Harmful Intent (25 page)

 

It didn't take long for Jeffrey to get the surgical lounge looking cleaner than it had in years. Housekeeping had a closet in the hall just outside the lounge. There, Jeffrey found a vacuum cleaner. He used it to vacuum not only the lounge, but also the dictation area and the hallway all the way to the elevators. Next, he attacked the small kitchen off the surgical lounge. He'd always felt the place was filthy. He actually enjoyed the chance to clean it up. He even cleaned the refrigerator, stove, and sink.

David still hadn't come back. Going into the locker room, Jeffrey found out why. David's modus operandi was to work for five or ten minutes, then take a five or ten minute break to smoke a cigarette. Sometimes he broke for a cigarette and coffee.

David didn't seem pleased that Jeffrey had accomplished so much in so little time. He told Jeffrey to slow down or he'd suffer a “cleaning burnout.” But Jeffrey felt it harder to stand around doing nothing than it was to work.

Once David gave up on any notion of the supervision game, he gave Jeffrey his own set of passkeys. He told Jeffrey he could head into the OR suite itself. “I'll stay here and finish the locker room,” he said. “Then I'll be in to help you. Start in the OR corridor. Be sure to hit the big blackboard. In fact, do that first. The director of nursing has a fit whenever we forget to wash it down. Then hit any of the ORs that have been used tonight. The others should have been cleaned during the evening shift.”

Jeffrey would have preferred to go straight to pathology to look up Patty Owen's pathology report, but he was happy to get into the OR. He put on a scrub suit as he'd been instructed. When he checked himself in the mirror, he was alarmed to see
that except for his new shade of hair and his bare upper lip, he looked much like his old self. He quickly put on a surgical mask as he'd planned.

“You don't need a mask,” David said when he caught sight of him.

“I'm coming down with a cold,” Jeffrey explained. “I think they'd want me to wear it.”

David nodded. “Good thinking.”

Pushing his cleaning cart ahead of him, Jeffrey went through the double doors to the OR. He hadn't been in there since the hospital had put him on leave, but the place looked exactly the same. As far as Jeffrey could tell, nothing had changed.

Following David's instructions, Jeffrey tackled the big blackboard first. A few staff members came and went as Jeffrey worked. Some of them Jeffrey knew by name, but none of them gave him a second look. Jeffrey had to believe his cleaning activities protected his true identity as much as his altered appearance did. He made it a point not to stray far from his mop and cleaning cart as he worked.

Even so, when an emergency appendectomy that had been in progress when he first entered the OR was at last completed and the operating team emerged, Jeffrey made it a point to keep his back to the group. The anesthesiologist and the surgeon were both good friends of his.

After the doors swung closed behind the departing team, a silence descended on the OR. Jeffrey could make out the faint sound of a radio coming from the direction of Central Supply. He mopped his way over to the main operating room desk.

The operating room desk was more of a long counter with several areas for people to sit. It served as the command post for moving people into and out of the ORs, calling to have patients brought up from their rooms, bringing in the patients from the holding area, and coordinating the flow of personnel. Under the center portion were a number of large file drawers. One was marked “scheduling.”

Jeffrey glanced up and down the corridor to make sure it was truly deserted. Then he pulled open the drawer. Since the operating schedules were filed according to date, Jeffrey was soon able to find the schedule for the fateful day: September 9. He scanned the day's cases, looking for epidurals that might have required .75% Marcaine, but there were none to be found. There were a number of spinal cases, but they would have used spinal
grade Marcaine if Marcaine had been used at all, not the 30 cc variety used for epidurals or regional blocks.

Going back in the drawer, Jeffrey pulled out the schedule for September 8. Although the biohazard disposal container on the side of the anesthesia machine was emptied every day, there was always a chance it had been missed for some reason. But the schedule for the 8th provided no more possible explanations than the one for the 9th had. Jeffrey was forced to wonder if he'd misread the Marcaine label for Patty Owen's epidural after all. How else could he account for the empty .75% Marcaine vial that had been found?

