Lethal Practice (11 page)

But right now I had to deal with the ER. “Keep me informed,” I added, stepping to my closet, where I exchanged my jacket for a lab coat.

“I see you finally got the case breakdowns per shift you’ve been waiting for.” She casually gestured to the printouts, adding,
“Everybody’s
dying to see them,” as if that excused her own prying.

Again I resented her snooping. I was too anxious to have much patience anyway. “Since I haven’t had a chance to look at them myself, I’ve no idea what they are,” I answered rather coolly. “I haven’t been through my mail yet. Now, if you’ll excuse me, I’ve more calls to make, and they obviously need you in the ER. Tell Susanne we won’t be getting ambulances for the next three hours.”

With that I ended what had been probably the nicest moment I’d had with the woman in recent months. Neither of us mentioned our conversation on the phone the previous day. She tried to smile. And failed. I noticed that once again she was wearing something green underneath her lab coat, this time with earrings to match. But her attempts to be stylish had always seemed a bit obvious and did nothing for me. At the door she rather pathetically asked, “Please give me any feedback you might have on my study.”

“Of course.”

I sighed after she left. Difficult was Valerie Jones’s middle name. At least she was here to work with Popovitch.

* * * *

Over the next ten minutes I made the usual calls to admitting, got Sean to cancel elective surgery, and managed to convince a few of our off-duty doctors to come in and help out for an hour or so. When the enraged surgeons whose cases I’d bumped started phoning back to scream at me, I switched the line onto my answering machine. As they recorded their fury, I leaned back in my chair and tried to think what the hell I was going to do about the whispered warning. Back off from what? Even if I wanted to take it seriously, how could I when I didn’t know what the hell I was supposed to be involved in?

It had to be about Kingsly’s murder. And though it could have been anyone—the voice was impossible to recognize—the first person I thought of was Hurst. He’d already given Bufort the idea that I had a motive for the killing, but I’d thought his insinuation had been a tactic, a despicable move designed to tie me up in Bufort’s investigation. Did he really believe I was the killer? /
know it’s you!
He had sounded livid last night after learning I was ready to close the ER to fight his bed cuts.
You’ve had your warning. Back off?
The thought of Hurst being so desperate chilled me. And what was making him so desperate?
You’ve had your warning.
Was he threatening to give Bufort even more ammunition against me, maybe even try to frame me for the killing? I felt a surge of panic as I had another idea direct from the depths of paranoia and not enough sleep—the dogs. The attack on the golf course.
You’ve had your warning.

I started to hyperventilate. No! That was off the wall. I fought to control my breathing. I had to be rational about this.

Should I report the call to Bufort? Or would it only make me more suspect in his eyes? I’d have to think this through when I was calmer. Meanwhile, I had no choice but to focus on the ER.

As I pushed out from my chair, I considered the stack of printouts on my desk that Jones had been sneaking a look at. Normally they would have offered a perfect bureaucratic escape from the mounting craziness outside.

She’d seen enough to spot the reams of numbers and diagnostic codes that were our first ever breakdown of which doctors saw what problems on what shifts and with what outcome. And she’d been right about another thing. All of us were nervous and yet irresistibly drawn to this measurement of our skills, victories, and disasters. It was like a book of judgment, beyond excuses and denial. Some called it quality assurance. Some called it Big Brother.

It was actually paper shuffling I’d been looking forward to, but my moment with our truths would have to wait. I locked the printouts in my desk drawer to prevent any of the other doctors from taking a premature peek.

Then I headed for the mess out front. On my way back to the nursing station, I glanced into the resuscitation room and saw Popovitch at the right arm of a very pale woman who was sweaty and having a lot of trouble breathing. He had just threaded a long Swan Gantz catheter under her right clavicle, through the subclavian vein, and on into her heart. It was a more complex version of the technique James Todd had used on my patient Sunday evening.

As I watched Popovitch’s practiced hands secure the line, the association between skills like his and the skills used by the killer spread over me like a stain of blood. While he was reassuring the gray-faced lady that the tip of the catheter would measure the response of her heart to the medication he’d given her to clear her lungs, I was wondering how many others besides myself would end up on Bufort’s list.

