“Someone call for a cardiology consult?” she asked the ward clerk when she went downstairs.
“I did.” One of the ER residents, Dr. Oussoren, was waiting near the desk. “Thanks for coming down so quickly, Dr. Gravel,” she said, shaking Elizabeth’s hand. “I have a 39-year-old male patient who was brought in by ambulance in full asystolic arrest. We achieved ROSC after almost thirty minutes of resuscitation, but the patient has yet to regain consciousness. He’s hypotensive with a pressure of 85 over 40, pulse 115, and febrile with a temp of 103.”
Elizabeth frowned. “Any other signs of systemic infection besides the fever? It sounds like septic shock to me,” she said matter-of-factly, as she walked alongside Dr. Oussoren on the way to the patient’s room.
The resident nodded. “I agree. The reason I called you down here is that he also has a history of alcoholic cardiomyopathy and was recently implanted with an ICD. I’m still waiting on lab work, but based on his symptoms, I suspect sepsis caused by a cardiac device infection.”
Her description sounded eerily familiar. Elizabeth began to feel uneasy. “I don’t think I caught the patient’s name,” she said, trying to play it casual. “Could you please repeat it?”
“I didn’t mention it for a reason,” Dr. Oussoren replied, stopping outside the room. She lowered her voice to a whisper as she added, “He’s a high-profile patient, and I didn’t want anyone to overhear.” Opening the door, she ushered Elizabeth inside. Elizabeth’s heart dropped when she saw who was lying in the bed. “It’s Nick Carter, one of the members of the Backstreet Boys who’d been missing for the past few weeks. He was found unresponsive on one of the beaches early this morning.”
How?? Elizabeth wondered. Her heart was racing, but she kept her face impassive, forcing herself to remain calm and composed on the outside. “I see,” she said, as she removed the stethoscope from around her neck and slipped it into her ears. She pressed the diaphragm to the center of Nick’s chest and pretended to listen, but she could barely hear his heartbeat over the panicked voice inside her head. How in the hell did he get out? There’s no way he would have been able to free himself from those restraints, let alone make it all the way to the beach in his condition. Someone had to have helped him.
She had a pretty good idea of who that had been, and it certainly wasn’t her brother Patrick. Dani must have dropped Nick off at the beach, knowing he would be found and brought to the hospital. She had been so determined not to let him die. But now that he was here, Elizabeth couldn’t let him live. If he woke up, he would tell the police everything, and she, Patrick, Dani, and Rob would all do prison time. She would lose her license to practice medicine; her career as a cardiologist would be over. She had to make sure Nick never regained consciousness.
Repositioning her stethoscope, she forced herself to focus on the sound of his faint, fluttering heartbeat. Based on what she heard, he wasn’t far from the brink of death. It wouldn’t be difficult for her to nudge him over the edge without attracting suspicion. Septic shock had a mortality rate of forty percent, so a fatal outcome could be explained by any number of unfortunate but not unforeseen complications of an already life-threatening condition.
“I’m admitting Mr. Carter to the ICU,” she told Dr. Oussoren after she’d finished examining him. “We’ll do an echo and proceed with lead extraction if it looks like the ICD is the source of the infection. Would you please put a rush on his labs and send us the results as soon as they come back?”
“Of course,” the resident promised. “Thanks again for being so responsive.”
“My pleasure,” replied Elizabeth, forcing a smile onto her face. She kept her composure as she hurried off down the hallway, her heels clicking purposefully across the tiled floor as her heart raced inside her chest. She waited until she was in the privacy of the women’s restroom to place a frantic phone call home to Patrick. “Come on… pick up!” she muttered impatiently as she listened to the phone purr in her ear.
“Hello?” her brother finally answered on the fourth ring, sounding like he had just woken up.
“What the hell is going on, Patrick?” Elizabeth hissed. “I just came from a consult in the emergency room, and guess who the patient was? Nick Fucking Carter.”
“Huh?” Patrick sounded completely confused. “Wait, how could that be? Nick Carter’s-”
“Not in his bed, is he? He can’t be, because he’s here, at my hospital! That bitch took off with him, didn’t she?”
