Snapshot (The Carlotta Carlyle Mysteries)

by Linda Barnes

  I didn’t see it. Savannah wasn’t the white male who’d entered Rebecca’s room on her final day. And I couldn’t buy Woodrow as the murderer of his own child. Arrogant, self-centered, yes. A killer, no. It was psychologically wrong.

  Psychologically … I released my hair and hustled upstairs.

  Dressed in jeans and my last clean shirt, I pushed Keith Donovan’s bell, toe-tapping impatiently until he wrenched the door open with an exasperated grunt. His legs were hairy beneath a blue robe, his feet bare.

  He said, “I thought it was the mailman, special delivery.”

  I said, “I didn’t think you’d be sleeping.”

  “Thursdays,” he said. “No patients. You heard from Emily?”

  “No. You?”

  “No.” With that resolved, he hesitated. “Uh, how’s your friend?” he asked. “The one with the pills.”

  “She’ll be okay. Pharmacists do that often?”

  “Not if they want to stay licensed. But, yeah. There are always a few cases a year, and everybody’s got a horror story about some drug sounds like some other drug, and how they were just about to pop a killer dose into somebody’s vein when the internal alarm bells went off. I remember—”

  “Yeah?”

  “See. I’m doing it.”

  “You get the medical records?”

  “I did.”

  “Can I see them?”

  “Right now?”

  “Right now,” I said. “And I’m gonna need help on the technical stuff. Also now. But I don’t mind seeing a doctor in his bathrobe; my doctor’s seen me in less.”

  He shrugged and smiled. “Come in, then. You want coffee?”

  “Sure.”

  “Make some in the kitchen while I pour cold water on my face, okay?”

  The kitchen, unlike the foyer and living room, hadn’t been renovated or redecorated. I liked its uneven floorboards, battered oak cupboards, and faint smell of cinnamon. Green plants hid some of the cracks in the yellow plaster. One of those automatic-drip coffee makers, bristling with buttons and dials, looked out of place on a countertop. I was hunting for instant and a spoon when he came back, looping a belt through khaki pants.

  “You got dressed,” I observed. His shirt was alternating bands of tan and blue, with a placket closing. I preferred it to his oxford shirt and tie.

  “Professional ethics,” he responded with a grin, removing a can of coffee grounds from the freezer. He counted spoons into a filter cone, inserted it into the recesses of the clinically white machine, and pressed buttons. The gizmo gave a contented beep.

  “While we’re waiting for the coffee, you want to tell me your horror story?” I asked.

  “The drug story? It isn’t mine. A friend of mine. Anesthesiologist.”

  “Like Pablo Peña.”

  “Not him. Somebody else.”

  “What happened?”

  “He had a patient hooked up to a continuous epidural pump. On Fentanyl. For pain. It’s a narcotic, side effects are nausea and itching. Had an old lady on the pump, she’s complaining about itching. Nurse calls my friend, and he says give her some Narcan. Works out the dose. All set.”

  “But.”

  “Gets paged back right away. Lady can’t breathe. So my buddy goes to check it out and he finds one frightened old woman. She’s more than willing to itch, just don’t give her any more of that stuff. So my friend checks, and the nurse didn’t give any Narcan, she gave Norcuron.”

  “Close,” I said.

  “Norcuron is used to paralyze patients during surgery. Pharmacist had no business even delivering it to a nursing floor. Sent up ten vials of the stuff, enough to kill everybody who itched and then some. See, Narcan’s a liquid and Norcuron had just switched over to liquid, and there was a mix-up. There’s always a new form of a drug coming out. Always something new.”

  “Nice story,” I said. “Remind me to stay out of hospitals.”

  “Advice I try to follow myself,” he said.

  “Where are the records?” I asked.

  He walked toward a small desk. “I left them down here. You know it was hard enough getting access. Copies were a bitch.”

  “I’m sure you did a great job.”

  He offered me a stack that must have been close to a foot high. “I pulled five files.”

  “Five?” I said sharply. “I asked for three.”

  “Five fit your specs.”

  “You’re telling me five kids died in a small hospital on the same day and nobody rang the alarm?” I asked.

