Rupture Read online

  “You’ve still got it,” Fran Lankford told her husband, sliding across the shiny leather seat until her hip pressed into his. For over thirty years, he had devoted his career to the cellular-based therapy of disease ranging from diabetes to Parkinson’s to cancer. And he had reached the pinnacle as the chief medical officer (CMO) in charge of RBI’s innovative, world-renowned Division of Stem Cell Therapy.

  “Did I . . .?”

  “No,” she said, gently squeezing his knee to reassure him. “No stammering, no stuttering, not any of that. This time.”

  Lankford smiled, leaned forward, and removed two glasses from a miniature bar carved in the lush interior. “The hard stuff?”

  “Yeah, why not.”

  He plopped a single cube of ice into each glass and poured a round of the island’s best sparkling water.

  “Now, home to that grandbaby,” Fran said.

  “I’m sorry, the timing of this conference was awful.”

  “We’ve been traveling as a team for what, twenty years or more?” Fran said, as if she needed to convince him of her loyalty. “They’ll be fine.” But as she said this, her new grandmother voice cracked. “Probably just out of recovery now.”

  They clinked their glasses in an awkward toast as the limo accelerated toward the airport.

  They had landed on the French side of the island barely ten hours before. Upon boarding the company jet in Memphis, they received an urgent call from their son-in-law.

  “They’re taking the baby. Stat C-section.”

  Now, Bernie and Fran Lankford stared out the window of their chauffeured car into a black Caribbean night. Each had the same thought.Taking the baby. Our little Celia. We’ve waited for years to be grandparents. And now we’re off on an island in the Caribbean Sea.

  Minutes later outside the airport in Marigot, Bernie Lankford stood beside the limousine, stretched his arms, and watched the flare of a commercial jet overhead. The night air was fresh with an island breeze that wafted the fragrance of jasmine under a heavy sky pulsating with stars. As the roar of jet engines peaked, pain ripped through his abdomen as though he had been shot.

  Fran Lankford stepped out of the car without assistance. Both the driver and a bodyguard were at the side of her husband, who was bent over at the curb. “Dr. Lankford. Sir?” They called to him but the man was on his knees, hands cupped against his chest, retching.

  “Bernie?” Fran said softly, thinking he had slipped. Then she knew otherwise. “Bernie!” she screamed as she lunged to see the face of her husband.

  His eyes were unfocused. An increasingly blue face, lathered in sweat. He moaned and pressed hard against his abdomen with a balled fist.

  “Call an ambulance,” Fran shouted.

  While the driver punched numbers into his cell phone, Bernie Lankford toppled forward. As though in slow motion, but before Fran could catch him, his face smacked the dull edge of the curb.

  Fran knelt by her husband and bathed his face with a cloth doused in the sparkling water. He was unresponsive, only shallow, wispy breaths indicating life. But at least he was alive. She talked to him, just inches from his left ear, with the life-sustaining words that only a wife of thirty-seven years could offer.

  “Your grandbaby is waiting for you. You hear me?”

  Fran placed her hand on his abdomen and noticed it tight and tense as if fluid had come from nowhere and was expanding under pressure. An airport attendant came out to assist them, but he could do nothing. A family of tourists gathered, quite disturbed at this scene on their first day of vacation. The father ran into the terminal to call an ambulance, again, while the mother held on to three small children and watched.

  After twelve agonizing minutes of the slowest possible island time, an ambulance pulled up beside them. No siren, no flashing lights. The passenger exited the vehicle, dreadlocks flowing from beneath a red cap that announced ISLAND MEDICAL TRANSPORT. The driver remained inside, smoking a cigarette.

  “What we got here, man?”

  “My husband, he collapsed,” Fran said. She was crying now for the first time since her husband went down, either from relief that help had arrived or her sense that she would soon be completely alone. “Please help him, he’s barely breathing.”

  The driver got out, walked casually to the back of the ambulance and swung the doors open.

  “Hey, Mars, throw me a blanket, man,” the dreadlocked partner said. “This guy’s bluer than Orient Bay.”

