CHAPTER FIFTEEN

There wasn’t a sunset that evening, just clouds and rain when they left the hospital. Jack had to stop for gas immediately if he was going to make it to Ms. Kovalenko’s hotel then get back home. With the rush hour traffic sizzling by on Bangalore Boulevard, he pumped gas into his SUV and could see through the car window that Marianna had turned to talk with Kaitlyn, who was in the back seat. He heard faint laughter and could see they were smiling. Kaitlyn was a bright kid. Tré clearly enjoyed her company—he’d kept her busy all afternoon. The resemblance between his niece and his wife was uncanny sometimes, but he noticed it less this evening, for some reason. Maybe the thought of Falconi’s visit was lifting his spirits.

Back in the vehicle, he set the GPS for Marianna’s hotel and got back into traffic, which was heavy.

“Dr. Forester,” said Marianna. “You were going to tell me something about your new project. I would very much love to hear.”

Ah, yes. How much should he share? Giving her some generic details shouldn’t be a problem. Genomic medicine research. Powered by AI. The possibility of building a new center here at New Canterbury. But it was all only a remote dream at this point.

“My God,” Marianna said, listening intently. “That is wonderful. What a super idea. I hope that you may you have great—”

She was interrupted by the ringing of his phone over the vehicle’s speakers. It was his brother Tony. He tapped the answer icon and Tony’s voice erupted before he’d even said hello.

“Slow down,” Jack said. “You’re saying Chad is sick? Repeat what you just said.” He glanced over at Ms. Kovalenko and whispered, “It’s my brother.”

The details emerged. Tony was still at Aldiss Scrap. Chad was too sick to drive them home. Lots of coughing, and he’d fainted and thrown up. Now he’s having trouble breathing. His skin is hot. He’s on the floor shaking.

“Okay, Tony. Hang on. I’m going to head over right now. We’re not that far away. I’ll call an ambulance to meet us there.”

He hung up and looked over at Marianna. She’d already grasped the situation.

“Please, not to worry about me,” she said. “Go now. I can be at hotel later. This is more important.”

On the outskirts of town already, he kept the vehicle moving as quickly as the potholes would allow.

“What do you think’s going on, Uncle Jack?” asked Kaitlyn, sounding worried. “Does Chad have pneumonia or something?”

Jack glanced back at her and nodded. “That’s a good thought, Kaitlyn. We’ll know soon.”

Gina braced herself as Forester sped through the dark and rain. They were soon passing through countryside that looked almost uninhabited. He took a particularly sharp corner, and she looked back to see the girl Kaitlyn swaying from side to side with the same focused looked in her eyes that Forester had.

“The night is dark,” Gina said.

“Stygian,” said Kaitlyn.

“Good word, yes,” she said. “From where did you learn that word?”

“It’s a band I like.”

“We’re close,” said Forester. “It’s right after this hill.”

They crested the rise and she could see the sprawl of a few large buildings and many lights down in a small valley.

“That’s it,” he said.

Gina relaxed at the presence of light. The pieces were falling into place. Forester had been stingy with details, not surprisingly, but he’d now let enough slip. The answer lay with Damien Falconi. She had Googled him that afternoon while waiting to interview a professor of internal medicine, which had been a total waste of time. Falconi was a very wealthy tech entrepreneur, and he was coming to New Canterbury tomorrow. Forester wanted him to bail the hospital out and finance the creation of a genomic research center. That had to be it. She would call Potemkin with the news as soon as possible.

Then would come the hardest part of her job. How to disrupt those plans? She could not let herself fail.

Windshield wipers slapping, they passed a sign that read Aldiss Scrap and Recycling, LLC. Well . . . It was a small world after all. She had to smile. This must be Potemkin’s local scrapyard, the one run for him by the man she could reach out to for help via the burner phone. This was a good omen. She crossed herself.

Forester noticed. “Does my driving scare you that much?”

“No, Dr. Forester. Of course not. It is just my habit when reaching destination.”

The scrapyard’s main building was a warehouse-like structure. Off to the right lay a field strewn with junked vehicles. The complex appeared to be bisected by a rail line they now thumped across. Forester turned the car into a gravel lot and parked in a row of cars and pickups.

“We beat EMS,” he said, leaping out. She climbed out into the drizzle and watched as he opened the hatchback and grabbed a black plastic suitcase, then dashed for the door, his niece close behind. Hindered by her heels on the gravel, Gina strove to keep up. A tall man at the counter was waiting for them. He had a brush cut and biceps bulging inside a long-sleeved black T-shirt. “You must be Dr. Forester,” the man said, and Gina registered his Russian accent. “Your brother said you were coming. Follow me.”

