Night Shift

Prologue

New York City

Monday, December 6

Dr. Susan Passero, an internist at the Manhattan Memorial Hospital, known colloquially as the MMH, ushered her forty-first and final patient of the day, Florence Williams, out of the examination room. It was nearly 6:00 p.m. She said a warm goodbye and encouraged Florence to keep up the good work adhering to her rather complicated medication schedule. Returning into the room, Sue took a deep breath, readjusted her Covid-19 mask, and sat back down at the computer terminal to finish the required entry. Like most doctors, she despised being so chained to the demands of the electronic health record because of the interference it invariably caused between her and her patients, yet she knew that modern medicine demanded it. When she was finished and had dutifully checked all the necessary boxes, she washed her hands for the thousandth time that day, pocketed her stethoscope, and headed out into the clinic proper.

As per usual she was the last doctor to finish seeing the scheduled patients, so the clinic was all but empty. At the far end the housekeeping crew was already starting the daily cleaning. Sue waved to them since she was on a first-name basis with several, and they waved back. Up until then it had been a normal, busy Monday, and Mondays were always the busiest day of the week since on top of the scheduled visits, a number of the patients who’d come into the Emergency Department over the weekend often needed follow-up.

Sue Passero was a big-boned, athletic African American woman whose body habitus still reflected her accomplishments in the collegiate sports of soccer, basketball, and softball. Mindful of her appearance, she was wearing a silk dress under her white doctor’s coat, her hair in a contemporary short, spiky style. As an outgoing person she was friendly to everyone at the hospital, particularly food service personnel and the cleaning people. Despite being a board-certified internist with subspecialty training in cardiology, she was never tempted to assume a holier-than-thou attitude with the other hospital employees like some narcissistic doctors she knew. The reason was simple. Out of necessity through high school, college, and even medical school, she’d worked at just about every low-level academic medical center job, including cleaning monkey cages. The result was that she sincerely appreciated everyone’s input. At the same time, she was demanding. No matter what someone’s work entailed, they had to give one hundred percent, which was the way she had always approached her duties.

“All done!” Sue called out to Virginia Davenport after leaning into the scheduling secretaries’ office. Like Sue, Virginia was always the last clinic secretary to leave for the day. In her role as the most senior clinic employee, she took her job seriously, which was why she and Sue clicked and worked well together.

“Here’s your patient schedule for tomorrow,” she said, leaping up and handing a printout to Sue. Virginia was a tall, slender woman with an oval face framed by tight blond curls and punctuated with dark eyes and very white teeth.

“Thank you, girl,” Sue said, taking the paper like a handoff to a relay race sprinter as she moved quickly down the hallway. Now that she was done seeing patients, she wanted to wrap up the day, get in her car, and head home to New Jersey. As she hustled down to her tiny office, she glanced at the schedule. It looked like any other day of late, with thirty patients on the calendar, although that would invariably balloon up.

“I also printed that article about the medical serial killer that you asked me to,” Virginia said, running to keep up with Sue. “And here are the phone calls that came in while you were seeing patients that need a response from you.”

Without slowing, Sue took the phone messages and the article, glancing at the latter. It was a New York Times piece from October about a Texas nurse who had been found guilty of killing four postoperative patients by injecting air into their arteries. Entering her office, Sue slipped behind her desk and sat down. “You are a dear,” she said, looking up at Virginia, who had followed her. This final interaction between them was part of their daily routine before Sue’s departure. “Did you happen to read the article?”

“I did,” Virginia said. “It would be hard not to, seeing the title. It’s horrific that people are capable of that kind of behavior, especially in the medical profession.”

“What scares me about this particular case is that the nurse’s motivation was to keep certain patients in the intensive care unit so he could get more work hours. Can you believe it? I mean, it’s a new one for me. I can sort of understand, in a sick way, the so-called mercy killers who mistakenly profess to be saving people from pain and suffering. I can even intellectually understand the scarier hero syndrome, where misguided sociopathic fruitcakes are trying to burnish their image by putting patients in jeopardy to get credit for supposedly saving them.” As she was speaking, Sue pulled out a large blue folder from between two bookends. Opening it, she slipped in the article to join a number of other similar ones.

“It’s a terrifying thought, no matter what the motivation,” Virginia said. “The hospital is supposed to save people and certainly not kill them. I tell you, the world seems to be getting more and more crazy.”

“Any of these calls demand immediate attention?” Sue asked, holding up the list of names and phone numbers. “Or can I call on my way home?”

