"That's what I meant," she said. "Mrs. Matthews received the morphine when she started to wake up."
"Yet the medication sheet lists the time as nine p.m. exactly. Mighty punctual of the lady, starting to rouse herself exactly on the hour."
"Are you insinuating-"
"I'm insisting you level with me about every detail of what happened here last night, down to the minute. Now when did you observe her coming around before administering the morphine?"
She drew her lips into a thin line and let out a long breath, making clear her exasperation. "Probably more like nine-ten."
"And afterward?"
"What do you mean?"
"Did you check on her?"
"Yes! Repeatedly. The larger dose worried me. And since you'd sent her husband home, I kept a close eye on her myself." Her disapproval of his having removed Mr. Matthews from the scene, thereby making it necessary for her to increase her own vigilance, hung heavily in the air.
"And?"
"She remained stable."
"Vitals and respiration normal?"
"Yes, as written on the patient's chart."
Check night nursing notes on any floor and the majority will have respirations listed as sixteen a minute, the average rate for adults who are awake, even though most people slow their breathing to twelve when they're asleep. The reason? A lot of caregivers, including doctors, never bother to count the actual number as long as they can eyeball that a person appears to be moving air in and out with no difficulty. "It says sixteen every time," Earl said, lowering his voice to a whisper. "How do you explain that?"
She flushed, yet didn't speak, having been around long enough to know exactly what he meant and to accept she'd been caught out on the point rather than argue about it.
"Obviously, whatever the rate," he continued, "the rise and fall of her chest seemed sufficiently vigorous that you didn't think the morphine had suppressed her breathing."
"No."
He looked back at the chart. "It says here you gave her the second injection at one a.m."
She swallowed, then nodded.
"Again, she started to moan at the top of the hour? The woman must have had a clock in her brain."
The skin around Yablonsky's eyes grew taut, purse-stringing her gaze into an angry stare. "All right. The morphine wore off sometime after midnight, but by then I had only two other nurses and an aide to help me- cutbacks you know- and we had to stay with some of the other patients you also medicated who were much nearer death." She didn't add, "Thanks to your injections," but her nasty scowl said as much.
"So you let her cry again. How long before you finally got to her?"
She drew in a long breath. "One-thirty." Her matter-of-fact tone held no admission of culpability for anything.
"Yet she had strong vitals, seemed no worse for wear from the first dose?"
"Her vitals were the same as before. And for your information, she'd fallen back to sleep. I remember thinking that the stronger dose hadn't worn off completely and maybe she didn't need the second shot just then, but went ahead with it anyway, given how she'd been screaming not half an hour earlier and you'd insisted we stay ahead of the pain." She'd resorted to pronouncing each word carefully and with perfect poise, as if speaking correctly could make what she'd done sound just fine.
Still, the plausibility of her explanation made him think that he'd probably gotten the truth from her. "And when did you next check her?"
Monica's face reddened to an even deeper shade of crimson.
"Let me guess," Earl said, feeling the pit of his stomach clench into a ball of muscle.
The taut defiance around her eyes slipped away, and, stealing a glance at the shrouded form, she seemed to age in front of him. "Six a.m.," she said, her voice reduced to a dry croak.
Jenny Fraser, chief of laboratories, had tracked Earl down in his office, where he'd retreated to think things over. "I have to warn you, Earl, Wyatt's riding my technician's ass for these results, but I heard what happened and wanted to get them to you first."
"That bad, are they?"
She gave a strained, tinny laugh. A small woman known for wearing pearls to a job that dealt with bodily fluids and slices of human anatomy, she also had a reputation for delivering bad news with the delicacy of a shark attack.
He braced himself.
"Unless the autopsy shows some catastrophic surprise, the cause of death will be morphine intoxication." Her slow cadence gave each word equal importance; it was a common technique used by clinical teachers in the belief it helped even the dimmest resident get the point. Except Jenny carried the practice over to talking with staff. "Her levels were double the normal therapeutic range."
"Shit."
"In your favor, her previous liver and renal tests showed normal function, so she should have theoretically been able to handle what you gave her, and no one could fault you for not thinking otherwise."
He knew all that, he thought as she continued to report her findings, had seen it in Elizabeth's chart before ever ordering the morphine. The truth was, Jenny couldn't provide the answers he needed now, such as how Elizabeth had survived the initial dose but not the second. How the first dose had worn off long enough to leave Elizabeth screaming with pain again, yet she'd managed to fall asleep before the second injection.
"Thanks, Jenny. I appreciate the heads-up," he said when she'd finished summarizing her take on the lab report.
After he put down the phone, a branching, cold logic took over his thinking, forking in various directions, and pointing to answers he didn't like.
He made a quick call to the operator, who connected him with the weekend nursing supervisor, Mrs. Louise Quint, as much a seasoned veteran at St. Paul's as himself. Like Earl, she harbored no illusions about the ruthlessness of hospital politics.
"Earl!" she said, her voice as hearty as ever. "I hear you're in the shithouse again. Just when I thought you finally got to the top of the crap pile. So much for my hopes the good guys might win a few for a change."
"Afraid so, Lou."
