Lethal Practice

by Peter Clement

  There ought to be a law against serving a doctor legal papers in the middle of an emergency shift, especially one from hell. Our instincts and training keep us making the right moves. Undermine those instincts, introduce self-doubt and second-guessing, and the result can be lethal. Nothing but nothing gets a doctor hesitating and second-guessing faster than the shock of being slapped with legal papers.

  “Look,” I said to Popovitch and Jones, “relax. It’s politics. It’s about not withdrawing services for want of beds. Go on being doctors and let me handle this shit.”

  Their expressions made me feel like the idiot I was for leading them into this, getting them named.

  “I know, I know! Another fine mess I got you into.” Before they could say anything, I lifted the injunctions out of their hands.

  “Popovitch, go on a diet or share your food with Jones. You two are beginning to look like Laurel and Hardy.” Their groans accompanied me halfway back to my office.

  Now I was in over my head.

  Working emergency always meant seizing control. With blood, pain, or a bubbling, choking airway, I had a move for it, knew what to do, could react fast. My greatest dread was freezing up.

  I actually had a recurrent dream. I would be ineffectively struggling to intubate through a bloody tangle of vessels, nerves, and smashed windpipe when I’d receive the ultimate condemnation from a Greek chorus of residents. “You don’t know your stuff!”

  As far as sorting out legal entanglements, I very definitely did not know my stuff. The stand against closing beds was right, but all I’d accomplished was to galvanize Hurst into taking legal action. The injunction could have as big an impact on morale and concentration in the ER as I’d feared the murder investigation would. Damn Hurst!

  He’d upped the cost of our defiance to a risk of fines, contempt charges, even prosecution. None of the doctors would go against that. Even if they threatened to resign through legal channels, it would take ninety days’ notice, and I shuddered at the thought of how much damage and death might be caused by ninety days of these conditions. What number of “preventable morbidities or mortalities” would it take to force Hurst to back down?

  My instinct—one I hadn’t felt in years—was to call for help. It was a reality of residency: Go as far as you can, and then get backup. It was harder later, after becoming staff, to admit to needing help. I’d seen experienced doctors actually kill a patient by not asking for support. As a result, I’d learned to fear such arrogance, and was pretty much ready to admit when I wasn’t cutting it.

  And right now I was not cutting it.

  If it wasn’t too late already, I had to alert the other doctors who hadn’t yet received summonses. I fantasized an army of Joan Crawford raincoats shouldering through the city to find them.

  Outside my window a distant siren warned of the rapidly approaching noon deadline when the ambulance ban would expire. I looked at the clock on my desk. 11:15. I wished Carole would get back.

  The phone rang. I let the answering machine get it and listened to the message.

  “Carole, this is Dr. Hurst’s office. Please tell Dr. Garnet that Detective Riley wants to see him as soon as possible.”

  So much for “arranging convenient times.”

  I literally turned a few circles and wondered what to do first. The phone rang again, but it was my private line. Only one person knew that number.

  I picked up. “Hi.”

  “Sure of me, are you?” Janet’s voice was an island of calm.

  “No, just really glad to hear from you.”

  “Bad day?”

  “Eleven-seventeen and I’m down to plan Y.”

  “Let’s see, that’s the one where I work and support you in the style you’ve become accustomed to.”

  “Hey, I’ll raise your kid.”

  “You’ll make the kid a bum, just like his father, or at least like his father was until I saved him and made him respectable.”

  “Yeah! You made me so damn respectable, I got this job and all the trouble I’m in.”

  “I’m the girl in trouble here.”

  “I love you.”

  “That’s the kind of talk that got me in trouble.”

  “I thought you seduced me.”

  “Yeah, well, your virtue will remain unsullied tonight. I’m sleeping over in the case room. I’ve two ladies in early labor. They’ll keep me here till dawn, so I’ll relieve one of the guys on call. He’ll owe me when I’ve got a new man in my life and want to spend the night with him.”

  “Janet!”

