Robin Cook - Marker

With hesitation, Laurie slowly got to her feet. It had been the sudden motion of half standing a few minutes earlier that had brought on the current episode, and she was eager to avoid a repeat. Luckily, there was no reoccurrence. Her perspiration was another matter. That had actually gotten worse.

Cautiously, Laurie took a few steps out of her office and into the hallway while continuing to support herself with her hand against the wall. The pain remained bearable. With gathering confidence, she walked slowly down the length of the corridor to the ladies' room. Inside, she got some toilet tissue and wiped herself. The spotting had reappeared, and there was more blood than there had been earlier. She knew she didn't have appendicitis.

With gathering anxiety, Laurie retraced her steps back to her office and returned to her chair. She eyed the phone. She was still hesitant to call Dr. Riley, though now she felt she had little choice. The spotting ruled out appendicitis, and along with the location of the pain, suggested a possible ectopic pregnancy, which was far more serious than a mere threatened miscarriage. Finally, she reluctantly picked up the phone and called Laura Riley's office number. When the operator answered, Laurie gave her name and direct-dial number. Thinking it might expedite the callback, she included her M.D. title and said she needed to talk with the doctor. She said it was an emergency.

As Laurie put the receiver back down, she noticed a new sensation: vague shoulder discomfort. It was so mild that she wondered if she was imagining it, yet it added to her already considerable anxiety. If it was real, it suggested the ominous development of peritoneal irritation. To test the possibility, Laurie carefully pushed in on her abdomen with her index finger, then suddenly took her hand away. She grimaced with a fleeting stab of pain. What she had felt was called "rebound tenderness," and it also suggested peritoneal irritation, which now made her worry that not only might she have an ectopic pregnancy, but that it might have already ruptured. If so, it was a true medical emergency for which time could be a critical factor. She could be hemorrhaging internally.

The phone's harsh ring interrupted her obsessing, and she snapped the receiver up to her ear. She was relieved when Dr. Riley identified herself. Laurie could tell she was on a cell phone and in a public place. Loud conversation could be heard in the background.

Laurie began by apologizing for calling on a Saturday night and said that she had resisted because she worried it was a bad way to start out a professional relationship, but she believed she truly had no choice. Laurie went on to describe her symptoms in detail, including the rebound tenderness. She admitted she'd had discomfort prior to speaking with her on the phone the previous day, but had forgotten to mention it and had thought it could wait until her scheduled visit the following Friday.

"First of all," Laura said when Laurie had finished, "there's no need to apologize. In fact, I would have preferred you call sooner. I don't want to alarm you, but it we should consider an ectopic pregnancy until we can rule it out. You might be bleeding internally."

"I thought as much," Laurie admitted.

"Are you still diaphoretic?"

Laurie felt her brow. It was damp with perspiration. "I'm afraid so."

"What's your pulse, approximately? Is it fast or normal?"

Using her shoulder to hold the phone, Laurie felt her pulse at her wrist. She knew it had been fast earlier, and she wanted to be certain it had remained so. "It's definitely on the fast side," she admitted. She had hoped the sweating and the rapid heartbeat had been due to her anxiety, but Laura's questions had made her acknowledge that there could be another explanation: She could be going into shock.

"Okay," Laura said in a controlled, businesslike voice. "I want to see you in the emergency room at the Manhattan General Hospital."

Laurie felt a shiver descend her spine at the thought of being a patient at the General. "Could we pick another hospital?" she questioned.

"I'm afraid not," Laura said. "It's the only hospital where I have privileges. Besides, they are fully equipped if we have to be aggressive. Where are you at the moment?"

"I'm in my office at the Office of the Chief Medical Examiner."

"On First Avenue and Thirtieth Street?"

"Yes."

"And where is your office in the building?"

"It's on the fifth floor. Why do you ask?"

"I'm going to send an ambulance."

Good God! Laurie thought. She didn't want to ride in an ambulance. "I can take a taxi," she suggested.

"You are not going to take a taxi," Laura stated unequivocally. "One of the first rules about being a patient in an emergency medical situation, a rule which is particularly hard for doctors to accept, is that you must follow orders. We can argue about the necessity later, but right now we are not taking any chances. I'm going to send an ambulance ASAP, and I will meet you in the ER. Do you know your blood type?"

"O positive," Laurie said.

"See you in the emergency room," Laura said and disconnected.

With a shaking hand, Laurie hung up the phone. She felt shell-shocked. Upheavals were becoming the norm. In a single day she'd been forced to identify a friend's corpse and now face the terrifying prospect of a medical emergency and possibly surgery at a hospital where a suspected serial killer was killing patients like her. The only consolation was that the most likely suspect was in custody.

Laurie snatched up the phone. She'd been reluctant to call Jack for a variety of reasons, but with this new development, her hand was forced. She needed his support, she needed him as an ombudsman or guardian in the hospital if she did end up having emergency surgery.

The phone rang once, then twice. "Come on, Jack!" Laurie urged. "Answer it!" The phone rang again, and Laurie knew he wasn't there. As she suspected, after the next ring, his answering machine picked up. As Laurie waited to leave a message, she felt a wave of resentment wash over her. It seemed uncanny how Jack managed to irritate her in so many different ways. Undoubtedly, he was out on his neighborhood basketball court, pretending he was a teenager. Laurie knew she was being unreasonable, but she couldn't help it. She was actually angry that he wasn't there. Although she knew it was an unfair comparison, she couldn't help but think that had Roger not been killed, he would have been available.

"A major problem has come up," Laurie said when it was time for her to speak. "I need your help again. At the moment, I am waiting for an ambulance to take me to the Manhattan General. Dr. Riley thinks I might have a ruptured ectopic pregnancy. On the plus side, it will mean that the pressure will be off you, but on the negative side, I'll be facing emergency surgery. I need you to be there. I don't want to become part of my own series. Please cornel"

After pressing the disconnect button, Laurie dialed Jack's cell phone. She went through the same process, leaving a similar message in hopes he'd get one or the other. Then she pushed away from the desk with the idea of getting her coat before heading down to the basement level, where she expected the ambulance to arrive. As she stood up, she kept her hand pressed against her lower abdomen, hoping to avoid another severe cramp. Instead, she heard ringing in her ears and felt a wave of dizziness.

The next thing Laurie was aware of was voices, particularly the voice of a man seemingly talking on the telephone. He was saying something about the blood pressure being low but steady, the pulse at one hundred, and the abdomen being slightly tense. Laurie realized her eyes were shut, and she opened them. She was on the floor of her office, facing up at the ceiling. A female EMT was busily taping an IV line against her left arm. A male EMT was standing to the side while speaking on his cell phone. Behind him, she recognized Mike Laster. Alongside Laurie was a collapsed gurney with an IV pole.