“I don’t see how they’re going to help you. I’ve already told you everything we know.”
“I need to do a full investigation. If I can’t find out anything else... that’s fine. That will be the end of it.”
He rolled his eyes, but nodded. “I’ll take you to his unit, and you can discuss it with the staff. But please be... discreet. I don’t want you upsetting the other residents. And I don’t want there to be rumors that there is something strange or ominous about Willie’s death. Sometimes people do die unexpectedly. Sometimes we can’t find a reason or an explanation.”
14
Kenzie was escorted to the living unit where Mr. Cartwright had been housed. It was not locked or alarmed in any way. It was a pleasant, homey atmosphere. Clean, bright, open. They saw other residents coming and going as they pleased without any need for checkout. People took walks up and down the halls, dropped in on each other, played games, or watched TV in the common room they passed. Dr. Able took Kenzie to the nurse at the desk and introduced her, explaining in a low voice what Kenzie was there for.
“Mr. Cartwright?” Nurse Summers asked with a sad smile. “What a lovely gentleman he was. I was very sorry to see him go. It was a bit of a shock.”
Kenzie nodded. “That’s what I understood.” She smiled and nodded at Dr. Able. “Thank you for your help.”
He looked at her for a moment, then shrugged and left, heading back toward his office. Kenzie didn’t want him hovering while she asked questions. She didn’t need him monitoring her or feeding lines to the nurse to make sure she said the right thing.
Kenzie sighed. “I understand Mr. Cartwright went downhill pretty quickly?”
“Downhill? Who told you he went downhill? That’s not what Dr. Able told you,” Summers said accusingly, looking in the direction Dr. Able had gone.
“Not in so many words, no. But I understand he was forgetting things, disoriented, had lost his appetite... and then, of course, there was his sudden death. I’m pretty sure that all of that together counts as going downhill.”
“You make it sound a lot worse than it was. Everybody forgets names now and then. It doesn’t mean there is anything wrong. And his falling down and disorientation...? He was probably just fighting a virus. It happens. I fully expected that in a few days, he would be over it and would be right back to normal. His old self.”
“So you don’t think there was anything wrong.”
“Not seriously, no. Now... I don’t know what that means for his cause of death... but sometimes I think patients do just choose their own time.”
“Do you mean suicide? Assisted death?”
“No!” Summer’s voice climbed louder, and a few people stopped what they were doing and looked at her. She looked embarrassed and lowered her chin, looking down at the top of her desk at nothing in particular. She spoke more quietly, in an excessively reasonable tone. “I don’t mean that he took something to cause his death or planned it out in any way. Just that sometimes, we have residents who... they know their time or they pick their time. They just decide that’s when they are going to stop living... and they do.”
Kenzie had heard this kind of thing before and thought it was a little suspect. She did not want to find out that they had an angel of death at the nursing home who was selectively ending its residents’ lives, but that was the first thing that came to her mind. Not a supernatural reason. Someone who, with a vial of insulin or some other medication, was deliberately putting an end to the lives of those she chose.
Of course there were cases where the cause of death could not be determined, where they had to list it as ‘sudden cardiac death’ or ‘natural causes incidental to age’ or some other phrasing to satisfy the law. They couldn’t always determine the exact cause of death. But that didn’t mean that those people were simply choosing to die. She didn’t believe that.
“I see,” she told Summers, nodding wisely. It wouldn’t do her any good to argue the point. She wanted to be able to continue with her investigation, not to get kicked out. “And those symptoms that Mr. Cartwright was having prior to his death, those were...”
“They were nothing, really. Just some minor changes that didn’t mean anything. They happen as people get older. Knees start to wear out. Balance goes. People lose their appetites. It’s all part of aging.”
“Yes, I see. Do you think I could see his room?”
“It’s already been cleaned out,” Summers said doubtfully. “His personal effects have been turned over to his family. I don’t think that there is anything in there that would help you. We’ve just refreshed it for the next resident. We have a waiting list, you know. We’ll have someone else in there within a week.”
“That’s wonderful. I’ve always heard great things about Champlain House. It’s quite the jewel for our little town.”
“Yes,” Summers nodded vigorously. “Nothing like the warehouses you see in the big city sometimes. I’ve worked places like that, and believe me, it is nothing like working at the House. We really are a close-knit family here. We care about our residents and we take exceptional care of them.”
As long as that didn’t involve a service to help them out the door at the end of their lives.
“I would still like to see his room and to talk to any of the staff who knew him. Just so I can wrap this up and say that I have pursued all appropriate avenues.”
Nurse Summers still seemed reluctant, but she shrugged her broad shoulders. “I don’t see any reason why not, if you want to waste your time.”
Kenzie smiled her agreement. Summers pushed herself up out of her chair and walked around the counter to Kenzie. “It’s just down here. Follow me.”
She led Kenzie down the hall. Many of the doors had pictures or flowery wreaths on them, as well as the nameplates. Sometimes crayon pictures drawn by grandchildren or great-grandchildren, with scrawled expressions of love slapped onto them.
