Devil Wind (Sammy Greene Mysteries) (5 page)

Inside the cath lab, beneath sterile blue drapes, the sedated congressman lay naked on the table, only his shaved and prepped left groin exposed to the room’s chill. One of the critical-care nurses had hooked up the cardiac monitor while the other had started an IV in his right arm.

Unable to find Prescott’s wife for official consent, Reed had consulted with Bishop, still stalled in fire-created traffic. “He was conscious enough to scribble his signature on the form, but—”

“I’ve just spoken with Julia—his wife. Go ahead with the procedure. I’ll be there as fast as I can.”

They both knew that “minutes mean muscle.” The sooner a patient like Prescott had his blocked artery opened, the lower the risk of damage to his heart from lack of oxygen, and the greater his chances for survival.

Now, masked and dressed in clean scrubs, Reed held up a small tapered plastic tube in his gloved hand. “Okay, Mr. Prescott, you may feel some pressure in your groin. I’ve numbed the area so you shouldn’t have pain. You’ll be sedated, but conscious enough to tell us if you’re uncomfortable.” He nodded to one of the nurses who administered the IV propofol and watched as within seconds, Prescott’s eyelids fluttered closed. “I’ll make a small incision, then put a thin wire through this sheath into your femoral artery.”

Reed took a deep breath, said a silent prayer, then deftly placed the rigid sheath through the puncture site and slowly threaded the wire toward the congressman’s heart. A fluoroscope moving above Prescott’s chest documented the guide wire’s journey. While Reed and the team could observe the procedure in real time, the fluoroscope had an X-ray subsystem recording on videotape for instant replay as needed. No doubt, Bishop would be reviewing and analyzing his performance. By his second month of fellowship, Reed had mastered the skills so that he reveled in the challenge of a procedure demanding such precision. All his years of training culminated here. Like an athlete running a championship race, Reed’s focus had narrowed to succeeding in his task with a winning performance, his goal, perfect technique, his patient, temporarily forgotten. As long as things didn’t go wrong.

Carefully, Reed inserted a flexible tube through the sheath over the wire. “A little more pressure,” he warned the congressman, threading the pigtail catheter across the aortic valve to the left ventricle. Satisfied it had reached its destination, he motioned for a syringe filled with contrast. “You might notice a warm, flushed sensation or slight nausea when I inject this dye. Don’t worry, that’s normal.”

Reed’s eyes were focused on the fluoroscopy monitor. The injected dye illuminated the left ventricle allowing Reed to determine the level of damage in the pumping chamber.

“Ejection fraction’s sixty percent. Normal,” he said, pulling the catheter back out and exchanging it for a left coronary catheter.

“Keep an eye on the rhythm,” Reed told the resident, as he adjusted the table, moving it back and forth to view the coronary arteries from several different angles.

Within moments of the second injection, the contrast media defined the route, fanning out into the coronaries like a road map.

“Widow maker,” Reed pointed to the middle of the left anterior descending artery that was over 90 percent occluded. Blockage of this critical blood vessel could lead to permanent heart damage and even death. Reed’s skills at reopening the vessel with an expandable balloon and putting in a stent would give the heart muscle a second lease at life. Reed injected a little more dye to visualize the right coronary artery, which, fortunately, was open. He withdrew the catheter and turned to the resident.

“Okay, let Eisenberg know we’re going for an angioplasty and a stent. Have him stand by just in case.”

“Thirty-five minutes,” reported the critical care nurse, indicating how much time had passed since the patient entered the hospital. Assuming Prescott had gotten to LAU within twenty minutes of his heart attack, Reed calculated nearly fifty-five minutes had gone by. The time between a patient’s arrival at the hospital to the time a stent was placed—what doctors called door-to-balloon time—should be no more than ninety minutes. He felt a rush of adrenaline as he realized he had less than thirty-five minutes to beat the clock.

“Mr. Prescott, we found a serious blockage in one of your arteries. That’s why you had the chest pain.”

Prescott’s eyes fluttered open. His monitor registered an increase in blood pressure and heart rate.

“We’ll fix it, don’t worry,” Reed said. “If this works, we can avoid surgery.”

Prescott’s smile was feeble. His heart rate and blood pressure remained elevated.

Reed nodded to the team. “Ready?”

