The Mask of Sanity

by Jacob M. Appel

  He no longer felt any urgency. If he was going to commit a murder, he was going to bide his time and avoid any mistakes. So whenever he had moments to spare, he found himself pondering various methods of execution. He considered staging a robbery, cutting the brake lines in the surgeon’s BMW, slipping incremental doses of arsenic into Sugarman’s food. During quiet afternoons at the office, he sneaked over to the branch library in the adjacent township and read accounts of unsolved crimes from the Black Dahlia murder to the Tylenol scare of 1982. He was careful never to check out any books, to browse when no other patrons stood nearby, donning leather gloves to conceal his fingerprints. One could never take too many precautions. By mid-September, he knew every detail of the Zodiac killings, Diane Suzuki’s disappearance, the paraquat spree in Japan. He’d read Dreiser’s An American Tragedy and Capote’s In Cold Blood as “how not to” books. What he realized, after his month of research, was that most “perfect crimes” stemmed at least partially from luck. Many victims found themselves in the wrong place at the wrong time; perpetrators often escaped identification through shoddy police work. Had he been conducting a controlled experiment, in which he was afforded multiple chances, Balint might have risked relying on a combination of skill and good fortune. But he had only one opportunity, only one life, so he refused to leave even the most trivial detail to circumstance. He thought of the horrors of prison, and about his own daughters, and he knew he had to get it right.

  A third alternate Saturday arrived and he again visited his parents in Hager Heights. More truck-ripened tomatoes. More watercolors. More doting praise from his mother and crisp admiration from his stepdad.

  Balint still did not have a plan. Yet he had made considerable progress: in only six weeks, he already had identified dozens of ways in which he would not kill Warren Sugarman.

  ANOTHER ODD thing occurred: he accompanied his girls to a farm in Marston Moor to purchase pumpkins for Halloween, on a Sunday when Amanda actually did have to cover the reference desk at the library, and he ran into Gloria Sugarman and her son. He’d encountered his wife’s friend many times in his own living room, and at dinners with their spouses, but he couldn’t recall the last time he’d crossed paths with her at random—certainly not forty-five minutes away from home. She’d aged a decade since he’d last seen her: crow’s-feet limned her eyes and her skin had acquired a sallow tone. The child, Davey, was a pale, pudgy creature; he reminded Balint of the cartoon piglet on Phoebe’s favorite television show. The notion crossed his mind that the boy was divine retribution, also that he didn’t particularly look like Sugarman. His own daughters, he reassured himself, both boasted the distinctive Balint family chin.

  Gloria spotted him in the pies and preserves aisle.

  “Jeremy,” she cried. “Jeremy Balint!”

  “What a surprise . . .”

  He dispatched Jessie and Phoebe to explore a stand of enormous pumpkins.

  “It’s so good to see you,” said Gloria. “Truly.”

  They stood facing each other in the fertile air. A hay cart entered the parking lot, discharging a swarm of raucous adolescents. Grackles and starlings scavenged on the gravel in front of the apple-weighing station. Balint had nothing to say.

  “Have you seen Warren?” she asked.

  “Here and there. In the hospital. Not socially.”

  He didn’t mention the upcoming dinner they had planned—which he vaguely recalled was still on his calendar.

  “It’s okay, if you do,” said Gloria. “I fully understand. But he’s an asshole. Just so you know.”

  I do know, thought Balint. Yet he held his tongue. He found himself thinking: You may hate him, Gloria, but I’m going to kill him. The certainty of this vow brought a genuine smile to his lips.

  “A real asshole,” she emphasized. “Not to be trusted.”

  Balint glanced around to make sure that his kids were out of earshot; he didn’t need them repeating Gloria’s remarks to Amanda. In one of the true crime digests at the Pontefract Library, he’d read about a scarlet macaw that had unwittingly divulged his owner’s career as a cat burglar.

  “I do hope you’ve landed on your feet,” said Balint. “You’re looking well.”

