Death Rounds (24 page)

“But this morning, he just seemed to have a cold,” she said, shaking her head and looking at me as if I were to provide answers about how he could have become so ill.

But the answer I had—that someone had deliberately infected him—wouldn’t do her any good. “Donna, was he complaining of any symptoms on Saturday?” I asked instead.

“No, not at all. He spent the day at UH going over records. He even seemed fine Saturday night, though I thought he was preoccupied by whatever he was looking into.”

“Why? Did he say anything?” I asked eagerly.

“No, it’s just that he was quiet all evening. Normally we play cards or watch a movie, but he insisted we go for a walk instead. If he said three words the whole hour we were outside, I couldn’t tell you what they were. We just strolled along, and when I asked him what was the matter, he simply told me that the audit wasn’t going the way he’d hoped and that he’d have to go back in to UH on Sunday.”

“How sick was he this morning?”

“Not very. He had a mild cough and complained of a bit of diarrhea, but neither seemed like much. The only thing unusual was his being concerned about it at all. He never takes care of himself, even when he’s obviously too ill to work. So when he said he was going to pick up some antibiotics, I was pretty surprised.”

“Did he?”

“Yes, I’ve got them here.” She reached for her purse. “Then he came home in the middle of the afternoon, went to bed, and told me if he wasn’t feeling better by morning he was going to check into ER as a patient. That shocked the hell out of me, because he still didn’t seem too bad. I actually kidded him that he was going soft in his young middle age and that I expected better stuff when I robbed the cradle.” She was fumbling for the pills and starting to cry. “Maybe if I’d checked on him sooner, he wouldn’t have gotten so bad. But I let him sleep, and only when I went to get into bed around eleven, did I realize how wheezy and hot he was. When I could hardly wake him up, I called an ambulance.” She sobbed, handing me a container full of red-and-black capsules, then groping back in her purse until she found a handkerchief.

I recognized what those capsules were without looking at the label—erythromycin.

While I comforted Donna and let her finish crying, my thoughts were racing. Michael must have suspected as early as Sunday morning that he’d been infected with
Legionella.
But he couldn’t have been all that sure. Otherwise he would have admitted himself to emergency for IV antibiotics then, not simply put himself on oral erythromycin. What pattern in what charts had he subsequently seen that convinced him there really was a phantom? Or had he seen something previously and only later realized what it meant? In fact, maybe the pattern didn’t strike him until he was on the way to ER by ambulance. If he’d been as certain about the Phantom earlier in me day as he obviously was when he arrived in ER, wouldn’t he have told me, or Cam, or someone? Slowly a horrible possibility dawned on me. It might have been his own progression through a vague prodrome to the brutal characteristics of respiratory distress and septic shock from
Legionella
that had finally convinced him there was a killer—when he knew beyond all doubt what he had and that he had become a victim of the Phantom.

Damn your skepticism, Michael, I thought. Despite his belated willingness to look at records for traces of a murderer, his stubborn doubts that anyone could transmit
Legionella
at will must have continued to dog him over the weekend. I prayed his delay in getting help wouldn’t cost him his life.

I escorted Donna to ICU and led her to the door of the isolation room where the staff had put Michael. There I helped her to don the protective clothing, followed her in, and stood behind her as she gazed down at her husband. His chest rose and fell to the rhythmic hiss of a respirator, his body full of tubes and lines, and his every sign of life wired into a tiered bank of monitors behind his head. Her tears flowed silently as she hesitantly ran her gloved hand through his hair, but she remained erect standing at his side. “You can leave me alone with him now, Earl,” she commanded softly, the steel in her voice catching me by surprise.

Looking back as I left ICU, I saw she hadn’t moved. She remained motionless in that lit chamber, the beginning swell of her pregnancy suggested by the green gown enveloping her. Off to the right, I could see a similar room, only dimly illuminated, where the form of Stewart Deloram stirred and turned in a restless sleep. How many more glass coffins would there be? I thought angrily, cursing the monster that had done this.

