Unnatural Causes

by Dawn Eastman

  She had been old. Katie did not remember how old, but she had looked ancient. The only indication of life had been the slight movement of her chest up and down. Her face had been drawn and immobile. This had not been the blissful sleep of a child. This sleep had looked painful and unnatural. The resident had pointed out the blotches. Not that anyone could have missed them. The end of her nose had been bruised-looking and purple. Her fingertips had been dark at the end of her curled fingers. He’d explained that she’d had what was called disseminated intravascular coagulation, or DIC. Tiny blood clots throughout her body had been cutting off the oxygen to vital organs. Her entire system had been shutting down, and there had been no way for them to stop it. Infection combined with age and general frailty, a weak heart, kidney disease, and a litany of other medical problems had contributed to her demise.

  He had talked about her as if she was already dead. Perhaps she had been, to him. If there was nothing more to do, you had to move on to help those that could be helped. There was no time in residency to dwell on those who couldn’t be saved, no time to even acknowledge their passing sometimes. That was what the nurses were for, she was told. Katie had once been reprimanded for getting a patient a drink of water. It was obviously nurse’s work. The teaching physician had been disappointed that she would “waste her time” with such activities. The message was, doctors are too important and too smart to be engaging in such small acts of human kindness. She remembered the lesson, but not in the way it was intended. After visiting the dying woman, they had had lunch and never mentioned her again.

  She pulled up a chair and took Mr. Foster’s hand. He was a funny old guy. An incurable flirt, he liked to chase the nurses down the hall in his wheelchair. Katie had once asked him what he planned to do if he ever actually caught up with one.

  “The fun is in the chase, Dr. LeClair. I’ll never catch one.”

  He loved jazz, and there was an unsubstantiated rumor that he had played in his own band when he was a young man. He referred to it all as “ancient history” and refused to talk about it. But he and Katie had bonded over their shared love of big band music.

  The night nurses used to bring in all sorts of music for him to listen to. He loved it all and always wanted to hear whatever had been released that week.

  “I like to hear the new stuff almost as much as I love the old stuff.”

  Katie stood up. “I’ll miss you, Mr. Foster.”

  She thought she felt him squeeze her hand, but it was probably just a reflex.

  7

  Katie was almost home when she decided on a detour. She still hadn’t been able to reach Beth Wixom, but she knew that Ellen Riley had lived just a couple of blocks from the downtown area. She turned onto Ellen’s street and parked in front of the large white colonial that she had shared with Christopher. Directly across the street was a bright-yellow Craftsman bungalow with red-trimmed windows and door. The porch overflowed with yellow, red, and orange mums in containers. There was an old blue Toyota in the driveway with “Coexist” and “My other car is a broom” bumper stickers.

  Katie walked up the front steps and knocked on the door. There were two cozy-looking chairs with thick cushions on the porch. Katie filed the idea away to consider for her own porch. She heard rustling inside and the sliding of a metal chain.

  “Hello?” Only one eye peeked out through the small opening. It was pale gray, and Katie saw long, curly gray hair.

  “Mrs. Travers?” Katie smiled. “I’m Dr. LeClair. I work with Dr. Hawkins.”

  “I know who you are. I’ve been waiting for you.” The door slammed shut, and Katie heard the sliding metal sound again. When the door swung open, Katie took a step back.

  Mrs. Travers wore a flowing purple tunic over bright-orange leggings. Her hair fell halfway down her back in silver waves. She’d layered more necklaces than Katie owned around her neck, and every finger wore at least one ring.

  Patsy Travers peered out of the door and looked up and down the street. “You’d better come in before anyone sees you.”

  She gestured to a small sitting room that was even more colorful than Gabrielle’s living room, mostly owing to the knickknacks on every flat surface and the tie-dye rainbow canvas hanging behind the couch.

  “Can I get you anything?” Patsy asked. “I have a lovely chamomile and vanilla tea. It will help you get some rest.”

  “Thank you, Mrs. Travers, that would be very nice.” Katie chose an armchair and sat.

