Book 2 in the Zach Templeton thriller series:
RAGE is currently being written.
The Prologue and Chapter One are placed here for your review and comments.
NOTE: The text below has only been through one round of editing. In addition, it may change as the book is completed and goes through any revisions.
Plaza de la Independencia
Anthony Sterling, in actuality Frank Porter, former Deputy Director of the FBI’s National Clandestine Service, strolled casually along Quayaquil Street on his way to the Plaza de la Independencia for his morning coffee. The sun was shining brightly. The weather was beautiful and Anthony was not in a hurry. Enjoying a leisure walk, from his luxury apartment eight blocks away on Vicente Leon Street, he had stopped several times to look in the windows of various shops. Continuing his stroll, he turned right onto Chile Street and walked past the Municipio de Quito, the city’s center of government and administration, approaching the plaza from the southeast.
Plaza de la Independencia, also called Plaza Grande by most locals, is the central public square of Quito, Ecuador. The plaza is flanked on all four sides by impressive buildings, most of which date to the colonial period. Anthony had chosen Quito as the location to establish his new life because of Ecuador’s extremely restrictive, and secretive, banking laws. The warm climate and the low cost of living were also deciding factors.
Many of the streets that surrounded the plaza were lined with regal, colonial mansions. Anthony had selected a very sumptuous apartment in one of those mansions as his residence. Life in Quito was slow and enjoyable. A sizable bank account guaranteed he would live quite comfortably for a long time. Still, Anthony was filled with intense anger that bordered on rage because he had been forced to abandon his beautiful house and successful FBI career in the United States. For months he had dreamed of revenge against the one person he held responsible.
Anthony hurried along the east side of the plaza. Spotting a break in the traffic, he crossed to the east side of the street. The objective of his morning walk, the outdoor café at the Hotel Plaza Grande, was just ahead. He selected a table adjacent to the street in the courtyard lined with metal barriers. A skinny young man with a heavily stained apron approached the table. Exactly as he had done every day for months, Anthony ordered a large coffee and an empanada. Anthony grabbed the copy of El Migrante Ecuatoriano, a local newspaper, that had been tucked under his arm and laid it on the table.
He reached in his left, inside jacket pocket, about to retrieve his cell phone when the server returned with his order. The server set the order down and hurried off to another table. Anthony picked up the cup and took a careful sip of the dark, steaming liquid. Delicious as always. The coffee was rich and dark, just the way he liked it. He took another sip, picked up the paper, and began reading. Twenty minutes and another cup of coffee later, he laid the paper on the table. Leaning back in the chair, he felt the warm sunshine on his face. His thoughts were interrupted by the vibrating cell phone in his pocket.
“Yes,” Anthony answered quizzically, not expecting a call from anyone.
“The last item is on its way,” a gravelly voice on the other end offered.
“Four days ago. It was carried personally. Should have arrived yesterday. Maybe today.”
Anthony ended the call without acknowledging and dropped the cell phone back in his jacket pocket. Smiling, he savored the thought that his long-awaited revenge was about to be realized. Not willing to wait until he was home in the safety of his apartment, he scanned the café to see if anyone was close enough to overhear. Satisfied, he retrieved the cell phone from his jacket pocket and dialed a number from memory. There was one last detail necessary to make his revenge complete.
After five rings, a sleepy female voice with a slight French accent answered, “Yes.”
“It’s time for that job I mentioned.”
“As soon as you can make it happen.”
“Consider it done.”
Anthony scanned the café again and lowered his voice. “By the way, I will double the fee if you make it very slow and very painful. I want him to suffer. I want his family to suffer. The more they suffer the better,” Anthony hissed, his face red and his voice full of rage.
He ended the call, his hands trembling as he dropped the cell phone back in his jacket pocket.
Seated at a street café fifty yards away, Sotero Rojas had watched Anthony’s every move. From the time Anthony left his apartment, Sotero had shadowed him as he strolled along Quayaquil Street, being very careful to not be noticed. Sotero and his partners, Nestor Guzman and Omer Herrera, took turns surveilling Mr. Sterling to minimize any possibility of him becoming aware of their presence.
Sotero took notice when he saw Mr. Sterling either receive or make two phone calls. Only once before had he made even a single phone call and now he made two short phone calls within seconds of each other and he seemed angry and agitated. Sotero had an earwig in his left ear connected to a highly directional listening device. However, there was so much activity and traffic in the plaza, he had only been able to catch a few words. Sotero watched as his query got up, dropped a couple of bills on the table, and hurried down Chile Street in the direction of his apartment.