“Who… Dani?” She could hear Patrick panting as he pounded down the stairs, presumably to see for himself that Nick was no longer in the house.
“Yes, Dani!” Elizabeth cried in exasperation. “Who else would I be talking about? She dumped him on the fucking beach so he would be found!”
“Well, shit,” Patrick swore, finally seeming to understand why this was a problem. “What do we do now?”
“I’ll take care of Carter,” Elizabeth promised. “I just need you to make sure Brian stays paralyzed until I get home. Can you do that for me?”
After a pause, Patrick replied, “Um… no.”
“No?” Elizabeth repeated, her voice rising. “What do you mean, no?”
Her brother took a huge breath and let it out with a heavy sigh. “You’re not gonna like this, Lizzie, but… Brian’s not in his bed either.”
“What?!” Her mind was now racing as fast as her heart. “Okay… stay calm,” she said, speaking more to herself than to him. “If he had been on the beach with Nick, he would have been brought to the hospital already, right? But I don’t think he’s here in the ER, or this place would be crawling with cops by now. So… think. What else would Dani have done with him? He couldn’t have gotten very far on his own, not in his condition. His muscles have been wasting away for almost three weeks; he would be too weak.”
“Do you want me to drive around and look for him?” Patrick offered.
“You damn well better!” snapped Elizabeth, as she clutched the phone to her ear. “And so help me god, Patrick, if you don’t fucking find him before the police do, we’re both gonna be in huge trouble. Go find him!”
After she had hung up on her brother, Elizabeth forced herself to forget about Brian for the time being and went back to work. She made arrangements for Nick to be transported to the third floor, where she would meet him for more diagnostic tests. Looks like I’ll be working overtime today, she thought, massaging her temples wearily as she rode the elevator upstairs. She was exhausted, but she knew she could not leave Nick in anyone else’s hands. She had to take care of him herself.
***
“Mrs. Carter?”
Lauren looked up as a nurse came into the waiting room. “Yes, I’m Nick’s wife,” she said apprehensively. “How is he? Can I see him now?”
The nurse nodded. “He’s being admitted to the intensive care unit. We’re about ready to take him up. If you and your family want to follow me, you can go with him.”
“Yes, of course. Thank you.” Lauren stood up, slinging her bag over her shoulder. “C’mon, guys,” she added, as she beckoned to the rest of the group.
Howie felt grateful to have been included as part of Nick’s family. He and the other guys may not have been blood relatives, but they were brothers just the same. They walked a few steps behind as the nurse led Lauren to a room near the end of the hallway. Before they went in, she stopped them outside the door, blocking it with her body, and said, “Just to warn you, he’s hooked up to a lot of equipment, but don’t let that scare you. You can touch him if you want to - and talk to him. He’s not conscious, but he may still be able to hear you.”
Lauren nodded. “Thanks for the heads up,” she said, as the nurse stepped aside to let her through the door. Howie held back, allowing Lauren to go in first. Wanting to give her a minute alone with her husband, the three guys watched from the doorway as she approached Nick’s bed. “Nick… I’m here, honey,” they heard her say, as she took his hand in hers. “I’m right here.”
There was no response from Nick, as far as they could tell. Howie took a tentative step into the room to get a closer look. He was relieved to see that the CPR device had been removed, but the nurse hadn’t been exaggerating about the equipment. There was a breathing tube sticking out of Nick’s mouth and IV lines in both arms. A bundle of wires was attached to the electrodes on his bare chest, connecting them to a monitor that displayed his heartbeat and other vital signs. Between the electrodes, Howie could see traces of the bruising Dr. Oussoren had talked to them about. He also noticed a raised, red incision below Nick’s left collarbone and, barely visible beneath it, a round disc the shape and size of a large watch embedded under his skin. Dear God, Nicky, Howie thought, staring down at his little brother in dismay. What did they do to you?
Nick was out cold, his eyes closed, his mouth hanging open around the breathing tube. Had the situation been less serious, Howie would have taken a picture of him looking like that as payback for all the photos Nick had snapped of him sleeping over the years. He only hoped they would be able to look back on this and laugh someday - or at least not cry.
