Dead Certain (33 page)

“I didn’t think you’d be coming in today,” she said, getting up from behind her desk and following me into my office. “Mr. Tillman just came by to offer his condolences, and I told him that I thought you’d be at home for the day.”

“That’s the last place I’d want to be,” I said.

“I’m sorry, I didn’t think... ,” she stammered.

“That’s okay. I ended up spending the night at the new apartment last night. I’m going to get the rest of my things moved in over the weekend.”

“Elliott just called. He said you’d be coming in. He’s on his way over. He said he’s bringing something you’d want to see—something important.”

“Anything else?” I asked.

“A Detective Peter Kowalczyk just called. He wants you to call him back.” Cheryl picked the pink message slip out of the pile and handed it to me. I punched in the number. Apparently he was sitting by the phone, because he picked it up on the first ring.

“Kowalczyk,” he said.

“This is Kate Millholland, returning your call.”

“Joe’s in with the vic’s—I mean, Dr. Stein’s father, but he wanted me to call you and let you know some of the preliminary autopsy results.” I could tell from his voice that he didn’t much like the idea of sharing information with civilians, especially high-priced lawyers.

“It looks like cause of death was due to a single stab wound through the neck, which severed the carotid artery. No evidence of sexual assault. She didn’t have alcohol or opiates on board. We’re still waiting for hair and fiber results, not to mention toxicology, but the doc said they’d be releasing the body to the family later in the day.”

“Don’t you think there’s something funny about the fact that it was a single stab wound?” I asked against my better judgment. “Wouldn’t you normally expect to see some kind of struggle if she’d really surprised a burglar?”

“Not if the burglar got lucky on the first try,” he replied. “Listen, I know you’re taking this kinda personal....”

“I wanted to tell you that I realized something is missing from the apartment,” I said, fighting down my irritation.

“What’s that?” he asked, sounding interested.

“Claudia’s backpack.”

“What did it look like?”

“Just a purple canvas backpack, the kind that college students carry. Claudia used it instead of a purse. She spent so much time at the hospital, she used to keep a toothbrush in there and a change of underwear.”

“What about her wallet?”

“In the smaller zipper compartment, why?”

“Because we didn’t find it in the apartment. We just assumed that she must have left it at the hospital. We’ve got someone over there right now taking a look through her locker.”

“Will you let me know if you turn it up?” I asked. I didn’t feel like explaining the whole story of the patient charts and the summary chart that Claudia was working on to Kowalczyk. I frankly didn’t t
hin
k he’d be interested in hearing anything that didn’t fit into his theory of the case, which seemed to be that she’d surprised a burglar, albeit a lucky one.

“If we find it, we’ll make sure that it gets turned over to her next of kin,” he replied. “In case you were wondering, that means her father.”

“Thanks for clearing that up for me,” I said, han
gin
g up the phone.

“Your mother?” demanded Elliott, surprising me from the doorway.

“Worse,” I said, waving him in. “It was Blades’s partner.”

“He may be a hard-ass, but he’s also a smart cop. He just doesn’t like uppity women.”

“I’ll keep that in mind.”

“Are you okay?” he asked, sliding into the visitor’s chair. His jacket caught on the back of the chair, revealing the shoulder holster and wood-grained grip that protruded from it.

“What’s that you’re carrying, cowboy?” I asked.

“My backup piece. I hope you still have the one I gave you this morning.”

“It’s in my purse. I promised that I’d keep it with me, and I’m as good as my word. Just tell me you’ll come and visit me at Menard after I drop my purse, the gun goes off, and I end up shooting an innocent bystander.”

“Every Wednesday.”

“Why Wednesday?”

“Visiting day. Where’s Claudia’s dad? Did he get in all right?”

“He’s talking to Blades. I took him to the apartment and met Agent Roth. She’s a pretty woman.”

“Not to mention a crack shot. She finished seventh at the Nagano Olympics in sharpshooting.”

“Cheryl said you had something you wanted to show me.”

“Yeah, though now that you’re here, I might as well just tell you.”

“Tell me what?”

“I had one of my people do a Lexis-Nexis search on each of the fab four, and they turned up something interesting on McDermott.”

“McDermott? What?”

“When you and Dr. Gordon had your little chat about hospital killers, did she happen to mention a case at the Bloomington VA?”

“No. What happened there?”

“A nurse was accused of systematically murdering patients. It happened almost twenty-five years ago, but there were a couple of remarkable features of the case.“

“Such as?”

“The number of patients involved. We’re talking about twenty-six deaths over a fourteen-month period. Not only that, but the way they were killed was pretty interesting.“

“Really? How did they die?”

“Apparently the killer injected a drug called succinyl-choline into the patients’ IV solution.”

“What’s succinylcholine?”

“It’s some kind of anesthesia drug that causes muscle paralysis.”

“Say that again?” I demanded sharply.

“It causes muscle paralysis. That’s how they died. The drug stops the heart and lungs from working. But that’s not the really incredible part.”

“No?”

“No. It turns out that the person who was accused of putting the anesthesia drug into the IV lines was a nurse who’d worked at the hospital for ten years. But guess who figured out what she was up to and blew the whistle?”

“I have no idea. Who?”

“A surgical resident named Gavin McDermott.“

“Gavin McDermott?” I echoed incredulously. “That is too weird. Twenty-five years ago he discovered a nurse killing off patients with a paralysis-inducing anesthesia agent, and now his patients are mysteriously dying in what appears to be exactly the same way?”

“Sort of makes you wonder why he’s never said anything about it at Prescott Memorial. You’d think he’d have figured out what was going on and been screaming blue murder months ago.”

