Critical Judgment (1996) (20 page)

Cadmium in the liver and in the kidney
, the abstract read,
can be measured in the lab by the technique of X-ray fluorescence
.

The science was simply too technical for her to understand. But at least the hint was there. Under certain circumstances cadmium in tissues
did
glow. She would have to try to get the original article and then maybe ask a biochemist to explain it.

She massaged her aching neck and shoulders. Tension, strain, and nearly ten hours of nonstop work had taken a toll on her body. It felt as if she had gone ten rounds with a heavyweight.
Enough
, she decided. She had had enough of this day. If it wasn’t busy out there, she
would
leave. She opened the door and nearly collided with Joe Henderson, the president of the hospital. Henderson was a well-built, balding outdoorsman who had lacquered trophy fish on his office wall along with an NRA poster extolling the constitutional right to bear arms. No matter how grim or intense the subject he was discussing, Henderson always seemed to be grinning. Not today, though.

“Abby,” he said, “they told me I’d find you here. Got a minute to speak with me and a couple of others?”

“Well, I don’t know how things are going out there.”

“They’re fine. I just checked with Ted Bogarsky.”

“Then I guess I’ve got a minute.”

“Terrible thing that happened to Peggy Wheaton. Just terrible,” he said as he led her to the small conference room just off the ER.

Len McCabe, the elder statesman of her ER group, was there along with George Oleander and a third man, who introduced himself as Terry Cox. Cox looked like a person whose passions included good food, fine wine, and money.

“I work for the hospital,” he said. “I’m an attorney. But I’m also an old friend of Gary and Peggy Wheaton.”

An attorney. What a surprise
.

“Should I be getting a lawyer of my own?” Abby asked, far too weary to be civil.

“Abby,” McCabe said, “there’s no need to get angry. We’d just like to know what went on out there today.”

“With a lawyer present?”

“A concerned friend,” Cox corrected. “And a hospital representative. Needless to say, Gary and his family are distraught. I thought I could help explain things to them.”

Abby calmed herself with a deep breath.

“Okay,” she said. “What happened out there was that for almost twenty minutes our disaster-alert system failed to bring in another physician except for one pediatrician. I examined Mrs. Wheaton and determined that she would not benefit from my time and effort as much as Mr. Cardoza would. I felt that his life was on the line, while hers was already lost.”

Cox grimaced.

“You mean,” he said, “that after less than a minute with Peggy Wheaton—a young woman with a pulse and blood pressure, breathing on her own—you could tell that she wasn’t worth trying to save, while the man who murdered her was?”

“Mr. Cox, this isn’t a courtroom,” Abby said, “and I don’t like the sense that you’re cross-examining me.” She paused while the lawyer mumbled an apology. “I’m horribly saddened by Mrs. Wheaton’s death,” she went on. “But I’m trained to evaluate patients quickly and to make decisions. That’s what ER doctors do every moment they’re on duty. Most of those decisions are quite minor and routine, some are life-and-death. The decision to concentrate on Mr. Cardoza was an extremely painful and difficult one for me to make, but it was the right one. I felt so at the time. I feel it even more strongly now.”

At that moment, inexplicably, she flashed on Willie Cardoza on his back on the Colstar Park grass, holding Angela Cristoforo tightly, yet tenderly, as he kept her from hurting herself anymore.

She would have done the same for me
, he had said to Abby.
We company grunts have to stick together
.

“Would you have done things differently if you had had more time?” Cox was asking.

Abby didn’t answer him. Instead, she turned to Oleander.

“George, did you examine Mrs. Wheaton’s skull? Did you see the extent of the damage?”

The medical chief flushed.

“I … no. No, I didn’t,” he admitted. “There was too much happening too fast. Abby, please understand, we’re not accusing you of doing anything wrong. I’ve been trying to explain to you some of the differences between a city like San Francisco and a place like Patience. By now everyone in town has heard some version of what went on here today. We just want to make sure that when we tell the hospital’s side of it, we’re all on the same page.”

“And are we?”

“What?”

“On the same page.”

