The Inquisitor

by Peter Clement

  Earl hesitated, not sure this would be the best time to bring up his own problem.

  "Out with it, Earl," Stewart said, but didn't look up. "What do you want?"

  "I need a favor about the Matthews case."

  Stewart's pen stopped in midstroke. "Oh?"

  "Yeah. I just came from her post. The gross showed tumor as expected and no surprises." He handed over the folder. "These are the morphine levels found in her blood, and the resuscitation team's observations, including an estimated time of death. The rest are lab reports, nursing notes, the times of the injections and the doses. Plus her height and weight."

  "So?"

  "I want you to calculate backward and figure out the dose she must have received before she died." Complex formulas existed in obscure pharmacology references involving the metabolic breakdown rate and body dispersion quotients for just about every drug in the world. They made the exercise possible, and Stewart read that kind of thing as light reading.

  "Wait a minute. You figure someone gave her more than what you prescribed?"

  "In a word, yeah."

  His eyes narrowed, suspicion displacing fatigue. "Why are you asking me to figure it out? You could do it yourself."

  "And Wyatt would immediately demand an independent opinion. He's lit a fire under pathology to have the slides ready early next week, plus scheduled death rounds for the day after. In other words, he's hot to nail me. I need you in my corner on this."

  Stewart continued to scrutinize Earl, his brow unfurling slightly. "Yes, of course. I'd be glad to help you out. But who do you suspect screwed up? I've pissed off too many people at St. Paul's already not to check out whom I'll offend this time."

  Earl told him his theory about the nurses and the double dose.

  Stewart's forehead relaxed the rest of the way. "Count on me."

  Evidently Yablonsky and company weren't on his don't-mess-with list.

  "But what if I don't get the results you expect?" he asked.

  "Then I'm probably screwed." Earl got up to leave, then added, "Oh, by the way, I heard about some other peculiar goings-on up there that I've been meaning to ask you about."

  The frown returned.

  "Wyatt told me some patients have been complaining they'd had near-death experiences, and when his nurses asked you to look into it-"

  "That was bogus!"

  "Bogus?"

  A flush spread over Stewart's face from under his mask. "Yes. The ones I talked to no more had a near-death experience than you or I."

  "I don't understand."

  "I told Wyatt it probably resulted from all the media reports my work has generated. The power of suggestion, combined with all those drugs they're on, can make for some pretty potent dreams."

  "But Wyatt said that after interviewing some of the patients you accused him of trying to set you up."

  His color deepened. "Well, that's not exactly true…"

  "And according to the nurses, you stormed off the ward mad as hell."

  "Mad? Not at all. Annoyed, maybe, that they'd wasted my time, making me check out crap reports."

  Earl's curiosity grew. Stewart never minimized a slight or perceived wrong, yet here he seemed intent on portraying whatever happened up there as inconsequential. "Explain crap."

  "The accounts were made up. Trust me, I've analyzed enough true experiences to know the components common to the real thing. These just weren't authentic."

  For a man who always had at least ten reasons to support an opinion, and in any discussion would usually machine-gun Earl with them, "Trust me" sounded positively evasive. "Look, I'm not blaming you for anything, Stewart. It's just if you found something screwy going on in Wyatt's department, I want to know about it."

  Stewart's ears became glowing red half shells. He took a breath, then exhaled slowly, practicing one of the many self-control techniques Earl knew he'd tried to learn over the years. "Okay, I first got a little steamed and figured Wyatt and the nurses had primed their patients to try to dupe me into believing a bunch of trumped-up accounts."

  "Dupe you? Why the hell would they want to do that?"

  The pupils of his eyes flared wide with anger. "To discredit me and my work." He leaned forward, continuing to speak with a hushed urgency that Earl found uncomfortable. "You see, if I fell for it and incorporated those stories as part of my research cases, then they could expose what happened, and it'd be ammo for all those who say my publications aren't real science."

  Lord help him. "Stewart, for what conceivable reason would Wyatt and a floor full of palliative care nurses even want to do such a thing, let alone go to all that trouble? And how do you figure they got the patients to cooperate?"

  Stewart took another protracted breath. "Well, I had to admit afterward that that part didn't make sense."

  Thank God, Earl thought, grateful to see that a flicker of reason had once again prevailed, however barely.

  A layperson might label Stewart paranoid. Earl knew better. He read him as someone bright enough to scan twelve steps ahead of everybody else and see possible scenarios that might mean very real trouble. A great asset in ICU, but a little hard to take in everyday life. What distinguished him from a truly crazy person? He could admit later, although it took a little encouragement, that perhaps his predictions, when they were based on his social exchanges with people, weren't all that probable. Stewart appeared to have once more cleared that hurdle as far as Wyatt was concerned, but Earl still sensed that he was holding something back. "You haven't explained why you thought the accounts were bogus," he said, trying not to sound confrontational.

  The flush receded. "I just knew, that's all. Pattern recognition. Hey, some things aren't quantifiable."

  Bullshit! Stewart could and would quantify anything remotely to do with his research, including how to recognize bogus data. But in an attempt to render him less defensive, not more, Earl nodded and took another tack. "So you don't think Wyatt is up to anything. Believe me, it might help my situation if I had something on the guy."

