Night Shift

Chapter 37

Thursday, December 9, 2:52 a.m.

It didn’t take Laurie long to start feeling sleepy again despite the additional coffee. The stultifying boredom of watching the unchanging cursors trace across the monitor in front of her was like a narcotic. The only relief was when Colleen would occasionally come and sit down next to her and chat for a few moments before making an entry into the hospital computer on a patient’s status like she was doing at that very moment.

To try to engage her mind and keep awake, Laurie thought about Lou’s phone call and how she wished she could take him up on his offer to come to the hospital to keep her company. Lou was truly a long-term, dear friend whose well-being was a concern for her since he lived alone and his entire world revolved about his job. Thinking about Lou reminded her of his mentioning Jasmine Rakoczi, the serial killer she had exposed so many years before, back when Laurie was single and even had had a crush on the chief medical officer of the MMH. She shook her head at the thought of the psychotic woman since the whole situation had been such an ugly experience on so many levels and had come very close to killing her after she had killed the chief medical officer.

“Okay, that’s done,” Colleen said, interrupting Laurie’s musings. Colleen stood up and stretched by extending her arms over her head. “I think I’m going to make a quick run to the cafeteria for some fruit or maybe even something naughtier. Can I bring you something? Anything at all? What about a banana? You must be starving.”

“A banana would be great,” Laurie said.

“Anything else? A piece of pie? Ice cream?”

“A banana is fine,” Laurie said, but then her attention was caught by a slight change in Jack’s ECG as it traced across the screen. The T wave, a graphic representation of the repolarization of the heart’s ventricles after a heartbeat, suddenly began to grow. Laurie could tell because a rapidly fading shadow of the previous beat still existed on the monitor over which the new beat was surcharged.

“A banana it is,” Colleen said as she leaned back over the desk to log out of the computer she’d been using. “I’ll be back in a jiffy.”

As Colleen started to leave, Laurie reached out and stopped her by grabbing her arm.

“What do you make of this?” Laurie questioned, pointing at the fading image of a T wave.

“Make of what?” Colleen asked. She paused and bent over Laurie’s shoulder to get a closer look at the monitor.

“I’m years away from my clinical residency,” Laurie confessed. “But suddenly there seems to be a change in the T waves, or am I hallucinating?”

“Hmmm,” Colleen said. “I think you’re right. What on earth could be causing that?” Both women straightened up and looked across the divide into the open door of Jack’s cubicle. All was quiet. Aliyah wasn’t to be seen although not all the cubicle’s interior was visible. To see better, Colleen took a few steps along the desk counter but immediately returned. “I don’t think anybody is in there. Any further changes in the ECG?”

“The T waves are gradually getting taller and steeper,” Laurie said. “It seems to be progressive.” In the back of her mind, she was trying to remember what she knew about T waves, but it was all a hazy, distant memory, and under the stress of the moment her mind wasn’t working well. She looked up at Colleen, whom she knew was an expert since watching and monitoring ECGs was part and parcel of her daily job.

“It could be an early sign of ST elevation,” Colleen said, but she clearly wasn’t convinced. “But that is hardly the case. If anything, the ST segment seems to be going down. Hmmm. I’ll head in there and see if anything has changed with the ECG leads.”

“Wait!” Laurie said, her heart beginning to race. She had the premonition something was wrong, something major. “The ECG is changing. Now it looks like the P wave is flattening. What on earth could that mean?”

“That happens in atrial flutter or atrial fibrillation, but the pulse seems to be slowing slightly, which doesn’t make sense. Yikes! What the hell is going on? I’m going in there and I’ll let Patti know. We need a cardiologist ASAP.”

With her eyes riveted to the monitor, Laurie watched as Jack’s heart rate slowed further until the entire ECG complex began to spread out. Then, to her horror, it degraded into a chicken scratch sine wave and the alarm went off, indicating a cardiac arrest.

The entire SICU erupted in response, with everyone not necessary to keep someone else alive rushing into Jack’s cubicle, while Patti placed an emergency code call to bring the circulating cardiac resuscitation team on the run.

With great restraint, Laurie kept her seat. She wanted to rush into Jack’s cubicle as well, but she knew she wasn’t supposed to leave the central desk. She also knew she wasn’t as prepared or as knowledgeable as the nurses and doctors who were already there, so it wasn’t as if she could really help, and might be in the way. As she sat there with her heart racing, she had the crushing feeling that she had failed Jack. Her whole effort had been to watch over him, but somehow she’d fallen short with no idea how. This thinking reminded her of Lou’s request to call him if anything untoward happened. Although there couldn’t be anything more untoward than what was occurring at the moment with Jack’s heart in arrest, she wasn’t going to call him, since there was nothing Lou could do. But thinking of Lou reminded her again of Jasmine Rakoczi and how she had tried to kill Laurie when Laurie had been a patient.

