Doing Harm (26 page)

“Wait.” I grab his arm. “Let’s do it.” Like a lot of things emerging from my mouth lately, the words are out there before I’ve consciously decided to say them.

“Okay, then,” he says, folding his arms and settling back down on the stool. “But first, I want a guarantee that you’re going to do exactly what I tell you, when I tell you. If we do this together, we do it my way. No questions asked.”

What choice do I have now?
“Fine.” I grit my teeth and, without thinking about it, extend my hand over the table.

His gaze flickers over my outstretched palm with thinly veiled contempt. “Are you kidding me? This isn’t some fucking contract negotiation, Steve.”

I flush at the rebuke, withdraw my hand, and ball it up in my lap, digging my fingernails hard into my palms. “So, now what?”

“Have you thought about other ways she might kill people and make it look like an accident?”

I have, actually. How could I not have, if only out of morbid curiosity? I clear my throat, relieved to be able to finally add something useful to the discussion. “Well, I think there are two points we need to keep in mind. First, I think she’s going to use a method she hasn’t used before. She made that clear to me on Saturday. Second, she’s going to do something that she believes, in her own twisted way, will benefit future patients.”

He strokes his chin and nods thoughtfully. “So what do you think?

“The potassium overdose was a perfect modus operandi. Quick, lethal, relatively easy to pull off, and difficult—if not impossible—to trace back to her. I’m not surprised she used it first.”

“Agreed. So what else is there?”

“Well, there’s a pulmonary air embolus. Like the one Dan told us about at the barbecue yesterday. A central venous line is a ripe target.”

He grunts, and the corner of his mouth twitches. Otherwise, he remains still as a statue. “Go on.”

“Except a determined killer wouldn’t leave anything to chance by simply uncapping a central line. What I would do is inject several hundred cc’s of air directly into the subclavian, internal jugular, or femoral vein. That amount of air rushing into the pulmonary artery all at once would stop the victim’s heart almost instantaneously. Just like the potassium—easy, quick, lethal, and difficult to trace.

“But I think also unlikely, at least in this case. According to Dan, that patient’s death in May triggered a hospital investigation. GG would know that.”

“What if she was the one who caused the embolus?”

I shift uneasily on the stool, which isn’t very comfortable and is pressing up against my tailbone. “That went through my mind, too. What if Mr. Bernard wasn’t her first victim?”

“Exactly.”

“But either way, even if she
did
kill that other patient, it wouldn’t benefit her to do it again. She’s not going to waste her time on something that’s already happened recently. She’s going to come up with something new. Otherwise, it’s not worth her while. So I think we can cross air embolism off our short list for now.”

He pauses for a fraction of a second. “Agreed. What else?”

“Insulin overdose. She could crash the blood sugar in a diabetic patient. Lethal within minutes. But more difficult to accomplish. How would she give the patient the insulin without anyone’s knowing it? And once the seizures start, the hospital code team is going to respond quickly, and one of the first things they’ll do is check blood sugar and give an amp of glucose.

“In addition to insulin, there are all kinds of potentially fatal medications. You and I have both changed our ERIN passwords, but we have to assume that she’s resourceful enough to find her way back into the medication-ordering system.”

“Agreed.” Luis has turned away from the door and is now scrutinizing me closely. His eyes are devoid of all emotion; his expression is like a blank sheet of paper. I’m again reminded of a large jungle predator—watching, listening, waiting.

“Medications lead to a host of possibilities. A big IV dose of epinephrine—say, a couple of milligrams—would induce a massive non-Q wave myocardial infarction. A huge bolus of morphine, obviously, would stop someone’s respirations cold. Overdoses of anticoagulants like heparin or Coumadin could precipitate devastating bleeding. Especially in a postop patient. All creative and harmful—but none with ironclad guarantees of lethality. MIs can be treated, morphine and other narcotics countered with naloxone, anticoagulants reversed.

“You could inject a lethal bacterium directly into a patient’s bloodstream. I read recently about several patients who died in a hospital because their TPN fluid was infected with
Serratia marcescens.
VRE or MRSA might work also. But you’d have to isolate and obtain the bacterium. And, of course, there’s always the possibility that somebody would identify the infection and treat it effectively before the patient died. Not very practical.