  “Oh, didn’t I tell you? Had an ultrasound this morning. Saw a little thingamajig hanging down. It looked just like his father’s—you know, the one that got me in trouble. Bye now.”

  Carole couldn’t for the life of her understand the goofy grin on my face when she came into the office while I still held the receiver.

  My mood didn’t change even as I went out the door to meet with Riley and Bufort and endure their attempt to hang a murder charge on me. It kept up when Sylvia Green, scared and waving her injunction, listened skeptically to my reassurances. Hell, it even endured the two ambulances that roared in twenty minutes before the ban expired, and it wasn’t altered at all by the resulting bedlam.

  I was going to have a son.

  Chapter 7

  “Dr. Garnet, let’s review the statement we took from you on the night of the murder. You said you saw the victim alive but inebriated on your way back from the ICU. What time was that?” Riley asked, showing no trace of the uneasiness I’d witnessed earlier. We were in a small, empty classroom. Riley was seated in front of me. Bufort was leaning against the back wall.

  “As I said, about seven o’clock.”

  “Are you in the habit of being here that late?”

  “I was on duty. The shift ends at midnight.”

  “Then why were you still here at one in the morning?”

  “Sign-out takes a little while, especially if we’re busy.”

  “Were you?”

  “Not especially. But my replacement was late that night.”

  “Who was that?”

  “Dr. Kradic.”

  And so it went. Riley scribbling away as if he hadn’t questioned me already; Bufort hovering in the corner, like a spider watching a protégé weave a beginner’s web.

  “And what did you say Kingsly was doing?”

  “He was walking down the hall on Second Main. That’s the center block on the floor above the administrative suites.”

  “So he had come from his office?”

  “Probably.”

  “Was he in the habit of being here so late, especially on a Sunday?”

  They must know by now. “Unfortunately, yes. He had a drinking problem. Lately he’d gotten worse, and was sometimes known to stay late and, well, maybe have a few belts in his office. I figured that Sunday he’d been drinking at home or out at a party somewhere before he came in.”

  “Did anyone ever have trouble with him when he was intoxicated?”

  Despite Bufort’s previous warning against keeping secrets, I decided to minimize. I still didn’t want his men hounding the women it was rumored Kingsly had tried to paw. “He was pretty harmless. I’ve heard he made a few feeble moves on any skirt he fell over, but nothing serious. Besides, the postmortem results showed this was not the random stab of some woman defending herself against one of his advances.”

  “What did you do to help him?” Bufort suddenly asked.

  The nearness of his voice made me jump. He’d moved up to stand directly behind my head.

  “I told the guards at the door. They usually got him home okay.”

  “I know that! They didn’t find him. I meant what did you doctors do to help him? He was an alcoholic. Who was treating him?”

  I was stung. I’d prepared for questions about a murder I hadn’t committed, not for a grilling about my indifference to Kingsly’s problem. “I don’t know,” I answered lamely.

  “How
could it be that this obvious alcoholic was allowed to continue in his job without help?” Bufort’s tone was hard, accusing.

  “I told you, I don’t know. To be honest, I feel damn guilty about it now, but I guess I was just too wrapped up in my own problems with the ER.” I was hearing my words at a distance; the truth of my admission unsettled me.

  “Hell, Doctor, if we had a cop in his shape, he’d be pulled from his job for treatment. Any half-decent corporation would have yanked this guy. Yet he’s been allowed to screw up here, a total incompetent from what I gather, in the middle of a sea of healers—and not one of you bothered to help him?”

  His disgust fed my own. I suddenly felt compelled to explain how we ended up so callous—not as an excuse but because I needed to explain it to myself.

  “Look, I know it was unforgivable.” I was finding it hard to keep my voice from shaking. “But maybe others here felt as I did—his drinking was his business. He had a family. I suppose that if I gave it any thought, I’d have guessed his wife or someone was taking care of him. He’d made such a mess of the hospital’s budget, however, I saw him more as an adversary that needed firing.”

  “You never thought of going into his office yourself and urging him to get help? You never thought of organizing your colleagues for an intervention?”

