Death Rounds (35 page)

I was speechless. “She could have killed you! If any part of this was deliberate, she should be charged with medical assault!”

Janet started coughing, then only partially recovered her voice. “Think about it. Earl,” she rasped. “This was a classic example of how Brown and the others like her got away with their nasty crap, though never with anything so lethal. But even here she did nothing more than show a note about scanty sputum written by someone in ER to the residents and then inform them of the ID directive about proper culture samples. We may know what she was really doing, but who can prove it, let alone have her indicted for it? Even in the morbidity review, Cam will probably only get her charged with a major error in judgment. But at least it will be enough to label her officially as trouble and keep her out of critical-care areas. Even if she isn’t fired now, she’ll finally be on such a short leash her days here will be numbered.”

Her days may be numbered, period, I thought. Messing with someone when they were helpless was indeed liable to make people very angry if my own anger was any gauge.

“Why didn’t
you
stop the residents?” I asked Janet as gently as I could. I still found it hard to believe how any of this could have happened. “You’re not known for being overruled easily.”

I saw her bristle. “Because,” she answered icily, “I didn’t catch on at first that it was Brown who’d put the residents up to it.” After a few seconds of cool silence she added, “Besides, I was determined to be a good patient and do what I was told, not act like a doctor and get special treatment. When I did start to protest, the resident who wanted to suction me kept insisting that he’d done it this way before and that he’d be in and out before I knew it. It sounded wrong, but I’m a gynecologist, not a respiratory specialist It was only after that catheter was down my throat that I realized they didn’t know what they were doing.”

I knew what she meant. Doctors invariably have a hard time finding the right distance to take either from their own care as a patient or from the care of a family member. Being too close and interfering could be as much a disaster as standing too far off and ignoring well-honed instincts that something’s wrong. The dynamic was hard on the treating doctor as well. The physician’s physician had to be a very special breed.

“And what about Cam’s cause?” I asked as unobtrusively as I could. That I suspected her friend was, I knew, painful to her. It would be even harder on her to tell me anything that she knew would add to those suspicions.

I watched her expel a long breath and lean back on her pillow.

“His father was a hemophiliac,” she began matter-of-factly, but in a hoarse whisper that was painful to listen to. “The man actually worked in this hospital as a lab technician. You can imagine how Cam grew up, witnessing the man suffer with crippling bleeds into his joints that sometimes only morphine could ease. Once Cam was in medical school, he learned the true extent of his father’s pain when he saw firsthand the incessant needles and invasive procedures all hemophiliacs are forced to endure. Besides, remember the attitude about giving narcotics to these people back then. It was pretty judgmental, and most hemophiliacs had to put up with a lot of insinuations that they were faking pain to get a fix.”

I knew exactly what she meant. I’d witnessed that kind of ignorance even in my own ER. What kind of impact could it have had on a son, knowing that his father was subjected to the indignity of having to prove again and again he was in pain?

“I think Cam became a director of laboratory services precisely because of his father,” Janet continued. “I suppose he sees it as a chance to make sure that, at least in his domain, no one suffers the sort of unnecessary pain that was inflicted on his dad.”

“Is his father still alive?” I asked, remembering the lack of recent photos back in Cam’s office.

“No,” Janet answered solemnly. “Like so many hemophiliacs in the early eighties, he became infected with HIV from improperly tested blood products. He died about ten years ago.”

It all made terrible sense. “Janet, do you realize what you’re saying?” I asked, my throat so dry I could barely speak.

She pulled back from my chest and looked at me with a hard blue stare that outdid anything Cam had fired my way in the last few hours. “What I’m saying. Earl,” she said, her cutting tone sounding through the hoarseness, “is that the experience turned him into a fine and caring doctor I trust with my life. He is not some twisted fiend hell-bent on revenge, and if you had any sense of intuition of your own, you’d know I’m right.”

The only sense I had was that it was pointless to argue with her.

