Authors: Daniel Palmer
Additional nursing staff charged into Shirley’s room. Tammy, the respiratory therapist, began bagging Shirley with an ambu bag while Julie set up her endotracheal tube. One nurse was drawing up etomidate and another busied herself with the suction tubing.
The intubation went as smoothly as expected given the circumstances. Shirley was heading toward unconsciousness and very little sedation was needed. Her blood pressure, however, tanked, as usually happens after an intubation, and additional boluses were given.
The surgeon, a handsome man with a Harvard pedigree, finally arrived to do his assessment.
It’s about time,
Julie thought.
He was immediately distracted by Shirley’s arm.
“Julie, good thing you called. Looks like she has a NSTI infection.”
Necrotizing soft-tissue infections were increasingly more common at hospitals everywhere, for reasons Julie could not quite fathom. Poor woman. Not only did she have hemorrhagic shock, but septic shock as well. One hour later, Shirley was on her way to the OR for emergency debridement, a procedure she was deemed fit enough to survive despite her fragile condition. The timing of Shirley’s departure coincided with the end of Julie’s workday, but she was not headed for home. She had a stop to make first.
MCI Cedar Junction.
* * *
LUCY FOUND
Dr. Becca Stinson with her eyes pressed against the lens of a microscope. She tapped the young resident on the shoulder, which caused a bit of a scare, but got her attention.
“Becca, do you have a minute?” Lucy asked.
The question was rhetorical. Everyone always had a minute for the boss.
“Yes, of course,” Becca said.
Lucy brought a clipboard that held printouts with the lab order for Sam Talbot’s stains. She handed the clipboard to Becca. “Do you recall doing these stains?”
As part of their training, residents learned the equipment and procedures by doing tests typically handled by the lab techs. For Becca and her peers, processing stains and reviewing path slides was as common a practice as checking e-mail. Equally common were long hours without sunlight. Lucy noticed Becca’s peaked complexion and how her wide eyes had rings around them, a mark of too many hours gazing through a microscope. Lucy brought the paper trail of Sam’s extensive lab tests, hoping a quick review would refresh Becca’s overtaxed memory.
“This is Sam Talbot, Julie Devereux’s husband, right?” Becca said, while leafing through the pages.
“Fiancé,” Lucy corrected. “And yes, that’s right. I was wondering if you remember anything about the stain.”
Becca’s expression went blank. “Like what?”
“Specifically if the eosinophils in the stain showed up pink.”
Becca strained, trying to recall.
“I think that’s right. It was a long time ago, though. I thought I had put something about allergic reaction in my lab report, but it’s not what’s indicated in the report you handed me, so I guess I’m mistaken.”
“Take a look at this, then. It’s the actual slide.”
Lucy went to the digital slide scanner and in no time had the slide of Sam’s heart on the display screen for Becca’s review. It was the same image Lucy had studied in her office after the autopsy and again moments ago. A sea of purple dots covered darker patches to indicate denser tissue morphology. Each slide was like a little painting, and Lucy found the variations, the differing contrasts, and abstract shapes endlessly fascinating. Like paintings, each slide had a story to tell, but the interpretations were seldom subjective. White Memorial used an automated system to apply the H&E stains, the gold standard for this procedure, and the slide on the screen clearly showed elevated neutrophils. The purple coloring was a common occurrence in myocardial infarctions, but also supported Lucy’s takotsubo theory. End of story. If Sam had experienced some sort of allergic reaction, as Julie speculated, the eosinophils in the slide would have stained pink during the chemical reaction, but such was not the case.
“Like I said, it was a while ago and I’ve done a lot of stains since then. So I guess my memory isn’t so great after all.”
Lucy thanked Becca, who did have a memory to rival Lucy’s. But slides were slides, and memories were not always to be trusted.
* * *
IT WAS
a repeat of the last time Julie was here. It was how prison life was designed to be—the same thing, day in and day out. Julie had made the call forty-eight hours earlier and gotten on the visitors’ list. A different employee with the same stern look processed Julie’s ID through a standard series of checks. Julie was cleared to go inside. While waiting for the trap guard to show, she phoned Dr. Goodman in the ICU.
“How’s Shirley Mitchell?”
“She’s out of surgery but not hemodynamically stable. Could take another twenty-four hours.”
Or longer than that.
