Plan to Kill

by Gregg E. Brickman

  The commotion in the center of the room told him what the rats ate now that the supply of human rubbish had diminished. A multitude feasted on carcasses of their own kind.

  He crashed the side of his fist against the wall. The creatures scattered, several of them running over his sneakers as they passed. He stifled a scream. Two or three remained, gnawing on the abandoned bounty.

  It took a few moments to regain his composure and regulate his breathing. Then, ignoring the rodents, he inspected the area. Overhead, beams that once supported cabinets appeared secure in the concrete slab ceiling. Three tables formed an H-shape in the center. Thick bolts held them in position. On the west wall, heavy utility sinks sat next to sterilizers with doors ajar.

  This location was better. Far better. If he could stand the rats.

  12

  On Thursday evening, the intensive care unit overflowed with patients. Miki, fresh from three nights away, pitched in, starting two IVs, accepting an admission from surgery, and comforting a distraught elderly family member.

  When the on call nurses arrived and took report, she excused herself. At half past twelve, she stopped on the last two units to check staffing and the sicker patients, then entered the ER through the rear door. By the time she reached the ER nursing station, she had made an assessment of the situation in the ER and the unmet demand for ICU beds.

  Arlene Porter sat in the charge nurse's position, a chart open on the counter in front of her.

  "Arlene, you guys have to hold the critical patients until morning. I just left the ICU, and there won't be anything open for hours."

  "Unless someone takes the big elevator ride." Porter's laugh and thick Jamaican tones lightened her macabre sense of humor.

  "Don't hold your breath. They're sick, but stable," Miki said.

  "Do you have any staff to send me?" Porter said, pointing across the hall to one of the monitored rooms where two patients were hooked to ventilators.

  "Nope. Who can we call to come in to work?" Miki flipped to a tattered roster on her clipboard.

  Porter stood and pointed at the schedule tacked to the bulletin board. She tugged at several of her plaits, twisting them in her fingers. "John Walden worked for the city yesterday and the day before, so he's off tonight. Did you see him upstairs?"

  "No. He was already gone when I checked on Madeline. I'll try him first. Do you know if he took the full-time tech position?"

  "I think so. Sounded like he planned to resign from Fire Rescue this week."

  Miki walked around the high counter and pulled a chair over to the desktop next to a telephone. "I'll call him first. Who else might be amenable to overtime?"

  Walden answered on the first ring. After Miki made her request, he said, "Yeah, Murphy, I'll come. I was hoping you'd call. In fact, I hung out a little longer than usual with Madeline to give you a chance to stop by."

  "I didn't know we were in a jam until a few minutes ago. When can you get here?"

  "Give me an hour to shower and drive over

  Five more phone calls produced two more workers, one promising to arrive in thirty minutes.

  "I think that's the best we're going to do." Miki looked around. "Anything else going on that I can't see with my own two eyes?"

  "No. Dr. Ephraim said she wanted to talk to you when you stopped by."

  "Where is she?"

  "In the back. Dictating." Porter tipped her head toward the rear of the station. "She doesn't like to get behind and make people wait."

  "How many patients out there?" Miki pointed toward the reception area behind the automatic double doors.

  "Ten or twelve when I checked ten minutes ago. We've got discharges as soon as Ephraim completes the charts. Then we'll bring more in."

  Miki made her way to the dictation room, stopping along the way to schedule a weekend overtime shift with a staff member who was always hungry for the extra money. Those shifts required more staff than were available.

  Ephraim glanced up when Miki entered the cramped space. "Sit a minute. I'll take these to the desk, then we can talk until the next wave settles on their stretchers."

  Miki rolled a chair from the second carrel, sat, and leaned back, propping her feet on a convenient trash can. She smiled when Ephraim reappeared with two cups of coffee.

  Ephraim took a moment to settle and sip. "Tastes like shit." She stuck her tongue out, then grinned, revealing clear braces.

  "You have some way to make an accurate comparison?" Miki ran her fingers through her short, blond curls.

  Ephraim laughed. "No. My imagination at work. Tastes like shit smells."

