Ellery Queen’s Mystery Magazine. Vol. 31, No. 4. Whole No. 173, April 1958

Alan E. Nourse Doors in the Mind

About one of the most horrifying dangers that nurses and doctors have to fight in a modern hospital — a cruel, vicious, almost unbelievable menace...

“In medicine,” said Dr. Ned Thompson, pouring his fourth cup of coffee for the evening, “there are no absolutes. There are light grays and dark grays, and mauve pinks and lime greens until you want to scream, but just try to find a rich jet black, or a good pure white. You can spend your life looking, but you’ll never find it.” He stirred in cream and sugar and glared across the table at Betty Gibson, the little blonde evening supervisor.

“Now what’s wrong?” asked Gibby. “Patient bite you?”

“A medicine bit me,” said the intern, looking at her strangely. His white jacket was mussed and soiled from two days use; the curved ends of a weary stethoscope drooped from a slightly torn side pocket. “It just makes me tired, that’s all. Here we have three hundred thousand men in medicine trying to find just one piddling answer that adds up the same way twice — any answer — and they can’t even count on their tools to be the same from one hour to the next.” He sipped coffee and hunched his long shoulders over the table. “Now take pain-relieving drugs, for instance. You use Demerol, or Dilaudid, or Pantapon, or Levo-Dromeran, or codeine, and you don’t expect too much. You’re sending a boy to do a man’s work, and if the job only gets half done, you can’t complain. But when you’ve got real pain to deal with, you send a man and not a boy. And there are very few kinds of pain that a dose of the poppy won’t take care of.” He sat back. “At least, I thought so until now.”

The evening nurse was suddenly watching her coffee very carefully, and not looking at the intern at all. They were alone in the dimly lit basement dining room of the hospital, the tiny pink-cheeked nurse and the tall, loose-jointed intern, and they knew each other far too well by now for embarrassing silences. But for a moment the silence was embarrassing. Then Gibby said, “What are you trying to say?”

“I’m trying to say that old Mr. Canlee on Fourth only got a half an hour’s relief from his morphine shot tonight,” said Dr. Ned Thompson. “A sixth of a grain always lasted him four or five hours — until now. Tonight it didn’t hold him for an hour.” He set his cup down with finality. “I don’t know how you figure it, but to me it adds up to something very fishy.”

Gibby nodded. “I know,” she said.

“Others, too?”

“Yes.”

“A week, more or less.” The girl shook her head unhappily. “I couldn’t be sure until the last couple of nights, but there can’t be much doubt any more.”

The intern stared at her. “Do you know who it is?”

“It’s Davis, obviously. She has the medications on Fourth floor, three o’clock to eleven. There’s no one else it could be.”

“Well, don’t we have any cops in this town? My God, girl, what are you waiting for?”

“Proof,” said Gibby. “It isn’t enough to know it, not with this. You’ve got to prove it. But just try to prove it, and see how far you get.”

For a moment the intern just blinked at her, shaking his head. But he knew she was perfectly right.

It was a vicious thing to have to prove.

It was a horrible, frightening thing. It happened so rarely as to be unimaginable — yet every hospital had seen it at one time or another. St. Christopher’s Hospital was not the first, nor the last.

And when it happened, it was unbelievable, and sickening.

How and when it would start nobody knew. Nurses are close to sickness and death; pain is the enemy, healing the goat. The drugs and medications for relief of pain are part of the nurse’s daily work, and she knows them well. But who could tell what pain the nurses suffered, too? To some of them, nursing is merely a job to be endured; to others it is a way of life, a glorification. But to a few it is a day’s work to be dreaded, an emptiness and a loneliness with nothing for fulfillment. A healthy mind would find a healthy answer — adjust to the way of life and find contentment, or leave the profession. But on rare occasions an unhealthy mind would find a different kind of fulfillment...

She would come to the hospital as an experienced medications nurse. She would probably not be, but she would be efficient, would know her job. A confident voice, an aura of solid reliability — not like the giddy senior students about to graduate. References? Perhaps — but the hospitals she names so firmly are good hospitals, and with nurses so badly needed these days—

She might not start as a medications nurse, but she would soon end up there, or her interest in the job would quickly fade and she would be gone — to another hospital. A week after she was hired, you would find her, quietly and efficiently dispensing medications on the surgical floor, or perhaps on a medical floor caring for patients with heart disease or cancer or gall bladder trouble. She would be working the shift from three in the afternoon until eleven at night — so obliging of her to fill in on the shift the younger girls find so unpopular, not to mention that this is the shift when the morning’s new surgical patients are recovering from their analgesics and hypnotics, and feeling the first bite of postsurgical pain — the shift when much narcotic is used, often freely used. And her narcotics-check with the evening supervisor before she went off duty each night would always be scrupulously accurate...

