That same day, Tuesday, November 6, 1:00 P.M.
Hampton Junction
Running was a drug to Mark.
Miss a day, he felt lousy.
Two, downright depressed.
Three, and he was convinced he had cancer.
He always followed the same route, turning left onto the road at the foot of his driveway, following it downhill a few miles toward town to loosen up, then going west on Route 4, a winding uphill grind that led farther into the mountains. How far he took it depended on the time he had and the caliber of tension he was trying to work off. Practicing medicine in a small town had different pressures than those of urban centers, but they were every bit as weighty.
This afternoon a heavy fog had settled into the valley. The tiny droplets it left on his face as he ran felt pleasantly cool, but it rendered the road, the forest, and anything else more than thirty feet away invisible, isolating him in a gray sphere of vague shapes. Yet as he passed through a corridor of towering maples and white birches, their foliage formed a canopy of iridescent orange and gold that floated above him like a gaily woven tapestry of silk. The effect became hallucinatory, and he inhaled deeply while he ran, as if to breathe in the color. The moist air filled his nostrils with the fresh smell of wet leaves, an aroma he found every bit as welcoming as the familiar scent of polished wood that greeted him whenever he entered the house he had grown up in.
Hampton Junction, Saratoga County, in the southern Adirondacks, was his home. An odd little town, its houses, businesses, and two churches stood scattered in a disorganized pattern as if the founders had thrown a handful of jacks into the hills, and wherever one landed, somebody built something. It continued to grow in an equally haphazard fashion. The official population of 2,985 – the number according to the sign on the highway – hadn’t changed since he was a kid. “No one ever seems to die in Hampton Junction without someone being born,” went the joke among locals. In truth, nobody could keep track of the population anymore. With the surrounding countryside so full of chalets, the count for the whole area could swell to twenty thousand on a weekend, then shrink back to the core group on Monday.
He grew up here. His love of the outdoor life was one of the reasons he’d returned after med school. He avidly hiked, kayaked, or skied whenever possible, thriving on the endless sweep of mountain wilderness that surrounded him. The hills and peaks, having engraved themselves on his psyche, looked as right to his eye as their rocky surfaces felt to the palms of his hands when he climbed them. Thick deciduous forests in summer. Massive, blue-green conifers rich with growth the year round. The panoply broken only by tumbling mountain streams, surging rivers, and cold lakes. He found it a place of powerful beauty and awe-inspiring solace.
Yet these mountains weren’t for everybody. Too much of them for too long at the wrong time, and a person with a troubled mind could end up so dwarfed by the vastness, so engulfed by the silence, and so hemmed in by the press of the forests that he panicked. That was the reason he’d forced Dan to take the diving course in Hawaii when they did three and a half years ago, just about six months after Dan’s wife had left him. Heartbroken though not showing it, no kids, and working twenty-four/seven, but still, to Mark’s eyes at least, a lost soul, Dan started to keep a wary eye on the surrounding hills. Mark knew he desperately needed the break. Sensory deprivation, isolation psychosis, fractured self-image – the terminology for it in textbooks was endless. “Bushed,” the locals called it.
Mark took pride in never having had to wrestle this demon. His secret – conquer and reconquer the wilderness – put the curve of his Telemark turn or the imprint of his boots on it before it ever got to him. He also got out regularly, choosing medical conferences in places that allowed him to feast on theater, dive in warm blue water with limitless visibility, or climb above the tree line where nothing surrounded him but open space.
The pitch of the road steepened, and his legs started to burn. Normally he welcomed the challenge and usually increased his pace at this point, wanting to push himself to the maximum. Today he glanced at his watch and started back. He and Dan were to meet with a cold-case specialist from the NYPD in less than an hour. But with the ease of his descent, the melancholy that he’d been trying to work off returned.
As a boy he’d understood only that Kelly had left for her own unexplained reasons. The possibility of her being dead never once entered his mind. As a result he unquestioningly carried this version of events forward over the years, continuing to see her disappearance through the optimistic gaze of youth, determined to protect at least that piece of childhood from the harsher scrutiny of his adult eye.
Even now a particle of hope, a relic from his days with her – the part of life before his father died when it seemed easy to keep dark terrors at bay – insisted she couldn’t have been murdered. But his clinical self, trained to stare at the worst possible truths and not flinch, knew differently.
Only in his memory did Kelly still gleefully win at Monopoly, stride through wildlife parks, and send sizzlers across strike zones.
Flashbacks of her crowded in… she arrived to baby-sit him wearing overalls… they made some fudge… he put chocolate freckles all over her face, and they tied her blond hair in two ponytails with red ribbon, like Daisy Mae’s from his comic books…
He started to sprint.
“Feels like I’m stepping on dog shit,” the man who walked between him and Dan complained. His leather soles kept slipping on the wet mush of fallen leaves that coated the sidewalk. “Is it always so soggy up here?” His breath hung white in the mist, and his frizzy gray hair glistened from the moisture it picked up from the air.
