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Spencer pushes a red pin into the fifth victim’s location and steps back. Their homes, the blue pins, are scattered across a ten block radius and more disorganised; the cluster of red are huddled closer together. Given the victims have little in common – gender, race, sexuality and religion align with the area’s demographics – it’s a fair bet their unsub isn’t stalking individual victims but choosing a common area to act upon.
On one hand, the locations he does choose create a brilliant geographical profile. On the other, it’s much harder to predict who the next victim will be. Whether or not he intended to have multiple targets or if they have just got lucky so far. He takes a step back and a long swig of coffee.
The unsub is a local man sticking to local haunts. One at a Costco. One at a public park. One at a café. One at a pub. And the latest at a grocery store. Spontaneous cardiac arrests.
“So he wants to poison people,” Morgan says. “Why not go en masse? He gets more victims, people are scared to go out anywhere, and the more victims we have means more suspects.”
“Less directed, too,” Prentiss adds. “If you kill one person it looks like you meant to kill them. If you kill five in one go, you were probably going for the number and not the person.”
“Unless he can’t,” Rossi says. “He – I don’t know – he drops something in the drink, it’s a one-time thing, he can’t get a lot of people without attracting attention.”
Morgan sits back. “Yeah, doesn’t mean he can’t do three, four drinks in a row. He’s just got to be good at it.”
“Oh, great,” Prentiss says, rolling her empty cup between her palms. “Now all we need to do is round up ‘successful date rapists’ and we’re golden.”
“Have Garcia run ViCAP on the CCTV,” Hotch says. “See if any of the people at the crime scene consistently appear at the others and look for anyone who shows particular interest.”
His coffee is gritty and cheap, ubiquitous to just about every regional police department in the country. Spencer cringes at the texture. “He’ll live locally. He’s trying to disguise it by keeping the locations far apart but they still center around town.”
Morgan hits speed dial and stands up.
“Do we know what he’s giving them?” JJ asks.
“Maybe a beta blocker,” Spencer suggests. “They lower the heart rate and blood pressure by blocking the effect of adrenaline and noradrenaline and disrupt electrical activity in the heart.”
“Fast acting?” Rossi says.
“They can be. They’re used for both chronic and acute management of hypertension and heart attacks, but for more chronic management they are usually pills. In emergency situations, they’re given intravenously.”
“No visible puncture wounds on the autopsies,” Hotch says.
“They have prescriptions?” Rossi asks.
JJ reaches for their records and flips through them. “Nope. Sandra Hansen had birth control and Sunil Devi was on Zoloft, but nothing about heart problems for any of them.”
“He drugs them,” Spencer says. “If it’s fast acting, it will have a short half-life and it might not show up on the preliminary toxicology reports. Actually, it might not show up at all.”
Morgan clips his phone to his belt and takes a seat. “Garcia’s running everything now – and we’re looking at someone in healthcare if they’re prescribed?”
“Fits the profile,” Rossi says. “Relatively intelligent, smart enough to try and hide a pattern, not smart enough to actually manage it, works alone, thirties to forties.”
“Lives and almost certainly works nearby,” Spencer says. “A hospital or pharmacy may have had unaccounted for medicine disappearing.”
Rossi pushes his chair back and tosses his cup into the trash. “Ready?”
Chairs drag on the carpet and the tables knock together as they get to their feet and gather up the documentation. Spencer puts the box of thumbtacks back beneath the corkboard and gives it one last look. He should’ve done a colour for local doctor’s offices and pharmacies—easier to see than looking for iconography up close on the map.
Hotch is the last up. Spencer catches the minute unsteadiness out of the corner of his eye, the half-second where his knuckles go pale gripping the top of the chair, an imperceptible slip to someone who doesn’t know him. But it’s over and he’s not sure if he was just imagining it so Spencer follows him out without a word.
