The seventy-six-year-old patient, Frederick Halloran, had been admitted to Riverview’s skilled nursing unit about a month earlier. Though Halloran was elderly and his cancer was terminal, the disease was not in the final stages. According to notations on the medical chart, the man’s doctor had expected him to live anywhere from eight months to two years.
Halloran had died barely a week after his admission to the nursing unit. And though his death had been unexpected, the attending physician attributed it to natural causes.
Entries made by a charge nurse the day before Halloran’s death indicated he'd been quite despondent since his arrival. Patient says medication is not relieving his pain. He continues to be severely agitated, moaning and loudly vocalizing his wish to die. Noon meal refused, the large, fluid handwriting on the chart spelled out. According to Nurse Johanssen, the information had been corroborated by several other nursing staff on that shift.
Michael himself knew it to be true. He rarely spent time on the nursing-care wings. By mutual agreement those areas were Beth VanMeter’s domain, while Michael concerned himself mainly with the apartments and the senior center. But Beth had been away much of the week in question, and that afternoon he'd taken a quick tour of the skilled nursing unit in her absence. He had clearly heard Frederick Halloran’s tortured cries. Oh, God! Oh, God! Let me die. Please . . . somebody help me!
He remembered because the cries had torn at his heart. The man’s agonized pleas echoed the words Michael’s own grandfather had screamed from his deathbed. He had been barely twenty when his grandfather died, and it had horrified him to see the man he loved and respected in such pain that he seemed not to be in command of his mind or body. His grandfather had always been a tower of strength, had never for a moment been out of control. But on the day of his death, he'd been reduced to a helpless animal, yowling for mercy, begging to be released from the agonizing snare of cancer.
Michael had wanted to leave his grandfather, to run outside, clap his hands over his ears like a frightened little boy. But he'd stayed. He had prayed for strength and had sat in anguish by his grandfather’s bed until death finally, mercifully, granted him peace.
He remembered how grateful he'd been the day of Halloran’s rantings, that his job did not require him to sit at the bedside of this dying man and relive all over again his grandfather’s death. He’d been so disturbed that day he'd asked Vera Johanssen about the man, asked if there wasn’t something that could relieve his pain. Vera had told him the patient had been given the maximum dose of pain medication and unfortunately in a few cases, pain seemed to persist despite what modern pharmaceuticals had to offer. He’d memorized the man’s name and lifted it to heaven, asking for mercy on behalf of one who could no longer ask for himself. He remembered thinking what a blessing death would be for Frederick Halloran. Little had he known the events of that afternoon would haunt him far beyond the day.
Michael pushed away the disturbing thought and adjusted the desk lamp to examine another page in the folder. There were no new orders for medication. However, a scribbled entry by an LPN on the evening shift the same day indicated Halloran, unaccountably, had eaten a light supper and was “resting comfortably.” He’d been discovered dead in his bed at nine o’clock that night when the evening shift made rounds.
According to Nurse Johanssen, it certainly wasn’t inconceivable that an elderly cancer patient could die so suddenly and unexpectedly, yet she'd confided in Michael that something about this particular case raised a red flag in her mind.
Vera Johanssen was as level-headed and experienced a nurse as Michael had ever known. He trusted her judgment and, in truth, was more troubled by her feelings of disquiet over the situation than he was by his own inconclusive findings from the charts that lay scattered across his desk now.
Frustration rose in him as he wondered what, if any, action he should take in this matter. There was nothing concrete to work with here, and yet he couldn’t help feeling the circumstances warranted at least a cursory investigation.
Frederick Halloran was dead and buried now. There had been no autopsy and no questions had been raised by his family or other staff members. It was tempting to let the matter rest. No nursing home administrator wanted his reputation or that of the institution he represented tainted by the stigma of an investigation or even rumors of suspicion. And yet, as a licensed health-care provider, he had a legal and moral obligation to report any valid suspicions involving the health and well-being of the patients in his center.
