The man didn’t like hearing that he had no control over the Guatemalan clinic. For that matter, neither did Barnesdale, but he had no say in the matter. Caleb Fagan, the head of Immunology at University Children’s, had funded the clinic using outside donations since its inception five years ago. It was the only clinical budget item outside of Barnesdale’s reach.
The clinic seemed to be part of some mid-life crisis for Fagan, who had taken up the mantle of healthcare in developing countries with the same zeal that had propelled him to near celebrity status in the field of immunology. Despite his seeming conversion to humanitarian causes, Barnesdale didn’t trust the man’s motives. Caleb was a self-important jerk.
“We have another problem,” the CEO said. “It’s Tartaglia.”
The starch in Barnesdale’s shirt collar began to give way to the warm moisture forming on his neck. “Oh, Christ.”
“Tartaglia’s not giving up. It looks like she’s going to tell her fairy tale to people outside the company.”
“Is it a fairy tale?”
During the long silence that followed, Barnesdale felt as if someone had lit a road flare inside his stomach.
When the CEO finally spoke, his voice was like molten steel. “There’s nothing wrong with our vaccines. It concerns me, Henry, that you doubt me.”
Barnesdale pulled a handkerchief from his breast pocket and wiped his forehead.
“You see,” the executive continued, “in exactly two weeks, we cross the finish line. I’m not letting anything get in our way.”
Barnesdale wasted no time bringing the discussion back to Tartaglia. “How do you know that she’s talking to people?”
“Not people — person,” the man said. “I have someone monitoring the situation. Two hours ago she sent an e-mail from her home. There’s a photograph attached.”
“Who — Who did she send it to?”
“Someone at your hospital — Luke McKenna.” A pause, then, “Any relation to Elmer?”
“That’s Elmer’s son.”
“Why would Tartaglia send the information to him?” the CEO asked.
“Luke McKenna’s one of our E.R. doctors.” Barnesdale pulled up the staffing roster on his computer screen. “He’s working Trauma tonight, which means he’s probably downstairs with the kid right now.”
Another heavy breath came through the phone. “So, unless you believe in coincidences, Tartaglia knows about the boy. She knew he was coming to the hospital.”
“What are you going to do?”
“You mean, what are we going to do? We both have a problem here,” the CEO said. “And I think you know what needs to be done.”
The phone line went dead.
Barnesdale’s eyelids fell closed. What did I get myself into?
When Zenavax had approached him four years ago, he was in no position to turn down the company’s “business proposition.” Several years earlier, a drunk driver had decimated not only his wife’s brain, but also their meager savings. Once the cost of her skilled nursing facility care had reached the lifetime limits of their insurance plan, it wasn’t long before he spent through his financial reserves, and then the proceeds from a heavily leveraged second mortgage. When the Zenavax CEO had made his offer, Barnesdale was despondent and on the brink of bankruptcy.
And the bastard knew it.
Life being what it is, his wife had died just one month after he traded his integrity and self-respect for a hefty bribe. He hadn’t had a decent night’s sleep since.
The intercom on his desk sounded. “Dr. Barnesdale, I’m sorry to interrupt, but you’re needed on the phone.”
“Tell them I’m busy.”
“I already have, sir. It’s the emergency room and they say it can’t wait. One of our doctors just got into a scuffle with someone.”
“Blood pressure is coming back,” Susan announced. “Systolic is now eighty-eight.”
As in most battles, the momentum tends to work for you or against you, and the tone of the nurse’s voice told Luke that she too could feel the tide turning in their favor.
Megan pulled her mask off, wiped her face with a four-by-four gauze, then shot a glance at Luke.
He gave her a nod.
She suppressed a small grin that looked as if it was fighting the urge to become a full-fledged smile.
Luke had never thought of Megan as classically beautiful — except, that is, when she smiled. Her agreeable face would suddenly become strikingly pretty. In the past three months she had rarely shown him anything but a resolute and dogged temperament. God, he missed her.
Megan said to the therapist, “Let’s get another blood gas.”
Luke sidled up to her. “So what do you think?” Seeing the question on Megan’s face, he elaborated. “We have a four-year-old boy, apparently breathing well a few hours ago, who suddenly decompensates. What are the most likely causes?”
“A chronic lung disease like cystic fibrosis might look like this, but not if he was breathing fine a few hours ago. It wouldn’t happen that fast.” She tapped the edge of the table a few times, staring at the boy. “Leukemia could explain this. It would set him up for sepsis, which in turn might lead to acute respiratory distress syndrome. That would explain most of his pulmonary and cardiovascular symptoms.”
“Am I hearing a ‘but’ somewhere in there?”
“Well, yeah.” Her eyes flitted toward his. “There’re a few things that just don’t make sense. Why don’t his lungs sound worse? And if this is all due to leukemia, why didn’t they find any blasts in his blood?”
Luke had the same questions.
“Anything else you’d do right now?” Megan asked.
“I’d add something to cover him for the possibility of a fungal infection. We have a patient we know very little about, from a place we know even less about.”
The respiratory therapist handed Megan the results of another blood gas.
“Blood pressure is dropping again,” Susan broke in, the pitch of her voice a notch higher.
Megan ordered another bolus of IV fluid while checking the blood gas. “He’s still not ventilating. He’s becoming more acidotic.” She passed the results to Luke.
He scanned the monitors. “Susan, give him twenty milliequivalents of bicarb.” He turned to Megan. “This patient needs to be on a ventilator. Call the ICU and tell them they need to take this patient now.” He pointed at a computer monitor across the room. “And pull up his X-rays.”
He looked back at Josue. The boy’s left arm hung limply over the side of the table, and his near lifeless form was quickly taking on a grayish hue. Only his chest was moving, rising and falling in rhythm with the respiratory therapist’s compressions.
Luke took the Ambu bag from the therapist, to feel for himself how much pressure was required to push oxygen into the boy’s lungs. The patient’s lungs were becoming stiff.
Megan, a phone cradled on her shoulder, was talking to someone in the ICU while working a computer keyboard to pull up the boy’s chest X-ray. A moment later, the black-and-white picture popped onto the screen.
Luke studied the X-ray for several seconds, leaning closer to see that the name in the corner of the screen matched the patient on the table. He looked back at the boy. His confusion swelled.
Megan still had the phone against her ear and didn’t look overly pleased to be playing the role of messenger.