Most of the station is rounded up in the bullpen, staring them down with unamused navy glares. This isn’t a case made easier by law enforcement co-operation, that much is very clear. He’s half convinced that’s why they put them in the room with the co-incidentally broken air conditioning. They file in and spread out at the front. Spencer can tolerate a room full of people watching him but he doubts he’ll ever come close to liking it, least of all with people veering more towards cold than welcoming.
The captain shuts the squad up.
“The unsub – unknown subject – is a white male in his thirties or forties,” Hotch begins. He doesn’t think he’d hear it if he wasn’t beside him but his breathing is strained, pausing a fraction too long between words. “He most likely works as a doctor or other position in the medical field.”
“He works alone,” Morgan says. “He’s a solitary kind of guy – you might see him around but he won’t really talk to you, he doesn’t care for small talk. Comes off as cold.”
“And he won’t have many close relationships,” Rossi says. “Even those won’t be particularly strong. He lashes out at people, not physically, but he’s still not a nice guy to be around.”
“The geographical profile indicates he lives in the area,” Spencer interjects, “and he will work in the wider area too. The crime scenes are a certain distance apart from each other, so he may be trying to conceal this, but we’ve narrowed it down to within a few blocks.”
“He’s good at blending in,” Prentiss says. “He uses public areas—”
Hotch takes an uncertain step back and the little colour is gone from his face. He moves behind Morgan and past Spencer with a low, “Excuse me.” and his shoulder just brushing the wall.
He’s almost to the door when he collapses.
Spencer’s fingers brush against his jacket and he holds on; he staggers from the dead weight but Hotch hits the ground with his shoulder, not his head. Voices erupt around them but he doesn’t register the sound, kneeling down on the thin carpet. “Hotch? Hotch!”
Nothing. No recognition, no movement.
He tilts his head back and leans down to listen for breathing, for the soft rise and fall of his chest.
“He’s not breathing,” Spencer calls, not sure who he’s talking to, if they can even hear him. His heart races.
Morgan crouches opposite and presses two fingers to Hotch’s neck.
“Give us space, go, go,” Prentiss snaps. Boots shuffle around on the carpet as voices spill out into the echoing corridor outside.
“No pulse,” Morgan says, raises his voice to a yell. “JJ, call 911.”
Hands on the centre of his chest. Dominant hand, weaker hand, interlaced fingers. Shoulders in line. Spencer presses down, throws his upper body weight into it, stops.
One, two, three
“—male, he just collapsed. He isn’t breathing—”
Four, five, six
“Defibrillator? Hey! Where’s the fucking defibrillator?”
Seven, eight, nine
Something gives; Spencer doesn’t let himself think.
Ten, eleven, twelve
“We don’t – we don’t have one, uh, I think—”
Thirteen, fourteen, fifteen
“Why the hell not?”
Sixteen, seventeen, eighteen.
“—station on Fifth and Maple. Yes, we’ve started CPR—”
Nineteen, twenty
Bones crunch.
Twenty-one, twenty-two, twenty-three
“Need me to do the breaths?” Morgan asks.
Twenty-four, twenty-five, twenty-six
“Yeah,” Spencer pants. “Nearly thirty.”
Twenty-seven, twenty-eight, twenty-nine.
Thirty.
“Go,” he breathes, falls back on his heels. Spencer’s arms burn and a bead of sweat rolls down his nose. Hotch still isn’t breathing. His chest rises once, twice, with Morgan’s breath.
No third time.
Spencer lurches forwards and throws himself back into the compressions; the bones are sickeningly unstable. He breathes out the count as he goes.
“Want me to do the next round?” Morgan says. “You’re doing good, but it’s tiring.”
Unable to talk, he just nods. Pushes down on the right beats. One-hundred and ten per minute.
“Go and get it then, Jesus fucking Christ!” Rossi barks. An officer races out of the room.
JJ cradles the phone between her ear and her shoulder, eyes the scene as it plays out right in front of her. She holds out a hand with her thumb down. Four minutes.
