The Inquisitor (9 page)

Mrs. Yablonsky's face flamed further, and the cords of her neck muscles tightened.

Oh, boy, thought Jane, who knew from other visits up here that the woman had a temper. And Thomas could be less than diplomatic when pointing out someone else's mistakes.

But thankfully, this morning Yablonsky seemed set on avoiding a fight. Her rigid posture relaxed a notch. "Sorry," she said, "I should have checked."

Thomas studied her, then his eyes crinkled good-naturedly as he gave her a smile. "That's okay. We can all forget something sometimes. It just surprised me. Calling a code on her"- he gestured at Matthews's body-"is a rookie move."

Yablonsky's eyes hardened.

Ah, shit! Jane thought. Now why did he have to add that? He seems set on provoking her.

The supervisor adopted a time-to-put-this-smartass-on-the-defensive look. "Oh, really? Well, I'd advise you to write it up by the book, Dr. Biggs, because Dr. Earl Garnet himself is going to be taking a big interest in her death."

The merriment in the corners of his eyes slipped a notch. "What do you mean?"

"Just what I said. Dr. Garnet will want to know what happened here, believe me."

"Why would Dr. Garnet be interested in a terminal cancer case?" he asked. The cockiness in his voice had faded a bit more.

"Because he personally doubled her morphine dose last night without her physician's knowledge."

Thomas's mask elongated as his jaw sagged in disbelief. "What made him do that?"

The other residents had started to pay attention.

"Ask the man yourself," she answered, making no attempt to lower her voice. "All I know is, he intended to jump-start some kind of audit into how we medicate pain. Well, it backfired. He'll get his audit, but now it'll be him on the hot seat."

"But surely a terminal patient's death won't be questioned." Thomas sounded more incredulous by the second.

"Oh, but it will, Dr. Biggs, because according to her doctor, she still had months to live."

"Nobody can predict that sort of thing with any certainty."

"That may be. But I advise you to write this one up without skipping any details. It's going to be gone over with a microscope, I promise you."

The ridges in Thomas's forehead thickened a little. "I see," he said.

"I should hope you all do," she added, addressing everyone in the room as if they'd all been errant schoolchildren.

The bitch! Jane thought, as wide-eyed with astonishment as everyone else at what she'd just heard. But the part that most shocked her was not that the woman had pulled a classic shift-the-focus-and-cover-your-own-behind move but that she'd done it specifically at Dr. G.'s expense. Thanks to her big mouth, rumors of his having possibly overmedicated the woman would be the talk of the hospital by breakfast. In the court of innuendo, he'd be convicted before noon. Getting out from under that kind of cloud, even if the official verdict cleared him, could be a struggle, and Yablonsky had been around long enough to know it. So why the hell would she do something so vicious?

If anyone hadn't heard about his connection to Elizabeth Matthews, Earl Garnet didn't run into them on his way to the eighth floor.

Among the groups of nurses, residents, or doctors he passed in the corridors, conversations stopped dead as he rushed by, replaced by whispers and embarrassed glances in his direction. Some he encountered avoided eye contact altogether. Even the janitors looked away. But everybody had a good gawk at him behind his back. He could feel their stares like a thousand arrows.

Thanks to small mercies, he got to ride the elevator alone. Sunday mornings, even at shift change, tended to be quieter than the start of other days. As the floors ticked by, he braced himself for the imminent confrontation with Peter Wyatt. Earl had hung up on the man rather than listen to him scream threats over the phone, but not before he'd heard a good part of what the oncologist had planned for him. For starters there'd be charges of unprofessional conduct; a motion to suspend his appointment as VP, medical; and, after confirmation of lethal morphine levels in Elizabeth Matthews's blood, an official coroner's inquiry. Wyatt then pledged to lead a push that would see Earl prosecuted by law for gross negligence at best, manslaughter at worst. And of course he'd indicated a willingness to leak every savory detail of the process to the media.

But what Earl dreaded most had nothing to do with facing Peter Wyatt.

The door slid open, and he stepped into the ward. His welcome committee stood waiting for him by the nursing station, but he focused only on the elderly man with the gaunt eyes who sat hunched in a chair, looking out the window at a dreary gray dawn.

Monica Yablonsky, her brow furrowed like a gathering storm, tried to glare at him, faltered, and fidgeted with her glasses. Two nurses whom he hadn't seen before flanked her, their expressions expectant, as if he might be there to fix the mess. Wyatt, dressed for the occasion in his three-piece churchgoing best, bolted forward like the leader of a lynch mob in a bad western.

