The Silence That Speaks

by Andrea Kane

  Casey waved away his confusion. “We didn’t think it related to our investigation, either. But now, we’re wondering if whoever is trying to kill you and Madeline might be motivated by revenge.” She proceeded to fill him in on the situation with Nancy Lexington and her children.

  Conrad blinked in momentary shock, and then his shoulders sagged. “I wouldn’t think Nancy, Felicia or Ron were capable of murder. But I saw how they were after I lost Ronald. They were furious. I don’t blame them. But Madeline? She played no part in the surgery, other than just being there at the very end.”

  “That doesn’t seem to make her less guilty in Nancy’s mind.” Casey stared straight at Conrad, never pausing or averting her gaze. “We need to discuss the surgery itself, and why anyone would believe that a cardiothoracic surgeon of your caliber would unexpectedly lose a patient—particularly this patient.”

  “Unexpectedly? Or on purpose?” Conrad asked the obvious question. “I swear to you that I would never intentionally harm any patient. I took an oath to save lives, and that was always my goal when I walked into the O.R. As for Ronald, he was my closest friend. The only reason I agreed to operate on him, despite our personal relationship, is that I knew I was the best surgeon to perform the surgery. Intent isn’t even in the room, in this case, no matter what anyone believes.”

  Casey never doubted the sincerity in Conrad’s tone or body language. He was innocent of any wrongdoing. The idea of killing his friend because he was an obstacle to a hospital merger was preposterous.

  “I believe you,” Casey said. “But we need to discuss the unintentional. What went wrong with the surgery and why?”

  Conrad sighed, a sigh that rippled through his whole body. “That question haunts me every day. I wish I had an answer for you. The surgery went well. It was a very delicate procedure, which is why Ronald came to me to begin with. He was suffering from aortic valve and ascending aorta disease.” Conrad glanced from Casey to Marc. “I don’t know how familiar either of you is with that disease or with the Bentall procedure.”

  “Not a clue on either.” Casey answered for both of them. “All I know is that the aorta is the large artery that leads from the heart.”

  “Correct.” Conrad snapped into surgeon mode. “The Bentall procedure involves replacing the aortic valve, the aortic root and the ascending aorta. Ronald was at a crisis point, and needed the surgery done immediately. He insisted that I be the one to perform it. My success rate is over ninety-nine percent,” Conrad stated the last without arrogance, only the factual, statistical reality.

  “What happened this time?”

  “I honestly don’t know. The surgery itself went flawlessly—everything from dilating the diseased aorta to replacing that diseased section with a Dacron graft. I finished up, and attached the right and left coronary buttons without incident. To be even more cautious, I reinforced the sutures with tissue sealant. Everything looked hemostatic, so we took Ronald off the cardiopulmonary bypass.”

  “Which is?”

  “Sorry. The CPB is the heart-lung machine. I closed up his chest. Everything looked fine, so I went out to give Nancy the good news, leaving the surgical team to put in the final skin sutures. While I was gone, there was an abrupt drop in Ronald’s blood pressure and massive bleeding from his chest tubes. A Code Blue was announced, and I rushed back to the O.R. We emergently opened the chest.”

  “And?”

  “And I couldn’t control the bleeding that was coming from the aortic root. By this time, Ronald’s blood pressure had been low for a prolonged period of time, so we had to put him back on the CPB machine. There was massive bleeding from both the coronary buttons. I removed the sealant to visualize the anastomosis, which I then redid. Things got worse, not better. The bleeding was now more diffuse. We were losing him and I knew it. We rushed him to the ICU with his chest open, held together with a vacuum dressing. We did an EEG and a CT scan, both of which confirmed brain death.”

  Conrad’s pain echoed from deep inside him. “So the patient—my patient—was declared. I couldn’t believe it. I still can’t. There were absolutely no indications that this would happen.”

  “When did Madeline factor in?” Marc asked.

