And occasionally, just as rarely, we achieved those elusive miracles. Still, I was as depressed as I was fascinated. Looking at a year of our cumulative mistakes had a sobering effect on me. Until I broke the code, I didn’t even know my own performance. Maybe I was the one sending home the acute appendixes.
It was ten o’clock when I shut down and got ready to leave for the city. I’d gotten barely a third of the way through the main groupings of possible errors.
Outside, I welcomed the frost to clear my head. At least I’d kept myself from feeling afraid for a while. I’d grabbed an apple for a late breakfast and balanced a final cup of coffee on the way out to my car. The footprints had vanished to a glistening varnish on the stone walkway. It was still cold enough that the lawn and surrounding forest floor had stayed white.
I got Muffy into the car, and we headed down the mountain and back toward Buffalo. The prettiness was lost, however, as I started to dwell on those footprints again, and inevitably Kingsly’s murder. Even in a hospital where death was common, the grisly killing sickened me. Maybe it was a delayed reaction, postponed like so many other emotions in a doctor’s life by all the practical coping we’re forced to do. More likely, I’d been trying to deny another question I feared, but Bufort’s dressing-down had finally shamed me into facing it. I could still visualize Kingsly’s pathetic body, as dissolute in death as was his life. Would his fate have been different if I’d tried to help him? My mood became even more morbid as I swung through shrouds of mist so thick, the wipers had to part the droplets left by them on the windshield. Other memories of death crowded in uninvited like silent accusers in the fog. I remembered two little girls and their dead father. I shook my head and tried to drive away the unwelcome visions.
The practice of medicine could rip your heart out. Most people can mercifully ignore the parade of terrors happening to others and trust that the odds will keep such horrors away from them. But our job is closer to the front, and we see every day the ways life can go horribly wrong and sink into pain and death. Some days I can’t keep the images of it all out of my head. And sometimes it makes me think the worst.
I thought again of the footprints. Despite my previous dismissal of their relationship with Kingsly, I now felt a lot less glib here in the fog than I had in the clear beauty of the mountains. Because there was yet another possibility. If the killer feared exposure from me, then I might very well be a target. Had the menace really faded with the melted snow? Or had those prints marked the approaching steps of my own turn with a murderer?
* * * *
It was less misty by the time I’d reentered the outskirts of Buffalo. There was no vestige of snow here, just gray sludge. The prenoon traffic rescued me from dwelling any further on the darker thoughts I’d had on the way in. I flicked the radio to a traffic report; bad everywhere. I listened to a weatherman assure me this was the worst November in ten years for consecutive days without
sunshine. He proceeded to interview three experts who argued with one another over the cause. They couldn’t agree on global warming, pollution, or rogue volcanoes, but all of them predicted tomorrow would be more heavily overcast than today and warned that record smog levels would make breathing difficult for people with lung conditions. Janis Joplin then rendered a little bit of therapy with “Me and Bobby McGee.”
When I finally got to hear the news, Kingsly’s murder was the lead story. It was brief, contained little more than the essential facts, and said nothing about a cardiac needle. There was a brief statement by Hurst assuring the public that the tragedy in no way compromised St. Paul’s capacity to give proper care to its patients.
I drove directly to my private office beside the hospital. The patients that I’d kept in my general practice put up with the crazy demands on my time that went with becoming chief of the ER. At least they had me where it mattered for emergencies, if I wasn’t in some damn meeting. More than this, I’d known them so long, many had become friends.
Muffy wasn’t thrilled at being left in the car. I’d call geriatrics and see if they wanted some pet therapy that morning.
It was 11:55 when I entered the quiet of my still-empty waiting room. Barbara O’Hara, semiretired, a grandmother, and previously secretary to a half dozen former chiefs, was my receptionist here. It was her judgment and interest in the patients that let me be away so much. She looked up from her crossword.
“Coffee? Or messages first?”
“Coffee, please, and good morning to you too.”
“Good, because your first appointment isn’t until twelve-fifteen, and I want to hear about Kingsly.”
