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

  Matthew snorted. “That guy Max was very irritating, had a high-pitched voice. I have the impression he was a nurse practitioner.”

  They were both quiet for a while.

  Matthew leaned back and downed the rest of his Scotch. “I heard Preswick died of a heart attack or arrhythmia? Something like that?”

  “That’s what it seemed at first. Actually, I think he may’ve been murdered, poisoned.”

  Matthew turned his head and stared at her. “Wow, that’s a strong statement. Are the police investigating?”

  “No, not enough evidence. It’s just a vague suspicion on my part.”

  “What makes you think he was murdered?”

  “I tried to resuscitate him in the ER when he was brought by ambulance. Some things about his exam didn’t add up.”

  “What do you think he was poisoned with?”

  “I’m not sure yet.”

  “Well, I’m sure he had more enemies than me.” He smiled. “I guess if you’re the detective, then I must be a suspect?”

  Laura coughed into her hand. “Strictly speaking, you do qualify as a suspect.”

  “Come on, Laura. You know me. Do you really think I could kill anybody?”

  Laura lowered her eyes. “No, I don’t.”

  They were both silent. Matthew seemed to be absorbed in memories of his nightmare trial again. He walked over to the bar at one end of his spacious living room and poured himself another Scotch and soda.

  “Another diet Coke?” he said.

  “No thanks. Is there anything I can do for you?”

  “No. You’ve done more than enough already. Some of my other so-called comrades are avoiding me. They try to hide it, but I can tell. It’s like I have a scarlet letter on my forehead. I know they’re wondering if I really screwed up.”

  Laura crossed her arms. She hoped he was exaggerating the reality of his situation. A physician’s clinical confidence was built up through medical school, residency, and then in practice. That confidence could be undermined in some individuals by a nasty malpractice case. A week or two of hearing your character and competence savaged could bring otherwise stalwart doctors to their knees. Laura had read about this adverse psychological response in medical articles and had listened to lectures about it, and now she was witnessing as it happened to her friend. She’d heard about some doctors even committing suicide after losing a case.

  Matthew sat down in his chair. “And that’s not the full extent of it. The judgment against me was more than my insurance covered me for.”

  “Oh, no. How much more?”

  “Three million dollars more.”

  “Three million? How can you get that kind of money?”

  “I can’t.” Matthew stood again and paced around the room. “I could lose just about everything I own, and I might have to pay a percentage of my future earnings to come up with that kind of money.”

  “Is it final? You have to pay three million dollars?”

  “Not yet. My attorneys have somehow postponed the final decision. I can hardly think about it. It’s difficult for me to follow their explanations. Hell, it’s difficult for me to concentrate on anything.”

  “I can understand why. Can you appeal?”

  “I hope so. My attorney’s looking into it.”

  This wasn’t her self-assured friend and colleague speaking—the Matthew that she had known. She figured he was dreading a replay of the lawsuit, with the same outcome.

  “You were one of the stars of our class,” Laura said. “I know you can get through this.”

  Matthew sighed. “I hope you’re right. We made it through the trials of med school without too many scars.”

  “Let’s find out when the next class reunion is happening.”

  “Sure.”

  Laura’s legs were wobbly as she stood up. “I can’t believe this is happening to you. I hope it gets resolved.”

  “Thanks for coming over.” He led her to the front door.

  She hugged him. “Keep your chin up.”

  He managed a hint of a smile.

  Outside, the evening sky was clouded, starless. Laura’s legs felt as if they were moving through molasses. She’d received the message—loud and clear—that Matthew despised Preswick, but she just couldn’t visualize her old friend as a killer.

  Chapter 11

  Max Flowers, nurse practitioner, sat on a couch in the living room of his modest house in Falls Church, Virginia. His hands shook as he stared at a small open plastic pill bottle lying on its side on a nearby end table. On the white label, he could make out most of the letters of the bottle’s previous contents: “Vicodin.”

