First Do No Harm

by L Jan Eira

  “What’s congestive heart failure?”

  “Water accumulation in the lungs from ineffective heart contractions. The fluid floods the airspaces and the patient becomes short of breath, weak, fatigued and so on.”

  “What other factors are there for sudden cardiac arrest?”

  “Very thick heart muscles, changes on the electrocardiogram indicating problems with how the electrical impulses recover after normal stimulation.”

  “How do you assess that?”

  “We look at the QT interval.” Before she could ask, Jack explained further. “The QT interval is a part of the EKG that measures electrical recovery. When this is either too long or too short, cardiac arrests can occur. None of these were found.” After a short moment, Jack continued. “There are conditions that can cause problems with very low or very high potassium levels in the blood, or very low magnesium levels. These can cause cardiac arrest.”

  “Let me guess. You found none of these. What about that nurse several years ago that was killing his patients with potassium injections? Did you look for that?”

  “Yes, there are specific EKG changes. The T-waves become peaked. I didn’t find any of these types of T waves.”

  “What about that movie—what was the name.” Claire paused pensively. “Coma, young people were being killed to harvest organs for transplantation. How were they killing those patients?”

  “They were given carbon monoxide instead of oxygen during minor surgery.”

  “Did you look for that?”

  “No, not really,” said Jack slowly and hesitatingly.

  “Should you?” she asked.

  “Well, carbon monoxide causes minor cardiac arrhythmias or skipped beats. And headaches and confusion. And disorientation. Come to think of it, we should really look into that. The perp at the hospital was said to have become confused.” Jack stopped, noticing a smirk on Claire’s face.

  “Listen to you. The perp. You’re talking like a cop already. How can you rule that in or out?”

  “Tissue and samples to measure carboxyhemoglobin levels. I will have the cops look to see if the oxygen bottles had been switched for either carbon monoxide or carbon dioxide. Thanks, Claire. You’re a great help.” That said, Jack yawned and put his head on Claire’s chest. She caressed his head and face approvingly.

  “Let’s get a few hours of sleep. What do you say?”

  “Yeah, lets.” They turned off the coffee machine and walked to the bedroom hand in hand. Soon they were both deep asleep.

  *****

  8:12 AM

  Jack arrived at the police station and walked to the front desk. He was eager to share his investigative work of the last three days with the detectives.

  “May I help you,” asked the sergeant behind the counter. She was heavyset and dressed in a blue police uniform.

  “I’m here for the detective meeting this morning,” said Jack.

  “Meeting? What meeting? Who are you meeting with?” she inquired.

  “Detectives Fuller and Quentin,” he answered.

  “I don’t know of any meetings. Let me find out for you,” she whispered. She dialed a number and waited for a connection. Her eyes wandered to avoid contact with Jack’s.

  “Are the detectives having a meeting this morning?” she finally spoke. She listened then hung up the phone.

  “There are no scheduled meetings this morning, sir,” she alleged.

  “No meeting?” Jack said, surprised.

  Jack thanked her and left. He walked to his car and looked up Herb’s cell number. He dialed it and waited.

  “Good morning, Herb. It’s Jack Norris. I thought you were having a meeting this morning.” Jack waited for a reply.

  “We have worked on this case for the last three days and came up with nothing. We’ve looked at every angle imaginable. We don’t need any more meetings. We’re ready to close the case.”

  “Close the case?” asked Jack, perplexedly.

  “Yes, we came to the conclusion that Butterworth must have had a gun when he was admitted and—”

  “What about my research?”

  “What did you find? Any drug that could have caused him to kill those people?”

  “Well, uh, no, not really.”

  “Okay, then. I don’t see any other possible explanation. The man was witnessed to have pulled the trigger. There was nobody else there with him. We’re putting the case on hold for now.”

  “I have some possible related cases. Can I—”

  “What cases?” interrupted Herb.

  Jack was flabbergasted. He was speechless. He wanted to scream aloud, but he was tongue-tied. He needed time to gather his thoughts.

  “Never mind. Can I meet with you sometime today?”

  “I don’t think we have anything to talk about, Jack. The case is closed; at least for now. Have a nice day.”

  The phone line was disconnected.

  “The case is closed?” whispered Jack to himself in astonishment.

  Jack drove around town aimlessly for an hour. When he stopped the car, he dialed Susan’s cell number.

  “Susan, we need to meet,” he proposed.

  “About what?”

  “The murders at Newton Memorial. Are you really giving up on the case already?”

  “Jack, we considered all the possibilities. Even Mike Ganz, our FBI liaison, agrees this case should be closed. Jack, we agree that the case was bizarre and unusual, but some people have weird responses to stress. We can’t find any connection to anyone other than the perp. We believe Arthur Butterworth was acting alone. We’re still searching for the gun. The FBI is helping us with that. They have an extensive database. So far, they have found nothing.”

  “I have some data to show you.” Jack paused for a second. “Some stuff I found.”

  “Herb told me you couldn’t find any drug,” said Susan.

  “No, not drugs. Other people that were killed, possibly in connection to this case.”

  “You think this guy had killed other people? We don’t have any other opened murder cases.”

