Chapter 5
I probed the foam. My fingertips, calloused from decades of thumbing through parchment and ledger linen, touched the small, dry bundle wrapped in plastic wrap stolen from a sandwich tray three weeks ago.
I withdrew the packet.
I didn't open it with my hands. My hands were monitored by the wide-angle camera above the door. I brought the packet to my mouth, shielding the movement by rolling onto my right side as if succumbing to another involuntary muscle spasm.
The plastic crinkled between my molars. I bit through the thin polyethylene.
The taste was horrific. Digoxin does not taste like chalk; it tastes of pure, metallic bitterness, an alkaline poison that makes the saliva glands under the tongue contract in violent revulsion.
I didn't take eighty-two. That would be suicide; ventricular fibrillation would seize my myocardium within forty minutes, before Keller could even clear the turnpike from Philadelphia.
I took eleven.
Eleven tablets, crushed between my back teeth into a fine, bitter paste.
I didn't drink water. Water would dilute the absorption in the stomach lining. I held the paste sublingually, allowing the active cardiac glycosides to pass directly through the mucous membranes of the floor of the mouth, straight into the internal jugular vein.
The bitterness burned my throat like battery acid. I swallowed the dry slurry with a ragged gasp, rolled onto my back, and let my limbs go limp.
Then, I began the breathing.
In my youth, before the fire, before the smoke took Claire and Lucy, I had spent two summers restoring eighteenth-century church organs in Bucks County. An organ is nothing more than a system of weighted bellows and wooden valves. If the pressure drops, the pipe loses its pitch; if the air is restricted at the manifold, the tone begins to flutter.
The human autonomic nervous system is no different.
By contracting the abdominal diaphragm while holding the glottis partially closed—a sustained Valsalva maneuver—the intrathoracic pressure spikes. Venous return to the right atrium drops by half. The carotid sinuses, sensing the phantom surge in arterial pressure, send frantic signals down the glossopharyngeal nerve to the brainstem: *Slow down. The vessel is going to burst.*
My pulse, already staggering under the chemical assault of the crushed foxglove, dropped like a stone down a well.
Seventy beats per minute.
Fifty-five.
Forty-two.
The ceiling above me began to change.
The white acoustic tiles, punctured with their regular grids of tiny acoustic holes, seemed to lose their hard edges. A faint, greenish-yellow halo began to bleed into the corners of my field of vision—the classic xanthopsia of acute digitalis toxicity. The world looked as if it were being submerged in stagnant pond water.
My chest felt as though an iron anvil had been lowered onto the sternum. Every inhalation required an immense, dragging effort that rattled in my trachea.
*Good,* I thought, staring through the yellow fog at the tiny red lens of the camera. *Let the computer read it.*
Above my head, the telemetry monitor attached to my left wrist via an adhesive sensor began to emit a low, rhythmic chime.
*Chime.* Pause. *Chime.*
Then, the rhythm fractured.
The monitor didn't beep in time anymore. It produced two double-taps—premature ventricular contractions—followed by a terrifying, five-second silence.
The alarm on the wall unit didn't chime. It shrieked.
A harsh, continuous electronic warble that echoed down the polished concrete of the corridor like a klaxon.
***
The door didn't open; it was thrown back so hard the brass handle punched a crater into the drywall.
"Vance!"
It was Miller, his paper cup of lukewarm breakroom coffee sloshing over his knuckles as he skidded across the wax. Behind him came Gable, her hair still tied in a loose shift-change kerchief, her plastic badge rattling against her chest.
"Code yellow!" Gable shouted toward the hallway. "Get the crash cart from Room 4! He’s in bigeminy!"
Miller dropped the coffee into the trash bin and grabbed my wrist. His fingers were cold, smelling of menthol cigarettes. He pressed two fingers into the hollow of my throat, searching for the carotid pulse.
His eyes widened.
"Shit," he breathed. "The pulse is like a thread. Thirty-two. He’s throwing runs of V-tach."
"Is he seizing?" Gable was at the head of the bed, tearing the Velcro straps of the oxygen mask from the wall bracket. She shoved the clear plastic cup over my mouth and nose. The dry, icy hiss of pressurized oxygen hit my lips, tasting of dust and cold rubber.
I gave them the performance of a lifetime.
I did not stiffen. I did not thrash. Thrashing looks like epilepsy; thrashing looks like hysteria.
I let my head fall back until the occipital bone pressed hard against the steel mattress bracket. My eyes rolled upward into the orbits, exposing only the yellowish whites of the sclera, veined with broken capillaries. My left hand—the "paralyzed" hand—began to flutter with fine, micro-tremors, three beats per second, the involuntary twitch of an ischemic brain stem running out of glucose.
"Look at the pupils," Miller muttered, peeling back my right lid with a thumb. "Sluggish. Unreactive. Gable, his pressure is dropping through the floor—sixty over forty."
The door opened again.
Dr. Keller walked in.
He didn't run. Men who hold five-hundred-thousand-dollar retainers from United States Senators do not run down hospital corridors. He was wearing his gray cashmere overcoat, his leather medical bag in his left hand, his face pale and sharp under the fluorescent tubes. He had been in his office at the end of the executive suite, waiting.
He had been waiting for this call for fourteen years.
"Step aside," Keller said quietly. His voice had the flat, surgical authority of a man who had signed two hundred death certificates without ever shedding a tear.
Miller backed away against the sink. Gable stepped back, holding the suction tube like a weapon.
Keller pulled a silver Littmann stethoscope from his pocket, warmed the diaphragm against his palm for a fraction of a second, and thrust it under my gown, directly over the apex of my heart.
He listened.
His eyes were fixed on the digital telemetry screen above my head.
The screen was a horror show. The neat, rhythmic green hills of a normal sinus rhythm had collapsed into a ragged, disorganized landscape of wide, slurred QRS complexes—the classic "bizarre" waveform of a dying ventricle struggling against a chemical blockade.
"He's in third-degree heart block," Keller murmured, more to himself than to the nurses. "The conduction system is failing. Bilateral rales in both lung bases."
He leaned down. His face was three inches from mine. I could smell the peppermint lozenge melting on his tongue, the cold wool of his coat, the dry scent of expensive bond paper.
"Arthur," Keller said, his voice dropping into that firm, hypnotic register he used during my quarterly examinations. "Arthur, can you hear my voice?"
I did not answer.
I let a thin, bubbly line of saliva escape the corner of my mouth, frothing slightly against the green edge of the plastic oxygen mask.
"Gable," Keller snapped, not looking back. "Push one milligram of atropine through the port. Now."
"Doctor, his DNR—"
"I don't give a damn about the DNR," Keller hissed, his professional mask slipping for a fraction of a second, revealing the cold, frantic calculation beneath. "He does not die on this shift. Push the atropine. And get the hell out of this room. Both of you."
