Patient One (12 page)

“I didn’t know you two were so close,” Karen remarked, keeping the jealousy out of her voice.

“We aren’t.”

“That’s not what I saw going on down in the bathroom,” Karen said. “I think you’ve got yourself a new girlfriend.”

“We’ll see after all this is said and done.”

“For being as clever as you are, David, sometimes you’re awfully blind to the obvious.”

“That’s one of my flaws,” David said gruffly. “Now I want you to return to your space by the far wall without making a sound. Do you think you can manage that?”

“I can try.” Karen nestled up against him and kissed his neck before backing away to her hiding place.

Eleven

David felt the vibration
of his cell phone through his pants pocket. He moved quickly and quietly over the nurses’ station. Jarrin Smith and the Russian security agent were seated at the desk, a terrorist standing guard over them. The floor around them was littered with trash and soaked with blood. The stale odor of decay was everywhere, and triggered a flashback in David’s mind, but he pushed it aside and crawled on until he was close to the treatment room, where there was little chance he’d be overheard.

He reached for his cell phone and answered in a whisper. “Yes?”

“Dr. Ballineau, this is Special Agent Cassidy. Are you still in the crawlspace?”

“Yes.”

“Good. Now we have to talk fast, because we don’t know how much power is left in your phone’s battery.”

“Fire away.”

“We finally got the floor plans for the Beaumont Pavilion and the floor beneath it,” Cassidy said hurriedly. “Let’s start with who is in which rooms. Begin with the President and his family.”

“Do you have numbers for the suites?”

“Yes.”

“The President is in suite one, the First Lady is in two, their daughter in three.” David rapidly went through all the rooms and the patients they contained. Then he described the nurses’ station, treatment room, nurses’ lounge, and kitchen area.

“Where is the First Daughter’s date?” Cassidy asked.

“Dead.”

“Is the President still hanging on?”

“Just barely,” David reported. “The plasma seems to have slowed his bleeding, and he’s receiving a blood transfusion now.”

“Hold on,” Cassidy said. “I want you to speak with a hematology specialist.”

David heard background noise. Then a voice came on. “David, this is Bill Gershon. Can you hear me?”

“I hear you,” David said, pleased to be talking with the medical center’s expert on coagulation defects. “We’ve got a big problem up here, Billy.”

“Are you certain it’s von Willebrand’s disease?” Gershon asked.

“Not positively,” David replied. “But the disorder runs in his family.”

“That’s good enough for now,” Gershon said. “What have you treated him with so far?”

“One unit of fresh frozen plasma and one unit of packed red cells.”

“In all likelihood that’s not going to hold him long.”

“I know.”

“He needs Factor VIII–rich concentrates.”

“I’m aware of that, but the terrorists won’t let anything or anybody come up to the Pavilion.”

“The concentrates may well be his only hope.”

“Then you’d better think of a way to get those bags of concentrates up here.”

There was a long silence.

“Put Agent Cassidy back on while you’re thinking,” David directed.

There was another pause before Cassidy returned to the line. “I’m here,” he said.

“We have to talk about the terrorists and what you’re up against,” David urged.

“Okay, let’s begin with—”

“Just listen!” David cut him off. “There are five terrorists, all Chechens, all experienced, all cold-blooded killers. One has an arm wound, but it’s minor and won’t stop him from fighting. They’re all armed with Uzis, clips in and ready to fire. All are carrying extra clips of ammunition under their belts. In addition, two have long knives, and two have grenades.”

“Stun grenades?” Cassidy asked quickly.

“I don’t think so,” David replied. “From high up they look like the explosive type.”

“And side arms?”

“Their leader is carrying a Sig Sauer automatic pistol, which he probably took from one of your dead agents.”

Cassidy cleared his throat. “How do you know so much about weapons?”

“I was in the military a long time ago.”

“Army?”

“A branch of it.”

“Ah-huh,” Cassidy said, like a man making a mental note. “A second ago you mentioned dead agents. Did any survive?”

“None that I know of.”

“What about Wells? Did you actually see his body?”

“He was the last to go,” David replied. “He went down at the President’s door, fighting until his last breath.”

There was a long pause before Cassidy spoke again. “Let’s go back to the terrorists. Do they tend to congregate in one place?”

