Shadow of Death Read online

  In time, Dr. David Monroe was appointed chairman of surgery. That had occurred based on his own merit, he wanted to think, but had his influential father-in-law paved the way? Did it matter? Deep down, he knew that it was his own personal vision that had transformed City Hospital in Detroit into the nation’s leading Trauma Surgery Center. And of that, he was immensely proud. Except for that incident with the Diggs boy.

  How could he forget the night Detroit went up in flames? More than a hundred doctors working around the clock from Sunday evening through Thursday. But no matter the chaos and the pure physical exhaustion of those days, it was inconceivable that a boy with a gaping head wound be left unattended on a stretcher. The Diggs boy arrived via ambulance with a gunshot wound to the head; but in the turmoil he was not logged into the system. Finding his head swathed in a bulky bandage, the emergency room staff assumed he’d been evaluated and judged stable. To compound matters, the female intern who found him in cardiac arrest had a difficult time intubating him, leading to prolonged anoxia.

  Each day he halfway expected notification of a lawsuit, or worse yet, a call from an investigative reporter from the Free Press, now that that nun was asking questions. Sister Mary Agnes, a friend of the patient’s family, had come to see him with what she called an eyewitness report of what had happened. The eyewitness was the patient’s brother who’d snuck into the ER and watched the botched resuscitation. David had been honest with the nun, admitting that the hospital had made a mistake that night. On impulse, he’d promised her that the hospital would cover all the patient’s medical costs, determined to personally pay if the hospital balked. Mistakes like that should not happen in his emergency room.

  Now the Diggs boy had no brain function. Whether from the gunshot wound or the lapse in emergency care, it was impossible to tell. There was no hope of recovery, yet his mother refused to turn off the ventilator. What would he do if this were happening to his son? Well, he’d never have a son and that was that.

  * * *

  As David entered the stop-and-go traffic along Jefferson Avenue, the present came into focus. Today the first year med students would be reporting on their first physical examinations. And he planned to attend although he usually delegated this to the junior staff. Naive students fumbling around with their first diagnostic cases usually made him impatient, but his mind kept returning to a certain student. What was her name? The one assigned to the Diggs boy. That must be why she lingered on his mind. He couldn’t shake the Diggs tragedy. And then he’d seen her last night in the parking lot. Looking so strange. Or was it scared? She had such distinctive green eyes. A pretty blonde with that all-American look he found so refreshing. Glancing out the car window at the misty river, David continued to wonder why this woman so intrigued him? Then he remembered her name, Laura Nelson. Amused at the rare feeling he was experiencing, he calmly made his way through the rush hour traffic. The feeling? It was anticipation.

  CHAPTER SIX

  “There was a call from the dean, Dr. Monroe,” David’s secretary announced as he walked into his office. Connie Zimmer, a prim woman in her early fifties, had worked for David since his arrival at the school nine years ago. By now, she could just about anticipate David’s reaction to everything. “He wants to see you in his office for a short meeting right away.”

  David sighed with irritation. “What’s it about, Connie?”

  “He didn’t say.”

  “My schedule’s too tight.”

  “This morning you have the first year students and no other meetings that I know of. I thought you’d appreciate the reprieve.”

  “Well, you thought wrong.” David tossed his leather briefcase on the credenza.

  “I’m sorry, Dr. Monroe,” she said slowly.

  He glanced at the stack of charts on his desk, then turned to Connie with a sheepish grin. “No, I’m sorry. I’ll go see what kind of bureaucracy Andrew’s dreamed up, but I am planning to make the student review.”

  “Now what’s got into him?” Connie muttered when her boss gave her shoulder an affectionate squeeze on the way out.