  I felt my face go hot. “No” was all I could say, but the question bored into the heart of my guilt.

  “He was one of your own. Doctor. Why didn’t you help him?” He let the question hang.

  I sat, silent, taken by surprise at the extent of the remorse and regret I felt. Then I began to feel angry. Bufort was peeling away my defenses, layer by layer, like a malevolent therapist.

  “Would you answer me. Doctor?”

  “I told you, I’m not proud of what I did—or, rather, what I didn’t do.” It felt like I was being skinned alive by this cop.

  By now he was in front of me. He leaned toward my left ear and said very quietly, “You mean you didn’t have time for a drunk in your busy, important schedule.”

  “Hey, you’re getting out of line!” I said sharply.

  He reared back in a sarcastic show of surprise. “Oh, really? Since you couldn’t get rid of him, you all seemed to prefer him ineffectual and inebriated on the sidelines.”

  I finally lost my temper. “This is really too much!” I instinctively looked over at Riley for help. I watched the muscles in the corner of his jaw tighten.

  Riley cleared his throat. “Look, maybe we should get back to the night of the murder.”

  There was a pause, cold as ice, before Bufort said, “I’m in charge of this interrogation, Riley.” He began pacing behind me so I’d have to keep turning my head to see him.

  Across from me, the side of Riley’s jaw bulged again. He got up and walked over to a desk at the front of the room. There he half sat, half leaned on its large top, fiddling with a piece of chalk from the sill of a nearby blackboard.

  Bufort now came around to where I could see him better. “Here’s my point. Doctor,” he started to say. “It seems everyone in your hospital conformed to a norm of indifference—sort of the hospital’s way of institutionalizing an acceptance of Kingsly’s alcoholism.” He sounded like he was reading from a textbook. “It certainly seems to have freed all of you from any thought of taking the trouble to help him.”

  By the expectant look on his face, I figured he wanted a reply, so I confessed, or surrendered, or maybe did a little of both. “Yes, I see what you mean.”

  But admitting my complicity didn’t end the ordeal. I tensed as he leaned toward me. “So who gains? Who does it serve to have the administrative head of this place continually out of it? Who could profit by that?”

  The obvious name came to mind. It was the perfect time to tell Bufort about the phone call and my suspicions about Hurst. I could throw in my story about being chased by the Dobermans and let the detective make whatever he wanted of it. But even after what I’d just been through, and as tempted as I was to subject Hurst to his own ordeal by innuendo and whispered allegations, I balked. I balked at resorting to the same underhanded level of treatment he had used against me when he first pointed Bufort my way. It wasn’t altruism. Being anything like Hurst just revolted me too much. And whatever I thought he was up to, I had no proof. Until I did, if I was going to stop Bufort from subjecting me and the rest of my staff to similar cheap shots and accusations, I couldn’t very well indulge in them myself. “I don’t know!” I finally answered, my dread about Hurst and what he was capable of in full force.

  The rest of the interview was mundane. Bufort asked me if I knew why anyone would murder Kingsly. I said no. Then he wanted to know if outsiders could get into private areas of the hospital at night. Sure, I told him. Sometimes street people hid out in the basement to keep warm or waited in washrooms till after visiting hours. Security wasn’t our highest priority in the ER. On the contrary our unit was—had to be—open, free-flowing, and constantly chaotic. Again I thought he was getting a little off track, given that the killer was probably a doctor, but I supposed he had to account for all possibilities.

  He finished by requesting a list of the doctors I’d seen in the hospital that night, particularly between seven and midnight or so. I presumed this was the estimated time of death that Watts had given him. I said I had seen only the residents scheduled to be there. He didn’t have any questions about them as I’d feared he might, and for that, at least, I was grateful.

  He didn’t once ask me if I’d killed Kingsly, or even allude to the possibility. It seemed he’d convicted me so far only of being a total shit as a doctor ... and as a human being. I felt deprived of a chance to hear his suspicions and answer allegations about me as a killer. Perhaps he’d even figured I’d feel that way, and not asking was part of his game to keep me off balance.

