Endorphin Conspiracy, The (10 page)

“Oh, my God!” exclaimed a startled Karen Choy as she stopped her chest compressions and jumped off the bed. The intern who had been breathing Jessica removed the mask and ambu bag.

Suddenly, Jessica’s head arched backwards, and her mouth gaped, every muscle of respiration in her neck and chest trying to suck in life-sustaining air in one final gasp.

“Agonal breathing, Karen,” Geoff said.

“Right, I forgot,” she replied, a little embarrassed. “A death reflex.”

Geoff knew it was over. He had already made the decision, but the words did not flow easily. “Let’s call it,” he said, defeat permeating his voice.

“I’ll go talk to the father.” Kapinsky started to leave the bedside.

Geoff grabbed him by the arm. “No, I’ll do it. I need to get his permission for an autopsy. I want to know what the hell happened here.”

Chapter 13

Geoff sat alone in the medical staff room of the NSICU. He had signed on to the computer to check for Jessica’s PET scan one more time, but the digital image of her most recent scan was still missing from the computer’s data banks. Strange, he thought. It had been two days since the scan and still nothing entered.

Even stranger was the latest, cryptic e-mail message. The sender was the same, Proteus, as were the convoluted gates the message had passed through to reach Geoff’s computer. The words pulsed brightly, burning an afterimage on his retinas.

There are no accidents in life.

What the hell was that supposed to mean? If this was a prank, Geoff failed to see the humor in it. He printed the new message along with the first one, so he could provide his brother with something from which to work to help him track down this Proteus. When he found out who it was, there’d be hell to pay. Geoff would turn whomever it was in to Dr. Pederson. Pederson had no tolerance for this sort of thing.

A knock on the door interrupted his thoughts. “Mind if we come in?” asked Karen. Kapinsky followed close behind her.

Geoff cleared the e-mail screen and swiveled his chair. He rubbed his eyes, took a sip of cold, black coffee. “No, of course not. I could use some help trying to piece all of this together.” He waved his hand over the hundreds of pages of chart notes and lab printouts spread over the surface of the table. On the corner of the table was a grease-stained box of pizza, one slice remaining.

Karen and Kapinsky sat down across from Geoff. “Have you made any sense of this stuff yet?” asked Karen.

“Two things stand out here. The nursing notes indicate she was a bit agitated during the night. The nurse reported she sat up in bed and let out a shriek in the middle of the night.”

“Don’t forget she is—was—just eight years old. The ICU is a pretty scary place,” said Kapinsky. He grabbed a stack of lab test results and flipped through the pages.

“She was too sedated to be scared like that.” Geoff picked up the medication record, pointed to an entry at the bottom of the page. “Says here she was given 250 milliliters of chloral hydrate at 2200, an hour before her fight or flight reaction.

“Fight or flight reaction?” asked Kapinsky. “What are you talking about? Either she was having a nightmare because the chloral hydrate hadn’t kicked in yet, or she had an adverse reaction to the medication.”

“I doubt it was the medication. Just like DeFranco, she’d had the medication—in this case, chloral hydrate, in his cimetidine—before without any adverse reaction.”

“Then what’s your explanation?” asked Kapinsky.

“The description of her behavior, her vitals and neuro exam all coincide with the fight or flight reaction. Look,” Geoff went on, plopping the relevant chart notes and vital sign flow sheets down in front of Kapinsky. It’s all right here. She had a massive sympathetic outpouring of adrenalin at around eleven o’clock last night.”

Kapinsky studied the flow sheets one at a time, scanning the log of her vital signs and her bedside neuro checks. It was all there in black and white. “Okay, let’s say she did have this outpouring of adrenalin affecting her nervous system. That still doesn’t explain her sudden, massive brain swelling.”

“No, but this does,” said Geoff as he unrolled the printout of her intracranial pressure monitor from the night before. “Look here. Her ICP had been stable in the twelve to sixteen range for several days, then
this
happened.”

