“This one just changed category,” said Karen.
“True. Makes Treacher’s numbers even worse.”
“Do you have any older copies of Lorraine’s chart?” asked Karen.
“I tossed ’em,” said Anne. “It doesn’t matter, medical records are cumulative.”
Not this one, thought Karen. She asked Anne if any additional cases of food poisoning had turned up since Sunday afternoon.
“Not so far, thank God.”
“Doesn’t it seem strange that one patient and the nurse attending that same patient got sick, but that’s all?”
“Strange, but possible,” said Anne. “Maybe there was only one bad chicken and they each got a piece, and nobody else did. Let’s count our blessings. I had lunch at the cafeteria last Saturday myself.”
“When are you going to stop being here on weekends?” scolded Karen.
“When the patients do,” said Anne.
Karen ended the conversation and soon found herself pacing about her office. In May, Lorraine’s chart showed her drug allergy. The allergy sheet was removed before her crisis on June 17. In all likelihood, the same was true of Lorraine’s Medic Alert bracelet.
Nurse Jazinski was wrong. The bracelet and allergy sheet were not removed to cover up a medical disaster.
They may have been removed to cause one.
KAREN’S LUNCH CONSISTED of a cup of strawberry-banana yogurt, a slice of whole-grain bread, and a can of lime-flavored sparkling water. Lunch at work was for fuel, not fun.
She looked around her office, feeling agitated. It wasn’t just the mess she hated. She was sick of the artwork on her walls. Her steel-framed modern art prints of angular geometric shapes, simple and stark, had once seemed right for the office of a smart young lawyer. Now they looked sterile and boring. The furniture—a plain walnut desk and practical gray-cloth chairs—also irritated her. She had worked too hard for too long to be stuck in this same puny office with its one little window and obsolete HVAC. Her office at Van Dyke ~ Eddington would be much larger, with nicer furniture and a better view. Somehow, the Van Dyke offer made her office at Shoreview seem shabbier.
She decided to review Lorraine Winslow’s records from her last hospitalization. Margaret was still acting surly, so Karen went to the medical records department, picked up a copy and brought it back to her office.
The resident’s notes were almost illegible and full of abbreviations, but Karen knew how to read a chart. The list of symptoms from Lorraine’s final illness went on and on. Urticaria, angioedema, erythema, pruritus. Hypotension, bronchospasm, dyspnea, hypoxia, acute anxiety, syncope. What it all meant was that during her last hours Lorraine had broken out in hives, had trouble breathing, panicked and passed out. Antihistamines and corticosteroids had been administered, to no avail. “Christ almighty,” said Karen. How could she leave Shore-view Memorial before she got to the bottom of this?
CHAPTER
13
According to the chart, the resident who ordered Lorraine Winslow’s antibiotics was C. Sylvester Hazelwood, M.D.
Karen wondered what god-awful name the “C” must stand for that he opted to go with “Sylvester” instead. She asked Margaret to locate Dr. Hazelwood and set up an appointment for Karen to interview him.
“I hope I can get to it today,” said Margaret sullenly. “With Ed out of work, I have to recalculate our whole budget or we could end up on the street.”
Margaret, a master of the art of secretarial blackmail, was letting Karen know that if she wanted to get any work out, she had better do what she could to help Ed Luebsdorf. Karen knew when to say uncle. “I can’t promise anything,” she said, “but I’ll talk to Max about it.”
With five clicks of her computer mouse Margaret had the residents’ call schedule for the Department of Medicine. Dr. Hazelwood would be in the hospital at 5:00 P.M. Margaret could be quite efficient when she wanted to be, which was seldom. Now if she would just get that hair out of her face and put that spaghetti strap up where it belonged.
Karen also wanted to interview Bonnie Bach, the nurse who had found Lorraine Winslow on the bathroom floor. Bonnie was the only person other than Lorraine to have contracted food poisoning at the hospital that day.
Bonnie Bach seemed more scared than sick when Karen talked to her on the telephone. She agreed to meet with Karen at 4:00 that afternoon at her home, which was within walking distance of the hospital. Karen called Jake to alert him that she would be home late. She got no answer. Flooded with anxiety, she called the cell phone.