They arrived at a blank door. No decoration or personal effects. No nameplate. Nurse Summers paused for a moment, perhaps quelling the impulse to knock on the door to announce herself before going in. Maybe a gesture of respect, a second to acknowledge that the former occupant had moved on. A moment of grief. Then she turned the handle and pushed the door open smoothly. She reached for the light switch and turned it on, even though the room was still well-lit from the sunlight outside. The windows were large, giving the little room an airy feel despite how small it was.
But the room was cold and sterile. There was a bed, neatly made in white sheets and a light mint-green cotton blanket. The flooring was a low-pile carpet rather than the hard tile seen in a hospital. There was a small dresser, a TV, and a closet empty of all but a couple of folding chairs to be used when the occupant had visitors. There were, as Nurse Summers had explained, no personal items left over from Willie Cartwright’s stay there.
Summers sighed and looked around, resting her hands on her hips. “This is it. Like I said... He was over there,” she pointed at the carpet, halfway between the bed and the door. “Curled up on the floor with Lola. The blood on his face was dry. He was cool to the touch.”
Kenzie frowned at this new revelation. “Lola?”
Summers gave a chuckle. “Not another of the residents, I assure you. Lola is a service dog. Emotional support. Makes a big difference to the residents here. Sitting and petting a dog is a very soothing, relaxing activity. Lowers blood pressure. We don’t need to give out as many painkillers. She does wonders in seeking out the patients who need her the most and giving them attention.”
“Oh, isn’t that nice? Where is Lola now?”
“One of the staff took her over to the non-ambulatory unit.” Summers looked at her watch. One of those fancy ones that counted steps. “She’ll probably be back here in about fifteen minutes. I’ll introduce you.”
“It’s nice that they can have an animal here. A lot of them probably had to give up pets before they could move in. And Lola stays here overnight?”
�
�Yes. She has a bed behind the desk, but more often than not, she goes and finds a patient to keep company.”
Kenzie made a mental note to double-check Cartwright for any parasitic infections. Some, like toxoplasmosis, could be difficult to find if you were not looking for them. And toxo could, Kenzie knew, cause behavioral changes. Though she didn’t think it could cause amyloid plaques.
“How long had Mr. Cartwright been a resident here?”
“Oh... I’m thinking it’s about three years now? Not a newcomer. But not the longest, either. We have a few here who have been around for ten years or more.”
“In this unit?”
“One of them. Mrs. Moses has been here for... twelve, I think.”
“Wow. I guess she must like it here!”
Summers nodded and looked around. “Do you need to see anything else here?”
“What else was in the room when Mr. Cartwright died? Do you know what he hit his head on?”
“There were a few other things... a chair. There was an IV stand, because he hadn’t been eating and we needed to make sure he stayed hydrated. We think that he hit his head on the corner of the dresser.” Summers indicated the corner in question. “But otherwise... well, you know, he just had personal effects. Some pictures and medals on the wall. His clothing in the dresser. Maybe a book and some writing materials. He didn’t have a lot of possessions. You really can’t, in a room like this. It’s hard for people when they come from a house crammed full of personal possessions to move into a room like this, where you have to fit everything you own into a little dresser.” She looked again at the piece of furniture. “But Willie always had everything ship-shape in here. He wasn’t one of those hoarders. Some residents, we have to clean their rooms out whenever they are not in there, because they’ll just grab everything they can. Plastic forks. Presents from family. Books from the library. They feel like they have to have things. More things all the time.”
“Someone said Mr. Cartwright had been in the army.”
“Yes, that’s right. He had medals up on the wall. And the way that he held himself, straight as a ruler, you knew he was military.”
“Did he ever talk about what he had been through in the army? Had he ever been gassed? Attacked with a chemical or biological weapon?”
“No, he didn’t talk about it. Not much.”
“Sometimes the army experimented on the soldiers too. Giving them drugs or food or other experiences to see if it would improve their ability to fight.”
“Oh, I don’t think they ever did that to Willie. He never talked about anything like that. He was very loyal to the army.”
15
Kenzie had to admit that there wasn’t anything in the bedroom that would help her. She and Summers exited, and Summers pulled the door shut behind her. Kenzie thought she detected a slight relaxing of her shoulders, a sigh of relief. She didn’t like being in that room, empty and bare of all decoration.
Kenzie nodded to a woman in a smock who was putting used linens and towels into a large wheeled bin. “Did she know Cartwright?”
Summers fumbled, not sure what to say. “I—I suppose so,” she admitted. “But the housekeeping staff doesn’t really have anything to do with the residents. They generally clean when the residents are out of the room, at meals, or participating in activities. They don’t visit with them.”
“I’d like to talk to her anyway.”
Summers shrugged, looking baffled at the request. “Of course. If you think it will help.”
Kenzie walked over to the little Hispanic woman and introduced herself. The woman’s eyes immediately got big and round. “I am legal,” she protested. “I have papers.”
Her name tag said Maria.
“I’m not looking for papers, Maria. I just wanted to ask you about one of the men who lived here. One of the men who died.”
