Natural Causes

by Michael Palmer

  “You’re doing wonderfully, Miss Richardson,” Rosa said, setting a tea biscuit on the woman’s saucer. “Was Martha’s last name Fezler, do you know?”

  “No. I’m afraid I—” She suddenly brightened. “The calendar,” she said.

  “Calendar?”

  “Mr. Fezler said it was from his sister’s place. He gave it to me because the numbers are big. He hung it up for me, too. But I’m afraid I never look at it. It’s in there, dear.”

  She pointed through her bedroom door. The calendar, hanging on a side wall, had a photo of a huge-breasted, platinum blond model on the top half. She was scantily clad in skin-tight overall shorts and was holding a gasoline can. Printed on the calendar was:

  FEZLER MARINE AND AUTOMOTIVE

  REPAIR SHOP

  MARTHA FEZLER, PROP.

  MERCRUISER SPECIALISTS

  The address of the shop, printed at the very bottom, was in Gloucester, a city Rosa knew was thirty or so miles north of Boston. She wrote it and the phone number down. Then she straightened up the bedroom as best she could, gave Elsie Richardson a hug and twenty dollars, and headed back to her rooming house. If Martha Fezler was not actually hiding her brother, she knew where he was. Every ounce of intuition was telling her so.

  Rosa walked to the closest thoroughfare and flagged a cab. She felt elated. Soon, very soon, her career as an epidemiologist would be over. But not before the ghost of BART was at last laid to rest.

  • • •

  “Ruth, hi, it’s Matt. I’m sorry to call you at home.”

  “That’s all right. How did your session with Mr. Mallon go?”

  “They’re dropping the Baldwin suit.”

  “Oh, that’s wonderful. Just wonderful. Congratulations.”

  “Thanks. Ruth, listen. I’m at the Medical Center of Boston and I can’t find Sarah. Have you heard from her?”

  “Yes. She called just before I left, an hour or so ago. I put the message on your desk. She said she’s not going to be on duty tonight. She’s staying at the hospital until six or so and will be home after that. She sounded upset.”

  “From what I’ve been able to learn, she has reason to be. Thanks, Ruth. I’ll see you tomorrow. And thanks for getting my office cleaned up.”

  “Is there anything else I can do?”

  “No. You switched the phone over to the answering machine?”

  “I always do that, Mr. Daniels.”

  “I know, I know. Good night, Ruth. I’ll see you tomorrow.”

  Matt set down the pay phone receiver and glanced about the busy lobby area. It was six-thirty. Sarah said she would be leaving the hospital at six. But her new bicycle was still chained outside. She had not answered her Motorola page, nor had she responded to two separate voice pages by the hospital operator. A call to her apartment had gotten only her answering machine, and there were no messages from her on the one at his home.

  Something significant and unpleasant had occurred involving Sarah and a patient. Matt had learned that much, although no one around MCB seemed anxious to share details. Apparently, she was being asked to take a leave from the hospital. Glenn Paris, to whom Matt had been referred for details, had been tied up in some sort of emergency meeting. Now, feeling more anxious and uncomfortable by the moment, Matt again sought the CEO out in his Thayer Building office.

  “I’m sorry, Mr. Paris is tied up on a call,” his harried secretary said.

  “Break in. Tell him it’s Matt Daniels, and that it’s an emergency.”

  “But—”

  “Do it, please. Or I’ll do it myself.”

  Less than a minute later, he was ushered into Paris’s inner office.

  “You can’t possibly think she would do such a thing,” Matt exclaimed, after Paris recounted the events surrounding Annalee Ettinger. “Mallon and the Graysons have dropped the malpractice suit against her completely. Doesn’t that tell you something?”

  “Look, all I know is that this hospital has received more negative publicity in the last six months than in the previous six years. And your client is involved in virtually every bit of it. We had to put her on leave until the dust settles and we can sort out what’s happened.”

  “Isn’t it clear what’s happened? Somebody’s tried to frame her.”

  “For Sarah’s sake, I hope that’s true. I like her, Daniels. I really do. But as things stand, we have to take action that’s in the best interest of the Medical Center of Boston and our patients. There are a good number of people on our medical staff and board of trustees who think that she is a very sick and dangerous person.”