  Mars rolled out a stretcher parallel with Lankford and lowered it to the ground while Fran continued to caress her husband’s forehead and whisper into his ear.

  With Mars at the feet, they secured a hold on Lankford’s body and lifted as his large, grotesquely protuberant abdomen folded in toward the pavement. “Here goes my back,” Mars said as they swung him onto the stretcher like a sack of mangos.

  Fran Lankford insisted that she ride in the back with her husband. When she climbed into the ambulance behind them, Mars looked at his partner and shrugged. “Whatever she wants, man.”

  Once the ambulance was moving, they drove like it was a real emergency with lights flashing, siren blaring, and racing through turns at full speed. Fran Lankford was thankful for the speed but feared they would turn the ambulance over, or worse, flip Bernie off the stretcher. She looked again at her husband, his abdomen hugely swollen, face the color of ash.

  At a medical facility in Marigot, Mars and his partner rolled the stretcher into a receiving area, where they were met by a young woman. A name tag that read MIRANDA, R.N. was displayed on her pink floral sundress.

  Fran hoped that the emergency team had at least called ahead about her husband.

  “Who’s this?” the nurse asked Mars with a frown.

  Neither paramedic had called the hospital.

  Miranda pointed to a curtained bay with a stretcher, an emergency cart, and a cardiac monitor overhead. “Take him over there. I’ll wake Dr. Francisco.”

  A male orderly helped them transfer Lankford to the bed and minutes later a short doctor appeared sporting a goatee and wearing a leather vest over a tie-dyed tee shirt.

  “Vitals?” he asked, in the final stretch of a yawn.

  No one answered as Miranda scrambled to hook him up to the monitor.

  He looked to Mrs. Lankford. “You his wife?”

  She stepped forward, hands folded in front of her as if in prayer. “Yes.”

  “What happened?” the doctor asked as he cleared his throat and swallowed hard.

  “We stepped out of the car at the airport and he collapsed. You’ve got to help him.”

  Dr. Francisco looked at a blank screen on the monitor and took Bernie’s wrist to check for a pulse. “Medical problems?”

  “Just diabetes, I mean, controlled by diet and he has —”

  The doctor moved from Lankford’s wrist to his neck, searching for a pulse while Fran completed her husband’s history.

  “—an aneurysm.” She pointed to her own abdomen.

  “Aneurysm!” Francisco repeated, his hands now on Lankford’s distended abdomen. “Oh, shit. He’s ruptured a triple A.”

  “But he just had it repaired a few months ago.” Fran’s voice pleaded, her hand cupped over her mouth in disbelief.

  The cardiac monitor blinked to life and a flat tracing confirmed Francisco’s exam. “Okay, here we go folks,” the doctor said, “he’s coding.” Then quietly to the nurse, “Get her out of here.”

  As Fran Lankford was escorted away, she turned to see the orderly crouched over her husband, pounding his chest.

  “A round of atropine, epinephrine, the works,” Francisco called out, as if ordering drinks at a local bar. “Continue compressions.” He yanked the portable ultrasound machine close to the table, ripped open Lankford’s shirt, and squirted a glob of gel onto the mound of abdomen. “Oh yeah, here it is,” he said as he ran the probe along lubricated skin and watched snowy shadows dance across the screen. “Blood everywhere. Damn, it’s blown to hell.�
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  The nurse pushed epinephrine into the IV and turned to face the machine.

  “See,” Francisco said, as if seeking confirmation. He pointed at the screen. “All this here? Blood. Liters of it.” He slammed the probe into a rack on the ultrasound machine. “Ain’t no way. Ain’t no freaking way. We can go through the motions but that’s it. He’s a dead man.”

  CHAPTER THREE

  GATES MEMORIAL HOSPITAL

  OPERATING ROOM ONE

  1:56 A.M.

  Intern Landers stood over the body of Mortimer Gaston. The volume of the man’s blood was divided between steel basins on the back table and sheets thrown over a thin lake, which spread across the floor and drained Gaston’s skin bluish-white. Poised in Landers’s right hand, a needle driver clamped a three-inch curved needle with black suture thick enough to sew elephant skin.