A nurse handed him a flexible catheter with a tiny deflated balloon surrounded by a wire mesh stent on the end. He threaded the tip of the catheter through the opening in Prescott’s groin, following its progress on the fluoroscope until it reached the blocked artery.

“Now I’m going to inflate the balloon. In a few minutes you should be feeling much better.”

The congressman’s face went slack. “Uhhhh.”

“He’s crashing!” the resident shouted.

Reed’s gaze flew to the monitor. The tracing showed ventricular fibrillation. The heart chambers were no longer contracting. Instead, individual muscle fibers were twitching erratically, turning the heart into a flaccid, useless bag.

One of the nurses grabbed the defibrillator and charged the paddles.

“Do it!” Reed ordered. “Clear!”

Everyone moved from the table as the nurse delivered a four hundred-joule jolt to the now unconscious patient.

Shit. Still in V fib.

“Should we call Eisenberg?” the resident suggested.

“One milligram epinephrine IV, then shock him again,” Reed snapped.

The second nurse injected a bolus of epinephrine into the IV line.

“Clear!” Again the group stepped away from the table as the paddles discharged, sending a second burst of electricity through the patient.

Reed held his breath as he watched the chaotic rhythm on the monitor slowly respond—first one regular beat, then two, then three, each perfectly formed and evenly spaced.

Slowly, the congressman opened his eyes.

Reed let out a sigh. “Welcome back,” he mumbled, willing himself to appear calm even though his own heart beat wildly. Fearing another complication, Reed quickly inflated the balloon inside the artery, compressing the occlusive plaque against the wall. The fully expanded balloon also extended the surrounding stent, pushing it into place in the vessel. Within the widened passageway, blood could now flow freely to the starved muscles of the heart. Almost immediately, Prescott’s color improved. His vital signs now stable, the congressman slipped into a restful sleep.

Reed deflated the balloon and removed it along with the catheter. His own heart rate had slowed to normal, and the butterflies in his stomach were gone.

The resident shook his head in awe. “Great save.”

A voice cracked on the intercom. “Dr. Wyndham. I’m calling for Dr. Eisenberg. Do you need him?”

Reed looked at the wall clock. Twenty-five minutes had passed. In total, eighty minutes from door-to-balloon time. Reed allowed himself a grin. It was a great save. He’d opened the artery and saved a life.

“No, no,” he said, pulling off his latex gloves. “We’re okay now.”

Kaye almost didn’t hear the muffled ring of her cell phone over the sounds of the roaring winds rattling their balcony doors. By the time she pulled it out from under her pillow, the caller had hung up. ID read Private Caller. Again.

Kaye tiptoed into the study as the phone rang a second time. It could only be Miller. No one else had the nerve to call her private line in the middle of the night.

“An unfortunate accident at the party tonight,” Miller began.

That bloated pig, Prescott, no doubt. Kaye waited to hear news about the porcine congressman.

Instead: “One of your girls is dead.”

Dead?

“We may have had some leakage. I’m sending my men to sweep her apartment.”

Now Kaye was on high alert. “For what?”

“The girl was a snitch.”

Kaye felt her heart jump. It had been a gamble sending Sylvie to spy on that Arab. Despite wavering loyalty, Sylvie had always been the best foxhound on her team. For years Sylvie’s pillow talk reports had kept the madam and most of her girls out of jail. Clients were much less inclined to disclose Kaye’s business once they realized she possessed secrets about their business. And every now and then, a few of those tidbits fed to a “friend” at the LAPD kept the vice squad from knocking at her door. To the cops, Kaye was more valuable gathering dirt on the street. Dirt that could bring down a white-collar target.

“My girls are straight shooters,” she said. “Someone has an active imagination.” Her phone read 2:14. Yevgeny should’ve found the client list Sylvie had stolen by now. Annoying enough having to convince Ana to join Sylvie at the party so Yevgeny could search the girls’ flat. It would be more than inconvenient to have Miller’s people run into her undocumented Russian hatchet man there.

“Fahim caught her spying.”

“I don’t believe it,” Kaye feigned indignation, though her emotions were a mixture of anger and ice. Damn that Sylvie. After ten years, the girl had gotten too overconfident, too aggressive. Kaye wouldn’t be sorry to see Sylvie out of the way—once Yevgeny found the copy of that list.

“So sad, such a young girl.” Miller’s concern was unconvincing. “Apparently too much cocaine and went off half-cocked running down the road. Poor Fahim tried to stop her, but she was too fast. She must have stumbled, knocked herself out. And then the fire. Such a tragedy.”

