by Robin Cook
After consulting their street map of Plymouth, the two men climbed back into the front bucket seats and set off toward Smith Street. It wasn’t far, as nothing in Plymouth was far. They first did a drive-by, noticing that 24 Smith Street was a small two-story white Victorian house with decorative bargeboard under the steeply angled eaves. The first-floor windows were illuminated, while those on the second floor were dark.
“Looks encouraging,” Keyon said. “Think she lives alone?”
“We can’t be that lucky two hits in a row,” George said. “But we can always hope.”
They parked the van on a neighboring cross street and hiked back. As they walked they checked out the nearby houses, most of which were dark. “People turn in early here in Plymouth,” Keyon said. “I guess there’s not a lot of nightlife.” He chuckled quietly at his understatement.
When they reached their destination, they glanced around at the immediate neighboring homes. Conveniently, they were all dark. Turning their attention to Margaret’s house, they could hear a noisy, old-fashioned window air conditioner, which they also thought advantageous. The sound of gunfire in the complete silence of a country town could carry far and wide. With that in mind, Keyon had brought along his Beretta semiautomatic pistol with suppressor. It was a surprisingly quiet weapon. The downside was that it was significantly bulky in its shoulder holster, and he wouldn’t have gotten away with wearing it in daylight.
As per usual, they positioned themselves on either side of the door, fake FBI badges at the ready. As there was no doorbell, George knocked. When no one responded, he knocked louder. This resulted in a carriage lamp going on right next to George, which he didn’t like. A moment later a female voice called through the door asking who was there.
On this occasion Keyon did the talking, essentially reiterating the FBI-agent spiel they gave Gary Sheffield about being part of the bureau’s Cyber Action Team. The difference was that Margaret didn’t open the door.
“What do you need to talk about?” Margaret asked.
Again, Keyon followed their usual protocol by explaining that there had been felonious cyber-activity emanating from the house that needed to be investigated.
“I would prefer that you come back tomorrow,” Margaret said. “How do I know you’re FBI agents?”
Keyon and George exchanged a worried glance. They also heard something else they didn’t like, a bark and growl, and it wasn’t from a miniature poodle.
“If you would open the door, we can show you our credentials,” Keyon said.
“I’ve never heard of FBI agents coming to someone’s door this time of night,” Margaret said. “I’m sorry. I’m here by myself.”
“Ma’am, we understand your reluctance, but if you don’t talk with us, we will have to come back with the local police and have you arrested. We are quite sure that we can clear this all up without that kind of embarrassment. But we can’t do it through the door.”
For a moment, there was silence marred only by the sound of the nearby window air conditioner. Keyon and George exchanged another glance, sensing they were losing control of the situation. Then they heard what sounded like the musical notes of a mobile phone being dialed.
“Shit!” George snapped, speaking up for the first time since they’d come onto the porch. He stepped back and raised his foot, kicking the paneled door with all the force he could muster just to the side of the doorknob. The old wood splintered and the door burst open. A second later they charged into the room, causing a shocked Margaret Stonebrenner to stumble backward. At the same moment, a large black German shepherd charged at George, who was first through the door.
Thanks to his Marine Corps training, which had included crowd control and dog attacks, George lifted his arms over his head to deny the shepherd a handy target. George absorbed the sizable dog’s attack and stayed on his feet. Although the dog was able to get a bite full of George’s right jacket sleeve, Keyon had his Beretta out and shot the animal twice in the chest. At first the bullets seemed to have had no effect, since the dog continued to shake its head, trying to tear George’s jacket. Then, with the same suddenness that the attack began, the dog let go of its hold on George’s sleeve, teetered for a moment, whimpered, and then sank to the floor. A moment later it rolled onto its side.
Seeing what had happened to her dog, Margaret began screaming, even as Keyon pointed the gun in her direction and yelled for her to shut up.
