Death Rounds

by Peter Clement

  This time it was my turn to stare openmouthed at him. I’d presumed he’d announced the search because it was forced on him. Unless what I’d just heard was an act, he actually seemed hugely enthusiastic about it.

  He sighed. “It’s my hope. Earl,” he continued, surprising me by speaking very slowly, very gently, “that if you believe I’ve nothing to hide, then maybe you’ll not prevent me from taking care of Janet She’s going to need good care. Earl, and I think I can give it to her. But if you and she do decide to transfer to another hospital, please do it quickly, before she’s too ill to make the trip. Another measure I strongly advise you to do is to put your baby on a prophylactic dose of erythromycin. Infants are in the vulnerable group, and even though person-to-person spread without an aerosol isn’t suppose to happen, we still protect those at risk. Obviously he’s been in close proximity to his mother. You and the nanny should be okay, but, well, with the unexplained spread to Deloram, Popovitch, and now to Janet, maybe you should protect yourselves too, until we make sure we’re not up against some new pattern of natural transmission.”

  I found it hard to process all the information he was giving me. He sounded kind, caring, and empathetic, but his eyes were saying something else. I felt transfixed in their blue glare, like a rabbit in front of an oncoming truck. “Cam, wait a minute—”

  He waved away my attempt to speak. “There’s just one thing you must agree to do. Abandon your talk about the Phantom and give up your hunt for whatever you think Michael found. I can’t have you stumbling around and possibly setting off rumors. If you give me your word on that, I won’t report your unauthorized entry last night. After the drubbing you took at Death Rounds today, that’s the last sort of trouble you need. What do you say?”

  I couldn’t say anything.

  He looked at his watch. “You’ll have to excuse me. I’ve got a lecture to give that started fifteen minutes ago. Make yourself comfortable here and think over my offer. Let me know what you decide about Janet as soon as possible.”

  With that, he was gone from the room.

  Chapter 17

  Well, well, well, I thought. That was about as subtle as being hit by a truck.

  Like me, he obviously wasn’t averse to a bit of bribery and blackmail, but I had to think I was better at it. The real question remained. Was he a monster reeling me in, or was he an honorable man trying to do what he thought was right for Janet, for his department, and for his hospital? In the final analysis I had no idea.

  My stomach rearranged itself a few more times, then clamped back down on the cola I’d treated it to five minutes ago.

  I’d found nothing that would persuade Janet that Cam shouldn’t be trusted. She’d be furious about his crude attempt to blackmail me and would have no qualms telling him to his face that he was pig-headedly wrong about the Phantom. But she’d buy his excuse that he was frantic to keep rumors from panicking the hospital. Cam himself could claim, “I explained everything to him, gave him carte blanche to explore the asylum, and he still won’t believe me.” Janet was then likely to invoke her often-used marital right to consider me a part-time dolt and blast me for continuing to suspect the man.

  What’s more, she might be correct.

  I had to wonder if my judgment wasn’t skewed by lack of sleep and if I wasn’t stirring up nightmares about the man for nothing. Being surrounded by Cam’s gallery of personal photos and testimonials didn’t make me feel any easier. It somehow seemed doubly offensive to be sitting in his own sanctuary and sullying it by thinking evil of him. If he was innocent, he had a perfect right to be outraged by my sneaking into his files. I knew that Janet would say I was off beam to call his reaction over the top, especially after he’d tried to help me with Miller.

  My back and legs hurt even from sitting still, while my head started throbbing and reminded me I’d better get to bed. If I wasn’t careful, I thought, I might end up snoring on Cam’s couch. I forced myself to stand up, groaning loudly as I did.

  Maybe all my suspicions were wrong, I continued to muse, even the ones about Rossit and Hurst But that vein of thought immediately led once more to the hideous possibility that the killer was a complete stranger.