But presently, insidiously, the complaints would begin. Mr. Thornton’s leg must be bothering him again — he needed two hypos between six and nine this evening before he got relief. And Mrs. Findley, complaining that her hypos aren’t relieving her the least bit (although one has been tempted to think that nothing short of a tap with a sledge hammer would effectively silence Mrs. Findley for more than half an hour at a stretch). But Mrs. Conway, always so quiet, now hesitantly and almost apologetically asking for just a tiny hypo before she goes to sleep tonight — her back has been acting up something terrible this afternoon, for some reason—

Once or twice it could be ignored. All patients had different needs, different pain thresholds. A cry-baby with an appendectomy might demand more narcotic than a stolid old trooper with massive cancer resection. But gradually the trend would appear, and the evening supervisor (who has been through this mill before, painfully and wearily, somewhere, sometime) knows without any possibility of doubt that a nurse drug addict is at work in the hospital.

“Davis!” said Dr. Ned Thompson. “You mean Jane Davis? The little brown-haired girl that started on Fourth last month?”

“That’s the one.”

“I’d never have thought it.”

Gibby grimaced. “Nobody ever does. She seems so — well, colorless. She’s never been particularly friendly with any of the girls, no gossiping about the doctors or the patients. She just keeps to herself most of the time, as quiet as can be. And now this.”

“Have you talked to Benedict down in the office about it?”

“Yes.”

“Why doesn’t he fire her”

“Because I talked him out of it,” Gibby snapped, suddenly angry. “I begged him not to fire her. That won’t solve the problem. She’ll just go on to another hospital, get the same job there, do the same thing there. And then what about us? How do we know we aren’t hiring another one to take her place?” She shook her blonde head emphatically. “Fire her, and you just turn her loose. This kind of person is horrible and cruel and you have to catch her to stop her, don’t you see? You have to actually catch her in the act of stealing the stuff, catch her giving it to herself, in order to stop her. Then you can do something — you can charge her and prosecute her and put her away somewhere.”

The girl took a deep breath and stamped out her cigarette. “But if you get excited and accuse her without proof — oh, brother! That’s what she’s waiting for. It’s the worst possible charge. A hundred thousand dollar suit against the hospital for slander and defamation of character, her choice of the slickest lawyers in town to help her win it — she’d love that! She’d win it, too. And a hundred thousand dollars would buy her an awful lot of morphine.”

“You really hate her, don’t you?”

“You bet I do,” said Gibby. “Wouldn’t you if you were a nurse?”

“So what are you going to do?” “Watch her. Mr. Benedict said he’d hold off for a few days. If we could catch her before the end of the week, he’d sit on my report without any action until then. But if we’re still sure then and can’t prove it—” she shrugged. “He can’t do any more than that. The hospital can’t afford to keep her.”

“All right,” said Ned Thompson, grimly. He poured more coffee, and stared up wearily at the clock. “If you’re going to nail her in that time, you’re going to need some help. You’ve got it.”

She was small, and wiry, and tied her brown hair into a bun on the back of her neck — which did nothing whatever to enhance her beauty. As Ned Thompson blinked at her across the nursing station he realized that he had simply never noticed her before. He had known she was there, he had seen her a dozen times — in the corridors, in the medications alcove, in the chart room. But there had been nothing about her to draw his active attention. She seemed deliberately a trifle dowdy, a quiet brown blob of nothing, standing at the counter, arranging medications in little cups on a tray. Three small syringes lay on the tray also, prepared for use, with little pledgets of alcohol sponge around the needles.

Jane Davis. A name as devoid of sparkle as the girl herself. Thirty-five years old, she looked forty-five. With a little care, Ned reflected, she could have looked twenty-five.

His eyes slid down to her arms, and looked quickly away. She wore a long-sleeved sweater of white wool, tight at the wrists. Nothing would be learned from her arms. She gave him a vacant smile as she moved out into the corridor with her tray. His smile was a barely concealed grimace.

Watch her, Gibby had said, and they had planned how to divide the job. Now he realized how impossible the plan would be to carry out. Fourth floor was mixed medical and surgical, but he had patients and obligations on all five floors of the hospital. Gibby had five floors of nurses to supervise. Even when he was on Fourth and free to watch, there were limitations. He could hardly walk into the nurses’ lounge. He couldn’t follow the woman into every room. He couldn’t be sure when a patient was to have a hypo, and then be there to see it given. He couldn’t even be sure that any hypo he happened to see given by her actually contained the narcotic in the amount that was charted.

