Prescription for Trouble - 03 - Diagnosis Death

by Richard L Mabry

  "So, what are you going to do?"

  "What's best for the patient, of course. Our esteemed administrator can go fly a kite." David flashed a grin. "But there's no need for you to worry. It's me he'll come after."

  "He's already after me," Elena said. She told him about her visit in the administrator's office earlier. "I've talked with Marcus Bell. He told me not to worry, but that's hard to do." She picked up a pencil from the desk and started tapping out a nervous rhythm on a metal chart cover. "Why is Nathan so uptight about insurance and payments?"

  "I can answer that," David said. "My associate told me the whole story when I first interviewed here. Marcus was doing a good job as chief of staff, but he wasn't riding herd on payments. You and I both know that most doctors aren't wired that way. So the hospital board hired Nathan. His contract specifies that Summers County General has to show a profit within two years, or he's gone. And the contract only has a few more months to run."

  "So the more nonpaying patients he can move out of here, the better his chances of keeping his job. Right?"

  David touched his nose. "Bingo. You got it."

  Elena finally told David goodnight, promising to call him tomorrow. She was driving out of the parking lot when her cell phone rang. Without taking time to see who was calling, she answered.

  "Elena, this is Marcus. Did I catch you at a bad time?"

  She wheeled into an empty parking space and killed the engine. "Not at all. Just tired. Are you through with your case?"

  "Uh-huh. Perforated peptic ulcer. Did it laparoscopically. Isn't modern technology wonderful?"

  "I don't think laparoscopic surgery would have worked for what we did. David did a stat C-section for a placental abruption."

  "Yeah, that's one reason I called. I wanted to thank you for stepping in. That's something the doctors here at Summers County General have to do—help out in a pinch."

  Elena pushed the lever to lean back in her seat. "Glad I could do it." She unfastened her seat belt. "You said one reason. Was there another?"

  "Um, yes. I didn't bring this up when we spoke earlier. It didn't seem like the right time. Would you like to have dinner with me some night this week?"

  "Marcus—"

  He hurried on. "As a friend. Remember, I know you're widowed, and as a widower I've been down that road. I just want to offer a listening ear. About anything."

  Now Elena knew what it felt like to be caught between the proverbial rock and hard place. Maybe it would be good to have someone else besides David to talk with about the struggles she'd had since Mark's death. On the other hand, Marcus might be called on soon to deal with a request to suspend some of her clinical privileges. Would a social relationship between them jeopardize their professional one?

  "I've had a really hard day, and it's hard for me to think," she said. "Can we talk about this later?"

  "Sure. Would you like me to call you, or shall I wait for you to call?"

  Elena yawned. "Call me tomorrow night. Is that okay?"

  She reached across to the passenger seat and dropped the phone into her purse. Oh, please let me make it home and into bed without any more interruptions. She navigated flawlessly through the dark streets, proud of how familiar she'd become with Dainger. Oh, don't mind the name. It's just named for some early settler. That might be true, she decided, but there was plenty of danger here as well. The threat to her career had followed her here. Someone was stalking her. And apparently her midnight caller hadn't given up after Elena relocated.

  She'd forgotten about her midnight caller. And this was Tuesday. She looked at the clock on the car's display. Two minutes to midnight.

  Elena saw a strip shopping center ahead. It was deserted at this hour, but the parking lot was well lit. It would be a good place to pull in. She wanted to focus her full attention on her caller tonight.

  She turned off the engine, checked to make sure her doors were locked, and reached into her purse. First she removed her cell phone and placed in on the dash in front of her. Then she rummaged until she found the slip of paper Will had given her. She unfolded it carefully, as though the information written on it might escape if mishandled. The light under which she was parked was bright. The words were clear, but the first time she read them Elena couldn't really process them. Surely not. There was no way.

  The phone rang. She looked once more at the name on the paper. Then she pushed the button to answer the call. Elena struggled to make her voice steady, her words neutral. "Hello, Karri. Why do you keep calling me?"

  There was a sharp gasp, then a click and silence.

