Genesis

Chapter 26

May 10th

3:05 A.M.

It was time and timing was critical. Through the day he’d given the problem a lot of thought and ultimately decided the best time to do what had to be done was between three and four A.M. That was the hour when the night shift had their respective lunches, so that at any given time within that interval there would be half the usual complement of hospitalists, nurses, nurses’ aides, and orderlies lurking in the area.

Getting up from the reading chair where he’d been sitting for several hours while trying to read and failing and instead watching mindless YouTube videos on his tablet, he went to the mirror he had hanging on the inside of his office door. The moment he’d gotten to his feet, he’d felt a surge of adrenaline course through his system such that as he tried to don the dark wig while looking into the mirror, his hands were shaking.

“Pull yourself together,” he commanded. For a moment he let his arms fall to his sides, closed his eyes, and he took a series of deep breaths. Within just a few seconds he felt better. If he was going to pull this off, and there was really no choice in the matter, it was important to control his anxieties and remember that he had planned everything to the T. It was going to work and work extremely well. He remembered his mother telling him when he’d been a boy that you shouldn’t lie because lies tended to propagate more lies. No one had told him that it was the same when you murdered someone, but then again, he should have known. Every contingency had to be accounted for, even the most unexpected. He’d been relatively certain that Kera had not told Madison his identity, but he couldn’t take the chance, especially now that the woman had somehow lived through getting run over by a train, which he’d never expected.

With his tremor under control, he went back to pulling on the wig, which was made of real hair, dyed black. The style was medium length with a central part so that the sides covered his own sideburns completely. Once the wig was in proper place, he used a wide-toothed comb to tame it a degree. As he regarded himself in the mirror when he was finished, he was pleased. Although it was only hair, the overall effect was quite a transition. He truly looked like someone else. But he wasn’t finished. The next part of his disguise was a pair of heavy-framed black glasses that reminded him of Woody Allen. With those in place, he was amazed. He hardly recognized himself.

The last part of the costume was the long white doctor’s coat. His idea was to look like a surgeon, and he was confident that he did once he pulled on the coat and put some hemostats and bandage scissors in the breast pocket, along with a few pens and a pencil flashlight. The final touch was the stethoscope, which he hung casually around his neck. With that in place, he stepped back a few paces and checked himself. It was perfect.

Walking over to the desk, he picked up the syringe that he’d prepared earlier. It was a ten-cc syringe that was already full. He’d gotten it that evening, which had been easy since there were hundreds of places he could have chosen. What had been a bit harder was the contents, an injectable form of potassium chloride, or KCl, which was the perfect drug for murder as it was fast, certain, and essentially undetectable. Obtaining it on short notice had been a bit more difficult but not impossible. He’d found a stash in the supply room for the Emergency Department with its main store of saline and other intravenous fluids. It wasn’t under lock and key like all the other drugs.

Now fully prepared, he left the office, taking the stairs to avoid the unlikely situation of running into anyone in the elevator even though he was certain no one would recognize him. Once outside, he made his way over to First Avenue and headed south, walking briskly as the temperature had fallen into the upper fifties.

At that time in the early-morning hours, the front entrance of Bellevue Hospital was almost deserted. He pushed through the revolving door and then crossed the expanse of the lobby where there was only a handful of people. The information desk was manned by several uniformed security people who were carrying on an animated conversation, which he guessed was most likely about the Yankees or the Mets as the complaints about the Knicks had finally fallen off.

Again, he avoided the elevator. Fortunately, he was only going up two floors. Exiting from the stairwell, he headed toward the ICU, which was in the west wing on the second floor. As he got closer, he began to see progressively more people, mostly nurses and nurses’ aides or assistants. No matter what time of day or night, there was always lots of activity in the various intensive-care units, as the name implied.

Without any hesitation, he headed to the central desk where there were a number of people sitting around chatting. Some were obviously nurses, but others in scrubs could have been hospitalist physicians or residents. Walking up to the counter, he stopped. From there he could see into the various rooms, including room 8, where Madison Bryant was located. He was encouraged. There seemed to be only one nurse or nurse’s aide in the room at the moment. He wasn’t surprised, as he had checked on Madison’s status a few hours ago. He’d learned that she was stable, although still critical, and was scheduled to be moved to a regular room the following day. Looking into other ICU rooms, he could see much more activity, some more than others. In one of the semi-private rooms there was a lot of action, suggesting a patient was in dire straits.

As he expected, dressed as he was, no one paid him any heed, which was good. He was just another one of the cavalcade of people necessary to run one of the busiest parts of the hospital. People came and went, especially doctors.

“Excuse me,” he said to one of the nurses behind the counter. “Who is the charge nurse tonight?” He knew he was taking a chance by asking for her, but he hoped he’d arrived when she was at lunch. It was a fifty-fifty risk, but even if he was wrong, he already had a plan of how to deal with her or him.