* * * *

I roared out of the parking lot at St. Paul’s and headed for UH with one objective. I was going into the hospital and I was going to find what Michael had discovered. I didn’t care if I had to jump the security guards, break a window, or smash locks. Pussyfooting around had cost too much. As for fear of running across the Phantom, heaven help him if I did. I was in a rage.

The storm hadn’t let up any, nor had my speed. Once more the car rocked as I flew through water-clogged streets and screeched around corners. Occasionally under a street lamp I saw my spray fly up to the front steps of the old gray stone houses that hugged the sidewalks in this part of town.

Thankfully part of my brain continued to serve me rationally. Halfway to UH I had a better idea than committing a B&E. Driving one-handed, I fished out of my coat pocket the telephone number that I’d made a point of getting earlier that evening, though I never expected to be using it so soon. I flicked on my overhead light so I could see the numbers and quickly punched them into my cellular. It took about a dozen rings, but finally Williams’s sleepy voice boomed out of the receiver, “This better be good.”

“Dr. Williams, it’s Garnet. We’ve got a serious situation here, and I need your help.”

“Now?” he queried. I could just imagine the expression on his face.

“Yeah, now. I haven’t got time to explain how or why, but I’ve got reason to believe the infections that killed Phyllis Sanders were deliberately inflicted. Most likely two other nurses where she worked were similarly infected with
Legionella
in the last six months. One of them died. Three days ago, as you know, the ICU doctor treating Sanders inexplicably contracted what we presume is
Legionella,
and an hour ago I resuscitated my best friend, a doctor in my ER. He’s in septic shock, also presumed to be from
Legionella.
His only risk factor was poking around UH to try to find out how the other infections got started!” My frustration and anger had exploded out of me as I talked. I paused for breath and drove, straining to see through the windshield, listening to the silence my outburst had provoked on the other end of the connection.

“Have you been drinking?”

“Christ!” I screamed at him, almost losing control of my steering. “I am not some weirdo,” I yelled at him. “You ought to know that from being in St. Paul’s just one day.” How hospital personnel react to a doctor on his or her own turf always gives a pretty quick and reliable take on a physician’s reputation, for better or worse. “Did anyone besides Rossit and Hurst imply anything but a favorable impression of me?” I wasn’t above arguing shamelessly on my own behalf, hoping he hadn’t run across a few of my other enemies. I was desperate for his help. Overhead a roll of thunder drowned out the sound of the rain on my car.

He chuckled. “Actually, it was those two turkeys trying to bad-mouth you that added most to your credibility.”

I felt a glimmer of hope.

“But what in the world makes you think such a wildly improbable story could be true?”

“Because the three nurses had a habit of being malicious to patients, and I think there’s someone at UH who’s taken a deadly exception to their cruelty.”

“What?”

I again imagined his incredulous expression from the tone in his voice. “Because there’s a history of someone punishing punishers in that place, but never this lethally,” I answered. “Look, I don’t expect you to believe this without evidence, but Michael Popovitch found something in the last few days that convinced him we’re up against a serial killer. He didn’t have time to tell me what it was before he arrested, and I must get at those same files he was looking at.”

“But how can I—”

“By calling the security guard at the front door, then saying that you’re in charge of the CDC investigation of the hospital and you suddenly need this additional information. Order him to let me in and give me whatever I want.”

“That will never work.”

“It won’t work if we wait until morning. Security would make me go through channels once all the regular staff are in. But if you make the request tonight, when the night guards are alone, we might pull it off.”

“But I told you I’m not even part of the hospital infection group—”

“You also told me the only way through a situation like this was bluff,” I shot back.
“Big, bold-faced, lying bluff!
Now was that little speech also just some of
your
bluff, or are you for real?” I held my breath, one-handed my way through more small lakes forming over me road, and waited for his reply.

