Lethal Practice

by Peter Clement

  As I talked, it all seemed so logical, I suddenly wondered why he hadn’t done it this way himself. It would have taken a lot longer and been a lot more work, but it wouldn’t have caused the chaos we were in now. And if I could figure out a way to balance the books that wasn’t disruptive, so could he. Whatever else he was. Hurst wasn’t stupid. So what was so urgent about cutting costs that he had to put patients at risk for it? And if something else that important to him was at stake, how hard would he resist backing off?

  At least the rest of my department seemed persuaded by the logic of what we were about to impose on him. As I looked around the table, I could see they were talking to one another more freely now, nodding approval, and clearly excited by our chances of winning. All except Kradic. He seemed nervous. He obviously didn’t agree, yet for the moment he kept silent. I wondered if he’d heard how angry I was at him for having left too early this morning.

  Just then Jones entered the room. Research must be finished for the day, I thought sarcastically. She was tall, thirty-something, and wore her red hair in a ponytail. This evening she was dressed in a green track suit that matched her eyes. Cute, until you got to know her. She mumbled something about traffic and took a seat, but the slight flush still in her cheeks made me suspect she’d gone for her daily run rather than be on time for our meeting. Not wanting to rekindle our fight on the phone, I ignored her and again glanced around the table. “Any more comments?” I asked.

  There were no takers. We voted. Secret ballot.

  I collected the papers. One against. (Kradic?) One abstention. (Jones?) The rest were in favor of closing down.

  Before I could adjourn, there were a few questions about Kingsly. While most of those present had heard the rumors that he’d been murdered, no one seemed aware yet that he’d been killed with a cardiac needle. But they’d all been told I’d discovered it was homicide, and they wanted to know more. My explanation that the police had instructed me not to talk about the case was met with catcalls, a few raspberries. So much for respect for the chief of the ER.

  We were starting to leave when I saw Popovitch take Kradic’s elbow, say a few words into his ear, and then walk away. Kradic caught my eye, quickly looked down, and shuffled out the door. I don’t know what Popovitch had said, but from the stunned look on Kradic’s face I was pretty sure he’d be staying for sign-out rounds.

  I looked across the table at Jones and my resentment from this morning rekindled. I was undecided whether to confront her now or continue to ignore her. I must have had a pretty unpleasant expression on my face, because when she glanced up and saw me watching her, I could have sworn she turned pale.

  * * * *

  The speed of rumor and the reaction from Hurst were equally swift. His page for me arrived at five-twenty.

  “What have you done?” he shrieked as soon as I picked up the phone on Carole’s desk.

  I didn’t bother putting it to my ear. Carole started to muffle her giggles.

  “Exactly what you heard.” I was trying to speak into the mouthpiece and keep the earphone as far away as I could. It wasn’t far enough.

  “I’ll have all of you suspended immediately!”

  Obviously I was up against a tactical genius. “We’ve just done that for you.” Then I hung up fast ... before Carole and I laughed ourselves to tears.

  * * * *

  I’d dropped in on Watts again to see if I could get a preliminary on Kingsly’s postmortem. Instead, I found him still gloved and garbed in protective gown, mask, and cap. He was stooped over Kingsly’s freshly opened and eviscerated corpse with a pile of broken and bent cardiac needles strewn about in the body cavity. Even for this place it was a sight. Watts was too involved to notice my arrival.

  “Those needles better not be on our budget,” I said. announcing my presence. Out of habit I had grabbed a mask on my way in. I didn’t intend to handle anything so I didn’t stop for gloves.

  “It can’t be done. Can’t use a cardiac needle like a stiletto. And look at this.” He was about to show me some other detail of Kingsly’s innards when a quiet knock interrupted, and we turned to see detectives Riley and Bufort on the threshold.

  “Ah, gentlemen,” Watts greeted them like a fine host welcoming dinner guests. “Come in. Please put on a mask from the counter over there and take a seat. I was about to get started with Dr. Garnet here.” He had obviously invited them down to demonstrate, with considerable relish, his exceptional skills.

