Critical Condition

Book 2: Dr Richard Steele

by Peter Clement

Genres: Thrillers; Suspense

Synopsis

In the heat of a passionate encounter, ecstasy suddenly turns to terror for renowned geneticist and TV personality Dr. Kathleen Sullivan. Stricken by a brain hemorrhage, she is rendered completely paralyzed and speechless . . . but still utterly aware; a prisoner inside her own body.

Kathleen is rushed to a Manhattan hospital, her chances of survival slim. Even if she pulls through, the likelihood that she’ll sustain permanent brain damage is near one hundred percent. But neither outcome can compare to the insidious fate in store for her masterminded by the very people entrusted with saving her life. As her lover, ER chief Richard Steele, watches and waits for a miracle, Kathleen becomes a pawn in a clandestine plot that runs deeper than medical politics–and reaches into the highest echelons of power at New York City Hospital.

Placed in the hands, and at the mercy, of revered Chief of Neurosurgery Dr. Tony Hamlin, Kathleen descends into a waking nightmare. Powerless to resist the sinister experiments she is subjected to, and unable to cry out for help, she must fight desperately to communicate her tortured, trapped thoughts to Steele–before her tormentors can carry their bizarre and potentially lethal work to its completion.

Ruthlessly determined to achieve their goals, the secret cabal of ambitious physicians will go to any length to avoid discovery, defy the law, and make medical history at all costs . . . even the human life they are sworn to preserve.

For anyone who has ever had a mortal fear of hospitals, and the sense of powerlessness that often transpires within their cold, sterile corridors, Peter Clement’s Critical Condition will provide chilling new nightmares–along with infectious suspense.

Release date: August 26, 2003

Publisher: Ballantine Books

Print pages: 384

Sample

Two Weeks Earlier, Wednesday, June 13, 6:45 a.m.

She felt the sound more than heard it. It came from deep within her brain, and in the first few seconds seemed to have no more significance than the tiny popping noise a congested sinus makes when it clears, or the slight creak that even a healthy neck can produce after the muscles and tendons have stiffened from being too long in one position.

So Kathleen Sullivan ignored it, automatically relegating the minute sensation to the background trivia of everyday life, deeming it part of approaching forty, unimportant, therefore not to be heeded, and resumed making love to Richard Steele, whom she sat astride watching his eyes glitter in the gray traces of morning light that had begun to creep into her still-darkened bedroom.

God, she loved him. Their sex seemed always such a celebration of how they matched each other in life.

Then the pain hit her at the base of her skull with the force of a two-by-four. “Oh, my God!” she screamed, clasping the back of her head and freezing.

She felt him initially increase his movements, then slow when she failed to respond, his flushed, smiling features growing puzzled.

A swirl of dizziness sent her reeling to the right as if she’d been slapped. She toppled off him. Nausea overwhelmed her, and vomit arched out of her mouth as if shot from a hose. She flopped down, half on and half off his chest. Blackness came quickly, but it took longer before she lost sensation enough to stop feeling the pain entirely.

And she could still hear.

“Kathleen! Kathleen, what's the matter?” he cried from somewhere far off.

Someone’s prying open my skull from the inside, she tried to tell him just before the pressure squeezed all consciousness out of her.

The pain, like roots, ate deep into her sleep, and tendrils of harsh light ripped her out of the merciful dark. She tried to scream, but no sound came. She could see racks of bottles, bags of fluid, and coils of plastic tubing lining the walls of whatever little room they were in, yet everything looked wrong, as if outlined in double. She blinked to clear her vision; it made no difference. She couldn’t shift her eyes from side to side, but she could look up and down. She tried to move her hands, but not even her fingers would budge. Had they tied her to the bed?

Someone loomed over her and placed a black mask on her face, then pumped air into her mouth and down her throat.

“Her breathing’s labored,” she heard Richard say from a place beyond her line of sight. “Step on it!”

“We’re a minute from the door, Doc!”

She felt the room sway hard to the left, and realized they were in an ambulance. Probably on the way to Richard’s ER. But why couldn’t she look at him? Move anything? God, what had happened to her?

“It’s okay, Kathleen,” she heard him say. “We’ve got you. Just relax and let us help you breathe.”

