The Bitterest Pill

Twenty-six

Dr. Nour wasn’t anything like Doc Goldfine, neither in temperament nor demeanor. Five-foot-six, with shoulder-length jet black hair, eyes nearly as dark, rich brown skin, and a downturned mouth, she was more the type of doctor Jesse had known at hospitals in L.A. — terse, impatient, and preoccupied. No matter what they said to him, it always seemed to Jesse that it translated into “What? What? I’m busy. Go away.” He didn’t judge them for it. He knew there wasn’t much glory in the profession. As with police work, the public’s perception of the medical arts was television-based.

“Dr. Nour,” Jesse said, “I’d like a minute.”

The doctor barely acknowledged his presence, tapping away at a mobile computer. “Yes, yes, Officer, what is it?”

Jesse couldn’t help but laugh.

That got her attention. She looked up. “I wasn’t aware I said something amusing.”

“I’m actually the Paradise police chief, but that’s not what I was laughing at.”

“Pardon me, Chief. I meant no offense.”

“None taken. And please, call me Jesse.”

“All right, Jesse. But may I ask what you found so amusing?”

“Your impatience.”

She shrugged, and Jesse wasn’t inclined to explain any further.

“You saw a patient here last year, Heather Mackey. She was sixteen at the time. She’d taken a fall and was diagnosed with compressed vertebrae.” He repeated the course of treatment Patti Mackey had described to him. “Do you recall treating her? I would like to discuss her case with you.”

Nour’s expression lost any hint of friendliness. “As police chief, you know I am legally and ethically prohibited from discussing my patients with—”

Jesse cut her off. “She’s dead.”

“My goodness. How?”

“Heroin overdose.”

“I see, yes, follow me.”

Dr. Nour led Jesse to a conference room. At first, they both sat, but when Jesse described how Heather was found by her mother, Dr. Nour rose out of her seat and paced.

Jesse asked again, “Do you remember her?”

Nour looked devastated. “I’m sorry, but I don’t. I treat many, many patients here and in Boston, where my practice is based. You say I diagnosed her with compressed vertebrae and that I prescribed rest, physical therapy, massage therapy, and that Dr. Goldfine gave her Motrin for the pain?”

Jesse nodded.

“That sounds consistent with a course of treatment I might suggest, but without looking at her charts... wait. Will you excuse me for a few moments?”

Ten minutes later she returned, holding a batch of papers in her hand. “I had the staff make a copy of the report from Heather’s visit here and I had my office scan and email the notes from her follow-up visits in Boston.” She sat and reviewed the files. “Yes, Heather had compressed vertebrae.” Dr. Nour stood, came around to Jesse, and slid MRI images in front of him. “See, right here. And, indeed, I did prescribe that exact treatment.”

But something else had gotten Jesse’s attention. “You said ‘follow-up visits.’ How many?”

She checked the files. “Four... yes, four visits in total, including her initial visit with me here at the hospital.”

“Is that unusual?”

“Each case is different, especially with spinal injuries. For instance, I’m sure that if I were to do an MRI on you, Jesse, I might find that you, too, have compressed vertebrae or possibly stenosis of your cervical spine. The general population all have injuries of some form or other. Give me a group of ten men or women with MRIs indicating the identical issue and there’s a likelihood that six of the ten would be asymptomatic and completely unaware of the damage. The remaining patients would likely display a range of symptoms with varying levels of distress.”

“Uh-huh. Fascinating, but what about Heather? Where did she land on the curve?”

“I’m afraid she wasn’t tolerating the pain very well with the Motrin. I prescribed Vicodin.”

“Is that usual, prescribing an opiate for teenagers?” Jesse asked, his tone calm and nonaccusatory.

“I prefer not to prescribe it for anyone, but my notes say she was in obvious distress and she was accompanied by her mother. See the notation here. Whenever I prescribe any controlled substance, I discuss with the patient the drug’s potential lethality and addictive characteristics. I prescribed a fifteen-day course of the drug for Heather. With Vicodin, I am loath to renew the prescription unless the patient reinjures herself or sustains a new injury. My file shows that was not the case with Miss Mackey.”

Jesse said, “That accounts for three visits. What happened on the fourth visit?”

“It was routine. She reported a considerable reduction in pain. Her physical-therapy report showed a marked improvement. She did not return for further treatment or consultation. I hope this has been of some help.”

“Thanks, Doc. At this point, I can’t say.”

“If you think I can be of any further use, please do not hesitate to contact me. Here.” She held a card out to him but pulled it back. When she did, she wrote a number on the back. “That is my cell phone number. I find this very distressing, so I don’t want you to have to go through my office to get in touch.”

Jesse stared at her after taking the card from her, then said, “I understand your distress, but is there any reason in particular Heather’s case disturbs you?”

“Heather’s is not the first such story I have heard. Several of my colleagues have had to deal with similar cases.”

Jesse didn’t say what he was thinking but knew the moment she said what she had about other similar cases that either he or Molly would definitely be getting in touch. A pattern was always easier to track than an isolated case, and if he could establish a pattern, he might find out why Heather Mackey was dead.