Imperfect Contract

by Brickman, Gregg E.

  She nodded, but continued writing.

  "What happened to Mr. Hutchinson?"

  "He was fine this morning when I made rounds upstairs. I'm trying to understand it now," Dr. Staiger said.

  I looked to where her finger pointed.

  "Everything was fine. Vital signs stable, neuro exam stable, vent management on track. Then he arrests." She glanced at me. "Any ideas?"

  "No, but that's why I came down to read the chart. It's a mystery to me, too."

  I've known Dr. Staiger for years. She was my neurologist when I was injured. She pays more attention to me than she does to most of the nursing staff, and she still ignores me about half the time.

  "Were you on the floor when he coded?"

  "No, sorry. I was at lunch. Connie responded when the monitor tech alerted her to the changes in Hutchinson's rhythm. Another staff nurse beat her to the room and was attaching the Ambu when Connie arrived."

  "Sophia, I talked to the other staff nurse already. She told me she found the ventilator tube disconnected and lying next to his neck."

  "I didn't know."

  "It's here in the chart." She pointed to the neat entry in the nurses' notes.

  "She should have told me." I felt stupid for not knowing and wondered why a staff nurse would write it in the chart and not tell the charge nurse. I planned to ask her later.

  "Look at this." Staiger flipped back a couple of pages to the ventilator management sheet. "We started weaning him a couple of days ago." She looked at me over her thick lenses. "He was doing better, triggering the vent a lot on Thursday and Friday, rate way down, pressures . . ." She pointed to a graph to show me his progress. "Yesterday the pulmonary guys started trials off the vent. He tolerated three or four minutes during the day, but last night he was up to almost six."

  "Do you think someone took him off for the weaning and forgot about him?" I said, thinking about Vanessa, though I didn't believe she would harm him.

  "That could be." She leaned closer to me. "But Sophia, you were a cop. Someone tried to kill him before. What better time than now to finish the job?"

  "Did they?"

  "Finish the job, you mean?" She raised her eyebrows over the top of her frames.

  I nodded.

  "Yes." She jerked her head in Hutchinson's direction. "Anything he was recovering is lost and more. I completed the physical examination for brain death. He didn't respond to any of the tests. I've ordered an EEG for confirmation and a consult with another neurologist. I expect we'll declare him brain dead by tomorrow morning."

  "Do you need to notify the medical examiner before you do anything? I mean, this would make him a murder victim, even if the ventilator thing was an accident."

  "I'll give him a call," she said.

  "Let me know what you find out, please."

  "Why are you so involved in this case?"

  "Um, well . . . Ray asked me to poke around. And, to tell you the truth, Amelia asked me to see what I could do, too."

  She waved me off. She knew I wouldn't tell her the details. She also knew I sometimes involved myself in things.

  She picked up the phone to call the medical examiner.

  I called Ray to tell him his attempted murder case would upgrade to murder by this time tomorrow. I left a message on his voice mail at the department. While I was at it, I thanked him for the concern he had shown the previous night.

  18

  Dr. Staiger declared Barry Hutchinson brain dead early the next morning—Monday, the twenty-first of May. It was one month after the first attempt on his life. The clues on the drive-by shooting had grown very cold in my estimation.

  Ray paged me around eight. After a moment's worth of small talk, he said, "Jamel has been dealin'. One of our boys on the street was very convincing. He's also has a history of bullying his parents. The other occupants of the strip center heard raised voices a number of times."

  "I thought you said you weren't going to spend anymore time on the case, that more recent homicides took precedence."

  "That was before I got the story from the informant."

  "I don't understand why he'd harangue his mother for money then. It doesn't make sense to me. If he's dealing, he should have enough money to buy and sell poor Amelia. Does it make sense to you?"

  "You said on your message that Hutchinson was going to be declared dead. Did that occur?"

  He asked a detective-like question of his own rather than answer mine. I couldn't tell if he didn't have an opinion about the money issue or didn't give a damn about my comment. What was obvious was he wanted to get off the telephone and onto whatever it was on his mind.