  In contrast, my resentment toward Bufort returned fall force. I had an overwhelming urge to demand that he explain himself and his behavior earlier in my office, but I held back and merely glared my disapproval at him instead. He seemed as though he couldn’t care less. But Riley nodded at me and smiled, then looked somewhat puzzled. I wondered if he was even aware of what had happened before with Bufort.

  The two detectives pulled up the only stools in the dissection room and positioned themselves for the best, though distant, view of Kingsly’s inner secrets. I noted how at ease they were with the gaping remains. Watts made some opening comment about our two professions being similar and that this was a room where we solved puzzles and answered riddles of death. He absently gestured to a row of labeled tubes and specimen jars neatly lined up on the gleaming countertop behind him. They were filled with various fluids and pieces of human tissue, presumably Kingsly’s.

  Watts then began to walk while he spoke. “When you came in, I was just starting to explain to Dr. Garnet that while the murder weapon was indeed a cardiac needle in the heart, there are a few big unanswered questions. First, a cardiac needle can’t be plunged in.”

  To make his point, he handed Detective Bufort an unused needle about a foot long, gleaming and sharp but flimsy.

  “When we teach residents,” Watts continued, “they all start out trying to hold the needle at the far end. They place the point on the skin and push; if we let them continue, it would just bow and break. Perhaps Dr. Garnet would like to demonstrate the proper technique that is necessary to successfully insert a cardiac needle.”

  Feeling like a magician’s assistant and not wanting to spoil Watts’s show, I slipped on a green OR gown and donned a pair of rubber gloves, took the needle from the detectives, and stepped to Kingsly’s right side. With my left hand I held the tip of the needle a few centimeters from the end and steadied the rest of the shaft with my right. With a slow but hard and steady force, I punctured the skin at the bottom of what remained of Kingsly’s breastbone. Aiming for the inside of Kingsly’s left shoulder, I slid the entire needle into what would have been Kingsly’s heart, if Watts hadn’t already taken it out.

  “Whoever got that needle into Kingsly’s heart,” Watts said, “had to use that technique. It means Kingsly had to stretch out on the floor—or stand there and cooperate— or that he was already out cold. Now look at this.”

  He turned and took a large Tupperware container off a shelf behind him, then flipped open the lid. A small shower of formaldehyde and pieces of God knows what sprayed our way. He extracted a dripping hunk of meat about the size of a small melon, which I recognized as a human heart, presumably Kingsly’s. Watts identified the chambers for the benefit of the detectives and pointed out the long, spindly guy wire sticking out of the muscle. “This is the track the needle took entering the heart.” He picked up another guy wire and poked it into the needle hole just below where I’d performed my own demonstration. “This marks the route of the needle when it first entered the skin. By alignment, it started perfectly on course for the center of the heart, but the two vectors don’t match. The track in the heart is skewered upward.”

  Riley caught on immediately. “Could he have been stabbed twice?”

  “No evidence of it. I’ll have more after I get my tissue samples back for microscopic examination. And of course we’ll do the usual biochemical screen, but I’ll bet his blood alcohol level will make embalming redundant.”

  Bufort had seemed to study his hands throughout mos
t of this. I’d already gotten a taste of a ruthless streak lurking beneath that rather gray exterior, but what he said and did next alerted me to an even more formidable threat—his shrewd and cunning intellect. “What you are telling us. Doctor,” he began without looking up, “is that the victim, though inebriated, felt what must have been expert hands inserting the needle into his chest and then managed to sit up, or, if he was standing in the first place, buckled forward as he fell. Either way, he would first bend, then snap the needle as it was driven home.”

