Pennsylvania's Finest, page 24
Knight looked up at the anesthesiologist saying, “What are you talking about?” It was apparent that he had not been listening to nurse Warner’s operatic summary.
“Tosca,” was the anesthesiologist’s response as he reoriented Knight to the conversation.
Nurse Warner sensed that her time was now limited and rapidly continued, “With a heavy heart she agreed, and old man Scarpia proceeded to immediately manhandle the beautiful young girl.”
“What are you talking about nurse Warner?” said Knight again with a concern in his voice.
Then, while continuing to describe the scene, nurse Warner said, “But Tosca had a hidden knife, and stuck it into the old fart’s gut, killing him.” She then acted out Tosca’s lethal forward lunge with a twist of her hand saying passionately, “Here is a kiss from Tosca.” Her theatrical thrust was directed straight towards Knight, who suddenly realized the implied parallels between Tosca and physician assistant Ranier.
“Bravo,” said Polk, “Magnifico.”
Knight then turned around to face nurse Warner who continued to twist her wrist back and forth in his direction. She had a smile in her eyes.
“That will be enough nurse Warner,” said Knight in a calm and stern voice. “That will surely be enough.”
“But what happened to Tosca and Mario?” asked nurse Frey.
“He was shot by a firing squad and she committed suicide,” said Warner rapidly. “Jumped off a cliff.” She then turned quickly away from Knight and walked away. Her mission was accomplished.
“Good God,” said the anesthesiologist. “Love stinks.”
“Great ending,” said Polk. “Everybody dies. I could have written that one.”
“Enough with Tosca!” barked Knight now fully aware of the tragic opera’s similarities to his life. “Enough! We’ve got a surgical problem on our hands everyone. Let’s act like professionals people.”
Knight then turned back to the damaged heart valve in front of him. He paused to regain his composure, then saying in a somewhat tragically sad tone, “Let’s get this thing replaced. Turn the music down. In fact, just please, turn the music off.”
There was no verbal response from the surgical team. Everyone was trying to mentally register the exchange that had just occurred. Polk looked at Phil noting a very serious and uncomfortable tone in his face. Larson looked back at nurse Warner who stared directly at him with a smile, her head nodding up and down in victory.
The remainder of the case was uneventful. The soprano’s damaged aortic valve was replaced with difficulty. Knight’s experience and technical skill led to a successful outcome. Helga Cox’s vitals remained stable throughout the case. She was then transported to the recovery room in good condition. Upon completion of the procedure, Knight left the room without saying a word to anyone. Fatigue and sorrowful emotion engulfed his body as he plodded out of the surgical theatre. The tension in the air was palpable.
Helga Cox sailed through the recovery room that day. Her postoperative course during the next twenty-four hours was unremarkable. Knight brought the starlet a large bouquet of roses the morning after surgery. The Philadelphia Chronicle ran a short article in their society section regarding her successful surgery. Rave reviews surrounded Knight and his cast of characters in reference to the principle vocalist. Knight was convinced the success would land him the coveted chairmanship of the Academy of Music next year.
Unfortunately, the Dallas diva was murdered per protocol, on postoperative day number two. The cursed team of Dr. O’Keefe and nurse Cruise were again unsuspecting witnesses to the event. A code was called that afternoon after an iatrogenic dose of potassium was administered to Ms. Cox. Her heart responded in physiologic fashion, triggering a fatal arrhythmia.
Throughout the code, Dr. Knight and his surgical team were in the operating room, completing the final case of the day. Shocking verbal reports were constantly relayed into the room, updating Knight on the progress of his superstar. With a patient’s heart exposed directly in front of him, the distraught surgeon stoically held his post. All news was bad news that fateful day. Soon afterward, a saddened Chairman Barnes entered the room, announcing the death of Helga Cox.
Sorrow and disbelief seized the head surgeon. He instructed nurse Warner to immediately play the second movement of Beethoven’s Seventh Symphony in honor of the maven. No other words were spoken throughout the remainder of the case. Sadness gripped the team as the angelic voice of the deceased echoed through their minds. Knight turned the closure over to the resident team and wandered unsteadily out of the room. All eyes were upon him as he slowly walked down the hallway towards the locker room. The eerie sound of a violin section trailed behind him. No one dared turn off the music until Knight had left the floor, heading to the deathbed of his patient.
