They’d already weighed him in, recorded his vital signs, taken two tubes of blood and made him sign a consent. What
was
next? Though the surgeon had explained the procedure in detail, Dan had no idea what to expect. It was one thing to discuss a horror show like this in a nice air-conditioned office, with three weeks breathing space ahead of you, and another thing entirely, as Dan was quickly learning, to actually go through it.
“Next we take you downstairs,” the nurse said. “They’re waiting for you now.”
* * *
The operating suite was cold and brightly lit, with a jointed table that looked like an autopsy slab, an anesthetic machine, a tall cart with a TV screen on it, and an instrument table on wheels. A scrub nurse stood at the instrument table with her back to him. Dan caught a glimpse of steel trokars and glinting instruments and jerked his gaze away.
The nurse said, “Okay, Dan, I want you to climb up here and lie down.” She patted the operating table. It was padded, but looked uncomfortable.
Still trying to hide his backside, Dan complied. Surgical spots hovered overhead like miniature spacecraft. Looking up at those lights Dan was reminded of a movie he’d seen as a kid, a sci-fi thriller about a guy who’s abducted by aliens, strapped to a table exactly like this one and then fucked full of space eggs.
He’d actually started to sit up when the anesthesiologist entered the room.
“Hi, Dan,” the small Asian woman said. She looked about seventeen. “I’m Doctor Ho and I’ll be looking after your anesthetic.”
Great
, Dan thought, his level of agitation approaching the redline. She’s not even tall enough to do this job...is she? Her name reminded him of an Eddie Murphy skit he’d seen—“I wanna be a Ho”—and he had to bite his lip against a sudden, hysterical bray of laughter.
He said, “That’s nice.”
Then she asked him the same questions he’d already answered, adding a few new wrinkles—“Do you use any street drugs? Has anyone in your family ever died under anesthesia?”—and finished up with a quick examination of his heart and lungs.
Then they were gluing electrodes to his chest, snugging a tourniquet around his arm, trying to wrap a blood pressure cuff around his enormous bicep.
Dan concentrated on Dr. Ho. She flicked a vein on the back of his hand, said, “Little pick,” and before he could brace himself jabbed a needle through his skin.
“You’ll be going off to sleep now,” the doctor said, and Dan could feel it coming in a hot swarm, filling his crevices with numbness. Sounds grew louder and incredibly harsh—chattering voices, the clang of instruments, gases hissing—and now a big black mask was coming down on his face. His last perception was of the spotlights going on. He could feel their heat...
Then he was gone.
* * *
Dr. Aileen Ho inflated Dan’s lungs with oxygen for about sixty seconds. Then she inserted an E-tube into his trachea, connected it to the breathing circuit and set the Forane vaporizer at two percent. For the next sixty seconds she manually inflated his lungs, squeezing the reservoir bag and watching the smooth excursions of his chest. To further ensure the proper placement of the tube, she listened to his chest with her stethoscope as she bagged him.
The circulating nurse folded Dan’s gown up to his chin, exposing his naked body. “Wow,” she said, prepping his belly with an iodine solution now. “Is this guy built or what.”
“Prep a little lower,” the scrub nurse said. “I think you’re waking it up.”
The circulating nurse said, “I meant his muscles, you pig.”
“Love muscle,” the scrub nurse said and chuckled. She toed the intercom button, telling the desk clerk to have the surgeon scrub his hands.
Smiling at the nurses’ comments, Dr. Ho switched the breathing circuit from manual to mechanical ventilation and set the rate for ten breaths a minute.
Almost instantly the high pressure alarm sounded, a piercingly shrill note, and Dr. Ho spun toward the panel of alarms. The ventilator bellows had collapsed, and in the split second before the alarm sounded the doctor thought she’d heard a low, blunted detonation in her patient’s chest, like dynamite going off underground.
Still unsure of what she was dealing with, Dr. Ho threw the lever back to manual and resumed bagging her patient. It was like trying to force air into a bag of sand.
The nurses were silent, stock-still, anxiously watching Dr. Ho. The oscilloscope, previously showing a normal cardiac rhythm, now indicated electrical chaos.
Frightened and confused, Dr. Ho squeezed the reservoir bag again, this time eliciting a wet gurgling sound from deep in the patient’s chest. When the breath was exhaled, bloody froth bubbled up into the E-tube.
Dr. Ho’s almond-shaped eyes grew round. She muttered something in her native Chinese, then said, “Get some help in here.