  “Nonsense. I look like shit,” answered Gloria. “I’m using my maiden name now, incidentally. Gloria Picardo. I always despised Sugarman . . . It sounds like a gingerbread cookie, doesn’t it?”

  “Gloria Picardo,” said Balint. “I’ll let Amanda know.”

  He turned toward the pumpkin grove—pretending that he’d heard one of his daughters summoning him. “So good to see you,” he said, already inching along the aisle. “I’m sure we’ll cross paths again soon.”

  He did not mention the encounter to Amanda.

  THE DINNER at Sugarman’s was actually scheduled for that Thursday. Amanda had arranged for a babysitter—a mousy girl who had previously worked for a cousin of a woman with whom his wife had once taken a pottery class. Or something like that. He couldn’t keep Amanda’s hobbies straight and he couldn’t keep her friends straight. If she in fact had been learning sculpting, after all, and not screwing some dashing art instructor. Yet deep down, Balint suspected that there were no other Sugarmans in her life. Her lover might be playing around with scores of women, but that wasn’t Amanda’s nature. One affair, maybe. But not two. Or, at least, that’s what he told himself. If his rival really had seduced his wife away from a life of fidelity, that justified the man’s murder all the more.

  Balint felt no desire to spend an evening in Sugarman’s company. On the other hand, he might postpone the dinner, but he couldn’t avoid it forever. Eventually, if he sent enough regrets, his rival was bound to grow suspicious. So far better to get the engagement over with as quickly as possible. Like lancing a boil. It might be torture. Yet even torture proved bearable when one knew that it wouldn’t last forever.

  They drove to dinner in the Saab. Amanda didn’t park under the basketball hoop, however, but at the curbside. Balint brought along a bottle of Cabernet Sauvignon. He took pride in the knowledge that he hadn’t tampered with the wine—that he was not the sort of dimwitted killer who’d let emotion cloud his judgment.

  Sugarman greeted him with a handshake, then had the nerve to clasp him around the shoulders. He didn’t attempt any physical contact with Amanda.

  “So here are the options,” declared their host. “We can order in Italian. Or we can order in Indian. Or we can order in sushi.” He handed Balint a stack of paper delivery menus. “Alternatively, we can show up at Gloria’s condominium, and demand that she cook us dinner, but she’s likely to sprinkle mine with cyanide. So what will it be?”

  “I vote cyanide,” said Balint. “I hear it tastes like almonds.”

  The surgeon led them into the den—the very room where the traitor’s nose had rubbed on Amanda’s. “Smells like almonds,” he said. “They claim it tastes bitter, but it probably anesthetizes the tongue on contact, so it’s hard to say . . .”

  “You know a lot about poisons,” mused Balint.

  “Just enough. You can’t be too careful. Definitely not with Gloria on the loose.”

  Balint watched his rival closely, on guard for any subtle exchanges between him and Amanda. He saw none. Sugarman blathered about his transplant cases, which he described using medical terminology, addressing Balint as though his wife weren’t even in the room. He sat on one of the love seats, leaving the sofa to his guests. Over cognac, they decided upon Indian, and Sugarman phoned in their order. Then his eyes gleamed, as though lit with a photographer’s flash, and he said, “I almost forgot. I’ve been meaning to give you follow-up on that dead dog business.”

  Balint’s ears perked up.

  “Turns out it was some troubled kid from Hager Park. They caught him stabbing a woman’s German shepherd last week—and he’s already confessed to at least two other animal killings. So far, he’s denying responsibility for my neighbor’s dog, but it seems rather implausible that he’s behind ev
ery other dog murder except this one. Strange, isn’t it, how criminals will confess to almost all of their crimes and then hold back and insist they’re innocent of only one or two.”

  “Maybe they really are innocent,” offered Amanda.

  “Could be. But I think a far more likely explanation is that people want to feel that they’ve been victimized. Even a serial killer can take pleasure in indignation. If he can say, I’ve done almost all you’ve accused me of—except not that—it lets him focus on the way he’s been wronged by the authorities, rather than on the wrongs that he’s done to others. It’s a coping mechanism.”

