HARMED - Book 1: First Do No Harm

by L Jan Eira

  Julie nodded. “Where can I start?”

  Jack pointed to a pile of charts. “As you go through each of these, if you have questions, let me know.” She nodded, already working on the top chart of the to-do pile.

  The therapeutic benefit of doing something constructive was priceless. They spoke to each other infrequently, and when words were exchanged, it was Julie asking a specific question about an EKG or laboratory result.

  They worked until five, though much more needed to be done. Jack thanked Julie for her help as she left. He continued to work until almost six. At that time, prompted by a text message from Claire, Jack gathered several charts and, loaded to the gills, walked to the parking lot.

  “The answer is in here,” said Jack to no one in the office, “and I will find it.”

  CHAPTER 21

  Jack fought nodding off to sleep. He had continued to work at home for hours on the large kitchen table. Data gathering was tedious, but Jack’s obsessive qualities did not permit him to stop until it was all done. Stacks of charts loomed in front of him. He finished his evaluation of another patient’s chart. He picked it up and placed it on the done mountain of records. This proved to be the straw that broke the proverbial camel’s back. The center of gravity of this stack changed sufficiently off axis that the whole heap spilled on the tile floor with a thunderous racket.

  “What’s all this clatter?” asked Claire, her eyes sleepy. She was wearing her robe over her pajamas. She ambled into the kitchen, where Jack was kneeling on the floor, picking up the charts.

  “Sorry I woke you up,” said Jack.

  She sat down heavily. “That’s OK.”

  “I’ve done a lot of work.” Jack gestured at the stack of charts about the table. “I’m almost done.”

  “You should come to bed,” said Claire. “You do need to get some shut-eye so you can think straight tomorrow. Actually, today.”

  “You’re right. But I can’t stop now. I need to go through all this information so I have time to analyze it before our next meeting.”

  Claire tossed a smile. “In that case, how about some coffee?”

  “Oh, my angel of mercy. Yes. Please.”

  Claire got up and began making a pot of coffee. “So what have you found so far?”

  “Well, several men were admitted to Newton Memorial with chest pains. “Most of them ruled out for heart attacks, with a few having had minor heart attacks.” Jack began to pace. “All patients were stable. All were relatively young.” He paused to glance at his report in progress. “From thirty-two to fifty-one years old.”

  “OK,” said Claire. “Go on.”

  “These patients then had a cardiac arrest for no good reason. Life-threatening heart rhythms that caused their hearts to stop.”

  “What makes this unusual? This sort of thing happens all the time, right?” Her eyes met his.

  “There are certain factors that most patients who eventually suffer a sudden cardiac-arrest display, such as a large heart attack, weak heart muscle, and significant blockages in the artery that feeds the heart muscle and many others.”

  “And let me guess—these patients had none of these risk factors,” said Claire.

  “Right,” said Jack. “They were checked out thoroughly and given a clean bill of heart health.”

  “What about electrolyte problems?”

  Jack nodded. “Each of the patients had all the blood tests and EKGs done and, you guessed it, all normal.”

  “What about that male nurse several years ago who was killing his patients with potassium injections? Did you look for that?”

  “Yes, there are specific EKG changes. The T waves become peaked. I didn’t find any of these types of T waves.”

  “What about that movie—what was the name?” Claire paused. “Coma. Remember? Young people were being killed to harvest organs for transplantation. How were they dying?”

  “They were given carbon monoxide instead of oxygen during minor surgery.”

  “Did you look for that?”

  “No, not really.”

  “Should you?”

  “Well, carbon-monoxide poisoning causes cardiac-rhythm disorders. And headaches and confusion. And disorientation. Come to think of it, we should really look into that. The perp at the hospital was said to have become confused.” Jack stopped, noticing a smirk on Claire’s face.

  “Listen to you,” said Claire. “The perp. You’re talking like a cop already. How can you rule that in or out?”

