Lethal Practice (14 page)

I took out my frustration on the junk mail by smashing each piece into a tight ball and hurling it into our recycling box. When I got to the recruitment flier, I called out to Carole, “If they ever send one of these recruitment things for a doctor in Hawaii, make sure I’m the only one who sees it.”

                                             * * * *

“So, did you name names?” Sean asked. He’d popped into my office after his own session with Bufort.

“Of course. One glimpse of the bamboo splinters and I immediately gave him your name. Told him you were planning to murder a horse.”

“Oh, really. I heard you were still his number one
needler.”

I groaned.

“Seriously,” Sean said, “is he going to start coming after your staff?”

“It looks like it.” I sighed. “How about you? How many of your surgeons regularly needle hearts?”

“Just four. The cardiothoracic surgeons. They don’t actually needle them much, but they do a lot more complicated things to living hearts on a daily basis. Needling them would be a snap.”

“What about the rest of you?”

“We were all trained to do it back in residency, but without having done it over the years in real practice, few of us could get the kind of accuracy Bufort seems to be looking for. At least not the younger surgeons.”

“What do you mean?”

“Our conversation the other day made me think of it. Up until the seventies, if a patient arrested on the OR table, the surgeon would give an intracardiac injection. It wouldn’t happen often, but over the years any surgeon from that era would get pretty good at needling hearts.”

I knew where this was going. “Sean, you didn’t!”

“You’re damn right I did. The good Dr. Hurst is now a suspect on Bufort’s list.”

“Holy Christ!”

“What? You think I shouldn’t have told Bufort that Hurst had the skill to kill Kingsly?”

“Not just to get even, Sean.”

“What makes you so sure he isn’t the murderer?” he asked, getting a little testy. “Hell, you know how he’s a fanatic for covering up any scandal in the hospital. Maybe Kingsly was about to cause a whopper. And what about this crazy agenda for budget cuts that Hurst is suddenly ramming down our throats, literally within hours of Kingsly’s death? The speed and size of it make no sense. I tell you, Earl, Bufort should take a damn close look at Hurst!”

Sean punctuated this accusation by stomping out of my office.

I was left totally amazed by his astonishing suggestion.

As much as I detested and distrusted Hurst, and as much as I found his behavior ruthless, bizarre, and, lately, even frightening, I didn’t think of him as the killer. I never doubted that his first reaction to seeing Kingsly’s body was sincere. But was it? Now I was racing to a different possibility. Had I actually witnessed a murderer reacting with horror as his cover-up failed? And if that was true, then his attempts to frame me for the killing were certain to continue—and have no limits.

I’d begun to sweat. Another possibility reappeared out of my rising fear. The dogs.
You’ve had your warning!
Had the whispering caller been the figure on the green after all? Hurst? Or someone he’d hired? No! It made no sense. Even if Hurst had killed Kingsly, he wouldn’t try to frame me for the murder and then risk killing me with Dobermans at the same time. I had to reign in my paranoia and think clearly. Besides, something else didn’t jibe. Something even more contradictory. If Hurst was the killer and the anonymous caller, why did he say
I
know it’s you
? Or why would he warn me to
back off!

Suddenly none of it made sense. I tried controlling my increasing panic about what I was up against, but Sean’s argument wouldn’t go away, and visions of Bufort with Hurst at his ear, pointing at me, pushed in on my mind as oppressively as when the detective had leaned against me last night, warning that I might get in trouble I couldn’t get out of.

Damn them both! I had to stop letting them scare me. I needed to get back on familiar ground, where I could shake off all this weird speculation. Only one place would do.

I retreated to the ward, where I saw patients for an hour. The routine was calming, therapeutic even, for me and, at first, for the patients.

I quickly got a young asthmatic breathing comfortably after giving him a mask of bronchodilators. He wanted to go home, but I explained one treatment wasn’t enough. He’d need steroids intravenously to dampen down the inflammation that was closing off his lung. Otherwise, he’d be in trouble again and back.

By chance, all the patients I saw after the asthmatic didn’t require admission. At least momentarily I was spared the frustration of sentencing anyone to corridor care.