When a director of nursing felt something was amiss, it could not be summarily dismissed. Even if it was merely an obscure hunch on her part. And now that he'd combed the files himself, he had to admit that while vague, the discrepancies he'd come across this afternoon filled him with a chill of foreboding.
Although he was highly reluctant to involve any personnel beyond his assistant administrator and the director of nursing, he nevertheless decided it would be prudent to visit with the nursing staff who had cared for Halloran during his last hours—to clarify details and put his mind at ease. He made a mental note to set up informal meetings the following day.
He rubbed his temples to combat the beginnings of a headache, carefully put the papers back in their folder, and switched off the lamp. There was nothing more he could do tonight.
“Yes, I heard Mr. Halloran yelling that afternoon, but like I said, Mr. Meredith, he'd calmed down considerably by the time I took his supper tray in.” Cynthia Harper shifted self-consciously in her chair. Harper was a licensed practical nurse who had worked at the 150-bed nursing-care center for the past four years. Beside her, looking equally nervous, sat Geneva Grayson, a registered nurse who had been at Riverview almost as long as Vera herself.
Vera Johanssen had called the nurses off the floor to speak with her and Michael Meredith about Frederick Halloran. The four of them sat in Vera’s office away from the curious glances of the nurses’ station. Michael had discussed the situation with Beth VanMeter at length this morning, and they'd agreed it was important to keep the initial inquiries very low-key, thus Beth’s absence from this meeting and from the one they’d had earlier this morning with two other nurses who had attended Halloran on the night he died.
“I remember he even joked with me a little about the ‘baby food’ we were feeding him. He was on a soft diet and had pureed beef on his tray,” the LPN explained.
“And you didn’t see him again before you went off duty?” Michael asked.
“No. I’m just part-time. I work the three-to-seven shift, so I went home shortly after supper trays were picked up,” she said somewhat defensively.
“I see.” Michael smiled at the petite middle-aged woman, wishing to put her at ease. “Vera tells me you worked as a hospice nurse for quite a number of years before coming to Riverview. Would you say this is fairly common—for a patient to die this many months ahead of the doctor’s prognosis?” By seeking her expertise he hoped to make the meeting seem less an interrogation.
She cocked her head to one side and scratched at the wiry blond hair now streaked with gray. Her voice was so soft he had to strain to hear her. “With the type of cancer he had, it is usually a long, drawn-out death. But if there’s one thing I’ve learned in twenty years of nursing, it’s that there is no such thing as a ‘normal’ death. Especially with the elderly. I’ve seen everything from a violent struggle for that last breath of life, to people literally falling asleep and just never waking up.”
“I see. Well, thank you for your help, Cynthia. I do appreciate your input.” He turned to Geneva Grayson. “Do you have anything to add to what Cynthia has said?”
“Not really. To be honest, I don’t remember the patient very well. He was only here a week. Cynthia apparently has a much better memory than I do.” She gave the LPN a sidewise glance Michael couldn’t interpret but which seemed to border on disdain.
“I can understand how you might not remember a patient who was only here for a short time, but”�
��he indicated the file before him—“based on the information here, do you feel there was anything untimely about this patient’s death?”
The older nurse shrugged. “Not necessarily. I wouldn’t say it was unheard of for a patient to die a week after admission. Is that what you’re asking?”
“My question has more to do with his death in relation to the medical prognosis. His doctors seemed to feel he had at the very least. . .” Unnecessarily, Michael paused as he referred to the medical chart in the file folder. “. . . eight months to live.”
“Not meaning any disrespect, Mr. Meredith, but I don’t put much stock in doctors’ predictions. If I had to guess, I’d say they’re wrong at least half the time. And of course, the will to live is a huge factor.’
“That’s what I wanted to know,” he said, satisfied with her answer.
“Do you have anything else, Mrs. Johanssen?” he asked Vera.