“My God!” Laurie shouted. Instantly all sorts of connections and associations coalesced in her brain. After the Rakoczi event, she had read a lot about the forensics of potassium chloride poisoning and how it was a near-perfect way for a medical serial killer to carry out their gruesome goals. After death, all the body’s cells that had been hoarding potassium in life let it out, so the dead body was essentially flooded with potassium, making the detection of an externally lethal dose having been administered impossible. Part of that reading was about the physiology of sudden high potassium and what it did to the ECG.

With sudden comprehension of what was happening, Laurie leaped up so fast her chair careened across the central desk area on its casters to crash into the counter on the opposite side. Laurie ran toward the opening out onto the main part of the unit. Almost simultaneous with her emergence, the swinging doors into the unit burst open and the resuscitation team came rushing in, pushing the crash cart with a defibrillator, medications, and supplies needed to treat a cardiac arrest.

Laurie and the resuscitation team arrived simultaneously at Jack’s cubicle, which was nearly filled with various personnel. The team surged ahead, pushing people aside. Laurie, who desperately wanted to get to Colleen, saw that she was on top of the bed kneeling alongside Jack’s right side and doing chest compressions. On the opposite side, Aliyah was using an ambu bag to respire Jack in concert with Colleen’s efforts. As the resuscitation team quickly and wordlessly took over both the chest compressions and the respiration efforts while also preparing the defibrillator, Patti, who had seen Laurie arrive, forced her way through the throng to get to Laurie’s side. For her part, Laurie was trying to reach Colleen while desperately calling out her name over the raucous sound of the monitor’s alarm.

“Dr. Montgomery!” Patti yelled sternly while grabbing Laurie’s arm and pulling her to a halt. “You can’t be here. You must leave this instant!”

Laurie knocked Patti’s arm to the side with shocking force, catching Patti completely by surprise. Laurie then barreled through two intensive care nurses who were talking while looking at the monitor. Laurie reached Colleen and forcibly yanked her wrist to get her attention.

“I know what it is!” Laurie yelled, catching Colleen by surprise. Colleen was watching the placement of the defibrillator paddles.

“Clear!” the leader of the resuscitation team yelled before discharging the machine. Jack’s body lurched from the shock. Everyone including Colleen turned their attention to the monitor, hoping the ECG cursor, when it reappeared, would show a heartbeat.

“Colleen!” Laurie yelled in frustration. “It’s potassium chloride!”

Colleen turned to her. “What?”

“Restart the compressions!” the team leader shouted when the cursor popped back onto the screen and traced a straight line. Now Jack’s heart was no longer fibrillating. It was at a standstill with no electrical activity whatsoever.

“I remembered those specific ECG changes!” Laurie yelled to Colleen. “The peaking of the T waves and the disappearance of the P wave is diagnostic. It’s the first signs of hyperkalemia! Jack’s been poisoned with potassium chloride. Tell them to start treatment for hyperkalemia immediately! Please! Every second counts.”

Frantically Colleen looked from Laurie’s tortured face to Patti, who had come up behind Laurie and was trying to pull Laurie from the cubicle. Colleen then looked back at the resident who was doing the chest compressions. She was torn with indecision. Laurie was making a certain amount of sense, but hyperkalemia was a rare problem causing cardiac arrest and mostly seen with serious kidney disorders, not healthy men.

“Tell them to use bicarbonate and whatever else helps!” Laurie shrieked, again knocking Patti’s arm away. At that point, Laurie noted the intravenous was going full tilt into Jack. Breaking off from both Colleen and Patti, she pushed her way up to the head of the bed and stopped the IV using the flow controller. Patti had pushed after her and roughly grabbed Laurie’s arm, angrily ordering her to leave at once and threatening to call security. But Colleen, who’d recovered from her sensory overload, came up behind Patti and intervened. “Hold on, Patti! I think Laurie has a point. The ECG changes we witnessed are pathognomonic of hyperkalemia. I think she’s right!”

“Could someone turn off that freaking alarm!” the resuscitation team leader yelled over the sound, as he prepared for a second defibrillation attempt. A second later, the cubicle fell into comparative silence as Jack’s body again heaved in response to the second shock.

