by Robin Cook
INSTEAD OF sitting down and having coffee on her afternoon coffee break, Janet took the elevator to the second floor and visited the intensive care unit. She had a lot of respect for the nurses who worked there. She never understood how they could take the constant strain. Janet had tried the ICU after graduation. She found the work intellectually stimulating, but after a few weeks decided it wasn’t for her. There was too much tension, and too little patient interaction. Most of the patients were in no position to relate on any level; many of them were unconscious.
Janet went over to Gloria’s bed and looked down at her. She was still in a coma and had not improved although she was still breathing without mechanical assistance. Her widely dilated pupils had not constricted, nor did they react to light. Most disturbing of all, an EEG showed very little brain activity.
A visitor was gently stroking Gloria’s forehead. She was about thirty years old with coloring and features similar to Gloria’s. As Janet raised her head, their eyes met.
“Are you one of Gloria’s nurses?” the visitor asked.
Janet nodded. She could tell the woman had been crying.
“I’m Marie.” she said. “Gloria’s older sister.”
“I’m very sorry this happened,” Janet said.
“Well,” Marie said with a sigh, “maybe it’s for the best. This way she won’t have to suffer.”
Janet agreed for Marie’s benefit, although in her own heart she felt differently. Gloria had still had a shot at beating breast cancer, especially with her positive, upbeat attitude. Janet had seen people with even more advanced disease go into remission.
Fighting tears of her own, Janet returned to the fourth floor. Again, she threw herself into her work. It was the easiest way to avoid thoughts that would only leave her cursing the unfairness of it all. Unfortunately the ruse was only partly successful, and she kept seeing the image of Gloria’s face as she thanked Janet for starting her IV. But men suddenly the ruse was no longer needed. A new tragedy intervened that matched Gloria’s and overwhelmed Janet.
A little after two, Janet gave an intramuscular injection to a patient whose room was at the far end of the corridor. On her way back to the nurses’ station, she decided to check in on Helen Cabot.
Earlier that morning and about an hour after Janet had added the coded medication to Helen’s IV and adjusted the rate, Helen complained of a headache. Concerned about her condition, Janet had called Dr. Mason and informed him of this development. He’d recommended treating the headache minimally and asked to be called back if it got worse.
Although the headache had not gone away after the administration of an oral analgesic, it had not grown worse. Nevertheless, Janet had checked on Helen frequently at first, then every hour or so throughout the day. With the headache unchanged and her vital signs and level of consciousness remaining normal, Janet’s concern had lessened.
Now, almost 2:15, as Janet came through the door, she was alarmed to discover that Helen’s head had lolled to the side and off the pillow. Approaching the bed, she noticed something even more disturbing: the woman’s breathing was irregular. It was waxing and waning in a pattern that suggested a serious neurological dysfunction. Janet phoned the nurses’ station and told Tim she had to speak with Marjorie immediately.
“Helen Cabot is Cheyne-Stoking,” Janet said when Marjorie came on the line, referring to Helen’s breathing.
“Oh no!” Marjorie exclaimed. “I’ll call the neurologist and Dr. Mason.”
Janet took the pillow away and straightened Helen’s head. Then she took a small flashlight she always carried and shined it in each of Helen’s pupils. They weren’t equal. One was dilated and unresponsive to the light. Janet shuddered. This was something she’d read about. She guessed that the pressure had built up inside Helen’s head to the point that part of her brain was herniating from the upper compartment into the lower, a life-threatening development.
Reaching up, Janet slowed Helen’s IV to a “keep open” rate. For the moment that was all she could do.
Soon other people started to arrive. First it was Marjorie and other nurses. Then the neurologist, Dr. Burt Atherton, and an anesthesiologist, Dr. Carl Seibert, rushed in. The doctors began barking orders in an attempt to lower the pressure inside Helen’s head. Then Dr. Mason arrived, winded by his run from the research building.
