Thursday, June 28, 10:04 a.m.
Gordon Ingram paced around his austere office. "Damn! I figured there was something screwy about Hamlin's statistics," he said. "I could shoot myself for not following up on them sooner."
"You knew?"
"Just the general morbidity-mortality numbers. His peculiar behavior around Dr. Sullivan got my antenna up. I wondered if he was over-medicating other cases as well, so I looked up his records. Then that bizarre argument between him and the others in the cafeteria that left him so ashen made me figure for sure there was some kind of trouble brewing, so I checked out all their stats."
You would, thought Richard, getting a sore neck following the man's progress back and forth. Yet it was precisely this suspicious nature and predatory determination that made him the one person in the hospital who might help.
"I was looking for bad news," he continued, "so super good results were a pleasant surprise. But I still intended to check them out, especially the two recent DOA sunder Hamlin's name. The diagnoses bothered me just as they did you. But the ethics caseload has gotten so heavy lately. Everyone's afraid to give an aspirin without a consult, and patient complaints are skyrocketing— well, I don't have to tell you the pattern. Poking through good news looking for problems was a luxury that had to wait."
"So what do we do now?" Richard asked, hoping his question would reign in Ingram's tendency to pontificate and get him focused on specifics.
Ingram flopped back into his chair, breathing heavily, and shoved his wire-rimmed glasses to the top of his head. Rubbing his eyes, he looked tired, more so than he ever had when he'd worked solely in ICU. Always a meticulous dresser, his dark jacket and charcoal shirt complemented his black eyes and hair in the best of style, but the outfit seemed to hang a little looser than usual on his slender frame, enough that Richard wondered if he'd lost weight.
"I suppose we can convene an emergency board meeting," Ingram said, "and demand they call in all Hamlin's patients who we think received stem cells. You say there's only eighteen?"
"Sixteen, not counting the two DOAs."
"It shouldn't be too hard to get MRIs on that many. And we can request exhumation orders and autopsies on the deceased. Finding out why they died will be the first priority."
"Do you think the hospital lawyers will let NYCH admit its liability just like that?"
"I'll argue that the real liability these days is sitting on a possible problem and not being forthright. Tell them we'll have our institutional ass in a sling if we don't warn everyone at risk immediately. Let's just pray we can offer something to prevent the sixteen from ending up like the first two."
Richard thought of Kathleen and winced.
"Sorry," Ingram said. "I didn't mean to be callous. You must be worried sick about Dr. Sullivan."
"What I'm worried about most right now is finding the killer before he gets another notion to attack her or tries again to get at me through our kids. For that I need Francesca Downs. I think she may have been using the son of a bitch to rid herself of potential witnesses."
Ingram flipped his glasses down onto his nose and looked at Richard as if he'd let out a bad smell. "You think what?"
"You heard me."
"Franceses in league with a killer? You're out of your mind."
"No I'm not. You saw her numbers. If you take a look at her individual charts, there's no other explanation but that she's been using stem cells for the last two years, probably stromal over the last twelve months."
Ingram pursed his lips and slipped his glasses back up on his forehead, then seemed to contemplate his bare desktop. After a few seconds he looked directly at Richard. "Suppose I bought the story of her using stem cells, which I'm not saying I will until I've looked at all her records myself. It's still a hell of a leap from there to her recruiting a homicidal zealot to get rid of people who might turn her in. Do you have proof of that?"
"No. Just that she's got motive, means, and opportunity."
"That's cop talk. Don't tell me they buy your theory."
"Not exactly."
"Not exactly? Are they doing anything about it? Bringing her in for questioning? Making her an official suspect as a conspirator in the killings?"
"No."
"So they haven't any proof either, but are thinking about it."
"You could say that."
He leaned back in his chair and exhaled his frustration. "Homicide detectives thinking the worst of her I can understand. It's their job. But you, Richard. Christ, you've worked with her. I don't condone her violating the usual protocols if she's done what you say with her patients, but she's a kid at heart and she's got stars in her eyes. Maybe she's capable of taking a big shortcut to grab the fame and glory. I mean, you can understand the lure, the potential of this stuff to give people their lives back is so magical, it's a wonder more doctors haven't jumped the gun. After all, just getting approval of phase-one clinical trials can take a year, and back when you say she started, the conservatives in government were threatening to ban stem cell research altogether. So yeah, I can see her rebelling against the rules. But commit murder to cover up for it? Never. She's been a celebrant of life in everything she's ever done, and you know it."
