Murder Ward td-15

  Murder Ward

  ( The Destroyer - 15 )

  Warren Murphy

  Richard Sapir

  The Robler Clinic is getting a reputation for too many deaths during routine operations. A gorgeous female administrator, Ms. Kathy Hahl, is discovering a profitable little racket, and her tame anaesthetist, Dan Demmet, is playing along nicely. When timid mother-dominated Nathan David Wilberforce - a subject of special interest to CURE - comes to a premature death at the clinic, Remo and Chiun decide it is time to infiltrate... And it is Remo who books in as the 'patient' - exposing him to the rare and deadly ageing drug.

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  * Title : #015 : MURDER WARD *

  * Series : The Destroyer *

  * Author(s) : Warren Murphy and Richard Sapir *

  * Location : Gillian Archives *

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  CHAPTER ONE

  Dr. Daniel Demmet was a true professional. When he decided it was time to kill his patient, he first made sure that the critical body functions were doing well. He checked the electrocardiogram screen, as he had been checking it since the patient had been wheeled into the operating room of the Robler Clinic, one of the finer hospitals just outside of Baltimore. Dr. Demmet sat on a stool behind the patient's head, from which point, as a modern anaesthesiologist, he could best supervise and protect the patient's hold on life. The surgeon, working a few feet from him, was too busy rearranging the body with instruments to worry about him. The surgeon worked on the appendix; the anaesthesiologist worked on the patient.

  The screen showed normal sinus rhythm, a sharp beeping line across the screen, which caught the electrical impulses from the heart. At the first stage of trouble, the wave would become ectopic, indicating cardiac malfunction.

  On the screen, death was a smooth flowing line, with little hills; life was sharp and discordant. What Dr. Demmet continuously looked at was the line that guaranteed life. Perfect. A perfect sinus rhythm. The low hill, the deep valley, the high peak, another valley, and then the pattern all over again. All this in a beep. Life.

  Perfect. But then, why shouldn't it be? The patient was healthy, and Dr. Demmet had done his job well, in the best tradition of modern, balanced anaesthesia. Gone were the days when good doctors would knock out a patient with a single massive dose of a potentially lethal chemical, with the inevitable residual toxicity that left the recovering patient nauseated, uncomfortable, and, sometimes, in pain.

  Now, anaesthesia is a symphony. Demmet had given the patient, a healthy, forty-five-year-old male, an initial injection of sodium pentothol, which put him quickly to sleep. The opening note.

  Then oxygen through the anaesthesia machine to assure good breathing. Intravenously, the succinyl-choline, which relaxed the body muscles and made way for the endotracheal intubation, affording Dr. Demmet greater control over the patient's breathing. Then, through the anaesthesia machine, nitrous oxide, a further nerve depressant. And finally halothane. Very carefully with the halothane, for this was the basic anaesthetic of the operation.

  It was also what was going to kill the patient.

  Intravenously, Dr. Demmet administered a small amount of curare to relax the stomach muscles, making the appendectomy that much easier for the surgeon to perform. The electrodes of the electrocardiograph were attached to both arms and a leg. There was a constant intravenous flow of 5 percent dextrose. Dr. Demmet felt for the pulse, checked the blood pressure, listened to the heartbeat through a stethoscope, which was not of course as accurate as the electrocardiogram but still a good backup check. Then he proceeded to kill the patient.

  He also did something that never appears in television dramas or great romances about hospitals but that is not at all uncommon in real operating rooms. He passed gas. Sitting on high stools for several hours, under great tension and with great need for concentration, anaesthesiologists help make operating rooms smell more like lavatories than like Marcus Welby's office. This is reality. No one ever comments, because everyone is too busy to notice.

  Dr. Demmet increased the level of halothane. He did not do it with a jolt. Everything was precise. He watched the screen. Normal sinus rhythm. He increased the halothane. The ectopic response came with a flutter. Gone were the high discordant peaks. More halothane, and he watched the ectopic levelling become bigeminal—two small beeps. A more even pattern on the EKG. Ordinarily, this pattern on the screen would have set a flurry of emergency measures into motion, but it took the anaesthesiologist to alert the team. Instead, Dr. Demmet watched the screen. Still bigeminal. The pulse lowered, blood pressure lowered, heartbeat weak and struggling. The patient needed no more halothane.