“That’s Barbara Strassman,” the nurse said.

“Is she here?”

“She’s at lunch but should be back any minute.”

“Okay, thanks,” he said. He was pleased. He knew that the ICU was significantly more efficient when the charge nurse was present, as it was her job to keep things under control with all the patients, a kind of watchful gatekeeper who knew what was happening at any given moment to everyone under her responsibility. That was important as far as he was concerned because he was planning on causing a scene and the less anyone anticipated it, the better. With what he had in mind, he needed only about ten seconds.

Leaving the central desk, he walked over to the open door leading into room 8. The bed was against the back wall. There were no windows. Above Madison’s head were several monitors displaying her vital signs, EEG, and cardiac rhythm. The nurse or nurse’s aide was busy hanging up a fresh container of intravenous fluid and then adjusting the drip rate. Madison herself seemed to be either sleeping or resting. Her eyes were closed. All that was perfect, almost more than he could have hoped for.

When he entered the room and got a look at the attendant’s name tag, he could tell that she was a nurse’s assistant trained with intensive care skills. He thought that was also helpful as fully trained nurses tended to be more questioning, particularly those trained in critical care.

“How is she doing?” he asked in a whisper as he approached the bed on the patient’s right side. He wanted to be on the right because he was right-handed.

“She’s doing very well,” the aide whispered back. “She’s asleep now, but she’s been talking a lot and has been taking fluids by mouth.”

“Does she know what happened to her?” he asked.

“She does but only because she’s been told,” the aide said. “She still can’t remember the details. All she remembers is ascending onto the Lexington Avenue subway platform.”

“Where’s the assigned nurse?”

“She’s at lunch.”

He inwardly smiled. Things seemed to be falling into place almost too perfectly. “Could you bring me some gauze and tape? I’d like to take a look at her stump and see how much bleeding there’s been.”

“Of course, Doctor,” the aide said. “I’ll be right back.”

“Thank you,” he said. He watched her until she disappeared out the open door. He could see over to the main desk. No one was looking in his direction. Quickly he pulled out the syringe from his jacket pocket, took off the protective plastic cap from the needle end, and inserted the needle into the intravenous port just above the catheter that disappeared into Madison’s right arm. In the next second, he injected the entire contents into her IV line in one rapid push, causing the fluid level in the drip chamber to suddenly rise. This was the critical stage because he knew from his reading that the pain would be considerable as the potassium chloride rushed up Madison’s arm vein.

Madison’s eyes shot open, her lips drew back, and a scream started in her throat. But it never got out. With all his might he tightly slapped his right hand over her mouth, forcing her lips closed so that the scream was transformed into a mumble that was easily drowned out by the metronomic beeping of the cardiac monitor. She tried desperately to wrest his hand off her face with the hand of her unbroken arm, but he leaned the entire weight of his upper body onto her while his eyes shot up to the cardiac monitor. Already he could see the telltale signs of imminent cardiac failure as the potassium chloride bolus reached the heart and instantly interrupted its electrical conduction. A moment later the heart essentially stopped beating and became a quivering mass of uncoordinated muscle known as ventricular fibrillation. Instantly the raucous sound of the cardiac alarm reverberated off the walls.

Knowing that in a few seconds the room would be full of doctors and nurses and a cardiac resuscitation team, he quickly let go of Madison’s face, pocketed the syringe, and then put down the side rail of the bed. As the first people came charging in, he was already climbing up on the bed to start cardiac massage.

“She’s in fibrillation,” someone said, rushing up to the bedside.

“I know,” he said frantically, starting the massage by alternately pressing down on her chest. Other people crowded around the bed, including the cardiac resuscitation team, which quickly took over. One of them climbed up onto the bed to replace him. Others yanked the bed away from the wall so someone else could intubate and then ventilate her with one hundred percent oxygen.

He backed up, giving the team space to do their thing. There were now ten to twenty people in the room, which gave him the opportunity to get out of the way and move toward the exit.

“Let me have the defibrillator paddles,” he heard the team leader call out. A moment later there was the characteristic thud of the defibrillator being discharged, followed by a short silent pause while everyone stared at the ECG screen in hopes that the heart would have returned to a normal rhythm. He knew it wouldn’t, and he knew that by now there was probably no way possible to save Madison. With a potassium chloride overdose, the corrective measures would have had to have been started immediately, and even then, they wouldn’t necessarily be successful, and there was no way the resuscitation team could even determine that the problem was hyperkalemia, or too much circulating potassium.

He heard the team leader yell out to defibrillate again, and while everyone was occupied and totally absorbed in the resuscitation attempt, he walked out into the hallway. At that moment there was no one at the central desk, which was convenient. Pleased with what he’d been able to accomplish, he headed in the direction of the elevators. After the anxiety he’d suffered for most of the day, his relief was palpable. He was also exhausted both mentally and physically and in dire need of a stiff drink.