Popovitch looked up and saw me watching him. Thank God he had no idea what I’d been thinking. “By the way,” he began, “I took care of that matter of Kradic leaving early.” He gave his patient a final check and joined me in the doorway.

“Michael, am I going to get an angry note?”

He winked. “I certainly hope so,” he answered, whistling the
Godfather
theme right after he brushed past me and started down the hall.

The next hour took all my thoughts away from suspicion and murder.

The ambulance ban I’d reinstated was helping. The staff could face the pandemonium knowing it wasn’t going to get worse. The surgical beds I’d commandeered and the reinforcements I’d called in cheered Susanne even more.

“Thank God,” she said. “Oh, and you too, of course.”

“Good to see you smile, Susanne, even if you are such a smart—”

“Never mind!” She shoved a file in my hand. It was for a forty-year-old man bleeding from both ends. He’d heard daily aspirin would prevent heart attacks but had given himself a GI hemorrhage by overenthusiastically dosing himself. When I found his stretcher, he was pale and smelled fecal. Black diarrhea poured from his rectum while brown vomit the color of coffee grounds stained his pillows and nightshirt.

“Oh, God, I’m going, I can feel it. Don’t let me go! I’m going!” His head thrashed around.

“It’s okay. We got you.” Two IVs raced fluid into his depleted veins. I felt for a pulse at his wrist. Not much, but it was there. “You’ve already got a pressure,” I told him as I jacked up the bottom end of his bed to rush the blood in his legs toward his heart. “This will boost it even more.” His oxygen mask had slipped to his forehead; I slid it back over his nose and mouth. Two sacks of type 0 blood arrived and were being hung up on IV poles. For the moment his pressure was holding, and some IV cimetidine would probably keep him from bleeding. Hopefully. We didn’t have a monitored bed for him if he went shocky again.

While writing my own orders at a free place on the counter, I could hear Popovitch behind me arguing with a junior neurosurgical resident. “Look, a thirty-five-year-old woman has the most severe headache of her life right after making love and is now slowly losing consciousness. This isn’t a postcoital snooze. She needs a CT of the brain in minutes and most likely neurosurgery in the hour or she’ll die.”

CT is a specialized X ray used to diagnose hemorrhages of the brain. It had to be done quickly and with a staff radiologist or neurologist present to assure it was interpreted correctly.

The resident stalled. “My staff man doesn’t like it when I interrupt his rounds upstairs.”

Popovitch lost it. “Your lady has a subarachnoid bleed. If you don’t get your staff man stat and she deteriorates, he will kill you. If he doesn’t, then I will. If after that there is enough of you left to have a career, we’ll both finish that for you as well.” The CT was under way within three minutes.

“Good teaching, Michael,” I said over my shoulder.

“If he reports me, flunk him.”

I heard the nurses out in the hallway greet Sylvia Green, one of the doctors I’d called in to help. Recently back from her second pregnancy leave, she was another veteran known for her technical skills. She could get an IV line on anyone no matter how flat or inaccessible the veins. Her help was welcome anytime, doubly so today.

After passing through the confusion and entering the nursing station, she gave a single comment. “Jesus Christ!”

“Sylvia, a nice Jewish girl like you,” chided Susanne, handing her a chart.

“Yeah, I know. After ten years in a Catholic hospital, I swear like a shiksa.” Sylvia grabbed the file, smiled hello at me, and went to find her patient.

Twenty minutes later the resident who’d reluctantly obeyed the ultimatum to get a CT was back in the department, proudly showing everyone the films of the subarachnoid hemorrhage
he’d
“picked up in the ER.” Popovitch gently handed him the phone and suggested he get on with the transfer to neurosurgery. We got to hear him proudly arrange for life-saving “burr holes” and explain to some wide-eyed students how these would relieve the pressure of accumulated blood on the brain. Popovitch gave me another wink.

Within an hour the place was calm. Well, relatively calm.

