Monday, July 7, 12:35 p.m.
The roof garden, St. Paul's Hospital
I leaned back on the chair and pretended to enjoy the heat of the noonday sun on my face. But fear had become my cancer. Always present, it ate away at me day and night.
There were moments when I forgot. Awakening from sleep, I could still surface to the promise of a new day with a peace of mind that belonged to the time before I'd killed. Then the memories would sweep through me, and I would sink beneath the weight of my secret, knowing I could never escape its chains, never redeem myself. But as soon as I started to play my part, I would be okay.
Until I thought of Earl Garnet being on my trail.
Like all good physicians, he had an obsessive nature when it came to solving clinical problems. But if he sensed something wrong- lab mistakes, errors in judgment, incompetent technique- watch out. It was almost as if he took screw-ups like that personally. He was forever lecturing about how they caused avoidable injuries that the culprits could have prevented, and just about everyone at St. Paul's knew he would consider such failures a betrayal of those who had entrusted their lives to his domain in ER. I don't think he consciously aggrandized himself with that way of thinking. It was more an attitude that he'd be damned if anything would go wrong on his watch. None of that bothered me as long as he'd confined himself and his scrutiny to his own department. But now that he'd expanded his territory…
Panic at the thought of capture spread through me like rot. And for the millionth time I silently railed at having been fool enough to think I could get away with it, that I'd be so clever and outsmart them all.
But I'd had this plan, this technique, my ability to wall off what I didn't want to be or feel, I would remind myself. I'd perfected it trying to separate me from her pain, her scars. Except back then I'd learned it too late- I hadn't gotten the barricades up in time to keep her anger from becoming mine. But now, with the trick down pat, I had a cloak to wrap around myself between murders and make me invisible, an entity able to move about like a ghost. Or to paraphrase the philosopher, I don't think, therefore I am not. If Garnet or anyone else ever did realize that a killer had been at work, they'd be after someone who'd vanished, ceased to exist. At least that was what I told myself until I lapsed and thought about what I'd done, like now.
A slow, cold chill shuddered through me despite the heat and extra clothing, and I broke into a clammy sweat.
Shit! If only I'd never started. Or quit at the first death. No one would have known. But instead I pushed on, certain that Algreave had been a fluke, that I could still pull the rest through their sessions. Now I'd no choice but to continue, just to stay clear of the living death of being buried in a prison cell forever or, worse, awaiting execution.
Through half-closed eyes I watched Garnet lounging in a seat nearby, and a surge of resentment grabbed me by the throat. Leave it to old Goody Two-shoes Earl, making this into a roof garden for staff and patients. Rumor had it that he'd arranged for the greenery to be on permanent loan, or at least until the snow flew in the fall. What a fucking god he'd become around here!
My bitterness toward him and his good works surprised me. But why should it? After all, I'd condemned myself to seeing him across a moral divide, the man's inherent decency a luxury I would never again enjoy. Little wonder I envied and hated him for it.
The warmth of my mask and gown grew sweltering, my skin hot and sticky. Nevertheless, I stayed put, glancing around the rest of the area.
A gaunt-eyed woman whose few remaining wisps of hair floated on the breeze like gossamer sat nearby in a wheelchair parked under one of the potted trees. Perfect place for her, I thought.
From a distance of ten yards I could make out the telltale red stripe on her wristband that Palliative Care attached to signal a DNR case. She also had the necessary IV, probably because chemo or radiotherapy had left her unable to drink and eat adequately. Yet she didn't seem gorked. Now and then a nurse or orderly paused to say hello and chat for a while.
That's the kind I would have to select from now on. People who still had their marbles, but for whom there'd be no code when the nurses found them after I'd finished the session. I could no longer allow my subjects to survive and spread tales of near-death experiences. They might recall one detail too many and give me away. At least DNRs meant there'd be no resuscitation team to raise suspicious questions about too many people dying before their time. I doubted their doctors would raise questions either. That would entail an admission their prognoses had been wrong. Or maybe they'd be so grateful for the empty beds they wouldn't entertain many second thoughts about how they had become available.
I continued to study her.
At one point I overheard a snatch of a person's greeting.
