Lethal Incision Page 2

  The line was silent for a moment. Zora could hear the clanking of surgical instruments in the background. “Okay, let’s get him into the OR. Tell the operating room manager I authorized it. I’m almost done with this surgery and will join you once I’ve finished.”

  Zora’s shoulders relaxed. This was the reason why she loved having him as a mentor. Even though the chance had been high that Dr. Edwards would give the go-ahead—since it was always patients first with him—she hadn’t been a hundred percent certain.

  “Alright, thanks.” Zora replaced the phone receiver.

  “Let’s get him into the OR,” she told Christina.

  She had a patient’s life to save.

  CHAPTER THREE

  Drake Pierce folded his arms across his chest as he stared out of the floor-to-ceiling windows of his office. It was mid-morning, but he had been up for several hours already. His sleep routine had changed since that memorable incident many years ago.

  His face tightened as he remembered what had happened. He’d been a fool to not suspect Susie. But how could he have known that the number one H Club courtesan was the mother of Anna, the girl that everyone said he had raped? But it wasn’t true. As far as he was concerned, it had been consensual, and she hadn’t really protested. Why she’d chosen to take her life a few weeks later was still a mystery to him till this day. But all the blame had been pushed on him, and he’d been punished for it. Susie had ganged up with Alfred Pickles—Anna’s father— to kidnap him. And Pickles had castrated Drake in the process.

  Drake had fled the hospital the police had taken him to after they had found him strapped on a table in the Gross Anatomy building, and had gone into hiding. He’d then turned around and meted out his own version of revenge. He never forgave anyone that crossed him. Susie was later found with her throat slit, and Drake put pressure on the police to close the case though the killer was never found. Pickles was found dead in prison a few days later, killed by one of his fellow inmates. The police contact who had helped Pickles along the way died by accident on a hunting trip.

  His lawyers had dealt with the rape charges that had been filed against him. And they had delivered—the charges had been dropped after some time on a technicality, and the judge had agreed with it. Not that the judge had a choice—Drake’s money had lined his pockets for many years.

  Being a ladies man, the castration had seemed like a death sentence for Drake, though his Adonis look remained intact—sun-kissed wavy hair that complemented his piercing blue eyes and a chiseled symmetrical jaw line that drew attention to a smile that the ladies loved. But he had been lucky. The castration hadn’t been total, and Drake had had a scrotum and testicular transplant done by a top Spanish surgical team. But it was never the same. He could never have biological children of his own.

  The loss had also closed the door with Zora Smyth. She’d linked him with the rape case, and had a hand in what befell him. So he passed judgement on her. If he, Drake, couldn’t have her, then no one else could.

  He’d kept tabs on her over the years through Tiny, his bodyguard. Somehow, he had become addicted to Tiny’s weekly updates about her. And apart from a few dates she’d had with her investigator, Marcus Tate, she hadn’t been with anyone else. Which suited him just fine. She’d since blossomed into a gifted surgeon while he, on the other hand, had been relegated to staying in the shadows.

  Drake’s jaw muscle twitched. But he’d also lost one more thing. When the incident broke over the news, Drake’s father had promptly disowned him and pushed him out of Collmark Group. He had lost his position in the company though he had retained his shares—they had been an inheritance from his late mother. Luckily, Drake had always had a contingency plan in place, and had squirreled away a lot of money in offshore accounts. But he had become bitter toward his father—he had been shocked at how easily his father had tossed him aside and broken contact.

  The new heir was his father’s protégé, Steven Knox, a young man who had graduated with a PhD in Finance from MIT, his father’s alma mater, and who sucked up to his father every chance he got. His old man’s eyes must be failing if he hadn’t noticed the burning ambition in Steven’s eyes. At that time, Drake had decided that if he couldn’t inherit the company, then no one else would—the company was meant to be his. So he had spent the last few years secretly putting his plan into place.

