by J. R. McLeay
The healing process would take a number of weeks to complete. After the surgical hemorrhage was plugged, Elias’s white blood cells had rushed to the area, engulfing and destroying any germs introduced through the open wound. Subsequently, clotting enzymes activated by the torn blood vessel mobilized sticky platelet cells which were dispatched to the site and clumped together to help plug the opening. The plug would form a scab and be reabsorbed into the body. Eventually, fibroblasts would begin to gather at the site and produce collagen, which would gradually heal the wound with natural connective tissue.
Although Elias was stable, he was still not out of danger. If part of the fibrin glue or the blood clot were to break off before the healing was complete, it could quickly travel through his bloodstream and become lodged in an artery, cutting off circulation and causing brain damage or cardiac arrest. Fortunately, post-operative cognitive tests with Elias had indicated the temporary stoppage of blood and oxygen to his brain was not long enough to cause any loss of mental acuity. He was now sleeping quietly in his hospital bed with tiny electrodes attached to his chest, monitoring his heart rate and the oxygen saturation of his blood.
Shortly after eleven a.m. on Tuesday morning, Elias’s body suddenly jerked and he woke up with a start. Almost immediately, his breathing became labored, and the normally regular oscillations of his heart rate pattern on the cardiac monitor beside his bed began dancing wildly. Fifty feet away, a loud alarm went off at the ICU nursing station.
Jane was the nurse on duty. She looked up from her charting responsibilities to view the monitor providing a live feed from Elias’s room and instantly leapt to her feet. She immediately recognized the signs of a cardiopulmonary emergency: the rapidly spiking EKG pattern and plummeting blood oxygen levels meant her patient was receiving insufficient oxygen to the heart and lungs and would soon be in danger of cardiac arrest. Instantly picking up her phone, she dialed the emergency extension and gave the operator the bare essential facts: code name, the hospital unit, and the room number. Then she rushed to Elias’s suite to initiate emergency life support procedures.
When she entered the room, Elias was sitting up clutching his chest and gasping for breath.
“It hurts—” he cried between gulps for air, “my chest hurts! I can’t breathe!!”
Following standard protocol, Jane immediately initiated an emergency assessment.
“Were you eating, or did you choke on anything?” she quickly asked.
Elias shook his head quickly from side to side.
From her years of experience providing critical care support to geriatric patients on the ICU, Jane had seen this condition before. She reached into a sideboard beside the bed and pulled out a high-flow oxygen mask then immediately connected the long transparent tube to an outlet in the wall. Placing the mask snugly over Elias’s nose and mouth, she dialed up the flowmeter to ten liters per minute.
“This should help,” she stated, while ratcheting up Elias’s bed to support his body. “Try to lean back and breathe deeply—the doctor will be here soon.”
In his elevated state of shock, Elias was only barely aware of the loud announcement over the hospital’s public address system.
“Code Blue,” the announcer called. “Respond immediately to Unit IC-2A. Repeat. Code Blue—Unit IC-2A.”
While she waited for the emergency response team, Jane tried to comfort her patient, but his rapidly deteriorating condition belied her gentle caresses and forced smile. Elias was beginning to cough raspily, and the spastic expansion and contraction of his abdomen indicated he was laboring to oxygenate his lungs. Unfortunately, Jane knew there was little else she could do for him until authorized personnel arrived on the scene.
Where is the EMT team?! she agonized.
Although it was only a few more seconds, it seemed like an eternity before Dr. Boyd, the ICU resident doctor, rushed into the room with two other nurses, one of whom was rolling a medical cart carrying a defibrillator, IV supply box, and an AmbuBag.
“Status?” Dr. Boyd curtly ordered.
“Heart rate 145, respiration 35, pulse oxymetry 85%—all rapidly deteriorating.” Jane answered.
“Is his airway clear?”
“From what I can tell, yes.”