Richard said nothing. The man's words resonated deeply with what had always been his own instincts about the woman. But he had other instincts, too, ones forged in the crucible of ER where he couldn't allow himself to be swayed by feelings, where he had to be ruthlessly analytical and consider all diagnostic possibilities, however unpalatable they might be— or fatal mistakes would be the result. McKnight's assertion that Downs had motive, means, and opportunity couldn't be ignored, whatever Ingram said.
Except an inner voice cautioned that he wasn't in ER now. Maybe in this case relying solely on logic was misleading in itself. He smiled, remembering how Luana had always warned him against measuring life outside emergency with a clinical yardstick.
"As for Jimmy Norris," Ingram continued, "he's also a bit of a dreamer, an idealist. Even though everyone knows he's so bewitched by Francesca she can lead him around by the nose, he's hardly a killer either."
Richard's instincts also had no problem with that conclusion.
"Now Paul Edwards and Adele Blaine, those two would carve up their own mothers if it proved to be in their interests. I wouldn't put it past one or both of them to unleash some crazy assassin to save their own skins. Especially with the financial rewards they'd have at stake."
Richard had been so preoccupied with the who, what, and how of the case, he hadn't given much thought to the money details, other than thinking there must be a ton of it to be made off this stuff. If anybody could explain the skinny of it to him, he'd pick Ingram. Ethicists by the nature of their turf come face-to-face with every scam going. "Suppose you tell me your take on the economics of it all, Gordon. I'm afraid I don't have much imagination when it comes to getting tricky with the market aspects of the healing profession."
Ingram grinned as he usually did when offered an opportunity to show his erudition about anything. It was a lip-licking, savoring, I'm going to enjoy this kind of smile. "Trust me. The potential for profits from stem cell products is nothing short of staggering. I sit on committees reviewing the submissions for clinical trials, and these days biotech labs are crawling all over each other to be the first with commercial offerings of different cell lines. Everything from preparations to regenerate brains and nerves to infusions for restoring hearts, kidneys, bones, pancreases, and livers— well, you know the possibilities, we've been reading about them for years— they're rushing them all to market. And what a market."
Richard chuckled. "Baby boomers. All us baby boomers refusing to accept mortality are ready to pay anything so we won't grow old and die."
Ingram smiled. "Exactly. And as a result, private pharmaceutical companies are not only after guys like Norris who could harvest and successfully replicate cells, they need doctors like Francesca and Hamlin willing to refine techniques for their clinical use.
So given that Paul Edwards and Adele Blaine have always been the kind of doctors who are preoccupied with the business side of medicine, I suspect the only reason they're involved in this at all is that they put together some sort of commercial package to take care of the entrepreneurial part of things— say, such as secretly selling the findings to one of these labs. And when Hamlin's shit hit the fan, maybe those two decided to eliminate witnesses to assure they'd remain out of jail and have a chance to enjoy the returns on whatever deal they cooked up."
Richard played with the idea that Downs and Norris acted frightened not from fear of getting caught, but of getting killed for what they knew, by Edwards and Blaine.
"Okay," Richard said finally. "Suppose it has gone down the way you say. Edwards may have disappeared, flown the coop. He hasn't come in, and his secretary says his housekeeper reported he wasn't home last night. For the moment, then, that leaves Adele Blaine. But she'll be disinclined to admit anything because there's nothing to connect her with the others apart from the patients going to her institute afterward. So I still need Downs, for what she knows. With her testimony against those two, maybe the police could at least pressure Blaine into telling us who this killer is in exchange for a lighter sentence."
"Sounds complicated."
"It is," said Richard, leaning forward in his chair and rubbing his face with his hands. "To make matters worse, I'll bet by now she and Norris are all lawyered up after our set-to this morning and won't talk to me or anyone about this business unless they're forced to. That's where you come in."
