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By John Benedict
Oceanview PublishingCopyright © 2015 John Benedict
All rights reserved.
Friday, September 1, 3:30 p.m.
"I want you to curl into a ball and arch your back like a mad cat at Halloween," Dr. Luke Daulton said. "Or a shrimp. Here, look at me." Luke bent over, demonstrating the proper position so he could administer the spinal anesthetic. He had a healthy respect for large obstetrical patients. Perhaps aversion was a better term, and maybe it wasn't so healthy.
"But you don't have a belly like I do," whined Shirley. She tried to lean forward, but only succeeded in bending her neck — her back remained ramrod straight.
Luke sighed and smiled under his mask. He had forgotten how much he disliked OB anesthesia — taking care of two patients at once was always tricky. He turned and winked at Teri, the anesthesia tech assigned to help him, trying to display more confidence than he felt as he snapped on his sterile gloves.
The Delivery Room was a busy place and everyone was in close quarters. To his left, two scrub nurses in sterile OR attire counted their surgical instruments, creating quite a racket as they banged them down on the metal trays. Across the room, a neonatologist and neonatal nurse practitioner were readying their pediatric resuscitation equipment. The large radiant warmer above the baby bassinet let out loud screeches intermittently and had to be repeatedly silenced. Two circulating nurses were talking and busily filling out paperwork. Luke could see the obstetrician through a window, scrubbing his hands at the scrub sink.
"That's Dr. Seidle," Teri said, nodding toward the window. She leaned in close and whispered, "He's pretty cranky for a young guy. Ever since he got sued last year for a bad baby, he's never been the same. He yells a lot — especially when the shit hits the fan."
"Great," Luke said, thinking he knew the type well. He made a mental note to try to keep shit away from the fan today.
Luke searched the faces of the obstetrical team assembled around him, looking for a sympathetic face; he found none. They eyed him curiously, undoubtedly because he was new, but there was no discernible warmth, either. He wouldn't get the benefit of the doubt around here. Plain and simple: this was a test and he was on trial.
There was also an edgy undercurrent present — a kind of dangerous electricity, a palpable tension. Everyone in the Delivery Room chuckled and talked nonchalantly, but they all knew that things could go horribly wrong in this place. People could die and careers could be ruined in a matter of minutes.
Luke shook his head to dispel these thoughts. Such negativity — Dad would've scolded him, if he were around.
"Teri, can you help Shirley lean forward?" Luke asked.
"Sure, Dr. Daulton." Teri stepped up on a footstool for better leverage. Luke was happy to have at least one ally in the room.
Shirley attempted to lean forward again, but this time managed to arch her back exactly the opposite way to what he had just demonstrated.
"That's better," Luke said with resignation. Time to punt on proper positioning. "Okay, a little bee sting," he said, the words making him smile as they always did. They brought to mind his medical student days five or six years ago, when an old man told him what large bees they had around these parts. He numbed her skin with a local anesthetic.
"Ouch!" Shirley cried. "Sonuva ..."
"That's the worst part," Luke soothed. He felt himself relax a little; he had done this procedure countless times. "Try not to move. A little pressure now." Luke advanced the delicate spinal needle, roughly the diameter of a human hair, hoping to hit pay dirt — the CSF, or cerebrospinal fluid that bathes the brain and spinal cord. He kept checking as he advanced. No fluid.
"Got it yet?" asked Shirley.
"You'll be the second to know."
Teri rolled her eyes at Luke. Even though she had her surgical mask on, Luke could tell she was smiling from the crinkling around her eyes. "Bone?" Teri asked.
"No, it's a clean shot."
Finally, Luke had the needle inserted to the hub, three and a half inches in, and still no CSF. "Teri, get me the next one up." This meant the five-inch needle, the "harpoon." Luke hated the harpoon because it was long enough to be dangerous. The aorta and the vena cava ran just in front of the spinal column and were easy targets for the big needle.
