Fatal Reaction (5 page)

CHAPTER 8

Mike entered the glass vestibule outside of the medical examiner’s office and stomped his boots. He dusted the snow from his hair and jacket and silenced his cell phone. The wet soles of his shoes squeaked against the tile floor as he made his way past a dozen quiet offices to the autopsy suite.

Dr. Kimberly Taylor waited at the door, wearing a white lab coat and holding an electronic voice recorder. The hem of her purple dress rested just above her knees, and a gold cross necklace hung around her neck. Her short hair, the color of dark honey, was styled to emphasize her hazel eyes. Kim was only two years younger than Mike, and he’d known her almost her entire life. They’d gone through school together with only a grade between them. Kim had started early, while he had started late. She’d come a long way from the pigtailed girl he had adored from afar, and he still found her breathtaking even at her current age fifty. She smiled and reached out to hug him.

“How are you holding up?”

He lingered in the comfort of her warm embrace a minute before answering. “As well as can be expected. I didn’t see this coming.”

Kim held her hand on his shoulder. “Are you sure you want to do this right now?”

He didn’t, but postponing hearing her findings for hours, a day at most, wasn’t going to change that. “I need to know what happened.”

Three self-draining, stainless steel tables cast long shadows across the dimly lit room. There were showerhead-type attachments in each of the sinks for washing down the bodies and scales for weighing organs. Several wheeled gurneys lined the side of the room opposite the refrigerated storage drawers.

A white sheet concealed Sydney’s body at the center of it all.

Mike swallowed the lump in his throat and moved toward her.

Kim pulled on a pair of rubber gloves, turned on an overhead light, and with Mike’s permission, folded the sheet back to Sydney’s shoulders.

Her blond-on-brown highlighted hair had been freshly washed and brushed, and her eyes were closed. Kim had taken obvious extra care in preparing her.

Mike did his best not to focus on the crude stitching that seamed Sydney’s head closed.

“The coffin pillow will hide that,” Kim said, repositioning Sydney’s hair. She lifted an evidence bag from the cart next to the table and showed Mike the label. “The bottle you found at the scene was a prescription for zopiclone, a sleep aid that is lethal in high doses, especially when mixed with alcohol.”

“We found an empty bottle of vodka in the room.”

Kim nodded. “I’ve gone over the case notes. The label says the prescription was filled the day before Sydney’s death, making it a reasonable guess that there were thirty pills in the bottle when she checked in at the Aquarian.”

“Would that be enough?”

Kim understood what he meant without his saying it. “It would, but . . .” She drew her lips together and tilted her head.

“But what?”

Kim pulled Sydney’s right hand out from under the sheet. The rose-pink polish was chipped on two of her nails. Kim called attention to Sydney’s index finger. “She was brought in with dried vomit around her mouth.” Mike remembered that from the Aquarian. “See here, where her nail is broken? There were traces of vomit, like she had tried to make herself throw up the pills.”

“Why would she do that? Second thoughts?” Mike operated under the assumption of suicide, whether or not he wanted to believe it.

Kim shook her head. “I don’t think so. There are a couple of things that make determining death by overdose difficult. One is tolerance level. What is lethal to some is normal for others. It makes it hard to standardize a fatal level. There’s also the possibility of postmortem distribution.” Mike shrugged and held out his hands. “Drugs contained in fatty tissue are released into bodily fluids after death. The postmortem result might have been skewed.”

“So you don’t know how much was in her system?”

“I have an idea. In a fatal acute overdose, one would expect to see zopiclone levels in the 0.4–3.9 milligrams per liter range. Sydney’s were at ninety
micro
grams per liter, which is less than the usual therapeutic dose. If she
did
take thirty pills, she got them out of her system before she digested them.” Kim set Sydney’s arm back under the white sheet. “Take a look at this.” She lifted Sydney’s eyelids to show him the smattering of tiny red and purple spots in the whites of her eyes. “Same as here.” She pointed them out in the skin around Sydney’s mouth. “Petechial hemorrhaging around the mouth could be caused by forceful vomiting, but I’m not sure that’s the case here. Her heart was significantly enlarged, and there was foam in her airway from mucus in her lungs mixing with air as she struggled to breathe. Cause of death is asphyxiation, not drug overdose. Sydney suffocated.”