  “When the Code Blue was announced. She rushed in, as did the rest of the code team. It was already too late. I’d reopened Ronald and was trying to repair the damage. The code team left the O.R. Madeline stayed. I believe she was in the ICU, as well, but I was concentrating only on Ronald. He was gone. I don’t recall what Madeline did after that.”

  Conrad dropped his head into his hands. “I constantly relive this surgery. I ask myself, did I tie the knots too tightly, causing the sutures to break? Did I tie the knots too loosely, resulting in the bleed-out? Should I not have used glue to clog the needle holes at all? I just don’t know. And I never will.”

  For the first time, Casey understood the enormity of the burden Conrad was carrying. To tell him that he’d done everything he could would be patronizing and useless. So she said the only sincere thing she could say. “I’m sorry you have to live with this. I’m also sorry we had to dredge it all up again.”

  “Don’t be sorry.” Conrad raised his head. “You’re not dredging up anything that doesn’t haunt me every day. As for Nancy and her kids—I don’t know what to think. I used to have an intuitive feel for people. I seem to have lost that completely. So pursue this in any way you need to.” He gave them a quizzical look. “Is it time for another payment? I can have it wired directly to your account.”

  “We’re fine,” Casey assured him. “Madeline paid us well.” She paused for a minute. “I have one more question to ask you before we go. It’s not a particularly comfortable one, but I have to ask it, anyway.”

  “Go ahead.”

  “What’s your relationship with Sharon Gilding?”

  Conrad looked surprised, as if that was the last question he’d been expecting. “Relationship? Do you mean professional or personal?”

  “Both.”

  “Professionally, we respect each other’s expertise. Sharon is a brilliant neurosurgeon. Yes, I know she’s my competition for the job of chief of surgery. That seemed to bother her a lot more than it did me. She’s a very high achiever. I can’t fault her for that.”

  “You didn’t answer the personal part.”

  “Sharon isn’t my favorite person,” Conrad admitted. “She’s cold and self-centered. She’s short on compassion for her patients. We’ve argued about that. We have different styles.”

  “But you aren’t or weren’t sleeping together?”

  “What?” Conrad’s head shot up. “Absolutely not. Why would you think that?”

  “We weren’t sure. Now we are.” Casey paused again. “What about Ronald Lexington? Was she sleeping with him?”

  This time, Conrad squirmed a bit. “I don’t think so. But I don’t know.”

  “Go on.” Casey knew there was more, and she wasn’t letting Conrad off the hook. “We need you to be totally candid with us.”

  There was a hint of a pause. “This is an uncomfortable subject for me. But fine. In the interest of full disclosure, Ronald liked women, and they liked him. He made it no secret to me that he had extramarital affairs. Some of those were with hospital personnel, and some were with women he met elsewhere. He wasn’t particularly discreet, at least not to my way of thinking. I called him out on it more than once, especially when a few of his paramours’ hospital work suffered so much from the affairs with Ronald that they had to be fired. But he couldn’t help it—he charmed every attractive young female who walked through the hospital doors. I called it the Bill Clinton effect.”

  “Can you give us any names?”

  Conrad’s forehead creased as he thought for a moment. Then he gave a rueful shrug. “I wish I could. The truth is, I was obsessed with my work. I lived and breathed i
t. I can tell you minute details of any of my surgeries, but I can’t give you the names of half my patients, much less the names of Ronald’s lovers. In both cases, there were so many.” A wry smile. “That should tell you how vast his sexual adventures were.”

  Marc made a disgusted sound.

  “I understand your distaste for the situation,” Conrad responded. “It wasn’t one of Ronald’s finer qualities. But he was a good man and a good friend. So Doug and I put up with his weekly sexual updates, and focused on our weekly golf games.”

  Doug Wilton. Casey remembered him well from the dedication ceremony.

  “Doug spoke very highly of you,” she said. “As he did of Ronald. But in your case, he was pretty devastated that you might not come back. He respects you enormously as a surgeon.”

  This time Conrad’s smile was genuine. “Doug is a great cardiologist and a great guy. We worked well together, and we were friends outside the hospital. I didn’t socialize much, since I spent most of my life in the O.R. But Doug, Ronald and I were pretty tight.”

