Lethal Practice (2 page)

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It was almost eleven-thirty. I’d taken care of a cut hand, a few sprained ankles, and four dozen other minor cases that had accumulated in the waiting room during the resuscitation. For the Buffalo area, this was quiet, even on a Sunday night. The few ambulances that did arrive brought mostly elderly patients with the flu. Serious, but not life-threatening. Nevertheless, I was feeling the fatigue of keeping the cases all straight in my mind, and I was glad my shift ended at midnight. At twelve-twenty my replacement still hadn’t arrived.

Kradic! The other evening-shift physicians had complained that he’d been turning up later and later. I’d talked to him, but he’d only scoffed. He was almost always so damn belligerent that the only way to make him admit any problem, let alone correct it, was to hit him head-on with undeniable evidence. So when one of the other doctors came down with the flu the day before and asked me to cover for him, I hadn’t been reluctant, because of Kradic. If he was late, he damn well couldn’t deny it to my face.

“Think you’ll get home tonight?” Susanne asked, coat on and heading out. The grin on her face gave me less than even odds. Even my resident had disappeared, probably to get some sleep, but at least there weren’t any patients waiting to be seen.

Forty minutes later Dr. Albert Kradic sauntered in. He was tall, a bit overweight, and had a pasty complexion from working nights. He kept his black hair combed flat except for a bit in the front that he let fall forward over some old acne scars. He was in his late twenties, but he looked older, and judging by the expression on his face, I could tell he hadn’t expected to see me.

I decided to fire first and fire loud so the nurses could hear. I knew Kradic had money problems, badly needed this job, and was fanatical about his reputation. I didn’t think that in front of all the regulars on the night shift he’d have the nerve to deny he was repeatedly late. The smirks of those nurses could make even him cower.

“Dr. Kradic, you have a problem starting at midnight?”

“What do you mean? My alarm didn’t go off, is all.” He had the nerve. One of the nurses snorted and Kradic shot her a hard glance.

Christ, I thought, they’ll be at each other worse than usual now. Whenever spats between staff got out of hand, they invariably sent me notes later, each side complaining about the other person’s offensive behavior. I’d have a few on my desk in the morning for sure, especially with Kradic trying to find out who had squealed about his being chronically late.

But tonight I was too tired to prolong the encounter. “Make sure it doesn’t happen again,” I snapped, and started right into sign-out rounds. I kept the synopsis on each case short and fast enough to cut off any attempt Kradic might make to come up with more alibis.

Five minutes later I was out of my white coat and lugging my briefcase toward the front entrance. My feet hurt, my back ached, and I needed a week of sleep. The security guard was just opening the door when my escape was thwarted by the PA.

“Ninety-nine, administration! Ninety-nine, administration!”

Shit!

The night air flowed cool and fresh through the still-open door. I could keep walking ... let the others take care of the arrest.

But I’d never sleep.

Resentfully, reflexes taking over, I charged back to the ER and met the nurses coming from the resuscitation room with a crash cart. A startled-looking Kradic tried to wave me off.

“You stay here and manage emerge!” I told him. I turned to the nurses. “Meet you there!”

I ran for the stairs. They would follow with the arrest team in the emergency elevator and arrive thirty seconds behind me. This was our automatic protocol for any cardiac arrest not in an admitting area.

Climbing the steps two at a time, I wondered who’d be in administration this time of night. Then I thought of Kingsly. Perhaps the guards hadn’t found him earlier and he had knocked himself off during one of his attempts at sex. As I entered the carpeted hallway unique to the administrative part of the hospital, I wasn’t surprised to see the hushed gathering of cleaning people, porters, and security guards at the far end of the corridor outside Kingsly’s corner office. Still puffing from racing up the stairs, I slowed to a brisk walk and prepared my mind to run an arrest. However, as soon as I stepped into the large and windowed reception area that was the antechamber leading to Kingsly’s inner office, my nose told me there would be no use offering life support, basic or advanced. Mixed with the stink of feces and sour urine was the odor of early rot.

A clutch of pale, wet-eyed cleaning women in greens huddled in the doorway, staring into the office, cloths pressed to their noses. The scene inside matched the smell. On the floor, in the middle of a thick powder blue rug in front of a mahogany desk, lay Kingsly, nearly naked, a mound of white belly below a purple face.

