“It isn’t unusual, after someone finds out they are terminal, for them to… let go. They make peace with their fate, tie up any loose ends, and let themselves go.”
“Bridget didn’t feel like Robin had done that. She said Robin was still fighting. She wasn’t giving in to the cancer.”
Dr. West shrugged. “We can’t always see what people are really thinking, can we?”
“What was your feeling? How much time did you think she had left?”
“Doctors are notorious for being wrong about these things. You would be amazed at how many doctors get sued for not properly predicting someone’s death date. In either direction, early or late.”
“Really?” Zachary considered the circumstances under which someone would sue the doctor because they had lived longer than he had predicted. “Wow. But you didn’t expect that Robin would die as early as she did?”
Dr. West rubbed his hands together, then folded them on top of his desk. “No. I didn’t. But as surprised as I was that she went so quickly… I never suspected any… outside influence. I don’t know exactly what you’re looking for, but I never saw any problems with Robin’s care or sign of outside influences. I think you’re just looking at a case where the cancer or a related condition took her sooner than anyone expected.”
“That’s pretty much what I expected. I know that when Bridget was here, she always said she was treated well and that the staff were very kind. It wasn’t like some of the horror stories you hear of people getting sepsis sitting for days in the emergency room. Very clean, very professional.” Zachary wasn’t worried about laying it on too thick. Doctors had big egos. And the more senior the doctor, the bigger his ego.
Dr. West smiled in appreciation. “We work very hard to provide a clean and homey environment for our patients. We know that no one chose to be there, and that the more comfortable and happier they are, the better they are able to fight cancer and tolerate the treatment protocol.”
“You’re doing a fine job.”
“Thank you. It’s really good to hear that.”
“You haven’t had anyone other than Robin who has died quite a bit earlier than you expected?”
Dr. West frowned and shook his head. “No, there’s no pattern that indicates we’ve got a resistant bacteria on the ward, or some kind of contaminated supplies or medications. Everything has been perfectly normal, no signs of trouble. And Robin’s death itself… as I said, it’s not abnormal or unexpected. She just went before we predicted. That happens.”
“Have you had any staffing changes lately? Anyone new, or anyone you’ve had to let go?”
“Working in oncology is difficult. People come and go. There’s always turnover. It’s very taxing to deal every day with people who are dying.”
“I would imagine so,” Zachary agreed. “You read in the news sometimes about staff in hospital wards or care centers who decide to take matters into their own hands.”
“Angels of death,” Dr. West said flatly. His smile was gone. He looked toward the door as if he were expecting someone to enter. Or to leave.
“Right. They’re not the type of people you expect to be murderers. It’s not done out of malice. It’s more along the lines of… assisted suicide. Except without consent.”
“Just because you’ve heard it in the news, that doesn’t mean it’s common. That kind of thing is very rare. Just like nursery nurses stealing infants. It happens a few times, and suddenly it has a name, it’s a recognized pattern. People suddenly think it’s a common occurrence. But it isn’t. There have only been a handful of these ‘angels of death’ ever identified in the whole country. You’re more likely to be hit by lightning than killed by one of these so-called angels.”
Zachary nodded. “I’ve never seen any sign of that kind of thing going on,” he agreed. “Certainly, Bridget never had any fear that someone was going to do her in while she was at the treatment center. It’s all a little over the top. I’m not even sure what you would look for, if you were administering a department like this. Is there a checklist of things to watch for? Things that should tip you off that you have an ‘angel of death’ on your staff?” He shook his head in disbelief.
Dr. West fell for it hook, line, and sinker. He leaned forward, dropping his voice like he might be overheard discussing such a thing. “There have actually been studies into this kind of thing. Red flags for medical serial killers. I attended a seminar while on a medical retreat. It’s one of those things that comes up during insurance reviews. Are your stats all in line? Are you aware of the red flags for medical serial killers? Do you have a proper vetting program and monitoring in place?”
Zachary nodded, mirroring Dr. West’s body language by leaning toward him. “Like what?”
“Carers who have a higher rate of deaths of patients in their care, obviously. Depression, personality disorder, preferring night shifts. People who make their colleagues nervous or have drugs in their possession.”
“How would you know that? How would you, as the head of a program like this, be aware of any of that? You’d have access to the death statistics, but do you get a breakdown of what staff members were on duty during each death?”
“It’s up to the employees in the department to notice and report any patterns. Obviously, if we had a rash of unexpected deaths or an increase in mortality rate, we would do a deeper review, but these people can be very sneaky. How would you know someone had drugs in their possession without doing a search? You can’t just randomly search people’s lockers or pockets. How would you know someone had depression or a personality disorder? You’re not allowed to ask during an employment interview. We have moms who prefer the night shift because they want to be home with their kids during the day. You can’t start accusing them of being serial killers because they’ve asked for night shift.”
Zachary chuckled. “No. Good way to get slapped.”
Dr. West laughed, agreeing.
“But you’ve never had any worries about that?” Zachary asked. “You’ve never had any scares, or had those doubts cross your mind because a death was unusual or unexpected?”
