“Why?” Mike asked. He continued to decorate his coffee cup in earnest with fingernail carvings.
“You, too, Rusty.”
“We had a visiting professor,” Rusty said quickly, “and I had to stay at the med center to hear his boring lecture.” With genuine disappointment he added, “What’d I miss?”
Before Doug could answer, Mike looked up and said, “I heard the nurses talking about it in my room this morning. What happened, Doug?”
“Well, not much to tell,” said Doug. “Really strange. I induced the guy, intubated him, and boom, his pressure went sky high. Next thing I knew, I had V-tach.”
“That sounds just like Dr. Carlucci’s case,” Rusty said excitedly. He pulled a second bagel out of his scrub jacket pocket and also produced a mini-container of cream cheese and a plastic knife.
“Yeah, I know,” said Doug. “I was there. Pretty weird, huh?”
Mike stopped playing with his coffee cup all of a sudden and became rigid in his seat. “Doug, did you have fib?” he asked.
“No, I was lucky,” Doug said. “I got the pressure down and shocked him out of V-tach before it got bad. He’s still in the SICU.”
Mike looked lost in thought.
Rusty said, “What d’ya make of it, Doctor Landry—”
“It’s Doug, Rusty.”
“OK. The cases being so similar and all?”
“I don’t know,” Doug said. “Bizarre coincidence, I guess.” Doug didn’t really think much of the experience. Twelve years in the OR had taught him to be a frank pragmatist. He was a firm believer in the expression that had been drilled into him as a resident: “When you hear hoofbeats, don’t think zebras.” Perfectly logical explanations abounded for the mishaps. Perhaps he had gotten a little sloppy with his induction. He knew intubation itself was a very powerful stimulation. If the patient isn’t deep enough prior to intubation, a large sympathetic outflow may be triggered and send the pressure very high. He’d seen it before. Although he had to admit, he’d never seen it progress to V-tach, but he figured that was just bad luck.
“Doug, did you hear about Ken’s case?” Mike asked impatiently, sounding almost agitated. He met Doug’s stare for the first time.
“I heard he had an awareness case last week—”
“Yeah,” Mike interrupted, “the lady, Mrs. Lubriani, remembered half of her surgery. Her lawyer’s going through her medical record now.”
“That’s too bad.”
“Too bad? Is that all you can say?” Mike was glaring at him. “Ken feels like shit—did you talk to him?”
“No, I haven’t run into him yet. Why, what’s up?”
“He thinks somebody tampered with his machine beforehand.” Mike was on his feet, his voice becoming shrill. “There was Suprane in the Forane vaporizer!”
“Get out of here. How did he know that?” Doug asked incredulously.
“He smelled it.”
“He’s probably just mixed up,” Doug said. “They don’t smell all that different, Mike.” Rusty had stopped eating his bagel and was following the conversation intently.
“No, really Doug. He drained the vaporizer after the case and had it analyzed by the lab with their mass spec. It was Suprane all right.”
“The techs probably got mixed up and filled the wrong vaporizer.” Doug chugged the remainder of his lukewarm coffee. He felt more tired now than when he had come in.
“Doug, you’re the one who’s mixed up!” Mike said heatedly. “You know how hard that would be to do. Ken thinks someone did it deliberately.”
“What!? Is Ken here today?” Doug was on his feet, heading for the door. “I’ll go talk to him right now.” He passed close by Mike on his way out.
“Doug, wait.” Mike reached out and put a hand on Doug’s shoulder. “He’s not here. He took the day off—he’s still kinda shaken up by the whole awareness thing.”
Doug stopped, turned and said quietly, “Hmmm, seems like a lot of people are getting shaken up around here, Mike.” Doug met Mike’s eyes, but Mike quickly dropped his gaze.
“Doug, what if somebody did sabotage his machine?” Mike lifted his head slowly and met Doug’s stare. “Maybe there’s a connection with our cases.”
Doug saw the sincere, almost pleading look in his friend’s eyes, and for a moment, as if a door had opened and slammed shut, he caught a glimpse of the enormity of Mike’s anguish, his private living hell. Doug shuddered. Unfortunately, he also saw enough to convince him of Mike’s continued narcotic usage.
