Four Classic Alex Delaware Thrillers 4-Book Bundle

by Jonathan Kellerman

3.

  4. …?

  Stepping away from the board, he said, “Is there someone who wants to say a few words about Dr. Ashmore?”

  Silence.

  “Let me say, then, that I know I speak for all of us in condemning the brutality of what happened to Larry. And in offering our deepest sympathy to his family. In lieu of flowers, I propose we get together a fund and donate it to an organization of the family’s choice. Or our choice, if it would be too disruptive to ask the family at this point. We can decide now, or at a later date, depending on what people feel. Anyone care to comment?”

  A short-haired woman in the third row said, “How about the Poison Control Center? He was a toxicologist.”

  “Poison Control Center sounds good,” said Afro. “Anyone second that?”

  A hand rose in the middle of the room.

  “Thanks, Barb. So moved. Anyone know the family? To inform them of our plan?”

  No response.

  He looked at the woman who’d made the suggestion. “Barb, would you be in charge of collecting the funds?”

  She nodded.

  “All right, people, bring your donations to Barb Loman’s office in Rheumatology and we’ll see that the Poison Control Center gets the money, posthaste. Anything more along those lines?”

  “Data,” said someone. “As in, we don’t have any.”

  “Could you stand and clarify, Greg?” said Afro.

  A stocky, bearded man in a checked shirt and wide, floral, retro tie rose. I thought I remembered him, as a resident, without the beard. An Italian name …

  “… I’m saying, John, is that security stinks around here. What happened to him could have happened to any of us, and since it’s our lives on the line we deserve to have full access to information. Exactly what happened, the progress of the police’s investigation, as well as any measures we can take to assure our safety.”

  “There aren’t any!” a bespectacled black man across the room called out. “Not unless the administration makes a real commitment to genuine security—twenty-four-hour guards at every entrance to the lot and at each and every stairwell.”

  “That means money, Hank,” said the bearded man. “Good luck.”

  A ponytailed woman with dishwater hair got up.

  “The money would be available, Greg,” she said, “if they got their priorities straight. What we don’t need are more paramilitary types obstructing our patients in the halls. What we do need is exactly what you and Hank just said: genuine security, including self-defense classes, karate, Mace, personal training, whatever. Especially for female staff. The nurses deal with this kind of threat every single day, coming from across the street. Especially the night shift—you know how a couple of them were beat up, and—”

  “I know tha—”

  “… the open lots have no security at all. As all of us are learning, from direct experience. I drove in at five this morning on an emergency call, and let me tell you, it felt scary, people. I also have to say I think it was a serious mistake to limit this meeting to physicians. This is no time for elitism. There are nurses and ancillary staff out there suffering just like we are, working for the same goals. We should be getting together, empowering each other, not fractionating.”

  No one spoke.

  The ponytailed woman looked around the auditorium and sat down.

  Afro said, “Thank you, Elaine, your point is well taken. Though I certainly don’t think any deliberate attempt was made to be exclusionary.”

  “Well,” said the ponytailed woman, standing again, “was anyone else other than physicians informed?”

  Afro smiled. “This was an ad hoc medical staff meeting, Elaine, so it’s only natural that physicians would—”

  “Don’t you think the rest of the staff cares, John?”

  “Of course,” said Afro. “I—”

  “Western Peds women are terrified! Wake up, people! Everyone needs to be empowered. If you recall, the last two assault victims were women and—”

  “Yes, I do recall, Elaine. We all do. And I assure you that in the event other meetings are scheduled—and it’s certainly clear to me that they need to be—a definite effort will be made to reach out.”

  Elaine contemplated debate, then shook her head and sat.

  Afro returned to the board, chalk poised. “I suppose we’ve moved on to another item, de facto, haven’t we. Staff security?”

  Scattered nods. The lack of group coherence was almost tangible. It reminded me of so many other meetings, years ago. Endless discussions, little or no resolution …

  Afro placed a check next to ASHMORE MEMORIAL, wrote STF SECURITY on the next line, and faced the assembly.

