That his father had gone after those same two charts didn’t surprise him. After all, it was evident from Kelly’s file he’d had an interest in them. What that interest had been, he still hadn’t a clue.
The coincidence of Bessie McDonald slipping into a coma the night after Kelly’s body was identified – that left him incredulous. He couldn’t help but speculate how someone could have arranged for her to convulse herself into the far side of oblivion. As ideas popped into his head, he grabbed a pencil and started to jot a few down.
Strychnine?
Convulsions were a hallmark of its lethal effects. Not only would it be detected on testing but also would leave a telltale rictus grin on the victim’s face. Not much of a choice if the “relapse” were to be taken as natural.
What about something that caused seizures but wasn’t normally thought of as a poison? There were a lot of medications with convulsions as a side effect that wouldn’t initially be thought of as an agent to test for, as long as no one suspected unnatural causes. Lidocaine, the antiarrhythmic and lo-cal anesthetic, for instance, could cause prolonged seizures if given intravenously in large enough doses. But it or other drugs wouldn’t be so likely to escape notice in a forensic investigation. After all, a suspicious toxicologist could think up just as many agents as any poisoner when it came to screening for the pharmacology of deliberately induced status epilepticus. Would Chaz, for instance, have been reckless enough to assume no one would consider the woman’s coma to be the result of foul play?
Maybe… or maybe not.
Mark grabbed his copy of Harrison’s Principles of Internal Medicine off his bookshelf and opened it to the section on seizures. Finding a table listing their causes, he considered other possibilities.
Trauma – too obvious.
Alcohol – too messy.
Recreational drugs – too obvious and messy.
Metabolic disturbances: Hypocalcemia; hypomagnesemia; hyponatremia – now here was something.
Some of these could be induced by medication, but persist after the offending pills were discontinued.
Take severe hyponatremia, a low sodium level in the blood, as an example. It could be brought on in susceptible individuals by certain diuretics, even at normal dose levels.
But that couldn’t be the case here. It would have taken days, maybe weeks to make it happen, not twenty-four hours. Unless Chaz, or someone, hadn’t waited for the police to confirm Kelly’s identity before making his move against Bessie. After all, he knew what the result would be, and it made sense to act ahead of time – no, that didn’t work either. The blood tests they’d done on Bessie the morning they found her would have revealed the drop in sodium.
Of course, there was the possibility of induced hypoglycemia. A shot of short-acting insulin could start a nondiabetic’s blood sugar heading downward in less than an hour, the maximum effect occurring within five to six hours. Since the nurses hadn’t been able to pin down the precise time of the seizure, the insulin could have been wearing off after they found her, and the intravenous dextrose she received would have masked any lingering effects. As for the time sequence, she would have had to receive the injection before midnight. Chaz could easily have concocted a reason to be in the hospital at that hour, though he’d have been taking a chance slipping into her room himself. So maybe he’d arranged for someone else to do his dirty work – He threw down his pencil and crumpled up his notes. Listen to me, he thought. Last night’s attack had him so chomping at the bit to nail Chaz, he was becoming obsessed with the man, dreaming up ludicrously wild scenarios about him.
For the hundredth time he eyed the phone, willing Dan to call with word on what he’d found at the wreck and whether he’d talked with Braden. Phoning the sheriff himself wasn’t exactly an option, having already bugged him so many times Dan had told him to back off.
He returned to opening his mail, trying to keep his mind off it all.
A few envelopes down the pile he found the letter from the Dean’s Office with Lucy O’Connor’s records and an accompanying letter explaining the change of schedule. Skimming through her résumé, he read she had completed medical school at McGill in Montreal, but had applied to the NYCH family medicine program after seven years in the field with a group called Médecins du Globe.
Wow, Mark thought, immediately recognizing the name. Those people were the Marines of medicine. Working out of Paris, the organization was known worldwide and had received the Nobel Peace Prize for going into areas of conflict all over the planet to treat civilian casualties. Anybody involved with them worked under the most grueling of situations. Not only would the job have been mentally devastating – a lot of volunteers returned with post-traumatic stress disorders – but physicians sometimes died, killed either by bullets or the diseases they were treating – cholera, dengue, Lhasa fever, and a host of other infectious horrors he’d read about but never faced firsthand.
No wonder she knew her stuff… and karate.
What also struck him was how quickly she’d been accepted into the two-year program at NYCH. She’d only approached them in June of the previous year, less than three weeks before the usual July 1 start of any residency. Her introductory letter stated she’d completed her current tour of duty with Médecins du Globe earlier than expected and inquired if they had any vacancies. The last-minute request for a position came with a half dozen glowing recommendations from her current colleagues and former professors at McGill. NYCH had immediately snapped her up.
Obviously they had an opening, he thought, knowing many posts went unfilled these days since HMOs were making the healing profession less attractive than an MBA. But she also must have impressed the admissions board as much as she was in the process of wowing him. They wouldn’t take just anybody.
He was about to put the papers away when he spotted the correspondence regarding her rural rotation. It was dated November 6, two weeks ago exactly, requesting the program director to allow her to switch her slot so as to do her rural training period as soon as possible. To facilitate the change, she’d even foregone her own vacation. Her manning the wards at the time the hospital would be most short of house staff was her offer, not the insistence of the director.
I’m flattered, he thought. He proceeded to file everything where he’d be able to find it again when her three months were up and it was time to fill in the evaluation forms. But from the looks of her, he could have filled them out now. It would be A+ right across the board.
He tried to get through another few letters, but once more his thoughts turned to Bessie McDonald and ways of inducing a coma.
Within minutes he was arguing with the head nurse of the geriatric wing at NYCH, insisting they check their short-acting insulin supplies to see if any were missing.
11:00 A.M.
Medical Records,
New York City Hospital
“Dr. Garnet,” Lena Downie whispered at his shoulder, “it’s the call you’ve been expecting from Dr. Collins.”
Finally! he thought, following in Lena’s wake as she led him to a phone behind the front counter. She had the rolling gait of a female John Wayne.
“Melanie?”
“Earl! Sorry I didn’t get back to you earlier, but I’ve been up to my ass in crocodiles with budget meetings last night and rounds this morning-”
“Hey, don’t apologize. I’ve been there many times.”
“What can I do for you?”
“Bessie McDonald, a former patient of yours, is the woman whose M and M report was in Kelly’s file. Mark said he spoke to you about it Sunday night, but didn’t have the name yet.”