Critical Judgment (1996)

by Michael Palmer

  She shook hands with each of the men and asked Cox to extend her condolences to Gary Wheaton. Then she gathered her things from the on-call room, signed out to Ted Bogarsky, and left the hospital, surprised that it was still light out. As she headed across the ER parking lot toward the doctors' parking lot, she didn't notice a thin young woman who stepped from the lengthening shadows and followed her.

  Abby was nearing the far end of the lot when the woman called to her. Abby turned as she approached. The stranger looked to be in her thirties. Her hair was dark and tied back in a ponytail that reached her midback. Her narrow face was plain, although her dark eyes were large and childlike. She wore jeans and a tie-dyed blouse.

  "Dr. Dolan," she said, stammering nervously, "I'm sorry to run after you like this. I tried speaking to you inside, but there were always too many people around."

  "What can I do for you?"

  "My name is Colette Simmons. Willie Cardoza is my boyfriend. We've been together for almost five years now."

  "Why didn't you come up to me earlier?"

  "I waitress at a restaurant twenty miles away. I didn't even know about the accident until I got home a little while ago. My girlfriend is a nurse on the second floor. She called me and told me what happened. She said you saved Willie's life."

  "I'm glad he made it."

  "Dr. Dolan, I'm so upset. Willie would never hurt anyone unless they hurt him first. The policeman told me he's been arrested for murder. They're going to take him to a prison hospital as soon as they can. But I think he was real sick before this ever happened."

  "Would you like to sit down and talk?"

  "Please."

  Abby motioned her to the low, secluded bench where Lew had first told her about the Alliance.

  "What do you mean, Willie was sick?"

  "Doctor, Willie 'n' me have been together for almost five years. We live in a trailer east of town. We don't bother folks and they don't bother us. But Willie has always tried to do what little things he could for people who were old or sick--fix their fence, pick up their groceries, things like that. He even helped that girl at the company picnic who was cutting herself. I don't know if you heard about that."

  "Actually, I was there, Colette. I saw what he did."

  "Then you know he's a good man."

  "What's been happening to him?"

  "For about four months he's been acting real strange. He's been, I don't know, moody. Everything gets on his nerves. And that's just not like him."

  Abby felt the tension building inside her with every word of the woman's story.

  "Please, go on," she said.

  "Well, on top of everything else, he's been having these terrible headaches. He gets this bad taste in his mouth, then he gets a headache. We think it has something to do with a fall he took off a ladder last March. He smashed his head on a rock and was knocked out for a few seconds. The cut took twenty-five stitches. After that he began to have trouble."

  "Sounds like a concussion. Did he have a CT scan? You know what that is?"

  "Yes, I know. He had one several months ago. The doctor at the Colstar clinic said it didn't show anything."

  "What did they say was wrong with him?"

  "Migraine headaches. They gave him some medicine, but he kept getting worse and worse. Finally, a couple of days ago, he had a fight with his boss about missing so much work, and Willie punched him. Dr. Dolan, that's not like Willie Cardoza. None of this is."

  "I understand," Abby said. "Do you have any idea what happened today?"

  Colette shook her head.

  "I left for work before he got up. He was bad yesterday, I can tell you that much. Real bad. Ranting and raving, and full of hate. Rich people. That's all he kept talkin' about, how much rich people were ruining his life. My friend told me the police were talking about how much everyone hates him now for what he did. I'm so frightened for him. Is there anything you can do to help him?"

  "I don't know, Colette."

  Abby started to say something about Josh but thought better of it. Colette Simmons might be a loose cannon in this situation. Instead, she wrote down her phone number.

  "Here," Abby said. "If you need to call me anytime, day or night, just do it. I'll either be at this number or at the hospital."

  "Please try to help him."

  "I'll do what I can."

  "Dr. Dolan, is there any chance that it wasn't Willie who did this?"

  "No," Abby said sadly. "That's about the only thing I'm certain of right now."

  "Thank you."