"Hello, Sadie…"
I'd need at least a dozen more subjects. Out of them I might get a couple of usable tapes- so many had turned out garbled. But added to the few other good ones I'd managed to record, that could finally be enough to convince everyone. Just the same, the added risks of being discovered scared me shitless. I still had no idea whom I'd seen prowling around Friday night or why the person had been there. No telling when that one might show up again. And since Garnet had decided to stick his nose into the business of that ward, he posed the biggest obstacle of all to my pulling off more undetected sessions.
So how would I get around him?
Until now Palliative Care had been a place where no one thought twice when a person died. Doctors hardly ever ordered autopsies, and family, in their heart of hearts, were secretly relieved at their loved one's passing. In other words, my perfect hunting ground.
And it still could be, despite talk of audits and the bad luck that Earl had taken a particular interest in the place. Because the new VP, medical, fastidious as he might be, had also created his own problems. With a little help, those difficulties might prove useful in several ways. At the very least they should keep him distracted. If they didn't…
I looked at Janet, who lay sprawled on a lawn chair nearby, her protective wear outlining the swell of her stomach.
I dreaded what it might be necessary to do. But a personal tragedy to anguish over- that would sidetrack Garnet.
My own loss once more exerted its iron grip on me, stirring a rage that wouldn't die, not since all those years ago when my world fell apart. The hesitation I'd felt vanished.
I would make it appear accidental. After all, pregnancy could still be a risky business.
1:07 p.m.
Not too bad, Earl thought, surveying the inner corridors of his department.
The line of stretchers in the hallway, once a temporary measure to handle the occasional overflow but now an all too permanent fixture, stood empty, and the modest volume of chatter told him that his staff had the rest of the place under control.
He ducked into the nursing station, and J.S. looked up from where she leaned against the counter riffling through a magazine. "Hi, Dr. G."
"Finally, a bit of rest for the wicked, I see."
"It's about time," she said with a wink, and returned to flipping pages.
He spotted Thomas huddled in a corner with the rest of the residents conducting an impromptu Q &A session. The man had the knack of all good ER teachers, knowing to seize spare moments whenever he could and turn them into mini seminars.
Earl waited for a pause in the proceedings, then signaled him to one side. "If you need me, I'll be in pathology. They're doing a case I want to see."
Thomas's eyes seemed to draw a bead on him. "The Matthews woman?"
Earl nodded. "I saw in the chart you answered the resus call. If it's not too busy here, you could join me-"
"Thanks, Dr. Garnet, but this bunch is pretty green." Thomas gestured with an extended thumb toward the members of his group as they continued an animated and somewhat misinformed discussion about the proper technique for pelvic exams. The corners of his eyes crinkled. "As you can hear, I'd better stay with them." He chuckled, hesitated a second, then glanced right and left, as if making sure no one stood within earshot.
Inadvertently Earl did the same.
All clear, apart from J.S.
"There's something you should know about Palliative Care that might help," Thomas said in an only slightly hushed voice. Her presence didn't seem to bother him.
"Oh?"
The resident proceeded to tell him about a pattern, a concentration of codes that occurred on that ward just before dawn.
Earl didn't find it all that surprising. Even on nonterminal floors overnight supervision could be notoriously lax, and patients were occasionally found dead in bed having obviously died hours before. Sometimes it got so bad that residents referred to morning rounds as a body search. He nevertheless thanked Thomas for the information, touched by his concern, and headed downstairs to the pathology department.
He approached the autopsy suite and pushed through a door marked ABSOLUTELY NO ADMITTANCE. The thin, high-pitched whine of a rotary bone saw set his back teeth on edge, and Len Gardner, a man of medium build even when swathed in full protective gear, looked up as the steel blade bit into one of Elizabeth Matthews's ribs. He'd already made a sweeping Y cut of her overlying skin, having sliced it open with a scalpel from beneath her collarbones down the sternum and all the way to her pubis.
"Hi, Earl," he greeted him, as casually as if they were meeting to have lunch. "I thought I'd better do this one myself."