“All right, Bruce, listen up,” Colleen yelled out to the team leader when the cursor continued to trace a flat line on the monitor. “We are going to treat this case as severe hyperkalemia. I want you to use sodium bicarbonate, along with calcium gluconate, and at least twenty units of regular insulin along with a fifty-gram dose of glucose. Also let’s get a stat electrolyte study. And somebody take down those two IV bottles and replace them with saline. Any questions?”

“Why do you suspect hyperkalemia?” Bruce questioned, looking confused. He was a senior medical resident in the last year of his internal medicine residency and lower in the hospital hierarchy than Colleen, who was a staff hospitalist.

“We happened to be viewing the ECG when this problem first started,” Colleen explained. “We witnessed the changes in real time as the heart’s conduction system went awry.”

“All right, team,” Bruce said while piling the defibrillator paddles on top of the machine to get them out of the way. “You heard the lady, let’s get to it.”

As the resuscitation team fell to work, one of the on-call anesthesiologists showed up and deftly intubated Jack so that the respiring could be done with more certainty and a respirator could be used if necessary. With Colleen’s encouragement, Patti reluctantly agreed to allow Laurie to stay in the cubicle while Patti left to return to the central desk.

As the minutes ticked by and no change was seen on the ECG monitor, Laurie again fell into despair, wondering how this could have happened, as she’d been there watching. She chided herself despite having no idea what she could have done differently. Looking at Jack, she wished she’d followed her initial inclination and had him transferred when the idea occurred to her when she’d first arrived in the Emergency Department.

When the stat electrolyte results came back, Patti rushed back to the cubicle herself to report them to the resuscitation team rather than using the audio system. After she’d called out the results, she added it was the highest potassium level she had ever seen in her career.

“My God,” Bruce responded. “That’s the highest I’ve ever seen as well. Good grief! With such a level I’m afraid we’re pissing on a forest fire here with this sodium bicarbonate and the rest. I suggest we get a surgical resident down here pronto and set up either peritoneal dialysis or, better yet, extracorporeal dialysis.”

“Do it!” Colleen said. She looked at Laurie. “It’s clearly what’s needed.”

Laurie nodded. She felt suddenly weak.

“How are you holding up?” Colleen asked, noticing her pallor.

“Not well,” Laurie admitted. “I think I’ll go back to my spot at the desk. I need to sit down.”

“Good idea. Please do,” Colleen said. “I’ll stay here and keep you informed of any changes. I promise.”

“Okay,” Laurie managed. She was beside herself with guilt and overwhelming anxiety. She turned around and started out of the cubicle. As there were still almost a dozen people jammed into the tiny room, people had to make way for her by stepping aside. She excused herself as she worked her way toward the exit.

Abruptly Laurie stopped in her tracks. She found herself staring at a man dressed in a white coat over scrubs who looked disturbingly familiar despite his Covid mask. Instantly she recognized him as the man she earlier had thought was a doctor when he’d come into the unit and briefly ducked into several of the occupied cubicles before doing the same into Jack’s. Attentive to all the comings and goings, she’d asked Colleen at the time who he was and learned that he wasn’t a doctor but rather the nursing supervisor who was responsible for allocating all the beds in the hospital’s intensive care units. She particularly remembered him because he’d nodded to her on his way out as if they knew each other. But far more important than that remembrance was that Laurie suddenly recalled she’d seen him a second time, apparently doing the same reconnoitering. What made this second sighting so disturbing and provocative was that it had preceded the first signs of trouble appearing on Jack’s ECG by minutes. He’d been the last person to enter Jack’s cubicle.

All these thoughts went through Laurie’s brain in milliseconds, igniting a firestorm of emotion. All at once and without an ounce of doubt, she knew in her heart that this man was the serial killer Sue Passero feared existed, and it was he who was responsible for Jack’s impending death.

“It was you!” she screamed. “You were the source of the potassium chloride!”

In a sudden, uncontrollable fury, Laurie launched herself at Ronnie with her fingers of both hands outstretched like cats’ claws, aimed at his neck. In her animal rage, she wanted to throttle him.

Shocked at this unexpected attack, Ronnie reared backward, trying to keep himself away from her hands while partially parrying her arms. Still, she was able to make contact with the base of his neck, scratching downward. Several nurses on either side of Laurie, equally shocked at her attack, tried to come to his assistance by grabbing her, but she was unstoppable. She lunged forward again and leaped at Ronnie with her hands outstretched. The nurses managed to sweep Laurie’s legs from under her, causing her to ram into Ronnie like a torpedo. As Laurie fell, she tried to grasp at anything with her hands as they slid down the front of his white coat. What they encountered were the two pockets, and, in an attempt to break her fall, she grabbed on, ripping both open and spilling out their contents.

