No Cure for Murder

by Lawrence Gold

  She met with Ira Green, her chief, one morning a week after beginning this assignment.

  “Ask me anything about the daytime soap opera that is Brier Hospital. I have it all.”

  “I’m too busy for that crap, Shelly...just give me the facts, ma’am.”

  “Skipping over the petty personality problems,” she smiled as she talked, “Brier Hospital has its own set of real problems. They’re what you’d expect in any large institution that functions under stress.”

  “Have you got anything or not, Shelly?”

  “Hold your horses, boss. I’m getting there. First, I looked into those who left Brier involuntarily; those fired for cause or those terminated under the pressure of downsizing. Nothing there. Then I looked for the oddballs, the personality problems, and especially the drug users. As you might expect in an institution the size of Brier, there’s quite a bit of recreational drug use, but nothing big time. Many staff talk about an interesting conflict between an elderly physician, Jacob Weizman and a number of nurses and physicians.”

  “Jacob Weizman? He’s our family doctor...I think he’s everyone’s doctor.”

  “With Weizman, it all seems personality based. I detect a hint of ageism as well. Thomas Wells, a lab technician, may be of interest. He’s had his run-ins with nurses, and finally, we have a nurse, Marion Krupp, who has had run-ins with just about everyone.”

  “What about the ancillary staff?”

  “It’s more difficult to get information about support personnel, but nothing stands out. Then we have professionals who come to the hospital to provide specific services, like the chaplain, psychologists, music therapists, etc. By the way, your doctor and the chaplain; they don’t get along at all.”

  “If I know Jacob, he has a good reason. What about the medical staff?”

  “You remember the Blue Wall that cops use to protect each other. That’s nothing compared with the White Wall used by docs. If you want me to get into that, I’ll need to talk with the Chief of Staff.”

  Ira stood, indicating the meeting was at an end. “Look a little harder at the possible drug connections. With what happened to Rory Calhoun, that looks like the best way to proceed.”

  Chapter Thirty-Four

  “I have Dr. Brickman on line two,” said Margaret Cohen as Jacob entered the office at 8:30 a.m.

  Jacob picked up the phone. “What’s up, Sharon?”

  “Mark Whitson called. He needs to see us. It’s important, he said.”

  “What is it?”

  “Don’t know, but it’s about Nathan Seigel. Can you meet me at Mark’s office at noon?”

  “I’ll be there.”

  I hate when they do that.

  When Jacob exited his office just before noon, he felt a light rain. He jammed his Bugsy Siegel fedora on his head and walked the two blocks to Brier. He kept his head down, trying to avoid the puddles of the earlier downpour. Water dripped over the brim of his hat. He swiped his card in the security reader at the hospital’s back door and entered a corridor by the pathology department.

  Sharon paced before Mark Whitson’s office.

  That woman’s driven, Jacob thought, but one hell of a physician.

  “It’s about time you dragged that old carcass here, Jacob.”

  “It’s good to see you too, Sharon. Accept an old man’s advice and take it down a notch or two. You’ll live longer.”

  “If I follow your advice, it will only seem longer. I’m intense. I was born intense, and I’ll die that way.”

  Just then, the door opened and Mark Whitson stuck his head out. “Come on in.” He shuffled through a pile of reports. “Have a seat. We have a big problem.”

  “Cut the drama, Mark,” said Sharon. “What do you have?”

  “Always the soul of patience, Sharon,” he said, finally finding the reports he was seeking. “I’m talking to you guys first as a courtesy, but I’m reporting this to administration and to risk assessment.”

  “Enough already,” said Jacob.

  “The Lidocaine levels in Mr. Seigel were through the roof, specifically 23 micrograms per milliliter.”

  Sharon leaned forward. “Bullshit! That’s impossible. Our dosing protocol, adjusted for the weight of the patient, should have produced a therapeutic level of 1.5 to 5. The level of 23 is twice the lethal dose. It must be a mistake.”

  “No mistake, Sharon. I drew the postmortem blood myself from the veins in the lower abdomen and directly from the heart. When I saw the levels, I had the same reaction; it’s a mistake. I sent the blood to two other reference labs who confirmed these findings.”

  Jacob paled. “My God! How is this possible?”

  “Logically, I can think of only two possibilities,” said Sharon. “He got too much Lidocaine or his body was unable to get rid of it for some reason.”

  Jacob scratched his head. “He was on medication that might make him more sensitive to the Lidocaine, like a beta blocker or a stomach acid reducer, but these levels are just too high to be anything but a mistake in administration.”

  “Not so fast, you two,” said Sharon. “Our CCU nurses make up dozens of Lidocaine infusions each day. It’s cookbook. I can’t believe anyone could make such an error.”

  “If it’s not an error,” said Mark, “then it’s deliberate. You want to consider that possibility for a moment?”

  “Ridiculous,” said Sharon.

  “I’m open to suggestions, doctors.”

  Sharon stood. “I’ll meet with everyone involved. I’ll get to the bottom of this.”

  “Make it quick. I’m going to administration with this.”

  “I know.”

