Terminally Ill Page 20

  “You have a bad history of jumping on things every time someone asks for something.”

  I shrugged. “All doctors are like that.”

  “No, we’re not! I let people do their jobs. Fighting crime is not your job! Your job is to fight disease.”

  I couldn’t speak for a second, I was so pissed off. “My job is to prescribe medications? My weapons are a stethoscope and a tongue depressor?”

  “Well...yeah!”

  “I’ve got news for you, buddy. More people have been saved by clean water and hand-washing than any of those things!” Thank you, Ryan, engineering ex-boyfriend, for the tip. I plowed on. “But that’s beside the point. Hypocrisy, thy name is Tucker. You’re just jealous because I didn’t take you along to look for Hugo!”

  “No! I’m looking out for you. I’ll get to the Hugo thing, trust me, but you spring this new case on me. What are you thinking? What happened to your retirement?”

  “I got back in the ring.” My voice trembled a little. I hoped he didn’t notice it over the phone line.

  He paused. I could practically hear him changing gears. “Let’s not argue about this.” His voice warmed. I rolled my eyes, but he continued layering on the charm. “Now you’re one person with two cases. Doesn’t it make sense to turn Elvis over to me now, so you can concentrate on Mr. Bérubé?”

  “Why don’t we both work on Elvis? I think he’s kind of expecting me to keep it up.” It wasn’t like Elvis was a train I could hop on and off, especially after leading the police to Hugo’s body. “We can work together. And I already said yes to Mrs. Bérubé and Dr. Huot.”

  He dropped the charm. “That’s your final answer? You’ve going to take on both cases, double time?”

  “That’s right.” My voice slashed through the receiver, but my heart pumped in my throat. I hated fighting with Tucker.

  “Then there’s only one thing for me to do.”

  “What?”

  “Solve Elvis’s case before you do.”

  “You wouldn’t.”

  “Try me.”

  I hung up on him, which I know is very junior high school (or I guess it’s not anymore. What do they do nowadays, block each other’s text messages when they get pissed? Anyway. Moving on).

  Doubt stabbed me. Here I was, launching from zero to two hundred, as usual. From no cases to two cases, simultaneously. What was I doing? Now I didn’t even have Tucker, and Ryan was in Ottawa. I took a deep breath and decided to ignore everything except the article in front of me.

  Of course it, too, stated that just because they’ve got spots in their eyes doesn’t mean they’ve been strangled.

  As usual, the story dates back to a doctor who named a finding after himself. In 1855, Tardieu published a paper on asphyxiation. He noticed tiny hemorrhages on the surfaces of the heart, lungs, and other body parts, because superficial vessels had ruptured. He said these were “characteristic of death from suffocation,” so they’re now called Tardieu spots.

  The problem was, you can be suffocated and have no petechiae, which is the most common thing, or you can not be suffocated but have lots of petechiae. Petechiae just means that you have superficial blood vessels that have burst.

  Case in point: in medical school, when we were talking about the difference between petechiae (less than 2 mm diameter) and ecchymosis (larger than 2 mm), one of my classmates sad, “If you want to see a good example of petechiae, you should ask Ginger if you can see her rash on her arm. She scratched so hard, she gave herself petechiae!” After a minute, the classmate paused and said, “I shouldn’t have said that.” But of course, when Ginger heard about it later, she was pissed. Naturally, Ginger had not been asphyxiated.

  One researcher reviewed the victims of strangulations in New York City in 1967. About half the cases had petechiae, most often in the whites of the eyes, but also in the face, especially if the strangler had used some sort of ligature, or tie, around the neck. Of course, then you often saw the mark from the ligature as well.

  I winced and rubbed my throat. I’d almost been strangled myself. I didn’t have any scars from it, but I was bruised and couldn’t talk for days afterward. My voice still got hoarse more easily when I was tired. I didn’t want to think about hemorrhages in the whites of my eyes.

  I put my mind back to Mr. Bérubé. I hadn’t seen any mark around his throat, either. I hadn’t gone back and examined him closely, because if this was going to be a criminal case, they needed fewer hands on deck, not more. But I’d gotten a gander at his neck, and I hadn’t seen anything. But you can suffocate someone without leaving much of a trace.