"Shut up, Peter," Earl said before Wyatt could open his mouth. Then he walked right by him, focusing solely on the frail figure by the window. "Mr. Matthews," he said, kneeling by his side.

The old man made no reply and didn't even glance his way.

Earl hesitated, uncertain whether to take the lack of response as a refusal to speak with him, or as the paralyzing impact of grief.

"Mr. Matthews," he repeated.

"Go away, please." The wavering voice sounded hollow, as if emanating from a gourd that had had the insides gouged out.

Earl swallowed. "Mr. Matthews, I know you have every right to be angry…" He trailed off, overwhelmed by how useless his words sounded. They always did when he attempted to comfort the living in the aftermath of a death, and this time he'd more than usual to account for. "I'm so sorry," he said again. He cast about for something to add, then let it be, resigned that nothing he could say would help.

In the depths of Matthews's eyes, previously so blank and lifeless, a dark glow began to burn, angry and hot. "I left her alone because you promised me she'd be all right." His voice rose barely above a whisper yet cut like steel. "From the day she got sick, that's what frightened her the most- my not being there at the end…" A sob convulsed him, choking off the rest of his lament, and left him struggling to draw breath. The jagged cry that finally burst from his throat resonated loudly along the corridor. Earl imagined it penetrating the elevator shafts and extending through the morning gloom to permeate the final seconds of every patient's awakening dream. This, it warned, is how much they can hurt you here.

Thomas's silence while Jane prepared brunch became bothersome.

True, they were both worried about Dr. G. They'd talked about little else. But then he'd fallen silent, and she wondered if something else was troubling him. Had he not liked their lovemaking? Or did he find it awkward being in her new apartment?

She'd moved here just a few weeks ago, having previously shared a pad with some of her female colleagues to save money, but after two years of sorority living, she wanted the privacy of being on her own. Simple, small, but neat, the place felt cozy. She'd adorned the walls with bright travel posters from Greece, Hawaii, and the Caribbean and prints of Klee, Townsend, and Chagall paintings to make up for the lack of view- other brownstone apartment buildings and a nearby freeway. Sheer white curtains over the large windows admitted plentiful supplies of natural light while deadening the sight of neighborhood grunge. In all, not bad, especially since she'd accomplished everything on a nurse's salary. At least that's how she felt showing it to the girls from work. With Thomas, she'd wondered if her efforts might look pathetic to someone a year away from earning a doctor's income.

Not that he'd ever acted like a snob. If he had, she would have dropped him in an instant, having no time for superficial losers of that sort. Her doubts about his reaction had more to do with something quite profound in him that had taken her a while to find out. From what he'd told her of his background- farm people much like her own, his mother also a widow to whom he sent money- he seemed grounded in the same values of hard work and responsibility to family that she'd been raised to cherish. But bit by bit, usually when he lay in her arms after they made love, he also revealed how much he'd detested the harsh circumstances he and his mother endured after his father died. She slowly discovered that under his easy southern charm there burned a resolve to never again let anyone he loved fall victim to poverty. So she didn't know exactly how he'd react to her modest new home- be comfortable in it, as she hoped, or be constantly thinking he should upgrade her to a better one?

Not that he had such a great apartment himself: top floor, contemporary furnishings, but a view of Buffalo's city hall, a stumpy thirty-story building lined with narrow, pointy windows intended as a tribute to Art Deco. Too bad it resembled a circumcised penis covered with shiny scales. "Obviously this neighborhood's well beyond my meager budget, thank God," she frequently teased him. Good thing he found her jokes about it as funny as she did.

But none of that had to do with why she'd been hesitant to invite him over. Since they'd first become lovers, their desire for each other blatantly mutual, the nights she spent with him had always been on his turf, at his invitation. Changing the equation worried her. Would he feel pushed now that she could ask him? Since they were still new enough to each other that reading his moods sometimes proved a challenge, she let things stay the way they were for the first few weeks. Until yesterday. By then she reached a so-what-if-he-feels-pressure state of mind, fed up playing Daisy Mae to his Li'l Abner. He might be a hotshot in ER and a rescuer ready to snatch her from abject poverty, but when it came to romance, did all Tennessee men need women to take the lead? The good thing about Thomas in that department, once she pointed him in the right direction, was that he made it well worth her while.

"Why so quiet?" she asked, flipping the eggs.

