Night Shift

Chapter 17

Tuesday, December 7, 5:42 p.m.

When Jack got up to the sixth floor of the Kaufman Outpatient Building, he understood why there was a pedestrian bridge over to the main hospital. The entire sixth floor was composed of various procedure rooms for such things as colonoscopies and cardioversions, which could be done as inpatient or outpatient. Once in the Anderson Building, he found it simple to locate the main elevators, and within minutes he walked out onto the ortho floor.

As it was now nearing 6:00, the orthopedic floor was busier than he expected, since he’d seen a sign in the hospital’s lobby limiting visitation due to the Covid pandemic. Besides visitors, there were also more patients being ambulated after joint replacements than he anticipated since he was aware that elective surgery was still not being encouraged for the same reason. To add to the chaos, Food Service was in the process of delivering the evening meal. All in all, it was a bit more pandemonium than Jack would have liked to see, including at the busy central desk where there were upward of a dozen doctors, nurses, and nurses’ aides busily working. From experience, he knew it was the charge nurse who was tasked to monitor it all and keep it all under control. He feared that Cherine Gardener wouldn’t be able to manage much of a conversation.

Making sure Sue’s ID photo was pointing toward himself to avoid any questions, Jack approached the nearest person at the central desk. He guessed he was a resident as he was dressed in scrubs, including a surgical cap with the usual stethoscope casually slung around his neck. Jack smiled to himself. As he had gotten older, hospital residents seemed to get younger. The youthful man was busy typing into a monitor, seemingly oblivious to the chaos around him.

“Excuse me,” Jack said to get the man’s attention. “Can you point out Cherine Gardener?”

Wordlessly the man gestured toward the last person in the mix that Jack would have chosen to be her. From Virginia’s description of her character, he’d envisioned someone in Sue Passero’s league, meaning athletic, muscular, and commanding. Instead, the individual the man had pointed at was a mere slip of a woman, whom Jack estimated weighed a hundred pounds give or take five. The only similarity to Sue was her short, spiky hairstyle that Jack guessed needed very little attention, which was how Sue had explained her preference for the look. Cherine had a lighter complexion than Sue, at least from what Jack could see visible above her mask. She was obviously a charge nurse who was hands-on. As he got closer, he could see she had a sprinkling of freckles over the bridge of her nose and on her temples.

After he waited for her to finish a phone call, he introduced himself. She responded by loudly calling out to one of her nursing colleagues, explaining she was going to be in the chart room for a minute or two. She then waved for Jack to follow her.

The chart room was behind the central desk next to the supply room, and when the door closed behind them, a welcome hush ensued. Although still called the chart room, there were no longer any hospital charts. The MMH, like all modern hospitals, was fully computerized, so the room’s name should have been updated to the computer room or data entry room. But, like at many hospitals, the staff persisted in calling it the chart room out of entrenched habit. Inside, three people were typing into monitors, two men and one woman. The only sounds were the clicks from the keyboards, although muffled remnants of the tumult outside at the central desk and hallway could be heard through the closed door. Jack guessed the three were attending surgeons as they were dressed in long white doctor’s coats over civilian dress like himself.

“Sorry about the chaos out there,” Cherine said as she pointed to a desk chair for him and took one herself a distance away from the other occupants. “It’s always like this at this time of day.”

“I remember it from when I was in clinical medicine many moons ago,” Jack said.

“How can I help you?” Cherine asked, ignoring Jack’s comment. “As I mentioned to Virginia, this has to be very short since I’m pressed for time with a full house and report starting in minutes.”

As quickly as he could, he reiterated who he was and why he was there. He told her that toxicology and histology results were still pending, but meanwhile he felt the need to investigate a bit more the circumstances around Sue’s untimely passing.

“I’m not sure I understand,” Cherine said. She knitted her brows and stared back at Jack intently. “What do you mean by ‘the circumstances around her death’? I was told she had a heart attack in her car in the garage.”

“I’m not completely sure what I mean myself,” Jack admitted, sensing the woman’s impatience, giving credence to Virginia’s description of her as a no-nonsense, serious person. “I suppose I mean her mindset and mood. I understand from Virginia that Dr. Passero was frustrated in her dealings with certain members of the administration about committee assignments and responsibilities. Is there any possibility from your vantage point that she could have been seriously depressed?”

Cherine gave a short, mirthless laugh. “You are right about her frustration, but believe me, she wasn’t depressed. Not in the slightest! If anything, she was becoming progressively determined over these last few weeks, and she didn’t hide it.”