  Dean Andrew Burke’s massive, boxy form overwhelmed even the oversize chair at his desk. The venerable dean of University Medical School needed a course in weight management. Three upholstered chairs were arranged in front of him. Ed Collins, the frail chairman of medicine, was settled in one. David valued his counterpart, twenty years his senior, as a trusted colleague, and a mentor in the politics of academic medicine. At the moment, Ed was talking to a man with coppery brown skin, a husky athletic build and intense black eyes. The stranger was middle-aged, with a shiny bald spot, and looked professional in a tailored charcoal gray suit. The third chair was empty and obviously intended for David. He mumbled a hello and sat down, unable to suppress a frown as he noted how pale Ed appeared.

  “Good morning, David,” the dean began. “Detective Reynolds, this is Dr. Monroe, chairman of surgery. Now, gentlemen, let’s get down to business.”

  As usual, Andrew took charge of the meeting. “Detective Reynolds called early this morning and requested this meeting. I think you ought to hear what he has to say.” He gestured with his hand. “Detective, please proceed.”

  “Sure thing,” Reynolds said with a curt nod. “Thanks for seeing me so quickly. I’m afraid I have some disturbing news. Last night there was a shooting, a homicide. It took place only steps away from here. The victim, a young black male about twenty years old, was shot at close range in the head. We have an I.D., but we don’t know why this happened, and why here.”

  Ed Collins shook his head. “Aftermath of these devastating riots, no doubt.”

  “Could be,” Reynolds nodded curtly. “Could be anything. Anyway, I’m here to urge you to do all you can to keep your staff and students safe. I’ll be talking to hospital security too, but I wanted to meet with you all first. I know hospitals operate around the clock; but the point is, I’d bet most everybody around here pays little attention to safety precautions. All those long hours add up to exhaustion, don’t they? What happened last night is a little too close for comfort. I’d like you all to relay to your staff and students a sense of urgency. You want to tell them to use the help at hand. There’s an armed security force, right? And some of our uniforms are still on patrol at the hospital. They’re here for a reason. To my mind, Detroit has seen enough killing in the last month to last till the end of time.”

  Dr. Collins nodded enthusiastically. David glanced at the dean, who was jotting some notes.

  “The police will increase their patrol, of course,” the detective continued, “but I’d advise reassessing your security. I admit I have a strong personal interest in this as well, gentleman, because I have a daughter in the first year class here.”

  “Our security people have already been providing a voluntary after-hours escort service,” the Dean replied.

  “We can make it mandatory, can’t we, Andrew?” Ed Collins asked.

  The dean nodded. “Of course, we can step it up. What time did this, er, incident occur, detective?”

  “The reports aren’t back, of course, but it’s estimated somewhere around seven p.m. I’d begin that service at five, Dr. Burke. I realize your doctors and students come and go at all hours. Get them to keep their eyes open. Tell them to report any suspicious activity around the school or hospital.”

  “Of course,” Burke replied. “Thank you.”

  The detective smiled. “I’m not done. We’ll stick around for a while today, looking for potential witnesses, that kind of thing. We’ll set up outside and ask your people questions as they come in. You never know if someone saw something unless you ask.”

  “You can count on our full cooperation,” the dean added, always the politician. “Thank you again and we’re delighted your daughter is here in our program.”

  David rose from his chair, offering his hand to the detective. “Her name?”

  “Susan Reynolds.”

  “I’ll keep my eye on her.”
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  “I’d appreciate that, doctor.”

  By the time David arrived at the conference room, freshman students were presenting their material in groups of six to an audience of four surgical residents and one member of the surgical faculty. As per tradition, this session would be grueling, testing the thickness of new medical students’ skin. The faculty and the house staff pulled no punches in interrogating the uninitiated as they fumbled to present their first clinical case. David slipped into a chair, quietly observing the end of Susan Reynolds’ report. She was tall like her father, with the same coppery skin tone, a beautiful girl. No wonder the detective was so concerned. He found himself nodding an approval of her self-confidence as she aptly responded to critiques of her examination of a patient with complications of cirrhosis of the liver. Miss Reynolds was the only African-American woman in the class and based on today’s performance, he judged that she’d do just fine.

  “Nelson is next,” the chief surgical resident called out as soon as Susan was dismissed.

  Laura stood up and hesitantly approached. Her heart beat out of control. Why hadn’t she stayed home? Told them she was sick?

