Diagnosis Death pft-3

by Richard L Mabry

  "Cook is my married name. After my mother threw me out of her house, calling me a hippie who'd never make anything of her life, I migrated to Santa Fe. I was scratching out a living selling trinkets in the town square when I met Clark. He was the youth pastor at a church there. We started dating and were married six months later."

  "Your mother never mentioned you."

  "No, when I didn't live up to the image she had in mind for her daughter, it was as though she'd taken white-out and erased my name from the family Bible. She wouldn't take my calls, returned my letters unopened. The only reason I know that you and my little brother were married is that one of my high school friends had my address and sent me the clipping from the paper."

  Elena tried to assimilate what she was hearing. "How do you go from selling jewelry on the square in Santa Fe to practicing social work in Texas?"

  "Clark was called to be associate pastor of the First Methodist Church here in town, and we found out the hospital was looking to add a social worker. I didn't have any training, just a couple of years of college, but I bluffed my way through the interview and got the position. I've been learning on the job ever since."

  "Do you and Clark have any children?"

  Natalie bit her lip. "Last year, Clark decided he wasn't cut out for ministry-or for marriage. I'm alone now."

  Elena hitched her chair closer. "Natalie, you're not alone anymore. I'm glad I found you. But I have some news about your family."

  "Sorry I'm late." Elena tossed her purse into her desk drawer. She snatched her white coat from the hook behind the door and shrugged into it, then scanned the hall. The plastic bins outside every exam room door held a chart. She was starting behind, and to catch up she had to put aside the events of the past hour. There'd be time enough to think about them this evening when she had dinner with David.

  Elena tapped on the door of the first exam room and entered to find an elderly woman fidgeting on the edge of the exam table. Her right shoe lay on the floor, and she was flexing the toes of that foot.

  "Mrs. Musgrove, I'm Dr. Gardner. I'm terribly sorry to keep you waiting. I was held up at the hospital." Elena perched on the rolling stool and studied the chart. This was the woman's first visit to the practice. She listed a chief complaint of foot trouble. "Tell me about the problem with your feet."

  The woman kept her eyes fixed on her foot, as though her gaze alone might make it well again. "I've got this place on it that won't heal."

  "How long has it been there?"

  "Maybe six months, might be a bit longer."

  "Does it hurt?"

  "No. But I told my daughter about it. She took one look at it and made this appointment. I don't think it's much, do you?"

  Elena had no trouble finding the ulcer on the bottom of the woman's foot. It was about an inch in diameter, fairly shallow, with a clean central crater. She placed her fingertips lightly on the top of the foot. The pulse was weak, and the skin was cool. Elena pulled a hatpin from the lapel of her white coat and lightly jabbed the woman's foot. "Feel that?"

  "Not really. But I don't have much feeling in my feet, anyway."

  Elena thought she knew what the woman's problem was, but she wanted to be certain. "How's your weight?"

  "I don't see what that has to do with my feet, but now that you mention it, I've been losing weight, even though I eat quite a bit."

  Elena went through several more questions. She made a couple of notes on the chart, then set it aside. "Mrs. Musgrove, I think you have diabetes. I'm not sure how long you've had it, but it's affected the nerves and the circulation in your feet. I'm going to have my nurse set up an appointment for some lab work to confirm that diagnosis. Meanwhile, here's what you need to do to keep that ulcer from getting worse."

  She gave the woman comprehensive directions, all the while trying to ignore the clock in her head that was saying, "You're behind. Hurry up." This patient deserved her best, and if it took a bit of time, so be it.

  The afternoon went by quickly. Some patients presented with problems that were simple, some with problems that were challenging. When she finished with the last patient on her list, it was almost six o'clock. She looked into the waiting room, expecting it to be empty. Instead, she saw a middle-aged Hispanic man in the far corner thumbing through a magazine. He wore a dark blue uniform of some kind. Maybe this was a mechanic, here to see her about an injury.

  Jane was still checking out the last patient, so Elena approached the man and said, "I'm Dr. Gardner. Are you here to see me?"

