Riley grinned. “I worked this one out with Madge in staff health.” He took a sip of coffee and settled back in his chair, obviously enjoying the chance to show off his discoveries. “Screening is done a ward at a time, but the exact date of each call-up is at the discretion of several people in that clinic, depending on how busy they are. Once a notice goes out, the nurses have two weeks to get their cultures done, at their convenience and without an appointment, either in staff health or in the labs. Madge thinks Harold Miller faked a message from staff health, notifying the floor where his target worked—ICU, the OR, or in the case of his mother, OB.”
Riley’s use of the abbreviations of our lingo made it hard for me not to smile.
“That started a screening process when it suited him,” Riley continued, “shortly before each of his targets was scheduled to leave on vacation. Since the only thing staff health cared about was that every nurse in a high risk area got a minimum number of cultures per year, they’d never be bothered, maybe not even notice that an extra set had been done.”
“But the nurses he’d targeted wouldn’t necessarily come to him for their cultures,” I said.
“The screening itself gave him an excuse to seek them out a few days later and reculture them. ‘Bad sample,’ he’d say. ‘Got to do it over.’ Then he’d use one of his swabs contaminated with staph.”
Williams joined in. “The timing of the screening was one of the things that tipped off your friend Popovitch. I talked to him briefly on the phone. The other clue was the unordered procedures that required the targeted nurses to get into protective gear, including masks. Like you, he found both those ‘coincidences’ suspicious. Then he started to figure how it could be done, just as you and I did, but it wasn’t until he was being resuscitated, with everyone wearing masks and taking cultures, including from inside his nose, that the exact technique struck him. He sounds like quite a guy. He said that he would have written you a longer note but his residents were impatient to get him fall of tubes.”
“Amazing” was all I could think to say, remembering how near death he’d been at that moment.
“You know,” Williams said, “it astonishes me how well Miller covered his tracks as the Phantom before he resorted to insecticides. I suppose it doesn’t matter now, but I couldn’t turn up anyone who could connect the ipecac to him. Even his targets from psychiatry couldn’t recall if Miller had been around shortly before they’d started hallucinating. We placed him in physio and rehab, though. He was down there a lot around the time of the insecticide poisonings, claiming to need therapy for a sore back. I think I figured out how he did it too. While I was interviewing workers in the department, I observed their routine. They sometimes leave their wet thongs unattended and off to one side while they’re in the whirlpool baths with a patient Miller probably watched his intended victim until he had a chance, then sprayed the target’s footwear with domestic pesticide. It’s as though he became more visible once he became more lethal, but...” The large man shrugged. “Ah, what the hell am I going on for? It’s over, thank God.”
I thought of a final question. “Riley, could Miller have gotten away with making you think Rossit was the killer, presuming you eventually found both our bodies?”
Riley grimaced. “Think about what nearly happened with you and Miller, Doc. Suppose he’d gotten one good whack at your head before you got him. You both could have died in there. Miller probably thought he’d make it look like you’d strangled Rossit while trying to escape from him, but that the head injuries you sustained in the process were too grave for you to get yourself out of the room afterward. To have set it up, all he’d have to have done would be to smash you into a coma, position you near Rossit, then let his organisms work on you. In time, either they or the results of the head injury would finish you off. When we came on the scene, we could very easily figure that Rossit was the Phantom and that he’d caught you snooping in his lair...with a tragic result.”
Williams added, “Even if the police found you before you were dead, you wouldn’t be in any condition to talk.”
We sat in silence for a while, sipping coffee. Whether Miller had that grisly fate in mind for me I’d never know for sure, but it would be the stuff of future nightmares.
Eventually we began chatting about more pleasant things, like going home. We were almost comfortable with each other after what we’d been through together. I’d also noticed how Riley had started calling Williams by his first name. Considering the way they’d been so testy with each other before, I commented on their apparent friendliness now.
Williams smiled. “It turns out we have a common interest in football.”
“Common!” Riley exclaimed excitedly. “Doc, you’re with someone famous. I only recognized him when I finally saw his face without a mask. This is Spider Williams, one of the greatest quarterbacks in the history of Michigan State. What an arm he had! My dad and I used to drive a hundred miles just to see him play.”
“Thanks, sonny,” Williams said.
I joined in the laugh—I figured Riley was ten years junior to Williams and me—then left them to their discussion of old plays and long ago victories.