Mike took a moment to absorb what he was hearing. Ana had been right
.
Someone staged Sydney’s death to look like a suicide. His mind went immediately to the scratches on Misty’s face. “Anything come back on her nail scrapings?”

Kim pulled the sheet up. “I don’t see anything in the reports, but I’ll check with the crime lab.” She peeled off her gloves and threw them into the garbage. “Do you have any idea who would want Sydney dead?”

Mike shook his head. “It’s a very short list.”

CHAPTER 9

Marco Prusak rolled up the sleeves of his collared shirt and scrubbed his stained hands at the bathroom sink of his modest, one-bedroom apartment. No matter what he used to clean them, the dye from his protest refused to come off. The fake blood faded to a shade of pink not easily noticed against his olive skin, but the guilt of what he’d done had him unable to ignore it. He’d gone too far, and being suspended at a time when he was so close to his goal had him anxious to get back to his lab.

He splashed a handful of water on his face and stared at his reflection.

Dark circles formed beneath his near-black eyes. His recent, extreme weight loss caused his skin to sag and made his age lines more visible. Fifty-seven hard years, most spent preaching the word of Jehovah door to door and walking for hours in the sun, had him looking at least fifteen years older.

Grief compounded his advanced aging.

His life seemed an endless timeline, each milestone punctuated by tragedy; losing his infant daughter, Jasmine, had been the worst of it.

At six weeks premature, Jasmine’s first days were filled with complications. She weighed only four and a half pounds and was slow to gain weight with only a feeding tube nourishing her. Days turned to weeks, and a list of new symptoms heralded something worse.

The color of her skin deepened in its yellow tone, her urine became dark, and her belly swelled. Doctors put her on phototherapy for jaundice, but when her condition didn’t improve, a battery of tests confirmed their suspicions. Jasmine was diagnosed with complete biliary atresia, a congenital, and if untreated, fatal, abnormality in the opening of her bile ducts.

Marco and his young wife, Faith, prayed for Jasmine’s improvement, spending all of their time in the Neonatal Intensive Care Unit, and suffering reprimand from Witness elders because of it. Preaching time, while independently reported, was monitored, and the dropping off of Marco and Faith’s efforts made them look weak in their devotion. Congregation pressure broke Faith first, leaving him alone, emotionally distraught, and conflicted about his beliefs.

Jasmine continued her slow decline, and a consulting surgeon at County laid out a terminal prognosis. Without Marco and Faith’s consent to a liver transplant, Jasmine would die.

To Faith, the news had been Jasmine’s death sentence.

Organ transplants were discouraged, and downright frowned upon in their faith, unless they could be done without any blood transference. Bloodless transplants could not be done at County, or at any hospital within a five-hundred-mile radius.

Marco pleaded with Faith, and with the elders, but ultimately, their religious beliefs won out. The transplant was denied.

Faith wasn’t at the hospital when Jasmine passed. Despite Faith’s postpartum weakness, she was out distributing tracts, preaching of Armageddon.

Marco couldn’t forgive her for not being there when Jasmine breathed her last breath. The nurse lifted Jasmine’s lifeless body out of the bassinette and, for the first time, Marco was able to hold her without the tubes and catheters in place. Her stomach had blown up and her liver hardened, like a stone in her side. She was the color of saffron, an image that, fifteen years later, Marco still couldn’t get out of his head.

Medical school was an act of defiance against the congregation and the beginning of a decades-long revenge plan already well under way.

Marco checked the time on his watch and paced his minimally furnished living room.
Watchtower
tracts and magazines covered the secondhand coffee table between an inexpensive sofa and a small tube television with no cable feed. He had no need of material things, only to finish what he had started. He picked up the handset on his cordless phone and dialed County Memorial’s switchboard for the third time that morning.

“County Memorial operator, how may I help you?”

“May I speak with Mitchell Altman, please?” Marco had left several messages for the CEO, but all of his calls had gone unreturned.

Hold music broke the tension of the momentary silence, and Mitchell’s secretary, Pam, came on the line. “Mitchell Altman’s office.”

