by Lucy Kerr
Also available by Lucy Kerr
Time of Death
No One Can Know
A Stillwater General Mystery
Lucy Kerr
NEW YORK
This is a work of fiction. All of the names, characters, organizations, places, and events portrayed in this novel are either products of the author’s imagination or used fictitiously. Any resemblance to real or actual events, locales, or persons, living or dead, is entirely coincidental.
Copyright © 2018 by Lucy Kerr
All rights reserved.
Published in the United States by Crooked Lane Books, an imprint of The Quick Brown Fox & Company LLC.
Crooked Lane Books and its logo are trademarks of The Quick Brown Fox & Company LLC.
Library of Congress Catalog-in-Publication data available upon request.
ISBN (hardcover): 978-1-68331-462-2
ISBN (ePub): 978-1-68331-463-9
ISBN (ePDF): 978-1-68331-464-6
Cover design by Melanie Sun
www.crookedlanebooks.com
Crooked Lane Books
34 West 27th St., 10th Floor
New York, NY 10001
First Edition: February 2018
To Danny,
who makes everything better and brighter, even on the darkest days.
And to my kids,
who make me the proudest mama bear around.
Contents
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Eleven
Twelve
Thirteen
Fourteen
Fifteen
Sixteen
Seventeen
Eighteen
Nineteen
Twenty
Twenty-One
Twenty-Two
Twenty-Three
Twenty-Four
Twenty-Five
Twenty-Six
Twenty-Seven
Twenty-Eight
Twenty-Nine
Thirty
Thirty-One
Acknowledgments
One
Tuesday nights in an emergency room are notoriously slow. I don’t know what strange combination of atmosphere, astrology, and human nature results in Tuesday graveyard shifts as quiet as their namesake, but it’s held true in every ER I’ve ever worked. Almost nothing happens on a Tuesday night.
Almost.
But when it does, it’s hard to miss.
Part of the reason an ER can swing into action so quickly is because when we’re not saving someone’s life, we’re preparing to. We’re double-checking inventory and restocking supplies, making sure that the moment the ambulance calls with an ETA and patient description, we’re ready to work.
Which is how I had ended up this Tuesday night checking the cabinets in the trauma bays, counting gauze pads and suture kits and iodine wipes. At my old hospital in Chicago, this would’ve been a lengthy process—six trauma bays in near-constant use tended to go through a lot of gauze. Here at Stillwater General, five hours from Chicago on the banks of the Illinois River, it was fifteen minutes’ work. I was more likely to find a layer of dust than an empty cabinet.
Tuesdays, I tell you.
Inventory complete, I headed back to the nurses’ station, ears straining to pick up anything unusual. Aside from the seallike barks of the croupy toddler in Exam Two, all I could hear was the storm raging outside our doors. The howling winds and relentless sheets of rain were keeping all but the most critical cases home, at least until the weather cleared.
“I’ve had more fun watching Jell-O set.” I threw myself into one of the chairs behind the nurses’ station. Then I grinned. “Bet you we’ll be swamped ten minutes after the rain stops.”
“More like five,” said Esme Vargas, our deceptively sweet-looking charge nurse. “And that’s a sucker’s bet.”
Esme was no sucker. With her dimpled cheeks and enormous brown eyes, she’d initially reminded me of some sort of woodland creature—friendly, soft, and liable to be eaten by a predator. After our first shift together, I’d realized just how deceiving appearances could be. Esme had expertly handled a gruesome compound fracture, a stroke, and an overdose, all within minutes of each other and without losing her composure. She was efficient but not cold, cheerful but not a pushover, and those doe-like eyes missed absolutely nothing. We make a good team, she’d told me that night, and I’d agreed. If I’d been planning to stay in Stillwater permanently, she might have made a good friend too.
But my visit here was temporary; in a few months, I’d be back at Chicago Memorial, where a slow shift meant enough time to wolf down a protein bar for dinner while I entered a chart. On a night like this one, the spacious, tidy Stillwater ER made Chicago Memorial feel light-years away, not miles.
