Marker (35 page)

With the papers in one hand, Laurie reached for the phone again, but then hesitated with her hand on the receiver. She had it in her mind to call Roger for several reasons, not the least of which was feeling guilty about leaving him in the dark about what must have seemed strange behavior in his office. But she didn't know what she was going to say. She wasn't yet willing to tell him the whole truth for a number of reasons, but she knew she would have to say something. Ultimately, she decided she'd use the BRCA1

issue, as she'd already done.

Laurie picked up the phone and dialed Roger's direct line. What was really motivating her was her desire to take copies of the Queens materials over to him so she could talk with him directly about them. Despite the turmoil in her mind from her personal problems, she'd come up with an idea about the cases from Queens that might possibly solve the mystery of SADS.

FOURTEEN

WHEN LAURIE GOT OVER TO the Manhattan General Hospital, she was ushered directly into Roger's office, where he was waiting for her. The first thing he did was close the door. Then he gave her a sustained, silent hug. Laurie hugged him back, but not with equivalent ardor. On top of the residuals from the marriage flap, she knew she wasn't going to be entirely forthright with him about her own situation, and it made her feel self-conscious. If he noticed her restraint, he didn't mention it. After the embrace, he turned his two straight-backed chairs around to face each other just as he had done the day before. He had Laurie sit in one, and he took the other.

"I'm glad to see you," he said. "I missed you last night." He was leaning forward into her space with his hands clasped and his elbows on his knees. Laurie was close enough to smell his aftershave lotion. His day was just beginning. His fresh shirt still had the telltale creases from the laundry box.

"I'm glad to see you, too," Laurie said. She reached out and handed him the investigative reports and the death certificates on the six cases from Queens. She hadn't had time to make copies, but it didn't matter. She could just as easily download them again. By giving him the material, she hoped to deflect the conversation away from her mental state, at least for the moment. Besides, she was eager to tell him her idea.

Roger scanned the pages quickly. "My word! They do seem similar to ours, even to the extent of occurring at around the same time in the morning."

"That's my take. I'll know more details when I get the hospital charts. But for the sake of the discussion, let's assume they are mirror images. Does that suggest anything to you?"

Roger looked down at the papers, thought for a moment, and then shrugged. "It means the number of cases has doubled. We now have twelve cases, not six. No, we have thirteen, including the death last night. I assume you've heard about Clark Mulhausen. Are you going to be doing the autopsy?"

"No, Jack is doing it," Laurie said. She had told Roger a little about Jack during their five-week courtship, including the fact that she and Jack had been lovers. When Laurie had first met Roger, she had described herself as "mostly unattached." Later, when she and Roger had gotten to know each other better, she had admitted that she had used that particular description of herself because of unresolved issues with Jack. She had even gone to the extent of confiding that the problem involved Jack's reluctance to make a commitment. Roger had accepted the news with great equanimity, which had enhanced Laurie's estimation of his maturity and self-confidence, and the issue had never resurfaced.

"Look at the dates on the Queens cases," Laurie suggested.

Roger again glanced through the papers then looked up. "They were all in the late fall of last year. The last one was in the latter part of November."

"Exactly," Laurie said. "They were clumped pretty close together, at a frequency of slightly more than one a week. Then they stopped. Does that suggest anything to you?"

"I suppose, but it sounds like you have something specific in mind. Why don't you tell me?"

"Fair enough, but first listen! You and I are the only ones who suspect we might be dealing with a serial killer, but we've been effectively gagged. I can't get the OCME to take a stand on the manner of death, and you can't get the hospital authorities even to admit there's a problem. What we're fighting here is institutional inertia. Both bureaucracies would rather sweep the issue under the rug until something forces their hand."

"I can't argue with that."

"What's held us so effectively in check from your side is that your hospital has such a good mortality rate that these deaths aren't appearing on the radar. From my side, it is the failure of toxicology."

"They still haven't found anything remotely suspicious?"