Then a little old lady was brought in because the day before she’d vomited up black liquid, but hadn’t told her daughter about it until this afternoon. The daughter had rushed her to ER and was pacing nervously all through the examinations and tests. The mother had had an upper GI bleed but was remarkably stable. Under other circumstances—namely, the hospital being run like a hospital—I’d have medicated the elderly woman and admitted her to a monitored bed in an intermediate unit for safekeeping until she could be scoped the next morning. So once again, just as Jones had done that morning, I tried medicating and discharging a patient who should have been kept for observation and more tests.

I tried to explain to her daughter. “If she starts to bleed again, she’ll get a faster response by you calling 911. That’ll get our attention by ambulance through the front door.”

“You’re out of your mind!” her daughter cried.

She was right, of course. “Look,” I said, knowing I had to be completely candid, “here she’ll be parked unmonitored at the end of a corridor.”

“You call this a hospital?”

I looked around at the rows of stretchers, where the elderly woman could slip unnoticed into shock. I remembered another daughter’s eyes.

“Not really, not tonight,” I answered.

“I want to speak to your director.”

“I am the director.”

Horrified, she gaped at my name tag. “Oh my God, you are!” She looked around at our controlled panic and asked, “What about another hospital?”

“Unfortunately, that’s unlikely. But come, we’ll check.” I knew it was futile, but I always showed families “the try.” According to our management manuals we then “share the frustration” and “demonstrate we are not on opposing sides.” The way the daughter chewed her gum and gave me disgusted looks suggested otherwise.

I took her to the computer reserved for a citywide bed registry. State of the art; instant documentation of no beds anywhere; all ERs saturated.

I knew that half the hospitals lied. Some pushed the “code in process” button to reroute ambulances during coffee break. But most of the time it was the same as here: medical patients in beds too long, “pet farms” all over the city. When the changeover to managed care is finally completed, our soft fraud artist Arnold Pinter and his buddies will be out of luck, and the beds will empty out. The trouble is, that’s the way they’ll stay, and everyone will get to experience the world of withheld care, just like Donald Cummings had.

I punched in a request for a monitored bed. Three came up. Two were obstetrical, one was in a cardiac unit—all three inappropriate.

Still convinced it was better to level, I explained my logic again, said it’d be what I’d offer my own mother given the circumstances, and meant it.

She took my name, called her lawyer on our phone, and then walked out, leaving her mother with us and threatening loudly that I’d be hearing from her soon.

It had worked better this morning.

I had the nurses place the lady as close to their station as possible, and then looked around the department for something else to do. It was packed with admitted patients and teeming with relatives. Cries of pain and calls for meds or bedpans added to the confusion, but there were no new incoming patients for the moment.

I went back to my office. Carole had left for the day. I was alone with my options and with the gloom applying itself to the window like a coat of paint.

I thought I’d better call Zak to make sure he’d go easy on sending us ambulances again that night. I caught him just as he was leaving.

“Sure,” he agreed. “But unofficially. Even
I
can’t ban ambulances for more than twenty-four hours.”

“Thanks, Zak.”

“So who killed him?”

Right to the point. Payment.

“Nobody knows yet, except the police think it’s a doctor who can needle hearts.”

“What!”

“You heard me.”

“But that’s your entire department!”

“Including me.”

“Get serious!”

“Oh, I am serious, unfortunately.” And I filled his ears with detail.

“Gee, Earl, I’m sorry,” he said when I’d finished. He actually sounded like he meant it.

While I was talking to him, I’d been absently fingering Jones’s paper. The whole project was under Zak’s supervision. “By the way,” I asked, “how’s the cardiac study going?”

“Pretty good!” Despite it being the end of the day, he sounded enthusiastic. “Nothing earth-shattering,” he began, “but a lot of confirmation of existing treatment protocols, with a few minor improvements.”

“Jones just handed me her magnesium sulfate study.”

“Nice piece of work, that. Too bad torsade de pointes is so esoteric.”

I was about to thank him and say good night when I asked on impulse, “Zak, have you ever had any trouble with her?”

