Critical Judgment (1996) (22 page)

Abby wasn’t certain, but it seemed to her that the woman’s bravado was forced and unnatural, and her response, including bringing along Harvey, was well out of proportion to the offense. Was she as angry and dismayed as she seemed, or was she frightened of something?

“Mrs. Ricci,” Abby said, “I still don’t understand. Exactly what rule is it that I’m violating?”

“There is an express hospital policy against any sort of chart review without written permission from the medical-records committee. It’s in the hospital bylaws,
which you were supposed to have read when you accepted a position on the staff.”

Abby had never heard of a hospital law prohibiting physicians from conducting a chart review without someone’s written permission. But, clearly, the records librarian was in no mood for a discussion.

“Well, could you at least tell me who the chairman of the records committee is?”

“Dr. Martin Bartholomew has been in charge for years.”

Inwardly, Abby groaned.
Another confrontation with Bartholomew
. Just what she needed. Well, the showdown wasn’t going to happen tonight. For the moment she had seen about as much of Patience Regional Hospital as she cared to.

“Sorry,” she said to Donna Tracy, who looked pale and shaken.

She picked up her briefcase and turned toward the door. Harvey, arms folded, puffed himself up like a eunuch at a harem-tent doorway, barring her return into the room. Suddenly, Abby turned back.

“Mrs. Ricci,” she said, “I just want you to know that Donna did not want me looking at any charts. She tried to explain the rules, and I just pooh-poohed them.”

“Well, she should have been more forceful.”

“That’s not so easy when you’re young and working in a hospital, and a physician orders you to do something.”

“That may be so. But it remains to be seen whether or not it is an acceptable excuse. I don’t know what it is with you ER doctors.”

“What do you mean?”

“I’ve been here for twelve years. The policy regarding chart reviews has been in place all that time, and you’re only the second doctor to violate it. But the other one was an emergency doctor, too.”

“Who?” Abby asked, trying to seem casual about the
question while doing her best to match the woman’s glare.

“It was Dr. Brooks,” Joanne Ricci said. “David Brooks. I don’t know what, if anything, the records committee decided to do to him, but they insisted that I fire the girl who let him stay down here.”

A
bby drove the Mazda home and then spent half an hour vacuuming out the glass. She felt tired, bewildered, and angry. It was as if she had done nothing more than buy a ticket to a play and suddenly found herself the protagonist … and the villain.

Leaving Patience was occupying more and more of her thoughts. In the morning, she decided, she would call her old boss at St. John’s. If he had a position for her, well … she would be very tempted to take it. Cadmium poisoning, mental breakdown, or whatever—Josh’s strange, threatening note had been very unsettling. She had done her best to get him diagnosed and treated. But from what she could tell, he was more irrational and uncooperative than ever. Where did her responsibility to him end?

Thanks to his last visit, there was no beer in the refrigerator. She settled instead for some iced tea and what remained of a box of vanilla fingers. She took a framed photograph of her and Josh from the counter and set it on the table. They had been hiking up Mt. Tamalpais in Marin County, ten miles northwest of San Francisco. Josh had wedged his Nikon on a tree branch and taken the snapshot using the automatic timer. The
resulting inadvertent tilt of the frame had turned a pleasant shot into art. Abby closed her eyes and relived the warmth and even the scents of that perfect autumn day. But the emotions—the incredible feelings of connection, of closeness—were harder to capture.

On an impulse she brought out the regional phone book. Josh had rented from people named Sawicki, Quinn had said. There couldn’t be too many of those in the book. Perhaps there had been some developments with the neurologist, she thought. Perhaps Josh was just too embarrassed by his recent behavior to call—or too pigheaded.

She was about to look up the name when her pager went off. The number that appeared on the liquid display was one she didn’t recognize.
There are no coincidences
, she thought. She dialed, expecting to hear Josh. But it was Lew Alvarez who answered on the first ring.

“Abby, I’m really glad I caught up with you. Where are you calling from—the hospital?”

“Home. I guess you heard about today.”