Volleys of air forced their way past the base of her tongue and down into her larynx. Each one felt big as a tennis ball and filled her with the urge to gag, but her pharynx stayed flaccid, refusing to respond. She wanted to shake off the mask and gasp for breath, yet couldn’t.

“If you can hear me, Kathleen, we’ve called ahead to the hospital, and the chief of neurosurgery is waiting for us. You’ve suffered some kind of stroke, probably hemorrhagic from the way it’s affected your eyes, but you’ll make it okay, Kathleen. Count on it!” His voice trembled and broke, leaving her wondering if he’d sobbed. Squeeze after squeeze of air went down her throat. “Hyperventilating you like this blows off carbon dioxide and constricts arteries in the brain,” Richard continued, his words coming in fragments as if they were catching on something sharp. “That’ll slow the bleeding.”

With a squeal of brakes the vehicle lurched to a stop. Instantly she heard the doors at her feet snap open and felt the cool morning air flow into the vehicle. Only then did she realize she was nude under a blanket.

The attendant went on ventilating her and a half dozen men and women in white clustered around to help lift out the stretcher. “Where’s Tony Hamlin?” she heard Richard ask.

“In resus, ready and waiting with his neurosurgical team,” someone answered as they raced into the ER and down a corridor, the sweep of the ceiling past her vertical stare adding to her dizziness. She could feel Richard’s hands against her face as he took over holding the mask tightly in place around her mouth and nose. By straining her eyes upward she could see him. His expression grim, he snapped off orders to his staff as he ran. Even when he glanced down at her and tried to smile it was a miserable attempt to reassure her.

My God, she thought, the poor man. He thinks I’m going to die, just like his wife.

They wheeled her into a vacuous cool chamber filled with a dozen people in green gowns, masks, and surgical gloves. Everyone grabbed a part of her and worked on it as if she was a race car at a pit stop. While IVs went in her arms, a tube was shoved down her throat, and what looked liked tiny spigots were stuck into her wrists. Once more she felt she had to gag, but not even a cough or sound of any kind emerged. She lay as motionless as a corpse, yet aware.

“We’ve got her stable, Richard. Why don’t you let us take it now?” said a man with long white hair standing by her head.

“Right, of course, Tony,” she heard her lover reply, his voice more strained and uncertain than ever.

No, don’t leave me alone, she wanted to cry out.

His face once more came into view, his handsome features as tense and pale as latex stretched over a skull. “Kathleen, our chief of neurosurgery, Tony Hamlin, is right here to take care of you.”

“Hi, Kathleen,” Hamlin said. “Sorry to meet you in such circumstances.”

“These people are the best,” Richard continued. “They’ll get you through this.” He leaned closer and whispered, “I love you.”

Please stay!

He turned, and out of the corner of her fixed field of vision she watched him disappear.

Then a nurse whipped off her blanket and proceeded to insert a catheter up her urethra. “Did the event happen during intercourse?” she asked coldly, examining the secretions she’ d picked up between her gloved fingers.

“Isn’t that one of the classic presentations of an arterial rupture?” asked a curly-haired man in a short clinical jacket as he adjusted her IV. He didn’t look much older than her daughter Lisa, who’d just turned nineteen. Christ, Richard had left her in the hands of a kid.

“When you’ve finished what you’re doing, Doctor, why not step outside and get a proper history from Dr. Steele?” said the white-haired man behind her head as he proceeded to shine a penlight into her eyes. Despite the glare, she couldn’t avert her gaze, only blink. His face looked to be in pieces, like a Picasso.

Richard stood in the corridor slumped against the wall. His taking charge in the ambulance had been both critically necessary and a retreat into action, his concentration on technique keeping his terror at bay. Now he had nothing to divert him from facing what had happened, not as a doctor, but as her lover. At the center of the domain where he’d spent his professional life resuscitating others from the dead, he began to tremble with helplessness.