  “Tissue and samples to measure carboxyhemoglobin levels,” said Jack. “I’ll ask the cops to see if the oxygen bottles had been switched for either carbon monoxide or carbon dioxide. Thanks, Claire. You’re a great help.” He yawned and put his head on Claire’s chest. She caressed his head and face.

  “Let’s get a few hours of sleep. What do you say?”

  “Yeah, let’s.” They turned off the coffee machine and walked to the bedroom hand in hand. “I need to be alert at the meeting with the cops in a few hours.”

  CHAPTER 22

  Jack arrived at the police station and walked to the front desk. He was eager to share his investigative work of the last three days with the detectives.

  “May I help you?” asked the sergeant behind the counter. She was heavyset and dressed in a blue police uniform.

  “I’m here for the detective meeting this morning,” said Jack.

  “Meeting? What meeting? Who are you meeting with?”

  “Detectives Fuller and Quentin,” he said.

  “I don’t know of any meetings,” she whispered. “Let me find out for you.” She dialed a number and waited for a connection. Her eyes wandered to avoid contact with Jack’s.

  “Are the detectives having a meeting this morning?” she finally said. She listened and then hung up the phone. “There are no scheduled meetings this morning,” she said.

  “No meeting?” said Jack.

  Jack walked to his car and looked up Herb’s cell number. He dialed it and waited. “Good morning, Herb. It’s Jack Norris. I thought you were having a meeting this morning.”

  “We have worked on this case for the last three days and came up with nothing. We’ve looked at every angle imaginable. We don’t need any more meetings. We’re ready to close the case.”

  “Close the case?” said Jack. “No, that can’t be.”

  “Yes, we came to the conclusion that Butterworth must have had a gun when he was admitted and—”

  Jack shook his head. “What about my research?”

  “You told us yesterday you found no drugs that could have caused the patient to kill those people?”

  “Well, uh, no, not really,” said Jack.

  “OK, then,” said Fuller. “I don’t see any other possible explanation. The man was witnessed to have pulled the trigger. There was nobody else there with him. We’re putting the case on hold for now.”

  “I have some possible related cases. Can I—”

  “What cases?” said Fuller.

  Jack was flabbergasted. He was speechless. He wanted to scream aloud, but he was tongue tied. He needed time to gather his thoughts. “Never mind. Can I meet with you sometime today?”

  “I don’t think we have anything to talk about, Jack. The case is closed, at least for now. Have a nice day.” The phone line was disconnected.

  “The case is closed?” whispered Jack to himself. “This is nuts!” He drove around town aimlessly for an hour. Thinking. Scheming. When he stopped the car, he dialed Susan’s cell number. “Susan, we need to meet.”

  “About what?”

  “The murders at Newton Memorial. Are you really giving up on the case already?”

  “Jack, we considered all the possibilities. Even Agent Ganz agrees this case should be closed. Jack, we agree that the case was bizarre and unusual, but some people have weird responses to stress. We believe Arthur Butterworth was acting alone. We’re still searching for the gun. The FBI is helping us with that. They have an extensive database. So f
ar, they have found nothing.”

  “I have some data to show you.” Jack paused for a second. “Some stuff I found.”

  “You said you couldn’t find any drug—”

  “No, not drugs. Other people who were killed, possibly in connection to this case.”

  “You think this guy had killed other people?” said Quentin. “We don’t have any other opened murder cases.”

  Jack took a deep breath. “Just hear me out. Can we meet? Please.”

  “OK. Meet me at the station in thirty minutes. I’ll see if I can talk Herb and Mike into coming, too.”

  Jack sighed. He drove toward the police station. He called Claire and updated her on all the frustrations of the day. In turn, she gave him the name of the patient whose unexpected, mysterious, and bizarre actions left a grieving daughter without parents or brother.

  Detective Quentin and Agent Ganz were waiting for Jack on the front steps to the enormous edifice. Together they walked into the police station and headed for the conference room. Detective Fuller arrived shortly afterward.

  “OK, what do you have that is so compelling that we should reopen this case?” asked Quentin as they all sat down.