Four minutes. Eight CPR cycles. Eight. Less than eight percent of cardiac arrests patients outside of hospital survive.
“—seven, twenty-eight, twenty-nine, thirty,” Spencer declares, scrambles out of the way.
With a growing dread, he kneels beside Hotch – pale and motionless – and watches Morgan breathe. Once, twice, nothing. Eight percent.
Heart attack is, statistically speaking, the second most likely cause of death for a man Hotch’s age. The first is suicide, but—heart attack can lead to cardiac arrest but a cardiac arrest isn’t the same and it doesn’t make sense.
Prentiss is beside him and Spencer leaves Hotch with her and Morgan – strong, precise compressions – because he can’t help. There’s something wrong and he can’t find the reason why.
Hotch was healthy. High blood pressure, possible. Stress, yes. Spencer paces. That isn’t enough evidence to guarantee heart attack as the cause. The only other symptom he’d seen was dizziness. It could be. Could. Could also be a random arrhythmia, an electrical impulse misfiring, a chamber contorting out of turn. Cardiomyopathy doesn’t fit. There’d be symptoms for a long time before it escalated to cardiac arrest.
Yes, some sort of electrical abnormality is most likely.
They can’t fix that here. Not without a defibrillator, without an ambulance crew. Spencer’s blood rushes in his ears. Morgan counts to thirty. Rossi’s yelling at someone, something outside.
Electrical impulses lead to a chaotic rhythm which leads to sudden cardiac arrest.
Sudden. Spontaneous.
Supposedly spontaneous cardiac arrest.
Fuck. Fuck. Fuck.
JJ’s on the phone, Prentiss and Morgan are preoccupied and he’s not going to distract them even if he was 100% certain. Spencer rushes into the dingy hall and just catches himself before he runs into Rossi.
“Sudden cardiac arrest,” Spencer breathes. “No history of heart problems. Public place. I don’t think it’s coincidental.”
“Shit. Those blockers?” Rossi says. “You think the bastard’s here?”
“An overdose on beta-blockers,” he confirms, “and he might be, I’m not sure, I think it was in the coffee.”
“I had some,” Rossi says. “You had some. Just his?”
“I got them,” Spencer says. A cold fist clamps around his chest. “I did mine last and I had everyone else’s on the side and I was putting the sugar in and I wouldn’t have seen—”
“Nobody’s leaving if he’s here,” Rossi says. “You go. Find the cup, the pot, whatever and don’t let anyone take them.”
It’s his fault. He feels sick. Spencer presses his hands together, laces his fingers. The guilt suffocates him and he wants to climb out of his skin.
“Not your fault,” Rossi says. “Now go. You’ve got the memory, you’ll know which is which.”
Spencer goes.
He races past the clumps of officers and pushes past people with no apology, stumbles out into the break room. Heads turn as he shoves through sour sweat and floor cleaner and old food to the corner with the coffee machine, the awful gritty cheap coffee, thinking a silent prayer that nobody else has used it, nobody has touched it. Spencer grabs the pot just before a fresh-faced young woman, cold dregs of coffee and all. He feels his words in his throat. Something about an emergency. He doesn’t care what they think of him, how strange he’s acting, not this close to their unsub and Hotch and sudden cardiac arrest—
Spencer’s shoes squeak on the linoleum and this time he does crash into Rossi, more concerned for the coffee pot than himself, and thrusts it at his colleague. It occurs to him as he goes for their allocated room that he didn’t check if Rossi meant it literally but… no, he must’ve. It doesn’t matter if he hadn’t.
The room is deserted. His cardigan catches on a tack as he scours the room for their cups and Spencer yanks it free in frustration. A red tack skitters across the ground. Doesn’t matter. Nothing matters. The generic Styrofoam type, he’s not sure whose is whose but he gathers them in his arms until he’s got six. Cold coffee leaks onto his sleeve.