Upon entering the room of Helga Cox a single white sheet covered her entire body. A representative of the cleaning staff was present in the room, amid a sea of debris generated by the code. The mere presence of Knight sent the cleaning lady scurrying out of the room. All was quiet as Knight approached the bed. He slowly lifted the sheet off the head of the patient, exposing the peaceful, blue face of Ms. Cox. Knight laid the back of his hand upon her cheek, which was ice cold. A tear slowly worked its way out of his left eye, as he wiped some clotted blood off the split lip of his patient. He then whispered words of solace to the deceased, who lay motionless in front of her beloved surgeon. Knight then recited a solemn prayer prior to gently placing the white sheet back over the head, seeing her for the last time.
He looked up, dazed. Signs of a chaotic cardiac resuscitation abounded. A nearby garbage can was filled with once sterile gloves and dressings sponges. The cardiac crash cart was in disarray with drawers opened, and supplies depleted. Vials of epinephrine and cardiac stimulants lay empty atop the cart. Above the patient sat several monitors, each turned off with no signs of life. Knight’s mind automatically reenacted each step of the unsuccessful resuscitation. Questions immediately arose as to who ran the code, and where were his fellow attending surgeons? Why did she die so suddenly? Someone surely had to be held accountable for this death.
His gaze then centered upon an I.V. pole near the head of the bed. It was supporting multiple bags of I.V. fluids that were hung haphazardly during the event. Knight reached his hand up to inspect the content of each bag of fluid, slowly rotating every liter in order to expose its label. Standard mixtures of saline and electrolytes were noted. All fluids were appropriate, except for a single mixture hidden in the midst of the larger fluid bags. Knight’s hand grasped the empty fluid container and lifted it off the pole, bringing it to eye level. A label, generated by a computer, identified the patient’s name and medical record number. Below the bar code read Potassium 80 mEq. The time registered on the sticker was noon, of that fateful day.
A collision of thoughts then roared through the mind of Richard Knight. Immediately, the deceased names of Katherine McDuff and Brett Charles came to light. The trusting face of Willie Brown appeared, as did his voice, calling Knight his “Messiah.” The snickering laugh of Dr. Falcon and her band of morbid pathologists arose, as did the wording of her reports. Knight then pictured the smug Dr. Riles, sitting in the front row during M & M Rounds, instigating doubt amongst the surgical department. The seemingly rational plan to ratchet up his surgical volume resonated in his cranium. Lastly, and most oddly, a picture of Jennifer Ranier entered his mind. It was a sad Jennifer, leaving her penthouse apartment in squalor and disgrace. She slowly carried a small moving box in her hands down the hallway towards the elevator. She appeared very pale. Ghostly music from Tosca then sang out, freezing the premier surgeons cognition, immediately bringing him to a physical and emotional standstill.
A voice from behind broke the gridlock saying, “Richard, Richard.”
Knight turned around to see Chairman Barnes standing in the doorway. A solemn look was upon his face.
“Michael,” said Knight while still holding the empty bag of potassium. “Someone is killing my patients.”
“I know,” said Chairman Barnes. “I know.”
Chairman Barnes then escorted the beleaguered surgeon to the office of Howard Rineman. The CEO of the hospital system awaited their arrival, having been earlier alerted by Dr. Barnes. Over the next thirty minutes Rineman and Barnes described their previous conversations with the hospital’s Information Technology department. They tactfully explained to Dr. Knight the monitoring system set up by James Asher, who just hours ago alerted Rineman of a breach into the system. Dr. Knight was initially caught off guard with the description of the covert operation. His bemusement slowly turned to anger as the discussion continued.
“How dare you monitor my patients without informing me!” screamed Knight.
“Richard, calm down,” said Rineman. “A concern was brought to our attention by the I.T. department, and we made an appropriate response.”
“That was my damn concern! I brought it to the attention of Asher,” said Knight in disbelief. “How long has this been going on?”
“About six weeks,” said Barnes while shaking his head in disgust. “This whole plan of yours was a bad idea Richard. Just a bad idea.”
“Don’t change the subject Michael. We all agreed to the plan a few months ago. Do you remember, we were sitting in this very office?” said Knight.
“I’m not sure I technically agreed,” said Chairman Barnes.
“Gentlemen, please,” said Rineman. “The problem at hand is an identified breach into our seemingly secure hospital computer system. This is a very serious matter.”
“Who else knows about your monitoring setup?” asked Knight.