I had something more current to do.
* * * *
I’d decided to meet with Harold Miller for no better reason than my own peace of mind, an aid to putting the ordeal to bed.
As I approached his brightly lit cubicle midst the dim lighting of ICU, I couldn’t help but think of the time when I saw Phyllis Sanders in an identical setting at St. Paul’s. Pulling on isolation garb at the door to his room, I watched two nurses ministering to him. One of them fiddled with the dressings around his neck and over many portions of his face. In most cases the gauze was soaked through with reddish brown stains. The other nurse adjusted a pad which had been secured over what should have been his right eye; I’d been told by the residents that it had been removed surgically, there being nothing viable after it had been enucleated by glass during our struggle.
The skin around his head and upper trunk that wasn’t covered with dressings was scarlet and puffy, as if he’d been scalded rather than infected. But as soon as I stepped into the room, the smell of the putrefying flesh left no doubt that infection was the underlying process. His coughing was paroxysmal, and rather than use a steel basin which one of his nurses held out to him, he let the resultant sputum roll down his chin. “My head,” he moaned. “My head.” On his arms and legs were more red swollen areas, some of them also covered by gauze, these too saturated through, but with yellow seepage.
Looking at him, I could think only of the state of the organs I’d seen at his mother’s autopsy. It was telling testimony to the destruction that was raging through his own body now. The staph bacteria had obviously been carried from his infected skin into his bloodstream and throughout his body. His lungs would be riddled with cavities of pus, his head pain was probably the result of developing brain abscesses, and further sites of infection were setting up deep within his skin and bone, giving rise to the sores over the rest of him.
As I approached his bed, he was staring off to one side, his remaining eye having the same faraway look I’d seen in the subbasement.
“Harold, it’s Dr. Garnet,” said one of the nurses.
There was no response. He simply lay there. I leaned over him. “Mr. Miller, I was told you wanted to speak to me.”
I wasn’t even sure he could hear. But seconds ago he’d been lucid enough to complain about his head. “Does he respond?” I asked the nurses.
“Sometimes,” the nearer one said, “when he wants to.”
As if to underline her point, he suddenly spoke, but without moving his head or shifting his gaze. “I want to speak to you in private.”
The two nurses quickly finished up what they were doing and left.
He slowly turned to look at me. “I obviously don’t have much time,” he rasped, “and it’s hard to talk. I think there’s an abscess starting in my throat.”
“What did you want, Mr. Miller?” I was determined to keep this short and get out as quickly as possible.
“I heard Williams and Riley talking about what you’re putting yourself through.” He went into another paroxysm of coughing. When it subsided, he said hoarsely, “She wanted to go back to your ER that evening. Dr. Garnet, but I dissuaded her.”
“Pardon?” I said, not sure what he was talking about.
“My mother. She told me over the phone she was going to return to St. Paul’s and tell you personally about her dizziness—she thought you were so nice and that you’d want to know—but I talked her out of it. If it hadn’t been for me, you would have had her at your doorstep a few hours after she’d been discharged, describing her orthostatic drop to you.”
I felt baffled, repulsed, and intrigued at one and the same time. But I made no show of my reactions, merely shrugged, then watched intently as he struggled for a deep breath. To my shame, I wanted to hear more.
“And Mackie, he was slated to die,” Miller said with difficulty. “Part of my plan to make him a scapegoat, whether you thought he was guilty or not. He had to disappear, to make it look like he’d gone into hiding but was continuing to kill. Except I had to get rid of him that night on the spur of the moment...to keep him from exposing me...and I didn’t have time to get his body to a safer hiding place.”
“And Rossit?”
“Well, his opportunism got him to the wrong spot at the wrong time. Of course, if I hadn’t left that door unlocked when I ran for a shovel...Who would have thought of rats?”
I couldn’t listen. It was too morbid. “Look, I don’t know what—”
“I murdered them, not you!” he said abruptly.
“Why are you telling me all this?” I was so bewildered by his declarations that I couldn’t think of anything else to ask.
But he didn’t answer. He simply turned his head, his gaze once more traveling far away.
“Why?” I repeated.
Nothing.
He lay completely motionless, and I saw under the glare of the overhead lights a sheen of perspiration break out over his forehead.
