Peter Clement - The Inquisitor

His sister, Madelaine Hurst, director and chief of all things to do with nursing at St. Paul's, occupied the place at his right side. No surprise there. She always took that position, either oblivious of or indifferent to its symbolic right-hand-man implication. An asthenic woman with austere gray eyes, and known to protect her domain as fiercely as her brother defended the hospital, she clamped her steel gaze on Earl. It felt cold and hard as shackles.

Next to her sat Mrs. Quint, seemingly relaxed, her expression a thousandfold more congenial than her boss's. Earlier she'd even wished Earl good morning. But her corpulent figure exuded an air of authority, and as acting supervisor at the time of the incident, she'd be defending her "girls" just as vigorously as Madelaine

Hurst would.

The most openly hostile pair, Peter Wyatt and Monica Yablonsky, glared at him in unison from the far end of the table. Having placed themselves near the large, wall-mounted video screen that would be used for the upcoming presentation, they'd picked the prime spot to make sure everyone else would witness their show of disapproval.

Predictable, Earl thought.

Stewart Deloram, however, surprised him. He'd positioned himself at Paul Hurst's left elbow and, with surprising charm, cozied up to him from the minute they sat down together, chatting breezily while studiously avoiding eye contact with Earl.

Now what could that be all about?

Len Gardner, habitually occupying the oversized chair at the other end of the table, rose to his feet. "We might as well begin," he said, and with a touch of a finger to his laptop computer, the wall-mounted screen sprang to life. A swirl of pink lines and blue dots appeared, the primal color scheme pathologists use when staining body tissues so that they will be visible under a microscope. This particular pattern, wavy mauve strands reminiscent of a van Gogh, were woven beneath an array of tiny purple dots worthy of a Monet. Together they depicted normal uterine muscle lined with disintegrated mucosa.

Len clicked through a series of such images- the strands of muscle and sheets of mucosa appearing successively more shredded- to document the tumor's relentless progress. "Invasion by increments," he described it, "destroying Elizabeth Matthews's reproductive system cell by cell."

Earl recalled the ghastly distortions on the woman's wan face as she'd endured what they were seeing.

As the demonstration continued, Stewart occasionally whispered something in Hurst's ear and pointed to the screen, seemingly adding his own spin to the narrative. He still hadn't looked in Earl's direction.

Len moved on to pictures that confirmed the cancer hadn't yet disseminated throughout the rest of her body, flicking through shots of the other vital organs and showing them to be free of any metastatic spread. "Certainly her neoplasm had not reached a stage such that it would be incompatible with life," he emphasized.

Laying down his laser pointer, he removed the tumor from its container and, sticking here and there with a steel stylet as long as a knitting needle, demonstrated in macroscopic terms the assault on Elizabeth Matthews's womb.

"Any questions?" he asked when finished.

No takers.

Earl often worried how voyeuristic and sicko these sessions would seem to the outsider. Yet they remained at the heart of learning medicine, exposing the profession's victories and errors with a certainty that no other part of the discipline could provide. Should they ever suffer the ax of public outrage because the media exposed them to lay scrutiny, doctors wouldn't be flying blind, but it would be as if they'd lost an eye.

Len gestured to Stewart. "Dr. Deloram has volunteered to present and interpret the biochemistry of the case, including the postmortem drug screens."

"Thanks, Len." Stewart stood up, and with a click of a remote, a slide projector mounted on a steel table began to whir noisily. A few more clicks, and its carousel advanced with a loud rattle. Pushing another button, he caused a movie screen to descend from the ceiling and come to a stop above the video monitor.

It's a wonder he didn't play the theme from 2001, Earl thought.

Enlarged charts of lab values sprang into focus on the white surface.

"As you can see, aside from a raised calcium level, the result of the tumor having eaten into the bones of her pelvis," Stewart began, "the hematological and biochemical values remained mostly normal until the time of death. In other words, as Dr. Gardner has so elegantly demonstrated, multiple organ failure had not yet become part of the picture." More numbers flicked by. "Specifically, I draw your attention to the patient's normal liver and kidney function, since this will have a bearing on our ruling about the cause of death." He turned to address the nurses. "You no doubt recall that morphine is broken down in the liver and excreted in the kidney. After looking at these standard values, a physician might reasonably conclude the patient ought to have been able to metabolize a dosage increase of the magnitude Dr. Garnet ordered, especially since previously prescribed amounts of the narcotic hadn't treated the woman's pain."

He paused and cast a glance at each of the women, eyebrows raised like a mime telegraphing that he expected a response.

Mrs. Quint gave a reluctant nod of agreement.

Madelaine Hurst simply stared back at him, unwilling to yield up so much as a blink.

Monica Yablonsky had the startled look of deer blinded by a poacher's light. She started to fidget with her glasses.

Attaboy, Stewart, Earl thought. So far so good.

"And I take it that all present are aware of the sequence of events leading up to this woman's demise," Stewart continued, "Dr. Garnet's doubling of her morphine dose, the times that the nurses administrated it, and the patient's vital signs throughout?"

Nobody indicated otherwise.

"Fine. Now while a lethal level of morphine undoubtedly killed this woman, the source of that toxic concentration is not at all clear."

What?

"The amount present in her blood at the time of death might indicate that approximately double the amount Dr. Garnet prescribed may have been administered to the patient, but this explanation isn't that certain."

Wait a minute. What's this "not all that clear" and "isn't that certain" crap?

"A fall in blood pressure could have resulted in a delayed uptake of the first injection that had been given around nine that evening. Later, should the pressure recover and the uptake of the drug into the patient's bloodstream return to normal, both the remnants of that shot and the entirety of the second dose would enter the circulation simultaneously, leading to the toxic levels that killed her."

No! Wrong! Wrong! Wrong!

"Even though the nursing records indicate no such fluctuations in her vitals," Stewart continued in a fluid, singsong delivery more appropriate to a travelogue than a death review, "they might have come and gone undetected. And to reiterate Dr. Gardner's findings that the woman's cancer, while undoubtedly painful, had not yet brought her near death, it's a known fact that morphine itself can drop a patient's blood pressure. So we are left with two possible scenarios: either someone doubled the second injection, or undetected fluctuations in blood pressure led to a delay in the absorption of the first, leading to an accumulation of the two shots."

Earl leapt to his feet. "What the hell are you talking about?"

Stewart sat down and studied the table between them.

"That's garbage, Stewart, and you know it."

Stewart said nothing, still avoiding eye contact, but Earl saw the black of his pupils grow wider.

Like a variation on Pinocchio's nose, the lying son of a bitch. "Why are you doing this, Stewart?"