Doing Harm (36 page)

I rest my face in my hand and knead my temples with my fingers.

I’m done. It’s over.
How can I possibly outmaneuver a psychotic med student who managed to take down a combat-hardened former Marine? All I can do now is keep my head down, wait for the next patient to die, and, once the dust has settled, try to pick up what’s left of my career and marriage. And hope I can forget any of this ever happened.

But, deep down, I know that, if I do nothing, if I just allow the next patient to die, then I won’t be able to leave any of this behind.

Ever.

Shania’s relentlessly sunny lyrics drift in from the cubicle next door.

Oh, oh, oh … men’s shirts, short skirts, oh, oh, oh …

“Hi, Dr. Mitchell. How are you tonight?” one of the nurses, just starting the evening shift, whispers as she enters the room.

“Hi, Carol,” I murmur, picking my head up and folding my hands in my lap. “I’m okay. How are you?”

“Oh, okay, I guess. Same old, same old.” She quietly starts adjusting some of Mrs. Samuelson’s intravenous lines. A fortysomething, battle-scarred veteran of the SICU front lines, Carol is plump with frizzy black hair, pendulous breasts, and a pragmatic, no-nonsense approach to nursing gained from decades of experience caring for critically ill patients. “Mrs. Samuelson here isn’t giving up without a fight.”

“No, she’s not.”

“Tough lady.”

“Yes, she is.”

The best part about ah-bee-yin’ a woman … is goin’ out and havin’ a good time …

“Carol?”

“Yes, Doctor?” she says absently, checking the ventilator settings.

“I’ve been meaning to ask … what’s with the Shania Twain concert every night next door?”

She chuckles. “Oh. You mean Mr. Nelson over there. He’s one of our permanent residents. No family. He’s been here almost four months now. He had a massive stroke after his surgery, and he’s been nonresponsive ever since. We can’t get him off the ventilator, and every time we try to move him, his blood pressure bottoms out. Nobody knows why. So he just sits there, while the doctors and lawyers try to figure out what to do with him.”

“So what about Shania?”

“Oh, right. Shania.” She’s finished with the ventilator and is now working on the array of tubes that still attend Mrs. Samuelson. “So, anyway, this one time, one of the other girls is a Shania fan, so she brings in that video, just for fun, and puts it on for him. From the moment that woman came strutting onto the screen, Mr. Nelson just lit up and smiled. Even his blood pressure went up. He does it every time. See for yourself.”

I crane my neck and catch a glimpse of Mr. Nelson on the other side of the cubicle wall. Sure enough, he’s watching the screen actively, eyes almost—not quite, but almost—clear. He’s bouncing his head slightly from side to side in time to the music.

“How about that. I’ll have to start prescribing Shania Twain for all my patients.”

She chuckles appreciatively as she drains urine into a disposal bucket. “So, you know, Dr. Mitchell, I’m not going to be working here much longer.”

“Why’s that?”

She finishes, pushes the bucket aside, and stands up with a small grimace, pressing both hands against the small of her back. “Oh, I just don’t feel comfortable working here anymore.” She looks around and lowers her voice even further. “I was taking care of a patient back in May, cross-covering down in the IMU, and he died. The hospital said I made a mistake, and that’s why he died.”

I suddenly remember the surgery patient who died from the pulmonary air embolus, the one Dan mentioned at his barbecue. “Carol, was that the patient who had an air embolus from a central line?”

She nods. “They said I left the cap off the line. But I didn’t. I cleaned the line and put the cap back on like I’d done thousands of times before. But they didn’t listen to me.” She shrugs, indifferent. “I know the truth. The other nurses know the truth, too. We’ve all seen it a hundred times: A patient died, and the hospital needed a fall guy. I was the fall guy. Mark my words, Dr. Mitchell: Somebody has always got to take the fall.”

“So what will you do now?”

“Take my pension and go somewhere else. The hospital big shots will be glad to see me go. They even helped me find a great job over at St. Luke’s. I guess they were afraid I’d put up a fight or something. But I’m smarter than that—smart enough to know that it wouldn’t do any good. I know what the score is. You can’t fight the system.”

“Well, for what it’s worth, I’ll be sorry to see you go.” That’s not entirely true. I’ve never been particularly close to Carol, or any of the other nurses, for that matter, but it seems like the polite thing to say.