A nurse with closely cropped gray hair and rectangular, gold-rimmed glasses came steaming out of the room he’d just left. “Dr. Steele, let’s sit together in your office. I’ ll get you a coffee.” Her name tag read Josephine O’Brien, but she’d been around the department longer than he, and everyone with whom she was friendly called her Jo. “Dr. Sullivan’s completely lined, we’ve wired her to every monitor we have, and her vitals are holding. A CT’s next, so there’ll be nothing new to report until then.”

A much younger colleague followed on her heels. “She’s in good hands with Dr. Hamlin,” she added. “You’re doing her and yourself no good hanging around the doorway.”

They spoke with exactly the mix of firmness and compassion that he expected everyone in his department to use when dealing with frightened family and friends of patients. He mumbled his thanks for their support, and had he not been a physician, might even have felt reassured. The trouble was, like most good ER doctors, he knew the odds. No niceties on the part of his staff could stop the percentages from pummeling his brain.

Mortality for this type of intracranial bleed — eighty percent.

Morbidity or permanent brain damage in those that survived — almost certain.

Chances of a fatal rebleed — high.

A cold empty feeling settled into the pit of his stomach. As the two women led him down the hallway, he had to watch his step the way a drunk man does. The numbers literally staggered him. At his door he fumbled his keys until Jo took them and unlocked it for him.

Don’t die on me, Kathleen, he kept saying to himself. Please, don’t die on me.

As soon as he stepped into his own small sanctuary — a carpeted shoe box with an oversized metal desk, two chairs, and a potted tree — he quickly raised a hand to his eyes, not wanting the nurses to see the tears brimming over his lower lids. But the streams were halfway down his cheeks before he could wipe them aside. “Please, just leave me be,” he said quickly, straining to keep his voice steady while looking up to avoid their gaze. The tiny perforations in the ceiling tiles shimmered like black stars in a white universe.

“Not on your life, Richard,” said Jo, one of the few who would dare use his first name. Keeping her hold on his arm, she added, “Now sit down and let us take care of you for a change, starting with the mug of hot caffeine we promised you.” A jerk of the head toward the door sent her junior running down the hallway to fetch it. “And don’t worry about letting down in front of me,” she continued when they were alone. “As for Kathleen, let me be telling you, us Irish women have a stubborn strength that adds up to an edge for seein’ us through any ordeal. It probably comes from dealing with all the ornery men in our lives. From what I’ve heard she’s as good a fighter as any, and that’s sure to help her survive.”

Richard looked up at her lined face and kind brown eyes. His wife had had fight in her, too. What good did it do her?

At that moment there was a knock, and a young resident stuck his head in the door. “Dr. Hamlin sent me to ask you a few questions, Dr. Steele,” he said.

“Not now!” Jo snapped.

He disappeared back out again.

“These kids they make into doctors nowadays,” she muttered after he’d fled. “Know all the facts, and nothing about people.”

Because the people part’ s too painful, Richard thought.

“It’s a pontine bleed,” Hamlin told Richard an hour later in that same office, referring to a specific part of the upper brain stem. “Her pupils are pinpoint and, for now, unreactive. She’s quadriplegic, has lost her gag reflex along with her ability to swallow. Control of her pharyngeal and facial muscles is gone as well, to the point she can’t speak or show any expression. But she’s conscious, and moves her eyes up or down on command. She can also blink up a storm. That’s what tipped me off when I examined her.”

“A locked-in syndrome?” Richard asked, the fearful sensation at the core of his innards turning to ice.

Hamlin nodded. “Her respirations haven’t deteriorated any further, though she still needs an assist from a ventilator. We had to leave her intubated anyway, to protect her airway from an aspiration of vomit — she can’t even keep her saliva out of her lungs. We’ve also sedated her — it’s obviously a hell of a panicky situation for her — but she can still signal with her eyes. We’re using morphine to manage the pain at the same time, and she’s indicated the headache’s lessened. You know, I was tell- ing the residents that Alexandre Dumas was the first to describe this condition — ”

“What’s her prognosis?” Richard cut in, unable to take anymore clinical detail, nor Hamlin’s pompous tendency to lecture even when he was talking alone with a colleague. “And don’t bother me with the general outcome for brain stem bleeds. I know that. Is the pons any less dismal?”

