by Dawn Eastman
ALSO AVAILABLE BY DAWN EASTMAN:
The Family Fortune Mysteries
Pall in the Family
Be Careful What You Witch For
A Fright to the Death
An Unhappy Medium
UNNATURAL CAUSES
A Dr. Katie LeClair Mystery
Dawn Eastman
NEW YORK
This is a work of fiction. All of the names, characters, organizations, places, and events portrayed in this novel are either products of the author’s imagination or used fictitiously. Any resemblance to real or actual events, locales, or persons, living or dead, is entirely coincidental.
Copyright © 2017 by Dawn Eastman.
All rights reserved.
Published in the United States by Crooked Lane Books, an imprint of The Quick Brown Fox & Company LLC.
Crooked Lane Books and its logo are trademarks of The Quick Brown Fox & Company LLC.
Library of Congress Catalog-in-Publication data available upon request.
ISBN (hardcover): 978-1-68331-313-7
ISBN (ePub): 978-1-68331-314-4
ISBN (ePDF): 978-1-68331-316-8
Cover design by Melanie Sun
www.crookedlanebooks.com
Crooked Lane Books
34 West 27th St., 10th Floor
New York, NY 10001
First Edition: December 2017
To Brent,
My favorite brother
Contents
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Acknowledgments
1
Although Dr. Katie LeClair knew her racing heartbeat was due to a surge of adrenaline, she couldn’t calm the fear and anxiety that fueled it as she strode through the sliding emergency room doors and into Baxter Community Hospital. A whoosh of cool September air followed her inside and blew her long auburn hair into her eyes and mouth. She pulled it back into a tight ponytail and kept walking. During medical school, she’d imagined running down a hospital corridor—hair flying out behind her, stethoscope around her neck, racing to save a life. She’d since discovered that it was hard to run with a stethoscope around her neck—even painful. And at least in residency, by the time she arrived at any emergency, there was already a whole crew working on the patient.
She slowed her pace when she saw that the ER waiting room was empty on this late Wednesday evening. Brightly colored plastic and metal chairs sat empty along the walls. No one to witness her arrival in paint-spattered jeans and an old men’s oxford shirt. Three months into a full-time job, in a small private practice, with a real emergency, and she’d been caught off guard. Nick Hawkins, one of her new partners, was on call but couldn’t be reached. When the answering service had called, she’d been on a ladder painting her new dining room. She’d dropped everything when she heard the patient’s name and driven to the ER. It was only when she noticed the empty waiting room that she realized she probably should have called first. Maybe the answering service had gotten it wrong. Maybe she was too late. She took a deep breath, adjusted her messenger bag on her shoulder, and approached the door leading to the exam rooms.
“Can I help you?” A bored voice emanated from under the reception desk.
Katie stopped and looked over the divider.
An older woman wearing pink hospital scrubs decorated with fairies climbed up from the floor with difficulty. By the time she was standing, she was breathing heavily. She brushed dust off the fairies and removed a fuzz-covered piece of surgical tape from her knee.
“Had to reboot the computer again,” she said. She must have seen the question on Katie’s face. She glanced angrily at the ancient plastic box and continued: “These things are so old, we have to crawl around underneath and unplug them.”
“I’m here to see a patient,” Katie said. She turned to go through the door.
The woman sat in her wheeled desk chair and rolled to the computer screen. “Patient’s name and your relationship.”
“No, I’m her doctor.” Katie pulled her jacket across her paint-splotched shirt and hoped the desk covered her ripped jeans.
“Oh, sorry.” The woman and her fairies looked Katie up and down as if she were the last word on fashion. She knew she should have changed before she left her house. “I didn’t recognize you. Dr. LeClair, right?”
After nodding to the receptionist, she stood taller and turned toward the door. She pushed the metal plate on the wall, and the frosted glass doors slid open to reveal the treatment area.
Baxter, Michigan, half an hour west of Ann Arbor, had a very small emergency room. It was no more than three cubicles with curtains for privacy and usually one doctor and one nurse.
“Hey, Doc! I thought they said Nick was on tonight.”
Katie turned toward the familiar gravelly voice and saw the chief of police, John Carlson, leaning against the wall by the door. He was stocky and balding and would soon have more belly weight than was healthy. But his eyes were kind, and Katie was happy to see him. His usual affable smile was missing this evening, replaced by a grim line.
“They couldn’t reach him, so they called me.”
Carlson lowered his voice. “It doesn’t look good.”
“What happened?”
“Beth Wixom, Ellen Riley’s daughter, couldn’t reach her on the phone. She went to the house and used her key to get in and found her mother unconscious. She called nine-one-one, and we got there just before the ambulance.”
“Poor Beth.” Katie scanned the ER. “Where is she?”
“They took her to a conference room back there.” Carlson pointed to a hallway off the main room.