Dr. West sat back again, hands folded in his lap, staring up at the ceiling. “I’m sure every hospital head of department has at some time or another. Or every head of oncology, anyway. You’ve been told to be vigilant, so you ask yourself ‘could it happen in my unit?’ ‘Is it happening in my unit?’ But no… I’ve never had any real concerns or suspicions.”
“No one you were relieved to let go, because they gave you the creeps? No patients complaining about unscheduled medical treatments or visits…?”
Was there a flicker in Dr. West’s eyes before he shook his head? Zachary leaned back as well, thinking it over.
“How does it usually happen? How do these angel-of-death cases go undetected for so long?”
“In a lot of cases, it’s insulin overdose. Insulin is naturally found in the body. The person just goes into a coma and dies. When you’re dealing with someone who is already on death’s door, that’s not an unusual event. No one would order an autopsy, and even if one was ordered, the pathologist wouldn’t find anything. Insulin breaks down within forty-eight hours, so even if they’re looking for it, they’re not likely to find it.”
And they were already past the forty-eight hour mark since Robin’s death.
“You have to get a confession in those cases,” Dr. West said. “Or catch them in the act. There’s no other way.”
“Would you even stock insulin in a cancer ward? Would that be normal?”
“Certainly. Diabetic people get cancer. At a higher rate than non-diabetics, in fact. And anyone with pancreatic cancer is going to get diabetes. Some of the cancer treatments we are using can cause diabetes. It’s important to monitor and manage patients’ blood glucose levels.”
“I didn’t know that. I guess that’s not something Bridget ever had to deal with, so I wasn’t aware of it. What about Robin? Did she have diabetes? Before or after the cancer?
”
Dr. West shook his head, but then his eyes drifted down to the file open in front of him. His attention was taken from Zachary as his eyes flicked back and forth over the papers. He turned a couple of sheets over.
“That’s confidential information,” he said. “I wouldn’t be able to tell you if Robin had high blood sugar a day or two before she died that required the administration of insulin.”
Zachary stared at him. “She did?” But he understood that Dr. West couldn’t confirm or deny the information. He had said only that he couldn’t tell Zachary the information. It wasn’t something that would ever hold up in court, but it was a direction for him to go.
“I couldn’t tell you,” Dr. West repeated. “Like I said, a lot of patients get high blood sugar. That’s not unusual. It’s not cause for concern. It’s just something that we keep an eye on.”
“Is there any way to tell how much insulin she was given?”
“It’s on her chart, if you had permission or a court order. But you don’t.”
“And can you match your insulin inventory to the charts? Can you tell for sure if she was given the right dose, or do you just assume that she was?”
“My staff know how to administer insulin.”
“Yes…” Zachary let Dr. West think about that for a few minutes. Knowing how to administer insulin made the staff potential suspects, it didn’t prove their innocence. Robin could have been given the wrong dosage of insulin either by accident or on purpose. If they had an angel of death on the staff, which Dr. West had pointed out was pretty much impossible to tell, then they could have administered the wrong dosage of insulin and gotten away with it.
Dr. West started to flush. “I don’t like your implication, Mr. Goldman.”
“Zachary.”
“Mr. Goldman. I explained to you why we have insulin stocked. I explained to you that Ms. Salter required insulin because of her cancer or her treatments. You can’t then jump to the conclusion that she was overdosed on insulin and that’s why she died. I told you there was nothing suspicious about her death and I am sticking to that statement. Ms. Salter died of natural causes. Not insulin overdose.
“Except there’s no way to know that.”
“I’m telling you.”
Dr. West’s phone rang. He looked at it for a moment, his brows drawing down in a frown. Then he picked it up. “Dr. Aaron West, oncology.”
He listened to the caller, the frown disappearing and his eyes instead going up in surprise. His eyes riveted on Zachary instead of getting that unfocused look people usually got when they talked on the phone, imagining the person on the other end of the call instead of seeing what was in front of them. He nodded and listened to the rapid voice on the other end. Eventually, the caller wound down so that Dr. West was able to speak.
“Yes, Miss Salter,” he agreed.
Zachary’s heart sank.
“Yes, I understand. Yes. I appreciate your call, thank you for letting me know.”
He made a few more calming and affirming noises, and was eventually able to hang up the phone. He put it down firmly, eyes still boring into Zachary.
“You led me to believe that you had been hired by Robin’s family to look into her case.”
“No.” Zachary kept his voice flat and empty. “I told you that Bridget was concerned. I didn’t claim to be hired by the family.”
Dr. West scowled. “Whether you said it or not, you clearly wanted me to believe it.”
“What you believed isn’t my responsibility,” Zachary pointed out. “I didn’t tell you that Robin’s family hired me.”
“I think it’s time for you to leave.”
Zachary nodded, getting to his feet. He kept a purposefully vague and unemotional exterior, but inside, his heart was racing like he was already on the run. He was aware of every twitch Dr. West made, ready for a full-blown confrontation. But luckily, Dr. West kept his own emotions under control and didn’t make any threats of violence. He allowed Zachary to simply retreat the way he had come and didn’t pursue him or call security.
