No Cure for Murder (14 page)
Jack grabbed his chart and made himself comfortable at the nurse’s station. Ross Cohen, one of Brier’s senior psychiatrists, and Rory’s shrink, pulled up a chair.
“What the hell happened last night, Jack?”
“Somehow, Rory got a massive overdose of a potent narcotic...heroin, I’d guess. If he wasn’t an addict with a high tolerance for drugs, and especially if he wasn’t on Methadone maintenance, he wouldn’t have made it.”
“How did he get it?”
“Don’t have a clue, but since he was in restraints, it came with someone’s help. Does he have any enemies?”
“Just himself.”
“Could he have arranged for someone to give it to him, and they screwed up?”
“I don’t see that,” said Ross. “On Methadone, he didn’t need anything to control withdrawal symptoms. Was he seeking a high? You can never be sure with an addict.”
They walked over to the bedside. Rory stared at Ross. “Hey, Dr. Cohen, what in hell am I doing in this damned place?”
Ross turned and pointed to Jack. “This is Dr. Byrnes. He saved your sorry ass last night.”
“Thanks, Doc. That must a been one hell of a ride. I haven’t felt a high like that in years, maybe never have.”
“Do you remember what happened?”
Rory smiled. “Someone gave me the rush of my lifetime...who can I thank? That was some great shit.”
“That stuff would have killed a normal person, Rory,” said Ross. “Your tolerance after all the years of dope and the Methadone, saved your life.”
“You mean something good came from my bad habits?”
“Who gave it to you?” asked Jack.
“Haven’t the slightest...”
“Don’t hold back on me now, Rory,” said Ross Cohen. “We just want to know what happened.”
”Me too, Doc. All I saw was a dark shadow and a glint of a white coat. When I saw that needle entering my IV line, I thought I’d had it, then the all time high...shit, I really miss that.”
They found nothing new on examination, so Ross wrote transfer orders returning Rory to the ward.
“I think we have a reportable problem here, Jack.”
“I know.”
“By intention or by mistake, this could have killed Rory.”
“I’ll talk with Brier’s CEO and with risk management, today. They’ll begin an investigation.”
“Can we get blood levels to find out what he received and how much?” asked Ross.
“I think police forensics can do that. I have a series of blood tubes drawn for analysis. Once we know the drug and can measure the blood levels over time, we can calculate the original dose.”
Jack called Warren Davidson, and together they met with Bruce Bryant, Brier’s CEO.
“Shit,” Bruce said. “That’s all we need now. I know Ira Green, the chief of the Berkeley P.D., we play tennis. Maybe he can get into this before the media does.”
“Maybe,” said Warren. “All the same, it’s time for us to take a hard look at hospital security.”
Ira Green looked more like an accountant than Chief of Police After meeting with Bruce Bryant, and Al David, Brier’s attorney, Ira met with Jack and Ross.
“Deliberate O.D. or a mistake?” he asked.
Ross stared at Ira. “You’ve dealt with addicts as much as I. It’s a culture that I still find difficult to understand. Nothing they do surprises me.”
“Has the hospital experienced any other unusual or unexpected deaths or injuries lately?”
“We always have deaths,” said Jack. “Some unanticipated, but nothing that’s raised suspicion. Have other hospitals in the area reported any type of suspicious activities, chief?”
“Not a thing. I’m assigning one of my best plainclothes detectives, Shelly Kahn, to the case. I’d like her to work with your risk management people so she can keep a low profile. She was a nurse, so she knows how to fit in. Any other suggestions?”
“Once the blood levels return, we can extrapolate backwards,” said Jack. “Then, we’ll know what someone gave him, and what dose. That should put us in a better position to tell if this was an accident.”
Ira looked at the group. “This was no accident.”
Chapter Twenty-Five
Jacob had bad patients in sixty years of practice, but Justine Howard was in a category of her own. He used all the considerable tricks in his bag attempting to control her obesity related diabetes.
“I ain’t takin’ no shots,” was her first salvo ten years ago, then after the family interventions, she finally agreed.
Then it was, “I ain’t stickin’ myself for them damn sugar tests four times a day...no way in hell.”
Ever the rational man, Jacob didn’t understand why she rejected all his efforts on her behalf.
“It’s that damn pride of yours, sweetheart,” said Lola. “How many years does it take before you understand that you can’t live your patients’ lives for them?”
“Look, I have no illusions that patients follow all my instructions to a T. The medical literature is clear on how poor compliance is for medication, diet, etc. Justine, however, is deteriorating right before my eyes, and I know that with a modicum of cooperation, I can reverse it.”
“I’ve been a shrink for a while, and I tell you, you can’t help anyone who won’t help themselves.”
Over the years, Justine’s condition deteriorated. Her recent hospitalization at Brier was the worst.
Justine called one afternoon. “I got this terrible pain in my belly, doc. I been putting a heating pad on it for days, but it ain’t helped it none.”
“How’s your sugar?” Jacob asked.
“Hell if I know.”
“Do you have any fever?”
“Ain’t got no thermometer, but I’m hot and sweaty.”
“Come in to Brier Emergency. I’ll see you there.”
“No thanks, Doc, I’m sticking with it for a while.”
“This could be serious.”
“Everything’s serious with you, Doc. I’ll call you back if’n it don’t get better.”
“But,” he shouted into the dial tone.
I had better get the visiting nurse out to see her ASAP, Jacob thought, or I’ll be hearing from her in the middle of the night.
At three a.m., Jacob’s phone rang.
“This is Brier Emergency, Dr. Weizman. You should see what we’ve got for you.”