Anything this out of the ordinary definitely needed to be reported. He lifted a cell phone out of the leather case clipped on his belt. He punched a speed dial number and waited.
In an office in the Suitland Federal Center in Suitland, Maryland, just east of Washington, D.C., a phone rang. Rear Admiral Charles Hadley, Director of Naval Intelligence, glanced at the secure phone sitting on the corner of his desk. Instantly recognizing the incoming number, he grabbed the receiver and answered, “My friend, do you have something”?
“Yes sir, I do. Just now he made two very short phone calls within seconds of each other. He looks as if he is very angry and agitated. He left the café in a hurry. Looks like he is heading back to his apartment.”
“No, too much background noise. I could only understand a few words. On the first call, all I heard was ‘arrived yesterday’. On the second call, all I heard was ‘soon’ and then ‘suffer’.”
“Any idea what that might mean?”, Admiral Hadley asked as he scribbled the words on a note pad.
“ Sorry, no. I don’t have any idea sir.”
“Okay. Keep eyes on him and report anything else that might explain what he’s up to.”
“Will do.” Sotero answered. He ended the call, dropped the cell phone back in the case, and hurried off to catch up with his query.
In his office, Admiral Hadley stared at the words he had scribbled on the note pad, wondering what they might mean.
He disliked Porter intensely and considered him a vile, traitorous rat. Porter was very smart and cunning and would not do anything to jeopardize his cover. That is, unless something unusual was happening. Deciding he should check to see if the CIA had any intel, he picked up the phone and dialed the number for the Director of the CIA.
“James Sandberg, can I help you?” The Director of the CIA mumbled, the stump of his ever-present cigar stuffed in the side of his mouth.
“Hey Jim. Admiral Hadley here. I need to know if there’s any recent intel on our old friend Frank Porter.”
“That stinking slime ball !” Director Sandberg snarled, jerking the cigar from his mouth and dropping it into an ashtray. “Not directly, but there has been increased chatter coming from the Middle East, Libya specifically. One of our assets thought they heard his name mentioned a few weeks ago in relation to something being smuggled.”
“Anything more specific than that?”
“No. Why do you ask?” Director Sandberg queried.
“Just a few minutes ago my asset observed Porter making two quick phone calls and said he seemed very angry. He was only able to catch a few words. One phrase ‘arrived yesterday’ might seem a bit worrisome. What do you think?”
“Are you on a secure phone?”
“Yes I am. I’ll activate encryption.”
Director Sandberg did the same on his end of the phone call. Hearing the tell-tale echo that signaled multi-layer encryption had been activated, he continued, “Several weeks ago hyperspectral satellite imaging detected a hot spot off the coast of Libya. Once NIAG (Nuclear Interdiction Action Group) arrived on scene, they got a hit on a freighter approximately fifty miles south of Malta. They stopped the freighter in international waters and boarded it. Supposedly the vessel was bound for the Strait of Gibraltar and then to Caracas, Venezuela. The interdiction team measured fairly high levels of background radiation in one compartment but that was all. A thorough search of the ship turned up no nuclear devices or weapons components. The ship captain claimed they transported medical imaging equipment a month earlier and that one container was severely damaged, causing it to break open and spill out some components. He claimed that had to be the source of the radiation.”
“He was lying Jim. That event makes what I just told you even more suspicious,” Admiral Hadley interrupted.
“Of course he was lying,” Director Sandberg agreed. “Without any evidence, the NIAG team didn’t have any choice but to let them go. If they had a nuclear device or any components on board, it had been offloaded before they arrived on scene.”
“I hope you put in a request to have the freighter tracked.”
“Certainly did Admiral. Won’t do any good though. Now that they know they have our attention, they won’t go anywhere near their original destination.”
“True,” Admiral Hadley replied. “In view of these events, I think we need to raise the threat level and assign some additional resources. What do you think Jim?”
“I concur. Let me know if you receive any further intel.”
Both men switched of the encryption system and hung up their phones. Admiral Hadley swiveled around and grabbed a carafe sitting on the credenza. He filled his coffee mug, swiveled back around toward his desk, took a sip of the coffee, and made a quick call to Matthew Tyler, the President’s national security advisor. They discussed the Admiral’s conversation with the CIA Director and Mr. Tyler quickly concurred with the decision to raise the threat level. Tyler agreed to alert the President immediately.