“Yeah, Doctor Landry, uh, Doug—maybe someone messed with your syringes—I saw it in a movie once,” Rusty said eagerly.
“Sounds pretty far fetched,” said Doug, shaking his head. He believed Mike was clutching at straws, looking for any excuse to exonerate him from Rakovic’s death, and thereby put an end to his torture.
Before Doug could leave, Bryan Marshall entered the room. He didn’t look too happy. He cleared his throat, looked directly at Doug and said, “I need to talk to you two, alone.” He nodded toward Mike. Wonderful, thought Doug. What could he want now?
Marshall shot a glance at Rusty that said, “Get out.”
Rusty headed for the door, mumbling, “I was just leaving.”
Strangely enough, Marshall continued to stare at Rusty while he made his way out of the room. It looked like he almost did a double take when Rusty walked by him. Doug thought, what in the world was that about?
Marshall continued, however, without missing a beat. “I just finished getting reamed out in Sister’s office. What the hell is going on down here?” Marshall’s face was characteristic beet red and his eyes bored into Doug. “First, Carlucci’s patient dies.”
Out of the corner of his eye, Doug saw Mike wince and look at the floor.
“And yesterday,” Marshall went on, “I hear your patient almost bought it. What the hell is going on?” He paused to catch his breath, and the redness in his face eased up a bit.
“Look, Bryan,” Doug answered sharply. “This is an operating room. Shit happens. We work on older and sicker people every day.” He knew it was never a good idea to argue with Marshall, but couldn’t help it. He had been stung by Marshall’s callous treatment of Mike and also felt a certain amount of guilt about his own case.
The redness flooded back into Marshall’s face with a vengeance and darkened to an ugly purple. Neck and temple veins bulged dangerously. Undoubtedly, he hadn’t expected any back talk. “Don’t you guys get it!?” Marshall screamed. “The timing couldn’t be worse. Pinnacle is breathing down our necks. We can’t afford any screw-ups now!” He pounded on the desk as he said this, and Doug’s empty coffee cup toppled over.
Doug picked up the cup slowly, trying to get a handle on his own emotions. He was determined not to get into a shouting match. “Nobody screwed up, Bryan,” he said as evenly as he could manage. “It could’ve happened to anyone.” He paused to glare at Marshall. “These patients had bad hearts—ticking time bombs just waiting to go off.”
“Don’t give me that crap, Landry!” Marshall fired back. For an instant, a slight grin appeared, but just as quickly it was gone. “I suppose you’re gonna tell me the lady who was cut open awake had a bad heart too!”
This caught Doug by surprise; he had no answer and felt his face start to burn. He’d definitely have to talk to Ken. He looked at Mike, but he was busy studying his Nikes. He looked back at Marshall. If he didn’t know better, he’d swear Marshall was enjoying this scene. Bastard. However, Marshall’s smug smile soon gave way to a troubled expression.
“You’ll have to deal with this someday when you’re chief,” Marshall said and eyed him curiously.
“Yeah, I guess so.” It was Doug’s turn to smile. He knew Marshall was always paranoid about other people assuming the chief-ship. He worried particularly that Doug’s main ambition in life was to replace him as chief. Nothing could be further from the truth, but it felt good to play into Marshall’s fear at this moment.
; “My break’s over,” said Doug, glancing at his watch. “I gotta get back.” He gave Mike a nod that said, “See you.” Marshall looked like he wasn’t quite finished, but Doug pushed by him.
“Remember, Landry. No more fuck-ups!” Marshall shouted at his back.
Doug headed down the corridor and out of the OR complex. He actually had ten minutes left on his lunch break, so he took the elevator up to the twelfth floor. Here at the top of the hospital was a spacious patient solarium with huge plate glass windows on three walls, overlooking the Susquehanna Valley. The room was empty. Doug came here from time to time to collect his thoughts. He rested one foot on a low magazine table and took in the view.
The winter sun shone painfully bright, and high wispy clouds floated in light blue. He could see the Susquehanna River, half sheathed in ice, as it sparkled and wound around like a giant serpent through the Appalachian mountains. The city and surrounding communities were all abuzz with activity, reminding him of his miniature train layout he had loved as a boy.