Hurry
.”
The circulating nurse burst out into the central corridor, shouting for assistance. The scrub nurse punched a red button on the wall, sounding a general alarm.
Dr. Ho stripped off her mask, her oval face porcelain. She switched off everything but the oxygen and squeezed the bag, the bell of her stethoscope pressed to Dan’s chest. Until she knew what she was up against there was little else she could do.
With each breath she administered, something deep in Dan’s chest burbled sickeningly. The exhalations were wet and asthmatic. The saturation monitor showed a steady decline in circulating oxygen, an ominous sign. And now, with each parcel of air she forced into Dan’s lungs, his upper body seemed to be swelling.
Subcutaneous emphysema
, Dr. Ho thought, understanding now what had happened.
Oh, God. Dear God.
Jack Fallon was the first to arrive in the room. The alarm on the saturation monitor was whining now, and foamy blood had sudzed its way back through the clear-plastic circuit as far as the reservoir bag.
“There was a high pressure surge when I switched on the ventilator,” Dr. Ho told him. “It blew him up, Jack. It blew him up.”
Jack took over bagging Dan Doogan, whose wife had taken the day off work to wait for him in the hospital cafeteria. She’d promised to take him to Baskin & Robbins afterward for a Pralines & Cream cone, Dan’s favorite.
Jack squeezed the reservoir bag, watching Dan’s scrotum inflate like a hideous party favor. “This is pointless,” he said. “He must have taken full wall pressure.” At their source the oxygen and nitrous oxide gases were under tremendous pressure. A series of spring loaded valves normally protected the patient from a sudden surge. “He’s all broken up.” He stopped squeezing the bag. “It’s useless to persist, Aileen. You’ll only make it worse—”
“No, I’ll bag him. You call one of the chest surgeons. Call Chevrette, he’s the best...” Her voice trailed off.
Dan’s tissue planes were filling up with gas, bloating his neck, impregnating his plank-hard abdomen. It tracked out into his limbs, swelling them. His scrotum was already the size of a grapefruit. The pressure spike had blown out his lungs, causing a billion capillary hemorrhages, reducing delicate lung tissue to bloody tapioca. It had opened a rent in the muscular cowling of his diaphragm, allowing the gas to leak into his belly. It had ruined him. Dan Doogan looked like a demonic version of the Michelin man.
“Stop,” Jack said, taking Dr. Ho by the wrist. “It’s over. There’s nothing more we can do.” He cranked the oxygen flow meter to zero. The oscilloscope showed a glowing flat line.
Jack escorted Dr. Ho out of the room.
* * *
Jack returned to the abandoned suite a few minutes later. The automatic blood pressure cuff was inflated—in the confusion no one had thought to turn it off—and it’s alarm sounded, the digital pulse and pressure readouts showing a solid bank of flashing red zeros.
Jack turned it off. He turned the oscilloscope off, too.
Then he uncoupled the breathing circuit from the tube in Dan’s throat. The frothy mix of tissue fluid and blood from Dan’s lungs had collapsed into a thin, claret-colored solution that puddled in the corrugations. When Jack removed the circuit some of it dribbled onto the floor.
Aiming the circuit away from himself, Jack flipped the ventilator lever from MANUAL to AUTO. Instantly a tremendous blast of dry gases whistled through the light-weight circuit, tearing it from Jack’s grasp. The accumulated gore spat through the aperture in a nebulized cloud, freckling the walls, spattering the ceiling and floor.
Jack threw the lever back to MANUAL, killing the unchecked gas flow. He glanced up and saw Will Armstrong gazing down blankly at him through the slanted glass panels of the observation booth. Then he went to the phone and called Biomed.
* * *
Shit on this,
Byron Waverly thought.
Oh, man, take a serious dump on
this
situation.
He arrayed his tools on an instrument table and pulled on a pair of rubber gloves. He could feel the dead man on the operating table behind him; the hairs on the back of his neck were having a field day.
“Why don’t you just wheel the machine outta there?” Byron had said to his supervisor, Oliver Cowan, VP of paramedical services. “That way I can scope it out in the induction room or downstairs in Biomed.”
“It’s a coroner’s case, Waverly,” Cowan told him. “Everything’s got to be left as is until the coroner arrives.”
“So why don’t they truck that...effing corpse out of there? I’m not paid to deal with that shit.”
“Are you not reading me, Byron? It’s a coroner’s case. That means the machine stays, the stiff stays, everything stays until the coroner checks it out.”