“Pretty much, this time of year,” Dan said. “We’ve already had a few dumps of snow, but the rain washed it away. Still, good shoes are a must.”
Mark’s own hiking boots had no such traction problems.
Their visitor, Detective William Everett, a cold-case specialist from the NYPD, shivered and dug his hands deeper into the pockets of a light tan raincoat. Short in stature, his craggy face had the pasty gray complexion of a smoker, and he chewed gum about sixty times a second.
Reformed, Mark figured, recognizing a chiclet that the man had popped in his mouth as a common nicotine substitute. But he’d quit too late. A mewing wheeze accompanied every word he said, and his chest heaved from walking up the gentle incline.
“Must be nice when you can see everything, though,” the detective added, peering into a fog so thick it made the houses along the road appear to be little more than looming gray cubes. “Or is this as good as it gets around here? Christ, you need a fuckin’ foghorn just to take a hike.”
A hike? Not with him along, or they’d end up carrying him. “You caught us on a bad day,” Mark said, slowing his step so as not to set too fast a pace for their visitor. The man looked fifty going on seventy, and the loose semicircles sagging from under his eyes suggested a lifetime of being tired.
“Still, even like this the air’s a whole lot cleaner than in New York,” Everett continued. As if to prove the point, he inhaled deeply, only his effort ended in a paroxysm of coughing that doubled him over. He spit on the pavement, then, wiping his mouth with a handkerchief, added, “So tell me about your town. This is the playground for the horsey set, isn’t it?”
“Not really,” Mark replied. “We’re above the money belt.”
“The what?”
“The wealth. It’s more down around Saratoga.”
“So the woman was dumped far away from where she lived?”
“Not too far. The Braden estate is only nine miles south.”
“But you said the money-”
“Every town along the railroad took a flyer on being great someday,” Dan cut in. “Saratoga Springs made it. Hampton Junction ended up a leftover water stop from the heyday of steam locomotives. Our roots are blue-collar, not blue-blood, but we’re proud of it.” He had a way of sounding defensive when dealing with outside officials, whatever their stripe. His speech would unwittingly elongate into a bit of a drawl, and, with his portly frame stuffed into a fleece-lined bomber jacket that strained at the zipper, he’d come off like a cross between Rod Steiger and a Rotary Club booster.
Mark figured the awkwardness stemmed from Dan being an outsider himself. As far as the locals saw such matters, a person could move to Hampton Junction, live and work in the place for twenty years, yet still not be “from here.” Since Dan had arrived from Syracuse a mere decade ago, the townspeople considered him a newcomer, and, as he confided to anyone who would listen, it bugged the hell out of him.
“We tend to be more a lunch bucket crowd, our inhabitants mostly descended from train people,” he continued, proprietary as any native son. “The crystal-and-silver bunch generally drew the line at building their big estates twenty miles south of this area. If it weren’t for the fog, you’d see clapboard houses are the preferred style. As for all our vacationers and weekenders, they can’t afford luxury addresses close to the horse race set either. You’ll find them squirreled away in cottages and cabins all through the woods. Of course, there are exceptions, places where people have gone all out-”
“The Bradens were among those,” Mark said, wanting to rein in the conversation closer to the business at hand.
“Really?” The New York detective briefly pondered the fact. “Now why would a family that powerful want to be away from their own kind and off by themselves?”
Mark shrugged.
“I don’t know their reasons for sure,” Dan said, “I suppose it’s because they’re what I’d call quiet money. They like to enjoy it with their friends, not show it off.” Dan’s voice had become normal again, the drawl gone and his manner casual, as if nothing had happened. But authority had been established and boundaries marked – Dan’s way of trying to make himself appear an insider, at least to the eyes of a visitor.
“What about here?” Everett said, nodding to a massive shape that emerged from the gloom at the end of the street. “Is this more quiet money?”
“The quietest there is,” said Dan. “Welcome to Blair’s Funeral Home.”
Even in the mist the structure appeared substantially bigger than anything they’d passed. Stepping through an elaborate wrought-iron gate guarding the entrance, they followed a well-raked path that meandered up a sloping lawn. What little foliage remained on the surrounding trees glowed a muted orange, like a bed of coals smothered in ash. As they drew closer the three-story mansion took on a warm yellow hue, and white railings of a long wraparound porch became easily visible. Capping the structure, a cupola with a black-shingled roof pointed upward like a witch’s hat.
Mark grimaced at the thought of what awaited them inside.
Everett gave a soft whistle, “Christ, it’s bigger than Gracie Mansion, where our mayor lives. Same paint job, though, except this one isn’t peeling… his is. Death must pay good here.”
Dan chuckled. “Not from us locals. We live forever. But the part-timers, the outsiders, after ruining their health with big-city stress and pollution, they all want plots where they spent their summers, sort of the ultimate vacation. Mr. Blair can hardly keep up.”
