Dr. Duncan Lathram is a brilliant plastic surgeon who recently invented a dissolving implant that allows incisions to heal without scarring. His unparalleled artistry in the operating room is the salvation of all the biggest power players in Washington, DC, whenever they need to be TV ready. Lathram appears to have it all, but something isn’t right . . .
When young Gina Panzella isn’t hustling as a house doctor at a local community hospital, she assists Dr. Lathram with surgery. She’s known him almost her entire life and respects him deeply, yet there are a few things about him she can’t quite figure out—like why so many of his patients are mysteriously dying.
Overcome with suspicion and fear, Panzella enlists the help of Gerry Canney, a high school classmate now working with the FBI, to dig deep into the doctor’s past. Soon they will discover what Lathram is truly capable of . . .
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About the Author
F. Paul Wilson is the author of more than fifty books spanning various genres, including science fiction, horror, thriller, and more. Four of his novels have been New York Times bestsellers, and his work has earned him four Prometheus Awards, the prestigious Inkpot Award from the San Diego Comic-Con, and the Pioneer Award from the RT Booklovers Convention.
Read an Excerpt
"Still flat-lined," someone said.
I know that, dammit, Gina Panzella thought as she stared helplessly at the monitor, willing the featureless thread of light to show systole, even a muscular twitch. It ignored her. Nothing but a little sixty-cycle interference marred its placid, unwavering course.
The sick sour smell of death filled the air and the three nurses who made up the Code Blue team were watching her expectantly, waiting for her to admit the obvious.
All right, she told herself. Call it off.
She sighed. "No use. He's not coming back."
The nurses nodded and began repacking their gear into the crash cart. Gina stepped back and took one final look at Mr. Nussbaum's pale, bloated, naked, lifeless, fifty-two-year-old body. His limbs were splayed, a ribbed plastic tube protruded from his slack mouth, wires strayed from plastic patches on his chest, clear IV tubes ran into both arms and under his right clavicle. He'd had a laparoscopic cholecystectomy yesterday, and he'd come through just fine. Tonight — this morning actually, at 3:05 or thereabouts — he'd gone into cardiac arrest and a code had sounded.
None of the staff cardiologists had been in hospital, and no way could one of them get here in time, so Gina, as house doctor, had run the code. The team had already slipped the board under Nussbaum's back and started CPR by the time she arrived. Gina had intubated him, then under her direction the team worked on him for forty minutes. She threw everything they had at Mr. Nussbaum: intracardiac injections, repeated defibrillation, the works. Everything short of cracking his chest and squeezing the heart with her hands.
Nothing. The Nussbaum heart had decided to quit and nothing she tried could change its mind.
"Good code, doc," said Judy Hooper, giving Gina's shoulder a squeeze. She was tall, thin, with a halo of bushy blond hair around her angular face; late thirties — maybe ten years older than Gina — and a veteran of more codes than Gina ever hoped to see.
"Not so good," Gina said, cocking her head toward Mr. Nussbaum. "He's going to the cooler instead of the CCU."
"You gave him every chance. Ten to one the post will show a major PE. Not much you can do about that.
Gina nodded. These obese patients, when they arrested like this, it was usually due to a pulmonary embolism — a big clot shooting to the lung from somewhere in the legs. All the drugs and electric shocks in the world couldn't clear a clogged pulmonary artery.
"Good working with you," Judy said, then went back to unhooking Mr. Nussbaum.
Yeah, Gina thought. Real good.
She hoped her skin never got as thick as Hooper's seemed to be. Then again, in Hooper's position a thick skin was probably essential for survival.
Gina felt her tense muscles begin to uncoil in the dimly lit silence and antiseptic tang of the hallway. She was halfway to the elevator when a young nurse approached her. She had short red hair, bad skin, and a considerable overbite. Her badge said T. Graves, RN.
"Dr. Panzella, would you mind very much taking a look at an IV in 307?"
"Where's the IV team?"
"Well ..." She nervously rubbed her hands together. "I'm it on this shift, and I can't seem to ..."
The nurse seemed terrified of her.
"Let's take a look."
"Oh, thank you!" She led Gina down the hall to her right. "I can't tell you how much I appreciate this."
