Lethal Practice

by Peter Clement

  I moved to his side and felt for a carotid pulse in the neck. None, and he was cool, even in the stifling heat of the room, which I absently noticed. His two resuscitators were still pumping, blowing, and choking. They had obviously been taught CPR, but the leap from training to the real thing wasn’t usually this bad.

  With him long out of his misery, I was about to put the women out of theirs and stop the arrest when I noticed something odd. Every time the woman pumped, a thin jet of bubbly blood squirted out onto his abdomen. I knelt down and stared. The blood came from under a recently formed scab the size of a blueberry that was just to the left of the tip of his sternum and had lifted loose. Under the scab, with each press on the chest, the small silver end of a broken needle rose out of the ooze and then receded back into Kingsly’s innards.

  More bubbles and thin jets of blood appeared with every chest compression. The bubbles indicated the channel of the wound was deep, burrowing at least into the lung. The jets of blood told me that unless the man had been trying to turn himself into a voodoo doll, someone had driven a cardiac needle into the center of Everett Kingsly’s heart.

  Chapter 2

  Despite the atrocity on the floor, I was almost unable to accept what I’d seen—that Kingsly had been killed— and I dreaded pronouncing it even more. I gently put a hand on the shoulder of the woman next to me to stop her attempts at CPR. Her companion made a few more futile puffs into Kingsly’s flabby mouth, then pulled back. They were both visibly shaken.

  “You did everything you could,” I said as I helped them up.

  “Are you sure?” one of them asked.

  “Absolutely,” I answered, patting her arm.

  I ushered the women to the door, where other comforting hands waited, and saw the cardiac arrest team racing with their cart down the corridor. I waved them off.

  Then I blanked. What to do now was not familiar. Death yes, but not the management of what I’d discovered here. I was still the only physician in the room and, therefore, in charge of the body. But being the only person who knew that Kingsly had a broken needle in his heart left me thinking back to old detective novels for guidance. I figured blurting out that he’d been stabbed wouldn’t help.

  More people were peeking into the office from the outside reception area. A security guard pushed to the front, saw Kingsly, and went a little pale. Two nursing supervisors caught him as he swayed and helped him to a chair.

  “Don’t touch anything” was what I finally said, trying to sound authoritative. One of the night supervisors gave me her who-do-you-think-you-are look and dropped a dust cloth over Kingsly’s partly exposed privates. Somehow, it didn’t help.

  I tried again. “I want this room cleared now, please, and someone find our chief of pathology and tell him to get here fast.” After they’d had their peek, and a whiff of the body, everybody was eager to get out anyway.

  Two orderlies came and helped the still-woozy guard to a couch in the reception area. The supervisors took turns with the phone on the secretary’s desk. I was just leaving Kingsly’s office when I thought again about how hot it was. I glanced at the thermostat mounted beside the door frame. It was set at the very top; the room must have been at least a hundred degrees. Unthinkingly, I turned it down.

  “Did anybody turn up this heat?” I shouted to the people in the reception area. I got only incredulous stares. Was it always so hot in there? I wondered. I didn’t recall from my previous visits, but I had kept those as rare as possible. Or had the heat been jacked up to prevent the loss of body temperature that would reveal time of death? And then I cursed myself. While pompously ordering everyone else to touch nothing, I’d gone and fingered the very dial that might have held a killer’s prints.

  As I closed the door, I saw Madelaine Hurst, associate director of nursing and the chief night supervisor, arrive and walk over to her assistants. The one on the phone immediately hung up, and I watched as they began talking to her in hushed voices. She was senior, discreet, and, I figured, best able to handle the next step. She was also the sister of Paul Hurst, former surgeon and now the medical vice president for the entire hospital.

  I went up to them. “Miss Hurst,” I interrupted, “I need a private phone, and then I need you to get the medical examiner for me. After that call the police—in particular a senior officer from their homicide department.”

  She looked at me like I was nuts. “The only person I’m calling is my brother—which I’ve already done. He’ll be here any second.” She didn’t add “so you’d better watch out,” but I still felt like a kid in a school yard.