  “Okay. Any suggestions beyond guards and karate?”

  “Yeah,” said a balding, swarthy, thick-shouldered man. “Guns.”

  A few chuckles.

  Afro gave a tight smile. “Thank you, Al. Was that the way things were handled in Houston?”

  “You bet, John. S and W in every black bag. That’s Smith and Wesson, for all you pacifist types.”

  Afro made a gun with his thumb and forefinger, pointed it at Bald, and winked. “Anything else, Al, short of turning the hospital into an armed camp?”

  Dan Kornblatt stood. “I hate to say it but I think we’re lapsing into tunnel vision here. What we need to do is address the larger issues.”

  “In what sense, Dan?”

  “In the sense of our purpose—the institution’s purpose.”

  Afro looked puzzled. “Are we through, then, with item two?”

  Kornblatt said, “I certainly am. Security is just a symptom of the greater malaise.”

  Afro waited a moment, then checked off STF SECURITY.

  “What malaise is that, Dan?”

  “Chronic, end-stage apathy—institutionally sanctioned apathy. Just look around. How many private physicians are there on staff, John? Two hundred? Just take a look what percentage cared enough to brown-bag it today and make a statement with their presence.”

  “Dan—”

  “Wait, let me finish. There’s a reason so few private people are here. And it’s the same reason they avoid sending their paying patients here if they can find semi-decent local facilities. Same reason so many of our top people have gone elsewhere. We’ve been tagged as a stepchild—an institutional loser. And the community’s bought into that because the board itself and the administration hold this institution in low regard. And so do we. I’m sure we’ve all had enough psych to know what happens to the self-image of a kid who keeps being told he’s a loser. He starts believing it. Same thing applies to—”

  The door opened wide. Heads turned. George Plumb entered and straightened his tie, a blood-red paisley against a white shirt and light-gray raw silk suit. His shoes clicked as he descended to the pit. When he got to the bottom he stood next to Afro, as if assuming his rightful position.

  “Afternoon, ladies and gentlemen,” he said.

  Kornblatt said, “We were just talking about institutional apathy, George.”

  Plumb gave a thoughtful look and placed one fist under his chin. “I was under the impression this was a memorial for Dr. Ashmore.”

  Afro said, “It was, but we’ve covered some additional ground.”

  Plumb turned and studied the writing on the board. “Quite a chunk of ground, it seems. Might I backtrack and talk a bit about Dr. Ashmore?”

  Silence. Then nods. Looking disgusted, Kornblatt sat down.

  “First of all,” said Plumb, “I want to communicate the sympathy of the board of directors and the administration for the loss of Dr. Laurence Ashmore. Dr. Ashmore was a noted researcher and his absence will be profoundly felt. In lieu of flowers, Mrs. Ashmore has requested that funds be sent to UNICEF. My office will be pleased to handle all donations. Second, I want to assure you that progress has been made fabricating new parking cards. The cards are ready and can be picked up from Security between three and five, today and tomorrow. We regret any inconvenience.
However, I’m sure all of you recognize the necessity of changing the keys. Any questions?”

  The stocky bearded man named Greg said, “What about real security—guards at each stairwell?”

  Plumb smiled. “I was just getting to that, Dr. Spironi. Yes, both the police and our own security staff inform us that the stairwells are a problem, and though the cost will be considerable, we are prepared to implement twenty-four-hour guards, one man per shift, for each level of the physicians’ lot, as well as one guard per shift for each of the three open lots across the boulevard. That adds up to a total parking staff of fifteen guards, meaning a net hire of eleven guards added to the four already on staff. The cost, including benefits and insurance, should amount to slightly under four hundred thousand dollars.”

  “Four hundred!” said Kornblatt, springing to his feet. “Almost forty thousand a cop?”