  "There are some things happening down in ICU, I think. Why don't you give Dr. Staiger a call? She can fill you in."

  "Sophia, just give me the damned information."

  "Sorry, Ray. I'm a little busy right now. I don't have the damned information." I rattled off the extension for critical care. "I'll try to transfer you. Have a nice day." I hit the switch hook twice and then hung up the telephone.

  I decided to stroll to ICU. My unit was quiet for a change, and I took a break off the unit—a rarity on the best of days.

  Amelia sat with Jamel in the ICU waiting room. It's a cozy room, decorated in muted teals and mauves, with the chairs arranged in family-sized conversation nooks. A couple of small windows opened onto the corridor leading to the unit.

  I slipped by, wanting to see what was going on inside before I spoke with them.

  Though officially dead, Hutchinson's chest moved up and down with the rhythm of the ventilator, and the cardiac monitor showed a regular heartbeat. There was a lot of activity near his room—organ donation, I thought. Several people I didn't recognize as regular staff members hung around, one of them deep in discussion with the nursing supervisor. Dr. Staiger sat in the dictation room with someone in a white coat. I decided to check it out.

  I tapped on the window. Dr. Staiger glanced at me, didn't smile, but waved me into the small room.

  "Sophia, this is Allison White. She's a nurse from the University Organ Procurement Agency." Staiger tipped her head in the direction of the attractive, mid-thirties, African-American woman sitting to her right.

  "It's nice to meet you, Allison."

  "It's never nice to be here, not in a situation like this," White said. "However, we were glad to get this call."

  "Dr. Staiger, I'm surprised. I hadn't considered this as a possibility."

  "When I called the M.E.," Staiger said, "he suggested we pursue transplantation. He said Medical Examiners provide a large number of healthy organs to the transplant programs. They work with the teams all the time."

  I looked at White. "How can he determine the cause of death after you harvest the organs?"

  "In this case the initial injury was to the head. We never open the cranium, so that's not a problem. We only take the undamaged organs. We take pictures, and the M.E. still has an opportunity to do an examination. Besides, we're very interested in donors like Mr. Hutchinson."

  "Why?" I had spent my nursing career working on medical-surgical units and in the emergency department, and I hadn't had much exposure to the organ transplant process.

  "A couple of reasons. Mr. Hutchinson was stable for the month after his injury. The accidental disconnecting of his ventilator . . ."

  "If it was accidental," I interrupted.

  "That doesn't matter to us in this case. His kidneys and his heart are in very good condition. His infections have all been resolved. He's an excellent candidate. The challenge is to get the family to consent."

  "Why is it so important? I know donor organs are in great demand, but one more or less?"

  White gazed at me, her dark eyes snapping with life. "Because, even though African-Americans comprise over thirteen percent of the population, they receive twenty-seven percent of the donated kidneys, but only donate a little over ten percent themselves. Minorities suffer more end-stage kidney disease than do whites. But whites donate the v
ast majority of the organs. It's important to have donations from different races and ethnic groups. People are more genetically similar to members of their own group, so they get a better match."

  I gave her an oh really rise of the eyebrows. It provoked her to continue her lecture on the ethnic issues of organ donation. I listened while she dispelled the myths about racial discrimination in organ transplantation programs.

  I asked, "If that's the way it is, why don't more African-Americans donate organs?"

  "Good question. Distrust of the system maybe, lack of knowledge about the problem, not understanding a normal funeral and burial can still take place. We deal with those issues every time we make a request." She raised one hand. "That's why I'm here today. We hope that by having the request made by someone culturally similar, we'll have greater success."

  "I know the family well," I said. "I'll be happy to help in any way I can."

  "Thanks." White faced Dr. Staiger. "Is there anything else you can tell me?"

  "No, I think it's all been covered." Dr. Staiger stood. "I'll come with you to make the request."

  "Sophia, would you like to come along?" White asked.

