The Inquisitor (28 page)

Could it be the work of a more recent enemy? One who knew about what had happened at NYCH, yet wanted to get rid of him for another reason altogether? Somebody determined to make it look like he'd chosen suicide over being discovered as a fraud? Someone who'd set up a scene to make it appear he'd copied Jerome Wilcher, the man he'd discredited so many years before?

He lost strength in his legs, and the leash choked him harder.

Like a man inebriated, Stewart could still snatch seconds of clarity from a progressive swoon into darkness, enough to know that this scenario definitely widened the field as to who might have done him in.

Everyone who hated his guts.

He sucked in air as if inhaling it through a straw. Soon his windpipe would be squeezed smaller still, and his brain would shut down, seize, and die for lack of oxygen. He'd see for himself the greatest riddle that had preoccupied him these last few years. Would there be a tunnel, the bright light, and loved ones?

His thoughts began to shatter and drift apart. He fought to hold them together, but it felt like trying to make jagged shapes fit alongside each other.

What loved ones?

His daughter had stopped visiting years ago.

Two wives no longer saw fit to even talk to him.

Colleagues admired his skills, but who liked him besides Garnet? And even Earl suspected him of murder.

All he had were legions of grateful patients whose lives he'd saved.

Not the same thing at all.

"Who are you?" he shrieked again, outraged he wouldn't know his killer or the reason why he'd been targeted for murder.

This time spittle rather than noise bubbled out his lips.

He again pushed up on his toes and recovered some slack. With the arrival of more blood to the brain, his desperation to live revived. New terrors raced through his head, insane panic driving his thoughts at high speed with the frantic, illogical, futile clarity that visits a man about to die.

"Are you there? Tell me why you did this," he sobbed, not realizing he no longer made a sound. "Is it punishment for Jerome? Yes, that's it, isn't it? Ail the reminders are to make me think of the poor man's last agony. Yes. Please, let it be punishment. Because that means you must still be here in the basement. Because what good would punishment be without someone to witness it and see the torment? And there still might be time for me to explain, make you take pity and cut me down. You see," he tried to say, "I hadn't meant Jerome to kill himself…"

He became faint. His vision closed in around the edges again, but this time it was as if he were inside a black hood and someone were pulling it shut with a drawstring.

No! No hood! This needn't be. Not an execution.

The pain in his legs trebled.

And he felt himself get an erection.

He could explain that too.

Something to do with the blood supply being cut off to a certain level of the spine.

But he couldn't remember the specifics.

All from insufficient oxygen.

A new panic blasted through his delirium.

His lifetime of medical knowledge, his skill to bring people back from death, would slip away into oblivion, cell by cell, memory by memory.

That's my legacy, my entire worth.

This time both his legs curled into spasm.

The noose cinched tighter and crushed his larynx.

No more breath.

The darkness swept it all away.

No white light.

No loved one.

No peaceful floating above himself.

Only inexorable pain.

And one last thought: end it fast.

Except…

He wouldn't kick away the stool to let his full weight hurry the process.

He'd simply allow himself to sag and prolong the agony.

Something a suicide wouldn't do.

Something someone smart enough might notice and figure out.

Earl, for instance…

That same evening, 8:27 p.m.

Damn," Janet said.

It had been the fifth time Earl heard the word coming from their study where she and Thomas were working.

Sounded like they weren't getting very far, he thought, putting away the last of the dishes from dinner.

Brendan steadied a stack of bowls under his chin and carried them toward their proper cupboard. "Is that the beaver kind of dam or the bad kind?" he asked, managing to set his load up on the counter, where it teetered precariously. Then he hoisted himself up beside them.

Earl tried not to smile. "Beavers."

"How do you know?"

"Because I do."

"How?"

"Just do. Now it's up to bed."

The familiar routine- bath, teeth, pajamas, story- unwound at its usual slow pace. Earl savored each step of it, the ritual having become an oasis for him at the end of each day.

Half an hour later he joined Janet and Thomas in the study only to hear her again mutter, "Damn."

"No correlations?"

"Not so far," she said. "But I'm trying a new approach."

He saw a printout of the New England Journal cluster study lying on the floor beside her chair and absently picked it up.

"I expanded the search to include the whole hospital," Janet continued, gesturing at the NO MATCHES FOUND message on her screen with one of Brendan's pencils. A tiny figure of Big Bird clung to the eraser end. "We thought we could save time by checking each staff category for a home run- namely, anyone who'd been on duty for eighty percent of the deaths in palliative care."

Earl saw in the article where she'd circled that number, it being the magic threshold in most cases where the study technique had actually unmasked serial killers.

She slumped back in her chair. "But I've checked every type of worker at St. Paul's I can think of- nurses, doctors, residents, orderlies, porters, cleaners, nursing aides, lab technicians, even secretaries and security guards. Who am I missing?"

"Visitors?" Earl said, resigned to the limits of a cluster study.

Her frown deepened. "Then we're out of luck."

"And pastoral services."

She threw him a give-me-a-break glower. "Stop it." She hadn't liked his voicing suspicions about Jimmy.

