Scarcity (Jack Randall #3) (39 page)

“Reduce the shipments? Why? You just told me we have enough warehoused for months. There’s no reason to ship less!” Rico laughed at them both before draining his drink. The sun had made its way across the table until it was on him also, and he was starting to sweat. It only served to irritate him more.

Nestor sat back with a sigh and shot a look at Pablo before taking another deep breath. Keeping his temper in check had been a struggle since they had sat down. But they had agreed that it was Pablo’s decision, and he had not made it yet.

Pablo waited a moment before he spoke and was careful to keep his tone neutral.

“The raise in price is necessary to make the Americans believe they have hurt us badly. If they think this, they will relax once they have exhausted the information they’ve obtained from Angel. If we don’t show a reduction in shipments and a price increase, they will know we have more means than Angel gave them, and they will then expand their efforts looking for them. It is not to our benefit for them to do so. Better to let them think they are winning.”

Rico heard the words, but they made no sense to him. Sending less was better then sending more? He tried to see through what Pablo was saying, but he just couldn’t wrap his mind around it. The booze was not helping and he felt a headache coming on.

“I don’t like it. So what if the Americans suspect we have more ways to get our
cocaine
into their country. What the hell can they do about it? Nothing! The fools have no idea how much we ship in. Their guesses aren’t even close! Buy some more of your fancy submarines if you want, I don’t care. But we’re not shipping less. The Americans are always thirsty for more. Who am I to deny them?”

Rico gestured to Carlos who left his spot behind the two men and quickly retrieved Rico’s empty glass. Rico ignored his guests and took in the view of the mountains as the setting sun painted them many colors. It was a nice view. Perhaps he would stay here longer than he had planned.

Carlos set the drink down in front of him and Rico noticed for the first time that his guests had yet to touch their drinks. No matter. He could care less if they died of thirst right now. He really just wanted them gone.

Pablo waited until Carlos had taken up his position behind them again before speaking.

“I think you should reconsider. The wise thing to do is to work around the Americans, not against them. We tried that in Mexico, and now we have an army to contend with. It’s bad for business.”

Rico’s drink was halfway to his mouth when he heard the words and he slammed it back down hard on the table. The whisky splashed across the table and onto the two men. They leaned back, half expecting the glass to follow.

“Listen to me, you skinny little bastards!
I
am the one in charge here!
I
will make the decisions! My brother left me in his place, not you! I say we ship more, and that is what we’re going to do! To hell with the Americans! You pencil pushing assholes! If you have a problem with that, I will find new people to take your place, and you can join your friend Jimmy rotting somewhere with a hole in his head! Now get the hell out of my sight!”

Pablo calmly reached out and took the napkin from under the beer in front of him. The beer had been sweating in the sun and the napkin was moist, but it worked to wipe the booze from his face. As he did so, a smile slowly formed on his face.

He raised the beer toward Rico in a mock salute.

“Whatever you say . . . boss.”

On that signal Carlos stepped forward. The pistol appeared in his giant fist and Rico found himself looking straight down its large barrel. The bullet exited the back of his head before he had a chance to figure out what was happening.

The sound of the gunshot echoed off the mountains for some time before finally fading.

“Why the hell did you wait so long?” Nestor asked as he dabbed at the booze on his shirt.

“I felt we owed him a chance. Oscar may just make it to prison alive.”

“If he does?”

Pablo shrugged. “Jimmy.”

“Speaking of which.” Nestor pulled out his cell phone and handed it to his new boss.

U.S. Will Require Hospitals to
Identify Potential Organ Donors
September 6, 1987—New York Times
 

—THIRTY-ONE—

“C
-V-I-C-U, this is Donna.”

“Hey Donna, it’s Paula. We’re done with Mr. Hernandez. Should be up there in about ten or so.”

“Okay, we’re ready here. He’s going to bed three.”

“Got it.”

Donna hung up the phone and turned to examine the room. Sharon was placing electrodes on the ends of the color-coded wires in anticipation of their patient’s arrival.

