Foreign Body

Chapter 14

October 17, 2007

Wednesday, 1:42 p.m.

New Delhi, India

“How long will you be, madam?” the driver asked. He was holding the car door as Jennifer climbed out. During the ride from the hotel to the hospital she had managed to fall asleep for some twenty minutes or so, and now felt distinctly worse than she had when she’d started. Still, she wanted to talk with Kashmira Varini.

“I’m not sure,” Jennifer said, looking up at the hospital. She’d just gotten the idea to go up to the fourth floor where she’d been told her grandmother’s room had been and see if she could find the day nurse who’d been assigned to her case. “But it won’t be long, not the way I feel.”

“I’ll try to stay here,” the driver said, pointing down at the ground, “but if the doormen chase me, you’ll have to call my mobile.”

“No problem,” Jennifer said.

As had been the case on the earlier visit, the two colorful doormen opened the double doors without Jennifer having to say a word. Because it was hotter outside than it had been that morning, it felt colder inside. As far as she was concerned, it was definitely over-air-conditioned.

At that time there were forty to fifty people in the lobby, all either upper-middle-class Indians or well-to-do foreigners. Near the admitting desk were a handful of prospective patients, some sitting in wheelchairs. A number of hospital staff were in evidence with their charges in varying stages of the admitting process. Glancing into the coffee shop, Jennifer could see it was full, with some people standing and waiting for tables.

With the aplomb garnered from all the hours she’d spent in a hospital, Jennifer didn’t hesitate in the slightest from making her way over to the elevators. When she boarded, she made certain the button for the fourth floor had been pressed, and then melted into the background.

For Jennifer, the patient floor was one of the most pleasant she’d seen, and she’d seen her share. The floor itself was covered with attractively colored high-quality sound-absorbing industrial carpet, and combining it with a high-tech acoustic ceiling and walls constructed of sound-dampening material, the ambient noise was muffled down to almost nothing. Even the sound of a large, fully loaded food tray cart was minimal as it passed behind Jennifer while she walked over to the nursing station.

Several patients had just returned from surgery, so most everyone was busy, including the floor clerk. Jennifer just watched. She was impressed how similar the protocols for running the floor seemed to be to what she’d experienced at UCLA Med Center, despite her being halfway around the world in a developing country.

In a relatively short time the immediately postoperative patients had been settled in their rooms, stabilized, and returned to the company of their next of kin. As abruptly as it had started, the flurry of activity dissipated. It was then that the floor clerk, whose nametag said merely “Kamna,” happened to notice Jennifer. “Can I help you?” she asked.

“I believe you can,” Jennifer responded. She wondered if Kamna was a proper name or meant something like clerk. “My name is Jennifer Hernandez, and I am Maria Hernandez’s granddaughter. I believe she was a patient on this floor.”

“You are correct,” Kamna said. “She was in room four-oh-eight. I’m very sorry.”

“I am, too. Is this a common problem here?”

“I’m not sure what you mean.”

“Are deaths relatively frequent?”

Kamna jerked almost as if Jennifer had hit her. Even the head of one of the nurses using a computer terminal bobbed up with a shocked expression on her face.

“No, it is very rare,” Kamna said.

“But there was another one just last night around the same time. That’s two in a row.”

“That’s true,” Kamna agreed nervously. She looked down at the nurse for support.

“I’m Nurse Kumar,” the woman said. “I’m the head nurse on this floor. Can I be of assistance?”

“I wanted to speak to whoever was taking care of my grandmother.”

“There were actually two. First there was Ms. Veena Chandra, who is new to our staff, and since she is new, a senior nurse by the name of Shruti Aggrawal was assigned to supervise.”

“I suppose it would be safe to say that Ms. Chandra would have been the person actually interacting with my grandmother.”

“That’s correct. Everything had gone entirely normally. There had been no problems whatsoever. Mrs. Hernandez had been doing excellently.”

“Is Ms. Chandra available?”

Nurse Kumar paused while giving Jennifer a moment of scrutiny, perhaps worried that Jennifer could possibly have been a deranged woman in the hospital to exact revenge. Everyone was acutely aware of the Hernandez demise. But apparently, Jennifer had passed muster. “I don’t see why not. I’ll see if she can speak with you now.”

