Death Rounds

by Peter Clement

  Our problem solving often proceeded this way, an idea at a time, layer by layer, back and forth. But usually the topic was interpreting a work of art, where to go on vacation, or how to redecorate the house. Yet it seemed as good a method as any to help unlock whatever might help us get a grasp on our killer who no one else even suspected existed.

  And unlock something it did. Another inconsistency, a big one that Stewart had noticed, flew into focus. I sat up and snapped my fingers. “Janet, you’re a genius. If Rossit needed another trick, something more to assure his advantage over Cam, why did he keep ridiculing my diagnosis of the Sanders’s case?”

  “What do you mean?”

  “Look. One of Cam’s most important responsibilities as chief of ID is the control of hospital-acquired infections. He’d already been unable to explain two cases of Legionella involving nurses from UH. What better way for Rossit to undermine Cam’s credibility than to discover a third? By doing so, Rossit could imply that University Hospital had a recurrent problem with the deadly organism and that Cam couldn’t solve it. A scare about uncontained Legionella, if it became public, would frighten away patients, shatter public confidence in UH, and be a disaster for the hospital’s contracts with HMOs. With the potential for such a catastrophe tied to Cam’s reputation, the board might hand the chair to Rossit instead.”

  I stopped for breath and took a big gulp of the Black Russian. Janet frowned, whether at what I was saying or at my wolfing down forty-proof alcohol, I was too caught up by what I was thinking to pause and ask. “So why wasn’t Rossit shouting the possibility of Legionella from the rooftops since day one,” I continued in a rush, “or at least since first thing this morning in the light of our autopsy findings? The case should have been like a gift to him, the ‘extra trick’ you said he needed to ‘win the day’ over Cam. Instead of ridiculing me for suggesting Legionella, he should have been encouraging me to confirm the diagnosis.” I caught my breath. “But it was almost as if he’d wanted to suppress any mention of the organism. Why would that be?”

  Janet grimaced, then shook her head. “I’ve no idea,” she said quietly.

  We sat for a while without speaking, Janet frowning at the rising bubbles in her drink, me slumped back in my chair and letting my eyes roam around the cozy dining room. We ate here with the lights low and candles lit whenever we managed to be home for dinner at the same time, to claim at least a little tranquility despite our insane schedules. The little flames from the candelabra bathed the room in a soft glow that was particularly calming. While they flickered and reflected off the rich mahogany surface of our table and the surrounding furniture, I found myself looking at a chess set we kept on a nearby buffet for the occasional after-dinner game. The candlelight projected shadows of the chess pieces against the wall and made them move and sway as in a dance. The effect was eerie, as though some tactical strategy that defied my understanding were being played out while I watched.

  Just as when I played Janet, I thought idly. She always beat me. Her moves inevitably caught me by surprise and seemed to anticipate anything I could throw at her. Like the Phantom, she too was a master of defense.

  I continued to watch the shadows of the chess pieces on the wall, letting my thoughts move with them, this way and that.

  The Phantom’s only slipup so far was that he hadn’t counted on someone like Janet making the connection between the three nurses.

  The turrets of a castle appeared and receded, followed by the shape of a horse’s head, followed by the flicker of an afterthought.

  Perhaps he had after all.

  If he was such a master tactician, surely he’d have taken into account that someone might see what Janet saw, link the three nurses together, and become suspicious about what was happening. Wouldn’t he then have been circumspect enough to try and prevent that from happening?

  “Janet,” I said, startling her, “if you hadn’t known Sanders had Legionella but thought she simply had a staph infection, would you have made the connection between her and the other two nurses?”

  She thought a minute. “I don’t know. Maybe, maybe not. It certainly wouldn’t have leaped at me the way it did when you mentioned Legionella. Why?”

