HARMED - Book 1: First Do No Harm Read online

  “Hey, let’s look for some health-related educational program,” interrupted Joe.

  “Great idea. I’m tired of the same old shows. Here’s the TV Guide.” She handed the small table booklet to Joe.

  • • •

  Outside, the air was warm. The small winding road in front of the McIntyre residence was silent and empty. The subdivision was either already asleep or getting ready to go to bed. A large dark luxury sedan drove by slowly. The car stopped in front of the McIntyre’s residence for a few seconds. Then it drove on. Slowly. Observing. Stealthily searching. It would go around the block and then stop short of the house. In the dark, quiet and still, like a jungle predator waiting for the right time to pounce on its prey, the car and driver would remain unnoticed.

  Inside the home, Sheila lay on Joe’s right shoulder gently, as if she could break him if she pressed with the full weight of her head. The TV was on.

  Suddenly, Joe stood up, shaking Sheila off him. He was profusely sweaty, and his pupils were shrunk to the size of a pinpoint. He became progressively agitated and began pacing back and forth through the small family room. Sheila stood and watched for a moment, unclear as to what she was witnessing.

  “What’s wrong, honey?” she said, her concern increasing.

  “What? What d’ya say? Who’s there?” Joe said, breathing a mile a minute. He looked confused and upset. But at what? Why? Joe continued to pace with increasing speed and vigor. He looked wild eyed. Sheila tried in vain to calm him. The more she persisted, the worse he got. He seemed to have forgotten who she was.

  She dialed 911. By the time Sheila got off the phone with the EMS operator, Joe was climbing on and off the couch. He rambled on about strangers watching him from here and there. He pointed wildly to the TV, a window, and the hall leading upstairs. He searched around the room, first behind the TV and then under the pillows. Then he grabbed a vase.

  “Who are you? Stay back,” Joe yelled. He then murmured something else, God knows what. Something Sheila could not make out.

  “What, baby? Tell me what’s bothering you.” Tears flowed down Sheila’s face.

  “Go away!” were words she understood, in between other incomprehensible phrases. He used the vase like a shield and weapon whenever Sheila attempted to come closer. For a short period, she was able to touch him. His heart thumped hard and fast inside his chest.

  “Sweetheart, your heart is pounding fast. Let me take you to the hospital,” she pleaded.

  He turned to get away, stumbling onto the ground. The vase broke in his hand, cutting him. Blood ran down his arm. Joe looked at his bleeding hand with confusion. A deep gash was visible, from which crimson pulsated profusely with each heartbeat. This appeared to make him even more like a dangerous wounded animal, if that was possible. Not at all the calm, cool, and collected man Sheila fell in love with many years before. Why was this happening?

  Joe ran around the room aimlessly. Then he paced frantically. He erratically looked around as he exited the family room, stumbling toward the kitchen. As he entered the breakfast nook, he gave the appearance of a wild beast in unfamiliar surroundings, cornered by perilous foes. He walked into the table, scattering the plates they had just neatly arranged in the proper places earlier that evening. The pain caused Joe to stop and flinch. For a split second, Sheila connected with Joe, looking into his eyes. All she could see in that glare was rage. By now, Joe’s speech was a completely incomprehensible jabber. He was pale, with rivulets of sweat streaming down his face. His chest wall overlying his heart was visibly thumping, even through his shirt.

  Sheila tried again to approach him using loving and soothing words. Wildly and with furious madness, Joe opened cabinet doors and pushed appliances off the kitchen counter, becoming increasingly startled as these items hit the tile floor noisily. He then pulled out the drawers, causing them to fall on the floor raucously. This exacerbated his fury. The next thing Sheila saw was a large butcher knife that sliced at her face, from her left temple to the lower portions of her neck. Horrified, Sheila suddenly stopped moving and took her last normal breath. Joe had plunged the huge knife deep into her chest. Blood and air gushed out of the wound as he removed the bloodied blade.

  Joe looked at her dying face and paused. As her brain function hastily dissipated into nothingness, Sheila’s last coherent thought was that she departed this world by the hand of the love of her life. She would never understand why.