Geoff unrolled the tape carefully, his gaze gliding along the even line until it abruptly changed course and climbed upward beyond the thirty millimeter mark.

“My God, her intracranial pressure spiked to thirty-five in a matter of seconds! I’ve never seen anything like this.” Karen Choy’s eyes widened in awe.

Geoff studied the tape further. “Looks like her intracranial pressure spiked from fifteen to thirty-five, then leveled off at twenty-five and stayed there until she became bradycardic and her heart rate slowed dramatically.”

“What could cause such a sudden rise, Geoff?” asked Karen.

“Uncal herniation, herniation of the base of the temporal lobes due to an expanding mass like a brain tumor, can cause a picture similar to this—agitation, sympathetic nervous system changes, then cardiac collapse. But the intracranial pressure rise is generally more gradual, over hours, not minutes. Short of cerebral hemorrhage, and she had no evidence of that by her MRI, done earlier in the day, I honestly don’t have a good explanation for what happened.”

“There is one other possibility we need to consider, Geoff,” said Kapinsky.

“I’m on the edge of my seat, Kapinsky.”

“What if Jessica and DeFranco were killed?”

Chapter 14

“Murdered! I think you’ve lost it, Kapinsky.”

“Who said anything about murder? Mercy killing is more what I had in mind,” he said in a hushed tone as he leaned towards Geoff.

“She had great nursing care, Howard. You said that yourself,” interjected a perplexed Karen Choy.

“That’s not the point.”

“Then get to the point, Kapinsky.”

“At 2200, she was supposedly given chloral hydrate. At 2210, her intracranial pressure spikes, and at 2300 she has her massive adrenalin surge. Obviously, it was a result of being given some sort of medication.”

“That’s easy enough to determine,” said Karen. “Chloral hydrate is a controlled substance. All we have to do is check the log in the pharmacy.”

“Logs can be altered, Karen,” Kapinsky said.

“Why would anyone do something like that?” Karen asked.

“Don’t you remember the Brookshire Nursing Home Killer? A nurses’ aid working on the night shift knocked off eight patients over a three-month period by injecting lethal doses of potassium. She thought she was doing them a favor, speeding them along to God’s Kingdom and—”

“Kapinsky, don’t you start talking about a mercy killer on the loose in the hospital, or the next thing you know we’ll all be on the front page of the
New York Post
, and you’ll be bounced out of this residency, with me close behind!”

Kapinsky persisted. “Let me check the medication log. The only thing that could have caused her ICP to spike like that was a drug.”

“I think it would be best if you stayed out of this, Kapinsky. I’ll check the log.”

“You mean the pharmacy still lets you do that?”

The jab came seemingly from nowhere and hit Geoff hard.
So much for confidentiality.
Anger and resentment welled up within Geoff. Someone had betrayed his trust. His jaw muscles tensed. He leaned forward across the table, then stopped.

To react with anger would be to play into Kapinsky’s game. Geoff took a deep breath, leaned back in the chair, his eyes all the while studying Kapinsky’s. “Why shouldn’t they?” asked Geoff.

“I don’t know, Geoff, I mean, I just didn’t know if things had—”

“Had what?” Geoff smiled.

Beads of sweat formed on Kapinsky’s upper lip. His small brown eyes darted back and forth. He sputtered, then answered. “Changed. That’s all, I didn’t know if things had changed, you know. I mean, if things were okay between you and the pharmacy after what happened.”

“Everything’s just fine, Kapinsky. Thanks for asking, but it’s not your concern. Now why don’t you do something productive like bring us Jessica’s last PET scan so we can review it together. Maybe it will corroborate your theory. While you’re at it, you better explain why you removed the scan from neuroimaging the other day. You got us in some pretty hot water with Dr. Balassi over it.”

“What are you talking about?”

“I’m talking about removing the scan from neuroimaging before Balassi had the chance to review it, and on top of that being stupid enough to sign your name as evidence. Might as well rob a bank and leave a calling card!”

