Marker

twenty-five

"EXCUSE ME," CAITLIN SAID after giving Jack's shoulder a nudge.

Jack blinked and pulled himself from the depths of sleep. He felt like death warmed over, but as his vision cleared and he became oriented to time, place, and person, he quickly straightened up. He was surprised and frankly aghast that he had fallen asleep.

"What's the matter?" he sputtered. "Is she okay?"

"She's fine," Caitlin said. "Her repeat potassium was normal, and her vital signs have stayed rock-solid. She's even had some fluid by mouth, which was ordered by Dr. Riley. The drain from her incision has also been removed, so she's doing very well."

"Fantastic," Jack said as he slid forward to stand up.

Caitlin reached out and gently pushed against his shoulder, keeping him sitting on the couch. "I know you want to visit, but I think it might be better to leave her be for now. She's exhausted, and she's sleeping."

Jack sat back and nodded. "I'm sure you're right. Actually, I'm more concerned about her safety at this point. Needless to say, as I'm sure you have surmised, someone deliberately gave her the potassium."

"I gathered as much," Caitlin said. "But rest assured! I'm confident the CCU is safe, but to be one hundred percent sure, I've asked one of my residents to stay at the bedside continually. He'll watch everything like a hawk. No one without his authorization will get near her."

"Perfect," Jack said.

"I suppose I shouldn't ask about who you think might have done this to her."

"Probably the less talk the better until it is resolved," Jack agreed. "I know that's difficult in a hospital where gossip spreads like wildfire, but it will probably be best for everyone if you and your colleagues don't say anything about what happened for a day or so. A homicide detective will be here shortly, and I hope he can get to the bottom of things."

At that moment, two uniformed policemen appeared at the doorway. One was a beefy African-American male whose bulging muscles stretched the limits of the fabric of his uniform. His name was Kevin Fletcher. The other was a comparatively slight Hispanic woman named Toya Sanchez. Both acted self-conscious about being in the hospital. They introduced themselves to Jack, speaking in no more than a whisper. They said that their orders were merely to check in with him. Then they acted as if they didn't know what to do.

"Why don't you take a couple of chairs out and sit by the cardiac care unit door," Jack suggested. "Make sure that everyone going in is legitimately supposed to go in." Then, looking at Caitlin, he said, "I'm assuming that is the only door."

"It is the only door," Caitlin assured him.

Glad to have some direction, the two policemen took Jack's advice and were soon sitting on either side of the unit's double doors. Jack felt their presence was imposing, if nothing else. It was the busy CCU itself that provided the safety.

"I've got rounds to do," Caitlin said. "So I'll leave you here on your vigil."

"Thanks for all you did," Jack said as sincerely as he could. "You were terrific."

"Your tip about potassium was key," Caitlin said. "Maybe you should think about taking a cardiology residency. We'd make a good team."

Jack laughed and wondered if the youthful woman was flirting with him. Then he smiled at his own vanity, thinking he was trying to compensate for how old she made him feel. He waved as the woman walked out of the waiting room.

After Caitlin left, Jack settled back in the sofa. He wasn't about to fall asleep again, since he'd gotten a shot of adrenaline when she'd awakened him. Instead, he began musing about what it really meant for someone to be killing patients who had positive markers for bad genes. It was immediately obvious to him that the explanation for such an unspeakable villainy couldn't simply be a person with an antisocial personality disorder, although the person who was actually injecting the potassium surely had to have such an affliction. Jack knew intuitively that it had to be a more extensive conspiracy, with the involvement of some higher-ups in the AmeriCare organization. In his mind, it was a horrid example of how the practice of medicine could be distorted from having evolved into big business with business interests in the ascendancy. He was personally aware that there were people hidden in the top-heavy administrations of these huge, sprawling managed-care and hospital-management companies similar to AmeriCare that were so far removed bureaucratically and often geographically from the professed primary mission of the organization that they could easily be blinded by the needs of the bottom line, and ultimately, the share price.

A commotion in the hall interrupted Jack's thoughts. A group of nurses had arrived, and there was a great titter about the presence of the police, who were checking IDs before letting them into the CCU. Jack watched them laugh and joke, and he wondered if they would be carrying on as they were if they knew what was going on behind the scenes in their hospital. Even more than the doctors, the nurses were in the trenches on a daily basis, involved in hand-to-hand combat with disease and disability. He was certain they would be outraged if they heard that one of their own was suspected of such treachery.

