Death Rounds (25 page)

I quickly found the two volumes I needed, and while the guard looked on, I found the minutes that dealt with the incidents from two years ago. Skimming them and working forward to the subsequent follow-up meetings, I saw nothing substantial that Janet hadn’t already told me. I jotted down what I’d come for—the chart numbers of the victims.

After returning the binders to their places, I spotted another shelf containing the minutes for Death Rounds at UH and shivered. My own appointment with that process at St. Paul’s for Phyllis Sanders’s case was scheduled to begin in about five hours.

After the guard locked up, I had him let me into the record room in the nearby staff health clinic. I’d obtained the numbers of eighteen charts, and if any of them were recently active, they would be on file there. I found two and signed them out. The remaining sixteen should be downstairs in the archives where Janet, and presumably Michael, had studied them.

I found myself tensing as we rode the elevator toward the sub-basement. I had to concentrate on keeping my breathing steady, and when we arrived with a definitive lurch, I felt my back dampen with sweat.

The guard stepped out and held the door for me. I swallowed, then forced myself to move. My eyes inadvertently focused on the steel frame of the elevator entrance where my head had been rammed. Once in the corridor, I found myself staring down the well-lit passage off to the right where, in the distance, I could see the darkened entrance that led to the basement of the abandoned asylum. But there was no movement in those shadows tonight

“This way. Doctor,” my escort said, starting to walk in the opposite direction. I turned and hurried to stay beside him, trying not to keep looking over my shoulder. The route we followed was a mirror image of the one I’d taken four nights ago, except this time we arrived at a door marked
ARCHIVES
at the end of our trek. The guard unlocked it, snapped on a light, and let me into yet another room filled with rows of shelves lined with files, but it was much larger than the other two rooms I’d just visited. The air was hot, the place smelt of dust, and there were plenty of places for someone to be standing unnoticed. Feeling as foolish as if I were checking under the bed, I made the guard wait until I walked up and down each aisle, making sure no one else was there. When he left, I locked the door and stood in the stillness, listening to his retreating steps. I looked around and realized, as Janet had told me, there was no phone. My own cellular was back in the car, as usual. Out of habit, I never brought the thing into a hospital to avoid the risk of scrambling a monitor or resetting a respirator. The faint sound of the elevator doors closing in the distance confirmed I was on my own.

I shoved away all thoughts of someone creeping up to my door and focused on finding the remaining charts. As I located them, I spread one out after the other on a large table and flipped through each dossier to entries dated approximately two years ago. It was an easy matter to locate the clinic visits I was looking for.

There were three types of events.

About ten of the victims had reported explosive vomiting with no other symptoms or signs to explain a cause. They were all isolated incidents, each had occurred shortly after they’d eaten a meal in the cafeteria, and in each case no one else who’d eaten the same food had reported any problems. Some were nurses, some were orderlies, some were technicians, and they’d all worked in different areas of the hospital.

There were five episodes of an acute syndrome involving dizziness, sweating, tearing, slowing of the heart rate, urgency to urinate, nausea, abdominal cramps, and small pupils. Again a variety of people with different jobs were involved, but this time they all worked in physiotherapy or rehabilitation.

The third grouping of cases were brief, solitary hallucinogenic experiences in three nurses from the psychiatry department The three occurrences were months apart, and none of the subjects had a history of mental illness or drug abuse.

I leaned back in my chair, stretched my arms and legs, and once more felt the ache of too little sleep. But my mind was revving. This was familiar turf for me—basic toxicology. Janet was right. Some agent or other had made these people sick, and while any alert physician could make an educated guess, it was routine work for an ER doctor to look at the signs and symptoms and figure out exactly what those agents could be.

The ten cases of explosive vomiting suggested an obvious cause. Ipecac—a rather tasteless syrup that we formerly administered to overdose patients in order to induce vomiting—could have been added to a sauce or gravy poured over the victims’ food. Even though we hardly ever used it anymore, it could still be found in most hospitals. A few of the victims had actually expressed the suspicion something had been slipped into their meal, but the attending doctors had mostly concluded it was mild food poisoning, viral gastritis, or malingering.