  The man put down his magazine and stood up. Elena got a closer look at his uniform, and his solemn expression confirmed her fear. "I'm Jesus Hernandez, Dainger Police Department. I wonder if I might have a few minutes of your time, Doctor?"

  He retrieved a worn leather briefcase from near his feet and followed Elena into her office. She eased into the chair behind her desk and waved him to a seat opposite her. It took everything she could muster not to show the panic she felt. "How can I help you, Officer?"

  "Doctor, we're working a case that involves a patient of yours, Charles Lambert. To assist us in our efforts, I'd like you to allow me to take your fingerprints."

  So that was it. No questions. No Miranda warning. Just a request for fingerprints. Elena had never been printed before. No military service. No fingerprinting when she began her residency. The police couldn't say the prints on the Anectine bottle were hers unless she gave them this sample.

  Should she call Will? Surely they had to have some sort of warrant to do this. Wasn't there something in the Constitution about unreasonable search and seizure? She might be able to delay the process for days, maybe even weeks. But what would that gain her?

  She pushed back the sleeves of her coat and held out her hands. "Certainly."

  As the man went through the process, Elena had a thought. "Tell me, did the police chief send you to do this because you're Hispanic? Did he think that would make me more cooperative?"

  A ghost of a smile flittered across Officer Hernandez's face. "No, ma'am. I'm a second-generation Texan. I can't do much more in Spanish than order in a Mexican restaurant." He handed her a moist towelette to clean her fingers. "The chief sent me because I'm the best one on the force at taking fingerprints."

  Will stopped his client in mid-sentence with an upraised index finger and reached to punch the flashing button on his private line. Only a few people had this number, and he didn't want to miss a call from any of them. "Yes?"

  "Will, it's Elena. Can you talk?"

  "Let me call you back in five minutes."

  It was actually ten minutes before Will shook hands with his client and showed him out of the office. The incorporation of a small business for the man was a simple matter. Will had a hunch that Elena's call didn't signal anything simple. Five minutes later, he knew he'd been right.

  "The police came for your fingerprints? Did they read you your rights?"

  "No," Elena said. "No questions. Not even any pressure to cooperate. He just said, 'I'd like you to allow me to take your fingerprints.' I started to tell him I'd need to call my lawyer, but then I decided there was really no benefit to refusing."

  "You could have made them come back with a warrant, but you're right. This way, you paint yourself as a cooperative citizen with nothing to hide."

  "How long do I have before they show up with handcuffs, though? If Godwin gave them the Anectine bottle, they're bound to identify my fingerprints on it."

  Will pulled a legal pad toward him and scribbled a few words. "First they'll take a statement from you and ask you a bunch of questions. How do you explain the fingerprints on the bottle? Can you account for your whereabouts during the time of Lambert's death? By the way, where were you then?"

  "I was in medical records, signing charts. And, before you ask, there was no one else around. The place was empty."

  "Not good," Will said.

  "But I have a little time. Right?"

  "Some. Let me call my source at the pol
ice department and see what he knows." Will scribbled a note on his pad. "Can you come by this evening to talk about this?"

  "Ummm… I'm supposed to have dinner with David tonight. There are some things we need to discuss. Can this wait until tomorrow?"

  Will wondered what could be more important than avoiding an arrest for murder. "I suppose so. Meet me in my office at noon tomorrow. If you hear from the police before then, call me immediately."

  "It seems to me that the only way I can be cleared is-"

  The silence stretched on. "Elena, are you still there?"

  "Let me think about this."

  Will heard a click, and realized he was holding a dead phone. He wasn't sure what Elena had in mind, but he was willing to bet it involved thinking outside the box. Way outside.

  David paused with a bite of enchilada halfway to his mouth. He'd hoped this would be a quiet dinner, one when he could convey to Elena how he felt about her. But she'd led with startling news, and that had been the topic of their conversation since. "She didn't know about Mark?" All around them, the little Tex-Mex restaurant buzzed with conversations, but David kept his attention riveted on Elena. "What an amazing story."