They passed a gleaming Cadillac hearse parked at the head of a curved driveway. A haphazard cluster of lesser vehicles reached all the way out to the street. Mark had suggested they walk the block from Dan’s office so as not to add a police car to the mix. He shipped most of the local dead here, and in exchange for the business got to keep his coroner cases in the refrigerator locker alongside the corpses slated to be embalmed. But, as old man Blair always reminded him, he had to keep his comings and goings out of sight and not disturb the viewings upstairs.
Mark led the way around to the back door, to which he had the key. They went down a wooden staircase and passed through a dimly lit hallway stacked with empty caskets. Some had sticker prices on them. There was a cloying sweetness in the air, offset by a hint of something sour.
Everett looked around and curled up his nose. “You do most of your autopsies in a mortuary? This place looks like it’s owned by the Addams family.”
“They let me use a slab in their refrigerator now and then. Autopsies we do at the hospital in Saratoga, or in Albany,” Mark said.
With a second key he unlocked a large metal door at the end of the corridor and ushered them into a gleaming tiled room that was markedly colder than the temperature outdoors. A stainless-steel table with a drain at its center and a bucket underneath occupied the middle of the floor. Suspended from the ceiling was a large OR lamp, and around the walls stood big yellow vats connected by beige tubing to shiny silver probes that looked like giant needles. Glass jars containing various colored fluids lined the counters, and two metal cabinets filled with stainless-steel instruments were against the walls. The aroma of formaldehyde picked at the back of his nostrils like a swarm of ants. “Better breathe through your mouth, gentlemen,” he warned, crossing over to what looked like a built-in filing cabinet with half a dozen giant drawers. He reached for the third handle down, and pulled out what was left of Kelly McShane.
Her bones had mostly come apart during the retrieval operation, and trying to lay them out in the correct anatomical order had taken Mark an entire weekend. He wasn’t sure he got all the small phalanges of the fingers exactly right, and everything was still discolored brown. The forensics pathologist he’d talked to in New York had told him to do the best he could and not clean the specimen until their own cold-case specialist could view the remains. Consequently, the piecemeal skeleton and remaining strands of tissue had the appearance of something dug up from antiquity.
“Race you to the raft, Mark!”
A flash of golden skin parted the water, and the splash sparkled white in the sun. He plunged after her, laughing with delight as he frantically swam through her wake, then drew alongside, managing to touch the bobbing platform first.
Only now did he realize she had let him win.
“So what do you have?” Everett asked, quickly removing his overcoat and snapping on a pair of latex gloves he took from a box on the counter.
“First, what we didn’t find. No jewelry, no buttons, no belt buckle, and not so much as a shred of clothing, some of which we figure should have survived in all that cold mud, so we assume she was stripped before going in the water…”
As he spoke, Mark envisioned her plunging through the murk, sleek and white as a taper, her strawberry blond hair streaming out behind her.
“… nor were there any distinctive marks on the anchor and chain used to weight her down. What we do have are the remains you see before you, the obvious feature being the skull fracture.” Mark retrieved a pen from his jacket pocket and used it to indicate a three-inch crack that cut across her right temple. Filled with debris, it stood out like a leech on the subtler corrugated markings where the various bony plates in the cranium joined together. “Whoever hit her knew exactly the spot,” he continued. “The point of impact measured two finger widths above the zygomatic arch and a thumb width behind the frontal process of the zygomatic bone itself. That’s directly over the middle meningeal artery.” He picked up the skull, turned it over, and held it so the detective could look inside the cranial vault through the foramen magnum, the large opening through which the spine had been connected to the brain.
The interior emitted a whiff of rot.
Everett screwed up his nose and jerked his head away.
“See how there are bony splinters pressed inward,” Mark continued, shoving the specimen back in front of his eyes. He’d be damned if he’d let this worn-out little man evade a single detail of what had been done to Kelly. The trick to getting the best out of cops was the same as with doctors – make them care. “They probably tore the vessel, setting off a massive hemorrhage. Pray to God she was still unconscious going in the water.”
“Still?”
“Trauma that tears the meningeal artery causes a bleed between the lining of the brain and the skull. Sometimes victims stay unconscious until they die. Sometimes they wake up and are lucid for a while. There’s a chance she was sent to the bottom awake and aware.”
“My God,” Dan said.
Even Everett looked taken aback. He rotated his neck as if it needed loosening up. “That’s it?”
“There’s nothing else to look at.”
“So it’s still a cold case.” The detective pulled off his gloves.
“What do you mean?”
“I mean, I’d love to spend a couple of weeks up here and work the evidence with you. Hell, I’m in love with your town, even though I can’t see it. It’s everything New York’s not, quiet, clean, and slow. Bet the fishing’s great. Trouble is, you don’t have any new evidence to work, and I got recent caseloads up the wazoo back home that do.”
