Madison’s eyes shot open, her lips drew back, and a scream started in her throat. But it never got out. With all his might he tightly slapped his right hand over her mouth, forcing her lips closed so that the scream was transformed into a mumble that was easily drowned out by the metronomic beeping of the cardiac monitor. She tried desperately to wrest his hand off her face with the hand of her unbroken arm, but he leaned the entire weight of his upper body onto her while his eyes shot up to the cardiac monitor. Already he could see the telltale signs of imminent cardiac failure as the potassium chloride bolus reached the heart and instantly interrupted its electrical conduction. A moment later the heart essentially stopped beating and became a quivering mass of uncoordinated muscle known as ventricular fibrillation. Instantly the raucous sound of the cardiac alarm reverberated off the walls.
Knowing that in a few seconds the room would be full of doctors and nurses and a cardiac resuscitation team, he quickly let go of Madison’s face, pocketed the syringe, and then put down the side rail of the bed. As the first people came charging in, he was already climbing up on the bed to start cardiac massage.
“She’s in fibrillation,” someone said, rushing up to the bedside.
“I know,” he said frantically, starting the massage by alternately pressing down on her chest. Other people crowded around the bed, including the cardiac resuscitation team, which quickly took over. One of them climbed up onto the bed to replace him. Others yanked the bed away from the wall so someone else could intubate and then ventilate her with one hundred percent oxygen.
He backed up, giving the team space to do their thing. There were now ten to twenty people in the room, which gave him the opportunity to get out of the way and move toward the exit.
“Let me have the defibrillator paddles,” he heard the team leader call out. A moment later there was the characteristic thud of the defibrillator being discharged, followed by a short silent pause while everyone stared at the ECG screen in hopes that the heart would have returned to a normal rhythm. He knew it wouldn’t, and he knew that by now there was probably no way possible to save Madison. With a potassium chloride overdose, the corrective measures would have had to have been started immediately, and even then, they wouldn’t necessarily be successful, and there was no way the resuscitation team could even determine that the problem was hyperkalemia, or too much circulating potassium.
He heard the team leader yell out to defibrillate again, and while everyone was occupied and totally absorbed in the resuscitation attempt, he walked out into the hallway. At that moment there was no one at the central desk, which was convenient. Pleased with what he’d been able to accomplish, he headed in the direction of the elevators. After the anxiety he’d suffered for most of the day, his relief was palpable. He was also exhausted both mentally and physically and in dire need of a stiff drink.
Chapter 27
May 10th
6:45 A.M.
The weather was perfect and at least for a few minutes Jack wasn’t thinking and wasn’t worrying, he was just enjoying himself as the wind whistled through his bicycle helmet. He was on the West Drive in Central Park heading south, perched on top of his relatively new Trek road bike, and pedaling to beat the band. When he’d just joined the roadway up near 106th Street, he’d happened upon a group of serious, significantly younger bikers all decked out in expensive biking finery and riding custom-made bikes from Italy or France. He loved to ride with these guys because they took themselves inordinately seriously and looked down on his wearing a corduroy jacket, jeans, a chambray shirt, and a knit tie. He got a kick out of not only keeping up with them, but challenging them, particularly on the uphill sections. Because of his pickup basketball, Jack was in superb cardiovascular shape.
He had not slept that well, which seemed mildly ironic because Laurie had. Now that she’d made up her mind about her surgery, she could relax, while the immediacy of it had the opposite effect on Jack. This morning had been his turn to wake up early and wander around the apartment, stealing long looks at his sleeping children. As he had said to Laurie the previous day, he wished it was he who was having the surgery. If that had been the case, there was no doubt in his mind that he would have been fast asleep at that point, waiting for the alarm and not being tortured by dark thoughts concerning Laurie’s well-being.
At the southeast corner of the park, Jack bid farewell to his fellow riders with a nod of his head as he peeled off, going south on East Drive while they went north. When he got to the Grand Army Plaza, he headed south on Fifth Avenue. It was his normal route, which he followed without giving it much thought. At that time in the morning the traffic was light. Although not that many years ago he used to challenge taxis on his morning commute, he didn’t do that anymore. In that regard he’d become relatively conservative now that he had family obligations.
Eventually he traveled east over to Second Avenue. This was the only portion of the bike ride that he varied on a whim from day to day. On this particular morning he took 54th Street. As per usual, he looked forward to getting to the OCME. Work was one of the ways that Jack dealt with his submerged anxieties, and whenever something was bothering him, he invariably worked harder. Yesterday he’d done four autopsies and the day before, five, such that cases were piling up on his desk, crying out to be completed. In contrast to most of the other medical examiners, he preferred to be in the pit actually doing the autopsies rather than the more sedentary aspect of sitting at his desk collating all the material to complete the death certificate. At least that was his preference unless there was a particularly challenging conundrum. Jack loved to do field work even though he was supposed to leave that aspect up to the medical-legal investigators. The problem was that Jack was trained at a forensic program that encouraged the medical examiners to go out in the field when it would be helpful, and from day one at the NYC OCME he’d strained at the limitations.
On reaching Second Avenue, he turned south. Here the traffic was significantly lighter than usual, which gave him a chance to think. After his run out on the neighborhood basketball court last night, where he didn’t play up to his expectations with everything on his mind, he’d had another talk with Laurie about Dr. Nichols. Laurie had told him that although she didn’t mind continuing to collaborate with her regarding the autopsy she’d done with her, she didn’t have the time or energy to deal with the problem her general performance created. She said she was going to tell Chet that it was up to him but wanted to encourage Jack to lend a hand without making the situation worse. Jack had promised he’d do so, which was going to require him to be more accommodating than usual.
As was his customary habit, he rode his bike down 30th Street alongside the OCME building and entered at the loading dock. Hefting his bike onto his shoulder, he brought it inside and locked it in its usual location not far from the autopsy room. From there he went up to the ID area on the ground floor, where the day started for all the medical examiners. Since it was only 7:15 there were only two people in the room, Dr. Jennifer Hernandez and Vinnie Amendola. Jennifer was there because it was her week as a junior ME to be the on-call ME, one of whose jobs was to go over the cases that had come in overnight, decide which of them should be autopsied, and to divvy them up to the various MEs. Vinnie, one of the more senior mortuary technicians, was there to make sure the transition from the night shift to the day shift proceeded without a hitch and, maybe more important for the OCME community, to make the coffee in the communal coffee pot.