The Diagnosis is Murder (A Dr. Valorian Mystery Book 1) Read online

  The Diagnosis is

  Murder

  Steven Gossington

  Copyright 2016 by Steven Gossington

  All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of quoting brief passages that are embodied in reviews and certain other noncommercial uses permitted by copyright law.

  This is a work of fiction. Names, characters, businesses, places, events and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.

  Developmental Editor - Andrea Hurst

  Cover design by Natasha Brown

  Marketing by 2Market Books

  Author photograph by Portrait Innovations Professional Studios

  ISBN-13:

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  You know my method. It is founded upon the observance of trifles.

  Sir Arthur Conan Doyle

  Chapter 1

  Laura Valorian, MD, felt the blood drain from her face. She’d just caught a few words of the paramedic’s report from the crackling radio out in the ER nurses’ station.

  “Doctor?”

  Laura looked away from her computer screen at Stacy, one of the ER nurses on duty, standing at the door of the doctors’ office.

  “Did you hear the EMS report that just came in?”

  Laura’s voice was hoarse when she spoke. “Part of it. It’s a child?”

  Stacy nodded. “They’re bringing an unconscious child with injuries.”

  Laura shot up from the chair. She inhaled twice, filling her lungs to the max each time, steeling herself for the coming challenge.

  Stacy frowned as Laura walked past her. “The paramedic also said the little girl had been here recently.”

  Laura stopped. That’s never good to hear, she thought.

  As Laura walked from the doctors’ office out into the main ER hallway, she sensed the escalation of activity, like heated molecules in Brownian motion, that accompanied impending excitement for the ER staff—especially when the patient about to appear was a child in distress.

  Several minutes later, two paramedics rushed a gurney through the ambulance entrance doors into Laura’s hospital emergency room in southeastern Washington, D.C. One medic squeezed a plastic bag to breathe for the patient, and the second applied rapid chest compressions as the gurney was whisked into a critical care room in the ER.

  Damn. Not only unconscious—in cardiac arrest? Laura ran into the room, and a medic launched into a report. “We were called to a home for an unresponsive four-year-old girl. Mother said she found the child unconscious in her room. She doesn’t know what happened. The child wasn’t breathing and didn’t have a pulse, so we intubated her and started chest compressions.”

  Laura examined the child and confirmed the lack of a spontaneous heartbeat. One of the medics pointed at the side of the child’s head and at her thighs, where reddish-purple blotches marred her fair skin. Laura put a hand over her stomach and nodded. “I see those bruises, too.” She leaned closer to the child’s face.

  Oh, boy. I do remember her. I examined her a few months ago. Laura covered her mouth as she was struck by a wave of nausea. Did I miss a case of child abuse?

  “I think the mother was high on drugs,” a medic said. “She didn’t seem concerned at all. Said she had to get to a party.”

  Nurses and techs assumed CPR duties from the medics, and Laura ordered intravenous epinephrine and an arterial blood gas. She monitored the resuscitation and gave orders to the nurses at intervals. After a while, her voice began to grow hoarse, and it was a strain for her to speak. Paralyzed by a feeling of helplessness, she could only gape in horror at the activity in front of her: the up and down of the chest compressor—like a frenzied oil derrick pumping liquid gold out of the ground—and the swoosh of the respirator bag squeezing oxygen into lifeless lungs. Time and motion slowed to a crawl—

  “Anything else, Doctor?” a nurse said.

  Laura caught her breath as she was yanked back to real-time. She glanced at the wall clock. Half an hour had passed.

  After one final overview of the scene, Laura leaned forward with her hands on the stretcher. “Stop, everyone. I’m calling it. She’s gone.” The words caught in her throat. “Severe head trauma.”

  Stacy walked up to her. “The father was just outside the room, but I can’t find him now.”

  “Let me know if you do,” Laura said. She remembered the father from the child’s visit several months before. He hadn’t talked with Laura then, either. She recalled having an odd feeling about him. “Notify the police about this death.”

  “We already have,” Stacy said.

  For the rest of her ER shift, Laura plodded around like a zombie. She kept visualizing the child’s appearance from a few months before—the strange bruises. I can’t believe I missed that damned diagnosis.

  Depressing memories of her previous rejection from surgical residency flooded back. She was fine with being an ER doc, but it had been her second choice. She’d initially gone after general surgery as her preferred career. It didn’t happen, and she wondered from time to time if it was because the admissions committee had judged her surgical diagnostic skills to be lacking.

  Am I incompetent? What the hell is wrong with me?

  She was sleepless the next few nights, alternating between sobbing and retching. Somehow, she dragged her body through work shifts and around her home, forcing herself to eat.

  One evening, the phone rang in her living room. It was Josh, one of the doctors in Laura’s ER group.

  “I just wanted to check on you,” he said. “You’ve seemed down lately. Is anything wrong?”

  Laura took a deep breath. “You heard about that child that died?”

  “Sure, I did. Is that what’s bothering you?”

  “It’s really been weighing on me. I saw that child a few months ago. I screwed up.”

