by L Jan Eira
What the hell is going on with me? he thought. Claire would call this post-traumatic stress disorder.
He felt weak in the knees, so he forced himself to amble slower than usual, his left hand touching the wall for support. When he reached a window, he paused briefly to take a deep breath and take a gander outside. From that vantage point, he could see the edifice that housed the emergency medical service rigs, next door to the emergency department main entrance. He observed the ambulance bay door open and saw an ambulance labeled Rescue One depart the premises with lights flashing and siren wailing on the way to some mysterious catastrophe.
I hope the guy you’re going to get doesn’t feel as bad as I do, he thought.
A feeling of doom was growing over him. He quickened his steps to the office where he would avail himself of cold, fresh water. He needed it desperately.
“Why aren’t I feeling better?” said Jack to no one in the corridor. “PTSD, one; Jack Norris, zero.”
CHAPTER 37
“Finally a break in the case,” said an energized voice. Quentin looked at Fuller, who was holding the cell phone previously placed on speakerphone when it rang.
“What is it, Mike?” asked Quentin. “I’ve never heard you this excited.”
“We finally got the son of a bitch,” said Ganz. “I found out about the gun. It was purchased illegally and without paperwork or registration by, you guessed it—”
“Dr. Ian Rupert,” said Fuller.
“Dr. Rupert, indeed. We got him now. Will you file for an APB and get a warrant for his arrest?”
“We’ll do it right now,” said Quentin. “We’ll pick him up and call you when we have him.”
As soon as Quentin ended the call, Fuller turned the unmarked police car toward the Evansville Courthouse. They were not far and would be there in no time.
Quentin smiled. “I’ll dial the DA to get the necessary paperwork in motion.”
Fuller nodded. It was then the sirens grew louder, as several emergency vehicles approached their location.
“It’s a fire truck,” said Fuller.
“No,” corrected Quentin. “It’s every fire truck in the Evansville Fire Department. Or so it seems.”
“Something bad’s going on not too far from here,” said Fuller, pulling his car over to the side of the road. The first emergency vehicle sped by. Behind this red truck was another and behind it a third one, all racing by, with lights and sirens. Hanging on were several firefighters with the typical hard hats and yellow Scott Air Tanks. From afar, more angry emergency sirens approached.
“You’re not kidding,” said Quentin. “What the hell just happened that requires so much manpower?”
CHAPTER 38
After drinking some cold water, Jack began feeling a bit closer to normal. He took a deep breath and walked back to join the others at ongoing ward rounds.
“Are you feeling better, Jack?” asked Jeffries.
“Much better, thanks.”
“You do have some color back,” said Twelly.
All looked concerned but remained silent for a moment.
Jack broke the stillness of the moment. “OK, what did I miss?”
“We were just talking about—” Jeffries was interrupted by loud beeps in unison from all the pagers: “Code blue, emergency department, trauma room one…code blue, emergency department, trauma room one…code blue…”
The group placed all the charts down and made a beeline to the ED. On their arrival, the ED staff was working diligently to save a bloody patient who was receiving CPR. His expensive suit had been extensively torn and cut up to allow rapid access to the chest and abdomen by the emergency personnel. Tubes entered the mouth and left nostril.
An emergency physician was inserting a chest tube. He first addressed the newly arrived cardiology team of doctors. “Hey, Jack. Tension pneumo with tracheal deviation.”
Jack nodded. “What do you need me to do, Lance?”
Still concentrating on his task, Lance briefly glanced over at Jack. “We have two large-bore IVs but could use a central line. His sternum is fractured, so he may have a cardiac contusion.”
“Give me a central line kit, Linda,” said Jack, his eye connecting with one of the ED nurses.
“Coming right up,” she said, hurrying to the cart in the corner of the room. “What size gloves?”
Jack took off his white lab coat and approached the dying man. “Eights.” He gave his jacket to Twelly and winked at him. “Here, make yourself useful.”
