Marker

by Robin Cook

  “I suppose,” Roger said. He detected a not-too-subtle change in the nurse’s demeanor. She had started out breezy but now seemed wary and taut, almost to the point of anger.

  “Are you asking me this because they occurred on my floor?”

  “Obviously.”

  “There have been similar deaths on other floors.”

  “I’m aware of that.”

  “In fact, there was one tonight, just a half hour ago, up on the OB-GYN floor. Why don’t you go up and hound them?”

  A distinctly unpleasant tenseness gripped Roger’s entire body, which he blamed on the caffeine. After the euphoria passed, he invariably felt as if all his nerves were exposed. Learning of yet another death right while he was there in the hospital supposedly looking for suspects, made him feel uncomfortably complicit, as if he should have been able to prevent it. “Were the specifics about the same?” he asked, hoping vainly for a negative reply.

  “I suppose,” Jazz responded. “The word is, it was a woman in her thirties, in for a hysterectomy. Seriously, why don’t you go on up and ask the nurses if it bothered them.”

  For a beat, Roger stared at this exotic-looking nurse whom he had originally thought of being attractive and rather sexy, while she brazenly stared back. Now he thought she was almost eerie, reminding him to a degree of his reaction to Dr. Cabreo and to the story about Dr. Najah. He couldn’t help but remember Cindy’s comment about people working the night shift being quirky, though maybe “quirky” wasn’t nearly strong enough. Maybe “neurotic” was closer to the mark. He couldn’t help but wonder if he’d find the whole lot of people on his supposed suspect list equally bizarre. One way or the other, it was becoming clear he would have to work on Rosalyn to get the transferees’ personal records, no matter the risk.

  “What is this?” Jazz sneered. “The silent treatment, or are we having some kind of juvenile staring contest?”

  “Sorry,” Roger said, breaking off eye contact. “I was just shocked to learn about yet another death. It’s upsetting and alarming. I’m surprised you seem to be able to take it so lightly.”

  “It’s called professional distance,” Jazz said. “Those of us who actually treat people have to maintain it.” She brought her feet down with a thud, tossed her magazine to the side, and stood up. “I got patients to see. Enjoy yourself upstairs on OB-GYN.”

  “Just a second,” Roger said. He grabbed Jazz’s arm as she tried to brush past him. He was surprised at its muscularity. “I have a few more questions.”

  Jazz looked down at Roger’s hand gripping her upper arm. There was a tense moment, but she controlled herself. She raised her eyes to Roger’s. “Let go of my arm or you will be very sorry. You hear what I’m saying?”

  Roger let go and recrossed his arms to be completely nonthreatening. He didn’t want to give this woman any excuse for physical violence, of which he intuited she was capable. In truth, she was scaring him. “I understand you transferred from Saint Francis recently. Would you mind telling me why?”

  It was Jazz’s turn to stare before responding. “What is this, an interrogation?”

  “As I told you, I’m chief of the medical staff. There was a mild complaint about your attitude by one of the doctors, and I’m looking into it. Frankly, this doctor has a history of unfounded complaints, but I still am obligated to check into the allegation.” Roger was lying, but he felt he had to come up with some explanation for his questioning her on the spur of the moment. The nursing staff was not under his jurisdiction.

  “What’s this freaking doctor’s name?”

  “I’m not at liberty to disclose the individual’s identity.”

  Jazz broke off eye contact with Roger. Her eyes darted around the room. Roger could see that her nostrils were flared, and she was breathing deeply. She was no longer wary. She was now definitely angry.

  “Let me explain,” Roger said. “I’m inquiring if you left Saint Francis for a similar reason. Did you have trouble with any doctor on the Saint Francis staff? We have to ask.”

  “Hell, no!” Jazz snapped. “I might have had a few words with my charge nurse on occasion, but never a doctor. I mean, I could count on one hand the number of times I even saw a doctor over there on the night shift. They were all home, screwing their wives.”

  “I see,” Roger said. He wasn’t about to comment on Jazz’s last inappropriate point but picked up on the first. “So you also felt your charge nurse over at Saint Francis was not as competent as you would have liked?”

