The Diagnosis is Murder (A Dr. Valorian Mystery Book 1)

by Steven Gossington

  “No, I can’t recall anything else about that. He didn’t talk to me much about it, except to brag that he’d won the lawsuit.”

  Another suspect I’ll add to my list. “One more question, Ms. Landry.”

  Tina looked up. “Yes?”

  “Was Dr. Preswick going to leave his wife?”

  Laura caught the faint nod of Tina’s head and the glint in her eyes. “Yes, for me.” Tina closed her eyes, crossed her arms again, and began to rock back and forth. Laura saw tears escaping from the corners of her lids and heard a few faint sniffles.

  Laura walked over to Tina and put a hand on her shoulder. “I’m so sorry. I’ll see myself out.” She turned to leave.

  “I guess someone saw us together?” Tina said.

  “It’s possible. Where would someone have seen you with him?”

  “I don’t know. We went to different restaurants and bars. I guess it could’ve been any of those places.” Tina sat forward and buried her face in her hands.

  Laura left her to her grieving.

  Before she drove away, Laura felt a surge of warmth, like when she’d just pinpointed an unlikely patient diagnosis from subtle physical clues. She lived for that feeling now, and never again would she give up on a sign or symptom, no matter how nondescript. It may lead nowhere, but she had to take the risk. She couldn’t tolerate the thought of misdiagnosing an abused child—or a victim of murder.

  Her fingers twitched as she added the term lab tech to her suspect list. It was a struggle to write legibly. After all, she’d just had three rewarding interviews in one day. Maybe I can land one more interview before it gets too late. She scrolled through the contacts list on her cell phone and placed a call to Matthew Kline. His voicemail answered. She decided not to leave a message but to try again tomorrow.

  She drove southeast down the Leesburg Pike back toward Alexandria, puttering along the road with her window down. Rain earlier in the day had brought out a fresh spring smell in the air. Back home, Laura played with Cosmo for a while, and then prepared and ate a large dinner salad. Cosmo was full of energy and bounded around near Laura, stopping at times in front of her, barking for attention. She patted Cosmo. “You can sense my excitement, can’t you?”

  After the meal, she spent several hours reviewing more of her toxicology text material and internet search information. Several glasses of Italian chianti wine slowed her racing thoughts. She sat in her living room, scrolled through the television menu and found a murder mystery movie based on an Agatha Christie novel. A murder committed with poison.

  Her mind took off again. Funny about poisons. How the progression of illness can sometimes be influenced by the dose and type of poison. Arsenic at low doses can lead to a gradual decline, while cyanide can kill within seconds.

  Later, she lay in her bed, ready for sleep. From her vantage point, Laura could stare into a painting hanging on her bedroom wall, a painting of a creek side thatch-roofed house with smoke drifting from a chimney and two horses in a lush, green pasture nearby. Even though no people were visible in the picture, she liked to imagine what the inhabitants of that comfortable home were like. Usually it was a family of four: a tall, stoic father; a rosy, hovering mother; and two playful children—a boy and a younger girl. Laura enjoyed recreating their conversations, their plans and dreams, their jokes and worries and fears. She smiled with her eyes closed as she visualized the two children riding their horses around the pasture.

  Replaying in her mind the interviews from earlier that day, she reminded herself that she couldn’t trust anybody to speak the whole truth. And another thing—why was Tina Landry so interested in how her affair with Dr. Preswick was discovered?

  Is Tina hiding something?

  After two more yawns, Laura was asleep.

  Chapter 10

  After breezing into the ER the next morning at 6:50 a.m., Laura stopped, took a deep breath, and muttered to herself, “Stay in control today—don’t lose it.”

  “Early as usual,” the night emergency physician said. He was poised to leave as soon as possible after his 12-hour shift.

  “How was your night?” Laura said.

  “Not too busy. No real problems.”

  “Maybe that’s a good omen. I hope my day goes as well.” Right, as if my hoping has anything to do with it.

  Laura settled her things in the doctors’ office while the night physician completed his computer chart work.

