Night Shift

Chapter 10

Tuesday, December 7, 1:05 p.m.

Once back in the ED waiting room, Jack checked his phone. He wanted to make sure there had been no calls and no texts, as he’d put it on silent mode while he was at the MMH. He was relieved to see he was still in the clear with no one questioning where he was. He also checked the time and moaned when he saw he’d already been away from the OCME for more than an hour and fifteen minutes. Although his absence so far hadn’t evoked any attention, he knew it wouldn’t last forever and that he’d better get back. The problem was, at least so far, his visit had done nothing to solve the dilemma of not knowing what he didn’t know about Sue Passero’s passing. There was still one more place that might offer some clues: her private office.

A visit to the information desk solved the minor problem that he had no idea where it was. Within minutes he was on his way to the Kaufman Outpatient Building. He’d been told Dr. Susan Passero’s office was located on the fourth floor in the Internal Medicine Clinic.

As he rode up in the elevator, he recognized he was now on more or less shaky legal ground. Up until that point he had been perfectly in his legal right as a medical examiner tasked to investigate Sue Passero’s death to check out the scene where she had been found as well as the Emergency Department where she had been declared dead. But now, going up to her office without probable cause, he was pushing the boundaries and legally he should obtain a warrant. But getting warrants was time-consuming, and time was something Jack didn’t have if he was going to be forced to produce a death certificate quickly. An added concern was by pushing the legal boundaries, he was also accepting a slightly bigger risk the hospital admin might find out about his presence and flag it to Laurie.

The Internal Medicine Clinic was as busy or busier than the ED as it was now early afternoon. Like clinics in all privately owned hospitals, the doctors were overscheduled as a way of maximizing corporate income. Every day the clinic was in operation, it would get backed up, and as a normal day progressed, the number of people waiting to be seen for supposedly scheduled appointments multiplied geometrically. As had happened in the ED, Jack was forced to wait in line at the clinic check-in desk. When it was his turn, he again flashed his badge and asked to speak to whoever worked the closest with Dr. Sue Passero. The clerk directed him into the scheduling office to talk with Virginia Davenport.

Jack knocked on the door. When no one answered, he repeated with a bit more force. When there was still no answer, he tried the door. It was unlocked, and he walked in. Inside the windowless room were four desks occupied by four women of various ages. All were wearing headphones and parked behind individual computer screens while busily engaged in ongoing scheduling conversations. Like the security office, none of them were wearing masks.

Approaching the nearest desk, he asked for Virginia Davenport. The clerk responded by pointing to one of her coworkers without interrupting a conversation she was having with someone on her phone line.

Approaching this second woman, Jack waited until she had finished a call. She then slipped off her headphones and looked up at him quizzically, making him sense that visitors were not a common phenomenon in the clinic scheduling office. Looking down at her, two things caught his attention: piercingly dark eyes and teeth white enough for him to be tempted to ask her brand of toothpaste.

“Sorry to interrupt,” Jack began as he once again held up his badge while introducing himself. He explained he’d like to ask her a few question about Dr. Sue Passero.

“Are you Dr. Laurie Montgomery’s husband?” Virginia asked after repeating his name. She was looking at him sideways and with a touch of surprise.

“I am,” Jack said. He inwardly grimaced at the unexpected question bringing up Laurie’s name.

“I’ve spoken with your wife on many occasions,” she said. “I’ve arranged lunches and dinners for her and Dr. Passero. What a surprise to meet you.”

“Small world,” he said, trying to be nonchalant. “Is there someplace we can talk briefly, provided you can take the time? Maybe it would be better if I come back if you are too busy.” The buzz of the ongoing conversations was distracting.

“No, this is fine. It’s always this hectic. We can use Dr. Passero’s office if that is okay with you.”

“That would be perfect,” Jack said. Getting to see Sue’s office was the goal. He was on a fishing trip with the only questionable justification of checking if she had an insulin source in her office and, if so, if it all looked normal.

