Foreign Body (26 page)

"That's my plan," Jack said. "It's amazing, isn't it, how many cases we see where the manner of death is different after the autopsy than what it was thought to be before."

"It's what makes our job so important," Laurie said.

"Hey!" Jack voiced. "Did you get to see Calvin yet?"

"Oh, yeah!" Laurie said remembering her mission. "That's why I popped down here. I'm on my way to Travisa to get our Indian visas. Calvin has given us the green light for a week."

"Damn," Jack said, but then he laughed before Laurie could get miffed.

Chapter 20

OCTOBER 17, 2007

WEDNESDAY, 7:40 P.M.

NEW DELHI, INDIA

Raj Khatwani cracked the door from the stairwell and peered out into the wedge of the third-floor corridor of the Aesculapian Medical Center hospital that was visible. There was no one in his line of sight, but he could hear a medication cart approaching with its characteristic rattling of glass against glass. He let the door close. Through its fire-resistant thickness, he heard the cart roll past.

Leaning back against the concrete-block wall, he tried to control his breathing. With the tension he was experiencing, it was difficult. Sweat dotted the upper part of his forehead.

All he could think of was his new respect for Veena and Samira. Now that he was in the middle of putting his first patient to sleep, he realized it was a lot more stressful than he had anticipated, especially after Samira had told him it was a breeze. Some breeze, he thought grudgingly.

When an adequate amount of time had passed, he cracked the door again. Not seeing anyone or hearing anything, he opened the door farther and slowly stuck his head out, looking up and down the hallway. The only people he saw were two nurses a distance down the main corridor at the central desk, talking to an ambulatory patient. They were far enough away so that Raj could just barely hear them. In the opposite direction, there were only three more patient rooms on either side of the corridor before a terminal conservatory. There were conservatories at both ends of the long corridor, each filled with plants and chairs for those patients able to use them.

In his mind, Raj could hear Samira's advice: Don't be seen, but if you are, act normally.

Let your nurse's uniform do the talking. Don't be seen! Raj scoffed silently. Since he was a big man, slightly more than two hundred pounds, not being seen was particularly difficult, especially on a full hospital floor with nurses and aides scurrying about on any one of myriad possible errands.

Raj had gone to Samira and Veena's room to seek advice that evening before he'd left for the Aesculapian Medical Center. He didn't think he'd really need help and did it more out of respect for his female colleagues, but now that he was there, he was glad he did.

Samira had finally admitted she had been nervous, which was good to know, since he, too, was definitely nervous. Veena, however, had said nothing.

Of the twelve nursing employees of Nurses International, as the only male, Raj provided a stark foil for the other eleven attractive and quite feminine females. He had medium-dark flawless skin, very dark closely cropped hair, darkly penetrating eyes, and a pencil-line mustache beneath a slightly hooked nose. But his most characteristic physical feature was his physique. He had broad shoulders, a narrow waist, and bulging muscles.

He looked every inch the enthusiastic weight lifter and black-belt martial arts expert he was. But despite his appearance, Raj was not a masculine-acting individual, but nor was he feminine, at least in his mind. Nor was he gay. He thought of himself as just Raj. The seemingly out-of-character weight lifting and martial arts had originally been his father's idea. Recognizing early his son's social proclivities, his father had wanted him to have some protection in a socially cruel world. As he got older, Raj liked the weight lifting, as looking buff had become enjoyable because of the attention it engendered from his mostly female friends, and he liked the martial arts because, in his mind, it was more like dance than an aggressive sport.

Suddenly Raj heard loud footsteps against bare concrete. To his horror, he realized that someone was behind him in the stairwell, descending from above. From the proximity of the noise he could tell the person was imminently going to reach and round the landing between the third and fourth floors, at which point Raj and his loitering would be in full view! Raj knew he had two choices if he didn't want to be seen: either he could run back down the stairs, maybe as far as the basement, or he could exit onto the third floor and take the risk of being seen there.

