Robin Cook - Foreign Body

To stay out of the way, Raj had slowly backed away until he’d hit up against the wall. He was thankful that people were so involved in the resuscitation activity that he was being virtually ignored. He again began to think about slipping out, although the specter of drawing attention to himself made him stay put.

“Dr. Mishra will be in as soon as he can,” the nurse yelled out while hanging up the phone. “He’s finishing up with another emergency.”

“That’s not good,” Dr. Krishna said. “I have a bad feeling. With this progressive bradycardia, it might be over by then. This heart is definitely having trouble. It looks to my untrained eye as if the QRS interval is widening.”

“The patient definitely has a fever,” the nurse blurted, staring at the thermometer in disbelief.

“What is it?” Dr. Krishna demanded.

“It’s over one hundred and nine.”

“Shit!” Dr. Krishna shouted. “That’s hyperpyrexia. Get ice!”

The floor nurse ran out of the room.

“You must be right, Dr. Dayal,” Dr. Krishna moaned. “We must be dealing with a heart attack and a stroke.”

The nurse who’d dashed up to the lab returned on the run. She was out of breath but managed to say, “The emergency potassium level is nine-point-one milliequivalents per liter. The tech says he’s never seen it that high, so he’s going to repeat it.”

“Yikes!” Dr. Krishna exclaimed. “I’ve never seen a potassium level like that. Let’s give some calcium gluconate: ten milliliters of a ten percent solution. Draw it up. We’ll give it over a couple of minutes. Plus, I want twenty units of regular insulin. And do we have cation-exchange resin available? If so, get it.”

The floor nurse came back with ice. Dr. Krishna dumped it over the patient, and a lot clattered to the floor. The nurse then ran back out to try to get the resin while the other began to draw up the medication.

“Damn!” Dr. Krishna shouted as the blip on the monitor flat-lined. “We lost the heartbeat.” He climbed up on the bed and began closed-chest massage.

The CPR attempt went on for another twenty minutes, but despite the medication, the ice, the cation-exchange resin, and a lot of effort, a heartbeat was not regained. “I think we are going to have to give up,” Dr. Krishna said finally. “It’s intuitive what we are doing is not working. And I’m afraid rigor mortis is setting in already, probably from the patient’s hyperthermia. It’s time to stop.” He let up from compressing the chest. Although Dr. Dayal had offered to relieve him ten minutes earlier, he’d refused. “It’s my patient,” he’d explained.

After thanking the two floor nurses for their help and Dr. Dayal for hers, Dr. Krishna pulled down the sleeves of his white coat from where he’d pushed them up at the outset of the resuscitation attempt, and started for the door. “I’ll do the paperwork,” he called over his shoulder as the others began to pick up the debris, put the room in order, and prepare the body. “As per that e-mail directive that came out just today from admin about reporting deaths immediately, I’ll also call CEO Khajan Chawdhry to give him the bad news.”

“Thank you, Dr. Krishna,” the two nurses echoed.

“I’ll do the phoning to Khajan, if you’d like,” Dr. Dayal offered.

“I think I should do it,” Dr. Krishna rejoined. “He was my patient, and I should take whatever heat this is going to create. With those deaths over at the Queen Victoria garnering international media attention, this episode is going to be looked upon as very inconvenient, to say the least. I’m sure there’ll be great pressure to keep it under wraps and dispose of it promptly. It’s too bad, because under more normal circumstances, I’d actually like to learn the physiological sequence of events, starting with the patient’s history of obstructive heart disease, right up to the hyperpyrexia and the massively elevated potassium level.”

“I doubt we’ll ever know,” Dr. Dayal said. “I agree with you about the admin wanting to keep this quiet. But if Khajan wants to talk to me, tell him I’m here at the hospital and can be paged.”

Dr. Krishna waved over his shoulder to indicate he’d heard. He was about to turn down the short corridor to the room’s door to the hall when his eyes passed over Raj. Reflexively they snapped back to the statue-like nurse. “My gosh, son, I forgot all about you. Come with me!” Dr. Krishna waved for Raj to follow, then preceded him out the door.

Vainly hoping he would have continued to be ignored as if he were invisible, Raj reluctantly followed the surgeon. Once again, his heart was racing. He had no idea of what to expect, but it was going to be bad.

Out in the hall, Dr. Krishna had waited for him. “Sorry to have ignored you, young man,” the surgeon said. “I’ve been seriously preoccupied, but now I recognize you. I saw you this morning when I stopped down here to check on Lucas. You’re the day nurse, if I’m not mistaken. What was your name again?”

“Raj Khatwani,” Raj hesitantly said.

“Oh, yes, Raj! My, you have long hours.”

“I’m not working. I get off after three.”

“You’re still here at the hospital and you certainly look like you are working, uniform and all.”

“I came back to the hospital to use the library. I wanted to learn about the surgery you did on Mr. Lucas. Obesity surgery was not included in our nursing-school curricula.”

“That’s very impressive! You remind me of myself when I was a student your age! Self-motivation is key to success in medicine. Come, walk with me down to the central desk.”

The two men began walking, with Raj having trouble resisting the temptation to flee. He knew that the longer he stayed and the more he said, the more apt he was to incriminate himself. He could even feel the succinylcholine syringe in his pants pocket, pressing against his thigh.

“Did your research result in any questions I might answer for you?”

Desperately, Raj tried to think up a question he could ask to make it seem believable that he’d truly been studying. “Umm...” he voiced. “How do you know how small to make the stomach?”

“Good question,” Dr. Krishna said, switching to a professional mien as he answered it with the help of elaborate hand gestures. He caught Raj’s eyes longingly taking in the stairwell door, which they were passing. The surgeon stopped, interrupting himself. “I’m sorry,” he said. “Do you have to be someplace?”

“I do have to get home,” Raj said.

“Don’t let me hold you up,” Dr. Krishna said. “But I do have a question. How was it you were in Mr. Lucas’s room just when he suffered his terminal event?”

Raj’s mind desperately raced for an explanation. Making the tension even worse, he knew that every moment he hesitated, the less convincing he would be. “After the reading I’d done, I had some questions for the patient. But the second I got into his room, I knew there was something seriously wrong.”

“Was he conscious?”

“I don’t know. He was writhing around as if in pain.”

“That was probably the heart attack. It’s what usually kills these overweight patients. Well, you almost saved the day. Thank you.”

“You’re welcome,” Raj said with a gulp, almost giving himself away. He couldn’t believe he was being thanked.

“I have some good journal articles on obesity surgery I can loan you if you’d like.”

“That would be terrific,” Raj managed.

After a quick shake of hands, the two men parted, Raj disappearing into the stairwell and Dr. Krishna heading for the central desk to fill out the death certificate and call the care manager and Khajan Chawdhry.

Once inside the stairwell, Raj had to pause. His heart was beating at such a rate that he felt mildly dizzy. Squatting down on his haunches for twenty or so seconds relieved the dizziness, and after wiping the cold sweat from his forehead he stood back up, holding on to the handrail. Relieved, he took a few steps down, and when he sensed he was back to normal, he let himself run down the rest of the stairs to the lobby floor.