Two other women were alternately gagging, pumping his chest, and trying to blow air through his gaping blue lips. There was vomit running out the side of his mouth, but whether it was his own or one of the rescuers’ I couldn’t tell. His undershorts, the only thing he was wearing, were halfway down his crotch and sodden with excrement. Some had bulged out between his legs. Jesus, what a mess.

I moved to his side and felt for a carotid pulse in the neck. None, and he was cool, even in the stifling heat of the room, which I absently noticed. His two resuscitators were still pumping, blowing, and choking. They had obviously been taught CPR, but the leap from training to the real thing wasn’t usually this bad.

With him long out of his misery, I was about to put the women out of theirs and stop the arrest when I noticed something odd. Every time the woman pumped, a thin jet of bubbly blood squirted out onto his abdomen. I knelt down and stared. The blood came from under a recently formed scab the size of a blueberry that was just to the left of the tip of his sternum and had lifted loose. Under the scab, with each press on the chest, the small silver end of a broken needle rose out of the ooze and then receded back into Kingsly’s innards.

More bubbles and thin jets of blood appeared with every chest compression. The bubbles indicated the channel of the wound was deep, burrowing at least into the lung. The jets of blood told me that unless the man had been trying to turn himself into a voodoo doll, someone had driven a cardiac needle into the center of Everett Kingsly’s heart.

Chapter 2

Despite the atrocity on the floor, I was almost unable to accept what I’d seen—that Kingsly had been killed— and I dreaded pronouncing it even more. I gently put a hand on the shoulder of the woman next to me to stop her attempts at CPR. Her companion made a few more futile puffs into Kingsly’s flabby mouth, then pulled back. They were both visibly shaken.

“You did everything you could,” I said as I helped them up.

“Are you sure?” one of them asked.

“Absolutely,” I answered, patting her arm.

I ushered the women to the door, where other comforting hands waited, and saw the cardiac arrest team racing with their cart down the corridor. I waved them off.

Then I blanked. What to do now was not familiar. Death yes, but not the management of what I’d discovered here. I was still the only physician in the room and, therefore, in charge of the body. But being the only person who knew that Kingsly had a broken needle in his heart left me thinking back to old detective novels for guidance. I figured blurting out that he’d been stabbed wouldn’t help.

More people were peeking into the office from the outside reception area. A security guard pushed to the front, saw Kingsly, and went a little pale. Two nursing supervisors caught him as he swayed and helped him to a chair.

“Don’t touch anything” was what I finally said, trying to sound authoritative. One of the night supervisors gave me her who-do-you-think-you-are look and dropped a dust cloth over Kingsly’s partly exposed privates. Somehow, it didn’t help.

I tried again. “I want this room cleared now, please, and someone find our chief of pathology and tell him to get here fast.” After they’d had their peek, and a whiff of the body, everybody was eager to get out anyway.

Two orderlies came and helped the still-woozy guard to a couch in the reception area. The supervisors took turns with the phone on the secretary’s desk. I was just leaving Kingsly’s office when I thought again about how hot it was. I glanced at the thermostat mounted beside the door frame. It was set at the very top; the room must have been at least a hundred degrees. Unthinkingly, I turned it down.

“Did anybody turn up this heat?” I shouted to the people in the reception area. I got only incredulous stares. Was it always so hot in there? I wondered. I didn’t recall from my previous visits, but I had kept those as rare as possible. Or had the heat been jacked up to prevent the loss of body temperature that would reveal time of death? And then I cursed myself. While pompously ordering everyone else to touch nothing, I’d gone and fingered the very dial that might have held a killer’s prints.

As I closed the door, I saw Madelaine Hurst, associate director of nursing and the chief night supervisor, arrive and walk over to her assistants. The one on the phone immediately hung up, and I watched as they began talking to her in hushed voices. She was senior, discreet, and, I figured, best able to handle the next step. She was also the sister of Paul Hurst, former surgeon and now the medical vice president for the entire hospital.

I went up to them. “Miss Hurst,” I interrupted, “I need a private phone, and then I need you to get the medical examiner for me. After that call the police—in particular a senior officer from their homicide department.”

