Diagnosis Murder 7 - The Double LIfe (11 page)

"Mercy killers," Steve said.

"But it's never really about easing anyone's suffering," she said. "It's about their own pleasure and neediness. Some do it because they get off on a godlike sense of power." 

"The more they kill, the more invincible they feel." 

"Exactly. Others do it for the attention, a disorder known as Munchausen syndrome by proxy. They like to be at the center of a medical crisis of their own creation."

"Why don't they just make themselves sick instead of some innocent victim?"

"They want attention," she said. "They don't want to die. Some don't intend to kill. They just want to set up a medical emergency so they can save the patient's life and be a hero."

"But they're better at the emergency than the saving." 

"Sadly, yes. Others kill out of disgust—they actually resent the vulnerability and weakness of their patients. But they're really acting out their own self-loathing."

"I hate myself so I'll kill you?"

"It's the only time they feel superior to anyone else," she said. "And, of course, there are those who kill simply because they enjoy it. Some even get sexual satisfaction from it."

"And you think you can spot these murderers?"

"I think they often reveal themselves if you know what to look for. I advise hospitals to keep track of who dies and who is the last person with the patient. If Nurse Ratched always seems to be the one around when people die, it may not be a coincidence. Watch the numbers. If there's a jump in death rates, go back and see if that occurred during certain shifts, then see if there's one doctor, nurse, or orderly who is always on that shift."

"Nurse Ratched again," Steve said.

"Or it may be the nicest, most giving nurse on the ward, the one who always shows up to help once the crisis occurs." 

"Because she gets off, one way or another, on the rush of excitement and the race against death."

"You're catching on," Dr. Hudson said.

"I'm a quick study when it comes to murder."

"Watch nurses or doctors who receive complaints from patients for being rude, abusive, or uncaring. Pay close attention to inexplicable shortages of epinephrine or other drugs in the hospital. It could mean someone is hoarding them to inject into patients."

"Those seem like pretty obvious signals."

"You'd be surprised how often they are ignored. When it comes to missing drugs, the assumption is they were stolen for sale or recreational use. Rarely do people consider that the drugs were taken to kill patients," she said. "But there are more subtle indications, too. I warn hospital administrators to be suspicious of anyone who has frequently moved from one hospital to another, is overly interested in death, or has a very difficult time with personal relationships."

"Based on those last two criteria, I could be a medical murderer."

"You don't strike me as someone who has difficulty with personal relationships."

"Ask my ex-girlfriends," Steve said.

She met his gaze and smiled. "Maybe I will."

He was pretty sure she was flirting with him, but he was terrible at judging women. Still, he made a mental note to give her a call if his current relationship fizzled.

Or
when,
given his romantic history.

Steve thanked Dr. Hudson for her help and gave her his card, asking her to call him if she thought of anything else that might be helpful.

"I'll do that," she said, in a way that sounded full of erotic possibility to him. Then again, he could read erotic possibility into just about anything any woman said to him.

She gave him her card and returned to her office, but Steve remained at the inverted fountain.

He called Dr. Barnes, the epidemiologist, and discovered after talking to him that Mark might have been onto something after all. Statistically speaking, too many patients were dying for it to be simply bad luck.

Someone was killing people. A
lot
of people.

But Steve didn't have enough evidence to convince his superiors to assign a task force. At least not yet.

He marveled at his father's instincts and wished, not for the first time, that he shared the trait. Steve knew he was a good detective, but it was a learned skill and he worked hard to get results. He didn't have his father's gift for deduction or his sixth sense for murder.

Once Mark's instincts were confirmed by the epidemiologist, his dad had taken a crash course in profiling medical murderers from Dr. Hudson and set out to unmask a serial killer.

Now Steve would do the same. But he was troubled by something else.

How did the killer find out that Mark was on the case?

Steve was pondering that question, and many others, when he got the page from Community General, where he now sat in the waiting room, worrying about his father and trying to figure out what to do next.

He was making an investigative To Do list in his little leather-bound notebook when the elevator doors opened and Jesse came out.

C
HAPTER
E
LEVEN

Jesse limped over, looking beaten and exhausted. There were dark circles under his bloodshot eyes and he winced with each step, trying to keep weight off his left knee, which he'd hurt while tackling Mark.

Steve rose to meet him. "How bad is it?"

Jesse stumbled past Steve and took a seat. Steve remained standing.

"Mark is going to be fine," Jesse said. "He'll be out of surgery in about an hour."

"What happened?"

"He had a seizure. We ran an MRI and discovered subdural bleeding."

"What does that mean?" Steve asked impatiently, a tinge of anger in his voice.

"It's an accumulation of blood beneath the protective membrane around the brain. The skull is rigid bone and it can't expand, so bleeding exerts pressure on the brain, essentially squeezing it into the opening at the base of the skull. If left untreated, the pressure will compress the brain stem, stopping respiration and leading to immediate death. We had to relieve the pressure, and there's only one way to do that."

"You cracked open his skull," Steve said.

"It's not that extreme. We're drilling a hole about the size of a quarter to drain the fluid," Jesse said. "Later, we'll seal it with a bone graft or a metal plate."

"That still sounds pretty extreme to me," Steve said. "Though I suppose there isn't any choice. What are the dangers?"

"Brain damage, infection, more bleeding," Jesse said. "But I don't think that will happen."

"You didn't think
this
would happen either," Steve snapped, then caught himself. "I'm sorry. This is the second time you've saved Dad's life today. What I should be saying is thank you."

"Don't worry, Steve. I won't leave him until he's conscious and out of danger."

"The hell you won't," Susan said, approaching them now. "You haven't slept in over twenty-four hours and you need to get that knee looked at."

"She's right," Steve said. "I'll stay with him."

