Lethal Remedy by Richard Mabry Page A

lost when I come back."

"No problem." The pager on her belt let out a muted buzz.

"I've got to answer this, but I'll be around if you need me."

John peered through the open door of an exam room. It was clean, compact, and pretty much like one in his private office— when he had a private office. Of course, in that setting, when he encountered an especially perplexing problem he'd often told the patient, "I need to send you to a specialist at the medical school." Now he was that specialist, or at least one of them.

"May I help you?" The woman in the doorway was about John's age. She wore a clean white coat over a simple blue dress. Low-heeled shoes put her eyes at the level of John's chin. Those eyes, behind rimless glasses, were pale blue, the same color as Beth's. He felt tears coming, and fought them back.

"Thanks, but I'm just looking around." He extended his hand. "I'm Dr. John Ramsey."

She tucked a stray lock of salt-and-pepper hair behind her ear. "I'm Lillian Goodman, one of the GIM clinic doctors. I understand you'll be joining us here soon."

"As soon as the paperwork is finished." He made a sweeping gesture. "Apparently news travels fast around here."

"You'd be surprised at how efficient the grapevine is." Her expression softened a bit. "And on a personal note, I was sorry to hear about your loss. My husband died almost ten years ago, so I really do know what you're going through."

John was trying to frame an appropriate response when he heard footsteps in the hall—not running, but definitely moving at a fast clip. Gloria appeared in the doorway and said in a low, urgent voice, "Dr. Goodman, a woman just collapsed in the hall near the elevators."

Lillian was already in motion, and John fell in behind her, not exactly sure what his role should be but anxious to help. People milled around in the elevator foyer. John pushed through and saw an elderly woman crumpled on the floor like a marionette dropped by a careless puppeteer.

John knelt at the side of the unconscious woman. Lillian assumed the same position opposite him.

"Carotid pulse is weak and irregular," he said.

"She's breathing spontaneously, but sort of shallow," Lillian replied. She looked up. "Did anyone see what happened?"

There was a general murmur in the group, a mass shaking of heads.

A rumble of wheels and rattle of equipment announced Gloria's arrival. "Here's the crash cart. What can I do?"

"Give me a second," Lillian said. "Right now she's breathing on her own. John, check her blood pressure. I'm going to do a quick neuro exam."

In a moment, John straightened. "Mildly hypertensive. Heart rate about seventy but the rhythm is grossly irregular. Probably atrial fibrillation."

Lillian didn't look up. "Atrial fib fits. She's probably had an embolic stroke."

John had already reached the same conclusion. A small clot forming on the heart wall had broken loose and made its way to the brain.

"We need to get her out of here so we can start treatment," Lillian said.

"How—?"

Lillian stood and swept her gaze over the small crowd that had gathered. "We've got a medical emergency here, folks. I'm going to ask all you visitors to clear the area. If there are physicians or nurses here, please stand by. All other medical center employees please go back to your positions."

"Do we transport her into the clinic?" John asked.

"It's a nightmare getting through all the hallways between here and Parkland. It works better if we get EMT's up here, take her down in this elevator and around to the Parkland Emergency area by ambulance."

"I'm on it," Gloria said. "I've already called 911. EMT's should be here any minute."

"Her breathing's slowed down considerably," John said. "Want me to intubate her?"

Lillian looked him in the eye. "How are you at inserting an endotracheal tube?"

"Probably a little rusty. I'm due for recertification in advanced cardiac life support."

"I had my ACLS refresher last week. I'll tube her. You start an IV."

John was