The End Game (23 page)

38

NewYork-Presbyterian Hospital, Manhattan

I strode across the limestone oasis that doubled as the reception area of the Perelman Heart Institute, my footsteps echoing across the vastness of its five-story atrium. A muzak-free ride up the elevator later, I was on the fourth floor and being ushered into the office of Waleed Alami, MD.

In keeping with his gregarious bio pic, he was very welcoming and didn’t scrutinize my creds, only giving them a cursory glance. In truth, only the guys who had something bad to hide ever did. I felt bad lying to him about who I was, but I didn’t have a choice. We shook hands and I thanked him for coming in to talk to me at such short notice, and on a Sunday too. I then told him I was investigating some recent deaths and asked him, straight up, if there was a way for someone to commit murder by giving someone else a heart attack besides using the old movie trope of scaring the crap out of them.

“That does really happen,” he said. He wasn’t smiling or taking it lightly in any way, which didn’t surprise me. In my experience, guys like him who were at the top of their game never did when discussing their field of expertise. “Are we talking heart attack, or cardiac arrest?” he asked. “’Cause you do know there’s a big difference, right?”

“I don’t, but—either one, if it’s fatal,” I said.

He thought about it for a moment, then decided he needed to take me through the basics.

Like most people, I guess, I had assumed both were synonymous, but he explained how they aren’t at all the same thing. A heart attack is a circulatory problem and occurs when the blood flow to part of the heart is blocked. Over time, coronary arteries that supply the heart with the oxygen and nutrients it needs to keep doing its job typically get blocked by fatty deposits—plaque—and the clogging eventually leads to heart damage. The injury can lead to electrical conduction defects in the form of blocked beats or disrupted electrical circuits. Surprisingly, he told me the heart usually didn’t stop beating during a heart attack. Some heart attacks, though, did lead to cardiac arrest.

The latter, though, is different. It, and not the proverbial “heart attack,” is the leading cause of death in our country, and it’s very prevalent—over a third of a million out-of-hospital cardiac arrests in the US alone each year. It’s an electrical problem, meaning it’s triggered by an electrical malfunction in the heart that causes an ineffective heartbeat. The heart’s pumping goes haywire, the brain, lungs and other vital organs get starved of blood and the victim stops breathing. Death occurs within minutes if CPR, or a defibrillator, aren’t used.

“It sounds to me like what you’re asking about is an SCA—a sudden cardiac arrest, when the heart just suddenly and unexpectedly stops beating.”

“Yes,” I said.

“Well, the heart has an electrical system of its own. It’s not like other muscles in the body that rely on nerve connections to get the electrical stimulation they need to function. The heart has its own battery, it’s called the sinus node and it’s in the upper right chamber of your heart. This is what controls the rate and rhythm of its heartbeat. If something goes wrong with the node or with the flow of electric impulses through your heart, you get an arrhythmia, which is when the heart starts beating too fast or too slowly or not at all. In the worst of these cases, your heart comes to a sudden stop—sudden cardiac arrest.”

I asked, “So is there something that can disrupt these electric signals—something someone could be given without knowing it, in one shot, one dose, not over time? Someone who’s in good health, who doesn’t have any kind of underlying heart disease?”

“Well, arrhythmias that cause cardiac arrests don’t just happen on their own, but they can happen to people who don’t have any pre-existing conditions.”

“How?”

“Stress. Strenuous exercise—you’ve read about young athletes who suddenly collapse in the middle of a game. An electric shock.”

I shook my head. “No. I’m talking about something like a drug, a pill—an injection, maybe. Some kind of toxin. One shot.”

Alami shrugged. “Well, an overdose of cocaine will do it. Or a bad reaction to any number of illegal drugs. You could also have a drug-to-drug interaction that could lead to a fatal arrhythmia. It could be a number of things.”

I shook my head again. “It needs to be something that won’t show up in an autopsy.”

Alami’s expression shifted. I felt like he was suddenly a bit wary, even suspicious, of me.

I raised my hands defensively. “Doc, please. I’m only asking because I’m trying to understand if it’s possible. ’Cause if it is, there could be a whole raft of murders that have gone unnoticed. And the people behind them need to be stopped before they can use it again.”

He studied me for a moment, his expression clouded. “Well, if someone has come up with something like this . . . I can’t imagine.” He thought some more. “Undetectable in an autopsy? That rules out a lot of compounds.”

“But do you think it’s possible?”