She looked at me like I was nuts. “The only person I’m calling is my brother—which I’ve already done. He’ll be here any second.” She didn’t add “so you’d better watch out,” but I still felt like a kid in a school yard.

“Please, just do what I asked,” I said in a low but forceful tone.

She backed away as though I’d let out a bad smell, but went to the secretary’s desk and started dialing. I spent the next fifteen minutes arguing with groggy clerks at the medical examiner’s office, being put on hold, and quarreling with Miss Hurst over calling the police until she suddenly shut up. Her brother had arrived. He had obviously dressed hastily, because his raincoat hung open over a wrinkled white shirt and baggy pants. His normally pale complexion had become even more pasty and shone with a sheen of perspiration.

“Oh, Dr. Hurst, thank God you’re here.” In public Madelaine Hurst always addressed her brother formally. “Poor Mr. Kingsly has died in there. He’s lying on the carpet with most of his clothes off, and now Dr. Garnet is making me call pathology, the medical examiner, the homicide squad....” She let the indictment hang there, in the air, while Paul Hurst slipped his arm around her shoulder and joined his sister in frowning at me.

Just then, thankfully, Robert Watts, chief of pathology, entered the reception area with his usual sense of quiet command.

“Where is he?” he asked calmly.

Tall and gray-haired, Watts retained his ease even during the toughest crises. He stood there, glancing first at Hurst, then at me, ready to get down to business.

Hurst, clearly annoyed with me, said, “Sorry, Robert, but Garnet here is out of—”

“Gentlemen,” I interrupted. “If you will step in here, you can see the situation yourselves.” I opened the door to the office and showed them Kingsly.

It took Watts thirty seconds to agree with me that we had cause to suspect murder and must notify the medical examiner. Hurst’s whining wasn’t going to change the law. Watts was also pretty sure the medical examiner would order us to call the cops immediately, but he went out to phone the city morgue and speak personally to the chief pathologist. Being a colleague, Watts might rate more attention than I’d gotten earlier from the clerks.

Hurst hung around in a sullen silence to make sure I didn’t cause any more harm to the hospital’s good name. He’d cover up the murder of his own mother to avoid a scandal, and this was going to be a tabloid special.

“What do you think happened?” I asked gently. The sooner he accepted the truth about Kingsly’s death, the better he’d help everyone at the hospital deal with it. Starting to analyze the gruesome situation would give him the start of the objectivity he was going to need ... or so I hoped.

“Lord knows” was all I got in reply.

Watts returned. “The medical examiner’s seeing to it that the chief of detectives is sent over. We can do the autopsy here, but he wants his own man on-site to take special forensic samples. Finding clues to a murder isn’t what we usually do.”

“Murder?” Hurst winced. “Surely you’re jumping to conclusions!” He looked around for corroboration. Watts and I looked at Kingsly. Hurst’s shoulders slumped. “Should we just wait here?” he asked.

Watts glared at him. “Wait in the reception area if you want.”

“Robert,” I said, “when I came in here, the room was hotter than Hades. I think someone must have turned the heat up to try to obscure the time of death.”

“How do we know it wasn’t suicide?” Hurst asked, pathetic now, still staring at Kingsly’s corpse.

Hurst’s question startled me, but Watts stepped over and gently took his arm. “Look, Paul, maybe it would be better to wait outside.” He spoke in that tone we too often use while dealing with geriatric cases; it inferred feeblemindedness and was grossly insulting, but Hurst didn’t seem to notice. He let Watts and me guide him out of the room and sit him down in a chair by the secretary’s desk now commandeered by his sister.

She’d been sternly snapping off a string of orders over the phone, presumably to the floor nurses, when the sight of her brother being so acquiescent must have sparked her hurried good-bye and quick move to comfort him. “Paul, are you all right?”

“It’s awful,” he said almost to himself, as if she weren’t even there. “Just awful.”

“Paul!” She stroked his hands, then awkwardly touched his cheek.

Finally he seemed to notice her. “I’m fine, really, I’ll be all right,” he said weakly. But he continued to slouch in the chair where we had put him while his sister made nervous fluttering movements. By the time she finished, she had also realized her brother was no longer in charge. She looked to Watts and me for orders as angrily as if we had just staged a coup d’etat.