“They’re constantly moving in the corridor and in and out of rooms,” David answered. “They’re obviously experienced. They know what they’re doing.”

“So they don’t have anyone standing guard at the elevator or fire stairs?”

“They don’t need permanent guards there,” David told him. “The elevator doors are jammed shut, and they’ve got some type of metal chain device locking the fire door. I think they’ve also planted some explosives in the fire stairs. If you tried to blow your way in, they’d kill everybody before the smoke cleared.”

“What about the dumbwaiter?”

“It’s up here, so you can’t get it back down to the kitchen,” David informed him. “And in addition, they’ve booby-trapped it with something that looks like C-4. But to be doubly sure, they always have a guard in or close by that room.”

“Clever bastards.”

“And some.”

Cassidy grumbled a profanity under his breath. “I need to know precisely how closely the President is being guarded.”

“There is always someone in the corridor just outside his room. And the door is kept partially open.”

“So if we placed someone in the crawlspace he could take the guard out,” Cassidy thought aloud.

“There’s no opening from the crawlspace to the roof,” David pointed out.

“We could make one,” Cassidy proposed.

“They’d hear you,” David warned. “But even if you could, then what?”

“Then we’d neutralize the guard and help the President up and out.”

“Forget it!” David told him. “The President is so weak he can barely stand, much less hoist himself up. He’d be two hundred pounds of dead weight. There’s no way you could lift him ten feet and get him up and out through this crawlspace, which is partially blocked by a metal grid. Everyone would be killed, including the President.”

“Have they planted explosives at the presidential end of the corridor?” Cassidy asked.

“Not yet,” David answered. “But I wouldn’t put it past them. If they think they’re going to die, they’ll want to take the President with them.”

Cassidy grunted unhappily under his breath before saying, “We’ve got a gastroenterologist here who needs to speak with you.”

He doesn’t need to speak with me,
David thought miserably.
He needs to be up on the Pavilion passing an endoscope that could stop the President’s bleeding.

“David? This is Jonathan Bell down here. Am I coming through?”

“Loud and clear,” David said to the co-chief of gastroenterology at University Hospital.

“This doesn’t sound like garden variety food poisoning.”

“It’s not,” David answered. “The terrorists somehow managed to put a toxin in the caviar served at the state dinner. That’s why the symptoms started so quickly.”

“What type of toxin?” Bell asked.

“I can’t be sure,” David replied. “I overheard Aliev say that it was encapsulated in tiny pellets for slow release, but he didn’t mention a specific name. The symptoms last for four to six hours, if you can believe what Aliev told the President.”

“It sounds like a bacterial enterotoxin.”

“Or its first cousin.”

“Well, that can be treated with simple fluid replacement.”

“Except for the President, who may be bleeding to death right under my nose.”

“I know, I know,” Bell said. “What have you done so far from a G.I. standpoint to stem the hemorrhaging?”

“I’ve got a nasogastric tube down to monitor the bleeding and suck out his gastric juice.”

“Good.”

“And I had to lavage his stomach with ice water early on.”

“You can do that again if needed and continue doing it for ten minutes. With a little ingenuity, you might be able to hook the suction apparatus—”

“I’m up in a crawlspace between the Pavilion and the roof,” David interrupted sharply. “Not down on the damn floor.”

“Sorry,” Bell apologized. “I forgot for a moment.”

“Do you have any other suggestions?”

“I’d give the President twenty milligrams of Pepcid IV,” Bell advised. “That’ll stop his acid production and might slow down his bleeding. You repeat that in—” He stopped in mid-sentence to berate himself. “Oh, Christ! I keep forgetting you’re not down on the floor.”

“I’ll try to get a message to the nurse.”

“Good show!” Bell said, then added, “Our prayers are with you, David.”

“Save them for the President,” David said hoarsely. “He’s the one who needs them.”

Cassidy came back on the line. “We’re going to sign off now, Dr. Ballineau. Hold tight while we figure a way to get those bags of Factor VIII up to you.”

“Be very, very careful,” David cautioned. “The ceiling is paper-thin. One slipup and I’m dead, and so is any chance you have to save the President.”