At St. Paul's Len had a reputation as the man who would not be chief. One of the most gifted pathologists in Buffalo, yet having no time for the political niceties that accompanied such appointments, he'd steadfastly refused the honor of heading his department. He also, more than anyone, knew all the dirty secrets about who got it wrong when it came to diagnostic and therapeutic mistakes at St. Paul's. Since Len made it his personal mission to bluntly confront doctors with their errors, Earl suspected he went out of his way to remain unpopular as added insurance against ever getting stuck with an administrative title. Maybe he should have taken Len for a role model. "Thanks. I'm glad you're here," Earl told him, and meant it. Above all, Len would be scrupulously honest.
"My pleasure." He went to work on another rib.
Earl leaned back against the counter where a row of open Tupperware containers half filled with formaldehyde stood ready to receive Elizabeth's major organs. The fumes wafted up his nose, then tingled the back of his throat despite the double mask and a noisy overhead hood designed to suck out such noxious odors. Farther along, racks of test tubes, each one aligned at attention, awaited the more fluid specimens: blood, urine, stomach contents, even her cerebrospinal fluid, the liquid that bathed the brain. These Len would send to the biochemistry lab for a determination of their morphine levels.
Earl turned back to the body and studied Elizabeth Matthews's face. Under the glare of the overhead surgical lamp, it resembled a shiny wax likeness, not flesh at all. He wished he could say she finally looked peaceful, but her features remained taut, accenting the bones beneath, and her mouth, pulled into a grimace, seemed about to emit that thin, piercing cry he couldn't get out of his head.
2:30 p.m.
The nausea hit without warning.
Ripping off her mask, Jane barely made it to the toilet before her stomach muscles started to undulate like a belly dancer's. Her entire lunch hurled into the porcelain bowl as if shot from a fire hose.
She nearly fainted from the force of it, and had to support herself with both hands on the tank.
Then she felt fine.
What the hell? she thought, and waited a few more minutes to be sure.
As she stood there swaying, a crazy, impossible notion crossed her mind.
No, it must have been the tuna salad they'd served in the cafeteria.
She quickly flushed the evidence and returned to the nursing station.
3:35 p.m.
ICU at St. Paul's and casinos had a lot in common, Earl had once joked. Both had no windows, making it impossible to tell night from day. Both had luminescent screens that beeped and flashed fluorescent numbers for winners and losers 24/7. And with both, all results were final.
Carrying a beige folder stuffed with papers, he walked the length of the dimly lit room, past curtained-off cubicles where bags of IV medication and banks of machines kept the hospital's sickest patients from shuffling off this mortal coil. At least that's how it seemed when Stewart ran the show. With his skills he could blur the lines between life and death more than any other intensivist on staff. A few people clucked their tongues and accused him of playing God, but not many. And most of them wouldn't have anyone else if their time to be a guest here turned up.
Earl had recognized Stewart's passion for critical care when they had been residents together at New York City Hospital. Back then Stewart's determination to combine clinical research with practical training showed in his choice of electives. He spent them with a fledgling group of physician-scientists dedicated to evaluating what treatment protocols worked best for an array of life-threatening conditions in ICU. After completing his specialty requirements, he accepted a faculty position at both the hospital and university, eventually becoming director of that same group, only to abandon them a few years later in 1989.
Out of the blue he'd called Earl and asked if there were any openings at St. Paul's. Aware of Stewart's impressive publication record, and having received a stack of sterling recommendations for him from NYCH, Earl pitched him to the credentials committee at St. Paul's. They immediately snapped him up.
But Earl had never fully understood why a man with such a narcissistic appetite to be recognized for his genius would make the jump from the Big Apple to a place like Buffalo.
"Pollution," Stewart had told him at the time.
Earl approached a row of four brightly lit glass chambers that stood along the end wall and instinctively grew wary. They were negative-pressure isolation units, designed to house patients with serious airborne infections. Any time the door opened, air rushed in, the idea being to prevent deadly microbes from floating back into the rest of the hospital where staff and patients could inhale them into their lungs. Up until three months ago, the rooms almost always had a vacancy. Today, every bed held a SARS victim.
He drew closer.
Through the window of the nearest compartment he watched a team of green-clad figures wearing both goggles and full plastic visors. They worked feverishly on a muscular, ebony-skinned man who had fought similar battles shoulder to shoulder with Earl in ER but now struggled for his own life. Teddy Burns had been a respiratory technician at St. Paul's for over twenty years. Just weeks ago the two had joked how neither of them was getting enough sleep, and they'd shared bragging rights over who had the bigger circles under his eyes.