A lot of things swirled through Doug’s mind, and he needed some time to be alone and think. Unfortunately, the nature of his work did not allow this; the next case to do, the next dire emergency, the next on-call night was always right around the corner. Everything moved so fast. Time to think, like in the old days, was a luxury.
He wasn’t ready to buy into Mike and Rusty’s imaginative sabotage theory. He had real concerns like Laura, and what to do about Mike’s drug use. And what the hell was eating Marshall?
He also couldn’t get Jenny out of his mind. Should I really meet her this weekend? He couldn’t deny the chemistry between them. Wait—no—chemistry was the wrong word. Too cold, analytical, pertaining to beakers and Erlenmeyer flasks. Rusting iron was chemistry. He needed some term to convey the heat, the incendiary intensity, the out of control nature of his feelings. Napalm. Now that was better. Napalm was dangerous. It was likely to scorch everything in sight—sometimes more than was intended.
What would it be like to hold her in his arms, caress her silky blond hair, kiss her willing mouth, bury his face in the warm softness of her breasts? He could see himself slowly undressing her in some room where sunlight streamed through partially closed blinds. Her tanned skin, so smooth and tight, shimmered almost iridescent in the shafts of light. His senses were all sharpened, heightened. The tiny blond hairs on the nape of her neck were clearly visible against her golden skin. He breathed in her natural scent, which blended deliciously with her light perfume. He felt her hungry hands on him and her warm breath tickled his ears. The scene was intoxicating to him as he stared off into space.
He also hated himself for it. He couldn’t help thinking about Laura and the kids. The soft fuzzy scene dissolved. In high-contrast black and white was his wife of twenty years looking at him with tears streaming down her determined face. She fixed him with an expression of such hurt and betrayal, that he squirmed like a bug under a boy’s magnifying glass on a sunny day. His three kids were there with bewildered looks on their innocent faces. Can I actually do this to them? Is it worth risking the marriage?
He stopped short. This line of questioning sounded awfully familiar to him; it was just like what he had said to Mike on Friday in the locker room. “What about Colleen and the kids?” He had ridden his high horse so much with Mike that his butt hurt. Was adultery any better than taking drugs?
Then the damage control part of his mind kicked in: Adultery? Whoa pardner. Who said anything about adultery? We’re just gonna meet for drinks. No biggee. “Yeah, right, dad—su-ure,” he could hear his seven-year-old son say.
The problem with Mike also continued to haunt him. Should I turn him in? He had the letter in his briefcase. All he needed to do was mail it and Mike’s career, not to mention their friendship, would be finished, but he felt his real obligation was to the unsuspecting patients. He couldn’t knowingly subject them to Mike. Yeah, that’s right—true blue Doug Landry here, alias Mr. Morals.
But something else even worse gnawed at the foundations of his mind—a large developing sinkhole that threatened to swallow him up whole. Maybe Marshall was right. Maybe he did screwup in the OR yesterday because of his preoccupation with Jenny, Mike, and Laura. He had always been extremely careful to separate his personal problems from his professional conduct. Anesthesia demanded vigilance if nothing else, a single-minded focus. He likened it to a laser cutting through the morass of insignificant data, false positives, and boring redundancies, to bring to light the essential facts upon which someone’s life rested. Jenny had blurred his mind; Mike had robbed his laser of its coherence. He, himself was impaired. Am I just as dangerous as Mike? Maybe I should remove myself from the OR, too?
The hospital overhead paging system crackled to life, interrupting his thoughts. “Doctor Landry, two-four-oh-oh. Doctor Douglas Landry, two-four-oh-oh.”
He knew he had been gone too long, and the OR was looking for him. Back to work. God, what a mess!
As he picked up the phone, he suddenly recalled Melissa’s message on his answering machine. She had said it was urgent. He punched in 2400.
“Operating room.”
“Hi, this is Doctor Landry—I’ll be there in a minute.”
“Doctor Goldsmith’s waiting. We couldn’t find you, and he’s getting upset.”