  Balint savored his good fortune; now even the dead dachshund wouldn’t be traced back to him. “Interesting theory, Warren. You sure you’re not thinking of transitioning into psychiatry?”

  “Only as a patient. And hopefully no time soon,” quipped Sugarman with a broad grin. “Seriously, headshrinking’s not for me. Do you know what the problem with psychiatry is?”

  Balint waited for his rival to answer his own question.

  “The problem with psychiatry is that you can’t sleep with your patients.” Sugarman beamed. “Or I suppose you can. But only until someone catches you.”

  He poured himself a second cognac and topped off Balint’s glass.

  “That was a joke, for the record,” he added. “In case you’re thinking of reporting me to the medical board. Anyway, what have you two been up to?”

  “The usual,” said Amanda. “Carpool. Violin. Ballet. I love my girls—don’t get me wrong—but I’m starting to understand the appeal of Swiss boarding school.”

  “Davey is with Gloria full-time now,” said Sugarman. “Probably for the best. We were never good at dividing responsibilities. You two, on the other hand . . . I admire how you work so well together.” He took a sip of cognac and nodded—but Balint couldn’t discern if he approved of the brandy or of his guests’ parenting. “You know, Jeremy, I should be angry with you. Gloria was always holding you up as an example in order to shame me. Practically every time you drove your kids to a birthday party or a music lesson. You’re lucky I didn’t name you as a corespondent in my divorce.”

  “I’m the luckiest guy on earth,” said Balint.

  He pictured his fingers choking off the air to his host’s lungs.

  “I do have an interesting case to tell you about,” continued Sugarman—apropos of absolutely nothing. “I’m actually going to be an expert witness in criminal court.”

  “Very impressive,” said Amanda.

  “It’s a manslaughter trial. You may have heard about it. Surgery resident up in Somerset County accidentally requested the wrong medication for a patient a few years back. He was supposed to order intravenous metoclopramide for nausea—and instead he ordered meperidine. Demerol. Sent the patient into a hypertensive crisis. Nearly killed him.”

  “Sounds like gross negligence, at a minimum,” said Balint.

  “That’s just the tip of the iceberg. So this kid—he’s only two years out of med school, after all—insists that he did order metoclopramide. That the nurse must have filled the syringe wrong. They were still using paper charts at this hospital at the time, mind you, so there’s no electronic record . . . and when the auditors searched for the carbon copy of the order slip, they found it had been torn from the logbook.”

  “Clever. His word against the nurse’s.”

  “But here’s the insane part, Balint. This resident gets it into his sociopathic head that they might not believe him. That he might still get fired. So for the next two months, every time that particular nurse is on duty—it’s a male nurse, a relatively new hire—the resident sneaks into the medication room and fills a metoclopramide bottle with Demerol, hoping to frame the guy. The nurse unwittingly injects four other patients before the hospital gets wind that something’s terribly wrong and suspends him. Two of those patients died.”

  “That’s awful,” cried Amanda.

  “You’ve got to wonder who let this nutcase into med school,” said Sugarman. “Nurse nearly ended up going on trial for murder too. You know what saved him?”

  “The resident had a guilty conscience?” suggested Balint.

  “Appendicitis. The lucky bastard comes down with appendicitis and has to skip his nursing shift at the last minute. So a different nurse is on duty for the fifth injection.” Sugarman leaned toward them, his face flushed. “The best part is that the resident was actually part of the team that scrubbed in on the appendectomy. That fellow must have been shitting bricks when he realized who was on the table. Talk about irony.”

  The doorbell rang. Sugarman set his drink on a coaster.

  “Every time one of my own residents makes a mistake,” he observed as he strode toward the door, “I’m just thankful he’s not that kid.”

  “At least the guy was smart,” said Amanda.

  “Not so smart,” objected Sugarman. “He got caught.”

  Yes, thought Balint. He got caught. But I won’t. And his plan for murder suddenly came into focus.

