PRAISE FOR ADRENALINE:
“If you like gripping drama, starkly effective description and almost unbearable suspense, then this book is for you.
The characters and places are engagingly real. It has been suggested by readers that this book would lend itself to an engrossing film.
Throughout intertwining subplots, significant hints are provided to the reader—including one startling revelation. The ending is breathless. I found myself totally unprepared for the plot twists, even though they had been amply prefigured. The rhapsodic tone of lovely inner reflection of love and its beauty when juxtaposed with the ugliness of killing is particularly welcome.
I hope that many will read Adrenaline. Without question, it will jolt you to some interesting insights.”
— Leslie S. March
Harrisburg Magazine Review
“This guy can flat out write. Benedict has a great grasp of the many ways language can be used in telling a story, paired with the skill to do it, which is the thing that makes him stand out… Add in a good feel for the basics of pacing the story and sentence structures, a superb eye for the role of detail, and the priceless ability to draw a reader in until they forget that they’re actually reading the story they’re in the middle of.”
— Poisonedpenpress.com
“Properly entitled, Adrenaline is a thrill ride from the opening chapter. Dr. John Benedict has written a novel encompassing the intrigue of Michael Crichton’s E.R. combined with the thrill of Crime Scene Investigations. This is a top-notch medical thriller and I hope it is the first of many from Benedict. He could easily become the next Dean Koontz with a medical degree.”
— Robert Denson III
Managing Editor of Sunpiper Press
www.sunpiperpress.com
“Benedict has done an outstanding job at creating scenes, as well as characters, using every detail no matter how miniscule to evoke clear images and emotional response from readers, thus allowing us to really care about what happens to these characters.”
— Betsie’s Literary Page
betsie.tripod.com/literary
“Filled with accelerating suspense, author Benedict builds the plot that moves Adrenaline forward with methodical and deliberate subplots and characters, each of which succeed to broaden the mystery and draw the reader deep into the workings of the operating rooms and administrative offices of Mercy Hospital. Characters are pleasantly humanized, his plotting is meticulous, offering a thrilling journey.
Adrenaline offers a new take on the term ‘Medical Thriller’ that offers a breath of fresh air to the meaning of the term.”
— Denise M. Clark
Denise’s Pieces Author Site & Book Reviews
www.denisemclark.com
“A series of mishaps and an accidental death at a Pennsylvania hospital raise suspicions of sabotage in the author's debut medical thriller. Doctors in the anesthesia department at Our Lady of Mercy Hospital are worried about losing their jobs in an impending merger, so it doesn't bode well when a patient dies soon after anesthesia is administered. Dr. Doug Landry and others are unaware that someone in their department is intentionally setting up the anesthesiologists for failure in a series of desperate acts that will ultimately lead to outright murder. Benedict's novel is a mystery story rife with suspense: A killer, whose identity is concealed, creeps into dark operating rooms; med student Rusty, searching for his elusive past, finds his way to Mercy; and a patient awakens in the midst of surgery, unable to move but feeling every agonizing cut. There's a hefty number of subplots: Doug's temptation to stray from his marriage vows with a flirtatious hospital employee; sympathetic Dr. Mike Carlucci recalling patients he's lost and trying not to succumb to the pressures of the job; plus Rusty's training and the threat of a suit against the hospital. But through shifting perspectives and a focus on the darker side of medical care--Doug tells Rusty how easily anesthesia, inadvertently or not, can become lethal--ensure that the various plots are less sentimental and more in tune with the murderous saboteur. Twists and turns abound as the story progresses, and they hit a crescendo in a scene of utter ferocity that's violent and intense.”
—Kirkus Reviews
PRAISE FOR THE EDGE OF DEATH:
“A deftly written masterwork in the medical thriller genre, author John Benedict's The Edge of Death is the riveting sequel to his earlier novel Adrenaline and very highly recommended reading.”
— Midwest Book Review,
James A. Cox, Editor-in-Chief
“Soul Satisfying!!! Another inspired book by Dr. Benedict! The book surpassed all my anticipations and took me to the realm of an incredible combination of scientific learning and mysticism.
