Peter Clement - The Inquisitor

He removed a pair of coffee mugs from their hooks on the underside of the cupboard and poured them each a cup from the the old-fashioned percolator she'd brought from her mother's kitchen in Grand Forks. "How?"

"I don't know. Point out that the patient would have died anyway?"

As they sat down to breakfast, continuing to share ideas about ways to protect Earl Garnet, Jane observed how Thomas appeared to be making himself at home. Her concerns about his coming here vanished, and she felt silly over having been worried in the first place. Like a friggin' schoolgirl, she chided herself again, happy to be in love.

But they came up blank again as far as a remedy for Dr. G.'s problem.

When she'd arrived fresh out of nursing school, Earl Garnet had told Jane on her first shift with him that she had the nerve and steady hands to be a great ER nurse. Tough as she'd found her rookie year, those words had kept her going. She sensed his pride in her, and under his protective wing Emergency eventually became a place where she felt not only fully confident but also as if she'd found her forte in life, that one special, exciting, worthwhile pursuit where she could excel over all else. So she'd come to care about him as much as she would her own father, were he still alive. "You can't think of anything we can do for him?" she asked, watching Thomas dig enthusiastically into the breakfast she'd prepared. The sight pleased her. "How about the fact there've been other patients without DNR orders who arrested in Palliative Care?"

He paused, his fork halfway to his mouth. "How do you mean?"

"It's not the first time the arrest team's been called up there during night shift."

"So?"

"So maybe this patient's death that Yablonsky is trying to blame on Dr. G. is simply part of the normal pattern."

"Pattern?"

"Yeah. That sometimes people die before they're expected to. And come to think of it, haven't there been more codes than usual up there lately?"

"I don't know. I haven't counted," said Thomas.

"Just seems to me there has."

"How can you tell? With this crazy backup system we have, I'm chasing all over the hospital some nights. All the R-threes do- whenever a junior resident gets scared and feels out of his or her depth."

"I know. But a run up there with the cart, even when I don't go myself- that's the kind of thing you notice. Every time it happens, I groan and wonder which doctor it was who didn't have the guts to discuss DNR orders with whoever the luckless patient is. Know what I mean?"

Thomas nodded, his fork remaining in midair. "Yeah… Maybe there is something I can do after all."

"What?"

His bearded face broke into that easy grin of his. "I can't tell you yet, not until I check something out." He gave her a mischievous wink and took another mouthful.

"Thomas!" She put down her utensils, having barely touched her own food. "Quit being so mysterious." His teasing ways had attracted her from the beginning as well. He had the confident air of a man with an inside track on how life worked, and in particular he possessed a knack for rooting out the juicier aspects of hospital life. She slid off her stool onto his lap, allowing her robe to fall open. "Now you 'fess up what you know," she said, slipping her arms around his neck.

"I'm not being mysterious." He gave her another wink. "Just careful. The last thing Dr. Garnet needs right now is more rumors."

"Rumors about what?"

"Palliative Care."

"You've heard something about Palliative Care?" She felt a guilty pleasure discovering the indiscretions of others at work. Who had slept with whom, which doctors or nurses screwed up, and even the occasional big-time crimes, such as sexual abuse or fraud. While the revelations appalled her, they kindled a smug confidence that she'd never make such a mess of her own life. She also felt flattered that Thomas trusted her enough to share in such unspeakable tidbits.

He reached around her, took a slice of bread, folded it in half, and proceeded to mop up the remains of onions, green peppers, and ham on his plate. "Not heard. Seen." He took a mouthful and chewed it carefully, all the while smiling at her. It was clear he knew full well he had her curiosity at the boiling point.

"Thomas!"

"Okay, okay. I don't know if you're right about the number of codes being up, but this morning isn't the first time I've been called up there to try to resuscitate someone found dead in bed. How about you?"

She shrugged. "Sometimes, I guess. But since I'm not always the one who goes, it could be happening more often. Why?"

"I want to check the records, but it seems to me that during the night shift, most codes on that ward have been around dawn, like this morning's. That means they discovered the bodies as they made their final rounds before the end of shift. Maybe Yablonsky's so hot to blame this death on Garnet because her nurses aren't keeping a close enough eye on the patients overnight."

"You're saying-"

He silenced her with a finger to her lips as he wolfed down his last bite, then slipped both hands gently inside her robe and began to caress her hips. Eyes sparkling and full of mischief, he glanced up to see if she approved.

She replied with a soft kiss.

"You could be right about this woman's death being part of a bigger pattern," he continued, speaking quietly while sliding the palms of his hands up her back, "one that has more to do with inadequate nursing surveillance than anything Dr. Garnet did."

"Now that is useful," she said, kissing him again, but not so gently this time.

"When did you give her the first ten-milligram dose of morphine?" Earl asked Monica Yablonsky, gesturing to the sheeted body that still remained on the bed. He'd insisted she accompany him into Elizabeth Matthews's room, as if the dead woman's presence might hold the nurse more accountable. Peter Wyatt had gone down to the labs, worried that the weekend technicians might not grant the determination of a blood morphine level on a corpse the priority he thought it deserved.

"An hour after the midazolam," she replied, "as you ordered."

"I ordered it to be administered the moment the midazolam started to wear off, which would have been approximately an hour later."

Monica Yablonsky wearily brought her gloved hands to her head and massaged her temples, theoretically contaminating herself, depending where the gloves had touched before coming in the room. Earl said nothing- that kind of unthinking gesture happening all over the hospital a hundred times a day- but some part of his brain registered that the battle to rid St. Paul's of SARS might already be a lost cause.

"That's what I meant," she said. "Mrs. Matthews received the morphine when she started to wake up."

"Yet the medication sheet lists the time as nine p.m. exactly. Mighty punctual of the lady, starting to rouse herself exactly on the hour."

"Are you insinuating-"

"I'm insisting you level with me about every detail of what happened here last night, down to the minute. Now when did you observe her coming around before administering the morphine?"

She drew her lips into a thin line and let out a long breath, making clear her exasperation. "Probably more like nine-ten."

"And afterward?"

"What do you mean?"

"Did you check on her?"

"Yes! Repeatedly. The larger dose worried me. And since you'd sent her husband home, I kept a close eye on her myself." Her disapproval of his having removed Mr. Matthews from the scene, thereby making it necessary for her to increase her own vigilance, hung heavily in the air.

"And?"

"She remained stable."

"Vitals and respiration normal?"

"Yes, as written on the patient's chart."

Check night nursing notes on any floor and the majority will have respirations listed as sixteen a minute, the average rate for adults who are awake, even though most people slow their breathing to twelve when they're asleep. The reason? A lot of caregivers, including doctors, never bother to count the actual number as long as they can eyeball that a person appears to be moving air in and out with no difficulty. "It says sixteen every time," Earl said, lowering his voice to a whisper. "How do you explain that?"