That same evening, 8:27 p.m.
Damn," Janet said.
It had been the fifth time Earl heard the word coming from their study where she and Thomas were working.
Sounded like they weren't getting very far, he thought, putting away the last of the dishes from dinner.
Brendan steadied a stack of bowls under his chin and carried them toward their proper cupboard. "Is that the beaver kind of dam or the bad kind?" he asked, managing to set his load up on the counter, where it teetered precariously. Then he hoisted himself up beside them.
Earl tried not to smile. "Beavers."
"How do you know?"
"Because I do."
"How?"
"Just do. Now it's up to bed."
The familiar routine- bath, teeth, pajamas, story- unwound at its usual slow pace. Earl savored each step of it, the ritual having become an oasis for him at the end of each day.
Half an hour later he joined Janet and Thomas in the study only to hear her again mutter, "Damn."
"No correlations?"
"Not so far," she said. "But I'm trying a new approach."
He saw a printout of the New England Journal cluster study lying on the floor beside her chair and absently picked it up.
"I expanded the search to include the whole hospital," Janet continued, gesturing at the NO MATCHES FOUND message on her screen with one of Brendan's pencils. A tiny figure of Big Bird clung to the eraser end. "We thought we could save time by checking each staff category for a home run- namely, anyone who'd been on duty for eighty percent of the deaths in palliative care."
Earl saw in the article where she'd circled that number, it being the magic threshold in most cases where the study technique had actually unmasked serial killers.
She slumped back in her chair. "But I've checked every type of worker at St. Paul's I can think of- nurses, doctors, residents, orderlies, porters, cleaners, nursing aides, lab technicians, even secretaries and security guards. Who am I missing?"
"Visitors?" Earl said, resigned to the limits of a cluster study.
Her frown deepened. "Then we're out of luck."
"And pastoral services."
She threw him a give-me-a-break glower. "Stop it." She hadn't liked his voicing suspicions about Jimmy.
"Dr. Garnet, you mentioned using the computer record of electronic keys," Thomas said, "to see who accessed the hospital after hours, when they weren't on duty?"
"Yeah, but I haven't had time to set that up yet," Earl replied, flipping through the article. Finally he reached the section that stressed: Suspicions should be raised only when clusters of deaths and cardiopulmonary arrests occur that are either unexpected in timing or inconsistent with a patient's previous clinical course.
Janet turned to Thomas and began to explain Earl's previous concern that another way someone could foil a cluster study would be to work with an accomplice.
The resident listened intently.
Earl barely paid attention. The words unexpected in timing or inconsistent with a patient's previous clinical course had jolted his memory, and the image of a dying woman's calendar, carefully marked with crosses, popped to mind. Crosses that marked the deaths of patients who had not been declared DNR. In other words, patients who, for the most part, were probably thought to have sufficient time left that the matter could be decided later. Their deaths, though anticipated, might have been unexpected in timing.
"Wait a minute," he said, and moved to the keyboard. As chief of ER, he still had access to all cardiac arrest statistics, since his staff responded to calls from the floors. He punched in the key words to pull up a list of all the code blues at St. Paul's from midnight to dawn in the last six months and organized them by date on a bar graph. "The trouble is, we've been looking at overall death statistics. But in front of our noses there's been a simple way to separate them into two groups- those who died when they were expected to, and those who went a bit prematurely." As the computer worked, he told them about Sadie Locke's calendar.
The image that appeared on the screen stunned him.
Above January, February, and March, the incidence of codes called in palliative care seemed practically nonexistent. But over April, May, and June, three tall columns, like black towers of equal height, indicated the arrest team had been summoned about fourteen times each month.
"Well, look at that," Janet murmured at his side.
Thomas leaned forward. "Wow!"
The odds were zero that so many patients not yet designated DNR would go into cardiac arrest before their expected time by pure chance. Someone had selected them for death.
After chasing vague trends and trying to make mere fractions of patients add up to something concrete, the stark, solid pattern gave Earl a hell of a sense of accomplishment. Now not even Hurst would be able to deny that they had a killer at work.
Except he hadn't a clue who or why.
"Any comments or ideas?" he asked, assuming the other two had reached the same conclusion and raised the same unknowns.
The three of them studied the screen, their grim silence cocooned in the sound of rain pelting the study window.