“No.” Vera turned to Nurse Harper, and there was an uncharacteristic coldness in her demeanor. “But if you think of anything else—anything at all—please don’t hesitate to let me know.” She addressed both nurses. “Of course, we’ll want you to keep everything we’ve talked about today strictly confidential. We’ve talked with the others who were on duty that night as well. We’re simply trying to make sure the details in his records are very clear,” she finished evasively.
Geneva Grayson raised a questioning eyebrow. “Yes, of course, Mrs. Johanssen.”
“Of course,” echoed Cynthia Harper.
Vera Johanssen nodded, dismissing the women. When the door closed behind them, Michael shot a questioning look at Vera.
“Does everything sound on the up and up to you?” he asked. They'd heard the same general account from each of the four members of the nursing staff they had questioned.
“Yes, it seems so,” she admitted. “I apologize if I caused you to worry needlessly, Michael. You don’t know how I dreaded even saying anything in the first place. But finally . . . well, it wouldn’t quit nagging at me. I felt I should let you know my concerns.”
“You did the right thing, Vera.”
The nurse opened her mouth to speak and then closed it again. She cleared her throat, apparently debating whether to voice her next thoughts.
“What is it, Vera?”
She sighed. “Oh . . . it’s nothing. Nothing,” she said firmly, shaking her head.
He looked at her, skeptical. “I want to be sure about this, Vera. There was obviously something about this situation that was disturbing to you in the first place. I don’t want to dismiss it lightly.”
They sat in silence for a long minute.
“Vera, think about this before you answer.” He posed the question in slow, deliberate words. “After talking today with the employees involved with this patient, are you completely comfortable with all the information we heard concerning Frederick Halloran’s case?”
“Yes, I think so,” she answered with reserved conviction.
“And you’re satisfied with the information in here as documented?” He slapped the slender file folder softly against his knee.
“Yes, I am.”
“Are you comfortable closing this file permanently then?” he reiterated, anxious to have her full agreement.
“Yes.” Her assent seemed more confident now.
He stood and reached for the doorknob. “All right. And please, Vera, don’t apologize for bringing this to my attention. I know it has weighed heavily on your mind. And I also realize the timing couldn’t have been worse.” He opened the door and she preceded him into the hallway. “This has been a hectic month for you, hasn’t it?”
Brushing a strand of snowy hair from her forehead, she sighed. “That’s putting it mildly. I can’t remember the last time we had so many dismissals and admissions in quick succession.”
“How many new ones this month already?”
“I’m not even sure. I’ve lost count. Five or six.”
He smiled sympathetically. “Well, hang in there. And, Vera, I do appreciate your conscientiousness. You did the right thing in coming to me about your concerns. I want you always to be able to do that.”
“I promise to try not to go looking for trouble,” she said almost sheepishly.
He laughed. “That would be greatly appreciated.”
As they reached the nurses’ station, a young aide motioned for Vera. He dismissed her with a wave of his hand. “Thanks for your time, Vera.”
“No problem.” She turned her attention to the papers the aide held out to her.
As Michael turned a corner onto the hallway that led to his office, he heard a commotion at the end of the hall. A tiny man in blue coveralls was fighting with a heavy industrial mop and bucket. His white-blond crewcut was almost invisible on his squarish skull, and over the clatter of the wooden mop handle Michael could hear the familiar garbled muttering.
“Having trouble there, Ollie?” Michael asked.
The elflike figure turned slowly, and a snaggletoothed smile spread over his smooth-shaven face. “Nah . . . nah… I got, Murmuff. I got.”
Michael couldn’t help but return the sturdy little man’s smile.
“Murmuff” was the best Ollie could do with Meredith. Michael had learned early on that Oliver Moon understood a great deal more than it might appear. A serious speech impediment made him seem more intellectually challenged than he actually was, but every employee of Riverview knew that despite his mental deficiencies and his diminutive size, they could count on Ollie to do the work of two men.