The three psychiatric cases I thought could be explained by a mild short-acting hallucinogenic. Psilocybin, a form of mescaline, or peyote, its naturally occurring precursor, came to mind. Though I rarely saw overdoses of these substances these days—they weren’t usually found on the current much deadlier menu of street drugs— they could be obtained in special places, such as on university campuses. Both substances existed in pill or powder form, they both had a bitter taste that might go undetected if mixed with something like strong coffee, and they both weren’t usually included in an initial drug screen. Given the perpetual pot of heavy-duty caffeine found on most psych wards, it wouldn’t be hard to slip a dose of either substance to an unsuspecting victim in a cup of that particular brew. I’d want to ask these nurses if anyone had offered them a coffee shortly before they’d hallucinated. The notes indicated that all three had raised the possibility they’d been given something. One of the examining physicians had written
Hallucinogen?
on one of the nurses’ charts but hadn’t pursued it. Several other doctors put the next two episodes down to stress.

The complex syndrome that had afflicted the physio and rehab workers was in fact the most straightforward of all. The symptoms and signs brought to mind an acronym we teach the residents— SLUDGE BAM—made up of the first letter of each symptom and sign produced by organic phosphate, or insecticide, poisoning. Not all the signs were there—they wouldn’t be in a mild exposure—but enough were to make the diagnosis: Salivation, Lacrimation, Urination, Diarrhea, Gastritis, Esophagitis, Bradycardia (or slow heart rate), Airway distress, and Miosis (the clinical term for small pupils). The attending physicians recognized this possibility in the differential, or list of probable diagnoses suggested in their notes, and had explained the episodes as accidental exposures to an unknown source of pesticide. Checks of the work area, however, had failed to turn up any trace of organic phosphates. I made a note to visit these people while they were on the job.

Most victims of accidental insecticide poisoning I’d treated in ER had absorbed the stuff through their skin. One woman had simply sprayed her bathroom floor, then walked on it in her bare feet. Perhaps there was something in the routine of workers in physio and rehab that exposed their skin to this type of contamination.

At first I found it puzzling that the examining doctors had given so little credence to all the victims who’d suggested they’d been attacked, but a glance through previous entries in their charts suggested why. The majority of them were frequent visitors to the health service with nonspecific trivial complaints—fatigue, dizziness, vague aches and pains—that on investigation never turned out to be significant. In short, the Phantom’s victims seemed to also have in common the trait of malingering—not the basis for a lot of credibility. I remembered my own suspicions about Phyllis Sanders. What was it her son had said about her?
She never minimized anything.

I glanced at my watch. It was 3:00. My usual limit of staying alert easily on an overnight shift without having to fight off sleep was around 4:00. After that I could be jolted awake by a hair-raising emergency but wasn’t mentally fit for much else. Tonight, however, I was charged with energy. Instead of chasing shadows I was finally faced with puzzles that I had the expertise to answer. These charts and their two-year-old secrets were like manuals outlining how the Phantom had carried out his deeds. Until now he’d managed to keep those means of attack hidden, just as he still succeeded in keeping his means of infecting people concealed. It was the Phantom’s trademark, his key to invisibility. If no one knew an attack had been made, there was no attacker; if no one knew a murder had been committed, there was no murderer. By exposing his means from two years ago, I’d breached that cloak of anonymity a little, given him form, and brought him a bit into existence. In other words, I’d gained a step on whomever I was pursuing.

But it was a step on an old trail. As tantalizing as these records were—no doubt Michael had recognized everything I had—they contained nothing beyond what had happened back then. Certainly they weren’t the files that convinced Michael this same creep had found a way to wield deadly organisms, one of them previously unknown, with stealth and specificity. He had to have found something more, some bridge between the previous attacks and the recent infections. The pattern he mentioned must have been in other charts somewhere else. If I was going to make Williams a believer, I had to find those charts.

