The 5th Horseman (22 page)
Authors: James Patterson
Tags: #Fiction, #Thrillers, #General, #Suspense, #antique
I remembered the arrogance of the man who’d overseen the care of many of the deceased. The doctor who’d said, “Sometimes a bad wind blows.”
And I wondered for the hundredth time if Dennis Garza was one of those deranged and profligate killers, like Charles Cullen and Swango, that surgeon from Ohio, medical practitioners addicted to the power of snuffing out life.
I shifted in my chair, knocked over a half-full coffee container on the floor, watched the lazy brown pool seep around my Nikes. “Jeez, Lindsay. You expect to catch a killer.” Can’t even drink coffee.
I sopped up the spill with a piece of newspaper, threw the cup into the trash, thinking, The day is done.
Garza had gone to bed, and if I had any brains, I’d do the same.
I was zipping up my jacket when my cell phone rang again.
“Lieutenant?” a woman’s voice whispered. “It’s Noddie Wilkins. The nurse from Municipal? You told me to call you,” Noddie said. “Another patient has died. There were buttons—”
A sick feeling washed through me.
“When did this happen?”
“Just now.”
“What was the patient’s name?”
“Anthony Ruffio. His body’s still in the ICU.”
I started running toward the stairs, wondering how many patients had died in this hospital, how many had been found with caduceus buttons on their dead eyes.
But there was one difference this time.
I was in the hospital, and the killer was probably here, too.
Womans Murder Club 5 - The 5th Horseman
Chapter 95
I TOOK THE STAIRS to the ICU two fast steps at a time. A homicidal maniac might be roaming the hospital, and right now might be my best opportunity to tag him.
I badged the senior nurse at her station outside the ICU, and stayed in her face as she paged the ICU’s attending physician.
Dr. Daniel Wassel materialized moments later. He was a thin man in his thirties with a long, narrow nose and sleepy, red-rimmed eyes.
I identified myself, told him that I was doing an investigation and needed a list of everyone on the staff who was on the floor when a patient named Anthony Ruffio was checked into the ICU after surgery.
And I told him I wanted to see Ruffio’s body right now.
The doctor became alarmed, his sleepy eyes widening as he shook off his torpor. “I don’t understand, Lieutenant. Why is this patient’s death a police matter?”
“For now, I’m calling it a suspicious death.”
“You are so off base, I can’t believe it,” he said.
Dr. Wassel opened the sliding door to the darkened stall, flipped on the light switch. The fluorescent light flickered.
My eyes went right to the body.
I felt a shiver of apprehension as I peeled the sheet down from the dead man’s face.
Ruffio looked shocked that he’d been wrenched from life. His mouth was open, his skin pale, almost translucent.
There was dried blood around his nostrils and the sticky remains of tape in the corner of his mouth where the respirator tube had been.
Pulling the sheet down farther, I saw the shocking, fresh surgical incision, a stitched line from his sternum to his navel.
I covered Mr. Ruffio with the sheet right up to his hairline.
When I turned away, I saw a pair of caduceus buttons winking at me from the console beside the bed. I stood between the buttons and Dr. Wassel.
“For now, this room is off-limits to hospital personnel,” I said. “Someone from the crime lab will be here shortly, and as soon as they’re done, the ME will transport Mr. Ruffio to the city morgue.”
“I have to tell someone in authority here.”
“Go straight to the top, Doctor.”
I took latex gloves and a glassine envelope from my jacket pocket, scooped up the buttons before they could disappear. I phoned CSU and located a pair of night-duty criminalists, who said they’d be right over. And I called Jacobi. Got him out of bed.
While I waited for support to arrive, I mounted my own investigation. It was like gunning a motorboat across the chop in a squall-tossed sea.
I flashed my badge repeatedly, questioned harried, irritated doctors, nurses, aides, and orderlies, asking, “Where were you when Anthony Ruffio was admitted to Municipal?”
“Where were you when he died?”
During each interview, I looked for a gesture, a tone of voice, a “tell” that would light up the board and spell out killer.
I detected nothing of the kind, nothing at all.
