“Good afternoon. How can I help you today?” Her eyes went quickly over Kenzie, evaluating her. She knew that Kenzie was not a regular visitor for one of the residents.
“My name is Kenzie Kirsch. I’m from the Medical Examiner’s Office.”
“Oh. And what can we do for you?”
“I would like to talk to anyone regularly involved in the care of Willis Cartwright.”
“I see...” The woman, the name Delores imprinted on her name badge, didn’t make a move toward the phone or computer keyboard. “Can I ask if there’s something wrong?”
“I’m just following up on a death.”
“I don’t remember ever having a personal visit from the Medical Examiner’s Office before.”
Kenzie didn’t want to say that it was out of the ordinary, which might make people defensive. But she wasn’t about to say that it was commonly done either, which Delores would know was a lie if she had worked there for very long. There were deaths at Champlain House regularly, like there would be at any other nursing home, and they would know that most did not require an in-person visit from the ME.
“There were a few things in this case that we wanted to be sure of,” she said vaguely. “So if I could talk to nurses, doctor, housekeeping...?”
“You don’t have an appointment...”
“No. And I think Mr. Cartwright’s family would probably like to hold his funeral sooner rather than later. Shall I tell them that you’re holding up the ME’s report?”
Delores didn’t like that idea. She wrinkled her nose. “I don’t know who you’ll want to talk to. He was in our independent living center, so he didn’t have dedicated nurses assigned to him. There was staff around if he needed assistance, but he was pretty self-sufficient.”
Kenzie hadn’t anticipated that Delores would know any details. She leaned forward on the counter, giving Delores a grateful smile. “That was what the report we received said. You knew Mr. Cartwright well?”
“I don’t know about well, but... yes. Certainly. He was around and I knew him by name to say hello or have a conversation. He wasn’t one of the troublemakers, you know, just a very pleasant old gentleman.”
“And had he been having any trouble recently? The report we received said that they had started running some tests, because his behavior had changed.”
“Changed? No, I don’t know if I would say that,” Delores shook her head. “He was having some trouble... but everybody does now and then. He might have had a bit of a bug. We were all very surprised to hear that he had passed away. He didn’t seem sick.”
Kenzie nodded. “What kinds of things was he having trouble with?”
“I don’t know.” Delores looked to each side as if she were afraid someone might overhear her gossiping. But there was no one else around. The lobby area was quiet and empty. “I’m not a nurse. Don’t have the stomach for it. He’d... had some dizzy spells. Seemed disoriented. He forgot names or would start to say something and then forget where he was going with it.” She shrugged. “We all do those things sometimes. It doesn’t mean anything.”
“But it was enough that his doctor had ordered some tests to be run.”
Delores looked reluctant, but nodded. “Maybe he saw something that I didn’t. He would have been privy to Mr. Cartwright’s private medical information. I only saw him casually, and I didn’t see much change from one day to the next.”
“So I should talk to his doctor for sure. And that would be doctor...?”
“Dr. Able.” Delores sighed, like she had been trying to protect him, but the cat was out of the bag now. “I suppose so.”
“Is he in today or will I need to set up an appointment with him?”
Delores looked at the watch on her wrist with a pretty silver-chain strap. “He will be doing rounds this afternoon. I can’t promise you that he’ll have any time to talk to you, but he is around.”
“Great. And if I could talk to any of the nursing and housekeeping staff that has contact with him.”
“People need to do the work that they’re here for. They don’t really have the time to be dealing with inquiries.” Delores shrugged as if Kenzie were being unreasonable.
“If I need longer than a few minutes, then I’ll set up an appointment for them to come into my office. But I’m sure they’d rather talk to me here than to have to set something up separately. And, of course, the Cartwright family wants to be able to proceed with their arrangements in a reasonable time period. We don’t want to keep putting this off. Eventually, they will get upset and start making waves. Maybe even go to the media about how Champlain House is holding things up and wondering if you’re trying to hide something.”
“We are not trying to hide anything!” Delores’s face grew red. “We’re a very good nursing home; we do a lot of good for the community. I won’t have you throwing around aspersions.”
“I didn’t say I was going to cause you any problems. I said that eventually, the family is going to get upset that the investigation hasn’t been completed and the remains are being held up. I don’t think either of us wants to be in that situation.”
12
Delores gave Kenzie a long, hard glare before finally breaking down. Of course, she didn’t want the facility to garner any negative media attention just because she was being a diligent gatekeeper.
“I will let Dr. Able know that you are here. But don’t be surprised if he reports back to the ME’s office about how... overzealous you are being here.”
Kenzie nodded and took a couple of steps back to allow Delores a semblance of privacy while she called the doctor. Delores’s job was to help the family and friends who came to see their patients and keep any media or unwanted attention out. They didn’t want people poking around and implying that they were not providing the best care possible. Anyone in the industry had to be aware of other facilities that had been exposed for substandard care. It was enough to scare even the best facilities. Walk in and find one patient complaining about falling down on the way to the bathroom, or the bad food, or saying that the staff was stealing from them, and it could be blown up into a three-ring circus.
