Lethal Practice (12 page)

Despite the urgency in his voice as he chronicled all the difficulties they were facing, that annoying little smile kept reappearing. Whatever game he was playing, he looked exceptionally pleased with himself. As if he had an ace up his sleeve.

On the other hand, Riley was sitting at the back of the room, staring up at the ceiling tiles. Even from where I was sitting I could see his jaw muscles repeatedly quiver and tense. I’d begun to suspect this younger detective had little patience with his boss’s preening. If Bufort was the kind of man who demanded stroking from his underlings, he certainly hadn’t gotten any show of adoration from Riley—at least not in my presence.

In any case, even without his junior’s encouragement, Bufort built to his climax. “And so, gentlemen, we must expand our investigation, and as you can see, we need your help.”

He didn’t look very needy to me.

“Detective Riley will arrange a meeting with each of you to discuss any new information you may have, any further thoughts since our preliminary interview, any rumors you’ve heard about the killing of your CEO. We particularly want to hear about possible motives for Kingsly’s murder.”

I repressed the urge to shiver. So, Bufort was going to open up the hampers and turn over the carts and spill our dirty laundry all over the place. I felt sick; so did the other chiefs, judging from the expressions on their faces. But Bufort clearly was pleased with himself. I squinted at him. Damned if his hands didn’t seem to be fidgeting as if he were trying hard to keep them from rubbing together in glee. The stocky detective with the big ego could have been funny—if I hadn’t already experienced the menace that accompanied his determination to jump to conclusions. Was he the kind of cop who, right or wrong, was more concerned with getting a conviction than finding out the truth? If so, then my own innocence, or anyone else’s, might not matter much to him. As I watched him stride out the door, I couldn’t help worrying about how thorough or scrupulous his investigation would be once he settled on the first available suspect and saw a chance to keep his solution rate intact— especially if Hurst was trying to feed me to him.

I decided telling Bufort an anonymous caller had whispered
I
know it’s you
wasn’t a good idea right now. He might agree. Nor was I any more encouraged by the troubled expression on Riley’s face when he looked over at me before he rose slowly from his chair and walked out the door, shaking his head.

The other chiefs continued to look tense, and a few talked quietly together as they got up from the table. Hurst left the room without a glance at me. There wasn’t the slightest hint of the kind of malice I’d felt listening to that whisper on the phone. Still, even if Hurst couldn’t get me charged with murder, he probably was angling to get me to resign. In fact, he was probably tempted to accept resignations to get rid of all of us. With troublemakers like me gone, he could approach the young guys and offer them their jobs back. Then he could reopen emergency with a staff of novices who didn’t oppose him. But even
he
must know emergency couldn’t survive the loss of all our experienced physicians. At the very least, he’d have to do a lot of explaining, especially when our sister hospitals made him look like an idiot by snatching up our best doctors before the next shift.

On the way back to the ER, I stopped at the vending machines near the front of the hospital and pushed enough buttons to win myself a hot chocolate. I didn’t have a clue who had killed Kingsly, let alone why. Nor could I figure out what Hurst was really up to, but for the moment I had to stop dwelling on it and try to face my more immediate worries in the ER.

The machine whirred and sputtered out my order. Trying not to spill the hot brown liquid, I had turned toward emergency when I saw what was left of the Cummings family approaching me in the corridor. Their vigil was finished. A brother supported his brother’s wife. She was clutching one of those obscene plastic bags that hold a patient’s belongings when it’s over. At their side walked two small girls.

I froze, wanting to escape, but on they came until they were right in front of me.

Mrs. Cummings tried to speak, failed, and my own mouth went dry. Then she swallowed harder and reached for my hand.

I flinched and almost jerked it away. I knew what was coming.

“Thank you,” she managed to whisper. “I know you did all you could.”

The little girls watched me from behind their mother’s skirt. Despite myself, I imagined first one, then the other of the girls held high in her daddy’s warm, comforting hands. Now Donald Cummings’s hands drooped cold and purple from the stainless gleam of an autopsy table— and we’d put him there. The charts of his case would probably show we were watching his blood pressure while waiting for a bed, because shock was a risk, but an acceptable one, with streptokinase. Yet on this day we hadn’t caught the drop, and two little girls had lost their dad, all within the standards of conventional care—if you didn’t count Hurst’s bed closures as the real reason it happened.

