Deadly Diversion: A Medical Thriller (21 page)

“Another metabolite, CPK, was elevated slightly.”

“What does that mean?”

“He had some muscle damage. Did you notice him trembling when it happened?”

“He didn’t move at all, Max. He looked like he was paralyzed.”

“Monika, this probably is just one of those deaths that happen, and we’re never exactly sure of the cause. Post-mortem tests don’t always tell you exactly. You know that. We try to piece it together from the diagnosis, treatment, physical findings from the autopsy and whatever lab tests are run. Just like when they’re alive. We rule out some things and what’s left is the diagnosis.

It’s not a perfect system, but it’s the best we have. That’s why they call medicine an art, not a science.”

“Max, the medical examiner called this death suspicious. One of my nurses is under suspicion for murder. We’ve got to know for sure. I know she didn’t do it. What if this happens again? Is there anything else it could be?”

“The only thing I can think of is succinylcholine, anectine is the trade name. It’s a neuroblocker—a paralytic agent—often used in surgery. Do you know of any way he could have gotten it? You don’t routinely use it on the unit, do you?”

“No, we don’t but can’t you test for it anyway? We’ve got to find out what happened to him! Laura and St. Teresa’s are both on the line. All of us are.”

“Monika, that test is expensive. Why do you think the ME won’t do any more testing? And I don’t even know if any lab in St. Louis does it. I think there’s only one place in the country that will test for it and that’s in Philadelphia, if I remember correctly. And even if we ran the test, it’d be unlikely to show up. Succinylcholine breaks down rapidly after death. I have no basis to run the test. Unless there’s a good reason to suspect it or the police requested it, in which case the ME would handle it.”

“Max—”

“I can’t do it. My budget’s stretched as far as it will go. And I just got the word that they’re taking the costs for the drug tests on the nurses out of my budget. Several hundred nurses work at St T’s full- or part-time. Where I’m going to find the money, I don’t know. Not and keep the lab running.

“I have to use what little money I have for tests on live people, patients who might get well. Not on every cadaver that comes through here. Nothing we can do for them now.” He closed the file and laid it on top of others piled on his desk. “I’m sorry I can’t help you. You know I would if I possibly could. I’m convinced that his liver status explained the elevated morphine level. I don’t know what would cause the respiratory arrest. That’s the best I can do.”

FIFTEEN

Wednesday, 15 August, 1735 Hours

I SQUEEZED INTO Black Beauty and released the catch for the top. It had been a long day and, even though the temperature was still in the high nineties, I needed the wind tonight to clear my mind. I laid my paper-towel-wrapped roses—the ones from the Guardino family attorney—on the floor and, wedging myself back out of the car, I snagged my lab coat on the latch and ripped the pocket. The plastic bag fell onto the garage floor, and when I stepped back to release my lab coat from the door latch, I inadvertently kicked the bag under the car.

It had been one of those days.

I crouched down and looked under the car. The baggie was sitting next to the right front tire, out of my reach. Why hadn’t I tossed it in with the medical waste? I walked around to the other side of the car, squatted down and tried to reach it. No luck. My arms were just too short.

“What are you doing there?” a male voice demanded.

I squeezed myself back up and turned toward the security guard, not one I recognized. “Just looking for something I dropped.” I said, feeling a familiar rush of guilt, even though I’d done nothing wrong. A legacy from my grade-school days at St. Aloysius.

“Can I help?” he asked, sounding less coplike.

“I can get it.” I levered myself back down and stretched out toward the packet. I couldn’t reach it. But I couldn’t leave it, either; he’d be sure to find it when I drove away. I scratched my fingers on the greasy cement and caught the bag’s edge, inching it towards me. I rolled a little to one side and tucked the baggie into the waistband of my scrubs, and pulled my top down over it as I stood up, hoping the bulge wouldn’t show.

The guard hadn’t moved.

“Got it,” I said. “Thank you!”

Keeping my arms crossed close to my waist, I inched around Black Beauty and slid into the driver’s seat. As I started to back out, the unlatched top bounced on its frame. I stopped and fastened it back down.

Turning at the exit ramp, I looked in the rearview mirror. The guard still stood there, hands on his waist. If he’d been a nun, he would have seen through my subterfuge.