“Y-y-yello.”
“Where in tarnation are you?”
“Tarnation?” said Jake. “Well by doggies, I must be down by the crick in the holler.”
“Allow me to rephrase,” said Karen. “Where the fuck are you?”
“I’m at home.”
“Why didn’t you answer the phone?”
“Couldn’t hear it,” said Jake. “I’m working in the studio. Don’t throw away empty egg cartons anymore. They make great soundproofing. The staple gun your dad gave me is cool.”
“Have you forgotten Inviolable Rule Number One?” said Karen.
“No leaving the house with the baby without prior notice.”
“And,” said Karen, “failure to answer the home phone will be deemed an emergency.”
“Oh, yeah. Sorry.”
“Why is the baby crying?”
“You can hear that? I’m going to need a lot more egg cartons.”
“Jake, go tend to McKinley. I’ll be home a little late.”
“Got it.”
Karen had recently read a magazine article opining that care by either parent was superior to day care. When she had time, she intended to write the editors a tough contradiction.
It was high summer in northern Illinois. Cottony cumulus clouds adrift on a pale blue sky. Lush lawns shaded by prim maples and beeches with leaves as big as dinner plates, their branches drooping, as if from the heat. Humidity so high anything that got wet, stayed wet. Five blocks from the hospital, Karen knew she would have to get her navy blue suit dry-cleaned before she could wear it again.
The area surrounding Shoreview Memorial was old and blue-collar, the sort of neighborhood where men washed their cars by hand and women still hung out the laundry occasionally. Bonnie Bach lived in a small bungalow with white lap siding and green faux shutters. The walk to her front door was lined with well-tended planters of red geraniums and round pots of white impatiens that looked like bowls of popcorn. Bonnie answered the door in a pink bathrobe and immediately apologized for her appearance: no makeup, hair matted, bedroom slippers. Karen had never met Bonnie before and was surprised that she was African American. Few blacks lived in Jefferson and those who did mostly resided in the Jamesville neighborhood on the other side of town. Karen had not guessed Bonnie’s race from talking to her on the telephone, and “Bach” sounded like a German name.
The front door of Bonnie’s house opened onto a small but tidy living room. Bonnie and Karen sat down on wing-backed chairs across a coffee table with a glass top that held down color snapshots and school photos. Bonnie offered Karen iced tea. Karen hesitated momentarily, unsure whether she wanted to eat or drink anything prepared by someone as ill as Bonnie appeared to be. But she accepted, deciding it would be unfriendly to refuse and she needed to establish a rapport with her hostess. Besides, what could grow in tea?
“I went on duty around 9:00 P.M.,” said Bonnie. “Mrs. Winslow seemed sort of confused, but otherwise she was fine. I gave her a sleeping pill. When I went to check on her after midnight she was in the bathroom, sitting on the floor, sick as could be. When I saw the blood, I called for Dr. Hazelwood.”
“Where was the blood?” said Karen.
“There was bright red blood in the toilet,” said Bonnie, “and some dark brown blood in her mouth.”
“In her mouth?”
“You see that in a patient who has a gastrointestinal bleed,” explained Bonnie. “They som
etimes spit a little clotted blood up into their mouths. If the blood in their mouth is red it usually just means they bit themselves.”
Karen asked whether Mrs. Winslow was wearing a Medic Alert bracelet and was not surprised that Bonnie answered in the negative.
“Were you around when she started reacting to the antibiotics?”
“Yes. It happened fast. She broke out and started wheezing almost immediately. Terrible thing. Dr. Hazelwood had left already. I had to call him again, and he came running. He looked terrified. But he did everything possible.”
“Had you taken care of Mrs. Winslow before?” asked Karen.
“No. I’ve only been at Shoreview since the beginning of June. Nice thing to happen your second week on the job.”
“Did anyone visit Mrs. Winslow while you were on duty?”
“Not that I saw. Someone could have come and gone while I was with another patient.”