  “That’s utter nonsense.”

  “I hope so. But at this point, there’s nothing I can, or want to, do.”

  “Listen, Sarah hasn’t answered her page for the past hour. Do you have any idea where she might be now?”

  “No.”

  “You’ve made a mistake,” Matt said.

  “As I said, I hope so,” Paris responded.

  Matt was already heading out the door. He made another pass through his office and home answering machines, and left another message on hers. Then he called the hospital operator, who again attempted to reach Sarah by her beeper and the hospital-wide loudspeaker system.

  “Tell me,” Matt asked, “when you can’t get hold of residents who are supposed to be on duty, what’s usually going on?”

  “That doesn’t happen very often,” the woman said.

  “But when it does.”

  “Our Motorolas have a display window, but they also can be voice activated. Usually, if a resident is on call and doesn’t respond, their page unit is defective, and they’re asleep in the house officers’ quarters. They wouldn’t be able to hear me on the overhead. There is none there. We use the room phones.”

  “Where are those rooms? Can you call them?”

  “Thayer Building. Fourth and fifth floor. But I can’t call every room. There are about twenty or twenty-five of them.”

  “Look,” Matt said. “Just in case, could you please keep paging Dr. Baldwin over her beeper every couple of minutes. Use the voice mode. It’s very, very important. You’ve got my name in case she calls in. I’ll check back with you shortly. And thank you.… Thank you very much.”

  She’s gone for a walk, or else she’s sleeping in one of the on-call rooms, Matt told himself as he headed up to Thayer Four. Either possibility makes perfect sense. She’s upset over what’s happened. A nap or a long walk. I’d do one or the other.… So would she.…

  He began going from room to room, knocking on each door, then trying the knob. Most of the small on-call quarters were open and empty. Two rooms were locked, but in both, a sleepy voice responded to his knock. A third, though unlocked, was also occupied. The resident within, fully dressed, lying facedown, spread-eagle on the narrow bed, was so deeply asleep that he barely stirred when Matt knocked and entered.

  You’ve got to really want it, Matt thought, gazing down at the exhausted young physician. He closed the door with unnecessary care and headed up to the fifth floor. The sixth or seventh door he tried was locked. He knocked and waited for the expected sleepy response. There was none. He knocked again, this time a bit louder. Only visions of the spread-eagle man on the fourth floor kept him from kicking at the door. He decided to check the rest of the floor before knocking any more forcefully. But then, just as he was about to turn away, he heard a woman’s voice broadcasted from within the room.

  “Dr. Baldwin. Dr. Sarah Baldwin. Please call the operator.… Dr. Baldwin. Dr. Sarah Baldwin, the operator please.”

  “Sarah!” Matt cried out, kicking the base of the oak door with force. The retort, piercing as a gunshot, echoed down the empty corridor. “Sarah!”

  Matt stepped back and rammed the sole of his shoe into the center of the door with all his strength. The wood split. A second kick opened a hole large enough for him to peer into the dimly lit room. Sarah was lying peacefully and motionless on the bed. Beside her, on a portable IV pole, a plastic
intravenous bag was draining its solution into her arm. Matt reached through the hole and unlocked the door from within. Sarah was warm, but her color was poor. And she was not breathing.

  He found a shut-off valve on the intravenous tubing and shut the infusion off. He hollered her name and checked her neck and wrist for a pulse. There was none that he could feel. He tilted her head back, pinched her nose closed, and tried several mouth-to-mouth breaths. After the third one, he thought he felt her jaw move. Again he cried out her name. Then, impulsively, he slapped her sharply across the face. She responded with a single, gurgling breath. He slapped her again. Again she took a breath.

  Battling dread unlike any he had ever known, Matt snatched up the phone and dialed the operator.

  “I found Dr. Baldwin,” he said breathlessly. “She’s in cardiac arrest. Fifth floor. Thayer Building. Please get a team up here now!”

