“It’s in my purse. I promised that I’d keep it with me, and I’m as good as my word. Just tell me you’ll come and visit me at Menard after I drop my purse, the gun goes off, and I end up shooting an innocent bystander.”
“Every Wednesday.”
“Why Wednesday?”
“Visiting day. Where’s Claudia’s dad? Did he get in all right?”
“He’s talking to Blades. I took him to the apartment and met Agent Roth. She’s a pretty woman.”
“Not to mention a crack shot. She finished seventh at the Nagano Olympics in sharpshooting.”
“Cheryl said you had something you wanted to show me.”
“Yeah, though now that you’re here, I might as well just tell you.”
“Tell me what?”
“I had one of my people do a Lexis-Nexis search on each of the fab four, and they turned up something interesting on McDermott.”
“McDermott? What?”
“When you and Dr. Gordon had your little chat about hospital killers, did she happen to mention a case at the Bloomington VA?”
“No. What happened there?”
“A nurse was accused of systematically murdering patients. It happened almost twenty-five years ago, but there were a couple of remarkable features of the case.“
“Such as?”
“The number of patients involved. We’re talking about twenty-six deaths over a fourteen-month period. Not only that, but the way they were killed was pretty interesting.“
“Really? How did they die?”
“Apparently the killer injected a drug called succinyl-choline into the patients’ IV solution.”
“What’s succinylcholine?”
“It’s some kind of anesthesia drug that causes muscle paralysis.”
“Say that again?” I demanded sharply.
“It causes muscle paralysis. That’s how they died. The drug stops the heart and lungs from working. But that’s not the really incredible part.”
“No?”
“No. It turns out that the person who was accused of putting the anesthesia drug into the IV lines was a nurse who’d worked at the hospital for ten years. But guess who figured out what she was up to and blew the whistle?”
“I have no idea. Who?”
“A surgical resident named Gavin McDermott.“
“Gavin McDermott?” I echoed incredulously. “That is too weird. Twenty-five years ago he discovered a nurse killing off patients with a paralysis-inducing anesthesia agent, and now his patients are mysteriously dying in what appears to be exactly the same way?”
“Sort of makes you wonder why he’s never said anything about it at Prescott Memorial. You’d think he’d have figured out what was going on and been screaming blue murder months ago.”
“So what about the nurse? Did she ever offer an explanation for what made her do it?”
“No,” replied Elliott. “She never did. It turns out that she killed herself before the case went to trial. She injected herself with a lethal dose of succinylcholine while she was out on bail.”
“Is that a drug that’s still in use?” I asked, wondering if it was something I should tell Julia Gordon she should look for.
“No. Now they use something else, the next generation of the drug. The action is basically the same, only quicker. Apparently it’s marketed under the brand name Pavulon.”
CHAPTER 25
The conference room at Joan Bornstein’s office had been transformed into a charting command center. Two physicians, both residents at Northwestern who were being paid the equivalent of a month’s salary per day in consulting fees, worked at either end of the long table. Neither looked old enough to have completed puberty. Flanking them were data techs working on their laptops, courtesy of Gabriel Hurt.
Having heard of Claudia’s death from Jeff Tannen-baum, Hurt had called Cheryl that morning to ask if there was anything he could do. Instead of flowers or sympathy, Cheryl explained that what was really needed was technical support to complete what she’d described only as the research project Claudia had been racing to complete when she died. Four data techs and an MIS specialist from Icon’s Chicago offices had arrived within the half hour. So far they’d set up an information paradigm and were busy entering the data as it was culled from the patient charts by the doctors. The MIS expert, a young woman with close-cropped hair and a Han Solo T-shirt that read NEVER TELL ME THE ODDS, was busy writing a program to evaluate the data.
“Can you go through the charts and quickly find the list of drugs that each patient was given during surgery?”
I asked.
“Are you talking about anesthesia agents?” asked one of the residents.
“Yes. Specifically I want to know if any of them were given Pavulon.”