  It was clearly his show now. “In other words, this was not a woman grabbing the nearest handy weapon to fight off a man who was trying to maul her. No, this was a deliberate, almost surgical act of murder.” He paused, presumably to let our own thoughts catch up with his. Even before he spoke, I felt what was coming with an unwelcome chill. “It seems likely, gentlemen, that our killer is a physician; moreover, a physician skilled in inserting cardiac needles.”

  Exactly as I’d been expecting, and dreading, Watts’s findings put every member of my department on a very short list of suspects.

  Bufort continued. “In a general hospital like yours, Dr. Garnet, how many doctors would be expert at needling hearts?”

  I hesitated. The question sounded offhanded, but it felt more like an opening gambit than a sincere request for information. He still hadn’t looked at me, and I sensed that at the least he was setting me up for another round of intimidation.

  My hesitation must have gone on long enough to make Watts uncomfortable, because he answered for me. “Outside of ER there are only a handful of doctors expert at needling hearts,” he said matter-of-factly. “These specially skilled physicians are found in specific areas. The OR, ICU, and cardiology together might include a few dozen individuals with the ability to have murdered Kingsly—though not every one of those doctors would still be performing the procedure routinely enough to have achieved the perfect entry path we observed here.”

  But most physicians on my staff could. By far the greatest number of doctors with such skill would be in emergency, and it was the most probable place for Bufort to look for the killer. Yet instinctively I felt protective about the ER—it sickened me that our entire department was about to fall under police scrutiny—and I felt a surge of annoyance at Watts for being so coldly forthright with Bufort. Almost immediately I knew it was irrational. What else could Watts have done?

  But as troubled as I was about emergency, I was even more unnerved by the growing silence in the room and by Bufort still not looking at me. The stares of Watts and Riley added to the tension. In those uneasy seconds I slowly became aware I’d just given Bufort a firsthand demonstration that I, too, had the skills of the killer.

  While continuing to gaze at Kingsly’s eviscerated heart, Bufort began speaking again very softly, very politely. “Dr. Garnet, it is early in the investigation, and I haven’t had much time to discover what goes on in this hospital, but it occurred to me that the motive for Mr. Kingsly’s murder might be connected to some issue, problem, or conflict in the administration here. I thought there might be some reference to such difficulties recorded in the minutes of meetings he attended.” He paused, still eyeing the grisly specimen on the table before him, then added, “Unfortunately, according to the records I looked through upstairs, the man didn’t seem to go to many meetings.”

  While Bufort talked, his partner’s unblinking stare remained on me. I suspected this was an interrogation technique they used often, a practiced routine intended to put the person they were questioning on edge. It worked. Even Watts was looking a little uneasy, glancing from me to Riley, then to Bufort as the detective continued speaking.

  “But the records did show something very curious. Dr. Garnet. The only two people who appeared to care about his absences were you and Dr. Carrington, the chief of surgery.” He suddenly raised his head and stared right at me. “In fact,” he added, getting off his stool and walking around to my side of the table, “for the last couple of years, the two of you have repeatedly demanded his absenteeism be recorded.” He stopped in front of me, his face a few inches from mine. “Why was that?” he asked almost in a whisper.

  I instinctively drew back, uncomfortable at his closeness, and again ashamed of my behavior with Kingsly.

  “Well?” he snapped impatiently, leaning a bit more into me.

  I was quickly realizing I’d better choose my words very carefully. I tried to swallow before answering, but my mouth had gone dry. “Because,” I croaked, “we both felt very strongly that the presence of the chief executive officer at our meetings was important for the hospital.”

  “Oh, really?” he asked sarcastically. “Dr. Hurst told me it was because the two of you were trying to get rid of Kingsly as chief executive officer.”

  At first I was too stunned to answer.

  Then I felt a burst of rage against Hurst for insinuating that I had a possible motive for murder. Yet surely Bufort hadn’t taken him seriously. It had to be a joke. But Bufort’s cold stare was anything but funny. “Come on!” I protested with rising alarm. “We wanted him fired, not dead.” Even having to explain myself against such an outrageous suspicion left me feeling resentful and astonished. I still half expected Bufort to crack a smile, poke me in the ribs, and admit he’d only been kidding.

