The Last Surgeon

CHAPTER 27

The psychiatric wing of Shelby Stone Memorial Hospital was overcrowded and understaffed, which for Jillian meant it was business as usual. She was halfway through a grueling twelve-hour shift, the second in as many days. Still, for her, work had always been a refuge, and getting outside of herself, taking on the challenge of caring for the sick, the sad, and the confused had almost always given her strength. Since Belle’s death, it seemed that she needed work and her patients more than ever.

This had been an especially challenging afternoon. Beds on the psych unit, and throughout the hospital, for that matter, were filled. The interns and residents on the ER were nearing the end of their training year, and were shipping patients up to the wards with minimal workups. Jillian’s feet had begun swelling beyond what her white canvas work shoes could comfortably contain. And now she had been assigned a new admission for whom there would not be a bed available for several hours, if that. A somnolent, jaundiced, alcoholic man, probably in his sixties, he should have been admitted to a medical floor. His right eye was discolored and swollen almost shut. Diagnosis: Acute and chronic alcohol intoxication. Possible impending delirium tremens.

Typical. The diagnosis of alcoholism of any kind would not have gotten the fellow past the managed care gatekeepers and off the ER, but “impending DTs” would, despite the fact that the condition only occurred after cessation of drinking. Technically, every active drinker had impending DTs. Now, instead of offering him privacy, Jillian had no choice but to treat the poor guy in the hallway. It was not that Shelby Stone was a bad hospital. The nursing service had won many awards and national acclaim. It was more that the sprawling institution was just unwieldy much of the time, and the patient population was so ill.

She had taken the man’s vital signs and was in the midst of changing his IV bag when Nick, wearing jeans, sneakers, and a plaid Western shirt, appeared at her side. He reminded her of Trapper John, M.D., from M*A*S*H, with his bushy reddish brown hair that seemed extra wild today. Actually, she acknowledged, she liked that look. A lot.

“Hey you,” Jillian said, “this is a fun surprise.”

“We brought the RV in early to pick up some supplies and have it serviced at a place that does it for free.”

“Sign me and my Honda up.”

Nick nodded down at her patient, lying quietly on his hospital gurney. Jillian had pushed the rolling bed up against the wall so at least they weren’t blocking foot traffic.

“I always believed that if there were no alcohol, there would hardly be any hospitals,” Nick said. “I haven’t worked inpatient for a while, but I’m guessing triage to the hallway isn’t exactly HIPAA compliant.”

“It’s not exactly Joint Commission sanctioned either. But we had our JCAHO certification approved last month, so I think we’re all safe to behave badly for another year. What brings you to paradise?”

I haven’t stopped thinking about you since we met, that’s what.

“That bizarre tour we took of the medi-spa just won’t clear out of my head,” Nick said instead. “I’m just not sure what our next move should be.”

“It’s been haunting me, too. Between Manny Ferris’s freak-out, Daintry getting her signals crossed about the whereabouts of the surgeons, those mysterious unaccounted-for two floors, and the nurse showing up in the deserted operating room, I think there is cause for concern. Besides, Daintry just seems like someone with secrets.”

Nick was paying attention, but he was also reflexively checking the battered man’s pulse at the wrist and neck, then pulling open his lids and examining his eyes with a penlight he had plucked from Jillian’s breast pocket. Next he gently palpated his belly. Finally, he glanced at the plastic ID bracelet on his wrist and bent close to his ear.

“Ray, it’s Dr. Nick Garrity. Can you hear me? Open your eyes if you can hear me.” He put some uncomfortable pressure on Ray’s breastbone with the knuckle of one index finger. “Ray? Come on, Ray, open your eyes. Jillian, have you or any of the docs examined him yet?”

“I assume they looked at him downstairs. Maybe not as carefully as they might have. I heard it’s a zoo down there. I was getting ready to go over him when you got here. Something the matter-I mean other than the obvious?”

“Dunno for certain,” Nick said, “but I think his right pupil is slightly larger than the left.”

“Subdural?” Jillian asked, referring to the life-threatening collection of blood expanding between the skull and brain that often followed head trauma.

“A lot of folks have gotten CT scans of their heads for less indication than this,” Nick said. “I think he could certainly use one, and I would say sooner rather than later.”

“If you’re right, Doc, you didn’t just drop by to see me, you were sent by a higher power.”

“Nonsense. We’re a team. The Jefferson Collinses. If a subdural’s there, you would have picked it up.”

To the hospital’s credit, within five minutes of Jillian’s call, residents from psych and neurosurgery were on the scene, and ten minutes after that, Ray Goodings was on his way down for a CT scan.