After telling her coworkers where she was going and grabbing a mask, Virginia led him out of the scheduling office, through the crowded clinic waiting area, and down a hallway before eventually stopping at an unmarked, closed door. Getting out a ring of keys, she unlocked it and stepped aside to let Jack enter. Following, she closed the door behind her. A sudden, welcome stillness prevailed.

It was a modest-sized room with a window that looked out into an interior courtyard. There was space enough for a nondescript desk, a desk chair, a reading chair, and a small bookcase. On top of the bookcase was a collection of family photos, mostly of Sue’s children as they had grown up. On the desk was a monitor and several bookends supporting a number of brightly colored folders, each clasped with a matching elastic. The room was neat and utilitarian.

“First let me express my sincere condolences for Dr. Passero’s death,” he began as he walked over to the desk.

“Thank you,” she said. “It’s been a terrible shock to all of us, but particularly to me. I’m the most senior scheduling clerk, and I worked closely with Dr. Passero, essentially functioning as her assistant. It’s why I got to talk with your wife as often as I did. She and Dr. Passero were extraordinarily good friends.”

“I can assure you that the doctor’s passing was a terrible shock to my wife as well,” Jack said. “How was Dr. Passero’s health in general? Was she having any problems?” He glanced at the labels on the folders. Each seemed to be titled with the name of a hospital committee.

“It was perfect, as far as I know,” Virginia said. She sat down on the edge of the reading chair, with her legs demurely tucked to one side. She was dressed in dark slacks and a sweater with a long white lab coat. “She was back to going to the gym three times a week now that it had reopened.”

“How about her diabetes?” he asked. “Do you know if that had been stable?”

“As far as I know. She was very careful.”

“Did she have an insulin source here?”

“Certainly. It’s in the closet behind you.”

Jack turned and opened the closet door. Inside were several highly starched white lab coats on hangers. To the side on the floor was a small refrigerator. He opened it and looked at the vials of insulin. It was obvious all was in order. Even the labels were lined up. So much for any idea that her death could have been due to an accidental mix-up with her medications — not that Jack had seriously considered it, but it was another fact to be checked off his mental list.

Closing the refrigerator door, he caught his breath as he felt his phone vibrate in his pocket. With trepidation he pulled it out and looked at the screen. With a sense of relief, he saw that it was John DeVries, head of the Toxicology Department. “Excuse me,” he said to Virginia as he took the call. She motioned she understood.

“I got some news on the Passero case and wanted to get it to you ASAP,” John said. “No ketoacidosis, no hyper- or hypoglycemia, meaning no need to check her insulin source or levels.”

“What about the general drug screen?” Jack asked.

“My God, you are impossible,” John teased. “You’re never satisfied. The rest is pending. I’ll let you know as soon as we have the answers.”

After repocketing his phone, Jack again apologized to Virginia for taking the call, mentioning it involved Dr. Passero. He then asked her if she knew who Dr. Passero used as her GP.

“Dr. Camelia Gomez. She’s an internist over at University Hospital who specializes in diabetes. I can get you the doctor’s number if you’d like.”

“No need. I’m sure I can find it,” he said. “Do you know if Dr. Passero had seen her recently?”

“I doubt it,” Virginia said. “When Dr. Passero did see her, I usually made the appointment, and the last time I did was probably six months ago.”

“Do you mind if I glance through these folders and Dr. Passero’s desk drawers?”

Virginia shrugged. “I don’t mind. Suit yourself. But why? I can probably answer any questions you might have. What else did you want to know?”

“To be honest, I’m struggling a bit with the exact cause of death,” Jack admitted. “I knew it is a long shot coming here, but I thought there could be a slim chance of finding some notes to herself or something that suggested she was worrying about some personal health issues that she was keeping to herself.”

“We were told she had a heart attack,” Virginia said, looking confused. “Is that not true?”

“It’s probably true,” Jack said. “Tests are still pending. I just want to make sure I’ve crossed the Ts and dotted the Is. Laurie is interested in knowing all the details for the family, particularly for the kids, who are now both doctors in their own right.”

