Doctor Assassin - A Medical Science Thriller

CHAPTER 11

Monday, March 6, 2017

Boston, Massachusetts

Back in Boston, Dr. Dent was about to start his fourth heart surgery case of the day, all part of an average day’s work. The first three surgeries, each with a valve replacement and three coronary artery bypass grafts, ran on time and without difficulties. Max was relieved that the crew had kept its efficiency despite David’s absence. For seven years, David Springs, R.N. had worked with Max to build the cardiac team of surgical nurses, pump technicians, and assistants, serving as their leader for all of Dr. Dent’s cases. His nickname was the Checklist Master. Being detail-oriented suited him, as he reminded everyone to tick off each line item in the list on the wall before starting surgery and before any of the high-risk steps.

Springs hadn’t shown up for work today, and he hadn’t called out sick, either. He’d never done that before. They missed his presence but plowed through the cases without their senior surgical nurse present. They followed the checklist cursorily, not as conscientiously as David would have demanded.

Max enjoyed working with this year’s cardiac fellow who was nearing the end of his three-month rotation. Having impressed Max, the young surgeon welcomed the privilege of starting the case and opening the chest. Eager to prove himself, the fellow rushed through the checklist, prepped, and draped the patient, and began the procedure by opening the woman’s sternum and exposing the heart. He cross-clamped the aorta, stopping the natural flow of blood from the heart to all the organs in the body, including the brain. As he opened the cannula from the pump into the aorta, placing the patient on bypass, Max entered the room, gowned, and gloved.

Suddenly, the senior pump technician exclaimed, “No blood flow!” The fellow froze. The two technicians started yelling at each other to do something. Lack of blood flow couldn’t continue for long because the patient wasn’t receiving any oxygen to the brain.

Max looked at the heart pump, and without raising his voice, demanded, “How much heparin did you inject?”

The fellow’s face reddened as he realized his mistake: he had forgotten to ask for an injection of the critical blood thinner. Sheepishly, he said, “I forgot.” If David had been there, thought Max, this never would have happened.

Despite being in gown and gloves, Max lithely knelt on the floor in front of the pump and removed all the clotted tubing and plastic pump parts while requesting that the pump technicians retrieve a replacement set. Simultaneously, he instructed the anesthesiologist to inject 10,000 units of heparin intravenously and place the patient on 100% oxygen.

He ordered the fellow to remove the cross-clamp on the aorta and begin cardiac massage to circulate the heparinized blood through the patient. Max reassembled the cardiac bypass pump in less than ninety seconds. He told the technicians to load another 10,000 units of heparin into the pump, add two units of blood into a fresh batch of Del Nido’s solution, which would mix with the patient’s blood in the bypass machine. Max stood up once the pump was primed; the second scrub nurse assisted with a new gown and gloves. Standing at the OR table, on the other side of the patient, Dr. Dent had the fellow to cross-clamp the aorta again and place the beating heart on by-pass.

The anesthesiologist reported that the monitoring EEG on the patient’s scalp documented no evidence of injury to the brain. At that, the entire team breathed a collective sigh of relief. The bypass had worked, and the patient hadn’t suffered from the error. Max lifted his head to the cardiac surgery fellow who had been deathly quiet since this near-catastrophe.

“Okay, let’s finish the operation we planned for Mrs. Collins today.” The fellow expected his boss to take over, but Max said, “Carry on.” He didn’t want to humiliate the guy. Fortunately, the rest of the case went well, and the patient awakened with no complications. Thank God, thought Max.

He left the operating room, chatted with the fellow, called Mrs. Collins’ family, and stopped at the main OR desk. He learned that David had not answered his cell phone, which was strange, not like David at all.

“Sheila, we should reach out to David’s brother,” Max told the nurse manager at the OR main desk. “He is the only family David has since he broke up with his partner last year. I think I remember David telling us he had planned a long weekend away in St. Thomas.” Max tried to remember the details; at the time, the conversation had felt so innocuous. “I suspect he traveled with friends,” Max said. “Can you text me the cell number for David’s brother?”