The footsteps were rapidly descending; Raj had to decide! He was in a panic. He heard the more hollow sound as the approaching individual reached the landing. In an even greater panic, Raj opened the door to the third floor only enough to step through and then used his hip to push it closed. Not realizing he'd been holding his breath, Raj allowed himself to breathe as he glanced up and down the corridor. Behind him, in the stairwell, he could hear the now muffled steps descending toward the third-floor landing.

For fear whomever it was might try to exit on the third floor, Raj pushed off the stairwell door and headed for his patient's room. He'd been forced into action. It had been like standing at the edge of a pool afraid of the water and then being pushed in. Raj did not look back until he'd reached David Lucas's door. Just ahead, two nurses emerged from the next patient room, in deep conversation about the individual's care. Luckily, they immediately turned toward the central desk. Had they looked in the opposite direction, they would have locked eyes with Raj a mere ten feet away, and he would have had some serious explaining to do.

Luckily, he was able to slip unseen into the room, but then he stopped just inside the door. He heard hushed conversation. Mr. David Lucas was not alone!

Confused about whether to stay or flee, Raj froze. A second later a wave of relief spread over him. It wasn't a visitor; it was the TV. With a surge of confidence, Raj walked farther into the room, rounding the outer wall of the bathroom, affording him a view of the strikingly obese patient propped up in the hospital bed. The patient was asleep. A nasogastric tube issued forth from one nostril and was connected to suction. About a half-cup of yellowish, blood-tinged fluid could be seen in the collecting bottle. A cardiac monitor on the wall behind Mr. Lucas played out a regular rhythm. All in all, the entire scene looked identical to how it had looked when Raj had left for the day a little after three that afternoon.

Raj reached into the pocket of his white nurse's trousers and pulled out the syringe he'd prepared back at the bungalow. In contrast to Veena and Samira, he'd not had to go to the empty operating room to get the succinylcholine, and for that he was pleased. He knew he had Samira to thank, and had already done so.

After checking the syringe to be certain none of the fluid had leaked out, a distinct possibility, since he had actually overfilled the 10 cc syringe, Raj was ready to go. He'd overfilled the syringe on purpose, thinking that the last thing he wanted to do was not give enough.

Returning to the door, Raj gave one last look up and down the corridor. There was one nurse walking toward him, but she turned into a room and disappeared. Sensing the time was never going to be better, he returned to the bedside. Carefully picking up the IV line without pulling on it, he took the cap off the needle with his teeth, and then gently poked the needle through the IV port. There was no need to worry about sterile technique.

Thus prepared, Raj paused for another moment, listening if there were any telltale sounds from the hall that he could hear over that of the lowered TV. There weren't, so he used both hands to discharge the entire contents of the syringe into the IV line in a large bolus. Having not stoppered the upper part of the IV line beforehand, the first thing he noticed was a rapid rise in the level of fluid in the millepore chamber. But that effect was overshadowed by the patient's response. As Samira had warned, there were almost instantaneous fasciculations of the facial muscles combined with David Lucas's eyes shooting open. He also started to cry out as his extremities began a series of myotonic jerks.

Raj took a step back, shocked by what he was observing. Although he'd been cautioned, the reaction had been more rapid and more disconcerting than he'd expected. He watched for another beat as the patient tried to sit up but immediately collapsed back like a freezer bag full of fluid. With a sense of revulsion, Raj turned and fled. The problem was, he didn't get far. As he yanked open the door to the corridor, he literally ran into a white-coated figure who'd just raised his hand to push open the door that because of Raj was no longer there.

Raj grabbed the man in a bear hug to keep from knocking him over as his inertia carried them out into the corridor. "I'm so sorry," the befuddled nurse blurted. The collision had been so unexpected, and making it even worse, he recognized the man. It was Dr. Nirav Krishna, David Lucas's surgeon, on late rounds before heading home.

"My God, man," Dr. Krishna snapped. "What the bloody devil is the rush?"

For a brief moment of utter panic, Raj tried to think of something to say. Realizing there was no way out, he told the truth. "It's an emergency. Mr. Lucas is having an emergency."

Without saying anything, Dr. Krishna pushed by Raj and dashed into the room. Coming to the bedside, he saw David Lucas's beginning cyanosis. Out of the corner of his eye he saw from the monitor the heart was beating relatively normally. It was then that he realized the patient was not breathing. He did not see any fasciculation, because they had already stopped.