"Well, I asked Dr. Grady last night for help with another patient and he ... he got upset."
If I know Grady, Gina thought, he probably damn near took your head off. A third-year resident at Georgetown, Grady was very bright but tended to be a little full of himself. Lynnbrook was a community hospital in the northwest section that dwelt in the shadow of Georgetown Medical Center. Not a teaching hospital like its renowned neighbor, but it served its purpose.
Gina knew how some house docs, especially those who considered themselves high powered, got uppity when asked to start an IV. Gina got annoyed herself at times. After all, the hospital was paying an IV team to do its job and paying Gina to do hers. But sooner or later everyone, no matter how good you were, ran up against a wall trying to find a vein.
"She's in the window bed," Graves said. "One of Conway's patients. Had pneumonia. Been on IV antibiotics, now she's just on D-5-W. Didn't have many veins to start with and those are all used up. The last usable one infiltrated the end of last shift and I can't find another."
Gina found a frail old woman with thin, pinched features and short white hair. She sat up in bed, wide awake, staring at them. She had the top of the sheet bunched in her hands and was kneading it like dough.
"Please don't send me home tomorrow," she said.
"She's scheduled for discharge tomorrow?" Gina said.
Graves placed the chart in Gina's outstretched hand. "Tentatively."
The chart said "Harriet Thompson" on the front. Age 78. Dr. Conway was one of the local family practitioners — quiet, competent, with a loyal following. Gina had met him only twice and had liked him. She flipped through the ream of color-coded paper. Mrs. Thompson's last chest x-ray was clear. Dr. Conway's scrawled progress note from the morning read, "Try again for disch in AM."
Gina found the order sheet and wrote, "Hold IV until AM." She scribbled her name and handed it back to the nurse.
"There. That solves the IV problem."
Graves smiled. "Great." She picked up her basket of needles and tubing and hurried on to the next patient on her list.
"Do you know Dr. Conway?" said Mrs. Thompson.
Gina turned. "A little."
"Tell him not to send me home tomorrow. I'm too weak."
"I can't tell him what to do. I'm just the house doctor here tonight."
"But all my strength is gone. I don't know what I'll do."
Gina patted her hand. "Tell you what, Mrs ..." Her name had slipped away.
"Thompson. But you can call me Harriet."
"Okay, Harriet. If I see Dr. Conway I'll mention it."
"Thank you," she said, smiling for the first time. "You're very kind."
Gina hadn't expected to be able to deliver on that promise, but as she was running a brush through her glossy black, blunt-cut hair and debating whether to bother fishing out her lipstick, Dr. Bill Conway strode into the doctors lounge.
"Cutting out early?" he said, smiling. "Starting your own practice?"
He was young, maybe two or three years older than Gina, and good- looking — he could have been another Baldwin brother. Gina found him immensely attractive, liked his attitude and liked his looks. But he was wearing a wedding ring. Very married.
"Grady's covering," she said. "No private practice yet. My day job is assisting Duncan Lathram a couple of times a week."
His eyebrows rose. "Whoa! I didn't know you moved in such rarefied circles. And since when did you become a surgeon?"
"Usually I hate surgery, but what Duncan does is fascinating. It's like art."
"The Art of the Nose Job. Good title for a book."
"Why not? If Donald Trump can write one, why not Duncan Lathram? Guaranteed big sales inside the Beltway. Oh, by the way, the IV on one of your patients infiltrated last night and I put a hold on it till you came in."
"Thompson on three north?"
"Right. Her veins are shot."
Gina was a little surprised by the reaction. There hadn't seemed to be any pressing reason for the IV.
"You could always go subclavian if —"
"No, it's not that. The PRO's been on my back about getting her out. According to their guidelines she doesn't need a hospital: Her pneumonia's cleared, ship her out."
"She said something about how weak she was feeling and she was scared to go home."
He was nodding. "One of those wonderful situations where she looks good on paper — her chest x-ray's clear, fever's down, white count back to normal, electrolytes balanced — but she's not ready to take care of herself. Can't get into a nursing home for a week, scared to death of having some stranger stay with her, and her daughter lives in San Diego and can't or won't come back and stay with Mom for a few days. So what do I do?"
