Toxin (23 page)

Kim twisted to look at Claire Stevens. Over her shoulder, he caught sight of Tracy and Marsha.

“We don't know what is going on,” Claire admitted. “There's no pericardial fluid, so it's not tamponade.”

“It seems to me it's something inherent in the myocardium itself,” Jason said. “I need a real EKG.”

No sooner had these words escaped from the cardiologist's mouth than the monitor alarm sounded. The cursor swept across the screen tracing a flat line. Becky had arrested again.

“Code blue!” one of the nurses shouted to alert the others out in the intensive-care unit proper.

Jason responded by pushing Kim away from the side of the bed. Immediately he began external cardiac massage by putting his hands together and pumping on Becky's frail chest. Jane Flanagan, the anesthesiologist who'd responded to the initial code and who was still there, made sure the endotracheal tube remained in proper place. She also upped the percentage of oxygen delivered by the respirator.

ICU nurses brought the cardiac crash cart on the run. They practically collided with Tracy and Marsha who had to leap out of the way.

Inside the cubicle there was a flurry of activity as the doctors present all lent a hand. It was apparent to everyone that the heart had not just stopped effective beating, but that all electrical activity had ceased.

Tracy clasped a hand to her face. She wanted to flee but she couldn't. It was as if she were frozen in place, fated to watch every agonizing detail.

All Marsha could do was cringe behind Tracy, fearful that she would be in the way.

Kim initially stepped back, recoiling in disbelief and horror. His eyes swept back and forth between the
monitor screen to his daughter's pitiful body being savaged by the pediatric cardiologist.

“Epinephrine!” Jason yelled while he continued his efforts.

The nurses at the crash cart responded by efficiently filling a syringe with the medication and handing it off. After several changes of hand, it was given to Jason who stopped his massage long enough to plunge the needle directly into Becky's heart.

Tracy covered her eyes and moaned. Marsha instinctively put her arms around her, but couldn't take her own eyes off the ghastly drama unfolding in front of her.

Jason went back to the massage while he eyed the monitor. There was no change in its relentless tracking straight across the screen.

“Bring the paddles!” Jason yelled. “Let's see if we can get some electrical activity going with a shock. If that doesn't work, we're going to have to pace her, so be prepared.”

The experienced nurses had already charged the defibrillator. They handed the paddles forward. Jason stopped his massage to take them.

“Everybody back!” he yelled while he positioned them. When everyone was clear, and the paddles where he wanted them, he pressed the discharge button.

Becky's pale body jerked and her white arms flailed. Everyone's eyes went to the monitor, hoping to see some change. But the cursor was not cooperating. It persisted in its straight, flat line.

Kim pushed forward. He didn't like the way Jason was doing the massage. “You're not getting enough excursion,” he said. “Let me take over.”

“No,” Claire said, coming up behind Kim and pulling
him back. “Dr. Reggis, it's not appropriate. We'll handle this. I think you should wait outside.”

Kim shook off the pediatrician. His pupils were dilated and his face flushed. He was not going anywhere.

Jason responded to Kim's complaint. As a man of small stature, it was hard for him to develop much force in a standing position. To make it easier for himself, he climbed up onto the bed and assumed a kneeling position. Now he got better chest compression. It was so much better that everyone present could hear several of Becky's ribs snap.

“More epinephrine!” Kim barked.

“No!” Jason managed between pants. “I want calcium!”

“Epinephrine,” Kim repeated. His eyes were glued to the monitor cursor. When no syringe was forthcoming, he turned to look at the crash cart. “Where's the epi?” he demanded.

“Calcium!” Jason repeated. “We've got to see some electrical activity. There's got to be an ion imbalance.”

“Calcium's coming up,” Claire said.

“No!” Kim yelled. He pushed through the group to stand in front of the crash cart. He glared at the nurse.

The nurse looked from Kim's florid face to Claire's. The nurse was confused as to what she should do.

