Scarcity (Jack Randall #3) (40 page)

Avoiding the lights, he felt his way across the dark interior and managed to reach his office without knocking anything over. Closing the door behind him, he once again left the light off. The lights of downtown Baltimore served to illuminate the interior well enough for him to see what he was doing, and he didn’t want someone working late to see him across the courtyard.

Sitting at his desk, he winced as the bottom drawer squeaked in his hand as he opened it. Back behind some files was a new box of cigars, a present from a former patient. A Canadian government employee, the man made the occasional trip to Cuba, and a box of cigars would find its way to his surgeon friend every few months. Being no fool, Dayo let him.

He quickly retrieved two Montecito’s, his cutter, and a box of matches before stuffing them in the pocket of his coat and opening the top drawer. Rooting around in the dark, he found the flashlight and placed it on the desk blotter before placing his pager next to it. Taking the cover off, he pulled the good battery from the pager and swapped it for the dead one from the flashlight. It flared briefly before he twisted it off and threw it back in the drawer. Putting the now dead pager back on his belt, he allowed himself a deep breath before sneaking back out of his office and on to the stairwell.

•      •      •

Jimmy waited. The silence was deafening inside the boat and his grip on the pistol was becoming slippery in the heavy humidity. He wished he had chosen a larger caliber of gun. He couldn’t count on the .38 making the head shot he needed. He adjusted it without moving his aim and Manuel flinched slightly, drawing a low growl from the dog. His protégé had a dominant left eye. Jimmy knew from watching him shoot on several occasions, so he centered his aim there, the better to give him a view directly down the barrel.

But Manuel’s aim was also rock solid, and it never wavered from the center of Jessica’s chest. Jimmy knew the power of the small handgun Manuel held as well as any trauma surgeon. While the caliber was small, the penetration power was high. The round would most likely enter her chest before spending its remaining energy bouncing around inside and shredding vital organs. If that happened, there would be nothing to stop him from finishing the job and eliminating any witnesses. Jimmy was not about to let that happen.

But they were at an impasse. Time was on Jimmy’s side, but he didn’t really want to wait for Manuel to get tired or impatient. The outcome would not be good for any of them.

They all jumped when Manuel’s phone rang. Jimmy recognized the tone.

“Your new boss,” he stated.

Manuel just grimaced and made no move to answer it.

“Go ahead. I’d like to hear this.”

Manuel let it ring once more before slowly reaching in his pocket and retrieving it. He set the phone down on the table in front of him and felt his way across the keyboard.

“Yes?”

Pablo’s voice came through the tiny speaker loud enough for them all to hear. “Manuel. You know who this is?”

“Yes.”

“There’ve been some changes. The brothers are no longer in charge. I have taken over for them.”

Manuel said nothing, but his face changed. Jimmy waited for what was next.

•      •      •

Dr. Fong pulled on the cigar repeatedly until he had a nice glow at the tip. Dr. Dayo puffed on his while he watched his friend enjoy the Cuban delicacy. He waited a full minute before his curiosity couldn’t.

“So what’s on your mind?”

Dr. Fong let some smoke escape before replying.

“You know, its bad enough that the girl’s only sixteen and needs a new heart, add to that the fact that she’s the daughter of a senator. I know, shouldn’t matter, but it does and there’s no changing that. But then, not only does she crash on the table, but the donor heart’s got a damn VSD!”

“A septal defect? You’re kidding.”

“Nope, high up, too. Luckily I caught it on the echo just as Jacobs was pulling it.”

“Small enough to sew?”

“No, I had to patch it. I was going to just use some pericardium, but Kye pulled some matrix out of the core, so I patched it with that. I swear she has her own secret stash hidden back there somewhere.”

“How close to the tricuspid?”

“Close enough. I had to anchor through the base and then on the cephalad edge . . . well . . . I always worry about damaging the aortic valve.”

“She start back up okay?”

“A little sluggish. The right ventricle didn’t want to play at first, but Jacobs coaxed it along. That’s why it took me so long. That’s not what I wanted to talk about anyway.”

“You want to know how a heart with a septal defect got through the system in the first place,” Dayo deadpanned.

“Exactly! How did that even happen? I couldn’t see it visually, but it was obvious on the echo. What happened to the strict screening process UNOS has? Ever since we started using that POPS machine we get less and less information about these organs coming in. Don’t get me wrong, it’s an amazing machine, and we need it. It’s saving a lot of lives. But when the chart is in Spanish, how the hell are we supposed to know anything about it? Am I just going to have to accept a chart I can’t read?”

“The technology is ahead of the system.”

“Well the system needs to catch up, and fast,” Fong grumbled. “Jacobs is going to write a letter for us. I’ll get you a copy before we send it out.”

Dayo just nodded and they both puffed for a moment. He wondered what was going on downstairs.

•      •      •

Jen’s fingers flew across the keyboard as she typed up her post-op report. Since her contribution to the surgery didn’t vary as much as it did for the surgeons, the words flowed onto the screen with little thought. She had joked with her colleagues many times about just creating a template and choosing the sentences she wanted from a menu, but it had always remained just a thought. The least she had wished for was a function key that would type “in the usual manner” for her.

Her thoughts were interrupted by a loud beeping and flashing light from the monitor screen in front of her. She looked up to see that the arterial blood pressure reading on her patient was erratic. Sharon walked past her and into the room to check on it, so she dismissed the alarm and returned to her report.

She had barely begun the next paragraph when Dr. Dryer hurried past. She got a smile and a wave from him, but he didn’t slow, and was quickly down the hall and through the double doors, probably in search of a bathroom, or maybe just in a hurry to get his own charting done. She dismissed the thought and again returned to the keyboard.