  My pager rang, this time for the floor. Mrs. Bérubé’s voice trembled with emotion. “They’re going to do a criminal autopsy on George. Thank you.”

  “You’re welcome,” I said, trying not to think of Tucker. I’d always thought I’d lose him over Ryan, or vice versa. But now I might lose him over a case.

  “Do you think you might be able to attend?”

  “I don’t know, Mrs. Bérubé.”

  “I’d feel so much better if you could be there.”

  “I’ll do my best,” I promised. After she thanked me about three more times, I managed to hang up, but I continued to stand by the phone, wondering if they’d give me permission to attend the post mortem.

  It sounds horrible, but I’ve never seen one. The pathologists would invite us to them after our Monday afternoon lectures in first year, but I always wanted to study or go to a spinning class or whatever. “I’ll go to the next one,” I kept saying, and of course I never did. Now was my chance.

  On the other hand, I’d probably already alienated Dr. Lapierre beyond redemption, and this was a criminal case. Even I knew that this wasn’t the best time to ask for a favour.

  So I made my way back to the ward to find someone who knew better how to catch flies with a bucket of honey instead of piss and vinegar.

  Dr. Huot.

  Ricky pointed me to a room down the hall, but since the door was closed, I waited for the good doctor back by the nursing station. Then I realized Karen was on break. I slipped inside the small room behind the nursing station.

  She’d pulled one of the wire chairs to the window, using the windowsill like a little table for her cup of coffee, while something sizzled in the microwave. She was on her phone, but when I came in, she met my eyes without smiling.

  I said, “Hi, Karen. Could I ask you a few questions?”

  She nodded. “I figured you’d be around.”

  Sort of a lukewarm response, but she was on break, which is sacrosanct. “Thanks for helping out. I was just wondering, when was the last time you saw Mr. Bérubé alive?”

  She set her phone on the windowsill and squinted a little, staring into the distance. “I’ve been thinking about my day. I did his vital signs on my morning rounds, which was from 7 a.m. to 7:45 a.m. I started with George and I spoke to him and Claire for a few minutes.”

  I belatedly realized that Claire must be Mrs. Bérubé’s first name. Some detective I was.

  “He said he wanted to sit up in the chair, but he was pretty shaky on his feet. I asked him to wait until I’d finished my vital signs, and he said, ‘Sure thing, doll. I got all the time in the world,’ and he squeezed my hand.”

  “He called you ‘doll’?” That seemed odd to me. He never seemed to have the strength to stay awake, let alone semi-flirt with anyone.

  She smiled. “I think that’s what he said. He had a hoarse voice and he never spoke very loudly.”

  Maybe the lung cancer had attacked the recurrent laryngeal nerve, the nerve that innervates the vocal cords. But before I got too distracted by this med school factoid, I paused to consider and realized that I’d never heard Mr. Bérubé speak. He was almost always asleep. Weird.

  Karen resumed her story. “I came back after I’d finished with the other patients, once I could get a préposé to give me a hand. That was Toni, around 9:45. Mrs. Bérubé had already changed him, helped him with his b
reakfast, brushed his teeth, and given him a sponge bath.”

  I sent a silent prayer that a) I would never get infirm enough to need a diaper and a sponge bath, and b) if I did, someone like Mrs. Bérubé would take care of me.

  “He said he wanted to walk down the hall, but he ended up just taking a few steps to the chair. That was enough. We tucked his quilt around him, and Mrs. Bérubé wanted to read him the newspaper.”

  “Did you see her leave to get him lunch?”

  “No, I was busy with 5886 for most of the morning. But he rang when he wanted to go back to bed, like I said, and we got him settled and he went to sleep.”

  I thought of another point. Because Mr. Bérubé slept during my visits, I almost never saw him with his eyes open. “He didn’t have any subconjunctival hemorrhages at that time?”

  She shook her head. “No. His eyes were a little bloodshot, but nothing like what we saw just now.”

  “And do you know what time you came to move him to his bed?”

  Her forehead pleated. “I’m thinking it was close to 1 p.m., because I took my lunch at 1:15, and I had to hurry a little.”

