Royal Pains : Sick Rich (9781101559536) (6 page)

Nathan was right. His copter was fast. Very fast. It seemed to take only a minute to gain altitude and reach cruising speed.

We learned that the pilot's name was Vinnie Conner. Call sign Con-Man. A former marine copter pilot who had seen duty in both Iraq and Afghanistan.

“This baby's a Sikorsky S-seventy-six. Top of the line. She'll do about one-seventy. We should be there in no time.”

I watched the terrain whip by below. Once we settled into straight-line flight I unbuckled my belt and reexamined Jimmy. He was lethargic and poorly responsive to my questions. His pupils were small and poorly reactive from the morphine. His blood pressure was now low. Too low. Seventy over forty.

Divya mixed up a Dobutamine drip and I plugged it into his IV.

“Jimmy? Look at me.”

His eyes fluttered open and he looked toward the ceiling, unfocused.

“Jimmy?”

He jerked in a deep breath and then his gaze landed on me. “Doc? How am I doing?”

“Blood pressure's up to one-oh-five,” Divya said.

“Better. Just hang in there, Jimmy. We'll be at the hospital shortly.”

“Never been in a helicopter before,” Jimmy said. “Wish I could see out the window.”

I laughed. “Maybe next time.”

“ETA is four minutes,” Vinnie said. “They'll have a crew waiting on the roof for us.”

“You sound like you've done this before,” I said.

“After the Marines, I flew a medevac copter for a while. Out on the West Coast. That's what I was doing when Nathan hired me.”

“You like this better?”

“Who wouldn't? This Sikorsky is a great rig, Nathan is an easy boss, and the pay is off the charts. Not to mention some pretty nice digs.”

“I take it you live on the property?” Divya asked.

“One of the guesthouses is part of the deal.” He raised a hand and then spoke into the mouthpiece of his headset. “Three minutes. We're passing over the freeway right now.” He listened a beat and then, “Roger that.”

“Roger that,” Jimmy said and then he laughed.

Morphine is a great drug. It'll make you giddy in even the direst of situations.

The freeway, packed with traffic, slid by beneath us. Good thing we took the air route. Wouldn't want to be sitting in that. The copter now began to rock and bounce.

Turning his head toward us, Vinnie said, “There's always a bit of wind with these rooftop landings.”

“Roger that,” Jimmy said and giggled again. “Roger that, Roger.”

“You guys might want to make sure he's secure and then buckle up again. It can get a little rough.”

We did. It was.

The copter pitched and yawed, but Vinnie handled it like a master. My heart not so well. It seemed to take refuge in my throat. Finally I felt the runners contact the roof and the engine drop to idle. I realized I'd been holding my breath and exhaled loudly. Through the window three men and a woman, each wearing dark blue surgical scrubs beneath white coats, ran toward us, a stretcher in tow.

When I stepped out of the copter, I saw that one of the white-coated men was Dr. Lloyd Baransky, Hamptons Heritage's best cardiovascular surgeon.

The other two men moved Jimmy from the lounge chair to a real stretcher, the woman holding the IV bag in one hand and our cardiac monitor in the other. They headed toward the entry door.

Dr. Baransky, Divya, and I followed.

“I understand it's an aortic dissection?” Baransky asked.

I went through the story with him as we followed the stretcher into the pre-op holding area.

“Let's get a CBC, SMA Twenty, PT, PTT, and type and cross for eight units stat,” Baransky said. “EKG and chest X-ray, too.”

The nurses transferred Jimmy to a bed and switched his leads over to their monitor. Divya took our portable unit and set it on the floor beside our crash kit.

I removed my laptop from my bag and popped it open. “Here's the X-ray we took twenty-five minutes ago.” The image appeared on the screen.

Baransky slipped on a pair of half-glasses and studied it. His brow furrowed. “Based on the mediastinal shadow, it looks like a Type One. Guess that rules out an endovascular approach.”

Aortic dissections—tears and rips in the aorta—are of three basic classifications. Type 2 involves the part just above the heart, the ascending aorta; Type 3 the descending aorta, the part past where the left subclavian artery branches off and heads toward the arm. Type 1 involves everything. The ascending, the descending, and most important, the aortic arch, the loop in the chest where the carotid arteries that supply blood to the brain come off. By far the most dangerous of the three types.

