Die Before Your Time (Elia Christie / Luis Echevarria medical mysteries)

by Polonus Mucha, Susan

He smiled at her, then looked away and studied the passing landscape out the window. He took a deep breath, turned back to his wife, and smiled at her again.

  Now they were on a road high above the Atlantic. At each stop the bus filled rapidly. Camera-toting tourists outnumbered brown-skinned Bermudians. At one stop a short wiry fellow stepped onto the bus and took the seat directly across from Elia.

  He wore a smile on his dark face and had a twinkle in his grandfatherly eyes. “Good morning,” he said to them. He carried a canvas bag full of books and set it on the floor at his feet.

  Elia returned his smile, but before she could speak loud laughter erupted from the back of the bus. She glanced back at the noisemakers than turned her attention to her neighbor. “Is Bermuda your home?” she asked.

  He nodded. “All my life, except for four years in New York for university.”

  “Don't tourists bother you?”

  “Oh no, no, no, we love tourists.”

  She motioned to the back of the bus. “All tourists?”

  “We Bermudians are taught to never be rude to a visitor.” He shook his head emphatically. “Not allowed, no indeed, we are encouraged to be gracious.” His accent was British, and it added refinement to the harsh racket coming from other riders.

  He leaned across the aisle. “You're important. You're our main industry — tourism.” His eyes twinkled again — ajolly elfin conspirator.

  While Elia talked to her neighbor, Luis's mind was elsewhere. He conjured up one of his medical school professors talking about gastrointestinal bleeders.

  “Careful, careful, “he'd say, “blood loss can be insidious. You won't lose a patient if you keep a close check on blood loss and replace it. But not too fast.” Then he'd say “Don't get complacent. The ulcer can erode the stomach and your patient can hemorrhage to death. “Is that what happened, Vicente? You bled to death?

  “Luis, where are you? We get off soon.” Elia was standing in the aisle.

  Luis stood and was careful to keep his head from grazing the roof of the bus. When they got off the bus they were directed to the ferry. They walked down a flight of stone steps to the shore of a bay. Multi-colored blooms cascaded down the edge of the stairs. Pastel-colored white-roofed homes lined the hillside and ended at the edge of the barely moving dark green water. Five young teens clad in cut-offs disrupted the tranquil scene. They were jumping off the roof of the ferry station into the water. As the ferry lumbered to shore, they scurried up the bank, climbed a trellis of white, pink and purple morning glories to the roof and stood poised once again on the fringe of their perch.

  Luis and Elia were the only passengers embarking, but they stood back as a tall, thin man left the ferry pushing a child in a stroller. Luis looked at his watch. Ten forty-five. Five minutes later, the ferry tooted three times and slowly moved away from shore. A loud thud rocked the boat. They turned to see the cause; one of the teens had jumped from the roof onto the moving ferry. He was dancing on deck like a young Muhammad Ali. Then he dove into the water and swam to his cheering friends.

  Luis and Elia sat on a wooden bench as the ferry trolled down the middle of the bay. They passed pink, green, blue and peach-colored homes nestled in the hills. Tucked among leaf-filled trees and lush green plants, they looked like scoops of sherbet on layers of lettuce.

  Luis reached for a ferry schedule from a rack near his seat and pulled his map out of his pocket. “We get off at the main ferry terminal in town and then walk a couple of blocks. Three more stops to go.” He refolded his map and stuck it and the ferry schedule in his shirt pocket.

  “This is picturesque and relaxing, but we'd get around faster if we rented a car,” Elia said.

  “We can't rent a car. No one can. Only way to get around is by taxi, bus, ferry, mopeds and scooters.” He ticked off the list on his fingers. “And carriages.”

  “Why no car?”

  “Probably because this is a small island and they don't want any more traffic. I read that homeowners are allowed only one car per household.”

  When they reached their stop, they strolled hand-in-hand in the direction of Queen Mother Hospital. They walked two blocks without saying a word. This was no Sunday morning sleepy village, but there were fewer cars on the roads than during the weekdays. Although most of the quayside shops were closed Sundays, tourists still flocked to the quaint town.

