“Anyway,” Kurtz said. “Steve Ryan is one of those guys who looks good and sounds good but who’s spent his whole career faking it. He means well but he doesn’t know an ileum from an appendix. I just don’t get it. How did he ever finish a residency?”
“Is he dyslexic?”
Kurtz spooned some dal and basmati rice onto his plate, paused for a moment, then added some raita and a little onion chutney. “That’s a thought. Dyslexics have trouble telling left from right. The letters all look the same, supposedly, like meaningless squiggles. Would being dyslexic make somebody a lousy surgeon?” He shrugged. “I don’t know. It’s an interesting theory.”
“How is the cop doing? Arnie Figueroa?”
“He’s still alive. Will he wake up? Will his brain still be there? They’re stopping the barbiturates tomorrow. We’ll soon know.”
Chapter 3
Juan Moreno had grown up in Cartagena at the height of the drug wars and had killed his first man at the age of eleven. He had been given a knife and a .22 caliber pistol and told to enter the victim’s house, shoot him in the abdomen, tie him down and then cut off both of his hands. He had been ordered to leave one hand at the scene and bring the other hand back to the gang’s headquarters, as proof that he had carried out his mission. He had waited until the man’s wife was out shopping and then had done as he was told.
Juan Moreno was small, even for an eleven-year-old, but he was smart. He knew that, contrary to what is shown in the movies, a man shot in the abdomen does not immediately collapse, roll over and die—not unless he is shot with a bullet large enough to tear open a very large hole. No, a man shot in the abdomen will most likely bleed to death but he will bleed to death slowly. In the meantime, he can run and he can fight, and he can probably live long enough to strangle an eleven year old kid who has the audacity to shoot him in the abdomen.
Of course, Juan Moreno could have shot him in the chest; a bullet in the chest will generally kill the victim much more quickly than a bullet in the abdomen, but that was at least part of the point. Juan Moreno’s putative victim was meant to be an object lesson. They didn’t want him to die quickly. They wanted him to die slowly. Without his hands.
The victim was named Hector Montillo. He was the owner of a small shop who had very stupidly refused to pay protection money. Unlike most such small business owners, Hector Montillo thought he was immune because his cousin was the Chief of the local police.
So, Juan Moreno, being a smart little eleven-year-old, waited, holding the pistol behind his back, until Hector Montillo opened the door and then Juan Moreno shot him in both knees before shooting him twice in the abdomen. Hector Montillo collapsed, screaming.
Ignoring the screams, Juan Moreno walked past the victim into the foyer. There, he found a large ceramic vase standing next to the doorway. The vase, he thought, should do nicely. He picked it up and smacked Hector Montillo in the head with it, which rendered him momentarily unconscious, then Juan Moreno dragged Hector Montillo inside, shut the door and tied his victim up. He waited for Hector Montillo to regain consciousness before he used the knife (it was a very large knife, more of a machete than a knife) to chop off both his hands. Then, as instructed, he took one of the hands and left.
That was many years ago, but Juan Moreno thought often of that day and of that victim, the first of many. In a way, Juan Moreno was grateful to Hector Montillo, grateful for the sacrifice (as Juan Moreno thought of it) that Hector Montillo had made, the sacrifice that had proved to be the making of Juan Moreno, propelling him upward on his subsequent criminal career. Aware and grateful even then that something special had been accomplished, Juan Moreno had dressed in his finest shorts, tee shirt and sneakers and gone to Hector Montillo’s funeral.
“You know what to do?” the Russian said, in English. The Russian did not speak Spanish and Juan Moreno did not speak Russian.
Juan Moreno noted that both Russians had bandages where the little finger of their left hand used to be. Juan Moreno blinked at him. “Eh?” he said. “Porqué?”
The Russian frowned. “Your instructions. You know what to do?”
Juan Moreno allowed a bewildered expression to pass across his face. “Si,” he said doubtfully. “Instructiones. Si.”
