Authors: Daniel Palmer
Mercy (35 page)
She glanced through the folder and claimed authorship for every document within.
“Okay, so I wrote these,” Julie said, waving the folder in front of her face like a fan. “But I wrote these before my fiancé’s accident, and to be honest, my views on the subject have changed since then. In fact, I believe my views are still evolving. I’m sorting it out. But what does this have to do with anything? These are policy opinions about medicine, not related to any of my patients or patient care. Certainly not related to Shirley Mitchell.”
Julie set her gaze on Max Gilbride, the beady-eyed director of patient safety, who sported jowls like an orangutan’s.
Lucy cleared her throat. Her expression was deeply pained. “I was very concerned with Shirley Mitchell’s labs,” she said. “In a typical DIC, the platelets would be low, the PT and PTT high, and the fibrinogen would be low. The labs on Shirley came back showing the opposite.”
A knot formed in Julie’s stomach. She understood now what was happening here.
“Those levels made me look beyond DIC as a cause of the bleed, which is why I asked Dr. Stinson, one of our residents in pathology, to look for heparin levels. For the benefit of those who do not practice medicine, the heparin xa level should be less than point one in anyone not on heparin. Shirley Mitchell was three-point-zero. The only possible way she could have a level that high is if someone injected her with heparin.”
The hairs on the back of Julie’s neck began to rise as she fixed Lucy with a wide-eyed stare.
“What are you saying, Lucy?” Julie’s mind was reeling.
“And why was Dr. Devereux in the patient’s room?” The question from Gilbride was directed at Amber.
“Someone pulled out the patient’s central line and it needed to be reconnected.”
“Wait, wait, wait,” Julie said, glaring now at Amber. “
Someone
pulled out the line? That someone was Shirley Mitchell.”
Gilbride cleared his throat. “She was on what dose of propofol?” he asked. Max Gilbride, an internist turned bureaucrat, was the internal affairs equivalent for doctors and put the A in a-hole.
“Thirty mic per kig,” Amber said.
Julie translated the dose in her head. Propofol is a weight-based drug and thirty was a high dose per minute.
“In other words, Shirley was pretty out of it,” Gilbride said.
“Yes,” Amber answered in a quiet voice.
“What are we thinking here?” Julie asked the question and sent nervous glances around the table.
“I’ll tell you what we’re thinking, Julie,” Roman answered. “I’m not here to waste your time, or ours. Shirley’s bleeding began minutes after you flushed the central line.”
“Yes, with saline I got from Amber.”
“That couldn’t have been just saline,” Roman said. “Somehow Shirley was given heparin, a blood thinner, and that caused her to bleed out.”
“Well, how would that have happened?”
“We don’t know,” Romey said. “We’re hoping you or Amber could enlighten us.”
Julie said, “Honestly, Roman, I have no idea.”
“We tested the rest of the flushes taken from that ICU room,” Lucy said. “They all came back as normal saline.”
“Well, there you have it,” Julie said.
“But that doesn’t mean someone didn’t use a little sleight of hand and swap a package containing a syringe of saline for one containing a syringe of heparin.”
Gilbride’s smug look made Julie want to explode. She felt her body heat up beneath her white lab coat.
“That’s perhaps the most preposterous thing I have ever heard in my life. You’re implying Amber or I had something to do with this. Lucy, please, you can’t possibly accept this rubbish as fact.”
Lucy was expressionless.
“How did she get the heparin, Julie?” Lucy asked.
Bob Anderson glanced at his notes and said, “According to Amber’s statement, the patient’s blood pressure dropped minutes after you flushed the line.”
“We believe that was the moment of injection,” Gilbride added.
“Given the levels of heparin in Shirley’s blood and the timing of her pressure drop, I would have to concur,” Lucy said.
Julie glanced around the table, looking for a sympathetic face, and found none. “I can’t believe what I’m hearing. You’ve got to be kidding me. Are you suggesting I killed Shirley Mitchell on purpose?”
Gilbride reached for the folder of Julie’s papers. “I’m suggesting you have motive, Julie. You’ve been feeding it to the public for years now.”
“I—I—I just don’t know what to say.”
“You and Amber were the last to treat Shirley,” Roman said.
“That’s true,” Julie answered.