Such thinking brought Jack's mind back to Jasmine Rakoczi. If she was the culprit, as he thought was possible, then she surely had to be severely antisocial. Jack couldn't help but think he had to be wrong about her. How could someone who is antisocial be a nurse? It seemed an oxymoron to him. But, in the unlikely case she was antisocial, how could she have gotten a nursing job at such a prestigious hospital? It didn't make any sense, especially with the idea that some bean counter buried deep in the fabric of AmeriCare's organizational structure had to tell her who to pump full of potassium.

The door to the CCU burst open and another group of both male and female nurses emerged. They were equally surprised and curious about the uniformed police. The police were polite but noncommittal, and within a few minutes, the nurses' voices trailed off as they disappeared down the hallway.

Jack's eyes wandered up to the wall clock. It was a little after seven in the morning. All of a sudden, it dawned on his tired mind why the group of nurses had come in and another group had gone out. It was the shift change. The day people were taking over from the night people.

Jack leaped off the sofa. It hadn't even occurred to him that Jasmine Rakoczi would be getting off before Lou got there. If she was the culprit and if she sensed that Jack knew it, she might disappear for good. Several strides took him out into the hall, where he quickly told the two police officers that he was going up to the sixth floor. He said that if Detective Lieutenant Soldano came in while he was away, they should tell him where he had gone and send him up there.

Then Jack rushed down to the elevator lobby, where it was apparent that the hospital had transformed itself: The busy day had begun. There were at least a dozen people waiting for an elevator, which included a number of orderlies with gurneys on their way to fetch patients for their scheduled surgeries.

The first up elevator that arrived appeared full when its door opened. Several people boarded just the same, and, not to be deterred, Jack literally pushed on as well. He could sense people's indignation as the door was barely able to close. Pressed cheek to jowl, no one spoke as the car rose.

To Jack's chagrin, the ascent was frustratingly slow. The elevator stopped on every floor and disgorged passengers, more often than not, from the rear, making Jack and a few others step out at each successive elevator lobby. By the time the elevator got to the sixth floor, Jack was having trouble controlling his impatience, and when the door opened, he was the first one out. His plan was to rush to the nurses' desk to inquire about Jasmine Rakoczi. He hoped by chance she'd been delayed so he could catch her before she left.

Directly opposite from Jack's elevator was another whose door was in the process of closing. Out of the corner of his eye, Jack thought he caught a glimpse of the nurse with her rather striking features. It had been a fleeting image, and by the time he had jerked his head around to look again, the elevator doors had closed.

For a second, Jack debated what to do. If he ran down the stairs, he had a good chance of beating the elevator. But what if he was wrong, and it hadn't been Rakoczi? After several false starts, Jack impulsively reverted to plan A and ran toward the nurses' station. There were a number of nurses in sight, some of whom he recognized, which he thought was encouraging. There was also a ward clerk who had just come on duty. He was busy straightening up the litter on the desk, a lot of which had resulted from Laurie's resuscitation.

In a rapid-fire manner, Jack introduced himself as Dr. Stapleton and asked for Jasmine Rakoczi. The ward clerk, who was a slightly built blond fellow with a ponytail, told him that Jazz Rakoczi had just left two seconds ago. He tried to look around Jack to see if he could see her in the elevator lobby.

"Do you know where she goes?" Jack demanded quickly, guessing that it had indeed been her in the elevator. "I mean which door she goes out or which direction she walks. I need to talk to her. It's important."

"She doesn't walk home," the clerk said. "She's got a cool, black H2 Hummer, which she actually showed me once. It's got a sound system you wouldn't believe. It's always parked on the second floor of the garage across from the door to the pedestrian bridge."

"What floor do you get off the elevator for the pedestrian bridge?" Jack hurriedly asked.

"The second floor, of course," the clerk said, making a face as if it had been the stupidest question he'd ever heard.

