Робин Кук - Mortal Fear

Then, less than a week after his physical, Cedric felt as if he were coming down with the flu. But that had been only the beginning. His digestive system began acting up, and he suffered terrible arthritis. Even his eyesight seemed to deteriorate. He remembered telling his wife it was as though he had aged thirty years. He had all the symptoms his father had endured during his final months in the nursing home. Sometimes when he caught an unexpected glimpse of his reflection, it was as if he were staring at the old man’s ghost.

Despite the morphine, Cedric felt a sudden stab of white-hot, crushing pain. He felt himself receding into a tunnel as he had in the car. He could still see Dr. Howard, but the doctor was far away, and his voice was fading. Then the tunnel started to fill with water. Cedric choked and tried to swim to the surface. His arms frantically grappled the air.

Later, Cedric regained consciousness for a few moments of agony. As he struggled back to awareness, he felt intermittent pressure on his chest, and something in his throat. Someone was kneeling beside him, crushing his chest with his hands. Cedric started to cry out when there was an explosion in his chest and darkness descended like a lead blanket.

Death had always been Dr. Jason Howard’s enemy. As a resident at Massachusetts General, he’d carried that belief to the extreme, never giving up on a cardiac arrest until a superior ordered him to stop.

Now he refused to believe that the fifty-six-year-old man whom he’d examined only three weeks earlier and had declared generally healthy was about to die. It was a personal affront.

Glancing up at the monitor, which still showed normal EKG activity, Jason touched Cedric’s neck. He could feel no pulse. “Let me have a cardiac needle,” he demanded. “And someone get a blood pressure.” A large cardiac needle was thrust into his hand as he palpated Cedric’s chest to locate the ridge on the sternum.

“No blood pressure,” reported Philip Barnes, an anesthesiologist who had responded to the code call that automatically went out when Cedric arrested. He’d placed an endotracheal tube into Cedric’s trachea and was ventilating him with oxygen by compressing the Ambu bag.

To Jason, the diagnosis was obvious: cardiac rupture. With the EKG still being recorded, yet no pumping action of the heart, a situation of electromechanical dissociation prevailed. It could mean only one thing. The portion of Cedric’s heart that had been deprived of its blood supply had split open like a squashed grape. To prove this horrendous diagnosis, Jason plunged the cardiac needle into Cedric’s chest, piercing the heart’s pericardial covering. When he drew back on the plunger, the syringe filled with blood. There was no doubt. Cedric’s heart had burst open inside his chest.

“Let’s get him to surgery,” Jason shouted, grabbing the end of the bed. Philip rolled his eyes at Judith Reinhart, the coronary care head nurse. They both knew it was futile. At best they might get Cedric on the heart-lung machine, but what then?

Philip stopped ventilating the patient. But instead of helping to push the bed, he walked over to Jason and gently put an arm on his shoulder, restraining him. “It’s got to be cardiac rupture. You know it. I know it. We’ve lost this one, Jason.”

Jason made a motion to protest, but Philip tightened his hold. Jason glanced at Cedric’s ivory-colored face. He knew Philip was right. As much as he hated to admit it, the patient was lost.

“You’re right,” he said, and reluctantly let Philip and-Judith lead him from the unit, leaving the other nurses to prepare the body.

As they walked over to the central desk, Jason admitted that Cedric was the third patient to die just weeks after having a clean physical. The first had been another heart attack, the other a massive stroke. “Maybe I should think about changing professions,” Jason said half seriously. “Even my inpatients have been doing poorly.”

“Just bad luck,” Philip said, giving Jason a playful poke in the shoulder. “We all have our bad times. It’ll get better.”

“Yeah, sure,” Jason said.

Philip left to return to surgery.

Jason found an empty chair and sat down heavily. He knew he’d have to get ready to face Cedric’s wife, who would be arriving at the hospital at any moment. He felt drained. “You’d think by now I’d have gotten a little more accustomed to death,” he said aloud.

“The fact that you don’t is what makes you a good doctor,” said Judith, attending to the paperwork associated with a death.

Jason accepted the compliment, but he knew his attitude toward death went far beyond the profession. Just two years ago death had destroyed all that Jason held dear. He could still remember the sound of the phone at quarter past midnight on a dark November night. He’d fallen asleep in the den trying to catch up on his journals. He thought it would be his wife, Danielle, calling from Children’s Hospital, saying she’d be delayed. She was a pediatrician and had been called back to the hospital that evening to attend to a preemie in respiratory distress. But it had been the turnpike police. They called to say that a semi coming from Albany with a load of aluminum siding had jumped the central divider and rammed into his wife’s car head-on. She had never had a chance.

Jason could still remember the trooper’s voice, as if it had been yesterday. First there’d been shock and disbelief, followed by anger. Then his own terrible guilt. If only he’d gone with Danielle as he sometimes had, and read at Countway Medical Library. Or if only he’d insisted she sleep at the hospital.

A few months later he’d sold the house that was haunted by Danielle’s presence and his private practice and the office he’d shared with her. That was when he had joined the Good Health Plan. He’d done everything Patrick Quillan, a psychiatrist friend, had suggested he do. But the pain was still there, and the anger, too.

“Excuse me, Dr. Howard?”

Jason looked up into the broad face of Kay Ramn, the unit secretary.

“Mrs. Harring is in the waiting room,” Kay said. “I told her you’d be out to talk with her.”

“Oh, God,” Jason said, rubbing his eyes. Speaking to the relatives after a patient died was difficult for any doctor, but since Danielle’s death, Jason felt the families’ pain as if it were his own.

Across from the coronary care unit was a small sitting room with outdated magazines, vinyl chairs and plastic plants. Mrs. Harring was staring out the window that faced north toward Fenway Park and the Charles River. She was a slight woman with hair that had been allowed to go naturally gray. When Jason entered, she turned and looked at him with red-rimmed, terrified eyes.

“I’m Dr. Howard,” Jason said, motioning for her to sit. She did, but on the very edge of the chair.

“So it is bad...” she began. Her voice trailed off.

“I’m afraid it is very bad,” Jason said. “Mr. Harring has passed away. We did all we could. At least he didn’t suffer.” Jason hated himself for voicing those expected lies. He knew Cedric had suffered. He’d seen the mortal fear in his face. Death was always a struggle, rarely the peaceful ebbing of life portrayed in film.

The color drained from Mrs. Harring’s face, and for a moment Jason thought she would faint. Finally, she said, “I can’t believe it.”

Jason nodded. “I know.” And know he did.

“It’s not right,” she said. She looked at Jason defiantly, her face reddening. “I mean, you just gave him a clean bill of health. You gave him all those tests and they were normal! Why didn’t you find something? You might have prevented this.”

Jason recognized the anger, the familiar precursor to grief. He felt great compassion for her. “I didn’t exactly give him a clean bill of health,” he said gently. “His lab studies were satisfactory, but I warned him as I always did about his smoking and diet. And I reminded him that his father had died of a heart attack. All these factors put him in a high-risk category despite his lab values.”