  The woman shook her hand gratefully and then hurried back into the hospital. Driven by a surge of nervous energy, Abby stayed on the bench, trying to figure out what her next move should be. Cardoza and Josh--both Colstar employees, both with bizarre headaches and deteriorating behavior, both with violent, paranoid outbursts. Were there others? Did some of those on the Alliance's list fit the pattern? And what about the strange eye findings--did Josh have them? It was time to put some data together. And soon, maybe later tonight, it would be time to share what she had learned with Lew.

  She collected her things. A shower at home, then maybe some Italian food at the Tower of Pizza. After that, she would return to the hospital to check on Willie Cardoza, reexamine his eyes, and review the information in his hospital record. Finally, she would take the list of names Barbara Torres had given her and get to work in the record room. A picture was emerging. Now it was time to color it in.

  Ahead of her, above the trees, eight-foot-high illuminated letters watched over the valley.

  Colstar International, Patience, CA. Employee Safety Is Our Highest Priority.

  Abby laughed bitterly at the memory of the sign as she headed for her car. She was actually unlocking the driver's-side door when she noticed the broken glass covering most of her backseat. A small boulder rested in the center. Above the seat the rear window--what remained of it--was shattered.

  Dismayed, Abby looked about. No one.

  She checked her tires. The window seemed to be the only casualty--this time.

  "Idiots," she muttered.

  She took her briefcase down from where she had set it on the roof and relocked the Mazda. There was nothing she wanted less right now than to report the incident to hospital security or the police. But, almost certainly, her insurance carrier would not cover the replacement unless she did. And the last thing she needed at the moment was to pile up any unnecessary expenses. Soon, possibly very soon, she might be out of a job.

  CHAPTER EIGHTEEN

  The intensive care unit on the second floor of PRH was, like almost everything else in the hospital, state of the art. It handled cardiac and major trauma cases as well as post-ops who were too shaky to go directly to a med-surg floor from the recovery room. Abby went up to the unit frequently to check on patients she had admitted there. Never had she seen it as busy as on this night. There were ten glass-enclosed cubicles arranged around the central nursing/monitoring station. The beds in all of them were filled.

  Abby's first stop was the nurses' station, where she reviewed Willie Cardoza's chart. Although some 50 percent of PRH's records were still kept in manila binders, the hospital's record keeping was in the process of being upgraded to a system nicknamed KarMen--the Karsten-Mendenhall voice-activated data-encodement system. Compared to it, the record keeping at St. John's was chisel-and-stone tablet. KarMen, a recent product of a Silicon Valley company, was built upon the instantaneous computer transcription of dictated notes. The dictation was then immediately printed out for inpatient use and also stored electronically for future reference. The hard copy and records yet to be switched to KarMen were kept in a fireproof vault as backup. KarMen was so sophisticated that physicians and nurses with foreign accents or speech impediments could "register" them by reading a series of prescribed words and phrases into the dictation phone. The system adjusted itself so that their variations in speech would not affect the transcription. Record retrieval was carefully guarded through a series
of passwords unique to each physician and nurse, and not to be shared under any circumstances.

  Abby reviewed the operative notes from Martin Bartholomew and had to admit that the bombastic surgeon had done a professional job. Cardoza had remained stable throughout his surgery, with no significant blood loss once the circulation to his spleen was tied off.

  Bartholomew's admission note cited an arthroscopic knee operation three years before, and a four-day hospitalization for pneumonia four years before that. There was no mention of the head injury that Colette Simmons believed was responsible for Cardoza's deteriorating condition. Abby wanted to check with KarMen for those records, but the nurses'-station terminals were all in use. She made a mental note to check Cardoza's record after she had finished examining him, then headed for his cubicle. Wedged in her clinic-coat pocket was the combination black light and magnifier she had borrowed from the ER. And folded alongside it was a copy of the report she had filed with hospital security.