“Perfect,” Jennifer said.

Nurse Kumar got up, walked down the corridor a way, and after a quick glance back at Jennifer, disappeared into a patient’s room.

Jennifer glanced back at Kamna, who’d not moved a muscle. She was clearly still unsure of Jennifer’s mind-set and intentions. Jennifer flashed a smile, intending to calm the woman, who appeared like a rabbit ready to flee. The woman flashed a smile back, one even more fake and fleeting than Jennifer’s. Before Jennifer could try to put the woman at ease, she saw Nurse Kumar emerge from the patient room with a young nurse in tow. Jennifer blinked. Even in a nursing uniform, the newly hired nurse looked like a beauty queen or a movie star, or even more irritating, as far as Jennifer was concerned, a lingerie model. She was the kind of female who never failed to make Jennifer feel fat. She had a perfect body and a photographer’s dream face.

“This is Nurse Veena Chandra,” the head nurse said when the women had reached the station. At the same moment, the elevator arrived and out stepped one of the uniformed guards Jennifer had seen downstairs. Since he just seemed to be lingering in the background, Jennifer sensed that the head nurse had called down when she’d been out of sight.

Veena greeted Jennifer, palms together. Jennifer tried to imitate the gesture. Veena was even more beautiful up close, with flawless bronze skin and stunning green eyes, which Jennifer found mesmerizing. The problem was the eyes didn’t engage hers except for fleeting moments before looking away, as if Veena was bashful or somehow self-conscious being in Jennifer’s presence.

“I’m Jennifer. Mrs. Hernandez’s granddaughter.”

“Yes, Nurse Kumar has told me.”

“Do you mind if I ask you a few questions?”

Veena exchanged a quick uncertain glance with her head nurse, who nodded that it was okay.

“I don’t mind.”

“Maybe we could step over to those chairs by the window,” Jennifer said, pointing to a small sitting area with a modern couch and two chairs. Jennifer felt crowded by the head nurse and the clerk, who were standing like statues, hanging on every word.

Veena again looked to Nurse Kumar, which began to confuse Jennifer. The woman was acting as if she were twelve, whereas Jennifer guessed she was in her twenties, even if just barely. She was acting as if she would have preferred being anywhere but where she was, facing a conversation with Jennifer.

Nurse Kumar shrugged and gestured toward the sitting area.

“I hope I’m not making you uncomfortable,” Jennifer said to Veena as they walked over and sat down. “I didn’t even know my grandmother was in India when I learned she had died. So I’m not very happy about her death, to put it mildly, and I’m looking into it to a degree.”

“No, you’re not making me uncomfortable,” Veena replied tensely. “I’m fine.” For a brief moment the image of Maria Hernandez’s contorting face flashed in her mind’s eye.

“You are acting very nervous,” Jennifer commented, trying vainly to make sustained eye contact.

“Maybe I’m afraid you are angry with me.”

Jennifer reflexively laughed, not loud but more in surprise. “Why would I be angry with you? You helped by grandmother. My goodness. No, I’m not angry. I’m thankful.”

Veena nodded but seemed unconvinced, although she did allow herself more eye contact.

“I just wanted to ask you how she was? Did she seem happy? Did she suffer at all?”

“She was fine. She wasn’t suffering. She even talked about you. She told me you were becoming a doctor.”

“That’s true,” Jennifer said. She wasn’t surprised. Her grandmother was extremely proud of what Jennifer had done, and to Jennifer’s chagrin bragged about it to anyone who would listen. Jennifer tried to think of what else to ask. She actually hadn’t given it a lot of prior thought. “Was it you who found Maria after her apparent heart attack?”

“No!” Veena said comparatively explosively. “No, no,” she repeated. “Mrs. Hernandez died on the evening shift. I work days. I’m off at three-thirty. I was home. This is my first month working here. I work days with supervision.”

Jennifer regarded the young nurse, who was, in actuality, a contemporary. Jennifer couldn’t help but feel there was something amiss, as if they weren’t quite on the same wavelength. “Can I ask you a couple of personal questions?”