Karen took a sip of iced tea. It was too sweet. As she set the glass down on the coffee table, she noticed a photograph of Bonnie with twin sienna-skinned children and a husky blond man, the apparent grantor of Bonnie’s Teutonic surname. Karen had seen the blond man before, behind the counter at a nearby fast food restaurant. No wonder Bonnie sounded scared on the phone. Her family undoubtedly needed her nurse’s income to stay in this house. It took some nerve for Bonnie to even talk to the hospital attorney.
In the photo, the Bachs were gathered around a picnic table covered with barbecue fare and condiments, smiling. At that moment, the idea of meat and mayonnaise sitting out under a hot sun made Karen queasy. It also put a question into her head.
“You said you came in at 9:00 P.M.?”
“That’s right.”
“What time did you eat dinner?”
“Around six.”
“Where?”
“Here.”
“Did you eat any hospital food that evening?”
“No.”
Bonnie finally said she needed to lie down, so Karen thanked her and left. She dragged herself through the oppressive heat, silently chastising herself for having made at least two incorrect assumptions: that Bonnie Bach was white and that the nurse had gotten sick from hospital food. Karen wondered what other false assumptions she was making about Lorraine Winslow’s case, assumptions that might blind her to truths that were lying in plain sight. She got back to the hospital a little after 5:00 P.M. and went straight to the call room to interview Dr. Hazelwood, the internal medicine resident who ordered the antibiotics for Lorraine.
To be in a medical residency, Hazelwood had to be in his late twenties at least, but to Karen he looked like a teenager. He also appeared to be dressed too trendily for a doctor, with an oversized tribal-print silk shirt under his lab coat and a pair of retro ’50s glasses that suggested he was trying to impersonate an alternative rocker. Like all residents, he looked dog-tired.
The call room was cramped and stale-smelling. Karen sat on a molded plastic chair while Dr. Hazelwood sat on the corner of a cot used by the residents to take naps during their thirty-six-hour shifts. Karen often wondered how many lives were lost because the residents were zonked out half the time from the grueling hours. It reminded her of Jake’s theory that the ridiculously harsh demands placed on medical trainees were intended, like military boot camp, to indoctrinate an unquestioning acceptance of authority—in this case, the dictates of the medical establishment.
“With a regular case of food poisoning,” explained Dr. Hazelwood, “we don’t treat with antibiotics. It just runs its course. But if there’s blood in the stool and a high fever, you’ve got to bring the infection under control. The antibiotics we gave were standard, the oral and the IV.”
Karen looked down at her notes. “What about the injection of diphenoxylate?”
“The most important thing with food poisoning,” said the resident with a self-assured hand-chop gesture, “is to prevent dehydration and exhaustion. The patient had diarrhea and was losing a lot of fluid. She also had cyclical vomiting and was nearly prostrate. Diphenoxylate is an antiperistaltic. It stops the vomiting. It’s used a lot in these cases. Unfortunately . . .”
“What?”
Dr. Hazelwood’s eyes were downcast. “If she’d kept vomiting she would at least have gotten some of the oral antibiotics out of her. The diphenoxylate kept it all down so she got maximum absorption.” He looked up and shrugged. “People with severe drug allergies who don’t wear Medic Alert bracelets are idiots.”
“You mentioned blood in the patient’s stool,” said Karen. “The night nurse said she also had dark brown blood in her mouth. There’s nothing in your notes about it.”
His eyes moved to the side and he made little popping noises with his lips. He shook his head. “I don’t remember seeing any blood in her mouth.”
Karen asked the resident about Lorraine’s allergic reaction, and how it was treated. It was Dr. Hazelwood who had directed the futile attempts to save Lorraine.
“She had a severe anaphylactic reaction while she was very ill from the food poisoning. We pulled out all the stops, but it was no use. I wasn’t around when she died.”
Karen thanked him and rose. On her way out, Dr. Hazel-wood asked her if she was any relation to Jake Hayes.
“He’s my husband,” said Karen. “Do you know him?”
“I’ve seen him play at the Caledonia Club,” said the resident. “Man, he really rocks! If you like that old stuff.”
“HE CALLED IT ‘old stuff?” Jake queried.