  “Because maybe I missed something. I haven’t given much thought to where Phyllis Sanders might have contracted staph on top of the Legionella,” I continued. “I simply assumed she must have already been carrying the organism like a lot of hospital workers unknowingly do, harboring it under their nails and up their noses. I knew the bacteria wouldn’t have penetrated into her lung and taken hold if the Legionella hadn’t first created breaks in the protective surface of her bronchi, but I never once thought that the staph infection had been anything but a fluke. Now I’m not so sure. What if he’s also found a way to infect his victims with staphylococcus?”

  “What! Why would he want to do that?”

  “To vary the infection. Such a strategist would have been wary that a third case of Legionella could tip his hand and lead to someone figuring out the connection between his victims, exactly the way it did with you. He still had to use the Legionella to set up the staph infection, but once the staph became an overwhelming pneumonia and all that pus became apparent, it was reasonable to expect no one would think of Legionella.”

  Janet stared at me, as if daring me to go the next step.

  I took the dare. “Obviously, however, the killer would be vigorously opposed to anyone who did think of it.”

  Janet became very still. “You’re not serious?”

  “The killer would behave toward me exactly as Rossit has from the beginning—doing everything in his power to suppress a diagnosis of Legionella in Sanders.”

  She looked astonished at what I was saying. “My God!”

  “His ‘hidden trick’ might have been to infect personnel at UH, knowing full well how it would reflect on Cam. But two things went wrong. She came to St. Paul’s, instead of going to her own ER, and I found the Legionella.”

  After days of snapping at mists and shadows, I felt I’d finally clamped down on real flesh and bone. I sat perfectly still, astonished that I’d actually come up with my prey, horrified by what I thought I’d uncovered.

  “There’s one problem,” Janet said in a cool quiet tone that was scalpel sharp. She immediately seized all my attention. Over the years I’d learned it was the voice she reserved for disagreeing with a colleague’s opinion when her own diagnosis was bad news—an unexpected cancer, a fetal deformity, or an unpleasant secret that her sharp intellect had discerned.

  I braced myself.

  “How do you explain his selecting only people who punished patients?” she asked.

  I couldn’t.

  Chapter 10

  That Friday morning I was driving into St. Paul’s an hour later than usual. It was stop and go on the so-called freeway, and as far as I could see, row on row of taillights, three abreast, blinked the on-and-off rhythm of our progress toward the stumpy skyline of downtown Buffalo. A few shafts of sunlight penetrated the otherwise leaden sky and roved over the city like silver beams searching out first one building, then another. I didn’t mind the slow pace much, because I had a lot to think about.

  Janet and I had talked long into the night about Rossit. “You’re simply pinning motives onto the parts of his behavior you can’t explain,” Janet had declared. “Apart from giving me nightmares, it does nothing.”

  “But that’s exactly how you started with the three nurses,” I’d protested.

  “Earl, don’t take this personally, but you’re just not as good at intuitively seeing things as I am,” had been her reply.

  I’d nearly slipped an ice cube down the back of her dress. Then I’d come up with another possibility, equally dark and troubling.

  “What if Rossit has resurrected the Phantom, taught him whatever is the lethal ID technique that’s being used here, then put him to work seeding infections at University Hospital? That way the motive would be Rossit’s, but the ki
llings would still have the hallmark of the Phantom, selecting victims who were punishers.”

  “Still a problem,” Janet had promptly replied in that same cutting tone. “Why would Rossit have his Phantom infect Stewart Deloram? And from what you described, Rossit seems as shocked as you are about that infection.”

  She had me stumped again. “Maybe the monster he’s created is out of control,” I’d mumbled.

  At that point she’d declared, “You’ve been watching too many horror movies,” and had ordered us to bed.

  Before obeying I’d called ICU to check on Stewart.

  “He’s coughing more and experiencing some increased difficulty breathing. But his pressure’s holding,” his nurse said.

  “If he’s awake, say hello from me.”

  Then we’d overslept until 7:00—a rare event, only possible because neither of us had gotten called...by Brendan or our hospitals.