  CHAPTER 37

  October 28

  IT WAS A NIGHTMARE WITHIN A NIGHTMARE. AT SOME level of her mind, Sarah struggled to believe that—to remember that as a teen she had always awakened, always been safe and in her bed. But there was nothing she could do with her thoughts, and absolutely nothing she could do with her body, to stem the helplessness, the pain, and the unremitting terror. As they had during countless dreams in her early life, rough hands pinned her on her back, then tied her down. She fought to free herself until her arms and legs burned. But the bonds were like steel.

  Then thick, powerful fingers began forcing a wadded cloth between her teeth. She pushed against the cloth with her tongue. She shook her head violently from side to side. But the gag was thrust deeper and deeper into her mouth, clogging the back of her throat and choking her. She strained to pull in air through swollen, narrowed nostrils. Her efforts grew weaker. She prayed for unconsciousness or even death. But always there was just enough air to keep going, just enough to prolong the agony.

  Please let me die! Please just let me go to sleep and die.…

  “Sarah.… Honey, listen to me. It’s Matt.… Try to hold still and listen.… Better. That’s better. You can keep your eyes closed, but please listen.… Sarah, you’re on a ventilator. There’s a tube down your nose and one down your throat and into your lungs helping you breathe. And they’ve got you strapped down. Squeeze my hand if you understand all that.… Good. Good. Just try and keep calm, honey. I’m going to tell the nurse you’re waking up.”

  Sarah felt Matt’s huge, comfortable hand squeeze hers and then vanish. She strained to separate nightmare from nightmare. Bit by bit she remembered.

  As her consciousness and awareness grew, so did the indescribable discomfort of the endotracheal breathing tube and the fearsome sensation of air hunger. She could hear the ventilator bucking and whirring as it fought against her own attempts to breathe. Clearly, it was set on automatic rather than assist. It was set to breathe for her, not necessarily with her.

  Slow down, she begged herself. Don’t fight it.… Remember what you tell patients on vents.… Easy now.… Go with it.… Relax and go with it.… Meditate.… Find the swan.… Find your spirit.… Find it and just watch it fly.…

  “Sarah, can you hear me? Sarah, open your eyes. It’s Alma. Alma Young.… There, that’s it.…”

  Sarah blinked against the blurriness and the sting of light. Gradually her vision cleared. The SICU nurse was looking down at her with concern.

  “They were full in the medical ICU,” she said. “We all wanted you in here anyway, and Dr. Blankenship said okay. One of the other nurses called to tell me what had happened, and I came back in to ‘special’ you. Do you understand all that?… Good. I’m going to undo the restraints on your wrists. Please don’t touch the tube. Understand?… Good.”

  Sarah waited patiently as the broad leather straps were loosened and then removed. Her pounding headache was subsiding. She was fully awake now and rapidly regaining control. Someone had tried to kill her! Someone had injected her beneath her scalp with something rapidly acting and incredibly potent. Now she was on a vent. All those school psychologists and university psychiatrists had been wrong. The recurring dreams that had once so plagued and disrupted her life had never been a distorted reenactment of some terrible event hidden in her past. Rather, they were a prophesy, just as Louis Han’s Thai healer had intimated they might be. This was the struggle for which the dreams were preparing her. This was the battle of her life. And she had survived—first in Chinatown and now in the SICU. Thanks in some way to the horrible nightmares, she was continuing to endure against whatever evil was trying to crush her.

  To everything there is a season, and a time to every purpose …

  Sarah flexed some circulation into her hand, and then reached up and pointed to the endotracheal tube.

  “I know. I know,” Alma said. “As soon as we get your blood gas results, I’m going to call anesthesia and Dr. Blankenship, and see if we can get that tube out. Are you okay for now?… Good. I’ve switched your vent to demand, so you can breathe any way you want. You sure you’re okay? Sarah, I just want to say that whatever’s going on will pass if you let it. There’s never the need to do what you thought you had to. But listen, we can talk about all that later. I’m just glad you’re all right.”

  A respiratory therapist came in and drew a sample of blood from the line in Sarah’s radial artery. During the interminable half hour that followed, Matt stayed beside her, doing what he could to keep her calm, and filling her in on the events surrounding her resuscitation.

