Dead Certain (14 page)

“So when did you bring it up again with McDermott? „

“The next time McDermott and I had words, Mrs. Estrada was already dead. She coded around four o’clock this afternoon. She’d already been moved out of recovery into a regular room. The floor nurse went in to check her vitals and found her in full arrest.”

“Were you there?”

“No, I was busy checking your Mr. Delius out of CCU. But as soon as I got the page, I was out of there like a bat on speed. Not that it made any difference. By the time I got to her room, there was nothing left for me to do except pronounce her and break the news to the family.”

“How did they take it?”

“About as well as can be expected, which is to say pretty terrible. The husband kept on asking me how something like this could have happened, and I didn’t have any answers for him.”

“Was her death like the others?”

“You mean the other postsurgical deaths? Only in that I have no more idea of what caused it than anyone has about any of the others.”

“What did McDermott have to say?”

“Oh, McDermott said plenty,” replied Claudia, barely suppressing a shudder. “They had to page him at his office at Northwestern, and he was still ballistic by the time he got to Prescott Memorial. I was in the hall talking to one of the nurses on the floor where it happened, and he just shot out of the elevator and tore into me. We actually drew a crowd. Patients even came out of their rooms to see what was going on. I have never felt so humiliated in my entire life.”

Having been on the receiving end of more than one unfair tirade, I knew just how devastating they could be. “Did he say anything of substance?”

“You mean besides the fact that he thought I was incompetent and incapable of performing even the most basic procedure without him holding my hand?” she reported, the lash of the chief of surgery’s words still fresh. “I guess you could say that he did. He told me that if he had anything to say about it, I could consider my career over.”

“You know he didn’t mean that.”

“Oh, please, I haven’t even told you the worst part.“

“Which is?”

“Mrs. Estrada’s husband overheard the whole thing. He was still in her room collecting her things. He heard every single word.”

“Did you talk to him?”

“I tried, but he said that under the circumstances he thought it best if all our communications went through our lawyers.”

“But won’t the autopsy show what killed her?” I asked, wanting desperately to reassure her.

“Normally when a patient dies in the hospital after surgery, they don’t do a post. They just assume that the death was caused by whatever underlying disease prompted the surgery.”

“But I thought you said you couldn’t feel any gallstones.”

“I couldn’t, but there’s no question her appendix was inflamed, and I performed an appendectomy. Under those circumstances you’d expect McDermott to sign the death certificate, no questions asked.”

“Will he?”

“Not now. Mrs. Estrada’s family has requested an autopsy.”

“Well then, it’s out of your hands. Now it’s up to the medical examiner to find the answers.”

“The medical examiner isn’t going to be doing the autopsy. I’m sure they’ve hired an independent forensic pathologist.”

“I didn’t know there was such a thing.”

“Are you kidding? There’s even a mobile service. They call themselves 1-800-Autopsy. They show up in a black van and do the post on your loved one, parked in your driveway.”

“Remind me to add that to my list of signs that the apocalypse is near.”

“For me, I’m afraid it’s nearer than you’d think. I have to appear before the morbidity and mortality board on Monday.”

“What’s that?”

“The M&M conference? It’s a confidential, closed-door review board that’s supposed to catch and correct physician error. Every hospital has one, but the proceedings are secret. You aren’t even allowed to take notes. They can be pretty brutal.”

“Have you ever been asked to appear before one before?”

“No, but I sat in on them as a resident.”

“What about McDermott? Doesn’t he share responsibility for all of this?”

“Oh, sure. He’ll hang his head and say he’s sorry for letting me do the procedure solo, and they’ll give him a rap across the knuckles and tell him not to do it again. Then they’ll hang me out to dry.”

“Won’t McDermott stand up for you?”

“Why on earth would he do that when it’s in his best interest to crucify me? Don’t you see? Up until now, every single respiratory-arrest death has been his patient.“

“So was this one,” I pointed out.

“But he never even set foot in the operating room. Not only that, but I looked at her chart. He never so much as ordered medication. I mean, unless the pathologist determines at autopsy that Mrs. Estrada died from having her abdomen palpated, then he’s off the hook.”

“And he gives up his title of Dr. Death,” I mused.

“Absolutely. Up until this afternoon, everybody’s been whispering about him. Has he lost his touch? His luck? His nerve? Could he be drinking? Dipping into the old pharmacy cupboard? But on Mrs. Estrada he’s clean, which means he has everything to gain from nailing it on me.”

“Who else knew that you were the one who operated on Mrs. Estrada?” I asked, suddenly seized by a truly terrible thought.

“The resident who assisted, the scrub nurse, and the anesthesiologist. Maybe the OR coordinator if she ever lifted her nose out of her romance novel.”

“Anybody else?”

“No. Not unless McDermott happened to mention it to somebody.”

“Would he?”

“Probably not. Technically what he did by letting me do the case wasn’t kosher. He wouldn’t want to advertise it. But I still have no idea what you’re getting at.”

“Don’t you see? Ever since you’ve been at Prescott Memorial, the hospital has been losing patients, all from respiratory arrest following routine surgery, all Gavin McDermott’s patients. No one can figure out why. Now, all of a sudden, Mrs. Estrada dies the same way after you operate on her.”

“Pm still not getting it.”

“To everybody but Gavin McDermott and the handful of people who were actually in the operating room with you, Mrs. Estrada wasn’t your patient, she was Gavin McDermott’s. What if those deaths weren’t caused by something that happened in the operating room? What if it was something that happened after?”

“You mean like an infection or a bad drug interaction? Believe me, Kate, the first thing they did was rule those things out,” protested my roommate.

“What I’m suggesting is much worse,” I said slowly. “I think somebody is going around Prescott Memorial Hospital killing off Gavin McDermott’s patients.”

