The Diagnosis is Murder (A Dr. Valorian Mystery Book 1)

by Steven Gossington

  Alec cradled his coffee cup, his eyelids narrowed.

  “But I remembered something about opiates,” Laura said. “This morning, I reviewed a toxicology textbook and did an online search. There are some unusual narcotics available to users—like synthetic opiates—which are often brewed in home laboratories and can be very potent in small quantities. These are often called ‘designer drugs,’ and they can escape detection by the usual blood and urine drug screens.”

  “These drugs can cause poisoning, yet the drug tests can still be negative?”

  “Yes.”

  “Interesting.” Alec put down his coffee cup. “If one of those drugs did kill him, maybe he was a closet abuser and just accidentally OD’d.”

  “There were no needle tracks or puncture wounds on his arms. I’m pretty sure he didn’t abuse drugs, although I could be wrong. Anyway, that brings up an interesting point. Addicts often inject designer drugs with needles, either directly into a vein or popped right under the skin. However, most opiates, such as Demerol or codeine, can be absorbed from the intestinal tract. I think that a designer opiate in large enough concentrations would be absorbed and cause symptoms if it were swallowed.”

  “You’re suggesting that someone slipped him a ‘designer Mickey’? Enough to kill him?”

  Laura looked down at the table. “That’s my theory.” She leaned forward toward Alec. “Does it sound too far-fetched?”

  “Over the years, I’ve learned there are certain people—like you—who can smell a rat. You’ve been right about several murder cases. Remember the ‘injected heart’?”

  Laura beamed. “I was proud of that one.”

  Alec told her before that it was one of his first big cases as a private investigator. Laura had alerted him to an almost invisible clue on a dead man brought to her ER—dead from cardiac arrest, which wasn’t all that unexpected since he’d had significant heart disease and a past coronary artery bypass operation. However, Laura had spotted a tiny red dot on the skin of his upper abdomen. She’d pointed it out, thinking it looked like the puncture wound from a small gauge needle. Laura was proved right by the autopsy. A small hole had been found in the heart muscle. The man had been killed by his wife, a critical care nurse, who’d doped his decaf coffee with Valium and then injected his heart with potassium chloride as he slept. Instant death. She’d almost gotten away with it, since she knew that autopsies weren’t always performed if the cause of death seemed straightforward or “natural.” In fact, she’d requested that an autopsy not be done.

  Laura was yanked out of her reverie by a clatter of plates as their dinners were served by an impatient waitress. Alec had barbecued ribs, and Laura a chef’s salad. Laura figured that it was difficult to screw up a chef’s salad, and it was healthier than a lot of other restaurant food. She did admit to herself, though, that those barbecued ribs sure smelled and looked appetizing.

  Alec cut into his food with a fork. “I thought people who OD’d on narcotics could usually be saved.”

  “Well, you’re right, if they haven’t been down and not breathing for too long. They must get respiratory support and the antidote in time, and if chest compressions are needed because the heart’s not pumping blood, it’s almost always too late.”

  “Why are they called designer drugs?”

  “Probably because these drugs are different from known opiates. People with a little knowledge of chemistry can take a basic opiate, such as Demerol, and modify it—design it—at the molecular level in some glass beakers in their garage. I’ve even heard of some instruction manuals that are floating around. Consider fentanyl—an approved medication used in anesthesia. A number of powerful illegal drugs have been designed as modifications of the fentanyl molecule. Powerful means much more potent than morphine, in some cases hundreds of times more potent.”

  “Damn, that’d give quite a high.” Alec drained his coffee.

  “Sometimes more than a high. One reason these designer drugs are synthesized is because a small amount can go a long way for the dealer. And the new compounds aren’t even technically illegal at first, because no one knows what they are until after they’ve been used for a while by abusers on the street. It often takes a death or two before the killer chemical is uncovered in a specialized lab.”

  “So, the abuser gets a high, but it might be his last.”

