Deadly Medicine

by Jaime Maddox

  “Well, that’s mature.”

  She’d managed to calm her pulse and her voice by the time Jess started to speak again. She cut her off before she could say anything further.

  “Don’t, Jess. I’ve heard enough. I’ve called the police, I’ve called the state medical board, and now I’ve called you. If Hawk kills again, it’s not on my conscience.”

  *

  Jess heard the click as Ward disconnected the call. Ward had gone off the cliff, and Jess was sorry for her part in it. She still thought of telling her about the drug in her system on the night she attacked Em and George, but each time she debated it, she decided against it. It might make Ward feel better, but it would make the situation worse for everyone else. And her own situation wasn’t great. Things weren’t going well with Wendy, and though she suspected they’d be great friends, she knew they wouldn’t make it as lovers. Her father was doing and saying things that concerned her, and she’d been trying to get him to the doctor for weeks. Dementia was a big concern. The ER was slammed with summer visitors, and she was working two or three hours extra every day to help the staff keep up. As the director, it was her job. Yet it all weighed heavily on her. It took all her strength to make it through her days, to keep it together, to get to work, and to not crack up. Being responsible for Ward, too, was just too much to ask.

  Reaching into the bedside table, she pulled out her pill bottles. First, she opened the Xanax and swallowed two tabs with the water sitting there. Carefully, she closed the lid. She couldn’t afford to lose pills. Yes, she could still get them, but since leaving Philly, it was much harder. Next, she opened the bottle of Percocet. She’d managed to convince the pain-management specialist that she needed six of the tablets daily, and mostly, she did. She’d spent the last two years of her life as small segments of time passed between narcotics doses. Through sheer force of will she’d managed to wean herself down to six tablets a day, but at times like now she definitely needed more. She tapped the bottle against her palm until three tablets sat in her hand. For a moment, she debated putting one back but then threw back her head and swallowed them before she could change her mind.

  She definitely needed a new source. For years she’d been able to find pills through her regular patients in the ER, mostly the guys with sickle-cell anemia, who made regular appearances in the ER for crises. After getting to know some of the faces, she’d developed the sort of relationship with one or two that allowed her to exchange money for the thirty extra oxycodone tabs she needed every week. The cost was a little higher when she used her patients, but she didn’t need to worry much about money. As long as she had her drugs, she could function, and she often needed as many as ten tablets a day to keep her that way. But then, the owner of the Happy and Healthy Pharmacies was arrested for distributing narcotics, and overnight the supply on the streets of Philadelphia ran dry.

  Jess had been able to painfully wean herself down, and she would do well for weeks on end, then crash. Her needs would rebound and she’d need a dozen tabs to recharge. Now, she was mostly stabilized on this dose, and she’d found a reliable doctor to prescribe the pills. All she needed was a little insurance, for stressful times, like when her ex-girlfriend called to tell her one of the doctors on her staff was murdering patients.

  Jess pulled on a pair of shorts and a T-shirt and sat on her bed. It had once been their bed, but the relationship had become too much for her. Her addiction to pain pills took all of her energy, and she just didn’t have enough to share with a partner. At times she’d contemplated telling Ward about her problem, but in the end, she’d decided against it.

  Jess had always been the prude, criticizing Ward for drinking too much, when, really, she was just having fun. Then, when her wrist surgery didn’t go as planned, Ward had nursed her gently, cautioning her every day about the use of pain pills, until one day, Jess just went out and got another prescription from her family doctor so she could take them without Ward’s knowledge. Her dependence on the drugs happened so quickly she’d never seen it coming. As her wrist healed, she’d tried to cut back, but within hours of taking a tablet, she started to feel the misery of withdrawal—anxiety, muscle aches, diarrhea, profuse sweating. It was hell, and just a single Percocet could make her normal again.

  For a moment, she wished she could have shared this trouble with Ward. But she was too good, too perfect. She would have insisted on something like rehab, or random urine drug screens before bed. It was much better for Jess to be alone with this problem than to deal with Ward. It took all she had to function as a doctor, and that was her first priority, her true love. Women were emotional and taxing, and medicine really wasn’t.