  Stewart immediately relaxed. He sank back in his chair, his high color returning the rest of the way toward normal, and cocked a bushy eyebrow as if Earl were the crazy one now. "I meant only that the idea of Wyatt recruiting patients and nurses to discredit me didn't make sense. But don't think he wouldn't sabotage another researcher's work, even outside his field. That hothead's so bitter about losing the limelight, he can't stand to see anybody else step into it." Stewart raised his head a little, as if posing for a profile shot. "Especially when that person is as controversial as I am."

  4:00 p.m.

  All researchers were crazy.

  Every one of them secretly believed that his or her work in whatever little corner of the scientific world, however obscure, deserved a Nobel prize. Lifelong feuds, suits, countersuits, allegations of plagiarism, fraud, and the theft of data, suicides, murders- all committed over impugned reputations. The high drama of behind-the-scenes passions remained legend, and this in a profession supposedly dedicated to the cool practice of objective reason.

  And Stewart carried that fire in spades, Earl thought, steaming into the elevator. He just wished he could keep St. Paul's free of it.

  Some VP, medicals, he knew, spent half their workweek pulling prima donnas from each other's throat. Stewart's wacky story hadn't made sense, but if it had even a speck of truth to it, he'd better check it out and nip in the bud whatever was developing between Stewart and Wyatt. One thing was for certain- Stewart had been hiding something. Earl felt that in his bones.

  The ride to the eighth floor took five minutes this time. Small groups of masked patients dressed in robes and pushing their portable IV stands tottered off at each stop, insisting loudly to each other that they should file a complaint about all the waiting they'd had to do in physio that afternoon. He thought nothing of it until he remembered that part of his new position meant he'd be the one who would ultimately answer to them.

  Monica Yablonsky stiffened as he ap
proached her desk, and she started to fidget with her glasses again.

  "Mrs. Yablonsky, I want to see that list you were to prepare for me, the one Dr. Deloram used when he came here to interview patients who'd reported-"

  "I know the one you mean, Dr. Garnet." She drew herself into a parade square stance, erect, as if ready for inspection. "Except I'm afraid it won't do you much good."

  "Why?"

  Her eyes avoided his. "There were only five names to begin with."

  "Then I'll talk to those five."

  "But you can't."

  "And why not?"

  "Three of them already died. The other two are comatose."

  4:25 p.m.

  Medical Records hadn't picked up the files of the deceased to store them in the archives yet, so he'd looked at them on the spot.

  Two of the dead had been DNRs, not expected to survive much longer. The third had rallied last week and had been slated to go home for a few days. A code had been called for her. None of the clinical notes for any of them indicated a thing out of the ordinary in their deaths, except that all three had been discovered pulseless and not breathing just before dawn.

  As for the two people in a coma, it took little more than a cursory glance at their recent lab results to see they'd been in bad shape to begin with, both having started the slide toward metabolic meltdown that often accompanies cancer patients in decline. Nobody found it unusual that they couldn't be roused as the nurses passed out breakfast trays that morning.

  He returned the dossiers to Yablonsky's care without comment. She'd hovered about him as he'd glanced through them, appearing as uneasy about him going over the five cases as she had with his questioning her about Elizabeth Matthews's death. Let her sweat, he thought, figuring it might trip her up if she had something to hide. Because if his instincts and math were right, somebody sure did.

  "The nurses who reported the near-death experiences- I'd like a list of their names," he told her.

  She swallowed. "That might take a few days."

  "I want it in twenty-four hours."

  He rode to the ground floor at the back of the elevator, scowling. No physician liked coincidences, especially when it came to explaining matters of life and death. People died when and where they did for specific reasons. Failure to know those reasons meant he'd missed something until proven otherwise. Yet here he had five patients able to talk with Stewart Deloram on Friday who were unable to talk to anyone by Monday.

  Unusual? Maybe not, he tried to tell himself, all at once following a talent he'd honed to a fine edge over the years: to play devil's advocate with his instincts. People died every day on a terminal ward. And those expected to pass on soon might have slipped into comas last night. Certainly the outcome for any of the five patients in question, taken individually, wouldn't raise suspicions. Natural causes could explain each one. Hell, if he tried to make a case otherwise, Wyatt could accuse him of dreaming up conspiracy theories to divert attention away from the Matthews inquiry. Still…

  He went directly to his office and sat down at his computer. Using his newfound powers as VP, medical, he entered the codes that let him access the records of all departments. He pulled up Palliative Care, intending to see how many other people had died up there overnight and whether the three deaths were part of a larger than usual number. Not that that would mean much in itself. Some days were simply bloodier than others. Nevertheless, it would be interesting to know.

  As a quick way to find out, he looked up discharges for Palliative Care this morning. There were six.

  Was that a lot? He had no idea. He clicked up the average number for other mornings over the last few months and got 2.7.

  "So there were three-point-four more bodies than usual," he muttered, impatient with how absurd statistics could seem at times. He also bet there were other days when the count would be just as high, and sure enough, when he requested a tally, he found that at least a dozen times in the last twelve weeks the morning dead had numbered six or more.