Janet had never met Dr. Mason, although she’d spoken with him on the phone. He was titularly in charge of Helen’s case, but in this neurological crisis he deferred to Dr. Atherton.
Unfortunately, none of the emergency measures worked, and Helen’s condition deteriorated further. It was decided that emergency brain surgery was needed. To Janet’s dismay, arrangements were made to transfer Helen to Miami General Hospital.
“Why is she being transferred?” Janet asked Marjorie when she had a moment.
“We’re a specialty hospital,” Marjorie explained. “We don’t have a neurosurgical service.”
Janet was shocked. The kind of emergency surgery Helen needed required speed. It did not require an entire neurosurgical service, just an operating room and someone who knew how to make a hole in the skull. Obviously with the biopsies they’d been doing, that expertise was available at the Forbes.
With frantic preparations, Helen was readied to leave. She was moved from her bed onto a gurney. Janet aided in the transfer, moving Helen’s feet, then running alongside holding the IV bottle aloft as the gurney was rushed to the elevator.
In the elevator Helen took a turn for the worse. Her breathing, which had been irregular when Janet had entered her room, now stopped altogether. Helen’s pale face quickly began to turn blue.
For the second time that day, Janet started mouth-to-mouth resuscitation while the anesthesiologist yelled for someone to get an endotracheal tube and an Ambu bag as soon as they got to the first floor.
When the elevator stopped and the doors opened, one of the fourth-floor nurses rushed out. Another kept the doors from closing. Janet continued her efforts until Dr. Seibert nudged her aside and deftly slipped in an endotracheal tube. After connecting the Ambu bag, he began to inflate Helen’s lungs to near capacity. The blue cast to Helen’s face transformed into a translucent alabaster.
“Okay, let’s go,” Dr. Seibert yelled.
The tightly packed group rushed Helen out to the ambulance receiving dock, collapsed the gurney, and pushed it inside the waiting vehicle. Dr. Seibert boarded with Helen, maintaining her respiration. The doors were slammed shut and secured.
With flashing light and piercing siren, the ambulance roared out of the parking bay and disappeared around the building.
Janet turned to look at Marjorie, who was standing next to Dr. Mason. She was consoling him with her hand on his shoulder.
“I can’t believe it,” Dr. Mason was saying with a halting voice. “I suppose I should have prepared myself. It was bound to happen. But we’ve been so lucky with our medulloblastoma treatments. With every success, I thought just maybe we could avoid this kind of tragedy.”
“It’s the people in Boston’s fault,” Ms. Richmond said. She’d appeared on the scene just before the ambulance had left. “They wouldn’t listen to us. They kept her too long.”
“We should have put her in the ICU,” Dr. Mason said. “But she’d been so stable.”
“Maybe they’ll save her at Miami General,” Marjorie said, trying to be optimistic.
“It would be a miracle,” Dr. Atherton said. “It was pretty clear her uncus had herniated below the calyx and was compressing her medulla oblongata.”
Janet repressed an urge to tell the man to keep his thoughts to himself. She hated the way some doctors hid behind their jargon.
All at once, as if on some unseen cue, the entire group turned and disappeared through the swinging doors of the Forbes ambulance dock. Janet was left outside. She was just as glad to be alone. It was suddenly so peaceful by the lawn. A huge banyan tree graced the grounds. Behind the banyan was a flowering tree
Janet had never seen before. A warm, moist tropical breeze caressed her face. But the pleasant scene was still marred by the undulating siren of the receding ambulance. To Janet, it sounded like a death knell for Helen Cabot.
TOM WIDDICOMB wandered from room to room in his mother’s ranch house, alternately crying and cursing. He was so anxious he couldn’t sit still. One minute he was hot, the next freezing. He felt sick.
In fact, he’d felt so sick he’d gone to his supervisor and told him as much. The supervisor had sent him home, commenting that he was pale. He’d even noticed that Tom was shaking.