I hadn’t seen her since the murder and had forgotten that among the many regimes she’d marshaled, she’d had a short stint as Kingsly’s secretary. When he put a move on her, she quit.
I settled into a chair with the cup warming my hands and gave her only what I had seen on the night he was found and later at the autopsy table. I left out my own speculations about Hurst and Gil Fernandez, but when I described how Bufort was starting to focus on the ER physicians, she stopped me with a question.
“What about you? Do you think someone in your own department did it?”
Right to the center of what I’d been avoiding. But my instinctive answer came without hesitation. “No. I don’t, and talking to you now, I just realized why.”
“You mean besides your not wanting to believe it?”
She was one cagey grandmother. “Yeah.” I smiled a little sheepishly. “I mean, Bufort is focused on who had the means, the skills to accomplish the killing, but not on who had the motive. I neither know of nor can imagine any connection between Kingsly and one of my staff that could be a motive for killing him. Until someone finds that link, if it exists, then the fact that we can all needle hearts doesn’t amount to much.”
She thought for a moment and then commented. “I bet it was one of the women he molested, because it’s what I would have done, with anything handy, if he had actually tried to force me into sex that night he came at me.”
It was after that encounter that she had come and offered to work for me. She was way overqualified, and I needed someone only part-time, but she’d had it with the seediness of hospital politics and a lifetime of keeping its secrets. Working for me freed her for her husband, garden, and grandchildren. Yet now her voice had a steel in it I’d never heard before, but it left no doubt. If Kingsly had stirred such fury in this gentlewoman’s soul, the list of possible killers could have gotten a lot longer.
Except that secretaries and cleaning women didn’t know how to use cardiac needles.
“You know, Mrs. O’Hara, it’s exactly what I thought at first. But the autopsy didn’t show he’d been stabbed blindly by someone trying to keep him from attacking. It was done by someone with the knowledge and skill to needle a heart.”
She looked a little surprised, then thoughtful, and was about to say something when my first patient arrived.
General practice is the minutia of medicine. Blood pressure checks, controlling angina, healing ulcers, managing pain, consoling, comforting, and above all listening. It’s the opposite of attempts to save a life in a matter of minutes. In general practice, patients’ stories are told at the pace of life unfolding. The visits and checkups over the years slowly reveal more than sickness and health.
I marveled at the courage, humor, and toughness of some of my patients who had survived great losses and yet managed to have fun between the disasters. Calamities hit everyone, but these special few showed me that escaping from a life of melancholy to a world of laughter and friends was sometimes a matter of choice. Even the uneventful lives with no big upheavals were fascinating. Visit by visit, a glimpse at a time, I came to know who lived with vigor and joy and who just moodily endured.
The slow pace of the afternoon was restorative. Who was healer and who was healed blurred. As three o’clock approached, however, the distant howl of ambulance sirens began penetrating the inner calm of my office. Each was a r
eminder that emergency was still getting hit and I was due back soon. The last patient barely got my attention.
At 3:01 my phone rang. I’d taught our doctors and nurses enough that emergency could solve its own problems and leave me uninterrupted when I was at my private office two times a week. Today the deal ended at three. “You on your way?” Susanne asked. No effort wasted; no need to identify herself.
“Nah! I got tickets to Cuba instead.”
“Must be the same flight I’m on. See you.”
* * * *
Ten seconds in the place and I wanted to resign. Stretchers ran double down both sides of the hall. I could barely pass. The stench of body dirt had trebled since the day before, and the noise was worse. There was nothing I could even pretend to do, and it scared me. Waiting relatives were looking at me with the expectancy that here was someone, finally, who was in charge and could allay their fears.
“Holy shit!” was all I could say. It wasn’t Churchillian.
In seconds they had reached the consensus that I was as useless as I felt, so they went back to arguing with the nurses and doctors. That freed me to start getting mad. I lit out down the corridor of reaching hands and sheeted misery and blasted open my outer office door so hard, Carole jumped and tangled herself in a Dictaphone wire.
