Death Rounds

by Peter Clement

  I assumed Cam had questioned the ICU nurse who had survived. Yet, if Janet was the first to consider the infections were deliberately inflicted, then Cam hadn’t known the right questions to ask. What would be that nurse’s response now if she were prompted to consider the infection as an attack?

  She’d think we were loony, was my instant reply, because whatever unsavory personality trait the three nurses had shared, the possibility they were all victims of a resurrected phantom stopped cold at the same unsolved puzzle I’d started with—how could each of them have been infected?

  I got a third cup of coffee and mulled this over. Maybe it couldn’t be done. Maybe Janet was wrong, and the three women being nurses who were obnoxious was a fluke. To be honest, if anyone besides Janet had tried to suggest such a wild idea as a murderer being behind the Legionella mystery, I’d have laughed in his face. Yet there I was, unable to toss off the idea and not at all comfortable with the logic that it could not be done simply because I couldn’t figure out a way to infect three women. Janet’s instincts were too often proven right.

  She possessed a rare gift—a brilliant intellect combined with plain common sense—that made her judgments sound and her insights something I’d learned to listen to or ignore at my peril. In University Hospital, where her quick mind and clinical accuracy were legendary, she was regarded as a treasure and was especially known for her ability to look at the same symptoms and signs her colleagues had seen and to think what no one else had thought.

  They were all women who made people angry. The words kept rolling through my thoughts like the ever-increasing thunder overhead, and were joined by another idea. If she were right and the Legionella cases were somehow part of a macabre vendetta being carried out at her hospital, then asking questions about those cases could be dangerous. Should I warn Michael?

  By the time the rain began to pelt against the glass panes in front of me, my stomach was churning on enough caffeine for the entire day.

  * * * *

  Dawn was little more than a gray smudge in the east when I started out for St. Paul’s at 6:15. The downpour was deafening on my car roof. It had soaked Muffy in the moments she’d taken to do her business in the lane, but she’d enjoyed the extra toweling I’d given her drying her off. When we’d finished, she’d playfully pranced about my feet, then had pawed at a rubber ring that was her favorite toy, inviting me to throw it. I’d bought her off instead with a dog biscuit, but as she’d watched me go upstairs to check on Brendan before I left, the sudden droop in her ears and sad-eyed stare from her brown eyes had left no doubts about what she’d thought of the deal. The object of her jealousy had still been sleeping off his early morning feed. He’d not even stirred when I’d gently stroked his head. Before leaving, I’d given a gentle tap on the door of the nanny’s third-floor bedroom to warn her she was back in charge.

  As I drove, the deluge increased and the wipers worked more like paddles trying to keep the windshield clear of water. By the time I reached the entrance to the expressway for downtown Buffalo, I found myself leaning forward straining to see the other cars ahead of me. We were all poking along at low speed, and the sign on the visor reminded me I was likely to be killed by the air bag if I had a collision while driving hunched up in my current position.

  I pulled over and called St. Paul’s on my car phone. As I was waiting on the line, the battering from the rain suddenly became so noisy that I could barely hear when someone finally answered, “ER, Mrs. Cooper speaking.”

  “Mrs. Cooper, it’s Dr. Garnet,” I shouted over the din. “I’m on my way, but for the moment I’m stuck in the storm; it’s too hard to see so I pulled over. How are things there?”

  “We just got an MVA that should have done what you did,” she answered in a faraway voice. “Apart from that it’s quiet, but if the storm keeps up, we’re liable to get a lot more of the same.” MVA referred to a victim of a motor vehicle accident. Through the window I could make out a few cars that were on the side of the road like myself. The rest formed a line of red taillights crawling up the expressway ramp, but overhead most of the vehicles already on the highway sped past in a swirl of blinding spray, giving credence to her grim prediction.

  “Who’s on?” I asked, wondering if we had enough veterans lined up to handle the possible carnage.

