24 Hours. Greg Iles

had washed her up from the cemetery.”

      Squeals of revulsion were drowned by a wave of male laughter. No one appreciated morbid humor more than a bunch of docs with a couple of drinks under their belts.

      “My presentation will be brief and to the point. The emergency physicians and anesthesiologists should find it provocative, and I hope the rest of you find it interesting. I’m going to try something new tonight, a bit of high-tech wizardry I’ve been toying with.” Will had videotaped his past year’s clinical work on a Canon XL-1, a broadcast-quality digital video camera that Karen had tried to talk him out of buying. He’d worked dozens of hours on his computer, editing it all down to the program that would accompany tonight’s talk. The finished product was seamless. But any time you worked with hard drives and video, glitches lurked in the wings. “If it doesn’t work,” he added, “at least nobody dies.”

      More laughter, wry this time.

      “Lights, please.”

      The lights dimmed. With a last flutter of nerves, Will clicked a file icon with his trackball, and the 61-inch Hitachi television behind him flashed up a high-resolution image of an operating room. A patient lay unconscious on the table as the OR team prepared for surgery. Wonder lit the faces in the crowd, most of them doctors with minimal computer knowledge. Their ages varied widely, with couples in their sixties seated beside others in their thirties. Some of the younger wives looked a lot like Karen.

      Will glanced at his large-font script and said, “This patient looks thoroughly prepped for surgery, doesn’t he? Twenty minutes before this picture was taken, he assaulted a doctor and two nurses with a broken coffee carafe, causing serious injuries.”

      The image on the Hitachi smash-cut to a jiggling, handheld shot that looked like something out of a Quentin Tarantino film. A wild-eyed man was jabbing a broken coffee carafe at whoever was behind the camera and screaming at the top of his lungs. “Satan’s hiding inside you, motherfucker!”

      The audience gasped.

      The man in the video swung the jagged carafe in a roundhouse arc, and the camera jerked wildly toward the ceiling as its operator leaped back to avoid being slashed. Only Will knew that the cameraman had been himself.

      “It’s the end times!” the man shrieked. “Jesus is coming!” In the background, a nurse cried, “Where the hell is security?” The man with the carafe charged her and began weeping and howling at once. “Where’s my Rhelda Jean? Somebody call Rhelda, goddamn it!”

      Suddenly the video cut back to the man lying prostrate and prepped in the OR.

      “If I were to tell you that this man was subdued in the ER not by police, but by me—using a drug—you might guess this was accomplished with a benzo-diazepene, a barbiturate, or a narcotic. You would be wrong. No doctor can hit the vein, or even the muscle, of a PCP-crazed man who is trying to kill him with a coffee carafe, not without grave risk to himself and other staff. The ER docs among you might make a more experienced guess and assume that it was done with a paraylzing relaxant like pancuronium bromide, curare, or succinylcholine. And you’d be right. Nowadays, emergency physicians routinely resort to the use of these drugs, because they sometimes offer the only means of compelling violent patients to accept lifesaving treatment. And though they won’t talk about it much, they sometimes use paralyzing relaxants without first administering sedatives, as a sort of punishment to ‘repeat offenders’—violent addicts and gangbangers who show up in the ER again and again, causing chaos and injury to staff.

      “All of you know how dangerous the paralyzing relaxants are, both medically and legally, because they leave patients unable to move or even breathe until they’re intubated and bagged, and their breathing done for them.”

      The Hitachi showed a nurse standing over the patient in the ER, working a breathing bag. Will glanced into the crowd. At the first table, a stunning young woman was staring at him with laserlike concentration. She was twenty years younger than most of the women in the audience, except the trophy wives escorted by those doctors who had ditched the loyal ladies who put them through medical school, in favor of newer models. This woman wore a tight black dress accented by a diamond drop necklace, and she seemed to be alone. Older couples sat on either side of her, framing her like bookends. Since she was sitting in front of the first table, Will had an unobstructed view, from her tapered legs and well-turned ankles to her impressive décolletage. The dress was shockingly short for a medical meeting, but it produced the desired effect. She was distracting enough that he had to remind himself to start talking again.

      “Tonight,” he said, “I’m going to tell you about a revolutionary new class of drug developed by myself and the Searle pharmaceutical company, and tested in my own clinical trials at University Hospital in Jackson. This drug, the chemical name of which I must keep under wraps for one more month, can completely counteract the effects of succinylcholine, restoring full nerve conductivity in less than thirty seconds.”

      Will heard murmurs of disbelief.

      “Beyond this, we have developed special new compressed-gas syringes that allow the safe injection of a therapeutic dose of Anectine—that’s a popular trade name for succinylcholine—into the external jugular vein, with one half second of skin contact.”

      The Hitachi showed the screaming man with a broken carafe again. This time, as he charged a female nurse, a tall man in a white coat stepped up behind him with something that looked like a small white pistol in his hand. The white-coated doctor was Will. As the patient jabbed the glittering shard at the brave nurse who had agreed to distract him, Will moved in and touched the side of his neck with the white pistol, which was in fact a compressed-gas syringe. There was an audible hiss, and the man’s free hand flew up to his neck. The dramatic fluttering of his eyelids and facial muscles was hard to see in the handheld camera shot, but when he threw up both arms and crossed them over his chest, the audience gasped. As he collapsed, Will caught him and dragged him toward a treatment table, and two nurses hurried over to help.

      The ballroom was silent as a cave.

      On screen, two nurses restrained the patient with straps. Then Will stepped up and injected him in the antecubital vein with a conventional syringe.

      “I am now injecting the patient with Restorase, the first of these new drugs to be approved by the FDA. Now, if you’ll look at your watches, please.”

      The camera operator moved up to the treatment table and focused on the patient’s face. His eyes were half closed. Every doctor in the audience knew that the man’s diaphragm was paralyzed. He could not move or breathe, yet he was fully conscious of what was going on around him.

      Will heard shuffles and whispers as the seconds ticked past. At twenty-five seconds, the patient’s eyes blinked, then opened. He tried to raise his hand, but the arm moved with a floppy motion. He gasped twice, then began to breathe.

      “What’s your name, sir?” Will asked.

      “Tommy Joe Smith,” he said, his eyes wide.

      “Do you know what just happened to you, Mr. Smith?”

      “Jesus Lord … don’t do that again.”

      “Are you going to try to stab anyone else, Mr. Smith?”

      He shook his head violently.

      The image cut to a shot of drug vials—Anectine and Restorase—sitting beside a compressed gas syringe on a soapstone surface.

      “I know how shocking that footage can be,” Will said. “But remember the scene that preceded it.”

      On the Hitachi, Tommy Joe Smith charged the nurse again with the shard of glass.

      “The potential applications are limited, thank God, but their necessity cannot be argued. In emergency rooms, psychiatric wards, and prison infirmaries, healthcare workers are suffering grave injury at the hands of violent patients. Now their safety can be insured without resorting to greater violence to restrain the out-of-control patient. Very soon, physicians will be able to use depolarizing relaxants without