“Here you go, Jack.” Linda poured Betadine, a dark-brown liquid used to disinfect the skin, generously in the area under the left collarbone. Another nurse with sterile gloves scrubbed the area vigorously.
By then, Jack had his sterile gloves on and was ready for action. In no time, a thin, long intravenous tube was inserted into the main vein under the collarbone.
“Check the CVP,” commanded Jack. “Let’s hang O-neg blood and lots of it.”
“The blood bank got warning of this trauma,” said Linda. “O-neg blood should be here by now. I’ll call downstairs and put some fire under their asses.”
Jack faced the wide-eyed medical students. “CVP or central venous pressure. It’ll give us an idea about how much blood volume is inside this guy’s central circulation and how the heart is dealing with it.”
The medical students nodded nervously.
“CVP is zero,” Linda shouted, her eyes still scrutinizing the monitor.
“Give the blood wide open,” said Lance.
“Zero’s not good!” said Jack. “He’s bleeding out somewhere.”
“Are we getting any pressure with chest compressions?” said Lance.
“I don’t feel much of a femoral pulse,” said Jack, his pulse on the patient’s groin.
“He may have cardiac tamponade,” said Lance.
“Continue CPR and prepare for a thoracotomy,” said Jack. “Page the CT surgeon on call, stat.”
Betadine was again used to paint and scrub the chest. Sterile drapes were used to attempt some form of a sterile field, although at this dismal time, infection was the least of all worries. The ED attending proceeded to use a chest saw to cut the breastbone and expose the patient’s dying heart.
“What are they doing?” asked Joseph, his eyes catching Jack’s.
“The patient is not responding to CPR, medications, or fluid and blood transfusions,” said Jack. “We’re checking to see if there’s blood around the heart. Sometimes, if the heart is lacerated, blood escapes out of the chambers into the sac around the heart. This can squeeze the pump and prevent it from working. This is called cardiac tamponade. The patient may also be bleeding into his chest from a major vessel. Cracking the chest cavity open will let us examine it and try to stop bleeding.”
“I don’t feel so good.” Twelly was pale and sickly looking.
“That’s OK,” said Jeffries. “Let’s step outside and get you some water.” And soon the two of them were gone.
The thoracic cavity was full of blood, which was quickly suctioned. The descending aorta was cross-clamped above the site of brisk bleeding. The pericardial sac was inspected and found to be normal. The heart itself was empty despite all the fluid and blood that had been administered. The team worked efficiently and without words.
“Nothing,” said Lance, palpating the pulse while Jack performed open massage of the heart. Bags of lactated ringers, saline, and O-negative blood hung high and dripped fast.
“Flatline on the monitor,” said Jack.
“What’s the down time?” asked Lance.
“Sixty-three minutes,” announced Linda.
“The guy’s had it,” said Lance. “Is there anything else you want to try before we call it, Jack?”
Jack shook his head and for the first time glanced at his patient’s face. Jack suddenly gasped, his eyes squinting, his jaw muscles tightening.
“Do we have an ID on this man?” asked Linda.
“Ian Rupert,” said Jack.
“Dr. Ian Rupert.”
CHAPTER 39
The medical team assembled in the solace room in the emergency department. This room was private and comfortable and was utilized for the doctors to meet with the families, traditionally to give bad news. This time there was no family to receive the reports.
Claire had text-messaged Jack about lunch an hour before. When the resuscitation efforts ended, Jack retrieved the message and called her. Claire arrived in the conference room a few moments later and was now at Jack’s side. Detectives Quentin and Fuller walked in.
“Did you hear?” said Jack, his expression gravely solemn.
“If you mean Rupert, yes,” said Fuller. “He had a car accident. Did he make it?”
“No, we just pronounced him,” said Jack. “Massive internal injuries.”
“I’m sorry to hear that,” said Quentin. “We had a warrant for his arrest. It turns out he was linked to the murders.”
“So is the case closed now?” asked Claire.
A moment of silence ensued.
