Night Shift

Chapter 19

Tuesday, December 7, 6:31 p.m.

As Jack descended in the elevator toward the ground floor, he found himself shaking his head at what a successful diversion he’d managed to find. Since arriving at work that morning and stumbling across Sue Passero’s case, the annoying issues on the home front seemed picayune, even a bit egotistic, and certainly manageable, so in one sense he’d accomplished his goal. Yet it was at a definite emotional cost. He’d had many complicated cases in his forensic career, but none had been as emotionally troubling as the one he was now caught up in, especially if his gnawing intuition turned out to be correct. If he was totally honest with himself, he’d have to admit that from the moment he closely examined Sue’s heart and was struck by its normality, the fear that he was dealing with the homicide of Laurie’s friend was a distinct possibility.

Occupied with these thoughts, he wasn’t as attentive as he should have been to his surroundings as he crossed the main hospital lobby on his way to the Emergency Department. It wasn’t until he’d practically bumped into his archenemy, Martin Cheveau, that he remembered he was supposed to be vigilant about not being recognized at the MMH, especially having already been officially escorted out of the hospital not that many hours before.

“Jack Stapleton?” Martin questioned in an artificially high-pitched voice. He had his hands spread wide, palms up in total amazement. “What the hell are you doing back here after having been summarily kicked out?”

“I guess it’s a kind of addiction,” Jack said. “It’s such an intriguing place. I just can’t stay away.”

“You are impossible!” Martin said, angrily changing his tone. “And I can assure you that the president is going to hear about this.”

“I would hope she has more important issues to deal with than a civil servant medical examiner legally investigating the death of one of the hospital staff. Besides, I’m almost done, and I’ll be on my way, so no need to bother yourself.”

Martin sputtered as Jack walked on, heading for the ED. Clearly infuriated, Martin hurried after him. Now, even more angered from being ignored, he said he’d see to it that the president lodged a formal complaint with the mayor’s office. Jack winced at this specific threat, knowing it was a possibility, as it had happened in the past. But the damage had been done, and he couldn’t think of any way to appease the irate Microbiology Department head.

To Jack’s relief, Martin finally gave up as Jack pushed through the swinging doors into the ED. But Jack’s relief was short-lived as his phone buzzed, indicating he’d gotten a text. When he looked at the screen, he saw it was from Laurie. Pausing, he guiltily read the message. It said the meeting with the mayor-elect was finally over, and although she had gotten his text, she wondered if he was still in the building.

He texted back he was on his way home and that he looked forward to hearing about how it had gone. He certainly didn’t mention where he was now. When that text got a thumbs-up from Laurie, he pocketed his phone and continued on into the ED main waiting room. As he expected, the ED was far busier now than it had been on his earlier visit. He wasn’t surprised, knowing that symptoms people had ignored all day often drove them to Emergency around evening mealtime.

Approaching the main desk, Jack was encouraged. He’d planned on having to ask for Dr. Carol Sidoti, but it wasn’t necessary. She happened to be there behind the desk, talking with several of the triage nurses. As soon as she broke off her conversation, he called out, “Dr. Sidoti, I decided to follow your advice and try to have a chat with Ronnie Cavanaugh. Have you seen him this evening?”

“Yes, I have,” Carol said. “I spoke with him minutes ago.”

“Do you have any idea where he might have gone?”

“I believe he went into the ED lounge.” She pointed at an unmarked door behind Jack in the corridor that led into the hospital proper. “Since the pandemic started, he’s been changing into scrubs for his shift.”

After flashing the woman a thumbs-up, Jack headed toward the indicated door. As he pushed into the room, he thought about how much things had changed with emergency medicine since he’d been a resident. Back then it had been called the emergency room and was one large room with curtained-off bays. More important, it had been manned by medical and surgical residents. Now it was called an Emergency Department or ED and was comparatively enormous, divided into separate areas depending on the degree of emergency involved. Emergency medicine had become a specialty in and of itself, composed of highly trained, board-certified emergency medicine doctors, like Carol Sidoti. Residents now merely pitched in to help. In a hospital the size of the MMH, the ED was almost a separate hospital under the same roof, with its own imaging and laboratory facilities as well as overnight beds so patients could be observed for twenty-four hours without having to go through the entire hospital admission process.