  Hoping to settle my stomach and find something for my headache, I wandered over to Cam’s minibar and checked if he kept some antacids or acetaminophen stashed with the cans of pop. I had to settle for a club soda. As the bubbles tried their best to be my breakfast, I ruminated once more about the killer being a man or woman I didn’t know. The roots of his or her motive, however twisted, would be beyond anything I was aware of or could ever hope to figure out, and his or her identity perhaps impossible for me to ever uncover.

  The thought made me shudder. I could never protect Janet against such an anonymous menace, even if I was with her twenty-four hours a day. Anyone—an orderly, a resident, a nurse—could slip her something during the routine maintenance of her IVs. The possibilities gave me the creeps—injected potassium to stop her heart, short-acting paralytics to stop her breathing, a syringe full of air through her intravenous line to block the flow of blood to her lungs—but this killer would probably use his trademark: completely resistant staphylococcus. I didn’t know how he had infected Phyllis Sanders without her knowing it, but I knew how I could do it to a woman full of IV lines as she lay sleeping. I’d inject the organism directly into her bloodstream. Once more an image of that shadowy figure from the subbasement spiraled into my mind, except this time he was creeping up to Janet’s bedside. My stomach lurched toward my throat.

  I marched over to Cam’s desk, my resolve on fire. I’d join in the search of the asylum tonight if I could, but getting the files that Michael had found remained my top priority. If going through the asylum did manage to flush out whoever I’d seen down there, without those records and the supposed proof they contained that a murderer was at work, I wouldn’t be able to turn him over to the police; officially there were no murders to charge him with. For the moment, everything depended on Fosse and Tippet not being able to refuse my offer and Cam’s being kept ignorant of it until it was a fait accompli.

  Nor could I let Cam report me for unlawful entry. One whiff of that kind of trouble and Fosse wouldn’t have anything to do with me. I had to let Cam think he’d cowed me into backing off.

  I scrolled a piece of printer paper out of Cam’s desktop computer setup and wrote:

  Dear Cam,

  Sorry for the misunderstanding, and thank you for your helpful suggestions about prophylactic erythromycin for Brendan. As for Janet, she has absolute faith in you, and I know of no better physician to get her through this ordeal. Earl

  If only it were so simple, I thought I knew Cam would decode my carefully chosen words and know I was still suspicious as hell. Maybe that wasn’t such a bad thing. The balance between his thinking I’d acquiesced, yet knowing I was onto him might be enough to keep him in check for a while if my worst fears about him turned out to be true.

  Then, in case my powers of subterfuge and intimidation weren’t all I hoped they were, I dug out a yellow pages from one of his desk drawers, looked up a private security company, and arranged for a uniformed guard to be at the door of Janet’s room twenty-four hours a day.

  Out in the hallway I passed by the classroom where Miller was still busily screening staff members seated at a row of desks. As he moved from person to person—hunching over each of them, culturing and plating, rhythmically getting the job done—he seemed to keep everyone relaxed, and none of his subjects ended up wincing with tears running out of their eyes as had many of the people I’d cultured.

  I found myself wondering if he should be trying to work off his grief. Doubtful, I decided, thinking like a clinician. Frenetic activity wasn’t always the best solution to mourning. It could delay his coming to grips with his mother’s death and actually prolong his sense of loss. Perhaps I’d have a chance to talk to him tonight about it, during the search.

  I was about to walk away when I though
t. Better make sure we don’t give the Phantom advance warning we’re coming. “Mr. Miller,” I called into the room, “could I have a word?”

  He looked up from where he was about to take another culture. “Sure,” he said, walking over to the doorway carrying the partially open packet of swabs.

  “I wonder if you could avoid broadcasting the search of the asylum and ask the other workers you recruit not to mention it as well.”

  “Oh?” he asked, cocking his head.

  I quickly invoked a little more authority. “To avoid panic,” I whispered. “Dr. Mackie says we must avoid panic at all costs.”

  He quickly nodded in agreement. “Of course. Good idea. I’ll call you when we’re ready.”