He introduced himself as Freddy Sokolov. That was him. Her contact. Fabulous. He looked capable. Sokolov led them behind the counter into a high open space divided by shelves rising to the ceiling, stacks of old computers, and monitors everywhere. A thunderous noise was vibrating through the building, a horrific banging sound. She clamped her hands over her ears. Forester slowed and his niece glanced around with a frightened expression.

“It’s just the shredder,” Sokolov shouted, laughing. “I’ll ask them to stop for a while.” A group of people were hovering around a man lying on the concrete. “Doctor’s here,” Sokolov shouted, and they moved aside. The awful din suddenly ceased. Gina had been bracing herself against it, and when it vanished, she felt slightly off-balance.

“Hi, Chad,” Forester said, as he knelt beside him and opened the black case. The young man’s eyes were half closed. He was pale and sweaty, and his respiratory rate was extremely fast.

“Dr. Forester,” Gina said. “Remember that I am a nurse. I once work for a while in the ICU. May I be of help?”

“Absolutely. You start the oxygen and check his vitals, and I’ll get an IV in.”

He took out a small green canister and she retrieved the oxygen tubing, fitting the cannula into the man’s nose, introducing herself as she worked. He smiled at her.

Forester got out the IV supplies and ran scissors up the man’s shirtsleeve to expose the arm. She clipped a pulse oximeter onto his fingertip and wrapped a blood pressure cuff around his other arm. Even on oxygen, his saturation was only 89 percent. His blood pressure was 85 systolic and his heart rate was over 120.

“Please get us a bag of saline,” Forester said, as he slipped in the IV needle.

She reached for the saline in his emergency kit, impressed by the contents. It was a mini crash cart. It contained intubation gear with various laryngoscope blades and endotracheal tubes of different sizes, along with a labeled plastic rack of medication vials. Though it had been a few years since her ICU days, she recognized most of the drugs—epinephrine, atropine, norepinephrine, adenosine, metoprolol, lorazepam, rocuronium, etomidate, and ketamine.

Ketamine. Interesting. A dissociative anesthetic agent, it was extremely useful in the ICU and ER for procedural sedation, including for intubations. It also had abuse potential as a hallucinogen.

She hooked up tubing to the IV bag and Forester opened it wide. “Let’s give him the whole liter ASAP.” Surprised at how much she remembered, she stood, holding the bag high while Forester started a second IV in the other arm. They needed to get in as much fluid as possible, two or three bags.

Gina motioned Kaitlyn to come closer. “Please hold this bag up while I get another one ready.”

Forester was doing a more thorough physical exam now, listening for heart and lung sounds, and palpating. “Look at this,” he said to her, pointing to a long scar running diagonally on the upper left abdomen.

She bent and peered more closely. “A scar of surgery?”

Forester nodded. “Chad, do you still have your spleen?”

The man looked more alert now. “No, Dr. Forester. I fell out of a tree when I was eleven and they had to take it out. Is that important?”

“It can make you more susceptible to some infections,” Forester said. “Marianna, is the other bag of saline ready?”

Retrieving it from the kit, she glanced again at the ketamine vial. Special K was its street name. Dmitry had tried it once and talked about the hallucinations, had asked her to steal him some from the hospital, which she refused to do. Its place was for patients, she’d told him. In the right dose it turned people into zombies for about half an hour, during which time they felt no pain and were oblivious to what was going on around them, sitting there with eyes wide open, breathing. You could kill them and they’d never know it.

The EMS unit arrived shortly thereafter. The medics greeted Forester like an old friend. They soon had the septic young man, this friend of Forester’s brother, loaded on a gurney. As they began rolling him outside toward the ambulance waiting in the rain, an idea came to Gina. She was walking next to Dr. Forester.

“I would like to ride in the ambulance to help,” she said. “They could use assistance of a nurse, I think. I have no license here, of course, but I have an extra pair of hands to be used.”

“That would be against our standard policy,” said one of the EMTs. “Unless you want to make an exception, Dr. Forester.”

Forester looked over and smiled at her. “If you could, please. She’s a nurse and she’ll only do what you order.”

“Fair enough,” said the EMT. “I’ll put it in my report. But if you trust her, it’s good enough for me.”

Forester reached out and shook her hand. “I am going to drop Kaitlyn off at home, then I’ll head right for the hospital with Tony to see how he’s doing. I’ll take you to your hotel.”

“Thank you so much,” she said, preparing to enter the ambulance. “By the way, Dr. Forester, I overheard early today that you are having a tour of the hospital tomorrow for the visitor. Might I be able to join in this?”

He looked at her for a moment, seeming to consider something, then smiled and agreed. “That’s the least we could do,” he said. “Thanks for your help.”