“Think, Think,” he muttered to himself. “Must’ve been playing possum.” Doug figured that Mr. Lehman may have appeared to have been adequately anesthetized just prior to intubation but actually wasn’t. He knew that intubation is a very stimulating procedure. It can cause a grossly elevated BP and a dangerously rapid heartbeat and/or V-tach in a sick heart.
Doug didn’t wait for his BP machine to cycle. He quickly turned his anesthetic agent to the max and in rapid succession administered as much Fentanyl as he had, injected one syringe of premixed emergency Lidocaine, and gave some Labetalol. In so doing, Doug went way out on a limb. His clinical instinct told him his patient had an exaggerated sympathetic response to the intubation; an outpouring of adrenaline from his adrenal glands in a classic flight or fright response. Doug didn’t have all the facts in yet, but sometimes waiting the extra thirty seconds to be sure of the diagnosis could cost thirty seconds of treatment time and push you over the edge into irreversible damage. He had just given enough drug to dangerously lower a normal person’s BP. But, it may have been lifesaving in a hypertensive crisis.
Funny thoughts ran through his head. He heard Kelly McGillis from the movie, Top Gun saying, “That’s a hell of a risk with a thirty-million-dollar airplane lieutenant. What were you thinking?” To which he responded in Tom Cruise fashion, “You don’t have time to think up there. If you think, you’re dead.”
230/110! I knew it! The V-tach had persisted and quickened. The crash cart rolled through the door with Dr. Kim Burrows, Dr. Patterson, the surgeon and several OR personnel in tow. Stat pages for the crash cart had a way of attracting people.
“What’s the problem, Doug?” Kim asked.
“V-tach on induction. Out of the blue. Gotta shock him quickly before it gets worse. Pressure went sky-high, but I think I got a handle on it—mix me some Nipride though.” Doug was happy to have Kim’s help; she was good in these situations.
“Landry, what’d you do to my patient?” bellowed Dr. Patterson.
“I’m kinda busy right now, Tom. If you wanna help, bring those paddles over here.” Doug knew Patterson didn’t like to relinquish control, what with the surgeon being captain of the ship and all, but he knew that in these situations the anesthesiologists were actually far better qualified to render emergency treatment. He pushed the defibrillator unit up to the OR table and handed the paddles to Doug.
“Charge to 200 joules,” Doug ordered. “Set to synchronous.”
“Synchronous set—charging—ready, Doug,” said Kim, who’d pushed the fumbling Patterson out of the way.
Doug applied the paddles, shouted “Clear,” and fired them into Mr. Lehman’s chest. God, he hoped this would turn around.
“No good!” shouted Kim. “Nipride’s ready. I’m plugging it in. What’s the pressure?”
On cue, the Dinamap beeped with the newest blood pressure, 220/100.
“Still up there,” said Doug, but he was thankful to see a lower pressure. “Give me three hundred. Run the Nipride wide.”
“Paddles ready,” said Kim.
Doug applied the paddles a second time and let the electricity loose. Everyone held their breath waiting for the electrical interference to die down so they could make heads or tails of the EKG.
“Sinus! Doug, you got sinus!” shouted Kim. Respirations resumed collectively in the room with an audible rush. “Better watch the pressure with all that pride on.”
“Yeah, I’m cutting it back, Kim.” Doug regulated the dangerous Nipride drip.
Doug and Kim stared at the Dinamap waiting for the next BP. The machine beeped and showed, 190/90.
“Nice going, Landry,” said Patterson. “You just saved the patient from yourself. Now can we proceed with the surgery?”
“Yeah, yeah,” Doug said. “Thanks a lot. You can forget about surgery today—”
“Now, wait just a minute,” Patterson interrupted. “He’s my patient and—”
“Surgery’s canceled, Tom,” Doug snapped back. “Get it? Canceled!”
This stopped Patterson momentarily and he gave Doug a puzzled look. The rest of the people in the room were also looking at him. Doug was pleased; he knew they were surprised to hear him tell off the surgeon.