  Miki grinned. "Arlene said you wanted to see me."

  "I talked to Saul Irvin earlier today. He spoke with the ME—Youngquist. Eric is his first name, I think. Youngquist ruled Peter Sanchez's death as unclassified. The tox screen showed high levels of digitalis, which, by the way, Irvin says wasn't prescribed—at least not by him. Could have been accidental—maybe Peter was self-medicating, and being a surgeon, got the dosages wrong. However, that would be odd on three counts. There was no reason for Peter to think he needed digitalis, he was thorough enough to have gotten the dose correct, and if he treated himself, he would be unlikely to get it wrong. That leaves suicide or homicide."

  Miki puzzled over the options for a long moment. "Digitalis would be my last resort if I wanted to do myself in. The symptoms of overdose are very uncomfortable, and it takes too long. Potassium would be my choice."

  "I agree. Which makes me think someone wanted Peter dead."

  "You think? I have trouble believing it. Sanchez might have been a bit egotistical and self-centered, but—murder?"

  "The police will decide. I know Youngquist released his report today, so we'll have detectives around here tomorrow asking questions." She pulled a paper from her lab coat pocket, looked at it, then put it back. "A Detective Cavanaugh called earlier and said she and her partner would be here before seven tomorrow morning. They want to catch the night shift." Ephraim stood, dropping her near empty Styrofoam cup into the trash. "Time to get busy." She kicked the doorstop in place and left.

  Feeling saddened, Miki hauled herself to her feet. When she got into the hallway, she saw Ephraim and Doctor Jamal Dempsey deep in conversation. It wasn't unusual to see him in the ER. As a new anesthesiologist on staff, Dempsey often drew the night call rotations. From the snatches Miki overheard in the noisy nursing station, it was obvious Ephraim had passed on the news about Sanchez's autopsy.

  Newly arrived staff members, Walden among them, gathered around Arlene Porter getting assignments. Porter stood out from the group, her dark skin rich-looking against the red background of her jungle-print uniform top. Walden appeared distracted and seemed to be listening to Ephraim and Dempsey rather than Porter.

  Miki, wondering what captured Walden's attention, stepped forward to better overhear the conversation.

  Dempsey, a young black man, leaned against the chart rack. At six-four, he towered over Ephraim and bent forward a bit when speaking. "I can't believe anyone would harm Sanchez. There has to be an explanation. If you talk to the police, suggest they check his prescription bottles at home. It's not unheard of for a pharmacy to dispense the incorrect drug. In fact, it happened to my wife with the antibiotic she took last week. Good thing it wasn't a generic drug. I recognized the capsule and knew it was an error."

  Ephraim frowned. "One scenario, I suppose." She retreated a step and turned toward the group of staff members. "Arlene, is Dr. Foster about ready to take his patient to the OR? Does he know Dr. Dempsey is here?"

  Porter said a couple more words to the staff, then joined Dempsey and Ephraim.

  Miki joined the group as well. The impending surgery had caught her attention.

  Porter said, "Dr. Foster went upstairs to change. The OR crew is about thirty minutes away, and the patient will be ready in another ten minutes or so."

  Dempsey said, "Are the labs ready?"

  Porter passed him the chart. "We'
re waiting on them."

  "Thanks." Dempsey studied the top page. "Arlene, this is good. I appreciate it. It's always nice when you're in charge."

  Porter smiled, nodded, and went about her work. Dempsey was one of the few who always thanked the staff. He showed his appreciation in other ways as well. In fact, a huge basket of goodies sat on the table in the lounge, courtesy of the young physician—and it wasn't even the winter holiday season.

  Dempsey turned his attention to the patient chart, grimaced, made eye contact with Ephraim, then returned his attention to the clipboard.

  "Something wrong?" Miki asked.

  He glanced at each woman, then spoke in a quiet voice tinged with guilt. "Every emergency, I think about John's wife. Lucky for me, his father-in-law convinced him to settle. If only I'd told Peter no, told him to get someone else, maybe she'd be healthy."