  He turned back to his work, and I scooted upstairs to ICU. I had questions for Janet regarding Brown...and Cam.

  * * * *

  “You aren’t starting to pin motives on Cam now, are you, Earl?” Janet demanded crossly.

  She was coughing more than before and beginning to wheeze loud enough that I could hear the high-pitched mewing sound without a stethoscope. But she wasn’t too sick to immediately sense what I was up to when I started asking her about Cam’s special cause.

  “No, not at all,” I lied. “Now how about answering the question. Or perhaps you’d like to explain what Cam meant when he said, ‘I knew Janet would tell you all about Brown.’”

  She started at the mention of Brown. “Earl, I swear, if you’ve embarrassed me by insulting Cam with one of those conspiracy theories of yours—”

  “Do you want me to ask him myself?” I interrupted.

  “You wouldn’t dare!”

  I made a move toward the door. “Watch me!” As much as I’d expected her not to take my suspicions seriously, I felt too tired and frayed to be very patient. I was also bluffing; I didn’t intend to stir him up about anything right now.

  “My God!” she declared, her eyes widening. “You seriously doubt him?”

  She could only see the upper half of my face over the top of my mask, but it must have shown her enough to make it clear I was deadly earnest.

  She immediately stopped sounding angry and implored, “Earl, whatever you’re thinking about him, I know it’s out of fear for my safety, but he’s not capable of hurting anyone—”

  “Janet, just tell me how Brown figures in this and explain why kindness to patients is such a special cause for Cam. I’ll make up my own mind about what it means.” Not meaning to be as curt as I sounded, I tried to soften my tone. “We can’t afford anything less than the same critical thinking you’d apply to a medical problem.”

  She gave me a puzzled look.

  “You know what I mean,” I added. “You’re refusing to do a complete differential on all the possibilities of who this killer is.”

  She started at the reprimand. The allusion to a physician failing to consider all the diagnostic possibilities when attacking a clinical problem was a low blow. But after another coughing spell, she reluctantly agreed to tell me what I wanted to know.

  “She’s the ICU nurse who survived the Phantom’s attack of Legionella.”

  So I was right, I thought, yet the revelation remained startling.

  Janet continued. “Today’s little effort, I’m sure, began as payback for my trying to nail her in the past about her little games and ordering her away from my patients. Except this time, she was stupid enough to make those residents mess with an airway and got herself in way over her head.”

  I couldn’t believe what I was hearing. I remembered Cam had said she should know the sputum would be scant. “You mean what happened was deliberate?”

  “I doubt she meant to put me into laryngospasm. She certainly never nearly killed anyone before. She’s always been just a petty tormentor, and, as I told you, she probably didn’t realize that the residents would bungle things so. Wanting me to choke and retch my guts out during an uneventful tracheal aspiration would be more her speed. It’s ironic. I couldn’t put her out of business for what she did with my patients, but what she pulled with me got so out of hand it will probably finish her, certainly in ICU as Cam said, if not altogether as a nurse at UH.”

  I was speechless. “She could have killed you! If any part of this was deliberate, she should be charged with medical assault!”

  Janet started coughing, then only partially recovered her voice. “Think about it. Earl,” she rasped. “This was a classic example of how Brown and the others like her got away with their nasty crap, though never with anything so lethal. But even here she did nothing more than show a note about scanty sputum written by someone in ER to the residents and then inform them of the ID directive about proper culture samples. We may know what she was really doing, but who can prove it, let alone have her indicted for it? Even in the morbidity review, Cam will probably only get her charged with a major error in judgment. But at least it will be enough to label her officially as trouble and keep her out of critical-care areas. Even if she isn’t fired now, she’ll finally be on such a short leash her days here will be numbered.”

  Her days may be numbered, period, I thought. Messing with someone when they were helpless was indeed liable to make people very angry if my own anger was any gauge.

  “Why didn’t you stop the residents?” I asked Janet as gently as I could. I still found it hard to believe how any of this could have happened. “You’re not known for being overruled easily.”

