Death by Request (Book #11 in the Caribbean Murder series)

by Jaden Skye

  “We also have to keep the patient from hurting themselves,” Dr. Padden continued. “They can become restless, thrash around and even pull on tubes or dressings. Wrist restraints may be put on or medicine given to calm them down. Sometimes side rails on the bed have to be up to prevent the patient from falling.”

  “Did that happen to Tara?” asked Mattheus horrified, “was she restless, did she toss around, pull on her tubes?”

  “Once or twice she did, as I recall,” said Dr. Padden.

  “Was she trying to tell you something by behaving that way?” Mattheus couldn’t help ask.

  Dr. Padden shook his head strongly. “Absolutely not,” he insisted. “A tremendous danger in working with comatose patients is assuming their behavior means something. It doesn’t. These are reflex behaviors made in response to bodily discomfort. The unconscious part of the brain does what it does, but it’s beyond the patient’s control.”

  “I see,” said Mattheus.

  “I’m glad you do,” replied Dr. Padden. “So many interpret every little move or grimace the patient makes. It’s common for the family to claim that the patient is trying to communicate with them, or that they’re about to wake up. It’s very difficult to disabuse them of that idea, too.”

  “I’m sure it is,” said Mattheus, “I can see how hard it must be sitting there, waiting.”

  “Excruciating,” Dr. Padden agreed, “and often the patient looks as though they’re about to return. And, of course, some do. When that happens they come back little by little.”

  “What were Tara’s chances of returning?” Mattheus asked bluntly then.

  “It’s hard to say what her chances were,” Dr. Padden began tapping his fingers on his legs.” Some come out, some progress to a vegetative state and others die. Some recover a life, others do not. Some go on to regain a degree of awareness, others remain in a vegetative state for years or even decades. The longest case recorded or remaining in a vegetative state was forty two years.”

  “Oh God,” said Mattheus, “forty two years of living in a fog.”

  “Some people in deep coma recover well while others in a so-called milder coma sometimes fail to improve. Some people come out fine, others with with significant impairments. Only time shows us what will happen,” said Dr. Padden.

  “This is a tough situation,” said Mattheus, “a hard call what to do.”

  “Nothing to do but wait,” Dr. Padden commented. “Patience is the best medicine here.”

  Mattheus was startled to realize that it was in the realm of possibility that Tara could have lived. “You were all hoping that Tara would regain full awareness weren’t you?” he asked.

  “Of course we were,” said Dr. Padden. “Everyone always hopes that. And it can be subtle. In the first days, patients may awake only for a few minutes, then the length of time awake gradually increases. A person with a low predicted chance of recovery may still awaken and do well. I tell that to the families, but they don’t listen.”

  “I can understand why not,” said Mattheus.

  “So can I,” said Dr. Padden.

  Mattheus felt momentarily shaken. Who could bear living with the unknown? He understood why people wanted probabilities, something to hold onto.

  “According to statistics, what were Tara’s chances?” Mattheus asked.

  “Tara was in a coma for two months. The chance of full recovery was very low, but still possible,” Dr. Padden replied.

  “But she wasn’t about to die, either,” said Mattheus. He had to focus on the immediate cause of her passing.

  “There was immediate reason to assume that,” said Dr. Padden. “Patients die in comas due to infection, difficulty breathing, pneumonia, etc. Tara was healthy.”

  “No sign of brain death, either?” Mattheus wanted total certainty.

  Dr. Padden seemed irritated by the question. “Many place a great deal of importance on the idea of “brain death” because most people equate brain death with death of the individual. But according to some researchers, death is characterized by irreversible cessation of all vital functions, circulation, respiration, and consciousness. For example, although a patient may be “brain dead”, they may still be considered alive because they can still grow and even reproduce.”

  Mattheus was stunned by his response. “So you considered Tara fully alive?” he asked.

  “Yes, of course she was,” said Dr. Padden startled, “no question about it.”

  “There was a possibility Tara could have returned and lived a useful life?” Mattheus tried to absorb this strange fact.