  “Buenos dias.” Derek appeared in crisp green scrubs at the door of the office. He held two cups of coffee and handed one to Laura.

  “Thanks.” She inhaled the rich aroma and took a sip. “Have you had some interesting shifts while I’ve been gone?”

  “Sure have, and I think I’m getting the hang of it.” Derek had worked with several of the other ER doctors during the previous two days. “Nothing beats the bug-eyed lady, though.”

  “Just wait a while. You never know what’s around the corner.”

  Derek moved away from the door to see a patient.

  Early afternoon, an ambulance call came in over the ER radio. “En route to your facility with a male, GSW to the abdomen. BP 80/40. ETA one minute.”

  Derek turned to Laura. “I thought a victim with major injuries went to the trauma center downtown.”

  “Not always. If the patient is unstable, they may decide to bring him to the closest hospital. It’s the paramedic’s judgment call.”

  Laura, Derek, and several nurses had less than one minute to prepare the critical care room for the patient.

  “Have someone page the surgeon on call to the ER stat,” Laura said to a nurse.

  Paramedics wheeled a stretcher through the ER ambulance doors and into the room. As the bleeding patient was lifted over to the ER bed, a paramedic addressed Laura. “We found him in a parking lot outside a store in a strip center, just five blocks from here. He was alert when we got to him. He said he’d been shot.”

  “He has a wound just below the sternum,” the senior paramedic said, pointing to a hole in the man’s skin.

  Laura spotted a wound oozing blood just below the center of the chest, between the breastbone and the upper abdomen. She felt a weak pulse at his wrist. “He’s not taking adequate breaths, and he’s not responding.”

  A paramedic nodded. “He became less alert as we were wheeling him in the door.”

  Laura turned to the respiratory technician. “We need to intubate him.” She said to a nurse, “Order a portable chest X-ray and call the blood bank for 4 units of O negative blood while we type and cross him for more blood. Give him an IV bolus of saline—one liter. If the surgeon doesn’t call soon, I may need to cut his chest open.”

  She spoke to Derek. “I think his chest or abdomen, or both, have been injured. We need to move fast and . . .” Laura stared at Derek’s sweaty face. “Are you okay?”

  Derek didn’t respond.

  Laura leaned closer to him. “Derek, can you hear me?”

  His chest heaved, each breath ending with a faint moan. His eyes were wide-open, unblinking.

  “Can you hear—”

  Derek pushed Laura back and bent over the comatose man. “Don’t die,” he screamed as he shook the body. “You can make it. Hang on. Don’t die.”

  Everyone else in the room froze. He’s lost it, Laura thought and turned to a nurse, “Call Security. We need to get Derek out of here.”

  Derek lifted the patient’s head with his hand. “Listen to me. I won’t let you die.” Derek moaned and rocked back and forth as he cradled the man’s head. “Please don’t die.”

  Laura stepped close to Derek. “Let us try to help him. Move back.”

  “No. I’m not leaving him again.”

  Laura saw that the patient was taking shallow breaths, and the respiratory therapists were poised to assist his ventilations and intubate him. A security guard and a male ER technician entered the room, and Laura guided them to Derek. “Take him by the arms and ease him back from the stretcher.”


  As they grabbed Derek’s arms, he tensed and glanced—wide-eyed—at each of them. After a few seconds, he exhaled and relaxed.

  “Take him to the family room,” Laura said.

  After the patient was intubated and a blood transfusion started, the surgeon called on the phone. Laura described the injury and the patient’s status to him. An OR crew soon appeared and whisked the patient away to surgery.

  Laura walked to the family room, and Derek stood as she entered.

  “I’m so sorry. I know I lost it in there. It’s all a blur. I’m sorry.”

  “That patient brought back bad memories for you.”

  “I had visions of my brother.”

  “We all carry baggage—me included. We have to learn to deal with that baggage. Maybe counseling can help.”

  “I know; I’ve been thinking about that.” Derek sighed. “What now? Should I go home? Am I toast here?”