Jack took off at a run for the stairs. Earlier, he thought he could have beat Rakoczi's elevator, but now, having spent the time going to the nurses' station, he knew it was out of the question. But he didn't regret his decision, since he would have missed her anyway. He would have run all the way down to the first floor to try to catch her going out the front door. As things turned out, he felt he still had a chance of catching her; she had to walk across the pedestrian bridge and then start her car. Knowing what kind of car she drove might turn out to be key.

The stairwell was painted gunmetal gray. The stairs themselves were steel, and each step sounded like a drum as his shoe thumped against it. The repetitive booming reverberated around the enclosed space. There were two flights for each floor, causing Jack to continually turn as he spiraled down clockwise. He was dizzy by the time he reached the second-floor door, and he staggered a bit when he entered the hallway.

As unshaven and disheveled as he appeared, coupled with his momentary careening, people gave him a wide berth as he hurriedly tried to get directions for the pedestrian bridge. Finally, someone took pity and responded by pointing, and Jack took off, moving as quickly as he could. While saying "excuse me" over and over, he pushed his way ahead in the stream of hospital personnel heading toward the parking garage. After a pair of doors, he could tell he was on the pedestrian bridge, as he could suddenly see up and down Madison Avenue. There was another pair of doors on the garage side that led into a small lobby area, which was crowded with people waiting for an elevator. Jack was reduced to squeezing through until he could push open the heavy door out into the garage's second level. The garage was alive with cars coming and going with their headlights crisscrossing in the exhaust-filled dim light. Outside, the dawn was just bleaching the night sky, whereas infrequent fluorescent lights poorly illuminated the interior of the garage.

Knowing the make of Jazz's vehicle was indeed key, and he was able to pick it out from all the others immediately. As the ward clerk had said, it was parked directly opposite the door to the connecting pedestrian bridge. Elevating himself on his tiptoes so he could see over the cars passing between him and the Hummer, Jack saw Rakoczi! She'd just made it across to her car. Jack could even make out what he guessed was a remote in her hand, which she was aiming at the car as she squeezed along its driver's side. It was separated by a little more than two feet from the neighboring vehicle.

"Miss Rakoczi!" Jack yelled over the sound of the car engines. He saw her turn and look in his direction. "Hold up a second! I need to talk with you!" For an instant, Jack's tired mind questioned the rationale for approaching a woman he suspected might be a serial killer. Yet his desire to keep her from leaving trumped his concerns. With all the commotion of people and cars, he felt reasonably safe, especially since he had no intention of being confrontational in any way or form, just firm.

Jack looked left and right, gauging his crossing with the comings and goings of the traffic. The exhaust as well as noise was unpleasant. Jack got over to the opposite side. Jazz was standing by her car with the driver's-side door ajar. The remote was gone and apparently in her pocket. She was dressed in an oversized, olive-drab coat over her scrubs. Her right hand was in her pocket. Her expression was haughty to the point of being challenging.

Slipping between Jazz's car and the one right next to it, Jack walked right up to the nurse, whose eyes narrowed the closer he got. Jack sensed that there wasn't a lot of human warmth in this person.

"You're needed back in the hospital," Jack said, speaking loud enough to be heard over the roar of the traffic. He tried to sound authoritative to avoid an argument. He even pointed over his shoulder with his thumb. "There are some people who want to talk with you."

"I'm off duty," Jazz sneered. "I'm going home."

Jazz turned and put a foot up into her SUV, with the obvious intention of swinging herself up behind the steering wheel. Jack caught her right arm just above the elbow and gripped it hard enough to keep her where she was.

"It's important you talk with these people," Jack said. He started to say something else about coming with him, but he never got it out. With totally unexpected swiftness, Jazz used a karate-like blow to free her arm and practically simultaneously kneed Jack in the groin. Jack doubled over, clutching his genitals while an involuntary groan escaped from his lips. The next thing he knew, the cold barrel of a gun was pressed against the back of his neck.

"Stand up, asshole," Jazz scoffed loud enough to be heard. "And get in the damn car."

Jack raised his head. He was squinting with pain and wasn't entirely sure he could walk.

"This gun's going to go off if you don't get the hell in there," Jazz hissed.

Jack moved forward as Jazz backed up a step. Still supporting his genitals with his right hand, he used his left to help him get up behind the steering wheel. The pain was like nothing else he'd ever experienced. It made him feel weak, as though he were made out of rubber.

