Foreign Body (27 page)

"What is it?" Dr. Krishna demanded.

"It's over one hundred and nine."

"Shit!" Dr. Krishna shouted. "That's hyperpyrexia. Get ice!"

The floor nurse ran out of the room.

"You must be right, Dr. Dayal," Dr. Krishna moaned. "We must be dealing with a heart attack and a stroke."

The nurse who'd dashed up to the lab returned on the run. She was out of breath but managed to say, "The emergency potassium level is nine-point-one milliequivalents per liter. The tech says he's never seen it that high, so he's going to repeat it."

"Yikes!" Dr. Krishna exclaimed. "I've never seen a potassium level like that. Let's give some calcium gluconate: ten milliliters of a ten percent solution. Draw it up. We'll give it over a couple of minutes. Plus, I want twenty units of regular insulin. And do we have cation-exchange resin available? If so, get it."

The floor nurse came back with ice. Dr. Krishna dumped it over the patient, and a lot clattered to the floor. The nurse then ran back out to try to get the resin while the other began to draw up the medication.

"Damn!" Dr. Krishna shouted as the blip on the monitor flat-lined. "We lost the heartbeat." He climbed up on the bed and began closed-chest massage.

The CPR attempt went on for another twenty minutes, but despite the medication, the ice, the cation-exchange resin, and a lot of effort, a heartbeat was not regained. "I think we are going to have to give up," Dr. Krishna said finally. "It's intuitive what we are doing is not working. And I'm afraid rigor mortis is setting in already, probably from the patient's hyperthermia. It's time to stop." He let up from compressing the chest. Although Dr. Dayal had offered to relieve him ten minutes earlier, he'd refused. "It's my patient,"

he'd explained.

After thanking the two floor nurses for their help and Dr. Dayal for hers, Dr. Krishna pulled down the sleeves of his white coat from where he'd pushed them up at the outset of the resuscitation attempt, and started for the door. "I'll do the paperwork," he called over his shoulder as the others began to pick up the debris, put the room in order, and prepare the body. "As per that e-mail directive that came out just today from admin about reporting deaths immediately, I'll also call CEO Khajan Chawdhry to give him the bad news."

"Thank you, Dr. Krishna," the two nurses echoed.

"I'll do the phoning to Khajan, if you'd like," Dr. Dayal offered.

"I think I should do it," Dr. Krishna rejoined. "He was my patient, and I should take whatever heat this is going to create. With those deaths over at the Queen Victoria garnering international media attention, this episode is going to be looked upon as very inconvenient, to say the least. I'm sure there'll be great pressure to keep it under wraps and dispose of it promptly. It's too bad, because under more normal circumstances, I'd actually like to learn the physiological sequence of events, starting with the patient's history of obstructive heart disease, right up to the hyperpyrexia and the massively elevated potassium level."

"I doubt we'll ever know," Dr. Dayal said. "I agree with you about the admin wanting to keep this quiet. But if Khajan wants to talk to me, tell him I'm here at the hospital and can be paged."

Dr. Krishna waved over his shoulder to indicate he'd heard. He was about to turn down the short corridor to the room's door to the hall when his eyes passed over Raj.

Reflexively they snapped back to the statue-like nurse. "My gosh, son, I forgot all about you. Come with me!" Dr. Krishna waved for Raj to follow, then preceded him out the door.

Vainly hoping he would have continued to be ignored as if he were invisible, Raj reluctantly followed the surgeon. Once again, his heart was racing. He had no idea of what to expect, but it was going to be bad.

Out in the hall, Dr. Krishna had waited for him. "Sorry to have ignored you, young man," the surgeon said. "I've been seriously preoccupied, but now I recognize you. I saw you this morning when I stopped down here to check on Lucas. You're the day nurse, if I'm not mistaken. What was your name again?"

"Raj Khatwani," Raj hesitantly said.

"Oh, yes, Raj! My, you have long hours."

"I'm not working. I get off after three."

"You're still here at the hospital and you certainly look like you are working, uniform and all."

"I came back to the hospital to use the library. I wanted to learn about the surgery you did on Mr. Lucas. Obesity surgery was not included in our nursing-school curricula."

