24 Hours (8 page)

FOUR

Will ate a bite of redfish and looked out over an audience of close to a thousand people eating the same dish. To his right, at the podium, Dr. Saul Stein was giving a rather digressive introductory speech. At last, like a man making a sudden left turn, he veered back onto the point.

“Ladies and gentlemen, we are very lucky to have with us tonight a physician of the first caliber. A man whose pioneering work on the clinical frontiers of anesthesiology will be published in next month’s
New England Journal of Medicine.
”

A burst of applause stopped Stein for several moments, and he smiled.

“Tonight, we will be treated to a précis of that article, which describes fundamental work carried out at our own University of Mississippi Medical Center. What’s amazing to me is that our speaker—a native Mississippian—entered his field as a second specialty, out of unfortunate necessity. We are very lucky that he did, because—”

A high-pitched beep stopped Stein in midsentence. Five hundred doctors simultaneously reached for their belts, Will included. General laughter rolled through the huge room as most of the physicians remembered that they were on vacation, their pagers back in their hometowns. Will was wearing his, but it had not produced the offending beep. Still, he moved the switch on the SkyTel from BEEP to VIBRATE.

“Who the hell’s on call down here?” Stein barked from the podium. “There’s no getting away from those damn things.” As the laughter died away, he said, “I could easily talk about our speaker for another hour, but I won’t. Dessert is coming, and I want to let Will get started. Ladies and gentlemen, Dr. Will Jennings.”

Applause filled the darkened ballroom. Will rose, speech in hand, and walked to the podium, where his notebook computer glowed softly. He sensed the expectation in the crowd.

“They tell me you should begin a speech with a joke,” he said. “My wife tells me I’m not much of a comedian, so I shouldn’t risk it. But flying down here today, I was reminded of a story an old paramedic told me about Hurricane Camille.”

Everybody thought about Camille when they came to the coast. You could still see trees that had been twisted into eerie contortions by the mother of all hurricanes.

“This guy was driving an ambulance down here in sixty-nine, and he was one of the first to go out on call after the storm surge receded. There were dead animals everywhere, and it was still raining like hell. On his second call, he and his partner saw a young woman lying beside the road in a formal dress. They thought she might be one of those fools who tried to ride out the hurricane by throwing a party. Anyway, he figures the girl is dead, but he doesn’t want to let her go without a fight, so he starts CPR, mouth-to-mouth, the whole bit. Nothing works, and he finally gives up. The next day, they’re hearing who died in the hurricane, because relatives of the missing are coming back to view the bodies in the morgue. The EMT asks about the girl he tried to save, but nobody’s come forward to identify her. A week goes by, and he still can’t forget her. Then the word comes down from the morgue. The girl’s mother finally ID’ed her. She’d been dead for two years. The hurricane had washed her up from the cemetery.”

Squeals of revulsion were drowned by a wave of male laughter. No one appreciated morbid humor more than a bunch of docs with a couple of drinks under their belts.

“My presentation will be brief and to the point. The emergency physicians and anesthesiologists should find it provocative, and I hope the rest of you find it interesting. I’m going to try something new tonight, a bit of high-tech wizardry I’ve been toying with.” Will had videotaped his past year ’s clinical work on a Canon XL-1, a broadcast-quality digital video camera that Karen had tried to talk him out of buying. He’d worked dozens of hours on his computer, editing it all down to the program that would accompany tonight’s talk. The finished product was seamless. But any time you worked with hard drives and video, glitches lurked in the wings. “If it doesn’t work,” he added, “at least nobody dies.”

More laughter, wry this time.

“Lights, please.”

The lights dimmed. With a last flutter of nerves, Will clicked a file icon with his trackball, and the 61-inch Hitachi television behind him flashed up a high-resolution image of an operating room. A patient lay unconscious on the table as the OR team prepared for surgery. Wonder lit the faces in the crowd, most of them doctors with minimal computer knowledge. Their ages varied widely, with couples in their sixties seated beside others in their thirties. Some of the younger wives looked a lot like Karen.