  18

  Elena leaned across the table to be heard over the din of the hospital cafeteria. "I'm glad we could get together for lunch."

  David took a sip of iced tea. "Sorry we had to eat here, but I have a lady in labor upstairs, so I need to be in the hospital."

  "How's Maria?"

  "Still in ICU. Showing a few signs of waking up. Breathing on her own now, so I've unhooked the respirator. Maria's still got a ways to go, but I think she's going to make it."

  Elena swallowed another bite of her BLT sandwich. "And the baby?"

  David beamed. "Beautiful baby girl. Everyone in the nursery's crazy about her."

  "Doctor Gardner. Who's your friend?"

  Elena's sandwich turned into a lump of lead in her stomach. "Hello, Eric."

  David stood and extended his hand. "David Merritt. I'm a new OB in town."

  "Eric Burson." Elena noticed Eric's hesitation before he returned the handshake. "I'm an EMT."

  "Nice to meet you. I look forward to seeing you around. Just not professionally."

  Eric scowled. "What's that supposed to mean? That you don't want me taking care of any of your patients?"

  David made a patting motion with his open palms. "Maybe I didn't say that well. I hope none of my patients have an emergency. But I do look forward to seeing you around the hospital. It's nice to meet you."

  The last words were said to Burson's retreating back.

  "Don't mind him," Elena said. "That's the way he's behaved since the first time I saw him." She went on to relate what she'd been told about Burson's wife and the effect her death had had on his view of doctors.

  "Whew. I wonder why he became an EMT. I'd think that being around doctors all the time would only keep him stirred up."

  "I guess we all wonder that. But everyone agrees he's good at what he does, so they put up with his attitude."

  "You don't suppose . . ."

  "What?" Elena asked.

  "If Burson's got something against doctors . . . Well, there's an old saying. 'Keep your friends close and your enemies closer.' You don't suppose he wants to be around doctors to look for a chance to get some sort of revenge, do you?"

  It sounded crazy when I first thought of it. Now I don't know. Elena looked at her watch. "I've got to get up to the ICU and see a patient."

  "I'll go with you," David said. He shoved the remaining potato chip remnants on his plate into his mouth, chewed and swallowed, and said, "Let's go."

  In the ICU, they split up. Elena took Mr. Lambert's chart from the rack and went into his room. The patient was still breathing on his own, and his vital signs remained stable. She called his name. No response. She pressed her knuckle into his sternum, and he seemed to pull away from her. Maybe his level of coma was lighter. Or maybe that was wishful thinking.

  "Do you think he'll ever wake up?" Mrs. Lambert asked. "What's going to happen?"

  Elena was totally conflicted in how she wished this scenario would play out. She settled for, "No one knows. We have to be patient."

  "I guess I'll just keep on praying."

  "You do that. And we'll keep taking the best possible care of your husband."

  Elena stopped at the nurse's station and made a couple of adjustments in Lambert's IV fluid orders. She wondered if Shelmire had considered a feeding tube or a gastrostomy. It was apparent that the man was likely to survive the bleeding into his brain,
but Elena was afraid that Charlie Lambert might remain in a vegetative state for a long time. Maybe years.

  Elena paused at the door of Maria Gomez's room. David was standing silently at the bedside, his eyes closed. She wasn't sure how long he stood there—maybe a minute, maybe five. She waited in uncomfortable silence until David turned toward her.

  "Oh, Elena. I was praying."

  "I wish I thought it did any good." She covered her mouth as though she could stop the words. "I'm sorry, David. I know you have deep faith. But I'm not sure I do anymore."

  David motioned her outside, and they found a quiet spot in the back hall. "I know you prayed after Mark's stroke. Did the fact that God didn't restore him to health mean that God didn't hear your prayers?"

  Elena knew the answer David wanted, but she answered with her heart, not her head. "Yes! That's exactly what it felt like. Doesn't it say somewhere in the Bible that whatever we ask, we'll get?" She swallowed hard. "Now that seems like a lie."

