JACK SLEPT THROUGH THE NEXT TWO nights and days without change.
Beth did not leave the Cape Cod Medical Center until they told her he had been stabilized and that he was ready to be moved to the intensive care unit of Boston’s Massachusetts General Hospital. Because she could not ride in the helicopter, Beth drove, stopping at home in Carleton to change and to update Vince Hammond. Once again he offered to accompany her, but she declined. Jack would not want anyone to see him in such a hideous state.
While they prepped Jack, Beth waited in the lobby of the ICU. Forty hours had passed since that awful call; yet she was still in a state of disbelief. Aimlessly she thumbed through the magazines and newspapers. The headlines of the
Boston Globe
were about the war in Iraq, another suicide bombing in Israel, a shooting in Dorchester. The usual horrors. But at the bottom of the front page her eye caught the headline, “Nursing Home Resident Arrested for Murder.” The story went on to say that yesterday a seventy-six-year-old woman had fatally attacked the floor manager of a local CVS with a pair of scissors. Witnesses reported that the woman had acted strangely; and when the store manager went to investigate, the woman plunged a scissors blade into his carotid artery. “It doesn’t make sense,” reported Captain Steven Menard of the Manchester Police Department. “Clara Devine was a docile old lady.”
Nothing makes sense
, Beth thought, and put the newspaper down. After nearly an hour, Nurse Laura Maffeo came out to announce that she could go in now. “How is he?” Beth asked.
“He’s still asleep but stable.” The nurse led Beth to a room down the hall. Jack was suspended in a contraption that looked like a medieval torture device in chrome, his body sandwiched between two platforms that were attached to a large circular frame resembling a giant hamster wheel. One of the two nurses hit a button and the structure—what the nurse later called a Circo-electric bed—rotated Jack a few degrees so he was faceup.
“It’s so we can dress him front and back without moving him.”
Although Beth had last seen him only eighteen hours ago, his appearance
this morning was nonetheless shocking—still bloated, lashed with fat red and purple welts, and basted all over his torso and limbs with a thick white ointment. His eyes were still taped and he was hooked up to half a dozen electronic monitors, drip bags, catheters, IVs, and an ICP plug taped to his skull. He was still on a ventilator, which snapped and hissed in persistent rhythm as his chest rose and fell, as if he were playing some strange wind instrument. But in a reverse illusion it appeared as if the machine were playing him—filling the bag of Jack as if he were some kind of inflatable Michelin Man.
“Most of his vital signs are stable,” the nurse said. “His heart is strong. His liver and kidneys are functioning well. We’ve given him medication to keep his blood pressure at an appropriate level.”
A woman in white entered the room and introduced herself as Dr. Vivian Heller, a neurologist. She was tall and lean with thick red hair pulled back and large dark eyes. “Mrs. Koryan, I’m very sorry about your husband’s condition, but we are monitoring him and thus far he’s fairly stable. The Woods Hole people have identified the jellyfish as a creature native to the Caribbean, and they’re on line with specialists in Jamaica. The tox screening is still ongoing, but they haven’t yet fully identified the agents, although they’re reporting unusual peaks on gas chromatography, and the lab is trying to isolate the chemical structure.”
Beth looked at her helplessly. “I don’t know what you’re telling me.”
“Just that there’s an odd neurotropic signature we’ve not seen before. But it’s conceivable that it will be out of his system by the time it’s identified. In the meantime, we’re monitoring his vital organs and assessing any damage.”
“Will he be … Does that mean there’s damage?” She could barely word her questions.
“He was without oxygen for some time, we think, but there’s no way to tell if there are any effects. There was initial cerebral bleeding, but that’s stopped, and the ICP is down to normal.”
All the technical jargon was fuzzing Beth’s mind. She looked down at Jack. “Why doesn’t he wake up?”
“Because he experienced major trauma to his neurological system. And we don’t know what the effects are. We just have to wait.”
“But how long?”
“It may take another few days before he comes out of it. But so far he’s not responded to commands or to stimuli. But that’s not unusual given the trauma.”
“How long will he have to have the ventilator?”
“Until we’re certain he can breathe on his own.”
The moment was interrupted by a call on the telephone, and Nurse Maffeo took it. “There’s a Vince Hammond who wants to visit.”
Beth nodded in relief. “He’s a friend.”
