Last Surgeon (15 page)

Mr. and Mrs. Jefferson Collins arrived at the Singh Medical Spa and Cosmetic Surgery Center at precisely three. Earlier in the day, Daintry Calnan had called with the news that Dr. Paresh Singh had been called out of town for an emergency consultation. She tried to reschedule their appointment, but Jillian told her that for the time being, it would suffice if they were able to tour the facility.

“It will save us time when we do get to come in and schedule my surgery with Dr. Singh.”

The novelty of their plan had worn off and the reality was sinking in. Despite her theater background, Jillian had never had any talent for lying or deceit. Now, she used mental images of Belle and memories of their last conversation together to keep her focus under some modicum of control.

Nick was at least a seven on the SUD scale:
Starting to freak out, on the edge of some definitely bad feelings. You can maintain control with difficulty
. He had not shared the fact that he had suffered through another bad night. Restlessness, insomnia, nightmares, free-floating anxiety, even leg cramps-the works. Brain chemistry run amok. As usual, there was nothing transpiring in his personal life to correlate with the flare-up-nothing, of course, except the sudden arrival in it of Jillian Coates. As exciting as it was to feel himself falling for a woman, it was also as frightening as his PTSD episodes themselves. How could he ever even consider bringing someone into the bog that was his recurrent mental turmoil? Perhaps when-
if
-they caught up with Umberto. Perhaps then.

The receptionist, Daintry, was posted by the massive glass doors, watching their approach. She was a statuesque blonde in her early forties, although Jillian had trouble being certain about that fact due, she suspected, to the artistry of the woman’s employer. By the time they had exchanged handshakes, the receptionist had obviously sized them up and decided they were the stuff of which patients of the Singh Medical Spa and Cosmetic Surgery Center were made.

The combination lobby and reception area was even more imposing than the Web site had led them to expect. The vast space-nearly all marble-featured an eight-foot-high fountain in the center and huge, original artwork on three walls.

Seated behind a marble counter to one side of the lobby, wearing a dark suit tailored to show off his linebacker’s build, was a security guard with a square jaw and a plastic ID around his neck.

“That’s a Shelby Stone ID,” Jillian whispered to Nick. “I guess this place is directly affiliated with the hospital.”

Nick and Jillian were both wondering about Manny and Umberto. At this point, the connection between the two soldiers was tenuous-identical somewhat casual remarks made four years ago by each man regarding their return to the military, and their enrollment in a top-secret covert mission. In addition, Manny was much more of a candidate for plastic surgery than a product of it.

Still, both Nick and Jillian had seen Manny’s powerful reaction to the vista they believed he had seen from high up in this building. Looking around at the opulence surrounding them, it was hard to believe either Manny or Umberto ever had anything to do with the place. But now it was time to home in on that possibility.

“So,” Daintry said, passing a price list across to Jillian, “I will check once you have given me your insurance, but it is doubtful they will provide coverage for any of our procedures.”

“I’m sure that won’t be a problem,” Jillian said.

“Yes, yes, of course.” Daintry passed over a tastefully done brochure and encouraged the Collinses to visit any floors that were available by elevator. “I have a patient coming in for preadmission,” she said, “otherwise I would be glad to accompany you.”

“Can I please see one of the suites where I might be staying for my recuperation?” Jillian asked.

“The actual suites are locked or occupied, but I’ll unlock the sixth floor where some of them are located. Once you’re staying here, you’ll need a room key to access your floor. I can’t imagine you won’t be totally pleased with your suite. It will have all the amenities you could ask for, plus a spectacular view of the city. Some very famous Hollywood personalities have stayed there, and they have had nothing but praise for it.”

“I would like to see the operating room or rooms,” Nick said. “I once had a bad outcome with knee surgery, and I prefer to be as careful as possible around hospitals.”

“Our two operating rooms are not in use at this time, but the elevator will take you to the observation balcony one floor above them.”

There was something about the receptionist’s expression that made Nick uneasy-a look of mistrust, perhaps. Had they already said or done something wrong?

Jillian took his arm as they headed for the elevator. Her closeness did away with much of the anxiety he was feeling.

The two operating rooms were located underground-floor B-2. The button was at the bottom of a column that went down to B-2 and up through L to 6. A row of five keyholes across the base of the stainless-steel plate confirmed that some of the floors could be closed off or accessed only after being unlocked. The security measures were no surprise. Privacy was the watchword of the rich.

