Genre: Psychological Thriller
Trusted surgeon. Loving wife. Murderer?
Before my world came crashing down, I had it all. The successful career I dreamed of. The beautiful red-brick home where I could relax in front of the fire. The handsome, devoted husband whose blue eyes and charming smile always made me feel safe.
As I call time of death, my voice is steady. My colleagues stand hushed around me, their eyes on me, confused, concerned.
I have never lost a patient until today.
My hands tremble inside their gloves. I slide down the cold tiled walls, my heart racing in my chest.
I have never hated a patient until today.
But what choice did I have, once I recognized him?
And what will I do to protect myself, if someone learns the truth?
A totally gripping psychological thriller that will have you racing through the pages, gasping for breath until the final jaw-dropping twist. If you love Freida McFadden, Shari Lapena and The Girl on the Train, you won’t be able to put this down.
Excerpt
The Patient
What have I done?
The thought races through my mind, searing and weakening my body. The rush of adrenaline fills my muscles with the urge to run, to escape, but there’s nowhere to go. Shaky and weak, I let myself slide to the floor; the cold, tiled wall against my back the only support I have. For a moment, I stare at my hands, barely recognizing them, as if I’d never before seen them sheathed in surgical gloves covered with blood. They feel foreign to me: a stranger’s hands attached to my body by some inexplicable mistake.
A faint, steady beep is sounding incessantly over the constant whoosh of air conditioning. I wish I could summon the strength to ask them to turn it off. The operating room is at a standstill, all eyes riveted on me, widened and tense above face masks.
Only one pair of eyes is glaring, drilling into mine whenever there’s a chance, the steel-blue irises deathly cold behind thick lenses and a face shield. Dr. Robert Bolger, still seated by the anesthesia machine, doesn’t need to say anything. We’ve said to each other everything that needed to be said. Too much, even.
“Turn that thing off,” Madison whispers. Lee Chen presses a button, and the ghastly sound is muted. Then she approaches me and crouches by my side. Her hand reaches for my shoulder but stops short of touching me.
“Dr. Wiley?” she whispers, her hand still hovering. “Anne? Come on, let’s go.”
I shake my head slowly, staring at the floor. I remember with perfect accuracy the properties of the polymer coating they apply on all the operating room floors. Useless information taking space in my brain for no reason, since I’m the surgeon, the end user of these blue mosaic floors, not someone who decides what coating should be used.
“Anne?” Madison says my name again, her voice reassuring, filled with warmth.
“No,” I whisper back. “I can’t.”
A bloody lap sponge has fallen from the table, staining the pristine floor inches away from the tip of my right foot. I fold my leg underneath me, staring at the sponge as if the bloodstain on it could come after me.
Madison withdraws under the fuming glare of Dr. Bolger.
He sighs and turns off his equipment, deepening the silence of the tense room. “Well, I guess we’re done here.” He stands with a frustrated groan and throws the echocardiologist Dr. Dean a loaded look. “Let’s grab a cup of coffee to rinse off the memory of this disaster.”
Dr. Dean throws me a quick glance as if asking for my approval. He probably feels guilty for being singled out by Bolger. I barely notice.
I don’t react. I can’t.
My mind is elsewhere, reliving moment by moment what has happened since this morning.
*****
The day started well for me, without a sign of what was to come. A capricious, windy spring morning that made my daily jog more of an exercise in willpower than in physical endurance. Chicago has a way of showing its residents some tough love, with chilly wind gusts that cut to the bone, so to speak—there’s no surgery involved; just weather and people’s perceptions of it.
Like the past couple of weeks, I ran the usual three-mile loop through Lincoln Park looking at elms and buckthorns with renewed hope that I’d find a budding leaf, no matter how small. I was ready for spring and flowering gardens and warmer sunshine. Nothing else was on my mind; at six thirty in the morning, it seemed to be just an ordinary Thursday. Deceptively so.
At about seven thirty, I drove into the hospital employee parking level, taking my reserved numbered spot.
