Diagnosis Death

by Richard L Mabry

  Matney and Clark engaged in a low-key debate about the best surgical approach to AVMs, as they called them, and one of the residents had a follow-up question. Then Matney called on the next presenter, and the discussion moved on.

  Elena let out a breath she didn't know she'd been holding. That was it. Could she slip out now? The clock was on the wall behind her. If she looked at her watch, Matney might see it. She decided to sit quietly until the conference ended. She might even learn something.

  After another half-hour the last presentation wound down. Matney made a few perfunctory announcements, and the conference was over. Faculty members and residents moved toward the door, most with pagers and cell phones at the ready. Elena insinuated herself into the crowd and inched out of the room, her shoulders hunched as though she could make herself smaller and avoid further contact with Matney or Clark.

  Once she was safely in the hall, she took a deep breath and strode rapidly toward the elevators. Three paces from safety, an all-too-familiar voice brought her up short. "Dr. Gardner. May I see you for a moment?"

  Elena followed Dr. Matney into his office.

  "Please have a seat." He hung his white coat carefully on a hook behind the door and took a seat behind his desk. "Thanks for coming to the conference. Your input wasn't necessary, but I wanted you to see for yourself that we are making an effort to put behind us the controversy about how Chester Pulliam's life ended. In the final analysis, whether you or someone else disconnected the respirator, the result was expected. Mrs. Pulliam remains convinced you were responsible, and tells Dr. Clark she hopes to see you again to thank you."

  Elena inclined her head, although she wasn't sure why she would be thanking Matney. After all, he hadn't yet said anything that indicated a belief in her innocence.

  "I spoke with two of the ICU nurses this morning," he continued. "One is new at St. Paul, a transfer from the Zale Hospital ICU. I didn't catch her name. She saw you go into Pulliam's room. She has no recollection of when you came out, or of anyone else going in until he was found dead."

  "So that doesn't help," Elena said. "What about Ann?"

  "I talked with her. She recalls speaking with you in Pulliam's room. She left you alone there when she was needed elsewhere in the unit. She doesn't know when you left. The emergency kept her tied up until the time Pulliam was found dead."

  "So no one saw anyone enter or leave Pulliam's room after I was there?"

  Matney's expression was that of a teacher sorely disappointed in a star pupil. "Although neither of these two nurses saw anything, there remain fully half a dozen people who might be interviewed." He held up a warning finger. "But I've chosen not to go further. As I told you, it's immaterial whether you or someone else wrote that DNR order and disconnected Pulliam's respirator. It's not homicide or manslaughter. It's not even malpractice. The acts merely brought to an inevitable end an unfortunate chain of events. Therefore, we plan to let the matter drop."

  Anything that might look bad, sweep it under the rug or deep-six it some way. Elena couldn't believe this. "What about the person behind this, the one who wants to cast suspicion on me? Aren't you going to look for them?"

  "We have no desire to keep this going and risk any hint of scandal for our department or the medical center. And, as for your reputation—because I know that's foremost in your mind—Dr. Gross and I talked earlier today about the best way to handle the problem. I was adamant in my insistence that the incidents be allowed to fade away without further mention." Matney looked down at the immaculate surface of his desk." To this end, Dr. Gross will give you a terminal leave for the last two weeks of your training. Your certificate will show a graduation date of June 30, but as of now you're relieved of all clinical duties."

  "I don't—"

  The chairman steamrolled on, apparently anxious to get this done. "Since the doctor whose practice you're entering is pregnant, it's likely she'll be grateful for your early arrival. Perhaps a change of scene will be beneficial to you. It would, after all, take you away from a setting that was the scene of a very traumatic event in your life—an event that could possibly have influenced the way you react to subsequent patients in that same situation."

  Elena tried unsuccessfully to wrap her mind around this change. "You're treating me like I'm the guilty party in all this. You're sending me into exile just to get me out of the way."