“We shouldn’t discuss these matters in such an unprotected area,” said Quentin, her eyes scanning the room. Her gaze first landed on Claire and then shifted to Jack.
“Does anybody else think it’s strange that Rupert has a fatal car accident the moment you find out he’s involved with the previous crimes and get a warrant for his arrest?” asked Jack.
“It is a huge coincidence, isn’t it?” said Fuller.
“Have you found out anything about the accident? Was it rigged?” asked Jack.
“We’re still investigating, but it looks like it was a legit accident,” said Quentin. “But we cannot rule out foul play yet.”
“That leads us to our next point, Jack.” Fuller was serious as he looked into Jack’s eyes. “This may be getting dangerous. For your protection, we do not want you involved with this case any longer. We’ll call you if we need you or when we have news to tell you. You have been of great assistance thus far. We appreciate all you’ve done. But you need to go back to work and back to your normal life.”
“Normal life? I don’t think I can ever have a normal life anymore,” said Jack. A long pause followed, terminated by the sound of the door to the room opening. James Miller was escorted into the small area by a nurse who accompanied the portly old man to where the others were. Once inside the room, Miller looked at them all, one by one, with a serious, concerned expression. The nurse closed the door behind her. For a short moment, the silence in the solace room was shattered by the distant loud buzz of the busy emergency department. When the door shut, silence and peace reigned once more.
“Is it true? Did Dr. Rupert have a car accident?” asked James, restless and apprehensive.
“I’m afraid so, Mr. Miller,” volunteered Claire.
“He arrived with massive internal injuries and could not be saved,” added Jack, looking into the old man’s eyes.
“Did he have any last words? Was he able to speak?” said Miller.
Jack shook his head. “No, he came in receiving CPR. He didn’t say anything here at the hospital.”
The group sat in silence. With tearful eyes, Miller sobbed reticently, both hands covering his face. The reddened rash Jack noticed on the lab tech’s right hand was now a bit more prominent. Claire offered a much-needed tissue, which Miller appreciatively accepted, weeping gloomily.
“Was he able to speak at the scene of the accident?” said Miller. “I loved Dr. Rupert like a son.” Miller blew his nose into the tissue. “If he had any last words, I’d love to know what they were.”
“I don’t think he was able to speak,” said Fuller. “The accident was pretty brutal. It was a head-on collision with a tree at high speed and—”
The door into the solace room was suddenly opened. In walked Agent Michael Ganz. “It is true?”
“Yes,” said Fuller, getting up from his chair. “Dr. Ian Rupert was killed in a car accident.”
Ganz stood there. Still. Unemotional. “Dammit!” he said. “So, where does that leave us?”
CHAPTER 40
“I guess we can close this case!” said Ganz.
The two Evansville detectives, Jack, and Agent Ganz were gathered at Newton Memorial Hospital’s walkway to the main parking lot. A nearby gigantic oak tree provided shade and respite from the otherwise bustling activities on campus. Claire had volunteered to accompany the despondent James Miller back to his car in the employee parking lot on the other side of the grounds.
“Well, the accident seems legit,” said Fuller. “We’ll transport the car to our headquarters for further analysis. We’ll see if there is any foul play.”
Ganz nodded his head. “The evidence against Rupert is strong!”
“What evidence?” asked Jack.
Quentin spoke before Ganz had a chance to respond. “Mike found out that Rupert had purchased the gun involved in the murder. We already knew Rupert was at the scene the morning of the shooting. So he had the opportunity to give Butterworth the gun.”
“What about Major Rooner and Muhammad Akrim? What have you found out about them?” asked Jack.
Fuller piped in, his tone determined. “Jack, we really do appreciate your help on this case. But for your protection, we must insist that you go back to work.”
“We’ll stay in touch with you and let you know how it turns out,” said Quentin. “If we need you for medical questions, we’ll come find you, OK?”
Ganz nodded his head. “Oh, and Jack, I cannot overemphasize this. Please do not discuss anything to do with this investigation with anyone. Even your wife.”