Veena nodded hesitantly.

“Have you recently graduated from nursing school?”

“About three months ago,” Veena said, nodding.

“Is my grandmother the first patient you’ve lost?”

“Yes, she was,” Veena said with another nod. “The first private patient.”

“I’m sorry. It’s never easy, whether you’re the doctor, the nurse, or even the medical student, and I’m certainly not angry with you. The fates, maybe, but not you. I don’t know if you are religious, but if you are, doesn’t your religion provide a source of comfort? I mean, apparently, it was my grandmother’s karma to leave this life, and maybe in her next life she won’t have to work quite so hard. She really worked hard all her life, and not for herself. She was truly a generous person. The best.”

When Jennifer saw Veena’s eyes glaze over with tears, she felt she had figured out the source of the nurse’s distress. Granny had been her first death as a real nurse, a difficult milestone, which Jennifer could certainly relate to. “You are a dear for caring so much,” Jennifer added. “I don’t mean to make you feel uncomfortable. But I do have a few more questions. Do you know much about my grandmother’s actual death? I mean, like, who found her and what were the circumstances? Even what time it was?”

“It was Theru Wadhwa who found her when he went in to see if she wanted sleep medication,” Veena said, wiping the corners of her eyes with a knuckle. “He thought she was asleep until he noticed her eyes were open. I asked him about it last night when he came to work, since she was my patient and all.”

“What time was it, do you know?” Jennifer asked. Having uncovered the young woman’s secret and broached the issue, Jennifer expected she’d relax. But such was not the case. If anything, she seemed even more anxious. Her hands were working at each other in her lap as if in a wrestling match.

“Around ten-thirty.”

“Since you talked directly with the nurse, did he describe her in any particular way? I mean, did she look calm, like it was an easy death? Did he say anything like that?”

“He said she looked blue when he turned the lights on and called a code.”

“So they tried to revive her?”

“Only briefly. He said it was apparent she was dead. There was no cardiac activity at all, and she was cool and already a little stiff.”

“That’s dead, alright. What about the blueness? Do you know if he meant more gray or really blue?”

Veena looked off as if thinking. Her hands detached from each other gripped the arms of the chair. “I think he meant blue.”

“Cyanosis-like blue?”

“I think so. That’s what I assumed.”

“That’s curious for a heart attack.”

“It is?” Veena asked, somewhat surprised.

“Did he say allover blue or just, like, blue lips and blue fingertips.”

“I don’t know. I think allover blue.”

“What about Mr. Benfatti?” Jennifer asked, rapidly switching the subject. She’d suddenly remembered stories of so-called angels of death, healthcare serial killers, who also were the ones who “found” their victims after the fact, sometimes to try to save them.

“What about Mr. Benfatti?” Veena questioned, startled.

“Did Nurse Wad-something happen to find him as well last night?” Jennifer asked. She knew the answer would be no, but she had to ask it anyway.

“No,” Veena blurted. “Mr. Benfatti wasn’t on this floor. He was on three. I don’t know who found Mr. Benfatti.”

“Ms. Hernandez!” a voice called from behind Jennifer. Startled, Jennifer turned and looked up. It was Head Nurse Kumar, who’d walked over from the central desk.

“I’m afraid Ms. Chandra has to get back to her patient. Also, I called down to Mrs. Kashmira Varini to let her know that you were here. She asked me to ask you to come by her office. She said you knew where it was. I’m sure she can handle any more questions you might have.” Nurse Kumar motioned for Veena to return to her charge.

Both Jennifer and Veena stood.

“Thank you very much,” Jennifer said. She reached out and shook hands with the woman and was surprised that her hand was like ice.

“You are welcome,” Veena said hesitantly, reverting back to acting like a shy girl. Her eyes darted self-consciously between the two women. “I’ll get back to work.”

Jennifer watched her walk away, lamenting just how little she’d be able to eat and how much she’d have to exercise to have an equivalent body. She then turned her attention and acknowledged as much to Nurse Kumar: “A beautiful woman.”

