The Pain Nurse Read online

  That had been the case with every Slasher scene: the most violent crime, accompanied by little or no damage to the physical environment aside from the blood. The exception was Theresa Chambers, who was clutching a framed photograph of her daughter, the glass shattered into a spider’s web. Had the Slasher taken his victims by such surprise, or had he somehow put them at ease? The arrest and conviction of Craig Factor had never really provided an answer. Aside from the semen evidence, they had found nothing linking him to the crime scenes, especially any of the missing ring fingers.

  The walls told him that Christine Lustig was a graduate of Tufts Medical School and a fellow in the American College of Surgeons. The desk had a computer and beside it, thick notebooks labeled Med-Interface and SoftChartZ. What was her job? Did she see patients? Will used a tissue to shield his hand as he opened desk drawers. Pens, pencils, more files with obscure names. There were no family photographs. He rolled around, seeing the office from the desk’s perspective. How could you sit with your back to that empty hallway late at night? The newspaper story said a nurse had discovered the doctor’s body, so the door might have been open. There was no sign of a broken lock. The Slasher never broke a lock, a door, or a window. Will pushed the drawer back in and by habit reached under it, sweeping the metal with his hand.

  He felt duct tape and then the unmistakable outlines of a knife.

  “Damn.”

  The doorknob shook. Will started and drew back from his discovery. He backed the wheelchair against the wall, hoping it would be in the safe place when the door opened. But no key was inserted into the lock. The knob rattled again and the door snapped against the frame from sudden pressure. Slap! The door was again pushed hard and the lock was rattled impatiently. Even when the sounds stopped, it was a long time before Will turned off the lights and ventured into the corridor.

  Chapter Seven

  Cheryl Beth answered the phone and could hear screaming in the background. It was the sound of the newest consult. It was going to be a bad day.

  She had hurried to recovery, to a patient with pancreatic cancer who had undergone a Whipple Procedure. It basically involves lopping off part of the pancreas and rebuilding the digestive tract. It’s difficult surgery, almost, but not quite, being made obsolete. The aftermath can be pain incarnate: evil, damnation, omnipotent. It reminded Cheryl Beth of the hell-fire Baptist sermons she had heard as a girl growing up in the little Kentucky railroad town of Corbin. This was pain as the Lake of Fire, and it was almost as hard to knock down as bargaining on judgment day.

  It was engulfing a woman so small and eaten up that it seemed barely possible she had the organs remaining to destroy or the breath to scream so loudly.

  “I didn’t know what to do. I was afraid to violate the orders.” A young nurse in purple scrubs spoke with a voice on the edge of panic.

  “You’re not violating anything, Megan,” Cheryl Beth said, getting the woman’s name off her name badge. Barely under her breath, she said, “I don’t know why people want to cover their ass when a patient is suffering. And does the damned anesthesiologist care?” Megan stared at the floor.

  Tamping down her fury, Cheryl Beth did a quick workup. The paperwork was a mess, as usual. It appeared that she had been undermedicated by one of the surgical residents. She touched the old woman, her skin like that covering a chicken wing after a week in the refrigerator. “I’m going to help you.”

  “I just want to die,” she wailed.

  Cheryl Beth’s brain and hands were on automatic now, a coordination born from years of training and experience.

  “What are you doing?” the young nurse asked.

  “Rescue dose,” Cheryl Beth said. She injected morphine and Ativan through a cap in the IV line. They rushed into the vein that would bear them like a liquid savior. She stroked the woman’s hand and the screaming subsided. Her pager vibrated again, even as she wrote out extensive orders for the pain meds to follow. She looked at it and decided it could wait. Around her, the general surgery recovery room looked like much of Cincinnati Memorial, a surreal combination of modern medical technology haphazardly fitted into rooms that had been built during the Great Depression and left to slowly rot ever since. She noticed more than usual the attendant fleeting odors of disinfectant, feces, vomit, and various medicines. They seemed colored with a brooding, claustrophobic tint in the aftermath of Christine’s murder.