Unaccustomed to being overruled, Kim snapped up a syringe packet and tore it open. Then he grabbed a vial of epinephrine and broke off its top. His trembling fingers dropped the needle. He had to get another.

“Dr. Reggis, no!” Claire said. She grabbed Kim's arm. Walter Ohanesian, the hematologist, tried to help by grabbing Kim's other arm.

Kim easily shook off both of these doctors and filled
the syringe unimpeded. Pandemonium ensued as he tried to push his way back to the bedside. Both Kathleen and Arthur, the nephrologist, came to Claire and Walter's aid. The scene devolved to a shoving match with shouts and threats.

“Oh, God!” Tracy moaned. “What a nightmare!”

“Hold it, everybody!” Jane shouted at the top of her lungs to get everyone's attention. The struggle stopped. Then Jane added with urgency but in a more normal volume: “There's something very strange happening. Jason's getting good chest excursion, and I'm up to a hundred-percent oxygen, and yet her pupils are dilating! For some reason, there's no circulation.”

Kim shook off the hands that were impeding him. No one moved or spoke except for Jason who kept up with the massage. The doctors were stymied. They were at a temporary loss as to what to do next.

Kim was the first to respond. His training as a surgeon would not allow him to deliberate a moment longer. He knew what he had to do. With no circulation despite good chest excursion, there was only one alternative. He spun around to face the nurses at the crash cart. “Scalpel!” he barked.

“Oh, no!” Claire shouted.

“Scalpel!” Kim repeated more insistently.

“You can't,” Claire yelled.

“Scalpel!” Kim screamed. Tossing the syringe of epinephrine aside, he lunged past the others in the direction of the crash cart.

Kim snatched the glass tube containing the scalpel. He unscrewed the top with trembling fingers and extracted the sterile instrument. He tossed the glass tube aside; it shattered on the tile floor. He picked up an alcohol swab and tore open its package with his teeth.

At this point, only Claire was willing to attempt to bar his way. But her efforts were in vain. He pushed her aside with a gentle but firm shove.

“No!” Tracy cried. She wasn't a physician, but her intuition told her what Kim was going to do. She started forward, and Marsha let her go.

Kim reached the bedside and literally knocked Jason off the bed. He swabbed Becky's chest with alcohol. Then, before Tracy could quite get to him, he sliced open his daughter's thorax in one decisive, bloodless sweep.

A collective gasp rose from everyone present except for Tracy. Her response was more of a wail. She staggered back from the appalling scene and would have collapsed if she hadn't been caught by the nephrologist, Arthur.

On the other side of the bed, Jason struggled to his feet. When he saw what was happening he, too, shrank back.

Kim lost no time. Oblivious to the others in the tiny room, the consummate surgeon used both hands to pull Becky's slender ribs apart with a decisive crack. Then he shoved his bare hand into his daughter's open chest and began rhythmically to compress her heart.

Kim's herculean effort was short-lived. After only a few compressions, he could feel that Becky's heart had perforated and was far from normal in texture. It was as if it weren't muscle but rather something much softer which seemed to squish between his fingers. Stunned by this unexpected situation, he withdrew his hand. In the process he also pulled out some of the foreign-feeling tissue. Confused as to what it could be, he brought the bloody material up to his face to inspect it.

A shrill, agonizing whine escaped from Kim's lips when he realized he was holding necrotic shreds of
Becky's heart and pericardium. The toxin had been merciless. It was as if his daughter had been eaten from within.

The door to the ICU burst open. Two uniformed hospital security personnel spilled into the room. They had been called by the head nurse after the scuffle over the epinephrine.

As soon as the two men took in the scene, they stopped in their tracks. Becky was still being respired by the ventilator; her pink lungs intermittently filled the gaping incision. Kim stood by her, his hands bloodied, his eyes wild with grief. He tried to gently return the necrotic tissue to Becky's chest cavity. When he was finished with this futile gesture, he put his head back and let out a wail of anguish unlike anything ever heard in the ICU before.

