Death Rounds

by Peter Clement

  The transformation in Madge was instantaneous. “Oh my gosh, you’re Janet’s husband. You should have told me, Mr. Graceton, I mean. Dr. Garnet,” she gushed, beaming me a warm smile. “I’ve heard so much about you.” Then she flushed and turned to Janet. “I’m terribly sorry about being so abrupt, but when he asked for Dr. Popovitch—”

  “Hey, think nothing of it, Madge. I treat him like that all the time.” Janet chuckled, putting the poor lady at ease. “I’ll take responsibility for him,” she further reassured her, leading me by the arm through a nearby, unmarked door.

  “Nice meeting you, Madge,” I called over my shoulder, letting myself be dragged along, presumably into the records department. The smile I got back from Madge let me know that the woman had no doubt Janet would keep me in line.

  “What are you doing here?” I asked as soon as we were out of sight and walking through rows of filing cabinets.

  “I phoned Cam this morning and got him to assign me to work with Michael. I figured it was the best way to check out what we were up against.” She sounded nonchalant, but I felt a stab of alarm at her revelation. To have rousted Cam out of bed and then insist on taking time from her busy practice to work on the audit meant that her Phantom idea must be disturbing her as much as it disturbed me.

  “Did you tell Cam about what you thought about the three nurses—”

  “Of course!” she cut me off, sounding annoyed. “The silly man told me I was nuts. He actually ordered me to keep my mouth shut about it, as if I didn’t know enough not to panic the whole hospital. He certainly won’t listen until we get some solid proof about what’s going on.” She was leading me around a corner and toward a small table where I could see Michael studying a chart.

  He looked up at the sound of our approaching voices.

  “Does this guy know?” I asked, smiling at his surprised expression when he saw me.

  A few minutes later, we’d also failed to convince him.

  “Listen, you two,” he replied, frowning deeply, “how the hell can Legionella be transmitted at will? And the idea that it’s being used as a weapon in some weird vendetta is crazy! Beyond crazy! I’m surprised at both of you,” he scolded. “The last thing we need are sensational rumors.”

  The three of us were huddled together around his table—more a desk meant for two—and we were speaking in terse whispers in case Madge or anyone else entered unexpectedly. Michael kept looking nervously over his shoulder, apparently more worried about being overheard than about what we’d said. At one point all of us thought we could hear someone in the rows of files behind us. Thinking it was Madge or one of the nurses, we immediately hushed up, but when I went to check, no one was there.

  “And so what if all three women had complaints against them,” he continued to scoff. “That puts them in the same company, unfortunately, with a lot of doctors and nurses.” Turning to me he added, “Christ, when you’re away and I’m acting as chief, there’s at least one letter a week against someone or another in our department who was stupid, callous, or rude.”

  “Michael, these women were systematically cruel,” countered Janet. “Cruel in a way that’s hard to catch, easy to deny, and almost impossible to prove. But the patients know, Michael. They’re the ones who clued me in. Over and over, they told me the same basic complaint; they were made to feel humiliated, helpless, and a burden in a hundred nasty little ways by those three nurses.”

  “So they were women who pissed patients off. Hell, like I said, that’s apt to get them reported, not killed,” snapped Michael. He was becoming increasingly impatient. “Aren’t there other nurses your patients haven’t liked? They didn’t get Legionella.”

  “These nurses pissed people off in a certain way,” Janet shot back, her frustration equally obvious.

  “So why haven’t these three got a high number of complaints against them in common? That at least would be something objective to link them together.”

  Janet leaned forward and stabbed at him with her finger. “Michael, I’ll bet you’ve had similar trouble with lots of residents who, when they’re angry about something or somebody, take it out on their patients—maybe they rip a dressing off a little too aggressively or catheterize someone too roughly—then say, ‘What did I do?’ You know the game they’re playing, Michael, and so do the patients, but let’s see you prove it. Most of my ladies didn’t even bother making a report. They simply vented their anger and swore they’d sign themselves out the next time one of those three came near them.”