“Then there’s acute radiation poisoning. Several hospitals have gotten into trouble when their patients were injured or killed by CT scanners mistakenly set to dangerously high radiation levels. Theoretically, you could rig one of the diagnostic CT scanners or radiation oncology-treatment machines to deliver a lethal dose of radiation. That would require some major recalibration of the hardware and the software, though, and that would be
really
tough to pull off. It’s a little far-fetched. Besides, death would be slow and painful. And, again, by no means guaranteed.”

Luis’s mouth twitches, like a cat flicking its tail. “Agreed. Anything else?”

“Not right now. I’ll keep working on it.”

“That’s a pretty good start,” he says, sounding impressed. “You have some good ones in there that I never would have thought of.” He snorts. “It’s amazing that there are so many different ways to die in a hospital that have nothing to do with being sick. Here. Before I forget. This is for you.” He discreetly passes me a cell phone underneath the table.

“I already have a phone,” I say, examining the cheap display.

“It’s a disposable. Prepaid. In cash. The account’s untraceable.”

“What do I use it for?”

“To communicate with me. Only texting. Never,
ever
any calls. And I’ll be the one doing the texting—from the disposable cell phone I’ll be using. Keep it on you at all times. Don’t ever lose it. Even though the account is untraceable, the number’s not, and if someone gets ahold of either of our cell phones, the other can be tracked through calls sent and received. Take this.”

“What’s this?” The sheet of paper he hands me has two columns printed on it: one column contains six rows, numbered one through six; the second column contains a single street address corresponding to each number.

“Code. I want you to memorize the number in the first column with its corresponding address in the second.”

“
Memorize?
”

“Yes. Right now.”

“How does this code work?” I peer at the numbers.

“I’ll text you the number in the first column, followed by a specific time—in four-digit, twenty-four-hour military time. We’ll meet at the corresponding location at the stated time.”

“So,” I say, picking the number five from the first column on the paper, “if you text to me the number five … followed by, uh, one-nine-zero-zero, we meet at—” I squint at the paper, examining the address printed in the second column next to the number five. “At 125 Chestnut Street. At 7:00
P.M.
”

“Roger that.”

“And you want me to memorize these codes. Now.”

“Roger that.”

“Why?”

“Basic counterintelligence. If it’s in your brain, nobody can get to the information unless you tell them.”

Swearing under my breath, I memorize the codes. He has me recite them back to him, twice, before taking back the piece of paper, stuffing it in his pocket, and dropping some cash on the table. “I’ll be in touch within the next few days. Just stick to a regular routine. Do what Collier says. Fade into the background.”

“How should I, you know, act around
her
?”

He strokes his chin thoughtfully. “Depressed. Beaten. Like you want no part of her
or
her game. Like all you want to do is pretend nothing ever happened and that you’re desperate to just go back to the way things were. In the meantime, keep working on her most likely strategy. Beginning tomorrow morning in clinic.”

“How do I do that?”

“I’ll leave that to you.” He shrugs. “Whatever you come up with, remember that she likes to get to clinic early. Usually by seven thirty. And don’t tell
anyone
about this. Not even your wife.”

I nod numbly. I have plenty of reasons to keep Sally in the dark for now.

“After I’m gone,” he instructs, “wait at least fifteen minutes, then leave through the front door.” He jumps off the stool, lithe as a panther, and moves quickly toward an inconspicuous door in the wall immediately next to us marked by an
EXIT
sign. I hadn’t noticed it before, but I note that nobody has come in or out of it the entire time we’ve been here.

“Hey. Luis.”

He stops under the
EXIT
sign, his field of vision evenly split between the front entrance of the bar and me.

“What did you do in the Marines?”

He flashes a crooked grin.

“Force Recon. Intelligence. Ooo-rah.”

He slips out the back door and is gone.

I stare dumbly at the disposable cell phone in my hand.

Now
what the hell do I do?

Try to anticipate her next move,
Luis had said.