Admiral Hadley needed to assign more assets to track down any known associates that former Director Porter had used in the past.
“Who should I call?” Admiral Hadley muttered out loud.
Arco Truck Stop
Three Miles north of Lodi, California
Sharan Husam Ahadi had driven the thirty-nine miles from Sacramento, carefully obeying all traffic laws to avoid arousing even the slightest suspicion. After exiting State Route 99, Sharan pulled into the Arco truck stop and drove his 2003 Renault Espace around toward the rear of the restaurant on the south side of the truck stop, selecting a spot in the parking area that was out of site.
After arriving in the United States, Sharan had assumed a Westernized appearance so he would not stand out. He had shaved off his beard and had purchased a wardrobe of ordinary American clothes. Sharan loathed the Western clothes he was wearing. Every fiber of his being wanted to rip them off and burn them. In his mind they represented everything he hated about America, the Great Satan. Every day he had to force himself to dress in attire that represented the immoral lifestyle of the western world because it was essential that he blend in.
Late getting started, he had been afraid to take the time to shave. He pulled off his sunglasses and stared into the rear-view mirror. The face staring back at him revealed a full day’s growth of dark stubble. There was nothing that could be done about it. Hopefully, he would look like any other midnight shift worker on his way home.
He sat in his car, waiting impatiently for his friend, Muti, to arrive with the package. Every few minutes Sharan glanced at his watch, growing angrier each time. The longer he sat there in the parking lot, the more likely it was that someone would notice him and become suspicious. An hour had passed and still no Muti. About to start the car and leave the truck stop, he sighed with relief when saw Muti pull into an empty spot in the opposite row.
Muti Nabih Daher got out of his car, hurried over to where Sharan was parked, and slipped into the passenger seat.
“Muti, I have been waiting for an hour. What kept you?”, Sharan asked, anger evident in his voice.
“I had to wait for the delivery. He was late. There was nothing I could do. I drove straight through without stopping,” Muti offered in defense.
“Well, you are here now. Did you have any difficulty?”
“No. I was very careful to stay under the speed limit. I only stopped once for fuel. I ah, ah…..”
“Yes Muti, out with it. Did something happen?”
“Not with me, Sharan. The man that carried the container across the border told me he opened it and looked inside.”
“What?” Sharan gasped. “Why? Muti, you know this was not allowed!”
“There was nothing I could do. It had already happened.”
“Did you question him?”
“Yes I did. He is stupid. He knows nothing. He said he only opened it for a few seconds and glanced inside.”
“Let us hope so, Muti. Let us hope so,” Sharan moaned, shaking his head. “No one must know of this. Did you warn him to say nothing?”
“Yes. I told him someone would slit his throat if he said anything and then I showed him this,” Muti answered, his eyes gleaming with hatred.
“Muti, put that away!” Sharan shouted, grabbing Muti’s hand and shoving it down out of sight. “Do you want to get us caught?”
Muti quickly slid the gleaming dagger back into the scabbard behind his back.
“Let’s get this done quickly,” Sharan said as he backed out of the parking space. He drove his Renault around the row of cars and over to where Muti’s car was parked. Muti watched for activity while Sharan struggled to get the heavy container up out of Muti’s trunk and into his.
“May Allah grant us safety and great success,” Muti said as hugged his old friend.
“Yes. May it be always true,” Sharan answered. “Hurry. We must go now. Quickly, before someone notices. Muti, go find our stupid friend and make sure he stays silent.”
Both men climbed into their cars and headed for the highway frontage road. Upon reaching the highway frontage road, Muti, with a menacing grin, turned south eager to find the man that delivered the container. He would enjoy very much making sure the stupid fool said nothing. Sharan turned north and headed toward Sacramento. He also was smiling, knowing he was about to accomplish the great act for which he had been born
* * *
Suitland Federal Center
Office of Director of Naval Intelligence
Admiral Hadley sat at his desk staring off into space. The very real threat of a nuclear weapon or at least the components necessary to build one slipping into the United States had him rattled. He needed to quickly identify and contact a trusted resource he could assign to track down leads but instead his mind had drifted off to the catastrophic consequences that would result if the extremist or extremists that possessed nuclear materials were not located in time.
A knock at the door and the sudden entrance of his administrative assistant interrupted the vision of cataclysm swirling before his eyes. Turning toward the door and seeing Jenny, his assistant, he remembered he had a meeting scheduled. A quick glance at his watch. “Good Lord,” he exclaimed. “The meeting started ten minutes ago.” Looking up at Jenny, he said, “Call the conference room and tell them to continue the meeting without me. I have something absolutely critical that I must attend to.”