Twelve

Marci leaned forward in
bed and strained to inhale air into her lungs. “Am I going to die?” she gasped.

“No,” Carolyn replied evenly. “It’s just pressure from your pericardial effusion.”

“But my symptoms have never been this bad.” Marci was now breathing rapidly through her nose and mouth. “I feel like I’m dying!”

“Let me increase your oxygen,” Carolyn said, adjusting the plastic cannula in Marci’s nose and raising the oxygen flow to four liters per minute. “Is that better?”

Marci nodded, but she was still sucking for air and her vital signs on the monitor were worsening. Her pulse was up to 112 beats per minute, her blood pressure dropping to 96/70. “Is Dr. Ballineau coming up to see me?”

“We’re trying to reach him now,” Carolyn lied and looked up at the ceiling, hoping that a sheet of instructions from David would come floating down. But none did.

“Maybe you should call him again,” Marci said weakly.

“Let’s give him another minute or two.”

Carolyn gazed over to the closed door and prayed Aliev wouldn’t open it and find her in Marci’s room. If he did he’d be furious, and only God knew what he might do. Despite Aliev’s warning, Carolyn had little choice but to be with Marci. It was as if some invisible force was making sure Marci wouldn’t suffer by herself.

Carolyn had been hurrying into the medicine room to fetch more drugs for Dr. Warren when she happened to notice a flashing light at the nurses’ station, indicating someone needed help. It was Marci. So Carolyn waited patiently for the guard in the corridor to move away, then crept into Marci’s suite, all the while holding her breath. Jesus! It was so dangerous! So risky! But she had to do it. She couldn’t just leave the desperately ill college student to die alone. Maybe she could help. But deep down Carolyn had the awful feeling Marci was going to die regardless of what she did.
Poor thing
, she thought sadly and turned her attention back to the patient who was struggling even more to breathe.

Marci had her mouth pursed like an
O
so she could draw in more air. Her lips turned to a dusky color as she bent over even farther in an effort to force more air into her lungs.

She’s dying
, Carolyn thought desperately.
And I don’t know what to do next. Do I increase the dose of prednisone and Imuran? And, if so, how much? Or should I give her morphine, like they do to patients having a myocardial infarction? No, no! This wasn’t an M.I. Don’t do something that could make her even worse.

Carolyn gazed over to the cardiac monitor. Marci’s vital signs were deteriorating, and would continue to do so without appropriate therapy. There was a treatment sure to save Marci’s life, but one Carolyn didn’t dare perform. Carolyn moaned to herself.
Without the right equipment, I couldn’t even think about doing a pericardiocentesis
. A pericardiocentesis! Sticking a big, long needle through the chest wall and into the heart, then aspirating the fluid that had accumulated in the pericardial space. It was a dangerous procedure, even when done by an experienced cardiologist. The last pericardiocentesis Carolyn had seen ended up with a terrible complication. The needle had sliced open a coronary artery, killing the patient.

She looked up at the ceiling again, with all its panels in place, and whispered loudly, “Damn it, David! Where are you?”

There was no response. The panels didn’t move.

Marci’s systolic blood pressure was down to 92, her pulse up to 118 per minute. And her respirations were growing weaker, the effort required to breathe exhausting her.

In the stillness Carolyn closed her eyes and prayed for guidance.
Tell me what to do, God! Tell me how I can help this poor girl!
Do I try—?

Suddenly the silence was broken by the sound of a gunshot coming from the corridor. Then another shot. Then the sound of running footsteps.

Carolyn shuddered.
They’ve killed somebody else!

She hesitated, not sure what to do. Racing into the corridor could get her shot. But then again, somebody might be badly hurt. Gathering up her courage, Carolyn slowly moved to the doorway and peeked out. Two terrorists were standing over a body outside Sol Simcha’s room. Carolyn’s heart dropped as she stepped into the hallway.

“Stupid old man!” Aliev was saying. “I warned him not to leave his room.”

Simcha was lying face down on the floor, not moving.

All he’s been through
, Carolyn thought sadly,
only to die like this
. It wasn’t right and it wasn’t fair. She went to his side and gently turned him over. There was no blood on his hospital gown, no sign of a wound.

Simcha smiled up at her weakly. “I think I slipped.”