“I don’t know, Garnet,” he said over the noise of the spray, “all this is flaky as hell—”

“Listen to me!” I cut him off again. “I looked up some of the papers you wrote. Your specialty seems to be analyzing unusual patterns in the spread of infectious diseases and determining whether a vector—a carrier like a rat, a mouse, or a tick on a deer—is responsible for the spread of otherwise inexplicable outbreaks. I think what we have here is an inexplicable series of infections where the ‘carrier’ is a serial killer. If you can track down a four-legged vermin, maybe you’re perfectly qualified to find a two-legged one so we can put a stop to him. Simply adopt the same perspective you’ve used to discover vectors in the other bizarre cases you’ve solved.”

There was complete silence for at least thirty seconds. Then I heard him chuckle again. “You impress me, Dr. Garnet. You really impress me. Give me a few minutes to get the security people at UH on the phone and I’ll see what I can do. In case this crazy idea of yours works and you actually find something worth looking at, where can I meet you tomorrow morning?”

I told him.

A few minutes later I was in the parking lot of UH. As I listened to the rain drum on the roof and gave Williams some time to work his magic over the phone, I began to make a mental list of what I’d look at first.
Check the charts!
Michael had written. To begin with I’d have to find out what charts he meant. Then hopefully I’d discover the pattern that had led him to believe the Phantom was real. But as I organized my plan it dawned on me that whatever that pattern was, it mustn’t have revealed me killer’s identity. Otherwise, he’d surely have scrawled a name on the note he’d been so desperate to write.

I glanced at my watch and decided it was time to go. Williams shouldn’t have needed more than five minutes to succeed or fail in his bluff. I glanced up at the forbidding building I was about to enter and thought seriously about taking a tire iron out of my trunk and carrying it under my raincoat, for protection. As angry as I was, I was still chilled by the thought of going alone into that isolated realm of subterranean corridors where the records were kept. But I remembered the metal detector at the front door, resigned myself to using only my wits for self-defense, and ran through the rain toward the entrance under the watchful eye of the gargoyles.

Williams had bluffed as promised.

“Yes, Dr. Garnet, we’ve been expecting you. It must be pretty important for the CDC to bring you out on a night like this.” Of the two guards on duty, it was the one with more stripes on the sleeve of his uniform who spoke to me. His colleague stood behind their desk, not at attention but not slouching either. To my surprise, they were both wearing surgical masks.

“Who ordered those?” I asked, pointing to their faces after I’d flashed my identity card and signed their book for after-hours visitors.

“No one. It’s just this business of checking everyone for infection, and now with two nurses dead, well, we’re all pretty nervous. Dr. Mackie insists we’re in no danger but has given permission to everybody working here to wear a mask if they feel more secure, for now. Even a lot of the patients have requested them.”

They’d clearly overreacted. But as Williams had cautioned on his first day, people weren’t always rational when it came to deadly microbes.

“Where do you want to start?” asked the senior guard.

“Administration,” I answered. “I’ll need the minutes from the last two years of the Infection Control Committee. We’ll find them wherever they keep the records of all confidential meetings.”

The hospital carried out these proceedings under the umbrella of quality assurance and, as such, records of them were immune even to subpoena by a court of law. The powers that be meant such confidentiality to assure frankness in exposing and correcting mistakes, which they thought to be more important than lawsuits in protecting the health of patients. Nevertheless, if any of this information leaked or got out by accident, individuals could use it in a court case, and so the hospital guarded such documents the most closely of any of its secrets.

But the security man nodded without question, his partner wrote our destination beside my name, and we set off in the direction I’d taken last week when I’d met Janet and Michael in staff health. This time I ended up in the lushly carpeted section of that wing, where the administrators obviously looked after their own comforts, whatever else they did. My guide led me down a hallway paneled with rich dark wood, checked his key ring, and unlocked a heavy double door opening into a large room lined with shelves holding nothing but black binders, rows and rows of them. Each shelf had a sign designating which committee its contents were from, and each binder had a label designating which year’s proceedings it contained. In an age of computer hackers, most hospitals preferred to keep a single copy of this kind of material on paper and locked in a vault. The only reason such records were kept at all was that accreditation boards demanded documentation of quality assurance activities. Michael would have access to these as a state accreditor. Williams must have sounded mighty impressive to get me in here.