Deadly Diversion: A Medical Thriller (31 page)

“Good, you’re back,” Max said.

“I’m so far behind—”

“I thought you’d want to know about Mr. Castle.”

“Yes?”

“They did find succinylcholine in his blood,” Max said, his voice quiet, steady. “Enough to kill him.”

My voice caught in my throat.

“What happens next?” I asked finally.

“I call the ME and administration, of course. Someone will contact the police. You were right after all.”

“I didn’t want to be right. I wanted you to tell me you didn’t find anything.”

“Believe me, I wish I could.”

How could Huey get succinylcholine, a drug that we seldom used in ICU? Where had it come from?

I called Max back. “How did he get it? In his IV line?”

Max laughed.

“I’m glad you can laugh,” I snapped.

“Sorry, Monika. I was just picturing him if he got a straight shot of succinylcholine. Every muscle would contract and he’d pop right up. My guess is somehow it got in his IV bag. It had to be a slow infusion or someone would have noticed what was happening to him.”

“So what did happen?”

“He had respiratory paralysis, then severe hypoxia set in.”

“So,” I said, “he suffocated to death.”

“Yes.”

I let out a breath that I didn’t know I’d been holding.

“How much time would it take?”

“Hmm. With his fatty liver, the muscle paralysis would be prolonged, but I couldn’t say how long it would be until he couldn’t breathe at all.”

“Would he be aware of what was happening?”

“I’m sure of it. Not an easy death, that’s for certain.”

“But wait, didn’t you say succinylcholine is unstable in solution? Huey had a TPN bag hanging, a high concentration of glucose, wouldn’t that affect the potency? Wouldn’t it break down pretty quickly?”

“Not right away, it wouldn’t, and I think it would hold up okay. They use a variety of mixtures in surgery and it still works. You say he had a central line?”

“In the jugular.”

“Well, in that case, it’d go pretty quickly. I assume the bag’s gone.”

“It went out the day he died.”

“Anyway, we’re out of it now. I’ve started the legal machinery. They’ll be taking over. Let them find out what happened.”

I sat staring at the phone and listening to a dial tone. Someone had deliberately tampered with Huey’s IV bag, adding a lethal drug intended to kill him. I couldn’t seem to take it all in. Who would do that? And why?

Laura?

Laura had been traumatized after a patient of hers died a few months ago. She’d been hospitalized in the psych ward for a week afterward, but she had been conscientious since she’d come back to work. I felt certain that Laura did not have any reason to kill Huey. She did have the opportunity, though. She’d been caring for Huey that morning, albeit only for a short while. She’d given him morphine—that the ME had confirmed from the first blood test—and hung his IV bag, which apparently contained succinylcholine. So she had the opportunity but no motive. Someone had put it in the bag, though. But who?

Someone knocked on my office door.

“Laura,” I said.

She burst into tears.

“Come into my office,” I told her, taking her arm.

After I had her settled, a tissue box at the ready, she began. “You can’t imagine how awful it is. Locked up like a, a...” She stopped to blow her nose. “I was so scared. I was afraid I’d never get out!” She clasped her trembling hands tightly in her lap.

I pulled the trash can over for her used tissues.

“They might arrest me again, Tim’s brother said. Just because they don’t have enough to charge me doesn’t mean they won’t. What am I going to do?” Her normally pale face was flushed. “I’m a nurse, not some criminal. I was only doing my job.” She pulled a thin white sweater tightly around her body.

The phone rang but I let my voice mail pick up.

“You know I didn’t kill him, don’t you, Monika?” she asked, looking at me with tear-filled eyes.

“There’s a problem,” I said.

She started to interrupt, but I held up my hand.

“They found succinylcholine in Huey’s blood. Max says he got it in the IV bag.”

“Oh, my God, no!” Her hand shook as she reached up and wiped her hand across her face as if to erase what she’d just heard. “I didn’t do it, Monika, you’ve got to believe me! I wouldn’t even know where it’s kept, or what to do with it.”

“Laura, I’m not accusing you. I’m just telling you what was found. Let’s think of how it could have happened.”

She nodded and looked up at me, her vision clearing.

“Now, when did you get the bag? Did it look like it had been tampered with in any way?”