Kaye wasn’t swallowing the story. She was outraged that that Arab john had murdered one of her girls. She’d catered to the tastes of sadistic clients many times, but there were limits. “Where is ‘poor’ Fahim?” she asked, the edge now clear in her voice.

“We’ll take care of Fahim,” Miller said, “and Anastasia’s body, of course.”

Anastasia? Kaye frowned. She’d told Sylvie to go with Fahim. Ana had hooked up with that cock-driven congressman, Prescott. Hadn’t she?

“Anastasia Pappajohn. She is one of your escorts?” The question had the barest hint of menace.

“One of my personal assistants, yes,” Kaye said smoothly. Who had spoken to her on the phone less than an hour ago. About Prescott, not Fahim. Wait. What had that stupid girl said? Something about losing her purse?

“Well, then, Kaye, my deepest condolences.” Abruptly, Miller clicked off.

Kaye stood staring at her cell, her mind racing. Anastasia’s body. So Miller believed Ana was dead. Kaye allowed herself a small smile as the truth dawned on her. Considering Sylvie’s unforgivable betrayal, perhaps it was a stroke of luck that Sylvie was the real victim. Yevgeny would soon return the stolen information to Kaye’s safekeeping, and Sylvie would no longer be a threat.

Kaye’s smile vanished with a new fear. Might Sylvie have bought herself a backup plan? Spilled the info on Kaye’s clients and their Achilles’ heels to Ana? If so, there would still be loose ends, running loose.

Kaye speed dialed the next number without looking. “Dobroye ‘ootro, Yevgeny.”

CHAPTER FIVE

December 24, 1999

L.A. is a city that thrives on scandals, so, by the two a.m. break, news of the fires had been relegated to the crawls running under the video footage of Courtney Phillips’s tumultuous journey to the ER for what was diplomatically labeled “exhaustion.” Eager to learn more about the burn victim discovered earlier, Sammy had asked Jim to follow up with the police.

As she waited, she gazed at the TV monitor in frustration. The shaky, grainy videos of the screaming starlet playing on the screen hinted at a more substantive cause for her trip. Or, more accurately, “substance-tive.”

Jim hung up the phone and flicked on his intercom. “They found the fire victim. Young woman. Breathing.Took her to LAU Med.” He added in a patronizing tone, “Los Angeles University Medical Center.”

So she was alive. That was lucky. It’d be nice to give the listeners some good news. Frowning, Sammy checked her clock. Five more minutes until her third hour. She glanced again at the TV screen now displaying a chaotic scene at the LAU Med ER. Drug-addled actors, keystone cops, and frenzied paparazzi. Welcome to L.A. “Can you please call the hospital? See how she’s doing?”

“Sorry,” Jim hit Enter on his keyboard. “Just sent you the number. I gotta go to the can.” Still clutching his coffee, the producer grunted as he rose and shuffled out of the studio.

Shaking her head, Sammy opened the e-mail on her computer, which typically displayed callers’ names and topics. If she had any, that is. Despite the excitement in the Santa Monica Mountains and at the Westwood hospital, the phone lines were mockingly unlit. She pressed the button of an open line and dialed the digits for the medical center.

“I can’t tell you anything,” the triage nurse responded after several transfers. “You’ll have to talk to a doctor. Please hold.” Again.

Two minutes left. Sammy drummed her fingers on her board, impatient. Finally, after multiple rings, someone in the doctors’ lounge answered. “Hello?”

Sammy dived in, “I’m looking for information on the young woman just brought in from the fire zone.”

There was a pause on the other end of the line. Then, “Hello, Sammy.”

A voice from the past. Reed. An unwelcome giggle rose in her throat. “Hey, what are you doing here? I mean, I know you’re a doctor, but I thought you were still in Boston.”

“Just started a cardiology fellowship out here in July. Glad to hear you on the radio again,” Reed said.

“Yeah, me, too. We, uh, gotta catch up, you know.” One minute on the clock. “Listen, you wouldn’t happen to know what happened to that fire victim?”

“Actually, I saw her, but she’s not my patient. They’re working on her now. Kind of touch and go.”

“Thirty seconds,” intoned Jim, back on the other side of the glass.

“I hope she makes it. Any ID?”

“You can’t put it on the air. They’ll need to contact family first,” Reed explained.