  For a split second, Joe seemed to comprehend the gravity of the situation. The large kitchen knife tightly grasped, he began pacing frantically around Sheila’s fallen body. He skidded on the quickly enlarging puddle of pulsated blood and fell flat on the kitchen tile floor, first smashing his head hard on the counter. The impact caused a deep laceration on Joe’s skull. Then Joe turned the long sharp knife on himself and plunged it deeply into his abdomen. Sheila’s blood flowed and mixed with his, an expanding pool of crimson surrounding both bodies.

  Just outside the house, a man peeped inside through a side window. He had made sure the sedan was hidden on a side street. It was dark out, and the sky became increasingly murky with the advancing nightfall. As the sirens approached, the visitor swiftly departed, making certain he continued to remain unnoticed.

  It would be later determined at autopsy that Joseph Matthew McIntyre’s cause of death was not due to a knife wound but rather a massive brain hemorrhage. The reason for this remained a mystery.

  CHAPTER 6

  The medical team took the elevator to the basement, and the group walked toward the employee cafeteria. They went through the cafeteria line, and each made their food selections, all except Jack, who had stopped momentarily to talk to one of the medical attendings.

  “Do you need adult supervision here?” said Jack when he finally arrived at the table where the students, Connor, and Claire were sitting with their food trays.

  “Very funny, ha, ha, ha,” mocked Claire, continuing to eat.

  “So, what’s up in research these days, John?” asked Jack, sitting down.

  “We’re doing some pretty neat stuff. I could tell you, but then—”

  Connor was interrupted first by Claire, and then all the others joined in. “You’d have to kill us!”

  “Seriously, you can tell us some stuff. What are we going to do, sell your trade secrets to the Russians?” continued Claire.

  “Nowadays, it’s not the Russians you have to worry about. It’s the terrorists,” said Peter.

  “You guys cooking up weapons of mass destruction in the lab these days?” asked Jack, a smirk on his face.

  “Yeah, if you’re a rat,” said Connor. He grinned. “We’re working on a new drug for patients with really bad hearts. It stimulates the cardiovascular system, and we hope it will improve heart function and quality of life. Do you know how many rats we have killed just trying to figure out the proper dose?”

  “How many?” asked Jack.

  “For a while, we called the stuff Rat Poison,” said Connor. “It took us several months just to get in the ballpark. But we got the dosing right now! We’ll be starting human trials soon. I’m working on the IRB protocol right now.”

  “What’s an IRB?” asked Peter.

  “Institutional Review Board,” said Connor. “It’s a committee that reviews and approves all research. It’s made up of doctors, lawyers, clergymen, businesspersons, and so on. All research has to be approved to make sure it’s ethical, and subjects are duly informed of their participation in the study, risks, that sort of thing. Once I have the protocol written up, we’ll go before this board and get approval for human research with the drug. For now, the drug seems to be doing some good on rats, at least if the dose is right. If we give too high a dose, the poor little creatures maul each other to death. Horrible stuff.”

  “How do you research heart disease in rats?” said Peter.

  “We cause a large heart attack in the rats,” said Connor. “Give them a really bad ticker.”

  “Poor l
ittle things,” said Claire, sad faced.

  “Well, it’s better them than me,” said Connor. “One day, I’ll be old, and I’ll get me a bad pump.” He pointed to his chest. “I want doctors to know how to treat me and help me live better and longer. For that we need animal research.”

  “Have you seen some of these patients with bad, weak hearts? They really need our help,” interjected Jack. The medical students nodded, all eyes on Claire.

  Connor continued, excitement in his voice. “We also have this new gadget to study the heart muscle. It helps visualize the walls of the heart and allows us to measure efficiency.”

  “Cool,” said all the students in unison.

  “We administer tiny air bubbles into the rat’s vein. These bubbles travel to the heart and allow us to improve visualization of the heart muscle. This permits determination of whether the muscle consists of healthy cells or cells about to die due to oxygen starvation.”

  “What type of imaging are you doing?” asked Jack.

  “Ultrasound,” said Connor.