“But it’s murder.”
Everett’s thin shoulders slumped, and he let out a rattling sigh. “It’s a body, what’s left of it, with a skull fracture. That anchor, chain, and padlock your retrieval team pulled up? We checked them out already. Virtually untraceable, they’re so common. Otherwise, there’s not a thing to point us where we haven’t already been. NYPD investigated the hell out of her disappearance twenty-seven years ago, the same as if she’d been a murder case. Not only did every lead come up empty – especially anything having to do with our prime suspect back then, her husband – but the PIs hired by the girl’s parents couldn’t find anything either. Factor in all the clout old man Braden still has in New York City, no one’s willing to put his son through a first-degree shit-ride again without a damn solid reason.”
To this point, Mark had considered the detective’s visit as simply the necessary first step in the NYPD resuming the hunt for Kelly’s murderer. That they’d try to dump it never occurred to him. “That sucks!”
“You bet.”
“And what would it take to reopen the case? I can’t just let it go.”
Everett shrugged and began pulling on his overcoat. “Well, say, you find a lead on the mystery man she met up with. We’d be on him in a New York minute.”
“I find a lead?”
“You want more done, do it yourself, Doc. You and the sheriff here.” He picked up his briefcase, snapped it open, and took out a pair of files, each the size of the Manhattan phone book. “I made copies of our records on the case, the basic stuff. Your body, your jurisdiction, guys. Sorry, but it’s the best I can offer.” He jammed the two tomes of paper into Mark’s chest and walked out the door.
“Jesus, what an asshole,” muttered Dan, and hurried after him.
Mark remained where he was, too astonished by the kiss-off to say anything. A slam echoed down the corridor, and once again he found himself alone with Kelly.
A half hour later he looked up from leafing through the material Everett had left, startled to see Dan standing at the door watching him. “Christ, I didn’t hear you return.”
“You were pretty engrossed in your reading. Find anything?”
“No. It’ll take forever to go through this stuff.” Mark slammed the files closed. “Can you believe that guy, laying the whole thing on us?”
Dan walked over and flipped one of the dossiers open again. Scanning the front page, he said, “Actually, it kind of makes sense.”
“Excuse me?”
“You know what cracks cold cases?”
“What?”
He nudged the folder he’d been looking at back toward Mark. “One guy who can’t get it out of his head. I’d say that’s you, buddy.”
5:00 P.M.
Geriatrics Wing,
New York City Hospital
Dr. Bessie McDonald didn’t like seeing the sun go down. The gathering blackness reminded her too much of her own end of days, and her breathing got worse at night.
She felt depressed, stuck in her hospital room. At least the nurses had allowed her more than the usual personal effects to help make it easier. She had a dozen framed photographs – a black-and-white of Fred in his uniform, smiling before he went off to Korea to be slaughtered and leave her a widow; color snaps of her son, Fred Junior; portraits of her three young grandsons, all grinning at her with various front teeth missing. She’d also brought a set of figurines depicting a young woman doctor performing her daily functions: administering to a newborn baby, listening to an old man’s chest, comforting a sick child. Though she never told anyone, the face on the porcelain statues was hers as a young woman, fired especially for her by a craftsman who had been her patient in the first years of her practice. She took nearly as much comfort looking at the figurines as at her family, not out of narcissism, but from pride at how she’d spent her life, from those early halcyon days up until the moment her own rendezvous with illness clipped her wings as a general practitioner.
She’d always been at risk of a stroke because of her crazy heart flying in and out of funny rhythms: a racing yet steady-as-a-jackhammer burst called PAT, or paroxysmal atrial tachycardia, when she was forty-three; then, in later years, atrial fibrillation, a chronic, wildly erratic tattoo. Whatever the beat, the muscle began to wear out, and eventually she slipped into congestive failure. Luckily, Melanie Collins saw her through it all. But she hadn’t suffered her first embolic event until four years ago at age sixty-six, when a blood clot formed in the fluttering upper chamber, broke off, and flew into her brain. Initially paralyzed on the right side, she’d been left with just her speech affected, again thanks to the precise diagnostic skills of Melanie and the quick use of clot busters – thrombolytic enzymes that break down the blockage before damage is done. Therapy got her back to talking so that no one would notice; however, at times, she had trouble finding the word she wanted.
The lasting harm had been done to her work, the ordeal derailing her from the practice of medicine for nearly a year. Although she’d arranged for a temporary replacement, many of her patients worried that she would stroke out again despite her intention to return, and found new doctors. With each departure, the sense of purpose she fought so valiantly to regain shriveled a little more.
Then, just three months ago, while digging in her garden, her right side went numb. She tumbled to the ground, her arm and leg like deadwood for all the good they were to her. She lay there, her face pressed into the earth, dirt up her nose, and bugs crawling between her lips. A worm’s-eye view of the world, she thought, wondering if it would be the last thing she ever saw.