“God, he looks like shit,” said AJ in a low voice as he stood next to Howie.
“Well, what do you expect, AJ? He was drugged… kidnapped… beaten… and left for dead. He’s lucky to be alive at all,” replied Howie, swallowing hard.
“Well said, D,” Kevin agreed, as he walked up to the bed. “Let’s try to stay focused on the positives here, fellas. Nick needs all the prayers and good vibes we can give him.” He bent down and planted a kiss on Nick’s forehead. “Stay strong, brother.”
“Love you, man,” added AJ, his voice sounding even raspier than usual. He pulled a pair of sunglasses out of the front pocket of his t-shirt and put them on to try and hide the tears in his eyes. Howie was not fooled for an instant.
Turning his attention back to Nick, he tried to think of something heartfelt to tell him, but his mind had gone blank. “Hang in there, bro,” he managed to say, rubbing the back of Nick’s hand. “You’ve gotta get better, all right?” He realized they still didn’t even know what was wrong with Nick. Was an infection making him sick, as Dr. Oussoren had suspected, or had he just been beaten to within an inch of his life?
A brief knock on the door interrupted Howie’s thoughts. He looked up to see Detective Overton escorting an orderly into the room. “I’m here to take Mr. Carter up to the third floor,” said the orderly, showing them his hospital ID badge before he bent down to unlock the wheels of Nick’s bed. Then he and the nurse rolled Nick out the door.
The rest of the group followed them down the hall to an elevator. When the doors opened, Howie saw that it was hardly big enough to hold all of them. “You go with him, Lauren,” he told Nick’s wife, nudging her forward. “We’ll wait for the next one.”
“Thanks,” she whispered, flashing him a tearful smile as the elevator doors slid shut.
Once they were alone in the hallway, AJ heaved a sigh. “God, that was a lot to take in. Have I told you guys lately how much I hate hospitals?”
Kevin laughed humorlessly. “We know. You’re gonna have to suck it up and deal it, though. Nick needs us to stay strong for him.”
AJ sighed again. “Yeah. I know. I was just saying…” He trailed off awkwardly, as they waited for the elevator to come back down. “Do you think he’s gonna be okay?”
Howie nodded. “He has to be,” he said stubbornly, refusing to consider the alternative. He had known Nick for twenty-seven years. He couldn’t imagine a world without him.
“He will be,” Leighanne agreed, hugging Baylee to her side. “God’s watching over him - and Brian. We just have to keep praying for them both.”
The elevator arrived with a ding, and they piled inside. On the silent ride up, Howie did just what Leighanne had said: he bowed his head, closed his eyes, clasped his hands together, and prayed that God would heal Nick and protect Brian, wherever he was.
Howie felt a sense of deja vu as he stepped off the elevator on the third floor and followed the signs to the intensive care unit. He had been there before - but this time, Nick was really there, too.
Once the nurses had gotten Nick settled into his new room, he was allowed to have visitors, two at a time. Again, they let Lauren go in to see him first. “Do you want some company?” Howie asked. “Or would you rather be alone with him?”
“I would love some company,” said Lauren with a sad smile, offering him her hand. He took it, and they walked into Nick’s room together.
Nick was wearing a hospital gown, which hid the bruises on his chest, but Howie couldn’t help but feel overwhelmed by all the tubes and wires that were attached to his body. They seemed to be everywhere, snaking up the neck of Nick’s gown and sticking out from underneath his blanket. Careful to avoid the equipment, Howie and Lauren sat down on either side of Nick’s bed and watched him sleep awhile. It was weird to see him lying so still. Nick had always been a bundle of energy, full of life. Now he was on life support.
“This is all my fault,” said Lauren out of the blue, her bottom lip trembling as she stared at Nick with tears in her eyes.
Howie turned his head to look at her. “What are you talking about?” he asked, frowning. “This is nobody’s fault except the people who did this to him. It’s definitely not yours.”