B-1 opened onto the observation balcony above the ORs themselves. Viewed through glass or Plexiglas from the overhead walkway, the rooms were gleaming spaces with state-of-the-art operating microscopes and monitoring equipment, along with screens most likely used to display projections of the befores and afters of noses, jawlines, chins, wattles, eyes, lips, and the like.

Both Nick and Jillian were impressed with the scene below them. It was impossible not to be. If plastic surgery were a religion, the Singh Medical Spa and Cosmetic Surgery Center was the Mother Church.

Jillian turned and headed back to the elevator. Nick was about to follow when he saw movement through the small glass window in the door to the operating room just below him. A moment later, the door opened and in came a tall, thin figure-a woman, it appeared-with a hair cover, surgical mask, maroon scrubs, shoe covers, and latex gloves. Nick pulled back from the edge of the balcony so he was probably out of her line of sight, and watched as she went directly to a floor-to-ceiling steel cabinet against one wall, retrieved a large, sterilized, cellophane-wrapped instrument tray, and quickly made her way back out of the room.

Nick waited a few seconds for her to return and then gave up and followed after Jillian. His thoughts were spinning. The woman might have had something to do with a central equipment supply room, but why would she be coming-rushing was a more appropriate word-into an unoccupied OR, dressed as if she had just left an active OR? And why would she need a sterilized instrument tray if, as Daintry had said, there were no operations taking place that day?

More likely, she was a nurse-possibly a circulating nurse, specially trained to oversee all aspects of patient care and nursing performance during an operation. There was a haste and purposefulness to her movements that suggested she needed to get the tray back to an ongoing procedure.

But there were no surgeons in the building… and no operating rooms in use-at least not on this floor.

“THE SECOND floor is the gym,” Jillian said, studying the brochure as they walked on excessively plush carpeting past the closed mahogany doorways of the offices of Paresh Singh, the nursing supervisor, and the business manager. “And the lap pool is also on two. At the end of this hallway is the family waiting area. Pretty amazing place.”

“Pretty amazing,” Nick echoed.

He scanned the corridor, noting the security cameras at each end. The medi-spa, for all of its elegance, gave him the creeps. There was something cold and lifeless about the place. He was anxious to share with Jillian what he had seen in the OR, and the conclusions he had drawn, but he sensed that they hadn’t really been alone for a moment.

They took the elevator to the sixth floor. Suites 6A and 6B were locked, but at the end of the corridor was a sitting area enclosed by huge plate-glass windows. The vista was an unobstructed panorama over the treetops to Washington. The view, including the back of the Lincoln Memorial, was spectacular, but hardly unexpected. They had seen something almost identical on Reggie’s computer screen.

Nick’s jaw was clenched.

He felt almost certain that Daintry Calnan had lied to them when she said there were only two operating rooms and no surgery going on. He wanted more than anything to get down to level B-2 and see if there were other operating rooms, and if one or more of them were in use. More likely, judging by the size of the two operatories they saw, there was a B-3 floor, probably accessed by one of the key slots in the elevator. Of course, he thought, there also had to be a stairway down from B-2. Maybe he could find it somehow.

The image of the broad-shouldered security guard, plus the plethora of monitoring cameras they had passed during their tour, argued for restraint. Any unusual movement in the building would be noticed immediately. Bad idea.

“Can you imagine either of our two friends basking in this place?” Jillian asked.

Nick wanted to warn her to say as little as possible, but she seemed to have picked up on his concern, and conveyed that fact to him with her eyes.

“Only as our guests,” he replied.

“Can you think of anything else we should be looking for, darling?”

“Just our car.”

The security guard in the lobby looked as if he hadn’t budged since their arrival. Daintry appeared to be expecting them.

“Quite a place,” Nick said.

“I’m pleased you like it.”

Jillian took the woman’s hand. “All we need to do is meet the doctor and plan the surgery,” she said.

Daintry seemed pleased.

Once at the car in the rear parking lot, Nick stood beside his door, and then asked Jillian to join him and gaze back at the medi-spa.

“What’s the deal?” she asked.

“The deal is that this is a bad place.”

“Daintry Calnan is certainly a bit on the chilly side, I’ll give you that.”