  CHAPTER THREE

  Most of Balint’s patients were hopeless cases. These men and women had already failed fluid restriction, digoxin, aldosterone antagonists. They’d visited cardiologists up and down the East Coast, paid out-of-pocket for third and fourth opinions. Unfortunately, what they needed were new hearts, substitute organs to replace their own failing tissue, but new hearts were in critically short supply. So they waited. And they suffered, sleeping on stacks of pillows to help them breathe. And a lucky few survived long enough for Warren Sugarman or Chester Pastarnack to slice open their chests and to rejuvenate them with a blood pump salvaged from a motorcycle fatality or a gunshot victim. For that’s all the human heart really is: a relentless blood pump. Several times a month, Balint had the unpleasant duty of phoning the family members of one of his patients and informing them that, in the case of their loved one, the original pump had stopped working too soon.

  Norman Navare was such a hopeless case. He’d been referred to Laurendale from a community hospital in Elizabeth Lakes on the remote chance that Balint might be able to slip him onto the transplant list. One look at his chart was all it took to recognize that the odds were grim. Navare was sixty-four—at the cusp of too old. He had diabetes, another strike. But his largest problem was that his heart’s ejection fraction had been measured at 14 percent. Anything below 15 percent was dire, a number below 10 percent usually incompatible with life. Even if he were eligible for an organ, he had little prospect of surviving until one became available. But Balint had agreed to see him—cultivating good relationships with Laurendale’s satellite hospitals was a crucial aspect of what made an effective division chief—and in late September, the man had arrived for his first appointment in the company of his adult daughter. Navare, despite his bleak health, displayed the confidence and flair of a man who had once been exceedingly handsome. He sported a guayabera and a Panama hat that gave him the look of a playboy from prerevolution Havana. But Balint hardly noticed the man’s rugged features, because he was immediately captivated by the black-eyed brunette at his patient’s side: Navare’s daughter was the most beautiful woman that Balint had ever laid eyes upon.

  “We’re so grateful to you for seeing us,” she said. She appeared to be about twenty-five. “We tried to get an appointment at Cornell, but they wanted us to wait six weeks. The Brigham in Boston wouldn’t see us at all.”

  Balint noted the girl wasn’t wearing a wedding ring. He hoped that she hadn’t spotted his own. As the diseased man settled himself into a chair, Balint concealed his hands beneath the desk and clandestinely slid the gold band off his finger. What authority did Amanda have to complain? If she spent her Saturdays on the sofa in Sugarman’s den, he had every right to flirt with anyone he damn pleased.

  “Well, that’s their loss,” said Balint. “Some of these fancy hospitals take only the easy cases. They’re more concerned about padding numbers than with saving lives. It’s sad. But I promise you we
’ll do the best for your father.”

  “So you think you can get him a heart?”

  Usually, this was the moment where Balint warned patients and families that he couldn’t make any promises. Instead, he said, “I’m certainly going to try like hell. If my own father needed a heart, I wouldn’t try any harder.”

  The girl’s eyes glowed. “Did you hear that, Papa? That’s not something you hear every day from a doctor.”

  Her father nodded. “We’ll see what happens.”

  Navare sounded short of breath. Balint listened to his heart and lungs with a stethoscope. He held his own shoulders out and sucked in his stomach while conducting the physical, striving to appear dashing—or, at least, professional.

  “I’m Delilah, by the way,” said the girl. “Like the woman in the Bible who gives Samson that nasty haircut. But I’m a nurse, not a hairdresser. A nursing student, really—for another nine months.” Her voice was tender and intensely feminine, a striking contrast to Amanda’s no-nonsense manner of speaking. “Forgive me for saying this, Dr. Balint, but I want you to know that we’ve seen God-knows-how-many cardiologists over the past few years, and you’re the first one who didn’t treat Papa like a number. Most of them look at his ejection fraction and more or less bury him alive.”

  “There’s a lesson in that. Don’t die on one doctor’s opinion,” said Balint. Then he took a risk and added, “But please, call me Jeremy. In Hebrew, it’s Jeremiah. Like the guy in the Bible who complains a lot.”