No Cure for Murder

by Lawrence Gold

  “I know.”

  “By intention or by mistake, this could have killed Rory.”

  “I’ll talk with Brier’s CEO and with risk management, today. They’ll begin an investigation.”

  “Can we get blood levels to find out what he received and how much?” asked Ross.

  “I think police forensics can do that. I have a series of blood tubes drawn for analysis. Once we know the drug and can measure the blood levels over time, we can calculate the original dose.”

  Jack called Warren Davidson, and together they met with Bruce Bryant, Brier’s CEO.

  “Shit,” Bruce said. “That’s all we need now. I know Ira Green, the chief of the Berkeley P.D., we play tennis. Maybe he can get into this before the media does.”

  “Maybe,” said Warren. “All the same, it’s time for us to take a hard look at hospital security.”

  Ira Green looked more like an accountant than Chief of Police After meeting with Bruce Bryant, and Al David, Brier’s attorney, Ira met with Jack and Ross.

  “Deliberate O.D. or a mistake?” he asked.

  Ross stared at Ira. “You’ve dealt with addicts as much as I. It’s a culture that I still find difficult to understand. Nothing they do surprises me.”

  “Has the hospital experienced any other unusual or unexpected deaths or injuries lately?”

  “We always have deaths,” said Jack. “Some unanticipated, but nothing that’s raised suspicion. Have other hospitals in the area reported any type of suspicious activities, chief?”

  “Not a thing. I’m assigning one of my best plainclothes detectives, Shelly Kahn, to the case. I’d like her to work with your risk management people so she can keep a low profile. She was a nurse, so she knows how to fit in. Any other suggestions?”

  “Once the blood levels return, we can extrapolate backwards,” said Jack. “Then, we’ll know what someone gave him, and what dose. That should put us in a better position to tell if this was an accident.”

  Ira looked at the group. “This was no accident.”

  Chapter Twenty-Five

  Jacob had bad patients in sixty years of practice, but Justine Howard was in a category of her own. He used all the considerable tricks in his bag attempting to control her obesity related diabetes.

  “I ain’t takin’ no shots,” was her first salvo ten years ago, then after the family interventions, she finally agreed.

  Then it was, “I ain’t stickin’ myself for them damn sugar tests four times a day...no way in hell.”

  Ever the rational man, Jacob didn’t understand why she rejected all his efforts on her behalf.

  “It’s that damn pride of yours, sweetheart,” said Lola. “How many years does it take before you understand that you can’t live your patients’ lives for them?”

  “Look, I have no illusions that patients follow all my instructions to a T. The medical literature is clear on how poor compliance is for medication, diet, etc. Justine, however, is deteriorating right before my eyes, and I know that with a modicum of cooperation, I can reverse it.”

  “I’ve been a shrink for a while, and I tell you, you can’t help anyone who won’t help themselves.”

  Over the years, Justine’s condition deteriorated. Her recent hospitalization at Brier was the worst.

  Justine called one afternoon. “I got this terrible pain in my belly, doc. I been putting a heating pad on it for days, but it ain’t helped it none.”

  “How’s your sugar?” Jacob asked.

  “Hell if I know.”

  “Do you have any fever?”

  “Ain’t got no thermometer, but I’m hot and sweaty.”

  “Come in to Brier Emergency. I’ll see you there.”

  “No thanks, Doc, I’m sticking with it for a while.”

  “This could be serious.”

  “Everything’s serious with you, Doc. I’ll call you back if’n it don’t get better.”

  “But,” he shouted into the dial tone.

  I had better get the visiting nurse out to see her ASAP, Jacob thought, or I’ll be hearing from her in the middle of the night.

  At three a.m., Jacob’s phone rang.

  “This is Brier Emergency, Dr. Weizman. You should see what we’ve got for you.”

  “Just don’t tell me it’s Justine Howard.”

  “You’re a mind reader, doc.”

