Stress Test (37 page)

Matt turned from the patient to the wife and back again. “Mr. Ferguson, you have an enlargement of the major blood vessel running through your body—the aorta. It’s bulging like the wall of a balloon, and the pressure of your pulse against it can eventually cause it to burst. We need to repair it before that happens.” He went on to explain the procedure and answer questions. “I need your permission for the surgery. We’ve called a specialist, and he’ll be here shortly.” He turned to Rita and said, “Who did you get?”

“Dr. Rawlings.”

“Excellent,” Matt said. “He’d be my first choice. Good surgeon, well trained.”

“What if he doesn’t get here in time?” Mrs. Ferguson asked.

“I’m a general surgeon. I’m going up to the operating room with your husband. If something happens before Dr. Rawlings gets here, I’ll step in.”

In a moment, with questions answered, forms signed, and two units of O negative blood in a container under the gurney, Matt and Rita wheeled Ferguson into the elevator, trailed by Randy, who insisted on coming along to help.

“Is the anesthesiologist in the OR?” Matt asked.

“He should be there by the time we get to the holding area,” Rita said. She checked Ferguson’s blood pressure and frowned.

“Dropping?” Matt asked.

“A little. And the pulse has gone up. I’d say he’s leaking a little more.”

The elevator was cool, but Matt felt sweat trickling down his spine. He’d assisted in repairs of aortic aneurysms during his training, but had never been the primary surgeon on one. What if this one broke before Rawlings arrived? If the big blood vessel blew, it would mean Matt had to quickly open the abdomen, clamp off the aorta, sew a graft into place, and do it rapidly enough that there was no damage to organs deprived of blood circulation. It was tricky under the best of circumstances. Matt wondered if he was up to the challenge.

“Check the vitals again, would you?” Matt asked.

Rita complied. “No change.”

Please, God. Keep him stable until Rawlings gets here. And if I have
to do the surgery, help me do it right
.

The elevator doors slid open. A nurse and Dr. Ellen Komitsky, an anesthesiologist, were waiting. “I’ve got it, Matt,” Ellen said. “You might want to get into a clean scrub suit.”

It wasn’t necessary for her to explain. She and Matt were on the same page. He might end up doing the case, and she wanted him ready. He motioned to Randy. “Come on. You need to change too.”

Five minutes later, Matt stuck his head in the OR. “I’ll scrub up so I can help prep and drape.” No one voiced the thought that was in everyone’s mind: Matt might have to do more than that. He grabbed a cap and mask, made sure Randy knew how to work the sink controls, and began the scrubbing routine he’d done so many times in the past.

Soon Matt bumped the swinging doors with his hip and backed into the OR, his dripping arms in front of him, elbows bent, hands high. He dried his hands with the towel the scrub nurse handed him, slid his arms into the sterile gown and turned so the circulating nurse
could tie it, and shoved his hands, first one and then the other, into sterile gloves held open for him.

The anesthesiologist said, “His pressure’s dropping. I think the leak’s increasing.”

Matt noted that the O negative blood was already running in via two IVs. “Any word from Rawlings?”

“Nothing,” the circulating nurse said.

Matt took a deep breath. “Let’s go, then.”

Ferguson looked pale and vulnerable, lying naked beneath the bright glare of the overhead light. The orange color of the antiseptic on his abdominal skin added a surreal touch to the picture. Matt and the scrub nurse draped sterile green sheets over the patient, leaving only the abdomen exposed through a central opening.

Matt took his position at the patient’s right. He looked at Ellen, sitting at the head of the table. “Ready?”

She nodded.

“Randy, stand opposite me. I’ll tell you what to do.” Matt held out his hand toward the scrub nurse. “Number ten blade.”

Matt sensed the vulnerability of the patient, the awesome responsibility on his own shoulders, as he felt the scalpel slap into his palm. He breathed a prayer and, with a single stroke, made a vertical incision from just below the patient’s breastbone to the bottom of his abdomen. Matt dropped the scalpel on the instrument table and held out his hand. The nurse slapped a clamp into his palm.

