The nurse swabbed at a place on Cormier’s left buttock and gave him the injection of preoperative medication. Fifteen minutes later, his mouth began feeling dry and a warm glow of detachment crept over him. Like the beacon from a lighthouse, the corridor ceiling lights flashed past as he was wheeled to the operating room.
* * *
Louis Ketchem was a towering, slope-shouldered veteran of more than twenty-five years as a surgeon. Over that span he had performed hundreds of gall bladder operations. None had ever gone any smoother than Senator Richard Cormier’s. The removal of the inflamed, stone-filled sac was uneventful except for the usual amount of bleeding from the adjacent liver. As he had done hundreds of times, Ketchem ordered a unit of blood to be transfused over the last half hour of the operation.
The anesthesiologist, John Singleberry, took the’ plastic bag of blood from the circulating nurse, a young woman named Jacqueline Miller. He double-checked the number on the bag before attaching it to the intravenous line. To speed the infusion, he slipped an air sleeve around the bag and pumped it up. Cormier, deeply anesthetized and receiving oxygen by a respirator, slept a dreamless sleep as the blood wound down the tubing toward his arm like a crimson serpent.
At the instant the blood slid beneath the green paper drape, Jacqueline Miller turned away. The drug she had been instructed to use, the drug she had injected into the plastic bag, was ouabain, the fastest acting and most powerful form of digitalis—a drug so rapidly cleared from the bloodstream, so difficult to find on chemical analysis, that even the massive doses she had used were virtually undetectable. Three minutes were all the ouabain required.
Without warning the cardiac monitor pattern leapt from slow and regular to totally chaotic. John Singleberry glanced at the golden light slashing up and down on the screen overhead and spent several seconds staring at it in disbelief.
“Holy shit, Louis,” Singleberry screamed. “He’s fibrillating!”
Ketchem, who had not encountered a cardiac arrest in the operating room in years, stood paralyzed, both hands still inside Cormier’s abdomen. His orders, when he was finally able to give them, were inadequate. But for the work of the nurses, including Jacqueline Miller, several minutes might have passed with no definitive action. Sterile drapes were quickly stuffed into the incision and two unsuccessful countershocks were given. Seconds later, the monitor pattern showed a straight line.
Without warning Ketchem grabbed a scalpel, extended his incision, and slashed an opening through the bottom of Cormier’s diaphragm. Reaching through the opening, he grasped the man’s heart and began rhythmically squeezing. A nurse ran for help, but everyone in the operating room already knew it was over. Ketchem pumped, then stopped and checked the monitor. Straight line. He pumped some more.
For twenty minutes he pumped, with absolutely no effect on the golden light. Finally he stopped. For more than a minute no one in the room moved. Ketchem bit down on his lower lip and peered over his mask at the body of his friend. Then two nurses took him by the arms and helped him move away from the operating table, back to the surgeons’ lounge.
Off to one side, Jacqueline Miller closed her eyes, fearing they might reflect the excited smile beneath her mask. The greatest adventure in her life was ending in triumph. Oh, Dahlia had told her where to go and what to say, but she had been the one to actually pull it off. Little Jackie Miller, ordering around one of the richest, most powerful oilmen in the world.
She tingled at the irony of it all: from girlhood in a squalid tenement to a secret meeting in Oklahoma with the president of Beecher Oil. What would Mr. Jed Beecher have said if he knew that the woman who was giving him instructions, the woman who was taking his quarter of a million dollars, the woman who was dictating his every move had just taken her first airplane flight.
Jacqueline silently cheered the good fortune that had brought Dahlia and The Garden into her life. She still knew little about either of them, but for the present she really didn’t care. When Dahlia was ready to disclose her identity, she would, and that was all there was to that. As long as the excitement and the monthly payments were there, Camellia would do what she was asked and keep her eyes and ears open for cases that might be of interest to The Garden. As for The Sisterhood of Life, they would simply have to survive without any further participation from Jackie Miller. No more free rides.
Mexico. Jamaica. Greece. Paris. Jacqueline ticked the places off in her mind. One more case like this one, and she would be able to see all of them. The prospects were dizzying.
