"Yeah, but I haven't had time to set that up yet," Earl replied, flipping through the article. Finally he reached the section that stressed: Suspicions should be raised only when clusters of deaths and cardiopulmonary arrests occur that are either unexpected in timing or inconsistent with a patient's previous clinical course.
Janet turned to Thomas and began to explain Earl's previous concern that another way someone could foil a cluster study would be to work with an accomplice.
The resident listened intently.
Earl barely paid attention. The words unexpected in timing or inconsistent with a patient's previous clinical course had jolted his memory, and the image of a dying woman's calendar, carefully marked with crosses, popped to mind. Crosses that marked the deaths of patients who had not been declared DNR. In other words, patients who, for the most part, were probably thought to have sufficient time left that the matter could be decided later. Their deaths, though anticipated, might have been unexpected in timing.
"Wait a minute," he said, and moved to the keyboard. As chief of ER, he still had access to all cardiac arrest statistics, since his staff responded to calls from the floors. He punched in the key words to pull up a list of all the code blues at St. Paul's from midnight to dawn in the last six months and organized them by date on a bar graph. "The trouble is, we've been looking at overall death statistics. But in front of our noses there's been a simple way to separate them into two groups- those who died when they were expected to, and those who went a bit prematurely." As the computer worked, he told them about Sadie Locke's calendar.
The image that appeared on the screen stunned him.
Above January, February, and March, the incidence of codes called in palliative care seemed practically nonexistent. But over April, May, and June, three tall columns, like black towers of equal height, indicated the arrest team had been summoned about fourteen times each month.
"Well, look at that," Janet murmured at his side.
Thomas leaned forward. "Wow!"
The odds were zero that so many patients not yet designated DNR would go into cardiac arrest before their expected time by pure chance. Someone had selected them for death.
After chasing vague trends and trying to make mere fractions of patients add up to something concrete, the stark, solid pattern gave Earl a hell of a sense of accomplishment. Now not even Hurst would be able to deny that they had a killer at work.
Except he hadn't a clue who or why.
"Any comments or ideas?" he asked, assuming the other two had reached the same conclusion and raised the same unknowns.
The three of them studied the screen, their grim silence cocooned in the sound of rain pelting the study window.
"If someone's been killing patients for the last three months," Janet said after a minute, her voice little more than a whisper, "let's assume that that same person is also responsible for the first increase in deaths. At least then we could ask the question, Why kill only DNR patients for three months, then add patients who were not DNR to the list?"
Earl saw Thomas open his mouth as if to say something, then close it again.
"Spit it out, Thomas. All ideas are welcome."
The young man's dark complexion reddened. "I just had a rather nasty thought."
"Go ahead."
He hesitated, running a hand over his beard. "Well, what if there were something to Yablonsky's claim that someone had been pestering patients with questions about a near-death experience? No, that's too weird."
"Hey, go on."
"Well, maybe that someone tried it with patients who were more advanced in their disease but couldn't get anywhere with them. The people might have been too obtunded to reply with anything meaningful. So it would make sense, in a weirdo's way of thinking, to use people who weren't that far along, figuring they'd be able to at least speak. But our weird someone would have to manipulate these relatively more stable patients, bring them near death using drugs, say, or simulating the experience with ketamine, like in that paper you found."
Janet looked at Thomas in surprise but said nothing.
"Are you thinking of Stewart again?" Earl asked. "I thought you were all for his being innocent now."
Thomas's color deepened. "I am, but figured we need to put all ideas on the table, whatever we want personally."
Earl agreed with the part of needing to be complete. "Right you are. But you'll be glad to know there are still problems with pinning it on Stewart. He wasn't in town during a few weeks of the first jump in the mortality rate."
"But you're the one who keeps telling me that that doesn't rule out an accomplice," Janet piped in. "And there's a hideous logic to what Thomas just said that could apply to Stewart."
"And there's still the possibility someone is setting Stewart up," Earl responded.
"Then I'd advise you to check out that ex-wife of his," Janet said. She'd already voiced this suspicion twice before, first when Earl told her about Dr. Cheryl Branagh a few hours ago, and again later when he briefed Thomas.
Earl shook his head. "My instinct says no."
"Patterns are your strong point. Instinct's mine."
"Mine are good."
"They've been wrong before."
"Yours too."
It took Earl a few seconds to realize that he and Janet had slipped into the shorthand form of sparring that they, like most couples, had built up over the years. Thomas might just as well not have been in the room. "Sorry, Thomas. Rude of us," Earl said, and glanced at his watch. Only 9:05. "Look, it's not too late for a visit to Stewart's. He doesn't live that far away and might be able to shed light on who could be after him." Especially if confronted with the name Jerome Wilcher, he thought, seeing no need to release that tidbit to Thomas. Stewart had enough gossip to live down. "So I'm going to leave the both of you at it here-"
The sound of Janet attacking the keyboard interrupted him. The two men turned to her. "What's up?" Thomas asked.
"Maybe nothing. But I'm going to try for a home run again. This time I'm using only the list of patients who were not DNR when they died, For starters, let's see if there's a particular nurse in-house most of those times."
A single answer popped up on the screen.
The three leaned in to read it.
Earl felt his stomach knot into a fist.
"It can't be," Janet whispered.
Thomas went rigid.
It read JANE SIMMONS.
Janet braced herself against the passenger door as Thomas swerved her car around yet another corner, then accelerated toward the freeway. Already she regretted having accepted his offer to drive, but he'd insisted on going with her so they could discuss how much to tell J.S., and on getting behind the wheel himself.
"It can't be too comfortable for you these days," he'd said, patting his flat stomach to contrast it with her own.
She'd initially been grateful for his thoughtfulness, if not his lack of tact, as it was true that getting in and out of the driver's seat was more difficult with this pregnancy than she recalled it being with Brendan. But then she couldn't adjust the seat belt on the passenger side to accommodate the new girth, and ended up leaving it off. "Just don't tell my patients."
He'd followed the quickest route to the freeway and downtown but drove her peppy little car at twice the speed she would have in this weather, even if a patient fully dilated awaited her at the hospital.
"Slow down," she told him, raising her voice above the din of rain that peppered the heavy leather top of her vehicle. It sounded like they were in a tent. "J.S. isn't going anywhere."