  Ephraim touched his arm. "Maybe Madeline would have bled to death from the rupture before someone got here."

  Dempsey exhaled in a rush. "There's always that."

  Miki wanted to give the two physicians a bit of privacy. In her haste, she pushed into the person behind her. When she turned, she stood face to chest with Walden. A flicker of anger crossed his face, and Miki knew he had overheard the conversation.

  On the night Walden brought Madeline in, screaming with pain, Miki was working the ER as an extra shift and covering the end rooms with Arlene Porter. Dr. Ephraim was the only physician on-duty in the busy ER. It was a Saturday night, the week before Christmas and at the height of the tourist season.

  A frail woman when in the best of health, Madeline grew worse by the minute. Peter Sanchez, the physician who delivered her first child, was on call. He hurried in, throwing his tuxedo jacket on an adjacent stretcher. The annual physician's dinner-dance was in progress, and the doctor commented about hoping to return to it before his wife had to beg a ride home.

  An ultrasound confirmed the ruptured tubal pregnancy. While Miki and Porter prepped Madeline for surgery, Sanchez bullied the young anesthesiologist, Jamal Dempsey, into doing one more case. Being chief of staff had its benefits. Dempsey agreed despite having spent sixteen straight hours working.

  Miki didn't know first-hand what happened during the surgery. The grapevine version said Dempsey fell asleep. The surgeon and the scrub tech were attending to a minor hemorrhage in Madeline's belly and didn't notice, and the R.N. was searching for a particular instrument Sanchez requested—demanded. With no support to her breathing from the sleeping anesthesiologist, Madeline suffered a cardiac arrest and never regained consciousness after the resuscitation.

  13

  At two a.m., Walden entered the staff lounge, glanced at the wall clock, and settled himself into a molded-plastic chair next to Arlene Porter. He watched as she untied the lavender bow on the huge gift basket in the middle of the battered gray mica table.

  "I saw your father-in-law in the hospital this evening when I came in though the main lobby." She removed a silvery foil package and raised it for him to see before setting it on the table. The label said it contained chocolate covered almonds, caramel coated popcorn, and chunks of both white and dark chocolate.

  "Al Gentry, the son of a bitch. I didn't know he was in town." Walden scowled.

  "He wore a suit. I get the idea he was at the board meetings. Didn't they keep him on the board?"

  "Yeah, yeah. Troicki made him retire, then insisted he keep a board seat to make it appear voluntary. At least, that's what Gentry told Madeline. No one knows for sure what happened behind closed doors."

  "Did Gentry say why? He was the hospital president for ten years. Seems a harsh move for Troicki to take as new board chairman."

  Walden thought a moment. "According to Gentry, the way it went was Troicki donated a bunch of money for the new building. Gentry thought it was because he wanted to be chairman, but Troicki was after the construction contract, too. Gentry tried to convince the board there was a conflict of interest. Pissed off Troicki."

  Porter raised her eyebrows, giving a wide-eyed appearance. "Troicki sure made a splash for Gentry at the retirement party. You wouldn't have known they weren't the best of friends."

  Walden laughed. "Both of them are bastards, you ask me. Do what they want, when they want."

  "You still not talking to him?" Porter said.

  "I haven't talked to him since Madeline's surgery, except when I was settling the case with the doctors. He came down from Virginia, stayed a few days, pissed off me and everyone else, then left. I think he gets his information about my wife from the staff on six and from the doctor."

  "Does he keep in touch with Katie?"

  "What's with the questions?" Walden snapped.

  "Nothing. Making conversation." Porter shrugged. "Want some?" She pulled apart the crimping at the top edge of the foil package and offered the bag.

  Walden pointed to the gift card dangling from the wicker basket. "It's from Dempsey. I'd starve first."

  "John." She paused and took a breath. "It's eating you alive. It's going to ruin your life, your daughter's life, and your ability to take care of Madeline."

  "I can't help it. He killed my wife, and he got away with it."

  "Jamal Dempsey didn't kill your wife. First, Sanchez did the surgery. Sanchez forced Dempsey to do the anesthesia. I was there, too, you know. I saw what happened. Dempsey is a young guy on staff. He couldn't say no to the chief."