As Laurie hit the floor, so did the empty 50ml syringe and the SIG Sauer P365, causing a collective gasp from all those people not directly participating in the resuscitation attempt and witnessing this sudden eruption of violence. Such a blowup, along with the appearance of a pistol within the sanctity of an intensive care unit, was a shocking and unexpected anathema. The two nurses who had essentially tackled her let go of her and took a step back in bewilderment.

Laurie scrambled to her feet and in the process snatched up both the pistol and the syringe and held them aloft. “Here’s proof!” she yelled. “This man is a killer!”

Ronnie was equally as shocked as everyone else, but in a far different way. When he had arrived at the code, which he’d timed to be sure the resuscitation team would already be there, he’d remained in the background to be available in case he was needed. Although he’d been mildly disconcerted when the decision was made to treat hyperkalemia early in the course of the cardiac arrest, he’d still been relatively confident enough potassium had already been delivered. But then, seemingly out of the blue, had come the surprise of his life. And now, facing this wild woman, he instantly knew he was facing an existential crisis despite his careful planning and faultless execution.

In milliseconds, it was utterly obvious to Ronnie that his carefully organized life was collapsing around him, and he had to react right now. There was no time to dither or argue or deny the obvious. He had to initiate his well-prepared escape plan by getting the hell out of the hospital. No doubt, the syringe still had potassium chloride residue in its chamber, which would be easy to verify.

Reaching out with determination, Ronnie grabbed his SIG Sauer, and with all his strength, he tore it out of Stapleton’s wife’s raised hand. Then he turned and charged out of the cubicle, roughly pushing people to the side.

Laurie reacted with similar impetuosity and, stuffing the empty syringe in her scrub pocket to preserve the evidence, she followed him, dashing out of the cubicle and running full tilt along the chest-high countertop of the central desk.

“Dr. Montgomery!” shouted Patti, who was within the desk and who happened to be on the phone with security. “Stop!”

But Laurie paid no heed. She could see that Ronnie had reached the swinging doors and had burst out into the hallway while still holding the pistol in full view.

“Dr. Montgomery!” Patti yelled out yet again.

Laurie wasn’t thinking, just reacting. The last thing she wanted was for this serial killer to get away, and, pistol notwithstanding, she wasn’t going to allow it. As she, too, burst out of the SICU, she confronted the two policeman who were seemingly confused about what was happening. Both had leaped to their feet as Ronnie had dashed past. One of the chairs had tipped over as evidence of how surprised they’d been. To the left down the corridor, she could see Ronnie’s rapidly diminishing figure as he was continuing his flight.

“Stop him!” Laurie yelled, pointing after him. “He’s a killer, and he’s got a gun!”

The two policemen took off down the hall in pursuit. One of them yelled “Stop!” but Ronnie ignored them. Laurie followed but slowed as she pulled her phone out. Coming to a near halt, she placed a call to Lou. As the call went through, she resumed her pursuit of the policemen and Ronnie as rapidly as using the phone would allow. Ahead, all of them had disappeared into a stairwell.

“What’s up, Laur?” Lou said without preamble.

“I’ve exposed a killer!” Laurie shrieked. “The two policemen are after him. He’s armed.” She reached the stairwell and pulled open the door.

“Good grief,” Lou said. “Where are you?”

“I’m in a stairwell,” she managed. She was getting progressively out of breath. As she plunged down the stairs, she saw the door to the second floor was just settling into its jamb. “They went out onto the second floor. They must be heading for the pedestrian bridge to the parking garage.”

“I’m on my way,” Lou said. “I’ll be there in minutes. And I’ll call in backup. Stay out of it, Laurie!”

Laurie disconnected as she pulled open the door to the second floor. From having accepted a ride home from Sue on several occasions, she knew the route to the pedestrian bridge. Running again, she reached it and crossed over to the parking garage, where she yanked open the door. Her hope was to see the policemen had nabbed the killer but what she saw instead were the two officers hunkering down behind the parking valet’s podium with their guns drawn. The tall, thin officer frantically motioned for her to go back, but ignoring him, she bent over and joined them, squatting down behind the podium.

“You shouldn’t be here!” Louie snapped. “The bastard fired at us.”

“I’m not surprised,” Laurie said. “I think he’s killed a lot of patients, and I have personal reasons to want to be sure he is caught. Where the hell is he?”

“He’s behind that gray Mercedes,” Don said. He pointed across the lot to a car parked alongside a wall. “We returned fire, and he ran behind that Benz.”

“What are you going to do?” Laurie asked. She tried to look. The lighting in the garage was not the best, and there were long areas of shadow.