In contrast to the surgical lounge, the ED lounge at that time of day was deserted. It also had no windows as it was in the middle of the ED. The furnishings, however, were similar with a couple of nondescript couches, the same variegated mixture of chairs, and a small kitchenette. A flat-screen TV had the evening news on but no sound. In hopes of finding someone, Jack pushed into the men’s locker room and immediately saw a muscular, angular man pulling on a scrub top who he estimated was in his mid-thirties. He was already wearing the scrub pants.

“Ronald Cavanaugh?” Jack questioned.

“None other, but I prefer Ronnie.” He smiled. His voice was a pleasant baritone. To Jack’s ear he had a mild Boston accent.

“Ronnie it is,” Jack said. He eyed the man, who was of equivalent height. To Jack, he looked as Irish as his name suggested with dark brown hair, narrow blue eyes, an upturned nose, high cheekbones, and a prominent, round chin. His complexion was on the pale side and mildly flushed, as if he’d just stepped in from the cold. A small scattering of tiny pockmarks on his cheeks suggested he’d had a bit of acne as a teenager.

Jack introduced himself while handing Ronnie one of his cards. He asked if he could have a moment to talk about Dr. Susan Passero’s death.

“No problem,” Ronnie said after glancing at Jack’s business card. “Provided it doesn’t take too long. My shift starts at seven on the dot, but since I’ve already taken report from the day shift supervisors, I’m golden until then.” He then picked up a mask he’d placed on the bench seat that ran down between the lockers and held it up in the air. “Want me to put on my mask?” he asked cheerfully.

“Not if you are vaccinated and boosted,” Jack said.

“I am indeed,” Ronnie answered. “Of course.”

“Same here,” Jack said, removing his mask as well.

“Where would you like to chat, here or out in the lounge?” While Ronnie spoke, he gestured at the long bench. It was a similar setup as in the surgical locker room.

“Here is fine with me,” Jack said.

The two men straddled the bench, facing each other about six feet apart. Ronnie had gone back to studying Jack’s card.

“You know, your name rings a bell,” Ronnie said. “And now I remember why. I read about you in the Daily News a couple of years ago. You were involved in exposing a pathologist over at NYU who’d murdered his girlfriend. Am I remembering correctly?”

“I played a minor role,” Jack said. “The real hero was a pathology resident.”

“What I particularly remember is that you play pickup basketball and exclusively use your bike to get around the city. Is all that true?”

“Yes,” Jack said simply.

“I played a lot of basketball when I was in the navy,” Ronnie said. “It’s great exercise but tough on the knees.”

“You were in the navy?” Jack asked. He didn’t want to waste time talking about himself.

“Yes, I was and retired as IDC, independent duty corpsman, on a fast-attack nuclear submarine out of Groton, Connecticut,” Ronnie said proudly. “Going into the navy was the best decision of my life. It’s where I got my initial medical training. The service even helped me get my veterans bachelor of science in nursing degree. But getting back to the issue at hand, I have to tell you that in the four years I’ve been here, you are the first medical examiner I’ve met. I’m accustomed to dealing with your field people on all the ME cases. It slips my mind what they call themselves.”

“Medical legal investigators,” Jack said.

“Right!” Ronnie responded. “And I assume you know that last night I talked at length about Dr. Passero’s death with Kevin Strauss. He’s someone I’ve dealt with many times before, mostly on the phone, since it is invariably me as the night nursing supervisor who calls in ME cases. He’s a sharp fellow and certainly knows his stuff.”

“I’m aware that you met with him,” Jack said. “And I have spoken with him about the case. I have to say, he was similarly complimentary about you.”

“We worker bees appreciate each other,” Ronnie said with a laugh and a wave of dismissal. “I’m not looking for compliments. My point here is that I don’t think there is anything I can add to what I told him. I’m sorry if I can’t be more helpful.”