  It was unpredictable at times—patients didn’t always respond the way they should have to treatment, but that made it challenging. Almost always, she could solve their riddles and diagnose their problems. Almost always she could make them feel better. And in the chaos of her life, that one little sliver of joy kept her alive. Ward couldn’t do it. Her career could. She’d had to let Ward go.

  Jess didn’t know what to make of Ward’s accusations. Ever since learning Ward had been drugged on the night she attacked Emory and George, Jess tended to sympathize with her. Not enough to tell her the truth—what was the point? The lie gave Jess the perfect excuse to break up with her, and that had been just what she needed at the time.

  What about now, though? Things with Wendy weren’t working out, and she could never be with a man. She’d been foolish to even entertain that idea, but her life was in the sort of state where foolish ideas seemed logical. Was her breakup with Ward another folly? Was it time to rethink Ward? She’d never find anyone kinder and better for her—better to her, either. Yet that was part of the problem. Ward enabled her, and Jess couldn’t help taking advantage. Ward was just an easy target.

  What about Hawk? Could Ward be right? He was a little strange; the staff had mentioned that. What would make Ward label him a killer? It sounded like bad luck more than anything. Still, three fatal air emboli—that was a bit hard to comprehend. It was rare to see a doctor make a fatal mistake more than once. Doctors were healers—they buried their mistakes but learned from them.

  I’ll have to keep an eye on him, she thought as she sat before her computer. She liked to scan her e-mail before work, just to know what was happening. After logging on, she scanned the list. Junk, junk, junk, Wendy.

  Jess clicked on the e-mail. She liked Wendy. She was cute, with rugged dark looks, but her personality attracted Jess the most. Serious, quiet, introverted. With Wendy, Jess felt at peace, unlike with Ward, whose energy left her feeling edgy. Wendy was like a balm, a drug to ease her suffering. Too bad there was no sexual attraction. The message was brief and to the point, like Wendy.

  Autopsy report on Christian Cooney says cause of death venous air embolus. Probably from central line. Call me later.

  Chapter Twenty-seven

  Paralysis

  The typical mid-afternoon lull in the Garden ER had stretched, and the entire staff of four had grown bored. They’d finished notes and cleaned and restocked rooms, organized supplies. Nothing was left to do except socialize.

  The smile plastered on Edward’s face hadn’t changed in twenty minutes, when he’d first sat down with the staff to look at the menu from the Chinese restaurant. Listening to their stories and smiling at the simplicity of their lives wasn’t easy, but he’d come to understand its necessity. If he wanted to avoid suspicion, he had to appear normal, just like all the common, ordinary people he encountered every day. It was difficult, but he could do it. He had to.

  When he’d first taken the job with the locums company, he’d assumed he’d continue to move around. But that wasn’t the case. The company was pestering him to return to Endless Mountains Medical Center, where he’d had a prolific month of June, but he hesitated. Five people had died at his hand. Wouldn’t someone get suspicious if so many deaths continued? There’d been two deaths in January at Endless Mountains as well. If
he went back, he’d have to tone things down. That wasn’t ideal if he wanted the world record for serial killers. To earn that trophy, he had to keep moving to new places, where there were no watchful eyes or prior incidents to raise questions when he struck down his next victim.

  Moving was ideal. He wasn’t sure it was going to happen, though. He’d started thinking about the things he’d seen over the years, the way his peers handled those bad outcomes. He’d seen it happen hundreds of times in his career. Incompetent doctors and nurses lost patients all the time, and their professional colleagues would rally beside them, heads held high and mouths held closed while inquiry boards got nowhere. The staff stood together and supported each other. At least the ones they liked. The colleagues and staff who dared to be different—or just were different—were left on their own to face the firing squad. The ones with friends rarely had worries.

