Lethal Practice (26 page)

Out of the corner of my eye I saw Watts frowning at me. When he caught me looking, he quickly turned away. Of all of them, his was the opinion I most cared about, but if something was troubling him, he didn’t let me in on it.

Chapter 12

It was the type of day when the afternoon light starts fading at one o’clock. Fog and low clouds slid over the city like rolls of steel wool. Even photo sensors on the street lamps had declared most of the sun’s effort invalid and left a ragtag pattern of some off, some on, and some flickering feebly in limbo—vital signs of a dying neighborhood on a monitor, part of a city weakening and shutting down.

The daylight filtering through the mist was little more than a dim glow, the kind that emanates from a TV set left on after sign-off. The houses, modest boxes set back from the street, were blurred. The few cars that were out hissed their approach before I could see them emerge and then vanished quietly in the white haze. Each time I heard the sounds I stiffened and hugged the inner sidewalk, then relaxed and tried to shake the previous morning’s attack.

But that wasn’t why I was out walking, at least not entirely. A bit of it was frustration at trying to dodge a faceless menace. But the real reason was a deeper niggling that had kept interfering with my attempts to work. I’d tried several routines throughout the morning to distract myself. In the end I felt like an actor, restlessly putting on one costume after another and none of them being right for the part.

I’d checked emerge. It was a mess. Did they need help? No, they needed beds. I called Janet. She was busy in the OR. At least she was safe, if operating on AIDS patients was safe. Her partner had just had his hand sliced by a resident’s slip with a scalpel while in the open abdomen of an HIV-positive woman. The risk depended on the amount of the patient’s blood that had contaminated his wound, but even if it was minimal, and even if his tests in three months and six months were negative, there would be lingering doubts for years each time he made love to his wife.

My feet made crunching sounds on the remains of a broken beer bottle. I sidestepped the jagged end piece and thought of our wallpaper. I scuffed the smaller glass bits off my wet soles and trudged on, but I couldn’t shake off my black thoughts.

I’d called the vet. No change. This was the gray time, hope soiled with dread. On many occasions I’d cast that same sentence over human life.

I’d tried working on the quality assurance study in my office. When Carole had placed all the material on the disks now in the trunk of my car, she had done the work on the hard disk of the computer she locked away each night. With her help—I was hopeless wading through her computer files myself—I had been able to work on the numbers, but the data was frustrating in its monotony. Any answer it held slid beyond my grasp. There were highs and lows, wins and losses, but mostly draws, and all within the norm. I could find nothing to kill for. At least, nothing I could see. But the image of a baby’s room slashed and coated with feces suggested madness, not logic.

I’d managed to make the record of my actions and conversations over the last few days for Bufort. The net result was, as he had so eloquently put it, I hadn’t a clue who I’d threatened or why anyone thought it necessary for me to die.

I felt a little satisfaction though. By taping the report instead of laboriously writing it out, I’d foiled Janet and Bufort’s plan to keep me busy for days. When I’d finished, I had asked Carole to type it up and send it to Bufort.

Then I’d ended up pacing the office, driving her insane. She suggested I go bother Mrs. O’Hara, but no patients were booked that day. Still, I’d shuffled over through the parking lot and found Mrs. 0 filing lab reports. After having me check a few abnormals and arrange follow-up tests or repeat examinations, she wasn’t putting up with me either.

So here I was, walking in the fog, trying to get past the debris of what I knew and tease out what was bothering me. Cushioned by the mist and braced by cold, I kept thinking I had missed something. I reran the morning meeting, and the fuzziness slid into a single focused image: Fernandez. But this time it wasn’t his fear and agitation that struck me. I’d just discovered what I’d overlooked. In fact, it was something that was missing from the events at the meeting that was incongruous. I’d missed it because it was a negative find—not there when it should have been. As I told my residents over and over, unless you go after negative signs, you’ll miss them every time. I had to talk to Fernandez. It didn’t make sense, but what wasn’t there that should have been was all I had.

I wheeled around and headed back toward the hospital through the fog. It was growing darker now, and the hospital’s lights loomed up over me like an onrushing ship.

