“It’s something plus staph,” Len replied grimly after a few more seconds. “It’ll take a microscopic examination of tissue samples to determine the exact sequence for sure.” He paused, looking back down at the grisly specimen he still held. “But one thing’s certain,” he went on, his voice regaining its usual authority, “staphylococcus wouldn’t get this big a toehold on an intact lung, even a smoker’s lung, without some process first attacking the pulmonary tree and making breaks in the lining through which the staph could penetrate.”
“Like Legionella?” I repeated.
“Really, Garnet,” interrupted Rossit, “will you drop your obsession with bizarre scenarios—”
“I think Legionella is a hell of a good clinical suggestion, Gary,” declared Len, placing the lung in one of the plastic containers, then stepping around from his side of the table and coming to stand over a considerably startled looking Rossit. “Dr. Garnet was incredibly astute to recognize from the beginning we might be dealing with two separate organisms here,” he continued, his usually taciturn voice rising. “And as for ‘bizarre scenarios,’ this case is already bizarre!” he bellowed.
I could see Rossit’s chin flutter overtime under his mask— whether trying to swallow or find words, I couldn’t tell. His forehead and neck flushed an even deeper crimson than when he’d first seen me at the start of the autopsy. He made a few more attempts behind his mask at whatever he was trying to do with his mouth, then spun around and strode from the room.
Len stood with his hands on his hips, somehow looking bigger as he watched the vanquished little man disappear between the swinging doors. “Like I told you, Rossit,” he muttered, “here you’re on my turf, and this is my case!”
“I wish I’d done that,” I said cheerfully, stepping up and patting him on the back. “Just watching you felt terrific.”
“Oh, Earl,” he exclaimed, turning and looking at me, as if he’d forgotten I was in the room. “Sorry for the outburst.”
“I want to thank you for standing up for me,” I told him. “I was beginning to fear I might not get a fair hearing. Rossit’s been on my case big time since I...well...” I paused and looked over at Phyllis Sanders’s corpse. Staring at her eviscerated trunk with the severed rib ends bent outward, I felt a sudden letdown and realized whatever petty little battle I’d won here just now with Rossit hadn’t really mattered, because no matter what else Gary Rossit might try to pin on me, what I had to answer for in Death Rounds wouldn’t change.
“...since I sent her home,” I finally said, trying to keep my voice from betraying how morose I felt, putting my guilt into words. Her disfigured body made me remember how she had stared at me in ER. Look at what you’ve done!
Len stepped back to the autopsy table. There was a great deal of work to be done yet.
“Don’t worry,” he answered, beginning to cut free the left lung. ‘That little bastard won’t use me, this department, or Death Rounds to railroad you or anyone else if I can help it. That’s why I put him on the spot—a reminder that questions about the management of this case could be asked of him as well as by him. If we’re right and there are two major infectious processes here, he’s not only going to have to explain why he didn’t catch on but why he was haranguing the one physician who did. And if our tissue samples confirm Legionella, you’re going to come out of this looking like a genius,” he declared enthusiastically as he carefully placed the left lung on his scale.
A genius with a dead patient, very possibly a murdered patient. Dare I tell Len?
All I had were Janet’s remarkable observations and a creepy tale about a figure in the dark. In medicine we called such evidence anecdotal. Interesting and sometimes considered, it usually didn’t count for much.
Better stick to the plan, I thought. Get into University Hospital as soon as possible and find some real proof. An idea suddenly occurred to me. “Is this infection unusual enough for us to warn UH about it right away?”
He didn’t answer immediately. “It’s the possible combination of organisms that’s strange here,” he finally replied. “I’ve seen Legionella by itself kill in twenty-four hours, and staph pneumonia can certainly be lethal within forty-eight hours, but having them together? I never heard of it.”
“But should we warn UH about what we found now?” I repeated, hoping that an alert about two such serious organisms would force University Hospital to allow Michael to add people—including me—to his investigation.