He knew only one thing for certain: somewhere on her person she carried a small vial with a rubber stopper. Some of the narcotic ordered for some of the patients went into that vial, the patient receiving only a half or a third of the dose ordered. Sometimes all the medication went into the vial, with the patient receiving sterile water of saline in substitution. But the chart would say M.S. gr. ⅙ or perhaps Demerol 100 mg. or Dilaudid gr. ⅓ given per hypo, 3:40 P.M.

Search her handbag or her pockets? Gibby was very hesitant. She could try, if the opportunity presented itself. But it would have to be done with the utmost caution. Give the woman the faintest hint that she was being watched, and the game was over. Miss Davis would become ill, miss a day or two, perhaps-come back for a day, and then express her regrets to the hospital and leave for good.

“That’s why we can’t alert the whole staff on the floor,” Gibby had said. “Only you and I and Mr. Benedict know. We mustn’t let anybody else know.”

“What about the other interns?” Ned Thompson said. “Endicott spends a lot of time on Fourth. And Fischer could keep an eye on her.”

Gibby shook her head. “She’d get on to it too soon. She’d know she was being watched from the first day. Ned, this girl has been through this time after time. She knows all the tricks, believe me. I just hope she doesn’t know too many that I don’t know—”

Endicott was not told, and neither was Fischer. Ned had finished his rounds on Third and Fifth by noon, saw three new patients after lunch, and completed rounds on Fourth just at 3:00 when the shift of nurses changed.

Now he placed the chart he was writing back in the rack and walked down the corridor toward the surgical Solarium at the end of the wing. Davis was there, passing out medications. She didn’t even look at him. He stopped to talk to Mrs. Cartwright with the gall bladder, a large lady snoring in the corner bed. He checked her heart rate and examined her eyes and fingernails, and inquired about the itching that had bothered her. He wrote for a repeat serum bilirubin to be done in the morning, and added a homeopathic fraction to Mrs. Cartwright’s bedtime sedative dose (“I haven’t slept a wink for the last three nights, Doctor,” she complained, and he valiantly resisted the impulse to suggest that if she slept less during the daytime she would sleep more at night.) He checked Mrs. Cartwright very carefully, but his eyes never left Jane Davis.

And he saw nothing. Mrs. Barnes, back from surgery that morning, had received her first hypo. Ned made a mental note to check back in an hour and see how it was holding. But he knew he probably wouldn’t be able to if things suddenly got busy.

At the other end of the hall he stopped to see Mr. Wilcox, a routine visit with a conversation so well rehearsed that Ned could repeat it in his sleep.

“About time you got up here,” Mr. Wilcox roared. “I tell you, Doc, I ain’t staying in this bed another minute, so help me if I drop dead! Damn’ foolishness, lying around here running up a bill.” He beat hammy paws on a massive girth of chest. Mr. Wilcox’s coronary regimen did not agree with him, and never had since the night he was brought to the hospital, gray-faced and shocky, closer to death than he had ever dreamed he would venture. He had been cajoled, reasoned with, and browbeaten into complete bed rest for thirty days, but he had fought every inch of the way. “I tell you, if you don’t let me up today I’m going to pile out of bed and run the hundred yard dash up the hall.”

Dr. Thompson grinned. “You might make it up there, but you’d never make it back. Why not relax and enjoy it?”

“Relax! So help me, Doc, I haven’t moved a finger in two weeks!”

“Fine! You’re an awful liar, George, but fine! Maybe if the boss okays it we’ll let you up in a chair this week.”

George Wilcox’s florid face was suddenly serious. “No kidding, Doc, is everything really going all right?”

“We sure hope so. Looks like par for the course.”

“The cardiogram was all right?”

“It showed changes — the right kind, this time. Let’s keep it that way.”

Ned grinned and pushed out into the corridor. Back in the nursing station, Davis was returning again with her tray. Three new patients had arrived for him to see, two of them admitted for complete diagnostic workups. He sighed, and turned to the new charts. If only he could take her by the collar, turn her upside down, and shake that little vial out—

But he couldn’t. He glared at her back and headed down the hall to see the first new patient.

He found Gibby on Second an hour or so later and said, “Let me see your keys.”

“What for?”

“I’d like a look at the narcotics drawer.”

Gibby found the tiny master key on her ring, and pulled open a large drawer in the medications alcove. “It isn’t just narcotics — we keep our emergency box in here, as well as all of our injection-type medications. Keeps them all under the control of a single nurse so she knows what’s where, and what should be stocked. Take a look.”