  “You started with him at 1 p.m., or you finished at 1:15?”

  “I was finished by 1 p.m., or pretty close to.”

  “Did he eat his lunch?”

  She shook her head. “He didn’t want it. Maybe he was waiting for the dolmades, but he seemed pretty tuckered out.”

  So Mr. Bérubé had been alone in his bed from about 1 p.m. to 1:40 p.m., when his wife returned with his lunch. It was possible that someone had come in and offed him, but it didn’t seemed likely, especially on such a small unit where everyone knows your name. “You and Judy are the only nurses working today?”

  “Yes. Judy is an RPN.” RPNs are registered practical nurses and do some of the same things as registered nurses (RNs), but can’t give narcotics and things like that. Judy smiled a lot and wore light blue scrubs, kind of like Nurse Jackie on a good day.

  “And Toni is the préposée?” I asked. Préposés are orderlies (add an extra e to the word if they’re female). They do a lot of the heavy lifting—literally—carrying patients around, delivering lunch trays, washing patients, getting them on and off commodes, that sort of thing.

  “Warren is a float nurse from oncology. We’re short-staffed today.” Warren was a weightlifting type in his twenties, big nose, shaggy brown hair, didn’t talk much. We’d nodded to each other a few times.

  “Who helped you move Mr. Bérubé?”

  “Judy did. Warren was on lunch.”

  So I could ask Judy. Maybe she’d seen someone in or out of Mr. Bérubé’s room. Usually Ricky, the unit clerk, might notice people coming on and off the elevator, but she was on lunch.

  Still. If you were going to kill someone, you’d be better off in the evening or at night time, when fewer staff and visitors are around. On the other hand, visiting hours might limit your access. I made a mental note to check on visiting hours. It’s something that doesn’t affect me, except for a woman’s voice blaring overhead, “Visiting hours are now over. Les heures de visites sont maintenant terminées.”

  “We don’t have any cameras in the halls here, do we?” I belatedly glanced up and down the hall. It’s something I should have noticed, but I’m focused on the patients, not on my surroundings, ninety percent of the time.

  She shook her head. “I don’t think we have them on any of the wards, just at the main entrance and the emergency entrance, for privacy reasons.”

  And you didn’t have to go through those two doors. Other doors are left unlocked during the day. I often nip in and out through back doors that face the Family Medicine Centre, instead of looping around to the main doors. Ah, well. As I’d told Mrs. Bérubé, the police could look through any camera footage, should they desire.

  Still, it looked like if you were going to kill someone, lunchtime was one of the better day time choices, because Mrs. Bérubé, Karen, and Ricky were all absent when Mr. Bérubé died.

  I couldn’t think of any more questions, but I did know enough to say, “Could you page me if you remember anything else?”

  She nodded. “I wish I could help. I liked both of them very much. But probably the best thing for her to do is to let him go.”

  I licked my lips. They felt cracked. I wondered if she was giving me the unspoken message that I was prolonging Mrs. Bérubé’s agony by giving her false expectations. But at least Dr. Huot backed me up. And, glancing through the break room door, I saw that the good doctor had returned.

  I bid Karen farewell and asked Dr. Huot, as nicely as possible, if she thought she could get me into the autopsy. She glowed at me. “I appreciate your enthusiasm, Hope. It revitalizes the department.”

  I didn’t know what she was talking about, but it’s always kind of funny how French people say “enthusiasm” because you can hear them struggling not to say it in French, like en-two-si-asme! I just said, “Uh, thanks.”

  “I will ask Dr. Lapierre, but of course, it is at his discretion to decide if the benefits of teaching a student outweigh the risk of having an extra person present in what could be a criminal matter.” She beamed brighter than anyone ever has while discussing a possible murder. She asked Ricky to page Dr. Lapierre and turned back to me. “Now. What have you learned so far?”

  Time to roll out the petechiae article once more. I brought it up on my phone, even though it reminded me of the fight with Tucker. C’mon, Hope. Concentrate.

  Dr. Huot released me at 5 p.m. so I could get sign-over from internal medicine. Omar would be my senior resident on call tonight. We smiled at each other, but I was busy taking notes on the thirty-odd new patients, on the ward and admitted in emerg, now under my care. Yowch.

