The Complication: A Camille Delaney Mystery

Chapter One

Everything unique about a person disappears once the blue surgical drapes are in place. Dallas Jackson was no exception; all that could be seen of him was a large orange rectangle of skin glowing under the harsh operating room lights. Digital readouts on the anesthesia equipment flashed and beeped as the surgeon whisked into the dingy, white-tiled operating room, holding his freshly scrubbed hands out in front of his chest.

Nurse Sally Berwyn snapped Dr. Willcox’s gloves around the cuffs of his gown and jerked back her birdlike hands as if she had just been burned. She repeated the procedure with assistant surgeon Dr. Burton, her eyes avoiding both men.

The scraping of the stainless steel instrument stand across the floor was like brakes squealing just before a high-speed crash. The sound exaggerated the familiar chill of the operating room.

Vic Jones looked more like a pirate than a scrub tech in a small-town hospital. He wore a black-and-silver Raiders scarf fashioned into a surgical hat and a thick silver hoop earring in his left ear. So, do you and the wife have big plans for the Fourth of July fireworks tonight, Dr. Willcox? Vic asked as he organized the instruments on his stand.

We sure do. You ready, Sally? Willcox asked the tiny nurse who was struggling to open a valve connected to a canister under the table by a stretch of clear tubing.

Just a sec. Okay, go ahead. It’s on. The patient’s chart clattered to the floor, and the nurse swore under her breath as she stooped down to retrieve it. She sat down, nearly missing the stool.

Willcox directed his attention to the patient and held out his hand, palm up, waiting for the familiar slap of the scalpel. Skin incision.

Two fifty-three. The slurping suction machine nearly drowned out Nurse Berwyn’s voice.

Willcox watched the thin line behind the scalpel transform into an oozing incision. He held his palm out for the electric cautery. He said nothing. They had been through this drill thousands of times. Willcox felt his pulse quicken as the pungent smell of burning tissue permeated his nostrils. A fog of wispy smoke gathered over the patient as he zapped the small bleeders.

Dr. Burton held the trocar over the patient expectantly. You ready? His booming voice was a sharp contrast to his slight stature.

Yep. Let’s do it. Willcox took the stake-like instrument and grabbed a fold of the patient’s yellow-stained skin, placing the tip of the stake into the small incision. He took a breath, stood up straight to get good leverage, and grunted as he threw his entire body weight against the instrument, shoving it forcefully into the patient’s upper abdomen. He deftly removed the inner, pointed portion of the trocar, leaving just a stainless steel sleeve approximately an inch in diameter protruding from the skin.

CO2. Willcox waited while Vic connected a tube to the trocar. A cobra-like hissing pierced the silence for the several minutes it took to expand the patient’s abdomen so that the instruments could be inserted though the sleeve.

His pressure’s dropping, Dick Stark, the anesthesiologist, reported. His BP was one sixty over ninety before I put him to sleep. It’s one twenty over sixty-four now.

Thank you, Dr. Stark, Burton responded.

BP one hundred over fifty-two; pulse one twenty. Is this guy bleeding?

Willcox continued slowly threading tiny instruments and a fiber-optic camera into the patient’s abdomen through the stainless steel sleeve.

The anesthesiologist twisted around toward Nurse Berwyn, who was flitting around the room, checking and rechecking the equipment. What’s the blood loss, Sally?

She ran over to the table. The paper drapes rustled as she pulled them aside. The suction canister’s got about six hundred cc’s of blood in it.

Willcox glanced down and noted the plastic canister gradually filling with thick red liquid.

Willcox and Burton locked eyes over their surgical masks.

Pulse ox is dropping. Stark turned and tended to the dials on his anesthesia cart. We got trouble, he said firmly. BP’s ninety over fifty-five. I’ve pushed volume expanders and ephedrine with no response. This guy’s bleeding from somewhere.

Willcox looked at the TV monitor that transmitted an image from inside the patient’s abdomen. It had been carefully angled so it was out of the line of vision of the anesthesiologist. He’s not bleeding. I have a perfect view of the operative field. He continued to manipulate the instruments through the stainless steel sleeve for several minutes as the nurse kept her eye on the clock. She hovered over the anesthesiologist, clearly concerned.