  A wry smile appeared on Jazz’s face. “You guessed it, but it’s not surprising. The night shift attracts some weirdoes.”

  Roger nodded. As a result of his first night-shift visit, he couldn’t have agreed more. “Out of curiosity, did you ever think you might share some of the blame if you didn’t get along too well with either charge nurse?”

  Any vestige of a smile disappeared from Jazz’s face. “Oh, yeah! It’s my fault that these two fat ladies were so stupid. Give me a break!”

  “So why did you transfer?”

  “I wanted a change, and I wanted to move into the city.”

  “Why do you personally work the night shift?”

  “Because there’s a lot less bullshit. There’s still some, I admit that, but it’s a lot less than during the day or even during the evening. When I was a corpsman in the military, I was assigned to the Marines for independent duty. I like working on my own the best.”

  “So you were in the military.”

  “Damn straight! I was with the Marines during the first Gulf War.”

  “Interesting,” Roger said. “Tell me, what is the background of the name Rakoczi?”

  “Hungarian. My grandfather was a freedom fighter.”

  “One other question if you don’t mind,” Roger said, trying to be nonchalant. “Did you know that when you were at Saint Francis, there was a series of similar deaths, back in November?”

  “It was the same: It would have been hard not to be aware.”

  “Thanks for your time,” Roger said, pushing away from the countertop. “I think I will follow your suggestion and go up to OB-GYN, but I might have a few more questions. Would you mind if I came back if that were the case?”

  “Suit yourself.”

  Roger tried to smile reassuringly at Jazz before walking out of the utility room and heading toward the bank of elevators. As he walked, he shook his head imperceptively. He couldn’t believe it. He’d talked to two people on his list and heard about a third, and he felt he could make a case for any of them possibly being deranged enough to be doing the unconscionable.

  Jazz leaned out of the utility room just enough to watch Roger head down toward the elevators. She couldn’t believe it. Trouble was coming out of the woodwork. The sanctioning had been going so well until Lewis, then all hell had broken loose. And just when she had eliminated one potential disaster, another one had popped up. “What a bastard!” she murmured. She knew from the way he dressed and spoke that he was another one of those damn Ivy League types.

  When Roger reached the elevators and pushed the call button, he turned and looked back toward the nurses’ station. Jazz pulled her head back. She didn’t want him to see her staring after him like she was concerned. She shook her head, then slammed an open palm onto the countertop. A few loose papers wafted to the floor.

  “What the hell should I do?” she murmured. She shook her head again. The thought went through her mind to call Mr. Bob, but she quickly dismissed it. She had the sense that if she complained about anything, she wouldn’t get any more names. She’d be dismissed from Operation Winnow. It was as simple as that.

  Jazz shrugged. She couldn’t think of anything. Although the worry gnawed at her, she didn’t know what to do. At the same time, she knew she had to be careful, because this freaking admin type could end up being a whole lot more than a ripple, the way he was talking.

  The elevator door slid open and Roger stepped out onto the seventh floor. To the left, beyo
nd double doors, was the medical ward, and to the right through similar doors was OB-GYN. He pushed into OB-GYN. In contrast to the surgical floor below, there were a lot of people in evidence both at the nurses’ station and in the hallway. He even saw an orderly pushing a gurney with a patient shrouded in a sheet toward the patient elevators. Roger guessed it was the patient he’d come up to inquire about.

  Advancing to the nurses’ station, Roger stood for a moment and just watched. He guessed it was the resuscitation team along with some of the floor’s nurses. The resuscitation cart with its defibrillator was parked against the corridor wall. The people were talking in small groups, most likely debriefing themselves about the failed resuscitation attempt.

  “Excuse me,” Roger said to a woman directly in front of him. She was busy writing in a chart but looked up. Like Jazz downstairs, she was dressed in scrubs, but unlike Jazz, she emanated both civility and respect. Also unlike Jazz, she was slightly obese, with a smattering of freckles across the bridge of her nose. “Could you tell me who is the charge nurse?”

  “I am. I’m Meryl Lanigan. What can I do for you?”

