Do No Harm (2002)

by Gregg Hurwitz

  "I'm aware that prisons aren't a good place to summer, Dash."

  "My point is that someone like Clyde is particularly ill equipped to handle it. The acute deprivation, the constant abuse--he'll be ripped apart. Look what happened to Jeffrey Dahmer."

  "What did happen to Dahmer?"

  "Bludgeoned to death with a metal bar." Dash hurled himself into the spin, his enormous body moving quick and graceful, and unleashed the discus with a grunt. It shot from his grip, arcing across the clear blue sky.

  David let out a long, weary sigh. "Well, odds are the cops'll shoot him anyway."

  Dash stood, hands on his hips, and watched the discus hit the grass and skid to a halt. When he turned back to David, his eyes were deeply sorrowful. "In some ways," he said, "that might be more humane."

  Chapter 43

  THE shadows were beginning to lengthen by the time David arrived at Carson's apartment complex, a two-story '70s stucco sprawl. The grounds were a confusion of stairs, patios, and short outdoor halls.

  Two guys in UCLA baseball caps sat in their fenced-in porch on crooked lawn chairs, watching a game of some sort, judging by the roar of the crowd that emanated from the TV. A video game unit was perched on a shoebox at their feet. The controls, attached to curling gray cords, looked complicated, with many buttons and dials. David remembered the Atari joysticks with their single red buttons and suddenly felt quite old. A female newscaster broke in on the TV, promising more details about the escaped "Westwood Acid Thrower" after the game. David leaned around a mountain bike hung vertically and asked to be pointed to Apartment 4B.

  "Right down there, man," one of the guys said, pointing around a can of beer. A flicker of recognition crossed his eyes, and he glanced back at the TV. "Hey, aren't you--?"

  "Yes," David said.

  He rang four times before Carson answered, wearing a ripped pair of gym shorts and no shirt. His hair was even more disheveled than usual, and his nose and eyes were a weary red. He looked simultaneously glad and ashamed to see David.

  "Dr. Spier. I got your message, but this isn't really the best time." Nonetheless, Carson stepped back and let the door swing open, and David followed him in.

  The square living room was filled with boxes, scattered clothes, and an old TV on a fruit crate. There were no chairs, so David followed Carson's lead and sat on the stained beige carpet, his back to the wall. They faced each other across the length of the room. A worn cardboard box to one side evidently served as Carson's dresser. An open suitcase sat barely visible in the hall, a few pieces of clothing thrown in haphazardly.

  "I haven't really had time to move in," Carson said.

  "When I was a resident, I earned a little under four thousand dollars a year. Elisabeth and I had just gotten married, and our big treat was going for a walk in Golden Gate Park once a week and buying licorice. That was really splurging."

  "I have loans out for med school," Carson said. "Not abject poverty, but I ain't living la vida loca either." He wiped his nose with his forearm. "You look like you haven't slept in days."

  "As you know, there's been a lot going on."

  "Yeah. With me too." When Carson spoke again, his voice trembled. "I should have cleared her C-spine with X rays."

  "Did she come in in a collar?"

  Carson shook his head.

  "Did Dr. Lambert order an X-ray series?"

  Carson seemed to recoil at the mention of Don's name. "No."

  "She was a stroke victim, Dr. Donalds. This wasn't a head trauma. There was no way to tell her C-spine was compromised."

  "I just did it too hard. Her bones were old and brittle. The last guy I tubed was the starting center for the football team--he had a neck like my waist. She was seventy years old. I should've handled her more carefully."

  "That's probably true," David said. "But it was an honest mistake, the kind of mistake that happens in a hospital. I might have made it myself as a medical student."

  Carson raised his head. "Really?"

  "Yes," David lied. Carson watched him for a moment. The room was poorly lit--the soft evening air barely filtering through a yellow curtain--and David couldn't make out his face clearly. "UCLA is a teaching hospital," he continued. "There is no teaching process that doesn't progress through trial and error. We have as many checks and balances in place as we can, but we learn with our hands in the body. Being a physician is different from being an accountant, a lawyer, a mechanic. When we slip up, the cost sometimes gets paid in human life. That's what we sign on for. We're not beyond error. We're not beyond causing pain when we misstep. Or death.