Stark swiveled on his stool, his long arms grabbing vials off his cart. He frantically drew up medicines in various syringes while keeping his attention on the digital readouts to see if any of the medications were producing results. He’s bleeding. Trust me. The anesthesiologist quickly slid another needle into the patient’s IV. You’re taking way too long screwing around in there.

No . . . he’s not bleeding. Here, I’ll stick another trocar in and get a better look around.

I wouldn’t, Stark snapped. You’d better get him open. You got a bleeder.

Willcox looked at Burton. Hand me another trocar, will ya, Carl?

Burton stared directly at the anesthesiologist as he very slowly handed Willcox the instrument.

Stark’s voice rose an octave. You can’t repair anything through that scope. You really need to get him open. Now!

Willcox looked at the large institutional clock over the doorway. It read three fifteen.

How much blood do we have in the canister, Sally? Stark demanded.

She squatted next to the table. Nine hundred cc’s. Her shaky voice was muffled by the surgical drapes.

Okay, Doctor, you got a pumper. Stark’s face flushed as he started an IV in the patient’s other arm.

I’m looking right at the field, and there’s no bleeding in sight. The patient’s having a reaction to the anesthesia. That’s your problem, not mine. Give him some drugs if you’re so goddamned concerned about his pressure, Willcox said as he continued to operate, asking for instruments.

Twelve hundred cc’s! Sally pleaded.

His pressure’s bottoming. For Christ’s sake, he’s lost a quarter of his blood volume! Get him open! Stark demanded.

Willcox waited as Vic hooked up the carbon dioxide again. It’ll just take a while to get the operative field open so I can investigate the possibility of any internal bleeding.

Fifteen hundred cc’s. Sally’s disembodied voice filled the OR.

Keep the CO2 going, Vic. I’m getting a better look at the field, and there’s nothing out of the ordinary here.

Stark stood up. Okay, no more fucking around. Let’s get going.

Willcox glared at the anesthesiologist. You sit down and shut up. I’m the surgeon here! You do your job, and I’ll do mine.

Stark’s long, slender fingers turned up the second IV so it was running wide open. Sally, get me some more blood in here stat! he said, looking directly at Willcox. "I’m telling you for the last time, Dr. Willcox. Your patient is in hypovolemic shock. Open him now and get the bleeding under control!"

Willcox stepped back from the patient and folded his arms across his chest. So, you wanna be a surgeon? Be my guest! He swept his arm in an arc.

Burton chuckled quietly.

Get Dr. Gonzalez in here! Stark directed the nurse. Tell him it’s an emergency.

He’s lost seventeen hundred cc’s and counting. Sally’s eyes darted from Willcox to Stark as she headed for the phone, narrowly avoiding tripping over the wires snaking across the floor.

Okay! Fine! You want the patient open? How’s this? Willcox pushed past Vic’s bulky shoulders and grabbed a scalpel off the instrument stand. He tore open the drape and petulantly slit the large orange globe from the pubic bone to the breastbone. Is this open enough for you?

Sally stretched the phone cord and craned her neck to see the clock. Laparotomy, three twenty-five. She quickly scribbled on her baggy scrub pants.

Stark had the blood set up in the warmer among the plethora of IVs already hanging around the head of the table. Get me more blood, Sally! And plasma expanders! And hurry!

They’re on the way.

Willcox and Burton slowly prodded around the deep incision. Okey doke, Willcox said slowly, here it is . . . Just a little puncture in the aorta. Don’t get so bent outta shape. I can repair this with one hand tied behind my back. Hang up the phone, Sally.

Sally trembled as she wrapped herself in the phone cord. Hello, Dr. Gonzalez? It’s Willcox. He hit the aorta. Please hurry.

I told you not to call him! I’m the surgeon. You follow my orders.

How soon will Gonzalez be here? Stark asked Sally anxiously.

It usually takes him about five minutes. His place is close—and he drives fast in an emergency.

Get some fresh frozen plasma, and order more whole blood. This guy’s oozing like a stuck pig. Stark looked like an octopus at the head of the table, his gangly arms twisting knobs, opening vials, and sticking syringes into the jumble of IV tubing. Do you have the aorta clamped off yet, Dr. Willcox?

Willcox watched the blood squirt violently from the aorta and slowly fill the patient’s gaping abdomen. What the hell else do you think I’ve been doing here?

