Mortal Remains (23 page)

Within minutes he was arguing with the head nurse of the geriatric wing at NYCH, insisting they check their short-acting insulin supplies to see if any were missing.

11:00 A.M.

Medical Records,

New York City Hospital

“Dr. Garnet,” Lena Downie whispered at his shoulder, “it’s the call you’ve been expecting from Dr. Collins.”

Finally!
he thought, following in Lena’s wake as she led him to a phone behind the front counter. She had the rolling gait of a female John Wayne.

“Melanie?”

“Earl! Sorry I didn’t get back to you earlier, but I’ve been up to my ass in crocodiles with budget meetings last night and rounds this morning-”

“Hey, don’t apologize. I’ve been there many times.”

“What can I do for you?”

“Bessie McDonald, a former patient of yours, is the woman whose M and M report was in Kelly’s file. Mark said he spoke to you about it Sunday night, but didn’t have the name yet.”

“Bessie? Well, my, God. That’s a weird coincidence. I knew she’d had a relapse two weeks ago. The nurses on her floor notified my office that she was found comatose one morning at 4:00 A.M. I’d even dropped in for a long overdue visit the day before, and she was fine – well, you know how these things go. I just assumed she must have thrown another embolus. But it was her chart Mark asked about? This is really strange. Do they know what happened to her?”

“The CT shows no infarcts, so it’s probably metabolic, but-”

The sight of Lena hovering nearby interrupted him. “I need to talk with you in private,” he said instead.

“Sure. I’ve got rounds until five. How about we meet at my apartment? I can make us a pitcher of the best martinis you ever had, and we can discuss whatever you want with no interruptions.”

“Sounds good.”

She gave him the directions.

Back at his desk, he returned to what he’d been doing since morning – reexamining Bessie’s old records from 1974 to the present. The reason? Tanya Wozcek had gotten him thinking the worst. Yet he’d gone over everything a second time and still couldn’t find a single entry that suggested an error in her management back then. At least not the kind that gets written down.

So he’d gone searching through the rest of her old charts, checking subsequent admissions to see if she had any tendency to develop any transient metabolic states that might have spiked her digoxin level, yet been missed in ‘seventy-four because they came and went: things like renal failure from dehydration; side effects of other medications; interactions with those drugs – he looked for them all.

The result? Nothing.

That left only two other possibilities: the sort of accident that occurs in the syringe, a nurse drawing up too much digoxin – or what Janet had suggested, a deliberate overdose. Given that the same woman now lay in a coma, also unexplained, tilted him toward the latter.

However, the records here only went up to the admission under Melanie four years ago, the one Tanya had mentioned. The more recent entries would be in her active chart on the floor. Should he go back upstairs and poke through them too? He glanced at his watch and saw it was nearly 1:00 P.M. He might as well, to be complete. After all, he had the rest of the afternoon before Melanie got off duty. He could also try to reach the people whose resident numbers were on the old M and M reports, if the teaching office could track them down for him. Who knew what bizarre piece of information one of them might remember that would prove useful?

Before closing the chart, he took a final glance through the clinical notes Melanie had written at the time of the first embolus, refreshing his memory about what had been done so he could more easily pick up the threads of the patient’s story when he got to the floor.

Precise, to the point, and clear, they documented why she had thought McDonald’s symptoms were the result of a clot, not a bleed, and warranted immediate thrombolitic therapy. Earl was impressed. The symptoms and signs distinguishing one from the other were subtle. In his own ER he’d seen seasoned neurologists dither over similar cases, then not insist as authoritatively as they should have for an immediate CT, thereby wasting precious minutes. Not Melanie. “Eyeball to needle time” as the residents called it, or the duration from when they first saw the patient to the infusion of a clot buster, had taken three-quarters of an hour, which meant she hadn’t squandered a second in making her own diagnosis and getting radiology to prove it. “Well done, Melanie,” he said under his breath.

As he walked out the door, Lena gave him a frosty good-bye, making it clear she hadn’t appreciated his denying her a chance to eavesdrop.