“You might be correct,” Jack agreed. “But we know more now about Dr. Passero’s case than we did last night. A full autopsy has been done, but no evidence of any cardiac pathology was found, meaning we have no cause and mechanism of death as of yet. The heart and the coronary arteries appeared entirely normal on gross inspection. Although histology is still pending, I doubt it is going to shed any light on the situation.”

“Really?” Ronnie questioned. “That’s a shock.” His narrow eyes narrowed further, and his brow creased dramatically. “A completely normal heart? How can that be? I thought for sure it was a heart attack. So did everyone in the ED, especially knowing she had diabetes.”

“We were surprised as well,” Jack said, “which is why I am here.”

“This is totally unexpected,” Ronnie said. “What about a stroke or a channelopathy? We were never able to get a heartbeat, which I think I mentioned to Kevin Strauss.”

“There was no sign of a stroke, and a channelopathy has been preliminarily ruled out,” Jack said. He was impressed. He remembered Carol Sidoti describing Ronnie as clinically astute as well as personable, and Kevin Strauss calling him a sharp dude, and Jack now had to agree on all accounts. It was encouraging and a relief after the not-so-pleasant conversations with the two doctors. Jack was about to continue by asking Ronnie exactly how things unfolded minute by minute in the garage when he held up. Ronnie had momentarily closed his eyes and cradled his head in both hands, letting out a plaintive sigh while massaging his eyes. Respectfully, Jack waited. It was apparent that Ronnie was struggling.

A moment later, Ronnie dropped his hands, blew out a deep breath, and looked directly at Jack with watery eyes. “Sorry about this,” he apologized. “I’m not being very professional, but I’m afraid I’m in uncharted emotional territory for me. I’ve never tried to resuscitate a friend and a colleague, and, let me tell you, dealing with it ain’t easy, especially since it wasn’t successful. I’ve been involved in more than my share of code blues, as it is incumbent on me to attend every code that occurs when I am on duty. And I have become pretty successful at handling them. Actually, I can say very successful. But the one time it really counted, I couldn’t make it happen.”

“I’m sorry to make you relive it,” Jack said. “But I’m sure you can understand the possible importance. In forensics, it is critical to have a cause and mechanism of death, and at the moment, we’re at a loss.”

“Of course I understand. But I do have to admit that I find talking about this difficult. Sue was one hell of a marvelous doctor, and she really appreciated us nurses as the ones who are in the trenches supplying the hands-on care of the patients. And I can tell you that type of recognition is not universal with all doctors. On top of that, she was also just a warm and gracious person. I’m going to miss her, as will a lot of other people.”

“Are you saying you were friends, as well as colleagues?” Jack asked with a bit of surprise. Such information was akin to the surprise he felt learning about the animosity of Thomas, Wingate, and Alinsky, just in a more positive direction.

“Oh, of course,” Ronnie said. “If she needed anything at night with one of her inpatients, she always called me directly on my mobile. She even invited me not too long ago to her home over in Jersey where I met her husband, Abby, and their two children.”

“That’s somewhat of a coincidence,” Jack said. “My wife and I were also friends of hers, and we’ve been to her home in Fort Lee as well, and she and her husband have been to our home here in the city.”

“I’m not surprised,” Ronnie said. “She was friends with just about everyone except some of the MMH muckety-mucks.”

“That’s interesting to hear you say. And I’d like to discuss that more, but first I’d like to concentrate on the details of when you first found Sue in the garage.”

Ronnie checked his watch, a gesture that wasn’t lost on Jack, who asked, “How are you doing with the time?”

“Not bad. I have another ten minutes until I have to clock in.”

“All right, I’ll try to speed things up,” Jack said. “Take me back to when you arrived last night in the garage. Did you see anyone or any vehicles out of the ordinary? Take a moment to think back.”

“I don’t need to think about it,” Ronnie said. “Last night when things had quieted down, I went over it in my mind. But it was just like normal. I always arrive about an hour before the shift change, which is earlier than most night-shift people, so there was no incoming traffic. I’m allowed to park my Cherokee in the doctors’ reserve section on the second floor near the pedestrian bridge, provided I make a point of leaving just after seven in the morning. That’s why I happened to catch Sue slumped over her steering wheel. I’m familiar with her BMW since we had occasionally run into each other. When I saw her car, I thought: Wow, Sue’s sure leaving late tonight, and then I happened to catch her silhouette.”

