Michael Palmer - Fatal

"Noooo!" Matt heard himself scream. "No more!"

Mortally injured, the beast toppled over, roaring at its killers, flailing out with its front claws, ripping at Matt's arm again and again. It was then he sensed he had awakened. His eyes opened a slit. The clawing against his arm persisted. Then he became aware that it was nothing more malevolent than a hand, scratching at his elbow. He was in a chair in a glass-enclosed cubicle in the ICU — Dr. Nikki Solari's cubicle, he realized. Slumped to one side, he had been asleep, his head resting half on his shoulder, half on the bed. The touch that had awakened him from his bizarre nightmare was Solari's. Through the glass, Julie Bellet, one of the night nurses, waved to him, smiling. The wall clock behind her read five-thirty.

Matt's thoughts quickly cleared. The stiffness in his neck suggested he had not moved for some time. His patient, arms restrained with leather straps, was silently imploring him through the gloom. Her eyes were wide with fear and confusion. The polystyrene tube he had slid between her vocal cords was still in place. The bedside ventilator attached to it whirred and hissed as it forced air into her lungs with every breath. Julie Bellet stepped into the room.

"Hi, there," she said. "You've been out for almost three hours. But you looked so peaceful that none of us had the heart to wake you up."

"I… um… was a little tired," he managed. "I guess it's time to ditch the decaf and go back to super."

He grinned sheepishly and turned back to Solari. He knew from the accounts of many who had woken up on a ventilator that having a half-inch tube down the back of their throat and into their trachea was as unpleasant and frightening a sensation as any they had ever experienced, especially with their hands lashed down as well. He switched on the overhead fluorescents.

"Dr. Solari, sorry about falling asleep like that. It's been a tough couple of days. I'm Matt Rutledge, your doctor. Do you understand?" Nikki nodded, her eyes still fixed on his face. "Good," he said. "You're in Montgomery County Regional Hospital in Belinda, West Virginia. The tube is in because you nearly drowned in a lake yesterday. You've been unconscious for more than twelve hours."

Nikki, ignoring the throbbing in her temples, moved her hand as far as the restraint allowed, and pointed desperately back at her face.

The tube. Get it out! Please, get it out. It's choking me!

Nikki prayed her doctor understood.

Matt Rutledge was probably a few years older than she was, with a kind, rugged face. His dark hair was pulled back into a ponytail that came down just over the collar of his shirt.

"I know you want that tube out this instant," he said. "I know it's awful. But please, please try your best to relax and breathe easily. Do you think you need some medicine to help you do that?… Good. Give me a signal if you change your mind about that. The vent's on assist, so all you have to do is breathe. I promise I'll get the tube out as soon as I can. First, I need to get a film and check your blood gases. If I loosen the straps on your wrists, do you promise you'll keep them away from the tube?"

Nikki nodded. The nurse who was in the doorway came over, introduced herself, and undid the restraints.

"Nikki," she said, "the balloon on your tube is still blown up. Please don't try and pull it out. It can damage your vocal cords if you do. Okay?"

Nikki forced herself to nod. The tube felt like a garden hose in her throat. Intellectually, she knew what it was and what it was doing for her, but at some uncontrollable, primal level, she was positive she was choking. She closed her eyes as her doctor listened to her heart and lungs, examined her belly, and checked the pulses in her arms and feet. Then he had her open her eyes and checked them with an ophthalmoscope. His manner was reassuring and his touch gentle. From what she could tell, he seemed to know what he was doing. She settled back into her pillow and forced herself to breathe more slowly. Piece by piece the events on the highway and in the woods floated into place.

Why"? The question burned in her thoughts. Why'?

"Things sound good," Matt said. "I'm going to write some orders and splash some water on my face. Then I'll be back."

After he had gone, the nurse, Julie, straightened the sheets and wiped off Nikki's face and hands.

"You're going to be fine," she said. "Dr. Rutledge may not look like a med school professor, but trust me, he's a really great doctor — the best in this hospital. I understand you're from Boston. Well, he grew up here, but he trained at Harvard. He actually rode out to the lake with the ambulance and put that tube in you out there."

Nikki nodded that she understood and made a weak thumbs-up sign.

Doctor. Just before the fat guy in the business suit had attacked her, he had called her "Doc." Who could have told him that? The two men weren't out to rob her or even to rape her. They were going to kill her.

Why?

Matt returned to Nikki Solari's bedside after washing, shaving, and gathering the things he had appropriated for Lewis Slocumb. The hours of sleep had served him well and, at least for the moment, he felt sharp and focused. Yesterday he had planned to return to the Slocumbs' farm to replace the jury-rigged chest tube after just a few hours of work in the hospital. Now nearly a full day had gone by. Well, he reminded himself, he could only do what he could do and hope that Frank Slocumb had the sense to drag his brother into the hospital if he was in trouble.

Solari looked alert and a bit more animated. Her X ray had showed no pneumonia and her blood gases were excellent. It was time to keep his promise and remove the tube. Hopefully, then, the questions surrounding the events at Crystal Lake would be answered. One mystery that had already been answered was the bizarre dream in which Matt had been immersed. On the top of Solari's left foot was a tattoo, orange and black, of a Gila monster. Matt had noticed it during his initial exam, but was far too engrossed in trying to save her life to give it much thought.

The woman with the elegant, long-fingered hands, who he'd guessed might be a potter, had turned out to be a coroner. And the coroner, who played bluegrass music, had an orange and black Gila monster tattooed on her foot. As popular as tattoos had become in the general public, they were still not that common among middle-of-the-road med students and doctors. Was she offbeat enough to be into drugs in some way? he wondered. Maybe dealing? Is that why she was being chased through the woods near Niles Ledge?

Matt considered the possibility as he prepared to remove the breathing tube from her throat. He also pictured his own tattoo — injected into his arm as a constant, permanent reminder of love and loss. No, he decided, glancing up at Nikki Solari's expressive eyes, whatever the significance of the odd tattoo, it had nothing to do with drugs.

The technique for removing the endotracheal tube was as straightforward as the potential complications of the procedure were life-threatening. Suction out the trachea, deflate the balloon, have the patient attempt to cough, and pull out the tube. Simple. Lurking in the shadows, however, was the specter of a reactive spasm of the larynx severe enough to shut off the airway, and tight enough to make reinsertion of a breathing tube near impossible.

Matt had never actually performed an emergency tracheotomy, but he had the equipment to do so near at hand. At that moment, there was nothing in the world he wanted to do less.

"Dr. Solari, we're all set," he said.

Nikki nodded and gave him a weak A-okay. The woman was tough, he was thinking. Whatever else she was, she was tough.

"Good," he said. "I know this next part isn't pleasant, but we've got to do it. Suction, please, Julie."