  Roger introduced himself and said that he was inquiring about the recent death.

  “The name was Patricia Pruit,” Meryl said. “This is the chart. Would you like to see it?”

  “I would indeed. Thank you.” Roger took the chart and rapidly scanned it. The demographics were as he had feared. Patricia Pruit was a healthy thirty-seven-year-old mother of three. The previous morning, she’d had an uncomplicated hysterectomy for fibroids. Her postoperative course had been entirely uneventful, and she had already been started on clear fluids by mouth. Then came disaster.

  Roger looked back down at Meryl. She was waiting for the chart, which she took back.

  “It certainly is a tragedy,” Roger said. “And so unexpected, given her age and past health.”

  “It’s heartbreaking,” Meryl agreed. She opened the chart to the nurses’ notes.

  “There have been others quite similar on other floors over the last month or so,” Roger said.

  “So I’ve heard. Luckily, this is our first. We might take it harder than others, since we’re accustomed to much happier outcomes.”

  “I have a couple of questions, if you don’t mind. Did you happen to see a Dr. Najah on your floor tonight?”

  “We did, just like we usually do.”

  “How about Dr. Cabreo?”

  “We saw him as well, but only after the code was called.”

  “How about a nurse named Jasmine Rakoczi, who goes by the name Jazz?”

  “Funny you should ask.”

  “How so?”

  “We see a little too much of Ms. Rakoczi most every night. I’ve even complained to Susan Chapman, who used to be her charge nurse, saying that I didn’t want her up here. I’m going to have to go a little higher now that we don’t have Susan with us any longer.”

  “What does Ms. Rakoczi do when she comes up here?”

  “She tries to be friendly with the aides. Other than that, she’s always looking in the charts, which she has no business doing.”

  “Do you recall specifically that she was up here tonight?”

  “I remember, all right, because whenever I see her, I challenge her. I challenged her tonight, just like I always do.”

  “What did she say?”

  “She said she was the acting charge nurse downstairs and needed some supplies. I can’t remember what it was. I sent her into our supply room to get whatever she needed, but I told her then to please leave. I also told her she’d have to replace whatever she borrowed, which she promised she would.”

  “And she went into your supply room?”

  “She did.”

  “And then what happened?”

  “I guess she got what she needed and went back downstairs. I really don’t know, because I was off taking care of a problem with one of the patients. And then, of course, we had the code.”

  “What room was Patricia Pruit in?”

  “703. Why do you ask?”

  “I’d like to take a look.”

  “Be my guest,” Meryl said while pointing down the appropriate corridor.

  Myriad thoughts were swirling around inside Roger’s head as he walked toward the patient’s room. In his estimation, Jasmine Rakoczi was becoming more and more of an enigma. He kept asking himself why she would constantly be coming up a floor to the OB-GYN section to hobnob with the aides when she seemed so asocial, and why would she be going through OB-GYN charts. It didn’t make any sense. What did make sense was that both she and Dr. Najah had come to OB-GYN prior to the code. Of course, he wondered how many others on his transfer list had come as well. For all he knew, it could have been all of them.

  Patricia’s room was a mess. The debris from the cardiac resuscitation attempt littered the floor. In the frenzy of the event, some of the wrappers, syringes, medication containers, and the like had been merely tossed aside. The bed had been cranked down flat, raised to help with the CPR, and the resuscitation board was still in place. A few telltale droplets of blood were sprinkled across the wrinkled, white sheet.

  Unfortunately, what Roger was looking for was not in evidence. The IV pole was in its usual position at the head of the bed, but without the bottle or plastic container of fluid that had to have hung there. As a consequence of being on the scene, Roger had gotten the idea of having the IV contents checked. Since Laurie had told him that toxicology had come up short, maybe testing the IV fluid would yield something.

  Roger turned around and went back to the nursing station. He got Meryl’s attention and asked her about the missing bottle.

  Meryl shrugged her shoulders. “I don’t have any idea where it is.” She then turned around and yelled to the medical resident who’d been in charge of the resuscitation, asking the same question. He shook his head, indicating that he didn’t know, either, before getting back to his sidewalk mini-conference. He and the other residents were still loudly debating why they had been unsuccessful.

