Marker

by Robin Cook

  “It is,” Jack said. He switched positions. His back was killing him the way it was pressed up against the passenger-side door.

  “I thought you promised you weren’t going to be a hero,” Lou complained. “Did you shoot her, too, or what?”

  “I didn’t shoot her,” Jack exclaimed. “It was the guy in the backseat.”

  “Whoever the guy is shot at me,” Lou said. “I don’t like that.”

  In addition to the gurgling, Jack now heard definite wheezing. At that moment, he caught sight of Lou’s eyes between the open driver’s side door and the doorframe. He was now squatting next to the driver’s-side front wheel, holding his pistol up alongside his head.

  Jack managed to get his legs down where they belonged under the dash so that he could move his head and cautiously look into the backseat between the front seats. In the dim light and limited view he could see a flaccid hand lying on the backseat with its index finger still within the trigger guard of a pistol. At that point, Jack heard stertorous breathing.

  Gaining courage, Jack raised his head and peered over the top of the front seat. He could just make out a man sitting upright but with his head back and arms splayed out to the sides. With his head back, Jack could see that he was wearing a ski mask. His breathing was labored.

  “I guess I shot him,” Jack said.

  Lou stood up, walked along the side of the car, and stuck his pistol through the back window that had been blown out. He was holding his gun in both hands and pointing it at the stricken individual. “Can you hit the lights?” Lou asked.

  Jack spun around and briefly searched for the interior lights. When he found them, he switched them on. He looked into the backseat at the man. An expanding stain of blood was on the man’s chest.

  “Can you reach his gun?” Lou asked. He kept his gun trained on the apparently unconscious stranger.

  Jack extended his hand warily toward the gun as if the man would suddenly wake up like in a thriller movie for one more desperate struggle.

  “Just touch the barrel, not the butt,” Lou directed. “And put it on the front seat.”

  Jack did as he was told, then quickly got out the passenger-side door. He opened up the back door and leaned in to get a closer look at the man. Up close it was more apparent how labored the individual’s breathing was. Jack pulled off the ski mask in hopes it would help the man breathe. Lou opened the door on the man’s other side.

  “Do you recognize him?” Lou asked.

  “Not at all,” Jack said.

  While Jack felt for a pulse, Lou grabbed the fabric on the front of the man’s shirt, and with a sudden lateral tear, ripped the shirt wide open. Buttons popped off. Three entrance wounds were apparent in the man’s chest.

  “I’ll say you shot him,” Lou remarked with admiration.

  “His pulse is thready and rapid,” Jack said. “He’s not long for this world unless we act fast. On the positive side, he’s already at the hospital.”

  “You check the nurse!” Lou said. “I’ll start getting him out of the car.”

  Jack ducked back out of the vehicle and ran around to the other side. Bending down, it took him only a second to ascertain that Jazz had been shot execution-style through the back of the head at very close range. The bullet had undoubtedly passed through the brainstem. She was clearly moribund.

  Jack stood back up and stepped over the woman. He could see that Lou had the injured individual half out of the car.

  “What’s the situation with the woman?” Lou grunted.

  “She’s gone. Let’s concentrate on the guy.”

  With the back door open against the neighboring vehicle, Jack had to reverse directions, step back over Rakoczi, and run all the way around the SUV to lend a hand with the man. Lou had his hands under the individual’s armpits. Jack squeezed by and grasped the man around the thighs.

  “God! He weighs a ton!” Lou complained as they managed to get out from between the parked cars. They were immediately caught in the headlights of a car attempting to exit the garage. The driver had the nerve to beep the horn.

  “Only in New York,” Lou complained at the impatient driver through clenched teeth. He struggled with the injured man. “What the hell is this guy anyway, a professional football player?”

  As they approached the doors to the pedestrian bridge, a few of the departing hospital workers stopped to gawk, unsure of what they were witnessing. At least one had the sense to reverse direction and reach back to hold open the door.

  Halfway across the bridge, Lou staggered. “I got to stop,” he said while panting.

