Critical Judgment (1996) (21 page)

After discovering the shattered window in her car, Abby had reluctantly sought out the guard on duty, a huge, porcine-faced man who chewed nonstop on a toothpick while he took down her complaint. His blatant lack of outrage at the damage to her car made it clear that he had been exposed to some version of the Cardoza-Wheaton story.

“We’ll look into it, Doc,” he said, scuffing at a few shards of glass on the tarmac by her car. “Looks like whoever did it had some muscles, though. That rock must weigh twenty pounds at least.”

Abby left, having little difficulty imagining the guard himself heaving the boulder through the rear window of her Mazda.

It was on her way up to the ICU that she had stopped by the ER for the ophthalmologic ultraviolet light. Before pursuing the strange eye findings on Willie Cardoza, she had wanted to verify them. Entering and leaving the ENT room, she passed several nurses and aides. Not one of them spoke to her except Bud Perlow, who seemed genuinely concerned for what she was going through. Rarely in her medical career had she clashed with physicians or nurses. In fact, during tough times she had drawn strength from the respect they had for her skill, her attitude, and even her worrywart approach to solving problems. Now she had performed almost flawlessly in the most challenging situation. And, as a result, she had placed her job and even her career in jeopardy. Welcome to Patience, CA.

The police officer seated on a folding chair just outside Willie Cardoza’s cubicle, looked ridiculously out of place in the bustling unit. If he knew who she was, he hid it well. He glanced at the plastic ID on her clinic coat but could not possibly have read her name as she walked straight past him and into the room.

Willie, eyes closed, was breathing comfortably on his own. Overhead, the monitoring equipment continuously traced out his EKG, blood pressure, central-venous pressure, pulmonary-artery pressure, and blood-oxygen concentration. State of the art. The lights were dim. The whirring, hissing, and gurgling of Willie’s oxygen-delivery system and chest-tube suction apparatus droned white noise in concert with the sounds from the other nine rooms. But within the cacophony Abby also heard the alarm on one of Cardoza’s IV infusion pumps beeping that the line was obstructed. The nurses were occupied with other patients and might not have heard it. But she wondered if the policeman was unaware of the significance of the sound, or was simply ignoring it.

She followed the IV tubing from the plastic bottle through the pump and down to Willie’s hand. No kinks. Next she gently straightened his arm out at the elbow. The alarm stopped almost immediately, and the red warning light went out. At the base of the plastic bottle she could see the droplets begin to flow once again. Instead of confronting the nurses with the information that the IV was easily occluded by Cardoza bending his elbow, she wrote it on a note and taped it to the infusion unit. It would be interesting to see if anyone bothered to splint his arm to keep it from bending.

“Everything okay?”

Willie was peering up at her through half-open eyes. He had on an oxygen mask, and there was a tube in his nose that kept his stomach from overfilling with acid. His lips were dry and cracked. There were faint bruises on his forehead. His voice had the raspiness of a patient who had been on artificial ventilation through a breathing tube. Abby moved to the side of the bed where the dim fluorescent light could best shine on her face.

“So far, so good,” she said. “How’re you doing?”

“Who are you?”

“My name’s Dr. Abby Dolan. I’m the emergency doctor who took care of you when you first came in.”

“Did I really kill someone like they say?”

“Don’t you remember what happened?”

“I remember I was angry and … and sick. And my head wouldn’t stop hurting.”

“That’s all you remember?”

“Did I really kill someone?”

Abby could feel his confusion and anguish. She took his hand in hers.

“You hit some people with your car, Mr. Cardoza. Three women. I’m very sorry, but one of them
did
die.”

Cardoza’s eyes closed.

“Oh, God,” he moaned softly.

There were many questions Abby wanted to ask him about the headaches and the months that preceded the
violence at the country club. But there would be time later on or in the morning. She plugged the black light into one of the wall sockets over the bed.

“Mr. Cardoza,” she said, “I know you’re tired, and I know I just gave you some awful news. But if you can help me, I’d like to examine your eyes with this special light. I took a piece of glass out of your eye earlier today, and I’d like to check and see if everything’s okay.”

