First Do No Harm

by L Jan Eira

  “While the cops do their thing, I will do my parallel investigation from the medical and hospital point of view. I know I can add to the search for the truth. I want you to help me.”

  “Okay, sure. What about motive? That’s what I can’t figure out,” said Claire after a short moment of silence.

  “Another million dollar question.”

  “What about the patient I was telling you about last night? Did you tell the cops?” inquired Claire.

  “No. Get me more information. Did you find out the name?”

  “No, not yet. I want to get permission from my patient. I need to be ethical. I already divulged too much to you. Give me a bit more time.”

  “A few days ago, Heather and Julie came up to me in CCU after a code and told me they thought there was a cardiac arrest epidemic at Memorial. I sort of blew them off. Next thing you know, Heather is shot.” Tears appeared in Jack’s lower eyelids. He paused. More tears appeared when he continued, “John, too, tried to talk to me about something that was bothering him at work. I didn’t pay much attention at the time and then—”

  “Jack, you don’t think it’s your fault, do you?” interjected Claire, dabbing Jack’s eyes with a tissue.

  “No, I don’t think it was my fault,” lied Jack. “But what if I had paid more attention to them? What if I looked at the patient records with cardiac arrests and found something obvious? Some connection to this madness! What if—”

  Claire clutched Jack’s hands and held them tightly. “Jack, don’t ‘What if—’ yourself, this is not on you,” Claire paused, looking into Jack’s eyes.

  “I know. I know. My resolve to help solve this is strong, Claire. Maybe, I should have done more before, but I will give it all I got now,” Jack said. Claire gave a faint accepting smile.

  In better spirits, Jack stood up straight. “Heather and Julie were going to pull out the medical records for the cardiac arrests at Memorial over the last year, so I can see if there was anything unusual. I’ll see if Julie has them.”

  With renewed interest, Jack gave a fake smile and walked to the small decorative table in the kitchen on which his cell phone rested. He removed the mobile device from its charging perch and prepared to dial the CCU at Newton Memorial Hospital.

  As Jack waited for the call to go through, Claire said softly: “Be gentle with her. Just like you, Julie has lost her best friend in a terrible tragedy. She may not be ready to deal with this yet.”

  “I know Julie pretty well. Believe you me she is ready to kick some ass. And so am I.”

  *****

  Eleven days ago

  September 20

  6:07 AM

  “Evansville departure, niner-eight-gulf-kilo with you, three thousand going to four thousand,” said Jack into the microphone in front of his lips. The headset was securely and comfortably positioned around his head and covered both ears, facilitating radio communications. Moments earlier, the Evansville Tower air traffic controller had commanded instructions for Jack to switch frequencies to the departure controller. Jack had done this routine numerous times before during his many flights. Like all others, the take-off had been precise. As expected, the departure controller’s voice returned an acknowledgement.

  “Gulf-kilo, radar contact; climb to nine thousand feet direct to Indianapolis.”

  “Nine thousand, direct to Indianapolis,” repeated Jack cryptically, as mandated by FAA regulations and protocol.

  Even as he spoke, Jack directed the Bonanza to fly a direct route to his destination. His GPS had been programmed before departure to allow this maneuver at this time with only minimal effort and little more input. In no time, the aircraft was climbing and on the proper course. The purpose of this trip was twofold. Most importantly, Jack wanted to clear his mind and think. The calming properties of flight were therapeutic for Jack, which was what the doctor ordered. For this effect to be maximal, Jack engaged the autopilot, which would reduce his need to concentrate on flying. The second reason for the trip was to visit the medical school library to continue his research endeavors for a drug that could have caused the effects observed on the man turned delusional killer.

  Almost reaching an altitude of nine thousand feet, the autopilot signaled and automatically made the appropriate changes in the trim settings to allow for leveled flight. Jack merely supervised in his continuing contemplative state.