Len stared over at the right lung lying in one of the Tupperware containers. “Not right away,” he said at last. “At least not until we get full culture and sensitivity results, and not until I see tissue samples under a microscope. If we are dealing with MRSA or Legionella or both, then immediately state health gets involved, and they’ll be jumping all over UH and St. Paul’s in a big way. To raise all those alarms with everyone just on the appearance of her lungs . ..” He shrugged, then added, “But I’ve got to admit—so much tissue damage so fast...” He shook his head and went back to slicing off the different specimens he’d need to solve the riddle.
Damn! Maybe I should haul Michael in here myself, I thought, force him to look at the telltale organs, and let them frighten him into listening. But the gory things weren’t finished with me yet. A terrifying question shot through me like a chill. Was this what the person who’ d come padding toward me in the dark had intended for me? Or Janet, if I hadn’t come looking for her? Might her lungs have ended up like the specimens in front of me, infected and devoured from within?
I wanted out of the autopsy room. I wanted to get away from Phyllis Sanders’s remains and call Janet. Maybe she shouldn’t even be at UH working until we had figured out what was going on or unmasked whoever was prowling around in the subbasement. Then I remembered all three nurses became ill while away from the hospital and felt even more at a loss what to do.
But I slowed my breathing and forced myself to focus instead on a final question I had meant to ask Len. It had nothing to do with Janet, but I still wanted to know.
“How did Rossit get you to give this case such an early date in Death Rounds?” I asked him point-blank.
He looked up from his cutting, an annoyed frown underlined by the top of his mask. “For Christ’s sake, give us some credit. Earl!” he ordered gruffly. “Rossit didn’t. He knew we wouldn’t go along with him, so he convinced somebody else whom we had to listen to.”
“What do you mean?” I asked, truly puzzled.
“Hey, I’m supposed to be the guy around here with no political smarts, but even I could figure that one out.”
“Len, what the hell are you talking about?”
“There’s one other person in this hospital who was hot to put you on trial for this case, and Rossit knew we couldn’t refuse him.”
“Who’s that?” I asked, my mouth going dry.
“Your good friend Paul Hurst, our acting CEO. Hurst ordered us to put Sanders on Death Rounds for Monday.”
Chapter 8
“It’s only a presumptive diagnosis, Janet, until we get confirmation by culture results,” I told her over the phone. I’d gone back to my office after the autopsy and finally tracked her down between deliveries in the UH birthing center. “But Len Gardner is certain there was a preliminary infection prior to the staphylococcus, and Legionella’s a good bet.”
“How’d Rossit like that?” she asked, her sarcasm evident.
“Speechless!”
“Does that solve your problem with him?”
“Not really. I found out he’s linked up with Hurst to nail me at Death Rounds.”
“What! How’d you find that out?”
I told her about the call Len had gotten from Hurst.
“Jesus Christ,” she exclaimed. “Rossit and Hurst—those two lizards deserve each other. But if you were right about the diagnosis, won’t that shut them up?”
“It’ll take some of the steam out of Rossit, but I did send the woman home, Janet. He’ll push t
hat to the max, and whichever way you dress it up, at the very least I made a lethal error in judgment. As for Hurst, well, you know how dangerous he can be if anyone or anything threatens the good name of St. Paul’s. He’d love to get rid of me at the best of times, so I’m sure he’d be particularly willing to throw me to the wolves over this.”
Complete silence was Janet’s answer to that reminder. Hurst had once gone as far as to make me a suspect in a homicide investigation at St. Paul’s to divert the police from discovering some of the more sleazy secrets in the place. As things turned out, the real killer was eventually discovered, but I’d exposed just how ruthless Hurst could be in pursuing whatever he thought would protect the hospital’s reputation and his place of power. We’d been wary enemies ever since and probably would remain so for life.
“It stinks!” Janet said vehemently, interrupting my gloomy musings. “How can Hurst get away with that kind of crap? Why don’t all the other wienies who call themselves chiefs over there stand up to him? Are you and Sean the only two with...”