  It was nearly 4 a.m. when Jacob entered the ER.

  The ER nurse pointed to the door to her right. “She’s in treatment room II. How long has she had that hernia?”

  “What hernia?”

  Jacob and the nurse gave their heads the knowing shake of those who tried and lost in the care of the pig-headed patient.

  Justine held her hands on her abdomen. “Hey, Doc. This thing is really killing me. Fix it up and let me get out of here.”

  Before Jacob lifted Justine’s hospital gown, he smelled it, the stench of decaying tissue, gangrene. He stared in disbelief as he exposed her abdomen, reeling from the full force of the foul odor and feeling his stomach churn.

  He recalled a case from medical school...his first days working with the living. The thirty-five-year-old woman came into the Vienna clinic with a grapefruit-sized tumor of her left breast. She’d had it for three years. How could someone let this go on for so long?

  Now he looked at Justine’s abdomen and saw an enormous hernia, a ballooning out of her intestine through an old C-section abdominal incision. The thin white scar over the hernia had a dark spot in its center.

  “My God, Justine! How long has it been this way?”

  “A couple of months Doc. I used to push it back in, but lately the damn thing won’t go in. Then it started to hurt a lot.”

  Jacob palpated the melon-sized mass. It was firm, tender, and he dared not reduce it... push it back into the abdominal cavity.

  “Hey, take it easy Doc...that kills.”

  “That’s an incarcerated hernia, Justine. It’s gangrene. You need surgery, and I mean right now.”

  “In car sir what?” she asked.

  “Incarcerated hernia. It’s stuck in that swelling and that dark spot means the tissue is dead or dying.”

  After a protracted argument, Justine finally agreed to surgery. Jacob called a general surgeon and he repaired the hernia by 9 a.m. that morning.

  In the recovery room, Jacob talked with Justine. “I want you in bed for the next 24 hours. Give us a few days to let this heal a bit, keep your sugar under control, and make sure that you don’t develop an infection, and I’ll get you out of here.”

  “Make it quick, Doc, this place gives me the willies.”

  Just as Jacob finished his afternoon office hours, the hospital called. “You’d better get over here to see Justine.”

  What now? When he arrived, three nurses were at Justine’s bedside. Two holding her arms, one pressing on her abdomen.

  “We told her not to get up, but we found her grunting on the toilet. When we got her back to bed,” the nurse said, pulling away the abdominal dressings, “this is what we found.”

  Jacob knew before he looked, but seeing the open incision with small intestines protruding . . . an evisceration was the technical name, was still a shock.

  Jacob shook his head at Justine.

  “Don’t blame me, Doc. I had to take a crap. I ain’t usin’ no bed pan.”

  Jacob held the earpiece of the phone away from his ear as the surgeon vented his anger. Justine was back in surgery within an hour. He repaired the wound and closed it over with thick stainless steel sutures. The real risk now was another evisceration due to weakened tissue and infection.

  For the next two days, with sedation, physical restraints, and the equivalent of a whalebone corset, they were able to keep Justine in bed. The angry wound was swollen, but showed no signs of infection...a small miracle.

  On day three, Jacob came into Justine’s room and smelled two distinct aromas...the ones best known in medicine: the Juicy Fruit aroma of uncontrolled diabetes and the disti
nctive stench of a Pseudomonas bacterial wound infection.

  When Jacob thought what more could go wrong? Marion Krupp entered the room. Oh...no!

  “Marion, do you have this morning’s lab?”

  She handed him the laboratory printout. “Yes, Doctor.”

  They were as he anticipated, but the magnitude of the uncontrolled diabetes (diabetic ketoacidosis, DKA ) and the signs of infection were alarming.

  “Nurse Krupp, we’re going to need an ICU bed for her ASAP. In the meanwhile, I’m ordering IV’s, insulin, bicarbonate and antibiotics. We’ve got to get on this before it’s too late.” He grabbed her chart, wrote the orders, and handed them to Marion.

