Getting you back to normal is going to make my Saturday night.”
For a few minutes, Laurie was left by herself. She felt curiously detached, as if the whole episode involved someone else. She could hear telltale evidence of dramas unfolding in neighboring rooms, and saw people dash by the open doorway on various urgent errands.
Laurie felt lucky to have Laura Riley as her doctor, and was indebted to Sue for recommending her. With the kind of confidence and professionalism that Laura projected, Laurie wasn’t as fearful about the upcoming surgery as she would have imagined. She knew she needed it, with the growing fullness in her abdomen and the general weakness the blood loss caused. Her only real worry was the fear of being victimized by SADS after the surgery and becoming a member of her own series, but she put the thought out of her mind. Instead, she thought about Jack and wondered when he would get her message. There was some concern that he was upset enough at her not to come in. If that were to happen, Laurie had no idea what she would do, so she put that thought out of her mind as well.
twenty
JACK HAD MANAGED TO FOOL Flash with a head fake and clever use of a pick, and for a moment, Flash had no idea where Jack was. By the time Flash had figured out what had happened, Jack had snaked his way in under the basket. Warren had seen the move out of the corner of his eye and shot a perfect pass into Jack’s waiting hands. Jack twisted around and was poised to make a simple layup to win the tied game. Unfortunately, that was not what happened. By some inexplicable miscalculation on Jack’s part, the ball didn’t glance off the backboard and drop through the basket as he intended. Instead, it fell far short, lodged between the basket’s rim and the backboard, and stayed there.
Play ground to a halt. Totally embarrassed to have missed such an easy shot, Jack had to leap up to knock the ball free. Then, as the final indignity, a player on the opposing team grabbed the ball, stepped out of bounds, then let loose with a long pass down the court to Flash, who’d taken advantage of Jack being under the basket to break free. Jack was supposed to be guarding him. Instead, Jack had to watch impotently while Flash went in to make a layup at the opposite end, and, unlike Jack, he didn’t miss. The game was over. Flash’s team had won.
Jack slunk off the court, wishing he could disappear. He dodged some of the puddles along the sidelines. With his back pressed against the chain-link fence in a dry area, he sank to a sitting position with his knees up in the air. Warren sauntered over, hands on his hips and a mocking, wry smile on his face. Warren was fifteen years Jack’s junior, with a body that would have made a men’s underwear model jealous. As the best basketball player in the neighborhood, and as a keen competitor, he hated to lose, and not just because it meant he might have to sit out a game or two. For him, it was a personal affront.
“What the hell’s the matter with you?” Warren questioned. “How could you miss that shot? I thought you had recovered, but that has to go down as one of your more pitiful exhibitions.”
“Sorry, man,” Jack said. “I guess I wasn’t concentrating.”
Warren gave a short, derisive laugh as if that was the understatement of the year before taking a seat next to Jack with his knees angled up in a similar fashion. In front of them, a new group of five was getting ready to take on Flash and his team. Despite the crummy weather and the fact that it was Saturday night, there had been a big turnout.
Jack’s basketball had recovered to a degree over the last several weeks, but that afternoon, Laurie’s
pushiness and her playing the victim role had provoked him to no end. He could sympathize with her about what she was facing lately, but from his perspective, she had no idea what being a victim was really like. On top of that he couldn’t believe she kept harping on him about his use of humor, which he felt was his only defense against the harsh reality that fate and AmeriCare had thrown at him. And, worse yet, he couldn’t comprehend that she wouldn’t listen to what he’d been thinking about this new curveball of her being pregnant. After she’d broken the news, he’d thought of nothing else and had been looking forward to sharing his feelings, both pro and con. The news had forced him to face the idea of a second family as a reality, and he’d come around to believing he might not be quite as scared of the situation as he thought . . . at least until that afternoon, when she acted so demanding and victimized. When he thought about the conversation again, he couldn’t believe she was “sick and tired” of discussing having a family, because, prior to her moving out, he couldn’t remember that last time she’d even brought up the subject.
“Hell!” Jack exclaimed suddenly, snapping his headband off his forehead and throwing it to the pavement.
Warren looked at him questioningly. “Man, you’re in bad shape! Let me guess! Laurie’s still acting up.”
“You’ve no idea,” Jack said scornfully. He was going to elaborate when he heard a distant muffled beeping. Grabbing his backpack, he opened the zipper and took out his cell phone, which he normally didn’t bring out onto the court unless he was on call. But that evening after the fracas with Laurie, he wanted to stay in touch in case she came to her senses. When he flipped the lid and saw that he had a message, he checked caller ID.
“It’s her,” Jack said with a touch of exasperation. With no idea what to expect and scant hope for a miracle, he called his voicemail. As he began to listen to the message, he stood up. As he continued to listen, his jaw slowly dropped, then he disconnected and looked down at Warren, momentarily paralyzed. “Good God! She’s been taken by ambulance to the Manhattan General for emergency surgery.”