  He squeezed his eyelids closed and slapped his knees. “Damn it.” The pleasant effects of the opiate were not lasting as long as they used to, and as time went by, he needed more pills each day. An agonizing wail threatened to shatter glass as he grabbed the pill bottle and threw it against the wall, and when the wail was spent, he sucked in air and screamed at the ceiling, “What else can I do? The son of a bitch wouldn’t help me.”

  Max staggered toward his front door, walked out to the driveway, and fell into his car. A short time after calling a well-used number on his cell phone, he pulled to a stop along a street curb in Georgetown. He jogged two blocks to a dark alley and groped his way to the wall where he was to wait—the wall where he always waited. Where are you? You’d better show up.

  After pacing back and forth along the alley wall for several minutes, he caught his breath when someone spoke, “I got your pills.” Max spotted the outline of a muscled figure in the shadows, close to him. He eased toward the silhouette, holding out a tremulous hand.

  “Money first,” the figure said.

  From his pocket, Max pulled out a wad of paper money, bound by a rubber band. A hand appeared from the shadows, grabbed the wad and retreated. Max cringed as he heard the man unroll the wad of money. “Doc, it’s all there. Hurry up. Give me the pills.”

  “You’re always in a hurry.”

  Max moaned; he knew the drill. Biting his fingernails, he waited as the dealer flipped through the stack of paper money—one bill at a time.

  After a few minutes, the money shuffling stopped, and a hand with a pill bottle appeared. “Here’s the good stuff,” the man said. “See you next time.”

  Max grabbed the pill bottle and sprinted to his car. He opened the bottle and swallowed one of the pills. Another car honked at him as he burned rubber and lurched into the road. It was all he could do to stop at red lights and stop signs on his way home. He managed to avoid contact with other cars and soon he was back in his house, planted on his living room couch.

  He swallowed several more of the Vicodins with sips of water and waited for the soothing, calming effect. After a few minutes, his breathing slowed, his hands no longer trembled, and the screaming inside his head softened to the sound of waves breaking near the ocean shore.

  ***

  That evening, Derek drove to his mother’s apartment in D.C. His mother Cecilia and his sister Sasha had planned dinner with him. As the front door opened, he caught the smell of herbs and tomato sauce.

  “My son, the doctor.”

  Derek hugged her. “I’m not a real doctor yet, Mom.”

  “Well, you’re a real doctor to me.”

  Derek crossed the living room and sat at the dinner table across from his sister.

  “You’re just in time,” his mother said as she brought him a plate of lettuce and tomato salad and sat down in the chair next to him.

  Derek poured dressing over his salad and began to eat.

  After several minutes, his mother touched his back. “You haven’t said much. Is anything wrong?”

  “I had a rough day. I’ll be all right.”

  “Want to tell us about it?”

  “It’s nothing. Everything’s fine.”

  His mother and sister talked about their day. Sasha was a business major at a local college. “I never realized how many variables have
to be considered when pricing and defining the monetary coverage of an insurance policy,” she said.

  “I think you’ll do well in the business world,” her mother said and then looked at Derek. “Don’t you agree?”

  Derek stared at his food. “Yes.”

  “Both you and your sister are very smart. You can do anything you put your mind to. Don’t let anything or anyone hold you back.”

  Spaghetti with meat sauce was served. Sasha and her mother tried several times to engage Derek in conversation.

  Derek finished his meal and stood to leave. “Thanks for dinner.”

  “I know what’s on your mind,” his mother said, pointing her finger at him. “I can see it in your face. You’ve raked it up again—wondering about your brother’s death.”

  “I’m sorry. I wasn’t good company tonight.”

  “We’re past that part of our lives. You have to let it go. You know that. You have to let it go.”

  Derek walked to the front door and looked back. “I can’t.”

  His mother followed him. “Your brother was seduced by evil.” She stood at the front door and called after him, “Please don’t go back there. I don’t want what happened to him to happen to you.”

  Chapter 12

  To describe this neighborhood, in an east side suburb of Washington, D.C., as lower middle class was being generous. Over the years, several generations of inhabitants had lived and died here. Tall trees loomed along residential streets, and now the lawns and houses were deteriorating. If a Neighborhood Association even existed, it was fighting a losing battle.