  Buildings were painted soft rainbow colors and were as lovely looking as the pastel-colored homes. Shutters to protect windows and interiors during hurricanes bordered the windows. Streets were clean — not even a scrap of paper lying about.

  “You're very quiet,” Luis said.

  “Just thinking.”

  He put his arm around her and pulled her close. “About Vicente.”

  She nodded and pointed up the street. “There it is.”

  Queen Mother Hospital was a four-story stucco building the color of a ripe mango. A portico covered the sidewalk and stopped two feet from the street seemingly reaching out in welcome. They walked through the main entrance into a refreshingly cool lobby. They approached the information desk and asked for Dr. Ramsey. The receptionist made a phone call and invited them to wait.

  They sat on hard wooden chairs with their backs to a bay window. The window faced a courtyard on one side and the main street on the other. A potted palm stood behind one of the chairs.

  “Sir? Ma'am?” The receptionist nodded toward a doorway. Elia and Luis stood when they saw Dr. Ramsey, his stethoscope draped around his shoulders, enter the lobby. He was accompanied by a man in his forties wearing a frown, a pink shirt, and an Argyle sweater vest. His tightly curling hair was cut short, and his determined blue eyes looked large behind thick glasses.

  “Dr. Echevarria, Mrs. Echevarria.” Dr. Ramsey reached out his hand to Luis. He extended his hand to Elia only after she first offered hers. “Dr. and Mrs. Echevarria, this is Dr. Jacob Riser, a friend of Dr. Pereda's.” His British accent rang sharp and clear.

  “Dr. Riser,” Elia said formally, “I'm sorry; we hadn't talked to Vicente about his friends with him in Bermuda.”

  Riser nodded. “We were here for the same meeting.”

  “Are you one of the speakers?” Luis asked.

  “No, I just came to hear the latest research. I'm a physiatrist on the staff at Charleston Spinal Center.

  “Physiatrist?” Elia asked.

  “Rehabilitation medicine. That's how I know Vicente.”

  Elia cocked her head in question.

  “Quadriplegics, paraplegics, stroke victims. We work with neurologists,” he said.

  “Vicente was anxious to get out of the hospital for the meeting,” Luis said.

  “He was a very responsible doctor.”

  Dr. Ramsey guided them to a sitting room off the main lobby. “Please excuse me, but I have a few more patients to see this morning. When Dr. Pereda's autopsy report is available, we'll talk.”

  “Dr. Ramsey, may I walk with you?” Luis asked.

  Ramsey looked at Luis and hesitated before answering. “Certainly. Come along.”

  “I'll come too,” Riser said.

  Before Ramsey could answer, Elia spoke up. “Dr. Riser, could we talk? About Vicente? About some problem he had in Charleston?”

  “I don't know if I can help you, but certainly we can talk.” He sounded conciliatory.

  “I'll meet you here,” Luis said to his wife. “Dr. Riser,” he said with a nod.

  Ramsey gestured toward an open door. “Mrs. Echevarria, there's a small sitting room next door. You'll have privacy there.”

  Luis and Ramsey left the coolness of the lobby behind as they walked down a narrow hallway lined with offices. Ramsey stopped in one and made a phone call. After a short conversation, he said, “Fax it.” He replaced the phone and rejoined Luis in the hall. “Come with me. The pathology lab is faxing Dr. Pereda's autopsy report.”

  An alcove at the end of the hallway contained a fax machine and copier. When they got there, the report was
threading through the machine. Ramsey picked up the sheet of paper and read it in the doorway. He stared at the words. He moved out to the hallway and the two doctors stood facing each other, their arms folded. “We have a problem, I'm afraid.”

  Chapter 7

  Elia and Riser might have been characters in an eighteenth century play. Victorian chairs were arranged around a fluted three-legged table. A Tiffany lamp with a leaded glass shade provided soft light in this darkened room, a striking contrast to the light-filled lobby.

  Elia sat forward in her chair, listening to Riser. If anyone had glanced into the room, they might have thought this was a mid-morning tea party — without the tea.

  “Vicente was a last-minute addition to the program.”

