Robin Cook - Toxin

Jason went back to the massage while he eyed the monitor. There was no change in its relentless tracking straight across the screen.

"Bring the paddles!" Jason yelled. "Let's see if we can get some electrical activity going with a shock. If that doesn't work, we're going to have to pace her, so be prepared."

The experienced nurses had already charged the defibrillator. They handed the paddles forward. Jason stopped his massage to take them.

"Everybody back!" he yelled while he positioned them. When everyone was clear, and the paddles where he wanted them, he pressed the discharge button.

Becky's pale body jerked and her white arms flailed. Everyone's eyes went to the monitor, hoping to see some change. But the cursor was not cooperating. It persisted in its straight, flat line.

Kim pushed forward. He didn't like the way Jason was doing the massage. "You're not getting enough excursion," he said. "Let me take over."

"No." Claire said, coming up behind Kim and pulling him back. "Dr. Reggis, it's not appropriate. We'll handle this. I think you should wait outside."

Kim shook off the pediatrician. His pupils were dilated and his face flushed. He was not going anywhere.

Jason responded to Kim's complaint. As a man of small stature, it was hard for him to develop much force in a standing position. To make it easier for himself, he climbed up onto the bed and assumed a kneeling position. Now he got better chest compression. It was so much better that everyone present could hear several of Becky's ribs snap.

"More epinephrine!" Kim barked.

"No!" Jason managed between pants. "I want calcium!"

"Epinephrine," Kim repeated. His eyes were glued to the monitor cursor. When no syringe was forthcoming, he turned to look at the crash cart. "Where's the epi?" he demanded.

"Calcium!" Jason repeated. "We've got to see some electrical activity. There's got to be an ion imbalance."

"Calcium's coming up," Claire said.

"No!" Kim yelled. He pushed through the group to stand in front of the crash cart. He glared at the nurse.

The nurse looked from Kim's florid face to Claire's. The nurse was confused as to what she should do.

Unaccustomed to being overruled, Kim snapped up a syringe packet and tore it open. Then he grabbed a vial of epinephrine and broke off its top. His trembling fingers dropped the needle. He had to get another.

"Dr. Reggis, no!" Claire said. She grabbed Kim's arm. Walter Ohanesian, the hematologist, tried to help by grabbing Kim's other arm.

Kim easily shook off both of these doctors and filled the syringe unimpeded. Pandemonium ensued as he tried to push his way back to the bedside. Both Kathleen and Arthur, the nephrologist, came to Claire and Walter's aid. The scene devolved to a shoving match with shouts and threats.

"Oh, God!" Tracy moaned. "What a nightmare."

"Hold it, everybody!" Jane shouted at the top of her lungs to get everyone's attention. The struggle stopped. Then Jane added with urgency but in a more normal volume: "There's something very strange happening. Jason's getting good chest excursion, and I'm up to a hundred-percent oxygen, and yet her pupils are dilating! For some reason, there's no circulation."

Kim shook off the hands that were impeding him. No one moved or spoke except for Jason who kept up with the massage. The doctors were stymied. They were at a temporary loss as to what to do next.

Kim was the first to respond. His training as a surgeon would not allow him to deliberate a moment longer. He knew what he had to do. With no circulation despite good chest excursion, there was only one alternative. He spun around to face the nurses at the crash cart. "Scalpel!" he barked.

"Oh, no!" Claire shouted.

"Scalpel!" Kim repeated more insistently.

"You can't," Claire yelled.

"Scalpel!" Kim screamed. Tossing the syringe of epinephrine aside, he lunged past the others in the direction of the crash cart.

Kim snatched the glass tube containing the scalpel. He unscrewed the top with trembling fingers and extracted the sterile instrument. He tossed the glass tube aside; it shattered on the tile floor. He picked up an alcohol swab and tore open its package with his teeth.

At this point, only Claire was willing to attempt to bar his way. But her efforts were in vain. He pushed her aside with a gentle but firm shove.

"No!" Tracy cried. She wasn't a physician, but her intuition told her what Kim was going to do. She started forward, and Marsha let her go.

Kim reached the bedside and literally knocked Jason off the bed. He swabbed Becky's chest with alcohol. Then, before Tracy could quite get to him, he sliced open his daughter's thorax in one decisive, bloodless sweep.

A collective gasp rose from everyone present except for Tracy. Her response was more of a wail. She staggered back from the appalling scene and would have collapsed if she hadn't been caught by the nephrologist, Arthur.

On the other side of the bed, Jason struggled to his feet. When he saw what was happening he, too, shrank back.

Kim lost no time. Oblivious to the others in the tiny room, the consummate surgeon used both hands to pull Becky's slender ribs apart with a decisive crack. Then he shoved his bare hand into his daughter's open chest and began rhythmically to compress her heart.

Kim's Herculean effort was short-lived. After only a few compressions, he could feel that Becky's heart had perforated and was far from normal in texture. It was as if it weren't muscle but rather something much softer which seemed to squish between his fingers. Stunned by this unexpected situation, he withdrew his hand. In the process he also pulled out some of the foreign-feeling tissue. Confused as to what it could be. he brought the bloody material up to his face to inspect it.

A shrill, agonizing whine escaped from Kim's lips when he realized he was holding necrotic shreds of Becky's heart and pericardium. The toxin had been merciless. It was as if his daughter had been eaten from within.

The door to the ICU burst open. Two uniformed hospital security personnel spilled into the room. They had been called by the head nurse after the scuffle over the epinephrine.

As soon as the two men took in the scene, they stopped in their tracks. Becky was still being respired by the ventilator; her pink lungs intermittently filled the gaping incision. Kim stood by her, his hands bloodied, his eyes wild with grief. He tried to gently return the necrotic tissue to Becky's chest cavity. When he was finished with this futile gesture, he put his head back and let out a wail of anguish unlike anything ever heard in the ICU before.

Tracy had recovered enough to step forward. Kim's anguished cry cut her to the quick. She wanted to comfort him and be comforted herself.

But Kim was blind to everyone and anything. He shoved his way out of the cubicle and dashed across the ICU. Before anyone could respond, he was through the door.

In the corridor. Kim went into headlong flight. People who saw him coming got out of the way. One orderly didn't move quickly enough; Kim slammed into him, sending the man and his water cart flying.

Outside of the hospital, Kim ran to his car. Gunning the engine, he shot out of the doctors' lot, leaving a line of rubber in his wake.

Kim drove like a madman out to Prairie Highway. Lucky for him, he encountered no police cruisers. When he turned into the Onion Ring parking lot he was going fast enough to bottom out just as he had on his previous visit. The car bounced violently until he brought it to a screeching stop directly in front of the busy restaurant. Yanking on the emergency brake, he made the motions to get out. Then he hesitated. A glimmer of rationality seeped into the corners of his emotionally overloaded brain. The Saturday afternoon crowd enjoying their burgers, milkshakes, and fries and oblivious to his psychic pain yanked him back to reality.