That same day, Tuesday, November 20, 1:15 P.M.

Hampton Junction

“I
read your transcript today,” Mark said to Lucy, as they shared a late lunch of soup and salad at his kitchen table. “No wonder you handled yourself so well with my patients.”

She chuckled, with her mouth full of lettuce. “My past was no secret, if you’d read your mail lately. That’s quite a pile on your desk.”

“It’s a bad habit of mine, avoiding mail. All I seem to get is forms, bills, and professional questionnaires. I hate paper-maze stuff.”

“Join the paperless society and use e-mail.”

“I did. That gave me even more junk to deal with, so I canceled it.”

“I’m surprised. You being way out here yet not wired-”

“Oh, I’m on the net and have necessary passwords that let me access labs and X-ray departments to get test results.” He knew he sounded defensive, but he didn’t want this sophisticated, world-traveled lady to think he was a hick.

“It’s just that I never met anybody in America who doesn’t have e-mail,” she said.

He grinned and held out his arm. “Want to touch me to see if I’m real?”

She laughed, skewering what looked like half a head of Romaine with her fork and toasting him with it.

“Tell me about where you were stationed with
Médecins du Globe
,” he said, figuring he’d mangled the pronunciation.

Her smile vanished. “I’m afraid it was the grand misery tour, from Papua New Guinea tribal wars to refugee camps in Somalia, Rwanda, Bosnia, and Albania.”

There was hardness in her voice that told him she didn’t want to talk about it. “I can only imagine what you’ve seen,” he said, after casting about for something to say. It sounded lame.

She remained quiet for a few seconds, then asked, “You were never tempted to join? Obviously you have a taste for challenge, working out here.”

“No, never tempted.”

“Why? Most of the time we’re not getting shot at, if that’s what you mean. Much of the work is a lot like this morning. Sick people come in, tell you what’s the matter, and you treat them. Except we deal out of tents and the backs of trucks.”

He noticed how she talked about the work as if it were ongoing for her. As for her making it sound routine, “Yeah, right,” he said. “You guys are awesome. It sure explains how you seemed so comfortable handling my patients. This practice must seem like child’s play compared to what you’re used to.”

The corners of her mouth twitched upward like a pair of mischievous quotation marks. “Well, we did have distractions in the field that you don’t, like local warlords to keep happy, and creepy crawlies in our sleeping bags, which I can definitely say I do not miss.”

“Don’t sell the Adirondacks short in the creepy crawlies department.”

“What do you mean?”

“When I was in medical school I did a rotation through an ER in Lake Placid. A hiker came in with puncture marks on his leg claiming a rattler bit him.”

“I thought there weren’t any poisonous snakes in upstate New York.”

“That’s exactly what they told the hiker in ER. Wouldn’t give him antivenom.”

“So what did he do?”

Mark’s grin widened. “Went back to the trail where the damn thing attacked him, found it, and killed it with a tire iron. He returned to the hospital and threw it on the desk of the triage nurse. He got the shot.”

Lucy started to laugh. “No!”

“Saw it with my own eyes. It was even in the journals. Apparently the rattler escaped from a reptile zoo nearby. Taught me to always believe the patient.” He glanced at his watch and pushed away from the table. “We’ve got to get moving. House calls.”

Lucy followed Mark’s directions along an unplowed back road. A brilliant sky provided the perfect blue to contrast with the fresh snow, the sun cast a glitter over everything, and the mountainous contours in the distance seductively beckoned him to ski their curves.

“You know what I love about the first winter storm?” Lucy said as she navigated the coiling road much faster than Mark would have liked.

“What?” He began to keep a wary eye on the ditch, as if that would protect them any.

“Overnight it smooths away all the boundaries, curbs, sidewalks, roads – the things that tell us where to go or what lines to stay between – and makes a place seem all so open, as if for once we can go any which way we want and ignore the rules.”

“Really.” Pressed against the passenger door as she slithered through yet another turn, he wondered if she meant it literally. “How come you dropped out from all the excitement of
Médecins du Globe
to take a residency in family medicine?” Perhaps if he got her talking, she’d slow down.