  In three minutes and forty-five seconds by Demmet's watch, the screen showed a smooth, even-flowing, up-and-down line. Dr. Demmet relaxed. For the first time since the operation began, he felt the hardness of the stool. He watched the surgeon work, watched the nurse count the sponges and make sure that everything brought to the operating table remained there, not inside the patient. A sponge or a clamp left inside a patient could mean a malpractice suit, even though a sponge might not do much harm. The supervising nurse's real job was the first step in the professional web that made it almost impossible for a doctor to lose a malpractice suit. Naturally, the patient's bill showed the cost of the nurse's services.

  Dr. Demmet waited another two minutes and then turned off the halothane, reduced the nitrous oxide, folded his arms, and watched the peaceful, level hills of death.

  When the surgeon looked up, Demmet shook his head. "I'm sorry. We've lost him," he said.

  The announcement snapped everyone's head toward the EKG screen, where the beeping dot painted the landscape of oblivion.

  The surgeon glared angrily at Demmet. He would complain later that Dr. Demmet should have let him know that the patient was in trouble. And Demmet would inform the surgeon that he had done everything possible to save the patient and that if the surgeon had any complaints, he should go see Ms. Hahl, the assistant administrator of the hospital.

  Now Dr. Demmet sat on the high stool, the stethoscope hanging from his neck, his ears blissfully free of any foreign objects, and watched the surgeon complete the operation down to the last suture. If no one left a sponge inside, and the nurse would see to that, then the operation was safely over, and no subsequent autopsy was ever going to reveal that the surgeon was at fault. When the surgeon left, sullenly and silently, Demmet rose from the stool, stretched his muscles and went out to break the tragic news to the next of kin. He had a reputation at the Robler Clinic of being the best at breaking this sort of news.

  It is a fact of hospital life that doctors instinctively avoid dying patients and spend more time with those who are going to get well. Even now, across the nation, doctors are just beginning to study their own attitudes toward the dying, something that they have instinctively avoided for centuries, though the rest of the populace believes that they are not uncomfortable with death. Doctors are supposed to be men of great compassion, courage, and knowledge. But it is only now being admitted that a doctor often avoids telling a patient his illness is terminal, not for the patient's benefit but for his own.

  Demmet, unlike his colleagues, had no such troubles. He whisked off his mask, examined his cool aquiline face for any resurgence of pimples, touched up his just-graying sandy-blond hair with his fingertips, removed his surgical gown, and went to the administrative offices to make the usual report for this special sort of operation.

  "What was it this time? Heart failure?" asked a graceful young woman with dark red hair and cool brown eyes. She was Kathy Hahl, assistant administrator of the hospital and director of hospital dev
elopment, another term for chief fund raiser.

  "Yeah. Heart failure will do," said Demmet. "You know, the sand wedge, the damned sand wedge, is a disaster off the fairway."

  "Not if you use it right. If you use it right, it's like a scalpel. Puts the ball just where you want it if you use it right," said Ms. Hahl.

  "If you can play six hours a day every day," said Demmet testily.

  "You get your game a day if you want it."

  "Not if I can't schedule these operations but have to take them mid-day, afternoons. Morning or late afternoon are too cold for golf these days."

  "A lot of doctors work twenty-four hours in a row sometimes, even come in in the wee hours. It's not a profession conducive to rest, Dan."

  "If I wanted an easy life, I wouldn't have to be going down to that waiting room now to tell the widow What's-her-name that her husband didn't survive an appendectomy. Really, the way you set things up, I'm going to have to work up a routine for terminal head cold."

  "Her name's Nancy Boulder. Mrs. Nancy Boulder. Her husband's name was John. John Boulder. He was with the Internal Revenue Service."

  "We seem to be getting a few Internal Revenue specials nowadays. Some sort of trend?" Demmet asked.

