Diagnosis Death pft-3 Read online

  "I'll go with you," David said. He shoved the remaining potato chip remnants on his plate into his mouth, chewed and swallowed, and said, "Let's go."

  In the ICU, they split up. Elena took Mr. Lambert's chart from the rack and went into his room. The patient was still breathing on his own, and his vital signs remained stable. She called his name. No response. She pressed her knuckle into his sternum, and he seemed to pull away from her. Maybe his level of coma was lighter. Or maybe that was wishful thinking.

  "Do you think he'll ever wake up?" Mrs. Lambert asked. "What's going to happen?"

  Elena was totally conflicted in how she wished this scenario would play out. She settled for, "No one knows. We have to be patient."

  "I guess I'll just keep on praying."

  "You do that. And we'll keep taking the best possible care of your husband."

  Elena stopped at the nurse's station and made a couple of adjustments in Lambert's IV fluid orders. She wondered if Shelmire had considered a feeding tube or a gastrostomy. It was apparent that the man was likely to survive the bleeding into his brain, but Elena was afraid that Charlie Lambert might remain in a vegetative state for a long time. Maybe years.

  Elena paused at the door of Maria Gomez's room. David was standing silently at the bedside, his eyes closed. She wasn't sure how long he stood there-maybe a minute, maybe five. She waited in uncomfortable silence until David turned toward her.

  "Oh, Elena. I was praying."

  "I wish I thought it did any good." She covered her mouth as though she could stop the words. "I'm sorry, David. I know you have deep faith. But I'm not sure I do anymore."

  David motioned her outside, and they found a quiet spot in the back hall. "I know you prayed after Mark's stroke. Did the fact that God didn't restore him to health mean that God didn't hear your prayers?"

  Elena knew the answer David wanted, but she answered with her heart, not her head. "Yes! That's exactly what it felt like. Doesn't it say somewhere in the Bible that whatever we ask, we'll get?" She swallowed hard. "Now that seems like a lie."

  "You're right about the passage. That's hard to understand when we ask for something and don't see the result we want. But there are other places that assure us God knows not just what we want, but what we need."

  "So why bother to pray, anyway?"

  David shrugged, as though the concept was beyond words. "I guess it's a way of staying connected. For me, part of praying is listening. It's a two-way conversation."

  "Right now, I'm not sure I feel like talking to God."

  "No problem. Just listen."

  Code Blue ICU! Code Blue ICU!

  Elena hurried down the hall and pushed through the double doors into the ICU. Her heart dropped when she saw the activity in Charlie Lambert's room. She edged nearer and saw an anesthesiologist at the head of Lambert's bed. He'd reinserted a breathing tube and was squeezing an Ambu bag to force air into Lambert's lungs. Another doctor-it looked like Marcus Bell-pumped on Lambert's chest at a pace of one hundred beats per minute. Just a couple of days ago she'd told her CPR class they could achieve the proper rhythm by humming the BeeGees song, "Stayin' Alive." The class thought that was comical. Now it was a serious matter.

  The drama dragged on, but eventually Marcus looked at the anesthesiologist. Both shook their heads and straightened, flexing their backs to ease tired muscles. Elena turned away and saw Mrs. Lambert huddled at the nurse's station, shivering despite the blanket someone had thrown over her shoulders.

  Elena eased over and stood beside the woman. "What happened?"

  "I slipped out to make a phone call. I was only gone for five or ten minutes. When I came back, Charlie wasn't breathing. His lips were blue. I screamed. A nurse came running in. They brought me out here, so that's all I know." She looked at the room, where the blinds were now drawn. "Is he…?"

  "I wasn't in the room. I'm sure someone will be here soon to tell you."

  Mrs. Lambert ignored Elena's carefully neutral answer. She seemed to shrink in on herself and started sobbing. A woman in a plain blue dress covered by a short white coat eased into the chair beside her. "Mrs. Lambert, I'm Chaplain Fulmer."

  Elena moved aside, her mind already locked in a comparison of this episode to the death of Chester Pulliam. Although she had no idea who could have done such a thing, she had a very good idea who might be blamed for it. She felt a tingling between her shoulder blades. Just as surely as if she had a target pinned to her back, she knew what was coming.