SIXTEEN

Wednesday, 15 August, 1940 Hours

I STOOD NEAR THE ENTRANCE, trying to get my bearings. I’d avoided the St. Louis casinos from the day they’d opened. I figured I didn’t need to test my resolve to not gamble. Now I knew I’d been right.

I felt right at home on the Ambassador, the casino built onto the old boat that paddled up and down the Mississippi in the Big Band era. Now it was docked and today’s amusement— gambling—drew St. Louisans and tourists to the riverfront.

The recorded sounds of an old-fashioned calliope accompanied me as I made my way up the gangplank to the entrance. There a carnival barker handed out coupons for a free drink to passersby, tipping his straw bowler at an elderly woman ahead of me.

The flashing lights and clanging bells inside were designed, I knew, to up the excitement. The sounds of coins dropping into metal trays were accompanied by excited squeals of the women parked in front of the slot machines. Even the blank faces of the too-cool men barely scratching the top of the blackjack table with their cards felt familiar. My heart was racing and, damn, I loved it.

I pulled myself together and wandered through the different rooms looking for Noni. She was at the farthest table dealing blackjack. I knew I couldn’t talk to her while she was working so I stopped at a nearby slot machine and bought a ten-dollar roll of quarters from a woman rolling a money cart up the aisle. I told myself to lose the money slowly, but I kept speeding up, hoping with each pull that I’d hit the big one.

An Elvis look-alike stepped up and straddled the stool next to me and gave me a quick glance, his slicked-back hair, sideburns and pink-tinted glasses designed to appeal, I supposed. Getting no response from me, he hooked yellow-and-black snakeskin cowboy boots on the rungs of the stool and dropped a quarter in the slot. The clanging cacophony of coins spilling into the metal tray brought stares of envy from those around and a broad grin from Elvis. The ringing continued, alerting casino staff and security guards, who hurried over to the machine. Elvis sat back while red-jacketed ambassadors collected the coins in cloth money bags and uniformed guards escorted him and his winnings away.

I had gone through two more rolls of quarters when I spotted a balcony above Noni’s table. I finished off the roll and headed for the stairway. I found a spot where I could look right down onto her table. She wore the standard uniform of black pants and white shirt and tie, but their simple lines only made her exotic beauty more apparent. Her hands moved surely and quickly as she dealt the cards, scooped them up and stacked the chips with no wasted movements. She smiled at a customer who said something to her. Standing a few feet away, a man in a sport jacket and tie kept his eyes on her table, and occasionally looked up at me.

I watched as the dealer at the next table handed off her position to another dealer and heard her say she was taking a break. Noni did the same thing a few minutes later and I hurried down the stairs to try to catch her.

She looked surprised when she saw me. I asked if I could talk to her.

“It’s against the rules to talk to the customers when I’m on break,” she said, looking around. “What do you want anyway?”

“Can we go in here?” I asked, pointing to the ladies’ room.

“I’m not supposed to. We have our own.”

“Please. It’s important.”

“Make it quick.”

She leaned against the sink and folded her arms across her chest.

“What can you tell me about Huey? Is there anyone who’d want to hurt him? Did he owe anybody big-time?”

“Well, Huey always lived on the edge.” She smiled.

“How much? Enough that someone would come after him?”

“The cops asked me that.”

“What’d you tell them?”

“What could I tell them? I don’t know.”

“How about here? Do they let people get in debt here? No, I guess not with the limits.”

“Oh, you mean the rule that says you can’t lose more than five hundred dollars in two hours? Ha! That never stopped Huey. But, no, they don’t let that happen. You can run up a credit card to the limit, a bunch of them if you want, but they don’t cover anyone’s gambling here.” She turned as if to leave, then stopped. “Why are you here? You were his nurse, right? I thought Huey died from the cancer.”

I hadn’t thought of how to answer this question, which if I were a real investigator, I surely would have known.

“Listen, if you or anyone at that hospital did anything wrong... I was a surgical tech in Texas before I moved up here. I know mistakes are made. That’s it, isn’t it? You think someone did something, don’t you?” She faced me, hands on her hips. “Huey told me that he was afraid. If anyone did anything wrong, he told me, it would be someone at the hospital. But,” she said, chewing the inside of her cheek, “I didn’t believe him.”

