Destroyer 015 - Murder Ward

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2024-12-15 0 0 294.21KB 115 页 5.9玖币
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THE DESTROYER—MURDER WARD
Richard Sapir and Warren Murphy
For Rita, who sits on a stool; David, who should sit at his typewriter; Etta, who sits away
from the table; and Mimi, who doesn't sit very much at all…
CONTENTS
CHAPTER ONE
CHAPTER TWO
CHAPTER THREE
CHAPTER FOUR
CHAPTER FIVE
CHAPTER SIX
CHAPTER SEVEN
CHAPTER EIGHT
CHAPTER NINE
CHAPTER TEN
CHAPTER ELEVEN
CHAPTER TWELVE
CHAPTER THIRTEEN
CHAPTER FOURTEEN
CHAPTER FIFTEEN
CHAPTER SIXTEEN
CHAPTER SEVENTEEN
CHAPTER ONE
Dr. Daniel Demmet was a true professional. When he decided it was time to kill his
patient, he first made sure that the critical body functions were doing well. He checked
the electrocardiogram screen, as he had been checking it since the patient had been
wheeled into the operating room of the Robler Clinic, one of the finer hospitals just
outside of Baltimore. Dr. Demmet sat on a stool behind the patient's head, from which
point, as a modern anesthesiologist, he could best supervise and protect the patient's
hold on life. The surgeon, working a few feet from him, was too busy rearranging the
body with instruments to worry about his Me. The surgeon worked on the appendix; the
anesthesiologist worked on the patient.
The screen showed normal sinus rhythm, a sharp beeping line across the screen, which
caught the electrical impulses from the heart. At the first stage of trouble, the wave
would become ectopic, indicating cardiac malfunction.
On the screen, death was a smooth flowing line, with little hills; life was sharp and
discordant. What Dr. Demmet continuously looked at was the line that guaranteed life.
Perfect. A perfect sinus rhythm. The low hill, the deep valley, the high peak, another
valley, and then the pattern all over again. All this in a beep. Life.
Perfect. But then, why shouldn't it be? The patient was healthy, and Dr. Demmet had
done his job well, in the best tradition of modern, balanced anesthesia. Gone were the
days when good doctors would knock out a patient with a single massive dose of a
potentially lethal chemical, with the inevitable residual toxtcity that left the recovering
patient nauseated, uncomfortable, and, sometimes, in pain.
Now, anesthesia is a symphony. Demmet had given the patient, a healthy, forty-five-
year-old male, an initial injection of sodium pentothol, which put him quickly to sleep.
The opening note.
Then oxygen through the anesthesia machine to assure good breathing. Intravenously,
the succinyl-choline, which relaxed the body muscles and made way for the
endotracheal intubation, affording Dr. Demmet greater control over the patient's
breathing. Then, through the anesthesia machine, nitrous oxide, a further nerve
depressant. And finally halothane. Very carefully with the halothane, for this was the
basic anesthetic of the operation.
It was also what was going to kill the patient.
Intravenously, Dr. Demmet administered a small amount of curare to relax the stomach
muscles, making the appendectomy that much easier for the surgeon to perform. The
electrodes of the electrocardiograph were attached to both arms and a leg. There was a
constant intravenous flow of 5 percent dextrose. Dr. Demmet felt for the pulse, checked
the blood pressure, listened to the heartbeat through a stethoscope, which was not of
course as accurate as the electrocardiogram but still a good backup check. Then he
proceeded to kill the patient.
He also did something that never appears in television dramas or great romances about
hospitals but that is not at all uncommon in real operating rooms. He passed gas. Sitting
on high stools for several hours, under great tension and with great need for
concentration, anesthesiologists help make operating rooms smell more like lavatories
than like Marcus Welby's office. This is reality. No one ever comments, because everyone
is too busy to notice.
Dr. Demmet increased the level of halothane. He did not do it with a jolt. Everything
was precise. He watched the screen. Normal sinus rhythm. He increased the halothane.
The ectopic response came with a flutter. Gone were the high discordant peaks. More
halothane, and he watched the ectopic leveling become bigeminal—two small beeps. A
more even pattern on the EKG. Ordinarily, this pattern on the screen would have set a
flurry of emergency measures into motion, but it took the anesthesiologist to alert the
team. Instead, Dr. Demmet watched the screen. Still bigeminal. The pulse lowered,
blood pressure lowered, heartbeat weak and struggling. The patient needed no more
halothane.