"That won't do Mark or you any good," Susan said. "I have a better idea. I'll keep an eye on Mark while Jesse gets some sleep and you catch whoever did this. Besides, it's my job and I'm pretty dam good at it."

Jesse looked at Steve. "She has a point."

"But I'm the only family he has," Steve said.

"No, you're not," Susan said, without a trace of anger or hurt feelings.

She was simply stating a fact that, in his worry, he'd overlooked. Mark had always considered Jesse, Susan, and Amanda his family, too.

"You're right. I'm sorry," Steve said. "I keep saying stupid things that I don't mean."

"It's okay. You're allowed when a loved one is hurt and you're afraid of what might happen," Susan said. "Saying stupid things is entirely normal in this situation."

"Thank you." Steve smiled and gave Susan a kiss on the cheek before turning to Jesse. "I'll need those files that Dad gave you."

Jesse tossed him a set of keys. "They're on the kitchen table."

Steve nodded and headed out the door, Susan and Jesse looking after him.

"That's the first time he's ever kissed me," Susan said.

"That's good to know," Jesse said, rising painfully to his feet and limping past her. "He's never kissed me."

"Jealous?" she teased.

Jesse grinned. "A man can dream."

Steve picked up Jesse's files on the way back to the beach house and brought them into the kitchen, setting the box on the table. He took a bottle of root beer out of the refrigerator, twisted off the cap, and began looking for Mark's copy of Amanda's report.

He found the report, and a legal pad full of notes, on the nightstand in Mark's bedroom. From what he could gather, Mark had begun sorting the patients based on their cause of death. A lot of the names were circled and connected with arrows to other names. Steve didn't know what the arrows meant.

It would have been helpful, Steve thought, if his father had included a key to the symbols. What does a circled name mean? How is it different from an underlined name? What do the arrows mean? And what about the lists of names without any heading? What are they lists of?

Steve set Mark's report and notes on the table, then went to the garage and brought in the dry-erase board and easel. He liked to see things in black and white, organized and clear. The way Steve solved cases was through dogged investigation, which often meant hours of research, sorting through facts and figures, interviews and autopsy reports, crime scene photos and physical evidence. The cliche goes that the devil is in the details. He often found that murderers were in the details, too.

He referred to his notebook and the To Do list he had begun writing in the hospital waiting room.

Sort patients by age.

Sort patients by sex.

Sort patients by race.

Sort patients by cause of death.

Sort patients by doctors, hospitals, and caregivers shared in common.

Sort patients by geographic location.

It looked like his father had already started doing the same thing. But there were other notations, about glass fish and dentures, that made no sense to Steve. Perhaps they would become clear once Steve began his own lists.

With at least forty-eight names to go through, and possibly as many as eight hundred, he was going to need a lot more dry-erase boards. And some extra manpower.

As if on cue, there was a knock at the door. He opened it to find Amanda and Jesse standing outside. She was holding a pizza and carrying a grocery bag full of soda and cookies. Jesse was wearing a Velcro splint on his knee and leaning on a cane, a laptop computer bag over his shoulder.

"The surgery was a success. We've relieved the pressure," Jesse said. "Mark is still unconscious, but he's out of danger. Susan is keeping a close eye on him anyway."

"That's a relief," Steve said. "But you didn't have to come all the way down here to tell me. You need to get some sleep."

Jesse waved off his concern. "I napped while Dr. Kozak examined me and x-rayed my knee."

"Is it broken?"

"Just a bad bruise," Jesse said.

"Don't you have work to do?" Amanda asked Steve impatiently.

"More than I can handle," he replied with a sigh.

"So what are we doing standing out here letting the pizza get cold? Let's get started," Amanda said as she stepped past him and into the house, Jesse hobbling in after her.

Steve closed the door and smiled to himself.

Four hours later, night had fallen, the pizza was finished, Jesse was asleep on the couch, and the dry-erase board was covered with Amanda's neat handwriting. Two laptops were open on the kitchen table, which was strewn with files, papers, and pizza crusts.

Steve and Amanda sat across from each other, inputting data into their laptops and sorting through files. It was tedious work, and the fatigue showed in their sagging posture and weary expressions. As hard as they were working, Steve didn't feel as if they'd accomplished anything. He wasn't alone.

Amanda groaned, leaned back in her chair, and sighed. "Do you have any idea how many different doctors, nurses, and technicians a patient sees? And not all of them are mentioned in patient records. To do this right, we'd have to see who was working on the floor every time the patient went in to see the doctor. But we don't even know which of these patents are victims and which aren't."

Steve got up and stretched. "In other words, we're getting nowhere slowly."

"What we need is more facts, something that will help us narrow our focus, or we'll be doing this for months."

"Maybe Dad will wake up tonight and just tell us who the killer is," Steve said.

"I doubt it."

"He's surprised us before."

"It's possible that Mark found some organizing principle
to
 wrestle all this data down to size, but I doubt he was much further along than we are, or you would have heard about it."

Steve searched through the papers on the table and finally found the yellow legal pad he was looking for. "But what about his notes? The glass fish and the dentures? What was he talking about?"

"I don't know," she said.

"He had something," Steve said.

"How do you know?"

"Jesse told me that he had The Look."

"It doesn't take much to give him The Look," Amanda said. "You and I would have to see the killer over the body or find a written confession to get The Look in our eyes." Steve's cell phone rang, playing a ring-tone version of the
Dragnet
theme.

"That means it's the office," Steve said, flipping open the phone.

"Cute," Amanda said.

"Sloan here," he answered. It was another detective, informing him that the Camaro had been found. He listened to the details, then thanked the detective for the call and hung up.

Steve smiled at Amanda. "We've had a break. The car was found abandoned in Van Nuys."

"Why's that a break?" Amanda asked. "Odds are that whoever was driving it wiped it down pretty good."