“Randy, you get a clamp too. Just get the major bleeders. We’ll deal with them later.”

In a moment, Matt held out his hand again. “Deep knife.” Then he heard a soft voice behind him.

“Want some help?”

Matt relaxed like a coiled spring with its tension released. “You
don’t know how good it is to see you, Clint.” He stepped back, and Dr. Rawlings took his place.

“I understand we have an aortic aneurysm that’s leaking, so while I continue the surgery, why don’t you fill me in on the details?” Rawlings took the scalpel from the instrument tray. “And would you like to assist me?”

Matt took Randy’s place across the table from Rawlings and gave him a rundown on the patient’s situation. “I didn’t think it was safe to take the time for a CT. And, frankly, I don’t know enough about the endovascular procedure to try one. I thought it was safer to go in this way.”

“And you were right,” Rawlings said. After a few moments, the surgeon pointed with a suction tip at the pulsating aneurysm of Ferguson’s abdominal aorta and the pool of blood accumulating around it. “If you hadn’t brought him right to the OR, he’d probably have ruptured this little beauty and died while he was downstairs.”

Behind him, Matt heard the phone buzz. The circulating nurse answered and a murmured conversation followed. Then she said, “Dr. Newman, that was the ER. Dr. McGee is here early, and he’s going to cover the rest of your shift. You’re clear to stay here as long as you’re needed.”

Matt couldn’t recall ever being more tired . . . and yet feeling more alive. He was proud of the diagnostic pickup he’d made. Clint Rawlings had complimented Matt’s skills as an assistant. And despite dismal survival statistics had his aneurysm actually burst, John Ferguson would most likely pull through. Matt was exhausted, but he felt good about the evening’s work.

After the surgery, when the patient was safely in the recovery
room, Matt and Rawlings talked with Ferguson’s wife and their son, who’d joined her. Then Matt dragged himself to the ER locker room and changed out of his scrub suit.
I am so ready for this night to end
.

Matt rolled his shoulders to ease the tension as he walked to the parking garage. His watch told him it was almost two in the morning. His body said it was even later than that. All he wanted was a quick, hot shower followed by eight or maybe ten hours’ sleep.

He unlocked his car, wondering, now that his legal problems were over, if he could afford to get the nonfunctional remote keyless feature repaired. Oh well, he’d worry about that later. Matt climbed in and started the car. He put it in reverse but kept his foot on the brake as he leaned his head against the steering wheel. He felt as though he could go to sleep right then and there. But the next thing he heard woke him like a bucket of ice water.

“I was beginning to think you weren’t coming.” The voice was unfamiliar, the tone menacing. Something cold and hard pressed against the back of Matt’s neck. “Keep both hands on the wheel where I can see them. We’re going for a little ride.” The sound that followed might have been a chuckle, but Matt saw no humor in the situation—especially after the next words. “But only one of us will be coming back.”

TWENTY-SEVEN

Matt drove without conscious thought, his mind frozen. He navigated the streets according to the directions from his captor. When he finally began to think, he wasted a minute or two mentally kicking himself for letting his fatigue make him vulnerable to the trap.

Because he’d been tired and preoccupied when he left the hospital, Matt’s pepper spray was still on the top shelf of his locker, along with the handcuffs and scalpel. He did have his cell phone in his pocket, mainly because grabbing it was an automatic reaction. Matt only hoped he’d have a chance to use it.

And who was this man? In the rearview mirror, Matt got glimpses of a tall, broad-shouldered black man. His clothing, what Matt could see, continued the monochromatic theme of deepest black. The voice certainly wasn’t the gravelly one he’d come to identify with Lou Hecht. It was deep but smooth, with a faint Caribbean lilt.

“Who are you?” Without thinking, Matt added, “Where’s Lou?”

“Lou’s the same place you’re going. Now shut up.”