“Pam, it’s Marco Prusak. Is Mitchell available?”

“Hold on just a minute while I check.” Normally Pam would chat, but this morning she was all business. A minute passed, maybe two, before she returned on the line. “I’m sorry, Mitchell isn’t in his office. Can I take a message?”

Pam was a terrible liar.

“No, thank you. I’ll deliver the message myself.”

CHAPTER 10

County Memorial’s Emergency Department hit a midafternoon lull after the early-morning rush of flu that had Marion’s people coming in by the dozen.

Jared washed his hands, sat down at one of several computers behind the nurses’ station, and sorted through the morning’s lab results. Two of his patients were ready for discharge. One would have to be admitted. Open beds were scarce, and if he was lucky, monitoring that admission would keep him late enough to excuse his sleeping in the on-call room rather than going home to Colby, whom he hadn’t spoken to since their most recent argument.

He typed in a series of orders and signed off on the discharge paperwork for his least sick patient, a young boy with an ear infection that could have easily been treated by his pediatrician.

Wilson Quinn, one of the department’s physician assistants, appeared in front of him. Six foot three and with a full beard, Wilson had the appearance of someone more suited to the woods than long hours in a hospital emergency room. Those who didn’t know him feared his meaty hands coming at them with needles and IVs, but despite his coarse exterior, Wilson had the best bedside manner in the unit, and the second steadiest hands Jared had ever seen. Ana Ashmore, a medic he’d worked with over the past couple of years, had the first.

Wilson leaned into the counter, his round belly straining the elastic waist of the green scrubs not intended for someone so large. “Ambulance is on its way in. You ready?”

Jared waved for Heather, one of the unit nurses, to take the papers. “Make sure you go over the instructions with the mom.” He scribbled out a prescription and handed it to her. “This is for his antibiotic.”

Heather nodded, took the paperwork, and headed to the room where the boy with the ear infection had been for hours.

Jared looked up at Wilson. “What do we know?”

Wilson read a scrap of paper in his hands. “The patient’s name is Stephanie Martin. A neighbor found her unconscious on her kitchen floor.”

“Symptoms?”

“Fever, delirium, and in quite a bit of pain. Jim says she’s too dehydrated for him to get the IV in.” Wilson rolled his eyes. “He says that a lot.”

Jared searched the patient’s name in the computer, and finding several Stephanie Martins, selected the most recent one. “Ana couldn’t get it?”

Wilson smirked, his expression amused and all-knowing. “Jim didn’t mention her.”

Jared tried to hide his disappointment as he scrolled through a list of reports. “Shit.” He pulled up Stephanie’s operative note dated four months earlier.

Wilson chuckled at Jared’s unusual use of profanity. “Something the matter?”

Jared nodded. “I knew I recognized the name. Stephanie Martin is Dorian’s transplant patient.”

“That isn’t going to make Mitchell happy.”

Stephanie Martin was the new transplant program’s second incident of bad publicity, and Jared wanted no part of it. “This is a malpractice suit waiting to happen.” He picked up the phone and dialed the operator.

“Switchboard, how can I help you?”

“This is Dr. Monroe in the Emergency Department. Can you get me Dr. Dorian Carmichael’s office, please?”

Hold music played, and then the phone rang twice.

“Oakland Street Obstetrics and Gynecology, this is Kristin.”

“Good morning, Kristin. This is Dr. Jared Monroe at County Memorial. I have an emergency for Dr. Carmichael. Can you connect us?”

“Just a minute, please.”

Jared tapped his fingers on the counter, waiting impatiently for Dorian to pick up. If he could get away with not having his name anywhere on Stephanie’s file, he’d be thrilled. He had only ever been named in one malpractice suit, a case on which he had performed only a brief, initial assessment. The patient’s cardiologist was heavily investigated, and though everyone was eventually exonerated, they’d spent an awful lot of time together in meetings with legal. Jared couldn’t imagine spending that kind of time with Dorian. Aside from the fact that his transplant program ate a good portion of the funds Jared desperately needed for the ER, Dorian had had a
thing
for Colby for as long as she had worked there.

“I’m sorry for the hold. This is Noreen. How can I help you?”