Behind her on the narrow operating table, covered to the neck by a sheet, Senator Richard Cormier looked as he had throughout his operation. But his dreamless sleep would last forever
CHAPTER XII
“Ladies and gentlemen, if you would all find seats, we can get started and hopefully make it through this inquiry in a reasonable amount of time. ”
Like an aging movie queen, the Morris Tweedy Amphitheater of Boston Doctors Hospital had handled the inexorable pressure of passing years with grace and style. Although undeniably frayed around the edges, the cozy, domed lecture hall still held its place proudly atop the thrice-renovated West Wing. There was a time when the seventy-five steeply banked seats of “The Amphi” had accommodated nearly the entire hospital staff—nurses, physicians, and students. However, in 1929, after almost fifty years of service, it had been replaced as the hospital’s major lecture and demonstration hall by a considerably larger amphitheater constructed in the Southeast Wing basement.
Hours upon hours of heated argument on the pros and cons of demolishing the jaded siren ended abruptly in 1952 when the state legislature designated the structure an historic landmark. Her stained glass skylights, severe wooden seats, and bas-relief sculptures depicting significant events in medical history were thus preserved for new generations of eager physicians-in-training.
But, despite a century of continuous service, never had the Morris Tweedy Amphitheater entertained a session such as the one for which this milling group of fifty men and women was assembled. It was eight o’clock on the evening of Sunday, October 5—two days after the postmortem examination on Charlotte Thomas.
As hospital chief of staff, Dr. Margaret Armstrong sat behind a heavy oak table facing the arc of seats. Beside her, attempting to bring some order to the room, was Detective Lieutenant John Dockerty. Dockerty was a thin, rumpled man in his late forties. He wore a gabardine suit that appeared large for him by at least two sizes. His limp green eyes scanned the hall, then turned to a sheaf of papers on the table in front of him. As he looked down, an errant wisp of thinning, reddish brown hair dropped over one eye. He absently swept the strands back in place, only to repeat the ritual moments later.
His languid, almost distracted air suggested he had encountered most of what there was in life to see. In fact, he had spent more than fifteen years on the Boston police force carefully cultivating that demeanor and learning how best to utilize it.
He looked over the hall again, then spoke to Margaret Armstrong out of the corner of his mouth. “This group is obviously much more adept at giving orders than they are at taking them.”
Armstrong laughed her agreement, then banged a notebook on the table several times. “Would you all please sit down,” she called out. “If we can’t show Lieutenant Dockerty cooperation, at least we can show him manners.” In less than a minute, everyone had found a place.
The hospital administrator sat to one side of the hall surrounded by his assistants. He was a paunchy, foppish man who had run away from his Brooklyn home at age seventeen and changed his name from Isaac Lifshitz to Edward Lipton III. For years he had kept his job by pitting his enemies against one another in a way so skillful that none of them ever had the unified backing needed to push for his ouster.
On the other side of the room were clustered the men and women who comprised the hospital board of trustees. The men, a homogeneous, patrician lot, were vastly more concerned with the impact that their trustee positi
on might have on their Who’s Who listings than with the influence that they might have on Boston Doctors Hospital. The token black on the board was distinguishable from the others only by color, and the four women were not distinguishable at all. The inquiry marked the first time in recent memory that the entire twenty-four-member board was present for a meeting.
Midway up the center aisle, Wallace Huttner sat with Ahmed Hadawi and the other members of the Medical Staff Executive Committee. Joining that group, occupying the chair just to Huttner’s right, was Peter Thomas.
The back of the amphitheater was the domain of the nurses. Eight of them, all in street clothes, formed a rosette around Dotty Dalrymple, who appeared volcanic in a plain black dress. Janet Poulos was there, along with Christine Beall, Winnie Edgerly, and several other nurses from Four South, including Angela Martin.
On the right-hand side of the hall, several rows behind Edward Lipton III, sat David. He sat alone until the very last minute, when Howard Kim, the anesthesiologist who had helped with Charlotte’s unsuccessful resuscitation, lumbered down the stairs and squeezed into the chair next to him.
