The Chairmen

by Robert I. Katz

  “So called ‘academic time,’” Serkin had said, “is a dying vestige of an outmoded practice model. We have an outcomes database that follows nearly two-hundred parameters related to every case that we do, and I’m in the process of hiring research coordinators. If a physician gets an idea for a study, there is no reason why ancillary personnel who are paid far less than that physician cannot carry out the legwork. Meanwhile, the anesthesiologists will be paid to give anesthesia.”

  Right. Except that if you didn’t have academic time then you might as well be in private practice, and the real private practitioners were paid a lot more than the pseudo-academic worker bees that they were all rapidly turning into. If you had to work like you were in private practice, then you might as well get paid like you were in private practice, and obviously (to everyone except Stewart Serkin, anyway), the only way to do that was to blow this shithouse and actually go into private practice. So here they were, with a department vanishing by the week.

  Patel smiled. Patel had no worries. All he had to do was go where he was told and do the cases that he was assigned. Since being relieved of his position by Serkin, Patel’s life had become a lot simpler, and a lot easier. Patel, Hernandez suspected, was getting considerable enjoyment out of watching the department fall apart.

  “Take a deep breath,” Patel advised. “If you don’t have the bodies, then you don’t have the bodies. Nobody is going to blame you.”

  “Hah! They’re all going to blame me.”

  “Well, maybe.” Patel smiled. “I’ve got a case to start. See you later.”

  “Uh, Dr. Hernandez?” A tall man with brown hair and a short dark beard, wearing surgical scrubs, a blue surgical cap and a surgical mask hanging from his neck, held out a hand. “I’m Ben Abbott.”

  “Dr. Abbott.” They shook hands. “Welcome aboard.”

  Abbott gave a tentative smile. He was rotating in from St. Agnes. Today was his first day.

  “Have you listened to the online tutorial?” Hernandez asked.

  “Of course,” Abbott said.

  “Good.” Hernandez, Vinnie Steinberg and Casey Thompson, the Site Director at St. Agnes had each put twenty-minute podcasts online, which described the physical makeup of their respective OR’s and the placement of all the anesthesia equipment. The podcasts had been Steinberg’s idea, a very good idea, Hernandez thought. It was Steinberg’s misfortune to be working for a guy who was deeply suspicious of all good ideas that he did not think of himself. Steinberg, to Hernandez’ certain knowledge, was already thinking of taking his talents and abilities elsewhere. Hernandez would have been thinking the same thing, except that in the past three years, he had taken care of the COO, the Chairman of the Board of Trustees and the Dean’s wife. Hernandez was perhaps the only member of the Department of Anesthesiology who was at least relatively immune to their Chairman’s insanity.

  “Any questions?” Hernandez asked.

  “Nope,” Abbott said. “I’ve met my resident. I’ve put a note in on my first patient. I think I’m ok.”

  “All right. I’ll be here all day. Let me know if there’s anything you need.”

  “Thanks.” Dr. Abbott nodded. “Will do.”

  Hernandez walked off down the hall while Abbott rubbed his hands together and smiled.

  This, unfortunately, was a little more serious than casual harassment.

  Ordinarily, Lew Barent would have come along but a dead body had been discovered in an apartment in mid-town. It didn’t look like murder, more like the unfortunate deceased had suffered a heart attack…except that he had been dead for at least three days before the victim’s wife had thought to call it in. Lew had taken Arnie Figueroa, which left a pissed off Harry Moran to deal with Staunton’s little problem. “So how much damage did he actually do?”

  Moran, Kurtz, Jerry Hernandez and Patrick O’Brien were clustered together in Hernandez’ office, which opened onto a hallway off the main operating room suite. “Hard to say,” Hernandez said. “We’re still sorting it out. The anesthesia work room has been demolished. Three ultrasound machines have been smashed. They cost about 25,000 bucks. Four anesthesia machines have been vandalized. I’m not sure how much actual damage has been done to them yet but if they have to be replaced, they’re over 50,000 each.” Hernandez hesitated. “We’ve had to delay all the cases except the ones that were already underway. We’re not certain how many OR’s he might have gotten into or what he might have done that’s not obvious yet. Everything will have to be checked out.”