I left my raincoat in the doctors’ coatroom, dripping alongside other bedraggled wet wear. The place smelled like the inside of a running shoe. Plaster fell out in chunks, pushed by fuzzy green and blue mold that bulged from inside the walls. Maybe Hurst’s cost cuts could lead to a new source of income—growing our own penicillin.

Hurrying down the hallway toward psychiatry, I had little idea of how to confront Fernandez other than surprise him into leveling with me. But as I got closer to his office, I remembered him screaming at me in the parking lot the day before and began to rethink the likelihood of startling the truth out of him.

My second thoughts brought me to a stop in front of the coffee shop. After the gloom outside, it looked like a sanctuary of warm light and delicious aromas. Hot soup and a bagel with lox suddenly seemed far more important than ambushing a frazzled shrink.

I slipped into line and caught the attention of the woman behind the counter. She mouthed over the other waiting heads, “The usual?”

I nodded thanks, stayed in line to prepay the order, and tried to think of a better way to question Fernandez.

At the cash register, my musings were interrupted by Bessie. Eighty-one now, and a regular volunteer for the auxiliary, she had been head nurse in emergency when I first came on staff. Trained and seasoned in World War II, she was at ease in a crisis and ever ready for a drink or a poker game after the work. “That’ll be six-fifty, Doc. When are you and that other doc of yours going to finally learn how to make kids?”

Janet was her doctor. She’d taken an ovarian cancer out of Bessie two years ago, and Bessie had been back on her stool three weeks later.

“Hey, lady,” I said, “shows you haven’t kept your appointment with Janet. We finally figured it out. Must’ve missed the lecture. Looked it up in one of her books. Our first will be here in April.”

Her smile and surprise were genuine. “I’m so glad for you.” She gave my hand a squeeze after handing back my change. “And my best to Janet. Tell her I’ll be in.”

“You’d better, Bessie. Skip one appointment and see what you miss?”

Another smile and she was on to the next in line.

I headed for a free table and passed a foursome of retired surgeons. They gathered each afternoon to relive old battles and rehash cases long since dust. Twenty years ago they were my teachers and in their prime. When I took over as chief eight years ago, one of them, Jack Graham, was still working emergency, hopelessly unable to keep up with the increasing pace and standards. He’d become outright dangerous. My first task was to tell him it was time to leave. It was like telling him he had cancer, but for him it was even worse: He was sentenced to go on living without his work.

I greeted them all by their formal names, since I remained an intern in their eyes. Three of them nodded, but all I got back from Jack Graham was an accusing silence.

I passed the very stool at the coffee counter where, as an intern those same twenty years ago, I’d received a hurried cup of coffee and a five-minute orientation from the chief resident. He had raced back to the OR and I walked into emergency for my first shift under Bessie’s ample wing. Now I was at the halfway point of my own journey toward the day when one of my current residents would probably tell me the ride was over, that it was time to go home. Would I blame the younger doctor, or only the bitter irony?

“Jack still hold you responsible for his old age?” It was Watts, sitting alone at a table, apparently amused at what he’d seen.

“Hey, for time itself.” I noticed his half-empty cup of coffee and an open sailing magazine by his elbow and invited myself to sit. “How’s your dream machine coming?”

“Going to be ready when the spring ice goes out, and I’ll be out of here with it.”

I paused with a spoonful of soup halfway to my mouth. “That’s bad news.” I meant it. I didn’t relish surviving the rampant rise of hospital bureaucrats without his deflating wit and clinical savoir-faire to keep
some
vestige of sanity. I also knew his term had two more years. “Why?”

“I’ve had it. My Christmas card this year will include my resignation. They’ll have till spring to find my successor.”

There was a heaviness about him that didn’t surprise me. He’d vigorously carried the load of being the hospital’s conscience for thirty years. As keeper of the final diagnosis, he had wielded his knife with a passion to improve care and learn from the verdicts: correct or incorrect, right or wrong, unavoidable or avoidable death. There was no appeal, and no one escaped his theater of judgment. Watts had been our gatekeeper.

All of this had changed forever when his wife died. He still did the job, but his passion and his quiet joy in excellence were mostly gone.