  “Two things,” said Jack. “There is a man by the name of Jeff Snyder who you should look into. He was admitted at Newton Memorial with chest pains. Everything checked out OK. His heart was normal. He went home and suddenly developed confusion and paranoia, just like Butterworth. He killed his wife and son, had a heart attack, and died.”

  “Where did this happen?” said Fuller. “It wasn’t in Evansville!”

  “And you think these cases are related? How?” said Ganz. His eyes peered raptly at Jack.

  “I don’t know yet, but don’t you agree that it sounds similar to our case?” said Jack.

  Ganz shook his head. “Sure it sounds similar, Jack. We see cases like this all the time. They sound alike, but it doesn’t mean they’re linked.”

  “You said you had two things,” interjected Susan.

  “There have been a slew of cardiac arrests at Newton Memorial over the last several months. I’d like to present the data to you,” said Jack.

  “I doubt the hospital or any of its staff had anything to do with these murders,” said Ganz, a shit-eating grin on his face. “Do you think there is a ring of murderers working at Newton Memorial? That’s a bit farfetched.”

  “I’d like to see what you have, Jack, but it does sound farfetched to have doctors or nurses responsible for these atrocities,” said Quentin.

  Mike turned to face Jack, his arms folded as he waited for a reply. Jack had learned from Claire to notice body language. She claimed he would learn a lot from it about the patient’s demeanor and feelings. She taught Jack that the body posture of folding one’s arms was a sign of nonacceptance. For some reason, Mike Ganz could not bear the notion that the professionals at Newton Memorial Hospital could engage in such foul play. For that matter, neither could anyone else.

  Jack’s exasperation intensified. “What happened to keeping an open mind?” He took a deep breath. “Look, I get bad vibes from one of the doctors, Dr. Ian Rupert. He’s in charge of the research laboratory. I had noticed he arrived at the hospital much earlier than usual the day of the murders. He was seen in CCU around five o’clock in the morning the day of the murders. Previous to that, I had never ever seen him at the hospital before ten o’clock. I think—”

  “Another coincidence,” interrupted Ganz. “We must be careful. You are talking about a powerful man who is well known for his work in research, isn’t he?”

  “Undoubtedly,” said Jack. “I’m just saying—”

  “What would his motive be?” said Ganz.

  “I don’t know. But I think you should investigate further,” said Jack.

  After a long moment of silence, Fuller nodded his head. “OK, show us the data you gathered.”

  Jack ran out to his car and brought back his laptop. Having delivered many lectures using PowerPoint, Jack felt back in his element. As he entered, they remained seated, motionless, and in silence.

  Jack set up his computer and began his presentation, describing his research findings. He started by describing the patient characteristics of those who were known to be at risk for cardiac arrests. He then described two groups of individuals: those who had cardiac arrests with these features and the group of patients who had cardiac arrests and died unexpectedly and unexplainably.

  He first depicted the great increase in total numbers of unusual deaths with a graph he titled Cardiac Arrest Epidemic at Newton Memorial Hospital. A clear-cut spike was obvious in the last six months as compared to the previous sixty. As far as the etiology leading to the deaths, Jack admitted to being befuddled. He enlightened the detectives about his theory that the patients might have been poisoned. The type of agent used remained an enigma, but it might be useful to obtain appropriate tissue from all the bodies, looking for something in common. The agent might have been carbon monoxide or carbon dioxide. This should be discussed with the medical examiners. They could entertain these diagnoses in their postmortem search for clues. The cops ought to look to see if the oxygen tanks could have been switched with one of these or other poisonous gases. Susan looked intrigued and little by little started to write notes on her notebook. The detectives remained silent, even when Jack finished his presentation.

  “This is way out there, Jack,” said Ganz eventually, breaking the uncomfortable silence.

  “Are there any other reasons to explain this spike in cardiac arrests? Anything at all?” inquired Fuller.

  “And how exactly do you tie these cardiac arrests to our murders?” said Quentin.