  Yet three deaths and two patients slipping into a coma continued to disturb him because of the odds.

  If he'd done the multiplication right, out of the hundred patients in palliative care, the chances that this would happen to the five Stewart talked to, all other things being equal, were one in nine trillion.

  Which meant someone must have had a hand in their outcome.

  But of course all things were never equal with a ward full of cancer patients. These five might have been closer to death than Wyatt thought, and maybe Stewart, in his perpetual readiness to take affront, had been wrong about their near-death accounts being bogus. They could have actually experienced what they reported because each of them really was about to die, and their deterioration was only nature taking its course.

  In terms of probability that made far more sense than scenarios suggesting foul Play-He began to feel sheepish about his initial reaction. Perhaps he'd let his imagination get the better of him. Having arrived on the floor convinced that Stewart had been hiding something, and unclear what Wyatt might be up to, if anything, he'd failed to coolly consider all the possibilities. What a dumb-ass medical-student move. He didn't usually jump to conclusions like that. Of course, his already being suspicious of Yablonsky didn't help matters any, having primed him to think the worst.

  But he damn well would insist that Stewart level with him about what exactly he'd thought was bogus when he talked with the five patients. And if even a hint turned up that Wyatt had tried to undermine Stewart's or any other researcher's credibility, he'd nail his hide. Whoa, there he went, leaping ahead of himself again. Better yank his urge to be in everybody's business back under control. Otherwise there'd be no end to the nastiness he might find. He'd taken the position of VP, medical to make his job of running ER easier, not to replace it with chasing down hospital shenanigans full-time.

  He sat in the stillness of his office and felt the place weigh on him. Eight hundred beds, eight hundred souls, and if he weren't careful, every one of them would land a problem in his lap. And to think that just two days ago Jimmy had accused him of being too little involved with the rest of St. Paul's. Earl wondered if the real danger wasn't that he might get too entangled and be sucked dry. Because when he sensed something wrong, he couldn't let it slide.

  But it was one thing to let the workings of an ER consume him. The tenacity that drove him not to quit on a patient took hold when trouble hit. His reflex as an ER physician was to leap on a problem the way he would a bleeder, well before it got out of hand. Yet he took the challenges in stride and inevitably, one way or another, found solutions. It all happened on a scale that never threatened to overpower him.

  He leaned back in his chair and regarded the spartan furnishings- a steel-gray standard hospital-issue desk, two simple chrome chairs covered in black Naugahyde for visitors, a solitary potted plant that somehow survived the closed space and poor light from a grime-coated window the size of a cafeteria tray- and chuckled. The hospital CEO had offered him surroundings "much more suitable" to his new position, but he'd declined the upgrade, having always found it an advantage to demand sacrifice and best efforts from people if he himself worked out of an austere setting. The trick now would be to keep his perception of what needed fixing just as free of clutter.

  He'd have to compartmentalize like never before, carefully choose his causes, and forget about charging off on wild hunches.

  Keep everything at scale.

  As for Yablonsky, well, he'd deal with her at death rounds.

  Except something about her bothered him. She had definitely been edgy as he looked through those five files. Of course, just being around him could make her nervous, especially if his double-dose theory regarding Matthews was true. Yet..

  Another event niggled at him- her reaction to the word cluster the evening before Matthews's death.

  In a medical context doctors used it frequently, referring to a grouping of any unusual incidents or diseases, even symptoms and s
igns. So it had an unpleasant connotation to begin with, but not one that should have upset an experienced nurse. Unless…

  He knew one context in which the term cluster carried a resonance that gave him a chill.

  He dialed the nursing station and asked for Dr. Biggs. "Hello, Thomas. I wonder if you could go to our teaching files and dig out an article for me. It's one of the epidemiologic chestnuts on CPR in the New England Journal that I present to the residents every year, so you'll probably remember it." A lot of nurses would too, including Monica Yablonsky. The nursing director had asked him to give sessions about it with her staff on several occasions.

  "Sure. What's the title?"

  " 'Mysterious Clusters of Deaths in Hospitals.'"

  Earl hung up and returned to checking discharge statistics for palliative care, going a lot farther back than three months.

  Jane Simmons bought the kit at a pharmacy far from her apartment where no one knew her. She needn't have gone to the trouble. The salesgirl didn't so much as look up during the purchase.

  In the privacy of her bathroom, she applied the drop of urine and waited.

  In one minute she'd know.

  Reruns of the last six weeks tumbled through her mind.

  She'd missed before. Rather, it had come late a few times, by as much as two weeks. She'd assumed that this time she'd skipped a cycle altogether but that her period would arrive any day now. She'd been so careful to use the foam with her diaphragm and insist he wear a condom. It never occurred to her that they could have messed up. "The problem arrives when you forget," Dr. Graceton had reassured her in recommending the switch after the damn pill kept causing nausea, even after many tries on different types and dosages.

  But there had been times in the middle of the night when she woke with him entering her again. God help her, she loved yielding to him in that half-asleep state. Even then she remained aware enough to feel he'd put on protection, and the diaphragm would still be in place from when they'd made love hours earlier, then fallen asleep in each other's arms.