The three law enforcers walked away, still disputing the next step in the investigation. Fuller and Quentin got into their unmarked vehicle. Ganz walked deeper into the parking lot in search of his car.
Jack stood under the oak tree pensively, feeling unfinished. Unsettled. He shook his head. “That’s crazy,” he said to no one there. “The case can’t be closed! Not if I have to pursue the investigation all by myself.”
CHAPTER 41
Back to your normal life. Detective Fuller’s words resounded in Jack’s mind.
The medical team was back in business. Morning report was about to begin.
“Let’s hear about Mr. Carl Morrison, Howard,” said Jack. Dr. Howard Hahn stood at the podium, the patient’s chart in his hand. He was a thin, muscular, and bright young man, with the physical attributes of a marathon runner. His hair was cut short, and he was clean shaven, atypical for anyone just postcall. Howard gathered his papers and commenced the case presentation.
“Mr. Morrison is a sixty-four-year-old diabetic man who presented to the emergency department last night with racing heartbeats at two hundred beats per minute. This is a recurrent problem for him with multiple such admissions. He’s now on appropriate optimized medical therapy.”
“What do you think we should offer the patient?” said Jack.
“Ablation,” said Howard.
“Will you explain what that means?” asked Jack. “The med students need to hear this.”
And Howard began describing the procedure to cure the patient of his recurrent, debilitating, rapid heart rhythm, a procedure Jack had done numerous times over the last two years. Jack visualized the middle-aged man as he suffered and complained to his family about the racing heart. As he did, Howard’s voice became drowned in his thoughts.
Abruptly, Jack beheld Rupert driving his 745Li BMW, a bullet from nowhere hitting him squarely in his chest. Blood spurted out, draining the doctor of his life essence as the out-of-control car crashed into a tree. Jack looked at his own hands and saw the smoking gun, the reek of it all lingering in his nose. His eyes shifted from the weapon he was holding to Rupert. More blood now soaked his entire body, although the spurting had become a trickle, as the soul of the man hastened into the beyond. Ambulance sirens grew increasingly loud, culminating in a deafening cacophony of tuneless detonations. The scene gradually became that of an operating room where Jack, sterilely
gloved and gowned, operated on Rupert, helped by John Connor and Heather McCormick.
Rupert floundered helplessly on the operating table, like a fish out of water. Straps and restrains secured the man to the surgical slab. A scalpel in one hand and a stiletto in the other, Jack prepared to send Rupert to the afterlife. John and Heather held the man down with all their might, empowering Jack to precisely and skillfully perform the deadly feat. With a grin, Jack raised both his hands high in the air to gather momentum in his effort to plunge the sharp objects deep into Rupert’s carcass, finishing off what the car crash had merely instigated.
Rupert uttered one final word. “Jack!” Rupert’s word became more real. Closer. More tangible.
“Jack, are you OK?” A distant, faint voice penetrated the grotesquely and outlandish daydream, ending it.
“Jack, are you all right?” asked Howard from the podium, yanking Jack back into reality.
“Yes, I’m fine,” whispered Jack, his words guileful.
“Do you agree, Jack?” repeated Howard.
Jack looked around and realized the room was dark, and a heart rhythm was projected on the large screen.
“It’s AV node reentry,” said Jack, merely five seconds after visually analyzing the rhythm strip. Jack was trembling, and waves of nausea assaulted his stomach.
“That’s what I thought,” said Howard.
“Taylor, give us a brief report on this type of arrhythmia tomorrow,” said Jack, trying to show a business-as-usual attitude with considerable difficulty.
“Sure, no problem,” said Taylor.
Morning report was over. The pack separated into groups. Those assigned to Jack followed him out of meeting room three. The others lingered in the room, conversing among themselves. Jack’s first stop was a drawn-out drink of cold water at a cooler nearby. He began to feel better. PTSD, two; Jack Norris, zero.
“We’re happy to have you back, Jack,” said Jill Jeffries, the first-year medical resident.
Jack nodded his head. Goddamn PTSD, he thought.