Genesis

Chapter 42

May 12th

3:05 A.M.

The alarm on his phone went off at exactly 3:05 A.M., and Carl turned it off. He hadn’t needed it to awaken him as he was already awake and pumped up about what he had to accomplish in the next half hour or so. On the previous occasion, when he was finally ready to take care of the Madison Bryant threat, he’d been apprehensive. But not on this occasion. In keeping with the adage “practice makes perfect,” Carl was confident that he would be able to eliminate with equal ease the even more worrisome threat Dr. Laurie Montgomery posed. His previous, hypothetical belief that a large intravenous bolus of potassium chloride would be the perfect surreptitious method to eliminate a human being had been proven beyond any doubt with the way it had worked with Madison Bryant. Even with the woman as a patient in an intensive care unit surrounded by intensivist doctors and nurses and her body later being subjected to an autopsy by forensic pathologists, no one had had any inkling of what had actually transpired. And tonight, with Laurie Montgomery, it was going to be a breeze with her being in a private room instead of the busy ICU. In many respects it was going to be too easy, without the intricacies of the challenge the Madison Bryant situation presented.

Despite his confidence, he did not shortchange himself on his disguise. He made the same amount of effort with the black wig, dark heavy glasses, and long white doctor’s coat complete with a hemostat, a pair of scissors, a penlight, and several pens on prominent display in the breast pocket. The KCl-filled syringe was nestled in the depths of his coat’s right-side pocket. Once he was ready, he made one last check in the medical center database to confirm his destination. As he suspected, Laurie Montgomery’s room was still listed as 838. Thus prepared and after a final check on his disguise using his full-length mirror to make certain no one would recognize him, he left his office.

Although he could have gotten to the eighth floor of the Kimmel Pavilion any number of ways through the labyrinthine medical center that stretched nearly from 34th Street in the north to just shy of 30th Street in the south, he chose to walk outside. Despite his confidence in his disguise, he preferred not to run into anyone he knew, which was always a possibility within the well-lighted main corridors. As a major medical center with surgery going on around the clock, surgeons in particular were often in the hospital at all hours. Since Surgery and Pathology often had to work in tandem, he was acquainted with a number of them. Carl also avoided entering through the main Kimmel Pavilion lobby entrance for fear it would be too quiet, and he might attract the attention of one of the security personnel who might feel obligated for some unknown reason to check his med center ID. Instead he entered back into the medical center through the Emergency Department, where there was more activity twenty-four/seven.

Arriving on the eighth floor, Carl was immediately encouraged by the general peacefulness as he walked quickly and silently down the long, dimly lit hallway. At that moment on that particular floor it was as if the hospital was deserted, save for an occasional nurse or aide coming out of one distant room and then quickly disappearing into another. Most of the rooms he passed were silent and dark, although there were a few where the lights were on and even a few where the quiet sound of the TVs drifted out into the corridor. Near the far end of the corridor he could plainly see the nurses’ desk because it stood out starkly as the only area brightly illuminated. Behind the counter-high barrier, he could just make out several heads either of nurses, aides, or clerks, who were most likely busy with data entry or paperwork.

Slowing down and then stopping when he came abreast of room 838, he noticed the door was nearly closed with but a half-inch gap between the door and the jamb. Pausing for a moment, he reached into his pocket to fondle the syringe loaded with the KCl just to reassure himself it was there waiting for him. After glancing up and down the hallway to make sure the coast was completely clear and his presence hadn’t attracted any attention, he used just the tips of his fingers to push gently against the door, slowly and silently opening it. Progressively the darkened room came into his view and ultimately the hospital bed. What caught Carl’s eye first, in addition to the dark-haired woman sleeping in the bed, was that her ECG was being continuously displayed on a monitor mounted in the wall behind and above the head of the bed. He thought this was convenient as it would immediately reflect the ventricular fibrillation and sound an alarm. Carl liked the idea of an alarm being involved as it would provide an explanation of why he had dashed into the room, if anyone were to ask. The other important thing he noticed was that there still was an intravenous line snaking into Laurie’s arm. If that had been removed, he might have had to scrap the entire plan and come up with a new idea. But he had been confident it would be there as normal protocol dictated it.