  “Dr. Kradic’s in with the MVA now. We’re not sure who’s taking over for days. It was suppose to be Dr. Popovitch, but he left a message that he’d signed out his shifts to a number of the other doctors until the end of the week. Apparently he’s doing some kind of emergency audit at University Hospital. Your secretary’s supposed to give us the revised schedule this morning.”

  “Shit,” I muttered. I’d wanted to see Michael before he started poking around over there. I’d decided to warn him about Janet’s suspicions.

  “Pardon, Dr. Garnet. I didn’t hear what you said.”

  “It’s nothing, Mrs. Cooper, just me thinking out loud. Tell Susanne I’ll be in as soon as I can.”

  I rang off and quickly dialed Michael’s home number.

  “Don’t you two know the rest of the world sleeps now and then?” yawned his wife, Donna. She was a fun lady, about five years older than Michael, and had good-naturedly put up with my phone calls at atrocious hours for over a decade. She was also twenty weeks pregnant and a patient of Janet’s.

  “You think I’m a sleep disturber?” I answered. “Just wait until your own little bundle of joy arrives. My interruptions will seem like the good old days.”

  “Michael’s already left, Earl,” she answered with a chuckle. “He’s headed to University Hospital but said he wouldn’t be at any one extension once he got there. He told me to page him if I needed him.”

  “Thanks, Donna,” I said. “How are you doing?”

  “Janet says great. But it will be a relief to get the amnio over with.” Donna was referring to a scheduled amniocentesis—the withdrawal of amniotic fluid from her uterus through a long needle—routinely done on pregnant women who were thirty-five or older. The fetal cells floating in the fluid would be examined for chromosome defects—particularly 21 trisomy, or Down’s syndrome. I remembered Janet’s and my own worry waiting for the results. The incidence wasn’t common, but at one in two hundred, it wasn’t so rare as not to cause concern.

  “I know what waiting for that can be like,” I commiserated, unable to change the odds for her. They were obviously on her mind.

  “You men,” she snorted. “It’s us who get the needle, not you guys.”

  I laughed, appreciating her way with troubles—beating them back with wisecracks—and added, “Now you sound like Janet.”

  “Thanks. I’ll take that as a compliment. Say hi to her for me.” She hung up.

  Gusts of wind were buffeting the car as I called locating at University Hospital.

  “Hello, Dr. Garnet,” the operator said. “Shall I find Janet for you?”

  “No, I actually need one of my own guys who’s doing an audit there—Dr. Michael Popovitch.”

  “At this hour?” she queried.

  I glanced at my watch and saw it was only 6:35. “He may not have arrived yet, but would you try him anyway?” I asked. The rain peppering the sides of my car made it clear I wasn’t going anywhere for the moment.

  She was back on the line in less than a minute. “Security at the front desk has him signed in, but he’s not answering. Do you know where he is? He may not be hearing the page.”

  There were a number of possibilities where he might start—labs, staff health, the medical records department—but at this hour there wouldn’t be any secretaries or clerks around to help him. He may have chosen instead to log onto the hospital computer at a charting station in one of the many doctors’ lounges, taking advantage of the early hour before the system got too busy. “No,” I answered, “he could be anywhere. Would you mind trying again later?” I gave her my cellular number.

  Visibility was still lousy, and the drumming sound of the
rain was unrelenting. Should I drop by UH and try to find him? I wanted to get to St. Paul’s as soon as possible. I wasn’t scheduled to see patients this morning, but my job as chief meant I was the ultimate backup—twenty-four hours a day. While all our physicians were competent to manage patients, not everyone—especially not rookies—could manage the department in a crisis. Without knowing yet who was coming in for the day shift, it was better I be there in case Mrs. Cooper was right and the load got heavy. One pileup, and we could be overrun.

  But the thought of Michael poking around UH completely unaware of Janet’s suspicions left me uneasy. Besides, the hospital was less than ten minutes away, and unlike St. Paul’s, which was downtown, it could be reached easily without using the freeway. I swung back out onto the road, bypassed the on-ramp, and headed toward a route Janet had taught me through quiet, still-deserted city streets.