Kapinsky looked confused. “I never removed the scan. I was only going by our discussion of it at rounds the other morning.”

“What do you mean? We got blasted by Balassi because you broke the rule and signed out the scan before he read it.”

Kapinsky stood his ground like a pit bull. “Like I said, I never saw it. I haven’t been down to PET scan in days. Mark and Karen took Jessica down last night for the repeat scan.”

Geoff locked stares with Kapinsky, searching for a sign of truth or falsity. “How do you explain your name in the log and her missing folder?”

“Obviously a mistake,” he answered matter-of-factly.

“But one you’re going to have to answer for to Balassi. I got my ass burned once already trying to protect yours.”

“Why don’t we check the computer filing system and see if it’s shown up?” Karen said.

So simple, thought Geoff, and here we are bantering like kids in the schoolyard. “Good idea, Karen. The bar code on the film plate may have been picked up on the laser scanner on someone’s light box.”

Karen nodded and they moved to the computer terminal. Geoff sat down at the console, Karen and Kapinsky standing on either side of him. They stared intently at the screen. The multi-colored CRT pulsed brightly as Geoff manipulated the mouse and entered the Neurad system. He typed the command “Petfile tracking” and watched the cursor blink as the computer processed the request.

“Welcome to Petfile tracking. Please enter your security code.”

Geoff entered his seven letter code and waited once again.

“Hello, Dr. Davis. Your access is cleared. Please enter patient name and birthdate or hospital number.”

Geoff punched in Jessica’s name and birthdate. The cursor pulsed as it searched thousands of files for the last time the bar code was scanned.

Then came the answer: PRC-217.

“PRC-217. Where is that, Geoff?” Karen asked.

“PETronics Research Center, Room 217. Balassi’s office.”

“I don’t get it. I thought you said he was pissed off because he couldn’t find it and thought I had it,” said Kapinsky.

“He was, and he couldn’t. Must have found it like Karen said and taken it to his office afterward.”

“Except the date and time it was logged in there by the computer precedes the incident,” Karen said.

“Someone’s trying to make me look bad, and I don’t like it,” said Kapinsky. “Walter reported my signature in the log book? That son-of-a—”

“Cool down, Kapinsky. I’ll clear it up with Dr. Balassi after we finish here.” There was clearly no love lost between Kapinsky and Walter. Geoff’s thoughts flashed to the cryptic e-mail messages, the strange deaths on his service, Kapinsky’s theory, the dig about the pharmacy log. Someone had betrayed him. He felt suddenly uneasy. Geoff shifted in his seat, stood abruptly.

“Where are you going?” Karen asked.

“I’ve got an important call to make, then I’m going to neuroimaging to talk to Balassi and find that scan. Somehow, I think it will give us an important clue regarding Jessica’s death. If I don’t make it back by sundown, call the FBI and tell them Balassi is holding me hostage in his office.”

Geoff paused at the doorway, looked at Kapinsky. “Take good care of Smithers. I want to be called for any problems, even a bowel movement that’s out of the ordinary. He’s the only patient left on our service.”

Chapter 15

“Kapinsky says he never signed the scan out, Dr. Balassi.” Geoff stood in front of Balassi, who leaned back in his desk chair staring intently at Geoff over his half-reading glasses.

“The scan’s still missing, and Kapinsky’s name is in the book. He must be lying to you. God knows why,” retorted Josef Balassi sharply. “You’re the chief resident, Geoff. Can’t you control your flock?”

“Kapinsky says that’s not his signature in the log book, Dr. Balassi.”

Balassi shifted in his chair, broke eye contact. “Then whose is it, Geoff? Some secret agent forging his signature?”

“That’s not exactly what I had in mind.”

Balassi leaned forward. “Just what did you have in mind, Geoff?”

“The computer tracked the scan to your office, Dr. Balassi.”

