Peter Clement - Mortal Remains

New York City Hospital

“My potassium’s 2.1?” Earl felt a ripple of fear. At anything below 3.0, heart muscle became so twitchy the slightest stimulation could throw it into various sorts of fibrillation. Just like what happened to Bessie McDonald. Except hers had been limited to the upper chambers. His entire myocardium could end up squirming like a useless sack of worms, in other words, complete cardiac arrest. He broke out in a cold sweat that had nothing to do with his gut.

Instinctively he didn’t want to move. Any exertion at all could tip him over the edge. Already he could feel his pulse start to pound, the effect he’d expect from all the adrenaline that must be surging through his blood. Christ, slow the rate down, he thought, trying to calm himself, but that only made it tick up higher. His intestines kicked in with a snarl, and hinted at sending another wave of cramps his way. “Oh, great,” he muttered, pain being another surefire way to get his heart racing. “Tanya, I need IV potassium fast, maximal dose, sixty milliequivalents in a liter, run it in at ten to twenty milliequivalents an hour.” The rate had to be exact. Too much too fast could also stop a heart cold.

She grabbed two more vials of potassium from the medication bin, having already added one to the new bag of normal saline that she’d brought with her.

“And I’ll need to be on a cardiac monitor, plus you better give me a hundred milligrams of Demerol after all, to at least take the edge off the spasms-”

“Whoa, I’m not even supposed to be here, remember?” She shook up the intravenous solution to mix in the added vials. “What I suggest,” she added, her fingers flying as she got the new bag up and running, “is request the Demerol yourself as already ordered, and complain of palpitations or something so they put you on a monitor while they sort it all out. That ought to just about cover your needs for the moment. Just before shift change in the morning I’ll phone the result to the floor clerk here, pretending I’m a lab tech reporting an error. She’ll tell the nurses, and they’ll order a repeat themselves. That way you’ll know if more potassium’s required.”

He felt sheepish about his previous suspicions of her. “You’re a wonder, Tanya Wozcek. I don’t know how to thank you.”

Her weak smile couldn’t hide the worry in her eyes as she fine-tuned the intravenous rate. She knew as well as he did it would be very touch and go. “Does that burn?” she asked.

The concentrated solution she’d prepared could strip the lining of a vein, sclerosing it. It already felt like fire going up his arm. “I’ll live,” he muttered.

She slowed the rate by two-thirds.

What he wanted to know was how his potassium could have been brought so low so fast. The runs? Not this quickly. Something else had to be depleting it. But what?

He glanced toward the IV bag Tanya had discarded. “Did your friend run any other tests on me?”

“Sure. Your white count’s up, which is to be expected with the infection, but everything else was fine, except for a high CO 2which probably doesn’t matter.” She anchored the tubing to his skin with tape.

CO 2was an indicator of his naturally occurring bicarbonate level, the base that balances all naturally occurring acids circulating in the body. It also existed as a pharmaceutical preparation. Though rarely used anymore, it was part of the emergency protocol for dropping critically high serum potassium levels, and large vials of it were common in hospitals. The solution itself looked clear as water, and if someone did do a blood test checking the bicarb level, it would normally be to make sure the reading wasn’t too low. Nobody would make too much out of an unexplained elevation, just as Tanya hadn’t. In other words, it would be a perfect agent to mess up a patient’s potassium without raising suspicions, and anyone could have slipped a dose into his IV while he’d been sleeping. It also had another nasty little property, he remembered, a chill slowly creeping up his spine. It could precipitate digoxin toxicity in patients who were already on the medication. “Tanya, quick, please grab a urine dipstick and hand me the IV bag you just replaced.”

She frowned, but did as he asked.

He released a few drops of the remaining fluid on the test strip.

The portion measuring acid-base should have remained a neutral beige. Instead it turned blue as a sapphire, indicating extreme alkalinity.

Bingo!

A sickening cold sensation filled his chest.

“Who else would know how to play with potassium like that but a doctor?” she said, once Earl told her what had been done to him. “Chaz still has my vote, or someone he ordered to do it. Christ, forget our other plan. We’ve got to get you out of here. If they can get to your IV bottles without you knowing-”

“Not just yet.”

“Are you nuts?”

“I’ll be okay for tonight,” he bluffed. “Whoever did this doesn’t know we’re onto them or that you’ve changed my IVs.”

“But what about telling the nurses, so you get the monitor, and the Demerol?”

“I’ll still ask for the Demerol, and make up enough of a story about fluttering in my chest they’ll wire me to something.”

“Then who’ll replace your intravenous with extra potassium when it’s empty? I can’t keep sneaking in here to do that.”

“This bag is good until morning. By then Melanie will be here, and she’ll handle everything. You forget, I start walking around now, my heart’s primed to break into a jitterbug.”

Scowling, she planted her hands on her hips. “I can arrange a wheelchair. A stretcher even.”

“And where would you put me? I need to be in a hospital. The worst of this damn infection is yet to come.”

“And you could have yourself transferred, by air ambulance if necessary, back to Buffalo, where you’d be a lot safer than you are here. So quit the bullshit and tell me the real reason you refuse to leave. Are you using yourself as bait?”

Damn right, he thought, more determined than ever to carry out his plan now that he knew what to expect. Logically, the person who’d gotten to his IV before would want to pull a repeat performance, but only after the next scheduled change of the intravenous bag. Since the old one would have run out around 5:00 A.M., that’s when Earl expected his would-be killer to come sneaking around. “Of course not,” he answered, giving Tanya his most sincere smile, until a new wave of cramps twisted him in two and sent his pulse into triple digits again.

“You are nuts!” Her voice slid a notch higher, sounding frightened.

No fooling her. Worse, he sensed she was going to blow the whistle on him. “Tanya, now don’t you tell anyone, hear me? I’ll be all right. Whoever added the bicarb probably won’t try to slip me another dose until after I’m due to get a new IV bag in the morning. And I’ll be ready to raise holy hell the second anyone comes near me. If I haven’t got a nibble by tomorrow, I promise you, I’m out of here.”

She stared at him with that odd moonlike face of hers, looking skeptical as hell.

It took some arguing, but he finally convinced her that if she made a fuss now about extra security or tried to keep watch over him herself, it would alert his attacker and only postpone another attempt on his life. She reluctantly agreed not to interfere.

“But it’s guards, an air ambulance, and home to your hospital in Buffalo if this nonsense doesn’t work,” she insisted.

“Agreed.”

Shaking her head, she turned and left.

He pressed the call button and waited for the nurses, trying to keep a grip on his nerve and ratchet down the drubbing that his heart-turned-boxing-glove continued to deliver against the inside of his chest.