Esme finished her charting and swiveled to face me. “You miss it, don’t you? Your old hospital?”
“Only when we’re slow.” Even then, I wasn’t sure if I missed my old life or the adrenaline that had accompanied it. “I’m not great at sitting still.”
“Be careful what you wish for, Frankie,” she said dryly. “The storm will blow through soon enough, and once it does, we won’t sit down until—”
She broke off at the sound of raised voices. Actually, only one raised voice, countered by the clear, patient reply of the admitting clerk.
The man’s shouts managed to sound both agonized and petulant, a sign that didn’t bode well for whoever took the case.
Esme and I exchanged glances.
“Better than Jell-O,” she reminded me, the corners of her mouth twitching.
I heaved a sigh and pushed up off the counter. “Exam Three,” I called to Alejandro, our unit clerk, and went out to greet my patient.
The man stood near the admitting desk, dripping a pinkish mixture of blood and rain on the freshly mopped linoleum. His nose was clearly broken, which accounted for the whine, and he clutched one shoulder with his opposite hand, the swelling evident even beneath his drenched and ratty-looking flannel shirt. “Lemme see a doctor,” he demanded. “That sign says you gotta treat me, so hurry up and do it.”
“We will,” said Eileen, the admitting clerk. Solid and implacable as a mountain, with her cat’s-eye glasses and helmet of iron-gray curls, Eileen was not cowed by mere mortals, whether they were patients or doctors. “Once we get your information, Nurse Stapleton will take you in back and get started.”
The man’s gaze flicked toward me, then back at Eileen. I folded my arms and waited, as if I had all the time in the world—which I did, at the moment. If this guy had come in by ambulance, the entire ER staff would have leaped into action. But anyone who could walk in, stand at the counter, and find the energy to yell at Eileen probably wasn’t in immediate danger of dying.
“Sir, your name would be an excellent start,” Eileen prompted.
He cursed, complained, and looked around the waiting room as if someone might provide it for him. Eileen merely blinked and kept her hands, with their shocking-pink manicure, on the keyboard.
“John,” he said eventually, grimacing. “Mueller.”
Eileen’s smile became a little more fixed, but she coaxed him through the rest of the intake process and then gave me a nod, indicating he was clear to take back into the exam rooms.
“Do you need a wheelchair, Mr. Mueller?” I asked.
He ignored me, muttering under his breath and checking his phone.
“Mr. Mueller?” His head snapped up, and I gestured to the wheelchair. “Would you like to get in?”
“Nah.” He followed me through the security doors, his movements stiff and o
bviously painful. When we reached the exam room, he sank onto the bed with a groan.
“You look pretty banged up,” I said, fastening a plastic hospital bracelet around his trembling wrist. Besides the shoulder and the nose, a gash on his temple was still oozing blood, the laceration continuing beneath his unkempt, rain-soaked hair. “Can you tell me what happened?”
He swallowed, fidgeting so that the paper beneath him crinkled. “Hit a deer. Out in the country.”
“I see.” I began taking his vitals, charting his information and getting a health history. All the standard questions, but his answers ranged from sullen to evasive. John Mueller was twenty-three, with a scraggly brown beard more unkempt than fashionable. He had yet to lose his baby fat, and his jean-clad leg jounced and jittered throughout the interview.
Patients lie for all sorts of reasons. They tell me they don’t drink when their breath says their liver is probably pickled. They shave years off their age and pounds off their weight. They “accidentally” fall down the stairs or “forget” how many pills they’ve taken. Shame, vanity, fear, pride, malice—the reasons are as varied as the lies. Over time, you learn to gauge which lies are harmless and which are dangerous, when to call a patient on it and when to let it slide.
You hone your instincts, the same way a rock climber hones their center of gravity, or you don’t last long.