“Get me that lawyer in Albany I talked to yesterday,” I ordered while marching into my office. “If he’s not in, tell them I need him now, even if he hasn’t finished lunch.” Then I dialed Hurst on my other line.
“Office of Dr. Paul Hur—
“This is Garnet in emergency,” I blurted out without letting his secretary finish. “Tell him to get down here now!”
“I’m sorry. Dr. Garnet, but he’s in a meeting with senior management, and I couldn’t possibly interrupt—”
“Get him to emergency in two minutes or he can senior-manage my calling the media and warning the public away from this meltdown!” I slammed down the phone before the gasp. Carole was at the door indicating she had the lawyer on the line. She discreetly reminded me of his name before I punched the button to speak with him.
“Bill! Earl Garnet here. About that problem I asked you about yesterday. It’s really hit the fan and I’ve got to move. Any luck?”
His answer started with “Well, here’s what I found.” The next few minutes were taken up by my saying “yeah” a lot and scribbling a few notes.
At the end I asked for a formal letter containing the substance of our conversation and thanked him. I meant it. He’d just given me the weapon I needed.
Back in the corridor I saw Hurst surrounded by the same desperate clutch of patients, husbands, wives, lovers, children, and friends of patients who justifiably had found me of no use before. While he worked his kind, concerned routine, I caught his eye and gave a mock salute, and left him there. I could sense his hatred pelting my back all the way out the door, where I quickly felt a lot less cocky. I hadn’t seen Hurst since Sean had voiced his suspicions and expanded my own wild speculations about him as well, but instinctively I feared him now. I’d no new inkling whether he had murdered Kingsly, or was taking our usual political skirmishes to a new extreme for some other hidden reason. Nor had I any better idea what he was capable of doing to me, or what he was up to. But until I knew why he had tried to make me a suspect, even challenging him on the bed cuts could be dangerous.
I didn’t have any destination at the moment, just the intent to let Hurst simmer in the mess he’d helped create while I planned my next move and the best way to use what our insurance agency lawyer had given me. Suddenly I realized my name was coming over the PA. I got to a wall phone and learned that Watts wanted to see me in his lab. I waited while they transferred me through to his private line.
“Earl?” he said on picking up.
“Yeah, Robert, what’s up?”
“Are you busy?”
“Am I ever. I’ve got a meltdown in the ER, and I just suckered Hurst into an unscheduled meeting with all our angry users. Let him explain budgets and bed closures.”
“I think you’d better come down here and see something.”
“Hey, Robert, I always learn from your sessions, but this just isn’t a good time.”
“You’ve got to see this now!” he said abruptly, and hung up.
It was unusual for Robert to press. Immediately worried, I walked quickly to the elevator, found it an inordinately long wait, and took the stairs instead. As I descended to the basement, then trudged through the tunnel passages that led to the autopsy room, I wondered with increasing dread what my usually friendly mentor wanted to show me that was so urgent.
Watts and I had grown to respect each other’s clinical skills, having met regularly about cases over the past twenty years. During the last eight, we’d managed to kid each other through the absurdities of hospital politics as well. In the interludes, with a comment here, a joke there, we had become friends of sorts, not close, but still friends. I knew he loved sailing and planned to escape to it when he retired. His last child had left home years ago and recently had started a surgical residency. One time, waiting for some useless meeting to begin, he’d leaned over and announced, “My wife and I were alone in the house for the first time in thirty years last night. It was weird.” Then, a little more than two years ago, his wife died. Colon cancer. Widespread metastases. She was dead within three months of the diagnosis.
I had found it hard to comfort him. His broad shoulders so bent with pain brought a lump to my throat. What could I say? Finally, I had chosen the ancient Irish phrase I’d heard from farmers at my father’s funeral: “I’m sorry for your troubles.”
His gray eyes had filled with tears, and he’d turned away. A week later he was back at work. We never spoke of it again.
