Death Rounds (42 page)

“Except they wouldn’t destroy the spoils of their victory,” I said without thinking. The realization had just popped out, unbidden, almost before I’d known the thought was in my head. Riley and Williams were looking at me sideways, puzzled expressions on their faces. I quickly explained. “Hurst and his friends would want UH left intact so they could dominate it.”

“Maybe not,” Williams countered. “At least not if they didn’t want to share the half billion.”

Riley and I both looked sideways at him.

He explained while all of us kept up the brisk pace, “Some hospital mergers I’ve witnessed actually abandon one of the two institutions and create a single superhospital. If UH crumbles, then St. Paul’s becomes the biggest show in town. How far would your board. Hurst, and guys like Rossit go to win that kind of prize?”

By the time we finished chewing over that possibility, we’d reached the third floor by elevator and were in the corridor passing some windows overlooking the grounds. Williams rushed on ahead toward the nearest ward, but Riley paused to look outside and I paused with him. I could see human forms reflecting the unmistakable glint of badges. Here and there police officers wandered into lighted areas where the amber glow of sodium lamps illuminated the little white plumes of their frosty breath. For about a second these wisps would drift along before dissipating and blending in with the haze of gray fog that filled the night. Farther back in the darker areas under the trees I caught the reflected glimmers of blue and red above the occasional gleam of white paint, the pattern repeating itself over and over— police cars.

Standing there, I found myself wondering if the Phantom was again out there somewhere, beyond the circles of police, past the mist, gloating once more over the impact of his work on the hospital. But was it Cam, forced out in the open, the advantage of his invisibility ripped away? Or was it Rossit, as an agent for Hurst and his board, executing the takeover that Williams had suggested? Or was it someone else, as Janet thought, who still evaded me, the master controller, his invisibility assured because he’d just offered us Cam as a scapegoat...with my help.

* * * *

Williams and I had no method as we attempted to calm people and keep everyone rational. We simply made it up as we ran from floor to floor, pleading the same arguments we’d used on the fly earlier in the auditorium and at St. Paul’s last week, coaxing, cajoling, intimidating, and when that didn’t work, we called the cops. We tried to teach a few of the clinical chiefs the things to say, hoping they’d exert some leadership, but they were too rattled themselves to be of much use. They stared at me blankly as I implored, “For God’s sake get a grip. If we don’t settle people down, someone’s going to bolt and inadvertently carry that organism out of here. At least help us get everyone cultured.”

Armed with a specific task, these “leaders” seemed to collect their wits enough to get working, but I found myself fuming at them for their feeble performance. It was clear the kind of weak leadership Fosse had encouraged.

Everywhere Williams and I went, we initially met panic, defiance, and anger—what we’d seen in the auditorium but tenfold. Physical scuffles broke out as some nurses tried to storm out of their wards. Orderlies had to restrain their own colleagues. Hallway shouting matches woke up the patients who soon learned enough fragments of what was happening to become panicky themselves. Fosse at least had had the foresight to cut off outgoing phone lines. But then the already explosive mood was fueled by outraged men and women screaming that they’d been foiled in their attempt to contact families, lawyers, and even the media.

The dynamo that came to the fore in the crisis was Harold Miller. He was everywhere, leading his small army of technicians into each and every ward, starting them off collecting cultures, then demonstrating the technique as he got the rest of the staff screening one another and the patients. Culturing and plating throughout the night, he was always explaining what he was doing, was always reassuring his subjects, and was forever offering little courtesies. More than once I saw him help people tie their masks back on or provide them with a fresh one instead. He, more than anyone, got us through the culturing that had to be done during those early hours.

The worst was rounding up the punishers. Some who were too frightened to resist stepped forward and begged our protection. Others were turned over to us.

“Looks good on you, Rachel!” a rather grandmotherly looking nurse screamed at a frightened and much skinnier, younger colleague who was being led away.

“You goddamned bitch, I’ll get you for this!” Rachel screamed back. The rest of the nurses on the ward and some patients who’d been wakened by the ruckus promptly booed and hissed Rachel as she was paraded off the floor. It was certainly rough justice, and probably a few innocents were rounded up with the guilty. I winced when it occurred to me how many lawyers would be employed indefinitely sorting out what we were doing tonight.

At one point during the evening I was asked to see three nurses who had complained of flulike symptoms, but on examining them, I found that none had a postural drop in blood pressure or the biochemical changes consistent with a
Legionella
prodrome, and none of them had findings suggestive of a staph infection. They asked about antibiotics, and I told them, “Medically it’s not indicated. But if you think you might be a target of the person making these threats...” I let the suggestion hang there.

When they vehemently denied they were “like that,” I assured them again that they needed no medication, but the encounter reminded me to take the second capsule of my own prescription.

Through all of this, I kept racing back to ICU where I’d look up Janet’s latest vitals on her chart and would check with the nurses that they’d seen no sign of her cough turning purulent. Despite there being no change in her condition and the guard at her door reporting that no one had tried to approach her, I’d run back to the floors haunted by my own proviso—
it’s early yet.

By 4:00
A
.
M
. an eerie lull had settled over the hospital. Eventually, again paralleling what had happened in the auditorium, most people had settled down, started cooperating, and wanted to do what was best for themselves and their families. Culturing was mostly complete. About seventy people were under special protection. Apart from some individuals who tried to get by the guards, and a few who actually made it to the grounds before they were stopped by the police, the quarantine was intact.

To say we couldn’t have hoped for better was true, but it was more an admission of how precarious the best we could hope for was. With the morning shift due to arrive within three hours unless we diverted them elsewhere, we all knew we were teetering toward worse.