“My office? I’m the one looking for the goddamn scan!” Balassi rose from his chair, his close-set brown eyes glaring at Geoff. His voice quivered with anger. “I’m not sure what you’re implying Geoff, but I suggest if you want to survive this year you refrain from meddling in my laboratory. If someone in my office misplaced that scan, I will deal with them myself. Is that understood?”

“I’m not implying anything other than what I stated. Petfile tracked the scan to your office. We’ve had two very strange deaths on our service, and I believe the girl’s PET scan may give us some very important information about the cause.”

“Strange deaths, indeed.” Balassi leaned back, stroked his beard, motioned Geoff to sit down. “I wonder if you’re making it all out to be more than it really is. Looks more like post-head trauma psychosis syndrome and death from cerebral edema to me. The only thing that’s strange is your paranoia, Geoff. I think you’ve been away from this too long.”

“I don’t think so, Dr. Balassi. These deaths just don’t sit right with me, sir. I think there’s more to it. I just don’t know what at this point.”

“We’re scientists, Geoff. We act on facts, not feelings.”

“That’s why I want to review the scan.”

Balassi paused, as if in thought, for a moment. “I’ll try and track the scan down, Geoff, and as soon as I find it, I’ll let you know.”

“Dr. Balassi,” interrupted Walter Krenholz, now standing in the doorway, “Dr. Zelenkov is here to see you.”

Geoff turned toward Walter, stared in annoyance at his intrusion. Walter broke the stare quickly and looked to Balassi for a response.

“Bureaucrats. Great!” He slammed his pencil down on the desk. “That’s all I need now, a visit from the PETronics home office. Things have been a mess around here ever since the new residents started July 1!

“You’d better clean up your team’s behavior, Geoff, or the main office will pull every dollar out of this place they put into it.”

Balassi put his hand to his chin and thought for an instant, then motioned to Walter with his hand. “Tell the good doctor our chief neurosurgery resident will be with him momentarily.”

“I thought Zelenkov was due tomorrow.”

“Just like the home office to try and catch us off guard. Can’t trust them for a minute, which leads me to your role here, Geoff.”

Balassi spun around and faced the wall behind the desk, gazing intently at an old photograph, one that Geoff had glanced at with curiosity many times before. It was a photograph of great significance to Balassi, a portrait of a time he spoke of with intense emotion to those who worked in his lab: Balassi, the young scientist, side-by-side with his one and only mentor, who in Geoff’s estimation bore an uncanny resemblance to Sigmund Freud, pocket watch and all. Balassi’s beard was more closely trimmed, his hair dark brown and closely shorn, but the same fiery intensity had burned in his eyes even then.

“I’ve worked too hard over the last thirty years to give it all away, Geoff. You can show our friends from PETronics the inner workings of our scanner, even the software for the imaging refinement. But keep them out of the cyclotron. I don’t want them near our new isotopes. Once they know the details, every two-bit researcher in the country will try to duplicate our efforts. Understood?”

Geoff nodded in agreement.

“And whatever your thoughts are about the tragic deaths of your patients recently, please don’t discuss them with Zelenkov. The last thing we need is PETronics getting involved.”

Dr. Pederson’s admonition echoed in his mind.
Keep your nose to the grindstone this year, and your future will be golden.

Geoff had all but accused Balassi of concealing the scan. Geoff had spent his entire last year in Balassi’s lab, building a mutual trust. What possible reason would Balassi have to do something so absurd?

“I understand and couldn’t agree more, Dr. Balassi. I’m really sorry about my tone earlier regarding the scan. I didn’t mean to—”

“Forget about it, Geoff,” Balassi interrupted, raising his right hand. “I’ll take care of it.”

He paused, then gave a smile. “Tell Dr. Zelenkov I’m tied up in the lab now but it will be my honor to meet with him tomorrow.”

“Will do.” Geoff stood and walked to the door.

“And, Geoff,” added Balassi. “Thanks.”