"What can I do to help?"
"I think Elizabeth Matthews may have gotten her dose of morphine twice."
"What!"
"You heard me."
"Why would you think that?"
"Because after midnight she woke up crying with pain again, the initial dose I ordered having worn off. Once she got like that, according to her husband, she couldn't rest. Yet around one she stopped crying, and Monica Yablonsky found her asleep when she finally went to check on her at one-thirty."
"So?"
"Apparently the staff had a busy night, especially during the time in question. I figure one of the other nurses might have given Matthews her injection after she first started to cry out, between midnight and one, but didn't sign it off in the order book or tell Yablonsky. Around one-thirty, when Yablonsky freed herself up from the other patients, she could have unwittingly given a second dose. Now they're both covering up."
"Jesus," she said, "that's pretty far-fetched." But Quint didn't dismiss the possibility outright. "Stay by the phone. I'm on it."
An hour later she called him back. "If one of my nurses gave an extra dose of morphine, they got it out of a private supply, because there's not a vial missing in the whole hospital." Her tone, now icy, made it clear that she considered the matter closed.
Every floor had a locked narcotics cupboard that required a pair of keys to open it, just like launching a nuclear missile, and the staff counted the vials at the start of every shift. Then they repeated the ritual on signing out, logging the ones they'd dispensed while on duty.
Not a foolproof system, but it uncovered mistakes, and to beat it took planning.
"They could have already replaced the vial they used?" he suggested, hoping she might not slam the door completely on his scenario. He'd need as many allies with open minds as he could muster to counter what Wyatt had in store for him.
"They'd have had to move awfully fast. A
nd again, where would they acquire a substitute identical to the ones the hospital uses if not from the stores themselves? As far as I'm concerned, the whole notion's a nonstarter."
Unless they'd stolen it previously, he thought. Unfortunately, he hadn't a shred of evidence to be making such serious charges.
"Earl, I'd have gone to the wall for you if you had a case," Mrs. Quint added, her tone somber, "even against my own girls." Half her "girls" were pushing sixty, but she'd called them that from the days when they were rookies together, as if choosing not to notice they'd all aged, herself included. "But without proof, I fully expect you won't be repeating your allegations against them, even hypothetically."
Tough, blunt, and putting him on notice- he'd expected nothing less from her. "Thanks, Lou, for what you did."
He replaced the receiver in its cradle.
And felt very alone.
He'd no choice now but to await the outcome of an autopsy. As VP, medical, he could push to get the postmortem done quickly, but solving the mystery of Elizabeth Matthews's death at the cellular level took time. His authority couldn't hurry the process of preparing thin slices of her vital tissues on glass slides, marinating them for a required number of hours in a sequence of solutions to color their various structural features, then examining them under a microscope one by one. His fate would be in limbo for at least a week or two.
Then odds were that the official cause of death would simply echo what everyone already suspected, including him: morphine intoxication.
And Wyatt would move in for the kill.
Yet the politics of it hardly mattered, compared to what preoccupied him most about the whole affair.
If someone had overdosed Elizabeth Matthews, whoever did it had come prepared.
Sunday, July 6, 11:52 p.m. Palliative Care, St. Paul's Hospital
Sadie Locke had had a good day.
Thanks to that nice Dr. Garnet, she'd spent several hours enjoying the evening air sitting out on the roof of the west wing. It felt cool against her face, despite having to still wear her mask. He'd insisted on that, explaining that other patients would soon be allowed to make excursions there and they had to keep the area free of contamination, just like any other part of the hospital. The rest was great. A perimeter of potted trees rustling in the breeze reminded her of the parks where she'd watched Donny play near her home in Lackawanna, a former railway town south of Buffalo. Later, as the sun dropped lower over Lake Erie, birds gathered in the branches above her head, mistaking the pretend forest among all the concrete for the real thing. They'd darted happily from branch to branch, oblivious to the artificiality of it all, filling the air with evening song. Along the lake's edge in the distance, the brick chimneys of deserted factories that hadn't belched smoke since the days when she'd been a young mother now attracted black swirling clouds of starlings above their orifices. At some unseen signal, they reared by the thousands into the dusky sky, then swooped inside, as if those towering columns had sucked them back down to their last flittering dark speck.
Now, after all that excitement, she couldn't sleep. The night noises of the hospital startled her awake whenever she drifted off, and an overhead air vent exhaled polar air that washed over her head with the chilling effect of ice water. Footfalls in the hallway as families on death watch came and went to the other rooms disturbed her further- not so much the sound, but what it evoked: the inevitable approach of that day when the steps would come for her. She thanked God Donny would return while she still had the strength for a few good hours, perhaps sit out on that roof with him. She'd like to pass an afternoon chatting about how much fun they'd had together when he'd been little and his father had been full of hope that his own dream, Lucky Locke's, would be the best restaurant in town.
She felt around in the darkness for the plastic cup of water that the nurses had left on the night table and, finding it, took a sip.
She wanted one more chance to tell Donny how much joy he'd given his father.
Otherwise she feared he would only remember the man who'd slowly withdrawn into sadness, overwhelmed by the ordinariness of what Lucky Locke's ultimately became- a dreary lunch counter that sucked eighteen hours a day from him for over twenty years until he died.