"If someone's been killing patients for the last three months," Janet said after a minute, her voice little more than a whisper, "let's assume that that same person is also responsible for the first increase in deaths. At least then we could ask the question, Why kill only DNR patients for three months, then add patients who were not DNR to the list?"
Earl saw Thomas open his mouth as if to say something, then close it again.
"Spit it out, Thomas. All ideas are welcome."
The young man's dark complexion reddened. "I just had a rather nasty thought."
"Go ahead."
He hesitated, running a hand over his beard. "Well, what if there were something to Yablonsky's claim that someone had been pestering patients with questions about a near-death experience? No, that's too weird."
"Hey, go on."
"Well, maybe that someone tried it with patients who were more advanced in their disease but couldn't get anywhere with them. The people might have been too obtunded to reply with anything meaningful. So it would make sense, in a weirdo's way of thinking, to use people who weren't that far along, figuring they'd be able to at least speak. But our weird someone would have to manipulate these relatively more stable patients, bring them near death using drugs, say, or simulating the experience with ketamine, like in that paper you found."
Janet looked at Thomas in surprise but said nothing.
"Are you thinking of Stewart again?" Earl asked. "I thought you were all for his being innocent now."
Thomas's color deepened. "I am, but figured we need to put all ideas on the table, whatever we want personally."
Earl agreed with the part of needing to be complete. "Right you are. But you'll be glad to know there are still problems with pinning it on Stewart. He wasn't in town during a few weeks of the first jump in the mortality rate."
"But you're the one who keeps telling me that that doesn't rule out an accomplice," Janet piped in. "And there's a hideous logic to what Thomas just said that could apply to Stewart."
"And there's still the possibility someone is setting Stewart up," Earl responded.
"Then I'd advise you to check out that ex-wife of his," Janet said. She'd already voiced this suspicion twice before, first when Earl told her about Dr. Cheryl Branagh a few hours ago, and again later when he briefed Thomas.
Earl shook his head. "My instinct says no."
"Patterns are your strong point. Instinct's mine."
"Mine are good."
"They've been wrong before."
"Yours too."
It took Earl a few seconds to realize that he and Janet had slipped into the shorthand form of sparring that they, like most couples, had built up over the years. Thomas might just as well not have been in the room. "Sorry, Thomas. Rude of us," Earl said, and glanced at his watch. Only 9:05. "Look, it's not too late for a visit to Stewart's. He doesn't live that far away and might be able to shed light on who could be after him." Especially if confronted with the name Jerome Wilcher, he thought, seeing no need to release that tidbit to Thomas. Stewart had enough gossip to live down. "So I'm going to leave the both of you at it here-"
The sound of Janet attacking the keyboard interrupted him. The two men turned to her. "What's up?" Thomas asked.
"Maybe nothing. But I'm going to try for a home run again. This time I'm using only the list of patients who were not DNR when they died, For starters, let's see if there's a particular nurse in-house most of those times."
A single answer popped up on the screen.
The three leaned in to read it.
Earl felt his stomach knot into a fist.
"It can't be," Janet whispered.
Thomas went rigid.
It read JANE SIMMONS.
Janet braced herself against the passenger door as Thomas swerved her car around yet another corner, then accelerated toward the freeway. Already she regretted having accepted his offer to drive, but he'd insisted on going with her so they could discuss how much to tell J.S., and on getting behind the wheel himself.
"It can't be too comfortable for you these days," he'd said, patting his flat stomach to contrast it with her own.
She'd initially been grateful for his thoughtfulness, if not his lack of tact, as it was true that getting in and out of the driver's seat was more difficult with this pregnancy than she recalled it being with Brendan. But then she couldn't adjust the seat belt on the passenger side to accommodate the new girth, and ended up leaving it off. "Just don't tell my patients."
He'd followed the quickest route to the freeway and downtown but drove her peppy little car at twice the speed she would have in this weather, even if a patient fully dilated awaited her at the hospital.
"Slow down," she told him, raising her voice above the din of rain that peppered the heavy leather top of her vehicle. It sounded like they were in a tent. "J.S. isn't going anywhere."
He eased off and leaned forward to see better. The wipers barely parted the steady cascade of water that poured down the windshield.