  Riley wasn’t any help either in determining how seriously he considered me a suspect. After his reprimand from Bufort, he’d sunk into an unreadable silence on his perch at the front of the room and had given his jaw muscles a good workout.

  One point Bufort congratulated me on. During their search of the hospital, they hadn’t found the room yet where the walls and ceiling had been given an unscheduled cleaning, but a sweeper had reported that when he came on duty Sunday at midnight, he had found a mop wet and recently used in his basement locker. They were checking it for traces of blood and other bodily fluids that had leaked out and squirted out of Kingsly as he died.

  * * * *

  Outside our department window, the afternoon light had dimmed to thin smoke. I was still stinging from the dressing-down I’d received from Bufort hours earlier, but where my own failure to help Kingsly’s alcoholism was inexcusable, it was passive. However, if Bufort’s line of reasoning was right. Hurst may have deliberately counted on Kingsly’s drinking going untreated to maintain his control over the hospital. The prospect of our medical vice president being that ruthless no longer surprised me.

  I found Sean Carrington talking to some residents near our X ray-viewing box. He’d just plopped an odd film of spindly bones on a lighted screen and was eliciting some very puzzled expressions from his audience. I paused to watch, but when he saw me, he grinned and said, “Go away. Earl, this is private. Shoo, shoo!”

  I knew what he was up to.

  Recently I’d heard he’d taken to buying racehorses as a tax write-off and that his latest nag pulled up lame after her first meet. Sean had wanted to shoot her there and then, but the track authorities said he couldn’t do that. He’d have to pay a vet for arthroscopic surgery—$1800 plus boarding fees. Sean had looked up the fee for the same procedure on humans: $1200. Now he was trying to snag an orthopedic surgeon who was unfortunate enough to be passing by.

  “Marty,” he called, “come here and look at this knee for me.”

  Marty squinted at the films for a few seconds and then gave his opinion. “This is not a human knee.”

  “So, can you operate on her?”
/>   “Is this one of your horses?”

  “Yeah, so what? Will you operate on her?”

  “I’m cheaper than the vet, right?” He started turning away.

  “No, no, it’s your skill. I love this animal so much, I wouldn’t trust her life with anyone but you.”

  Marty chuckled. “Who’s going to give the anesthesia, you?”

  A demonic light came into Sean’s eyes. “Anesthetic death! Sure! Who’d know?” He turned to one of the incredulous residents. “You want to earn fifty bucks? Look, give me an hour. You just stand there. We don’t say you’re a vet, but we don’t say you’re not. It’ll be over before you’d be expected to actually do anything. Now, we get a scope from day surgery, just to look good, and I’ll get some pentobarbitol syringes ...”

  The rest was lost to me as he slipped his arm around the shaken resident and led him to a corner where, obviously, he intended to sell him on his plan.

  Funny, I always found his zany performances a breath of relief compared to the pompous demeanor that masked many of our less competent yet more proper practitioners of the healing arts. But today his flash left me empty. He hadn’t been physician enough to help Kingsly either ... and his callousness about the horse disturbed me.

  * * * *

  The sound of Carole’s long fingernails clicking on her keyboard blended with the steady patter of rain on my own office window. Here too, very little light got through the opaque square of glass. Grime or design, I couldn’t tell. The dirt on the outside pane curdled into a greasy sludge.

  When Carole and I were using our desks at the same time, our two tiny adjoining offices were cramped, but that happened so infrequently, we rarely found it a problem. We usually left the door between us open so we could easily speak to each other without getting up.

  Carole had given me my messages when I came in. A number of the doctors had dropped by, wanting a look at the ER study. She’d even walked in on Kradic and Green hovering over my desk, much the way I’d surprised Jones earlier that morning. Obviously, Jones had been telling everyone about it, and until I sorted out those statistics, the whole department was going to be nervous waiting for the results. It was a good thing I’d locked up the printouts.