"Me?"
"Yeah. You could officially sweat her, put her on the hot seat for all those extra angiograms she did. Force her to answer questions. Maybe that would shake her up enough that she'd let something slip. You could even appeal to her celebration-of-life side, challenge her to fess up and help stop a killer."
"You know as well as I do that Francesca's got ice in her veins when it comes to a crisis. An ethics hearing isn't exactly going to set her trembling in her OR boots."
"I know, but it's all I've got right now. As I said, it's anybody's guess what this guy's going to do next if we don't grab him fast."
He nodded. "Of course. I'll do what I can."
Having succeeded in getting what he came for, Richard rose from his chair. "By the way, I owe you big-time for taking care of Kathleen's tracheotomy. So much has happened since you helped out that night, I never got back and thanked you properly."
Ingram gave a dismissive wave of his hand. "Glad to be of service. Dealing with airways and tissue is so refreshingly clear-cut compared to right and wrong, it's like a vacation for me."
Richard smiled at him. Sometimes the yearning in the man's eyes for his days of being a tireless lion with the physical stamina to take on all that ICU could throw at him was painful to look at.
"By the way," Ingram said, "did any of Hamlin's patients strike you as more appropriate to start with than others, in terms of giving us the best chance of finding out what he did to them?"
"Not really. But there's one case I was in on from the beginning. My having had hands-on involvement might give us an advantage in spotting something out of line."
"Sounds good. Remember the name?"
"Abraham Paxton."
"I'll let you know as soon as we get him in." 2:10 p.m.
Richard heard McKnight's rumbling voice when the doors to ICU slid open.". . . but there's no need, now that we know what Hamlin was doing—"
"Do you know . . . who the killer is . . . where to find him?"
To his surprise he could also make out Kathleen's voice from the entrance, it was so much stronger.
"No, not yet. And that's a good reason to stay away," McKnight answered.
"Stay away from where?" asked Richard, parting the curtains and stepping into the cubicle. To his surprise he found Jo O'Brien was also there. She sat protectively by Kathleen's side on the bed, her glasses parked halfway down the bridge of her nose. Jo's stare over the top of the gold rims was as bristling as her short gray hair. Kathleen's gaze was just as pointed. Uh-oh, he thought, recognizing a common front when he saw one.
Mc Knight spun toward him, a look of relief passing over his dark face. "Dr. Sullivan's still insisting on going into Blaine's institute as a patient."
"What?"
"And I'm going with her," Jo said. "Wait a minute—"
"It's all arranged . . . I've hired Jo ... as a private nurse."
"But why?"
"Because I'm not . . . waiting for . . . another attempt ... on the children . . . because this sick monster . . . can't get ... at you or me. . . . I'll lure him ... to a trap instead."
"But Chet and Lisa are under police protection."
"That doesn't . . . always work."
"It's a secure hotel. I left them there this morning. They're well guarded."
"This guy . . . seems to have a way ... of getting past police."
McKnight's jaw clenched at that one, but he said nothing.
"So you'd use yourself as bait?" Richard continued, realizing he was on his own as far as carrying on the argument. "That's nuts."
"Think about it, Richard. . . . You told me yourself. . . Blaine's even less likely ... to talk . . . than Downs or Norris. ... So let's change tactics. ... If she's behind the killer... let her try ... to set him on me ... at her institute. ... If she does . . . Detective McKnight's people . . . can grab him."
"Ah-ha! You just said police protection might not work."
McKnight looked affronted, but he stayed stubbornly silent.
"Better it fail . . . with me . . . than Chet and Lisa."
Richard swung over to Jo. "Surely you're not going to go along with this?"
"I think Dr. Sullivan is going to go to Adele Blaine's whether we agree or not," the grandmotherly woman said in a voice that had the iron determination of a marine. "I'm just going to help her the best I can. A nurse can blend in and still be close enough to spot any funny stuff."
"But you being there will put Blaine on guard."
"She's already on her guard, wouldn't you say? Especially if Downs or Norris has already talked to her. From what I understand, with all due respect, you were about as subtle as a cruise missile with those two this morning."
"Oh, Jesus," said McKnight, his eyes rolling.