“I’m gonna take him to the SICU,” said Doug, “and let the cardiologists evaluate his heart. Something’s obviously not right.” Doug took a couple of deep breaths and tried to urge his own heart to slow down. One patient with V-tach was enough.
Patterson huffed out of the room, muttering something about not having these problems at Poly.
“You OK, Doug?” asked Kim.
“Yeah. Thanks for your help, Kim.”
“Sure,” she said. “Way to tell Patterson off. He’s such a pain in the butt.” She paused for a couple of seconds and looked at him. “I’ve never heard you raise your voice before. I didn’t know you could.”
“Yeah, I know it’s unusual.”
“You save the guy’s life, and all Patterson’s concerned about is having his surgery canceled.” She walked out of the room shaking her head.
Sue Hoffman came over, put her hand on Doug’s arm, and squeezed gently. “Nice going, Doug.” He met her eyes and could tell she was smiling beneath her mask.
Doug stared out of the window in the OR complex, far down at the end of the hallway. He had just returned from tucking Mr. Lehman safely in the SICU. Snow flurries swirled about outside. He imagined their delicate, individual shapes being whipped thoughtlessly by the rough December wind. He had come down here to try to collect his thoughts after Mr. Lehman’s case. He had to pull himself together; he still had two cases to go. He took several deep breaths, closed his eyes, and focused on the crystalline snow and ice—pure and simple. What was the point of emotions anyway? They just got him into hot water. Doug tucked his feelings back into the freezer of his mind and headed down the hall to meet his next patient.
CHAPTER SIXTEEN
Bryan Marshall couldn’t get Karen McCarthy out of his mind. She had always been a favorite of his. Except now, he wasn’t focusing on the good times. Here he was, sitting in his office Monday morning supposedly preparing for a big meeting with Pinnacle and hospital administration. Instead the door was locked, the metal box in the drawer was open, and her pictures were strewn about the desk. He kept thinking about their conversation that stifling hot night in August so long ago; it had been the last time they had ever spoken. God, his head hurt. He leaned forward and cradled his throbbing head in his hands. Was it really possible to develop a conscience after twenty-five years? He only did what he had to do. He could still hear her voice, quavering but full of determination.
“May I come in,” Karen McCarthy asked, standing in the doorway to his office.
“Of course,” Marshall answered. He was seated at his desk and motioned for her to enter. “What a pleasant surprise,” he said warmly; he was always pleased to see her. The two were on call together, but the OR was quiet, and the last thing he expected was for her to drop by. “It’s kind of late for a meeting.” He checked his watch. “It’s past midnight. What will people think?” he asked and chuckled.
Karen ignored him. “I have something to tell you,” she said. Her face held a grim expression. She looked past him, avoiding direct eye contact.
“Ah, you’ve made a decision regarding your, uh, problem?”
“Yes, I have.”
“Good girl.” He had never doubted Karen was a bright girl. “I know just the place in Chambersburg.” He reached forward to consult his Rolodex. “Friend of mine runs it and—”
“I’m not going there,” she said firmly.
He paused for a moment and raised his eyebrows with surprise. “You prefer some other facility?”
“No, I’m not going anyplace. I’m going to have this baby!”
“Are you now?” Interesting, he thought. This girl was feistier than he had given her credit for. He had been taking advantage of her regularly for six months, and by some stroke of bad luck, s
he had become pregnant. But so far, she had shown no sign of backbone. He slid out of his chair and rounded the desk. “What about your career? What about your baby at home? Are you forgetting all this, dear girl?” he asked smoothly, as he narrowed the distance between them.
She began to tremble, but held her ground. “We’ll manage. I’ll get another job.” She locked eyes with him, and through the fear, Marshall thought he saw some strength, some determination, he wouldn’t have thought possible. But he wasn’t about to be cowed by anyone, let alone a young woman with a big problem. He had plenty of experience bending people to his will. He adopted a menacing tone. “Don’t be so sure. I have contacts all over. You’ll never set foot in another OR!”