Abby had no intention of making excuses for anything she had done. For years she had feared being faced with a day like this. Now it had happened. And whether this impromptu men’s club wanted to accept it or not, she had performed damn well. Whether they were pleased about it or not, a man’s life had been saved. And whether they truly believed it or not, Peggy Wheaton was doomed before she had ever entered the ER.

“I … yes, I suppose we are,” Oleander said. “Joe, Terry, Len?”

The men exchanged glances. None of them looked pleased, although none of them looked as if he had anything further to say. Abby thought she could read their eyes, though, and the set of their jaws.
Our community has its way of dealing with people who turn their backs on us, Dr. Dolan. You’ve had a number of chances to demonstrate you really want to fit in here. Don’t count on being around much longer
.

She shook hands with each of the men and asked
Cox to extend her condolences to Gary Wheaton. Then she gathered her things from the on-call room, signed out to Ted Bogarsky, and left the hospital, surprised that it was still light out. As she headed across the ER parking lot toward the doctors’ parking lot, she didn’t notice a thin young woman who stepped from the lengthening shadows and followed her.

Abby was nearing the far end of the lot when the woman called to her. Abby turned as she approached. The stranger looked to be in her thirties. Her hair was dark and tied back in a ponytail that reached her midback. Her narrow face was plain, although her dark eyes were large and childlike. She wore jeans and a tie-dyed blouse.

“Dr. Dolan,” she said, stammering nervously, “I’m sorry to run after you like this. I tried speaking to you inside, but there were always too many people around.”

“What can I do for you?”

“My name is Colette Simmons. Willie Cardoza is my boyfriend. We’ve been together for almost five years now.”

“Why didn’t you come up to me earlier?”

“I waitress at a restaurant twenty miles away. I didn’t even know about the accident until I got home a little while ago. My girlfriend is a nurse on the second floor. She called me and told me what happened. She said you saved Willie’s life.”

“I’m glad he made it.”

“Dr. Dolan, I’m so upset. Willie would never hurt anyone unless they hurt him first. The policeman told me he’s been arrested for murder. They’re going to take him to a prison hospital as soon as they can. But I think he was real sick before this ever happened.”

“Would you like to sit down and talk?”

“Please.”

Abby motioned her to the low, secluded bench where Lew had first told her about the Alliance.

“What do you mean, Willie was sick?”

“Doctor, Willie ‘n’ me have been together for almost five years. We live in a trailer east of town. We don’t bother folks and they don’t bother us. But Willie has always tried to do what little things he could for people who were old or sick—fix their fence, pick up their groceries, things like that. He even helped that girl at the company picnic who was cutting herself. I don’t know if you heard about that.”

“Actually, I was there, Colette. I saw what he did.”

“Then you know he’s a good man.”

“What’s been happening to him?”

“For about four months he’s been acting real strange. He’s been, I don’t know, moody. Everything gets on his nerves. And that’s just not like him.”

Abby felt the tension building inside her with every word of the woman’s story.

“Please, go on,” she said.

“Well, on top of everything else, he’s been having these terrible headaches. He gets this bad taste in his mouth, then he gets a headache. We think it has something to do with a fall he took off a ladder last March. He smashed his head on a rock and was knocked out for a few seconds. The cut took twenty-five stitches. After that he began to have trouble.”

“Sounds like a concussion. Did he have a CT scan? You know what that is?”

“Yes, I know. He had one several months ago. The doctor at the Colstar clinic said it didn’t show anything.”

“What did they say was wrong with him?”

“Migraine headaches. They gave him some medicine, but he kept getting worse and worse. Finally, a couple of days ago, he had a fight with his boss about missing so much work, and Willie punched him. Dr. Dolan, that’s not like Willie Cardoza. None of this is.”

“I understand,” Abby said. “Do you have any idea what happened today?”

Colette shook her head.

“I left for work before he got up. He was bad yesterday,
I can tell you that much. Real bad. Ranting and raving, and full of hate.
Rich
people. That’s all he kept talkin’ about, how much
rich
people were ruining his life. My friend told me the police were talking about how much everyone hates
him
now for what he did. I’m so frightened for him. Is there anything you can do to help him?”

“I don’t know, Colette.”

Abby started to say something about Josh but thought better of it. Colette Simmons might be a loose cannon in this situation. Instead, she wrote down her phone number.