A minute later he walked into the room. Vince Hammond was a big man, about six-one with an athletic frame from years of working out at gyms with Jack. But as he laid eyes on Jack, he seemed to shrink in on himself. “Jesus!” he whispered, his eyes filling up. “What’s the prognosis?”
Dr. Heller repeated what she had told Beth. “In a few days the swelling will go down and the sores will begin to fade.”
Vince shook his head in disbelief that this was his old pal and partner who in less than a month was supposed to be popping champagne at the grand opening of Yesterdays. “How long do you expect him to remain unconscious?”
“As I explained to Mrs. Koryan, it’s hard to tell. With cases of coma caused by a near-drowning or toxic shock, there is a seventy-two-hour window in which we begin to see responses to stimuli. We’re keeping a close watch.” Heller checked her watch.
“Uh-huh,” Vince said, and put his arm around Beth’s shoulder.
Beth nodded in autoreflex to the doctor. But the word “coma” cracked through her mind like an electric arc.
THE CAFETERIA AT MASS GENERAL WAS located three floors below. It was midafternoon, and the place had only a few people scattered at the tables. Vince and Beth took a small table along the back wall.
“I’m scared,” Beth said, putting her hand out to Vince. He took it in both of his. And it occurred to her that the last time they had held hands like this was when Vince came to their house to announce that he and Veronica were separating. Now it was Jack near death.
“Of course you are. Me, too. What the hell was he doing out there?”
“The anniversary of his mother’s death. You believe that? Thirty years ago she gets lost in a boat accident, and he goes out there to commemorate it.” She shook her head. “He’s got this thing about his mother. He doesn’t even remember her, for God’s sake. It was stupid, going out there alone with a storm coming. Now he’s in a coma.”
“He could still wake up any time now. The doctor said so herself.”
“But what if he doesn’t? What am I going to do? And what about you and the restaurant? I don’t believe this is happening.” She began to cry again.
He squeezed her hand. “Come on, come on, hang in there.”
“It’s my fault he went. We had a fight, a dumb fight. Ever since I lost the baby, he convinced himself we weren’t going to have kids, that he’d never be a father. That got to him, because he wanted a big family. I don’t know.”
Vince nodded and let her continue.
“He wanted me to go out there with him, but I didn’t want to. So he got mad and went off in a huff.” She wiped her eyes. “Jellyfish. You believe it?”
“Did you talk about adoption?”
“He wasn’t interested. The thing is that we had other problems. Things weren’t right between us … I was thinking of leaving him.”
“Maybe we should change the subject.”
“I didn’t mean to make you uncomfortable. It’s just if he doesn’t make it, I never get to say I’m sorry.”
“He’s going to make it. And when he does, you can say you’re sorry all you want.”
She looked at Vince and nodded, struggling against dark sensations roiling just beneath the surface—sensations that she wanted so much to get out. But she couldn’t. Nor could she find the right words. And she hated herself. Besides, how could Vince understand when she herself didn’t—that when the doctors told her that Jack might not make it, her immediate reaction was relief?
IT WAS A LITTLE AFTER EIGHT on Saturday morning when the drilling ring of the doorbell startled René awake. Silky, her black-and-white cat, curled around her feet as René padded to the window. In her driveway was a Cobbsville, N.H., police car.
She threw on a bathrobe, made a fast gargle of mouthwash, and went down to the front door. A large man of about forty smiled and introduced himself as Officer Steven Menard of the Manchester P.D., Homicide Division. He was dressed in a navy blue sportcoat over a blue work shirt and chinos. “René Ballard?”
“Yes.”
He flashed his badge. “Sorry to bother you, but we’re investigating the murder of Edward Zuchowsky at the CVS yesterday. Are you familiar with the case?”
“No. What’s the name?”
“Edward Zuchowsky.”
“I’m sorry, but I’ve never heard of him.”
“Okay, but I’m wondering if I can come in to ask you a few questions.”
“Oh, of course.” René opened the door and Silky dashed out as the officer entered. She led him into the living room, where Menard settled on the couch.
From a folder he handed her an enlarged photograph of a man smiling and holding a pool stick in what looked like a basement rec room. “Edward Zuchowsky. He was assistant manager of the Cobbsville CVS.”
René studied the picture and shook her head. “Sorry, but I don’t recognize him.”
The officer nodded and returned the photo to the folder. “Okay, then does the name Clara Devine mean anything to you?”