The Russian drew a deep breath. He seemed annoyed. He tapped his foot against the carpet in front of Juan Moreno’s desk and glanced at the second Russian, who stood by his side without speaking. Juan Moreno smiled at the first Russian, his expression suddenly no longer bewildered. The Russian’s face went blank. His foot stopped tapping.
“Yesss…” Juan Moreno hissed in unaccented English. “I do know what to do. Tell your boss that his request will be carried out. Now get out of here.”
The Russian said not another word. Both of them turned and walked out.
Russians, Juan Moreno reflected, liked to give orders. Despite their ultimately disastrous seventy-year flirtation with Communism, the secular religion of the common man, Russians had this unconscious assumption that they, their culture and their society were superior to those of all other races and people, and that this superiority gave them the right to tell all others what to do. It was a delusion most common among the young and the dumb ones. These two, he thought, were particularly dumb. Inwardly, he shrugged. Dumb Russians were not his problem.
Still, doing their boss this little favor cost him very little, and it put the Russians in his debt. It was always useful, Juan Moreno reflected, for other people to owe him favors. One never knew when a favor could come in handy.
Lew Barent had just finished eating his dinner when the phone rang. He sighed and stared at it for a moment, then shook his head and picked it up. His wife, Betty, gave him a sad smile but said not a word. Betty had been a cop’s wife for many years. She knew the score.
“Dead body reported in Apartment 3B, 1437 McCallister Street. The scene has been secured,” the dispatcher said.
“Right,” Barent said. “Has Detective Moran been notified?”
“Detective Moran is on his way.”
Forty minutes later, Barent pulled his car up to the yellow barrier and parked. A uniform came over, disapproval plain on his face. His expression smoothed out when he recognized Barent. Silently, the uniform moved the sawhorse to the side and Barent stepped through.
The building was old but immaculate, small by modern standards, four floors, each floor divided into four large apartments. A small tiled lobby led to an elevator and a set of stairs. Two security cameras were suspended near the ceiling. He took the elevator up to the top floor, which opened up into another small lobby with two stout, wooden doors. One door, to the side of the elevator, led into the stairwell. The second, directly across from the elevator, opened into Apartment 3B. Two uniformed cops stood flanking the apartment door. Both nodded at Barent. The one on the left frowned and puffed up his cheeks.
Harry Moran was already inside. He grinned crookedly as Barent walked into the spacious living room, waited while Barent inspected the scene.
Cause of death was obvious: a slit throat. A lot of blood, Barent noted. None of the furniture appeared to have been disturbed. The victim was male, white and middle-aged, dressed in a business suit. Two expensive looking leather couches surrounded an oak coffee table, facing a large screen TV mounted on the wall. The victim was sitting on one of the couches, his legs crossed in front of him, his expression vacant. An open bottle of wine and two glasses sat on the coffee table. A brown leather briefcase lay on its side on a granite counter that demarcated the living room from the kitchen. The crime scene guys were carefully covering the room, taking photos and in some cases, samples of blood, dust and microscopic debris.
“What do we know?” Barent asked.
“His name is Mitchell Price, a stockbroker. He’s divorced and currently lives alone. One ex-wife and three grown children, none of them in New York.”
“Who called it in?”
Moran hesitated. “Anonymous. Female.”
�
�Good old anonymous.”
Moran nodded.
“ME already gone?”
“Ten minutes ago.”
“He have anything to say, aside from the obvious?”
Moran shrugged. “I’m not sure what you consider obvious, aside from the slit throat.”
“No signs of a struggle, that’s obvious.”
“The ME did note that the victim seemed to expire rather more peacefully than would have been expected. Most people try to fight back when somebody is slitting their throat.”
“Any sign of the knife?”
“No. Presumably, our perpetrator took it with him.” Moran shrugged. “Or her.”
“The bottle of wine should prove interesting,” Barent said.
“I expect so,” Moran said. He mirthlessly grinned. “Also, the second wineglass. Hopefully we’ll get some prints, or even DNA.”