"Climb over into the passenger seat," Jazz ordered as she took a quick glimpse around to see if anyone had noticed what had happened. With all the confusion and noise in the garage, no one paid the slightest heed. "Come on!" Jazz snapped. As an added incentive, she poked the side of Jack's head with the tip of the gun's suppressor.

With the vehicle's gear box in the way, Jack wasn't sure he could physically do what Jazz was ordering, but he felt as if he had no choice but to try. He sagged over the median console into the passenger seat, rotated onto his back, and with his knees bent, brought his feet over. He was now in a tight ball, more or less on his back.

Jazz quickly climbed in behind the steering wheel and pulled the driver's-side door shut, eliminating most of the garage's noise. She kept her gun pointed at Jack's face, just inches from his forehead. "And what do these people want to talk to me about?" Jazz demanded with obvious derision.

Jack started to answer, but Jazz cut him off. "Don't bother answering, because it doesn't matter. What matters is that you've managed to get yourself killed."

The sound of the gun going off despite its suppressor was loud enough within the confines of the vehicle's cab to cause ears to ring. Jack's eyes, which had reflexly blinked closed at the noise, popped open in time to see Jazz's head sag forward and bump against the steering wheel. A rivulet of blood appeared and ran down the nape of her neck. To add to his confusion, Jazz's gun fell onto his chest.

"Excuse me," a male voice said from the dark depths of the backseat. "Would you mind handing Miss Rakoczi's Glock back to me? I prefer that you do it by holding on to the suppressor, not the butt."

Jack picked up the gun as he was directed, and then, by wiggling himself backward, he was able to partially right himself so that he could raise his head high enough to see over the back of the passenger seat. The view was limited because of the heavily tinted windows. All Jack could see was the mere outline of a figure sitting in the backseat directly behind the driver's seat. There was a heavy smell of cordite in the air.

"I'm waiting for the gun," the shadowy man said. "If you don't do as I say, there will be dire consequences. I would think you would be eager to help, since I obviously saved your life."

Bewildered at these unexpected and shocking developments, Jack was in no condition to question the man's request, and he started to extend the gun through the separation between the two front seats. It was at that instance that the driver's-side door was yanked open, and Jazz's limp body tumbled out onto the concrete. Surprised anew, Jack caught sight of an equally surprised Lou. "In the backseat!" Jack yelled. "Watch out!"

Lou disappeared at the same instant the shadowy backseat figure discharged his pistol yet again, followed by the noise of shattering glass. Without thinking, Jack flipped the gun he was holding around so that his index finger slipped into the trigger guard. Still crouching behind the back of the passenger seat, he raised the gun, and aiming blindly in the direction of the shadowy person, pulled off three shots in rapid succession. To Jack, the sound of the weapon was a loud hissing thud like a combination of a fist hitting a punching bag and air being let out of a tire. The expended shell casings clanked down between the front seats. Although his ears were ringing, silence returned. Again, the smell of cordite permeated the vehicle's cab.

Jack's heart was pounding. As he huddled against the back of his seat, he heard a gurgling sound from the rear seat. He was afraid to move and half expected the man in the back to loom up and shoot him like he had shot Rakoczi.

"Lou?" Jack called. He was afraid to move, and he was afraid Lou might have gotten shot.

"Yeah!" Lou's voice sounded from someplace outside the car.

"Are you all right?"

"Yeah, I'm fine. Who fired those last three shots?"

"I did. I shot blindly."

"Who is it you shot at?"

"I haven't the slightest idea."

"Is this the nurse you were talking about on the phone lying next to me on the pavement out here?"

"It is," Jack said. He switched positions. His back was killing him the way it was pressed up against the passenger-side door.

"I thought you promised you weren't going to be a hero," Lou complained. "Did you shoot her, too, or what?"

"I didn't shoot her," Jack exclaimed. "It was the guy in the backseat."

"Whoever the guy is shot at me," Lou said. "I don't like that."

In addition to the gurgling, Jack now heard definite wheezing. At that moment, he caught sight of Lou's eyes between the open driver's side door and the doorframe. He was now squatting next to the driver's-side front wheel, holding his pistol up alongside his head.