“Legal counsel for the hospital was present when we talked to Asher,” said Rineman. “Counsel agreed to the plan, and thought it was an appropriate response to a concern raised by a single surgeon.”
“You’re all a bunch of idiots,” barked Knight.
“A surgeon who quite frankly, has been under a lot of self imposed stress,” said Rineman calmly.
“Your obsessed with the Chronicle article,” said Barnes.
“Don’t call me obsessed,” yelled Knight. “Somebody is killing my patients! Don’t you understand?”
“Hold on you two!” said Rineman. “Please, settle down.”
All three men then took a deep breath while trying to gather their composure. Knight leaned forward on his chair, holding his head between his hands, while looking at the floor. Rineman was staring directly at Chairman Barnes shaking his head in disgust. Chairman Barnes appeared pale, realizing the consequences of his passive agreement to Knight’s warped plan.
“Now,” said Rineman after a sense of order was restored. “Let’s not jump to conclusions about patients being killed.”
“What else can explain the deaths of four of my patients?” asked a dejected Knight.
“What we know is that someone has breached our computer system,” said Rineman ignoring Knight’s question. “We are also aware of your recent string of postoperative fatalities.”
“We need to call the police,” said Barnes, who appeared ready to vomit.
“We just can’t haphazardly connect a computer security leak to a series of deaths within the hospital,” said Rineman.
“Where is Asher?” asked Knight. “Where are the overpaid attorneys that you call legal? I mean, shouldn’t they be here in the discussion.”
“Asher is in California,” said Rineman holding his hands up in a calming fashion towards the two surgeons. “I just got off the phone with him, he is heading back as soon as possible, will be in town early afternoon tomorrow.”
“He did alert you to the system breach?” asked Barnes.
“Yes, the alarm was triggered around noon time today,” said Rineman.
“Well, who is killing my patients?” asked Knight. “He must know the identity of the intruder.”
“Apparently its not that simple,” replied Rineman. “He got into a lot of technical jargon, saying the trail had to be followed a bit more.” Rineman then looked at his two friends staring at him in disgust. He then methodically said, “He assured me by tomorrow he would have the identity code of the intruder, at least that’s a start.”
Rineman then began to inform the duo of a planned meeting for the next day. He had already alerted legal of the matter, who agreed to be present. The CEO then assured the surgeons that prompt action would be taken under the guidance of the legal department. A lengthy discussion then occurred between Rineman and Barnes regarding the pros and cons of alerting the local authorities.
Throughout the discussion, Dr. Knight’s thoughts were consumed by the realization that someone was methodically murdering his patients. A single question arose in his mind - “Who?” His memory spontaneously imported and exported the names and faces of hundreds of people. Who had he wronged so badly in the past, that their retribution would be so severe? Certainly his demeanor and demand for excellence had stomped on the ego of many a medical colleague and resident. Could it be another physician? Over the past twenty years he had been part of multiple business ventures, some successful and others not. Had he ever knowingly brought financial ruin to a fellow investor? He recalled thirty years of womanizing, along with the peculiarities of each tryst. Was it a jolted lover or jealous husband? Family members and close social acquaintances from Philadelphia entered the thought process. Who had he rubbed wrong within the upper crust of society? To the disturbed doctor there was no obvious answer, only a recurring question -”Who?”
“Richard, are you with us?” asked Rineman. “Do you agree?”
“Agree with what?” asked Knight snapping out of his fog.
“That we hold off on notifying the local authorities until after our meeting tomorrow afternoon?” said Rineman, aware that Knight had no knowledge of the discussion that just occurred.
“Yea, yea, that’s fine,” said Knight while reorienting himself. “What time tomorrow? Isn’t it New Year’s Eve?”
“3 PM” said Rineman. “And yes, it is New Year’s Eve, but this matter cannot wait.”
“No problem,” said Knight without recalling the longstanding reservations that he and his wife had for the night. “No problem, we all have to be there, and get to the bottom of this.”
The three heavyweights of the Philadelphia General Hospital system then dispersed in solemn fashion. Knight spent the next three hours consoling the grieving family of Helga Cox, who remained sadly unaware that their loved one was murdered on that very cold December day.
CHAPTER 22 The Token
Dr. Knight suffered a fitful night of sleep that evening. The Cox family was distraught over the loss of their loved one. A close relative of the deceased was a pathologist from the Dallas area, who demanded an independent autopsy be performed, outside of the PGH system. Knight obliged to the request, and the body of Helga Cox was transferred to Jefferson Hospital in downtown Philadelphia. The autopsy report and final wording were therefore out of the hands of Knight and his PGH machine.