  The digital clock just flashed to 6:04 p.m. when Bruce Bryant, Brier’s CEO, admitted the group to his office. Following the call from Mark Whitson, Bruce had called Warren Davidson, Jack Byrnes, Al David, the hospital attorney, and Ira Green. Ira asked Shelly Kahn to join them as well.

  As they settled into place, Bruce looked out his street level window spattered with rain, the plants, and trees swaying in the strong wind gusts. He made the introductions, and then scanned the group. “We’ve got a problem...maybe more than one. Mark called today with disturbing findings.”

  Mark reviewed the circumstances surrounding Nathan Seigel’s death and the lethal Lidocaine levels. “Sharon Brickman thinks it might be a mistake. I’m not buying it. Our worst nurses or pharmacists couldn’t have provided this lethal dose by error. I think death was the result of a deliberate action, a premeditated murder.”

  The room remained silent until Ira Green said, “Hold on for a second. Only the Medical Examiner can make such a designation.”

  “I’m not talking legalities here, chief,” said Mark. “I’m giving you my medical opinion. Sharon Brickman’s trying to see if it was an error of some sort, but she’s kidding herself.”

  “We’re already dealing with the massive narcotic overdose in the Rory Calhoun case,” said Ira. “Shelly Kahn’s investigating. Tell them what you’ve discovered so far.”

  Shelly grabbed her notes. “We have no doubt that Mr. Calhoun received an overdose of a narcotic that would have killed a normal person. His long history of narcotic abuse and the Methadone maintenance saved his life. We’re still not sure if he got heroin or something else.”

  “Have you identified any suspects?” asked Warren.

  “No,” said Ira, “but this Lidocaine overdosage puts the investigation on another level.” He paused to scan the faces, then continued, “My mind keeps asking the same questions: do we have other unexplained deaths, and is Brier Hospital dealing with a serial killer?”

  Bruce slumped back in his chair. “My God!”

  “My God is right,” said Ira. “Is it possible to write-off deaths as natural when they were anything but?”

  “Of course it’s possible,” said Warren. “Since the managed care, HMO era, our patients are older and sicker than ever before. Absent anything suspicious, death in this group of patients is considered natu
ral or the result of their underlying medical condition.”

  “I’m referring the Nathan Seigel case to the Medical Examiner,” said Ira. “Shelly will continue her investigation, and Mr. Bryant, I’m requesting that Brier Hospital conduct its own review of all hospital deaths in the last 18 months. God help us, if our suspicions prove accurate.”

  The next day, when Jacob looked at Kate Planchette, she reddened and looked away.

  “I want to talk with you a moment, Kate.”

  “I have to give some meds.” She started to walk away.

  “Kate...”

  She stopped and looked at her feet.

  “I’ll wait for you in the dictation room.”

  When Kate finally arrived, she stood across from Jacob with the expression of a prisoner awaiting execution.

  “Sit, please. Put it out of your mind.”

  “Put what?”

  “You didn’t do anything wrong. It’s not your fault.”

  “Are you sure, Dr. Weizman?”

  “The Lidocaine levels were through the roof. An accidental overdose is impossible. Someone murdered Nathan.”

  “I kept thinking that it was my fault...that maybe the MS allowed me to make a mistake.”

  “How is your MS?”

  “Dr. Roth says I’m still in remission, although I guess I really can’t ever leave it behind.”

  “You’re doing great. In my experience, when you’ve had a benign course for as long as you have, the odds are overwhelming that you’ll be fine.”

  Kate walked up to Jacob, kissed him on his cheek, and gave him a hug.

  She took her first deep breath in a while. “They’re right,”

  “Who’s right?”

  “Whatever it is that makes people trust you, derive comfort from you, Jacob, you have it.”

  Chapter Thirty-Five

  “Shit,” Byron said when the phone rang for the fifth time that evening.

  “You know I’m on call tonight,” said Zoe. “Grow up!”

  “We have Sunshine Manor on the line, Dr. Spelling. They say it’s an emergency.”

  “Put them through.”

  “It’s Mildred Kaysen, Doctor. She’s in severe respiratory distress, turning blue, and sitting upright. It looks like heart failure to us, Doctor.”

  “What happened?”

  “Nothing. She just awakened and couldn’t breathe. We put an oxygen mask on her, but that didn’t do much.”

  “Give her a shot of morphine sulfate and call 911. I’m on my way into Brier Emergency.”

  Zoe arrived just as the ambulance pulled up to the ER entrance. She followed Mildred into Treatment Room One and began her assessment. Mildred was still sitting upright and struggling to breathe. She had a bluish tinge around her mouth and in her nail beds. Her respirations were 40/minute.

  The EMT looked up from his clipboard. “She’s much better since getting the morphine, Doctor.”

  Zoe turned to Mildred. “I’m Doctor Spelling, Dr. Weizman’s partner. We’re going to get this thing under control.”

  Mildred looked up at Zoe. “You’re a very beautiful woman.”

  Zoe smiled, and when she placed her stethoscope on Mildred’s back, she jumped.

  “Oh...that’s cold,” she gasped.

  Zoe smiled. “It’s not easy to keep it that cold.”

  Mildred took Zoe’s hand and gave it a firm squeeze.