  “I’m not telling you anything,” he said. “I’m just handing you some extremely private files.”

  “This looks like fifty files, not five.”

  “Disease generates a lot of paper.”

  Each file consisted of an unburst sheaf of computer printout, with MEDICAL RECORDS, JHHI, 259 LONGWOOD AVENUE, BOSTON, MA 02117, DO NOT REMOVE, at the top of the first page.

  I read the names of the dead in alphabetical order:

  Avalone, Renee F.

  Eaton-Fitzgerald, William P.

  Milbury, Heather C.

  Schulman, Justin A.

  Woodrow, Rebecca E.

  “Common factors,” I murmured, sitting unbidden at the kitchen table. “I need common factors.”

  “That’s how I yanked these,” Donovan protested.

  “All acute lymphoblastic leukemia patients, and they all died at JHHI on the same day. I know. But I need more.”

  After each patient’s name, age was noted, then date of birth. Renee Avalone had lived the longest. She’d been eleven, almost twelve—the same age as Paolina—when she died.

  I’d started with a question: Why had Rebecca Woodrow died? It was no longer that simple. Not “Why this child?” but “Why these children?” Not “What could Rebecca have heard or seen or done?” but “What could these children have heard or seen or done?”

  Please, I thought. Please, let me find it in the files. Let me not have to interview Heather’s mom, William’s parents, Renee’s loved ones.

  People think the hardest part of being a cop is shooting it out with bad guys on some dark street corner. The toughest thing I ever did when I was on the force was tell a dazed woman kneeling by the side of a busy road that her four-year-old had been hit by a car.

  “But he’s okay,” she’d insisted, even though she must have seen what I’d seen, known the truth. “He’s going to be okay.” She wouldn’t let go of my arm. I remember she wouldn’t let go of my arm.

  “You all right?” Donovan asked.

  I tapped a finger on the laminated table top, found it reassuringly sticky. “Yeah,” I said quickly. “I’ll need a list of all medical personnel in common. And treatments in common, and drugs in common. It was on my mind with my friend and the Xanax-Zantac thing, even before you told about your Narcan-Norcuron mix-up. I want to know if they all got the same drug or the same combination of drugs on the day they died.”

  His phone rang. “Damn,” he said, making no move toward the wall-mounted instrument. “Ignore it.”

  “Why?”

  “It’s another hang-up. I’ve been getting them all morning.”

  “I got another one last night. Answer it, okay?”

  He picked up the receiver.

  “Hello?” He shook his head and made a face, repeated his greeting, then said, “Nothing.”

  “Can you hear breathing?” I asked.

  “Not now. Dial tone.”

  “Could it be Emily?”

  “Emily? I hadn’t thought of it. I don’t know …” Almost to himself, he murmured, “What do hang-up calls mean?”

  “You’re the shrink,” I said.

  “Rhetorical question,” he responded dryly. “Sometimes I can’t help myself.”

  “If I’m after a runaway,” I said, “I’ll put a trace on the home phone. The kid’ll always call. Won’t talk, but she’ll call. Just to hear Mom’s voice.”

  “Reassurance,” he said.

  “W
hat else?”

  “Hate calls, love calls. Annoyance calls. Anything you can imagine, people do.”

  “Anything that would fit with what you know about Emily?”

  “I don’t know enough about Emily.”

  “Look, I saw her for fifteen minutes,” I said. “You’ve been her therapist more than three months. You have to know more than I do.”

  “Three months. Twelve weeks: a scratch on the surface with someone as reserved as Emily.”

  “You found her reserved? Cold?”

  “Afraid. Maybe shy is a better term,” he said, sitting across from me at the table. “I don’t mean that she was afraid of anything specific. More frightened of life, which isn’t unusual in someone who’s experienced a devastating loss. She felt out of control. Lost in space. If Rebecca could get leukemia and die, she saw no reason why Harold wouldn’t crack up the car on the way home from work. She expected to be struck by lightning.”

  “She had been.”

  “Exactly. It was like trying to convince someone who’s been mauled by a shark that there are really very few sharks in the water.”