  She felt herself silently mouthing the word: Murder. She stopped when she was aware that Megan was hovering nearby. Cheryl Beth instructed her on monitoring and administering the morphine and the Ativan, an antianxiety drug, and regulating the PCA pump that would prevent an overdose.

  “Thank you so much.” She seemed so young. Was I ever that young? Cheryl Beth asked herself. She also knew how difficult it was to recruit nurses, especially at Memorial. She wrote out the new orders—she always covered her backside—and would get Dr. Ames to sign them.

  “No worries,” Cheryl Beth responded, smiling at her and handing back the chart.

  “I just didn’t know how her doc would react to changing her dose.”

  Well, thought Cheryl Beth, at least she was young enough to be honest. It was the usual chickenshit thing that left patients to suffer. Docs could be inattentive or stubborn, and nurses were afraid to challenge them. Cheryl Beth had never been that way. In this case, she had an added measure of protection because the patient’s main surgeon was one of her fans.

  “Do your thing and sign my name,” the surgeon, Dr. Brice, had said years ago. “You know more about this than most docs.”

  Cheryl Beth was in the hallway outside recovery, slathering hand sanitizer into her palms, when the page repeated.

  ***

  In five minutes she was in the spacious, wood-paneled administrative offices. The outer hallways were lined with oil paintings of eighty years of hospital presidents. Not surprisingly, Stephanie Ott made her wait twenty minutes in her outer office. She made conversation with Ott’s secretary, Bridget, a compact, formidable woman with slate gray hair. She intimidated most of the staff, but Cheryl Beth got along fine with her. Halfway into a discussion about artificial Christmas trees, the door to Stephanie Ott’s office swooshed open and a compact young man strode out. He couldn’t have been more than thirty, with fashionably punked-up blond hair and a movie star tan on a face most women would have found cute. He wore black jeans and a French blue dress shirt, open at the collar. His fists were clenched and he stared straight ahead, his mouth set at an angry angle.

  “Oh, joy,” Cheryl Beth said. “I’m next.”

  “He’s a prima donna,” Bridget said after he had gone. “He’s from California.”

  “He didn’t look like he was from Cincinnati. I thought he might be Stephanie’s son, he looks like such a kid.”

  Bridget looked over her reading glasses. “That kid is a multi-millionaire and the chief executive of a company in Silicon Valley.” The sarcasm in her voice was barely concealed. “He’s twenty-six.”

  Cheryl Beth cocked her head in disbelief.

  “Oh, yes. Mister Josh Barnett, the chief executive officer of SoftChartZ. He started the company when he was a graduate student at Stanford. Promises to take the entire health-care industry and ‘digitalize it.’” She made mocking quotation marks in the air with her fingers. Bridget could be fun if you got to know her. She added, “We’re paying him $10 million, you know. I haven’t had a raise in three years.”

  Cheryl Beth thought about what Lisa had said, but couldn’t believe Christine Lustig could have slept with the man. She said, “So he was working with Christine.”

  Bridget let the statement hang just long enough for Stephanie Ott to open her office door and beckon Cheryl Beth inside.

  Chapter Eight

  There are two kinds of nurses: scrubs and suits. Stephanie Ott, RN, MSN, emphatically fell into the latter category. Stephanie was even wearing a suit that day. Combined with her short dark hair and angular features, the suit’s red coat
and shoulder pads gave her the appearance of a toy soldier, or, Cheryl Beth thought, a nutcracker.

  Suits and scrubs. The best nursing administrators maintained the fine balance. Stephanie Ott, RN, MSN, seemed to have little interest in such esoterica. After five years as vice president for nursing, she had yet to visit many of the wards and departments at Cincinnati Memorial. Most of the nursing staff had never seen her outside the large meetings or video-casts that usually announced an unpleasant new policy or staff cutback. She probably hadn’t touched a patient in years, but her ability to reach out with vengeance was legend. One victim was Cheryl Beth’s friend Denise, who had kicked an obnoxious film crew out of the ICU. Denise was one of the best ICU nurses Cheryl Beth had known, and she couldn’t have cared less that the crew worked for an advertising agency owned by a member of the hospital’s board. Stephanie Ott cared, and the next day Denise was banished to the overnight shift on a patient floor.