“I knew there was a multiple-injury accident of some sort when they tried to get me to come in. But when I called later in the day, they said everything was under control. I heard that Gary Wheaton’s wife got killed. I feel awful for you about that. I’m just calling to find out exactly what happened and if you’re okay.”

“What happened depends on who you talk to. And I’m okay, but I’ve certainly been better.”

“Tell me about it.”

Abby glanced through the empty dining room into the empty living room. As tired as she was, spending the rest of the evening alone had no appeal. It wasn’t sex she was after, but somehow the timing of Lew’s call, just when she was about to give in and try to reconnect with Josh,
had
to mean something.

“Are you busy right now?” she suddenly heard herself ask.

“Not really. My shift at the state hospital was only
twelve hours, and not a bad twelve hours at that. I was going to do some reading and then call it a night.”

“Well, would you like to get together? I have a great deal to tell you about.”

Lew’s hesitation, although brief, made her uncomfortable. He
had
to be involved with someone. That must be it. And the woman was probably sitting right there.

“The night is very clear,” he said, “and the view from the meadow up here is spectacular. If you’d like to come up, I’d be very happy to see you.”

Abby set the Tamalpais photo on the table, facedown.

“Is twenty minutes too soon?”

“I’m not a bit surprised by all this,” Lew said, after Abby had reviewed the events in the ER and her subsequent meeting with Oleander, Henderson, McCabe, and Terry Cox, the attorney. “I doubt anyone who matters in Patience even knew this Willie Cardoza existed before today. And if they did, I doubt they thought much of him. Even before I began making enemies around here by siding with Dave Brooks, I was treated like an outsider. At the time they hired me, they were in pretty desperate need of good help in the ER—desperate enough to overlook my being Hispanic. But I was certainly never invited to belong to the country club.”

Abby thought about the country-dub feelers she had already received from both Oleander and Lyle Quinn.

“I think you should be proud of that,” she said.

They were on a weathered wooden-slatted swing, placed atop a knoll in the meadow beyond Lew’s house. The night was intensely clear and just chilly enough to warrant the frayed quilt he had carried up. In less than an hour Abby had counted half a dozen shooting stars. But although Lew was certainly warm toward her, as understanding and supportive as she could wish, he had not responded at all to the romantic setting. He sat well
to his side of the swing, absorbed in her story, but hardly lost in her eyes.

“How was Cardoza when you left?” he asked.

“Well, let’s see. He’d been charged with murder and was under police guard, plus being cared for by a staff that would have been much happier if he had died. Other than that, I would say he was doing okay.”

“There’s a prison hospital at Las Rosas. He’ll probably be moved there soon—maybe even tomorrow.”

“Not
that
soon.”

“Don’t be surprised if it happens. The hospital there is not that bad. They even have an ICU and a couple of ORs. And the last thing Patience wants is a crazed killer lolling around its hospital’s ICU.”

“Well, then, there’s another big part of the story I think you should know about.”

Abby began with the bizarre ocular findings on Willie, followed by the meeting with Colette Simmons in the hospital parking lot.

“So you think these rings in this man’s eyes might be a manifestation of cadmium poisoning?” Lew asked, clearly intrigued.

“It’s possible.”

“Needless to say, I’ve read a great deal on the subject. Why haven’t I ever run into anything like this?”

“I’m not sure anything’s been published describing it. The two thoughts I had were, first, that the rings need a black light to be seen, and maybe no one with cadmium poisoning has ever been examined that way before.”

“Possibly.”

“And, second, maybe the amount of cadmium exposure in Willie’s case is exceedingly high. Most of what I’ve read describes the effects of a low-dose, cumulative exposure over a long period of time. Perhaps the ocular rings come from a one-time, or short-term, high-dose exposure.”

“A single spill. An accident of some sort.”

“Air or water.”

“Abby, we’ve got to test him, and soon.”

“I’d already decided he should have blood sent for a cadmium level at some point, but until you told me about the prison hospital, I didn’t think there was any rush.”

“There is.”