“Just don’t tell me it’s Justine Howard.”
“You’re a mind reader, doc.”
It was nearly 4 a.m. when Jacob entered the ER.
The ER nurse pointed to the door to her right. “She’s in treatment room II. How long has she had that hernia?”
“What hernia?”
Jacob and the nurse gave their heads the knowing shake of those who tried and lost in the care of the pig-headed patient.
Justine held her hands on her abdomen. “Hey, Doc. This thing is really killing me. Fix it up and let me get out of here.”
Before Jacob lifted Justine’s hospital gown, he smelled it, the stench of decaying tissue, gangrene. He stared in disbelief as he exposed her abdomen, reeling from the full force of the foul odor and feeling his stomach churn.
He recalled a case from medical school...his first days working with the living. The thirty-five-year-old woman came into the Vienna clinic with a grapefruit-sized tumor of her left breast. She’d had it for three years. How could someone let this go on for so long?
Now he looked at Justine’s abdomen and saw an enormous hernia, a ballooning out of her intestine through an old C-section abdominal incision. The thin white scar over the hernia had a dark spot in its center.
“My God, Justine! How long has it been this way?”
“A couple of months Doc. I used to push it back in, but lately the damn thing won’t go in. Then it started to hurt a lot.”
Jacob palpated the melon-sized mass. It was firm, tender, and he dared not reduce it... push it back into the abdominal cavity.
“Hey, take it easy Doc...that kills.”
“That’s an incarcerated hernia, Justine. It’s gangrene. You need surgery, and I mean right now.”
“In car sir what?” she asked.
“Incarcerated hernia. It’s stuck in that swelling and that dark spot means the tissue is dead or dying.”
After a protracted argument, Justine finally agreed to surgery. Jacob called a general surgeon and he repaired the hernia by 9 a.m. that morning.
In the recovery room, Jacob talked with Justine. “I want you in bed for the next 24 hours. Give us a few days to let this heal a bit, keep your sugar under control, and make sure that you don’t develop an infection, and I’ll get you out of here.”
“Make it quick, Doc, this place gives me the willies.”
Just as Jacob finished his afternoon office hours, the hospital called. “You’d better get over here to see Justine.”
What now? When he arrived, three nurses were at Justine’s bedside. Two holding her arms, one pressing on her abdomen.
“We told her not to get up, but we found her grunting on the toilet. When we got her back to bed,” the nurse said, pulling away the abdominal dressings, “this is what we found.”
Jacob knew before he looked, but seeing the open incision with small intestines protruding . . . an evisceration was the technical name, was still a shock.
Jacob shook his head at Justine.
“Don’t blame me, Doc. I had to take a crap. I ain’t usin’ no bed pan.”
Jacob held the earpiece of the phone away from his ear as the surgeon vented his anger. Justine was back in surgery within an hour. He repaired the wound and closed it over with thick stainless steel sutures. The real risk now was another evisceration due to weakened tissue and infection.
For the next two days, with sedation, physical restraints, and the equivalent of a whalebone corset, they were able to keep Justine in bed. The angry wound was swollen, but showed no signs of infection...a small miracle.
On day three, Jacob came into Justine’s room and smelled two distinct aromas...the ones best known in medicine: the Juicy Fruit aroma of uncontrolled diabetes and the distinctive stench of a Pseudomonas bacterial wound infection.
When Jacob thought what more could go wrong? Marion Krupp entered the room. Oh...no!
“Marion, do you have this morning’s lab?”
She handed him the laboratory printout. “Yes, Doctor.”
They were as he anticipated, but the magnitude of the uncontrolled diabetes (diabetic ketoacidosis, DKA ) and the signs of infection were alarming.
“Nurse Krupp, we’re going to need an ICU bed for her ASAP. In the meanwhile, I’m ordering IV’s, insulin, bicarbonate and antibiotics. We’ve got to get on this before it’s too late.” He grabbed her chart, wrote the orders, and handed them to Marion.
She scanned his orders and frowned. “Are you sure you want this much insulin, Doctor?”
“Of course I’m sure. This is a sick woman with severe DKA and infection. She needs aggressive treatment.”
Marion smirked. “I’m sorry, Dr. Weizman. I’ll need to check these orders with my head nurse...I don’t think they’re appropriate.”
“Are you out of your mind? We don’t have time for this, Marion. Any delay could kill her.”
“I’m sorry, Doctor. I’m responsible and cannot follow orders which are questionable.”
Jacob looked up and shook his head. “Questionable? Give me the keys to the medicine cabinet!”
“I can’t do that, Doctor.”
After finally finding Mary Oakes, the ward’s head nurse, and having her berate Marion for obstructing the doctor’s perfectly appropriate orders, getting the insulin, the bicarbonate, and the IV’s, they returned to Justine’s room to find her unresponsive.
Jacob listened to her heart, checked her pupils. “She’s dead.”
He turned to Mary Oakes, pointed to Marion Krupp. “Get her out of here and never let her set foot again in this hospital.”
Marion reddened, and without a word, departed.
Chapter Twenty-Six
Instead of his leisurely breakfast ritual, reading the papers and doing the crossword puzzles, Jacob gobbled down his lox, eggs, and onions.
“What’s the rush this morning?” asked Lola.
“Sunshine Manor called me to see a new patient. With five patients in the hospital and a full office, I need an early start.”
“Can’t the nursing home patient wait a few days?”
“She’s been waiting. Every doctor the family called refused to come to the home. Finally, all they had left was old doc Weizman...some testimonial. It’s been a week now, and someone has to see her.”
“Getting sensitive in your old age?”