In three minutes and forty-five seconds by Demmet's watch, the screen showed a
smooth, even-flowing, up-and-down line. Dr. Demmet relaxed. For the first time since
the operation began, he felt the hardness of the stool. He watched the surgeon work,
watched the nurse count the sponges and make sure that everything brought to the
operating table remained there, not inside the patient. A sponge or a clamp left inside a
patient could mean a malpractice suit, even though a sponge might not do much harm.
The supervising nurse's real job was the first step in the professional web that made it
almost impossible for a doctor to lose a malpractice suit. Naturally, the patient's bill
showed the cost of the nurse's services.
Dr. Demmet waited another two minutes and then turned off the halothane, reduced
the nitrous oxide, folded his arms, and watched the peaceful, level hills of death.
When the surgeon looked up, Demmet shook his head. "I'm sorry. We've lost him," he
said.
The announcement snapped everyone's head toward the EKG screen, where the
beeping dot painted the landscape of oblivion.
The surgeon glared angrily at Demmet. He would complain later that Dr. Demmet
should have let him know that the patient was in trouble. And Demmet would inform
the surgeon that he had done everything possible to save the patient and that if the
surgeon had any complaints, he should go see Ms. Hahl, the assistant administrator of
the hospital.
Now Dr. Demmet sat on the high stool, the stethoscope hanging from his neck, his ears
blissfully free of any foreign objects, and watched the surgeon complete the operation
down to the last suture. If no one left a sponge inside, and the nurse would see to that,
then the operation was safely over, and no subsequent autopsy was ever going to reveal
that the surgeon was at fault. When the surgeon left, sullenly and silently, Demmet
rose from the stool, stretched his muscles and went out to break the tragic news to the
next of kin. He had a reputation at the Robler Clinic of being the best at breaking this
sort of news.
It is a fact of hospital life that doctors instinctively avoid dying patients and spend more
time with those who are going to get well. Even now, across the nation, doctors are just
beginning to study their own attitudes toward the dying, something that they have
instinctively avoided for centuries, though the rest of the populace believes that they are
not uncomfortable with death. Doctors are supposed to be men of great compassion,
courage, and knowledge. But it is only now being admitted that a doctor often avoids
telling a patient his illness is terminal, not for the patient's benefit but for his own.
Demmet, unlike his colleagues, had no such troubles. He whisked off his mask,
examined his cool aquiline face for any resurgence of pimples, touched up his just-
graying sandy-blond hair with his fingertips, removed his surgical gown, and went to the
administrative offices to make the usual report for this special sort of operation.
"What was it this time? Heart failure?" asked a graceful young woman with dark red
hair and cool brown eyes. She was Kathy Hahl, assistant administrator of the hospital
and director of hospital development, another term for chief fund raiser.
"Yeah. Heart failure will do," said Demmet. "You know, the sand wedge, the damned
sand wedge, is a disaster off the fairway."
"Not if you use it right. If you use it right, it's like a.scalpel. Puts the ball just where you
want it if you use it right," said Ms. Hahl.
"If you can play six hours a day every day," said Demmet testily.
"You get your game a day if you want it."
"Not if I can't schedule these operations but have to take them mid-day, afternoons.
Morning or late afternoon are too cold for golf these days."
"A lot of doctors work twenty-four hours in a row sometimes, even come in in the wee
hours. It's not a profession conducive to rest, Dan."
"If I wanted an easy life, I wouldn't have to be going down to that waiting room now to
tell the widow What's-her-name that her husband didn't survive an appendectomy.
Really, the way you set things up, I'm going to have to work up a routine for terminal
head cold."
"Her name's Nancy Boulder. Mrs. Nancy Boulder. Her husband's name was John. John
Boulder. He was with the Internal Revenue Service."
"We seem to be getting a few Internal Revenue specials nowadays. Some sort of trend?"
Demmet asked.
"Not your worry, Dan."
"Boulder. John Boulder," Demmet repeated. "If I keep on getting these specials, I'll
never break eighty."
"If the sand wedge doesn't work for you, try running the ball up to the green. You can
use a three iron like a heavy putter," said Kathy Hahl.
Demmet stared at a large red arrow painted on a sign that said $20 million
advancement goal. The arrow was almost reaching the top of the black line that marked
progress.