  “Any drugs missing?” O’Brien asked.

  “Oh, yeah.”

  Moran gave him a disgusted look. “How did that happen? I thought you were required to keep medications locked up.”

  “Jesus,” Hernandez said, and swiped a hand through his hair. “We keep track of the inventory in the PYXIS machines but a lot of stuff, like the volatile anesthetics, aren’t in the machines. They’re sitting on shelves in the work rooms. They’re not controlled substances. We have to be able to re-fill the vaporizers whenever they get low, which sometimes happens in the middle of a case, so all the rooms have a few bottles in the carts in every room. Nobody is going to notice if a couple of bottles go missing. As for the narcotics, the residents and nurse anesthetists are required to either lock them up in the lock box in each OR or keep them on their persons at all times. The guy asked his resident for the key. It seems he wanted to show him some new technique and he needed to draw up some meds. The resident gave him the key. Why wouldn’t he? The guy was supposed to be his supervising physician.

  “All the stuff that the resident signed out this morning is gone.”

  “What was it?”

  Hernandez sighed. “Two thousand micrograms of fentanyl, fifty milligrams of morphine, ten milligrams of midazolam and a thousand milligrams of ketamine.”

  Moran looked at him and shook his head. “Benjamin Abbott, MD,” he said.

  “Supposedly.”

  “And where is the real Dr. Benjamin Abbott? I’m assuming that there is a real Dr. Benjamin Abbott?”

  “Yeah,” Hernandez said. “There is. We don’t know. He’s divorced. He lives alone. He’s not answering his cell phone.”

  “And nobody here recognized that this guy was a phony because he was rotating in from another hospital and you had never seen him before.”

  “That’s correct.”

  “But he had a valid looking ID card and he seemed like he knew his way around an OR.”

  “Yeah,” Hernandez said.

  “I’ve sent some uniforms over to his house. They should check in shortly.”

  “Stick around,” Moran told Hernandez. “I may need you to translate.”

  A minute later, the resident, a bewildered looking kid named Kevin Kucera was sitting across the desk from Moran. Hernandez sat in a chair by Kucera’s side. Moran had given Kurtz and Patrick O’Brien sour looks but reluctantly allowed both of them to stay. They were standing against the wall next to the desk.

  “What happened?” Moran asked.

  Kucera shrugged. “He introduced himself as Dr. Abbott. We discussed the first case. He seemed to know what he was doing.”

  Moran briefly glanced at Hernandez. “In what way did he seem to know what he was doing?”

  “He knew the drugs that we use. He knew the dosages. He asked me if I wanted to intubate with a Mac blade, a Miller blade or a Glidescope.”

  Moran glanced again at Hernandez. “All reasonable options,” Hernandez said.

  “He asked you for the key to the narcotics box,” Moran said.

  “Yeah.”

  “Why?”

  “He said he wanted to show me a ketamine induction. I’ve never done that.”

  “It’s not the most usual induction but it’s not uncommon, either,” Hernandez said.

  “Why not?” Moran asked.

  “Ketamine lasts longer than propofol, the stuff we usually use, and it’s psychotropic. It can cause hallucinations.”

  “Why
use it at all, then?”

  “It has some advantages. It causes catecholamine release. It supports blood pressure and cardiac output. It has prolonged effects on pain modulation. If you use ketamine as part of the induction, they generally need less pain medication after the case.”

  Moran frowned. “Is this stuff that a pharmacy technician would be likely to know?”

  “Maybe, if he worked in the OR, and if he paid attention.”

  “So, you gave him the key,” Moran said to Kucera.

  “Yeah. Why wouldn’t I? He was supposed to be my attending.”

  “And then what?”

  “I went to the pre-op area and started the IV line on the patient and then I came back to the OR to see if the nurses were ready for us to bring the patient back.”

  “Did you notice anything unusual in the OR?”

  “Unusual how?”

  “Anything broken, misplaced, stolen…?”

  Kucera shook his head. “Not that I noticed.”

  “And where was Dr. Abbott?”