  Michael threw his hands up. “Janet, do you know what people will say if you keep on with this? ‘Next you’ll be claiming a patient tried to kill those nurses with Legionella instead of registering a complaint against them.’“ His sarcasm was blistering even though he continued to whisper.

  Janet’s eyes flashed. It was time for me to intervene. “Hey, Michael,” I quickly admonished, “what the hell’s the matter with—”

  Janet waved me quiet. “What I’m saying, Michael,” she whispered back at him through clenched teeth, “is that three women have all come down with mysterious infections neither you nor anyone else can explain. One of them’s dead, one’s dying, and the only thing the three of them have in common is they like to punish patients!”

  Michael startled us both by slamming his hand down on the table, “What I’m saying, Janet, is that Earl can’t afford this kind of talk!” he thundered.

  She jerked back from him, stunned.

  He glared at me. “Don’t you realize how much trouble you’re in? Hell, half of last night’s shift at St. Paul’s does. I found out when I got home from Cam Mackie’s meeting and discovered I had an urgent message to call Susanne.” He took a breath and then exhaled it slowly as he used to do with cigarette smoke before he quit. “Rossit seems to be coming down on you a lot harder than you initially realized,” he stated. His frown deepened, but from what I now suspected was concern, not anger.

  “Susanne told me about the run he took at you in ICU,” he continued, speaking low and quickly, “and that you’d both put it down to his usual troublemaking. But by evening her nurses were hearing rumors that you were going to be charged with everything from missing vital signs through diagnostic errors to overprescribing antibiotics. Susanne was alarmed to the extent she thought you should be warned, yet felt uncomfortable calling you herself. I told her I’d speak to you this morning, but I’ve been lying awake half the night, unable to figure a way you can respond to what Rossit’s mounting against you. Besides that, I’ve already heard rumors here that the woman’s son. Miller, is equally stirred up and hostile as well. So for God’s sake, man, going overboard with crazy stories about phantoms is the worst thing you can do for your credibility right now!”

  I was staggered by the alarm in Michael’s voice. It was in such sharp contrast to his easy reassurances yesterday that all would be well. Nor had I expected Rossit’s lighting into me to grow into his leveling such damning broadsides against my reputation. That kind of assault was beyond the usual way he’d lit into others who’d misjudged an infection. Even Harold Miller’s being so outspoken about my incompetence shook me up, though God knows the man had cause.

  Taken together, all this bad-mouthing served as a supreme wake-up call. Rossit’s antics in ICU yesterday—his criticisms and threats of a hostile case review—were suddenly more chilling, more credible than they’d first seemed.

  Michael grasped both my shoulders and broke me out of my thoughts with a little shake. “I warn you. Earl,” he said, his voice sounding strained, “if you persist with this nonsense, you’ll hand Rossit and Miller your own head on a platter!”

  I glanced over at Janet. She now appeared more startled than angry.

  Chapter 6

  I pulled away from the parking lot of University Hospital and started driving toward St. Paul’s. The wipers slapped the rain back and forth more easily than before, like a pair of metronomes keeping time as I batted my thoughts around.

  I gl
anced in my rearview mirror and decided I’d learned a lot during my visit to the gray building that was receding into the mist. I certainly had a whole new understanding of how much trouble I was in. I also had to admit that it was clearly going to be difficult to pursue Janet’s suspicions about the Phantom and protect myself from Rossit at the same time.

  Particularly galling was that I’d absolutely no idea why Rossit was singling me out for such particularly vicious treatment in the first place. Damn him anyway, I thought, wondering how much damage the spiteful little man could do. To be honest, as much as I’d always considered him a loathsome nuisance and a nasty troublemaker, I’d never really believed until now that he’d be able to cause lasting harm to a physician of my standing.

  Working ER—being there day after day and pulling the tough cases through year after year—gives a doctor a certain status in a hospital. In my case I’d come to take it for granted that I didn’t have to prove myself anymore. I knew my clinical judgment and diagnostic skills carried a certain weight with my colleagues, and I was used to them turning to me for help when they or their patients were in trouble.