Jenny backed out and quietly pulled the door closed.
“Well, who will it be?” he asked himself for the second time as he picked up his coffee cup. About to take a swallow, he realized the coffee had gone cold. He pushed back from the desk, walked over to the sink, and dumped the cold coffee. As his hand touched the handle of the carafe, he stopped suddenly, staring at the photo directly in front of him.
“I know exactly who I need,” he thought to himself as he rushed back to his desk. He tapped the space bar on the keyboard and waited for the computer to wake up. Opening his electronic contact list, he searched for the name that had just flashed into his mind. Reading from the screen, he quickly punched in the number and waited. It would be a monumental mission to dump on his new friend, but he did not know of anyone else better suited for the task.
“What if he refuses?” Admiral Hadley wondered as he listened to ringing on the other end of the call. “But he can’t. He mustn’t,” he begged out loud.
* * *
West Elgin Street
Zachariah James Templeton gritted his teeth and pulled on the pipe wrench as hard as he dared. The water heater’s cold water input fitting had decided to start leaking. “Why do these things always happen at the worst possible time?” he gasped, giving the wrench one last tug. He wiped the fitting dry with an old rag and waited. So far so good. No more leaking. He stood there watching the fitting for several minutes. Satisfied it had stopped leaking, he dropped the wrench in the bucket of tools sitting beside the water heater, grabbed the bucket, and slammed the mechanical room door much harder than necessary.
After a quick stop in the garage to put the tools away, he headed for the bedroom to pack for his upcoming trip. If everything went smoothly and traffic cooperated, he might just make his flight. Busy stuffing clothes into his suitcase, he did not notice Angie, his wife, enter the bedroom.
“Zach, phone call,” she announced.
“Huh, what?” he said, turning toward Angie.
“Phone call,” she repeated, holding out the cell phone.
“Don’t have time. Tell whoever it is to call back next week.”
“Zach, it’s Admiral Hadley. He says it’s urgent and he sounds frantic.”
“Okay, okay,” Zach answered, taking the cell phone and putting it to his ear. “Sorry to cut you off Admiral, but I don’t have…..”
Admiral Hadley interrupted Zach and hurriedly explained the basics for the unexpected phone call. As Zach listened, his eyes grew wider and wider.
“When did you learn of this?” Zach asked.
“Less than thirty minutes ago Zach.”
“Did you call anybody else Admiral or was I your first call?”
“There’s nobody better for this and you know it.”
“I’m not so sure Admiral. I can think….”
“Zach, we don’t have time to argue about this,” Admiral Hadley interrupted again. “This is time critical. We absolutely have to get more intel on this threat, and quickly? What we currently know may be several days old.”
Zach just stood there staring at Angie, not saying anything. Angie walked over and poked Zach on the arm. “Zach, what’s the matter?” She asked, concern growing in her mind. The last experience Zach had with Admiral Hadley had nearly cost him his life.
“Admiral, hang on a minute. Angie is here with me.” Zach put the phone on mute and turned toward Angie. “Angie, this is beyond serious. I don’t know what I will be able to tell you. Can you give me a few minutes alone so I can get the rest of the details?”
“Zach, you can’t do this again. You promised,” Angie complained.
“Let me finish with the Admiral. Then we’ll talk. Okay?”
“Okay Zach. I’ll be in the living room waiting,” Angie answered as she walked out of the bedroom and pulled the door shut.
“Okay Admiral, continue,” Zach said.
“I probably shouldn’t say this on an unsecure line but I simply don’t have time to get you to a secure phone. The Nuclear Interdiction Action Group intercepted a freighter near Malta because satellite imaging detected a hot target near Libya. The NIAG team found evidence of radiation but nothing else. If there were nuclear weapons of components on the ship, they were long gone. However, what is more worrisome is two communications fragments picked up during surveillance of our old friend Frank Porter. “Remember his Zach?”
“Oh yes, I remember him well,” Zach replied, anger instantly rising inside him. “I would very much like to get my hands on him Admiral.”
“I thought that would be the case,” Admiral Hadley answered. He continued with the details of what was known, “The fragments that were intercepted were ‘arrived yesterday’, ‘soon’ and ‘suffer’. We believe those fragments along with the hot freighter indicate a nuclear weapon or its components may already be in the country. It is enough of a significant threat that Matthew Tyler agreed to take this information to the President and request an increased threat level. Zach we desperately need your help on this.”