"But the wedge looks so nice popping up on the green and stopping."
"Do you want form or score?"
"I want both."
"So do we all, Dan. Give the widow Boulder your regrets, and I'll meet you at the club."
"I'd like three strokes a side."
"Your handicap is big enough already."
"I'll use my pitching wedge, my old pitching wedge. Three strokes a side," Demmet said.
"Two," said Kathy Hahl, smiling the special smile that made men aware of their own
heartbeat.
"You're a cruel, hard, ungiving person," said Dr. Demmet.
"Never forget that, Dan," said Kathy Hahl.
When Dr. Demmet told the head nurse he wished to see a Mrs. Nancy Boulder who was
in the waiting room, the nurse asked, "Another one?"
"Are you keeping score?" asked Dr. Demmet sternly. The nurse had violated professional
decorum, and she knew it.
"No, doctor. My apologies."
"Accepted," said Dr. Demmet.
Nancy Boulder was in the waiting room, explaining to an elderly gentleman that he
really had no cause for worry, when she heard a nurse call her name. She excused
herself momentarily from the man, who was fingering a small brown paper bag, and
quietly told the nurse she would be with her in a minute.
"I think it's important," said the nurse.
"That man is important, too," said Nancy Boulder. "He's in agony. His wife is having a
hysterectomy and…"
"A hysterectomy is nothing to worry about."
"That's not the point," said Nancy Boulder. "He thinks so, and he's terrified. I just can't
leave him here. Give me a minute, please."
The nurse sighed in resignation, and Nancy Boulder went back to the man, who, in his
anxiety, hardly heard her words. But she tried.
"Listen. I know it's very important to you and your wife. It is to the hospital, too. But
just because it's important doesn't mean it's dangerous. They do these operations
because they are safe."
The man nodded dully.
"I don't know what to say to you, sir, but you're going to look back on this some day
and laugh," said Nancy Boulder, giving him a big, hopeful smile. He saw the smile and
like so many others who knew her, could not resist its warmth and openness. He smiled
back briefly.
Well, at least he had a brief respite, thought Nancy Boulder. It was a nice thing about
people that they responded to warmth. She tried to explain this to the nurse, but the
nurse did not seem to understand. She just asked Mrs. Boulder to follow her please.
"You know, it's funny how superstitions linger. Even John had a premonition," Nancy
said to the nurse. "He was in pain. But when the doctor told us it was appendicitis, I
stopped worrying. An appendectomy is the simplest operation in the world, isn't it?"
"Well," said the nurse. "No operation is really simple."
There was something in her tone that made Mrs. Boulder's hands tighten. She tried to
remain calm. All the nurse had said was that no operation was simple. That was all.
Mrs. Boulder's dark, middle-aged face suddenly showed the lines normally hidden by her
ever-present smile. The happy brown eyes became dull with a gnawing terror and her
brisk gait became a forced trudge. She held her pocketbook in front of her chest like a
shield. All the nurse had said was that no operation was simple. So why should she
worry?
"Everything worked out all right, didn't it?" asked Mrs. Boulder. "I mean, John is all
right, isn't he? Tell me he's all right!"
"The doctor will explain everything," said the nurse.
"I mean he's all right. He's all right, isn't he? John's all right." Mrs. Boulder's voice rose,
loud and tense. She grasped the nurse by an arm. "Tell me John's all right. Tell me he's
all right."
"Your husband was not my patient."
"Was? Was?"
"He is not my patient. Is," said the nurse and freed her arm with a fast snap of the
elbow.
"Oh, thank God," said Mrs. Boulder. "Thank merciful God."
The nurse, beyond an arm's distance, led Mrs. Boulder down the corridor to a frosted
glass door that read, "Anesthesiology. Dr. Daniel Demmet, Chief."
"The doctor is waiting for you," said the nurse, knocking twice on the door. Before Mrs.
Boulder could say thank you for showing her the way to the doctor's office, the nurse
was gone, walking very quickly down the hall as if on an urgent matter. If Mrs. Boulder
had not had as much faith in hospitals as she did, she would have sworn it was flight.
Dr. Demmet heard the knock and put his sand wedge into a closet. He had been
chipping peanuts from the wall-to-wall dull gray carpeting to the back of a worn leather
chair. If he could chip a peanut off a carpet with a sand wedge, why couldn't he do it
with a golf ball close to the green?