He had seen the drawer open before, of course, but had never paid much attention to it. In a busy hospital the intern’s job was to decide when a sixth grain of morphine sulphate was to be given to a patient, and how often, and to write the order on the patient’s chart accordingly. It was the responsibility of the medications nurse to see that it was given. He had never, he reflected, even seen many of the medications he had ordered during his internship months. Now he lifted the narcotics tray out of the drawer, blinking at the tubes and ampules critically.

There were the long, thin, pencil-like glass tubes with red-lettered labels saying MORPHINE SULPHATE GR ⅙ or GR ¼. Inside the tubes the tiny dead-white tablets were lined up in a row. A box marked DEMEROL (100 MG) contained a dozen or more clear glass ampules, heat-sealed at the top, with the drug name imprinted in blue ink on the outside of each ampule. Here the drug was already in solution, quite colorless, like a cc or two of water.

“I thought Demerol came in tablets,” Ned grunted.

“It does, for oral use. This is for injection.”

“Is this more of it?” He picked another ampule from the drawer. “I guess not. The name’s different.”

“You’re getting into the emergency box now. That’s Coramine, a heart stimulant. And here’s adrenalin, and nor-adrenalin, and Mecholyl. And those tabs in the narcotics tray are Dilaudid, and that’s Pantapon—”

He examined each tube carefully. “What do you do with the M.S. in tablets — dissolve it in a spoon?”

“Sometimes. Usually it’s a lot easier to pop the tablet into a clean syringe and draw up a cc of water on top of it. It dissolves pretty quickly.”

Ned nodded. “And suppose you were to give 50 mg. of Demerol instead of 100? You can’t leave half the dose in the ampule and use it again, can you?”

“No, of course not. The other half is discarded.”

Dr. Thompson raised his eyebrows.

“Oh, that’s perfectly legitimate. It’s just recorded as ‘wasted’.”

“Yeah, that’s nice. How much has been ‘wasted’ on Fourth in the past week or so?”

“Some — but very little. Certainly not enough to supply—” She glanced aside and shrugged.

“And you actually count all this stuff with the medications nurse at the end of a shift?”

“After every shift. Every tablet and tube, three times a day, including Christmas.”

“Supposing the nurse can’t account for some?”

Gibby shook her head grimly. “She can. If she can’t, we hunt for what’s missing until she can. If we just can’t find it anywhere, it’s reported to the nursing office, and a report is filed with the Federal Narcotics Bureau, and that medications nurse isn’t on medications any more. Period. We haven’t had any missing on the report since that idiot Lesswing got married.”

“Which just goes to prove that all that glitters is not gold,” said Ned Thompson.

“Wrong proverb, but right idea,” said Gibby. “Any luck at all yet?”

“Not a bit.”

“Well—” She snapped the drawer closed and locked it carefully. “I guess we just keep trying.”

By five o’clock he was weary enough to welcome the early hospital supper. He had the duty to look forward to, covering all medical patients in the house, so he strolled down to the intern’s quarters, waved Endicott off en route to a dinner date, and sprawled on the sofa in the lounge in hopes of catching an hour’s sleep before the evening rush began. After three calls about one patient and one call apiece about three others in the next half hour, he gave up in disgust. He rang the operator and “checked out” for ten minutes — his usual dodge to insure a few moments without interruption — and took a quick shower and shave. A clean shirt and a change of uniform cheered him somewhat. Ten minutes later he was stepping off the elevator on Fourth.

The floor seemed quiet. Miss Allison, the little gray-haired, bird like charge nurse, was churning with activity at the desk (“That woman,” Dr. Endicott had once said in his soft southern drawl, “can work harder to get less done than any other woman I ever knew”). She greeted him with her usual effusiveness. “Oh, Dr. Thompson, I’m so glad you came up. I was just about to page you—”

“I felt sure you were, Allison,” said Ned. “I could feel it in my bones. I said to myself, ‘You might just as well go up there now, because you’re going to be called in five minutes anyway—’ ”

Allison blinked at him for a moment. “Well, I think somebody ought to go see Mrs. Conway. She’s been lying there suffering since five o’clock, poor soul.”

“Oh? What’s on her order sheet?”

Allison handed him a chart, “You know, Dr. Morton was in and put her on half a grain every two hours if she needed it — but I think she needs more. Half a grain just doesn’t hold her—”

“Half a grain of what?” Ned broke in.

“M.S.”

“And that doesn’t hold her?”