  Matney cleared his throat and put on his best hyper-administrator manner. "I am neither affirming nor denying any culpability you have in the matter. What I am doing is protecting the reputation of the department and this institution by avoiding an investigation into a matter that, although the outcome was in no way unexpected or even improper, is best left alone."

  "So I'm out of here," Elena said.

  "Actually, when I first approached her, Dr. Gross was inclined to let you continue your residency to its conclusion. However, I felt it best that you leave the campus and managed to convince her to go along with my recommendation. You may consider yourself on probation under the supervision of Dr. Sewell for the next three months. If, at the end of that time, we find no further incidents of this nature, I will accept that you were blameless in the ones about which we've already talked. On the other hand, if a pattern emerges of—shall we say—early termination of life, I will turn the matter over to the authorities for investigation."

  And, of course, by the time any of that happens, you'll be safely in the Dean's office and it will be someone else's problem. Elena sat, stunned. Even though she was certain that given enough time she could prove she had nothing to do with Pulliam's death, she was being sent away under a cloud. Even worse, the person or persons willing to go to these lengths to discredit her remained unidentified and unpunished. They were still out there somewhere, perhaps poised to strike again. And she wasn't sure that leaving Dallas would make a difference.

  Elena's first instinct was to make a beeline to Amy Gross and confront her face-to-face, but she never made it to the shuttle bus stop. Halfway across the plaza, she collapsed onto a bench like a marionette abandoned by its handler. Spots danced in front of her eyes. A high-pitched ringing overrode the noise from the people who flowed around her in a steady stream, a part of the endless activity of a medical center.

  "Are you all right?" The question came from an older woman in a business suit. Elena guessed she was probably from the administrative offices in the tall building to her right, the so-called Tower. "Can I get you anything?"

  "No, thank you. I've . . . I've had some bad news."

  "Dear, I've lived long enough to know that there's very little bad news we can't survive. What's your name?"

  The sudden change in subject caught Elena off guard. "Elena Gardner."

  "And are you a resident? Research fellow? Maybe an instructor?"

  What was she, exactly? She guessed that, officially at least, she was still a resident. "I'm completing my FP residency."

  "Well, Dr. Gardner, why don't you sit here and fill your tank? It seems to be pretty empty right now." She laid her hand on Elena's shoulder, squeezed, then turned and walked away.

  In a few moments, Elena felt a bit better. She pulled out her cell phone and dialed the Department of Family Practice office. Yes, Dr. Gross was in, but she was on another call. Would Elena like to hold? She did.

  She was serenaded by the strains of a classical piece while her mind worked a mile a minute. The knowledge that her tormentor would get off scot-free offended her innate sense of right and wrong. And the manner of her leaving was certain to cause some talk among her fellow residents. "Did you hear about Elena?" "One of her patients died under suspicious circumstances." "They terminated her." "I hear she negotiated an early release." The truth might be in there somewhere, but it wouldn't be easy to find.

  Amy's voice broke into Elena's thoughts. "Dr. Gross."

  "This is Elena. Dr. Matney told me you're terminating my residency." Not exactly accurate, but maybe it would force her chair to explain her actions.

>   "I know you're upset, but look at it this way. Cathy Sewell needs help, the sooner the better. You're under a great deal of stress here. If someone tried to make it look like you took things into your own hands with Chester Pulliam, it makes sense to me that you'll be safer in a different location—preferably one that makes you hard to find."

  "What about—?"

  "I know. Your sense of justice rebels at this, but I'm not so interested in justice as I am your safety and well-being." Elena heard pages turning. "I'm looking up Cathy's number right now. When we hang up, I'll call her and tell her that we're able to let you go a couple of weeks early if she could use the help. If she says 'no,' I'll buy you a steak dinner."

  "I guess you're right."

  "I know I am. Now go home and start packing. Come by my office at eight in the morning and we'll talk. After that, it will take you a couple of hours to clear the campus. I'm going to tell Cathy to expect you this weekend."