  After discovering the shattered window in her car, Abby had reluctantly sought out the guard on duty, a huge, porcine-faced man who chewed nonstop on a toothpick while he took down her complaint. His blatant lack of outrage at the damage to her car made it clear that he had been exposed to some version of the Cardoza-Wheaton story.

  "We'll look into it, Doc," he said, scuffing at a few shards of glass on the tarmac by her car. "Looks like whoever did it had some muscles, though. That rock must weigh twenty pounds at least."

  Abby left, having little difficulty imagining the guard himself heaving the boulder through the rear window of her Mazda.

  It was on her way up to the ICU that she had stopped by the ER for the ophthalmologic ultraviolet light. Before pursuing the strange eye findings on Willie Cardoza, she had wanted to verify them. Entering and leaving the ENT room, she passed several nurses and aides. Not one of them spoke to her except Bud Perlow, who seemed genuinely concerned for what she was going through. Rarely in her medical career had she clashed with physicians or nurses. In fact, during tough times she had drawn strength from the respect they had for her skill, her attitude, and even her worrywart approach to solving problems. Now she had performed almost flawlessly in the most challenging situation. And, as a result, she had placed her job and even her career in jeopardy. Welcome to Patience, CA.

  The police officer seated on a folding chair just outside Willie Cardoza's cubicle, looked ridiculously out of place in the bustling unit. If he knew who she was, he hid it well. He glanced at the plastic ID on her clinic coat but could not possibly have read her name as she walked straight past him and into the room.

  Willie, eyes closed, was breathing comfortably on his own. Overhead, the monitoring equipment continuously traced out his EKG, blood pressure, central-venous pressure, pulmonary-artery pressure, and blood-oxygen concentration. State of the art. The lights were dim. The whirring, hissing, and gurgling of Willie's oxygen-delivery system and chest-tube suction apparatus droned white noise in concert with the sounds from the other nine rooms. But within the cacophony Abby also heard the alarm on one of Cardoza's IV infusion pumps beeping that the line was obstructed. The nurses were occupied with other patients and might not have heard it. But she wondered if the policeman was unaware of the significance of the sound, or was simply ignoring it.

  She followed the IV tubing from the plastic bottle through the pump and down to Willie's hand. No kinks. Next she gently straightened his arm out at the elbow. The alarm stopped almost immediately, and the red warning light went out. At the base of the plastic bottle she could see the droplets begin to flow once again. Instead of confronting the nurses with the information that the IV was easily occluded by Cardoza bending his elbow, she wrote it on a note and taped it to the infusion unit. It would be interesting to see if anyone bothered to splint his arm to keep it from bending.

  "Everything okay?"

  Willie was peering up at her through half-open eyes. He had on an oxygen mask, and there was a tube in his nose that kept his stomach from overfilling with acid. His lips were dry and cracked. There were faint bruises on his forehead. His voice had the raspiness of a patient who had been on artificial ventilation through a breathing tube. Abby moved to the side of the bed where the dim fluorescent light could best shine on her face.

  "So far, so good," she said. "How're you doing?"

  "Who are you?"

  "My name's Dr. Abby Dolan. I'm the emergency doctor who took care of you when you first came in."

  "Did I really kill someone like they say?"

  "Don't you remember what happened?"

  "I remember I was angry and ... and sick. And my head wouldn't stop hurting."

  "That's all you remember?"

  "Did I really kill someone?"

  Abby could feel his confusion and anguish. She took his hand in hers.

  "You hit some people with your car, Mr. Cardoza. Three women. I'm very sorry, but one of them did die."

  Cardoza's eyes closed.

  "Oh, God," he moaned softly.

  There were many questions Abby wanted to ask him about the headaches and the months that preceded the violence at the country club. But there would be time later on or in the morning. She plugged the black light into one of the wall sockets over the bed.

  "Mr. Cardoza," she said, "I know you're tired, and I know I just gave you some awful news. But if you can help me, I'd like to examine your eyes with this special light. I took a piece of glass out of your eye earlier today, and I'd like to check and see if everything's okay."