“So where
is
the man?”
“Just get your ass in there and do it.”
Byron fitted his iPod headphones into his ears, thumbed the volume up to the barely-tolerable range and set about his task. It took him less than ten minutes to isolate the problem.
“Hellfire,” Byron said. With a pair of forceps he held up to the light the corroded remains of three gas-line valve springs. They reeked of sulfuric acid. “Hellfire and damnation.”
He dropped the springs into a zip-lock baggie, removed his headphones and gathered his tools. Then he looked at Dan Doogan’s body. He couldn’t help himself.
“Shit, man,” Byron said. “Look at you. You’re a freakin’ battleship and somebody scragged your ass.”
Byron ducked out of the room. He knew it was only his nerves, but for a second there it sure did look as if the dead man had nodded his agreement.
* * *
When Byron showed his findings to his boss, Oliver Cowan grabbed the nearest phone and called Peter Chartrand, president of the hospital. No sense dicking around.
“Are you certain about this?” Chartrand said.
“One hundred percent. The pressure reduction valves are acid eaten. There’s no question it was deliberate.”
“Jesus Christ... Okay, Oliver, listen. Don’t breathe a word of this to anyone. I’m going to call an emergency meeting for one o’clock. That’s thirty minutes from now. In the boardroom. I want you there and I want your man there. Until then, speak to no one.”
“My lips are sealed,” Cowan said. “I’ll talk to Byron, make sure he understands.”
“Good. You do that.”
* * *
The meeting began on schedule, all of the hospital’s key people in attendance. Emergency meetings at this level seldom meant good news, and the presence of a trio of hospital lawyers confirmed that assumption. Everyone looked grim and apprehensive.
Once the members were seated Chartrand said, “People, we’ve got a situation. A suspicious death in one of our ORs. According to Mr. Cowan—for those of you who don’t know him, Oliver heads up our paramedical team—one of our anesthetic machines has apparently been tampered with.”
Shocked gasps and muted whispers sifted through the boardroom.
Chartrand waited, giving the news time to sink in. Then he said, “The way I see it, our course of action is three-pronged. First, we must ensure that a disaster of this magnitude cannot occur again. Dr. Fallon, I’ll be looking to you for suggestions in this regard. Second, if Mr. Cowan’s assertions prove correct—and we’ll need forensics’ input on this—we must devise a means of identifying the guilty party. Which brings me to my third point.” He turned to the lawyers. “Do we involve the police?”
Jackie Fox, spokesperson for the lawyers, said, “I don’t see that we have any choice.”
There was a sudden uproar: hands flying up, members springing to their feet, the aggressive overlap of raised voices.
Red-faced, Chartrand stood. He was a tall man with overlong arms and when he raised them he looked like the host of a modern-day Last Supper. “Please, people. Order. There’ll be time for discussion later.”
When the members settled, the administrator waved Byron Waverly up to the front. Byron’s presentation was brief, it’s effect, devastating. You could hear a pin drop.
Jack’s voice cut into the silence. “This may not be the only instance of foul play.”
Chartrand looked gray. “Jack, what do you mean? And why haven’t you spoken up before now?”
“Because I have no real evidence,” Jack said. “But there have been a number of...unusual mishaps in the recent past, both in the OR and the ICU.” As examples he sited the case of Ben Crabtree, the would-be armed robber shot-gunned during a holdup attempt, and the pump failure in cardiac. “As in other cases I could mention, these could have been innocent mishaps. Probably were. But they could also have been deliberate.”
“Jesus,” Chartrand said. He buzzed his secretary on the intercom. “Sophie, could you come in here a moment, please? I want you to show Ms. Fox to my office. She has an important call to make.” To the lawyer he said, “Call the police. Ask for Detective-Sergeant Wesley Fransen in Major Crimes.” He cleared his throat. “We’ve had some dealings with him in the past.” He looked at Jack. “Jesus,” was all he could say.
* * *
The meeting wore on for another hour, the discussion heated, at times turning nasty. One member felt the public should be warned. Another argued that the ORs should be closed until the perpetrator was safely behind bars. Ultimately, Chartrand was compelled to warn them that no one—at the risk of their jobs and/or their hospital privileges—
no
one was to breathe a word of this to anyone outside of the boardroom. Something like this could ruin the hospital, he told them, hurl it into infamy, not to mention bankruptcy. And no one wanted that.