“More like an iceberg. But there’s more. She’s also a liar-either a liar or the most uninformed receptionist imaginable. I’ll tell you about what I saw in the OR when we’re on the way home, but suffice it to say that I believe Dr. Paresh Singh is not only in the building, but performing surgery at this very minute.”

“Performing where?”

“When we’re away from here we can speculate. First, take a look at the place. Gaze at it lovingly.”

“Okay. I’m doing lovingly.”

“How many floors do you remember from the elevator, not counting the basement ones?”

“Seven, counting the lobby.”

“Okay, now count up starting from L. Quickly, though. I’m certain the Dragon Lady is watching, and I don’t want her to suspect what we’re doing.”

“One, two, three, four, five, six, seven, eight, nine. But-”

“Exactly. I counted on the way in. I’m quirky about numbers. There are two floors that no one, not even the elevator, wants to acknowledge even exist. Let’s talk on the way home, Mrs. Collins.”

“I don’t think I want to trust this place with my body,” Mrs. Collins replied.

The psychiatric wing of Shelby Stone Memorial Hospital was overcrowded and understaffed, which for Jillian meant it was business as usual. She was halfway through a grueling twelve-hour shift, the second in as many days. Still, for her, work had always been a refuge, and getting outside of herself, taking on the challenge of caring for the sick, the sad, and the confused had almost always given her strength. Since Belle’s death, it seemed that she needed work and her patients more than ever.

This had been an especially challenging afternoon. Beds on the psych unit, and throughout the hospital, for that matter, were filled. The interns and residents on the ER were nearing the end of their training year, and were shipping patients up to the wards with minimal workups. Jillian’s feet had begun swelling beyond what her white canvas work shoes could comfortably contain. And now she had been assigned a new admission for whom there would not be a bed available for several hours, if that. A somnolent, jaundiced, alcoholic man, probably in his sixties, he should have been admitted to a medical floor. His right eye was discolored and swollen almost shut. Diagnosis:
Acute and chronic alcohol intoxication. Possible impending delirium tremens.

Typical.
The diagnosis of alcoholism of any kind would not have gotten the fellow past the managed care gatekeepers and off the ER, but “impending DTs” would, despite the fact that the condition only occurred
after
cessation of drinking. Technically, every active drinker had impending DTs. Now, instead of offering him privacy, Jillian had no choice but to treat the poor guy in the hallway. It was not that Shelby Stone was a bad hospital. The nursing service had won many awards and national acclaim. It was more that the sprawling institution was just unwieldy much of the time, and the patient population was so ill.

She had taken the man’s vital signs and was in the midst of changing his IV bag when Nick, wearing jeans, sneakers, and a plaid Western shirt, appeared at her side. He reminded her of Trapper John, M.D., from
M*A*S*H
, with his bushy reddish brown hair that seemed extra wild today. Actually, she acknowledged, she liked that look. A lot.

“Hey you,” Jillian said, “this is a fun surprise.”

“We brought the RV in early to pick up some supplies and have it serviced at a place that does it for free.”

“Sign me and my Honda up.”

Nick nodded down at her patient, lying quietly on his hospital gurney. Jillian had pushed the rolling bed up against the wall so at least they weren’t blocking foot traffic.

“I always believed that if there were no alcohol, there would hardly be any hospitals,” Nick said. “I haven’t worked inpatient for a while, but I’m guessing triage to the hallway isn’t exactly HIPAA compliant.”

“It’s not exactly Joint Commission sanctioned either. But we had our JCAHO certification approved last month, so I think we’re all safe to behave badly for another year. What brings you to paradise?”

I haven’t stopped thinking about you since we met, that’s what.

“That bizarre tour we took of the medi-spa just won’t clear out of my head,” Nick said instead. “I’m just not sure what our next move should be.”

“It’s been haunting me, too. Between Manny Ferris’s freak-out, Daintry getting her signals crossed about the whereabouts of the surgeons, those mysterious unaccounted-for two floors, and the nurse showing up in the deserted operating room, I think there is cause for concern. Besides, Daintry just seems like someone with secrets.”

Nick was paying attention, but he was also reflexively checking the battered man’s pulse at the wrist and neck, then pulling open his lids and examining his eyes with a penlight he had plucked from Jillian’s breast pocket. Next he gently palpated his belly. Finally, he glanced at the plastic ID bracelet on his wrist and bent close to his ear.