These patches of insight made a collage more than a portrait. I didn’t really know him. But we faced pain and death together, and we exposed our triumphs and failures to each other. Now and then, when it was most needed, we told each other, “You did good.” Watts was a guy I laughed with, a guy I liked a lot.
He met me at the door of his autopsy suite in full protective garb and made me stop by the lockers in the changing area to replace my white coat with a green OR gown. I also put on a mask, pulled on a hair cap, and slid a pair of paper slippers over my shoes. He advised me we wouldn’t be cutting tissue, so I needn’t put protective goggles over my glasses, but that I should double-glove for handling organs. Since the resurgence of antibiotic-resistant tuberculosis in America’s inner cities, most of these precautions were protection against airborne organisms as well as parenteral agents such as the viruses causing AIDS or hepatitis. We would also practice reverse isolation on the way out, carefully depositing our protective garb in a bin at the door, to avoid carrying lethal strains of anything into the rest of the hospital.
Stepping into the brightly lit autopsy suite, I noted he had two corpses there, and both were cut open. The insides of the bodies looked the same, the postmortem having reduced them to basic colors. Their trunks were slit from the top of the breastbone to the pubis and the halves spread to expose two red pods streaked with yellow fat and white sinew. The lungs were blue with pollution, and in each abdominal cavity a purple liver and an ochre spleen lay atop a glistening tangle of intestines. On one, the breasts had been parted and laid to each side. On the other, a limp and bedraggled penis hung down between withered legs.
The heart had been removed from the male, but was left in place in the female.
Watts hadn’t yet opened the craniums, but in the male, the scalp had been given an incision around the back of the head and peeled over his face. A small circular bone saw lay on a nearby instrument table ready for use. On the left-hand counter by the male were two rows of labeled tubes and small specimen jars containing various body fluids ready for toxicologic testing. Other bottles stood empty and would be used for tissue samples taken later. An open Tupperware container in the bottom of one of the deep sinks held the removed heart. More co
ntainers were stacked on wall shelves and would eventually hold other vital organs. On the right-hand counter by the female lay a complete set of tubes and jars, still empty. Over each dissecting table, large venting hoods hummed, doing their best, but the fumes of formaldehyde and other toxic reagents stung my eyes. And, in spite of my mask, there was, of course, the smell of dead flesh.
But I was puzzled. It looked like he was partway through a complete autopsy on me male, then stopped, and had done only a partial “limited look” at me heart, lungs, and abdominal cavity of the female. I waited for him to explain.
Watts pointed to the female. ‘This is the Jane Doe you got yesterday,” he began in his familiar, professorial way. “And this,” he added, turning to the male, “is the John Doe from Monday.”
He caught my surprise.
“I know,” he continued, sounding abject, “I didn’t take your concern about the mark on his chest seriously. But when we got the Jane Doe yesterday, I called the medical examiner and he confirmed there really have been too many of these DOAs all over the city lately. He’s going to start having all the hospitals look closely at them. Since I had John here on ice as well, the ME said to give him a thorough autopsy.” He was putting a heavy apron on as he talked.
“There was nothing unusual on Jane there.” He nodded toward her corpse. Then he leaned over John and reached into his chest cavity to what was left of the cut-open sternum, or breastbone.
I was getting a funny feeling.
Watts was folding back in place the two halves of the chest wall he had cut open to start the post. There, like a dancing marionette wire, quivered a thin stylet identical to the one he’d used earlier to trace Kingsly’s mortal wound.
“Unfortunately, Earl, you were right. That small mark you noticed was a scab over a puncture mark. Except the needle had been inserted and withdrawn cleanly, unlike in Kingsly’s case, so it was even less perceptible. I doubt anyone else but you would have noticed it, even after Kingsly’s murder. I feel like a fool for having ridiculed you, because right now we have to assume it’s possible the chief executive officer of this hospital and this down-and-out homeless John Doe were both murdered with a needle to the heart, and I delayed the police finding out by forty-eight hours.”
Lethal Practice Page 13