  She scanned his orders and frowned. “Are you sure you want this much insulin, Doctor?”

  “Of course I’m sure. This is a sick woman with severe DKA and infection. She needs aggressive treatment.”

  Marion smirked. “I’m sorry, Dr. Weizman. I’ll need to check these orders with my head nurse...I don’t think they’re appropriate.”

  “Are you out of your mind? We don’t have time for this, Marion. Any delay could kill her.”

  “I’m sorry, Doctor. I’m responsible and cannot follow orders which are questionable.”

  Jacob looked up and shook his head. “Questionable? Give me the keys to the medicine cabinet!”

  “I can’t do that, Doctor.”

  After finally finding Mary Oakes, the ward’s head nurse, and having her berate Marion for obstructing the doctor’s perfectly appropriate orders, getting the insulin, the bicarbonate, and the IV’s, they returned to Justine’s room to find her unresponsive.

  Jacob listened to her heart, checked her pupils. “She’s dead.”

  He turned to Mary Oakes, pointed to Marion Krupp. “Get her out of here and never let her set foot again in this hospital.”

  Marion reddened, and without a word, departed.

  Chapter Twenty-Six

  Instead of his leisurely breakfast ritual, reading the papers and doing the crossword puzzles, Jacob gobbled down his lox, eggs, and onions.

  “What’s the rush this morning?” asked Lola.

  “Sunshine Manor called me to see a new patient. With five patients in the hospital and a full office, I need an early start.”

  “Can’t the nursing home patient wait a few days?”

  “She’s been waiting. Every doctor the family called refused to come to the home. Finally, all they had left was old doc Weizman...some testimonial. It’s been a week now, and someone has to see her.”

  “Getting sensitive in your old age?”

  “Not the esteemed Jacob Weizman.”

  Sunshine Manor, a modern one-story glass and redwood building, sat on the outskirts of town. Its broad decks and large skylights created a bright and cheery atmosphere. The glass automatic doors whooshed open as Jacob approached. When he entered the lobby, Marcia Katz, the nursing supervisor, came from behind the nurse’s station to greet him.

  Marcia hugged Jacob. “Thanks for coming. We’re finding it nearly impossible to get physicians in to see our patients. I don’t know what we’d do without you.”

  “I’m not going to live forever, Marcia. Maybe if the home puts a physician on salary and pays him or her enough that will solve your problem.”

  “Sure, Jacob. I can just see the board of directors signing up for that. They’re constantly complaining that they can’t make it as things are now.”

  “Where is my patient?”

  “I’ll introduce you.”

  “No, that’s okay. What room?”

  “Room 1247. Her name is Mildred Kaysen. Her daughter Paige is with her.” She bent over to whisper, “I’d watch out for that one.”

  As Jacob walked through the quiet corridors, he looked at the photos, art reproductions, and craft work of some residents that decorated the off-white walls. Some inmates shuffled, hands on walkers, vacant eyes down. Some remained fixed by an umbilical cord, the tether, to an attendant immediately behind. Others, also head down, were wheelchair-bound, literally tied into the seat by a broad canvas waistband around their torsos. Diapers protruded from trousers and hospital gowns. The stench of disinfectant, Desitin, and excrement defiled the air.

  Jacob, all too familiar with this display of degradation, felt embarrassed as if he was somehow responsible. This was a disgrace and a dishonor to lives once valued. To this group, Sunshine Manor was the warehouse for the unwanted, the decrepit, and the useless—the last train station on the route to nothingness.

  Jacob and Lola had survived one holocaust. He thanked the fates for their luck, so far, in avoiding this one. He knocked on the door marked 1247 and entered.

  A well-dressed middle-aged woman stood next to the bed. She stared at Jacob. “I’m so sorry. I’ll call the nurse. She can show you back to your room.”

  Jacob reddened, and then laughed.