Minutes later I was advising everyone in the nurses’ station that I’d arranged for a security guard to be at the entrance of Janet’s room and that he’d be logging anyone who went near her. I didn’t give them any reasons and got more than a few raised eyebrows, but nobody protested out loud. I also gave strict orders that no one, not even Janet, was to send the guard away. After our talk about Cam, I didn’t have the nerve to tell her what I’d done to protect her.

* * * *

Half an hour later I was in ICU at St. Paul’s looking at Michael through the window of his isolation room. As alarming as it was again to see him so helpless, I was also appalled to see that Gary Rossit had taken over his care. He was in the cubicle inserting a long thick needle under Michael’s right clavicle to serve as a conduit to his central venous system.

The nurses assured me the little man was hovering over Michael like a mother hen, then gave me a brief synopsis of the treatment he’d ordered. It seemed complete and included rifampin, the second-line antibiotic used in patients desperately ill with
Legionella—
the same one that he’d lambasted me for suggesting in Sanders’s case.

Michael’s most recent chest X rays—taken about an hour ago— were up on a nearby viewing box beside the ones done last night when he was admitted. The whited-out areas were clearly larger, indicating the infection was spreading. I blocked out images of lungs in Tupperware that tried to crowd in on my thoughts.

The nurses found it reassuring that as of yet his sputum hadn’t turned copiously purulent. “It may be too early for staph,” I told them, while thinking it may already be too late for my friend.

I turned back to the cubicle as Rossit threaded a plastic catheter into Michael’s subclavicular vein. Two residents watched with rapt attention a set of fluorescent green numbers and curving lines appearing on a small overhead monitor. These were the pressure readings that confirmed the tip of the catheter was gliding through the right-sided chambers of Michael’s heart and into the large pulmonary artery leading from the heart to the lung. Rossit could now determine Michael’s huge fluid requirements in the presence of septic shock and hydrate him properly without overloading his circulatory system.

As far as I could tell, Rossit was making Michael one of his master efforts. The most aggravating thing about enduring the little man’s bullshit over the years was getting a glimpse of what a good doctor he could be when he pulled out all the stops, then seeing him revert to his nasty one-upmanship once he’d pulled off yet another of his miracle saves.

But today there was another possible explanation for Rossit’s attentiveness. If he were involved with the killings, he might be hovering over Michael to assure his death at the first opportunity.

Rossit caught my eye through the window and quickly turned away. Whether the reaction of a man guilty of murder or simply that of a creep who had loaded the dice against me at Death Rounds this morning—either way he didn’t seem happy to see me. Fresh from my showdown with Cam, I was primed to take on little Gary.

I put on a protective outfit and stepped into the room. “Dr. Rossit, I’d like a word in private, please.” Turning to the residents, I asked, “Would you two gentlemen excuse us?” My tone of voice made it an order, not a request.

They quickly left, taking only seconds to discard their gear at the door.

Rossit eyed me over the top of his mask. “Look, Earl, about this morning—”

“Shut up, Rossit! I just got back from admitting my wife to ICU in University Hospital. She’s also been diagnosed with
Legionella,
and I’m in no mood for your crap!”

“Your wife!” he exclaimed. From the part of his face I could see, his shock seemed genuine enough.

“Surprised, are you, Gary?” I shot back. “I wonder. Because I think someone deliberately infected her, just like someone probably deliberately infected Michael and Stewart Deloram. Now I’m not sure why Stewart was a target, but I think Michael and Janet were attacked because they were trying to expose whoever had also infected the nurses from UH. Am I going too fast for you, Gary, or do you know this already? Stop me if you do.”

I was standing over him, making him look up at me, and I felt a glint of satisfaction at seeing his pupils widen ever so slightly. I was scaring him.

“Earl, for God’s sake, what are you saying—”

“I’m saying I’m going to expose this killer. In the meantime, nothing further had better happen to Janet or Michael, is that clear?” I refrained from my urge to tap him on the top of his head with my fingernail.

“You can’t be serious,” he protested.

“What I’ m serious about, Rossit, is that you better be at your healing best with Michael here. I’m going to be double-checking every molecule of stuff you put into him, and there damn well better not be any suspicious incidents. Got me?”