Can you open up another pack of clamps when you have a sec, Sally? Vic winked flirtatiously at the harried nurse as she popped a freshly sterilized pack onto the instrument tray.

On her way back, Sally pulled the suction canister out from under the table. Her eyes widened. There’s nineteen hundred cc’s of blood in the suction now!

The intercom crackled. Dr. Gonzalez is here!

Shit! I can’t get this guy’s pressure up! Stark screamed as he wiped the sweat from his forehead with the back of his hand.

A man in his late thirties backed into the room, his wet arms raised out in front of him. He shuffled through the multicolored wrappers strewn haphazardly across the floor of the operating room and grabbed a gown off the table. Okay . . . What’s going on, Willcox? Dr. Max Gonzalez asked impatiently.

Willcox sighed. The patient’s aorta was slightly perforated when I advanced the trocar. He dropped his voice. "I immediately opened him up and clamped the aorta. Stark overreacted. I’ve got everything under control. You can leave."

Gonzalez gloved himself and roughly elbowed his way into the surgical field. Blood loss? He glanced at Sally.

Twenty-two hundred cc’s.

Holy shit! Gonzalez stared at Willcox and shook his head. He turned his full attention to the patient. "Sally, you scrub in! Get me more clamps! Stat! Let’s move it! Now! Gonzalez placed his entire hand over the aorta and stood on his tiptoes to stop the bleeding. He turned to Willcox. Dr. Willcox, your services are no longer necessary. I’m officially taking over."

The hell you are!

Gonzalez stood firmly, holding his hand over the aorta. A thick pool of dark-red blood crept up to the cuff of his gown. Look, this guy’s got disseminated intravascular coagulopathy, and we both know that means he has a shitty chance of surviving the next few hours. Gonzalez grabbed a huge clamp. Give me some room here. He slid the instrument around the backside of the aorta. I need some suction! Let’s hurry it up, Sally!

Sally hooked her foot under the step stool and dragged it through the sticky puddle of blood and climbed up next to Gonzalez. The metallic smell of blood was everywhere.

The rapid clicking of surgical clamps filled the room. Need I remind you, Willcox, I’m a board-certified vascular surgeon. And you’re not, Gonzalez said without looking up. You want to explain to the disciplinary board why you wouldn’t relinquish care of this patient?

Willcox stood close enough to Gonzalez to breathe down his neck. You wouldn’t dare.

The hell I wouldn’t. Gonzalez wiggled his shoulders irritably. Now get out and leave me alone so I can try to undo this mess.

He’s right, Andy. Let’s go. Burton grabbed Willcox by the elbow and pulled him firmly toward the thick double doors. Good day, everyone. We’ll give the family an update on the patient’s status.

Here we go again, Gonzalez said to no one in particular as the doors swung shut.

Chapter Two

Camille Delaney leaned over her husband’s shoulder, watching him clean and fillet the salmon he and their three daughters had caught that morning. Their annual Fourth of July salmon BBQ was scheduled to begin in less than an hour, and, as usual, they were running late.

Camille wrinkled her nose as Sam threw another handful of fish guts off the deck of their Seattle houseboat and into the water. I don’t know how you can do that.

Sam paused. They’re fish, Camille. They have tiny little brains. They don’t know what hit them. He lined the fish up in a perfect row on the blood-soaked newspaper and, starting at one end, began to cut off the fins.

Do you think the fish families swimming around out there miss these guys? Camille asked only half-jokingly.

Probably no more than some of your divorce clients miss their kids.

That’s a low blow, Dr. Taylor. Camille recalled with fondness the day she had met the handsome resident during her first career as head nurse in the emergency room at Boston General Hospital. With the exception of his silver-streaked hair, her husband hadn’t changed much in the ensuing twenty-one years. She smiled.

Well, at least the fish don’t pretend to care about each other. Sam stacked the last fillet on a clean newspaper. I don’t know how you can sit there and watch families get chewed up and torn apart day in and day out. If you ask me, these fish are better off. At least we appreciate their sacrifice.

You have a point. I don’t imagine that there are many baby fish held hostage out there just so the mommy or daddy fish can get a better financial settlement, Camille agreed.