  “I don’t know. I never saw him again.”

  Moran frowned at Hernandez, who was sitting with his hands folded, looking morose.

  “And when did you notice that the narcotics were missing?”

  “People started yelling out in the hallway. Stuff was smashed up. Dr. Hernandez came in a few minutes later with a master key and checked the narc box.”

  “I checked all the narc boxes in all the OR’s,” Hernandez said. “This was the only room where anything was missing.”

  “Take a look at this,” Moran said. “Tell me if you recognize this guy.” He handed Kucera a copy of the photograph from James McDonald’s ID card.

  Kucera looked at it closely, frowning. “It could be him. Dr. Abbott had a beard. This guy doesn’t.”

  Hernandez nodded. He had said the same thing when shown the same picture.

  Moran looked at Kurtz and Patrick O’Brien. “You guys got anything to add?”

  “Nope,” Kurtz said. Patrick shook his head.

  “Okay,” Moran said to Kucera. “Thanks.” Kucera rose to his feet and walked out, looking relieved.

  Moran’s cell phone went off. He glanced at Kurtz and Patrick O’Brien. “Let’s hope,” he said. He picked up the phone. “Moran,” he said. He listened, then nodded. “I understand. Get him to the hospital and get his statement.”

  Moran sighed, then looked at Hernandez, Patrick and Kurtz. “Dr. Abbott was found, barely conscious, on his living room couch. As he left the house this morning, somebody knocked him over the head, dragged him back inside and tied him up.”

  “So now what?” Kurtz asked.

  Patrick O’Brien had already established that James McDonald had not shown up for work that day. “Now, I think we have enough for a search warrant,” Moran said. “Play time’s over.”

  “Amen to that,” Kurtz said.

  Chapter 25

  The victim had indeed died of a heart attack, not unusual in an eighty-year old with a history of coronary artery disease. The victim’s wife hadn’t called it in because she was suffering from advanced Alzheimer’s disease and hadn’t realized her husband of fifty-seven years was dead.

  Barent took the wife’s addled statement, sent the deceased to the morgue and made his way back to the station.

  Two hours later, Barent and Harry Moran, armed with a newly issued warrant and accompanied by Kurtz, Patrick O’Brien and three uniformed police officers, knocked on the door of James McDonald’s apartment. There was no answer. Moran waited a moment, and then knocked again. Still nothing. He turned to the Superintendent, a small, middle-aged Hispanic man in blue coveralls. “Open it up,” he said.

  The Superintendent selected a key from a key ring and slid it into the lock. The door silently opened. Barent, Moran and the three officers pulled their guns and entered. Patrick O’Brien and Richard Kurtz waited in the hall outside. Moran had grudgingly allowed them to come along, on condition that they stay out of the way. Both had agreed.

  A male figure sat on the couch, only the head visible from behind. Silently, Moran extended his arm. “This is the police,” Moran said. “There is a gun pointed at your head. Don’t make any sudden moves and put your hands up where we can see them.”

  The man did not respond. His head remained still. Slowly, carefully, one of the uniforms moved around the couch. A surprised look crossed his face. He grinned. “You might as well put the gun down. This guy isn’t dangerous.” Moran looked at him, shrugged and holstered his weapon. He moved around the couch. Facing him sat a crudely fashioned scarecrow with a bloody mask covering its face, a knife in its chest and a bottle of Scotch cradled in the crook of its left arm. The scarecrow’s extended right hand held a folded piece of paper. Moran reached out, took the paper and unfolded it. In light green crayon, it read:

  Wondering what I’ll do next? Keep on wondering. You’ll never see me coming.

  The apartment was bland, Kurtz thought, the furniture functional, modern and a monotone gray. Three bottles of expensive Scotch and two bottles of brandy sat on a sideboard next to a wooden dining room table. There were no pictures on the shelves, no artwork on the walls.

  One of the two bedrooms was set up as an office, with a gray filing cabinet and a gray metal desk with a ThinkPad on top of it. “Don’t touch anything,” Barent said. He and Moran pulled on rubber gloves, then opened drawers. In the first drawer of the desk, Barent found a large box of crayons, most of them barely used, a box of envelopes and a sheaf of blank, white paper, plus two sheets of paper with writing on them. One read:

  We reap what we sow. They that sow the wind shall reap the whirlwind

  The other said simply:

  Soon.