I adore the way the book ends with that veiled promise of there being more to follow!!! All in all, a MUST NEVER MISS magnificent book! I would recommend everyone to read it.
Thank you, Dr. Benedict. I look forward to your next book, Fatal Complications with a tremendous amount of eagerness.”
—Uma I. Van Roosenbeek
Breathtaking! Once started, there is no way you can put this book down! Suspenseful to the max, this medical thriller is tightly paced and takes your breath away. With a supernatural twist, it keeps you thinking. This book made it all the way to Germany and you can tell that this author knows what he is talking about when he takes the reader to the OR or ICU - since he is an anesthesiologist himself. So be sure not to miss this exciting medical thriller and Dr. Benedict’s debut work: Adrenaline! These books can definitely be placed in a row with Tess Gerritsen or Patricia Cornwell. Five Stars!
—U. John
“Absolutely brilliant! We do put a lot of trust in our medical care providers. How far will technology go in the future to sustain life? This book kept me on the edge.”
—Sharese Reese
Top-Notch Medical Thriller! As in his first book, Adrenaline, the author takes several subplots and connects them to bring you the full story in the end. The story is excellently written, with lots of action and a few “nail-biting” moments. The characters are well-developed, from bad guy Nick Chandler, to underdog Chip Allison, to creepy Frankenstein-ish Dr. Mueller, to Adrenaline alumni Doug Landry.
Oh, and an ending that you’ll never see coming! The Edge of Death gets 5 well-deserved stars!
—Kristen Chandler
Heart-pounding Medical Thriller! Oh my gosh, I got caught up in this book so fast, I just hated to put it down to get other things done. This was a page-turner from beginning to end as it kept me guessing and visualizing every scene and character. This fabulous book gets you thinking about and looking at people with near death experiences differently. Dr. Landry and his wife Laura along with Chip and Kristin go through one horrific ordeal after another in this spine-tingling tale. I definitely recommend this to anyone who loves thrillers, especially medical ones. Hope there’s another novel coming soon from the brilliant John Benedict!
—PammySue
By John Benedict
Adrenaline
The Edge of Death (sequel to Adrenaline)
Fatal Complications (coming: December 2014)
Copyright © 2013 John Benedict
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopy, recording or any other, except for brief quotations in printed reviews—without prior permission of the author.
This is a work of fiction. Names, characters, places and incidents are the product of the author's imagination or are used fictitiously. Any resemblance to actual events or persons, living or dead, is entirely coincidental.
ISBN# 1-56315-355-6
Libra
ry of Congress # 2004109498
ISBN# 1484897528
EAN# 9781484897522
Cover Design: Jonah Lloyd
Cover Art: Jonah Lloyd
To my dearest wife,
Lou Ann,
whose constant love and support
continually transform my dreams into reality.
CONTENTS
CHAPTER ONE
CHAPTER TWO
CHAPTER THREE
CHAPTER FOUR
CHAPTER FIVE
CHAPTER SIX
CHAPTER SEVEN
CHAPTER EIGHT
CHAPTER NINE
CHAPTER TEN
CHAPTER ELEVEN
CHAPTER TWELVE
CHAPTER THIRTEEN
CHAPTER FOURTEEN
CHAPTER FIFTEEN
CHAPTER SIXTEEN
CHAPTER SEVENTEEN
CHAPTER EIGHTEEN
CHAPTER NINETEEN
CHAPTER TWENTY
CHAPTER TWENTY-ONE
CHAPTER TWENTY-TWO
CHAPTER TWENTY-THREE
CHAPTER TWENTY-FOUR
CHAPTER TWENTY-FIVE
CHAPTER TWENTY-SIX
CHAPTER TWENTY-SEVEN
CHAPTER TWENTY-EIGHT
CHAPTER TWENTY-NINE
CHAPTER THIRTY
CHAPTER THIRTY-ONE
CHAPTER THIRTY-TWO
CHAPTER THIRTY-THREE
CHAPTER THIRTY-FOUR
CHAPTER THIRTY-FIVE
CHAPTER THIRTY-SIX
CHAPTER THIRTY-SEVEN
CHAPTER THIRTY-EIGHT
EXCERPT FROM THE EDGE OF DEATH:
CHAPTER ONE
“Shit! Don’t give me any bullshit!” said Dr. Mike Carlucci under his breath, as his gaze locked on the unusual rhythm displayed on the EKG monitor. His warning was meant mostly for his patient, Mr. Rakovic, who was scheduled to undergo an arthroscopy of his right knee. Mike’s plea was also directed at God, just in case he was listening, and at the monitor itself to cover all bases. Mike didn’t expect a reply from any of them. Mr. Rakovic was deeply unconscious with an endotracheal tube sprouting from his mouth. Mike had just induced general anesthesia and was preparing to fill out his chart when the trouble began.
