Death Rounds

by Peter Clement

  Janet lifted her head from my chest and gently cradled my face in her hands. “Will you listen to yourself?” she said softly. “I know that it’s because you love me and that you’re frazzled by the fact I’ve been infected”—she took off my glasses, kissed me on my forehead above my mask—“and having had to rescue me from those doltish residents must have scared you silly.” She kissed me again, this time on my eyes, then brushed her lips across my ear while moving her mouth closer to my neck. “Will you listen to yourself?” She brought her head up, still clasping my face in her hands, and, staring me right in the eyes, said, “Come on, get off Cam’s case.”

  Before I could sputter an answer, I was startled by the sound of someone clearing his throat behind me.

  “Earl, you’ve got to let her rest,” said Cam from the entrance to the room. Sitting on the bed holding Janet, I’d been facing the other way and hadn’t seen him return. He was already in clean protective gear; that meant he must have been putting it on just outside the door while we were talking. His voice was polite, but his presence filled me with anxiety. As I stood up and looked at the man who had become such a dreadful enigma to me, I wondered how much he’d heard of our conversation.

  “I’m sorry, Cam,” I protested, making no attempt to hide my hostility, “but I need to talk with her, and under the circumstances—”

  “It’s okay, Earl, Cam’s right,” Janet cut me off. “You should go now and let me sleep. Kiss Brendan for me.” She was giving me an order. She pushed herself away and lay back on her pillow. I was disturbed by how drawn she looked.

  “That despicable nurse won’t bother you anymore, Janet,” Cam told her, speaking very quietly. “I’ve arranged for only our best ICU staff to take care of you from here on. Anything medical I’ll do myself, that is...” He let his voice trail off and looked sideways at me. “That is, if you still want me as your physician,” he concluded, turning his eyes back toward her.

  “Of course. Cam,” she said, sounding surprised but shooting me a warning glare, making it very clear I was to stay silent. “Who else would take care of me but you?”

  Cam glanced over at me again, and my stomach writhed like a bunch of cold snakes. But I stood there saying nothing, racked by confusion about what to do as much as gripped by panic. He in turn seemed to relax a notch and stepped closer to the bed. “That’s settled then,” he said, taking Janet’s hand in his.

  What if I confronted him, I wondered, tried to scare him off by throwing all my suspicions at him here and now, even without proof? How would he react?

  “I now order this beautiful woman to sleep,” he was proclaiming with a warm smile, “which is an important step in getting her back on her feet.” He’d reverted to the pleasant self-confident tone I was used to hearing when he’d kept me laughing at dinner parties.

  While Janet’s returning smile revealed how comforted she was by this brilliant physician’s physician, I felt warning bells going off throughout my head telling me to be very, very careful. Since she was staying put, if I opened my mouth and threatened him, I might end up placing her in more danger than if I kept quiet. Perhaps I’d already said too much if he’d eavesdropped on most of what I’d been saying to Janet before he came into the room.

  He straightened to his full height, gave her a friendly wink along with a final pat on her hand, and then turned toward me. As pleasant as his expression seemed, his eyes were hard as blue ice. “Now Earl,” he said quietly, gesturing to the door, “how about meeting me in my office after my clinical rounds, say, about eleven? I think you and I should have a chat about what happened at Death Rounds this morning.”

  Chapter 16

  I needed proof that Janet would believe, even if it pointed to Cam. I figured the best way to get it was to pursue my original plan—go back through the confidential files of University Hospital and find whatever Michael had discovered. Even if the pattern hadn’t told him who the killer was, that same evidence that had convinced him there was a killer could perhaps point Janet and me toward a name. Except now I’d have to somehow do an end run around Cam to get to those files.

  I decided to take my problem to the top, and in Janet’s hospital that meant I had to go down to the third floor and meet with Reginald Fosse, the CEO. His office was housed in the plush confines of the administration wing.