Dr. Boyd pulled a tongue depressor out of his pocket and tilted Elias’s head back. By now, Elias was hacking and wheezing, and his eyes were wide as saucers with fright. Dr. Boyd quickly placed the wooden stick on the back of Elias’s tongue and looked down his throat with a lighted laryngoscope.
“Prepare a syringe with five thousand units Heparin—stat!” he ordered.
After confirming an unobstructed airway, Dr. Boyd knew there was only one other explanation for Elias’s alarming symptoms—he’d experienced a massive pulmonary embolism, with a large blood clot lodged in the major artery leading from the heart to the lungs. If the clot weren’t removed soon, Elias would be unable to deliver oxygen to his lungs or his heart, which would lead to imminent cardiac arrest.
As Jane quickly plunged a sterile syringe into a bottle of the prescribed anti-coagulant and filled it to the indicated level, Elias began thrashing wildly on his bed in respiratory distress. With the three nurses helping to hold Elias down, Dr. Boyd drove the needle into Elias’s arm and emptied the contents into his bloodstream.
“He’s turning blue!” another nurse shouted.
“Prepare for CPR,” Dr. Boyd announced.
“No!!” Rick shouted, suddenly appearing in the doorway. He’d rushed to Elias’s room as soon as he received the emergency page. A quick scan of the monitors above the bed confirmed his grim diagnosis: the tall, peaked P waves in a tightly bunched S1-Q3-T3 pattern clearly indicated Elias was suffering from Cor Pulmonale: acute distress in the right ventricle, from which the pulmonary artery descended. Elias’s lungs were quickly filling with blood, and Rick knew that the normally prescribed chest compressions and electrical defibrillation associated with cardiopulmonary resuscitation would only aggravate the condition.
“The only way to save the patient now is to remove the embolus,” he said, quickly pushing the less experienced doctor aside.
“Jane—bring me a pigtail catheter right away. I’m going to attempt a percutaneous thrombectomy.”
Having assisted doctors with these kinds of procedures previously, Jane knew this was a complicated operation which involved threading a thin guide wire with a coiled tip through Elias’s femoral artery up into the base of his heart, where the surgeon would attempt to scrape away the occluding tissue mass.
“Shall I prepare the OR?” she asked.
“There’s no time,” Rick declared, seeing Elias starting to cough up blood. “We need to do it right now!”
37
Calvin James lay on his cold damp bunk at the Manhattan Detention Complex, where he’d been moved two days ago after being denied bail at his latest arraignment hearing. Nicknamed ‘The Tombs’, the city-block sized structure had been built in the mid-nineteenth century over a boggy swamp in the Bowery, after which the massive complex soon began to sink into the fetid ground, creating a festering dungeon where thousands of prisoners abjectly awaited word of their fate or were sentenced to hang. Over the years, the facility had housed such notorious inmates as Mark David Chapman, Carlo ‘Don Capo’ Gambini, and the infamous hedge fund swindler, Bernie Madoff. Now thoroughly modernized, the nearly empty nine hundred bed jailhouse echoed with the ghosts of its long departed souls.
Calvin looked up at the dull gray concrete ceiling of his cell and contemplated his next step. Although his attempted interruption of Elias’s surgery had been repelled by hospital security forces, he had accomplished his primary goal of stopping the operation and at least temporarily preventing the removal of his son’s pituitary. During Elias’s recovery from surgery, he planned to launch a new legal challenge to the state’s plan to supersede his parental authority over Elias’s health.
In consideration of his current situation, although he had seriously vio
lated the provisions of his earlier release from custody, Calvin believed his latest offense would not be deemed sufficiently grievous to keep him behind bars for long. Even if he were sentenced to a short jail term, he was confident he’d be able to continue directing his subversive campaign from the inside, since he still had many unfinished plans to carry out.
Just as a sinister smile gradually developed on his thin lips, he heard the sound of a key rattle in his cell door.
“Mr. James,” the prison guard improperly addressed him, as he swung open the heavy metal door, “there’s an officer here to see you from the FBI. You’ll have to come with us to the interview room.”
As two juvenile guards escorted him down a long hall, Calvin felt the need to correct the ill-informed correctional officer.