  In other words, for years I’d presumed my track record gave me immunity against having to defend myself in front of the likes of Rossit.

  Apparently not anymore.

  Could he actually help Miller convict me for negligence in a court of law? Miller’s behavior on the stairs and his mouthing off had made it pretty clear his bitterness hadn’t subsided any. Might the conviction lead to suspension, even a withdrawal of hospital privileges? I shivered and again felt a cold prickle of perspiration on my back.

  I focused on threading my car through the traffic to get to St. Paul’s as fast as I could but seemed to hit every red light on the way. Listening to the wipers tick off the time only increased my impatience at each stop.

  Michael had held fast to his theory that the Legionella cases must have originated from a source or case in the hospital that had been overlooked or missed. As lightning continued to send cracks through the morning gloom, part of me wanted to agree with him, wanted to dismiss the alarming possibility of a phantom as little more than a troubling fantasy fueled by thunderstorms, lack of steep, and too much caffeine.

  But I couldn’t. Each time I recalled Janet’s unyielding insistence that the three women had been attacked, my fears for her own safety made my stomach clench like a fist. Michael’s arguing with her about a lack of proof had only increased that foreboding. He no more had proof for his position than she did for hers. Until he found hard evidence of an undetected source of Legionella, connected the three nurses with that source, then explained how they’d all contracted the disease just before leaving on vacation, I was going to find Janet’s suspicions impossible to ignore.

  But my reasons for taking her suspicions seriously weren’t going to be enough to persuade others. No one would believe a murderer was on the loose simply because Janet had seen a trait of cruelty common to the three victims which everyone else had missed.

  Except, of course, the killer.

  Predictably, Janet and Michael had equally frustrated my concern for their safety. “If you’re probing the work of a maniac, it could be lethal,” I’d argued.

  Michael had scoffed some more, and Janet, once again seething at him, snapped, “With reactions like that, who else but me could do the job?”

  For my sake, they had at least promised not to fight anymore and to be careful. I’d ended up trying to ward off visions of someone prowling after them as they worked.

  Michael had readily accepted Janet’s help. No matter how much their perspectives differed, there was a lot of work to do. Charts of the infected nurses, charts of the patients those nurses had come in contact with, records outlining the ID investigation into possible sources of the Legionella organism—all had to be reviewed. But Michael rejected my offer to stay and look through files with them.

  “Are you kidding?” he’d exclaimed. “A lot of people were edgy about letting me snoop around.”

  “You know, amalgamation paranoia,” Janet had added, sounding resigned to agree with Michael on this point. “If you got caught, they’d shut down the audit and call us all spies.”

  As if to underline their caution, when I’d stopped at Madge’s desk to use her phone on the way out, I’d noticed a stack of files placed beside me with a piece of paper bearing Michael’s name on top. Waiting for St. Paul’s to answer, I’d been trying to see what the top folder contained, when a red-faced woman in a nurse’s uniform had whipped the entire pile away from me and off the counter. “Well!” she’d exclaimed and huffed off. Even Madge had protested, “Dr. Garnet!”

  “Sorry!” I’d pleaded, putting down the phone. “Force of habit. I always check my charts when I’m on hold in my own office. I didn’t see anything—honest! Hey, Madge, please don’t tell Janet!” I’d added, backing out of the room and trying to act the harmless husband that Janet had introduced me as.

  I smiled, recalling this performance, then quickly lost patience again as I missed yet another green light. But instead of once more sitting there and fuming over the slow pace, I thought of a call I could make. I dialed the number for our ICU.

  “It’s Dr. Garnet,” I announced when one of the nurses answered. “Could you tell me the status of Phyllis Sanders, please?” Had she survived the night was my real question.

  “One moment, I’ll give you the doctor who just saw her.”

  I braced myself. Normally a nurse would simply give me the report. Passing me on usually meant bad news.