  “Why don’t you take the rest of the day off?”

  “Okay.”

  “And yes, you can continue to work here. I’ll explain everything to the staff. It can happen to any of us. You’re a good student, and you’ll bounce back from this.”

  “Will I be reprimanded? Will this go on my record?”

  “I won’t mention it in my evaluation. Your record will be fine, unless someone complains—someone who was in the room. In that case, a hospital committee might be assigned to review the incident. But that kind of committee review is much more likely to happen to me than to you. They’re more forgiving to medical students. You’ll be okay. I’ll support you.”

  “Thanks.” He stopped as he walked through the family room door. “He’s not going to make it, is he?”

  “I don’t know.”

  Derek bowed his head and walked out of the ER.

  Laura grabbed some take-out Mexican food on her way home. Mexican food was her main gastronomic vice. She allowed herself to indulge in the high-fat, cheesy food from time to time, especially if she’d been jogging regularly. Mainly, she had to monitor her chips and salsa intake. She’d play a broken record in her mind: Go slow with the chips, go slow with the chips . . .

  After satisfying her stomach and feeding Cosmo, Laura cleaned up her kitchen and dining room. She played catch the doggie bone with Cosmo for a while and then placed a call to Dr. Matthew Kline. She figured the malpractice trial had been tough on him, and she felt a need to talk with him about it, in person if possible. Besides, it would just be good to sit with an old friend again.

  “Matthew, this is Laura Valorian.”

  “Hi, Laura.” She could barely make out his words.

  “Can I come over for a short visit?”

  Laura and Matthew had been members of a close group of students who’d studied and socialized together in medical school, giving each other emotional support through the long hours of review and the rigors of tough written and oral exams.

  His voice was louder. “Sure, I’d like that. Just like the good old days.” He gave her directions for the shortest route to his home.

  “I’ll be there in an hour or so.”

  She thought about Matthew during the drive. He’d done well for himself, considering he was a young surgeon in a major metropolitan area like Washington, D.C. Sometimes, in such circumstances, it took a while to build a practice—a referral network—so that other physicians would send their patients for surgical consultation. Matthew was friendly and competent. Laura knew that doctors and patients liked him. He’d developed a solid reputation, and he had a busy operating schedule at his hospital. His marriage seemed solid, and he’d moved into a large house on the Maryland side of the Potomac River, northwest of D.C.

  Then he got sued.

  Laura took the quickest route to the northwest—the Capital Beltway—that huge circular loop around Washington, D.C. Its southern leg passed just south of Alexandria, about one mile from Laura’s house. She followed the Beltway into Maryland, exited onto River Road, and drove northwest through forested countryside toward the town of Potomac.

  Matthew lived about a half mile north of River Road. After several turns, Laura found his place and parked in the long driveway. His house sat on a large lot, and tall trees hid most of the house from the street. Laura walked up a curving sidewalk bordered with bushes and flowers to the front door. Before Laura could ring the bell, the door swung open. “Come on in,” Matthew said.

  He led her down a long hall to the main living room, which was so dark that Laura couldn’t make out fine details of the furniture and accessories. A table lamp offered the only light in the room. Laura sat down on the end of a plush white sofa next to the lamp.

  Matthew wore a white dress shirt, open at the collar and in need of ironing. “Something to drink? Your usual, maybe?” he said.

  “Sure.” Laura had survived on diet Cokes during their long study sessions in medical school.

  Matthew soon reappeared with a tall glass for Laura. He’d mixed himself a Scotch and soda. “Lisa’s in the back with the baby.” He settled into a black recliner chair near the sofa. An end table separated them.

  “How old is your baby?”

  “Six months. My and Lisa’s little bundle of joy.” He sipped his drink. “How’ve you been? Is everything good with you?”

  “Yes. My career is going well. Have you made it to a med school class reunion?”

  “Not yet.”

  “I haven’t, either. We should meet at one someday. It would be fun to catch up with everyone.”

  Matthew was quiet.