“Are you talking about her wanting to become a member of the Mortality and Morbidity Task Force? Virginia talked about that being important to her.”

“Absolutely! There’s no doubt in the slightest,” Cherine said. “Dr. Passero was gearing up to make a big stink about being denied an appointment to the task force. She fully intended to force the issue, which is why her death is such an organizational tragedy as well as a personal one. She saw getting on the task force as the only way to initiate much-needed reform, because the task force essentially dictates what the M and M Committee does. The task force picks which cases, out of all the deaths and episodes of adverse outcomes, will be discussed at the committee hearings and which cases will be ignored. And I was going to help her. I’ve only been a member of the M and M Committee for a bit more than six months, but it’s clear to me, as it had been to Dr. Passero for several years, that the committee is hardly equipped to find out which hospital deaths and which adverse patient outcomes could have been prevented by instituting systemic reforms. That’s what the committee was intended to do. Instead, it’s devolved to be a kind of sham, just going through the motions to fulfill the Joint Commission requirements to maintain hospital accreditation.”

Jack was taken aback by the women’s vehemence and her emotion. He could see it in her dark eyes and hear it in her voice, which had grown increasingly more strident despite her effort at keeping her volume down. Jack gathered from her obvious passion that she was undoubtedly as much a reformer as Sue Passero apparently had been, meaning the two women could very well have been perceived as provocateurs or agitators. “This is all very interesting,” he said while trying to rein in his ricocheting thoughts and orient himself around this new information. He couldn’t help but recognize its potential significance if it turned out that a cause and mechanism of Sue’s death remained elusive and the idea of a homicide had to be considered. “Virginia alluded to some of what you are saying, but I don’t think she is quite aware of the details. She did mention three people who Dr. Passero bumped heads with, namely Peter Alinsky, Dr. Carl Wingate, and Dr. Henry Thomas.”

Cherine let out another brief laugh of derision. “She got that right! That’s the triumvirate, which was what Dr. Passero and I called them. But it was more than just bumping heads with them. Dr. Passero couldn’t abide any of them, and they control who gets appointed to the M and M Task Force. All three of them are serious narcissists. Funny you should mention Dr. Thomas. I was just talking with him on the phone after he finished his final case for the day. He’s an orthopedic surgeon, and I’m forced to interact with him pretty much on a daily basis. To give you an idea of what he is like, he called to inform me that his patient is a VIP, and he ordered me to treat him as such. Can you imagine? I’m a charge nurse. I treat all patients as VIPs. The nerve.”

“So, he’s in Surgery right now?” Jack asked, thinking this might be fortuitous. With what he was learning, it seemed Dr. Thomas was someone he’d love to chat with to get a sense of how the administration felt about Sue Passero’s advocacy inclinations.

“Probably,” Cherine said. “He was calling from the post-anesthesia recovery room.” She then leaned forward and, after a quick glance to make sure the attending physicians weren’t paying them any attention, she said in a lowered voice, “I can tell you a major secret that Dr. Passero recently told me, which will surprise you, as it did me. She was worried that a medical serial killer has been active in this hospital over this past year. No, let me correct that: She was more than worried. She was convinced.”

The moment Cherine made this revelation, an alarm bell sounded in Jack’s mind. All at once, the cache of articles about medical serial killers he had seen in Sue’s folder titled hospital mortality articles of interest assumed a new significance. More important, what it said to him was that if there was a serial killer and the killer found out that Sue was convinced of his or her existence, Sue surely would have been courting mortal danger. For Jack, this new information seriously raised the possibility of Sue’s death being homicidal.

“When did Dr. Passero tell you this?” Jack asked.

“Four or five days ago,” Cherine said. “It was Thursday or Friday. Probably Thursday.”

Immediately following dropping her bomb, Cherine intently stared back at Jack as if challenging him to refute what she had just revealed. After clearing his throat to help organize his thoughts, he asked in as calm a voice as he could conjure, “Well, I do find that interesting for lots of reasons. But tell me, did Dr. Passero explain to you exactly why she was convinced there was a medical serial killer on the loose?”

“Oh, yeah,” Cherine said decidedly, but keeping her volume low. “She even showed me some data she’d put together from material she’d gathered from the M and M Task Force and the Hospital Compliance Committee. I was initially quite skeptical, but she was beginning to convince me.”

“And you think you’re the only person she told about this,” he said.