For several seconds Cardoza remained as he was, eyes closed. Then, slowly, he opened them. As he did, a tear broke free from the corner of his right eye and glided down along the edge of the oxygen mask.

“Thank you,” Abby whispered. “I want to help you, Willie. I really do.”

She shined the light in Cardoza’s eyes. The glowing golden ring was there in each eye—thin as a pencil lead, but definite.

She examined Cardoza’s eyes for half a minute and then allowed them to close. Except in textbooks she had never seen the golden-brown Kayser-Fleischer rings that were diagnostic of copper toxicity. But from what she remembered, the thickness and location were almost identical to these. And didn’t poisoning with silver and gold do something to the cornea as well? An hour or two in the library would fill the gaps in her memory. The rings didn’t mean anything yet in terms of signifying an underlying problem, but she strongly sensed they were going to. Later tonight or tomorrow she would discuss the bizarre finding with Lew. In the meantime, as long as her nervous energy was keeping her awake and keen, she would see what the record room had to offer.

She pulled up the sheet and adjusted the pillow beneath Willie’s head.

“Hang in there,” she said.

The record room at PRH, as in many hospitals, was located in the basement. Abby walked down from the
ICU, aware of the toll that the stressful day was beginning to take on her mind and body. But there were too many unanswered questions for her to stop now. And, besides, she had little desire to hurry home for yet another night in an empty house.

The record-room door was locked, although light shone through the opaque glass panel. Abby knocked once, then again.

“Just a minute,” a woman called out.

Through the glass Abby saw her approaching. The door opened, and before Abby could place the woman, she identified herself.

“Dr. Dolan, hi—I’m Donna Tracy, Bill’s daughter. Come in.”

“How’s your dad?”

“He’s home and doing very well, thanks to you. You know that the test for Cushing’s disease did come back positive.”

“I did know that, yes.”

“He’s gone to see a specialist at University Hospital in San Francisco. Dr. Fitzgerald. Do you know him?”

“He’s the best around.”

“That’s great to hear.”

Bill Tracy, Willie Cardoza—two lives she had been directly responsible for saving. But for one she was criticized for embarrassing another physician, and for the other she was an instant pariah just for succeeding. Tough gig, this place.

“I heard about that woman who got killed today.”

“It was pretty bad.”

“I don’t know how you do it.”

“Sometimes I don’t know either.”

“How can I help you?”

“I’m doing a little research about allergic reactions seen in the ER. Since I’m still a little wound up from all that’s happened today, I thought I’d begin to put together some of the data. I don’t know how many of the
cases I want to review are on KarMen, and how many are still in regular files.”

Donna Tracy bit at her lower lip.

“Dr. Dolan, I’m not sure you can do that,” she said.

“Why? I have a password to get into the retrieval side of KarMen. I just need to know where to find things. I won’t be in your way, I promise.”

“I may have to clear this with my boss.”

Abby glanced at the clock.

“It won’t take me long. Maybe an hour or two at the most. I really am glad your dad’s doing so well.”

“Thank you. Oh, well, I suppose while I’m trying to get in touch with Joanne Ricci, you can get started. I’m sure she’ll say it’s okay. I do need to check, though.”

“Thank you, Donna.”

“Do you have the names and hospital numbers? … Good. Just give them to me, and I’ll check off which ones are in the new system and which ones are still in files. The ER and the OR are the only parts of the hospital completely on KarMen, but they have two people working every day to load in the rest of the medical records. We still have everything on hard copy, and I suspect we will for a long time to come. But KarMen is much easier to use and certainly takes up a lot less space.”

“Let’s do it. One thing?”

“Yes?”

“Do you have a street map of Patience and the rest of the valley?”

“No, but I imagine security does. Harvey’s around someplace. Do you want me to call and check with him?”

“No, no, that’s all right.”

Harvey
. Abby handed over the first half of the Alliance’s list, then took the other half and settled in at the nearest dictation carrel.