“Some investments I made came through,” Watts added. “I’m expecting some more final dividends soon. I don’t need the next two years. Enough’s enough.”

There was a bleakness now to his plan in contrast to the same dream he had expressed to me at a happier time three years ago. He stared at the photo on the open page, a sailboat ad, with a robust gray-haired man and woman at the wheel of a yacht on open seas.

My bagel tasted dry. “What was bothering you at the end of today’s meeting, Robert?”

His double-take startled me. “What do you mean?” he asked.

“Your look. At the end of Bufort’s soliloquy.”

He shrugged as if he didn’t know what I was talking about.

“C’mon, Robert, I’ve seen that look before. Your nose was definitely out of joint—and that’s something, considering what your nose puts up with. So what was it?”

He sat completely still, like a card player weighing his hand, trying to decide whether to play or fold. Finally, he said, “It shook me that an attempt had been made against you.”

I waited for more.

“Hey, that’s it! I swear! It’s one thing to do what I do to strangers. It’s another when a pal threatens to become one of my patients!”

He sounded sincere, but I didn’t believe him. I also knew pushing him wouldn’t help. Over the years I’d seen how stubborn he could be once he decided something.

“What about the derelict?” I asked instead.

He seemed relieved to change the subject. "Funny, that. The tox screen was nonsignificant apart from his maintenance level of alcohol, but it was alcohol, not some cocktail better suited for cars.”

He meant no antifreeze or methanol.

“I don’t have the trace-element levels yet. We send them out to another lab. The rest was negative, pretty much.”

“Pretty much?”

“Yeah. He had hay fever, but some rookie, probably in a street clinic, thought it was a cold.”

“You might diagnose chronic allergies from tissue samples on a post,” I answered, “but find out the thoughts of people he met too?” I knew it was my expected role to play incredulous. I was going to be taught something.

‘Traces of terfenadine and a touch of erythromycin.” He leaned back with a smug smile.

I saw what he meant. Terfenadine was a hay fever medication, but alcoholics living on the streets usually spend what little cash they scrounge on booze. The John Doe must have gotten a clinic sample. Erythromycin was a form of penicillin especially for people with a penicillin allergy. It took a prescription, and only a rookie would have given antibiotics for hay fever or been browbeaten by a patient into prescribing them for the symptoms of a viral infection that hay fever might mimic. Worse, a precautionary had been issued against giving the two together. Fatal arrhythmias had occurred with little more than therapeutic doses.

“Do you think it’s a drug-induced dysrhythmia?”

“No. But you’re right to think of it. These things rarely leave footprints. His anatomy and conduction pathways were normal, and the rest of the drug screen was negative. However, you’re forgetting another little feature in this guy’s heart that was a lot more obvious cause of death.”

He made a stabbing motion with his finger over the left side of his chest. “The slides of tissue samples along the needle track show extensive intracellular bleeding and none of the degenerative changes I’d expect to see if the needle went in postmortem.”

In his own inimitable fashion Watts had made a clinical description of the stark way the DOA had died. The needle had gone into the beating, healthy heart of a very live man and then killed him, fast. The mechanical effect of the tip or something injected had stopped his heart cold. Either way, it was murder. The needle definitely hadn’t gone in after he was dead. He had been killed just like Kingsly.

“Did you tell Bufort?”

“After our last encounter? Fuck him. I’m submitting my written report as required.”

He surprised me; revealing nasty news to people bent on keeping their illusions was Watts’s specialty. Besides, this morning Bufort had seemed pretty resigned about what Watts was going to find.

“Do you mind if I do?” I asked. Bufort needed to know as soon as possible.

He hesitated, then replied quietly, “Be my guest. By the way,” he added, “I’ve called a few of our sister hospitals to see if anyone found cardiac needle tracks on any other DOAs, and I suggested that they keep their eyes open.”

“My God! And did they?”

“They haven’t had the chance. It seems the run has dried up for now.” He gathered his magazine, stood up, and said, “Well, back to work.” I watched him carry his tray to the rack by the door. He found a slot for it there, then smiled and gave me a parting wave. Always a teacher, he should have been restored from enlightening me. Instead, he looked worried.