“There are only so many nights a person can sleep on the ground worried about bullets and bugs. I was due to come home.”

“Where’s that now?”

“New York. I can’t get enough of the city.”

Like all the other women he knew. “So how did you like McGill?”

“Ah, Montréal,” she said, leaving out the
t
and pronouncing the city’s name the French way. The ease with which she slipped into the accent suggested a facility with the language rather than affectation. “Wonderful.”

“I take it you speak French?”

They weaved through an
S
that should have qualified them for the Grand Prix circuit, and a smile created tiny creases around her eyes.

He had to admit she was a superb driver.

“Raised with it,” she said. “My mother was French.”

“But O’Connor is Irish.”

“That’s Dad. He worked for a petrochemical company when he met Mom during a posting in Montréal. Fire meeting fire, those two. For my brothers and me, it was like living between two opera stars – passion personified.”

“You grew up in Montreal?”

“First years of my life only. Dad led us all over the world, including the Middle East. I guess that’s where I inherited my wanderlust. But enough about me. Tell me your story, Dr. Mark Roper, starting with what the hell happened to you last night. I presume it’s got something to do with why you don’t have wheels today.”

Should he confide the events of the last few weeks to her? Part of the curriculum he promised residents included exposure to the world of a country coroner, so why not? After all, it would be no different than trusting her with medically confidential material in his files. “You read about the body of Chaz Braden’s wife being found near here?”

“Who at NYCH hasn’t? I also saw your name in the paper, and Dan’s too, come to think of it, in connection with the investigation.” Her eyes widened. “Does that case have to do with last night?”

“I’m afraid so.” He began to relate the events that had unfolded since he and Dan discovered the remains at the bottom of Trout Lake. As the story progressed and he recounted his childhood impressions of Kelly, Lucy’s expression grew somber. When he described what he’d found in his father’s medical files, quoting parts of the letter by memory, she shook her head.

“That ill-starred woman,” she said. “To sound so happy – yet be on the brink of her death. Do you have any idea who the man was?”

“No,” he answered, a little too quickly, and moved on to describe how Chaz Braden had been a suspect at the time of the disappearance, then cleared by the police. He also filled her in on the file Everett had given him. He left out a lot, too, said nothing about Chaz’s or anyone else’s behavior at the funeral, and, when recounting the previous night’s shooting, made no mention of who he suspected had been the man with the rifle. After all, she was a resident in the hospital where Braden worked. Whatever he thought of the creep, he had no right to share his suspicions. They could blight any future teacher-resident relationship she might be obliged to have with Chaz as part of her program.

When he’d finished, she gaped at him in amazement. “You think he killed her, then tried to kill you because you’re onto him?”

“I’m not saying that.”

“But you feel it was him, don’t you?”

So much for pulling off the persona of being an unbiased investigator. He’d have to be more careful to distance himself from whatever he said about the case to her, but she felt so much more a colleague than a protégé. Still, he held to propriety. “No comment, Dr. O’Connor, and you don’t talk about this conversation with your friends back in New York, understand?”

“Of course not.” She sounded annoyed with him for even thinking such a thing.

“Sorry, but this is a murder investigation, and I want it done by the book, so nobody can scream ‘foul.’ ”

“I understand entirely.” Her tone said the opposite.

God, he hated when women did that, got all frosty and reasonable, while making it clear they thought he was full of crap.

They drove a few miles without saying anything, the easy ambiance they’d first established replaced by awkward silence.

Why should he feel so bad? It wasn’t as if he’d overreacted.

A few more miles went by.

Okay, maybe he overreacted a little bit. She must have felt he was putting her in her place, or something silly like that.

But he definitely didn’t have anything to apologize for.

Not a damn thing.

Nothing.

“Sorry, Lucy, for speaking so sharply. After last night, this case has me on edge.”

“Oh, don’t apologize. You’re absolutely within your rights, protecting the integrity of an inquiry.”

Like hell she thought that. “No, I apologize.”