  Driving onto the large grounds of University Hospital was like a trip back to the turn of the century. The sprawling stone institution, built in the towering gothic style favored by Buffalo’s early industrialists, had initially been a county hospital housing both the mentally and physically ill. It was surrounded by sweeping lawns under ancient shade trees that once had occupied a small army of gardeners and groundskeepers. Now many wings were shut down to save money, and the land was being auctioned off to developers.

  The hospital itself had been acquired by the university in the fifties, and the acute care portions had been renovated, rewired, and brought up to snuff for the sixties. The high risk areas—ER, ICU, the case room, and the ORs—had all been updated repeatedly since. But changing times, economies, and ideology had led to the gradual closing of the psychiatric portions of the building. Now they remained dark and unused, cold gray structures with bars on the windows that made me shudder. Janet once told me that some of the basement rooms in these sections had earthen floors, and the places where inmates had been chained to the wall were still visible.

  Cars were numerous as people were arriving to make the 7:00 start of sign-out rounds—the routine by which patients in hospitals the world over are handed off to the day shift. I used my university ID to get into the parking section for physicians, then ran for the front entrance with the rest of the staff—mostly nurses, residents, and orderlies, alongside the occasional doctor huddled in his or her lab coat. The rain wasn’t as heavy as before, but I managed to get pretty wet anyway. Searing flashes of lightning crackled overhead, and glancing up, I saw a light mist had wrapped itself around the upper stories of the hulking building. No wonder they’ve got a phantom, I thought, rushing through a massive arch that supported a pair of gargoyles at its corners. While they guarded the doorway from up there, down here two overweight security officers manning a metal detector were doing the best they could to keep evil from entering the premises.

  The high-domed foyer and marble floor inside belonged to the era when grand train stations had rivaled cathedrals and rail travel had held the height of promise for the city of Buffalo. The evocative construction had been a deliberate tribute to the railway barons who had provided the bulk of the money to build the place. Today, ironically, the structure was an unwitting memorial to what had been the real pride and joy of those same barons—the once magnificent Buffalo Central Station, now abandoned and disintegrating into ruin, along with so much else in the East Side section of the city.

  My leather soles slipped on the polished stone floor while others around me flapped umbrellas and shook off the water from their soggy overcoats. Pocketing my glasses, which had immediately steamed up, I headed over to the house phones and dialed locating.

  “This is a surprise,” commented the operator, realizing I was calling from inside the building. I didn’t often have cause to visit. My counterpart in ER here, William Tippet, was an insecure man ten years my junior who seemed to get nervous anytime I came around. As a result I stayed away as much as possible, and he kept joint meetings about our shared residency program to a minimum. It didn’t help any that the residents called him Wild Bill Tippet behind his back.

  “Yeah, it’s even a surprise to me. Did you ever locate Dr. Popovitch?”

  “Yes, I got off the phone with him a few minutes ago. We gave him your number, but he called back and said you weren’t answering.”

  I’d left my cell phone in the car, not wanting to use it in the hospital. He must have just missed me.

  “He’s now up in the records department for staff health. He said to put you through if you rang again. I can get him if you want, or are you going there in person?”

  “Just tell me where it is, and I’ll find him myself.” I got directions—third floor in one of the rear wings—and started out.

  The bustle of activity in the corridors was familiar to any teaching hospital. The clinicians who had been running alongside me moments earlier were now striding through the hallways followed by groups of sleepy-looking residents, interns, and medical students.

  Already the question-and-answer routine of clinical teaching had started. “What’s the most common cause of fever two days postop?” I heard one staff man snap as he swept by at the head of his procession. “Pneumonia!” called out someone a short distance behind him. “What kind?” continued the staff man. “Right upper lobe, from aspiration,” came an answer from a bit farther back in the line. “Any other ideas?” I couldn’t hear the reply as they moved out of earshot. The medical students hustling along at the rear were recognizable by the shortness of their clinical jackets and the number of reference manuals they kept stuffed in their pockets. Some were trying to thumb through the well-worn texts for answers as they hurried to keep up with the rest.

