Death Rounds (7 page)

“Yeah, it’s even a surprise to me. Did you ever locate Dr. Popovitch?”

“Yes, I got off the phone with him a few minutes ago. We gave him your number, but he called back and said you weren’t answering.”

I’d left my cell phone in the car, not wanting to use it in the hospital. He must have just missed me.

“He’s now up in the records department for staff health. He said to put you through if you rang again. I can get him if you want, or are you going there in person?”

“Just tell me where it is, and I’ll find him myself.” I got directions—third floor in one of the rear wings—and started out.

The bustle of activity in the corridors was familiar to any teaching hospital. The clinicians who had been running alongside me moments earlier were now striding through the hallways followed by groups of sleepy-looking residents, interns, and medical students.

Already the question-and-answer routine of clinical teaching had started. “What’s the most common cause of fever two days postop?” I heard one staff man snap as he swept by at the head of his procession. “Pneumonia!” called out someone a short distance behind him. “What kind?” continued the staff man. “Right upper lobe, from aspiration,” came an answer from a bit farther back in the line. “Any other ideas?” I couldn’t hear the reply as they moved out of earshot. The medical students hustling along at the rear were recognizable by the shortness of their clinical jackets and the number of reference manuals they kept stuffed in their pockets. Some were trying to thumb through the well-worn texts for answers as they hurried to keep up with the rest.

Surgical patients from all over the hospital were being taken by stretcher to the OR for their early morning rendezvous with the knife. There was a lineup of them outside the elevator. Most were already beyond fear, snoozing under the effects of their preoperative sedation, but a few chatted nervously as they waited with the orderlies who were wheeling them to their fate. I used the stairs to save time.

As I climbed, the door on the landing above me pushed open and yet another group of students in lab jackets started down the steps toward me. Their instructor was still out of sight behind them, but I could hear his voice.

“. . . most still don’t order enough blood cultures or the right screening tests to reliably detect bacteremia...”

I’d reflexively stepped aside to let the group pass when I suddenly recognized the voice at the same instant I saw the broad-shouldered figure in a white coat follow the others through the door.

“You’ll find out a lot of doctors aren’t knowledgeable in their use of lab tests—” Miller was saying when he caught sight of me pressed against the wall. He froze, his mouth open in midsentence; then his eyes narrowed, becoming hard and hurt looking. He swallowed once and started down, saying nothing to me as he passed. “Like I was saying,” he continued, “as lab technicians you’ll often feel frustrated at the tests ordered by doctors…” He didn’t look back as he descended the rest of the stairs and strode out the door below.

When he and his entourage were gone, I let my breath out. I hadn’t even been aware I’d been holding it. I felt a wave of perspiration prickle out of my skin. The pain in Miller’s eyes had been frightful.”

* * * *

Staff health turned out to be on the same floor as administration in this hospital. It was easy to tell which was which, even without following the arrows and signs. I knew I was headed for the section without the lush carpeting and oversized offices. The clinic was also the only area where some people were actually at work. If this hospital was like St. Paul’s, the gurus of management wouldn’t make a showing much before 8:00.

At the front reception desk in the waiting room, clerks were busily sorting charts and preparing for the day. In the hallway behind them I could see nurses running in and out of a line of doorways carrying equipment trays, presumably stocking up the examining cubicles. A young man with crutches hobbled up to one of these nurses, who showed him into a room.

Before stepping up to the counter, I had to pause.

Miller’s single accusing stare had left me shaken. Feelings of guilt, regret, and disgust over my decision to send his mother home had flooded through me. I had to compose myself, force a smile, and keep control of my voice to speak with an assurance I definitely didn’t feel.

A clerk looked up from her work and, seeing me standing in the entranceway, asked, “Do you have an appointment?”

“No, I’m Dr. Garnet from St. Paul’s Hospital. I’m looking for Dr. Popovitch who’s supposed to be here doing an audit,” I explained, walking up to her.

Her smile vanished immediately. “I’m sorry,” she said, frowning disapprovingly, “but Dr. Mackie told me we were only to let Dr. Popovitch and Dr. Graceton in to see our records.”

That caught me by surprise. “Janet’s here?”