With a final glance up and down the corridor, he pushed open the door enough to allow him to step silently into the room. Pausing for a moment to allow his eyes to fully adjust to the relative darkness, he glanced around at the rest of the interior. Suddenly he froze. With an unpleasant sense of shock, he noticed a second occupant in the room. Curled up in a fetal position on a small couch was a man who Carl immediately assumed was Laurie Montgomery’s husband, Jack Stapleton, with whom he’d spoken on the phone that afternoon.

Carl’s first inclination was to immediately flee as this was an unexpected and unfortunate change in the circumstances. But he hesitated, silently telling himself that perhaps it wasn’t quite as bad as he had initially feared and might actually help to deflect attention once the feverish activity of the resuscitation attempt was initiated. On top of trying to save the patient, the resuscitation team and the floor nurses inevitably would have to deal with the aggrieved husband.

What had brought all this to his mind after the initial concern was recalling how rapidly the fibrillation would occur. Just like he had done in the ICU, Carl would start resuscitation immediately. By the time the husband would wake up, orient himself, and get over to the bedside, Carl could already be giving external cardiac massage, saying he’d heard the alarm while passing by in the hallway. If anything, the husband, as a physician himself, would surely participate, perhaps by giving mouth-to-mouth respiration. Suddenly Carl was so confident, he found himself smiling at the mental image of him and the husband trying to save the doomed Laurie. Carl knew full well that once the bolus of KCl was in her system and wasn’t immediately reversed, there was no way for the cardiac conduction system to function, no matter what any resuscitation team tried to do.

For another minute Carl continued to stand in the middle of the dark room as he rethought the entire scenario. When he did so, he was even more convinced that having Stapleton unexpectedly present actually afforded a way around the problem of his getting away after the deed had been done. It had worked like a charm in the ICU, but that was because there were so many people involved. Here on the private floor there would be far fewer people, particularly fewer staff doctors since the entire resuscitation team was composed of residents, mostly in internal medicine, and Carl’s presence would stand out, especially if someone questioned whether he had any private patients on the floor. As for Jack Stapleton recognizing him, he thought the chances were essentially zero. He doubted they had ever met, but even if they had, with his wig and dark glasses, Carl didn’t even recognize himself.

Fully reassured of his plan, he silently advanced up along the right side of Laurie’s bed. For a moment, as he listened to Laurie’s regular breath sounds in the darkness, he glanced up at the ECG as it metronomically traced its normal squiggle across the screen. He inwardly smiled as he anticipated that in a few seconds the tracing would suddenly change into the sinusoidal jumble of ventricular fibrillation, meaning the entire heart’s electrical conduction system had devolved to pure chaos.

Carl pulled the loaded syringe out. The meager light coming from the bathroom was just enough to make sure it was still entirely full. Using his teeth, he pulled off the plastic protective cap from the large-bore needle. After one more glance back at the sleeping husband who’d not moved a muscle or made a sound, Carl picked up the IV line with his left hand so that with his right hand he could insert the needle into the IV port. Holding the syringe in both hands, with both thumbs on the plunger, and after one more quick glance at Jack Stapleton’s sleeping form, he rapidly injected the entire contents into Laurie’s intravenous line. As with Madison Bryant, the level in the drip chamber rose suddenly as a bit of the KCl traveled retrograde. In the next instant he opened the IV line completely, letting it run free.

As he had anticipated, almost simultaneous with his withdrawing the syringe, he saw the initial changes appear on the ECG tracing that included a dramatic upward shift of the T wave. With the very next beat it was worse. Two beats later the entire normal ECG complex disintegrated into a kind of chicken scratch or child’s scribble to reflect that the heart had stopped beating and had become a quivering mass of muscle. At the same time the cardiac alarm went off to shatter the room’s silence, causing Carl to start despite his fully expecting it.

Vaguely aware of the figure on the couch leaping up, Carl quickly pocketed the empty syringe and then collapsed the safety rail to facilitate his climbing onto the bed to start closed chest massage. He couldn’t have been more confident and more content. For him it was a kind of confirmation of the scientific method as things were going like clockwork. He knew full well that first one of the nurses, followed by one of the hospital’s on-call resuscitation team, would be rushing into the room in a matter of seconds to take over what would turn out to be a hopeless task.