He patted her shoulder and bestowed a kind smile. A month into her new life in Baxter, Katie had witnessed an accident that had left John’s dog, Bubba, bloody and scared. She’d scooped up the black lab and driven him to the emergency vet clinic, which had been closed. She’d taken him to her own clinic, patched him up, and stitched his wounds. Only afterward did she realize it was the chief of police’s dog. She had hoped that he wouldn’t arrest her for treating Bubba without consent or a veterinary license.
Instead of arresting her, John Carlson treated her like a hero. By the next morning, everyone in Baxter knew that she had pulled Bubba from a ditch and carried him over her shoulder two miles to her clinic, where she wrested him from the brink of death. The gossip mill was nothing if not inventive.
Their brief conversation had alerted the staff to her presence.
A nurse approached with her hands up like a traffic cop.
“No family back here right now; we’re dealing with an emer—oh, Dr. LeClair. I didn’t recognize you.”
A curtain whisked open, and a gurney emerged. There were several people working around it. One adjusted an IV drip, one pushed the bed, and another barked orders. They were intensive care nurses and therapists, who must have b
een called from the ICU to assist.
“Get her settled and call Hawkins again; I can’t babysit his patient all night,” a man in a white coat said to a nurse.
He turned quickly and almost knocked Katie over.
“Sorry,” he said. He put his hand under her elbow to steady her. “Can I help you?” He was tall, at least six feet to Katie’s five and a half, and she had to tilt her head back to look him in the eye. Matt Gregor.
Flustered, she took a step back and stuck out her hand. “Katie LeClair. I’m covering for Dr. Hawkins. The answering service couldn’t reach him.”
His dark hair was long and fell forward as he looked down at her. He took her hand. “Matt Gregor. Aren’t you a resident? I’ve seen you before.”
“I just joined the family medicine practice in town,” Katie said, “but yes, I was a resident here and at University Hospital.” She couldn’t believe that he recognized her. He’d been chief resident when she was an intern, and their paths had rarely crossed. University Hospital was the teaching hospital in Ann Arbor. It was a behemoth compared to Baxter’s tiny community hospital. Katie looked forward to working in a place where she could get to know everyone from the physical therapists to the ICU nurses. Her constant rotation through the different areas of the hospital in residency had meant that she’d felt like she was starting a new job every month.
Matt Gregor was a good doctor, and Katie was happy that he had been taking care of Ellen even though she wondered why he was working the ER here in Baxter.
“I thought you were in private practice in Ann Arbor,” Katie said.
Gregor nodded. “I am, but I’m doing some moonlighting out here since they’re short staffed.” He grabbed a clipboard off a nearby counter. “Okay. It’s not good news. Frankly, I’ll be surprised if she makes it through the night.” The gurney had disappeared through another set of doors, and he started walking in that direction.
Katie ran to catch up to him.
“That was Ellen Riley?” She gestured toward the end of the hall.
He nodded. “Overdose, we think. We coded her for fifteen minutes after she got here. The EMTs found her unresponsive at home, barely breathing but with a heartbeat. They had to shock her once on the way here, and by the time she hit the ER, she had a weak pulse. While we were assessing, she flatlined. We coded her again and finally got her tubed. I’ve already pumped her stomach, but there wasn’t much there. Her daughter found her, so we have no idea when she took the drugs.”
Katie’s mind was spinning. Ellen taking drugs? It was unbelievable.
She cleared her throat. “What did she take?”
“The EMTs grabbed everything from the scene. Looks like she took a bunch of diazepam. The bottle was empty, and she only filled the prescription a few days ago.” He glanced at her and then quickly looked away. “Diazepam can be a dangerous drug in the wrong patient.”
Katie felt her shoulders stiffen. Diazepam was also known as Valium and could be very sedating. “I know that. Where did she get it?”
Dr. Gregor stopped walking. “From you. Your name was on the bottle. That’s why we called your practice.”
Katie didn’t say anything. She sensed that he was studying her the way an attending studies a new intern, but she didn’t like those questions in his eyes: Can this person be trusted with my patient? Do I have to watch everything they do?
She had thought the need to prove herself would be over once she finished residency, but apparently it just went on and on.
He turned away from her and walked quickly down the hall. Katie hurried to keep up with him as he rushed after the gurney.
The ICU was chaotic. Usually a quiet area with beeping machines and hushed voices, the entire staff gathered in one section to work on a patient. The only patient—Ellen Riley.
Respiratory therapists barked orders at the nurses, and the nurses spoke over one another. It was all a babble of coded instructions about vitals and medicines, but it conveyed two things: fear and urgency. A young pharmacy tech hovered outside the room, obviously afraid to go in.
Dr. Gregor strode forward. He spoke very softly and calmed the room with his voice. “Vitals?” Katie had to lean forward to catch it, and the rest of the team quieted in order to hear his questions and to answer.
“BP sixty over palp. Heart rate thirty-five.”
“Atropine ready, Doctor,” said a nurse.
Katie hung back. Ellen was technically her patient now that she was here in the ICU, but Gregor had been working on the situation for an hour. It made no sense to step in and take over when she only knew the outlines of the case. She stayed to the periphery, trying not to get in the way.