“I come from a school of thought that believes everything is possible. Whether or not we’ve discovered it yet, that’s the question.”

“Where would you look?”

He thought about it for a few seconds. “There are compounds that could trigger a bad reaction that might not be detected in an autopsy because we already have them. It’s just a question of how much is there, I suppose. Something based around calcium gluconate, maybe. At a much higher concentration than normally found in the body, it’s conceivable that it might create an electrolytic imbalance. Or potassium chloride. It’s in a lot of prescription drugs, and both potassium and chloride are present in the body. A spike of potassium could trigger ventricular fibrillation, which could lead to cardiac arrest, like they sometimes use in state executions. But again, the difficulty is in figuring out what the right dose is, being able to concentrate it into a small enough dose so it passes unnoticed when you’re administering it, I suppose . . . and figuring out how to not have it break down and get absorbed into the body quickly so it doesn’t show up in an autopsy. We’re talking about much, much higher concentrations than you’d normally find.”

“But if no autopsy were performed there wouldn’t be any obvious external signs anyway, right? It would just look like a cardiac arrest.”

“Yes.” He had a worried look on his face, like it had sunk in. “You really think someone’s doing this?”

“More so than before I walked in here.”

He went pensive for a moment, then said, “Is there a recent victim? Someone you suspect this might have been do to?”

“Yes.”

“And is an autopsy being done?”

“Yes.”

“Can you get me in to see the body?”

“You’re not a coroner. I don’t know.”

“Get me in. Let me have a look and run some tests of my own. The best way to figure out how it’s being done—if it’s being done—is by examining the body.”

It made sense. Of course, I couldn’t arrange it, not in my current persona non grata status. But I couldn’t tell him that. Not yet, anyway. “OK. I’ll see what I can do. In the meantime, will you think about it some more and let me know if you come up with anything?”

He let out a dry chuckle. “You think I can help it?”

I shook his hand and thanked him for his time, then I said I wasn’t carrying an extra card, you know, it being Sunday and all. It didn’t look like it worried him in the least. I gave him my burner’s number and the office line at Federal Plaza. It was a risk, but I had to give him a working number in case he did come up with something, and it would have been odd not to give him the office number too. I hoped it wouldn’t come back and bite me in the ass.

As he was showing me out, he said, “Next time you get someone you think this was done to, get the paramedics to bring them here as fast as they can. To the cardiac care unit, not the ER.”

“Why?”

“Maybe we can help where others can’t.”

I wasn’t sure what he meant, then I remembered what Kurt/Cid/Snake had mentioned. “Someone at the office said you had some kind of Frankenstein machine?”

He chortled. “Hardly. Come, I’ll show you.”

He led me to a medical ward and onto an OR that was unoccupied, and showed me a wheeled trolley that was packed with equipment—several monitoring readouts, pumps, and all kinds of tubes running between them. It looked like a robot someone put together in their garage.

He patted it. “This is it. And it doesn’t need lightning to work.” His face barely cracked into a smile, which was probably as much as I was going to get out of him today. “It’s an ECMO. An Extra Corporeal Membrane Oxygenation. Since we’ve been using it, we’ve had twice the success rate of other hospitals in bringing people back from ‘death.’” He used air quotes on that last word.

I didn’t quite understand what that meant. I mimicked his quotes. “‘Death?’ You’re dead or you’re not, no?”

“It depends on what you mean by ‘dead.’ That’s a whole other discussion … what I can tell you is, based on my research and after talking to a lot of people who we and others have brought back after their bodies were considered ‘dead,’ when any monitor you hooked them up to showed zero life in their bodies or brains—many of them had clear recollections of those lost hours. Their consciousness was still there, even if their brains didn’t exhibit any signs of life—at least, none that we can detect. We can’t explain it, neurologically. But it’s a fact.”

I would have loved to tell him about what I’d experienced over the summer in Mexico with Alex and El Brujo and how open-minded I’d become on the subject of our souls and their ability to transcend time and live beyond our physical bodies. But now was not the time for it.

“The thing is, at some point,” he continued, “you, me, all of us—we’re all going to experience cardiac arrest. That’s ultimately the cause of death for most people. Usually, it’s because something else in the body fails, maybe from an advanced cancer, and the heart is overstretched without getting what it needs to keep pumping. But if it happens when the rest of the body has the ability to keep going, which is very common, then the minutes and hours after your heart stops are critical. And right now, I’m sad to say, in most of the hospitals out there, the way they respond in that most crucial moment hasn’t really evolved since the sixties.”