  Casey exchanged a quick glance with Marc. He understood. Her next job would be to talk to Janet. His would be to talk to Doug.

  “One last question, and then we’ll let you get some rest,” she said. “Did Nancy Lexington know about her husband’s indiscretions?”

  “Can I swear to it?” Conrad replied. “No. But Nancy is a very shrewd woman. She’d have to be very naive—which she’s not—to be totally unaware of Ronald’s sexual liaisons. When Madeline and I went out to dinner with them or socialized with them in any way, Nancy kept a tight watch on her husband. So I’d have to say yes, Nancy knew Ronald had a roving eye.”

  “Thank you.” Casey rose. “We’ve tired you out enough. We’ll get back to work and let you lie down.”

  “Did Ronald hit on Madeline?” Marc’s question came out of nowhere.

  Conrad’s head shake was adamant. “Absolutely not. Ronald was a loyal friend. He would never do that to me. Plus, Madeline would have told me. She was not a fan of Ronald’s behavior.”

  “Okay, then that’s a dead end,” Marc replied. “There’s no one who would be jealous of Madeline, at least not for that.”

  “No.”

  “This whole case could have nothing to do with Ronald Lexington,” Casey said. “But we have to check every angle, which we are. In fact, I’m going to lunch with Janet Moss tomorrow to see what I can learn.”

  Conrad chuckled. “You’re going to the right source. No one sneezes in Manhattan Memorial without Janet knowing about it.”

  “Then she might be a gold mine. By your own account, you practically lived at that hospital. And Madeline’s life is pretty tied up there, too. Not to mention the fact that whoever tried to kill you managed to be at Crest Haven and also knew what combination of meds would cause a massive overdose. So it’s probable that the perp works in your hospital or possibly even here.”

  Conrad’s lips thinned into a grim line. “I know. That’s why I’m so grateful for the security you’re providing.”

  “Don’t be grateful. Just let our security guys do their job. And make us the list of what might have been on that external hard drive. It’s possible we’ll spot something you’re missing.”

  16

  CASEY EDGED A look at Marc as he drove out of the Crest Haven gates.

  “Careful, navy SEAL. Your personal feelings are starting to show again.”

  Marc’s jaw tightened. “The question was a legitimate one, and had nothing to do with personal feelings. I was trying to find a common motive that would explain why the killer wants to get rid of both Madeline and Conrad.”

  “I get it. But you don’t usually ask questions with such passion.”

  “Stop looking for things that aren’t there, Casey. I’m just doing my job.”

  “Uh-huh.” Casey dropped the subject. She’d made her point.

  “You’ll set up a meeting with Doug Wilton?” she asked.

  “Yup. ASAP. Followed by Jacob Casper.” Marc frowned. “But when I talk with them, I’m going to concentrate on Conrad and Madeline, not just Ronald. I feel as if we’re forgetting who the intended victims are. Lexington is dead. He’s not a victim or a suspect. It’s a shame he died, but Conrad didn’t murder him. Nor did Madeline.”

  “I agree.” Casey pursed her lips. “So you think we’re getting off track?”

  “Unless the killers are the Lexingtons, yes. It’s been three months since Lexington’s death. Only his family could be so affected by his loss for their pain to fester and grow until it exploded into revenge against the people they hold responsible. Even then, Madeline’s guilt in the failed surgery is weak. Add up the pieces and the only people who fit the guilty bill are Nancy and her kids. And Ryan’s already all over that angle. So it’s time we spread our investigative wings and look elsewhere.”

  “You’re right,” Casey agreed. “And I plan to do exactly that with Janet Moss. Tomorrow’s lunch will be very interesting.”

  * * *

  The next morning at 10:00 a.m. Casey’s cell phone rang.

  Her heart sank when she saw Janet’s number. Dammit. The woman was probably canceling.

  “Hi, Janet. What’s up?” She could hear the bustling hum of the hospital in the background.