  The woman watched Jacob as if he were a lunatic. “Please, I’m sorry. This is a private room. No guests.”

  “I’m sorry too, but I can’t help the way I look. I’m Dr. Weizman. I’m here to see Mrs. Kaysen.”

  “Oh, excuse me, Doctor. I’m Paige Sims, Mildred’s daughter. I wasn’t expecting someone so....” she hesitated.

  “Old,” said Jacob with a laugh. “You’re not the first one to confuse me with a resident of Sunshine Manor. Once, they forced me to sit down to play games with the group. A nurse who knew me, set me free...too bad, I was about to yell ‘Bingo’.”

  Jacob spent twenty minutes examining Mildred and obtaining a brief history.

  Mildred was a sweet, intelligent woman, a year younger than her new doctor. “Thank you, Doctor. It’s great, for a change, to see a doc who doesn’t have pimples.”

  Jacob laughed. He turned to Paige. “If we don’t have all her old medical records, we’ll request them. After I have a chance to review it all, we’ll meet again to discuss the treatment plan with you and your mother. For the moment, I’ll keep everything the same.”

  Paige offered a cool hand. “Thank you, Doctor.”

  When Jacob began to leave, Mildred smiled and winked. “Do you need help finding your way out, Doctor?”

  Jacob laughed. “No thanks, Mildred. I left a trail of breadcrumbs behind. I’ll find my way.”

  I really like Mildred Kaysen, he thought.

  After Jacob departed, Mildred turned to her daughter. “I like Dr. Weizman. The nurses say he’s one of the best physicians in the community.”

  “Mother. He’s even older than you.”

  “I love that...older than me.”

  A week later, Jacob returned. “I’ve reviewed all your medical records, Mildred. I have but one suggestion.”

  “What is it?” asked Paige.

  “The digoxin. You’ve been on it for twenty years, yet I can’t find a good indication for its use.”

  “Her internist said it was for mother’s heart. He’s on the staff at Columbia University in New York.”

  “Whatever. Without a legitimate indication, I’m recommending that we gradually stop it. When you age, pardon the expression, Mildred, and as your kidney function slows down, the drug poses a real possibility of danger. If I felt we have a good reason for its use, I’d leave it alone, but I can’t find justification for digoxin in your chart or on your examination.”

  Mildred looked at Paige, and then turned back to Jacob. “If you think that’s the thing to do, then sign me on.”

  “Mother,” said Paige, alarmed.

  “If you like, I can ask one of our cardiologists at Brier Hospital to consult with your mother for a second opinion about the digoxin.”

  “That won’t be necessary,” said Mildred, staring at her daughter.

  Paige’s lips pressed together as she stared at Jacob.

  Chapter Twenty-Seven

  Sherrie Lotts, a new graduate nurse, and just two weeks on the job, watched as Jacob meandered down the hallway. “Who is that?”

  Mary Oakes, the head nurse, stared down the ha
llway. “That’s Dr. Jacob Weizman. He’s an institution around here.”

  “That’s Weizman? He looks like he ought to be in an institution. How old is he?”

  Mary rolled her eyes. “Jacob will be eighty-nine in the fall, I think.”

  “Isn’t he a little old to be practicing medicine?”

  “You’ll find out when you work with him and you’ll get your chance today. Alice Kramer is Dr. Weizman’s patient.”

  While Jacob sat at the nursing station reviewing Alice’s chart, Mary and Sherrie approached.

  “Jacob, I’d like you to meet Sherrie Lotts. She’s a new grad and she’s taking care of Alice today.”

  Jacob stood, bowed slightly, and extended his wrinkled hand to Sherrie, whose tentative touch suggested she was shaking hands with a Leper.

  “Nice to meet you Doctor,” Sherrie shouted.

  Jacob stared at Mary as they communicated as by telepathy…give the girl another chance, Jacob.

  Jacob stood. “Come, let’s make rounds.”