"That's very impressive! You remind me of myself when I was a student your age! Self-motivation is key to success in medicine. Come, walk with me down to the central desk."

The two men began walking, with Raj having trouble resisting the temptation to flee. He knew that the longer he stayed and the more he said, the more apt he was to incriminate himself. He could even feel the succinylcholine syringe in his pants pocket, pressing against his thigh.

"Did your research result in any questions I might answer for you?"

Desperately, Raj tried to think up a question he could ask to make it seem believable that he'd truly been studying. "Umm . . ." he voiced. "How do you know how small to make the stomach?"

"Good question," Dr. Krishna said, switching to a professional mien as he answered it with the help of elaborate hand gestures. He caught Raj's eyes longingly taking in the stairwell door, which they were passing. The surgeon stopped, interrupting himself. "I'm sorry," he said. "Do you have to be someplace?"

"I do have to get home," Raj said.

"Don't let me hold you up," Dr. Krishna said. "But I do have a question. How was it you were in Mr. Lucas's room just when he suffered his terminal event?"

Raj's mind desperately raced for an explanation. Making the tension even worse, he knew that every moment he hesitated, the less convincing he would be. "After the reading I'd done, I had some questions for the patient. But the second I got into his room, I knew there was something seriously wrong."

"Was he conscious?"

"I don't know. He was writhing around as if in pain."

"That was probably the heart attack. It's what usually kills these overweight patients.

Well, you almost saved the day. Thank you."

"You're welcome," Raj said with a gulp, almost giving himself away. He couldn't believe he was being thanked.

"I have some good journal articles on obesity surgery I can loan you if you'd like."

"That would be terrific," Raj managed.

After a quick shake of hands, the two men parted, Raj disappearing into the stairwell and Dr. Krishna heading for the central desk to fill out the death certificate and call the care manager and Khajan Chawdhry.

Once inside the stairwell, Raj had to pause. His heart was beating at such a rate that he felt mildly dizzy. Squatting down on his haunches for twenty or so seconds relieved the dizziness, and after wiping the cold sweat from his forehead he stood back up, holding on to the handrail. Relieved, he took a few steps down, and when he sensed he was back to normal, he let himself run down the rest of the stairs to the lobby floor.

Pleased that the lobby was as deserted as it was, Raj half ran across the room to the main exit door and left the building. Outside, he forced himself to slow to a rapid walk, finding it difficult not to give in to his panic and bolt. He felt like a bank robber exiting a bank with all the cash and every eye on him. At any moment he half expected to hear a shrill whistle and a shouted command to stop.

Reaching the still-crowded street, Raj hailed an auto rickshaw, and it wasn't until the Aesculapian Medical Center faded from view out the small rear window that he could begin to relax. Facing forward in a near trance, Raj terrorized himself by rehashing the whole unfortunate episode. He was afraid to tell the others, but he was more afraid not to tell them, unsure of what the ultimate fallout was going to be.

After passing through the front door of the bungalow, Raj stopped to listen. He could feel the vibration of the large sub-woofer of the video system pumping out the bass in the formal living room, so he headed in that direction. He found Cal, Durell, Petra, and Santana, along with Veena, Samira, and two other nurses, watching a taut action DVD.

Durell was enthusiastically into it and cheering on the protagonists, who were facing insurmountable odds.

Raj went up behind Cal, and after a moment's hesitation gently shook his shoulder.

Tense from the movie, Cal jumped when he felt the nudge, took one look at who'd caught his attention, and then paused the movie. "Raj! We're glad to see you back. How did it go?"

"I'm afraid it did not go well at all," Raj admitted, and dropped his eyes from Cal's to the floor. "It was a disaster."

There was a moment of silence as all eyes regarded Raj.

"I thought we shouldn't have gone ahead with another so soon," Veena blurted out. "You should have listened to me!"

Cal raised his hand to quiet her. "I think we should hear from Raj before we jump to any conclusions. Tell us what happened, Raj. Don't spare the details."

Without much embellishment, Raj told the whole story, from colliding with the doctor to being thanked by the doctor in the hospital corridor after the failed resuscitation attempt.

