by Jaime Maddox
The signs were there. He drew up his own medication, which gave him opportunity to inject something, like air, into an unsuspecting patient. He’d prepped his own IV tubing, creating the perfect scenario for an air embolus. Ward thought of the other two patients who’d died on Hawk’s watch. Their charts seemed clean, with nothing significant or unusual coming to mind. One had suffered a pulmonary embolus, a large blood clot in the lung, just after stepping off a tourist bus. She was quite unstable on arrival and died shortly afterward. Hawk had given clot-busters, but they hadn’t helped. The other patient was also a heart-attack victim. Perfectly understandable, both deaths. Yet they made Ward uneasy. There were just so many deaths in June. So many on Hawk’s watch.
Suddenly, she felt like she’d been thrown into the path of a tornado. Everything was moving around her, and the air seemed to get sucked from her lungs. She closed her eyes to calm herself.
“Are you okay?”
Instead of her calming Abby, the roles were now reversed. She opened her eyes, nodded, reached for her notes. She began computing something else.
Five of the six patients who’d died at EM over the year had succumbed on Hawk’s watch. Ron Farley had seen eleven; Mario Litzi, ten; Al Briner, eight; and Dick Rove, five. They were all full-time docs. It was Rove’s five that bothered Ward. He’d seen five, just like Hawk. Only Dick had seen them over the course of a year, and Hawk in just a month. “Abby, this isn’t adding up.” She handed her the data Frankie had extracted. “Look at the provider column.”
Abby studied the data. “Hawk and Rove are tied.”
“Exactly! But it’s the data that’s missing that’s really important. How many hours did each provider work?”
“Oh, shit,” Abby said as she began to understand. Her jaw dropped and she turned to look out the window beyond Ward. She spoke in a hushed tone. “At the rate he was going, Hawk would have sixty dead patients in the year. That’s five times more than Ron Farley.”
“It’s almost twice as many as the rest of the staff combined.”
Picking up her phone, Ward made the call to the ER. After an endless minute of catching up with the clerk, she asked for Erin, only to learn she was on vacation. Backpacking out West, with no cell-phone service. “Damn,” she said as she turned to Abby and mouthed the news.
“Is there anyone else you can talk to?” Abby whispered.
Ward asked, “Who’s the nurse?”
A minute later, a friendly voice greeted her. “Hi, Doc. It’s Kelly. How the heck are you?”
Ward gave a generic reply before getting to the purpose of her call. She needed to gather information, without rousing suspicion. Small sparks of gossip tend to explode into infernos in fertile ground like an ER. “I’m doing a research paper,” she lied. “About deaths in the ER. How they affect the staff.”
“Wow. That’s a great topic.”
Suddenly Ward realized it actually was a great topic. Maybe she’d write it one day. “Yeah, you know how it is. Especially those unexpected deaths—the traumas, the sudden cardiac deaths. It really is hard.”
“Don’t I know it,” Kelly said softly.
“I was hoping to talk to Erin. I know a few months back she had a patient who died. A diabetic. It was a woman she knew, and she took her death hard.”
“It’s awful when it’s someone you know, Dr. Thrasher. And, unfortunately, in a small town like this, you know almost everybody.”
“Do you remember that case? Erin’s patient?”
There was a pause, as if Kelly was debating her response. “I wasn’t here, so I only heard secondhand.” But Kelly relayed what she’d heard, anyway.
Ward sat forward as she listened, pinching the bridge of her nose to chase away the threatening headache. It was similar, Erin’s case. Too similar. It was unbelievable bad luck when a patient died of something strange, something difficult to anticipate and prevent. What was it called when the same thing happened three times? And then you have another patient, who dies of something equally bizarre? Is that just really bad luck, or something else, something far worse?
Abby had been watching Ward, listening to her side of the conversation, apparently hearing and understanding enough to look concerned.
“Well?” she asked when Ward disconnected the call.
“There are similarities.”
