Kurtz and Barent Mystery Series: Books 1-3, page 6
On the morning of his fifth day in the new place, he found himself unable to get out of bed. When the aide came in to usher him up, he ignored the insistent voice and simply lay there, huddled in misery around the pain in his gut.
“Come on,” the aide said. “None of that.” He reached out a hand, shook Mose by the shoulder. Mose ignored him.
The aide shook his head. “It’s time to get up. You know you’re not allowed to just lie there.” He gave Mose another shake, then grabbed him under the arms and attempted to haul him out of bed.
It was too much. With a convulsive heave, Mose’s stomach spasmed. He groaned in misery and collapsed back onto the bed as a torrent of green bile spewed out of his mouth and covered the legs of the astonished aide.
“Shit!” the aide shrieked. “Look what you’ve done to me!”
Mose ignored him. He was too busy retching.
“Goddammit...” The aide stuck his head out into the hall and called out to the nursing station. “Get somebody in here with a mop and a bucket!” He wrinkled his nose. “And get a doctor!” He muttered, “They better pay me for these pants. God damn nut case...”
Three hours later, Mose was in an ambulance back to Easton. The staff psychiatrist had had enough presence of mind to evaluate his distended abdomen and high pitched bowel sounds, make a tentative diagnosis of bowel obstruction and put down a nasogastric tube. Mose pulled it out through his nose as soon as the ambulance got under way.
After that, they tied his hands together, which served little purpose since the damage had already been done but which made the aides feel better. The two policemen assigned to guard the prisoner en route watched impassively and said nothing.
When they arrived at the E.R., Mose was trundled in on a stretcher and deposited on a hard metal table while his entourage sat down in chairs to wait. After a half hour, Mose again began to vomit. The policemen looked at each other and decided to wait in the hall. One of the aides stuck his head out and said to a passing nurse, “This guy is throwing up. Can’t you get a doctor in here?”
The nurse puffed up her cheeks and gave him an irritated look. “We’re very busy,” she said. “Someone will be with you shortly.”
“But—” the aide began.
The nurse cut him off. “You’ll just have to wait your turn.” Defeated, the aide went back into the room and watched helplessly as Mose continued to retch, covering himself, the table and the floor around him with foul smelling, watery green fluid.
Finally, a harried looking intern came in, took as much of Bill Mose’s history from the aides as they could recall, listened to the patient’s heart, lungs and abdomen, called for x-ray, started an I.V. and phoned in a consult to surgery. Then he left.
Fifteen minutes later, a technician rolled in a portable x-ray machine. The technician glanced at the order sheet and said, “Chest and abdomen?”
The aides looked at him. One of them shrugged helplessly.
The technician grunted. “Help me up with him, would you?” he said. The aides lifted Mose while the technician slid an x-ray plate under his back. “Okay,” he said, “step back.” The aides left the room until the machine buzzed, then returned.
“Now the chest,” the technician said. They repeated the process and the technician left to develop the films.
Mose, his stomach finally empty, closed his eyes and had almost dropped off to sleep when Nolan arrived, accompanied by Liebert. “Oh, boy...” Nolan muttered. “Kurtz isn’t going to be too happy about this.”
Liebert wrinkled his brow and gave Nolan a worried frown.
While they were examining Mose, the technician arrived with the films and Nolan snapped them into a view box on the wall. “What do you think, Doctor?” he asked Liebert.
“Dilated small intestine with air fluid levels. A bowel obstruction?”
Nolan gave him an approving look. “Very good,” he said. “How about this?” He pointed to a hazy shadow surrounding a clear density in the middle of the abdomen.
Liebert wrinkled his brow. “I don’t know,” he said at last. “It looks like metal.”
“Well, it’s not soft tissue and it’s not bone,” Nolan said. He grinned. “He probably swallowed something.” Nolan sat down, quickly wrote up an admission History and Physical and some orders while Liebert examined the somnolent Mose more thoroughly, daintily stepping around the puddles of vomit on the floor.
“Okay,” Nolan said to Liebert. “Let’s go tell the O.R.”