The three of them had agreed there must be a simple explanation. But they needed to talk with J.S. and discover that reason before anyone else stumbled onto the data, because the history of cluster studies had a dark side. Effective as they were in nailing the guilty, they had also destroyed the lives of the innocent, the same persuasiveness of numbers that made them so successful also being what made them so dangerous. Whenever such studies fingered someone who happened to be around but had nothing to do with the killings, even in cases when formal charges were never laid, the accused inevitably went through a legal wringer for years before being exonerated. Often the person never worked in health care again, and sometimes lost the support of family and friends in the process.
"My worry is Yablonsky," Earl had said. "As long as she feels threatened that someone might try to blame the rise in deaths on her, she'll continue her attempts to pin them on anyone else who's handy."
"But she's already done a pretty good job at setting up Stewart," Thomas had countered, his voice tight with tension. He seemed the most shaken up by what they'd found.
Earl had scowled at him. "Maybe. But you saw how scared she was yesterday. And once everybody else starts thinking straight, they're also going to have serious doubts that Stewart would knock off patients as part of some weird near-death research. So who's to say dear Monica won't see the writing on the wall, realize she could still take the fall, and mount her own study to try to shift the blame to yet another patsy? Hell, my talking about clusters yesterday might even have given her the idea. She knows as well as anyone what kind of trap they can be, and she already has access to the ward's death records. She could be sitting at home right now, trying to tap into nursing rosters and doing the same thing we are. If J.S. pops up on her screen, she's finished."
Thomas's ruddy complexion had gone pale listening to Earl's all-too-blunt stark assessment, so much so Janet felt obliged to give her husband a pinch on the butt to shut him up.
She also had said nothing about an even more obvious and imminent danger for J.S. The young nurse might be able to identify the real killer- she might be aware of someone else who worked the same nights as she did, someone who hadn't yet shown up on their study. That put her in danger. Some slight slip on her part, an innocent comment about having a schedule similar to that of the actual murderer, could be a death warrant- if it wasn't already too late. When Janet had phoned ICU to check on her this evening, the supervisor reported that J.S. had received a steady stream of nurses, clerks, porters, orderlies, even interns and doctors from ER, all dropping by to wish her well. And since her endotracheal tube came out, she'd been talking to all of them.
Thank God Earl had had the good sense not to blab out that particular risk- he must have seen it as readily as she had- or the already skittery Thomas would really be climbing the walls.
She glanced sideways at him and saw that he remained hunched forward as he drove, staring straight ahead, his jaw clenched, his features ghastly as they moved in and out of the shadows between overhead streetlamps. Maybe he'd already figured it out anyway.
Back at the house Janet had insisted to both men that she be the only one to talk with J.S. tonight. "For no other reason than she's my patient, and I won't have you two descending on her, scaring her silly. Besides, I may be able to keep what she says under doctor-patient confidentiality," she told them, figuring it sounded reasonable that she'd also want to protect Jane from the police. Mostly she needed as many reasons as possible to keep Thomas away from J.S. until he calmed down. The last thing J.S. needed would be for him to pass all his anxiety on to her. "And I'm going to briefly see her tonight, warn her to watch what she says, so she doesn't incriminate herself with some off-the-cuff comment about her schedule to the likes of Monica Yablonsky." At this point she'd managed to slip her husband a private little wink. He'd fired one right back. He knew her real concern, just as she'd thought. "I should give her a post-op check anyway, so my dropping by won't seem too out of the ordinary or alarming. So why don't both of you stay here until I come back?"
Thomas had refused to wait behind.
Now as she watched him drive, the tension in his neck and shoulders grew, subtly sculpting the shape of the muscles visible at the open collar of his white golf shirt. Definitely not in a state of mind to calm J.S.
"I have to see her alone," she reiterated for about the tenth time. "Until we know more, for her own good. Of course there's a perfectly plausible explanation for her schedule, but it may take a while to figure it out, and until then we must be careful."
He slowly turned and looked at her, a dappled yellow hue playing across his cheekbones from the rain-filtered glare of sodium lights. His eyes seemed sunken in their sockets and glittered at her through the darkness. "It's only right that I be at her side," he said, his voice a grim monotone.
She felt a chill at the flatness of it.
Earl punched redial.
"You have reached the home of Dr. Stewart-"
He slammed down the receiver.
He couldn't just stay here, pacing the floor and trying to figure out connections that didn't make sense.
The flashback of a dark form hurtling at him in the darkness increased his sense of urgency. He had to get answers before the real killer realized J.S. could identify him.