She appeared to cringe at his voice, but amazingly continued to hold his gaze. He felt his face flush with blood; his anger, simmering always just beneath the surface, threatened to erupt. He took several deep breaths to calm himself and played his trump card. “Karen, no one will believe your little fantasy of coerced sex. There was no gun to your head; you put up no struggle.” She tried to protest, but he continued, louder. “What they will believe, is that you came on to me, and in a moment of weakness, I acquiesced. It’ll be your word against mine. Remember though, you’re the one with the credibility problem. You lied on your application—you do have an out-of-wedlock child.”
Marshall studied her pretty face; his words had the desired effect. Her head drooped, and he saw the determination drain out of her face. “We’ll work it out Karen,” he said soothingly and began to stroke her shoulder. “We always have. No need for rash decisions.” He became aroused seeing her helplessness and reached out with his other hand to fondle her.
Suddenly, her head snapped up and she glared at him. Before he could react, she coiled her arm and let loose a vicious blow that connected solidly with the side of his head, sending his glasses flying. Marshall reeled backwards in total shock. Pain reverberated through his skull, and his face stung miserably. He sucked in several large ragged breaths, as he rubbed his face. He took a step toward her and stopped. His anger burned hugely through him, and he was shaking. Only a Herculean effort on his part stopped him from strangling her on the spot. “Get out of here, you whore!” he bellowed, pointing at the door. “You’re finished here! You’re finished!”
“No, I’m not,” she said, as she made for the door. “One more thing.” She turned to face him. “I’m going to tell everyone who the father is!” She slammed the door in his face.
Marshall’s watch beeped on the hour—10:00 a.m. His heart was pounding from the memory of his encounter with Karen. Stupid, idealistic girl. What a waste.
Marshall rocked back in his chair and wondered what was taking Sister so long to summon him to the meeting? Pinnacle, with their army of arrogant consultants and high-powered lawyers, must already be there, poisoning the well. Marshall hated the ever-increasing intrusion of big business, law, and politics into medicine. He smiled with the realization that if Karen and he had tangled nowadays, she would’ve slapped him with a sexual harassment suit so fast his head would’ve spun. And she would’ve easily prevailed. Luckily, things were different back then. He remembered the way Karen had looked as she had left the hospital that morning—the morning after she had hit him. He walked over to the window overlooking the parking lot, the same window he had watched her leave for the last time twenty-four years ago.
Karen was all smiles and looked light on her feet as she made her way out to her VW beetle. Her recent defiance made his blood boil all over again. Marshall absently stroked the side of his face where she had whacked him last night. He’d teach her a lesson or two about who was boss around here. She reversed her car out of the parking space and then pulled smartly away, windows rolled down. He knew she would head home to Halifax via Route 225. The road was a treacherous, two-lane affair that snaked over Peter’s Mountain. The lanes were narrow, shoulders were often absent, and it had numerous hairpin turns, a carryover from road design of bygone years. Old, rusted guardrails offered only illusory protection from several hundred-foot drop-offs.
Marshall believed he could see her singing, probably to the radio, as she pulled out. She obviously hadn’t noticed the greenish fluid underneath her car. He couldn’t see it from here, but he knew it was there—little puddles of brake fluid that had dribbled onto the asphalt from the brake lines he had cut several hours ago. Sing Karen, go ahead and sing.
Karen was very proud of herself as she made her way out of the hospital. Her night shift was over, and she was headed home. She laughed out loud for the first time in months.
They’d make it. Marshall had underestimated her strength when he had targeted her. She turned on the radio and started humming along with the Bee Gees as she headed out of the parking lot.
She had a good twenty-five mile drive over Peter’s Mountain to get home. Normally she minded the commute, but today she knew she’d enjoy it. Not even the gray, clumping storm clouds could dampen her spirits. She was free of him.
As she braked for the first stoplight, the Beetle lurched a bit, but the engine rumbled happily as it idled. She was in such a good mood, singing aloud with the blaring radio as she planned her new life, that she ignored the odd feel of her brake pedal. Soon she was climbing Peter’s Mountain and had no need for the brakes.
Rain let loose with a fury on top of Peter’s Mountain. Karen turned on her lights and windshield wipers and tried to pay more attention to the road. She was coming up on the first and sharpest of the hairpin curves, going about forty mph.