A half hour later, Nolan and Liebert wheeled Mose into the operating room, his hands tied to the rails of the stretcher. Nolan had put down another N.G. tube but Mose had managed to twist himself around and once again pull it out. The two policemen, wearing surgical headcaps, shoe covers and white paper “bunny suits” over their uniforms followed along behind.
Liebert was still arguing. “The patient is incompetent. There’s no consent. You can’t operate without consent.”
“It’s an emergency,” Nolan said. “You don’t bother getting consent in an emergency.”
“Kurtz shouldn’t do it. He’s too involved.”
“Tell it to him.”
Liebert frowned unhappily. “I already did. He told me he’s on call, it’s his patient and I should mind my own business.”
“Good advice,” Nolan said.
“Well, then we should get an ethics consult. There’s always an ethics counselor on call. That’s what they told us.”
Nolan turned and gave Liebert an annoyed look as the stretcher skidded around a corner. “Look, kid, you want to call the chaplain or the hospital lawyer or whatever other bureaucrat they supposedly have available to help us poor nincompoops make difficult moral decisions? Jesus. These people get bothered so seldom with this sort of stuff it would take ten, maybe fifteen minutes for whoever it is to wake up and even understand what you want. Then he’d probably decide to consult the rest of the committee, because frankly, the people who are supposed to make difficult moral decisions are usually better at passing the buck than doing their jobs. All told, you’re going to waste at least another hour, probably a lot more, and this guy needs to be operated on right now. So forget about it.”
Liebert shook his head. “Hell,” he said. “I’m only a medical student. I’m just trying to do the right thing.”
“Well, the right thing to do right now is to shut up and let’s start operating.”
Kurtz met them in the O.R. Mose had already been placed on the table. The EKG showed a rapid but regular rhythm and his blood pressure was normal. Steinberg nodded to him when he walked in but was too absorbed in what he was doing to talk and Kurtz sat down in a corner of the room. Truthfully, Kurtz hardly knew how he felt about this case. Bill Mose was small, dirty, miserable and sick. He didn’t look like Kurtz’ conception of a murderer. Still, Kurtz knew that Liebert had a point. Maybe his personal involvement should have disqualified him from operating. Morosely, Kurtz shook his head. Mose was his patient and he wanted to do it, and he was going to do it. And if anybody had a problem with that, they could argue about it later—after it was too late.
With great concern, he watched what Steinberg was doing, ready to step in and lend a hand if he was asked. The induction of anesthesia was particularly dangerous in a bowel obstruction. The intestines were bloated and full and even if the stomach was de-pressurized with a nasogastric tube, there was no guarantee that the tube had gotten into every fold and corner. The patient had to be presumed to have a stomach full of vomitus, and if Mose happened to vomit after the anesthetic had deprived him of his normal reflexes but before the trachea was protected by an endotracheal tube, then the acidic bile would flow down into the lungs and the patient would most likely die from aspiration pneumonia—if he didn’t drown outright.
“You ready?” Steinberg asked his resident. The resident nodded. “You checked your laryngoscope? The suction is on?”
The resident gave him a harried look and nodded again. “Okay,” Steinberg said. He glanced once more at his monitors, then pushed a syringe of a short acting narcotic, waited thirty seconds and gave propofol, followed immediately by succinylcholine. He pushed down on the larynx with his left hand, compressing the trachea onto the esophagus, and waited.
The patient’s eyes glazed over and he stopped breathing and thirty seconds later, he began to shake all over as the succinylcholine took effect and every neuromuscular junction in his body discharged at once. Then he stopped shaking. For three minutes at least, he would be completely paralyzed. “Go,” Steinberg said.
The resident inserted the laryngoscope into Mose’s mouth and lifted the jaw. “You see it?” Steinberg demanded.
“Good view.” The resident kept his eye on the vocal cords and held up his hand. Steinberg, still keeping pressure on the larynx, handed him the endotracheal tube and the resident slipped the tube between the vocal cords and into the trachea.
Steinberg breathed an audible sigh of relief and turned to Kurtz. “He’s all yours.”