“Ray, it’s Dr. Nick Garrity. Can you hear me? Open your eyes if you can hear me.” He put some uncomfortable pressure on Ray’s breastbone with the knuckle of one index finger. “Ray? Come on, Ray, open your eyes. Jillian, have you or any of the docs examined him yet?”

“I assume they looked at him downstairs. Maybe not as carefully as they might have. I heard it’s a zoo down there. I was getting ready to go over him when you got here. Something the matter-I mean other than the obvious?”

“Dunno for certain,” Nick said, “but I think his right pupil is slightly larger than the left.”

“Subdural?” Jillian asked, referring to the life-threatening collection of blood expanding between the skull and brain that often followed head trauma.

“A lot of folks have gotten CT scans of their heads for less indication than this,” Nick said. “I think he could certainly use one, and I would say sooner rather than later.”

“If you’re right, Doc, you didn’t just drop by to see me, you were sent by a higher power.”

“Nonsense. We’re a team. The Jefferson Collinses. If a subdural’s there, you would have picked it up.”

To the hospital’s credit, within five minutes of Jillian’s call, residents from psych and neurosurgery were on the scene, and ten minutes after that, Ray Goodings was on his way down for a CT scan.

“When this place works, it works,” Jillian said, looking up at him with an expression he wanted to capture and bottle for future use. “How about you wait in the lounge if you have time? I have some reporting to do about how poor Ray could have just made it off our service before he was ever really on it.”

Thirty minutes later, she entered the lounge, unable to contain her excitement.

“Subdural,” she said simply. “Pretty big one, too, according to the psych resident who went down with him. Ray’s on the neurosurgery service now. What a man you are. Five minutes in this hospital and you save a patient’s life and make a heroine out of one of the nurses. No wonder they call you Dr. Fury.”

Mentioning the words sent a shadow across her face.

“Hey, nice going,” Nick said, clasping her shoulders and hoping he could soften her thoughts of Belle. “You were connected to that guy. That’s what this caregiving stuff is all about. Connection.”

Jillian glanced about, then stood on her tiptoes and kissed him gently.

“There’s more where that came from,” she whispered. “Now, where do you want to start?”

“Well, let’s step back some and look at what we already know. We think poor Manny might have some connection to Umberto, based on what McBean told me, and we believe Umberto has some connection to Belle based on the Nick Fury comic books you found in her apartment. We also believe that Manny’s reaction to the photographs is a result of his having been a patient at the medi-spa.”

“And?”

“Umberto is between Manny and Belle. He’s the one linked to each of them.”

“So what are you getting at?”

“I think we need to take a close look at what happened at the medi-spa around the time Umberto and Manny disappeared.”

“By that you mean…”

“Check out the patient records from four years ago. See if we can learn anything.”

“Do you think Umberto was also a patient there?”

“I don’t know, but it’s worth investigating to see if the timing might be a missing link.”

“Four years. Excuse me for saying so, but that’s a stretch.”

Jillian rose and walked over to the single, narrow window. The panoramic view of Virginia and the Potomac from the seventh floor was breathtaking. She followed a sailboat skimming across diamond ripples. When Belle was a child, the two of them loved to go out together on their family’s Sunfish. Then, suddenly, they were orphans, and now, Belle herself was gone. Jillian felt completely adrift. When-if-they found Belle’s killer, would it really put an end to the profound emptiness she battled each day? The possibility gave her hope and, at the moment, that hope was all she could really ask for.

Fighting the fullness in her throat, Jillian returned to the table.

“I agree it’s worth looking into,” she said.

“Okay. I spent a little time on the Internet. The Singh medi-spa is a joint venture between Paresh Singh and your employer, Shelby Stone Memorial Hospital. Remember that badge on the security guard?”

“I do. One of the brochures in the medi-spa lobby said it’s been that way since before I started working here ten years ago.”

“So, since you’re an employee of Shelby Stone Memorial, you should be able to access the electronic medical records for the spa, assuming the two facilities share the data. We can start by looking at medi-spa patients from four years ago and work our way back from there.”

“We have a computer near the nurses’ station. Let me see what I can do.”

Jillian exited the lounge and followed the circular corridor to the nurses’ station, where they had recently installed a computer kiosk. She parked herself in front of the kiosk, which was really just a laptop computer locked inside a black metal case, providing employees access to various applications including shift and medication schedules, room assignments, and of course, electronic medical records. The psych floor was one of the first to get trained on the new EMR system, affectionately known among the nurses as the Even More Redundancy application.