Like I said, it’s a heartless game you play, babe.

Well, I don’t see you complaining about the new Boston Whaler I bought you for your birthday. It had been such fun to see the look on his face that day as he came out on the deck of their houseboat to see their three daughters all bundled up and ready for a ride in their dad’s new boat.

Yeah, you’ve come a long way from the days when you barely got a paycheck. Sam methodically wrapped the fish in a clean piece of newspaper, tucking the corners to form a perfect package.

You mean back when I felt like I was actually making a difference in the world, representing plaintiffs who were taking on big insurance companies in the name of truth and justice? Camille grabbed Sam’s hand and pulled him up from his position squatting on the deck. You know, I never thought I’d miss scrapping around with those insurance assholes.

As I recall, truth and justice didn’t pay the girls’ tuition.

But it sure felt better than arguing about who’s gonna get the condo at Lake Chelan and who gets the house in Vail.

Sam handed the neatly wrapped fish to Camille. There you go. Now you can pretend that you got the fish from the market, and you won’t have to admit that you’re eating some poor salmon’s father or brother. He kissed her on the cheek.

Camille turned around to see their oldest daughter, sixteen-year-old Angela, standing in the doorway, hollering at a group of her friends who were running down the wide cement dock that was lined with large elegant floating homes. Angela shrieked as she ducked to avoid a water balloon that bounced off Sam’s shoulder and hit the new leaded glass window in the blue houseboat next to the Delaney-Taylor’s.

Sam grabbed a kayak paddle perched next to their front door and splashed the kids as they hopped onto the houseboat. One of the boys swore loudly as he dropped the end of his sleeping bag in the lake while fending off a surprise attack from another gang on an inflatable rubber raft. He saw Camille and quickly clamped his hand over his mouth.

Okay, children. Camille glared jokingly at her husband. Take the balloon fight up on the roof deck. And try not to hit any of the neighbors’ windows. Camille tousled her husband’s wavy salt-and-pepper hair. And you are no help at all. She laughed.

Camille glanced at her watch and headed up to the large gourmet kitchen on the second floor of the two-thousand-square-foot floating home. Camille loved the reverse floor plan. The city view was so spectacular. And by the way, I could use some help here. Camille looked at Angela, who was running up the stairs into the living area, and gestured with her head at the bag of corn on the butcher-block island in the middle of the kitchen. She unwrapped the fish and plopped it into the teriyaki marinade. Her friends had been to parties at her house often enough to know that party prep was simply part and parcel of the evening’s entertainment. She was never ready on time. Let’s get moving, she shouted at Angela, whose perfectly round face was temporarily obliterated by a huge pink bubble as she grabbed the brown paper bag of corn and headed out to the deck to husk it.

As they began to husk the corn, Robin, Camille’s surrogate sister, breezed into the kitchen carrying a heaping platter of gooey nachos. She dodged the parade of screaming teenagers racing by, their water balloons poised for attack. Robin balanced the heavy tray in one hand as she pushed away a tendril of frizzy brown hair that had escaped from a haphazardly placed ponytail. I used low-fat ground beef, but that fat-free cheese wouldn’t melt, so I went ahead with the Monterey Jack.

Camille cleared a place for the nachos by rearranging open containers of soy sauce and sesame oil. She brushed a pile of ginger remnants into her hand. Here.

Robin put down the platter and started cleaning up after her friend. God, you really know how to make a mess.

Camille grabbed the T-shirt of a six-foot-tall adolescent boy racing to catch up with his friends. Hey, slow down, you guys. And please take the water balloons outside! Camille ran her fingers through her short dark hair as she greeted the first group of adult partygoers ascending the stairway into her living room.

By nine thirty, the party was in full swing. Laughter filled the huge kitchen-living area. Smoke swirled around the Weber kettle grill, and the aroma of mesquite salmon floated in through the open french doors. Camille bopped around the kitchen in time with marimba music that pulsated through the ceiling from the rooftop deck. The ring of Robin’s cell phone could barely be heard above the din. The name Gloria flashed on the phone.

Robin, Gloria’s calling! Angela yelled up the stairs to the rooftop deck.

Can you grab it? I’ll be right down!

Happy Fourth of July! Angela screamed. Sure, she’s right here. She handed the phone to Robin.