Will glanced at his large-font script and said, “This patient looks thoroughly prepped for surgery, doesn’t he? Twenty minutes before this picture was taken, he assaulted a doctor and two nurses with a broken coffee carafe, causing serious injuries.”

The image on the Hitachi smash-cut to a jiggling, handheld shot that looked like something out of a Quentin Tarantino film. A wild-eyed man was jabbing a broken coffee carafe at whoever was behind the camera and screaming at the top of his lungs. “
Satan’s hiding inside you, motherfucker!
”

The audience gasped.

The man in the video swung the jagged carafe in a roundhouse arc, and the camera jerked wildly toward the ceiling as its operator leaped back to avoid being slashed. Only Will knew that the cameraman had been himself.

“
It’s the end times!
” the man shrieked. “
Jesus is coming!
” In the background, a nurse cried, “Where the hell is security?” The man with the carafe charged her and began weeping and howling at once. “
Where’s my Rhelda Jean? Somebody call Rhelda, goddamn it!
”

Suddenly the video cut back to the man lying prostrate and prepped in the OR.

“If I were to tell you that this man was subdued in the ER not by police, but by me—using a drug—you might guess this was accomplished with a benzodiazepene , a barbiturate, or a narcotic. You would be wrong. No doctor can hit the vein, or even the muscle, of a PCP-crazed man who is trying to kill him with a coffee carafe, not without grave risk to himself and other staff. The ER docs among you might make a more experienced guess and assume that it was done with a paralyzing relaxant like pancuronium bromide, curate, or succinylcholine. And you’d be right. Nowadays, emergency physicians routinely resort to the use of these drugs, because they sometimes offer the only means of compelling violent patients to accept lifesaving treatment. And though they don’t talk about it much, they sometimes use paralyzing relaxants without first administering sedatives, as a sort of punishment to ‘repeat offenders’—violent addicts and gangbangers who show up in the ER again and again, causing chaos and injury to staff.

“All of you know how dangerous the paralyzing relaxants are, both medically and legally, because they leave patients unable to move or even breathe until they’re intubated and bagged, and their breathing done for them.”

The Hitachi showed a nurse standing over the patient in the ER, working a breathing bag. Will glanced into the crowd. At the first table, a stunning young woman was staring at him with laserlike concentration. She was twenty years younger than most of the women in the audience, except the trophy wives escorted by those doctors who had ditched the loyal ladies who put them through medical school, in favor of newer models. This woman wore a tight black dress accented by a diamond drop necklace, and she seemed to be alone. Older couples sat on either side of her, framing her like bookends. Since she was sitting in front of the first table, Will had an unobstructed view, from her tapered legs and well-turned ankles to her impressive décolletage. The dress was shockingly short for a medical meeting, but it produced the desired effect. She was distracting enough that he had to remind himself to start talking again.

“Tonight,” he said, “I’m going to tell you about a revolutionary new class of drug developed by myself and the Klein-Adams pharmaceutical company, and tested in my own clinical trials at University Hospital in Jackson. This drug, the chemical name of which I must keep under wraps for one more month, can completely counteract the effects of succinylcholine, restoring full nerve conductivity in less than thirty seconds.”

Will heard murmurs of disbelief.

“Beyond this, we have developed special new compressed-gas syringes that allow the safe injection of a therapeutic dose of Anectine—that’s a popular trade name for succinylcholine—into the external jugular vein, with one half second of skin contact.”

The Hitachi showed the screaming man with the broken carafe again. This time, as he charged a female nurse, a tall man in a white coat stepped up behind him with something that looked like a small white pistol in his hand. The white-coated doctor was Will. As the patient jabbed the glittering shard at the brave nurse who had agreed to distract him, Will moved in and touched the side of neck with the white pistol, which was in fact a compressed-gas syringe. There was an audible hiss, and the man’s free hand flew up to his neck. The dramatic fluttering of his eyelids and facial muscles was hard to see in the handheld camera shot, but when he threw up both arms and crossed them over his chest, the audience gasped. As he collapsed, Will caught him and dragged him toward a treatment table, and two nurses hurried over to help.

The ballroom was silent as a cave.

On screen, two nurses restrained the patient with straps. Then Will stepped up and injected him in the antecubital vein with a conventional syringe.