  Where did the gun come from? Who could gain from these catastrophes? What could Rupert’s involvement be? These questions tumbled inside Jack’s brain.

  “We will find the son of a bitch responsible for all this,” resolved Jack in deep thought.

  Time flew by and before Jack knew it, the airplane approached its destination airport, now seven miles from touch down.

  “Bonanza niner-eight-gulf-kilo, descend to three thousand and join the localizer; cleared for the ILS-2-3-right approach.” The approach controller spoke in a matter of fact manner, conveying a sense of calmness and professionalism. Jack repeated the instructions acknowledging them.

  A long moment later, now with the runway in sight, Jack received further instructions.

  “Niner-eight-gulf-kilo contact Indianapolis Tower at 120.9.”

  “Tower, 120.9 for niner-eight-gulf-kilo.” Jack changed frequencies and spoke again. “Tower, niner-eight-gulf-kilo, ILS-2-3-right.”

  “Niner-eight-gulf-kilo cleared to land 2-3-right, wind 190 at five knots.”

  “Clear to land, 2-3-right, niner-eight-gulf-kilo.”

  The landing on the runway lined up at 230 degrees was impeccable and soon the plane was parked at the ramp in front of the Indianapolis Signature FBO, the local business that provided services for general aviators. They would be requested to fuel the airplane and keep it safe until Jack’s return later in the day. Jack had called ahead and requested a rental car, which was ready to go. Very familiar with the city from his days as a medical student, Jack drove to the medical school library. He detoured briefly from his journey to stop at Starbucks for a grande, dry, one-extra-shot cappuccino. Caffeine ammunition was a necessary ingredient for this mission.

  The library was almost a home away from home. Having been in school before the Internet explosion, Jack had spent a lot of time at the library. He was familiar with the place and it was like coming home to Mama. He placed his coffee cup on an out of sight table in the back of the cavernous room and went about procuring books. The search itself took almost two hours. Several books of different size, age and repair were strewn on the table. Jack’s hunt for information was long and lasted way past lunch. It had also been fruitless and unrewarding. Beginning to be aware of hunger pains, he stopped to take a sip of coffee. This was the third time in the last hour he tried to drink out of an empty cup.

  “It can’t be a drug. There is no known drug that could do all this to a man, without other manifestations. This has to be the wrong angle. Unless it is an unknown experimental agent; maybe one Rupert is—”

  Jack’s thoughts were brusquely interrupted by an earsplitting familiar ring tone from the cellular phone on the table. The loud sound jerked Jack into the here-and-now. The caller ID indicated the caller was from Newton Memorial Hospital. He put the Bluetooth receiver in his ear and answered.

  “Hello.”

  “Dr. Norris, it’s Julie. I have all the charts for you.”

  “How could you have had time to—”

  “I stayed up all night,” interrupted the nurse. “I put the charts on your desk. Somebody killed my best friend and I will do what it takes to see justice served.” Jack could tell in her voice she was determined, but emotionally devastated.

  “Thank you, Julie. I will look at the charts and see if that takes us anywhere. Hang in there, okay? We’ll get to the bottom of this.”

  “Please let me know if I can be of any other help.”

  After exchanging a few pleasantries, they hung up. Jack sat for a long moment, numb, unmoving, unthinking. Then, he got up, drove back to the airport and flew home.


  *****

  Ten days ago

  September 21

  8:30 AM

  “We are gathered here today to pay our last respects to our dear friends and colleagues, John Connor and Heather McCormick.” The priest spoke slowly, clearly, and solemnly into the microphone amplifying his voice. As he spoke, Father Daniel looked at the people filling all the available pews. It was standing room only at Holy Rosary Catholic Church. On this sorrowful morning, the ceremonial acknowledgement of these lives lost, heralded the burial of two young and dedicated souls. All eyes were moist, most pockets and purses equipped with the necessary tissues. Soft whimpers could be heard in the background here and there, as the words echoed throughout the large room.