  “Let’s switch,” Jack suggested. They put the man down on the concrete floor of the bridge, quickly changed places, and then picked up the man again.

  “You certainly picked a good time to show up,” Jack said and grunted.

  “Apparently, I just missed you outside the CCU,” Lou said. “Then I just missed you on the sixth floor. It was a good thing the clerk told me to look for a black Hummer.”

  In the better light, it was apparent that the stains on the man’s shirt were blood, and people were now willing to help. By the time they got across the bridge, two male nurses had pitched in. One was at the head with Jack, while the other had a leg with Lou.

  “The ER is on the floor below,” one of the nurses said between breaths. “Should we wait for an elevator or try the stairs?”

  “The elevator,” Jack answered. He was aware the man was no longer breathing. “But we’re going up, not down. He needs a thoracic surgeon, and he needs him now.”

  The two nurses looked at each other in consternation but didn’t say anything. Rather than put the man down, Jack backed up against the wall and hit the elevator button with his free hand. Luckily, a car arrived almost immediately. Unfortunately, it was full.

  “Coming in!” Jack yelled. He was not to be deterred, and he backed right into people who momentarily had not moved. Recognizing the degree of the emergency, a number of people got off, creating the necessary space. The door closed.

  The four people holding the injured man looked at one another while the people in the elevator stared at the wounded individual. No one said anything as the elevator rose up a floor.

  When the doors opened on the third floor, they carried the man out and then pushed through the double doors. As they passed the arched opening into the surgical lounge, Jack cried out that they had a man who had been shot in the chest three times. By the time they got to the doors leading into the OR itself, a number of surgeons who had been waiting for their cases to start were walking alongside. Several of them were thoracic surgeons, and they started to assess the man’s condition, as evidenced by the position of the entrance wounds. Although there was some disagreement about the nature of the injuries, all thought that the only chance the patient had for survival was to be put on cardiopulmonary bypass immediately.

  As the group came abreast of the OR desk, several of the nurses were aghast that people had entered their sterile domain in street clothes. Their indignation was shortlived when they realized that a patient with a mortal wound was being rushed in.

  “Room 8 is being set up for open-heart surgery,” one of the nurses behind the desk yelled.

  The group hustled down to room 8 where they put the man directly onto the operating table. The surgeons wasted no time. They cut off the man’s clothes. An anesthesiologist appeared and yelled that the man was no longer breathing and had no pulse. He quickly intubated the patient and started respiring him with one hundred percent oxygen. Another anesthesiologist started several large-bore IVs and began running fluid into the man as fast as possible. He also called for blood to be typed and cross-matched stat.

  Jack and Lou stepped back as the surgeons crowded around. One of the thoracic surgeons barked for a scalpel, and one was quickly slapped into his waiting palm. With no hesitation and without even bothering to glove, the surgeon cut through the man’s chest with a decisive swipe. Then, using his bare hands, he cracked open t
he ribs only, to be faced with an enormous amount of blood. At that point, Lou decided he’d wait out in the surgical lounge.

  “Suction,” the surgeon yelled.

  Jack tried to see as best he could from the head of the table. It was a spectacle the likes of which he had never seen. None of the surgeons had on gloves, masks, or gowns, and they had blood up to their elbows. It had all happened so quickly that no one had had a chance to follow the normal presurgical protocol. Jack listened intently to the banter, which only underlined something that he had already known: namely, that surgeons were a breed unto themselves. Despite the unorthodox nature of the event and the gore, they were enjoying themselves. It was as if the episode served to conveniently validate their enormous curative powers.

  It was quickly determined that the man had suffered what would have been a mortal wound, except for the fact that it had happened at a major hospital. Two of the bullets had gone through the lungs. For the surgeons, that was a pedestrian problem. It was the third bullet that presented the challenge. It had, among other things, pierced the great vessels.