Although it could have been the result of his fever, I suspected it was because Miller was back home, in that basement, with him.
* * * *
I discarded my protective gear, walked to the door of the ICU, and turned to look at him in his cubicle. He slowly brought his stare back around, his one eye burning into me.
Was he out of his mind? Probably. Had he tried to absolve me? Sounded like it. But it also could have been a con, telling me what he thought I wanted to hear. Why? I’d no idea. Except I could think of little else but him as I stood there. Maybe that was the point of his show—to plant a final hook in my thoughts so I’d never be quite free of wondering about him.
I heard the sliding doors glide open behind me, then close.
“I figured you’d go see him.” Riley was at my shoulder. “Did he reveal anything important?”
Important? For the police, not at all. For me, I couldn’t tell yet. Perhaps in time I’d sort out whether his last act toward me was noble or in some way malicious. But I doubted that would lighten the load I’d carry for the deaths of Cam and Rossit. “Not really,” I finally said.
I stood watching Miller in that chamber until he shifted his gaze away from me, once more casting it into the distance. “It does look like he’s in a glass coffin,” I muttered.
“Pardon?”
“It’s what he said when he first saw his mother in isolation at St. Paul’s—that it reminded him of the Snow White story she used to read to him when he was a child.”
Riley said nothing at first. When he did speak, he seemed to be choosing his words very carefully. “Doc, what happened to him as a kid was an atrocity, and in my book those two so-called parents are among the worst kind of lowlifes I deal with. But however it started, he’s a grown man now—and a killer. That means he plays by adult rules, or else other innocents, like Mackie, pay the price.”
My rules as a doctor were so different from Riley’s as a cop. Do no harm; comfort always; treat pain; and whenever possible, cure the illness or injury at hand. Those were the fundamentals of my code. I knew that Miller was beyond the help of any measures from that realm, but it felt like such a failure simply to deliver him into Riley’s domain and its justice.
“Do you know what that isolation room reminds me of?” Riley asked.
I turned in time to see a look of satisfaction pass over his face before he answered.
“An execution chamber.”
Epilogue:
Ten Months Later
Mortality Morbidity Bulletin-
Monday, September 1
Update: Vancomydn-Resistant MRSA
A second outbreak of Staph aureus resistant to both vancomycin and methicillin has been reported in the United States. The infections occurred in a hospital in Philadelphia and have resulted in six deaths so far. While local health authorities are stressing that there is no danger to the community at large, quarantine measures have been instituted for all staff and patients at the afflicted institution. The first known encounter with this untreatable organism occurred in Buffalo, New York, late last year, but under unnatural circumstances— a deranged individual had acquired the bacterium and was using it to deliberately infect personnel at a university teaching hospital. Although the present outbreak is spontaneous, a CDC spokesperson says that the lessons learned during the previous incident are pertinent to the situation in Pennsylvania. As a result the CDC has created a task force reuniting the physicians and officials who were instrumental in containing the problem in Buffalo and have dispatched them to help out. Unfortunately, fallout from the crisis won’t necessarily end once the infections are dealt with by these experts. In Buffalo, even after officials ultimately gave the affected hospital there a clean bill of health, public confidence was so shaken by the prospect of the superbug recurring on its own that the venerable landmark never reopened and most of its staff and programs had to be transferred to a nearby facility. It is feared that the hospital in Pennsylvania may face a similar fate.
The next issue of the MMB will focus on what the natural occurrence of this much-anticipated and much-dreaded superbug means or Americans who must undergo hospitalization in the foreseeable future. Our update will include the transcript of a planned interview with the leaders of the appointed task force—Dr. Douglas Williams of the CDC and Dr. Earl Garnet, chairperson of Emergency Medicine at the newly designated St. Paul’s University Health Center in Buffalo.
Copyright © 1999 by Peter Clement Duffy
Originally published by Fawcett (ISBN 0449004503)
Electronically published in 2010 by Belgrave House
ALL RIGHTS RESERVED
No portion of this book may be reprinted in whole or in part, by printing, faxing, E-mail, copying electronically or by any other means without permission of the publisher. For more information, contact Belgrave House, 190 Belgrave Avenue, San Francisco, CA 94117-4228
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This is a work of fiction. All names in this publication are fictitious and any resemblance to any person living or dead is coincidental.
Death Rounds Page 42