“Then until we get more facts, both you and Amber are being suspended from White with pay until a thorough investigation can be conducted. You will not have access to these facilities or any hospital systems during this suspension period. Val is here to work through your exit paperwork.”
Amber burst into a sob, shaking her head in disbelief. “I didn’t do anything wrong. I swear it.”
Janowski eyed her with disgust. “If our findings show malice, being fired will be the least of your concerns. I fully intend to report this matter to the authorities, and you should expect an investigation and possible charges.”
“Charges?” Julie asked. “What sort of charges are we talking about?”
Bob Anderson got up from his seat and buttoned his suit. “The biggest charge would be murder.”
Julie refused to sign any of the paperwork required by HR; not without her lawyer present, she said. She advised Amber to do the same, but the poor girl was utterly shell-shocked, too young and inexperienced to defy authority.
Amber sorrowfully followed Val to her office down the hall, while Julie was stripped of her badge and unceremoniously escorted out of the building by security. Nobody gawked because nobody knew what had gone down, but soon word would spread via social media and Julie’s troubles would become White’s version of a viral video. Julie felt weightless and strange in her own skin, as if this experience was happening to someone else and she somehow had become a detached observer.
From her car, Julie phoned Lucy.
“Please come to the parking garage. I’m on level B2 near the elevator. Let’s talk,” Julie said.
Ten minutes later, Lucy, cocooned inside her warm jacket, opened the passenger-side door of Julie’s Prius with the bent front fender and dent in the hood. As she climbed in, Lucy looked straight ahead in an effort to avoid Julie’s penetrating stare.
“Hey, hey, Lucy, it’s me, it’s Julie, your friend, and I need you now more than ever.” Tears came to Julie’s eyes and blurred her vision. Lucy gave in to the tugging on her arm and turned to meet Julie’s gaze.
“Did you do it?” Lucy asked in a harsh whisper.
Julie could not contain her look of disgust. “How could you even ask me such a thing?”
“Because I know what you believe,” Lucy said. “The articles in that folder weren’t exactly a surprise to me.”
Julie’s mouth fell agape. “I can’t believe you just said that to me.”
“If you did it, you have to own it,” Lucy said.
Julie knew Lucy could be distant, but her icy treatment caught her off guard and hurt deeply.
“If I did it,” Julie said, “I’d have been a hell of a lot smarter than to use heparin. I could have used bupivacaine, for goodness’ sake. I’m not stupid, Lucy, and I’m certainly not a killer.”
Lucy’s eyes narrowed. She knew about the anesthetic drug. “Bupivacaine wouldn’t have been too smart, either,” she said. “I would have noticed the QT prolongation on the EKG and run a tox test for it. I’d still have caught you.”
A slip of a smile came to Lucy’s face and Julie broke into a laugh that sounded like she had stifled a sob. Even under duress, Lucy’s brain worked in overdrive. She simply could not help being the brilliant pathologist she was. It was a moment between them, one that gave Julie hope Lucy was not completely lost to her, hope she could still be an ally in this fight.
They fell into a heavy silence, broken when Lucy asked, “What do you want me to do, Julie?”
The desperation in Lucy’s voice implied they had arrived at some sort of impasse.
“Just be open-minded right now,” Julie said. “I just need you to hear me.”
“I’m listening.”
“While I was waiting for you, I had time to think a little more clearly about things. Isn’t it a bit coincidental that Jordan and I got fired on the same day?”
Lucy’s face turned taut. “Are you suggesting someone killed Shirley Mitchell to get you out of White?”
“I’m saying we can’t stop looking for Sam’s true killer. Whatever it is that caused his heart to stop, it’s killing others at White, maybe elsewhere, and somebody doesn’t want us to find out what’s really going on.”
“Julie, stop. Just stop it.”
“No. I can’t and I won’t.”
“I don’t know what’s happened to you, hell, even me, for getting so involved in this whole affair, but it’s gone too far. I should have turned Jordan in when I found out what he was doing with the patient records. I should never have brought the two of you together.”
“I didn’t kill Shirley.”