  "Not your worry, Dan."

  "Boulder. John Boulder," Demmet repeated. "If I keep on getting these specials, I'll never break eighty."

  "If the sand wedge doesn't work for you, try running the ball up to the green. You can use a three iron like a heavy putter," said Kathy Hahl.

  Demmet stared at a large red arrow painted on a sign that said $20 million advancement goal. The arrow was almost reaching the top of the black line that marked progress.

  "But the wedge looks so nice popping up on the green and stopping."

  "Do you want form or score?"

  "I want both."

  "So do we all, Dan. Give the widow Boulder your regrets, and I'll meet you at the club."

  "I'd like three strokes a side."

  "Your handicap is big enough already."

  "I'll use my pitching wedge, my old pitching wedge. Three strokes a side," Demmet said.

  "Two," said Kathy Hahl, smiling the special smile that made men aware of their own heartbeat.

  "You're a cruel, hard, ungiving person," said Dr. Demmet.

  "Never forget that, Dan," said Kathy Hahl.

  When Dr. Demmet told the head nurse he wished to see a Mrs. Nancy Boulder who was in the waiting room, the nurse asked, "Another one?"

  "Are you keeping score?" asked Dr. Demmet sternly. The nurse had violated professional decorum, and she knew it.

  "No, doctor. My apologies."

  "Accepted," said Dr. Demmet.

  Nancy Boulder was in the waiting room, explaining to an elderly gentleman that he really had no cause for worry, when she heard a nurse call her name. She excused herself momentarily from the man, who was fingering a small brown paper bag, and quietly told the nurse she would be with her in a minute.

  "I think it's important," said the nurse.

  "That man is important, too," said Nancy Boulder. "He's in agony. His wife is having a hysterectomy and…"

  "A hysterectomy is nothing to worry about."

  "That's not the point," said Nancy Boulder. "He thinks so, and he's terrified. I just can't leave him here. Give me a minute, please."

  The nurse sighed in resignation, and Nancy Boulder went back to the man, who, in his anxiety, hardly heard her words. But she tried.

  "Listen. I know it's very important to you and your wife. It is to the hospital, too. But just because it's important doesn't mean it's dangerous. They do these operations because they are safe."

  The man nodded dully.

  "I don't know what to say to you, sir, but you're going to look back on this some day and laugh," said Nancy Boulder, giving him a big, hopeful smile. He saw the smile and like so many others who knew her, could not resist its warmth and openness. He smiled back briefly.

  Well, at least he had a brief respite, thought Nancy Boulder. It was a nice thing about people that they responded to warmth. She tried to explain this to the nurse, but the nurse did not seem to understand. She just asked Mrs. Boulder to follow her please.

  "You know, it's funny how superstitions linger. Even John had a premonition," Nancy said to the nurse. "He was in pain. But when the doctor told us it was appendicitis, I stopped worrying. An appendectomy is the simplest operation in the world, isn't it?"

  "Well," said the nurse. "No operation is really simple."

  There was something in her tone that made Mrs. Boulder's hands tighten. She tried to remain calm. All the nurse had said was that no operation was simple. That was all.

  Mrs. Boulder's dark, middle-aged face suddenly showed the lines normally hidden by her ever-present smile. The happy brown eyes became dull with a gnawing terror and her brisk gait became a forced trudge. She held her pocketbook in front of her chest like a shield. All the nurse had said was that no operation was simple. So why should she worry?

  "Everything worked out all right, didn't it?" asked Mrs. Boulder. "I mean, John is all right, isn't he? Tell me he's all right!"

  "The doctor will explain everything," said the nurse.

  "I mean he's all right. He's all right, isn't he? John's all right." Mrs. Boulder's voice rose, loud and tense. She grasped the nurse by an arm. "Tell me John's all right. Tell me he's all right."

  "Your husband was not my patient."

  "Was? Was?"

  "He is not my patient. Is," said the nurse and freed her arm with a fast snap of the elbow.

  "Oh, thank God," said Mrs. Boulder. "Thank merciful God."