As Kurtz expected, the morbidly obese lady, whose name was Mrs. Lydia James, was not doing well. As a mere assistant on the case, Kurtz had no specific responsibilities for her ongoing care, but of course, he had an interest. Steve Ryan, Kurtz noted, seemed depressed. And why not? He had missed the principal diagnosis and had mishandled the operation. By the time Kurtz had arrived to help out, the damage had already been done.
Grand rounds on Friday morning, which doubled as the joint Staunton/Easton Quality Assurance Conference, proved interesting. Surgeons, Kurtz had often noted, were an unforgiving bunch, trained to regard themselves as both responsible for everything around them and in-charge at all times, each the Captain of his ship. With great power comes great responsibility, Kurtz thought. Not necessarily a realistic way of looking at things, but that’s the way it was. Their judgments tended to be harsh.
In the old days, and those days were not so very long ago, it was just casually assumed that whenever something went wrong, it was because somebody had fucked up. The more modern way of thinking maintained that an adverse outcome was more likely to be the result of a “system error,” this theory holding that almost all of the people, almost all of the time, were doing exactly what they were supposed to be doing and if something went wrong, it was because the system was poorly designed. Surgeons had been slower to adopt this attitude than most, and in times of trouble, tended to revert to type.
It was just so much easier to find somebody to blame, to point out the numerous ways in which the offending practitioner had screwed up, maybe give some poor resident or a junior attending a symbolic ten lashes or so, and in really bad cases, even fire the offending practitioner and then assume that the problem had been fixed.
In this case, however, Steve Ryan really had screwed up. Sometimes, it happened.
Quality Assurance proceedings, for some idiotic reason, were treated differently in New York than in any other state, where QA deliberations were confidential and could not be used in a court of law (unless a lawyer tried to introduce such deliberations and some self-important judge decreed that the outcome in this case was so heinous that, by God, he would allow it…in which event, he would probably—though not certainly—be reversed on appeal). Confidentiality in such proceedings was a concession to the generally recognized need to honestly evaluate an adverse outcome and then hopefully change things for the better. In New York, however, QA proceedings were confidential with the singular exception that any statements made by the principals in the case were discoverable. Anything that anybody else might have to say, remained confidential. Steve Ryan, therefore, plus Kurtz, plus any resident, any nurse and anybody else who might have had anything at all to do with the case and might therefore be subject to a future professional liability suit, were strongly advised to keep their mouths shut.
This did not prevent anybody else in the audience from crucifying poor Steve Ryan.
A senior resident, in this case Drew Johnson, presented the case. He outlined the lab results, the physical findings and the preliminary diagnosis, the first slides snapping from one to the next in the darkened auditorium. At this point, he paused. “Any questions?”
A few of the audience turned and surveyed Steve Ryan, sitting near the back. None of them said a word. Steve Ryan hunched down in his seat and did his best to turn invisible.
“No?” Drew Johnson smiled. “Let me go on.”
Things got a bit testy as Drew Johnson described the surgery itself. The first question came from Elias Levin, an old timer who fancied himself a hernia specialist. “Why did you make a vertical incision?”
Drew Johnson smiled the happy smile of a man who had no axe to grind, no stake in the outcome and was not, despite superficial appearances, anywhere in the line of fire. “I didn’t do the case,” he reminded the audience.
Amazing, Kurtz thought. They went through this every week, and every week, the audience seemed to have trouble with the concept that the guy presenting the case was not the guy who did the case. Probably instinct, Kurtz thought. As it did with most predators, the scent of blood drove surgeons into a frenzy.
Elias Levin frowned. “Why was a vertical incision made? It should have been a transverse incision below the umbilicus.”
“I believe that in this case, the volume of excess adipose was believed to require a vertical incision, as well. The plan was to use both a vertical incision and a transverse incision.”
Elias Levin shook his head. He looked grim.
Walter Stockton, a wizened, crotchety little guy who should have retired ten years ago, called out, “What was your first clue that you were dealing with a hernia instead of a pannus?”