He looked up from where he'd been sitting cross-legged on the floor and leafing through the Sunday New York Herald. Having often seen it lying around his place, she'd bought a copy on the way home from the hospital, fantasizing about them reading it together afterward, lounging in bathrobes, sharing interesting articles, comfortable with each other's company. She'd had it waiting for him when he arrived, along with a glass of freshly squeezed orange juice, and herself, fresh out of the shower. As she hoped, the paper ended up tossed in a corner, the drink remained untouched, and he'd quenched his thirst for her.

But as attentive as he'd been in bed, and as passionately as he swore to protect Dr. G., he seemed distracted afterward.

"Sorry, Jane, but I still can't get what happened this morning out of my head- that Yablonsky, accusing Dr. Garnet out loud the way she did. And why would he be up on Palliative Care giving out morphine in the first place? Whatever the reason, I think she may be making big trouble for him."

He echoed her own fears. "Yeah, I found her really out of line too. She must have known the others would spread the word." And boy, did they. By the time she'd come off duty, the whole hospital had been nattering about how Dr. Earl Garnet overdosed a patient. She angrily threw a handful of grated cheese on top of the half-cooked eggs and folded it in. "In fact, maybe someone should ask her why she acted so quickly to shift blame onto him. What's she got to hide?"

"Nothing, probably. Just doesn't want to be tagged for bad stuff on her watch and isn't above causing a good man a truckful of trouble in the process. At least that's my guess."

"But to insinuate he'd overdosed her like she did- that totally sucks. It can't be true!"

"You'd think not." He got up from where he sat, found her cutlery drawer, and began to lay out the appropriate utensils. "But I'm afraid that won't stop the gossip from causing him a lot of grief, especially because he's so good."

She knew what he meant. Even the few years she'd been there, it had become obvious to her there were two camps at St. Paul's when it came to Dr. G.: the ones who loved him- generally the deep end of the talent pool- and the lesser lights, who bitterly resented his competence. Unfortunately, the latter outnumbered the former. Not that he helped his own cause with them. Though he struggled to deal with fools diplomatically, anyone whose stupidity endangered a patient quickly felt the lash of his temper. Those who had would all too gladly see him fall on his face; some might even line up behind Yablonsky to make sure he got blamed for whatever had happened to Elizabeth Matthews. "Can you help him?" she asked Thomas.

He removed a pair of coffee mugs from their hooks on the underside of the cupboard and poured them each a cup from the the old-fashioned percolator she'd brought from her mother's kitchen in Grand Forks. "How?"

"I don't know. Point out that the patient would have died anyway?"

As they sat down to breakfast, continuing to share ideas about ways to protect Earl Garnet, Jane observed how Thomas appeared to be making himself at home. Her concerns about his coming here vanished, and she felt silly over having been worried in the first place. Like a friggin' schoolgirl, she chided herself again, happy to be in love.

But they came up blank again as far as a remedy for Dr. G.'s problem.

When she'd arrived fresh out of nursing school, Earl Garnet had told Jane on her first shift with him that she had the nerve and steady hands to be a great ER nurse. Tough as she'd found her rookie year, those words had kept her going. She sensed his pride in her, and under his protective wing Emergency eventually became a place where she felt not only fully confident but also as if she'd found her forte in life, that one special, exciting, worthwhile pursuit where she could excel over all else. So she'd come to care about him as much as she would her own father, were he still alive. "You can't think of anything we can do for him?" she asked, watching Thomas dig enthusiastically into the breakfast she'd prepared. The sight pleased her. "How about the fact there've been other patients without DNR orders who arrested in Palliative Care?"

He paused, his fork halfway to his mouth. "How do you mean?"

"It's not the first time the arrest team's been called up there during night shift."

"So?"

"So maybe this patient's death that Yablonsky is trying to blame on Dr. G. is simply part of the normal pattern."

"Pattern?"

"Yeah. That sometimes people die before they're expected to. And come to think of it, haven't there been more codes than usual up there lately?"

"I don't know. I haven't counted," said Thomas.

"Just seems to me there has."

"How can you tell? With this crazy backup system we have, I'm chasing all over the hospital some nights. All the R-threes do- whenever a junior resident gets scared and feels out of his or her depth."

"I know. But a run up there with the cart, even when I don't go myself- that's the kind of thing you notice. Every time it happens, I groan and wonder which doctor it was who didn't have the guts to discuss DNR orders with whoever the luckless patient is. Know what I mean?"

Thomas nodded, his fork remaining in midair. "Yeah… Maybe there is something I can do after all."

"What?"

His bearded face broke into that easy grin of his. "I can't tell you yet, not until I check something out." He gave her a mischievous wink and took another mouthful.