  "You certainly need to learn from this--you'd be a fool not to--but this was not compromised care. She was a seventy-year-old stroke victim, for Christ's sake, and you had to get her tubed quickly."

  Carson's lips trembled. "I saw her daughter on my way out." He lowered his eyes behind a hand, and his breathing quickened.

  "And you'll see more crying family members over the course of your career. But you'll also see some who are elated because you just saved a child, a parent, a sibling."

  "Dr. Lambert told me to take some time off. He said I should--"

  David glanced again at the half-packed suitcase. "Dr. Lambert doesn't make the decisions in my division." He stood and faced Carson's lowered head. "You're a fine physician. With fine medical instincts. Don't make us lose a good doctor over something like this. It could have happened to anyone."

  When Carson raised his head, his eyes shone, red-rimmed and moist. Before he could respond, the doorbell rang. David took the liberty of answering it and found Diane outside, tapping a notebook against her thigh. "Is he all right?"

  "Seems to be holding up."

  "Can I see him?"

  "You know what?" Carson's voice was cracked and wavering. He did not rise. "I appreciate your both stopping by, but I could use a little time by myself right now."

  Diane leaned around David. "If you need us," she said. "Page away."

  David stepped outside and pulled the door gently shut behind him. They walked down Barrington, side by side. Diane opened her notebook, a hint of excitement creeping into her voice. "So, get this. When Clyde--or Douglas--worked at the hospital, he had a prescription for lithium carbonate. Eskalith, to be precise."

  David readjusted his stethoscope across his shoulders. "Well, the patient in the NPI whom I just interviewed--he said that Clyde tried to steal his medication once. And guess what one of his meds is?"

  "Lithium."

  "That's right. Evidently Clyde thought it would help control his emerging violent urges."

  "But its primary use isn't to control violence. It's for mania."

  "I know. But it can help against violence. It's been used to treat aggression in prison inmates and the mentally retarded. But the extent to which lithium actually controls violence isn't important. What's important is Clyde thinks it helps control violence. If he's after lithium, we have a paper trail. Who wrote the prescription?"

  "Well, that's just it," Diane said. "Dr. Warren."

  "Dr. Warren? An orthopod prescribing lithium?"

  "I know. I checked it out with him. He's never heard of Douglas Da-Vella, of course. Clyde must've gotten ahold of his DEA number somehow."

  "Well," David said, "Clyde must've made plenty of deliveries to Orthopedics. Horace does a lot of cutting for them. Joints and whatnot. It would have been easy enough to lift a loose prescription off a counter somewhere and copy down a DEA number."

  "Why didn't he just go see someone and get drugs prescribed legally?"

  "When he came into the ER, I asked him if he was on any drugs, and he became intensely defensive. I'd guess he's ashamed of the fact he needs help. Scared to admit it outright. It's not uncommon, especially for someone presumably uneducated. So he forged a prescription."

  Diane added, "And his meds would've all been covered by his employee health plan. Eskalith doesn't come free."

  "But he gets fired--"

  "--goes off the he
alth plan--"

  "--can't afford drugs--"

  "--believes that this affects him--"

  "--and begins acting drastically," David finished.

  Diane whistled. "Holy shit."

  "What are the signs of lithium toxicity, Dr. Trace?"

  "Upset stomach, difficulty concentrating, clouding of consciousness, hair loss, weight gain . . . " She paused. "It's as bad as Dilantin."

  "What else?"

  "Excessive thirst, metallic taste in the mouth, GI distress, acne, frequent urination." She paused, shaking her head, a faint smile crossing her face.

  "Slurring of speech, swelling of hands, psoriasis of the fingernails, nystagmus, ataxia, hypothyroidism," David added. "There are many more, of course, but these seem to be the relevant ones."

  "But one thing doesn't make sense," Diane said. "If he lost his prescription coverage when he was fired months ago, then why was he displaying signs of lithium toxicity just last week?"

