by Kati Eisenhuth (@katieisenhuth.bsky.social)
Adult Thriller
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Query
FLATLINE is an 87,000-word thriller featuring a female physician protagonist, as in Listen to Me by Tess Gerritsen, the medical drama as seen on The Pitt, and the literary style of Jennifer Hillier in Things We Do in the Dark.
Dr. Anna Horowitz is the best Internal Medicine resident at University Hospital, the most prestigious and cutthroat training program in the country. Just ask her. But an unsuccessful Code Blue on the day before her promotion to Cardiology fellowship lands her a month of probation and a new intern to train, her reviled former stepbrother, Justin.
When a twisted joke inside a congratulations card gives Anna one week to confess to a decade-old misdeed or face death, she does not even consider spilling her secret. The revelation would end her career. Besides, Justin is the only one who knows about her role in the death from her past, or so she thinks. Then Anna’s patients begin to die. Each death is preceded by another card, another menacing joke, and a ten-year-old newspaper article from events leading up to the tragedy. Anna sets out to prove her stepbrother is orchestrating the murders. Instead, her medical expertise leads her to other viable suspects and she becomes the focus of law enforcement’s investigation. As the clock ticks, the police close in, and the victims become increasingly more important to Anna. Now, she must choose between protecting her past and the lives of those at the hospital, hers included.
I am a pediatrician in central Pennsylvania, where I live with my kids (including one who stutters, like Anna), my husband, and two 100-pound lap dogs. My short literary fiction has recently been nominated for a Pushcart Prize by Bellevue Literary Review and has also appeared in Bayou Magazine, failbetter, Into the Void, Ghost Parachute, and elsewhere.
Thank you in advance for your consideration.
First Five Pages
The General Medicine ward at University Hospital grows fangs at night. It lures patients in with cozy beds and a sterile, faintly-bleachy aroma, shiny devices and cutting-edge medical care. But within the curtained oasis, a snarling beast lies in wait. There comes a moment when patients find themselves alone and vulnerable. Then the brute sinks its teeth in.
I don’t fully exhale until sunrise. I spend the night pacing between old, silent patients, agonizing over the cardiac rhythm on the monitor, the sound of breath through my stethoscope, the lab values returning in the early morning hours. While I’m an expert at cardiac resuscitation—the best in my year—even my statistics are not favorable for survival.
I never rest in the Resident Call Room when I’m on duty. Tonight, however, facing my own brand of monster, I’m willing to make an exception.
“Dr. Horowitz,” a nasal voice says from down the hallway.
I freeze. Did Colin see me or can I still slip away?
“I just calculated Mrs. Dronnet’s urine output. Two point five milliliters per kilogram per hour. Should we turn her IV fluids down?”
The pride in the med student’s voice grates on my nerves. He thinks he knows a lot because he’s made it to his third year. But that just proves he can achieve 70% on a multiple-choice test. Here, on the ward, he’ll learn everything he’s read in a textbook amounts to just about nothing. “That’s a lot of pee, Colin. Any idea why she’s producing so much urine, other than too many IV fluids?”
His dark, wavy hair falls over one eye but doesn’t hide his knitted brow. “Acute kidney failure?” I cock my head and he adds, “Glomerulonephritis?”
How the hell did he get into a program like this? My former stepfather—Doug, the smartest man I know—trained here. I started working on my application at age 15. “Or maybe the Lasix we started her on this morning for her heart failure?”
“Oh, right.” His voice is quiet. “The water pills.”
“Diuretics, Colin. You’re studying to be a doctor. The patients call it a water pill. Not you. I’ll be in my call room.” The one place he won’t follow me.
“Wait!”
I consider blowing him off. But what would Doug say if he were here?
Usually, interns train med students. As a third-year resident, I’m needed elsewhere. But today is July 1: Turnover Day. Which means I have no buffer. I take a deep breath and turn back to Colin.
“I was wondering why you ordered epinephrine for the new pneumonia patient. Do you think she’s that sick?”
At least he knows one thing: epinephrine is the most useful drug when patients are one step away from death. Still, in this case, he’s way off the mark. “No, Colin. It’s not that. Take a look.” I lead him to a computer at the nurse’s station and flash my badge at the scanner. The patient’s chart appears on the screen. I lean back and wait for Colin to take in the snapshot of her health.
“Her heart rate’s only 70. Is that too low?”
“No, Colin. 70 is fine. Look again.”