Best just go over to Stewart's house. Confront the son of a bitch face-to-face. Force him to reveal what he knew about the pattern of DNR and non-DNR deaths. Pin him down over what J.S.'s schedule might have to do with the killings. Grill him to admit who might want to get even with him for Jerome Wilcher's suicide.
He phoned Annie, their housekeeper, explained that an emergency had come up, and asked that she watch Brendan.
"Be there in five minutes, Doc."
Always willing to bail him out, bless her heart.
As he waited, he racked his brain over how J.S.'s name could have come up, but as before, got nowhere. He even considered the possibility there could have been a glitch in the program.
He went back to the computer screen and typed in his own name.
Zero correlation.
Janet's.
Same result.
He stood there, unable to think of what else to try.
Into that vacuum crept a gloomy acknowledgment. Even as the three of them had stood in this room and openly proclaimed that J.S. had to be innocent, a little stir of protest had wormed its way along the dark veins of his pessimism. In complete contrast to the way Janet's instincts could give J.S. a pass or Thomas's love could preclude his doubting her, Earl would test whether his comfortable assumptions about J.S. withstood scrutiny. It always had been his way of ordering the world- troubleshoot it and avoid nasty surprises- which meant he allowed himself to ask questions that no one else dared raise. In this case, could J.S. be someone he didn't know at all?
Annie arrived, using her own key to let herself in.
"Off you go," she said, waving him out. Then she gave Muffy a big pat and shook the rain from a soaked umbrella before folding it up. "I'm sure you've got lives to save." Though sixty, she wore her white hair in a Gl cut and still had a figure that let her borrow some of Janet's dresses. She swept by him into his den to plunk herself down in front of the computer.
Muffy, having long ago decided that here was a lady who knew how to pamper a poodle, settled happily at her feet.
"I'm in the middle of a Rogue Squadron game with my grandson on the Internet and can't talk right now," Annie called over her shoulder.
"You're an angel, Annie."
She grinned and clicked open a Web page picturing a heavily armed man in a Special Forces uniform. "Oh, I know I am," she said, without so much as a glance in his direction.
Sixty seconds later he reversed out of the driveway and started up the street, forced to lean forward, his visibility nil because of the storm. Plowing through shimmering black pools that covered the streets, his tires started to hydroplane, and his knuckles went white from holding the steering wheel against the pull.
"Christ," he muttered, regaining control.
In ten minutes he came to a stop under the black canopy of trees drooping over Stewart's driveway.
The house remained in absolute darkness.
Not at home?
Earl couldn't tell if Stewart's Mercedes was gone, the garage being closed up tight.
He got out of his van and ran for the front door.
A four-chime bell sounded inside, then died out in the answering silence.
Shit. Tocco usually barked up a storm whenever anyone came calling if she had Stewart in there with her. But leave her alone in the house and she would hide in the basement, never making a sound. Dog lovers said she knew enough to protect people, not belongings. Stewart had a slightly different take on the matter. "The mutt barks when I'm there so I'll come and protect her. Otherwise she's a scared wimp, and anyone could break in."
So maybe Tocco's silence meant Stewart had gone out again. Damn, he should have checked the hospital. Probably the guy went back to the sanctuary of ICU. He used the place the way lesser mortals found comfort in a tavern.
Lightning sent molten cracks through the black sky.
Earl hesitated about using his cell phone out here, never having seen anyone get their brain fried while making a call during a thunderstorm, but not willing to risk the remote chance of being a first. Before returning to his car, he turned the front door's ornate brass handle, figuring it a useless gesture.
The door opened.
He quickly stepped inside and pulled it closed behind him.
"Stewart!" he called out, fumbling for a light switch as he stood dripping on the marble floor of the foyer. He braced himself to feel Tocco's cool nose coming out of the darkness to give him a sniff. Although the dog was timid, it took only one meeting to be her friend for life. Whenever he'd visited before, once she recognized him, he inevitably got a good going over, probably because he carried Muffy's scent.
He found what felt like a row of rheostat dials and pressed. The overhead chandelier flooded the room with an amber glow.
No Tocco and no Stewart.
"Hello?" he called out again.
Absolute stillness.
Stewart must be out, but there was one way to be sure. Earl made his way to the kitchen, flicking switches as he went, and found the door to the garage.
The dark blue Mercedes glistened in the light streaming past him.
Out for a walk with Tocco? Could be. But back at the main entrance he'd seen Stewart's big umbrella in its stand as usual. Still, the leash didn't occupy its regular spot on a varnished pine coatrack.