“Keep your head down,” Louie demanded.

“We’re going to wait for backup like we are supposed to do,” Don said. “They should be here very shortly. When we called for backup, we were told that it was already on its way, which surprised us. When he went into the SICU, this dude told us he was the nursing supervisor. We thought he was a doctor.”

“I was told he is the nursing supervisor,” Laurie said. “More important, he’s also a killer and probably a serial killer.”

“Jesus Christ.” Don moaned. “We thought this was going to be a cushy detail, not a goddamned firefight.”

“When you said you have personal reasons to want him caught, what did you mean?” Louie asked.

“I’d rather not say at the moment,” she responded. She didn’t want to think about it. Instead, she took out her phone and placed another call to Lou. He answered on the first ring.

“I’m almost there,” he said. “Two minutes. Where are you and where is the killer? Do you know?”

“I’m in the parking garage,” Laurie said. “And he is, too. I’m with the two officers. There has been gunfire. They have him pinned behind a gray Mercedes on the second floor.”

“Tell them not to do anything stupid and that backup is on its way.”

“Don’t worry! They seem appropriately conservative.”

“Good,” Lou said. “And it goes for you, too.” He disconnected.

For a few minutes, the three people huddled behind the valet podium were silent as they kept their eyes on the gray Mercedes, then all at once they jumped. Behind them the door to the pedestrian bridge burst open and four hospital security men in black suits, talking loudly among themselves, came running into the garage.

“Good God,” Louie said exasperatedly as he again frantically waved for the new arrivals to take cover.

“What’s going on here?” one of the new arrivals demanded.

“We’ve got a homicide suspect who fired at us cornered behind that Mercedes across the way,” the first officer snapped. “So get the hell down!”

The moment he spoke, a hail of gunfire erupted and one of the arriving security people cried out as he was hit in the leg and fell to the pavement. Everyone else ducked. It was Laurie who spotted the killer, who had run out from behind the Mercedes to take advantage of the commotion caused by the security peoples’ arrival.

“He’s escaping!” she cried. The two officers hesitantly stood up and then ran out into the roadway, aiming their guns. But the killer disappeared behind a black Cherokee. The security people, still hunched over, crowded around their fallen comrade to lend a hand while one of them called down to the ED to send help.

In the next instant, the Cherokee shot backward with its wheels sending a high-pitched screeching that reverberated around the confines of the garage. Then the SUV powered forward with equal squealing, heading away down the inclined ramp. The smell of burnt rubber permeated the air. In response, the two patrolmen each fired several shots at the departing Cherokee but didn’t try to pursue. Don pulled his radio off his shoulder and used it to let his precinct operator know the suspect was fleeing and described the vehicle.

Still holding her phone, she called Lou.

“I’m in sight of the parking garage,” Lou barked.

“He’s in a black SUV with flames painted on it, heading for the exit from the second floor!” Laurie yelled back. “He shot one of the hospital security people.”

“Ten-four!” Lou said, and disconnected.

Gripping the steering wheel with both hands, Lou turned his Malibu sharply to the right into one of the MMH’s garage entrance/exits and crashed through the black-and-white-striped wooden gate. On the other side of the gate area, he pulled into an open slot and then rapidly backed out, completely blocking the roadway. Leaping out of the vehicle, he pulled out his service pistol from his belt holster and then hunkered down behind his car with a view up the ramp over his car’s front hood. A flat black SUV appeared at the top of the ramp with screeching tires while making a 180-degree turn to come into view. Accelerating, it came at Lou, closing the gap rapidly.

Realizing the man was not going to stop, Lou dove out of the way at the last second, hitting the pavement hard with his right shoulder. Behind him he heard the thundering crash of glass and metal as the SUV rammed the Malibu and then drove it back to smash against the exit stanchions, where both vehicles finally came to a smoking halt.

Leaping up, Lou raced the few steps to bring him near to the SUV’s driver’s-side door while he yelled for the driver, who he could see despite the tinted windows, to come out with his hands held high. Lou waited a beat and then repeated his order, yelling even more loudly. He was holding his service pistol in both hands out in front of him, pointed at the indistinct profile.

The car door suddenly flew open, and a man came into view, gun in hand, trained on Lou. Reacting by reflex honed over the years, Lou shot the man three times. Still the man managed to discharge his weapon, but it was after having taken a round in his chest and his aim was off, and the bullet harmlessly ricocheted around the garage.

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.”

Laurie advanced into the room and looked down at Jack. Despite the abrasion on his cheek, he looked remarkably normal. She felt enormous relief although she knew she’d feel even more if he would only wake up.