“Are you all right?” Carolyn asked.

“Yes,” Simcha said and reached a hand out. “Could you help me sit up, please?”

Carolyn gently pulled the elderly man up to a sitting position. “Sol, you must stay in your room. It’s very dangerous to step out into the corridor.”

Aliev glared down at Simcha. “If it happens again, old man, the bullets will end up in your head rather than in the wall.”

“Come on, Sol,” Carolyn said, raising him to his feet. “Let’s get you back into your bed.”

Simcha resisted her pull. “I’m not going back in that room. The ceiling is falling.”

“What?” Aliev asked. “What are you talking about?”

Simcha gestured with his withered arms. “The panels were coming down from the ceiling. I could see the openings where they once were.”

Aliev dashed into the room and looked up, pointing his Uzi at the ceiling. All the panels were in place. There were no open spaces. He glanced back to Simcha in the doorway. “Where was this opening?”

“Above my pillow,” Simcha replied.

Again Aliev studied the ceiling, now focusing in on the panels above the bed. He climbed up on the mattress to see if any of the panels were loose.

Carolyn immediately surmised what Sol had seen. It was David, peering down from an opened panel as he made rounds on his patients. The old man had seen a space without a panel and assumed the panel had fallen off. Quickly she thought of a way to explain Sol’s sighting. She turned to Aliev, who was jumping down from the bed. “It was probably the medication he’s taking. High doses of prednisone can cause hallucinations.”

“Well, he had better stay in his room while he is having hallucinations,” Aliev warned. “Because if he steps out again, my men will have orders to kill him.”

“I’ll make sure he stays in bed,” Carolyn said, then thought of a way to return to Marci’s side. “Perhaps I should remind all the patients to do likewise, if of course you agree.”

“Do it,” Aliev ordered. “Then you are to—” He stopped in mid-sentence and narrowed his eyes. “What are you doing in this area? You were told to remain near the President and his family.”

“I … I had to fetch some drugs from the medicine room,” Carolyn explained hesitantly.

Aliev gave her a long skeptical look. “Obtain all the drugs you will need, because you will not be returning to this end of the corridor again.”

“But some of the patients require—”

“You will not be returning,” Aliev reiterated. “And anyone caught in the corridor who shouldn’t be there will be shot. That includes you, major nurse.”

Carolyn swallowed hard as a chill ran down her spine. “May I have permission to go for drugs for the President again, if needed?”

“No, you may not,” Aliev replied icily.

You bastard
, Carolyn thought.
You merciless, cold-blooded bastard.

“Now finish up in here and return to your station,” Aliev directed. “And stay there!”

Carolyn waited for Aliev to leave, then helped Simcha back into bed. Once he was comfortably situated, she leaned in close and said in a stern voice, “Don’t mention the ceiling again to anyone.”

“But it was falling down, and I wasn’t hallucinating,” Simcha argued.

Carolyn took his hand and squeezed it tightly, making sure she had his full attention. “Listen carefully to me, Sol. Regardless of what you see or don’t see, never mention the ceiling to anyone. Our lives may depend on it.”

Simcha stared at her, mystified. “I don’t understand.”

“Just do what I tell you to do,” Carolyn urged.

The cardiac monitor’s alarm suddenly sounded in Marci’s room.
Ping! Ping! Ping!

Carolyn sprinted out across the corridor and rushed to Marci’s bedside. The young woman was wide-eyed and gasping for breath, her color even worse than before. Her pulse was 128 per minute, her blood pressure down to 86/64.

Marci feebly reached out a hand. “Help me, Carolyn! Please!”

A panel directly above opened.

David stuck out his arm and pointed to the nightstand. On it was a folded prescription blank. Carolyn grabbed it and quickly read the instructions.

Give Solu-Medrol 1000 mg IV push.

Carolyn ran for the medicine room.

_____

David crawled away, cursing under his breath for not being more careful when he peered down into Sol Simcha’s room. The old man had seen the ceiling panel move and thought it was about to fall on him. And he almost divulged David’s position in the crawlspace.
Damn it
!
Watch your step or you’ll get yourself killed.