“When this place works, it works,” Jillian said, looking up at him with an expression he wanted to capture and bottle for future use. “How about you wait in the lounge if you have time? I have some reporting to do about how poor Ray could have just made it off our service before he was ever really on it.”

Thirty minutes later, she entered the lounge, unable to contain her excitement.

“Subdural,” she said simply. “Pretty big one, too, according to the psych resident who went down with him. Ray’s on the neurosurgery service now. What a man you are. Five minutes in this hospital and you save a patient’s life and make a heroine out of one of the nurses. No wonder they call you Dr. Fury.”

Mentioning the words sent a shadow across her face.

“Hey, nice going,” Nick said, clasping her shoulders and hoping he could soften her thoughts of Belle. “You were connected to that guy. That’s what this caregiving stuff is all about. Connection.”

Jillian glanced about, then stood on her tiptoes and kissed him gently.

“There’s more where that came from,” she whispered. “Now, where do you want to start?”

“Well, let’s step back some and look at what we already know. We think poor Manny might have some connection to Umberto, based on what McBean told me, and we believe Umberto has some connection to Belle based on the Nick Fury comic books you found in her apartment. We also believe that Manny’s reaction to the photographs is a result of his having been a patient at the medi-spa.”

“And?”

“Umberto is between Manny and Belle. He’s the one linked to each of them.”

“So what are you getting at?”

“I think we need to take a close look at what happened at the medi-spa around the time Umberto and Manny disappeared.”

“By that you mean…”

“Check out the patient records from four years ago. See if we can learn anything.”

“Do you think Umberto was also a patient there?”

“I don’t know, but it’s worth investigating to see if the timing might be a missing link.”

“Four years. Excuse me for saying so, but that’s a stretch.”

Jillian rose and walked over to the single, narrow window. The panoramic view of Virginia and the Potomac from the seventh floor was breathtaking. She followed a sailboat skimming across diamond ripples. When Belle was a child, the two of them loved to go out together on their family’s Sunfish. Then, suddenly, they were orphans, and now, Belle herself was gone. Jillian felt completely adrift. When-if-they found Belle’s killer, would it really put an end to the profound emptiness she battled each day? The possibility gave her hope and, at the moment, that hope was all she could really ask for.

Fighting the fullness in her throat, Jillian returned to the table.

“I agree it’s worth looking into,” she said.

“Okay. I spent a little time on the Internet. The Singh medi-spa is a joint venture between Paresh Singh and your employer, Shelby Stone Memorial Hospital. Remember that badge on the security guard?”

“I do. One of the brochures in the medi-spa lobby said it’s been that way since before I started working here ten years ago.”

“So, since you’re an employee of Shelby Stone Memorial, you should be able to access the electronic medical records for the spa, assuming the two facilities share the data. We can start by looking at medi-spa patients from four years ago and work our way back from there.”

“We have a computer near the nurses’ station. Let me see what I can do.”

Jillian exited the lounge and followed the circular corridor to the nurses’ station, where they had recently installed a computer kiosk. She parked herself in front of the kiosk, which was really just a laptop computer locked inside a black metal case, providing employees access to various applications including shift and medication schedules, room assignments, and of course, electronic medical records. The psych floor was one of the first to get trained on the new EMR system, affectionately known among the nurses as the Even More Redundancy application.

Jillian logged in to her account, but accessing records other than those of her own patients was clearly an ethical breach. She launched the EMR application and clicked on the pull-down menu for “Facility Name.” As Nick had suspected, there was an entry for the Singh Medical Spa and Cosmetic Surgery Center, in addition to other facilities connected to Shelby Stone Memorial. When she tried to access those records, however, Jillian got a PERMISSION DENIED pop-up dialog box, followed by a loud and somewhat startling error beep. Logging off quickly, and smiling sheepishly as if she had made an inadvertent mistake, Jillian returned to the nurses’ lounge.

“I can’t get access.”

“So much for Plan A,” Nick said.

“But wait, there actually is a Plan B. Let’s go down and check on Ray. Then I can scrounge maybe twenty minutes if the floor is still quiet. We can take a trip down to the records room and see if we can get those files the old-fashioned way.”

“There still is an old-fashioned way?”

“Last I heard.”

Within the hour, the neurosurgery resident told them, Ray Goodings would be in the OR having a drainage procedure. Then the hard work would begin-finding a way to get him off booze and into recovery.

“Turns out shipping him to the psych ward in error may have saved him,” Jillian said.

“Maybe this experience will scare him into sobriety, providing he even remembers it.”

“Every time an alcoholic stops drinking, there’s a possibility that this will be it, and he’ll never have to stop again.”

“I like the way you think, nurse.”

Taking the patient elevator down to subbasement level two, the pair emerged into a windowless, dank, and eerily quiet hallway.