Her outburst went on for more than a minute. Whenever she sprang to my defense like that, it meant she thought I was in a lot of trouble. But right now I was a whole lot more worried about her safety than my career.
“.., more women on that council of yours would put an end to his smarmy nonsense—”
“Janet,” I interrupted, “the only important thing right now is what’s going on at your hospital. I’m even beginning to think it’s dangerous for you to continue working there.” I hadn’t intended to blurt out my worst fears. But I kept seeing Sanders’s corpse, and I couldn’t shake the sounds of that creeping figure in the dark. My pacing the carpet last night hadn’t helped either. I’d imagined enough “what if” nightmares for a Wes Craven festival.
“Earl!” she exclaimed, sounding appalled, “I couldn’t leave my practice!” Her silence made me feel I should have known better. “Besides,” she added in a much softer voice, “those nurses became ill away from the hospital.”
Startled to hear her echo my own thoughts from earlier that morning, I reexperienced the same panicky fear I’d had then; there was no safe place for her. I felt my courage collapsing in a rush.
“Don’t think I haven’t taken precautions,” she quickly added, “and Cam’s insisting everybody in the hospital pay strict attention to isolation procedures until this business is sorted out.”
I wasn’t at all reassured, and Janet must have sensed it.
“Look, Earl, there’s nowhere we can run to,” she persisted. “Our best chance is to see if we can find out how those two women were killed. There’s got to be a common link, someone with a connection to all those cases.”
It sounded hopeless. “But you couldn’t find it. That may mean it’s not there.”
“I won’t accept that until you go over the files of the Phantom’s victims with me.” Her voice was getting a clipped edge to it that warned she was digging in her heels.
But out of fear, I could be stubborn too. “Hell,” I persisted, “if there was something incriminating in those files, they may have been stolen last night.”
“They’re fine. I checked first thing this morning after I had the same worry.”
The thought of her going back down to that basement, even during the day, abruptly refilled my head with nightmares.
“Janet! I thought we had a deal! You agreed you wouldn’t do anything alone—”
“Relax. I had security accompany me to open the room.”
I tried another tack to dissuade her. “Well then, if those records held such incriminating evidence, don’t you think whoever’s behind this would have taken them last night to keep you from looking at them anymore? Maybe the fact he left them is proof that further checking is pointless.”
“Maybe he couldn’t risk going back to get them, what with all the excitement you caused down there and electricians prowling around the place,” she replied sweetly.
I knew I wasn’t going to budge her. Her determination was steel once she made up her mind about something important. Clearly she’d decided we were continuing the hunt.
She listened to my silence for a moment, then added, “Earl, I know last night scared you, deeply, just as it scared me. And the autopsy today must have been gruesome for you. I can only guess at how all that has left you terribly frightened for me.”
She paused, giving me time to mutter, “You got me pegged again, lady.”
“But I’m not being stupid,” she continued, ignoring the wisecrack. “One thing I’ve done today is broadcast that Michael and I found nothing. I’ve told everyone here that the investigation was a complete waste of time and that’s why I’m back at work. Even what happened at the elevator, I said, was the result of your imagining noises and having a panic attack.”
“What!” I couldn’t believe I’d heard her right. “Janet! You didn’t,” I protested. “I don’t want people at UH thinking I get panic attacks. I’m a chief of ER, for Christ’s sake. Wild Bill Tippet will have a field day teasing—”
“Well excuse me!” she interrupted, laughing. “One minute you’re worried about my life, but the next, your reputation takes a little ding, and you get all upset!”
She’d gotten me. “I’m not upset,” I objected, feeling foolish. But within seconds I’d joined her in laughing at myself. With one yank of my own ego she’d distracted me out of my fear. For a brief moment I felt my anxiety lessen a notch. God, she knew how to handle me.
“Good, because it’s a small price to pay,” she concluded. “Now, whoever’s behind the infections won’t see you or me as a threat.”
Still pretty thin protection, I thought. But thanks to Janet, I was a little calmer. Maybe I was prone to panic attacks. If so, Janet was a better remedy than Ativan any day.