She’d had no pain, and knew this was the same kind of stroke as before, a blockage, not a bleed. If she got help fast enough, maybe the clot-busting enzymes that rescued her before could help again. Yet second by second, her time nearly ran out. When a neighbor spotted her and called an ambulance, she knew the three-hour window for treatment would soon close.
Once she got to the hospital, there had been no Melanie on hand to speedily diagnose and treat her.
“Since she’s already anticoagulated, it must be a bleed,” one of the ER residents, a sleepy-eyed kid, had said to her nurses as he methodically checked her reflexes.
No! she’d wanted to scream as she pawed feebly at his arm trying to get his attention.
He’d ignored her, and added, “Besides, we don’t know how long it’s been since she stroked out.”
Two hours, forty minutes, asshole! There’s still time.
“Send her for a CAT scan?” one of the women had asked, recording her vitals.
“Of course,” he said, and wandered out of the room.
No, don’t leave. Talk to the radiologist yourself. Bump me to the head of the line!
Three hours too late they’d made the correct diagnosis.
Her speech returned, but the delay cost her partial use of her right arm and her ability to walk normally. It also turned her into an old woman overnight.
“Hi, Bessie.” A pint-sized nurse with a GI haircut and a name tag that read NURSE TANYA WOZCEK pinned to her uniform bopped across to her bed. “All set for your meds?”
“As much as I’ll ever be.”
Everyone called her Bessie. It sprang from her insistence that she be registered as Mrs. Bessie McDonald, not Dr. McDonald, during her admissions. “Things go wrong when they know you’re a physician,” she’d repeatedly explained to the admitting office. “Doctors, nurses, techs – they all start doing what they wouldn’t normally do, second-guessing themselves. Leads to mistakes.”
But since the night of this most recent stroke, she’d had plenty of time to do some second-guessing herself. Had they known she was a doctor, would they have listened to what she was trying to tell them?
“Here, let me prop up your pillows,” Tanya said.
Bessie grew short of breath if she didn’t sleep partially upright. The result of heart failure. “Thank you, dear.”
“And here are your pills.” Tanya handed over a paper cup that had five tablets in it.
Bessie poured herself a glass of water from her pitcher, then downed the bunch of them in a swallow. She’d been on them for years: Digoxin to control her heart rate and increase its pump action; furosemide to keep water from accumulating in her lungs; rampril to relax her arterial tree and reduce the cardiac workload; warfarin, also known as rat poison, the anticoagulant that had led the resident off track; and a baby aspirin, to thin the blood and prevent more clots. As easy as one, two, three, four, five. Except having to take pills at all bored her, and the treatment, like all regimens, wasn’t perfect.
To control her angina, she had to take a spray of nitroglycerine under her tongue, in addition to wearing a patch of it on her skin. The latter could be worn anywhere, but most patients put it on their arm or chest. She stuck hers on her ass every morning just to be contrary, having precious few other ways to say, I’m here and I’ll do things my way.
“Skin’s skin,” she told the residents whenever they objected.
“You go right ahead and put it where you want, girl,” Tanya would say to her in private.
She liked Tanya. The woman always worked evenings, which led Bessie to try figure out what this nurse did during the days. She never talked about herself, and, of course, Bessie never pried. The fun lay in the guessing, not the answers. Bessie’s active mind grated against the hours of idleness and pounced on any puzzle for entertainment.
“I see you’ve been reading about Kelly McShane,” Tanya said, picking up a newspaper from the nightstand that lay open to the article. “The whole hospital’s buzzing about it.”
“I’ll bet. How’s Chaz Braden taking it?”
Tanya looked up from scanning the column. “Do you know him?”
“He was my cardiologist the first time I got admitted for my heart, about six months before his wife disappeared. Didn’t like him.”
The nurse’s expression slipped into neutral, and she glanced nervously at the doorway. “Can I get you anything? How about some juice?” Obviously, she wasn’t about to engage in a round of bad-mouthing the man, which, of course, was professionally correct.
But not fun.
Tanya leaned in close as if fluffing up the pillows a second time. “Our supervisor’s warned us not to gossip about it, but I bet you want to tell me every word of what went on back then, don’t you?” she whispered, dispatching propriety with a grin.
Nice girl, Bessie thought. “Of course I do.”
“Well, it’ll have to wait. You’re not my only patient, you know.” She gave a conspiratorial wink. “But maybe later, when I drop by with your needle.”
6:00 P.M.
St. Paul’s Hospital,
Buffalo, New York
Earl sat rereading the article for the tenth time when a quick rap on the door startled him.
Janet walked in. “Hi, love. Got a minute for me? It’s been a hell of a day in the case room.” She came up to him and pulled off her surgical cap, her short blond hair popping out from its confines like a golden star burst. She flipped the paper aside and pulled him to his feet, slipping her arms around him.