  A man named Jake lived alone in one of the more unpretentious houses. It cried out for a fresh coat or two of paint. A motorcycle and a new deluxe SUV sat in the driveway. Motorcycle tracks were etched across the front yard. A large oak tree in front of the house looked sad and withered, its leaves shriveled at their edges.

  Jake hadn’t opened the garage door in years. It was, in fact, permanently closed. Glass panes across the upper part of the door had been painted and boarded up, so that no one could peer inside, and no light could escape from within. However, a tiny hole had appeared in recent months at one corner of one of the windows. If a prying person positioned himself in just the right way, he could manage a glimpse of the garage within.

  This evening, Jake was hard at work in his garage. In the midst of the cement floor was a series of tables supporting an elaborate clutter of glass and plastic beakers, vials, and other chemistry paraphernalia. Jake read at times from a small booklet. In a choreographed series of steps, he mixed fluids, heated and stirred them, and poured the contents from one container to another.

  A snooping person might judge Jake to be a bright and industrious—but suspicious— fellow to be performing such chemistry experiments in a garage on a Friday evening. Indeed, Jake was intelligent and tireless. He had a graduate degree in chemistry and once had high hopes of a brilliant scientific career. But the few jobs he’d attained after graduation were lackluster types of jobs, and Jake had become bored. He had to advance faster. He wanted to become wealthy in the shortest possible time. He’d never get anywhere close to wealthy unless he did something different and creative. Jake had become a different kind of man: an industrious man, a creative chemist, a creator of wealth.

  Even at university, he’d been intrigued with narcotics, opiates, and what a smart chemist could do with them. Before graduation, he’d played around with fentanyl. After a few years of legitimate chemistry work, Jake had gone underground and started his own business. He’d always respected the entrepreneur—the small businessman. His father had been a successful small businessman. Jake saw his chance to become a successful entrepreneur, to be his own man—brilliant and rich.

  Jake could brew his own fentanyl from other chemicals, but, to save time, he bought fentanyl from a nurse anesthetist who was addicted to it. She would steal the drug, accumulating it over time from anesthesia supplies at her D.C. hospital. She stole enough to fix herself and make money on the side by selling fentanyl to Jake. Their arrangement had remained intact and undiscovered for almost a year now, and Jake would use most of the fentanyl he had to make white heroin—a high-grade heroin that opiate addicts loved.

  Jake was almost always clear-headed enough to get the heroin potency just right.

  Eventually, the prying person at the tiny hole in the garage window would see Jake complete the last step and raise a vial of the magical powder toward the ceiling. Jake would stare at the vial with a wild look in his eyes and a wicked smile that exposed a few unhealthy teeth. “Hello, my ticket to paradise,” he’d say, dreaming of the money the designer drug would bring him.

  Jake would smile, even laugh, at the irony of it all. Although he bought the drug from an addict and sold it to addicts, he never indulged himself. Wealth was what he yearned for, not temporary narcotic highs. Actually, he considered it a perfect setup. Jake was the indispensable chemist, the all-important source of the drug itself. He didn’t have to dirty his hands on the streets. Instead, he sold white heroin (or sometimes diluted fentanyl) to the dealers, who then sold it to the public. Jake pitied the poor bastards he had to deal with. He was better than them—a genius.

  “One day soon, I’ll be a very rich genius.”

  ***

  In another neighborhood to the west of Jake’s house, a figure sat alone in the shadows on a living room couch. On an end table next to the couch, a dim lamp with a tilted shade cast the only light in the room. A hand lifted a vial up to the light, and the few drops of remaining fluid were greeted with a smile.

  “Justice has been served. One less asshole in the world.”

  Chapter 13

  Laura jerked awake to her alarm the next morning at 5:30. She sat on the side of her bed and stretched her arms but couldn’t shake off the foggy feeling in her head. A heaviness settled in her stomach as Matthew Kline’s furrowed face appeared before her. During her drive to work, gray clouds sagged toward her, and the Potomac River was choppy and restless.