This was the problem, then, that faced him as the distraught woman entered. He knew
immediately that the nurse had let on. He saw Mrs. What's-her-name, clutching her
pocketbook, knuckles white. Her jaw quivered.
"Will you sit down please?" said Dr. Demmet, motioning to the green leather chair near
his desk. He whisked away the peanuts with a swipe of his left hand.
"Thank you," said Mrs. Boulder. "Everything is all right, isn't it?"
Dr. Demmet's face was somber. He lowered his eyes momentarily, circled the desk and
sat down, even though he knew he must rise again in a moment. He made a cathedral
arch of his fingers before him, nails immaculately white, hands scrubbed clean, clean to
the redness of the palms and knuckles.
Dr. Demmet stared mournfully at the hands. Mrs. Boulder trembled.
"We did everything we could for Jim," said Dr. Demmet.
"John," corrected Mrs. Boulder weakly.
"We did everything we could for John. There were complications."
"No," cried Mrs. Boulder.
"The heart gave out. The appendectomy was perfect. Perfect. It was the heart."
"No. Not John. Not John. No!" cried Mrs. Boulder, and then the tears came in
overwhelming grief.
"We took every precaution," said Dr. Demmet. He let the first rush of grief run itself out
before he rose from his seat, placed a comforting arm around the widow, helped her to
her feet, and out the door to the first nurse they encountered in the hallway, giving
explicit instructions that everything that was possible should be done for this woman. He
ordered a mild sedative.
"What is her name, doctor?" asked the nurse.
"She'll give it to you," said Dr. Demmet.
By the time he reached the Fair Oaks Country Club outside Baltimore, he knew what he
must do. He could delay it no longer. He was only deceiving himself if he thought he
could, and he was not one to encourage self-deception.
"I've got to give that funny knuckle club a chance," Dr. Demmet told the golf pro. "I've
tried the sand wedge, considered going back to running a three iron onto the green, but
I've got to give your club a chance."
"It doesn't look pretty, Dr. Demmet, but it certainly gets the ball up to the hole from
anywhere near the apron," said the pro.
"I suppose so," said Dr. Demmet sadly, and this time the mournful tone was sincere.
Mrs. Boulder woke up at three in the morning in her bedroom, saw that her husband's
bed had not been slept in, and realized he would not be coming home. She had told the
children the night before, and they had cried. She had spoken with the funeral people
and paid more than she could afford, not really caring all that much and almost
welcoming the assault of the high expenses. She had told John's brother, who would
notify the rest of the family, and she had received a multitude of sympathy calls. But it
was in the morning that she realized in her body and in her senses, finally understood,
and began to accept that John would not be coming home again. It was then that the
grief came, full and deep and unremitting.
She wanted to share the grief with him as she had shared everything else with him
since they were married after his graduation from the University of Maryland. It was too
much pain for her to bear alone, and she did not know how to pray.
So she began to pack his things, trying to separate what her son might want from what
John's brother might want from what the Salvation Army might want. In the basement,
she taped his cross-country skis together, packed his squash rackets, and wondered why
he had never thrown out his old jogging sneakers. She left his scuba tanks in the corner
because they were too heavy to lift.
And when she looked back at all those pairs of jogging sneakers, tattered testimony of
the three miles he had run every day of their marriage, except during the honeymoon,
it came to her with a jarring shock.
"Heart gave out. No way. No way. No way."
John did not smoke, rarely drank, exercised daily, watched his diet, and no one in his
family had ever suffered heart disease.
"No way," she said again, and she was suddenly very excited as though by establishing
this fact conclusively, it would in some way bring him back.
She forced herself to wait until nine-thirty in the morning before phoning the family
physician. The doctor's receptionist-nurse answered, and she made an appointment for
that day. She only needed five minutes, she said. Actually, she needed less.
"John's heart was in good shape, wasn't it, doctor?" she asked before he could offer his
sympathy.
"Well, yes. For a man of his age, his heart was functioning well. He took care of himself
properly."
"Should his heart have failed on the operating table?"
"Well, Mrs. Boulder, an operation puts an incredible strain on the body."
"Should it have failed?"
"Robler has some of the finest surgical teams in the country, Mrs. Boulder. Many of the
nation's highest officials go there. If there were any way for them to save your
husband…"
"He shouldn't have died of a heart failure, should he, doctor? Tell me. You're our family
physician."