Ward dialed Frieda, and before she could say anything else, Frieda answered. Another minute of gossip followed as Ward wondered how to phrase her questions. She wouldn’t be able to bullshit Frieda as easily as Kelly. She decided to be as honest as possible. “Remember that committee Dr. Rosen assigned me to?”
“The unexpectedly dead people?”
Ward chuckled. “That’s the one. I’m working on it now, and I couldn’t help thinking about your neighbor. You said you found him in his room at the ER. Do they know what happened?”
“Just that his heart stopped. They didn’t know why.”
“Do you by any chance know which physician took care of him?”
“It was the one who came before you. From your company. Dr. Hawk.”
Ward wasn’t surprised, but the news was still numbing. What the fuck was going on with Hawk? She closed her eyes and leaned back as she disconnected the phone.
Suddenly Abby leaned forward and touched Ward’s leg. “What are you thinking?”
She didn’t want to tell her what she was thinking. That maybe there was more to this than bad luck. “There are too many similarities in these cases, Abby.”
“Similarities? Is that a coincidence? Like the million-to-one thing? Can a few million-to-one things happen to the same person? Can this guy be that stupid? Or unlucky? What if it wasn’t an accident?”
“It had to be, Abby. Right? Because if it wasn’t…it was intentional.”
Ward wasn’t surprised that Abby had voiced her thoughts, nor was Abby’s suggestion unexpected. “Maybe you should make some more calls.”
Ward kept dialing the phone and talking to people long after Abby went to bed. She was just too preoccupied to rest. Her exercise proved to be futile, however. The ERs were staffed with new employees she didn’t know well enough to talk to, old ones too busy to talk, and people with no information to share. Her only consolation as she looked at the clock at three in the morning was the promise two people had made to call her the next day. That and the fact that she didn’t have to get up for work in two hours.
*
Abby’s hair dryer awakened Ward a few hours later, and she marveled at the difference a day had made. Twenty-four hours earlier she’d awakened feeling calm and peaceful, but the peer reviews had left her anxious. She was truly frightened about what her investigation would reveal. It saddened her that people died because of someone’s incompetence. It horrified her to think of other possibilities, but the more she reviewed the things she’d heard over the months, the things she’d automatically dismissed because, really, almost everything could be explained away, the more tense she became.
She stepped from the bed and pulled on a sweatshirt to chase the morning chill, then made her way to the kitchen. Abby consumed large volumes of coffee every day, starting with a cup in the morning while she read the newspaper. Ward made herself a cup and one for Abby, then carried both back to the bedroom.
Abby smiled and held out her arms, one for a lop-sided hug and the other for her coffee mug. “Morning. And thanks for this.”
“My pleasure.”
“What time did you come to bed?”
“Don’t ask.” Ward collapsed onto the bed.
Abby hummed as she dressed and then kissed Ward passionately once again. “I think I can make it an early night. Any chance you’re free for dinner? You can update me on your findings.”
Ward rolled over and leaned onto her elbow, resting her head in her hand as she stretched out on the bed. She was off for another twenty-four hours, until beginning the first of three consecutive day shifts. “People are going to start talking, Abby.”
A
bby used her small finger to spread something shiny across her bottom lip, then rubbed both lips together. “Fuck them.”
“I’d rather keep fucking you.”
“Then I guess you’re free for dinner.” Abby didn’t risk smudging her lipstick and blew a kiss instead, which Ward caught and placed gently on her own lips. She didn’t move and didn’t stop smiling until the sound of the Porsche’s engine faded in the distance and she finally had to face the day.
After brushing her teeth, she headed into the kitchen and picked up where she’d left off the night before, calling the ERs at the hospitals where Edward Hawk had worked in March and April. Her memory was correct, and her friends confirmed that Hawk had been the doctor on duty when some unexpected deaths occurred. Other than the fact that he was there, though, the deaths weren’t at all unusual for an ER. One patient had died from a heart attack, another from a blood clot, one from a brain hemorrhage, and two from trauma. The best doctor in the world might have lost those patients as well. Only Frieda’s friend stood out from the winter months.