  Each file was divided into sections with subheadings: Diagnoses and Notes, Hospitalizations, Therapies, Test Results, Internal Consultations.

  “You know,” Donovan said, frowning, “I don’t think Emily’s fear started with Rebecca’s death. I think she was timid before that.”

  “Why?”

  Frowning, he laced his fingers together and rested them on the table. “I’m speculating now, but if she hadn’t married Harold, she’d probably have stayed out of sight, hidden behind that camera of hers.”

  “Her camera?” I said.

  “Emily Ruhly, she was. E. J. Ruhly. Ever hear of her? She took pictures—you probably saw some of them. Studies of migrant workers, Native Americans. I guess you’d have called her a photojournalist. She didn’t keep up with it after she married. Harold objected to the hours and the travel, and then when she had Rebecca, she gave it up entirely.”

  The snapshots. So clear, so sharp, so illuminating. And yet, there was nothing in her photos of Rebecca that I’d have labeled technique, nothing that cried out professional. No tricks. Just the child, caught at the perfect moment.

  “Very shy people sometimes become addicted to cameras,” Donovan went on. “Or sketchbooks. It’s a way to shift the eyes of the world away from themselves. To stay in the background. Oh, I know it smacks of dime psych, but the obvious is sometimes true.”

  My gut reaction was: Patsy Ronetti never told me, damn her! She’d never come through with the promised employment check on Emily. My second reaction was to examine my first: If Patsy had told me, would I have given more credence to Emily’s story? Was unfocused speculation from a mother less believable in my eyes than unfocused speculation from an ex-professional photojournalist?

  “Coffee,” Donovan said.

  “Thanks. I need it. I mean, I’ll need some before tackling these. Rebecca’s file alone is what? Two-and-a-half-inches thick. It’s … daunting.”

  “She was sick for months. She put in a lot of hours at JHHI.”

  So had Emily Woodrow. E. J. Ruhly.

  “All you really need to focus on is the end,” Donovan said. “Right? The final day.”

  “Maybe.”

  “They all died from complications of ALL,” he said.

  “On Becca’s death certificate, it lists ALL and then something else. Sepsis. What’s that?”

  “Septic shock. Bacteria in the bloodstream.”

  “What would cause it?”

  “Sepsis? Contamination of some sort.”

  “Would it kill somebody quickly?”

  “That would depend on all sorts of things.”

  “Is sepsis unusual?”

  “I don’t study death certificates. I’d certainly expect the hospital to check it out. Hospitals have review boards, morbidity and mortality reviews, all sorts of governing bodies.”

  He drank coffee and I read. It was slow, tortuous going, like reading a foreign language, jammed with multisyllabic words I had to break down into parts before they yielded information.

  “Hepatic,” I said. “That’s liver, right?”

  “Pertaining to functions of the liver. Maybe I should cook some eggs.” He didn’t sound enthusiastic at the prospect.

  “Don’t bother on my account.”

  “Coffee cake?”

  “Sounds great.”

  He pulled a Sara Lee ring out of the freezer, started messing with the microwave oven while I waded through sentences laden with extravasation and myelosuppression.

  “Alopecia,” I said.

  “Hair loss,” he countered.

  “Couldn’t they just say that?” Several times I came close to quitting in a fit of frustration, but strong coffee and the aroma of defrosting coffee cake glued me to my chair, and I soldiered on. Occasionally I asked a question, and Donovan gravely responded.

  If I gave up on the files, I’d have to face the bereaved families, rip away stitches on wounds that had scarcely crusted over.

  “This,” I said into silence. “What is this?” I must have spoken loudly. Donovan gave me a look.

  “What? Cephamycin?” he said. “I think it’s a chemotherapy drug.”

  “Who makes it?”

  “You mean who manufactures it?”

  “Where does it come from?” I said, very slowly.

  “I don’t know. Here. Look it up in the PDR.”

  He handed over a hardbound Physician’s Desk Reference the size of the Yellow Pages, but heavier, with tinier print. I located the drug but got bogged down on “cytotoxic anthracycline antibiotic.”

  “What’s a naphthacenequinone?” I asked, murdering the pronunciation.