  Quickly, the damaged vessels were clamped off, and the patient was put on the heart-lung machine. At that point, some of the surgeons left to start their own scheduled cases while the two thoracic surgeons stopped long enough to scrub and don the usual operating-room apparel. Jack moved over to chat with the anesthesiologist about what she thought the chances were the man would survive, but the nursing supervisor tapped him on the shoulder.

  “I’m sorry,” the supervisor said, “but we’re trying to reclaim sterility here. You’ll have to leave and put on scrubs if you want to observe.” She handed him a pair of booties to cover his street shoes.

  “Okay,” Jack said agreeably. He’d been amazed that he hadn’t been kicked out earlier.

  As Jack walked back down the long operating-room corridor, the events of the long night began to take their toll. He was exhausted to the point that his legs and feet felt as if he had weights strapped to them. As he passed the operating-room desk he shivered through a bout of discomfort akin to nausea. He found Lou sitting in the crowded surgical lounge, talking on his cell phone. In front of him on the coffee table were a wallet and a driver’s license.

  Jack sat down heavily in a chair facing Lou. Lou pointed to the driver’s license without interrupting his conversation. Jack leaned forward and picked up the license. The name was David Rosenkrantz. Holding the card closer, Jack studied the laminated picture. The individual appeared like an all-American football player with a thick neck and a broad, toothy smile. He was a handsome man.

  After flipping his phone shut, Lou looked over at Jack. Then he leaned forward with his elbows on his knees. “At the moment, I don’t want a long explanation how this all happened,” he said in a tired voice. “But I’d just like to know why. The last thing you promised me was that you were going to sit outside the CCU.”

  “I meant to,” Jack said. “Then I realized the shift was changing, and I was suddenly worried the Rakoczi woman would disappear. I just wanted to make sure she hung around until you got here.”

  Lou rubbed his face briskly with both hands and groaned. When he took his hands away, his eyes were red. He looked almost as bad as Jack. “Amateurs! I hate them,” he remarked rhetorically.

  “It never dawned on me she’d have a gun,” Jack said.

  “What about the other two recent gunshot-wound deaths over here? Didn’t they at least go through your pea brain?”

  “No,” Jack admitted. “I was really worried we wouldn’t see her again. I thought I’d just ask her to stay. I wasn’t going to accuse her of anything.”

  “Bad decision,” Lou said. “That’s the way people like you get killed.”

  Jack shrugged. In retrospect, he knew Lou was right.

  “Did you look at the license of the man you shot?”

  Jack nodded. He didn’t like to think he’d actually shot somebody.

  “Well, who is David Rosenkrantz?”

  Jack shook his head. “I haven’t the slightest idea. I’ve never seen him before nor heard his name.”

  “Is he going to live?”

  “I don’t know. I was about to ask the anesthesiologist’s opinion, but I was told to leave. I think the surgeons are pretty optimistic, the way they have been talking. If he does make it, it proves that if you are going to get shot, make sure you get shot in a decent hospital.”

  “Very funny,” Lou said without laughing. “What’s Laurie’s status?”

  “Good! Very good! Or at least it was when I left. Let’s walk down and check in with the CCU. I didn’t expect to be gone this long. It’s just down the hall.”

  “Fine with me,” Lou said, getting to his feet.

  The CCU charge nurse came out of the unit and told Jack and Lou that Laurie was doing fine, she was sleeping, and that her doctor had been in to see her. She also said that there were plans afoot to move her to the University Hospital, where her father was on staff.

  “Sounds good,” Jack said. He looked at Lou.

  “Sounds good to me, too,” Lou said.

  After the CCU, Lou wanted Jack to come with him down to the emergency room. He wanted Jack to identify for the record that the dead woman was the nurse who Jack had seen in Laurie’s room. He explained that when he’d left the OR earlier, he’d called police headquarters about setting up the Hummer as a crime scene and bringing the body inside the hospital. He was particularly interested in having the Glock checked by ballistics.

  As they walked back toward the elevator, Lou cleared his throat. “I know you’re exhausted, and for good reason, but I’m afraid I have to know what happened from the moment you got down to the garage.”