“I am now injecting the patient with Restorase, the first of these new drugs to be approved by the FDA. Now, if you’ll look at your watches, please.”

The camera operator moved up to the treatment table and focused on the patient’s face. His eyes were half closed. Every doctor in the audience knew that the man’s diaphragm was paralyzed. He could not move or breathe, yet he was fully conscious of what was going on around him.

Will heard shuffles and whispers as the seconds ticked past. At twenty-five seconds, the patient’s eyes blinked, then opened. He tried to raise his hand, but the arm moved with a floppy motion. He gasped twice, then began to breathe.

“What’s your name, sir?” Will asked.

“Tommy Joe Smith,” he said, his eyes wide.

“Do you know what just happened to you, Mr Smith?”

“Jesus Lord . . . don’t do that again.”

“Are you going to try to stab anyone else, Mr. Smith?”

He shook his head violently.

The image cut to a shot of drug vials—Anectine and Restorase—sitting beside a compressed gas syringe on a soapstone surface.

“I know how shocking that footage can be,” Will said. “But remember the scene that preceded it.”

On the Hitachi, Tommy Joe Smith charged the nurse again with the shard of glass.

“The potential applications are limited, thank God, but their necessity cannot be argued. In emergency rooms, psychiatric wards, and prison infirmaries, healthcare workers are suffering grave injury at the hands of violent patients. Now their safety can be insured without resorting to greater violence to restrain the out-of-control patient. Very soon, physicians will be able to use depolarizing relaxants without fear of fatal outcomes or costly lawsuits.”

A collective murmur of approval swept through the darkened room, followed by a wave of applause. Will had known the video would disturb them—as it should have—but he also knew they would recognize the enormous potential of the drug. He glanced to his left and saw Saul Stein grinning like a proud parent.

“As you know,” he said, checking to be sure that the Hitachi showed an anatomical diagram of a hand, “the relaxants work primarily at the myoneural junction, interrupting the normal flow of impulses from the brain to the skeletal muscles. . . .”

He continued almost without thought, thanks to the rehearsals he had done with Karen and Abby. The woman in black was still staring from the front table. She wasn’t smiling exactly, but there was a suggestive curve to her lips that signaled interest in more than drug therapy. He tried to make eye contact with several other audience members, but every few seconds his gaze returned to the young woman. And why not? It was natural for a lecturer to pick out an individual and speak directly to him—or her. It eased the nerves and gave the voice an undertone of intimacy. Tonight he would speak to the woman in black.

Whenever he turned back from pointing out something on the Hitachi, she was watching him. She had large eyes that never seemed to blink, and a mane of blond hair that fell to her shoulders in the style of Lauren Bacall in
To Have and Have Not.
Blondes had never done much for Will, but this one was different. What struck him—even in the dim spill of light from the big Hitachi—was her remarkable symmetry. His eyes followed the curve of her long legs as they rose to feminine hips, the hips curving into an hourglass waist. Her breasts were not too large, but almost too perfect. The strapless black dress revealed fine collar-bones and strong shoulders. Her neck was long and graceful, her jaw defined, her lips full. But what held him was her eyes. They never left his face, even as he studied her from head to toe.

He turned to the Hitachi to check the video feed, and when he turned back, she shifted in her seat, uncrossed her legs, then recrossed them with the languid grace of a lioness stretching her flanks. The shortness of the cocktail dress gave him a brief but direct sight line between her legs, even from the podium. He felt blood rush to his face. It wasn’t quite Sharon Stone in
Basic Instinct
—this woman was wearing panties—but she had made sure he could see everything but the brand name on the silk. Those dark panties were a far cry from the white cotton “granny” panties Karen had taken to wearing the past couple of years. As Will dropped his gaze to look at his speech, he realized that he had fallen behind the video. He looked back up and skipped ahead to the proper cue line.

The ghost of a smile touched the woman’s lips.

Huey Cotton stood on the cabin porch, looking into darkening trees as the sun sank behind them. Tiny flashes of greenish-yellow light floated beneath the branches like phosphorescent sparks from an unseen fire.