  "You're right about the passage. That's hard to understand when we ask for something and don't see the result we want. But there are other places that assure us God knows not just what we want, but what we need."

  "So why bother to pray, anyway?"

  David shrugged, as though the concept was beyond words. "I guess it's a way of staying connected. For me, part of praying is listening. It's a two-way conversation."

  "Right now, I'm not sure I feel like talking to God."

  "No problem. Just listen."

  Code Blue ICU! Code Blue ICU!

  Elena hurried down the hall and pushed through the double doors into the ICU. Her heart dropped when she saw the activity in Charlie Lambert's room. She edged nearer and saw an anesthesiologist at the head of Lambert's bed. He'd reinserted a breathing tube and was squeezing an Ambu bag to force air into Lambert's lungs. Another doctor—it looked like Marcus Bell—pumped on Lambert's chest at a pace of one hundred beats per minute. Just a couple of days ago she'd told her CPR class they could achieve the proper rhythm by humming the BeeGees song, "Stayin' Alive." The class thought that was comical. Now it was a serious matter.

  The drama dragged on, but eventually Marcus looked at the anesthesiologist. Both shook their heads and straightened, flexing their backs to ease tired muscles. Elena turned away and saw Mrs. Lambert huddled at the nurse's station, shivering despite the blanket someone had thrown over her shoulders.

  Elena eased over and stood beside the woman. "What happened?"

  "I slipped out to make a phone call. I was only gone for five or ten minutes. When I came back, Charlie wasn't breathing. His lips were blue. I screamed. A nurse came running in. They brought me out here, so that's all I know." She looked at the room, where the blinds were now drawn. "Is he . . . ?"

  "I wasn't in the room. I'm sure someone will be here soon to tell you."

  Mrs. Lambert ignored Elena's carefully neutral answer. She seemed to shrink in on herself and started sobbing. A woman in a plain blue dress covered by a short white coat eased into the chair beside her. "Mrs. Lambert, I'm Chaplain Fulmer."

  Elena moved aside, her mind already locked in a comparison of this episode to the death of Chester Pulliam. Although she had no idea who could have done such a thing, she had a very good idea who might be blamed for it. She felt a tingling between her shoulder blades. Just as surely as if she had a target pinned to her back, she knew what was coming.

  Elena wished she'd sneaked a peek at the thermostat as she entered Nathan Godwin's office. Surely he had the air conditioning cranked up full tilt. She shivered inside her white coat. Then again, maybe the fault lay not with the thermostat but with her situation.

  "Doctor Gardner, I appreciate your coming by." Godwin's voice showed none of the appreciation his words supposedly conveyed. "Please have a seat."

  Elena took one of the two visitor's chairs. She hitched it forward so that only an expanse of uncluttered mahogany separated her from the administrator. Don't show your fear. Don't get angry. Let it play out. "Under the circumstances, I expected the call." She looked at her watch. Still plenty of time to get through this before she left for Fort Worth.

  "I perceive you're in a hurry," Godwin's smile carried more triumph than mirth. "Very well. I'll get right to it. As you know, I'm already aware of your involvement in the suspicious deaths of two patients during your residency training."

  Elena bristled. She leaned forward until she was halfway across Godwin's desk. "For the last time, these deaths were the result of withdrawal of life support from two patients with no hope of recovery. And one of those patients happened to be my . . ." Her throat caught. She couldn't say the word.

  "Your husband," Godwin said. "Yes, I know. Nevertheless, you left your residency under something of a cloud, with your ability to deal with brain-dead patients in question." Not only was the administrator capable of using the dreaded phrase, he seemed to delight in it.

  "What's your point?"

  "You were in the ICU at noon, shortly before your patient, Mr. Lambert, was found unresponsive, with no respirations and only a faint heartbeat. Efforts to resuscitate him were not successful."

  "I don't deny that. I saw him, talked with his wife, and then met a colleague to discuss one of his patients. After that I went to medical records to sign some charts. I was on my way back to the ICU when I heard the emergency page."