"Dr. Garnet, you mentioned using the computer record of electronic keys," Thomas said, "to see who accessed the hospital after hours, when they weren't on duty?"

"Yeah, but I haven't had time to set that up yet," Earl replied, flipping through the article. Finally he reached the section that stressed: Suspicions should be raised only when clusters of deaths and cardiopulmonary arrests occur that are either unexpected in timing or inconsistent with a patient's previous clinical course.

Janet turned to Thomas and began to explain Earl's previous concern that another way someone could foil a cluster study would be to work with an accomplice.

The resident listened intently.

Earl barely paid attention. The words unexpected in timing or inconsistent with a patient's previous clinical course had jolted his memory, and the image of a dying woman's calendar, carefully marked with crosses, popped to mind. Crosses that marked the deaths of patients who had not been declared DNR. In other words, patients who, for the most part, were probably thought to have sufficient time left that the matter could be decided later. Their deaths, though anticipated, might have been unexpected in timing.

"Wait a minute," he said, and moved to the keyboard. As chief of ER, he still had access to all cardiac arrest statistics, since his staff responded to calls from the floors. He punched in the key words to pull up a list of all the code blues at St. Paul's from midnight to dawn in the last six months and organized them by date on a bar graph. "The trouble is, we've been looking at overall death statistics. But in front of our noses there's been a simple way to separate them into two groups- those who died when they were expected to, and those who went a bit prematurely." As the computer worked, he told them about Sadie Locke's calendar.

The image that appeared on the screen stunned him.

Above January, February, and March, the incidence of codes called in palliative care seemed practically nonexistent. But over April, May, and June, three tall columns, like black towers of equal height, indicated the arrest team had been summoned about fourteen times each month.

"Well, look at that," Janet murmured at his side.

Thomas leaned forward. "Wow!"

The odds were zero that so many patients not yet designated DNR would go into cardiac arrest before their expected time by pure chance. Someone had selected them for death.

After chasing vague trends and trying to make mere fractions of patients add up to something concrete, the stark, solid pattern gave Earl a hell of a sense of accomplishment. Now not even Hurst would be able to deny that they had a killer at work.

Except he hadn't a clue who or why.

"Any comments or ideas?" he asked, assuming the other two had reached the same conclusion and raised the same unknowns.

The three of them studied the screen, their grim silence cocooned in the sound of rain pelting the study window.

"If someone's been killing patients for the last three months," Janet said after a minute, her voice little more than a whisper, "let's assume that that same person is also responsible for the first increase in deaths. At least then we could ask the question, Why kill only DNR patients for three months, then add patients who were not DNR to the list?"

Earl saw Thomas open his mouth as if to say something, then close it again.

"Spit it out, Thomas. All ideas are welcome."

The young man's dark complexion reddened. "I just had a rather nasty thought."

"Go ahead."

He hesitated, running a hand over his beard. "Well, what if there were something to Yablonsky's claim that someone had been pestering patients with questions about a near-death experience? No, that's too weird."

"Hey, go on."

"Well, maybe that someone tried it with patients who were more advanced in their disease but couldn't get anywhere with them. The people might have been too obtunded to reply with anything meaningful. So it would make sense, in a weirdo's way of thinking, to use people who weren't that far along, figuring they'd be able to at least speak. But our weird someone would have to manipulate these relatively more stable patients, bring them near death using drugs, say, or simulating the experience with ketamine, like in that paper you found."

Janet looked at Thomas in surprise but said nothing.

"Are you thinking of Stewart again?" Earl asked. "I thought you were all for his being innocent now."

Thomas's color deepened. "I am, but figured we need to put all ideas on the table, whatever we want personally."

Earl agreed with the part of needing to be complete. "Right you are. But you'll be glad to know there are still problems with pinning it on Stewart. He wasn't in town during a few weeks of the first jump in the mortality rate."

"But you're the one who keeps telling me that that doesn't rule out an accomplice," Janet piped in. "And there's a hideous logic to what Thomas just said that could apply to Stewart."

"And there's still the possibility someone is setting Stewart up," Earl responded.

"Then I'd advise you to check out that ex-wife of his," Janet said. She'd already voiced this suspicion twice before, first when Earl told her about Dr. Cheryl Branagh a few hours ago, and again later when he briefed Thomas.

Earl shook his head. "My instinct says no."

"Patterns are your strong point. Instinct's mine."

"Mine are good."

"They've been wrong before."

"Yours too."

It took Earl a few seconds to realize that he and Janet had slipped into the shorthand form of sparring that they, like most couples, had built up over the years. Thomas might just as well not have been in the room. "Sorry, Thomas. Rude of us," Earl said, and glanced at his watch. Only 9:05. "Look, it's not too late for a visit to Stewart's. He doesn't live that far away and might be able to shed light on who could be after him." Especially if confronted with the name Jerome Wilcher, he thought, seeing no need to release that tidbit to Thomas. Stewart had enough gossip to live down. "So I'm going to leave the both of you at it here-"

The sound of Janet attacking the keyboard interrupted him. The two men turned to her. "What's up?" Thomas asked.