“You mean with CPR and paddles?”

“Well, yes. We use them, of course—you have to, it’s key. But it’s not enough. See, most doctors out there, they’ll do CPR for fifteen, twenty minutes tops, then they’ll stop. It’s like they’ve given up before they’ve even started. But this term, ‘clinically dead’ . . . it’s nonsense. I don’t know what that means, medically speaking. In those situations, the decision to declare someone dead is completely arbitrary. It doesn’t reflect what we know about life, and how long after such a ‘death’ someone can be brought back. If you know what you’re doing and you have the right tools to do it.”

“How long are you talking about?”

“There’s a girl in Japan who had been declared dead for three hours. Dead. Gone. They hooked her up and spent six hours resuscitating her.” He smiled. “She’s fine. In fact, she just had a baby.” He moved closer to his prized machine. “We can work miracles with this thing. Well, maybe a combination of miracles and scientific wonders.” He pointed out the various pumps, heat exchangers and oxygenators on the trolley. “We first cool down the body drastically and very quickly, in order to slow down any damage to brain cells. You need state-of-the-art machines to monitor and maintain oxygen levels to the brain, that’s key. Then we siphon out the patient’s blood, re-oxygenate it, warm it up and filter it and pump it around again. This buys us time to fix whatever caused the problem in the first place. We’re doubling survival rates and when they come back, they’re not brain damaged.”

“Sounds like they should have them in every ER in the country,” I said.

“From your lips,” he replied.

I liked him. A lot. But I left there with a seething rage. Somehow, I was sure they’d killed Nick. Which, added to everything else, made me absolutely desperate to get my hands on these scumbags.

Forget about clearing my name—right now, it was only pure, primal revenge that was on my mind.

MONDAY

39

Cape Cod, Massachusetts

It was inching up to noon by the time I was guiding Gigi’s BMW down a winding lane, a parade of red oak trees looming over me from either side of the road like emaciated sentinels, still annoyed it had taken being a fugitive to motivate me to visit my mom and her husband for the first time in almost a year.

We’d never been as close as some mothers and sons. The combination of a career she frowned upon, my failure to find a wife—then finding one and not marrying her—plus the physical distance, meant we were only ever going to drift further apart as the years passed.

Across two decades, I’d probably spent no more than two weeks around her, and that was probably down to both of us. I guess I reminded her of my dad—like most sons, by the time I was thirty, I’d started to accumulate both physical traits and mannerisms that directly echoed his—and she reminded me of the first ten years of my life, which seemed near-perfect from my innocent perspective. Innocent till my dad blew his brains out.

I hadn’t told my mom any of what was happening, both in the present and over the past six months, since I found out about Alex. All she knew was that I had a son who was now living with us, a grandson she was desperate to meet. Not involving her in the dramas of my life suited us both, since she didn’t have to fret about things she had no way to influence, and I didn’t have to worry that she was fretting.

Half a mile down the lane stood a classic Cape Code house, perfectly symmetrical, white portico, sloped shingled roof and two dormer windows. Pastel-blue wooden slats covered the front of the house and all the windows had well-maintained, hung-back shutters. An equally well-maintained dark-green panel van with the words “Standish Tree & Landscaping Service—serving Cape Cod since 1972” stenciled in discrete letters on the side stood alongside the car port, in which sat my mom’s Volvo SUV. The van belonged to Eric, my stepdad—though I never called him that.

My mom had remarried and moved out to Cape Cod while I was an FBI rookie in Chicago, so I’d never lived with him. He still co-owned and ran his own business, though most of the work was now done by his younger brother and nephews. As so often happens, my mom had chosen someone at the opposite end of the spectrum from her first husband. While Colin Reilly was an intense, self-contained intellectual who could easily spend sixteen hours a day alone in his study, Eric Standish was easygoing and warm and was happiest in nature when he wasn’t with his extended family.

I parked Gigi’s car behind the panel van, climbed out and stretched my legs.

The air was different here. Somehow sweeter than Mamaroneck, even though both places were bounded by the sea. It was also milder than New York, there having been only a couple of mild snow flurries in the past couple of weeks, neither of which had settled for longer than a few hours, though heavier snow was forecast.

As I rocked on my heels to get the blood flowing through my legs, I saw Eric walking toward me. He was wearing a thick woolen jacket and holding a small hand saw.

“Busy day?” I asked.

“Winter’s the best time to prune,” he said. “You can see the tree structure better without the leaves.”