He was clearly taken aback. But when she worked the ambulances on the research study, he was her boss. “With Jones?” he repeated.

I began to feel a little foolish, but pressed on. “Yeah, with Jones.”

He was silent for a moment. Then he asked, “What do you mean by trouble?”

So there
was
something. “Look, Zak, this is completely confidential. It would help me if you could answer.”

“You mean trouble with her work?” he asked, still cautious.

“With anything.”

He was silent again.

While waiting for his answer, right out of nowhere, I suddenly thought that Zak had had sex with her too. That startled me, and I was wondering where the hell it had come from when he finally spoke.

“Never any trouble with her work,” Zak said slowly. “She’s become our best resuscitator over the last few years. I’d be lost without her.”

“What about her personal relationships with the staff?” I asked, still trying to shake off my intuition that he’d been involved with her.

He snorted. “What relationships? The other doctors resent her like hell. She’s abrasive and rude, and very defensive whenever I try to deal with their complaints about her.”

Just like here. Sort of Kradic in a dress. So it wasn’t only me.

“Funny though,” he added, “the technicians love her. She’s always teaching them, and they can’t get enough time with her on the road. She’s good with patients too. It’s the other doctors she can’t get along with. And it doesn’t help matters any that her survival rates are way ahead of theirs. Why are you asking about her?”

“I’m having similar problems. I wondered if it was a personality clash between us.”

“Well, stop blaming yourself. She’s a brilliant clinician and an insufferable prima donna. They exist all over our profession. Patients are lucky to have them, we mere mortals have to endure them. Good night, Chief. I’m going home.”

“And I’m blessed with two of them,” I muttered as Zak hung up.

I did glance quickly at the summary of Jones’s study. As she had said, there were good results for a rare condition, but no clear-cut extra help against our common enemies. The method and statistical precaution against chance giving false conclusions seemed sound. Still, as I filed it, something that I couldn’t pinpoint niggled at the back of my mind. If we ever got back to normal, I’d sit down to dissect the paper in detail.

Janet was on duty in the case room at her hospital for the night. There was nothing more to do here. Tomorrow at noon I had private office hours for patients from my former general practice. I’d kept them on to counterbalance taking over emergency eight years ago. It was shelter from the storm.

But I needed a respite now. If I didn’t occupy myself with something engaging, I’d end up dwelling on Kingsly’s murder and likely make myself panicky again. I unlocked my desk drawer and eyed the statistics I’d hidden there earlier. They were the perfect excuse to indulge in a guilty pleasure and a way to keep myself calm.

I made a quick call to Janet’s answering service and left a message about where I was heading. Pocketing the computer disks I’d need, I scooped the reports under one arm and carried them with me while I gave the ER a final check.

“We’re okay for the moment,” Popovitch said good-naturedly. He eyed the printouts. “And good luck with the statistics, but you’re going to get a hernia lugging all that paper around.”

‘Take care,” added Jones with a slight smile.

I didn’t smile back. I still resented her snooping this morning, and evidently talking about it later, but it was her liaison with James Todd that troubled me most. I wasn’t going to confront her on the ethics of it tonight, but as I looked at this fierce, athletic woman, I suddenly visualized her writhing naked with Zak, then Todd. It had been little more than a subliminal flash, but thinking anything erotic about her at all surprised the hell out of me, and I turned away, embarrassed, dismissing it as part of my preoccupation about her and Todd. I wished everyone else a good evening and left by the back door.

The parking lot was filled with more mist than cars. At the freight entrance, an ambulance stood in a pool of sodium light, and through its rear doors two attendants were loading a stretcher with a body bag on it. Probably they were making a pickup for a funeral home of a patient who had died recently. I wondered if it was Cummings. Above, the hospital lights disappeared upward into gray. Only the administration wing was dark— except for the finance office. Like the night before, it was still lit. I could even make out a figure moving behind the glass. As I watched, I became aware of someone else nearby. Turning, I saw Gil Fernandez standing beside his car and looking up at the same windows. Huddled in a raincoat, he lacked his usual bravado. It was probably the streetlight, but I’d seen precodes with more color.