He felt his wife’s slim body beneath her OR greens, but returned the hug woodenly.
“Hey! That’s no way to treat a lady,” she said, pushing back and smiling up at him. Tall as he was, his six-foot frame outranked hers by only a couple of inches. Whatever she saw in his expression, she immediately knew that he was upset as hell. “Earl, what’s the matter?”
He sighed and handed her the article.
“Did you know her?” she said after skimming through it.
“She was in my class.”
“My God! That’s awful. I’m sorry. Were you friends?”
“She was in my study group. Along with Melanie Collins, Ronda Collins’s older sister, and, of course, Jack MacGregor,” he quickly added, giving her names he knew she’d recognize.
On hearing Jack MacGregor, Janet grimaced, and a pained expression crossed her face. MacGregor had died two years ago saving Earl’s life.
“There were a few others with us whom you don’t know,” Earl continued, feeling uneasy.
She read a little more of the column. “How creepy. Did you have any idea she’d been murdered?”
“No.”
“Even after she just disappeared without a trace?”
“We all thought she’d run away from her husband. It really wasn’t a happy marriage.”
“But no word from her, and you suspected nothing?”
“Of course we were worried. But you don’t know the man we thought she was escaping from. She’d told most of us she was going to leave him, yet insisted we not try and trace where she went. She was afraid he’d track her down by following us if we tried to contact her, so we figured that was why she just cut off all ties. After the police found no evidence of foul play, as far as I was concerned, no news meant she’d gotten away, free and clear.”
“Do you think he killed her?”
“Chaz? He was mean enough to. I met him during our cardiology rotation at NYCH and when Kelly had our group up to their country home. He could be a bit of a charmer on the outside, but always found a sneaky way to criticize her, hiding it in a joke. And he could sure throw back the martinis at her parties. His comments got more cutting as the day wore on. None of us liked the son of a bitch.”
She put down the paper and studied him. “You sound angry.”
“I am. She was a friend. We all felt protective of her, especially since the rest of the class had given her the cold shoulder from the get-go. Most figured her a dilettante who was just slumming, riding the Braden name. Then when she worked her butt off and cut it better than a lot of them, they resented her more.”
“Sounds like she was a pretty remarkable lady.”
“She wanted to do pediatrics, and would have been great at it. Whoever killed her snuffed out all that.”
“But you went on thinking she’d run off, even when her parents insisted her husband had a hand in her disappearance?” Janet’s blue gaze grew skeptical. “That doesn’t sound like the poke-his-nose-where-it-doesn’t-belong man I married. Didn’t you wonder why she never so much as contacted them?”
“She seemed to have little to do with her mother and father. I never knew why and, believe it or not, since it wasn’t any of my business, didn’t ask. As I said, we all wanted to believe she’d successfully pulled off a vanishing act. It seems stupid now, but we convinced ourselves.”
Janet studied him a few more seconds, put her hands around his face, and kissed him gently on the lips. “She was lucky to have you as her friend.”
Some friend, he thought.
She turned for the door. “I’ve got to get back to the case room, but should be home in a couple of hours. Can you stop by the store and pick up some milk?”
“Sure.”
“And tell Brendan I’ll be there to tuck him in. Poor little tyke probably feels abandoned.”
“How about I promise we’ll sandwich him between us for his story tonight.”
She laughed, said, “Love you,” and was gone.
He hadn’t lied outright to Janet, but what he’d left unsaid seemed tantamount to lying… big-time.
The ache in his gut spread through him – like a stain.
8:00 P.M.
Geriatrics Wing,
New York City Hospital
She had no idea how long she’d been dozing when a soft cough roused her.
“Hi, Bessie.”
She blinked a few times to bring her eyes into focus on the figure who was standing inside the room. “Melanie? Melanie Collins?”
“Yes. I just dropped by to say hello.”
“My, I didn’t hear you come in.”
“Little wonder. You were snoring like a truck driver. How are you doing?”
“Well, I obviously could have used you when I came into ER three months ago.”
“Oh, Bessie, I’m so sorry I wasn’t there.”
“Pull up a seat.” She gestured to the little-used visitor’s chair with her good arm.
Melanie obliged.
Soon they fell deep in conversation making small talk, but after a few minutes Bessie inexorably returned to her present plight. She found release in complaining about it to other doctors, knowing they would best understand the scope of the outrage that had been done to her. When her own patients had gone on and on about their various illnesses, reciting the relapses and symptoms far more than necessary for her to make the diagnosis, she thought it was because they had little else to talk about, their diseases having pervaded every aspect of their lives. Over the last few months she’d come to realize that they’d been venting, sharing their symptoms so they wouldn’t feel so alone – a compulsion, she ruefully acknowledged, that she couldn’t even stop in herself.
“So-called emergency doctors – they simply didn’t get it the way you did.”