  “Guards, not cops, Dr. Kornblatt. Cops would cost much, much more. As I said, the figure includes benefits, insurance, workman’s compensation, supplies and equipment, and site-specific ancillary costs such as orientation and in-house training. The company with which we’ve contracted has an excellent track record and their proposal includes self-defense and crime-prevention education for the entire staff. The administration didn’t feel it was appropriate to bargain-hunt in this matter, Dr. Kornblatt. However, if you’d like to shop around for a more competitive price, be our guest. Bear in mind, however, that time is an issue—we want to restore a sense of security and well-being for everyone, with maximal haste.”

  Lacing his hands across his abdomen, he looked at Kornblatt.

  The cardiologist said, “Last time I checked, my job was treating kids, George.”

  “Precisely,” said Plumb. Turning his back on Kornblatt, he said, “Any additional questions?”

  There was a moment of silence, as long as the one honoring Ashmore’s memory.

  Kornblatt stood and said, “I don’t know about the rest of you but I’m feeling co-opted.”

  Plumb said, “Co-opted? In what sense, Dr. Kornblatt?”

  “In the sense, George, that this was supposed to be a physicians’ meeting and you’ve just walked in and taken over.”

  Plumb rubbed his jaw. Looked at the doctors. Smiled. Shook his head.

  “Well,” he said, “that certainly wasn’t my intent.”

  “Maybe not, George, but it’s sure coming out that way.”

  Plumb stepped forward, toward the front row. Lowering one leg to the cushion of an empty seat, he rested his elbow on the bent knee. Chin on hand again, and he was Rodin’s “Thinker.”

  “Co-opting,” he said. “All I can say is that was not my intention.”

  Afro said, “George, what Dan—”

  “No need to explain, Dr. Runge. The tragic incident with Dr. Ashmore has left all of us on edge.”

  Maintaining the thinker’s pose, he turned back to Kornblatt: “I must say, Doctor, that I’m surprised to be hearing that kind of sectarian talk from you in particular. If I recall correctly, you drafted a memorandum last month calling for greater communication between the administration and the professional staff. I believe the term you used was cross-pollination?”

  “I was talking about decision-making, George.”

  “And that’s exactly what I’m attempting to do, Dr. Kornblatt. Cross-pollinate vis-à-vis security decisions. In that spirit I reiterate my offer to you—to any of you. Come up with your own security proposals. If you can develop one as comprehensive as ours, at equal or lower cost, the administration and the board will be more than happy to entertain it seriously. I mean that. I’m sure I don’t need to remind you of the institution’s financial situation. That four hundred thousand will have to come from somewhere.”

  “Patient care, no doubt,” said Kornblatt.

  Plumb gave a sad smile. “As I’ve stressed in the past, patient-care reduction is always the court of last resort,” he said. “But each month strips us closer and closer to the bone. No one’s fault—it’s just present-day reality. In fact, perhaps it’s good we’ve wandered afield of the issue of Dr. Ashmore’s murder and are talking about it in open forum. To some extent, fiscal and security issues dovetail—both stem from demographic issues outside of anyone’s control.”

  “There goes the neighborhood?” said Spironi.

  “Unfortunately, Doctor, the neighborhood has already gone.”

  “So what do you suggest?” said Elaine, the ponytailed woman. “Closing down?”

  Plumb shifted his gaze to her sharply. Lifting his foot from the chair, he straightened and sighed.

  “What I suggest, Dr. Eubanks, is that we all remain painfully aware of the realities that, for all intents and purposes, imprison us. Institution-specific problems that augment the already difficult state of health care in this city, county, state, and to some extent, the entire country. I suggest that all of us work within a realistic framework in order to keep this institution going at some level.”

  “Some level?” said Kornblatt. “That sounds like more cuts a-comin’, George. What’s next, another pogrom, like Psychiatry? Or radical surgery on every division, like the rumors we’ve been hearing?”

  “I really don’t think,” said Plumb, “that this is the right time to get into that kind of detail.”

  “Why not? It’s an open forum.”

  “Because the facts simply aren’t available at present.”

  “So you’re not denying there will be cuts, soon?”

