Robin Cook - Critical

Adam turned left on 61 st Street, and halfway down the block pulled over to the Pierre's entrance marquee. The doorman tipped his hat and opened the Range Rover's door. "Checking in, sir?"

Adam merely nodded as he climbed out of the car. Following the doorman to the car's rear, Adam insisted on taking the tennis bag, which contained the tools of his trade, the moment the doorman opened the hatchback. The small overnight bag he allowed to be carried for him.

"Will you be needing your vehicle this evening?" the doorman asked as he held open the hotel's door.

Adam nodded again.

"Fine, I'll keep it right here at the door," the doorman said as he gestured toward the registration desk.

Directions weren't necessary for Adam, as the lobby had barely changed over the twenty or so years he had intermittently stayed at the hotel. Pausing at the flower-bedecked center table in the middle of the carpet, Adam let his eyes take in the familiar surroundings, including the raised sitting area to the right and mostly nineteenth-century English furniture. As he'd expected, he didn't feel anything. The scene evoked no emotion whatsoever. It was like his memories were of someone else's life.

The check-in was dispatched with commendable speed, after which the receptionist called for a porter, saying, "Hector, this is Mr. Bramford from Connecticut. Would you show him to his room? By the way, Mr. Bramford, we've given you a very nice park view."

Bramford was one of the several identities Adam carried on this particular mission, along with all the associated documentation. His handlers in Washington ran a discreet risk-management/security firm with branches in major cities around the world, and Adam worked for them for special operations as an independent contractor. The clients for the current mission, all former lawyers and politicians, had contacts in the highest levels of government, so obtaining the identities had been relatively simple.

"This way, Mr. Bramford," Hector said, pointing toward the elevators.

The interior of the elevator was unique in regard to its French style, and Adam remembered it the moment he stepped in. Its frivolousness as well as its cleanliness stood in such sharp juxtaposition to his war experience that he marveled it could exist on the same planet as Iraq. And as he rose up in the fussy decor, the sheer contrast of the total situation made him think back to his release from captivity. At that time, he'd been picked up in the scrubby, battle-scarred desert dressed only in a soiled pair of boxer shorts and limping on a deformed leg.

Within hours, he'd been airlifted to Germany where his leg was rebroken and reset, and he began treatment for what was called a post-traumatic stress disorder variant. Under the psychiatrist's guidance, Adam made considerable strides in dealing with his anxiety, his inability to concentrate, his joylessness, and his difficulty sleeping. He had had less success with generating any interest whatsoever in returning to any semblance of his former life, which included resurrecting his relationships with his family, his family's business, his fiancee, or Harvard Business School. He also had had no success in adjusting to the loss of the camaraderie of his Delta Force colleagues and the unique and addictive risk of making a kill.

Adam's psychiatrist had become frustrated by what she considered Adam's lack of progress, until she suggested a new strategy: namely, for Adam to embrace what he'd been morphed into from his military experience rather than attempting to suppress or ignore it. It was even she, as an Alexandria, Virginia, resident, who had introduced Adam to the founder and CEO of Risk Control and Security Solutions, which was extremely receptive to the combination of his Special Forces training and his experience of having been a POW. To protect his identity, they worked out an employment relationship, which didn't show up on their books. In return, they paid him extremely well.

The Pierre elevator reached the correct floor. Hector allowed Adam to disembark first, then pushed ahead to open the door to Adam's room. He gave Adam a rapid tour of the room, including how to navigate the hotel's simple entertainment systems and the location of the minibar. Then he backed out of the room, obsequiously clutching Adam's tip.

For a few minutes, Adam stood in front of the window that gave out onto Central Park. The most apparent object was the skating rink, brightly illuminated in the center of the park's mostly dark expanse. He then turned back into the room. He took his tennis bag from his shoulder and unzipped it. Inside was a selection of favorite firearms, carefully wrapped in towels and tape. He took each out, unwrapped them, and checked to make sure they were all in the same working order as they had been when he had packed them. When he was satisfied that his arsenal was unscathed by the drive, he pulled out a single sheet of paper from an inner zipped pocket. On it was the target's name, a brief and probably useless description, and the rather odd address of the Office of the Chief Medical Examiner of the City of New York.

It doesn't look good," Dr. Tom Flanagan said. "It doesn't look good at all."

Dr. Tom Flanagan was one of eight intensivists employed by University Hospital at great cost to supervise care in the intensive-care unit, or ICU. He was either there at the unit or on call 24/7. He was speaking to Dr. Marlene Ravelo, who was board-certified in internal medicine and infectious disease and who ran the University Hospital department of infectious disease.

"Unfortunately, I agree," Dr. Ravelo said.

They were standing at the foot of Ramona Torres's bed in a special isolation cubicle off the main ICU room.

On the right side of the bed was Dr. Raymond Grady, a pulmonologist. He was busy adjusting her positive-pressure ventilating machine in an attempt to give adequate volume. It was becoming difficult. He glanced at the readout for the central venous pressure and the other one for the pulmonary wedge pressure. "We're not ventilating her very well," he called across the bed to Dr. Phyllis Bohrman, the cardiologist consult they'd called. She was watching the ECG on another monitor. Next to her was the chief resident in medicine, Marvin Poole.

"It's pretty clear why" Dr. Bohrman said. "Look at that last chest X-ray. The lungs are full of fluid."

"Let's look on the bright side," Dr. Flanagan said. "We're getting a lot more practice handling sepsis with septic shock than usual with these Angels Healthcare patients."

"That's true," Dr. Ravelo agreed. "But it would be nice to save one of them now and then."

"We can't be faulted. Having had a liposuction, this individual's surgical site infection covered a significant percentage of her body's surface area."

"Let's not forget what I believe is necrotizing pneumonia," Dr. Ravelo said.

"Do you think the pneumonia is a result of seeding by her surgical-site infection, or do you think it is primary – I mean, isn't primary staph pneumonia rather rare?"

"It is, but the time interval seems strange. Weren't we told the pulmonary symptoms preceded the symptoms of cellulitis?"

"That was what was on the record."

"It's very strange, especially considering last night's case was so similar, although the surgical-site infection was so much smaller."

"Okay, guys and girls," Dr. Flanagan called out. "Pulmonary function is heading south to Antarctica, cardiac function is going in the same direction so that the blood pressure is in the basement. There's no longer any urinary output, so that tells us what's happening in the kidneys, and the liver is not doing what it should be doing. Thank you all for your hard work, but we've clearly lost the battle."