I paused in front of the same window Riley and I had looked out of a few hours ago. The fog was thicker now, but I could still distinguish the shapes of police officers on patrol. The area under the trees, however, where I’d caught glimpses of their cars before, was so thick with shrouds of gray that not even the overhead sodium lamps could penetrate the gloom. Yet I could tell something new was happening out there. Through the panes of glass in front of me the persistent guttural growl of diesel engines made itself heard— the kind of noise I’d have expected from heavy equipment at a construction site.

The National Guard was moving into position.

Chapter 20

Fifteen minutes later Williams reached me by phone. “The ID guys have found something,” he said curtly. “They’re in archives.”

When I walked in the door of that familiar room, I saw a half dozen men and women standing with Williams in front of three tables that had charts spread over them. A tall gray-headed man was directing his comments mainly at Williams. While he spoke, a few of his colleagues were sipping from coffee mugs, having untied the bottom of their masks so that they could lift them up each time they drank. A large silver thermos sat on one of the tables in their midst. The aroma of the fresh brew was tantalizing, but no one offered me any.

Riley stood off to one side, and if the way he was giving the ties to his mask a good stretch test was any indication, he was obviously unhappy. When he saw me enter, he walked over and whispered, “These guys mean well, but frankly, between you and me I don’t think they’ll find squat. They’re too…too…well, doctorish. They’re looking for medical inconsistencies, not murder.”

I held a finger up to my lips, signing he should keep quiet, and focused on what was being said.

“...Dr. Mackie had left out a few hundred charts sorted into different piles,” the elder physician was explaining to Williams, gesturing to the tables.

“A few hundred!” exclaimed Williams. His frown shot into previously unfurrowed territory.

“We figured he couldn’t have gathered so many without help, so we called the clerks who work here.”

Behind me on a table was a phone that had a yellow
Buffalo P.D.
sticker on it. I thought about how much more comfortable I would have felt if I’d had that with me when I was here the other night.

“…They told us Dr. Mackie had stormed in around six
P
.
M
., catching them just as they were leaving for the day. He had with him records from our own Infection Control Committee and had marked on them three lists of charts which he insisted the clerks pull. We discovered the first list was for the charts of patients who’d been screened after being exposed to Phyllis Sanders in the ten days before she became ill. He’d then sorted those into piles arranged according to which patients she’d cared for on the last day before she left on vacation, on the second to the last day, the third last, and so on. The second list was, we found, for the charts of patients exposed to Brown during the ten days preceding her
Legionella
infection. He’d arranged them the same way and repeated the procedure with the charts of patients who were exposed to the OR nurse prior to her pneumonia. Remember, these two nurses had also left on vacation a few days before their illnesses.”

“That’s interesting,” said Williams. “How did you guys see all that?”

The older man reached for a chart on a nearby pile, flipped it open to some blue-colored pages, and pointed. “We found the pattern by looking at entries in the nurses’ notes for each file. But that’s all we got.” He handed the chart to Williams and continued, “What I hoped to see was a single nursing act that Sanders and the two others had each performed during the days when they would have been exposed to
Legionella.
I thought perhaps we’d find they were infected during a specific procedure. Unfortunately, all the nursing procedures listed in these charts were routine—dressing changes, monitoring vital signs, administering medications—and nothing stood out. Cam must have been after something else.”

Williams flipped through a few pages, then closed the file and handed it back. “Then we’ll keep looking through these for that something else,” he said. “I’ll stay and help you.”

There was a murmur of appreciation from the others sitting around the room. One of the women in the group stepped up to Williams. “Is it true that Dr. Mackie’s a suspect...” At that point her voice lowered beyond what I could hear.

When I turned to look at Riley I could see he was anything but pleased with the results he’d just heard. He leaned over to me, his eyes wide with alarm. “You see. Doc! They found nothing, just like I told you. You’ve got to get me more than this, and I mean now, or your Phantom’s going to get his chance to deal out another round of infections like he threatened.” He sounded both frustrated and more than a little desperate. “Why aren’t
you
checking out some of the other places Dr. Popovitch visited?”

I knew exactly where I’d start.

* * * *

“Mr. Fosse, what got Cam Mackie off the hook two years ago when he was suspected of being the Phantom?” I asked. We were in his office. I’d dropped by to advise him I’d be working just outside his door, revisiting the vault where confidential minutes were kept, then going into the human resources department. I’d thought it wise to let him know I was there, not that he heard noises and figured the Phantom was back. Before leaving I’d decided to ask about Cam.

“Two things, really,” Fosse answered, leaning back in his chair, “though one raised a few eyebrows. The whisperings about him started to pretty well die down when an attack occurred while he was lecturing out of town. What made people suspicious again was that there was another attack two weeks later, also on a day he was away. That caused a few nasty comments about the timing of the two occurrences being a bit too convenient for him. But the gossip ultimately ended when, after those two episodes, the events stopped entirely. Everyone eventually assumed the Phantom business was over and put it behind them.”

“Was anyone else a suspect at the time?”

“No,” Fosse answered with a shake of his head.

At that moment his phone rang. He was soon engaged in a conversation about the plans to receive the day shift at a number of outside facilities, and I stood up to leave while he was ticking off his orders.

“...have our eighty supervisors each call twenty of their people at home from lines that are still open in administration. Tell them that there’s been a threat but the situation’s under control, and then direct them to where they’re to report. I’m expecting all my chiefs momentarily, to further discuss strategy for the people here...”

That was one group I didn’t want to get stuck with again, I thought as I scurried out the door.

* * * *

The vault full of confidential minutes now had a strip of yellow police tape across it, making it necessary that I have both a security guard and one of Riley’s men get me through the door. Once in, I retrieved the volumes containing the minutes of Cam’s Infection Control Committee. They were, as I expected them to be, in their proper place on the shelf, since Cam would hardly need to look up records of his own meetings.