Jack initially tried to avoid waking up because he was in the middle of one of his favorite dreams. He was playing basketball, but he wasn’t playing the way he normally played in real life. He was playing a type of basketball where he was capable of jumping so high that he could hang in the air and easily dunk. Even when he’d been at his physical peak somewhere around age seventeen, although he could manage to touch the rim with ease, he could never dunk because he couldn’t palm the basketball. Yet despite the enjoyable high the dream engendered, the raucous sound of the ventricular fibrillation alarm, which he initially had incorporated into his dream, finally yanked him into full wakefulness. Becoming oriented to time, place, and person, he leaped off the couch.

The first thing Jack saw in the half-light was a man dressed in a long white lab coat struggling to put down the hospital bed’s safety rail, and the sight propelled Jack into action. He knew what the alarm had to signify, namely that this shadowy individual had knowingly injected Laurie with KCl in order to kill her, and the realization infuriated him as much as he could remember anything angering him. It seemed as if every bad or terrible thing that had happened to him in his whole life coalesced into this one horrible act. Seeing red and instead of running up alongside the bed’s free side, Jack ran up behind the man who was now kneeling on the bed. From the back he grabbed a handful of the man’s white coat and pulled as hard as he possibly could. Since the man was essentially teetering on the bed’s edge, Jack’s fearful yank caused him to completely lose balance, falling over backward onto Jack. In the process, his flailing arm swept off the water pitcher, the telephone, and some of Laurie’s personal items from the bed’s side table, creating a gigantic clatter.

For a few moments in the semidarkness a violent struggle ensued, trapped between the confines of the bed and the wall to the bathroom. It involved floundering legs and flailing arms all tangled in a confusing mass. It wasn’t until the mystery man, who was splayed on top, managed to roll off Jack into the center of the room that both were able to scramble to their feet and face off. “What the hell?” the man yelled. He frantically pointed back toward the hospital bed. “The patient’s in ventricular fibrillation! She’s going to die!”

Jack didn’t answer but in a singular fury lunged forward with the idea of retackling his adversary, but the man, in a purely defensive move, stepped to the side and deflected Jack’s outstretched arms. In his uncontrolled rage, Jack bounced off the wall that had the large-screen TV.

“What are you, crazy?” the man yelled in bewilderment as Jack immediately regrouped and came at him in a headlong rush for a second time, forcing him to again step to the side like a matador dealing with an enraged bull. “The patient is in extremis!” the man cried. “We have to start CPR!”

On this occasion Jack collided with the sofa he’d been sleeping on and his momentum bent him over the couch’s back, forcing him to thrust out his arms and hands to keep from somersaulting over it. With a few seconds’ respite, the man abandoned any hope that Jack’s attention would be dominated by the need to save Laurie’s life, and in a pure panic he opted to flee the scene while Jack was regaining his footing. Wrenching open the door, the man dashed out into the corridor and disappeared.

A moment later Jack burst out of the dimly lit hospital room into the comparatively well-illuminated hospital corridor in pursuit of the man he now strongly suspected was a serial killer. It took him only a split second to determine that his adversary had run to the right toward the elevators and not back toward the nurses’ station, and he guessed why: Several nurses were rapidly approaching from that direction in response to the cardiac alarm that was still raucously blaring.

Ignoring the nurses, Jack took off like a sprinter in hot pursuit of the fleeing man, but the mere sight of the nurses had finally awakened the rational, thinking part of his brain, which then wrested control from his more primitive, aggressive, flight-or-fight reptilian center that had been in command from the moment he’d been rudely awakened by the fibrillation alarm. The first thing he noticed was that he was rapidly gaining ground on the man, suggesting Jack was ostensibly in better shape. The second thing was seeing in the distance a resuscitation team of four resident physicians in scrubs pushing a four-wheeled crash cart rushing toward them on a collision course.

Jack slowed. Ahead the man had collided with the team, roughly shoving aside the bewildered residents and commandeering the cardiac resuscitation team’s sizable crash cart. Getting on the opposite side from Jack, he forcibly wedged it sideways in the corridor, blocking Jack’s way. In the process many of its contents noisily crashed to the floor. The man then recommenced running down the corridor toward the elevators and the stairs.

“So sorry!” Jack yelled to the totally perplexed residents as he struggled to free up the crash cart to get by. Behind him he caught a glimpse of nurses ducking into the room he’d just left.

