To The Bone

Chapter 33

The following Monday morning at seven, Mercy Hospital Emergency Room's monthly Quality Assurance committee meeting was starting. The conference room was unusually crowded. In fact, it was packed. All the thirty-some seats were taken, and there were more people in the hall. The air was filled with a low buzz of talk.

Monks had gotten there early and found a chair near the back. He was moving very carefully and stiffly because of his wounds. None of the scalpel slashes had been deep, thanks, in part, to the canvas tarp that had enwrapped him. But they had required a total of 173 stitches. He felt like Frankenstein's monster, his torso a tight sack stuffed full of flesh that the wrong twitch could pop open, ripping a seam like a zipper. The cuts hurt like hell, too, and he was almost salivating with anticipation of an afternoon feast of Percocet and vodka.

But not yet. He was staying clearheaded for this meeting. This was where judgment of his treatment of Eden Hale was going to be rendered by his peers.

He did not know which way it was going to go.

Most of the faces were familiar. Vernon Dickhaut was sitting beside him, and all the other ER docs who were not on duty were also present, along with Jackie Lukas and Mary Helfert, the nurses who had worked with him on Eden. Roman Kasmarek, the pathologist, was sitting on his other side. Baird Necker, the chief administrator, and Paul Winner, the internist who had criticized him, were there, too, along with several nurses and physicians from other departments. Apparently, the word had spread. This case was not just interesting – it was now tinged with notoriety.

Dick Speidel, the committee chairman, stood up at the head of the long conference table. He was a commanding figure, big and bearlike. The room got quiet.

"I'm sure I don't have to remind anybody that these proceedings are protected from discovery," Speidel said. "I've approved some non-ER personnel who have asked to sit in. But what happens here, stays here.

"We're going to start right off with Dr. Monks's case, because I don't think we have three times the usual number of people just for the coffee and doughnuts." A sprinkling of laughter arose. Monks did not join in. "Committee members have had a chance to look over the material, including my own review. I'll recap it.

"In brief, it's been established beyond doubt that the patient, Eden Hale, died of florid DIC. We're quite sure now that it was caused by ricin – a poison that was deliberately administered to her – but there was no hint of that at the time.

"Dr. Monks's diagnosis was correct, and, by my lights, very astute. He also acted correctly in addressing the DIC with utmost urgency. It was far and away the most serious presenting problem.

"The pathway he chose is a thornier issue. Blood products are the major treatment for DIC. But heparin's clinical boundaries aren't established. There's no definite evidence it would have helped with someone that far gone. It might have helped, and in the circumstances it certainly wasn't unreasonable. He was fully aware that it was a desperate measure, and it probably wouldn't succeed – but it was either that or stand there and watch her die.

"However, there's a case to be made that administering the heparin was an unnecessary procedure, and even inappropriate."

Speidel paused, with a certain amount of dramatic flair, like a jury foreman about to take the poll.

"My own opinion is that the outcome was predictable – the patient was beyond saving when she came in – and that Dr. Monks acted well within the reasonable standard of care," he said. "I'll open this up by asking the other ER physicians if they agree. Gentlemen and ladies, this is not a feel-good encounter session. If you think Dr. Monks performed unacceptably, let him have it."

Monks waited, his sore gut tensed like a prizefighter's, waiting for a punch.

There was a nervous rustling, people rearranging themselves in their seats, recrossing legs, shuffling through their notes.

No one spoke.

"Birds of a feather, sticking together, huh?" Paul Winner said sarcastically.

"And now," Speidel said, without looking at him, "I'll invite comment from other departments."

Winner stood up, too. "Dr. Monks, I know you just went through a traumatic experience. But this happened before that, and we can't just let it slide out of sympathy for you, or because the ER wants to protect its own. Matters like this reflect on the overall reputation of this hospital, and everybody associated with it. I'm sure a lot of people in this room feel the same way."

He surveyed the crowd with stern eyes, waiting for support. Mary Helfert, the nurse who had questioned Monks's use of the blood thinner, raised a tentative hand, and a few of the non-ER physicians nodded uncertainly. But still, no one spoke.

Speidel gave the silence plenty of time before he said, "What's your specific objection, Dr. Winner?"

"My specific objection is pumping a potent drug into somebody when you aren't sure of the consequences. You can't go treating patients like guinea pigs!"

"How would you have handled it?"

"I'm not an ER physician, but-"

"But you feel free to correct those of us who are?" Speidel interrupted.

Winner slammed his hand down on the table. "He's not the kind of doctor we need at this hospital – him and all the muck he finds to roll around in." His forefinger stabbed the air toward Monks. "I don't want you seeing my patients anymore."

"Done," Monks said.

"I'm taking this up with the chief of staff," Winner said. He left the room, pushing his way roughly through the crowded chairs.

"You want to take my next shift for me, Paul?" Vernon Dickhaut called after him. "I'd like to see you take on the Saturday Night Knife and Gun Club."

There was laughter again, longer and louder.

This time, Monks smiled, too.

Baird Necker was waiting for Monks outside in the hall.

"All right, I should have backed you up," Baird said. "I feel like shit. That's my apology. I don't expect you to accept it."

"I think Paul Winner's right, Baird. I'm not the kind of doc you need around here."

'Tuck him. He's adequate, and he'll be retiring soon. Those are the two best things I can say about him." He clapped Monks on the shoulder and started walking toward the elevator. "Except for all the publicity you can't seem to help attracting, we've come out of it fine. Come on upstairs, I need a smoke."

"I don't think you heard me," Monks said, not moving. "I'm tendering my resignation. I haven't had time to write the letter yet, but I'll get to it in the next couple of days."

Baird stopped and looked at Monks, puzzled, still not seeming to grasp it. Then he scowled.