Drew Johnson smiled again. “I believe that the surgeon’s first clue was when the first loop of bowel popped out of the wound.”
Drew Johnson was being diplomatic, or maybe he just didn’t know what had actually happened. The real first clue had come when Steve Ryan’s scalpel opened a three-centimeter incision in the small intestine (leaking the contaminated remains of the patient’s last meal into the abdomen), which was looping in and out of about a hundred pounds of fat.
And so it went, on and on and on, and as the hour dragged to its exhausted, merciless close, Steve Ryan slumped lower and lower in his chair.
Poor fucker, Kurtz thought. Not as poor as the poor patient, of course, but still…Steve Ryan was trapped in a job that he had no talent for. He wasn’t a bad guy. He didn’t want to fuck up. He tried not to, but it didn’t matter. As a surgeon, Steve Ryan was, and would remain, a fuck-up.
Poor fucker, Kurtz thought again.
Chapter 4
The second wineglass yielded neither fingerprints nor DNA, nor did the bottle, nor did any polished surface anywhere in the apartment. The bottle of wine and the glasses had been washed out with water and detergent and then placed back on the coffee table, almost as if they were staged. Too much to say that the perp was a professional, but he or she (okay, probably she) certainly knew enough about crime scene analysis to remove any trace of her presence.
The traces of wine left in the bottle did yield a clue, however.
“Alpha-methylfentanyl,” Moran said.
Barent, sitting at his desk and eating a ham and Swiss, blinked at him. “Really?”
“Take a look.” He placed a sheet of paper down on Barent’s desk, then sat in the opposite chair.
“Oh, crap,” Barent muttered as he scanned the report. The tox screens employed by law enforcement covered a much larger number of illicit substances than the screens routinely used in an ER. Some traces of Naproxen, probably non-prescription, a little Viagra, some Minoxidil, probably for hair loss since the guy had no history of high blood pressure and at the age of fifty-three, he didn’t have much left on top, and there it was, alpha-methylfentanyl, flagged in red on the report.
Fentanyl was a synthetic opioid originally developed by the Jannsen Corporation and widely used as an adjunct to anesthesia since the early 1970’s. It was a hundred times more potent than morphine and fifty times more potent than heroin. It had a faster onset of action and a shorter duration than either drug
. Unfortunately, it caused a similar high, was easy to make and was much cheaper. A kilo of the stuff, legitimately purchased, cost about ten thousand bucks and had a street value of over twenty million.
Fentanyl was rarely used on its own, however, since its potency made it difficult to judge the dosage. Drug dealers depend on the needs and desires of their clients to make money. Not much money to be made when your clients all stop breathing. It had become common, therefore, to cut heroin with just a bit of fentanyl.
Alpha-methylfentanyl was even worse, being considerably more potent and longer lasting than its parent drug. Most of it came from China, hence the street name: “China White.”
“We haven’t seen any of this stuff around,” Barent said. “Not lately.”
“Thank God,” Moran said.
“Why this guy? Where did he get it?”
Moran shrugged. “You mean who slipped it into his wine glass?”
Barent frowned. “Yeah. That, too.”
The questioning of the buildings’ other occupants had revealed nothing. Not surprising, since there were only four apartments on each floor and each column of apartments above the ground floor had its own semi-private elevator, four elevators in total. The walls were thick and effectively sound-proof. Nobody in the building had more than a superficial acquaintance with their neighbors.
The ex-wife had remarried, lived in Oregon and expressed regret, but by the tone of her voice, couldn’t have cared less. The three children spoke to their father every few weeks or so but hadn’t seen him in months. One of them, the oldest daughter, said, “I think he had a new girlfriend.”
“Do you have a name,” Barent had asked.
“No. He never mentioned it.”
“Can you tell me anything about her?”
“I wish I could, but he liked to keep his love life private.” The daughter’s voice seemed to hesitate over the phone. “This wasn’t the first. He liked them young.”
Brighton Beach: A Kurtz and Barent Mystery (Kurtz and Barent Mysteries Book 5) Page 3
