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The best-selling author of the blockbuster medical thriller, The Select, presents a chilling suspense story involving a plastic surgeon who creates a miraculous implant that may be an instrument of evil.
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F. Paul Wilson, the New York Times bestselling author of the Repairman Jack novels, lives in Wall, NJ.Excerpt. © Reprinted by permission. All rights reserved.:
"still flat-lined," someone said.
I know that, dammit, Gina Panzella thought as she stared helplessly at the monitor, willing the featureless thread of light to show systole, even a muscular twitch. It ignored her. Nothing but a little sixty-cycle interference marred its placid, unwavering course.
The sick sour smell of death filled the air and the three nurses who made up the Code Blue team were watching her expectantly, waiting for her to admit the obvious.
All right, she told herself. Call it off.
She sighed. "No use. He's not coming back."
The nurses nodded and began repacking their gear into the crash cart. Gina stepped back and took one final look at Mr. Nussbaum's pale, bloated, naked, lifeless, fifty-two-year-old body. His limbs were splayed, a ribbed plastic tube protruded from his slack mouth, wires strayed from plastic patches from his slack mouth, wires strayed from plastic under his right clavicle. He'd had a laparoscopic cholecystectomy yesterday, and he'd come through just fine. Tonight--this morning actually, at 3:05 or thereabours--he'd gone into cardiac arrest and a code had sounded.
None of the staff cardiologists had been in the hospital, and no way could one of them arrive in time, so Gina, as house doctor, had run the code. The team had already slipped the board under Nussbaum's back and started CPR by the time she arrived. Gina had intubated him, then under her direction the team worked on him for forty minutes. She threw everything they had at Mr. Nussbaum: intracardiac injections, repeated defibrillation, the works. Everything short of cracking his chest and squeezing the heart with her hands.
Nothing. The Nussbaum heart had decided to quit and nothing she tried could change its mind.
"Good code, Doc," said Judy Hooper, giving Gina's shoulder a squeeze. She was tall, thin, with a halo of bushy blond hair around her angular face; late thirties--maybe ten years older than Gina--and a veteran of more codes than Gina ever hoped to see.
"Not so good," Gina said, cocking her head toward Mr. Nussbaum. "He's going to the cooler instead of the CCU."
"You gave him every chance. Ten to one the post will show a major PE. Not much you can do about that."
Gina nodded. These obese patients, when they arrested like this, usually it was due to a pulmonary embolism--a big clot shooting to the lung from somewhere in the leg. All the drugs and electric shocks in the world couldn't clear a clogged pulmonary artery.
"Good working with you," Judy said, then went back to unhooking Mr. Nussbaum.
Yeah, Gina thought. Real good.
She hoped her skin never got as thick as Hooper's seemed to be. Then again, in Hooper's position a thick skin was probably essential for survival.
Gina felt her tense muscles begin to uncoil in the dimly lit silence and antiseptic tang of the hallway. She was halfway to the elevator when a young nurse approached her. She had short red hair, bad skin, and a considerable overbite. Her badge said T. Graves, RN.
"Dr. Panzella, would you mind very much taking a look at an IV in 307?"
"Where's the IV team?"
"Well..." She nervously rubbed her hands together.
"I'm it on this shift, and I can't seem to..."
The nurse seemed terrified of her.
"Let's take a look."
"Oh, thank you!" She led Gina down the hall to her right.
"I can't tell you how much I appreciate this."
"Well, I asked Dr. Grady last night for help with another patient and he...he got upset."
If I know Grady, Gina thought, he probably damn near took your head off. A third-year resident at Georgetown, Grady was very bright but tended to be a little full of himself. Lynnbrook was a community hospital in the north-west section and dwelt in the shadow of Georgetown Medical Center. Not a teaching hospital like its renowned neighbor, but it served its purpose.
Gina knew how some house docs, especially those who considered themselves high-powered, got uppity when asked to start an IV. Gina got annoyed herself at times. After all, the hospital was paying an IV team to do its job and paying Gina to do hers. But sooner or later everyone, no matter how good they were, ran up against a wall trying no find a vein.
"She's in the window bed," Graves said. "One of Conway's patients. Had pneumonia. Been on IV antibiotics, now she's just on D-5-W. Didn't have many veins to start with and those are all used up. The last usable one infiltrated the end of last shift and I can't find another."
Gina found a frail old woman with thin, pinched features and short white hair. She sat up in bed, wide awake, staring at them. She had the top of the sheet bunched in her hands and was kneading it like dough.
"Please don't send me home tomorrow," she said.
"She's scheduled for discharge tomorrow?" Gina said.
Graves placed the chart in Gina's outstretched hand.
The chart said. "Harriet Thompson" on the front. Age seventy-eight. Dr. Conway was one of the local family practitioners--quiet, competent, with a loyal following. Gina had met him a few times and liked him. She flipped through the ream of color-coded paper. Mrs. Thomson's last chest X ray was clear. Dr. Conway's scrawled progress note from the morning read, "Try again for disch in AM."
Gina found the order sheet and wrote, "Hold IV until AM" She scribbled her name and handed it back to the nurse.
"There. That solves the IV problem."
Graves smiled. "Great." She picked up her basket of needles and tubing and hurried to the next patient on her list.
"Do you know Dr. Conway?" said. Mrs. Thompson.
Gina turned. "A little."
"Tell him not to send me home tomorrow. I'm too weak."
"I can't tell him what to do. I'm just the house doctor here tonight."
"But all my strength is gone. I don't know what I'll do."
Gina patted her hand. "Tell you what, Mrs..." Her named had slipped away.
"Thompson. But you can call me Harriet."