She took another sip.
God willing, she would talk more frankly than ever with Donny now, hold nothing back, make sure he understood how his own achievement must be soothing to his father's dear departed soul. Especially the name Lucky Locke Two. That had been a nice gesture on Donny's part.
A third sip.
Before the cancer tied her more and more to treatments at home, she'd visited Hawaii several times and seen the restaurant. It stood in a grove of palm trees on a street with a lot of A*s in the name that she could never remember, like a lot of Hawaiian words. Of course, any more trips there would be impossible.
A figure darkened her doorway.
She sat up.
"You awake, Sadie?" said a familiar voice.
"Father Jimmy. You're late tonight." The chaplain never failed to drop in to see if she'd fallen asleep yet, having learned of her insomnia shortly after her arrival.
He walked over and sat on the end of her bed as usual. In the half-light from the corridor, she saw that his eyes were more drawn and tired than ever.
"Thinking of Donny again?" he asked.
She smiled. He always knew. "I miss him so. And want to see him while I still can… before I…" She nodded toward the corridor where the latest visitors shuffled by, also garbed in protective gear, their muted voices already funereal.
He patted her hand and said the reassuring things he always did, but he seemed distant.
"How are you, Father? You're not your usual chipper self tonight."
"Me? Oh, thank you for asking. I'm fine- just tired after yesterday's big race. Did I tell you our Flying Angels won?"
"Yes. When you were here last night."
"Did I? Oh, sorry. I'm getting forgetful. And boastful, it appears, judging by my going on about our win. Pride goes before the fall."
"Depends on what you're proud of, Father. I'd say it's permissible to let your light shine in the matter of raising money for the hospital." She'd hoped to get a chuckle from him, but no such luck. "And you were right about that Dr. Earl Garnet. Remember I told you about his paying me a visit?" she continued, trying a different tack.
"Oh?"
"A first-rate man. He came by here again today and arranged for me to sit out on a lovely roof garden. He looked almost as tired as you, Father, yet took the time. I hope you don't mind, but he also seemed a bit down, so I said that you thought the world of him. That cheered him a bit. He laughed and said you'd put him up to coming on the ward in the first place." She'd hoped that after hearing one of the many small ways he had made a difference to her and others, Father Jimmy might relax a little. The tension around his eyes made it obvious that he needed someone to cheer him up once in a while.
Instead he cringed. She also noticed that, side-lit from the hallway, his normally youthful skin looked puffy in the shadows.
He must really have had a hard day, she thought, after they'd said good night.
She next awoke to the sound of running feet and the wobble of fast-turning wheels that she immediately recognized, and dreaded.
Another one unprepared to die.
As much as she wanted to see Donny again, she'd signed the DNR form when the nurses first presented it to her. Otherwise, when her time came, they might resuscitate her, and she'd have to meet death twice or more. Once would be enough, thank you very much.
She lay there, listening to the whump of the paddles as they delivered their shocks of electricity and the hushed, clipped voices of the team as they called it, then the telltale quiet.
Rarely they'd rush back out of the ward, pushing the bed, pumping breath into a ghastly-faced man or woman who would then linger on tubes, IVs, and a respirator in what must be a living purgatory. More commonly, the team quietly returned do
wnstairs with their cart, and it would be the sobs of the family, if there were any present, that broke the stillness. Afterward the staff would lead them away, green-shrouded figures escorting the family members slowly in a ghostly procession. Finally, the sheeted form would be wheeled out.
The thought of herself eventually ending up in a refrigerated morgue with a lot of other corpses gave Sadie the creeps, and she tried not to think about it.
Outside her window a rind of gray light had eaten into the night sky along the eastern horizon. She turned to her bed table and did what she always did when the resuscitation team came calling: marked a tiny cross on her calendar and said a prayer for the victim, however the body left the floor.
Chapter 7
Monday, July 7, 12:35 p.m.
The roof garden, St. Paul's Hospital
I leaned back on the chair and pretended to enjoy the heat of the noonday sun on my face. But fear had become my cancer. Always present, it ate away at me day and night.
There were moments when I forgot. Awakening from sleep, I could still surface to the promise of a new day with a peace of mind that belonged to the time before I'd killed. Then the memories would sweep through me, and I would sink beneath the weight of my secret, knowing I could never escape its chains, never redeem myself. But as soon as I started to play my part, I would be okay.
Until I thought of Earl Garnet being on my trail.
Like all good physicians, he had an obsessive nature when it came to solving clinical problems. But if he sensed something wrong- lab mistakes, errors in judgment, incompetent technique- watch out. It was almost as if he took screw-ups like that personally. He was forever lecturing about how they caused avoidable injuries that the culprits could have prevented, and just about everyone at St. Paul's knew he would consider such failures a betrayal of those who had entrusted their lives to his domain in ER. I don't think he consciously aggrandized himself with that way of thinking. It was more an attitude that he'd be damned if anything would go wrong on his watch. None of that bothered me as long as he'd confined himself and his scrutiny to his own department. But now that he'd expanded his territory…
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