  While walking from ICU to the stairs and descending one flight, I worked out the details of what I would say. By the time I was striding over the thick carpets, my torn pant cuff flapping, I’d concocted a scheme made up of a bit of blackmail, a touch of bribery, and a whole lot of bluster.

  Reginald Fosse had diplomas for a master’s in business administration and a master’s in health-care administration hanging on his wall, but no M.D. As such he was part of the managerial breed that has taken over the running of hospitals in the United States during the past ten years. This group has served shareholders in publicly traded providers of health care well, but its impact on the health of the nation has been less clear. Every hospital it kept out of bankruptcy hasn’t necessarily been a victory for the sick, especially when it did it with disastrous money savers such as the ill-fated one-day-obstetrical-stay policy for a delivery. Janet had fought against that loopy idea, and Fosse, to his credit, had listened to reason before state legislation forced him to.

  He was a pleasant enough looking man. The top of his head was balding, he had a few strands of white hair that he kept combed over it, and his midriff bulged over his belt. But the grandfatherly wire-rimmed glasses he wore perched on the end of his nose made him seem comfortable with his middle age and his smile was full of warmth. He’d agreed to see me right away and expressed his concern about Janet, obviously having already been informed of her admission.

  A hospital CEO who is not an M.D. must rely on doctors for advice on medical issues and can end up feeling at a disadvantage against the brightest and best clinicians in the place. Nevertheless, smart CEOs will recruit the support of these doctors to obtain the soundest advice possible on medical matters, while keeping their own council for managerial decisions. Too often, however, out of insecurity, a nonphysician manager will try to exert his or her authority by battling doctors and blocking anyone with clinical competence from gaining too much political influence. These CEOs tend to surround themselves with wimps and weaklings and reap the inferior caliber of advice appropriate to such circles. Over the years, from Janet I’d learned Fosse leaned slightly toward this latter school of thought. As I took the chair he offered me in his sitting area, I thought of a way I might turn the tendency against him.

  Looking around, I found it hard not to admire the man’s office. The room was big, the rose-colored rug under my feet was thick, and his windows were full sized, though almost all I could see through them were the other wings of the hospital, a patch of the grounds, and beyond that, curling tar paper on the rooftops of nearby houses. His dark mahogany desk was about as large as the entire floor space in my own spartan work area back at St. Paul’s.

  The photos hanging beside Fosse’s two diplomas showed him smiling and shaking hands with a variety of people, none of whom I recognized. In most of them he was also holding up an oversized check with lots of zeros behind the first number, donations, presumably—often the only way to finance innovative programs, new construction, or state-of-the-art equipment now that the profits of Health Maintenance Organizations went more to Wall Street than into patient care.

  I thanked him for his concern about Janet and then in twenty minutes told him everything I knew about the Phantom: the events from two years ago, the Legionella infections of the nurses, Michael’s infection and his note, and Janet’s infection. Without other doctors around to inform him that I was crazy, my fantastic tale seemed to overwhelm him. During the telling of it he leaned more and more off the edge of his seat, and when I made it clear that I feared more attacks, a sheen of perspiration appeared on his scalp that turned his hairdo into a series of wet strings. I then implied that while
I didn’t have any evidence that I could take to the police, I’d have to report Michael’s illness and all that had happened here to the state accreditation board, so they could name a replacement for Michael. Even if they didn’t believe a killer was on the loose, I explained, once they learned of the infections, they’d be officially obliged to redo their accreditation.

  By the time I finished with him he looked thoroughly frazzled as well as frightened.

  “But why couldn’t we continue the search informally, the way Dr. Popovitch was doing for Dr. Mackie?” he blurted out after a few seconds. “If someone’s doing the hideous things you claim, we can’t wait for outsiders to get going on the problem. At least it would give us a chance to get at whatever Dr. Popovitch discovered and to see what we’re up against.” His tone was almost pleading, and while I’d no doubt his main priority was preventing further infections, I suspected he was also thinking a lot about damage control for his hospital’s reputation.