“Here,” Abby said. “If you need to call me anytime, day or night, just do it. I’ll either be at this number or at the hospital.”

“Please try to help him.”

“I’ll do what I can.”

“Dr. Dolan, is there any chance that it wasn’t Willie who did this?”

“No,” Abby said sadly. “That’s about the only thing I’m certain of right now.”

“Thank you.”

The woman shook her hand gratefully and then hurried back into the hospital. Driven by a surge of nervous energy, Abby stayed on the bench, trying to figure out what her next move should be. Cardoza and Josh—both Colstar employees, both with bizarre headaches and deteriorating behavior, both with violent, paranoid outbursts. Were there others? Did some of those on the Alliance’s list fit the pattern? And what about the strange eye findings—did Josh have them? It was time to put some data together. And soon, maybe later tonight, it would be time to share what she had learned with Lew.

She collected her things. A shower at home, then maybe some Italian food at the Tower of Pizza. After that, she would return to the hospital to check on Willie Cardoza, reexamine his eyes, and review the information in his hospital record. Finally, she would take the list of
names Barbara Torres had given her and get to work in the record room. A picture was emerging. Now it was time to color it in.

Ahead of her, above the trees, eight-foot-high illuminated letters watched over the valley.

Colstar International, Patience, CA. Employee Safety Is Our Highest Priority
.

Abby laughed bitterly at the memory of the sign as she headed for her car. She was actually unlocking the driver’s-side door when she noticed the broken glass covering most of her backseat. A small boulder rested in the center. Above the seat the rear window—what remained of it—was shattered.

Dismayed, Abby looked about. No one.

She checked her tires. The window seemed to be the only casualty—this time.

“Idiots,” she muttered.

She took her briefcase down from where she had set it on the roof and relocked the Mazda. There was nothing she wanted less right now than to report the incident to hospital security or the police. But, almost certainly, her insurance carrier would not cover the replacement unless she did. And the last thing she needed at the moment was to pile up any unnecessary expenses. Soon, possibly very soon, she might be out of a job.

T
he intensive care unit on the second floor of PRH was, like almost everything else in the hospital, state of the art. It handled cardiac and major trauma cases as well as post-ops who were too shaky to go directly to a med-surg floor from the recovery room. Abby went up to the unit frequently to check on patients she had admitted there. Never had she seen it as busy as on this night. There were ten glass-enclosed cubicles arranged around the central nursing/monitoring station. The beds in all of them were filled.

Abby’s first stop was the nurses’ station, where she reviewed Willie Cardoza’s chart. Although some 50 percent of PRH’s records were still kept in manila binders, the hospital’s record keeping was in the process of being upgraded to a system nicknamed KarMen—the Karsten-Mendenhall voice-activated data-encodement system. Compared to it, the record keeping at St. John’s was chisel-and-stone tablet. KarMen, a recent product of a Silicon Valley company, was built upon the instantaneous computer transcription of dictated notes. The dictation was then immediately printed out for inpatient use and also stored electronically for future reference. The hard copy and records yet to be switched to KarMen
were kept in a fireproof vault as backup. KarMen was so sophisticated that physicians and nurses with foreign accents or speech impediments could “register” them by reading a series of prescribed words and phrases into the dictation phone. The system adjusted itself so that their variations in speech would not affect the transcription. Record retrieval was carefully guarded through a series of passwords unique to each physician and nurse, and not to be shared under any circumstances.

Abby reviewed the operative notes from Martin Bartholomew and had to admit that the bombastic surgeon had done a professional job. Cardoza had remained stable throughout his surgery, with no significant blood loss once the circulation to his spleen was tied off.

Bartholomew’s admission note cited an arthroscopic knee operation three years before, and a four-day hospitalization for pneumonia four years before that. There was no mention of the head injury that Colette Simmons believed was responsible for Cardoza’s deteriorating condition. Abby wanted to check with KarMen for those records, but the nurses’-station terminals were all in use. She made a mental note to check Cardoza’s record after she had finished examining him, then headed for his cubicle. Wedged in her clinic-coat pocket was the combination black light and magnifier she had borrowed from the ER. And folded alongside it was a copy of the report she had filed with hospital security.