“Have you talked to Michael yet?” she asked in a firm voice, making it clear we were switching away from the topic of her safety. Part of her remarkable spirit was her capacity to not dwell on a problem that nothing more could be done about for the moment. “Things we cannot change,” she would repeatedly remind me when I bogged down in worry that was futile. It was one of the ways she had of finding enough courage for us both.
“No, I’ m phoning him right now,” I replied. Determined to match her bravery, I added, “Either he lets me in officially, or I do a B&E on all your records tonight.”
“Not alone you won’t!” she snapped. “Our deal goes both ways.”
“Hey, just kidding,” I answered. “There’s no way I’d go back into that basement by myself.” But I’ d thought about it if Michael balked on me and if that’s what it was going to take to identify a murderer. Along with the return of my nerve came resignation. Until this killer was caught, neither Janet nor I could be safe. I said good-bye, then tried to reach Michael through locating. They couldn’t find him.
* * * *
By midafternoon I’d worked through the usual menu of a busy day in ER—heart attacks, asthmatics, hemorrhagic shock, and a half-dozen complaints of abdominal pain. The MVAs had kept rolling in, a few strokes arrived, and the psychiatric emergencies—some of them violent—were many, due to the storm. Between these big cases were the legions of minor problems, everything from colds to VD. But it was a good thing no one asked me the patients’ names. I’d like to think I’d been kind and reassuring, yet in the heat of restoring breath, restarting a stalled heart, or replenishing lost blood, I remained obsessed with Janet’s safety.
I returned to my office again and again to try to reach Michael but each time had no luck. I kept wondering if I should head over to UH after my shift to look for him. Sitting at my desk, puzzling over what to do, I absently flipped through a pile of mail my secretary had left for me. Most pieces—notices of various meetings, bureaucratic shuffles, receptions— I tossed into the recycling bin. I’d scrupulously attended all these things in my greener years but long since learned they were a total waste of time. However, today a memo intended to summon me to a specia
l meeting at 4:00 that afternoon, with hospital physicians, the chiefs, and Hurst regarding “the pending amalgamation and the growing dissent of the medical staff at St. Paul’s” caught my interest, especially the sole item on the agenda: a threat from physicians to withdraw services if the merger process continued.
Maybe Hurst had finally gone too far, I thought. He could play us off one against the other individually and had done so successfully for years, but perhaps with all the doctors angry at him at once about the same thing, he’d be in for a rough ride. Maybe some of the wienies Janet had alluded to were finally going to stand up to him.
My phone interrupted this fantasy. Hoping it was Michael, I answered before the first ring was complete. “Yes?”
“Dr. Garnet?” was the startled response. I recognized the voice of one of the residents.
“I’m sorry, I thought you were someone else,” I explained. “What can I do for you?”
“Well,” she started, sounding embarrassed. “We’re all waiting for you in the classroom. You’re supposed to give us a talk at three today?”
Shit!
I quickly glanced at my calendar and saw I was scheduled to give the residents a session on “The weak and dizzy patient in ER” from 2:45 until 4:00. My watch said I was already a quarter of an hour late.
“Yes, on dizziness, right? I’m just getting my notes together,” I lied. “Tell the others to have a coffee and I’ll be with you in five minutes.”
We plan such seminars weeks in advance, and it was a topic for which I’d already built up quite a file of teaching cases. I’d even planned on including Phyllis Sanders’s story to demonstrate the importance of checking for orthostatic hypotension and at least ensure others would learn from my mistake. But today the whole thing had slipped my mind.
I’d need her chest films, I thought as I headed for the door. They were probably still in pathology. Len would have used them to correlate the radiology findings with what he discovered in the lung itself. I decided on the run that I’d pass by the morgue and retrieve them before meeting the residents. Damn Michael anyway! Why couldn’t I reach him? Not knowing if he’d now agree to let me help Janet was one of the reasons I was so distracted.
Death Rounds Page 10