“It’s Doctor James, if you don’t mind. I’d appreciate you accord me the proper respect while I’m under temporary detention.”
When Calvin arrived at the sterile interview room, he saw a single polished steel table with two metal chairs, surrounded by four walls embedded with smoky glass panels. In one chair sat a serious looking individual wearing a dark gray suit. The two guards closed the door behind him and retreated to sentry positions in the adjacent hall.
“Dr. James,” the seated juvenile declared when he saw Calvin enter the room. “I’m Special Agent Sanchez from the Federal Bureau of Investigation, and I’m here to ask you a few questions. Please make yourself comfortable.”
“Whatever would the FBI want with me?” Calvin asked, looking surprised. “Does your agency have jurisdiction over the incident at the hospital?”
“We’re not interested in that matter—that is a concern for the local police. I’m here regarding a matter of interstate commerce and industrial sabotage.”
“I can’t imagine how I could help you with that,” Calvin replied. “I have no involvement in any of that business.”
As a consequence of his confinement over the last few days, Calvin was genuinely unaware of the recent news concerning the hormone outbreak and the suspicion of patch tampering.
“Perhaps not,” continued the agent, “nonetheless, because of your past actions speaking out against the Global Longevity Initiative and your continuing interference in its related activities, you are a prime suspect.”
“I have no idea what you’re talking about. I’ve only exercised my civil rights in respect of peaceful protest in defense of my own rights and those of my constituency.”
The FBI agent eyed Calvin carefully for any sign of nervousness.
“Until recently, you mean,” he said. “Your forced intrusion at Mount Sinai could hardly be termed a peaceful protest.”
“Like you said, that’s a matter for the local police,” Calvin replied dismissively. “It doesn’t concern you.”
Agent Sanchez could feel his blood pressure starting to rise. Apparently, he had misjudged Dr. James—this was not going to be an easy interview subject.
“Yes,” he continued. “Except as it pertains to your possible motivation for this other, more serious, crime.”
“What is it exactly, Agent Sanchez, that you wish to ask me?” Calvin said, feigning irritation. “Perhaps you should stop dancing around the issue, and get right to the point.”
Calvin was actually quite interested to hear the latest news and get an update on recent external developments, even if it came from this adversarial source.
“Where were you on the evening of Saturday, November twelve?” Agent Sanchez demanded.
Calvin paused for a moment, unsure whether to reply.
“Where I usually am at that time of the week,” he finally replied. “In my personal rectory at the Garden of Eden church, where I reside.”
“Were you with anyone who can attest to your activities and whereabouts on that evening?”
“Normally, I would have been spending a quiet evening with my son—but as you may already know, he was viciously removed from his home by the Child Services Agency earlier that week.”
Calvin stared at Agent Sanchez with cold, blank eyes.
“Yes, I’m aware he’s been relocated,” Agent Sanchez replied. “And there was no one else you saw, or met with, that evening?”
“No—I was quietly preparing my sermon for the following day’s address.”
Agent Sanchez paused for a moment to review his notes.
“Do you know anyone who works at the Endogen headquarters in New Jersey?”
Calvin smiled, as the purpose of Agent Sanchez’ investigation was now becoming apparent—and he had no intention of providing information that might incriminate any of his followers.
“Not directly,” he replied, “but I have a large congregation at my church, and Endogen is a very large company. There’s a good chance that some members of my assembly may in fact work there.”
“I see.” Agent Sanchez scribbled some notes on his note pad. “What kind of interaction do you have, exactly, with your congregants beyond the delivery of your weekly sermon?”
Calvin was beginning to enjoy this little battle of wits with his opponent, for he knew that Agent Sanchez wouldn’t be able to connect him to any wrongdoing at Endogen, and he was happy to continue playing this game while misdirecting the FBI agent as much as possible.
“I take their periodic confessions as their spiritual counselor of course and offer additional personal guidance and counseling as requested.”
“Who did you specifically see for any direct consultations in the week leading up to the tenth?”
