“Calm down,” Hal said. “I’m not accusing you of anything. But you did go to lunch with him, and he did have his arms around you. Can you honestly say that it never occurred to you that it could go further? That you thought about it?”
I sighed. “Yes, to be honest, I did consider having an affair with him. After all, I thought you were having one with Bambi. But I didn’t.”
“Okay,” Hal said. “You didn’t have an affair. I didn’t have an affair. Now can we put all that behind us?” He held out his arms. “How about it?”
Trust is a two-way street. You trust me. I trust you. I moved closer, and we held each other tight.
“I love you, Toni,” he said into my hair.
“I love you, Hal.”
He let go of me and stood up, offering me a hand. “Good. Now let’s go downstairs and try to explain all this to the others.”
When we went downstairs, we found that Jodi and Elliott had left. “They got a phone call, dear,” Mum said, “and they just left.”
“Didn’t they tell you why?” I asked.
“It seemed to be some kind of emergency,” Mum replied. “But they didn’t stay long enough to explain.”
“Jeez,” Hal said. “I hope it’s not one of the kids.”
“And there was a call for you too, kitten,” Mum said. “You’re supposed to call the lab.”
“Are you on call?” Hal asked me.
“No,” I said. “Mike is. But I think I know what this is about.”
“What?” Hal asked, but I had already picked up the phone. “Tell you in a minute,” I said, “assuming this is what I think it is.”
Brenda answered the phone when I called the lab. “I did all those anti-Xa’s,” she said, “but did you realize that all the specimens from the Burke family are over forty-eight hours old?”
“I knew that,” I said, “but I just wanted to know if they had any anti-Xa at all. Do they?”
“They sure do. A lot of it,” Brenda said. “Were they on heparin in the hospital?”
“No. They weren’t. That’s the point.”
“Well, then, how …” Brenda began, and then she said, “Oh. You think they were poisoned.”
“Exactly.”
“Are you saying,” Brenda said, “that you think somebody in the hospital poisoned them?”
“No, it happened before they were in the hospital.”
“But how?”
“Brenda,” I said. “Sometime I’ll tell you all about it, but for right now, keep it under your hat, okay? It might end up in court someday.”
“Oh, is it a murder case?” she asked.
“It might turn out that way,” I replied.
“Lance Brooks had a lot of it too,” Brenda said. “But he was on heparin, wasn’t he?”
“Yes, he was.”
“So he wasn’t poisoned,” Brenda said.
That remains to be seen. “Probably not,” I said.
What I needed to do now was to go to the hospital and try to correlate all those anti-Xa levels with the amount of heparin it would take to get them that high. There were graphs available with which to do that. Using them, maybe I could figure out how much rivaroxaban each of the Burkes had been given to get them that high. In Lance’s case, I would try to correlate his anti-Xa level with the amount of heparin his medical record said he got, and see if it jibed.
If it didn’t, then maybe Lance was poisoned too.
As I was explaining all this to Hal, the doorbell rang. Mum opened the door to admit Jodi, who now wore a bright-orange warm-up suit that absolutely screamed at her red hair. I squinted at her; the color combination made my eyes hurt. “Thank God you guys are still here,” she said breathlessly. “Have you got some extra blankets and pillows we can borrow?”
Oh, no, not again. This could only mean one thing.
Chapter 20
Mordre wol out, that we see day by day.
—Chaucer
“I’m sure we do,” Hal said, “but what do you need them for … oh, no, don’t tell me.”
“Let me guess,” I chimed in. “Ruthie had a fire.”
Jodi nodded grimly. “You got it,” she said. “We’ve got Ruthie and all the Burkes, Tiffany, and Emily. We’ll take anything you can spare.”
The firebug was obviously not done.
“Holy shit,” Hal said. “Honey? Can you …?” He gestured in the general direction of the stairs.
He didn’t have to say any more. Groaning, I heaved myself off the couch, dislodging Geraldine, who moved to the end of the couch and gave me a dirty look. Killer, who had been lying on the floor next to me, got to his feet, tail wagging. No doubt he expected a Milk Bone, but he was doomed to disappointment this time.
Bambi, who had come downstairs just in time to hear the tail end of this conversation, said, “I’ll help you, Toni,” and followed me upstairs to the linen closet, where we found several blankets and quilts and throws and pillows—and even Hal’s and my sleeping bags—while Killer and Geraldine danced around us, convinced that they were helping too.
Of course, the reason I had to do linen detail in the first place was that Hal never put anything away, so he never knew where anything was. He was great at folding things up and putting them into a nice neat pile, as I’ve already mentioned, but never in the linen closet where they belonged. In Hal’s world, the linen closet was my domain, where no man dared to venture.
Then, of course, I had to do cat detail. We’d never forgotten the time Spook had gotten into the linen closet while I was putting things away and then hadn’t been seen for two days. Hal had said to me, just in passing, “You know, I haven’t seen Spook for a while, and his food dish is still full,” and I’d said, “Oh my God” and run upstairs to open the linen closet; whereupon one very irate cat had leaped out at me, snarling, and headed like a blue streak right for his food dish.