"Tell the PRO to take over her case," Gina cracked.
"Yeah, right," Conway said. "When was the last time those paper shufflers treated a patient? If they had real practices they wouldn't have time to stick their noses in other people's charts." He sighed. "That IV was useless, but it gave me an excuse to keep her a few more days. But now, without a line running, they're really going to push for her discharge. Want to guess how many hours before I get a call from the administration?"
"Sometime right after lunch, I'd say."
She knew what the hospital administrators would be worrying about: money. The PRO board couldn't kick Mrs. Thompson out, but it would rule that her condition no longer required hospital-level care. With that, Medicare would stop all further payment for services. The hospital would have to eat the extra days she was kept on, and Dr. Conway would not get paid after today. Gina was pretty sure Conway didn't give a damn about treating Mrs. Thompson a few more days at no charge. But she doubted the hospital would be so casual.
Once again Gina found herself wondering whether she wanted to go into private practice. Sometimes moonlighting as house physician for the rest of her life didn't look so bad.
"So what are you going to do?"
Conway shrugged. "Screw 'em. She stays till she's ready to go."
Gina gave him a thumbs up and waved good bye. But she wondered how long he'd be able to withstand that sort of pressure.
The sun was rising, birds were chirping madly, and the air was fresh and invigorating as she hopped into her old red Pontiac Sunbird to head for home. But not to bed. She had an important appointment coming up. Sleep was not in the cards.
Gina wasn't tired. As Chief Resident in the Tulane University internal medicine/public policy program, she'd been putting in more than a hundred hours a week until only a few months ago. Now with her three twelve-hour shifts a week as house doctor at Lynnbrook, plus doing physicals and assisting with surgery at Duncan Lathram's surgicenter three mornings, it all totaled out to only sixty hours a week.
Almost like a vacation. She hardly knew what to do with so much free time.
Well, yes, she did. Or at least she knew what she wanted to do. Senator Hugh Marsden was chairing the Joint Committee on Medical Ethics and Practice Guidelines. She wanted to be on his staff, to work as a legislative aide. And at ten a.m. she had an interview in his office.
Everyone she knew thought she was crazy. She'd tried to make her parents understand, but it was hard.
They couldn't see how all the new legislation was throwing medicine into turmoil. As she was completing her residency at Tulane, she'd looked around and asked herself where she could go, what she could do that would make the greatest difference. She'd read everything she could find, button- holed everyone she knew, and came to realize that the future of medicine was being decided in Washington by people who knew next to nothing about it. So maybe she could do more for her patients — and for the medical profession itself — in Washington than in the Louisiana multi- specialty medical group that had offered her that attractive starting salary.
Medicine was becoming a new game now, so maybe it was time for a new kind of doctor, one who could operate comfortably in both worlds — practice medicine and still get the ear of the legislators who were making the rules. If that new kind of doctor had the skills, the drive, knew the ins and outs of how these rules were being shaped, she might develop enough respect and credibility to have a decisive impact.
Gina felt strangely sure she was that kind of doctor.
Sure enough to leave behind a man she loved to return to the area where she'd grown up to prove it.
She blinked away the memory of Peter Hanson's stricken expression the last time she'd seen him. His usually perfect brown hair had been wet from the rain, his dark eyes full of hurt and disbelief as she'd stepped toward the boarding ramp. She remembered how she'd wavered then, how she'd had to fight the urge to run back to him and throw herself into his arms. But she'd known in her heart that if she didn't give this a shot, she'd forever wonder what might have been. She didn't want to spend the rest of her life regretting, asking, "What if ..."
All she asked now was a chance to show her stuff. The first step toward that chance was scheduled in a few hours.
She sent up a silent prayer: Don't let me blow it.CHAPTER 2
ON THE HILL
For Gina, the best improvement in D.C. since her childhood had to be the Metro. Sure, the monuments had been spruced up and the Statue of Freedom atop the Capitol had been refurbished, but she'd grown up just across the river. The sights people traveled thousands of miles to see were wallpaper to her. But the Metro — this was progress. The three-mile drive from her apartment in the Adams Morgan section could take up to three- quarters of an hour sometimes. But with the Metro, no traffic jams, no parking hassles, just a short walk from her apartment to Connecticut Avenue, hop the Red Line near the zoo, and a few minutes later she was in Union Station.