“Yeah, but what does he know? He’s in his twenties and looks about fifteen.”
“He probably likes *NSync,” said Jake.
“Don’t take it personally, sweetheart,” said Karen. “So how’s my little snookum-wookums?”
“He’s fed, bathed, changed and in his sleepers,” boasted Jake. “Check him out.”
Karen tiptoed into the baby’s room. She looked into the crib and dissolved into a fit of giggles.
“What’s so funny?”
“His sleepers are on backward,” said Karen, holding her stomach and bursting into laughter. “The footie things are supposed to point forward, not backward! It looks like his feet point the wrong way.”
“When you’re finished laughing yourself sick, could we eat?” Jake asked stiffly.
Dinner consisted of leftovers from the previous day’s birthday/ Father’s Day party and a couple of cold beers. They ate in the backyard, where the heat of the day had mellowed into a sultry late afternoon. A low sun and pink horizon warned of the impending dusk, when the mosquitoes would inevitably invade. Jake remarked on how the burgers retained their charcoal-grilled flavor when reheated in the microwave. Karen just pushed baked beans around on a white paper plate.
“Something is weighing on your mind,” said Jake.
“Do you think I should start coloring my hair? Will you still love me if I look like a gray-haired granny?”
“The answer to the second question,” said Jake, “is, ‘yes, with all my heart and soul.’ The answer to the first question is, ‘no comment.’ And stop dissembling. You’re worried about something more important than your hair color.”
“Lorraine Winslow’s death,” confessed Karen. “Some things about it just don’t add up.” She described how Lorraine’s hospital records had previously disclosed her allergy to antibiotics, but the drug allergy sheet had disappeared at some point, along with her Medic Alert bracelet. “It’s hard to avoid the conclusion that someone set her up.”
“Like who?”
“No idea. Her attending physician has lost a suspiciously high number of patients. We’re reviewing his cases. He would have been in a position to pull her allergy sheet, but could he have taken her bracelet from her? And how did he arrange for her to need the antibiotics?”
Jake swatted a mosquito on his forearm. “You said she got sick from the hospital food. Was her doctor around when her meals came?”
“He admitted her, he may have been. But here’s some
thing strange. The night nurse who came on at 9:00 P.M. came down with food poisoning a few hours after Lorraine. Nobody else, just those two. By 9:00 P.M. Lorraine’s dinner tray would have been gone.”
“So either they didn’t get sick from the hospital food or they didn’t get sick from the same thing,” said Jake.
“That sounds logical,” said Karen. “Another peculiar thing about the case. The nurse and the resident are inconsistent in their descriptions of Lorraine’s symptoms of internal bleeding. Mind if I talk about this while you’re eating?”
“No problema,” said Jake. “Pass the ketchup.”
“The nurse said Lorraine had dark brown blood in her mouth, indicating she was bleeding into her stomach and spitting it up. The resident said he didn’t observe it. No chance he’d miss that on an examination for gastrointestinal illness.”
“So either the nurse was mistaken or one of them is lying,” said Jake.
“Also logical.”
Jake raised his beer can and shook it to demonstrate its emptiness. “‘Logic, like alcohol,’” he quoted, ‘“loses its beneficial effect when taken in too large quantities.’ Lord Dunsany. You want a glass of milk?”
“No, thanks.”
“You can’t have chocolate cake with beer,” said Jake.
“Yes, I can.”
Jake gave an exaggerated shudder and disappeared into the house. The sun was below the horizon. It was getting dark, but not any cooler. Karen had another, more difficult topic to discuss with her husband. Best to get it over with.
“My parents are agitating about getting McKinley baptized,” said Karen when Jake returned.
“I know. Your dad brought it up with me.” Jake used his tongue to remove chocolate frosting from between his teeth. “What are you staring at?” He raised his napkin to his face. “You’re staring at my mouth. Have I got a milk mustache?”
“No,” said Karen. She balled her napkin onto her plate and rose abruptly.
“Are the mosquitoes getting you?” asked Jake.
“I have to make a phone call,” Karen said, bolting from the table.
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