  She gripped the sides of the podium as the gunshot wound in her patient’s head and gunshot wound in the head of the man she’d shot kept mixing and matching in her mind. Should she just turn around now? At the head of the conference table, she froze. Her eyes were so irritated that she’d worn her glasses instead of her contacts, her legs were weak, and her pelvis still throbbed. She wore lipstick to cover her cut lower lip, but licked it subconsciously as she stared at the curious faces of her fellow students and instructors.

  “Miss Nelson, are you okay?” Laura’s hand flew to cover her mouth. The voice was Dr. Monroe’s. The same voice she’d heard in the hospital parking lot last night.

  She looked over to him, and he nodded his head in encouragement. The others began to shuffle and squirm. She clenched her teeth, urging herself to focus on what she had to do: report on her patient. After a moment adjusting her glasses, she reached for her notes and began. Her voice shook, but she found herself able to go on.

  “Anthony Diggs is an eighteen-year-old black male with a gunshot wound to the head. Since arrival at City Hospital, he has been comatose and on a ventilator. So I took his medical history from his mother.”

  She could feel all eyes staring, as she prayed that God would help her keep her patient and the man she shot separate. She tried so hard to concentrate on Anthony Diggs and to expunge thoughts on the path of the bullet through the skull of the man whom she herself had shot, that she forgot much of what she’d tried to read in the library last night. She felt herself bungling anatomical terms. She knew her delivery sounded confusing, disjointed. She talked too fast as she rushed to conclude with the report of the neurological examination, concluding that her patient had irreversible brain damage. Then she straightened and braced for the barrage of humiliating questions and criticisms sure to follow.

  She didn’t have to wait long. An aggressive surgical resident jumped right in.

  “What about the Babinsky reflex?”

  Laura struggled to recall what she’d read about this strange test, in which it was necessary to take the dull handle of a reflex hammer and stroke the side of the foot from the heel to the ball and then move it upward to the base of each toe. She was pretty sure she had done that to her patient according to the instructions in the manual.

  “The Babinsky reflex,” she repeated in order to gain some time. “Positive, bilaterally.”

  “Explain what you actually saw,” demanded the same resident.

  “Uhh, the big toe flexed and the other toes fanned out,” Laura answered from somewhere inside herself.

  Another voice piped up. “And what is the significance?”

  “It’s a sign of deep coma,” Laura said. Yes, she did remember that.

  “How did you judge the level of consciousness?” Yet another interrogator jumped in.

  “The patient did not react to the pinprick test. No reaction, nothing.” Laura wished that she’d paid more attention to the section on coma scales. She wanted to leave this interrogation and run home to Steve.

  “Okay,” the only woman in the group offered. “Your patient was unresponsive. What position was he lying in?”

  “Flat in bed. Not moving. I can’t remember exactly.” Laura stopped, thinking now of how her victim had been curled in the fetal position.

  A prolonged silence as Laura left Anthony Diggs entirely.

  Finally, the chief resident spoke impatiently. “Okay students, this course is all about observation. Miss Nelson’s report is lacking critical details. “Dr. Monroe, any comments?”

  “Yes. Miss Nelson, did you note the development of any decubiti when you examined the patient?”

  “I’m sorry?” Again that voice from the parking lot focused her. “Decubiti?”

  A few subdued snickers could be heard.

  “Yes, Miss Nelson, decubiti. Bedsores, to the layman. Were there any bedsores?”

  Not really sure what a bedsore looked like, Laura closed her eyes to remember her examination of the patient. “I did see some dark, blotchy areas,” she said, opening her eyes and blinking. “Also, there were some oozing sores on his buttocks.” She prayed that her answer was at least close to right.

  “Fine, Miss Nelson. I want you to prepare a written report on the causes of morbidity and mortality in comatose patients. Hand it in early next week.”