“I have hundreds of members in my congregation who need frequent spiritual guidance and support. I don’t keep track of the names and addresses of everyone who comes to see me in times of need.”
Agent Sanchez peered into Calvin’s eyes for any sign of subterfuge or any nervous twitch that might belie his true knowledge and motivations.
“Have any of your followers confided in you that they had planned or undertaken any illegal activities pertaining to Endogen’s operations?”
“They have not,” Calvin replied flatly. “But even if anyone had, I would not be at liberty to share that information with you, as their confessions are a sacred and private covenant between themselves and their pastor.”
“We could subpoena you,” Agent Sanchez threatened, “where you would be required to disclose such information under oath.”
Calvin’s face suddenly filled with blood as he lost his cool.
“Are you kidding me? Under oath?! What do you and the rest of your security apparatus know about oaths?” he railed, staring directly at the dark glass windows behind Agent Sanchez, knowing full well others were observing the interview. “There is only one valid oath that I, and the rest of my brethren, are duty-bound to follow, and that is our oath to God in heaven—to follow His commandments, and His will. There is no other valid law!”
Agent Sanchez saw that he was starting to get under Calvin’s skin and decided to press the advantage in an attempt to make him crack and possibly reveal some relevant information.
“There are also the laws of men, sir,” he replied firmly, “that must still be respected in order to live in a civilized society. And may I remind you, these are laws that are also enforced by men—with serious consequences. We are all duty-bound by these laws.”
“Perhaps lesser men—or boys,” Calvin mocked, looking again directly into Agent Sanchez’s eyes. “Those in the service of God know a higher power. I’m not afraid of the laws of men, as you call them. They have only led to the desecration of this society, and there is only one Judgment Day that everybody must reckon with. And that will happen after you and I, and everyone else in this world, dies—which you surely will.”
Sanchez decided to ignore the veiled threat and attempted to calm Calvin down in a last ditch attempt to extract some useful information.
“I respect your right to practice your beliefs, sir and only ask that you respect my duty to protect those under my jurisdiction as well. If you would be kind enough to a
nswer just one last question before I leave—have you noticed anyone missing from your weekly sermons since the evening in question? We’re specifically looking for someone who abandoned his job last Monday.”
Calvin took a minute to settle down before he replied.
“I’ve only been able to conduct one sermon since then because of my incarceration. But I assure you, my assemblies are always full. My congregation is very devoted—they always pay their respect on the Sabbath.”
“I’m sure they are, Dr. James,” Agent Sanchez said, finally giving up. “I’m sure they are a very devoted following.”
As Calvin smiled smugly at the FBI agent, the two guards suddenly entered the room and stopped about ten feet back of the table. Looking very nervous, their hands hovered close to the holstered taser pistols by their sides.
“I’m sorry to inform you, Mr. James,” the first one again erroneously addressed Calvin. “We’ve just been advised that there was an emergency at the hospital. Your son has passed away.”
Calvin’s smile quickly faded from his lips and the color drained from his face. Everything in the room suddenly seemed to fade away, and he became lost in his thoughts, anguishing over the loss of his son.
Then, just as abruptly, he became filled with rage as he slowly rose from his chair.
“Sir,” Calvin could hear one of the guards vaguely utter in his subconscious, “we need to take you back to your cell now. Please come with us…”
As Calvin clenched his fists and the veins began to visibly rise in his neck, the two guards slowly withdrew their tasers and all three officers nervously stepped back a few paces, awaiting their captive’s next move.
38
Joe Morgan shifted uncomfortably in his chair as he reviewed the hospital’s operations reports for the week. In his role as Chief of Staff, one of his primary responsibilities was monitoring and controlling the key performance measures for a range of patient and staff services. Every day he received electronic summaries showing updates and changes in vital statistics relating to patient inflows and outflows, average wait times, treatment time, length of stay, capacity utilization, and the number of NYDs—an indication that the evaluating doctor had not yet diagnosed the cause of the patient’s presenting problem.