“Please, look as much as you want,” Virginia said. “I did all of Dr. Passero’s copying, which was always rather extensive because of her hospital committee responsibilities, and she was a bit old school about having hard copies. I can tell you it’s never been about an individual illness or symptoms she might have been worried about. But talking about family, maybe you should know that Dr. Passero’s husband has already been here, gone through the desk, and possibly taken some of Dr. Passero’s personal items.”

He froze in the process of glancing into the center drawer of the desk and slowly let his point of view rise to stare at her. He wasn’t sure he’d heard correctly. “Did you say Abraham has already been here?”

“Yes, this morning, rather early, while we were still setting up to open.”

“That’s curious,” Jack said. It was more than curious in his mind and immediately raised the life insurance issue and its implications. But as fast as the idea occurred to him, he dismissed it. The idea that Abby would take out life insurance on his wife and then murder her was preposterous. Same with the idea that Sue might be involved in some nefarious plot, waiting the desired grace period, and then killing herself in some undetectable way.

After Jack ran his fingers through his hair a couple of times, which he often did as a way to reboot his brain, he asked, “Did you happen to notice if he removed a lot of things?”

“I don’t know if he took anything because I didn’t see him leave,” Virginia said. “But just looking around now that I am in here, it doesn’t appear so. I mean, all the kids’ photos are still there on the bookcase.”

“I noticed the photos when I first came in,” he said. He shrugged, wondering why Abby had thought coming to the office to rescue personal items was a priority, especially leaving all the photos. Being involved with death as much as he had been as a medical examiner, Jack was well aware that most people were paralyzed by grief with the passing of a family member, especially a spouse. And why would Abby make the effort to come to the office and yet leave the BMW in the garage?

“To change the subject, let me ask you this,” Jack said. “How was Dr. Passero’s mood lately? Did she act at all depressed over the last month?”

“Not in the slightest,” she said without hesitation. “Dr. Passero was not the depressive type. She was much too busy day in and day out to be depressed. She even insisted on coming in on most Saturdays, and so did I even though the clinic was closed. She did it just to see the patients she couldn’t see during the week but felt needed to be seen, and I couldn’t let her be here by herself.”

“Sometimes depression can be subtle,” he suggested. He glanced in each desk drawer in turn.

“I’m aware,” Virginia said. “In fact, I’m probably more aware than most people. I have a master’s degree in psychology and know a fair bit about depression. If anything, instead of showing any depressive symptoms, Dr. Passero had been fired up of late. I’m not trying to suggest she was manic, but she was, let’s say, very enthused over multiple committee-related issues and campaigning hard despite how busy she was with her patient load.”

“I noticed these folders,” Jack said, redirecting his attention to the desk’s surface. He slipped a couple out whose labels read compliance committee and infectious control committee. He glanced in each. Both were jammed full of meeting programs and handouts of case histories, as well as copies of emails Sue had sent to fellow committee members on a variety of topics. Glancing at them it was obvious to him that Sue had been a very active member, just as Virginia suggested.

“What exactly was she campaigning for?” Jack asked as he returned the two folders to where they had been. He then pulled out a third that was labeled simply hospital mortality articles of interest. He pulled off the elastic and opened it.

“Mainly two positions she dearly wanted,” Virginia said. “First and foremost was the Mortality and Morbidity Task Force, which was a subcommittee of the Mortality and Morbidity Committee, of which she was already a member. The second was becoming a member of the hospital board itself. She’d been trying her darndest to join both for well over a year, and it was frustrating for her.”

“Whoa!” he said. He looked up at her. He was surprised. “Dr. Passero was trying to get on the hospital board? That’s a steep mountain to climb, especially being one of the frontline workers who actually saw patients.” AmeriCare Corporation, the owner of the supposedly nonprofit Manhattan Memorial Hospital, was controlled by a private equity group, which was demanding increased profitability. The fastest way to accomplish that was to raise prices and drastically lower costs by firing a bunch of highly paid nurses, particularly more senior ones. There had been a big article about it in the New York Times.