  “I guess it went down with the patient,” Meryl said. “We always at least leave the IVs in place, along with any other tubes.”

  “This might be a silly question, but I haven’t been on staff that long. Where exactly did the patient go?”

  “To the morgue, or what we use as the morgue. It’s the old autopsy theater in the basement.”

  “Thanks,” Roger said.

  “Not at all,” Meryl said.

  Roger went back to the elevators. He pressed the down button but then eyed the sign for the stairs. He suddenly had it in his mind to ask Ms. Rakoczi why she went to the OB-GYN floor so often, and what it was that she needed that night. Since the elevator was taking its time arriving, Roger used the stairs. As he descended, he acknowledged that the caffeine was finally starting to wear off. His legs felt heavy. He decided that he’d have one more chat with Ms. Rakoczi, hunt briefly for the IV bottle, and then head for home.

  The surgical floor was as quiet as it had been earlier. Roger surmised that the nurses were all attending to their patients. He saw some of them as he passed open doors into the patients’ rooms. Rather than bother anyone, he thought he’d wait at the nurses’ station for Ms. Rakoczi to return. To his surprise, he found her where he’d found her earlier, in the same position, reading the same magazine.

  “I thought you said you had patients to see,” Roger said. He knew he was being abrasively provocative with someone with a volatile temperament, but he couldn’t help himself. This woman was obviously goldbricking.

  “I saw them. Now I’m manning the nurses’ station. Do you have a problem with that?”

  “Luckily for both of us it’s not my bailiwick,” Roger said. “But I do have another question for you. I followed your suggestion and went upstairs to OB-GYN and spoke with Meryl Lanigan. She said you were a frequent visitor to her floor. In fact, she said you were up there earlier. I’d like to know why.”

  “For my continuing education,” J
azz said. “OB-GYN interests me, but I didn’t get much exposure to it with the Marines, for obvious reasons. So I frequently go up there on my breaks. Now that I’ve learned a bit about the field, I’m thinking of putting in for an opening in OB-GYN.”

  “So it was for continuing education that took you up there tonight?”

  “Is that so hard to believe? Instead of going down to the cafeteria on my lunch hour with my half of the surgical-floor team and talking about drivel, I went up to OB-GYN to learn something. I don’t know what it is about this place. Whenever you make an extra effort to improve yourself, you get nothing but grief.”

  “I don’t want to add to your burden,” Roger said, struggling to keep the sarcasm from his voice. “But there seems to be a discrepancy. Ms. Lanigan told me that when she confronted you earlier, you said you wanted to borrow something.”

  “Is that what she said?” Jazz questioned with a scornful laugh. “Well, she’s right in one sense. I did need to borrow some infusion lines, thanks to central supply not restocking us, but that was an afterthought. What I was really doing up there was sucking up information from reading nursing notes. She probably doesn’t want to admit that, because she’s probably worried I’m gunning for her job.”

  “That wouldn’t be my take,” Roger said. “But what do I know? Thanks for your time, Ms. Rakoczi. I’ll be back in touch if I have any more questions.”

  Roger walked out of the utility room and rounded the nurses’ station countertop. He was now feeling genuinely fatigued. The caffeine had completely worn off. A few moments earlier, he’d entertained the idea after talking again with Ms. Rakoczi of returning to the OR to see if he could find Dr. Najah. As with Rakoczi, he wanted to ask him what he had been doing on the OB-GYN floor, but now he had second thoughts. He was exhausted. It was nearly four o’clock in the morning.

  Roger resolved that the first thing he would do when he got into his office later that morning was call Rosalyn and beg for Jasmine Rakoczi’s St. Francis record. He didn’t care about the consequences. He found himself wondering how much the general nursing shortage had to do with the fact that Jasmine Rakoczi was employed. The overwhelming chances were that she was not a serial killer. That would be too easy. But the fact that she was employed as a nurse with her attitude was a travesty as far as he was concerned, and he intended to do something about it.