  “Who is to say whether a life is useful or not?” Dr. Padden was offended by the question. “That is not a judgment I would make, nor should anybody. Who is to say how long a person deserves to remain alive? Who is so wise to decide their moment of death? Still, some family members feel differently. They don’t want to risk having their loved permanently disabled. Some feel tremendously relieved when the patient passes away. Some actively ask the staff to help the person die.”

  “That’s illegal in Jamaica, isn’t it?” asked Mattheus, looking at Dr. Padden carefully.

  “Yes, euthanasia is illegal here,” Dr. Padden said, “we are not able to respect requests of that kind.”

  “It must happen anyway, though,” said Mattheus, confidentially. “Doesn’t it?”

  “I have nothing to say about that,” Dr. Padden said, professionally. “If it happens, I know nothing of it.”

  “But when the toxicology results come back, like they did with Tara, it’s clear when someone intervenes,” Mattheus insisted.

  “Yes, in Tara’s case, it was clear,” Dr. Padden commented. “Many families don’t request toxicology reports or autopsies though.”

  Mattheus bolted up straight. “Who requested them for Tara?”

  “I believe her brother, Hank, insisted,” Dr. Padden said, startling Mattheus.

  “Her brother suspected foul play?” Mattheus asked.

  A strange look came over Dr. Padden’s face. “Her brother suspected that someone intervened in Tara’s passing,” he replied methodically.

  “Who did it? Who?” asked Mattheus, suddenly agitated.

  “That question is not within my domain,” Dr. Padden remarked, “I look to you for that answer.”

  “Help me out, give me some suggestions,” Mattheus wouldn’t back away.

  “I can’t say who, but I will say one thing,” Dr. Padden relented, “there was a great deal of pressure on the hospital for this case to end.”

  “Pressure on the hospital to let Tara die?” Mattheus was horrified.

  “All kinds of voices were raised in the matter,” Dr. Padden replied, edgy. “Some insisted it was cruel to keep the patient alive. Actually, there was nothing cruel about it. Tara was in absolutely no pain. The ones who suffered most were the family who kept waiting for her to return.”

  “What other voices were raised?” asked Mattheus?

  “The paparazzi started camping out at our doors in increasing numbers every day,” Dr. Padden said frankly. “Hospital officials, patients and visitors found them invasive, intrusive and disturbing, to say the least.”

  “I can only imagine,” said Mattheus. “What other voices were raised?”

  “One newspaper article went so far as to suggest that Tara remained in a coma due to medical incompetency and error. They called for the hospital to be investigated,” said Dr. Padden nervously.

  That was the first Mattheus heard of that.

  “Of course Konrad, our hospital administrator, knew how to get around that claim. Up to now, anyway,” Dr. Padden continued.

  “What’s changing now?” asked Mattheus.

  “The pressure’s increasing since Tara passed away,” he said. “Many are convinced her husband is innocent. Owen himself has started a letter writing campaign. He’s in touch with Senators, reporters, you name it.”

  “Unusual behavior for a grieving husband,” Mattheus commented.

 
“People grieve in all kinds of ways,” Dr. Padden replied.

  “Are the press blaming the staff who cared for Tara, are they blaming you?” Mattheus could not hold back.

  “There’s no question of blaming me at all!” Dr Padden’s face flushed. “If you check, you’ll see that I have an impeccable record. I, personally, have not made even one of the normal medical errors that naturally plague others.”

  “Plague who?” asked Mattheus.

  “All hospitals and physicians are subject to medical error,” Dr Padden suddenly became harsh. “That’s why we’re burdened with such huge malpractice insurance costs.”

  “Yes, of course,” said Mattheus, suddenly wondering about the medical mistakes that went on at this hospital. This was something he definitely had to check out quickly. “I’m sure you’ve done a wonderful job, Dr. Padden” Mattheus turned to him warmly then and changed his tone. “And you’ve been incredibly helpful. I appreciate your time, I appreciate your expertise.”