Gina caught herself chewing a fingernail as she rode the escalator up to ground level. She jammed her hand into the pocket of her jacket. Jittery. Too much coffee and just plain nervous. The next hour could decide the course of her professional life.
The outside air was warm and heavy. To her left a raggedy homeless man slouched on a wooden bench chattering away into a cellular phone. Gina doubted it was a real working telephone, but it certainly made a great prop if you had a tendency to talk to yourself.
She remembered coming here as a child, accompanying Mama to pick her up Papa after one of his regular trips to New York to visit his mother. She'd been afraid then. Union Station had been a cold, forbidding place in those days, a cavernous tomb of stained granite and shadowy corners, the area immediately surrounding notoriously dangerous after dark.
Now it was a shopping mall with dozens of clothing and accessory shops, restaurants, a pharmacy, even a B Dalton. And the area around it had been cleaned up, with the Postal Museum on one side and the Federal Judiciary Center on the other. All the dingy brownstones along Massachusetts seemed to have been converted to restaurants.
What a change.
But she knew the magic spell that gentrified this area ran out of steam a few blocks east. There, out of sight of the tourists, the politicians, and their staffs lurked the deteriorating houses, abandoned cars, poverty, and crime of the old days.
She passed the Columbus monument in the semicircular plaza in front of the station, wove between the idling tour buses, dodged a yellow trolley, and scooted across Massachusetts to one of the small parks that blanketed the upslope toward the Capitol. This one had an unreal feel to it: perfectly manicured grass, no litter, neat rows of trees, each labeled with its genus and species.
Welcome to Federal World.
She cut diagonally across to her left, weaving between suited federal employees and T-shirted tourists, and came out on First Street. She consulted her hand-drawn map — she'd been to the Capitol area many times as a child, but never to a Senate office building. Up ahead were the white blocks of the Russell Building on the right, the Dirksen Building on the left. She hurried past the shrub and flower-lined parking lot behind the Dirksen labeled "Federal Employees Only" — hopefully she'd have a spot there soon — and up to Constitution, then left past the Dirksen and a scruffy clutch of helmeted bike messengers lounging on the sidewalk, waiting for a call on the walkie-talkies protruding from their vests. Her destination was the adjoining block of white marble, the Hart Building.
In the white marble lobby inside the front doors she gave her name to the uniformed security guard and signed in. She was directed to place her bag on a conveyor belt. As it was swallowed by the x-ray box, Gina stepped through the metal detector. Just like an airport.
More white marble beyond the guards — the whole building seemed to be made of it. A short walk down a corridor lined with potted trees and she came to the Hart's huge central atrium.
She stopped, struck by the sheer mass of the enormous black steel sculpture that dominated the space. A series of jagged black peaks, stark against the white of their surroundings, thrust upward, reaching for the sunlight streaming through the ceiling beyond. Between the skylight and the peaks floated a gargantuan mobile of equally black disks.
Black mountains and black clouds in a white room. Arresting. But the tension coiled inside prevented her from fully appreciating it. Had to move, keep going, get upstairs to Senator Marsden's office.
As she passed through the atrium she noticed a man staring at her. In his gray suit he could have been any one of the thousands of senate aides who worked on the Hill. He was good-looking, though; thirtyish, fair, tall, close-cropped blond hair, blue eyes, square jaw. But why was he staring at her like that? She wasn't dressed in any way to make her stand out from all the other women passing through the atrium. Nothing special about her sedate, navy pin-stripe suit—just a knee-length skirt and a short fitted jacket. So why was he ogling her like she was wearing a micro mini and a halter top?(Continues…)
Excerpted from "Implant"
Copyright © 1995 F. Paul Wilson.
Excerpted by permission of MysteriousPress.com/Open Road Integrated Media.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
The Week of September 17,
The Week of September 24,
The Week of October 1,
The Week of October 8,
The Week of October 15,
The Week of October 22,