Jillian logged in to her account, but accessing records other than those of her own patients was clearly an ethical breach. She launched the EMR application and clicked on the pull-down menu for “Facility Name.” As Nick had suspected, there was an entry for the Singh Medical Spa and Cosmetic Surgery Center, in addition to other facilities connected to Shelby Stone Memorial. When she tried to access those records, however, Jillian got a PERMISSION DENIED pop-up dialog box, followed by a loud and somewhat startling error beep. Logging off quickly, and smiling sheepishly as if she had made an inadvertent mistake, Jillian returned to the nurses’ lounge.

“I can’t get access.”

“So much for Plan A,” Nick said.

“But wait, there actually is a Plan B. Let’s go down and check on Ray. Then I can scrounge maybe twenty minutes if the floor is still quiet. We can take a trip down to the records room and see if we can get those files the old-fashioned way.”

“There still
is
an old-fashioned way?”

“Last I heard.”

Within the hour, the neurosurgery resident told them, Ray Goodings would be in the OR having a drainage procedure. Then the hard work would begin-finding a way to get him off booze and into recovery.

“Turns out shipping him to the psych ward in error may have saved him,” Jillian said.

“Maybe this experience will scare him into sobriety, providing he even remembers it.”

“Every time an alcoholic stops drinking, there’s a possibility that this will be it, and he’ll never have to stop again.”

“I like the way you think, nurse.”

Taking the patient elevator down to subbasement level two, the pair emerged into a windowless, dank, and eerily quiet hallway.

“Makes Manny Ferris’s bedroom seem like a suite at the Four Seasons,” Jillian muttered. “This area used to be the very center of the hospital. I have to come down here less and less as the changeover to EMRs progresses, but I really hate it when I do. I think the records room-what’s left of it-is the last door on the right.”

They proceeded along the dimly lit corridor with their eyes adjusting to the gloom as they went.

“Who on earth works down here?” Nick asked.

“I’ve only met him a couple times. The Mole, they call him,” Jillian said, “but his real name is Mollender. Saul Mollender, I think. I heard that when the whole EMR unit was created and moved to the top two floors of the Corwin Building, he just stayed.”

“A dinosaur.”

At the corridor’s end was a classroom-style door with a frosted-glass windowpane, upon which, painted in peeling letters, were the words RECORD ROOM. Jillian opened the door without bothering to knock. It was a cavernous space, made somewhat claustrophobic by a drop ceiling and row upon row of stacked cardboard storage cartons and tall metal shelving units, a number of which were still packed with color-coded patient records. The only other furniture in the room was a slate-colored fiberboard desk, positioned directly in front of the entrance.

Saul Mollender sat in his chair behind the desk. There was a large stack of records piled neatly on top of the otherwise uncluttered surface. No photos, no pictures on the wall, no calendar. The topmost patient record folder was flipped open and Mollender, cadaverously thin, with graying hair and wire-rimmed glasses, appeared to be entering data from it into his computer.

“Can I help you?” he asked, not bothering to look up from his work. His voice was nasally and his tone unfriendly.

“Yes,” Jillian said. “I’m sorry to trouble you, but-”

Mollender cut her off. “No, you’re not really sorry. You’re here, aren’t you? If you were really sorry, you would have acted on that fact and left me alone.”

For a moment, Jillian was speechless.

“Well, yes, but what I mean to say is that I’m trying to access some records, but the system won’t allow me.”

“Name?”

“Of the patient?”

At this Mollender groaned and closed the file he was examining. As he looked up at Jillian, he took off his oval spectacles, the lenses nearly as large as his owl-like eyes.

“
Your
name.”

“Jillian. Jillian Coates, R.N. Seventh floor.”

Mollender put his glasses back on and keyed her name into his computer.

“What records?”

“The patient?”

Again, Mollender groaned.

“Do you see this stack of paper?” he said. He tapped his index finger repeatedly on the file of folders. His tone seemed even more annoyed than before.

“Yes.”

“Well, these aren’t going to key themselves into our system, despite what the optical character recognition software people seem to think. So, I don’t really have time for your lack of clarity, Ms. Coates.
Facility
. What facility’s records are you trying to access?”

“Oh, right. The records are from the Singh Medical Spa and Cosmetic Surgery Center. It’s jointly owned by-”

Mollender cut her off again. “I know what it is. But you can’t see them.”