Life Support (30 page)

"Yes, but she's so superficial about these things. It was really my responsibility. After you quit, I was in a panic. You gave me so little time to find . . ." She paused, a thought suddenly occurring to her.

That's why Jane came into my life. Because Bryan quit.

"I would have given you more notice," he said. "But they wanted me to start immediately."

"Why did they choose you, Bryan?"

"What?"

"You said you weren't looking for a new job. Then suddenly you were hired. How did that happen?"

"They called me."

"Who did?"

"Twin Pines Nursing Home. They wanted a recreational art therapist.

They knew I'd been a nurse's aide. And they knew I was an artist.

That I had paintings for sale in three galleries."

"How did they know?"

He shrugged."I guess someone gave them my name."

And hired you away from me, she thought. Leaving me scrambling for a replacement She left Bryan's house with more unanswered questions than when she'd arrived.

She drove to Springer Hospital to check on her mother.

It was 10 P.M. and visiting hours were already over, but no one stopped her from entering Ellen's ICU cubicle. The lights had been dimmed, and Ellen lay in semidarkness. Toby sat down by the bed and listened to the cycling of the ventilator. On the oscilloscope above the bed, a neon green line traced the rhythm of Ellen's heart. The nurse's clipboard hung at the foot of the bed. Toby reached for it and turned on the small reading light to scan the most recent entries.

1545, skin warm, dry, no response to painful stimuli. 1715, daughter Vickie in to see her. 1903, vitals stable, still unresponsive.

She flipped to the next sheet and saw the most recent entry, 2030, lab tech here to draw blood for 7-deDydre)xywarfarin screen.

At once she left the cubicle and crossed to the nurses' station. "Who ordered this test?" she asked, handing the clipboard to the ward clerk.

"The hydroxywarfarin screen?"

"This is on Mrs. Harper?"

"Yes, on my mother."

The ward clerk pulled Ellen's medical chart from the rack and turned to the order sheets. "Dr. Steinglass did."

Toby picked up the telephone and dialed. It rang twice. Dr. Steinglass barely got out his "hello" when Toby snapped, "Bob, why did you order a warfarin screen on my mother? Do you have reason to think she's been given Coumadin? Or rat poison?"

"It was . . . because of the bruises. And that intracerebral bleed. I told you her prothrombin time came back severely prolonged�" "Yesterday you said you thought it might be due to liver inflammation."

"The PT was too abnormal. Hepatitis wouldn't explain it."

"So why the warfarin screen? She hasn't been getting warfarin."

There was a long silence. "They asked me to order the test," Steinglass said at last.

"Who? "

"The police. They told me to call the medical examiner for advice. He suggested the warfarin screen."

"Who did you talk to? Which doctor?"

"It was a Dr. Dvorak."

Barely awake, Dvorak fumbled in the darkness for the phone, finally picking it up on the fourth ring. "Hello?"

"Why, Dan? Why are you doing this?"

"Toby? "

"I thought we were friends. Now I find out you're on the other side. I don't understand how I could have been so wrong about you."

"Listen to me, Toby�" sorry."

l "No, you listen to me! Her voice cracked. A sob spilled out, but was ruthlessly choked back. "I didn't hurt my mother. I didn't poison her.

If anyone hurt her, it was Jane Nolan."

"No one's saying you did anything wrong. I'm not saying it."

"Then why didn't you tell me you're checking her blood for warfarin?

Why are you doing this behind my back? If you have information that she's been poisoned, you should have talked to me. Told me. Not slipped in this test while I wasn't looking."

"I tried to call you earlier, to explain, but you weren't home."

"I've been at the hospital. Where else would I be?"

"Okay, I guess I should have tried calling you at Springer. I'm "Sorry doesn't cut it. Not when you're working behind my back."

"That's not how it happened. I got a call from Detective Alpren. He said your mother's clotting times came back abnormal. He asked me what could cause that and would I talk to her doctor about it. A screen for warfarin is just the next logical step."

"Logical." She gave a bitter laugh. "Yes, that sounds like you."

"Toby, there are half a dozen other reasons why her clotting times might be abnormal. A warfarin screen is part of the workup. The police asked for my advice, and I gave it. It's my job."

She said nothing for a moment, but he could hear her shaky exhalation, and he knew she was struggling not to cry.

"Toby?"