  Derek sat in the ER doctors’ office. “How are you doing?” Laura said.

  “I didn’t sleep much.”

  “Do you feel up for this today?”

  Derek stood. “Yes, I want to show everyone I can do it.”

  “Good. I like the sound of that. I told the nurses about your brother. They’ll be sympathetic, but be the calm professional out there.” She decided to keep a closer eye on Derek today.

  Derek walked toward the door and turned to Laura. “Thanks for your support.”

  “You have real potential. You have to find your place. Just move on—one day at a time—one patient at a time.”

  Derek nodded and looked down. “I heard the gunshot patient died.”

  “Yes. He had a fatal injury. There was nothing we could do.”

  “I’ll try to do better next time.”

  “I know you will.”

  It was busier than usual in the ER. Laura worked at maximum speed and still couldn’t keep up with the patient flow. Derek seemed to relax after his first patient, and he fell right into the rhythm of the ER. He was a big help, especially with suturing wounds and managing simple, straightforward problems. Laura and Derek didn’t have much time to talk to each other, except to discuss patients. She saw no problems with Derek’s performance.

  Toward the end of the shift, the stream of patients slowed a bit. Laura and Derek relaxed in their squeaky chairs for a few minutes in the doctors’ office.

  Derek smiled. “You were right. The nurses are treating me fine. I feel like I’m contributing again.”

  “You are.”

  “I’ve been listening to them and talking more with them. They seem friendly enough.”

  “Give them time.”

  “That reminds me. I overheard the nurses talking earlier today. One of them said that Dr. Preswick had fired a surgery resident last week, just a few days before he died. I’ve never heard of a resident getting fired. That’s not common, is it? Non
e of my professors have ever mentioned it.”

  Laura cocked her head. “No, it’s not common at all.”

  Higher-level residents in general surgery, in their fourth or fifth year of residency at the academic center, could elect to do a rotation in certain community hospitals. Residents who wanted to stay in the D.C. area for their surgery practices after graduation often sought out local elective rotations to enhance their chances of being offered a position with a group of surgeons in the community. It was a medical form of networking. Roderick Preswick had been the coordinator for the elective rotation in general surgery at Laura’s hospital.

  Laura placed a call to the administration office. No one answered—it was Saturday. Laura then asked the hospital operator to page the administrative person on call. Several minutes later, an administrative assistant responded to the ER phone number.

  “Hi, Sheila, this is Dr. Valorian. Sorry to bother you, but I have a simple question. I heard that Dr. Preswick fired the surgery resident we had over from the university. Is that true?”

  Laura and Sheila were on a few hospital committees together. They often discussed problems concerning hospital employees, knowing that such information would be kept confidential by the committee members.

  “Yes. He told the resident—Dr. Blake Sutcliff—to leave and not come back. I guess that’s about the same as being fired. I had to prepare the report about it. Anyway, it happened over a week ago.”

  “What did Dr. Sutcliff do to get himself fired?”

  “Something about he’d changed Dr. Preswick’s medication orders on a VIP patient, without prior approval. They hadn’t been getting along anyway, according to the nurses.”

  “Thanks, Sheila.” Laura hung up the phone and turned to Derek. “What you heard is true. He was fired. I don’t think it’s happened before at this hospital. It’s got to be rare at any hospital.”

  Firing a fourth or fifth-year resident was unusual. A drastic act like that required egregious behavior from a young physician-in-training, such as unacceptable or outlandish clinical decision-making that was construed as dangerous to the health of a patient. Such a resident would have to plead his case to the main faculty supervisors at the university. They might require him or her to repeat the month or even an entire year of surgery residency, or leave surgery and transfer to a different specialty program entirely, or any number of other rehabilitative measures. Of course, they might decide to do nothing at all, or they could impose the maximum penalty and fire the resident from the training program and the university, thereby potentially limiting or possibly even ending a preferred career in general surgery.