  “I can’t, except that this is an unusual discovery,” said Jack. “The murders, we have all agreed, were extremely odd. To have two extraordinary events occur at the same time and place, it would be unlikely these events are unconnected. It is more likely that one single causative factor is at play, leading to both peculiar circumstances. It’s just playing the odds. We do this in medicine all the time. Two weird symptoms at the same time in an otherwise healthy patient—it is most likely that both symptoms are connected rather than unrelated and appearing out of the blue.”

  “I’m sold,” said Quentin, looking at Fuller and Ganz. “I think we should reopen the case.”

  Fuller took a deep breath, his jaw muscles tightening. “I imagine it’s worth a fresh look. What do you think, Mike?”

  Ganz got up from his chair. His voice was calm. “I think there’s a good medical reason for the increased numbers of cardiac arrests at Newton Memorial that is unrelated to the murders. I think Jack is biased to the connection and is missing something. Probably something simple. No offense, Jack.”

  “None taken. But Mike, prove me wrong.” Jack felt his compelling argument gather momentum. Silence reigned again.

  “OK, we’ll reopen the case,” said Fuller. Quentin nodded and then stared at Ganz.

  “OK, fine,” said Ganz. “We’ll keep investigating, but don’t be surprised when we find out later this was all a big waste of time and money. Just saying!”

  “Suzy, talk to the medical examiners and ask them to specifically look into the possibility of poisoning with gases,” said Fuller.

  In fact, Jack soon learned that the medical examiner had already been keen on the possibility of poisoning and had spent a great deal of time and money gathering data to prove or disprove this hypothesis. The results from all the specimens collected for chemical analysis were pending. Unfortunately, an exhaustive search for unusual chemicals would take a long time.

  With the case back on the front burner, attention was again turned to the weapon. The questions were again delineated: Where did the gun come from? How did it get to the patient? It didn’t seem that the patient brought the pistol to the hospital with him, although that remained the most likely possibility. If someone else provided the weapon, he or she would be the most culpable person and the real killer, most especially, if Butt
erworth was found to have been poisoned. Theories were reentertained about the nursing staff, the cleaning crew, and the previous patient in that room possibly leaving it there, and so on.

  The detectives agreed that they would reinterview the previous patient to occupy the bed and whoever cleaned the room and made the bed before it became Butterworth’s. They would speak to the nursing staff again, although the first go-around, on the day of the murders, had proven fruitless.

  Jack learned that one of the strategies of proper police interviewing is to go over details repeatedly. What once remained locked and hidden by the mysterious neural connections of the shocked and stressed brain would sometimes later surface and become quite clear once the dust settled.

  The ongoing endeavor to find the gun’s previous owner had remained fruitless. According to Agent Ganz, despite all the tricks of the trade used, the serial number continued to resist identification at the FBI lab. Whoever destroyed this information really knew what he or she was doing. When ballistic analysis was conducted, there was no record of this gun being utilized in a crime beforehand, according to the vast FBI database. The search for the gun connection continued. Ganz discussed the details of his diligent pursuit for the gun’s owner.

  The group also discussed Jeff Snyder. During a short lunch break, Fuller and Quentin consulted their police computer and made several phone calls. Snyder’s case occurred in a small rural town several counties away, the reason the Evansville Police were unaware of it. Although likewise bizarre, the Snyder murders were hard to tie into the hospital murders. The question arose about the possibility that there were cases like it in other townships, a question worthy of investigation.

  After three hours of discussion, it felt as if there was no forward progress at all, except, of course, that Jack was able to spark up interest in the case. The truth remained undiscovered with no end in sight. At the conclusion of the meeting, Jack felt a twinge of hopelessness. The miracle of television had distorted his reality about detective and police work. In the real world, the process was slow, tedious, and methodic. There was a lot of painstaking theorizing and diligent assessment and reexamination of what was known and unknown. It was going to take a long time to get to the truth. Nevertheless, the truth would become known. Jack just knew it.