“She knew it was an uphill struggle,” Virginia said, “but it didn’t deter her from trying. She was horrified by the hospital reducing the nurse-to-patient ratio, believing patient care was suffering. She was intent on reversing the trend.”

“There’s absolutely no doubt that reducing nursing staff negatively affects patient outcomes,” Jack said. “Wow! I can’t imagine administration was fond of the idea of her being on the board.” This information was putting a new spin on his thinking. He’d always thought Sue Passero was a universally appreciated individual. Apparently, that wasn’t necessarily true.

“That’s an understatement,” Virginia admitted. “There were a few people Dr. Passero clashed with on a regular basis because of her activism, particularly Peter Alinsky, one of the executive vice presidents in charge of the outpatient clinics who also oversees the Outpatient Reorganizing Committee, another committee on which Dr. Passero was a member. He and Dr. Passero were always exchanging less than flattering emails on all sorts of issues. I know because I printed all of them for her files. And to make matters worse, Mr. Alinsky was also the major opposition to her joining the Mortality and Morbidity Task Force, where he was also a member along with a surgeon and an anesthesiologist who shared his views about Dr. Passero. Alinsky was, in many respects, Dr. Passero’s bête noire.”

“Wow!” Jack voiced. “This is all new to me. I thought Dr. Passero was a particularly well-liked and highly respected member of the MMH community.” He recalled having just heard Dr. Carol Sidoti sing Sue’s praises.

“Don’t get me wrong. She was adored, truly, but mainly by the clinical community, particularly the Department of Internal Medicine, and, of course, all her patients. From my perspective, she was far and away the most respected doctor. Unfortunately, that didn’t necessarily extend to segments of administration, and the feelings were mutual.”

“Well, I can understand,” he said. “I’ve never been thrilled by the MMH admin nor its parent corporation, AmeriCare. But getting back to this task force. What is it or what’s its role? I’ve never heard of it. I’m certainly familiar with the Mortality and Morbidity Committee. I even had a stint on one way back when.”

“I’m hardly an authority, but according to what Dr. Passero communicated, it’s a small committee whose main function is to decide which deaths or adverse outcome cases get presented by the residents to the Mortality and Morbidity Committee itself. Not all of them are presented. Second, it generates the hospital’s mortality ratio, which I never could quite understand, to be honest. But Dr. Passero understood it, and it motivated her. She told me it was the statistic used by the hospital along with the M and M Committee to maintain its accreditation, which was the reason she wanted to make sure it was accurate.”

“I’m not sure if I have heard of a mortality ratio, either,” Jack said. He made a mental note to look it up later while he returned his attention to the folder he was holding, hospital mortality articles of interest. He pulled out the contents and noticed that they were printouts of various pieces, some from medical journals and others from newspapers or magazines. The first one was the heavily underlined, shocking 1999 report put out by the Institute of Medicine called “To Err Is Human.” He remembered it well, as did anyone who had read it, because it revealed the sobering fact that somewhere between 44,000 and 98,000 people died in American hospitals every year from preventable medical errors.

“That’s the article that motivated Dr. Passero to get so engaged in her committee work,” Virginia said. She stood up from the reading chair. “At least that’s what she told me when I came on board. In the ten years I’ve been here, Dr. Passero has never stopped being a patient advocate. We are all going to miss her terribly. And speaking of missing her, I’d better get back to help my team. Dr. Passero saw more patients than any of the other doctors on the staff and rescheduling them is going to take weeks, if not a month. She is going to be difficult to replace, and she is going to be sorely missed on multiple levels.”

“It certainly sounds like it,” Jack said. “Do you mind if I stay here a bit longer?”

“Of course not,” she said. “Stay as long as you’d like. I’ll be in the scheduling office if you have any additional questions that I can try to answer.”

“Thank you,” Jack said. “I really appreciate your help.”

“Not at all,” Virginia said. A moment later she was gone.