John Mueller, if that was really his name, was a liar. I could practically smell it on him, sour and hot like an infection. He been lying from the moment he’d stepped up to the desk. As far as I could tell, the only things he hadn’t lied about were the accident—the pattern of bruising across his torso confirmed injuries from a seat belt—and his pain, which had to be considerable.
I finished the initial exam and ducked outside. Esme and Alejandro, arguing about Internet dating etiquette, broke off when they saw me.
“Three’s got a dislocated shoulder,” I said. “Can you let Costello know—”
“Let me know what?”
I turned. Paul Costello, the doctor who’d once proclaimed his hands God’s gift to emergency medicine, stood a few feet away, scribbling on a clipboard.
“Patient in Three claims he was in a single-car MVA; no loss of consciousness or signs of concussion. Three-inch laceration on the left temple, a broken nose, and an anterior dislocation of the left shoulder.”
“Claims?” Costello’s eyebrows lifted.
“The injuries are consistent, but the rest of his story …” I shrugged. “Something’s off about him.”
“Off how?” demanded Costello. When I didn’t answer, he rolled his eyes. “Another one of your gut feelings, Stapleton? Spare us the wisdom of your large intestine.”
I didn’t point out that my gut feeling had caught a murderer in this hospital a few weeks ago. Costello wasn’t exactly my biggest fan. The first time we met, I’d just treated an ER patient despite the fact that I wasn’t actually employed here, then publicly questioned Costello’s diagnosis. When the patient was found dead, we’d each blamed the other, but it had turned out to be murder, not medical error. Whatever truce we’d called when I caught the killer had evaporated a day later, when the hospital president had hired me without Costello’s input.
Rumor had it that the language he’d used upon hearing the news had made a seasoned paramedic blush.
Tonight was our first night working together since the announcement, and he’d alternated between ignoring me and criticizing my every move. Now he shoved the clipboard at Esme and beckoned to me. “If it’s all the same to you, Stapleton, I’ll stick with practicing real medicine, not voodoo. Grab fifteen hundred mil of methocarbamol and meet me in there.”
He strode off toward Exam Three without another glance. Costello wasn’t a big man—a head taller than me, with the compact build of a wrestler—but he never slowed down.
He never let up either.
Costello was accustomed to nurses obeying his every command; I was accustomed to doctors who respected my opinion. Our rocky start didn’t look to be growing smoother any time soon.
When I opened the door to Exam Three, Costello’s exam was already under way, judging from the way Mueller was yowling in pain and pleading for meds.
“You have a dislocated shoulder,” Costello said as I handed Mueller the pills and a cup of water. “We need to get an X-ray, then reset your arm bone within the socket of your shoulder, and the sooner the better. How long ago was the accident?”
“I dunno.” He yelped as Costello pressed lightly against his shoulder blade. “Half an hour or so. Why do you care?”
“Because,” Costello said, “after about an hour, this gets much worse for you.”
“Can’t you pop it back in? They do it on TV all the time.”
Costello waved a hand, the gesture encompassing the room. “Do you see a camera crew? This is a hospital, not a sound stage.”
“I don’t want an X-ray,” Mueller said, chin jutting out. “Just fix my damn shoulder.”
“If you’ve broken a bone,” I said, ignoring Costello’s glare, “performing the reduction could make your shoulder worse. It could tear up your muscles or cause permanent nerve damage. Taking an X-ray will make sure we’re not doing more harm than good.”
His fingers twitched. No doubt the hand was already numb as bones pressed on nerves they weren’t meant to.
“Just shove it back in and give me another pill,” Mueller demanded through clenched and crooked teeth. He began to rock back and forth, agitation increasing. “I don’t have time for this.”
“And I don’t do my job halfway.” Costello turned to me. “X-ray for the shoulder, MRI for internal bleeding and concussion. We’ll do the reduction as soon as he’s out.”
“Do it now,” Mueller snarled. “I don’t need the other crap.”
Patients have every right to refuse treatment, and plenty do. But that doesn’t mean we have to like it.