“Thanks, Dr. Mitchell. I appreciate that.”

She hustles away, and I’m left alone with Mrs. Samuelson, Shania, and my thoughts.

Okay, so you’re Brad Pitt … That don’t impress me much …

*   *   *

Somebody has always got to take the fall.

Carol’s words ring in my ears as I choke down a few bites of stale pizza in my empty kitchen. Carol’s story seems to corroborate what Luis and I had suspected: that Mr. Bernard was not GG’s first victim. Carol and I, it seems, have a lot in common: We’ve both been set up by GG. Except it sounds like Carol’s story is probably going to have a happier ending than mine.

I can’t just roll over.
All of Luis’s efforts, everything he strove for, would have been in vain. I picture him on Dan’s porch, cigar in hand, his face partially shrouded by the night wrapping around him, earnestly telling me that it was the right thing to do to stop her. The
honorable
thing.

I dare you to try to stop me, Steve,
she had said.

Maybe I still
can
stop her. Even without Luis. I owe it to him to at least try.

But how?

I close my eyes and allow my mind to wander along shadowy corridors, to traverse the kinds of twisted, thorny paths I imagine GG herself would trek in order to find the surest, most expedient way to put an end to this nonsense. I quickly arrive at a single, simple conclusion.

The simplest one, really. The obvious one. Ugly and cold.

I sense that, psychologically, I’m in a dark place right now. Probably the darkest place I’ve ever been in my life, a black place deep within the primordial recesses of my mind that I can only now access because of everything that’s happened to me over the last few weeks.

I could kill her.

Direct and permanent. Not to mention what GG would probably do if she were in my position.

I’m a doctor, after all. I’ve got access to all kinds of nasty things. Powerful intravenous heart medications. Paralysis agents to lock up respiratory muscles. Hell, even cyanide.

Killing her would save whatever future victims she’s marked down on her list.

Killing her would solve all of my problems in one fell swoop.

Or would it?

I open my eyes. My gaze strays to the other side of the table, where one of Annabelle’s bibs is draped over the side of the chair. Printed on the bib, a troop of smiling, cartoon monkeys regard me in cheerful repose. Behind the bib, affixed to the kitchen wall, is a picture of the four of us—Sally, myself, Katie, and Annabelle—at the neighborhood playground, back at the beginning of the summer, before my universe started spinning on its head.

I can’t kill her
.

I can’t kill her because then I would become her.

I’m not a cold-blooded murderer. I won’t do that. I won’t stoop to her level. I’m a doctor. I save lives. I don’t take them. Besides, I know nothing about planning a murder and, even more important, getting away with one. I can guess that even the simplest police investigation would turn up our sex video, which would in turn point to me as a prime suspect.

No. Like it or not, if I’m going to try to stop her, I’m still going to have to play the game by her rules. Which means that, once and for all, I need to identify who she’s going to target. I need to find a patient with an ICD.

So I push the pizza aside, crack open a can of soda, and open my laptop. The friendly
ping
of the operating system booting up echoes through the empty kitchen. I remotely log into ERIN. Scanning rapidly through the names in University Hospital’s current census, I eliminate the patients in the hospital that GG is currently taking care of because none of them has an ICD. That leaves the patients who haven’t yet been admitted. I rule out the possibility that GG would count on a patient’s coming to the emergency room; she’s far too meticulous for that kind of unpredictable approach.

I access the directory in ERIN that contains all of the patients who are scheduled to undergo elective surgery at University Hospital this week, beginning tomorrow morning, limiting the search to the patients GG will be taking care of. It takes me over an hour and a half of intense research, but I eventually happen upon Mr. Schultz.

Mr. Schultz is a patient who’s being admitted to University Hospital Wednesday morning for routine kidney-stone surgery. According to his chart, he suffers from a condition called cardiomyopathy, or weakening of the heart muscle. He’s had several heart attacks and repeated episodes of v-fib. Lucky for Mr. Schultz, the first time the v-fib occurred was at a high-stakes poker table in Vegas, where well-practiced casino employees slapped an automatic external defibrillator on his chest that saved his life (I pause briefly to savor the details of that particular story, related in the crisp and clear clinical language of the medical chart; I love it when doctors insert that kind of stuff into medical records). His cardiologist implanted the ICD a short time later.