“Nice job,” Kurtz said. He stepped outside to scrub and by the time he returned, Nolan had opened a huge incision from the sternum all the way down to the pelvis. The bowel lay inside the abdominal cavity, swollen and distended. Kurtz elbowed Nolan aside, reached into the pelvis and ran his fingers up the length of the descending colon, which felt entirely normal. The same for the transverse and the ascending colon. The ileum too was fine, undulating with peristalsis like a gigantic earthworm. Midway through the jejunem, he found it. “See here?” he said.
Nolan and Liebert peered in. Nolan nodded, reached in, felt the area that Kurtz had indicated and nodded again. “Something hard.”
Kurtz lifted the bowel up onto the skin, made an incision and inserted a suction catheter. At least five hundred cc’s of green fluid drained out. Then he put clamps on both sides of the obstruction, cut off the offending segment, plopped it into a basin and handed it to the scrub nurse. He stapled the ends together, told Nolan to close and went over to the scrub table. “Could I see that?” he said.
The scrub nurse handed him the basin. With the clamps on, the segment of bowel looked like a stuffed sausage. Kurtz picked up a knife and cut into it. In the middle, blocking the passage, was a sodden mass of fibrous material. With a Kelly clamp and a pair of forceps, he delicately spread the fibers. In the center of the mass was...Kurtz frowned.
“What is it,” Nolan asked.
Kurtz picked it out. It glinted in the light. “It looks like a gold ring,” Kurtz said.
Chapter 8
Sharon Lee and Richard Kurtz had been a beautiful couple. Everybody said so. None of their friends could understand it when they broke up. “It’s my fault,” Kurtz would tell them. “She’s too good for me.” Since nobody felt it prudent to ask him exactly what he meant, the comment tended to forestall further questions.
What he meant, actually, was that Sharon Lee had been a lunatic. He never did completely figure her out, though when he met Sharon’s mother he thought he understood her a little better. Children of alcoholic parents often grew up with a chip on their shoulder and a need for control, which made medicine an appropriate career choice because it was a field where Sharon’s particular craziness was almost admired. Great doc, that Sharon Lee, really takes care of her patients. Except that she was nuts. Kurtz had given her a key to his apartment and once, when he called to tell her he had to break a date because he had an emergency case in the O.R., he arrived home later to find Sharon gone and the telephone ripped out of the wall. Kurtz shook his head in amazement, remembering. Nuts. If there was anything an obstetrician should have understood, it was the unpredictable nature of both their jobs. She was wild in bed, though. She had made love obsessively and passionately, groaning and crying out, almost screaming, which had embarrassed Kurtz at first but which he got a kick out of once he got used to it. But even in bed, she had to keep control. You get on top. Turn that way. Kiss my nipples. Rub there. Harder.
Kurtz figured that he was probably not the easiest person in the world to get along with but Sharon Lee had been something else entirely.
Kurtz sighed and looked out the window and sipped his brandy.
His apartment was on the Eighteenth Floor of a building across town from the Medical Center, overlooking the East River. One whole wall was covered with plate glass. Two nights after he had operated on Bill Mose, he lay on the couch in his living room with a snifter of Courvoisier X.O. and watched the water flowing by. The Gil Evans Orchestra with Miles Davis was playing softly in the background: “Summertime,” from Porgy and Bess.
He and Sharon had been together in the summertime. For three whole months, they had spent all their nights together, sometimes at Kurtz’ apartment, more often at Sharon’s place on the lower East Side. There was a little park-like area out back, almost a courtyard, which had a winding stone path surrounded by a garden. They would lie in bed at night after making love and hold hands and stare out at the stone path surrounded by yucca and Japanese maples and azaleas, the stars shining overhead and the moths flying through the beams of antique copper lamps that made their wings glow like they were on fire.
Real romantic. Except it had only lasted for three months, which was probably about a month and a half too long.
Sharon hadn’t been a bad sort, he reflected. Be generous. Their personalities had simply been incompatible. Everybody has their little quirks. Their quirks just hadn’t meshed.
After the breakup, they had hardly spoken for a year. After that...it no longer mattered. They were simply two people who knew each other. They said “hello” when they passed in the hallways and that was about it.