  “Call me Patsy. And it’s Miss—I never married.” Patsy bustled out of the sitting room and began clanking dishes in the kitchen.

  Katie surveyed the room and understood what Debra had meant by “woo-woo.” An overstuffed bookshelf groaned under the weight of astrology, tarot, rune, and psychic development books. Ellen Riley had been so sensible and no-nonsense. How had these two become friends?

  A few minutes later, Patsy entered rattling a tea tray and followed by a white Persian cat who looked down its nose at Katie. It sat in the doorway, tail twitching, watching her.

  Katie took the cup offered by Patsy and sipped.

  “This is delicious,” Katie said.

  “I make it myself. I can never find the right mixture in the store-bought kind.”

  “Patsy, what did you mean when you said you’ve been waiting for me?”

  “You’re here about Ellen Riley, right?”

  Katie put her cup down on the side table.

  “Well, yes.”

  “I didn’t know it would be you exactly, but I figured someone would come. Ellen didn’t kill herself.” Patsy took a sip of her own tea and wrapped her hands around the cup.

  Katie sat back in the chair, uncertain how to proceed. This wasn’t going the way that she had planned at all. She’d felt wrong-footed from the moment she stepped onto the porch. And the cat had not taken its eyes off her. It was very disconcerting.

  “Ellen was my patient, and I was shocked by her death,” Katie said. “I heard you two were close and thought you could shed some light on her state of mind.”

  Patsy turned toward the cat. “Rufus, that’s enough.” The cat walked to Katie and began rubbing its face on her leg and purring. “He thinks he’s guarding me. I have to tell him when to take a break.” Patsy watched him, and her eyebrows twitched upward. “He’s not usually so friendly with new people.”

  Katie gave her a weak smile and reached down to pet Rufus.

  “Ellen’s state of mind was the same as it always had been. She was a very courageous woman, very strong. I don’t know if she told you about her first husband, but he died quite young of a heart attack. She raised Beth on her own and put herself through school. All while working two or three jobs just to keep food on the table.”

  “I didn’t know that. She never talked about her first husband, only Christopher. They seemed very happy together.”

  Patsy pressed her lips together and put down her cup. “I think they were happy. Christopher has a lot of baggage. In fact, if either of them were going to kill themselves, I would have bet on him. His parents were horrible to each other, and his mother was a master manipulator. I think he has a lot of stress with all the restaurants and that son of his. And his aura has become very muddy recently.” Patsy shook her head and stared out the window.

  Katie sipped her tea and waited.

  “I only know that she was stressed about something to do with Christopher’s family in those last few weeks. Certainly not depressed or suicidal. In fact, I think she was excited. But I did sense an evil presence over there the last few times I visited. I couldn’t put my finger on it, and she never listened to my warnings anyway, so I let it go.” Patsy dug a tissue out of her pocket and dabbed at her eyes. “I wish now that I had warned her and made her listen to me.”

  Katie leaned forward. “You aren’t saying that you think someone killed her?”

  Patsy shrugged and stuffed the crumpled tissue back in her pocket. “I don’t know what happened. Maybe it was an accident,
but I know she wouldn’t have done it on purpose.”

  “Did she give you any hint about why she was stressed?”

  Patsy shook her head. “Not really. But if it had anything to do with Sylvia Riley, she probably should have left it alone. The whole neighborhood breathed a sigh of relief when that woman died.” Patsy waggled a finger at Katie. “Don’t look so shocked; some people just suck the energy out of every place they go.”

  Katie tried for a neutral expression. “And Sylvia Riley was like that.”

  Patsy nodded. “She liked to collect secrets. Her favorite thing was to wheedle confidences out of people and then use them later to manipulate.”

  Katie sat back in her chair. She had never heard much about old Mrs. Riley, even from Ellen. “She was a blackmailer?”

  “Not in the usual sense. I don’t think she ever asked for money—just favors. And sometimes she only held it over people and made them worry.”

  Katie frowned, taking in this new information. “How do you know this?”