"I suppose it'll also be your job to testify against me in court."

"It won't come to that."

"If it did. If it did come to that."

"Jesus, Toby." He sighed in exasperation. "I'm not going to answer that question."

"Never mind," she said just before she hung up. "You already did."

Detective Alpren had eyes like a marmoset's, bright, inquisitive, quick to pick up details. He couldn't seem to stand in one spot for more than a minute, had paced back and forth in the autopsy lab, and when not pacing, would rock from foot to foot. The dead body on the table interested him not at all, it was Dvorak he'd come to see, and for ten minutes he'd been waiting impatiently for the autopsy to end.

At last, Dvorak shut off his cassette recorder, and Alpren said, "Now can we taLk about it?"

"Go ahead," said Dvorak, not looking up from the table, his gaze still contemplating the corpse. It was a young man's, the torso hollowed out from neck to pubis. Inside we are all the same, he thought as he looked at the empty cavity. We're just identical sets of organs, packaged in various shades of skin. He picked up a needle and suture and began to sew the cavity shut, taking deep bites of flesh with his needle. There was no need to be elegant, this was merely a cleanup task, to prepare the body for transfer to the mortuary. A job Lisa normally performed.

Alpren, oblivious to the gruesome needlework, stepped up to the table.

"The test came back," he said. "That�what do you call it? RHPLC?"

"Rapid high-performance liquid chromatography."

iiRight. Anyway, the hospital lab just called me. The test is positive.

" Dvorak momentarily froze. He forced himself to keep stitching, to close the skin over the empty cavity. Had Alpren noticed? he wondered.

"So what does that mean?"

Dvorak kept his gaze tightly focused on the task. "The RHPLC is a screening test for the presence of 7-hydroxywarfarin."

"Which is?"

"A metabolite of warfarin."

"Which is?"

Dvorak tied a knot and reached for another length of suture. "A drug that affects normal clotting. It can lead to excessive bruising.

Bleeding."

"Into the brain? Like Mrs. Harper?"

Dvorak paused. "Yes. It may explain the bruises on her legs as well."

"So that's why you suggested the test."

"Dr. Steinglass told me about the abnormal prothrombin time. Warfarin poisoning is on the differential diagnosis."

Alpren was busy scribbling notes as he asked the next question. "And how do you get this drug, warfarin?"

"It can be found in certain rat poisons."

"Makes them bleed to death?"

"It takes some time to be effective. But eventually they hemorrhage internally."

"Pleasant image. Where else can you get warfarin?"

Again Dvorak paused. He didn't want to be having this conversation, didn't want to be considering the possibilities. "It can be given as a prescription medication called Coumadin. For use as a blood thinner."

"Only by prescription?"

"Yes."

"So you'd need a doctor to order it, and a pharmacy to fill it."

"That's right."

The pen was scribbling faster. "That gives me something to work on."

"What?"

"Area pharmacies. Who's had Coumadin prescribed for them and which doctors ordered it."

"It's not that unusual a prescription. You'd find a number of doctors ordering it."

"I'm screening for one particular name. Dr. Harper's."

Dvorak set down the needle holder and looked at Alpren. "Why focus solely on her? What about the mother's caregiver?"

"Jane Nolan has a spotless record. We've checked with her last three employers. And remember, s/ve was the one who called us and raised the question of abuse."

"To cover her own ass, maybe?"

"Look at it from Dr. Harper's point of view. She's a nice-looking woman, but no husband, no family of her own. Probably never even dates.

She's trapped with a senile old mother who refuses to die. Then she starts screwing up at work and the stress builds."

"Leading to attempted murder?" Dvorak shook his head.

"Number one rule, look at the family first."

Dvorak tied the final knot on the corpse and snipped the suture.

Glancing at the stitched torso, Alpren gave a grunt of disgust. "Jesus.

Frankenstein."

"It'll all be hidden under a dress suit. Even a beggar is allowed to look distinguished in his coffin." Dvorak stripped off the gown and gloves and washed his hands in the sink. "What about accidental poisoning?" he said. "The mother has Alzheimer's. There's no telling what she may have put in her mouth. There could be rat poison in the house."

"Which the daughter conveniently left out for old Mom to find. Right.

" Dvorak just kept washing his hands.

"I find it interesting that Dr. Harper now refuses to talk to me without her attorney," said Alpren.

