“Why do you suspect hyperkalemia?” Bruce questioned, looking confused. He was a senior medical resident in the last year of his internal medicine residency and lower in the hospital hierarchy than Colleen, who was a staff hospitalist.
“We happened to be viewing the ECG when this problem first started,” Colleen explained. “We witnessed the changes in real time as the heart’s conduction system went awry.”
“All right, team,” Bruce said while piling the defibrillator paddles on top of the machine to get them out of the way. “You heard the lady, let’s get to it.”
As the resuscitation team fell to work, one of the on-call anesthesiologists showed up and deftly intubated Jack so that the respiring could be done with more certainty and a respirator could be used if necessary. With Colleen’s encouragement, Patti reluctantly agreed to allow Laurie to stay in the cubicle while Patti left to return to the central desk.
As the minutes ticked by and no change was seen on the ECG monitor, Laurie again fell into despair, wondering how this could have happened, as she’d been there watching. She chided herself despite having no idea what she could have done differently. Looking at Jack, she wished she’d followed her initial inclination and had him transferred when the idea occurred to her when she’d first arrived in the Emergency Department.
When the stat electrolyte results came back, Patti rushed back to the cubicle herself to report them to the resuscitation team rather than using the audio system. After she’d called out the results, she added it was the highest potassium level she had ever seen in her career.
“My God,” Bruce responded. “That’s the highest I’ve ever seen as well. Good grief! With such a level I’m afraid we’re pissing on a forest fire here with this sodium bicarbonate and the rest. I suggest we get a surgical resident down here pronto and set up either peritoneal dialysis or, better yet, extracorporeal dialysis.”
“Do it!” Colleen said. She looked at Laurie. “It’s clearly what’s needed.”
Laurie nodded. She felt suddenly weak.
“How are you holding up?” Colleen asked, noticing her pallor.
“Not well,” Laurie admitted. “I think I’ll go back to my spot at the desk. I need to sit down.”
“Good idea. Please do,” Colleen said. “I’ll stay here and keep you informed of any changes. I promise.”
“Okay,” Laurie managed. She was beside herself with guilt and overwhelming anxiety. She turned around and started out of the cubicle. As there were still almost a dozen people jammed into the tiny room, people had to make way for her by stepping aside. She excused herself as she worked her way toward the exit.
Abruptly Laurie stopped in her tracks. She found herself staring at a man dressed in a white coat over scrubs who looked disturbingly familiar despite his Covid mask. Instantly she recognized him as the man she earlier had thought was a doctor when he’d come into the unit and briefly ducked into several of the occupied cubicles before doing the same into Jack’s. Attentive to all the comings and goings, she’d asked Colleen at the time who he was and learned that he wasn’t a doctor but rather the nursing supervisor who was responsible for allocating all the beds in the hospital’s intensive care units. She particularly remembered him because he’d nodded to her on his way out as if they knew each other. But far more important than that remembrance was that Laurie suddenly recalled she’d seen him a second time, apparently doing the same reconnoitering. What made this second sighting so disturbing and provocative was that it had preceded the first signs of trouble appearing on Jack’s ECG by minutes. He’d been the last person to enter Jack’s cubicle.
All these thoughts went through Laurie’s brain in milliseconds, igniting a firestorm of emotion. All at once and without an ounce of doubt, she knew in her heart that this man was the serial killer Sue Passero feared existed, and it was he who was responsible for Jack’s impending death.
“It was you!” she screamed. “You were the source of the potassium chloride!”
In a sudden, uncontrollable fury, Laurie launched herself at Ronnie with her fingers of both hands outstretched like cats’ claws, aimed at his neck. In her animal rage, she wanted to throttle him.
Shocked at this unexpected attack, Ronnie reared backward, trying to keep himself away from her hands while partially parrying her arms. Still, she was able to make contact with the base of his neck, scratching downward. Several nurses on either side of Laurie, equally shocked at her attack, tried to come to his assistance by grabbing her, but she was unstoppable. She lunged forward again and leaped at Ronnie with her hands outstretched. The nurses managed to sweep Laurie’s legs from under her, causing her to ram into Ronnie like a torpedo. As Laurie fell, she tried to grasp at anything with her hands as they slid down the front of his white coat. What they encountered were the two pockets, and, in an attempt to break her fall, she grabbed on, ripping both open and spilling out their contents.
As Laurie hit the floor, so did the empty 50ml syringe and the SIG Sauer P365, causing a collective gasp from all those people not directly participating in the resuscitation attempt and witnessing this sudden eruption of violence. Such a blowup, along with the appearance of a pistol within the sanctity of an intensive care unit, was a shocking and unexpected anathema. The two nurses who had essentially tackled her let go of her and took a step back in bewilderment.
Laurie scrambled to her feet and in the process snatched up both the pistol and the syringe and held them aloft. “Here’s proof!” she yelled. “This man is a killer!”
Ronnie was equally as shocked as everyone else, but in a far different way. When he had arrived at the code, which he’d timed to be sure the resuscitation team would already be there, he’d remained in the background to be available in case he was needed. Although he’d been mildly disconcerted when the decision was made to treat hyperkalemia early in the course of the cardiac arrest, he’d still been relatively confident enough potassium had already been delivered. But then, seemingly out of the blue, had come the surprise of his life. And now, facing this wild woman, he instantly knew he was facing an existential crisis despite his careful planning and faultless execution.
In milliseconds, it was utterly obvious to Ronnie that his carefully organized life was collapsing around him, and he had to react right now. There was no time to dither or argue or deny the obvious. He had to initiate his well-prepared escape plan by getting the hell out of the hospital. No doubt, the syringe still had potassium chloride residue in its chamber, which would be easy to verify.
Reaching out with determination, Ronnie grabbed his SIG Sauer, and with all his strength, he tore it out of Stapleton’s wife’s raised hand. Then he turned and charged out of the cubicle, roughly pushing people to the side.
Laurie reacted with similar impetuosity and, stuffing the empty syringe in her scrub pocket to preserve the evidence, she followed him, dashing out of the cubicle and running full tilt along the chest-high countertop of the central desk.
“Dr. Montgomery!” shouted Patti, who was within the desk and who happened to be on the phone with security. “Stop!”
But Laurie paid no heed. She could see that Ronnie had reached the swinging doors and had burst out into the hallway while still holding the pistol in full view.
“Dr. Montgomery!” Patti yelled out yet again.
Laurie wasn’t thinking, just reacting. The last thing she wanted was for this serial killer to get away, and, pistol notwithstanding, she wasn’t going to allow it. As she, too, burst out of the SICU, she confronted the two policeman who were seemingly confused about what was happening. Both had leaped to their feet as Ronnie had dashed past. One of the chairs had tipped over as evidence of how surprised they’d been. To the left down the corridor, she could see Ronnie’s rapidly diminishing figure as he was continuing his flight.