  “Please, just do what I asked,” I said in a low but forceful tone.

  She backed away as though I’d let out a bad smell, but went to the secretary’s desk and started dialing. I spent the next fifteen minutes arguing with groggy clerks at the medical examiner’s office, being put on hold, and quarreling with Miss Hurst over calling the police until she suddenly shut up. Her brother had arrived. He had obviously dressed hastily, because his raincoat hung open over a wrinkled white shirt and baggy pants. His normally pale complexion had become even more pasty and shone with a sheen of perspiration.

  “Oh, Dr. Hurst, thank God you’re here.” In public Madelaine Hurst always addressed her brother formally. “Poor Mr. Kingsly has died in there. He’s lying on the carpet with most of his clothes off, and now Dr. Garnet is making me call pathology, the medical examiner, the homicide squad....” She let the indictment hang there, in the air, while Paul Hurst slipped his arm around her shoulder and joined his sister in frowning at me.

  Just then, thankfully, Robert Watts, chief of pathology, entered the reception area with his usual sense of quiet command.

  “Where is he?” he asked calmly.

  Tall and gray-haired, Watts retained his ease even during the toughest crises. He stood there, glancing first at Hurst, then at me, ready to get down to business.

  Hurst, clearly annoyed with me, said, “Sorry, Robert, but Garnet here is out of—”

  “Gentlemen,” I interrupted. “If you will step in here, you can see the situation yourselves.” I opened the door to the office and showed them Kingsly.

  It took Watts thirty seconds to agree with me that we had cause to suspect murder and must notify the medical examiner. Hurst’s whining wasn’t going to change the law. Watts was also pretty sure the medical examiner would order us to call the cops immediately, but he went out to phone the city morgue and speak personally to the chief pathologist. Being a colleague, Watts might rate more attention than I’d gotten earlier from the clerks.

  Hurst hung around in a sullen silence to make sure I didn’t cause any more harm to the hospital’s good name. He’d cover up the murder of his own mother to avoid a scandal, and this was going to be a tabloid special.

  “What do you think happened?” I asked gently. The sooner he accepted the truth about Kingsly’s death, the better he’d help everyone at the hospital deal with it. Starting to analyze the gruesome situation would give him the start of the objectivity he was going to need ... or so I hoped.

  “Lord knows” was all I got in reply.

  Watts returned. “The medical examiner’s seeing to it that the chief of detectives is sent over. We can do the autopsy here, but he wants his own man on-site to take special forensic samples. Finding clues to a murder isn’t what we usually do.”

  “Murder?” Hurst winced. “Surely you’re jumping to conclusions!” He looked around for corroboration. Watts and I looked at Kingsly. Hurst’s shoulders slumped. “Should we just wait here?” he asked.

  Watts glared at him. “Wait in the reception area if you want.”

  “Robert,” I said, “when I came in here, the room was hotter than Hades. I think someone must have turned the heat up to try to obscure the time of death.”

  “How do we know it wasn’t suicide?” Hurst asked, pathetic now, still staring at Kingsly’s corpse.

  Hurst’s question startled me, but Watts stepped over and ge
ntly took his arm. “Look, Paul, maybe it would be better to wait outside.” He spoke in that tone we too often use while dealing with geriatric cases; it inferred feeblemindedness and was grossly insulting, but Hurst didn’t seem to notice. He let Watts and me guide him out of the room and sit him down in a chair by the secretary’s desk now commandeered by his sister.

  She’d been sternly snapping off a string of orders over the phone, presumably to the floor nurses, when the sight of her brother being so acquiescent must have sparked her hurried good-bye and quick move to comfort him. “Paul, are you all right?”

  “It’s awful,” he said almost to himself, as if she weren’t even there. “Just awful.”

  “Paul!” She stroked his hands, then awkwardly touched his cheek.