Womans Murder Club 5 - The 5th Horseman
Chapter 96
DR. MARIE CALHOUN was the attending physician in the ER that night. She was in her early thirties with springy brunette curls, ragged cuticles, and an energy level I’d call manic.
We stood together behind a bank of nurses at the hub of the ER. Looking past me much of the time, speaking in a clipped, hurry-up manner, Dr. Calhoun tried to explain Anthony Ruffio’s death.
“Mr. Ruffio had been on a flight from Geneva by way of New York,” she said tersely. “It was a long flight, and his left leg was in a cast. He developed acute shortness of breath on the plane. As soon as it landed, he was rushed to the ER.”
“You saw him when he came in?”
“Yes. We did a lung scan. Turned out he had a big pulmonary embolus. We also did an ultrasound on the broken leg, found another big clot there.
“We gave him a blood thinner, an anticoagulant called heparin, to break up the clots; then we put him on a respirator in the ICU.
“Next thing I hear, he’s vomiting blood, excreting blood, and then he goes into shock.”
“What caused this to happen?”
“I didn’t know at the time. We rushed him into surgery, found out he was bleeding massively from a stomach ulcer. Because of the heparin, his blood was superthin. . . .”
The doctor shook her head, her curls swinging as she described what happened next, seemingly trying to get her own mind around the patient’s death.
“Bill Rosen,” she said. “A great surgeon. Tried like crazy to tie off the major vessel to the ulcer.
“We gave the patient a bunch of transfusions, but he was exsanguinating and we couldn’t keep up with him. He was already in severe respiratory distress, and everything just went all to hell in surgery.”
“Meaning?”
“We lost him on the table. Rosen brought him back. Stabilized him. Ruffio was in the ICU for about twenty minutes when he died.”
I was having a horrible sense of déjà vu. Keiko Castellano had received too much of a different blood thinner, streptokinase. It had caused her death.
“Forgive my ignorance, Doctor, but how often does heparin cause ‘superthin’ blood?”
She looked at me, her dark eyes going as hard as onyx.
“What in God’s name are you asking me?”
“Is it possible that Ruffio received too much heparin?”
“Anything’s possible. But there’s a more obvious cause of death, and that’s what’s going into my report,” Calhoun said emphatically. I could almost hear her teeth grinding.
“The man’s blood alcohol level was point two six when he came in. In medical terms, that’s blotto. He was definitely tippling on the plane. Maybe drinking is why he broke his leg on the slopes.”
“Sorry. I’m not making the connection.”
“Bleeding ulcers are common in alcoholics. He didn’t tell anyone about his ulcer,” Calhoun continued. “Maybe he was embarrassed that he was a drunk. There’s a reason for patient intake forms, and this is it.”
“So you’re saying it was death by omission.”
“Exactly! Now, are we finished?”
“Not quite,” I said.
A young man was brought into the ER on a gurney. I saw blood oozing from a gunshot wound to the leg, and the kid was screaming. I stepped in front of Calhoun before she could brush past me.
“Was Dr. Garza in the hospital when Ruffio was admitted?”
“I really don’t remember. I have no idea. Why don’t you ask him?”
“I will. Do you know about the buttons an orderly found on Ruffio’s eyes postmortem?”
“Buttons? I don’t know what you’re talking about, Lieutenant. But Anthony Ruffio didn’t die from buttons. His bleeding ulcer got him.”
Womans Murder Club 5 - The 5th Horseman
Chapter 97
THE NEXT MORNING, I sat inside my battered Explorer thinking about the long hours I’d just spent with CSU and Jacobi, mulling over Ruffio’s dead body.
Now I watched the light silver rain in my headlight beams as a pale sun rose over the skyline.
I pulled out of the parking lot onto Pine, still wondering if Ruffio’s death had happened as Calhoun had described it — a medical accident. Not the hospital’s fault.
I remembered the despair on Calhoun’s face when she said “superthin blood,” her expression as well as her words sticking with me.
I knew this for sure: no fewer than sixty hospital employees had been near Ruffio as he lay unconscious in the ICU, a respirator doing his breathing for him.
Someone could have injected Ruffio’s IV bag with an overdose of heparin before or after his surgery.