“It certainly does not! She had a hypo not twenty minutes ago—”

Ned was already halfway down the hall. Mrs. Conway was a favorite of his — an old friend, in a way. He had seen her first during her initial admission for surgery months before; since then she had been back five times. This was her final admission to St. Christopher’s Hospital. She knew it, and Dr. Thompson knew it. She had been failing rapidly in recent weeks, still Ned was shocked when he saw her. She seemed to have grown more gaunt and shriveled in just the past day; her thin sallow face was a rigid grimace when she tried to smile at him, and she gripped his hand as he stopped by the bedside.

“Little trouble tonight, Margaret?”

She shook her head weakly. “I just don’t know what’s wrong with me. You know, I was doing so well yesterday. And now every time I move a muscle — Dr. Thompson, isn’t there anything you can do? I’ve tried to fight it, you know I have, but when it breaks loose like this—” She turned her face away. “I don’t think I can take it much longer.”

“Did that last hypo help?”

“It didn’t even touch it. It might as well have been water.”

Ned stared at her. “I see,” he said.

“If there were only something to give me an hour’s rest—”

“Yes, ma’am. There is something,” said Ned Thompson softly. “You just rest a minute and we’ll get you straightened out.”

His face was white when he reached the nursing station, but somehow he kept his voice under control. “Get her a half grain of M.S. right now,” he said to Allison, scribbling the order on the chart.

“All right. I’ll have to get Davis—”

“Well, get her.” He waited until the medications nurse came into the station.

“A half grain, Doctor?”

“That’s what it says on the order sheet.”

She opened the drawer, slowly, began to prepare the syringe. Ned watched her take out the two quarter-grain tablets, drop them into the syringe, draw in a cc of water. She took a small alcohol sponge in one hand, picked up the syringe.

He held his hand out. “I’ll give it,” he said tightly.

Her eyes widened for just an instant. Then: “If you wish.”

“I wish.” He took the syringe and turned to Allison. “After I give this I want you to check Mrs. Conway every fifteen minutes without fail until you go off duty... I mean you, not somebody else, okay? I want that woman kept out of pain tonight if you have to give her a half a grain every quarter hour until dawn. Got that now?”

“Check her every fifteen minutes,” said Allison, her eyes wide. “I’ll take care of it.”

“Fine,” said Ned Thompson. He glared at Davis, then turned on his heel and strode down the hall.

He was still fuming when he met Gibby for coffee at 11:00. “I spilled it,” he said. “I’m sorry, but if she doesn’t know we’re onto her now, she’s an imbecile.”

Gibby looked stricken. “I thought she gave me a funny look when she checked out the drawer with me a little while ago. And you know, there haven’t been any complaints all evening. But she didn’t seem scared. She kept giving me that weird little grin of hers. Patronizing, almost.” The girl stirred her coffee in silence for a moment. “Oh, Ned, why did you have to do it that way?”

Thompson shook his head, “I couldn’t help myself. Of all the vicious—” He broke off helplessly. “Gibby, Margaret Conway has had the Bad Disease for a long time, and she’s put up a real fight, right from the first. I just couldn’t stand around and know what was happening and let that creature get away with it. Not with Margaret. If it blows off the lid, it blows off the lid. I’m sorry.”

Gibby shrugged. “I just hope it doesn’t do worse than that. If she stays, she’s going to get her stuff — somehow. But if she can’t withhold it from the patients, what can she do?” She dug into her handbag and produced a small envelope. “I filched this out of her handbag this evening. Took it from a pillbox holding a dozen or more just like it.”

Ned rolled the tiny dead-white tablet out on his palm, and whistled. “It sure looks like the real stuff. But it could be nitroglycerine or atropine or half a dozen other things that aren’t narcotic—”

“It could be M.S. that she’s just stolen, too,” said Gibby. “You’re the doctor. How do you tell?”

Ned dropped the envelope in his pocket. “I’m not sure,” he said. “But don’t worry. We’ll find out.”

At 3:00 a.m. they called him to see Mr. Wilcox. “He’s had a bad night ever since we came on,” the night floor nurse said on the phone. “First he had some trouble breathing, and now he’s complaining of chest pain—”

Ned sighed and slipped on his clothes in the dark. The corridor in the quarters was dim; as he stood waiting for the elevator he tried to shake away sleep and orient his thinking. George Wilcox had been doing well — but so soon after a coronary anything could happen. On Fourth he found the man moaning quietly, his face ashen, one hand to his chest.

“When did it start, George?”

“Couple of hours ago, Doc. I thought maybe I could sweat it out, but it’s getting worse. Took a couple of my nitroglycerine like I used to, but it didn’t ease up a bit.”