“Okay, let me think.” She closed her eyes, hands pressed to her cheeks. “First, I checked on Huey. His BP was high and he complained of pain. His morphine syringe was empty so I went in the med room and signed out the morphine.

“That’s when I saw the bag,” she said, looking up. “It was lying on the counter. Maybe the pharmacy was late in sending it up, or Bart was in a hurry. I checked it carefully. Huey’s name was on it, I remember that specifically because it was the only one there. I carried it back out with the morphine. Huey’s bag was nearly empty so I changed it. Bart had signed off that he’d flushed the port, and I just assumed he hadn’t had time to change the bag.”

She sat back in the chair and her arms dropped to her lap. “How could this have happened, Monika? Are you sure they didn’t make a mistake in the lab? It just doesn’t make sense.”

“It happened, though, and Max is certain the results are correct.”

“Well, I know I didn’t do anything wrong,” she said, pushing her chin into the air. “So when can I come back to work?”

“Hmm. That’s a problem right now. Judyth has put you on administrative leave until all of this is straightened out.”

“What am I supposed to do for money? I’ve got rent due, school loans...”

“You’ll still get your salary, don’t worry about that. And I’m sure it won’t be long. I hope not, I need you!” I added, smiling. “Why don’t you go home and get some rest, and I’m sure this will all be over soon.”

“I am tired,” she admitted. “I just came in to get some things out of my locker.” After she left I got up, went back out to the unit, waved off Ruby’s question and grabbed a Coke out of the refrigerator in the conference room. Back in my office, I locked the door, pulled out the bottom drawer of my desk, and propped my feet on it. The tab on the can gave a reassuring hiss as I folded it back on itself. I took a long drink and let the fizzy bubbles work their way into my brain.

Even though she seemed to be the most likely suspect, I just couldn’t see Laura killing Huey. She lacked the initiative and the cunning to do anything so devious. She had enough trouble just following her patients’ care plans. How could she devise and carry out a scheme that demanded such resourcefulness and nerve? No, I just didn’t see her doing it.

Had it not been for Ruby’s insistence that she kept Lisa out of the med room, I would have suspected Lisa, although what her motive could have been I couldn’t imagine.

Noni had been a surgical tech, she’d told me. She most likely knew what succinylcholine was and what it would do. But how would she know where it was kept? Even if she found it, how could she get into the unit without being seen? And the most important question, why would she want to kill him?

Then it must have been someone on the staff. That seemed the only logical conclusion. Even if they had never worked in surgery, everyone had been to the adjacent supply room for scrubs, and anyone could see the med cabinet with its key in the lock. It must have been someone who knew what succinylcholine would do. And someone who would have had a reason to want Huey dead.

Tim and Jessie had known Huey when he’d been hospitalized a few months ago when he’d hemorrhaged in a parking lot close to St. T’s. I couldn’t see any connection between Huey and either of them. They were both experienced, competent nurses. By no stretch of the imagination could I think that Tim would harm a patient just because he was fighting with administration. He just wanted better care for patients and better treatment for nurses. Who could argue with that?

Serena’s questions about the licensure application troubled me, but only because I was worried about her being eligible to sit for the exam, not because I thought she’d killed Huey. Her brush with the law had been when she was a juvenile; I didn’t think she was the criminal type. And she, like Tim and the others, didn’t know Huey and wouldn’t have any reason to harm him.

I tossed the empty can in the trash and stretched my arms up over my head. I grabbed an elbow and pulled it across my back, doing the same with the other one. My neck still felt tight so I swung my head around in half circles.

Something was wiggling around the edges of my mind but I couldn’t get to it. Something I could almost remember.

I closed my eyes, letting my arms drop into my lap. I took a breath and let my mind drift. Maybe if I didn’t try...

I rolled my shoulders several times and the vertebrae in my neck shifted.

The bag! Now I remembered what it was about Huey’s bag that had kept troubling me! The foil covering on one of the ports on his IV line had been removed and its stopper had been discolored, which wouldn’t have been unusual if the bag had been in use for some time. But it had been a new bag. The foil covering should have been intact, keeping the stopper sterile.