  The corners of Drake’s lips twitched upward. One good thing had come out of the experience though—it had brought a new financial opportunity his way that would accelerate his long-term plans. He’d been approached through Tiny to invest in a certain kind of business, and it had since paid off in spades. And all he had been required to do was provide the cashflow—the rest had nothing to do with him.

  And the business had an extra benefit.

  It provided the perfect opportunity to rattle Zora’s cage.

  CHAPTER FOUR

  Forty-five minutes after Rick Williams’ surgery, Zora walked out of the OR, and made her way through the hallways to the call room. The surgery had been straight forward. She had ended up only removing the spleen; it had been severely damaged from multiple lacerations. Now, all they had to do was wait for him to regain consciousness. He’d been moved to the Recovery Room and would be transferred from there to the Surgical Intensive Care Unit, where the SICU team would monitor him closely.

  Zora collapsed in one of the two chairs in the room, and stretched out her legs in front of her. She removed the hair tie holding up her long curly dark hair in a ponytail and ran her fingers through her scalp. Aah, this feels good. The call room was just good enough to unwind, but too small for anything else. She looked down and saw the stains on her green scrubs. Ugh. Though Zora was used to the metallic cloying scent of blood, she didn’t like to be around it any longer than necessary. She needed to change, but her body felt like jelly.

  It had been a long day. Two appendectomies, one small bowel obstruction surgery, and one colon resection before this last surgery. Hopefully, the rest of the call would be easy. But that was the stuff of dreams. The ER was as unpredictable as a storm on the sea. Some days were quiet, while others were so chaotic that it was hard to catch one’s breath. She made a note to change her scrubs before attending to the next patient.

  “Zora!” She looked up at the harsh sound of her name to see Graham standing before her, a Goliath on a mission, with his goatee-framed face looking ready to burst and his nostrils flared. His bald head seemed to pulsate. She hadn’t heard him come in. “How could you take my spot?”

  Zora sat up straight and sighed. She had known he would come and find her sooner or later. “Well, technically, I didn’t take your spot. I just took advantage of an open OR, and finished with enough time for it to be prepped for your patient.”

  Graham put his hands on his hips. “But that’s not the point and you know it. You didn’t even ask my permission.”

  Zora rubbed her forehead. “Sorry about that. I should have told you.”

  “That’s it?”

  Every word he spoke was like a hammer to her head. Zora massaged her temples. If only he could stop talking and leave her alone. “What else do you want me to say? I had Dr. Edwards’ permission to make the change.”

  Graham pointed a shaky finger at her face. “Zora, you haven’t heard the end of this.” He turned and stormed out of the room.

  Zora leaned back and closed her eyes. Finally, he was gone. She would have to face the music tomorrow, but that was okay.

  For now, her body ached and she needed some sleep.

  A little after midnight, Zora’s pager buzzed. She rubbed her eyes, but the sandpaper-like feeling behind her eyelids did not go away. She forced herself to sit upright, reach for the pager, and look at the screen. It was the ER. She picked up the landline and called the ER nursing station. It was a patient with suspected abdominal bleeding. He had presented unconscious, with a roughly stitched gash on the right side of a taut abdomen. The ER team had already placed him on the vent
ilator, and he had an IV line connected to his forearm.

  Zora twisted her hair into a bun as she made her way to the ER. She’d changed her scrubs as planned, but had ended up forgetting her hair tie. The area was so quiet that her footsteps echoed as she strode toward Trauma Two. Stewart was already waiting beside the patient, his thin lips in a frown as he stared at a CT scan film. He looked up and dropped the film back at the foot of the patient’s bed when she stepped in, and moved to the right side of the gurney. “What do we have here?” she asked Stewart. The patient appeared to be of Eastern European descent, with a physique that was no stranger to workouts.

  “Patient is unconscious, but responsive to pain—there is abdominal tenderness, especially on the right upper quadrant. Lungs are clear and well perfused, BP is hundred over fifty, and the heart is in sinus rhythm. CT scan shows possible internal bleeding, but the liver appears normal.”