  “Just baseball stitch it,” Roberta, the scrub nurse said, coaxing the intern to close the dead man’s abdomen.

  Landers grabbed a thick plug of abdominal wall with heavy forceps but stopped before he drove the needle. He looked again through the door at his attending surgeon, Dr. Branch. Eli bent over the scrub sink and held to its side with both hands.

  Virginia, the circulating nurse, tossed a bundle of blood-soaked linens into a hamper. To Landers, she said, “He’ll be back in. Just needs a second.”

  Korinsky had stormed out of the OR during the final minutes of a failed resuscitation, leaving Eli and the intern to decide the time of death and make the declaration. But the senior surgeon continued an eloquent oration during his exit.

  “Would you mind closing for me? I’m going to watch the back of my eyelids.”

  Like a kid shooting a rubber band, the chief of vascular surgery flung his bloody gloves against the wall. They were still in Gaston’s chest when Korinsky added, “Just remember, doctors, all bleeding eventually stops.”

  That bastard, Landers thought, still feeling harassed by Korinsky’s invisible presence. He threw in the sutures, over and over, like sewing a seam, and pulled them tight. As Landers jerked the needle through the tissue, it jammed deep into the joint of his left thumb.

  “Damn it.” He threw the needle driver against the cover drape.

  “Did it get you?” Roberta asked, as if she didn’t know that the point had penetrated Landers’s skin.

  He stepped back, pulled off his glove, and squeezed the entrance wound. A large drop of blood formed and ran down his hand. The dangers of a needle stick flooded his mind.

  Eli reentered the OR and Roberta told him what had happened.

  “Scrub out and wash your hands with alcohol,” he told Landers. “Go. I’ll finish.”

  Virginia led the intern well away from the electrocautery machine and poured alcohol over his hand, letting it run into a waste can before he washed at the sink.

  When he came back in the room, Landers had pulled his mask down to his chin and his face looked washed out. He had had enough of this case. Needle sticks, although infrequent, were the dreaded risk of a surgical career. Hepatitis B, Hep C, not to mention HIV. “Well, at least he’s an old man, probably harmless.”

  “You need to get tested, Landers. I’ll draw his blood and send it for everything. Occupational Health is closed this time of night. Go down to the ER and get your blood drawn.”

  “I’ll get the paperwork started,” Virginia said. “You can take it with you.”

  “Listen,” the intern urged, “this old guy doesn’t have any risk factors. It’ll take two hours to get through the ER mess.”

  “No, you listen,” Eli said, and everyone in the room stopped. “I know this man and . . .” Eli hesitated. “He had a risky lifestyle. You need to get checked.”

  Landers gathered the paperwork, muttered “Thanks,” and left.

  Eli placed the final stitches and tied the two ends together in a bulky knot at the pubis. He knew that this was a temporary closure that would be reopened soon for the autopsy. He hadn’t wanted to scare the intern, but Eli was the only person in the room who knew the history of Mortimer Gaston. And he knew it all too well.

  He tried to suppress the crazed images of Gaston. It had been late at night.

  Dark.

  Maybe too dark.

  The ten-year-old’s mind was probably playing tricks on him. What did a child know about such things?

  “Virginia, give me a spinal needle on a twenty-cc syringe,” Eli requested.

  A senior nurse who had been at Gates forever, Virginia could guide even a junior surgical resident through major abdominal operations.

  Eli remembered her from his time as a medical student eight years ago at University of the Mid-South’s School of Medicine, before his near decade of surgical training.

  While he waited, Roberta stood nearby, curiosity crinkling her face. She asked in a near whisper, “What was his lifestyle?”

  Virginia handed the syringe to Eli. “I’m not sure he has any blood left. I should’ve squeezed some out of the laps.”

  Eli knew that he was reopening a deep wound that had taken years for him to heal. He turned to Roberta. “Mort Gaston worked with my father in the anatomy lab at the medical school. For over thirty years, he prepared the cadavers for dissection.”

  “So you knew him as a medical student?” she asked.