  “Yep, right before he blissfully descends into a coma. What a way to go. Actually, if someone decided to end it all, I can’t think of a better way. You’d never know what hit you, and you might even die smiling.”

  “I’ll remember that the next time I see a smiling corpse.”

  Laura chuckled and stared past Alec.

  “What’re you grinning at?” Alec said.

  “Smiling corpses. I saw a movie about a woman assassin who killed her victims right after making love to them. They died happy.”

  “You’re thinking of a new form of euthanasia? I like it. How about this epitaph: ‘He made love all his life, even ‘til his last breath.’ ”

  Laura laughed. “You want that to be on your tombstone?”

  Alec sighed and looked down. “I don’t know how I want to die. It doesn’t matter, as long as it’s quick.”

  Oops. I think I brought up some unpleasant memories.

  They ate their food in silence for several minutes.

  Laura put down her fork. “Dr. Preswick didn’t die smiling. What can we do now?”

  “If you’re right, it’s a slick job. We need more evidence, and it wouldn’t hurt to work up a list of suspects.”

  “Should we notify the police?”

  “When we have more evidence. Otherwise, I don’t think they’d be interested.”

  “I knew him fairly well. I can snoop around the hospital and talk with people he worked with. I’ll work up a list of possible suspects.”

  “I can do my own kind of snooping, too. Like drug dealers,” Alec said. “We’ll compare notes in a couple of days, and you need to be thinking about some other kind of medical evidence we can dig up. Tiny pupils alone won’t cut it.”

  “I’ll work on that. By the way, there’s something I haven’t mentioned yet. There’s no client.”

  “I’d figured that out already.”

  “You’ll still help me?”

  Alec sighed. “I said that my work is picking up. It’s not. I need to get busy, and you’ve helped me before.” He leaned toward her. “If you’re right about this case, it’ll be in the news, and that might bring me more business. So, yes, I’ll help you.”

  “Thanks.”

  “You really think I could refuse you?”

  Laura smiled. “I’m just glad you don’t think I’m crazy.”

  “Let’s not jump to conclusions yet.” They both laughed.

  Alec polished off his last rib and wiped his fingers. “A minute ago, you mentioned a specialized lab. Is there a lab somewhere that can find this drug in his tissues?” he said.

  “Maybe. I’ll speak to the ME about it.”

  Laura splurged and ate apple pie a la mode for dessert. She figured she could handle it. After all, she did jog earlier in the day.

  A smile was plastered across Laura’s face during her short drive home. She felt confident that she’d convinced Alec about the case, and he hadn’t even cautioned her about this new mission of hers or suggested that she leave everything to him.

  Later, as she drifted off to sleep, her pleasurable thoughts were replaced by visions of the corpse in the ER. She could see those eyes again. The blank, unseeing eyes of death. Only these eyes had tiny, pinpoint pupils.

  It’s the only clue you left me, Dr. Preswick.

  Chapter 7

  Day Two - Matthew Kline’s Medical Malpractice Trial

  “All rise,” the bailiff said as the judge entered the courtroom.

  It was four days before the death of Roderick Preswick, the proctologist. Laura’s medical school friend, Dr. Matthew Kline—general surgeon—stood and watched the judge
take his seat at the head of the courtroom in a Washington, D.C. courthouse. On the right side at the front of the room, six jurors with wooden faces waited to find out more about Dr. Kline—what kind of doctor he was, and whether he was guilty of any substandard medical care.

  Matthew Kline was a slender man with broad shoulders. His dark brown hair was more disheveled than usual, and his almond eyes appeared dull and vacant. He couldn’t look the judge in the eye. I don’t belong here.

  Matthew and his defense attorney, Robert Collingsworth, had been confident before the trial, which was about the death of a female patient of Matthew’s. The plaintiff’s attorney described her to the jury as “a young beautiful wife and mother of three angelic children—a high school prom queen who’d once dreamed of and had surely deserved a chance at a full and productive life.” She was dead, and the plaintiffs believed she’d been the victim of a bad doctor.