“Honestly, I don’t know if that’s true. You’re asking me to swallow an awful lot here. What’s not debatable is that someone injected Shirley with heparin, and by all accounts it appears to have been intentional. You had the means, motive, and opportunity. You don’t have to be a mystery novel enthusiast to know those are three criteria for proving a murder. I might be able to buy some weird drug allergy causing fatal heart attacks. Maybe something we didn’t know about, something we potentially could have uncovered in this investigation of ours. It’s possible, I grant you that. But now you’re saying someone was murdered to throw us off the trail? Think about it for a moment and try to see it through my eyes. Shirley Mitchell was a very sick woman, the kind of woman whose right to die you would have fully supported.”
“Supported only if it was the law.”
“What do you want from me, Julie?”
“I need you to find samples and run some tests. Jordan and I no longer have access to the computer systems, and I don’t believe that’s an unintentional consequence. Someone didn’t want us to find other victims.”
“Do you even hear yourself?”
“Yes, other victims,” Julie repeated with more emphasis. “I hear myself perfectly well, thank you. We need you monitoring the EMR system for patients with hives who later die of a heart attack. The hives will be deleted from the patient’s record postmortem. I promise you this is true. Test the tissue from the corpse for various allergy-causing antigens and foreign substances. Whatever is killing these patients, we’ll find it in that test.”
“Who, Julie? Who is doing this and why?”
Julie shook her head in frustration. “I don’t know. But somehow William Colchester and Gerald Coffey are involved, I’m sure of it.”
“Yeah? Well, I’m sure of this: if I do anything to help you, I’ll lose my job, and I sincerely doubt I’ll get another.”
“Please, Lucy. You’re my only hope.”
“My opinion? You need to focus on yourself and your family. Romey is coming after you for Shirley’s death and that’s a fact, not an opinion. Somebody has to take the fall for the heparin and it’s going to be you, not Amber. So please, don’t ask me for any favors right now.”
“Why, Lucy?” Julie’s voice cracked. “Why won’t you help us?”
“Because this job is all I have,” Lucy said. “I don’t have a partner, kids, a pet, anything. I run. I read. I play chess. But what I really love, my life’s purpose, my passion, is pathology. You’re asking me to risk everything for something I don’t fully believe. To put myself on the line to support you when I have doubts about your innocence here. Put yourself in my shoes and see if you would do the same.”
Lucy opened the car door and got out. She had nothing more to say.
It was Wednesday morning, the day before Thanksgiving. The kitchen should have been the most active room in the home, but the stove burners were off and the refrigerator mostly empty. Paul sat at the kitchen table drinking coffee Julie had brewed for him. Trevor was in his bedroom, packing his bags and preparing for a lengthy stay with his father. With all that had happened, Julie could not deal with meal preparation, hosting, or even being with others. The turkey would stay put in the freezer until she got around to thawing and cooking it.
Everyone who had been invited to Julie’s home for the Thanksgiving meal made other arrangements, including Julie’s mother, who made no secret of her worry and concern.
“I’m fine, honest, Mom,” Julie said to her mother, one of the few people who still called the landline. “Everything will get cleared up. Just give it time. Okay?”
Julie must have had this conversation with her mother half a dozen times since her ouster from White only a day ago. She might have sounded convincing, but it was not exactly how she felt. Worry lingered about how the investigation into Shirley Mitchell’s death would ripple through all facets of Julie’s life and how it would impact her son.
As if her thoughts had summoned him, Trevor lumbered out of the bedroom with his overnight bag slung across one shoulder. “I’m all set,” he announced.
Julie did not believe in keeping secrets, and had told Trevor what had happened to her at White and how the incident was under investigation.
Trevor took the news in stride. “I’ve seen you at work, Mom,” he’d said. “I know you wouldn’t do anything to harm that woman on purpose.”
I didn’t harm her at all,
Julie thought.
No point being defensive. Julie thanked Trevor for his support. What she needed now was a way to prove him right. She did not question that heparin had entered Shirley Mitchell’s blood, but how did the drug get there?
Julie was not the only one suffering. Jordan felt despondent over his predicament and Julie’s. They had spoken by phone, but had not met in person. During their conversation, they agreed—without Lucy’s support, their investigation was at a complete standstill.
Trevor had forgotten something in his room, and went back to retrieve it.
“You sure you don’t want to join us tomorrow night?” Paul asked.