Night Shift

Chapter 22

Tuesday, December 7, 9:31 p.m.

As on edge as Cherine was with having her normal schedule interrupted unexpectedly, she sensed sudden movement behind her and started to turn around when Ronnie collided with her. He had intended to throw a dark blue pillowcase over her head as he had done with Sue Passero, but Cherine saw it coming and ducked to the side. Abandoning the sack, Ronnie tried to envelop her in a bear hug, but Cherine straight-armed him. Knocking her arm to the side, Ronnie lunged forward, essentially tackling her and causing both to collide with the kitchen table, sending books, pencils, dishes, and computer flying to create a gigantic clatter.

Cherine was a slight woman, but lithe and strong. She was also in relatively good physical shape.

Although Ronnie had thought subduing Cherine would be easy considering her comparative size, he was shocked at how fiercely and successfully she now was able to resist his attempts to subdue her. Several times when he thought he had her pinned, she squiggled partially free. She also let out a scream that rang in Ronnie’s ears and infuriated him, forcing him to use one hand to slap over her mouth. In the next instant they collided against a rickety secondhand bookshelf filled with a combination of books and knickknacks that also crashed to the floor, creating even a bigger clatter than the upending of the kitchen table.

Even with his hand firmly clasped over the lower part of her face, she was able to make significant but muffled noises. Eventually, with some effort, he was able to get her pinned in the angle created by the wall and the floor. At that point, just when he was sensing success, she managed to get a small part of his palm inside her mouth and bit down on it as hard as she could.

“Goddamnit!” he spat, yanking his hand free and losing a tiny bit of skin in the process. As she started another scream, he slapped her hard enough to bounce her head off the wall. Even though now for the moment she was only moaning and not screaming, he reclasped his hand back over her mouth. At the same time, he reached down with his free hand while pressing his full weight on top of her to pull out of his pocket a syringe he’d loaded with a carefully calculated dose of succinylcholine. All he wanted to do was paralyze her for the time necessary to stop her breathing long enough to kill her, yet small enough to be rapidly metabolized. In Ronnie’s armamentarium, succinylcholine and potassium chloride were his go-to agents, since they were all but impossible to detect after the fact.

Using his teeth to remove the syringe’s cap, Ronnie jammed the needle through Cherine’s jeans into the side of her buttock and pressed the plunger. Putting the syringe and its cap to the side, he now waited while keeping her pinned to the floor. It didn’t take long. He could feel the resistance drain out of her. An arm and a hand that she had been using to flail against his side went limp, as did her whole body. Rearing back and taking his hand off her face, he looked at her. She stared back at him with eyes that reflected terror. She knew what was happening.

A moment later, he rolled over, sat up, and got to his feet. When he looked down at her he could see her eyes were now glazed and she wasn’t breathing. She was also turning blue with cyanosis. He snapped up the syringe and replaced the cap. After putting it back into his pocket and picking up the pillowcase, he rapidly glanced around at the mess the apartment had become. After all the crashing noises, ruckus, and particularly Cherine’s semi-scream, he wanted to get the hell away ASAP in case a neighbor decided to investigate or call 911. Yet he also wanted to make completely sure there was no evidence of his visit. When he was convinced, he pulled out of his pocket a small plastic bag containing powdered cocaine laced with fentanyl. He’d added the fentanyl himself, so he knew it would be lethal. He sprinkled some of the powder into her nostrils before placing the bag on the coffee table in full view.

Rushing over to the door, he donned his coat and hat before using the pillowcase to open the door to avoid leaving any fingerprints. He’d been careful not to touch anything in the apartment during his visit. After glancing up and down the stairs to make sure they were clear of any of the tenants, he stepped out into the hallway and closed the door, again with the pillowcase. Pulling his cap low over his ears, he descended the first flight of stairs and then the second, all the while fearing he’d run into someone. Luckily it didn’t happen. It wasn’t until he’d pulled open the heavy front door that he heard someone from a floor or two above call out, “Hey, what’s going on in 3B?”

The next instant Ronnie was outside, thundering down the granite stoop, and then heading west in the direction of his Cherokee. Luckily there was no one in the immediate area he had to worry about seeing him. He moved quickly but resisted the temptation to run, reasoning that running might attract more attention if anyone happened to be looking out their window. Keeping himself at a fast walk, he put distance between himself and what he called ground zero. It wasn’t until he arrived at Columbus Avenue, where there were lots of people going about their business, that he allowed himself to slow down and relax to a degree.