Jack managed to get his legs down where they belonged under the dash so that he could move his head and cautiously look into the backseat between the front seats. In the dim light and limited view he could see a flaccid hand lying on the backseat with its index finger still within the trigger guard of a pistol. At that point, Jack heard stertorous breathing.

Gaining courage, Jack raised his head and peered over the top of the front seat. He could just make out a man sitting upright but with his head back and arms splayed out to the sides. With his head back, Jack could see that he was wearing a ski mask. His breathing was labored.

"I guess I shot him," Jack said.

Lou stood up, walked along the side of the car, and stuck his pistol through the back window that had been blown out. He was holding his gun in both hands and pointing it at the stricken individual. "Can you hit the lights?" Lou asked.

Jack spun around and briefly searched for the interior lights. When he found them, he switched them on. He looked into the backseat at the man. An expanding stain of blood was on the man's chest.

"Can you reach his gun?" Lou asked. He kept his gun trained on the apparently unconscious stranger.

Jack extended his hand warily toward the gun as if the man would suddenly wake up like in a thriller movie for one more desperate struggle.

"Just touch the barrel, not the butt," Lou directed. "And put it on the front seat."

Jack did as he was told, then quickly got out the passenger-side door. He opened up the back door and leaned in to get a closer look at the man. Up close it was more apparent how labored the individual's breathing was. Jack pulled off the ski mask in hopes it would help the man breathe. Lou opened the door on the man's other side.

"Do you recognize him?" Lou asked.

"Not at all," Jack said.

While Jack felt for a pulse, Lou grabbed the fabric on the front of the man's shirt, and with a sudden lateral tear, ripped the shirt wide open. Buttons popped off. Three entrance wounds were apparent in the man's chest.

"I'll say you shot him," Lou remarked with admiration.

"His pulse is thready and rapid," Jack said. "He's not long for this world unless we act fast. On the positive side, he's already at the hospital."

"You check the nurse!" Lou said. "I'll start getting him out of the car."

Jack ducked back out of the vehicle and ran around to the other side. Bending down, it took him only a second to ascertain that Jazz had been shot execution-style through the back of the head at very close range. The bullet had undoubtedly passed through the brainstem. She was clearly moribund.

Jack stood back up and stepped over the woman. He could see that Lou had the injured individual half out of the car.

"What's the situation with the woman?" Lou grunted.

"She's gone. Let's concentrate on the guy."

With the back door open against the neighboring vehicle, Jack had to reverse directions, step back over Rakoczi, and run all the way around the SUV to lend a hand with the man. Lou had his hands under the individual's armpits. Jack squeezed by and grasped the man around the thighs.

"God! He weighs a ton!" Lou complained as they managed to get out from between the parked cars. They were immediately caught in the headlights of a car attempting to exit the garage. The driver had the nerve to beep the horn.

"Only in New York," Lou complained at the impatient driver through clenched teeth. He struggled with the injured man. "What the hell is this guy anyway, a professional football player?"

As they approached the doors to the pedestrian bridge, a few of the departing hospital workers stopped to gawk, unsure of what they were witnessing. At least one had the sense to reverse direction and reach back to hold open the door.

Halfway across the bridge, Lou staggered. "I got to stop," he said while panting.

"Let's switch," Jack suggested. They put the man down on the concrete floor of the bridge, quickly changed places, and then picked up the man again.

"You certainly picked a good time to show up," Jack said and grunted.

"Apparently, I just missed you outside the CCU," Lou said. "Then I just missed you on the sixth floor. It was a good thing the clerk told me to look for a black Hummer."

In the better light, it was apparent that the stains on the man's shirt were blood, and people were now willing to help. By the time they got across the bridge, two male nurses had pitched in. One was at the head with Jack, while the other had a leg with Lou.

"The ER is on the floor below," one of the nurses said between breaths. "Should we wait for an elevator or try the stairs?"

"The elevator," Jack answered. He was aware the man was no longer breathing. "But we're going up, not down. He needs a thoracic surgeon, and he needs him now."

The two nurses looked at each other in consternation but didn't say anything. Rather than put the man down, Jack backed up against the wall and hit the elevator button with his free hand. Luckily, a car arrived almost immediately. Unfortunately, it was full.