“Noreen, I need to talk to Dorian.”

“I’m sorry, but he’s in surgery today. I can get ahold of him—”

“Is he operating at County?”

“Yes, but—”

“Thanks, I’ll find him.”

The ambulance siren silenced as Jim, a seasoned EMS veteran and supervisor, backed into the receiving bay. The automatic doors slid open, and Jared headed over to meet him.

Jim hopped down from the driver’s seat and rushed to open the back door. His eyes were glossed over, and he yawned.

“Long night?” Jared looked around him, hoping to catch a glimpse of Ana and finding Ethan Kerr instead.

Ethan, an EMT in his early twenties, with his precision haircut, chiseled facial features, and vivid blue eyes, stepped out of the ambulance as if walking out of a magazine.

“Fever’s climbing,” Ethan said. “We couldn’t get a line, but she’s stable.”

Wilson waited until they unloaded Stephanie to have a look at her right hand and arm. “You stuck her, what, four times?”

“Five, by my count,” said Jared, shaking his head. “Set her up in room one. Get an IV in her other arm and I’ll be right there.” Monica, one of several unit clerks, rushed past him, and he called out to her. “I need an overhead page. Call for Dr. Carmichael. I need him here,
stat
.”

“You got it.” Monica jogged to the nearest phone and placed the call.

Wilson and Ethan wheeled Stephanie away.

Jim rubbed his eyes and handed Jared his copy of the prehospital care report. “Her husband should be here any minute. His name is”—Jim flipped the sheet on the clipboard—“Riley Martin.”

Jared reviewed the list of Stephanie’s symptoms—fever, malaise, abdominal pain—and formulated a list of differential diagnoses from infection to organ rejection.

The latter spelled disaster.

Jim’s radio announced another call, and he waved for Ethan to join him. “No rest for the weary, right? Pulling a double shift after two days of visitation with Kayla, I’m beat. Who would have thought a three-year-old could be so draining? After what happened, though, I mean, I had to cover Ana’s shifts.”

“What do you mean, ‘what happened’? Is she all right?”

Wilson called from the doorway of room 1. “Line’s in.”

Ethan rolled his eyes as he pushed the empty gurney toward the ambulance.

“Jim, is Ana okay?” Jared ignored Wilson’s repeated attempts to get his attention.

“She is, but her sister was found dead at the Aquarian last night.”

Jared didn’t know Sydney well, but he had met her at a couple of medical community functions and knew she and Ana were very close.

Wilson grabbed Jared by the sleeve and all but dragged him toward Stephanie’s room. “I said
we’re ready
.”

The overhead page called Dorian to the ER for the third time.

Monica shrugged and shook her head, a sign that he wasn’t answering.

“Keep trying.” Jared turned at the sound of fast-approaching, high-heeled footsteps.

Noreen Pafford, wearing a white lab coat over a fitted, blue dress, hurried toward him. A section of folded newspaper stuck up from her pocket and left a dark smudge where the melted snow smeared the ink. She ran her hand through her short hair and narrowed her eyes with obvious anger. “Where’s Dorian?”

Jared, already on edge, fired back. “That’s a good question, and one I’ve been trying to have answered for the past ten minutes.”

Noreen checked her watch. “His case got out a half hour ago.” She tapped away at the keys on her cell phone.

Jared started a triage sheet and went into Stephanie’s room, noticing her increased heart rate on the vitals monitor.

“Stephanie, my name is Dr. Monroe. Can you hear me?”

The ebony-haired woman rolled her head toward him and groaned in pain. The fever had her sweating, and her hair clung to her flushed face. She appeared thin, too thin, and barely lucid.

Noreen stormed into the room and interrupted. “Why didn’t you tell me that Stephanie Martin was the emergency?”

“Because
you’re
not a doctor.” Jared pulled a penlight from his pocket and continued his examination. He’d dealt with Noreen enough to know that she didn’t believe in limitations. “Wilson, get her out of here.”

Noreen stood her ground. “I’m not leaving until Dorian gets here.”

“And I’m not going to ask again.” Jared turned to Wilson. “Count to three, and if she still isn’t out of here, call Security. I have a patient to treat.”