ADRENALINE: New 2013 edition (32 page)

Doug knew he had to race down the hall as fast as he could while he still had some strength. He was facing a grisly battle with time. He couldn’t get it out of his mind what a horrible way to die this would be—mind alert and unable to breathe. This is what
Stephanie, the obstetrical patient from his residency days, must’ve felt like.

Focus, he commanded himself.

He ignored the ever-increasing weight of his limbs.

He ignored the work it took to suck in a deep breath.

He ignored his heart hammering wildly in his chest on an adrenaline frenzy.

He had gone fifteen feet down the hall when he collapsed onto his chest. His arms and legs were giving out under the crushing weight of his body. Odd thoughts sparked across his mind:
Luke, his six-month-old nephew—this is what it must feel like to be a baby, to have flailing arms and legs, but not enough strength to propel the body. Very frustrating. Maybe that’s why babies cry so much? Focus! Focus! Get to the workroom
.

He crept down the hall snakelike, scraping his face on the cold linoleum floor.

Four feet. Three feet. Two feet.

He grasped the doorjamb and taking advantage of the extra leverage managed to pull himself to the doorway threshold. His legs were now useless pillars of lead.
Get the lead out—gotta get the lead out boys
, his brain gibbered. Pushing against the inside of the doorjamb, he crossed into the interior of the anesthesia workroom.

Here were countless drawers and cabinets containing hundreds of different drugs and assorted airway supplies. Doug could no longer move his body any further on the floor. However, he could still move his arms and hands. Barely able to reach, he quickly opened the drawer marked with the letters M- T.
Thank God for my gorilla arms
. Lying on the floor, he couldn’t see inside the drawer. He frantically scooped out the contents. Several ampules shattered on the floor, leaving slivers of glass strewn about. He searched the intact vials and ampules, cutting his fingers in the process.
Where is it? Where is it? Must be here. Not much time
.

Finally he found what he was looking for—a small bottle of Tensilon. He reached into his jacket pocket where he knew he
had some used syringes.
Won’t worry about a dirty syringe and AIDS today
. He quickly drew up approximately 100 milligrams of Tensilon into one of the syringes. Tensilon was a cholinesterase inhibitor drug, which acts to antagonize a drug-induced neuromuscular blockade. In short, it was the antidote to his paralysis.

Doug, of course, knew two other important considerations of reversal drugs, like Tensilon. First, they are typically given intravenously when used in the O.R. Intravenous administration provides quick access to the bloodstream, and from there to the entire body. Doug also knew he had neither the time nor strength to start an IV, even if he had all the equipment right at hand. Still, the medicine would work intramuscularly, although the onset would be slower. There was one other route that he knew would be faster.

Doug rammed the needle through the skin underneath his chin, upward into the fleshy underbelly of his tongue. No alcohol swab today. He injected the contents rapidly into his tongue, ignoring the exquisite pain elicited by this maneuver. The tongue was a highly vascular muscle, allowing for relatively rapid absorption—not as fast as the intravenous route, but far superior to a shot in the arm, leg, or buttock. He knew seconds counted.

Doug was also acutely aware that Tensilon had some potent side effects. These are routinely countered by the administration of a second drug—Atropine. He didn’t have the luxury of time to give two injections; besides, he couldn’t reach the A-G drawer. Tensilon by itself causes a severe vagal response, which if unopposed may cause a profound slowing or even cessation of the heartbeat. Doug knew he had run out of options, and would have to chance it.

Doug’s breathing became markedly labored. He needed to do one more thing. Just inside the doorway in the corner of the workroom was a green E-cylinder of oxygen fitted with a regulator device and Ambu bag attachment. Using all his dwindling strength, Doug managed to topple the Ambu bag off the top of the cylinder. Propping his left arm with his right, he reached the
oxygen flowmeter and turned it on. A loud hissing noise of the gas flowing down the plastic tubing and into the Ambu filled his ears. His left arm crashed down uselessly to the floor, crunching some ampules underneath. He felt sharp stabs of pain as several shards of broken glass embedded in his arm. The Ambu bag came to rest about a foot from his face. He felt the stream of oxygen emanating from the mask wash coolly over his face. It would have to be enough.

Doug could not move. He continued to breathe in short rapid gasps, as his diaphragm continued to struggle. Even though the diaphragm is the most resistant muscle in the body to neuromuscular blockers, it too could not stand up long to the paralyzing onslaught. Doug took his last gasp. He could still see and think clearly, if you counted suffocating awake conducive to lucid thought.

His chest began to burn as he ached to breathe. How long could you hold your breath? One minute, maybe two at tops. He knew that I.V. Tensilon took about three minutes to work—intramuscular probably double. The hissing of the oxygen became a roaring in his ears like the surf crashing over his head. Mixed in with the roar, he heard his heartbeat pounding wildly. His surroundings began to dim, and he realized he was slipping into the black oblivion of unconsciousness.

Please God, don’t let me die like this
. He recalled the panicked look in Stephanie’s eyes and realized he must look just like her. His mind wandered, and he saw his three boys playing tag on an impossibly green field. The boys’ faces were resplendent with their innocent child-smiles, although Anthony’s toothy grin always tended toward the impish. He saw Laura standing off to the side, gazing at him with her beautiful smile and long black hair; her clear laughter surrounded them.