I had reviewed the details about the day’s surgery a final time the night before from the comfort of my home office, another set routine I have.
The procedure on schedule was an ascending aortic aneurysm. The patient, a fifty-nine-year-old male by the name of Caleb Donaghy. We were scheduled to start at ten sharp.
I’d met Caleb Donaghy twice before. The first time was during a consult. His cardiologist had found a large aneurysm and referred him to us for surgical repair. I remembered that consult clearly. The patient was understandably scared by the findings, and became more so with every word I said. He kept his arms crossed firmly at his chest as if protecting his heart from my scalpel. His unkempt beard had streaks of yellowish gray, and the same gray adorned his temples, as much as I could see from under the ball cap he had refused to take off.
I let him keep it.
He was morose and argumentative for a while, disputing everything I said. What had he done to deserve the aneurysm? His parents had only recently died, and not of any heart-related issues. Only after spending a good fifteen minutes managing his anxiety was I able to evaluate him.
That was the first time we met.
Then I saw him again last night, after completing the surgical planning session with my team. Caleb Donaghy had been admitted two days before and had all his blood tests redrawn. He was sitting upright in his bed, stained Cubs ball cap on his head, arms folded, leaning against the pillows doing absolutely nothing when I came in. The TV was off, there were no magazines on his bed, his phone was placed face-down on his night table.
The room smelled faintly of stale tobacco and boozy sweat. He was brooding, miserable and alone. And he was pissed. He’d just learned they were going to shave his beard and chest in pre-op. To add insult to injury, someone in hospital administration had swung by and asked him if he was a registered organ donor. For seven long minutes, he told me in various ways he wasn’t going to let himself be sold for parts. He knew what we, doctors, did to people like him, who had no family left to sue us and no money to matter. We took their organs and transplanted
them into the highest bidders. Why else would entire buildings in our hospital be named after Chicago’s wealthiest?
I promised him that wasn’t the case. He wouldn’t listen. Then I told him that all he had to do was say no and organ transplant stopped being a possibility in case of a negative surgery outcome. Which is surgeon lingo for death on the table. That silenced him in an instant.
But that was yesterday.
*****
This morning, Madison had my coffee ready for me when I got to the office. She’s the best surgical nurse I’ve worked with, and my personal assistant when she’s not scrubbed in.
Madison; Lee Chen, the talented second surgical nurse on my team; Tim Crosley, the cardiovascular perfusionist who operates the heart and lung machine we call the pump; and Dr. Francis Dean, the echocardiologist, are part of my permanent surgical team. Then it’s the luck of the draw with anesthesiologists, and I drew the short and very annoying straw with Dr. Bolger. There’s something off-putting about him. Could be his undisguised misogyny. Rumors have it he’s been written up twice by the hospital administration for sexist diatribes insisting women don’t belong in a clinical setting anywhere above the nursing profession. Contempt for women seeps through his pores, although recently he’s grown more careful about letting it show. He’s also an arrogant son of a bitch, albeit an excellent anesthesiologist. His professional achievements fuel his hubris and dilute the resolve of the hospital administration when dealing with his behavioral issues. That’s who Dr. Bolger is.
When we’re in surgery together, I always try to make it work as well as possible, for the good of the patient and the surgical team.
It never works. It takes two to dance in harmony.
I remember swearing under my breath when I saw his name on the schedule, then pushed the issue out of my mind.
Dr. Bolger was already in the operating room when I came in. “Good morning,” I said, not expecting an answer. None came, just a quick nod and a side glance from behind the surgical drape that separates his world from mine, before he turned his attention back to the equipment cart at his right. The anesthesia machine helps him deliver precise doses. He controls the patient’s airway from behind that protective drape. During surgery, I rarely, if ever, get to see my patients’ faces.
My focus is on their hearts.
I’m forty-one and I’ve been doing this for twelve years, since I finished my general surgery residency. I moved to cardiothoracic right after that, and I never looked back. It’s what I’ve always wanted to do. And I’ve never lost a patient on the table.