She touched her brakes, intending to slow down. Nothing happened. She pushed harder on the pedal, and it slid all the way to the floorboard with sickening ease. Again, nothing happened to slow the vehicle. The Beetle even accelerated from the downhill grade of the road.
“Oh shit!” she said, jarred completely out of her daydreams. Something’s horribly wrong. She mashed on the pedal with all her strength. Nothing. The guardrail loomed ahead, perhaps thirty feet and getting closer all the time.
I’m not going to make it! The Beetle was now going forty-five mph and still accelerating.
She quickly downshifted to first gear and popped the clutch, gears grinding loudly. Even the Bug’s renowned synchromesh transmission was not up to this abuse. The engine howled in distress when the gears finally engaged. The car shuddered, and she was thrown forward by the force of deceleration. The car slowed, but it still didn’t seem like enough.
The guardrail was fifteen feet away. She grabbed the emergency brake lever and ripped it with all her might. The car slowed further. Please God, help me!
The Beetle plowed through the rusted guardrail at twenty mph, retaining just enough momentum to send it over the steep embankment. It rumbled and rolled like a toy, bouncing off rocky ledges and stunted trees before coming to rest on a gentle slope wedged up against two larger trees. Amazingly, Karen still clung to consciousness. She felt no pain, although she could feel something warm running down her neck and soaking her shirt. She looked down and saw dark blood mingle with her strawberry hair and thought the colors were beautiful. She lifted her head with effort and had trouble focusing her eyes. Finally, she made out an exquisite spider web pattern in the front windshield. My head made that, she thought giddily. So pretty. Sadly the shattered glass wouldn’t stay in focus and began to dim. She was so tired, so weak, all she could do was listen to the rain drum heavily on the crumpled metal roof. Time for a quick nap, she thought and closed her eyes.
The office intercom buzzed. Julie, the group’s secretary, said, “Doctor Marshall, Sister’s calling for you now.”
“OK, thanks.” He hastily scooped up the photos and replaced them in the box. A single newspaper clipping was left on his desk. He unfolded the old, yellowed paper carefully and read the headline—“Nurse dies in accident on Peter’s Mountain.” He shook his head, folded the clipping and put it back. He locked the box and closed the drawer.
The intercom came to life again. “Doctor Mar
shall, I just got word from the OR,” Julie said. “They had another cardiac arrest down there. It was Landry’s case.”
CHAPTER SEVENTEEN
Melissa Draybeck spun the dial hard on her combination lock. “Damn it!” she muttered to herself. Finally, on the third try, the lock yielded to her nervous fingers. She tugged her scrub top over her head.
“Hey, Melissa,” Sue Hoffman said. “Heading out?”
Melissa startled from the question; she hadn’t noticed Sue’s approach. “Yeah, I’m going home,” she replied. She thought her own voice sounded high and squeaky.
“Didn’t mean to scare you, there,” Sue said. “You OK? You look a little pale.”
“Yeah, fine,” Melissa said halfheartedly as she stripped off her pants. Sue was a comfortable work friend, and they occasionally socialized outside of the hospital. “You leaving?”
“Naw, I’m taking Bonnie’s evening shift. I need the OT,” Sue said, as she opened her locker several rows over. “I’m just getting some dinner money.” She clanged her locker shut and turned to leave. “See ya.”
“Take care.” Suddenly, Melissa was struck by an idea and called to Sue excitedly, “Hey Sue, wait. You were there.”
Sue stopped and turned, a puzzled look on her face. “What’re you talking about?”
“I heard Landry’s guy cased and all, but what went on?”
“Oh, that,” Sue said. She took on a thoughtful expression. “Well, it was a little odd. He was a real big guy, not really fat, just big. Right after Doctor Landry intubated him, he went into V-tach out of the blue.”
“Did Landry have trouble with the tube?” Melissa asked.
“No, didn’t seem to.”
Melissa ignored her clothes for the moment and just stood there in her underwear. She stared at Sue and asked, “Sue, did you notice anything funny when you set up the room?”
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