Costello clearly didn’t, which was no surprise. Bad enough when a nurse questioned one of his orders—to have a patient do so was beyond insulting. But while arrogance was first among Costello’s many flaws, indecision was not. He studied Mueller, brows drawn together in annoyance, square-tipped fingers tapping lightly on his watch. Three taps—one, two, three—and he’d made up his mind.
“Mr. Mueller, this note states we recommended an X-ray, and against my advice you are insisting on a closed reduction despite the risks we’ve outlined.” Costello charted the note himself, signing off on it and shaking his head in disgust.
“Ready?” he asked as we got into position: me holding Mueller by the wrist, his left arm extended while my other hand braced against the front of his shoulder. Costello stood at his back, ready to manipulate the bones back into place.
“Stay still,” he barked. Mueller was still agitated, leg jouncing, eyes darting around the room, body tensed for flight despite the muscle relaxant working its way through his system. Costello warned, “This is probably going to hurt.”
He was right.
The good news was that an instant after Mueller’s humerus bone had clunked back into place, the pain eased. Mueller took a long, ragged breath while Costello stripped off his gloves and left, saying, “Clean him up; set the nose. Get an ice pack for the shoulder. I’ll come back later for the sutures.”
I eased Mueller back onto the bed and went in search of an ice pack.
“I’m telling you, there’s something really off about that guy,” I said to Esme. We kept a freezer full of reusable cold packs beneath the counter at the nurses’ station, and I tugged the door open.
“I think Costello agrees,” she said, tipping her head toward the staff lounge. “You want someone to back you up in there? I can get one of the orderlies.”
“He’s not threatening me,” I said. “He’s just …”
“… off,” Esme finished. She understood. Every once in a while, a patient gives off a bad vibe. It’s never specific, just a feeling: a shark below the waterline, a watcher in
the shadows, a monster under the bed. An instinct too nebulous to act on, too insistent to ignore. No matter how dismissive Costello might be, every nurse I’ve worked with knew that feeling. None had ever ignored it twice. Esme frowned. “What do you want to do?”
It wasn’t the lying or the agitation. Those were common. Obvious. Those were the signs even Costello noticed. I stared at the shelf full of cold packs, letting my gaze go soft and unfocused, my thoughts following suit. Whatever was bothering me about John Mueller would disappear if I looked too hard, so I tried not to look at all.
He’d been honest about his accident and his pain—the only two things he couldn’t conceal. He’d barely had enough time for the meds to kick in before we’d maneuvered his arm back into place.
There. A flash of understanding like a small silvery fish in the murky waters of my brain.
Who demands drugs and then doesn’t wait for them to work? Someone desperate. And in my experience, desperate people were either dangerous or in danger—or both.
“Let’s call—”
Let’s call security, I was about to say, but the radio squawked and crackled to life before I could finish.
“Stillwater Gen, this is Riverside Ambulance number seven five two. We are en route to your facility with a female, approximately midthirties, visible late-term pregnancy. She’s the restrained driver of a vehicle involved in an MVA, unknown speed, unknown cause. Significant driver’s side damage, intrusion into driver’s side compartment. Patient has visible head injury and cannot maintain consciousness …”
I didn’t wait to hear more. “Trauma One,” Esme called, writing down more information while I sprinted toward the room. Behind me, I could hear Alejandro, the unit clerk, calling in the trauma team and paging to various departments. Motor vehicle accidents, or MVAs, could range from a simple fender bender to major crashes, and with a pregnant victim, we’d need all hands on deck.
I took a quick detour, poking my head into the staff lounge. “We’ve got another MVA incoming. Single victim, late-term pregnancy, Trauma One.”
Costello, alerted by the pages sounding overhead, was already on his feet. He followed me out, peppering me with questions.
“Trauma team is on its way in,” I said as we entered. Trauma rooms aren’t like the usual ER exam cubes. They’re designed to have every piece of equipment you might need within arm’s reach, from tongue depressors to tracheotomy kits, and they’ve got plenty of space, because traumas tend to be crowded affairs. “The storm’s going to slow them down.”