Kurtz had gone out with a lot of women. He had never felt like sticking with any of them...until Kathy. Kathy, he had to admit, was different. He thought about Kathy a lot lately. Kathy could let a man be. Kathy felt no obligation whatsoever to conform to anyone else’s expectations and she didn’t expect anyone else to conform to hers. Sharon, in addition to her need to keep the upper hand in a relationship, had always seemed to define herself in terms of other people: her snide, rich friends, her almost but not quite adequate boyfriend. Kurtz, frankly, had no desire at all to re-make himself into anybody’s image of the ideal man.
Who might have wanted Sharon Lee dead?
That was the question, wasn’t it? Barent thought Mose had done it... Even Bill Werth thought so, and truthfully, Kurtz had no good reason to think otherwise. Only a feeling.
Just then, the phone rang. Kurtz gave it a frown but it kept on ringing. Finally, he reached over and picked it up.
“Hello, Dr. Kurtz?”
“Yes?”
“This is Harry Moran. Sorry to bother you, but Detective Barent and I were wondering if you might be able to come downtown and talk with us.”
“Now?” Kurtz glanced at the clock across the room. “It’s eight o’clock. I have surgery in the morning.”
“Something’s come up. We think that you might be able to help.”
“Is this about Sharon Lee?”
“We’re not interested in your parking tickets, Doctor. You know what I mean?”
Kurtz hesitated. “Where are you?”
“We’ll send a car.”
“Coffee, Doctor?”
“No, thank you.”
“You mind if I smoke?”
Kurtz grimaced at the air outside the glass separating Barent’s office from the rest of the squadroom. The place was filled with desks, most of them empty at this hour. “If it’s all the same to you, I’d rather you didn’t. It gives me a headache.”
Barent shrugged. “Sure.”
The door opened. Moran came in, sat down in a corner and proceeded to look bored. Moran, Kurtz had already figured out, liked to look bored.
“We have a problem,” Barent said. He stopped, frowned down at his desk and swirled his cup of coffee with one hand. “Harry and I are no longer as certain as we were that Bill Mose is the one who murdered Sharon Lee.”
“Really...” Kurtz sat up straight in his chair. “That’s a surprise.”
Barent morosely nodded. “Two nights after she was killed, Sharon Lee’s apartment was robbed. All of her jewelry was stolen.”
Kurtz frowned, mulling this over. Barent gave him a moment to think about it, then said, “Yesterday afternoon, the body of a man named Herman Delgado was found in a dumpster near the Hudson River. He was murdered—shot in the chest.” Barent held up a photograph of a white, circular smudge, perhaps six inches across. “You know what this is?” he asked.
Kurtz shook his head.
“It’s a gloveprint. You wear them for awhile, leather gloves pick up oils from your hands and your fingers. The pattern of pores and ridges on a piece of leather can be just as distinctive as a fingerprint.”
“Go on,” Kurtz said.
“That’s an enlargement of a print taken from Sharon Lee’s apartment. It matches the forefinger of the right hand glove that Herman Delgado was wearing when he was killed.” Barent reached into his desk and held up a small object. “And then there’s this.” He flipped it to Kurtz.
Kurtz caught it. It sat delicately in his large fingers, a man’s gold ring, with a black onyx face. The letter “D” was inscribed on the face next to a single small diamond. The ring glittered in the bright light. “It looks like the ring I dug out of Mose,” Kurtz said.
“It is the ring you dug out of Mose. The Pathology Department at Easton didn’t want to give it to us, claimed it was confidential. We had to threaten them with a subpoena.”
The ring had lodged in Bill Mose’s small intestine and a mass of fibrous material, presumably a collection of cigarette butts, had adhered to it, making an obstruction that had blocked his small bowel. Kurtz turned it every which way, but it remained a simple gold ring.
“When he was a kid, Herman Delgado used to run with an uptown gang that called themselves the ‘Blades.’ He had a fairly extensive criminal record. Petty larceny, assault, car theft.” Barent shrugged. “Of course none of this proves anything at all. D for Delgado? Who knows? There are twenty six letters in the alphabet and millions of rings around. No way to tell for certain where Mose ran across it. Still, psych patients don’t move around much and there were never a lot of visitors up there on the Unit.”