The dark thought passed quickly. There was every chance Shirley Mitchell would never be stable enough to be taken off mechanical ventilation. Julie’s conversation with the sick woman came back to her. “Let me die,” she had said, or something to that effect. Sam had asked the same of Julie, Julie had championed that very right, and Brandon Stahl might be imprisoned for fulfilling that very wish. Julie ended her call with Dr. Goodman and was soon led down a familiar corridor, stuck in the middle of a grim processional.
The trap guard escorted Julie to an empty partitioned section. She took a seat on a metal stool bolted to the floor, and waited. A loud buzzer went off. Looking to her left, Julie saw Brandon Stahl enter the room behind the glass. This time, Brandon did not need to prompt Julie to pick up the wall-mounted phone. He still looked frail to her with his mop-top hairdo, twiggy arms, and a face incapable of hiding his humanity.
“How are you, Brandon?”
Brandon’s expression was grave. “I should be asking you.”
“You heard the news about Sherri, I take it.”
“We may be locked up from the outside world, but we’re not cut off completely. Tragic.”
Julie returned a skeptical stare and said nothing for a time.
“You don’t think I had anything to do with her death, do you?” Brandon asked.
“Did you?”
“No,” Brandon said emphatically.
“I saw the bullet hole in Sherri’s head, and it’s not something that will leave me anytime soon.”
Brandon’s eyes flared. For the first time Julie saw in them a look befitting a hardened criminal.
“Have you come here to tell me you’re not going to try to help anymore?”
“No.”
“Good. Because I had nothing to do with that poor girl’s murder. I don’t care if she testified against me or not. What happened to her was a horrible crime. But I didn’t send any inflammatory messages to my so-called devotees, like some of the news reports implied. Contrary to popular belief, I do not want to be, nor should I be, the poster child for mercy killing. Don’t thrust that mantle on me.”
Brandon jabbed with his finger. “I never asked one person to stand outside the prison and protest on my behalf. They send me letters all the time with stories about their sick mothers and fathers, aunts, uncles, whatever, and ask for my advice on how to kill them. How do they get the drugs? How do they properly inject them with a needle? Like I’m Dr. Kevorkian’s protégé or something. That’s my legacy. I’m the how-to-do-it guy for murder.” Brandon shook his head in disgust. “That’s not me. That’s not who I am.” His eyes narrowed. “I’m just a nurse. That’s all I ever wanted to be.”
Tears almost came to Brandon’s eyes. He could cry, and would not be alone. On both sides of the partition tears flowed freely, and the emotions spilling out were raw and unfiltered.
“I want you to try and remember something for me,” Julie said.
“Okay.”
“Did Donald Colchester have any allergic reaction that you can remember?”
“Allergic reaction?”
“Anything that stood out in your mind.”
“That’s a long time ago, and I’ve had a lot on my mind since then.”
“Understood. But I’m looking for a link between Sam’s case and Donald’s.”
“And you think it could be allergy related?”
“We’re having a hard time coming up with an event that could cause these disabled men to have been scared or stressed to death.”
Brandon leaned back in his chair, lowered his gaze, and folded his arms. “Did you look at Sam’s medical record?”
“I did,” Julie said. “But nothing jumped out at me.”
Brandon rubbed his chin, deep in thought.
Julie’s mouth formed a grimace. She wanted an answer, a bit of light shined in the dark.
“Are you thinking an anaphylaxis-type allergic reaction?”
“Doesn’t even have to be that severe.”
“And there was
nothing
in Sam’s file?”
“No. And I looked it over very closely.”
“What about Colchester’s file, then? Did you look at that?”
“It’s gone.”
“Gone?”
“As in, deleted from the EMR system, or some glitch. IT can’t figure it out. Believe me, I’ve asked. Best I came away with is a help desk ticket, which is why I’m counting on your memory.”
“Seems funny, you know. You looking into this and then Colchester’s EMR file goes missing.”
“Yeah, though ‘suspicious’ was the word that popped into my mind. The doctor who took my copy of the file suddenly isn’t answering my calls and surprise, surprise, I can’t seem to get a meeting with him, either.”
“I don’t know.” Brandon held a breath. “I mean, we’re talking a long time ago. Years.”
“Just try.” Julie leaned forward and put her hand against the glass. “Was there anything?”