Hello? Robin plugged her free ear with her hand so she could hear. Oh my God! When? Where are you? I’ll be right there.

Robin fell into the nearest chair, her eyes unfocused.

Camille stopped arranging the huge tray of grilled veggies and wiped her hands on a green-and-white dish towel. She felt a twinge of butterflies as she dropped into the oversized chair next to Robin and gave her a hug. What happened? What’s the matter?

Robin was clearly in shock. I gotta go. It’s my dad. He’s in the hospital, something about a surgical complication. Oh my God. She hunched over and took a shallow breath.

Surgery? When did your dad have surgery? Camille asked. I didn’t know he was sick.

It was some kind of an emergency.

Waves of nausea overcame Camille. As a former nurse, she knew that doctors rarely performed surgery on holidays. It must have been serious. Camille’s heart sank as she pictured her friend and mentor lying on an operating room table. One step at a time. Maybe it was just an appendectomy or something.

What hospital’s he in? Camille knew enough to be wary of hospitals in small towns like Friday Harbor in the San Juan Islands, where Robin’s dad, Dallas, lived with his wife, Gloria, aboard the forty-two-foot wooden sailboat he had built himself.

Friday Harbor General.

Camille drew a sharp breath. Robin and Dallas were much more than friends to Camille. They had met years ago when she had answered an ad in the Daily, offering free room and board at Dallas’s drafty but charming old urban cabin on Portage Bay, across from the University of Washington. The deal was free rent in exchange for someone who would hang out with his ten-year-old daughter. It was family at first sight.

Camille told herself to stop jumping to conclusions. But the thought of Dallas undergoing emergency surgery in a small-town hospital on the Fourth of July bounced around inside her head like a pinball. Dallas had taught her long ago not to let negative thoughts overtake her and that she could always center herself by taking deep, slow Kundalini breaths. Camille stood up and tried to breathe away the fear that was currently washing through her body.

Robin’s eyes slowly came back into focus. He had to have emergency gallbladder surgery this afternoon, around three o’clock. There was some kind of complication, and he’s in intensive care. Her voice cracked. They’re not sure he’s going to make it. The doctor said something about an aneurysm. Cam, what does that mean?

Emergency gallbladder surgery? Shit. As far as Camille could remember, there was no reason on earth why someone would need emergency gallbladder surgery on a holiday. The Kundalini breaths didn’t seem to be working.

Sam danced through the deck door into the kitchen. He twirled around, gyrating his pelvis, and sang Elvis’s Hound Dog into the BBQ tongs, then stopped abruptly and threw the tongs onto the countertop. What’s up?

Robin spoke softly. Dallas is in intensive care.

Sam pulled off his stained apron and sat on the footstool in front of Robin, holding her knees. What happened? he asked softly.

Camille watched her husband comfort their friend. He was a gentle man, with more yin than yang—or was it more yang than yin? At any rate, he had a way about him that set him distinctly apart from any other man Camille had ever known.

It was an emergency, Robin whispered.

At times like this, Camille was grateful to have a doctor in the family, even though Sam was a research epidemiologist who hadn’t practiced clinical medicine in twenty years.

Sam grabbed the phone. I’ll call and find out what’s going on. What hospital’s he in?

Friday Harbor General.

Camille caught Sam’s gaze. His look spoke volumes. She knew he too was questioning the reason for doing so-called emergency gallbladder surgery on a holiday in a small-town hospital.

Smoke began to pour in off the deck. Camille jumped up and headed out to rescue the salmon while Sam rubbed Robin’s back as he popped in his EarPods.

Camille hastily piled the salmon fillets on a platter and climbed up to the rooftop deck, where a sea of colorfully adorned bodies bounced and swayed to the beat of the live marimba band. Drinks seemed to be supernaturally suspended in outstretched hands. She scanned the party for her paralegal, Amy.

Camille handed her the fish. Can you keep an eye on the food for me? She hollered, Dallas is in the hospital. I’ll be back up in a bit.

Don’t worry. I’ve got everything under control. Amy shot Camille a worried look. Go ahead.

Just as Camille opened the kitchen door, her middle daughter, thirteen-year-old Libby, and three of Libby’s dripping-wet friends threaded past her, snaking their way up to the party. Libby’s delicate appearance was in complete contradiction to her outspoken personality.