But they were still answerable to their regulators and law enforcement. They couldn’t just brush off an inquiry from the Medical Examiner.
“Dr. Able is just finishing up his rounds now,” Delores said. “He will be fifteen or twenty minutes, and then he will see you in his office.”
“Thank you,” Kenzie acknowledged. Rather than asking whether she could talk to the other staff in the meantime, she chose one of the comfortable-looking pieces of furniture and sat down to wait, pulling out her phone to check her email. Things would go much better if the doctor were satisfied with Kenzie’s professionalism and reasons for showing up at Champlain House. He could smooth the way for her to talk to the rest of the staff. Or he could make a big stink with the ME’s office and try to get her pushed out.
There were a few emails in her work inbox that she could handle with a brief reply or file into one of her action folders. But most of it was stuff that she had to print out or would take a longer time to handle. Kenzie switched over to her personal email instead. There were a few emails from friends, mostly girlfriends that she liked to go out to eat with. There were a few emails from online acquaintances or men she had previously gone out with or who had tracked her down through one of her dating app profiles. She just deleted them. She had closed her profiles since getting more serious with Zachary, but that didn’t stop people from tracking her down.
Zachary had sent her an email with a query about a couple of prescription medications and what they might be for. He could search them on the internet just as easily, but he liked to refer medical questions to her since it was an interest they shared. Kenzie would have more insight on why someone would be taking a certain combination of drugs. The internet might tell him the possibilities for each individual one, but two or three together gave a better picture of what condition the subject might be dealing w
ith. Kenzie glanced over the names. He had inverted a couple of letters, but it was still obvious what he had intended. She clicked reply and thumbed out a quick answer.
Viagra and blood pressure. Is this a cheating spouse?
It was email rather than an instant messenger, so she wasn’t expecting an immediate reply, but either he was already in his email or he had an alert set up for her reply.
Looks like it, unless he’s selling them on the street.
Kenzie thought it unlikely that they had a very high street value. It looked like someone was taking his extra-curricular activities somewhere else.
“Miss Kirsch?”
Kenzie looked up at the man standing a few feet away from her. She hadn’t even heard his approach. She glanced down at his shoes. Rather than the black dress shoes that she often saw doctors in, he was wearing white sneakers, like the nurses wore for long days on their feet.
“Yes.” Kenzie stood and reached out her hand to him. “Are you Dr. Able?”
If he weren’t, it was better to mistake a nurse for a doctor than vice versa.
“At your service.” He smiled, “Ready, willing, and Able.”
Kenzie laughed. She wondered how many times he had used that line. The nurses probably all rolled their eyes when they heard it. “It’s very nice to meet you. Thank you for agreeing to see me; I know it isn’t easy to make time for unexpected visitors.”
“No, but if they were all as pretty as you, I would make the time.” He smiled charmingly.
He’d hit a home run in the looks department. Several inches taller than Kenzie or Zachary, dark wavy hair, piercing blue eyes, and a ruggedly handsome face and strong jaw. He was undoubtedly used to women falling victim to his charms. Looks and money and prestige.
“And it’s Dr. Kirsch,” Kenzie said. “With the Medical Examiner’s Office.”
His smile wavered. He released her hand and gave a more professional nod. “Of course. I’m sorry.”
“I’d like to ask you a few questions about Willis Cartwright, if I could. You were his regular physician?”
“Willie was in pretty good shape.” Able gestured in the direction they were to go and escorted Kenzie into one of the long, brightly-lit corridors. “He didn’t need a lot of my attention.”
“But you must have still seen him fairly regularly. Was he on any medications?”
“Just blood pressure,” Able said proudly, as if it were due to his own excellent care of Cartwright. “Maybe the occasional painkiller for his joints or something to help the digestion along, but those are pretty common in old age. Not much anyone can do about that.”
“Wow. Good for him. He must have really taken care of himself.”
“Ex-army, from what I understand. That type likes to stay in shape. Very well-disciplined. Got his exercise, watched what he ate.”
Kenzie nodded. “Yeah. I’ve seen a few. But then in the last few days before his death...?”
They entered Dr. Able’s office. He sat down behind his large, dark desk and Kenzie sat in one of the visitor chairs, sitting forward on the edge of it so that she was closer to him.
“Yes. I thought he might be fighting a virus. Certainly not anything dangerous. I was as surprised as anyone when we found him down in his room.”
“He’d had a fall?”
“Yes. I feel bad that it happened. We are very careful with our patients’ health. If he’d been someone who regularly had falls or was out of his bed in the night, we would have had either a bed alarm or a fall alarm or both. But as it was, they did not know that he’d gotten out of bed and fallen in the night. We’re very sorry that happened. But as we told his family, we could not have foreseen that would happen. He wasn’t a habitual wanderer.”
“He had experienced a couple of falls, though, hadn’t he?”
Able considered for a moment before nodding. “Yes, minor. He wasn’t hurt.”
“And he had several bruises on his shins or knees that would suggest he’d been walking into things.”