Then, of course, I’d had to do cat shit detail.
With Bambi helping, it only took two trips to get all the bedding downstairs.
“Is there anything we can do to help?” my mother asked, but Jodi shook her head.
“It’s all under control, so far.”
Better her than me, I thought uncharitably. She and Kathleen were far better equipped to deal with hordes of distraught children than I was. Bambi helped Jodi carry all the bedding back over to her house and told us that she was going to stay for a while and see what she could do to help. Maybe she knew what she was doing; after all, she did have younger brothers. Anyway, if she got in the way, Jodi wouldn’t hesitate to send her home.
I knew darn well that I’d only be in the way. My experiences with other people’s children frequently included some thoughtless person saying, “She’s a doctor. If you don’t behave, she’ll give you a shot,” which caused the children to shrink from me in terror, and any chance of ever gaining some kind of rapport with them went right out the window.
So I took the opportunity to go back to my office and do a little research. Brenda, on call for the weekend, was working alone and running her feet off between the lab, the emergency room, and the hospital floor—going to draw specimens, bringing them back to the lab to run tests, and then getting called to draw somebody else.
I knew from my own experiences as a med tech that holiday weekends were the pits as far as accidents and sudden illnesses were concerned, and Christmas was the worst. All that stress. All that rich food. All those GI bleeders and heart attacks. The occasional slip of the carving knife. It reminded me of Dickens’s A Christmas Carol.
An undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato …
I pulled Lance Brooks up on the computer and reviewed his postmortem lab results as well as his medication history.
His prothr
ombin time and INR were normal, but his activated PTT and his anti-Xa were sky high.
On the Internet I found a table showing the heparin dosage needed to put the anti-Xa at a therapeutic level in patients of various body weights. Not surprisingly, obese patients required a much higher dosage than those wasted away to skin and bone, like Lance. In the electronic medical record, I noted the heparin dosage Lance had been on.
They didn’t correlate.
Not even a little bit.
There was no way that the heparin Lance was documented to have received in the hospital accounted for the anti-Xa level in his blood. Not unless someone had given him a whole lot of extra heparin, off the record.
So, who did we know that had sat by Lance’s bedside for days, even before he was taken to ICU? And furthermore, who did we know that had a bagful of Lovenox at her disposal? And who could have injected a truckload of it into Lance’s IV when nobody was looking—like an entire boxful of ten syringes? She’d probably had them in her purse.
I went back and looked at premortem records, just in case this had been going on for a while. But Lance’s heparin had been monitored with the PTT, and that had been therapeutic or close to it. This meant that Ruthie, or somebody else, couldn’t have been giving Lance Lovenox until the day before he died.
Just for the hell of it, I went back to the Internet and looked up rivaroxaban again and discovered that while anti-Xa could be used to monitor it, PTT could not. Ruthie could have been giving Lance rivaroxaban all along, at home and in the hospital, right up until he was intubated, and his physicians, who had ordered only PTTs, would never have known.
What surprised me was that rivaroxaban prolonged the prothrombin time. I supposed it made sense in a way. The prothrombin time was affected by the Vitamin K-dependent coagulation factors, prothrombin, VII, IX, and X. Rivaroxaban was an activated factor X inhibitor.
So that’s why Jay Braithwaite Burke’s pro-time and INR were elevated.
The phone rang. And kept ringing. I went into the lab. No Brenda. I picked up the phone. “Lab, Dr. Day.”
“Dr. Day?” The charge nurse sounded frazzled. Her voice was raspy. “What are you doing here today?”
“Just catching up on a little work,” I told her. “If you’re looking for Brenda, she’s in the ER.”
Not for the first time, I wondered why the on-call techs couldn’t carry pagers. We’d asked for them repeatedly but had been told they were too expensive: that poor-relation thing again.
Brenda walked in and put her tray down on the desk. She looked exhausted. I told her the charge nurse was looking for her, and she sagged visibly.
“Brenda, you’ve been run ragged already. Don’t you have someone on standby in case you get hammered?”
“Yeah. Margo.”
“Call her,” I urged. “Get some help. You keep on like this and you’ll make yourself sick.”
“Are you sure, Doctor? They’re always after us to cut back on call time.”
I knew that. I also remembered the time Monty had come into the lab to talk to Margo about that. “Is there any way that you and your techs can cut back on call time?” he’d asked.
“Certainly,” she’d answered calmly. “Nothing easier. Which of the doctors would you like us to ignore?”
Monty hadn’t been able to answer that question, because it was an unanswerable question. It was the doctors who asked for lab work during on-call hours, and who was going to tell them they couldn’t?
For that matter, when were the powers-that-be going to realize that a hospital this size needed three shifts in the lab? It wasn’t like I hadn’t nagged them unmercifully for the last four hundred years.
“This is only Saturday, and you’re half dead,” I said in answer to Brenda’s question. “So call Margo.”