  Finally he seemed to notice her. “I’m fine, really, I’ll be all right,” he said weakly. But he continued to slouch in the chair where we had put him while his sister made nervous fluttering movements. By the time she finished, she had also realized her brother was no longer in charge. She looked to Watts and me for orders as angrily as if we had just staged a coup d’etat.

  Watts continued the takeover. “Miss Hurst,” he asserted, fully formal now, “would you please get your brother a cup of tea? Dr. Garnet and I will stay here and wait for the police.”

  She grudgingly nodded and left, but on the way out she gave me a sullen look to make it clear I didn’t rate similar respect. Gray hair again. It conveys automatic seniority in our business and, in this case, not wrongly. Watts’s excellence with the living reflected his years spent as a general practitioner before he became a doctor for the dead.

  We stationed ourselves at the doorway of Kingsly’s office. I continued bothering Watts about the thermostat and a time of death. “I saw him earlier tonight, around seven. He’d been drinking and was stumbling along the hall, so I alerted security. We can check why they didn’t pick him up or, if they did, why they didn’t take him home. But the room here was an oven when I arrived, so the heat must have been on for quite a while before the cleaners found him.”

  Watts looked at me intently as I talked, probably thinking he was hearing the raving of an amateur detective.

  “Maybe,” he finally said. “Room temperature wouldn’t change heat loss much though. Besides, there are other signs to estimate the time of death. Leave that for a moment. Where’s the blood?”

  He looked at me, saw I hadn’t a clue what he meant, and went on. “If that bit of metal in his chest turns out to be the cardiac needle we both think it is, then there should be at least a few spurts of blood that shot out during the time it took the pressure to fall. Even if the stab stopped the heart instantaneously, which is unlikely if the needle broke off, then a stream of blood would still have sprayed all over the place for a few seconds. Think back to the times you’ve put a needle in a patient with cardiac tamponade.”

  I did think about it. Tamponade is a condition where the sac around the heart becomes filled with fluid. The tension prevents the heart from beating even though the electrical impulses keep firing to organize the pump of a heartbeat.

  We would routinely get the pumping action back by sticking a special long needle attached to a syringe into the swollen sac around the heart to pull off the constricting fluid. If we went too far, the tip of the needle would enter the heart muscle and set off an electrical disturbance that if allowed to continue could degenerate into ventricular fibrillation and a full cardiac arrest. But Robert was right; this took time. In Kingsly’s case the needle would have passed directly into the center of his heart and set up the fatal dysrhythmia. Unless the needle had been attached to a containing syringe until Kingsly had died and the needle had been broken off afterward, there should have been a lot of blood, streams of it everywhere.

  “And,” Watts said, “if the needle hadn’t broken off in the struggle but was intact, then whoever stabbed him simply could have removed the needle with the syringe attached. A neat withdrawal leaves a minimal mark and would have been the logical way to try to hide that Kingsly was murdered. No one would deliberately snap it off after and risk the broken fragment being found in the body.”

  “I suppose you’re right, but once the needle had broken off, why not just pull it out then?”

  He frowned at me as if I were one of his residents and should have known the answer myself. “Because the killer wouldn’t know how deep in it was without probing for it,” he explained not too patiently, “and that would enlarge the puncture site, making the wound obvious.” He paused and looked around. “And where are his clothes?”

  I shrugged. Watts had noticed the most obvious inconsistency, which I’d completely missed.

  “Probably far from here,” he added, “and I bet they’re covered with blood, maybe even burned already.”

  “What do you mean?”

  “I mean he was attacked, and broke off the syringe either thrashing to death or struggling when he was stabbed. Blood must have been flying everywhere, all over his clothes, the walls, ceiling, and floor.”

  Watts suddenly bent over the bloated belly and sniffed. “His chest’s been washed clean with rubbing alcohol.”

  I resisted sniffing for a telltale aroma of isopropyl.

  “That’s why the heat was up,” he went on. “To dry him off.” He shook his head. “No, he wasn’t murdered here.” He glanced around the room. “But I have a good idea how to find out where.”