  “I’d heard about your lawsuit. I just wanted to get your perspective on the whole ordeal. Is it over yet?”

  “Yeah, not too long ago.” He sighed. “I lost.”

  “Oh, no. I’m sorry. What happened?”

  “I thought it was going fine early on. But one of their expert witnesses skewered me good, and I guess the jury wasn’t as impressed by our side.”

  Laura watched him as he spoke. Jagged shadows crossed his face in the dim light from the lamp, and his shoulders drooped. She remembered him as a lively, upbeat person in medical school. They’d all felt upbeat in those days, with an almost guaranteed comfortable livelihood ahead of them. Laura and the close circle of friends had looked up to Matthew—the promising young surgeon.

  “You look short of sleep,” Laura said. “It’s the trial, right?”

  “Yes, I can’t stop thinking about it.”

  “Was it just bad luck?”

  “The patient was a young lady. She was in a car accident. She had multiple rib fractures and a large lung contusion. Her main problem at first was hypoxia and difficulty breathing. Otherwise, her blood pressure and mental status were stable. She died suddenly in the CT room. Her liver and spleen were lacerated and she bled out. They said I should’ve taken her from the ER to the operating room instead of to CT scan.”

  “You’re a good surgeon. That was just bad luck.”

  He didn’t answer.

  Even though the last few weeks had been hell for him, Laura had to press on with the difficult interview. She knew the answer to the next question, but it served as a segue to the real purpose of her visit. “Who was the expert for the plaintiff?”

  He sighed again and looked toward the ceiling. His voice was hoarse. “The main one was Roderick Preswick.”

  “I knew him. He’s dead now, you know.”

  “I heard.” Matthew raised his glass. “Poetic justice, maybe?” He stared at Laura, his eyes glinting, then he stood and paced around the room. “Forgive me if I’m not too sad about that. The bastard lied under oath. He said unfair things about me, called me incompetent. He wasn’t on that stand to just say what he believed. He wanted their side to win, like it was a game. He was determined to beat me. No, more than that—he wanted to torture me. That asshole proctologist was up there perched on his throne, acting like the all-knowing surgeon expert.”

  Matthew gulped his Scotch. When he spoke again, his voice trembled, and the words sounded like they
were getting stuck in his throat. “He told the jury, ‘If that poor young lady had been my patient, she’d be alive today.’ Can you believe it?” He sat down again, his head bowed.

  “I’m so sorry.” A wave of nausea swept over Laura as she thought of what that egotistical prick had said about Matthew. She’d heard about such doctors in the courtroom. These plaintiff experts were common discussion items among physicians, especially those who’d been sued. Expert witnesses would testify for plaintiffs and charge hefty fees, generally more than defense experts charge. However, the worst of it was, they’d often say outlandish things in court. After all, you could say whatever you wanted to say as an expert. Only your peers would know the difference, and they weren’t usually in the courtroom listening and probably wouldn’t read any transcripts about what was said. Expert witnessing was an unregulated business. They charged whatever they felt like charging, and any ‘ethical guidelines’ that existed were used voluntarily only.

  Matthew looked up. “I’d met Preswick before. A few years ago, he tried to convince me to invest with him and another guy in a new medical invention.”

  “Dr. Preswick wanted you to invest money with him?”

  Matthew nodded. “I had lunch with him one afternoon. He had this idea about a new product that could make us all very rich. A new kind of painless liquid bandage—with antibacterial and antiviral properties—that would seal the wound and speed healing without the need for stitches or staples or needles of any kind.”

  “I guess you didn’t go for it?”

  “I had a bad feeling about the whole deal. I didn’t trust him or the other guy.”

  Laura leaned forward. “Who was the other guy?”

  “I don’t know. I’d never met him before.”

  “Do you remember his name?”

  Matthew looked up and furrowed his forehead. “I think it was Max—Max Flowers. They wanted to name the product ‘Flawless Wound Care’ or something like that. I remember because his last name was Flowers, and the product name sounded similar.”

  Laura filed the name away in her mind—she might need to find out more about Max Flowers.