  He made a wry face. “Go to the beginning of the entry for the name of the lab.”

  Cephagen. The Cephagen Company. An Orlando address.

  “Keith,” I said, very quietly. “The president of this company was killed in a Boston hotel yesterday.”

  “Killed?” he repeated.

  “How do you administer Cephamycin?”

  “Give me the book.”

  “With pleasure.”

  “Here,” he said after a long two minutes. “Intravenous. ‘Slowly administered into the tubing of a freely running intravenous infusion of Sodium Chloride injection USP or five percent Dextrose injection USP.’”

  “Huh?”

  “In an IV drip,” he said.

  “How’s Cephamycin packaged?”

  “Let me check.” He ran his fingers over the three-columned page, dense with print. “Two ways. As a liquid, you can get it in ten-, twenty-, or fifty-milligram vials. And it comes in a powder, too. You reconstitute that.”

  “If contamination—sepsis—was in an IV drip, how long would it take someone to die?” I asked.

  “If the contamination were in an administered fluid—which would be extremely unlikely—the patient would get shaking chills, spike a high fever, blood pressure would drop. The patient could die within hours, sooner.”

  “Can I make a phone call?” I asked. “Long distance?”

  “Help yourself.”

  My fingers hit information for area code 407, and I requested the number of the Cephagen Company.

  “Cephagen. How may I direct your call?” The receptionist was female. She sounded both harried and hostile.

  “Sales, please.”

  “We are not accepting any calls from the press.” She practically spat out the last word.

  “No. no, nothing like that,” I said. “This is Diana Hudson. We’ve talked before. I’m calling from the JHHI pharmacy. Boston.”

  “Oh.” She sounded only slightly mollified.

  “Things must be really hectic there,” I went on, oozing sympathy. “I hate to bother you with this. I’d call another time, but you know how it is, everybody wants things done yesterday.”

  “I think Mr. Knowlton is in.”

  “That would be great. T
hanks.”

  He came on the line with no further secretarial interference. A gentleman pretty far down in the food chain, I guessed.

  “Knowlton,” he said. “How may I help you?”

  I gave the Diana Hudson name again, the JHHI affiliation, the apology.

  “What do you need?” he said, apparently taking me at my word.

  Encouraged, I went on. “It’s not an order, Mr. Knowlton. We’re, uh, updating our list of approved chemotherapy drugs, with emphasis on ALL treatment. And I’m the lucky one who’s supposed to make sure all the spelling’s correct before we go to the printer—”

  “Hah. Then the printer’ll louse it up.”

  Good. He was buying it.

  “I know, but you’ve got to try, don’t you?” I said. “My boss is a real stickler for spelling. So could you please spell out the brand names of any drugs Cephagen would want placed on that list?”

  “We just have the one.”

  “Go ahead.”

  “It’s Cephamycin. I know it as well as my own name, but let me check to make sure. C–E–P–H–A–M–Y–C–I–N. One Y and one I.”

  “Thanks,” I said.

  “You’re welcome. Good luck.”

  “Oh, one more thing. A friend of mine used to work for you. She really had great things to say about the company, and how nice it is in Orlando. The weather up here is just vile, you know?”

  “Don’t tell me. I used to live in New Hampshire.”

  “Really? Where?”

  “Hollis.”

  “No kidding. I used to date a guy from Nashua.”

  “I don’t miss the winter.”

  “I’ll bet,” I said. “Anyhow, my friend had to move away from Orlando, and I was thinking, you know, if her job’s open, I’d really like a change of climate.”

  “What division was she in?”

  “Gee, I can’t remember.”

  “Well, hey, Diana—you say your name was Diana?”

  “Diana Hudson. What’s yours?”

  “Peter. But I wouldn’t know about job openings. Let me transfer you to Personnel.”

  “Mr. Knowlton, please. Peter. Wait a second. You transfer me to Personnel, we both know what’ll happen, right? They’ll just say they’re not hiring, or tell me to send a résumé.”

  “Look, Diana,” he said, softening. “I’ll try to transfer you to Janet Lee. She’s a friend of mine and she might be able to help.”