“Well, this isn’t a job for nitroglycerine.” Ned listened to his chest and checked his blood pressure, then attached the electrocardiograph leads. After a few moments he rolled up the tracing.

“Can you give me something for it, Doc? It’s really hurting.”

“We’ll take care of that, don’t worry. This will probably pass — the tracing doesn’t look bad at all.”

It didn’t look good, either. Ned could not tell whether the changes indicated fresh damage or merely an extension of the old — an expert reading in the morning would tell that; but George Wilcox was in trouble. Back at the nursing station Ned made a note on the chart and wrote orders with the night nurse peering over his shoulder.

“He gets sick with M.S., you know,” the nurse said.

“So he does. We’d better make this a hundred milligrams of Demerol, and put him in the oxygen tent for the rest of the night. We’ll see how he looks in the morning.”

In the intern’s quarters he sat staring at the clock, and out at the growing light in the East. He was wide-awake now. With a disgusted sigh he went out to the lounge and poured himself a cup of coffee.

Presently he took the white tablet Gibby had given him out of his pocket and stared at it. It looked like a sixth-grain tablet of morphine sulphate. But there was no mark to distinguish it from non-narcotic drugs like nitroglycerine, used for relief of the pain of angina pectoris — or atropine, given pre-operatively to reduce secretions. The Narcotics Bureau could analyze it, of course, and tell them what it was — but that might take weeks, and even then it would be evidence that had been illegally obtained...

He stared at the tablet, and then suddenly popped it under his tongue. He waited for a few moments. Nothing happened. Then his fingers began to tingle as a feeling of warmth crept down his arms and legs. He felt suddenly light-headed as he stood up. In the mirror his face was flushed, his pupils large and black.

He didn’t have a blood pressure cuff on, but he knew what it would show. The tablet was not morphine sulphate. Nitroglycerine. A vascular dilator, used by patients with angina pectoris to ease the pain of their hungry heart muscle. About as dangerous as a shot of good whiskey, and not even remotely as narcotic.

He shrugged in disgust and went back to bed.

He was tired the next day, and by afternoon he felt it in every bone. It was a day of heavy admissions, with too many little decisions to make, too much rapid thinking-deciding-forgetting-reconsidering-remembering-checking which is the intern’s work. When Endicott relieved him at 5:30 he drove downtown to supper, took in a very dull movie, and was back at the hospital by nine, determined to sleep and angry because he was still wide-awake.

Instead of sleeping he read, or pretended to read, but his mind kept coming back in anger and bafflement to the thin brown nurse on the Fourth floor.

How was she getting her drugs?

He had checked with Gibby when he returned, and heard what he had dreaded hearing. No significant complaints. A tight, patronizing smile on Davis’s lips — and no sign of any narcotics withheld.

But something more fundamental lay deeper: why did she do it? That was the question that was so baffling, the thing that made it so sickening and shameful. What she was doing was cruel and vicious, certainly, but it was not the cruelty of meanness. It was not cruelty for the sake of cruelty. It was, ultimately, the cruelty of selfishness — utter, abysmal, soul-consuming selfishness. She glutted herself at the expense of the pain and need of others. She drank, and in drinking fouled the spring. But surely she had not always been that way. What strange door in her mind had opened and started her need? The door of idle curiosity? Of bitterness and hunger? The hope of filling ever-so-briefly some gaping well of loneliness? Of brightening for a few moments some barrenness of life? Perhaps... but how much more lonely she was now, how much more barren! She must have fought it once — fought to close the door. Now she no longer fought — she fed on it. Now she didn’t care about the pain and need of others...

And that, of course, was what made her so dangerous. She didn’t care any more. Normal restraints of common humanity had been sidetracked, somehow. They didn’t apply to her any more. That was why she couldn’t simply be sent away.

And always you knew she’d be back, someday. Another face, another body, but she’d be back—

He growled at himself and picked up the phone, even though it was barely 10:00. “Got the chow hall open, Gibby? Be a good girl, huh? I’m starving.”

He met her in the basement corridor, and there was trouble in her eyes. Her blonde hair was rumpled, her cheeks very red. She looked close to tears. “I don’t like this, Ned. I’m beginning to get scared.”

“No complaints, eh?”

“Nothing.” She pushed back a stray forelock wearily. “I pushed this thing, and now I’m afraid it’s getting out of control. Maybe we should have fired her, right at the start, just got rid of her and forgotten the whole mess.”

“It won’t go away just because we close our eyes, Gibby. You know that.”

“But what can we do?”

“Watch and wait.”

“That’s what scares me. What are we waiting for?”