Endovascular treatment is the placing of a stent in the aorta to repair the tear. Perfect for Type 3 dissections and those involving the abdominal aorta. Not useful for the Type 1 that Jimmy Sutter had. He needed to be opened up. Soon.

“Somebody want to tell me what's going on?” Jimmy asked.

While blood was drawn, X-rays and an EKG taken, that's what Baransky did, even drawing a diagram on the back of Jimmy's medical chart to help explain what had happened and what needed to be done.

“Sounds serious,” Jimmy said.

“Very,” I said. “But you're in the right place. Dr. Baransky and his team will fix this.”

“I owe you, Doc.”

“You just get better. I'm going to call your wife again and let her know we're here and that you're heading for the operating room.”

“I know she's freaked out. Tell her to take her time if she's going to drive here.”

“Will do.”

Chapter 7

With Jimmy Sutter off to the OR, Divya and I headed down to the ER. It was quiet and calm, with only a handful of patients and neither of the major trauma rooms occupied. I remembered days like this from when I ran an ER. Moments like this, when you actually had time to think, were treasured gifts to any ER physician or nurse. Moments when you weren't so swamped with the injured and the ill that sitting down and reflecting was actually possible. Moments when you weren't jumping from crisis to crisis, catastrophe to catastrophe, barely finding time to breathe. These moments never lasted long, but they were always a welcome respite.

We each made a few calls, one of mine to Jimmy's wife. I told her Jimmy was on his way to surgery and that Dr. Baransky would talk with her as soon as he finished.

“How long does this type of surgery take?” she asked.

“Hours,” I said. “Could be five or six or could be twelve.”

“Twelve? Is it that serious?”

“Very. It's a complex surgery and takes time.”

“Is he going to be okay?”

“He's in good hands. He'll do just fine.”

I left it at that. I didn't want to tell her that the mortality associated with this type of dissection was not a small number. She didn't need to hear that right now. She needed comforting. She needed not to panic. After she promised to take her time driving over, I hung up.

Finally, Evan arrived in the HankMed van. Divya and I dropped him at Shadow Pond and headed out to do the follow-up visits we had delayed due to Jimmy's emergency.

Divya and I made it back to Shadow Pond just before six p.m. Divya packed up our computers and went inside while I restocked the emergency kit from the supplies in the back of the HankMed van. Just as I closed the rear and clicked the lock, Jill pulled up. I held her car door and she stepped out, purse over her shoulder, bottle of wine in her hand.

“I was hoping you'd make it back in time for dinner,” she said. “How's your patient doing?”

“He's in surgery. It'll be a long one so I don't expect to hear anything until very late tonight or more likely tomorrow.”

“I heard Dr. Baransky is doing the surgery.”

“That's right.”

“He's one of the best, so it should go well.”

“As well as this type of surgery can go.”

“A bad one?”

“The worst. Any aortic dissection is tricky, but the one Jimmy Sutter has is at the high end of tricky.”

Jill's gaze settled beyond my right shoulder. I turned to see Boris's Bentley moving up the drive toward where we stood.

Jill and Boris had at one time had a strained relationship. Boris had given a very generous donation to Jill's community clinic. An anonymous donation. Something the very private Boris Kuester von Jurgens-Ratenicz takes seriously. Jill had mistakenly leaked his name in an attempt to garner more donors and word filtered to Boris. He felt Jill had betrayed his trust, which of course she had. She apologized, Boris accepted, and now all was back in balance.

Dieter parked next to the HankMed van and Boris climbed from the backseat.

“How is your patient doing?” he asked me.

It never failed to amaze me how Boris seemed to know things. Like he had a fly on every wall in the Hamptons. Who knows, maybe he did.

“You heard about that,” I said, more a statement than a question.

He shrugged.

“He's in surgery, so we'll see.”

He turned to Jill. “And you, Miss Casey? I imagine you're quite busy with your health fair preparations, no?”

“There's a lot to do.”

“And your fund-raising? Has it gone well?”

“Very. We're ahead of our goal.”

“Excellent.” He hesitated for a beat. “Perhaps I could help? If it isn't too late.”

“It's never too late for donations.” She stopped suddenly, eyes wide. “I'm sorry. I assumed that's what you meant?”