  “How does someone get invited to speak at these meetings?” Elia asked.

  “He was being considered to replace someone on the team.”

  “Team?” Elia asked.

  “A group of doctors was researching a specific drug, and Vicente's chief was prescribing it quite a bit, meaning the patients Vicente was following were using it.”

  “And he was invited?”

  “No. He asked to present a paper and some slides, and since he most probably would have soon been on the team, he was added to the program.”

  “What was he going to present?”

  Riser looked away from Elia for a moment. “I don't really know, but most likely his information will be covered by another speaker. Some talks overlap.”

  “He didn't discuss his presentation with you?”

  “As a matter of fact, we were going to go over his talk last evening.”

  “You mentioned his chief. Is he here for the meeting?”

  “Frankly, I'm not sure. I haven't even signed in myself, so I can't say who is here.”

  “Who is his chief?”

  “Paul Kittrick. Kitt. He's good.”

  “Chief of…?”

  “Neurology. Vicente was in the neurology service.”

  Elia explained, “You see, we haven't talked in a long time. We just happened to be here at the same time, so we don't know too much about what he was doing. Did he seem nervous about the talk?”

  “Probably no more than any speaker at his first major presentation.”

  Elia made a mental note to ask Luis if the anticipation of speaking in front of a large group of scientists would be enough to aggravate Vicente's gastritis. And a second mental note to talk to Paul Kittrick.

  “You've been so kind to talk to me, Dr. Riser. Our family's understandably upset, and I know Vicente's parents will want to know as much as possible.”

  “Of course.”

  “When will you be returning to Charleston?” Elia, the journalist, looked in her purse for a notebook and pen, then stopped herself. She wasn't writing a story. She just wanted to make sense of Vicente's death. Something to tell his parents.

  “I'm afraid I have to stay for the meeting. One of the bigwigs from the drug company is coming in from Connecticut. This couldn't have happened at a worse time.”

  Riser's last sentence felt like a whip across Elia's face.

  He must have noticed her reaction. “I'm so sorry, I didn't mean that the way it sounded.”

  Elia leaned back in her chair and looked around the room. Sadness engulfed her, and she said nothing more. From where Elia sat, she could look out the door into the lobby. She saw Luis walking toward her.

  “Elia, Dr. Riser.” Luis addressed the pair as he entered the room. He was frowning.

  “Luis, what's the matter?”

  Luis pulled out a chair and sat down. “You'll want to hear this, too, Dr. Riser. I just saw Vicente's autopsy report.”

  Chapter 8

  “Vicente bled to death.”

  “But I thought they got the bleeding stopped. And what about the transfusion he got last night?” Elia asked.

  “The night nurse checked on him every hour. Or so she told Dr. Ramsey. But there's a shortage of nurses here, just like at home, and Ramsey told me he wouldn't be surprised if she missed something. It was obvious he had hemorrhaged,” Luis said. “Blood had oozed from every orifice. The medical examiner checked for fibrinogen in the heart.”

  “Fibrinogen?” Elia asked.

  “Needed for coagulation. The M.E. inserts a long needle into the heart to determine clotting time of the blood. Vicente had no fibrinogen.”

  “So his doctor made a mistake?” Elia said. “The bleeding hadn't stopped after all?”

  “No. No mistake.”

  “But how?” Elia began.

  Before she could finish the question, Luis answered. “They found a massive amount of heparin, an anticoagulant, in his system.”

  Riser had been quiet through their exchange but sat up straighter in his chair at Luis's words.

  “Meaning?” Elia asked.

  “We give an anticoagulant, a blood thinner, to patients with heart attacks,” Luis said.

  Elia spoke slowly. “And Vicente did not have a heart attack.”

  Luis shook his head. “No, he did not.”

  “Can that substance be produced by the body?” Elia asked.

  “Not in this form, no.”

  “He's got the nursing supervisor checking, but it's highly unlikely it was given by mistake.” Again Luis shook his head. “No. There's a protocol to follow with this drug.”

  Luis looked at Riser, who was nodding in agreement.

  “That's right. It's given by a doctor, and the patient is closely monitored to see if the clot has dissolved.”