"You got a better offer someplace else?" he said suspiciously. "If that's it, we could deal."

"No."

"Why, then? You're pissed at me?"

"I am. But don't flatter yourself. That wouldn't run me off."

"Because you killed somebody who needed killing?"

Monks's head snapped back, as if the words were a punch.

"Spoken like a marine," he said. "Semper fi, and all that."

Baird's gaze stayed level. "Okay, it was crude. But I know you better than you think, Carroll. You could take something like that to heart. Decide you're not worthy anymore."

Baird was shrewd. There was some truth to it. But only some.

"I feel like I'm in some kind of spiral that's getting out of control," Monks said. "It happened to me once before, and it almost took me down. I need to back away, take some time off. That's the best reason I can give."

Baird rubbed his bulldog jaw. "What are you going to do?"

"I'll still investigate for ASCLEP. There's plenty of locum tenens work around."

Baird pulled one of the foot-long Tabacaleros out of his inside suit jacket pocket and tore at the wrapper, stripping it off impatiently.

"I'll miss having you around, Carroll. These have been some great times," he said. "Never knowing when I might find a body gutted on a gurney. The psychos lurking in the furnace room, the labs getting smashed up, the TV crews shoving microphones in my face. The sleepless nights trying to figure out how the fuck to keep the board of directors from hemorrhaging, and the board of accreditation from dumping us. Hey, hospital administrators are a dime a dozen, but those were the things that made my job special."

"Jesus, Baird. You're making me go all gooey inside."

"You'll be back," Baird said. "It's in your blood." He did an about-face with marine drill precision and stomped down the hall, on his way to the rooftop and a nicotine fix.

Monks walked the other direction, toward the ER, feeling like he had been carrying a sack of huge rocks on his back for so long he had forgotten about it, and now he had dropped a couple of the biggest ones.

There were no witnesses to the complex series of events, and none was likely to appear. But it seemed clear that Monks had suspected all the wrong people. Initial speculation went that Todd Peploe, the clinic's maintenance man, was the one who had butchered Coffee Trenette and had killed Gwen Bricknell – being careful to make it look like D'Anton's work. He had killed D'Anton, too. The surgeon's body, overdosed with Demerol and carefully enclosed in garbage bags, had been found in the trunk of his own Jaguar.

The police had found jewelry in Todd's apartment that pointed to other victims. There was also a crudely written journal, which indicated that the bodies had been left in a cave on D'Anton's property. Search dogs found them. Apparently, Todd was on his way to hide D'Anton's corpse there, too, trying to make it appear that D'Anton had gone on a final murderous rampage, then fled.

But Todd had learned from Julia D'Anton that Monks was coming. He had killed her, still using the scalpel with D' Anton's fingerprints, then taken her hair as a disguise, and set the trap for Monks.

Further checking showed that Todd had started impersonating a physician while working at a San Diego hospital. He had approached an unknown number of women and given them pelvic exams. This might have gone on indefinitely – hospitals were reluctant to deal with that sort of thing, even when they knew about it – but then his penchant for sharp instruments had come to the fore. Sedated patients started turning up with mysterious incisions. None was seriously injured – Monks guessed that Todd was practicing, working himself up for what was to come – but it had landed him in prison. Then, like many other parolees, he had disappeared from the system's radar and walked into another job at another hospital.

A faked California medical license, a supply of pharmaceutical drugs, and a hoard of surgical implements and supplies, also found in his apartment, made it clear that he had escalated his doctor persona. And in his garage, there was a Jaguar XJS the same color as D'Anton's – several years older, but almost identical. It was unclear whether this was another way of imitating D'Anton, or Todd had used it somehow for disguise.

A huge amount of work lay ahead for authorities – forensically, to probe the physical evidence, and psychologically, to delve into the psyche of Todd Peploe. His journal included a jumble of beliefs that he was a superior being, above any law, using medical skills to satisfy the hidden cravings of women.

But Monks had already formed his opinion. Anyone capable of doing what Todd had done was a vicious, sadistic son of a bitch whose true reason for killing was pleasure.

That made the memory of pumping five bullets into him a little easier.

Martine Rostanov had not attended the QA meeting because she was not on Mercy Hospital's staff, but she was waiting for him in the ER lobby. Monks recalled that that was the first place he had ever seen her, walking through the door with the slight limp that instantly had awakened a protective urge in him. He had the eerie sense that their relationship was unraveling literally, a step at a time, like a videotape played backward.

"I already heard the buzz," she said. "Congratulations." She was smiling, summery-looking in a long flowered dress, but her face was dark around the eyes.

"It's a relief," Monks admitted. "How's your body holding up?"

"I won't be playing rugby for a while."

"I feel like I should be nursing you, in your hour of need."

"I don't think either of us wants that," Monks said. He was surprised by the bluntness in his own voice, and he saw that she was, too. Then hurt. She lowered her eyes.

"It's terrible, what you've been through," she said. "I know I haven't helped."

"Of course you have."

"Are you all right with what you had to do? Never mind. Dumb question."

Neither of them spoke for another moment. Monks thought about asking her if she was getting involved with someone else, perhaps the owner of the black Saab he had seen in her driveway – thought about confessing his own infidelity, if that was what it had been. Thought about suggesting another try. They had talked a lot about an autumn in Donegal.

But the words were just not in him. The issues that had seemed important between them a few days ago had been swept from his consciousness. He was distant from the rest of the world right now, and she was part of that world.

"I'd better go," he said. "Thanks for coming by."

"Don't lose my phone number, okay?"

He walked her out into the parking lot. They kissed quickly, like friends. She waved from her car as she pulled away – maybe sadly, maybe not.

And that was that.