  Elena dipped a chip into the salsa. "Her mother had effectively disinherited her, cut off all communication. She knew we were married because a high school friend tracked down Natalie's address and sent her a copy of the story. She recognized me from the picture. We're still not sure how her name ended up in the list of survivors in Lillian's obituary. Probably one of Lillian's acquaintances mentioned her."

  David chewed and swallowed. "Wow. Sort of like the line from Casablanca. 'Of all the hospitals in all the states, you had to come to the one where she works.' "

  "I don't think that's what Bogart said, but I get the picture. And I'm glad I found her. I think there's a connection there that will be good for both of us. I really need a friend right now."

  "Excuse me, but what am I?" David's words were light, his tone serious.

  "I'm sorry. Of course you're a friend. A good one, too."

  David forced a smile. Tell her now. She knows it, but she just won't let herself admit it. "Elena, let's not ignore it. You know how I feel about you. Mark's been gone for more than half a year. Isn't it time you began thinking about the rest of your life?"

  He saw her open her mouth, then close it again. Maybe his words had hit home this time. Finally, she shook her head. "There's just too much uncertainty in my life right now. Maybe, when I get out from under this cloud-"

  David nodded. At least it wasn't a "no." Just a "maybe later." He could live with that.

  Elena bit into a chip, then licked a bit of salsa off her fingertips. "Tell me, how's Mrs. Gomez?"

  "Good news there. Today she roused when her husband called her name. She's still in and out of consciousness, but she's breathing on her own. I think she's going to make it."

  "Still in ICU?"

  "Yeah. I figure I've got at least another day's grace before Godwin really pushes me to transfer her to a postpartum room."

  As David watched, Elena seemed to retreat deep inside herself. "Penny for your thoughts."

  She shook her head and pushed away her plate. "Would you mind if we cut this short?" Elena dipped into her purse and dropped some bills on the check. "I hate to hurry off, but I was thinking about something I have to do, and it looks like I don't have much time."

  Darkness was descending on the city, but still Elena sat in her office, her fingertips pressed to her temples. The lamp on her desk provided the only illumination of the yellow legal pad before her. Random thoughts flew through her head, while she did her best to capture them and arrange them to make some sort of sense. Who would want to kill Charlie Lambert? And why?

  She ran down her list of suspects once more. Nathan Godwin. Marcus Bell. Eric Burson. Frank Perrin. Natalie Gardner Cook. She could imagine motives for each of them. What about access?

  Godwin could go anywhere in the hospital without question. Eric was a frequent visitor to the ICU. So was Marcus. Frank made calls to the hospital to take statements from accident victims-could some of those take him to the ICU? Natalie worked in the hospital.

  Elena dropped her head to the desk. God, I don't know what to do.

  There was no divine voice from the clouds, no lightning flash or burning bush. Instead, the answer came to her the way algebra had finally begun to make sense to her in high school. One minute it was a crazy, senseless exercise. The next, everything fell into place.

  Now she knew who the killer was. Even better, she knew who the next victim would be, and when the attempt would take place.

  She picked up the phone, found the number she wanted, and dialed it. "Hi, this is Elena Gardner. Listen, I need a big favor from you."

  Elena stood in the closet and listened to the hospital sounds around her. The overhead paging system was silent at 2:00 a.m. The squeak of rubber soles and the occasional murmured conversation marked the passage of nurses on their rounds, accompanied at times by the clacking wheels of a medication cart.

  Elena had taken the head nurse aside and asked her to avoid this room as much as possible. The nurse seemed puzzled, but at last she agreed.

  This had to be the room. This had to be the patient. And, most important, if rumors spread throughout the hospital as rapidly as Elena thought, this had to be the night. It would happen on the 11:00 p.m. to 7:00 a.m. shift-the time when life was at its lowest ebb, for medical staff and patients alike.

  Elena stretched, and listened to her bones creak. She'd stood here for three hours. How much longer could she-

  The door opened. A dark form slipped into the room and pushed the door closed. The soft "whoosh" of the pneumatic closer ended with a sharp "click." The intruder crept further into the room. The beam of a pencil flash, softened by a finger over the lens, swept over the bed and picked out a form hidden under the covers.