The lady’s frown deepened. “Not yet, but Dr. Mackie called a few moments ago and told us to expect her as well. He didn’t say a word about you or anyone else. It’s quite irregular as it is, you know, looking at staff medical files even if it is a part of a hospital audit. If you are to be given access to our confidential records, I’m afraid it will be only on orders from Dr. Mackie.”

“Look, I don’t want to see any charts.” I lied, but I had to reassure her. “I simply need to speak to Dr. Popovitch for a moment. It’s business. We’re colleagues at St. Paul’s and—”

“It’s okay, Madge, he’s harmless,” said Janet’s voice from behind me. I hadn’t heard the elevator. She must have come up by the stairs the same way I had. She swept toward us, the crisp lab coat she wore over her wrinkled greens flowing after her like a cape. “Believe it or not,” she added, reaching me and fingering my own sodden coat, “this bedraggled specimen happens to be all I could come up with for a husband. Earl, meet Madge. She runs this place—has all the malingerers pegged even before the nurses and doctors get to them.”

The transformation in Madge was instantaneous. “Oh my gosh, you’re Janet’s husband. You should have told me, Mr. Graceton, I mean. Dr. Garnet,” she gushed, beaming me a warm smile. “I’ve heard so much about you.” Then she flushed and turned to Janet. “I’m terribly sorry about being so abrupt, but when he asked for Dr. Popovitch—”

“Hey, think nothing of it, Madge. I treat him like that all the time.” Janet chuckled, putting the poor lady at ease. “I’ll take responsibility for him,” she further reassured her, leading me by the arm through a nearby, unmarked door.

“Nice meeting you, Madge,” I called over my shoulder, letting myself be dragged along, presumably into the records department. The smile I got back from Madge let me know that the woman had no doubt Janet would keep me in line.

“What are you doing here?” I asked as soon as we were out of sight and walking through rows of filing cabinets.

“I phoned Cam this morning and got him to assign me to work with Michael. I figured it was the best way to check out what we were up against.” She sounded nonchalant, but I felt a stab of alarm at her revelation. To have rousted Cam out of bed and then insist on taking time from her busy practice to work on the audit meant that her Phantom idea must be disturbing her as much as it disturbed me.

“Did you tell Cam about what you thought about the three nurses—”

“Of course!” she cut me off, sounding annoyed. “The silly man told me I was nuts. He actually ordered me to keep my mouth shut about it, as if I didn’t know enough not to panic the whole hospital. He certainly won’t listen until we get some solid proof about what’s going on.” She was leading me around a corner and toward a small table where I could see Michael studying a chart.

He looked up at the sound of our approaching voices.

“Does this guy know?” I asked, smiling at his surprised expression when he saw me.

A few minutes later, we’d also failed to convince him.

“Listen, you two,” he replied, frowning deeply, “how the hell can
Legionella
be transmitted at will? And the idea that it’s being used as a weapon in some weird vendetta is crazy! Beyond crazy! I’m surprised at both of you,” he scolded. “The last thing we need are sensational rumors.”

The three of us were huddled together around his table—more a desk meant for two—and we were speaking in terse whispers in case Madge or anyone else entered unexpectedly. Michael kept looking nervously over his shoulder, apparently more worried about being overheard than about what we’d said. At one point all of us thought we could hear someone in the rows of files behind us. Thinking it was Madge or one of the nurses, we immediately hushed up, but when I went to check, no one was there.

“And so what if all three women had complaints against them,” he continued to scoff. “That puts them in the same company, unfortunately, with a lot of doctors and nurses.” Turning to me he added, “Christ, when you’re away and I’m acting as chief, there’s at least one letter a week against someone or another in our department who was stupid, callous, or rude.”

“Michael, these women were systematically cruel,” countered Janet. “Cruel in a way that’s hard to catch, easy to deny, and almost impossible to prove. But the patients know, Michael. They’re the ones who clued me in. Over and over, they told me the same basic complaint; they were made to feel humiliated, helpless, and a burden in a hundred nasty little ways by those three nurses.”