  "Give me a minute to call my unit and see if it's a problem." I used one of the telephones in the dictation room. Everything was fine. The charge nurse said she'd reassign my few patients to another nurse. It took me about five minutes to give a report on my patients, then I was ready to go into the waiting room with White and Dr. Staiger.

  The family knew Hutchinson was brain dead. Dr. Staiger had spoken with them earlier. They had had some quiet time to contemplate the situation. Now was the opportunity to make the request.

  Dr. Staiger introduced Allison White. "She's from the University transplant team and would like to talk with you about making a donation."

  Amelia, with her nursing background, didn't seem surprised and appeared eager to agree. Jamel acted wary of the process.

  I stood in the background and listened as White explained the program, the fact there was no cost to the donor family, and that something good would come of all this grief.

  Jamel spoke first. "You gonna pay us to take the old man's organs?"

  "We can't do that, Mr. Hutchinson. The law forbids it. It would be an act of charity and kindness on your part. We desperately need organs for other African-Americans. It reduces the risks of rejection."

  "You probably want to stick my old man's insides into some rich white dude."

  "We try to get the best tissue match possible." White sat next to Jamel and explained the facts about organ donation.

  "Seems to me we should get paid." He pointed to the ICU unit's door. "Besides, who's going to pay for all of this?"

  "That's not the family's responsibility," White said. "Any charges entered after your father was declared brain dead are paid by the program."

  The conversation continued with assurances the family could have an open casket funeral, promises to let them know about the organ recipients, and more firm refusals to consider paying the family for the organs.

  Jamel, to Amelia's obvious relief, finally gave up the notion. He said, "Do whatever you want. I'm outta here." He left.

  I thought he left the hospital, but I found him a few minutes later standing outside the men's room, tears flowing over his cheeks.

  It was good to see some emotion from the punk. I asked him to come back to his mother. He shuffled in the direction of the room, and I kept pace with him.

  Dr. Staiger was gone, but two ancient women had arrived during my absence. They wore flowered dresses, white gloves, and white hats. A folder chrome walker with tennis balls on the tips of the legs leaned against an empty chair.

  "Sophia," Amelia said, "these ladies are my distant cousins Clara and Martha Lee. They're about the only kin I have around here."

  White excused herself, saying she'd be back in a few minutes with the papers.

  I sat with the family until it was obvious they no longer desired or welcomed my presence. When I returned to my nursing unit, they didn't need me either. The South Florida population is seasonal, and the hospital census fluctuates. Glad to be free for the rest of the day, I clocked out and went home.

  19

  After I let Sunshine out of his crate and submitted to the expected welcoming ritual, I called Samantha Davis, the staff nurse who found Hutchinson in cardiac arrest.

  "Tell me what you saw when you found Hutchinson."

  "He wasn't breathing, making no respiratory effort at all. His ventilator tubing was lying next to him on the pillow—like it had popped off."

  "Did you have any reason to think he disconnected himself when he coughed?"

  "You mean with a lot of secretions?"

  "Yes."

  "No, the respiratory therapist left the room a few minutes earlier. I saw her go from Hutchinson's room to the patient down the hall. The tubing was clean as a whistle."

  "Did you see anyone else around?"

  "There have been so many people in and out of Hutchinson's room. Umm. A bunch of young dudes. A tall, white, skinny guy with a big scar on his face. Barry's wife, and I don't know who else. I had the patient in the next room, and we were talking about the amount of commotion and the number of visitors."

  "Samantha, I was in charge. Why didn't you tell me you found the vent disconnected?"

  "I told the doctor. I told Connie. I charted it. I put it in the incident report. I just forgot to tell you. What's the big deal?" She sounded annoyed.

  "I'm curious, that's all. Staiger raised the issue. I didn't know the details until I read the incident report. You'd left for the day. Then I find my name on a serious incident. Caught my attention."

  "Anything else you want to know?" The tone was cutting.

  "No, you've told me enough. Thanks for the help."