Brandon groaned, closed his eyes tight, and grabbed a clump of his hair as if it hurt to think that far in the past, to think about it at all. Then his eyes sprang open and he looked almost pleased.
“I got something,” he said. “I just remembered. It was horrible, too, because he was paralyzed.”
“What was horrible?”
“Urticaria,” Brandon said. “Hives. A bad case of them, too. They just broke out one day. We gave him antihistamines of course, but I spent a lot of time putting cold compresses and wet cloths on the affected areas.”
Julie’s stomach dropped at the same time her mouth fell open. So much had happened since the accident. It was all a blur. She had cared for Sam, eaten lunch with him, cried with him, nurtured him, brought in Michelle so he would stop begging to die—all while working her job and looking after Trevor. Of course it could slip her mind. Hives. And Julie now knew exactly what entry someone had deleted from Sam’s medical record.
The overcast day seemed a perfect match for Trevor’s somber mood. Poor kid, he wanted to be anywhere but in the car driving with his mom to Beverly Municipal Airport on Massachusetts’s North Shore.
For the past few miles Trevor had kept his face in his phone.
“What time are we going to get back?” Trevor asked. “Jake wants me to come over.”
Julie mulled it over a moment. “Well, to be honest, I thought we could spend the day together,” she said. “After this jaunt we could maybe get a bite to eat, catch a movie or something. The IMAX isn’t too far from here.”
Julie came up with this plan only after her son tried to make a plan of his own. She wanted time with Trevor, as much of it as she could get, but had been so preoccupied with this upcoming rendezvous it had not occurred to her to make a day out of it.
Trevor contemplated the offer, and eventually he gave a gentle nod.
“Sounds like fun, Mom. I’ll see what’s playing.” He returned to his smartphone.
“Nothing too violent, please.”
Trevor gave a sidelong glance with a perfect “come on now” expression.
“Okay, how about nothing crazy violent,” Julie said. “Superhero violence, fine, but no serial killers, or assassins or ninjas or any of that. Deal? I just don’t think I can handle it.”
Trevor reached up and touched Julie’s shoulder. She could see in his eyes he was thinking about his mom and Sherri Platt.
“Maybe let’s just go for lunch somewhere,” Trevor suggested.
Julie gave Trevor’s hand an appreciative squeeze. “Sounds good to me, honey,” she said.
With everything that had happened, Julie was not about to leave Trevor home alone while she went on this jaunt. It did not take an M.D. to know Dr. Gerald Coffey had been intentionally avoiding her for days. She had called and e-mailed, all without reply. She even resorted to camping out in front of his office only to learn he was off for the week. A staycation, his assistant had called it. The same assistant also made a point of saying Dr. Coffey was available for patient consultation if needed. This meant he should have been available to answer Julie’s numerous calls.
What Julie wanted were answers, and those answers could not wait for Dr. Coffey’s return. Someone had intentionally deleted data from Sam’s file, and from the file of Tommy Grasso, and quite probably from Donald Colchester’s as well. Julie confirmed with Lynn Golden, Tommy Grasso’s respiratory therapist, that not long before Tommy died, he’d developed a bad case of hives. Stunned by the revelation, Julie double-checked Tommy’s EMR and found no entry of the reaction anywhere. Jordan double-checked and had confirmed a single deletion in the transaction log. They both saw reasonable cause to correlate the two. Someone had answers, and Julie hoped that someone was landing at Beverly Municipal Airport on time.
This rendezvous would not have taken place, at least not in this way, without Trevor’s help. Julie knew Dr. Coffey owned a plane. He’d made a point of bragging to her about his flying during that awful meeting. On a whim, she’d asked Trevor if it was possible to track down a pilot by their flight plan. Not that she expected Trevor to know, but she thought he might be able to figure it out. Trevor jumped on the assignment in a way he rarely did with homework, and in a matter of minutes came up with the answer.
“I just searched Gerald Coffey’s name in the FAA’s online registry and found a record of his plane,” he had said.
Julie had been in Trevor’s bedroom, staring over his shoulder in astonishment as he typed with dazzling speed. It seemed a new Web page loaded with each blink of his eyes. In the background Winston could be heard scampering about his cage, seeming as excited as Julie. The FAA page Trevor found showed an entry for a Diamond DA40 owned by Dr. Gerald Coffey.