Diagnosis Murder 7 - The Double LIfe (8 page)

His office was crisp and austere, more like the workplace of an accountant or a lawyer. It had no waiting room, no nurse, no exam tables. He wasn't even wearing a lab coat.

Dr. Barnes was an African American man in his thirties, wearing a polo shirt and slacks, his hair cut so short it looked like a shadow on his head. He smiled broadly the moment Mark and Emily stepped into the office.

"Dr. Sloan, it's good to see you again," he said, giving Mark a hearty handshake. The man spoke with a slight British accent.

"You too," Mark said, though he didn't recognize the man at all. He assumed Barnes didn't know Emily, since the epidemiologist didn't greet her with the same enthusiasm. "This is my wife, Dr. Emily Noble."

"A pleasure." Barnes shook her hand, then turned back to Mark. "I didn't expect to see you again so soon. What can I do for you this time?"

"Exactly what you did before."

"I'm always glad to help. Do you have more patient death statistics for me to study?"

"Actually, the same ones."

As they all settled into the plush leather furniture in Barnes's wood-paneled office, Mark quickly explained his unusual plight, the loss of memory, and his effort to recapture the facts of his investigation.

"Fascinating," Barnes said. "I have never personally encountered a situation like yours before. It must be especially hard for you, Dr. Noble."

"Call me Emily, please," she said. "It is hard, but I must admit there's a part of me that shares your fascination. Who knows, perhaps I'll write a paper on this someday."

"If you do, let me know. I'd love to read it."

Mark shifted impatiently in his seat. "Right now, I'm less concerned about my own condition that I am with resuming my investigation. Do you mind going over everything you told me again?"

"Not at all," Barnes said. "You came to me with statistics on several years' worth of deaths involving patients who'd died within a few months after surviving a life-threatening episode. You asked me if it was simply cruel fate or an epidemic. At first I thought you were joking, but you weren't." 

"He wanted you to look at those stats using the principles of applied epidemiology," Emily said. "As you did in your study ten years ago of sudden deaths in the ICUs of several rural Texas hospitals."

Mark looked at her in amazement. "I thought I kept you out of my criminal investigations."

"I read the same medical journals you do," she said. "And I was still working in Houston at the time the study was published. I found it very interesting. Thanks to Dr. Barnes's study, and the statistical impossibility that such a cluster of deaths would occur naturally, authorities were able to discover there was a nurse killing patients. Without his study, the unusual number of deaths might have gone completely undetected."

"I was actually contacted by an administrator I knew who'd worked at two of the hospitals," Barnes said. "He was hoping I might be able to reveal some deficiencies in care that he could correct to reduce the number of patient deaths in rural ICUs. I was as shocked as anybody by what I discovered. It's one of the reasons I'm so outspoken about the need for hospitals to have a full-time epidemiologist on staff to identify rapidly spreading anomalies, natural or otherwise, that might otherwise go unnoticed. That's what I do—I help to find the medical, cultural, institutional, or behavioral causes and their solutions."

"What did you detect, if anything, from the information I gave you?" Mark asked.

Barnes sighed heavily.

"I won't bore you again with all the mathematical formulas I used. Suffice it to say I went back six years instead of three. What I discovered was that patients who'd survived near-death episodes this year were almost fifty percent more likely to die within ninety days than those with similar conditions in the past six years. The probability of such a significant increase in deaths occurring by chance alone is less than one in a trillion. That leads to only one possible explanation for this troubling epidemic."

"Murder," Mark said.

Barnes nodded. "The problem you faced after we met was identifying which of the cases were natural, or truly accidental, and which were homicides."

There were too many variables, too many possible suspects, and still no evidence, beyond statistics, that a crime had occurred. There wasn't enough yet to get Steve involved and, with him, the resources of the LAPD. That was why Mark had assigned Jesse the thankless and tedious job of going through hospital records. Mark was searching for any possible commonalities between the patients in an effort to sort out the natural and accidental deaths from the homicides.