“We’re ready, right?”

Sharon laughed. “You said we were!”

“I know, just checking. Respiratory here yet?”

“I’ll call them.”

“Thanks.”

Donna checked items off her mental list as her eyes roamed the room and located them. The bed was made, and its internal scale was zeroed. Sharon had prepped all the leads and they were now draped over the monitor, along with the pulse oximetry sensor. Both IV poles and the Gemini pumps mounted to them were in place. Blood tubing and several pressure bags hung ready from the multiple hooks. Both suction units were connected and standing by, and she had syringes and lab tubes sitting next to her I-STAT blood analyzer. Several blankets sat stacked on a nearby chair. All that was missing was the ventilator and the tech to run it.

As if to answer her thoughts, the tech could be heard rolling into the unit, pulling the ventilator with the one squeaky wheel along with her. As she entered the room, her purple scrubs seemed to add more light.

“How long?”

“Any minute.”

The doors at the end of the hall hissed open on their hydraulic hinges and Dr. Dryer’s voice boomed out across the ward.

“Patient coming through. Make some room please!”

Donna had just enough time to write the arrival time on the board and cross the room before the group pushed the bed into place. It was an impressive display of teamwork despite the fact that they resembled a group of ants working together to haul a leaf across the ground. Dr. Dryer followed along with the chart and a stack of empty forms. The room had gone from virtually empty to overcrowded within a few seconds. Working together, they quickly had all the tubes and wires accounted for before sliding Oscar over and onto his new bed. There was now a flurry of activity as he was wired, vented, poked and prodded. The monitor screen came to life with a stack of colored numbers and waveforms. The ventilator was connected, and its settings were adjusted as Dr. Dryer dictated them. Blood was drawn and passed off for analysis by the waiting machines. Foleys were drained and chest tubes secured. There was a brief lull as everyone double checked their portion of the work before the blankets were applied. Oscar became a cocoon of cotton, with only his face and the breathing tube visible.

Donna helped Sharon work the compression stockings over Oscar’s swollen legs while she listened to Dr. Dryer’s report.

“Keep him on the Nitro at one mic for now. He had some S-T elevation in the inferior leads, but it resolved on its own. No wall motion changes that we could see on the echo, so we want to bring his pressure up. His new heart seems to like it, and the twelve-lead looks okay.”

Donna followed his gaze to the overhead monitor. “That double P-wave always looks weird to me, no matter how many times I see it.”

“As long as he’s got one I’m happy. I’m gonna go chart. Page me if you need anything.”

“Okay . . . oh, last crit?”

“Ummm . . . twenty-nine.”

“Got it.”

Dr. Dryer walked out to the nurse’s station, only to find that Jen had beat him to the computer. Dayo already had the one out in the hall. He shrugged and headed off to the on-call room. This late it would be empty and quieter there anyway.

•      •      •

Dr. Fong backed into the OR with his hands up only to see Dr. Jacobs standing over their patient and contemplating the overhead monitor. Tony rounded the foot end of the operating table with a sterile gown and the two of them did a silent dance as he assisted the surgeon in donning it. Dr. Fong checked the monitor while Tony fetched a pair of gloves.

“Any change?”

“Nope.”

Dr. Fong paused long enough to thrust his hands deep into the gloves before approaching the table. He clasped his hands together across his gown as he checked the movement of Tessa’s new heart beating in her open chest. An involuntary sigh escaped him when he confirmed what he was just told.

“Okay, let’s come off and see how she does.”

Fifteen minutes later Tessa’s new heart was once again beating on its own with no additional help from the bypass machine. Dr. Fong frowned behind his mask when he saw no improvement. Dr. Jacobs adjusted his echo sensor and shook his head at their unspoken question.

“The R.V.s still struggling. Septal wall looks okay. Your patch seems to be holding fine.”

“So what are you thinking?”

“I played with the wedge pressures and they’re a little high. I think the right ventricle just needs a little help pushing against it.”

