A few envelopes down the pile he found the letter from the Dean’s Office with Lucy O’Connor’s records and an accompanying letter explaining the change of schedule. Skimming through her résumé, he read she had completed medical school at McGill in Montreal, but had applied to the NYCH family medicine program after seven years in the field with a group called Médecins du Globe.

Wow, Mark thought, immediately recognizing the name. Those people were the Marines of medicine. Working out of Paris, the organization was known worldwide and had received the Nobel Peace Prize for going into areas of conflict all over the planet to treat civilian casualties. Anybody involved with them worked under the most grueling of situations. Not only would the job have been mentally devastating – a lot of volunteers returned with post-traumatic stress disorders – but physicians sometimes died, killed either by bullets or the diseases they were treating – cholera, dengue, Lhasa fever, and a host of other infectious horrors he’d read about but never faced firsthand.

No wonder she knew her stuff… and karate.

What also struck him was how quickly she’d been accepted into the two-year program at NYCH. She’d only approached them in June of the previous year, less than three weeks before the usual July 1 start of any residency. Her introductory letter stated she’d completed her current tour of duty with Médecins du Globe earlier than expected and inquired if they had any vacancies. The last-minute request for a position came with a half dozen glowing recommendations from her current colleagues and former professors at McGill. NYCH had immediately snapped her up.

Obviously they had an opening, he thought, knowing many posts went unfilled these days since HMOs were making the healing profession less attractive than an MBA. But she also must have impressed the admissions board as much as she was in the process of wowing him. They wouldn’t take just anybody.

He was about to put the papers away when he spotted the correspondence regarding her rural rotation. It was dated November 6, two weeks ago exactly, requesting the program director to allow her to switch her slot so as to do her rural training period as soon as possible. To facilitate the change, she’d even foregone her own vacation. Her manning the wards at the time the hospital would be most short of house staff was her offer, not the insistence of the director.

I’m flattered, he thought. He proceeded to file everything where he’d be able to find it again when her three months were up and it was time to fill in the evaluation forms. But from the looks of her, he could have filled them out now. It would be A+ right across the board.

He tried to get through another few letters, but once more his thoughts turned to Bessie McDonald and ways of inducing a coma.

Within minutes he was arguing with the head nurse of the geriatric wing at NYCH, insisting they check their short-acting insulin supplies to see if any were missing.

11:00 A.M.

Medical Records,

New York City Hospital

“Dr. Garnet,” Lena Downie whispered at his shoulder, “it’s the call you’ve been expecting from Dr. Collins.”

Finally! he thought, following in Lena’s wake as she led him to a phone behind the front counter. She had the rolling gait of a female John Wayne.

“Melanie?”

“Earl! Sorry I didn’t get back to you earlier, but I’ve been up to my ass in crocodiles with budget meetings last night and rounds this morning-”

“Hey, don’t apologize. I’ve been there many times.”

“What can I do for you?”

“Bessie McDonald, a former patient of yours, is the woman whose M and M report was in Kelly’s file. Mark said he spoke to you about it Sunday night, but didn’t have the name yet.”

“Bessie? Well, my, God. That’s a weird coincidence. I knew she’d had a relapse two weeks ago. The nurses on her floor notified my office that she was found comatose one morning at 4:00 A.M. I’d even dropped in for a long overdue visit the day before, and she was fine – well, you know how these things go. I just assumed she must have thrown another embolus. But it was her chart Mark asked about? This is really strange. Do they know what happened to her?”

“The CT shows no infarcts, so it’s probably metabolic, but-”

The sight of Lena hovering nearby interrupted him. “I need to talk with you in private,” he said instead.

“Sure. I’ve got rounds until five. How about we meet at my apartment? I can make us a pitcher of the best martinis you ever had, and we can discuss whatever you want with no interruptions.”

“Sounds good.”

She gave him the directions.

Back at his desk, he returned to what he’d been doing since morning – reexamining Bessie’s old records from 1974 to the present. The reason? Tanya Wozcek had gotten him thinking the worst. Yet he’d gone over everything a second time and still couldn’t find a single entry that suggested an error in her management back then. At least not the kind that gets written down.

So he’d gone searching through the rest of her old charts, checking subsequent admissions to see if she had any tendency to develop any transient metabolic states that might have spiked her digoxin level, yet been missed in ‘seventy-four because they came and went: things like renal failure from dehydration; side effects of other medications; interactions with those drugs – he looked for them all.

The result? Nothing.

That left only two other possibilities: the sort of accident that occurs in the syringe, a nurse drawing up too much digoxin – or what Janet had suggested, a deliberate overdose. Given that the same woman now lay in a coma, also unexplained, tilted him toward the latter.

However, the records here only went up to the admission under Melanie four years ago, the one Tanya had mentioned. The more recent entries would be in her active chart on the floor. Should he go back upstairs and poke through them too? He glanced at his watch and saw it was nearly 1:00 P.M. He might as well, to be complete. After all, he had the rest of the afternoon before Melanie got off duty. He could also try to reach the people whose resident numbers were on the old M and M reports, if the teaching office could track them down for him. Who knew what bizarre piece of information one of them might remember that would prove useful?

Before closing the chart, he took a final glance through the clinical notes Melanie had written at the time of the first embolus, refreshing his memory about what had been done so he could more easily pick up the threads of the patient’s story when he got to the floor.

Precise, to the point, and clear, they documented why she had thought McDonald’s symptoms were the result of a clot, not a bleed, and warranted immediate thrombolitic therapy. Earl was impressed. The symptoms and signs distinguishing one from the other were subtle. In his own ER he’d seen seasoned neurologists dither over similar cases, then not insist as authoritatively as they should have for an immediate CT, thereby wasting precious minutes. Not Melanie. “Eyeball to needle time” as the residents called it, or the duration from when they first saw the patient to the infusion of a clot buster, had taken three-quarters of an hour, which meant she hadn’t squandered a second in making her own diagnosis and getting radiology to prove it. “Well done, Melanie,” he said under his breath.

As he walked out the door, Lena gave him a frosty good-bye, making it clear she hadn’t appreciated his denying her a chance to eavesdrop.