“Well, I knew your history. And remember, you were already admitted for pneumonia, so there were no delays. Who knows what would have been the outcome if I hadn’t had you on the floor and under my thumb when it happened? But since I did, the rest was easy-”
“Easy my ass, Melanie. Remember, you’re talking to a physician here. Don’t make excuses for their shoddy work by minimizing how great you were.”
“Now, Bessie-”
“I know full well that the blood tests indicated I was properly anticoagulated and shouldn’t have had another embolus. But unlike the bozos this last time, you were smart enough to treat the patient-”
“ ‘And not the test.’ ” Melanie gave an understanding shake of the head. “I know. I tell that to the residents all the time.”
“I hope those young punks in ER have at least learned to listen, or pay attention to someone even when they can’t talk.”
“I’m sure they have.”
“But look at me.” She laboriously raised her right shoulder and upper limb. Her hand and fingers drooped off the forearm, curled into a lifeless claw. “God, I didn’t think I’d end up like this.”
“I know.”
“And does anybody want to talk about it? Not on your life. They all think I’m going to sue.”
“Are you?”
“Of course not. I’m a doctor. I won’t go after my own. But I damn well want them to improve – be like you were in training.”
“Bessie, you’re making me blush-”
“In ’seventy-four you did nothing less than give me the second half of my life. The residents back then would have done me in, too, if you hadn’t stopped them. I’d never have seen my grandchildren. So give credit where credit is due, I say.”
“It was nothing.”
“There you go again. Nothing? My heart racing. Unable to get my breath. And everybody shouting, grabbing at the ECG tracing. I remember everything like yesterday.”
“Well, you know how it is in a precode when only residents are around.”
“But you measured out the rhythm and saw it for what it was.”
As part of developing the lore of her own sickness, Bessie had never stopped extolling to anyone who would listen how someone so young had maintained the presence of mind to pick out such a subtle distinction on a cardiogram in the midst of all that wild confusion. As she told and retold the story, she recalled seeing everything as if from the wrong end of a telescope, feeling desperate for air despite wearing an oxygen mask, and being about to pass out. The chief resident kept yelling for intravenous digoxin while others stuck her with IV needles and shouted a flurry of other orders:
“Furosemide!”
“Nitro!”
“Morphine!”
Like happy hour at a bar, she’d thought, watching the darkness close in on her.
A nurse had brought the syringe of digoxin up to the rubber injection port on a small intravenous bag.
Then that lone clear voice. “No! This is dig toxicity.” And a dark-haired girl with a plain face had grabbed the needle away before it could be injected. “The rhythm strip shows atrial flutter with block,” she added, speaking firmly and loudly enough to cut through the melee without resorting to panicky shouting like everyone else.
The rest of the team had immediately turned to give her their attention. “Look,” she said, running the long strip of paper upon which the ECG had been printed through her fingers, handling it like a ticker tape and pointing out the salient features.
Yes, yes, yes, the doctor in Bessie McDonald had thought, her hearing intact enough to pick up sufficient snatches of the quick-fire explanation to know it was correct even as her vision narrowed to mere pinpoints of light.
Atrial flutter with block, a hallmark of digoxin toxicity, meant a far too rapid heartbeat where the upper chambers, the atria, pounded along at 300 a minute, and the lower chambers, the ventricles, contracted at exactly half that rate, 150 a minute. The trick? To recognize it from the other arrhythmias where the atria and ventricles raced ahead at the same speed and the drug of choice was more digoxin. Had the chief resident succeeded in giving an additional dose to Bessie, however, he would have entrenched the problem, rendering her myocardium twice as resistant to treatment, and she could have died. Pumping at that speed, the chambers weren’t emptying properly, and her lungs were filling up with fluid. While the other drugs they’d ordered would help empty it out, the definitive step to solve the problem – slowing down her heart – had to be done by a synchronized countershock of electricity.
Melanie had come through for her on that count as well. Bessie felt the paddles lathering up her chest with lubricant, then “Pow!” A huge white light ripped up the inside of her skull. Yes! Despite the sensation of being kicked by a horse, the jolt of direct current, she knew, would stun the atria, render their conduction pathways refractory to the fast impulses, and allow her own natural pacemaker time to reassert itself. Within minutes she began to feel better, opened her eyes, and saw Melanie smiling at her.
“Quite a feat for a fourth-year student,” Bessie said. “You know, up until that point, I got the impression nobody on staff appreciated your skills.”
Melanie chuckled. “Hey, that’s the job of teachers with medical students. Keep ‘em tired and feeling stupid. Makes it easier to stuff them with knowledge. But to what do I owe this trip down memory lane?”
Bessie reached for the paper with her good arm. “This got me going,” she said, tapping the article about Kelly McShane. “It all happened that same year. I remember her. She was so pretty and pleasant around patients. I thought then she’d make a great doctor. And if you recall, Chaz Braden had been my cardiologist. Come to think of it, he kept ignoring my complaints of being nauseated. That should have tipped him off my digoxin level was rising.”