  Instead, he said, “Don’t try to keep things from me, Dr. Garnet. If you do, you’ll get in trouble you can’t get out of.” Then, apparently feeling his job of unsettling me was well and truly done, which it was, he backed away and went out of the autopsy suite without saying another word. Leaving me hanging like that must have been a well-used tactic too, except that Riley seemed genuinely caught off guard. He looked embarrassed to be alone with Watts and me after his boss’s performance. He left fast.

  “Holy shit” was Watts’s professional opinion.

  I probably looked a little unprofessionally shocked myself, because he immediately tried to cheer me up.

  “Don’t worry. If they do nail you for the old bastard’s murder, you’ll be a hero, and we’ll all bring you cake.”

  I managed a weak “Thanks, pal.”

  On my way out through Watts’s anteroom, the scurryings and scuttlings in the corners seemed more menacing than usual. After Bufort’s behavior tonight I thanked God Watts had prevented me from drawing attention to the DOA.

  Chapter 6

  The cold mist felt soothing against my face but did little for my jumbled brain. Just on the edge of the hospital parking lot were a half dozen police cruisers; a small fleet of plain-looking vehicles was in the section reserved for doctors. If I’d known which one was Bufort’s, I’d have had it towed. I’d been dodging a couple of reporters who’d barged into the ER in the late afternoon, and I was relieved to see there wasn’t a gauntlet of their tribe to run on the way to my car. As I unlocked my door, I noticed that all the lights in the finance office were on. Odd, I thought. Laverty and his staff usually left at four.

  All the way home, I kept trying to trivialize the risk of Bufort concocting a murder charge against me, but the black thoughts stayed. And I still couldn’t fathom why Hurst had suddenly become so ruthless, even by his usual seamy standards. Had he tried to implicate me in Kingsly’s murder because of my blow-up with him that morning over the bed closures? It was certainly strange that within hours of Kingsly’s killing, after tolerating our financial mess for years, he’d launched massive and sudden cuts that went way beyond simple economic sense. Or was he retaliating against my threat to close emergency? In either case, his behavior seemed driven by something more than a desire for balanced books. Whatever he was up to, he obviously had no qualms about doing me professional or personal damage in the process.

  And then came the question I’d been trying to avoid the most but had to face: Could someone in my own department be the killer?

  There were fifteen of us in emergency, and I dreaded the inevitable thoughts and suspicions that were bound to surface once Bufort and his team started que
stioning everyone. Lose trust in a person working in a high-risk area and immediately his effectiveness plummets. Support and backup, freely given, are what keep patients alive. One of my professors had called it a magnificent dependency that can perform miracles, and it had a lot to do with what kept me addicted to ER work. If Bufort managed to clog that synchrony with doubt and fear, our team could fall to pieces and become uncoordinated, even deadly.

  One thing was certain: All this was going to undermine emergency’s fight for beds. The moral high ground I’d charged up to go against Hurst would be muddied with the slimy innuendo and suspicion he’d pushed my way. While Bufort stalked each one of us. Hurst would have the perfect excuse to stall and keep his deadly closures in force. “How can we believe emergency?” he’d say. “A killer lurks in their midst.” It wasn’t a logical dodge, but it would work when no one wanted to listen anyway. Worse still, he might be right

  I figured it would be hard to sleep this night. I opened my window. The familiar sound of my tires on the pavement only reinforced my dark mood.

  Janet’s car was in the garage, but I knew she must have already gone to bed, because only the kitchen light was left on. After a wagging, slurpy welcome by Muffy, I snapped on her leash and stepped back outside. She tugged me down the porch steps, but then I turned away from our regular route. I was going to need a much longer walk than our usual circuit if I’d any hope of quieting my nerves. Muffy immediately bounded and pulled ahead in anticipation of different spots and new smells.