“Only time will tell,” said Hamlin, assuming an even more professorial tone. “On her CAT scan the hemorrhage seems confined to that area. If it stays there, without penetrating into the fourth ventricle that’s nearby, and she survives the next few hours, she might have a considerable recovery. We’ll get a better view when she’s stable enough for an MRI, and of course I’ve scheduled an angiogram. But if she rebleeds and the hemorrhage extends into the ventricular space where there’s no stopping it . . .” He let his voice trail off.

Richard didn’t need to be told that these were the ones with the highest death rates. “What’s a ‘considerable recovery’? ” he asked, his mouth so dry he could barely speak.

“Sometimes it means that patients regain sufficient respiratory function to get off a ventilator. Sometimes they do much better and are left with a deficit only in the legs, remaining paraplegic, or with luck, recover partial movement there as well. A small number actually walk again. In other words, I’ve seen instances where they win back almost full function, especially in the upper body, including the ability to swallow and talk. Of course, it’s impossible to predict the outcome of any given case.”

Hamlin’s voice faded into the background as Richard’s mind conjured an image for each scenario: Kathleen withering away on the end of a breathing tube, dragging her lifeless legs along on crutches; Kathleen feeding herself, garbed in a food-stained bib — nothing he hadn’ t seen before . . . in strangers.

“Her angiogram will give us a better idea of the reason for the bleed, which I suspect is a congenital arterial malformation, probably a capsular angioma, since she’s no history of hypertension. Of course I don’t have to tell you it’s got to come out. Unless this underlying deformity is removed in its entirety, the risk of another hemorrhage will always be there. But first we have to stabilize her enough for the OR and verify with imag- ing that we can get at it surgically without doing too much collateral damage.”

Richard shuddered. The term collateral damage was code for an even more chilling outcome. If the many neural pathways and centers that passed within millimeters of each other in the section of the brain Hamlin cited, those controlling breathing, walking, voluntary bladder or bowel control, finger-hand-arm movements, speech, and eating, had survived the bleeds, they might not survive the surgery. His cutting out the tangle of abnormal vessels, the capsular angioma that he suspected, while leaving the rest of the anatomy intact, was so tricky the operation itself could further destroy neurons, making her worse off and possibly kill- ing her.

Again it wasn’t anything he didn’t know or hadn’t already feared. But even doctors escape into false hopes when faced with a catastrophic ill- ness that’s personal. Hamlin’s words slammed the door on anymore such retreats.

“Thank you for letting me know, Tony,” Richard said, barely able to find his voice.

When he was alone, the well-practiced grip he usually kept on his nerve broke completely. Sobs came from so deep within they racked him with the cruelty of convulsions, wrenching the air out of his lungs and filling the room with a grotesque, high-pitched, hacking wail. He had cried like this only once before, years ago on the day Luana died. Then it heralded an eighteen-month spiral of grief, drinking, and denial that nearly lost him his son, his job, and his life.

“Not this time,” he whispered through clenched teeth, still doubled over and struggling for breath. “Whatever happens, I won’t cop out this time.”

But the cold fear in his belly twisted as if to mock his brave words. Once a coward, always a coward, it seemed to say.

Others who loved Kathleen flew to mind — her daughter Lisa, and his own son Chet.

He had to let them know. He pulled himself together enough to reach for the phone and dial Lisa’s apartment first. As he waited for her to pick up, he prayed the iron resolve he’d used when making similar calls to faceless next of kin would help him now.

“Hello?”

“Lisa, it’s Richard.”

“Hi! What’s up?”

The youthful eagerness of her greeting hung between them. “Lisa, I’ve got bad news. . . .”

Where the hell was Richard? Goddamn it, Kathleen thought. Why didn’t he come back? And why didn’ t anyone tell her anything. It seemed as though it had been forever since that Beethoven look-alike and his pack of apprentices finished their methodical tapping and prodding.

The tube down her throat continued to keep her perpetually on the verge of gagging, and still the choking never came. A new treat was the catheter in her bladder burning like a line of coals, leaving her feeling a constant urge to pee. The nausea never abated. And the unrelenting spin inside her head so tilted the room that she thought some masochist in white had strapped her to a table designed for training astronauts.