  “ According to Ramsey, who checked, the drug wasn't even in the ICU. It's kept in the pharmacy until the doctor orders it.”

  “I don't understand. How did Vicente get it?” Elia asked.

  “That's the problem.” Luis looked from Elia to Riser. “That's the problem.”

  Chapter 9

  “We'll call you if we learn anything,” Eliatold Riser. “Where are you staying?” Riser pulled out his wallet and handed Elia his card. “Maybe we can get together after the conference and compare notes.”

  “We'll see. We're staying on the Old Cliff Road in the Waller Cottages.” Elia gave him her card. “My cell's here. That's a good way to reach us.”

  After Riser left, Luis called Raf to tell him about the autopsy. Before he finished talking, he had a smile on his face. “Your brother said your grandparents are doing fine and they insist that you and I try to enjoy the rest of the day.” He recited the lines as if rehearsed.

  They made their way across the lobby and out the door. They stood on the sidewalk outside the hospital and looked up and down the street, as if trying to decide their next move. Hamilton Harbour was across the street.

  “Got a coin?” Luis asked.

  “We came from there.” Elia pointed up the street.

  “Settled.” They started walking in the opposite direction.

  They walked in silence. “You're pensive,” Luis said.

  “Yes, I guess I am.”

  “Well?”

  “Luis, you don't think the heparin was given on purpose, do you?”

  “I can't see it.”

  “But if it was, by someone who knew Vicente's condition, and knew it would harm him, my question is, why?”

  Luis frowned and took his time to answer. Finally he spoke. “I have no idea why.”

  “I wonder about Dr. Ramsey. Was he on the defensive about the autopsy report?”

  “He was surprised that Vicente died. And definitely upset about the drug. But defensive? No.”

  They stopped at the end of the block and were about to cross when Elia pulled back. “Look right!”

  “Como?” Luis looked to the right.

  “British colony,” Elia said. “They drive on the left.”

  “Ah, yes. I tried to drive in England and had such a hard time keeping to the correct side of the road, I had to give up; I got myself a Tube pass.” He smiled at the memory. “Much easier. It's no wonder the British ride the subway — er
— the Tube every day.”

  They watched automobiles, mopeds and scooters pass on the opposite side of the road. The traffic chugged at twenty miles per hour. Mopeds and scooters seemed to be the preferred mode of transportation. Men in neckties and long-sleeved starched white shirts, tailored Bermuda shorts, dark knee socks and dress shoes, and women with their skirts tucked around stockinged legs and hair mashed under helmets, shared the road with reckless tourists in bright-colored shorts, wrinkled T-shirts and dirty tennis shoes.

  “That'll be us before we go home,” Elia said.

  They crossed the street, walked a few doors and paused in front of a restaurant. Luis looked at his watch. “It's way past lunch time; let's stop.”

  They were shown a table on a covered verandah on the second floor overlooking the street and harbor. They ordered wine and set their menus aside.

  Luis took Elia's hand. “I love you, Elia. You're my life.” He spoke quietly; his Spanish eyes were serious as he looked at his bride. Then he grinned. “And I pray we don't lose our lives when we get on mopeds.”

  “Is that the Bermuda experience you were talking about?”

  “Yep. One of the doctors in the ER told me they see dozens of tourist accidents every week from mopeds and scooters. Vacationers are having fun, and bam!” Luis's fist hit his open hand.

  They walked hand-in-hand past upscale shops and restaurants with British sounding names: Archie Brown & Son Ltd., The English Sports Shop, The Chancery Wine Bar and Restaurant.

  “Luis, what's Dr. Ramsey doing about the medicine error?”

  “They have a protocol to follow. After they run all the checks at the hospital, then they go further.”

  “Further?”

  “He said they would have to contact the authorities. Police.”

  “Maybe we could talk to them.”

  “Honey, let Dr. Ramsey take care of it; they have to finish things at the hospital first.”

  They had stopped at a street corner and both hesitated. “Right, look right,” Luis said under his breath. They dashed across the street. The traffic moved so slowly, the dash was wasted energy.