  Patsy swept her arm in the direction of her bookcases. “People come to me to help them understand their problems. It’s one of the things Ellen and I had in common.”

  Katie left that statement alone. If Patsy thought her fortune telling was the same as Ellen’s therapy sessions, Katie wasn’t going to argue about it now. “How did you become friends?” she asked.

  “She took one of my meditation classes at the library.” Patsy sniffed and poured more tea in both of their cups. “She wanted to be able to teach it to her clients. We just hit it off and started having a cup of tea together in the afternoons. I’ll miss her.”

  Katie glanced out the window. The unobstructed view of Ellen’s house gave Katie another hunch.

  “Patsy, did you see anything the day she died?”

  Patsy shook her head. “Nothing unusual. Your partner was over there that afternoon, but he was there quite a bit.”

  “Emmett?”

  “No, the son, Nick. Ellen and Cecily spent a lot of time together as well. I think Nick and Christopher were friends, although Nick was quite a bit younger . . .”

  “You saw Nick Hawkins at Ellen’s house the day she died?”

  Patsy nodded. “Oh, and Wednesday is the cleaning lady’s day. But I don’t remember seeing her.”

  “I thought Christopher was out of town that day,” Katie said.

  “I think he was. Nick was there to see Ellen.”

  Why would Nick be visiting Ellen? He could have faked a prescription easily. Was that why he didn’t answer his phone the night she died?

  Katie waited for more. Rufus purred.

  “I think they were friends as well.” Patsy shrugged, unaware that Katie’s mind was spinning a scenario where her partner was a murderer. “I suppose he could have been a client. She never said, and I never asked.”

  Twenty minutes later, Katie had declined Patsy’s offer of a tarot reading and managed to get out the door with only a small stack of books on psychic healing. Patsy thought that she could supplement her medical practice with aura cleansings. Rufus sat in the doorway, twitching his tail and watching her as she climbed into her car.

  She glanced at Ellen’s house, which appeared closed up, abandoned, and cold on this bright fall day. Katie was sure that she was imagining things after spending time with Patsy. Houses didn’t have feelings. She started the engine and pulled away from the curb. At the end of the street, she turned and headed home. She pulled into her driveway and heard loud voices. Well, one loud voice.

  Caleb had commandeered the dining room table. Paper, pens, books, and wires littered its surface. Caleb sat hunched over his laptop and shouted into his headset. He was deep into an online world involving knights and kings or soldiers and war. Katie couldn’t keep it straight.

  She shook her head, feeling old. All the years of med school and residency had whittled her leisure time to only allow for an occasional novel or television comedy. Gone were the days of whiling away an afternoon drawing in her sketchbook or listening to music. There were large chunks of pop culture and news events that she’d never know, as if she’d been on an isolated island for the past seven years.

  Caleb must have sensed Katie standing there and swiveled in his seat.

  “Hey, sis!” He pulled off his headset and shut his laptop.

  “Saving the world again?” Katie asked.

  “I had to take a break from coding this app,” he said. “I was seeing double and couldn’t find the bug that makes it crash midload.”

  Katie nodded and tried to look as if she knew what Caleb was talking about.

  “I saved some dinner for you.” He tilted his head in the direction of the kitchen.

  Katie stepped into the kitchen as Caleb began scribbling notes and sighing.

  Caleb had made his specialty—vegetable stir-fry. Even though he made it a lot, Katie loved it. He had a secret ingredient that gave it just a touch of spicy heat. But she especially loved that she didn’t have to cook.

  Katie walked back out to the dining room to grab her messenger bag from the table.

  Caleb snapped his laptop shut again.

  “Working on a top-secret app?” Katie nodded at his computer and tried to meet his eyes. He studiously avoided her gaze. “I promise I won’t steal your idea.” She held her hands up. “Just getting my notebook.” She pulled it out of her bag and held it up.

  A mumbled “No problem” was his only response. He opened the laptop again and glared at the screen while scribbling notes.