  So did I. Kingsly’s lonely killing ground would be in whatever part of the hospital the walls and ceiling had gotten an unscheduled cleaning.

  “Has anyone called his wife?” Watts suddenly asked. “Or has she called here looking for him?”

  I’d forgotten the long-suffering Mrs. Kingsly.

  “I’ll phone her!” It was Hurst’s voice, calling to us from the chair outside, where we had left him. He began to straighten from the slouch he had sunk into when we’d deposited him there, and started to take back the control he’d lost.

  “Thanks, Paul,” said Watts.

  “I’ll do it from my office.” He left to perform what was probably the worst job in medicine.

  Madelaine arrived an instant later with a silver tea set and an array of china cups. No Styrofoam here.

  “Where did he go?” she demanded protectively. To her. Watts and I were now guilty of even more than insurrection: we’d shooed away her brother from her custody. Moreover, we appeared to be about to steal his tea. She didn’t offer us any.

  But Watts undid her with his most lethal weapon—blarney. “Why, Miss Hurst, you always know the perfect thing to do in any situation.”

  Watts had suggested the tea, but he made it seem as if it had been her idea, and she beamed. He helped himself, sighed in appreciation at his first sip, and added, “I don’t know what this hospital would do without you and your brother.”

  Only Watts had the skill to make this crap work. If I’d tried the same line, she’d have started counting the silverware. Instead, her protestations begged Watts for more of his nonsense. I had to look away and chew my lip to keep a smile off my face.

  ‘Tea, Dr. Garnet?” asked Watts, seeing my difficulty and cocking his head away from Madelaine so only I could catch his smug grin.

  As I took the cup, I glanced through the reception area window. Cop cars pulled up. Behind me Watts chatted quietly with Madelaine. Bless him. Sometimes celebrating the absurd was the only way through the pain and dying.

  Watts was a remarkable man, I thought. He enjoyed his role as the final diagnostician and keeper of clinical truths. His word on each and every physician’s performance was absolute. Some saw him as a teacher and guide. Others hated and feared his verdicts on their competence and character. The pathologist is key in every hospital in the world, and if he or she is a jerk, stay away, because it means incompetents in the place can get by with murder—and probably do. Have a good pathologist in the house and dangerous fools don’t last long. Borderline incompetents are more subtle creatures, however. Never b
latant enough to lose their licenses, they can weave and bob for years. Sometimes nurses can keep very sick patients out of their grasp by unofficially suggesting other doctors, but it’s a good pathologist who really keeps those incompetents in check; they can’t hide their fatal mistakes from him. And Watts was the best.

  Hurst, Watts, and I looked up at the commotion coming from the entrance to the hallway. Two so-called plainclothes detectives stood at the open door. They were dressed almost identically in raincoats, gray slacks, and black shoes. Probably the outfits came in sets with the unmarked cars these guys cruised around in. No one in Buffalo reaches legal age without the smarts to pick cops out of a crowd.

  “Dr. Watts?” asked the stout one with gray hair.

  “I’m Watts,” Robert said.

  “Detective Bufort,” he introduced himself. Turning to the younger and much taller man standing at his side, he added, “And this is Detective Riley.”

  Watts made the introductions on our side, and we all shook hands as politely as if we were meeting for a round of golf. Funny thing about police. The more serious the crime, the more polite the cops. In some neighborhoods, if you were too poor, drunk, or hostile, you could end up down at the station being pounded with a telephone book around the ribs for peeing on the sidewalk. But commit a murder and it’s first-class treatment all the way.

  Detective Bufort and I were the last to shake hands, then Dr. Watts invited them in to meet Kingsly.

  The two officers quietly and competently took charge. They quickly inspected the body and the room, then questioned Watts and me. When I told them I’d seen Kingsly staggering down the hall earlier that evening and reported it, Detective Riley made a note. I guessed he was going to check with security and housekeeping to see if they’d found him or if I was the last person to see him alive—besides the killer, of course. Watts mentioned the raised room temperature and explained that it wouldn’t interfere significantly with his ability to estimate the time of death.