  In the second drawer of the filing cabinet, Moran found two University Hospital ID cards, one with the name Richard Lester, MD, the second with the name Benjamin Abbott, MD. Both cards had a picture of James McDonald in the upper left corner. Beneath the cards lay a box of stamps and a photograph of a young man, smiling, with his arm around Lydia Cho, who was looking straight into the camera with a serious expression on her face. The man bore a marked resemblance to James McDonald. Lydia Cho, Kurtz noted, did not look happy.

  In addition to the desk and the filing cabinet, a tall, black safe stood in the corner of the room. It had a keypad with a digital lock. Moran, Patrick O’Brien and Kurtz glumly stared at it. No way to figure out the combination. It looked like a gun safe.

  “If we open it up and it’s empty,” Kurtz said, “he may have taken a gun with him, and if it’s not empty, he still may have taken a gun with him.”

  Moran briefly raised his eyes to the heavens and gave an almost inaudible sigh. “This is true,” he said.

  “Or more than one,” Patrick O’Brien said.

  “The techs will go through the place and let us know what they’ve found. Hopefully, they can break the encryption on the computer.” Moran cracked a slight smile. “Maybe we’ll learn something.”

  The NYPD’s computer tech was a tall, thin guy with sharp gray eyes named Rich Styles. It took him about ten minutes to get into James McDonald’s computer. “No encryption at all,” Styles said. He sounded offended, as if any self-respecting criminal should have had more security on his computer. “Once I got through the password, it was wide open. Piece of cake.” Styles raised his brows, blew a bubble on the wad of gum that he kept in his right cheek, and gestured at the computer. “It’s all yours,” he said.

  In the end, the computer contained a remarkable trove of downloaded pornography, plus various environmental screeds and declarations. Nothing overtly criminal, though, and no hint as to where James McDonald might have gone, where he might be hiding or what he might be planning next.

  “Now,” Harry Moran said. “We wait.”

  An all-points bulletin was issued. Word was put out on the street that a small reward for usable information would be forthcoming. A license to possess a handgun had never been issued to James McDonald but
a rifle did not require registration. The gun safe proved to be empty, which might mean nothing but at least gave them cause to worry. The suspect was assumed to be armed and dangerous.

  Three hours later, a uniform came into Lew Barent’s office and said, “Call for you. Line 3.”

  Barent gave the phone a suspicious look, then picked it up and flicked it to speaker. “Barent,” he said.

  “Barent? This is Lieutenant Darren Gibson, 24th Precinct. I thought you would like to know that a couple of concerned local citizens have informed us that somebody meeting the description of your suspect has pitched a tent in the vicinity of the Blockhouse.”

  Barent raised an eyebrow and gave the phone a benign smile. “We in law enforcement always appreciate the concern of local citizens, but aside from a general sense of civic obligation, might anything else have been motivating these concerned citizens?”

  “They were reluctant to say. I gather that some members of their organization approached the gentleman in question and were not satisfied with the results of their enquiry.”

  Barent nodded his head. “Well, we shall definitely look into it. Please give your local citizens our thanks.”

  Gibson chuckled. “I’ll do that.”

  Barent clicked off the phone, sat back and pondered. The Blockhouse was built as one of a series of fortifications intended to protect New York from the British during the War of 1812. A picturesque but largely abandoned ruin, it sits today in the Northwest corner of Central Park, on a high, rarely traversed wooded ridge. In 1905, a bronze plaque commemorating its history was placed above the door. Within a few years, the plaque vanished, presumably stolen. In 1999, the plaque was replaced and within a few more years, this second plaque, too, went missing. People wandering through the Northwest section of Central Park were advised to travel in groups and never go there at night. It was an excellent hiding place, however, for somebody with outdoor skills who did not wish to be found. Barent thought about this for a moment, then shrugged and picked up the phone to call Harry Moran, Richard Kurtz and Patrick O’Brien.