Clearly Kathleen had told Jo everything.
"It's one thing to be guilty of a plot to use stem cells on unsuspecting patients," Jo went on. "It's quite another to be manipulating a psychopath to commit murder. If she's only the former, her nervousness about having Kathleen, me, and the police around will be nothing compared to her fear she's become a target as well. We might even persuade her that it'll be safer if she comes clean and gets protection from him herself."
"And if it's . . . the latter . . . well ... as I said . . . the police will be ready. . . . Either way . . . it's our best chance ... to grab this guy."
Richard gaped at them both. He was outnumbered and out-argued. They'd rehearsed this, he thought, incredulous at Kathleen's determination to put herself in harm's way. But he had to admit he'd do exactly the same thing if he thought it would draw out this maniac and lead to his capture. "Look, Kathleen," he said, "I can see I'm not going to change your mind right now. Just give me a chance to come up with a better idea."
"You do . . . what you think best. ... It changes nothing ... as far as . . . my plans are concerned." He found himself swallowing and casting about for a reply. She was distancing herself from him again, just like last night. It left a hollow burning in his chest, as if she were slowly withdrawing a knife.
"So, Detective, since I'm going to be around, shouldn't we liaise, or something?" said Jo, mercifully breaking the frosty silence that had settled into their tiny space. "Your people call my people, that kind of thing."
"Really Mrs. O'Brien—"
"It's Miss O'Brien."
"Ah, yes. As I started to say, Miss O'Brien, civilians have no place in a police operation—"
"Nonsense. You use informants all the time. Not that I'm a snitch, but the precedent for turning to the public for help is there. Now this is where you can reach me," she said, snapping a folded piece of paper out of her breast pocket and giving it to him, "my home number."
She wrote it out beforehand, Richard thought. Yet another detail in her and Kathleen's well-prepared plan. McKnight seemed about to try and give it back, then shrugged, and slid it inside his jacket. "Good afternoon, ladies," he said with a nod of his head. "I've a three o'clock debriefing with my officers." His big frame left the curtains hanging open after he shoved his way through.
He was halfway to the exit when Jo leaned over to Richard and gave him a wink. "Tell me," she said in a stage whisper that would have carried to the back row of the Lincoln Center opera house, "is there a Mrs. McKnight?" 4:00 p.m. NYCH Lecture Amphitheater
Though ostensibly for the media, the assembly had attracted every physician, resident, and intern in the hospital who didn't absolutely have to be somewhere else. Packing themselves into a high semicircle of steeply raked seats, they created a wall of white before Francesca Downs, who stood on the small stage at their feet. She also wore a lab coat, but unlike the creased, wrinkled garb that usually marked the end of a busy day on the wards, hers appeared crisply pressed, elegant almost, and a red business suit underneath set off her blond hair and brown eyes.
The cameras must love her, Richard thought as he looked down at the array of media surrounding the slender woman, her face flushed a radiant gold, her voice assuming the elegiac tones of someone summing up.". . . and so, ladies and gentlemen of the press, as we cross this exciting threshold into a world of medicine where we can regenerate and restore ourselves, I invite you to imagine the possibilities. Victims of heart disease who can't walk across the room without getting short of breath might once more regain a youthful stride. A productive and healthy old age could become routine as researchers apply the applications of stem cell therapeutics to other fields . . ."
It was certainly exciting stuff, Richard granted. He thought of all the patients he'd seen who would otherwise end up battling to breathe, their lungs filling with fluid as they raced every few weeks to ER to save their very lives. He found himself seeking out Gordon Ingram in the audience, wondering what possibilities he must be imagining. But Ingram sat motionless, leaning forward, his chin propped on his hand, his thin face inscrutable. The guy had to be feeling excited, Richard thought. ICU provided a showcase of what stem cells could prevent, both for themselves and their patients. He let his own imagination roam over the possibilities. How many people might now be spared a relentless decline into end-stage heart, kidney, or liver disease, hopelessly clinging to life with a sodden body invaded and drained by machines, the only prospect death? Even Ingram's personal fate as set out in whatever scars were on his own myocardium could be rewritten.
Critical Condition Page 28