"Too damn proud to let the ship sink- that's us in a nutshell," Teddy had said with a wink, and rushed off.
Now those same dark, deep-set eyes desperately searched the masked faces who towered above him. Teddy's chest heaved as he bucked the tube his rescuers had inserted down his throat to hook him up on a respirator. His gaze found Earl's, and the creases in his face furrowed, angrily funneling in on the outrage that protruded from his mouth, as if ending up like one of his past patients meant the ultimate indignity.
Earl shuddered and placed the palm of his gloved hand against the pane separating them, hoping that Teddy would see it as a gesture of wishing him well.
But Teddy looked away instead, seemingly in disgust that such niceties would be offered in the midst of his agony.
Stewart Deloram, recognizable from the others by black eyebrows that were equally as unruly as his hair and which no protective gear could hide, expertly inserted a clear plastic tube between Teddy's left ribs.
It instantly filled with a foamy, pink fluid.
Kir royale, Earl thought, remembering Teddy's own unique turn of phrase to describe bloody pleural exudates when he taught medical students. Its presence meant the virus had attacked the lining of his lungs.
And a quick glance at his biochemistry results posted on the windows told Earl the infection had also damaged his liver, kidney, and muscle tissue.
Multisystem failure.
The faces of two teenage sons whom Teddy had so proudly brought to work from time to time flashed to mind, and Earl's stomach gave a sickening lurch.
Stewart emerged minutes later, having discarded his outer layer of contaminated gear just inside the airtight door, then immediately double-gowned, double-gloved, and masked himself again, including shoe and hair covers.
So many steps, so easy to miss one, Earl thought.
After nurses and doctors in Toronto started getting infected, mostly in ER and ICU despite wearing full protective gear, he and Stewart had sat side by side in each other's units, trying to figure out what extra precautions might prevent the same thing from happening at St. Paul's.
"You look like a pair of Georgia crackers sittin' on the veranda," Thomas had teased them, exaggerating his southern drawl.
Earl had laughed, then fired back, "And I suppose guys from Tennessee never pulled up a couple of chairs on a porch?"
"Ah, but we call them deep thinkers."
"Well, sit yourself down, Mr. Deep Thinker, and help us out."
Within fifteen minutes the three of them had identified a half dozen obvious breeches, from masks being improperly tied to people scratching their heads or raising their goggles and rubbing their eyes. Around infected patients during airway procedures- the spray zone, they called it- one cough and the virus could land on hair, eyewear, shoes, anywhere. If staff took off their gloves first before removing head and footwear, or if they retied a lace before taking off their gloves and then went home and pulled off their shoes, or did any of a number of variations of the same scenario, the SARS virus could end up on their fingers.
"Then it's pick your nose and die," Thomas had drawled, driving the point home to anyone who disputed the possibility. The phrase became their watchword in a campaign to heighten people's vigilance against contaminating themselves.
Teddy Burns had been the latest proof that they hadn't done enough.
"What are his chances?" Earl asked when Stewart finished changing.
The weariness in Stewart's gaze trebled. "I don't know." He pulled Teddy's chart from a wall slot beside the test result sheets and flipped to the progress notes. "Did you hear the latest rumors out of the CDC?" he asked while scribbling a few lines to describe what he'd done. "That intensive care and emergency staff will have to wear Stryker suits all the time?"
Earl's heart sank. Critical care workers across North America had been dreading it might come to that.
Stewart was referring to the outfits with self-contained oxygen supplies that personnel in level four virology labs or investigators at the hot zone site of a virulent outbreak would wear. "Space suits," the residents called them. The thought of ending up in one as a part of the new normal for ER left Earl feeling defeated. Gloves and masks created barriers that were distancing enough, but at least he could still speak to those under his care, allay their fears with the sound of his true voice. But to confront already frightened patients while dressed like something out of a science fiction movie and talk to them with the muffled tones of a voice coming through a completely enclosed hood- that tore it, stripped the final human touches from the profession he loved. People like Teddy Burns would die in total isolation, barely able to see, feel, or hear the ones taking care of them.
Earl hesitated, not sure this would be the best time to bring up his own problem.