  I continued to set the hook. “Of course, that was my first preference,” I told him, “provided we moved quickly, but Dr. Mackie has adamantly refused even to consider the possibility that someone is infecting personnel in your hospital. He’s left me no choice.”

  Fosse blanched anew at this piece of news. “He’s what?”

  I told him about Cam’s reaction to my having tried to look at the files in the archives, without revealing my suspicions about Cam.

  “Jesus Christ!” he exclaimed after removing his glasses and rubbing his eyes. He looked increasingly troubled as I talked and didn’t even question how I’d gotten access.

  “May I make a suggestion?” I figured it was time for the bribe. “Since I’m going to be around here a lot on account of Janet, why not let me continue to go after the files Dr. Popovitch found? I’d be discreet and could report solely to you. You’d have to overrule Dr. Mackie, of course, but I don’t see you’ve got any choice.”

  His worried expression shifted into a mask of cool neutrality. Since he wasn’t a doctor, I guessed he’d never cross a physician as important as Cam without having at least some M.D.s from his own hospital lined up on his side of the argument. “Well, Dr. Garnet,” he began while the muscles in his face squirmed, “I appreciate the offer, but it’s a difficult time for you—”

  “I know how you can get another of your chiefs here to wholeheartedly back the plan,” I interrupted. I let him stare at me a few seconds, just to whet his appetite, before adding, “I’ll do anything to stop this killer, because until he’s stopped, I’m convinced Janet’s life is still at risk. Trying to convince the police or anyone else that he exists is hopeless unless I find whatever Dr. Popovitch discovered.” I wanted him to know what was at stake in case Cam tried to intimidate him into backtracking.

  Finally, having suitably prepared him, I offered what I felt certain neither he nor the chief I had in mind would refuse. “Here’s what I propose. Tell your chief of emergency, William Tippet, that I’ll support his being named the new joint chairperson of emergency medicine in return for his granting me temporary privileges in his department and appointing me to do a special audit. He can call it something vague, such as a joint project comparing mortality rates of ER cases common to both our hospitals. Unofficially he can play it down and say it’s really just a courtesy, meant to give me something to do while I stay near Janet. That should keep my poking around from raising too many eyebrows and would give you the reasons you’d need to counter any howls of protest from Dr. Mackie. It won’t fool him, but he won’t be able to give you much heat either.”

  Fosse looked interested. I knew William Tippet would jump at the chance to be overall chairperson. Wild Bill’s longtime insecurity around me would make the opportunity to finally prevail irresistible to him. And Fosse himself would much prefer one of his wimps to be chairperson of a key department like ER. At this stage, neither of them would have any idea Hurst was in the process of dumping me anyway.

  “I’ll speak with Tippet,” he said after a few seconds. “Where can I reach you?”

  I gave him my numbers. While I was shaking hands with him at the door to his office, I asked, “By the way, do you know of any reason why Dr. Mackie should be so defensive about the Phantom story?”

  “No, not at all,” he replied without hesitation.

  His answer had seemed straightforward enough; his eyes certainly hadn’t flickered from my own, nor had his voice changed in tone. But in the last half hour it was the first time this institutional politician had said anything to me without at least a few seconds hesitation. If he weighed the truth so carefully, might his answer at the ready be a lie? In any case, I didn’t believe him.

  I descended to the first level basement and headed toward Cam’s office, which was located near the labs. As near as I could tell, with all the twists and turns in the hallways, I was directly over the sub-basement wing where I’d spent the night. Unlike the subbasement, however, this level had been renovated, and the corridors were wide and well lit. I was five minutes early for our eleven o’clock chat.

  CENTER FOR BIOLOGICAL INVESTIGATIVE STUDIES declared a large wall-mounted sign in gold lettering at the entrance to Cam’s domain. Beside it someone had pasted up a more modest Labs, written by hand on a piece of cardboard. The pompous version probably hadn’t made it clear that this was the right place to hand in a lowly sample of pee or give a specimen of blood.