“I’m sure they were,” the doctor at the other end of the table answered promptly. His name was Francis Cho, and as it turned out, he was a surgical resident from the same program at the University of Chicago where Claudia had done her training. “Pavulon is part of the most commonly used combination of anesthesia drugs.“
“So far I’ve got drug lists for all but two patients,” volunteered one of the data techs.
He gave the physicians the names of two patients from whom the data was missing. It took a couple of minutes to wade through all the paper, but in the end the data confirmed Dr. Cho’s suspicion. All of the patients had been given Pavulon as part of their surgical anesthetic. “Damn!” I muttered under my breath.
“Why’s that?” asked Dr. Cho.
“It gets us nowhere,” I replied. “Even if Pavulon was found in their bodies at autopsy, there’d be a good explanation for it.”
“You know, speaking of autopsies,” chimed in the other resident, a young man with Oklahoma in his voice, named Larry Spader, “not all of these patients are dead.“
“What do you mean they’re not all dead?” demanded Joan Bornstein, appearing in the doorway.
“This one, here, that I’ve just been going through. She suffered respiratory arrest, but they were able to resuscitate her. She spent nine days in ICU, but eventually she went into a convalescent home.”
“What’s her name?” I asked, feeling the stirrings of buried memory, but unable to make the necessary connection. “I vaguely remember the night that Claudia answered the code on her arrest. She said she wasn’t sure if the woman would ever fully recover.”
“The patient’s name is Ida Lapinsky,” he replied, consulting the chart in front of him. “Apparently she recovered most of her neurologic functions, certainly to the point where she was able to communicate and take part in her own care. I guess the thing that caught my attention is the fact that the neurologist who examined her in ICU made a note that she might be delusional.”
“On what basis?” demanded Joan.
“Apparently Mrs. Lapinsky kept repeating the same story over and over again until she became quite agitated. She claims that immediately before she went into respiratory arrest, she saw the devil come into her room, a monster with a big eye, who put something into her IV.”
“Who put something into her IV?” I echoed.
“That’s all she said,” replied Dr. Cho. “The neurologist seemed to think the whole thing was a hallucination resulting from grand mal seizure. Still,” continued the doctor earnestly, “if I were really interested in what was going on, I’d want to interview the only survivor.”
Before I left, I called Elliott’s office. He was out, but I asked to be connected to the lead investigator on HCC. I gave him the address and phone number listed in Mrs. Lapinsky’s chart, and he promised to do his best to locate her immediately.
Driving back to the office, I tried to put the pieces together. The only trouble was that I didn’t know whether they were to one puzzle or two. What Elliott had reported proved beyond any doubt that Gavin McDermott knew all about causing respiratory arrest in patients using paralyzing anesthesia drugs. But what possible reason could he have for killing his own patients? He gained nothing fr
om their deaths, and indeed, the cumulative result had been a slipping of his reputation and whispering among his peers. I remembered what Julia Gordon had said about these cases usually being the work of deranged individuals. Surely Gavin McDermott wouldn’t be the first surgeon to slip off the edge. Perhaps the deaths were part of a systematic effort on his part to free up beds for more critically ill patients? But in the past when Gavin had gotten into trouble, it had been with alcohol. If he were going through some kind of personal crisis, you’d expect him to start drinking, not become psychotic.
And where did Claudia fit into all of this? Was it possible that Carlos was Prescott Memorial’s angel of death? It certainly made sense. Not only was he in and out of the hospital with access to all kinds of drugs, but usually it was first-line caregivers—nurses and paramedics— whose burnout manifested itself in homicide. I wondered if perhaps he had some sort of grudge against McDermott, and made a mental note to mention it to Blades.
When I got back to the office, I found a note from Cheryl saying that she’d gone to the police station to pick up Claudia’s father, as well as a message to call Julia Gordon at the medical examiner’s office. I punched in the number on the message slip and found myself listening to elevator music while I waited on hold for the forensic pathologist to come to the phone.