  “I caught the nurse just as she was about to get into her car,” Jack said. “She already had the door open, so I yelled and ran up to her. Obviously, she wasn’t cooperative, which is an understatement. When I grabbed her arm to keep her from getting in the vehicle, she kneed me in the balls.”

  “Ouch!” Lou commiserated.

  “That was when she pulled out the gun and ordered me into the car.”

  “Take this as a lesson,” Lou said. “Never get into a car with an armed felon.”

  “I didn’t think I had a lot of choice,” Jack said.

  They reached the elevator lobby, where there was a smattering of people waiting. They lowered their voices.

  “That’s when I appeared on the scene,” Lou said. “I saw you get into the car. I could even see the woman’s gun. Unfortunately, I had to wait for a few cars before I ran over. What went on in the car?”

  “It all happened so fast. The guy was obviously already in there, apparently waiting for Rakoczi. Just when she was about to shoot me, he shot her. God . . .” Jack’s voice trailed off as he thought of how close he had come to one last trip over to the OCME.

  “You crazy ass,” Lou complained. He gave Jack’s shoulder a light smack and then shook his head. “You have this weird penchant for getting into the damnedest situations. You walked right into the middle of an execution-style hit. Are you aware of that?”

  “I am now,” Jack admitted.

  The elevator arrived and they boarded. They moved to the back of the car.

  “Okay,” Lou said. “The question is why? Do you have any ideas?”

  “I do,” Jack said. “But let me backtrack. First of all, Laurie was almost killed with a sudden overwhelming dose of potassium, which is a clever way to kill someone. There’s no way to document it, thanks to the physiology of potassium in the human body, but don’t get hung up on that. The point is that I think all the patients in Laurie’s series were killed in this shrewd fashion, but they weren’t random targets. All of them, including Laurie, had tested positive for the genetic markers of serious medical illnesses.”

  The elevator arrived on the first floor, and Lou and Jack got off. The hospital was crowded with people, and they kept their voices down.

  “So how does all this add up to a gangland-s
tyle hit on the nurse?” Lou questioned.

  “I think it is evidence that there is a major conspiracy here,” Jack said. “I think if you are lucky, you’re going to learn the nurse was working for someone in some tangled web which will eventually lead back to an actuarial type within the AmeriCare administration.”

  “Wait a second!” Lou said, pulling Jack to a stop. “Are you suggesting that a major healthcare provider like AmeriCare might be involved with killing their own patients? That’s crazy!”

  “Is it?” Jack questioned. “In any geographical area where these healthcare giants actually compete with each other, something they try to avoid by choking off competition or buying out the opposition if they are big enough, they compete with the cost of premiums. How do they determine their premiums? Well, the old-fashioned, actuarial way was to pool risk, figure out how much it is going to cost to take care of a group of people by essentially guessing, then add on profit, divide by the number of people, and bingo, there’s the premium. Suddenly, under everybody’s noses, the rules have changed. With the decipherment of the human genome, the old concept of health insurance is bound for the trash heap. Using single, easily performed tests, people who are destined to cost them significant money can be recognized. The problem is that the large healthcare companies cannot show discrimination, so they have to take them. At that juncture, from a purely business perspective, they should be eliminated.”

  “You mean to tell me that you think some AmeriCare administrators are capable of committing murder?”

  “Actually, no!” Jack said. “The actual killing has to be done by severely screwed-up individuals, which I’m quite certain you’ll be learning about Miss Rakoczi if she is indeed the culprit. What I’m talking about is a horrid variant of white-collar crime with varying levels of complicity. At the top, I’m talking about some person who might have been recruited from the automobile industry or any other business, who sits in an office, far removed from patients, and thinks about the bottom line exclusively. Unfortunately, that’s the way business works and why some level of government oversight is necessary as a general rule in a free-market economy. I might sound like a misanthrope, but human beings tend to be basically self-interested and often function as if they are wearing blinders.”