He checked her landmarks again. They were difficult to palpate, owing to the size of his patient. Teri gave him an encouraging look. The rest of the team stared at him coolly, fidgeting with their instruments or shooting each other glances.
One inch. Two inches. Three. Four. Still no CSF. Luke began to sweat and felt the droplets course down his arms. For the first time, it hit home that there was a real transition to be made here. Two and a half months ago, he was a well-respected, confident senior resident who knew all the ropes at the Hospital of the University of Pennsylvania. Now, after taking the job at Swatara Regional Hospital, he had thrust himself into the real world of private practice.
At four and a half inches, Luke struck white gold. Precious CSF dripped from the hub of his needle after he removed the inner stylet. Releasing a big sigh of relief, he turned to wink at Teri again. He attached the syringe and injected the spinal anesthetic agent and quickly withdrew the needle.
"Okay, Shirley, all done. Gonna lay you flat now." He grasped her shoulders and pulled her down.
"Wow, my feet are getting warm already," Shirley said.
"Good, good. You did great sitting there. Hope I didn't hurt you too much."
"No, it wasn't bad. I can't move my feet, though. Is that normal?"
"Perfectly normal," he said, although he thought it was a bit fast. "Time to check your level." He poked her gently in her groin region with a needle. "Can you feel this?"
He worked the testing needle up onto her sizable belly. "This?" Still no response.
When he got up to her mid-chest, she said, "Yeah, I can just barely feel that."
"Great; you're going to be very comfortable." Luke felt relief and a certain degree of satisfaction wash over him. He couldn't wait to tell Kim about it — the two of them loved to exchange work stories.
Teri nudged him and threw a glance at the blood pressure monitor. It read 90/60, down from 145/80 three minutes ago.
Luke reached around to his anesthesia cart and picked up the ephedrine syringe. He injected some into the intravenous port and ensured the IV was running maximally.
"I feel kinda sick," Shirley moaned.
"I just gave you some medicine to fix that, Shirley," he said, and patted her gently on her head. "It'll work in about a minute."
Dr. Seidle entered the room from the scrub sink, hands held high. "Everything okay?"
"Fine," Luke said. "Ready to go. I'm Luke Daulton."
"Mark Seidle. Nice to meet you." Seidle gave Luke a quick, penetrating stare, then turned to the nurses who were waiting to gown and glove him. "Your wife goes to our practice, doesn't she?" Seidle asked over his shoulder.
"Yes, Kim sees Rob Gentry; he's a great guy."
"Yes, he is." Seidle stepped up to the OR table. "Where are you from, Daulton?"
"I trained at Penn," Luke answered, but quickly wondered if this was what he had meant. "I grew up outside Philly — Media, actually."
"I see," Seidle said, losing interest in the conversation. He peeked around the drapes to look at his patient and said, "Okay, Shirley, let's have this baby."
The BP monitor beeped and displayed its latest reading: 90/60.
Luke scowled briefly at this lack of response to his first dose of ephedrine. He pumped in another 10 milligrams and began to wonder if his spinal was too high, a distinct possibility in an obese patient.
"I think I'm going to —" Shirley let out a loud belch, then showered her pillow with green vomitus.
"You all right up there?" asked Seidle.
"I just yorked all over the place," Shirley said. "Where's my husband?"
Luke groaned inwardly, but said, "You can bring him in now." Having family present in the OR was always a bad idea.
"Okay to start?" Seidle asked, knife in hand, poised to make incision, not bothering to look up.
"She seems good and numb," Luke said, "but why don't you check her."
Seidle fixed Luke with a hard stare. "I guess we could do that." He smacked the scalpel down and demanded a hemostat. "Shirley, can you feel this?" he asked as he clamped her skin roughly with the large instrument.
Shirley gave him a puzzled look. "Nope, not a thing."
"Good. Knife." The scrub nurse handed Seidle the scalpel back.