  Robert Collingsworth was a first-rate, experienced malpractice defense attorney. A tall man with an addiction to cigars and a generous abdominal girth not quite contained by the belt around his waist, Robert had come to understand physicians well. He’d learned how to handle their often egotistical and inflammable personalities before and during a trial.

  One of the expert witnesses for the plaintiff was Dr. Roderick Preswick. Matthew had never imagined the day that a local doctor would testify against him in court. But that day had arrived.

  Matthew sat to the left of his attorney at a table facing the judge. He watched from the corner of his eye as Roderick Preswick walked from the center of the courtroom and approached the witness stand.

  “Dr. Preswick, do you swear to tell the truth, the whole truth, and nothing but the truth, so help you God?” a court clerk said.

  “I do,” Dr. Preswick said with his right hand held high. He then took his seat in the witness box. He didn’t look at Matthew.

  The plaintiff’s attorney, a smooth-talking man sporting an expensive beige suit, shiny brown wing-tipped shoes, and a picture-perfect tan, prompted Dr. Preswick with a series of opening questions to highlight his stellar medical background, numerous worthwhile accomplishments, and thus, his eminent credibility to testify in this tragic case. As the good doctor was regaling the jury with his life story, the immaculate attorney eased away from the lectern and stood in front of the jury box, smiling and nodding at the jurors.

  Robert leaned over to Matthew. “Got to admit. Preswick has impressive credentials.”

  Matthew felt queasy. He reached into his pants pocket and retrieved a roll of antacid tablets.

  “Put those back,” Robert said in a harsh whisper. “Don’t let the jury sense that you’re afraid of this witness.”

  Matthew slid the offending medication back into his pocket.

  Returning to the lectern, the opposing attorney launched into a series of questions. “Dr. Preswick, do you have any criticisms of Dr. Kline’s medical care of young Mrs. Markum?”

  “I have a number of criticisms. The main problem is that he should’ve taken the patient to surgery directly from the emergency room.”

  “Why do you say that?”

  “It was obvious that Mrs. Markum was seriously injured and was deteriorating rapidly in the ER. She needed surgery.”

  “How was she deteriorating?”

  “She complained of chest and abdominal pain, and she was combative, very anxious. Her pulse rate was rapid—120 per minute.”

  “What do those findings indicate to you?”

  “That she was in shock and bleeding internally.”

  “What would you have done in the operating room, Dr. Preswick?”

  “I would’ve repaired the injuries to her spleen and liver.”

  “Those injuries—those lacerations to her otherwise healthy spleen and liver. Were those injuries fixable, Doctor?”

  “Oh, yes, absolutely.”

  “And that’s what a surgeon’s supposed to do, right? Decide when a patient needs surgery and then operate and correct the problem?”

  “Yes.”

  “Objection.” Robert shot out of his chair. “Leading the witness. Not all problems are correctable, even under ideal circumstances.”

  “Objection sustained. Rephrase the question,” the judge said.

  The plaintiff’s attorney turned toward Robert with a faint smile. “Counselor, you’ll get your chance to cross-examine.” He then raised his hand and faced the judge. “I’ll amend my question, your honor.”

  He looked at the witness. “A competent surgeon is trained to decide when a patient needs surgery and then perform the indicated operation, correct?”

  “Yes.”

  “So, a surgeon who fails at either is incompetent, right?”

  “Yes.”

  Robert’s hand shot up. “Objection—leading.”

  “I withdraw that last question, your honor. But I have one more.” He paused and scanned the rapt faces of the jurors. “If you’d been the surgeon for this young woman on that fateful evening—the last evening of her brief time on earth—would she be alive today?”

  “Yes, I believe she’d be alive today.”

  Robert slapped the table. “Objection. Calls for speculation, your honor. Hypothetical—”

  “Well, your honor, that’s what this doctor is here for, to give us his opinion,” the opposing attorney said, his head tilted at Robert. “He’s just giving us his opinion as an expert witness.”