He shook his head. “I wasn’t aware of that. Elderly people often bruise very easily. They might have been caused by very minor bumps. Hitting a knee when he sat down at the table, for example. Not even enough that he would remember it later. He didn’t have any complaints about walking into things, bruises, or hurting himself.”
“And the staff didn’t know anything about them?”
“Not that I am aware.”
“Speaking of what he could remember...”
Able looked at her steadily. Kenzie looked for any sign that he was keeping secrets. She couldn’t see anything that would suggest deception. “Yes?”
“Mr. Cartwright had been displaying some memory problems? Dementia?”
“No, I certainly wouldn’t go that far. He’d had a couple of episodes just in the week before he died when he had experienced some disorientation or confusion. But it wasn’t that notable. I wouldn’t classify it as dementia.”
“But you were looking into it.”
“Certainly. Even if we thought it was only being tired or a simple mistake, we were still following up to make sure that it wasn’t the development of something more serious. I had set up some blood tests, brain imaging, cardiac just in case. So many systems can affect the brain... I thought it was simply being short on sleep or fighting a UTI, but was following up just to be sure.”
Kenzie nodded. She made a few notes on her phone just to make sure she wouldn’t forget anything when she returned to the office to write up a report on her findings at Champlain House.
“And nothing showed up in those tests?”
“No.”
“And up until his last few days, no problems at all. You felt he was in good shape.”
“I figured he would live to be a hundred, honestly. Or older. He wasn’t even ready for managed care yet. He was here for the convenience of having professionals around, someone else making his meals, having a community of people of his age to do things with. It wasn’t because he could no longer manage on his own. I’m sure he could have. Up until... the end.”
“I’m sure you’re wondering why I’m here.”
He gazed at her. “It did occur to me.”
“Mr. Cartwright’s brain showed signs of advanced Alzheimer’s Disease.”
13
Dr. Able’s brows shot up. He leaned forward over his desk, staring at Kenzie. “What?”
Kenzie had brought several of the images with her. She assumed that working with seniors, Dr. Able would have at least a working knowledge of Alzheimer’s Disease and its markers. She took a couple of pictures out of her slim briefcase and slid them across the desk to him.
He looked them over, frowning, and shook his head. “I think the samples must have gotten mixed up at your lab.”
“That was our first thought too. But I prepared slides and examined them myself today. There is no doubt that the man in our morgue under the name of Willis Cartwright had extensive AD markers in his brain tissue.”
“But that just can’t be. That much damage... it takes years to develop and he would have shown signs.”
“There are cases of Rapidly Developing Alzheimer’s Disease.”
“Rapidly Developing, yes. But overnight? No. This man,” Able pointed at the images. “He wouldn’t be able to function in our independent living center. I know the effects of Alzheimer’s Disease, Dr. Kirsch, and I can assure you that Willie did not have it.”
“You don’t think that the symptoms you saw the last few days might have been signs of Alzheimer’s Disease?”
“And he just got it last week?” Able’s voice dripped with sarcasm. “He started showing symptoms last week and then was dead? Rapidly Developing AD takes weeks to months, not days, to kill.”
Kenzie nodded slowly. The symptoms, then, were probably just what Able had initially thought. Cartwright fighting a virus. Something that might have been completely innocuous to someone else but had caused damage to his brain or heart that had resulted in his
death. Nothing to do with the amyloid plaques.
“Let’s say it’s not AD,” Kenzie said, following this train of thought. “Let’s say it’s something different. When did he start showing changes in behavior?”
“As I said, it was only a few days before he died. He had a couple of falls. Nothing serious. He would get dizzy or disoriented. Forgot people’s names or the conversation you had just had with him. But that’s all. It could have been vertigo from an ear infection.”
“Yes. Except that we didn’t find any sign of infection in his body. In fact, he was in pretty good shape, considering his age.”
“And the fact that he was dead.”
“And the fact that he was dead,” Kenzie acknowledged. “He seemed to be strong and healthy. Other than the bruises, the blow to his head, and the brain pathology.” She considered, trying to think of whether there was anything else she should ask Able about. “Oh. Can you tell me if he was continent?”
“Yes. Certainly. No issues there.”
“And he didn’t have much appetite the final few days.”
Able shrugged. “Like a man with a virus. We weren’t particularly worried about it. Like you said, he was apparently in good health and we figured he would rally and be feeling better again in no time.”
“Yes, that’s understandable. You had no way of knowing that there was anything wrong. We still aren’t sure what it was that killed him.”
“Not the fall? The blow to his head? That’s what I was worried about.”
“No. There was no hematoma. No clot. No concussion. Just a laceration.”
“Well, thank you for that. I appreciate knowing that it wasn’t the fall that killed him. Or the fact that it wasn’t discovered until the morning.”
“I wonder if I could talk to any of the nursing or housekeeping staff who are around today who are familiar with Mr. Cartwright? I won’t take up a lot of their time, but it will be faster to deal with this and get Mr. Cartwright’s remains back to his family than if we have to go back and forth making appointments.”
Doctored Death Page 5