"That's not suspicious. That's smart."

"Still, it makes you wonder."

Dvorak dried his hands, not looking at Alpren, not really daring to. I shouldn't be commenting on this investigation, he thought. I'm not detached enough. I don't have the heart to build a criminal case against Toby Harper. Yet that's what he should be doing, what his job required of him. Examine the evidence. Draw the logical conclusions.

He didn't like what the evidence was telling him.

Clearly the old woman had been poisoned, but whether by accident or by intention was impossible to determine at this point. He could not believe Toby was responsible. Or was he simply refusing to believe? Had he lost his objectivity simply because he was attracted to her?

All last night he'd fought the urge to call her back. Twice he had even picked up the phone but then had hung up, reminding himself he could not discuss the evidence with a possible suspect. Then this morning, she had tried calling him. He'd used his secretary as a barrier, had asked her to screen out Toby's calls. He felt sick about it, but he had little choice. As friendless and vulnerable as Toby was right now, he could offer no comfort to her.

After Alpren left, Dvorak retreated to the lab next door. Boxes of tissue slides were stacked up on the cotmtertop, waiting to be interpreted . It was quiet, solitary work, and he was grateful for it. For an hour he sat hunched over his microscope, the world shut out, the silence broken only by the occasional clink of glass slides. The hermit in his cell, shut off from the rest of the world. Normally he enjoyed working in isolation, but today he felt miserable and unable to concentrate.

He looked down at his finger, where the scalpel nick had healed, leaving a tiny scar. It was a reminder of his own mortality, of the seemingly trivial events that can lead to catastrophe. Stepping off a curb too soon. Catching an earlier plane flight. Smoking one last cigarette before bed. The specter of death is always watching, waiting for its chance. He gazed at the scar, and he imagined his own neurons imploding even now, driven to self-destruction by a horde of alien prions.

There was nothing to be done about it, nothing that could be done except to wait and watch for the signs. A year, two years at the most.

Then he'd be home free. He'd have his life back.

He closed the slide box and stared at the blank wall in front of him.

When did I truly have a life?

He wondered if it wasn't already too late to start one.

He was forty-five, his ex-wife was happily remarried, and his only son had already made the leap to independence. Dvorak's last vacation six months ago had been taken alone, a driving tour through Ireland, pub to pub, enjoying the occasional human contact, however brief and superficial. He had not considered himself a man in need of companionship until he'd arrived one evening in a small village in the west and found that the only pub was closed. Standing on that deserted road, in a place where no one knew his name, he had felt such deep and unexpected despair that he had climbed into his car and driven straight to Dublin.

He could feel that same despair coming on ilOW as he stared at the wall.

The intercom buzzed. Startled, he rose to his feet and picked up the phone. "Yes?"

"You have two calls. On line one's Toby Harper. Do you want me to keep brushing her off?"

It took all his willpower to say, "Tell her I'm unavailable. Indefinitely."

"The other call is Detective Sheehan, line two."

Dvorak punched the button for line two. "Roy?"

"We have some follow-up on that dead baby. Or whatever it was," said Sheehan. "You know that young female who called for the ambulance?"

"Molly Picker?" "Yeah. We found her."

i� .

I 'm sorry, but Dr. Dvorak is unable to take your call."

Toby hung up and glanced in frustration at her watch. She'd been trying to reach Dvorak all day. Every call had been refused. She knew the police were building some kind of case against her, and if she could just talk to Dvorak, she might convince him, as a friend, to reveal what the evidence was.

But he wouldn't accept her calls.

She left the ICU nurses' station and crossed to her mother's cubicle.

She stood outside the window, watching Ellen's chest rise and fall. The coma had deepened, and Ellen had no spontaneous respiratiOns. The last CT scan had shown the hemorrhage had extended, and there was now a question of a pontine bleed as well. A nurse was at the bedside, adjusting the IV infusion rate. Sensing she was being watched, the nurse turned to the window and saw Toby. Too quickly, she looked away again.

That lack of acknowledgment, of even a courteous nod, spoke volumes. The staff no longer trusted Toby. Nobody did.

She left the hospital and got into her car but didn't start the engine.

She didn't know where to go. Home was out of the question�too empty, too silent. It was four o'clock, not time yet for dinner, even if she had an appetite. Her body's circadian rhythm was askew, still in transition to a daytime schedule, and she never knew when hunger or fatigue would strike. She knew only that her mind was fuzzy, that nothing felt right.

