This morning, I have a medical mystery / thriller in our book spotlight! Check out Misfire, the second book in The Kate Downey Medical Mystery series by Tammy Euliano! Learn about the book and the author and read an excerpt from the novel!
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A device that can save a life is also one that can end it
Kadence, a new type of implanted defibrillator, misfires in a patient visiting University Hospital for a routine medical procedure—causing the heart rhythm problem it's meant to correct. Dr. Kate Downey, an experienced anesthesiologist, resuscitates the patient, but she grows concerned for a loved one who recently received the same device—her beloved Great-Aunt Irm.
When a second device misfires, Kate turns to Nikki Yarborough, her friend and Aunt Irm's cardiologist. Though Nikki helps protect Kate's aunt, she is prevented from alerting other patients by the corporate greed of her department chairman. As the inventor of the device and part owner of MDI, the company he formed to commercialize it, he claims that the device misfires are due to a soon-to-be-corrected software bug. Kate learns his claim is false.
The misfires continue as Christian O'Donnell, a friend and lawyer, comes to town to facilitate the sale of MDI. Kate and Nikki are drawn into a race to find the source of the malfunctions, but threats to Nikki and a mysterious murder complicate their progress. Are the seemingly random shocks misfires, or are they attacks?
A jaw-dropping twist causes her to rethink everything she once thought she knew, but Kate will stop at nothing to protect her aunt and the other patients whose life-saving devices could turn on them at any moment.
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read an excerpt
“You aren’t gonna let me die this time, are ya, Doc?”
Oh boy.
So started my Wednesday, with about the worst line any anesthesiologist can hear from a patient in
preoperative holding.
“This time?” the nurse said.
“Last time my heart decided to dance a little jig instead of pumpin’ my blood.”
Sitting close beside Mr. Abrams, his wife squeezed her eyes closed. “Abe, tell Dr. Downey the whole
story.”
“I read about it in your chart last night,” I said. “Last time they tried to fix your hernia, your heart
needed a jump start.” To the nurse I added, “V fib,” a chaotic heart rhythm that usually requires
electrical shock to convert back to a normal rhythm. “It happened when they were putting you to sleep
and they canceled the case.” Instead of a hernia operation, Mr. Abrams ended up with a very different
procedure that day—placement of an automated internal cardioverter defibrillator, or AICD. A device
implanted in his chest to detect and treat the problem should it recur.
“Your AICD hasn’t fired, right?” The device had been checked by cardiology the day before.
“Right. Rosie watches it like a hawk huntin’ a rodent.” He nodded to his wife, who slipped her phone
under the book in her lap.
“I completely understand,” I said to her, nodding at the hidden phone. “My aunt has the same AICD, and
I can’t stop checking the app either.” Maybe a downside of the novel AICD, the Kadence communicated
through the patient’s phone to the cloud, where I could view status reports on my beloved Aunt Irm’s
heart. “I don’t expect any problems this time, but we’re ready if your heart decides on another jig.”
“Dr. Downey, I need to ask a favor.” Mrs. Abrams didn’t look at me, or at anyone. She gripped her
paperback as if it would fly open.
“Call me Kate.”
“Come on, Rosie, let the doc do her job,” Mr. Abrams said.
She ignored him. “Dr. Yarborough is his cardiologist. She said if he could keep his phone during the
operation, she would be able to watch his AICD.”
I generally like to honor requests. This one required a caveat. “I’ll make a deal with you. We’ll keep the
phone close for Dr. Yarborough as long as you promise not to watch the app.”
Her sparse gray eyebrows drew together.
“During surgery, there’s electrical noise that can confuse the AICD. I don’t know what it might report
and I don’t want you frightened.” Sometimes we turn off AICDs during surgery, but this operation was
far enough away from the device implanted near his left shoulder that the noise shouldn’t cause a
problem. What she might see on the app, though, I couldn’t predict.
She nodded uncertainly.
Eric, the anesthesia resident assigned to work with me on the case, arrived with a small syringe of a
sedative. “What do you think about some happy juice?”
“I think my wife needs it more than me,” Mr. Abrams said.
Her lipstick appeared to redden as her face paled.
“Unfortunately, it goes in the IV,” Eric said with a kind smile for her. “We’ll take good care of him.”
“You’ll watch his blood sugar,” she said.
“Yes, ma’am.” Eric unlocked the bed.
“And be careful with his AICD.”
“We will.” He unhooked the IV bag from the ceiling-mounted pole and attached it to one on the
stretcher.
Tears dampened her eyes as Mrs. Abrams stood and leaned down to kiss her husband’s cheek.
“I’m gonna be fine, Rosie. Don’t you worry. I’ll be huntin’ by the weekend, and we can try out that new
squirrel recipe before our anniversary.”
“We are not serving squirrel stew for our fiftieth anniversary,” she said.
Eric and I exchanged a smile.
“Oh now, you wait and see.” Mr. Abrams patted his wife’s hand.
“What’s squirrel taste like?” Eric pushed the bed from the wall.
“Tastes like chicken.” Mr. Abrams laughed loudly. “No, just kiddin’ with ya . . .” As they turned the
corner, the voices faded. I stayed behind to reassure Mrs. Abrams.
“I can’t lose him.” Eyes squeezed shut, a sob escaped.
I wrapped an arm around her ample shoulders and waited. I knew that feeling; had lived that feeling;
had lost.
“I’m sorry.” She dabbed her eyes with a tissue.
“No need to apologize. Last time scared you. Tell you what, once he’s asleep, I’ll give you a call and let
you know it went fine.”
That calmed her. We walked together to the main doors, where I directed her to the waiting room. I
turned the opposite direction to not let her husband of fifty years die during a hernia operation. No
pressure there.
In the OR, we helped Mr. Abrams move to the operating table. After applying monitors and going
through our safety checks, Eric held the clear plastic mask over his face and said, “Pick out a good
dream.”
“Oh, I got one.” He winked at me. “I’ll try to behave this time, Doc.”
“I’d appreciate that.” I maintained eye contact and held his hand as I injected the drugs to put him off to
sleep. Despite having induced anesthesia thousands of times, I always experience a tense few moments
between the time the patient stops breathing and when the breathing tube is confirmed in the
windpipe. During those couple of minutes, if we couldn’t breathe for him, there’s a real, if remote,
chance the patient could die. Not a failure to save, but, in essence, a kill. Anesthesia is unique in that.
We take people who are breathing fine, mess it up, then fix it, so the surgeon can correct the real
problem.
When Mr. Abrams’ induction proceeded without incident, I felt an extra sense of relief and was happy to
share that with his wife. The operation, too, went well, and an hour later, he awoke from anesthesia,
gave a sleepy smile, and said, “How’d it go, Doc?”
“Fine. No more hernia. Are you in any pain?”
He shook his head. “Nope, you done good.”
about the author
Tammy Euliano writes medical thrillers. She's inspired by her day job as a physician, researcher and medical educator. She is a tenured professor at the University of Florida, where she's been honored with numerous teaching awards, nearly 100,000 views of her YouTube teaching videos, and was featured in a calendar of women inventors (copies available wherever you buy your out-of-date calendars).
When she's not writing or at the hospital, she enjoys traveling with her family, playing sports, cheering on the Gators, and entertaining her two wonderful dogs.
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