“You bastards,” she cried, her face a picture of terror and anguish. She started coming at Keyon with fire in her eyes. Keyon responded by shooting her in the forehead. The result was the same as it had been for Gary Sheffield. Margaret was knocked over backward onto the floor. For a second or two there was some quivering in her limbs. A moment later her sightless eyes stared up at the ceiling.
“Goddamn it,” George exploded. “Now we can’t question her.”
Before Keyon could respond, both heard a male voice coming from Margaret’s mobile phone. She had dropped it onto the hall carpet when she was shot. “This is the Plymouth Police Department. Is everything okay there, Miss Stonebrenner?”
Keyon snapped up the phone, turned it off, and pocketed it. “We have to get the fuck out of here.”
“We need her computer,” George said.
“I see it,” Keyon said. He pushed past George into the dining room, where an open computer sat on the table. Keyon slammed it shut and took it under his arm. There was also a woman’s purse. He snapped that up as well.
While Keyon was in the dining room, George hurriedly pulled on some latex gloves. Going to an open roll-top desk, he rifled through a few drawers, leaving them open, dumping one onto the floor. Then the two men hurried out into the night, slowing to a normal walk when they reached the street. As they headed for the van, they cast worried glances at the neighboring houses, but nothing had changed. The neighborhood seemed as quiet as it had been earlier.
“That was messy,” George said with disgust as he climbed into the van’s driver’s seat. It was his turn to drive. “Probably our worst job.” He snapped off the gloves before starting the engine.
“In this business, you never know what you’re going to get,” Keyon said. “Let’s not own up to what happened unless we are specifically asked. Let’s also hope the new VPN is as good as it’s claimed to be so this is our last job like this.”
“I’ll second that,” George said. “But you know what surprised me? How normal this Stonebrenner looked. I expected her to be more like the others, like Sheffield. Somebody you wouldn’t look at twice, living a boring humdrum life, kinda nerdy and dumb, relying on social media to have a life, even if only virtual. She didn’t strike me like that. And she didn’t buy our FBI story, not for a second.”
“Social media is taking over our culture,” Keyon said. “It’s not just the teenyboppers anymore. It’s everybody.”
To avoid driving back through town, George took a circuitous route to I-93 on their way back to Boston.
18
FRIDAY, JULY 21, 9:15 P.M.
For a bit of variety after exhausting the Toscano menu for five nights in a row, Noah was back in the Thai restaurant called King & I. He’d called in an order after leaving the hospital and talking briefly with Ava to get her preferences, and now he stood by the cashier to wait.
It had been a very busy Friday. It had started earlier than usual because Friday morning’s basic science lecturer had canceled, forcing Noah to give the important lecture on postoperative electrolyte maintenance, which required a bit of preparation. To do so, he’d awakened at 4:00 A.M. and managed to leave Ava’s without waking her.
Following the basic science lecture, Noah had four surgeries, including a complicated esophagectomy, or removal and replacement of the esophagus. It was a difficult procedure that he’d done only once before. Luckily it had gone well, although he didn’t have high hopes for the patient; esophageal c
ancer was a particularly difficult disease for the oncologists.
Although all the surgeries had gone well, there was one unfortunate occurrence. Although he generally tried to avoid running into Dr. Mason by keeping track of his schedule, that morning it had happened despite his best intentions. Noah had just finished his first case and was accompanying the patient along with the anesthesiologist to the PACU when Dr. Mason unexpectedly appeared out of a case that was supposed to take four hours yet had been under way for only less than two. Despite Noah’s attempts to indicate he was busy, Dr. Mason insisted he talk and pulled him aside. He then proceeded to rail Noah about the quality of residents Noah was assigning to Dr. Mason’s cases. “With the kind of patients I bring into this hospital, I shouldn’t have to deal with incompetence in the assistants I’m assigned,” Mason had spat. “And let me tell you, I’m going to bring this up with Dr. Herandez, Dr. Cantor, and Ms. Hutchinson.” Gloria Hutchinson was the president of BMH.