This time I did poke my index finger into his chest, then spun around and strode out of the room. I didn’t look back as I discarded my gear into the bin at the door.

“You’re crazy. Garnet,” I heard him shout from behind me, “certifiably bonkers, crazy!”

* * * *

I called the same security company and made identical arrangements for Michael’s room as I had for Janet’s. The nurses were just as puzzled as their colleagues had been at UH, but once again I gave orders, not answers. I signed out for the rest of the day and headed home to sleep. It was 2:00
P
.
M
., but I was fighting to keep my eyes open and knew I wasn’t safe to see patients in ER. On my way out I stopped at the hospital pharmacy to get Brendan, our nanny, and myself some erythromycin.

As I stood at the counter and waited for the pharmacist to prepare the medication, I wondered about my own chances of being attacked by the Phantom. Michael and Janet had done little more than discreetly look through old records, yet that was enough to provoke this killer. I’d just confronted the two people I suspected most and practically accused them of murder. Even if I was wrong about Cam or Rossit, it was a pretty good bet that if this maniac was close enough at hand to have known what Michael and Janet were up to, he’d know what I was doing as well. I tried to convince myself that, unlike Michael and Janet, I was sure to be ready for any move he made against me. But I also decided it was time to finally tell Williams about my list of suspects, short as it was, just in case things didn’t work out the way I hoped. After all, he was the only other person left standing who was suspicious enough about the infections to take over the hunt. I’d phone him tonight, when he was back in his hotel.

In case things didn’t work out the way I hoped—
I cringed as I thought of the phrase. It was one I sometimes used to prepare a patient for the possibility of death.

* * * *

Brendan was asleep when I got to the house, and I resisted picking him up and rocking with him. The Phantom could add making me afraid to touch my own son to his list of victories.

After I showed Amy, our nanny, how to give him his medicine— the banana-flavored liquid looked a lot easier to down than the big red-and-black capsules Amy and I had to cope with—I spent time explaining to her that Janet was stable and the medication for us was simply a precaution. She looked worried and asked a lot of questions about
Legionella,
but most of those questions were about what early signs she should watch for in Brendan.

My long overdue shower came next. I turned the nozzle on full and stepped into the heat, steam, and noise. For something like a second, enveloped in the force and feel of the water pounding down on me, my mind washed itself free and gave no thought to the gathering dangers outside.

Finally, sitting on the side of my bed, barely able to stay awake, I phoned ICU at University Hospital and learned from one of the nurses that Janet was sleeping, her condition no worse.

“By the way, the first of your guards is here,” the woman added. “He’s big, I’ll grant you that.”

“Good,” I replied sleepily.

“And your wife’s hopping mad at you about it.”

Muffy jumped up beside me as I put down the receiver and lay back, ready to surrender my mind to sleep for a while. Tonight, I thought, if Miller kept his team quiet, we might grab the shadowy figure prowling around in the asylum and put an end to the need for guards.

Lingering on, the image of that dark shape trespassed into my dreams. I was chasing it through dark passages lined with stone walls and floored with earth. However fast I ran, the form ahead disappeared around corners and turns in the endless maze. Some of the passages must have come back out behind me, because soon, whoever I was hunting was behind me, and I was running for my life.

* * * *

The ringing wouldn’t stop. It went on and on, louder and louder, piercing the blackness and hurting my ears. I knew it would go away if I waited long enough, yet every time it sounded, I got pushed closer to opening my eyes. One more ring and I’ll take a look, I promised, but I let three more go by. Finally my eyes did open, and all I saw was black. It was night, and the luminous dial on the alarm clock read 9:10. I flailed around with my hand, found the phone, and managed to get the receiver end to my ear. Cam’s voice startled me awake.

“Earl, get over here as fast as you can!”

I was instantly on my feet. “What happened to Janet?” I believe I yelled the question.

“It’s not Janet,” he said quickly, his voice tremulous. “I think I found what Michael Popovitch discovered. You were right all along, but I have to show you, and I want Williams here as well. Do you know how I can reach him?”