“Do you remember seeing anyone else around you or her car at that point?”

“Not around her car,” Ronnie said. “I did hear someone coming along behind me, which turned out to be Barbara Collins from the GYN floor. She was the one I ended up flagging down to lend a hand.”

“Okay. What happened next?”

“I stopped and watched Sue for a second. I couldn’t see her all that well, but it suddenly dawned on me she wasn’t moving. Wondering if she was having car trouble, I hustled over to her driver’s-side window. That’s really when I could see she was probably unconscious.”

“Okay,” Jack said. “What did you do then? Try to remember everything. Was she moving at all, like clutching her chest or completely still?”

“I didn’t wait to see if she was moving,” Ronnie said. “I rapped on the glass, though pounded on it is probably more accurate. She, of course, didn’t budge, so I tried the door, which was unlocked. In the next second, I could tell she was in extremis, as she tumbled out of the car into my arms. I yelled for Barbara as I laid her on the pavement. Sue wasn’t breathing, had no pulse, and her color was strikingly pale around her mouth and her conjunctivae were slate blue. Without hesitation, I started CPR with chest compressions.”

“I understand you told Kevin Strauss that Sue’s color definitely improved.”

“Yes, and I told the ED docs the same. Almost immediately her cyanosis pinked up rather dramatically. I was very encouraged, which only made the final outcome that much more difficult to accept. On other code blues that I’ve been on, when something like that happened, it usually was a harbinger of a positive outcome. Why it wasn’t in this case is probably going to haunt me forever.” For a moment Ronnie stared off into the near distance. He sighed again before redirecting his attention to Jack. “Sorry,” he said.

“No problem,” Jack said. “I can appreciate it’s not been easy for you. Tell me, did the ED people get to the scene in short order?”

“Oh, yeah,” Ronnie said. “While I was doing the chest compressions and the mouth-to-mouth at a thirty-to-two ratio, Barbara called the ED, and they were there in minutes, including several nurses and a doc. They also brought oxygen and an ambu bag, and Sue’s color improved even more. We had her down in one of the trauma rooms in under five minutes, continuing the CPR all the way. There they started a serious resuscitation attempt and, believe you me, they tried their darndest.”

“That was my impression when I talked with Dr. Sidoti,” Jack said. “How are we doing with the time?”

Ronnie checked his watch once again. “Not bad. I’ve got another five minutes.”

“Okay, good,” Jack said. “Before I leave you alone, I’d like to go back to your curious statement regarding Sue’s being friends with everyone except some of the MMH muckety-mucks. Can you elaborate on that?”

“Sure,” Ronnie said. “It’s common knowledge that a relatively small number of higher-ups thought Sue was a troublemaker bent on tarnishing this institution’s good name. Recently, they’d become a bit desperate, since there was a rumor she might get on the hospital board. The irony is that from my perspective, and most other people’s, she was more concerned about the hospital’s reputation than just about anyone, which was the motivation for her activism. She practically wanted to be on every hospital committee, and when she served on one, she really took it seriously, in contrast with most doctors.”

“When you say higher-ups, I assume you are talking about the triumvirate of Thomas, Wingate, and Alinsky,” Jack said, feeling like he had to speed up the conversation to get more in before Ronnie had to leave. Normally he made it a point not to lead people when he was doing a forensic interview.

Ronnie’s jaw slowly dropped open in surprise at Jack’s comment, and then he snickered. “Whoa! You have been busy! I’m getting the impression you have talked about all this with more people than just your medical legal investigator.”

“I’m committed,” Jack said. “It’s why I’m here, trying to get all the information I can if it turns out I can’t come up with a cause of death. This is actually my second visit here today. Earlier I’d checked out her car and spoke with Virginia Davenport, who was quite helpful.”

“Virginia will be a good source for you since she and Sue worked together closely but only vis-à-vis Outpatient Clinic affairs,” Ronnie said. “I was going to suggest someone else who you would find more interesting for your purposes, but I’m getting the impression there’s no need. I’m sensing that you’ve already spoken with Cherine Gardener. Am I right?”

