“Virginia will be a good source for you since she and Sue worked together closely but only vis-à-vis Outpatient Clinic affairs,” Ronnie said. “I was going to suggest someone else who you would find more interesting for your purposes, but I’m getting the impression there’s no need. I’m sensing that you’ve already spoken with Cherine Gardener. Am I right?”
“I did talk with Cherine Gardener,” Jack said, surprised that Ronnie had guessed. “How did you know?”
“I knew as soon as you used the term triumvirate. It was a private and somewhat derogatory moniker that just Sue, Cherine, and I used as a kind of code for the three people you named. But we used it exclusively just among ourselves.”
Jack’s ears perked up with the idea that the triumvirate of Thomas, Wingate, and Alinsky had spurred a triumvirate of Sue, Cherine, and Ronnie, meaning that perhaps Sue had shared her concerns about a medical serial killer with Ronnie as well as Cherine. The problem was how to find out. He was in the same bind he’d felt with Thomas and Wingate and didn’t know how to proceed.
“Was Cherine helpful?” Ronnie asked.
“Shockingly so, although she could only spare a few minutes from her duties,” Jack said. “But she’s off tomorrow and has offered to get in touch with me to give me all the details she didn’t have time to explain. She did say that Sue was gearing up to make a big production about being denied a seat on the Mortality and Morbidity Task Force. I assume this is something you know about.”
“In intimate detail,” Ronnie said with another half laugh. “When I have more time, I can tell you all the ins and outs about that. It’s all rather involved, with oversized egos in jeopardy, if you get my drift.”
“When will you have some free time?” Jack asked.
“I’m working tonight, obviously. Then I have three nights free. We could arrange something maybe Wednesday or Thursday during the afternoon. I don’t need much sleep. I’ll send you a text, so you’ll have my number.”
“That would be terrific,” Jack said. “In terms of getting together, the sooner the better. In the meantime, are you the only nursing supervisor on the night shift?”
“That’s an affirmative,” Ronnie said. “There used to be two of us, which worked a lot better than just one supervisor. But a bit over a year ago, AmeriCare, in their infinite wisdom, cut us back to a single night nursing supervisor at the same time they reduced the nurse-to-patient ratio from one-to-five to one-to-eight. It’s all about saving money, if you know what I’m saying. But the reality is that it’s made my job nearly impossible. At night, I’m it! I’m where the buck stops for just about anything that happens because there is no administrator on duty. There’s one on call, but they hate to be called, so everything that happens in this whole damn hospital falls on my shoulders.”
“That sounds stressful,” Jack said. “Do you work exclusively nights? Is it your choice?”
“It is my choice,” Ronnie said. “I mean, I complain about it, as do the other night supervisors because it’s stressful, but we like there being no administrators here with their big egos. Also, there’s not so many private doctors around demanding this and demanding that. They can be as bad or worse than the administrators.”
“You said earlier that you speak often with Kevin Strauss. Why is that the case? Are you often involved in reporting medical examiner deaths?”
“Absolutely,” Ronnie said. “I’m called in on every death. It’s why I’m so familiar with what constitutes a medical examiner case and what doesn’t. When it is a medical examiner case, I’m invariably the one who calls it in to your people.”
“The private physician or the staff physician isn’t involved?”
Ronnie gave a short laugh. “Rarely! As I said, being the night nursing supervisor, the buck stops on my desk. Whether it’s a patient falling out of bed or kicking the bucket at three o’clock in the morning, I’m the one who handles it from A to Z.”
Ronnie again glanced at his watch and, seeing the time, he got to his feet. “Uh-oh! Sorry, but I have to break off this chat to clock in. We can continue tomorrow or Thursday, your choice. I’ll give you a call tomorrow when I wake up, and we can arrange it. Ciao!”
“One last quick question,” Jack said. “I’ve heard that the M and M Task Force was a small committee. How small, and by any chance do you know everyone who sits on it?” Jack remembered from Virginia that Thomas, Wingate, and Alinsky were members.
“It’s very small,” Ronnie said as he slammed his locker and spun the combination dial. “It’s only four of us.”
“Wow, that is small!” Jack marveled. “And you said ‘us.’ Are you on the committee?”
Ronnie gave another short laugh. “I’m not only on the committee, but for all intents and purposes, I am the committee. The other members are the triumvirate, but they are members in name only. I have to do everything myself and just get their rubber stamp of approval. I’m the one who plans and schedules the full M and M Committee meetings, which is a royal pain in the butt. And it was why I was heavily championing Sue Passero’s appointment. She would have helped and carried her weight, which I can’t say for the three other muckety-mucks.”
Brandishing Jack’s card to indicate he’d be in contact, Ronald Cavanaugh started for the door. Jack reached out and grabbed his arm, pulling him to a stop. Ronnie looked down at Jack’s hand on his forearm with a quizzical expression. It was as if the gesture caught him totally unawares. “I really have to go,” he said. “I make it a point never to be late, something I learned in the military.”
“Of course,” Jack said. He let go of the man’s arm. “But I heard that the M and M Task Force was also responsible for generating the death ratio. Is that true?”
“Supposedly,” Ronnie hurriedly said. “But actually, the death ratio is generated by the hospital computer on a regular basis with all the daily input vis-à-vis hospital deaths. The task force just approves it for the Compliance Committee to indicate that the M and M Committee is keeping an eye on it.”
“How has the death ratio been running, say, over the last year?” Jack asked, trying to get in one last question despite Ronnie’s need to leave. With the idea of a possible active medical serial killer on the loose, it suddenly occurred to him that the statistic would be particularly telling and might have been what had convinced Sue.
“The death ratio has been terrific,” Ronnie said as he pulled open the door to the hallway. “In fact, during this year it’s fallen to less than point-eight-five, which is damn good for an academic medical center that deals with referrals of difficult cases from other hospitals. In fact, it’s the best in New York academic centers, including Columbia, Cornell, and NYU. Ciao! I’ll call you sometime tomorrow afternoon.” In the next instant the door closed, and the nurse was gone.
For a few minutes Jack remained where he was, straddling the bench, marveling that the diversion he’d managed to find was getting progressively more complicated. He’d learned a lot from Ronnie and would undoubtedly have to learn more if he ended up having to pursue both Sue’s death as a homicide as well as the serial killer issue, especially if they were somehow related, with a putative serial killer feeling that Sue had to be eliminated to keep from being exposed.
Going back over the conversation with Ronnie, he regretted not having brought up the medical serial killer issue to get his take on the possibility, as integrated as he was in the MMH world. The reason he didn’t was the same reason he didn’t bring it up with Wingate or Thomas: Everybody was a suspect. But if Sue, Cherine, and Ronnie had been an opposing triumvirate, it seemed only reasonable they would have shared such a momentous and serious concern. At the same time, he couldn’t be sure Ronnie knew about it, as it had only been four or five days, with an intervening weekend, since Sue had told Cherine her theory, and Cherine had been adamant she was the only one Sue had told. And now Jack had learned that the mortality ratio for MMH had been going down over the past year. How could there be statistical evidence of a very active medical serial killer, meaning deaths of people who weren’t supposed to die? Cherine had suggested Sue’s belief was based on statistics, but if Ronnie was right about the mortality ratio going down, it seemed far-fetched indeed.