“Yes,” Cherine said. “The only other possibility is Virginia Davenport. She and Dr. Passero worked as a team running the Internal Medicine Clinic, but truthfully, I would have been shocked if they discussed this subject. Dr. Passero was not the talkative type about such issues, especially something as serious as this. By any chance, did Virginia mention anything to you that might make you suspect she’d been told?”

“No, she didn’t. Not at all, and she gave me the impression of being entirely forthright.”

“She’s the only one I can imagine might possibly have known,” Cherine said. “Over the last few days, Dr. Passero and I discussed who should be told. It wasn’t an easy decision. Without hard-and-fast proof, she was afraid to bring it to the attention of the muckety-mucks for fear they would see it more as a publicity nightmare and just try to bury it. Nor did she want whoever was responsible to be forewarned in case the only way to figure out who it was, was to catch the person in the act.”

“Did she suspect anyone in particular?”

“No. That was what was the whole problem. She didn’t know if the murderer was a doctor, a nurse, an aide, or part of the housekeeping crew. All these people have frequent access to patients.”

“Okay, okay,” Jack said, his mind racing. “Tell me exactly why she was so convinced a medical serial killer was operating here.” He inwardly smiled at his ironic verb choice.

“I can’t right now,” Cherine said. “It’s a complicated story involving hospital data and statistics and policy, and it will just take too long to explain. I’m already late for report as it is, and to be honest, I’m exhausted. But this is the last day of my three-day, twelve-hour shift cycle. I’m off tomorrow, and if you are available sometime during the day after I’ve had some sleep, I can explain it all then.”

“Fair enough,” he said, although he was disappointed. He fumbled in his pocket to get out one of his business cards. He circled his mobile number and handed the card to Cherine. “Call when convenient tomorrow. I truly appreciate you talking with me, as busy as you are. Thank you for your time, and I look forward to hearing from you tomorrow.”

They both got to their feet.

“I think it is important someone knows,” Cherine said. “When I heard that Dr. Passero had passed away and after I got over the initial shock, I was at a complete loss of who I was going to approach, for obvious reasons. In a way, you are an unexpected savior.”

“It is a role I cherish,” Jack said. “It’s what we medical examiners do: We speak for the dead.”

Cherine nodded and then flew out the door, disappearing in a flash and leaving Jack standing by himself. He turned and looked at the three attending physicians, half expecting they would have expressions of shock from having overheard Cherine’s exposé. Instead, they were still engrossed inputting data into the hospital’s insatiable computer bank, oblivious to what he had just been told.

Checking his watch and seeing it was now just after 6:00, Jack thought it was time to head down to the Emergency Department in hopes that Ronnie Cavanaugh had shown up before his shift began, as Dr. Sidoti suggested he was wont to do. With the idea there was a possible medical serial killer on the loose, talking with Ronnie and finding out more about Sue’s death seemed even more crucial. Yet, as soon as he thought about heading down to the ED, he remembered that Dr. Henry Thomas might be serendipitously available for a quick casual chat.

With that thought in mind, Jack hurriedly left the chart room and wended his way back toward the main bank of elevators. Having an idea of what the hospital administration thought of Sue Passero had taken on new significance, particularly from a member of what Cherine had described as the triumvirate. Knowing what he did about the generally cool relationship between the clinical staff and the administrative staff of a chain hospital, Jack wasn’t particularly worried about word getting back to Laurie that he was out in the field investigating.

The orthopedics floor was even busier now with more visitors. As he progressed toward the elevators, another thought occurred to him concerning the possibility of a medical serial killer operating in the MMH, and he took out his mobile phone. Using his contacts, he put in a call to Bart Arnold, the OCME Medical Legal Investigation Department head, hoping to catch him before he left for the day. Jack was pleased when the phone was picked up on the second ring.

“I’m glad I caught you,” Jack said with no introduction. “I have a favor to ask.”

“I’ve got one foot out the door,” Bart said. “What do you need?” Bart and Jack had a superb working relationship, as each appreciated the other’s talents. They frequently worked hand in hand on complicated cases. At the same time, Jack wasn’t about to tell the man where he was at the moment and what he was doing, for fear he’d take offense. He was understandably protective of the MLI Department prerogatives.

“I’d like you to get me some figures,” Jack said. “Do you think it is possible to find out the monthly death rates called in to the OCME from the Manhattan Memorial Hospital over the previous two years?”

“I don’t see why not,” Bart said. “Can this wait until tomorrow?”

“Truthfully, the sooner the better,” Jack said.

“If the team isn’t too busy tonight, I’ll have someone start looking into it. I imagine I’ll have something for you tomorrow. Will that work?”

“Perfect,” Jack said.