  The nurse, beyond an arm's distance, led Mrs. Boulder down the corridor to a frosted glass door that read, "Anaesthesiology. Dr. Daniel Demmet, Chief."

  "The doctor is waiting for you," said the nurse, knocking twice on the door. Before Mrs. Boulder could say thank you for showing her the way to the doctor's office, the nurse was gone, walking very quickly down the hall as if on an urgent matter. If Mrs. Boulder had not had as much faith in hospitals as she did, she would have sworn it was flight.

  Dr. Demmet heard the knock and put his sand wedge into a closet. He had been chipping peanuts from the wall-to-wall dull gray carpeting to the back of a worn leather chair. If he could chip a peanut off a carpet with a sand wedge, why couldn't he do it with a golf ball close to the green?

  This was the problem, then, that faced him as the distraught woman entered. He knew immediately that the nurse had let on. He saw Mrs. What's-her-name, clutching her pocketbook, knuckles white. Her jaw quivered.

  "Will you sit down please?" said Dr. Demmet, motioning to the green leather chair near his desk. He whisked away the peanuts with a swipe of his left hand.

  "Thank you," said Mrs. Boulder. "Everything is all right, isn't it?"

  Dr. Demmet's face was sombre. He lowered his eyes momentarily, circled the desk and sat down, even though he knew he must rise again in a moment. He made a cathedral arch of his fingers before him, nails immaculately white, hands scrubbed clean, clean to the redness of the palms and knuckles.

  Dr. Demmet stared mournfully at the hands. Mrs. Boulder trembled.

  "We did everything we could for Jim," said Dr. Demmet.

  "John," corrected Mrs. Boulder weakly.

  "We did everything we could for John. There were complications."

  "No," cried Mrs. Boulder.

  "The heart gave out. The appendectomy was perfect. Perfect. It was the heart."

  "No. Not John. Not John. No!" cried Mrs. Boulder, and then the tears came in overwhelming grief.

  "We took every precaution," said Dr. Demmet. He let the first rush of grief run itself out before he rose from his seat, placed a comforting arm around the widow, helped her to her feet, and out the door to the first nurse they encountered in the hallway, giving explicit instructions that everything that was possible should be done for this woman. He ordered a mild sedative.

  "What is her name, doctor?
" asked the nurse.

  "She'll give it to you," said Dr. Demmet.

  By the time he reached the Fair Oaks Country Club outside Baltimore, he knew what he must do. He could delay it no longer. He was only deceiving himself if he thought he could, and he was not one to encourage self-deception.

  "I've got to give that funny knuckle club a chance," Dr. Demmet told the golf pro. "I've tried the sand wedge, considered going back to running a three iron onto the green, but I've got to give your club a chance."

  "It doesn't look pretty, Dr. Demmet, but it certainly gets the ball up to the hole from anywhere near the apron," said the pro.

  "I suppose so," said Dr. Demmet sadly, and this time the mournful tone was sincere.

  Mrs. Boulder woke up at three in the morning in her bedroom, saw that her husband's bed had not been slept in, and realized he would not be coming home. She had told the children the night before, and they had cried. She had spoken with the funeral people and paid more than she could afford, not really caring all that much and almost welcoming the assault of the high expenses. She had told John's brother, who would notify the rest of the family, and she had received a multitude of sympathy calls. But it was in the morning that she realized in her body and in her senses, finally understood, and began to accept that John would not be coming home again. It was then that the grief came, full and deep and unremitting.

  She wanted to share the grief with him as she had shared everything else with him since they were married after his graduation from the University of Maryland. It was too much pain for her to bear alone, and she did not know how to pray.

  So she began to pack his things, trying to separate what her son might want from what John's brother might want from what the Salvation Army might want. In the basement, she taped his cross-country skis together, packed his squash rackets, and wondered why he had never thrown out his old jogging sneakers. She left his scuba tanks in the corner because they were too heavy to lift.

  And when she looked back at all those pairs of jogging sneakers, tattered testimony of the three miles he had run every day of their marriage, except during the honeymoon, it came to her with a jarring shock.