  "Because he's still taking it."

  "But my friend at the DEA said there have been no prescriptions of any kind filled in the past three months for either Clyde C. Slade or Douglas DaVella. So how's he getting it?"

  "Maybe he's been stealing it." David made a mental note to tell Ed about this possibility.

  Just south of the post office, they turned into a park composed of two converted baseball fields. Range Rovers and Land Cruisers pulled up and dogs bounded from tailgates--dalmatians and Rhodesian Ridgebacks and Great Danes--and headed for the large lawn ahead. David had forgotten about the dog park, and found himself entertaining the idea of trading in his wife's cockatoo for a Labrador. A golden retriever nuzzled Diane's hand and she laughed, crouching to scratch behind its ears. Its owner, a young Hollywood type in a tight black Kenneth Cole T-shirt that showed off his prodigious biceps, used the opportunity to strike up a conversation with Diane, while David stood by dumbly.

  When Muscles finally strode off to join the other dog owners, Diane and David headed for the field. David felt a tug at his sleeve and looked down to see a hand covered with paint, the fingernails and rough cuticles flecked white and green. It belonged to a disheveled kid in his midtwenties with a long, pointed goatee and a pair of glasses with a green thumbprint at the edge of one of the lenses. The kid wore Tevas and a ripped Berkeley T-shirt, also splattered with paint. Even the greyhound dog at his side was speckled with green dots.

  "Hey, Dr. S!" the kid said amicably.

  "Hello, Shane."

  "Hey, man, I'm sorry about Elisabeth. She was one of the good ones."

  "Yes. Yes she was."

  "If she hadn't come to my opening at that shithole gallery on Cahuenga, I'd still be running the coasters at Magic Mountain."

  The greyhound sped off and began furiously humping Hollywood guy's leg. David watched with perverse amusement.

  "Oh, shit," Shane said, running over to retrieve his dog. "I'll see you around, man," he called over his shoulder.

  Diane and David hiked up in the bleachers overlooking the former baseball diamond and watched the dogs wrestle and chase objects. The brief discussion about Elisabeth, compounded by his sleep deprivation, had unsettled him. He knew Diane could see it in his face and was grateful she turned to the more pressing matters at hand.

  "Now," she said. "Your turn. What have you discovered?"

  David filled her in, telling her about meeting Ed, discovering the lozenge wrapper, and discussing matters with Horace, Ralph, Mouse, and Dash. The information came flooding out. He realized how much he missed having Diane as his confidante and colleague, being able to talk openly.

  "You certainly pulled out all stops," Diane said. "Are you sure you want to get involved to this extent?"

  "Yes," David said. "I can pursue this in ways that the cops can't."

  "Your diagnostic eye."

  "It sounds ridiculous, I know, but I have a sense of this man."

  "You think the police are still out to kill him?"

  "Yes. But I think I can find my way to him first."

  "And then what, David?"

  David watched Shane's greyhound zipping across the open field. "I guess I turn him in to the authorities I trust and hope he can get the kind of rehabilitation a person is entitled to. In a hospital or a jail."

  Diane watched him closely. "Dash said his prognosis is bad."

  "It's terrible. But that's irrelevant. We don't always fight these battles to win them."

  Diane made a popping sound with her lips, then took a deep breath. "There's no outcome here that you want to feel like you made happen."

  "No, there's not. I guess I have to find the most acceptable version of defeat."

  They sat for a while, watching the dogs run. David enjoyed the brief respite, knowing he had to return to the hospital soon and begin slogging through records. As dusk encroached, the park cleared out until only a confused miniature poodle remained. It stood on second base until its owner collected it and carried it off, and then, save for the soft whistle of the wind through the chain-link backboard, the park was silent.

  "Well, I need to go home and catch some sleep if I'm gonna go back on at ten," Diane said. She rose to go, but David laid his hand over hers.

  She sat back down, putting her heels up on the edge of her bleacher plank and hugging her knees. The sky had dulled to a heavy gray, perhaps in anticipation of rain. The smog wreathing Westwood made a beautiful filter for the setting sun, scattered petals of violet and orange.