  “Just hear me out. Can we meet? Please.” solicited Jack insistently.

  “Okay. Meet me at the station in thirty minutes. I’ll see if I can talk Herb and Mike into coming, too.”

  Jack sighed. He drove towards the police station. He called Claire. He updated her on all the frustrations of the day. In turn, she gave him the name of the patient whose unexpected, mysterious and bizarre actions left a grieving daughter without parents or brother.

  Susan and Mike were waiting for Jack on the front steps to the enormous edifice. Together they walked into the police station and headed for the conference room.

  “Okay, what do you have that is so compelling, we should reopen this case?” asked Susan, calmly.

  “Two things,” answered Jack. “There is a man by the name of Jeff Snyder that you should look into. He was admitted at Newton Memorial with chest pains. Everything checked out okay. His heart was normal. He went home and suddenly developed confusion and paranoia, just like Butterworth. He killed his wife and son, had a heart attack and died.”

  “Where did this happen? It wasn’t in Evansville,” said Susan.

  “And you think these cases are related? How?” inquired Mike, looking intently at Jack.

  “I don’t know yet, but don’t you agree that it sounds similar to our case?” asked Jack.

  “Sure it sounds similar, Jack; we see cases like this all the time. They sound alike, but it doesn’t mean they are linked.” Mike spoke confidently.

  “You said you had two things,” interjected Susan.

  “There has been a slew of cardiac arrests at Newton Memorial over the last several months. I’d like to present the data to you,” proposed Jack.

  “I doubt the hospital or any of its staff had anything to do with these murders. Do you think there is a ring of murderers working at Newton Memorial? That’s a bit far-fetched.” Mike spoke authoritatively, as only an agent of th
e FBI would dare, during such great uncertainty.

  “I’d like to see what you have, Jack, but it does sound far-fetched to have doctors or nurses responsible for these atrocities,” interrupted Susan. Mike turned to face Jack, his arms folded as he waited for a reply. Jack had learned from Claire to notice body language. She claimed he would learn a lot from it about the patient’s demeanor and feelings. She taught Jack that the body posture of folding one’s arms was a sign of non-acceptance. For some reason, Mike Ganz could not bear the notion that the professionals at Newton Memorial Hospital could engage in such foul play. For that matter, neither could anyone else.

  “Interesting,” Jack thought to himself. “What happened to keeping an open mind?” As these thoughts emerged in his mind, Jack said aloud facing the inquiring eyes now turned toward him, “I get bad vibes from one of the doctors: a Dr. Ian Rupert. He is in charge of the research laboratory. I had noticed he arrived at the hospital much earlier than usual the day of the murders. He was seen in CCU around five o’clock in the morning the day of the murders. Previous to that, I had never seen him at the hospital before ten o’clock.”

  Mike interrupted Jack rudely. “We must be careful. You are talking about a powerful man who is known for his work in research. Isn’t he?”

  “Undoubtedly; I’m just saying—”

  “What would his motive be?” Another discourteous interruption followed by an awkward moment of silence.

  “I don’t know. But I think you should investigate further,” responded Jack sternly.

  After a long moment of silence, Herb and Susan agreed to consider the information Jack had gathered. Overwhelmed, Mike remained skeptically unspoken, his body language speaking volumes.

  Jack went out to his car and brought back his laptop. The three detectives sat in the conference room, quietly waiting Jack’s return. Having delivered many lectures using PowerPoint, Jack felt back in his element. As he entered, they remained seated, motionless and in silence.

  Jack set up his computer and began his presentation, describing his research findings. He started by describing the patient characteristics of those who are known to be at risk for cardiac arrests. He then described two groups of individuals: those that had cardiac arrests with these features and the group of patients that had cardiac arrests unexpectedly.

  He first depicted the great increase in total numbers in cardiac arrests with a graph he titled “Cardiac Arrest Epidemic at Newton Memorial Hospital.” A clear-cut spike could be seen in the last six months, as compared to the previous sixty. As far as the etiology leading to the deaths, Jack admitted to being befuddled. He enlightened the detectives about his theory that the patients may have been poisoned. The type of agent used was not known but it may be useful to obtain appropriate tissue from all the bodies looking for something in common. The agent might have been carbon monoxide or carbon dioxide. This should be discussed with the medical examiners. They could entertain these diagnoses in their post-mortem search for clues and the truth. The cops ought to look to see if the oxygen tanks could have been switched with one of these or other poisonous gases. Susan looked intrigued and little by little started to write notes on her notebook. The detectives remained silent, even when Jack finished his presentation.

  “This seems too far-fetched.” Mike spoke first breaking the uncomfortable silence.

  “Are there any other reasons to explain this spike in cardiac arrests? Anything at all?” inquired Herb.

  “And how do you tie these cardiac arrests to our murders?” asked Susan.

  “I can’t, except that this is an unusual discovery. The murders, we have all agreed, were extremely odd. To have two extraordinary events occur at the same time, it would be unlikely these events are unconnected. It is more likely that one single causative factor is at play leading to both peculiar circumstances. It is just playing the odds. We do this in medicine all the time. Two weird symptoms at the same time in an otherwise healthy patient, it is most likely that both symptoms are connected than unrelated and appearing out of the blue,” explained Jack persistently.