"Out with it, Earl," Stewart said, but didn't look up. "What do you want?"
"I need a favor about the Matthews case."
Stewart's pen stopped in midstroke. "Oh?"
"Yeah. I just came from her post. The gross showed tumor as expected and no surprises." He handed over the folder. "These are the morphine levels found in her blood, and the resuscitation team's observations, including an estimated time of death. The rest are lab reports, nursing notes, the times of the injections and the doses. Plus her height and weight."
"So?"
"I want you to calculate backward and figure out the dose she must have received before she died." Complex formulas existed in obscure pharmacology references involving the metabolic breakdown rate and body dispersion quotients for just about every drug in the world. They made the exercise possible, and Stewart read that kind of thing as light reading.
"Wait a minute. You figure someone gave her more than what you prescribed?"
"In a word, yeah."
His eyes narrowed, suspicion displacing fatigue. "Why are you asking me to figure it out? You could do it yourself."
"And Wyatt would immediately demand an independent opinion. He's lit a fire under pathology to have the slides ready early next week, plus scheduled death rounds for the day after. In other words, he's hot to nail me. I need you in my corner on this."
Stewart continued to scrutinize Earl, his brow unfurling slightly. "Yes, of course. I'd be glad to help you out. But who do you suspect screwed up? I've pissed off too many people at St. Paul's already not to check out whom I'll offend this time."
Earl told him his theory about the nurses and the double dose.
Stewart's forehead relaxed the rest of the way. "Count on me."
Evidently Yablonsky and company weren't on his don't-mess-with list.
"But what if I don't get the results you expect?" he asked.
"Then I'm probably screwed." Earl got up to leave, then added, "Oh, by the way, I heard about some other peculiar goings-on up there that I've been meaning to ask you about."
The frown returned.
"Wyatt told me some patients have been complaining they'd had near-death experiences, and when his nurses asked you to look into it-"
"That was bogus!"
"Bogus?"
A flush spread over Stewart's face from under his mask. "Yes. The ones I talked to no more had a near-death experience than you or I."
"I don't understand."
"I told Wyatt it probably resulted from all the media reports my work has generated. The power of suggestion, combined with all those drugs they're on, can make for some pretty potent dreams."
"But Wyatt said that after interviewing some of the patients you accused him of trying to set you up."
His color deepened. "Well, that's not exactly true…"
"And according to the nurses, you stormed off the ward mad as hell."
"Mad? Not at all. Annoyed, maybe, that they'd wasted my time, making me check out crap reports."
Earl's curiosity grew. Stewart never minimized a slight or perceived wrong, yet here he seemed intent on portraying whatever happened up there as inconsequential. "Explain crap."
"The accounts were made up. Trust me, I've analyzed enough true experiences to know the components common to the real thing. These just weren't authentic."
For a man who always had at least ten reasons to support an opinion, and in any discussion would usually machine-gun Earl with them, "Trust me" sounded positively evasive. "Look, I'm not blaming you for anything, Stewart. It's just if you found something screwy going on in Wyatt's department, I want to know about it."
Stewart's ears became glowing red half shells. He took a breath, then exhaled slowly, practicing one of the many self-control techniques Earl knew he'd tried to learn over the years. "Okay, I first got a little steamed and figured Wyatt and the nurses had primed their patients to try to dupe me into believing a bunch of trumped-up accounts."
"Dupe you? Why the hell would they want to do that?"
The pupils of his eyes flared wide with anger. "To discredit me and my work." He leaned forward, continuing to speak with a hushed urgency that Earl found uncomfortable. "You see, if I fell for it and incorporated those stories as part of my research cases, then they could expose what happened, and it'd be ammo for all those who say my publications aren't real science."
Lord help him. "Stewart, for what conceivable reason would Wyatt and a floor full of palliative care nurses even want to do such a thing, let alone go to all that trouble? And how do you figure they got the patients to cooperate?"
Stewart took another protracted breath. "Well, I had to admit afterward that that part didn't make sense."
Thank God, Earl thought, grateful to see that a flicker of reason had once again prevailed, however barely.