  Right away, I got called because a demented man had ripped his Foley catheter out of his bladder through his penis. Note to laymen who want to try this at home: you’re supposed to deflate the catheter’s bladder first so it doesn’t shred your urethra.

  Long story short, blood everywhere. I did my best to examine the patient while his nurse held him down. I paged urology and did bloodwork with a repeat hemoglobin in four hours, hoping he wouldn’t bleed out, out of his penis, since urology wanted to sit on him until the morning, and no one wants to bleed to death through his dick.

  Day just kind of drifts into evening and night time when you’re on call, running your feet off. I made it to the cafeteria before it closed, but had to shove my food in the fridge because I got paged before I could eat it. In between cases, I texted Ryan back, who asked if I’d heard from the police (“Not today, but I’ve got something else to talk to you about tomorrow”). Then I decided to take the plunge, break my unofficial no-call-on-call rule a second time, and text Tucker. I didn’t want us to go for another few days incommunicado, and tomorrow, with any luck, I’d be napping. I typed “So? You solved it yet?” and slid the phone in my lab coat pocket.

  I managed to wash my hands and hustle to the residents’ room without getting paged. I glugged down half a litre of water and tended to my now-cold supper. It was the “union meal,” the hot meal we can get through our on-call meal ticket, but since I hadn’t had time to eat it fresh, the instant mashed potatoes had congealed, and I wasn’t sure what kind of stew nestled beside it. I dug my fork in anyway. Two of the general surgeons used to reminisce about how they’d have speed-eating contests during residency, seeing how fast they could gulp down their grub between cases, but the staff surgeon would beat them every time.

  I could’ve given them a run for their money. Not only did I inhale my food, I managed to slip off my running shoes and curl and uncurl my toes. Ideally, the smell wouldn’t disturb the medical student watching TV on the other side of the residents’ room, but as usual, the room stank so bad, my foot sweat just wafted into the general miasma.

  The strawberry Jell-O was old enough to have developed a chewy skin. I made a face, but it was better than nothing. I was just scraping the sides of the plastic cup by the
time Tucker texted back, Come down to the emerg and see what I got.

  I typed, What? You’re not on call.

  He wrote back, Yeah, I took Mireille’s.

  That seemed to be going around. And you still got to see Elvis this morning?

  Come down, he repeated.

  Huh. I shut my phone without answering. Most likely, he’d managed to sneak in a visit to Elvis this morning before his clinic. That made him seem more keen on the case, which bugged me, even if he was just doing a day of clinics plus the 4 to midnight emerg shift before he’d get to go home and sleep. He was also on call for family medicine patients, but it’s telephone service only. That just means that once in a while, someone calls because their baby has a rash, and if you want to, you can say, “Bring the baby in and I’ll see him in the emerg tonight.” Meanwhile, I’d be running my feet off for at least 24 hours. Not the same animal.

  I swallowed the last of my Jell-O, finished my water, and hustled down to the ER. Tucker was reviewing a case with Dr. Chia. He met my eye and tipped his head toward the resident’s room, the little call room where we sleep if we’re lucky enough to take five on a night shift.

  Message received. I walked over to the ledge above unit coordinator’s fax machine and grabbed the room key, which is attached to a giant yellow stick that guarantees you’ll never walk home with it in your hand, no matter how tired you are.

  Andrea, my other favourite emerg nurse, raised her eyebrows at me. “Hi, Hope. Are you on tonight?”

  “I’m doing call for medicine. I just need to grab something from the residents’ room,” I said, but my cheeks flushed. I’m a terrible liar.

  “Are you investigating another case?” she asked.

  I felt my cheeks heat up even more. “Um, where’d you hear that?”

  She rolled her eyes. “Everywhere. So, are you?”

  “Sort of.” I didn’t bother clarifying that it was really two cases.

  “Uh huh.” Andrea didn’t say anything else. She didn’t have to. I hurried to the residents’ room located just off the small hallway between stretchers 8 and 9. She’d probably spot Tucker making his way over in the next few minutes, but what could I do?