Peter Clement - Mortal Remains

“The whole planet’s gone wireless, and I can’t talk to a soul,” he muttered, waiting for an operator to get him the man’s home number.

This time he got through.

“Roper.”

“Mark, it’s Earl Garnet. I’ve got news.”

“I hope it’s better than mine. But you first.”

Earl told him all about Bessie McDonald, including the possibility that a few weeks after Kelly’s disappearance his father might have pulled her chart along with that of the man who’d died of digoxin toxicity. As he talked, he heard an annoying series of clicks on the line. Probably the result of a poor connection, he thought, ignoring them.

10:30 A.M.

Hampton Junction

Mark could tell a lot about a medical resident’s skill after observing the person handle a single patient.

Watching Lucy O’Connor, he waited until a half dozen of his regulars had passed through her hands before he admitted she practiced medicine as well as he’d first thought, she was that good. Most trainees managed a small number of people while he saw to the bulk of the visits, the entire process made much longer by his need to review and sometimes revise what they did. So far Lucy had seen all the morning appointments by herself, doing it as efficiently and thoroughly as he normally would. On checking her work, he found himself discussing cases with her on the level of a colleague, and she referred to recent journal articles with ease. What impressed him most was how, while drawing on an academic knowledge base that he considered awesome, she kept her therapeutic decisions practical and her recommendations for referrals or tests tailored to what they had available in the sticks.

And the local vote was unanimous.

“I like her!”

“She’s wonderful.”

“Not like those other ‘kids’ they usually send you.”

So he sat at his desk with time on his hands while Lucy worked the examining room. Besides using the opportunity to arrange for a loaner Jeep with his insurance company and make a stab at the piles of unopened mail, he kept trying to make sense of everything Earl had told him.

That his father had gone after those same two charts didn’t surprise him. After all, it was evident from Kelly’s file he’d had an interest in them. What that interest had been, he still hadn’t a clue.

The coincidence of Bessie McDonald slipping into a coma the night after Kelly’s body was identified – that left him incredulous. He couldn’t help but speculate how someone could have arranged for her to convulse herself into the far side of oblivion. As ideas popped into his head, he grabbed a pencil and started to jot a few down.

Strychnine?

Convulsions were a hallmark of its lethal effects. Not only would it be detected on testing but also would leave a telltale rictus grin on the victim’s face. Not much of a choice if the “relapse” were to be taken as natural.

What about something that caused seizures but wasn’t normally thought of as a poison? There were a lot of medications with convulsions as a side effect that wouldn’t initially be thought of as an agent to test for, as long as no one suspected unnatural causes. Lidocaine, the antiarrhythmic and lo-cal anesthetic, for instance, could cause prolonged seizures if given intravenously in large enough doses. But it or other drugs wouldn’t be so likely to escape notice in a forensic investigation. After all, a suspicious toxicologist could think up just as many agents as any poisoner when it came to screening for the pharmacology of deliberately induced status epilepticus. Would Chaz, for instance, have been reckless enough to assume no one would consider the woman’s coma to be the result of foul play?

Maybe… or maybe not.

Mark grabbed his copy of Harrison’s Principles of Internal Medicine off his bookshelf and opened it to the section on seizures. Finding a table listing their causes, he considered other possibilities.

Trauma – too obvious.

Alcohol – too messy.

Recreational drugs – too obvious and messy.

Metabolic disturbances: Hypocalcemia; hypomagnesemia; hyponatremia – now here was something.

Some of these could be induced by medication, but persist after the offending pills were discontinued.

Take severe hyponatremia, a low sodium level in the blood, as an example. It could be brought on in susceptible individuals by certain diuretics, even at normal dose levels.

But that couldn’t be the case here. It would have taken days, maybe weeks to make it happen, not twenty-four hours. Unless Chaz, or someone, hadn’t waited for the police to confirm Kelly’s identity before making his move against Bessie. After all, he knew what the result would be, and it made sense to act ahead of time – no, that didn’t work either. The blood tests they’d done on Bessie the morning they found her would have revealed the drop in sodium.

Of course, there was the possibility of induced hypoglycemia. A shot of short-acting insulin could start a nondiabetic’s blood sugar heading downward in less than an hour, the maximum effect occurring within five to six hours. Since the nurses hadn’t been able to pin down the precise time of the seizure, the insulin could have been wearing off after they found her, and the intravenous dextrose she received would have masked any lingering effects. As for the time sequence, she would have had to receive the injection before midnight. Chaz could easily have concocted a reason to be in the hospital at that hour, though he’d have been taking a chance slipping into her room himself. So maybe he’d arranged for someone else to do his dirty work – He threw down his pencil and crumpled up his notes. Listen to me, he thought. Last night’s attack had him so chomping at the bit to nail Chaz, he was becoming obsessed with the man, dreaming up ludicrously wild scenarios about him.

For the hundredth time he eyed the phone, willing Dan to call with word on what he’d found at the wreck and whether he’d talked with Braden. Phoning the sheriff himself wasn’t exactly an option, having already bugged him so many times Dan had told him to back off.

He returned to opening his mail, trying to keep his mind off it all.

A few envelopes down the pile he found the letter from the Dean’s Office with Lucy O’Connor’s records and an accompanying letter explaining the change of schedule. Skimming through her résumé, he read she had completed medical school at McGill in Montreal, but had applied to the NYCH family medicine program after seven years in the field with a group called Médecins du Globe .

Wow, Mark thought, immediately recognizing the name. Those people were the Marines of medicine. Working out of Paris, the organization was known worldwide and had received the Nobel Peace Prize for going into areas of conflict all over the planet to treat civilian casualties. Anybody involved with them worked under the most grueling of situations. Not only would the job have been mentally devastating – a lot of volunteers returned with post-traumatic stress disorders – but physicians sometimes died, killed either by bullets or the diseases they were treating – cholera, dengue, Lhasa fever, and a host of other infectious horrors he’d read about but never faced firsthand.

No wonder she knew her stuff… and karate.

What also struck him was how quickly she’d been accepted into the two-year program at NYCH. She’d only approached them in June of the previous year, less than three weeks before the usual July 1 start of any residency. Her introductory letter stated she’d completed her current tour of duty with Médecins du Globe earlier than expected and inquired if they had any vacancies. The last-minute request for a position came with a half dozen glowing recommendations from her current colleagues and former professors at McGill. NYCH had immediately snapped her up.