  “Neat,” said Peter. “Can we come down to the lab and see it?”

  “Sure. Come down later today,” suggested Connor. “Are you done with ward rounds?”

  “Not even close,” said Jack. “We’ll try to stop in later, though, if we have time.”

  “I have a slow afternoon. I would love to see the lab, too, if it’s OK,” said Claire.

  “Of course.” Connor smiled and then looked at his wristwatch. “I’ll see you later. I’m late for a meeting.” He got up and left at a fast pace.

  Lunch over, the group dispersed. The medical team returned to rounds, and Claire returned to the psychology department, where she had a patient to see in twenty minutes.

  • • •

  The team gathered around the bed of an elderly woman, Peter’s patient. He began the bedside comments. “This is Mrs. Joy Nathan. She is eighty-six and presented with a heart attack three days ago. She had coronary angiography that showed an occluded right coronary artery. This was angioplastied and stented two days ago. That was followed by atrial fibrillation. We were called on consult.”

  “Doctor, what is arterial fibula—” asked the patient, her face showing signs of concern.

  “Atrial fibrillation,” said Peter. “It’s an electrical problem in your heart affecting the top two chambers. Instead of beating, they are quivering fast. That makes the bottom two chambers of your heart go fast and out of rhythm. It also puts you at risk for clots that can cause strokes.”

  “Oh, I don’t want a stroke. My mother died of a stroke. My father lived with a stroke, and I think my mother was better off than my poor father,” said Mrs. Nathan.

  “We’ve started you on a blood thinner called Pradaxa to prevent clots from forming so you won’t have a stroke.”

  “I noticed that you gave me a few new medicines,” she said.

  “Yes, the other is a beta-blocker to lower your heart rate,” said Peter. “If you tolerate all your new medications and your pulse is slower by tomorrow, we’ll give our OK for you to be discharged.”

  Smiling, the group left the patient’s room.

  “How have her lab numbers been? And her resting heart rates?” asked Jack as they reached the hall outside room 817, where a cart with many patient charts was waiting.

  “I have them right here,” said Peter. He proceeded to dig first into his lab-coat pockets; then he put down his clipboard to facilitate the process and dug deep into his front-pant pockets, then the shirt pocket, and finally the pockets in the back of his trousers. All grinned at this amusing display of disorganization. Finally, Peter returned to the clipboard he had put down over the chart rack.

  “Ha, here they are.” Peter removed several papers, which he spread out on display over the chart stand in front of them. Several fell onto the floor. Peter bent down to pick them up, causing more to fly off. The other two medical students joined the process. As this scene was unfolding, Jack looked up the lab values on his handheld Palm Treo.

  “Hey, Larry, Curly, and Moe,” interrupted Jack, shaking his head, his gaze on his cell phone. “Here are her labs.” He turned his cell phone toward the students.

  Peter glanced at the display. “Everything seems in order.”

  “OK, write the order so we can get out of here,” said Jack, as he dialed a number on the phone. “I’d like to make an appointment, please,” he said in a serious voice a few seconds after dialing. “When’s the next available appointment for Dr. Claire Norris? I have a patient for her, a med student with an aversion to orderliness.” He smirked as he listened. “Are you ready to meet us downstairs?” he asked. “OK, we’ll be there in a few.”

  The group took the stairs two flights down.

  “Perfect timing,” said Chris as he opened the door for Claire and all the others to enter the research laboratory. Having walked a few feet into the lab, they spied John Connor, who strolled toward them to greet them.

  “Welcome to my home away from home. I just purchased a new scent spray. I hope you like it,” said Connor, taking in a big breath. All imitated him and in doing so, experienced the typical odor that was the animal lab. They walked toward the ultrasound room, first passing through the lab where the smell intensified significantly.

  As they passed by the rat cages, Connor pointed to a sign on a door: Experimental Drug LFJ659. “This is Rat Poison, the drug I was telling you about at lunch,” he said, continuing to walk. The others followed him. “L-F-J-six-five-nine is being tested to try to improve the quality of life in patients with heart failure. The mechanism of action remains unknown, but seems to be different than any other known cardiovascular treatment. The drug seems to work well in the rat model. We’ll see what it does in humans when we get that phase started. I will need your help to recruit patients for this study, OK?” Connor looked back at the students, who nodded. They entered the ultrasound room.

