While Marwan showered, Dorothy slept, and Philip dressed, Ray Gilbert was scrambling to prepare himself and his patient for the short but exciting ride to NorthBroad. Unlike some large university hospitals, Allentown General couldn’t afford its own helicopter, so the hospital had arranged with a local airport to have a chopper and crew available on short notice. It was important to have this capability, even though they didn’t use it very often. It was a way of reaching out to their northern neighbors and attracting the referral business that had become so important to their bottom line. They knew that most of their feeder hospitals were able to stabilize almost all of their patients and ship them to Allentown General by ambulance, but the availability of air transport—at Allentown’s expense, of course—made the hospitals and doctors in the hinterlands feel secure and confident that their southern neighbor was there when they needed help in a hurry.
Given the cost involved, physicians weren’t permitted to order air transport without the authorization of the hospital administrator. So Gilbert had spent the last twenty minutes identifying which of the dozens of hospitals administrators’ turn it was to take the call. The person this particular evening had a day job running cafeteria services. Getting her on the phone and then convincing her that there was no other way to save the patient’s life was pure torture.
“Dr. Gilbert, can you tell me why we can’t just send the patient to NorthBroad by ambulance?” the administrator asked.
“We don’t have time for that, Ms. Savitz,” Gilbert said, trying to remain civil. “The patient is very sick and might die on the way.”
“And do you know if the patient’s insurance will pay for the transfer? It’s very expensive, you know.”
“I have absolutely no idea, and I don’t have time to check. We have to leave now. The helicopter is landing on our pad as we speak.”
“Dr. Gilbert, you should have cleared this with me before you called for the helicopter.”
“I was trying to save time and a life, Ms. Savitz.”
“I’m going to have to call the hospital president and get back to you, Dr. Gilbert.”
“Fine; you do that, Ms. Savitz. We’ll wait.”
Gilbert hung up and immediately went to the unit where Mr. Perini had already been transferred to a stretcher. He was scared out of his wits. His wife, Ellen, stood by his bed, holding his hand, trying to overcome her own terror while helping her husband remain calm.
“How much Valium have you given him?” Gilbert asked the nurse who was taking care of Perini.
“He’s had twenty milligrams IV over the last few hours, Dr. Gilbert.”
“Give him another five, and let’s go. Hospital administration has approved the helicopter.”
“They did?” the nurse asked. “Do you have the signed forms?”
“Being faxed—on their way. Now let’s get Mr. Perini on his way.”
The nurse, obviously wary, told Gilbert that she would have to talk to the nursing supervisor on call.
“Go right ahead. Liz Gold, my nurse practitioner, will take over until you get back.”
As soon as the nurse was out of sight, Gilbert told Liz to help him push Perini and his IV poles to the elevator and then to the roof. He invited Mrs. Perini to accompany them to the helipad; then he whispered to Liz, “We have to hurry, before the nursing supervisor or the dumb-ass hospital administrator puts the kibosh on this.”
While they waited for the elevator, Gilbert realized that he now had to replace the nurse for the transfer. He anticipated, correctly as it turned out, that the patient would need active resuscitation while in the air. Since the helicopter was for civilian and not medical use, Gilbert would have to bring his own people and equipment. A paramedic had been easy to recruit from one of the ambulance teams that hung out at the ER, but he needed somebody with considerably more experience and expertise in handling serious cardiac arrhythmias. The only person he could trust in this situation was his nurse practitioner, Liz Gold.
“Liz, I want you to go on the helicopter with me. Are you willing to do that?”
The decision was complicated. Beyond her concern for her own personal safety, Liz and Gilbert had lots of history, some of it good but most of it bad. Liz had been the nurse in charge of the electrophysiology program when Gilbert arrived to take his staff position. It was a small operation with a limited number of procedures, and Gilbert was charged with modernizing things, bringing in new procedures and techniques, and building referral. Liz found all of this exciting and spent many hours with Gilbert, organizing the program, hiring staff, previewing and buying new equipment, and even working with architects to design a unit to house and monitor the arrhythmia patients they planned to attract.
It didn’t take long before Liz and Gilbert started to spend a lot of time together outside the hospital. Sure, they brought along work that they pretended to care about and discuss, but as time went by, the venues became much less amenable to work than to plain old cheating. The affair should have been predictable. Both were good-looking. Liz wouldn’t be mistaken for “pretty,” but she was a maniacal exerciser who kept her forty-year-old body trim and athletic. Gilbert was younger than Liz and also had a good body, his by genetic default, with boyish good looks that had always gotten him the women he wanted. And Gilbert was a hound, already known to have preyed on several nurses and staff at the hospital, even before his wife, Linda, had died. Liz knew all that and didn’t care. She was having some overdue fun.