“Makes Manny Ferris’s bedroom seem like a suite at the Four Seasons,” Jillian muttered. “This area used to be the very center of the hospital. I have to come down here less and less as the changeover to EMRs progresses, but I really hate it when I do. I think the records room-what’s left of it-is the last door on the right.”

They proceeded along the dimly lit corridor with their eyes adjusting to the gloom as they went.

“Who on earth works down here?” Nick asked.

“I’ve only met him a couple times. The Mole, they call him,” Jillian said, “but his real name is Mollender. Saul Mollender, I think. I heard that when the whole EMR unit was created and moved to the top two floors of the Corwin Building, he just stayed.”

“A dinosaur.”

At the corridor’s end was a classroom-style door with a frosted-glass windowpane, upon which, painted in peeling letters, were the words RECORD ROOM. Jillian opened the door without bothering to knock. It was a cavernous space, made somewhat claustrophobic by a drop ceiling and row upon row of stacked cardboard storage cartons and tall metal shelving units, a number of which were still packed with color-coded patient records. The only other furniture in the room was a slate-colored fiberboard desk, positioned directly in front of the entrance.

Saul Mollender sat in his chair behind the desk. There was a large stack of records piled neatly on top of the otherwise uncluttered surface. No photos, no pictures on the wall, no calendar. The topmost patient record folder was flipped open and Mollender, cadaverously thin, with graying hair and wire-rimmed glasses, appeared to be entering data from it into his computer.

“Can I help you?” he asked, not bothering to look up from his work. His voice was nasally and his tone unfriendly.

“Yes,” Jillian said. “I’m sorry to trouble you, but-”

Mollender cut her off. “No, you’re not really sorry. You’re here, aren’t you? If you were really sorry, you would have acted on that fact and left me alone.”

For a moment, Jillian was speechless.

“Well, yes, but what I mean to say is that I’m trying to access some records, but the system won’t allow me.”

“Name?”

“Of the patient?”

At this Mollender groaned and closed the file he was examining. As he looked up at Jillian, he took off his oval spectacles, the lenses nearly as large as his owl-like eyes.

“Your name.”

“Jillian. Jillian Coates, R.N. Seventh floor.”

Mollender put his glasses back on and keyed her name into his computer.

“What records?”

“The patient?”

Again, Mollender groaned.

“Do you see this stack of paper?” he said. He tapped his index finger repeatedly on the file of folders. His tone seemed even more annoyed than before.

“Yes.”

“Well, these aren’t going to key themselves into our system, despite what the optical character recognition software people seem to think. So, I don’t really have time for your lack of clarity, Ms. Coates. Facility. What facility’s records are you trying to access?”

“Oh, right. The records are from the Singh Medical Spa and Cosmetic Surgery Center. It’s jointly owned by-”

Mollender cut her off again. “I know what it is. But you can’t see them.”

“Yes, I know I can’t see them, that’s why I’m here.”

“No, by ‘can’t see them’ I mean not authorized to see them. Do not have the proper permission-that kind of can’t see them.”

“But aren’t the records in our system?”

“Well of course they are,” he said, as though she had just asked if air was necessary to breathe. “They’re in our system assuming they’re not more than ten years old, and my dwindling staff and I haven’t keyed them in manually yet. Manual data entry, if you didn’t already know, is very error prone. Which is why DISTRACTIONS ARE DEADLY, or did you not read the sign.” He pointed behind them, where a handwritten sign taped to the door read precisely that: distractions are deadly. “But despite our archaic methods of record management, we have what is known as a firewall. Ever heard of it?”

“Computer security,” Nick said.

“Who’s the boy genius?” Mollender quipped.

“Dr. Nick Garrity,” Jillian said, no longer bothering to disguise her growing irritation. “So what can I do to get access to the files?”

“Well, you could go get a job there. I hear they’re hiring.”

“Cute,” Jillian countered. “Now I understand all those employee-of-the-month awards on that empty wall over there.”

She found herself purposely leaning over Mollender’s desk, getting into his personal space. The man really was pathetic. She had never hit a person before, but the Mole was inspiring such thoughts.

“What else can we do?” Nick asked.

“It’s a firewall, sir,” Mollender reiterated. “That means no access unless authorized. So unless in your spare time you or Ms. Nurse here are hobbyist computer hackers, you’re S.O.L.”

“S.O.L.?” Jillian asked.

“And I thought you medical types were acronym happy. That means shit out of luck.”

“You’ve been very helpful, Mr. Mollender,” Nick said.

Jillian shot Nick a confused look. Leaning in close, Nick whispered a single word into Jillian’s ear.

“Reggie,” he said.