Mike stared grimly at the potentially lethal dysrhythmia known as ventricular tachycardia, or V-tach, and felt the first raw edge of fear scrape lightly across his nerves. It occurred to him that he had never actually seen V-tach during a routine induction in his six years at Mercy Hospital, or during any induction for that matter. It was something that happened in the case reports, not in real life. He wondered if Doug Landry, his best friend and colleague, had ever seen it.
His first instinct was to doubt the EKG. Frequently movement of the patient or electrical interference caused the EKG to register falsely. He rapidly scanned his array of other monitors. Modern anesthetic workstations had upwards of ten sophisticated computer-driven monitors. Substantial redundancy of these instruments allowed him to check one machine’s errors against another. The pulse oximeter, a small finger-clip sensor, beeped at a heart rate exactly the same as the EKG. This unfortunately ruled out the possibility of EKG artifact; there was no false reading this time.
Mike absently fingered the gold crucifix dangling from his neck. Grandma Carlucci had brought it back from Lourdes, and had given it to him when he had graduated from med school. The medallion always comforted him. He punched his Dinamap, the automatic blood pressure machine, for a stat reading. The mass spectrometer system, which continually monitored the gasses going in and out of Mr. Rakovic’s lungs via the endotracheal tube, registered normal carbon dioxide levels. Mike breathed a sigh of relief; it meant the breathing tube was properly positioned in his patient’s trachea and not in the esophagus. He quickly checked breath sounds with his stethoscope to ensure both lungs were being ventilated normally. They were. The pulse oximeter showed a ninety-eight percent oxygen saturation level, confirming beyond doubt that his patient was being adequately oxygenated. Again good. However, nothing to explain the sudden appearance of V-tach.
The blood pressure reading would be key for a number of reasons. First and foremost, Mike knew he must treat the offending rhythm; its cause was of secondary importance at the moment. A normal blood pressure reading would mean Mr. Rakovic would still have adequate blood flow to his vital organs—brain most importantly—in spite of the rhythm disturbance. Mike knew that as V-tach accelerates, the heart can beat so fast it doesn’t have time to fill and fails as a reliable pump. The blood pressure can fall drastically or disappear altogether.
“C’mon you piece of shit! Read, damn it!” Mike hissed under his breath to his Dinamap. Fifteen seconds never seemed so long. While waiting for the blood pressure, he opened the top drawer of his anesthesia cart and pulled out two boxes of premixed Lidocaine, a first-line emergency antidysrhythmic drug. He ripped open the boxes and assembled the syringes. He glanced up at Diane, the circulating nurse. She was busily filling out her paperwork, oblivious to any problem.
“Diane,” Mike called out, “I got trouble here. Get the crash cart!”
“Jesus, Mike! Are you kidding?” asked Diane, eyes bugging wide, pen frozen in mid-task.
“Serious badness,” Mike said, trying to keep the dread he felt out of his voice. “Looks like V-tach.” His voice sounded a little higher than he had intended.
“Oh shit!” she said as she hurried out of the room, almost tripping over the trash bucket. Mike was thankful that Dr. Sanders, the orthopedic surgeon, was still out of the room scrubbing his hands. No time to tell him just yet; he wouldn’t take it well. If the blood pressure were unacceptably low, Mike would need to shock the patient back into a normal rhythm. He injected one of the syringes of Lidocaine into the intravenous line and simultaneously felt Mr. Rakovic’s carotid pulse. It was bounding, arguing against a low blood pressure.