  I crawled through an interchange where I turned onto the Kensington Expressway, but the switch in routes didn’t let me drive any faster. I spent five minutes passing a golf course, then another five contemplating an adjacent cemetery. I wondered if it were some kind of weird retirement package. I halfheartedly listened to the radio and continued to brood over my thoughts from last night.

  There was no denying Janet’s observations. Just as I’d learned to trust her insights, I’ d grown to respect those same instincts when she declared something didn’t make sense. But I couldn’t ignore my own intuition either, whatever Janet thought of it. Maybe parts of my ideas about Rossit were right, I thought. Maybe I had only some of the motives wrong, or the motives right and some of the players wrong. In the light of day I had to admit that the idea of Rossit recruiting a murderous Phantom to advance his career was a bit much. Surely there’d have to be a hell of a lot more at stake for someone to be that crazy, even Rossit.

  After I finally reached the exit ramp, I inched toward the hospital through congested streets and listened to the news, the weather, the sports scores—it took one block for each—and then a business report. Some spokesperson for the Buffalo Chamber of Commerce prattled away for five minutes about the booming economy, low unemployment, and billions in investment that the business community hoped to attract to the city in the coming years. Except nobody can get to where they work, I muttered, leaning impatiently on my horn after a delivery truck blocked my way. A cacophony of other horns joined in. I winced at the noise and thought that maybe the bunch of business leaders at the meeting yesterday could do something about traffic.

  I recalled the sight of them all sitting there behind Hurst and smiled at how I’d thwarted him and Baker, the hospital lawyer. Except the forces behind the merger were nothing to smile at. There had been a lot of power on that stage and a lot of money. It was the kind of board hospitals liked to have these days—made up mainly of CEOs, best suited for the business of medicine, and loyal to the chain of command. This usually meant they saw the hospital CEO as one of their own and would back him to the hilt.

  “Hurst’s kind of people,” I said aloud, breaking the monotony of the traffic noise, and wondered if our little revolt yesterday would really accomplish anything. Again I thought of Hurst huddled with Rossit, and Rossit’s angry warning. Fuck up this merger, and you’ll make yourself a lot of powerful enemies. I don’t know why he was so worded about my little speech having any lasting effect. Seemed to me he should have also given the same advice to the other six hundred doctors in the room.

  Unless it was exposing the Phantom that threatened the amalgamation or at least Rossit’s own interests in it, or Hurst’s, or others like Hurst. If I were going to consider other motives, the merger itself represented a huge opportunity for power and money. The resulting complex would have an operating budget of half a billion a year. That was a lot of influence and a lot of motivation for a whole new group of players. Hurst and his cronies would be wanting to come out of the amalgamation process with the upper hand and as much control as possible over the new venture. It was a pretty heady prize, but was it dazzling enough someone would commit murder for it? I found myself revising who might have recruited whom and set off on an even more macabre chain of thought. What if it were Hurst, or Hurst and members of the board, who had recruited the Phantom to help destabilize University Hospital, to give St. Paul’s a huge advantage in the amalgamation? Rossit might have been persuaded, in exchange for the promise of the chair, to develop and then teach the Phantom the infection technique. Later, when things went wrong, he would have been ordered to prevent Janet and me from exposing the Phantom at all costs.

  Loud honking behind me made me realize I was still stopped after the light had turned green. I hit the accelerator, sped across the intersection, then immediately was back in my stop-and-go routine, not unlike the way I was thinking over my latest bizarre scenario. While there was enough power and money at stake to make a motive for murder seem feasible and the ghoulish scheme was consistent with Hurst’s and Rossit’s recent behavior to discredit me, it still failed to explain why Stewart Deloram had been infected. Besides, I figured Janet would be about as enthralled with a conspiracy theory as she had been with the monster-out-of-control idea. “Now it’s too much X-Files,” I could imagine her saying.

