Wait a minute. What's this "not all that clear" and "isn't that certain" crap?
"A fall in blood pressure could have resulted in a delayed uptake of the first injection that had been given around nine that evening. Later, should the pressure recover and the uptake of the drug into the patient's bloodstream return to normal, both the remnants of that shot and the entirety of the second dose would enter the circulation simultaneously, leading to the toxic levels that killed her."
No! Wrong! Wrong! Wrong!
"Even though the nursing records indicate no such fluctuations in her vitals," Stewart continued in a fluid, singsong delivery more appropriate to a travelogue than a death review, "they might have come and gone undetected. And to reiterate Dr. Gardner's findings that the woman's cancer, while undoubtedly painful, had not yet brought her near death, it's a known fact that morphine itself can drop a patient's blood pressure. So we are left with two possible scenarios: either someone doubled the second injection, or undetected fluctuations in blood pressure led to a delay in the absorption of the first, leading to an accumulation of the two shots."
Earl leapt to his feet. "What the hell are you talking about?"
Stewart sat down and studied the table between them.
"That's garbage, Stewart, and you know it."
Stewart said nothing, still avoiding eye contact, but Earl saw the black of his pupils grow wider.
Like a variation on Pinocchio's nose, the lying son of a bitch. "Why are you doing this, Stewart?"
"Doing what?"
"You know damn well. All that 'fluctuating pressure' bullshit." But Earl had already guessed the reason: to provide a scenario that could give Hurst an out. Not a good one with legs, but enough to confound the findings and keep the table from reaching a definitive conclusion. Then the whole mess would end in limbo, and he'd avoid a public scandal.
"Patients fluctuate wildly near death," Stewart said with a shrug. "They can be nearly comatose one day and rally the next, the improvement there for no more apparent reason than a need to say good-bye, and it all happens with no change in their metabolic numbers. It's a part of cancer we don't understand, almost as if bad humors were at work-"
"Level with me, you son of a bitch." Earl nearly grabbed him by the collar.
"How can you be sure it isn't so?" Paul Hurst said, maintaining his finger pyramid as he looked up at Earl. His voice remained as calm as a pond locked in ice. "Actually, both scenarios seem reasonable to me. Do you have proof to support one over the other?"
"There were never any serious dips in Matthews's blood pressure, not that night, not ever," Earl said, controlling his anger.
"Not recorded, no. But without continuous monitoring, how can you say for sure?"
"It's unlikely as hell, and you know it." He turned to Len. "Do you agree with this?"
The pathologist's scowl said it all. "Of course not. No way shock had anything to do with this woman's death. Stewart, this is a crock."
"Hey," the intensivist said, locking eyes with him, "I'm just laying out all the possibilities. You guys decide which one's most probable." He sounded miserable.
"You were told to pull this stunt, weren't you?" Earl said. "I might have expected as much from some." He gestured toward the Hursts. "But you?"
Stewart shook his head as if denying the accusation and finally looked directly at Earl. The pitiful gloom in his eyes admitted everything. "Don't you understand? A hung jury here gets you off the hook too," he said, as if that justified what he'd done. "This way neither you nor the nurse can be officially cited for negligence. The matter dies."
Paul squinted imperiously over the top of his bifocals at Len. "Of course, as a former surgeon I know enough never to go against the pathologist as far as cause of death is concerned. Morphine overdose, right? There we are in agreement?"
"Yes. But I repeat, shock did not play a role in that overdose."
"And the minutes will record your opinion. As for the rest, we'll just have to agree to disagree on this one."
His arrogance took Earl's breath away. In a court of law he'd never get away with such a bald-faced attempt to distort the facts. But death rounds had no legal status. Touted as a sacred crucible of final clinical truths, nothing guarded its integrity but good faith between physicians.
The constriction in Earl's gut coiled even tighter. He looked over at Yablonsky. She blanched and began to use her glasses as worry beads.
"Do you have anything to say, Monica?" he asked. "This leaves you much more out on a limb than it does me, and you know it."
Jimmy shot him a disapproving glance, as if to tell him to cut his losses and run.
Madelaine Hurst hunched forward, and her brow acquired the sharp-edged contours of a hawk's. "Now see here, Dr. Garnet-"
"I'm waiting for an answer, Monica," he said, ignoring them both.
Paul Hurst leaned closer to his sister. His normally colorless skin became dusky gray, the change suffusing up his temples, across his forehead, and down from under his mask to his neck like creeping smoke. "Garnet, we agreed not to discuss this-"
"I agreed to wait and hear the pathology reports before I took any action, not to cover them up."
"You can't be serious, throwing the hospital into a tumult at a time when-"
"What tumult? That's why I restricted this gathering to the people most directly involved. I'm betting someone in this room knows the truth about Elizabeth Matthews's death and the deaths of other patients on this ward. We can get at it, here and now, behind closed doors."
"You still aren't seeing the bigger picture."
"Oh, no?" He pointed at Yablonsky. "The bigger picture is that she tried to shift the blame for this patient's death onto me. And my chief resident, Thomas Biggs, tells me there's also been a rise in the number of people who die on the ward but are discovered only in the early morning. Clearly no one is keeping close watch during the night. A few days ago I witnessed that for myself, and our hospital chaplain, Jimmy Fitzpatrick, will back me up. Not only could I sneak onto the ward, but some other intruder came prowling around as well. I don't think we can ignore events like that, can we, Paul, what with a rise in the mortality rate and the possibility that Elizabeth Matthews's death might be part of a cluster-"
"No!" shrieked Monica Yablonsky, her eyes wide with fright. "I won't be your scapegoat." Her voice soared into the high, thin register that jangles the human ear and makes dogs howl. "I won't!"
Bingo! Earl thought. This was shaping up to be a "You can't handle the truth" moment.
Despite working on the numbers all weekend, even with Janet's help, Earl hadn't been able to conclude whether the statistics really indicated a cluster of suspicious deaths. He certainly hadn't been able to incriminate Yablonsky in anything specific. Nor could he tell whether his assailant had played a role in it all. But he'd come here to squeeze Yablonsky, because all her anxiety told him she knew something about what had been going on, and this in itself gave her good cause to be afraid.
Why? Ever since that groundbreaking article in the New England Journal, it was the nurses whom investigators went after when patients died and the reason wasn't clear. She'd know that, and it would scare her, whether she'd accidentally overdosed a single patient and lied about it, or done much worse, or hadn't done anything herself but covered up for the real culprit. Earl intended to rattle her enough that she'd drop her guard and let slip her secret, whatever it might be.
At least, that had been his plan, and it seemed to be working.
But then Jimmy sprang to her side, his arms protectively around her shoulders. "For the love of God, Earl, back off!"
Mrs. Quint quickly walked over to join them. "Monica, calm down," she said, rubbing her underling's back the way she would a child's. Her voice, no louder than usual, but ice smooth, rang out like a command.
Monica looked desperately from her to Jimmy and back again. "Calm down? It's not you he's after."