“Clara Devine?” For the last two months René had been working as a consulting pharmacist who monitored the medication of nearly six hundred nursing home patients in facilities throughout southern New Hamsphire and eastern Massachusetts. At the present time most were still names attached to
folders. The officer showed her the woman’s photograph—a wide-faced elderly woman with flat dark eyes.
He checked his clipboard. “She was living at the Broadview Nursing Home.”
“That’s one of my homes.” Clara Devine. The name did not register in René’s memory. “I’ll have to check my records. I’m still new at this.” She made a nervous smile, embarrassed that she couldn’t place a patient’s name. “Is there a problem?”
“She’s been arrested for Mr. Zuchowsky’s murder.”
“What?”
“She stabbed him in the neck with a pair of scissors at the CVS on Everett.”
“My God, that’s terrible. Are you sure it’s the same woman? I mean, nearly all of my patients are elderly and suffering from dementia.”
“There were several witnesses, plus, she was caught on security cameras.”
“That’s incredible.” René got up and got her laptop from the other room. In it were the medical records, bios, and pharmaceutical charts on her patients. She set the machine up on a table and began a search. “I’m very sorry about the young man, but I find it hard to believe that someone like her could have done this.” She scrolled her files.
“You’re not alone. So what’s your professional connection to Broadview?”
“I’m a consultant pharmacist for CommCare.”
“What’s that?”
“CommunityCare. It’s a pharmacy that provides medications to patients at nursing homes and rehabilitation centers. It’s a federal regulation that a pharmacist reviews all patients’ charts. And that’s what I do—visit nursing homes once or twice a month to review charts and look for possible medication-related problems. If problems are seen, I’ll make recommendations for changes to the patient’s doctor.”
“Interesting. And what if the doctor doesn’t agree with your recommendations?”
“She or he has that right, but they’re obligated to respond to the recommendation in order to comply with federal regulations.”
“Uh-huh. So how well do you get to know the patients personally?”
“Well, I mostly get my information about them from their medical records and talking with the nursing home staff. But I’m getting to know some of them.”
“And when was the last time you visited Broadview?”
“I guess about three weeks ago.”
“And you’re saying you didn’t know the perpetrator.”
Perpetrator.
It was hard to think of that elderly woman in the photo as a perpetrator—a term she associated with thuggy males in T-shirts. “I don’t know her.”
“But she’s one of your patients.” It sounded like an accusation.
“She’s on my list. Officer, you say this happened in the CVS. Where were the nurse and aides at the time? When patients go on outings, they’re heavily chaperoned.”
Menard looked up at her. “She was alone.”
“Alone? How could she be alone?”
“There were no staffers from the home with her.”
“But residents never leave the ward without staffers. How did she get there? How did she leave the home?”
“That’s what we’d like to know.”
René’s mouth made an O of comprehension. “You mean she eloped, she escaped?”
“Our guess.”
“But … that’s impossible.”
“Well, that’s what happened.” Menard flipped a few pages on the clipboard. “I’m wondering if you could check your records. According to the Broadview nursing staff, Mrs. Devine was not taking any antipsychotic medications. Is that your understanding?”
René scrolled through Clara Devine’s file. The woman had mild heart problems, high blood pressure, high cholesterol, and had been diagnosed with depression and moderate dementia. She had been admitted to Broadview by her sister a year ago at age seventy-two. The sister, Cassandra Gould from Dudley, N.H., was the listed sole survivor. Clara was also designated a ward of the state, which meant that her sister had not been willing to assume power of attorney. “As you know, without a search warrant I’m bound by patient confidentiality not to reveal details, including the medications she was on.”
“Of course, but that can be taken care of if something comes up.” And he gave her a look that said,
Don’t play Polly Protocol, lady.
They both knew that he could have the records subpoenaed; but that would take time, and he wanted to know if the woman was on any medications that might have made her nutty. She scrolled down the list: Atorvastatin for high cholesterol, hydrochlorothiazide, Atenolol, Captopril, and a baby aspirin daily for her heart disease and high blood pressure; paroxetine for depression;
donepezil for dementia. It was a pretty standard menu of medications for an elderly nursing home patient. And while some of the drugs had the potential to affect mental status, none could account for a volcanic urge to kill. According to her medication profile, Clara Devine had been on these same medications at the same doses for months, also decreasing the likelihood that any had caused her sudden homicidal behavior. “Looks like the standard laundry list for elderly patients.”