  “That could’ve happened to any of us.”

  Laura paused. “I know . . . But it will never happen to me again.”

  “I don’t doubt it. You’re one of the best ER docs I’ve ever worked with.”

  “That’s nice of you to say.”

  “No, I mean it. We all see it. Hell, when I get a patient with weird signs and symptoms and can’t figure out what the diagnosis is, I think to myself ‘What would Laura do?’ ”

  “Oh, come on, Josh. You’re laying it on thick.”

  “I’m telling you the truth. We all see it.”

  After thanking Josh for the call, Laura eased the receiver down. He had stirred something deep inside her—a kernel of confidence. She just knew she had something to offer. There was a place for her. There had to be.

  The next day, Laura walked into the ER with clenched fists, mumbling under her breath. “Pull yourself together. You’re better than this.” She stopped in the hallway, taking in the antiseptic aroma, the glistening floor and counters, the soft, rhythmic beeping of a patient monitor. A sense of relief swept over her. She felt welcome here.

  Nurse Betty approached. “Everything okay?”

  Laura hesitated and then turned to her. “It will be.”

  Nurses and techs stood like statues as they watched Laura walk past them into the doctors’ office. Laura sensed they were wondering how she was doing. Four days before, they’d posed the same way, watching Laura drag herself out of the ER after the ch
ild-abuse death.

  She propped her briefcase against the wall and slapped the counter. Gritting her teeth, she took a silent oath: I swear to God, I’ll never again miss those physical signs of abuse . . . And I will become the best damn ER diagnostician I can possibly be.

  Chapter 2

  Laura, in her bright white, dry-cleaned lab coat, walked out of a patient room into the main ER hallway. It was Monday morning, and she was the emergency physician on duty for the next 12 hours.

  As she approached the central nursing station, a tall man limped toward her, his eyes squinted and his red flannel shirt fluttered over soiled blue jeans. Laura snorted. I recognize that guy. He’s trouble.

  “Doc, can I talk with you?”

  She stopped and turned to him.

  “I need some medication for my back pain. I’m really hurting. My pain is 10 out of 10.”

  Laura knew he was a patient from the night shift. She’d noticed him when she arrived to work that morning. “Sir, the night doctor has already examined and treated you.”

  “If you could just write me for some pain medicine? You can’t believe how much pain I’m in.”

  “No, sir. I can’t do that. If you’re having trouble with your need for pain medication, I can help you with—”

  “Don’t give me your crap.” He glared at Laura, his nostrils flaring with each breath. “Just give me the pain pills—oxycodone. That’s what I need.”

  Laura clenched her fists as the man stepped closer, and her breaths came faster, shallower, like a panting dog. Calm down. Slow your breathing. After a few more breaths, Laura backed away from the man and glanced at two nearby nurses. “Call security, please,” she said, emphasizing each word.

  One of the nurses put a phone to her ear and stared at the patient.

  “All right, I’m leaving,” the man said, jabbing his finger at Laura. “This is the last time I’ll ever come to this hospital.” As he hurried away, flailing his arms, the tirade continued. “You can’t get any decent service here. Nobody cares.” He disappeared through the automatic doors at the ER’s ambulance entrance.

  Laura and the nurses watched him stomp out.

  “Drug seeker,” Laura said.

  Betty nodded. “We figured that.” Betty was one of the ER’s veteran nurses. “He walks normal now. His severe back pain seems to have suddenly resolved.”

  “Did you notice his skin and eyes?” Laura said, her voice more natural.

  Betty looked up. “He was sweaty.”

  “Yes, his skin was clammy, sweaty, and his pupils were large.”

  “Drugs?”

  “I think so. He might’ve been high on cocaine or amphetamine.”

  “So, maybe he wanted the pain pills to come down from his high?”

  “Possibly. Or his main problem may be an addiction to opiates, and he just uses stimulants now and then for a little variety.”

  “Are you okay, Dr. Valorian?” Betty said. “You looked a little out of sorts with him. I thought you were going to punch his lights out.”

  Laura opened her fists. “I’m fine. He just unnerved me.”

  “I know what you mean. It can be frustrating to take care of addicts.”

  Tell me about it.

  “I think we’re going to have a busy day,” Betty said.

  “What makes you think so?”

  “For one thing, code blues come in threes. We had two cardiac arrests last night, so we’re due at least one more.”

  “Bring it on.”

  “That will give some excitement for our med student. We have a med student today, right?”

  “Yes.”

  Laura had agreed to tutor a medical student who’d chosen an emergency department elective rotation for a month during his fourth year of medical school. She enjoyed teaching medical students, even though students were sometimes not useful and slowed down a busy physician’s practice. Laura didn’t mind those negatives as long as the student kept pace with her, showed interest, and worked his or her butt off.

  Laura turned and clattered down the hallway, her hair bouncing with each step. She kept her blonde hair short with sweeping curls on the front and sides so that she could use a stethoscope and bend over a patient without interference from falling strands. Her short hair was also out of range of tiny exploring hands.