A layperson might label Stewart paranoid. Earl knew better. He read him as someone bright enough to scan twelve steps ahead of everybody else and see possible scenarios that might mean very real trouble. A great asset in ICU, but a little hard to take in everyday life. What distinguished him from a truly crazy person? He could admit later, although it took a little encouragement, that perhaps his predictions, when they were based on his social exchanges with people, weren't all that probable. Stewart appeared to have once more cleared that hurdle as far as Wyatt was concerned, but Earl still sensed that he was holding something back. "You haven't explained why you thought the accounts were bogus," he said, trying not to sound confrontational.
The flush receded. "I just knew, that's all. Pattern recognition. Hey, some things aren't quantifiable."
Bullshit! Stewart could and would quantify anything remotely to do with his research, including how to recognize bogus data. But in an attempt to render him less defensive, not more, Earl nodded and took another tack. "So you don't think Wyatt is up to anything. Believe me, it might help my situation if I had something on the guy."
Stewart immediately relaxed. He sank back in his chair, his high color returning the rest of the way toward normal, and cocked a bushy eyebrow as if Earl were the crazy one now. "I meant only that the idea of Wyatt recruiting patients and nurses to discredit me didn't make sense. But don't think he wouldn't sabotage another researcher's work, even outside his field. That hothead's so bitter about losing the limelight, he can't stand to see anybody else step into it." Stewart raised his head a little, as if posing for a profile shot. "Especially when that person is as controversial as I am."
4:00 p.m.
All researchers were crazy.
Every one of them secretly believed that his or her work in whatever little corner of the scientific world, however obscure, deserved a Nobel prize. Lifelong feuds, suits, countersuits, allegations of plagiarism, fraud, and the theft of data, suicides, murders- all committed over impugned reputations. The high drama of behind-the-scenes passions remained legend, and this in a profession supposedly dedicated to the cool practice of objective reason.
And Stewart carried that fire in spades, Earl thought, steaming into the elevator. He just wished he could keep St. Paul's free of it.
Some VP, medicals, he knew, spent half their workweek pulling prima donnas from each other's throat. Stewart's wacky story hadn't made sense, but if it had even a speck of truth to it, he'd better check it out and nip in the bud whatever was developing between Stewart and Wyatt. One thing was for certain- Stewart had been hiding something. Earl felt that in his bones.
The ride to the eighth floor took five minutes this time. Small groups of masked patients dressed in robes and pushing their portable IV stands tottered off at each stop, insisting loudly to each other that they should file a complaint about all the waiting they'd had to do in physio that afternoon. He thought nothing of it until he remembered that part of his new position meant he'd be the one who would ultimately answer to them.
Monica Yablonsky stiffened as he approached her desk, and she started to fidget with her glasses again.
"Mrs. Yablonsky, I want to see that list you were to prepare for me, the one Dr. Deloram used when he came here to interview patients who'd reported-"
"I know the one you mean, Dr. Garnet." She drew herself into a parade square stance, erect, as if ready for inspection. "Except I'm afraid it won't do you much good."
"Why?"
Her eyes avoided his. "There were only five names to begin with."
"Then I'll talk to those five."
"But you can't."
"And why not?"
"Three of them already died. The other two are comatose."
4:25 p.m.
Medical Records hadn't picked up the files of the deceased to store them in the archives yet, so he'd looked at them on the spot.
Two of the dead had been DNRs, not expected to survive much longer. The third had rallied last week and had been slated to go home for a few days. A code had been called for her. None of the clinical notes for any of them indicated a thing out of the ordinary in their deaths, except that all three had been discovered pulseless and not breathing just before dawn.
As for the two people in a coma, it took little more than a cursory glance at their recent lab results to see they'd been in bad shape to begin with, both having started the slide toward metabolic meltdown that often accompanies cancer patients in decline. Nobody found it unusual that they couldn't be roused as the nurses passed out breakfast trays that morning.
He returned the dossiers to Yablonsky's care without comment. She'd hovered about him as he'd glanced through them, appearing as uneasy about him going over the five cases as she had with his questioning her about Elizabeth Matthews's death. Let her sweat, he thought, figuring it might trip her up if she had something to hide. Because if his instincts and math were right, somebody sure did.
"The nurses who reported the near-death experiences- I'd like a list of their names," he told her.
She swallowed. "That might take a few days."