Ward had taken this assignment merely to help Abby and pass the time, and she’d expected to find nothing other than incompetence on Hawk’s part. But she hadn’t. In fact, he appeared to be a very knowledgeable physician, with good skills and a trail of dead bodies following him. Was it all just bad luck? The deaths gave her an uneasy feeling, and knowing Hawk’s reputation fortified her anxiety.
She wished she could talk to Erin. She could tell her what had happened and bounce her thoughts off her. She couldn’t trust anyone else with the nagging thoughts that had been hounding her since she read about the diabetic patient who died in the ER. Technically, her job was done. She’d reviewed the cases and made her recommendations. So what was she looking for now? Why was she still digging?
Because of the uneasy feeling. She wouldn’t rest until she knew everything possible about these deaths.
She stood and stretched, then took her cup of coffee onto the deck and simply enjoyed a peaceful hour, listening to the birds and stretching her muscles in the early morning sunshine. Feeling refreshed, she picked up her pile of notes and began flipping through them. She read and reread, trying not to focus on any pattern, because it didn’t seem there was one. The patients who’d died were young and old, male and female, and afflicted by a variety of illness and injury.
She’d just decided that she couldn’t reach a concrete conclusion when her phone rang. A glance at the screen showed Abby’s beautiful, smiling face, and Ward’s expression instantly mirrored hers. Why did it feel so good just to see Abby’s picture on her phone?
She accepted the call. “Hello, Abby.”
“Hello, Doc. How’s the detective work going?”
Ward relayed her findings.
“Well, that’s good then, right? I mean, we don’t actually want a psychopathic doctor on the loose, do we?”
“Yeah, you’re right.” Ward agreed reluctantly. “I was just so sure when I read that case about the diabetic patient. I thought if I started asking around I’d find the proverbial smoking gun.”
“Well, I’m relieved. Because, truthfully, if you’d have found something, what would we have done?”
Ward smiled at Abby’s use of the word “we.” They were in this together. And they had no proof, not even enough evidence to revoke Hawk’s hospital privileges. Abby was right, of course. Finding nothing was good.
Chapter Twenty-four
Compound Fracture
In spite of many telephone calls, a few texts, and hours spent on the Internet researching probabilities and diseases, Ward made no further progress in her unofficial investigation of Dr. Edward Hawk. A handful of patients were dead under Hawk’s watch, some from relatively routine causes, others from bizarre factors. Ward had no idea if Hawk was a good doctor with bad luck or a homicidal maniac with a literal license to kill. She’d met him, although briefly, and he’d seemed normal. He was handsome, well dressed, and polite. The nurses thought he was creepy, but that didn’t mean much. Ward had worked with many physicians who hadn’t managed to find themselves in the good favor of the nursing staff, and that didn’t mean they were murderers. They just lacked personality, and while that wasn’t ideal, it wasn’t illegal, either.
Hawk’s profile was available on the Internet, and Ward read the reviews from multiple sites that rate physicians. She knew the sites well. She’d been warned at conferences and by administrators about the power of the Internet, where anonymous posters are able to make comments about physicians they don’t like. Yet in spite of his bad reputation amongst his peers, Hawk’s patients seemed to love him. All of his scores were high, ranging from four to five stars out of a possible five. Either Hawk wasn’t what he seemed to the nurses, or he’d really managed to snow the patients.
Erin was still out of cell-phone range, and Ward was waiting on a return call from another colleague, but she was beginning to accept the fact that she might have to just forget about this little investigation and focus on other things, because it wasn’t likely she’d ever have any more answers than she already had.
With so much happening in her career as a detective, it seemed like weeks had passed since her last ER shift. Yet she quickly got into the flow of things when she reached the hospital the next morning, taking care of a wound and a broken toe before her coffee had a chance to grow cold.