“You think so?” Nurse Kumar questioned stiffly. “You do know where Mrs. Varini’s office is, I trust.”

“I do,” Jennifer agreed. “Thank you for your help in allowing me to speak with her.”

“You are entirely welcome,” Nurse Kumar said, but she then abruptly spun on her heel and headed back toward the nurses’ station.

Sensing a snub of sorts, Jennifer walked over to the elevators. She thought briefly of asking to see her granny’s room but changed her mind. She knew it would look like any hospital room, just upscale. When the elevator came and she boarded, she noticed the guard who’d come to the floor earlier did, too. She was clearly being treated with great suspicion.

As the elevator descended, Jennifer thought over the conversation she’d had with the newly hired nurse. She was touched the woman was still so emotional about Granny’s passing, since she probably had spent only hours over the course of several days in Granny’s presence. Of course, the most interesting part of the conversation was about Granny’s reputed cyanosis. Closing her eyes for a second, Jennifer transported herself back to physiology class and tried to scientifically think what kind of heart attack might cause generalized cyanosis. Unfortunately, she couldn’t think of any. The only thing that came to mind was possible aspiration and choking on food. To get generalized cyanosis, Granny’s heart would have had to have been pumping fine; it would have had to be her lungs that weren’t doing their part.

Jennifer opened her eyes. Such thinking raised the issue of smothering. Someone could have smothered her grandmother and produced generalized cyanosis, but as soon as the idea occurred to her, Jennifer actively swept it from her mind. She couldn’t believe how paranoid she was becoming. She felt embarrassed. She knew, just as she knew where her next breath was coming from, that no one had smothered Granny.

The elevator landed at the lobby and most everyone got out, including Jennifer, who made it a point to lock eyes for a moment with the guard, who was holding the doors ajar. “Why, thank you,” Jennifer said brightly. The guard acted surprised to be addressed but didn’t return the nicety.

Wasting no time, Jennifer headed to the marble front desk, rounded it, and walked to Kashmira Varini’s open door. Jennifer rapped on the jamb. Kashmira was at her desk, filling in a form. “Come in, please,” she said when she looked up in response to Jennifer’s knock. She stood and went through her usual greeting, which Jennifer merely acknowledged with a slight bowing of her head. Kashmira then motioned to a seat and Jennifer dutifully sat. Jennifer looked at Kashmira.

“Thank you for coming back,” Kashmira said. “I hope you had a refreshing nap.”

“I didn’t sleep a wink.”

“Oh!” Kashmira voiced, apparently expecting a more positive reaction to what she meant more as a rhetorical question. She was definitely hoping to begin the discussion on a more favorable note then it had ended that morning in the basement. “Did you get something to eat? I could order you a small sandwich or a salad.”

“I had my lunch, thank you.”

“Did you see your consular officer at your embassy?”

“Nope,” Jennifer said and then added, “Mrs. Varini—”

“Please call me Kashmira.”

“Okay, Kashmira. I think we should clear the air. This morning I specifically asked you about Mr. Benfatti. You lied to me. You said you didn’t know anything about a Mr. Benfatti, and then I learn you are his case manager. What gives?”

For a moment, Kashmira pondered her words. She cleared her throat before speaking. “I apologize for that. It came out of a sense of frustration. I was trying to convince you to stay on the subject of your grandmother and the dire need to make a decision, which should not be so difficult. I’m sure you know we do not talk about other patients. That’s what I should have said. I must confess I was exasperated with you, and still am to a degree. I just got a call from Lucinda Benfatti, and she has informed me that you specifically advised her to wait with her decision as well. Now, I know she’d thought about waiting until her sons got here, but I was hoping that after the shock wore off, I could ask her to ask them their preference before they started their trip so the body could be dealt with appropriately. That’s how it has always worked in the past. This kind of problem has never come up before.”

“Are you saying that dealing with patient death is a common problem here?”

“Quite the contrary,” Kashmira said forcefully. “Don’t read something into my words which is not there.”