Luke tensed — he had one more hurdle to clear. There was no such thing as a guaranteed perfect spinal, especially in an obese patient. The spinal block could sometimes range high or low. Luke stared over the drape as Seidle prepared to make the incision. This was the moment of truth. If the spinal was good, Shirley would be unaware of the incision. If not, she would scream.CHAPTER 2
Friday, September 1, 6:00 p.m.
Bart Hinkle adjusted his cummerbund for the fourth time in what he was beginning to realize was a futile attempt to rein in his gut. He took another swallow of his scotch, ice clinking, and grimaced. His head was pounding and his back ached — he couldn't tell which was worse. Another fundraiser at the Forum in Harrisburg for Senator Pierce's re-election campaign. Another fucking waste of time.
Bart stifled a yawn and surveyed the large banquet hall. Tables were situated all about the room, but few were occupied during the cocktail hour, when everyone stood talking and boozing it up in small groups. Jazz music came from the far end of the room, where a four-man band played somewhere beyond the haze of smoke. The music was decent enough, and some other evening he might have enjoyed it. But tonight he found it loud and tinny. And he felt as if the bass drum was screwed into his skull.
All the city's high rollers were here, decked out in their tuxes and evening gowns — this included representatives from each major law firm. Lots of younger in-crowd women, staffers, and young trophy wives were strutting their stuff. Maybe the night wouldn't be a total waste.
A young hostess in a black French maid getup walked up carrying a silver platter of hors d'oeuvres. "Would you care for some?" she asked in a high, nasal voice.
Bart was famished; he despised the long wait for dinner at these affairs. He grabbed three chicken-wrapped-in-bacon gizmos and almost spilled his scotch in the process. "Thank you, my dear," he mumbled as he ogled the hostess. She was nice and slim and sort of cute, in a rough, slutty way. He took special note of her black fishnet stockings as she walked away. He imagined her wrapping those long legs around him in some nook in the kitchen.
Mimi tugged on his arm and demanded in a screeching voice, "Bart, are you listening to me?" He had almost forgotten his wife was standing next to him. The way she spewed smoke and alcohol fumes everywhere reminded him of a diesel bus belching exhaust. She waved her hand holding the glowing cigarette after the waitress and almost burned the gentleman standing beside her. "I guess you were too busy drooling over Little Miss Muffet there." Bart could already detect the slur in her speech — an increasingly common occurrence these days.
Bart took a step backwards. "Mimi, keep it down," he said in a low voice, lifting both hands in a shushing gesture.
"Keep what down?" she bellowed.
"I mean it, Mimi. Don't you embarrass me here." He looked at her closely for the first time that evening and shuddered. Her red lipstick was smudged. And her expensive plaid dress failed to hide a bulging midsection that no amount of liposuction seemed to touch. He made a mental note to withhold the next payment to her plastic surgeon — the joker certainly charged enough money to entitle his clients to results.
Before he and Mimi could escalate things into a full-blown shouting match, Kyle Schmidt, senior partner at Bart's law firm, approached. He slapped Bart on the shoulder and grabbed his hand, pumping it vigorously. "Bart, you old fox — good to see you!"
"Kyle, glad you could make it." Bart disengaged his hand from the older man's crushing grip. Although Kyle was in his late fifties, he was one of those guys who clearly didn't miss many sessions at the gym. Bart was about to say more when a stunning woman appeared at Kyle's shoulder. She had long blond hair, and wore a tight evening gown that displayed an unbelievable amount of cleavage. Bart stared.
"Bart, you've met my wife, Bunny," Kyle said, smiling.
"Of course I have." Bart held out his hand, using any excuse to continue staring. He vaguely felt Mimi elbowing him. He had met Kyle's new, thirty-something wife once before, but it had been at some outdoor function and she had had a coat on, for God's sake. Bart reluctantly dropped her hand and forced himself to turn away from those beautiful breasts toward Kyle.