  “What’s this? It seems someone has cut into this abdomen before.” Zora asked, pointing to the gash on the right side of the abdomen.

  Stewart’s nose twitched. “We don’t know. The person who brought the patient in has disappeared.”

  Zora donned a pair of gloves and examined the area closely. She could see that the cut had been made with a surgical blade, but the stitching appeared wonky. “This looks like the work of an amateur,” she said. She peered closer at the wound. The epidermis over the area looked reddened and was slightly warm to touch. She removed one of her gloves and checked the pulse on his wrist.

  “Did we take a swab of this wound?” Zora asked Stewart.

  “Yes, the ER nurse sent it to the lab. The STAT results should also be out soon.”

  “Anything else from the results we have so far?”

  “The right kidney appears missing.”

  “What do you mean there’s no kidney?” Zora grabbed the CT scan film and examined it. There was no mass where the kidney was supposed to be; the empty space was filled with a pooling of contrast material. Zora’s eyes widened. This patient needed an emergency laparotomy ASAP.

  “Stewart, you should have told me about this first! Page Dr. Edwards,” Zora said. “Let’s get John Doe to the OR!”

  Zora woke up in the call room as the hazy light from the rising sun peeked through the curtains and cast its scattered rays on her face. She sat up, yawned, and then stretched out her arms in front of and above her head. She was sure her eyes were red. This was why she never carried a mirror in her locker. There was no point in torturing herself to confirm the puffy eyes and dark circles that came with each call. She needed more sleep, but she couldn’t afford to dawdle. Today promised to be a full schedule before she could leave for the day.

  John Doe’s surgery—they still had no name for the patient—had ended well. They had drained a significant amount of blood from his abdomen, and Zora had been able to find and cauterize the bleeders. The renal blood supply had not been secured properly when the kidney had been hacked out—hacked instead of incised because it couldn’t be the work of a surgeon. Otherwise, patients were in big trouble in the hands of such a quack.

  Dr. Brennan was supposed to have been on-call for the surgery, but a different anesthesiologist had stepped in for him. She had been disappointed. Given how many times they had worked together, she had expected Dr. Brennan to give her a heads up if he wasn’t going to be there. But he may have been held up in an emergency. She would check in with him to see if everything was okay.

  Dr. Edwards hadn’t made it to the OR as well, but the case had been simple enough for her to handle on her own. And she had kept him in the loop before and after the surgery. Zora had asked Stewart to follow the patient from the recovery room to the SICU. The rest of the night had been uneventful, nothing that she hadn’t been able to handle.

  Zora stepped into the adjoining closet-sized bathroom and took a quick shower. The cascading water soothed her skin and washed away some of her tiredness. It would suffice for now—she would take a full soak in the bathtub at home after the call.

  She dried her hair and ran a comb through it before pulling it back into a ponytail. After donning a fresh set of scrubs, she put on her slip-ons and made her way to the SICU to get a head start on seeing all the patients she had admitted.

  “I’m here to see John Doe,” she told the SICU nurse at the central station, which was the primary hub for the twelve-bed closed SICU unit. Lexinbridge Regional Hospital’s SICU—manned by a collaborative, multidisciplinary team of health professionals—provided a high level of intensive care for over seven hundred critically ill surgical and trauma patients annually. These patients had either undergone highly complex surgical procedures or were very ill and required close monitoring. John Doe had fallen into the latter category.

  “Give me one moment.” The nurse typed into the computer in front of her. She tilted her head to the side and typed in some more. She looked back with a furrowed brow at the board behind her head.

  “What is it?” Zora asked.

  The nurse turned back at Zora. “There’s no John Doe in the system,” she said.

  CHAPTER FIVE

  Zora stared back at her in disbelief. “Are you sure?” she asked. “He was sent in here around two a.m. from the OR.”