Just as Jeffrey was almost through, the swinging doors burst open. Jeffrey grabbed his mop and frantically started mopping. For a moment, he dared not look up. But after it became clear no one was approaching, he raised his head in time to see a surgical team rushing a patient on a gurney toward the OR set up for emergencies. Several units of blood were hanging above the stretcher. Jeffrey guessed the patient was a victim of an automobile accident.

Only after calm had returned did Jeffrey go back to the schedules. He replaced each one in its respective slot and closed the file drawer. The emergency case that had just gone by started him thinking. Emergencies wouldn't appear on an OR schedule. For that matter, neither would a case like Patty Owen's. Her Caesarean had not been anticipated. How could it have been scheduled? Jeffrey moved on to the previous year's scheduling book. This was the book that contained listings of all the OR cases, including emergencies and operations that may have been scheduled, only to be canceled or postponed.

Other than Caesareans, epidural anesthesia was not commonly used in emergencies. Jeffrey knew that, but he decided to check the scheduling book anyway, just to be sure. There were exceptions. He looked at entries on the 8th first, running his finger down the list. It was not easy to read since it was in longhand by many different hands. He found nothing remotely suspicious. He turned the page to the 9th and started down the list. He didn't have to check far. In OR 15, the same OR that Patty Owen had been treated in, there had been a corneal laceration repair at five in the morning. Jeffrey's pulse quickened. An ophthalmic emergency was promising indeed.

Jeffrey tore a piece of paper from a pad on the counter and quickly jotted down the patient's name. Then he closed the book and returned it to its spot on the shelf. Pushing his bucket along
on its unsteady wheels, Jeffrey made his way down the hall to the anesthesia office. He opened the door and turned on the light. He ran to the anesthesia file drawer and pulled out the anesthesia record for the patient in question.

“Bingo!” Jeffrey whispered. The anesthesia record indicated that the patient had received retrobulbar anesthesia with .75% Marcaine! Jeffrey put the anesthesia record back in place and shut the file drawer. Kelly had been right. He could hardly believe it. Instantly he felt better about himself, and more confident about his judgment. He knew that what he'd found wouldn't have much import in court, but it meant the world to him. He hadn't misread the label on the Marcaine!

When the time for the lunch break arrived, David came looking for Jeffrey. Jeffrey had finished the main OR corridor and had cleaned the two operating rooms that had been used for the emergencies. He was busy in Central Supply when David found him.

“I'd just as soon keep working,” Jeffrey said. “I'm not hungry. I'll head down to the labs and get started.”

“You gotta slow down,” David said with a bit less friendliness than he'd shown initially. “You'll make the rest of us look bad.”

Jeffrey smiled sheepishly. “I guess I'm just eager because it's my first day. Don't worry, I'll calm down.”

“I hope so,” David muttered. Then he turned and left.

Jeffrey finished what he was doing in Central Supply, then pushed his cart the length of the OR corridor and out the swinging doors. Changing back to his housekeeping uniform, he pushed the cart down to the pathology department. He wanted to take advantage of the fact that David and the other cleaning personnel were lunching.

He tried the passkeys in the door that led to the administrative section of pathology. The third key opened the door. Jeffrey was amazed where his uniform and passkeys could take him.

The place was deserted. The only people around in that whole section of the hospital were the technicians in the chemistry, hematology, and microbiology labs. Jeffrey lost no time. Propping his mop up against the massive file cabinets, he searched for the pathology file on Patty Owen. He found it easily.

He put the folder on a desk and opened it. Flipping through the pages, he found copies of the Medical Examiner's autopsy report. He turned to the toxicology section, which had graphs of the results of the gas chromatography-mass spectroscopy of blood, cerebrospinal fluid, and urine. The only compound that
was listed as having been found was bupivacaine, the generic name for Marcaine. No other chemicals had been found in her body fluids, at least none that the tests had discovered.