"Sorry we're late," Kyle said. "Bunny and I had some — uh — things to take care of." He wrapped his arm around Bunny's slim waist and pulled her tight. He pecked her on the cheek and a syrupy grin spread across his face.
"I'll bet," Bart mumbled as Bunny's pretty face blushed pink and she giggled easily. Bart took another swallow of his scotch.
"Mimi, are you enjoying the gala so far?" Kyle asked, dropping the teenage grin.
"Well," Mimi said, "the drinks are always watered down at these things. You'd think they could afford better." She pinched her perpetual look of irritation into one of exasperation. She also belted down her third drink with a fierce determination as if, by God, she'd overcome any silly watered-down effect.
"So Bart, what do you think of our Senator Pierce?" Kyle asked.
"I think he's got a lock on this election," Bart said. "They say he's got the biggest war chest in the history of the state."
"That's true. He is, after all, the distinguished president pro tem of the Senate. And of course Schmidt, Evans and Knobe contributed heavily to his war chest." Kyle flashed his bleached white teeth in another smile.
"Don't I know it. But why are we even here tonight, Kyle? At a damn fundraiser? Barring some major fuckup, Pierce should win in a landslide."
"You know how these things work. Election results are never guaranteed. Polls can be dreadfully wrong — remember the New Hampshire primary. The party doesn't want to take anything for granted."
"I guess so."
"After all," Kyle said, "the Dems have a real chance of taking back control of Congress this year. The stakes could not be higher. The very balance of power in the US Senate might hinge on Pierce's re-election."
"You really think so?" Bart rubbed his temple and considered making another trip to the bar. The first scotch had done squat to erase his headache.
"Of course I do." Kyle studied him for a moment. "What's bugging you, Bart?"
"It's just — I'm not a huge fan of Pierce. I've met him several times. The guy's a first rate asshole."
Kyle raised his eyebrows and took a sip of his red wine.
"I can't take his goddamn sanctimonious style," Bart said.
"What do you mean?"
"He kills me with all his environmental crap."
"He does own the green position and is crushing his Republican opponent, is he not?" Kyle said.
"Yes, he is," Bart admitted. "But Kyle, I'm telling you, Pierce would support child molesters if he thought it would help him get elected."
Kyle chuckled. "Look, maybe you're right, Bart. He is a piece of work, but he does have a knack for reinventing himself. Could be you're just a bit jealous of his success?"
"Maybe," Bart conceded.
Mimi yawned. "Bunny, let's go to the bar and get you a drink. We can leave these old farts to talk politics." Politics came out powitix.
"Sounds good, Mimi," Bunny said, breaking into a new fit of giggles. The two headed for the bar. Bunny glided across the floor in her high heels, her silky evening gown hugging her figure, the thigh-high slits revealing titillating glimpses. Half the men in the room watched her, undoubtedly hoping she would lean toward them or, better still, suffer some wardrobe malfunction. Mimi waddled along beside her, looking a little unsteady on her feet.
Bart also followed Bunny's departure with interest. "God almighty, Kyle, you're a lucky man!"
"Bunny, you mean. Yep — she's a real peach. She's teaching me stuff I've never dreamt of." He was all smiles. "How are you and Mimi doing?"
"Funny you should ask," Bart said, shaking his head. "Not so well."
"Is it that bad?"
Excerpted from Fatal Complications by John Benedict. Copyright © 2015 John Benedict. Excerpted by permission of Oceanview Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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What People are Saying About This
“With Fatal Complications, a taut medical thriller that is equal parts King and Koontz, John Benedict delivers a devastating tale of infidelity, deception, and bad intentions, proving nothing paints a soul darker than desire, and trying to outrun the past is always the fastest way to fall.”
“When anesthesiologist Luke Daulton becomes the newest member of the hospital staff, he is quickly confronted with a series of bizarre anesthetic deaths and a conspiracy that just might cost him his life, as well as those of his wife and unborn child.Fatal Complicationsis a medical thriller that will keep you up late into the night.”