  At home, Elena dropped her backpack by the door, grabbed a soft drink from the refrigerator, and pawed through a desk drawer until she located her address book.

  It wasn't difficult to find the number. The page was unwrinkled, the writing crisp and clean. She'd called it perhaps half a dozen times in her life. This was the hardest.

  She settled into the armchair by the phone but made no move to pick up the receiver. What would it matter if she confirmed the identity of her Tuesday caller? Would the woman be likely to tell how—or even if—she'd managed to cast a pall over Elena's professional life? No, the call made no sense. But Elena decided to make it anyway. She had to confront Lillian, and it was probably for the best that it wouldn't be face-to-face.

  She punched in the numbers and waited through half a dozen rings before a wavering tone assaulted her ears. Then an electronic voice told her that number was no longer in service.

  She redialed, thinking she must have made a mistake. Same results. Elena called directory assistance and received the news that there was no listing for a Lillian Gardner at that address, nor in that city. How could that be? Lillian would be as likely to cut off an arm as to move. The house sat in a ritzy neighborhood. It was perfectly set up for entertaining, something Lillian loved to do. "See me. I'm important. People scramble for invitations to my parties. And I hire Mexicans to serve my guests—I certainly don't expect my son to marry one."

  Elena decided maybe she wasn't fated to talk with her ex-mother-in-law today. It was probably a good thing, the way she felt. But tomorrow she'd get on the Internet—amazing what one could find out using that tool—and track down Lillian Gardner.

  The ring of her phone startled her. The Caller ID showed "Private Number." Cathy's first reaction was to let it ring. Then again, it might be important. She answered the call just before it rolled over to voice mail.

  "Hello?"

  "What time do you close tonight?"

  "I beg your pardon?"

  The caller repeated the question.

  "What number were you calling?"

  "Sorry." And there was a click.

  Cathy breathed a sigh. Was she going to dread every phone call in the future? Not if she could help it. Tomorrow, she'd have her landline disconnected. Anyone who really needed to contact her could do so via her cell phone, and only a limited number of people had that number.

  That reminded her of a call she wanted to make. She dialed the number, one she knew by heart. David answered his cell phone on the third ring.

  "Can you talk right now?" she asked.

  "Sure. I'm in the surgeon's lounge waiting for my case to start. What's up?"

  For the next ten minutes, Elena poured out her heart. David listened without comment or question. "So I guess I'll start packing tomorrow. I don't think I could stand to start tonight."

  "No, that's probably not a good idea," he said. "Tell you what. Join me for one last dinner in Dallas. You pick the place. I'm buying."

  They settled on Del Frisco's Steak House after David assured her that price was no object. "After all, I have a job too. Starting in two weeks, I'll be the junior partner of an established obstetrician. Salary, benefits, the works."

  "Oh, David. I'm sorry. I've been so upset the past few weeks, I never asked you about your practice plans. Where are you going?"

  David chuckled. "I've been dying to tell you this, but somehow the time never seemed right. I'm joining the practice of Dr. Milton Gaines, in a beautiful town with the unlikely name of Dainger, Texas."

  David walked her to the door. "I enjoyed dinner."

  "So did I," Elena said. "Thanks."

  She unlocked the door and replayed the evening in her mind. She'd been grateful for David's support after Mark died. It was wonderful to have someone to talk to, someone who understood what it was like to lose a loved one. But tonight, he'd acted like more than a friend. Was David developing feelings for her? And after just six months was she ready to open up to that possibility? No. Definitely not. It was too soon, and her life was too hectic.

  Elena turned in the doorway. "I'd invite you in for coffee, but to tell the truth, I'm exhausted. Think we might hook up for lunch tomorrow after I clear the campus?"

  David shook his head. "I'm in surgery, with back-to-back cases from dawn to dusk."

  "That's okay. Now that I know you're going to be in the same city with me, I don't feel so bad about making the move."