  “John and Heather will be missed dearly. They were devoted to their profession and—”

  The words were difficult to utter; the brain wants to say, but the emotions choke the sound. Many well-dressed young professionals took turns speaking at the microphone, sharing their sincere tender sentiments about John and Heather. The sadness in the room expressed the poignancy in their hearts.

  A long line walked slowly from the back of the church to the altar, in front of which were the two coffins, where the two lifeless bodies laid in their final resting position. Each visitor glanced at John, who rested peacefully in an open casket, his clothes concealing the wound that ended it all. Heather’s coffin was closed. A picture of her young beautiful person was perched nearby, a sorrowful reminder of what once was. An overwhelming feeling of disgust and grief was palpable. Two people destined for greatness now lay lifeless.

  The families were sitting in the front. They were hugged lovingly by those passing, mostly in silence, as there were no fitting words to be murmured. No words that could possibly soften the blow that was the loss of a child. Of a sibling. Of a friend. A best friend.

  When the procession was over, the coffins were transported with much ceremony to the awaiting limousines outside Holy Rosary Catholic Church. These hearses would transport the immediate family and guide a long motorcade of vehicles with headlights on, to the cemetery. It was all so sad. Disheartening.

  The burials proceeded as usual. The overcast gloomy day’s misty rain added unnecessary melancholy to the event.

  *****

  1:30 PM

  Jack returned to his office after the funeral. More than ever, the fire raged inside, heightening his resolve. He sat at his desk in his office at Newton Memorial with the door closed. Beverley had knocked twice, once to bring him a cup of her famous coffee and another to remind him it was lunchtime. She offered to bring him a sandwich from the cafeteria and, after some persuasion, he agreed. The short pause to eat actually did Jack more good than he bargained for. More relaxed and clear-headed, he continued to work. A knock on the door interrupted the silence.

  “Come in.”

  “Hi, Dr. Norris.” It was Julie.

  “You can call me Jack, Julie. I’m making some progress. How are you holding up?” He stopped what he was doing, pausing to attend to the young nurse.

  “It’s quiet upstairs in CCU. The hospital is on diversion and the patients in the unit are just the ones we had from before. They are all doing okay. I asked permission to come see if you needed my help.”

  Jack realized that, just like him, Julie needed to do something constructive to calm the fire inside. A fire created by the loss of a best friend.

  She brought coffee. Jack realized the secret was out.

  “Does everybody in the whole hospital know of my coffee addiction? I vehemently deny it, you know.”

  “Your secret is safe with me, if mine is safe with you.” She lifted her other hand, showing a cup. “It’s an iced white chocolate mocha,” she said after a short pause. She smiled.

  “Here’s what I have so far. First, I did a computer search to determine the number of in-hospital cardiac arrests. I didn’t count those occurring in the catheterization laboratory. From 2000 until 2004, there were about fifty cases per year.” Jack suspended his conversation for a few seconds as he searched for a particular file on his laptop, where he had tabulated the data.

  “Ah, here it is. Fifty-two in 2000, fifty-five in 2001, forty-nine in 2002, fifty-three in 2003 and fifty-two in 2004. Last year, the number was forty-six. This year, if the numbers continue to rise at the present rate, we’ll have sixty-one.”

  “It looks like something happened starting earlier in 2006 and continues until now. But, Jack, what does this have to do with Heather and John’s murders?”

  “I’m not sure yet but this is either a huge coincidence, or there is some connection.”

  “I know what you always say to the students and residents about coincidences. You don’t believe in them. I don’t either.” There was a pause. Then she continued.

  “I want you to count on me for any help I can give.”

  “Thanks, Julie. I appreciate that.”

  “What else have you found out?”

  “I went back to when the number of cardiac arrests sharply increased and looked through all the charts, including those you had given me. So far, I intensely reviewed five charts belonging to patients who arrested with no good cause. I still have many more to go through. Are you sure you want to help?”

  “I need to. Tell me what to do.”