Worse was how they all talked over her, reducing her to a set of bodily functions and discussing her solely in terms of numbers. To them she wasn’t even there.

“Respirations set at eighteen.”

“O2 sat’s ninety-six.”

“CO2’s twenty; pulse seventy; BP one-thirty over seventy.”

Why couldn’t she move? Why didn’t someone tell her? She blinked furiously, wanting to catch the attention of a passing figure in white.

No one paid her the slightest heed.

What had happened to her?

“Some kind of hemorrhagic stroke” Richard had said. But he’d also promised she’d be okay. This sure as hell wasn’t okay. Christ, they’d just parked her, plugged into a bunch of machines.

Then a woman with short gray hair and small gold glasses loomed into view. “Dr. Sullivan, my name’s Josephine O’Brien, but around here they call me Jo. I know you’re frightened, and it won’t do you any good to hear a bunch of lies about your being fine. But you are what we call stable, and that’s the best we can hope for in this place. Richard’s gone to get your daughter, Lisa. Blink twice if you’re up to seeing her.”

Hearing her name spoken with such simple kindness brought Kathleen hurtling back from the anonymity the others had cast her into. “Yes! Yes!” she blinked through tears. It took her a few seconds more to realize that at least she could still cry.

Dr. Tony Hamlin’ s gaze swept the crowded cafeteria until he spotted the man he wanted. He quickly weaved a path through the crowded tables where nurses, orderlies, and residents wolfed down the remains of breakfast. Those already finished raced by him, Styrofoam cups in hand, heading to the wards for the start of another day-shift at New York City Hospital. Everyone was more or less color coded — nurses of both sexes sporting pale green, orderlies powder blue, personnel from the OR and critical care areas garbed in scrubs of darker tones to better mask the stains from all the bodily fluids splashed about during invasive procedures. Doctors wore white coats of varying length — short jackets for students, mid-to-long ones signifying increasing seniority.

Hamlin’s coat flowed out behind him like a cape. Matching his mane of white hair, it was a chieftain’s regalia in any tribe.

His target, Dr. Jim Norris, had his own singular dress code — a dark brown bomber jacket, the leather cracked and weathered to the point it almost matched its owner’s well-worn, bearded face. The man sat alone, his lean six-foot figure hunched over a porcelain cup of steaming water into which he repeatedly dunked a tea bag. When he saw the older man approaching, he narrowed his dark eyes, the way a bad-tempered dog might signal it doesn’t want to be disturbed. “Now, why is the chief of neurosurgery descending on me at this hour?” he said as soon as Hamlin got within earshot. “Don’t tell me you’ve another of your catastrophic cases, Tony, and I can’t finish my tea.”

“Go on, Norris. You love it when I pull you away from your rats and give you a chance to do some real medicine. Don’t pretend otherwise.”

The researcher flashed a smile that looked surprisingly brilliant amidst the wiry tangle of hairs in his salt-and-pepper mustache. “So what is it this time?”

“We’ve got to hurry,” said Hamlin, leaning over the otherwise deserted table and lowering his voice. “I just examined the famous girlfriend of our esteemed chief of ER. She’s had an intracranial bleed — I take it they were going at it rather vigorously in the sack at the time. The hemorrhage is localized to the pons, and she’s got a locked-in syndrome. She’s also young, not yet forty, and otherwise healthy with no risk factors, according to him. That makes her a candidate, just like the others — ”

“You’re not suggesting we do her!”

“Of course I am.”

“Are you nuts? What if Steele finds out? We’ll be finished.”

“Not necessarily. In fact, saving her may give us a way out of our current mess.”

“How?”

“If the infusion works in her case, we’ll have a chance to get him on board. Think how beneficial it would be — his alerting us anytime a patient of ours comes into ER, before some other doctor or resident gets a closer look at the old records. It’ll be one less way we can get caught.”

“What if the infusion doesn’t work?”

“Then she’s probably dead anyway, or worse, a vegetable in a wheelchair. It’ll be the outcome he expects.”

“And if he still finds out what we did to her?”

“The only way he’ll find out is if this stuff works. Because then I’ll tell him myself. And make it clear that unless he goes along with us she won’t get the second round of treatment she’ll need.”