  The rooms I walked by were each as big as a three-car garage, and in every one of them was a labyrinth of scientific equipment bedecked with flashing lights and endless displays of digital readouts.

  HEMATOLOGY, BIOCHEMISTRY, VIROLOGY, CYTOLOGY, and BACTERIOLOGY read the signs over each doorway. These various areas of expertise would together determine the thousands of individual clinical measurements done here daily—the levels of sodiums, potassiums, sugars, proteins, red cells, white cells, and dozens of other ingredients in the human body—that would help quantify the diagnostic mysteries of the more than eight hundred patients lying in the beds upstairs. Through the open doors over the hum of the ventilation system I could hear the casual chatter of busy lab workers, mingled with the incessant summons of beeping monitors, warning buzzers, and timing bells. Along the corridor where the air didn’t circulate as well, my nose tingled with a stinging aroma of unrecognizable chemical reagents mixed with the familiar scent of coffee. Occasionally I got a whiff of an all-too-recognizable stench, such as the one that emanated from a string of carts loaded with half-filled urine cups.

  I also noticed that here hardly anyone was wearing a surgical mask, as opposed to the way a majority of personnel were in the rest of the hospital. Probably Cam’s influence, I thought. He’d made a point of not wearing one himself once we left Janet’s room. “If we don’t act rationally through all this and encourage others to do so by example, we’re in danger of ending up with outright panic,” he’d declared overloudly in the nurses’ station, making sure they heard him before he walked out of ICU.

  Down here the only people I saw through the various lab windows wearing masks, a usual precaution when working with potentially airborne agents, were either working directly with fluids that might splash or plating organisms onto petri dishes under ventilating hoods in the bacteriology lab.

  Through yet another open door I saw into a classroom and caught sight of Harold Miller taking nasal swabs from about a dozen people in housekeeping uniforms. Another thirty or so were lined up waiting in the hallway outside. UH was clearly carrying out its commitment to screen every single worker in the hospital.

  In fact, the entire place was a superb testimony to the competence and exemplary leadership of Cam. It was impossible to reconcile the man in charge of these works with the monster I’d been making him out to be. Yet, on seeing all the technical prowess under his control, I couldn’t help thinking that if anybody were able to find a way to use microbes as murder weapons, perhaps Cam could here.

  I paused outside his closed door and focused on how I intended to ha
ndle myself. Whatever he had to say about what happened at Death Rounds, I’d be trying to get a sense of whether he was lying. If the chance came, I’d press him about why my poking into the business of the Phantom upset him so, but I’d have to be careful on that topic. He’d obviously be upset enough when he learned that I’d already been to Fosse behind his back. It might enrage him further if he realized I’d then come down here to try to catch him out. Above all, I had to make sure my feinting with him didn’t precipitate a further attack on Janet.

  He was waiting for me.

  His office was both spacious and luxurious, equal in every way to Fosse’s. It was paneled with dark wood, lined with wall units of bookshelves, and carpeted with rich blue broadloom. In one half of his large room was a sitting area, as there had been in Fosse’s, defined by a couch and matching easy chair. Occupying the other half was a desk that looked about the size of the CEO’s, but behind Cam’s, tastefully positioned off to one side, was a potted tree. Natural light came in through a long narrow line of windows at the level of the ceiling, about the only clue we were in a basement. Thin-slatted Venetian blinds dressed up the effect, and track lighting gave the room a soft illumination that was easy on the eyes. The final result seemed to be the hospital’s way of stating, “You are honored as a world-renowned physician.”

  “Have a seat,” he said, casually indicating the couch. He walked over to a wooden hutch, slid open a panel door to reveal a small fridge and a row of glasses. “Would you like a Coke, or can I have my secretary get you a coffee?”

  “Nothing, thanks,” I said, far more coldly than I intended.

  He stopped in midreach for a glass, turned to look at me with no trace of a smile left on his face, and slowly closed the door to his minibar without taking anything for himself. “Right,” he said, his own cool tone seconding mine and making it clear we were both finished with niceties.