  “No, Daniel,” said Plumb, straightening and placing his hands behind his back. “I couldn’t be honest and deny it. I’m neither denying nor confirming, because to do either would be to perform a disservice to you as well as to the institution. My reason for attending this meeting was to pay respect to Dr. Ashmore and to express solidarity—personal and institutional—with your well-intentioned memorial for him. The political nature of the meeting was never made clear to me and had I known I was intruding, I would have steered clear. So please excuse that intrusion, right now—though if I’m not mistaken, I do spot a few other Ph.D.’s out there.” He looked at me briefly. “Good day.”

  He gave a small wave and headed up the stairs.

  Afro said, “George—Dr. Plumb?”

  Plumb stopped and turned. “Yes, Dr. Runge?”

  “We do—I’m sure I speak for all of us in saying this—we do appreciate your presence.”

  “Thank you, John.”

  “Perhaps if this leads to greater communication between administration and the professional staff, Dr. Ashmore’s death will have acquired a tiny bit of meaning.”

  “God willing, John,” said Plumb. “God willing.”

  12

  After Plumb left, the meeting lost its steam. Some of the doctors stayed behind, clustering in small discussion groups, but most disappeared. As I exited the auditorium I saw Stephanie coming down the hall.

  “Is it over?” she said, walking faster. “I got hung up.”

  “Over and done. But you didn’t miss much. No one seemed to have much to say about Ashmore. It started to evolve into a gripe session against the administration. Then Plumb showed up and took the wind out of the staffs sails by offering to do everything they were demanding.”

  “Like what?”

  “Better security.” I told her the details, then recounted Plumb’s exchange with Dan Kornblatt.

  “On a brighter note,” she said, “we seem finally to have found something physical on Cassie. Look here.”

  She reached into her pocket and drew out a piece of paper. Cassie’s name and hospital registration number were at the top. Below was a column of numbers.

  “Fresh from this morning’s labs.”

  She pointed to a number.

  “Low sugar—hypoglycemia. Which could easily explain the grand mal, Alex. There were no focal sites on the EEG and very little if any wave abnormality—Bogner says it’s one of those profiles that’s open to interpretation. I’m sure you know that happens all the time in
kids. So if we hadn’t found low sugar, we would have really been stumped.”

  She pocketed the paper.

  I said, “Hypoglycemia never showed up in her tests before, did it?”

  “No, and I checked for it each time. When you see seizures in a kid you always look at sugar and calcium imbalance. The layman thinks of hypoglycemia as something minor but in babies it can really trash their nervous systems. Both times after her seizures, Cassie had normal sugar, but I asked Cindy if she’d given her anything to drink before she brought her into the E.R. and she said she had—juice or soda. Reasonable thing to do—kid looks dehydrated, get some fluids in her. But that, plus the time lag getting over here, could very well have messed up the other labs. So in some sense it’s good she seized here in the hospital and we were able to check her out right away.”

  “Any idea why her sugar’s low?”

  She gave a grim look. “That’s the question, Alex. Severe hypoglycemia with seizures is usually more common in infants than in toddlers. Preemies, babies of diabetic mothers, perinatal problems—anything that messes up the pancreas. In older kids, you tend to think more in terms of infection. Cassie’s white count is normal, but maybe what we’re seeing are residual effects. Gradual damage to the pancreas brought about by an old infection. I can’t rule out metabolic disorders either, even though we checked for that back when she had breathing problems. She could have some sort of rare glycogen-storage problem that we don’t have an assay for.”

  She looked up the hall and blew out air. “The other possibility’s an insulin-secreting pancreatic tumor. Which is not good news.”

  “None of them sound like good news,” I said.

  “No, but at least we’ll know what we’re dealing with.”

  “Have you told Cindy and Chip?”

  “I told them Cassie’s sugar was low and she probably doesn’t have classical epilepsy. I can’t see any reason to go into any more detail while we’re still groping for a diagnosis.”

  “How’d they react?”

  “They were both kind of passive—wiped out. Like, Give me one more punch in the face.’ Neither of them got much sleep last night. He just left to go to work and she’s bunked out on the couch.”