So he'd wait, Earl decided. Stewart wouldn't be long in this downpour.
After ten minutes of sitting at the bottom of the spiral staircase leading to the upper floor, he figured hanging around any longer would be a waste of time.
But Stewart must have the dog with him, so he wouldn't have gone far, especially without an umbrella. Maybe he'd taken shelter somewhere.
He got up and went into the living room to peer out the front window, trying to catch a glimpse of the pair returning home.
The streetlights illuminated falling rain but no people or animals of any kind.
At least the downpour had started to recede. It no longer hit the glass with the force of a fire hose, and the accompanying roar had begun to diminish.
Good. If Stewart and Tocco had holed up someplace, they ought to be back anytime now. He sat on the sill to keep watch.
Over the next few minutes the rain became a gentle patter, and quiet filled the empty house, except now he could hear what sounded like faint voices.
What the hell?
He got up and walked back into the foyer.
"Stewart," he called upstairs, wondering if he'd been in his bedroom watching television the whole time and hadn't heard he had a visitor.
No answer.
And Tocco would have barked by now.
Besides, the noise, more a distant murmur than distinguishable talking, didn't seem to be coming from there.
For a second Earl thought it might be outside, and went to the front door. When he opened it only the hiss of a gentle shower filled his ears. The voices remained at his back.
Closing up, he wandered into the interior of the house and paused where the hallway met the kitchen. The murmurings came from behind a door he thought led to the basement.
Turning the handle, he pushed. Immediately faint words floated up from the darkness below. They sounded like something on a radio or from a television. Had Stewart a den down here?
"Stewart?"
He expected a response.
Again none came.
He flicked the light switches.
The blackness remained.
A blown fuse?
He began to catch snatches of what seemed to be a conversation between two people.
"Any more pain?"
"None. It's gone…"
"Do you see anything?"
"Only blackness…"
The questions were whispered, the words barely loud enough to make out. The rasping replies, more audible, seemed to come from a woman. "Hello?" he called.
Still no answer.
"Look harder! Now tell me what's there."
"You're not my doctor…"
"No, I'm replacing him tonight…"
Definitely a television left on, or a radio.
"Just leave me be. It doesn't hurt anymore…"
"Do you see anything yet?"
"Yes…"
He wanted to go down but needed a light and had no idea where Stewart might keep one. He stepped into the kitchen and, after a little looking, found a handheld spot on a charger in the pantry. The harsh white beam probed the thick blackness like a sword as he started down the steps with it, still listening to the voices.
"Do you sense yourself rising?"
"Leave… me… alone…"
"Not until you tell me what you see. Are you looking down on us yet?"
There followed what sounded like static.
"What did you say?" the whisperer asked.
"I… see… me…"
What the hell? Earl thought, and slowed to a halt halfway down the steps, unable to believe he'd heard correctly. But the conversation continued, the telltale reverberation of speakers evident now.
"What else can you make out?"
"The… bed… nightstand… pictures… all my pictures…"
"Is that your husband?"
"Yes…"
In that closed space Earl caught a whiff of a very medicinal smell that tingled the inside of his nose. A more cloying, fecal aroma joined it, causing the back of his throat to tighten. Oh, no, he thought, and started down again, the spot throwing garish shadows against the walls.
"Is he dead?"
"Yes…"
"Do you want to find him?"
"Yes…"
He rounded the bottom landing and stepped into the basement proper.
"Are you still looking down on yourself in bed?"
"Yes…"
"Let go. Allow yourself to float, escape the hospital, go high above the building. You must do this before you can see Frank…"
He swept the lamp's beam toward the sound. A miniature cassette recorder, the kind doctors often used when they dictated clinical notes, lay on the floor not far from his feet, and the tiny, slowly turning spools glistened as they caught the light. He guided his cone of light onto a small dark mound against the wall. It became shiny black fur that stood out in stark relief against a background of gray cinder blocks. He took a step closer and saw a motionless pink tongue lolling out over white fangs like a carefully placed ribbon. Farther into the darkness something much larger loomed. By reflex, he started to breathe through his mouth, and the sounds from the tape seemed swallowed by the heavy stillness of that suspended shape.
He slowly brought his beam to it.
Stewart's swollen, purple face stared back at him, eyes protruding from their sockets, the whites crisscrossed with broken veins, the pupils so huge they seemed filled with a starless night.