John Dockerty had drawn up the guest list for the evening. Dr. Armstrong had made the arrangements.
“I want to thank you all for coming,” Dockerty began. “You must believe me that inquiries such as the one I have requested tonight occur much more frequently on Columbo and in Agatha Christie novels than they do in actual police work. However, I want to move forward as quickly as possible on the matter of Charlotte Thomas, a matter involving all of you in one way or another. Theatrics have never been my bag, so to speak, but this meeting seemed like the most effective way for me to gather the preliminary information I need, while at the same time keeping all interested parties informed. In the next few days I’ll be contacting some of you for individual questioning.” He looked down at Margaret Armstrong, who nodded her approval of his opening remarks. Then, sweeping his hair back in place, Dockerty called Ahmed Hadawi and motioned him to a seat angled across from the oak table, so that the pathologist could look at him without completely turning his back to the audience.
“Dr. Hadawi, will you please review for us your involvement in the case of Charlotte Thomas?” Dockerty asked.
Hadawi spread a few sheets of notes in front of him, then said, “On October third I performed a postmortem examination on the woman in question. The gross examination showed that she had a deep pressure sore over her sacrum, moderately advanced coronary artery narrowing, and an extensive pneumonia. It was my initial impression that she had died from sudden cardiac arrest caused by her infections and the generally debilitated condition resulting from her two operations.”
“Dr. Hadawi, is that your impression now?” Dockerty asked.
“No, it is not. The patient’s physicians, Dr. Wallace Huttner and Dr. David Shelton, were present at the autopsy. They requested a detailed chemical analysis of her blood.”
“Help me out here, Dr. Hadawi,” Dockerty cut in. “Don’t you do these chemical analyses routinely on each—er—patient?”
Hadawi smiled sardonically and folded his hands on the table. “I wish that were possible,” he said. “Unfortunately, the cost of postmortem examinations must be borne by the institution involved, and it is hardly an inexpensive proposition, what with sophisticated tissue stains, clerical help, and all else that is required. While we would never knowingly omit a critical stain or test, we of the pathology department must nevertheless temper our zeal with judgment that will enable us to stay within our budget.” He paused for a moment and gave a prolonged, hostile look at Edward Lipton III.
“Please proceed,” Dockerty said, scribbling a few words on the pad in front of him.
Hadawi referred to his notes. “Of the many chemical analyses that were done, two came back with abnormally high levels. The first of these, potassium, was seven-point-four, where the upper limit of normal is five-point-zero. The second was her blood morphine level, which was elevated far above that found in a patient receiving the usual doses of morphine sulfate for pain.”
“Dr. Hadawi, would you please give us your impression of these findings?” Dockerty’s voice was free of even the slightest hint of tension.
“Well, my impression of the potassium elevation—and please keep in mind that it is an opinion—is that it is artificially high, a reflection of events occurring in the tissues during and just after the cardiac arrest. The morphine elevation is an entirely different story. Without question, the level measured in this woman was critically high. Easily, although not necessarily, high enough to have caused cessation of respiration and, ultimately, death.”
Dockerty spent a few seconds distractedly combing his hair with his fingers. “Doctor, you imply that death was caused by an overdosage of morphine.” Hadawi nodded. “Tell me, do you think an overdose of this magnitude could have been accidental?”
Hadawi drew in a short breath, looked at the detective, then shook his head. “No,” he said. “No, I do not believe that is possible.”
There was not a whisper or movement in the amphitheater. For several seconds Dockerty allowed the eerie silence to hold sway. Then he said softly, “That, ladies and gentlemen, makes Charlotte Thomas’s death murder. And her murder is why we are assembled nere.” Again silence. This time, Hadawi shifted uncomfortably in his seat, anxious to be done with his part.
“Thank you for your help, Doctor,” Dockerty said to him. As Hadawi stood to go, the detective added, “Oh, one more small thing. You mentioned that the chemical tests were ordered by Mrs. Thomas’s doctors, ah”—he glanced at his notes—“Dr. Huttner and Dr. Shelton. Do you remember specifically which one of them actually asked for the tests?”