“Okay, okay,” Jennifer said, afraid she might have pushed the woman a little too far. “Thank you for your apology, and I accept. Actually, I’m impressed how you explained it. I was very curious how you were going to, because I didn’t think you could.”

“This issue about your grandmother has me entirely flummoxed.”

“It’s nice to know we at least see eye-to-eye about something,” Jennifer mumbled.

“Excuse me?”

“Forget it,” Jennifer added. “I was making a bad joke. But there is something I would like to see. I’d like to see my grandmother’s death certificate.”

“What on earth for?”

“I just want to see what it has on it as the cause of death.”

“It has heart attack, just like I said.”

“I’d still like to see it. Do you have it, or at least a copy?”

“I do. It’s in the master folder.”

“May I see? I assume I’ll be getting a copy at some point anyway. It’s not a state secret.”

Kashmira thought for a moment, shrugged, and pushed herself in her chair over to a bank of file cabinets. Pulling out one of the drawers, she scanned the tabs and eventually pulled out an individual file. Opening it, she found a very Indian-looking government document. She returned to the desk, handing the document across to Jennifer.

Jennifer took it, and seeing her grandmother’s name gave her a stab of emotion. The languages were Hindi and English, so she had no trouble going over it. She scanned the hand-lettered entries to alight on the cause of death, heart attack, and the time of death, ten-thirty-five p.m., October 15, 2007. Jennifer committed it to memory and handed the paper back to Kashmira. Kashmira returned it to the file and the file to its rightful place in the cabinet.

Scooting her chair once again back to the desk, Kashmira glanced over at Jennifer. “Now! After all is said and done, are you ready to tell me what we are to do, cremate or embalm?”

Jennifer shook her head. “I’m at my wit’s end as well. But there’s hope on the horizon. My grandmother was nanny to a woman who has conveniently become a forensic pathologist. I spoke with her, and she’s on her way here, which will, I believe, have her arriving tomorrow night. I’m going to defer to her and her husband, who is a medical examiner as well.”

“I remind you, forensic pathologists or not, it will make no difference. There’s to be no autopsy, period. It has not and will not be authorized.”

“Maybe, maybe not. At least I’ll feel like I’ve got someone on my side. I know I’m not thinking too well. I’m utterly exhausted, but I can’t sleep.”

“Perhaps I could get you some sleeping medication.”

“No, thanks,” Jennifer said. “What I would like is a copy of my grandmother’s hospital records.”

“That can be arranged, but it might take twenty-four hours.”

“Whatever! And I’d like to talk to the chief surgeon.”

“He’s very busy. If you have some specific questions, write them down, and I’ll try to get some answers.”

“What if there was malpractice involved?”

“There is no such thing as malpractice in an international setting. Sorry.”

“I have to say you’re not being very helpful.”

“Listen, Miss Hernandez. You would undoubtedly find us more helpful if you would be cooperative with us.”

Jennifer stood up.

“Really,” Kashmira said. “I could get you something for sleep. Perhaps after a good night’s rest you’d come to your senses and realize you must make a decision. Your grandmother cannot stay in our cooler.”

“I already realize that,” Jennifer said. “Why not transfer the body to a regular city mortuary?”

“That would be impossible. Public mortuaries in our country are in frightful condition thanks to our byzantine bureaucracy. Mortuaries are administered by the home ministry, not the ministry of health, as they should be, and the home ministry cares little about them and grossly underfunds them. Some have no refrigeration, others only intermittently, and bodies routinely rot. To be brutally honest, we cannot allow that to happen even to your grandmother because of the potential negative media consequences. We’re trying to help you. Please help us!”

All at once, Jennifer felt off-balance. She got to her feet. Although still being less than tactful, Queen Victoria Hospital seemed to be going from trying to bully her to pleading with her. “I’m going back to the hotel,” Jennifer managed. “I need to rest.”

“Yes, you go have a long sleep,” Kashmira said. She stood as well and bowed over her pressed-together hands.

Jennifer stumbled out into the confusion of the lobby, where a dozen more admissions were waiting to be processed. She went to the front glass wall and looked for her car and driver in the hospital’s small turnout. Not seeing him, she pulled out her cell phone and punched in the numbers.