And that her life, once so well ordered, was now totally and irretrievably screwed up.

She opened her purse and took out Jane Nolan's resume. She'd been carrying it around, intending to call all four of Jane's former employers for more information, any hint that their "perfect" nurse was not so perfect. She'd already spoken to three nursing directors over the phone, and all had given Jane glowing evaluations.

You pulled one over on them. But I know the truth.

The one employer she hadn't spoken to was Wayside Nursing Home. The address was only a few miles away.

She started the car.

"We'd welcome Jane back in a heartbeat," said Doris Macon, the nursing supervisor. "Of all our nurses, she was the one our patients seemed to love the most."

It was suppertime at Wayside Nursing Home, and the meal cart had just rattled into the dining room. Patients in various states of awareness sat at the four long tables, saying little. The only voices in the room were those of the staff as they set down the trays, There's your supper, dear. Do you need help with that napkin? Let me cutyour meatforyou . .

.

Doris surveyed the gathering of gray heads and said, "They get so fond of particular nurses, you know. A familiar voice, a friendly face, it means everything to them. When a nurse leaves, some of our patients actually go into mourning. They don't all have families, so we become their families."

"And Jane was good with them?"

"Absolutely. If you're thinking of hiring her, you're lucky to have such a wonderful applicant. We were so sorry when she left us to take that job with Orcutt Health."

"Orcutt? I didn't see that on her resume."

"I know she worked for them at least a year after she left us."

Toby unfolded Jane's resume. "It's not here. After you, she lists Garden Grove Nursing Home."

"Oh, that's part of the Orcutt chain. It's a group of nursing homes, owned by the same corporation. If you work for Orcutt, you can be assigned to any one of their facilities."

"How many do they have?"

"A dozen? I'm not sure. But they're one of our biggest competitors. " Orcutt, thought Toby. Why did the name sound familiar?

"I didn't realize Jane was back in Massachusetts looking for a job," said Doris. "I'm sorry she didn't call us."

Toby refocused her attention on Doris. "She left the state?"

"A few months ago, she sent us a postcard from Arizona, telling us she'd gotten married. Living the life of leisure now. That's the last I heard. I guess she's moved back." Doris looked curiously at Toby. "If you're thinking of hiring her, why don't you just talk to her? She'll explain the resume."

"I'm double-checking," lied Toby. "I'm thinking of hiring her, but something about her makes me uncomfortable. It's for my mother, who really can't fend for herself. I have to be careful."

"Well, I can vouch for Jane. She was wonderful with our patients."

Doris moved to one of the dining tables, where she rested a hand on an elderly woman's shoulder. "Miriam, dear. You remember Jane, don't you?"

The woman smiled, a spoonful of mashed potatoes hovering at her dentureless mouth. "Is she coming back?"

"No, dear. I just want you to tell this lady whether you liked Jane or not."

"I love Janey. She hasn't been to see me in a long time."

"Jane's been away, dear."

"And the baby! I wonder how big the baby is. Tell her to come back. " Doris straightened and looked at Toby. "I'd call that a pretty good recommendation."

Back in her car, Toby sat staring at the dashboard in frustration.

Why did no one recognize the truth? Jane's former patients loved her.

Her ex-employers loved her. She was a dear woman, a saint.

And I've become the devil.

She reached for the ignition and was about to turn the key when she suddenly remembered where she'd heard the name Orcutt.

From Robbie Brace. That night, in the medical records room at Brant Hill, he had told her their building served as central records storage for Orcutt Health's other nursing homes.

She got out of the car and went back into the building.

Doris Macon was in the nurses' station, taking off order sheets. She looked up, obviously surprised to see Toby had returned.

"I have another question," said Toby. "That woman in the dining room.

She said something about a baby. Did Jane have a child?"

"A daughter. Why?"

"She never said anything about . . ." Toby paused, her thoughts scattering in a dozen different directions at once. Had the baby since died? Had there ever been a child? Or had Jane simply not bothered to mention the fact she had a daughter?

Doris was looking at her with a puzzled expression. "Excuse me, but is this relevant to your hiring her?"

Why was a baby never mentioned? Toby suddenly straightened. "What does Jane look like?"