"Coming in!" Jack yelled. He was not to be deterred, and he backed right into people who momentarily had not moved. Recognizing the degree of the emergency, a number of people got off, creating the necessary space. The door closed.

The four people holding the injured man looked at one another while the people in the elevator stared at the wounded individual. No one said anything as the elevator rose up a floor.

When the doors opened on the third floor, they carried the man out and then pushed through the double doors. As they passed the arched opening into the surgical lounge, Jack cried out that they had a man who had been shot in the chest three times. By the time they got to the doors leading into the OR itself, a number of surgeons who had been waiting for their cases to start were walking alongside. Several of them were thoracic surgeons, and they started to assess the man's condition, as evidenced by the position of the entrance wounds. Although there was some disagreement about the nature of the injuries, all thought that the only chance the patient had for survival was to be put on cardiopulmonary bypass immediately.

As the group came abreast of the OR desk, several of the nurses were aghast that people had entered their sterile domain in street clothes. Their indignation was shortlived when they realized that a patient with a mortal wound was being rushed in.

"Room 8 is being set up for open-heart surgery," one of the nurses behind the desk yelled.

The group hustled down to room 8 where they put the man directly onto the operating table. The surgeons wasted no time. They cut off the man's clothes. An anesthesiologist appeared and yelled that the man was no longer breathing and had no pulse. He quickly intubated the patient and started respiring him with one hundred percent oxygen. Another anesthesiologist started several large-bore IVs and began running fluid into the man as fast as possible. He also called for blood to be typed and cross-matched stat.

Jack and Lou stepped back as the surgeons crowded around. One of the thoracic surgeons barked for a scalpel, and one was quickly slapped into his waiting palm. With no hesitation and without even bothering to glove, the surgeon cut through the man's chest with a decisive swipe. Then, using his bare hands, he cracked open the ribs only, to be faced with an enormous amount of blood. At that point, Lou decided he'd wait out in the surgical lounge.

"Suction," the surgeon yelled.

Jack tried to see as best he could from the head of the table. It was a spectacle the likes of which he had never seen. None of the surgeons had on gloves, masks, or gowns, and they had blood up to their elbows. It had all happened so quickly that no one had had a chance to follow the normal presurgical protocol. Jack listened intently to the banter, which only underlined something that he had already known: namely, that surgeons were a breed unto themselves. Despite the unorthodox nature of the event and the gore, they were enjoying themselves. It was as if the episode served to conveniently validate their enormous curative powers.

It was quickly determined that the man had suffered what would have been a mortal wound, except for the fact that it had happened at a major hospital. Two of the bullets had gone through the lungs. For the surgeons, that was a pedestrian problem. It was the third bullet that presented the challenge. It had, among other things, pierced the great vessels.

Quickly, the damaged vessels were clamped off, and the patient was put on the heart-lung machine. At that point, some of the surgeons left to start their own scheduled cases while the two thoracic surgeons stopped long enough to scrub and don the usual operating-room apparel. Jack moved over to chat with the anesthesiologist about what she thought the chances were the man would survive, but the nursing supervisor tapped him on the shoulder.

"I'm sorry," the supervisor said, "but we're trying to reclaim sterility here. You'll have to leave and put on scrubs if you want to observe." She handed him a pair of booties to cover his street shoes.

"Okay," Jack said agreeably. He'd been amazed that he hadn't been kicked out earlier.

As Jack walked back down the long operating-room corridor, the events of the long night began to take their toll. He was exhausted to the point that his legs and feet felt as if he had weights strapped to them. As he passed the operating-room desk he shivered through a bout of discomfort akin to nausea. He found Lou sitting in the crowded surgical lounge, talking on his cell phone. In front of him on the coffee table were a wallet and a driver's license.

Jack sat down heavily in a chair facing Lou. Lou pointed to the driver's license without interrupting his conversation. Jack leaned forward and picked up the license. The name was David Rosenkrantz. Holding the card closer, Jack studied the laminated picture. The individual appeared like an all-American football player with a thick neck and a broad, toothy smile. He was a handsome man.

After flipping his phone shut, Lou looked over at Jack. Then he leaned forward with his elbows on his knees. "At the moment, I don't want a long explanation how this all happened," he said in a tired voice. "But I'd just like to know why. The last thing you promised me was that you were going to sit outside the CCU."