“If we knew that we’d have her right where we want her.” Ned sighed. “If only there were some way we could really put the screws on her, shake her down—”

“Well, there isn’t.”

“No, I mean unofficially. Get Endicott into it with me, and the two of us can take her out somewhere and break her apart.”

“Oh, that would be just great,” said Gibby heatedly. “Get right down in the gutter and fight it out on her level, I suppose! And you’re supposed to be a doctor.”

“Well, damn it, Gibby—”

“Now look, Dr. Thompson — you either forget about that sort of thing, or else you can forget I ever thought you were worth spitting at. If you so much as lay a hand on her you can count me out, do you understand? I won’t play it that way, that’s all. I just won’t” She blew her nose and tried to wipe her eyes with her starched cuff. “I love my work more than anything else I know. I wouldn’t ever want to do anything except nursing, and I hate people like that woman who come in and dirty it and degrade it. But I won’t let them get me dirty trying to stop them.”

He watched her across the table, then suddenly grinned and tossed her his handkerchief. “Blow,” he said. “Go ahead, don’t be afraid, wake up the whole first floor. We’ll sweat it out a while longer.”

“None of this strong-arm stuff?”

“Not a bit of it.”

She grinned back, and blew with vigor. “Maybe you’re not such a slob after all,” she said.

He took Gibby’s master key to the narcotics drawer — an infringement of the strictest of all hospital rules — after promising faithfully to return it to the nursing office when he was through, and made his way to Fourth floor after the shift change at eleven o’clock. Somewhere there was an answer; there had to be, yet in three days they were further from the answer than when they started.

He walked into the medications alcove, took a stool, and sat staring at the high wall cabinets filled with stock medications, at the gleaming stainless-steel sink, the syringe sterilizer, the sterile tray with needles, sponges, tourniquets, forceps. This was where she worked, her niche, her corner in the busy activities of the place — but the walls did not repeat the echoes of her thoughts.

Murky thoughts, Ned Thompson reflected. Desperate and empty thoughts. No escape from the everpresent fear of all drug addicts, even here in the midst of plenty. He opened the drawer, stared down at the tubes and vials and ampules. Piece by piece he emptied the drawer, narcotics tray, emergency tray, injection medications of all sorts, trying to think as she would think, to see what she might see, trying to find the simple answer he knew could be found here. Thinking—

But what does a drug addict think? A preoccupation with two principles, with all else cast aside. First: get the drug, at any cost whatsoever; second: don’t get caught. Simple, and imponderable.

And then, quite suddenly, another kind of door opened in his mind — and he knew what Jane Davis was doing. It was obvious — and fearful. He blinked at the drawer open before him, and smoked a cigarette, and then-smoked another. Then, quickly, he replaced the drugs and slammed the drawer shut, as though he had to get it closed quickly, quickly, while there was still time. He wiped large wet drops from his forehead.

He knew now that they couldn’t go on waiting any longer. They wouldn’t catch her because they couldn’t risk it at this price. Fire her, yes, get rid of her, fast, while there was still time. But no more waiting—

He started to call Gibby, then realized how foolish it was. She’d be in bed, there would be plenty of time to warn her in the morning that Davis mustn’t come to work another day, not another hour. By three o’clock the formalities could be taken care of.

He went downstairs and fell asleep like a rock. At breakfast he would tell Gibby...

But he never got to breakfast. His day started at 5:15 A.M. with a call to the emergency room that drove every other thought from his mind. There are few true medical emergencies that demand immediate action, on the spot, now; but diabetic acidosis is that kind of emergency. The patient was a boy of seven years who had never been suspected of diabetes before. When he arrived at St. Christopher’s emergency room, he was nearly dead. Ned Thompson met Dr. Morton, the attending man, coming in the door to the hospital as Ned ran upstairs; they nodded without words, because they knew what lay ahead for both of them.

After six hours of solid unbroken work, they knew the child would not die if they kept at it. Morton took a break for lunch, and brought Ned back a sandwich. Later, Ned stepped out into the corridor for a smoke, and nearly tripped over the floor nurse coming to fetch him. “They’ve been paging you for half an hour, Doctor. You have a new coronary in 301, just came in the ambulance, and three other new patients to see—”

It was one of those days. He saw the coronary just long enough to assure himself that an expiration was not imminent, and got back to the diabetic. By four o’clock in the afternoon Dr. Morton nodded, glanced over the chart, and then at the boy, who was sitting up in bed, wan but cheerful. “Well, I think we’re out of the woods. These juveniles are tough.”

“You’re telling me,” said Ned. “You think these fluid orders will hold him for an hour or so?”