  Once inside, Elena dropped her purse on the desk beside a pile of mail. Idly, she thumbed through it. Bills went into one pile. She'd write checks tomorrow and notify her creditors of her new address. She tossed the ads and junk mail. Maybe they wouldn't follow her without a forwarding address. That left one first-class envelope.

  This wasn't the envelope she'd come to dread, the cheap one addressed in block capitals. This was heavy stock, computer addressed, and it bore a Houston return address: the offices of Gilmore, Chrisman and Rutledge, whoever they were.

  She ripped open the envelope and withdrew a letter on stationery that matched the envelope. Along the left side was a list of attorneys. At the bottom of the letter was the signature of the senior managing partner, one Jerry C. Gilmore. Interesting, but what could they want from her?

  Elena's dealings with legal matters had been limited, but the phrases that jumped out at her were easy enough to decipher. "We regret to inform you of the death of your former mother-in-law, Lillian Gardner—Her will provided a specific bequest to you of one dollar, with the balance going to a number of charities, including the Daughters Of The American Revolution—In accordance with her wishes, she was cremated and interred beside her husband without a public ceremony."

  Lillian was dead. But when did she die? The last midnight call came less than twenty-four hours ago. How did she manage that? Did this mean that there would be no more calls, no more letters? And, if Lillian had managed to arrange for someone at the hospital to disconnect Chester Pulliam's life support, would there be further efforts against Elena?

  Elena dug inside the envelope and withdrew three pieces of paper. The first was a check from the law firm in the amount of one dollar. She tore it to shreds and dropped it into the wastebasket. Elena ground her teeth as she considered Lillian's last dig at her former daughter-in-law. See, I could have left you an inheritance, but I didn't.

  The second piece of paper was an obituary, detailing the death of Houston socialite Lillian Gardner. "Predeceased by husband . . . son Mark. Survived by daughter, Natalie, of Santa Fe, New Mexico . . . No services. Memorial gifts to . . ." Brief, sterile, to the point.

  Who was Natalie? Mark had never talked about a sister. She hadn't been at the wedding. Lillian had certainly never mentioned her. What had Natalie done to merit being effectively erased from her family's life? Well, at least Elena had company in that regard.

  The third piece of paper was an article neatly clipped from the Houston Chronicle. This went into a great deal more detail about Lillian's life, but there was nothing about the mysterious Natalie. Apparently she'd been reduced to a vita
l statistic, included in the obituary but not meriting further mention in a story that seemed no more than a puff piece praising Lillian, the Houston socialite.

  Elena read the first paragraph again. "Despondent after her son's death, prominent Houston socialite Lillian Gardner took her life with an overdose of sleeping pills." And the date of her death was five days after Mark's funeral.

  The voice on the phone yesterday hadn't been Lillian's, was never Lillian's. The letters hadn't come from her. She hadn't manipulated Pulliam's death to cast suspicion on Elena.

  But, if not Lillian . . . who? And why?

  9

  Elena's exit interview with Amy went as expected. They both said all the right things, while they carefully ignored the elephant in the room: the person who tried to throw the blame for Chester Pulliam's death onto Elena.

  The mechanics of "clearing the campus" mainly involved shuttling between buildings and offices. Elena collected signatures on a form, gave a forwarding address only when it was absolutely necessary, said a few heartfelt "good-byes" and a lot of "see ya"s. Then it was over. She'd severed her connection with the medical center that had been her home for the past six years with less ceremony than the lowering of the flag at day's end. In her head, she began humming "Taps." Well, tomorrow was a new day, and she'd better get ready for "Reveille."

  She wasn't really hungry, but she knew if she didn't eat something her blood sugar would dive, and she'd be even more depressed than she was now—if that was possible. Automatically, Elena reached for her cell phone. She stopped with it halfway out of her purse. David was in surgery all day. Was there anyone else whose company she'd enjoy? Not really.