“You’ve got the whole weekend,” the supervisor had said. “Go to bed, sleep it off. It’s probably a touch of the ‘snowbird flu.’”
So Tom had gone home, but he’d been unable to rest. The problem was Janet Reardon. He’d almost had a heart attack when she’d come knocking on Gloria’s door minutes after he’d put Gloria to sleep. In an absolute panic he’d fled into the bathroom, sure that he’d been cornered. He’d gotten desperate enough to take his gun out.
But then the pandemonium in the room gave him the diversion he needed to get away. When he’d emerged from the bathroom, no one had even noticed. He’d been able to slip into the hall with his bucket.
The problem was that Gloria was still alive. Janet Reardon had saved her, and Gloria was still suffering, although now she was out of reach. She was in the ICU where Tom was not allowed to go.
Consequently, Alice still wouldn’t talk to him. Tom had continued to plead, but without success. Alice knew Tom couldn’t get to Gloria until she was transferred out of the ICU and put back into a private room.
That left Janet Reardon. To Tom, she seemed like a devil sent to destroy the life that he and his mother had created. He knew he had to get rid of her. Only now he didn’t know where she lived. Her name had been removed from the residence chart in administration. She’d moved out.
Tom checked his watch. He knew her shift ended when his would have ended: three P.M. But he also knew nurses stayed longer because of their report. He’d have to be in the parking lot when she came out. Then he could follow her home and shoot her. If he was able to do that he was reasonably confident Alice would break this petulant silence and talk with him.
“HELEN CABOT died!” Janet repeated through sudden tears. As a professional it wasn’t like her to cry over the death of a patient, but she was extra sensitive since there’d been two tragedies in the same day. Besides, Sean’s response frustrated her. He was more interested in where Helen’s body was than the fact that the woman was dead.
“I understand she died,” Sean said soothingly. “I don’t mean to sound callous. Part of the way I respond is to cover the pain I feel. She was a wonderful person. It’s such a shame. And to think that her father runs one of the largest computer software companies in the world.”
“What difference does that make?” Janet snapped. She wiped under her eyes with the knuckle of her index finger.
“Not much,” Sean admitted. “It’s just that death is such a leveler. Having all the money in the world makes no difference.”
“So now you’re a philosopher,” Janet said wryly.
“All of us Irish are philosophers,” Sean said. “It’s how we deal with the tragedy of our lives.”
They were sitting in the cafeteria where Sean had agreed to come when Janet called him. She’d called him after report, before she left for the apartment. She’d said she needed to talk.
“I don’t mean to upset you,” Sean continued. “But I’m truly interested in the location of Helen’s body. Is it here?”
Janet rolled her eyes. “No, it’s not here,” she said. “I don’t know where it is truthfully. But I suppose it’s over at the Miami General.”
“Why would it be there?” Sean asked. He leaned across the table.
Janet explained the whole episode, indicating her indignation that they couldn’t do an emergency craniotomy at the Forbes.
“She was in extremities,” Janet said. “They never should have transferred her. She never even made it to the OR. We heard she died in the Miami General emergency room.”
“How about you and me driving over there?” Sean suggested. “I’d like to find her.”
For a moment, Janet thought Sean was kidding. She rolled her eyes again, thinking Sean was about to make some sick joke.
“I’m serious,” Sean said. “There’s a chance they’ll do an autopsy. I’d love to have a tumor sample. For that matter, I’d like to have some blood and even some cerebrospinal fluid.”
Janet shuddered in revulsion.
“Come on,” Sean said. “Remember, we’re in this thing together. I’m really sorry she died—you know I am. But now that she’s dead, we should concentrate on the science. With you in a nursing uniform and me in a white coat, we’ll have the run of the place. In fact, let’s bring some of our own syringes just in case.”
“In case of what?” Janet asked.
“In case we need them,” Sean said. He winked conspiratorially. “It’s best to be prepared,” he added.