  Dr Padden stood up pleased. “I want this case solved as badly as you do,” he said definitively. “If there’s anything further you need to know, please do not hesitate to call. Or, why not come to the Jamaica Jazz Festival, in two days. The hospital has seats reserved for the Board of Directors, top doctors and hospital administrators. Most importantly, Konrad will be there. You’ll have time to talk to everyone. You never know when or how a new piece of information will come out.”

  “That’s right, you never know,” said Mattheus, pleased with the invitation. “I’d love to come.”

  “Good,” said Dr. Padden. “In my view, it’s especially important for you to talk to Konrad. He usually gives the press a few headlines and dashes away. Wouldn’t hurt for you to pin him down.”

  “Is Konrad keeping something from us?” Mattheus asked directly,

  “It’s certainly possible,” Dr. Padden replied non-commitally, “he always has a thousand things up his sleeve. Why should it be any different now?”

  Chapter 12

  While Mattheus was interviewing Dr. Padden Cindy could only think of one thing, getting in touch with Alana and speaking to her immediately. Cindy called the number she had for Alana and let the phone ring and ring. No answer. There was no way to leave a message either. Alana’s in hiding, Cindy realized. There was no choice then but to go to Alana’s home directly and see if Cindy could surprise her there. Alana lived south of the hospital, just barely commuting distance. It shouldn’t take too long to get there.

  Cindy quickly got ready to leave. The taxi she took wove round and round, across circular roads, along pools of water and through old streets dotted with small homes crammed close to one another. Cindy wondered why Alana would be living in this kind of neighborhood. Todd had described her as a beautiful, charming, compelling woman. Something didn’t add up.

  Cindy had the taxi stop a few blocks away from Alana’s place. She didn’t want to create a stir riding up to her home in a taxi. It would be better to walk there simply under the shade of the trees. The more Cindy walked, the more unsavory the area seemed. The streets were dark and narrow, with little sun coming through. What if Alana wasn’t home now? What if she’d left town? It made sense that Alana might skip out if she was in trouble.

  Cindy found the address to the house easily. It was like all the others, small, a bit wobbly and made of old wood. Cindy walked to the front entrance, stood there a moment and rang the bell. To her delight, she quickly heard footsteps coming to the door. Then someone flung it open.

  “Come in, Blair,” a throaty voice responded. Obviously, the person at home was expecting someone else.

  Cindy stepped inside nevertheless. The room had low ceilings, small windows and smelled of old wine. A young woman stood there, her back turned to Cindy.

  “Excuse me,” said Cindy, as a young, beautiful Jamaica woman suddenly flung herself around and stared.

  “What’s going on?” the young woman burst out. She wore a thin, cotton dress and had wild hair that was uncombed. Cindy wondered if she were slightly drunk. “Who are you?” the young woman demanded, totally taken aback. “What are you doing here?”

  “Alana?” asked Cindy, responding to her immediately.

  “Yeah, I’m Alana, who are you?” Alana zeroed in to get a better look at Cindy.

  “I’m Cindy Blaine of C and M investigations,” Cindy answered in a forthright manner. There was such a sense of disarray about this young woman that this was certainly no time for playing games.

  “Investigations?” Alana’s voice rose a notch. “Who are you investigating, me?”

  “No, not you,” Cindy tried to soothe her. “I’m investigating Tara’s death.”

  “What’s there to investigate? She’s gone,” Alana shrugged.

  “I’m trying to find out if Tara’s husband Owen was involved,” Cindy replied quickly. “He’s being held for the crime.”

  “Yeah, I heard that,” Alana quieted down. “That’s a shame, isn’t it?”

  “A terrible shame,” Cindy responded, “everything about the case is.”

  “What’s a shame, the accident or the coma?” Alana’s eyes narrowed and she actually seemed interested in what Cindy had to say.

  “I mean it’s a shame for everyone involved in the case,” Cindy answered slowly. “It has to have taken a terrible toll.”

  “You can say that again,” Alana began to relax. “And Tara was a good person, too.”

  That remark surprised Cindy. “Why would you say that? You never got to know her really,” Cindy replied.