Adding to his angst was the fact that Chairman Barnes called him late that night with news regarding the Chronicle article. Barnes informed him that Associate Editor Russo had completed his article, which was ready for public consumption on New Year’s Day. The Chronicle always released this series on New Year’s Day, realizing that the majority of the populace was at home and therefore more inclined to read the article. Russo was calling for an update on the numbers and data from the cardiothoracic department. His statistic department was tallying the final percentages for each hospital and physician. The deadline for the final numbers was that very night. Incapable of telling a lie or stretching the truth, the chairman’s update was accurate, and included the fatality of Helga Cox on that very day. Russo was only capable of saying that Dr. Knight’s numbers were running “right in line” with the others. Of course this was prior to receiving the update, which included another fatality. Beyond that wording, Russo would divulge no further information regarding the ranking of Dr. Knight or the PGH cardiothoracic department.
Lastly, the news that her New Year’s Eve plans were being disrupted did not sit well with Mrs. Knight. To offset the pretense of their relationship, Mrs. Knight courted personal satisfaction outside of the physical realm. She enjoyed society and everything about it, including her perception within society circles. Over the past three months she served as the planning co-chairperson of a benefit gala supporting breast cancer research. The confirmed guest list for the event included the Philadelphia elite. The “must be seen at” gala was scheduled for New Year’s Eve and included a formal dinner and orchestral band. The thought of not having her husband next to her at the head table was unacceptable, the equivalent of social suicide. She made every effort to avoid this scenario. As a veteran wife of a surgeon, she repeatedly notified every scheduler in her husband’s chain of command in regards to the event. Constant reminders were personally given to her spouse over the past several weeks, all met with an incredulous sense of insult, and absolute commitment to attend. Then, twenty-four hours prior to the event, she received a terse notification from her morbid husband that his attendance was in jeopardy. Upon hearing the news the usually reserved Mrs. Knight went berserk, verbally abusing her spouse to the fullest degree. Even the calloused surgeon was taken aback by the malice and disdain in her words, prompting him to compromise a bit. He promised to wrap up the critically important meeting at the hospital by 4 PM and then, meet his wife at the event, dressed in full tuxedo by 5 PM. The timing would be close, but possible if all went well. Mrs. Knight begrudgingly agreed to the plan, yet still protested the whole situation, in order to stress the social magnitude of the dinner.
To make sleeping matters worse, Dr. Knight had a bizarre dream that night. He dreamt being rolled into operating room number four as a patient, then being placed on the surgical table by the nursing staff. The disdainful nurse Warner helped to shift his body onto the table, smirking at a seemingly comical view of his partially exposed genitalia. The table was cold and the atmosphere unwelcoming, as the bright overhead surgical lights shined in his eyes. Loud, heavy metal music was being played over the stereo system. Then a surrounding cast of surgeons appeared on each side of the table. Behind their surgical masks Dr. Knight was able to identify interns Polk and Drummer. Chief resident Larson was present and standing strangely next to CEO Rineman, who appeared frightened. Knight tried to speak and argue the fact that he didn’t need surgery, but the head of the anesthesiologist peered over a sheet with a smile, asking him to relax. Knight tried to recall why he was being operated on, and what led to this surgery. However his mind was blank, only finding solace in thoughts of Jennifer Ranier, and the good times they had spent together. Her carefree and spontaneous nature warmed his heart, as did the momentary belief that they were still together and heading away for the weekend. Certainly she would care for him throughout the post-operative state, easing his expected pain. Then nurse Frey’s voice could be heard welcoming a surgeon with dismay. Knight looked up to see visiting professor Riles step up to the table as the others stepped aside. He then asked his exiled son to stand beside him in preparation for surgery. The youngest Riles then took a scalpel and began to incise the chest of Knight, causing an intense pain. Knight let out a vile scream, which awoke him from the nightmare. Spontaneously he then reached for his wife who was not beside him, choosing to spend the night in a separate bedroom of dissent. Suddenly the surgeon felt completely alone. The room was dark and the walls seemed close. A realization that Jenna was no longer with him occurred. Howling winds rattled the shutters of the historical house as a cold chill blew through the antique windows. The frightened surgeon then spent the next hour trying to morally examine his conscience, in a way that his father taught him as a young boy. Unfortunately, he self graded the attempt a failure.