  I showered, slipped on an above-the-knee black skirt and white pullover, then applied blusher, shadow, mascara, and lipstick. I spritzed Chanel No. 5 behind my ears and between my breasts—I can't quite call it cleavage. I planned to find Ray, and I intended to get his attention. It was time to get to the truth.

  I had no facts to support the ventilator tubing popping off versus someone removing it. If my hunch was accurate, someone disconnected Hutchinson's vent. That would make the drive-by shooting an attempted homicide, and this the actual murder. Maybe it was the same person behind it all. Hutchinson was dead either way.

  I inventoried the suspects. Amelia. Possible but doubtful. Jamel. More feasible. I heard him threaten to disconnect the ventilator, but I thought him to be spineless. Michael Wiley. Competition gone bad? Hutchinson's girlfriend? Improbable, she would have everything to lose and nothing to gain by his death. Who else? If Hutchinson had mishandled Vanessa's real estate deal, he might have done the same with others. The possibility existed that Barry Hutchinson created many enemies.

  Rather than calling, I decided to drop by the police department. I hadn't set foot inside for two or three years.

  A handwritten sign taped to the glass in the first floor lobby directed all comers to the second floor by way of the elevator. Beyond the unused reception window, bare two-by-fours framed a small area. A stack of sheet rock blocked an unfinished spiral stairway.

  When I approached the glass-enclosed counter in the second floor lobby, the woman sitting there greeted me by name. I hadn't seen her in years. "Are you here to see Detective Stone? I think he's back there." She motioned over her shoulder. She called Ray's extension.

  I made my way through the maze of unmarked corridors. Though the building appeared modern from the outside, the inside showed the years of use and abuse—drab paint, worn tile, and marred furnishings.

  Ray smiled as I approached. He seemed glad to see me. A couple of the other detectives watched me walk by, one commenting I never looked like that in uniform.

  "Chuck," I said, throwing him my biggest smile, "police uniforms weren't intended to be attractive—what with bullet proof vests and all."

  One thi
ng I remembered hating about the job was the nasty pants—cut for a man. As a result, women ended up with square hips, and the heavy belts covered any hint of a waistline.

  "How you doing?" he said when I stopped next to his desk.

  "Fine. Nursing is my niche. It fits me."

  "Why are you here then?" he persisted.

  "Just came by to see Ray, that's all."

  He cocked an eyebrow and nodded in Ray's direction. Chuck had been around a long time and knew my history with Ray. By tomorrow everyone in the department would know I visited and rumors of a renewed romance would be rampant. The department is like a small town. Everyone knows everyone's business.

  I pulled a chair next to Ray's desk. He looked good. He'd opened his white shirt at the neck and loosened his gray and red print tie. Wisps of chest hair peeked out. A slate gray suit coat hung on the back of his chair. I waited for him to finish whatever he was writing.

  He laid his pen on the legal pad and smiled, his eyes traveling the length of my body. "To what do I owe the honor of this visit?" He leaned back in his swivel chair, making eye contact. "I expected a phone call, maybe."

  "You know Hutchinson was declared brain dead," I said, intent on my agenda. "They’re harvesting his organs at this very minute."

  "I didn't know about the organs." He reached for the telephone. "Have they been in contact with the M.E.?"

  "Sure. He made the suggestion."

  He dialed the telephone. "I'll just verify that if you don't mind."

  "Sure, why not? I came from there. What would I know?" I stood to leave. I didn't like distrust.

  "Sophi, sit."

  "Arf, arf." He pissed me off. I waited while he finished his discussion with the M.E. I saw his point. If he didn't make the call, and the organ donation compromised the case, it'd be his butt in the sling.

  "Now, would you like to relax, or did you come here to get ticked off?" He raised his left eyebrow and waited.

  I sat. "It was a tough morning. I went to ICU to check on Barry and ended up staying through the donor request process and the aftermath. It's draining, exhausting." I told him about the whole thing, including Jamel's repeated request for payment. "I don't know about that kid." I finished my tirade and smiled, relieved to have it off my chest.