“I hear you,” she said.
“We’re going to get those bastards,” I told her. “Every last one of them.”
I hung up, wondering if I believed my own words.
A thousand miles south, Sandman exited the United Airlines Airbus that had brought him down to Miami.
He picked up the waiting rental car and drove off, feeling a familiar tingle, the one that preceded the adrenaline spike of a well-executed kill. He sensed a clean, strong bite there, one that could well lead to his quarry. He’d be getting that spike before, of course, here in Miami. He wouldn’t be there for long. Then he’d fly back to New York and, with a bit of luck, he’d finally put the Reilly saga to bed.
38
NewYork-Presbyterian Hospital, Manhattan
I strode across the limestone oasis that doubled as the reception area of the Perelman Heart Institute, my footsteps echoing across the vastness of its five-story atrium. A muzak-free ride up the elevator later, I was on the fourth floor and being ushered into the office of Waleed Alami, MD.
In keeping with his gregarious bio pic, he was very welcoming and didn’t scrutinize my creds, only giving them a cursory glance. In truth, only the guys who had something bad to hide ever did. I felt bad lying to him about who I was, but I didn’t have a choice. We shook hands and I thanked him for coming in to talk to me at such short notice, and on a Sunday too. I then told him I was investigating some recent deaths and asked him, straight up, if there was a way for someone to commit murder by giving someone else a heart attack besides using the old movie trope of scaring the crap out of them.
“That does really happen,” he said. He wasn’t smiling or taking it lightly in any way, which didn’t surprise me. In my experience, guys like him who were at the top of their game never did when discussing their field of expertise. “Are we talking heart attack, or cardiac arrest?” he asked. “’Cause you do know there’s a big difference, right?”
“I don’t, but-either one, if it’s fatal,” I said.
He thought about it for a moment, then decided he needed to take me through the basics.
Like most people, I guess, I had assumed both were synonymous, but he explained how they aren’t at all the same thing. A heart attack is a circulatory problem and occurs when the blood flow to part of the heart is blocked. Over time, coronary arteries that supply the heart with the oxygen and nutrients it needs to keep doing its job typically get blocked by fatty deposits-plaque-and the clogging eventually leads to heart damage. The injury can lead to electrical conduction defects in the form of blocked beats or disrupted electrical circuits. Surprisingly, he told me the heart usually didn’t stop beating during a heart attack. Some heart attacks, though, did lead to cardiac arrest.
The latter, though, is different. It, and not the proverbial “heart attack,” is the leading cause of death in our country, and it’s very prevalent-over a third of a million out-of-hospital cardiac arrests in the US alone each year. It’s an electrical problem, meaning it’s triggered by an electrical malfunction in the heart that causes an ineffective heartbeat. The heart’s pumping goes haywire, the brain, lungs and other vital organs get starved of blood and the victim stops breathing. Death occurs within minutes if CPR, or a defibrillator, aren’t used.
“It sounds to me like what you’re asking about is an SCA-a sudden cardiac arrest, when the heart just suddenly and unexpectedly stops beating.”
“Yes,” I said.
“Well, the heart has an electrical system of its own. It’s not like other muscles in the body that rely on nerve connections to get the electrical stimulation they need to function. The heart has its own battery, it’s called the sinus node and it’s in the upper right chamber of your heart. This is what controls the rate and rhythm of its heartbeat. If something goes wrong with the node or with the flow of electric impulses through your heart, you get an arrhythmia, which is when the heart starts beating too fast or too slowly or not at all. In the worst of these cases, your heart comes to a sudden stop-sudden cardiac arrest.”
I asked, “So is there something that can disrupt these electric signals-something someone could be given without knowing it, in one shot, one dose, not over time? Someone who’s in good health, who doesn’t have any kind of underlying heart disease?”
“Well, arrhythmias that cause cardiac arrests don’t just happen on their own, but they can happen to people who don’t have any pre-existing conditions.”
“How?”
“Stress. Strenuous exercise-you’ve read about young athletes who suddenly collapse in the middle of a game. An electric shock.”
I shook my head. “No. I’m talking about something like a drug, a pill-an injection, maybe. Some kind of toxin. One shot.”
Alami shrugged. “Well, an overdose of cocaine will do it. Or a bad reaction to any number of illegal drugs. You could also have a drug-to-drug interaction that could lead to a fatal arrhythmia. It could be a number of things.”
I shook my head again. “It needs to be something that won’t show up in an autopsy.”
Alami’s expression shifted. I felt like he was suddenly a bit wary, even suspicious, of me.
I raised my hands defensively. “Doc, please. I’m only asking because I’m trying to understand if it’s possible. ’Cause if it is, there could be a whole raft of murders that have gone unnoticed. And the people behind them need to be stopped before they can use it again.”
He studied me for a moment, his expression clouded. “Well, if someone has come up with something like this… I can’t imagine.” He thought some more. “Undetectable in an autopsy? That rules out a lot of compounds.”
“But do you think it’s possible?”
“I come from a school of thought that believes everything is possible. Whether or not we’ve discovered it yet, that’s the question.”
“Where would you look?”
He thought about it for a few seconds. “There are compounds that could trigger a bad reaction that might not be detected in an autopsy because we already have them. It’s just a question of how much is there, I suppose. Something based around calcium gluconate, maybe. At a much higher concentration than normally found in the body, it’s conceivable that it might create an electrolytic imbalance. Or potassium chloride. It’s in a lot of prescription drugs, and both potassium and chloride are present in the body. A spike of potassium could trigger ventricular fibrillation, which could lead to cardiac arrest, like they sometimes use in state executions. But again, the difficulty is in figuring out what the right dose is, being able to concentrate it into a small enough dose so it passes unnoticed when you’re administering it, I suppose… and figuring out how to not have it break down and get absorbed into the body quickly so it doesn’t show up in an autopsy. We’re talking about much, much higher concentrations than you’d normally find.”
“But if no autopsy were performed there wouldn’t be any obvious external signs anyway, right? It would just look like a cardiac arrest.”
“Yes.” He had a worried look on his face, like it had sunk in. “You really think someone’s doing this?”
“More so than before I walked in here.”
He went pensive for a moment, then said, “Is there a recent victim? Someone you suspect this might have been do to?”
“Yes.”
“And is an autopsy being done?”
“Yes.”
“Can you get me in to see the body?”
“You’re not a coroner. I don’t know.”
“Get me in. Let me have a look and run some tests of my own. The best way to figure out how it’s being done-if it’s being done-is by examining the body.”
It made sense. Of course, I couldn’t arrange it, not in my current persona non grata status. But I couldn’t tell him that. Not yet, anyway. “OK. I’ll see what I can do. In the meantime, will you think about it some more and let me know if you come up with anything?”