When he was finished he fell silent, still looking down at the floor and avoiding eye contact with anyone.

"That was it?" Cal asked, after a brief silence. Cal was relieved. He and everyone else had expected something a lot worse, like Raj being accused of doing what he in reality did do. "And let me review. The working diagnosis was heart attack and stroke of some sort. That's what will be on the death certificate?"

Raj nodded. "That's my understanding."

"And you heard nothing about an inquest, an autopsy, or any investigation?"

"No. Nothing like that. What I did overhear from the surgeon was that an e-mail had come out that obligated him to call the hospital CEO and report the death immediately.

Apparently there's concern because of the two deaths at the Queen Victoria Hospital causing international attention. They are going to want to suppress any attention toward tonight's death."

"That sounds almost too good to me," Cal said. "Under the circumstances I can't imagine that this kind of potential disaster could have any better outcome. Raj, it seems as if you did a terrific job."

Raj began to perk up. He even made eye contact with several people. Led by Cal, there was even spontaneous applause. "Let's get a bunch of Kingfisher from the fridge and make a toast to Raj," Cal said.

"What about stopping any more episodes?" Veena questioned. "I think we should decide now to stop them, at least for a few days. Let's not push our luck."

"That seems reasonable," Cal said, "but let's get full advantage of this one. Did you get the patient's hospital record?" Cal asked Raj. Raj went into one of his pockets and pulled out his USB storage device and the succinylcholine syringe. Cal took the storage device and handed it to Santana. "Let's get this death episode right to CNN. With the failed resuscitation attempt, it should make good copy and have even more impact. Encourage them to get it on the air ASAP."

Santana took the storage device. "It will only take me a few minutes, then I'll be back for that beer. How about waiting."

Chapter 21

OCTOBER 17, 2007

WEDNESDAY, 9:05 P.M.

NEW DELHI, INDIA

Jennifer's sleep pattern had never been so out of whack. When she'd returned to her room from having dinner with Lucinda Benfatti, she was so tired she'd almost fallen asleep brushing her teeth. But once she'd gotten into bed and turned out the lights, her mind started waking up. Before she knew it, she was anticipating Laurie and Jack's arrival with great excitement and wondering whether she should have already reserved one of the hotel cars to pick them up. It seemed that ten p.m. to two a.m. was when most of the international flights arrived, so the demand for the hotel's vehicles was the highest then.

Worried that she might already be out of luck, Jennifer sat up, turned on the light, and called down to the concierge's desk. Talking with the concierge, she learned something she didn't know. An airport pickup for Amal Palace guests was complimentary, and a vehicle was already scheduled to pick up Laurie and Jack. Asking if she could join the pickup, the concierge assured her she could, told her when it would be leaving, and promised to let transportation know that she would be going along.

With that job out of the way, Jennifer turned the light off again and wriggled down under the covers. At first she started out on her back with her hands comfortably folded on her chest. But with her mind activated from making the car reservation, she found herself puzzling over whether Laurie and Jack would have more luck dealing with the case manager than she did, and what that would mean in regard to a possible autopsy.

A few minutes later, Jennifer turned on her side while she thought about cyanosis and wondered if Herbert Benfatti had been cyanotic, and how she might find out.

Five minutes later, she was on her stomach thinking about what she should do the following day. She certainly had no intention of hanging around the Queen Victoria Hospital and being badgered all day. She thought she might try to do a bit of sightseeing, even though, as preoccupied as she was, she thought she might find it tedious. She knew herself well enough to know that even in the best of circumstances, she wasn't much of the sightseeing type as far as old buildings and tombs were concerned. What she did find interesting was people.

At that point she started thinking about how little she knew about India, Indians, and Indian culture.

"Damn!" Jennifer suddenly said to the darkness. Despite her body's insistence that it was exhausted, her mind was buzzing like a beehive. With frustration Jennifer sat up, turned the bedside lamp on, and got out of bed. In the walk-in closet she located the several Indian guidebooks she'd gotten at LAX, brought them back into the room, and tossed them onto the bed. She then went over to the TV and angled it from pointing at the couch to point at the bed. Leaping back into the bed, she used the remote to tune in CNN