“If I were to agree, what exactly would be my objective?” Zach asked, not certain he really wanted to hear the Admiral’s answer.
“We need you to interface with the Border Patrol and determine if there is any evidence of nuclear materials coming across the border, specifically in Arizona. I cannot tell you why Arizona specifically. Not yet anyway.” Admiral Hadley paused, not certain he should say what he wanted to.
Zach waited. When the Admiral did not continue, he asked, “Admiral, is there something else I should know?”
“Yes there is, but you must absolutely promise this goes no further. There is reason to believe someone high up is helping terrorists get weapons across the border.”
“What?”, Zach exclaimed.
“Zach, I only told you that so you will be aware of the need for absolute secrecy. You will need to be extremely careful when you question anyone. You will report anything you learn to me and to me only.”
“Sounds like you believe I have already accepted your request Admiral.”
“In view of what I just told you, there is no one else I can trust. Will you help us?”
“Okay, Admiral. If it means Porter will get what’s coming to him, I will help you.”
“That’s great Zach. There’s one more thing. You will need backup and protection. I can think of only one person that both you and I trust implicitly. Do you think Mr. Glover would agree to join you?”
Zach thought about disagreeing with Admiral Hadley, but he knew the Admiral was right. There simply was no one else. “I want to say no, but I know you’re right.”
“Hang on Zach,” the Admiral said, searching through his contact list again. “Here’s his phone number. I think it would be best if you talked to him.”
Zach scribbled the phone number on a note pad sitting on the dresser. “There’s one additional thing Admiral. I need your permission to tell Angie something. We got back together and are doing great. If I run off after talking to you with no explanation, our marriage will be over for sure. If I can’t tell her something that will convince her this is necessary, I won’t help you. Non-negotiable Admiral.”
“You have my permission, but only if she agrees to tell no one. I agree it is necessary for Angie to know. She will likely be in as much danger as you are if any of this leaks out. You have my number. Once you get Mr. Glover to agree, let me know what you need and where you need it. I mean absolutely anything Zach. Just name it.”
“Well, for starters, I will need total access to the Gulfstream for the duration. Get it started toward McChord Air Force Base immediately. Call me and let me know when its wheels up.”
“Done,” Admiral Hadley agreed.
I’ll get you a list everything else we will need as soon as I can.”
“Fair weather and good hunting Zach,” Admiral Hadley offered.
“Thanks Admiral. Call you soon,” Zach replied as he ended the call.
Zach took a deep breath and headed for the living room to discuss the details with Angie.
Once Zach had Angie’s assurance that she would just sit and listen until he was finished, he spent the next fifteen minutes telling her what he had learned from Admiral Hadley. The expression on Angie’s face went from shock to anger to horror and back to anger and finally to acceptance.
Angie could tell by the expression on Zach’s face that his mind was already made up. How could she refuse if Zach had even the remotest prospect of stopping the horror of nuclear weapons.
Knowing that Zach was committed, Angie hugged Zach and begged him to be careful.
“You know I will Angie,” Zach answered. “There’s one other thing.”
“What?” Angie blurted out, fearing the worst.
“The Admiral asked me to call Normal Glover and ask him to help me,” Zach answered.
“If it weren’t so dangerous, I would say great. Do you think he will agree?”
“I certainly hope so. A plane is already on the way to pick him up. I need to go call him and convince him,” Zach called out over his shoulder as he walked into the bedroom and closed the door. He looked down at the note pad, punched in the number, and waited.
After eight rings, Zach was about to give up.
“Hello,” a winded voice answered.
Zach crossed his fingers and said, “Mr. Glover, this is Zach Templeton. How are you?”
“Uh, I’m fine. Can’t say I expected you hear from you,” Mr. Glover answered.
“Are you alone?” Zach asked.
“Yes. Mrs. Glover is out in the garden.”
“You know I wouldn’t have called unless it was important. Well, it is critical. I think maybe you should sit down.”
Mr. Glover pulled a chair over by the desk and sat down, “Okay, shoot.”
“I just got a call from Admiral Hadley. Seems there is very real and serious threat involving our old friend Frank Porter. Remember him?”
“That miserable weasel. You bet I remember him. I’m only sorry he got away.”
“It seems someone has eyes on him. The surveillance team picked up some fragments from two phone calls he made earlier this morning. Are you familiar with NIAG?”
“Yes, I know who they are and what they do.”