Thinking back on what had transpired, he shook his head in dismay. It certainly hadn’t gone as smoothly as planned, yet at least it was over. The one thing he had to give himself credit for was that he had been correct in worrying that Cherine knew about Sue’s recent fears of the existence of a medical serial killer. Although Sue had implied she’d talked to no one about it when she had confided in him, she obviously had.

“God,” he whispered to himself as he walked. His anxiety was reverting to anger. “When it rains, it pours.” Up until the moment Sue had gotten active on the M and M Committee, demanding this and demanding that, insisting on getting onto the task force subcommittee, everything had been running perfectly, essentially like clockwork. He’d been totally confident the secret of his behind-the-scenes activities was his alone, and he’d had no fear of being discovered or even suspected. He didn’t have to be a rocket scientist to know that if Sue had succeeded in being appointed to the task force, all the effort he’d expended getting Thomas and Wingate to let him do the work of the subcommittee, which they merely rubber-stamped, would have been put in jeopardy, particularly Ronnie’s insistence that the only data given over to the Compliance Committee once a month was the death ratio and not the raw data including of the total unadjusted number of deaths.

A half a block south on Columbus Avenue was where Ronnie had found a parking spot for his beloved flat-black Cherokee. Using his key fob, he unlocked the vehicle as he approached, and the SUV responded by switching on its interior lights to welcome his return. For him the vehicle was like family, and he took care of it as such. He’d even had an artist paint some flames extending back from the wheel wells. Climbing in behind the steering wheel he first reached over and put his SIG Sauer P365 pistol in the glove compartment. It was his second-favorite possession, which he used frequently at a pistol range not too far away from his apartment and in the woods surrounding his hideaway up in the Catskills. He’d had the gun in one of his jacket pockets on his visit to Cherine’s just in case he needed it, which he certainly hadn’t expected. Still, he thought it best to be prepared, come what may.

Straightening back up in the driver’s seat, Ronnie peered out the front windshield with unseeing eyes as his mind went back to musing about his suddenly worrisome situation and how he’d gotten to where he was currently. He’d always had a soft spot for those people unlucky enough to be diagnosed with incurable, deadly diseases, particularly patients with cancer that had metastasized. As doomed individuals, they were ripe for modern medicine to experiment on, torture, and mutilate needlessly with all sorts of harrowing drugs and horrendous surgical procedures knowing full well it was not going to be curative. As a regular floor nurse, Ronnie had had limited opportunities to save these people from their fate, the same fate his foster mother had suffered, for fear of being exposed by a medical system that had evolved to protect its rights to do what it pleased. It hadn’t been until he’d risen to the role of nursing supervisor that he was able to help a significant number since the role gave him access to the whole hospital and the freedom to roam at will. But the biggest boost to his avowed crusade was when AmeriCare decided, in its infinite wisdom, to save money by reducing the night-shift nursing supervisors from two people to a single individual, meaning, to Ronnie’s delight, there was suddenly no one supervising the supervisors.

On his first night as the sole supervisor, Ronnie was able to save four people from a frightful and painful fate. It was up to him to decide after a death whether it was expected. If it was expected, which was what he always determined, it contributed to the denominator of the mortality ratio, hence making the hospital appear better. Also, it was up to him to declare if a death was a medical examiner case, and he made sure that none of the people whom he had saved from being tortured by the profession were ME cases. But even if they had been ME cases, it wouldn’t have mattered since Ronnie invariably used for the coup de grâce one of the drugs that the patient was already being given, like insulin or digitalis, but in a lethal amount. Over time Ronnie had amassed an entire pharmacopeia of drugs and had them stored in one of his private drawers in the nursing supervisor’s tiny office.

As he got better and better at his personal crusade, something interesting occurred to him one night five months ago in the beginning of July, when he arrived at the bedside of one of his beneficiaries after a code blue had been called. He was required to respond to all the code blues, but on those he was responsible for causing, he never wanted to be the first to arrive to avoid any chance at suspicion of having caused the emergency. On this occasion, when he dashed into the room after an appropriate wait, he couldn’t help but notice that the rather green, new residents, all of whom had just started their graduate training and who had already arrived at the bedside, were seemingly at a loss of what to do. As he was wont to do in such circumstances, Ronnie took control. Since he knew what the problem was in this instance from having caused it, he also knew what would reverse the situation immediately, and before he really thought about what he was doing, he barked out an order for the appropriate antidote.