  Zoe moved the head of her stethoscope over Mildred’s back and front of her chest, hearing the coarse bubbling sounds of fluid in her lungs. When she listened to Mildred’s heart, she heard the telltale sounds of the struggling, overburdened, and failing heart.

  The portable x-ray machine banged against the door to enter the room. Paige Sims, Mildred’s daughter, followed behind.

  “What going on here?” she yelled. She stared at Zoe. “And who the hell are you?”

  “I’m Dr. Spelling, Dr. Weizman’s associate.”

  “I told mother not to listen to that old man...now see what’s happened.”

  “I’m sorry, Mrs. or is it Ms. Sims...”

  “It’s Mrs.”

  “I’m afraid I don’t know what you’re talking about...listen about what?”

  “Mother...Mother,” Paige cried. She hugged Mildred. “It’s Paige...are you all right?”

  “I’m just a little winded, sweetheart,” Mildred gasped. “I’ll be fine. I don’t know what the whole fuss is about.”

  Paige formed her mouth into a tight sneer, and then turned to Zoe. “I told her it was a mistake...now see what you’ve done.”

  “I still don’t know what you’re talking about, Mrs. Sims.”

  “Twenty years on digoxin and never a problem. Then Weizman stops it. Why? Look what happened.”

  “If Dr. Weizman stopped digoxin, he had a good reason.”

  “Stop making excuses for that old man. I don’t want him touching my mother ever again. I demand that you call a heart specialist.”

  Zoe lowered her voice. “Please. You’re upsetting yourself and your mother for nothing. It’s not necessary to demand anything. All you need do is ask that we get a cardiologist to evaluate your mother.”

  “Don’t play word games with me, Doctor.” Paige burst into tears. “I want to file a formal complaint against Weizman...I’ll make sure he doesn’t hurt another patient.”

  What have you done, Jacob? Zoe thought.

  “Oh, by the way,” said Paige. “I love your dress.”

  Zoe gave Mildred a powerful diuretic and within two hours, she was breathing easily. Sharon Brickman consulted and they agreed to place Mildred in the cardiac step-down unit for observation.

  “What do you think?” asked Zoe.

  “The cardiogram doesn’t show any acute changes, Zoe. I’m getting an echocardiogram . . . maybe that will help pin down the cause of her heart failure.”

  “Her daughter Paige...she’s got it in for Jacob for some reason,” said Zoe. “What do you think about Jacob stopping the digoxin?”

  “Medically, he made the right decision. Knowing this patient and especially her demanding daughter, I might have kept it up just not to rock the boat. After all those years, I doubt that the digoxin would have hurt her.”

  “You know Jacob, and how he feels about the risks of medication. He’s always looking for an excuse to stop useless or potentially dangerous meds. He calls himself a therapeutic nihilist, skeptical about all medications. Maybe, as a purist, he’s right, but this case and several others have caused people to question his judgment.”

  “Can you talk with him, Zoe? Will he listen to you?”

  “I’ll try, but I don’t think it’s an argument I can win.”

  Sharon nodded. “He’s headed for a fall, Zoe. It’s cases like this, his therapeutic bias, and his outspoken position on right-to-die issues that’s undercutting a lifetime of excellence and achievement. I’ll do anything to make sure that doesn’t happen.”

  When Zoe entered the office the next morning, she walked into Jacob’s office. “I had to admit Mildred Kaysen last night.”

  “What happened?”

  “Don’t know for sure, but when I arrived, she was in heart failure.”

  “I should get up to see her.”

  “That’s a problem, Jacob,” Zoe said as she sat next to his desk.

  “Problem?”

  “It’s Mildred’s daughter Paige. She blames you for her mother’s condition. She doesn’t want you on her mother’s case.”

  “What about Mildred? What does she want?”

  “I don’t know, but perhaps it would be best if I took care of her with Sharon Brickman as a consultant.”

  “Best for whom?”

  “Please, Jacob, don’t make an issue out of this now. Paige is an angry woman. She has a problem with you. Let it go.”

  “She can’t dismiss me like that, Zoe. Mildred’s my patient...if she refuses to see me...”

  “It’s no reflection on you. You must have dealt with angry patients and r
elatives.”

  “Listen for a minute, would you. In sixty years of practice, patients have rejected me for all sorts of reasons...many completely irrational. Do I like it? Hell no.

  “If I screwed up, it wouldn’t be the first time, and it won’t be the last. “

  “Did I do something wrong with Mildred? I doubt it. I’m going to let this go for a while or at least until Sharon completes her evaluation, but I’m not going to abandon Mildred to the ministrations of a controlling and misguided daughter...count on it.”

  “Why in hell is the hospital administration sticking their noses into the QA process?” asked Warren Davidson, the chief of medicine as he sat with Arnie Roth in the QA office the next morning.

  “You know why, Warren,” said Arnie, Chairman of the QA Committee. “They don’t want a repeat of the situation we had with that psychopath, Joe Polk, or with several other physicians who we discovered, too late, I might add, to have psychiatric illness or Alzheimer’s. We all share a degree of responsibility when patients are injured under those circumstances.”