  For several seconds Cardoza remained as he was, eyes closed. Then, slowly, he opened them. As he did, a tear broke free from the corner of his right eye and glided down along the edge of the oxygen mask.

  "Thank you," Abby whispered. "I want to help you, Willie. I really do."

  She shined the light in Cardoza's eyes. The glowing golden ring was there in each eye--thin as a pencil lead, but definite.

  She examined Cardoza's eyes for half a minute and then allowed them to close. Except in textbooks she had never seen the golden-brown Kayser-Fleischer rings that were diagnostic of copper toxicity. But from what she remembered, the thickness and location were almost identical to these. And didn't poisoning with silver and gold do something to the cornea as well? An hour or two in the library would fill the gaps in her memory. The rings didn't mean anything yet in terms of signifying an underlying problem, but she strongly sensed they were going to. Later tonight or tomorrow she would discuss the bizarre finding with Lew. In the meantime, as long as her nervous energy was keeping her awake and keen, she would see what the record room had to offer.

  She pulled up the sheet and adjusted the pillow beneath Willie's head.

  "Hang in there," she said.

  The record room at PRH, as in many hospitals, was located in the basement. Abby walked down from the ICU, aware of the toll that the stressful day was beginning to take on her mind and body. But there were too many unanswered questions for her to stop now. And, besides, she had little desire to hurry home for yet another night in an empty house.

  The record-room door was locked, although light shone through the opaque glass panel. Abby knocked once, then again.

  "Just a minute," a woman called out.

  Through the glass Abby saw her approaching. The door opened, and before Abby could place the woman, she identified herself.

  "Dr. Dolan, hi--I'm Donna Tracy, Bill's daughter. Come in."

  "How's your dad?"

  "He's home and doing very well, thanks to you. You know that the test for Cushing's disease did come back positive."

  "I did know that, yes."

  "He's gone to see a specialist at University Hospital in San Francisco. Dr. Fitzgerald. Do you know him?"

  "He's the best around."

  "That's great to hear."

  Bill Tracy, Willie Cardoza--two lives she had been directly responsible for saving. But for one she was criticized for embarrassing another physician, and for the other she was an instant pa
riah just for succeeding. Tough gig, this place.

  "I heard about that woman who got killed today."

  "It was pretty bad."

  "I don't know how you do it."

  "Sometimes I don't know either."

  "How can I help you?"

  "I'm doing a little research about allergic reactions seen in the ER. Since I'm still a little wound up from all that's happened today, I thought I'd begin to put together some of the data. I don't know how many of the cases I want to review are on KarMen, and how many are still in regular files."

  Donna Tracy bit at her lower lip.

  "Dr. Dolan, I'm not sure you can do that," she said.

  "Why? I have a password to get into the retrieval side of KarMen. I just need to know where to find things. I won't be in your way, I promise."

  "I may have to clear this with my boss."

  Abby glanced at the clock.

  "It won't take me long. Maybe an hour or two at the most. I really am glad your dad's doing so well."

  "Thank you. Oh, well, I suppose while I'm trying to get in touch with Joanne Ricci, you can get started. I'm sure she'll say it's okay. I do need to check, though."

  "Thank you, Donna."

  "Do you have the names and hospital numbers? ... Good. Just give them to me, and I'll check off which ones are in the new system and which ones are still in files. The ER and the OR are the only parts of the hospital completely on KarMen, but they have two people working every day to load in the rest of the medical records. We still have everything on hard copy, and I suspect we will for a long time to come. But KarMen is much easier to use and certainly takes up a lot less space."

  "Let's do it. One thing?"

  "Yes?"

  "Do you have a street map of Patience and the rest of the valley?"

  "No, but I imagine security does. Harvey's around someplace. Do you want me to call and check with him?"

  "No, no, that's all right."

  Harvey. Abby handed over the first half of the Alliance's list, then took the other half and settled in at the nearest dictation carrel.