“I did talk with Cherine Gardener,” Jack said, surprised that Ronnie had guessed. “How did you know?”

“I knew as soon as you used the term triumvirate. It was a private and somewhat derogatory moniker that just Sue, Cherine, and I used as a kind of code for the three people you named. But we used it exclusively just among ourselves.”

Jack’s ears perked up with the idea that the triumvirate of Thomas, Wingate, and Alinsky had spurred a triumvirate of Sue, Cherine, and Ronnie, meaning that perhaps Sue had shared her concerns about a medical serial killer with Ronnie as well as Cherine. The problem was how to find out. He was in the same bind he’d felt with Thomas and Wingate and didn’t know how to proceed.

“Was Cherine helpful?” Ronnie asked.

“Shockingly so, although she could only spare a few minutes from her duties,” Jack said. “But she’s off tomorrow and has offered to get in touch with me to give me all the details she didn’t have time to explain. She did say that Sue was gearing up to make a big production about being denied a seat on the Mortality and Morbidity Task Force. I assume this is something you know about.”

“In intimate detail,” Ronnie said with another half laugh. “When I have more time, I can tell you all the ins and outs about that. It’s all rather involved, with oversized egos in jeopardy, if you get my drift.”

“When will you have some free time?” Jack asked.

“I’m working tonight, obviously. Then I have three nights free. We could arrange something maybe Wednesday or Thursday during the afternoon. I don’t need much sleep. I’ll send you a text, so you’ll have my number.”

“That would be terrific,” Jack said. “In terms of getting together, the sooner the better. In the meantime, are you the only nursing supervisor on the night shift?”

“That’s an affirmative,” Ronnie said. “There used to be two of us, which worked a lot better than just one supervisor. But a bit over a year ago, AmeriCare, in their infinite wisdom, cut us back to a single night nursing supervisor at the same time they reduced the nurse-to-patient ratio from one-to-five to one-to-eight. It’s all about saving money, if you know what I’m saying. But the reality is that it’s made my job nearly impossible. At night, I’m it! I’m where the buck stops for just about anything that happens because there is no administrator on duty. There’s one on call, but they hate to be called, so everything that happens in this whole damn hospital falls on my shoulders.”

“That sounds stressful,” Jack said. “Do you work exclusively nights? Is it your choice?”

“It is my choice,” Ronnie said. “I mean, I complain about it, as do the other night supervisors because it’s stressful, but we like there being no administrators here with their big egos. Also, there’s not so many private doctors around demanding this and demanding that. They can be as bad or worse than the administrators.”

“You said earlier that you speak often with Kevin Strauss. Why is that the case? Are you often involved in reporting medical examiner deaths?”

“Absolutely,” Ronnie said. “I’m called in on every death. It’s why I’m so familiar with what constitutes a medical examiner case and what doesn’t. When it is a medical examiner case, I’m invariably the one who calls it in to your people.”

“The private physician or the staff physician isn’t involved?”

Ronnie gave a short laugh. “Rarely! As I said, being the night nursing supervisor, the buck stops on my desk. Whether it’s a patient falling out of bed or kicking the bucket at three o’clock in the morning, I’m the one who handles it from A to Z.”

Ronnie again glanced at his watch and, seeing the time, he got to his feet. “Uh-oh! Sorry, but I have to break off this chat to clock in. We can continue tomorrow or Thursday, your choice. I’ll give you a call tomorrow when I wake up, and we can arrange it. Ciao!”

“One last quick question,” Jack said. “I’ve heard that the M and M Task Force was a small committee. How small, and by any chance do you know everyone who sits on it?” Jack remembered from Virginia that Thomas, Wingate, and Alinsky were members.

“It’s very small,” Ronnie said as he slammed his locker and spun the combination dial. “It’s only four of us.”

“Wow, that is small!” Jack marveled. “And you said ‘us.’ Are you on the committee?”