Not until today.
The thought of that hits me in the stomach like a fist.
For an instant, pulled back into the grim present moment, I look around me and try to register what I’m seeing. The surgical lights are off. Madison is still there, looking at me with concern. Lee Chen is sitting on his stool, ready to spring to his feet when needed. Tim Crosley is seated by the pump, his back hunched, his head hung low. If he could, he’d probably rest his forehead against his hands, but he’s still working, still keeping sterile.
As long as that pump’s whirring, he’s on duty.
My thoughts race back to the surgery. The operating room was filled with excited chatter, like normal.
Virginia Gonzales, the semi-scrubbed nurse who runs back and forth, keeping us all organized and bringing us what we need, was sharing her experience with online dating. She’s just been through a terrible divorce. She’d recently decided she could still go out there and meet people. I admired that resilience in her, and secretly hoped it wasn’t desperation at the thought of living an entirely lonely life. But her first Tinder match had proven to be a man who’d misrepresented himself dramatically, and everyone on the team was laughing as she shared the details.
He’d said he was a transportation executive, when he was in fact a truck driver. Nothing wrong with that, Ginny was quick to say, but the man had never heard of flossing, and during the twenty-five-minute encounter he’d let it slip he used hookers while he was on the road. Cheap ones, he immediately reassured a stunned Ginny.
A quick bout of laughter erupted in the operating room when Ginny added, “I just ran out of there.”
Dr. Bolger glared at her. “Let’s try to have some professionalism in here, if at all possible,” he said, speaking slowly, pacing his words for impact. “If I’m not asking for too much.”
I refrained from arguing with him. Everyone was working, doing their jobs. Surgical teams perform best when they have a way to let off some steam. If there’s silence in an operating room, if no one’s sharing a story, if the music isn’t playing, then something’s going terribly wrong.
I’d rather have them laughing all day long. That’s how you keep death at bay. It’s worked for me anyway.
So far.
“What will you have?” Madison asked me, standing by the stereo.
“Um, let me think.” The early morning jog had me thinking of The Beatles. “Do you have ‘Here Comes the Sun’?”
Madison grinned from behind her mask; I could see it in her eyes. She loved them. “I got the entire greatest hits collection right here.”
“Punch it,” I said, moving between equipment and the operating table until I reached my station, by the patient’s chest. Music filled the room.
Humming along, I held out my hand and the scalpel landed firmly in it. No need for me to ask; Madison knows how I work. I’m sure she can read my mind, although that possibility isn’t scientifically proven.
From the first incision—a vertical line at the center of his breastbone—every step of the procedure was routine.
The sternotomy to expose the heart.
Opening the pericardium, the thin wrapping around the heart, and exposing the aneurysm.
It was big, one of the biggest I’d seen. But I knew that already from prior imaging studies. We were prepared for it.
“On pump,” I said, instructing Tim to start circulating the patient’s blood through the heart and lung machine.
“Cross clamp in position,” I announced. “Cold flush,” I asked. A cold solution of potassium was administered into the chambers of the heart. I flushed the exterior of the heart generously with the solution, knowing the cold fluid preserved the heart tissue while we worked. Within seconds, the heart stopped, its death-like stillness announced by the droning sound we were waiting for. The sound of flatline, or the absence of a heartbeat.
With the heart perfectly still, I started working to replace the aortic aneurysm with a graft. It took me almost an entire Beatles album to finish sewing it in.
It feels strange how I remember the cold above all else. It’s always cold in the operating room. The air conditioning system blows air at sixty-two degrees. The cold flush that lowers the heart temperature and renders it still is delivered at forty degrees, barely above freezing. My fingers become numb after a while, but I move as fast as I can. Yet today it seemed colder than usual, the only premonition I can say I had.
I don’t believe in them. I have my reasons.
When I was done with the sewing of the graft, I examined my work closely, checking if the stitching was tight enough. The final test would be when the blood started rushing through that graft. Then I’d see if there were any leaks and fix them. Usually there weren’t. For now, I was satisfied.