Boris gave a curt nod. “That's exactly what I meant. I'll have Dieter bring a check around.”

“That's very kind of you.”

“Anonymous, no?”

“You can count on it.”

“I do.” He nodded toward the bottle of wine. “And perhaps a second bottle of wine.”

“That's not necessary,” I said.

He casually waved a hand. “Something that will go with the excellent meal Evan is preparing.”

Boris nodded again, turned, and walked toward the front door. Dieter gave a half bow and followed.

I watched them go while wondering how Boris could know what Evan was making. If he did, that is. But if he didn't, how would he know which wine to select?

Boris the enigma.

Even I didn't know what Evan had planned. I wasn't sure Evan did. I think more often than not he simply opened the fridge and threw together whatever was in there. Usually not much. But somehow he always seemed to make it work.

My brother the chef.

“What was that all about?” Jill asked.

“I guess he wants us to have an expensive wine with our dinner.”

“Not that. I was talking about his offer to donate money to the health fair.”

“It's just Boris being Boris,” I said. “You know he's always giving money in situations like this.”

“I know. But I didn't ask him for money.”

“Maybe Evan did.”

“Maybe. Anyway it's very generous of him to offer.”

“Like I said, Boris being Boris.”

“Have you talked to Boris recently?” I asked Evan as I walked into the kitchen.

Evan stood at the stove, spoon in his hand, wearing a dark green apron that said
KISS THE COOK
in white lettering.

“No. Why?”

“He just offered Jill a donation for the fair and I thought maybe you had talked with him about it.”

“Nope.”

“So how did he know we were gathering donations?” Jill asked.

“Because Boris knows everything,” Evan said.

I shrugged. “It does seem that way.”

“He'd make a good spy,” Evan said. “Like me.”

I let the editorial comment slide and said, “Maybe Boris is a spy.”

Evan stopped and stared at me. “You think so? That would be so cool.” He looked at Divya. “Make a note to ask him.”

“I think not,” Divya said.

“Why not?”

“Because what Boris is or isn't is none of your concern.”

“But us spies have to stick together.”

My brother's delusions know no bounds. I started to point that out but instead said, “I think most real spies don't advertise the fact that they're spies.”

“Unlike you,” Divya said to Evan.

Evan shook his head but somehow managed to stifle any retort.

Jill placed the wine on the table. “What are you making? It smells delicious.”

Evan ran through the menu.

While Divya and I were seeing our follow-ups, Evan had finally settled on what to cook for dinner. He had apparently gotten the 1776 theme in his head and decided to make a Williamsburg dinner.

I couldn't help but think part of his culinary decision was a remnant of the trip we had taken to Williamsburg when we were kids. Evan had been fascinated with all the workshops—the blacksmith, the tailor, and the glassblowers, but mostly the bread makers. We had stayed in a small off-the-beaten-path bed-and-breakfast with our dad and had dinner at one of the colonial taverns. That was where Evan was introduced to Sally Lunn bread. He obsessed about that for at least a year.

So tonight he decided to make roast chicken breast, apple-and-cranberry cornbread stuffing, stewed apples, and of course Sally Lunn bread. The aroma of the baking bread made my stomach growl.

“I think I like this new domestic side of you,” I said to Evan.

“What domestic side? Just because I like to cook?”

Jill opened the wine and poured four glasses. She asked Evan if she could help, but he said he had everything under control, so she, Divya, and I sat at the counter and watched him finish things up.

“I got a brief break today and went by a cool costume shop,” Jill said. “They have some pretty amazing stuff.”

“Any bookkeeper outfits?” I asked.

Evan turned, glared at me, and then returned to stirring the pot of simmering apples.

Jill laughed. “Didn't see any of those. But I did like their highwayman outfits. That might be pretty cool for us.” She looked at me.

“Maybe that would be better for Evan,” Divya said. “After all, he's the money man.”

Evan turned and looked at her. “Somehow I don't see the CFO of HankMed dressed as a highwayman. It might send the wrong message.”

“Perhaps. But for you it would be perfect.”

“But I'm a spy. That's so much cooler than being a robber.”

“And of course you are a superspy,” Divya said.

Evan looked toward where his cell phone lay beneath the lamp next to the sofa and took a step in that direction.

Divya stopped him by saying, “Don't you dare.”