Later he silently lambasted himself for what he had done, as the hospice patient had been revived and the heart returned to a normal sinus rhythm. As he was preparing to leave, several of the new residents came up to him and congratulated him on his clinical astuteness and willingness to take charge. Ronnie had been surprised at the compliments and also taken aback at how much he enjoyed them. He had been even more amazed at how much it had raised his credibility as a nurse par excellence.

As a result, Ronnie had begun to expand his covert activities to include nonterminal patients if a situation presented itself. As he did this, his clinical reputation had soared. He liked this so much because it ameliorated the mild inferiority complex he’d always had from having gotten his nursing training from the military and a community college rather than a fancy Ivy League university and academic medical center. Although a few of these patients ended up dying, the downside was more than worth the results. He even started to be treated as a clinical equal by some of the attending physicians.

Ronnie started his Cherokee, and it responded with a roar, as he’d customized his muffler to sound like a McLaren 720. Pulling out from the parking spot into the traffic, he headed south with the intention of working his way over to the Queensboro Bridge and then on to his apartment in Woodside. As he drove, he found himself getting angry all over again at Sue Passero and her incessant meddling and how much damage she’d managed to inflict on his world. What had started merely as her complaining about which cases were being presented at the full M and M meetings had morphed into her insistence to get a task force appointment. Although Ronnie had been able to convince both Dr. Thomas and Dr. Wingate it was a bad idea, it had become obvious to Ronnie that Sue was not going to give up, especially after she’d managed to get from him by his own carelessness some of the raw death rate data that showed a rather steep increase in the number of hospital deaths over the year without an associated increase in the severity of the general admissions. Of course, that had been a giveaway to his extensive efforts to eliminate the unnecessary suffering of a hundred or so patients being kept alive without regard for their quality of life or the pain and disfigurement they endured. Now, in retrospect, he realized that he should have shut her down way back when rather than acting as if he were on her side.

As unsettled as Ronnie felt, at least he could give himself credit for ridding himself of both Sue and Cherine before they could do too much damage. He also gave himself credit for cleverly learning that the ME, Jack Stapleton, had been told of Sue’s suspicions, although thankfully without getting any of the corroborating evidence. The previous night when things had quieted down around three, he’d made the effort of getting into Sue Passero’s office using a housekeeping passkey. There he’d been able to easily find the facts and figures Sue had put together from what he had unsuspectingly provided. For his convenience, he’d come across the incriminating papers in a folder right on top of her desk conveniently labeled mortality and morbidity committee. After taking and destroying them, he had thought he was back in the clear until the unexpected meeting with Jack Stapleton and learning that Cherine had known and had agreed to meet with him the next day to spill the beans.

Cursing with a series of particularly offensive expletives he’d learned in the navy, Ronnie pounded his steering wheel several times in frustration. The outburst and the physical activity calmed him, and he was able to regain his composure and think more clearly. He was even able to see a bright side: The situation had awakened him to the reality that he needed to be more careful in the future, perhaps even to the point of cutting down on proving himself with saves, despite how much he enjoyed those episodes. The reason, of course, was that those deaths, if they occurred, were more difficult to pass off as expected, meaning they’d be added to the numerator, thereby raising the mortality ratio. It was also harder to declare them non-ME cases.

Ronnie felt himself smiling as he drove up the ramp leading to the top level of the Queensboro Bridge with its impressive view of lower Manhattan and the burgeoning development of the opposing side in Brooklyn. The situation as he saw it was not unlike the efforts that had to be undertaken to keep a viral outbreak like Covid-19 from becoming an epidemic or even pandemic. Cases had to be diagnosed quickly, isolated, and removed before the disease spread. He’d been able to take care of Sue Passero and Cherine Gardener with comparative ease, although Cherine had been a bit more difficult than expected. That left only Jack Stapleton. There was no question in Ronnie’s mind that the pesky ME had to be eliminated soon, before a possible contagion erupted.

The problem was that Stapleton was not a member of the MMH community, which limited Ronnie’s access to him. On the plus side, he knew that the man wanted to meet with him again and that he foolishly used his bike for traveling around New York City. Like many medical personnel, Ronnie was aware that there were almost twenty thousand bike and vehicle collisions each year with a score or more deaths. It almost seemed as if the man was asking to be eliminated by tempting fate.

Reaching out with his right hand, Ronnie patted the dash of his Cherokee, which he often did because he liked to treat the vehicle as a pet. As he did so he murmured, “You and I will take care of this pest for good tomorrow.”