Of course, Dr. Mason’s complaints were baseless. If anything, Noah went out of his way always to provide as senior as possible residents for Dr. Mason, anticipating the man’s tendency to blame everyone around him whenever something out of the ordinary happened. It was also true that Noah had not received any complaints about surgical resident assistants from any other surgeon, and that included all twenty-four of the first-year people.
Noah had tried to end the conversation by asking Dr. Mason if he might provide Noah with a list of the residents he enjoyed working with so that Noah could attempt to assign those people to Mason. But instead of taking this peace offering, Dr. Mason had switched the subject of the conversation to the upcoming M&M.
“I hope to God you are not planning on shielding your incompetent lover like you so obviously did with the Vincent case,” Dr. Mason had snarled. “Because you are not going to get away with it this time. I had to hold my tongue during the last conference because I was the surgeon. Not so on this occasion. No free lunch this time.”
Once again, Noah had to endure being stabbed in the chest by Dr. Mason’s persistent index finger as the surgeon made his final point before he continued toward the surgical lounge.
“Your take-out is ready,” the King & I cashier said, pulling Noah back to the present.
Noah paid and left the restaurant. Charles Street was alive, with people enjoying themselves. As he walked he felt one with this world, which was unique for him. Anticipating spending another pleasant evening with Ava, he didn’t feel his usual sense of isolation from normal society, as he now had a life outside of the hospital. He smiled, thinking that maybe there was hope for him after all.
As he trudged up Pinckney Street on his way to Louisburg Square his thoughts went back to his busy day, which had included several important conversations that he was eager to share with Ava. After the run-in with Dr. Mason, which jolted him into remembering exactly how close the M&M Conference was, he first made it a point to investigate which junior resident had been assigned to the emergency room on that particular day. It was Dr. Harriet Schonfeld. He’d found her in the ER sewing up a laceration. He was pleased with what he had learned from her and looked forward to telling Ava.
Next Noah had met with the anesthesia resident, Dr. Carla Violeta, plus the circulating nurse and the scrub nurse on the Gibson case, but he didn’t learn anything from the three of them that he didn’t already know. Finally, following Ava’s encouragement the night before, he had arranged to meet with Dr. Warren Jackson, which he dreaded and had put off just as he had put off meeting with Dr. Mason before the last M&M. As an older surgeon who had trained at the same place Dr. Mason had trained, Dr. Jackson shared some of Dr. Mason’s unpleasant narcissistic traits, in particular an easily offended, arrogant attitude and a stubborn reluctance to accept any blame, even if warranted. To his surprise, Noah had found Dr. Jackson much more reasonable than Dr. Mason.
Ava was particularly happy to see Noah when he finally rang her bell and got buzzed in. It was nearly 10:00 P.M., and she admitted to being starved when Noah found her in the kitchen. She had opened a bottle of wine and had already drunk a quarter of it while she’d used her iPhone to go on Facebook while she waited. Noah apologized for being kept at the hospital because of a late-afternoon emergency.
They ate at their usual location, looking out at the garden. Noah was eager to tell her what he had learned but had to bide his time while she told him about several demanding cases she’d had that day that had required more anesthesia skill than the usual. Noah was impressed with how she had handled them. Her encyclopedic knowledge of anesthesia rivaled his command of the minutiae of surgery. After dinner they ended up in the study as per usual. Noah had come to understand why it was her favorite sitting room in the house. It was rapidly becoming his as well. Almost like Pavlov’s dogs, each took the exact same chair they’d occupied on previous evenings, as if responding to some internal directive.
“Okay, your turn,” Ava said, realizing how much she had been dominating the conversation. “Sorry for carrying on.”
“Not at all,” Noah said. “I’m intrigued by your command of your field.”
“I’ve had superb training,” Ava said, pleased.
“I have some good news and some bad news,” Noah said. “Which do you prefer first?”
“Let’s get the bad out of the way so we can rest on the good.”
“Unfortunately for me, I ran into Dr. Mason in the OR hallway,” Noah said. “He cornered me as usual and mouthed off with a complaint about the assistants I’ve been assigning him, which is all a bunch of nonsense. But more important, he warned me not to shield you during this M&M like he feels I did during the last M&M.”