What’s going on with Dad and Robin? Libby hung from her perch halfway up the ladder.

Camille tried to sound casual. Dallas is in the hospital. He had some kind of complication in surgery.

Libby stopped. I hope he didn’t have to go to some Podunk hospital. Those places are full of quacks, aren’t they, Mom?

Camille looked down, searching for an explanation that would satisfy Libby’s curiosity. But her pause was a dead giveaway.

Mom! Oh my God. He’s in some icky little hospital, isn’t he?

With Libby, Camille wasn’t always sure who was the mother and who was the daughter. Ever since Angela and Libby had made their dramatic entrance into the lives of the Delaney-Taylor family on a 747 from Korea when they were four and seven years old, it had been obvious to Camille that Libby was a very old soul. As it turned out, Libby never had entirely fit in with her peers and was currently in the process of dragging the entire family through a long and tortuous childhood.

Libby ran past Camille and threw herself, wet bathing suit and all, onto their friend’s lap. Oh my God, Robin! Oh my God!

Robin smoothed Libby’s tangled hair. Thanks, Libs. He’s gonna be fine. Robin’s voice was uncharacteristically soft.

Robin and Libby curled up together in the big cream-colored chair. Their eyes reflected their fervent prayer for Dallas’s health, but from the looks on their faces, they feared the worst.

Sam put down his phone. The nurse said Dallas had a congenital condition called an aortic aneurysm. Apparently, the doctor inadvertently hit the aneurysm with one of the instruments. He sounded stern. Like a doctor. He’s extremely critical. Robin, you’d better get up there. He turned to Camille. Tony’s upstairs. Can you go ask him to get Robin on a flight up to the Island ASAP?

Camille rushed up to the deck and yelled into the ear of the lanky retired airline pilot who owned and operated the local floatplane service. Hey, Tony! She gently yanked his gray ponytail. Can you get Robin up to Friday Harbor? Like right now?

Tony was lost in the music. Are you crazy? No one’s flying out of Lake Union tonight. The place is completely closed to air traffic because of the fireworks! The aloha shirt would have looked ridiculous on anyone else in Seattle, but it was so very Tony. He held a Full-Sail Amber Ale in one hand and a clove cigarette in the other. Both were still as the rest of his body gyrated like a Sufi dancer.

How ’bout Lake Washington? Kenmore must be open.

What’s the rush? I can get her on a flight tomorrow. Eyes closed, he didn’t miss a beat.

It’s Dallas. He’s in intensive care.

Tony’s head snapped around, and his body stiffened. What do you mean? I just had dinner with them on their sailboat last night. He must’ve eaten three platefuls of enchiladas. With lots of Tabasco. He was fine. He pulled his phone out of his pocket. I’ll see if Steve can take her up. He held up his beer. I can’t exactly fly tonight. How’s she gonna get to Kenmore? The traffic’s a nightmare.

She can take the Boston Whaler. It’s not more than an hour to Kenmore from here by boat. Camille gave Tony a peck on the cheek and wound her way through the party to Sam, who was leaning on the rail, looking across the lake at Gas Works Park, where the Seattle Symphony would soon be accompanying the fireworks.

At exactly ten o’clock, a hush fell over the crowd. A helicopter flew around the lake with an enormous American flag hanging proudly from its underbelly while the symphony thundered the national anthem. A couple hundred thousand spectators stood at the perimeter of the lake with their hands over their hearts.

The fireworks had taken on special significance for Camille after her adopted daughters had been sworn in as citizens at an emotional ceremony on the Fourth of July several years earlier. It seemed beyond comprehension that this fateful day in Dallas’s life would happen on the family’s special holiday. Camille squeezed Sam’s elbow and whispered into his ear. I’m going with Robin. I can’t just wait around here—besides, she’s gonna flip out when she sees her dad on all that equipment in intensive care. Camille kissed her husband. I gotta go.

Sam put his hand under Camille’s chin and looked her directly in the eye. You’re going to fly up to the Island now? Tonight?

It’s really important to me.

You don’t fly with anyone but Tony. And you never fly at night. Are you sure you want to do this?

I don’t have any choice. Camille didn’t even try to blink back the tears. Twenty years earlier, she had crashed