The area around the house had no lawn to speak of. Just neatly maintained areas of native trees and shrubs, the ones I remembered him pointing out being dogwood, hazelnut, black cherry, witch-hazel and pepperbush. As you’d expect, Eric could reel off the names of every single New England native, as well as an exhaustive list of non-native invasive varieties that he’d spent years encouraging his clients to eradicate.

He swapped the saw to his left hand and held out his right. Although he was the kind of guy who hugged men and women alike, we’d never got to the point where either of us felt comfortable enough to try it.

I shook his hand. “Sorry I didn’t bring the kids.”

He hadn’t yet met Alex either, of course, but Kim had taken rather a shine to Eric and the admiration went both ways. Even counting the weeks spent on her Aunt Hazel’s Arizona ranch, Kim was fast becoming a staunch city girl, but she’d still enjoyed the couple of times Eric had taken her out on jobs and shared his love of the local habitat with her.

He smiled. “Sarah’s going to be disappointed. She’s dying to meet Alex, you know.”

“I know, and I’m sorry. This wasn’t planned. Next time, though. Soon.”

“She’d like that,” he said, his tone conveying that while she really would, he wasn’t holding his breath while I made it happen. He thumbed a gesture at the house. “She’s in the kitchen.”

I nodded and stepped through the open front door, pausing to override a fleeting change of heart about my visit.

“Mom?”

She emerged from the kitchen, wiping her hands on an apron.

“Sean.”

We hugged awkwardly.

“Come into the living room. I’ve got some fish pies in the oven. Eric will finish the vegetables.”

That’s something my dad would never have done. I don’t think I saw him set foot in the kitchen once.

She untied her apron, slung it over a kitchen chair then led the way through to a cozy living area. A log fire was burning in the grate. Two perfect miniature pine trees stood at either end of the mantel, each of them adorned with shiny red wooden Christmas baubles. Tiny handcrafted anchors and ships’ wheels also hung from the branches. On a varnished beech table sat a Christmas centerpiece, with snow-dusted pinecones and dried starfish.

Up here, the ocean got into everything, even Christmas.

I’d called ahead to see if my mom was around and to say that I needed to ask her a few things. I’d had to say it was about dad when she got all worried about what I needed to talk to her about, and it felt like she had asked Eric to give us space to talk uninterrupted, which meant he must have had some idea why I was here. Even me driving all the way out to talk to his wife about her first husband had zero effect on his positive mood or gracious demeanor. He was about as comfortable in his skin as it’s possible to be. I admired him for that.

We sat opposite each other, mom on a floral-patterned armchair and me on a brown leather sofa. We spent a few minutes on niceties, she asking how everyone was, about Alex in particular, chiding me for not having brought him up to see her already. I had to accept the blame sheepishly without being able to tell her what he’d been through. Then her whole body tensed up a bit and she asked, “So what did you want to ask me about regarding your dad?”

It was immediately clear she really didn’t want to talk about him, but I could see she was ready to force herself, for which I was grateful.

“I need to know more about what was going on in his life in the months and weeks leading up to . . . you know.”

I could see her trying to decide where to start.

She told me about how he’d become too caught up in his work, how it seemed to have taken over his life and pushed everything else aside. How his general mood had changed.

“He didn’t seem there when we were together, most of the time,” she said. “We’d be out having dinner with friends and it was like his mind was elsewhere. He’d stay at the office late, then spend hours in that damn study of his—you probably don’t remember, but he’d come down sometimes, serve himself a plate and take it back up there and eat alone. It was like he’d lose all interest in family life. It wasn’t until after that I found out he was clinically depressed.”

“Yes, tell me more about that.” While trying not to sound accusatory at all, I added, “I mean, how could you not have known? All that time?”

She shifted in her seat, her body language betraying some defensiveness. “He never talked. From time to time, when the moment was right, I’d ask, ‘Are you OK? Are you happy? Are we good?’ He’d just say ‘Yes, of course,” give me a smile and a kiss—but I knew he was just avoiding something.”

“But you never saw him take any pills, nothing like that?”

“No. He kept the diagnosis to himself.”

“But, I mean—” I caught myself and took a breath. She was going to clam up if I started accusing her. Funny how being with family makes you forget everything you’ve ever learnt about how to interview someone. Not that mom was a suspect, just that she knew so much that I didn’t. Not yet, anyway. “Sorry,” I said.

She smiled. “It’s all right. This was never going to be easy. For either of us. It’s why I’d hoped we’d never have to dig it up.”