“So what about the nurse? Did she ever offer an explanation for what made her do it?”

“No,” replied Elliott. “She never did. It turns out that she killed herself before the case went to trial. She injected herself with a lethal dose of succinylcholine while she was out on bail.”

“Is that a drug that’s still in use?” I asked, wondering if it was something I should tell Julia Gordon she should look for.

“No. Now they use something else, the next generation of the drug. The action is basically the same, only quicker. Apparently it’s marketed under the brand name Pavulon.”

CHAPTER 25

The conference room at Joan Bornstein’s office had been transformed into a charting command center. Two physicians, both residents at Northwestern who were being paid the equivalent of a month’s salary per day in consulting fees, worked at either end of the long table. Neither looked old enough to have completed puberty. Flanking them were data techs working on their laptops, courtesy of Gabriel Hurt.

Having heard of Claudia’s death from Jeff Tannen-baum, Hurt had called Cheryl that morning to ask if there was anything he could do. Instead of flowers or sympathy, Cheryl explained that what was really needed was technical support to complete what she’d described only as the research project Claudia had been racing to complete when she died. Four data techs and an MIS specialist from Icon’s Chicago offices had arrived within the half hour. So far they’d set up an information paradigm and were busy entering the data as it was culled from the patient charts by the doctors. The MIS expert, a young woman with close-cropped hair and a Han Solo T-shirt that read NEVER TELL ME THE ODDS, was busy writing a program to evaluate the data.

“Can you go through the charts and quickly find the list of drugs that each patient was given during surgery?”

I asked.

“Are you talking about anesthesia agents?” asked one of the residents.

“Yes. Specifically I want to know if any of them were given Pavulon.”

“I’m sure they were,” the doctor at the other end of the table answered promptly. His name was Francis Cho, and as it turned out, he was a surgical resident from the same program at the University of Chicago where Claudia had done her training. “Pavulon is part of the most commonly used combination of anesthesia drugs.“

“So far I’ve got drug lists for all but two patients,” volunteered one of the data techs.

He gave the physicians the names of two patients from whom the data was missing. It took a couple of minutes to wade through all the paper, but in the end the data confirmed Dr. Cho’s suspicion. All of the patients had been given Pavulon as part of their surgical anesthetic. “Damn!” I muttered under my breath.

“Why’s that?” asked Dr. Cho.

“It gets us nowhere,” I replied. “Even if Pavulon was found in their bodies at autopsy, there’d be a good explanation for it.”

“You know, speaking of autopsies,” chimed in the other resident, a young man with Oklahoma in his voice, named Larry Spader, “not all of these patients are dead.“

“What do you mean they’re not all dead?” demanded Joan Bornstein, appearing in the doorway.

“This one, here, that I’ve just been going through. She suffered respiratory arrest, but they were able to resuscitate her. She spent nine days in ICU, but eventually she went into a convalescent home.”

“What’s her name?” I asked, feeling the stirrings of buried memory, but unable to make the necessary connection. “I vaguely remember the night that Claudia answered the code on her arrest. She said she wasn’t sure if the woman would ever fully recover.”

“The patient’s name is Ida Lapinsky,” he replied, consulting the chart in front of him. “Apparently she recovered most of her neurologic functions, certainly to the point where she was able to communicate and take part in her own care. I guess the thing that caught my attention is the fact that the neurologist who examined her in ICU made a note that she might be delusional.”

“On what basis?” demanded Joan.

“Apparently Mrs. Lapinsky kept repeating the same story over and over again until she became quite agitated. She claims that immediately before she went into respiratory arrest, she saw the devil come into her room, a monster with a big eye, who put something into her IV.”

“Who put something into her IV?” I echoed.

“That’s all she said,” replied Dr. Cho. “The neurologist seemed to think the whole thing was a hallucination resulting from grand mal seizure. Still,” continued the doctor earnestly, “if I were really interested in what was going on, I’d want to interview the only survivor.”

Before I left, I called Elliott’s office. He was out, but I asked to be connected to the lead investigator on HCC. I gave him the address and phone number listed in Mrs. Lapinsky’s chart, and he promised to do his best to locate her immediately.

Driving back to the office, I tried to put the pieces together. The only trouble was that I didn’t know whether they were to one puzzle or two. What Elliott had reported proved beyond any doubt that Gavin McDermott knew all about causing respiratory arrest in patients using paralyzing anesthesia drugs. But what possible reason could he have for killing his own patients? He gained nothing from their deaths, and indeed, the cumulative result had been a slipping of his reputation and whispering among his peers. I remembered what Julia Gordon had said about these cases usually being the work of deranged individuals. Surely Gavin McDermott wouldn’t be the first surgeon to slip off the edge. Perhaps the deaths were part of a systematic effort on his part to free up beds for more critically ill patients? But in the past when Gavin had gotten into trouble, it had been with alcohol. If he were going through some kind of personal crisis, you’d expect him to start drinking, not become psychotic.

And where did Claudia fit into all of this? Was it possible that Carlos was Prescott Memorial’s angel of death? It certainly made sense. Not only was he in and out of the hospital with access to all kinds of drugs, but usually it was first-line caregivers—nurses and paramedics— whose burnout manifested itself in homicide. I wondered if perhaps he had some sort of grudge against McDermott, and made a mental note to mention it to Blades.

When I got back to the office, I found a note from Cheryl saying that she’d gone to the police station to pick up Claudia’s father, as well as a message to call Julia Gordon at the medical examiner’s office. I punched in the number on the message slip and found myself listening to elevator music while I waited on hold for the forensic pathologist to come to the phone.