Garza could have done it before he left work for the evening.
But one piece of the puzzle troubled me.
How could Garza have put buttons on the dead man’s eyes?
Womans Murder Club 5 - The 5th Horseman
Chapter 98
CINDY WAS AT HER DESK in the City room at the Chronicle, fine-tuning her story, tweaking it again. She was on deadline, but still, she was glad when the phone rang and she saw the name on her caller ID.
She picked up the line, thinking, Great. Maybe we’ll grab a quick lunch.
“Cindy, what the hell?” Lindsay barked, almost shouted, over the phone. “I asked you please not to do a story on Garza and you agreed!”
“Linds, I had to do it,” Cindy said, keeping her voice low so that everyone in the world didn’t tune in. “My source at Municipal has told me that Garza is being questioned by the board—”
“That’s not proof of anything, Cindy.”
“Did you read the story? I wrote, and I quote, ‘Suspicion has fallen on ER chief Dr. Dennis Garza.’ Suspicion means speculation with foundation. Jeez, Lindsay. Last week the guy completely melted down in court. He warrants some ink of his own!”
“What if he’s guilty of more than malpractice? What if the spotlight you just threw on him drives him underground? What if he packs up and leaves San Francisco?”
“What do you mean ‘more than malpractice’?”
“I don’t know what I mean,” Lindsay said, her voice stiff with pique. “I’m working on it.”
“So am I,” Cindy said. “Look, you haven’t given me anything on this story. It’s mine. It’s been mine from the beginning. And it’s not right for you to come down on me for doing my job.”
A static, gray silence followed, Cindy feeling the seconds mount up, thinking a lot of things she didn’t want to say. But it all came down to this: Lindsay was leaning on her because of their friendship — and she was out of line, way out of line.
“Dozens of reporters are on this story, Lindsay! Whether I break the story or someone else does, Garza’s going to get press.”
Lindsay sighed in her ear, said, “I hoped I’d have more time.”
“Well, you were dreaming.”
Cool good-byes followed.
Cindy hung up the phone and looked down at her notepad. She read the words she’d just scribbled: guilty of more than malpractice.
Womans Murder Club 5 - The 5th Horseman
Chapter 99
MY ALL-NIGHTER at Municipal Hospital had left me bone weary and frustrated beyond belief. I tossed the morning paper into the trash can under my desk, pretty sure that Cindy’s next story would be about how people were being murdered at Municipal — and how the SFPD was doing nothing about it.
The time had come to abandon my off-the-books investigation and make “the brass button case” official before a very large sinkhole opened under the Hall of Justice.
I picked up the phone and called the chief, said, “Tony, I have to see you. It’s urgent.”
The Flower Market Cafe on Brannan and Sixth is near the onramp to 280 south and a few blocks from the Hall. Any other day I would have appreciated the cozy ambience of the eatery, its pretty tiled floor, dark wainscoting, and view of the flower-market stalls down the alley.
But not today.
Tracchio and I took one of the small, round tables and ordered sandwiches.
“Start talking, Boxer,” he said.
I found that I was relieved to tell him every bit of it — about Yuki’s mom, the buttoned-up eyes of thirty-three dead patients, the rumors, the statistics, and the malpractice trial against Municipal Hospital to date.
I also told him about Garza’s stinking track record at various hospitals around the country, concluding with a report of Jacobi’s surveillance and our off-duty interrogations last night after a patient had died.
“Ruffio’s body was in the ICU waiting to be moved to the hospital morgue,” I said, “when someone put brass buttons on his eyes.”
“Humph,” the chief grunted.
“Garza left the hospital at six p.m. The patient died at just after eight,” I told him, “but I can’t say for sure that Garza wasn’t involved.”
“If Garza wasn’t there, how do you figure he had anything to do with it?”
“He has access to any place in the hospital. Maybe he overdosed the patient before he quit work for the day and it took a few hours for the medication to work.
“Maybe he has an accomplice, or maybe he’s not our guy at all,” I admitted. “But, Christ, Tony, Garza could be a world-class monster! I think he probably is. At the very least, we’ve got to play ‘beat the press.’ The Chronicle put him on page three this morning.”
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