  “We’re all eager to feed you patients,” said Jack. “Despite the bad reputation of the drug on the rats, this agent seems intriguing.”

  Connor gave the thumbs-up sign. “Here we have an echocardiogram of a rat. This is not too different structurally from that of a human. Just smaller.” As he talked, Connor touched the appropriate buttons on the ultrasound machine, and the screen came alive, revealing a little rat heart beating rapidly.

  “It’s like HDTV,” remarked Peter in admiration. “Even I can read this study. It’s so much clearer.”

  As Connor continued to awe the visitors with the ongoing research efforts, an older man peered through a glass window, causing Claire to gasp. His double-barrel gaze scanned the visitors and then landed on Connor, who paused, his muscles visibly tensing. Suddenly and briskly, the door to the lab opened, and Rupert stormed in.

  “What are they doing here?” demanded the director with an air of arrogance and irritation.

  “I was just showing Dr. Norris and his students—” John began, his voice timid.

  “I can see that. I need you to finish your work, and I do not appreciate interruptions and delays.”

  Caught by surprise, Claire, Jack, and the medical students retreated, leaving John to receive the tongue-lashing alone. Even as the door to the research lab closed, Rupert’s shouts were still audible.

  A man passed the troop of doctors going the other way, as they were about to exit the lab proper. He stopped, noticing the situation. Flustered, he said, “Oh my. Dr. Rupert is on a rampage again. I am so sorry. I’m James Miller. I’m the chief technician here in the lab. I’m sorry about the yelling. Dr. Rupert is under a lot of pressure and gets disturbed easily.” He was a portly man in his early sixties, with scant gray hair and a protruding belly. “He yells a lot, but he doesn’t mean anything by it. He’ll be OK. Don’t any of you worry about it,” continued Miller, his voice soothing. “Let me go in there and rescue poor Dr. Connor.” With this, he smiled and disappeared behind the echo-room door.

  “Thank you, Mr. Miller,” said Claire, not s
ure if he had heard her at all. “What a nice man. He reminds me of my grandfather, so kind and attentive.”

  “What an idiot, that Rupert,” said Jack. All remained silent as they exited the research lab. “He has no right behaving like that.”

  CHAPTER 7

  Jack was happy to be home, though Rupert’s angry words were still unsettling him. In the shower, Jack’s thoughts returned yet again to the outburst displayed in the research lab. Just like a child having a temper tantrum! he contemplated. I don’t care if he is the research director. What an asshole.

  After his shower, Jack put on comfortable clothes and joined Claire, who was cooking supper, in the kitchen. On his arrival, she was singing.

  Jack sat down in front of the TV and tried to shake off his resentment. “Hey, what did you do with the money?”

  “What money?”

  “The money your mother gave you for singing lessons.”

  A kitchen towel hit him on the head. “I used it for throwing lessons,” Claire replied.

  “I’m still fuming about Rupert—”

  “Can we please stop thinking about him? Let go of it. He’s a man under a lot of stress and—”

  “OK, let’s drop it. Your psych analysis, too.”

  “Fair enough.” Claire ambled to the couch and sat right next to Jack. “The Department of Psychology is creating a new section at the hospital, cardiac psychology. I’m thinking of taking the position. I would work solely with the psychological issues and problems of cardiac patients. What do you think?”

  “If you think that would make you happy, you should do it. I do agree that cardiac patients are complex and unique, and having someone who would deal only with cardiac patients would seem beneficial. I love the idea.” A smile emerged on Jack’s face.

  After a short moment of silence, Claire continued, a dreamy look in her eyes. “After I get this new program started and you finish your fellowship, maybe we can add on to the family.”

  “A puppy?” said Jack. “Yes, I’ve always wanted a puppy.”

  “You’re impossible!” she said. They wrestled playfully and laughed for several seconds, ending up with a long, amorous kiss.