Either Sean was the world’s best salesman or she was so stressed out, she was incapable of resisting. Fifteen minutes later she found herself climbing into the passenger side of Sean’s 4×4 to head over to a hospital she’d never visited, in hopes of obtaining the brain tissue of one of her patients who’d just expired.
“THAT’S HIM.” Sterling pointed at Sean Murphy through the car’s windshield for Wayne Edwards’s benefit. Wayne was a formidable Afro-American whose services Sterling enlisted when he did business in south Florida. Wayne was an ex-Army sergeant, ex-policeman, and ex-small businessman who’d gone into the security business. He was an ex from as many things as Sterling was, and like Sterling, he now used his varied experience for a similar career. Wayne was a private investigator, and although he specialized in domestic squabbles, he was talented and effective in other areas as well. Sterling had met him a few years previously when both were representing a powerful Miami businessman.
“He looks like a tough kid,” Wayne said. He prided himself on instantaneous assessments.
“I believe he is,” Sterling said. “He was an all-star hockey player from Harvard who could have played professionally if he’d been inclined.”
“Who’s the chick?” Wayne asked.
“Obviously one of the nurses,” Sterling said. “I don’t know anything about his female liaisons.”
“She’s a looker,” Wayne said. “What about Tanaka Yamaguchi? Have you seen him lately?”
“No, I haven’t,” Sterling said. “But I think I will. My contact at the FAA told me the Sushita jet has just refiled a flight plan to Miami.”
“Sounds like action,” Wayne said.
“In a way, I hope so.” Sterling said. “It will give us a chance to resolve this problem.”
Wayne started his dark green Mercedes 420SEL. The windows were heavily tinted. From the outside it was difficult to see within, especially in bright sunlight. He eased the car away from the curb and headed for the exit. Since a hospital shift had changed half an hour earlier, there was still considerable traffic leaving the parking area. Wayne allowed several cars to come between his car and Sean’s. Once on Twelfth, they headed north over the Miami River.
“I got sandwiches and drinks in the cooler in the back seat,” Wayne said while motioning over his shoulder.
“Good thinking,” Sterling said. That was one of the things he liked about Wayne. He thought ahead.
“Well, well,” Wayne said. “Short trip. They’re turning already.”
“Isn’t this another hospital?” Sterling asked. He leaned forward to survey the building Sean was approaching.
“This area is hospital city, man,” Wayne said. “You can’t drive a mile without running into one. But they’re heading to the mama hospital. That’s Miami General.”
“That’s curious,” Sterling said. “Maybe the nurse works there.”
“Uh oh,” Wayne said. “
I do believe we have company.”
“What do you mean?” Sterling asked.
“See that lime green Caddy behind us?” Wayne asked.
“It would be hard to miss it,” Sterling said.
“I’ve been watching it since we crossed the Miami River,” Wayne said. “I have the distinct impression it’s following our Mr. Murphy. I wouldn’t have noticed it except I used to have wheels just like it in my younger days. Mine was burgundy. Good car, but a devil to parallel park.”
Sterling and Wayne watched as Sean and his companion entered the hospital through the emergency entrance. Not far behind was the man who’d arrived in the lime green Cadillac.
“I think my initial impression was correct,” Wayne said. “Looks to me like that dude is tighter on their tail than we are.”
“I don’t like this,” Sterling said. He opened the passenger door, got out, and glanced back at the dumpy Cadillac. Then he bent down to talk to Wayne. “This is not Tanaka’s style, but I can’t risk it. I’m going in. If Murphy comes out, follow him. If the man in the Cadillac comes out first, follow him. I’ll be in touch over the cellular phone.”
Grabbing his portable phone, Sterling hurried after Tom Widdicomb, who was climbing the steps on the side of the ambulance dock outside the Miami General emergency room.
WITH THE assistance of a harried resident in the emergency room who’d given them directions, it did not take Sean and Janet long to find the pathology department. Once there, Sean sought out another resident. He told Janet that between the residents and the nurses you could find out anything you wanted to know about a hospital.