“Several days ago satellite imaging detected a hot target coming out of Libya. The NIAG team boarded a freighter, but found only residual radiation. Any nuclear weapons or components that might have been there were already long gone.”
“Where do they think the material was headed?”, Norman asked.
“Admiral Hadley and others think they are or were bound for the States.”
“Is he certain? Exactly how long ago was this? What do you mean were?” Norman asked, emphasizing the word ‘were’.
“One of the fragments overheard was ‘already arrived’. That means the material could already be here in the States.” Zach replied.
“That certainly is serious, but how do you figure into that or better yet how do I figure into this?”
“Admiral Hadley asked me to see if I could find out where it might be. He said there is no one else he could trust because someone high up is suspected of helping terrorists get nuclear weapons into the country. He also suggested I convince you to help me.”
“You can’t be serious,” Norman stammered.
“You bet I’m serious. The President is going to raise the threat level. If he’s right and we can’t locate it and stop it, the consequences will be catastrophic.”
“Do I have any choice?”
“Sorry no. I requested total access to the Gulfstream for as long as we need it. It should already be on its way to McChord Air Force Base to pick you up.”
“Well then, I guess I will be joining you.”
“Work up a list of anything you might need and pass it along to the pilot. I’ll do the same on my end. The Gulfstream will stop here in Tulsa and pick me up.”
“What is our final destination?”
“Not on the phone. I’ll let you know when you get here. Sorry, but I can’t talk any longer. I have a lot to do to get ready.”
“Understood. It will be good to see you again,” Norman said as he ended the call and stuffed the phone back into its charger.
Norman headed for the garden to tell his wife that he was taking a little trip. He dreaded the conversation to come, knowing his wife would be furious. After the last assignment he had given his word there would be no more sudden disappearances. “I shouldn’t make promises I can’t keep,” he told himself as he pushed the door open.
Copper Queen Community Hospital
Dr. Marshall K. Woods sat alone at a small table in the corner of the Emergency Department break room. Exhausted and bleary-eyed, he caught himself nodding off, nearly slipping out of his chair. Easing out of the chair, he stood and stretched his tired aching muscles. Having nearly completed his third full day on duty, it was impossible to sit still without falling asleep.
As was the case with nearly all small town hospitals, Copper Queen Community Hospital was severely understaffed. Dr. Woods was one of only two emergency department physicians and the other physician, Dr. Ramona Berger, had been home sick with a severe case of the flu. It had been a busy night and Dr. Woods had gotten very little rest. If Dr. Berger didn’t show up for shift change, he would be forced to request the hospital assign one of its other physicians to the ER Department.
Normally, a hospital in a town with a population just shy of seventeen thousand, would not be that busy, especially on the 12:00 a.m. to 8:00 a.m. shift. However, Douglas, Arizona, sat right on the United States border across from Agua Prieta, Mexico. That fact created a nearly constant flow of individuals, legal and illegal, suffering from exposure, sick from some disease, or injured during a scuffle with Border Patrol agents.
Dr. Woods was tall, standing six feet, three inches, and quite slim, partly from the effect of two years internship and nearly two years at his current position. Immediately after graduating from University of Houston Medical School he had accepted an internship in internal medicine at Texas Health Presbyterian Hospital in Dallas, Texas. To help finance his education, he had joined the U.S. Army Reserves. He would not normally have considered a position in such an out of the way place, but to partly satisfy his U.S. Army requirements he had accepted the position at Queen Community Hospital, also assisting the United States Border Patrol in Douglas as necessary and as he had time.
Dr. Woods yawned as he ambled over to the counter where the coffee pot sat. He picked up the pot and sniffed it. As usual, it was old and burnt, but it was hot and he definitely needed a jolt of caffeine. He poured the cup two-thirds full, topped it off with artificial creamer, and slid the pot back on the burner. He walked back over to the table and sat down. He blew across the hot liquid several times and then took a small sip. If he had been near a sink, he would have spit out the bitter swill.
Observing the sour look on his face, “Dr. Woods, I take it you don’t like our wonderful coffee,” Dr. Ramona Berger said as she pulled out a chair and sat down opposite Dr. woods.
“Oh, is that what you call this slop?” Dr. Woods shot back. “I think motor oil or, perhaps, road tar would be a much better description.”
“I’m sorry I couldn’t make my shift yesterday. I don’t’ think I spent more than ten minutes out of bed all day. I stayed wrapped up in my blankets like a cocoon.”