  “My schedule, that’s what’s up.” Janet sounded frazzled and upset. “I can’t get away at noon. I can take a one o’clock break, but probably only for forty-five minutes. I know this is a tacky thing to ask, but would you mind meeting me at the first-floor Au Bon Pain? I so don’t want to cancel, but unfortunately, convenience has to trump a good meal.”

  How much more perfect could it get? Access to Janet and the hospital staff all at once.

  “Of course I don’t mind,” Casey replied. “I’ll meet you outside the entrance at one.”

  “Oh, thank you.” Janet sounded as relieved as Casey felt. “I want to hear all about you and Forensic Instincts.”

  “And you will. I’ll see you at one.”

  * * *

  It was astonishing how “cafeterias” in hospitals had changed—at least this one, Casey noted, standing outside Au Bon Pain at 12:55 p.m. Gone was the old-fashioned institutional cafeteria. In its place was one of several small but modern, well-known eateries scattered throughout the hospital. Space-efficient and a lot more pleasing to the palette.

  Scanning the busy first floor, Casey was pleased to see that the people passing through the corridor were either arriving visitors or destination-oriented personnel. The restaurant followed suit: its patrons were mostly those who were grabbing a quick cup of coffee or a light meal to take with them.

  That meant that the little round tables and matching white chairs were almost completely empty. Casey suspected that the upper-level eateries had a lot more sit-down traffic, but this was the in-and-out level.

  Maybe that’s why Janet had picked it.

  At that moment, Janet appeared, weaving hurriedly between the passersby until she reached Casey’s side.

  “I got here the moment I could,” she said breathlessly.

  “I was early. You’re more than on time.” Casey extended her hand. “It’s good to see you again.”

  “I’m thrilled.” Janet’s handshake was firm and friendly. “I can’t thank you enough for taking the time to talk with me.” She gestured at the restaurant. “Let’s get our food. The farthest table on the right is empty and the longest distance from the corridor. We’ll have some privacy to talk.”

  “Great,” Casey replied. “You sound like you’ve done this before.”

  “For more private conversations, yes.” Janet smiled. “After twenty-six years of working here, I’d better have picked up a few tricks. Otherwise, I’d be a complete idiot.”

  The two women got their salads and coffee and sat down
at the table Janet had indicated.

  Casey glanced at her watch. Forty minutes to go. She’d spend fifteen of those minutes telling Janet the most exciting aspects of Forensic Instincts, and then shift the conversation where she wanted it—on Conrad, Madeline, Ronald and other hospital personnel.

  Janet pushed aside her salad, propped her elbows on the table and leaned forward.

  “So what’s it like running Forensic Instincts? Is it similar to what you see on Criminal Minds? You’re an expert in human behavior. That’s kind of like what they are on that show. It’s scary and riveting all at once.”

  Casey had heard that question a dozen times.

  “It’s a lot less Hollywood, but no less exciting,” she replied, giving Janet a mixture of the truth and the answer she wanted to hear. “We catch all kinds of criminals, from kidnappers, to money launderers, to rapists and murderers.”

  Janet’s eyes grew huge. “I read all about your last case. You were the target. How terrifying. What happened when—?”

  “Janet.” Casey held up her palm. There was no acting involved here. “I can’t talk about that case. It’s still too raw.”

  “I understand.” She nodded sagely. “Can you tell me about your team? How did you put it together?”

  That was a far easier question, one that Casey explained candidly. She was damned proud of the FI team, and tooting their horns was something she did without hesitation.

  She gave Janet a few more highlights, then took a bite of her salad.

  “I know you need to get back soon,” she said. “You must have a very significant job here.”

  Janet puffed up a bit. “I started at the bottom. Twenty-six years later, I run the administrative wing. All the staff members there report to me.”

  “Pretty impressive. I don’t know how you keep it all straight.”

  “I have an unbelievable memory. I remember everything, not only about my staff but about everything that goes on in this hospital. Of course, I was outclassed by Ronald.” She smiled fondly. “He had a photographic memory. There was nothing he couldn’t recall. It was sometimes frustrating as hell to work with him.”