  Now Ott was leaning against an L-shaped desk covered with thick reports constrained by colored binders, blue, taupe, yellow, orange, sage. A small Christmas tree anchored one corner of the desk. As Cheryl Beth entered, she stood, crossed the carpet and took both her hands, leading her to a nearby sofa.

  “How are you holding up?”

  “I’m okay. It’s been a rough few days.” She sat and relaxed a bit.

  “I can only imagine.” Ott sat precisely in a nearby armchair. “Finding her that way.”

  Cheryl Beth’s native volubility deserted her. That had been happening a lot the past week.

  “What in the world were you doing down there, at that time of night?”

  The question was in the same conversational tone, but Cheryl Beth’s initial caution returned. She explained about Christine’s message, told more than was needed about the deserted hallway, the bloody body, the phone ripped from the wall and the inability of cell phone signals to escape that damned basement. Ott continued to look at her, but her attention shut off, as if on a timer. Cheryl Beth shut up.

  “I got a call this morning from one of our board members. She told me that a friend of hers was brought here from an auto accident, and the emergency room had run out of stretchers.” A harder tone slowly took over her voice. “Ran…out…of…stretchers. Can you believe it?” Cheryl Beth nodded sympathetically. The ER often ran out of stretchers. Memorial was the primary caregiver for thousands of low-income and indigent people. It also operated a Level One trauma center. The hospital had been through years of budget cuts that had not just made it hard to buy new equipment, but had even reduced the nursing staff. Cheryl Beth could see it on nearly every floor, the nurses overworked, understaffed. It was a wonder they did so well.

  “This hospital is in trouble,” Stephanie said. “I’m told this used to be the top hospital in the city, the place where the rich came for treatment. Now we have a great neuro-science unit. We’re still a teaching hospital. Then, well, what’s left is pretty much a welfare hospital.” Her eyes narrowed. “There’s talk of merging with University Hospital, if they would have us. Or simply shutting down. Do you know that?”

  She didn’t wait for an answer. Cheryl Beth, of course, had heard all the gossip. She also had been approached several times about joining University Hospital, which made her even less afraid of Stephanie Ott.

  The suit kept talking. “It doesn’t help that the black ministers have been holding a vigil outside every night this week, because of that boy, I mean, young man, whom the police shot. Do we need this kind of trouble? Why are they singling us out? I just don’t understand this sense of grievance.”

  “Well, I’m not black,” Cheryl Beth said. “So I can’t see it through their eyes. There’s a lot of hurt…” She stopped herself.

  Ott looked at Cheryl Beth as if she should say something, to make sense of all this…to take the blame? She said, “Why are you telling me this, Stephanie?”

  The woman stood and strode to her window, staring out at the black scrimshaw of winter trees. “I’ve always had my reservations about you. You like to make your own rules.”

  “I can play well with others,” Cheryl Beth said lightly.

  “You didn’t want to stay on the pain management committee…”

  “I just thought I could use those eight hours a week to be helping people.”

  “Yes, well. We’d all like to stay in our comfort zones.” She turned back and stared at Cheryl Beth. “You do things you shouldn’t. Doctors complain.”

  “Who? What?” Cheryl Beth demanded, unable to control her temper. “I work directly for Dr. Ames and Dr. Carpenter. I’m certified with advanced practice credentials.” Just like her grandmother, she talked, shouted, with her hands. “Docs sign off on my orders. I work with them. My record is totally clean. The only ones who complain are the same bastards who say ‘pain isn’t an emergency’ and let their patients hurt. They say, ‘This namby-pamby patient’s still moaning seven days after surgery and needs to get a grip.’ And too many nurses are terrified to say anything about it. That’s not me.” She made herself calm down and put her hands obediently in her lap.