Max stepped outside, into the hospital courtyard, and found the phone number he needed. David’s brother picked up on the first ring.

“Hello, this is Dr. Max Dent. I am calling to see if you know where David is. He didn’t show up for…”

Interrupting Max, David’s brother spoke in a pained voice, struggling to form the words, “The St. Thomas police just hung up. They told me…” Max heard loud sobbing over the phone, and then the brother continued: “They found David dead in his bed yesterday, Sunday morning. They think he died in his sleep. The police officer gave me no details.” Neither he nor Max said anything for a long moment. Then he went on. “I can’t believe it. This whole thing sounds unbelievable.” Max heard David’s brother crying uncontrollably.

“I am so sorry,” Max said, still letting the weight of the news sink in. His immediate thought was a practical one: they would need an autopsy to figure this out. But what he said was, “David was an exceptional nurse, an invaluable member of our team. And such a good person, too. I am truly sorry.” Then Max said, “Did they say anything about when they were sending David’s body home for a funeral?”

“No.” Between tears, David’s brother answered, “They told me I had to go to St. Thomas to identify David before that could happen. Silence followed before he added, “I can’t do that. He is—was—the professional in our family. My wife and I are artists. This whole thing scares me; I’m no use in these situations…” Max heard the tears filling the man’s throat again, “Flying to some island is out of the question. I can’t.” His voice broke, and loud sobs filled the phone’s earpiece again. Max let the brother cry, thinking about what to do.

“What if I went to St. Thomas to identify David and brought him home?” asked Max.

There was a dramatic pause in the crying. “Um, sure.” David’s brother said, surprised. “You would go down there for me?”

“Yes, of course,” Max said, half-surprised at himself. “I would go for you and David. He was a critical member of our surgical team. We got close over the years. Since he and Marshall broke up, he was not alone in his melancholy. He spoke with me and others on the team about his sadness.” Max sighed. “We missed him today, and he will be hard to replace. The least I can do is help.”

“Thank you, Dr. Dent. I can’t thank you enough,” said David’s brother. Then he asked abruptly, “You don’t think he committed suicide?”

“I very much doubt that. David was in pain from the breakup, but he still had his upbeat spirit. And I know he was excited about the trip. I’ll find out what I can when I get to St. Thomas.”

“The St. Thomas police are emailing me some paperwork. I’ll forward the information to you, signed, so they will allow you to claim David’s body. It’s all so painful.”

“I know,” Max said. “Sudden losses just feel unreal at first.” Then he promised, “I’ll fly out tomorrow morning and call you from St. Thomas when I have things figured out.”

In his Porsche, Max picked up Lilah at their waterfront apartment and drove to Brookline for an early dinner at Zaftigs. He related the story about David Springs to her but didn’t share his heroics in the OR. He looked over at her as they got out of the car and felt a surge of love. Goosebumps formed down his spine staring at her large brown eyes and full-lipped smile.

Waiting for them at their usual table was Shalom. The older barrel-chested gray-haired man, speaking in Hebrew, greeted them in his gravelly voice, “I am so glad you agreed to eat with me this afternoon.” Shalom hugged Lilah first, then bearhugged Max as he whispered into his ear.

“Uncle Shalom, what a pleasant surprise,” Lilah said as she bit her lip and looked askance at Max.

“Just don’t tell Miriam,” Shalom smiled, pointing a finger as he instructed Lilah and Max, “that I am here enjoying their hot pastrami. She says it aggravates my diverticulitis! But what does she know, she’s no doctor!”

Max replied, “Miriam is probably right.”

Lilah got up, “I’m going to the lady’s room while you two talk about what you need to discuss,” said with a wry smile.

Shalom began, “How did she know…?”

“Your whispering in my ear was pretty obvious,” said Max. “What’s up?”

“Rosh insists you return to HQ. They need you to solve a problem. I don’t know any details.”

Max responded in a calm but clear voice. “I told Rosh that Aspen was my last mission. My life is here now.”

“Didn’t you get HQ’s signal to come home?” Shalom asked incredulously.

“I got the signal on my phone, but I ignored...