  “It was morphine in the IV bag,” he said. “The empty vials were on the floor. Dr. Blankenship says we got to you just in time. Whatever the emergency team gave you worked incredibly well. You’ve actually been awake for most of the night. But the nurses have been giving you stuff so that they could keep you on the ventilator. The box of acupuncture needles that you reported as stolen was on the desk in that room, along with an unopened vial of the rattlesnake venom and a scribbled, unsigned note on a prescription blank, that just said ‘I’m sorry.’ The door to the room was bolted from the inside. Right now I’m about the only one in this hospital who doesn’t believe you tried to kill yourself.… Am I right?”

  Sarah squeezed his hand and nodded as vigorously as she could manage.

  “I knew it,” Matt whispered. “It’s been at least, oh, three or four months since any woman who was my lover tried to kill herself.… Squeeze my hand if you think that was funny.… Oh, I see.… Listen, there have been some wild things going on in this Ayurvedic powder business—not the least of which is that Mallon is going to tell the Graysons to drop their suit against you. Not settle, drop. I’ll tell you all the details later.

  “Rosa told you she found out who engineered that virus, right? The guy who stutters. But she wouldn’t tell you or anyone else his name, right? Well, now she thinks she knows where he is. She tried calling you at home and at the hospital to bring you up to date. Finally, one of the nurses told her what had happened and exactly where you were, and she showed up here around eleven last night. She came in again at two this morning. She really cares about you. I’d be surprised if she’s slept any more than I have. She won’t say where this virus guy is, but she’s driving there today to try to find him. Eli’s arranging for her to use a hospital car for the day, no questions asked.…

  “Hey, hang on now, pal. Alma’s coming, and I think the anesthesiologist is with her.”

  The news from the laboratory was excellent. Sarah’s blood gases—her pH, oxygen, and carbon dioxide levels—were all good enough for her to come off of assisted ventilation. The sensation of having her trachea suctioned out, and then the endotracheal tube pulled, was one Sarah hoped never to experience again. She sputtered and gagged, and coughed spasmodically. But again, Matt was there for her, steadying her through the coughing jag, stroking her arm, even kissing her on the forehead.

  “Careful you don’t get disbarred,” she rasped, when the cough had finally subsided.

  “I told you, they’re dropping the cas
e. I won’t be your attorney anymore. We can go public. In fact, I’ve rented a sound truck for later today just to cruise the streets and tell the people of Boston that I love you and that we’re going to get to the bottom of this.”

  “I love you, too, Matt. I really do. Hey, what time is it, anyhow?”

  “Six. A little after.”

  “God, twelve hours of my life, gone just like that.”

  “It could have been all of it,” Matt reminded her.

  Sarah’s response was cut short by the sound of a throat being politely cleared. Standing at the foot of the bed was a rumpled, graying man wearing a red clip-on bow tie. He held Sarah’s loose-leaf SICU record cradled open in one arm and peered down at it through Ben Franklin spectacles. Although she had never met or even seen the man, Sarah correctly guessed his specialty before he introduced himself.

  “I’m Dr. Goldschmidt,” he said. “I’m a psychiatrist. Sir, if you’ll excuse us for a few minutes …”

  “This is Matt Daniels,” Sarah said quickly. “He’s my—my lawyer.”

  Goldschmidt eyed Matt for a few seconds.

  “Perhaps he should stay, then,” he said. “If it’s all right with you.”

  “Please,” she said hoarsely.

  “Very well, then. I know you’ve been through a lot and that they just took your breathing tube out. So I’ll be as brief as I can.” He moistened his thin, bluish lips with his tongue. “Tell me, Dr. Baldwin. Have you ever tried to hurt yourself before last night?”

  Sarah’s eyes flashed. She glanced over at Matt, who motioned for her to keep calm.

  “The answer is no. But I did not try to hurt myself last night either, Dr. Goldschmidt. Someone tried to kill me and make it look like suicide.”

  “I see,” Goldschmidt said, scratching something down in her chart. “But how do you explain the door being bolted from inside?”