“I just take care of the rooms. No medicine. I don’t treat anyone.”
“I understand.” Kenzie nodded.
The woman still shook her head in protest. “I not have anything to do with Mr. Cartwright.”
“Did you clean his room?”
“Yes.”
“When he was alive? You worked here and cleaned his room sometimes?”
“Yes.”
“That’s all I want to talk to you about. I don’t think that you did anything wrong. I just wanted to ask a few questions about his room. About whether you noticed anything strange the last week or two.”
“Strange. How?” The woman cocked her head, mystified.
“I wonder if anything had changed. If you saw him do or say anything that was different than before. Or if he had anything in his room that he didn’t before. Or if there was anything... anything at all that was different than last week.”
“His bedsheets?”
“Yes... was there anything different about his bedsheets?”
“Well, he not wet the bed before. But at the end, he sick, then yes.”
“He wet the bed the last week? And he never had before?”
She nodded her agreement.
“One time? More than one time?”
Maria thought about this, then held up three fingers. “Three times.”
“Three times. And he never had before.” Kenzie thought about the rash Dr. Wiltshire had noticed. “What about... was it ever dirty?” Kenzie wrinkled her nose to convey her meaning to Maria while trying to think of the Spanish word for feces.
Maria started to shake her head. Then she put her hand to her mouth. “Not the bed. But when I pick up his laundry, his pants... he had tried to wash them. In the sink, maybe. They were wet, and he did not get it all out.”
“And he didn’t wear diapers. Did anyone else know about this?”
Maria shook her head.
“You didn’t tell anyone?”
“I thought... it is only once. He is an old man. Wait and see if it happens again.”
Kenzie nodded. Two more symptoms to add to the last week of Cartwright’s life. Both urinary and bowel incontinence. Symptoms of Alzheimer’s Disease, or something else?
16
Kenzie figured she had about worn out her welcome at Champlain House, having talked to everybody that she could. Others were not on shift, of course, but Kenzie figured the chances that they would have anything more to say than Kenzie had already heard was pretty low. She was getting pretty much the same information from everyone. Surprise that Mr. Cartwright had passed away, only minor concerns in the week before he died, certainly nothing that could have contributed to his death, other than the dizziness. Most thought that the cause of death had been the blow to his head. And Kenzie would have thought the same, except she had seen the state of Cartwright’s brain. No bleeding in the brain due to the fall. Instead, tissue clogged with plaques and tau tangles. A very different picture from what they had expected.
She was just going up to the nursing station to thank Nurse Summers for her cooperation and that of the staff when Lola got back.
Kenzie had completely forgotten about the dog. She looked up to see a nurse with a shaggy mane of blond hair coming down the hall with a large, mostly brown German shepherd. Kenzie’s mind went blank for a moment, thinking that the dog must belong to one of the patients, and then she remembered what she had already been told about Lola.
Lola had been curled up with Cartwright the night he died. She had apparently discovered him on the floor after his fall and had kept him company until after he had passed. Maybe they should have gotten a collie rather than a German shepherd. On TV, Lassie always went to get help and bring them back to anyone who was injured. If the dog had attracted attention instead of just curling up to go to sleep with the fallen man, would it have made any difference?
Kenzie smiled. She couldn’t help but be attracted to the big dog walking down the hall toward her, mouth open in a broad doggy smile. “This must be Lola.”
The nurse didn’t know who Kenzie was, but smiled in return. “Yes, this is Lola.” They walked
up to her.
Kenzie immediately stooped down to offer her hand to the dog. “She’s friendly?”
“Oh yes. She loves meeting new people,” the nurse assured her. Her name tag said Ellie.
Lola proved Ellie’s point, smelling Kenzie and then thrusting her snout and head under her hand to encourage Kenzie to pet her and scratch her ears.
“Oh, you are, aren’t you? What a sweet girl,” Kenzie cooed to the dog. “I’ll bet everybody loves having you around here.”
Ellie nodded. “She’s very popular. Even people who are usually afraid of dogs don’t usually have a problem with her; she’s so well-behaved. She doesn’t jump up or bark. She’s just very quiet and friendly. She’ll sit with someone for hours if she thinks they need it.”
“She must be very patient.”
“Yes. And intuitive. Dogs can tell things, you know, that we can’t sense.”
“I’ve heard of dogs that can sense low blood sugar or when someone is going to have a seizure.”
Ellie joined Kenzie in scratching Lola’s ears. Her tail waved back and forth in long, sweeping arcs, and she panted her appreciation.
“Yes. It’s amazing what they can do. Lola hasn’t even been trained as an emotional support animal; it just comes to her naturally. She always wants to take care of people. I think we’re all her puppies here.” Ellie grinned.
“Have you had her for long?”
“No, not long. The other units enjoy visits from her too. Even in the dementia unit, she’s very good at soothing agitated patients, getting them to settle down.”
Kenzie considered that. “Does she spend a lot of time with dementia patients?”
“A lot? No. We try to take her over there a couple times a week, maybe. She enjoys it, but she belongs here.”
Doctored Death Page 6