  Elena wished she'd sneaked a peek at the thermostat as she entered Nathan Godwin's office. Surely he had the air conditioning cranked up full tilt. She shivered inside her white coat. Then again, maybe the fault lay not with the thermostat but with her situation.

  "Doctor Gardner, I appreciate your coming by." Godwin's voice showed none of the appreciation his words supposedly conveyed. "Please have a seat."

  Elena took one of the two visitor's chairs. She hitched it forward so that only an expanse of uncluttered mahogany separated her from the administrator. Don't show your fear. Don't get angry. Let it play out. "Under the circumstances, I expected the call." She looked at her watch. Still plenty of time to get through this before she left for Fort Worth.

  "I perceive you're in a hurry," Godwin's smile carried more triumph than mirth. "Very well. I'll get right to it. As you know, I'm already aware of your involvement in the suspicious deaths of two patients during your residency training."

  Elena bristled. She leaned forward until she was halfway across Godwin's desk. "For the last time, these deaths were the result of withdrawal of life support from two patients with no hope of recovery. And one of those patients happened to be my…" Her throat caught. She couldn't say the word.

  "Your husband," Godwin said. "Yes, I know. Nevertheless, you left your residency under something of a cloud, with your ability to deal with brain-dead patients in question." Not only was the administrator capable of using the dreaded phrase, he seemed to delight in it.

  "What's your point?"

  "You were in the ICU at noon, shortly before your patient, Mr. Lambert, was found unresponsive, with no respirations and only a faint heartbeat. Efforts to resuscitate him were not successful."

  "I don't deny that. I saw him, talked with his wife, and then met a colleague to discuss one of his patients. After that I went to medical records to sign some charts. I was on my way back to the ICU when I heard the emergency page."

  Godwin opened his desk drawer and pulled out a plastic bag containing a small vial and a syringe. "This was found in Mr. Lambert's bedside table. It's succinylcholine, commonly known by its trade name of Anectine. I believe someone injected Lambert with this drug. Since he no longer had the respiratory support of a ventilator, when the Anectine paralyzed him he stopped breathing."

  Elena clamped her jaws shut. Don't say anything. See where he's going.

  "I intend to turn this evidence over to the police. At that time, I'll make them aware of your history and suggest they investigate Mr. Lambert's death as a homicide." He turned the bag, letting the light catch the vial. "It appears to me that there's a clear set of fingerprints on the vial. If they're found to be yours, I have no doubt that you'll be charged with murder. At that time, I intend to summarily suspend your hospital privileges."

  "You can't do that. This is America. I'm innocent until proven guilty."

  Godwin pointed to a thick binder on his desk. "I've carefully researched the hospital bylaws. If there is reasonable suspicion that a staff member's continued practice in this hospital constitutes a threat to the well-being of its patients, the hospital administrator may suspend that doctor's privileges pending a full investigation. I don't need the approval of the Credentials Committee or your precious Dr. Bell. It is within my power, and that's exactly what I intend to do at the first opportunity."

  He dropped the bag back into his desk drawer. "Good day, Doctor."

  As Elena left the city limits of Dainger, she wished she could leave her troubl
es behind as well. All the way to Fort Worth, thoughts circled in her head like a cloud of vultures over carrion. She felt certain this vial of Anectine was the same one she'd found in his bedside table earlier-the one she'd so innocently picked up and examined-which meant that her fingerprints would be on the vial. Someone was trying to frame her. But who? And why?

  Was Nathan Godwin the culprit? He had no reason to hate her. But she'd aligned herself, no matter how innocently, with Marcus Bell, and the enmity between Bell and the administrator was obvious. Could Godwin have gone so far as to kill a man in order to cast suspicion on her as a way to demonstrate his power? It was far-fetched, but so was everything else that had gone on in her life recently.