"I want it in twenty-four hours."
He rode to the ground floor at the back of the elevator, scowling. No physician liked coincidences, especially when it came to explaining matters of life and death. People died when and where they did for specific reasons. Failure to know those reasons meant he'd missed something until proven otherwise. Yet here he had five patients able to talk with Stewart Deloram on Friday who were unable to talk to anyone by Monday.
Unusual? Maybe not, he tried to tell himself, all at once following a talent he'd honed to a fine edge over the years: to play devil's advocate with his instincts. People died every day on a terminal ward. And those expected to pass on soon might have slipped into comas last night. Certainly the outcome for any of the five patients in question, taken individually, wouldn't raise suspicions. Natural causes could explain each one. Hell, if he tried to make a case otherwise, Wyatt could accuse him of dreaming up conspiracy theories to divert attention away from the Matthews inquiry. Still…
He went directly to his office and sat down at his computer. Using his newfound powers as VP, medical, he entered the codes that let him access the records of all departments. He pulled up Palliative Care, intending to see how many other people had died up there overnight and whether the three deaths were part of a larger than usual number. Not that that would mean much in itself. Some days were simply bloodier than others. Nevertheless, it would be interesting to know.
As a quick way to find out, he looked up discharges for Palliative Care this morning. There were six.
Was that a lot? He had no idea. He clicked up the average number for other mornings over the last few months and got 2.7.
"So there were three-point-four more bodies than usual," he muttered, impatient with how absurd statistics could seem at times. He also bet there were other days when the count would be just as high, and sure enough, when he requested a tally, he found that at least a dozen times in the last twelve weeks the morning dead had numbered six or more.
Yet three deaths and two patients slipping into a coma continued to disturb him because of the odds.
If he'd done the multiplication right, out of the hundred patients in palliative care, the chances that this would happen to the five Stewart talked to, all other things being equal, were one in nine trillion.
Which meant someone must have had a hand in their outcome.
But of course all things were never equal with a ward full of cancer patients. These five might have been closer to death than Wyatt thought, and maybe Stewart, in his perpetual readiness to take affront, had been wrong about their near-death accounts being bogus. They could have actually experienced what they reported because each of them really was about to die, and their deterioration was only nature taking its course.
In terms of probability that made far more sense than scenarios suggesting foul Play-He began to feel sheepish about his initial reaction. Perhaps he'd let his imagination get the better of him. Having arrived on the floor convinced that Stewart had been hiding something, and unclear what Wyatt might be up to, if anything, he'd failed to coolly consider all the possibilities. What a dumb-ass medical-student move. He didn't usually jump to conclusions like that. Of course, his already being suspicious of Yablonsky didn't help matters any, having primed him to think the worst.
But he damn well would insist that Stewart level with him about what exactly he'd thought was bogus when he talked with the five patients. And if even a hint turned up that Wyatt had tried to undermine Stewart's or any other researcher's credibility, he'd nail his hide. Whoa, there he went, leaping ahead of himself again. Better yank his urge to be in everybody's business back under control. Otherwise there'd be no end to the nastiness he might find. He'd taken the position of VP, medical to make his job of running ER easier, not to replace it with chasing down hospital shenanigans full-time.
He sat in the stillness of his office and felt the place weigh on him. Eight hundred beds, eight hundred souls, and if he weren't careful, every one of them would land a problem in his lap. And to think that just two days ago Jimmy had accused him of being too little involved with the rest of St. Paul's. Earl wondered if the real danger wasn't that he might get too entangled and be sucked dry. Because when he sensed something wrong, he couldn't let it slide.
But it was one thing to let the workings of an ER consume him. The tenacity that drove him not to quit on a patient took hold when trouble hit. His reflex as an ER physician was to leap on a problem the way he would a bleeder, well before it got out of hand. Yet he took the challenges in stride and inevitably, one way or another, found solutions. It all happened on a scale that never threatened to overpower him.
He leaned back in his chair and regarded the spartan furnishings- a steel-gray standard hospital-issue desk, two simple chrome chairs covered in black Naugahyde for visitors, a solitary potted plant that somehow survived the closed space and poor light from a grime-coated window the size of a cafeteria tray- and chuckled. The hospital CEO had offered him surroundings "much more suitable" to his new position, but he'd declined the upgrade, having always found it an advantage to demand sacrifice and best efforts from people if he himself worked out of an austere setting. The trick now would be to keep his perception of what needed fixing just as free of clutter.
