THE BILLIONAIRE'S SURGEON BRIDE

Chapter Seven: Wide Complex

Thirty-one minutes is enough time to kill a man four times over.

I drove it in nineteen. I do not remember most of them. What I remember is that my brain, which had spent nine days being a wife, came back online as something colder and started running a differential at eighty miles an hour on the Parkway.

Seizure. Rate one-ninety. Digoxin at 0.9 as of yesterday, falling, essentially subtherapeutic.

It isn't the digoxin.

Which meant somebody had watched me remove one weapon and had reached for another.

Which meant they were watching me.

* * *

The EMS rig was in the drive with its doors open and nobody in it, which told me they were still inside, which told me it was still happening.

I went through the house at a dead run. Priya was on her knees in the low room by the water glass with two paramedics, and Damian was on the floor between them, and he was not seizing anymore, and for one second that was the worst thing I have ever seen, because there are two reasons a seizure stops.

Then I saw his chest move.

"I'm his physician," I said, which was a lie, and "I'm his wife," which was not, and I went down on the floor on his other side and the older medic started to say something about scene control and then looked at my face and stopped.

"Status for eleven minutes, broke with midazolam ninety seconds ago," he said instead. "Rate one-eighty-six. He's hypotensive. We're loading for transport."

"Show me the strip."

He turned the monitor.

I looked at it for perhaps a second and a half.

The complexes were wide. Not the ugly narrow tachycardia of a heart being driven too fast — wide, slurred, ungainly, each one dragging a tail behind it like something wounded. And in the last lead, in aVR, a tall clean terminal R wave standing up where nothing should be standing.

There is a very short list. It is one of the first lists you learn and one of the only ones you never look up.

"He's not in VT," I said. "Sodium bicarbonate. Now. Amp of eight-point-four, IV push, and get me a second one drawn up."

"Ma'am, protocol for a wide-complex at this rate is—"

"His QRS is a hundred and eighty milliseconds and he has an R wave in aVR." I was already reaching past him for the drug box. "This is a sodium channel blockade. If you cardiovert him you will kill him. Bicarb. Now."

Something in the way I said it worked.

The first amp went in at 8:51.

Nothing happened for forty seconds, and I knelt on the floor of my husband's house holding his wrist and counting and thinking, with total detachment, if I'm wrong he dies in the next two minutes and I will have killed him in front of three witnesses.

Then the monitor did the thing I have never in my life been so glad to see.

The complexes narrowed. Just slightly — a hundred and eighty to a hundred and fifty, then to a hundred and twenty — the tracing pulling itself in, tidying up, the way a drunk man straightens when he sees a policeman.

"Second amp," I said. "Then start a drip. Three amps in a litre of D5W, run it at one-fifty an hour, and somebody get me a blood gas."

"What is it?" Priya said. She was white to the lips. "Doctor, what is it?"

"Tricyclic," I said. "Somebody gave him an antidepressant."

* * *

They took him in.

I did not go with him.

I want to be honest that this was not a decision I'm proud of, and that I made it in about four seconds standing in a doorway watching them load my husband into an ambulance. Marsh would meet the rig. Cardiology would meet the rig. Damian Vale would be, for the next forty minutes, the most closely observed human being in the state of New York.

And the house would be empty.

I went back in and stood in the kitchen and made myself breathe.

They watched me take the digoxin away.

Nine days. In nine days somebody had understood that oral digoxin no longer had a route into him, and had found a different door, and had used a drug that would look — to any honest emergency physician who didn't know the history — exactly like a wealthy depressed widower taking his own amitriptyline.

I opened the cabinet above the sink.

The organizer was where I had left it. It was an ugly grey plastic thing, medical grade, four compartments a day for seven days, with a combination latch — I'd ordered it on my second night in the house and filled it on Tuesday afternoon at the kitchen island while Damian sat across from me and made increasingly unhelpful observations about my handwriting.

Aspirin. Statin. Beta blocker. Nothing else. He wouldn't take the analgesia.

The latch was closed.

I stood there with my hand on it and I did not want to open it, and I have thought many times since about the fact that some part of me already knew.

3-1-0-4. Clara's birthday. He'd chosen it and hadn't explained and I hadn't asked.

The lid came up.

Tuesday: correct. Wednesday: correct. Thursday morning — aspirin, statin, beta blocker.

And a fourth tablet.

Small. Round. Faintly blue. Sitting in the corner of a compartment I had filled with my own hands seventy-two hours earlier, in a locked box, in a house with a security system and two men in the drive.

I did not touch it. I took a photograph of it. Then I took a photograph of the entire tray, and one of the latch, and one of the cabinet, and one of the room, because at some point in the last four days I had become a person who documents things.

And then the arithmetic arrived, and it was very simple, and there was no way around it.

Two people on this earth knew that combination.

One of them was in an ambulance.

The other one was me.

* * *

Marsh called at 11:20.

"He's up," she said. "He's oriented. QRS is one-oh-two, gas is corrected, we're keeping the bicarb running overnight. Elena — he asked for you before he asked what happened to him."

"Vivian." My voice came out of somewhere far away. "The tox panel."

"Amitriptyline. Two hundred and eleven nanograms per millilitre." A pause. "Elena, that's not a therapeutic level and it's not an accident. And there is no prescription for it in his chart, in his history, in anything."

"I know."

"The hospital is required to notify—"

"I know what the hospital is required to do."

I got there at ten past midnight.

He was in a bed on eleven again, in the same room, which someone had thought was efficient and which was in fact obscene. Bicarb running. Cardiac monitor with a QRS I could have kissed. The sternotomy dressing was rucked up on one side where somebody had put pads on him in a hurry, and that, absurdly, was the thing that nearly finished me — that they'd disturbed my dressing.

I sat down and fixed it. Because I couldn't do anything else with my hands.

His eyes opened.

"Elena."

"Don't talk."

"Where were you." Not an accusation. He was too weak for an accusation. "Priya said you weren't—"

"I was at the hospital." I taped the last edge down. "In Vivian Marsh's office. Asking her about your wife."

I watched him take that. Nine days ago it would have been unreadable. It wasn't anymore, and I don't know whether that's because he'd stopped bothering or because I'd learned him.

"Good," he said.

"Damian." I put both hands flat on the blanket. "Somebody got into the house."

"I know."

"Somebody put a tablet of amitriptyline into a locked pill organizer on a Thursday. And the latch was still closed when I found it."

He went completely still.

"You opened the box," he said.

"Of course I opened the box, that's how I—"

"Elena." He got his hand around my wrist. There was more strength in it than there had any right to be. "Listen to me. Did you open the box before you called anyone, or after?"

"Before. Why does that—"

"And you photographed it."

"Yes."

Damian Vale let his head go back against the pillow and shut his eyes, and something that was not quite a laugh came out of him.

"Then we have about an hour," he said.