Their flirting kept heating up until Gilbert leaned over and kissed Liz in a parking lot one night when he was dropping her off at her car. Groping led to petting led to motel rooms led to hot sex that neither could get enough of. And that would have been fine and dandy except for one small detail named Noah Gold.
Noah was Liz’s husband, a junior-college professor in Allentown who’d met Liz on a blind date shortly after her arrival from nurse practitioner school in Baltimore. Their courtship had been anything but promising. It wasn’t Noah’s doing. He was totally convinced that Liz was going to be his wife. Rather, Liz was the vacillator. She just wasn’t sure he was the one. She felt comfortable with Noah and lonely without him, and she knew her biological clock was running out of ticks, so after many months of uncertainty, she succumbed and agreed to marriage. Noah was ecstatic and spent the next few years attempting, in any way he could, to prove to Liz that she had made the right decision. They tried to have kids, but Liz couldn’t conceive. She was secretly relieved about that and found ways to delay the infertility work-up that Noah wanted so badly.
Which was a good thing, as it turned out, because shortly thereafter, Gilbert came along. Liz had feelings for him she never had for poor Noah. “Is it love,” she asked herself several times a day, “or infatuation that will eventually melt away?” It didn’t matter; Liz was smitten and had no plans to give up Gilbert for anything or anybody, including Noah.
Easy to say, but Liz was increasingly concerned that Noah was becoming suspicious about her absences. Liz frequently used nurse practitioner–practice meetings for cover, but Noah was now asking more questions about the subject matter of the meetings and who else from Allentown General attended. His questions convinced her that he was on her trail.
Liz knew she was playing a dangerous game. There were plenty of ways that Noah could discover her duplicity. People in Allentown liked to gossip, and Noah was friends with a number of people who worked at Allentown General. True, Noah liked to play the absent-minded professor, but Liz knew it was a ruse. He was keen observer who took everything in and, worse, had a temper that made Liz worry about what he might do to Gilbert and to her if he ever discovered their affair.
Fear of Noah’s reprisals and her animal attraction to Gilbert prompted Liz to pressure Gilbert to leave Allentown with her, to start their life together someplace—anyplace—else. Not exactly what Gilbert had in mind. Not only had he grown up in the area, but he liked his job at Allentown General and didn’t want to give up the referral practice he had so carefully built. He liked Liz a lot, and they had fun together, but she was not the woman he envisioned spending his life with, not by a long shot. He was enjoying his freedom.
So he made excuse after excuse for why he couldn’t take off with her and cohabit. They still saw each other because Ray enjoyed the sex, but Liz was impatient for a commitment of some kind. That they worked together only made things more difficult. His hope tonight was that she wouldn’t interpret his asking her to take on this emergency mission as anything more that it was—desperation. Her response worried him.
“If you need me, Ray, of course I’ll do it. I would do anything for you.”
“It’s a little dangerous, Liz. The weather is awful, and I expect that we’re going to have to continue to resuscitate Mr. Perini all the way to Philly.”
“I’m here for you, Ray.”
Crap, Gilbert thought. This woman has glommed on to me, and it’s not going to be easy to scrape her off. I’m going to have to work on that when I get back—if I get back. Right now, I have no choice.
“OK. Then let’s get this show on the road,” Gilbert said, trying to sound braver than he felt.
The helicopter was waiting for them. Harry, Gilbert’s enlisted EMT, had already assembled a defibrillator and a medical kit. Gilbert and Liz pushed the stretcher to the door of the chopper, with Perini’s wife, Ellen, walking briskly behind them.
“I’m sorry, Mrs. Perini, but we can’t take you on the chopper,” Gilbert turned to tell her. “Our insurance doesn’t cover family members, and this is going to be a wild ride with this weather. You can drive down there and meet us at NorthBroad. I’ll tell them to expect you. Shouldn’t take you more than an hour on the turnpike. Is that OK?”
Ellen was disappointed but relieved since she hated flying, and the helicopter scared her to death. “Whatever you say, Dr. Gilbert. I’ll make other arrangements with my family. Just make Nolan better, please!”
“We will, Ellen. I promise,” Gilbert said, only half believing it himself.
Gilbert next had to deal with the helicopter pilot, George Blake, a crusty Vietnam War veteran who owned the helicopter and piloted it for his customers. His copilot was his son, recently licensed, following his father into the private flight business.
“How you doin’, Dr. Gilbert? I’m your pilot, George, and this is my son, George Junior, or just Junior.”
“Nice to meet you,” Gilbert said, introducing Liz and Harry. “Thanks for taking us to NorthBroad.”