  Edward began to wonder about friendship, a social arena into which he’d never ventured. Sharing, exchanging, compromising weren’t comfortable concepts. He’d never really gotten close to anyone except his family, and barely tolerated them for the obligatory holiday functions. He used his job as an excuse and worked his way out of much of that, too. He was trying now, though. If he befriended his coworkers and a question ever came up about his character or his motives with a patient, would they stand beside him? Maybe. Stranger things had happened.

  Sitting there wasting valuable time making friends, Edward was bored senseless. The ER was quiet, and the inactivity made him nervous. Edward looked up at the security-camera monitors. One of the six screens caught the image of Jessica Benson opening the door to her office, just outside the main ER doors in the hallway leading toward the hospital’s back entrance. What was she doing at the hospital? Her shift didn’t start for two hours. She typically came in on her day off to do paperwork, but not before shifts. The twelve-hour days were long enough without further extending them.

  Was something wrong? He’d had a strong month, sending four patients out of the Garden ER in body bags. Had one of them betrayed him? Filled with a sudden sense of dread, he leaned back and stared at the benign image on the monitor. An empty hallway and a closed door, with no signs of life at all. Jess had disappeared into her office. What was she doing in there?

  The call to the ER an hour earlier replayed in his mind. Ringing telephones annoyed him, and so he’d picked up the receiver and answered when the unit clerk was busy with another call. It was Dr. Ward Thrasher, calling for Jess, and she’d said her message was urgent. Thrasher had been following him on his journey through the mountain hospitals. Was it possible she’d learned something about him? Perhaps heard some nasty rumor?

  Edward had always been careful, choosing methods of murder that were hard to identify. Most times his victims didn’t even have autopsies because their deaths weren’t outside the range of possibilities for people of their age and with their particular medical problems. Even so, someone had figured something out in New Jersey, and someone might have gotten lucky again. With his particular hobby, he could never be too careful.

  Dozens of thoughts ran through his mind as he reached into his pockets, pondering his options. Confront her? Spy on her? Kill her? He needed to know what she knew, but how to get that information? He closed his hand on the syringe in his pocket, and an idea came to him. He could take advantage of the empty ER and disappear for a few minutes, then hopefully convince Jessica Benson to cooperate.

  “I need to use the restroom,” he informed the staff. They barely acknowledged him as they studied the menu. “Shrimp with broccoli,” he said as he stood.

  He walked in the direction of the restroom, checked to see that no one was watching, then turned toward Jess’s office. His fingers slid over the syringe of succinylcholine in his pocket. It was a powerful medication used to paralyze patients before inserting breathing tubes. He’d used the sux earlier in the day, mostly as an excuse to open the vial and pilfer the leftover medication to have on hand for later use. What a wonderful way to kill someone! The sux paralyzes all of the muscles, including those responsible for breathing, but doesn’t do a thing to change the level of consciousness. A person is wide-awake but can’t move a muscle. He remembered the scenes he’d orchestrated over the years, his patients staring straight ahead as he told them they were going to die. Unfortunately, people become a little foggy when they go without oxygen for too long, so they’re not usually aware of their heart slowing and stopping as it cries out before death.

  He would have loved to see it all play out on a heart monitor, watching the oxygen level drop, and then the erratic pattern of the heart’s rhythm—perhaps extra beats, or a fast rate, but eventually it would all end with the beautiful flat line of death.

  When he’d drawn up the syringe of sux earlier in his shift, he’d had no idea who he’d use it on. If his concerns were founded, he had his answer, and nothing could have made him happier. He didn’t like Jessica Benson. She was too controlling, always reminding him of the stupid protocols in place at the Garden ER. She’d come to Garden from the big city and had made endless changes, and challenged everyone who questioned them, including him. It was hard to murder people when he was forced to follow a standard guideline for medical care, but he’d managed it anyway. Just to stick it to Jessica Benson, Hawk planned to make his month in Garden a record breaker. Maybe he’d even add her death certificate to his collection.

