Authors: Katherine Stone
“Hi,” Mark said as he walked into the small lab in the intensive care unit at San Francisco General Hospital.
Leslie spun around, startled.
Everyone was a little on edge, watchful. The ICU was housing a very important, and very ill, patient. He was a police informant. He hadn’t yet been able to tell his story. The people who wanted him never to tell it had already made one very nearly successful attempt on his life.
Everyone who worked in the ICU was on alert. Even though the patient was heavily guarded, the police were fearful of another attempt on his life. The police told them all to be on the lookout for someone who looked out of place, who didn’t belong. Someone whom they didn’t recognize.
But it was July. Half the physician staff was new. There were the interns, their eager faces just beginning to show the inevitable signs of strain and fatigue, and there were new residents, ones who had transferred from other programs. Then, there were fellows who had completed residencies elsewhere and had come to San Francisco for subspecialty training.
Leslie met new people every day. On her way to the lab just now, she had seen yet another new face. He was a handsome man with stylish blond hair, intelligent blue eyes and a long white coat signifying his status as a fellow. Probably the new nephrology fellow, Leslie decided. She knew a patient had just been admitted to the ICU for emergency hemodialysis. He smiled at her as she passed him. She returned the smile but didn’t stop. She was carrying the blood gas she had just drawn. She would meet him later.
“Mark! Hi,” she breathed. Then, as her edginess vanished, she teased, “Is this one of your nights? A cameo appearance?”
“Just you wait. You’ll be amazed how quickly every sixth night rolls around. This is my fifth night on call of the year, and it’s only July thirtieth.”
“Well, it’s my
tenth
, but who’s counting?” Leslie countered lightly. Then, looking at his slightly tanned, less gaunt face and his relaxed brown eyes, she added, “You look good. Rested.”
Happy, she thought. She realized that he hadn’t been happy before, but she hadn’t known it. It was only obvious in retrospect.
“I am. This R-
3
business is just fine.”
“You’re on the infectious disease consult service, aren’t you? Is it a good elective?”
“Very good.”
“Anything new on AIDS?”
“Just that the epidemic is continuing with dramatic doubling rates. Most people think it will turn out to be a virus. Transmission probably like hepatitis B.”
“Sexual transmission we all know about. Blood, too?”
“Probably blood. That’s the rumor. Cases in hemophiliacs are being recognized.”
“Huh.”
“Nobody’s sure, of course, but it would be a good time not to get a blood transfusion in New York or LA. Or
here
.”
“It’s such an awful disease,” Leslie said, then, focusing on the blood gas machine and the blood sample she had brought into the lab, she said, “Damn!”
“What?”
“I get so tired of people using this blood gas machine and not flushing it with heparin afterward!”
“Is it clotted?” Mark asked, moving beside her to inspect the decrepit machine and its slender plastic tubing.
“The clot can be worked out, but it’s such a nuisance.”
“Allow me, your friendly mellow R-
3
.”
Leslie laughed.
“I’m a little snappy aren’t I?” she asked.
“A little.”
“Have you met my intern, Hal? Excuse me, Dr. Hal Perry.”
“OK, so Hal thinks he has a few answers,” Mark said, laughing.
“A few?”
“All.”
“You told me, almost precisely a year ago, that by this time this year I’d have an intern with a crush on me, padding obediently behind me, wagging his tail and drooling. Instead, I get Hal, who, by his own humble assessment, is God’s gift to medicine.”
“In a month he’ll have a crush on you. When he learns how little he really knows.”
“Grrr. This is his blood gas I’m running. His patient. Hal didn’t think he needed a repeat gas.”
“So you’re just quietly doing it? Not good, Leslie. You have to be tough.”
“I have to make sure that the patients are OK, right? Top priority.”
“Yeah. But you have to be tough with these little whippersnappers, too,” Mark said firmly. “OK, give me the syringe. The clot’s gone.”
“My hero,” Leslie said, still fuming at the thought of her intern. “Hal’s the one who probably clogged it up.”
“Oh,” Mark said, looking at the label on the blood gas syringe that Leslie handed him. “This is from the fellow who turned state’s evidence.”
“Tried to,” Leslie said. “He got shot before he gave them the key information.”
“How’s he doing?”
“I think he’ll get another chance. Today he’s much better.”
“That’s why the ICU is teeming with police.”
“Yes. They seem to think someone is going to walk in and shoot him in broad daylight in the ICU.”
“It could happen,” Mark said.
“That’s what they keep telling us.” It was why they were all so edgy, why they were all so watchful. “They seem pretty convinced it’s possible.”
“Don’t you agree? A white coat is all the disguise someone would need, assuming he or she wasn’t wearing army fatigues beneath the coat, carrying an ill-concealed weapon, and looking like a psychopathic thug.”
“A white coat might be enough, even with battle fatigues and a thug-like look.”
“You really are in a charming mood tonight,” Mark teased. “Modern medicine hasn’t come to that. I have yet to spot even one thug, or one battle fatigue wearing intern, in this year’s group. Maybe in the early seventies, but not now. I mean, look at Hal.”
Leslie smiled at last. “He does wear bow ties, doesn’t he? Bow ties!”
“OK. Here are your results,” Mark said, reading the dials on the machine. “The pH is seven point three—”
Shots rang out. Then screaming. Shouting. Running. More shots.
Mark and Leslie froze.
“Stay here,” Mark said, moving toward the door.
Leslie grabbed his arm.
“You stay here, too, Mark.”
The door crashed open. A blond man, wearing a long white coat and carrying a black gun, entered and pulled the door shut behind him.
Leslie and Mark retreated to the far corner of the tiny lab.
“Don’t say a word,” the man hissed as he faced them.