  Ott was nearly shaking with anger. She took several deep breaths, sat at her desk, and rearranged a pile of papers. Her head shook fiercely. “My God, Cheryl Beth, what were you thinking?”

  “What?”

  “You’re involved in a homicide investigation. You have involved this hospital in a homicide investigation.”

  “I found her,” Cheryl Beth said heatedly. “She was murdered here.”

  “That’s not what Detective Dodds tells me. They are looking at you, Cheryl Beth. You. And to have become romantically involved with Dr. Nagle. That’s terribly unprofessional. Just…unconscionable.”

  Cheryl Beth felt a burning on her ears and cheeks. She said nothing.

  “Why did you go to Dr. Lustig’s office that night?”

  “She left word for me. I told you. She asked me to come down.”

  “In the middle of the night?” Ott’s voice rose. “So you were fighting with her over Dr. Nagle?”

  “No. That was over a long time ago.”

  “So what did she want?”

  Cheryl Beth shook her head. “I honestly don’t know.”

  “Dr. Lustig was a key member of our technology committee. She was working directly with SoftChartZ to bring this hospital into the twenty-first century. Now she’s gone.”

  Cheryl Beth made herself say nothing. Any words bubbling up inside her would only make things worse, especially the ones that were careening around in her head at that moment.

  Stephanie stared at her. “You have charmed a lot of the physicians here. I don’t get it, but that has given you tremendous freedom. But you have never charmed me. You’re a bull in a china shop with some powerful protectors. I’m going to be watching you even more closely.” Her shoulder pads quivered. “And if this matter is not resolved quickly… I will not tolerate this.” She leaned forward. “You are not to discuss Dr. Lustig’s murder with anyone: colleagues, patients, and absolutely not the press.”

  Stephanie Ott turned to her computer screen and began furiously typing. “You can leave now.”

  ***

  Cheryl Beth left the office and walked directly to the parking garage, barely containing her angry tears. God, she hated it when she cried. It made people think she was weak. Certain people. She had to get away from the hospital for a while. This, even though the work allowed her to momentarily forget Christine and the blood, that night in the basement, the yawning canyon in her life “before” and “after.” When she was helping patients she could be herself again. She tried not to think how badly she wanted a glass of whiskey. Five minutes later, she was back home.

  Cheryl Beth’s small house backed up to a thick stand of trees. Beyond that, a park fell off toward Over-the-Rhine and downtown. But the incline began in her driveway. Her old, wooden garage was lower than the house, the result being that in the cold months she often parked nearer to the street, to keep from being stranded
in the garage by an overnight ice or snowstorm. An oak stood in her small backyard, its branches overhanging the old garage. The location made her uneasy late at night. The park attracted unsavory characters, so even before Christine’s murder Cheryl Beth had avoided the tree line after dark.

  So it had been days since she had pulled down the driveway. She went all the way down today and walked back through the cold, crisp air. She looked back at the house and felt centered again. She would get through this, through the horrible discovery in the basement of the hospital, and through the debris of her breakup with Gary. She would live in this house, enjoy her music and her gardening, watch the tiny perfection of birds from her porch, forget about men. No more blind dates set up by friends. No more waiting for the phone to ring. No married men, ever. She walked up the incline of the drive, admiring the flower beds that she had cleared of leaves. Even on her small city lot, she could fill dozens of bags with leaves every fall. The flower beds were the last touch. At least one thing in her life was neat, she thought, even as Stephanie Ott’s words burned inside her head. Maybe next year she would plant gardenias.

  The indentations on the ground. She noticed them only on a second look, the realization that comes when the brain processes a mundane scene, one noticed a thousand times before, but this time something is subtly different.

  She walked slowly back to the flower beds that stood beside the house. It was unmistakable, two footprints dug deep into the soil, just behind the hedge that stood at the corner of the house. They might as well have been the first footprints on Mars for the primal force with which they hit her. They were large footprints, fresh since she had cleared out the leaves. Someone had been standing there, easily concealed by the hedge. Since Christine had been murdered. Standing there where he could look through the large bay window into her living room.