Despite taking a list of daily heart and blood-pressure medications as long as my arm and undergoing several heart procedures to try to correct the problem, Mr. Schultz’s intermittent v-fib has persisted. He also has had one of his heart valves surgically replaced and must, as a result, take a blood-thinning medication called Coumadin.

By now, it feels like my own heart is going into v-fib. My hands tremble slightly over the computer keyboard. No wonder GG was studying up on ICDs last weekend: She has access to the same operating-room schedules that I do, and I’m sure she marked Mr. Schultz as a ripe target long ago.

I take a few deep breaths, crack my knuckles, and then—just to be sure—double-check all the patients scheduled to undergo elective surgery the rest of the week, then all the ones scheduled for the following week. None of them have implantable heart devices. None of them are even remotely as sick as Mr. Schultz.

It’s got to be Mr. Schultz.

Okay. Now I’ve identified her method and her target. So how do I stop her? And collect the evidence I need to beat her?

Think.

The overnight shift is undoubtedly when she’ll strike. Mr. Schultz will need to be asleep when it happens, so that he won’t realize what’s going on and call for help; plus, the skeleton crew of nurses working the night shift is usually stretched pretty thin, which will make it easier for GG to slip in and out of his room undetected. Mr. Schultz also can’t be hooked up to a continuous heart monitor—otherwise, the monitor will immediately sense the v-fib and alert the nurses with its automated alarms.

The most straightforward approach would be simply to park myself in Mr. Schultz’s room each night for the entire duration of his hospital stay. But that would tip my hand and defeat my purpose.

Because of his blood-thinning medication and health problems, the plan is for Mr. Schultz to remain in the hospital for a total of three nights after his surgery. During the first two nights, he’ll be staying in one of the specialized cardiac units, where he’ll be hooked to heart monitors and under the constant surveillance of nurses with expertise in taking care of heart patients. There’s no way she can effectively strike then—even if she manages to sneak into his room and access the ICD signal, any problems will immediately show up on the monitors and alert the nurses.

But for the third night, if all goes according to plan and he recovers from his surgery as expected, Mr. Schultz will be transferred to a different, less intense area of the hospital. He’ll no longer be hooked up to the heart monitors or under the watchful eyes of the cardiac nurses. He’ll be alone in his room for several hours at a time between routine nursing checks. Completely vulnerable.

So Friday night will be the night. It has to be. That’s four days from now. I have clinic tomorrow, but if I call in sick, they’ll just cancel the clinic, and that should give me plenty of time to prepare since I’m still banned from the operating room.

I yawn and glance at a wall clock. It’s 2:00
A.M.
, and my thoughts are bogging down, like feet slogging through thick mud. I’m not quite there yet. I still need to figure out a way to trap her. I’ve made a lot of progress, but I’m hitting a mental wall. I need sleep. Badly.

I shut down my laptop, trudge upstairs, and crawl into bed.

My sleep is dreamless and unexpectedly energizing.

CHAPTER 18

Tuesday, August 18

After calling in sick early in the morning, I have the entire day free to prepare my trap. It’s hard work, but in the end, I’m surprised, really, at how everything comes together so smoothly. By evening, I’ve worked out all the details and collected the necessary equipment: a software program, downloaded from a cardiology Web site onto my laptop, that captures wireless signals from ICDs and displays the EKG tracings in real time on my computer; and a small, top-of-the-line, remote webcam with night-vision capability, which I found in a big-box consumer-electronics store near my house.

Because of the limited radio range of the ICD signal, GG will need to enter his room; quite likely, she’ll even need to stand over his bed in order to hack the software—especially if she uses her smartphone, which I’m betting she will. The plan seems straightforward enough: Hide the remote webcam with night-vision capability in Mr. Schultz’s room, then conceal myself somewhere within the radius of the ICD signal, from which I’ll guard him all night. The webcam and ICD will beam their respective signals to my laptop. When she makes her move, the camera should capture the visual act of her disrupting Mr. Schultz’s ICD, while the cardiac software simultaneously records the wireless commands she inputs from the smart phone and the instantaneous and potentially deadly effect on his heart—all in real time. Meanwhile, I’ll have a crash cart secretly at the ready to shock Mr. Schultz’s heart back into its normal rhythm.