“Sorry you were sick,” Dr. Woods offered. “I sure am glad you made it today though. I don’t think I could….”
The vibration and chirping from the pager clipped on the waistband Dr. Woods’ scrubs interrupted him mid-sentence.
“Looks like I have to go. EMTs are bringing in a patient with severe vomiting and disorientation. See you after turnover,” Dr. Woods yelled over his shoulder as he disappeared into the hallway.
Arriving in the emergency room at the same time as the EMTs, Dr. Woods grabbed one side of the gurney and helped guide it into bay two. The patient was trying to speak but his words were unintelligible.
“Carol, O-Two, two liters, insert a Foley catheter. Get a sample for a full drug screen, CBC, arterial blood gas, chem screen, and a full tox panel.”
Carol Morgan, one of three ER nurses, busied herself slicing the patient’s trousers from ankle to waist and then his shirt from waist to neck. She gathered the shredded clothes and stuffed them into a white plastic, patient belongings bag.
As soon as Carol finished with the clothes, Dr. Woods jammed the stethoscope in his ears and listened to the patient’s chest. With Carol’s help, they rolled the patient on his side and he listened to the patient’s breath sounds. After checking for any visible signs of trauma, they rolled the patient onto his back and he checked the patient’s pupils reaction to light.
“Any details we should know?” Dr. Woods asked the EMTs, pulling the stethoscope from his ears and draping it around his neck.
The EMT standing closest to the gurney answered, “Don’t know much. The Border Patrol agents said they found him wandering in the desert three miles east of town. They said he was babbling nonsense. All they could get is that his name is Paulo Cordova Palomo and that he’s from Juarez, Mexico.”
“That’s all?”, Dr. Woods asked.
“Sorry Doc. That’s it.”
The EMTs gathered up their equipment and exited the room as Dr. Woods continued his physical examination of the patient. While waiting for the labs to come back, He grabbed the chart and entered what physical information was known: name, city, age – early forties, height – five feet, seven inches, weight – approximately two hundred twenty pounds. He drew a thermometer across Paulo’s forehead and noted in the chart that his temperature was 100.9 degrees. Mr. Polomo’s skin showed considerable reddening but there were no visible signs of rash or injury.
So far, all the physical symptoms suggested this might be a simple case of exposure. However, the temperature yesterday and overnight had been reasonably mild. Perhaps the lab results would point to something more definitive. Dr. Woods continued his physical exam of the patient while waiting for the results of the blood tests to come back. The patient’s symptoms did not appear to be drug related, but those results would take two hours to complete. He added the physical exam observations into the chart.
Looking up from the patient’s chart, he saw Carol rushing into the room holding up a yellow sheet of paper. The blood test results were back. He grabbed the sheet of paper and quickly reviewed the results. It did not take long for him to realize Mr. Palomo was even sicker that he looked. The preliminary blood test results indicated Mr. Polomo might have aplastic anemia. His hematocrit percentage, red blood cell count, and hemoglobin level were all significantly below normal. Shaking his head and still holding the blood test results, Dr. Woods returned to the patient and lifted the gown that was covering him.
“Something’s not right. Carol, come over here and look at Mr. Polomo’s skin. What does that look like to you?”
Carol leaned over the bed and looked where Dr. Woods was pointing. “Quite red. Looks more like a burn than a rash in my opinion.”
“Exactly my thought,” Dr. Woods answered.
Since entering the emergency department, Mr. Polomo had become progressively more unresponsive. His breathing had become very shallow, his temperature had increased a half degree, and he was going into shock. Dr. Woods was about to order additional tests, when Mr. Polomo began seizing which lasted for less than a minute. When the seizing stopped, the alarm on the heart monitor began screeching.
Dr. Wood stomped the release pedal on the bed allowing the bed to go completely flat. “Carol, ET tube now,” he shouted as he grabbed a laryngoscope. He titled the patient’s head back and quickly inserted the tube and affixed the Ambu bag to the tube. “Carol, take over while I start CPR.”
Carol and Dr. Woods worked frantically for several minutes trying to revive Mr. Polomo. The heart monitor stopped its screeching. Dr. Woods glanced up at the monitor, grabbed his stethoscope, and listened for heart sounds. It appeared the crisis was over at least for the moment.
“Normal rhythm. Carol, get Mr. Polomo hooked up to a ventilator,” Dr. Woods said, backing away, panting from the sudden and intense exertion. “Carol where’s the chart?”