  She walked into a patient room and shook her head at the clutter left over from the night shift—the wastebaskets brimming with refuse. A middle-aged man sat on the edge of a stretcher, his right hand on his abdomen.

  “Hello, sir. My name is Dr. Valorian. I understand you’re hurting in your abdomen?”

  “Yes, right here.” He pointed to his lower abdomen, toward the right side. Laura asked him other questions and then performed a physical examination. After a few minutes, she left the room with a short list of possible diagnoses swirling around in her head.

  Back in the doctors’ area, she gulped down strong, black, cinnamon-flavored coffee, ran her fingers through her hair, and entered information into a computer, ordering specific laboratory tests and X-rays that would complete her evaluation.

  “Good morning, Dr. Valorian.” A tall, clean-shaven, young black man leaned in at the office door. He wore a white shirt and a maroon tie dotted with small off-white baseballs. “I’m Derek Hollister, the medical student assigned to your rotation this month.”

  Laura looked up at a slim, attractive man with a broad smile and the faintest scar on his left earlobe. She wondered how long it had been since he’d worn an earring. Maybe it was ripped out by a tiny, exploring hand. Ouch.

  She shook his hand. “Hello, Derek. Have a seat.”

  The emergency doctors’ office was a small room tucked away behind the expansive and open nurses’ and clerks’ station, which faced the emergency room proper. The office had two squeaky but comfortable chairs on rollers in front of a table stained with large, amorphous splotches from numerous coffee spills over the years. In fact, a permanent coffee odor drifted through the room.

  Laura pointed to computer screens on the table. “This is where you’ll enter patient data and look at your X-rays and lab results.”

  To one side of the table were two bulletin boards cluttered with papers and thumbtacks. Some of the papers were old policies or medical directives. Derek smiled and pointed to one yellowed sheet. It read:

  LAWYER BUYOUTS

  In the wake of a study showing each of the country’s 777,000 lawyers costs us $1 million a year, a “recovering lawyer” has come up with a plan. The idea: Pay lawyers not to practice. Offer them $500,000 to turn in the law license. Benefit: The profit (the $500,000 per lawyer saved the first year) could be used to steer people away from law schools and into “more useful” professions. (From U.S. News & World Report)

  Laura nodded. “It’s a humorous idea, don’t you think? We still get a laugh out of it, especially when one of us gets sued.”

  “How often does that happen?”

  “Not often. I’ve been sued a couple of times, but both lawsuits were frivolous—in my opinion—and both were dropped before trial. We’re in a risky business, and you can’t predict when or why the subpoena will appear at your door.”

  “Like the grim reaper?”

  “Well, no. It’s not exactly the end of everything. You may feel like hanging up your stethoscope when you’re staring at the subpoena, but most doctors survive it.”

  Derek studied one of the computer screens. “I was introduced to the ER when I was on call for emergency patients on other rotations, like internal medicine, general surgery—”

  “Well, actually working in the ER, with responsibility for the initial evaluation of people with all types of problems, will be different.”

  “I know. I’ve talked to other medical students who’ve done the ER rotation. They say it can get crazy down here.”

  Laura stood. “We try to keep it under control.” She shook her head. Yeah, right. You can’t even control your own flaming emotions. She recalled the tim
e she threw a dirty tongue depressor at that idiot nurse—

  “Are you okay?” Derek asked.

  Laura stepped back and focused on a concerned-looking Derek. “Sure.” She gestured out the door. “Let me show you the battlefield.” As they walked out of the office, Laura noticed that Derek towered over her own five feet-seven inches.

  He followed Laura into the nurses’ station, which was a large area with plastic laminate counters and cabinets ringing the pastel-colored walls. Telephones and computer screens were sprinkled around. A huge electronic screen on one wall displayed the current patient population of the ER, with their names, locations, and sometimes their current activity, such as ‘in X-ray’, or ‘Admitted to Room 312.’ The ER was relatively quiet now, early in the morning.

  “Hello, everyone,” Laura said. Three nurses and the unit clerk turned to listen. “This is Derek Hollister. I think you know why he’s here.”

  Derek nodded to the group. Laura knew they were studying him, sizing him up.

  She stepped toward one of the nurses. “I’ve ordered some lab tests and X-rays for the patient in Room Three.”

  Derek pointed at the electronic screen. “I see that a patient is here to get an enema?”

  Laura studied the list of patients. Words scrawled on a piece of tape stuck to the screen stated that a patient named ‘Shields, A.’ was to receive an enema. She laughed and said, “Oh, that’s our security guard on duty now. He often complains of constipation.”

  “He always looks constipated when he struts around in here,” Nurse Betty said. “It’s painful to watch.” The others chuckled.

  “The nurses tease him about it,” Laura said to Derek. “It’s just a joke. Everyone will get a good laugh out of it. Believe me, enemas are dished out only on rare occasions in a busy ER. That’s not generally considered an emergency procedure.” She turned to the nurses. “Am I right?”

  Betty nodded. “Absolutely.”

  “So, when’s the last time you gave an enema to a patient?”