"Get the emergency cart!" Dr. Krishna yelled. He yanked out the nasogastric tube and threw it to the side. Grabbing the bed control, he began to lower the head. Seeing Raj glued to his spot, he again yelled for him to get the crash cart. They were going to have to resuscitate.

Raj recovered from his paralysis but not his terror. He raced from the room and ran headlong down the corridor toward the nurses' station, where the emergency cart was stored. As he ran he tried to think of what he should do. He couldn't think of anything other than to help. The surgeon had gotten a good look at him, and if he just disappeared, he'd surely be implicated.

Reaching the central station, Raj blurted out to the two nurses sitting at the desk that there was a code in room 304. Without stopping, Raj threw open the door to the storeroom where the crash cart was kept, grabbed it, backed out with it in tow, and then raced back down to David Lucas's room, making an enormous racket in the process.

When he got there, the lights had been turned up. Dr. Krishna was doing mouth-to-mouth, and to Raj's added horror, Mr. Lucas didn't look so bad; his cyanosis had faded to a large extent.

"Ambu bag!" Dr. Krishna shouted. One of the floor nurses who'd raced after Raj grabbed it from the cart and tossed it to the doctor. Dr. Krishna repositioned the patient's head, applied the bag, and began respiring the victim. Now the chest was moving even better than it was with the mouth-to-mouth. "Oxygen!" Dr. Krishna barked. The other floor nurse got the cylinder over to the head of the bed, and between Dr. Krishna's compressions, she connected it to the breathing bag. Within seconds Mr. Lucas's color improved dramatically; it was now actually pink.

As these activities progressed, Raj had an opportunity to appreciate just what kind of disaster he was in. He didn't even know for certain whether it would be better if the patient died or was saved. Nor did he know if it would be better for him to slink away or stay, and the uncertainty kept him riveted in place.

At that point the evening house doctor, Dr. Sarla Dayal, arrived at a run. She crowded in at the head of the bed, and Dr. Krishna gave her a rapid summary of what had happened.

"When I got here he was definitely cyanotic," Dr. Krishna said, "and the cardiac monitor looked reasonable, but it's only one lead. The problem was, he'd stopped breathing."

"You think it was a stroke?" Dr. Dayal questioned. "Maybe a heart attack precipitated a stroke of some sort. The patient has a history of occlusive cardiovascular disease."

"Could be," Dr. Krishna agreed. "It does look now like the cardiac monitor is telling us something. The rhythm is certainly slowing."

Dr. Dayal placed a hand on the patient's chest. "The heart rate is slowing and feels rather faint."

"It's probably the patient's obesity."

"The patient also feels really hot. Take a feel. I'll breathe for a while."

Dr. Krishna turned the ambu bag over to the house doctor and felt David Lucas's chest.

"I agree with you." He looked over to one of the floor nurses. "Let's get a temperature!"

The nurse nodded and got the patient's thermometer.

"Do we have a cardiologist on call?" Dr. Krishna asked.

"We certainly do," Dr. Dayal said. She called over to the other floor nurse to give Dr.

Ashok Mishra a call and ask him to come in immediately. "Tell him it's an emergency,"

she added.

"I don't like that the heart rate keeps slowing," Dr. Krishna said, watching the monitor.

"Let's get a stat potassium level."

The floor nurse who was not on the phone drew some blood and rushed it off to the lab herself.

To stay out of the way, Raj had slowly backed away until he'd hit up against the wall. He was thankful that people were so involved in the resuscitation activity that he was being virtually ignored. He again began to think about slipping out, although the specter of drawing attention to himself made him stay put.

"Dr. Mishra will be in as soon as he can," the nurse yelled out while hanging up the phone. "He's finishing up with another emergency."

"That's not good," Dr. Krishna said. "I have a bad feeling. With this progressive bradycardia, it might be over by then. This heart is definitely having trouble. It looks to my untrained eye as if the QRS interval is widening."

"The patient definitely has a fever," the nurse blurted, staring at the thermometer in disbelief.