Lou watched as the man tumbled out of the SUV onto the pavement. His gun skidded off several feet. Lou pulled out his phone, calling the nineteenth precinct for help, and then the ED. Despite his experience, his hands were trembling.
Laurie had heard the gunshots as they echoed in the garage and hoped that they were from Lou’s gun and not the killer’s. She also now heard multiple police sirens in the distance as they converged. After the SUV had left, she’d rushed over to see if she could help the injured security man and had assisted in the placement of the man’s belt as a tourniquet around his thigh to stanch the bleeding. Now he was being taken away on a gurney brought up from the Emergency Department. She was about to head back upstairs to the SICU when her phone rang. As she expected, it was Lou.
“Are you okay?” Laurie demanded. The sounds of the approaching police sirens were even louder coming through her phone.
“Yeah, I’m okay,” Lou said. “But the suspect isn’t. I had to shoot the son of a bitch before he shot me. How about you? Are you okay?”
“I’m okay, but Jack isn’t. The man you shot tried to kill him the same way that horrid Jasmine Rakoczi tried to kill me, with potassium chloride.”
“Good God,” Lou said. “How is he?”
“I don’t know, and I’m scared to find out,” she said. “But I have to get back to the SICU. When I left to chase the bastard, Jack’s condition wasn’t good. He’d had a cardiac arrest from the potassium he’d been given.”
“Don’t tell me that,” Lou said with alarm. “You’re scaring me.”
“I’m terrified, too,” Laurie said. “I can’t believe it happened right under my nose. I was supposed to be watching over him to keep him safe. I’m furious with myself for not having had him transferred and for not keeping him safe when I didn’t.”
“Oh, come on, Laur! Don’t fault yourself! I’m sure you did the best you could and better than anyone else could have done. Minding Jack is a Herculean job. Listen, as soon as I wrap up here, I’ll come up and keep you company.” The sounds of the sirens reached a crescendo and then rapidly trailed off, suggesting multiple squad cars had arrived.
“It would be nice to have your company and support, but I’m afraid it is out of the question. The only reason I’ve been permitted in is thanks to one of the senior hospitalists, who I met through Sue and who has taken pity on me. And they might not let me return since I caused a hell of a commotion. I’ll have to see.”
“All right, I understand,” Lou said. “I won’t push, but good luck all around. I’ve got to go, but keep me informed. Please!”
“Okay, will do,” Laurie said, even though she wasn’t sure she’d have the strength if the news wasn’t good. She then pocketed her phone as she made her way to the exit door and then over the pedestrian bridge.
Once in the hospital, she used the elevator to go a single floor since she felt weak-kneed after the ordeal. Getting out on the third floor, she struggled with ambivalence. On the one hand she wanted to rush back to the SICU to find out how Jack was doing, while at the same time she was nervous that the news might not be what she wanted to hear.
She walked down the long hallway to the double doors leading into the SICU. The two chairs that had been occupied by the police remained. One was still tipped over on its side. After taking a deep breath for fortitude, Laurie pushed inside and then stopped just beyond the doors. From where she was standing, she could see the usual activities in a number of the cubicles, but, more important, she could see that Jack’s cubicle was still a center of activity. The cardiac crash cart was positioned by its entrance, which at least meant that the resuscitation team had not given up.
Glancing at the central desk, she saw it had returned to a semblance of normal. The clerk and several resident physicians were sitting in front of monitors making entries into the hospital’s central computer data bank. Patti Hoagland was standing in the center of it all and on the phone. The person Laurie most wanted to see, Colleen Benn, wasn’t in sight.
Laurie hesitated, unsure what to do. She questioned if she should just ignore everyone and proceed down to Jack’s cubicle as if she was entitled to be there or instead approach the central desk, get Patti’s attention, and perhaps apologize for the commotion she’d caused.
Laurie didn’t deliberate for long. Almost immediately Patti caught sight of her, and despite continuing her conversation with her mobile phone to her ear, she enthusiastically waved for Laurie to approach the desk. Relieved of having to make a decision, Laurie complied. As she neared, she had no idea what to expect.
“Dr. Montgomery,” Patti said once she was off the phone. “I was just talking with one of the administrators who has been in contact with security. Your suspicions about Ronald Cavanaugh seem to have been right. I won’t ask you how you knew because I’m sure you are anxious to know about your husband’s status. Colleen is still with him, and I’m sure she’s eager to talk with you.” She pointed toward Jack’s cubicle.
“Thank you. I’m sorry for having caused such a scene,” Laurie said.
“No problem! You were justified, and we as an institution are shocked, saddened, and frankly embarrassed to say the very least. But please, don’t let me hold you up. I know Colleen wants desperately to talk with you.” Patti gestured toward Jack’s cubicle again.
Laurie started in its direction, fearing for the worst but hoping for the best. She knew the term desperately could be interpreted either way. As she rounded the crash cart and stepped into the space, she could see the CPR was still being maintained. There was also another piece of equipment in the room, which was attached to blood-filled tubing that ran into Jack’s right arm. Laurie assumed it was an emergency dialysis machine despite having never seen one.
Colleen saw Laurie and joined her. “I think we are making progress,” Colleen said.
“Is that a dialysis machine?” Laurie asked while pointing.
“It is indeed,” Colleen said. “We’ve pulled out all the stops and started extracorporeal dialysis and peritoneal dialysis simultaneously. We’re already seeing a sharp drop in potassium level and even a little bit of electrical activity in the heart. I wouldn’t be at all surprised if we see significant electrical activity in the next few minutes. I don’t want to be premature, but I do believe we are over the hump. The fact that you recognized the signs of hyperkalemia so fast, I believe, saved the day.”
“That’s nice of you to say,” Laurie said. “Are you being sincere or just trying to be optimistic for my benefit?”
“Absolutely sincere,” Colleen said. “And since resuscitation was started so early, there was zero period of hypoxia. During the whole time we’ve been in here, the oxygen saturation has been in the nineties, so there won’t be any problem there, either.”
“Hey, look at this, everyone!” the resuscitation team leader yelled enthusiastically. “We’ve got relatively normal-looking electrical activity.”
“Just a minute,” Colleen said to Laurie before hurrying back to look at the ECG. After studying it for a moment she called out, “I’d say that looks pretty damn good. Hold up on the CPR!” Then, to the person doing the respiring, “Do we have a pulse?”
“We’ve got a pulse, and a good one,” the resident who had been using the ambu bag said, feeling for the carotid pulse in Jack’s neck.
“Is he breathing?” Colleen asked.
The same resident put her hand over the tip of the endotracheal tube to feel if there was air going in and out. “Yes, he’s breathing.”
“Fabulous,” Colleen said. “Go ahead and remove the endotracheal tube. Also, let’s run another stat electrolytes. We need to see exactly where the potassium is before we stop the dialysis.”