Jeffrey went through the rest of the file, glancing at each page. He was surprised to find a number of eight-by-ten photos. Jeffrey pulled them free. They were electron micrographs made at Boston Memorial. Jeffrey's curiosity was piqued: electron micrographs were certainly not done for every autopsy. He was sorry he wasn't more skilled at interpreting electron microscope sections. As it was, he had a hard time deciding which end was up. After studying the micrographs carefully, he finally realized that he was looking at magnified images of nerve ganglia cells and nerve axons.

Reading the descriptions on the back of each photo, Jeffrey learned that the electron micrographs showed marked destruction of the intracellular architecture. He was intrigued. These photos had not been exhibited during pretrial discovery. With the hospital involved as a defendant in the same case as Jeffrey, the pathology department had not been acting with Jeffrey's best interest in mind. Jeffrey had not even been informed of the existence of these photos. If he and Randolph had, they might have been subpoenaed, not that Jeffrey had been particularly interested in possible axonal degeneration at the time of his trial.

Seeing the axonal degeneration evident in Patty Owen's electron micrographs made Jeffrey recall the axonal degeneration Chris Everson had described in his patient's autopsy. What was so startling about the degeneration in both cases was that local anesthetics could not have been responsible. There had to be some other explanation.

Jeffrey took the file to the copy machine and copied the parts he thought he'd need. These included the electron microscopic reports, although not the photos themselves. It also included the toxicology section with the gas chromatography and mass spectroscopy graphs. To properly decipher the graphs, he knew he would have to spend more time in the library.

When he was finished with the copy machine, he found a large manila envelope and put the copies into it. Then he returned the original to its folder and refiled it. Jeffrey stowed the manila envelope on the lower shelf of his cleaning cart under some replacement rolls of toilet paper.

Then Jeffrey turned his attention back to cleaning. He was excited about what he had found. The idea of a contaminant was
still viable indeed. In fact, given the results of the electron micrographs, it was almost a certainty.

As the night wore on, Jeffrey's energy waned. By the time the sky began to brighten, he was thoroughly exhausted. He'd been running on nervous energy for hours. At six-fifteen, he took the opportunity of a phone in an empty social service office to give Kelly a call. If she had to leave the house by six forty-five, she was sure to be up.

As soon as she came on the line, Jeffrey excitedly told her about the emergency eye case the morning of the Patty Owen disaster and that .75% Marcaine had been used. “Kelly, you were so right. I don't understand why no one thought to look into such a possibility. Randolph didn't, and I never did.” Then he told her about the electron micrographs.

“Does that suggest a contaminant?” Kelly asked.

“It makes it almost certain. The next step is to try to figure out what it could be and why it didn't show up in the toxicology report.”

“This whole thing scares me,” Kelly said.

“Me too,” Jeffrey agreed. He then asked her if she knew anybody in pathology at Valley Hospital.

“Not in pathology,” Kelly answered. “But I still know several of the anesthesiologists. Hart Ruddock was Chris's best friend. I'm sure he'll know someone in pathology.”

“Could you give him a call?” Jeffrey asked. “See if he'd be willing to get copies of whatever the pathology department has on Henry Noble. I'd be particularly interested in EM studies or histology of nervous tissue.”

“What will I say if he asks why I want it?”

“I don't know. Tell him you're interested, that you were reading Chris's notes and read that there was axonal degeneration. That should pique his curiosity.”

“All right,” Kelly said. “And you better get back here and get some rest. You must be asleep on your feet.”

“I'm exhausted,” Jeffrey admitted. “Cleaning is a hell of a lot more tiring than giving anesthesia.”

 

Early that morning, Trent made his way down the OR corridor of St. Joseph's Hospital with the doctored vial back in his briefs. He went through the same motions he had the previous morning, being especially sure no one was anywhere near Central Supply before he went in to switch the ampules. Since there were now only two ampules of .5% Marcaine in the open box, the
chances that his ampule would be used that day were good, especially with two epidural cases listed on the big board. Of course, there was no guarantee Marcaine would be used, much less the .5%. But there was a good chance. The cases scheduled were a herniorrhaphy and a laparoscopy. If it was one or the other, Trent hoped his ampule would make it to the laparoscopy. It would be too perfect; that prick Doherty was listed as the anesthesiologist.