It was after nine when Abby called her. She was straight to the point and all business, which turned Ward on. “What’s the name of the app you told me about? The one that logs business expenses?”
Ward’s accountant had informed her of the phone app, and she was using it to track the expenses she incurred on her travels through the mountains. Since so many doctors traveled for conferences, Abby told her it might be helpful info to share with the medical staff. “Let me look at my phone,” Ward said.
She pulled the device out of her backpack and turned it on. “So how’s your day going?” she asked as it powered up.
“Ah…” Abby practically moaned. “It started out great.”
Ward tried hard to suppress the grin that threatened to erupt as she recalled their morning. Multiple orgasms before breakfast, again. A beep made her glance at the phone in her hand. She had a text from Kathy Henderfield, Frieda’s niece and the head nurse at the hospital where Ward had spent the month of April.
Call me. Important.
Ward checked her apps and gave Abby the information she’d requested. “So, what’s for dinner?” she asked.
“Oh, so you’re available?”
“Oh, yeah.”
Abby giggled, and Ward imagined the twinkle in her eyes and the smile on her face. They made plans to drive to Clarks Summit for sushi, and as soon as Ward disconnected the phone, she dialed Kathy’s number.
“Hey, Kath, what’s up?”
“I don’t know, something kind of weird. Frieda told me you’d asked about her neighbor, and when I mentioned your call, the unit clerk reminded me about another patient.”
“Oh, really?” Ward sat upright. Kathy had her full attention.
“Yeah. The patient was here in the beginning of March, during one of those freak late-winter snowstorms. He came in at the change of shift and Dr. Somerset was listed as the doctor of record, but actually Dr. Hawk took care of him.”
“So what happened with the patient?”
“Well, that’s what’s weird. He suffered a compound fracture of his leg in a snowmobile accident. He seemed stable, but then he coded. Something you hear about but never, ever, see.”
Ward’s mouth went dry. She clutched the phone with a choking grip. “What did he die from?”
“A venous air embolism.”
Chapter Twenty-five
Vertigo
Her ER was empty, and Ward was happy. As she hung up the phone, Kathy’s words rang in her ears. She was dizzy, her mind overwhelmed. Kathy had confirmed that Dr. Hawk had placed a central line in the dead snowmobiler and that he’d coded immediately afterwar
d. That made two patients in four months with fatal venous air emboli, when the odds dictated it should have taken Hawk more than a thousand years to accumulate such bad luck. When Ward considered the fact that his colleagues thought he was creepy, in addition to the two diabetic patients who’d died for no apparent reason, and Frieda’s neighbor who was found dead in a similar manner, she could no longer wishfully suppose this was just bad luck or incompetence. This had to be intentional. Hawk was murdering his patients, using a syringe of air instead of a knife or a gun, but he was murdering them, she was sure. The odds simply didn’t support any other conclusion.
What to do now? Ward had no proof of any wrongdoing, just this circumstantial evidence, but she had to stop Hawk. If she didn’t, the body count would continue to climb. Should she call the state medical board? It had been her sad duty to report a physician colleague once before, when he refused to step down in spite of multiple appearances at work while visibly intoxicated. The process had been rather benign. As soon as the state launched their investigation, the physician in question had admitted he had a problem and voluntarily entered a rehab program. A year later, he sent Ward a card of thanks for her intervention.
Something told Ward it wouldn’t go the same way this time. It was hard to imagine Hawk taking a call from the medical board and admitting to murder.
Thankfully, she’d never found herself in this position before. Pulling up the state board’s Web site, she read about handling a physician suspected of illegal behavior. It suggested making a formal report to the local police in addition to a complaint with the board.
Ward picked up the ER phone and dialed the direct extension to Abby’s office. “Abby Rosen,” she said a second later.
Normally, Abby’s voice brought a smile to her face, but not this time. Ward was nervous. “I really need to talk to you. Do you have a minute?”