“He wouldn’t have been down here by himself if it wasn’t for me,” argued Lauren. “When he came home from the tour, I wouldn’t even let him back in the house. I was still so angry at him for leaving after we lost Arya, I wanted to punish him, make him hurt as much as he hurt me. But I shouldn’t have pushed him away like that.” She shook her head with regret. “I should have him let him stay so we could have started to work through everything. Now we may never get the chance.”
“You could never have known something like this would happen,” said Howie. “Don’t beat yourself up about it. Just be here for him when he wakes up. Knowing Nick, your face is the first one he’ll want to see.”
Lauren managed a tiny smile through her tears. “I hope so. Thanks, Howie.”
Before he could reply, there was a rap on the door. They both looked up as a tall, slim brunette woman in a white coat walked into the room.
“Good morning. I’m Dr. Gravel, the cardiologist,” she introduced herself, shaking each of their hands. “I examined Nick briefly in the ER. I’m not sure how much Dr. Oussoren explained to you, but we’re concerned Nick may have contracted an infection from his ICD. Mrs. Carter, I’ll need your permission to do a diagnostic procedure called a transesophageal echocardiogram. It involves putting a probe down Nick’s throat to take pictures of his heart. Once I have a better idea of what we’re dealing with, I’ll be able to determine our next steps.”
Lauren nodded. “Whatever you need to do. Please, just help him get better,” she pleaded.
Dr. Gravel went over the risks of the procedure with Lauren and had her sign a consent form. “I can do the echo right here in Nick’s room, but I’ll need the two of you to step out,” said the doctor. “It should only take half an hour or so.”
Howie could tell Lauren wasn’t comfortable with the idea of leaving Nick alone. “Come on,” he said, putting his arm around her. “Let’s go get a cup of coffee or something.” Reluctantly, Lauren allowed him to lead her out of the room.
They went back to the ICU waiting area, where they filled the rest of the group in on what was happening with Nick before they headed downstairs to find the cafeteria. Howie bought as many coffees as he and Lauren could carry, and they brought them back up to drink while they waited.
It wasn’t long before Dr. Gravel came in to talk to them. At first, Howie was worried something had gone wrong. It had barely been half an hour since he and Lauren had left Nick’s bedside, and he was used to doctors running behind, just like Backstreet Time. But Dr. Gravel smiled and said, “I just finished with the echocardiogram. There were no complications; Nick came through with flying colors.”
“Thank god,” sighed Lauren with relief. “Were you able to get a good look at his heart?”
The doctor’s smile faded. “Yes - and unfortunately, I found evidence of a very serious condition called endocarditis, which is an infection of his heart’s inner lining. It’s become an increasingly common complication of cardiac device implantation. Basically, some bacteria got into Nick’s bloodstream and set up shop inside his tricuspid valve, which connects the right atrium of the heart to the right ventricle. We can treat it with antibiotics, but we’ll need to be aggressive - if left untreated, endocarditis is almost always fatal.”
Howie felt sick to his stomach upon hearing that. Beside him, Kevin let out his breath in a low sigh. “Endocarditis… that’s the same thing Brian had as a little boy,” he said, looking at Leighanne and Baylee. “It almost killed him, too.”
“But it didn’t,” Leighanne countered. She turned to Lauren and added with confidence, “Brian got better, and I know Nick will, too.”
Lauren nodded. “Nick’s a fighter. He would want you to be aggressive,” she told Dr. Gravel. “Do whatever it takes to get rid of the infection.”
“I’d like to remove the ICD right away,” the doctor replied. “The risks of leaving it in outweigh the risks of extracting it.”
“Good,” Lauren agreed. “Take it out. He doesn’t need it anyway.”
“Will that require surgery?” Kevin wanted to know.
“In most cases, it’s a minimally invasive procedure,” said Dr. Gravel. “I’ll go in through the same incision that was used to implant the device. As long as there’s not too much scar tissue built up around it, I should be able to pull it right out.”
It sounded simple enough. After listening to Dr. Gravel go over a list of possible complications, Lauren signed another consent form. “Take care of my man,” she said as she handed it back.
The cardiologist smiled and nodded. “Of course, Mrs. Carter.”
***