"Mrs. Boulder, I sent my own daughter to the Robler Clinic."
"But John shouldn't have died of heart failure in his condition at his ago, should he?"
"There are many things in medicine that we can't explain," he said. But Mrs. Boulder
wasn't listening to him; she was already composing her letter to the American Medical
Association and the medical societies. By afternoon she was outlining her strategy to the
family lawyer. He was more blunt than the family doctor.
"Save your money, Mrs. Boulder. The only way we can get the Robler people for
malpractice is to get another physician to testify against them."
"Well, let's do that."
"It's a fine strategy, Mrs. Boulder. But it won't work."
"Why not?" she asked, her voice sharp and angry. "Because if your own family physician
wouldn't back you up in private, what do you expect from some impartial doctor in the
courtroom? Doctors don't testify against doctors. That's not in the Hippocratic oath, but
it's one rule doctors follow faithfully."
"You mean doctors can kill patients and get away with it?"
"I mean sometimes they don't perform well, or even properly, and there's nothing
anyone can do about it."
"I read of a doctor out west who was convicted of malpractice just last… last… last year,
I think it was."
"That's right. You read of it. When a doctor is convicted of malpractice, it's news. And I
believe that doctor was an oddball who had made waves and was fighting the medical
societies. Did you read about the auto accident in Phoenix where the driver was found
guilty of careless driving and reckless endangerment?"
"No, I don't think I did."
"Neither did I. That's because people are regularly convicted of careless driving.
Policemen testify. For doctors, there are no policemen."
"But there are medical boards, laws, the American Medical Association."
"The AMA? That's like asking the National Association of Manufacturers to investigate
excessive profits. Mrs. Boulder, I'm your friend, and I was John's friend. And as your
friend and as a good lawyer, which I am, I'm going to give you some excellent
professional advice. And by the way, I'm going to charge you for it, so you'd better listen
to me. To bring a malpractice suit against the Robler Clinic or Dr. Demmet is a waste of
your time and your money and your emotions. I won't let you do it because you can't
win."
"What about an autopsy?"
"We can get one."
"Well, won't that prove our case?"
"It will probably prove Robler's case."
"The coroners are part of the club, too? Is that what you're saying?"
"It's not what I'm saying. They're not. But doctors, like everyone else, learn to cover
themselves properly. If they say heart failure was the cause of death, then that's just
what the coroner is going to find. A medical career is worth more than a million dollars.
Doctors don't risk that lightly. Now, I will do something else. If you promise not to
pursue this, Mrs. Boulder, I'll forget the bill for this appointment. I'm sorry. I grieve with
you, and if there were some way we could bring John back, even on the longest chance,
or make amends for his death, I would go with you on this thing despite the odds. But
there's nothing we can do. I'm sorry."
"We'll see," said Mrs. Boulder, who was not thanking people for their services anymore.
Her letters were answered politely, giving the impression that the correspondents had
looked into the matter. But when she reread them and analyzed each sentence
carefully, she realized that all the authorities had said was how wonderful the profession
of medicine was and how thorough doctors were in their concern.
And there she finally let the matter drop. The only time she ever saw Dr. Demmet's
name again was in the sports pages when he won the low gross in the Fair Oaks Scotch
Foursome winter tournament.
CHAPTER TWO
His name was Remo and the Bay winds out of the Pacific whipped at him with all the
fury gathered over the vast stretch of ocean. The Golden Gate spun out before him to
Marin County, the gateway to the northwest. Behind him was San Francisco and going
east, the rest of America.
He stood on the guardrail, where four hundred and ninety-nine others had plunged to
their deaths in suicides marking otherwise insignificant lives.
The man was about six feet tall, normal in build. Only extra-thick wrists suggested he
摘要：

THEDESTROYER—MURDERWARDRichardSapirandWarrenMurphyForRita,whositsonastool;David,whoshouldsitathistypewriter;Etta,whositsawayfromthetable;andMimi,whodoesn'tsitverymuchatall…CONTENTSCHAPTERONECHAPTERTWOCHAPTERTHREECHAPTERFOURCHAPTERFIVECHAPTERSIXCHAPTERSEVENCHAPTEREIGHTCHAPTERNINECHAPTERTENCHAPTERELEV...

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