  Surgical patients from all over the hospital were being taken by stretcher to the OR for their early morning rendezvous with the knife. There was a lineup of them outside the elevator. Most were already beyond fear, snoozing under the effects of their preoperative sedation, but a few chatted nervously as they waited with the orderlies who were wheeling them to their fate. I used the stairs to save time.

  As I climbed, the door on the landing above me pushed open and yet another group of students in lab jackets started down the steps toward me. Their instructor was still out of sight behind them, but I could hear his voice.

  “. . . most still don’t order enough blood cultures or the right screening tests to reliably detect bacteremia...”

  I’d reflexively stepped aside to let the group pass when I suddenly recognized the voice at the same instant I saw the broad-shouldered figure in a white coat follow the others through the door.

  “You’ll find out a lot of doctors aren’t knowledgeable in their use of lab tests—” Miller was saying when he caught sight of me pressed against the wall. He froze, his mouth open in midsentence; then his eyes narrowed, becoming hard and hurt looking. He swallowed once and started down, saying nothing to me as he passed. “Like I was saying,” he continued, “as lab technicians you’ll often feel frustrated at the tests ordered by doctors…” He didn’t look back as he descended the rest of the stairs and strode out the door below.

  When he and his entourage were gone, I let my breath out. I hadn’t even been aware I’d been holding it. I felt a wave of perspiration prickle out of my skin. The pain in Miller’s eyes had been frightful.”

  * * * *

  Staff health turned out to be on the same floor as administration in this hospital. It was easy to tell which was which, even without following the arrows and signs. I knew I was headed for the section without the lush carpeting and oversized offices. The clinic was also the only area where some people were actually at work. If this hospital was like St. Paul’s, the gurus of management wouldn’t make a showing much before 8:00.

  At the front reception desk in the waiting room, clerks were busily sorting charts and preparing for the day. In the hallway behind them I could see nurses running in and out of a line of doorways carrying equipment trays, presumably stocking up the examining cubicles. A young man with crutches ho
bbled up to one of these nurses, who showed him into a room.

  Before stepping up to the counter, I had to pause.

  Miller’s single accusing stare had left me shaken. Feelings of guilt, regret, and disgust over my decision to send his mother home had flooded through me. I had to compose myself, force a smile, and keep control of my voice to speak with an assurance I definitely didn’t feel.

  A clerk looked up from her work and, seeing me standing in the entranceway, asked, “Do you have an appointment?”

  “No, I’m Dr. Garnet from St. Paul’s Hospital. I’m looking for Dr. Popovitch who’s supposed to be here doing an audit,” I explained, walking up to her.

  Her smile vanished immediately. “I’m sorry,” she said, frowning disapprovingly, “but Dr. Mackie told me we were only to let Dr. Popovitch and Dr. Graceton in to see our records.”

  That caught me by surprise. “Janet’s here?”

  The lady’s frown deepened. “Not yet, but Dr. Mackie called a few moments ago and told us to expect her as well. He didn’t say a word about you or anyone else. It’s quite irregular as it is, you know, looking at staff medical files even if it is a part of a hospital audit. If you are to be given access to our confidential records, I’m afraid it will be only on orders from Dr. Mackie.”

  “Look, I don’t want to see any charts.” I lied, but I had to reassure her. “I simply need to speak to Dr. Popovitch for a moment. It’s business. We’re colleagues at St. Paul’s and—”

  “It’s okay, Madge, he’s harmless,” said Janet’s voice from behind me. I hadn’t heard the elevator. She must have come up by the stairs the same way I had. She swept toward us, the crisp lab coat she wore over her wrinkled greens flowing after her like a cape. “Believe it or not,” she added, reaching me and fingering my own sodden coat, “this bedraggled specimen happens to be all I could come up with for a husband. Earl, meet Madge. She runs this place—has all the malingerers pegged even before the nurses and doctors get to them.”