“So they were women who pissed patients off. Hell, like I said, that’s apt to get them reported, not killed,” snapped Michael. He was becoming increasingly impatient. “Aren’t there other nurses your patients haven’t liked? They didn’t get
Legionella.”

“These nurses pissed people off in a certain way,” Janet shot back, her frustration equally obvious.

“So why haven’t these three got a high number of complaints against them in common? That at least would be something objective to link them together.”

Janet leaned forward and stabbed at him with her finger. “Michael, I’ll bet you’ve had similar trouble with lots of residents who, when they’re angry about something or somebody, take it out on their patients—maybe they rip a dressing off a little too aggressively or catheterize someone too roughly—then say, ‘What did I do?’ You know the game they’re playing, Michael, and so do the patients, but let’s see you prove it. Most of my ladies didn’t even bother making a report. They simply vented their anger and swore they’d sign themselves out the next time one of those three came near them.”

Michael threw his hands up. “Janet, do you know what people will say if you keep on with this? ‘Next you’ll be claiming a patient tried to kill those nurses with
Legionella
instead of registering a complaint against them.’“ His sarcasm was blistering even though he continued to whisper.

Janet’s eyes flashed. It was time for me to intervene. “Hey, Michael,” I quickly admonished, “what the hell’s the matter with—”

Janet waved me quiet. “What I’m
saying,
Michael,” she whispered back at him through clenched teeth, “is that three women have all come down with mysterious infections neither you nor anyone else can explain. One of them’s dead, one’s dying, and the only thing the three of them have in common is they like to punish patients!”

Michael startled us both by slamming his hand down on the table, “What
I’m
saying, Janet, is that Earl can’t afford this kind of talk!” he thundered.

She jerked back from him, stunned.

He glared at me. “Don’t you realize how much trouble you’re in? Hell, half of last night’s shift at St. Paul’s does. I found out when I got home from Cam Mackie’s meeting and discovered I had an urgent message to call Susanne.” He took a breath and then exhaled it slowly as he used to do with cigarette smoke before he quit. “Rossit seems to be coming down on you a lot harder than you initially realized,” he stated. His frown deepened, but from what I now suspected was concern, not anger.

“Susanne told me about the run he took at you in ICU,” he continued, speaking low and quickly, “and that you’d both put it down to his usual troublemaking. But by evening her nurses were hearing rumors that you were going to be charged with everything from missing vital signs through diagnostic errors to overprescribing antibiotics. Susanne was alarmed to the extent she thought you should be warned, yet felt uncomfortable calling you herself. I told her I’d speak to you this morning, but I’ve been lying awake half the night, unable to figure a way you can respond to what Rossit’s mounting against you. Besides that, I’ve already heard rumors here that the woman’s son. Miller, is equally stirred up and hostile as well. So for God’s sake, man, going overboard with crazy stories about phantoms is the worst thing you can do for your credibility right now!”

I was staggered by the alarm in Michael’s voice. It was in such sharp contrast to his easy reassurances yesterday that all would be well. Nor had I expected Rossit’s lighting into me to grow into his leveling such damning broadsides against my reputation. That kind of assault was beyond the usual way he’d lit into others who’d misjudged an infection. Even Harold Miller’s being so outspoken about my incompetence shook me up, though God knows the man had cause.

Taken together, all this bad-mouthing served as a supreme wake-up call. Rossit’s antics in ICU yesterday—his criticisms and threats of a hostile case review—were suddenly more chilling, more credible than they’d first seemed.

Michael grasped both my shoulders and broke me out of my thoughts with a little shake. “I warn you. Earl,” he said, his voice sounding strained, “if you persist with this nonsense, you’ll hand Rossit and Miller your own head on a platter!”

I glanced over at Janet. She now appeared more startled than angry.

Chapter 6

I pulled away from the parking lot of University Hospital and started driving toward St. Paul’s. The wipers slapped the rain back and forth more easily than before, like a pair of metronomes keeping time as I batted my thoughts around.

I glanced in my rearview mirror and decided I’d learned a lot during my visit to the gray building that was receding into the mist. I certainly had a whole new understanding of how much trouble I was in. I also had to admit that it was clearly going to be difficult to pursue Janet’s suspicions about the Phantom and protect myself from Rossit at the same time.