Then I went back to my office and pulled up the records of Kathleen and the children, noting their anti-Xa levels. It took me a while, but I managed to figure out the amount of rivaroxaban needed to get the Burkes’ anti-Xa levels that high by comparing them to Lovenox dosages; admittedly an inexact method, but all of their anti-Xa levels were way out of the therapeutic range from either drug, no matter how exact or inexact my calculations were.
I printed off all the lab reports for the police and put them in my purse. Then I called the station and talked to Pete. “I’ve got some lab results you might be interested in,” I said.
“Really? On who?”
“Lance Brooks,” I said. “Also Kathleen Burke and the kids. It proves they were poisoned. Do you want me to bring them down to the station?”
“Where are you?”
“In my office.”
“We’ll meet you there.” He hung up.
We? Uh-oh.
Not only that, but now I was stuck there waiting for them to show up. To kill time, I decided that I might as well haul out Lance’s autopsy tissues and cut them into sections to be processed on Monday. The sooner I had slides, the sooner I could sign it out, and then it would be ready for Ruthie to sue us.
Pete and Bernie showed up after about fifteen minutes. “Okay, let’s see whatcha got,” demanded Bernie gruffly.
See what I’ve got? Seriously? No, he didn’t mean it that way. Did he?
I showed them the lab reports and explained what they meant. It didn’t take long. I think I was talking extra fast, because I was extremely uncomfortable around Kincaid. Not because of anything he said or did. He was the epitome of propriety. No, it was all me. When they took the lab reports and left, I heaved a huge sigh of relief.
I dumped the tissue cassettes into a container of formalin, labeled it with the autopsy number, and went home.
Hal sat glowering like a thundercloud from his recliner. “Where the hell have you been?”
“At work,” I said.
“All this time?”
“Before you start your rant, could you please give me time to tell you what I found? You might want to congratulate me instead of ripping me a new asshole.”
“Yes, Hal, dear,” my mother said. “I, for one, would like to hear what she’s got to say.”
Hal folded his arms and looked mutinous.
“I got anti-Xa’s on Lance and Kathleen and all the kids,” I said. “They were off the chart. All of them. Do you realize what that means?”
“That’s a test for heparin, right?” he asked. “Does that mean that Kathleen and the kids had been given heparin?”
“That’s exactly what it means,” I said. “That’s why they were bleeding.”
“Wait a minute,” Hal objected. “Heparin has to be given IV, doesn’t it?”
“Not always. Lance took it subcutaneously. But it’s also available in an oral form called rivaroxaban. And guess who takes it.”
“I’m thinking it’s not Kathleen and the kids,” Hal said.
“Well, not voluntarily, anyway. They didn’t get sick until they went to Ruthie’s house.”
“Darling,” Mum said. “Are you telling us that you think Ruthie poisoned Kathleen and the kids?”
“I think so,” I said. “And furthermore, I think she poisoned Lance too.”
“But Lance was already on heparin, wasn’t he?” Hal asked.
“Not enough to account for his anti-Xa level,” I said.
“Oh, dear,” Mum said. “Have you told the police, kitten?”
“Yep. I called the station, and Pete and Bernie came right over and got them.”
“Kincaid came to your office?” Hal was back in thundercloud mode.
“Yes, both of them. Hal, don’t you dare tell me you think I’ve been having a quickie with Bernie all this time!”
“Were you?”
“No. Are you kidding? Didn’t we talk all this out this morning?” Was it only this morning? It seemed like day
s ago. And who was this person wearing Hal’s skin and acting like Othello? Was this what it was going to be like from now on? Hal going ballistic at the very mention of Bernie Kincaid?
“Hal,” I said. “There are going to be times when I have to deal with the police. There will be times when the police I have to deal with will be Bernie Kincaid. Are you going to go off the deep end every time I have to do that? Because this is my job, and if I’m going to do it properly, I can’t have that. I’ll have to choose between you and my job. Please don’t make me do that.”
Hal crossed his arms again. “Okay, now that you mention it, what if you had to choose? Which would it be, me or your job?”
I crossed my arms too and began to pace. “I love you, Hal, and I don’t want a divorce. But I have to be able to support myself.”
“Oh, here it comes,” he grumbled. “I don’t make as much money as you do. We couldn’t have this lifestyle without your income. Well, for your information, we could live just fine on my salary. We’ve talked about this before.”
“I know,” I said. “You’re right. We could do just fine on your salary. But what if something else happened that threatened our marriage? What if we end up getting divorced anyway? Or what if you get sick or injured and can’t work anymore? What if you die? I need my job.”
Hal put his hands over his face. “I just can’t stand the thought of you and Bernie Kincaid,” he mumbled.
I went over and sat on the arm of his chair. “Don’t you realize that’s exactly how I felt about you and Bambi?”
He removed his hands. “You did?”
“I did. Ever since school started.”
“Since August?”
“Well, I didn’t know about Bambi then, but I knew something was wrong, and you wouldn’t talk about it. So after a while, I began to wonder if you had met someone else and might be having an affair, and then Marilyn told me about Bambi, and then I saw her with you in that bar.”
“Oh, honey, I didn’t know. Why didn’t you say something?”
“I did. You got mad. You told me to get off your case.”
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