Five victims. DOA. Unable to be resuscitated.
Eight percent.
He has the evidence – possible evidence – and it’s useless if he can’t find what it was. If it’s anything at all. Spencer glances at the board again: crowded public places. The pattern fits.
Something about the standard procedure hadn’t worked as well on the victims as it should have. Medical personnel arrived in time to conceivably start their hearts again but of the five, none survived.
Beta blockers. Adrenaline and noradrenaline. The receptors blocked prevents the heart cells receiving chemical signals and therefore electrical activity.
Spencer drops the cups and flicks through the nearest file for the EMTs’ reports. He skims the paperwork and (eight percent, eight percent, eight percent) there it is: adrenaline administered.
Adrenaline doesn’t work if the body can’t use it.
(Eight percent is for regular situations and it has to be lower if they don’t know—)
The corridor is crowded. He cuts through it sideways on, pushing past disgruntled and nervous cops, and almost trips on a heavy kit bag set in front of the door.
“Clear,” the EMT calls.
Hotch jolts. The pulse spikes and falls back to a wavering green line tracing across the monitor to an bare 0.
He resumes CPR. Morgan glances up at him.
“It’s beta-blockers,” Spencer gasps, falling to his knees beside the EMT. She gives him an incredulous look.
“Sir, can you—”
“Adrenaline won’t work,” he says, pointing at the syringe she’s drawing up. “You need glucose or you won’t get a normal rhythm.”
“Are you a doctor?” she asks, looking him up and down.
“Yes,” Spencer says. “No. Not – I have a doctorate in chemistry, I know how beta-blockers function.”
He tries not to look at Hotch, pale and motionless and sprawled out just where he’d fallen. The paramedic’s gaze bores into him and Spencer forces himself to look back.
“What medication is he on?”
“He isn’t,” Spencer says. “It wasn’t intentional.”
Her attention is only on him for brief snippets as she concentrates on setting out her kit. He avoids looking past her to Hotch, wired up for the ECG, shirt unbuttoned to just above the scars he carefully doesn’t let them see.
“We’re working on a poisoning case,” Morgan says. “It’s all across the county. Sudden cardiac arrest calls and no identified cause?”
An alcohol wipe on his upper shoulder, jacket cut off. She lines up the tip of the thick needle and he winces as she drills it into the bone beneath.
“Trust me,” Spencer says. “It’s a beta blocker.”
She draws back the plunger and a dark red rushes up the tubing. The monitor beeps. Hotch isn’t breathing, his heart isn’t beating right and (eight percent) he needs them to listen.
“It’s blocking the adrenaline,” he explains. She pushes the adrenaline down the winding IV. “They bind to the beta-1 or beta-2 receptors in the heart and blood vessels and prevent them from receiving chemical signals which otherwise would lead to the electrical impulses keeping the heart beating. If you don’t treat the overdose he’ll—”
Spencer swallows past the lump in his throat.
“He knows what he’s saying,” Morgan says.
“Clear,” the man announces.
A shock; a thump. Nothing.
“Both of you, back,” she says, but she reaches for a different syringe.
Spencer stands on weak legs, finds himself backing up against a table beside JJ. Morgan watches behind the other EMT. The infusion is painstakingly slow. How long has it been? Two minutes, three? How much longer?
More adrenaline. JJ’s hand finds its way into his and he squeezes gently. He has to be right because the normal treatment isn’t working and these things aren’t supposed to happen so it has to be a mistake, a deliberate poisoning, it has to be.
Spencer doesn’t breathe. The man positions the paddles and she adjusts the voltage. The monitor whines.
Hotch jolts, head tilting to the side, back arching. JJ’s hand hurts and Spencer thinks vaguely he might be hurting her too.
The line flattens.
A heartbeat rises up, a distinct peak, and falls. The next comes complete, and the next, and the next. Too slow, but a heartbeat.
Hotch breathes.