"Okay, Harriet. If I see Dr. Conway I'll mention it."
"Thank you," she said, smiling for the first time. "You're very kind."
Gina hadn't expected to be able to deliver on that promise, but as she was running a brush through her glossy back, blunt-cut hair and debating whether to bother fishing out her lipstick, Dr. Bill Conway strode into the doctors' lounge.
"Cutting out early?" he said, smiling. "Starting your own practice?"
He was young, maybe two or three years older than Gina, and good-looking--he could have been another Baldwin brother. Gina found him immensely attractive, liked his attitude and liked his looks. But he was wearing a wedding ring. Very married.
"Grady's covering," she said. "No private practice yet. My day job is assisting Duncan Lathram a couple of times a week."
His eyebrows rose. "Whoa! I didn't know you moved in such rarefied circles. And since when did you become a surgeon?"
"Usually I hate surgery, but what Duncan does is fascinating. It's like art."
"The Art of the Nose Job. Good title for a book."
"Why not? If Donald Trump can write one, why not Duncan Lathram? Guaranteed big sales inside the beltway. Oh, by the way, the IV on one of your patients infiltrated last night and I put a hold on it till you came in."
"Thompson on Three North?"
"Right. Her veins are shot."
Gina was a little surprised by the reaction. She hadn't seen any pressing reason for the IV.
"You could always go subclavian if--"
"No, it's not that. The PRO's been on my back about getting her out. According to their guidelines she doesn't need a hospital: Her pneumonia's cleared, ship her out."
"She said something about how weak she was feeling, and she was scared to go home."
He was nodding. "One of those wonderful situations where she looks good on paper--her chest X ray's clear, fever's down, white count back to normal, electrolytes balanced--but she's not ready to take care of herself. Can't get into a nursing home for a week, scared to death of having some stranger stay with her, and her daughter lived in San Diego and can't or won't come back and stay with Mom for a few days. So what do I do?"
"Tell the PRO to take over her case," Gina cracked.
"Yeah, right," Conway said. "When was the last time those paper shufflers treated a patient? If they had real practices they wouldn't have time to stick their noses in other people's charts." He sighed. "That IV was useless, but it gave me an excuse to keep her a few more days. But now, without a line running, they're really going to push for discharge. Want to guess how many hours before I get a call from the administration?"
"Sometime right after lunch, I'd say."
She knew what the hospital administrators would be worrying about: money. The PRO board couldn't kick Mrs. Thompson out, but it would rule that her condition to longer required hospital-level care. With that, Medicate would stop all further payment for services. The hospital would have to eat the extra days she was kept on, and Dr. Conway didn't give a damn about treating Mrs. Thompson a few more days at no charge. But she doubted the hospital would be so casual.
Once again Gina found herself wondering whether she wanted to go into private practice. Sometimes moonlighting as house physician for the rest of her life didn't look so bad.
"So what are you going to do?"
Conway shrugged. "Screw 'em. She stays till she's ready to go."
Gina gave him a thumbs-up and waved good-bye. But she wondered how long he'd be able to withstand that sort of pressure.
The sun was rising, the air was fresh and invigorating, and birds were chirping like a roomful of cardiac monitors in atrial fib. She hopped into her old red Pontiac Sunbird and headed for home. But not to bed. She had an important appointment coming up. Sleep was not in the cards.
Gina wasn't tired. As chief resident in the Tulane University internal medicine/public policy program, she'd been putting in more than a hundred hours a week until only a few months ago. Now with her three twelve-hour shifts a week as house doctor at Lynnbrook, plus doing physicals and assisting with surgery at Duncan Lathram's surgicenter three mornings, it all totaled out to only sixty hours a week.
Almost like a vacation. She hardly knew what to do with so much free time.
Well, yes, she did. Or at least she knew what she wanted to do. Senator Hugh Marsden was chairing the Joint committee on Medical Ethics and Practice Guidelines. She wanted to be on his staff, to work as a legislative aide. And at 10 a.m. she had an interview in his office.
Everyone she knew thought she was crazy. She'd tried to make her parents understand, but it was hard.
Sure, major health-care overhaul was stalled, but its inevitability was throwing medicine into turmoil. As she was completing her residency at Tulane, she'd looked around and asked herself where she could go, what she could do that would make the greatest difference. She'd read everything she could find, buttonholed everyone she knew, and come to realize that the future of medicine would be decided in Washington by people who knew next to nothing about it. So maybe she could do more for her patients--and for the medical profession itself--in Washington than in the Louisiana multispecialty medical group that had offered her that attractive starting salary.
Medicine was becoming a new game now, so maybe it was time for a new kind of doctor, one who could operate comfortably
in both worlds--practice medicine and still get the ear of the legislators who were making of the rules. If that new kind of doctor had the skills, the drive, knew the ins and outs of how these rules were being shaped, she might develop enough respect and credibility to have a decisive impact.
Gina felt strangely sure she was that kind of doctor.
Sure enough to leave behind the man she loved to return to the area where she'd grown up to prove it.
She blinked away the memory of Peter Hanson's stricken expression the last time she'd seen him. His usually perfect brown hair had been wet from the rain, his dark eyes full of hurt and disbelief as she'd stepped toward the boarding ramp. She remembered now she'd wavered then, how she'd had to fight the urge to run back to him and throw herself into his arms. But she'd known in her heart that if she didn't give this a shot, she'd forever wonder what might have been. She didn't want to spend the rest of her life regretting, asking, "What if..."
All she asked now was a chance to show her stuff. The first step toward that chance was scheduled in a few hours.
She sent up a silent prayer: Don't let me blow it.
Copyright © 1995 by F. Paul Wilson
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