Shoofly Pie & Chop Shop (51 page)

“We went down together,” Santangelo shrugged. “Last I saw them, they were headed the opposite direction.”

The car slowly rolled away.

There was a beeping sound from the duffel bag. He pulled out his pager and checked his text messages. The single memo read: ZOHAR: MANDATORY: THURSDAY 2300: FOX CHAPEL YACHT CLUB.

Dr. Jack Kaplan sat slumped behind the wheel of his Porsche 911 Turbo, drumming his thumbs on the steering wheel in time to the thundering pulses of two fifteen-inch subwoofers. Half a block ahead he watched two squad cars, lights flashing, a thin band of yellow tape fluttering in the breeze between them. One officer restrained a weeping mother and daughter; another knelt beside a reclining body, while a third reached through the window of his black-and-white cruiser.

It was almost 2:00 a.m.; Kaplan’s shift at the UPMC Trauma Center had ended at midnight, and adrenaline still coursed through his veins like jet fuel. He had spent the last two hours slowly cruising the city, listening to his police scanner, hoping for some medical emergency that might keep him from having to return home to yet another sleepless night.

He looked impatiently at the two officers; they seemed to take forever. “C’mon, boys,” Kaplan grumbled. “It’s the Golden Hour.”

At last, he heard his police scanner crackle.

“Scene secured. Med One can approach.”

A block and a half ahead, a pair of headlights blinked on, and an orange and white EMS rig began to roll slowly toward the scene. Kaplan revved his own engine, shoved the stick into gear, and pulled away from the curb. His silver Porsche and the cube-shaped EMS truck arrived simultaneously.

A paramedic and two EMTs scurried over the rig, gathering equipment from a series of side compartments: a bright orange backboard with nylon restraining belts, a torpedo-like oxygen tank, a trauma kit, a Kevlar med bag, and Advanced Life Support equipment.

Kaplan approached the scene at a jog, neatly scissors-kicking
the yellow barrier tape, holding his credentials in front of him like a shield.

“Dr. Jack Kaplan,” he said to the kneeling officer. “I’m a trauma surgeon at UPMC Presbyterian. What have you got?”

The officer reached up, steadied the credentials, then nodded to Jack. “Male, Caucasian, twenty-eight,” he began. “He’s a local resident—”

“I don’t need his life story,” Kaplan said. “I want to know why he’s lying here in a pool of blood.”

“Multiple stab wounds to the chest.”

“Pulse?” Jack opened his medical bag and began to pull on a pair of greenish blue latex gloves.

“Yes—at least, I think so.”

“You
think
so. That’s kind of important.”

Kaplan ripped open the shirt. He wiped a sterile pad once across the bloody chest and watched; three small scarlet fountains reemerged through horizontal slits just below the rib cage.

“The attacker was a big man,” Kaplan said. “See the angle of the wounds? That’s a thrusting stroke. If he came at him overhead, the ribs would have stopped at least one of them.”

The EMS team approached now; the officer rose and stepped back away from the body.

“Do you mind?” the paramedic said to Kaplan. “We got a job to do here.”

“Your job is to assist
me
—I’m signing off on this one.”

“And just who exactly are—”

“Ask him.” Kaplan nodded to the officer. “We’re old pals. Now, backboard this guy, block him, whatever you’ve got to do to get him on the truck—but get a cuff on him and get me a pulse
fast.
”

The EMS crew went to work. Within a minute the body was restrained, lifted to a stretcher, and headed for the truck.

“We’ve got an erratic pulse,” the paramedic said, “and his BP is dropping off the charts.”

“Keep the straps clear of the chest area,” Kaplan said. “On the truck I want you to tube him, and I want two IV lines. You’ve got ALS equipment? Good—get a heart monitor on him right away.”

The stretcher rolled in head-forward and locked into place. The paramedic turned for the driver’s door—Kaplan stopped him.

“Uh-uh. You’re in the back with me.”

“Wait a minute, this is
my
rig—”

“And you’ve got the most medical training. You’re in the back.” He turned to the two EMTs. “Who’s the third man here?” he said. They glanced at one another, and the man on the left sheepishly raised his hand. “You’re out,” Kaplan said. “You bring my car—I’m not leaving it in this dump. The keys are in it. Touch the radio and I’ll remove your spleen—scratch it and I’ll use a chain saw.” Kaplan turned to the remaining EMT. “You do know how to drive?” The man nodded. “Then do it. UPMC Presbyterian,” he called back to the officer. “Let the family know.”

“Hold it,” the paramedic broke in. “Presby is ten minutes farther away.”

“Keep talking and it’ll be fifteen minutes. Get in the truck.”

The doors closed solidly like the doors of a meat locker; bright overhead lights flickered on, and the siren started its keening wail. The truck rolled slowly forward and then rapidly accelerated. The paramedic slid down the long vinyl bench on the right, connecting and adjusting the heart monitor; it was on less than five seconds before emitting a high, even tone.

“Cardiac arrest!” the paramedic shouted. “I’m going to defib!”

“No you’re not,” Kaplan said. “Not with a penetrating injury. Betadine the chest area—all of it, from the clavicle down.”

“Why? What are you going to do?”

“A thoracotomy.”

“A what?”

“I need you to switch places with me—now!”

The paramedic worked his way around the head of the stretcher. “What’s a thoracotomy?”

“I’m going to make an incision right here,” he said, drawing a line with his finger between two ribs. “I’m going to spread the ribs, open the pericardium, and repair any damage to the heart and coronary vessels. I’m going to clamp off the descending aorta to redirect blood flow to the lungs and brain, and then I’m going to reach in and massage the heart by hand until we get to UPMC.”

The paramedic swallowed hard. “Have you done this before?”

“Nope. Always wanted to try it, though.”