  Godwin opened his desk drawer and pulled out a plastic bag containing a small vial and a syringe. "This was found in Mr. Lambert's bedside table. It's succinylcholine, commonly known by its trade name of Anectine. I believe someone injected Lambert with this drug. Since he no longer had the respiratory support of a ventilator, when the Anectine paralyzed him he stopped breathing."

  Elena clamped her jaws shut. Don't say anything. See where he's going.

  "I intend to turn this evidence over to the police. At that time, I'll make them aware of your history and suggest they investigate Mr. Lambert's death as a homicide." He turned the bag, letting the light catch the vial. "It appears to me that there's a clear set of fingerprints on the vial. If they're found to be yours, I have no doubt that you'll be charged with murder. At that time, I intend to summarily suspend your hospital privileges."

  "You can't do that. This is America. I'm innocent until proven guilty."

  Godwin pointed to a thick binder on his desk. "I've carefully researched the hospital bylaws. If there is reasonable suspicion that a staff member's continued practice in this hospital constitutes a threat to the well-being of its patients, the hospital administrator may suspend that doctor's privileges pending a full investigation. I don't need the approval of the Credentials Committee or your precious Dr. Bell. It is within my power, and that's exactly what I intend to do at the first opportunity."

  He dropped the bag back into his desk drawer. "Good day, Doctor."

  As Elena left the city limits of Dainger, she wished she could leave her troubles behind as well. All the way to Fort Worth, thoughts circled in her head like a cloud of vultures over carrion. She felt certain this vial of Anectine was the same one she'd found in his bedside table earlier—the one she'd so innocently picked up and examined—which meant that her fingerprints would be on the vial. Someone was trying to frame her. But who? And why?

  Was Nathan Godwin the culprit? He had no reason to hate her. But she'd aligned herself, no matter how innocently, with Marcus Bell, and the enmity between Bell and the administrator was obvious. Could Godwin have gone so far as to kill a man in order to cast suspicion on her as a way to demonstrate his power? It was far-fetched, but so was everything else that had gone on in her life recently.

  Then there was Eric Burson. He made it a frequent practice to be in the ICU. He'd been there right before the first episode that almost took Lambert's life. As an EMT, Burson had access to Anectine and was familiar with its action. He hated doctors. That was no secret. And he'd apparently directed some of that hate toward Elena from the moment they'd met. Was this the endgame of some arcane plot to harm
her? Elena found it hard to believe that someone whose profession involved the daily saving of lives could sacrifice one in order to get revenge on a member of the medical community.

  Marcus Bell? He'd been in the ICU at the time of Lambert's death, but she couldn't think of any motive he might have to do such a thing. She'd tried to turn away his advances graciously, pleading her recent widowhood. Surely he understood that, since he'd gone through the same experience. No, Elena couldn't bring herself to consider him a suspect.

  She thought of her midnight caller, the mysterious Karri. When she'd first seen the name on Will's note, Elena couldn't place Karri Lawson, but soon the picture came clear. Karri, the attractive brunette nurse who'd cared for Mark during his terminal stay in the ICU. Karri, who was so attentive. Karri, who always seemed to be around Mark. Could they have been having an affair before Mark was stricken? Was Karri the reason for Mark's note? Was it jealousy that drove Karri to torment Elena with the cards and midnight calls? But did it go even further? Had Karri somehow managed to arrange for Charlie Lambert to die under circumstances that would cast suspicion on Elena?

  What about Mark's sister, Natalie? Elena had no idea the woman even existed until the name appeared in Lillian's obituary. Had Natalie come out of the shadows to carry on the vendetta against Elena that her mother had started? Could she have had a hand in Lambert's death? Was it possible that she was in Dainger even now? Perhaps under an assumed name?

  A loud honk from behind her brought Elena's attention back to the road. A glance at her speedometer told her she'd slowed to forty miles an hour. Ahead of her a solid double line divided the highway as far as she could see, while behind her was a string of cars almost a half mile long. She waved an apology and pulled onto the shoulder. She sat there, her emergency flashers going, while car after car passed. As the slipstream from each passing car rocked her little Ford, Elena fought back the tears.