Laurie shook her head. "And the chances they might in the near future just took a nosedive. I'm afraid our crotchety laboratory director discovered my undercover effort this morning. If I know him, from now on he'll make sure that any further work on our cases will go to the very back of the queue. And even when he does get around to them, he's surely not going to do anything special."

"So, where are you going with all this?"

"It means it's up to us alone to try to root out this possible serial killer, and we'd better do something if we're going to prevent any more senseless deaths."

"We've known that practically from day one."

"Yes, but up until now we have tried to work within the constraints of our institutions and our job descriptions. I think we have to try something else, and it seems to me these cases from Queens present an opportunity. If these deaths are homicides, my guess is that there is one serial killer, not two or more."

"I suppose I had assumed as much."

"Since Saint Francis is another AmeriCare institution you should have reasonable access to their personnel database. You're in the perfect position to get personnel information. What we need is a list of people, from janitors to anesthesiologists, who worked the eleven-to-seven shift at Saint Francis in the fall and Manhattan General in the winter. Once we have the list, then we could check the people out. This is where my idea gets a little fuzzy, but if we could come up with a couple of credible suspects, then maybe we'll be able to get the hospital or the OCME to take a stand."

A slight smile played across Roger's craggy face as he nodded. "An elegant ideal I'm glad I thought of it." He laughed and gave Laurie's thigh a playful pat. "You make it sound so simple. But that's okay. I think I should be able to cajole that kind of information out of someone, and wouldn't it be interesting if it really came to something? I mean, I wonder if there really will be such a list. I know another list that exists for sure, a list of the professional staff with admitting privileges at both institutions. I have direct access to it as chief of the medical staff."

"That might even be a better idea than mine," Laurie admitted. "If I were asked who I would consider the most likely suspect in the hospital community, I'd have to say a deranged doctor. It's passed through my mind that if these deaths are homicides, then whoever is responsible must have a significant knowledge of physiology, pharmacology, and maybe even forensics. Otherwise, we'd already know how he or she is pulling it off."

"And we both know which group of doctors is the most knowledgeable in those regards."

"Who?"

"Anesthesiologists."

Laurie nodded. It was true that anesthesiologists would be the most skillful at dispatching patients, yet despite her comments, she had trouble believing as a doctor herself that a doctor could be behind the killings. It seemed so contrary to a doctor's role, but then again, it was contrary to the role of all healthcare professionals. And, of course, there was the staggering case in England of a doctor suspected of murdering upwards of two hundred people.

"How about jumping on this idea," Laurie suggested. "I know it's Friday, and people are not excited about having a new task plopped in their laps just before the weekend.

But we have to do something, and we have to do it fast, and not only because it might prevent more deaths. It might be that our supposed serial killer is also smart enough to know that it would be safer for him to move to another hospital after a certain number of episodes. The assumption here is that he has moved once after six episodes, so there's reason to believe he could move again after seven. If he does, then our equivalent colleagues at some other hospital, maybe even in another city, will be starting from square one. That was one of the reasons that the other recent, infamous healthcare serial killer here in the metropolitan area wasn't caught for so long."

"Hey, Queens might not have been his first hospital."

"You're right," Laurie said with a shiver. "I never thought of that."

"I'll get right on it," Roger promised.

"I'm on call all weekend," Laurie said, "which means I'll probably be at the OCME, so call me there. Whatever I can do to help, I'd be happy to do. I know the whole process will be more difficult than I have suggested."

"We'll see. Maybe I'll be able to find a computer nerd in personnel who could help us." Roger aligned the pages Laurie had given him. "Now, I have something rather interesting to tell you about our cases. By chance, I've uncovered a curious commonality."

"Oh?" Laurie questioned. She was fascinated. "What is it?"

"Now, I don't mean to suggest that this is significant, but it holds for all seven cases, including Mulhausen last night. All of them were relatively recent AmeriCare subscribers, having joined the plan within the year. I actually discovered it by accident, looking at their subscriber numbers."