  I quickly snapped back to reality at a few minutes before 8:00 when a bulletin cut into the regular chatter on the radio. “The administration of St. Paul’s has just announced a temporary closure of its emergency department due to some unscheduled maintenance problems. Ambulances are currently being rerouted, and the public is advised to use ER facilities in other hospitals until the situation is rectified. And now back to the weather. More rain will be...”

  “What the hell?” I muttered, reaching for my car phone. It rang before I could start punching in the number of ER. “Garnet here,” I answered briskly.

  “Have you been told what’s up?” It was Susanne.

  “Not a goddamned thing! What the hell’s going on?”

  “We don’t know. The radio announced we were closed about the same moment Hurst’s office called looking for you a few seconds ago. His secretary said to get you pronto!” As Susanne spoke, I could hear the PA in the background asking a string of names, all of them chiefs, to report immediately to the boardroom. “What do they mean, ‘unscheduled maintenance’?” she demanded, obviously upset. “There’s nothing broken here.”

  “I’ve no idea. I’ll call Hurst’s office right now. I should be arriving in five minutes, traffic permitting.”

  I one-handed the steering wheel, kept an eye on the road, and managed to dial a bakery before I finally got the number right for Hurst’s private line.

  Busy!

  The light at Main and High Streets was unusually long. I kept pressing my redial button, my frustration rising as each repeated attempt ended with that same annoying buzz. The light changed, and once again I shot across an intersection only to get ensnared in yet another tangle of cars halfway up the next block. Stone and brick office buildings loomed over me on each side of the street, adding to my sense of being blocked in. Exasperated, I called back to ER. The clerk passed me to Susanne immediately.

  “I can’t get through to Hurst. Do you know what’s up yet?”

  “No, but somebody’s really spooked,” she reported, sounding shaken. The change in her voice from minutes earlier was alarming. “All the patients in the department are suddenly being moved to an empty ward that was closed down during last year’s budget cuts. And get this. We’ve all been ordered not to leave ER, while every orderly transferring patients is wearing gloves and a mask. Somebody better tell us damn quick...”

  As her words continued to come in a rush the radio suddenly caught my attention again. “...My, the gremlins are certainly plaguing Buffalo’s hospitals this morning. We have news of another closure. This time University Hospital is advising all its obstetrical patients that the delivery rooms and attendant wards are going to be out of service until at least this afternoon. Any of their patie
nts who go into labor during...”

  “Susanne, I’ve got to hang up. I’ll be there in minutes.” I cut her off, not even having heard her last few words. I did some more one-eyed, one-armed driving while punching in the number of Janet’s case room.

  “Just a minute, Dr. Garnet,” answered a clerk who sounded as rattled as Susanne. In seconds Janet was on the line. “I’ve no idea what’s up. Patients and babies are being taken to another wing in the hospital, the orderlies and nurses accompanying them are wearing gloves and masks, and it’s scaring the shit out of everyone.” She sounded furious.

  “No one’s told you anything?”

  “Nada! We’re waiting for Cam now. Waiting, hell! We’ve been ordered to stay here until he comes.”

  My car was finally nosing into the entrance of St. Paul’s. “Did you hear they’ve done the same thing with my ER?” I asked while cutting off a red four-by-four with tires as big as my car and slipping into one of the few remaining parking spaces ahead of it. The driver honked angrily and roared off to another part of the lot.

  “Oh my God. You don’t think—”

  “I don’t know, Janet.” I cut her off. “I’ve got to run. I’ll call you as soon as I learn what’s happening here.”

  My mounting sense of alarm made me fumble my car keys and drop my briefcase while I hurriedly locked up. The elements— Janet’s case room, my ER, and people in both places running around in gloves and masks—had only one thing in common, Phyllis Sanders. Thoughts of more Legionnella victims swept through me like a chill as I ran for the entrance to emergency. On the other side of the lot I could see the huge red RV still circling, presumably trying to find a spot.

  Everyone in the department immediately surrounded me.