CHAPTER 10

That night I slept so badly that it almost didn’t feel like rest but rather just an inferior form of waking. Claudia and I had stayed up until the small hours of the morning discussing what she’d dubbed my angel-of-death theory. It’s true that talking about something can make it seem real. By the time I finally went to bed, I found myself fearing for the helpless patients at Prescott Memorial.

Usually I’m not prone to flights of fancy, but Claudia had had no trouble coming up with any number of ways to keep an already weakened patient just recovering from surgery from taking their next breath. She ticked them off on her fingers—everything from a pillow over the face to an overdose of morphine, all unlikely to be suspected or detected, especially in the absence of an autopsy.

But what I found really chilling was the matter-of-fact way that Claudia had accepted the idea of the deaths being caused deliberately. Claudia went to work every day in a world where mothers set fire to their children and fathers raped their daughters. To her, the idea that someone was wandering the halls of Prescott Memorial killing off patients hadn’t seemed far-fetched. Indeed, murders of this kind were not uncommon. Exhausted caregivers, burned-out nurses, and the occasional psychopath had all been known to systematically help patients ' into the great unknown.

However, how any of this was related to Mrs. Estrada— much less the other deaths at Prescott Memorial—was pure conjecture. Claudia had no idea whether the bodies of any of the other patients who’d died had been autopsied, much less what the results had shown. She also couldn’t say whether Mrs. Estrada and the other patients had anything in common other than the fact that they were patients of McDermott. When I asked her whether the hospital had conducted any kind of inquiry into the other deaths, she’d replied that as a mere trauma fellow, she would be the last to know and suggested that I talk to the chief of staff, Carl Laffer.

But when I woke up the next morning, talking to Laffer—at least about patient deaths—was the last thing on my mind. Indeed, in the light of a new day my entire discussion with Claudia seemed absurd—the product of my desire to offer an explanation that would exonerate Claudia from responsibility for Mrs. Estrada’s death and Claudia’s eagerness to embrace it.

As I made my way to the kitchen to start the coffee I stopped long enough to peek into Claudia’s room, but she’d already left for the hospital. As I went about the business of getting ready for my day I found myself wishing her a quiet shift. It had taken a fair amount of courage for Claudia to just go into work. By now there wasn’t a dietary or maintenance worker at Prescott Memorial Hospital who hadn’t heard about yesterday’s tongue-lashing from Dr. McDermott.

Saturday-morning traffic was light going downtown, and the lakefront was already filling up with people who were out enjoying the beautiful day. I wondered what it would be like to wake up and have a whole weekend to myself. To get up and look out the window at the weather and then sit on the sunporch sipping coffee and considering the alternatives—a leisurely run by the lake, window shopping, reading a novel in the park... It was an agreeable fantasy, like daydreaming about being a ballerina. In my line of work, Saturday was a workday, distinguished from the rest of the week only by the facts that the phone didn’t ring quite so much and I didn’t have to put on stockings and high heels.

When I arrived at Callahan Ross, I found Sherman in the library in exactly the same place I’d left him the night before, only this time with his face pressed to the keyboard, fast asleep. I shook him by the shoulder and told him to meet me in my office. Then I sent out for coffee. Sherman and the coffee arrived at the same time, and we got right down to work.

It took us most of the morning to draft our complaint against Health Care Corporation. Legally we both knew that it was something of a stretch. Our claim was based on a dubious precedent that Sherman had unearthed involving the sale of a nursing home owned by the Catholic Church to a for-profit chain. While the decision itself supported our argument, the facts of the two situations were hardly identical. However, at this point we didn’t have time to come up with something better.

Neither Sherman nor I thought our claim would stand up under judicial scrutiny, but with a little luck it might be enough to buy us a thirty-day injunction delaying the sale, which would give us time to come up with something better. Besides, all my instincts told me that time was on our side. I still had no idea why HCC wanted to move so fast, but whatever their reasons, there was a good chance that any delay would work to our advantage. Sherman, who had a weakness for football analogies, referred to this as our Hail Mary strategy.

Mark Millman called just as I was about to take the first bite of my lunch. “Polish interruptus,” quipped Cheryl, who’d stopped at Gold Coast Dogs on her way from Loyola. The business half of Delirium was calling from his cell phone in the lobby of the building to say that he was on his way up. He did not sound pleased.

I sighed and wrapped my lunch back up and handed it to Cheryl, who departed along with Sherman, leaving the scent of melted cheddar and jalapenos in their wake. I didn’t know what to expect from Millman, so I braced myself for the worst. It wasn’t a wasted effort.

Mark Millman looked like a man who’d spent the night on a ledge threatening to jump. His shirt was grimy around the collar and saddlebagged with sweat. There was an unhealthy flush to his complexion, and unless he’d been substituting Absolut for Aqua Velva, it seemed a fair guess to say that he’d been hitting the bottle pretty hard.

“Hello, Mark,” I said, waving him into a chair. “You’re an awfully hard man to get ahold of.”

“I’ve been busy.”

“At COMDEX?”

“Uh-huh. I’ve been hanging out at the Icon hospitality suite. They have the best booze. Not only that, but I figure it’s all I’m going to get out of that asshole Hurt so I might as well get as much of it as I can.”

I punched the button on the intercom and asked Cheryl to bring us in some fresh coffee, not that I thought it would actually help. Years of watching my father had taught me all the signs. Millman had been drinking for so long that he didn’t seem overtly drunk, but whatever you wanted to call his current state, it was a far cry from sober.

“Why don’t you let me get somebody to drive you home,” I suggested.

“Home? I can’t go home. That bitch threw me out.“

“Your wife threw you out?” I asked, feeling a little foggy on the details of Millman’s personal life.