Evan shrugged. “Not necessary anyway. Everyone knows that Evan R. Lawson is a superspy.”

“And a modest one,” Divya fired back.

“Who got the critical information from StellarCare?” Evan asked.

Evan never lets go of his victories, big or little. He holds on to them forever. I guess we all do that; Evan just does it with passion. The truth was that he did indeed get the crucial information we needed to resolve the Julian Morelli affair.

Divya rolled her eyes. “You did.”

“Yes, I did.” Evan began spooning the stuffing and the apples into serving bowls. “Dinnertime.”

Jill helped Evan carry the serving dishes to the table and we all sat.

Evan had outdone himself. The chicken was perfect, the apples sweet and rich, and the Sally Lunn bread light and yeasty.

“Excellent,” I said.

“Maybe you should go as a baker?” Divya said.

“And what would you be? A tavern wench?”

“Not likely.” She took a bite of stuffing. “What would a baker wear?”

“An apron,” I said. “Just not one that says ‘Kiss the cook.'”

“Maybe a puffy hat,” Jill added.

“Did they wear puffy hats back then?” Divya asked.

Evan hesitated a beat as if considering that and then shook his head. “No, I should be a spy.”

“Maybe a baker-spy,” Divya said. “You could wear the hat and a cape and steal recipes.”

Everyone laughed.

“Maybe we should consider the highwayman thing,” Jill said to me. “It might not be good for a CFO but for a CEO it would fit.”

“Are you saying I'm a robber baron?”

She laughed. “No. But it still might be fun.”

I thought about that for a minute. It beat any idea that I had come up with, which of course was no idea at all. “What exactly did highwaymen wear?”

“The outfits they had at the store had long shirts, a wide leather belt, and capes. Oh, and a fake pistol you could stuff beneath the belt.”

“Where is this place?” I asked.

“Over toward Montauk. Want to swing by and see what they look like?” Jill asked.

“Tomorrow?”

“We probably should. We only have a few days to come up with something.”

“Maybe after our first patient tomorrow?” Divya said.

“Sure,” I said. “We could be there about nine.”

Jill pulled her phone from her purse and worked its keyboard. “Looks like that'll work. I have an eight o'clock meeting and then I was going over to the high school to see how the preparations are going. I'll meet you there in between.”

“Then maybe we'll follow you to the school,” Divya said, and then to me, “We need to take another look at our booth and decide how we're going to set it up.”

I forked a piece of chicken. “Sounds like a plan.”

Conversation ended for a few minutes as everyone enjoyed the meal. The silence was broken by a knock at the door. When I opened it, Dieter looked at me. He extended both hands. One held a check, the other a bottle of wine.

I took them both and said, “Want to come in?”

“No. Boris wanted you to have the check this evening and, of course, the wine.”

“That's very kind of him. Tell him we are grateful.”

Dieter gave a mechanical smile and a slight bow. “Then I'm off.” He turned and walked away. Just like that.

I placed the wine on the table. The label said it was a 2000 Château Latour Pauillac. I assumed it was good, and expensive, but my knowledge of wine is near zero.

“What's that?” Evan asked, picking up the bottle.

“A gift from Boris.”

Evan studied the label. “Dude, this is expensive.”

Jill looked at it. “Wow. This is the good stuff.”

“What's with Boris being so generous?” Evan asked.

“He's always generous,” I said.

“I'll open it,” Divya said. She stood and walked to the counter where the opener lay.

“That's not the half of it,” I said. I handed the check to Jill.

She looked at it, then up at me, and then back to the check. “Are you kidding?”

Evan snatched it. “Let me see.” He looked at it, his eyes widening. “Dude, this is serious coin.”

“That's Boris,” I said. “He doesn't do anything halfway.”

Divya returned with the wine and four fresh glasses and sat. Evan handed her the check. “Oh, my, this is serious.” She gave the check back to Jill.

“Adding this to the great job Evan has done puts us way over the top,” Jill said.

“That's Evan R. Lawson, fund-raiser extraordinaire.”

“Your business card is getting quite cluttered,” Divya said.

“How so?”

“Let's see—superspy, master chef, and now fund-raiser extraordinaire. That's a lot to get on a card.”

“Don't forget supercool bon vivant,” Evan said.

“How could I forget that?” Divya asked.