“Warm saline,” I asked. Those two words marked the end of the cardioplegia stage of the surgery, when the heart is perfectly still. I flushed the organ generously with warm saline solution, relishing the feeling of warmth on my frozen fingers, then used suction to get rid of the excess solution. “Releasing clamp.”
The clamp clattered when it landed on the pile of used instruments. I held my breath, knowing this was the moment of truth.
The heart remained perfectly still.
Not fibrillating, not barely beating. Nothing. Just perfectly still.
And that almost never happens.
“Starting resuscitation,” I announced. Madison gestured toward the stereo and Ginny turned it off, then started a second timer with large, red digital numbers. Silence filled the room, an ominous, unwanted silence underlined by the flatline droning of the heart monitor. “Epinephrine, stat.”
“Epi in,” Dr. Bolger confirmed.
The shot of epi should’ve done something. It didn’t. I massaged the heart quickly, feeling it completely unresponsive under the pressure.
“Paddles,” I asked, my voice tense, impatient. Madison put the paddles in my hands. Placing them carefully on opposing sides of the heart, I called, “Clear,” and pushed the button. A brief interruption in the steady droning, then the sound of bad news was back.
I tried that a few more times, then returned to massaging the heart with my hands. “I need another shot of epi. Time?”
“Seventeen minutes,” Madison announced, grimly.
“Damn it to hell,” I mumbled under my breath. “Come on, Caleb, stay with me.”
For a couple more minutes, I kept on with the massage, but nothing happened. The pump still kept his blood oxygenated and delivered to his organs, but the heart was another issue. Its tissue was no longer preserved by the cold potassium solution. With every passing minute, it was deteriorating, its chances of ever beating again waning fast.
“Come on, already! Live!” I snapped. “Come back.”
I felt the urge to look at the patient’s face as if it could hold some answers. I took a small step past the surgical drape—and froze, mouth agape under the mask, hand stuck in mid-air. I believe I gasped, but I don’t think anyone noticed under the hum of air conditioning, the whirring of the pump, and the blaring of the monitor.
I recognized that man.
My blood turned to ice.
The face I’d seen yesterday and hadn’t recognized was now clean-shaven. The ball cap was gone, his bald forehead marked by a port-wine stain on the right side. The birthmark was an irregular shape of red splashed across his forehead as if someone had spilled some wine there.
It took all my willpower to step back behind the drape. Breathing deeply, thankful for the cool air that kept my mind from going crazy, I abandoned the paddles on the table and stared at the heart that refused to beat.
“Time?” I asked again, this time my voice choked.
“Twenty-one minutes,” Madison replied.
I slipped my hands into the chest and massaged the heart, knowing very well the heart compressions I was delivering wouldn’t work.
I forced one more breath of air out of my chest, then said, “I’m calling it.”
“What?” Dr. Bolger sprang to his feet. “Are you insane? Keep going.”
I was expecting that. “I could do that, but he won’t come back, Robert. We tried everything. The heart’s not even giving me the tiniest flutter.”
His steely eyes threw poisonous darts at me. “Giving up already? Why? Are your pretty little hands tired, sweetheart?”
I let that one go. It wouldn’t help anyone if we argued over the open chest of Caleb Donaghy. “My case, my call.” I held his seething gaze steadily for a moment. “Time of death, 1:47 p.m.”
Heavy silence took over the room. Then people started shifting around, collecting instruments, peeling off gloves, turning off equipment. Only Tim stayed in place, the pump still working, still preserving Caleb’s organs and tissues.
“It’s unbelievable what happened here today,” Dr. Bolger said. “You’re unbelievable. Pathetic even. You didn’t just lose your cherry… you threw it away.”
The sexualized reference to the fact that I’d never lost a patient before left me wondering how much of his disdain was in fact envy. But that thought went away quickly.
Then reality hit me like a freight train.
What have I done? Have I just killed a man?
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