"I meant to," Jack said. "Then I realized the shift was changing, and I was suddenly worried the Rakoczi woman would disappear. I just wanted to make sure she hung around until you got here."

Lou rubbed his face briskly with both hands and groaned. When he took his hands away, his eyes were red. He looked almost as bad as Jack. "Amateurs! I hate them," he remarked rhetorically.

"It never dawned on me she'd have a gun," Jack said.

"What about the other two recent gunshot-wound deaths over here? Didn't they at least go through your pea brain?"

"No," Jack admitted. "I was really worried we wouldn't see her again. I thought I'd just ask her to stay. I wasn't going to accuse her of anything."

"Bad decision," Lou said. "That's the way people like you get killed."

Jack shrugged. In retrospect, he knew Lou was right.

"Did you look at the license of the man you shot?"

Jack nodded. He didn't like to think he'd actually shot somebody.

"Well, who is David Rosenkrantz?"

Jack shook his head. "I haven't the slightest idea. I've never seen him before nor heard his name."

"Is he going to live?"

"I don't know. I was about to ask the anesthesiologist's opinion, but I was told to leave. I think the surgeons are pretty optimistic, the way they have been talking. If he does make it, it proves that if you are going to get shot, make sure you get shot in a decent hospital."

"Very funny," Lou said without laughing. "What's Laurie's status?"

"Good! Very good! Or at least it was when I left. Let's walk down and check in with the CCU. I didn't expect to be gone this long. It's just down the hall."

"Fine with me," Lou said, getting to his feet.

The CCU charge nurse came out of the unit and told Jack and Lou that Laurie was doing fine, she was sleeping, and that her doctor had been in to see her. She also said that there were plans afoot to move her to the University Hospital, where her father was on staff.

"Sounds good," Jack said. He looked at Lou.

"Sounds good to me, too," Lou said.

After the CCU, Lou wanted Jack to come with him down to the emergency room. He wanted Jack to identify for the record that the dead woman was the nurse who Jack had seen in Laurie's room. He explained that when he'd left the OR earlier, he'd called police headquarters about setting up the Hummer as a crime scene and bringing the body inside the hospital. He was particularly interested in having the Glock checked by ballistics.

As they walked back toward the elevator, Lou cleared his throat. "I know you're exhausted, and for good reason, but I'm afraid I have to know what happened from the moment you got down to the garage."

"I caught the nurse just as she was about to get into her car," Jack said. "She already had the door open, so I yelled and ran up to her. Obviously, she wasn't cooperative, which is an understatement. When I grabbed her arm to keep her from getting in the vehicle, she kneed me in the balls."

"Ouch!" Lou commiserated.

"That was when she pulled out the gun and ordered me into the car."

"Take this as a lesson," Lou said. "Never get into a car with an armed felon."

"I didn't think I had a lot of choice," Jack said.

They reached the elevator lobby, where there was a smattering of people waiting. They lowered their voices.

"That's when I appeared on the scene," Lou said. "I saw you get into the car. I could even see the woman's gun. Unfortunately, I had to wait for a few cars before I ran over. What went on in the car?"

"It all happened so fast. The guy was obviously already in there, apparently waiting for Rakoczi. Just when she was about to shoot me, he shot her. God…" Jack's voice trailed off as he thought of how close he had come to one last trip over to the OCME.

"You crazy ass," Lou complained. He gave Jack's shoulder a light smack and then shook his head. "You have this weird penchant for getting into the damnedest situations. You walked right into the middle of an execution-style hit. Are you aware of that?"

"I am now," Jack admitted.

The elevator arrived and they boarded. They moved to the back of the car.

"Okay," Lou said. "The question is why? Do you have any ideas?"

"I do," Jack said. "But let me backtrack. First of all, Laurie was almost killed with a sudden overwhelming dose of potassium, which is a clever way to kill someone. There's no way to document it, thanks to the physiology of potassium in the human body, but don't get hung up on that. The point is that I think all the patients in Laurie's series were killed in this shrewd fashion, but they weren't random targets. All of them, including Laurie, had tested positive for the genetic markers of serious medical illnesses."