Patient name, age, sex, address, marital status, date, time, presenting complaint, discharge diagnosis, private
physician, treating physician, blood work, X rays. Meticulously, Abby set up her database. As ER residents, she and each of the others in her program had been required to spend three months writing a literature-review article or conducting a retrospective record review. Abby’s research, involving the correlation of internal damage with the entry location of gunshot wounds that had no exit holes, had actually been published. At the time, she and the others had groused about the impracticality of forcing action-oriented ER trainees to develop techniques of setting up databases and to relearn the various statistical tests for data analysis. Now she was grateful.

By the time Abby had completed setting up the data grid she would be filling in, Donna Tracy returned with half of her list, along with a stack of records.

“Some of these people have never been inpatients here,” Donna said. “The ones on the list marked
K
are in KarMen. You can access them right there with your password. Most are ER records of people who have never been admitted.”

It was well after nine by the time Abby began reviewing the charts. The process was more difficult than she had anticipated for several reasons, the first of which was that she was absolutely exhausted. Her concentration was compromised, and she was reduced to logging in the data on each patient without trying to reach any conclusions. Another problem was the lack of a clearly defined hypothesis—the postulate that she intended to prove or disprove through her research. Instead, she was taking the scattershot approach of amassing as much information as possible in hopes that some similarities or, better still, a pattern, would emerge.

By ten she had completed the review on eight cases. Half were Colstar employees, three of whom had George Oleander as their primary doctor. One from the non-Colstar group had also been a patient of Oleander. None of the eight had a final diagnosis that was confirmed by
a positive laboratory test, although all of them had been put through impressively detailed workups.

Abby checked the time. Something about what she was seeing was bothering her, but she was too tired to put her finger on what it might be. Instead, she pulled out one last record. If she didn’t quit for the night very soon, she was sure to start missing things. It was then that she noticed that she still had the ultraviolet light in her pocket. The way things were going, Harvey would be waiting outside the hospital to arrest her for grand larceny. The black light drew her thoughts back to the unfinished business of reviewing the record of Willie Cardoza’s head injury.

She entered the KarMen retrieval system and typed in JOSHWY, the first of her two passwords. After responding to a series of questions about who she was and why she wanted the record, she logged in her other password, KILKENNY, the county in Ireland where her father had been born. Willie’s KarMen record quickly appeared on the screen. It showed precisely what Bartholomew had noted in his workup: an outpatient knee operation and a four-day stay for pneumococcal pneumonia. No head injury.

“Donna,” she called out, “sorry to bother you, but do you happen to have the actual chart for Willie Cardoza?”

“The patient who’s in the unit?”

“Yes.”

“It may have gone up, but I’ll check.” She disappeared into the record vault for only a minute. “I can’t find it. It must be—”

The door to the record room slammed open, and a middle-aged woman strode in, followed closely by Harvey, the guard. She clearly had come directly from some sort of dress-up affair and was wearing an evening pants suit and a great deal of makeup and jewelry.

“Mrs. Ricci!” Donna exclaimed, clearly startled and concerned by the woman’s arrival.

“Donna, instead of leaving a message on my machine, you should have had me paged. This situation is an emergency that requires my immediate attention.”

Harvey’s pig face looked down at Abby. He shook his massive head reprovingly.

“I … I’m sorry,” Donna stammered. “I didn’t think—”

“This was not the time for thinking,” Ricci snapped. “It was the time for knowing our policy.”

By now Abby had regained her composure. Ignoring the guard, she stood to confront the woman.

“Excuse me, but what is this all about?” she asked.

Joanne Ricci met her gaze with the ease of someone used to being in charge.

“Donna left a message that you were here. Obviously, she saw nothing wrong with allowing you to examine the charts of our patients, but I do. And so does the medical records committee of
your
medical staff. It was just fortunate that I called into my answering machine from the dinner party I was attending.”

“All I was doing was checking for patients who might have been having allergic reactions,” Abby said.

“Frankly, Dr. Dolan, I have no interest in what you were looking for, only in the rule you”—she shot a withering look at Donna—
“and
you, were breaking. Now, if you’d please set those records on the counter, I’d like you to leave.”