“Happy to do it, but I won’t shit you, Doc. We really shouldn’t be flying in this weather. I know you need to get this patient down there in a hurry. And if anybody can get you there, we can. I’m just warning you that you’re going to have to hold on for dear life. There’s a lot of wind and turbulence.”
Gilbert nodded and looked over at Liz and Harry, hoping they weren’t losing their nerve.
“You got your paperwork, Doc?” Blake asked.
As if on cue, Nolan’s heart went out of rhythm, setting off the portable alarm that was on the stretcher between his legs. Fortunately, after just a few seconds and before anyone could react, his defibrillator charged and shocked his heart back into a normal rhythm. It all happened so quickly that Nolan never had time to pass out. Consequently, he felt the shock. Sedated but awake, Nolan groaned, bringing Ellen back to his side to hold his hand and reassure him, tears welling up in her eyes, as they had so many times over the last several hours.
“You see, George, we need to get going right now. Can’t wait for the paperwork. My team and I are going to be pretty busy keeping Mr. Perini alive. So whatever you can do to keep our flight smooth will be greatly appreciated.”
“Got it, Doc,” George said. “Let’s get loaded up. We’ll deal with the hospital types later.”
A few seats had been removed from the passenger helicopter to accommodate the stretcher and to permit Nolan’s caregivers to access him from either side. The equipment took up almost all the rest of the space, so Gilbert, Liz, and Harry were forced to squat or kneel on the floor of the copter. George warned them again to hold on as best they could to avoid getting thrown around the cabin. After seeing all of the stuff they had brought on board, George dispensed with the lecture about seat belts and flotation devices that he normally gave to his passengers.
George steered a direct course to NorthBroad, making sure that air traffic in the area was aware of the urgency of the situation. Though clearance was not necessary because of their low altitude, George knew that everyone on his bird would appreciate knowing that the tracks had been cleared and that the NorthBroad staff would be waiting for them with open arms. Though they were bounced around in flight, they managed to avoid lightning strikes and were able to land precisely on target at the NorthBroad helipad. Perini had cooperated and had needed only a couple of shocks for arrhythmia, one with the device and one delivered externally to keep his circulation intact. Liz was liberal with the use of the sedative and narcotic drugs that were being used to keep Perini calm and minimally aware of the mayhem his heart was causing. Harry sampled vital signs every five minutes and sat by the drug box, ready to dispense whatever other medication Gilbert might need.
They were greeted by several members of the NorthBroad staff, including the nursing supervisor and an intensivist and anesthesiologist. Nolan was offloaded carefully, shielded by blankets against the torrents of rain and wind that were sweeping the roof of the NorthBroad hospital facility. They moved quickly and were just about inside the hospital building when all hell broke loose. Nolan’s heart went out of rhythm, and this time, when shocked by his implanted device, it decided to go flatline.
“Asystole!” Liz yelled as she looked at the monitor, which was followed by a full-scale cardiac resuscitation. Nolan stopped breathing and had to be intubated in the hallway by the anesthesiologist, who had thoughtfully brought along the required equipment. He used a bag to breathe for Nolan while they continued their sprint down the hallway toward the elevator bank. Gilbert was able to reprogram his device to begin to pace his heart artificially at a more rapid rate, and over the next few seconds, Nolan’s rhythm finally returned and with it, his blood pressure and ability to breathe on his own.
“Let’s knock him out with narcotics and put him on a ventilator as soon as we get to the EP lab,” Gilbert said. “There’s no point in having him awake for what they might have to do there.”
They maneuvered their way into the oversized elevator car, designed to transport patients with loads of equipment, exiting at the sixth floor. Two turns brought them to the electrophysiology laboratory, where Marwan and Philip were waiting anxiously, along with three members of the lab team who had been summoned from their beds to aid Philip. Two of the staff came out into the hallway, introduced themselves briefly, and then quickly wheeled the stretcher into the lab to begin their preparations.
Gilbert recognized Philip immediately and was impressed with how good he looked—a new beard, a lot more gray hair, but the same athletic body and piercing brown eyes behind stylishly oval spectacles.
“Dr. Sarkis, it’s so good to see you again. Thanks for doing all of this.”
“Happy to help, Ray,” Philip answered
“It’s been a long time.”
“Yes, it has, Ray. A lot of water over the damn.” Philip said, trying to remain polite but feeling deeply stressed as he anticipated getting started on the complex case that would determine whether Mr. Perini would live or die.
“We really need to catch up, Philip,” Gilbert said, hoping that Philip wouldn’t be offended if he called his old mentor by his preferred first name—not Phil, but Philip.
“That we will, Ray,” Philip replied, either ignoring the familiarity or not caring, wondering why Gilbert didn’t have the same sense of urgency about saving the patient. “For now, let’s focus on what we have to do to keep your patient alive.”