For perhaps the first time, he fully fathomed the enormity of her love, of their love, and it shook him to the core. He saw that his whole life of burying emotions and love was a fool’s game. He
was hurting the very people he loved. Because of his cowardice, his unwillingness to risk vulnerability, he had cheated himself out of the fullness of love, deprived himself of unknown heights their relationship could’ve attained. Doug saw all of this as clearly as he saw his death approaching. He ached with intense regret and shame; what he’d give for a second chance. Although he felt he had failed them, Doug immersed himself in the protective womb of his family, trying to attain a measure of peace as he waited for the end. His last flicker of conscious thought noted that his runaway heartbeat was slowing rapidly.

Raskin removed the sterile cap from the end of the epidural catheter and attached a ten cc syringe filled with 0.25% Marcaine. He injected with the surprising amount of force necessary to overcome the resistance of the two-and-a-half foot, narrow-bore tubing protruding from his patient’s lumbar spine.

“There, there, Mrs. Concepcion. That should take care of the pain,” he said to the sobbing woman, trying to sound like he gave a shit. Raskin realized he had a problem. Ordinarily after reinjecting an epidural, one waited and observed the patient for at least fifteen minutes for any side effects. Most common was a fall in the blood pressure. It was also possible, although rare, to see grand-mal seizures following an inadvertent intravascular injection of Marcaine into an epidural vein. Raskin didn’t have fifteen minutes.

He knew he had a tight schedule to keep if he was going to rid himself once and for all from that meddlesome creep Landry. He also had to get rid of that coffeepot before anyone else drank from it. He checked his watch again for the hundredth time—1:05 a.m. The Atracurium should be taking effect right about now.

His plan was simple, but required his presence. He went over it again. Raskin wanted to be first on the scene to aid the
good Doctor Landry. He would pretend to resuscitate him in case anyone was watching. He intended to inject a lethal quantity of cocaine intravenously during the “resuscitation.” Then his death would look like an unintentional overdose, not a strange asphyxiation with no apparent cause.

Raskin smiled inwardly at the simplicity of his plan. So, Doctor Landry is revealed as an IV drug abuser. Not much sympathy there, he thought. Another victim of the high-stress OR environment. Regrettable. Not really. People always wanted to believe the worst about fat-cat doctors anyway. Raskin chuckled, then abruptly stopped.

One small problem remained. What if someone had already found Landry? He reasoned this was unlikely, since he had heard no ‘Code Blue’ announced over the hospital intercom. But even if they had, he would immediately take over the code, being the most appropriate ranking physician in the house. He would then give the cocaine, which he had already labeled as epinephrine, a standard drug given at resuscitations. This would guarantee an unsuccessful outcome of the resuscitation, had it in fact begun before Landry was actually dead from the Atracurium. It would also ensure that the toxicology screen would be positive in spades for cocaine. Nobody would bother to look further for traces of Atracurium, a drug all but unknown to the pathologists. Anyway, even if they thought to look for it, the Atracurium would be long gone, owing to its ongoing molecular disintegration.

But he needed to get downstairs immediately. So he left the wailing Mrs. Concepcion, assured her the epidural would kick in soon, hoped her blood pressure would remain stable, and hightailed it down to the OR. He, of course, couldn’t have cared less whether her blood pressure fell, or for that matter whether she seized and died. He was beyond all that. However, he didn’t want any suspicions aroused toward him that he was behaving peculiarly and not following standard protocol. Or worse, if
Mrs. Concepcion had a problem, they would be stat paging him just when he planned to be occupied.

Raskin took the steps two at a time down to the OR. He burst through the automatic doors, almost walking into them as they failed to get out of his way quickly enough. The OR complex was darkened and had an eerie quality about it; a place of such usual frenetic activity, crowded with all sorts of scurrying people, seemed unnaturally still as if some large catastrophe had befallen mankind and he was the only survivor. He entered the surgeon’s lounge.

Empty. The coffeepot was there, looking guilty as sin. The only light issued tentatively from a small table lamp in the far corner of the room. There was a spilled cup of coffee on the floor. No Landry, though. He can’t have gotten far. He dumped the coffeepot and ran down the main corridor into the OR complex. He quickly scanned all six operating rooms. Nothing.

Luckily, the place was devoid of people. No pain-in-the-ass cleaning personnel or night nursing supervisors roaming the halls. Where the hell was Landry, though? Could someone have found him? No, he reminded himself, they would’ve called a code, and he would have heard it on the overhead page. He’s got to be here somewhere. Maybe the recovery room.

Raskin reversed his direction down the corridor and made a left to the hallway, which led to the recovery room. Soon, he heard a hissing sound coming from somewhere up ahead. The workroom—and aha!—here was the good Doctor Landry looking rather dead; at least he didn’t see any evidence of respiration. Strange, he didn’t look more cyanotic. No matter. If he wasn’t entirely dead, he would be in a matter of moments. Chuckling to himself, he whipped out the syringe loaded with enough cocaine to send ten men to their graves.

Raskin turned toward the row of drawers to get a tourniquet to allow him to carry out the lethal venipuncture. He found one and knelt down beside the prone body. He rolled Landry’s limp
body over onto its back and roughly cinched the tourniquet around his right arm. He tapped briskly at the crook of Landry’s elbow, coaxing a large antecubital vein to stand out. He paused for a moment and bent down until his beard was practically touching Landry’s right ear. He said in a low voice, “You two smart guys fell for the oldest trick in the book.” He took the syringe and deftly inserted the needle into the vein and prepared to push the plunger. “Goodbye Doctor Landry.”

CHAPTER THIRTY-TWO