His tongue presses against his upper lip as he scans the screen with full, exasperating concentration. “Oh.” He looks sheepish. “Peanut allergy. It’s her epi-pen.”
“And we make it a point to never need those here,” Thula says.
Thula’s a nurse with enough clinical acumen to be mistaken for a physician. She speaks with a mesmerizing Swazi accent that makes me lean toward her to soak in every word.
“Yes, ma’am,” Colin says.
Thula shakes her head at him and focuses her gaze at an old man carrying a pitcher of water down the hall. His plain, white undershirt hangs limp, like his skin, his movement, sluggish.
“What’s that man doing here?” My watch reads 5 am. “Visiting hours ended a long time ago.”
Thula waves her hand through the perilous air. “That’s Mr. Rodrigo. I told him he could sleep in the chair at his friend’s bedside.”
I don’t argue with Thula. No one does. Still, the hair on my arms stands on end at the sight of Mr. Rodrigo’s unsteady shuffle. My body responds to sickly old men like him the way some people shiver when a black cat crosses their path. A bad omen. “His friend? Who volunteers to sleep in the hospital for anyone but family?” My voice doesn’t rise beyond a whisper, but something inside me screams.
“Ach. Some families are found, not born,” Thula says.
That shuts me up. I don’t have much to contribute on families. I share my basement apartment with an infestation of crickets.
“He doesn’t look so good,” Colin says. Eyes like an eagle, this one.
Mr. Rodrigo seems to sense our eyes on his back and turns slowly to wave. I wonder if his hand in the air might be less friendly and more a call to action because he looks like a man signaling for help.
“I mean, he’s got to be at least a hundred,” Colin says.
I turn to carp at him and, when I do, a wave of white shirt passes by my line of sight.
“He’s down.” Thula’s voice is calm and practiced but she rushes to the man now sprawled across the hallway, his empty water pitcher rolling 20 yards away.
I suppress my gasp. “Call a co—” The word catches in my throat until I let it relax out, as my speech therapist taught me in elementary school. “--ode,” I finish. Childhood Onset Fluency Disorder—growing up, kids called it stuttering—is a neurologic condition that has no correlation whatsoever with intelligence. I wish more people knew that.
When I arrive by Mr. Rodrigo’s side, he’s ghost-white and unmoving. His head is bent at an awkward angle. Thula has her hand on his neck, feeling for a pulse.
“Nothing,” she tells me. I don’t repeat her exam even though I am the physician.
I kneel beside the man, straighten out the dead weight of his torso, then make eye contact with the tech. “Get the defibrillator.”
She runs off. A crowd gathers behind me, waiting for orders. I am the senior-most resident on the medicine floor and at this time of day, my attending physician hasn’t arrived yet. I meet eyes with another tech. “Get the portable oxygen.”
“Starting chest compressions now.” I place my right palm against the back of my left hand and lace my fingers together. The weight of my body falls against his sternum and several ribs crack with the pressure. The sensation assures me my compressions are effective. “1…2…3…,” I count out loud with each compression. Someone places a bag-valve-mask over his face, readying to give breaths. A metallic rattle tells me the code cart has arrived with the defibrillator and medications we’ll need.
The code team moves with the precision of a clock, all the pieces ticking into place. The rhythm soothes me, as does the sensation of blood rushing from Mr. Rodrigo’s heart, through his aorta, and up to his brain. This man is going to live. I will make it so.
“Pause.” I stop compressions to analyze Mr. Rodrigo’s heart rhythm on the monitor. The wave tracing of any ECG is a visual representation of the electrical activity of a heart, a masterpiece of pure, intricate beauty. But in this case, Mr. Rodrigo’s wave traces the shape of miniature gravestones.
Ventricular tachycardia. Not good.
“Clear!” I yell and we all lift our hands from Mr. Rodrigo’s body. “Shock!” Two hundred Joules of electricity course into his heart. At the same time, a nurse from the ER takes over compressions so I can dictate further instructions.
My own fingers twitch as I watch for Mr. Rodrigo’s to do the same, something to indicate he is waking up. But he’s still. I check the depth of the nurse’s chest compressions and the timing of the breaths. All perfect.
He just needs a higher dose of energy to restart his normal heart rhythm. He is old, after all. “One mi—" My larynx catches on the word, my neck muscles spasming out of control.
The action of the medical team follows the pattern of my speech, and the pleasant whir of our machinery grinds to a halt.
The hospital beast clutches Mr. Rodrigo by the throat.