  "He should have been awake for the whole surgery."

  "I agree. Sanchez should have allowed him to go home, too. Now Sanchez is dead, maybe murdered."

  "Huh? What did you say?"

  "I said he's dead, maybe murdered. The ME released the report to the police today. His death is unclassified. Ephraim said it could mean a lot of things." Porter went on to repeat the information she received from Ephraim earlier in the shift.

  Walden stared at the wall, biting his bottom lip. "Whatever. Doesn't change what I think of Dempsey."

  Porter held up a hand. "Listen. It wasn't his fault, and even so, he's devastated. Didn't you hear him before?" She pointed in the direction of the nursing station.

  "Yes." Making excuses, he thought. "At least the hospital could have fired him, and Sanchez for that matter."

  "From what I heard on the vine, you're the one who let them off the hook by settling before going to court. You could have made a fuss. Then administration and the rest of the medical staff would have done something more."

  "Okay, Arlene. Of course you're right." Sarcasm soaked his voice.

  She held out the bag of treats.

  "I said I'd rather starve. I'm going to walk outside for the rest of my lunch break." He stood, pushing his chair away with such force it smacked the bank of lockers that covered one wall of the lounge.

  "Fine." Porter sounded annoyed. "I have to run over to the old facilities building and get another lumbar puncture tray anyway. It'll give me a chance to smoke a cigarette on the way."

  14

  Miki returned to the ER a few minutes before four in the morning, taking a route through the almost deserted waiting area.

  "Hi, Sam." She stopped by the security guard who manned the small welcome desk outside the automatic doors. "Looks like it quieted down."

  "An hour or so ago."

  "What's going on?"

  "Don't know for sure. That new little nurse seems upset."

  Miki hit the button for the door, hurried toward the nursing station, and stopped in front of Kimberly Hackim, who was red-faced and seemed on the verge of tears. "Where's Arlene?" Miki said. "She paged me."

  "No, I did. We don't know where she is." The young woman flung an arm around the general vicinity. "She's not here. John said the last he saw her, she was going to central to get a sterile tray, but she didn't tell anyone else."

  "When did she leave?"

  Hackim's color returned to normal. "I don't know for sure." She scraped at a fingernail with her teeth. "I'm thinking around two-fifteen, maybe a little later. She t
old me to watch the desk and went into the lounge to take her break. That's the last I saw her."

  "Did you call central?" Miki asked, puzzled. As the charge nurse, it was inappropriate for Porter to leave the department for more than a few minutes.

  "I did. They haven't seen her. The lumbar puncture tray was still in their window waiting for someone from here to get it."

  "Did you page her?"

  "No. The operator refused. She said there's a rule about the noise during the night."

  "There is." Miki used the desk phone and asked the operator to page Porter. After hearing the page, Miki said, "Now we wait. Has anyone done anything else to find her?"

  "Well, yeah." Hackim stretched the word, her tone highlighting her youth.

  "Kimberly, just give me the information." Miki tapped her foot. "What's been done to find Arlene?"

  Hackim flushed, turning the heart-shaped birthmark on her cheek bright red. When she continued, her voice was businesslike. "Dr. Ephraim called her house, thinking maybe she went home on her break and something happened, or she fell asleep, maybe. Her husband answered and said she was working." She paused. "I had John go for the tray. He looked for her—said he even checked the ladies lounge and the cafeteria while he was in the old facilities building. I called every nursing station and searched in the bathrooms here and the one across the hall, next to the lab. The security supervisor had his guys outside walk the lot, the front lobby, and the outpatient lobby. We couldn't think of anywhere else."

  "Neither can I." Miki left the station and checked the rooms within the ER, then she called security using her in-house cellular. When the night shift security supervisor answered, she said, "Have you had any luck finding Arlene Porter?"

  "No, but someone just paged her overhead," Victor Zoller said, his voice gruff.

  "I did. She hasn't answered. The last anyone knows she was going to central." Miki explained what the staff had done to locate the missing nurse.