  Alana took exception to that. She stood up taller, pushed her hair off her face and walked around the room with a sudden grace and agility, almost looking like a beautiful, wild bird.

  “People think you don’t know a person if you don’t talk to them, or do things together,” Alana was edgy. “But none of that is true. When you’re with someone every day, when you take care of them, wash their body, move them in the bed, you feel who they are, believe me. Words can just get in the way sometimes, cover up the truth. Ever notice that?”

  “I have,” said Cindy, touched by Alana’s response. She could feel Alana’s love for Tara. Alana was nothing at all like Cindy had expected. Nothing about this case was. None of it fit.

  “You sound like a wonderful nurse,” Cindy commented.

  Despite herself Alana smiled. “Not better than anyone else,” she murmured.

  “But you love what you do,” Cindy persisted.

  “Sure, I love what I do, or I wouldn’t do it,” Alana answered heartily. “The patients feel it too when you don’t care about them.”

  Cindy never thought of it that way.

  “You look like someone who loves what she does too,” Alana perked up. “Look how you tracked me down right to my house.”

  It was a smart observation and Cindy felt good about it. “I do love what I do,” Cindy admitted, glad someone understood.

  “Well, it’s not often you meet someone who cares,” Alana smiled, unwinding. “How in hell did you find me here?”

  Cindy side stepped the question. “This is not exactly where I would have expected you to live,” she answered lightly instead.

  Once again Alana took exception. “Why not? This is where I come from, raised a few blocks away. If the neighborhood was good enough for my parents, it’s good enough for me.” She looked at Cindy proudly.

  “Are your parents alive?” Cindy was curious.

  “No, my father died when I was young and my mother died a few years ago. I moved back after my mother died,” Alana said, swiftly.

  Cindy wondered where Alana moved back from, and where the other hospital she’d worked at was located.

  “Yeah, this is a poor neighborhood,” Alana went on, encouraged by Cindy’s genuine interest. “So what? There’s plenty of poverty and unemployment everywhere in Jamaica. And, what goes with that? Crime. Poor people are afraid to go out of their neighborhoods and kids have trouble getting to school because it’s not
safe. But I feel safe here. I like it. It’s where I come from.”

  “You’re proud of Jamaica,” Cindy commented, impressed.

  “Bet your life, I am,” said Alana. “We’re doing our best to handle our problems. There are programs educating the poor and matching them up with employers. There are also programs giving poor people cash in exchange for sending their kids to school and making sure they have medical care. That’s important, even though most medical care down here leaves plenty to be desired!”

  It was inspiring to feel Alana’s pride in the world she came from. Cindy also found it curious that despite her identification with the poor, Alana worked in one of the most exclusive hospitals on the island.

  “You have quite a fabulous job yourself,” Cindy commented. “It must have been hard to get it.”

  Alana face lit up and Cindy could suddenly see the beauty and strength in it.

  “Very hard,” Alana confessed, “everyone wanted it. I got lucky. Who knows why?”

  More than luck, thought Cindy. “Who hired you?” she asked. Even though she didn’t want to, Cindy had to keep probing.

  Alana brushed the question off. “I went through a bunch of interviews. Why?”

  Cindy didn’t want to bring up Konrad at the moment, fearing it would put Alana off. She didn’t want to question whether the job she’d landed had been in exchange for sex. So far the relationship between Cindy and Alana had been friendly and easy, and Cindy wanted to keep it that way.

  “Hey, come in and sit down,” Alana suddenly realized that Cindy was still standing at the door. “Let me get you some coffee.”

  Cindy was surprised at how comfortable she felt with Alana. “Sure, thanks,” Cindy agreed, following Alana deeper into her small house and sitting at a round table near the kitchen. “Sorry to barge in like this. I tried to find you at the hospital,” Cindy continued, “but you hadn’t come in.”

  Alana was in the narrow kitchen now, pouring coffee and didn’t respond. Cindy waited for her to return to the table before repeating her question.

  “Why aren’t you at work today, Alana?” Cindy asked as she took the large mug of coffee and started to drink.