“Kate,” exclaimed Dr. Gordon, coming on the line. From the booming quality of her voice and the sound of running water in the background, I surmised she was on the speakerphone in one of the autopsy suites.
“Thank you for seeing to it that things got moved along,” I said. “I talked to Detective Kowalczyk and he told me that you’d already released the body.”
“Yes. The funeral home has already picked it up. I understand the young woman’s father is taking the body back to New York with him for burial.”
“Yes. All the arrangements have already been made.“
“Well, I just wanted you to know that I kept my promise and called in a favor from one of the chemists in the toxicology lab and had him screen for the kinds of drugs you and I talked about.”
“And?”
“You’ll be interested to know that Dr. Sylvestri noticed a fresh puncture mark on your roommate’s arm.“
“What kind of puncture?”
“Consistent with a hypodermic injection. It turns out your suspicions were correct. Dr. Stein was injected with Pavulon before she died.”
CHAPTER 26
I rocked back in my desk chair and told myself to breathe. Suspicion is one thing. Knowing is another.
“So she didn’t surprise a burglar,” I said finally.
“No,” agreed Julia Gordon, “it doesn’t look that way.“
“But what I don’t understand is, if you were going to inject her with Pavulon, why would you then stab her? What’s the point?”
“Perhaps whoever did it was trying to disguise the nature of the crime by making it appear to have occurred during the course of a robbery. Besides, injecting someone with Pavulon probably wouldn’t kill them.”
“I don’t get it,” I said, confused. “I thought you told me that Pavulon is a derivative of curare.”
“It is. But it’s a relatively short-acting drug. It works by temporarily paralyzing the long muscles of the body. Administered continuously through an IV, it causes respiratory arrest, but given in a single dose in an injection would probably only render the subject incapable.”
“For how long?” I demanded, as the sickening realization of what had happened slowly began to dawn.
“That would depend on how much was given, as well as the size of the person it was administered to.”
“I understand all that, but what would be your best ballpark guess?”
“Somewhere between thirty and ninety seconds.”
“Just long enough to make it easy to stab her in exactly the right spot,” I declared bitterly, “and then leave her there to die without the murderer so much as getting blood on his shoes.”
As soon as I got off the phone I called Joe Blades. At this point I didn’t care about HCC and Prescott Memorial Hospital, I didn’t even care if my mother never spoke to me again. I was determined to do what I could to help find out who’d murdered Claudia.
I also needed to keep moving, if only to keep myself from dwelling on the horror of what had happened to her. Even as I dialed the number, all I could think of was her lying paralyzed on the floor of her own apartment watching as someone she trusted enough to let into the apartment fetched a knife from the block in order to stab her.
I didn’t know if Dr. Gordon had already called Blades and let him know about the toxicology results, but it was clear he was expecting my call.
We agreed to meet at a restaurant called Emperor’s Choice, a storefront in Chinatown that was convenient to the sixth district police station where he was assigned. Through the dim light of the restaurant I could make out two heads in the booth at the back of the restaurant, and my heart sank, thinking that I’d have to contend with Blades’s partner, Kowalczyk. But when I got back to the table, I was relieved to find Joe reliving the highlights of their most recent police league basketball game with Elliott.
They were drinking Tsing Tao beer and eating hot scallion pancakes. I slid into the booth beside Elliott, grateful for the reassuring warmth of his thigh against mine. A waiter materialized, and I ordered myself a beer, but couldn’t stomach the thought of food. Elliott took my hand under the table and gave it a reassuring squeeze.
“When Joe told me that you guys were meeting, I thought I’d come along and make sure he brought the rubber hoses.”
“You just heard she was buying dinner and didn’t want to pass up a free meal,” Joe replied.
“Have you brought Carlos in for questioning yet?” I asked. Usually I enjoyed listening to their gym-floor banter, but tonight I had no patience for it.