  "You're not stunning," he said.

  "I know."

  "I don't think about you when we're not together." He leaned forward, hands laced together. The skin on his knuckles was hard and cracked from overwashing. "I don't love the way your hair collects around your neck. Your eyes aren't the most deep and exquisite I've ever seen."

  When he finally looked up, her face was soft and unlined, like a Renaissance angel's. Her eyes, slightly misty, sparkled like green gems.

  "I don't think about you either," she said.

  Leaning over, he pressed his lips tenderly to her forehead. He held the moment, his eyes closed, before breaking off the kiss. A strand of her hair clung to his face for an instant before blowing free.

  They looked at each other, confused and a bit breathless.

  Chapter 44

  THE Medical Records Office hummed with an all-hours vibrancy. A young clerk leaned back in his chair behind the counter, listening to the Dodgers game on the radio and flipping through a worn Michael Crichton paperback.

  He didn't so much as look up when David slid into a seat at one of the computer terminals and began punching the keys. To access the confidential records, he typed in his user name and then his password--Elisabeth's maiden name. His password, which he'd kept for the past four years, struck him for the first time as dire and slightly pathetic, so he changed it to pinkerton, in keeping with his new respect for security matters. On the drive over, he'd called Ed to set him on the trail of stolen lithium.

  He entered the database and typed in clyde slade and Clyde's birthday. The search engine seemed to run for an eternity, the cursor turning into a ticking clock icon that stared out at him like a miniature eye. No results.

  Sheffield tripled, and the radio roared with applause.

  David tried CLYDE C. SLADE. Another tedious wait, and again, no results.

  He pushed out from the terminal and crossed to the counter. "Excuse me."

  The clerk held up a finger. "Hang on."

  "Listen, I really need--"

  "Just lemme finish this page."

  David set aside his irritation. "Crichton, huh? I enjoy him."

  The clerk slid a bookmark between the pages and looked up. "Pretty cool stuff. I dig his range. Doctors to dinosaurs."

  "I was hoping you could tell me how far back these records are computerized."

  "I don't know. Like twenty years."

  Not far enough back to include relevant records, if Clyde was indeed harboring a childhood grudge against the hosp
ital. "I need to look for a pediatrics file that's probably older," David said. "Where would it be?"

  "Medical Records Storage. Culver City."

  "Any way I could get it tonight?"

  "No. Sorry." The clerk thrust a form across the counter at David. "Fill this out. Usually takes four to six days."

  "Can I go down there myself?"

  "Nope. They're closed. It's not run by the Med Center--it's just some warehouse that stores old files for companies."

  David jotted down Clyde's information on the sheet and passed it back. "I don't have four to six days. This is an absolute emergency, and I'd really appreciate it if you could put a rush on it and get this file for me first thing tomorrow."

  "Okay, I'll do my best." The clerk glanced at the name. "The cops were down here asking about records for this guy," he said. "Anything related?"

  "Did you give them access?"

  "No way. Not without a court order and my boss's signature."

  "Okay." David slid his card across the counter. "I'd really appreciate it if you would page me the minute that file hits this office."

  Returning to the computer terminal, David typed in douglas davella and tried to be patient as the clock icon stared out at him cheerily.

  The clock radio jarred Diane from her nap, blaring "La Macarena," a song she thought had been consigned to "Achy Breaky Heart" obscurity. With a groan, she slapped at the top of the radio until she hit the appropriate button, and slid out of bed. She'd barely napped for an hour before being awakened for her night shift.

  Lowering her feet into a pair of slippers, she shuffled to the bathroom and turned on the shower so hot water would be flowing by the time she finished brushing her teeth. The fact that she didn't drink coffee made her that much more reliant on a hot shower to get her rolling before a long shift. She undressed and regarded her body in the mirror as she brushed, turning sideways for a better view of her rear end. Behind her, the showerhead coughed a few times, then the water steadied again.

  She climbed into the steaming shower with a groan of pleasure and turned her face up into the flow, running her hands through her hair. The water went from clear to a cloudy white.