  Jack explained to the determined nurse to look for age, presence of known heart disease in the past medical history, whether the patient had a heart attack during the index admission, look at the lab data for cardiac marker elevation, potassium levels, EKG abnormalities, test results, especially those that determined the overall heart function and so on. He helped create a chart on a blank piece of paper for information gathering.

  “As you go through the charts, if you have questions, let me know, okay?” asked Jack. She nodded already working on the top chart of the To Do pile.

  The therapeutic benefit of doing something constructive was priceless to the two friends. They spoke to each other infrequently and when words were exchanged, it was Julie asking a specific question about an EKG or laboratory result.

  They worked until five, though much more needed to be done. Jack thanked Julie for all her help as she left. He continued to work until six. At that time, prompted by a text message from Claire, Jack gathered several charts and, loaded to the gills, walked to the parking lot.

  *****

  Nine days ago

  September 22

  2:02 AM

  Jack fought nodding off to sleep. He had continued to work for hours on the large kitchen table. Data gathering and tabulation was tedious but Jack’s obsessive qualities did not permit him to stop until it was all done. Stacks of charts loomed in front of him. Jack finished his evaluation of another patient’s chart. He picked it up and placed it on the Done mountain of records. This proved to be the straw that broke the proverbial camel’s back. The center of gravity of this stack changed sufficiently off axis that the whole heap spilled on the tile floor with a thunderous racket. The clatter woke Claire up, who had previously been sound asleep in the bedroom. She put on her robe and walked to the kitchen. As she approached, Jack was kneeling on the floor picking up the charts.

  “Sorry, I woke you up, honey.”

  “That’s okay. I hate to spend a third of my life sleeping. What a waste,” she said with a sleepy smile.

  “I’ve done a lot of work. I’m almost done.”

  “You should come to bed. You do need to get some shut-eye so you can think straight tomorrow. Actually, today.”

  “You’re right. But I can’t stop now. I need to go through all this information so I have time to analyze it before our next meeting.”

  “In that case, how about some coffee?”

  “Oh, my angel of mercy. Yes. Please.”

  Claire made a pot of coffee as they continued to speak.

  “So, what have you found so far, Jack? Use this as a practice session for the meeting with the cops.”

  “Great idea. Well, several men wer
e admitted to Newton Memorial with chest pains. Most of them ruled out for acute coronary syndrome—”

  “Which means the pain was non-cardiac, right?”

  “Right, pain from other causes; some had chest wall pain, others had stomach upsets, and so on.”

  “All those things can cause chest pains but the heart checked out okay; is that what you’re saying?”

  “Exactly. A few had minor heart attacks, but all were stable. All were relatively young.” Jack paused to look at his report in progress. “From thirty-two to fifty-one years old. All the patients then had a cardiac arrest for no good reason. The code team responded.”

  “Hang on, slow down a bit. Remember, when you talk to the cops, they will require you to speak in non-technical language. What’s a code team? They need to understand the usual routine at the hospital.”

  “I know. I appreciate you stopping me to correct me. The code team is the pre-appointed team of nurses and doctors that responds to the bedside of a patient in case of a dire emergency, such as a cardiac arrest.”

  “What exactly is a cardiac arrest? Will you explain that a bit?”

  “An arrhythmia causes the heart, all of a sudden, to go into a rapid tremble. The heart muscle quivers so fast, that there is no effective pumping and the blood flow stops.” Jack stopped for a moment to demonstrate a quivering heart with his cupped hands. “The patient drops dead and will die unless an immediate shock, or defibrillation, is delivered across the chest. The monitors at the nurse’s station pick up the rapid heart rhythm disorder and alert the techs to call a code. The code team responds.”

  “Why do you feel these patients should not have had a cardiac arrest?”

  “There are certain factors that most patients who eventually suffer a sudden cardiac arrest display, such as a large heart attack, weak heart muscle with congestive heart failure—”