She had just collected her thoughts when the alarm sounded again. She looked up only to see the same problem with the arterial blood pressure. This time she watched the waveform more closely as the reading seemed to be stepping down in increments. Looking through the glass wall of the patient’s room, she saw Sharon still hovering over him. The frown on her face got her attention.

“Problem with the art line Sharon?”

“Not that I can find.”

The reply got Jen out of her chair and she walked into the room. Oscar looked the same as when they had moved him into the room, other than his now exposed arm where Sharon was troubleshooting the problem. Jen checked the monitor again only to see that the numbers were continuing to fall. Donna joined them and eyeballed the equipment.

“Stopcock off a little?”

“No, I just checked. The line isn’t pinched either.”

“Pressure bag?”

“It’s fine.”

Jen watched silently as the two nurses checked the equipment again. Her little voice was beginning to speak to her.

“Is it the transducer?” she asked.

Donna checked the device over before replying.

“It looks fine. Can we still draw off of it, Sharon?”

“I don’t know, let’s find out.”

She grabbed a syringe and connected it to the port before working the three-way stopcock and drawing some blood.

“It feels a little resistant, but I can still draw.”

“It shouldn’t be resistant. Are we still in the artery?”

“We wouldn’t get anything if we weren’t.”

They were cut off by the alarm sounding again. Sharon reached up and silenced it. The screen now read zero and showed no waveform at all. Jen’s little voice was screaming at her now.

“Get a blood pressure.”

Her tone startled them both as it was out of character for her. Donna complied by wrapping a cuff around Oscar’s arm. She donned her stethoscope before placing the bell at his elbow and searched for a pulse before she started pumping.

“I’ve got no pulse.”

“Really? Sharon searched for one also and her face clouded. They all checked the monitor which showed a beating heart.

“I’ve got nothing.”

“A carotid?”

“Yeah . . . it’s there. Faint though.”

“It’s not PEA . . . check the other arm.”

Sharon scrambled to comply.

“It’s here. It matches the monitor.”

Jen stared at the screen and watched the waveform that told her the heart was beating fine. No pulses on the right, yet they had one at the neck and the left arm? The voice in her head stopped screaming.

“Page Dayo,” she whispered.

“What?”

“Page Dayo! And get Dryer back in here. He’s probably in the on-call room.”

Donna ran to the desk and grabbed the phone while Jen tore the blankets from Oscar’s body. She checked the two drains protruding from his chest and then the screen of the balloon pump before staring again at the monitor.

“Kill the balloon pump.”

Sharon flipped switches until the screen was blank.

“What is it?”

“His aorta . . . I think it’s dissecting.”

•      •      •

“So how did yours go?”

“Our bypass machine caught on fire.”

Fong choked on some smoke and had a brief coughing fit. Dayo smiled while he waited for him to recover.

“Your bypass machine . . . caught on fire?”

“Yup. Brian says one of the circuit boards failed. It just had an overhaul and most of the boards were updated. He thinks we got a bad one. Factory defect. One-in-a-million chance, but it happened. I’m thinking of buying a lottery ticket tonight.”

“We talking actual flames here? What did you do?”

“Mostly just a lot of smoke. Brian stayed cool through the whole thing. Turns out it was the circuit board for the gauges. The pumps kept running, except for one that got hot. He switched it out.”

“Where were you?”

“In the chest. We were committed. Dryer ran down the hall for the machine out of trauma, but Brian just made the broken one work somehow. I haven’t gotten the whole story yet. He called a guy up from maintenance with a timing light, and he just sat there giving Brian RPM readings until I got the patient off bypass. Paula had a bunch of people fanning the smoke out the doors. Me, I just kept going, not a whole lot of options really.”

“Amazing. How’s the patient?”

“Alive.”

“You don’t sound too happy about that.”

“Bastard stopped us right before we put him under and called everyone in the room by their full name. A nice veiled threat.”

Dr. Fong didn’t know what to say to that, so he puffed on his cigar instead. The rich tobacco soothed him and he turned his gaze to the sky over the city. The full moon competed with the man-made lighting below to illuminate the night. A bat passed by with its broken-wing flight, making impossible turns as it rid the air of mosquitoes. The lights of the baseball stadium could be seen off to the south.

“Who the Orioles playing tonight?”

“Couldn’t tell ya.”

They smoked in silence for awhile, neither one of them wanting to go back inside.

“So . . . think we should head back down?”

“Let’s stay awhile,” Dayo replied. “I think we’ve earned it tonight. They’ll page us if they need something.”

“I’ll agree with you there.”

Fong tapped his cigar and watched as the slight breeze carried the ashes up and over the edge of the roof. It made him think of his sailboat.

“How come you’ve never come sailing with me?”

Dayo shrugged. Seemed like a good enough time to come clean.

“I get sea sick.”

“They say it goes away after three days.”

“Oh, well in that case . . .”

They fell silent again and enjoyed the quiet of the roof.

Drug Suspect Who Fled U.S. With New Heart Is Captured
October 24, 1994,—New York Times
 
 

—THIRTY-TWO—

T
here were now five people standing around Oscar, gazing up at the monitors. Donna cycled the blood pressure cuff again, and they impatiently waited for the numbers to flash on the screen.

“Still crap,” Jen voiced their collected thoughts.

“What’s going on?” Dr. Dryer asked as he was led into the room by Sharon.

“I think he’s dissecting. We lost the art line and the radial pulse on the right side. We can’t find anything wrong with the equipment, and that arm’s getting pale and cyanotic.

“Did it just cut out, or did it kind of step down?”

“It stepped down. His pressures were different in each arm, too, before the right one quit.”

“Shit, get me an echo in here. Where’s Dayo?”