  The nurse bristled. “Of course I’m sure. Look, he is not even on our board.” She pointed to the digital whiteboard behind her head. “And if he is not in the system, that means no nurse or other members of the SICU team were assigned to him.”

  Zora stared at the list. There was no John Doe on it though she could see the names of the other patients she had operated on. But there was no way he would have been transferred to the acute care general surgical unit without an initial twenty-four-hour monitoring period, since he’d been unconscious. Zora glanced around the unit, her mind racing for answers.

  “What about Rick Williams?”

  The nurse typed again into the terminal in front of her. “He is in N515.” She clicked some more with the attached mouse. “Your other patients are also in the system. And as you can see, Rick’s name is up there.” She pointed to the whiteboard behind her again.

  “Okay. Thanks. I’ll take a look around to see if I can find him.”

  “Be my guest.” The nurse turned back to what she had been doing.

  Zora felt the eyes of the nurse on her back as she hurried through the SICU. She probably thinks I’m cuckoo. But Zora had operated on John Doe. That was the truth no matter what anyone said.

  She looked into each rectangular cubicle. John Doe wasn’t in any of them. She reached the end of the unit and turned back to check the other side. No John Doe. Zora leaned against the outside wall of the first cubicle and rubbed her forehead. What was going on? She’d never lost a patient before. And John Doe was not in a state where he could just walk off on his own. Unless someone took him away. But how was that possible without any discharge records? Zora would have been notified to sign off on it even if the discharge was against medical advice.

  The missing records were more baffling. How could that even happen? With the HIPAA law—Health Insurance Portability and Accountability Act of 1996, which was a United States legislated privacy rule that protected individually identifiable health information held or transmitted by covered entities such as hospitals—patient records were sacrosanct, and measures had been put in place to ensure controlled access to the information. There was no way the records could have just disappeared.

  Or had the SICU computer terminals malfunctioned? Zora shook her head. If that were the case, it would have affected other SICU patients, and the SICU nurses would have been aware of the issue since they were each assigned to at most two patients per shift to ensure an effective twenty-four-hour monitoring of the patients. The nurse she had spoken to hadn’t indicated that it was anything other than business as usual. And Zora’s other patient records were just fine.

  So what was really going on? Zora’s head ached and she rubbed her temples. This was not the best way to start the day.
But where else could she check? The main medical records office was still closed, and it felt like an overkill to go there anyway. And she still had to follow departmental protocol.

  She would start at the beginning. Since John Doe was admitted through the ER, there should be records there. Then there was her own operative report that she’d inputed into the Electronic Health Records system. The anesthesiologist’s inputs should be available too. Even the OR nurses would have their records as well. She’d also spoken to Dr. Edwards about the patient, and Stewart had been her first assist. So her first stop would be the ER, and then she would work through the list. If she hurried, maybe she might be able to catch one of the medical staff she had worked with overnight.

  She straightened up and headed out of the SICU. Just outside its main entrance, she met the surgical attending intensivist and a senior anesthesiology resident—who had both been on call—coming in to begin their morning round. Zora had worked with them before so she knew who they were. She stopped to ask them about John Doe. They both confirmed that they had been in the SICU for most of the call and hadn’t met any John Doe either.

  Zora rubbed the back of her neck. So where had John Doe been for most of their call? Stewart ought to know since he was supposed to have followed him to the SICU. So Zora called Stewart on her cellphone as she walked toward the elevators. The call rang through. “Strange,” she muttered to herself. Stewart was still supposed to be on-call with her till eight a.m. She paged him and waited for his call back. No response.

  She took the elevators down to the ground floor where the ER was located. The orchestrated madness called the ER—with its patients, family members, and hospital staff—gave off its unique cacophony as Zora walked in. She strode to one of the computer terminals at the central nursing station, accessed the system, and checked for her notes regarding John Doe. The search returned no results. She tried again to see if they were any reports linked to a John Doe. Nothing. No anesthesiologist’s or OR nurses’ reports. She turned to the nurse on duty who was working at another terminal.