For a moment, Laurie stared at Roger, and Roger stared back. Laurie mulled over this new fact and tried to think how it could be connected. Nothing came to mind although it reminded her of Jack's comment the day before during the afternoon conference when he learned St. Francis, another AmeriCare institution, had seemingly had a similar series of deaths like hers. He'd said, "The plot thickens." She'd not had a chance to ask him what he had meant, nor did she follow up this morning when he'd said the new cases "cast a pall over AmeriCare," but now that Roger had told her this new fact, she was even more eager to ask him to explain. Laurie knew that Jack had a visceral hatred for AmeriCare, which colored his thinking, but still, he was smart and also intuitive.

"I really don't know if this is significant," Roger repeated. "But it is curious."

"Then it has to be significant in some form or fashion," Laurie said. "But I don't know how. These victims have all been young and healthy. AmeriCare actively recruits such customers. It's to their detriment to lose them."

"I know. It doesn't make sense, but I thought I should inform you anyway."

"I'm glad you did," Laurie said. She stood up. "Well, I've got to get back. The reason I'm not doing Mulhausen's autopsy is that I was supposed to go right up to my office and sign out McGillin and Morgan's deaths as being natural this very morning."

"Not so fast!" Roger said. He caught Laurie's arm and, with a little pressure, eased her back down into her seat. "You're not getting away that easy. But first, who's forcing you to sign out the cases as natural?"

"The deputy chief, Calvin Washington. He claims that the Chief, Harold Bingham, is getting pressure from the mayor's office."

Roger shook his head. He had a disgusted expression on his face. "I'm not surprised, considering what the hospital president said to me yesterday. He said that I should know for my own good that AmeriCare wants this problem to fade into the woodwork."

"That's hardly surprising. It would be a PR nightmare. But how does it come through the mayor's office?"

"I'm new to the organization, but I've gotten the sense that AmeriCare puts a lot of stock on being politically connected, as evidenced by them landing the city contract. I don't have to remind you that healthcare is big business, and there's always a lot of lobbying going on about a myriad of issues."

Laurie nodded as if she understood, but she didn't. "I'm going to sign them out as natural deaths, but I'm hoping with your help I'll be changing the certificates in the near future."

"Enough of this business talk," Roger said. "More important, how are you? I've been really concerned, and frankly, I've had to hold myself back from calling you every fifteen minutes."

"I'm sorry I've made you concerned," Laurie said as her mind frantically searched for a way to placate Roger without lying and without telling him the crux of the problem.

"But as I said yesterday, I'm holding my own. It's just a difficult time for me."

"I understand. I tried to imagine how I would feel if I had been told I had a marker for a gene that was associated with developing cancer and then allowed to walk out the door. The burgeoning field of medical genetics has to come up with a better way to present this kind of information to patients than they do now, along with some reasonable cures."

"As someone who's in the process of going through it, I'd have to agree, although the social worker did make an attempt. But American medicine has always been like that.

Technology has been the driving force, pulling the sociology of patient care behind."

"I wish I knew how to be more supportive for you."

"I'm afraid at the moment you really can't be. I'm caught up in my own personal odyssey. But that doesn't mean I'm not appreciative of your thoughts, and you have been supportive."

"What about tonight? Can we get together?"

Laurie peered into Roger's pale eyes. It bothered her that she wasn't being forthright, but she could not get herself to tell him she was pregnant and was having dinner with Jack because she and Jack had conceived a child. It wasn't that she thought he couldn't handle it, because she thought he could. It was more because of her sense of privacy, and until she told Jack, she didn't want to share it with anyone, even someone she cared for, such as Roger.

"We could have an early dinner," Roger urged. "We don't even have to talk about the BRCA issue if you don't want to. Maybe I'll already have some personnel data from here or Saint Francis. I mean, it's possible I could get some, even though, as you say, it's Friday."