“That’s nuts. He could still refuse to go along and turn us in. How do you know he won’t?”

“Because I’m betting he’ll do anything not to lose this woman. Remember what happened to him when he lost his wife?”

Norris scowled, clasped his cup between both hands and took a sip of tea, then said, “I don’t know.”

“Damn it, it’s my name on those patients’ charts, and if anyone gets suspicious, it’s me they’re going to come after with all their questions. Shall I refer them on to you?”

The bearded man went still, his white smile once more coming into view, but slowly this time, tooth by tooth. “Threats don’t become you, Hamlin, or did I misunderstand your point?”

“We’re all under threat here. The only way you and the rest stay safe is to keep me safe. And that means we need Steele. Christ, if I’d known it was going to be like this I never would have gone along with your crazy scheme.”

“My crazy scheme?” Norris’s forced grin never wavered. “Hey, we’re victims of our own success. Who knew our subjects would do so damn well at first that we’d have to let them go home?”

“You call what happened to them a success? Christ, it’s got all of us living like fugitives. And you’re damn lucky I’ve been able to talk the families out of autopsies so far.”

Norris chuckled. Anyone paying him any attention would have thought him the happiest guy in the room. “So someday we’ll be heroes, and you’ll be a star in Neurology Today just the way you’ve always wanted.” He downed his tea and shoved away from the table. “But let’s just hope you’re right about Steele being a good friend in ER. If you want me, I’ll be in my lab, preparing what you’ll need. I assume you’re going to slip it to her during an after hours angiogram, as usual.”

Hamlin bristled at the researcher’s cavalier attitude, detesting the man’s arrogance. Or was it sarcasm? With Norris he could never tell. Yet he remained professionally cold toward him, long resigned to being dependent on the brilliant prick. “That’s right. And the rest during surgery, if she lives that long. I’ll call you when we’re ready.”

“This is the last one I do for you, Tony,” he said, his expression all at once deteriorating to a lipless grimace. The leathery features made Hamlin imagine fangs and venom concealed within.

She thought it was night, but wasn’t sure.

“Hell of a time for an angiogram,” said the nurse who wheeled Kathleen out of ICU and down a corridor.

“It’s all that ‘minimizing downtime’ and ‘maximizing efficiency’ they keep harping on,” Kathleen heard a man’s voice reply. His job seemed to be steering the portable respirator they were pushing alongside her. Occasionally she saw his ebony-colored hand reach into view and steady the monitors they’d piled onto her bed for the trip.

The woman let out a hoot of laughter. “Tell me about it. Hell, I got a cousin over in Jersey who works in a hospital where they rent out their MRI machine to veterinarians from midnight till dawn.”

“No! What about fleas?”

Their voices drifted in and out as the effects of the morphine they’d been giving her kicked in, and she watched the ceiling roll by. She felt them turn a succession of corners until they passed through a set of doors marked radiology.

Wait! she wanted to shout. She needed Richard with her. Because only when Richard was around did they really take care and treat her with respect.

It had been good in ER. Richard’s nurses had comforted her when they could, and Jo had taken the time to hold her hand, stroke her forehead, and explain whatever they were about to do to her. But once they transferred her to Intensive Care, soon as he left the room, the medical personnel became more inhuman. She’d overheard their snide remarks between Richard’s visits.

“What gets me is how they expect special treatment for her.”

“She’s not even his wife.”

“Just because she’ s some big shot geneticist on TV, and the chief of emergency’s got the hots for her . . .”

Once even the word mistress came up.

How quaintly old-fashioned, she had thought during one of her more morphine-suffused interludes.

But in the harshly jagged interval after the medication had worn off when they left her shot long past its due, she took the delay personally.

Why not just carve a bloody A on her forehead, you self-righteous cows, she had wanted to scream, certain that they’d withheld the injection because of their resentment of her. Straining in mute fury against the unyielding sheath in which her failed nerves and muscles so brutally trapped her, she pulsed her eyes up and down and put her lids through a good imitation of a butterfly’ s wings. But the tiny movements caught no one’s attention, and claustrophobia tightened its grip, suffocating her as surely as a pillow to the face. After what seemed an e