  Then there was Eric Burson. He made it a frequent practice to be in the ICU. He'd been there right before the first episode that almost took Lambert's life. As an EMT, Burson had access to Anectine and was familiar with its action. He hated doctors. That was no secret. And he'd apparently directed some of that hate toward Elena from the moment they'd met. Was this the endgame of some arcane plot to harm her? Elena found it hard to believe that someone whose profession involved the daily saving of lives could sacrifice one in order to get revenge on a member of the medical community.

  Marcus Bell? He'd been in the ICU at the time of Lambert's death, but she couldn't think of any motive he might have to do such a thing. She'd tried to turn away his advances graciously, pleading her recent widowhood. Surely he understood that, since he'd gone through the same experience. No, Elena couldn't bring herself to consider him a suspect.

  She thought of her midnight caller, the mysterious Karri. When she'd first seen the name on Will's note, Elena couldn't place Karri Lawson, but soon the picture came clear. Karri, the attractive brunette nurse who'd cared for Mark during his terminal stay in the ICU. Karri, who was so attentive. Karri, who always seemed to be around Mark. Could they have been having an affair before Mark was stricken? Was Karri the reason for Mark's note? Was it jealousy that drove Karri to torment Elena with the cards and midnight calls? But did it go even further? Had Karri somehow managed to arrange for Charlie Lambert to die under circumstances that would cast suspicion on Elena?

  What about Mark's sister, Natalie? Elena had no idea the woman even existed until the name appeared in Lillian's obituary. Had Natalie come out of the shadows to carry on the vendetta against Elena that her mother had started? Could she have had a hand in Lambert's death? Was it possible that she was in Dainger even now? Perhaps under an assumed name?

  A loud honk from behind her brought Elena's attention back to the road. A glance at her speedometer told her she'd slowed to forty miles an hour. Ahead of her a solid double line divided the highway as far as she could see, while behind her was a string of cars almost a half mile long. She waved an apology and pulled onto the shoulder. She sat there, her emergency flashers going, while car after car passed. As the slipstream from each passing car rocked her little Ford, Elena fought back the tears.

  The last car passed, but she didn't pull out. Instead, she did something she hadn't done in months. She'd read somewhere that the two most fervent prayers anyone could utter were "Please, please, please" and "Thank you, thank you, thank you." Before Elena turned the wheel and pulled back onto the road, her lips formed the words: "Please. Please. Please."

  Every step from the parking garage to the elevator to Josh Samuels's office was like moving through a field of tar. To dredge up the events of five months ago was more than Elena could contemplate. Yet she trudged on.

  Once she stopped in her tracks, frozen, until words began playing in her head like an endless loop: "Investigate my life, O God… See for yourself whether I've done anything wrong." Surely God already knew whether she'd done anything wrong. Now it was time for it all to be brought into the light. It would either help… or hurt. But it was time.

  The waiting room was small, neat, and empty of patients. Elena took a seat in the farthest corner and picked up a magazine, hiding behind it as though it could shield her from unseen eyes.

  "Elena?"

  She hadn't heard the inner door open. Now Josh Samuels filled it, a look of genuine welcome on his face. Knowing gray eyes stared out from a craggy face with a distinct five o'clock shadow. Ridges marked his shaved head like a relief map. Samuels wore a starched white dress shirt, open at the collar, the cuffs laid back two neat turns. Creased Dockers and white Reeboks completed his outfit. Not exactly what she expected a psychologist to wear. But, according to Cathy, Samuels wasn't a typical psychologist.

  She followed him into an office that was just as small and cozy as the waiting room. A desk sat butted against the far wall, facing a landscape Elena thought was by Monet.

  Samuels led Elena to the corner of the room where a group of three armchairs formed a semicircle around a coffee table. He motioned her to take one of the chairs. A number of certificates and plaques hung on the wall nearby, and she tried to sneak a look as she was seated.

  "Perfectly normal to be curious about the credentials of someone to whom you're about to pour out your secrets," Samuels said. "Let me save you the trouble of straining your eyes." He pointed to two certificates in the center of the grouping. "Undergraduate work at USC. Graduate degree from Stanford. Stayed on the faculty for a couple of years. Married a Texas girl and moved here." He crossed his legs, revealing white crew socks. "Now, how can I help you?"