“Dr. Kaplan, we’re not set up for that kind of surgery—our job
is to stabilize and transport. We’ve got no instruments—one little tracheotomy scalpel, that’s all, and maybe a forceps.”

“Get them out. I need your trauma shears, too, and anything we can use for suction. I’ve got most of what I need with me—for the rest, we’ll improvise.”

“Will this work?”

“The survival rate is somewhere between 0 and 4 percent.”

“Dr. Kaplan, we’re
two minutes
from Allegheny General.”

“I need more than two minutes. Don’t you guys have a radio? Hey, driver! Give me something to work by back here.”

“Allegheny General is set up for this kind of thing. Please—don’t do this.”

Kaplan said nothing. He placed the gleaming point of the scalpel near the sternum in the fifth intercostal space and drew it firmly down.

“You’re killing him,” the paramedic said.

“He’s dead now,” Kaplan shrugged.

Eight minutes later the twin doors of UPMC Presbyterian Trauma Center burst open, and the stretcher raced in. The paramedic was at the head, pushing and guiding, while an EMT hurried along at his side, steadying the IV bag and line. On the opposite side, Jack Kaplan walked quickly and evenly, with both hands extending into a gaping scarlet hole.

A tall, thin woman in a white lab coat swept in behind them. “Jack, don’t you ever go home? Isn’t a twelve-hour shift long enough for you?”

“I was gone for two hours,” he said. “I got bored.”

“What did you
do
?” she said, staring into the wound.

“A resuscitative thoracotomy.”

“In the back of an ambulance? What were you thinking?”

Three more ER staff came alongside now, and the paramedic and EMT passed off the stretcher like a baton in a relay race.

“He’s got multiple stab wounds to the chest,” Kaplan announced to the group. “He was in arrhythmia at the scene and went into cardiac arrest in the ambulance. I opened him up and checked for cardiac wounds—the vessels were all intact, but I sutured one atrial laceration. I displaced the heart and searched for posterior wounds—there were none. And I’ve been massaging this thing for
ten minutes now, and my hands are cramping—somebody want to take over for me here?”

Kaplan stepped away as the stretcher disappeared into the OR. He stepped to a waste receptacle and began to strip off his dripping gloves.

“Hey, Rosa,” he called to a passing nurse. “You’re looking good tonight. When are you going driving with me?”

“When I feel like putting a gun to my head,” the nurse said without turning.

He was at the sink, scrubbing, when the paramedic and both EMTs approached.

“I just want to say one thing,” the paramedic growled. “You didn’t have to do that. You can explain it away to the family, maybe even to your doctor friends, but
you
know and I know. We were two minutes away from a fully equipped ER. You did it the hard way, and you did it just for the doing.” The paramedic shook his head in disgust. “Don’t ever ride on my rig again.”

Kaplan looked at him without expression, then turned to the EMT at his side. “How did it drive?”

The EMT dropped the keys on the floor. All three men turned and left.

Kaplan stepped into the waiting area. In the center of the room, two women stood embracing and weeping. The older woman was fiftyish, heavy and thick-limbed, her eyes bloated and red. Kaplan’s eyes moved quickly to the daughter, who looked twenty, maybe twenty-five, with the face and body her mother might have had a very long time ago. Both women looked up as he entered.

“I’m Dr. Kaplan,” he said solemnly. “I was the surgeon in charge tonight. I took responsibility for your—”
Husband? Brother? Jack never even got a name. No matter.

“It’s lucky I happened along when I did. I just want you to know, I did everything I could, and he’s in the best of hands now.”

At this, both women began to weep openly. The mother turned to Kaplan with a look of infinite gratitude, her arms outstretched. Kaplan brushed past her and took the younger woman in his arms, comforting her as best he could.

There was a beeping sound at his belt. He glanced down at the luminous green LCD. It read, ZOHAR: MANDATORY: THURSDAY 2300: FOX CHAPEL YACHT CLUB.

The Allegheny River cuts a three-hundred-mile channel from New York state across western Pennsylvania to the city of Pittsburgh. The Allegheny’s riverbed is solid rock, smoothed by some ancient glacier, and the water that flows across its siltless bottom is a clear greenish blue. To the south, the Monongahela River wallows its way toward Pittsburgh through a hundred and twenty-five miles of mud and clay, pumping its red brown water through the old Steel Valley that once belched out so much smoke and soot that the streetlights had to be turned on at noon. Both rivers were once choked with debris and industrial effluent; now both are clean again, lined with marinas and private quays dotted with weekend pleasure boats. The two rivers join to form the mighty Ohio at a place simply known as the Point, at the tip of downtown Pittsburgh.

Nick Polchak stood with his toes overhanging the concrete ledge, staring into the churning waters. To his right the water flowed clear green; to his left, muddy brown; straight ahead, the two colors swirled together in a watery palette and disappeared into the distance. The Point is one of the most dangerous places to swim in all of Pittsburgh; the two rivers collide like angry storm fronts to spawn tornadolike undercurrents—but the Point is also the most tempting place to swim in all of Pittsburgh, and each year a handful of the brave and the foolish surrender to temptation at the cost of their lives.

“Thinking of jumping in?” a voice said behind him.

“Every time I come here,” Nick replied.

Riley McKay’s hair was straight and whitish blond, cut off above the shoulders and pulled back from her face with a thin, tortoiseshell band. Nick cocked his head and took her measure, comparing this new image with the one burned into his memory just a week and a half ago. Her cheekbones were high and her skin was fair—the Scots
blood in her, Nick thought. Her shoulders were broad, well-boned, and her lean arms hung down from them like stockings from a coat hanger. Her fingertips broke just below midthigh, a bit longer than usual; her hands were long and slender, and her fingernails were cut to the quick like a concert pianist—no, like a forensic pathologist.