Jones had even managed to discharge a couple of patients with abdominal pain. Instead of lying in the corridor with nonacute abdomens and borderline blood results while waiting for a trial of oral liquids, they would do their “observation” at home and be reexamined tomorrow morning in a follow-up clinic. Ironically, they were safer out of the ER. Should something go wrong, a vigilant family member would pick up a change for the worse and get the patient back to us faster through the front door than one of our busy nurses might notice them go sour in a rear corridor. With this degree of overcrowding we were in danger of finding patients dead in beds.

Susanne had a mental filter like mine—get to the important stuff; ignore the crap—and she showed it now. “Oh, I forgot,” she said. “Hurst’s secretary called and left a message. You’re to meet him in the boardroom at ten-thirty.”

I stiffened. I was going to have to be very careful in my dealings with Hurst. From now on there would be no business as usual, and I’d have to decide whether I should report my suspicions about him to Bufort. I glanced at my watch: 10:40.

“Susanne!” So much for time to plan. Now I’d have to improvise my way.

“Hey, we needed you more. You can’t save lives from the boardroom.”

“I’m in enough trouble—”

“So what difference does it make? And before you run off,” she added, stopping me as I was halfway out the door, “we got another DOA last night, a bag lady. MAS figured we’d still have room in the morgue.”

My mind was already preoccupied trying to piece together a way to confront Hurst in front of Bufort, but I tried to pay attention. “Another one?” I asked. Two DOAs in as many days
was
unusual. “Any idea what killed her?”

“Probably exposure, alcohol, whatever—like the rest.”

“Is the paperwork done?”

“Yeah. We sent her right down to Watts. Funny, he seemed hot to do a full post on this one. Go figure.”

“Really?” I winced again at the dressing-down I’d gotten from Watts for my stupidity over yesterday’s DOA, then remembered something.

“Dr. Watts thinks if the numbers of vagrant DOAs really are up all over the city,” she explained, “the medical examiner’s going to push for thorough autopsies to find out what’s killing more street people than usual.”

Deaths could be caused by new batches of lethal crack or bad hooch. It was important to find the latest poison of choice and issue a strong warning. If Watts was willing to add another extensive autopsy to his workload when he was already so busy, it was because it was a hell of a lot more legitimate than chasing after moles. Even for autopsies handled in a pretty cursory fashion, many of the DOAs were sent straight to the city morgue.

“Did he say anything about the one from yesterday?” I asked.

“Not specifically, but it was getting two within twenty-four hours that seemed to get him so stirred up.”

Despite the ban, two more ambulances rolled in. Susanne turned to real work, and I headed off to my meeting with Hurst, trying to plan my next move with him and Bufort as I went.

* * * *

I was surprised to see it was the detective himself who had the floor. He paused politely as I took my seat. From the poleaxed look on a few of the chiefs’ faces, I presumed he’d just announced that Kingsly had been murdered. The others in the room looked appropriately somber, but their lack of surprise probably meant they’d heard the gossip. Hurst, however, was taking a showy look at his watch and all but tapping the dial to make sure none of those assembled missed the outrageously late hour of my arrival.

“I’m late because emergency’s a mess!” I snarled, unable to control my anger at him. I noticed some of the chiefs exchanging concerned looks, probably afraid that we were going to continue our fight from yesterday morning.

Bufort seemed kinder. “I was just running through what we discussed in the morgue. Dr. Garnet.” He sounded respectful, as though we were colleagues and I was his chosen confidant. But it was bull. I knew Bufort was mocking me with his politeness. The little smirk playing at the comers of his smile made sure I remembered what he could put me through if it suited him.

I felt livid with both of them, but took a seat without saying anything more.

Bufort continued speaking, describing the problems of investigating a homicide in a hospital. Just conducting brief interviews with everyone who’d been on duty Sunday night had taken over twenty-four hours. The site of the actual murder was still unknown. Combing Kingsly’s office for prints or other traces of the killer had been fruitless. It was particularly confounding that the body had been washed. When he got to the autopsy results and how the killer clearly knew how to needle hearts, everyone shifted away from me.

He advised us his department would issue a brief press release later in the day, but if reporters approached any of us individually, we were to refer them to the police or to the hospital spokesperson. We definitely were not to discuss any details of the case with the media.