David pulled on the collar of his shirt, which was drenched with perspiration. The space above the ceiling was becoming uncomfortably warm, causing him to sweat heavily. And now he was aware of his parched throat and growing thirst. He knew that would only get worse as he lost more body fluids in the heat. Then dehydration would set in and lead to weakness and mental slowing, he thought miserably.
Somehow I’ve got to find water. But where?
He passed alongside a very warm metal pipe, and that caused him to sweat even more profusely. Again he pulled at his soaked collar.
Where the hell was water available?

He couldn’t use the faucets in the bathrooms because of the noise they made. The sound of running water might attract the attention of one of the terrorists who were continually sticking their heads into the suites to check on patients. And the water fountains were all in the corridor. There was no way to get to them unseen. Just the thought of water intensified David’s thirst. He concentrated on finding a place where liquids might be located, going from room to room in his mind. Then it came to him. The kitchen! The refrigerator in the kitchen! They kept cartons of bottled water in there. He crawled along the metal grid more rapidly, heading for the kitchen and hoping it wasn’t being guarded at the moment. Coming to the end of the corridor, he peered through a slit in the ceiling and searched the area. There were no guards and no sounds. Silently he crept over the kitchen and again looked down. No guard! The door closed! All clear!

Suddenly there was a noise. It was a noise like rubbing, and it wasn’t far off.

David stayed motionless as the sound grew closer and closer. Peering into the dimness, he couldn’t make out any moving shadows or figures. He held his breath and prepared to lash out at the sound. Then Karen appeared.

David exhaled at length and wriggled alongside her. “Next time warn me when you’re crawling around.”

“You told me to be quiet,” Karen whispered.

“Then warn me quietly.”

“I’ll try,” Karen said and loosened the collar of her Oxford blouse. “David, it’s getting really hot in this area.”

“The whole ceiling space is heating up and we’re rapidly becoming dehydrated,” David told her. “Without some replacement fluids soon, we’re going to be in deep trouble.”

“We—we won’t have to give up, will we?” Karen asked hesitantly.

“Not while there’s bottled water down in the kitchen.”

“How will we get to it?”

“Watch.”

David removed a ceiling panel and, holding onto the metal grid, lowered himself onto the sink. He paused briefly and listened for sounds. There weren’t any. He jumped to the floor and hurried over to the refrigerator. In a flash he had the door open and the top off a bottle of ice-cold water. He gulped down a pint and was reaching for a second bottle when he heard footsteps approaching. Quickly he grabbed the second bottle and tossed it up to Karen’s outstretched hands. In a split second, he closed the refrigerator door and discharged his empty bottle onto a nearby counter. Then he leaped up onto the sink and climbed into the crawlspace.

As he replaced the ceiling panel, the door opened and a terrorist entered. David slowly backed away, thinking the terrorist might see the discarded bottle and become suspicious. Quietly wiggling backwards, he was unaware that his stethoscope was slipping out of his side pocket. It dropped down onto a steel grid and made a loud, metallic ping. David froze in place. The terrorist must have heard the noise.

David heard the terrorist grumble, then grunt. Then everything became quiet. The silence lasted for several seconds before the terrorist grunted again. The man sounded closer now. David remained absolutely still, barely breathing. Slowly the ceiling panel directly in front of him slid away. David saw the terrorist’s large hands reaching up through the opening.

A moment later the terrorist’s head appeared in the crawlspace, his eyes staring straight into David’s.

“Ali—,” the terrorist began to yell.

But before he could utter a complete word, David grabbed the terrorist by the throat and, placing his thumbs over the Adam’s apple, crushed the man’s larynx and shut off his airway completely.

The terrorist struggled to free himself, but David lifted him up so his feet dangled in the air. The Chechen could make only a gurgling sound, with his larynx shattered and caved in. He twisted and turned as he suffocated to death.

David released his hold and the terrorist fell heavily to the floor, bouncing up once before settling. Then all was quiet again.

David hurriedly climbed down, trying to think where he could hide the body. There were no closets in the kitchen, and the space under the sink wasn’t large enough to contain the terrorist. His gaze went over to the dumbwaiter, but then David recalled it was booby-trapped. Suddenly there were voices in the corridor. Two voices! Maybe three! David reached for the terrorist’s Uzi, but it was attached to a sling and crammed under the man’s body. The voices came even closer.