I nodded. “So how did you finally find out?”

“It was part of the coroner’s report. The men investigating his death turned up the shrink he’d been seeing. Turns out he’d been diagnosed with clinical depression about nine months before . . . before he died.”

“Did you ever meet this guy?”

“Oh, yes. I went to see him. He couldn’t tell me much—you know, that ridiculous doctor-patient thing, even after death. I mean, how silly is that?” Her face relaxed with a bittersweet, faraway look. “He couldn’t tell me much. He was just very sorry about what happened.”

“Can you remember his name?”

“Oh, Lord.” She thought about it. “Something like . . . Orwell? No . . .”

I could see her trying to retrieve the name from some burial ground deep inside her memory.

“Orford? Yes, Orford. That’s was his name. I can’t recall his first name though.”

I bookmarked it.

“Had he ever suffered with it before?”

“Not that I ever knew, and the psychiatrist said he didn’t think there had been any previous history, but that there were aspects to his personality which were warning signs it could develop.”

“Like what?”

“His insularity. Always wanting to be on his own. Focused on work to the point of obsession. Never really, truly happy. I mean, do you remember him smiling or laughing with a big, hearty, honest laugh?”

I thought about this and could only think of one time. When he unwrapped a parcel from a university publisher to find his first book inside, the title of which was so obscure I didn’t remember it the next day, let alone almost thirty-five years later. His face been beaming with pride—but she was right. He wasn’t a fount of joy.

She shook her head—the memories flooding in.

“Those last months, over a year really, he couldn’t see the beauty in life and he had this broken smile . . . except with you. With you, I saw a different side of him. You lit him up like I never could. You made him forget about the heaviness of the world that he was immersed in. Then one day it stopped. Even you couldn’t make him happy. No wonder . . .”

Her eyes had started to fill with tears. She took out a crisp, folded white handkerchief, shook it out, and dabbed at her eyes.

I made my voice as gentle as possible, hoping I was on the edge of a genuine revelation. “No wonder what?”

“No wonder I fell in love with Eric.”

It was guilt, as much as sadness. Some small part of her must still have felt that falling for someone else was a betrayal. Both of her husband and of their son.

“He doesn’t want to change the world,” she added, “or stand up for justice.” She gestured to the house. “This is enough for him. We spent more time together in our first six months than your father and I did in our last five years together. It must make me sound so very selfish . . .”

The tears started to flow again.

I shook my head.

“Not at all. And I’m happy you found him. You deserve this. You deserve to be happy. Everyone does.”

We were both silent for a long moment as she shed a few more tears, dried her eyes and composed herself. Then she stood, refolded her handkerchief and placed it carefully back inside her pocket.

“Let’s get some food.”

Sitting in his rental car across from Flo Line Autos, Sandman studied his target with unerring concentration.

The high-performance car shop’s owner, Marcus Siddle, was showing some guy and his girlfriend around a newly customized Chevy Impala low rider. The client oozed the testosterone and barely suppressed violence of a soldier in one of Miami’s many drug gangs, while his girlfriend was a classic Florida muscle-car babe—apart from the ubiquitous tattoos scattered around her curvy body, she was, even in December, wearing denim micro-shorts the size of knickers and a midriff-baring, too-tight T-shirt. Her only concession to the weather was a pair of knee-high UGG boots and the extra coke she had to be snorting to ward off the goose pimples.

Siddle’s outfit had gone the whole nine yards on the thug’s car. The Impala was a deep purple color, its rear sitting barely an inch off the ground. The sound system was at full blast and was so loud it was making Sandman’s car vibrate.

At the flick of a switch, the rear suspension jumped skyward, sending the rear of the car at least three feet off the tarmac. The owner clicked the fingers of one hand together, his gold bracelets fighting to stay on his wrist, grinning like the babe had just told him she’d invited her girlfriend over for a three-way.

As the guy climbed into the Impala to check out the interior, Siddle walked over to the babe, casually brushed his right palm against her ass and slipped a business card into a rear pocket of her shorts.

Sandman knew of Siddle’s seductive abilities when it came to the opposite sex, but he still couldn’t wrap his head around how the guy managed it with such ease. On top of being certain that his target would find him attractive, he had to be absolutely sure they wouldn’t mention his approach to their husband or boyfriend, especially if it was someone who, by the looks of it, was far from averse to inflicting serious pain on anyone who crossed him. Sandman supposed it was all down to selection. Identifying a target, then choosing the right moment.