"Maybe nothing. But I'm going to try for a home run again. This time I'm using only the list of patients who were not DNR when they died, For starters, let's see if there's a particular nurse in-house most of those times."

A single answer popped up on the screen.

The three leaned in to read it.

Earl felt his stomach knot into a fist.

"It can't be," Janet whispered.

Thomas went rigid.

It read JANE SIMMONS.

Janet braced herself against the passenger door as Thomas swerved her car around yet another corner, then accelerated toward the freeway. Already she regretted having accepted his offer to drive, but he'd insisted on going with her so they could discuss how much to tell J.S., and on getting behind the wheel himself.

"It can't be too comfortable for you these days," he'd said, patting his flat stomach to contrast it with her own.

She'd initially been grateful for his thoughtfulness, if not his lack of tact, as it was true that getting in and out of the driver's seat was more difficult with this pregnancy than she recalled it being with Brendan. But then she couldn't adjust the seat belt on the passenger side to accommodate the new girth, and ended up leaving it off. "Just don't tell my patients."

He'd followed the quickest route to the freeway and downtown but drove her peppy little car at twice the speed she would have in this weather, even if a patient fully dilated awaited her at the hospital.

"Slow down," she told him, raising her voice above the din of rain that peppered the heavy leather top of her vehicle. It sounded like they were in a tent. "J.S. isn't going anywhere."

He eased off and leaned forward to see better. The wipers barely parted the steady cascade of water that poured down the windshield.

The three of them had agreed there must be a simple explanation. But they needed to talk with J.S. and discover that reason before anyone else stumbled onto the data, because the history of cluster studies had a dark side. Effective as they were in nailing the guilty, they had also destroyed the lives of the innocent, the same persuasiveness of numbers that made them so successful also being what made them so dangerous. Whenever such studies fingered someone who happened to be around but had nothing to do with the killings, even in cases when formal charges were never laid, the accused inevitably went through a legal wringer for years before being exonerated. Often the person never worked in health care again, and sometimes lost the support of family and friends in the process.

"My worry is Yablonsky," Earl had said. "As long as she feels threatened that someone might try to blame the rise in deaths on her, she'll continue her attempts to pin them on anyone else who's handy."

"But she's already done a pretty good job at setting up Stewart," Thomas had countered, his voice tight with tension. He seemed the most shaken up by what they'd found.

Earl had scowled at him. "Maybe. But you saw how scared she was yesterday. And once everybody else starts thinking straight, they're also going to have serious doubts that Stewart would knock off patients as part of some weird near-death research. So who's to say dear Monica won't see the writing on the wall, realize she could still take the fall, and mount her own study to try to shift the blame to yet another patsy? Hell, my talking about clusters yesterday might even have given her the idea. She knows as well as anyone what kind of trap they can be, and she already has access to the ward's death records. She could be sitting at home right now, trying to tap into nursing rosters and doing the same thing we are. If J.S. pops up on her screen, she's finished."

Thomas's ruddy complexion had gone pale listening to Earl's all-too-blunt stark assessment, so much so Janet felt obliged to give her husband a pinch on the butt to shut him up.

She also had said nothing about an even more obvious and imminent danger for J.S. The young nurse might be able to identify the real killer- she might be aware of someone else who worked the same nights as she did, someone who hadn't yet shown up on their study. That put her in danger. Some slight slip on her part, an innocent comment about having a schedule similar to that of the actual murderer, could be a death warrant- if it wasn't already too late. When Janet had phoned ICU to check on her this evening, the supervisor reported that J.S. had received a steady stream of nurses, clerks, porters, orderlies, even interns and doctors from ER, all dropping by to wish her well. And since her endotracheal tube came out, she'd been talking to all of them.

Thank God Earl had had the good sense not to blab out that particular risk- he must have seen it as readily as she had- or the already skittery Thomas would really be climbing the walls.

She glanced sideways at him and saw that he remained hunched forward as he drove, staring straight ahead, his jaw clenched, his features ghastly as they moved in and out of the shadows between overhead streetlamps. Maybe he'd already figured it out anyway.

Back at the house Janet had insisted to both men that she be the only one to talk with J.S. tonight. "For no other reason than she's my patient, and I won't have you two descending on her, scaring her silly. Besides, I may be able to keep what she says under doctor-patient confidentiality," she told them, figuring it sounded reasonable that she'd also want to protect Jane from the police. Mostly she needed as many reasons as possible to keep Thomas away from J.S. until he calmed down. The last thing J.S. needed would be for him to pass all his anxiety on to her. "And I'm going to briefly see her tonight, warn her to watch what she says, so she doesn't incriminate herself with some off-the-cuff comment about her schedule to the likes of Monica Yablonsky." At this point she'd managed to slip her husband a private little wink. He'd fired one right back. He knew her real concern, just as she'd thought. "I should give her a post-op check anyway, so my dropping by won't seem too out of the ordinary or alarming. So why don't both of you stay here until I come back?"