  *

  Jess didn’t know what to do. After reading the e-mail from Wendy, she’d tried the cell phone of the hospital CEO, hoping for some advice, but he hadn’t picked up. With no real plan in mind, it seemed prudent for her to review the chart of the patient who’d died of the venous air embolus. Perhaps she’d find something there she could use to help her determine what to do about Hawk, but she doubted it. If Ward was correct, and he was murdering ER patients, he was clever enough to cover his tracks. The proof wouldn’t be in the chart of this particular patient but in the pattern of the deaths that had happened while he was working. And four patients dying of rare diseases on his watch was all the pattern she needed to be convinced. Still, she’d look anyway, at the chart of Christian Cooney and the other patients who’d died at Garden since Hawk had arrived.

  After quickly putting on her makeup and pulling on her sneakers, Jess packed some food for her overnight shift and began her walk to the hospital. It had been a humid day, and even though it had cleared into a pleasant afternoon, the streets were deserted as her neighbors sought relief inside their air-conditioned homes. She let herself in through the hospital’s employee entrance with her ID badge and headed for her office.

  She supposed she could just show up early for work and tell Hawk to take off early. After he finished this shift, he had three days off and usually headed to his apartment in New York to enjoy his downtime. She could call the extra two hours a gift, but would that gesture draw his suspicions? A murderer probably had his antenna finely tuned to other people’s behavior, and letting him go earlier would have been atypical. No, best to let him finish the shift. She’d sort out what to do sometime during the next three days. She only hoped no one died in the next two hours.

  Jess unlocked her office door, turned on the lights and the computer, and sat down in front of it. She wanted to review all the ER and hospital deaths that had occurred since Hawk came to Garden, just to see if anything seemed unusual. She’d look for Hawk’s name everywhere, because in a small hospital like Garden, he might have been called to care for a patient outside her department. If someone was in labor and no obstetrician was available, the ER doc would be summoned. If someone was in cardiac arrest in the cafeteria, Hawk would have gotten that call, too. Just by scanning the files she remembered, she came up with four ER deaths connected to him. Why hadn’t that concerned her before? God, maybe her personal issues were affecting her job. The whole ER usually saw four deaths in a month; why did Hawk have so many? Whether bad medicine or murder, the situation certainly warranted review. Jess only hoped she f
ound no evidence of cases outside the ER to pad the total.

  Her computer asked for her password, and she entered it and quickly found the file she needed. As ER director, she was on the M & M committee. Each department head from pediatrics to surgery entered information about hospital deaths into this file for the process of review. At a monthly meeting, those chairs would meet over dinner and discuss the cases. The departments were listed alphabetically, and she began with the Department of Anesthesia. There were no deaths due to anesthesia in the month of July. The Emergency Department was next. She skipped that file. ICU was next. Jess clicked on that file and scanned the names of a dozen people who’d died in intensive care. Each of them had a death certificate, and if Hawk was the physician caring for them at the time of death, she’d see his name listed on the paper, but it was nowhere on the list. She’d just clicked on the ER patients when a knock on her door interrupted her. Strange. No one knew she was here. Perhaps they’d seen the light beneath the door, or someone saw her walk into the hospital.

  She opened the door to find Edward Hawk standing before her. She tried not to let the fear spreading through her show on her face.

  “I saw you come in,” he said, a warm smile on his face. “Can I talk to you?”

  “Sure,” Jess said. “How about the staff lounge?” she suggested, attempting to divert him out of the private space of her office and the list of patient charts on her computer screen.

  “No, here,” he said, and pushed through the door.

  “Hey,” she said as she saw him walk right to the computer screen. It took a fraction of a second to see what she was reading, and his reaction was sudden and violent. He lunged at her, and before she could react, she felt the bite of a needle tearing into the flesh of her thigh. She screamed, batted at this hand, and attempted to jump from his grasp. They landed on the floor, his weight pinning her, his hand suffocating her. He finished with the syringe and discarded it on the floor with a flick of his hand, then focused on subduing her. Wrapping both legs around her lower body, he effectively immobilized her. His right arm managed to somehow pin hers and grasp her left, and the left hand over her mouth was like a vise. She tried biting but couldn’t open her mouth enough to do any damage. Her muffled moans were a waste of the precious breath she could barely siphon through the narrow gap between her nose and Hawk’s hand.