Did the victims have the same medical insurance company? Go to the same hospitals? See the same doctors? Have their prescriptions filled by the same pharmacist? Share the same caregivers, nurses, or lab technicians?

Somewhere there was a point of convergence, but without more to go on, a way to narrow the field, it would take Mark months to find it. And in the meantime more people could be killed.

"Did you have any advice for me?" Mark asked Barnes. 

"I'm afraid this is out of my range of expertise," he said. "I'm not well versed in the intricacies of murder."

Emily tipped her head towards Mark. "He is."

C
HAPTER
E
IGHT

Now that Mark's instincts had been confirmed, he faced the daunting task of sifting through the forty-eight deaths, identifying the victims, and determining the pattern that would flush out the killer.

Again.

He was certain that he'd already accomplished the task once before. Now he just had to find a shortcut to reaching the same conclusions, whatever they were, all over again.

One of the two remaining doctors on Mark's list was Dr. Bernard Dalton, a cardiologist who had two patients who'd recently died and whose names showed up on Amanda's report. Dr. Dalton's office happened to be in the building next door, so Mark and Emily went over to see him.

Dalton worked out of the Bell Canyon Cardiology Group, presumably named for the exclusive gated community where most of the partners in the practice lived. The practice took up an entire floor of the building. The vast waiting room was lit by pinpoint halogens and was dominated by two large, flat-screen TVs mounted on the wall, one tuned to CNN, the other showing a computer-generated, and surprisingly lifelike, aquarium full of tropical fish. The patients sat on couches lined with pillows of varying sizes and patterns.

Most of the waiting patients were elderly and seemed, to Mark's experienced eye, to be suffering from more than cardiac problems. Many of them used walkers or canes and were accompanied by caregivers or younger family members.

Mark went to the front desk and presented himself to the nurse, who sent them right in, motioning them to the doctor's office at the end of the hall.

The comer office turned out to be a suite shared by five doctors, each of whom had his own built-in desk that faced a window with a view of John Muir Hospital across the street.

Dr. Dalton was the only doctor present when Mark and Emily came in. He was a large man who seemed well on his way to his own heart attack, his huge gut spilling over his belt.

The cardiologist rose from his seat, its springs squealing in relief from the burden of his tonnage, and vigorously shook hands with his guests. Mark explained his situation and asked the doctor if he would mind repeating whatever he'd said before.

"You asked me about Leila Pevney," Dalton said, dropping back into his seat, which let out a screech and seemed to sink a good six inches under his weight. "She was a seventy-eight-year-old woman with a long history of heart disease who also suffered from cancer and senility."

"You mean Alzheimer's?" Emily said.

"I mean she was forgetful, scatterbrained, and a little dazed. Some of it was from her chemo. The rest?" Dalton shrugged. "I referred her to a neurologist, but he determined she was simply suffering from old age."

"How did she die?" Mark asked.

"That's the really ironic thing. She was a fighter. Over the years she survived two heart attacks, quadruple bypass surgery, and two bouts of lung cancer. Then she died from a common cold."

"Colds aren't usually fatal," Emily said.

"They are when you take too many decongestants," Dr. Dalton said. "I found the cold medication on her nightstand. The pills were in a foil packet. I counted eight tablets missing. Whether she took them all at once or in close succession, I don't know."

It was obvious to Mark what had happened. Many cold medications contained pseudoephedrine, which is a stimulant. For someone with advanced cardiovascular disease, all it would take was as few as three or four pills to cause a rapid increase in heart rate and blood pressure, producing a deadly cardiac arrhythmia such as ventricular tachycardia or ventricular fibrillation. Death could occur in seconds.

"Didn't she know better than to take pseudoephedrine?" Mark said.

"Like I said, she was forgetful. She probably forgot how many pills she'd taken and when she took them," Dalton said. "All she knew was that her nose was still stuffy and her eyes were watery."

"What were the cold pills even doing in the house?" Emily asked. "That's like keeping rat poison where a child can reach it."

"I don't know. One of her kids or grandkids may have had the sniffles last time they visited and left the pills behind," Dalton said. "Maybe even one of her caregivers." 