  “Objection overruled,” the judge said.

  The plaintiff’s attorney arranged and folded up his notebook of papers. “Pass the witness, your honor.” He walked away from the lectern, the faint smile still on his lips.

  At no point did Dr. Roderick Preswick acknowledge Matthew’s presence.

  ***

  Robert had been initially supportive of his client—helpful like a counselor—but soon he sensed a cloud of melancholy surrounding Matthew, a darkening cloud. Despite Robert’s pep talks, Matthew remained glum. Outside on the courthouse steps, Robert raised his voice at him, like a coach berating one of his players for giving up on the game.

  “Listen, Matthew. Your butt’s on the line here, not mine. You could lose. Your name could go in the loss column on the big list of doctors who’ve been sued. It may be difficult for you to get hospital privileges if you lose. Hell, you could have trouble renewing your state medical license. Are you listening to me, damn it?”

  Day Three

  Robert offered a different proposal, “I’m losing faith, too, Matthew. I’m thinking about talking to the plaintiff’s attorney about a settlement. I don’t know if he’ll deal, but I can try.”

  “Sure.”

  “So, it’s okay with you if I ask to settle?”

  Matthew looked down and rubbed his forehead. “Yes.”

  Day Four

  Each morning of the trial, Matthew’s legs wobbled as he approached the imposing courthouse building. Since he was seven years old, anything associated with a courthouse would trigger a flood of memories of his father, who had stayed drunk most of the time, and drunk meant violent. He would yell and curse and look around for the nearest animate object—often it was Matthew—to kick and slap around. The abuse finally came to an end with his father’s DUI vehicular manslaughter conviction, and—in a courthouse—he was sentenced to prison, where he died.

  Now, in the present, stumbling down the unfriendly hallway, which echoed the footsteps of those who would rather remain unnoticed, Matthew imagined that his body was shrinking. My suits don’t seem to fit anymore. People roaming around inside the courthouse stared at him, judging him. His words and whispers seemed to resound around the walls, audible to everyone.

  Maybe they can even hear my heart pounding.

  Matthew tried his best to appear upbeat and confident to the jury. However, during the last days of the trial, it was difficult for him to raise the corners of his mouth for even a semblance of a smile.

  Maybe I did make a mistake. Maybe I should’ve taken her to surgery. He didn
’t dare mention this thought to Robert.

  It didn’t help that the dead woman’s husband, a rough-looking man with a ruddy, sun-wrinkled face and thick, callused hands, glared at Matthew with an ever more menacing scowl as the trial dragged on.

  Robert leaned toward Matthew. “The plaintiff doesn’t want to settle. We’ve got to fight on.”

  Matthew stared at the ceiling.

  “Okay, Matthew, for the last time, get your shit together. If you don’t believe in yourself, the jury sure as hell isn’t going to, either.”

  Day Six

  On the last day, Matthew finally had his chance to say his piece from the witness stand. He’d been rehearsing for that moment with Robert since the beginning of the trial. His fingers twitched and his heart pounded as the plaintiff’s attorney, baring his teeth, approached the stand.

  “Dr. Kline, we all know why this poor young woman died, right?”

  Matthew didn’t answer.

  “Don’t you agree that she bled to death in her abdomen?”

  Matthew couldn’t bring himself to speak.

  “Dr. Kline, did you understand my question?”

  Matthew’s voice squeaked. “Yes.”

  “Doctor, please speak up. Everyone here is interested in what you have to say.”

  “Okay.” His voice gained some strength.

  “Isn’t it true that she bled to death in her abdomen?”

  “Yes, but—”

  “But what, Doctor?”

  Matthew sat forward. “She died so fast, I don’t think I could’ve saved her. Even if I’d gone straight to the operating room from the ER.”

  “Aren’t liver and spleen lacerations fixable?”

  “Not all of them.”

  “You knew she was seriously injured after that massive head-on car collision, didn’t you?”