"Thomas!" She put down her utensils, having barely touched her own food. "Quit being so mysterious." His teasing ways had attracted her from the beginning as well. He had the confident air of a man with an inside track on how life worked, and in particular he possessed a knack for rooting out the juicier aspects of hospital life. She slid off her stool onto his lap, allowing her robe to fall open. "Now you 'fess up what you know," she said, slipping her arms around his neck.

"I'm not being mysterious." He gave her another wink. "Just careful. The last thing Dr. Garnet needs right now is more rumors."

"Rumors about what?"

"Palliative Care."

"You've heard something about Palliative Care?" She felt a guilty pleasure discovering the indiscretions of others at work. Who had slept with whom, which doctors or nurses screwed up, and even the occasional big-time crimes, such as sexual abuse or fraud. While the revelations appalled her, they kindled a smug confidence that she'd never make such a mess of her own life. She also felt flattered that Thomas trusted her enough to share in such unspeakable tidbits.

He reached around her, took a slice of bread, folded it in half, and proceeded to mop up the remains of onions, green peppers, and ham on his plate. "Not heard. Seen." He took a mouthful and chewed it carefully, all the while smiling at her. It was clear he knew full well he had her curiosity at the boiling point.

"Thomas!"

"Okay, okay. I don't know if you're right about the number of codes being up, but this morning isn't the first time I've been called up there to try to resuscitate someone found dead in bed. How about you?"

She shrugged. "Sometimes, I guess. But since I'm not always the one who goes, it could be happening more often. Why?"

"I want to check the records, but it seems to me that during the night shift, most codes on that ward have been around dawn, like this morning's. That means they discovered the bodies as they made their final rounds before the end of shift. Maybe Yablonsky's so hot to blame this death on Garnet because her nurses aren't keeping a close enough eye on the patients overnight."

"You're saying-"

He silenced her with a finger to her lips as he wolfed down his last bite, then slipped both hands gently inside her robe and began to caress her hips. Eyes sparkling and full of mischief, he glanced up to see if she approved.

She replied with a soft kiss.

"You could be right about this woman's death being part of a bigger pattern," he continued, speaking quietly while sliding the palms of his hands up her back, "one that has more to do with inadequate nursing surveillance than anything Dr. Garnet did."

"Now that is useful," she said, kissing him again, but not so gently this time.

"When did you give her the first ten-milligram dose of morphine?" Earl asked Monica Yablonsky, gesturing to the sheeted body that still remained on the bed. He'd insisted she accompany him into Elizabeth Matthews's room, as if the dead woman's presence might hold the nurse more accountable. Peter Wyatt had gone down to the labs, worried that the weekend technicians might not grant the determination of a blood morphine level on a corpse the priority he thought it deserved.

"An hour after the midazolam," she replied, "as you ordered."

"I ordered it to be administered the moment the midazolam started to wear off, which would have been approximately an hour later."

Monica Yablonsky wearily brought her gloved hands to her head and massaged her temples, theoretically contaminating herself, depending where the gloves had touched before coming in the room. Earl said nothing- that kind of unthinking gesture happening all over the hospital a hundred times a day- but some part of his brain registered that the battle to rid St. Paul's of SARS might already be a lost cause.

"That's what I meant," she said. "Mrs. Matthews received the morphine when she started to wake up."

"Yet the medication sheet lists the time as nine p.m. exactly. Mighty punctual of the lady, starting to rouse herself exactly on the hour."

"Are you insinuating-"

"I'm insisting you level with me about every detail of what happened here last night, down to the minute. Now when did you observe her coming around before administering the morphine?"

She drew her lips into a thin line and let out a long breath, making clear her exasperation. "Probably more like nine-ten."

"And afterward?"

"What do you mean?"

"Did you check on her?"

"Yes! Repeatedly. The larger dose worried me. And since you'd sent her husband home, I kept a close eye on her myself." Her disapproval of his having removed Mr. Matthews from the scene, thereby making it necessary for her to increase her own vigilance, hung heavily in the air.

"And?"

"She remained stable."

"Vitals and respiration normal?"

"Yes, as written on the patient's chart."

Check night nursing notes on any floor and the majority will have respirations listed as sixteen a minute, the average rate for adults who are awake, even though most people slow their breathing to twelve when they're asleep. The reason? A lot of caregivers, including doctors, never bother to count the actual number as long as they can eyeball that a person appears to be moving air in and out with no difficulty. "It says sixteen every time," Earl said, lowering his voice to a whisper. "How do you explain that?"