"She had nursing help?" Mark said.

"Not full-time. They were drop-ins. Because she was living alone, they'd check up on her every day, make sure she was taking her pills, eating and drinking enough, that sort of thing. There was also a food service that stopped by three times a week with home-cooked meals she could stick in her freezer and defrost later."

"Who notified you of her death?"

"The caregiver. I found Leila sitting in her recliner in front of the TV, balls of used Kleenex all over the floor ground her. It was obvious to me what had happened, and the toxicology tests proved me correct."

Mark checked his notes. "Tell me about Chadwick Saxelid."

"Chad was thirty-seven years old and had a history of atherosclerosis and angina. The men in his family died young, and he was no exception. His gardener found him dead in the backyard, in his bathing suit, a few feet from the hot tub. The way I heard it, the cops found his nitro pills in the pocket of his bathrobe, which he was clutching when he died, and a couple of empty beer bottles by the hot tub. I'm not a detective, but it was pretty clear to me what happened." 

It was clear to Mark, too.

"Chad got in the hot tub and had a couple of beers," Mark said. "The hot water dilated his blood vessels and lowered his blood pressure."

"So did the beers," Emily added.

"The combination of the two lowered the supply of blood to his heart," Mark said. "Giving him a stabbing chest pain that he mistook for angina."

"But the pain wasn't from clogged arteries," Emily said. "It was actually the reverse."

"Chad didn't know that," Dalton said. "He took a nitro tablet and made everything worse."

"He might as well have shot himself in the chest," Emily said.

"The pill caused a massive drop in blood pressure, provoking a fatal myocardial infarction," Mark said.

"I can forgive the guy for mistaking the chest pain for angina," Emily said, "but he should have known better than to get into a hot tub and drink in the first place."

"Chad was young, single, and he liked to party," Dalton said. "He certainly isn't the first person to die because of it." 

"Some people are just too stupid to live," Emily said. 

"Chad was already living on borrowed time," Dalton said. "Less than a year earlier, he had a massive heart attack at a club. Turns out he'd taken some meth. He would have died, too, but the guy next to him happened to be an off-duty fireman who knew CPR."

There was something about the fates of Leila Pevney and Chadwick Saxelid that troubled Mark, but he couldn't figure out what it was. The two had several things in common besides being Dr. Dalton's patients: They both had coronary diseases, and their deaths, to some degree, were both the result of fatal reactions to drugs.

But that was a stretch, and neither of those similarities was what was nagging Mark. It was something else. He just couldn't identify it and couldn't think of what to ask Dr. Dalton that might bring it to light.

So he thanked Dr. Dalton for his time and he and Emily left.

Emily drove with the top down, wearing a baseball cap and sunglasses. Mark wore sunglasses but no hat. They were on the southbound San Diego Freeway going over the Sepulveda Pass, leaving the smog-choked San Fernando Valley and heading into the smog-choked Los Angeles Basin.

"You should be wearing a hat," Emily said.

"I don't mind the air," Mark said.

"It's not the air I'm worried about, it's the sun. Have you forgotten about that gash on your head? You're going to have an ugly scar if you don't wear sunscreen and a hat."

"If you're so worried," Mark said, "put up the top."

She glared at him. "What's the matter with you?"

"Besides losing Jesse and two years of my memory?"

"And me," she said. "I'd say ‘don't forget that,' but you already have."

Mark reached into the backseat, grabbed the baseball cap that was there, and put it snugly on his head.

"There," he said. "Happy now?"

They were silent for a long moment, making a point of not looking at each other. Finally, Emily sighed.

"I'm sorry. That wasn't fair," she said. "I shouldn't have said that."

"It's okay," Mark said. "You were right about the scar and about the way I am treating you. I'm being very selfish when, in fact, it's you who is suffering the most. My condition is a lot harder on you than it is for me."

"Why do you say that?"

"Because you remember everything," Mark said. "Your love hasn't dimmed a bit, and yet here I sit, treating you like a stranger. I feel awkwardness, but you feel heartbreak."