  “Dr. Rossit here,” snapped the unpleasant voice.

  Shit!

  “Uh, it’s Dr. Garnet, Dr. Rossit. I just wanted to have the nurse give me a report—”

  “She’s as good as dead. Garnet. Calling in and wringing your hands over a near corpse isn’t going to make you any less negligent. And it sure isn’t going to make any difference when this case is reviewed. I promise you I’ll take care of that personally!”

  He was practically screaming, his voice crackling through the receiver and sounding ten times as venomous as what I’d endured yesterday. I could even hear him breathing hard over the noise of the rain. Christ! Susanne and Michael had been perfectly right. No matter how bad his reputation was, this was definitely over the top. Nailing me to the wall must be pretty lusty stuff for the little prick. A nasty afterthought flashed through my mind. Maybe his loathsome practice of hunting doctors who’d screwed up was the man’s substitute for sex—the result of small equipment.

  “Rossit, either keep this professional or get off the line and put somebody on who can!” I ordered. I knew that he’d had his own problems with the ethics committee as a result of other witch hunts he’d launched and been reprimanded several times for unprofessional conduct. However he planned to get me, I could at least make sure he was going to have to do it by the book.

  I listened as his breathing slowed down. “Now, Rossit!” I insisted. The light changed. I had trouble concentrating as I picked my way through the traffic. There was still no reply. I was about to hang up in disgust when I finally heard him say, “What do you want to know?”

  I want to know how she is, you asshole, I nearly screamed, but instead I replied coldly, “How are her vitals?”

  “Not much change. Her systolic’s floating around ninety, the central pressure’s still down, and despite the ventilator, she’s increasingly hypoxic with respiratory acidosis. Did I mention her bicarb’s falling by the hour? You can guess the rest—low white count; rising BUN, creatinine, and liver enzymes; decreasing urinary output—like I said, she’s kaput.”

  My anger at his callous description was quickly replaced by a sense of hopelessness. Rossit had described the laboratory findings of unchecked septic shock and circulatory failure. Her immunity was being wiped out, her respiratory function was deteriorating, and she was sliding into complete renal shutdown. I knew it was unlikely she’d ever regain consciousness. “What about a trial of rifampin?�
� I asked, knowing it would probably be a futile measure. Rifampin was an antibiotic initially used decades ago against TB. Some recent articles had suggested it was effective in nonresponsive cases of Legionella.

  The unguarded suggestion absolutely ended our truce. “Christ! You hand out drugs like candy!” he exploded.

  “What!” I exclaimed.

  “It’s hot dogs like you who are mostly responsible for drug-resistant infections in the first place!” he screamed. “From the beginning of this case you’ve shown a clear tendency to overuse antibiotics, and I intend to order a full chart review of your prescribing competency. Such abuse is the main cause of virulent new strains—”

  I hung up on him.

  * * * *

  I arrived back at St. Paul’s at 8:15. Casualties from a five-car pileup on the expressway inundated ER.

  “We need you in resus!” Susanne said, rushing by me with bags of blood under her arm.

  “Dr. Garnet,” called the clerk from the nursing station, waving a phone at me. “Dr. Carrington wants to know if you need him down here.”

  “Yes!” yelled Susanne, answering for me over her shoulder.

  I was pulling off my wet coat and running to catch up with her. “What have we got?”

  “Six casualties, two critical, this one’s the worst,” she summarized as we entered the tiled, echoing room where we managed major trauma. The chatter and noise matched the confusion. Residents and nurses in surgical greens were circled around the pale lifeless body of a middle-aged man, busily sticking him with needles and attaching him to a web of tubes, catheters, and monitor wires. A high white cervical collar immobilized his head and neck while a respiratory technician struggled to pass a ventilation tube through his nose and on down into his trachea. Yet another tube, this one transparent, was sticking out of his upper left side and draining pure blood into a bottle under the stretcher. These were all lifesaving procedures, but to the uninitiated, the scene might have been a tableau depicting the agony of torture.