Abby wanted to share everything with him, to tell him about her odd experience with Joanne Ricci in the record room and the visit from Lyle Quinn and subsequent tour of Colstar with Kelly Franklin. But could she do that without firmly committing herself to the Alliance? She was in a very shaky position at PRH. Openly joining the Alliance would almost certainly put her on the unemployment line.

She wasn’t certain anymore how she felt about helping Josh get to the bottom of his problem. But losing her job at the hospital would effectively relieve her of the chance to decide, as well as the opportunity to determine whether her efforts on Willie Cardoza had saved the life of a man who should not be held responsible for what he had done. Joining the Alliance now, she reasoned, would cause her more problems than it would solve. Besides, the truth was, the only objective finding they had was the rings in Willie’s eyes. Everything else was still speculation.

“Lew, I just don’t know about ordering any tests on Willie,” she said. “I got into trouble with George this morning for ordering cadmium levels on three of his patients.”

“You did that?”

“I … I thought there were good indications.”

She could tell he was thrilled with the news.

“I knew you were impressed by what you learned at the meeting. I could tell. The tests were done at the hospital?”

“Yes.”

“Then I assume they were negative.”

“Lew, I need to think about this. Willie is Martin Bartholomew’s patient. He and George are like this.” She crossed two fingers. “If George finds out I had anything to do with sending off more blood tests for cadmium, I’m finished.”

“That’s the point, Abby. We don’t order any tests.”

The excitement blazing in his dark eyes made him that much more appealing to her.

“I don’t understand,” she said.

“We draw the blood ourselves. Right now. You said at the meeting you had a friend who was a toxicologist at St. John’s.”

“Sandy Stuart. She’s the best.”

“We just get the blood to her for testing.”

“And what if it’s positive?”

“We use the result as a lever to pry some cooperation from OSHA and the EPA. They go to wherever Willie Cardoza is and draw the blood themselves for retesting, and just like that, we’ve got a foothold.”

“And what if it’s negative?”

“Then I back off, and you don’t hear another word from the Alliance. But it’s not going to be negative. I know it in my bones. Oh, Abby, we’ve worked so damn hard for this breakthrough. We need your help right now. We need it so much.”

Before Abby even realized what she was doing, she had reached across to him. He took her hands, then gently drew her toward him. His kiss was tentative at first, asking.

I don’t know, Lew
, her mind cried out.
I don’t know what in the hell I’m doing.… But, please, don’t stop
.

She cupped his face in her hands and brought his lips against hers. His arms tightened around her. His lips parted as the uncertainty in his kiss vanished.

“I’ve wanted to hold you and kiss you like this since the day we met,” he said. “I just … didn’t know your situation. I didn’t want to do anything wrong.”

She tucked her legs beneath her and rested her head
against his chest. Across the valley a shooting star held on for longer than any of the others.

“The only thing you could do wrong at this moment,” she whispered, “is to let go of me.”

They arrived at the hospital separately and parked in different lots. He would enter first and go to the ICU through the ER, stopping only to pick up the ophthalmologic black light. His excuse for being in the ICU would be to visit a coronary patient he had admitted the day before. She would enter through the ER five minutes later and immediately cut over to the laboratory. There she would pick up two large blood-collection tubes with anticoagulant and a large syringe.

Abby drove to the hospital listening to Van Morrison and thinking about what it had been like to be kissed and touched for the first time in over two years by a man other than Josh Wyler. Josh’s kisses were always an urgent prelude to making love. Lew seemed satisfied just to be close to her—to have her respond to him. His touch was searching and sensual, but also tender and even protective. Had he moved toward making love with her, she probably would have declined. But she sensed that no matter how much he wanted her, he would not say anything until she had made it clear the time was right. For the moment, at least, she felt schoolgirl giddy, on the threshold of learning what this man was all about.

“More stuff for Old Man Ives?”

The twenty-year-old lab tech startled Abby as she was slipping a thirty-cc syringe and three collection tubes into her clinic-coat pocket.

“Oh, hi, Grace. That’s right. His leg is improving every day. I appreciate everyone looking the other way when I make my raids. Ives appreciates it, too. How’re
you
doing?”