“You’ve got a pretty good memory for something so long ago.”
“What do you expect? I nearly died. As for the time when Kelly McShane disappeared, I figure just about everyone remembers that, at least where they were.”
“How do you mean?”
“Thursday, August 8, 1974. That was the night Nixon resigned. He gave a TV speech at nine P.M, announcing he’d be gone by noon the next day. I was glued to my TV at home. And in my office, Friday, the patients and I watched his departure from the White House. I’ll bet you can tell me where you were, too.”
Melanie frowned a few seconds, as if trying to recall her whereabouts, then shrugged. “Not really. I remember it happening, but not where I was. Must have been busy days on the floors. Say, the nurses told me you’re going to your son’s home to live.” She got up and walked over to the family photos on the bureau, leaning over to get a better look at them.
Bessie immediately felt excited. The mere mention of what lay ahead brought her to life again. “That’s right. Me on the Big Sur. Fred Junior and his wife have built their dream house, including a cottage for me, plus arranged for private nurses, all thanks to the dot-coms. The kid had the smarts to sell before they went bust, and I’m going out in style.”
“Hey, I think you should take a doctor along with you.” She delicately fingered the frames as she looked at the pictures one by one.
“Come along. That would be the dream team, having you in charge. You’ve always been there for me, when you’ve been there at all.”
Melanie laughed and moved to inspect the figurines near the head of the bed. “Will you listen to yourself? You can’t blame gibberish like that on the stroke.”
“You know what I mean. You saved my life twice. Why not a third time? I’ll bet there are lots of opportunities for someone like you in California.”
“Be careful. I might take you up on it.” She carefully picked up the piece depicting Bessie examining an old man. “This is beautiful. Is that you?”
“A long time ago-” She stopped short at the sight of Tanya standing at the door. How long the young nurse had been there she couldn’t say. “Yes, Tanya?”
“I’m sorry to interrupt, Bessie, but it’s time for your shot.”
“Oh!” Melanie said, peeking at her watch, “Well, guess I better be off, then.” She quickly replaced the porcelain figure.
Bessie flashed an annoyed look at Tanya for interrupting them. She’d been enjoying the company. “Oh, Melanie, please don’t go.”
“I really have to. Sorry it took me so long to stop by, yet better late than never, eh? Have a good sleep, and I’ll try to see you before you leave.”
Obviously their visit was over. Contemplating the striking woman Melanie had become in middle age, Bessie reached for her hand and took it in hers. “All the best.”
“To you as well,” Melanie said, returning the gesture with a warm squeeze.
Out of nowhere an insolent little question popped into Bessie’s mind. How come such a good-looking woman had never married?
Once she’d left, Tanya walked over to a stand where a small, multidose bottle of heparin and packets of needles were kept.
Low molecular weight heparin was another anticoagulant, this one used in small injected doses to prevent blood clots from forming in the limbs of patients who were bedridden. She wouldn’t normally have needed it, being on warfarin and the baby aspirin already, but having thrown two emboli from her heart so far, the doctors were taking no chances.
Which was fine with Bessie. No way did she intend to be waylaid again and miss the Big Sur, she thought, watching Tanya, who stood with her back turned as she drew up the injection. Her annoyance with the girl vanished. After all, she’d just been doing her job. “Don’t worry, Tanya,” she said with a chuckle, wanting to make amends for her nasty glance of a moment ago. “I won’t faint if I catch sight of the needle.”
The nurse laughed, but continued to shield the syringe from Bessie’s view as any thoughtful nurse or doctor does when preparing a hypodermic for a patient. “I know, Bessie. It’s force of habit. You’d probably do the same with me if the situation were reversed.” She dropped the bottle in a plastic container for medical waste, pivoted around, and walked to the bedside. “Where do you want it?”
“Actually, in the mornings I’ve started giving them to myself.”
“Oh?”
“Yep. In case they want to keep me on the stuff when I go to my son’s. I don’t want to be totally dependent. Just leave the syringe on my nightstand.”
Tanya frowned. “You’re sure?”
“Yep.”
Tanya hesitated, the capped syringe in her hand, then shrugged. “Okay. You’re the doctor,” she said with a grin, and placed it on Bessie’s side table along with an alcohol swab. “But I can’t stay to talk. We’re short-staffed again.”
Time to sleep, Bessie decided.
She rolled over and reached for the syringe and swab. “Might as well be at the good old belly button,” she muttered, whipping up her nightdress and exposing what looked like a horseshoe of pinpricks around her umbilicus. She wiped the skin with an alcohol swab, then managed to bunch up a roll of flesh using the limited movements of her right forearm. With a quick thrust, she sank the needle in to its hilt, and slowly pushed in the plunger.