“We picked him up at home this morning and brought him in,” replied Blades. “It doesn’t look like he’s our guy.”
“Why not?” I demanded.
“Somebody called in sick in his unit, and he ended up pulling a double shift last night.”
“That doesn’t necessarily mean anything,” I pointed out. “Paramedics are like firemen. They come and go while they’re on. It’s not like they ride around on patrol. Did you check his log? Just because he was working doesn’t mean he couldn’t have come to the apartment—“
“That’s why we’re pretty sure it’s not him,” reported Blades patiently. “He and his partner answered a call last night at seven-ten. A four-hundred-pound woman got wedged into her bathroom and couldn’t get out. Her neighbors heard her screaming for help and dialed 911, but by the time Carlos and his partner got there, she was having chest pains to boot. They weren’t able to get her stable and out of there until after midnight. The medical examiner puts the time of her death somewhere between nine and midnight, so our friend Carlos is off the hook.“
“Shit.”
“Why do you say that?” asked Elliott.
“I was working on a theory, and I was starting to get attached to it,” I confessed. I went on to tell Joe about the postsurgical deaths at Prescott Memorial and my suspicion that Pavulon had been the agent used to cause them. I also told him about Mrs. Estrada and Claudia’s efforts to find a common denominator among the patients and the fact that her notes and backpack had disappeared from the apartment.
“We had them check at the hospital,” reported Blades. “They didn’t find her backpack or anything like the notes you described. Are you sure you saw them when you left the apartment that morning?”
“Yes. They were on the dining room table. Where did you look at the hospital? Maybe she left them someplace weird....”
“By the time we got to the hospital, the head of her department had already gone in and emptied out her locker and retrieved all of her things. He said he didn’t want the sight of them to traumatize her coworkers any more than they already were by her death. It was all boxed up and
ready for us. No backpack. No notes.”
“So if it wasn’t Carlos, who was it?”
“Well, from what the medical examiner’s saying, I think we can pretty much rule out a surprised burglar, unless they’re starting to carry hypodermics filled with anesthesia stuff around with them,” Blades replied. “Which means that it was premeditated,” said Elliott. “Looks that way,” said Blades, “and from what Kate is telling me, we’re probably looking at this as a series of related crimes.” From the weariness in his voice, I could tell he was less than thrilled by the prospect. “I’m going to go to the D.A. Monday morning and see if I can get him to sign on to opening up an investigation.” His beeper went off at his waist, and Elliott slid him his cell phone so that he could call in to the dispatch operator. He punched in the number and pulled out the little notebook he invariably kept in his jacket pocket. Apparently the conversation was one-sided, because as soon as he’d identified himself, he started writing. When he was finished, he handed Elliott back his phone and said, “Got to go, kids. Duty calls.”
“What’s up?” asked Elliott.
“Somebody just turned up ten-seven in a vacant lot on King Drive.”
“Ten-seven?” I asked.
“Police communication code for ‘out of service,’ ” Elliott informed me as he got to his feet to shake Joe’s hand good-bye.
“It’s probably nothing. Just a little friendly competition among heavily armed drug dealers,” sighed Blades. “I’ll take that kind of case any day over a string of mysterious deaths at a highly respected hospital.”
After Joe left, Elliott slid into his place so that he could face me from across the table. I kicked off my high heels and slipped my stockinged feet into Elliott’s lap.
“You okay?” he asked.
I didn’t answer. Instead I picked up a chopstick and started pushing grains of rice around a plate.
“You know that eventually Joe will get this guy, whoever he is.”
“I know,” I sighed. “It’s the eventually part that I don’t like. With Joe going to the D.A., you know as well as I do what we’re talking about—a massive investigation that drags out over months. Not only will I have to read Claudia’s name in the newspaper every day, but also the damage to the hospital will be irreparable. How many old rich guys do you think are going to want their name associated with a place where they let somebody run around killing patients? Now we have no choice but to sell to HCC....”
Dead Certain Page 25