  The detectives once again considered the implications of the information in silence.

  “I’m sold,” said Susan looking at Herb and Mike. Herb took a deep breath but did not speak for a beat.

  “I imagine it’s worth a fresh look. What do you think, Mike?” asked Herb.

  “I think there’s a good medical reason for the increased numbers of cardiac arrests at Newton Memorial that is unrelated to the murders. I think Jack is biased to the connection and is missing something. Probably something simple. No offense, Jack,” said Mike calmly and reassuringly.

  “None taken, but Mike, prove me wrong.” Jack knew he made a compelling argument and his point was gathering momentum. Silence reigned again.

  “Okay, we’ll reopen the case.” Herb spoke authoritatively, convinced of Jack’s assertions. Susan nodded then stared at Mike.

  “Okay, fine,” Mike said reluctantly, finally agreeing with the others.

  “Suzy, talk to the medical examiners and ask them to specifically look into the possibility of poisoning with gases,” said Herb.

  The truth, the detectives would soon learn, was that Butterworth’s erratic and bizarre behavior was likely to have been induced by some sort of chemical poisoning. As such, the medical examiner had already been keen on the possibility and had spent a great deal of time and money gathering data to prove or disprove this hypothesis. The results from all the specimens collected for chemical analysis were pending. Unfortunately, the most commonly sought drugs had not been found. A more thorough search for unusual chemicals would take a long time.

  With the case back on the front burner, attention was turned to the weapon once again. The questions were again delineated and entertained: Where did the gun come from? How did it get to the patient? It didn’t seem that the patient brought the revolver to the hospital with him, although that remained the most likely possibility. If someone else provided the weapon, he or she would be the most culpable person and the real killer, most especially, if Butterworth was found to have been poisoned. Theories were re-entertained about the nursing staff, the cleaning crew, and the previous patient in that room possibly leaving it there and so on. No speculation made sense.

  The detectives agreed that they would find and interview the previous patient to occupy the bed and whoever cleaned the room and made the bed before it became Mr. Butterworth’s. They would speak to the nursing staff again, although the first go-around, on the day of the murders, had proven fruitless. One of the strategies of proper police interviewing is to go over details repeatedly. What once remained locked and hidden by the mysterious neural connections of the shocked and stressed brain would sometimes later surface and become quite clear, once the dust settled.

  The ongoing endeavor to find the gun’s previous owner had remained fruitless. According to Mike Ganz, the great FBI detective, despite all the tricks of the trade used, the serial number continued to resist identification. Whoever destroyed this information really knew what he or she was doing. When ballistic analysis was conducted, there was no record of this gun being utilized in a crime beforehand, according to the vast FBI database. The search for the gun connection continued. Mike discussed the details of his diligent pursuit for the gun’s owner.

  The group also discussed Jeff Snyder. During a short lunch break, Herb and Susan consulted their police computer and made several phone calls. Snyder’s case occurred in a small rural town several counties away, the reason the Evansville Police was unaware of it. Although likewise bizarre, the Snyder case was hard to tie into the hospital murders. The question arose about the possibility that there were cases like it in other townships, a question worthy of investigation.

  After three hours of discussion, it felt like there was no forward progress at all except, of course, that Jack was able to spark up interest in the case. The truth remained undiscovered with no end in sight. At the conclusion of the meeting, Jack
felt a twinge of hopelessness. The miracle of television had distorted his reality about detective and police work. In the real world, the process was slow, tedious and methodic. There was a lot of painstaking theorizing and diligent assessment and re-examination of that which was known and unknown. It was going to take a long time to get to the truth. Nevertheless, the truth would become known. Jack just knew it.

  Herb Fuller, who was turning out to be first-class at quarterback, gave each participant marching orders. With renewed interest, Herb was once again calling all the right plays and doing it in such a way that engendered all team members to work hard towards the common goal.

  Jack’s assignment was to return to his office. At the behest of the detective, Jack requested Jeff Snyder’s hospital chart for his review. Susan and Mike would search for unusual homicide or suicide cases throughout surrounding counties, especially those typically obtaining medical care from Newton Memorial. On the hunch that the patient in CCU was drugged, since no drugs were known to cause those effects, Jack considered a research agent. He asked the cops to call Rupert and get him to disclose all the research drugs he was using. They would call the hospital’s attorney and get the ball rolling.

  Jack sat at his desk going through the medical records tabulating his results and writing comments as he went.

  The door to his office suddenly opened.

  “Why are you sticking your nose into my business?”

  Jack recognized the voice, even before he looked up to see who had spoken.

  “Dr. Rupert, what makes you think I’m doing that?” This time Jack would not be intimidated.

  “You’re checking up on my research protocols, aren’t you?”

  “Yes, I am. I am interested in finding out what sorts of experiments are being done at Newton. Is that wrong of me?”

  “You’re damn right, it’s wrong! It’s none of your business.”

  “Why is it a secret?”

  “It’s just none of your business, young man. You are in deep trouble. I will see to it that you never practice medicine in this state or in this country.” Dr. Rupert angrily stomped out of the room.