When Leslie saw his face she gasped. It was the same man, the one who she had decided was the new nephrology fellow, she had seen moments ago. The man who looked like a board certified internist, not a thug. The man with the intelligent eyes.
The eyes were transformed now. They were wild, darting, crazed. Crazy. They were also a little euphoric, manic, triumphant. He had probably successfully killed his target, Leslie’s patient. Now he only had to escape.
He was prepared to take hostages. Or to leave more victims.
He pressed his back against the door and leveled the gun at Mark and Leslie. He realized in an instant that there was no way out of the tiny lab except by the door through which he had entered.
The assassin grabbed Leslie’s arm and pulled her beside him.
“C’mon, little nursey. You’re comin’ with me.
He jerked her toward him and held her, squeezing her arm until it ached. Then he put the gun to her head, pressing its cold barrel against her temple, and put his finger on the trigger.
“One peep and you’re dead.”
The room was silent except for the sound of their breathing. Outside, in the hallway, the shouting and footsteps had become distant. They were chasing the assassin out of the hospital.
But he was still in the ICU.
He’s bleeding, Mark realized. The man had been shot in the leg. Large drops of blood splashed onto the linoleum floor.
Surely, Mark thought, he left a trail of blood leading to the lab.
Despite the silence from the other side of the door—too silent given the commotion that would be going on in the ICU in the aftermath—they must be out there. The police must know exactly where the murderer is.
They probably have the hallway sealed off, Mark decided. How many guns are pointed at the door? What if they decide to open fire, believing the man is alone in the lab? If they open fire, they will hit Leslie.
The man held Leslie in front of him, pressed against the door. The gun was still pointed at her head. His finger was on the trigger.
Mark couldn’t let it happen. Ten more seconds of silence, he decided, hoping it wasn’t too much.
He counted patiently, evenly.
Nine. Ten.
“HEY!” Mark yelled and lunged at the startled assassin, who spun, the barrel of the gun leaving Leslie’s temple and ramming, as he pulled the trigger, into Mark’s chest.
“
Mark!
” Leslie screamed, rushing past the man who bolted for the door, opened it and ran into a circle of police. Trapped, he became frantic and started shooting, wounding two officers before he died.
“Mark, Mark,” Leslie said, over and over, as she knelt beside him.
The bullet had created a gaping hole in Mark’s chest. He gasped for breath. Despite the pain, he lay still. Afraid. In shock.
Bright red blood spurted from the wound and onto Leslie’s face and chest as she hovered over him. Bright red blood. Arterial blood. He was losing blood quickly. With each heartbeat, and his heart was beating rapidly, another large spurt of blood left Mark’s body.
He would bleed out, die from acute blood loss, very quickly. His strong young heart would pump harder and harder. Each pump more and more lethal.
Unless and until the hole in the artery was closed.
Leslie reached into the wound in Mark’s chest with her left hand. She felt the hot blood pulsing toward her. She tried to determine the direction with the sensitive tips of her fingers, praying she would be able to reach the severed artery.
What if she couldn’t find it?
What if her fingers wouldn’t reach?
As Leslie rammed her hand inside his chest, deeper and deeper, she felt his shattered ribs and the sharp points of the broken bone tearing her own skin. She felt the warmth of his body, his hot pulsing blood and his lacy delicate lung moving, gasping against her hand.
“Leslie, let’s get him out of here. Down to the trauma room.”
The hall outside the tiny lab was now crowded with police, nurses, house staff, camera crews and reporters. The lab was too small for more than one or two more people. They couldn’t take care of Mark there. They needed to get him into a big room with equipment and a trained trauma team.
“I have to do this,” Leslie said as her fingers finally reached the artery that was allowing Mark’s life to bleed away. She gave her hand one final shove, stretching her fingers to the area of pulsation. With all her strength she pressed her fingers over the hot, slippery vessel.
The bleeding slowed.
“C’mon, Les!” The people in the hallway were getting anxious. They had no idea why Leslie wouldn’t get out of the lab. Why she wouldn’t move to let them get to Mark so they could take him to the ER.
“I’m tamponading an arterial bleeder,” she said. “I have it now, so we can move him. But I can’t take my hand away.”
Until then they had only seen her back, her body hunched over Mark feverishly doing something. She turned slightly as she spoke. They saw her face, drenched in Mark’s blood, and the red wetness of her chest.
They knew instantly she was right. They could all see how much blood he had lost. If she had the bleeding stopped, the top priority for all of them as they transported him to the trauma room was to protect her hold on the artery.
“Can we clamp it here, Leslie?”
In time, as soon as possible, Leslie’s finger would be replaced by a metal clamp. Properly positioned, it would hold the artery closed until they could get him to surgery.
“I don’t know. Maybe. I really have a good hold right now.” Once she had the bleeding slowed, she had repositioned her hand, wedging the palm against the sharp bones of his broken ribs. She had a good, firm grasp of Mark’s chest wall and of the severed artery.
“OK. Let’s move him, then. He needs to be intubated as soon as possible.”
The hole in Mark’s chest did not allow him to breathe effectively. Each breath, each gasp sucked air in through the hole, putting pressure on the lung, preventing its normal expansion, making it collapse.
Mark was unconscious. He needed many things all at once. He needed an endotracheal tube, intravenous lines, blood, oxygen and surgery. One and a half minutes after they left the ICU lab, Mark was in the trauma room in the emergency room, intubated, with two intravenous lines. Blood work had been sent.
San Francisco General
Hospital
was one of the first and best trauma centers in the country. A team of trained doctors, each with a specific pre-assigned task, quickly and efficiently worked to give each trauma patient the best possible chance of survival.