Mrs. Cummings still held my hand. I gently withdrew it, mumbling words of consolation. Then, I have to admit, I fled.

I didn’t have the stomach to face the ER at the moment, so I went to my office by a back corridor. Carole had begun storing our interminable memos, minutes, reports, and written recommendations—good intentions on paper—in her computer to save space, but the changeover had produced more printouts than I’d ever seen before we’d started putting shelves of words on disks. Her desk was scattered with these leavings, but she was out, probably generating even more copies of copies. I was glad for the moment alone.

I leaned back in my chair and thought about the reams of numbers and coded outcomes of the ER study that now lay locked in my desk. There I would probably find a small number of catastrophes like Cummings, and a few cures. But mostly there would be draws, stabilizing patients by the book and buying them the time they needed for healing.

I entered Cummings’s name in our mortality review list. The recorded verdict would be “unexpected” and, depending on the size of the guy’s original infarct on postmortem, probably “unavoidable death.” The delay in getting a bed in the cardiac monitoring unit would be noted; the importance of monitoring blood pressure while using streptokinase would be reiterated. Then memory would fade until the cuts exacted another life. In a way, those cuts were as much murder as plunging a needle into Kingsly’s heart. The computer printouts held all our ghosts ... except one.

* * * *

Paper wars, paper cuts. The injunction arrived at 11:10 forbidding any organized withdrawal of service.

Hurst! The son of a bitch had thrown lawyers into our mess. And I’d been stupid enough to be caught by surprise. The injunction would take hours to unravel. Worse, we would need even more lawyers.

The server, a little man in a big-shouldered raincoat, smirked at me. “You weren’t expecting that, were you?”

I was stunned; he actually liked his work. As I held the unfolded legal sheets in front of me like a scroll, I realized all at once where he was headed.

I ran out of the office and into the ER yelling, “Hey, you!” Nurses and patients recoiled as if I were the latest psycho dumped on the ward. But I was too late. The little guy with the Joan Crawford shoulders was disappearing out the far door. Popovitch and Jones, papers in hand, looked as if they were about to have heart attacks.

There ought to be a law against serving a doctor legal papers in the middle of an emergency shift, especially one from hell. Our instincts and training keep us making the right moves. Undermine those instincts, introduce self-doubt and second-guessing, and the result can be lethal. Nothing but nothing gets a doctor hesitating and second-guessing faster than the shock of being slapped with legal papers.

“Look,” I said to Popovitch and Jones, “relax. It’s politics. It’s about not withdrawing services for want of beds. Go on being doctors and let me handle this shit.”

Their expressions made me feel like the idiot I was for leading them into this, getting them named.

“I know, I know! Another fine mess I got you into.” Before they could say anything, I lifted the injunctions out of their hands.

“Popovitch, go on a diet or share your food with Jones. You two are beginning to look like Laurel and Hardy.” Their groans accompanied me halfway back to my office.

Now I was
in over my head.

Working emergency always meant seizing control. With blood, pain, or a bubbling, choking airway, I had a move for it, knew what to do, could react fast. My greatest dread was freezing up.

I actually had a recurrent dream. I would be ineffectively struggling to intubate through a bloody tangle of vessels, nerves, and smashed windpipe when I’d receive the ultimate condemnation from a Greek chorus of residents. “You don’t know your stuff!”

As far as sorting out legal entanglements, I very definitely did not know my stuff. The stand against closing beds was right, but all I’d accomplished was to galvanize Hurst into taking legal action. The injunction could have as big an impact on morale and concentration in the ER as I’d feared the murder investigation would. Damn Hurst!

He’d upped the cost of our defiance to a risk of fines, contempt charges, even prosecution. None of the doctors would go against that. Even if they threatened to resign through legal channels, it would take ninety days’ notice, and I shuddered at the thought of how much damage and death might be caused by ninety days of these conditions. What number of “preventable morbidities or mortalities” would it take to force Hurst to back down?