“I think so.” The older man slipped on his jacket. “And Ned — thanks. Hope you haven’t got too much piled up on you.”

He left as Dr. Endicott stuck his long nose into the room. “Say, Ned — old Wilcox is having trouble up on Fourth. Will you have a chance to look in on him?”

Ned stepped into the corridor with him. “What’s wrong?”

“Well, you know as well as I do. Dr. Frank read yesterday’s tracing and figured he was extending, and he just hasn’t got much anterior cardiac wall left to work with. I talked to Frank about it, and he’d like you to look in, then give him a call.”

Ned nodded. “Heavy schedule upstairs today?”

Endicott’s face settled into a grimace. “It’s the Chopper’s day to scream, you know. He’s starting one of these subtotal disembowelments in about ten minutes and I’m anchor man on the retractor.”

Ned was checking the boy again when he heard himself being paged. It was Allison on Fourth. “You’d better come up right away, Doctor. It’s Mr. Wilcox. He’s very bad.”

“But Dr. Endicott just saw him—”

“He’s got much worse in just the last few minutes.”

“Chest pain?”

“Terrible pain. He had a hundred milligrams of Demerol at two o’clock and then fifty more an hour ago—”

“Give him another hundred. I’ll be right up.” He slammed down the telephone, swearing under his breath. The diabetic’s chart was still in his hand; he scribbled some orders, studied them a moment, trying to force Mr. Wilcox out of his mind, then grunted in approval and started for the stairs. On the way he met another of the attending men, and was stopped for a report on another patient. It was almost ten minutes before he reached the Fourth floor, and nearly tripped over Jane Davis emerging from Mr. Wilcox’s room—

He stared at her, unbelieving, then remembered with a jolt. He hadn’t told Gibby. He hadn’t even seen Gibby. The nurse’s eyes caught his, held them for an instant — bottomless, expressionless eyes.

“That the Demerol for Wilcox?”

She nodded, and moved past him down the hall.

On the bed George Wilcox was gasping, his hand pressed tight to his chest. He looked bad. A single glance at the gray-faced man told Ned Thompson more than a dozen questions. Allison was there in the room, moving birdlike, twittering in her over-efficient way. Ned checked the man’s blood pressure. “Get an ampule of nor-epinephrine in 500 cc of water. Quick!”

She started for the door. The man in the bed gave a sudden loud gasp, turned blue, convulsed—

“Wait,” said Ned Thompson.

“It’ll only take two minutes, Doctor.”

“That’s two minutes too long.” He stared at the pinprick in the man’s arm, the tiny trickle of blood already congealing, the stained sponge fallen down from the injection site.

And then with a snarl he was out the door, pelting down the hall to the nursing station and into the medications alcove.

The woman there whirled, her eyes wide. The syringe still lay on the tray, the tiny glass ampule sitting on the counter nearby...

She kicked him hard in the shin, cursing as her hand flashed out for the ampule. Ned’s hand crashed down on her wrist until she screamed out, her fingers opening to release the tubule. Swiftly he plunged his hand into her pocket, felt another ampule there, unbroken. He tossed it out on the counter beside the other. “All right now,” he panted, “that’s all for you. You’ve got a murder to answer for now.”

“I should have seen it as soon as I knew it was nitroglycerine in her purse,” he said later to Gibby. “The only people who carry nitroglycerine are people with angina pectoris, and she didn’t have that trouble, not at her young age. There was only one other thing she could have wanted it for — and I made my mistake when I didn’t realize what fantastic chances she’d take. We knew she was withholding drugs, of course. It didn’t even occur to me that she might start substituting—”

“But why the nitroglycerine?”

“It’s indistinguishable from morphine, in tablets like that. It dissolves like morphine. There are plenty of coronaries on this floor getting morphine who might even get some pain relief from the nitro she gave them when she pocketed the morphine. But Demerol was different — it’s already dissolved, in sterile ampules, in solution. And in the emergency tray right in the same drawer, another drug, also dissolved, in solution, in identical ampules.” He sighed and rubbed his forehead. “I knew last night that she must be substituting Coramine for Demerol. A powerful cardiac stimulant. As good a way to kill a man with a sick, weakened heart muscle as a bullet through the brain. She’s undoubtedly used it before and got away with it. This time she picked a man who was a little too sick.”

Gibby sighed and turned back to her coffee. “Feels funny,” she said. “It’s such a relief to have it over — but now there’s nothing to watch.”

“Come watch a movie with me tonight, then. You need a rest. There’s one downtown that will rest you just fine.”

“Oh?”

“They say it’s a great picture,” said Ned Thompson. “All about this doctor that strangles his patient, see—”