When they reached a darkened industrial area, his captor said,
“Pull over here.” Warehouses were butted together, walls touching, their loading docks empty. Matt wheeled into a parking lot that by day undoubtedly was home to a number of eighteen-wheelers. Now his was the only vehicle in sight.

Matt tensed his neck and shoulder muscles, waiting for the shot that would end his life. Could he wheel around, grab the gun, and overpower the man? Maybe on his best day it would be worth a try, but not now.

The only sound in the car was the ticking of the cooling motor. Matt was ready to say, “So shoot. Don’t keep me waiting any longer,” when his captor said, “Get out of the car.”

Matt opened the door and stepped out, happy to smell fresh air one last time. The moon was a bare sliver. One streetlight half a block away, together with the faint security lights over the nearest loading dock, gave barely enough illumination for him to see his attacker as he exited the backseat. It confirmed Matt’s first impression: a black man with the build of a linebacker, a calm expression and dead eyes. The gun in his fist had the squared-off appearance of a semi-automatic.
Too
bad
. Matt had read somewhere that it was sometimes possible to grab the cylinder of a revolver and hold it tightly enough to keep it from revolving and firing. Then again, after three hours holding retractors, he probably didn’t have the strength in his hands to do that anyway.

“Who are you?” Matt asked again.

“Guess it won’t make any difference if you know the name of the man who kills you. You can call me Lester,” the smooth voice answered. “Now turn around, lean over the hood of the car, hands behind you.”

Matt felt cold metal against his wrists, then the familiar click and bite of handcuffs. His scalpel, had he brought it, would be useless anyway. What he needed now were bolt cutters.

Lester reached into Matt’s pocket and removed his cell phone.
“I don’t think you’ll be needing this.” Lester leaned into the car and pushed a button. The trunk lid sprang open, and Matt knew where he was going next. Maybe he had a chance. After all, he’d done it once before.

“I’ve heard about your last escape act. Don’t bother looking for the emergency release.” Lester lifted a T-shaped piece of plastic from the floor of the trunk and waved it in front of Matt before tossing it away.

There had to be a way out—unless Lester planned to shoot him here, then take his body somewhere and dump it. Matt didn’t have to wait long for the answer.

“Climb in. Make yourself comfortable. We’ve got a long ride. You can use that time to make your peace with God . . . if you believe in God.”

Matt climbed in and watched the few stars visible through the opening disappear as Lester slammed the lid. Once more, Matt was in what amounted to a coffin. How many times could he escape death? Surely this was it.
God, I need help. Please
.

In one sense, Matt was glad of the darkness. He recalled that moving lights could sometimes trigger seizures in people with such disorders. That would be the last thing he needed.

The car started and began to move, slowly at first, then more rapidly. Matt bounced around in the trunk with every pothole and sharp turn, his mind darting about like a rat caught in a maze.

He struggled vainly against the handcuffs, then remembered the maneuver he’d tried with his first kidnapping. It hadn’t worked because the duct tape bonds were too tight. But Houdini had done it with cuffs, and this time Matt thought he could as well, given the few inches of slack the handcuff chain afforded him.

He ignored the pain in his muscles as he drew his legs up under him and worked his hands down behind him, straining with everything he
could muster to pass the handcuff chain beneath his feet. Matt had almost completed the maneuver when a cramp in his shoulders made him relax. He tried again, and once more had to stop. One final effort, and this time he was determined to ignore the pain, to move on despite it. Finally the chain caught on the heel of his athletic shoe. He took a deep breath and shoved his hands forward while pulling his legs as far upward and backward as he could. He sawed the chain of his handcuffs farther and farther forward, until he felt his hands come free in front of him.

Matt lay back and breathed deeply, wanting to get as much oxygen to his tortured muscles as possible. In a moment he explored the area above him and confirmed that his captor had indeed removed the emergency trunk release. He took a mental inventory of the material in his trunk, and found it woefully wanting. The jack handle and jack were stowed under the spare tire. No road flares with spiked ends. No battery jumper cables to be used as a noose. No flashlight to shine in his attacker’s eyes or use as a club. Nothing.