That was where the succinylcholine had been injected, purposely, to end Huey’s life in a most painful way.

Only one person could have done it.

Bart.

Bart had access to all kinds of paralytic agents in the O.R., including succinylcholine, commonly used. It would have been easy for him to pocket a vial and then mix it into Huey’s IV bag right before the end of his shift. He must have left the bag on the counter for Laura to hang. That way, in the unlikely event that anyone would test Huey’s blood for succinylcholine and discover its presence, Laura would be the most obvious suspect, especially because she had abandoned a former patient and she was still on probation with the state licensing board.

And Lisa had been there. She had seen him do it! That was what she’d been trying to tell me!

I dialed BJ’s cell phone. Her voice mail picked up.

“BJ, listen. I’m at the hospital. I know what happened! Bart did it! I don’t know why, but it was Bart. I need you to—”

“Your time is up,” a robotic operator on BJ’s phone intoned.

“Damn.” I slammed the phone down.

I looked up. Bart stood outside my door. A smile spread slowly across his face. He walked away and I dialed BJ again. Her cell phone voice mail picked up. I left a message: “It’s Monika! I need you!” Then I called the station. “I need to talk to BJ Nieswander, now. It’s an emergency.”

“Okay, ma’am, just a minute please.”

I waited while “Meet me in St. Louis” played in the background. 1 stood up and stretched the phone out, trying to see if Bart was still outside my office. Finally a voice came on the phone. “Hello, this is Officer Nieswander—”

“BJ,” I said, “listen—”

But her voice kept going; it was her voice mail at the station. I pressed “O” and got a recording. “Just a minute and we’ll connect you to the operator.” I waited, the phone clamped to my ear until a voice answered, “This is the St. Louis City Police Department. All operators are busy now, but if you’ll wait on the line, the next available operator will take your call.”

“Damn!” I slammed the phone down and promptly picked it back up. I punched in the number again. This time the operator answered, and I asked her to page BJ.

Ruby stuck her head in the door. “Phone for you,” she said, but I waved her off. The line clicked and BJ’s voice mail came on again. I hung up and dialed her cell. Her voice mail picked up again and I left another message, “Call me!”

Panic fluttered up from my stomach into my chest, but I pushed it down. I had to think what to do. Would anyone in our security office do anything? They probably wouldn’t believe me and even if they did, I doubted they’d stop Bart. I had to find BJ.

I grabbed my bag, tossed my cell phone and keys into it, and dashed out. The strap of my bag caught in the door as I slammed it shut. The door locked automatically. Shit! The strap was tangled in the door, the bag hanging on the outside. I took a breath. I squashed my fingers together and squeezed them between the door knob and the opening to my bag, which in my hurry I had not zipped shut. I could just snag the key ring. I wiggled it out, unlocked the door, and pulled the strap free.

Ruby called out to me but I ignored her. I heard my name over the paging system, but all I could think about was how I had to get to the police station and tell BJ. Or Rosan. I should have called her, but I wanted to get out of there and away from Bart. Who knew what he was capable of doing.

I didn’t wait for the elevator but ran down the four floors to the lobby entrance where I stopped to take a breath. I pulled my phone out and tried BJ again. This time the automated voice told me I couldn’t leave a message because BJ’s voice mail box was full.

I took the stairs down to the basement tunnel that snaked under the street to the garage. I reached the door just as it opened. Bart stepped aside and waved me through.

I tried to catch my breath.

Bart smiled, his handsome face calm and collected. “So you found out, didn’t you?” he asked. He stood with his legs spread, hands in his lab coat pockets.

I turned back with a quick move, but Bart grabbed my arm. “I was afraid you’d figure it out somehow.” Bart whipped a syringe out of his lab coat pocket, put the needle cap in his mouth, pulled the syringe away from his face with practiced skill, and spat the cap out. It bounced away on the tile floor.

“Put that thing away,” I demanded, trying to sound stern. But the quiver in my voice betrayed me. “Or I’ll call security,” I added with more force.

With a lunge Bart shoved me back and slammed my head against the wall. Waves of dizziness washed over me. When my vision cleared, Bart had his arm across my chest, pinning me to the wall. My arms flapped uselessly as I struggled to get free.