Hadawi’s dark eyes narrowed as he searched Dockerty’s face for some hint of the significance in his question. Finally, with a bewildered shrug, he said, “Well, as I recall, Dr. Shelton requested the potassium level. The rest of the tests were ordered by Dr. Huttner.”
Dockerty nodded the pathologist back to his row, whispering another “Thank you” at the same time. He searched the hall for a moment and was facing away from David when he said, “Dr. Shelton?”
Howard Kim reached up a massive paw and patted David on the back as he inched sideways past the giant and into the aisle. David had known for a day about the abnormal blood tests, had even heard the wildfire rumor around the wards that some kind of police investigation was under way. Although Dr. Armstrong had not told him that he would be asked to make a statement, he was not at all surprised to be called by the detective.
Dockerty smiled, shook his hand firmly, motioned him to the seat vacated by Hadawi, and then, seeming at times disinterested, led him minute by minute through the events that followed Charlotte Thomas’s cardiac arrest. Gradually David’s statements became free-flowing and animated. Dockerty’s style made it easy for him to talk. Soon he was sharing information with the disheveled lieutenant in the relaxed manner of two friends in an alehouse. Then, without changing the pace or tone of their conversation, Dockerty said, “Tell me, Dr. Shelton. I understand that shortly before Mrs. Thomas was found by you to be without pulse or respiration, you had a discussion about her and about seriously ill patients in general with Dr. Armstrong here and some of the nurses—namely, ah”—he consulted his notes—“nurses Edgerly, Gold, and Beall. Do you mind telling me what you had to say in that discussion?”
For five seconds, ten, fifteen, David was unable to speak. The question didn’t fit. It made no sense unless … His mind began spinning through the implications of Dockerty’s question to Hadawi as to which doctor had actually ordered the test that had disclosed the high morphine level. The indefinable sense of fear, so vague among his feelings that night on Four South, now thundered through him. His temples began to throb. His hands grew stiff and numb. Holy shit, he’s going after me! He’s going after me!
At that moment he realized that Dockerty’s eyes had changed from liquid to steel and were locked on him, probing, gauging,
boring in. David knew it had already taken him too long—far too long—to react to the question. He inhaled deeply and fought the panic. Loosen up and stop reading so much into this, he thought. Just tell the man what he wants to know.
“Dr. Shelton, do you recall the incident I’m asking about?” The elaborate patience in Dockerty’s voice had a cutting edge.
Even before he answered, David sensed that his words would be stammered and clumsy. They were. Expressing his thoughts around “er’s” and “ah’s,” he said, “I simply told them … that a patient who is … in great pain with little hope of surviving his illness might … might be treated with some temperance. Especially if the therapy planned is … particularly painful or … dehumanizing … such as being put on a respirator.” He battled back the urge to say more, consciously avoiding the panicked talking that comes with trying to explain an explanation.
Dockerty ran his tongue slowly over his teeth. He bounced the eraser end of his pencil on the table. He scratched his head. “Dr. Shelton,” he said finally, “don’t you think that withholding treatment from a sick patient is a form of mercy killing? Of euthanasia?”
“No, I don’t think it’s a form of any kind of killing.” Molten drops of anger began to smolder beneath his fear. His voice grew strained. His words came too rapidly. “It is good, sensitive clinical judgment. It is what being a doctor is all about. For God’s sake, I’ve never advocated shutting off a respirator or giving anything lethal to a patient.”
“Never?” Dockerty delivered the spark softly.
David exploded. “Dammit, Lieutenant, I’ve had more than enough of your insinuations!” He was totally oblivious now to all the others in the amphitheater. “If you have an accusation to make, then make it. And while you’re at it, explain why I was the one who kept saying that something wasn’t right during the resuscitation. Why I was the one who requested the potass …” The word froze in his mouth. He realized even before Dockerty spoke, what the detective was driving at. “Damn,” he hissed his frustration.
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