The elevator arrived on the first floor, and Lou and Jack got off. The hospital was crowded with people, and they kept their voices down.

"So how does all this add up to a gangland-style hit on the nurse?" Lou questioned.

"I think it is evidence that there is a major conspiracy here," Jack said. "I think if you are lucky you're going to learn the nurse was working for someone in some tangled web which will eventually lead back to an actuarial type within the AmeriCare administration."

"Wait a second!" Lou said, pulling Jack to a stop. "Are you suggesting that a major healthcare provider like AmeriCare might be involved with killing their own patients? That's crazy!"

"Is it?" Jack questioned. "In any geographical area where these healthcare giants actually compete with each other, something they try to avoid by choking off competition or buying out the opposition if they are big enough, they compete with the cost of premiums. How do they determine their premiums? Well, the old-fashioned, actuarial way was to pool risk, figure out how much it is going to cost to take care of a group of people by essentially guessing, then add on profit, divide by the number of people, and bingo, there's the premium. Suddenly, under everybody's noses, the rules have changed. With the decipherment of the human genome, the old concept of health insurance is bound for the trash heap. Using single, easily performed tests, people who are destined to cost them significant money can be recognized. The problem is that the large healthcare companies cannot show discrimination, so they have to take them. At that juncture, from a purely business perspective, they should be eliminated."

"You mean to tell me that you think some AmeriCare administrators are capable of committing murder?"

"Actually, no!" Jack said. "The actual killing has to be done by severely screwed-up individuals, which I'm quite certain you'll be learning about Miss Rakoczi if she is indeed the culprit. What I'm talking about is a horrid variant of white-collar crime with varying levels of complicity. At the top, I'm talking about some person who might have been recruited from the automobile industry or any other business, who sits in an office, far removed from patients, and thinks about the bottom line exclusively. Unfortunately, that's the way business works and why some level of government oversight is necessary as a general rule in a free-market economy. I might sound like a misanthrope, but human beings tend to be basically self-interested and often function as if they are wearing blinders."

Lou shook his head. He was disgusted. "I can't believe you're saying all this. Hospitals for me have always been the place you go to be taken care of."

"Sorry," Jack said. "Times are changing. The deciphering of the human genome has been a monumental event. It has briefly dropped off everyone's radar, but it is coming back big-time. It is going to change everything we know about medicine in the not-too-distant future. Most changes are going to be for the good, but some are going to be for the bad. It's always that way with technological advances. Maybe we shouldn't label them 'advances.' Maybe a less value-laden word like 'changes' would be better."

Lou stared at Jack. Jack stared back. Jack thought the detective's expression hovered somewhere between frustration and irritation.

"Are you pulling my leg about all this?" Lou questioned.

"No," Jack said with a short laugh. "I'm being serious."

Lou meditated for a moment and then said moodily, "I don't know if I want to live in your world. But screw it! Come on! Let's make this ID on Rakoczi."

They entered the ER, which was already overflowing with patients. Several uniformed policemen were in evidence. Lou sought out the ER director, Dr. Robert Springer. Dr. Springer took Lou and Jack back to a trauma room, the door of which was closed. Inside, they found Jasmine Rakoczi. She was lying naked on an ER bed. An endotracheal tube had been inserted and then attached to a respirator. Her chest was intermittently rising and falling. Behind her, on a flat-screen monitor, blips recorded her pulse and blood pressure. The blood pressure was low, but the pulse was normal.

"Well?" Lou asked. "Is this the lady you saw in Laurie's room?"

"It is," Jack said. Then he looked at Dr. Springer. "Why are you respiring her?"

"We want to keep her oxygenated," Dr. Springer said while he adjusted the respirator's rate.

"Don't you suspect her brainstem was destroyed?" Jack questioned. He was surprised that they were making such an effort in such a clearly moribund situation.

"Without doubt," Dr. Springer said, straightening up. "The organ people are trying to locate any next of kin. They want to salvage the internal organs."

Lou looked up at Jack. "Now that is going to be ironic," he said. "She might save a handful of people."

"Ironic isn't a strong enough word," Jack replied. "I'd lean toward mordantly satirical."

To Dr. Springer's surprise, the detective then cuffed the medical examiner on the head, accused him of being a pompous ass, and then the two walked out, laughing.