Zachary walked back past the reception desk and gave the pretty receptionist a smile and a nod, projecting the impression that everything had gone as he had hoped and all was well between him and Dr. West. If he ended up having to call her or ask her for further information, he didn’t want to have given away the fact that Dr. West had sent him packing. If she were under the impression that Dr. West had cooperated with him fully, she would be far more accommodating of any further queries.
Chapter Six
I
t was late enough in the afternoon that Zachary decided to simply go home. He could have a bite to eat, check his email and voice messages, and plan out his evening. But when he got home and looked in the fridge at the food Bridget had brought him, nothing appealed to him. His appetite was usually suppressed by his meds, and he and Bridget had never really seen eye-to-eye on dietary choices. Bridget was, of course, big on whole foods, salads, vegetables, and juices, all those things that helped her to keep her figure and to have a strong immune system in order to fight the cancer. While she was not a vegetarian, she eschewed red meat and stuck to occasional skinless chicken and fish. Zachary had no desire to eat either one.
Every foster home had been different, but instead of adjusting to a wide variety of cuisines, Zachary had gotten pickier and pickier. If forced, he would eat whatever was put on the table in front of him. He’d never had a showdown with a foster father over food where he’d been physically force-fed. He’d seen it happen to others. But given the choice, his diet was limited to highly processed foods. Peanut butter sandwiches. Pepperoni and sausage pizzas. Cheese burritos. Greasy fast-food hamburgers. Along with plenty of coffee and cola.
Bridget’s “clean” diet of fresh fruits, vegetables, and lean meats just didn’t cut it.
Zachary checked his email, made some notes about what he had learned on the Robin Salter case, and pondered over calling Kenzie.
Previously, he wouldn’t have hesitated to call her to get her insight and suggest that they go out for dinner. But previously, Bridget had been out of the picture. Not only had she divorced Zachary, but she’d been furious with him. She hadn’t wanted to see or hear from him. She didn’t want anything to do with him unless it was her own idea.
But that had changed. Suddenly she was in his life again. Asking him for favors. Thanking him. Making him feel like he was worthwhile instead of a piece of dung that had stuck to her shoe after the divorce. He thought he might have a chance with her again.
And that made calling Kenzie a difficult decision. Would it upset Bridget? She’d tried to warn Kenzie away from Zachary before. But she’d also called Kenzie when she thought Zachary needed someone to check in on him. Bridget was too unpredictable for Zachary to be sure how she would react to a potential rival now that she was back in Zachary’s life.
Not that he and Kenzie were hot and heavy. They were friends, but Zachary still wasn’t sure where he stood with her. Bowman assured him that Kenzie was interested in him and he had a chance of snagging her if he approached it the right way. But Zachary had been too uncertain to pursue her. He’d almost scared her off in the beginning, and he wasn’t sure she trusted him yet.
Eventually, Zachary picked up his phone and dialed.
The phone rang a few times before Kenzie picked it up, and Zachary wondered whether she was in the morgue rather than at her desk. She’d been getting a little more time with hands-on work recently, and that meant when the phone rang, she had to decide whether to let it ring, or to stop what she was doing, take off her gloves and whatever other protective gear she was wearing, and then go to the phone.
Eventually, Kenzie answered the phone. “Is this my favorite private eye?”
Zachary snorted. “Do you know any other private eyes?”
“No.”
“Then I guess that’s a yes. This is your favorite private eye.”
“What’s up?”
“I have
a new case.” He wasn’t about to tell her that it was an unpaid case, or that it had come to him through Bridget.
“Something of interest to the coroner’s office?”
“Well… Probably not something that will ever come across your desk, but I am investigating whether it might not have been natural causes.”
“What makes you think it is not?”
“The client thinks it might not be. I’m not so sure yet.”
“What makes him think it wasn’t natural causes?”
“It was unexpected. Well, not unexpected… but before it was expected. She had cancer. It had metastasized. But they thought she still had a few months.”
Kenzie made an irritated noise. “That doesn’t sound like anything to me. Just because someone dies of cancer a few weeks before you expected them to, that doesn’t mean anything.”
“I know. That’s what I keep hearing. But I’m looking into it, asking some questions… just exploring a little.”
“And…?”
“I don’t really have anything for you. She had high blood sugar, so she was being given insulin. I just wonder…”
“If someone gave her too much?”
Zachary didn’t say anything, waiting to see what Kenzie had to say without his input.
“It’s a stretch, Zachary. Yes, she could have been given the wrong dosage of insulin, but chances are, they would figure it out right away and would dose her with glucagon. She’d recover just fine.”
“What if it wasn’t accidental? What if someone gave it to her on purpose?”
“Like who?”
“I don’t know. One of the nurses or other staff. An ‘angel of death.’”
“Really? You haven’t found any evidence that there’s an angel of death there. If you had, it would be all over the place. I would have heard.”
“No, there’s no evidence. It’s just… she went before her time. Everybody thought it was too early. I thought… if it wasn’t caused by an accident, an accidental overdose, or drug interaction, or allergic reaction… some kind of treatment that was contraindicated… then what? I know it’s rare, but you can’t deny the fact that it happens.”
She was Dying Anyway Page 5