  Katie sighed and went back into the kitchen. She never knew when she should worry about Caleb, and so, by default, she worried all the time. He was a genius with computers, and she knew he’d messed around with hacking into computer systems in college. It was more the fun of the chase than any real desire to obtain information, but she knew the courts wouldn’t see it that way if he was ever caught. He’d promised he was done with all that, but Katie wondered if it was true.

  She warmed up her plate in the microwave and poured a glass of pinot noir. Sipping the wine, she watched the breeze blow more colored leaves into the yard outside the window. Usually this after-work ritual was calming, but this time the wine made her jumpy, and the pleasant breeze seemed to be blowing in unwelcome changes. She couldn’t shake the thoughts of Ellen Riley and what might have gone wrong. The ding from the microwave startled her out of her contemplation. Bringing her plate to the kitchen table, she glared at the stack of medical journals awaiting her. She sometimes felt crushed by the sheer volume of information that came to her mailbox each week. There had been a time when she read the journals cover to cover in a mad desire to know everything she could. Now she chose only the articles she knew would apply to her practice. And she often only read the conclusions. Her former teachers would have been scandalized.

  She pushed the journals aside and instead pulled out a spiral notebook. She liked to jot down questions and new treatment options in her notebook. This time she turned to a clean page and wrote, “Ellen Riley.”

  The practice of medicine was mostly detective work. The physician had to collect clues and piece together the identity of the culprit based on the patient’s symptoms. Katie decided to apply her medical thought process to the mystery of Ellen Riley.

  Using a modified history and physical template, she began to list what she knew and what she still needed to know.

  She started her note with the chief complaint. For patients, that was the reason they came to see a doctor.

  CC: patient dead from apparent overdose of diazepam.

  History of Present Illness: Happy, healthy psychologist and small business owner found unconscious by daughter. Daughter reports that her mother had been “stressed” recently and doing research. Good friend also reports a change in mood over the past couple of weeks, but neither one believes it was depression or that she was suicidal.

  Social History: Married to second husband for two years. One daughter from previous marriage. Recent falling o
ut with good friend Cecily Hawkins.

  Family History: Unknown. Husband’s mother was a known social blackmailer.

  Review of systems suspicions:

  1. Maybe Ellen uncovered one of the secrets Sylvia Riley had been hoarding when she died.

  2. Maybe Ellen knew something about a client that they regretted sharing with her.

  3. The prescription for diazepam was probably obtained illegally—there is no record of it coming from my office.

  Differential Diagnosis (list of suspects):

  Nick?

  Christopher?

  Unknown clients of Ellen

  Unknown victims of Sylvia

  Assessment: Death due to diazepam overdose. Likely not suicide or accident. Therefore, the only possibility is murder.

  Plan/questions to answer:

  1. Find out where she got the diazepam. No record in chart or med book.

  2. Find out what research she was working on.

  3. Why was Nick at her house the day she died?

  4. Who were her clients?

  5. What secrets did Sylvia Riley leave behind?

  6. Talk to Chief Carlson about the prescription. Suicide seems unlikely.

  7. Talk to Emmett.

  Katie sighed. She felt that there were more questions than facts. Selfishly, she was most worried about the first question. According to the label on the bottle, Katie had written the prescription that Ellen had used to kill herself.

  No matter how hard she tried, she couldn’t remember writing that script. The possibility of early memory loss aside, the other explanations were even more worrisome. Did one of her partners—likely Nick, since she couldn’t imagine Emmett doing it—write it and not chart it? Nick was at Ellen’s house that day, and the two couples were friends. Would he have prescribed diazepam for Ellen using Katie’s name? If Ellen hadn’t died, Katie never would have known. Did Ellen somehow manage to write it for herself? Could it have been one of Katie’s staff?

  She wasn’t even sure where it had been filled. And some inner instinct warned her to tread lightly. She couldn’t just accuse Nick. If she was wrong, they’d never be able to work together. If she was right, she had an even bigger problem. She would have to try to find more information to get to the truth. She flipped the notebook shut and ate her now-cold vegetable stir-fry.