“You let me know if you need any help there,” Michael told the man.
Back in his office, he tossed the file that’d stirred up so much anxiety onto his desk. He was relieved their concerns had apparently been unfounded. Opening the folder a final time, he took out the copies Vera had made. He ran them through the paper shredder and into the waste basket, trying as he did to discard his worries as well. But a tiny scrap of doubt clung tenaciously to his brain, refusing to be dismissed.
Chapter 8
On the eighteenth of December, Claire turned out of the school parking lot and headed toward the south end of town to her landlady’s apartment. Her rent check wasn’t due until the end of the month, but she was trying to tie up all the loose ends before she left Hanover Falls the following Wednesday to spend Christmas in Kansas City with her grandmother.
On the seat beside her was a small, gaily wrapped package. She was pleased with her gift for Millie. She could scarcely wait for the old woman to open it. Over the past few weeks she'd brushed up on her skills with her 35-millimeter camera—a high school graduation gift from her father—and she'd snapped pictures of Smokey in various poses: washing himself by the fireplace, curled up asleep on the sofa, lapping milk from a dish. The photos had turned out surprisingly well. She’d had the best ones enlarged and had arranged them in a pretty album. She was certain Millie would be delighted with the gift.
As she pulled into the circular drive, she looked across the field at the new senior center that was rising from the once empty lot at the center of the complex. Despite the cold, snowy weather, the construction crew was making rapid progress on the building. Claire had watched with interest over the past few weeks as the structure took shape. The building was projected to be finished by late spring, and Claire could imagine that by summer’s end the landscaping would be well-established, attractively integrating all the buildings of the Riverview Manor complex. It amazed her how quickly such elaborate architecture could spring up from a field of dirt.
Claire got out of the car and grabbed her purse and Millie’s package. She’d just turned the corner into Millie’s courtyard when Michael Meredith stepped out of the entryway door.
“Hello, Claire.”
Claire felt herself blush, suddenly self-conscious at running into him unexpectedly. She hadn’t seen him since their date several weeks ago. His warm smile quickly put her at ease.
“Millie said you were coming,” he told he
r as they walked toward each other on the long walk. “Just a warning—she has quite a spread of Christmas goodies in there.” He rubbed his stomach pointedly.
Claire laughed and groaned. “Oh great, just what I need. Between that and all the Christmas parties at school, it’ll take me till Easter to get back in shape.”
“Well, you’ve had fair warning.”
“Thanks a lot.”
They passed on the walk, smiling at each other, and Claire reached for the door.
“Hey, Claire . . . wait a minute.”
She let go of the door handle and turned toward him.
“Would you… are you free for dinner tonight?”
“Tonight?”
“Yes. I know it’s a school night and terribly short notice, but. . . well, you have to eat anyway. I promise to have you home at a decent hour.” He grinned, seemingly self-conscious, waiting for her reply.
“Well . . . sure. That would be nice.”
“Great! We’ll just go to Amigos, if that’s okay. Nothing fancy.” He glanced at his watch. “Could you be ready around six-thirty?”
“I’ll be ready.” Claire headed down the hallway to Millie’s apartment singing to herself.
They sat across from each other in a wide booth at Hanover Falls’ only Mexican restaurant. Candles dripped and flickered in old wine bottles on the tables, and a scratchy sound system played mariachi music.
From the minute Claire climbed into Michael’s old truck that evening, they recaptured the easy, comfortable friendliness she'd felt at the beginning of their first date. They were both in good spirits, laughing and teasing each other.
After conversing animatedly through appetizers and huge plates of sanchos, beans, and rice, the conversation turned more serious.
Michael took a sip of steaming coffee. “Claire, I know the last time we went out I… I kind of shut down on you when we started talking about our childhoods.” He sighed and leaned closer, elbows resting on the table, hands clasped in front of him. “In case you haven’t guessed, my childhood was not a very happy one—at least not the early years. I’ll tell you about it sometime.”
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