  Once Elena started, the words tumbled out one after the other with hardly a pause for breath. Samuels didn't move, didn't ask a question, didn't take a note. He spoke only when it was obvious she had finished.

  "You want me to see if I can regress you to those times in the ICU when your husband and Mr. Pulliam died. Is that right?"

  It seemed to Elena that she had no more words, might never speak again. She nodded.

  "You realize that I have no legal privilege. If I find that you committed a crime, I have to report it."

  "Both Mark and Chester Pulliam were essentially…" She swallowed hard and forced out the hated word. "They were brain-dead. I'd already given permission to withdraw Mark's life support. Mrs. Pulliam was reaching the same conclusion. My attorney tells me that the worst thing I could be guilty of was going outside ethical boundaries. If something else comes up, and you think there's a crime involved, I'd ask that you discuss it with an attorney before proceeding."

  Samuels was silent for several minutes, his gaze fixed on the painting across the room. Finally, he nodded. "Fair enough. I'll hypnotize you, and we'll see where it takes us."

  Elena looked around. "Do you want me to lie down on a couch or something?"

  A ghost of a grin flitted across Samuels's face. "You're fine right where you are. Are you comfortable?"

  Elena nodded.

  "There's a lot of misinformation about hypnosis. Some psychiatrists use a drug like amytal to induce a hypnotic state. I'm not an MD, so that's not an option. However, I've found that it's easy to hypnotize a cooperative subject. If we had time, I could teach you self-hypnosis. I've helped people lose weight and stop smoking that way."

  "I just want you to get that information. Please."

  "I'll do my best. Now lean back. Close your eyes. Concentrate on the sound of my voice."

  Elena recalled having her tonsils removed in childhood. As she came out of the anesthetic, she heard the voice of her mother as though it were issuing from a tunnel, echoing and hollow but still recognizable. She remembered the pleasant feeling as though she were emerging from a deep and restful sleep into a day full of promise. Of course, then the pleasant feeling gave way to a terrible burning in her throat and things went downhill from there.

  This time she was experiencing the pleasure without the pain. The voice that echoed through the tunnel of her mind wasn't that of her mother. Nevertheless, it was associated with a feeling of comfort, of security. "Elena, wake up. You're coming awake now. Can you open your eyes?"

  She did, and saw Josh Samuels sitting in his chair opposite her. "Did… did you
get what we wanted?"

  "Yes. I took you back to the day of Mark's death. Then we went forward to Mr. Pulliam's death. You were a very easy subject."

  "Did… did I do anything bad?"

  Samuels pointed to a small tape recorder on the table. "I took the liberty of recording the session. You can listen if you wish. If not, I'll let you erase the recording."

  Elena was already shaking her head. "No, I can't relive those times. Will you just tell me what you learned?"

  "Very well. Would you like some water? A soft drink?"

  Her throat was parched as the Sahara, but she couldn't wait even another minute. "After we finish. Tell me, please."

  "Let's start with Pulliam. You spoke with Mrs. Pulliam. When she left the room, you spent five minutes considering all the ways you could put an end to his life-your words were 'give him a death with dignity'-but you didn't act on those impulses."

  Elena felt tears forming in her eyes. "Thank God."

  "That's another interesting thing. Before you walked out of the room, you paused at his bedside, took his hand, and prayed. For him, and for you."

  "Are you sure? That would be so out of character," Elena said. "I stopped praying when Mark died."

  Samuels's hand moved toward the recorder. "Want to hear it?"

  "No, I believe you." There it was. She hadn't removed Pulliam's life support while in a fugue state. She wasn't really a danger to terminally ill patients. Elena couldn't process all the implications yet, but she would eventually. "What about Mark?"

  "Before we go there, you mentioned one more thing that might be important. As you left the ICU, you felt for your pager at your waist but didn't find it. You turned back toward Pulliam's room, thinking it might have slipped off in there. Just as you found it in the pocket of your white coat, you saw a nurse going into that room. Your words, as I recall, were 'I wonder what Karri is doing in there?' "

  19

  Even after the puzzle piece marked "Karri" dropped into place, Elena still had more questions than answers. But she could think about that later. Right now, all she felt was a sense of relief.