Tracy had recovered enough to step forward. Kim's anguished cry cut her to the quick. She wanted to comfort him and be comforted herself.

But Kim was blind to everyone and anything. He shoved his way out of the cubicle and dashed across the ICU. Before anyone could respond, he was through the door.

In the corridor, Kim went into headlong flight. People who saw him coming got out of the way. One orderly didn't move quickly enough; Kim slammed into him, sending the man and his water cart flying.

Outside of the hospital, Kim ran to his car. Gunning the engine, he shot out of the doctors' lot, leaving a line of rubber in his wake.

Kim drove like a madman out to Prairie Highway. Lucky for him, he encountered no police cruisers. When he turned into the Onion Ring parking lot he was going fast enough to bottom out just as he had on his previous
visit. The car bounced violently until he brought it to a screeching stop directly in front of the busy restaurant. Yanking on the emergency brake, he made the motions to get out. Then he hesitated. A glimmer of rationality seeped into the corners of his emotionally overloaded brain. The Saturday afternoon crowd enjoying their burgers, milkshakes, and fries and oblivious to his psychic pain yanked him back to reality.

Kim had raced to the Onion Ring in search of a scapegoat. But now that he was there, he didn't get out of the car.

Instead he raised his right hand and stared at it. Seeing his daughter's dark, dried blood confirmed the awful reality: Becky was dead. And he hadn't been able to do a thing to save her. He began to sob. All he could do was drape himself helplessly over the steering wheel.

 

T
racy shook her head in disbelief of everything that had happened. She ran her hand through her tangled hair as Marsha Baldwin patted her shoulder. On top of everything else, it was hard to believe she was being consoled by a stranger.

Tracy had responded the opposite of Kim. Instead of flying off in a blind rage, she'd found herself paralyzed, unable to even cry.

Right after Kim's precipitous departure, Claire and Kathleen had accompanied Tracy to the ICU waiting room. Marsha had followed although at the time Tracy was unaware of her presence. Claire and Kathleen had stayed with Tracy for some time to offer their sympathies and to explain what had happened. They had spared no details in response to Tracy's questions, including how
the E. coli toxin had obviously attacked both Becky's heart muscle as well as her pericardium, the covering around the heart.

Claire and Kathleen had offered to help get Tracy home, but Tracy had told them that she had her car and that she'd be all right to drive. It wasn't until the two doctors had left that Tracy realized that Marsha was still there, and the two women had begun a long conversation.

“I want to thank you for staying here all this time,” Tracy said. “You've been a wonderful support. I hope I haven't bored you with all these Becky stories.”

“She sounds like she was a wonderful child.”

“The best,” Tracy said wistfully. Then she took a fortifying breath and sat up straight in her chair. The two women were sitting in the far corner of the room by the window where they'd pulled two chairs close together. Outside the long shadows of a late, wintery afternoon crept ever eastward.

“You know,” Tracy said. “We've been talking all this time and haven't mentioned my ex-husband, the man who's responsible for your being here.”

Marsha nodded.

“Life is full of surprises,” Tracy said with a sigh. “Here I lose my beloved daughter who was the center of my life, and I surprise myself by worrying about him. I just hope Becky's passing doesn't drive him over the edge.”

“What do you mean?” Marsha asked.

“I'm not sure,” Tracy admitted. “I guess I'm terrified at what he might do. He's already been arrested for assaulting the manager at the restaurant where he suspects Becky got sick. I just hope he doesn't do something really crazy and end up hurting someone or himself.”

“He does seem angry,” Marsha said.

“That's putting it mildly,” Tracy said. “He was always such a perfectionist. It used to be his anger was directed mostly toward himself. It served as a stimulus for achievement, but that's been changing over the last few years. It's a big reason why we ended up divorcing.”