As soon as he could, he recommenced running. Bursting into the stairwell where he had seen the man disappear, the first thing Jack did was determine whether the man had gone up or down. It wasn’t difficult. Jack managed to see glimpses of the man’s white coat flapping in the breeze and hear his thundering footsteps pounding on the metal stairs several flights down as he was descending as fast as he possibly could. It was the type of stairwell that had two flights of stairs and a landing between each floor, creating a kind of rectilinear spiral. It was also possible to lean over the railing and see all the way down to the basement level nine stories below. He started down, and once again and rather quickly he could tell he was gaining on the individual.

Jack’s anger had not abated, but with his cerebrum having kicked in, he was recognizing he was chasing someone who wasn’t defenseless but rather a sizable, muscular opponent who seemed reasonably athletic. The man had done an acceptable job parrying Jack’s headlong attacks in the hospital room despite being hampered by being dressed in a long doctor’s coat whose pockets contained surgical instruments and other medical paraphernalia; he had heard them when they had noisily clattered to the floor during their brief tussle. With these thoughts in mind, Jack began to worry what else his adversary might have on his person, such as a scalpel or sharp surgeon’s scissors. Accordingly, Jack slowed to a degree to avoid catching up with him in the stairwell yet fast enough to keep pressure on him in a manner similar to how an experienced angler plays a large sport fish. It was his belief that unless the man indulged in the kind of athletics akin to the basketball Jack played or rode his bike like Jack, which Jack seriously doubted as few people did, he was confident the man would soon seriously tire from the amount of energy he was expending in his breakneck flight.

By the time they passed the building’s second floor, Jack could tell his plan was already working. It was becoming obvious that the man was clearly in trouble from the monumental exertion the panicked descent demanded. Upon passing the first floor, the loud, rapid, and repetitive drumbeat of the man’s footfalls had slowed significantly, particularly on the final flight. As Jack passed the ground level and started down the last two flights of stairs, all he could hear was the man’s labored breathing, particularly on the exhale. As Jack rounded the landing and started down the final flight of steps, he could see that the man was stooped over, hands on his knees, struggling to catch his breath. His coloring was ashen, his mouth slack. It appeared that he didn’t have the energy to open the heavy fire door from the stairwell into the basement.

Jack slowed as he descended the last few stairs, warily keeping his eye on the man as he approached, wondering if the individual’s distress could be a ploy and whether he might suddenly brandish a weapon of some sort. Now only five or six feet away, Jack could see that the man was wearing a wig, as it was askew on his head. Also, his glasses were crooked with one of the temple pieces bent at a right angle.

Jack reached the basement level and stepped off the last step onto the concrete floor. In contrast to his opponent, his breathing was deep but not labored, particularly not to the extent of excluding any other activity. He could see that the man was watching him with his bloodshot, pained eyes. In obvious fear of Jack’s tight-lipped expression and his relentless approach, the man straightened up with great effort and stumbled backward to press his back against the closed door.

Without the slightest hesitation once in range, Jack balled his right hand into a tight fist and smacked the man directly in the nose, sending the heavy-framed eyeglasses flying. The man’s legs buckled as if they were made of rubber, and he collapsed into a sitting position with his back against the door. He was still fighting for breath.

“Stupid bastard,” Jack said as much to himself as to his adversary, while he wildly flapped his hand in the air to counteract the sharp pain he felt in his knuckles. He hadn’t planned on striking the man. It had been an irresistible spur-of-the-moment urge to give vent to the roiling anger that he still felt. Next, he reached down and grabbed the wig and yanked it off the man’s head. Tossing that aside, he looked at the individual’s face. Although the man looked vaguely familiar, Jack couldn’t place him. Next, Jack lifted the man’s ID that was hanging around his neck on a lanyard and glanced briefly at the picture. Only then did he read the name.

“Carl Henderson?” he cried in astonishment. With disbelief he again looked at the photo laminated into the ID and then back down at the man sprawled out against the fire door. The image and the person matched. “Are you really Carl Henderson?” Jack asked in disbelief.

The man didn’t answer. Instead he closed his eyes and let his head slowly fall back to lean against the fire door as he continued to try and desperately catch his breath.

Standing over the downed man, Jack reached into his pocket and pulled out his phone. With a couple of pokes against the touchscreen, he pulled up Lou Soldano’s information from his contacts and put in a call to the Homicide detective. Despite the hour, he knew Lou would answer. He was, after all, one of his best friends and an admitted workaholic.