Ronnie gave another short laugh. “I’m not only on the committee, but for all intents and purposes, I am the committee. The other members are the triumvirate, but they are members in name only. I have to do everything myself and just get their rubber stamp of approval. I’m the one who plans and schedules the full M and M Committee meetings, which is a royal pain in the butt. And it was why I was heavily championing Sue Passero’s appointment. She would have helped and carried her weight, which I can’t say for the three other muckety-mucks.”

Brandishing Jack’s card to indicate he’d be in contact, Ronald Cavanaugh started for the door. Jack reached out and grabbed his arm, pulling him to a stop. Ronnie looked down at Jack’s hand on his forearm with a quizzical expression. It was as if the gesture caught him totally unawares. “I really have to go,” he said. “I make it a point never to be late, something I learned in the military.”

“Of course,” Jack said. He let go of the man’s arm. “But I heard that the M and M Task Force was also responsible for generating the death ratio. Is that true?”

“Supposedly,” Ronnie hurriedly said. “But actually, the death ratio is generated by the hospital computer on a regular basis with all the daily input vis-à-vis hospital deaths. The task force just approves it for the Compliance Committee to indicate that the M and M Committee is keeping an eye on it.”

“How has the death ratio been running, say, over the last year?” Jack asked, trying to get in one last question despite Ronnie’s need to leave. With the idea of a possible active medical serial killer on the loose, it suddenly occurred to him that the statistic would be particularly telling and might have been what had convinced Sue.

“The death ratio has been terrific,” Ronnie said as he pulled open the door to the hallway. “In fact, during this year it’s fallen to less than point-eight-five, which is damn good for an academic medical center that deals with referrals of difficult cases from other hospitals. In fact, it’s the best in New York academic centers, including Columbia, Cornell, and NYU. Ciao! I’ll call you sometime tomorrow afternoon.” In the next instant the door closed, and the nurse was gone.

For a few minutes Jack remained where he was, straddling the bench, marveling that the diversion he’d managed to find was getting progressively more complicated. He’d learned a lot from Ronnie and would undoubtedly have to learn more if he ended up having to pursue both Sue’s death as a homicide as well as the serial killer issue, especially if they were somehow related, with a putative serial killer feeling that Sue had to be eliminated to keep from being exposed.

Going back over the conversation with Ronnie, he regretted not having brought up the medical serial killer issue to get his take on the possibility, as integrated as he was in the MMH world. The reason he didn’t was the same reason he didn’t bring it up with Wingate or Thomas: Everybody was a suspect. But if Sue, Cherine, and Ronnie had been an opposing triumvirate, it seemed only reasonable they would have shared such a momentous and serious concern. At the same time, he couldn’t be sure Ronnie knew about it, as it had only been four or five days, with an intervening weekend, since Sue had told Cherine her theory, and Cherine had been adamant she was the only one Sue had told. And now Jack had learned that the mortality ratio for MMH had been going down over the past year. How could there be statistical evidence of a very active medical serial killer, meaning deaths of people who weren’t supposed to die? Cherine had suggested Sue’s belief was based on statistics, but if Ronnie was right about the mortality ratio going down, it seemed far-fetched indeed.

With a sigh, Jack got to his feet. There was no doubt Ronnie and Cherine had been the two most fruitful sources so far, and he was certainly glad he’d made the effort to come back here. Yet despite what he’d learned, he couldn’t help but admit that he still didn’t know what he didn’t know. The key issues were going to have to wait until tomorrow, when he hoped to learn from Cherine exactly what statistics had made Sue convinced a serial killer was on the loose, and he’d find out if histology and/or toxicology were going to provide a cause and mechanism for Sue’s death.

Leaving the ED, he headed back toward the main lobby with the hopes he wouldn’t again run into Martin Cheveau or Alinsky or, worse yet, President Schechter. As it was now almost seven, he thought the chances were slim but not impossible. And as he rounded a corner his worst fears were realized. Beyond the crowd waiting for an elevator he caught a glimpse of the hospital president, Cheveau, and several black-suited security guards coming rapidly in his direction. Immediately reversing direction, Jack hustled back toward the ED, fearing that he’d hear his name called out. Thankfully, that didn’t happen, and he was able to exit the ED through its entrance. To avoid another scene, he then hurried around the hospital to retrieve his bike at the front.