Carol pointed down at the floor where the chart had fallen during the commotion. Dr. Woods leaned over, picked up the chart, grabbed the lab results from the bed tray, and slumped into the chair that had been pushed up against the wall. Something was not right. Aplastic anemia was certainly a serious condition but it would not account for Mr. Polomo’s sudden deterioration and cardiac arrest.
Dr. Woods inserted the lab results into the chart and reviewed all the particulars of Mr. Polomo’s case. There was very little to review in regard to an outward physical explanation of the patient’s condition and there was absolutely no medical history. Turning to the only other source of information, Dr. Woods studied the lab results carefully. He rechecked each of the abnormal values he had already observed that pointed toward a diagnosis of aplastic anemia. There was one value that was inconsistent with the other abnormal values. Mr. Polomo’s MCV value was eighty-two right in the middle of the normal range. MCV, or mean corpuscular volume, is a measure of the average size of the sample’s red blood cells. In cases of aplastic anemia, a patient’s red blood cells would be smaller and would produce a low MCV value.
“Something just doesn’t add up,” Dr. Woods muttered to himself. “If Mr. Polomo doesn’t have aplastic anemia, what does he have?”
He got up, went over to the bed, and looked down at Mr. Polomo. “What are you not telling us?”, he said, as he pulled back Mr. Polomo’s gown and examined the reddened skin more closely. It looked like a sunburn but it had been cloudy for several days. A memory from long ago, during the first year of his residency, flashed into his mind. He remembered he had seen something similar. He lifted the receiver from the wall phone and dialed the hematology lab.
“Hematology lab,” the on-duty technician answered.
“This is Dr. Woods. Do you still have Mr. Polomo’s blood sample in the lab?”
“It’s ready to go to the freezer for storage. I was just walking out the door when you called.”
“Great. I want you to run one more test. An E-Tr assay. Do you have enough sample left?”
“Sure do. That test only takes a drop or two of blood, but the analysis will take two hours.”
“That’s fine. As soon as the results are back, call Carol Morgan in the emergency department or page Dr. Ramona Berger and give her the results.”
“Yes sir. Will do.”
“Thanks,” Dr. Woods said. He hung up the phone and headed for the emergency department admin desk.
After Mr. Polomo was finally stable and had been turned over to Dr. Berger, a profound fatigue set in. Dr. Woods was mentally and physically exhausted. He felt as if he had barely enough energy left to walk to his car.
Heading for the locker room, he stopped at the ER doorway, “Hey Carol, when the lab calls with the results of the test I ordered, call me. I hope I’m wrong, but I have an uneasy feeling about Mr. Polomo’s case.”
Dr. Woods turned, shuffled off toward the locker room to change out of his scrubs, and head home to get some much needed sleep. In the locker room, he slumped down on the bench and rubbed his tired eyes. He kicked off his shoes and threw them into the bottom of his locker. He sat there for some time going over everything that had transpired regarding Mr. Polomo. A nagging feeling that something was very wrong would not go away. Deciding there was nothing further he could do until the result of the last blood test came back, he changed into street clothes and headed for the exit.
Dr. Woods rushed out of the locker room and headed for the exit before anything else could happen. He pushed the exit door open and hurried to the last row in the parking lot where his faded, blue 1999 Chevrolet Tracker was parked. Quickly unlocking the door, he tossed his backpack in the back seat, and slumped down into the front seat. He started the engine and waited a few minutes for it to warm up.
He certainly could afford a better car, but the old car had been very dependable all the way through medical school and his internship. Old Blue as he called it had become like an old friend. It ran well, did not burn any oil, and got reasonably good gas mileage. But most important of all; it was paid for and he hated spending money unnecessarily. He was not the least concerned about flaunting a successful doctor image. In his mind, spending tens of thousands of dollars on an expensive luxury car was foolish.
He backed out of the parking space and headed west toward Highway 80. Turning right on Highway 80, he drove north for nine blocks then turned left onto Highway 191. He turned on the radio and tuned in the local country western station. He did not particularly care for country western music, but it was the only station he could pick up on Old Blue’s radio. Knowing it was going to be difficult to stay awake, he rolled down the driver’s side window and settled in for the thirty minute drive to his rental house near Elfrida.
Even if he had been looking in the rear-view mirror, he likely would not have noticed the dark green Jeep Wrangler that followed him out of the hospital parking lot because Jeep Wranglers were an extremely popular vehicle in the desert southwest. The Jeep had settled in behind him and was following at a safe distance.