  David Monroe rose from the conference table and headed for the exit. Now why had he asked for that report? There’d been a certain sophistication as she began discussing the patient’s history, but then she’d lapsed into some kind of funk. The additional report might give him some indication. At the door he turned back, remembering the haunted look of this student when he’d run across her last night in the rain. She still seemed shaken, distraught. Maybe just nervous, but wasn’t there something else? Yes, she now wore glasses, adding a scholarly note.

  Laura’s knees felt week as she left the surgical conference room, and she felt lightheaded. She’d come so close to losing it. Already late for gross anatomy lab, Susan hurried her along.

  “Dr. Cunningham — Will — wants to have coffee with me after dissection,” Susan was saying. “Do you think that’s okay? Being he’s an instructor? I don’t want to get in any trouble.”

  “That report,” Laura’s voice shook. “I was so bad.”

  “You did okay,” Susan said, “but you did seem distracted at one point. Now about Will Cunningham? Should I or shouldn’t I?”

  “Uh, sorry?” Laura mumbled as they pushed though the swinging doors into a macabre sea of cadavers each laid out on a stainless steel table, covered by sheets of heavy plastic to keep them saturated with formaldehyde.

  “Harry,” the cadaver they shared with two other students, was centrally located among his peers of forty men and women. Anatomical charts in vivid colors lined the walls of the huge rectangular room. Organs in jars, intact skeletons, and detached skeletal parts filled every nook and cranny.

  “Harry’s ‘perfume’ gets stronger every day,” Susan stated the obvious as they approached. “At least if I go out with Will, we’ll have that ‘certain smell’ in common. Hey, doesn’t your husband complain? I mean, formaldehyde’s seeping out of every pore. And my hair stinks.”

  “It irritates my eyes,” Laura remarked, shivering inside her stained white lab coat, not so much because they kept the anatomy lab very cold, but at the pall of death that surrounded her.

  “Yeah, and he has to last the whole year.”

  “About time you two showed up,” a friendly voice called out. “We’ve got to crack the chest wall today.”

  “So far the morning’s been interesting,” Susan reported. “Dr. Monroe gave Laura an extra assignment.” She gave Laura a friendly punch in the shoulder, but Laura did not respond.

  Against big odds, four freshman women had found themselves randomly assigned to a di
ssection table: out of a hundred and fifty students. Considering that there were only ten women, and only one black woman, in the entire first year class, the quartet attracted more than their share of attention. Despite different backgrounds, personalities, and skills, by the end of the first month the girls had bonded into a tight clique, founded on mutual respect for each other’s strengths and weaknesses.

  Laura Nelson, from Grand Rapids and a graduate of the University of Michigan, was hardworking, pragmatic and family oriented. With her easy smile and even temperament, Laura engendered their trust. No matter the demands of her home life, she never let them down.

  Susan Reynolds, from Detroit, impressed her colleagues with her studious nature and professional appearance, complete with large wire-rimmed glasses. Susan’s mother had died when she was a teen, but she adored her father, a detective with the Detroit Police. Susan was no-nonsense, intensely dedicated to academic success. She never let them slack off.

  Vicky Walson, from Grosse Pointe Shores was the most attractive of the ten women in the class. Willow thin with platinum blonde hair styled as if she’d just walked off a modeling set, she flaunted expensive clothes and jewelry that should be kept locked in a safe. She was twenty-five, three years older than her partners and married to a rich lawyer, who indulged her every whim. Women tended to resent her flamboyance. Not her partners. Vickie was their secret weapon, the smartest of the four.

  Rosie Santangelo, from Miami, was petite, cute, vivacious, and funny. Spiked black hair, dancing black eyes, a sexy wardrobe on the dramatic side, and an outgoing personality all combined to attract the single guys. She’d already dated so many men from the class that the girls lost count.

  Their subject, Harry — skinny, waxy skin, a garish scar running the entire length of the abdomen, thinning black hair on his head surrounding a bald spot the size of a nickel, coarse black hair shrouding his thin chest — looked to be in his fifties. The girls had no idea how he’d ended up on their dissection table, veins pumped full of blue latex-like material, arteries with red.