“No smoking gun?”
“No smoking gun.” Then she moved ahead toward the present. Suddenly René hit a blank. She went back and double-checked. “That’s odd,” she said.
“What’s odd?”
Clara Devine did not appear on René’s patient census for the last six months. And all of the woman’s medication orders were from last February or earlier. René felt Menard’s eyes scratch at her for an explanation. If she overreacted, he’d want to know how she could have a half-year hole in her records; then he’d go to Broadview to complain, and in no time her superiors at CommCare would wonder why they hired her. “A little computer glitch. Okay, here we are,” she pretended. “From what I can tell, she hadn’t been on any kinds of meds that would cause such behavior.”
“Any record of psychotic behavior on the ward or before?”
René checked the nurses’ notes to the six-month dead-end, feeling her face flush, and trying not to let on that she somehow had screwed up. “No. In fact, she was pretty well behaved.” Then some nurse’s notes made her smile. “Apparently she came out with some funny lyrics.” And she read: “‘Roses are red, violets are blue, look at my titties and say I do! ‘Had us laughing out loud,’ one nurse wrote. She also once announced that she was having a baby. Doesn’t sound like someone who’d attack a perfect stranger.”
“No, but she sounds delusional.”
“Many dementia patients are, but that doesn’t mean violent.”
Menard laid his pen hand on the clipboard. “So what do you think happened, Ms. Ballard?”
“I don’t have a clue.” But she’d go back to the home and double-check the master charts to see what she’d missed—and why there was a six-month blank in her files. She closed her laptop, feeling distracted that something was amiss. She had prided herself on keeping meticulous details, of being able to hold in her head the hundreds of unpronounceable syllables that made up drug indices, the technical details of complex chemical arrangements, their intended effects and side effects. And she had worked to attach names and
faces to the reams of data. Yet here she was missing records of a patient who was the epicenter of a murder investigation. “So what happens to her now?”
“Well, she’s been sent to McLean’s for evaluation.”
McLean’s Hospital in Belmont, Massachusetts—part of Harvard Medical School—was one of the top psychiatric hospitals in the nation, and where dangerous patients were evaluated.
Menard got up and headed for the door, stopping by a table with an array of photographs. One of them was a shot of René in her cap and gown posing with her parents and Nick Mavros, her favorite professor at the New England School of Pharmacy. Beside it were pictures of her father, before he got sick. Also one of him as a little boy in a porch rocking chair—an image of him that she adored. Menard picked up a close-up portrait of Silky. “Is this the guy I met earlier?”
“Yes. Silky.” In the picture, the black longhaired tabby with the white nose patch looked like a mobster with a menacing wide-eyed gaze—the kind of photo you’d imagine hanging in a mouse post office stamped WANTED. At the moment he was out back thinking about chipmunks.
“For the record, are you living alone?”
The question sent a little ripple of unease through her. Until a few months ago, she had been living in Boston with Todd and planning a June marriage—June 26, to be exact. Then after nearly two years of cohabitation—bridal gown purchase, Mr. Tux reservations, seat upgrades on Delta flights to Maui, seaside view at the Kapalua Bay Hotel, honeymoon-special sunset-mai-tai-catamaran cruise, and one hundred and twenty unused “René and Todd” invitations—dear old Todd, in a last-moment panic, decided he couldn’t go through with it and moved back to New Jersey, where he took up with his high school girlfriend.
If the jilting hadn’t been so painful, it would’ve been comic. In her twenty-nine years, René had never met or heard of any woman or man actually being jilted. Todd’s announcement raised a lot of screaming and accusations, but he still left. And after three months of wound licking, René quit her job at the local pharmacy and with the help of Nick Mavros accepted an offer with CommCare that brought her here to Dover Falls where she now lived in a converted barn, stripped down to bare happiness. Since then, René had resolved that she didn’t need Todd—that she would embrace the split as an opportunity to find new traction in life and a chance to become a part of something good—something bigger than herself, the welfare of others. “Yes, I live alone.”
He thanked her and handed her his card. “Just in case you think of anything that might explain what set her off or how she escaped.”
“I’m sure you’ve already checked, but maybe the security door malfunctioned?”
“We checked. It’s working just fine.”
“And no family member signed her out.”
“Nothing like that. And she didn’t put a chair through the window.”
And there’s a bloody six-month hole I have to account for.