250/120! “Holy shit! Where’d that come from?” Mike asked the leering LED face of the Dinamap. Accusatory alarms screeched from the Dinamap in response. Mike truly had not expected such a high blood pressure and was momentarily confused. The temperature in the OR seemed to have jumped twenty degrees, and he felt rivulets of sweat coursing down his arms. The fear was back and not so easily dismissed this time. Think, damn it, think! What would Doug do?
He quickly reviewed what he knew of Mr. Rakovic’s medical history and his own induction sequence. Mr. Rakovic was a sixty-two-year-old hypertensive with a history of coronary disease and a prior heart attack. But, his hypertension was well controlled on his current regimen of beta and calcium-channel blockers. Mike knew his patient had a bad heart, and had taken care to do a smooth induction along with all the usual precautions to avoid stressing the heart. A blood pressure of 250/120 and V-tach at 160 beats-per-minute were about the worst stresses any heart could undergo. Mike knew this, but was still baffled. Be cool, Mike. Be cool.
He had been stumped before; medicine was by no means an exact science, and anesthesia was one of the frontiers. Mike also knew better than to waste precious time pondering this. As long as he had reviewed it sufficiently to make sure he hadn’t overlooked something, it was time to move on to the immediate treatment. He could replay the case to search for subtle clues when Mr. Rakovic was safely tucked in the recovery room.
What lurked in the back of Mike’s mind during these first few minutes, prodding him along, was the specter of ventricular fibrillation or V-fib. V-tach was reversible with rapid proper treatment. V-fib, on the other hand, was often refractory to treatment, leading to death. The problem was that V-tach had a nasty habit of degenerating into the dreaded V-fib without warning. The longer V-tach hung around, the more likely V-fib would appear. So Mike knew time was of the essence.
“Gotta bring that pressure down,” Mike mumbled to himself. He reached back into his drawer for Esmolol, a rapidly acting, short duration beta-blocker designed to lower blood pressure. He drew up 30 mg and pumped it into the IV port. He also punched in the second syringe of Lidocaine
. Mike tried hard not to take his eyes off the EKG monitor for long as he drew up and administered the drugs. He wanted to see if the V-tach broke into a normal rhythm or converted into V-fib. Irrationally, he felt that if he continued to watch the rhythm it wouldn’t convert to V-fib; if he took his eyes off it for too long, the demon might appear.
His Dinamap on STAT mode continued to pour forth BP readings every 45 seconds. 290/140.
“What the hell!” Mike said. Alarms were now singing wildly in the background, adding to the confusion.
Just then, Dr. Sanders charged into the room demanding answers. “What’s going on here, Carlucci?” roared Sanders.
Mike didn’t have time to deal with the irate surgeon. A wave of nausea swept over him as he felt events slipping out of control. Things were moving so goddamned fast. Fear threatened to engulf him. “Hypertensive crisis!” he managed to blurt out while he grabbed for some Nipride, his strongest antihypertensive. Unfortunately, it had to be mixed and given as an intravenous infusion rather than straight from the ampule. This would take a minute Mike and his patient could ill-afford. Diane returned with the crash cart and several other nurses. She looked at Mike and said, “Do you need help?” It certainly sounded like she thought he did.
“Get Landry in here stat!” Mike yelled in response. He took his eyes off the monitor as he worked on the Nipride drip. Just as he got the Nipride plugged into the IV port, he heard an ominous silence.
The pulse oximeter had become quiet. Usually the pulse ox signaled trouble, such as a falling oxygen saturation, by a gradual lowering of the pitch, not an abrupt silence. Mike could think of only three possible causes, and two of them were disasters—V-fib or cardiac standstill. The third reason could be as simple as the probe slipping off the finger. Although this third possibility was enormously more likely, Mike doubted it. As he turned his head toward the EKG monitor, he knew with eerie prescience what awaited him.
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