“Hey, I did do an O2 sat, and it was fine just as it is now, and if she mistakenly got a narcotic overdose, her respirations would have been suppressed,” he said, beginning to sound more annoyed than defensive. “As for thiamine, she sure as hell hadn’t been malnourished or gone on a recent bender…”
Earl ignored whatever lame excuses the kid offered up – chances were good he wouldn’t screw up his next coma case – and refocused on what bothered him most about Bessie McDonald – her lack of focal signs. “What’s her level of consciousness today?” he asked, referring to a scoring system by which a patient’s response to verbal and painful stimuli was measured.
Roy looked taken aback, having built up a good head of indignation trying to justify himself and implying that an outsider who wasn’t on staff had no business berating him anyway. “Lousy,” he said after a few seconds, his face sullen. “She’s a three, exactly like the night we found her.”
A dead body would earn as much, just for being there.
“You ordered a CT scan?”
“What was the point? I thought I knew the diagnosis – a massive stroke – plus the lady was gorked.”
“Has your differential expanded any, after our discussion?”
He sighed heavily. Deflated, he seemed a shirt size smaller and an inch shorter, as did most kiddie-docs foolish enough to attempt a head-butt with a veteran rather than admit a mistake. “A CT will be done later today, sir,” he said, his unconditional capitulation made evident by the sudden disappearance of the word “but” from his vocabulary. “And an EEG.”
The former would visualize the extent of damage from a recent blood clot, if that was the cause. The latter, an electrical encephalogram, would pick up any remaining spark of electrical activity in the cortex of her brain, the stuff of walking and talking.
Earl asked Tanya to come back in the room. “You said she was found on the floor by the door?”
“Yes. We think she knew something wasn’t right and was trying to get help.”
“She didn’t use the call button?”
“They found it unplugged.”
“I think she must have pulled it out by accident when she reached for it,” Roy added.
Tanya’s brow arched, but she said nothing.
Earl followed her back toward the nursing station. “Anybody see Chaz Braden around here that night?”
She immediately slowed. “So you agree with me, that it’s possible he did this to her?” she whispered, once they were side by side.
“I agree only that it doesn’t look like a stroke, nothing more. For God’s sake, don’t go spouting crazy ideas.”
She gave him a “yeah, right” look.
“So did somebody see him?”
“No. I already checked. But that doesn’t mean he wasn’t on the floor. Coverage is minimal that shift, and he could easily have sneaked in.”
“Care to tell me now why you’re so down on him?”
“Why? My reasons have nothing to do with Bessie.”
“I want to know the extent of your beef with the man, and if that might cloud your judgment toward him.”
She walked a few steps farther without saying anything, then slowed her pace until they were walking alongside each other. “I worked in cardiac ICU before being transferred here. He’s a slimeball. Put his hands on me one night. I complained, and got transferred for my trouble. Not that I mind it here. I like old people. But my training is in critical care.”
He eyed the procession of elderly men and women tottering back and forth along the corridor and wondered how he’d feel if someone pulled him out of ER to plunk him down in their midst. “Quite a culture shock,” he said.
“But don’t think I’m fingering him just because I want to get even with the guy. I really liked Bessie. If someone did mess with her, all I’m after is to damn well make sure nobody just shuffles what happened here under the rug. They’re a little laissez-faire about relapses and death around this floor for my liking.”
Earl again sympathized. Geriatrics was a discipline of settling, becoming resigned to death; in critical care, however, as in ER, they defied it.
“There’s another person to whom she might have confided. Dr. Collins visited her that night.”
“Melanie?”
“Just a social call. Bessie wasn’t admitted under her this time. But she thought the world of Dr. Collins. Told me more than once how that woman’s fast action staved off her first stroke. She blamed her current doctors for not doing the same.”
“Why do you think she’d tell Melanie anything about Chaz?”
“Bessie had been in a mood to talk about him, and I don’t think she intended to be flattering. Since I didn’t have time to listen, maybe she bent Dr. Collins’s ear.”
Earl thanked her and took the elevator down to the ground floor where he slipped outside the Thirty-third Street entrance, determined to contact Melanie. In the harsh glare of winter sunlight, he joined the other cell phone users who restlessly circled and turned like pigeons flocked at the pedestal of a statue, their murmurings rising above the noisy morning traffic.
He had to settle on leaving her yet another message. Why wasn’t she answering her calls?
An attempt to reach Mark yielded the same out-of-order recording he’d gotten last night.
“The whole planet’s gone wireless, and I can’t talk to a soul,” he muttered, waiting for an operator to get him the man’s home number.
This time he got through.
“Roper.”
“Mark, it’s Earl Garnet. I’ve got news.”
“I hope it’s better than mine. But you first.”
Earl told him all about Bessie McDonald, including the possibility that a few weeks after Kelly’s disappearance his father might have pulled her chart along with that of the man who’d died of digoxin toxicity. As he talked, he heard an annoying series of clicks on the line. Probably the result of a poor connection, he thought, ignoring them.
10:30 A.M.
Hampton Junction
Mark could tell a lot about a medical resident’s skill after observing the person handle a single patient.
Watching Lucy O’Connor, he waited until a half dozen of his regulars had passed through her hands before he admitted she practiced medicine as well as he’d first thought, she was that good. Most trainees managed a small number of people while he saw to the bulk of the visits, the entire process made much longer by his need to review and sometimes revise what they did. So far Lucy had seen all the morning appointments by herself, doing it as efficiently and thoroughly as he normally would. On checking her work, he found himself discussing cases with her on the level of a colleague, and she referred to recent journal articles with ease. What impressed him most was how, while drawing on an academic knowledge base that he considered awesome, she kept her therapeutic decisions practical and her recommendations for referrals or tests tailored to what they had available in the sticks.
And the local vote was unanimous.
“I like her!”
“She’s wonderful.”
“Not like those other ‘kids’ they usually send you.”
So he sat at his desk with time on his hands while Lucy worked the examining room. Besides using the opportunity to arrange for a loaner Jeep with his insurance company and make a stab at the piles of unopened mail, he kept trying to make sense of everything Earl had told him.