“Noni!” yelled a male voice. “What are you doing in there?”

“Just leaving,” she told him.

I was still shaking when I got to my car. The encounter with Noni and the rush from gambling, just being in the casino, had left me feeling weak and scared. I started the car and backed out slowly over the bumpy bricks that still paved the riverfront. I drove around downtown until I found myself on a street with boarded-up buildings. I turned at the next corner and knew where to go next.

Hannah was surprised to see me. The girls were already in bed, Roger had gone to the men’s meeting at church, and her three teenage boys were on a camping trip. She made some popcorn that we took out on the porch along with two Cokes. When we were settled in the wooden rocking chairs, she said, “Okay, what’s up? There’s something on your mind or you wouldn’t have dropped in like this.”

I took a few minutes to think, slowly rocking back and forth. Then it all poured out. How I was afraid Guardino’s sons somehow knew that Bart hadn’t resuscitated their father, that Huey’s death wasn’t from his cancer or an overdose of drugs and, finally, what I hadn’t wanted to tell anyone.

“I felt like something had taken over my body and was controlling me. I just couldn’t stop.” I turned to her in the dark. “I wanted to stay in that casino and gamble until I turned numb. Every pull on the slot machine was a rush. When it didn’t happen, I’d try again, each time thinking—no, knowing—I was going to win. A few times when some quarters fell in the tray, I just knew my luck had changed.”

I heard her draw in her breath.

“Hannah, it’s not winning. It’s the anticipation. That’s the rush. Just waiting, hoping, praying it will happen and, if it doesn’t, wanting that rush again.” A sob choked my voice.

Hannah reached across and took my hand in hers. “It’s okay, Monika. You didn’t stay. You left. You’re okay now.”

“I did, didn’t I? I went in there, felt it, and still I left.”

“That’s all you can do. If you do have a gambling problem, just do what they say in AA—one day at a time.”

“I’ve heard that.”

“Just don’t gamble for that one day. You can do that, can’t you?”

“Heck, I don’t think I ever want to be that scared again. I felt like the thing was controlling me and I couldn’t do anything about it. I hated that feeling.”

‘That’s good. Just remember it if you’re tempted.”

We rocked back and forth for a few moments, stirring a warm breeze. Cicadas’ raucous voices got louder, then died down again. A car full of laughing teenagers passed by on the street. There was a taillight missing on their older model car.

“And if it ever happens again,” she said softly, “just do what you did tonight. Tell someone.”

“You think I should go to Gamblers Anonymous?”

“Do you think you should?”

“I think I should just stay away from the boats. I haven’t had any trouble otherwise. 1 just buy a lottery ticket now and then. That’s all.”

“You can sign up to have yourself barred from the casinos, you know. If you’re still worried.”

“No. I’m okay now.” I handed her the popcorn bowl. “Thanks, Hannah, I think I’ll go home. I’m beat.”

She stood up to hug me.

“I don’t know what I’d do without you,” I told her, tears threatening.

“You don’t have to find out. I’ll always be here for you.”

We patted each other on the back, and I mumbled a few more teary words. I felt better by the time I reached the corner. The top was down on Black Beauty and I laid my head back on the seat and let the warmth of the city envelop me. Mostly, I just felt lighter, as if a great weight had been lifted. Nothing could hurt me now.

SEVENTEEN

Thursday, 16 August, 0650 Hours

RUBY WAS WAITING FOR me when I came through the door the next morning. She handed me a stack of messages and left with a requisition for the lab. Serena, who had been standing at the corner of the desk, sidled up to me.

“I was wondering,” Serena began, chewing on her lower lip.

“Yes,” I said, impatient to get to work. Mr. Kleinfeldt was worse, Jessie’d said, and I’d need to talk to Jake about a DNR order.

“Do you know about getting a license to be a nurse?”

“Well, it’s been a long time since I took boards. Aren’t they preparing you for that at school?” I flipped open Kleinfeldt’s chart.

“It’s not about the exam. It’s about the application for a license. We have to turn it in at school next week.”