He'd have to compartmentalize like never before, carefully choose his causes, and forget about charging off on wild hunches.
Keep everything at scale.
As for Yablonsky, well, he'd deal with her at death rounds.
Except something about her bothered him. She had definitely been edgy as he looked through those five files. Of course, just being around him could make her nervous, especially if his double-dose theory regarding Matthews was true. Yet..
Another event niggled at him- her reaction to the word cluster the evening before Matthews's death.
In a medical context doctors used it frequently, referring to a grouping of any unusual incidents or diseases, even symptoms and signs. So it had an unpleasant connotation to begin with, but not one that should have upset an experienced nurse. Unless…
He knew one context in which the term cluster carried a resonance that gave him a chill.
He dialed the nursing station and asked for Dr. Biggs. "Hello, Thomas. I wonder if you could go to our teaching files and dig out an article for me. It's one of the epidemiologic chestnuts on CPR in the New England Journal that I present to the residents every year, so you'll probably remember it." A lot of nurses would too, including Monica Yablonsky. The nursing director had asked him to give sessions about it with her staff on several occasions.
"Sure. What's the title?"
" 'Mysterious Clusters of Deaths in Hospitals.'"
Earl hung up and returned to checking discharge statistics for palliative care, going a lot farther back than three months.
Jane Simmons bought the kit at a pharmacy far from her apartment where no one knew her. She needn't have gone to the trouble. The salesgirl didn't so much as look up during the purchase.
In the privacy of her bathroom, she applied the drop of urine and waited.
In one minute she'd know.
Reruns of the last six weeks tumbled through her mind.
She'd missed before. Rather, it had come late a few times, by as much as two weeks. She'd assumed that this time she'd skipped a cycle altogether but that her period would arrive any day now. She'd been so careful to use the foam with her diaphragm and insist he wear a condom. It never occurred to her that they could have messed up. "The problem arrives when you forget," Dr. Graceton had reassured her in recommending the switch after the damn pill kept causing nausea, even after many tries on different types and dosages.
But there had been times in the middle of the night when she woke with him entering her again. God help her, she loved yielding to him in that half-asleep state. Even then she remained aware enough to feel he'd put on protection, and the diaphragm would still be in place from when they'd made love hours earlier, then fallen asleep in each other's arms.
The trouble was she hadn't added more foam.
Thirty seconds.
She looked out the open door at the rest of her apartment. It didn't seem so bright anymore. The paintings she'd chosen for color rather than any specific artist looked drab and cheap, every bit the pathetic imitations they were. Strange how baubles meant to comfort lost their luster when real trouble hit.
Ten seconds.
She felt so stupid sitting there on the tile floor, her future in the hands of a reagent to detect the chemistry of an embryo implanted in her womb. It would be six weeks old now, little more than a ball of cells, but the tissue already beginning to differentiate into what would become brain, heart, and skin. She hugged her knees and began to rock slightly, the way she had as a little girl whenever something worried her.
Such little problems then: homework, what boy would or wouldn't talk to her, exams. Even her worries an hour ago now seemed insignificant: paying bills, what groceries to get. All little stuff. Her only big concern had been what would happen to Dr. G. That still mattered.
Shit, what would he think of her now? And Dr. Graceton. She'd been so kind, taking her on as a new patient- doubtless because Dr. G. had spoken to her.
Or her mother. She'd been ecstatically proud to have a daughter who would be the first woman in the family to have a profession, as opposed to her own lifetime of waiting on tables at the local Denny's, double shifts galore after Dad died.
Now this.
And how would Arliss, her little brother, take it? They'd planned to escape Grand Forks together. First she'd get out through nursing, then he'd follow, and she'd help with the money for his college tuition. He'd been crazy about animals since they got their first puppy, and he dreamed of becoming a vet. If she stopped work, his future crashed as well.
And most of all, what would Thomas think?
Or would she tell anyone? She could just get rid of it privately, with no one she cared about the wiser.
She stared at the indicator dot.
It turned blue as a newborn's eyes.