It still didn’t feel right between them. The only way to make amends was to go on taking her into his confidence. “Now let me tell you the rest of what you need to know, then I’d like to hear your ideas.” He continued the story, describing the morbidity-mortality reports in Kelly’s file, the fact that someone had broken into his house after the funeral, apparently to go through them, and what happened to Bessie McDonald two weeks ago. “I’ve recruited one of Kelly’s former classmates to go over the woman’s files. Her coma seemed a little too convenient for my liking.”

Lucy continued to drive without speaking, but obviously lost in thought. The chill had vanished and Mark started to relax, finding her speed didn’t bother him as much. It wasn’t reckless, and he’d often driven faster. He just resisted relinquishing control to someone else behind the wheel.

“I really would like to work on this with you while I’m here,” she said after a few minutes, “if you’ll accept my help.”

“No question of it. Your rotation is meant to let you experience all aspects of being a rural physician, and this business is part of my job.”

She glanced over at him. “Solving Kelly McShane’s murder has to mean a lot more to you than just being part of your job. From the way you described knowing her, she must have been very important to you as a child.”

The velvet quiet of her voice surprised him more than what she’d said. “Yes. She certainly was special.”

“Your telling about her, what she’d been like, really got to me. I couldn’t help thinking…”

“She reminded you of yourself, maybe? Young, ambitious, ready to take on the world?” He’d said it without thinking, and no sooner were the words out of his mouth, he felt presumptuous at finishing a thought for her.

Lucy flushed. “I was thinking how close we were in age. She was just three years younger than me when it happened.”

A few minutes later they pulled into an unplowed driveway beside single-story bungalow not much bigger than a single-car garage. White smoke drifted out a rusted stovepipe protruding through a tar paper roof. The wood siding had once been painted lime green, but not recently. What few flecks of color remained appeared about to blow off, and the surface beneath had weathered to a nice gray.

“Who are we seeing here?” Lucy asked, getting out of the car.

“Mary Thomson and her sister Betty. Mary’s got terminal breast CA, but refuses hospitalization.” He grabbed his black bag from the backseat and trudged through an unbroken half foot of snow toward the front entrance. “With Betty’s help, I’m keeping Mary at home as long as I can.” He rapped sharply on a new-looking white door with a large windowpane covered by a curtain on the inside. “Betty, it’s Dr. Roper.”

Introductions having been made, he and Lucy entered the bedroom. He removed the dressings from under Mary Thomson’s right arm and exposed a glistening black cavity the diameter of a walnut where the tumor had eaten through the skin of her axilla. Thousands of tiny, scarlet metastases extended to the middle of her chest, rendering it red as a boiled lobster, and from biceps to wrist her arm was swollen the size of a thigh. Where her breast had been, the tissue lay stretched and scarred, some of it cratered like a lunar surface. Everywhere he touched felt hard as wood, and a cloying aroma of decay hovered over it all.

“Now you don’t be shy, dear,” Mary said to Lucy, flashing an overly white smile of false teeth that seemed too big for her gray, gaunt face. “Take a good look, and ask me anything you like.” Lying flat for the examination, she had been sitting propped up against a bank of pillows to greet them when they arrived. Just the simple act of getting upright, he knew, exhausted her, but it remained her way of welcoming visitors to her home, and she always made the effort. “Arm swelled up like that after radiation to the nodes under my arm,” she continued. “Blocked the lymph ducts. At least that’s how Dr. Mark here explained it to me.”

Lucy smiled down at her and slipped on a pair of latex gloves. “How’s your pain?” she said, with the same softness Mark had heard in the car. She gently slid her hand over Mary’s inflamed skin, carefully palpating every inch of the way.

Cuts right to the heart of the matter,
Mark thought. With cancer, pain management mattered most, and too many doctors sucked at it.

Mary looked over to him. “Can I tell her, Doc?”

He adjusted an IV line attached to Mary’s left arm. At the other end of it stood a small, square machine winking fluorescent green numbers at them. An electrical wire connected it to a button by her hand, completing the circle. “Go ahead,” he said. “We can trust her.”