“Nothing earth-shattering,” Virginia assured her. Although trained in psychology and social work, rather than in healthcare per se, she had learned over the ten years she’d worked in the Internal Medicine Clinic to recognize true medical emergencies. From experience Sue had learned to trust her. “Has the MMH ever had such a problem?”

“Interesting you should ask. I’m afraid the answer is yes. About fifteen years ago, my friend Laurie Montgomery, in her inimitable style as a medical examiner extraordinaire, outed a nurse here who was being paid by a shady organization working for a health insurance company to kill postoperative patients who carried the markers for bad genes.”

Virginia knew Laurie from having set up numerous lunches and even an occasional dinner date for her and Sue. The two doctors were old friends from their college days and had gone to medical school together.

“Why?”

“To save the insurance company money. With their genetic baggage, the involved patients were destined to need lots of expensive healthcare.”

“Oh, my goodness,” Virginia said, covering her mouth with her hand in dismay. “That’s awful. That’s worse than the Texas nurse. How many patients were involved?”

“A half a dozen or so,” Sue said. “I don’t remember exactly. It was bad, and I’ve tried to forget the details but not the lesson. It was an awful reminder of how much business interests have taken over medicine. Especially with private equity trying to eke out every last penny of compensation.”

“That’s unfortunately true,” Virginia said. “And mentioning business interests reminds me that you have a Compliance Committee meeting tomorrow at noon.”

“Thank you. I appreciate the reminder, and if that’s it, I’m out of here.” Sue slapped the surface of her desk, stood up, and pulled off her long white coat. The fact that she had another committee meeting didn’t surprise her. As a particularly dedicated member of the MMH staff, she felt it was her duty to volunteer for multiple committees. Currently she was a member of the Mortality and Morbidity Committee, the Infection Control Committee, and the Outpatient Reorganizing Committee, as well as the Compliance Committee. On top of that, she was vying for a seat on the hospital board. Luckily Virginia Davenport was willing to assist with all this added work.

“You are all caught up,” Virginia assured her, heading for the doorway. “Drive carefully on your way home. See you in the morning.”

“Same to you on the subway.” Sue exchanged her white coat for her winter coat, which was hanging on the back of the door to the hallway. Picking up her mobile phone, purse, and the list of patients whom she needed to contact, she followed Virginia out into the hallway, where they parted ways. Sue was intent to get out of the high-rise garage before the rush of cars coming in for the night shift starting at 7:00. Although most of the employees came by mass transit, enough private vehicles were involved that it could be a minor traffic jam.

The route required taking the pedestrian bridge from the outpatient building to the main building and from there a second pedestrian bridge to the garage. Although a few of the night-shift personnel were arriving, as were some visitors, it was not nearly as busy as it would get between 6:30 and 7:00. Sue found her car where it had been parked that morning by the valet service in the doctors’ section, which was already mostly empty, as was usually the case. As she approached her beloved BMW with its heavily tinted windows, she reached into her coat pocket and fondled the electronic key fob, pressing the door open button in the process. The car responded by turning on its interior as well as outside lights.

Sue opened the driver’s-side door and tossed her purse into the passenger seat before slipping in behind the wheel. As she always did, she hung her ID lanyard on the rearview mirror. She reached for the starter button, but her hand never made it. To her shock and horror, a cloth hood was thrown over her head and pulled down around her shoulders. As she reached up to tear the hood away, an arm came around her throat, yanking her back against the headrest with such force that her back was arched away from the seat. Letting go of the hood, she tried to pull the arm away using both hands while crying out in utter terror. Unfortunately, her voice was muffled due to both the hood and the compression on her neck. In the next instant she felt a stabbing pain in her right thigh.

Gritting her teeth, Sue managed to pull away the arm encircling her head enough to take a breath. But then a second arm came to the aid of the first, dislodging one of her hands and repinning her head back against the headrest, again restricting her airway.

Out of sheer desperation, Sue tried to bite the arm that was around her neck, but her efforts were restricted by the cloth hood. The attacker responded by upping the compression of her neck and increasing the hyperextension of her back. As forcefully as she could, she then tried to dig the nails of both of her hands into the restraining arms, but as she struggled to do so, she suddenly became aware of losing strength. It was as if the muscles in her arms and neck were becoming unresponsive. At first, she thought it might be a kind of fatigue from making a superhuman effort, but it progressed relentlessly. Rapidly her hands lost their grip on the arms encircling her neck. Then, even more frightening, she found herself struggling to breathe.

Marshaling her last ounce of strength, Sue tried once more to cry out, but no sound escaped her lips, and with an agonizing roar in her ears, she lost consciousness...