“Yeah, yeah. I said I’d be right there.” Always in such a god-damned hurry. “Oh, which room is Melissa Draybeck in today?”
“Hold on, let me check.” He heard muffled talk in the background. “She didn’t show up for work today,” came the reply.
“You mean called off sick?”
“Well, not exactly. She just didn’t show up.”
“Hmmm—thanks.” What the hell does that mean?
CHAPTER TWENTY
“Sorry, it took me so long, Doctor Carlucci,” Rusty said. “I had to make an important phone call.”
Mike studied him for a second. Rusty was grinning as usual, and his red hair stuck out around his ears in contrast to his blue surgical cap. He looked excited about something. “I still took a couple of wrong turns on the way back, though,” he said.
“No problem, Rusty,” Mike said. He liked Rusty; he helped take his mind off his own problems. “Look, maybe I can help you with the layout. Basically, the OR complex is arranged in a cross shape. Here, I’ll show you.” He drew a diagram on his scrub pants. “The control office, where we are now, is the nerve center of the department. It’s here at the center of the cross.” He pointed to the appropriate place on his pants. “The anesthesia on-call room, where we had out little discussion over bagels this morning, is at one end. The recovery room is at the other end. The OR’s are here.” He slid his finger down the long part of the cross.
“Thanks,” said Rusty. “That helps.”
“Here, have a seat.” Mike gestured to one of the other four chairs in the room. “I just started reviewing our next patient’s chart. He’s the one sawing wood out there.” They both paused to listen. Loud snoring could easily be heard coming from the holding area across the hall.
“Yeah, I noticed him on the way in,” Rusty said. “He must’ve had some good pre-op medication. What was it?”
“Midazolam.”
Rusty reached for one of his pocket pharmacology handbooks and started to page through it. “What kind of drug is it?”
“Midazolam is in a class of potent tranquilizer, anxiolytic drugs in the benzodiazepine family of Valium fame.”
“Geez, I guess I don’t need this,” Rusty said and put the book back. “You’re a walking encyclopedia.”
“Wake him up and ask him how sleepy he is.”
A bewildered look appeared on Rusty’s face that Mike found amusing.
“OK, you’re the boss,” Rusty said and dutifully got up and walked out. Moments later he returned smiling. “It’s weird.” Rusty leaned his tall frame against the doorway. “The patient says he’s relaxed, but not sleepy. Then he closed his eyes and started snoring again.”<
br />
“That’s exactly what I wanted you to see,” Mike said. Midazolam is incredibly insidious in its effect. Many patients deny feeling any effect whatsoever, even though they are obviously impaired—slurred speech, loss of short term memory, and marked drowsiness.”
“That’s pretty cool.”
Mike frowned. “It’s also dangerous in the wrong hands.” Mike lowered his voice. “Maybe you’ve heard of “Easy-Lay?” It’s a date-rape drug with a chemical structure similar to Midazolam.”
“Oh,” Rusty said, erasing his smile. He hesitated for a moment and asked, “What’s up with Doctor Landry today?”
“What do you mean?” Mike replied and went back to studying his patient’s EKG.
“He seemed kinda upset.” Rusty shuffled his sneakers on the floor and looked at them intently. “I just saw him in the locker room getting ready to leave. It’s only four o’clock. Why is he going home so early?”
“He’s pre-call,” Mike answered. “He’s on call tomorrow.”
“Oh—didn’t you think he was upset?” Rusty asked, looking up directly at Mike.
Mike was surprised that Rusty had picked up on the tension between them this morning. Although, on second thought, maybe it wasn’t that hard. “He must have his reasons.” Mike quickly broke eye contact and resumed reading his patient’s chart. He hoped Rusty would let it drop.
“Don’t you know?” Rusty pressed. “I thought you guys were buddies.”
Mike paused from reading the lab values, sighed, and met Rusty’s gaze. His initial irritation quickly subsided when he saw that Rusty’s concern was sincere; Rusty wasn’t just being a meddlesome, pain-in-the-butt kid. A rare quality in a med student. He decided to answer him. “I’m not so sure—”
A loud, electronic screech, followed by the blaring of the OR-wide intercom interrupted him. “Anesthesia! STAT! PACU!”
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