I got out of my chair, groaned as my knees and back lodged their own protest against no sleep, then started pacing to loosen up and better think what to do next. The silence of the place magnified the sound of my shoes on the linoleum floor.

I’d interview all these people as soon as I could if they were still around, I thought. The two whose active charts I’d found upstairs would be no problem, but the fact that the other sixteen files had been out of circulation long enough to have been put back in the archives, especially after showing a pattern of frequent visits, might mean those people no longer worked here. I returned to the table and started making a list of the eighteen names, addresses, and telephone numbers. Not wanting to stiffen up again in the chair, I wrote standing up. As I worked, the ancient pipes running across the ceiling gave an occasional clank. The scratch of my pen across the notepaper provided the only other sound in that deserted place.

Once, reaching for another chart, I inadvertently pressed my weight against the table and caused it to shift. The screech of its metal legs scraping across the linoleum sounded like a blast on a trumpet and made me jump so abruptly that the file flew out of my hand. Christ, I thought, decrying my own skittishness, let me finish and get out of here.

While I continued to scribble, I began to think where I might ask the guard to let me look next. Janet had said the sort of cruelty that this group practiced was hard to prove and not often reported. But what if that wasn’t entirely true? Perhaps some of their victims had complained, were on record somewhere as having done so, and might be well worth talking to. I’d at least get a gauge as to the degree of anger they felt toward their punishers, perhaps even a sense of whether that anger could be motive enough for revenge. But there was another even more likely possibility to be explored. Who had these victims complained to? Was there someone in the process of hearing such complaints who’d decided to administer a little rough justice on his or her own outside of official channels?

Either way, if anyone had ever leveled charges against any of the people on the list I was compiling, their personnel records would probably contain a copy of any such complaints and the name of the patient who had complained. That’s where I’d ask to go, the personnel department, I decided, rushing to finish with the second-to-last chart and feeling ecstatic at the sensation of finally making some headway.

If I wasn’t so sensitized to sounds in the eerie silence of that sub-basement or if I hadn’t been so on edge, I might never have heard the familiar distant hum. It came more through the walls and overhead ducts than through the air. It was so far away that for the first few seconds my mind processed it out as an unimportant noise. Only when it ended and was followed by the faint distant rattle of the doors sliding open did I realize the elevator had come back down.

I felt a wave of alarm sweep through my stomach, then tried to reassure myself. Perhaps it was only the guard doing rounds or coming to check on me. I stood absolutely motionless. Maybe someone needed an old chart from this very room for a patient who had just arrived in ER.

But no steps came my way.

I quietly walked over to the door and listened. Still nothing.

Okay, I thought, forcing myself to breathe slowly. The elevator may simply have come down empty, sent by someone who had gotten off at a higher floor but also pushed the subbasement button by mistake.

Maybe. I wanted to grab my list and get the hell out of there. I tiptoed back to the table; added the final name, address, and telephone number; and returned to the door jamming my notes into my pocket

There wasn’t a sound outside. I turned the lock as slowly as possible, but it opened with a loud click. I froze, ready to twist it shut again if I heard the approaching thud of running footsteps. Nothing came. I pulled the door open a crack and peeked out. Thankfully I was at the end of this particular corridor, so even with the sliver of a view I gave myself, I could see enough to tell no one was there.

I stepped out and made my way toward the first intersection. Holding my breath when I got there, I slowly looked around the corner and down the next hallway. It was also empty. I turned left and crept along, passing two more intersections with equal care. When I got near the long corridor where the elevator was located, my real trepidation began. Even though I was at the opposite end of where the passage led to the basement of the old asylum, I couldn’t help but imagine that the figure I dreaded seeing was out there waiting for me. My heart raced faster than ever and my breathing once more quickened. I pressed my back against the wall and prayed that the lights wouldn’t go off again. I don’t know how many seconds I was standing there, rapidly losing my battle with panic, when I heard something—something so faint and far off I wasn’t sure it was real.