A respiratory therapist bumped into her when he moved to the head of the bed. Katie stepped back and felt like a student again, watching the action but not participating.
While she watched, the frantic movements slowed and finally stopped.
Dr. Gregor looked at the clock on the wall. “Time of death 11:16.”
A silence fell over the room as it always did when a patient died during a code. The battle had been lost.
It felt like a kick to the gut. Katie had seen many deaths, but Ellen’s felt personal. She had known and liked Ellen Riley. The tentative friendship that they’d begun had made Katie feel like she might actually fit in in Baxter.
In the quiet, they heard the door swoosh open.
“Where’s Ellen? Where’s my wife?”
Christopher Riley looked wildly around the ICU. His usual elegant businessman image had faded. He wore jeans and a Michigan sweat shirt. His salt-and-pepper hair stuck up in odd places as if he had just woken or had been running his hands through it. And as he got closer, he looked every one of his fifty-odd years.
The nurses and therapists began to quietly clean up the area. Matt Gregor stepped forward to block Christopher’s view.
“Mr. Riley?” Dr. Gregor put his hand out. “I’m Dr. Gregor.”
Christopher looked past him and saw Katie.
“Dr. LeClair? What happened?”
Katie cleared her throat and pulled her shoulders back. She needed to be a doctor now, not a friend. She glanced at the entrance to the ICU and saw John Carlson standing there. She met his eyes and then looked away. He studied his shoes, and she could see his sigh of resignation from across the room.
“Mr. Riley, let’s go sit over here for a moment.” Dr. Gregor turned him away from Ellen’s room.
Katie followed them to a small room with a table and a few chairs. The family conference room. The room where people decided to remove life support or send a loved one for rehabilitation or where they learned that they had narrowly dodged a tragedy—or not.
After they sat, Dr. Gregor said, “Your wife came to us unconscious with a very weak heart rate. We did everything we could, but we were not able to save her. I’m very sorry for your loss.”
It was the standard bad-news speech. As medical students and residents, Katie and her colleagues had been coached in the best way to deliver bad news. For Katie, the hardest cases were the ones where she barely knew the patient or the family. Emergency room physicians had to do it all the time. Sudden death through accident or illness, no relationship with the patient or the family, and then saddled with the job of shattering someone’s life with a few words.
Christopher let his head fall into his hands. “This can’t be happening. She was so healthy.” He looked at them with red eyes, pleading with them to tell him something, anything else. “What happened?”
“We’ll have to do some more tests, but there was an empty bottle of Valium at the scene. We assume it was an overdose,” Gregor said.
“Overdose? Ellen?” Christopher looked at Katie. “She hated taking any medicine. I didn’t even know she was taking Valium.”
Christopher had echoed her thoughts. She frantically searched for something to say that wasn’t “I didn’t know either.” Instead, she stood and said, “I’ll go find Beth. She probably hasn’t heard.”
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Katie breathed deeply for the first time as she left the ICU. There was something stifling about a closed space holding so much fear and sadness. She squared her shoulders and walked in the direction of the ER, bracing herself to give the same speech to Beth that Gregor had given to Christopher.
It hadn’t gotten easier as time passed, and she doubted it ever would.
She found Beth sitting alone in the ER conference room. She was petite with dark spiky hair. She reminded Katie of a brunette Tinkerbell. Beth leapt to her feet as soon as she spotted Katie.
“Dr. LeClair, is my mom okay?” Beth rushed toward Katie. “The nurses won’t tell me anything.” Her eyes were red and swollen, and she clutched a crumpled tissue.
Katie gestured to the chairs, and both women sat.
Katie took a deep breath.
“Beth, as you know, your mom was unconscious when you found her. Her pulse was weak, and her heart failed on the way to the ER. They worked for over an hour and couldn’t stabilize her. I’m so sorry for your loss.”
Beth sat completely still, as if she hadn’t heard Katie. Then one tear tracked its way down her cheek.
“What happened?” Beth’s voice was hoarse.
“They think she overdosed on diazepam. They found an empty bottle at the scene.”
Beth shook her head. “She hated taking medicine. I’m sure you knew that.” She looked at Katie. “You aren’t saying this was suicide? There’s no way my mom would kill herself.”
“We don’t know yet. They’ll do an autopsy, and we should have some more information then.”
“Dr. LeClair, she was happy. Maybe a little stressed, but happy.”
“That was my impression too. But we don’t always know when people are struggling.” This was so hard. Katie focused on staying calm and helping Beth, not dredging up her own issues.
Beth shook her head. “No, that’s not my mom. It was just the two of us for years after my dad died and before she married Christopher.” Beth took a breath, and she blinked back tears. “She was my best friend.”
“What was she stressed about?”
Beth shrugged. “She was doing some sort of research and was worried about what she’d found. She never had a chance to tell me about it. We kept rescheduling our dinner plans.” Beth’s voice cracked, and she began crying.