  I saw her bristle. “Because,” she answered icily, “I didn’t catch on at first that it was Brown who’d put the residents up to it.” After a few seconds of cool silence she added, “Besides, I was determined to be a good patient and do what I was told, not act like a doctor and get special treatment. When I did start to protest, the resident who wanted to suction me kept insisting that he’d done it this way before and that he’d be in and out before I knew it. It sounded wrong, but I’m a gynecologist, not a respiratory specialist It was only after that catheter was down my throat that I realized they didn’t know what they were doing.”

  I knew what she meant. Doctors invariably have a hard time finding the right distance to take either from their own care as a patient or from the care of a family member. Being too close and interfering could be as much a disaster as standing too far off and ignoring well-honed instincts that something’s wrong. The dynamic was hard on the treating doctor as well. The physician’s physician had to be a very special breed.

  “And what about Cam’s cause?” I asked as unobtrusively as I could. That I suspected her friend was, I knew, painful to her. It would be even harder on her to tell me anything that she knew would add to those suspicions.

  I watched her expel a long breath and lean back on her pillow.

  “His father was a hemophiliac,” she began matter-of-factly, but in a hoarse whisper that was painful to listen to. “The man actually worked in this hospital as a lab technician. You can imagine how Cam grew up, witnessing the man suffer with crippling bleeds into his joints that sometimes only morphine could ease. Once Cam was in medical school, he learned the true extent of his father’s pain when he saw firsthand the incessant needles and invasive procedures all hemophiliacs are forced to endure. Besides, remember the attitude about giving narcotics to these people back then. It was pretty judgmental, and most hemophiliacs had to put up with a lot of insinuations that they were faking pain to get a fix.”

  I knew exactly what she meant. I’d witnessed that kind of ignorance even in my own ER. What kind of impact could it have had on a son, knowing that his father was subjected to the indignity of having to prove again and again he was in pain?

  “I think Cam became a director of laboratory services precisely because of his father,” Janet continued. “I suppose he sees it as a chance to make sure that, at least in his domain, no one suffers the sort of unnecessary pain that was inflicted on his dad.”

  “Is his father still alive?” I asked, remembering the lack of recent photos back in Cam’s office.

  “No,�
�� Janet answered solemnly. “Like so many hemophiliacs in the early eighties, he became infected with HIV from improperly tested blood products. He died about ten years ago.”

  It all made terrible sense. “Janet, do you realize what you’re saying?” I asked, my throat so dry I could barely speak.

  She pulled back from my chest and looked at me with a hard blue stare that outdid anything Cam had fired my way in the last few hours. “What I’m saying. Earl,” she said, her cutting tone sounding through the hoarseness, “is that the experience turned him into a fine and caring doctor I trust with my life. He is not some twisted fiend hell-bent on revenge, and if you had any sense of intuition of your own, you’d know I’m right.”

  The only sense I had was that it was pointless to argue with her.

  Minutes later I was advising everyone in the nurses’ station that I’d arranged for a security guard to be at the entrance of Janet’s room and that he’d be logging anyone who went near her. I didn’t give them any reasons and got more than a few raised eyebrows, but nobody protested out loud. I also gave strict orders that no one, not even Janet, was to send the guard away. After our talk about Cam, I didn’t have the nerve to tell her what I’d done to protect her.

  * * * *

  Half an hour later I was in ICU at St. Paul’s looking at Michael through the window of his isolation room. As alarming as it was again to see him so helpless, I was also appalled to see that Gary Rossit had taken over his care. He was in the cubicle inserting a long thick needle under Michael’s right clavicle to serve as a conduit to his central venous system.

  The nurses assured me the little man was hovering over Michael like a mother hen, then gave me a brief synopsis of the treatment he’d ordered. It seemed complete and included rifampin, the second-line antibiotic used in patients desperately ill with Legionella—the same one that he’d lambasted me for suggesting in Sanders’s case.