Richard Mabry: Diagnosis Death

She ran down her list of suspects once more. Nathan Godwin. Marcus Bell. Eric Burson. Frank Perrin. Natalie Gardner Cook. She could imagine motives for each of them. What about access?

Godwin could go anywhere in the hospital without question. Eric was a frequent visitor to the ICU. So was Marcus. Frank made calls to the hospital to take statements from accident victims-could some of those take him to the ICU? Natalie worked in the hospital.

Elena dropped her head to the desk. God, I don't know what to do.

There was no divine voice from the clouds, no lightning flash or burning bush. Instead, the answer came to her the way algebra had finally begun to make sense to her in high school. One minute it was a crazy, senseless exercise. The next, everything fell into place.

Now she knew who the killer was. Even better, she knew who the next victim would be, and when the attempt would take place.

She picked up the phone, found the number she wanted, and dialed it. "Hi, this is Elena Gardner. Listen, I need a big favor from you."

Elena stood in the closet and listened to the hospital sounds around her. The overhead paging system was silent at 2:00 a.m. The squeak of rubber soles and the occasional murmured conversation marked the passage of nurses on their rounds, accompanied at times by the clacking wheels of a medication cart.

Elena had taken the head nurse aside and asked her to avoid this room as much as possible. The nurse seemed puzzled, but at last she agreed.

This had to be the room. This had to be the patient. And, most important, if rumors spread throughout the hospital as rapidly as Elena thought, this had to be the night. It would happen on the 11:00 p.m. to 7:00 a.m. shift-the time when life was at its lowest ebb, for medical staff and patients alike.

Elena stretched, and listened to her bones creak. She'd stood here for three hours. How much longer could she-

The door opened. A dark form slipped into the room and pushed the door closed. The soft "whoosh" of the pneumatic closer ended with a sharp "click." The intruder crept further into the room. The beam of a pencil flash, softened by a finger over the lens, swept over the bed and picked out a form hidden under the covers.

The intruder pulled a cylindrical object from a pocket and flicked a plastic cover off the tip.

Elena stepped from the closet. "That's enough. Stop right there." Her hand found the light switch, and light flooded the room.

Glenna Dunn shielded her eyes with her hand, still holding the pencil flash. She put the syringe behind her like a child caught with a forbidden cookie. "Dr. Gardner, you surprised me. I came by to check on my husband."

"At 2:00 a. m?"

"I'm working a double shift in the ER tonight. I thought I'd slip up here on my break."

Elena closed the distance between them. "Great alibi, Glenna. Your husband stops breathing, and any number of people would say you were in the ER the whole time. Nobody pays any attention to the time you're gone on break, especially if things are busy down there."

"I don't know what you mean."

"By the way, you can put down that syringe of Anectine. Your husband was moved to another room earlier today. This-" She whisked back the covers. "This is Resusci-Annie, the mannequin I use for CPR classes. Makes a pretty realistic patient in the dark, doesn't she?"

Glenna lunged forward, the syringe held like a knife, the deadly needle poised to plunge into vulnerable tissue. Elena dodged back like a matador avoiding the horns of a charging bull.

This wasn't the way Elena pictured the scene. She'd confront Glenna, the nurse would break down crying, and Elena would call the police to take her. But apparently, Glenna had no intention of going quietly. If she could jab that needle into one of Elena's muscles and empty the contents of the syringe, paralysis would occur within a minute, giving Glenna plenty of time to get away. Since Elena wouldn't be able to breathe for five minutes or more, she'd die.

Elena locked Glenna's right wrist in both hands, fighting with all her might to keep that deadly point away. Glenna tried to scratch Elena's eyes with her free left hand. Elena dodged just in time.

Back and forth the battle raged. At last, Elena focused every ounce of strength she could muster, and began to bend Glenna's hand backward. Elena gave one final heave, and the needle jabbed into the base of Glenna's neck. Glenna strained to pull the syringe away, but only succeeded in pushing down on the plunger.

Elena pulled back in horror. Glenna stood for a moment, the syringe dangling from the needle still sunk into her neck.

Elena ripped the syringe away. "Glenna, breathe," she yelled. "Take some deep breaths while you can."

Glenna fell to the floor. It seemed that all her muscles contracted at once. Then she went limp as a rag doll.

Elena knelt at the woman's head, positioned her head to open her airway, and put her lips around Glenna's mouth. Elena gave three quick breaths. She didn't think she could do that for five or six more minutes. There had to be a better way.

Her eyes swept the room. There was a ventilator in the corner, left there when Glenna's husband was moved earlier in the day. But how to put it to use?

Elena bent and gave Glenna another four breaths. As she straightened, she saw the case she'd shoved under the bed when she put Resusci-Annie in place. It contained the laryngoscope and endotracheal tubes she'd used to teach advanced resuscitation techniques.

Elena pulled the case toward her and opened it, then turned away to breathe for Glenna once more. She had to hurry. Elena made a quick guess about the size tube needed. She pulled it from the case and snapped the laryngoscope open. The light didn't go on.

Breathe for Glenna again. Look back in the case and see the batteries lying free in one corner. Insert the batteries, open the laryngoscope, mutter a quick "thank-you" when the light came on.

Four more quick breaths. Elena inserted the laryngoscope, pulled upward to visualize the larynx. Hard to see the vocal cords. Try anyway. She shoved the tube into Glenna's throat. Two quick breaths into the tube with one hand on Glenna's chest. No movement. Move her hand downward, another couple of breaths. The stomach rose. Glenna produced a massive belch. The tube was in the esophagus-the swallowing tube- not the airway.

Elena removed the tube, gave Glenna three mouth-to-mouth breaths. One more try with the laryngoscope. This time she got a good view of the vocal cords, and slid the tube between them. Two quick breaths. The chest rose. She was in.

Elena scrambled to roll the ventilator close enough for the tubing to reach Glenna's endotracheal tube. She flipped the switch, adjusted the dial, and relaxed as the rhythmic "chuff, chuff" filled Glenna's lungs.

Elena sat back on her heels for a moment. Then she rose and reached across the bed to ring the call button.

"Yes?"

"This is Dr. Gardner. Please get hospital security up here stat. Then put in a call to the police. We're going to need them."

Elena stretched and yawned. She decided the police station in Dainger was nicer, both outside and in, than the sheriff' s office. On the other hand, the personnel were definitely less inclined to be friendly. Elena and Will sat in chairs apparently chosen with an eye toward cost rather than comfort. All things considered, she would have preferred bright lights and a rubber hose to four hours in these chairs.

Officer Hernandez, whom she now knew was actually Sergeant Hernandez, consulted his notes. "Doctor, you took a big chance trying to catch the perpetrator yourself. If you'd simply shared your suspicions with us, we could have investigated Mrs. Dunn and saved everyone some excitement."

Will leaned forward. "We've been through this twice now. My client appreciates the civics lesson, but we both know she's innocent. If Mrs. Dunn's actions didn't indicate her guilt, her voluntary confession afterward certainly buttons things up. What more do you want?"