Great. And how the hell am I supposed to do
that
?

Think,
the rational half of my mind, the persistent friend I’ve been snubbing a lot lately, urges.
What are you good at?

I chew on my lower lip, staring into space, as the Sox pull ahead and the increasingly raucous evening crowd presses in around me. Luis’s designated fifteen-minute wait time bleeds into twenty, then thirty.

My mind lingers over the fact that I’ll be working with GG in clinic tomorrow morning.
A good opportunity to collect some intel,
Luis had said. But how?

And then I get an idea.

I dutifully exit through the front door and, before heading home, drive to a small computer store in Cambridge. It’s been a while since I last shopped here, but I immediately recognize the clerk behind the counter: a guy with perpetually half-closed eyelids, greasy blond, waist-length hair, and a nose ring. He’s wearing an untucked, faded Pink Floyd T-shirt. His potbelly bulges over the beltline of his jeans. We trade some obligatory but friendly small talk before I tell him what I need.

“Keystroke logger? Sure, man. I’ve got just the thing. Top-of-the-line.” He heads into a back room and emerges with two items: a software CD and a small, gray, rectangular object about the size of a car key. He places them on the counter between us.

I pick up the CD. “Easy to install,” he says. “Works on just about any operating system around.
Totally
undetectable by antispyware or countersurveillance security programs. And it’ll automatically sort and then forward the keystroke data to an encrypted Web account accessible only to you.” He grins. He’s missing one of his incisors. It looks like a hole in a white picket fence. “The trick, of course, is loading the software onto the target without getting caught.”

“It always is,” I reply absently. “And this?” I hold up the smaller object. “A portable one, I’m guessing? With a USB interface?”

“Yep. It’s got an eight-megabyte memory core built directly into the casing. It instantaneously downloads and stores the keystrokes—again, in an encrypted format. Might come in handy in a pinch, man.”

“Pricey.”

He shrugs. “You get what you pay for. These’ll never let you down, man.” He moistens his lips with a brief flick of his tongue. It reminds me of a lizard. His eyes gleam under the half-closed lids. “So. Which’ll it be?”

“Both.”

“Right on, man.” He grins. He may look like he just spilled out of a Grateful Dead concert from the seventies, but deep down, he’s pure capitalist.

On the drive home, I glance down from time to time at my purchases lying on the passenger seat next to me, my palms slick on the steering wheel, my guts twisted into a ponderous Gordian knot as a single, gnawing thought worms itself deep into my brain, like a splinter.

What the hell am I getting myself into?

CHAPTER 11

Tuesday, August 11, 7:01
A.M.

I grit my teeth and speed through the empty clinic waiting room. I was too nervous to eat anything for breakfast, and my stomach acids feel like they’re burning a hole through my stomach wall. Clinic doesn’t start until eight, but I need to load the software onto the clinic computer before GG comes in, and Luis had pointed out that she always gets there by seven thirty. Unfortunately, the automated electronic doors leading into the clinic don’t unlock themselves until seven, so I haven’t been able to enter the area until now.

It’s going to take me about thirty minutes, plus or minus, to load the keystroke software, so I’m going to be cutting it
awfully
close. In other situations, I might have been able to load the program onto the clinic computers remotely, from a different computer. But because of the University Hospital security lockouts, I need to download it directly using the software CD.

I don’t know which stresses me out more: trying to download the software before GG arrives, or the mere prospect of spending the entire morning with her. I’m not scared of her, or anything. Not anymore. It’s more like performance anxiety. I still haven’t decided how I’m going to act.
Depressed,
Luis has said.
Beaten.
I’d lain awake half the night trying to figure out what a
beaten
guy would say and do in this situation.

Not to mention that the thought of being in the same room with her makes my skin crawl. By now, I’m way over the shock I experienced Sunday morning. Helplessness and fear have taken a 180-degree turn into repugnance and anger. The way she manipulated me makes me feel …
used.
I hate being played. I hate not being in control. I love control. It’s one of the reasons I became a surgeon. So it
really
pisses me off, what GG’s done to me, boxing me into a corner like this. I want control again.