  Eli held the syringe in a vertical position, the five-inch needle pointing to the ceiling like a spire.

  “I knew him since I was a kid hanging out in the anatomy lab. Gaston lived in the basement of what the medical students called Cadaver Hall. I learned more anatomy from this old man than all my professors combined.”

  “Doesn’t sound like a risky lifestyle to me,” Virginia said, while she finished counting the instruments.

  The needle pierced Gaston’s skin just to the left of the xyphoid process. Eli angled it to forty-five degrees and plunged it toward the man’s heart.

  “Eli,” Virginia blurted, “your student just got stuck by a dirty needle. We need to know what this man’s risk factors are.”

  What does it matter now? he thought, watching Virginia pull a sheet over the greyed head. Eli unscrewed the needle and handed the blood-filled syringe to his nurse.

  “Just send the blood. Trust me.”

  All the doors to Gates Memorial Hospital were locked at night except the exit from the emergency room to the parking lot. Eli approached the sliding glass doors and nodded to the guard.

  “Evening, doc.” The guard checked his watch and the motion pulled his blazer open, revealing a holstered pistol. “Morning, rather.”

  The outdoor oven that greeted Eli made him stop momentarily under the neon emergency room sign for his daily readjustment to Memphis in July. The combination of sultry air and the site of the weapon recalled a similar night when he was a medical student on emergency room call.

  A prisoner from a maximum-security facility was brought in with complaints of abdominal pain. Eli’s resident assigned him the case. When Eli entered the exam room he was skeptical, knowing that prisoners often faked symptoms to go on hospital field trips. They were notorious for ingesting foreign objects—pencils, watches, packs of cigarettes, even razor blades. These they wrapped in tape to prevent laceration of the gastrointestinal tract. Yet the presence of a razor blade on an X-ray won them an operation and a week’s vacation.

  The first thing Eli noticed was the guard who accompanied the prisoner—a frail man in his mid-sixties. The prisoner was a forty-two-year-old male. The man opened his bright orange jumpsuit to reveal a scarred landscape of stab wounds, surgical incisions, and a tattooed fist in the middle of his chest with the middle finger extending up his sternum.

  During the abdominal exam when Eli pressed on the prisoner’s right side, the man groaned and bent his right leg.

  The guard came to Eli’s side. “Be still and let the doctor examine you.”

  Eli moved his hands to the prisoner’s left side but got no pain response. Back to the right lower quadrant. At the location of
the appendix, the man grimaced and tensed his abdominal muscles.

  “I need to bring in my chief resident,” Eli told the patient and confirmed this with the guard. But his chief resident was busy in a trauma resuscitation, so Eli returned, alone, two minutes later. As he approached the examining room again, he heard the rattle of handcuffs, the crash of a metal tray against the floor. The blast of a gun ricocheted through the emergency department. The prisoner burst from the room, his shackled hands gripping the pistol and aiming it up and down the hallway. Nurses and technicians scattered. Eli found the guard lying face down in an enlarging pool of blood.

  He picked up a phone in the hallway to notify hospital police, when the man aimed the gun at Eli’s head.

  “Hang it up,” the prisoner demanded.

  For a moment, they stared at one another. Without looking away, Eli dialed the number as the man walked toward him, sighting down the barrel.

  “Code Black, emergency room,” Eli said.

  Immediately, an alarm sounded and the prisoner took off down the hall toward the pediatric wing. Eli drew a deep breath and rushed to attend to the injured guard, but he was already dead. A few minutes later, the prisoner was apprehended in the hospital parking lot.

  Later, when it was all over, the ER staff applauded Eli for acting so quickly and calmly. Eli remembered the fear as nearly incapacitating.

  “Hey, Doc, you okay?”

  Eli shuddered and wiped sweat off his face. His skin fluoresced green under the neon ER sign.

  “I said, are you okay?” An ambulance had backed up to the bay and a paramedic opened the back doors. He stopped and watched Eli.

  Eli nodded and started toward his car. After ten years, the memory occurred less often now, but seemed to grow even more vivid.