  The intruder pulled a cylindrical object from a pocket and flicked a plastic cover off the tip.

  Elena stepped from the closet. "That's enough. Stop right there." Her hand found the light switch, and light flooded the room.

  Glenna Dunn shielded her eyes with her hand, still holding the pencil flash. She put the syringe behind her like a child caught with a forbidden cookie. "Dr. Gardner, you surprised me. I came by to check on my husband."

  "At 2:00 a. m?"

  "I'm working a double shift in the ER tonight. I thought I'd slip up here on my break."

  Elena closed the distance between them. "Great alibi, Glenna. Your husband stops breathing, and any number of people would say you were in the ER the whole time. Nobody pays any attention to the time you're gone on break, especially if things are busy down there."

  "I don't know what you mean."

  "By the way, you can put down that syringe of Anectine. Your husband was moved to another room earlier today. This-" She whisked back the covers. "This is Resusci-Annie, the mannequin I use for CPR classes. Makes a pretty realistic patient in the dark, doesn't she?"

  Glenna lunged forward, the syringe held like a knife, the deadly needle poised to plunge into vulnerable tissue. Elena dodged back like a matador avoiding the horns of a charging bull.

  This wasn't the way Elena pictured the scene. She'd confront Glenna, the nurse would break down crying, and Elena would call the police to take her. But apparently, Glenna had no intention of going quietly. If she could jab that needle into one of Elena's muscles and empty the contents of the syringe, paralysis would occur within a minute, giving Glenna plenty of time to get away. Since Elena wouldn't be able to breathe for five minutes or more, she'd die.

  Elena locked Glenna's right wrist in both hands, fighting with all her might to keep that deadly point away. Glenna tried to scratch Elena's eyes with her free left hand. Elena dodged just in time.

  Back and forth the battle raged. At last, Elena focused every ounce of strength she could muster, and began to bend Glenna's hand backward. Elena gave one final heave, and the needl
e jabbed into the base of Glenna's neck. Glenna strained to pull the syringe away, but only succeeded in pushing down on the plunger.

  Elena pulled back in horror. Glenna stood for a moment, the syringe dangling from the needle still sunk into her neck.

  Elena ripped the syringe away. "Glenna, breathe," she yelled. "Take some deep breaths while you can."

  Glenna fell to the floor. It seemed that all her muscles contracted at once. Then she went limp as a rag doll.

  Elena knelt at the woman's head, positioned her head to open her airway, and put her lips around Glenna's mouth. Elena gave three quick breaths. She didn't think she could do that for five or six more minutes. There had to be a better way.

  Her eyes swept the room. There was a ventilator in the corner, left there when Glenna's husband was moved earlier in the day. But how to put it to use?

  Elena bent and gave Glenna another four breaths. As she straightened, she saw the case she'd shoved under the bed when she put Resusci-Annie in place. It contained the laryngoscope and endotracheal tubes she'd used to teach advanced resuscitation techniques.

  Elena pulled the case toward her and opened it, then turned away to breathe for Glenna once more. She had to hurry. Elena made a quick guess about the size tube needed. She pulled it from the case and snapped the laryngoscope open. The light didn't go on.

  Breathe for Glenna again. Look back in the case and see the batteries lying free in one corner. Insert the batteries, open the laryngoscope, mutter a quick "thank-you" when the light came on.

  Four more quick breaths. Elena inserted the laryngoscope, pulled upward to visualize the larynx. Hard to see the vocal cords. Try anyway. She shoved the tube into Glenna's throat. Two quick breaths into the tube with one hand on Glenna's chest. No movement. Move her hand downward, another couple of breaths. The stomach rose. Glenna produced a massive belch. The tube was in the esophagus-the swallowing tube- not the airway.

  Elena removed the tube, gave Glenna three mouth-to-mouth breaths. One more try with the laryngoscope. This time she got a good view of the vocal cords, and slid the tube between them. Two quick breaths. The chest rose. She was in.