My instinct—one I hadn’t felt in years—was to call for help. It was a reality of residency: Go as far as you can, and then get backup. It was harder later, after becoming staff, to admit to needing help. I’d seen experienced doctors actually kill a patient by not asking for support. As a result, I’d learned to fear such arrogance, and was pretty much ready to admit when I wasn’t cutting it.

And right now I was not cutting it.

If it wasn’t too late already, I had to alert the other doctors who hadn’t yet received summonses. I fantasized an army of Joan Crawford raincoats shouldering through the city to find them.

Outside my window a distant siren warned of the rapidly approaching noon deadline when the ambulance ban would expire. I looked at the clock on my desk. 11:15. I wished Carole would get back.

The phone rang. I let the answering machine get it and listened to the message.

“Carole, this is Dr. Hurst’s office. Please tell Dr. Garnet that Detective Riley wants to see him as soon as possible.”

So much for “arranging convenient times.”

I literally turned a few circles and wondered what to do first. The phone rang again, but it was my private line. Only one person knew that number.

I picked up. “Hi.”

“Sure of me, are you?” Janet’s voice was an island of calm.

“No, just really glad to hear from you.”

“Bad day?”

“Eleven-seventeen and I’m down to plan Y.”

“Let’s see, that’s the one where I work and support you in the style you’ve become accustomed to.”

“Hey, I’ll raise your kid.”

“You’ll make the kid a bum, just like his father, or at least like his father was until I saved him and made him respectable.”

“Yeah! You made me so damn respectable, I got this job and all the trouble I’m in.”

“I’m the girl in trouble here.”

“I love you.”

“That’s the kind of talk that got me in trouble.”

“I thought you seduced me.”

“Yeah, well, your virtue will remain unsullied tonight. I’m sleeping over in the case room. I’ve two ladies in early labor. They’ll keep me here till dawn, so I’ll relieve one of the guys on call. He’ll owe me when I’ve got a new man in my life and want to spend the night with him.”

“Janet!”

“Oh, didn’t I tell you? Had an ultrasound this morning. Saw a little thingamajig hanging down. It looked just like his father’s—you know, the one that got me in trouble. Bye now.”

Carole couldn’t for the life of her understand the goofy grin on my face when she came into the office while I still held the receiver.

My mood didn’t change even as I went out the door to meet with Riley and Bufort and endure their attempt to hang a murder charge on me. It kept up when Sylvia Green, scared and waving her injunction, listened skeptically to my reassurances. Hell, it even endured the two ambulances that roared in twenty minutes before the ban expired, and it wasn’t altered at all by the resulting bedlam.

I was going to have a son.

Chapter 7

“Dr. Garnet, let’s review the statement we took from you on the night of the murder. You said you saw the victim alive but inebriated on your way back from the ICU. What time was that?” Riley asked, showing no trace of the uneasiness I’d witnessed earlier. We were in a small, empty classroom. Riley was seated in front of me. Bufort was leaning against the back wall.

“As I said, about seven o’clock.”

“Are you in the habit of being here that late?”

“I was on duty. The shift ends at midnight.”

“Then why were you still here at one in the morning?”

“Sign-out takes a little while, especially if we’re busy.”

“Were you?”

“Not especially. But my replacement was late that night.”

“Who was that?”

“Dr. Kradic.”

And so it went. Riley scribbling away as if he hadn’t questioned me already; Bufort hovering in the corner, like a spider watching a protégé weave a beginner’s web.

“And what did you say Kingsly was doing?”

“He was walking down the hall on Second Main. That’s the center block on the floor above the administrative suites.”

“So he had come from his office?”

“Probably.”

“Was he in the habit of being here so late, especially on a Sunday?”

They must know by now. “Unfortunately, yes. He had a drinking problem. Lately he’d gotten worse, and was sometimes known to stay late and, well, maybe have a few belts in his office. I figured that Sunday he’d been drinking at home or out at a party somewhere before he came in.”