“He said that specifically?” Ava questioned.
“Very specifically,” Noah said, “using the exact same words.” Noah did not add that Dr. Mason had referred to her as “your lover.” “He also remarked that he’d been muzzled at the last M&M, which wasn’t going to be the case this time.”
“Okay, that’s the bad news. What’s the good?”
“My meeting with Dr. Jackson wasn’t anything like I expected,” Noah said. “He actually admitted that he’d made a mistake pressuring the first-year resident into starting the case before you were in the room. He said he’d come to the realization after giving the episode more thought.”
“That’s terrific,” Ava said, her face lighting up. “Do you think he might be willing to say something to that effect at the conference?”
“I think so,” Noah said. “I also talked with Dr. Violeta.”
“I know,” Ava said. “She told me.”
“She’s willing to confirm being pressured,” Noah said. “So I won’t mind bringing it up.”
“You’ll have to bring it up,” Ava said. “It has to be established that I wasn’t in the room when the patient was given the paralyzing drug and had already arrested. Both are key.”
“You are right,” Noah agreed. “I’ll definitely mention it.”
“This is good news,” Ava said. “I feel better already about this M&M.”
“And I got more significant news today,” Noah said. “I talked with the junior surgical resident who handled the case in the ER. When I told her that the neck problem wasn’t in the electronic medical record, she was astounded and insisted that she had included it.”
“It wasn’t in the EMR,” Ava snapped. She sat up and moved forward in her chair, ready to do battle.
“It was, and it wasn’t,” Noah said. He reached out and put a calming hand on Ava’s thigh. “What we found were two EMRs for the same patient with an inversion of two letters in the spelling of the name, one with the problem described and another without it. Somehow the computer had made two records. I already visited IT about it, and one of their people is going to look into it, figure out how it happened and how to keep it from happening in the future.”
“That’s perfect,”
Ava said. With a sigh of relief, she sat back in her chair. “That alone could eat up a good portion of the discussion time. Most of the staff are down on the EMR already and will love to offer their opinions.”
“Exactly my thoughts as well,” Noah said. “It’s looking good, like we’ll be able to get through this next M&M as well as we did with the first. What I plan to do is leave Helen Gibson for last, just like I did with Bruce Vincent. If I time it right, maybe there won’t be any discussion time and we won’t have to listen to Dr. Mason carry on.”
“I was just going to suggest as much,” Ava said. “I love it.”
“I do have one question for you, though,” Noah said. “Were you familiar with the video laryngoscope you were using that day? I know there are a number of different brands, each a little different.” Noah tried to use an offhand tone of voice as he asked this question, as if the idea just occurred to him. It was an issue that had been bothering him in the back of his mind since the event. He’d had the impression Ava had seemed less than adept with the instrument than she should have been, although he was the first to admit he might have been expecting the impossible. When Ava was using the device, the patient’s head had been bouncing all over the place from the cardiac massage, which would have made it difficult for anyone. Putting in an endotracheal tube on certain patients with restricted neck motion could be incredibly difficult, as Noah painfully knew from personal experience.
“Of course I was familiar with the McGrath laryngoscope,” Ava said with a touch of irritation. “Just like I’m familiar with all the other scopes on the market, such as the Airtraq or the GlideScope. They are all more similar than different, although I do prefer the GlideScope because it has a larger screen.”
“I see,” Noah said, nodding. That was already more than he knew about video laryngoscopes. But the issue of Ava’s struggles bothered him like a pebble in his shoe. He was also mildly troubled by something else he had learned. There was more time than he expected between the moment the first-year resident sent out the alarm that she was having trouble and needed help and Ava’s arrival in the room. Of course, Ava was observing another patient being put under general anesthesia at the time. Yet that induction had been carried out without any trouble whatsoever, so why didn’t Ava come right away? And why hadn’t Ava ordered a tracheostomy immediately when she saw how difficult it was to put in an endotracheal tube and the patient had already had a cardiac arrest from low oxygen?