“Did you give her some volume?”

“Yeah, but I don’t want to get her up too high. I’m keeping her central venous pressure under twenty.”

“You worried about a septal shift?”

“Well, that and I don’t want to stress your patch job either.”

“Well thanks for that note of confidence.”

“Any time.”

“So we need to lower her pulmonary artery pressure. How do you want to do it?”

Jacobs picked up his clipboard and scribbled some numbers before replying. “Let’s try some Natrocor and see how she responds. I’ll bolus her and then run a drip at .01 mics.”

“Okay . . . I’ll find myself a chair.”

Unable to touch anything without compromising his sterile status, Dr. Fong crossed the room and carefully sat on a stool. He could do nothing but watch as Dr. Jacobs slowly injected the drug into the girl’s central line before mixing still more in a small bag of saline. He soon had that running through one of his many pumps. They both settled down to see how the new heart responded.

Tony had heard the whole exchange and was now watching the screens as well.

“So what are you expecting to see first?”

Dr. Jacobs, ever the teacher, answered him. “We think the right ventricle is struggling because the pressure in her lungs is too high and it’s having a hard time pumping against it. The drug I just gave her will dilate the blood vessels in her lungs and hopefully make it easier for her new heart to do its job. We should see improvement across the board, but probably on the EKG first. If it works, we can close her chest and hopefully manage her medically.”

“What if it doesn’t?”

Dr. Jacobs shrugged. “RVAD.”

Tony knew what that meant, so he fell silent and found something to do with his tray of instruments.

A minute later they had their answer. Tessa’s EKG waveform slowly became less rounded and more upright. Her blood pressure soon followed with a slow but steady increase. Dr. Jacobs once again fired up the echo machine and scanned the girl’s heart.

“Better. Good wall movement. Her cardiac output is up, too.”

Dr. Fong rose from his seat. They all stepped up to the table and silently waited while he made his decision.

“We’ve done all we can here. Let’s close her up and get her upstairs.”

•      •      •

Dayo looked up from his paperwork as Dr. Fong’s team pushed the teenage girl around the corner. Dr. Jacobs hit the door button before he followed them in.

“How’d yours go?” he asked the surgeon as he passed.

Dayo offered a thumb’s up for a reply before they disappeared around the corner and into the cardio-vascular intensive care unit. The doors had barely shut when Dr. Fong rounded the corner.

“What took you so long?” Dayo asked.

Dr. Fong just sighed and shook his head before finding a spot to sit on the corner of the desk. He pulled his surgical cap off and tossed it in the trash before rubbing his eyes.

“She arrested as soon as she hit the table.”

“Really? Ouch. Get her back okay?”

“No, we crashed-on instead. We got her on bypass with only a minute or so of down time. Good CPR the whole way, so I don’t think there was any ischemic injury. But then we had to sit and wait for the new heart to arrive.”

“Figures. How was the donor heart?”

Fong shook his head again before replying. “That’s a whole other issue I need to talk to you about.” He nodded to a passing employee. “Not here though.”

“All right. How about the roof in ten? I got another care package yesterday.”

Dr. Fong perked up at that. “Cubans?”

Dayo grinned. “Montecito’s.”

“You got a deal. Let me settle my teenager in and I’ll meet you in ten.” He stood and patted his waistline. “I left my pager in the OR.”

“I’ll grab mine on the way up. Don’t tell anyone unless you want to share.”

“Not a problem.”

Dayo watched casually as Fong disappeared into the CVICU, but as soon as the doors shut he was on his feet and hurrying toward his office. He avoided the elevator and looked through the window into the stairwell, as he didn’t wish to be seen right now. Seeing it empty, he was quickly through the door and bounding up the stairs. The surgical booties he had purposely kept on served him well by keeping his shoes from squeaking on the tile floor, but they were slippery, and in his haste he nearly busted his ass as he rounded a corner. Reaching his office, he had a momentary flash of panic before determining that Christine had left the door unlocked for him.